Procalcitonin accurately predicts lung transplant adults with low risk of pulmonary graft dysfunction and intensive care mortality.

PURPOSE: We evaluated the association of procalcitonin (PCT), IL-6-8-10 plasma levels during the first 72h after lung transplantation (LT) with ICU-mortality, oxygenation, primary graft dysfunction (PGD), and one-year graft function after LT. MATERIAL AND METHODS: Prospective, observational study. PCT and IL-6-8-10 plasma levels were measured at 24h, 48h and 72h after LT from 100 lung transplant recipients (LTr). Patients were followed until one year after LT. End-points were ICU survival, grade 3 PGD at 72h and one-year graft function. RESULTS: Higher PCT at 24h was associated with lower PaO2/FIO2 ratio and Grade 3 PGD over the first 72h after LT (p<0.05). PCT at 24h was higher in the 9 patients who died (2.90 vs 1.47ng/mL, p<0.05), with AUC=0.74 for predicting ICU-mortality. All patients with PCT<2ng/mL at 24h following LT, survived in the ICU (p<0.05). PCT and IL-10 at 48h were correlated with FEV1 (rho=-0.35) and FVC (rho=-0.29) one year after LT. (p<0.05). CONCLUSIONS: A breakpoint of PCT<2ng/mL within 24h has a high predictive value to exclude grade 3 PGD at 72h and for ICU survival. Moreover, both PCT and IL-10 within 48h were associated with significantly better graft function one year after surgery.

Sepsis: A Review of Advances in Management.

Infections represent a common health problem in people of all ages. Usually, the response given to them is appropriate and so little treatment is needed. Sometimes, however, the response to the infection is inadequate and may lead to organ dysfunction; this is the condition known as sepsis. Sepsis can be caused by bacteria, fungi or viruses and at present there is no specific treatment; its management basically focuses on containing the infection through source control and antibiotics plus organ function support. This article reviews key elements of sepsis management, focusing on diagnosis, biomarkers and therapy. The main recent advance in therapy is the strategy of personalized medicine, based on a precise approach using biomarkers to identify specific individuals who are likely to benefit from more personalized attention.

The discoidin domain receptor 1 gene has a functional A2RE sequence.

Discoidin domain receptor 1 (DDR1) is expressed in myelin oligodendrocytes and co-localizes with myelin basic protein (MBP). Alternative splicing of DDR1 generates five isoforms designated DDR1a-e. The MBP mRNA contains an hnRNP A2 response element (A2RE) sequence that is recognized by heterogeneous nuclear ribonucleoprotein (hnRNP) A2/B1, which is responsible for transport of the MBP mRNA to oligodendrocyte processes. We hypothesized that DDR1 could have a functional A2RE sequence. By in silico analysis, we identified an A2RE-like sequence in the human DDR1 mRNA. We observed nuclear and dendrite cytoplasmic immunofluorescence, indicating that DDR1 and hnRNP A2/B1 co-localize in human oligodendrocytes and in differentiated HOG16 cells. The A2RE-like sequence of DDR1 contains the single nucleotide polymorphism rs2267641, and we found that in the human brain, the minor allele is associated with lower and higher levels DDR1b and DDR1c mRNA expression, respectively. Moreover, a positive correlation between DDR1c and the myelin genes myelin-associated glycoprotein and oligodendrocyte lineage transcription factor 2 was found. Differentiated HOG16 cells transfected with an hnRNP A2/B1 siRNA simultaneously show a decrease and an increase in the DDR1c and DDR1b mRNA expression levels, respectively, which was accompanied by a decrease in DDR1 protein levels at the cytoplasmic edges. These results suggest that the DDR1 A2RE sequence is functionally involved in the hnRNP A2/B1-mediated splicing and transport of the DDR1c mRNA.

RT-qPCR study on post-mortem brain samples from patients with major psychiatric disorders: reference genes and specimen characteristics.

BACKGROUND: Gene expression studies conducted in post-mortem human brain samples have the potential to identify relevant genes implicated in psychiatric disorders. Although reverse transcription quantitative real-time PCR (RT-qPCR) has emerged as the method of choice for specific gene expression studies, it requires the use of stable reference genes, and it is necessary to control for pre- and post-mortem factors to obtain reliable data. OBJECTIVE: The aim of this study was to identify suitable reference genes and specimen characteristics that can be taken into account when comparing mRNA expression data between post-mortem brain specimens from psychiatric patients and controls. METHOD: We used a selection of suitably matched occipital cortex specimens from subjects in each of the following groups: schizophrenia (N = 15), bipolar disorder (N = 13), major depressive disorder (N = 15), and control (N = 15). Quantitative and qualitative RNA analyses were performed prior to RT-qPCR and gene expression stability was evaluated with geNorm and NormFinder. RESULTS: We identified GAPDH, RPS17, RPL30, RPLP0, and TFRC as potential reference genes from a sample plate containing 32 candidates commonly used as reference genes. Further analyses of these 5 genes highlighted that 1) they are suitable reference genes for RT-qPCR studies in these post-mortem brain samples from psychiatric patients, and 2) the RNA quality index is highly correlated with gene expression values (r = -0.681, p < 0.0001). CONCLUSIONS: In addition to controlling for pre- and post-mortem factors and selecting stable reference genes for normalization, sample sets should be matched with regard to RNA quality.

[Matrix analysis of the client's voice: QFD applied to healthcare management]. / Análisis matricial de la voz del cliente: QFD aplicado a la gestión sanitaria.

OBJECTIVE: To apply quality function deployment (QFD) methodology to identify clients' needs by relating complaints with perceived quality domains. SETTING: A hospital within the Public Health Service of Madrid. METHODS: Matrix analysis based on the QFD model was performed, using the surveys (1998-2002) conducted in the hospital with the Servqhos questionnaire and a sample of 363 complaints made in 2002. The complaints analyzed were selected using a non-probabilistic sampling method. RESULTS: QFD methodology was highly useful, allowing complaints to be related to the results of a perceived quality questionnaire and identification of the attributes with the greatest influence on patient satisfaction. It also allowed us to identify areas for improvement according to clients' needs.

Análisis matricial de la voz del cliente: QFD aplicadoa la gestión sanitaria / Matrix analysis of the client’s voice: QFD applied to healthcare management

Objetivo: Aplicar la metodología Quality Function Deployment (QFD) para identificar los requerimientos y necesidades de los clientes mediante la relación de las reclamaciones con las dimensiones del cuestionario de calidad percibida utilizado en el centro. Ámbito: Hospital del Servicio Madrileño de Salud. Métodos: Análisis matricial basado en el modelo QFD mediante la utilización como herramientas de las encuestas realizadas con el cuestionario Servqhos (1998-2002) y una muestra de 363 reclamaciones correspondientes a 2002. La muestra de reclamaciones fue seleccionada mediante la aplicación de un muestreo no probabilístico. Resultados: La metodología QFD ha resultado de gran utilidad: permitió relacionar las reclamaciones y los resultados del cuestionario de calidad percibida e identificar los atributos con una mayor influencia en el nivel de satisfacción del paciente. Asimismo, ha permitido identificar áreas de mejora para orientar nuestra estrategia hacia los requisitos del cliente (AU)

Objective: To apply quality function deployment (QFD) methodology to identify clients’ needs by relating complaints with perceived quality domains. Setting: A hospital within the Public Health Service of Madrid. Methods: Matrix analysis based on the QFD model was performed, using the surveys (1998-2002) conducted in the hospital with the Servqhos questionnaire and a sample of 363 complaints made in 2002. The complaints analyzed were selected using a non-probabilistic sampling method. Results: QFD methodology was highly useful, allowing complaints to be related to the results of a perceived quality questionnaire and identification of the attributes with the greatest influence on patient satisfaction. It also allowed us to identify areas for improvement according to clients’ needs (AU)

Evolución de la calidad percibida por los pacientes en dos hospitales públicos / Health outcomes from the patient's views: an analysis of the evolution of the perceived quality in two public hospitals

El modelo EFQM recomienda evaluar periódicamente la satisfacción de los clientes y establecer comparaciones entre organizaciones. Este estudio se basa en dicha recomendación y compara los resultados de dos hospitales públicos. En el estudio, utilizando el Cuestionario SERVQHOS junto a una escala de 4 preguntas directas, se encuestó a 664 pacientes mayores de 18 años que recibieron el alta hospitalaria por cualquier proceso, excepto trastorno mental severo. Los datos se analizaron mediante estadísticos no paramétricos realizando comparaciones intra hospital y entre hospitales. Estos análisis permitieron identificar las áreas de mejora de cada hospital y analizar la evolución en el tiempo de la percepción de los pacientes sobre cada centro (AU)

Total quality management models recommend to evaluate periodically clients’ satisfaction and to make comparisons among organisations. This study is based on this recommendation and it compares the results of two public hospitals. In this study the SERVQHOS Questionnaire and a rating-scale with four questions were used to survey 664 patients. All patients were older than 18 years, they have been discharged from hospitals for any medical disorder, excluding severe mental dysfunction. Non-parametric analyses of data were used. The outcomes showed the areas of improvement for each of the participating hospitals. At the same time, data showed the tendency of patients’ views along the time (AU)

Klebocinas K6 y K150: producción y actividad en diferentes condiciones experimentales / Klebocins K6 y K150: production and activity in various experimental conditions

Se investigó la produción de bacteriocina en cepas de Klebsiella pneumoniae aisladas de pacientes con diversas infecciones. Mediante el método de estrías cruzadas se encontraron dos cepas capaces de inhibir el crecimiento de un alto número de bacterias de la misma especie. La Klebocina K150 presentó mayores halos de inhibición y un espectro de Klebsielas sensibles más amplio que la K6. Ambas se produjeron en medios complejos pero no se pusieron en evidencia en los medios de cultivo sintéticos empleados; la cepa 150 fue incapaz de elaborar bacteriocina en agar nutritivo, triptosa-extracto de carne y eosina-azul de metileno, mientras que la cepa 6 sintetizó la klebocina en todos excepto en triptosa-extracto de carne. Laa K150 es más susceptible al tratamiento con calor que la K6. Se estimó el peso molecular de las bacteriocinas como inferior a 10.000 D. Laa producción de bacteriocina se presentó asociada a la capacidad de hemolizar glóbulos rojos y a la actividad de lipasa. Además las cepas Klebocina-positivas se caracterizaron por un espectro de multiresistencia a antimicrobianos que las diferenció de otras cepas, resistentes

Klebocinas K6 y K150: producción y actividad en diferentes condiciones experimentales / Klebocins K6 y K150: production and activity in various experimental conditions

Se investigó la produción de bacteriocina en cepas de Klebsiella pneumoniae aisladas de pacientes con diversas infecciones. Mediante el método de estrías cruzadas se encontraron dos cepas capaces de inhibir el crecimiento de un alto número de bacterias de la misma especie. La Klebocina K150 presentó mayores halos de inhibición y un espectro de Klebsielas sensibles más amplio que la K6. Ambas se produjeron en medios complejos pero no se pusieron en evidencia en los medios de cultivo sintéticos empleados; la cepa 150 fue incapaz de elaborar bacteriocina en agar nutritivo, triptosa-extracto de carne y eosina-azul de metileno, mientras que la cepa 6 sintetizó la klebocina en todos excepto en triptosa-extracto de carne. Laa K150 es más susceptible al tratamiento con calor que la K6. Se estimó el peso molecular de las bacteriocinas como inferior a 10.000 D. Laa producción de bacteriocina se presentó asociada a la capacidad de hemolizar glóbulos rojos y a la actividad de lipasa. Además las cepas Klebocina-positivas se caracterizaron por un espectro de multiresistencia a antimicrobianos que las diferenció de otras cepas, resistentes (AU)