The IASLC Lung Cancer Staging Project: Proposals for the Revision of the M Descriptors in the Forthcoming 9th edition of the TNM Classification of Lung Cancer

INTRODUCTION

This study analyzed all metastatic categories of the current tumor, node, and metastasis (TNM) classification of non-small cell lung cancer to propose modifications of the M component in the next edition (9th) of the classification.

METHODS

A database of 124,581 patients diagnosed between 2011 and 2019 was established; of these, 14,937 with NSCLC in stage IVA-IVB were available for this analysis. Overall survival was calculated using the Kaplan-Meier method, and prognosis assessed using multivariable-adjusted Cox proportional hazards regression.

RESULTS

The 8th edition M categories demonstrated good discrimination in the 9th edition dataset. Assessments demonstrated that an increasing number of metastatic lesions was associated with decreasing prognosis; because this appears to be a continuum and adjustment for confounders was not possible, no specific lesion number was deemed appropriate for stage classification. Among tumors involving multiple metastases, decreasing prognosis was seen with an increasing number of organ systems involved. Multiple assessments, including after adjustment for potential confounders, demonstrated that patients with M1c patients who had metastases to a single extrathoracic organ system were prognostically distinct from M1c patients who had involvement of multiple extrathoracic organ systems.

CONCLUSIONS

These data validate the 8th edition M1a and M1b categories, that are recommended to be maintained. We propose the M1c category be divided into M1c1 (involvement of a single extrathoracic organ system) and M1c2 (involvement of multiple extrathoracic organ systems).

Toward sustainability and resilience in Chilean cities: Lessons and recommendations for air, water, and soil issues

Achieving sustainability and resilience depends on the conciliation of environmental, social, and economic issues integrated into a long-term perspective to ensure communities flourish. Many nations are transitioning toward both objectives, while at the same time addressing structural concerns that have not allowed them to look after the environment in the past. Chile is one of these nations dealing with such challenges within a particular administrative context, an increasing environmental awareness, and a set of unique and complex geophysical boundaries that impose a plethora of hazards for cities, ecosystems, and human health. This paper presents recent accomplishments and gaps, mostly from an environmental perspective, on issues related to air pollution, the urban water cycle, and soil contamination, in the path being followed by Chile toward urban sustainability and resilience. The focus is on the bonds between cities and their geophysical context, as well as the relationships between environmental issues, the built environment, and public health. The description and diagnosis are illustrated using two cities as case studies, Temuco and Copiapó, whose socioeconomic, geographical, and environmental attributes differ considerably. Particulate matter pollution produced by the residential sector, drinking water availability, wastewater treatment, stormwater management, and soil contamination from the mining industry are discussed for these cities. Overall, the case studies highlight how tackling these issues requires coordinated actions in multiple areas, including regulatory, information, and financial incentive measures. Finally, the policy analysis discusses frameworks and opportunities for Chilean cities, which may be of interest when conceiving transitional paths toward sustainability and resilience for other cities elsewhere.

Evaluating the contribution of satellite-derived evapotranspiration in the calibration of numerical groundwater models in remote zones using the EEFlux tool

Assessment of groundwater resources is crucial for developing water management practices for its sustainable exploitation, both for current and future needs. Numerical models are useful tools for such purpose. However, the lack of continuous monitoring networks, mainly due to difficult access to some remote locations, poses a challenge in developing and calibrating groundwater models. Remote sensing offers an alternative for acquiring information on hydrological and climatic variables at multiple spatiotemporal scales that has the potential to strengthen groundwater modeling. The aim of this study is to develop a methodology that uses remote sensing products to support model calibration. With this aim, we used the Parameter Estimation software (PEST) to calibrate a hydrogeological model of an unexploited basin located in the arid Chilean Altiplano using observed groundwater levels and evapotranspiration (ET) derived from the Earth Engine Evapotranspiration Flux (EEFlux) tool as observations. Our results show that the best model calibration is achieved using both EEFlux-ET and heads as observations to calibrate the hydraulic properties (normalized root mean square error = 4.1 %). We analyzed the effect of EEFlux-ET on the calibration of these properties and found a direct effect on specific yield parameters, which regulate the fluctuations of the water table over time. Incorporating EEFlux-ET estimates in the calibration resulted in lower values of specific yield across the aquifer. Therefore, incorporating remotely sensed ET as observations in the calibration of the groundwater model contributes to a better simulation of the spatiotemporal head variations in the basin.

Extension of Duplexed Single-Ended Distributed Temperature Sensing Calibration Algorithms and Their Application in Geothermal Systems

Fiber-optic distributed temperature sensing (DTS) has been widely used since the end of the 20th century, with various industrial, Earth sciences, and research applications. To obtain precise thermal measurements, it is important to extend the currently available DTS calibration methods, considering that environmental and deployment factors can strongly impact these measurements. In this work, a laboratory experiment was performed to assess a currently available duplexed single-ended DTS calibration algorithm and to extend it in case no temperature information is available at the end of the cables, which is extremely important in geothermal applications. The extended calibration algorithms were tested in different boreholes located in the Atacama Desert and in the Central Andes Mountains to estimate the geothermal gradient in these regions. The best algorithm found achieved a root mean square error of 0.31 ± 0.07 °C at the far end of a ~1.1-km cable, which is much smaller than that obtained using the manufacturer algorithm (2.17 ± 0.35 °C). Moreover, temperature differences between single- and double-ended measurements were less than 0.3 °C at the far end of the cable, which results in differences of ~0.5 °C km^-1 when determining the geothermal gradient. This improvement in the geothermal gradient is relevant, as it can reduce the drilling depth by at least 700 m in the study area. Future work should investigate new extensions of the algorithms for other DTS configurations and determining the flow rate of the Central Andes Mountains artesian well using the geothermal profile provided by the DTS measurements and the available data of the borehole.

Long-term spatiotemporal variability in high Andean wetlands in northern Chile

High Andean wetlands of the elevated plateaus of the Andes Mountains of Chile, Argentina, Perú and Bolivia are true oases that sustain life in this arid region. Despite their ecological value, they have been rarely studied and are vulnerable to climate change and human activities that require groundwater resources. One such activity that may be intensified in the near future is mining for nonmetallic minerals such as lithium, whose worldwide demand is expected to increase with the rise of electric vehicles that need batteries. To determine a baseline of the natural dynamics of these systems, which allows sustainable management, it is essential to understand the spatiotemporal dynamics of these wetlands. In this article, we studied the temporal and spatial dynamics of high Andean wetlands of Chile, with the aim of identifying the key processes that govern their dynamics. To do this, we used time series of Landsat data from 1984 to 2019 to study 10 high Andean wetlands. Furthermore, to characterize the climate variability in these systems, we studied the long-term relation between the changes in water and vegetation areas with rainfall and evaporation variability. It was found that the groundwater reservoir plays a key role in sustaining the high Andean wetlands. Wet years with a period of occurrence of 20-30 years are the years in which the groundwater reservoirs are actually recharged, and in between wet years, the groundwater reservoirs gradually release the water that sustains the aquatic ecosystems. Hence, groundwater exploitation should be carefully designed from a long-term perspective, as groundwater levels could take decades to recover.

Challenges in determining soil moisture and evaporation fluxes using distributed temperature sensing methods

To protect fragile groundwater-dependent environments of arid zones, it is important to monitor soil moisture and groundwater evaporation. Hence, it is important to assess new methods to quantify these environmental variables. In this work, we propose a new method to determine groundwater evaporation rates by combining the actively heated fiber-optic (AHFO) method with vadose zone modeling, assuming that the evaporation front remains at the soil surface. In our study, the AHFO method yielded estimates of the soil moisture (θ) profile with a spatial resolution of ~6.5 mm and with an error of 0.026 m³ m^-3. The numerical model resulted in a slightly different θ profile than that measured, where the largest differences occurred at the soil surface. Sensitivity and uncertainty analyses highlighted that a better precision is required when determining the soil hydraulic parameters. To improve the proposed method, the soil heat-vapor-water dynamics should be included and the assumption that the evaporation front remains at the soil surface must be relaxed. Additionally, if the AHFO calibration curve is enhanced, the errors of the estimated θ profile can be reduced and thus, successful estimation of the evaporation rates for a wider range of soil textures can be achieved. The spatial scales measured are an important advantage of the proposed method that should be further explored to improve the analysis presented here.

Deep-sequencing reveals broad subtype-specific HCV resistance mutations associated with treatment failure

A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) α-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of "extra-target" RAS suggests the need for RAS screening in all three DAA target regions.

How Do Hepatologists Gain Access to Liver Transplant Units?

Liver transplantation has evolved from an experimental treatment to be considered as the most effective therapy for end-stage liver disease and selected cases of hepatocellular carcinoma. Transplant hepatologists must have specific knowledge and abilities to treat those patients who receive a liver transplant. In Spain, approximately 1100 liver transplants are performed each year, and most centers assume both postoperative care and long-term follow-up, which has led to a significant work load in liver transplant units. Despite previous attempts to establish an official training program in hepatology, the Spanish health system does not presently have a specific liver transplant training program to guarantee that future needs of physicians are covered. Collaboration between health authorities and scientific societies is required to guarantee adequate assistance to liver transplant recipients in the future.

Thoracic and diaphragmatic endometriosis: Single-institution experience using novel, broadened diagnostic criteria

Objective:

To describe our experience with the multidisciplinary management of both thoracic/diaphragmatic endometriosis (TED), applying a broadened definition of the “Thoracic endometriosis syndrome (TES)” to define cases.

Material and Methods:

We present a retrospective series of consecutive patients affected by pathology-proven TED, treated at our institution, during a period of 7 years.

Results:

Five women were included. Two patients were referred due to catamenial chest/shoulder pain, one due to recurrent catamenial pneumothorax, and one due to new-onset diaphragmatic hernia. One patient had no thoracic symptoms, but diaphragmatic endometriosis was found during gynecologic laparoscopy for pelvic endometriosis. Endometriosis was histologically confirmed in all cases. After follow-up, all patients remain asymptomatic.

Conclusion:

Broadened TES criteria could increase the incidence of TED and determine better knowledge of this condition. Multidisciplinary, minimally invasive surgery is effective and safe, but should be reserved for tertiary referral centers.

Niche-habitat mechanisms and biotic interactions explain the coexistence and abundance of congeneric sandgrouse species

Ascertaining which niche processes allow coexistence between closely related species is of special interest in ecology. We quantified variations in the environmental niches and densities of two congeneric species, the pin-tailed and the black-bellied sandgrouse (Pterocles alchata and Pterocles orientalis) in allopatry and sympatry under similar abiotic, habitat and dispersal contexts to understand their coexistence. Using principal component analysis, we defined environmental gradients (niche dimensions) including abiotic, habitat and anthropogenic variables, and calculated niche breadth, position and overlap of both species in sympatry and allopatry. Additionally, sandgrouse density was modelled as a function of the niche dimensions and the density of the other species. We found evidence that each species occupies distinct environmental niches in sympatry and in allopatry. The black-bellied sandgrouse exploits a broader range of environmental conditions (wider niche breadth) while the pin-tailed sandgrouse reaches high densities where conditions seem to match its optimum. In sympatry, both species shift their niches to intermediate positions, indicating the importance of abiotic factors in setting coexistence areas. Environmental conditions determine regional densities of pin-tailed sandgrouse whereas biotic interactions explain the density of the black-bellied sandgrouse in areas with abiotic conditions similarly conducive for both species. Highly suitable areas for the pin-tailed sandgrouse fall beyond the upper thermal limit of the black-bellied sandgrouse, leading to niche segregation and low densities for the latter. Finally, local niche shift and expansion plus possible heterospecific aggregation allow the pin-tailed sandgrouse to thrive in a priori less favourable environments. This work provides insight into how different mechanisms allow species coexistence and how species densities vary in sympatry compared to allopatry as a result of environmental filtering and biotic interactions.

Prosthetic Abutment Height is a Key Factor in Peri-implant Marginal Bone Loss

In this study, we analyzed the influence of prosthetic abutment height on marginal bone loss (MBL) around implants in the posterior maxilla. In this retrospective cohort study, the radiographically determined MBL was related to the height of the abutments of internal conical connection implants at 6 and 18 months post-loading. Data were gathered on age, sex, bone substratum, smoking habit, history of periodontitis, and prosthetic features, among other variables. A linear mixed model was used for statistical analysis. The study included 131 patients receiving 315 implants. MBL rates at 6 and 18 months were mainly affected by the abutment height but were also significantly influenced by the bone substratum, periodontitis, and smoking habit. MBL rates were higher for prosthetic abutment < 2 mm vs. ≥ 2 mm, for periodontal vs. non-periodontal patients, for grafted vs. pristine bone, and for a heavier smoking habit. The abutment height is a key factor in MBL. MBL rates followed a non-linear trend, with a greater MBL rate during the first 6 months post-loading than during the next 12 months.

Simazine transport in undisturbed soils from a vineyard at the Casablanca valley, Chile

Simazine is a soil-active herbicide that has been applied worldwide in agricultural soils, being the second most commonly detected herbicide in groundwater and surface waters. Although its use has been restricted in many countries of Europe, it is still applied in many locations around the world in orchards, vineyards and forestry. Therefore, it is important to study its fate and transport in the environment. This paper investigates simazine transport in undisturbed bare soils from a vineyard at the Casablanca valley, Chile. In the study site, shallow groundwater tables (<1.0 m depth) and high simazine levels (>15 μg L(-1)) in the groundwater were observed and thus, there is potential for simazine to be transported further away through the saturated zone. The soils from the study site were characterized and the hydrodynamic transport parameters were determined. Column leaching experiments showed that the two-site chemical non-equilibrium model correctly represented simazine transport. It was found that 36.3% of the adsorption sites achieve instantaneous equilibrium and that the first-order kinetic rate of the non-equilibrium sites was 6.2 × 10(-3) h(-1). Hydrus 2D was used to predict the transport of simazine in the study site under natural field conditions. Simulation results showed that simazine concentrations at depths shallower than 2.1 m are above the maximum contaminant level of 4 μg L(-1) (defined by the U.S. Environmental Protection Agency). The timing of herbicide application was found to be important on simazine leaching and the main processes involved in simazine transport were degradation and adsorption, which accounted for 95.78 and 4.19% of the simulated mass of pesticide, respectively. A qualitative agreement in the timing and magnitude of simazine concentration was obtained between the simulations and the field data. Therefore, the model utilized in this investigation can be used to predict simazine transport and is a valuable tool to assess agricultural practices to minimize environmental impacts of simazine.

Liver transplantation as treatment in a massive metastasis from Gruber-Frantz pancreatic tumor: a case report

The Gruber-Frantz tumor or solid pseudopapillary tumor of the pancreas accounts for 1% to 2% of pancreatic tumors. It occurs more frequently among women between 20 and 40 years of age and in the Asian population. These tumors are of low malignant potential and show slow growth. The symptoms are subtle, the most striking being pain and an abdominal mass. The most common site is the pancreatic tail. The location and local invasion determine the surgical technique. With R0 resection, survival is 95% at 5 years. In 15% of cases metastatic disease appears, mostly in the liver. The treatment of liver metastases is surgical resection. In the case of multiple liver metastases, the treatment is controversial. QT has been used, as well as radiofrequency ablation, arterial embolization, and intraarterial chemotherapy. Herein we have described the case of a 44-year-old woman with massive liver metastases who did not respond to QT lines and underwent successful liver transplantation with survival free of recurrence at 1 year later. This is the first liver transplantation for a metastatic pancreatic pseudopapillary tumor in Spain and the second described in the literature.

Calibrating single-ended fiber-optic Raman spectra distributed temperature sensing data

Hydrologic research is a very demanding application of fiber-optic distributed temperature sensing (DTS) in terms of precision, accuracy and calibration. The physics behind the most frequently used DTS instruments are considered as they apply to four calibration methods for single-ended DTS installations. The new methods presented are more accurate than the instrument-calibrated data, achieving accuracies on the order of tenths of a degree root mean square error (RMSE) and mean bias. Effects of localized non-uniformities that violate the assumptions of single-ended calibration data are explored and quantified. Experimental design considerations such as selection of integration times or selection of the length of the reference sections are discussed, and the impacts of these considerations on calibrated temperatures are explored in two case studies.

[Surgical treatment of liver cancer: experience of the A Coruña UHC (Spain)]

INTRODUCTION

Liver cancer (LC) is one of the most frequent tumours, in which the potentially curative treatment is surgery: partial surgical resection or liver transplant.

OBJECTIVES

To determine the morbidity and mortality, survival, and their associated factors in patients with LC, according to the type of surgical treatment: partial surgical resection or liver transplant.

MATERIAL AND METHODS

A retrospective, observational follow-up study of LC patients diagnosed and treated from June 1994 to December 2007. A descriptive analysis of the variables was performed, as well as a Kaplan- Meier survival analysis and Cox regression.

RESULTS

The incidence of tumour recurrence in the 150 transplant patients was 13.3%, with a survival at 1, 3, and 5 years of 89.3%, 73.1% and 61.4%, respectively. The multivariate analysis showed that only the histological grade/differentiation was an independent risk factor. In the 33 patients with partial surgical resection, the incidence of tumour was 51.5%, with a survival at 1, 3, and 5 years of 90.9%, 60.2%, and 38.6%, respectively. A significantly higher mortality was observed in patients with higher tumour and TNM staging.

CONCLUSIONS

The survival throughout follow-up was higher in liver transplant, and tumour recurrence was more frequent in patients with partial surgical resection. The survival results in transplanted patients are consistent with the Spanish and European Liver Transplant Register and with the United Network for Organ Sharing register.

Prognostic and developmental factors in patients receiving liver transplant due to hepatocellular carcinoma: one center's experience in the north of Spain

BACKGROUND

Hepatocellular carcinoma (HCC) is one of the most frequent types of tumor. The aim of this study was to determine the survival of patients who had received liver transplants as a result of the disease.

METHODS

This observational follow-up study included 150 patients who received liver transplantations from June 1994 to December 2007. The study considered epidemiological and staging variables, tumor descriptions, and follow-up variables. We employed Kaplan-Meier methodology together with a Cox multivariate regression analysis.

RESULTS

The incidence of tumor relapse was 13.3%, with survival rates at 1, 3, and 5 years of 89.3%, 73.1%, and 61.4%, respectively. Variables that showed an independent effect to predict mortality were the degree of histological differentiation and of macrovascular invasion. Patients with poorly differentiated HCC had a 4.03 fold (95% confidence interval [CI]: 1.61-10.06) greater possibility of dying. Macrovascular involvement increased the risk of death (relative risk = 2.23), an effect that was at the limit of significance (95% CI 0.99-5.04).

CONCLUSIONS

The survival rate was consistent with the literature. Poor tumor differentiation and macrovascular involvement were independent predictors of mortality.

A theoretical study of a direct contact membrane distillation system coupled to a salt-gradient solar pond for terminal lakes reclamation

Terminal lakes are water bodies that are located in closed watersheds with the only output of water occurring through evaporation or infiltration. The majority of these lakes, which are commonly located in the desert and influenced by human activities, are increasing in salinity. Treatment options are limited, due to energy costs, and many of these lakes provide an excellent opportunity to test solar-powered desalination systems. This paper theoretically investigates utilization of direct contact membrane distillation (DCMD) coupled to a salt-gradient solar pond (SGSP) for sustainable freshwater production at terminal lakes. A model for heat and mass transport in the DCMD module and a thermal model for an SGSP were developed and coupled to evaluate the feasibility of freshwater production. The construction of an SGSP outside and inside of a terminal lake was studied. As results showed that freshwater flows are on the same order of magnitude as evaporation, these systems will only be successful if the SGSP is constructed inside the terminal lake so that there is little or no net increase in surface area. For the study site of this investigation, water production on the order of 2.7 x 10(-3) m(3) d(-1) per m(2) of SGSP is possible. The major advantages of this system are that renewable thermal energy is used so that little electrical energy is required, the coupled system requires low maintenance, and the terminal lake provides a source of salts to create the stratification in the SGSP.

Functional heterogeneity of NMDA receptors in rat substantia nigra pars compacta and reticulata neurones

The nigra substantia nigra pars compacta (SNc) and substantia pars reticulata (SNr) form two major basal ganglia components with different functional roles. SNc dopaminergic (DA) neurones are vulnerable to cell death in Parkinson's disease, and NMDA receptor activation is a potential contributing mechanism. We have investigated the sensitivity of whole-cell and synaptic NMDA responses to intracellular ATP and GTP application in the SNc and SNr from rats on postnatal day (P) 7 and P28. Both NMDA current density (pA/pF) and desensitization to prolonged or repeated NMDA application were greater in the SNr than in the SNc. When ATP levels were not supplemented, responses to prolonged NMDA administration desensitized in P7 SNc DA neurones but not at P28. At P28, SNr neurones desensitized more than SNc neurones, with or without added ATP. Responses to brief NMDA applications and synaptic NMDA currents were not sensitive to inclusion of ATP in the pipette solution. To investigate these differences between the SNc and SNr, NR2 subunit-selective antagonists were tested. NMDA currents were inhibited by ifenprodil (10 microM) and UBP141 (4 microM), but not by Zn(2+) (100 nm), in both the SNr and SNc, suggesting that SNc and SNr neurones express similar receptor subunits; NR2B and NR2D, but not NR2A. The different NMDA response properties in the SNc and SNr may be caused by differences in receptor modulation and/or trafficking. The vulnerability of SNc DA neurones to cell death is not correlated with NMDA current density or receptor subtypes, but could in part be related to inadequate NMDA receptor desensitization.

Pamidronate in the prevention of bone loss after liver transplantation: a randomized controlled trial

Rapid bone loss and high rates of fractures occur following liver transplantation. To analyze the effect of intravenous pamidronate on bone loss after liver transplantation. A randomized, double-blind, placebo-controlled study was performed. Seventy-nine patients were randomized to two groups of treatment: the pamidronate group (n = 38) was treated with 90 mg/IV of pamidronate within the first 2 weeks and at 3 months after transplantation; the placebo group (n = 41) received glucose infusions at the same time points. All patients received calcium and vitamin D. Bone mineral density (BMD) at the lumbar spine (L(2)-L(4)) and proximal femur using dual energy X-ray absorptiometry and also spinal X-rays were performed before, and at 6 and 12 months after liver transplantation. Biochemical and hormonal determinations were performed previous to transplantation, at 24 h before and after treatment, as well as at 6 and 12 months after liver transplantation. At 12 months after transplantation, there were significant differences in lumbar BMD changes (6 months: pamidronate 1.6% vs. placebo 0.8%, P = NS; 12 months: pamidronate 2.9% vs. placebo 1%, P < 0.05). Femoral neck BMD decreased in the pamidronate- and placebo groups during the first 6 months (6 months: pamidronate -3.1% vs. placebo -2.9%, P = NS; 12 months: pamidronate -3.2% vs. placebo -3.1%, P = NS). BMD at the trochanter remained stable in the pamidronate group, whilst a reduction was observed in the placebo group at 6 months (6 months: pamidronate -0.7% vs. placebo -3.7%, P < 0.05; 12 months: pamidronate -0.5% vs. placebo -1.2%, P = NS). Moreover, no significant differences in the incidence of fractures, serum parathyroid hormone and serum 25-hydroxyvitamin D values between both groups were found. Pamidronate did not increase the risk of serious adverse events. The results of this study show that 90 mg of intravenous pamidronate within the first 2 weeks and at 3 months following liver transplantation preserve lumbar bone mass during the first year, without significant adverse events. However, pamidronate does not reduce bone loss at the femoral neck and furthermore it does not reduce skeletal fractures.

Are motorway wildlife passages worth building? Vertebrate use of road-crossing structures on a Spanish motorway

Numerous road and railway construction projects include costly mitigation measures to offset the barrier effect produced on local fauna, despite the scarcity of data on the effectiveness of such mitigation measures. In this study, we evaluate the utility of different types of crossing structures. Vertebrate use of 43 transverse crossing structures along the A-52 motorway (north-western Spain) was studied during spring 2001. Research centered on wildlife passages (9), wildlife-adapted box culverts (7), functional passages (6 overpasses, 7 underpasses) and culverts (14), with marble dust being used to record animal tracks. A total of 424 track-days were recorded, with most of the larger vertebrate groups present in the area being detected. All crossing structure types were used by animals, although the intensity of use varied significantly among them (Kruskal-Wallis test, p<0.05); culverts were used less frequently than other structures. Crossing structure type and width were identified as the most important factors in their selection for use. Wildlife passages and adapted culverts allowed crossing by certain species (wild boar, roe deer, Eurasian badger), which do not tend to cross elsewhere. These results highlight the importance of using both mixed-type structures and wildlife passages in reducing the barrier effect of roads.

Reversal of cardiac cirrhosis following orthotopic heart transplantation

Irreversible hepatic cirrhosis greatly increases the risks attending heart transplantation (HT), and is accordingly considered to be an absolute contraindication for HT unless combined heart and liver transplantation can be performed. It is now recognized that hepatic cirrhosis can undergo regression if the source of insult is removed, but no cases of post-HT regression of cirrhosis of cardiac origin have hitherto been reported. Here we report a case of cardiac cirrhosis that underwent complete regression following orthotopic HT, and we discuss the implications of this case.

Genetic and phenotypic variation among geographically isolated populations of the globally threatened Dupont’s lark Chersophilus duponti

Identifying genetically and phenotypically distinct populations of threatened species is critical if we are to delineate appropriate plans for their conservation. We conducted an integrated analysis of population genetic structure, historical demographic events, current gene flow (all based on mtDNA sequences) and morphological variation of three geographically separated groups of populations of Dupont's lark Chersophilus duponti, located in the Iberian Peninsula (three populations), Morocco (two populations), and Tunisia (one population). Unusually, this lark species is the only one among the genus Chersophilus. Our results revealed the early historical divergence of an eastern Dupont's lark lineage (in Tunisia) and a western lineage (in Morocco and Spain), consistent with subspecies taxonomy and distribution. The western lineage subsequently split into two lineages, following the isolation of Iberian and African populations. Such pattern of historical differentiation caused great population genetic structure, with differences among geographic areas explaining more than 80% of total genetic variation. Mismatch distributions and coalescent estimates of divergence time showed that lineage divergence was associated with sudden population expansion events, which apparently took place during the last glaciation, when steppe habitats were widespread across the Mediterranean region. Extant populations from different geographic areas hardly shared any haplotype (only one out of 16 ND2 haplotypes was shared by Tunisian and Moroccan Dupont's larks), and consequently gene flow between geographic areas was found to be virtually absent. Apart from showing great genetic differentiation, Dupont's larks from different geographic areas were morphologically distinct, showing substantial variation in body size and feeding-related traits (length of feet and bill). We conclude that Dupont's lark populations isolated in the Iberian Peninsula, Morocco, and Tunisia are distinct evolutionary entities and should be considered as such in conservation plans. Such circumstance sets a daunting conservation challenge that exemplifies the need of incorporating knowledge of historical processes to our general understanding of the demography of threatened species.

Transport of simazine in unsaturated sandy soil and predictions of its leaching under hypothetical field conditions

The potential contamination of groundwater by herbicides is often controlled by processes in the vadose zone, through which herbicides travel before entering groundwater. In the vadose zone, both physical and chemical processes affect the fate and transport of herbicides, therefore it is important to represent these processes by mathematical models to predict contaminant movement. To simulate the movement of simazine, a herbicide commonly used in Chilean vineyards, batch and miscible displacement column experiments were performed on a disturbed sandy soil to quantify the primary parameters and processes of simazine transport. Chloride (Cl(-)) was used as a non-reactive tracer, and simazine as the reactive tracer. The Hydrus-1D model was used to estimate the parameters by inversion from the breakthrough curves of the columns and to evaluate the potential groundwater contamination in a sandy soil from the Casablanca Valley, Chile. The two-site, chemical non-equilibrium model was observed to best represent the experimental results of the miscible displacement experiments in laboratory soil columns. Predictions of transport under hypothetical field conditions using the same soil from the column experiments were made for 40 years by applying herbicide during the first 20 years, and then halting the application and considering different rates of groundwater recharge. For recharge rates smaller than 84 mm year(-1), the predicted concentration of simazine at a depth of 1 m is below the U.S. EPA's maximum contaminant levels (4 microg L(-1)). After eight years of application at a groundwater recharge rate of 180 mm year(-1) (approximately 50% of the annual rainfall), simazine was found to reach the groundwater (located at 1 m depth) at a higher concentration (more than 40 microg L(-1)) than the existing guidelines in the USA and Europe.

[Enucleation and evisceration: 370 cases review. Results and complications]

PURPOSE

To analyze the surgical results in 370 patients who underwent enucleation or evisceration at our center, during a period of 11 years (1990-2000), determining the kind of correction used and the complications associated with the procedure.

METHODS

This was a retrospective study of medical records from all patients who underwent surgery by the same surgeon (FS) in the Oculoplastic Department. Demographic data, diagnosis, previous and associated ophthalmic surgeries, implant or graft characteristics, follow up period and postoperative complications were determined in all patients.

RESULTS

One hundred sixty-one enucleations and 209 eviscerations were performed. Some kind of implant or graft was associated with 98.4% of these procedures. During the first 6 years of the study, lipodermal grafts were performed in 58.8% of the total, while in the last 5 years hydroxyapatite implants were performed in 90.9% of the cases. In 39 (10.6%) of 369 patients with registered follow up data, 58 complications requiring surgical correction were observed.

CONCLUSIONS

Hydroxyapatite implants gave an excellent anophthalmic socket reconstruction, and improved esthetic and motility results. Lipodermal grafts were an excellent alternative in our environment. We observed some complications with the different techniques, but only a few required surgical correction.

Gastrointestinal complications in liver transplant recipients: MITOS study

INTRODUCTION

Liver transplant recipients frequently suffer gastrointestinal (GI) complications but their prevalence and their influence on quality of life remain unknown.

OBJECTIVE

The objective of this study was to asses the prevalence, impact on quality of life, and management of GI complications in liver transplant recipients.

PATIENTS AND METHODS

This was an epidemiologic, cross-sectional, multicenter study. Four hundred seventeen liver recipients were recruited in 14 centers. A questionnaire was filled for every patient.

RESULTS

The median age of the patients was 55 years. The median time since transplantation was 4.1 +/- 4 years. Whereas 19.2% presented some GI disease before transplantation, 49.4% showed this type of complication after transplantation. Diarrhea was the most prevalent GI complication, and anorexia was the GI disorder that affected patients daily activities the most frequently. GI complications were more frequent among female patients, subjects with pretransplantation hiatal hernia, and those readmitted after transplantation. Of the patients with GI complications, 70.9% received pharmacological treatment (89.7% with gastric protectors). Immunosuppressive therapy was also modified because of GI complications. Immunosuppressive drug dose was reduced in 18.1%, transiently stopped in 3.4%, and definitively stopped in 3.4% of cases. The drug most frequently changed was mycophenolate mofetil: dose reduction, 23.6%; transient withdrawal, 5.7%; and definitive withdrawal, 6.6%.

CONCLUSIONS

The prevalence of GI complications in the liver transplant population was approximately 50%. GI complications showed a significant impact on the quality of life of the patients. They were related to female gender, to pretransplantation GI pathology, and posttransplantation hospital admission. These complications were frequently managed with pharmacological therapy or with changes in immunosuppressive therapy.

Evaluation of six pesticides leaching indexes using field data of herbicide application in Casablanca Valley, Chile

A field study was performed to evaluate the accuracy of six pesticide screening leaching indexes for herbicide movement. Adsorption, dissipation and soil movement were studied in a vineyard in a sandy loam soil during 2005 season. Simazine, diuron, pendimethalin, oxyfluorfen and flumioxazin were applied to bare soil at rates commonly used, and their soil concentrations throughout soil profile were determined at 0, 10, 20, 40 and 90 days after application (DAA). Herbicides were subjected to two pluviometric regimens, natural field condition and modified conditions (plus natural rainfall 180 mm). Leaching indexes utilized were: Briggs's Rf, Hamaker's Rf, LEACH, LPI, GUS and LIX. Simazine reached 120 cm, diuron 90 cm, flumioxazin 30 cm soil depth respectively. Pendimethalin and oxyfluorfen were retained up to 5 cm. None of the herbicides leaching was affected by rainfall regimen. Only flumioxazin field dissipation was clearly affected by pluviometric condition. The best representation of the herbicide soil depth movement and leaching below 15 cm soil depth were: Hamaker's Rf < Briggs's Rf < GUS < LPI, < LEACH < LIX. Field results showed a good correlation between herbicides K(d) and their soil depth movement and mass leached below 15 cm soil depth.

Daclizumab induction and maintenance steroid-free immunosuppression with mycophenolate mofetil and tacrolimus to prevent acute rejection of hepatic allografts

Steroid-free immunosuppressive regimens reduce corticosteroid-related side effects in liver transplant recipients although their efficacy is very variable. We evaluated the efficacy and safety of a steroid-free regimen in a 6-month, open-label, multicenter, pilot study, which involved 102 liver transplant patients treated with daclizumab (2 mg/kg within 6 h following transplant and 1 mg/kg on day 7), mycophenolate mofetil (MMF, 1 g b.i.d) and tacrolimus (trough levels of 5-15 ng/ml in the first month and 5-10 ng/ml thereafter). One intra-operative dose of methylprednisolone was administered. At 6 months, the acute rejection rate was 9.8%, and patient and graft survival rates were 96% and 95%, respectively. Acute rejection rates were similar for hepatitis C-positive patients (8.6%) and hepatitis C-negative patients (10.4%). Infections occurred in 22% of patients; most cases were considered mild or moderate. Post-transplantation hypertension and diabetes mellitus developed in 37% and 14% of patients, respectively, during the study period, but were markedly less frequent (8% and 6%, respectively) at 6 months. Hypercholesterolemia was observed in only 2% of patients. In conclusion, the steroid-free immunosuppressive regimen of daclizumab, MMF, and tacrolimus effectively prevents acute rejection after liver transplantation without decreasing safety.

Long-term results for liver transplantation from non-heart-beating donors maintained with chest and abdominal compression-decompression

INTRODUCTION

The aim of this study was to evaluate long-term results after liver transplantation from non-heart-beating donors (NHBD) using the method of chest and abdominal compression-decompression to maintain donors.

METHODS

From December 1995 to November 2004, 10 NHBD were identified and maintained by means of the method of chest and abdominal compression-decompression until family and judicial permission were granted. Nine donors were Maastricht type II and one was type IV.

RESULTS

The mean age of donors was 40.5 years and the mean time under cardiopulmonary resuscitation (CPR) was 80 minutes. Orthotopic liver transplantation (OLT) was performed using these 10 liver grafts after a mean cold ischemia time of 561.5 minutes. All patients developed good posttransplant function, except for one patient who presented with primary nonfunction corrected with retransplantation. This complication was directly related to a long CPR time (P < .01). After a mean follow-up of 57 months, only one patient died from a hepatitis C virus (HCV) recurrence. The rest of the patients have maintained good graft function over time.

CONCLUSIONS

NHBD maintained with the method of chest and abdominal compression-decompression are a valid choice to increase the donor pool. Liver transplantation using these grafts has proven good long-term results, comparable to their heart-beating counterparts.

Benefits of recombinant activated factor VII in complicated liver transplantation

INTRODUCTION

Recombinant activated factor VII (rFVIIa, NovoSeven, NovoNordiskA/S, Bagsvaerd, Denmark) has shown benefits in hemophilic patients and recently in transplant recipients. This study presents our experiences with rFVIIa in complicated liver transplant recipients.

METHODS

From May 2001 to August 2004, rFVIIa was administered to 7 patients undergoing liver transplantation. All treatments were made on emergency bases, except for 1 case with hemophilia A, who received prophylactic treatment. The drug was delivered when severe bleeding with coagulopathy persisted despite the usual treatment with blood products. The drug doses were 60-90 mug/kg; the results were evaluated clinically and analytically.

RESULTS

Seven patients undergoing liver transplantation were treated with FVIIa. Mean prothrombin times before and after treatment were 17.5 and 10.9 seconds, respectively, with a mean reduction of 7.2 seconds (P = .03). Mean thromboplastin times before and after treatment were 38.1 and 29.4 seconds, respectively, with a mean reduction of 8.7 seconds (P = .034). The average dose was 83.6 mug/kg, leading to decreased consumption of blood products (P < .01). In all cases, rFVIIa allowed sufficient hemostasis to carry on definitive treatment. There was no mortality in this series.

CONCLUSIONS

These results provide new evidence on the potential benefits of rFVIIa in liver transplantation, especially for rescue therapy in cases of severe bleeding.

Steroid-free immunosuppression for pancreas-after-liver transplantation

Simultaneous pancreas-kidney transplantation is presently a well-accepted procedure for patients with type 1 diabetes mellitus and renal failure. However, experiences with combined pancreas and liver transplantation are scarce, a few data are available about the best immunosuppression for these patients. We report our experience with two patients who received a pancreas after liver transplantation for long-standing insulin-dependent diabetes mellitus, with steroid-free immunosuppression based on daclizumab, tacrolimus, and mycophenolate mofetil. Short- and long-term evolution was uneventful. Currently, both patients are insulin free with appropriate metabolic control after 12 and 6 months follow-up. Considering our preliminary results, we suggest a steroid-free immunosuppressive regimen as an option for pancreas-after-liver transplantation.

Shade tolerance, photoinhibition sensitivity and phenotypic plasticity of Ilex aquifolium in continental Mediterranean sites

Shade tolerance, plastic phenotypic response to light and sensitivity to photoinhibition were studied in holly (Ilex aquifolium L.) seedlings transported from the field to a greenhouse and in adult trees in the field. All plants were growing in, or originated from, continental Mediterranean sites in central Spain. Seedlings tolerated moderate but not deep shade. Mortality was high and growth reduced in 1% sunlight. Survival was maximal in 12% sunlight and minimal in full sunlight, although the relative growth rate of the seedlings surviving in high light was similar to that of plants in moderate shade. Maximum photochemical efficiency at predawn was significantly lower in sun plants than in shade plants in the field, revealing chronic photoinhibition that was most pronounced in winter. Plasticity in response to available light varied according to the variable studied, being low for photosynthetic capacity and stomatal conductance, and high for specific leaf area, root:shoot ratio and leaf area ratio, particularly in seedlings. Differences in water relations and hydraulic features between sun and shade plants in the field were marginal. High water potential at the turgor loss point of field-grown plants suggested that holly is sensitive to drought during both the seedling and the adult stage. Low relative growth rates in both high and low light with low physiological plasticity in response to light indicate the existence of a stress-tolerance mechanism. We conclude that holly is a facultative understory plant in areas of oceanic and relatively mild climate, but an obligate understory plant in dry continental areas such as the study site. The impact of abandonment of traditional management practices and climate change on these Mediterranean populations is discussed.

Laboratory study of inocula production for composting processes

Six ligno-cellulolytic fungi were tested regarding to examine their capability to grow on agricultural wastes and produce inocula for composting. Two residues were used: pepper plant wastes and almond shell residues. Results showed the latter as the most adequate substrate for growth of fungi tested. On the contrary, Trichoderma koningii, as well as HLC1 and HLC3, both fungi isolated from almond shell wastes, were able to persist in pepper plant wastes. Modifications of aeration and pH significantly influenced growth of Coriolus versicolor, HLC1 and Phanerochaete. flavido alba and P. flavido alba and Phlebia radiata, respectively, while P. flavido alba was the only microorganism whose growth was not significantly altered by temperature. In competitive assays, where fungi were growth together with other species, growth of both microorganisms isolated from almond shell residues, HLC1 and HLC3, were stimulated while T. koningii showed the better results in sterile conditions.

Presynaptic NMDA autoreceptors facilitate axon excitability: a new molecular target for the anticonvulsant gabapentin

Gabapentin is a drug with anticonvulsant and analgesic properties causing the reduction of neurotransmitter release. We show that one of the mechanisms implicated in this effect of gabapentin is the reduction of the axon excitability measured as an amplitude change of the presynaptic fibre volley (FV) in the CA1 area of rat hippocampal slices. Interestingly, we found that gabapentin-induced depression of FV is mimicked and occluded by NMDA receptor (NMDA-R) antagonists, indicating that these receptors are located presynaptically and are activated by ambient levels of glutamate. Conversely, NMDA application (20 microM, 10 min) elicits a reversible FV potentiation which is reduced by gabapentin. Both NMDA- and gabapentin-induced FV changes are partially explained by modifications in the firing threshold of individual fibres. Increasing [K(+)](o) does not mimic or occlude (at a concentration of 6.5 mM) the effect of NMDA on FV amplitude, which makes it unlikely that a rise in [K(+)](o) induced by NMDA receptor activation could indirectly participate in the potentiation of the FV. The NMDA-induced FV potentiation is independent of extracellular calcium presence but is completely inhibited in a low-Na(+) solution (50% reduction) or under NMDA channel block (high Mg(2+) or MK 801). These findings suggest that sodium entry through presynaptic NMDA-R channels facilitates axon excitability. The interaction of gabapentin with this newly described mechanism might contribute to its therapeutic benefits.

Liver transplantation from maastricht category 2 non-heart-beating donors: a source to increase the donor pool?

INTRODUCTION

The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non-heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool. The outcome of 20 liver transplants from Maastricht category 2 NHBD was compared with that of 40 liver transplants from heart-beating donors (HBDs). After unsuccessful cardiopulmonary resuscitation (CPR), cardiopulmonary support with simultaneous application of chest and abdominal compression (CPS; n = 6) or cardiopulmonary bypass (CPB; n = 14) was used to maintain the donors.

RESULTS

At a minimum follow-up of 2 years, actuarial patient and graft survival rates with livers from Maastricht category 2 NHBD were 80% and 55%, respectively. Transplantation of organs from these donors was associated with a significantly higher incidence of primary nonfunction, biliary complications, and more severe initial liver dysfunction compared with organs from HBDs. The graft survival rates was 83% for livers from NHBDs preserved with CPS and 42% in those maintained with CPB.

Liver transplantation from maastricht category 2 non-heart-beating donors: a source to increase the donor pool?

INTRODUCTION

The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non-heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool. The outcome of 20 liver transplants from Maastricht category 2 NHBD was compared with that of 40 liver transplants from heart-beating donors (HBDs). After unsuccessful cardiopulmonary resuscitation (CPR), cardiopulmonary support with simultaneous application of chest and abdominal compression (CPS; n = 6) or cardiopulmonary bypass (CPB; n = 14) was used to maintain the donors.

RESULTS

At a minimum follow-up of 2 years, actuarial patient and graft survival rates with livers from Maastricht category 2 NHBD were 80% and 55%, respectively. Transplantation of organs from these donors was associated with a significantly higher incidence of primary nonfunction, biliary complications, and more severe initial liver dysfunction compared with organs from HBDs. The graft survival rates was 83% for livers from NHBDs preserved with CPS and 42% in those maintained with CPB.

Role of taurine uptake on the induction of long-term synaptic potentiation

Taurine application in the CA1 area of rat hippocampal slices induces a long-lasting potentiation of excitatory synaptic transmission that has some mechanistic similitude with the late phase of long-term potentiation (L-LTP). Previous indirect evidence such as temperature and sodium dependence indicated that taurine uptake is one of the primary steps leading to the taurine-induced synaptic potentiation. We show that taurine-induced potentiation is not related to the intracellular accumulation of taurine and is not impaired by 2-guanidinoethanesulphonic acid, a taurine transport inhibitor that is a substrate of taurine transporter. We have found that taurine uptake in hippocampal synaptosomes was inhibited by SKF 89976A, a GABA uptake blocker that is not transportable by GABA transporters. SKF 89976A prevents the induction of synaptic potentiation by taurine application. This effect is neither mimicked by nipecotic acid, a broad inhibitor of GABA transporters that does not affect taurine uptake, nor by NO-711, a specific and potent inhibitor of GABA transporter GAT-1. In addition, L-LTP induced by trains of high-frequency stimulation is also inhibited by SKF 89976A, and taurine, at a concentration that does not change basal synaptic transmission, overcomes such inhibition. We conclude that taurine induces synaptic potentiation through the activation of a system transporting taurine and that taurine uptake is required for the induction of synaptic plasticity phenomena such as L-LTP.

Retransplantation for hepatitis c–related cirrhosis under long-term pegylated interferon therapy

INTRODUCTION

Because of an increased organ shortage, one of the most controversial questions is whether hepatic retransplantation should be offered to transplant recipients with hepatitis C virus (HCV)-related graft failure because of their worse survival and the inevitable denial of other patients to access to primary transplantation. The objective of the present study was to review our experience with HCV-infected transplant recipients undergoing re-orthotopic liver transplantation (OLT) for HCV graft cirrhosis and receiving pegylated interferon and ribavirin on a prophylactic basis.

RESULTS

With a median follow-up of 26 months, all 5 patients are alive with stable graft function. Four patients are still receiving pegylated interferon at a mean duration of 20 months (range, 15-32 months). Although none of the patients has cleared HCV RNA by polymerase chain reaction the mean serum levels have decreased significantly when compared with pre-retransplantation amounts. One year after re-OLT, both grade and fibrosis stage had significantly decreased; the rate of post-retransplantation fibrosis progression was significantly lower than that pre-retransplantation (3.4 +/- 0.2 vs 0.6 +/- 0.3; P <.05).

Discriminative capacity of calcaneal quantitative ultrasound and of osteoporosis and fracture risk factors in postmenopausal women with osteoporotic fractures

Bone fragility fractures constitute the principal complication of osteoporosis. The identification of individuals at high risk of sustaining osteoporotic fractures is important for implementing preventive measures. The purpose of this study is to analyze the discriminative capacity of a series of osteoporosis and fracture risk factors, and of calcaneal quantitative ultrasound (QUS), in a population of postmenopausal women with a history of osteoporotic fracture. A cross-sectional analysis was made of a cohort of 5195 women aged 65 or older (mean +/- SD: 72.3 +/- 5.4 years) seen in 58 primary care centers in Spain. A total of 1042 women (20.1%) presented with a history of osteoporotic fracture. Most fractures (93%) were non-vertebral. Age-adjusted odds ratios corresponding to each decrease in one standard deviation of the different QUS parameters ranged from 1.47 to 1.55 (P < 0.001) for fractures. The age-adjusted multivariate analysis yielded the following risk factors independently associated with a history of osteoporotic fracture: number of fertile years, a family history of fracture, falls in the previous year, a history of chronic obstructive airway disease, the use of antiarrhythmic drugs, and a low value for any of the QUS parameters. The area under the receiver operating characteristic curve of the best model was 0.656. In summary, a series of easily assessable osteoporotic fracture risk factors has been identified. QUS was shown to discriminate between women with and without a history of fracture, and constitutes a useful tool for assessing fracture risk. Various of the vertebral and hip fracture risk factors frequently cited in North American and British populations showed no discriminative capacity in our series--thus suggesting that such factors may not be fully applicable to our population and/or to the predominant type of fractures included in the present study.

Liver transplantation from Maastricht category 2 non-heart-beating donors

BACKGROUND

The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non-heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool.

METHODS

The outcome of 20 liver transplants from Maastricht category 2 NHBDs is compared with 40 liver transplants from heart-beating donors (HBDs). After unsuccessful cardiopulmonary resuscitation (CPR), cardiopulmonary support (CPS) with simultaneous application of chest and abdominal compression (n=6), and cardiopulmonary bypass (CPB; n=14), which was hypothermic (n=7) or normothermic (n=7), were used to preserve the organs from NHBDs. Factors that may influence the outcome of livers from Maastricht category 2 NHBDs were also investigated.

RESULTS

With a minimum follow-up of 2 years, actuarial patient and graft survivals with livers from Maastricht category 2 NHBDs were 80% and 55%, respectively. Transplantation of organs from these donors was associated with a significantly higher incidence of primary nonfunction, biliary complications, and more severe initial liver dysfunction compared with livers from HBDs. Graft survival was 83% in livers from NHBDs preserved with CPS and 42% in those maintained with CPB. No graft failed if the duration of warm ischemia did not exceed 130 min with CPR or CPS, and if the period of CPB did not surpass 150 min when this method was used after CPR, regardless if it was hypothermic or normothermic.

CONCLUSION

Livers from Maastricht type 2 NHBDs may be used for transplantation if the period of warm ischemia during CPR or CPS does not exceed 130 min. Hypothermic or normothermic CPB after CPR preserves liver viability for an additional 150 min.

[Incidence, risk factors and influence on survival of infectious complications in liver transplantation]

INTRODUCTION

Orthotopic liver transplantation (OLT) is successful therapy for patients with end-stage liver disease. Infection is currently a life-threatening complication for these patients. The aims of this study are to determine the incidence of various infections in patients with OLT, to study overall survival rates and survival as related to individual infections, and to investigate the risk factors associated with first episodes of bacterial (BI), fungal (FI), invasive fungal (IFI) and cytomegalovirus (CMV) infections.

METHODS

The study includes 165 OLTs performed in 152 recipients from May 1994 to May 1998. A descriptive analysis estimating the 95% confidence interval was performed with 100 variables stratified according to preoperative, operative and postoperative conditions. Cox regression analysis was used to identify the variables associated with infection. Survival studies were carried out with the Kaplan-Meier method.

RESULTS

Among the total, 66% of patients developed infection: 41.8% viral, 33.9% BI, 20.6% FI and 4.2% IFI. One-year and 4-year survival rates after transplantation were 90% and 75%, respectively. All the infections decreased survival. Multivariate analyses identified the following risk factors for the specific infections: BI - dialysis, mechanical ventilation, and time of organ ischemia during harvesting; FI - number of hours of surgery and pretransplantation plasma albumin concentrations; IFI - number of blood units transfused, pretransplantation plasma albumin and retransplantation. Cytomegalovirus infection was associated with FI and IFI in the univariate analysis, but the multivariate analysis identified no variables that independently increased the risk of developing this infection.

Strategic Environmental Assessment of the Effects of European Union's Regional Development Plans in Doñana National Park (Spain)

The European Union's Structural Funds are implemented by means of Regional Development Plans (RDP), whose regionally scoped environmental assessment is required. We highlight the deficiencies faced by this approach when subregional areas with high conservation natural values are involved and illustrate it with the case of the RDP of Andalusia region on Doñana National Park area (Spain). Commissioned by the World Wildlife Fund, a Strategic Environmental Assessment (SEA) of the Andalusian RDP was carried out focusing on Doñana and its area of influence. This is a complex space where some of the most environmentally valuable features in the continent coexist with a surrounding intense and multi-sector economic activity, threatening its conservation. In the absence of an established sustainability framework in the Region, a "trickle-down" SEA approach evidenced the need to produce a set of environmental, economic and social guidelines for sustainable management of land, against which the RDP objectives were tested for coherence. An "incremental" SEA approach was also tested, which involved the identification of 79 measures and actions stemming from the RDP provisions and other concurrent planning documents reviewed and the qualitative assessment of their individual and cumulative potential impacts on Doñana environments. In the light of the results, a set of complementary mitigating measures was proposed for inclusion in tiered stages of the planning process. Measures to avoid, reduce, remedy and monitor the major types of impact were proposed, including provisions for public participation. SEA emerges as an instrument for non-governmental organizations (NGOs) to carry out independent assessment of public development initiatives.

Physiology of exopolysaccharide production by Azotobacter vinelandii from 4-hydroxybenzoic acid

The relationship between exopolysaccharide (EPS) production by Azotobacter vinelandii ATCC 12837 from 4-hydroxybenzoic acid as sole carbon source and other physiological parameters was investigated. In relation to growth, Azotobacter needed more time in 4-hydroxybenzoic acid to reach levels of biomass similar to those obtained when sugars were used, although the phenolic compound led to a more extensive exponential phase. The encystment process was initiated after cells had grown for 24 h, in which small amounts of EPS were synthesized and poly-beta-hydroxybutyrate (PHB) accumulation began. Both polymers, EPS and PHB, showed a similar evolution with time, as well as the formation of cysts, which points out the existence of a relation between these parameters. This was corroborated by a statistical study, in which significant correlations (P<0.05) were observed when each parameter was compared to the two others.