Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation.

INTRODUCTION: Despite the benefits of mobilisation in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is scarce. The objective of this study is to analyze the impact of mobility on these patients. METHODS: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to a tertiary hospital. Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. RESULTS: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24,5 g/L (IQR: 23-30) vs 33 g/L (IQR: 26-36); p = .029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = .014). There were no significant differences in appearance of pressure ulcers, or post HT infections among mobility groups. CONCLUSIONS: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post HT adverse events.

Impacto de la movilización en pacientes portadores de soporte circulatorio mecánico de corta duración tipo Levitronix® CentriMag como puente a trasplante cardíaco / Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation

Introducción: Pese a los beneficios de la movilización en el paciente crítico, la evidencia de su aplicación en pacientes portadores de Levitronix® CentriMag como puente a trasplante cardíaco (TC) es prácticamente nula. El objetivo del estudio fue analizar el impacto de la movilidad en estos pacientes. Métodos: Estudio observacional retrospectivo. Se incluyeron los pacientes sometidos a un TC previamente portadores de Levitronix® CentriMag ingresados entre el 2010 y el 2019 en el Hospital Universitario de Bellvitge. Se relacionaron las variables grado de movilidad y estado nutricional con la evolución clínica posterior al TC (infecciones, tiempo de estancia en UCI y mortalidad). Resultados: Los 27 pacientes seleccionados se dividieron en dos grupos según el grado de movilidad (22 baja y 5 alta). Se observó una supervivencia a 90 días post-TC del 63,6% en el grupo de pacientes con movilidad baja, mientras que en el grupo con movilidad alta fue del 80%; no se observaron diferencias estadísticamente significativas. Tampoco las hubo en la distribución de las altas de UCI desde el TC a 30 días. Por otro lado, se observaron unos menores niveles de albúmina en el grupo de movilidad baja, con una diferencia estadísticamente significativa (24,5 g/L [RIC: 23-30] vs. 33 g/L [RIC: 26-36]; p = 0,029). También se observaron diferencias en la mediana de días de ventilación mecánica invasiva (VMI) post-TC (p = 0,014), siendo mayor en el grupo de movilidad baja. No se observaron diferencias en la aparición de infecciones ni UPP. Conclusiones: Los pacientes con un grado de movilidad alto presentaron un menor tiempo de VMI y un mejor estado nutricional. No se observaron complicaciones asociadas a la movilidad. No se encontraron diferencias significativas entre el grado de movilidad y la mortalidad a 90 días, el tiempo de ingreso en UCI, la aparición de infecciones o UPP post-TC.(AU)

Introduction: Despite the benefits of mobilization in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is almost absent. The objective of this study is to analyze the impact of mobility on these patients. Methods: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to “Hospital Universitario de Bellvitge” (Barcelona). Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. Results: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24.5 g/L (IQR: 23-30) vs. 33 g/L (IQR: 26-36); p = 0.029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = 0.014). There were no significant differences in appearance of pressure ulcers, or post-HT infections among mobility groups. Conclusions: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post-HT adverse events.(AU)

Efectividad del uso de ketamina perioperatoria en pacientes sometidos a cirugía de raquis en tratamiento crónico con opioides / Postoperative ketamine efficacy in patients receiving chronic opioids undergoing spinal surgery

Introducción: El número de pacientes en tratamiento con opioides de forma crónica sometidos a una cirugía espinal ha aumentado en los últimos años. Los registros de dolor mediante la escala visual analógica (EVA) y el consumo de opioides durante el postoperatorio son más elevados en esta clase de pacientes.Material y métodos: Siguiendo las recomendaciones de la American Pain Society (APS), en 2018 se diseñó un nuevo protocolo analgésico intra y postoperatorio basado en el uso de ketamina. En el intraoperatorio, se administró un bolus de 0,5 mg/kg de ketamina, seguido por una perfusión a dosis de 0,2 mg/kg/h hasta el cierre de la herida. Durante las 48 horas postoperatorias, se mantuvo una bomba de analgesia controlada por el paciente (PCA) de morfina-ketamina junto con un régimen de analgesia multimodal con paracetamol y dexketoprofeno. Se realizó un análisis de la efectividad del nuevo protocolo (grupo ketamina) comparándolo con el protocolo seguido el año anterior (grupo control), basado en el uso de tramadol 100 mg/6 h o PCA de morfina. Se analizaron los registros de dolor mediante la escala verbal numérica (EVN) durante las primeras 48 horas postoperatorias, la necesidad de administración de bolus puntuales de morfina y la necesidad de iniciar una perfusión continua de morfina (grupo control) o morfina ketamina (grupo ketamina). Resultados: Los pacientes del grupo ketamina presentaron EVN inferiores a los del grupo control durante las dos primeras horas postoperatorias (p = 0,001) y menores necesidades de rescates de morfina en el segundo día postoperatorio (p = 0,003). La necesidad de perfusión continua de morfina-ketamina fue significativamente inferior a la necesidad de inicio de perfusión continua de morfina en el grupo control (p = 0,011). Conclusión: El protocolo basado en el uso de ketamina consiguió mejorar el control del dolor postoperatorio y reducir de forma significativa el consumo de opioides en las primeras 48 horas...(AU)

Introduction: The number of patients receiving chronic opioids undergoing spinal surgery has increased lately. Elevate records in visual analog scale (VAS) and opioid consumption are higher in this group of patients. Material and methods: Following the recommendations of the American Pain Society (APS), a new intra and postoperative analgesic protocol based on the use of ketamine was designed in 2018. Intraoperatively, a bolus of 0.5 mg/kg of ketamine was administered, followed by a dose infusion of 0.2 mg/kg/h until the surgical wound was closed. During the first 48 post­operative hours, a patient-controlled analgesia pump (PCA) of morphine-ke­tamine was maintained along with a multimodal analgesia regimen with paracetamol and dexketoprofen. An effectiveness analysis comparing the new protocol (ketamine group) with the previous one (control group), based on the use of tramadol 100 mg / 6h or PCA morphine, was done. During the first 48 postoperative hours, NVS records, need of rescue analgesia, morphine bolus or continuous morphine infusion (control group) or ketamine morphine infusion (ketamine group) were analyzed. Results: The patients in the ketamine group had lo­­wer NVS records than those in the control group during the first two postoperative hours (p = 0.001) and lower morphine rescues needs on the second postoperative day (p = 0.003). The need for continuous morphine-ke­tamine perfusion was significantly lower than the need for continuous morphine perfusion on the control group (p = 0.011). Conclusion: The protocol based on the use of ke­tamine, managed to improve the control of postoperative pain and significantly reduce the consumption of opioids in the first 48 hours after the intervention.(AU)

X-ray microtomographic characterization of highly rough titanium cold gas sprayed coating for identification of effective surfaces for osseointegration.

A highly rough titanium coating obtained by Cold Gas Spray (CGS) has been characterized by means of high-resolution 3D microtomography (micro-CT) with the aim to evaluate its open and close porosity for possible use in orthopaedic implants to promote osseointegration. Micro-CT allowed a qualitative and quantitative description of the main features, morphology of the pores and surface roughness of the coating. Several numerical values were obtained to describe size, form and distribution of the closed/inner and open/outer pores. Additionally, surface roughness and open porosity were image-analyzed to find the effective surface for osseointegration.

Comparison of three pesticide fate models with respect to the leaching of two herbicides under field conditions in an irrigated maize cropping system.

The ability of three models (PEARL, MACRO and PRZM) to describe the water transfer and leaching of the herbicides S-metolachlor and mesotrione as observed in an irrigated maize monoculture system in Toulouse area (France) was compared. The models were parameterized with field, laboratory and literature data, and pedotransfer functions using equivalent parameterization to better compare the results and the performance of the models. The models were evaluated and compared from soil water pressure, water content and temperature data monitored at 0.2, 0.5 and 1 m depth, together with water percolates and herbicide concentrations measured in a tension plate lysimeter at 1 m depth. Some hydraulic (n, θ(s)) parameters and mesotrione DT50 needed calibration. After calibration, the comparison of the results obtained by the three models indicated that PRZM was not able to simulate properly the water dynamic in the soil profile. On the contrary, PEARL and MACRO simulated generally quite well the observed water pressure head and volumetric water content at the three different depths during wetting periods (e.g. irrigated cropping period) while a poorest performance was obtained for drying periods (fallow period with bare soil and beginning of crop period). Similar water flow dynamics were simulated by PEARL and MACRO in the soil profile although in general, and due to a higher evapotranspiration in MACRO, PEARL simulated a wetter soil than MACRO. For the whole simulated period, the performance of all models to simulate water leaching at 1m depth was poor, with an overestimation of the total water volume measured in the lysimeter (ranging from 2.2 to 6.6 times). By contrast, soil temperature was properly reproduced by the three models. The models were able to simulate the leaching of herbicides at 1m depth in similar appearance time and order of magnitude as field observations. Cumulative observed and simulated mesotrione losses by leaching were consistently higher than the observed and simulated losses of the less mobile herbicide, S-metolachlor. In general, PRZM predicted the highest concentrations for both herbicides in the leachates while PEARL simulated the observed herbicide concentrations better than MACRO and PRZM.

Fenómeno de Kernohan-Woltman secundario a un hematoma epidural craneal / Kernohan-Woltman notch phenomenon secondary to a cranial epidural hematoma

El fenómeno de la escotadura de Kernohan-Woltman es una manifestación neurológica paradójica que consiste en un déficit motor ipsilateral a la lesión cerebral primaria. Este fenómeno es causado principalmente por hematomas subdurales agudos o crónicos postraumáticos, siendo los hematomas epidurales una causa menos frecuente. Este fenómeno debe ser tenido en cuenta en casos de déficit motor ipsilateral, ya que puede resultar en procedimientos quirúrgicos del lado equivocado. Presentamos el caso de un paciente de 40 años quien, tras sufrir un traumatismo craneoencefálico, presentó disminución del nivel de conciencia y anisocoria. La tomografía computarizada de cráneo evidenció un hematoma epidural parietofrontal derecho con desplazamiento de la línea media y herniación uncal. Se realizó craneotomía y drenaje del hematoma y al sexto día del postoperatorio se evidenció una hemiparesia braquiocrural derecha. En la resonancia magnética se observó un área de isquemia capsulopeduncular izquierda acorde con el diagnóstico de fenómeno de la escotadura de Kernohan-Woltman (AU)

Kernohan-Woltman notch phenomenon is a paradoxical neurological manifestation which involves a motor deficit on the same side as the primary brain injury. It is produced mainly by acute or chronic subdural hematomas, and less frequently by post-traumatic epidural ones. It should be taken into consideration in cases of ipsilateral motor deficit, as it may lead to surgical procedures being performed on the incorrect side. We report the case of a 40 year old man who sustained a major head injury which was followed by a decreased level of consciousness and anisocoria. Computed tomography of the brain revealed a frontal and parietal epidural hematoma with right midline shift and uncal herniation. Craniotomy and drainage of the hematoma was performed, and on the sixth day after surgery it was observed that the patient had a brachio-crural right hemiparesis. Magnetic resonance imaging showed an ischemic area on the left capsule and cerebral peduncle consistent with the diagnosis of Kernohan-Woltman notch phenomenon

[Kernohan-Woltman notch phenomenon secondary to a cranial epidural hematoma]. / Fenómeno de Kernohan-Woltman secundario a un hematoma epidural craneal.

Kernohan-Woltman notch phenomenon is a paradoxical neurological manifestation which involves a motor deficit on the same side as the primary brain injury. It is produced mainly by acute or chronic subdural hematomas, and less frequently by post-traumatic epidural ones. It should be taken into consideration in cases of ipsilateral motor deficit, as it may lead to surgical procedures being performed on the incorrect side. We report the case of a 40 year old man who sustained a major head injury which was followed by a decreased level of consciousness and anisocoria. Computed tomography of the brain revealed a frontal and parietal epidural hematoma with right midline shift and uncal herniation. Craniotomy and drainage of the hematoma was performed, and on the sixth day after surgery it was observed that the patient had a brachio-crural right hemiparesis. Magnetic resonance imaging showed an ischemic area on the left capsule and cerebral peduncle consistent with the diagnosis of Kernohan-Woltman notch phenomenon.

COP-compost: a software to study the degradation of organic pollutants in composts.

Composting has been demonstrated to be effective in degrading organic pollutants (OP) whose behaviour depends on the composting conditions, the microbial populations activated and interactions with organic matters. The fate of OP during composting involves complex mechanisms and models can be helpful tools for educational and scientific purposes, as well as for industrialists who want to optimise the composting process for OP elimination. A COP-Compost model, which couples an organic carbon (OC) module and an organic pollutant (OP) module and which simulates the changes of organic matter, organic pollutants and the microbial activities during the composting process, has been proposed and calibrated for a first set of OP in a previous study. The objectives of the present work were (1) to introduce the COP-Compost model from its convenient interface to a potential panel of users, (2) to show the variety of OP that could be simulated, including the possibility of choosing between degradation through co-metabolism or specific metabolism and (3) to show the effect of the initial characteristics of organic matter quality and its microbial biomass on the simulated results of the OP dynamic. In the model, we assumed that the pollutants can be adsorbed on organic matter according to the biochemical quality of the OC and that the microorganisms can degrade the pollutants at the same time as they degrade OC (by co-metabolism). A composting experiment describing two different (14)C-labelled organic pollutants, simazine and pyrene, were chosen from the literature because the four OP fractions simulated in the model were measured during the study (the mineralised, soluble, sorbed and non-extractable fractions). Except for the mineralised fraction of simazine, a good agreement was achieved between the simulated and experimental results describing the evolution of the different organic fractions. For simazine, a specific biomass had to be added. To assess the relative importance of organic matter dynamics on the organic pollutants' behaviour, a sensitivity analysis was conducted. The sensitivity analysis demonstrated that the parameters associated with organic matter dynamics and its initial microbial biomass greatly influenced the evolution of all the OP fractions, although the initial biochemical quality of the OC did not have a significant impact on the OP evolution.

Simulation of Organic Matter and Pollutant Evolution during Composting: The COP-Compost Model.

Organic pollutants (OPs) are potentially present in composts and the assessment of their content and bioaccessibility in these composts is of paramount importance. In this work, we proposed a model to simulate the behavior of OPs and the dynamic of organic C during composting. This model, named COP-Compost, includes two modules. An existing organic C module is based on the biochemical composition of the initial waste mixture and simulates the organic matter transformation during composting. An additional OP module simulates OP mineralization and the evolution of its bioaccessibility. Coupling hypotheses were proposed to describe the interactions between organic C and OP modules. The organic C module, evaluated using experimental data obtained from 4-L composting pilots, was independently tested. The COP-Compost model was evaluated during composting experiments containing four OPs representative of the major pollutants detected in compost and targeted by current and future regulations. These OPs included a polycyclic aromatic hydrocarbon (fluoranthene), two surfactants (4--nonylphenol and a linear alkylbenzene sulfonate), and an herbicide (glyphosate). Residues of C-labeled OP with different bioaccessibility were characterized by sequential extraction and quantified as soluble, sorbed, and nonextractable fractions. The model was calibrated and coupling the organic C and OP modules improved the simulation of the OP behavior and bioaccessibility during composting.

Spatial distribution of Lindane concentration in topsoil across France.

Lindane [γ-hexachlorocyclohexane (γ-HCH)] is an organochlorine pesticide with toxic effects on humans. It is bioaccumulative and can remain in soils for long periods, and although its use for crop spraying was banned in France in 1998, it is possible that residues from before this time remain in the soil. The RMQS soil monitoring network consists of soil samples from 2200 sites on a 16 km regular grid across France, collected between 2002 and 2009. We use 726 measurements of the Lindane concentration in these samples to (i) investigate the main explanatory factors for its spatial distribution across France, and (ii) map this distribution. Geostatistics provides an appropriate framework to analyze our spatial dataset, though two issues regarding the data are worth special consideration: first, the harmonization of two subsets of the data (which were analyzed using different measurement processes), and second, the large proportion of data from one of these subsets that fell below a limit of quantification. We deal with these issues using recent methodological developments in geostatistics. Results demonstrate the importance of land use and rainfall for explaining part of the variability of Lindane across France: land use due to the past direct input of Lindane on cropland and its subsequent persistence in the soil, and rainfall due to the re-deposition of volatilized Lindane. Maps show the concentrations to be generally largest in the north and northwest of France, areas of more intensive agricultural land. We also compare levels to some contamination thresholds taken from the literature, and present maps showing the probability of Lindane concentrations exceeding these thresholds across France. These maps could be used as guidelines for deciding which areas require further sampling before some possible remediation strategy could be applied.

Composting in small laboratory pilots: performance and reproducibility.

Small-scale reactors (<10 l) have been employed in composting research, but few attempts have assessed the performance of composting considering the transformations of organic matter. Moreover, composting at small scales is often performed by imposing a fixed temperature, thus creating artificial conditions, and the reproducibility of composting has rarely been reported. The objectives of this study are to design an innovative small-scale composting device safeguarding self-heating to drive the composting process and to assess the performance and reproducibility of composting in small-scale pilots. The experimental setup included six 4-l reactors used for composting a mixture of sewage sludge and green wastes. The performance of the process was assessed by monitoring the temperature, O(2) consumption and CO(2) emissions, and characterising the biochemical evolution of organic matter. A good reproducibility was found for the six replicates with coefficients of variation for all parameters generally lower than 19%. An intense self-heating ensured the existence of a spontaneous thermophilic phase in all reactors. The average loss of total organic matter (TOM) was 46% of the initial content. Compared to the initial mixture, the hot water soluble fraction decreased by 62%, the hemicellulose-like fraction by 68%, the cellulose-like fraction by 50% and the lignin-like fractions by 12% in the final compost. The TOM losses, compost stabilisation and evolution of the biochemical fractions were similar to observed in large reactors or on-site experiments, excluding the lignin degradation, which was less important than in full-scale systems. The reproducibility of the process and the quality of the final compost make it possible to propose the use of this experimental device for research requiring a mass reduction of the initial composted waste mixtures.

Modelling of organic matter dynamics during the composting process.

Composting urban organic wastes enables the recycling of their organic fraction in agriculture. The objective of this new composting model was to gain a clearer understanding of the dynamics of organic fractions during composting and to predict the final quality of composts. Organic matter was split into different compartments according to its degradability. The nature and size of these compartments were studied using a biochemical fractionation method. The evolution of each compartment and the microbial biomass were simulated, as was the total organic carbon loss corresponding to organic carbon mineralisation into CO(2). Twelve composting experiments from different feedstocks were used to calibrate and validate our model. We obtained a unique set of estimated parameters. Good agreement was achieved between the simulated and experimental results that described the evolution of different organic fractions, with the exception of some compost because of a poor simulation of the cellulosic and soluble pools. The degradation rate of the cellulosic fraction appeared to be highly variable and dependent on the origin of the feedstocks. The initial soluble fraction could contain some degradable and recalcitrant elements that are not easily accessible experimentally.

Enfermedad tromboembólica en la embarazada: estrategias de profilaxis y tratamiento / No disponible

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Sorption and mineralization of organic pollutants during different stages of composting.

The organic pollutant (OP) content is a key factor when determining compost quality. The OPs present in feedstock materials may either be degraded during composting or stabilized in the compost by sorption interactions with organic matter (OM), which may reduce the availability of OP to microorganism degradation. It is particularly important to identify the key stages during composting that are involved in OP mineralization so as to be able to optimize the composting process and determine whether OP sorption on OM is a limiting factor to OP mineralization. Four (14)C-labeled OPs were used during the study: a polycyclic aromatic hydrocarbon (fluoranthene), two surfactants (4-n-nonylphenol - NP and sodium linear dodecylbenzene sulfonate - LAS) and a herbicide (glyphosate). The potential for compost microflora to degrade OP, and compost sorption properties, were characterized at different stages of composting. The highest levels of LAS and glyphosate mineralization were found during the thermophilic stage, at the beginning of maturation for NP and at the end of maturation for fluoranthene. A specific microflora was probably involved in the biodegradation of fluoranthene while NP, LAS and glyphosate mineralization were linked to total microbial activity. OP sorption on compost was linked to their hydrophobicity, decreasing in the order: fluoranthene>NP>LAS>glyphosate. Moreover, sorption decreased as compost maturity increased, except for glyphosate. The sorption coefficients were positively correlated to mineralization kinetics parameters for NP, LAS and glyphosate, suggesting a positive effect of sorption on increasing mineralization rates.

Ageing processes and soil microbial community effects on the biodegradation of soil (13)C-2,4-D nonextractable residues.

The biodegradation of nonextractable residues (NER) of pesticides in soil is still poorly understood. The aim of this study was to evaluate the influence of NER ageing and fresh soil addition on the microbial communities responsible for their mineralisation. Soil containing either 15 or 90-day-old NER of (13)C-2,4-D (NER15 and NER90, respectively) was incubated for 90 days with or without fresh soil. The addition of fresh soil had no effect on the mineralisation of NER90 or of SOM, but increased the extent and rate of NER15 mineralisation. The analyses of (13)C-enriched FAME (fatty acids methyl esters) profiles showed that the fresh soil amendment only influenced the amount and structure of microbial populations responsible for the biodegradation of NER15. By coupling biological and chemical analyses, we gained some insight into the nature and the biodegradability of pesticide NER.