DNA damage triggers squamous metaplasia in human lung and mammary cells via mitotic checkpoints.

Epithelial transdifferentiation is frequent in tissue hyperplasia and contributes to disease in various degrees. Squamous metaplasia (SQM) precedes epidermoid lung cancer, an aggressive and frequent malignancy, but it is rare in the epithelium of the mammary gland. The mechanisms leading to SQM in the lung have been very poorly investigated. We have studied this issue on human freshly isolated cells and organoids. Here we show that human lung or mammary cells strikingly undergo SQM with polyploidisation when they are exposed to genotoxic or mitotic drugs, such as Doxorubicin or the cigarette carcinogen DMBA, Nocodazole, Taxol or inhibitors of Aurora-B kinase or Polo-like kinase. To note, the epidermoid response was attenuated when DNA repair was enhanced by Enoxacin or when mitotic checkpoints where abrogated by inhibition of Chk1 and Chk2. The results show that DNA damage has the potential to drive SQM via mitotic checkpoints, thus providing novel molecular candidate targets to tackle lung SCC. Our findings might also explain why SCC is frequent in the lung, but not in the mammary gland and why chemotherapy often causes complicating skin toxicity.

Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience.

Despite the benefits of abdominal normothermic regional perfusion (A-NRP) for abdominal grafts in controlled donation after circulatory death (cDCD), there is limited information on the effect of A-NRP on the quality of the cDCD lungs. We aimed to study the effect of A-NRP in lungs obtained from cDCD and its impact on recipients´ outcomes. This is a study comparing outcomes of lung transplants (LT) from cDCD donors (September 2014 to December 2021) obtained using A-NRP as the abdominal preservation method. As controls, all lung recipients transplanted from donors after brain death (DBD) were considered. The primary outcomes were lung recipient 3-month, 1-year, and 5-year survival. A total of 269 LT were performed (60 cDCD and 209 DBD). There was no difference in survival at 3 months (98.3% cDCD vs. 93.7% DBD), 1 year (90.9% vs. 87.2%), and 5 years (68.7% vs. 69%). LT from the cDCD group had a higher rate of primary graft dysfunction grade 3 at 72 h (10% vs. 3.4%; p <  .001). This is the largest experience ever reported with the use of A-NRP combined with lung retrieval in cDCD donors. This combined method is safe for lung grafts presenting short-term survival outcomes equivalent to those transplanted through DBD.

Alteraciones citogenéticas en gestantes con edad avanzada. Granma. 2016-2018 / Cytogenetic alterations in pregnant women with advanced age. Granma 2016 - 2018

Uno de los riesgos asociados al embarazo es la edad materna avanzada, la cual es considerada en nuestro país, a partir de los 35 años de edad. En la actualidad, constituye el principal motivo de indicación para el diagnóstico prenatal citogenético (DPC). Se realizó un estudio descriptivo transversal, con el objetivo de describir la frecuencia de las alteraciones citogenéticas en gestantes con avanzada edad en la provincia Granma en el período de 2016 a 2018. La muestra estuvo constituida por 803 gestantes de 37 años y más a las que se le realizó el diagnóstico prenatal citogenético por amniocentesis entre las 16 y 20 semanas de acuerdo a la fecha de la última menstruación (FUM) o por ultrasonido del primer trimestre en las gestantes con FUM dudosa. Los estudios citogenéticos en el líquido amniótico dirigidos a mujeres de edad materna avanzada están establecidos en nuestro país a las gestantes que tengan ≥ 37 años ya que se considera el grupo poblacional de mayor riesgo. En el período estudiado se realizaron 803 estudios citogenéticos. Durante estos tres años de trabajo se obtuvo un 2,6 por ciento de resultados positivos, dentro de ellos 57,1 por ciento corresponden a aberraciones numéricas y 42,9 por ciento a estructurales. Bayamo (52,4 por ciento) resultó el municipio con mayor número de casos positivos(AU)

One of the risks associated with pregnancy is advanced maternal age, which is considered in our country, from 35 years of age. At present, it constitutes the main reason for indication for cytogenetic prenatal diagnosis (CPD). A descriptive cross-sectional study was carried out, with the objectiveof describing the frequency of cytogenetic alterations in pregnant women with advanced age in the province of Granma in the period from 2016 to 2018. The sample consisted of 803 pregnant women aged 37 years and older at whom the cytogenetic prenatal diagnosis was made by amniocentesis between 16 and 20 weeks according to the date of the last menstruation (FUM) or by ultrasound of the first trimester in pregnant women with doubtful FUM. Cytogenetic studies in amniotic fluid aimed at women of advanced maternal age are established in our country to pregnant women who are ≥ 37 years old since it is considered the population group with the highest risk. In the period studied, 803 cytogenetic studies were performed. During these three years of work, 2.6 percent of positive results were obtained, 57.1 percent of which correspond to numerical aberrations and 42.9 percent to structural ones. Bayamo (52.4 percent) was the municipality with the highest number of positive cases(EU)

Alteraciones citogenéticas en gestantes con edad avanzada. Granma. 2016-2018 / Cytogenetic alterations in pregnant women with advanced age. Granma 2016-2018 / Alterações citogenéticas em gestantes com idade avançada. Granma 2016-2018

RESUMEN Uno de los riesgos asociados al embarazo es la edad materna avanzada, la cual es considerada en nuestro país, a partir de los 35 años de edad. En la actualidad, constituye el principal motivo de indicación para el diagnóstico prenatal citogenético (DPC). Se realizó un estudio descriptivo transversal, con el objetivo de describir la frecuencia de las alteraciones citogenéticas en gestantes con avanzada edad en la provincia Granma en el período de 2016 a 2018. La muestra estuvo constituida por 803 gestantes de 37 años y más a las que se le realizó el diagnóstico prenatal citogenético por amniocentesis entre las 16 y 20 semanas de acuerdo a la fecha de la última menstruación (FUM) o por ultrasonido del primer trimestre en las gestantes con FUM dudosa. Los estudios citogenéticos en el líquido amniótico dirigidos a mujeres de edad materna avanzada están establecidos en nuestro país a las gestantes que tengan≥ 37 años ya que se considera el grupo poblacional de mayor riesgo. En el período estudiado se realizaron 803 estudios citogenéticos. Durante estos tres años de trabajo se obtuvo un 2,6% de resultados positivos, dentro de ellos 57,1% corresponden a aberraciones numéricas y 42,9% a estructurales. Bayamo (52,4%) resultó el municipio con mayor número de casos positivos.

ABSTRACT One of the risks associated with pregnancy is advanced maternal age, which is considered in our country, from 35 years of age. At present, it constitutes the main reason for indication for cytogenetic prenatal diagnosis (CPD). A descriptive cross-sectional study was carried out, with the objective of describing the frequency of cytogenetic alterations in pregnant women with advanced age in the province of Granma in the period from 2016 to 2018. The sample consisted of 803 pregnant women aged 37 years and older at whom the cytogenetic prenatal diagnosis was made by amniocentesis between 16 and 20 weeks according to the date of the last menstruation (FUM) or by ultrasound of the first trimester in pregnant women with doubtful FUM. Cytogenetic studies in amniotic fluid aimed at women of advanced maternal age are established in our country to pregnant women who are ≥ 37 years old since it is considered the population group with the highest risk. In the period studied, 803 cytogenetic studies were performed. During these three years of work, 2.6% of positive results were obtained, 57.1% of which correspond to numerical aberrations and 42.9% to structural ones. Bayamo (52.4%) was the municipality with the highest number of positive cases.

RESUMO Um dos riscos associados à gravidez é a idade materna avançada, considerada em nosso país a partir dos 35 anos de idade. Atualmente, constitui o principal motivo de indicação para o diagnóstico pré-natal citogenético (DPC). Foi realizado um estudo transversal descritivo, com o objetivo de descrever a frequência de alterações citogenéticas em gestantes com idade avançada na província de Granma no período de 2016 a 2018. A amostra foi composta por 803 gestantes com 37 anos ou mais de idade, nas quais o diagnóstico citogenético pré-natal foi realizado por amniocentese entre 16 e 20 semanas, de acordo com a data da última menstruação (FUM) ou por ultrassom do primeiro trimestre em gestantes com FUM duvidoso. Estudos citogenéticos em líquido amniótico direcionados a mulheres em idade materna avançada são estabelecidos em nosso país para gestantes com idade ≥ 37 anos, uma vez que é considerado o grupo populacional de maior risco. No período estudado, foram realizados 803 estudos citogenéticos. Durante esses três anos de trabalho, foram obtidos 2,6% de resultados positivos, 57,1% dos quais correspondem a aberrações numéricas e 42,9% a estruturais. Bayamo (52,4%) foi o município com o maior número de casos positivos.

Excellent long-term outcome with lungs obtained from uncontrolled donation after circulatory death.

We aimed to propose a simple and effective preservation method in lungs procured for transplantation from uncontrolled donation after circulatory death (uDCD) associated with excellent long-term results. Outcome measures for lung recipients were survival and primary graft dysfunction (PGD) grade 3. Survival was estimated using the Kaplan-Meier method. A total of 9 lung uDCDs were evaluated and 8 lung transplants were performed. Mean no-flow time was 9.8 minutes (standard deviation [SD] 8.6). Mean time from cardiac arrest to topical cooling was 96.8 minutes (SD 16.8). Preservation time was 159 minutes (SD 31). Ex vivo lung perfusion was used to assess lung function prior to transplantation in 2 cases. Mean recipient age was 60.8 years (SD 3.1), and mean total ischemic time was 678 minutes (SD 132). PGD grade 3 was observed in 2 cases (25%). The 1-month, 1-year, and 5-year survival rates were 100%, 87.5%, and 87.5%, respectively. Mean follow-up was 52 months. The logistic complexity of procuring lungs from uDCDs for transplantation requires the development of new strategies designed to facilitate this type of donation. A program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes.

Diagnóstico prenatal citogenético a gestantes de avanzada edad materna durante el período 2013-2017 en la provincia Granma / Prenatal cytogenetic diagnosis of pregnant women of advanced maternal age during the period 2013-2017 in Granma province

Uno de los riesgos asociados al embarazo es la edad materna avanzada, la cual se considera en Cuba, a partir de los 35 años de edad. En la actualidad, constituye el principal motivo de indicación para el diagnóstico prenatal citogenético. Se realizó un estudio descriptivo-retrospectivo de corte transversal, en el Centro de Genética Médica de la provincia Granma, con el objetivo de describir el diagnóstico prenatal citogenético en gestantes de avanzada edad materna durante el período 2013-2017. El universo estuvo constituido por 1544 pacientes, gestantes con avanzada edad materna a las que se les practicó el diagnóstico por amniocentesis entre las 16 y 20 semanas. En el período estudiado se realizaron 1544 estudios citogenéticos prenatales de un total de 2229 gestantes captadas con avanzada edad materna (69 por ciento). Durante estos cinco años de trabajo se obtuvo un total de 1502 estudios normales (97 por ciento) y los resultados positivos fueron 42 estudios que representan el 3 por ciento. El síndrome de Down mostró una frecuencia del 45 por ciento (19/42) y el resto de las anomalías cromosómicas encontradas el 55 por ciento (23/42). La edad materna avanzada condiciona desde la etapa preconcepcional y durante la evolución del embarazo, afectaciones en el desarrollo fetal y en su calidad de vida por lo que se recomienda desarrollar y perfeccionar estrategias informativas y educativas sobre estos temas a la población en riesgo(AU)

One of the risks associated with pregnancy is advanced maternal age, which is considered in Cuba, from 35 years of age. At present, it constitutes the main indication reason for the prenatal cytogenetic diagnosis. A cross-sectional descriptive-retrospective study was conducted at the Medical Genetics Center of Granma province, with the aim of describing the cytogenetic prenatal diagnosis in pregnant women of advanced maternal age during the period 2013-2017. The universe consisted of 1544 patients, pregnant women with advanced maternal age who were diagnosed byamniocentesis between 16 and 20 weeks. In the period under study, 1544 prenatal cytogenetic studies were performed on a total of 2229 pregnant women with advanced maternal age (69 percent). During these five years of work a total of 1502 normal studies were obtained (97 percent) and the positive results were 42 studies representing 3 percent. Down syndrome showed a frequency of 45 percent (19/42) and the rest of the chromosomal anomalies found 55 percent (23/42). The advanced maternal age conditions from the preconceptional stage and during the evolution of the pregnancy, affectations in the fetal development and in its quality of life for what is recommended to develop and perfect informative and educational strategies on these subjects to the population at risk(EU)

Infección vaginal. Causas más frecuentes, 2017 / Vaginal infection Most frequent causes 2017

Se realizó un estudio descriptivo retrospectivo con el objetivo de identificar las causas microbiológicas de infecciones vaginales más diagnosticadas por el laboratorio de microbiología del Centro Provincial de Reproducción Asistida de Granma, de enero a diciembre de 2017. El universo quedó conformado por 129 mujeres procedentes del municipio Bayamo que se estudiaron por microbiología como casos nuevos. Las variables incluidas fueron: área de salud, agente biológico, método de diagnóstico microbiológico y cantidad de lactobacilos identificados.Se empleó el método de análisis y síntesis y los datos se expresaron en frecuencias absolutas y relativas. Por exudado vaginal simple se encontró 62,6 por ciento sugestivo de Gardnerella, 52,8 por ciento Mobiluncus. Los test específicos confirmaron 81 por ciento de Chlamidia y 93,9 por ciento de Ureaplasmas. Los agentes biológicos más identificados fueron Chlamidia,seguido de Ureaplasmas(AU)

A descriptive retrospective study was done with the aim of identifying the microbiological causes of vaginal infections more frequently diagnosed at the microbiology laboratory of the Provincial Assisted Reproduction Center of Granma, from January to December 2017. The universe consisted of 129 women from Bayamo municipality that were studied as new cases. The variables studied were area of health, biological agent, microbiological diagnostic method and amount of lactobacilli identified. The method of analysis and synthesis was used andthe data expressed using absolute and relative frequencies. Simple vaginal exudates showed that 62.6 percent was suggestive of Gardnerella and 52.8 percent of Mobiluncus. The specifictests confirmed that was 81 percent positive for chlamydia and 93.9 percent for Ureaplasmas. The biological agentmore often identified was: chlamydia, followed by Ureaplasmas(EU)

La disciplina principal integradora en la carrera de medicina / The main integrative discipline in the medical career

En la disciplina principal integradora se sintetizan todos los contenidos del plan de estudios. Se reflexiona sobre los principales elementos que contiene, las tendencias internacionales de la educación médica superior y se destaca el papel de la disciplina integradora como rectora del proceso de aprendizaje(AU)

All the contents of the curriculum are synthesized in the main integrative discipline. It reflects on the main elements that it contains, the international tendencies of higher medical education and highlights the role of the integrating discipline as rector of the learning process(EU)

Hábito de fumar. Cómo abandonar este mal hábito a través de consejería por el médico de familia / Habit of smoking. How to give up this bad habit through counselling by the family doctor

Se exponen algunos consejos para facilitarle a los médicos de familia el abordaje de las personas dependientes del tabaco que acudan a su consulta con la intención de dejar de consumirlo(AU)

Some tips are presented to make it easier for family doctors to approach people dependent on tobacco who come to your practice with the intention of stopping it(EU)

Intervención educativa para internos sobre infección por virus papiloma humano. Centro Penitenciario Provincial,Granma, 2013-2014 / Educational intervention for inmates on human papillomavirus infection. Provincial Penitentiary Center, Granma 2013-2014

Introducción: el virus del papiloma humano es la infección de transmisión sexual más común. Objetivo: determinar la efectividad de una estrategia de intervención sobre lasinfecciones por el virus del papiloma humano (VPH). Método: se realizó un estudio cuasi experimental desde enerode 2013 a noviembre de 2014, en el destacamento de jóvenes del Centro Penitenciario Provincial Granma. El universo estuvo constituido por 83 jóvenes, de los cuales se seleccionó una muestra de 60 pacientes, que cumplieron los criterios de inclusión. Para determinar el nivel de conocimientos sobre las infecciones causadas por el virus del papiloma humano, existente antes y después de la intervención se empleó la encuesta sobre conocimientos de los internos acerca de las manifestaciones clínicas de esa enfermedad, las vías de trasmisión, la prevención y la protección que ofrece el preservativo en las infecciones que se transmiten por contacto sexual; se utilizaron técnicas participativas y de reflexión, entre otras. Se analizó la información utilizando el test de MacNemar, mediante análisis de proporciones emparejadas y se sometió a criterio de expertos (DELPHI). Los métodos estadísticos empleados para ello fueron el cálculo de frecuencia relativa, paquete estadístico STATISICS versión 8.0 y las pruebas de hipótesis con valor significativo p≥0,05 con un intervalo de confianza de 95 por ciento. Resultados: se observó que los participantes poseían un inadecuado nivel de conocimientos sobre las manifestaciones clínicas, vías de transmisión, formas de evitar las ITS y la protección del condón frente a las infecciones causadas por el VPH antes de aplicar la intervención, luego con la intervención educativa se logró elevar el nivel de conocimientos. Conclusiones: la intervención fue eficazal modificar conocimientos sobre la temática abordada(AU)

Introducción: human papillomavirus is the most common sexually transmitted infection. Objective: to determine the effectiveness of an intervention strategy on human papillomavirus (HPV) infections. Method: a quasi-experimental study was carried out from January 2013 to November 2014, in the youth detachment of the Granma Provincial Penitentiary Center. The universe consisted of 83 young people, from whom a sample of 60 patients was selected, who met the inclusion criteria. In order to determine the level of knowledge about infections caused by human papillomavirus, which existed before and after the intervention, the survey was used including clinical manifestations of this disease, the transmission routes, the prevention and the protection offered by the condom in the infections transmitted through sexual contact, were used participatory techniques and reflection, among others. The information was analyzed using the MacNemar test, by means of paired proportions analysis and was submitted to expert judgment (DELPHI). The statistical methods employed were the relative frequency calculation, statistical package STATISICS version 8.0 and hypothesis tests with significant value p≥0.05 with a 95 percent confidence interval. Results: the participants had an inadequate level of knowledge about the clinical manifestations, routes of transmission, ways of avoiding STIs and the protection of the condom from HPV infections before applying the intervention, then with the intervention was able to raise the level of knowledge. Conclusions: the intervention was effective in modifying knowledge on the subject(EU)

Schwannoma intratorácico del nervio vago / Intrathoracic Schwannoma of the Vagus Nerve

No disponible

Increased numbers of circulating CD8 effector memory T cells before transplantation enhance the risk of acute rejection in lung transplant recipients.

The effector and regulatory T cell subpopulations involved in the development of acute rejection episodes in lung transplantation remain to be elucidated. Twenty-seven lung transplant candidates were prospectively monitored before transplantation and within the first year post-transplantation. Regulatory, Th17, memory and naïve T cells were measured in peripheral blood of lung transplant recipients by flow cytometry. No association of acute rejection with number of peripheral regulatory T cells and Th17 cells was found. However, effector memory subsets in acute rejection patients were increased during the first two months post-transplant. Interestingly, patients waiting for lung transplant with levels of CD8(+) effector memory T cells over 185 cells/mm(3) had a significant increased risk of rejection [OR: 5.62 (95% CI: 1.08-29.37), p=0.04]. In multivariate analysis adjusted for age and gender the odds ratio for rejection was: OR: 5.89 (95% CI: 1.08-32.24), p=0.04. These data suggest a correlation between acute rejection and effector memory T cells in lung transplant recipients. The measurement of peripheral blood CD8(+) effector memory T cells prior to lung transplant may define patients at high risk of acute lung rejection.

Ultrasound-guided percutaneous drainage of a traumatic abdominal wall hematoma in the emergency department.

BACKGROUND: Abdominal wall hematoma is due to trauma, coagulation disorders or anticoagulation therapy complications. METHODS: In this report we present a case of a 44-year-old female who suffered from blunt abdominal trauma and presented to the emergency department with sharp abdominal pain and ecchymosis. FAST and abdominal computerized tomography (CT) revealed an abdominal wall hematoma. Treatment with an ultrasound-guided percutaneous drainage was performed successfully. RESULTS: The patient remained under observation for six hours with serial ultrasound scans, and no signs of hematoma recurrence were present. She was discharged the same day with clinical improvement. CONCLUSION: Complete history investigation and clinical examination help to make a correct diagnosis of abdominal wall hematoma, select a prompt treatment, and reduce complications.

Ultrasound-guided percutaneous drainage of a traumatic abdominal wall hematoma in the emergency department / 世界急诊医学杂志（英文）

BACKGROUND: Abdominal wall hematoma is due to trauma, coagulation disorders or anticoagulation therapy complications. METHODS: In this report we present a case of a 44-year-old female who suffered from blunt abdominal trauma and presented to the emergency department with sharp abdominal pain and ecchymosis. FAST and abdominal computerized tomography (CT) revealed an abdominal wall hematoma. Treatment with an ultrasound-guided percutaneous drainage was performed successfully. RESULTS: The patient remained under observation for six hours with serial ultrasound scans, and no signs of hematoma recurrence were present. She was discharged the same day with clinical improvement. CONCLUSION: Complete history investigation and clinical examination help to make a correct diagnosis of abdominal wall hematoma, select a prompt treatment, and reduce complications.

Trasplante de pulmón con donantes no controlados a corazón parado. Factores pronósticos dependientes del donante y evolución inmediata postrasplante / Lung Transplantation with Uncontrolled Non-Heart-Beating Donors. Transplantation. Donor Prognostic Factor and Immediate Evolution Post Transplant

Introducción: La donación en asistolia no controlada (DANC) constituye una alternativa al trasplantepulmonar con donantes en muerte encefálica. El objetivo principal del estudio es describir la incidenciade eventos al mes tras el trasplante con pulmones de DANC, y la influencia de los factores dependientesdel donante y del proceso de donación.Pacientes y métodos: Estudio de una cohorte histórica de 33 receptores de trasplante pulmonar realizadosen los hospitales Puerta de Hierro y Marqués de Valdecilla con 32 DANC procedentes del Hospital ClínicoSan Carlos durante el periodo 2002-2008. Se estudiaron los siguientes eventos: complicaciones quirúrgicasy médicas, disfunción primaria del injerto, rechazo agudo, neumonía y mortalidad. Se evaluaron lascaracterísticas del donante y los tiempos del proceso de donación (minutos).Resultados: La mediana de edad de los receptores fue 50,5 años (rango intercuartílico, 38,5-58); 28 hombresy 5 mujeres. La incidencia acumulada de los eventos al mes fue: neumonía, 10 (31,3%); disfunciónprimaria del injerto, 15 (46,9%); rechazo, 12 (37,5%); mortalidad, 4 (12,1%); complicaciones médicas,25 (78,1%), y quirúrgicas, 18 (56,3%). La mediana del tiempo de asistolia fue mayor en los sujetos conneumonía (15 vs. 7,5; p = 0,027), la mediana del tiempo de isquemia fría fue superior en los sujetos quepresentaron complicaciones quirúrgicas y mortalidad (436 vs. 343,5; p = 0,04; 505 vs. 410; p = 0,033, respectivamente),y las medianas de los tiempos de isquemia total fueron superiores en los receptores quefallecieron (828 vs. 695; p = 0,036).Conclusiones: Los DANC constituyen una alternativa válida para expandir el pool de donantes pulmonaresante la carencia actual de pulmones válidos para el trasplante. La incidencia de complicaciones escomparable con los datos publicados en la literatura(AU)

Introduction: Uncontrolled donation after cardiac death (DACD) has become an alternative to lung transplantationwith encephalic-death donation. The main objective of this study is to describe the incidenceof clinically relevant events in the period of thirty days after lung transplant with uncontrolled DACD andthe influence of factors depending on the donor and donation process as well.Patients and methods: Historical cohort study of 33 lung transplant receivers at Hospital Puerta de Hierro and Hospital Marqués de Valdecilla with 32 DACD from Hospital Clínico San Carlos from 2002 to 2008.We studied surgical and medical complications, primary graft dysfunction, acute rejection, pneumonia and mortality. We made an evaluation of the donor characteristics and donation procedure times (minutes). Results: Median age of recipients was 50.5 years (interquartile range, 38.5-58). There were 28 malesand 5 females. Cumulative incidence of events in the first month was: pneumonia 10 (31.3%); primarygraft dysfunction 15 (46.9%); rejection 12 (37.5%); mortality 4 (12.1%); medical complications 25 (78.1%);and surgical complications 18(56.3%). Median time of cardiac arrest was higher in those who presentedpneumonia (15 vs. 7.5; p = 0.027). Median time of cold ischemia was higher in those who presentedsurgical complications and mortality (436 vs. 343.5; p = 0.04; 505 vs. 410; p = 0.033, respectively), andmedian of total ischemia times were longer in the recipients who died (828 vs. 695; p = 0.036).Conclusions: Uncontrolled DACD are a valid alternative for expanding the donor pool in order to mitigatethe current shortage of lungs that are valid for transplantation. The incidence of complications iscomparable with published data in the literature(AU)

[Lung transplantation with uncontrolled non-heart-beating donors. Transplantation. Donor prognostic factor and immediate evolution post transplant]. / Trasplante de pulmón con donantes no controlados a corazón parado. Factores pronósticos dependientes del donante y evolución inmediata postrasplante.

INTRODUCTION: Uncontrolled donation after cardiac death (DACD) has become an alternative to lung transplantation with encephalic-death donation. The main objective of this study is to describe the incidence of clinically relevant events in the period of thirty days after lung transplant with uncontrolled DACD and the influence of factors depending on the donor and donation process as well. PATIENTS AND METHODS: Historical cohort study of 33 lung transplant receivers at Hospital Puerta de Hierro and Hospital Marqués de Valdecilla with 32 DACD from Hospital Clínico San Carlos from 2002 to 2008. We studied surgical and medical complications, primary graft dysfunction, acute rejection, pneumonia and mortality. We made an evaluation of the donor characteristics and donation procedure times (minutes). RESULTS: Median age of recipients was 50.5 years (interquartile range, 38.5-58). There were 28 males and 5 females. Cumulative incidence of events in the first month was: pneumonia 10 (31.3%); primary graft dysfunction 15 (46.9%); rejection 12 (37.5%); mortality 4 (12.1%); medical complications 25 (78.1%); and surgical complications 18 (56.3%). Median time of cardiac arrest was higher in those who presented pneumonia (15 vs. 7.5; p = 0.027). Median time of cold ischemia was higher in those who presented surgical complications and mortality (436 vs. 343.5; p = 0.04; 505 vs. 410; p = 0.033, respectively), and median of total ischemia times were longer in the recipients who died (828 vs. 695; p = 0.036). CONCLUSIONS: Uncontrolled DACD are a valid alternative for expanding the donor pool in order to mitigate the current shortage of lungs that are valid for transplantation. The incidence of complications is comparable with published data in the literature.

Trasplante de pulmón en casos de enfisema: análisis de la mortalidad / Mortality Analysis of Patients Undergoing Lung Transplantation for Emphysema

IntroducciónSe presentan los resultados del trasplante pulmonar (TP) en casos de enfisema, tras 11 años desde el inicio del programa de TP, y se analizan los factores de riesgo asociados a la mortalidad a corto, medio y largo plazo en los receptores del trasplante.Pacientes y métodosSe ha incluido a todos los pacientes diagnosticados de enfisema que recibieron un TP entre marzo de 1997 y junio de 2008. Se analizó la asociación de las diferentes variables estudiadas con la mortalidad precoz, anual y al quinto año. Se realizó un análisis de supervivencia mediante el método de Kaplan-Meier. Mediante regresión logística se estudió la asociación entre las variables que en el análisis univariante habían mostrado tendencia a la significación estadística (p<0,2) frente a la mortalidad precoz. Los factores de riesgo para la mortalidad anual y al quinto año se analizaron mediante regresión de Cox. ResultadosSe incluyó en total a 92 pacientes. La tasa de supervivencia fue del 89,3, el 70 y el 54% al mes, al año y al quinto año del trasplante. La dehiscencia de la sutura quirúrgica (p<0,001), el tiempo de ventilación mecánica en la Unidad de Cuidados Intensivos (p=0,04), la duración de la intervención quirúrgica (p<0,001) y la realización de un trasplante unipulmonar (p=0,007) fueron las variables asociadas a la mortalidad. El uso de circulación extracorpórea y la necesidad de técnicas de hemodiafiltración en la Unidad de Cuidados Intensivos incrementaron el riesgo de muerte a corto plazo (p<0,05). La edad del receptor fue la variable asociada a la mortalidad a largo plazo (p=0,02). La duración de la intervención quirúrgica se asoció a un incremento de la mortalidad a corto, medio y largo plazo(AU)

ConclusionesLas complicaciones son las responsables del incremento de la mortalidad a corto plazo, mientras que la edad del receptor es la variable que mayor influencia tiene en la mortalidad a largo plazo. Los receptores de un trasplante unipulmonar presentaron un riesgo de fallecimiento mayor que aquellos que recibieron un trasplante bipulmonar(AU)

BackgroundThe outcomes of lung transplantation 11 years after starting the transplantation program in our hospital are presented. Risk factors associated with short-, medium-, and long-term mortality in transplant recipients were analyzed.Patients and MethodsAll patients diagnosed with emphysema who underwent lung transplantation between March 1997 and June 2008 were included. The association between different study variables and early death and death at 1 year and 5 years was studied. The Kaplan-Meier method was used to analyze survival. A logistic regression model was used to study the association between early death and variables with a trend towards significance (P<.2) in the univariate analysis. The risk factors for mortality at 1 year and 5 years were analyzed by a Cox regression model.ResultsA total of 92 patients were included. Survival was 89.3%, 70%, and 54% at 1 month, 1 year, and 5 years after transplantation, respectively. Dehiscence of the surgical suture (P<.001), duration of mechanical ventilation in the intensive care unit (P=.04), duration of the surgical procedure (P<.001), and single-lung transplantation (P=.007) were the variables associated with mortality. Extracorporeal circulation and the need for hemodiafiltration in the intensive care unit increased the short-term risk of death (P<.05). The age of the recipient was the variable associated with long-term mortality (P=.02). The duration of the surgical intervention was associated with an increase in short-, medium-, and long-term mortality.ConclusionsComplications were responsible for short-term mortality, while age of the recipient was the most important factor in determining long-term survival. Mortality was higher in single-lung transplant recipients compared to double-lung transplant recipients(AU)

[Mortality analysis of patients undergoing lung transplantation for emphysema]. / Trasplante de pulmón en casos de enfisema: análisis de la mortalidad.

BACKGROUND: The outcomes of lung transplantation 11 years after starting the transplantation program in our hospital are presented. Risk factors associated with short-, medium-, and long-term mortality in transplant recipients were analyzed. PATIENTS AND METHODS: All patients diagnosed with emphysema who underwent lung transplantation between March 1997 and June 2008 were included. The association between different study variables and early death and death at 1 year and 5 years was studied. The Kaplan-Meier method was used to analyze survival. A logistic regression model was used to study the association between early death and variables with a trend towards significance (P<.2) in the univariate analysis. The risk factors for mortality at 1 year and 5 years were analyzed by a Cox regression model. RESULTS: A total of 92 patients were included. Survival was 89.3%, 70%, and 54% at 1 month, 1 year, and 5 years after transplantation, respectively. Dehiscence of the surgical suture (P<.001), duration of mechanical ventilation in the intensive care unit (P=.04), duration of the surgical procedure (P<.001), and single-lung transplantation (P=.007) were the variables associated with mortality. Extracorporeal circulation and the need for hemodiafiltration in the intensive care unit increased the short-term risk of death (P<.05). The age of the recipient was the variable associated with long-term mortality (P=.02). The duration of the surgical intervention was associated with an increase in short-, medium-, and long-term mortality. CONCLUSIONS: Complications were responsible for short-term mortality, while age of the recipient was the most important factor in determining long-term survival. Mortality was higher in single-lung transplant recipients compared to double-lung transplant recipients.

[Bladder lymphoepithelioma-like carcinoma. Bibliographic review and case report]. / Carcinoma vesical linfoepiteuoma- like: revisión de la literatura y aportación de un nuevo caso.

OBJECTIVE: Lymphoepithelial-carcinoma or lymphoepithelioma-like carcinoma is a rare tumour, the histology of which remembers nasal pharyngeal is lymphoepitheliomas. Their presence has been described in multiple localizations, but only 55 cases have been described in the bladder. We present a new case of bladder lymphoepithelial carcinoma and performed a review of all published cases, with the aim of defining its characteristics and try to obtain a therapeutic and prognostic guide applicable to this disease. METHODS: We reviewed the literature related to lymphoepithelial carcinoma and epidemiological characteristics, treatments administered, and outcomes of the 56 published cases (including ours) have been analyzed, both globally and as a function of histological subtypes following the classification of Amin et al. RESULTS: 56 cases have been described, 40 males and 16 women, with a mean age of 69 years. Nineteen of the pure subtype (33.9%), 20 of the predominant type (35.7%) and 11 focal (19.6%) were diagnosed, without any indications of histology in six of them (10.7%). Regarding tumor stages: 10.7% (6) were T1, 57.1% (32) T2, and 30.4% (17) T3. 58.9% of the cases underwent transurethral resection (TUR), 35.7% radical cystectomy, and 5.4% partial cystectomy. 42.9% did not receive any adjuvant treatment, 30.4% received chemotherapy, and 19.6% radiotherapy. Overall survival was 67.9%, 64.3% disease-free, with a mean and median follow up of 34.5 and 25 months respectively. If we differentiate histological subtypes, 84.3% of the pure, 100% of the predominant, and 76.7% of focal presented infiltration (T2/T3). 78.9% of the pure, 45% of the predominant and 45.5% of the focal underwent TUR. 83% of the pure receive adjuvant treatment, whereas 60% of the predominant and 63% of the focal types did not receive any adjuvant treatment. Disease-free survival for stages T2/T3 was 87.5% for the pure with a median follow up of 39 months, 75% for the predominant with a median follow-up of 22 months and 0% for the focal with a median followup of 18 months. CONCLUSIONS: Currently, no specific therapeutic protocol can be established for patients with bladder lymphoepithelial carcinoma, although taking into consideration the apparent good outcome of the pure and predominant subtypes and the bad outcome of the focal subtype, it seems that TUR may be a good alternative in selected patients with pure our predominant histology, even with infiltrative stages. Oppositely, radical treatment with cystectomy and systemic adjuvant treatment seems to be the best choice for focal subtypes.