20 años de experiencia en trasplante renal en bloque de donantes pediátricos en receptores adultos / A 20-year experience in cadaveric pediatric en bloc kidney transplantation in adult recipients

Introducción y objetivos El trasplante renal en bloque de donantes pediátricos en receptores adultos permite aumentar el pool de donantes, pero son pocos los centros que lo realizan. Mostramos los resultados de la técnica en nuestro centro tras su introducción en el año 1999.Material y métodos Análisis retrospectivo de los 42 procedimientos realizados en nuestro centro con una mediana de seguimiento de 73 meses (5-233) en los que se monitorizó la función renal de los pacientes y se registraron las complicaciones sucedidas.Resultados Se han realizado 42 trasplantes renales en bloque en adultos de donantes pediátricos en nuestro centro hasta el momento. La media de edad de los receptores fue de 44,1±11,8 años y la de los donantes de 22,4±14,7 meses, con un peso medio de 11,3±3,6kg. El tiempo medio de isquemia fría fue de 15,7±4,5 h. Al finalizar el seguimiento, 35 injertos eran funcionantes (83,3%) y mantenían una excelente función. Hubo 7 pérdidas de injerto (16,7%) en el postoperatorio inmediato (4 trombosis vasculares, una dehiscencia de anastomosis y 2necrosis corticales) y un fallecimiento durante el seguimiento por una causa no relacionada.Conclusiones El uso de injertos renales en bloque de origen pediátrico en adultos es un procedimiento seguro y con un excelente rendimiento funcional a medio y largo plazo. El postoperatorio inmediato es el periodo en el que se establecen la mayoría de las complicaciones importantes que pueden derivar en la pérdida del injerto. La adecuada selección de donantes y receptores, así como una correcta técnica quirúrgica, son imprescindibles para minimizar la aparición de eventos adversos (AU)

Background En bloc kidney transplantation from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of bloc kidney transplantation from pediatric donors into adult recipients in a single center.Material and methods Retrospective analysis of 42 patients who received pediatric cadaveric bloc kidney transplantation in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered.ResultsWe have performed 42 bloc kidney transplantation from pediatric donors into adult recipients in our center. The recipients’ age was 44.1±11.8 years. Pediatric donors were 22.4±14.7 months old and weighted 11.3±3.6kg. Cold ischemia time was 15.7±4.5hours. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99±0.25mg/dl). There were 7graft losses (16.7%) in the immediate postoperative period (4 cases of vascular thrombosis, one anastomosis dehiscence and 2cortical necrosis).Conclusions The pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events (AU)

A 20-year experience in cadaveric pediatric en bloc kidney transplantation in adult recipients.

BACKGROUND AND OBJECTIVES: En bloc kidney transplantation (EBKT) from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of EBKT from pediatric donors into adult recipients in a single center. MATERIAL AND METHODS: Retrospective analysis of 42 patients who received pediatric cadaveric EBKT in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered. RESULTS: We have performed 42 EBKT from pediatric donors into adult recipients in our center. The recipients' age was 44.1 ± 11.8 years. Pediatric donors were 22.4 ± 14.7 months old and weighted 11.3 ± 3.6 kg. Cold ischemia time was 15.7 ± 4.5 h. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99 ± 0.25 mg/dl). There were seven graft losses (16.7%) in the immediate postoperative period (four cases of vascular thrombosis, one anastomosis dehiscence and two cortical necrosis). CONCLUSIONS: The pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events.

Exploring the role of lignin structure in molecular dynamics of lignin/bio-derived thermoplastic elastomer polyurethane blends.

The relaxation behavior of two lignins (Alcell organosolv, OSL, and hydroxypropyl modified Kraft, ML) and bio-based thermoplastic polyurethane (TPU) blends have been studied by Differential Scanning Calorimetry (DSC), Dynamic-Mechanical Analysis (DMA) and Dielectric Relaxation Spectroscopy (DRS). The effect of blending on the glass and local relaxation processes as a function of composition, frequency, and temperature has been assessed. The dielectric spectra were resolved into dipolar relaxations as well as conductive processes for differing blend compositions. Characteristic relaxation times, activation energies and dielectric relaxation strengths of lignin/xTPU blends were also investigated. It was found that blending suppresses the α-relaxation process of the blends compared to virgin TPU. On the other hand, while the position of the ß-relaxation was not influenced by blending, a reduction of the activation energies, Ea, of this process was observed in the lignin/xTPU blends. Finally, changes are observed in the conductivity behavior of both blends, with conductivity processes more favorable for the OSL/xTPU blends.

Molecular dynamics of carrageenan composites reinforced with Cloisite Na+ montmorillonite nanoclay.

Nanocomposites comprising biodegradable carrageenan and glycerol (KCg) as the host polymer, with different contents of natural montmorillonite (MMT) as filler, were prepared by a solution casting process. Different techniques have been used to determine the interaction/behavior among the different components of the samples such as Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), Transmission electron microscope (TEM) and, mainly, Dielectric relaxation spectroscopy (DRS). FTIR indicates hydrogen interaction between carrageenan matrix and silicate that is confirmed by the XRD data indicating some kind of carrageenan intercalation between the MMT layers. A rather homogenous distribution of MMT into KCg matrix were observed using transmission electron microscopy. The MMT effect on the molecular mobility at the glass transition was studied by dielectric relaxation spectroscopy. The MMT addition resulted in a slower relaxation and a wider distribution of the relaxation times. The fragility index, m, increased upon MMT incorporation, which may be attributed to a reduction in mobility chains, due to the MMT confinement of the KCg network. In addition, the apparent activation energy associated with the relaxation dynamics of the chains at Tg increased with the MMT content. The modified films developed in this paper could be used to prepare biodegradable and edible packaging films and films for biomedical applications with improved mechanical and good dielectric response.

Monitoring molecular dynamics of bacterial cellulose composites reinforced with graphene oxide by carboxymethyl cellulose addition.

Broadband Dielectric Relaxation Spectroscopy was performed to study the molecular dynamics of dried Bacterial Cellulose/Carboxymethyl Cellulose-Graphene Oxide (BC/CMC-GO) composites as a function of the concentration of CMC in the culture media. At low temperature the dielectric spectra are dominated by a dipolar process labelled as a ß-relaxation, whereas electrode polarization and the contribution of dc-conductivity dominate the spectra at high temperatures and low frequency. The CMC concentration affects the morphological structure of cellulose and subsequently alters its physical properties. X-ray diffractometry measurements show that increasing the concentration of CMC promotes a decrease of the Iα/Iß ratio. This structural change in BC, that involves a variation in inter- and intramolecular interactions (hydrogen-bonding interactions), affects steeply their molecular dynamics. So, an increase of CMC concentration produces a significantly decrease of the ß-relaxation strength and an increase of the dc-conductivity.

Juxtapapillary neovascular membrane secondary to idiopathic intracranial hypertension treated with intravitreal bevacizumab: A case report. / Membrana neovascular coroidea yuxtapapilar secundaria a hipertensión intracraneal idiopática tratada con bevacizumab intravítreo: a propósito de un caso.

CASE REPORT: A 48 year-old woman with visual acuity loss in left eye (0.3). Funduscopic examination showed papillary oedema and neovascular membrane in the left eye. All neurological tests were normal, except the lumbar puncture with opening pressure of 35cmH2O, being diagnosed with idiopathic intracranial hypertension (IIH). After four doses of bevacizumab, the visual acuity of the left eye has not improved and is counting fingers. DISCUSSION: Pathogenesis of the juxtapapillary neovascular membrane associated with IIH is not well known. An effect was observed after the anti-VEGF treatment. In our case, there was no improvement after four doses of intravitreal bevacizumab.

Interconversion algorithm between mechanical and dielectric relaxation measurements for acetate of cis- and trans-2-phenyl-5-hydroxymethyl-1,3-dioxane.

The dielectric and mechanical spectroscopies of acetate of cis- and trans-2-phenyl-5-hydroxymethyl-1,3-dioxane are reported in the frequency domain from 10(-2) to 10(6)Hz. This ester has been selected in this study for its predominant α relaxation with regard to the ß relaxation, which can be neglected. This study consists of determining an interconversion algorithm between dielectric and mechanical measurements, given by using a relation between rotational and translational complex viscosities. These important viscosities were obtained from measures of the dielectric complex permittivity and by dynamic mechanical analysis, respectively. The definitions of rotational and translational viscosities were evaluated by means of fractional calculus, by using the fit parameters of the Havriliak-Negami empirical model obtained in the dielectric and mechanical characterization of the α relaxation. This interconversion algorithm is a generalization of the break of the Stokes-Einstein-Debye relationship. It uses a power law with an exponent defined as the shape factor, which modifies the translational viscosity. Two others factors are introduced for the interconversion, a shift factor, which displaces the translational viscosity in the frequency domain, and a scale factor, which makes equal values of the two viscosities. In this paper, the shape factor has been identified as the relation between the slopes of the moduli of the complex viscosities at higher frequency. This is interpreted as the degree of kinetic coupling between the molecular rotation and translational movements. Alternatively, another interconversion algorithm has been expressed by means of dielectric and mechanical moduli.

Análisis de la cultura de seguridad en el ámbito de la identificación del paciente por el alumnado de enfermería egresado de la Universidad / Analysis of safety culture in the field of patient identification by the students of Nursing degree from the University

Objetivos: El proceso asistencial supone la existencia de problemas de seguridad que afectan a la calidad de vida y que se incrementan en la ancianidad. El objetivo de este trabajo es analizar la cultura de seguridad de los profesionales de enfermería. Metodología: Se planteó la elaboración de un estudio descriptivo de corte transversal mediante la administración de una encuesta a una muestra de los alumnos/as egresados/as de la facultad en los últimos tres cursos. El cuestionario constaba de 39 ítems de respuesta múltiple estructurado en aspectos profesionales, seguridad del paciente e identificación del paciente. Los datos fueron recopilados en una base de datos Excel y se realizó el análisis descriptivo con el paquete estadístico SPSS 19. Resultados: El 94,3% de los/as entrevistados mantenía contacto directo con los pacientes. El 77,1% consideró que en su servicio no había suficiente personal para afrontar la carga de trabajo. Los problemas más frecuentes relacionados con la seguridad del paciente son: la disponibilidad de la historia clínica cuando se precisa (48,6% de los casos), la inexistencia de informes de historias clínicas (36% de los casos) y, en ocasiones, el cambio de historia clínica de un paciente por la de otro (31,4% de los casos). Un 68,6% no notificó por escrito ningún incidente. Conclusiones: Los problemas más frecuentes relacionados con la seguridad son la falta de información en la historia clínica y los problemas de identificación que se agravan en la persona mayor. Existe una infranotificación de errores/incidentes, persistiendo prácticas que favorecen errores en la identificación

Objectives: The treatment process involves the existence of security issues that affect the quality of life and increase in old age. The aim of this paper is to analyze the safety culture of nursing professionals. Methodology: Developing a cross-sectional descriptive study was raised by administering a survey to a sample of students graduates of the Faculty in the last three years. The questionnaire consisted of 39 multiple-choice items divided into professional aspects, Patient Safety and Patient ID. Data were collected on an Excel database and descriptive analysis with SPSS 19 was performed. Results: 94.3% of the interviewees maintained direct contact with patients. 77.1% felt that not enough staff in their service to meet the workload. The most common problems related to patient safety are: the availability of medical records when required (48.6% of cases), the absence of reports of medical records (36% of cases) and sometimes the change history of a patient by another (31.4% of cases). 68.6% reported no written incident. Conclusions: The most common problems related to security are lack of information on the history and identification problems that are exacerbated in the elderly. There is underreporting of errors/incidents, practices favoring identification errors persist

Emmonsiellopsis, a new genus related to the thermally dimorphic fungi of the family Ajellomycetaceae.

Two interesting fungi were isolated from fluvial sediments collected in the North of Spain. They were morphologically related to the thermally dimorphic fungi of the family Ajellomycetaceae, but the analysis of the internal transcribed spacer region of the rDNA, and the domains D1 and D2 of the 28S rRNA gene sequences confirmed that they were different from all the species described in that family. They were accommodated in the new genus Emmonsiellopsis as E. coralliformis sp. nov. and E. terrestris sp. nov. The two species are distinguished mainly by the maximum temper-ature of growth (up to 33 °C for E. coralliformis and to 42 °C for E. terrestris), the dendritic mycelium of E. coralliformis and the conidial ornamentation (verrucose in E. coralliformis and spinulose in E. terrestris). In addition, the phylogenetic data demonstrated that Ajellomyces griseus also represents a new genus within the Ajellomycetaceae, namely Helicocarpus. This new genus is easily distinguished by the lack of asexual morph, the production of brownish gymnothecial ascomata and oblate to lenticular, sparingly pitted ascospores. The proposal of both new genera was confirmed by the analysis of actin gene sequences.

Resultados preliminares de un programa comunitario de prevención de caídas: estudio Precari (prevención de caídas en La Ribera) / Preliminary results of a community fall prevention programme: Precan study (falls prevention in La Ribera)

Objetivo. Evaluar la posible reducción en la incidencia de caídas y la ganancia funcional de un programa de prevención de caídas. Material y métodos. Doscientos cuarenta y nueve sujetos no institucionalizados fueron repartidos aleatoriamente en 3 grupos: el grupo intervención mensual (GIM), el cual recibió instrucción teórica sobre prevención de caídas y ejercicios que mejoran la función física y el equilibrio de forma mensual complementado con una clase práctica con la misma periodicidad. El grupo intervención trimestral (GIT), el cual recibió la misma información teórica con periodicidad trimestral. El grupo control (GC), instruido teóricamente al inicio del estudio, sin refuerzos posteriores. La duración del estudio fue de 12 meses. Resultados. Edad media 74,47 (DE: 5,33) años, mujeres: 64%. La incidencia de caídas se redujo del GIM desde el 0,64 por paciente y año en el año previo al 0,39 en el año posterior a la intervención, en el GIT desde 0,49 a 0,47 y en el GC desde se mantuvo en el 0,47, no existiendo diferencias significativas en dicha reducción entre grupos (p = 0,062). También se objetiva un descenso de la puntuación en la escala de Rizzo de 0,72 (IC 95%: 0,57-0,88) puntos, p < 0,001. Conclusión. Una intervención comunitaria interdisciplinar puede contribuir a la reducción de la incidencia de caídas, aunque estos resultados no son concluyentes. Es necesario seguir estudiando el abordaje de la incidencia de caídas en poblaciones ancianas de ámbito comunitario (AU)

Objective. To evaluate the results of a fall prevention programme designed to be applied to the elderly living in the community. Material and methods. The sample consisted of 249 participants ≥70 years of age, who were randomly assigned to one of three groups. The monthly intervention group (GIM): instructions on fall prevention and healthy exercises to improve physical function and balance at beginning of the study, and a monthly theoretical and practical refresher session. The quarterly intervention group (GIT), with the same beginning intervention and a refresher session every three months. The control group (GC), the same beginning intervention but no refresher sessions. Results. The mean age of the sample was 74.47 years (SD 5.33), with 64% women. The incidence of falls was reduced from 0.64 per patient year in the previous year to 0.39 in the post-intervention year in GIM, from 0.49 to 0.47 in GIT, and in the GC it remained at 0.47 before and twelve months after, but with no significant differences in the reduction between groups (P=.062). At the end of the study there was a decrease in Rizzo scale of 0.72 points (95% CI: 0.57-0.88, P<.001). Conclusion. An interdisciplinary community intervention programme can contribute to reducing the incidence of falls. Further studies are required to continue research into the incidence of falls in the elderly living in the community (AU)

Automatic control of pollutant on a shallow river using surface water systems: application to the Ebro River.

In this paper, the problem of automatic control of pollutant on a shallow river using surface water systems is addressed using a benchmark test case based in the Ebro River. The Ebro River presents flooding episodes in the city of Zaragoza in Spring when snow melts in the Pyrenees. To avoid flooding and high pollutant levels in living areas, some lands outside the city are prepared to be flooded. Going one step further, this paper is focused on the pollutant level control at a certain point downstream of the river under flooding episodes, and several control strategies for that purpose are presented and tested.

[Preliminary results of a community fall prevention programme: Precan study (falls prevention in La Ribera)]. / Resultados preliminares de un programa comunitario de prevención de caídas: estudio Precari (prevención de caídas en La Ribera).

OBJECTIVE: To evaluate the results of a fall prevention programme designed to be applied to the elderly living in the community. MATERIAL AND METHODS: The sample consisted of 249 participants ≥70 years of age, who were randomly assigned to one of three groups. The monthly intervention group (GIM): instructions on fall prevention and healthy exercises to improve physical function and balance at beginning of the study, and a monthly theoretical and practical refresher session. The quarterly intervention group (GIT), with the same beginning intervention and a refresher session every three months. The control group (GC), the same beginning intervention but no refresher sessions. RESULTS: The mean age of the sample was 74.47 years (SD 5.33), with 64% women. The incidence of falls was reduced from 0.64 per patient year in the previous year to 0.39 in the post-intervention year in GIM, from 0.49 to 0.47 in GIT, and in the GC it remained at 0.47 before and twelve months after, but with no significant differences in the reduction between groups (P=.062). At the end of the study there was a decrease in Rizzo scale of 0.72 points (95% CI: 0.57-0.88, P<.001). CONCLUSION: An interdisciplinary community intervention programme can contribute to reducing the incidence of falls. Further studies are required to continue research into the incidence of falls in the elderly living in the community.

Contributions of dipolar relaxation processes and ionic transport to the response of liquids to electrical perturbation fields.

The objective of this work was to study the influence of small variations in the chemical structure on the molecular dynamics of liquids using as models bis(cyclohexylmethyl) 2-methyl- and dicyclohexyl 2-methylsuccinate. The dielectric behavior of the low molecular weight liquids was studied over a wide range of frequencies and temperatures. The results show that the temperature dependence of the dielectric strengths, relaxation times, and shape parameters of the secondary and glass-liquid relaxations are very sensitive to the slight differences in the structures of the liquids. Significant changes take place in the dielectric strength of the ß relaxation in the glass liquid transition. Moreover, the temperature dependence of the ß relaxation exhibits Arrhenius behavior in the glassy state and departs from this behavior in the liquid state. Special attention is paid to the temperature dependence of low-frequency relaxations produced by the motion of a macrodipole arising from charges located near the liquid-electrode boundaries.

Instability of incompressible cylinder rubber tubes under radial electric fields.

The possibility of instability of cylindrical tubes of elastomers is analyzed taking into account Mooney-Rivlin (M. Mooney, J. Appl. Phys. 11, 582 (1940)) and Ogden (R.W. Ogden, Proc. R. Soc. London, Ser. A 326, 565 (1972)) models. In some aspects this paper is the elasto-electric counterpart of a previous paper by Bustamante, Dorfmann and Ogden (R. Bustamante, A. Dorfmann, R.W. Ogden, J. Engn. Math. 59, 139 (2007)). However in the present case the appearance of instability is checked. The results indicate that models more complex than the Mooney-Rivlin model are necessary to predict instability zones showing minimum critical points.

Effect of an electric field on the bifurcation of a biaxially stretched incompressible slab rubber.

This paper describes the effect of an electrical field on the bifurcation phenomenon that appears in a biaxially stretched slab of Mooney-Rivlin material (M. Mooney, J. Appl. Phys. 11, 582 (1940)) subjected to equal dead loads. The main conclusion of the analysis is that the stretch ratio at which the bifurcation phenomenon appears crucially depends on the configuration of the system rubber slab-electrodes. The theoretical foundations of the present study are based on a recent formulation on this subject carried out by Dorfmann and Ogden (A. Dorfmann, R.W. Ogden, Acta Mech. 174, 167 (2005); J. Elasticity 82, 99 (2006)).

Masa abdominal indolora / No disponible

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Vogt-Koyanagi-Harada syndrome in a case of multiple sclerosis.

A 34-year-old woman in whom multiple sclerosis (MS) had been diagnosed 2 years earlier developed progressive bilateral visual loss associated with peripapillary exudative retinal detachment and other features of Vogt-Koyanagi-Harada (VKH) syndrome. She was treated with corticosteroid pulses and interferon beta-1A with visual acuity improvement and resolution of the retinal detachment. This is the first reported case of VKH syndrome in a patient with MS. The combination of VKH syndrome and MS suggests a common autoimmune pathogenesis.