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Introduction: The global motorcycle market has grown significantly, with over 770 million vehicles estimated to be in use worldwide. Motorcycle-related road traffic deaths in low and middle-income countries (LMICs) like Colombia are concerning, comprising 30% of all reported fatalities. Cartagena has an average of 70 motorcycle-related deaths annually between 2019 and 2022, making it a high-risk area for motorcyclists., Objective: The study aimed to identify factors associated with motorcyclist safety at unsignalized three-legged and four-legged intersections in Cartagena by observing the behavior of the motorcyclists and the analysis of the potential traffic conflicts. The observational analysis focused on the access of motorcyclists from a secondary road to a main road since it is the behavior offered by the most significant road interaction and the potential risk of traffic conflicts due to crossing., Methods: The observational process was consolidated at ten three-legged intersections and seven four-legged intersections. Thirty-six hours of videos were collected considering different time slots and weekdays randomly distributed during September 2019 and March 2020. The selection of the intersections included different vehicular flows and road safety conditions. The variables considered in the study were: interaction with other road users, motorcyclist behavior, vehicle handling, potential distractors, and safety elements. The study used the Swedish Traffic Conflict Technique to analyze conflict analysis, incorporating the Post Encroachment Time (PET) measurement. The analysis was developed with descriptive and inferential statistical techniques. The collected variables were analyzed individually (frequency analysis), and contrasts were conducted with the PET values. The study evaluated associations between motorcycles and other motorized road actors at intersections about behaviors and crossroads., Results: In the Records, 10,281 motorcycle accesses at three and four-Legged Intersections were interactions with other road users, where 2417 and 1903 resulted in potential traffic conflicts, respectively. Average potential conflicts per hour were 115 and 127 at three and four-legged intersections. At the two intersections, the average PET values in motorcycles were between 2.09 and 2.10 s, while in the other motorized road users, it averaged around 2.67 to 2.71 s. In the road conditions, it was identified that intersections with a traffic flow of<10,000 vehicles/day and poor visibility to the left of the intersection lead to more unsafe conditions for motorcyclists. Motorcycle taxi drivers were the user group most frequently involved in traffic conflicts. Actions on the part of motorcyclists, such as risky behaviors, not using helmets, not using turn signals, and not waiting patiently for access, showed a relationship with the potential for traffic conflicts. Finally, turns to the left, particularly the indirect turn to the left on the opposite road, showed a greater risk of traffic conflicts., Conclusions: The study found that motorcycles exhibit more severe traffic conflicts than motorized vehicles at intersections. Infrastructure conditions significantly impact the risk of intersection conflicts. Individual behaviors such as not stopping at intersections and driving recklessly increased the risk of traffic conflicts. The study recommends improving infrastructure such as visibility and signaling and implementing separators to reduce travel speed and traffic conflicts for motorcycles., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: This study aims to report two cases of symptomatic extrinsic compression of the inferior vena cava and left iliac vein caused by vertebral osteophytes., Methods: We present two case reports of extrinsic venous compression by vertebral osteophytes. Both cases were endovascularly treated, with a successful outcome. A review of the literature of this unusual condition is also presented., Results: The first patient is an 80-year-old woman who presented to the vascular surgery clinic with bilateral lower extremity edema and pain. A computed-tomography angiography (CTA) revealed extrinsic compression of the inferior vena cava from enlarged osteophytes. Venography and intravascular ultrasound were performed, confirming the diagnosis. A self-expanding venous stent was successfully deployed in the inferior vena cava relieving the extrinsic compression. The edema resolved the following day and was discharged without complications. The second patient is a 61-year-old male that presented to the emergency department with a left iliofemoral deep venous thrombosis. CTA showed left iliac vein compression by a lumbar osteophyte. Percutaneous thrombectomy was successfully achieved and an expanding stent was deployed covering the entire lesion. One month after the procedure the patient died from COVID-19-associated respiratory failure., Conclusion: Osteophytes must be considered when dealing with extrinsic venous compression, especially in elderly people.

Introduction: Chest deformation has been proposed as the best predictor of thoracic injury risk in frontal impacts. Finite Element Human Body Models (FE-HBM) can enhance the results obtained in physical crash tests with Anthropometric Test Devices (ATD) since they can be exposed to omnidirectional impacts and their geometry can be modified to reflect specific population groups. This study aims to assess the sensitivity of two thoracic injury risk criteria (PC Score and Cmax) to several personalization techniques of FE-HBMs. Methods: Three 30° nearside oblique sled tests were reproduced using the SAFER HBM v8 and three personalization techniques were applied to this model to evaluate the influence on the risk of thoracic injuries. First, the overall mass of the model was adjusted to represent the weight of the subjects. Second, the model anthropometry and mass were modified to represent the characteristics of the post-mortem human subjects (PMHS). Finally, the spine alignment of the model was adapted to the PMHS posture at t = 0 ms, to conform to the angles between spinal landmarks measured in the PMHS. The following two metrics were used to predict three or more fractured ribs (AIS3+) of the SAFER HBM v8 and the effect of personalization techniques: the maximum posterior displacement of any studied chest point (Cmax), and the sum of the upper and lower deformation of selected rib points (PC score). Results: Despite having led to statistically significant differences in the probability of AIS3+ calculations, the mass-scaled and morphed version provided, in general, lower values for injury risk than the baseline model and the postured version being the latter, which exhibited the better approximation to the PMHS tests in terms of probability of injury. Additionally, this study found that the prediction of AIS3+ chest injuries based on PC Score resulted in higher probability values than the prediction based on Cmax for the loading conditions and personalization techniques analyzed within this study. Discussion: This study could demonstrate that the personalization techniques do not lead to linear trends when they are used in combination. Furthermore, the results included here suggest that these two criteria will result in significantly different predictions if the chest is loaded more asymmetrically., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Piqueras, Iraeus, Pipkorn and López-Valdés.)

Objective: The objective of this study is to analyze the 6 degrees of freedom (DOF) motion of the spine using the finite helical axis (FHA) in three postmortem human surrogates (PMHS) sled tests. Methods: The sled test configurations corresponded to a 30° nearside oblique impact at 35 km/h. Two different restraint system versions (RSv) were used. RSv1 was used for PMHS A and B while RSv2 was used for PMHS C. The 6 DOF motion of the head and three selected vertebrae have been analyzed using the FHA which describes the 3 D motion of a rigid body between two instants of time as a rotation about and a translation along a unit vector. A minimal amount of rotation is necessary to the FHA calculation, thus the FHA components have been calculated based on a pre-defined interval of 8° of rotation. Results: The analysis of the FHA components demonstrated right lateral bending until around 100 ms, when the rebound phase was reached and the head and the lower spine undergoes left lateral bending. The three PMHS exhibited, in general, flexion movement of the whole body and torsion to the right side of the occupant. This general motion can be associated to the effect of the seatbelt acting as a fulcrum of the rotational movement of the bony landmarks. The interaction of the PMHS with the retention system can be noted by analyzing the time in which the head and the upper spine initiated the rotation and the sudden changes of rotational direction of the three PMHS's head. Conclusions : The rotational analyses have shown to be more sensitive to experimental events than the trajectory analyses for the studied physical tests. Additionally, the results presented in the present study contributes to the analysis of the body kinematics during an oblique impact and adds new experimental data for Human Body Models (HBM) and Anthropometric Test Devices (ATD) benchmarking.

Background: Innominate artery embolism may result in upper extremity ischemia or stroke. A free-floating thrombus originating from the IA is an unusual and dangerous disorder with embolic potential. Only isolated cases have been described showing different treatment modalities., Purpose: To present 3 cases of free-floating thrombus in the IA treated at our institution with 3 different approaches., Cases: The first case is a patient with a free-floating thrombus in the IA treated with cervical debranching and ligation of the proximal right carotid artery; another case of a patient treated with a hybrid approach with deployment of an iliac limb in the IA plus right carotid to subclavian bypass; and a third case of a patient operated by open arch thrombectomy., Conclusions: Free-floating thrombus in the IA is a threatening condition feasible to be managed through different customized surgical approaches in specialized centers.

Background: Adenosine is a natural nucleoside present in a variety of organs and tissues, where it acts as a modulator of diverse physiological and pathophysiological processes. These actions are mediated by at least four G protein-coupled receptors, which are widely and differentially expressed in tissues. Interestingly, high concentrations of adenosine have been reported in a variety of tumors. In this context, the final output of adenosine in tumorigenesis will likely depend on the constellation of adenosine receptors expressed by tumor and stromal cells. Notably, activation of the A3 receptor can reduce the proliferative capacity of various cancer cells., Objective: This study aimed to describe the anti-proliferative effects of two previously synthesized adenosine derivatives with A3 agonist action (compounds 2b and 2f) through in vitro assays., Methods: We used gastric and breast cancer cell lines expressing the A3 receptor as in vitro models and theoretical experiments for molecular dynamics and determination of ADME properties., Results: The antiproliferative effects of adenosine derivatives (after determining IC50 values) were comparable or even higher than those described for IB-MECA, a commercially available A3 agonist. Among possible mechanisms involved, apoptosis was found to be induced in MCF-7 cells but not in AGS or MDA-MB-231 cells. Surprisingly, we were unable to observe cellular senescence induction upon treatment with compounds 2b and 2f in any of the cell lines studied, although we cannot rule out other forms of cell cycles exit at this point., Conclusion: Both adenosine derivatives showed antiproliferative effects on gastric and breast cancer cell lines, and were able to induce apoptosis, at least in the MCF-7 cell line. Further studies will be necessary to unveil receptor specificity and mechanisms accounting for the antiproliferative properties of these novel semi-synthetic compounds., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: The present study has three objectives: First, to analyze the chest deflection measured in nearside oblique tests performed with three post mortem human subjects (PMHS). Second, to assess the capability of a HBM to predict the chest deflection sustained by the PMHS. Third to evaluate the influence on chest deflection prediction of subject-specific HBM., Methods: Three dimensional chest deformation of five anterior chest landmarks was extracted from three PMHS (A-C) in three sled tests. The sled test configurations corresponded to a 30 degree nearside oblique impact at 35 km/h. Two different restraint system versions (RSv) were used. RSv1 was used for PMHS A and B while RSv2 was used for PMHS C. The capability of the SAFER HBM (called baseline model) to predict PMHS chest deflection was benchmarked by means of the PMHS test results. In a second step, the anthropometry, mass and pre-impact posture of the baseline HBM were modified to the PMHS-specific characteristics to develop a model to assess the influence of personalization techniques in the capability of the human body model to predict PMHS chest deflection., Results: In the sled tests, the measured sternum compression relative to the eighth thoracic vertebra in the PMHS tests was 49, 54 and 55 millimeters respectively. The HBM baseline model predicted 48%, 43% and 34% of the deflections measured in the PMHS tests, while the personalized version predicted 38%, 34% and 28%. When chest deflection was analyzed in x-, y- and z-direction for the five chest landmarks it was found that neither the baseline HBM nor the personalized model predicted x, y and z axis deflections., Conclusions: The PMHS in situ chest deflection was found to be sensitive to the variation in restraint system and the three PMHS exhibited greater values of lower right chest deflection compared to what was found in available literature. The baseline HBM underpredicted peak chest deflection obtained in the PMHS test. The personalized model was not capable of predicting the chest deflection sustained by the PMHS. Hence, further biofidelity investigations have to be carried out on the human body thorax model for oblique loading.

Water is indispensable for the life of any organism on Earth. Consequently, osmotic stress due to salinity and drought is the greatest threat to crop productivity. Ongoing climate change includes rising temperatures and less precipitation over large areas of the planet. This is leading to increased vulnerability to the drought conditions that habitually threaten food security in many countries. Such a scenario poses a daunting challenge for scientists: the search for innovative solutions to save water and cultivate under water deficit. A search for formulations including biostimulants capable of improving tolerance to this stress is a promising specific approach. This review updates the most recent state of the art in the field.

Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.

Objective: This study aimed to identify the association between behavioral factors and crashes of motorcycle taxi riders using the Motorcycle Rider Behavior Questionnaire (MRBQ)., Methods: This study was a cross-sectional survey of motorcycle taxi riders in Cartagena. The MRBQ was adapted to the socio-cultural context and contained 45 items. The survey was conducted between February 2019 and May 2019. The items of the MRBQ were processed using factor analysis. Four logistic regression models were used to analyze the association between behavioral factors and aspects of demographics, operating conditions, and experiencing near-crashes, crashes, traffic tickets, and at-fault crashes., Results: Four hundred and thirty-eight motorcyclists participated. The exploratory factor analysis extracted five elements: stunts, speed violations, traffic errors, control errors, and safety, explaining 42% of the variance. The increase in riding per week showed significant differences with stunts, speed violations, and traffic errors. Riding experiences, traffic errors, control errors, and safety were significantly associated with crashes and near-crashes. Stunts were the strongest factors related to traffic tickets. Speed violations were the strongest factors associated with at-fault accidents., Conclusions: The study showed recent results considering behavioral, exposure, and operational conditions in a group of motorcycle taxi riders. The study recommends some practical implications for the well-being of motorcyclists and road safety.

Background: Chronic limb ischemia can lead to high rates of limb loss and mortality. Open surgery is the gold standard for treatment of distal disease. Endovascular surgery should have less complications with similar outcomes., Aim: To report a cohort of patients with distal arterial disease treated with endovascular surgery at our institution., Material and Methods: Review of angioplasty records of patients undergoing distal lower extremity endovascular procedures between 2016 and 2019. Demographics, comorbidities, form of presentation, type of intervention, perioperative complications, and length of stay were analyzed. The primary outcomes were wound healing, reinterventions and freedom from major amputation. Secondary outcomes were overall survival and amputation-free survival., Results: Forty-eight limbs of 41 patients with a mean age 75 years (78% males) were treated. Ninety-three percent had hypertension, 88% diabetes, 30% chronic kidney disease. 73% presented with major wounds. Plain balloon and drug coated balloon angioplasties were carried out in 65 and 31% of procedures respectively, with no difference in results. In 46% of the cases, only chronic total occlusions were treated. Wound healing was achieved in 85% of procedures and 90% of patients were free from amputation at one year of follow up. Complications were observed in 18% of procedures, perioperative mortality was 2% and one-year survival was 76%., Conclusions: Endovascular therapy achieves high rates of wound healing and freedom from amputation with low perioperative mortality and moderate complication rates.

Background: The prevalence of a bovine aortic arch configuration is higher in patients treated for thoracic aortic aneurysms and type B dissection; its prevalence in aortic isthmic trauma has not been described., Methods: A case control study was performed comparing consecutive patients treated at our institution for acute isthmic aortic transection after blunt trauma between 2002 and 2019 and a control group of consecutive sex-matched individuals undergoing imaging for nonaortic disease. Imaging and clinical findings were reviewed. Subjects were divided into bovine and nonbovine groups and prevalence was compared. The length of the aortic segment between the left subclavian artery (LSA) and the next proximal great vessel was measured in the control population and a comparison was performed between bovine and nonbovine aortic arch subjects., Results: Thirty-three consecutive (30 male) patients were reviewed, 66 individuals (60 male) were included in the control group. A higher incidence of bovine arch in trauma patients was found: 57.6% vs. 34.8% (P = 0.007). The median (range, mm) and mean (SD) distance between the bovine trunk and the LSA were 13 mm (2-27) and 12.4 mm (5.9), respectively, compared with 5 mm (1-27) and 7.8 mm (6.1) between the left common carotid and LSA in nonbovine aortic arches (P < 0.005)., Conclusion: A higher incidence of bovine arch in patients reaching out for surgical treatment for traumatic isthmic aortic transection was found in our population. Clinical interpretation of this finding can lead to several alternatives. Confirmation with larger series and data on prevalence of this anatomic variation in nonsurvivors is needed to provide a better understanding of this finding., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The successful integration of sample pretreatment stages, sensors, actuators and electronics in microfluidic devices enables the attainment of complete micro total analysis systems, also known as lab-on-a-chip devices. In this work, we present a novel monolithic autonomous microanalyzer that integrates microfluidics, electronics, a highly sensitive photometric detection system and a sample pretreatment stage consisting on an embedded microcolumn, all in the same device, for on-line determination of relevant environmental parameters. The microcolumn can be filled/emptied with any resin or powder substrate whenever required, paving the way for its application to several analytical processes: separation, pre-concentration or ionic-exchange. To promote its autonomous operation, avoiding issues caused by bubbles in photometric detection systems, an efficient monolithic bubble removal structure was also integrated. To demonstrate its feasibility, the microanalyzer was successfully used to determine nitrate and nitrite in continuous flow conditions, providing real time and continuous information.

Since 1929, several researchers have conducted studies in relation to the nucleoside of adenosine (1) mainly distribution identifying, characterizing their biological importance and synthetic chemistry to which this type of molecule has been subjected to obtain multiple of its derivatives. The receptors that interact with adenosine and its derivatives, called purinergic receptors, are classified as A1, A2A, A2B and A3. In the presence of agonists and antagonists, these receptors are involved in various physiological processes and diseases. This review describes and compares some of the synthetic methods that have been developed over the last 30 years for obtaining some adenosine derivatives, classified according to substitution processes, complexation, mating and conjugation. Finally, we mention that although the concentrations of these nucleosides are low in normal tissues, they can increase rapidly in pathophysiological conditions such as hypoxia, ischemia, inflammation, trauma and cancer. In particular, the evaluation of adenosine derivatives as adjunctive therapy promises to have a significant impact on the treatment of certain cancers, although the transfer of these results to clinical practice requires a deeper understanding of how adenosine regulates the process of tumorigenesis., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Atypical hemolytic uremic syndrome (aHUS) is a rare disease characterized by hemolysis, thrombocytopenia, and renal failure. It is related to genetic mutations of the alternative complement pathway and is difficult to differentiate from other prothrombotic microangiopathies. Eosinophilic granulomatosis with polyangiitis (EGPA) (Churg-Strauss syndrome, CSS) is a systemic ANCA-associated vasculitis and a hypereosinophilic disorder where eosinophils seem to induce cell apoptosis and necrosis and therefore, vasculitis. Here, we report the case of two CSS patients with a genetic complement disorder consistent with aHUS diagnosis. Both patients showed histologic features that supported the diagnosis of CSS, and a genetic complement study confirmed the suspected aHUS diagnosis. In the case where eculizumab was administered, the global response was excellent. There is very limited understanding of the genetics and epidemiology of both, atypical HUS and EGPA, but considering our two patients we suggest that an etiopathogenic link exists among patients diagnosed with both entities.

Background: Conventional treatment of deep vein thrombosis (DVT) is anticoagulation, bed rest and limb elevation. Proximal DVT patients with persisting edema, pain and cyanosis of extremities despite of conventional therapy may develop ischemia. Direct treatment of thrombosis becomes necessary., Aim: To report our experience with mechanical trombolysis of proximal lower extremity DVT., Material and Methods: Retrospective review of medical records of proximal DVT patients treated with thrombolysis between March 2012 and August 2015. Thirteen patients, 14 limbs, median age 34 years (22-85), 8 women, were admitted with pain and swelling of recent onset; one patient with venous gangrene. All patients initially received heparin in therapeutic doses without clinical improvement., Results: In all 13 cases, mechanical thrombolysis was performed using AngioJet®, and associated with single dose thrombolytic agent in 9. Additional angioplasty for residual stenosis was performed in 12 (7 stents) and IVCF were implanted in 8. All patients were subsequently anticoagulated. Early outcomes with disappearance of pain and decrease of edema, with no mortality or bleeding complications. The patient with foot gangrene required amputation., Conclusions: Mechanical thrombolysis with a single dose of a thrombolytic agent is safe and effective in patients with proximal DVT with an unfavorable evolution.

Objectives: The objective of this study was to determine the potential chest injury benefits and influence on occupant kinematics of a belt system with independent control of the shoulder and lap portions., Methods: This article investigates the kinematics and dynamics of human surrogates in 35 km/h impacts with 2 different restraints: a pretensioning (PT), force-limiting (FL) seat belt, a reference belt system, and a concept design with a split buckle consisting (SB) of 2 separate shoulder and lap belt bands. The study combines mathematical simulations with the THOR dummy and THUMS human body model, and mechanical tests with the THOR dummy and 2 postmortem human surrogate (PMHS) tests of similar age (39 and 42 years) and anthropometry (62 kg, 181 cm vs. 60 kg, 171.5 cm). The test setup consisted of a rigid metallic frame representing a standard seating position of a right front passenger. The THOR dummy model predictions were compared to the mechanical THOR dummy test results. The THUMS-predicted number of fractured ribs were compared to the number of fractured ribs in the PMHS., Results: THOR sled tests showed that the SB seat belt system decreased chest deflection significantly without increasing the forward displacement of the head. The THOR model and the THOR physical dummy predicted a 13- and 7-mm reduction in peak chest deflection, respectively. Peak diagonal belt force in the mechanical test with the reference belt was 5,582 N and the predicted force was 4,770 N. The THOR model also predicted lower belt forces with the SB system than observed in the tests (5,606 vs. 6,085 N). THUMS predicted somewhat increased head displacement for the SB system compared to the reference system. Peak diagonal force with the reference belt was 4,000 N and for the SB system it was 5,200 N. The PMHS test with the SB belt resulted in improved kinematics and a smaller number of rib fractures (2 vs. 5 fractures) compared to the reference belt., Conclusion: Concepts for a belt system that can reduce the load on the chest of the occupant in a crash and thereby reduce the number of injured occupants, in particular the elderly, was proposed.

Background: The carotid bifurcation can host a variety of tumors requiring complex surgical management. Treatment requires resection and, in some cases, vascular reconstruction that may compromise the cerebral circulation. The most frequent lesion at this location is the carotid body tumor (CBT). CBT are classified according to Shamblin in 3 types depending on the degree of carotid vessels encasement. Our main objective was to report our clinical experience managing carotid bifurcation tumors throughout the last 30 years., Methods: Between 1984 and 2014, we treated 30 patients with 32 carotid bifurcation tumors. There were 21 women and 9 men (2.3:1), with a mean age of 45.5 years (18-75). The most frequent presentation was an asymptomatic neck swelling or palpable mass localized at the carotid triangle (86.7%)., Results: Thirty of 32 tumors were resected. Since 1994, computed tomography scan has been the most frequently used diagnostic imaging tool (80%), followed by magnetic resonance imaging. Angiography was used mainly during the first 10 years of the study period. Mean size of the tumor was 44.6 mm (20-73 mm). Nineteen (63%) were classified as Shamblin II and 6 (20%) as Shamblin's III. All specimens were analyzed by a pathologist; 28 tumors (93%) were confirmed as paragangliomas, 2 (7%) were diagnosed as schwannomas. Two patients underwent preoperative embolization of the CBT; 5 patients (17%) required simultaneous carotid revascularization, all of them Shamblin III. Mean hospitalization time was 4.5 days (1-35 days). Transient extracranial nerve deficit was observed in 7 patients (23.3%). Three patients (Shamblin III) required red blood cells transfusion. One patient (Shamblin III) underwent a planned en bloc excision of the vagus nerve. There was no perioperative mortality or procedure-related stroke. No malignancy or tumor recurrence were observed during follow-up., Conclusions: CBTs can be diagnosed on clinical grounds requiring vascular imaging confirmation. These infrequent lesions are generally benign. Early surgical removal by surgeons with vascular expertise avoids permanent neurologic and or vascular complications., (Copyright © 2016 Elsevier Inc. All rights reserved.)

This paper reviews state-of-the-art microwave ablation (MWA) of tumors. MWA is a novel method for treating inoperable tumors, ie, tumors that cannot be treated surgically. However, patients generally choose removal of the tumor by conventional techniques. A literature review of MWA for breast, liver, lung, and kidney tumors is reported here, with tabulation of our findings according to the type of technique used, with a detailed description of the time, type of microwave generator used, and number of patients treated with MWA. In some cases, the subjects were not human patients, but pig or bovine liver specimens. MWA is a technique that has proved to be promising and likely to be used increasingly in the ablation of cancerous tumors. However, MWA needs to be used more widely to establish itself as a common tool in the treatment of inoperable tumors.

Haemolytic uraemic syndrome (HUS) is a clinical entity defined as the triad of nonimmune haemolytic anaemia, thrombocytopenia, and acute renal failure, in which the underlying lesions are mediated by systemic thrombotic microangiopathy (TMA). Different causes can induce the TMA process that characterizes HUS. In this document we consider atypical HUS (aHUS) a sub-type of HUS in which the TMA phenomena are the consequence of the endotelial damage in the microvasculature of the kidneys and other organs due to a disregulation of the activity of the complement system. In recent years, a variety of aHUs-related mutations have been identified in genes of the the complement system, which can explain approximately 60% of the aHUS cases, and a number of mutations and polymorphisms have been functionally characterized. These findings have stablished that aHUS is a consequence of the insufficient regulation of the activiation of the complement on cell surfaces, leading to endotelial damage mediated by C5 and the complement terminal pathway. Eculizumab is a monoclonal antibody that inhibits the activation of C5 and blocks the generation of the pro-inflammatory molecule C5a and the formation of the cell membrane attack complex. In prospective studies in patients with aHUS, the use of Eculizumab has shown a fast and sustained interruption of the TMA process and it has been associated with significative long-term improvements in renal function, the interruption of plasma therapy and important reductions in the need of dialysis. According to the existing literature and the accumulated clinical experience, the Spanish aHUS Group published a consensus document with recommendations for the treatment of aHUs (Nefrologia 2013;33[1]:27-45). In the current online version of this document, we update the aetiological classification of TMAs, the pathophysiology of aHUS, its differential diagnosis and its therapeutic management., (Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: This study evaluated 1-year safety and effectiveness outcomes of the United States regulatory trial for the Ovation Abdominal Stent Graft System (TriVascular Inc, Santa Rosa, Calif) for endovascular repair of abdominal aortic aneurysms (AAAs)., Methods: This prospective, multicenter, single-arm trial was conducted at 36 sites in the United States, Germany, and Chile to evaluate the safety and effectiveness of the Ovation stent graft. From November 2009 to May 2011, 161 patients (88% males; mean age, 73 ± 8 years) with AAAs (mean diameter, 54 ± 9 mm) were treated with the Ovation stent graft. The main body is a modular two-docking limb device with a 14F outer diameter delivery system, active suprarenal fixation, and polymer-filled proximal rings that accommodate the aortic neck for seal. Main inclusion criteria included proximal aortic neck length ≥ 7 mm, inner neck diameter between 16 and 30 mm, distal iliac landing zones length ≥ 10 mm, and diameter between 8 and 20 mm. Patients were treated under a common protocol, including clinical and imaging follow-up at discharge, 30 days, 6 months, and annually through 5 years. A Clinical Events Committee adjudicated adverse events, an independent imaging core laboratory analyzed imaging, and a Data Safety and Monitoring Board provided study oversight. Complete 1-year follow-up data were available for this report., Results: The Ovation stent graft was implanted successfully in 161 patients (100%), including 69 (42.9%) by percutaneous access. General anesthesia was used in 106 patients (65.8%). Technical success was 100%, and mean procedure time was 110 minutes. Median procedural blood loss was 150 mL, and median hospital stay was 1 day. The 30-day major adverse event rate was 2.5%. At 1 year, AAA-related and all-cause mortality were 0.6% and 2.5%, respectively. Major adverse event and serious adverse event rates through 1 year were 6.2% and 38.5%, respectively. The 1-year treatment success rate was 99.3%. The imaging core laboratory reported no stent graft migration or type I, III, or IV endoleaks. At 1 year, type II endoleaks were identified in 34% of patients, and AAA enlargement was identified in one patient (0.7%). No AAA rupture or conversion to open surgery was reported. AAA-related secondary procedures were performed in 10 patients (6.2%) for 12 findings, including endoleak (six), aortic main body stenosis (three), and iliac limb stenosis or occlusion (three)., Conclusions: The 1-year results of the Ovation Abdominal Stent Graft System demonstrate excellent safety and effectiveness in treatment of patients with AAAs, particularly in patients with challenging anatomic characteristics, including short aortic necks and narrow iliac arteries. Longer-term follow-up is needed., (Copyright © 2014. Published by Mosby, Inc.)

Cystic adventitial disease of the popliteal artery is an uncommon cause of intermittent claudication in young patients. Several treatment options are available, oriented to either drainage of the cyst and/or arterial reconstruction. Endovascular techniques have been used in exceptional cases to treat this condition, mostly balloon angioplasty and only 2 cases of stenting, with mixed to poor results. We report the case of a 36-year-old female patient with claudication who was treated with primary stenting with long-term symptomatic relief and arterial patency., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: To describe the causes of graft loss, patient death and survival figures in kidney transplant patients in Spain based on the recipient's age., Methods: The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively analysed, i.e. a total of 2600 transplanted patients during 2000-2002 in 14 Spanish renal transplant units, most of them receiving their organ from cadaver donors. Patients were grouped according to the recipient's age: Group A: <40 years, Group B: 40-60 years and Group C: >60 years. The most frequent immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids., Results: Patients were distributed as follows: 25.85% in Group A (>40 years), 50.9% in Group B (40-60 years) and 23.19% in Group C (>60). The 5-year survival for the different age groups was 97.4, 90.8 and 77.7%, respectively. Death-censored graft survival was 88, 84.2 and 79.1%, respectively, and non death-censored graft survival was 82.1, 80.3 and 64.7%, respectively. Across all age groups, CVD and infections were the most frequent cause of death. The main causes of graft loss were chronic allograft dysfunction in patients <40 years old and death with functioning graft in the two remaining groups. In the multivariate analysis for graft survival, only elevated creatinine levels and proteinuria >1 g at 6 months post-transplantation were statistically significant in the three age groups. The patient survival multivariate analysis did not achieve a statistically significant common factor in the three age groups., Conclusions: Five-year results show an excellent recipient survival and graft survival, especially in the youngest age group. Death with functioning graft is the leading cause of graft loss in patients >40 years. Early improvement of renal function and proteinuria together with strict control of cardiovascular risk factors are mandatory.

Symptoms predominate. Diagnosis is based on clinical findings and appropriate imaging. We report two females, aged 35 and 51 years. One of them presented with a pelvic mass and dyspnea, the other patient had severe cardiac failure on admission. Computed axial tomography scan allowed an accurate preoperative diagnosis on both patients. Successful one stage resection of the tumor was performed under cardiopulmonary bypass. Both patients are asymptomatic on follow up at 6 months and 25 years.

Purpose: To describe the initial use of an off-the-shelf fenestrated stent-graft system for endovascular repair of juxtarenal abdominal aortic aneurysms., Technique: The off-the-shelf Ventana fenestrated stent-graft system consists of a 25-mm IntuiTrak self-expanding bifurcated stent-graft implanted at the aortic bifurcation. A Ventana self-expanding fenestrated proximal extension stent-graft is overlapped with the bifurcated body distally and sealed proximally in the visceral segment with a 4-cm-long scallop below and around the SMA and celiac artery, obviating the need for an infrarenal neck. Movable, non-reinforced, 3-mm fenestrations for the renal arteries can be expanded to 10 mm. The 22-F delivery system includes 6.5-F guide sheaths pre-inserted through the stent-graft fenestrations so that the renal arteries are cannulated before the fenestrated stent-graft is deployed. The Xpand renal stent-grafts, with a proximal segment intended for flaring in the aorta, are delivered on 5-F or 6-F balloon catheters through the 6.5-F guide sheaths. The technique is illustrated in 2 patients (76 and 77 years of age) with significant comorbidities and juxtarenal aortic aneurysms measuring 5.9 and 7.4 mm, respectively, who were enrolled in an ongoing prospective trial ( www.ClinicalTrials.gov identifier NCT01348828 ) of this new device. Patient 1 had a 28-mm fenestrated stent-graft system with the aligned fenestration configuration deployed, while the stent-graft in Patient 2 was 32 mm in diameter and had offset fenestrations to accommodate the renal artery geometry. Mean fluoroscopy times were 27 and 35 minutes, and the contrast volumes were 72 and 67 mL. Total procedure times were 84 and 71 minutes. The aneurysms were effectively excluded in uneventful procedures, with no migration, endoleak, or renal dysfunction at 6-month follow-up., Conclusion: There exists an unmet clinical need for a broadly applicable endovascular option for repair of more complex juxtarenal or pararenal aortic aneurysms. These cases suggest that endovascular repair of such aneurysms using the Ventana fully integrated off-the-shelf stent-graft system is safe and feasible.

Nowadays, the attainment of microsystems that integrate most of the stages involved in an analytical process has raised an enormous interest in several research fields. This approach provides experimental set-ups of increased robustness and reliability, which simplify their application to in-line and continuous biomedical and environmental monitoring. In this work, a novel, compact and autonomous microanalyzer aimed at multiwavelength colorimetric determinations is presented. It integrates the microfluidics (a three-dimensional mixer and a 25 mm length "Z-shape" optical flow-cell), a highly versatile multiwavelength optical detection system and the associated electronics for signal processing and drive, all in the same device. The flexibility provided by its design allows the microanalyzer to be operated either in single fixed mode to provide a dedicated photometer or in multiple wavelength mode to obtain discrete pseudospectra. To increase its reliability, automate its operation and allow it to work under unattended conditions, a multicommutation sub-system was developed and integrated with the experimental set-up. The device was initially evaluated in the absence of chemical reactions using four acidochromic dyes and later applied to determine some key environmental parameters such as phenol index, chromium(VI) and nitrite ions. Results were comparable with those obtained with commercial instrumentation and allowed to demonstrate the versatility of the proposed microanalyzer as an autonomous and portable device able to be applied to other analytical methodologies based on colorimetric determinations.

Anatomy has been the major challenge to overcome to increase safe and durable applicability of endografting for the treatment of abdominal aortic aneurysm. Bilateral iliac aneurysm preventing an appropriate distal landing zone for the endograft is a common condition and can be managed by (a) increasing the diameter of the endograft, with limitations in available sizes, (b) bilateral hypogastric embolization, accepting an increased morbidity, (c) the use of a branched device, increasing the cost and currently with limited availability, (d) combined surgical hypogastric revascularization by the retroperitoneal approach, or (e) retrograde revascularization from the ipsilateral external iliac artery using an endograft. We describe the use of widely available devices to obtain stable antegrade revascularization of one hypogastric artery during aortic endografting. We report the case of a 68-year-old man, at high risk for an open procedure, who presented with bilateral iliac aneurysm and minor aortic ectasia; no iliac landing zone was available. A regular bifurcated graft was deployed and extended into one of the external iliac arteries, preceded by ipsilateral hypogastric embolization. Through an upper extremity approach, an endograft was deployed from the remaining bifurcated graft branch into the other hypogastric artery, followed by ipsilateral external iliac occlusion. Finally a femorofemoral crossover bypass was performed. The patient recovered event free, and patency of the endograft and absence of endoleak were demonstrated on computed tomography. Minor unilateral buttock claudication resolved in 6 weeks and sexual function was preserved. This technique is a reasonable alternative to consider in the endovascular treatment of patients with bilateral iliac aneurysm, allowing preservation of pelvic perfusion, limiting cost, and using available devices., (Copyright 2009 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

The development of micro total analysis systems (muTAS) has become a growing research field. Devices that include not only the fluidics and the detection system but also the associated electronics are reported scarcely in the literature because of the complexity and the cost involved for their monolithic integration. Frequently, dedicated devices aimed at solving specific analytical problems are needed. In these cases, low-volume production processes are a better alternative to mass production technologies such as silicon and glass. In this work, the design, fabrication, and evaluation of a continuous-flow amperometric microanalyzer based on the green tape technology is presented. The device includes the microfluidics, a complete amperometric detection system, and the associated electronics. The operational lifetime of the working electrode constitutes a major weak point in electrochemical detection systems, especially when it is integrated in monolithic analytical devices. To increase the overall system reliability and its versatility, it was integrated following an exchangeable configuration. Using this approach, working electrodes can be readily exchanged, according to the analyte to be determined or when their surfaces become passivated or poisoned. Furthermore, the electronics of the system allow applying different voltamperometric techniques and provide four operational working ranges (125, 12.5, 1.25, and 0.375 microA) to do precise determinations at different levels of current intensity.

This study assays therapy with basiliximab and different patterns of cyclosporin A (CsA) initiation in renal transplant (RT) recipients from expanded criteria donors (ECD) and at high risk of delayed graft function (DGF). A multicentre six-month open-label randomized trial with three parallel groups treated with basiliximab plus steroids, mycophenolate mofetil and different patterns of CsA initiation: early within 24 h post-RT at 3 mg/kg/d (Group 1; n = 38), and at 5 mg/kg/d (Group 2; n = 40), or delayed after 7-10 d at 5 mg/kg/d (Group 3; n = 36). There were no differences among groups in six months GFR (43.1 +/- 12, 48.0 +/- 14 and 47.2 +/- 17 mL/min, respectively), DGF (Group 1: 31%, Group 2: 37%, Group 3: 42%), nor biopsy-proven acute rejection, although clinically treated and biopsy-proven acute rejection was significantly higher in Group 3 (25%) vs. Group 1 (5.3%, p < 0.05). At six months no differences were observed in death-censored graft survival or patient survival. Induction therapy with basiliximab and three CsA-ME initiation patterns in RT recipients from ECD and at high risk of DGF presented good renal function and graft survival at six months. Late onset group did not achieve improvement in DGF rate and showed a higher incidence of clinically treated and biopsy-proven acute rejection.

To evaluate cardiovascular disease (CVD) after renal transplantation we established a CVD database (no-intervention) including all patients transplanted among 2000-2002 in 14 hospitals from Spain (Renal Forum Group) (n=2600). They were prospective followed annually thereafter and we present herein the most important results concerning survival figures and CVD at four years. Mean recipient age was 49.7+/-13.7 years: 16% retransplanted and 12.5% hyperimmunized. Tacrolimus, mycophenolate mofetil, and steroids was used in 63%. Acute rejection (AR) rate at 1 year was 14.8%. Graft and patient survival at 48 months were 85.6% (death censored) and 91.7% respectively. The first cause of graft loss was vascular in the first year, death with function during the 2-3 years, and chronic allograft nephropathy at the 4th year. Donor age, time on dialysis, acute tubular necrosis (ATN), AR, SCr at 6 months, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in the first year, and systolic blood pressure at 24 months were independent risk factors for graft loss at 4th year. The first cause of death was CVD (predominantly ischemic heart disease (IHD) in the first year). Recipient age, ATN, and SCr at 6 months were independent predictors of mortality. Despite worsening of donor age, comorbidity, and advanced age of recipients, survival figures at four years are considered good in our Spanish non-selected population. Cardiovascular mortality is the most important cause of death and graft loss particularly, IHD in the first year. Therefore, to decrease post-transplant mortality a careful cardiovascular evaluation and treatment in the waiting list and a close follow-up of patients after transplantation is mandatory.

Background: Inferior vena cava (IVC) filters are used to prevent massive pulmonary embolism in cases where anticoagulation is contraindicated or has failed. It is usually implanted below the renal veins. In a few cases it is necessary to deploy the filter above them, with theoretical risk of secondary renal failure., Aim: To report the experience with filters located above the renal veins., Patients and Methods: Medical records of all patients with percutaneous suprarenal filters are reviewed., Results: Between May 1993 and May 2007, 361 percutaneous IVC filter procedures were performed. In thirty patients aged 19 to 77 years (average 48 years, 50% males), they were placed in suprarenal position (8,3%). Suprarenal IVC filters were implanted in patients with extensive caval thrombosis, renal vein thrombosis extending to cava, displacement of previous IVC filters and double IVC system. Jugular vein approach was the access of choice. Technical success was 100%, no death or pulmonary embolism occurred. Patients were followed from 1 to 165 months (average 57 months). Eight deaths were recorded, five in patients with cancer No patient had renal failure on follow up (average creatinine 0.90+0,26 mg/dL). Three patients developed a new deep vein thrombosis (10%), without pulmonary embolism., Conclusions: In this retrospective analysis of patients, suprarenal placement of IVC filters was not associated to secondary renal failure, and showed good short and long term results.

Background: Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery., Aim: To report the results of endovascular treatment of type B aortic dissection., Material and Methods: Report of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39% smoked. The diagnosis was confirmed by CAT scan. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography., Results: All procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up period ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak., Conclusion: Endovascular treatment of type B aortic dissection has good immediate and long term results.

Aims: Studies in rats with bilateral clamping of renal arteries showed transient Bcl-2, Bcl-xL and Bax expression in renal tubular epithelium following ischemia-reperfusion. However, current data on the preferential localization of specific mRNAs or proteins are limited because gene expression was not analysed at segmental level. This study analyses the mRNA expression of Bcl-2, Bcl-xL and Bax in four segments of proximal and distal tubules localized in the renal cortex and outer medulla in rat kidneys with bilateral renal clamping for 30 min and seven reperfusion times versus control animals without clamp., Methods: Proximal convoluted tubule (PCT), distal convoluted tubule (DCT), proximal straight tubule (PST) and medullary thick ascending limb (MTAL) were obtained by manual microdissection. RT-PCR was used to analyse mRNA expression at segmental level., Results: Proximal convoluted tubule and MTAL showed early, persistent and balanced up-regulation of Bcl-2, Bcl-xL and Bax, while PST and DCT revealed only Bcl-2 and Bcl-xL, when only Bax was detected in PST. DCT expressed Bcl-xL initially, and persistent Bcl-2 later., Conclusion: These patterns suggest a heterogeneous apoptosis regulatory response in rat renal tubules after ischemia-reperfusion, independently of cortical or medullary location. This heterogeneity of the expression patterns of Bcl-2 genes could explain the different susceptibility to undergo apoptosis, the different threshold to ischemic damage and the different adaptive capacity to injury among these tubular segments.

The advantages of microanalyzers, usually fabricated in silicon, glass, or polymers, are well-known. The design and construction of fluidic platforms are well-developed areas due to the perfectly established microfabrication technologies used. However, there is still the need to achieve devices that include not only the fluid management system but also the measurement electronics, so that real portable miniaturized analyzers can be obtained. Low-temperature co-fired ceramics technology permits the incorporation of actuators, such as micropumps and microvalves, controlled either magnetically, piezoelectrically, or thermally. Furthermore, electronic circuits can be also easily built exploiting the properties of these ceramics and the fact that they can be fabricated using a multilayer approach. In this work, taking advantage of the possibility of combining fluidics and electronics in a single substrate and using the same fabrication methodology, a chemical microanalyzer that integrates microfluidics, the detection system, and also the data acquisition and digital signal processing electronics is presented. To demonstrate the versatility of the technology, two alternative setups have been developed. In the first one, a modular configuration is proposed. In this case, the same electronic module can be used to determine different chemical parameters by simply exchanging the chemical module. In the second one, the monolithic integration of all the elements was accomplished, allowing the construction of compact and dedicated devices. Chloride ion microanalyzers have been constructed to demonstrate the operability of both device configurations. In all cases, the results obtained showed adequate analytical features.

Two rosemary accessions were subjected to chilling temperatures in control environmental cabins analyzing their variations in rosmarinic and carnosic acids together with their adaptability to these stress conditions. Cold stressed plants of both accessions showed increases in caffeic acid and carnosic acid concentration levels, while other secondary metabolites such as rosmarinic acid, naringin, cirsimaritin, hispidulin, and carnosol showed different responses in both accessions. In addition, cold stressed plants exhibited significant reductions in chlorophylls, beta-carotene, and violaxanthin levels as well as the maximum quantum yield of PSII in both accessions. Hydrogen peroxide and lipid peroxidation levels showed similar responses in both accessions, which were positively and negatively correlated with rosmarinic and carnosic acids. From these results it is therefore suggested that carnosic acid biosynthesis in rosemary plants is induced by chilling periods. On the other hand, we demonstrate that not all rosemary accessions are equally well adapted to chilling temperatures. In fact, for (one) accession cold treated plants severe losses in chlorophyll, beta-carotene, and even xanthophylls (including zeaxanthin and antheraxanthin) were observed, despite no visual symptoms of leaf injury. More research is needed to understand rosmarinic acid variations in rosemary plants under stress conditions.

Background: Anticoagulation is the treatment of choice for deep vein thrombosis (DVT) and pulmonary embolism (PE). Occasionally this treatment is contraindicated or fails to prevent PE. In these patients, inferior vena caval (IVC) interruption is indicated and insertion of a filter is the most commonly performed procedure., Aim: To report the experience with IVC filters., Material and Methods: Retrospective review of all medical records and operative protocols of patients subjected to IVC filter implantations. Follow up was performed by telephone contact with the patient, relatives or primary physicians, ambulatory consultation or by death certificates., Results: During the period 1993-2005 we implanted IVC filters on 287 patients, 55.4% male, average age: 62.1 yrs (17-99). Indications for the procedure were DVT or PE and contraindication of anticoagulation in 141 patients (49.1%), DVT or PE and complication of anticoagulation in 65 patients (22.6%), prophylaxis in 39 patients (13.6%), massive PE or poor respiratory function in 31 patients (10.8%), paradoxal emboli in 4 patients (1.4%) and other causes in seven patients. All percutaneous devices were successfully inserted. There was no morbidity or mortality related to the procedure. The most frequent access site was the internal jugular vein (66.6%). In 24 patients (8.4%) the filter was intentionally deployed above the renal veins. Six patients (2.1%) were lost to follow up after discharge. A mean follow up of 41.5 months was achieved. Ninety one patients died, with a 5 years survival of 64.7%. Symptomatic recurrent PE occurred in 6 patients (2.1%) and was the cause of death on 3 of them (1%), DVT has been detected in 22 patients (7.7%) during the follow up period., Conclusions: IVC filter implantation is a safe and effective short and long term measure to prevent PE and its consequences.

Background: Endovascular repair of abdominal aortic aneurysms (AAA) avoids laparotomy, shortens hospital stay and reduces morbidity and mortality related to surgical repair, allowing full patient recovery in less time., Aim: To report short and long term results of endovascular repair of AAA in 80 consecutive patients treated at our institution., Patients and Methods: Between September 1997 and February 2005, three women and 77 men with a mean age 73.6+/-7.7 years with AAA 5.8+/-1.0 cm in diameter, were treated. The surgical risk of 38% of patients was grade III according to the American Society of Anesthesiologists classification. Each procedure was performed in the operating room, under local or regional anesthesia, with the aid of digital substraction angiography. The endograft was deployed through the femoral artery (83.7% bifurcated, 16.3% tubular graft). A femoro-femoral bypass was required in 11.3% of cases. Follow-up included a spiral CT scan at 1, 6 and 12 months postoperatively, and then annually., Results: Endovascular repair was successfully completed in 79/80 patients (98.7% technical success). The procedures lasted 147+/-71 min. Length of stay in the observation unit was 20.6+/-13.5 h. Blood transfusion was required in 10%. Sixty two percent of the patients were discharged before 72 h. One patient died 8 days after surgery due to a myocardial infarction (1.3%). During follow-up (3-90 months), 1 patient developed late AAA enlargement due to a type I endoleak, requiring a new endograft. No AAA rupture was observed. Survival at 4 years was 84.2% (SE =9.2). Endovascular re-intervention free survival was 82.7% (SE =9.5)., Conclusion: Endovascular surgery allows effective exclusion of AAA avoiding progressive enlargement and/or rupture and is a good alternative to open repair. Close and frequent postoperative follow up is mandatory.

Background: Transplantation is the best treatment for patients with chronic renal failure, including the elderly. However, the patient's age was traditionally considered as a relative contraindication for it., Objective: To compare the results of renal transplantation in patients over and under 60 years of age., Methods: Analysis of 621 transplant recipients in Galicia (Spain) between 1996 and 2000, divided into two groups, according to age over 60 years (484) or under 60 years (137). The actuarial method, Kaplan-Meier curves, log-rank test and Cox proportional hazard model were used to study survival., Results: Graft survival for those aged under 60 years was 82% and 70% at 1 and 5 years, while it was 73% and 56% for those over 60 years. However, censuring the deceased patients with a functioning graft, it was 84% and 76% for those aged under 60 years and 83% and 77% for those over 60 years. A total of 47% of the graft losses in the group over 60 years were due to the patient's death. Overall graft survival for all the patients was greater (P<0.0001) when the donor was under 60 years of age., Conclusions: Recipient age alone cannot be a criterion to exclude patients over 60 years from transplantation, since their lower survival is influenced by comorbidity and the donor's age.

Peritonitis is a well-known cause of mortality in peritoneal dialysis (PD) patients. We carried out a retrospective study to disclose the clinical spectrum and risk profile of peritonitis-related mortality. We analyzed 693 episodes of infectious peritonitis suffered by 565 patients (follow-up 1149 patient-years). Death was the final outcome in 41 cases (5.9% of episodes), peritonitis being directly implicated in 15.2% of the global mortality and 68.5% of the infectious mortality observed. In 41.5% of patients with peritonitis-related mortality, the immediate cause of death was a cardiovascular event. Highest mortality rates corresponded to fungal (27.5%), enteric (19.3%), and Staphylococcus aureus (15.2%) peritonitis. Multivariate analysis disclosed thatthe baseline risk of peritonitis-related mortality was significantly higher in female [relative risk (RR) 2.13, 95% confidence interval (CI) 1.24-4.09, p = 0.02], older (RR 1.10/year, CI 1.06-1.14, p < 0.0005), and malnourished patients (RR 2.51, CI 1.21-5.23, p = 0.01) with high serum C-reactive protein (s-CRP) levels (RR 4.04, CI 1.45-11.32, p = 0.008) and a low glomerular filtration rate (RR 0.75 per mL/minute, CI 0.64 -0.87, p < 0.0005). Analysis of risk after a single episode of peritonitis and/or subanalysis restricted to peritonitis caused by more aggressive micro-organisms disclosed that overall comorbidity [odds ratio (OR) 1.21, CI 1.05-1.71, p = 0.005], depression (OR 2.35, CI 1.14-4.84, p = 0.02), and time on PD at the time of the event (OR 1.02/month, CI 1.00-1.03, p = 0.02) were other predictors of mortality. In summary, the etiologic agent is a definite marker of peritonitis-related mortality but gender, age, residual renal function, inflammation (s-CRP), malnutrition, and depression are other significant correlates of this outcome. Most of these risk factors are common to cardiovascular and peritonitis-related mortality, which may explain the high incidence of cardiovascular event as the immediate cause of death in patients with peritonitis-related mortality.

Background: Policosanol is a drug derived from sugar cane wax that has cholesterol-lowering and antiplatelet properties. Randomized, controlled studies are the gold standard for demonstrating drug efficacy, safety, and tolerability, but postmarketing surveillance studies are encouraged for corroborating drug effects. A valid proof of the safety of a drug is a well-documented, good tolerability profile in older individuals, since this population is more prone to drug-related adverse events (AEs)., Objective: This study investigated the tolerability of policosanol in the elderly population by monitoring the incidence and nature of AEs occurring in older Cuban patients treated with policosanol in routine clinical practice., Methods: All patients aged > or =60 years treated with policosanol at 7 major medical centers from January 2000 to May 2003 were included. Policosanol (5, 10, or 20 mg/d) was prescribed to patients eligible to receive cholesterol-lowering and/or antiplatelet drugs, with the dosage recommended according to their individual atherosclerotic risk. Patients had follow-up visits approximately every 6 months. Data on AEs and other relevant information, including changes in policosanol treatment, concomitant medications, and discontinuations, were recorded on individual case-report forms., Results: This study included 2252 patients (1306 women, 946 men): 647 (28.7%), 244 (10.8%), and 173 (7.7%) patients had coronary, cerebrovascular, and peripheral artery disease, respectively. A total of 1485 patients had hypercholesterolemia (65.9%), 1322 (58.7%) had hypertension, and 323 (14.3%) had diabetes mellitus. Of the enrolled patients, 1123 (49.9%), 644 (28.6%), and 485 (21.5%) received policosanol 5, 10, and 20 mg/d, respectively. Treatment duration varied: 2169 (96.3%), 1861 (82.6%), 1116 (49.6%), and 412 (18.3%) patients were treated for 6, 12, 24, and 36 months, respectively. Thirty-one patients (1.4%) experienced serious AEs, 18 of them fatal. Death was most often due to vascular events: myocardial infarction (4 patients), sudden cardiac arrest (1), ventricular arrhythmia (2), ischemic stroke (1), lung thromboembolism (1), cancer (5), pneumonia (1), peritonitis (1), lung edema (1), and dehydration (1). Another 13 patients (0.6%) were hospitalized, and 61 (2.7%) reported moderate or mild AEs. Overall, 21 patients (0.9%) discontinued prematurely from the study, 18 of them due to a fatal serious AE., Conclusions: Long-term tolerability of policosanol in elderly patients at high vascular risk was very good, as assessed under conditions of routine clinical practice. These results are consistent with those obtained in randomized, double-blind clinical studies of older patients treated with policosanol.

Treatment with transforming growth factor beta (TGF-beta) of hepatocytes from two different proliferative conditions, such as fetal development and adult liver regeneration, shows that regenerating cells respond to this cytokine in terms of growth inhibition, but are less sensitive than the fetal ones to the apoptosis induced by this factor. Regenerating TGF-beta treated cells show higher cell viability and lower percentage of apoptotic cells than the fetal treated ones. Furthermore, TGF-beta treated regenerating hepatocytes maintain a well-preserved parenchyma-like organization. Treatment with TGF-beta induces the loss of mitochondrial transmembrane potential in fetal but not in regenerating hepatocytes and activation of caspase-3 is lower in regenerating than in fetal cells. Regenerating hepatocytes show higher intracellular levels of some antiapoptotic proteins, such as Bcl-x(L) and c-IAP-1 and, interestingly, they present higher intracellular glutathione levels, which might provide of mechanisms to avoid potential dangerous effects of the oxidative stress-mediated apoptosis induced by TGF-beta. In fact, treatment with BSO (a glutathione synthesis inhibitor) restores the response of regenerating hepatocytes to TGF-beta in terms of cell death. In conclusion, increased levels of Bcl-x(L) and cIAP-1 and higher intracellular glutathione levels could confer resistance to the apoptosis induced by TGF-beta during liver regeneration.

Background: A renal transplant is the best possible treatment for patients with terminal renal failure. Advances in the development of techniques of screening of pre-formed antibodies have contributed to a notable improvement in the results obtained with allogenic transplants., Methods: The aim of the present work is to study the nature, class, isotype and specificity of antibodies detected in patients awaiting renal transplantation at Complejo Hospitalario Universitario Juan Canalejo, as well as their relation with the level of anti-human leucocyte antigen (HLA) sensitization., Results: In all patient groups, there was a predominance of IgG. The distribution of anti-HLA antibody class showed that the most frequent pattern corresponded to a mixture of class I and class II antibodies for all groups. The study of specificity of anti-HLA antibody showed that of the patients with at least one previous transplant, 72% developed specific anti-HLA antibodies against some of the incompatible antigens of the donor, 12% against HLA antigens not related with the phenotype of the donor and in 16% it was not possible to determine their specificity. Most patients developed antibodies against antigens of locus B, probably because of that the number of incompatibilities contributed by the donors is also greater for locus B., Conclusions: The exhaustive study of sera of patients on a waiting list for transplantation with respect to the nature, isotype, class and specificity of the antibody is important since it is possible that different antibodies can bring about, in the transplant, events that will have different consequences for the survival of the graft.

The Snail zinc-finger transcription factors trigger epithelial-mesenchymal transitions (EMTs), endowing epithelial cells with migratory and invasive properties during both embryonic development and tumor progression. During EMT, Snail provokes the loss of epithelial markers, as well as changes in cell shape and the expression of mesenchymal markers. Here, we show that in addition to inducing dramatic phenotypic alterations, Snail attenuates the cell cycle and confers resistance to cell death induced by the withdrawal of survival factors and by pro-apoptotic signals. Hence, Snail favors changes in cell shape versus cell division, indicating that with respect to oncogenesis, although a deregulation/increase in proliferation is crucial for tumor formation and growth, this may not be so for tumor malignization. Finally, the resistance to cell death conferred by Snail provides a selective advantage to embryonic cells to migrate and colonize distant territories, and to malignant cells to separate from the primary tumor, invade, and form metastasis.