Donor notification of permanent deferral: a qualitative study on the perceptions and practices of notifier and blood donor in Mexico.

BACKGROUND: Informing about permanent deferral requires a process that links the notifier with the donor in a particular way. Little is known about the type of information and how it is disclosed to the donors. The current study aimed to examine perceptions and practices of notifier and blood donor within the framework of the notification process of permanent deferral and from the perspective of the notifier-blood donor relationship. METHODS: A qualitative study with in-depth interviews. The participants were 13 notifiers and 25 permanently deferred donors. Participants were recruited from a national blood bank and a state's blood bank. The entire dataset/narratives were analysed using the method of thematic analysis. RESULTS: The disclosure of permanent deferral was understood as a matter of disclosing the serological test results and their medical meaning along with a concise explanation of the deferral status with regard to future blood donation and the plan to be followed. The notifiers preferred to act in accordance with the standard protocol despite acknowledging the adverse psychological and social effects to which donors are exposed when they are informed of the possible disease and the consequent permanent deferral. Donors described a variety of psychological and social affectations. They valued honesty in the communication, the clarity of the information provided and a greater involvement of the notifier. CONCLUSION: Even though the notification process does not imply that medical care is being offered to donors, the notifier is the administrator of the well-being of the donor. Notification must not be considered as something apart from care, since it is intimately related to the health of each of the donors and their medical care.

Reclassification of aortic stenosis by fusion of echocardiography and computed tomography in low-gradient aortic stenosis.

BACKGROUND: The integration of computed tomography (CT)-derived left ventricular outflow tract area into the echocardiography-derived continuity equation results in the reclassification of a significant proportion of patients with severe aortic stenosis (AS) into moderate AS based on aortic valve area indexed to body surface area determined by fusion imaging (fusion AVAi). The aim of this study was to evaluate AS severity by a fusion imaging technique in patients with low-gradient AS and to compare the clinical impact of reclassified moderate AS versus severe AS. METHODS: We included 359 consecutive patients who underwent transcatheter aortic valve implantation for low-gradient, severe AS at two academic institutions and created a joint database. The primary endpoint was a composite of all-cause mortality and rehospitalisations for heart failure at 1 year. RESULTS: Overall, 35% of the population (n = 126) were reclassified to moderate AS [median fusion AVAi 0.70 (interquartile range, IQR 0.65-0.80) cm2/m2] and severe AS was retained as the classification in 65% [median fusion AVAi 0.49 (IQR 0.43-0.54) cm2/m2]. Lower body mass index, higher logistic EuroSCORE and larger aortic dimensions characterised patients reclassified to moderate AS. Overall, 57% of patients had a left ventricular ejection fraction (LVEF) <50%. Clinical outcome was similar in patients with reclassified moderate or severe AS. Among patients reclassified to moderate AS, non-cardiac mortality was higher in those with LVEF <50% than in those with LVEF ≥50% (log-rank p = 0.029). CONCLUSIONS: The integration of CT and transthoracic echocardiography to obtain fusion AVAi led to the reclassification of one third of patients with low-gradient AS to moderate AS. Reclassification did not affect clinical outcome, although patients reclassified to moderate AS with a LVEF <50% had worse outcomes owing to excess non-cardiac mortality.

Renal function in patients with significant tricuspid regurgitation: pathophysiological mechanisms and prognostic implications.

BACKGROUND: The pathophysiological mechanisms linking tricuspid regurgitation (TR) and chronic kidney disease (CKD) remain unknown. This study aimed to determine which pathophysiological mechanisms related to TR are independently associated with renal dysfunction and to evaluate the impact of renal impairment on long-term prognosis in patients with significant (≥ moderate) secondary TR. METHODS: A total of 1234 individuals (72 [IQR 63-78] years, 50% male) with significant secondary TR were followed up for the occurrence of all-cause mortality and the presence of significant renal impairment (eGFR of <60 mL min-1  1.73 m-2 ) at the time of baseline echocardiography. RESULTS: Multivariable analysis demonstrated that severe right ventricular (RV) dysfunction (TAPSE < 14 mm) was independently associated with the presence of significant renal impairment (OR 1.49, 95% CI 1.11 to 1.99, P = 0.008). Worse renal function was associated with a significant reduction in survival at 1 and 5 years (85% vs. 87% vs. 68% vs. 58% at 1 year, and 72% vs. 64% vs. 39% vs. 19% at 5 years, for stage 1, 2, 3 and 4-5 CKD groups, respectively, P < 0.001). The presence of severe RV dysfunction was associated with reduced overall survival in stage 1-3 CKD groups, but not in stage 4-5 CKD groups. CONCLUSIONS: Of the pathophysiological mechanisms identified by echocardiography that are associated with significant secondary TR, only severe RV dysfunction was independently associated with the presence of significant renal impairment. In addition, worse renal function according to CKD group was associated with a significant reduction in survival.

Platelet-Derived Growth Factor C in Alcoholics.

AIMS: Platelet-derived growth factor (PDGF) promotes liver collagen deposition, acting on hepatic stellate cells. Despite this, low serum PDGF levels were reported in chronic hepatitis C or B infection, although some studies yield the opposite result. Since PDGF may be related not only to fibrosis but also with vascular, neuronal or muscle disease, it is important to analyze its behavior in alcoholics. METHODS: In total, 17 controls and 62 alcoholic patients consecutively admitted to the hospitalization unit of the Internal Medicine Service were included. We determined serum levels of PDGF C, routine laboratory evaluation, tumor necrosis factor-α, interleukin (IL)-6 and IL-8 and malondialdehyde (MDA) levels. We analyzed the relationships between PDGF and liver function, ethanol intake and inflammatory reaction by both univariate and multivariate analysis to discern which variables PDGF levels depend on. RESULTS: Serum PDGF levels were significantly lower among patients (675 ± 466 pg/ml) than among controls (1074 ± 337 pg/ml; Z = 3.70; P < 0.001), and even lower among cirrhotics (549 ± 412 among cirrhotics vs 778 ± 487 among non-cirrhotics; Z = 2.33; P = 0.02). PDGF levels showed a direct correlation with prothrombin activity (ρ = 0.50; P < 0.001), platelet count (ρ = 0.44; P < 0.001) and inverse ones with bilirubin (ρ = -0.39; P = 0.002), IL-6 (ρ = -0.33; P = 0.016), IL-8 (ρ = -0.47; P < 0.001), and MDA levels (ρ = -0.44; P < 0.001). By multivariate analysis, only prothrombin activity and platelet count were independently related to PDGF. CONCLUSION: PDGF-C levels are decreased in alcoholics, especially among cirrhotics. Multivariate analysis discloses that only prothrombin activity and platelet count are independently related to PDGF-C levels.

Current MitraClip experience, safety and feasibility in the Netherlands.

PURPOSE: Data on MitraClip procedural safety and efficacy in the Netherlands are scarce. We aim to provide an overview of the Dutch MitraClip experience. METHODS: We pooled anonymised demographic and procedural data of 1151 consecutive MitraClip patients, from 13 Dutch hospitals. Data was collected by product specialists in collaboration with local operators. Effect on mitral regurgitation was intra-procedurally assessed by transoesophageal echocardiography. Technical success and device success were defined according to modified definitions of the Mitral Valve Academic Research Consortium (MVARC). RESULTS: Median age was 76 (interquartile range 69-82) years and 59% were males. Patients presented with ≥moderate mitral regurgitation and a predominance of functional mitral regurgitation (72%). Overall, 611 (53%) patients were treated with one Clip, 486 (42%) with ≥2 Clips and 54 (5%) received no Clip. The number of patients with ≥2 Clips increased from 22% in 2009 to 52% in 2016. Device success and technical success were 91 and 95%, respectively, and were consistent over the years. Significant reduction of mitral regurgitation by MitraClip was achieved in 94% of patients and was observed more often in patients with functional mitral regurgitation (95% vs. 91%, p = 0.025). Device time declined from 145 min in 2009 to 55 min in 2016. CONCLUSION: MitraClip experience in the Netherlands is growing with excellent technical success and device success. Over the years, device time decreased and more patients were treated with ≥2 Clips.

Differential influence of urbanisation on Coccidian infection in two passerine birds.

Urbanisation has the potential to increase the risk of parasitism on wildlife. Although some ectoparasite groups appear unaffected, different responses are hypothesised for parasites with simpler life histories such as gastrointestinal parasites. Red-browed finches (RBF) and the superb fairywrens (SFW), two native passerine birds affected by urbanisation, were examined for Coccidian parasites along an urbanisation gradient in New South Wales, Australia, in order to detect if prevalence might be directly related to the degree of urbanisation. Influence of urbanisation on Coccidian infection was differential. In RBF, the prevalence of Isospora increased significantly in more urbanised areas but prevalence did not change between breeding and non-breeding seasons. In contrast, in SFW, the degree of urbanisation did not significantly change with the degree of urbanisation, and season exhibited no significant effects on the prevalence of coccidians. Diet, behaviour and habits are suspected to be the most influential factors on the variation seen between both species where granivorous and gregarious species are significantly infected. Since the dynamics of urban wildlife-pathogen interactions is largely unexplored, more studies are needed to corroborate if this pattern of Isospora infections can be extended to other passerine birds in cities from Australia and overseas.

Left ventricular assist device for end-stage heart failure: results of the first LVAD destination program in the Netherlands.

PURPOSE: Mechanical circulatory support with a continuous-flow left ventricular assist device (LVAD) may be a valuable treatment in end-stage heart failure patients for an extended period of time. The purpose of this study was to evaluate the safety and efficacy of implantation of a continuous-flow LVAD in end-stage heart failure patients within the first destination program in the Netherlands. METHODS: A third-generation LVAD was implanted in 16 heart failure patients (age 61 ± 8; 81 % male; left ventricular ejection fraction 20 ± 6 %) as destination therapy. All patients were ineligible for heart transplant. At baseline, 3 and 6 months, New York Heart Association (NYHA) functional class, quality-of-life and exercise capacity were assessed. Clinical adverse events were registered. RESULTS: Survival at 30 days and 6 months was 88 and 75 %, respectively. In the postoperative phase, 6 (38 %) patients required continuous veno-venous haemofiltration for renal failure and 2 (13 %) patients required extracorporeal membrane oxygenation because of severe right ventricular failure. During follow-up, NYHA functional class and quality-of-life improved from 3.7 ± 0.1 to 2.3 ± 0.1 and 57 ± 5 to 23 ± 3 at 6 months (P < 0.001), respectively. The 6 min walking distance improved from 168 ± 42 m to 291 ± 29 m at 6 months (P = 0.001). CONCLUSION: Continuous-flow LVAD therapy is a promising treatment for patients with end-stage heart failure ineligible for heart transplant.

EACVI survey on radiation exposure in interventional echocardiography.

AIMS: The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey on radiation exposure in interventional echocardiography. The survey aimed to collect data on local practices for radioprotection in interventional echocardiography and to assess the awareness of echocardiography operators about radiation-related risks. METHODS AND RESULTS: A total of 258 interventional echocardiographers from 52 different countries (48% European) responded to the survey. One hundred twenty-two (47%) participants were women. Two-thirds (76%) of interventional echocardiographers worked in tertiary care/university hospitals. Interventional echocardiography was the main clinical activity for 34% of the survey participants. The median time spent in the cath-lab for the echocardiographic monitoring of structural heart procedures was 10 (5-20) hours/month. Despite this, only 28% of interventional echocardiographers received periodic training and certification in radioprotection and 72% of them did not know their annual radiation dose. The main adopted personal protection devices were lead aprons and thyroid collars (95% and 92% of use, respectively). Dedicated architectural protective shielding was not available for 33% of interventional echocardiographers. Nearly two-thirds of responders thought that the radiation exposure of interventional echocardiographers was higher than that of interventional cardiologists and 72% claimed for an improvement in the radioprotection measures. CONCLUSION: Radioprotection measures for interventional echocardiographers are widely variable across centres. Radioprotection devices are often underused by interventional echocardiographers, portending an increased radiation-related risk. International scientific societies working in the field should collaborate to endorse radioprotection training, promote reliable radiation dose assessment, and support the adoption of radioprotection shielding dedicated to interventional echocardiographers.

Proximate analysis and GC-MS phytochemical profiling of aqueous extracts of Doryopteris raddiana, a plant used by the Mbya-Guaraní as a contraceptive.

Doryopteris raddiana (Presl) Fée, a traditional contraceptive in Mbya culture, lacks scientific scrutiny regarding its chemical composition and contraceptive efficacy. Employing X-ray fluorescence, Fourier-transform infrared spectroscopy, and thermal analysis, we explored the plant's organs. Multielemental analysis excluded toxic elements. Key phytoconstituents identified by gas chromatography-mass spectrometry in the extracts obtained through infusion were glycerine, 1,3-dimethyl propane, and catechol in leaves; glycerine, cis-13-octadecenoic acid methyl ester, and 2-deoxy-D-erythro-pentose in stems and roots. Among these chemicals, glycerine emerged as the sole constituent with contraceptive potential, particularly intravaginally. Extract activity tests conducted on ram spermatozoa exhibited a reduction in the percentage of rapid spermatozoa but no significant impact on total motility, progressive motility, or viability. The reported data would only weakly support the advocated contraceptive action of this fern upon vaginal application, not through the oral administration of its decoction.

Are birds more afraid in urban parks or cemeteries? A Latin American study contrasts with results from Europe.

The escape behaviour, measured as flight initiation distance (FID; the distance at which individuals take flight when approached by a potential predator, usually a human in the study systems), is a measure widely used to study fearfulness and risk-taking in animals. Previous studies have shown significant differences in the escape behaviour of birds inhabiting cemeteries and urban parks in European cities, where birds seem to be shyer in the latter. We collected a regional dataset of the FID of birds inhabiting cemeteries and parks across Latin America in peri-urban, suburban and urban parks and cemeteries. FIDs were recorded for eighty-one bird species. Mean species-specific FIDs ranged from 1.9 to 19.7 m for species with at least two observations (fifty-seven species). Using Bayesian regression modelling and controlling for the phylogenetic relatedness of the FID among bird species and city and country, we found that, in contrast to a recent publication from Europe, birds escape earlier in cemeteries than parks in the studied Latin American cities. FIDs were also significantly shorter in urban areas than in peri-urban areas and in areas with higher human density. Our results indicate that some idiosyncratic patterns in animal fearfulness towards humans may emerge among different geographic regions, highlighting difficulties with scaling up and application of regional findings to other ecosystems and world regions. Such differences could be associated with intrinsic differences between the pool of bird species from temperate European and mostly tropical Latin American cities, characterized by different evolutionary histories, but also with differences in the historical process of urbanization.

Surface impedance model for extraordinary transmission in 1D metallic and dielectric screens.

Extraordinary Optical Transmission of TM waves impinging at oblique incidence on metallic or high permittivity dielectric screens with a periodic distribution of 1D slits or any other kind of 1D defects is analyzed. Generalized waveguide theory altogether with the surface impedance concept are used for modeling such phenomena. A numerical analysis based on the mode matching technique proves to be an efficient tool for the characterization of these structures for any angle of incidence and slit or defect apertures.

Extraordinary transmission through dielectric screens with 1D sub-wavelength metallic inclusions.

Extraordinary optical transmission (EOT) through dielectric screens periodically loaded with sub-wavelength 1D discontinuities, such as apertures or metallic insets is analyzed. The results of the analysis and computational electromagnetic simulations show that the transmission is higher for for metallic inclusions than for empty slits. This effect confirms that EOT is a quite general property of weakly transparent periodic diffraction screens and opens the door to optically induced EOT in photo-conductive semiconductor screens.

[Superficial mycoses in the city of Valparaiso, Chile: period 2007-2009]. / Micosis superficiales en la ciudad de Valparaíso, Chile: Período 2007-2009.

INTRODUCTION: Superficial mycoses are infections of the keratinous tissue caused by dermatophytes, yeasts and environmental fungi. OBJECTIVES: To identify the species of dermatophytes, yeasts and environmental fungi that cause superficial mycosis and analyze their differences by sex, age and location of the lesion, in patients from the region of Valparaiso, during 2007-2009. MATERIALS AND METHODS: 1004 patients diagnosed with superficial mycoses were studied. All ages and both genera were included. The study was done using direct microscopic examination with 20% KOH and culture of the lesions. Fungi identification was mainly morphophysiological. RESULTS: Of the 1004 patients studied, 609 were women and 87.7% was 15 years old or younger. Toenail onychomycosis was the most frequent lesion (58.1%), followed by tinea pedis and interdigitalis (16.3%). In patients younger than 8 years old, tinea capitis by Microsporum canis was the most common mycoses. Among dermatophytes, Trichophyton rubrum (78.9%) predominated in most locations, followed by Trichophyton mentagrophytes (14.9%) and M. canis (5.4%). Candida spp. (95.4%) prevailed among the yeasts causing onychomycosis. There were 27 cases of toenail onychomycosis caused by environmental fungi, mainly Fusarium. CONCLUSIONS: Our results are consistent with national and international data, where T. rubrum is the predominant agent of dermatomycoses. We report the emergency of agents not described in Chile or Latin America in these infections.

Delayed Iatrogenic Left Ventricular Apex Perforation Sealed With an Amplatzer Septal Occluder Device Under Transthoracic Echocardiography Guidance.

High rates of spontaneous rupture and death have been described when the pseudoaneurysm is left untreated. Percutaneous closure has emerged as an alternative to surgery in patients with unacceptable surgical risk. In this case, transthoracic echocardiography allowed optimal characterization of the defect and successful procedure guidance, avoiding risks derived from more invasive intraprocedural imaging techniques.

Jejunal wall triglyceride concentration of morbidly obese persons is lower in those with type 2 diabetes mellitus.

The overproduction of intestinal lipoproteins may contribute to the dyslipidemia found in diabetes. We studied the influence of diabetes on the fasting jejunal lipid content and its association with plasma lipids and the expression of genes involved in the synthesis and secretion of these lipoproteins. The study was undertaken in 27 morbidly obese persons, 12 of whom had type 2 diabetes mellitus (T2DM). The morbidly obese persons with diabetes had higher levels of chylomicron (CM) triglycerides (P < 0.001) and apolipoprotein (apo)B48 (P = 0.012). The jejunum samples obtained from the subjects with diabetes had a lower jejunal triglyceride content (P = 0.012) and angiopoietin-like protein 4 (ANGPTL4) mRNA expression (P = 0.043). However, the apoA-IV mRNA expression was significantly greater (P = 0.036). The jejunal triglyceride content correlated negatively with apoA-IV mRNA expression (r = -0.587, P = 0.027). The variables that explained the jejunal triglyceride content in a multiple linear regression model were the insulin resistance state and the apoA-IV mRNA expression. Our results show that the morbidly obese subjects with diabetes had lower jejunal lipid content and that this correlated negatively with apoA-IV mRNA expression. These findings show that the jejunum appears to play an active role in lipid homeostasis in the fasting state.

Analytical theory of extraordinary optical transmission through realistic metallic screens.

An analytical theory of extraordinary optical transmission (EOT) through realistic metallic screens perforated by a periodic array of subwavelength holes is presented. The theory is based on our previous work on EOT through perfect conducting screens and on the surface impedance concept. The proposed theory is valid for the complete frequency range where EOT has been reported, including microwaves and optics. A reasonably good agreement with electromagnetic simulations is shown in all this frequency range. We feel that the proposed theory may help to clarify the physics underlying EOT and serve as a first step to more accurate analysis.