Postoperative surgical complications after lung transplantation

This is a review article on the main postoperative complications after lung transplantation: airways complications, vascular complications, pleural complications, surgical wound complications, and abdominal complications. Incidence data, severity, and major management regimens are reported. Postoperative complications after lung transplantation result in a significantly increased morbidity and mortality, with early diagnosis and therapy being extremely important.

WITHDRAWN:Postoperative surgical complications after lung transplantation

This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.09.007. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Maternal administration of flutamide during late gestation affects the brain and reproductive organs development in the rat male offspring

We have previously demonstrated that male rats exposed to stress during the last week of gestation present age-specific impairments of brain development. Since the organization of the fetal developing brain is subject to androgen exposure and prenatal stress was reported to disrupt perinatal testosterone surges, the aim of this research was to explore whether abnormal androgen concentrations during late gestation affects the morphology of the prefrontal cortex (PFC), hippocampus (HPC) and ventral tegmental area (VTA), three major areas that were shown to be affected by prenatal stress in our previous studies. We administered 10-mg/kg/day of the androgen receptor antagonist flutamide (4'nitro-3'-trifluoromethylsobutyranilide) or vehicle injections to pregnant rats from days 15-21 of gestation. The antiandrogenic effects of flutamide were confirmed by the analysis of androgen-dependent developmental markers: flutamide-exposed rats showed reduced anogenital distance, delay in the completion of testis descent, hypospadias, cryptorchidism and atrophied seminal vesicles. Brain morphological studies revealed that prenatal flutamide decreased the number of MAP2 (a microtubule-associated protein type 2, present almost exclusively in dendrites) immunoreactive neuronal processes in all evaluated brain areas, both in prepubertal and adult offspring, suggesting that prenatal androgen disruption induces long-term reductions of the dendritic arborization of several brain structures, affecting the normal connectivity between areas. Moreover, the number of tyrosine hydroxylase (TH)-immunopositive neurons in the VTA of prepubertal offspring was reduced in flutamide rats but reach normal values at adulthood. Our results demonstrate that the effects of prenatal flutamide on the offspring brain morphology resemble several prenatal stress effects suggesting that the mechanism of action of prenatal stress might be related to the impairment of the organizational role of androgens on brain development.

Pharmacogenomics in colorectal cancer: a genome-wide association study to predict toxicity after 5-fluorouracil or FOLFOX administration

The development of genotyping technologies has allowed for wider screening for inherited causes of variable outcomes following drug administration. We have performed a genome-wide association study (GWAS) on 221 colorectal cancer (CRC) patients that had been treated with 5-fluorouracil (5-FU), either alone or in combination with oxaliplatin (FOLFOX). A validation set of 791 patients was also studied. Seven SNPs (rs16857540, rs2465403, rs10876844, rs10784749, rs17626122, rs7325568 and rs4243761) showed evidence of association (pooled P-values 0.020, 9.426E-03, 0.010, 0.017, 0.042, 2.302E-04, 2.803E-03) with adverse drug reactions (ADRs). This is the first study to explore the genetic basis of inter-individual variation in toxicity responses to the administration of 5-FU or FOLFOX in CRC patients on a genome-wide scale.

Real-time simulation of biological soft tissues: a PGD approach

We introduce here a novel approach for the numerical simulation of nonlinear, hyperelastic soft tissues at kilohertz feedback rates necessary for haptic rendering. This approach is based upon the use of proper generalized decomposition techniques, a generalization of PODs. Proper generalized decomposition techniques can be considered as a means of a priori model order reduction and provides a physics-based meta-model without the need for prior computer experiments. The suggested strategy is thus composed of an offline phase, in which a general meta-model is computed, and an online evaluation phase in which the results are obtained at real time. Results are provided that show the potential of the proposed technique, together with some benchmark test that shows the accuracy of the method.

Quantitative analysis of pheromone-binding protein specificity

Many pheromones have very low water solubility, posing experimental difficulties for quantitative binding measurements. A new method is presented for determining thermodynamically valid dissociation constants for ligands binding to pheromone-binding proteins, using β-cyclodextrin as a solubilizer and transfer agent. The method is applied to LUSH, a Drosophila odorant-binding protein that binds the pheromone 11-cis vaccenyl acetate (cVA). Refolding of LUSH expressed in Escherichia coli was assessed by measuring N-phenyl-1-naphthylamine (NPN) binding and Förster resonance energy transfer between LUSH tryptophan 123 (W123) and NPN. Binding of cVA was measured from quenching of W123 fluorescence as a function of cVA concentration. The equilibrium constant for transfer of cVA between β-cyclodextrin and LUSH was determined from a linked equilibria model. This constant, multiplied by the β-cyclodextrin-cVA dissociation constant, gives the LUSH-cVA dissociation constant: ∼100 nM. It was also found that other ligands quench W123 fluorescence. The LUSH-ligand dissociation constants were determined to be ∼200 nM for the silk moth pheromone bombykol and ∼90 nM for methyl oleate. The results indicate that the ligand-binding cavity of LUSH can accommodate a variety ligands with strong binding interactions. Implications of this for the Laughlin, Ha, Jones and Smith model of pheromone reception are discussed.

Regulation of the tumor suppressor PTEN by SUMO

The crucial function of the PTEN tumor suppressor in multiple cellular processes suggests that its activity must be tightly controlled. Both, membrane association and a variety of post-translational modifications, such as acetylation, phosphorylation, and mono- and polyubiquitination, have been reported to regulate PTEN activity. Here, we demonstrated that PTEN is also post-translationally modified by the small ubiquitin-like proteins, small ubiquitin-related modifier 1 (SUMO1) and SUMO2. We identified lysine residue 266 and the major monoubiquitination site 289, both located within the C2 domain required for PTEN membrane association, as SUMO acceptors in PTEN. We demonstrated the existence of a crosstalk between PTEN SUMOylation and ubiquitination, with PTEN-SUMO1 showing a reduced capacity to form covalent interactions with monoubiquitin and accumulation of PTEN-SUMO2 conjugates after inhibition of the proteasome. Moreover, we found that virus infection induces PTEN SUMOylation and favors PTEN localization at the cell membrane. Finally, we demonstrated that SUMOylation contributes to the control of virus infection by PTEN.

Neuroma under the fifth metatarsal head. A retrospective study

This retrospective study was carried out over 83 surgical cases at the distal portion of the fifth metatarsal, compromising the treatment of tailor's bunion, fifth metatarsal overload and the concomitant presence of both pathologies in some cases. Neuromas were founded under the fifth metatarsal head in 18 of the cases studied (21.7%). The results look at whether if there is an association between different fifth metatarsal pathologies and the presence of neuromas and found a significant association between the appearance of neuromas in patients with the same metatarsal overload, especially if it is accompanied by a tailor's bunion pathology.

Real-time simulation of surgery by reduced-order modeling and X-FEM techniques

This paper describes a novel approach for the simulation of surgery by a combined technique of model order reduction and extended finite element method (X-FEM) methods. Whereas model order reduction techniques employ globally supported (Ritz) shape functions, a combination with X-FEM methods on a locally superimposed patch is developed for cutting simulation without remeshing. This enables to obtain models with very few degrees of freedom that run under real-time constrains even for highly non-linear tissue constitutive equations. To show the performance of the technique, we studied an application to refractive surgery in the cornea.

Impact on patient care time and tumor stage of a program for fast diagnostic and treatment of colorectal cancer

OBJECTIVES

To evaluate the effectiveness of a fast track diagnosis and treatment program for colorectal cancer (CRC) in reducing the diagnosis to treatment interval (DTI) and tumor stage. To analyze the association between DTI and tumor stage.

METHODS

A quasi-experimental study with a control group was conducted, and 156 incident cases of CRC referred through a preferential pathway between July 2005 and December 2008 in a tertiary hospital were included, after excluding those treated urgently, treated by endoscopic polypectomy only or having periodic colonoscopies. A control group of 156 patients was randomly selected from all the patients referred through habitual pathways, frequency matched by tumor location, age and year of entry. Data was analyzed with multivariate linear and logistic regression.

RESULTS

Mean DTI was 39.20 days (95% CI: 36.21-42.42) for fast track patients and 63.40 days (95% CI: 57.08-70.41) for controls (p < 0.001), and this difference persisted after multivariate analysis. The odds of having a DTI longer than 30 days was 4.79 (95% CI: 2.19-10.51) higher for controls. There were no significant differences in tumor stage according to the pathway followed. Independently of the track followed, a DTI longer than 30 days was associated with advanced tumor stages for colon cancer, while it was associated with low stages for rectal cancer.

CONCLUSIONS

The PDTR strategy is effective in reducing DTI and may reduce patients' and relatives' anxiety. However, it is far from reaching the DTI recommended. The achieved reduction of the delay has no impact on tumor stage.

Metabolitos nitrogenados en el hámster dorado alimentado a base de harina de lombriz (eisenia spp.)

Se evaluó en el plasma sanguíneo del hámster dorado (Mesocrisetus auratus L.) el contenido total de proteína (PT), albúmina (Alb), globulinas (Glb), urea (U), ácido úrico (AU), creatinina (Ct) y los niveles de transaminasas (glutámico oxal-acética (TGO) y glutámico-pirúvica (TGP)) a partir del consumo de dietas (proteína bruta; PB= 13,5-19,6%) con harina de lombriz roja (HL) (Eisenia spp.) y dos alimentos convencionales (Coneja-rina®; PB= 11,4% y Ratarina®; PB= 21,1%). La concentración de PT, Alb, Glb y Ct osciló entre 5-6; 2-3; 2-3 g/dL y 0,3-0,4 mg/dL, respectivamente, sin observarse diferencias significativas entre las dietas (p>0,05). En todo el experimento los niveles de U y AU fluctuaron entre 23-101 y 3-9 mg/dL, respectivamente, en función del nivel de PB, la inclusión de HL y el momento de muestreo. Los niveles de transaminasas fueron elevados y variables, acorde al valor proteico de las dietas (TGO: 101-699 y TGP: 54-890 UI/L). Se comprobó que los contenidos séricos de PT, Glb, Alb y Ct fueron independientes de la inclusión de HL y los niveles de PB de cada alimento; mientras que la concentración de U (R2= 0,509*), TGO (R2= 0,661**) y TGP (R2= 0,524*) se encontraron relacionados con los valores proteicos de las raciones, y el contenido de U (R2= 0,502*) y AU (R2= 0,531*) con la inclusión de HL. La adición de HL en proporciones de 24, 27 y 30% a dietas formuladas para M. auratus aumenta significativamente los valores normales de U, AU y transaminasas.

Respirometric assays of two different MBR (microfiltration and ultrafiltration) to obtain kinetic and stoichiometric parameters

A comparison of two different medium scale MBRs (ultrafiltration and microfiltration) using respirometric methods has been achieved. The ultrafiltration membrane plant (0.034 microm pore size) maintained recirculation sludge flow at seven times the influent flow, and membranes were backwashed every 5 min and chemically cleaned weekly. The microfiltration membrane plant (0.4 microm pore size) maintained recirculation sludge flow at four times the influent flow, membrane-relax was applied after the production phase and membranes were chemically cleaned in the event of high trans-membrane pressure. Both technologies showed a similar performance with regard to heterotrophic kinetic and stoichiometric parameters and organic matter effluent concentrations. The influent was characterized by means of its COD fractions and the average removal percentages for COD concentrations were around 97% for both plants in spite of influent COD fluctuation, temperature variations and sludge retention time (SRT) evolution. Both SRT evolution and temperature affect the heterotrophic yield (Y(H)) and the decay coefficient (bH) in the same range for both plants. Y(H) values of over 0.8 mg COD/mg COD were obtained during the unsteady periods, while under steady state conditions these values fell to less than 0.4 mg COD/mg COD. bH by contrast reached values of less than 0.05 d(-1).

Bronchoscopic lung volume reduction in a single-lung transplant recipient with natal lung hyperinflation: a case report

After single lung transplantation for emphysema native lung hyperinflation is a common complication that may cause respiratory failure. Herein we have reported satisfactory bronchoscopic lung volume reduction in a left single-lung transplant recipient with native lung hyperinflation, who suffered from Medical Research Council (MRC) class 3 dyspnea and chest pain. Three endobronchial valves (Zephyr; Emphasys Medical, Redwood, Calif, United States) were placed into the segmental bronchi of the right upper lobe, using videobronchoscopy under general anesthesia. Postoperative chest computed tomography revealed subsegmental atelectasis in that lobe. The clinical benefit was an improved MRC dyspnea class from 3 to 2, which was still present at 4 months after the procedure, although there were no remarkable changes in spirometric parameters.

Identification of III-N nanowire growth kinetics via a marker technique

By using a marker technique based on nanowire (NW) heterostructure, we have identified the Ga-limited and N-limited GaN NW growth regimes, which are shifted in comparison to those in two-dimensional GaN layers. The results show that the Ga atoms diffusing along NW sidewalls have a significant contribution to the NW vertical growth. By reducing the substrate temperature, Ga-rich conditions locally activate the lateral growth. In contrast to Ga atoms, the contribution of Al and N adatom diffusion to the NW vertical growth is negligible. Finally, the control of GaN/AlN heterostructures in NWs is demonstrated.

Phase mapping of aging process in InN nanostructures: oxygen incorporation and the role of the zinc blende phase

Uncapped InN nanostructures undergo a deleterious natural aging process at ambient conditions by oxygen incorporation. The phases involved in this process and their localization is mapped by transmission electron microscopy (TEM)-related techniques. The parent wurtzite InN (InN-w) phase disappears from the surface and gradually forms a highly textured cubic layer that completely wraps up a InN-w nucleus which still remains from the original single-crystalline quantum dots. The good reticular relationships between the different crystals generate low misfit strains and explain the apparent easiness for phase transformations at room temperature and pressure conditions, but also disable the classical methods to identify phases and grains from TEM images. The application of the geometrical phase algorithm in order to form numerical moiré mappings and RGB multilayered image reconstructions allows us to discern among the different phases and grains formed inside these nanostructures. Samples aged for shorter times reveal the presence of metastable InN:O zinc blende (zb) volumes, which act as the intermediate phase between the initial InN-w and the most stable cubic In(2)O(3) end phase. These cubic phases are highly twinned with a proportion of 50:50 between both orientations. We suggest that the existence of the intermediate InN:O-zb phase should be seriously considered to understand the reason for the widely scattered reported fundamental properties of thought to be InN-w, as its bandgap or superconductivity.

A clomazone immunoassay to study the environmental fate of the herbicide in rice (Oryza sativa) agriculture

The environmental impact of rice agriculture is poorly studied in developing countries, mainly due to limitations of the analytical capacity. Here, we report the development of a clomazone enzyme-linked immunosorbent assay as a fast and cost-effective tool to monitor the dissipation of this herbicide along the harvest. Antibodies were prepared using different strategies of hapten conjugation, and the best hapten/antibody pair was selected. It proved to be a reliable tool to measure the herbicide in the 2.0-20 ng/mL range in field samples, with excellent correlation with high-performance liquid chromatography results. The assay was used to study the dissipation of the herbicide in the floodwater of experimental rice paddies in Uruguay. Large differences in the residual amounts of herbicide were observed depending on the flooding practices. Because of its robustness and simplicity, the assay may be useful to delineate and monitor management practices that can contribute to minimizing the release of the herbicide in the environment.

Surgical risk factors associated with lung transplantation

BACKGROUND

Despite years of experience with lung transplantation, perioperative morbidity rates remain high. The objective of this study was to analyze our series of lung transplant recipients, seeking to identify possible intra- and postoperative risk factors associated with mortality.

PATIENTS AND METHODS

We performed a descriptive, retrospective study of 224 consecutive patients undergoing lung transplantation over a period of 112 months; we excluded retransplant procedures. We gathered details of the surgical procedure and postoperative period in the recovery unit. Univariate analysis using the chi-square test identified variables associated with the incidence of mortality.

RESULTS

From 1999 to 2008, we performed 224 lung transplants, including 66% in men and 34% in women. Their overall mean age was 49.9 +/- 13.5 years. The conditions that led to transplantation were pulmonary fibrosis (38.4%); chronic obstructive pulmonary disease emphysema (29%); cystic fibrosis (10.7%); bronchiectasis (8.9%); pulmonary hypertension (3.1%); and other diseases (9.9%). A total of 124 (55.4%) patients underwent single and 100 (44.6%) received sequential bilateral lung transplantations. Surgical risk factors were identified in 51.3% of the cases, the most frequent being hemorrhage (25.3%), followed by severe pulmonary hypertension (14.7%) and cardiopulmonary bypass (12.1%). Greater perioperative mortality was detected among patients with surgical risk factors, namely, significantly related to cardiopulmonary bypass, pulmonary hypertension, and air leak. A higher frequency of surgical risk factors was observed among patients with bilateral lung transplantations and longer procedures, but they were not associated with greater perioperative mortality. Reoperation was necessary in 16 patients (7.2%), mainly owing to bleeding, it was not significantly related to mortality risk.

CONCLUSIONS

The incidence of surgical risk factors in lung transplantation was high, especially in bilateral lung transplantations and prolonged procedures. Postoperative bleeding requiring reoperation was not frequent and not associated with increased preoperative mortality in our series.