Systematic Implementation of Effective Quality Assurance Processes for the Assessment of Radiation Target Volumes in Head and Neck Cancer.

PURPOSE: Significant heterogeneity exists in clinical quality assurance (QA) practices within radiation oncology departments, with most chart rounds lacking prospective peer-reviewed contour evaluation. This has the potential to significantly affect patient outcomes, particularly for head and neck cancers (HNC) given the large variance in target volume delineation. With this understanding, we incorporated a prospective systematic peer contour-review process into our workflow for all patients with HNC. This study aims to assess the effectiveness of implementing prospective peer review into practice for our National Cancer Institute Designated Cancer Center and to report factors associated with contour modifications. METHODS AND MATERIALS: Starting in November 2020, our department adopted a systematic QA process with real-time metrics, in which contours for all patients with HNC treated with radiation therapy were prospectively peer reviewed and graded. Contours were graded with green (unnecessary), yellow (minor), or red (major) colors based on the degree of peer-recommended modifications. Contours from November 2020 through September 2021 were included for analysis. RESULTS: Three hundred sixty contours were included. Contour grades were made up of 89.7% green, 8.9% yellow, and 1.4% red grades. Physicians with >12 months of clinical experience were less likely to have contour changes requested than those with <12 months (8.3% vs 40.9%; P < .001). Contour grades were significantly associated with physician case load, with physicians presenting more than the median number of 50 cases having significantly less modifications requested than those presenting <50 (6.7% vs 13.3%; P = .013). Physicians working with a resident or fellow were less likely to have contour changes requested than those without a trainee (5.2% vs 12.6%; P = .039). Frequency of major modification requests significantly decreased over time after adoption of prospective peer contour review, with no red grades occurring >6 months after adoption. CONCLUSIONS: This study highlights the importance of prospective peer contour-review implementation into systematic clinical QA processes for HNC. Physician experience proved to be the highest predictor of approved contours. A growth curve was demonstrated, with major modifications declining after prospective contour review implementation. Even within a high-volume academic practice with subspecialist attendings, >10% of patients had contour changes made as a direct result of prospective peer review.

Population dynamics of mites in slow-release sachets used in biological control: a new study methodology.

Predatory mite species (Acari: Phytoseiidae) are essential tools in the biological control of greenhouses pests. The natural enemies can be released directly into a crop. A better, partly preventive system is to place slow-release sachets on the plants. Inside such sachets is a factitious prey's food substrate-which also acts as refuge-and the predator. The objective of this study was to develop a new methodology to evaluate the population dynamics of this sachet system, based on the factitious prey Carpoglyphus lactis and the predatory mite Amblyseius swirskii. Through two tests carried out under laboratory conditions, the sachets were first compared to the traditional extraction method that uses Berlese-Tullgren funnels and an extraction method using flotation in hexane. The latter method proved more effective at sampling the motile states (larvae, nymphs, and adults), both for the predatory species and for the factitious prey, extracting up to 3.7 × more mites than the Berlese-Tullgren funnel. Second, the population dynamics of both mite species was studied in a laboratory test, both inside and outside the sachets. In this way, a positive correlation was demonstrated between the number of predatory mites and the number of prey mites inside the sachets. Conversely, no correlation was found between the interior population of predatory mites and the number that venture outside. We can conclude that hexane extraction is very useful both in quality control of predatory mites and in studying how the sachets behave when faced with various factors.

Cambios en la masa ósea en una población infantil con diabetes mellitus tipo 1. Estudio longitudinal / Changes in bone mass in a paediatric population with type 1 diabetes mellitus. Longitudinal study

Objetivo: Evaluar, a lo largo de un seguimiento de 79,2 meses, el comportamiento de la densidad mineral ósea (DMO) determinada mediante Densitometría Axial Computarizada (DXA), la densidad mineral ósea volumétrica (DMOvol) y su relación con los datos antropométricos, junto con los parámetros relativos al metabolismo óseo (calcio, fósforo, fosfatasa alcalina, parathormona (PTH) y vitamina D (25-OH-D3)) en una población infantil con Diabetes Mellitus Tipo 1 (DM1) sin complicaciones microvasculares y un grupo control de referencia de similares características.Material y métodos: Inicialmente, se realizó un estudio transversal en 40 niños diabéticos (edad media 9,4±2,8 años) y 108 controles (9,3±1,5 años) para valorar las posibles diferencias entre ambas poblaciones. 26 pacientes del grupo diabético inicial, fueron reevaluados tras 79,2 meses de seguimiento.Resultados: Se observó que, al inicio, la masa ósea fue similar en los diabéticos y controles. Después del seguimiento, la DMO de los niños diabéticos era muy inferior a la esperada en población infantil no diabética.El peso, la altura y el Índice de Masa Corporal (IMC) siguieron el mismo patrón que la DMO. Los valores de calcio, fósforo, fosfatasa alcalina, PTH y vitamina D, aunque en rango de normalidad, fueron más bajos que en los controles. La fosfatasa alcalina no se incrementó en el periodo puberal.Conclusiones: El presente estudio demuestra que los niños y adolescentes con un diagnóstico reciente de DM1 tienen una DMO normal. Sin embargo, con el paso del tiempo, y sobre todo durante la adolescencia, muestran una menor ganancia de masa ósea y alteraciones en los parámetros de recambio óseo. (AU)

Incidence, morbidity and mortality of hip fractures over a period of 20 years in a health area of Southern Spain.

OBJECTIVE: To evaluate the incidence of osteoporotic hip fracture in the Macarena Health Area (Seville). SETTING AND PARTICIPANTS: This was a prospective observational study that collected all osteoporotic hip fractures that occurred between March 2013 and February 2014 at the Clinical Unit of Traumatology and Orthopaedics. All cases collected during the first 6 months of the study were followed for 1 year after the occurrence of the event. OUTCOME MEASURES: We evaluated the incidence of osteoporotic hip fractures in the Macarena Health Area (Seville) from 1 March 2013 to 28 February 2014, and we compared the incidence with that in 2 previous studies carried out with the same methodology in 1994 and 2006. Furthermore, we calculated the morbidity and degree of disability 1 year after the fracture occurred and determined mortality and the associated factors. RESULTS: The overall incidence was 228 per 100 000 individuals/year (95% CI 204.5 to 251.6), and the incidence was higher in women than in men. In women, the incidence rate decreased in all age groups over time, while in men, the incidence rate increased. The mortality rate 1 year after the episode was 27.2%. The factors associated with overall mortality were a body mass index below 25 kg/m2, renal failure and low plasma proteins. CONCLUSIONS: Our results show a high incidence of osteoporotic hip fracture that is increasing in men, and in men it is associated with a higher mortality than in women. There is room to improve the modifiable factors associated with mortality and the available rehabilitation interventions to reduce the disability associated with these fractures.

Radiation therapy strategies for skull-base malignancies.

INTRODUCTION: The management of skull base malignancies continues to evolve with improvements in surgical technique, advances in radiation delivery and novel systemic agents. METHODS: In this review, we aim to discuss in detail the management of common skull base pathologies which typically require multimodality therapy, focusing on the radiotherapeutic aspects of care. RESULTS: Technological advances in the administration of radiation therapy have led to a wide variety of different treatment strategies for the treatment of skull base malignances, with outcomes summarized herein. CONCLUSION: Radiation treatment plays a key and critical role in the management of patients with skull base tumors. Recent advancements continue to improve the risk/benefit ratio for radiotherapy in this setting.

A predictive survival model for patients with head and neck squamous cell carcinoma treated with immune check point inhibitors.

BACKGROUND: ICIs have expanded treatment options for HNSCC. A minority of the patients respond to these expensive treatments. PATIENTS AND METHODS: This is a single institutional retrospective review on 121 unresectable or metastatic HNSCC patients treated with ICIs. We predicted that inflammatory markers available through routine blood work, in addition to clinical characteristics may divide patients into groups more or less likely to respond to these agents. Here we develop and internally validate our nomogram to predict survival in patients treated with ICIs.

Does the Antitumor Necrosis Factor-α Therapy Decrease the Vertebral Fractures Occurrence in Inflammatory Bowel Disease?

BACKGROUND/OBJECTIVE: Osteoporosis and osteoporotic fracture risk are extraintestinal manifestations of the inflammatory bowel disease, whose etiopathogenic mechanisms have not been determined yet. Anti-tumor necrosis factor (TNF)-α are used in treatment of inflammatory bowel disease (IBD), but it is unknown if they play a role in osteoporotic fracture prevention. The objective of this study was to know if anti-TNF decreases fracture risk or modifies bone mineral density. To determine the possible risk factors associated with fractures, and assess the incidence of vertebral fractures in IBD patients. METHODS: Longitudinal prospective cohort study (7 yr of follow-up); which included 71 IBD patients, 23 received anti-TNF-α; the remaining 48 received conventional treatment, constituted the control group. Patients participated in a questionnaire which gathered risk factors associated with the development of osteoporosis and fractures. Radiographs of the dorsolumbar-spine were performed and also a bone density measurement. Their biochemical and bone remodeling parameters were determined. RESULTS: Although patients who did not receive anti-TNF-α, suffered more fractures but biologic therapy did not reduce the risk of new vertebral fractures. The increase of bone mass was significantly higher the group treated with anti-TNF-α. The increase in the lumbar spine was of 8% and in the femoral neck was of 6.7%. The only determinant factor for the incidence of vertebral fractures was a history of previous fractures (odds ratio of 12.8; confidence interval 95% 2.37-69.9; p = 0.003). The incidence of vertebral fractures in IBD patients was considerably high: 26.7/700 patient-yr. CONCLUSIONS: Anti-TNF-α, although increased bone mass in these patients, did not reduce the risk of new vertebral fractures. In this study, patients with IBD have a considerably high incidence of fractures. Only the existence of previous vertebral fractures was a predictive factor for consistent fractures.

Ecological monitoring in a discrete-time prey-predator model.

The paper is aimed at the methodological development of ecological monitoring in discrete-time dynamic models. In earlier papers, in the framework of continuous-time models, we have shown how a systems-theoretical methodology can be applied to the monitoring of the state process of a system of interacting populations, also estimating certain abiotic environmental changes such as pollution, climatic or seasonal changes. In practice, however, there may be good reasons to use discrete-time models. (For instance, there may be discrete cycles in the development of the populations, or observations can be made only at discrete time steps.) Therefore the present paper is devoted to the development of the monitoring methodology in the framework of discrete-time models of population ecology. By monitoring we mean that, observing only certain component(s) of the system, we reconstruct the whole state process. This may be necessary, e.g., when in a complex ecosystem the observation of the densities of certain species is impossible, or too expensive. For the first presentation of the offered methodology, we have chosen a discrete-time version of the classical Lotka-Volterra prey-predator model. This is a minimal but not trivial system where the methodology can still be presented. We also show how this methodology can be applied to estimate the effect of an abiotic environmental change, using a component of the population system as an environmental indicator. Although this approach is illustrated in a simplest possible case, it can be easily extended to larger ecosystems with several interacting populations and different types of abiotic environmental effects.

Randomized control trial to assess the efficacy of metacognitive training compared with a psycho-educational group in people with a recent-onset psychosis.

BACKGROUND: Aims were to assess the efficacy of metacognitive training (MCT) in people with a recent onset of psychosis in terms of symptoms as a primary outcome and metacognitive variables as a secondary outcome. METHOD: A multicenter, randomized, controlled clinical trial was performed. A total of 126 patients were randomized to an MCT or a psycho-educational intervention with cognitive-behavioral elements. The sample was composed of people with a recent onset of psychosis, recruited from nine public centers in Spain. The treatment consisted of eight weekly sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at 6 months follow-up. The evaluator was blinded to the condition of the patient. Symptoms were assessed with the PANSS and metacognition was assessed with a battery of questionnaires of cognitive biases and social cognition. RESULTS: Both MCT and psycho-educational groups had improved symptoms post-treatment and at follow-up, with greater improvements in the MCT group. The MCT group was superior to the psycho-educational group on the Beck Cognitive Insight Scale (BCIS) total (p = 0.026) and self-certainty (p = 0.035) and dependence self-subscale of irrational beliefs, comparing baseline and post-treatment. Moreover, comparing baseline and follow-up, the MCT group was better than the psycho-educational group in self-reflectiveness on the BCIS (p = 0.047), total BCIS (p = 0.045), and intolerance to frustration (p = 0.014). Jumping to Conclusions (JTC) improved more in the MCT group than the psycho-educational group (p = 0.021). Regarding the comparison within each group, Theory of Mind (ToM), Personalizing Bias, and other subscales of irrational beliefs improved in the MCT group but not the psycho-educational group (p < 0.001-0.032). CONCLUSIONS: MCT could be an effective psychological intervention for people with recent onset of psychosis in order to improve cognitive insight, JTC, and tolerance to frustration. It seems that MCT could be useful to improve symptoms, ToM, and personalizing bias.

Enhanced near-infrared emission from holmium-ytterbium co-doped phosphate glasses containing silver nanoparticles.

The fabrication and spectroscopic characterization of Ho(3+) and Yb(3+) co-doped phosphate glasses, also containing silver nanoparticles (SNPs), is reported. The nucleation and formation of nanoparticle structures in the samples are confirmed using transmission electron microscopy analyses. It is found that the Ho(3+)-Yb(3+)-SNP phosphate glasses exhibit an enhancement of both the resonant-absorption and the fluorescence properties when the SNP concentration is increased.

Effect of E-beam treatment on the chemistry and on the antioxidant activity of lycopene from dry tomato peel and tomato powder.

Tomato powder (TP) and dry tomato peel (DTP) have been previously used in our laboratory as a source of lycopene to manufacture meat products ready-to-eat (RTE) submitted to E-beam irradiation with good technological and sensory results. Present work describes the studies performed in order to investigate the effect of radiation on chemical changes and antioxidant properties of lycopene. DTP and TP were irradiated (4 kGy). Changes on lycopene were analyzed by HPLC; inhibition of reactive oxygen species (ROS), possible modulation of mitogen-activated protein kinases (MAPK) cascade, nuclear factor κ-light-chain-enhancer of activated B cells (NP-κB) activation and expression of proteins involved in oxidation stress were analyzed in RAT-1 fibroblasts cell culture. Radiation reduced the content of all-E-lycopene and increased (Z)-lycopene, lycopene isomerization, and degradation being higher in DTP than in TP. E-Beam treatment increased the antioxidant ability of both DTP and TP in inhibiting spontaneous and H2O2-induced oxidative stress in cultured fibroblasts. Antioxidant activity was higher in DTP than in TP samples.

Embryonal sarcoma of the liver.

PURPOSE: Embryonal sarcoma accounts for 6 % of liver tumors. This study reviews its features and the results of treatment in a referral center. METHODS: We retrospectively reviewed liver tumors treated between 1995 and 2011. PRETEXT staging and biopsy were used to tailor chemotherapy according to SIOP protocols. Radical surgery was performed when possible. Complications and cumulative survival were the outcome endpoints. RESULTS: Six out of 156 primary liver tumors (four males and two females) were sarcomas. The mean age at diagnosis was 81 ± 8.5 months. The most frequent finding was abdominal mass. Alfa-fetoprotein was normal. Imaging depicted heterogeneous tumors with septa, necrosis, and hemorrhagic areas. The diagnosis was ascertained by biopsy. Three tumors were located in the right lobe (PRETEXT II): two were bilobar (PRETEXT III) and one was in the left lobe (PRETEXT I). Two children had metastases at diagnosis and high-risk chemotherapy (vincristine, carboplatin, epirubicin) was administered with poor response. They died without operation 4 and 10 months later. Four patients with local disease underwent typical liver resections after chemotherapy (iphosphamide, vincristine, actinomycin D, and doxorrubicin). Overall actuarial survival at 70 months was 66.6 %. CONCLUSIONS: Extended and metastatic embryonal sarcoma do poorly whereas localized tumors amenable to complete surgical removal after chemotherapy can cure.

Preservation of the native spleen in multivisceral transplantation.

The native spleen is usually removed in patients undergoing MTV. The consequential asplenic state is associated with a high risk of sepsis, especially in immunosuppressed children. In contrast, the inclusion of an allogeneic spleen in multivisceral grafts has been associated with a high incidence of GVHD. We propose an alternative technique for patients undergoing MTV, consisting of the preservation of the native spleen. This approach avoids the additional risk of infection that characterizes the asplenic state without the detrimental side effects of the allogeneic spleen.

Equilibrium control of nonlinear verticum-type systems, applied to integrated pest control.

Linear verticum-type control and observation systems have been introduced for modelling certain industrial systems, consisting of subsystems, vertically connected by certain state variables. Recently the concept of verticum-type observation systems and the corresponding observability condition have been extended by the authors to the nonlinear case. In the present paper the general concept of a nonlinear verticum-type control system is introduced, and a sufficient condition for local controllability to equilibrium is obtained. In addition to a usual linearization, the basic idea is a decomposition of the control of the whole system into the control of the subsystems. Starting from the integrated pest control model of Rafikov and Limeira (2012) and Rafikov et al. (2012), a nonlinear verticum-type model has been set up an equilibrium control is obtained. Furthermore, a corresponding bioeconomical problem is solved minimizing the total cost of integrated pest control (combining chemical control with a biological one).

[Do men and women have the same risk factors for hip fractures?]. / ¿Se fracturan la cadera los hombres y las mujeres ante los mismos factores de riesgo?

BACKGROUND AND AIMS: Osteoporosis has been traditionally considered as a disease in women. However, it is now known that this condition is also important in men. It is a multifactor condition whose main independent risk factor to suffer fractures, in general, and those of the hip, specifically, is bone mass. Nonetheless, there are other independent risk factors of importance. This study has aimed to study if men and women suffer hip fractures with the same bone mass and if they have the same risk factors associated to this condition. PATIENTS AND METHODS: We studied 105 patients with non-traumatic hip fracture and 68 healthy controls. The different risk factors were analyzed, including clinical data, lifestyle, analytic data, data related to bone metabolism and sex hormones as well as a complete bone evaluation. RESULTS AND CONCLUSIONS: Hip bone mass density (BMD) values are the main risk factor for osteoporotic fractures in both genders. These values are comparable when expressed in terms of volumetric density. In women, risk factors that determine the appearance of fractures are previous non-traumatic fractures when they are older than 50 years, total hip BMD, serum calcium levels and thiazide intake while in men only total hip BMD reaches statistical significance.

Study of the GC-MS determination of the palmitic-stearic acid ratio for the characterisation of drying oil in painting: La Encarnación by Alonso Cano as a case study.

The correct identification of drying oils plays an essential role in providing an understanding of the conservation and deterioration of artistic materials in works of art. To this end, this work proposes the use of peak area ratios from fatty acids after ensuring that the linear responses of the detector are tested. A GC-MS method, previously reported in the literature, was revisited to its developed and validated in order to identify and quantify of eight fatty acids that are widely used as markers for drying oils in paintings, namely myristic acid (C(14:0)), palmitic acid (C(16:0)), stearic acid (C(18:0)), oleic acid (C(18:1)), linoleic acid (C(18:2)), suberic acid (2C(8)), azelaic acid, (2C(9)) and sebacic acid (2C(10)). The quaternary ammonium reagent m-(trifluoromethyl)phenyltrimethylammonium hydroxide (TMTFAH) was used for derivatization prior to GC-MS analysis of the oils. MS spectra were obtained for each methyl ester derivative of the fatty acids and the characteristic fragments were identified. The method was validated in terms of calibration functions, detection and quantification limits and reproducibility using the signal recorded in SIR mode, since two of the methyl derivatives were not totally separated in the chromatographic run. The proposed method was successfully applied to identify and characterise the most widely used drying oils (linseed oil, poppy seed oil and walnut oil) in the painting La Encarnación. This 17th century easel painting is located in the main chapel of the cathedral in Granada (Spain) and was painted by the well-known artist of the Spanish Golden Age, Alonso Cano (1601-1667).

High-risk hepatoblastoma: results in a pediatric liver transplantation center.

AIM: Aim of the study was assess the results of the treatment of High-Risk Hepatoblastoma (HRH) in a tertiary center where all liver surgery facilities, including pediatric transplantation (LT), are available. METHODS: 91 primary liver tumors treated between 1991 and 2009 were retrospectively reviewed. HRHs as defined by the SIOP criteria (PRETEXT IV or any stage with venous involvement, extrahepatic disease, tumor rupture and <100 ng/ml serum AFP) were identified and imaging and biopsies were reviewed. The treatment consisted of total removal of the tumor, involving extended hepatectomies and LT if necessary, together with SIOPEL-guided chemotherapy. RESULTS: 23/57 hepatoblastomas were HRH (11F/12M). 17 were considered unresectable by standard techniques, 3 had extrahepatic disease, and 3 fulfilled both criteria. Mean age at diagnosis was 2.3 ± 2.4 years. 3 children (referred after chemotherapy) died without surgery. 4 had resections (2 left and 2 right trisegmentectomies). Primary LT was required in 15 children (7 cadaveric donors and 8 living related donor transplantations (LRDT), 2 of them with retrohepatic vena cava replacement), and 1 patient had rescue LT after recurrence. Mean follow-up was 4.8 ± 2.9 years. 2 children who had undergone liver resection developed pulmonary metastases at 1.7 and 1.6 years postoperatively and survived after surgical treatment. 2 children with LT developed EBV-related lymphoma and leukemia respectively but survived. Event-free survival (EFS) at 1, 5, and 10 years was 78.3 ± 8.6%, 63.1 ± 10.5%, and 63.1 ± 10.5%, respectively. 6 children died (3 without surgery, 1 after liver resection, 1 after primary LT and 1 after rescue LT). Overall survival at 1, 5 and 10 years was 78.3 ± 21.7%, 73.2 ± 26.8% and 73.2 ± 26.8%. Of those with primary LT, survival at 1, 5 and 10 years was 93.3 ± 6.4%, 93.3 ± 6.4% and 93.3 ± 6.4%. CONCLUSIONS: Outstanding results in the treatment of HRH are possible in tertiary centers when referral is early (preferably at diagnosis) and specialized liver surgery and transplantation facilities are available.

Necesidad de la bipartición hepática o split en el trasplante en niños / Need of hepatic bipartition or split in the transplant in children

Objetivo. Analizar el beneficio del trasplante hepático (TH) con labipartición adulto-niño. Pacientes /métodos. 1) Análisis de la mortalidad pretrasplante calculadas sobre 228 inclusiones a TH (enero 2004-diciembre 2008).2) Impacto de las técnicas alternativas (donante vivo/bipartición) en la mortalidad pretrasplante de nuestros enfermos. 3) Análisis de los resultados de 33 biparticiones que dieron lugar a 66 trasplantes (1994-2008). Resultados. Referida por 1.000 enfermos y año de exposición, la mortalidad pretrasplante fue de 110 en niños mayores de 5 años, 180en niños de 2 a 5 años, 90 en niños entre 1 y 2 años, y 510 en menores de 1 año (p<0,05 respecto a restantes grupos). 36/66 injertos divididos fueron implantados por nuestro grupo. Cinco se perdieron, 3 por retrasplante, 2 por fallecimiento. La supervivencia actuarial a 10 años fue94,5% (enfermos) y 85,1% (injerto). Los 30 injertos restantes fueron trasplantados en otros hospitales, de los que 4 se perdieron precozmente. En el (..) (AU)

Aim. To analyze the benefits of Split (for adult and for child) in liver transplantation. Patient/methods. 1) Analysis of the waiting list mortality estimated on 228 inclusions for transplant since January 2004 to December2008. 2) Impact of the variant techniques (living-related donor and split)on the waiting list mortality in our patients. 3) Analysis of the outcome of 33 split livers which allowed to perform 66 transplants (1994-2008). Results. Estimated as number of patients by 1,000 candidates by year of exposure, the waiting list mortality was 110 in children older than5 year old, 180 in children from 2 to 5 year-old, 90 in children between1 and 2 year-old and 510 in younger than 1 year (p<0.05 for the last group). 36/66 split grafts were implanted by our group. Five grafts were (..) (AU)

Trasplante intestinal: ¿en qué fase estamos? / Intestinal transplant: in what phase are we?

Objetivo. Analizar la evolución del trasplante intestinal (TI) desde el inicio del programa .Material y métodos. Estudiamos retrospectivamente todos los niños con TI (1997-2009): epidemiología, situación previa, técnica quirúrgica, inmunosupresión, resultados, supervivencia y calidad de vida .Resultados. Realizamos 52 TI (20 intestinal aislado, 20 hepatointestinal, 12 multiviscerales) en 46 niños, edad mediana 32m (rango7m-19a); peso 12,3 kg (rango 3,9-60); 31 tenían intestino corto, 8 dismotilidad, 5 diarrea intratable y 2 misceláneos. Veintiséis se intentaronadaptar inicialmente, 20 se incluyeron directamente como candidatos. La modalidad de trasplante se modificó durante su espera en 18. Todos recibieron tacrolimus y corticoides requiriendo 5 conversión a sirolimus posteriormente. Seis fallecieron el primer mes por sepsis/fallo multiorgánico (mala situación basal); 13 fallecieron tardíamente; observamos rechazo agudo en 20, rechazo crónico en 3, síndrome linfoproliferativo en 8 (fallecieron 6), y EICH en 5 (fallecieron 3). La supervivencia tras 5 años es del 65,2 % (51,7% el injerto). Desde 2006-2008,la supervivencia a los 6m, 1 y 3 años del paciente/injerto es 88,7/84,1,81,2/81,2 y 81,2/71,1%, respectivamente. Tras un seguimiento medio de 39 ± 29 meses, todos los pacientes vivos (n=27, 59%) son autónomos digestivos (70% ya sin estoma), están escolarizados, con mínimosingresos y buena calidad de vida. Conclusiones. El TI se afianza como alternativa de tratamiento en (..) (AU)

Objective. To analyze the evolution of Small Bowel Transplantation program since the beginning of the program. Matherial and methods. All children who underwent intestinal transplantation between 1997 and 2009 were retrospectively reviewed: epidemiological data, status before transplant, surgical technique, immunosupression, results, survival and long. term quality of life were analysed. Results. Fifty-two intestinal transplants were performed in 46 children (20 isolated bowel, 20 combined liver and intestine, and 12 multivisceral); median age was 32m (range 7m-19a); weight 12,3 kg (range3,9-60); 31 had short gut syndrome, 8 dismotility, 5 intractable diarrhea, and two were miscellaneous. Intestinal adaptation was initially attempted in 26 patients, without success, 20 were directly listed for transplant. The modality of transplant was modified in 17 while listed. Baseline immune supression consisted of tacrolimus and steroids, although 5 required conversion to Sirolimus later. Six died during the first month, due to sepsis/multiorganic failure (poor status at transplant);13 died during the long-term follow-up. Acute rejection was seen in 20,chronic rejection in 3, PTLD in 8 (6 died) and GVHD in 5 patients (3died). Overall survival after 5 years of follow-up is 65,2 % (51,7% for (..) (AU)

[Need of hepatic bipartition or split in the transplant in children]. / Necesidad de la bipartición hepática o split en el trasplante en niños.

AIM: To analyze the benefits of Split (for adult and for child) in liver transplantation. PATIENT/METHODS: 1) Analysis of the waiting list mortality estimated on 228 inclusions for transplant since January 2004 to December 2008.2) Impact of the variant techniques (living-related donor and split) on the waiting list mortality in our patients. 3) Analysis of the outcome of 33 split livers which allowed to perform 66 transplants (1994-2008). RESULTS: Estimated as number of patients by 1,000 candidates by year of exposure, the waiting list mortality was 110 in children older than 5 year old, 180 in children from 2 to 5 year-old, 90 in children between 1 and 2 year-old and 510 in younger than 1 year (p<0.05 for the last group). 36/66 split grafts were implanted by our group. Five grafts were lost, 3 due to retransplantation and 2 due to death. Overall patient/graft survival alter 10 years of follow-up was 94.5% and 85.1%, respectively. The rest of the grafts (n=30), were used in other hospitals, and 4 were lost in the early postoperative period. Since the beginning of the study, 85.4% of children between 1 and 2 years, received a living-donor or a split graft, as only 59.9% in the younger than 1 year-old group. CONCLUSION: Our results absolutely justify the ethics of split liver transplantation for an adult and a child. Despite other factors, the benefits of the variant techniques in the 1-2 year-old group are obvious. Up to 60% optimization with these techniques in children younger than 1 year would not be yet enough in order to decrease the mortality waiting list down to that of the rest of the groups.