Heart transplantation using allografts from older donors: multicenter study results

33rd Annual Meeting and Scientific Session of the International Society for Heart and Lung Transplantation, April 24–27, 2013, Montreal, Canada.[Abstract] Background. The lengthy waiting time for heart transplantation is associated with high mortality. To increase the number of donors, new strategies have emerged, including the use of hearts from donors ≥50 years old. However, this practice remains controversial. The aim of this study was to evaluate outcomes of patients receiving heart transplants from older donors. Methods. We retrospectively analyzed 2,102 consecutive heart transplants in 8 Spanish hospitals from 1998 to 2010. Acute and overall mortality were compared in patients with grafts from donors ≥50 years old versus grafts from younger donors. Results. There were 1,758 (84%) transplanted grafts from donors < 50 years old (Group I) and 344 (16%) from donors ≥50 years old (Group II). Group I had more male donors than Group II (71% vs 57%, p = 0.0001). The incidence of cardiovascular risk factors was higher in older donors. There were no differences in acute mortality or acute rejection episodes between the 2 groups. Global mortality was higher in Group II (rate ratio, 1.40; 95% confidence interval, 1.18–1.67; p = 0.001) than in Group I. After adjusting for donor cause of death, donor smoking history, recipient age, induction therapy, and cyclosporine therapy, the differences lost significance. Group II had a higher incidence of coronary allograft vasculopathy at 5 years (rate ratio, 1.67; 95% confidence interval, 1.22–2.27; p = 0.001). Conclusions. There were no differences in acute and overall mortality after adjusting for confounding factors. However, there was a midterm increased risk of coronary allograft vasculopathy with the use of older donors. Careful selection of recipients and close monitoring of coronary allograft vasculopathy are warranted in these patients.Instituto de Salud Carlos III; RD12/0042/00

Obsolescence in the neighbourhood of Nuestra Señora del Carmen

Actualmente, áreas urbanas donde habita un importantísimo sector poblacional están afectadas por una compleja problemática que se materializa en cuestiones arquitectónicas (desencaje tipológico, deficiencias técnicas, deterioro físico), urbanísticas (aislamiento, carencias funcionales, degradación del espacio público) y sociales (desempleo, segregación, conflictividad). El análisis del estado de obsolescencia de la barriada de El Carmen ha sido el punto de inicio de este trabajo de investigación. A partir de indicadores de obsolescencia socioeconómicos y físicos, anteriormente definidos por el proyecto de investigación «Intervención en barriadas residenciales obsoletas: manual de buenas prácticas» (G-GI3001/IDIH), financiado por la Unión Europea –Fondos FEDER– y gestionado por la Consejería de Fomento y Vivienda de la Junta de Andalucía, se ha establecido la situación de la barriada con referencia a valores máximos y mínimos, hallados a través del estudio de un número representativo de barriadas andaluzas. Tras la valoración del estado de obsolescencia de la barriada, se profundizó en su estudio a través de la comparación del cumplimiento de las recomendaciones establecidas como buenas prácticas en la publicación Intervención en barriadas residenciales obsoletas. Manual de buenas prácticas. Esta verificación permitió la elaboración de un diagnóstico pormenorizado basado en el análisis de los diferentes aspectos atendidos por las buenas prácticas, donde se evaluaban las deficiencias de El Carmen a escala urbana y arquitectónica, y dentro de estas, en diferentes categorías, siendo las urbanas: compacidad, conectividad, zonas verdes, funcionalidad, seguridad e inclusividad; y las arquitectónicas: hibridación, diversidad y flexibilidad, comunidad y accesibilidad. Esta evaluación detallada de las deficiencias y potencialidades de la barriada establecía los fundamentos para la definición de criterios y estrategias de intervención. Estos criterios de intervención tenían como base una selección de las buenas prácticas más adecuadas de acuerdo con las circunstancias halladas en la barriada, sistematizando las actuaciones que priorizan la atención de aspectos primordiales o que actúan mitigando carencias graves. Los criterios que se establecen son: sostenibilidad, la mejora de la calidad de vida de sus residentes y la atracción de nueva población a la barriada. Respondiendo a este estudio y la definición de criterios se proponen actuaciones estratégicas englobadas en cuatro líneas de trabajo: relación con la ciudad y su contexto, cualificación del espacio público y dotaciones existentes, cualificación de edificios existentes y actualización tipológica.Today, a number of high-occupancy urban areas are being affected by a complex problem that materialises in architectural issues (typological mismatch, technical deficiencies, physical deterioration), urban planning issues (isolation, functional inadequacies, deterioration of public space) and social issues (unemployment, segregation, conflict). Analysing the state of obsolescence of the neighbourhood of El Carmen was the starting point of this research project. Using socio-economic and physical obsolescence indicators established in an earlier research project–“Intervention in Obsolete Residential Neighbourhoods: Manual of Best Practices” (G-GI3001/IDIH), funded by the ERDF and managed by the Regional Ministry of Public Works and Housing of Andalusia–the situation of this neighbourhood was defined with reference to minimum and maximum values identified by studying a representative number of Andalusian neighbourhoods. After assessing the neighbourhood’s state of obsolescence, it was then studied to determine the degree of compliance with the best practices recommended in the publication Intervención en barriadas residenciales obsoletas. Manual de buenas prácticas. This verification made it possible to come up with a detailed diagnosis based on the analysis of different aspects addressed in that manual of best practices, evaluating the urban and architectural deficiencies of El Carmen and subdividing each into different categories. Urban deficiencies included compactness, connectivity, green areas, functionality, safety and inclusiveness; and architectural deficiencies were hybridisation, diversity, flexibility, community and accessibility. This detailed analysis of the neighbourhood’s shortcomings and potential improvements provided a solid foundation for defining intervention criteria and strategies. Those intervention criteria were based on a selection of the best practices deemed most appropriate in light of the neighbourhood’s current situation, systematising actions that address the most important aspects or attempt to mitigate serious deficiencies. The established criteria are as follows: sustainability, improving the residents’ quality of life, and bringing new residents to the neighbourhood. Based on this study and the defined criteria, strategic courses of action were proposed in four general areas: relationship with the city and its context, qualification of existing facilities and public spaces, qualification of existing buildings, and typological modernisation

Obtención, evaluación y manipulación del semen de verraco en una unidad de producción mexicana

Córdova Izquierdo, A.; Pérez Gutiérrez, J.F.; Méndez Hernández, W.; Villa Mancera, A.E.; Huerta Crispín, R.: Obtención, evaluación y manipulación del semen de verraco en una unidad de producción mexicana. Rev. vet. 26: 1, 69-74, 201

Funerary practices or food delicatessen? Human remains with anthropic marks from the Western Mediterranean Mesolithic

The identification of unarticulated human remains with anthropic marks in archaeological contexts normally involves solving two issues: a general one associated with the analysis and description of the anthropic manipulation marks, and another with regard to the interpretation of their purpose. In this paper we present new evidence of anthropophagic behaviour amongst hunter-gatherer groups of the Mediterranean Mesolithic. A total of 30 human remains with anthropic manipulation marks have been found in the Mesolithic layers of Coves de Santa Maira (Castell de Castells, Alicante, Spain), dating from ca. 10.2-9 cal ky BP. We describe the different marks identified on both human and faunal remains at the site (lithic, tooth, percussion and fire marks on bone cortex). As well as describing these marks, and considering that both human and faunal remains at the site present similar depositional and taphonomic features, this paper also contextualizes them within the archaeological context and subsistence patterns described for Mesolithic groups in the region. We cannot entirely rule out the possibility that these practices may be the result of periodic food stress suffered by the human populations. These anthropophagic events at the site coincide with a cultural change at the regional Epipalaeolithic-Mesolithic transition

Data on clinical characteristics of a heart failure patients’ cohort with reduced ejection fraction and analysis of the circulating values of five different heart failure biomarkers; high sensitivity troponin T, galectin-3, C-terminal propeptide of type I procollagen, soluble AXL and BNP

AbstractIn this article, the full description of a heart failure with reduced ejection fraction (HF_REF) cohort of 192 patients is provided. Tables with the baseline demographic, prior history, ECG parameters, echocardiographic parameters, laboratory values and pharmacological treatment of these patients are included. Also, the quartile values of the analyzed circulating biomarkers: high sensitivity Troponin T (hs-TnT), galectin-3 (Gal-3), C-terminal propeptide of type I procollagen (CICP), soluble AXL (sAXL) and Brain Natriuretic Peptide (BNP) are given. The main demographic and clinical features of the patients’ subgroups that have hs-TnT, Gal-3, CICP or BNP above the third quartile are described. Tables with Pearson correlation analysis of the HF_REF patients’ biomarker levels are included. And Pearson correlation analysis of the HF_REF patients’ hs-TnT, Gal-3, CICP levels with patients’ biochemical parameters, blood count and inflammation parameters are also described. These data are related to the research articles (AXL receptor tyrosine kinase is increased in patients with heart failure (M. Batlle, P. Recarte-Pelz, E. Roig, M.A. Castel, M. Cardona, M. Farrero, et al., 2014) [1] and Use of serum levels of high sensitivity troponin T, galectin-3 and C-terminal propeptide of type I procollagen at long term follow-up in Heart Failure patients with reduced ejection fraction: comparison with soluble AXL and BNP (M. Batlle, B. Campos, M. Farrero, M. Cardona, B. González, M.A. Castel, et al., 2016) [2]

Registro Español de Trasplante Cardiaco: XXXI Informe Oficial de la Asociación de Insuficiencia Cardiaca de la Sociedad Española de Cardiología

[Abstract] Introduction and objectives. The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019. Methods. We describe the clinical characteristics and outcomes of heart transplants performed in Spain in 2019, as well as trends in this procedure from 2010 to 2018. Results. In 2019, 300 transplants were performed (8794 since 1984; 2745 between 2010 and 2019). Compared with previous years, the most notable findings were the decreasing rate of urgent transplants (38%), and the consolidation of the type of circulatory support prior to transplant, with an almost complete disappearance of counterpulsation balloon (0.7%), stabilization in the use of extracorporeal membrane oxygenation (9.6%), and an increase in the use of ventricular assist devices (29.0%). Survival from 2016 to 2018 was similar to that from 2013 to 2015 (P=.34). Survival in both these periods was better than that from 2010 to 2012 (P=.002 and P=.01, respectively). Conclusions. Heart transplant activity has remained stable during the last few years, as have outcomes (in terms of survival). There has been a trend to a lower rate of urgent transplants and to a higher use of ventricular assist devices prior to transplant.[Resumen] Introducción y objetivos. Se presentan las características clínicas y los resultados de los trasplantes cardiacos realizados en España con la actualización correspondiente a 2019. Métodos. Se describen las características clínicas y los resultados de los trasplantes cardiacos realizados en 2019, así como las tendencias de estos en el periodo 2010-2018. Resultados. En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a años previos, los cambios más llamativos son el descenso hasta el 38% de los trasplantes realizados en código urgente, y la consolidación en el cambio de asistencia circulatoria pretrasplante, con la práctica desaparición del balón de contrapulsación (0,7%), la estabilización del uso del oxigenador extracorpóreo de membrana (9,6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p=0,34), y ambas mejores que la del trienio 2010-2012 (p=0,002 y p=0,01 respectivamente). Conclusiones. Se mantienen estables tanto la actividad del trasplante cardiaco en España como los resultados en supervivencia en los últimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoría con dispositivos de asistencia ventricular

Impact of short-term mechanical circulatory support with extracorporeal devices on postoperative outcomes after emergency heart transplantation: data from a multi-institutional Spanish cohort

[Abstract] Objectives. We sought to investigate the potential impact of preoperative short-term mechanical circulatory support (MCS) with extracorporeal devices on postoperative outcomes after emergency heart transplantation (HT). Methods. We conducted an observational study of 669 patients who underwent emergency HT in 15 Spanish hospitals between 2000 and 2009. Postoperative outcomes of patients bridged to HT on short-term MCS (n = 101) were compared with those of the rest of the cohort (n = 568). Short-term MCS included veno-arterial extracorporeal membrane oxygenators (VA-ECMOs, n = 23), and both pulsatile-flow (n = 53) and continuous-flow (n = 25) extracorporeal ventricular assist devices (VADs). No patient underwent HT on intracorporeal VADs. Results. Preoperative short-term MCS was independently associated with increased in-hospital postoperative mortality (adjusted odds-ratio 1.75, 95% CI 1.05–2.91) and overall post-transplant mortality (adjusted hazard-ratio 1.60, 95% CI 1.15–2.23). Rates of major surgical bleeding, cardiac reoperation, postoperative infection and primary graft failure were also significantly higher among MCS patients. Causes of death and survival after hospital discharge were similar in MCS and non-MCS candidates. Increased risk of post-transplant mortality affected patients bridged on pulsatile-flow extracorporeal VADs (adjusted hazard-ratio 2.21, 95% CI 1.48–3.30) and continuous-flow extracorporeal VADs (adjusted hazard-ratio 2.24, 95% CI 1.20–4.19), but not those bridged on VA-ECMO (adjusted hazard-ratio 0.51, 95% CI 0.21–1.25). Conclusions. Patients bridged to emergency HT on short-term MCS are exposed to an increased risk of postoperative complications and mortality. In our series, preoperative bridging with VA-ECMO resulted in comparable post-transplant outcomes to those of patients transplanted on conventional support

Preoperative INTERMACS profiles determine postoperative outcomes in critically ill patients undergoing emergency heart transplantation: analysis of the Spanish National Heart Transplant Registry

[Abstract] Background. Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar association exists in patients undergoing emergency heart transplantation. Methods and Results. By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 (P<0.001). INTERMACS 1 patients also presented the highest incidence of primary graft failure (1: 31.3%, 2: 22.3%, 3–4: 21.8%; P=0.03) and postoperative need for dialysis (1: 33.2%, 2: 18.9%, 3–4: 21.5%; P<0.001). Adjusted odds-ratios for in-hospital postoperative mortality were 4.38 (95% confidence interval, 2.51–7.66) for profile 1 versus 3 to 4, 2.49 (95% confidence interval, 1.56–3.97) for profile 1 versus 2, and 1.76 (95% confidence interval, 1.02–3.03) for profile 2 versus 3 to 4. Long-term survival after hospital discharge was not influenced by preoperative INTERMACS profiles. Conclusions. Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2

Stellar populations of bulges at low redshift

This chapter summarizes our current understanding of the stellar population properties of bulges and outlines important future research directions.Comment: Review article to appear in "Galactic Bulges", Editors: Laurikainen E., Peletier R., Gadotti D., Springer Publishing. 34 pages, 12 figure

The QUIJOTE experiment: project overview and first results

QUIJOTE (Q-U-I JOint TEnerife) is a new polarimeter aimed to characterize the polarization of the Cosmic Microwave Background and other Galactic and extragalactic signals at medium and large angular scales in the frequency range 10-40 GHz. The multi-frequency (10-20~GHz) instrument, mounted on the first QUIJOTE telescope, saw first light on November 2012 from the Teide Observatory (2400~m a.s.l). During 2014 the second telescope has been installed at this observatory. A second instrument at 30~GHz will be ready for commissioning at this telescope during summer 2015, and a third additional instrument at 40~GHz is now being developed. These instruments will have nominal sensitivities to detect the B-mode polarization due to the primordial gravitational-wave component if the tensor-to-scalar ratio is larger than r=0.05.Comment: To appear in "Highlights of Spanish Astrophysics VIII", Proceedings of the XI Scientific Meeting of the Spanish Astronomical Society, Teruel, Spain (2014