BCG shortage for intravesical instillation is associated with early tumoral recurrence in patients with high-risk non-muscle invasive bladder tumours.

INTRODUCTION: During 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression-free survival rates and tumoral relapse specific characteristics. METHODS: Retrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain. Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan-Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. RESULTS: Median follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145-448) during 2019 and 382 days (215-567) in 2017 were observed (logRank p = 0.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04-3.37 p = 0.036). No statistically significant differences in tumoral relapse characteristics were observed. CONCLUSION: BCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses.

Microseismicity Appears to Outline Highly Coupled Regions on the Central Chile Megathrust.

We compiled a novel microseismicity catalog for the Central Chile megathrust (29°-35°S), comprising 8,750 earthquakes between April 2014 and December 2018. These events describe a pattern of three trenchward open half-ellipses, consisting of a continuous, coast-parallel seismicity band at 30-45 km depth, and narrow elongated seismicity clusters that protrude to the shallow megathrust and separate largely aseismic regions along strike. To test whether these shapes could outline highly coupled regions ("asperities") on the megathrust, we invert GPS displacement data for interplate locking. The best-fit locking model does not show good correspondence to seismicity, possibly due to lacking resolution. When we prescribe high locking inside the half-ellipses, however, we obtain models with similar data fits that are preferred according to the Bayesian Information Criterion (BIC). We thus propose that seismicity on the Central Chile megathrust may outline three adjacent highly coupled regions, two of them located between the rupture areas of the 2010 Maule and the 2015 Illapel earthquakes, a segment of the Chilean margin that may be in a late interseismic stage of the seismic cycle.

Development of biocompatible and fully bioabsorbable PLA/Mg films for tissue regeneration applications.

During recent years, Mg reinforced polylactic acid (PLA) composites have emerged as potential biocompatible and bioabsorbable materials for biomedical applications. It has been shown that Mg particles added to a matrix based on a biodegradable polymer can address the lack of bioactivity and the low mechanical properties of the polymers and, furthermore, it can counteract the detrimental effects associated to the high degradation rate of Mg, as alkalinization and elevated H2 release. Additionally, the polymer can protect the Mg particles, by tailoring their degradation rate. Former processing of these composites performed by extrusion, compression and injection molding employed Mg contents up to 10 wt%. Higher amounts of Mg resulted in heterogeneous materials and thermally degraded matrices, with the corresponding higher degradation rate. In the present work, Mg reinforced PLA films with Mg content as high as 50 wt% were obtained without compromising the thermal stability of the polymer. Firstly, a successful dispersion of Mg microparticles was achieved by a breakthrough in processing introducing a colloidal step where organic additives were added to modify the Mg particle surface and promote a chemically stable suspension. The resulting colloidal suspension was then used as feedstock to obtain composite films by tape casting. The films show advantageous in vitro behaviour in terms of degradation, hydrogen release and oxygen permeability. In addition, the viability with fibroblast cells (MEF) opens a window of opportunity for these composite films as bioabsorbable material for tissue engineering and wound dressing applications. STATEMENT OF SIGNIFICANCE: Magnesium materials have extraordinary biodegradable properties and bioactive behavior due to release of Mg2+ ions, which offer a promising opportunity for their applicability as biomaterials for tissue regeneration. However, Mg is one of the most reactive metals with a high degradation rate. In contact with water produces H2, associated with a risk of failure of the implant. One alternative to minimize this drawback is the use of Mg particles surrounded by a biodegradable biocompatible polymer such as polylactic acid (PLA) to obtain PLA/Mg composites. In this work we processed Mg reinforced PLA in the shape of films that would be suitable for tissue regeneration. In vitro behavior of PLA/Mg films demonstrated that Mg2+ ions increase the fibroblast cells growth.

Selective advantage of euploid spermatocytes I in an azoospermic 47,XYY man with gonadal mosaicism.

Although most XYY men have normal sperm counts and are fertile (supposedly due to the loss of the extra Y before meiosis), there is a minority who are infertile. In these cases, the XYY spermatocytes are able to enter meiosis and form different synaptic configurations. With regard to mosaics, there is scarce well-defined information on the presence of the second Y and its meiotic behaviour. In this study, the chromosome constitution and the synaptic behaviour of pachytene spermatocytes from an azoospermic man with testicular hypotrophy and non-mosaic 47,XYY karyotype were analysed. Furthermore, we determined the chromosome constitution of the somatic Sertoli cells. Five karyotypically normal men with obstructive azoospermia, but having complete spermatogenesis, were included as controls. Immuno-FISH using specific protein markers of synapsis and recombination (SYCP3, SYCP1, BRCA1, MLH1, CREST) and a specific Yq12 DNA probe were used. In addition, we used the newly developed Super-Resolution Structured Illumination Microscopy (SR-SIM) to clearly define the synaptic configurations. FISH analysis was also performed on Sertoli cells. The histopathological analysis showed variable degrees of spermatogenesis development in the testicular tissue of the propositus. Immuno-FISH analysis showed that most of the primary spermatocytes were euploid 46, XY. The use of SR-SIM confirmed the existence of this euploidy. Only a few pachytene spermatocytes showed an aneuploid X + YY constitution. Sertoli cells showed two different populations with one or two Y chromosomes, in similar proportions. Thus an abnormal niche of sex-trisomic Sertoli cells should be also considered when searching for the origin of spermatogenesis failure in XYY men.

Effect of Mg content on the thermal stability and mechanical behaviour of PLLA/Mg composites processed by hot extrusion.

In the field of bioabsorbable composites for biomedical applications, extrusion has been employed as a method to prepare homogeneous blends of polymeric matrices with bioactive ceramic fillers. In this work, the suitability of processing poly-l-lactic acid/Magnesium (PLLA/Mg) composites by hot extrusion has been assessed by a systematic characterization of PLLA/Mg composites containing different amounts of Mg particles up to 7wt%. The results show that extrusion causes a reduction of almost 20% in the viscosity average molecular weight of PLLA, which further decreases with increasing Mg content. Extrusion gave always rise to a homogeneous distribution of Mg particles within the PLLA matrix. This composite processing was not compromised by the degradation of the polymeric matrix because the processing temperature was always below the onset degradation temperature. In the processing conditions employed in the present work, degradation of the composite slightly increases as more Mg is added up to 5wt%, but is very high at 7wt%. This was also evident from the mechanical behaviour, so that Mg particles improved the stiffness and compression strength of neat PLLA until 5wt% of Mg content, which dropped drastically when the material had 7wt% of Mg. The filler strengthening factor decreases with the increment in Mg content. In order to obtain an optimised contribution of Mg particles, a balance between thermal degradation and mechanical resistance of PLLA must be achieved.

Assessment of mechanical behavior of PLA composites reinforced with Mg micro-particles through depth-sensing indentations analysis.

This work deals with the mechanical characterization by depth-sensing indentation (DSI) of PLLA and PLDA composites reinforced with micro-particles of Mg (up to 15wt%), which is a challenging task since the indented volume must provide information of the bulk composite, i.e. contain enough reinforcement particles. The composites were fabricated by combining hot extrusion and compression moulding. Physico-chemical characterization by TGA and DSC indicates that Mg anticipates the thermal degradation of the polymers but does not compromise their stability during processing. Especial emphasis is devoted to determine the effect of strain rate and Mg content on mechanical behavior, thus important information about the visco-elastic behavior and time-dependent response of the composites is obtained. Relevant for the intended application is that Mg addition increases the elastic modulus and hardness of the polymeric matrices and induces a higher resistance to flow. The elastic modulus obtained by DSI experiments shows good agreement with that obtained by uniaxial compression tests. The results indicate that DSI experiments are a reliable method to calculate the modulus of polymeric composites reinforced with micro-particles. Taking into consideration the mechanical properties results, PLA/Mg composite could be used as substitute for biodegradable monolithic polymeric implants already in the market for orthopedics (freeform meshes, mini plates, screws, pins, …), craniomaxillofacial, or spine.

In vitro degradation of biodegradable polylactic acid/magnesium composites: Relevance of Mg particle shape.

Absorbable medical devices must be developed in order to have an appropriate degradation rate in agreement with the healing rate of bone in the implantation site. In this work, biodegradable composites formed by a polylactic acid matrix reinforced with 10%wt. magnesium microparticles were processed and their in vitro degradation investigated during 28 days. A joint analysis of the amount of H2 released, the changes in pH in buffered (PBS) and non-buffered media (distilled water), the variations in mass, microstructure and the mechanical performance of the specimens was developed. The main aim was to elucidate the relevance of Mg particles shape on tailoring the degradation kinetics of these novel composites. The results show that the shape of the Mg reinforcing particles plays a crucial role in the degradation rate of PLA/Mg composites, with spherical particles promoting a lower degradation rate than irregular particles. This fact is only partially due to the smaller surface area to volume ratio of the spherical particles. Irregular particles promote a faster formation of cracks and, therefore, an increasingly faster degradation of the polymeric matrix. In every case, the amount of H2 released by the composites was well below that released by monolithic Mg. The pH of PBS during degradation remained always within 7.2 and 7.4. PLA/Mg reinforced with spherical particles retains more than 90% of its mechanical properties after 7 days of immersion and more than 60% after 28 days. STATEMENT OF SIGNIFICANCE: The increasing demand for temporary orthopaedic implants is the driving force to seek new strategies to decrease costs and simultaneously improve patients comfort as well as simplify surgical procedures. Resorbable medical devices must be developed in order to have an appropriate degradation rate in agreement with the healing rate of bone. We are presenting for the first time results of the degradation kinetics of a new material based on polylactic acid reinforced with 10%wt. Mg microparticles. This work analyzes the relevance of Mg particle shape (irregular and spherical) on tailoring the degradation behaviour of these composites. Conclusions withdrawn from this study help to customize bioabsorbable materials in order to meet the requirements for a specific application and patient.

Residencia de urología y formación en trasplante renal: resultados de una encuesta a nivel nacional / Residency in urology and training in kidney transplantation. Results of a national survey

Objetivos: Conocer la situación actual sobre el adiestramiento en trasplante renal (TxR) en un país líder en donación y trasplante. Material y métodos: Realizamos una encuesta on-line vía correo electrónico a 138 residentes de urología con 5 apartados: filiación, formación en TxR, interés por el TxR, residentes de centros trasplantadores y de centros no trasplantadores. Resultados: Respondieron 65 residentes, un 47,1% de los urólogos en formación encuestados, desde 28 ciudades en 15 provincias. Para un 55% (n = 36) la formación que se ofrece sobre el TxR les parece insuficiente y el 85% (n = 55) demanda más medios. Más de la mitad no confía en realizar una cirugía de trasplante a lo largo de su residencia (n = 35). El 19% lo considera una disciplina importante, otorgándole una puntuación media de 56,2 (1-100). Entre los residentes de centros trasplantadores -69,2% (n = 45)-: el 73% (n = 33) consideraron el TxR a la hora de elegir centro para hacer la residencia. Los residentes encuestados de centros no trasplantadores -30,7% (n = 20)-: un 45% (n = 9) no realiza rotación externa en TxR. Conclusiones: Los residentes encuestados demandan más formación en TxR. La situación más habitual es terminar la residencia sin haber realizado un TxR de forma completa. Se contempla el TxR como un activo a la hora de elegir plaza MIR. El residente forma habitualmente parte del equipo de trasplante. La mayoría se forma en centros con menos de 75 trasplantes/año. La rotación externa en TxR no es la norma en los centros donde no se realiza trasplante

Objectives: To determine the current state of kidney transplantation (KT) training in a country that is leader in organ donation and transplantation. Material and methods: We conducted an online survey by e-mail to 138 urology residents. The survey contained 5 sections: affiliation, training in KT, interest in KT, residents of transplant centers and residents of nontransplant centers. Results: Sixty-five residents responded, 47.1% of the urologists in training surveyed, representing 28 cities and 15 provinces. Fifty-five percent (n = 36) of the respondents deemed the KT training offered during their residency as insufficient, and 85% (n = 55) demanded more resources. More than half were not confident in their abilities to perform transplantation surgery over the course of their residency (n = 35). Nineteen percent of the residents considered KT an important discipline in their residency, with a mean score of 56.2 (1-100). Among the residents of the transplant centers (69.2%, n = 45), 73% (n = 33) considered KT when choosing a center for their residency. Of the surveyed residents from nontransplant centers (30.7%, n = 20), 45% (n = 9) do not perform an external rotation in KT. Conclusions: The surveyed residents demand more training in KT. The most common situation is to end a residency without having performed a complete KT. KT is considered an asset when selecting a resident medical intern position and commonly they are part of the transplantation team. The majority of residents are trained in centers with less than 75 transplants/year. External rotations in KT are not the rule in centers where transplantation is not performed

Residency in urology and training in kidney transplantation. Results of a national survey.

OBJECTIVES: To determine the current state of kidney transplantation (KT) training in a country that is leader in organ donation and transplantation. MATERIAL AND METHODS: We conducted an online survey by e-mail to 138 urology residents. The survey contained 5 sections: affiliation, training in KT, interest in KT, residents of transplant centers and residents of nontransplant centers. RESULTS: Sixty-five residents responded, 47.1% of the urologists in training surveyed, representing 28 cities and 15 provinces. Fifty-five percent (n=36) of the respondents deemed the KT training offered during their residency as insufficient, and 85% (n=55) demanded more resources. More than half were not confident in their abilities to perform transplantation surgery over the course of their residency (n=35). Nineteen percent of the residents considered KT an important discipline in their residency, with a mean score of 56.2 (1-100). Among the residents of the transplant centers (69.2%, n=45), 73% (n=33) considered KT when choosing a center for their residency. Of the surveyed residents from nontransplant centers (30.7%, n=20), 45% (n=9) do not perform an external rotation in KT. CONCLUSIONS: The surveyed residents demand more training in KT. The most common situation is to end a residency without having performed a complete KT. KT is considered an asset when selecting a resident medical intern position and commonly they are part of the transplantation team. The majority of residents are trained in centers with less than 75 transplants/year. External rotations in KT are not the rule in centers where transplantation is not performed.

The candidate for renal transplantation work up: medical, urological and oncological evaluation.

UNLABELLED: Renal transplantation prolongs life, reduces morbidity, improves quality of life, and enables social rehabilitation of patients with end stage renal disease (ESRD). Kidney transplantation is a surgical procedure with inherent risks due to anesthesia and the surgical procedure itself. In ESRD patients medical background and comorbidities are crucial at the time of considering a renal transplant candidate because they can determine the procedure success OBJECTIVES: To update and review, according to recent literature, the evaluation of renal transplant candidates. METHODS: We performed a retrospective review of medical literature published in Medline/Pubmed about the most important facts of medical, urological and oncological evaluation of ESRD patients candidates to renal transplant. RESULTS: Pretransplant medical evaluation aims to diagnose, treat, and optimize any preexisting disease, and how these can interfere with patient and graft survival. It is important to consider age, cardiovascular disease, presence of diabetes mellitus, coagulation disorders, obesity, gastrointestinal diseases, ESRD situation and associated complications, active infection and non compliance with treatment and follow up. Urological requirements for successful renal transplantation are the absence of urinary infections, a compliant and continent reservoir, and a reliable method of achieving complete bladder evacuation. Certain urological diseases may not be obvious in the anuric patient. Pretransplant urological evaluation aims to diagnose, treat, and optimize any preexisting urological disease that can jeopardize transplant evolution. Cancer is a frequent and recognized complication of organ transplantation. The need of continuous immunosuppressive therapy may lead to immunosuppression-related side effects and direct oncogenic effects. Pre-existing malignancies should be extensively evaluated before proceeding to transplantation. Appropriate screening for malignancies is recommended in ESRD patients during routine pretransplant evaluation. CONCLUSION: This review highlights the importance of performing a comprehensive medical, urological and oncological assessment before transplantation. We will go through these mayor aspects of the evaluation of ESRD patients, how these might affect renal transplantation, which complementary test should be performed, and what are the latest recommendations for those situations. Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients ' specific conditions, by a multidisciplinary approach before proceeding to transplantation.

Estudio del candidato a trasplante renal: Evaluación médica, urológica y oncológica / The candidate for renal transplantation work up: medical, urological and oncological evaluation

El trasplante renal aumenta la supervivencia, reduce la morbilidad y mejora la calidad de vida del enfermo en insuficiencia renal crónica terminal (IRCT). Es un procedimiento quirúrgico con inherentes riesgos relacionados con la anestesia y la propia cirugía.Los antecedentes y enfermedades comórbidas del paciente con IRCT son muy importantes a la hora de considerarlo candidato a trasplante.OBJETIVOS: Revisar y actualizar, según la literatura reciente, la evaluación del paciente candidato a trasplante renal.MÉTODOS: Realizamos una revisión retrospectiva de la literatura publicada en Medline/Pubmed sobre los aspectos más importantes a tener en cuenta en la evaluación del candidato a trasplante renal en lo que se refiere a la situación médica, del aparato genitourinario y a posibles neoplasias concomitantes. RESULTADOS: La evaluación médica pretrasplante pretende poner de manifiesto los antecedentes clínicos del paciente así como estos pueden condicionar la evolución del enfermo e injerto una vez trasplantado. Se debe considerar la edad, la enfermedad cardiovascular, la existencia de diabetes mellitus, potenciales alteraciones de la coagulación, la obesidad, la presencia de patología en el tracto gastrointestinal, situación y complicaciones asociadas a su IRCT, una infección activa, la falta de compliance con el tratamiento y seguimiento(AU)

El aparato urinario deseable para cualquier candidato a trasplante debe ser estéril, de buena capacidad, compliance y con un mecanismo seguro de conseguir un correcto vaciado vesical. Algunas anomalías urológicas pueden pasar desapercibidas en el paciente anúrico. La evaluación prestrasplante del aparato urológico, pretende diagnosticar, tratar y optimizar cualquier patología urológica presente, así como detectar alteraciones anatómicas que pongan en riesgo el éxito de la cirugía.La patología neoplásica es una frecuente y reconocida complicación asociada al trasplante de órganos. El tratamiento inmunosupresor puede condicionar efectos secundarios directos así como un potencial efecto oncogénico. Los tumores prexistentes deben evaluarse concienzudamente antes de realizar el trasplante, así como la existencia de una neoplasia oculta.CONCLUSIÓN: En esta revisión destacamos la importancia de realizar una exhaustiva evaluación médica, urológica y oncológica antes del trasplante renal. Repasaremos los principales aspectos de la evaluación de los enfermos en IRCT, que pruebas diagnósticas se deben aplicar y cuáles son las últimas recomendaciones al respecto.Es imprescindible una evaluación cuidadosa de cada candidato a entrar en lista de espera para trasplante para mejorar la supervivencia de injerto y receptor. El estudio debe ser individualizado según la condición particular de cada paciente, a través de un abordaje multidisciplinar antes de proceder con el trasplante(AU)

Renal transplantation prolongs life, reduces morbidity, improves quality of life, and enables social rehabilitation of patients with end stage renal disease (ESRD). Kidney transplantation is a surgical procedure with inherent risks due to anesthesia and the surgical procedure itself.In ESRD patients medical background and comorbidities are crucial at the time of considering a renal transplant candidate because they can determine the procedure success.OBJECTIVES: To update and review, according to recent literature, the evaluation of renal transplant candidates.METHODS: We performed a retrospective review of medical literature published in Medline/Pubmed about the most important facts of medical, urological and oncological evaluation of ESRD patients candidates to renal transplant(AU)

RESULTS: Pretransplant medical evaluation aims to diagnose, treat, and optimize any preexisting disease, and how these can interfere with patient and graft survival. It is important to consider age, cardiovascular disease, presence of diabetes mellitus, coagulation disorders, obesity, gastrointestinal diseases, ESRD situation and associated complications, active infection and non compliance with treatment and follow up.Urological requirements for successful renal transplantation are the absence of urinary infections, a compliant and continent reservoir, and a reliable method of achieving complete bladder evacuation. Certain urological diseases may not be obvious in the anuric patient. Pretransplant urological evaluation aims to diagnose, treat, and optimize any preexisting urological disease that can jeopardize transplant evolution.Cancer is a frequent and recognized complication of organ transplantation. The need of continuous immunosuppressive therapy may lead to immunosuppression-related side effects and direct oncogenic effects. Pre-existing malignancies should be extensively evaluated before proceeding to transplantation. Appropriate screening for malignancies is recommended in ESRD patients during routine pretransplant evaluation.CONCLUSION: This review highlights the importance of performing a comprehensive medical, urological and oncological assessment before transplantation. We will go through these mayor aspects of the evaluation of ESRD patients, how these might affect renal transplantation, which complementary test should be performed, and what are the latest recommendations for those situations.Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients` specific conditions, by a multidisciplinary approach before proceeding to transplantation(AU)

Ventilación de alta frecuencia en infección respiratoria grave por VRS / High frequency oscillatory ventilation in severe RSV infection

High frequency oscillatory (HFOV) has been progressively useful in children with severe hypoxemic and Iry-percapnic respiratory insufficiency, at Pediatric Intensive Care Units. Objectives: To describe our experience in treatment of children with severe RSV infection unresponsive to conventional ventilation (CV), to describe effectiveness in gas exchange and to evaluate the safety of the method. A descriptive and prospective study set at two paediatric intensive care units, in Hospital Roberto del Río and Clínica Santa María of Santiago, Chile between January 2001 and December 2004. Results: 36 patients between 0.5 and 10 months of age with severe RSV infection and respiratory failure unresponsive to mechanical ventilation were connected to HFOV after an average time of conventional ventilation of 2.6 days. Arterial pH improved during the first hour in HFOV from 7.18 to > 7.3. Initial PaO2/FiO2 in average was 104.8, there was a slow and progressive improvement until 72 hours (138). FiO2 diminished since an average of 74 percent till 63.6 percent at 72 hours pCO2 went down from an average of 88 mm de Hg pre HFOV to 50 mmHg at 12 hours, remaining low. Oxygenation Index, preHFOV, was in average 18 and it maintained in 17 at 72 hours, with a FiO2 < 60 percent. Patients were hold in HFOV between 2-18 days. 3/36 patients died after 1.5, 4 and 18 days of HFOV. 8,3 percent presented air leak. One of these patients is oxygen dependent after 12 months of following. Conclusions: High frequency oscillatory ventilation is a useful method in the management of acute respiratory failure in children with severe infection for RSV unresponsive to conventional ventilation. It can improve gas exchange slowly and progressively with a low risk of air leak, secuelae and death.

La ventilación de alta frecuencia oscilatoria (VAFO) es un modo ventilatorio cada vez más utilizado en el manejo del paciente pediátrico con insuficiencia respiratoria grave, tanto hipoxémica como hipercápnica, en unidades de paciente crítico. Objetivos. Describir nuestra experiencia en el uso de VAFO en niños con infección respiratoria aguda grave por Virus Respiratorio Sincicial (VRS), su efectividad en el intercambio gaseoso y la seguridad del método. Método: Estudio descriptivo, retrospectivo, realizado en unidades de cuidado intensivo pediátricos de Hospital Roberto del Río y Clínica Santa María de Santiago, Chile, entre los meses de Enero 2001 y Diciembre 2004. Resultados: Se conectaron a VAFO 36 pacientes de 0,5 a 10 meses de edad con falla respiratoria aguda por infección por VRS y sin respuesta a VMC, luego de un promedio de 2,6 días. El pH arterial mejora durante la primera hora en VAFO, de 7,18 a 7,3. PaO2/FiO2 inicial promedio fue de 104,8, se observó una lenta y progresiva mejoría hasta las 72 horas (138). FiO2 disminuyó de 74 por ciento hasta 63,6 por ciento en las primeras 72 horas. La PCO2fue disminuyendo desde un promedio en VMC de 88 a 50 mmHg a las 12 horas, permaneciendo luego en rangos bajos. El índice de oxigenación pre VAFO, fue en promedio 18 y se mantuvo en 17 a las 72 horas de conexión, con una FiO2 < 60 por ciento. El tiempo de VAFO fue de 2-18 días. 3/36 pacientes fallecieron a los 1,5, 4 y 18 días de VAFO, 8,3 por ciento presentaron escape aéreo. 1/36 paciente es oxígeno dependiente luego de 12 meses de seguimiento. Conclusiones: VAFO se constituyó en un método eficaz en el manejo de la falla respiratoria aguda en niños con una infección grave por VRS, que no respondieron a la VMC. Podría mejorar rápidamente la hipercapnia, y la oxigenación lenta y progresivamente, con un bajo riesgo de escape aéreo, secuelas y mortalidad.

Synaptonemal complex protein SYCP3 exists in two isoforms showing different conservation in mammalian evolution.

Meiosis-specific protein SYCP3 is a major structural component of synaptonemal complex (SC) lateral elements. SYCP3 is rather well conserved in vertebrates. However, some differences in SYCP3 expression have been shown among mammals. To clarifiy these differences, we have investigated SYCP3 expression with the aid of bioinformatic, biochemical and cell biological methods. Here we show that, in contrast to other vertebrates, rat and mouse SYCP3 exist in 2 isoforms. The short isoform is conserved among vertebrates. However, the longer isoform, which represents an N-terminal extension of the shorter one, most likely appeared about 15 million years ago in a common ancestor of rat and mouse and after separation from the hamster branch.

[Response to adjuvant chemotherapy after radical cystectomy in patients with infiltrative bladder: Analysis of 397 cases]. / Respuesta a la quimioterapia adyuvante post-cistectomía en pacientes con tumor de vejiga infiltrante:análisis de 397 casos.

OBJECTIVES: To define the usefulness of adjuvant chemo-therapy in patients with pT2, pN0, pT3-4, pN0 and pN+ disease. METHODS: Retrospective analysis of 397 patients with transitional bladder cancer who underwent radical cys-tectomy between 1986 and 2005. Adjuvant chemo-therapy was administered to 40.2% of patients. Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin and cisplatin) were given. RESULTS: In patients with pT3, pN0 (p=0.04) and/or N+ stages (p=0.001), adjuvant chemotherapy significantly improved cancer-specific survival, which did not occur in pT2N0 (p=0.9) and pT4, pN0 (p=0.6) patients. In the univariate analysis, adjuvant chemotherapy was significantly associated with a lower cancer-specific survival rate (RR 1.452 95% CI: 1.028- 2.057 p= 0.03), while the multivariate analysis showed a trend (RR: 0.651 95% CI 0.398-1.065, p=0.08) towards a decrease in cancer-specific mortality. CONCLUSIONS: Although adjuvant chemotherapy was not shown to improve survival in patients with pT0-2, pN0 and pT4, pN0 disease, it did increase survival in those with extravesical disease, pathological state T3, pN0 and/or pN+. Considering its tendency to improve cancer-specific survival, adjuvant chemotherapy may be considered as a "protective factor" (RR=0.651, p=0.08).

Respuesta a la quimioterapia adyuvante post-cistectomía en pacientes con tumor de vejiga infiltrante: Análisis de 397 casos / Response to adjuvant chemotherapy after radical cystectomy in patients with infiltrative bladder: Analysis of 397 cases

OBJETIVO: Conocer la utilidad de la quimioterapia adyuvante en los pacientes con enfermedad pT2, pN0, pT3-4, pN0 y pN+.MÉTODOS: Análisis retrospectivo de 397 pacientes con cáncer transicional de vejiga tratados mediante cistectomía radical entre el año 1986 y 2005. Al 40,2% de los pacientes se les administró quimioterapia adyuvante. Se administraron 3 ciclos de MVAC adyuvante (metotrexate, vinblastina, adriamicina y cisplatino).RESULTADOS: En pacientes con estadio pT3, pN0 (p=0,04) y/o N+ (p=0,001), la quimioterapia adyuvante aumentó la supervivencia cáncer-específica de forma significativa, no siendo así en pacientes pT2N0 (p=0,9) y pT4, pN0 (p=0,6). En el análisis univariante la quimioterapia adyuvante se asoció de forma significativa con una menor supervivencia cáncer-específica (RR 1,452 IC 95%: 1,028- 2,057 p= 0,03) En el análisis multivariante presentó una tendencia (RR: 0,651 IC 95% 0,398-1,065, p=0,08) a la disminución de la mortalidad cáncer-específica.CONCLUSIONES: La quimioterapia adyuvante no demostró mejorar la supervivencia en pacientes con estadio pT0-2, pN0 y pT4, pN0. En cambio, la aumentó en los pacientes con enfermedad extravesical, estadio pT3, pN0 y/o pN+. Debido a la tendencia de la quimioterapia adyuvante a mejorar la supervivencia cáncer específica podemos considerarla como “protectora” (RR=0,651, p=0,08)(AU)

OBJECTIVES: To define the usefulness of adjuvant chemotherapy in patients with pT2, pN0, pT3-4, pN0 and pN+ disease.METHODS: Retrospective analysis of 397 patients with transitional bladder cancer who underwent radical cys-tectomy between 1986 and 2005. Adjuvant chemo-therapy was administered to 40.2% of patients. Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin and cisplatin) were given. RESULTS: In patients with pT3, pN0 (p=0.04) and/or N+ stages (p=0.001), adjuvant chemotherapy signifi-cantly improved cancer-specific survival, which did not occur in pT2N0 (p=0.9) and pT4, pN0 (p=0.6) pa-tients. In the univariate analysis, adjuvant chemotherapy was significantly associated with a lower cancer-speci-fic survival rate (RR 1.452 95% CI: 1.028- 2.057 p= 0.03), while the multivariate analysis showed a trend (RR: 0.651 95% CI 0.398-1.065, p=0.08) towards a decrease in cancer-specific mortality.CONCLUSIONS: Although adjuvant chemotherapy was not shown to improve survival in patients with pT0-2, pN0 and pT4, pN0 disease, it did increase survival in those with extravesical disease, pathological state T3, pN0 and/or pN+. Considering its tendency to im-prove cancer-specific survival, adjuvant chemotherapy may be considered as a “protective factor” (RR=0.651, p=0.08)(AU)

[Technical aspects of isolated organ perfusion devices]. / Aspectos técnicos de los dispositivos de perfusión de órgano aislado.

An aspect of capital importance in the transplant field is the maintainance and preservation of organs during the ischemic phase. Organ susceptibility and injuries secondary to ischemia, organ procurement and transportation are still nowadays one of the main causes for organ failure. Effective artificial organ perfusion has remained a main goal for researchers in this field for more than 100 years. In the second half of the XXth century these techniques have been applied to experimental and clinical organ preservation, with the aim of extending the period of an effective storage (which guarantees an early and good function after the transplant). Primary goal of any organ preservation is to maintain integrity in every cell system in order to minimize those injuries which produces graft dysfunction.

[Pharmacological preconditioning with sildenafil of warm ischemic kidneys]. / Precondicionamiento farmacológico con sildenafilo del riñón con isquemia normotérmica.

OBJECTIVES: To evaluate the preconditioning effect of sildenafil administered preoperatively in kidneys subjected to a period of warm ischemia (WI), hypothermic perfusion (HP) or cold storage (CS) and finally, autotransplant (AT). MATERIAL AND METHOD: We studied 6 groups of autotransplanted kidneys: no-WI-inmediate AT (Group A); 45 min of WI + immediate AT (Group B); 45 min of WI + 60 min of HP + autotransplant (Group C); 45 min of WI + 60 min of CS + autotransplant (Group D); 100 mg of oral sildenafil preoperatively + 45 min of WI + autotransplant (Group E); 100 mg of oral sildenafil preoperatively + 45 min of WI+60 min of HP + autotransplant (Group F). Belzer solution was used for HP; UW-Viaspan for CS. Inmediately after the autotransplant (reperfusion period), we recorded in real time for 60 min the values of Renal vascular Flow (RVF) and Renal Vascular Resistance (RVR). Nitric Oxide levels in the cava and renal graft vein were recorded every 15 min during the 60 min of the reperfusion-study period. Conventional & Electronic microscopy were completed after the process. RESULTS: We obtained significant higher values of RVF and lower values of RVR in sildenafil groups (E and F) in comparison to the other groups (A-D) (Table 1). NO levels were also significantly higher in groups E and F (Fig. 1). Groups A, B, E and F showed integrity of tubule and endothelium in comparison to groups C and D in the microscopic study. CONCLUSIONS: We showed a beneficious effect of sildenafil in inmediate post-transplant reperfusion hemodynamic and biochemical parameters of kidneys subjected to a critical period of warm-ischemia.

[Hystologic and hemodynamic aspects of warm ischemic graft in relation to the preservation method]. / Caracterización histoló6gica y hemodinámica del injerto con isquemia caliente según el método de preservación.

OBJECTIVE: The non-heart-beating donor has been proposed as a solution to donor shortage for renal transplantation. Because the nature of such donors, the kidneys so derived have been damaged by primary warm ischemia (WI), and so potentially they may never function. Minimizing graft injury is especially important in case of transplantation form marginal donors because of a high rate of delayed graft function or primary nonfunction. The aim of this experimental study is to assess the structural and hemodynamic consequences of hypothermic perfusion (HP) versus cold storage (CS), in renal allograft after a period of WI. MATERIAL AND METHODS: We used 20 mini-pigs. WI was achieved by vascular pedicle occlusion during 45 min. We divided organs in 4 groups: A (n=5), kidneys with WI and then transplanted; group B (n=5), grafts with WI and implanted after HP with Belzer solution in our computerized perfusion system. Group C-control, (n=5) transplanted without WI and D (n=5) with WI and 60 min of CS in UW-Viaspan solution. All the procedure was recorded by a computerized data system. Renal vascular resistance (RVR) and renal vascular flow (RVF) were automatically calculated by means of mathematical formulas after renal transplantation. Subsequently histological study was completed in all cases. RESULTS: We observed two patterns after transplantation: (1). Initial increase of RVR with posterior decrease and increase of vascular flow: in organs with WI and HP prior to transplantation (group B) // organs transplanted without WI (group C-control). Electronic and conventional microscopy showed integrity of endothelial and tubule structure. (2). Initial decrease with posterior increase of RVR. Organs with WI (group A) // organs with WI and CS (group D). Structural study showed endothelial and tubule disruption. CONCLUSION: In our experimental model machine perfusion preserves endothelial and tubule structure of kidneys with WI. After transplantation the hemodynamic pattern of grafts with WI and HP is similar to the control group (without WI and direct transplantation).

[Experimental renal preservation units: is this activity necessary in Spain?]. / Unidades de preservación renal experimental. Es necesaria esta actividad en España?

Renal graft preservation research is considered complementary but at the same time important activity in high-quality Kidney Transplant Programs. It provides information on limitations of kidneys to be transplanted and to discard those organs with high probability of failure. Unification of criteria in the selection of organs is essential. We think that this activity should be encouraged by Health Institutions although requires investment in staff and technology.