Undetectable circulating tumor DNA confirms the inability of pseudomyxoma peritonei to systemic dissemination.

The study of circulating tumor DNA (ctDNA) plays a pivotal role in advancing precision oncology, providing valuable information for individualized patient care and contributing to the ongoing effort to improve cancer diagnosis, treatment, and management. However, its applicability in pseudomyxoma peritonei (PMP) remains unexplored. In this multicenter retrospective study involving 21 PMP patients, we investigated ctDNA presence in peripheral blood using three distinct methodologies. Despite mucinous tumor tissues exhibiting KRAS and GNAS mutations, ctDNA for these mutations was undetectable in blood samples. In this pilot study, circulating tumor DNA was not detected in blood when the tumor harbored mutations of known significance. In the future, a study with a larger sample size is needed to confirm these findings and to determine whether ctDNA could identify patients at risk for early recurrence and/or systemic metastases.

Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Long term oncologic outcomes from the international PSOGI registry.

The laparoscopic approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (L-CRS + HIPEC) in highly selected patients was previously reported from the PSOGI registry with a demonstrable reduction in length of stay and post-operative morbidity. This study aims to update this international PSOGI registry with a larger cohort of patients and a longer follow-up period. METHODS: An international registry was designed through a networking database (REDCAP®). All centers performing L-CRS + HIPEC were invited through PSOGI to submit data on their cases. Variables such as demographics, clinical outcomes, and survival were analyzed. RESULTS: A total of 315 L-CRS + HIPEC cases were provided by 14 worldwide centers. A total of 215 patients were included in the L-CRS + HIPEC group. The median peritoneal cancer index (PCI) was 3 (3-5). The median length of stay was 7 days (5-10) and the major morbidity (Clavien-Dindo ≥3) was 6.1% after 30 days. The 5-year disease-free survival (DFS) per tumor origin was: 94% for PMP-LG, 85% for PMP-HG, 100% for benign multicyst peritoneal mesothelioma (MPM), 37.4% for colonic origin, and 54%(at 3 years) for ovarian origin. The 5 years overall survival (OS) per tumor origin was: 100% for PMP-LG, PMP-HG and MPM; 61% for colonic origin, and 74% (at 3 years) for ovarian origin. In addition, a total of 85 patients were analyzed in the laparoscopic risk-reducing HIPEC (L-RR + HIPEC). The median length of stay was 5 days (4-6) and the major morbidity was 6% after 30 days. The 5-year DFS per tumor origin was: 96% for perforated low grade appendiceal mucinous neoplasm (LAMN II) and 68.1% for colon origin. The 5 years OS per tumor origin was: 98% for LAMN II and 83.5% for colonic origin. CONCLUSIONS: Minimally invasive CRS + HIPEC is a safe procedure for selected patients with peritoneal carcinomatosis in specialized centers. It improves perioperative results while providing satisfactory oncologic outcomes. L-RR + HIPEC represents a promising strategy that could be evaluated in patients with high risk of developing peritoneal carcinomatosis into prospective randomized trials.

Establishment of a desirable dose using neutral argon plasma to eradicate miliary peritoneal implants: A phase I/II controlled trial.

INTRODUCTION: Neutral argon plasma (NAP) system could meet the requirements to achieve oncological cytoreduction of peritoneal carcinomatosis with miliary lesions, minimizing the associated morbidity. This phase I/II trial aims to establish the desirable dose that is safe and effective in eliminating tumor cells with lower penetration. METHODS: Patients diagnosed with different origins for peritoneal carcinomatosis and miliary implants were selected for the study. The safe and potentially effective dose (desirability) of NAP was evaluated according to three factors: distance (mm), application time (s) and power (%), to evaluate the response variables such as the presence of tumor cells (Y/N) and the depth of penetration. RESULTS: Ten patients and 120 samples were evaluated and treated with NAP. There was no vascular or organ injury intraoperative using a pre-established dose of 100% (coagulation mode) at a distance of 2-3 cm. The distance was found to be correlated with the presence of the tumor cells in ex-vivo analysis, with an OR of 15.4 (4.0-111.4). The time and energy used were protective factors to eliminate tumor cells with an OR of 0.4 (0.1-0.9) and 0.8 (0.8-0.9), respectively. The safest and most effective desirability results were as follows i) energy 80% during 2-4 s with a distance of 2 cm (0.89), and ii) energy 100% during 2-4 s with a distance of 3 cm (0.90). CONCLUSIONS: The use of NAP during a CRS and HIPEC is safe and effective for eradicating tumor cells on the peritoneal surface at suggested doses of energy, distance and duration. TRIAL IDENTIFICATION: ClinicalTrials.gov Identifier: NCT04904042.

External multicentre validation of pseudomyxoma peritonei PSOGI-Ki67 classification.

BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare malignant disease. Adding of the Ki67 proliferation index to the PSOGI PMP classification provided two different subcategories of the extensive HG-PMP group (HG-PMP ≤15% and HG-PMP >15%) with different survival in a previous unicentric study. This study aims to carry out an external and multicentre validation of this new proposed classification. METHOD: It was a prospective analysis of samples from a historical and international cohort of patients. A representative area with higher cellular density was used to determine the Ki67%. The Ki67 proliferation index (%) was determined in all the HG-PMP patients. A Cox proportional hazard models and multivariable COX models were used. The Kaplan-Meier method and the two-tailed log-rank test were used to analyse the effect of different PSOGI-Ki67 categories on OS and DFS. Its predictive accuracy was analysed using Harrel's C-index and the ROC curve. The calibration was performed using the calibration plots matching. RESULTS: After exclusions, 349 patients were available for analysis. The 5-years OS were 86% for LG-PMP, 59% for HG-PMP≤15, 38% for HG-PMP>15 and 42% for SRC-PMP (p = 0.0001). The 5-years DFS were 49% for LG-PMP, 35% for HG-PMP≤15, 16% for HG-PMP>15 and 18% SRC-PMP (p = 0.0001). The discrimination capability of PSOGI-Ki67 was validated. CONCLUSION: the PSOGI-Ki67 classification discriminates and predicts the OS and DFS in patients with PMP dividing the HG-PMP category into two well-defined sub-categories. The Ki67 proliferation index should be incorporated routinely in the pathology report for these patients.

Complete laparoscopic pelvic peritonectomy plus hyperthermic intraperitoneal chemotherapy.

BACKGROUND: The aim of our study was to present the technique for, and early results of complete laparoscopic pelvic peritonectomy (LPP) plus hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: We conducted a study on consecutive patients who had LPP for limited peritoneal carcinomatosis (peritoneal carcinomatosis index < 10) from ovarian cancer, colon cancer and benign multicystic mesothelioma, from January 2017 to November 2019 at 2 referral centers in Spain. Perioperative, pathologic, 30-day major morbidity and mortality characteristics were analyzed. The surgical technique is shown in the attached video. RESULTS: Twelve LPP + HIPEC were performed. Complete cytoreduction was achieved in 100% of the patients, the median duration of the operation was 450 min (range 360-600 min). There were 2 cases (16%) of IIIa morbidity (trocar hernia and pleural effusion), and no mortality. The median length of hospital stay was 5.5 days (range 4-10 days). The median length of follow-up was 10 months (range 2-30 months). There was a recurrence at the splenic hilum in 1 patient which was treated by laparoscopic splenectomy and one nodal recurrence at 13 months while all other patients are alive and free of disease at last follow-up. CONCLUSIONS: This is the first technical video of a minimally invasive approach for complete pelvic peritonectomy plus omentectomy associated with HIPEC. For highly selected patients, this procedure presents a feasible and safe alternative to the maximally invasive approach.

Kisspeptin treatment induces gonadotropic responses and rescues ovulation in a subset of preclinical models and women with polycystic ovary syndrome.

STUDY QUESTION: Can kisspeptin treatment induce gonadotrophin responses and ovulation in preclinical models and anovulatory women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER: Kisspeptin administration in some anovulatory preclinical models and women with PCOS can stimulate reproductive hormone secretion and ovulation, albeit with incomplete efficacy. WHAT IS KNOWN ALREADY: PCOS is a prevalent, heterogeneous endocrine disorder, characterized by ovulatory dysfunction, hyperandrogenism and deregulated gonadotrophin secretion, in need of improved therapeutic options. Kisspeptins (encoded by Kiss1) are master regulators of the reproductive axis, acting mainly at GnRH neurons, with kisspeptins being an essential drive for gonadotrophin-driven ovarian follicular maturation and ovulation. Altered Kiss1 expression has been found in rodent models of PCOS, although the eventual pathophysiological role of kisspeptins in PCOS remains unknown. STUDY DESIGN, SIZE, DURATION: Gonadotrophin and ovarian/ovulatory responses to kisspeptin-54 (KP-54) were evaluated in three preclinical models of PCOS, generated by androgen exposures at different developmental windows, and a pilot exploratory cohort of anovulatory women with PCOS. PARTICIPANTS/MATERIALS, SETTING, METHODS: Three models of PCOS were generated by exposure of female rats to androgens at different periods of development: PNA (prenatal androgenization; N = 20), NeNA (neonatal androgenization; N = 20) and PWA (post-weaning androgenization; N = 20). At adulthood (postnatal day 100), rats were subjected to daily treatments with a bolus of KP-54 (100 µg/kg, s.c.) or vehicle for 11 days (N = 10 per model and treatment). On Days 1, 4, 7 and 11, LH and FSH responses were assessed at different time-points within 4 h after KP-54 injection, while ovarian responses, in terms of follicular maturation and ovulation, were measured at the end of the treatment. In addition, hormonal (gonadotrophin, estrogen and inhibin B) and ovulatory responses to repeated KP-54 administration, at doses of 6.4-12.8 nmol/kg, s.c. bd for 21 days, were evaluated in a pilot cohort of anovulatory women (N = 12) diagnosed with PCOS, according to the Rotterdam criteria. MAIN RESULTS AND THE ROLE OF CHANCE: Deregulated reproductive indices were detected in all PCOS models: PNA, NeNA and PWA. Yet, anovulation was observed only in NeNA and PWA rats. However, while anovulatory NeNA rats displayed significant LH and FSH responses to KP-54 (P < 0.05), which rescued ovulation, PWA rats showed blunted LH secretion after repeated KP-54 injection and failed to ovulate. In women with PCOS, KP-54 resulted in a small rise in LH (P < 0.05), with an equivalent elevation in serum estradiol levels (P < 0.05). Two women showed growth of a dominant follicle with subsequent ovulation, one woman displayed follicle growth but not ovulation and desensitization was observed in another patient. No follicular response was detected in the other women. LIMITATIONS, REASONS FOR CAUTION: While three different preclinical PCOS models were used in order to capture the heterogeneity of clinical presentations of the syndrome, it must be noted that rat models recapitulate many but not all the features of this condition. Additionally, our pilot study was intended as proof of principle, and the number of participants is low, but the convergent findings in preclinical and clinical studies reinforce the validity of our conclusions. WIDER IMPLICATIONS OF THE FINDINGS: Our first-in-rodent and -human studies demonstrate that KP-54 administration in anovulatory preclinical models and women with PCOS can stimulate reproductive hormone secretion and ovulation, albeit with incomplete efficacy. As our rat models likely reflect the diversity of PCOS phenotypes, our results argue for the need of personalized management of anovulatory dysfunction in women with PCOS, some of whom may benefit from kisspeptin-based treatments. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by research agreements between Ferring Research Institute and the Universities of Cordoba and Edinburgh. K.S. was supported by the Wellcome Trust Scottish Translational Medicine and Therapeutics Initiative (STMTI). Some of this work was undertaken in the MRC Centre for Reproductive Health which is funded by the MRC Centre grant MR/N022556/1. M.T.-S. is a member of CIBER Fisiopatología de la Obesidad y Nutrición, which is an initiative of Instituto de Salud Carlos III. Dr Mannaerts is an employee of Ferring International PharmaScience Center (Copenhagen, Denmark), and Drs Qi, van Duin and Kohout are employees of the Ferring Research Institute (San Diego, USA). Dr Anderson and Dr Tena-Sempere were recipients of a grant support from the Ferring Research Institute, and Dr Anderson has undertaken consultancy work and received speaker fees outside this study from Merck, IBSA, Roche Diagnostics, NeRRe Therapeutics and Sojournix Inc. Dr Skorupskaite was supported by the Wellcome Trust through the Scottish Translational Medicine and Therapeutics Initiative 102419/Z/13/A. The other authors have no competing interest.

Metabolic programming of puberty: sexually dimorphic responses to early nutritional challenges.

Body energy stores and metabolic cues influence the onset of puberty. However, the pubertal impact of early nutritional challenges has been only fragmentarily addressed. We evaluated here the consequences, in terms of pubertal timing and hormonal markers, of various nutritional manipulations during pre- or postnatal maturation in rats of both sexes. Males and females were submitted to gestational undernutrition (UNG) or peripubertal (SUB) subnutrition or were raised in large (LL; underfeeding) or small (SL; overfeeding) litters. In addition, groups of UNG, LL, and SL rats were fed on a high-fat diet (HFD) after weaning. Postnatal overfeeding resulted in higher body weights (BWs) during pubertal transition in both sexes, but only SL males displayed overtly advanced external signs of puberty. Postnatal underfeeding persistently decreased BW gain during puberty, yet the magnitude of pubertal delay was greater in LL males. In contrast, regardless of postnatal nutrition, HFD tended to advance the onset of puberty in females but did not alter pubertal timing in males. Likewise, SUB females displayed a marked delay in BW gain and puberty onset, whereas despite similar reduction in BW, SUB males showed normal timing of puberty. These sex divergences were also detected in various hormonal and metabolic indices so that postnatal overnutrition consistently increased LH, FSH, leptin, and insulin levels only in pubertal females, whereas HFD decreased gonadotropin levels in SL females but increased them in SL males. Notably, UNG rats did not show signs of delayed puberty but displayed a striking sex dimorphism in serum insulin/glucose levels, regardless of the diet, so that only UNG males had signs of presumable insulin resistance. Our data disclose important sex differences in the impact of various early nutritional challenges on the timing of puberty, which may help to explain the different trends of altered puberty and related comorbidities between sexes.

Cellular distribution, regulated expression, and functional role of the anorexigenic peptide, NUCB2/nesfatin-1, in the testis.

Nesfatin-1, product of the precursor NEFA/nucleobindin2 (NUCB2), was initially identified as anorectic hypothalamic neuropeptide, acting in a leptin-independent manner. In addition to its central role in the control of energy homeostasis, evidence has mounted recently that nesfatin-1 is also produced in peripheral metabolic tissues, such as pancreas, adipose, and gut. Moreover, nesfatin-1 has been shown to participate in the control of body functions gated by whole-body energy homeostasis, including puberty onset. Yet, whether, as is the case for other metabolic neuropeptides, NUCB2/nesfatin-1 participates in the direct control of gonadal function remains unexplored. We document here for the first time the expression of NUCB2 mRNA in rat, mouse, and human testes, where NUCB2/nesfatin-1 protein was identified in interstitial mature Leydig cells. Yet in rats, NUCB2/nesfatin-1 became expressed in Sertoli cells upon Leydig cell elimination and was also detected in Leydig cell progenitors. Although NUCB2 mRNA levels did not overtly change in rat testis during pubertal maturation and after short-term fasting, NUCB2/nesfatin-1 content significantly increased along the puberty-to-adult transition and was markedly suppressed after fasting. In addition, testicular NUCB2/nesfatin-1 expression was up-regulated by pituitary LH, because hypophysectomy decreased, whereas human choriogonadotropin (super-agonist of LH receptors) replacement enhanced, NUCB2/nesfatin-1 mRNA and peptide levels. Finally, nesfatin-1 increased human choriogonadotropin-stimulated testosterone secretion by rat testicular explants ex vivo. Our data are the first to disclose the presence and functional role of NUCB2/nesfatin-1 in the testis, where its expression is regulated by developmental, metabolic, and hormonal cues as well as by Leydig cell-derived factors. Our observations expand the reproductive dimension of nesfatin-1, which may operate directly at the testicular level to link energy homeostasis, puberty onset, and gonadal function.

Material de seguridad para cateterización periférica venosa / Security material for venous peripheral. Catheterization evaluation in an emergency ward

La canalización venosa puede ser uno de los motivos másfrecuentes de accidentes por punción accidental. La realizaciónde actividades encaminadas a disminuir estos percances,de elevado riesgo biológico, debe ser una prioridad paralas instituciones sanitarias y para sus profesionales. Dentrode una estrategia global que incida en este aspecto y con elobjetivo de evaluar la idoneidad de estos dispositivos ennuestro centro, se realiza una valoración práctica de unaserie de ellos para conocer su viabilidad técnica y la apreciaciónsubjetiva de los profesionales que los prueben. Pormotivos relacionados con las prácticas del servicio en el quese desarrolla la investigación (Servicio de Urgencias), seseleccionan intencionalmente dos dispositivos pasivos,disponibles en el mercado, y tres enfermeros, que recibieron120 muestras de catéteres de seguridad (60 del producto A,60 del producto B) para realizar las prácticas clínicas habituales,junto con una hoja de incidencias. Con respecto aldispositivo A, se detectaron 30 incidencias (52,6%) y seprocedió a toma de muestras en 37 ocasiones. Con respectoal dispositivo B, se detectaron cuatro incidencias (7,01%)y se procedió a la toma de muestras en 47 ocasiones. En términosabsolutos, ninguno de los dos dispositivos ha mostradoproblemas con la práctica segura, es decir, no han provocadoincidencias relacionadas con la aparición de percancesasociados a punciones accidentales. La menor frecuencia deincidencias en el dispositivo B parece estar relacionada con eluso habitual del catéter convencional (no de seguridad) delmismo fabricante en nuestro centro. Trabajo subvencionadopor el Fondo de Investigaciones Sanitarias. PI 051265(AU)

Venous canalization can be one of the most frequent causesof accidents due to an accidental puncture. To carry out activitieswhich serve to lessen these misfortunes, bearing highbiological risk, should become a priority for sanitary institutionsand for their professionals. Inside a global strategywhich deals with this aspect and with the objective of evaluatingthe convenience these instruments have in our center,the authors made a practical evaluation on a series of themto discover their technical viability and their subjective considerationby professionals who employ them. For motives relatedto the practices of the ward in which this research tookplace, an emergency ward, the authors intentionally chosetwo passive instruments, available on the market, and threenurses who received 120 sample security catheters, 60 eachfor products A and B, to carry out habitual clinical practices,alongside a pad of paper on which to record any incidents.Regarding instrument A, 30 incidents, 52.6%, were detectedwhile 37 sample procedures occurred. Regarding instrumentB, 4 incidents, 7.01%, were detected while 47 sample proceduresoccurred. In absolute terms, neither of the two instrumentsdemonstrated problems of an insecure manner; whichis to say, neither produced a situation related to the appearanceof misfortunate incidents associated to accidentalpunctures. The lower number of incidents with instrument Bappears to be related to the habitual use of a conventionalcatheter, not a security one, produced by the same manufacturerin our center. This research project was subsidized bythe Sanitary Research Fund, PI 051265(AU)

[Evaluation of the OrthoPAT autologous transfusion system by experimental models simulating intra- and postoperative blood salvage]. / Evaluación del sistema de autotransfusión orthoPat, utilizando modelos experimentales de simulación de recuperación de sangre intra y postoperatoria.

OBJECTIVE: To evaluate the efficacy of the OrthoPAT (Haemonetics) system for blood salvage and for removing chemical or cellular debris, by experimental models simulating intra- and postoperative conditions. MATERIAL AND METHODS: Blood samples (20%-25% packed red cells) were prepared for the intraoperative model (n=8) and the postoperative model (n=22). Surgical compresses were soaked in some samples (n=5). Other samples were supplemented with hemolyzed blood (n=7). From others cytokines were removed and blood activated with bacterial liposaccharides (n=10) was added. The samples were analyzed before and after processing; tests included detection of free plasma hemoglobin (FPH), potassium ions (K+), glutamic oxalic transaminase (GOT), lactate dehydrogenase (LDH), proteins, and cytokines. RESULTS: In the intraoperative model 2935 (SD 260) mL of blood was processed. The concentration of packed red cells was 63% and 80% of the red cells were recovered. In the postoperative model 652 (35) mL was processed, the packed red cell concentration was 67% and 81% of the red cells were recovered. Reductions were observed in the concentrations of white blood cells (72%), platelets (88%), GOT and LDH (75%), and proteins and K+ (>95%). Fifty percent of the red cells were recovered in the surgical compresses model. In the hemolysis model, the K+ and FPH concentrations were reduced more than 95%. In the cytokine model, up to 90% of the interleukin 1beta, interleukin 6, and tumor necrosis factor content was removed from the activated blood samples. CONCLUSIONS: These findings suggest that the OrthoPAT system washes blood and salvages content effectively, recovering 80% of red cells. Moreover, its processing capacity (800-1000 mL x h(-1)) seems adequate for blood replacement in orthopedic surgery.

Evaluación del sistema de autotransfusión OrthoPAT®, utilizando modelos experimentales de simulación de recuperación de sangre intra y postoperatoria / Evaluation of the OrthoPAT® autologous transfusion system by experimental models simulating intra- and postoperative blood salvage

OBJETIVO: Evaluar la eficacia del sistema de autotransfusión OrthoPAT® (Haemonetics) en la recuperación de hematíes y su capacidad para eliminar contaminantes químicos o celulares, utilizando diferentes modelos experimentales de recuperación de sangre intra y post-operatoria. MATERIAL Y MÉTODOS: Se prepararon mezclas de sangre (Htc=20-25%) que fueron utilizadas en los modelos de recuperación intraoperatoria (n=8), postoperatoria (n=22), y de compresas quirúrgicas (n=5), así como en los de hemólisis (suplementadas sangre hemolizada, n=7) y eliminación de citocinas (suplementadas con sangre activada con liposacárido bacteriano, n=10). Se determinaron hematimetría, hemoglobina libre en plasma (HBLP), K+, GOT, LDH, proteínas y citocinas, antes y después del procesamiento de la sangre. RESULTADOS: En modelo intraoperatorio, se procesaron 2935±260 mL de sangre, obteniéndose un concentrado de hematíes con Htc del 63% y recuperándose el 80% de los hematíes. En el postoperatorio, estos valores fueron 652±35 mL, 67% y 81%, respectivamente, y se redujo el contenido de leucocitos (72%), plaquetas (88%), GOT y LDH (75%), proteínas y potasio (>95%). En el de compresas, se recuperó el 50% de los hematíes. En el de hemólisis, hubo una reducción >95% del contenido de K+ y HBLP. En el de citocinas, se eliminó hasta el 90% del contenido de IL-1β, IL-6 y TNFα de las mezclas suplementadas con sangre activada. CONCLUSIONES: De estos resultados parece concluirse que el sistema OrthoPAT® realiza un lavado y concentración efectivos de la sangre, recuperando el 80% de los hematíes. Además, su capacidad de procesamiento (800- 1000 mL h-1) parece ser adecuada para la reposición hemática en cirugía ortopédica

OBJECTIVE: To evaluate the efficacy of the OrthoPAT® (Haemonetics) system for blood salvage and for removing chemical or cellular debris, by experimental models simulating intra- and postoperative conditions. MATERIAL AND METHODS: Blood samples (20%-25% packed red cells) were prepared for the intraoperative model (n=8) and the postoperative model (n=22). Surgical compresses were soaked in some samples (n=5). Other samples were supplemented with hemolyzed blood (n=7). From others cytokines were removed and blood activated with bacterial liposaccharides (n=10) was added. The samples were analyzed before and after processing; tests included detection of free plasma hemoglobin (FPH), potassium ions (K+), glutamic oxalic transaminase (GOT), lactate dehydrogenase (LDH), proteins, and cytokines. RESULTS: In the intraoperative model 2935 (SD 260) mL of blood was processed. The concentration of packed red cells was 63% and 80% of the red cells were recovered. In the postoperative model 652 (35) mL was processed, the packed red cell concentration was 67% and 81% of the red cells were recovered. Reductions were observed in the concentrations of white blood cells (72%), platelets (88%), GOT and LDH(75%), and proteins and K+ (>95%). Fifty percent of the red cells were recovered in the surgical compresses model. In the hemolysis model, the K+ and FPH concentrations were reduced more than 95%. In the cytokine model, up to 90% of the interleukin 1β, interleukin 6, and tumor necrosis factor content was removed from the activated blood samples. CONCLUSIONS: These findings suggest that the OrthoPAT® system washes blood and salvages content effectively, recovering 80% of red cells. Moreover, its processing capacity (800-1000 mL·h-1) seems adequate for blood replacement in orthopedic surgery

[Ability of leukocyte reduction filters to remove fat particles from blood in experimental models simulating blood salvage in orthopedic surgery]. / Capacidad de los filtros leucorreductores para la eliminación de partículas de grasa en sangre. Modelo experimental de simulación de la sangre recuperada en cirugía ortopédica.

BACKGROUND: Salvaged autologous blood in orthopedic surgery may contain tissular debris such as fat particles (FP), possibly increasing the risk of fat embolism after bone surgery. Therefore, this study was initiated to ascertain the capacity of leukocyte filters to remove FP using in vitro models. METHODS: All experiments were performed in triplicate using donor blood bags within 15 days of their donation. Five different olive oil volumes were added to blood to obtain 5 oil concentrations (1% to 5%), and blood was subsequently filtered through a PureCell (Pall Biomedical, Portsmouth, UK) leukocyte-reduction filter. In another set of experiments, 5 different oil volumes (1, 2.5, 5, 7.5 or 10 mL) were injected into the line during filtration of oil-free blood. In addition, 3 preparations of blood supplemented with 5% oil were processed in the autotransfusion device OrthoPAT (Haemonetics Corp, Braintree, MA, USA), and the obtained red cell concentrate was subsequently filtered through PureCell. We collected samples for cell counting and analysis and FP detection with a Pentra 120 Retic (ABX, Montpellier, France) flow cytometer. RESULTS: Specific signals corresponding to FP were clearly detected in the white blood cell scattergrams yielded by the cytometer for oil supplemented blood. PureCell removed FP up to an oil concentration of 3% or up to an injected oil volume of less than 10 mL. Addition of a filtration step through a PureCell filter after blood washing by the OrthoPAT device completely removed FP. CONCLUSIONS: Leukocyte filters seem to be useful for removing FP from unprocessed blood with a low degree of fat contamination (less than 10 mL) and to complete FP removal from processed blood. Therefore, using a leukocyte filter in the patient's line should contribute to improving the safety of perioperative autologous blood salvage.

Capacidad de los filtros leucorreductores para la eliminación de partículas de grasa en sangre. Modelo experimental de simulación de la sangre recuperada en cirugía ortopédica / Ability of leukocyte reduction filters to remove fat particles from blood in experimental models simulating blood salvage in orthopedic surgery

OBJETIVOS: La sangre autóloga recuperada en cirugía ortopédica puede contener detritus tisulares, como partículas grasas (PG),con riesgo de embolismo graso. Se ha estudiado la capacidad de los filtros de leucocitos en la eliminación de PG, utilizando diferentes modelos in vitro . MÉTODOS: Todos los ensayos se realizaron por triplicado utilizando bolsas de sangre con menos de 15 días de almacenamiento. Se añadieron diferentes volúmenes de aceite de oliva a la sangre, para obtener 5 concentraciones de aceite (1 a 5%),siendo posteriormente filtrada a través del filtro de leucocitos PureCell (Pall). En otra serie de experimentos, se inyectaron diferentes volúmenes de aceite (1;2,5;5;7,5 ó 10 ml)en el circuito durante la filtración de sangre sin grasa. Además, se procesaron 3 preparaciones de sangre con aceite al 5% en el autotransfusor OrthoPAT (Haemonetics)y el con- centrado de hematíes obtenido se filtró a través de PureCell.Se tomaron muestras para hematimetría y detección de PG (analizador Pentra 120 Retic,ABX). RESULTADOS: En los diagramas de dispersión de leucocitos obtenidos para la sangre que contenía aceite, se detectaron claramente las señales específicas correspondientes a PG. El filtro PureCell eliminó las PG hasta una concentración de aceite del 3%o hasta un volumen de aceite inyectado en el circuito inferior a 10 ml. Además, PureCell eliminó totalmente las PG remanentes en sangre procesada por OrthoPAT. CONCLUSIONES: Los filtros de leucocitos parecen ser útiles para eliminar las PG de sangre no procesa- da con bajo grado de contaminación grasa (inferior a 10 mL),y para completar la eliminación de PG en sangre procesada. Por tanto, su uso en la línea de infusión al paciente podría contribuir a aumentar la seguridad de la recuperación perioperatoria de sangre autóloga

BACKGROUND: Salvaged autologous blood in ortho- pedic surgery may contain tissular debris such as fat par- ticles (FP), possibly increasing the risk of fat embolism after bone surgery. Therefore, this study was initiated to ascertain the capacity of leukocyte filters to remove FP using in vitro models. METHODS: All experiments were performed in triplicate using donor blood bags within 15 days of their donation. Five different olive oil volumes were added to blood to obtain 5 oil concentrations (1%to 5%),and blood was subsequently filtered through a PureCell (Pall Biomedical,Portsmouth,UK)leukocyte-reduction filter. In another set of experiments,5 different oil volumes (1, 2.5,5,7.5 or 10 mL)were injected into the line during filtration of oil-free blood.In addition,3 preparations of blood supplemented with 5%oil were processed in the autotransfusion device OrthoPAT (Haemonetics Corp, Braintree, MA, USA),and the obtained red cell concentrate was subsequently filtered through PureCell. We collected samples for cell counting and analysis and FP detection with a Pentra 120 Retic (ABX, Montpellier, France)flow cytometer. RESULTS: Specific signals corresponding to FP were cle- arly detected in the white blood cell scattergrams yielded by the cytometer for oil supplemented blood. PureCell removed FP up to an oil concentration of 3%or up to an injected oil volume of less than 10 mL. Addition of a filtration step through a PureCell filter after blood washing by the OrthoPAT device completely removed FP. CONCLUSIONS: Leukocyte filters seem to be useful for removing FP from unprocessed blood with a low degree of fat contamination (less than 10 mL)and to complete FP removal from processed blood. Therefore, using a leukocyte filter in the patient ’s line should contribute to improving the safety of perioperative autologous blood salvage

[Precision and accuracy of the immediate determination of hemoglobin using HemoCueB Hemoglobin in urgent, surgical, and critical patients]. / Exactitud y precisión de la determinación inmediata de hemoglobina con el HemoCue B Hemoglobin en pacientes urgentes, quirúrgicos y críticos.

OBJECTIVES: The prevalence of anemia among emergency, surgery and critically ill patients is high. As a consequence, many of these patients receive transfusions of packed red cells, with hemoglobin (Hb) concentration being one of the most widely applied criteria for prescription. Accordingly, this study was undertaken 1) to ascertain the accuracy and precision of point-of-care Hb measurements obtained with the portable photometric HemoCue B-Hemoglobin analyzer (HBH) in comparison those performed with the reference cell counter Pentra 120 Retic (ABX), and 2) to evaluate the potential clinical utility of the HCB. MATERIALS AND METHODS: Patients from postanaesthesic recovery unit (PRU, n = 37), intensive care unit (ICU, n = 43) were enrolled and capillary and venous blood samples were taken; emergency room patients with bleeding (ER, n = 35) were also enrolled and arterial blood samples were taken. Hb concentrations were measured 3 times for each patient, using both the HBH and the ABX analyzers. RESULTS: No significant differences between mean Hb values obtained with the HBH and the ABX were found; nor were coefficients of variation significantly different. The coefficients of correlation (Pearson'sr) between the 2 devices were > 0.95 for both arterial and venous blood samples, whereas the correlations for capillary blood samples were 0.747 for PRU patients and 0.859 for ICU patients. CONCLUSION: Based on the reliable results obtained for venous and arterial blood samples, Hb concentrations determined with the portable HBH analyzer may be highly useful for point-of-care monitoring of anemia and evaluating the transfusion requirements of ER, PRU, and ICU patients. However, the degree of inaccuracy and variability of Hb measurements in capillary blood samples would discourage us from using it in these patients.

Exactitud y precisión de la determinación inmediata de hemoglobina con el HemoCue B Hemoglobin en pacientes urgentes, quirúrgicos y críticos / Accuracy and precision in point-of-care hemoglobin measurements with the HemoCue B Hemoglobin analyzer in emergency, surgical and critically ill patients

OBJETIVOS: La anemia tiene una gran prevalencia entre los pacientes urgentes, quirúrgicos y críticos, por lo que un alto porcentaje de ellos reciben concentrados de hematíes, siendo la concentración de hemoglobina (Hb) uno de los parámetros más frecuentemente usados en su prescripción. Los objetivos de este estudio han sido: comprobar la exactitud y precisión de la determinación inmediata de la Hb con el HemoCue B Hemoglobin (HBH) en relación al contador automatizado Pentra 120 Retic (ABX); y evaluar su posible utilidad clínica en estos pacientes. PACIENTES Y MÉTODOS: Se han incluido pacientes de la Unidad de Recuperación Postanestésica (URPA, n=37), de la Unidad de Cuidados Intensivos (UCI, n=43) (sangre capilar y venosa), y del Área de Urgencias Hospitalaria (AUH, n=35) con patología sangrante (sangre arterial), en los que se midió por triplicado el nivel de Hb en el HBH y el ABX. RESULTADOS: No hubo diferencias entre los valores de Hb obtenidos con el ABX y el HBH, ni entre sus coeficientes de variación. Los coeficientes de correlación (r de Pearson) fueron >0,95 en muestras venosas y arteriales, mientras que en muestras capilares fueron de 0,747 (URPA) y 0,859 (UCI). CONCLUSIONES: Dada la fiabilidad de los valores obtenidos en muestras venosas y arteriales, la determinación de Hb con el HBH podría ser de gran utilidad para el control de la anemia y los requerimientos transfusionales en los pacientes de AUH, URPA y UCI. Sin embargo, debido al grado de inexactitud y variabilidad de los resultados obtenidos con muestras capilares no se aconseja su uso en estos pacientes (AU)

[The evaluation of noncompliance in an anti-influenza vaccination program]. / Evaluación del incumplimiento en un programa de vacunación antigripal.

The article presents an evaluation of an anti-influenza vaccination programme in a population at risk, with a special study of the general characteristics of the group of non-complying patients, and the possible relation of these characteristics with their conduct. Moreover, a study was made of the possible motives for not complying with the vaccination programme by means of a survey carried out by post and telephone in a representative sample of 108 individuals. A 34.77% of the registered population did not receive the anti-influenza vaccine, corresponding largely with the youngest age group (15 to 44 years) and there were no significant differences determined by sex or risk factor or doctor. A positive response was received from 75% of those surveyed, and the basic conclusions drawn were a low proportion of information error attributable to the programme (2.94%), and patient refusal as the principal cause of non-compliance (54.41%), followed by "other reasons" (hospitalisation, absence from home, etc.) (32.35%). The strategies that may be followed in the face of this problem require definition of the group of non-compliers, further understanding of the motives for their conduct, and educational measures to change their attitude. 95.9%). Incidence of hypertension and hyperlipemia was 56.2% and 47.3%. Late vascular events varied between 2.6% (nephropathy) and 19.5% (retinopathy). A total of 101 patients (44.6%) were unaware of the existence of diabetic health education programmes. Moreover, 68 (30.3%) declared that they had never received any previous information about their diabetes. Practical skills were evaluated on an individual basis.