Risk scores' performance and their impact on operative decision-making in left-sided endocarditis: a cohort study.

The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91-98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors (> 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.

Metabolic profile in endothelial cells of chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) are two forms of pulmonary hypertension (PH) characterized by obstructive vasculopathy. Endothelial dysfunction along with metabolic changes towards increased glycolysis are important in PAH pathophysiology. Less is known about such abnormalities in endothelial cells (ECs) from CTEPH patients. This study provides a systematic metabolic comparison of ECs derived from CTEPH and PAH patients. Metabolic gene expression was studied using qPCR in cultured CTEPH-EC and PAH-EC. Western blot analyses were done for HK2, LDHA, PDHA1, PDK and G6PD. Basal viability of CTEPH-EC and PAH-EC with the incubation with metabolic inhibitors was measured using colorimetric viability assays. Human pulmonary artery endothelial cells (HPAEC) were used as healthy controls. Whereas PAH-EC showed significant higher mRNA levels of GLUT1, HK2, LDHA, PDHA1 and GLUD1 metabolic enzymes compared to HPAEC, CTEPH-EC did not. Oxidative phosphorylation associated proteins had an increased expression in PAH-EC compared to CTEPH-EC and HPAEC. PAH-EC, CTEPH-EC and HPAEC presented similar HOXD macrovascular gene expression. Metabolic inhibitors showed a dose-dependent reduction in viability in all three groups, predominantly in PAH-EC. A different metabolic profile is present in CTEPH-EC compared to PAH-EC and suggests differences in molecular mechanisms important in the disease pathology and treatment.

Extracellular NK histones promote immune cell anti-tumor activity by inducing cell clusters through binding to CD138 receptor.

BACKGROUND: Natural killer (NK) cells are important anti-tumor cells of our innate immune system. Their anti-cancer activity is mediated through interaction of a wide array of activating and inhibitory receptors with their ligands on tumor cells. After activation, NK cells also secrete a variety of pro-inflammatory molecules that contribute to the final immune response by modulating other innate and adaptive immune cells. In this regard, external proteins from NK cell secretome and the mechanisms by which they mediate these responses are poorly defined. METHODS: TRANS-stable-isotope labeling of amino acids in cell culture (TRANS-SILAC) combined with proteomic was undertaken to identify early materials transferred between cord blood-derived NK cells (CB-NK) and multiple myeloma (MM) cells. Further in vitro and in vivo studies with knock-down of histones and CD138, overexpression of histones and addition of exogenous histones were undertaken to confirm TRANS-SILAC results and to determine functional roles of this material transferred. RESULTS: We describe a novel mechanism by which histones are actively released by NK cells early after contact with MM cells. We show that extracellular histones bind to the heparan sulfate proteoglycan CD138 on the surface of MM cells to promote the creation of immune-tumor cell clusters bringing immune and MM cells into close proximity, and thus facilitating not only NK but also T lymphocyte anti-MM activity. CONCLUSION: This study demonstrates a novel immunoregulatory role of NK cells against MM cells mediated by histones, and an additional role of NK cells modulating T lymphocytes activity that will open up new avenues to design future immunotherapy clinical strategies.

Atrial Fibrillation and Stroke Risk After Coronary Artery Bypass Grafting Surgery.

Background: The present multicentre study was aimed at determining the effect of preoperative atrial fibrillation (preop-AF) as stroke risk factor in coronary artery bypass graft surgery (CABG) during the perioperative period. Methods: Patients undergoing isolated CABG surgery were enrolled from 21 Spanish centers. Baseline variables related with perioperative stroke risk were recorded and analysed. The Northern New England Cardiovascular Disease Study Group (NNECVDSG) stroke risk schema was used to stratify stroke risk and compare predicted vs observed neurologic outcomes in this study. Results: 26347 patients were enrolled in the study. Prevalence of preop-AF was 4.2%, and was associated significantly with major cardiovascular comorbidities. The stroke rate was 1.38% (365 strokes), and it was slightly higher for patients with preop-AF vs non preop-AF, 1.82% vs 1.36%, p = 0.2. NNECVDSG schema showed good predictive ability calculating the area under the receiver operating characteristic curve (c-statistic 0.696; 95% CI 0.668 to 0.723). To investigate the associations of baseline preoperative variables with perioperative CABG-stroke a logistic regression model was performed. Preop-AF impact on perioperative stroke was lower that other variables. Preop-AF did not show an adverse impact in the quartiles groups according to NNECVDSG Stroke Risk Index. Conclusion: Risk of perioperative stroke in isolated CABG surgery patients is not significantly increased by preop-AF.

Long-term outcome of high-urgency heart transplant patients with and without temporary ventricular assist device support.

BACKGROUND: The use of short-term ventricular assist devices (VAD) in patients awaiting high-urgency (HU) heart transplantation (HTx) in Spain has steadily increased due to longer waiting times and the new heart allocation system. It is unknown whether the use of short-term VAD support in patients with cardiogenic shock affects HTx outcome. We sought to investigate long-term outcomes of HU transplanted patients with VAD compared with HU transplanted patients without device support. METHODS: We retrospectively evaluated all HTx patients transplanted between 1999 and 2011 in our institution. Patients were categorized by urgency: elective HTx, HU-HTx with VAD (status 0), and HU-HTx without VAD (status 1). Actuarial survival rates were compared. RESULTS: Of 237 transplanted patients, 55 (23%) were HU-HTx, including 16 on VAD support and 39 without VAD. Mean time in the HU waiting list was 6.5 ± 6 days and mean VAD support was 8.4 ± 8 days (range, 1 to 31 days). Assist devices used were Levitronix Centrimag (6), Abiomed (9), and extracorporeal membrane oxygenation (ECMO) (1). After a mean follow-up of 4.6 ± 4.1 years (range 0 to 13 years), 22 patients had died: 5 VAD and 17 non-VAD. The 1- and 5-year survival rates were 73% and 61% for the VAD and 74% and 62% for the non-VAD group, respectively (P = ns). Kaplan-Meier and Cox regression analyses did not show survival differences, HR 1.11 (95% CI 0.41-3.02), P = 0.84. The presence of renal failure was associated with increased mortality risk, HR 1.9 (95% CI 1.1-3.2), P = 0.02. The presence of renal failure was associated with increased mortality risk [HR 1.9 (95% CI 1.1-3.2), P = .02.). CONCLUSIONS: In our experience, the long-term outcome of patients receiving HU-HTx under short-term VAD support is comparable to that of patients undergoing HU-HTx without VAD support. Patients with renal failure had an increased risk for overall mortality in this set of patients.

Plasma exchange for acute attacks of CNS demyelination: Predictors of improvement at 6 months.

BACKGROUND: Plasma exchange (PE) is used to treat severe episodes of CNS demyelination unresponsive to corticosteroids. Predictors of long-term response are not well known. METHODS: We retrospectively reviewed the medical records of 41 patients consecutively treated by PE between January 1995 and July 2007. The primary outcome was improvement at 6 months after PE defined as decrease of >or=1 point in the Expanded Disability Status Scale (EDSS) score for patients with EDSS or=8.0 or improvement of more than 2 lines in the visual acuity chart for patients with optic neuritis (ON). RESULTS: Twenty-five patients (61%) were women, and the median age was 33 years (range 14-57 years). Twenty-three (56%) had multiple sclerosis, 2 (5%) had clinically isolated syndrome, 2 (5%) had Marburg disease, 7 (17%) had acute disseminated encephalomyelitis, 4 (10%) had neuromyelitis optica, 2 (5%) had idiopathic ON, and 1 (2%) had idiopathic transverse myelitis. The median EDSS score before the attack was 1.0 (range 0-6.5). At PE onset, the median EDSS score was 7.0 (range 3.0-9.5). Sixteen patients (39%) improved at discharge, and 26 (63%) improved at 6 months. In the multivariate analysis, early initiation of PE (odds ratio [OR] 6.29, 95% confidence interval [CI] 1.18-52.96) and improvement at discharge (OR 7.32, 95% CI 1.21-44.38) were significantly associated with response at 6 months. CONCLUSIONS: Plasma exchange (PE) was associated with clinical improvement in 63% of patients at 6 months. Early initiation of PE and improvement at discharge were predictors of this response. Twelve patients (48%) who did not improve early did so during follow-up.

CarboMedics Mitroflow pericardial aortic bioprosthesis - performance in patients aged 60 years and older after 15 years.

BACKGROUND: The purpose of this study was to carry out a current assessment of the Mitroflow pericardial bioprosthesis (model 11) according to the durability of the prosthesis after 15 years in patients aged 60 years or older. METHODS: This bioprosthesis was implanted in 161 patients (mean age 69.5 +/- 6.3 years; range 60 - 94 years) undergoing aortic valve replacement (AVR) between 1982 and 1992. There were 84 patients aged 60 - 69 years (mean 64.5 +/- 3.1years) and 77 patients aged 70 years or older (mean 74.8 +/- 4.3 years). Of the total population, concomitant procedures were performed in 63 patients (39.1 %); of these, coronary artery bypass grafting was performed in 39 (24.2 %). RESULTS: Early mortality was 4.8 % (4 patients) in the 60 - 69 year age group and 10.4 % (8) in patients aged 70 years or older ( P = 0.290). Late mortality was 4.5 %/patient-year (35) for those aged 60 - 69 years and 8.1 %/patient-year (49) for those aged 70 years or older ( P = 0.007). Patient survival at 15 years of patients aged 60 - 69 years was 47.6 +/- 6.3 % and of patients aged 70 years or older was 20.9 +/- 5.4 % ( P = 0.003) ( ). Freedom from valve-related mortality for patients in the 60 - 69 year age group was 92.1 +/- 3.5 % at 15 years (0.6 %/patient-year [5]), and in the patient group aged 70 years or older it was 84.4 +/- 5.3 % (1.3 %/patient-year [8]; P = 0.194). Freedom from reoperation for patients in the 60 - 69 year age group was 73.9 +/- 5.0 % (2.6 %/patient-year [20]), and for patients aged 70 years or older it was 91.4 +/- 3.4 % (1.0 %/patient-year [6]; P = 0.029). The structural valve deterioration (SVD) rate for patients in the 60 - 69 year age group was 2.4 %/patient-year (19), and for patients aged 70 years or older it was 1.0 %/patient-year (6) ( P = 0.041). Actuarial freedom from structural valve deterioration at 15 years for patients aged 60 - 69 years was 62.0 +/- 7.3 %, and 80.8 +/- 7.9 % for patients aged 70 years and older ( P = 0.049) (actual freedom 73.9 +/- 5.2 % and 91.4 +/- 3.4 %, respectively). CONCLUSIONS: The Mitroflow pericardial bioprosthesis can still be recommended for aortic valve replacement in patients 70 years and older.

Telomere length modulates human radiation sensitivity in vitro.

The molecular basis of the interindividual differences of normal individuals to ionizing radiation is poorly understood. Several studies in telomerase KO mice with short telomeres have uncovered an inverse relationship between telomere length and radiation sensitivity. The present work aims to determine if chromosome radiosensitivity is correlated with telomere length in healthy individuals. With this purpose, individual radiosensitivity was determined by the micronucleus assay in peripheral blood lymphocytes from two groups of individuals of the same age but with highly heterogeneous telomere length, selected from a population of 181 individuals where we previously measured telomere length. Our study demonstrates that telomere length modulates chromosome in vitro radiosensitivity in healthy individuals as the group with short telomeres presented higher frequencies of ionizing radiation-induced micronuclei when compared to the long telomeres group. This result supports the conclusion that individual telomere length acts as biomarker of individual chromosome instability upon exposure to ionizing radiation.

Nutritional support and quality of life in stable chronic obstructive pulmonary disease (COPD) patients.

RATIONALE: Nutritional depletion is a common problem in chronic obstructive pulmonary disease (COPD) patients. It is caused, to a large extent, by an imbalance between low-energy intake and high-energy requirements. This problem adversely affects morbidity and mortality. However, the use of nutritional supplements to reach their energy necessities requires optimisation between positive and adverse effects on outcome before being used systematically as part of their comprehensive care. PURPOSE: The aim of our study was to investigate the effects of oral nutritional repletion on quality of life in stable COPD patients. METHODS: Prospective, randomised and multi-centre study. Stable COPD patients with a body mass index 22, a fat-free mass index 16, and/or a recent involuntary weight loss (5% during last month, or 10% during the last 3 months) were studied. Exclusion criteria were to present signs of an airway infection, to have a cardiovascular, neurological, or endocrine disease, to be treated with oral steroids, immunosuppressors or oxygen therapy at home, and to receive nutritional supplements. During 12 weeks, patients were encouraged to ingest a total daily defined energy intake. Randomly, in patients from group A the total daily energy load was Resting Energy Expenditure (REE)x1.7, and those from group B, REE x1.3. Total daily energy intake was achieved with regular food plus, if necessary, oral nutritional supplement rich in proteins (with 50% of whey protein), with predominance of carbohydrates over fat, and enriched in antioxidants. Primary end-point variable was quality of life. Secondary end-point outcomes included body weight, body composition, lung function, handgrip strength, and compliance with the energy intake previously planned. Data were treated with a SAS System. Student's test, Wilcoxon's rank sum test, and Mann-Whitney's test were used. RESULTS: At baseline both groups of patients were comparable. All patients needed oral nutritional supplements to achieve total daily defined energy intake. After 12 weeks of follow-up, patients in both groups significantly increased energy intake. Patients in group A increased body weight (P=0.001), triceps skin fold thickness (P=0.009) and body fat mass (P=0.02), and decreased body fat-free mass index (P=0.02). In this group a marked increase in airflow limitation was observed. A tendency to increase body weight and handgrip strength, and to decrease airflow limitation was observed in patients from group B. Furthermore, patients in the later group showed a significant improvement in the feeling of control over the disease (P=0.007) and a tendency to better the other criteria in a quality of life scale. CONCLUSIONS: According to our results, total daily energy intake of REE x 1.3 is preferable to REE x 1.7 in mild stable COPD patients. The administration of oral nutritional supplements, rich in proteins (with 50% of whey protein), with predominance of carbohydrates over fat, and enriched in antioxidants, to achieve total daily defined energy intake in patients in group B was followed by a significant improvement of one criteria (mastery) among many others in a quality of life scale.

Thrombotic thrombocytopenic purpura and pregnancy: a review of ten cases.

BACKGROUND AND OBJECTIVES: A series of women with pregnancy-associated thrombotic thrombocytopenic purpura, is presented. This study will focus on the relationship between thrombotic thrombocytopenic purpura and pregnancy and on maternal and neonatal outcomes. MATERIALS AND METHODS: Among forty-six consecutive patients with thrombotic thrombocytopenic purpura, nine pregnant patients were identified. RESULTS: Seven patients presented an acute single episode associated with pregnancy and two patients had a chronic relapsing form of the disease. None of these two patients were diagnosed during pregnancy or in the postpartum period. There was one maternal death. Fetal mortality was 33%. CONCLUSIONS: The recurrence is rare in women who had the prior episode related to pregnancy. The risk of death for these patients seems not higher than that of the remaining patients in the series. Preterm delivery and intrauterine fetal death were frequent complications of these pregnancies.

[National Registry of Home Parenteral Nutrition of the year 2001]. / Registro Nacional de la Nutrición Parenteral Domiciliaria (NPD) del año 2001.

AIM: We analyse the registered data of home parenteral nutrition (HPN) in our country during the year 2001. METHOD: The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Seventeen hospitals participated, and 66 patients were enrolled. Middle age was 5.5 +/- 4.9 years for patients < 14 years old, and 49.2 +/- 15.8 years for those > or = 14 years old. The more prevalent diagnosis were: ischemic bowel (28.9%), neoplasm (22.7%), radiation enteritis (12.1%), motility disorders (4.5%) and Crohn's disease (4.5%). The mean time on HPN was 8.4 +/- 4.5 months. Tunnelled catheter was the preferential route (62.1%), followed by the implantated one (33.3%). The intermittent method (nocturnal) was preferential (81.8%). Patients receive the formula, mainly from hospital pharmacy (75.7%). The complications related to nutrition (1.3/patient) included the infections (0.46 sepsis/patient, and 0.19 catheter contamination/patients), mechanic (0.15/patient), metabolic (0.1/patient) and electrolytic disorders (0.07/patient). The readmission rate, for nutritional problems, was 1.34/patient. At the end of the year, 74.2% of the patients remained in the HPN program, and 25.8% abandoned the treatment (due to death: 52.9%, and to progress to oral feeding (25.3%). CONCLUSIONS: This review illustrates that the registration of HPN patients in our country is standing (1.65 patients/10(6) habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of readmission and complications and the behaviour is similar to other series making this as a safe treatment in our place.

[Home Enteral Nutrition: National Registry 2001]. / Nutrición Enteral Domiciliaria (NED): registro nacional 2001.

GOAL: The NADYA-SENPE Working Group analyzed the registered data of patients on Home Enteral Nutrition (HEN) in our country, during year 2001. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were processed and analyzed by the coordinating team. RESULTS: Twenty two hospitals participated and 3,458 patients, aged 5.6 +/- 4.0 y for those younger than 14 y, and 67.1 +/- 19.5 y for those older than 14 y, were enrolled. Of these patients, 43.4% were diagnosed with neurological diseases and 33.5% with cancer. The mean time on HEN was 6.5 +/- 4.5 months. Oral nutrition was the preferential route (54.5%), followed by nasoenteral tube (32.3%), and in 13.3% ostomy tubes were placed. Polymeric was the formula composition mainly used (85.9%). Patients were followed (71.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included mainly the gastrointestinal (0.16 complications/patient), and the mechanical one (0.15 complications/patient). At the end for the year, 48.3% of the patients were in the HEN program, and in 33.3% HEN was finish due to different reasons. In 22.9% of the patients no, o light, discapacity degree was found. CONCLUSIONS: Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients, as previous years, were feed with ostomy tube. Due to the few complications observed, HEN is a safe treatment in our country.

Registro Nacional de la Nutrición Parenteral Domiciliaria (NPD) del año 2001 / Registered data of home parenteral nutrition (HPN) in our country during the year 2001

Objetivo: El objetivo de este estudio es analizar los datos registrados por el Grupo de Trabajo NADYA-SENPE de pacientes que han recibido Nutrición Parenteral Domiciliaria (NPD) en nuestro país durante el año 2001. Material y métodos: A partir de un cuestionario previamente diseñado, los médicos del grupo NADYA introducen en la página web (www.nadya-senpe.com), para su ulterior análisis, datos epidemiológicos, diagnóstico, vía de acceso, complicaciones, ingresos hospitalarios, duración del tratamiento, evolución y calidad de vida de los pacientes con NPD. Resultados: Los datos correspondían a 66 pacientes (edad media de 5,5 ñ 4,9 años para pacientes < 14 años y 49,2 ñ 15,8 años para 14 años) controlados por 17 centros hospitalarios. Las patologías que con más frecuencia han comportado este tratamiento fueron: isquemia mesentérica (28,9 por ciento), seguida de enfermedad neoplásica (22,7 por ciento), enteritis rádica (12,13 por ciento), alteraciones de la motilidad (4,5 por ciento) y enfermedad de Crohn (4,5 por ciento), entre otras. Se observó un predominio de los catéteres tunelizados (62,1 por ciento) sobre los implantados (33,3 por ciento) y de la administración cíclica (nocturna) de la nutrición parenteral (NP) (81,8 por ciento). Las farmacias hospitalarias suministraron las fórmulas de NPD con más frecuencia que el Nutriservice (75,7 por ciento versus 24,3 por ciento). La duración media del tratamiento fue de 8,43 ñ 4,52 meses. Se presentaron 86 complicaciones relacionadas con el tratamiento nutritivo (1,3 / paciente), con predominio de las infecciosas (0,67 / paciente) (sepsis: 0,46 / paciente y contaminación de catéter: 0,19 / paciente), seguidas de las mecánicas (0,15 / paciente), de las metabólicas (0,1 / paciente) y de las hidroelectrolíticas (0,07 / paciente). Estas complicaciones comportaron 1,34 hospitalizaciones / paciente. Al finalizar el año, seguían en activo 74,2 por ciento de los pacientes; mientras que en el resto (25,8 por ciento) se había retirado este tratamiento. Las principales causas de retirada fueron por éxitus (52,9 por ciento) y por pasar a depender de dieta oral (25,3 por ciento). El 10,6 por ciento estaban confinados en silla o cama y el 10,6 por ciento no presentaba ningún grado de incapacidad. Conclusiones: Aunque inferior a otros países europeos, se mantiene el número de pacientes con NPD registrados en nuestro país (1,65 pacientes / 106 habitantes). Si bien predomina la patología vascular, sigue creciendo el peso de las neoplasias. Predominio de las complicaciones infecciosas que generan la mayoría de los ingresos hospitalarios (AU)

Aim: We analyse the registered data of home parenteral nutrition (HPN) in our country during the year 2001. Method: The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. Results: Seventeen hospitals participated, and 66 patients were enrolled. Middle age was 5.5 ± 4.9 years for patients < 14 years old, and 49,2 ± 15.8 years for those ≥ 14 years old. The more prevalent diagnosis were: ischemic bowel (28.9%), neoplasm (22.7%), radiation enteritis (12.1%), motility disorders (4.5%) and Crohn's disease (4.5%). The mean time on HPN was 8.4 ± 4.5 months. Tunnelled catheter was the preferential route (62.1%), followed by the implantated one (33.3%). The intermittent method (nocturnal) was preferential (81.8%). Patients receive the formula, mainly from hospital pharmacy (75.7%). The complications related to nutrition (1.3/patient) included the infections (0.46 sepsis/patient, and 0,19 catheter contamination/patients), mechanic (0.15/patient), metabolic (0.1/patient) and electrolytic disorders (0.07/patient). The readmission rate, for nutritional problems, was 1.34/patient. At the end of the year, 74.2% of the patients remained in the HPN program, and 25.8% abandoned the treatment (due to death: 52.9%, and to progress to oral feeding (25.3%). Conclusions: This review illustrates that the registration of HPN patients in our country is standing (1.65 patients/106 habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of re-admission and complications and the behaviour is similar to other series making this as a safe treatment in our place (AU)

Nutrición enteral domiciliaria (NED): registro nacional 2001 / Home enteral nutrition (HEN) in our country, during the year 2001

Introducción y objetivos: Análisis del registro de los pacientes en programa de Nutrición Enteral Domiciliaria (NED) en nuestro país durante el año 2001. Material y métodos: Estudio analítico realizado mediante una base de datos incluida en la web del Grupo NADYA (www.nadya-senpe.com) con los pacientes en NED el año 2001. Han participado 22 hospitales. Se aportan datos epidemiológicos, diagnósticos, vía de acceso, pautas de administración, fórmulas, duración, complicaciones, evolución y grado de incapacidad. Resultados: Incidencia: Se han comunicado 3.458 pacientes, 1.818 varones (53,7 por ciento) y 1.567 hembras (46,3 por ciento). Edad media 5,6 ñ 4,0 años en los menores de 14 años, y 67,1 ñ 19,5 en los mayores de 14 años. Patologías: Predominio de la patología neurológica (43,4 por ciento), seguida de la neoplásica (33,5 por ciento) sobre las demás. Duración: Tiempo medio en NED de 6,5 ñ 4,5 meses. Vías de administración: La vía oral es la más frecuente (54,5 por ciento), seguida de la sonda naso gástrica (SNG) (32,2 por ciento) y de las ostomías (13,3 por ciento). Formas de administración: Predominio de la forma discontinua (66,1 por ciento), mediante goteo (43,4 por ciento) o bolus (22,7 por ciento). Fórmula: La fórmula polimérica fue la más utilizada (85,9 por ciento). Seguimiento: Los pacientes fueron mayoritariamente controlados por la unidad de nutrición de su hospital de referencia (69,3 por ciento). Hospitalizaciones: Se han registrado 7,3 por ciento hospitalizaciones asociadas a la nutrición [0,02 hospitalizaciones / paciente (c / p)]. Complicaciones: Las más frecuentes relacionadas con la nutrición fueron las gastrointestinales (25,9 por ciento; 0,16 c / p) y las mecánicas (24,2 por ciento, 0,15 c / p). Las diarreas han sido las complicaciones gastrointestinales más frecuentes (11,5 por ciento, 0,07 c / p). Evolución: Al finalizar el año el 48,3 por ciento de los pacientes continuaban en activo, mientras que en un 33,3 por ciento se suspendió la NE y en 18,4 por ciento no hubo continuidad de seguimiento. La causa más común de suspensión fue el paso a nutrición oral convencional (47,3 por ciento), seguido de la muerte relacionada con la enfermedad de base (43,5 por ciento). Un 29,7 por ciento de los pacientes estaban confinados en cama o silla, mientras que un 22,9 por ciento no presentaba prácticamente ningún grado de incapacidad. Conclusiones: Persiste la vía de administración oral como la más prevalente frente a la sonda y ostomía. Predominio de la patología neurológica. El bajo número de complicaciones e ingresos comportan que la NED sea un tratamiento seguro en nuestro medio (AU)

Goal: The NADYA-SENPE Working Group analyzed the registered data of patients on Home Enteral Nutrition (HEN) in our country, during year 2001. Material and methods: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and read-mission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were precessed and analyzed by the coordinating team. Results: Twenty two hospitals participated and 3,458 patients, aged 5.6 ± 4.0 y for those younger than 14 y, and 67.1 ± 19.5 y for those older than 14 y, were enrolled. Of these patients, 43.4% were diagnosed with neurological diseases and 33.5% with cancer. The mean time on HEN was 6.5 ± 4.5 months. Oral nutrition was the preferential route (54.5%), followed by nasoenteral tube (32.3%), and in 13.3% ostomy tubes were placed. Polymeric was the formula composition mainly used(85.9%). Patients were followed (71.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included mainly the gastrointestinal (0.16 complications/patient), and the mechanical one (0.15 complications/patient). At the end for the year, 48.3% of the patients were in the HEN program, and in 33.3% HEN was finish due to different reasons. In 22.9% of the patients no, o light, discapacity degree was found. Conclusions: Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients, as previous years, were feed with ostomy tube. Due to the few complications observed, HEN is a safe treatment in our country (AU)

Cryopreservation alters antigenicity of allografts in a porcine model of transplant vasculopathy.

UNLABELLED: The need for arterial grafts in coronary surgery to complement autologous vessels has generated interest in cryopreservation of small diameter allografts. We evaluated functional and histologic changes occurring in cryopreserved allografts 3 months after porcine femoral artery transplants. METHODS: Twenty recipient and 15 donor pigs included a control group of 16 fresh and 12 cryopreserved nonimplant arteries were used. Fresh (n=5) and cryopreserved (n=5) autografts were implanted to assess cryopreservation effects in the absence of rejection. Fresh allografts with or without treatment with cyclosporine (CsA) (n=6 of 8) and cryopreserved allografts with or without treatment with CsA (n=6 of 10) were performed to study the antigenicity of cryopreserved allografts. Arteries were stained with hematoxylin and eosin, Masson's trichrome, and orcein for morphometric analyses and immunostained to identify endothelial cells, smooth muscle cells, T lymphocytes, and macrophages. RESULTS: Among nonimplant arteries, cryopreservation reduced alpha-actin expression and increased the luminal area. All implanted autografts were patent. Cryopreserved autografts showed reduced alpha-actin expression and developed intimal hyperplasia compared to fresh autografts. Treatment with CsA improved the patency of fresh allografts from 0% to 83% (P <.01) and of cryopreserved allografts from 40% to 100% (P <.05). Cryopreserved allografts showed substantial intimal hyperplasia, and fresh allografts had more T lymphocyte infiltration in the intimal layer with aneurysmal dilatation. CONCLUSIONS: Cryopreservation reduces the deposition of inflammatory cells and prevents the thrombosis or aneurysmal lesions observed in fresh allografts. Therefore, cryopreservation modifies the antigenicity of vascular allografts.

[Parenteral nutrition at home: NADYA register for the year 2000]. / Nutrición parenteral domiciliaria (NPD): registro NADYA. Año 2000.

AIM: We analyze the registered data of home parenteral nutrition (HPN) in our country during the year 2000. METHOD: The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Fourteen hospitals participated, and 67 patients were enrolled. Middle age was 5 +/- 4 years for patients < 14 years old, and 48 +/- 15 years for those > or = 14 years old. The more prevalent diagnosis were: ischemic bowel (28.4%), neoplasm (16.4%), radiation enteritis (13.4%), motility disorders (7.5%), Crohn's disease (2.9%), and other. The mean time on HPN was 7.5 +/- 4.4 months. Tunelized catheter was the preferential route (77.6%), followed by the implantated one (20.9%). The intermittent method (nocturnal) was preferential (91.0%). Patients receive the formula from hospital pharmacy more frequently than from Nutriservice (71.5% versus 19.4%). The complications related to nutrition (0.32/100 days of HPN) included the infections (0.12 catheter sepsis/100 d of HPN), metabolic (0.06/100 d of HPN), mechanic (0.03/100 d of HPN) and electrolitic disorders (0.03/100 d of HPN). The readmission rate, for nutritional problems, was 0.3 hospitalizations/100 d of HPN. At the end of the year, 61.2% of the patients remained in the HPN program, 37.3% abandoned the treatment (due to death (40%), to progress to oral feeding (48%), and to progress to enteral nutrition (4%); and 1.5% of the patients were not follow up. CONCLUSIONS: This review illustrates that there is an increment in the registration of HPN patients in our country (1997: 0.7 patients/10(6) habitants, 2000: 1.9 patients/10(6) habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of readmission and complications and the behaviour is similar to other series making this as a safe treatment in our place.

[Enteral nutrition at home: National register for the year 2000]. / Nutrición enteral domiciliaria (NED): Registro Nacional del año 2000.

GOAL: Once again, the NADYA-SENPE Working Group analysed the registered data of Home Enteral Nutrition (HEN) in our country, during the year 2000. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Twenty two hospital participated and 2,986 patients, aged 65.1 +/- 19.7 years, were enrolled. Of these patients, 41.2% were diagnosed with neurological diseases and 33.3% with cancer. The mean time on HEN was 6.3 +/- 4.4 months. Oral nutrition was the preferential route (50.8%), followed by nasoenteral tube (30.5%), and in 17.4% ostomy tubes were placed. Polymeric was the formula composition mainly used (83.2%). Patients were followed (70.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included the gastrointestinal (0.25 complications/patient), the mechanical one (0.19 complications/patient), and the metabolic (0.007 complications/patient). Feeding tube need to be replaced 0.3 times/patient/year. The readmission rate, for nutritional problems, was observed in 0.03 patients. At the end of the year, 54.9% of the patients were in the HEN program, and in 30.3% HEN was finish due to different reasons. In 21.9% of the patients no, o light, discapacity degree was found. CONCLUSIONS: Related to previous years, there is an increment in the number of enrolled patients. Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients were feed with ostomy tube. Finally, due to the few readmission rate and complications, HEN is a safe treatment in our country.

Nutrición parenteral domiciliaria (NPD): registro NADYA. Año 2000 / Parenteral nutrition at home: NADYA register for 2000

Objetivo: Análisis descriptivo y valoración de los datos registrados por el Grupo de Trabajo NADYA-SENPE de pacientes que han recibido nutrición parenteral domiciliaria (NPD) en nuestro país durante el año 2000.Material y métodos: Se han recopilado datos (epidemiológicos, diagnóstico, vía de acceso, complicaciones, reingresos hospitalarios, duración del tratamiento y evolución) a partir de un cuestionario previamente diseñado para ello. Los datos obtenidos del cuestionario se introdujeron en una base de datos para la ulterior gestión de los mismos. Resultados: Los datos correspondían a 67 pacientes (edad media de 5 ñ 4 años para pacientes < 14 años y 48 ñ 15 años para 14 años) controlados por 14 centros hospitalarios. Las patologías que con más frecuencia han comportado este tratamiento fueron: isquemia mesentérica (28,4 per cent), seguida de enfermedad neoplásica (16,4 per cent), enteritis rádica (13,4 per cent), alteraciones de la motilidad (7,5 per cent) y enfermedad de Crohn (2,9 per cent), entre otras. Se observó un predominio de los catéteres tunelizados (77,6 per cent) sobre los implantados (20,9 per cent), y de la administración cíclica (nocturna) de la nutrición parenteral (NP) (91,0 per cent). Las farmacias hospitalarias suministraron las fórmulas de NPD con más frecuencia que el Nutriservice (71,5 per cent frente a 19,4 per cent).La duración media del tratamiento fue de 7,48 ñ 4,39 meses. Se presentaron 0,32 complicaciones/100 días de NPD relacionadas con el tratamiento nutritivo con predominio de las infecciosas (0,12 sepsis por catéter/100 d de NPD), seguidas de las metabólicas (0,06/100 d de NPD), y de las mecánicas (0,03/100 d de NPD) e hidroelectrolíticas (0,03/100 días de NPD). Estas complicaciones comportaron 0,3 hospitalizaciones/100 días de NPD. Al finalizar el año, seguían en activo 61,2 per cent de los pacientes; 37,3 per cent habían abandonado el tratamiento (exitus 40 per cent, nutrición oral 48 per cent y nutrición enteral 4 per cent), y 1,5 per cent pacientes habían dejado de ser controlados por el equipo inicialmente responsable. Conclusiones: Podemos concluir que existe un incremento del registro de la NPD en nuestro país (1997: 0,7 pacientes/106 habitantes, 2000: 1,9 pacientes/106 habitantes), que hay un predominio de patología vascular y que la incidencia de complicaciones, retirada del tratamiento e ingresos hospitalarios son semejantes a otras series lo que avala la calidad del tratamiento (AU)

Aim: We analyze the registered data of home parenteral nutrition (HPN) in our country during the year 2000. Method: The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. Results: Fourten hospitals participated, and 67 pacientes were enrolled. Middle age was 5 ± 4 years for patients < 14 years old, and 48 ± 15 years for those ≥ 14 years old. The more prevalent diagnosis were: ischemic bowel (28.4%), neoplasm (16.4%), radiation enteritis (13.4%), motility disorders (7.5%), Crohn’s disease (2.9%), and other. The mean time on HPN was 7.5 ± 4.4 months. Tunelized catheter was the preferential route (77.6%), followed by the implantated one (20.9%). The intermittent method (nocturnal) was preferential (91.0%). Patients receive the formula from hospital pharmacy more frequently than from Nutriservice (71.5% versus 19.4%). The complications related to nutrition (0.32/100 days of HPN) included the infections (0,12 catheter sepsis/100 d of HPN), metabolic (0.06/100 d of HPN), mechanic (0.03/100 d of HPN) and electrolitic disorders (0.03/100 d of HPN). The readmission rate, for nutritional problems, was 0,3 hospitalizations /100 d of HPN. At the end of the year, 61.2% of the patients remained in the HPN program, 37.3% abandoned the treatment (due to death (40%), to progress to oral feeding (48%), and to progress to enteral nutrition (4%); and 1.5% of the patients were not follow up. Conclusions: This review illustrates that there is an increment in the registration of HPN patients in our country (1997: 0.7 pacients/106habitants, 2000: 1.9 pacients/ 106 habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of readmission and complications and the behaviour is similar to other series making this as a safe treatment in our place (AU)