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One of the signicant obstacles to donor heart utilization is that increasingly prolonged cold ischemic times are associated with worsened short- and long-term outcomes. As a result, most transplant centers aim to limit cold ischemic times to less than four hours. The TransMedics Organ Care System (OCS) (Trans Medics, Andover MA) is a portable ex vivo perfusion system designed to store a donor heart in a beating, metabolically active state, until it reaches the recipient, thereby allowing extended time outside the body while minimizing the effects of cold storage. We present a case of a heart transplant recipient supported with the Impella 5.5 as a bridge to transplantation who received a donation after circulatory death (DCD) heart supported by OCS. To our knowledge, this is the rst report of such a case.

Background: COVIDApp is a platform created for management of COVID-19 in the workplace. Methods: COVIDApp was designed and implemented for the follow-up of 253 workers from seven companies in Catalonia. The assessment was based on two actions: first, the early detection and management of close contacts and potential cases of COVID-19, and second, the rapid remote activation of protocols. The main objectives of this strategy were to minimize the risk of transmission of COVID-19 infection in the work area through a new real-time communication channel and to avoid unnecessary sick leave. The parameters reported daily by workers were close contact with COVID cases and signs and/or symptoms of COVID-19. Results: Data were recorded between 1 May and 30 November 2020. A total of 765 alerts were activated by 76 workers: 127 green alarms (16.6%), 301 orange alarms (39.3%), and 337 red alarms (44.1%). Of all the red alarms activated, 274 (81.3%) were activated for symptoms potentially associated with COVID-19, and 63 (18.7%) for reporting close contact with COVID-19 cases. Only eight workers (3.1%) presented symptoms associated with COVID-19 infection. All of these workers underwent RT-PCR tests, which yielded negative results for SARS-CoV2. Three workers were considered to have had a risk contact with COVID-19 cases; only 1 (0.4%) asymptomatic worker had a positive RT-PCR test result, requiring the activation of protocols, isolation, and contact tracing. Conclusions: COVIDApp contributes to the early detection and rapid activation of protocols in the workplace, thus limiting the risk of spreading the virus and reducing the economic impact caused by COVID-19 in the productive sector. The platform shows the progression of infection in real time and can help design new strategies.

To assess the structure of health care delivery and the clinical characteristics of adults with congenital heart disease (ACHD) attending specialized centers in Spain.

Medullary thyroid cancer is a rare malignant neoplasm of the epithelium that derives from the C cells (parafollicular) and occurs spontaneously or as part of multiple endocrine neoplastic syndromes. The diagnosis is made by histopathology and clinical history. Might be familiar due to genetic mutation which can be identified by the genetic testing ret oncogene. The main marker is Calcitonin in blood. Prophylactic surgery in children and youth is indicated in MEN 2 (Multiple Endocrine Neoplasia). In this study we present a case of Ca Medullary Thyroid diagnosed post operatively and where the family including sons, brothers and nephews were studied for the ret oncogene mutation. Results showed that 2 of the children were positive and due to the diagnosis were operated. One showed medullary Thyroid Ca associated hyperparathyroidism and the other was negative. Ret proto oncogene mutation studies were performed in patients with this pathology in Paraguay for the first time. The association of Thyroid Medullary carcinoma and hyperparathyroidism is rare and both were resolved with surgery and ablative therapy with 131 I-MIBG.

Introduction: Aflatoxins (AFs) are fungal secondary metabolites with potent carcinogenic properties´ and pistachios are susceptible oilseeds for AF contamination. Objective: To determine the concentration of the four AFs types (AFB1, AFB2, AFG1 and AFG2) from 48 pistachio samples from Mexico, six from Turkey and 3 from Greece. Methods: The AFs of the 57 analysed samples of pistachio seeds were quantified by liquid chromatography. The calibration curves had R2 values near 1. The LOD values were low and were acceptable to identify and quantify the AFs. The recovery percentages were >80%, which indicated that the extraction method was efficient, and in the selectivity test, no interference between the retention times of the AFs and the pistachio matrix were observed. Results: This study validated an analytical method developed to quantify AFs in pistachios. All samples were contaminated with trace levels of AFs. A total of 36.4% were contaminated with AFB1 (0.10 to 4.15 ng/g), 100% of the samples had both AFB2 (0.01 to 4.00 ng/g) and AFG1 (0.02 to 1.02 ng/g), 56.4% had AFG2 (0.46 to 8.09 ng/g) and 100% were contaminated with total aflatoxin (AFt) (0.04 to 8.39 ng/g). The samples most contaminated with AFB1 (4.15 ng/g) and AFG1 (1.02 ng/g), and with AFB2 (4.00 ng/g) were from Mexico. The highest contamination by AFG2 (8.09 ng/g) and AFt (8.39 ng/g) was in one sample from Istanbul, Turkey. Conclusion: All the samples resulted contaminated with AFs although the levels do not risk the health because they are below the tolerance levels of World Health Organization (5 μg/kg for AFB1 and 10 μg/kg for AFt) and Food and Agriculture Organization of United Nations (FAO) (20 μg/kg for AFB1 and 35 μg/kg for AFt).There was a significant difference between the AF content and the place of origin of the samples.

We conducted a daily analysis of bile cellularity in 16 orthotopic liver transplant patients fitted with a T-tube, and correlated the cytological parameters (number of cells per slide, and percentage of difference cell types) with the duration of cold ischemia time (CIT). Two groups were established: one comprised patients whose CIT was less than 7 hr (CIT averaged 345 min) and the other comprised patients with a CIT of more than 7 hr (CIT averaged 505 min). The control group consisted of 15 patients who had received cholecystectomy for biliary lithiasis and were fitted with a T-tube. All 3 groups showed the highest cell density on the 1st postoperative day (control: 53.3 +/- 15.5 cells/slide; short ischemia: 70 +/0 21.4 cells/slide; long ischemia: 158.8 +/- 53.2 cells/slide), which steadily ischemia group showed a higher cell density than did the control group for the first 2 days, although this was not significant. The long ischemia group showed the highest cell density, although only significantly for the first 2 days when compared with the controls, and basically at the expense of a increase in ductal epithelial cells. Our results show that prolonged cold ischemia causes an increase in bile cell density at the expense of ductal epithelial cells: the longer the preservation time, the greater the increase.

Amorphous thin films of Fe/Sm, prepared by evaporation methods, have been magnetically characterized and the results were interpreted in terms of the random magnets theory. The samples behave as 2D and 3D random magnets depending on the total thickness of the film. From our data the existence of orientational order, which greatly influences the magnetic behavior of the films, is also clear.

Objective: To compare the effectiveness and safety of a combination of rituximab (RTX) with either methotrexate (MTX) or leflunomide (LEF) in the treatment of patients with active rheumatoid arthritis (RA) and inadequate response to anti-tumor necrosis factor agents or traditional disease-modifying antirheumatic drugs (DMARD) in a real-world setting. Methods: Data from 77 consecutive unselected patients with active RA and treated with at least 1 cycle of RTX (1 g x 2 weeks) plus MTX or LEE were retrospectively collected. A comparative study between the 2 combinations of treatment (RTX+MTX and RTX+LEF) was performed at 6 months of follow-up considering 3 outcomes: the improvement of RA disease activity, the evolution of functional disability, and the tolerability and side effect profile. Results: Of the 77 patients, 45 received RTX+MTX and 32 RTX+LEF. At baseline there were no significant differences between the groups in terms of the main clinical and laboratory data, or in the number of previous DMARD and anti-tumor necrosis factor agents used. At 6 months of follow-up, we did not find significant differences between the 2 combinations in the evolution of RA disease activity (DAS28 response, according to the European League Against Rheumatism (EULAR) improvement criteria) and functional disability progression (health assessment questionnaire) over time. Minor adverse events occurred in 9% of RTX+MTX patients and in 9% of RTX+LEF patients. None of the patients had serious adverse events and none discontinued the treatment during the study period. Conclusions: Our preliminary data support the view that LEF is a useful alternative if MTX is contraindicated, since its effectiveness and safety seem similar. (C) 2011 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 41:401-405

Changes in small intestinal motility were studied during restraint stress in fasting animals and after food; the involvement of the vagal system in the pathophysiology of these changes was assessed. Small intestinal motility was recorded in 40 dogs using electromyography with monopolar electrodes and manometry with submucosal microballoons. Twenty animals underwent bilateral truncal vagotomy. Stress increased intestinal motility (percentage of slow waves followed by action potentials in 1 min), both in fasting conditions (P < 0.001) and postprandially (P < 0.001). It also completely abolished the migrating motor complex–interdigestive myoelectric complex periodicity characteristic of the normal fasting pattern. In dogs subjected to vagotomy, restraint stress increased motility during fasting (P < 0.001) but decreased it after feeding (P < 0.01). Restraint stress thus increases small intestinal motility, both during fasting and after food. The vagal system is partially involved in this hypermotility response.

During the last century, the presence of icy particles throughout the universe has been confirmed by numerous ground and space based observations. Ultrathin icy layers are known to cover dust particles within the cold regions of the interstellar medium, and drive a rich chemistry in energetic star-forming regions. The polar caps of terrestrial planets, as well as most of the outer-solar-system satellites, are covered with an icy surface. Smaller solar system bodies, such as comets and Kuiper Belt Objects (KBOs), contain a significant fraction of icy materials. Icy particles are also present in planetary atmospheres and play an important role in determining the climate and the environmental conditions on our host planet, Earth. Water ice seems universal in space and is by far the most abundant condensed-phase species in our universe. Many research groups have focused their efforts on understanding the physical and chemical nature of water ice. However, open questions remain as to whether ices produced in Earth's laboratories are indeed good analogs for ices observed in space environments. Although temperature and pressure conditions can be very well controlled in the laboratory, it is very difficult to simulate the time-scales and gravity conditions of space environments. The bulk structure of ice, and the catalytic properties of the surface, could be rather different when formed in zero gravity in space. The author list comprises the members of the ESA Topical Team: Physico-chemistry of ices in space. In this paper we present recent results including ground-based experiments on ice and dust, models as well as related space experiments performed under microgravity conditions. We also investigate the possibilities of designing a new infrastructure, and /or making improvements to the existing hardware in order to study ices on the International Space Station (ISS). The type of multidisciplinary facility that we describe will support research in crystal growth of ices and other solid refractory materials, aerosol microphysics, light scattering properties of solid particles, the physics of icy particle aggregates, and radiation processing of molecular ices. Studying ices in microgravity conditions will provide us with fundamental data on the nature of extraterrestrial ices and allow us to enhance our knowledge on the physical and chemical processes prevailing in different space environments.

The relationship between anxiety and mathematics has often been investigated in the literature. Different forms of anxiety have been evaluated, with math anxiety (MA) and test anxiety (TA) consistently being associated with various aspects of mathematics. In this meta-analysis, we have evaluated the impact of these forms of anxiety, distinguishing between different types of mathematical tasks. In investigating this relationship, we have also included potential moderators, such as age, gender, working memory, type of task, and type of material. One hundred seventy-seven studies met the inclusion criteria, providing an overall sample of 906,311 participants. Results showed that both MA and TA had a significant impact on mathematics. Sociodemographic factors had modest moderating effects. Working memory (WM) also mediated the relationship between MA and TA with mathematics; however, this indirect effect was weak. Theoretical and educational implications, as well as future directions for research in this field, are discussed.

Case Reports English Abstract Endoscopic percutaneous gastrostomy is a safe technique although with potential complications before which the clinician has to be on alert in order to early detect them even after a long period of normal functioning. Most of them represent minor problems. Gastrocolocutaneous fistula is a rare but severe complication favored by some risk factors such as previous post-surgical adherences, deformities of the spine, or excessive gastric inflation at the time of performing the technique. We present the case of a patient with PEG with this complication that occurred after the first tube replacement. Our goal was in two senses: on the one hand, to analyze the preventive aspects and basic guidelines for a safe PEG placement to minimize the risks; on the other hand, to alert on the possible presence of this entity to prevent a progressive nutritional impairment. This complication ought to be included in the differential diagnosis of the diarrhea syndrome in the patient carrying a PEG. The diagnostic techniques of choice are radiologic tests such as CT scan and contrast media administration through the tube. Surgical therapy should be reserved to patients with acute peritonitis in order to perform a new gastrostomy. Yes La gastrostomía percutánea endoscópica, es una técnica segura, aunque no exenta de complicaciones y ante las cuales el clínico deberá permanecer alerta con objeto de una detección precoz de las mismas incluso tras largos periodos con funcionamiento normal de la sonda. La mayoría de los problemas suelen ser menores. La fístula gastrocolocutánea supone una rara y grave complicación favorecida por algunos factores de riesgo tales como adherencias previas postquirúrgicas, deformidades de la columna ó una insuflación gástrica excesiva en el momento de la realización de la técnica. Presentamos un caso de un paciente portador de PEG con esta complicación manifestada tras el primer recambio de sonda. Nuestro objetivo es doble: por una parte analizar aspectos preventivos y normas básicas de prudencia a la hora de implantar la PEG para minimizar los riesgos; por otro lado alertar sobre la posible presencia de esta entidad evitando un progresivo deterioro nutricional. Esta complicación deberá estar presente en el diagnóstico diferencial de todo síndrome diarreico en paciente portador de PEG. Las técnicas diagnósticas de elección consisten en pruebas radiológicas como TAC e inyección de contraste a través de sonda. En cuanto al tratamiento la cirugía sólo debe reservarse en pacientes que presentan cuadro de peritonitis aguda y como medio de colocación de nueva gastrostomía.