Evaluación de las alteraciones de la coagulación de los donantes a corazón parado, su relación con la viabilidad de los injertos hepáticos y posibles acciones terapéuticas

[spa] INTRODUCCIÓN Y OBJETIVOS El uso de injertos provenientes de donantes en asistolia (DA) como estrategia para reducir la mortalidad en lista de espera presenta como menoscabo una mayor incidencia de estenosis biliares no anastomóticas. Esto se debe a la mayor susceptibilidad del epitelio biliar a la isquemia caliente que se da durante la fase de asistolia. La activación del endotelio del plexo peribiliar y la consecuente formación de microtrombos exacerbaría la hipoxia colangiocelular. Ante dicha hipótesis, el uso de fibrinolíticos se postuló como una prometedora estrategia para mejorar la viabilidad de los órganos, al lisar los trombos y permitir el paso de sangre. Sin embargo, estudios realizados en pacientes que han sufrido una parada cardiorespiratoria recuperada muestran un estado de hiperfibrinolisis mediante tromboelastometría. Para valorar la efectividad del tratamiento con fibrinolíticos en los DA no controlados, por un lado analizamos el patrón de coagulación de éstos a su llegada a nuestro hospital; y paralelamente, mediante un estudio experimental, analizamos la efectividad del uso de fibrinolíticos sobre los injertos hepáticos. MATERIAL, MÉTODOS Y RESULTADOS En el estudio clínico se describen las alteraciones en la coagulación de los DA tipo 2 de la clasificación de Maastricht. De los 33 potenciales donantes llegados al hospital durante 18 meses, se trasplantaron 22 riñones y 5 hígados. El análisis tromboelastométrico muestra un patrón de hipocoagulabilidad e hiperfibrinolisis en todos ellos. Se vio una correlación inversa entre el grado de lisis a los 30 minutos y el pico de transaminasas. En el estudio experimental porcino, se reproduce la situación clínica del DA. Se analizó el efecto de la heparina pre-PCR, de 60 minutos de duración; o fibrinolítico (tPA) tras PCR y durante la perfusión regional abdominal normotérmica (PRAN), que se mantuvo 60 minutos. El injerto hepático se implantó en un receptor, seguido durante 5 días. Se observó una mejoría en los flujos durante la PRAN en aquellos animales que recibieron heparina pre-parada frente a aquellos animales que no la recibieron. Así mismo, la supervivencia fue superior en este grupo, con un menor pico de transaminasas y mayor recuperación de la función hepática medida por el tiempo de protrombina. No se observaron diferencias en el grupo en el que se administró tPA en comparación con el grupo control. En cuanto al análisis histológico, en ninguno de los grupos se observaron depósitos de fibrina significativos. La lesión por isquemia-reperfusión y la expresión de los marcadores de activación endotelial e inflamación fue menor en aquellos animales pre-tratados con heparina. DISCUSIÓN Y CONCLUSIONES En el estudio clínico, el patrón de hiperfibrinolisis en todos los potenciales DA es similar a los resultados de los estudios en pacientes que sufrieron PCR recuperadas. Dicha hiperfibrinolisis podría atribuirse a un mecanismo de protección mediado por la vía de la proteína C. En el estudio experimental, el hecho de que no hubiera diferencias en cuanto a la calidad del injerto hepático y la viabilidad del mismo en aquellos animales que habían recibido tPA en comparación con los controles; así como la ausencia de depósitos significativos de fibrina tras 60 minutos de parada cardíaca, no justifica la administración de fibrinolítico. Por otro lado, la heparina administrada pre-PCR la viabilidad del injerto. En conclusión, el patrón de hiperfibrinolisis en los DA tipo 2 de la clasificación de Maastricht, la ausencia de depósitos de fibrina en el tejido hepático después de la PRC en el modelo animal, y el hecho de que el tratamiento con un agente fibrinolítico fuera inefectivo para mejorar la viabilidad del injerto hepático, ponen en entredicho la utilidad de este tratamiento. Por otro lado, la administración de heparina pre-PCR ha demostrado su utilidad para mejorar tanto la calidad del injerto durante la PRAN como su viabilidad postoperatoria.[eng] INTRODUCTION AND GOAL The use of organs obtained from donation after cardiocirculatory death (DCD) is limited by the appearance of ischemic-type biliary strictures. These are due to a greater susceptibility of the biliary epithelium to warm ischemia. Some studies suggest the use of fibrinolytics to dissolve microthrombi formed during this period to improve graft function; however, other studies describe a hiperfibrinolytic thromboelastometry pattern in patients who suffer cardiac arrest (CA). To evaluate the adequacy of fibrinolytic treatment in the Maastricht type II donor, we performed a clinical and an experimental study. MATERIAL AND METHODS In the clinical study, lab analysis and viscoelastic assays were performed in all potential DCD type II donors arriving at our hospital during an 18-month period. In the experimental study performed in a previously validated porcine model, we analyzed the usefulness of fibrinolysis in liver outcomes by either administering tPA after a 60 minute CA and during normothermic abdominal perfusion, or the use of heparin prior to CA. RESULTS 33 potential donors arrived in our hospital during the period of study, from which 22 kidneys and 5 livers were transplanted. Viscoelastic assays in all cases found a pattern of hyperfibrinolysis. There was an inverse correlation between clot stability as measured by Ly30 and transaminase levels. In the experimental study, there were no differences in pump flows, liver graft function or histologic parameters in those animals treated with tPA as compared to the control group. Moreover, fibrin deposition was not detected in any group after one hour of cardiac arrest. On the other hand, the use of pre-arrest heparin did improve pump flow and liver graft quality. CONCLUSIONS Both results in the clinical and experimental studies indicate no additional role for fibrinolytic therapy in the Maastricht type II setting. Heparin does offer anti-inflammatory and other cytoprotective effects that help improve DCD liver graft quality

GEMA2:Geometrical matching analytical algorithm for fast mobile robots global self-localization

[EN] This paper presents a new algorithm for fast mobile robot self-localization in structured indoor environments based on geometrical and analytical matching, GEMA(2). The proposed method takes advantage of the available structural information to perform a geometrical matching with the environment information provided by measurements collected by a laser range finder. In contrast to other global self-localization algorithms like Monte Carlo or SLAM, GEMA(2) provides a linear cost with respect the number of measures collected, making it suitable for resource-constrained embedded systems. The proposed approach has been implemented and tested in a mobile robot with limited computational resources showing a fast converge from global self-localization. (C) 2014 Elsevier B.V. All rights reserved.This work has been partially funded by FEDER-CICYT projects with references DPI2011-28507-C02-01 and HAR2012-38391-C02-02 financed by Ministerio de Ciencia e Innovacion and Ministerio de Economia y Competitividad (Spain).Sánchez Belenguer, C.; Soriano Vigueras, Á.; Vallés Miquel, M.; Vendrell Vidal, E.; Valera Fernández, Á. (2014). GEMA2:Geometrical matching analytical algorithm for fast mobile robots global self-localization. Robotics and Autonomous Systems. 62(6):855-863. https://doi.org/10.1016/j.robot.2014.01.009S85586362

Gestión del dolor en pacientes del programa Rapid Recovery (RR) en artroplastia total de rodilla (ATR)

La artroplastia total de rodilla (ATR) es una cirugía consisten­te en la sustitución artificial de la articulación, debido a una lesión traumática o bien a un proceso degenerativo o de ar­trosis, con un dolor importante asociado que en ocasiones afecta de forma negativa a la recuperación del paciente. La elección de la prótesis dependerá de las características ana­tómicas del paciente y del criterio del cirujano. El concepto de «cirugía de recuperación rápida» fue intro­ducido en 1997 por Khelet y significó el inicio del modelo Fast Track o de Rapid Recovery (RR), ligado a una rehabilitación acelerada, un alta precoz y la optimización de todos los as­pectos de la experiencia del paciente pre, intra y posoperato­ria. La recuperación rápida es un proceso quirúrgico que pre­tende conseguir la máxima autonomía del paciente mediante la educación, el control del dolor y la movilización precoz. El instrumento fundamental para la recuperación rápida es conseguir la implicación del paciente mediante el empodera­miento, es decir, por medio de la educación preoperatoria del paciente, que contribuirá a reducir la ansiedad y facilitará que se involucre en su propia recuperación. Así, será partícipe de una terapia física posoperatoria eficaz, utilizando todas aque­llas herramientas necesarias para aumentar su capacidad de gestionar los problemas de salud. El empoderamiento del paciente forma parte del modelo de enfermería del Hospital Clínic de Barcelona (HCB) adoptado por la Dirección de Enfer­mería en diciembre del año 2012. La cirugía convencional de ATR en Cataluña hasta el ini­cio de la cirugía RR ocasionó 14 132 intervenciones en el año 2008, con hospitalización convencional posterior. Este artículo describe los cuidados y los resultados de las intervenciones enfermeras, definidas en la vía clínica RR de ATR dirigidas a la minimización del dolor, y las repercusiones sobre la movilización de los pacientes. Se efectuó en una uni­dad monográfica de un hospital terciario de Barcelona en el año 2013

Bimetallic NiFe nanoparticles supported on CeO2 as catalysts for methane steam reforming

Ni-Fe nanocatalysts supported on CeO2 have been prepared for the catalysis of methane steam reforming (MSR) aiming for coke-resistant noble metal-free catalysts. The catalysts have been synthesized by traditional incipient wetness impregnation as well as dry ball milling, a green and more sustainable preparation method. The impact of the synthesis method on the catalytic performance and the catalysts’ nanostructure has been investigated. The influence of Fe addition has been addressed as well. The reducibility and the electronic and crystalline structure of Ni and Ni-Fe mono- and bimetallic catalysts have been characterized by temperature programmed reduction (H2-TPR), in situ synchrotron X-ray diffraction (SXRD), X-ray photoelectron spectroscopy (XPS), and Raman spectroscopy. Their catalytic activity was tested between 700 and 950 °C at 108 L gcat-1 h-1 and with the reactant flow varying between 54 and 415 L gcat-1 h-1 at 700 °C. Hydrogen production rates of 67 mol gmet-1 h-1 have been achieved. The performance of the ball-milled Fe0.1Ni0.9/CeO2 catalyst was similar to that of Ni/CeO2 at high temperatures, but Raman spectroscopy revealed a higher amount of highly defective carbon on the surface of Ni-Fe nanocatalysts. The reorganization of the surface under MSR of the ball-milled NiFe/CeO2 has been monitored by in situ near-ambient pressure XPS experiments, where a strong reorganization of the Ni-Fe nanoparticles with segregation of Fe toward the surface has been observed. Despite the catalytic activity being lower in the low-temperature regime, Fe addition for the milled nanocatalyst increased the coke resistance and could be an efficient alternative to industrial Ni/Al2O3 catalysts.Peer ReviewedPostprint (published version

Compressional tectonic inversion of the Algero-Balearic basin: Latemost Miocene to present oblique convergence at the Palomares margin (Western Mediterranean)

Interpretation of new multichannel seismic reflection profiles indicates that the Palomares margin was formed by crustal-scale extension and coeval magmatic accretion during middle to late Miocene opening of the Algero-Balearic basin. The margin formed at the transition between thinned continental crust intruded by arc volcanism and back-arc oceanic crust. Deformation produced during the later positive inversion of the margin offshore and onshore is partitioned between ~N50°E striking reverse faults and associated folds like the Sierra Cabrera and Abubacer anticlines and N10–20°E sinistral strike-slip faults like Palomares and Terreros faults. Parametric subbottom profiles and multibeam bathymetry offshore, structural analysis, available GPS geodetic displacement data, and earthquake focal mechanisms jointly indicate that tectonic inversion of the Palomares margin is currently active. The Palomares margin shows a structural pattern comparable to the north Maghrebian margins where Africa-Eurasia plate convergence is accommodated by NE-SW reverse faults, NNW-SSE sinistral faults, and WNW-ESE dextral ones. Contractive structures at this margin contribute to the general inversion of the Western Mediterranean since ~7 Ma, coeval to inversion at the Algerian margin. Shortening at the Alboran ridge and Al-Idrisi faults occurred later, since 5 Ma, indicating a westward propagation of the compressional inversion of the Western Mediterranean

Colangitis biliar primaria en España. Resultados de un estudio Delphi sobre su epidemiología, diagnóstico, seguimiento y tratamiento

Introducción: la colangitis biliar primaria (CBP) es una enfermedad rara, de la que existe información limitada en España sobre su epidemiología y manejo en la práctica clínica habitual. Objetivos: conocer la epidemiología, flujo del paciente, diagnóstico, seguimiento y tratamiento de la CBP en España. Métodos: revisión de la literatura y estudio siguiendo la metodología Delphi con participación de 28 especialistas en dos rondas de consulta y un taller de validación de resultados presencial. Resultados: existen, aproximadamente, 9.400 pacientes con CBP en España, con una incidencia anual de entre 0,51 y 3,86 casos/100.000 habitantes, aunque el margen de error se presupone alto dada la escasez de estudios. El intervalo entre sospecha y confirmación diagnóstica puede ser de varios meses, realizándola mayoritariamente un gastroenterólogo o hepatólogo. El papel de la biopsia hepática en el diagnóstico y seguimiento es heterogéneo. El 95% de los pacientes son tratados con ácido ursodesoxicólico (AUDC) y la respuesta se monitoriza mayoritariamente utilizando el criterio de Barcelona. El seguimiento es semestral, con un uso heterogéneo de las diferentes técnicas disponibles. No existen recomendaciones ni fármacos comercializados en segunda línea en caso de no respuesta, respuesta insuficiente o intolerancia al tratamiento con AUDC. Conclusiones: aunque es posible estimar la epidemiología a partir de la opinión de expertos, se necesitan registros nacionales que aporten información precisa y actualizada sobre la epidemiología, el estadio y la respuesta al tratamiento de los pacientes con CBP, así como tratamientos nuevos para ciertos grupos de pacientes

Succinate Pathway in Head and Neck Squamous Cell Carcinoma: Potential as a Diagnostic and Prognostic Marker

Simple Summary: Emerging evidence points to succinate as an important oncometabolite in cancer development; however, the contribution of the succinate-SUCNR1 axis to cancer progression remains unclear. Head and neck squamous cell carcinoma (HNSCC) is associated with disease and treatmentrelated morbidity so there is an urgent need for innovation in treatment and diagnosis practices. Our aim was to evaluate the potential of the succinate-related pathway as a diagnostic and prognostic biomarker in HNSCC. The circulating succinate levels are increased in HNSCC, being a potential noninvasive biomarker for HNSCC diagnosis. Moreover, the succinate receptor (SUCNR1) and genes related to succinate metabolism, which are predominantly expressed in the tumoral mucosa as compared with healthy tissue, are positively associated with plasma succinate. Remarkably, we found that SUCNR1 and SDHA expression levels predict prognosis

An urgent call for more ambitious ocean literacy strategies in marine protected areas: a collaboration project with small-scale fishers as a case study

19 pages, 12 figures, 2 tables, supplementary material https://www.frontiersin.org/articles/10.3389/fmars.2024.1320515/full#supplementary-material.-- Data availability statement: The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding authorCold-Water Corals play a paramount role in marine benthic ecosystems, increasing their complexity and providing spawning and nursery habitats to many species. However, due to their sessile lifestyle and ramified shape they are commonly entangled in nets and even by-caught during the practice of bottom-contact fishing, which includes impacts from both large-scale activities such as trawling and small-scale fishing (e.g., trammel nets or pots). In this context, passive and active restoration measures are crucial to avoid their damage and disappearance, which might cause the consequent loss of complexity and biodiversity of marine benthic communities. With the aim of modifying these fishing practices in the Marine Protected Area of Cap de Creus (North-Western Mediterranean), small-scale fishers and scientists (marine biologists) started a Participatory Process in which they agreed to develop a joint marine conservation program combining two distinct projects: a restoration project of the Cold-Water Corals incidentally captured on fishing nets for their subsequent reintroduction at sea (RESCAP project) and also a project on mitigation of fishing impacts on marine benthic communities (MITICAP project). Collaborative actions were carried out including interviews and exchanges of information with the purpose of collecting all the knowledge required for conducting the actions of the projects. This study shows the results of the assessment throughout five years (2017-2022) of cooperative work and highlights how crucial it is to develop long-term and revisable ocean literacy strategies for ensuring a sustainable ocean governance. An ocean literacy test evaluated the scientific knowledge of fishers at the end of the projects and revealed that despite all the efforts applied, still more work is needed, which reinforces the importance of improving the strategies of knowledge transfer for MPA management. Under the coordination of marine social anthropologists, a Cultural Consensus Analysis was conducted with the fishers. Results revealed a protoculture that should be characterized and considered when developing management strategies in the area. Additionally, the Personal Network Analysis showed that fishers have become agents of change and transmitted the learnings of the projects to their communities, fishers from nearby guilds, local educational centers and even the press. Furthermore, a list of recommendations is provided to optimize the multisector opportunities emerging from collaborative projects with marine scientists and fishers in MPAsThis work was performed under the MITICAP (https://www.programapleamar.es/miticap-implementacion-de-medidas-innovadoras-de-cooperacion-entre-pescadores-y-cientificos-para-una) and RESCAP (https://www.programapleamar.es/rescap-conservacion-y-recuperacion-de-poblaciones-de-gorgonias-y-corales-blandos-mediante) projects, which are funded by “Fundación Biodiversidad” of the Spanish Ministry for Ecological Transition, through the PLEAMAR Funding Program, co-funded by the European Maritime and Fisheries Fund. Also, the research counted with the support of the European project RESBIOS that received funding from the European Union’s Horizon 2020 Research and Innovation Programme under the Grant Agreement N°872146. In addition, the authors affiliated to the Institut de Ciències del Mar had the institutional support of the “Severo Ochoa Centre of Excellence’’ accreditation (CEX2019-000928-S)Peer reviewe

Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients

Background Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. Methods In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. Results A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.17.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days >= 30%,>= 50%,>= 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). Conclusions Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020

[EN] Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3,4,5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes.S