Intravenous Ascorbic Acid for the Prevention of Postreperfusion Syndrome in Orthotopic Liver Transplantation: Protocol for a Randomized Controlled Trial.

BACKGROUND: Liver transplantation is the last therapeutic option for patients with end-stage liver disease. Postreperfusion syndrome (PRS), defined as a fall in mean arterial pressure of more than 30% within the first 5 minutes after reperfusion of at least 1 minute, can occur in liver transplantation as a deep hemodynamic instability with associated hyperfibrinolysis immediately after reperfusion of the new graft. Its incidence has remained unchanged since it was first described in 1987. PRS is related to ischemia-reperfusion (I/R) injury, whose pathophysiology involves the release of several mediators from both the donor and the recipient. The antioxidant effect of ascorbic acid has been studied in resuscitating patients with septic shock and burns. Even today, there are publications with conflicting results, and there is a need for further studies to confirm or rule out the usefulness of this drug in this group of patients. The addition of ascorbic acid to preservation solutions used in solid organ transplantation is under investigation to harness its antioxidant effect and mitigate I/R injury. Since PRS could be considered a manifestation of I/R injury, we believe that the possible beneficial effect of ascorbic acid on the occurrence of PRS should be investigated. OBJECTIVE: The aim of this randomized controlled trial is to assess the benefits of ascorbic acid over saline in the development of PRS in adult liver transplantation. METHODS: We plan to conduct a single-center randomized controlled trial at the Hospital Universitario Ramón y Cajal in Spain. A total of 70 participants aged 18 years or older undergoing liver transplantation will be randomized to receive either ascorbic acid or saline. The primary outcome will be the difference between groups in the incidence of PRS. The randomized controlled trial will be conducted under conditions of respect for fundamental human rights and ethical principles governing biomedical research involving human participants and in accordance with the international recommendations contained in the Declaration of Helsinki and its subsequent revisions. RESULTS: The enrollment process began in 2020. A total of 35 patients have been recruited so far. Data cleaning and analysis are expected to occur in the first months of 2024. Results are expected around the middle of 2024. CONCLUSIONS: We believe that this study could be particularly relevant because it will be the first to analyze the clinical effect of ascorbic acid in liver transplantation. Moreover, we believe that this study fills an important gap in the knowledge of the potential benefits of ascorbic acid in the field of liver transplantation, particularly in relation to PRS. TRIAL REGISTRATION: European Union Drug Regulating Authorities Clinical Trials Database 2020-000123-39; https://tinyurl.com/2cfzddw8; ClinicalTrials.gov NCT05754242; https://tinyurl.com/346vw7sm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50091.

¿Controlamos la dislipemia en pacientes con cardiopatía isquémica en atención primaria? / Are we monitoring, in primary care, dyslipaemia in patients with ischaemic cardiopathy?

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Macroscopic, mesostructured cationic surfactant/neutral polymer films: structure and cross-linking.

Mesostructured films of alkyltrimethylammonium bromides or cetylpyridinium bromide and polyethylenimines that spontaneously self-assemble at the air/water interface have been examined using a range of surface sensitive techniques. These films are unusual in that they can be micrometers thick and are relatively robust. Here we show that the films can be cross-linked and thus removed from the liquid surface where they form, as solid, mesostructured polymer-surfactant membranes. Cross-linking causes little change in the structure of the films but freezes in the metastable mesostructures, enhancing the potential of these films for future applications. Cross-linked films, dried after removal from the solution surface, retain the ordered nanoscale structure within the film. We also report grazing incidence X-ray diffraction (GID), which shows that most films display scattering consistent with 2D-hexagonal phase crystallites of rodlike surfactant micelles encased in polymer. Polymer branching makes little difference to the film structures; however, polymer molecular weight has a significant effect. Films with lower polymer MW are generally thinner and more ordered, while higher polymer MW films were thicker and less ordered. Increased pH causes formation of thicker films and improves the ordering in low MW films, while high MW films lose order. To rationalize these results, we propose a model for the film formation process that relates the kinetic and thermodynamic limits of phase separation and mesophase ordering to the structures observed.

Effect of micelle composition on the formation of surfactant-templated polymer films.

Surfactant-templated polymer films prepared from polyethylenimine (PEI), cetyltrimethylammonium bromide (CTAB), and octaethylene glycol monohexadecyl ether (C(16)E(8)) were examined and the effect of increasing the percentage of nonionic surfactant in the micelles measured using both surface and bulk-sensitive techniques. It was found that there is a strong interaction between CTAB and C(16)E(8), although no interaction between the C(16)E(8) and PEI was observed. Generally, increasing the percentage of C(16)E(8) in the micelles decreases both the thickness and degree of order in the films; however, it was observed, depending on the conditions, that films could still be formed with as little as 20% cationic surfactant. Experiments on the CTAB/Brij56/PEI system were also performed and these indicate that it is similar to the CTAB/C(16)E(8)/PEI system.

Humidity and temperature effects on CTAB-templated mesophase silicate films at the air-liquid interface.

Off-specular X-ray reflectivity measurements were carried out to follow the in situ development of surfactant-templated silica thin films at the air-water interface under conditions of controlled relative humidity and temperature, using an enclosed sample cell designed for this purpose. The results suggest a strong dependence of formation time and growth mechanism on ambient conditions. Thin films were synthesized at the air-water interface using cetyltrimethylammonium bromide (CTAB, 0.075 M) and a silica precursor, tetramethoxysilane (TMOS, 0.29-0.80 M) in an acidic medium. The studied humidity range was from 50 to 100%, the temperature was between 25 and 40 degrees C, and the TMOS/CTAB molar ratio was between 3.3 and 10.7. We observed that high humidity slows down the growth process due to lack of evaporation. However, increasing the temperature results in a decrease in the film-formation time. We proposed a formation mechanism for film growth as a consequence of phase separation, organic array assembly, and silica polymerization.