Surgical management of tumor thrombus into the right atrium

Renal cell carcinoma represents 3% of solid tumors. In 4-10% of patients, venous tumor thrombosis is present, and 1% reaches the right atrium. Other tumors can be associated with tumor thrombosis. The natural history of venous tumor thrombosis implies a mean survival of 5 months. Between 2001 and 2021, 4 patients underwent resection of tumor thrombi into the right atrium, requiring cardiopulmonary bypass. None of the patients died within 30 days postoperatively. Mean follow-up time was 30.9 months (2.4- 96.1). Two patients are still alive and two died due to disease progression. Died patient’s follow-up was 7.5 and 17.4 months, surpassing life expectancy of those without surgery. We present a series of patients who underwent lumpectomy and IVC thrombectomy. IVC tumor thrombosis has an ominous prognosis, however surgical treatment has an important role by improving the survival of these patients. The multidisciplinary approach is necessary to obtain good postoperative results

Data analysis from the Spanish Registry of Cardiac Surgery (RECC) 2021-2022

Cardiovascular surgery; Acquired cardiac disease; Aortic surgeryCirurgia cardiovascular; Cardiopaties adquirides; Cirurgia aòrticaCirugía cardiovascular; Cardiopatías adquiridas; Cirugía aórticaIntroducción Desde el 8 de febrero de 2021, la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) puso en marcha el Registro Español de Cirugía Cardiaca (RECC) que está disponible para las diferentes unidades de cirujanos cardiovasculares de nuestro país. Es una herramienta que permite recopilar datos de pacientes sometidos a cirugía cardiaca, vascular o endovascular. Tras dos años de desarrollo, hemos llevado a cabo un análisis de la calidad de la información obtenida para adquirir una visión general de su contenido. Métodos La información ha sido analizada de forma anónima a nivel de paciente, hospital y provincia. Para la estimación de la mortalidad ajustada por riesgo se utilizó la escala de estimación de riesgo preoperatorio EuroSCORE II. Resultados Se han incluido en el RECC un total de 7.087 intervenciones, de las cuales 6.267 se trataban de cirugías cardiacas mayores. Del total de intervenciones mayores, 53,9% eran cirugías valvulares, 25,2% de revascularización miocárdica y 14,9% de aorta. La mortalidad global de la serie fue de 5,0% y el índice de mortalidad ajustada al riesgo (IMAR) de 0,88. La calibración del EuroSCORE II en la muestra global fue buena en los pacientes de riesgo más bajo, aunque sobreestimó la mortalidad en los de alto riesgo. Conclusiones El RECC se trata de una base de datos clínica nacional que permite el análisis de datos de pacientes con el fin de evaluar de forma precisa el volumen de la actividad, riesgo y resultados. A nivel local, podría utilizarse como una herramienta para mejorar la calidad de la atención y el desarrollo de programas correctivos.Introduction Since February 8, 2021, the Spanish Society of Cardiovascular and Endovascular Surgery got under way the Spanish Registry of Cardiac Surgery (RECC), which is available for the different units of cardiovascular surgeons in our country. It is a tool that allows collect patient-level data of patients undergoing cardiac, vascular or endovascular surgery. After two years of development, we have carried out an analysis of the quality of the information obtained in order to acquire an overview of its content. Methods The information has been analyzed anonymously at patient, hospital and province level. For risk-adjusted mortality estimation, the EuroSCORE II preoperative risk estimation scale was used. Results A total of 7087 interventions have been included. Six thousand two hundred and sixty-seven were major cardiac surgeries: 53.9% valvular, 25.2% coronary artery bypass grafting, and 14.9% aortic procedures. The overall mortality was 5.0% and the risk-adjusted mortality rate was 0.88. The EuroSCORE II calibration in the overall sample was good in the lowest-risk patients, although it overestimated mortality in high-risk patients. Conclusions RECC is a nationally defined clinical database in the field of cardiovascular surgery. RECC allows a patient-level data analysis in order to perform an accurate analysis of the volumen of activity, risk adjustment and results. Locally, it could be used as a tool to improve the quality of care and development of corrective programs

Radioterapia estereotáctica

La radioterapia con técnica estereotáctica es una modalidad de radioterapia externa que utiliza un sistema de coordenadas tridimensionales independientes del paciente para la localización precisa de la lesión. También se caracteriza porque los haces de irradiación son altamente conformados, precisos y convergentes sobre la lesión que hacen posible la administración de dosis muy altas de radioterapia sin incrementar la irradiación de los órganos o estructuras sanas adyacentes. Cuando el procedimiento se realiza en una sesión de tratamiento se denomina radiocirugía y si se administra en varias sesiones se denomina radioterapia estereotáctica. Se precisa de sistemas de fijación e inmovilización del paciente especiales (guías o marcos estereotácticos) y dispositivos de radioterapia capaces de generar haces muy conformados (acelerador lineal, gammaknife, cyberknife, tomoterapia, ciclotrones). La radioterapia estereotáctica moderna utiliza marcas radioopacas intratumorales o sistemas de imágenes de TAC incluidos en el dispositivo de irradiación, que permiten una precisa localización de las lesiones móviles en cada sesión de tratamiento. Además, los avances tecnológicos hacen posible coordinar los movimientos de la lesión en la respiración con la unidad de radioterapia (gaiting y tracking) de forma que pueden estrecharse al máximo los márgenes y por lo tanto excluir un mayor volumen de tejido sano La radiocirugía está indicada principalmente en lesiones cerebrales benignas o malignas menores de 3-4 centímetros (malformaciones arteriovenosas, neurinomas, meningiomas, metástasis cerebrales) y la radioterapia estereotáctica se administra fundamentalmente en tumores de localización extracraneal que requieran una alta conformación y precisión como cáncer precoz de pulmón inoperable y metástasis hepáticas.Stereotactic radiotherapy is an external radiation modality that uses a system of three dimensional references independent of the patient to achive a precise location of the lesion. Stereotactic radiotherapy generate highly conformal, precisely focused radiation beams to administer very high doses of radiation without increasing the radiation to healthy surrounding organs or structures. When the procedure is carried out in one treatment session the procedure is termed radiosurgery, and when the treatment is administered in several fractions, the radiation modality is termed stereotactic radiotherapy. Special systems of patient immobilization (guides or stereotactic frames) are required together with radiotherapy devices capable of generating conformal beams (lineal accelerator, gammaknife, cyberknife, tomotherapy, cyclotrons). Modern stereotactic radiotherapy techniques employ intratumoural radio-opaque fiducials or CT image systems included in the irradiation device, which make possible a precise location of mobile lesions in each treatment session. Besides, technological advances permit breathing synchronized radiation (gating and tracking) for maximum tightening of margins and excluding a greater volume of healthy tissue. Radiosurgery is mainly indicated in benign or malign cerebral lesions less than 3-4 centimetres (arteriovenous malformations, neurinomas, meningiomas, cerebral metastases) and stereotactic radiotherapy is basically administered in tumours of extracraneal location that require high conformation and precision, such as inoperable early lung cancer and liver metastasis

Oxigenación con membrana extracorpórea en el paciente COVID-19: resultados del Registro Español ECMO-COVID de la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE)

Background and aim: COVID-19 patients with severe heart or respiratory failure are potential candidates for extracorporeal membrane oxygenation (ECMO). Indications and management of these patients are unclear. Our aim is to describe the results of a prospective registry of COVID-19 patients treated with ECMO. Methods: An anonymous prospective registry of COVID-19 patients treated with veno-arterial (V-A) or veno-venous (V-V) ECMO was created on march 2020. Clinical, analytical and respiratory preimplantation variables, implantation data and post-implantation course data were recorded. The primary endpoint was all cause in-hospital mortality. Secondary events were functional recovery and the combined endpoint of mortality and functional recovery in patients followed at least 3 months after discharge. Results: Three hundred and sixty-six patients from 25 hospitals were analyzed, 347 V-V ECMO and 18 V-A ECMO patients (mean age 52.7 and 49.5 years respectively). Patients with V-V ECMO were more obese, had less frequently organ damage other than respiratory failure and needed less inotropic support; Thirty three percent of V-A ECMO and 34.9% of V-A ECMO were discharged (P = NS). Hospital mortality was non-significantly different, 56.2% versus 50.9% respectively, mainly during ECMO therapy and mostly due to multiorgan failure. Other 51 patients (14%) remained admitted. Mean follow-up was 196 +/- 101.7 days (95%CI: 170.8-221.6). After logistic regression, body weight (OR 0.967, 95%CI: 0.95-0.99, P = 0.004) and ECMO implantation in the own centre (OR 0.48, 95%CI: 0.27-0.88, P = 0.018) were protective for hospital mortality. Age (OR 1.063, 95%CI: 1.005-1.12, P = 0.032), arterial hypertension (3.593, 95%CI: 1.06-12.19, P = 0.04) and global (2.44, 95%CI: 0.27-0.88, P = 0.019), digestive (OR 4,23, 95%CI: 1.27-14.07, P = 0.019) and neurological (OR 4.66, 95%CI: 1.39-15.62, P = 0.013) complications during ECMO therapy were independent predictors of primary endpoint occurrence. Only the post-discharge day at follow-up was independent predictor of both secondary endpoints occurrence. Conclusions: Hospital survival of severely ill COVID-19 patients treated with ECMO is near 50%. Age, arterial hypertension and ECMO complications are predictors of hospital mortality, and body weight and implantation in the own centre are protective. Functional recovery is only predicted by the follow-up time after discharge. A more homogeneous management of these patients is warranted for clinical results and future research optimization. (C) 2022 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U

Detection and replication of QTL underlying resistance to gastrointestinal nematodes in adult sheep using the ovine 50K SNP array

16 p.Persistence of gastrointestinal nematode (GIN) infection and the related control methods have major impacts on the sheep industry worldwide. Based on the information generated with the Illumina OvineSNP50 BeadChip (50 K chip), this study aims at confirming quantitative trait loci (QTL) that were previously identified by microsatellite ‑ based genome scans and identifying new QTL and allelic variants that are associated with indicator traits of parasite resistance in adult sheep. We used a commercial half ‑ sib population of 518 Spanish Churra ewes with available data for fecal egg counts (FEC) and serum levels of immunoglobulin A (IgA) to perform different genome scan QTL mapping analyses based on classical linkage analysis (LA), a combined linkage disequilibrium and linkage analysis (LDLA) and a genome ‑ wide association study (GWAS)This work was supported by a competitive grant from the Castilla and León regional government (Junta de Castilla y León) (Ref. LE245A12-2) and the AGL2012-34437 project funded by the Spanish Ministry of Economy and Competitiveness (MINECO). M Atlija is a grateful grantee of a Marie Curie fellowship funded by the EC-funded Initial Training Network (ITN) NematodeSystemHealth (FP7-PEOPLE-2010-ITN Ref. 264639). B Gutiérrez-Gil is funded through the Spanish “Ramón y Cajal” Programme (RYC-2012-10230) from the MINECO.S

Genetic and genomic analyses underpin the feasibility of concomitant genetic improvement of milk yield and mastitis resistance in dairy sheep

Milk yield is the most important dairy sheep trait and constitutes the key genetic improvement goal via selective breeding. Mastitis is one of the most prevalent diseases, significantly impacting on animal welfare, milk yield and quality, while incurring substantial costs. Our objectives were to determine the feasibility of a concomitant genetic improvement programme for enhanced milk production and resistance to mastitis. Individual records for milk yield, and four mastitis-related traits (milk somatic cell count, California Mastitis Test score, total viable bacterial count in milk and clinical mastitis presence) were collected monthly throughout lactation for 609 ewes of the Chios breed. All ewes were genotyped with a mastitis specific custom-made 960 single nucleotide polymorphism (SNP) array. We performed targeted genomic association studies, (co)variance component estimation and pathway enrichment analysis, and characterised gene expression levels and the extent of allelic expression imbalance. Presence of heritable variation for milk yield was confirmed. There was no significant genetic correlation between milk yield and mastitis traits. Environmental factors appeared to favour both milk production and udder health. There were no overlapping of SNPs associated with mastitis resistance and milk yield in Chios sheep. Furthermore, four distinct Quantitative Trait Loci (QTLs) affecting milk yield were detected on chromosomes 2, 12, 16 and 19, in locations other than those previously identified to affect mastitis resistance. Five genes (DNAJA1, GHR, LYPLA1, NUP35 and OXCT1) located within the QTL regions were highly expressed in both the mammary gland and milk transcriptome, suggesting involvement in milk synthesis and production. Furthermore, the expression of two of these genes (NUP35 and OXCT1) was enriched in immune tissues implying a potentially pleiotropic effect or likely role in milk production during udder infection, which needs to be further elucidated in future studies. In conclusion, the absence of genetic antagonism between milk yield and mastitis resistance suggests that simultaneous genetic improvement of both traits be achievable

Thermal and hydraulic design of water-based cooling systems for electrical machines.

Thermal management of electrical machines is gaining more and more attention from the research and industrial community, due to the demanding power density and reliability conditions of present and future applications. The aim of this research work is to draw some conclusions about which is the best way of designing and optimizing two types of cooling systems for electrical machines. More precisely, the cooling systems studied use water as a secondary coolant, and are classified by IEC60034 as IC71W and IC81W. These systems are very popular in traction and marine applications. For this purpose, both algebraic and CFD based models have been developed in order to precisely calculate the behavior of the main components of these cooling systems. Once these models have been validated experimentally, they have been employed to derive design and optimization criteria for the systems. Thus, as a first step, the main considerations for the development of an algebraic thermal model for the IC71W cooling system are examined. A detailed classification of the most critical convective correlations and a review of the modelling of the water jacket is given. Once the model is described, the solving procedure and its experimental validation is exposed. Secondly, using the previously validated model a complete design methodology for the water jacket of an IC71W cooling system is proposed. Different elements such as the shaft or the housing are analyzed in order to obtain some criteria for their design. The inclusion of wafters in this kind of cooling systems is examined, proposing an optimum configuration and evaluating the effect of this element on the temperatures of the stator end-windings. Regarding the IC81W cooling system, the same process has been followed. As a first step, both a hydraulic and a thermal model have been developed. The hydraulic model is defined in more detail, because it is crucial to obtain a realistic behavior of airflow inside the machine. After that, a method for the computation and solving of these models and its experimental validation process is presented. Finally, with the developed models, the main elements defining an IC81W cooling system (which is very extended for marine applications), the fan and the primary circuit, are studied. A design methodology for the fan fixed to the shaft is proposed, including the effect of the main parameters defining this element on the airflow and the pressure rise. Furthermore, different elements in the primary circuit are studied, obtaining the thermal behavior of different configurations and determining the best choice in order to reduce temperatures in the active parts of the machine

Intervencionismo coronario en la oclusión iatrogénica de circunfleja tras anuloplastia mitral

Describimos el caso de un paciente con obstrucción de la arteria circunfleja dominante tras una cirugía de reparación mitral, resuelta con éxito mediante intervencionismo coronario percutáneo realizado en el postoperatorio inmediato. Se discute la etiopatogenia con vistas a la prevención de esta complicación y su manejo, con especial énfasis en el intervencionismo coronario percutáne