There is a discrepancy in the literature as to whether authorising or refusing the recovery of organs for transplantation is of direct benefit to families in their subsequent grieving process. This ...study aims to explore the impact of the family interview to pose the option of posthumous donation and the decision to authorise or refuse organ recovery on the grieving process of potential donors' relatives.
A protocol for mixed methods, prospective cohort longitudinal study is proposed. Researchers do not randomly assign participants to groups. Instead, participants are considered to belong to one of three groups based on factors related to their experiences at the hospital. In this regard, families in G1, G2 and G3 would be those who authorised organ donation, declined organ donation or were not asked about organ donation, respectively. Their grieving process is monitored at three points in time: 1 month after the patient's death, when a semistructured interview focused on the lived experience during the donation process is carried out, 3 months and 9 months after the death. At the second and third time points, relatives' grieving process is assessed using six psychometric tests: State-Trait Anxiety Inventory, Beck Depression Inventory-II, Inventory of Complicated Grief, The Impact of Event Scale: Revised, Posttraumatic Growth Inventory and Connor-Davidson Resilience Scale. Descriptive statistics (means, SDs and frequencies) are computed for each group and time point. Through a series of regression models, differences between groups in the evolution of bereavement are estimated. Additionally, qualitative analyses of the semistructured interviews are conducted using the ATLAS.ti software.
This study involves human participants and was approved by Comité Coordinador de Ética de la Investigación Biomédica de Andalucía (CCEIBA) ID:1052-N-21. The results will be disseminated at congresses and ordinary academic forums. Participants gave informed consent to participate in the study before taking part.
The benefits of normothermic regional perfusion (NRP) in posttransplant outcomes after controlled donation after the determination of death by circulatory criteria (cDCD) has been shown in different ...international adult experiences. However, there is no information on the use of NRP in pediatric cDCD donors.
This is a multicenter, retrospective, observational cohort study describing the pediatric (<18 y) cDCD procedures performed in Spain, using either abdominal NRP or thoracoabdominal NRP and the outcomes of recipients of the obtained organs.
Thirteen pediatric cDCD donors (age range, 2-17 y) subject to abdominal NRP or thoracoabdominal NRP were included. A total of 46 grafts (24 kidneys, 11 livers, 8 lungs, 2 hearts, and 1 pancreas) were finally transplanted (3.5 grafts per donor). The mean functional warm ischemic time was 15 min (SD 6 min)' and the median duration of NRP was 87 min (interquartile range, 69-101 min). One-year noncensored for death kidney graft survival was 91.3%. The incidence of delayed graft function was 13%. One-year' noncensored-for-death liver graft survival was 90.9%. All lung and pancreas recipients had an excellent evolution. One heart recipient died due to a septic shock.
This is the largest experience of pediatric cDCD using NRP as graft preservation method. Although our study has several limitations, such as its retrospective nature and the small sample size, its reveals that NRP may increase the utilization of cDCD pediatric organs and offer optimal recipients' outcomes.
Normothermic regional perfusion (NRP) allows the in situ perfusion of organs with oxygenated blood in donation after the circulatory determination of death (DCDD). We aimed at evaluating the impact ...of NRP on the short‐term outcomes of kidney transplants in controlled DCDD (cDCDD). This is a multicenter, nationwide, retrospective study comparing cDCDD kidneys obtained with NRP versus the standard rapid recovery (RR) technique. During 2012–2018, 2302 cDCDD adult kidney transplants were performed in Spain using NRP (n = 865) or RR (n = 1437). The study groups differed in donor and recipient age, warm, and cold ischemic time and use of ex situ machine perfusion. Transplants in the NRP group were more frequently performed in high‐volume centers (≥90 transplants/year). Through matching by propensity score, two cohorts with a total of 770 patients were obtained. After the matching, no statistically significant differences were observed between the groups in terms of primary nonfunction (p = .261) and mortality at 1 year (p = .111). However, the RR of kidneys was associated with a significantly increased odds of delayed graft function (OR 1.97 95% CI 1.43–2.72; p < .001) and 1‐year graft loss (OR 1.77 95% CI 1.01–3.17; p = .034). In conclusion, compared with RR, NRP appears to improve the short‐term outcomes of cDCDD kidney transplants.
This multicenter, nationwide, retrospective study that uses propensity score matching shows lower delayed graft function and higher 1‐year graft survival rates for transplants using kidneys from controlled donation after circulatory determination of death donors procured with normothermic regional perfusion versus through rapid recovery.
Intensive Care to facilitate Organ Donation (ICOD) consists of the initiation or continuation of intensive care measures in patients with a devastating brain injury (DBI) in whom curative treatment ...is deemed futile and death by neurological criteria (DNC) is foreseen, to incorporate organ donation into their end-of-life plans. In this study we evaluate the outcomes of patients subject to ICOD and identify radiological and clinical factors associated with progression to DNC. In this first prospective multicenter study we tested by multivariate regression the association of clinical and radiological severity features with progression to DNC. Of the 194 patients, 144 (74.2%) patients fulfilled DNC after a median of 25 h (95% IQR: 17-44) from ICOD onset. Two patients (1%) shifted from ICOD to curative treatment, both were alive at discharge. Factors associated with progression to DNC included: age below 70 years, clinical score consistent with severe brain injury, instability, intracranial hemorrhage, midline shift ≥5 mm and certain types of brain herniation. Overall 151 (77.8%) patients progressed to organ donation. Based on these results, we conclude that ICOD is a beneficial and efficient practice that can contribute to the pool of deceased donors.
The upward trend in energy prices makes it necessary to find new ways to provide electricity to end consumers. The cooperation between different self-consumption facilities that form an energy ...community based on networked microgrids can be a more efficient way of managing the available renewable resources. However, the complexity of its associated control problem is bringing unresolved challenges from the point of view of its formulation. The optimization of energy exchanges among microgrids in the day-ahead electricity market needs to generate an optimal profile for the purchase and sale of energy with the main grid, being charged for any deviation from the schedule proposed in the regulation service market. Microgrids based on renewable generation are systems subject to inherited uncertainties in their energy forecast, whose interconnection generates a distributed control problem of stochastic systems. Microgrids are systems of subsystems that can integrate various components, such as hybrid energy storage systems (ESS), generating multiple terms to be included in the associated cost function for its optimization. In this work, the problem of solving complex distributed stochastic systems in the Mixed Logic Dynamic (MLD) framework is addressed, generating a tractable formulation to generate deterministic values for both exchange and output variables in interconnected systems subject to uncertainties using hybrid, stochastic and distributed Model Predictive Control (MPC) techniques.
Puedo asegurar que, en mi propia experiencia, ninguna de mis curaciones quirúrgicas más acertadas me ha dejado tan satisfecho como la curación de una fractura abierta grave. (Theodor Billroth)1. Se ...conoce que la fractura es abierta cuando su foco se comunica con el exterior a través de una herida, y constituye una urgencia que en la mayoría de los casos pone en peligro inminente la vida del paciente, si no se toma una conducta enérgica y responsable. Las fracturas abiertas son emergencias quirúrgicas que quizás deben pensarse como si fuesen amputaciones incompletas1,2.
Methylenetetrahydrofolate reductase (
) gene polymorphisms have been associated with overweight people and obesity. The goal of this study was to investigate the relationship of the
677C>T ...polymorphism with obesity and biochemical variables in young individuals of Mexico.
A total of 316 young individuals were included in the study, 172 with normal weight (NW) and 144 with over weight/obesity. Body mass index (BMI) was classified as NW, overweight, and obesity. Also, waist circumference was measured. Moreover, glucose, total cholesterol, and triglycerides were determined. Genotyping for
677C>T polymorphism was performed by the PCR-RFLP method.
There was no difference in the distribution of the
677C>T polymorphism between individuals with NW and overweight/obesity; neither when they were divided by overweight vs NW, nor when we contrasted obese vs NW. However, an analysis stratified by gender showed a significant protector effect of the TT genotype against obesity in males and elevated waist circumference in females. Also, overweight/obese individuals with TT genotype had less risk of high cholesterol or triglycerides than overweight/obese subjects with the other genotypes.
These results suggest that the
677T polymorphism might not be a risk factor for being overweight/obesity. Rather, on the basis of our results, this variant could be a protector effect. However, further large-scale population-based studies are still necessary to clarify the role of the
677C>T polymorphism in overweight, obesity, and lipid profile level.
El nematodo Panagrellus redivivus se cultivó en dos medios: uno con hojuelas de avena y otro con hojuelas de avena enriquecido con Spirulina sp., en recipientes de plástico de 15x15x5 cm de altura ...con 200 g de hojuela de avena y 300 mL de agua purificada. Se utilizaron 5 g de Spirulina en el medio. Se utilizó el programa SYSTAT versión 10.2 para el análisis estadístico; para determinar las diferencias significativas entre los tratamientos, se usó un análisis de varianza unidireccional (ANDEVA) con una confiabilidad a= 0,05. Los resultados obtenidos muestran que el crecimiento de las poblaciones de nematodos en el medio enriquecido con Spirulina presentó la mayor abundancia de individuos a la segunda semana del cultivo, mientras que la población que creció en el medio de avena, presentó su mayor registro a la quinta semana del cultivo y no alcanzó el número de organismos que tuvo la población cultivada en el medio con Spirulina. El contenido de aminoácidos de las poblaciones de ambos medios se comparó y se cotejaron con los reportados para Artemia alimentada con Spirulina, observándose que en la mayoría de los aminoácidos las cantidades fueron mayores en P. redivivus cultivado en el medio con Spirulina. La composición de ácidos grasos en los nematodos cultivados en ambos medios presentó diferencias significativas entre los ácidos grasos linoleico, araquidónico y eicosapentenoico los cuales fueron en mayor porcentaje que los reportados en P. redivivus cultivado en avena con aceite de girasol. Estos datos demuestran que la cianobacteria Spirulina sp. acelera el crecimiento de la población del nematodo y permite la presencia de aminoácidos y ácidos grasos, y hace que estos nematodos puedan cubrir los requerimientos nutritivos de larvas de peces dulceacuícolas, sin embargo, se requieren estudios que lo demuestren.
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