Determination of soluble tumor necrosis factor receptor II and secretory immunoglobulin A in saliva of patients with dementia.

The prevalence of pain and dementia increases with age, affecting a significant percentage of the population due to aging. Both pathologies are connected through the inflammatory process, specifically through the tumor necrosis factor. The effect of this cytokine is mediated through the modulation of its TNFRI and TNFRII receptors, which are linked to the dementia process. In addition, immunoglobulins such as secretory immunoglobulin A (sIgA) have been recognized as one of the main biomarkers of pain in saliva. sTNFRII and sIgA levels were determined in saliva samples by ELISA from healthy people and patients with dementia in GDS stages 5-7. The concentrations of these markers were also correlated with the GDS stage and sex. We observed a significant decrease (*** p ≤ 0.001) in the levels of sTNFRII (pg/mL) and a significant increase (** p ≤ 0.01) in the levels of sIgA (ng/mL) in the saliva of patients with dementia compared to the healthy control group. We did not observe a correlation with the data of the biomarkers regarding the GDS stage and sex. The results obtained for sTNFRII are consistent with those obtained by other authors on brain tissue, who conclude that unopposed neuronal TNFRI signaling, when TNFRII is selectively downregulated, leads to a more severe course of AD pathogenesis. Regarding sIgA, the elevated values of sIgA may reflect the immune status of these patients. Therefore, these biomarkers can provide us with relevant information through a non-invasive method such as saliva analysis.

Acute seizure crisis after an unexpected sudden hypomagnesemia / Crisis convulsiva aguda después de una hipomagnesemia repentina inesperada

Hypomagnesemia, one of the most common underdiagnosed metabolic disorders in patients admitted to Postoperative Intensive Care. It is associated with presence of hypocalcemia, hypokalemia, and alkalosis. Severe magnesium deficiency can trigger life-threatening cardiac and neurological disorders however those clinical effects have not been reported immediately after surgery or magnesium infusion cessation. We present a case of women who had several switch-off episodes and generalized sudden seizures secondary to hypomagnesemia without any metabolic disturbances, even after replenishing magnesium levels. It underlines the importance, of continuous patient´s motorization who undergoes intestinal elective surgery and gene screening. Although this side effect has been reported, evidence not showed the immediacy of our case and different course than expected due to concomitant electrolytes disturbances were not found. Magnesium deficiency should be taken in patients undergoing elective bowel surgery with greater resection than 50 centimeters. This deficiency may occur as single electrolyte disturbance with sudden onset. (AU)

La hipomagnesemia es uno de los trastornos metabólicos infradiagnosticados más frecuentemente en pacientes ingresados en cuidados intensivos postoperatorios. Se asocia con la presencia de hipocalcemia, hipopotasemia y alcalosis. La deficiencia severa de magnesio puede desencadenar trastornos cardíacos y neurológicos potencialmente mortales, sin embargo, esos efectos clínicos no han sido identificados de una manera inmediata tras la cirugía o el cese de la infusión de magnesio. Presentamos el caso de una mujer que tuvo varios episodios de desconexión y crisis comiciales repentinas generalizadas secundarias a hipomagnesemia, sin alteraciones metabólicas, incluso después de reponer los niveles de magnesio. Casos como el que presentamos, destaca la importancia de la motorización continua del paciente sometido a cirugía intestinal electiva y un cribado genético. Aunque este efecto secundario ha sido reportado, la evidencia no mostró la inmediatez de nuestro caso y no se encontró un curso diferente al esperado debido a alteraciones electrolíticas concomitantes. La deficiencia de magnesio debe tomarse en serio en pacientes sometidos a cirugía intestinal electiva con resección mayor de 50 centímetros. Esta deficiencia puede ocurrir como una alteración electrolítica única con inicio repentino. (AU)

Melting Temperature Depression of Polymer Single Crystals: Application to the Eco-Design of Tie-Layers in Polyolefinic-Based Multilayered Films.

In this paper, we describe a method for determining polymer compatibility, which will aid in establishing the requirements of polyolefinic materials for the eco-design of multilayer films for mechanical recycling while avoiding the use of reactive tie layers. Our ultimate goal is to define the molecular characteristics of the polyolefinic structural layer that improve compatibility with the tie layer during mechanical recycling. We have investigated the melting temperature depression of single crystals of various polyethylenes embedded in commercial polymeric matrices with various functionalities (ester, acrylate, acetate and methacrylic acid sodium ionomer), which can be potentially used as tie layers. We demonstrate how the concentration and molecular architecture of the matrices affect the melting temperature of the embedded single crystals differently depending on the latter's molecular architecture. The main finding indicates that the tie layers are more compatible with linear polyethylene than with branched polyethylenes. Indeed, our results show that the heterogeneous Ziegler-Natta linear low-density polyethylene is incompatible with all of the tie layers tested. The depression of melting temperatures observed are in excellent agreement with the results obtained by investigating the rheological behaviour and morphological features of solution-mixed blends in which segmental interactions between polymeric chains have been, in theory, maximized. Because Ziegler-Natta linear density polyethylene is one of the most commonly used polymers as a structural layer in multi-layer applications, the findings of this study are useful as they clearly show the unsuitability of this type of polyethylene for recycling from an eco-design standpoint. The specific molecular requirements for polyethylene layers (branching content less than 0.5/100 carbon atoms) can be specified for use in packaging, guiding the eco-design and valorisation of recycled multi-layered films containing this material.

Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica / Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique

Introducción y objetivo: El abordaje mediante cirugía mínimamente invasiva de la patología de la glándula suprarrenal es el más extendido hoy en día, en donde la retroperitoneoscopia ocupa un lugar a tener muy en cuenta; sin embargo, la evolución de estas técnicas hacia abordajes todavía menos invasivos a través de puerto único es anecdótica.La finalidad de este trabajo es describir nuestra experiencia inicial en cirugía retroperitoneoscópica por puerto único (SPORS) de la glándula suprarrenal centrándonos en los datos perioperatorios y dolor postoperatorio.Material y métodosRecogimos y analizamos los datos demográficos y operatorios de una serie de pacientes tratados mediante suprarrenalectomía mediante SPORS. Todos los procedimientos se realizaron mediante una única incisión subcostal de 3-4cm a través de un puerto multicanal. Se recogen diferentes datos quirúrgicos como tiempo operatorio, sangrado, estancia o presencia de complicaciones. Empleamos la escala visual analógica (EVA) para la valoración del dolor postoperatorio.ResultadosEntre diciembre del 2018 y agosto del 2020, 6 pacientes con diferentes patologías suprarrenales fueron intervenidos en nuestro Departamento de forma consecutiva por el mismo cirujano mediante SPORS. Todas las cirugías se realizaron sin requerir colocación de trocares accesorios o reconversión a cirugía abierta. El tiempo medio de las intervenciones fue de 91,6±16,3 min, con un sangrado <150ml, una estancia media de 35,8±13,3 h y un dolor postoperatorio analizado EVA ≤ 3 (mediana de 0,5). El tamaño medio de las piezas fue de 57,8±18mm. No se reportó ninguna complicación según la escala Clavien-Dindo.

Introduction and objective: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain.Material and methodsWe collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment.ResultsFrom December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6±16.3minutes, with <150mL bleeding, mean length of stay of 35.8±13.3hours and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8±18mm. No complications were reported according to the Clavien-Dindo scale. (AU)

Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique.

INTRODUCTION AND OBJECTIVE: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS: We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4 cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS: From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6 ±â€¯16.3 min, with <150 mL bleeding, mean length of stay of 35.8 ±â€¯13.3 h and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8 ±â€¯18 mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS: Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique. / Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica.

INTRODUCTION AND OBJECTIVE: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS: We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS: From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6±16.3minutes, with <150mL bleeding, mean length of stay of 35.8±13.3hours and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8±18mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS: Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

Sesgos de género y limitación del esfuerzo terapéutico / Gender bias and limitation of therapeutic effort

Objetivo: Comparar el manejo y los resultados en mujeres y hombres en estado crítico por sepsis en los servicios de urgencias extrahospitalarias, los servicios de urgencias hospitalarias y las unidades de Cuidados Intensivos (UCI). Método: Utilización de los datos de las encuestas suecas National Quality Sepsis Registry y Swedish Intensive Care Registry para identificar una cohorte, a escala nacional, de 2.720 personas ingresadas en una UCI dentro de las 24 h siguientes a la llegada a cualquiera de las 32 unidades de urgencias hospitalarias suecas, con un diagnóstico de sepsis severa o shock séptico, entre 2008 y 2015. Resultados: del total de pacientes de la muestra, el 44,5% eran mujeres. En los servicios de Urgencias extrahospitalarias un porcentaje mayor en el grupo de los hombres tenía todos los signos vitales registrados (54,4 vs. 49,9%, p=0,02) y recibió líquidos por vía intravenosa y oxígeno (40,0 vs. 34,8%, p=0,02). En el servicio de Urgencias hospitalario, los hombres habían completado el bundle de sepsis en la primera hora en el 41,5% de los casos en comparación con el 30,0% en las mujeres (p <0,001) y habían recibido antibióticos en un tiempo menor: 65 (RIQ 30-136) vs. 87min (RIQ 39-172) (p=0,0001). No hubo diferencias significativas entre hombres y mujeres con respecto a la carga de trabajo de enfermería en la UCI, la ventilación mecánica o la duración de la estancia en la UCI. En el análisis multivariante ajustado por gravedad, la OR para las mujeres a las que se les aplicó el bundle completo, en comparación con los hombres, fue de 0,64 (IC: 0,51-0,81). La mortalidad a los 30 días fue del 25,0% para las mujeres y del 23,1% para los hombres (p=0,24). La OR ajustada para la muerte femenina fue de 1,28 (IC: 1,00-1,64), pero el aumento de la mortalidad no estuvo mediado por la finalización diferencial del bundle de sepsis. (AU)

Gender differences in the antioxidant response of oral administration of hydroxytyrosol and oleuropein against N-ethyl-N-nitrosourea (ENU)-induced glioma.

Brain tumorigenesis has been associated not only with oxidative stress, but also with a reduced response of non-enzyme and enzyme antioxidant defense systems. In fact, the imbalance between free-radical production and the efficiency of the antioxidant defense systems triggers the process because the central nervous system (CNS) is very sensitive to free-radical damage. Phenolic compounds, mainly oleuropein and its major metabolite hydroxytyrosol, derived from olives and virgin olive oil, have been shown to exert important anticancer activities both in vitro and in vivo due to their antioxidant properties. The present study analyzes the effects of the oral administration of oleuropein, hydroxytyrosol and the mixture of both phenolic compounds in rats with transplacental N-ethyl-N-nitrosourea (ENU)-induced brain tumors to analyze their potential effect against brain tumorigenesis through the modification of redox system components. Oxidative stress parameters, non-enzyme and enzyme antioxidant defense systems and blood chemistry were assayed in the different experimental groups. The treatment with oleuropein, hydroxytyrosol and/or the mixture of both phenolic compounds promotes a limited beneficial effect as anticancer compounds in our ENU-induced animal model of brain tumor. These effects occur via redox control mechanisms involving endogenous enzymatic and non-enzymatic antioxidant defense systems, and are highly dependent on the gender of the animals.

Sex differences exist in brain renin-angiotensin system-regulating aminopeptidase activities in transplacental ethyl-nitrosourea-induced gliomas.

INTRODUCTION: The renin angiotensin system (RAS) is emerging as an important target for the treatment of glioma. We had described that the local RAS is involved in vivo in tumor growth in the rat model of experimental C6 glioma implanted at the subcutaneous region, through the modification of several proteolytic regulatory enzymes of aminopeptidase type. METHODS: We analyze RAS-regulating aminopeptidase activities in plasma and brain tissue of control male and female rats and rats with transplacental ethylnitrosourea-induced gliomas. RESULTS: No differences were found either the mean total number of tumors per animal or the tumor volume between male and female animals. However, we have found increased levels in aspartyl aminopeptidase in both males and females and of aminopeptidase B only in males. On the contrary, decreased levels were found in aminopeptidase N and insulin-regulated aminopeptidase activities in both males and females, whereas aminopeptidase A only decreased in females. Decreased levels of aminopeptidase N, aminopeptidase B and insulin-regulated aminopeptidase were also shown in plasma of only female rats. CONCLUSIONS: Under the complexity of RAS cascade, the changes found suggest the predominant actions of angiotensin III against a decreased action of angiotensin II and angiotensin IV. We conclude that angiotensin peptides are involved in tumor growth in this rat model of glioma and that their role in tumor growth can be analyzed through their corresponding proteolytic regulatory enzymes, which make them new and attractive therapeutic targets beyond the use or angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).

Brain metastases treated with radiosurgery or hypofractionated stereotactic radiotherapy: outcomes and predictors of survival.

INTRODUCTION: To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). METHODS/PATIENTS: This study retrospectively reviewed 200 patients with 324 BM treated with one fraction (15-21 Gy) or 5-10 fractions (25-40 Gy) between January 2010 and August 2016. 26.5% of patients received whole brain radiotherapy (WBRT) and 25% initial surgery. Demographics, prognostic scales, systemic and local controls, patterns of relapse and rescue, toxicity, and cause of death were analyzed. A stratified analysis by primary tumor was done. RESULTS: Median overall survival (OS) was 8 months from SRS/HFSRT. Breast cancer patients had a median OS of 17 months, followed by renal (11 months), lung (8 months), colorectal (5 months), and melanoma (4 months). The univariate analysis showed improved OS in females (p 0.004), RPA I-II (p < 0.001) initial surgery (p < 0.001), absence of extracranial disease (p 0.023), and good disease control (p 0.002). There were no differences in OS or local control between SRS and HFSRT or in patients receiving WBRT. Among 44% of brain recurrences, 11% were in field. 174 patients died, 10% from confirmed intracranial progression. CONCLUSIONS: SRS and HSFRT are equally effective and safe for the treatment of BM, with no exceptions among different primary tumors. Disease control, surgery, age, and prognostic scales correlated with OS. However, the lack of survival benefit regarding WBRT might become logical evidence for its omission in a subset of patients.

External photon radiation treatment for prostate cancer: Uncomplicated and cancer-free control probability assessment of 36 plans.

PURPOSE: To perform a systematic and thorough assessment, using the Uncomplicated and Cancer-Free Control Probability (UCFCP) function, of a broad range of photon prostate cancer RT treatments, on the same scenario (a unique pelvic CT set). UCFCP considers, together with the probabilities of local tumour control (TCP) and deterministic (late) sequelae (NTCP), the second primary cancer risk (SPCR) due to photon and neutron peripheral doses. METHODS AND MATERIALS: Thirty-six radiotherapy plans were produced for the same CT. 6, 10, 15 and 18 MV 3DCRT, IMRT and VMAT (77.4 Gy in 43 fractions) and 6 and 10 MV SBRT (36.25 Gy in 5 fractions with flattened and FFF beams) for Elekta, Siemens and Varian Linacs plans were included. DVH and peripheral organ dosimetry were used to compute TCP, NTCP, and SPCR (the competition and LNT models) for further plan ranking. RESULTS: Biological models (and parameters) used predicted an outcome which is in agreement with epidemiological findings. SBRT plans showed the lowest SPCR and a below average NTCPrectal. High energy plans did not rank worse than the low energy ones. Intensity modulated plans were ranked above the 3D conformal techniques. CONCLUSIONS: According to UCFCP, the best plans were the10 MV SBRTs. SPCR rates were low and did not show a substantial impact on plan ranking. High energy intensity-modulated plans did not increase in excess the average of SPCR. Even more, they ranked among the best, provided that MU were efficiently managed.

CHARACTERIZATION OF THE EPITHERMAL NEUTRON FIELD PRODUCED BY p+7Li REACTION IN A TANDEM ACCELERATOR USING A BONNER SPHERE SPECTROMETER.

The proton beam produced in the Nuclear Physics line of the tandem accelerator of the Centro Nacional de Aceleradores was used to generate a neutron field. In particular, 1.912 MeV protons were used to produce well-known epithermal neutrons through the p+7Li → n+7Be reaction. The aim of the work was to characterize this field while testing the performance of a Bonner sphere spectrometer in the epithermal range. Measurements were performed in four locations at different angle (0°, 30°, 60° and 90°) from beam incidence direction in order to study the angular dependence of the field. Both a parametric and numerical unfolding methods were tested to process the counts of the central detectors and obtain the energy distribution of the neutron fluence. In addition, a Monte Carlo simulation was carried out to complete the study and provide a guess spectrum for numerical unfolding. It was found that the fluence rate and mean energy decrease as the angle from beam direction increases. Total fluence was 2.75, 1.36, 0.366 and 0.216 cm-2 per charge collected in the target at 0°, 30°, 60° and 90°, respectively. Mean energy of the field ranges from 46 to 17 keV at 0° and 60°, respectively. In all cases, given that the irradiation room is so large, the contribution of thermal neutrons to the field is small. Regarding the unfolding, the total fluences estimated by all methods were in agreement within the uncertainties.

Dose distribution of secondary radiation in a water phantom for a proton pencil beam-EURADOS WG9 intercomparison exercise.

Systematic 3D mapping of out-of-field doses induced by a therapeutic proton pencil scanning beam in a 300 × 300 × 600 mm3 water phantom was performed using a set of thermoluminescence detectors (TLDs): MTS-7 (7LiF:Mg,Ti), MTS-6 (6LiF:Mg,Ti), MTS-N (natLiF:Mg,Ti) and TLD-700 (7LiF:Mg,Ti), radiophotoluminescent (RPL) detectors GD-352M and GD-302M, and polyallyldiglycol carbonate (PADC)-based (C12H18O7) track-etched detectors. Neutron and gamma-ray doses, as well as linear energy transfer distributions, were experimentally determined at 200 points within the phantom. In parallel, the Geant4 Monte Carlo code was applied to calculate neutron and gamma radiation spectra at the position of each detector. For the cubic proton target volume of 100 × 100 × 100 mm3 (spread out Bragg peak with a modulation of 100 mm) the scattered photon doses along the main axis of the phantom perpendicular to the primary beam were approximately 0.5 mGy Gy-1 at a distance of 100 mm and 0.02 mGy Gy-1 at 300 mm from the center of the target. For the neutrons, the corresponding values of dose equivalent were found to be ~0.7 and ~0.06 mSv Gy-1, respectively. The measured neutron doses were comparable with the out-of-field neutron doses from a similar experiment with 20 MV x-rays, whereas photon doses for the scanning proton beam were up to three orders of magnitude lower.

COMPARISON OF RESPONSE OF PASSIVE DOSIMETRY SYSTEMS IN SCANNING PROTON RADIOTHERAPY-A STUDY USING PAEDIATRIC ANTHROPOMORPHIC PHANTOMS.

Proton beam therapy has advantages in comparison to conventional photon radiotherapy due to the physical properties of proton beams (e.g. sharp distal fall off, adjustable range and modulation). In proton therapy, there is the possibility of sparing healthy tissue close to the target volume. This is especially important when tumours are located next to critical organs and while treating cancer in paediatric patients. On the other hand, the interactions of protons with matter result in the production of secondary radiation, mostly neutrons and gamma radiation, which deposit their energy at a distance from the target. The aim of this study was to compare the response of different passive dosimetry systems in mixed radiation field induced by proton pencil beam inside anthropomorphic phantoms representing 5 and 10 years old children. Doses were measured in different organs with thermoluminescent (MTS-7, MTS-6 and MCP-N), radiophotoluminescent (GD-352 M and GD-302M), bubble and poly-allyl-diglycol carbonate (PADC) track detectors. Results show that RPL detectors are the less sensitive for neutrons than LiF TLDs and can be applied for in-phantom dosimetry of gamma component. Neutron doses determined using track detectors, bubble detectors and pairs of MTS-7/MTS-6 are consistent within the uncertainty range. This is the first study dealing with measurements on child anthropomorphic phantoms irradiated by a pencil scanning beam technique.

Influence of Obesity on Liver Transplantation Outcomes.

OBJECTIVE: The aim of this work was to determine the impact of obesity on the morbidity and mortality of liver transplantation (LT) recipients. METHODS: A single-center, observational-cohort, retrospective study was conducted in patients undergoing LT from January 2008 to December 2014 to compare complications and survival between those with body mass index (BMI) <35 kg/m2 and those with BMI ≥35 kg/m2. RESULTS: The study included 170 patients: 162 (95.3%) with BMI <35 kg/m2 and 8 (4.7%) with BMI ≥35 kg/m2. The groups significantly differed in overall mortality and graft survival: The risk of death was 3.54-fold higher (95% confidence interval, 1.39-9.03) and the mean graft survival was shorter (61 vs 21 mo; P = .001) in the group with BMI ≥35 kg/m2. The groups did not significantly differ in rates of biliary complications, arterial and portal vein thrombosis, retransplantation or reintervention, intraoperative requirement for blood products, length of intensive care unit stay, or post-reperfusion syndrome or rejection rates. CONCLUSIONS: Although no significant differences were found between these groups in post-transplantation complications, BMI ≥35 kg/m2 emerged as a mortality risk factor in these patients.

Experimental evaluation of neutron dose in radiotherapy patients: Which dose?

PURPOSE: The evaluation of peripheral dose has become a relevant issue recently, in particular, the contribution of secondary neutrons. However, after the revision of the Recommendations of the International Commission on Radiological Protection, there has been a lack of experimental procedure for its evaluation. Specifically, the problem comes from the replacement of organ dose equivalent by the organ-equivalent dose, being the latter "immeasurable" by definition. Therefore, dose equivalent has to be still used although it needs the calculation of the radiation quality factor Q, which depends on the unrestricted linear energy transfer, for the specific neutron irradiation conditions. On the other hand, equivalent dose is computed through the radiation weighting factor wR, which can be easily calculated using the continuous function provided by the recommendations. The aim of the paper is to compare the dose equivalent evaluated following the definition, that is, using Q, with the values obtained by replacing the quality factor with wR. METHODS: Dose equivalents were estimated in selected points inside a phantom. Two types of medical environments were chosen for the irradiations: a photon- and a proton-therapy facility. For the estimation of dose equivalent, a poly-allyl-diglicol-carbonate-based neutron dosimeter was used for neutron fluence measurements and, additionally, Monte Carlo simulations were performed to obtain the energy spectrum of the fluence in each point. RESULTS: The main contribution to dose equivalent comes from neutrons with energy higher than 0.1 MeV, even when they represent the smallest contribution in fluence. For this range of energy, the radiation quality factor and the radiation weighting factor are approximately equal. Then, dose equivalents evaluated using both factors are compatible, with differences below 12%. CONCLUSIONS: Quality factor can be replaced by the radiation weighting factor in the evaluation of dose equivalent in radiotherapy environments simplifying the practical procedure.

Role of Transarterial Chemoembolization to Downstage Hepatocellular Carcinoma Within the Milan Criteria.

The practice of treating candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC), with locoregional therapies, is common in most transplantation centers. We present our results using transarterial chemoembolization (TACE) as a neo-adjuvant treatment in our center between 2002 and 2013 to determine its effectiveness in downstaging (DS) HCC within the Milan criteria (MC). Clinical variables were recorded of both donors and recipients, such as diagnosis and treatment, variables related to its etiology, the use of TACE as a neo-adjuvant treatment, immunosuppressive therapy, toxicity, recurrence of disease, exitus, and others. Sixty-four patients were analyzed. Median age was 57 (range, 51-64) years. In this study, 84% (54) were male and 16% (10) were women. Etiology of HCC was viral in 47% (30), alcoholic in 25% (16), and other in 28% (18). TACE was conducted in 45 patients (70%). Every patient included in our study presented a T2 stage (of tumor-nodes-metastasis [TNM]) before surgery, thus within the MC. However, DS protocol was performed in 5 patients (7.8%). We performed a bivariate analysis, having assessed that the use of TACE decreases T2 stage into T1-T0 stage (P < .05). We have also calculated the recurrence-free survival, which reaches up to 80% to 125 months. Furthermore, even though the statistical differences are not consistent due to the simple size presented, we conclude that TACE is a safe and effective therapy to control HCC progression during the waiting list time.

Influence of Waiting List in Recurrence Disease of Hepatocellular Carcinoma.

BACKGROUND: We describe the results of our liver transplantation (LT) patients for hepatocellular carcinoma (HCC) in 2004 to 2012 to determine the differences on the basis of time on the waiting list to establish the risk of recurrence of liver disease. METHODS: Clinical variables were recorded for both donors and recipients as well as variables of diagnosis, the use of transarterial chemoembolization during the waiting list time (WLT), complications, re-transplantation, and exitus. Fifty-eight patients were analyzed. Mean age was 57 ± 8 years (men, 83%; 48 patients). Viral etiology of HCC was 50% (n = 29); alcoholic, 26% (n = 15); and others, 24% (n = 14). RESULTS: Exitus was established in 24 patients (41%); only 5 patients (7%) were attributable to HCC. In the cohort of patients with less than 6 months of WLT, we registered both higher rates of downstaging protocols (10.7% vs 7.5%) and tumor size (3 cm vs 2 cm) compared with the other group. Bivariate studies were conducted according to the WLT (WLT <6 months, WLT ≥6 months), finding differences in recurrence of liver disease (P < .05). This fact was confirmed after a binary logistic regression. CONCLUSIONS: Our results in a subgroup of less than 6 months of WLT included patients with increased tumor size or presentation of multiple nodes, with a worse prognosis and therefore to be prioritized in the treatment of LT. Therefore, in our population there is a significant risk of tumor recurrence in patients with less WLT for LT, but it cannot be overestimated to all type of patients with HCC.

Complications Associated With Liver Transplantation in Recipients With Body Mass Index >35 kg/m(2): Would It Be a Poor Prognosis Predictive Factor?

BACKGROUND: Obesity is a global epidemic that continues to increase in a great number of countries, and it has become a major public health problem in Spain. Unfortunately, the impact of obesity on survival in liver transplantation (LT) recipients is underestimated and controversial. The aim of this study was to determine if obesity is a risk factor for morbidity and mortality after LT. METHODS: In a retrospective cohort study of the records of 180 consecutive patients who had undergone to LT from 2007 to 2013, 11 obese patients with body mass index (BMI) >35 kg/m(2) were identified. Their data have been compared with recipients with BMI 20-25 kg/m(2). RESULTS: There were no differences in demographic data, Child-Pugh score, Model for End-Stage Liver Disease score, or cause of liver failure. BMI >35 kg/m(2) recipients had a significantly higher rate of portal vein thrombosis before LT, compared with the BMI 20-25 kg/m(2) group (36.5% vs 13.9%; P = .041). There were also no differences in development of post-reperfusion syndrome. The groups were also comparable concerning morbidity rate after LT, stay in the intensive care unit, and global hospital stay. However, the mortality rate was significantly higher in the obese group compared with the nonobese group (72.7% vs 38.9%; P = .032). CONCLUSIONS: The results of the study clearly demonstrate higher mortality rates in obese patients undergoing LT; thus, it is fair to consider obesity as a poor prognosis predictive factor concerning mortality rate.