Biomarkers of Early Liver Graft Damage in Circulatory Death and Brain Death Donors: A Propensity Score Matching Analysis.

BACKGROUND: Donation after circulatory death (DCD) is related to a warm ischemia time and more complications compared with traditional donors (donation after brain death [DBD]). METHODS: This study included biopsy samples retrospectively collected from November 2014 to December 2018 to compare histologic and biological markers of DCD and DBD liver grafts. The analysis includes marker of early apoptosis (p21), senescence (telomerase reverse transcriptase [TERT]), cell damage (caspase-3 active), endothelial damage (vascular endothelial growth factor), stem cell (CD90), hypoxia (HIF1A), inflammatory activation (COX-2), and cross-organ allograft rejection (CD44). A propensity score matching (PSM) was used to match patients receiving DCD livers to those receiving DBD livers. We analyzed the immunohistochemical initial liver damage-related warm ischemia time. RESULTS: Positive staining expression of liver damage biomarkers (COX-2, CD44, TERT, HIF1A, and CD90) was found, but no significant differences were found between DCD and DBD and with ischemic cholangiopathy. After PSM, there was a significant relationship between CD90 and male donors (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.07-0.91), TERT with donor sodium (OR, 1.11; 95% CI, 1.02-1.2), HIF1A with steatosis (OR, 0.33; 95% CI, 0.13-0.83), and CD44 with donor vasoactive drugs (OR, 0.36; 95% CI, 0.13-1) and glutamic oxaloacetic transaminase 1 week increase (OR, 1.01; 95% CI, 1-1.03). CONCLUSIONS: DCD immunohistochemical initial liver damage was found to behave similarly to DBD. The increase in complications and cholangiopathy associated with warm ischemia could be related to a different later phenomenon.

Wheezing Sound Separation Based on Informed Inter-Segment Non-Negative Matrix Partial Co-Factorization.

Wheezing reveals important cues that can be useful in alerting about respiratory disorders, such as Chronic Obstructive Pulmonary Disease. Early detection of wheezing through auscultation will allow the physician to be aware of the existence of the respiratory disorder in its early stage, thus minimizing the damage the disorder can cause to the subject, especially in low-income and middle-income countries. The proposed method presents an extended version of Non-negative Matrix Partial Co-Factorization (NMPCF) that eliminates most of the acoustic interference caused by normal respiratory sounds while preserving the wheezing content needed by the physician to make a reliable diagnosis of the subject's airway status. This extension, called Informed Inter-Segment NMPCF (IIS-NMPCF), attempts to overcome the drawback of the conventional NMPCF that treats all segments of the spectrogram equally, adding greater importance for signal reconstruction of repetitive sound events to those segments where wheezing sounds have not been detected. Specifically, IIS-NMPCF is based on a bases sharing process in which inter-segment information, informed by a wheezing detection system, is incorporated into the factorization to reconstruct a more accurate modelling of normal respiratory sounds. Results demonstrate the significant improvement obtained in the wheezing sound quality by IIS-NMPCF compared to the conventional NMPCF for all the Signal-to-Noise Ratio (SNR) scenarios evaluated, specifically, an SDR, SIR and SAR improvement equals 5.8 dB, 4.9 dB and 7.5 dB evaluating a noisy scenario with SNR = -5 dB.

Diferencias entre el control clínico y ambulatorio de la hipertensión arterial en pacientes muy ancianos. Proyecto CARDIORISC–MAPAPRES / Differences between office and ambulatory control of hypertension in very elderly patients. The CARDIORISC – MAPAPRES project

Fundamento y objetivos: La hipertensión arterial (HTA) afecta a la mayoría de la población muy anciana. El objetivo de este estudio fue estimar el grado de control de la HTA según se registre la presión arterial (PA) en la consulta o por monitorización ambulatoria de PA (MAPA). Pacientes y método: Estudio transversal y multicéntrico sobre pacientes hipertensos de 80 o más años de edad con tratamiento farmacológico antihipertensivo incluidos en el proyecto CARDIORISC–MAPAPRES. Entre junio de 2004 y abril de 2007 se obtuvo una base de datos de 33.829 registros de MAPA que cumplieron estándares de calidad preestablecidos. Se definió como buen control clínico a valores de PA menores de 140/90mmHg, y como buen control ambulatorio a valores de PA por MAPA en período de 24h menores de 130/80mmHg.Resultados: Se identificaron 2.311 pacientes (6,8%) de 80 o más años de edad. La edad media fue de 83,1 años (DE de 3,2) y un 63% fueron mujeres. El 21,5% (intervalo de confianza [IC] del 95%: 19,1–23,9) presentó buen control clínico y un 42,1% (IC del 95%: 39,7–45,3) presentó buen control ambulatorio (p<0,001). La prevalencia de HTA enmascarada fue del 7,0% (IC del 95%: 6,0–8,0) y la prevalencia de resistencia aislada en la clínica fue del 27,6% (IC del 95%: 25,7–29,4). La diabetes, la enfermedad renal crónica y la duración de la HTA fueron los factores más asociados al mal control de la HTA (p<0,001) en la MAPA de 24h.Conclusiones: Sólo 2 de cada 10 pacientes muy ancianos hipertensos tuvieron controlada adecuadamente su HTA por medida casual. Sin embargo, prácticamente el doble estaban controlados con el criterio de la MAPA. Estos hallazgos justifican un uso más amplio de la MAPA en el paciente hipertenso de edad muy avanzada (AU)

Background and objective: Hypertension is highly prevalent in the very elderly. We studied control rates of hypertension according to clinic blood pressure (BP) and ambulatory BP monitoring (ABPM) in treated hypertensives aged ≥80 years.Patients and method: Data came from the Spanish Society of Hypertension ABPM Registry (CARDIORISC – MAPAPRES project), which comprises a nation-wide network of more than 1,000 physicians sending standardized ABPM registries via web. Between June 2004 and April 2007 we obtained a 33.829-patient database. Control of hypertension was defined at the clinic when office BP was <140/90mmHg and at the ABPM when mean BP during the 24-h period was <130/80mmHg.Results: We identified 2,311 patients (6.8%) aged ≥80 years. Mean age (SD) was 83.1 (3.2) years and 63% were women. Control of clinic BP was observed in 21.5% of cases (95%CI: 19.1–23.9) and control of 24-h BP in ABPM was 42.1% (95%CI: 39.7–45.3). Prevalence of masked hypertension was 7.0% (95%CI: 6.0–8.0) and prevalence of office-resistant control (white coat) was 27.6% (95% CI: 25.7–29.4). Diabetes, kidney disease, and duration of hypertension were associated with lack of control in ABPM. Conclusions: In very old hypertensives, control of clinic BP was 21.5% but ambulatory-based hypertension control was 42.1%. Physicians should be aware that the likelihood of misestimating BP control is high in these subjects. A wider use of ABPM in the elderly with hypertension should be considered (AU)