Impacto del equipo multidisciplinario “ECMO Team” en el pronóstico de pacientes sometidos a membrana de oxigenación extracorpórea venoarterial por choque cardiogénico o paro cardiorrespiratorio refractario

Objectives. Veno-arterial Extracorporeal membrane oxygenation (VA ECMO) is a salvage intervention in patients with cardiogenic shock (CS), and cardiac arrest  (CA) refractory to standard therapies. The design of ECMO Teams has achieved the standardization of processes, although its impact on survival and prognosis is unknown. Objective: We aimed to analyze whether the creation of an ECMO Team has modified the prognosis of patients undergoing VA ECMO for refractory CS or CA. Materials and methods. We conducted a single-center retrospective cohort study. Patients with refractory CS or CA who underwent VA ECMO were divided in two consecutive periods: from 2014 to April 2019 (pre-ECMO T) and from May 2019 to December 2022 (Post ECMO T). The main outcomes were survival on ECMO, in-hospital survival, complications, and annual ECMO volume. Results. Eighty-three patients were included (36 pre-ECMO T and 47 post-ECMO T). The mean age was 53 +/-13 years. The most common reason for  device indication was different:  postcardiotomy shock (47.2%) pre-ECMO T and refractory cardiogenic shock (29.7%) post-ECMO T. The rate of extracorporeal  cardiopulmonary resuscitation was 14.5%.  The median duration of VA ECMO was longer after ECMO team implementation: 8 days (IQR 5-12.5) vs. five days (IQR 2-9, p=0.04). Global in-hospital survival was 45.8% (38.9% pre-ECMO T vs. 51.1% post-ECMO T; p=0.37),  and the survival rate from VA ECMO was 60.2% (55.6% pre-ECMO T vs 63.8% post-ECMO T; p= 0.50). The volume of VA ECMO implantation was significantly higher in the post-ECMO team period (13.2  +/3.5 per year vs. 6.5 +/-3.5 per year, p: 0.02). The rate of complications was similar in both groups. Conclusions. After the implementation of an ECMO team, there was no statistical difference in the survival rate of patients treated with VA ECMO. However, a significant increase in the number of patients supported per year was observed after the implementation of this multidisciplinary team. Post-ECMO T, the most common reason for device indication was cardiogenic shock, with longer run times and a higher rate of extracorporeal cardiopulmonary resuscitation.Introducción. La oxigenación por membrana extracorpórea venoarterial (ECMO VA) es una intervención de rescate utilizada en choque cardiogénico (CC) o paro cardiorrespiratorio (PCR) refractario. La creación de equipos multidisciplinarios ECMO Teams (ECMO T), ha permitido la estandarización de procesos, aunque se desconoce su impacto en  sobrevida y pronóstico. Objetivo: El propósito es analizar si la creación del ECMO Team ha modificado el pronóstico de los pacientes sometidos a ECMO VA por CC o PCR refractario. Materiales y métodos. Estudio observacional, unicéntrico, retrospectivo, que comparó los resultados del implante de ECMO VA por CC o PCR refractario en dos períodos consecutivos: entre 2014 y abril de 2019 (pre-ECMO T), y entre mayo de 2019 y diciembre de 2022 (pos-ECMO T). Como puntos finales, se evaluó la sobrevida intrahospitalaria y en ECMO, complicaciones, y volumen de ECMO anual. Resultados. Se analizaron 83 pacientes (36 pre-ECMO T, y 47 pos-ECMO T), con edad de 53 +/-13 años. La causa más frecuente de asistencia fue: poscardiotomía pre-ECMO T (47,2%) y CC refractario pos-ECMO T (29,7%). En el 14,5% se realizó ECMO en PCR. La mediana de asistencia fue mayor pos-ECMO T (8 días, RIC 5-12,5 vs. 5 días, RIC 2-9 pre-ECMO T; p:0,04). La supervivencia al alta fue del 45,8% (38,9% pre-ECMO T vs. 51,1% pos-ECMO T;p:0,37) y en ECMO VA del 60,2% (55,6% pre-ECMO T y 63,8% pos-ECMO T; p:0,50). El volumen de ECMO VA fue significativamente mayor pos-ECMO T (13,2+/3,5 por año vs. 6,5+/-3,5 por año, p: 0,02). La tasa de complicaciones fue similar en ambos períodos. Conclusiones.Luego de la implementación del ECMO Team no se observó una diferencia significativa en la sobrevida en pacientes asistidoscon ECMO VA. Sin embargo, luego de su creación se evidenció un aumento significativo del volumen de pacientes asistidos por año. Pos-ECMO T se asistió mayor número de pacientes por choque cardiogénico, en PCR y con más días de asistencia

Isolation and characterization of the biotin genes of Escherichia coli K-12

DNA containing the biotin gene cluster, bioABFCD, of E. coli K-12 has been isolated from the EcoRI cleavage products of λbiot124-10 phage DNA and subsequently characterized by electron microscopic studies. The biotin-DNA fragment obtained after EcoRI cleavage of the λbiot124-10 DNA measures 18.7% λ DNA length (approx. 9000 base pairs). In addition to the biotin genes, it contains 4.75% and 3.08% λ phage DNA at the left and right endpoints of the bioABFCD cluster, respectively. The two bio promoter sites of the divergently transcribed biotin genes have been visualized under the electron microscope by binding RNA polymerase holoenzyme to the biotin DNA fragment. The two promoters are located at 41% and 43% length of the DNA fragment from its left endpoint. In vitro transcription of RNA from the biotin-DNA fragment has been visualized with the electron microscope, but so far no simultaneously transcribing "RNA:DNA" loops of the divergently oriented genes have been observed

Model-based diagnosis for a gas-liquid separation unit

info:eu-repo/semantics/publishe

131I-induced changes in rat thyroid gland function

Therapeutic doses of 131I administered to thyrotoxic patients may cause thyroid failure. The present study used a rat model to determine thyroid function after the administration of different doses of 131I (64-277 µCi). Thirty male Fisher rats in the experimental group and 30 in the control group (untreated) were followed for 6 months. The animals were 4 months old at the beginning of the experiment and were sacrificed at an age of 9 months. Hormone concentration was determined before 131I administration (4-month-old animals) and three times following 131I administration, when the animals were 7, 8, and 9 months old. The thyroid glands were removed and weighed, their volume was determined and histopathological examination was performed at the end of the experiment. Significant differences in serum triiodothyronine and thyroid-stimulating hormone concentration, measured at the age of 7, 8, and 9 months, were found in the experimental group. During aging of the animals, the concentration of thyroxin fell from 64.8 ± 8.16 to 55.0 ± 6.1 nM in the control group and from 69.4 ± 6.9 to 25.4 ± 3.2 nM in the experimental group. Thyroid gland volume and weight were significantly lower in the experimental than in the control group. Thyroid glands from the experimental group showed hyaline thickness of the blood vessel wall, necrotic follicles, a strong inflammatory reaction, and peeling of necrotic cells in the follicles. In conclusion, significant differences in hormone levels and histopathological findings indicated prolonged hypothyroidism after 131I administration to rats, which was not 131I dose dependent

Valor pronóstico del índice leucoglucémico en el postoperatorio de cirugía cardíaca

Resumen: Introducción y objetivos: El índice leucoglucémico (ILG) ha mostrado ser un buen marcador pronóstico en diversos escenarios de la medicina crítica. Sin embargo, existe escasa evidencia respecto a su valor predictivo en el postoperatorio de cirugía cardíaca. El objetivo de este estudio fue analizar el valor pronóstico del ILG en pacientes cursando el posoperatorio de cirugía cardíaca. Métodos: Se analizó retrospectivamente la base de datos de cirugía cardíaca, completada prospectivamente entre 2010 y 2015. Se evaluó el ILG en cuartiles y se utilizó curva de ROC para determinar un valor de corte. El objetivo final primario analizado fue un combinado de mortalidad intrahospitalaria o bajo gasto. Como objetivos finales secundarios se evaluaron la incidencia de mortalidad intrahospitalaria, la fibrilación auricular, el bajo gasto (BGC), la insuficiencia renal aguda (IRA), la necesidad de diálisis y la duración de estancia hospitalaria. Resultados: Se analizó a 2.743 pacientes a los que se les realizó cirugía cardíaca. La media de edad fue de 66 años (DE 11,8). El objetivo final primario en los diferentes cuartiles analizados fue significativamente creciente (el 5,4, el 7,1, el 7,7 y el 10,1%, respectivamente; p: 0,025). Respecto a los objetivos finales secundarios, el ILG fue predictor de BGC, IRA y necesidad de diálisis. El mejor valor de corte pronóstico del ILG para el objetivo final primario fue de 2.000. En un modelo de regresión logística, el ILG se asoció independientemente a mayor tasa de mortalidad intrahospitalaria y/o bajo gasto (OR: 1,40, IC del 95%, 1,01-1,94, p: 0,03). Conclusiones: EL ILG demostró ser un predictor de peor evolución en pacientes durante el postoperatorio de cirugía cardíaca. Abstract: Introduction and background: The leuko-glycaemic index (LGI) has been associated with a poor prognosis in many critical care settings. However there is no evidence regarding the prognostic value in postoperative cardiac surgery. The aim of this study was to analyse the prognostic value of LGI in postoperative cardiac surgery. Methods: A study was performed using the Cardiac Surgery database, prospectively completed between 2010 and 2015. The LGI was analysed in quartiles according to 25, 50, and 75 percentile values. The ROC curve was used to determine a cut-off value. The primary endpoint was in-hospital death or low cardiac output (LCO). Secondary endpoints included in-hospital death, atrial fibrillation (AF), LCO, acute kidney injury (AKI), dialysis requirement, and length of hospital stay. Results: The study evaluated 2743 patients undergoing cardiac surgery. The mean age was 66 (SD 11.8). Presence of the primary endpoint significantly increased per LGI quartile (5.4%, 7.1%, 7.7% and 10.1%; P=.025). The LGI was also associated with an increased occurrence of LCO, AKI and dyalisis requirement. The best prognostic cut-off value for the primary endpoint was 2000. In a multivariate logistic regression model, LGI was independently associated with in-hospital death or LCO (OR: 1.40, 95% CI; 1.01-1.94, P=.03). Conclusion: The LGI was an independent predictor of adverse outcomes in postoperative of cardiac surgery. Palabras clave: Índice leucoglucémico, Cirugía cardíaca, Respuesta inflamatoria postoperatoria, Leucocitosis, Hiperglucemia, Keywords: Leuko-glycaemic index, Cardiac surgery, Postoperative systemic inflammatory response syndrome, Leukocytosis, Hyperglycaemi