Edad retiniana como biomarcador predictivo del grado de retinopatía diabética / Retinal age as a predictive biomarker of the diabetic retinopathy grade

Objetivo Aplicar técnicas de inteligencia artificial, mediante algoritmos de aprendizaje profundo, para el desarrollo y optimización de un sistema de predicción de la edad de una persona con base en una retinografía color, y estudiar una posible relación entre la evolución de la retinopatía diabética (RD) y un envejecimiento prematuro de la retina. Métodos Se entrenó una red convolucional para calcular la edad de una persona con base en una retinografía. Dicho entrenamiento fue realizado sobre un conjunto de retinografías de pacientes con diabetes previamente dividido en 3 subconjuntos (entrenamiento, validación y test). La diferencia entre la edad cronológica del paciente y la edad biológica de la retina se definió como gap de edad retiniano. Resultados Se utilizó un conjunto de 98.400 imágenes para la fase de entrenamiento, 1.000 imágenes para la fase de validación y 13.544 para la fase de test. El gap retiniano de los pacientes sin RD fue de 0,609 años y el de los pacientes con RD de 1,905 años (p<0,001), siendo la distribución por grado de RD de: RD leve 1,541 años; RD moderada 3,017 años; RD severa 3,117 años, y RD proliferativa 8,583 años. Conclusiones El gap de edad retiniano muestra una diferencia en positivo de media entre las personas diabéticas con RD frente a las que no tienen RD, y además aumenta progresivamente, de acuerdo con el grado de RD. Estos resultados podrían indicar la existencia de una relación entre la evolución de la enfermedad y un envejecimiento prematuro de la retina (AU)

Objective To apply artificial intelligence techniques, through deep learning algorithms, for the development and optimization of a system for predicting the age of a person based on a color retinography, and to study a possible relationship between the evolution of retinopathy diabetes (RD) and premature aging of the retina. Methods A convolutional network was trained to calculate the age of a person based on a retinography. Said training was carried out on a set of retinographies of patients with diabetes previously divided into 3 subsets (training, validation and test). The difference between the chronological age of the patient and the biological age of the retina was defined as the retinal age gap. Results A set of 98,400 images was used for the training phase, 1000 images for the validation phase and 13,544 for the test phase. The retinal gap of the patients without RD was 0.609 years and that of the patients with RD was 1905 years (p<0.001), with the distribution by degree of RD being: mild RD 1541 years; moderate RD 3017 years; RD severe 3117 years, and proliferative RD 8583 years. Conclusions The retinal age gap shows a positive mean difference between diabetics with RD versus those without RD, and it increases progressively, according to the degree of RD. These results could indicate the existence of a relationship between the evolution of the disease and premature aging of the retina (AU)

Retinal age as a predictive biomarker of the diabetic retinopathy grade.

OBJECTIVE: To apply artificial intelligence (AI) techniques, through deep learning algorithms, for the development and optimization of a system for predicting the age of a person based on a color retinography and to study a possible relationship between the evolution of retinopathy diabetes and premature ageing of the retina. METHODS: A convolutional network was trained to calculate the age of a person based on a retinography. Said training was carried out on a set of retinographies of patients with diabetes previously divided into three subsets (training, validation and test). The difference between the chronological age of the patient and the biological age of the retina was defined as the retinal age gap. RESULTS: A set of 98,400 images was used for the training phase, 1000 images for the validation phase and 13,544 for the test phase. The retinal gap of the patients without DR was 0.609 years and that of the patients with DR was 1905 years (p < 0.001), with the distribution by degree of DR being: mild DR: 1541 years, moderate DR: 3017 years, DR severe: 3117 years and proliferative DR: 8583 years. CONCLUSIONS: The retinal age gap shows a positive mean difference between diabetics with DR versus those without DR, and it increases progressively, according to the degree of DR. These results could indicate the existence of a relationship between the evolution of the disease and premature ageing of the retina.

Salt marsh fragmentation in a mesotidal estuary: Implications for medium to long-term management.

During the last decades many salt marshes worldwide have suffered important losses in their extent and associated ecosystem services. The salt marshes of San Vicente de la Barquera estuary (N Spain) are a clear example of this, with a drastic reduction in vegetation surface over the last 60 years. This paper provides insights into the main factors controlling salt marsh functioning in sheltered estuarine areas. Regional and local factors have been disaggregated to identify the main drivers controlling the functioning of the salt marsh to develop appropriate management measures according to the evolution of the system. These factors have been studied in their spatial context through detailed maps of change in vegetation cover combined with topographic data obtained from UAV and RTK-DGPS surveys. The results demonstrate that in this estuary the salt marsh area is declining following a fragmentation process. No clear pattern of vegetation loss/gain with elevation has been identified. However, the results point to increased hydrodynamic stress in the area, with stronger currents inside the estuary. This is probably the major factor responsible for the decline of the salt marshes in the San Vicente de la Barquera estuary. Furthermore, several human interventions during the 20th century (local drivers) have also probably contributed to a lower resilience against SLR (regional driver). This work demonstrates that both natural and human drivers of change need to be considered when characterizing the evolution of salt marshes, wherever efficient management strategies need to be designed.

The morphometric acclimation to depth explains the long-term resilience of the seagrass Cymodocea nodosa in a shallow tidal lagoon.

Cadiz Bay is a shallow mesotidal lagoon with extensive populations of the seagrass Cymodocea nodosa at intertidal and shallow subtidal elevations. This work aims to understand the mechanisms behind the resilience of this species to gradual sea level rise by studying its acclimation capacity to depth along the shallow littoral, and therefore, to gradual variations in the light environment. To address this objective, these populations have been monitored seasonally over a 10 year period, representing the longest seasonal database available in the literature for this species. The monitoring included populations at 0.4, -0.08 and -0.5 m LAT. The results show that C. nodosa has a strong seasonality for demographic and shoot dynamic properties - with longer shoots and larger growth in summer (high temperature) than in winter (low temperature), but also some losses. Moreover, shoots have different leaf morphometry depending on depth, with small and dense shoots in the intertidal areas (0.4 m) and sparse large shoots in the subtidal ones (-0.08 and 0.5 m). These differences in morphometry and shoot dynamic properties, combined with the differences in shoot density, explain the lack of differences in meadow production balance (i.e. meadow growth - meadow losses) between the intertidal (0.4 m) and the deepest population (-0.5 m), supporting the long term resilience of Cymodocea nodosa in Cadiz Bay. This study contributes to the understanding of the mechanisms behind seagrass stability and resilience, which is particularly important towards predicting the effects of climate change on these key coastal ecosystems, and also highlights the value of continuous long-term monitoring efforts to evaluate seagrass trajectories.

Postbiotics produced at laboratory and industrial level as potential functional food ingredients with the capacity to protect mice against Salmonella infection.

AIM: To determine the protective capacity against Salmonella infection in mice of the cell-free fraction (postbiotic) of fermented milk, produced at laboratory and industrial level. METHODS AND RESULTS: The proteolytic activity (PA) of 5 commercial cultures and 11 autochthonous Lactobacillus strains was evaluated. The DSM-100H culture displayed the highest PA and it was selected for further studies. The capacity of the postbiotics produced by pH-controlled fermentation to stimulate the production of secretory IgA in faeces and to protect mice against Salmonella infection was evaluated. A significant increase in secretory IgA in faeces of mice fed 14 days the postbiotic obtained at the laboratory (F36) was detected compared to control animals. A significantly higher survival was observed in mice fed the F36 and the FiSD (industrial product) compared to controls. CONCLUSION: The postbiotics obtained showed immunomodulatory and protective capacity against Salmonella infection in mice. SIGNIFICANCE AND IMPACT OF THE STUDY: The pH-controlled milk fermentation by the proteolytic DSM-100H culture could be a suitable strategy to obtain a food ingredient to be added to a given food matrix, not adequate to host viable cells of probiotics, to confer it enhanced functionality and thus expand the functional food market.

Pollen limitation may be a common Allee effect in marine hydrophilous plants: implications for decline and recovery in seagrasses.

Pollen limitation may be an important factor in accelerated decline of sparse or fragmented populations. Little is known whether hydrophilous plants (pollen transport by water) suffer from an Allee effect due to pollen limitation or not. Hydrophilous pollination is a typical trait of marine angiosperms or seagrasses. Although seagrass flowers usually have high pollen production, floral densities are highly variable. We evaluated pollen limitation for intertidal populations of the seagrass Zostera noltei in The Netherlands and found a significant positive relation between flowering spathe density and fruit-set, which was suboptimal at <1200 flowering spathes m(-2) (corresponding to <600 reproductive shoots m(-2)). A fragmented population had ≈35 % lower fruit-set at similar reproductive density than a continuous population. 75 % of all European populations studied over a large latitudinal gradient had flowering spathe densities below that required for optimal fruit-set, particularly in Southern countries. Literature review of the reproductive output of hydrophilous pollinated plants revealed that seed- or fruit-set of marine hydrophilous plants is generally low, as compared to hydrophilous freshwater and wind-pollinated plants. We conclude that pollen limitation as found in Z. noltei may be a common Allee effect for seagrasses, potentially accelerating decline and impairing recovery even after environmental conditions have improved substantially.

Growth, survival, and peptidolytic activity of Lactobacillus plantarum I91 in a hard-cheese model.

In this work, we studied the growth, survival, and peptidolytic activity of Lactobacillus plantarum I91 in a hard-cheese model consisting of a sterile extract of Reggianito cheese. To assess the influence of the primary starter and initial proteolysis level on these parameters, we prepared the extracts with cheeses that were produced using 2 different starter strains of Lactobacillus helveticus 138 or 209 (Lh138 or Lh209) at 3 ripening times: 3, 90, and 180 d. The experimental extracts were inoculated with Lb. plantarum I91; the control extracts were not inoculated and the blank extracts were heat-treated to inactivate enzymes and were not inoculated. All extracts were incubated at 34°C for 21 d, and then the pH, microbiological counts, and proteolysis profiles were determined. The basal proteolysis profiles in the extracts of young cheeses made with either strain tested were similar, but many differences between the proteolysis profiles of the extracts of the Lh138 and Lh209 cheeses were found when riper cheeses were used. The pH values in the blank and control extracts did not change, and no microbial growth was detected. In contrast, the pH value in experimental extracts decreased, and this decrease was more pronounced in extracts obtained from either of the young cheeses and from the Lh209 cheese at any stage of ripening. Lactobacillus plantarum I91 grew up to 8 log during the first days of incubation in all of the extracts, but then the number of viable cells decreased, the extent of which depended on the starter strain and the age of the cheese used for the extract. The decrease in the counts of Lb. plantarum I91 was observed mainly in the extracts in which the pH had diminished the most. In addition, the extracts that best supported the viability of Lb. plantarum I91 during incubation had the highest free amino acids content. The effect of Lb. plantarum I91 on the proteolysis profile of the extracts was marginal. Significant changes in the content of free amino acids suggested that the catabolism of free amino acids by Lb. plantarum I91 prevailed in a weakly proteolyzed medium, whereas the release of amino acids due to peptidolysis overcame their catabolism in a medium with high levels of free amino acids. Lactobacillus plantarum I91 was able to use energy sources other than lactose to support its growth because equivalent numbers of cells were observed in extracts containing residual amounts of lactose and in lactose-depleted extracts. The contribution of Lb. plantarum I91 to hard-cooked cheese peptidolysis was negligible compared with that of the starter strain; however, its ability to transform amino acids is a promising feature of this strain.

Effects of intertidal seagrass habitat fragmentation on turbulent diffusion and retention time of solutes.

An in-depth knowledge of solutes advection and turbulent diffusion is crucial to estimate dispersion area and retention time (t(R)) of pollutants within seagrass habitats. However, there is little knowledge on the influence of seagrass habitat fragmentation on such mechanisms. A set of dye tracer experiments and acoustic Doppler velocimeter measurements (ADV) were conducted. Solute transport conditions were compared in between fragmented (FM) vs homogeneous (HM) intertidal meadows, and in vertical gradients (canopy vs overlaying flow). Results showed the highest horizontal diffusion coefficient (K(y), c.a. 10(-3)m(2)s(-1)) on FM and at the canopy-water column interface, whereas t(R) (2.6-5.6 min) was not affected by fragmentation. It suggests that (1) FM are more vulnerable to pollution events in terms of dispersion area and (2) at low tide, advection rather than turbulent diffusion determines t(R). Furthermore, Taylor's theorem is revealed as a powerful tool to analyze vertical gradients on K(y) within seagrass canopies.

Análisis y tratamiento de las barreras motrices de la cadera según el concepto Sohier. A propósito de un caso / Analysis and treatment of motor barriers of the hip according to the sohier method. A case report

El objetivo del trabajo se basa en comparar la eficacia del tratamiento mediante fisioterapia, ejercicios isométricos y técnicas analíticas según el concepto Sohier en la articulación coxofemoral, respecto a la fisioterapia sin emplear rearmonizaciones en un paciente con rotura fibrilar recidivante del recto anterior. El sujeto de estudio fue un futbolista profesional de 33 años al que se le valoró el dolor, antes y después de las dos fases de que consta el tratamiento, mediante la Escala Visual Analógica (EVA), la amplitud articular de la cadera derecha mediante goniómetro manual de dos ramas y el índice de esfuerzo percibido (IEP) mediante la escala adaptada del índice de esfuerzo percibido para los músculos activos (Borg¿s RPE Scale). Como resultados destacamos la reducción del dolor en ambas fases (mayor en la fase 2) y aumento y estabilización en cantidad y/o calidad de la movilidad coxofemoral en la fase 2(AU)

This work has aimed to compare the effectiveness of treatment through physical therapy, isometric exercises and analytical techniques according to the Sohier method in the hip joint compared with physical therapy without using resets in a patient with recurrent muscle fiber strain of the rectus femoris. The study subject was a 33-year old professional football player who was studied prior to and following the two treatment phases. The study included pain with the Visual Analog Scale (VAS), amplitude of the right hip joint through two manual goniometer arms and the Borg's perceived exertion scale (PES), using the modified rate of perceived exertion scale for active muscles (Borg's RPE Scale). Standing out among the results are reduction of pain in both phases (higher in phase 2) and increase and stabilization in quantity or quality of hip mobility in phase 2(AU)

Magnetic circular dichroism of phthalocyanine (m=mg, zn) and tetraazaporphyrin (m=mg, zn, ni) metal complexes. A computational study based on time-dependent density functional theory.

We present here simulated magnetic circular dichroism (MCD) spectra of MTAP (M=Mg, Ni, Zn) and MPc (M=Mg, Zn) where TAP=tetraazaporphyrin and Pc=phthalocyanine. The study is based on magnetically perturbed time-dependent density functional theory (MP-TDDFT) and a newly implemented method for the calculation of A and B terms from the theory of MCD. It follows from our investigation that the MCD spectrum for the MTAP and MPc systems in the Q-band region consists of a single positive A term augmented by a positive B term, in agreement with experiment where available. The Q band can be fully characterized in terms of the 2a1u-->2eg one-electron excitation. For the aza systems MgTAP and ZnTAP, the simulated MCD spectra in the Soret region are dominated by the two one-electron excitations 2a2u-->2eg and 1a2u-->2eg and has the appearance of a positive A term (with values between 1.33-1.55, depending on the MTAP system) made asymmetric by a negative B term, in good agreement with experiment. We find, in agreement with all available experimental findings on MPc (M=Mg, Zn) type systems, that the MCD spectra in the Soret region are dominated by two transitions with positive A/ D-term values and two negative B/ D-term values. The major contribution to the two transitions comes from the 2a2u-->2eg and 1a2u-->2eg one-electron excitations. It appears that the ratio of A/ B for the term parameters is underestimated by theory.

Clinical and capillaroscopic evaluation in the treatment of chronic venous insufficiency with Ruscus aculeatus, hesperidin methylchalcone and ascorbic acid in venous insufficiency treatment of ambulatory patients.

AIM: Clinical and capillaroscopic evaluation of an association of Ruscus aculeatus, hesperidin methylchalcone (HMC) and ascorbic acid in chronic venous insufficiency METHODS: A prospective, multicenter and open clinical study. Chronic venous insufficiency patients were studied using clinical, etiological, anatomical, physiological classification (CEAP) symptom scale. Symptomatology, CEAP scale, and baseline, 2-, 4-, 6- and 8-week skin capillaroscopy were assessed. Treatment consisted of two capsules per day of Ruscus aculeatus 150 mg/HMC 150 mg/ascorbic acid 100 mg during 8 weeks. RESULTS: A total of 124 patients were studied, 109 female (89.28%), with a mean age of 52.5 (33-80+9.8). Initial intense reports were 79% pain, 85% heaviness, 74% cramps, 82% edema, decreasing to 20%, 12%, 8% and 14%, respectively, within two weeks, and symptomatology being absent at the end of treatment. Capillaroscopy changes at treatment completion were: 98% to 20% inter-capillary fluid decrease; 80% to 20% efferent loop thickening; 5% to 2% peri-capillary bed, and 5% to 4% mega-capillaries. CONCLUSION: Severe symptom decrease started from the second week until there were no symptoms at the end of treatment. It is the first time morphologic changes were observed in chronic venous insufficiency through capillaroscopy following a pharmacological intervention. Capillary-level effect was proportional to symptom decrease. Improvement was seen from the second week of treatment.

Magnetic circular dichroism of porphyrins containing M = Ca, Ni, and Zn. A computational study based on time-dependent density functional theory.

A theoretical study is presented on the magnetic circular dichroism (MCD) exhibited by the porphyrin complexes MP (M = Mg,Ni,Zn), MTPP (M = Mg,Ni,Zn), and NiOEP, where P = porphyrin, TPP = tetraphenylporphyrin, and OEP = octaethylporphyrin. The study makes use of a newly implemented method for the calculation of A and B terms from the theory of MCD and is based on time-dependent density functional theory (TD-DFT). It is shown that the MCD spectrum is dominated by a single positive A term in the Q-band region in agreement with experiment where available. The band can be fully explained as the first transition in Gouterman's four-orbital model for the type of porphyrins studied here. For the Soret band, the experimental MCD spectrum appears as a single positive A term. This is also what is found computationally for NiP and NiTPP, where the second transition in Gouterman's four-orbital model give rise to a positive A term. However, for the remaining systems, the simulated MCD spectrum is actually due to two B terms that have the appearance of one positive pseudo A term. The two B terms appear because the second Gouterman state is coupled strongly to a second excited state (b(2u) --> 2e(g)) of nearly the same energy by the external magnetic field.

Time-to-positivity in patients with Escherichia coli bacteraemia.

The time from the start of incubation to a positive reading of blood cultures (time-to-positivity; TTP) is related to the concentration of bacteria in blood. Information concerning the correlation of TTP with clinical parameters, and its usefulness as a prognostic factor in patients with Escherichia coli bacteraemia, is limited. To investigate the relationship of TTP to clinical parameters, 459 cases of monomicrobial E. coli bloodstream infections from a single institution between 1997 and 2005 were reviewed. All cases involved patients who were not undergoing antibiotic treatment at the time of blood sampling. The in-hospital mortality rate was 6.3%. Median TTP was significantly shorter for patients who died than for those who survived (9.7 h, inter-quartile range 7.85-11.05 h vs. 11.2 h, inter-quartile range 10.1-11.4 h; p <0.001). Patients with TTP in the lowest quartile were more likely to be female, to have a non-urinary tract or an unknown origin of bacteraemia, to have severe sepsis or shock, and to subsequently die. In a multivariable Cox regression model, the hazard ratio for death from any cause for patients with a short TTP was 3.13 (95% CI 1.28-7.64; p 0.01). TTP in patients with E. coli bacteraemia provides prognostic information beyond that provided by the presence of haematological illness, a Charlson score > or =3, a non-urinary tract origin of bacteraemia, and the presence of severe sepsis or shock.

Risk factors for bacteremia in patients with limb cellulitis.

The aim of this study was to identify the risk factors for bacteremia in patients with limb cellulitis. Using the administrative and microbiology laboratory databases of a community teaching hospital, a review was conducted of all cases of community-acquired limb cellulitis that occurred during the period 1997-2004 and in which blood cultures had been performed. A comparison of demographical, clinical, and analytical data of patients with bacteremia versus patients without bacteremia was performed by univariate and multivariate analyses. Of 2,678 patients with cellulitis who presented to the hospital's emergency department, 308 were diagnosed with limb cellulitis and had blood cultures. Of these, 57 (18.5%) had bacteremia. In 24 of the 57 (42.1%) patients with bacteremia, the microorganism isolated in blood cultures was non-group-A beta-hemolytic Streptococcus, and in another 14 (24.6%), the microorganism identified was a gram-negative bacterium. Staphylococcus aureus was determined as the cause of bacteremia in just 6 (10.5%) patients and group A Streptococcus in 2 (3.5%). By logistic regression analysis, the following factors were associated with bacteremia: absence of previous antibiotic treatment (OR 5.3, 95% CI 1.4-20.3), presence of two or more comorbid factors simultaneously (OR 4.3, 95% CI 1.6-11.7), length of illness<2 days OR 2.44, 95% CI 1.07-5.56), and proximal limb involvement (OR 6, 95% CI 3.03-12.04). Patients with limb cellulitis who exhibit any of these characteristics are at increased risk of bacteremia. In such patients, it is imperative that blood cultures be performed.

New Pulsed Cold Neutron Beam Line for Fundamental Nuclear Physics at LANSCE.

The NPDGamma collaboration has completed the construction of a pulsed cold neutron beam line on flight path12 at the Los Alamos Neutron Science Center (LANSCE). We describe the new beam line and characteristics of the beam. We report results of the moderator brightness and the guide performance measurements. FP12 has the highest pulsed cold neutron intensity for nuclear physics in the world.

Aspectos psicosociales de la diabetes / Psychosocial aspects in diabetes

En este texto se analizan las reacciones más usuales que subyacen al diagnóstico de la enfermedad, así como la influencia que tienen las actitudes de la familia y del entorno laboral afectivo. Se apuntan algunas recomendaciones a los profesionales de la salud para contribuir a mejorar la sensación de bienestar del individuo y facilitar el cumplimiento terapéutico (AU)

Manifestaciones psicopatológicas en pacientes con cervicalgia aguda antes y después del tratamiento rehabilitador / Psychopathological manifestations in patients with acute cervicalgia before and after rehabilitation treatment

El presente estudio ha ido encaminado a analizar las manifestaciones psicopatológicas de un grupo de pacientes con cervicalgia aguda antes y después del tratamiento rehabilitador, es decir, en el momento del dolor agudo y tras una mejoría significativa del mismo. La muestra ha estado compuesta por 50 pacientes afectos de cervicalgia aguda, nueve varones y 41 mujeres, con edades comprendidas entre los 17 y los 71 años. Estos pacientes realizaron tratamiento sintomático en una clínica de rehabilitación, que consistió básicamente en masoterapia, tracciones y microonda cervical. Todos los pacientes completaron 'la Sympton Checklist 90 revised' (SCL-90-R) en dos ocasiones: antes de comenzar el tratamiento, y al finalizar el mismo. Esta escala valora la severidad de la psicopatología presentada a distintos niveles: somatización, obsesivo-compulsivo, ansiedad, depresión, sensitividad interpersonal, hostilidad, ansiedad fóbica, ideación paranoide y psicoticismo. Al comparar los resultados observamos una reducción en las puntuaciones de todos estos factores psicopatológicos, siendo estadísticamente significativa en el caso de somatización, ansiedad, ansiedad fóbica y psicoticismo, así como en el 'Índice Global de Severidad'. Por tanto, la mejoría de la cervicalgia aguda tras el tratamiento rehabilitador, implica una mejoría a nivel psicopatológico, y una mejora de la calidad de vida a nivel no sólo orgánico sino también psicosocial (AU)

[Biphasic graft preservation for lung transplantation]. / Preservación bifásica del injerto en el trasplante pulmonar.

The standard, most widely applied way of preserving a lung for transplantation is infusion through the pulmonary artery (PA) of a pulmonaryplegic solution. In this prospective study, we analyzed the initial function of the pulmonary and cardiac graft after biphasic infusion of a solution introduced retrograde through the left auricle and antegrade through the PA. Twenty-six heart and lung grafts (9 unilateral and 17 bilateral) were preserved by cardioplegia and pulmonaryplegia (biphasic) between January 1996 and March 1997. Indicators of graft viability recorded were the ratio of arterial oxygen pressure (PaO2) to inspired fraction (FiO2), mean systemic pressure (MSP), mean pulmonary artery pressure (MPAP) cardiac output, pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). The variables were recorded upon arrival of the grafts in the intensive care unit and in the first 24 h. Morbidity and mortality after heart transplants were recorded throughout a follow-up period of one month. After transplantation, most patients had a oxygenation coefficient (PaO2/FiO2) greater than 252 mmHg in the first 48 h. Hemodynamic parameters were also kept within normal ranges immediately after surgery and 24 h later. Mean ischemic time was 245 min for unilateral transplants, 215 for the first lung in double lung transplants, and 300 min for the second lung. In the early postoperative period, 3 patients suffered lung graft dysfunction, which was treated satisfactorily with nitric oxide (NO). No heart transplant patient suffered primary heart failure or left ventricular dilatation. We conclude that biphasic pulmonary preservation achieves satisfactory initial functional viability of the graft. Heart grafts removed simultaneously functioned successfully in the transplanted patient without additional pharmacological or mechanical support.