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(1) Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. (2) Methods: This single-center, ambispective cohort study included forty-six candidates for elective heart transplantation from 2017 to 2021 attending a multimodal prehabilitation program consisting of supervised exercise training, physical activity promotion, nutritional optimization, and psychological support. The postoperative course was compared to a control cohort consisting of patients transplanted from 2014 to 2017 and those contemporaneously not involved in prehabilitation. (3) Results: A significant improvement was observed in preoperative functional capacity (endurance time 281 vs. 728 s, p < 0.001) and quality-of-life (Minnesota score 58 vs. 47, p = 0.046) after the program. No exercise-related events were registered. The prehabilitation cohort showed a lower rate and severity of postoperative complications (comprehensive complication index 37 vs. 31, p = 0.033), lower mechanical ventilation time (37 vs. 20 h, p = 0.032), ICU stay (7 vs. 5 days, p = 0.01), total hospitalization stay (23 vs. 18 days, p = 0.008) and less need for transfer to nursing/rehabilitation facilities after hospital discharge (31% vs. 3%, p = 0.009). A cost-consequence analysis showed that prehabilitation did not increase the total surgical process costs. (4) Conclusions: Multimodal prehabilitation before heart transplantation has benefits on short-term postoperative outcomes potentially attributable to enhancement of physical status, without cost-increasing.

BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperative pulmonary complications within the first week, analysed using mixed-effect logistic regression. Pre-specified subgroup analyses of nine patient characteristics and seven procedure and care-delivery characteristics were also performed. RESULTS: Complete datasets were available for 1913 participants ventilated with high PEEP and recruitment manoeuvres, compared with 1924 participants who received low PEEP. The primary outcome occurred in 562/1913 (29.4%) participants randomised to high PEEP, compared with 620/1924 (32.2%) participants randomised to low PEEP (unadjusted odds ratio [OR]=0.87; 95% confidence interval [95% CI], 0.75-1.01; P=0.06). Higher PEEP resulted in 87/1913 (4.5%) participants requiring interventions for desaturation, compared with 216/1924 (11.2%) participants randomised to low PEEP (OR=0.34; 95% CI, 0.26-0.45). Intraoperative hypotension was associated more frequently (784/1913 [41.0%]) with high PEEP, compared with low PEEP (579/1924 [30.1%]; OR=1.87; 95% CI, 1.60-2.17). CONCLUSIONS: High PEEP combined with recruitment manoeuvres during low tidal volume ventilation in patients undergoing major surgery did not reduce postoperative pulmonary complications. CLINICAL TRIAL REGISTRATION: NCT03937375 (Clinicaltrials.gov).

Background: Tree height is an important variable in forestry, as it is commonly used to estimate volume and biomass, and to evaluate site productivity. In this study, we developed four generalized equations to model height-diameter ( h-d) relationships for coniferous and broadleaf species. For this purpose, we used information from 49 permanent sampling plots located in the natural forests of Puebla, Mexico. Non-linear fixed and mixed-effects modeling approaches were used to fit generalized versions of the Gompertz function to Pinus patula and the Pinus group, the Näslund function to Abies religiosa, and the Curtis function to the Quercus group. Results: Stand variables included in the models were the number of trees per hectare ( N), quadratic mean diameter ( dg), and basal area per hectare ( G). The results showed a model efficiency (EF) = 0.91 and root mean square error (RMSE) = 2.04 for P. patula, as well as an EF = 0.91 and RMSE = 1.63 for the Pinus group. The EF and RMSE for Abies religiosa were 0.88 and 2.21, while for the Quercus group these values were 0.72 and 1.9, respectively. From the mixed-effects model calibration, only a sub-sample of three trees from different quantiles of the diameter distribution is required to make accurate predictions. No stand-level variables related to tree height are included in any of the selected models, thus no additional measurements beyond tree diameter are required. Conclusion: Compared to conventional non-linear least squares (ONLS), mixed-effects models are more flexible and accurate and represent a new tool for sustainable forest management of natural forests in the study area.

All over the world ischemic heart disease remains as the leading cause of death, followed by stroke. Ischemic heart disease, also called coronary artery disease has a broad spectrum of clinical manifestations from the acute coronary syndromes which include, unstable angina pectoris and acute myocardial infarction with and without elevation of the ST segment and chronic coronary disease. In patients with diabetes mellitus the cardiovascular complications mainly ischemic heart disease, are the main cause of morbidity and mortality. However, in population-based studies, the risk of heart failure in patients with diabetes mellitus is significantly increased following adjustment for well-established heart failure risk factors such as hypertension or ischemic heart disease. Ischemic heart failure angiographically diagnosed is associated with a shorter survival than non-ischemic heart failure. Coronary artery disease is independently associated with higher mortality.

The prognosis, in the long term, of adolescents and young adults with acute de novo lymphoblastic leukemia, treated with a pediatric type protocol.To analyze the efficacy and tolerability of a chemotherapy regimen of pediatric type on patients 15-35 years old with de novo acute lymphoblastic leukemia, Ph(-).A retrospective study of patients received from 2001 to 2013, without initial infiltration of the central nervous system. They received the regimen called LALÍN. Terminal goals: frequency of initial remission, probability of survival free of leukemia and event-free survival for five years.We included 101 patients; there were 29 relapses and 19 deaths. There was initial remission in 97% of the cases; survival free of leukemia of 0.58 and event-free survival 0.44. No difference in patients aged 16-21 years vs. 22-35 (p0.55). Negative prognostic factors: abnormal karyotypes, except hyperdiploids (p = 0.001);5% of blasts, on 14 day induction (p = 0. 0001); delay in the punctuality of the courses of the chemotherapy regimen (p = 0.0001).A pediatric type regimen is applicable to patients aged from 16 to 35 years with acute lymphoblastic leukemia, without greater toxicity and a best survival free of leukemia. The count of5% of blasts and the delay in the execution of the stages of the chemotherapy regimen are the stronger negative prognostic factors.

The aim of this paper is to put forward a beta convergence model using spatial interaction to evaluate the dynamics of financial ratios. We overcome some of the limitations that come from the traditional partial adjustment model by relating both models. We show that the parameters of the two models may be connected. As an example, we discuss the case of a large sample of medium to high-tech industrial small and medium enterprises (SMEs) located along the Spanish Mediterranean coast. Our findings support the existence of a long-term average adjustment process in the financial ratios of this set of companies which depends on the characteristics of the firms in their neighborhood.

La presente investigación se realizó con el objetivo de evaluar la composición y la diversidad de las especies forestales en bosques templados en la zona este del estado de Puebla (centro de México). La base de datos se obtuvo de 45 sitios permanentes de investigación silvícola (SPIS), ubicados en la región forestal Centro y Pico de Orizaba pertenecientes a la Unidad de Manejo Forestal, Umafor 2105. Se registró información dasométrica de altura total (m), diámetro a la altura del pecho (cm) y cobertura de copa de ejemplares con un diámetro a la altura del pecho mayor o igual a 7.5 cm. Para cada una de las especies se cuantificó su dominancia a través del área basal, su abundancia de acuerdo con el número de árboles y su frecuencia en las parcelas de muestreo. Se generó un valor ponderado para cada especie, denominado índice valor de importancia (IVI). La diversidad y la riqueza de especies se estimaron utilizando el índice de diversidad de Shannon-Wiener (H´) y el índice de Margalef (DMg). Los resultados mostraron 11 especies arbóreas, distribuidas en cinco géneros. La familia con mayor riqueza fue Pinácea, con seis especies; de las cuales P. montezumae fue la que presentó los valores mayores de densidad, área basal y área de copa seguida por A. religiosa. Para la comunidad estudiada se registró un valor de índice de Shannon-Wiener de 1.37 y uno de índice de Margalef de 1.35. Estos valores obtenidos indican tendencia a la heterogeneidad del ecosistema.

To determine the overall survival (OS) of Ph1 positive chronic myeloid leukemia (CML) patients treated with allogeneic hematopoietic stem cell transplant (AHSCT) vs. imatinib.We retrospectively included CML patients treated with related donor myeolablative and non-myeloablative AHSCT, between 1992 and 2009. Another group consisted of a patient cohort treated with imatinib between 2001 and 2009. The main variable was the persistence of hematologic remission.The AHSCT/ imatinib groups included 36/46 patients, average age was 36/46, patients in chronic phase 34/44 and in blastic phase, 2/2. The number of myeloablative/non-myeloablative transplants was 28/8. Imatinib was administered at a dose of 400 to 800 mg/day (median 500 mg). The following events developed in both groups: death 14/3, hematological progression 4/5, 17/41 are alive and in hematological remission (p = 0.00009). The OS probability is 0.42 and 0.76 at 100 months (p = 0.0001). The decrease in absolute risk is 42%. The OS after 17 years remains unmodified in the AHSCT group after the first 6 years.OS at 100 months is superior with imatinib than with AHSCT (p = 0.0001).

To ascertain the efficacy and safety of two chemotherapy regimens, one designed for adults and the other for children, in adolescent patients with acute lymphoblastic leukemia (ALL).Between 2001-2006, we included patients aged 15-25, with de novo, Phi(-) ALL, without initial central nervous system (CNS) infiltration. Twenty patients received a chemotherapy regimen designed for children with high-risk ALL (LALIN) and twenty a regimen for adults (LALA). Both were intensive and included dexamethasone, daunorubicin, cyclophosphamide, vincristine, cytarabine, methotrexate and mercaptopurine as well as CNS prophylaxis. Elective suspension of chemotherapy occurred at two and three years respectively, in patients with continued complete remission.Patients in both groups were comparable in age, sex, presence and size of hepatosplenomegaly, initial leukocytes and platelet counts. Predominant in both groups was L2 morphology and B-cell CD10(+) immunophenotype. Results for the LALIN/ LALA groups were: failures 2/0 (p=0.49); relapses 0/4 (p= 0.05); therapy associated deaths 4/7 (p= 0.48); and event free survival at 70 months follow-up was 70% and 40% (p=0.12).In patients aged 15-25, with de novo ALL, a chemotherapy regimen designed for children had significantly less relapses than a regimen for adults. We saw no increase in toxicity in the LALIN versus the LALA group.