To assess the incidence of surgical complications after lung transplantation and its influence on early mortality and long-term survival.
Retrospective review of 792 lung transplants (LTs) performed ...from 1994 to 2022. Among them, 769 with complete data were selected. Patients with and without surgical complications were compared by univariable and multivariable analyses.
There were 385 single LTs (50%), 371 double LTs (48%), 8 bilobar LTs (1%), and 5 combined liver LTs (1%). Two hundred forty-nine patients presented surgical complications (32%) as follows: bronchial (n = 61), vascular (n = 55), pneumothorax (n = 33), and phrenic nerve palsy (n = 22). Thirty-day mortality (noncomplicated vs complicated) was 57 (41%) vs 80 (59%), P < .001. Transplants for bronchiectasis (58%), pulmonary hypertension (50%), and re-transplants (78%) presented more surgical complications (P < .001). Double LT (40%), bilobar LT (88%), and combined liver LT (100%) presented more surgical complications (P < .001). Complicated recipients were younger (49 ± 15 vs 45 ± 17 years; P = .001), with longer ischemic times (429 ± 67 vs 450 ± 76 min 2nd graft; P = .007), and required extracorporeal support (ECLS) more often (43% vs 57%; P < .001). Survival at 1, 5, 10, 15, and 20 years (noncomplicated vs complicated): 78%, 63%, 52%, 41%, 31% vs 52%, 42%, 35%, 26%, 22%; P < .001). Predictors of mortality were the need for ECLS (odds ratio OR 4.14; P < .001), postoperative ventilation (hours) (OR 1.01; P < .001), and vascular complications (OR 4.78; P < .001).
Surgical complications remain an important source of morbidity and mortality after lung transplantation. Complex surgical procedures requiring ECLS develop frequent surgical complications needing long postoperative ventilation that are associated with early mortality and poorer long-term survival.
(1) Background: Malignancies are an important cause of mortality after solid organ transplantation. The purpose of this study was to analyze the incidence of malignancies in patients receiving lung ...transplants (LT) and their influence on patients' survival. (2) Methods: Review of consecutive LT from 1994 to 2021. Patients with and without malignancies were compared by univariable and multivariable analyses. Survival was compared with Kaplan-Meier and Cox regression analysis. (3) Results: There were 731 LT malignancies developed in 91 patients (12.4%) with related mortality of 47% (
= 43). Native lung cancer, digestive and hematological malignancies were associated with higher lethality. Malignancies were more frequent in males (81%;
= 0.005), transplanted for emphysema (55%;
= 0.003), with cyclosporine-based immunosuppression (58%;
< 0.001), and receiving single LT (65%;
= 0.011). Survival was worse in patients with malignancies (overall) and with native lung cancer. Risk factors for mortality were cyclosporine-based immunosuppression (OR 1.8; 95%CI: 1.3-2.4;
< 0.001) and de novo lung cancer (OR 2.6; 95%CI: 1.5-4.4;
< 0.001). (4) Conclusions: Malignancies are an important source of morbidity and mortality following lung transplantation that should not be neglected. Patients undergoing single LT for emphysema are especially at higher risk of mortality due to lung cancer in the native lung.
Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent disorders in the child and adolescent population, with a known impact on learning, social relations and quality of life. ...However, the lifestyle habits of patients with this disorder have been poorly studied.
A total of 160 children and adolescents, aged between 6 and 16 years, participated in the study. Half of them were treatment-naïve patients with a clinical diagnosis of ADHD according to DSM-IV-TR criteria, and without comorbidities. The remaining 80 participants were typically developing (TD) controls without known neurodevelopmental or psychiatric disorders. Parents of all participants completed a questionnaire about their children´s lifestyle habits (e.g, daily hours of sleep, media use and study).
The groups had a similar socioeconomic background and did not differ with respect to age and sex distribution. However, patients with ADHD spent more time than TD children studying, and less time watching TV, playing video games, using computers and playing with other people. They also slept fewer hours per night than children and adolescents with TD. ADHD and TD groups spent similar time reading, listening to music and playing sports.
The results of this study suggest that children and adolescents with ADHD have different lifestyle habits compared to age- and sex-matched controls. These findings are not explained by comorbid disorders or medication/ psychological treatment.
Standard medical treatment for patent ductus arteriosus (PDA) closure has been indomethacin/ibuprofen or surgical ligation. Up to date, new strategies have been reported with paracetamol. The aim of ...this study was to present our experience with intravenous paracetamol for closing PDA in preterm neonates presenting contraindication to ibuprofen or ibuprofen had failed and no candidates for surgical ligation because of huge instability.
We conducted a retrospective case series study in a neonatal intensive care unit from a tertiary hospital. 9 preterm infants ≤32 weeks of gestational age with hemodynamically significant PDA (hsPDA) were enrolled. They received 15 mg/kg/6h intravenous paracetamol for ductal closure. Demographic data and transaminase levels before and after treatment were collected.
30 preterm babies were diagnosed of hsPDA. 11/30 received ibuprofen with closure in 81.1%. 9 received intravenous paracetamol mainly due to bleeding disorders or thrombocytopenia. Successful closure on paracetamol was achieved in seven of nine babies (77.7%). There was a significant increase in transaminase levels in two patients. They required no treatment for normalization.
Paracetamol is an effective option in closure PDA. It should be a first-line therapeutic option when there are contraindications for ibuprofen treatment. Transaminases must be checked during treatment.
This study aimed to evaluate the concurrent validity of two different inertial measurement units for measuring spatiotemporal parameters during running on a treadmill, by comparing data with a ...high-speed video analysis (VA) at 1,000 Hz. Forty-nine endurance runners performed a running protocol on a treadmill at comfortable velocity (i.e., 3.25 ± 0.36 m.s-1). Those wearable devices (i.e., Stryd™ and RunScribe™ systems) were compared to a high-speed VA, as a reference system for measuring spatiotemporal parameters (i.e. contact time CT, flight time FT, step frequency SF and step length SL) during running at comfortable velocity. The pairwise comparison revealed that the Stryd™ system underestimated CT (5.2%, p < 0.001) and overestimated FT (15.1%, p < 0.001) compared to the VA; whereas the RunScribe™ system underestimated CT (2.3%, p = 0.009). No significant differences were observed in SF and SL between the wearable devices and VA. The intra class correlation coefficient (ICC) revealed an almost perfect association between both systems and high-speed VA (ICC > 0.81). The Bland-Altman plots revealed heteroscedasticity of error (r2 = 0.166) for the CT from the Stryd™ system, whereas no heteroscedasticity of error (r2 < 0.1) was revealed in the rest of parameters. In conclusion, the results obtained suggest that both foot pods are valid tools for measuring spatiotemporal parameters during running on a treadmill at comfortable velocity. If the limits of agreement of both systems are considered in respect to high-speed VA, the RunScribe™ seems to be a more accurate system for measuring temporal parameters and SL than the Stryd™ system.
Patients' decisions on prostate cancer (PCa) opportunistic screening may vary. This study aimed to assess how demographic and health-related characteristics may influence knowledge and decisions ...regarding PCa screening.
A cross-sectional survey was conducted among men aged over 40, randomly sampled from the Spanish population, 2022. The survey underwent development and content validation using a modified Delphi method and was administered via telephone. Binomial logistic regression was used to explore the relationship between respondents' characteristics and participants' knowledge and practices concerning PCa and the PSA test.
Out of 1,334 men, 1,067 (80%) respondents were interviewed with a mean age of 58.6 years (sd 11.9). Most had secondary or university studies (787, 73.8%) and 61 (5.7%) self-reported their health status as bad or very bad. Most of the respondents (1,018, 95.4%) had knowledge regarding PCa with nearly 70% expressed significant concern about its potential development (720, 70.8%), particularly among those under 64 years (p = 0.001). Out of 847 respondents, 573 (67.7%) reported that they have knowledge regarding the PSA test: 374 (65.4%) reported receiving information from a clinicians, 324 (86.6%) information about the benefits of the test and 189 (49,5%) about its risks, with differences based on educational background. In a multivariable analysis (adjusted for age, educational level and previous prostate problems), respondents with higher levels of education were more likely to have higher knowledge regarding the PSA test (OR 1.75, 95%CI 1.24-2.50, p<0.001).
Although most of the patients reported to have knowledge regarding PCa, half of the interviewed men reported knowledge about PSA test. Differences in knowledge prostate cancer screening and undesirable consequences highlight the need to develop and provide tailored information for patients.
This study aimed to determine the minimum time required for assessing spatiotemporal variability during continuous running at different submaximal velocities and, thereby, the number of steps ...required. Nineteen trained endurance runners performed an incremental running protocol, with a 3-min recording period at 10, 12, 14 and 16 km/h. Spatiotemporal parameters (contact and flight times, step length and step frequency) were measured using the OptoGait system and step variability was considered for each parameter, in terms of within-participants standard deviation (SD) and coefficient of variation (CV%). Step variability was considered over six different durations at every velocity tested: 0–10 s, 0–20 s, 0–30 s, 0–60 s, 0–120 s and 0–180 s. The repeated measures ANOVA revealed no significant differences in the magnitude of the four spatiotemporal parameters between the recording intervals at each running velocity tested (p ≥ 0.05, ICC > 0.90). The post-hoc analysis confirmed no significant differences in step variability (SD and CV% of each spatiotemporal parameter at any velocity tested) between measurements. The Bland-Altman limits of agreement method showed that longer recording intervals yield smaller systematic bias, random errors, and narrower limits of agreement, regardless of running velocity. The results suggest that the duration of the recording period required to estimate spatiotemporal variability plays an important role in the accuracy of the measurement, regardless of running velocity (10–16 km/h).
•Increased slope gradient during running caused spatiotemporal adaptations.•No significant differences in the adaptations between amateur and trained athletes.•Kleg was strongly associated with ...spatiotemporal parameters during level running.•Kvert was associated with spatiotemporal adaptations at increasing gradients.
The current evidence leaves certain questions unanswered, including whether well-trained athletes adapt to different slope gradients in the same way as amateurs, and whether stiffness influences spatiotemporal adaptations during uphill running.
This study aimed to determine the effect of different slope gradients (0%–11%) on spatiotemporal gait characteristics during running, taking into account the influence of athletic level, vertical and leg stiffness.
Male endurance runners (12 amateurs, 10 highly-trained) performed a running test on a motorized treadmill. The running velocity was set at 12 km/h, and participants completed six different running conditions (0, 3, 5, 7, 9 and 11% gradients). Spatiotemporal parameters were measured using the OptoGait system. Vertical (Kvert) and leg (Kleg) stiffness were calculated according to the sine-wave method.
A 2 (amateur; highly-trained) × 6 (running conditions) ANOVA found no significant between-group differences in spatiotemporal parameters at any gradient (P ≥ 0.05); however, significant Kvert and Kleg differences (P < 0.05) were found within both groups with increasing gradients. Stepwise linear regression analysis showed that Kleg was strongly associated with contact time (R2 = 0.797, P < 0.001), whereas Kvert was associated with spatiotemporal adaptations to different slope gradients (R2 = 0.547, P = 0.002).
An increased slope gradient (0–11%) at a given running velocity (12 km.h−1) caused spatiotemporal adaptations (i.e., increased CT and SF and decreased FT, SL and SA) regardless of the athletic level of the runner, although a non-significant trend differentiated the adaptations between the amateur and highly-trained groups. The results also indicated that leg stiffness plays a key role in the characteristics of spatiotemporal gait during level running, whereas vertical stiffness is strongly associated with spatiotemporal adaptations when running uphill.
Species of Balaenophilus are the only harpacticoid copepods that exhibit a widespread, obligate association with vertebrates, i.e., B. unisetus with whales and B. manatorum with marine turtles and ...manatees. In the western Mediterranean, juveniles of the loggerhead sea turtle, Caretta caretta are the only available hosts for B. manatorum, which has been found occurring at high prevalence (>80%) on them. A key question is how these epibionts are transmitted from host to host. We investigated this issue based on experiments with live specimens of B. manatorum that were cultured with turtle skin. Specimens were obtained from head-started hatchlings of C. caretta from the western Mediterranean. Hatched nauplii crawled only on rough substrates and lacked the ability to swim. Only copepodites IV and V, and adults, were able to perform directional swimming. Legs 2, 3 and 4 played a major role in swimming and were only well-developed in these stages. Nauplii reared in wells with turtle skin readily fed on this item. Late copepodites and adults also fed on turtle skin but did not consume other potential food items such as fish skin, baleen plates or planktonic algae. Evidences suggest that the transmission of B. manatorum should rely on hosts' bodily contacts and/or swimming of late developmental stages between spatially close hosts. The possibility of long-ranged dispersal is unlikely for two reasons. First, all developmental stages seem to depend on turtle skin as a food resource. Second, the average clutch size of ovigerous females was small (< 70 eggs) for free-living phases to successfully contact turtles that occur at very low densities (< 0.6 turtles·km-2) in the western Mediterranean. The high prevalence of B. manatorum in loggerhead turtles in this area raises the question whether these turtles have contacts, or tend to closely aggregate, more than is currently believed.
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