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Extended criteria donor livers are increasingly being accepted for transplant in an attempt to bridge the gap between the number of patients on the waiting list and the number of available donor livers. Our objective was to describe our first case of hepatic resuscitation by means of an ex situ perfusion machine in hypothermia with oxygen insufflation of a liver graft extracted from a donor in type 3 asystole after regional perfusion in normothermia.A 53-year-old woman with disabling polycystic liver disease was included on the liver transplant waiting list. Donation was offered in type 3 asystole with regional perfusion in normothermia. Given that it was an elderly donor with a low-weight graft, hepatic resuscitation was decided by means of an ex situ perfusion machine in hypothermia with oxygen insufflation.After performing the bench work, the injector is selectively cannulated via the portal to connect it to the hypothermic perfusion machine. The average temperature of the perfusate (3 L modified Belzer) was 10°C for 120 minutes at 250 mL/min. The implant was completed without the need for transfusion of blood products, postreperfusion Sd, or vasoactive support. Peak of GOT/GPT was 803/276 at 24 hours posttransplant.

Objectives Several studies have shown an inverse association between diabetes mellitus and prostate cancer (PCa). Some researchers suggest that this relationship is due to reduced PCa detection in diabetics due to lower prostate-specific antigen (PSA) levels compared to non-diabetics. Our objective is to analyze the impact of diabetes on PSA in asymptomatic men without known prostate pathology and without prior prostate intervention. Methods We searched Medline (via PubMed), Embase and Scopus. We included studies that reported the relationship between serum PSA levels and diabetes or diabetes treatment in asymptomatic adult men without known prostate pathology, and without prior prostate intervention. Pooled mean differences were compared between diabetics and non-diabetics. Results Of 2,392 screened abstracts, thirteen studies met the inclusion criteria and 8 (62%) reported appropriate measures that could be included in a meta-analysis. Eleven (85%) examined the influence of diabetes on PSA levels and 8 (62%) evaluated the influence of diabetes treatments on PSA levels. Overall diabetics had a significantly lower PSA level compared to non-diabetics (mean difference: −0.07 ng/mL; 95% CI −0.10, −0.04). Conclusions Diabetes and related factors (such as disease duration, severity and treatment) were significantly associated with lower PSA levels among asymptomatic men, yet differences were small and are unlikely to influence PCa detection in a screening setting.

Objetivo: Determinar la relación entre el Nivel de Percepción de la cultura de Seguridad del paciente y la notificación de eventos adversos referida por el personal asistencial de un hospital nivel I de la provincia de Ferreñafe, Lambayeque, Perú durante el año 2015. Materiales y Métodos: La población muestral estuvo conformada por 91 profesionales de la salud. El estudio fue de tipo analítico, prospectivo, transversal y el diseño de contrastación de hipótesis utilizado fue el descriptivo relacional. Para el análisis estadístico se utilizó la prueba de la Chi- cuadrado leída al 95% de confiabilidad, en la recolección de datos se empleó el cuestionario denominado “Cuestionario sobre seguridad del paciente en los hospitales” de la Agencia de Salud, Investigación y calidad de Estados Unidos (AHRQ). Resultados: los resultados evidenciaron que el nivel de percepción general de la Cultura de Seguridad manifestado por el personal asistencial fue neutral y negativo (90%), consecuentemente estuvo relacionado con un alto porcentaje de eventos adversos no notificados (74%). (p

espanolObjetivo: describir las caracteristicas demograficas y clinicas de los pacientes evaluados por primera vez en el Servicio de Glaucoma del Hospital Especializado Mexiquense de Salud Visual, en Naucalpan, Estado de Mexico. Metodologia: se realizo un estudio observacional de tipo transversal que incluyo a todos los pacientes de primer contacto en el Departamento de Glaucoma entre agosto de 2015 y julio de 2016. Posteriormente se analizaron los datos recabados con el programa Excel 2011, realizando para las variables cuantitativas todas las medidas de tendencia central y de dispersion y para las variables cualitativas frecuencias y porcentajes. Resultados: de 17.206 consultas de primer contacto, 1613 sujetos fueron referidos al servicio de glaucoma, y en 569 casos logro integrarse el diagnostico de algun tipo de glaucoma, lo que representa el 3,30 % de la poblacion. El 58 % de los sujetos pertenecian al sexo femenino (n = 383). El promedio de edad fue 62,9 anos (DE ± 14,17, IC 95 %: 61,73-64,07). La distribucion de los diagnosticos integrados durante la evaluacion inicial fue la siguiente: glaucoma primario angulo abierto (GPAA), 274 sujetos (48,15 %); sospecha de glaucoma, 180 sujetos (31,63 %); glaucoma de angulo cerrado (GAC), 43 sujetos (7,46 %); glaucoma neovascular (GNV), 32 sujetos (5,62 %), y 40 sujetos con otros tipos de glaucoma (7,02 %). Conclusiones: en este estudio se encontro que el tipo de glaucoma con mayor incidencia fue el GPAA, seguido de los pacientes sospechosos de glaucoma; en ambos casos el sexo femenino fue el de mayor frecuencia EnglishObjective: To describe the demographic and clinical characteristics of the patients evaluated for the first time in the Glaucoma Service of the Mexiquense Specialized Hospital of Visual Health, in Naucalpan State of Mexico. Methodology: An observational cross-sectional study was carried out, in which all the patients of first contact in the glaucoma department were included during the period from August 2015 to July 2016. Subsequently, the data collected with Excel 2011 program were analyzed, performing for the quantitative variables all measures of central tendency and dispersion and for the qualitative variables frequencies and percentages. Results: Of 17,206 first contact consultations, 1,613 subjects were referred to the glaucoma service and in 569 cases the diagnosis of some type of glaucoma was integrated, representing 3.30 % of the population. 58 % of the subjects belonged to the female sex (n = 383). The average age was 62.9 years (SD ± 14.17, CI 95: 61.73-64.07). The following diagnoses were assigned during the initial assessment: primary open-angle glaucoma (POAG) 274 subjects (48.15 %), glaucoma suspects 180 subjects (31.63 %), closed angle glaucoma (CAG) 43 subjects (7.46 % ), neovascular glaucoma (NVG) 32 subjects (5.62 %), and 40 subjects with other types of glaucoma representing 7.02 %. Conclusions: In this study it was found that the type of glaucoma with the highest incidence was POAG, followed by patients suspected of glaucoma, being more frequent in females

[Simple Summary] Effective biomarkers are needed to enable personalized medicine for pancreatic cancer patients. This study analyzes the prognostic value, in early pancreatic cancer, of circulating tumor cells and clusters from the central venous catheter and portal blood. Circulating tumor cells were isolated using an immunomagnetic selection and were detected by microscopy using immunocytochemistry staining. In conclusion, the circulating tumor cell number in portal blood identifies a death risk in patients with early pancreatic cancer., [Abstract] Background. Effective biomarkers are needed to enable personalized medicine for pancreatic cancer patients. This study analyzes the prognostic value, in early pancreatic cancer, of single circulating tumor cell (CTC) and CTC clusters from the central venous catheter (CVC) and portal blood (PV). Methods. In total, 7 mL of PV and CVC blood from 35 patients with early pancreatic cancer were analyzed. CTC were isolated using a positive immunomagnetic selection. The detection and identification of CTC were performed by immunocytochemistry (ICC) and were analyzed by Epi-fluorescence and confocal microscopy. Results. CTC and the clusters were detected both in PV and CVC. In both samples, the CTC number per cluster was higher in patients with grade three or poorly differentiated tumors (G3) than in patients with well (G1) or moderately (G2) differentiated. Patients with fewer than 185 CTC in PV exhibited a longer OS than patients with more than 185 CTC (24.5 vs. 10.0 months; p = 0.018). Similarly, patients with fewer than 15 clusters in PV showed a longer OS than patients with more than 15 clusters (19 vs. 10 months; p = 0.004). These significant correlations were not observed in CVC analyses. Conclusions. CTC presence in PV could be an important prognostic factor to predict poor prognosis in early pancreatic cancer. In addition, the number of clustered-CTC correlate to a tumor negative differentiation degree and, therefore, could be used as a diagnostic biomarker for pancreatic cancer., This research was funded by Carlos III Health Institute (Health Research Fund) grant number PI16/01465 and PI19/01821 (Co-financed by the European Regional Development Fund “A way to make Europe”).

Bernal-Soriano, Mari Carmen/0000-0002-9174-0068; Berbel, Pere/0000-0001-6124-6037, WOS: 000555874000001, PubMed: 32498666, Background:Thyroxine (T4) to triiodothyronine (T3) deiodination in the hypothalamus/pituitary is mediated by deiodinase type-2 (D2) activity.Dio2((-/-))mice show central resistance to exogenous T4. Patients with resistance to exogenous thyroxine (RETH) have not been described. the aim of this study was to identify hypothyroid patients with thyrotropin (TSH) unresponsiveness to levothyroxine (LT4) and to characterize the clinical, hormonal, and genetic features of human RETH. Methods:We investigated hypothyroid patients with elevated TSH under LT4 treatment at doses leading to clinical and/or biochemical hyperthyroidism. TSH and free T4 (fT4) were determined by chemiluminescence, and total T4, T3, and reverse T3 (rT3) by radioimmunoassay. TSH/fT4 ratio at inclusion and T3/T4, rT3/T4, and T3/rT3 ratios at follow-up were compared with those from patients with resistance to thyroid hormone (RTH) due to thyroid hormone receptor-beta (THRB) mutations.DIO2,including the Ala92-D2 polymorphism, selenocysteine binding protein 2 (SECISBP2), andTHRBwere fully sequenced. Results:Eighteen hypothyroid patients (nine of each sex, 3-59 years) treated with LT4 showed elevated TSH (15.5 +/- 4.7 mU/L; reference range [RR]: 0.4-4.5), fT4 (20.8 +/- 2.4 pM; RR: 9-20.6), and TSH/fT4 ratio (0.74 +/- 0.25; RR: 0.03-0.13). Despite increasing LT4 doses from 1.7 +/- 1.0 to 2.4 +/- 1.7 mu g/kg/day, TSH remained elevated (6.9 +/- 2.7 mU/L). Due to hyperthyroid symptoms, LT4 doses were reduced, and TSH increased again to 7.9 +/- 3.2 mU/L. in the euthyroid/hyperthyrotropinemic state, T3/T4 and T3/rT3 ratios were decreased (9.2 +/- 2.4, RR: 11.3-15.3 and 2.5 +/- 1.4, RR: 7.5-8.5, respectively) whereas rT3/T4 was increased (0.6 +/- 0.2; RR: 0.43-0.49), suggesting reduced T4 to T3 and increased T4 to rT3 conversion. These ratios were serum T4-independent and were not observed in RTH patients. Genetic testing was normal. the Ala92-D2 polymorphism was present in 7 of 18 patients, but the allele dose did not correlate with RETH. Conclusions:Human RETH is characterized by iatrogenic thyrotoxicosis and elevated TSH/fT4 ratio. in the euthyroid/hyperthyrotropinemic state, it is confirmed by decreased T3/T4 and T3/rT3 ratios, and elevated rT3/T4 ratio. This phenotype may guide clinicians to consider combined T4+T3 therapy in a targeted fashion. the absence of germlineDIO2mutations suggests that aberrant post-translational D2 modifications in pituitary/hypothalamus or defects in other genes regulating the T4 to T3 conversion pathway could be involved in RETH., Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos IIIInstituto de Salud Carlos III [PI16/00830]; Rare Diseases Networking Biomedical Research Centre (CIBERER), This work was supported by funding from the Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III (grant PI16/00830 to J.C.M.) and by the Rare Diseases Networking Biomedical Research Centre (CIBERER).

Introduction The Diabetes Health Profile (DHP‐18), structured in three dimensions (psychological distress (PD), barriers to activity (BA) and disinhibited eating (DE)), assesses the psychological and behavioural burden of living with type 2 diabetes. The objectives were to adapt the DHP‐18 linguistically and culturally for use with patients with type 2 DM in Ecuador, and to evaluate its psychometric properties. Methods Participants were recruited using purposive sampling through patient clubs at primary health centres in Quito, Ecuador. The DHP-18 validation consisted in the linguistic validation made by two Ecuadorian doctors and eight patient interviews. And in the psychometric validation, where participants provided clinical and sociodemographic data and responded to the SF-12v2 health survey and the linguistically and culturally adapted version of the DHP-18. The original measurement model was evaluated with confirmatory factor analysis (CFA). Reliability was assessed through internal consistency using Cronbach’s alpha and test–retest reproducibility by administering DHP-18 in a random subgroup of the participants two weeks after (n = 75) using intraclass correlation coefficient (ICC). Convergent validity was assessed by establishing previous hypotheses of the expected correlations with the SF12v2 using Spearman’s coefficient. Results Firstly, the DHP-18 was linguistically and culturally adapted. Secondly, in the psychometric validation, we included 146 participants, 58.2% female, the mean age was 56.8 and 31% had diabetes complications. The CFA indicated a good fit to the original three factor model (χ2 (132) = 162.738, p −0.40 in two of three hypotheses). Conclusions The original three factor model showed good fit to the data. Although reliability parameters were adequate for PD and DE dimensions, the BA presented lower internal consistency and future analysis should verify the applicability and cultural equivalence of some of the items of this dimension to Ecuador.

Scientific societies have provided guidelines to reduce PSA-specific harms. We studied the potential non-compliance of PSA testing with current guidelines in general practice. A cross-sectional study of a random sample of 1291 patients with a PSA test was performed between January and April 2018 in primary health care. Patients with a previous prostate cancer diagnosis or those who were being followed-up for previous high PSA values were excluded. Two independent researchers classified whether each test was potentially non-compliant with recommendations. We estimated frequencies of potentially non-compliant PSA determinations and calculated prevalence ratios (PR) to assess their relationship with possible explanatory variables. A total of 66% (95% CI: 62–69%) of PSA requests in asymptomatic patients were potentially non-compliant with the current guideline. This was associated with having a previous diagnosis of neoplasm (PR adjusted by age and life expectancy: 1.18, 95% CI: 1.02–1.37) as well as being a current consumer of tobacco, alcohol, or other drugs (PR: 0.80, 95% CI: 0.67–0.97). Real world data shows that patients are still frequently exposed to overdiagnosis risk with a PSA potentially non-compliant with recommendations. Patients diagnosed with another neoplasm or non-consumers of toxic substances were more exposed, probably due to increased contact with doctors or health-seeking behaviour.

Diabetes is a major public health problem, increasingly affecting low- and middle-income countries. The project CEAD (Contextualizing Evidence for Action in Diabetes in low-resource settings) aims to evaluate the implementation of comprehensive diabetes care in two low-resource settings in Ecuador and to stimulate context-led health systems innovations to improve diabetes care and reduce inequity. The mixed-methods approach includes a 24-month retrospective study to assess the current level of implementation of comprehensive diabetes care and participants will be followed up prospectively for two years to assess changes in healthcare and clinical outcomes from the outset of the research. We will include individuals diagnosed with type-2 diabetes aged over 18 years, who are accessing diabetes care in health facilities in the study districts. Varied stakeholders (patients and family members, community members, healthcare workers and decision-makers) will interpret the underlying causes of the observed weaknesses and propose solutions to strengthen diabetes-related healthcare in focus group discussions (FG). A second set of FG will analyze perceived improvements in healthcare based on prospective cohort findings and consider the success/failure of any context-led innovations occurring throughout the research. Our study will demonstrate how evidence can be contextualized to stimulate local innovations and overcome weaknesses of diabetes-related healthcare in low resource settings.

Background: Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimize disease management. We aimed to assess the impact of patients' perception of their treatment and disease on adherence and Health-Related Quality of Life (HRQL) in patients attending a community pharmacy, where usually subjects have a better condition than those in clinical settings. Methods: We performed a cross-sectional study of 318 patients with COPD in treatment with inhalers in the last 3 months from 53 community pharmacies. We assessed HRQL with St George's Respiratory Questionnaire (SGRQ). Persistence was assessed from the three previous refills and adherence through the Test of Adherence to Inhalers test. Results: Persistence was achieved by 78.6% of the patients and 58.5% had good adherence. Patients having a multidose DPI and those with MDI showed a 2.8-fold and 4.1-fold increased association, respectively, with intermediate/poor adherence in comparison with those having a single dose DPI. Those patients who did not have knowledge about COPD (aOR 2.106, p = 0.006) and those who thought that the inhaler effectiveness was fair/poor (aOR 2.361, p = 0.006) were more likely to have intermediate/poor adherence. Overall SGRQ score was significantly worse in patients with intermediate/poor adherence (p = 0.036) and in those who thought the inhaler's effectiveness was fair/poor (p < 0.001). Conclusions: The type of inhaler and patients' knowledge and perceptions of their disease and treatment were associated with good adherence and higher HRQL. Clinicians should promote shared-decision making in the choice of inhaler depending on patients' individual abilities and beliefs.

11th Congress of the Andalusian Society of Organ and Tissue Transplantation. Liver transplantation., [Background] The presence of collateral circulation in liver cirrhosis patients with portal hypertension is quite frequent due to re-permeabilization of closed embryonic channels. In some cases, these shunts could measure over 1 cm wide, therefore, containing a significative blood flow. Its management during liver transplantation could be challenging due to possible complications resulting from either ligation of the shunts or from ignoring them. We present the case of a patient with recurrent hepatic encephalopathy (HE) and a large spontaneous portosystemic shunt (SPSS) who submitted to liver transplant and review the literature identifying options, complications, and outcomes with the aim of facilitating decision making., [Material and Methods] A 68-year-old, Spanish man diagnosed with liver cirrhosis with portal hypertension and recurrent episodes of HE is proposed for LT. The patient’s Child-Pugh score was A6-B7, and the Model for End-stage Liver Disease score was 12. Preoperatively, a computed tomography scan showed a large SPSS running to the inferior cava vein. During the surgery, a small-sized portal vein and a large shunt measuring almost 3 cm wide were identified. After reperfusion, portal vein flow was 1000 to 1100 mL/min. Owing to the previous HE and the risk of low portal flow, the shunt was closed increasing the portal flow to 1800 mL/min. The patient was discharged without any complications., [Conclusions] The presence of large SPSSs are frequent during LT. Decision making intraoperatively can be challenging due to possible complications derived from ligation of the SPSS or from ignoring it. Either preoperative assessment of a further HE risk or portal vein flow measurement after reperfusion are essential to achieve a correct resolution.

The aim of the study was to evaluate the clinical features and long-term therapeutic outcome of giant prolactinoma (gPRLoma) in men and to compare them with those of a group of male patients with non-gPRL macroprolactinomas (non-gPRLomas). A retrospective and multicenter study of gPRLomas in men diagnosed in a 20-year period was performed. Clinical data and treatment outcome were registered. The diagnosis of gPRLoma was established when the maximal tumor diameter was ≥40 mm or the tumor had ≥20 mm of suprasellar extension associated to hyperprolactinemia (PRL>1000 ng/ml). Non-gPRLoma was considered when tumor diameter was ≥ 10 mm and1 year and no radiological evidence of pituitary tumor) was achieved in 2 (8.7%) gPRLoma patients and in 2 (4.8%) non-gPRLoma patients (NS). gPRLomas in men are usually diagnosed at a mean age of 40 years, an age similar to that of non-gPRLomas. The only clinical difference with non-gPRLomas is their greater prevalence of visual disturbances. The therapeutic approaches and tumor outcomes were similar to those obtained in patients with non-gPRLomas. Complete cure in gPRLoma is rare, but similar to that achieved in non-gPRLomas, reached in less than 10% of patients.

El familiar del adulto mayor al brindar cuidado puede sentir satisfacción por ayudar a otro a continuar su vida, aunque también se pueden generan sentimientos de insatisfacción debido a la sobrecarga percibida, relacionada muchas veces con la dependencia del adulto mayor, esta situación motivó a investigar ¿Cuál es la asociación entre el grado de carga del cuidador familiar y el grado de dependencia del adulto mayor atendido en el Servicio de Hospitalización del Hospital Agustín Arbulú Neyra Essalud- Ferreñafe, 2017?. El objetivo de esta investigación cuantitativa, correlacional fue determinar la asociación entre el grado de carga del cuidador familiar y el grado de dependencia del adulto mayor. Siendo importante porque permitirá implementar estrategias para el cuidado del cuidador. La muestra estuvo conformada por 33 cuidadores que cumplieron con los criterios de inclusión, a quienes se les aplicó el cuestionario de Zarith para cuantifica el grado de sobrecarga y para evaluar el grado de dependencia en el adulto mayor se empleó el índice de Barthel. Los resultados revelaron que un 63.6% de los cuidadores presenta sobrecarga, los adultos mayores son en su mayoría dependientes (82%), percibiéndose sobrecarga en los diferentes dimensiones física (Gamma = 0,737, p< 0.01), psicológica (Gamma = 0,691, p< 0.01) y social (Gamma = 0,798, p< 0.01). En conclusión el nivel de sobrecarga se asocia con el grado de dependencia del adulto mayor cuidado existiendo una relación de asociación positiva y estadísticamente significativa (Gamma =0,691, p< 0.01).

Introduction: Prostate-specific antigen (PSA) is the main tool for early detection, risk stratification and monitoring of prostate cancer (PCa). However, there are controversies about the use of PSA as a population screening test because of the high potential for overdiagnosis and overtreatment associated. The net benefit of screening is unclear and according to the available recommendations, it should be offered to well-informed men with an adequate health status and a life-expectancy of at least 10 years or to men at elevated risk of having PCa. In addition, the factors that influence test results are unclear, as is impact of false positive or negative results on patient health. Our objective is to assess the clinical and analytical factors associated with the presence of false positive and false negative results and the diagnostic/therapeutic process followed by these patients. Methods and analysis: A prospective observational cohort study will be carried out. We will include a cohort of patients with a positive PSA result (1.081 patients) and a sample of patients with negative results (572 patients); both will be followed for 2 years by reviewing medical records to assess the variables associated with these results, as well as characteristics of patient management after a positive PSA value. We will include those patients with a PSA determination from 2 hospitals in the Valencian Community. Patients who have been previously diagnosed with prostate cancer or who are being followed for previous high PSA values will be excluded. Discussion: The study will estimate the frequency of false positive and false negative PSA results in routine clinical practice, and allow us to quantify the potential harm caused. Study registration: Clinicaltrials.gov (https://clinicaltrials.gov/): NCT03978299, June 7, 2019.

Las personas aprendemos de manera natural. Sin embargo, enseñar se ha vuelto una tarea cada vez más exigente para quienes ejercen la docencia en los diferentes niveles. La experiencia dicta, en palabras de Mark Prensky, que «hoy tenemos alumnos para los que nuestro sistema educativo no fue creado» (Prensky, 2001, 1). Lo anterior manifiesta la urgencia de innovar la labor docente y encontrar mejores metodologías para hacer asequible el aprendizaje a los estudiantes.

Yeasts involved in veil formation during biological ageing of Sherry wines are mainly Saccharomyces cerevisiae, and they have traditionally been divided into four races or varieties: beticus, cheresiensis, montuliensis and rouxii. Recent progress in molecular biology has led to the development of several techniques for yeast identification, based on similarity or dissimilarity of DNA, RNA or proteins. In view of the latest yeast taxonomy, there are no more races. However, molecular techniques are not enough to understand the real veil-forming yeast diversity and dynamics in Sherry wines. We propose a reliable method, using a microtiter reader, to evaluate the fermentation and assimilation of carbon and nitrogen sources, the osmotolerance and the antibiotic resistance, using 18 S. cerevisiae and 5 non-Saccharomyces yeast strains, to allow correct identification and classification of the yeast strains present in the velum of flor complex.

espanolIntroduccion: el sindrome linfoproliferativo postrasplante (SLPT) es una complicacion infrecuente que ensombrece el pronostico de los pacientes sometidos a un trasplante hepatico (TH). Su patogenia es multifactorial, siendo sus dos principales factores de riesgo la inmunodepresion y la infeccion del virus de EpsteinBarr (VEB); sin embargo, en actualidad se piensa que puede estar relacionada con otros factores. Metodos: estudio observacional en el que hemos analizado de forma retrospectiva 851 casos que fueron sometidos a un trasplante hepatico, de los cuales diez casos han desarrollado un SLPT. Se han analizado sus caracteristicas clinicopatologicas y el tratamiento recibido. Resultados: la incidencia del SLPT ha sido del 1,2% (10/851) y el tiempo medio de presentacion desde el TH hasta el diagnostico, de 36 meses (rango 1,2-144 meses). El lugar de presentacion ha sido extranodal en todos los casos, siendo mas frecuente la localizacion intestinal. Siete casos presentaron un SLPT monomorfo, todos ellos linfomas diferenciados de celulas B. El 50% de la serie presento seronegatividad para el virus de Epstein-Barr. La supervivencia global ha sido del 50%. Entre estos pacientes, hemos observado tres casos de curacion completa, un caso de estabilizacion de la enfermedad y otro caso de recurrencia. Conclusion: el SLPT es una complicacion infrecuente que supone una amenaza para la vida del paciente. Para poder instaurar un diagnostico precoz y un tratamiento que pueda modificar el curso de la enfermedad, es fundamental la identificacion de los pacientes en riesgo. Englishntroduction: Post-transplant lymphoproliferative syndrome (PTLD) is a rare and potentially life-threatening complication after liver transplantation. The aim of this study was to analyze the clinicopathologic features related to PTLD in a single institution after liver transplantation. Methods: Observational study where we have retrospectively analyzed 851 cases who underwent liver transplantation. Ten cases have developed PTLD. Their clinical-pathological characteristics and the treatment received have been analyzed. Results: PTLD incidence was 1.2% (10/851). The mean time from liver transplantation to PTLD diagnosis was 36 months (range 1.2 to 144 months). PTLD localization was extranodal in all cases, the most frequent location being intestinal. Seven cases showed a monomorphic lymphoma which in all cases was differentiated B cell lymphomas. Fifty per cent of the series were seropositive for Epstein-Barr virus. Five patients were alive at the time of the review. Among these patients, we observed three cases of complete remission and two cases of disease stabilization. The death rate was higher in the first year after diagnosis of PTLD. Conclusion: PTLD is a rare complication after liver transplantation, but it may pose a threat to the life of a liver transplant recipient. It is essential to identify patients at risk, to establish an early diagnosis and treatment that can change the outcome of the disease.

Objective Acromegaly associated to schizophrenia was first reported ~60 years ago, and so far, it is unclear whether this association is causal or not. Our aim was to report new cases with both clinical entities and to discuss the potential pathophysiological mechanisms of this association. Methods Three new cases and data from literature are reviewed. Results We report 2 males and 1 female diagnosed with schizophrenia and treated for several years with antipsychotics who developed acromegaly due to a growth hormone (GH)-secreting pituitary macroadenoma. In all cases, the diagnosis of schizophrenia preceded acromegaly with mean disease duration of ~12 years. Antipsychotic therapy was different in every patient. Two patients underwent transsphenoidal surgery. Histopathological study showed mixed GH- and prolactin-secreting adenoma in 1 patient and pure GH-secreting adenoma in the other patient. Several pathophysiological mechanisms related to alterations in dopaminergic neurotransmission due to psychiatric disease itself or its pharmacological treatment are proposed and discussed as likely linkage between schizophrenia and acromegaly. Conclusion These case reports suggest that schizophrenia and/or its antipsychotic therapy in the long term might be in relation with the development of GH-secreting pituitary adenomas.

Pheochromocytomas (PCCs) and paragangliomas (PGLs) are chromaffin-cell tumors that arise from the adrenal medulla and extra-adrenal paraganglia, respectively. The dysfunction of genes involved in the cellular response to hypoxia, such as VHL, EGL nine homolog 1, and the succinate dehydrogenase (SDH) genes, leads to a direct abrogation of hypoxia inducible factor (HIF) degradation, resulting in a pseudo-hypoxic state implicated in PCC/PGL development. Recently, somatic post-zygotic mutations in EPAS1 (HIF2A) have been found in patients with multiple PGLs and congenital erythrocytosis. We assessed 41 PCCs/PGLs for mutations in EPAS1 and herein describe the clinical, molecular and genetic characteristics of the 7 patients found to carry somatic EPAS1 mutations; 4 presented with multiple PGLs (3 of them also had congenital erythrocytosis), whereas 3 were single sporadic PCC/PGL cases. Gene expression analysis of EPAS1-mutated tumors revealed similar mRNA EPAS1 levels to those found in SDH-gene- and VHL-mutated cases and a significant up-regulation of two hypoxia-induced genes (PCSK6 and GNA14). Interestingly, single nucleotide polymorphism array analysis revealed an exclusive gain of chromosome 2p in three EPAS1-mutated tumors. Furthermore, multiplex-PCR screening for small rearrangements detected a specific EPAS1 gain in another EPAS1-mutated tumor and in three non-EPAS1-mutated cases. The finding that EPAS1 is involved in the sporadic presentation of the disease not only increases the percentage of PCCs/PGLs with known driver mutations, but also highlights the relevance of studying other hypoxia-related genes in apparently sporadic tumors. Finally, the detection of a specific copy number alteration affecting chromosome 2p in EPAS1-mutated tumors may guide the genetic diagnosis of patients with this disease.

Information regarding liver retransplantation in HIV-infected patients is scant. Data from 14 HIV-infected patients retransplanted between 2002 and 2011 in Spain (6% retransplantation rate) were analyzed and compared with those from 157 matched HIV-negative retransplanted patients. In HIV-infected patients, early (≤30 days) retransplantation was more frequently indicated (57% vs. 29%; p = 0.057), and retransplantation for HCV recurrence was less frequently indicated (7% vs. 37%; p = 0.036). Survival probability after retransplantation in HIV-positive patients was lower than in HIV-negative patients, 42% versus 64% at 3 years, although not significantly (p = 0.160). Among HIV-infected patients, those with undetectable HCV RNA at retransplantation and those with late (>30 days) retransplantation showed better 3-year survival probability (80% and 67%, respectively), similar to that in their respective HIV-negative counterparts (72% and 70%). In HIV-infected and HIV-negative patients, 3-year survival probability in those with positive HCV RNA at retransplantation was 22% versus 65% (p = 0.008); in those with early retransplantation, 3-year survival probability was 25% versus 56% (p = 0.282). HIV infection was controlled with antiretroviral therapy after retransplantation. In conclusion, HIV-infected patients taken as a whole have unsatisfactory survival after liver retransplantation, although patients with undetectable HCV RNA at retransplantation or undergoing late retransplantation show a more favorable outcome.

Solid organ transplant recipients (SOTR) are at risk of serious influenza-related complications. The impact of respiratory co-infection in SOTR with 2009 pandemic influenza A(H1N1) is unknown. A multicentre prospective study of consecutive cases of pandemic influenza A(H1N1) in SOTR was carried out to assess the clinical characteristics and outcome and the risk factors for co-infection. Overall, 51 patients were included. Median time from transplant was 3.7years, 5.9% of the cases occurred perioperatively and 7.8% were hospital-acquired. Pneumonia was diagnosed in 15 (29.4%) patients. Ten cases were severe (19.6%): 13.7% were admitted to intensive care units, 5.9% suffered septic shock, 5.9% developed acute graft rejection and 7.8% died. Co-infection was detected in 15 patients (29.4%): eight viral, six bacterial and one fungal. Viral co-infection did not affect the outcome. Patients with non-viral co-infection had a worse outcome: longer hospital stay (26.2±20.7 vs. 5.5±10.2) and higher rate of severe diseases (85.7% vs. 2.3%) and mortality (42.8% vs. 2.3%). Independent risk factors for non-viral co-infection were: diabetes mellitus and septic shock. Other factors associated with severe influenza were: delayed antiviral therapy, diabetes mellitus, time since transplantation

Information about infections unrelated to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus (HIV)-infected liver recipients is scarce. The aims of this study were to describe the prevalence, clinical characteristics, time of onset, and outcomes of bacterial, viral, and fungal infections in HIV/hepatitis C virus (HCV)-coinfected orthotopic liver transplant recipients and to identify risk factors for developing severe infections. We studied 84 consecutive HIV/HCV-coinfected patients who underwent liver transplantation at 17 sites in Spain between 2002 and 2006 and were followed until December 2009. The median age was 42 years, and 76% were men. The median follow-up was 2.6 years (interquartile range = 1.25-3.53 years), and 54 recipients (64%) developed at least 1 infection. Thirty-eight (45%) patients had bacterial infections, 21 (25%) had cytomegalovirus (CMV) infections (2 had CMV disease), 13 (15%) had herpes simplex virus infections, and 16 (19%) had fungal infections (7 cases were invasive). Nine patients (11%) developed 10 opportunistic infections with a 44% mortality rate. Forty-three of 119 infectious episodes (36%) occurred in the first month after transplantation, and 53 (45%) occurred after the sixth month. Thirty-six patients (43%) had severe infections. Overall, 36 patients (43%) died, and the deaths were related to severe infections in 7 cases (19%). Severe infections increased the mortality rate almost 3-fold [hazard ratio (HR) = 2.9, 95% confidence interval (CI) = 1.5-5.8]. Independent factors for severe infections included a pretransplant Model for End-Stage Liver Disease (MELD) score >15 (HR = 3.5, 95% CI = 1.70-7.1), a history of AIDS-defining events before transplantation (HR = 4.0, 95% CI = 1.9-8.6), and non-tacrolimus-based immunosuppression (HR = 2.5, 95% CI = 1.3-4.8). In conclusion, the rates of severe and opportunistic infections are high in HIV/HCV-coinfected liver recipients and especially in those with a history of AIDS, a high MELD score, or non-tacrolimus-based immunosuppression.

El presente estudio de tipo cualitativo y etnográfico de pequeño alcance, tiene como objetivo describir el significado del cuidado de sí de un grupo de gestantes adolescentes y su hijo por nacer, con relación a la alimentación, a partir de sus prácticas, creencias y valores culturales, quienes asistieron a control prenatal a la Unidad de Atención Primaria (UPA) de Candelaria la Nueva, Hospital Vista Hermosa, Ciudad Bolívar, Localidad 19 de Bogotá, en 2007. La información fue aportada por ocho adolescentes primigestantes de entre 17 y 19 años de edad, que estaban entre el cuarto y séptimo meses de gestación, sin patologías asociadas, que asistieron al primer control prenatal, seleccionadas intencionalmente y que estuvieron dispuestas a participar de la investigación (previo consentimiento informado). La recolección de datos se realizó a través de la entrevista etnográfica no estructurada; se obtuvo como resultado el significado del cuidado en las gestantes adolescentes y se aportaron tres grandes beneficios positivos del cuidado de la alimentación materna: cambio de hábito alimentario, alimentarse para proteger la salud del bebé y para que nazca sano, y alimentarse para proteger la salud de la madre adolescente. Dichos resultados, conjugados en el escenario cultural de las gestantes adolescentes, permiten explorar y conocer cómo se cuidan ellas a través de las prácticas soportadas en el saber como conocimiento y razón, y el uso como los artefactos que utiliza.

The principal role of wine yeast is to transform efficiently the grape-berries’ sugars to ethanol, carbon dioxide, and other metabolites, without the production of off-flavors. Wine yeast strains are able to ferment musts, while other commercial or laboratory strains fail to do so. The genetic differences that characterize wine yeast strains in contrast to the biological ageing of the veil-forming yeasts in Sherry wines are poorly understood. Saccharomyces cerevisiae strains frequently exhibit rather specific phenotypic features needed for adaptation to a special environment, like fortified wines with ethanol up to 15% (v/v), known as Sherry wines. Factors that affect the correct development of the veil of flor during ageing are also reviewed, along with the related aspects of wine composition, biofilm formation processes, and yeast autolysis. This review highlights the importance of yeast ecology and yeast metabolic reactions in determining Sherry wine quality and the wealth of untapped indigenous microorganisms co-existing with the veil-forming yeast strains. It covers the complexity of the veil forming wine yeasts’ genetic features, and the genetic techniques often used in strain selection and monitoring during fermentation or biological ageing. Finally, the outlook for new insights to protect and to maintain the microbiota of the Sherry wines will be discussed.

Introduction: The anatomical variants of the hepatic artery may have important implications for pancreatic cancer surgery. The aim of our study is to compare the outcome following a pancreatoduodenectomy (PD) in patients with or without a variant hepatic artery arising from superior mesenteric artery. Material and methods: We reviewed 151 patients with periampullary tumoral pathology. All patients underwent oncological PD between January 2005 and February 2012. Our series was divided into two groups: Group A: Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Patients without a hepatic artery arising from superior mesenteric artery. We expressed the results as mean ± standard deviation for continuous variables and percentages for qualitative variables. Statistical tests were considered significant if p < 0.05. Results: We identified 11 patients with a hepatic artery arising from superior mesenteric artery (7.3%). The most frequent variant was an aberrant right hepatic artery (n = 7), following by the accessory right hepatic artery (n = 2) and the common hepatic artery trunk arising from the superior mesenteric artery (n = 2). In 73% of cases the diagnosis of the variant was intraoperative. R0 resection was performed in all patients with a hepatic artery arising from superior mesenteric artery. There were no significant differences in the tumor resection margins and the incidence of postoperative complications. Conclusion: Oncological PD is feasible by the presence of a hepatic artery arising from superior mesenteric artery. The complexity of having it does not seem to influence in tumor resection margins, complications and survival.

Background & Aims: The aim of this study was to evaluate the results of treatment with pegylated interferon and ribavirin for the recurrence of hepatitis C after liver transplantation in HCV/ HIV-coinfected patients. Methods: This was a prospective, multicentre cohort study, including 78 HCV/HIV-coinfected liver transplant patients who received treatment for recurrent hepatitis C. For comparison, we included 176 matched HCV-monoinfected patients who underwent liver transplantation during the same period of time at the same centres and were treated for recurrent hepatitis C. Results: Antiviral therapy was discontinued prematurely in 56% and 39% (p = 0.016), mainly because of toxicity (22% and 11%, respectively; p = 0.034). Sustained virological response (SVR) was achieved in 21% of the coinfected patients and in 36% of monoinfected patients (p = 0.013). For genotype 1, SVR rates were 10% and 33% (p = 0.002), respectively; no significant differences were observed for the other genotypes. A multivariate analysis based on the whole series identified HIV-coinfection as an independent predictor of lack of SVR (OR, 0.17; 95% CI, 0.06-0.42). Other predictors of SVR were donor age, pretreatment HCV viral load, HCV genotype, and early virological response. SVR was associated with a significant improvement in survival: 5-year survival after antiviral treatment was 79% for HCV/HIV-coinfected patients with SVR vs. 43% for those without (p = 0.02) and 92% vs. 60% in HCV-monoinfected patients (p < 0.001), respectively. Conclusions: The response to pegylated interferon and ribavirin was poorer in HCV/HIV-coinfected liver recipients, particularly those with genotype 1. However, when SVR was achieved, survival of coinfected patients increased significantly. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.