Protocolos de selección y estudio del donante y receptor aplicables a la práctica chilena, en trasplante de intestino

ResumenLa insuficiencia intestinal se define como la pérdida de la autonomía nutricional debido a disfunción intestinal. Su única opción de tratamiento adecuado es la Nutrición Parenteral Total Central. El trasplante de intestino se presenta como una alternativa de tratamiento.Los resultados iniciales del trasplante de intestino evidenciaron una alta incidencia de rechazo, infección y complicaciones técnicas que frenaron el desarrollo de esta técnica, sin embargo con la disminución de los problemas técnicos por la experiencia acumulada y la mejoría de los tratamientos inmunosupresores los resultados mejoraron en forma importante. Si bien en Chile la experiencia es limitada la indicación para su realización existe y aumenta debido al interés creciente por los buenos resultados demostrados a nivel mundial.En este breve artículo se revisan las indicaciones y contraindicaciones del procedimiento, el estudio del receptor y del donante, la técnica de procuramiento y se analizan los resultados actuales y las perspectivas futuras.SummaryIntestinal insufficiency is defined as the loss of nutricional autonomy as a result of intestinal malfunction. The only adequate treatment option is Total Central Parenteral Nutrition. Intestinal transplantation is proposed as a treatment alternative.Initial intestinal transplantation results showed a high incidence of rejection, infection and technical complications that stunted the development of this technique. Results have however greatly improved with the enhancement of immunosuppressive therapy and increased experience which has led to a subsequent decrease in technical problems.Even though Chile has limited experience, the demand for intestinal transplantation exists and increases due to a rising interest brought about by the good results presented worldwide.This short article addresses the indications and contraindications of this procedure, receptor and donor studies, the procurement technique and also analyzes current results and future prospects

TRASPLANTE SIMULTÿNEO DE PANCREAS-RIÿÿN. CONCEPTOS ACTUALES Y EXPERIENCIA EN CLÿNICA LAS CONDES

RESUMENEl trasplante de páncreas-riñón (TPR) para pacientes portadores de diabetes mellitus tipo 1 (DM1) con insuficiencia renal crónica terminal, ha demostrado ser una terapia eficaz para alcanzar el estado de normoglicemia de manera estable, con la consecuente disminución de las complicaciones crónicas de la DM y mejoría de la expectativa y calidad de vida. Actualmente, en casos seleccionados, se ha planteado el trasplante de páncreas (TP) como una alternativa para los pacientes con diabetes mellitus tipo 2 (DM2) considerando la diferencia entre los pacientes del tipo 1 y 2. Si bien es menos frecuente en la experiencia mundial, trasplantar pacientes con DM2 demuestra cifras alentadoras y comparables con el TP en enfermos portadores de DM1. En general, pacientes que desarrollan enfermedad renal terminal secundaria a diabetes 1 o 2 que requieren insulina, no obesos, deben ser considerados para el trasplante de páncreas con riñón simultáneo o secuencial. Clínica Las Condes es la de mayor experiencia en Chile, con resultados muy comparables a centros de gran importancia a nivel internacional.ObjetivoDar a conocer la situación actual del trasplante de páncreas y sus modalidades en el mundo y mostrar la experiencia en TPR en Clínica Las Condes en la sobrevida de los pacientes, de injerto de páncreas e injerto de riñón en 10 años y sus complicaciones, además de las técnicas quirúrgicas realizadas.MétodoSe recolectó la información de 16 pacientes sometidos a trasplante páncreas-riñón en Clínica Las Condes entre 1994-2014, analizando las variables con estadística descriptiva.ResultadosDe los 16 enfermos, 9 de ellos fueron hombres, la edad promedio fue 38,7 años al momento del trasplante, el tiempo promedio de diabetes fue 23,5+/-7.3 años. Todos los injertos pancreáticos fueron anastomosados a los vasos ilíacos comunes derechos en forma término-terminal y el duodeno fue anastomosado en 8 casos a la vejiga y en los últimos 8 al íleon. La sobrevida de los pacientes a 10 años fue del 81%, del injerto de páncreas el 82% y del injerto renal el 65%. La complicación post operatoria más importante fue sepsis, causando la muerte en 2 pacientes. Y entre las complicaciones de tipo inmunológico, 8 pacientes presentaron rechazo agudo, siendo manejados con terapia esteroidal de rescate o timo globulina.SUMMARYCombined kidney pancreas trasplant (PKT) in diabetes mellitus type 1 (DM1) patients with end stage renal disease, has proven to be an effective therapy to reach normoglicemia stability, with the consequent reduction of diabetes chronic complications an improvement in life expectancy and Quality of Life. Currently in selected cases of type 2 diabetes mellitus (DM2) patients with terminal nephropathy it has been proposed pancreas transplantation (PT) as an effective alternative. The results have been comparable between DM1 and DM2 patients. Patients who develop end stage renal disease secondary to type 1 or 2 DM, insulin dependent, non obese, should be considered for PKT. Clínica Las Condes has one of the mayor experience in Chile, in PKT, with comparable results to centers of great importance of International Level.ObjectiveTo show the situation of Pancreas Transplantation and its different modalities in the world. Also to show the experience in PKT at Clinica Las Condes, in 10 years patient's survival, in pancreas and kidney graft survival and complications and the surgical techniques.MethodInformation collected from 16 patients undergoing PKT at Clinica Las Condes between 1994-2014, analyzing the variables with descriptive statistics.ResultsOf the 16 patients, 9 were men, average age 38.7 years at transplant time; the average time of diabetes was 23.5+/-7.3 years. All pancreatic grafts were term-terminal to anastomosed the right iliac common vessels and duodenum was anastomosed is 8 cases to the bladder and in the last 8 to the ileum. Patient survival at 10 years was 81%, pancreatic graft 82% and 65% renal graft. The most relevant postoperative complication was sepsis, killing two patients. The immune complications were presented in eight patients. It was acute rejection, being managed with steroid therapy or thymoglobuline

The PLASMONX Project for advanced beam physics experiments

The Project PLASMONX is well progressing into its design phase and has entered as well its second phase of procurements for main components. The project foresees the installation at LNF of a Ti:Sa laser system (peak power > 170 TW), synchronized to the high brightness electron beam produced by the SPARC photo-injector. The advancement of the procurement of such a laser system is reported, as well as the construction plans of a new building at LNF to host a dedicated laboratory for high intensity photon beam experiments (High Intensity Laser Laboratory). Several experiments are foreseen using this complex facility, mainly in the high gradient plasma acceleration field and in the field of mono- chromatic ultra-fast X-ray pulse generation via Thomson back-scattering. Detailed numerical simulations have been carried out to study the generation of tightly focused electron bunches to collide with laser pulses in the Thomson source: results on the emitted spectra of X-rays are presented

Surface electromyography pattern of human swallowing

<p>Abstract</p> <p>Background</p> <p>The physiology of swallowing is characterized by a complex and coordinated activation of many stomatognathic, pharyngeal, and laryngeal muscles. Kinetics and electromyographic studies have widely investigated the pharyngeal and laryngeal pattern of deglutition in order to point out the differences between normal and dysphagic people. In the dental field, muscular activation during swallowing is believed to be the cause of malocclusion.</p> <p>Despite the clinical importance given to spontaneous swallowing, few physiologic works have studied stomatognathic muscular activation and mandibular movement during spontaneous saliva swallowing.</p> <p>The aim of our study was to investigate the activity patterns of the mandibular elevator muscles (masseter and anterior temporalis muscles), the submental muscles, and the neck muscles (sternocleidomastoid muscles) in healthy people during spontaneous swallowing of saliva and to relate the muscular activities to mandibular movement.</p> <p>Methods</p> <p>The spontaneous swallowing of saliva of 111 healthy individuals was analyzed using surface electromyography (SEMG) and a computerized kinesiography of mandibular movement.</p> <p>Results</p> <p>Fifty-seven of 111 patients swallowed without occlusal contact (SNOC) and 54 individuals had occlusal contact (SOC). The sternocleidomastoid muscles showed a slight, but constant activation during swallowing. The SEMG of the submental and sternocleidomastoid muscles showed no differences between the two groups. The SEMG of the anterior temporalis and masseter muscles showed significant differences (p < 0.0001). The duration of swallowing was significantly higher in the SNOC subjects. Gender and age were not related to electromyographic activation. Healthy SOC and SNOC behaved in different ways.</p> <p>Conclusion</p> <p>The data suggest that there is not a single "normal" or "typical" pattern for spontaneous saliva swallowing. The polygraph seemed a valuable, simple, non-invasive and reliable tool to study the physiology of swallowing.</p

Association of Mild Anemia with Cognitive, Functional, Mood and Quality of Life Outcomes in the Elderly: The “Health and Anemia” Study

BACKGROUND: In the elderly persons, hemoglobin concentrations slightly below the lower limit of normal are common, but scant evidence is available on their relationship with significant health indicators. The objective of the present study was to cross-sectionally investigate the association of mild grade anemia with cognitive, functional, mood, and quality of life (QoL) variables in community-dwelling elderly persons. METHODS: Among the 4,068 eligible individuals aged 65-84 years, all persons with mild anemia (n = 170) and a randomly selected sample of non-anemic controls (n = 547) were included in the study. Anemia was defined according to World Health Organization (WHO) criteria and mild grade anemia was defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men. Cognition and functional status were assessed using measures of selective attention, episodic memory, cognitive flexibility and instrumental and basic activities of daily living. Mood and QoL were evaluated by means of the Geriatric Depression Scale-10, the Short-Form health survey (SF-12), and the Functional Assessment of Cancer Therapy-Anemia. RESULTS: In univariate analyses, mild anemic elderly persons had significantly worse results on almost all cognitive, functional, mood, and QoL measures. In multivariable logistic regressions, after adjustment for a large number of demographic and clinical confounders, mild anemia remained significantly associated with measures of selective attention and disease-specific QoL (all fully adjusted p<.046). When the lower limit of normal hemoglobin concentration according to WHO criteria was raised to define anemia (+0.2 g/dL), differences between mild anemic and non anemic elderly persons tended to increase on almost every variable. CONCLUSIONS: Cross-sectionally, mild grade anemia was independently associated with worse selective attention performance and disease-specific QoL ratings

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO