Novel portable hypothermic machine perfusion preservation device enhances cardiac viability of donated human hearts.

Introduction: Heart transplant remains the gold standard treatment for patients with advanced heart failure. However, the list of patients waiting for a heart transplant continues to increase. We have developed a portable hypothermic oxygenated machine perfusion device, the VP.S ENCORE®, to extend the allowable preservation time. The purpose of this study was to test the efficacy of the VP.S. ENCORE® using deceased donors derived hearts. Methods: Hearts from brain-dead donors not utilized for transplant (n = 11) were offered for research from the Texas Organ Sharing Alliance (TOSA), South and Central Texas' Organ Procurement Organization (OPO) and were preserved in the VP.S ENCORE® for 4 (n = 2), 6 (n = 3), and 8 (n = 3) hours or were kept in static cold storage (SCS) (n = 3). After preservation, the hearts were placed in an isolated heart Langendorff model for reperfusion and evaluated for cardiac function. Results: The mean donor age was 37.82 ± 12.67 with the youngest donor being 19 and the oldest donor being 58 years old. SCS hearts mean weight gain (%) was -1.4 ± 2.77, while perfused at 4 h was 5.6 ± 6.04, perfused at 6 h 2.1 ± 6.04, and 8 h was 7.2 ± 10.76. Venous and arterial lactate concentrations were less than 2.0 mmol/L across all perfused hearts. Left ventricular contractility (+dPdT, mmHg/s) for 4 h (1,214 ± 1,064), 6 (1,565 ± 141.3), and 8 h (1,331 ± 403.6) were within the range of healthy human heart function. Thus, not significant as compared to the SCS group (1,597 ± 342.2). However, the left ventricular relaxation (mmHg/s) was significant in 6-hour perfused heart (p < 0.05) as compared to SCS. Gene expression analysis of inflammation markers (IL-6, IL-1ß) showed no significant differences between SCS and perfused hearts, but a 6-hour perfusion led to a downregulated expression of these markers. Discussion: The results demonstrate that the VP.S ENCORE® device enhances cardiac viability and exhibits comparable cardiac function to a healthy heart. The implications of these findings suggest that the VP.S ENCORE® could introduce a new paradigm in the field of organ preservation, especially for marginal hearts.

Decentralization and efficiency of subsidy targeting: Evidence from chiefs in rural Malawi.

Lower-income countries spend vast sums on subsidies. Beneficiaries are typically selected via either a proxy-means test (PMT) or through a decentralized identification process led by local leaders. A decentralized allocation may offer informational advantages, but may be prone to elite capture. We study this trade-off in the context of two large-scale subsidy programs in Malawi (for agricultural inputs and food) decentralized to traditional leaders ("chiefs") who are asked to target the needy. Using household panel data, we find that nepotism exists but has only limited mistargeting consequences. Importantly, we find that chiefs target households with higher returns to farm inputs, generating an allocation that is more productively efficient than what could be achieved through strict poverty-targeting. This could be welfare improving, since within-village redistribution is common. Productive efficiency targeting is concentrated in villages with above-median levels of redistribution.

Hipertensión arterial sistémica y ejercicio / Systemic arterial hypertension and exercise

La tendencia del hombre moderno hacia una mejor actividad física, tanto en su trabajo como en sus horas libres, favorece el desarrollo de hipertensión arterial sistémica (HSA). Por esta razón, se ha promovido al ejercicio en las últimas décadas como medio para conservar y fortalecer la salud y la calidad de vida, y más recientemente, como alternativa de tratamiento en la HAS. Sin embargo, antes de prescribirlo hay que tener en cuenta las siguientes consideraciones: 1) la respuesta cardiovascular (RVC) del paciente hipertenso al ejercicio, 2) el tipo de ejercicio que puede realizar, 3) en qué forma puede el ejercicio bajar la presión arterial y 4) si deben o no hacer ejercicio los pacientes hipertensos. Hechas estas consideraciones, se concluye que la actividad física, dinámica, regular y supervisada, es una buena alternativa de tratamiento para pacientes con HAS leve o moderada.

Muerte cardíaca súbita registrada durante electrocardiografía ambulatoria / Sudden death during ambulatory electrocardiography

Se describen dos casos de pacientes que sufrieron muerte súbita durante el registro electrocardiográfico ambulatorio. El primeiro, un paciente con disnea y trastornos del rítmo cardiaco; en el cual el registro electrocardiográfico mostró un bloqueo aurículo-ventricular de primer grado, bloqueo de rama izquierda progresivo y asistolia. El segundo, un paciente con historia de enfermedad coronaria e infarto del miocardio reciente, en el cual el registro electrocardiográfico contínuo reveló arritmia cardiaca con extrasístoles ventriculares multifocales bi y trigeminadas, previas a la instalación de taquicardia y fibrilación ventricular. Se hace énfasis en la necesidad de detectar los sujetos con alto riesgo de muerte súbita y de establecer programas preventivos post-hospitalarios, que modifiquem la evolución y el pronóstico en este grupo de pacientes