227 research outputs found
Immunological and Immunogenetic Parameters on the Diversity of Ocular Toxoplasmosis: Evidence to Support Morphological Criteria to Classify Retinal/Retinochoroidal Scar Lesions in Epidemiologic Surveys
Clinical outcomes of temporary mechanical circulatory support as a direct bridge to heart transplantation: a nationwide Spanish registry
Background: In Spain, listing for high-urgent heart transplantation is allowed for critically ill candidates not weanable from temporary mechanical circulatory support (T-MCS). We sought to analyse the clinical outcomes of this strategy.
Methods and results: We conducted a case-by-case, retrospective review of clinical records of 291 adult patients listed for high-urgent heart transplantation under temporary devices from 2010 to 2015 in 16 Spanish institutions. Survival after listing and adverse clinical events were studied. At the time of listing, 169 (58%) patients were supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO), 70 (24%) on temporary left ventricular assist devices (T-LVAD) and 52 (18%) on temporary biventricular assist devices (T-BiVAD). Seven patients transitioned from VA-ECMO to temporary ventricular assist devices while on the waiting list. Mean time on T-MCS was 13.1 ± 12.6 days. Mean time from listing to transplantation was 7.6 ± 8.5 days. Overall, 230 (79%) patients were transplanted and 54 (18.6%) died during MCS. In-hospital postoperative mortality after transplantation was 33.3%, 11.9% and 26.2% for patients bridged on VA-ECMO, T-LVAD and T-BiVAD, respectively (P = 0.008). Overall survival from listing to hospital discharge was 54.4%, 78.6% and 55.8%, respectively (P = 0.002). T-LVAD support was independently associated with a lower risk of death over the first year after listing (hazard ratio 0.52, 95% confidence interval 0.30â0.92). Patients treated with VA-ECMO showed the highest incidence rate of adverse clinical events associated with T-MCS.
Conclusion: Temporary devices may be used to bridge critically ill candidates directly to heart transplantation in a setting of short waiting list times, as is the case of Spain. In our series, bridging with T-LVAD was associated with more favourable outcomes than bridging with T-BiVAD or VA-ECMO
Partial diallel to evaluate the combining ability for economically important traits of papaya
Empleo del balón de contrapulsación intraaórtico como puente al trasplante cardiaco en España: resultados del estudio ASIS-TC
IntroducciĂłn y objetivos
En España, el balón de contrapulsación intraaórtico (BCIA) se ha usado frecuentemente como puente al trasplante cardiaco (TxC) urgente. El propósito es analizar los resultados de esta estrategia.
MĂ©todos
Se realizĂł una revisiĂłn retrospectiva caso por caso de los registros clĂnicos de 281 pacientes adultos listados para TxC urgente asistidos con BCIA en 16 hospitales españoles entre 2010 y 2015. Se analizaron la supervivencia antes y despuĂ©s del trasplante y la incidencia de eventos adversos.
Resultados
Se trasplantĂł a 194 pacientes (69%; IC95%, 63, 3-74, 4) y 20 (7, 1%; IC95%, 4, 4-10, 8) fallecieron durante la asistencia, cuya duraciĂłn media fue de 10, 9 ± 9, 7 dĂas. El BCIA se explantĂł antes de obtener un Ăłrgano a 32 pacientes (11, 4%). En 35 pacientes (12, 5%; IC95%, 8, 8-16, 9) se implantĂł un dispositivo de asistencia circulatoria mecĂĄnica completa. El tiempo en la lista de espera urgente se incrementĂł desde 5, 9 ± 6, 3 dĂas en 2010 hasta 15 ± 11, 7 dĂas en 2015 (p = 0, 001). La supervivencia a 30 dĂas y a 1 y 5 años tras el TxC fue del 88, 1% (IC95%, 85, 7-90, 5), 76% (IC95%, 72, 9-79, 1) y 67, 8% (IC95%, 63, 7-71, 9) respectivamente. La tasa de incidencia de eventos adversos mayores âdisfunciĂłn del BCIA, ictus, hemorragia o infecciĂłnâ durante la asistencia fue de 26 (IC95%, 20, 6-32, 4) eventos/1.000 pacientes-dĂa. La tasa de incidencia de explante del BCIA por complicaciones fue de 7, 2 (IC95%, 4, 5-10, 8) casos/1.000 pacientes-dĂa.
Conclusiones
En el contexto de listas de espera cortas, el BCIA puede utilizarse como puente al TxC urgente con resultados aceptables. Esta estrategia conlleva una incidencia significativa de eventos adversos.
Introduction and objectives: In Spain, intra-aortic balloon pump (IABP) has been used frequently as a bridge to urgent heart transplant (HT). We sought to analyze the clinical outcomes of this strategy. Methods: We conducted a case-by-case, retrospective review of clinical records of 281 adult patients listed for urgent HT under IABP support in 16 Spanish institutions from 2010 to 2015. Pre- and post-transplant survival and adverse clinical events were analyzed. Results: A total of 194 (69%, 95%CI, 63.3-74.4) patients were transplanted and 20 (7.1%, 95%CI, 4.4-10.8) died during a mean period of IABP support of 10.9 ± 9.7 days. IABP support was withdrawn before an organ became available in 32 (11.4%) patients. Thirty-five (12.5%, 95%CI, 8.8-16.9) patients transitioned from IABP to full-support mechanical devices. Mean urgent waiting list time increased from 5.9 ± 6.3 days in 2010 to 15 ± 11.7 days in 2015 (P =.001). Post-transplant survival rates at 30-days, 1-year, and 5-years were 88.1% (95%CI, 85.7-90.5), 76% (95%CI, 72.9-79.1), and 67.8% (95%CI, 63.7-71.9), respectively. The incidence rate of major adverse clinical outcomesâdevice dysfunction, stroke, bleeding or infectionâduring IABP support was 26 (95%CI, 20.6-32.4) episodes per 1000 patient-days. The incidence rate of IABP explantation due to complications was 7.2 (95%CI, 4.5-10.8) cases per 1000 patient-days. Conclusions: In a setting of short waiting list times, IABP can be used to bridge candidates to urgent HT with acceptable postoperative results, but there were significant rates of adverse clinical events during support. Full English text available from:www.revespcardiol.org/e
Complicaciones infecciosas relacionadas con la asistencia circulatoria mecĂĄnica de corta duraciĂłn en candidatos a trasplante cardiaco urgente
IntroducciĂłn y objetivos
El uso de dispositivos de asistencia circulatoria mecĂĄnica de corta duraciĂłn como puente a trasplante es frecuente en España. Se desconocen la epidemiologĂa y la repercusiĂłn de las complicaciones infecciosas en estos pacientes.
MĂ©todos
DescripciĂłn sistemĂĄtica de la epidemiologĂa y anĂĄlisis de la repercusiĂłn pronĂłstica de las complicaciones infecciosas en un registro multicĂ©ntrico retrospectivo de pacientes tratados con dispositivos de asistencia circulatoria mecĂĄnica de corta duraciĂłn como puente a trasplante cardiaco urgente entre 2010 y 2015 en 16 hospitales españoles.
Resultados
Se estudiĂł a 249 pacientes; 87 (34, 9%) de ellos tuvieron un total de 102 infecciones. La vĂa respiratoria fue la localizaciĂłn mĂĄs frecuente (n = 47; 46, 1%). En 78 casos (76, 5%) se obtuvo confirmaciĂłn microbiolĂłgica; se aislaron en total 100 gĂ©rmenes causales, con predominio de bacterias gramnegativas (n = 58, 58%). Los pacientes con complicaciones infecciosas presentaron mayor mortalidad durante el periodo de asistencia circulatoria mecĂĄnica (el 25, 3 frente al 12, 3%; p = 0, 009) y menor probabilidad de recibir un trasplante (el 73, 6 frente al 85, 2%; p = 0, 025) que los pacientes sin infecciĂłn. La mortalidad posoperatoria tras el trasplante fue similar en ambos grupos (con infecciĂłn, el 28, 3%; sin infecciĂłn, el 23, 4%; p = 0, 471).
Conclusiones
Los pacientes tratados con dispositivos de asistencia circulatoria mecĂĄnica de corta duraciĂłn como puente al trasplante cardiaco estĂĄn expuestos a un alto riesgo de complicaciones infecciosas, las cuales se asocian con una mayor mortalidad en espera del Ăłrgano.
Introduction and objectives
Short-term mechanical circulatory support is frequently used as a bridge to heart transplant in Spain. The epidemiology and prognostic impact of infectious complications in these patients are unknown.
Methods
Systematic description of the epidemiology of infectious complications and analysis of their prognostic impact in a multicenter, retrospective registry of patients treated with short-term mechanical devices as a bridge to urgent heart transplant from 2010 to 2015 in 16 Spanish hospitals.
Results
We studied 249 patients, of which 87 (34.9%) had a total of 102 infections. The most frequent site was the respiratory tract (n = 47; 46.1%). Microbiological confirmation was obtained in 78 (76.5%) episodes, with a total of 100 causative agents, showing a predominance of gram-negative bacteria (n = 58, 58%). Compared with patients without infection, those with infectious complications showed higher mortality during the support period (25.3% vs 12.3%, P = .009) and a lower probability of receiving a transplant (73.6% vs 85.2%, P = .025). In-hospital posttransplant mortality was similar in the 2 groups (with infection: 28.3%; without infection: 23.4%; P = .471).
Conclusions
Patients supported with temporary devices as a bridge to heart transplant are exposed to a high risk of infectious complications, which are associated with higher mortality during the organ waiting period
Avaliação do teste de imunofluorescĂȘncia indireta para diagnĂłstico da filariose bancroftiana usando a microfilĂĄria de W. bancrofti como antĂgeno, em Recife-PE, Brasil
Sistemas de efluxo multidrogas em Escherichia coli e uso de inibidores como possĂveis adjuvantes na terapia da mastite bovina
Measurement of the cross section for isolated-photon plus jet production in pp collisions at âs=13 TeV using the ATLAS detector
The dynamics of isolated-photon production in association with a jet in protonâproton collisions at a centre-of-mass energy of 13 TeV are studied with the ATLAS detector at the LHC using a dataset with an integrated luminosity of 3.2 fbâ1. Photons are required to have transverse energies above 125 GeV. Jets are identified using the anti- algorithm with radius parameter and required to have transverse momenta above 100 GeV. Measurements of isolated-photon plus jet cross sections are presented as functions of the leading-photon transverse energy, the leading-jet transverse momentum, the azimuthal angular separation between the photon and the jet, the photonâjet invariant mass and the scattering angle in the photonâjet centre-of-mass system. Tree-level plus parton-shower predictions from Sherpa and Pythia as well as next-to-leading-order QCD predictions from Jetphox and Sherpa are compared to the measurements
Measurement of the View the tt production cross-section using eÎŒ events with b-tagged jets in pp collisions at âs = 13 TeV with the ATLAS detector
This paper describes a measurement of the inclusive top quark pair production cross-section (ÏttÂŻ) with a data sample of 3.2 fbâ1 of protonâproton collisions at a centre-of-mass energy of âs = 13 TeV, collected in 2015 by the ATLAS detector at the LHC. This measurement uses events with an opposite-charge electronâmuon pair in the final state. Jets containing b-quarks are tagged using an algorithm based on track impact parameters and reconstructed secondary vertices. The numbers of events with exactly one and exactly two b-tagged jets are counted and used to determine simultaneously ÏttÂŻ and the efficiency to reconstruct and b-tag a jet from a top quark decay, thereby minimising the associated systematic uncertainties. The cross-section is measured to be:
ÏttÂŻ = 818 ± 8 (stat) ± 27 (syst) ± 19 (lumi) ± 12 (beam) pb,
where the four uncertainties arise from data statistics, experimental and theoretical systematic effects, the integrated luminosity and the LHC beam energy, giving a total relative uncertainty of 4.4%. The result is consistent with theoretical QCD calculations at next-to-next-to-leading order. A fiducial measurement corresponding to the experimental acceptance of the leptons is also presented
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