ABSTRACT
INTRODUCCIÓN: El trasplante auxiliar heterotópico hepático con arterialización de la vena porta (TAHH-AVP) es un modelo poco estudiado a pesar de su potencial terapéutico. El objetivo del estudio es valorar la respuesta hemodinámica y bioquímica durante el implante y analizar la repercusión de la arterialización portal en la funcionalidad y morfología hepática. MÉTODOS: Se realizó un estudio hemodinámico y bioquímico durante el implante auxiliar en un modelo porcino (n = 15 TAHH-AVP). Además, se analizaron las consecuencias de la arterialización portal sobre la arquitectura hepática mediante un estudio ultraestructural. RESULTADOS: La reperfusión del injerto arterializado aumentó la frecuencia cardiaca (FC) respecto a los valores basales (p = 0,004) y a la fase del pinzamiento de la vena cava (p = 0,004) y disminuyó las resistencias vasculares sistémicas respecto a la fase del pinzamiento de la vena cava (p = 0,021). Al final del implante, el gasto cardiaco permaneció elevado (p = 0,001), al igual que la FC respecto a la fase basal (p = 0,002). La presión arterial media disminuyó con el pinzamiento venoso, pero no se vio afectada ni por la reperfusión del injerto ni por el cierre de la piel. Todas las muestras histológicas obtenidas a los 3, 10 y 21 días conservaron su morfología y arquitectura hepáticas. Si bien se observaron algunos focos de necrosis perilobular el día 3 (p = 0,049) y proliferación conectiva perilobular el día 10 (p = 0,007), respecto al hígado nativo. CONCLUSIONES: El trasplante del injerto hepático arterializado descrito minimiza el número de anastomosis vasculares respecto a los modelos previamente publicados, presenta una buena tolerancia hemodinámica y metabólica, y la arterialización portal del injerto no produce cambios significativos en la histología hepática
BACKGROUND: Auxiliary heterotopic liver transplantation with portal vein arterialization (AHLT-PVA) is a model that has been hardly studied, despite its therapeutic potential. METHODS: Hemodynamic and biochemical characterization was carried out during graft implantation, in a pig-to-pig model (n = 15 AHLT-PVA). Furthermore a histopathological study was performed to establish microscopic alterations due to PVA. RESULTS: Reperfusion of the arterialized graft produced an increase in heart rate (HR) vs. baseline (P=.004) and vs. inferior vena cava clamping phase (P=.004); and a decrease in systemic vascular resistance vs. cava clamping phase (P=.021). At the end of implantation, cardiac output remained elevated (P=.001), likewise HR remained increased vs. baseline phase (P=.002). Mean arterial pressure decreased with cava clamping, but was not affected by the reperfusion of the graft, nor the skin closure. The histopathological study at 3, 10, and 21 days post-PVA revealed that functional liver structure was maintained although it is common to find foci of perilobular necrosis on day 3 (P=.049), and perilobular connective tissue proliferation at day 10 (P=.007), vs. native liver. CONCLUSIONS: The described arterialized liver graft model minimizes the number of vascular anastomoses vs. previously described models. It is hemodynamically and metabolically well tolerated and the double arterial vascularization of the graft does not cause significant changes in liver histology
Subject(s)
Cats , Animals , Liver Transplantation/methods , Transplantation, Heterotopic/methods , Disease Models, Animal , Anastomosis, Surgical/methods , Hemodynamics/physiology , Reperfusion/methods , Swine/surgeryABSTRACT
BACKGROUND: Auxiliary heterotopic liver transplantation with portal vein arterialization (AHLT-PVA) is a model that has been hardly studied, despite its therapeutic potential. METHODS: Hemodynamic and biochemical characterization was carried out during graft implantation, in a pig-to-pig model (n=15 AHLT-PVA). Furthermore a histopathological study was performed to establish microscopic alterations due to PVA. RESULTS: Reperfusion of the arterialized graft produced an increase in heart rate (HR) vs. baseline (P=.004) and vs. inferior vena cava clamping phase (P=.004); and a decrease in systemic vascular resistance vs. cava clamping phase (P=.021). At the end of implantation, cardiac output remained elevated (P=.001), likewise HR remained increased vs. baseline phase (P=.002). Mean arterial pressure decreased with cava clamping, but was not affected by the reperfusion of the graft, nor the skin closure. The histopathological study at 3, 10, and 21 days post-PVA revealed that functional liver structure was maintained although it is common to find foci of perilobular necrosis on day 3 (P=.049), and perilobular connective tissue proliferation at day 10 (P=.007), vs. native liver. CONCLUSIONS: The described arterialized liver graft model minimizes the number of vascular anastomoses vs. previously described models. It is hemodynamically and metabolically well tolerated and the double arterial vascularization of the graft does not cause significant changes in liver histology.
Subject(s)
Liver/blood supply , Animals , Hemodynamics , Liver Transplantation , Portal Vein , Swine , Transplantation, HeterotopicABSTRACT
Objetivos. Conocer las características del sueño en profesionales de atención primaria y su relacióncon la atención continuada y con la actividad asistencial.Diseño. Estudio multicéntrico, descriptivo y transversal mediante cuestionario anónimo autocumplimentado.Emplazamiento. Áreas de Toledo y Alcázar de San Juan.Participantes. Médicos de familia y profesionales de enfermería.Mediciones principales. Variables sociodemográfi cas, de la actividad asistencial y de las característicasdel sueño.Resultados. Contestaron 281 profesionales, con una edad media de 41,27 años (DE 8,76). La proporciónde hombres fue del 37,7%, de médicos el 37,9% y de los que realizaban guardias el 72,2%.Refi rieron trastornos del sueño el 31,7% (IC95%: 26,65-38,46), sin diferencias signifi cativas respectoa la realización de guardias, al sexo (31,6% hombres vs 31,2% mujeres) ni a la profesión (29,7%médicos vs 32,7% enfermeros). Para un 72,5% estos trastornos infl uían en su actividad habitual ypara el 55,6% en su conducta. Entre los profesionales que realizaban guardias, un 18,8% tomabaestimulantes durante ellas (sin diferencias por sexo ni profesión) y el 5,5% relajantes, más los médicosque enfermería (10,7% vs 1,7%; χ2 7,66; p<0,01). El 47,7% refi rió haber cometido errores postguardia,más los médicos (65,1% vs 34,8%; χ2 17,7, p< 0,001) y los varones (57,8% vs 39,4%; χ2 6,63, p<0,05).Un 29,6% había sufrido algún accidente postguardia, siendo mayor en enfermería (21,2% vs 35%; χ24,57; p<0,05). Para un 76,1% fue peor el trato a los pacientes postguardia.Conclusiones. La prevalencia de trastornos del sueño encontrada es similar a la de la poblacióngeneral. Las guardias no parecen asociarse a dichos trastornos, pero sí podrían relacionarse con unapeor calidad asistencial y un aumento de los riesgos
Objectives. To determine the characteristics of sleep patterns of primary health care professionalsand their relation to continous medical attention and health care.Design. This is a multicenter, descriptive, cross-sectional study, consisting of a questionnaire completedby the participants.Setting. Toledo and Alcazar de San Juan health areas.Participants. General practitioners (GPs) and nurses.Main measurement. Sociodemographic, health care and characteristic sleep factors.Results. 281 professionals answered the questionnaire. Average age: 41.27 years (SD 8.76). 37.7%were men; 37.9% GPs; 72.2% were on duty. 31.7% reported that they have sleep disorders (CI 95%26,65-38,46) irrespective of shift work, sex (31.6% men vs 31.2% women) or occupation (29.7%GPs vs 32.7% nurses). For 72.5% these sleep disorders infl uenced their daily activity and for 55.6%it infl uenced their behaviour. Of the professionals who were on duty, 18.8% took stimulants whiledoing shiftwork (there was no difference in sex or occupation) and 5.5% took sleeping pills, moreGPs than nurses (10.7% vs 1.7%; .2 7.66; p<0.01). A total of 47.7% said that they have made errorswhen they come off duty, more GPs (65.1% vs 34.8%;.2 17.7, p< 0.001) and men (57.8% vs 39.4%; .2 6.63, p<0.05). A total of 29.6% had had an accident after a night shift. This was more frequentamong nurses (21.2% vs 35%; .2 4.57; p<0.05). 76.1% admitted having a worse behaviour towardspatients after having been on a shift.Conclusions. The prevalence of sleep disorders is similar to those of the general population. Shiftworkdoes not seem to increase these disorders, although they could be associated with a poorer qualityof medical care and an increase of risk factors
