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El presente artículo examina aquellas obras de arquitectura que reinterpretan en clave contemporánea estados de orden arraigados a lo largo de la historia de la arquitectura. Como estrategia básica de un estado de orden, el uso de la retícula ha sido uno de los sistemas de orden que ha caracterizado la evolución de la arquitectura. Lejos de ser una crítica a los sistemas consolidados, se intenta dar un paso más allá de la aparente seguridad que se ha mantenido al aplicar ciertas reglas de orden. En particular, esta reinterpretación supone una manipulación que altera específicamente el orden geométrico-estructural en el proyecto. Se intentará dilucidar que estas prácticas son resultado del uso de fuertes definiciones geométrico-estructurales como puntos de partida del proyecto, y no de procesos lúdicos y azarosos. Este nuevo patrón, que supone una estrategia de suavización y de intencionalidad poética, servirá para comprender el orden contingente en la arquitectura reciente.

En el presente artículo, se analiza la infracción aduanera de contravención, estatuida inicialmente en una ley del año 2010, pero que fue recogida en el Código Aduanero de la República Oriental del Uruguay, vigente desde marzo de 2015, y que tiene como finalidad reprimir la violación de determinadas normas que establecen deberes formales respecto de procedimientos aduaneros. En particular, se analizan las conductas atrapadas por el tipo, los requisitos para su imputación y sus consecuencias.

OBJECTIVES Bronchial anastomotic complications remain a major concern in lung transplantation. We aim to compare 2 different techniques, continuous suture (CS) versus interrupted suture (IS) by analysing airway complications requiring intervention. METHODS Lung transplantations between January 2015 and December 2020 were included. Airway complications requiring intervention were classified following the 2018 International Society for Heart and Lung Transplantation consensus and analysed comparing 3 groups of patients according to surgical technique: group A, both anastomosis performed with CS; group B, both with interrupted; and group C, IS for 1 side and CS for the contralateral side. RESULTS A total of 461 anastomoses were performed in 245 patients. The incidence of airway complications requiring intervention was 5.7% [95% confidence interval (CI): 2.8–8.6] per patient (14/245) and 3.7% (95% CI: 2.0–5.4) per anastomosis (17/461). Complications that required intervention were present in 5 out of 164 (3.1%) anastomosis with interrupted technique, and in 12/240 (5%) with CS. No significant differences were found between techniques (P = 0.184). No statistical differences were found among group A, B or C in terms of incidence of anastomotic complications, demographics, transplant outcomes or overall survival (log-rank P = 0.513). In a multivariable analysis, right laterality was significantly associated to complications requiring intervention (OR 3.7 [95% CI: 1.1–12.3], P = 0.030). Endoscopic treatment was successful in 12 patients (85.7%). Retransplantation was necessary in 2 patients. CONCLUSIONS In summary, although it seems that anastomotic complications requiring intervention occur more frequently with CS, there are no statistical differences compared to IS. Endoscopic treatment offers good outcomes in most of the airway complications after lung transplantation.

OBJECTIVES Controlled donation after circulatory death (cDCD) donors are becoming a common source of organs for transplantation globally. However, the graft survival rate of cDCD abdominal organs is inferior to that of organs from brain-dead donors. The rapid retrieval (RR) technique is used by most donor organ procurement teams. The abdominal normothermic regional perfusion (A-NRP) technique has been implemented to minimize warm ischaemic damage to the abdominal organs. However, there is limited information on the effect of A-NRP on the quality of the donor lungs. This study aimed to compare lung transplantation outcomes using lungs procured from cDCD donors using the A-NRP and abdominal RR techniques. METHODS A single-centre retrospective analysis of consecutive transplant recipients of cDCD lungs from June 2013 to December 2019 was performed. The recipients were divided into 2 cohorts according to the abdominal procurement technique used. The recipient and donor characteristics (age, sex, cause of brain injury, warm ischaemic time, diagnosis, lung allocation score and other factors), incidence of primary graft dysfunction and early survival were monitored. RESULTS Twenty-eight consecutive lung transplantation recipients were identified (median age 59 years; 61% male); 14 recipients received lungs using the A-NRP and 14 using abdominal RR for abdominal organ retrieval. There were no significant differences in the baseline characteristics, primary graft dysfunction (P = 0.70), hospital mortality (P = 1.0) and 1-year survival rate (P = 1.0) between the 2 groups. CONCLUSIONS No difference was observed in lung transplantation outcomes irrespective of the abdominal organ procurement technique used (A-NRP or abdominal RR).

OBJECTIVES We reviewed the incidence of coronavirus disease 2019 cases and the postoperative outcomes of patients who had thoracic surgery during the beginning and at the highest point of transmission in our community. METHODS We retrospectively reviewed patients who had undergone elective thoracic surgery from 12 February 2020 to 30 April 2020 and were symptomatic or tested positive for severe acute respiratory syndrome coronavirus 2 infection within 14 days after surgery, with a focus on their complications and potential deaths. RESULTS Out of 101 surgical procedures, including 57 primary oncological resections, 6 lung transplants and 18 emergency procedures, only 5 cases of coronavirus disease 2019 were identified, 3 in the immediate postoperative period and 2 as outpatients. All 5 patients had cancer; the median age was 64 years. The main virus-related symptom was fever (80%), and the median onset of coronavirus disease 2019 was 3 days. Although 80% of the patients who had positive test results for severe acute respiratory syndrome coronavirus 2 required in-hospital care, none of them were considered severe or critical and none died. CONCLUSIONS These results indicate that, in properly selected cases, with short preoperative in-hospital stays, strict isolation and infection control protocols, managed by a dedicated multidisciplinary team, a surgical procedure could be performed with a relatively low risk for the patient., Since the outbreak of the novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China [1], over 4.9 million cases have been diagnosed around the world [2].

El presente artículo pretende hacer foco en algunas cuestiones del proceso judicial por infracciones aduaneras en Uruguay, en particular, se reflexiona en torno al contenido del Derecho Aduanero y a las infracciones aduaneras. Se analiza el contenido, necesidad y finalidad del Proceso Aduanero por Infracciones Aduaneras editado por el Código Aduanero de la República Oriental del Uruguay. Asimismo, mediante un análisis de las características de su contenido, se proponen recalificaciones a su pretendida ubicación como Proceso Civil, reconociéndolo como Proceso “Aduanero”, y con ello, como una categoría dentro de los Procesos Sancionatorios. Se analiza el objeto del Proceso Aduanero y su vinculación con la pretensión, para determinar que el mismo se forma progresivamente hasta su fijación en la Demanda Acusación Fiscal. This paper focuses on some issues regarding the judicial process for customs offenses in Uruguay, particularly, it reflexes about the content of Customs Law and customs offenses. The content, necessity and purpose of the customs offenses judicial process ruled by the Uruguayan customs code are analyzed. Also, through the assessment of the characteristics of the process, rectifications to its pretended ubication like a civil process are proposed, re-qualifying it as the "customs" process, falling as a category within the sanctionatory process. There is also an analysis of the object of the process, assessing its relationship with the claim, in order to determine if the claim is progressively construed throughout the process until its final determination in the State's representative accusation.

Introduction Controlled donation after circulatory-death donors (cDCD) are becoming a frequent source of lungs grafts worldwide. Conversely, lung transplantations (LTx) from uncontrolled donors (uDCD) are sporadically reported. We aimed to review our institutional experience using both uDCD and cDCD and compare to LTx from brain death donors (DBD). Methods This is a retrospective analysis of all LTx performed between January 2013- December 2019 in our institution. Donor and recipient characteristics were collected and univariate, multivariate and survival analyses were carried out comparing the three cohorts of donors. Results A total of 239 (84.7%) LTx were performed from DBD, 29 (10.3%) from cDCD and 14 (5%) from uDCD. There were no statistically significant differences in primary graft dysfunction grade 3 at 72 hours, 30- and 90-day mortality, need for extracorporeal membrane oxygenation after procedure, ICU and hospital length of stay, airway complications, CLAD incidence or survival at 1 and 3 years after transplant (DBD: 87.1% and 78.1%; cDCD: 89.7% and 89.7%; uDCD: 85.7% and 85.7%, respectively; p=0.42). Short- and mid-term outcomes are comparable between the three types of donors. Conclusions These findings may encourage and reinforce all types of donation after circulatory-death programmes as a valid and growing source of suitable organs for transplantation.

The Airborne Wind Energy (AWE) is a growing field of research that intends to develop solutions for harvesting wind energy using airborne vehicles. The main advantage of this concept is the capability to explore high altitude winds, which are typically stronger and less variable than in low altitudes. In addition, airborne vehicles tend to require only a fraction of infrastructure costs, when compared with the traditional wind turbines. One usual AWE design is the Leading Edge Inflatable (LEI) kites. In the current Airborne Wind Energy (AWE) literature, many modeling strategies for the dynamics of tethered wings are proposed. Important works explored the typical ground generation AWE system with flexible LEI wings, adopting a variety of combinations of wing structural, aerodynamic and tether models. Notably, flexible LEI wings have already been modeled using membrane and inflatable beam elements. The time-integration scheme included a static structural solution at each time step and simplified aerodynamic and tether models. On the other hand, the studies on flexible aircraft dynamics have been a well established subject of research. A useful idea in modeling flexible aircraft is adding the equations of the elastic degrees of freedom (DOFs) using modal coordinates. Aerodynamic forces can be provided by low fidelity methods. As LEI wings are usually very flexible structures, it emerges an opportunity to apply this same methodology to the AWE systems. Additionally, the tether dynamics can be included, taking into account the effects of flexibility, weight distribution and drag forces over the tether. This work will present an approach that unifies: 1) Flight dynamics, with the classical rigid-body 6 DOFs; 2) Structural dynamics, with wing elastic DOFs in modal coordinates; 3) Tether dynamics, including the DOFs of the flexible tether, as well as the control inputs in the bridle lines; and 4) Quasi-steady aerodynamics, using a Vortex Lattice Method (VLM) implementation, resulting in a seamless integration framework. Therefore, this work intends to bring to AWE an application of an established knowledge in the flexible aircraft dynamics, in order to provide a suitable methodology for the dynamics of a flexible tethered wing. A generic LEI kite design is studied. The mode shapes and frequencies are obtained via Finite Element Method (FEM).

Según temáticas patológicas farmacológicas y lesiones musculoesqueléticos, se indago en la necesidad de conocer las consecuencias que pueden influir en la salud de personas del común las consecuencias del consumo de sustancias, anabólicas, androgénicas o esteroides frente a la salud y las lesiones permanentes del sistema musculoesquelético frente a un mal asesoramiento. Para esto, se aplicó una encuesta cuantitativa de 20 preguntas donde 14 de ellas buscan indagar qué conocimiento se tiene frente a los procesos adecuados de prescripción del ejercicio. Una vez reunida la información, esta permitió analizar el desconocimiento del usuario frente al asesoramiento y los procesos adecuado que lleva practicar algún deporte o realizar actividad física si el debido conocimiento anterior a este. Se plantean como conclusiones empíricas que determinan en qué puntos relevantes se tiene falencia como entrenado y bajo qué parámetros se puede atender las necesidades de gozar de un buen estado físico, tener una buena salud o, incluso, llegar a un punto de profesionalización de la práctica deportiva. Por consiguiente, lo que impone un entrenador no es entrenado bajo su experiencia como exatleta ni gozando una composición corporal admirable, esto no determina que se debe contar con un conocimiento técnico dado por instituciones universitarias para poder imponer y compartir información con una persona del común.

OBJECTIVES Most transplant centres use donation after brain death (DBD) criteria to assess the quality of controlled donation after circulatory death (cDCD) lungs. However, research on the relationship between DBD extended criteria and cDCD lung transplantation outcomes is limited. We investigated the outcomes of using DBD extended criteria donor organs in cDCD lung transplantation, compared to the standard criteria cDCD lung transplantation. METHODS A retrospective chart review of consecutive cDCD lung referrals to Hospital Universitario Puerta de Hierro-Majadahonda from June 2013 to December 2019 was undertaken. Donors were divided into standard and extended criteria groups. Early outcomes after lung transplant were compared between these groups using the Kaplan–Meier method and log-rank test. RESULTS Thirty out of 91 cDCD donor lung offers were accepted for transplantation, of which 11 were from standard criteria donors and 19 were extended criteria donors. The baseline characteristics of the 2 recipient groups were similar. There were no differences in the rates of grade 3 primary graft dysfunction at 72 h after lung transplantation (21% vs 18%), duration of mechanical ventilation (48 h vs 36 h), total intensive care unit stay (10 days vs 7 days) and 1-year survival (89% vs 90%). CONCLUSIONS Carefully selecting cDCD lungs from outside the standard acceptability criteria may expand the existing donor pool with no detrimental effects on lung transplantation outcomes.

There are six major airway complications after lung transplantation: necrosis/dehiscence; infection; bronchial stenosis; granuloma tissue formation; tracheobronchomalacia; and fistula. Although their frequency has decreased in the recent past, such complications are associated with significant morbidity, reduction of quality of life, and an increased economic cost. Many risk factors have been described, ranging from surgical technique to immunosuppressive regimen. Bronchial stenosis is the most common airway complication. Options for treatment of symptomatic patients include dilation, bronchoscopic removal of scar tissue, stenting, and resection and reanastomosis. Dilation via balloon bronchoplasty, with or without scar tissue resection, is the safest and most effective first-line intervention. Stenting may be considered for stenosis refractory to dilation. Surgery is the most aggressive option and should be reserved for patients who have failed other interventions.

Background: The optimal induction treatment in potentially-resectable stage IIIA-N2 NSCLC remains undefined. Aim: To compare neoadjuvant high-dose chemoradiotherapy (CRT) to neoadjuvant chemotherapy (CHT) in patients with resectable, stage IIIA-N2 non-small-cell lung cancer (NSCLC). Methods: Retrospective, multicentre study of 99 patients diagnosed with stage cT1-T3N2M0 NSCLC who underwent neoadjuvant treatment (high-dose CRT or CHT) followed by surgery between January 2005 and December 2014. Results: 47 patients (47.5%) underwent CRT and 52 (52.5%) CHT, with a median follow-up of 41 months. Surgery consisted of lobectomy (87.2% and 82.7%, in the CRT and CHT groups, respectively) or pneumonectomy (12.8% vs. 17.3%). Nodal downstaging (to N1/N0) and Pathologic complete response (pCR; pT0pN0) rates were significantly higher in the CRT group (89.4% vs. 57.7% and 46.8% vs. 7.7%, respectively; p < 0.001)). Locoregional recurrence was significantly lower in the CRT group (8.5% vs. 13.5%; p = 0.047) but distant recurrence rates were similar in the two groups. Median PFS was 45 months (CHT) vs. "not reached" (CRT). Median OS was similar: 61 vs. 56 months (p = 0.803). No differences in grade ≥3 toxicity were observed. On the Cox regression analysis, advanced pT stage was associated with worse OS and PFS (p < 0.001) and persistent N2 disease (p = 0.002) was associated with worse PFS. Conclusions: Compared to neoadjuvant chemotherapy alone, a higher proportion of patients treated with preoperative CRT achieved nodal downstaging and pCR with better locoregional control. However, there were no differences in survival. More studies are needed to know the optimal treatment of these patients. Sin financiación No data JCR 2020 0.367 SJR (2020) Q3, 253/354 Oncology No data IDR 2020 UEM

Este artículo estudia los mecanismos de circulación de intelectuales hispanoamericanos en Colombia durante la segunda mitad del siglo xix. Dicho período evidenció una modernización de la prensa y el mercado del libro en la región, que expandió el espacio de acción de los intelectuales, generando conexiones entre ellos y permitiendo el desarrollo de un debate continental, especialmente alrededor del liberalismo. En particular, el liberalismo colombiano tuvo álgidos debates con el liberalismo chileno. A raíz de los intercambios, se consolidó una comunidad intelectual hispanoamericana., This paper examines the mechanisms of circulation of Spanish American intellectuals in Colombia during the second half of the nineteenth century. This period witnessed a modernization of press and the book market in the region, which broadened the scope of action of intellectuals. These processes generated connections between the thinkers and a truly continental debate developed, especially on liberalism. In particular, Colombian liberalism engaged in a heated debate with Chilean liberalism. As a result of these exchanges, a Spanish American intellectual community was consolidated.

Airway complication (AC) after lung transplant, although rare nowadays, leads to increased costs, greater morbidity, and decreased quality of life of patients. Over the years, many risk factors have been described, ranging from surgical technique to immunosuppressive regimen. There are essentially 6 major airway complications (necrosis/dehiscence, infection, bronchial stenosis, granulomas, tracheo-bronchomalacia, and fistula) all of which require a multidisciplinary approach based on the performance status of patients. In this article, the authors review the risk factors, clinical presentation, diagnosis methods, and management options in the most common AC after lung transplantation.

Survival rates in patients with stage IIIA non-small cell lung cancer (NSCLC) remain low despite curative treatment. This is due to tumor recurrence at distant sites. The aim of neoadjuvant chemotherapy (NA-CT) is to eradicate occult micrometastatic disease and improve survival in patients that are not candidates for surgery following induction therapy. A total of 21 patients with ipsilateral mediastinal node involvement (N2) with potentially resectable disease, who had been diagnosed with stage IIIA (T1-3 N1-2 and T4N0) NSCLC and who had received cisplatin and vinorelbine as induction treatment were included in this retrospective study. Patients who responded to the treatment underwent surgery, and those who were unresponsive received radical radiotherapy. Follow-up was conducted between March 2008 and April 2014. The median age of patients was 61 years, and all patients exhibited a good Eastern Cooperative Oncology Group performance status. The majority of patients were histologically diagnosed with adenocarcinoma (48%) or squamous cell carcinoma (38%), which was a poor prognostic factor for overall survival (OS). A total of 7 patients underwent surgery (of which 6 were down-staged), with a 3-year survival rate of 42.8%. The most significant factor associated with response to induction treatment was multistation nodal involvement. The complete resection rate for surgical patients was 85.7%. Unresectable patients had a 3-year survival rate of 25.8%. OS time for the whole cohort was 28.5 months, and the 3- and 5-year OS rates were 28.5% and 4.7%, respectively. CT-induced toxicity did not affect any treatment regime or surgical procedures. In conclusion, the use of cisplatin plus vinorelbine is feasible in a neoadjuvant setting, with good response rates and acceptable toxicity. Multistation N2 involvement is the main prognostic factor for a poor response to induction treatment.

espanolEl presente articulo aborda el estudio del regimen de responsabilidad objetiva que subsiste en materia infraccional aduanera, los fundamentos sostenidos para su existencia o pervivencia, y sus consecuencias. Asimismo, se desarrollan los argumentos contrarios a dicho regimen de imputacion de la responsabilidad. Asi, y partido de ello, se tratan de encontrar soluciones juridicas que, sin vulneren los derechos de los administrados al juzgar las infracciones aduaneras, permitan resolver el fundamento de su sustitucion, y ello, mediante un correcto establecimiento de presunciones legales relativas que permitan presumir la intencion, cuando ella sea de dificil comprobacion para el Fisco. EnglishThis paper analyzes the strict liability system surviving in customs infringement procedures, the grounds for its existence or survival and its consequences. Also, the arguments against such system of liability attribution are examined. Thus, from such starting point, through a precise enumeration of statutory rebuttable presumptions whose intention can be presumed whenever it is difficult for Tax Authorities to prove such presumptions, I intend to find legal solutions to determine the grounds for its replacement without affecting the rights of the relevant individuals or legal entities when the customs infringements are decided.

Bronchiolitis obliterans (BO) is the most common expression of chronic allograft dysfunction in lung transplantation. Moreover, BO represents the major cause of death in the long-term after this procedure. On the other hand, mesenchymal stem cells have been tested in animal models of BO aiming to interfere in its development. The aim of this experimental study is to explore the role of bone-marrow derived stem cells (BMSCs) as a preventive intervention of BO occurrence.This an experimental randomized study. A bronchiolitis obliterans animal model in rats was reproduced: heterotopical tracheal transplant model in lung parenchyma. Five of these animals were used as control group. After setting up the model, individuals were divided in 3 groups of treatment (n=15), in which BMSCs were administered in 3 different time points after the tracheal transplant (tracheal transplantation and BMSCs administration occurred the same day, group G0; after 7 days, group G7; after 14 days, group G14. In addition, within each group, BMSCs were administered through 3 different routes: endotracheally, endovascular and topically in the lung parenchyma). Animals were sacrificed at 21 days. Histology, fluorescence in situ hybridization and immunohistochemistry techniques were performed for identifying stem cells.Compared to control group, animals receiving BMSCs showed large neovessels in a loose fibrous matrix. Group G7 showed less fibrosis (p0.033) and edema (p0.028). Moreover, G7 animals receiving stem cells endotracheally showed no fibrosis (p0.008). Alveolar-like patches of tissue were observed among all groups (53.4%, 46.7% and 40% in G0, G7 and G14 respectively), consisting of cells expressing both stem and alveolar cells biomarkers.BMSCs modify the course of bronchiolitis obliterans and differentiate into alveolar cells. Endotracheal administration of BMSCs 7 days after the heterotopical tracheal transplant might be considered an effective way to prevent BO in this animal model.

Introduction The aim of this study is to demonstrate our experience at a volunteer surgical program in Cameroon, which is of special interest given to the inability to adopt international treatment guidelines for thyroid surgery in areas of limited resources due to the lack of preoperative testing and to the difficulty to obtain sustitutive hormonal treatment. Methods This is a prospective observational study that includes 16 cases of thyroid surgery in Dschang (Cameroon) during June 2015. The patients were previously selected by a local medical team. All patients were black, 15 women and one man, with a mean age of 41 years. The surgical technique used for the removal of unilateral disease was hemithyroidectomy with isthmectomy and bilateral subtotal thyroidectomy for bilateral disease. Results Five subtotal thyroidectomies, 9 hemithyroidectomies and 2 isthmectomies were performed. Prethyroid muscles were divided only in one case. We visualized 86% of the parathyroid glands and 84% of the recurrent laryngeal nerves. The main complications observed were one symptomatic cervical hematoma that required reoperation and 2 surgical wound infections. There were no clinical episodes of hypocalemia or recurrent nerve lesion. The mean length of stay was 2.3 days. At follow-up, all bilateral thyroidectomies developed high TSH levels. Conclusions Thyroid surgery is safe in developing countries adopting protocols and techniques we use in our environment (avoiding total thyroidectomy). Bilateral thyroidectomies should not be performed unless functional studies are available in the follow-up and a thyroid hormone supplement stock guaranteed whenever necessary.

Resumen Introduccion Nuestro objetivo es describir la experiencia adquirida en un programa de cooperacion dedicado a la cirugia tiroidea en Camerun. Su interes radica en la imposibilidad para seguir las guias internacionales de tratamiento en areas de recursos imitados debido a la falta de estudios preoperatorios y a la dificultad para conseguir medicacion hormonal sustitutiva de por vida. Metodos Estudio observacional de una cohorte de 16 pacientes operados de enfermedad tiroidea en Dschang (Camerun) en junio de 2015. La tecnica quirurgica empleada fue la hemitiroidectomia con istmectomia en la enfermedad unilateral y la tiroidectomia subtotal bilateral en la enfermedad bilateral. Resultados Todos los pacientes eran de raza negra, 15 mujeres y un hombre, con edad media de 41 anos. Se realizaron 5 tiroidectomias subtotales, 9 hemitiroidectomias y 2 istmectomias. Cuatro pacientes presentaban componente intratoracico. Fue necesaria la seccion de musculos pretiroideos en un caso. Se visualizaron las glandulas paratiroides y los nervios laringeos recurrentes en el 86 y el 84% de los casos, respectivamente. Se dejaron drenajes en 7 casos y la mediana de duracion de la intervencion fue de 75 min. Como complicaciones cabe destacar un hematoma cervical que preciso reintervencion y 2 infecciones de herida quirurgica. No hubo hipocalcemias clinicas ni lesiones recurrenciales apreciables. La estancia media fue de 2,3 dias. A largo plazo, los pacientes con tiroidectomias bilaterales presentaban niveles elevados de TSH. Conclusiones La cirugia tiroidea en paises subdesarrollados, adaptando los protocolos y tecnicas que utilizamos en nuestro medio (evitando la tiroidectomia total), tiene una tasa de complicaciones asumible. No deben realizarse tiroidectomias bilaterales salvo que se disponga de estudios funcionales y se asegure previamente la disponibilidad de la hormona tiroidea.

Chest wall resection and reconstruction for neoplastic diseases has unique oncologic, structural, and functional challenges. In a young and fit patient with a mediastinal mass and extensive anterior chest wall invasion, purely structural solutions were deemed insufficient. We hereby present a novel three-dimensionally printed patient-specific titanium implant of sternum and ribs. This osteointegrable implant was designed with biomechanical capabilities using a unique "Greek wave" folding pattern. Postoperative dynamic computed tomography showed that the implant allowed for controlled flexing during the respiratory cycle. Three-dimensional printing with biocompatible materials could enable a new generation of chest wall implants strongly focused on functional reconstruction.

Uncontrolled donation after cardiac death is an appealing source of organs for lung transplantation. We compare early and long-term outcomes of lung transplantation with these donors with a cohort of transplants from brain death donors at our institution. Retrospective analysis of all lung transplantations was performed from 2002 to 2012. We collected variables regarding recipients, donors, recover and transplant procedures, early and late complications, and survival. We included 292 lung transplants from brain death donors and 38 from uncontrolled donors after cardiac death. Both groups were comparable except for sex mismatch (male recipient-female donor was more frequent in the brain death cohort, 17.8% vs 0%, P 0.002), total ischemic time (longer for donors after cardiac death, 657 minutes for the first lung and 822 minutes for the second vs 309 and 425 minutes, P

OBJECTIVES: The role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT). MATERIAL AND METHODS: A total of 247 patients with potentially resectable stage T1-T3N2M0 NSCLC treated with either CRTS or dCRT between January 2005 and December 2014 at 15 hospitals in Spain were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group). RESULTS: Of the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, median overall survival (OS; 56 vs 29 months, log-rank p = .002) and progression-free survival (PFS; 46 vs 15 months, log-rank p

Summary Background Severe primary graft dysfunction (PGD) of grade 3 (PGD3) is a common serious complication following lung transplantation. We aimed to assess physiological donor lung preservation using the Organ Care System (OCS) Lung device compared with cold static storage. Methods In this non-inferiority, randomised, controlled, open-label, phase 3 trial (INSPIRE) recipients were aged 18 years or older and were registered as standard criteria primary double lung transplant candidates. Eligible donors were younger than 65 years old with a ratio of partial pressure of oxygen in arterial blood to the fraction of inspired oxygen of more than 300 mm Hg. Transplant recipients were randomly assigned (1:1) with permuted blocks, stratified by centre, to receive standard criteria donor lungs preserved in the OCS Lung device (OCS arm) or cold storage at 4°C (control arm). The composite primary effectiveness endpoint was absence of PGD3 within the first 72 h after transplant and 30-day survival in the per-protocol population, with a stringent 4% non-inferiority margin. Superiority was tested upon meeting non-inferiority. The primary safety endpoint was the mean number of lung graft-related serious adverse events within 30 days of transplant. We did analyses in the per-protocol and intention-to-treat populations. This trial is registered with ClinicalTrials.gov, number NCT01630434. Findings Between Nov 17, 2011, and Nov 24, 2014, we randomly assigned 370 patients, and 320 (86%) underwent transplantation (n=151 OCS and n=169 control); follow-up was completed in Nov 24, 2016. The primary endpoint was met in 112 (79·4%) of 141 patients (95% CI 71·8 to 85·8) in the OCS group compared with 116 (70·3%) of 165 patients (62·7 to 77·2) in the control group (non-inferiority point estimate −9·1%; 95% CI −∞ to −1·0; p=0·0038; and superiority test p=0·068). Patient survival at day 30 post-transplant was 135 (95·7%) of 141 patients (95% CI 91·0–98·4) in the OCS group and 165 patients (100%; 97·8–100·0) in the control group (p=0·0090) and at 12 months was 126 (89·4%) of 141 patients (83·1–93·9) for the OCS group compared with 146 (88·1%) of 165 patients (81·8–92·8) for the control group. Incidence of PGD3 within 72 h was reported in 25 (17·7%) of 141 patients in the OCS group (95% CI 11·8 to 25·1) and 49 (29·7%) of 165 patients in the control group (22·8 to 37·3; superiority test p=0·015). The primary safety endpoint was met (0·23 lung graft-related serious adverse events in the OCS group compared with 0·28 events in the control group [point estimate −0·045%; 95% CI −∞ to 0·047; non-inferiority test p=0·020]). In the intention-to-treat population, causes of death at 30 days and in hospital were lung graft failure or lung infection (n=2 for OCS vs n=7 for control), cardiac causes (n=4 vs n=1), vascular or stroke (n=3 vs n=0), metabolic coma (n=0 vs n=2), and generalised sepsis (n=0 vs n=1). Interpretation The INSPIRE trial met its primary effectiveness and safety endpoints. Although no short-term survival benefit was reported, further research is needed to see whether the reduced incidence of PGD3 within 72 h of a transplant might translate into earlier recovery and improved long-term outcomes after lung transplantation. Funding TransMedics Inc.

Resumen Debido a que los resultados del trasplante pulmonar son todavia inferiores a los obtenidos en otros trasplantes como el cardiaco, el renal o el hepatico, los retos de la medicina se deben centrar en aumentar la supervivencia funcional de los injertos. La intervencion provoca marcados cambios fisiopatologicos posquirurgicos a nivel del parenquima pulmonar, la caja toracica, las vias aereas y la circulacion pulmonar. No obstante, el paciente esta sometido a riesgos que es importante conocer y controlar, como las complicaciones atribuibles total o parcialmente al tratamiento inmunosupresor, entre ellas la patologia cardiovascular, la aparicion de tumores, infecciones y, por supuesto, la disfuncion cronica del injerto. El pronostico del paciente va a depender, en gran medida, de la mayor o menor eficacia en prevenir, diagnosticar precozmente y en su caso tratar de forma adecuada las posibles complicaciones. Por ello, independientemente del tiempo postrasplante, los receptores son sometidos a una estrecha monitorizacion funcional y clinica. En este articulo revisaremos las alteraciones funcionales caracteristicas del receptor de un trasplante pulmonar y la utilidad en el seguimiento del paciente de las diferentes tecnicas diagnosticas.

Although the number of lung transplants in Spain is increasing annually, more organs are required to ease waiting lists. Controlled non-heart beating donors (cNHBD) (Maastricht III) are a reality at international level, and contribute significantly to increasing donor numbers. In this study, we present our cNHBD protocol and the initial experience in Spain using lung grafts from this type of donor. Three bilateral lung transplants were performed between January 2012 and December 2014. Preservation was by ex vivo lung perfusion in 2 cases and by traditional cold perfusion in the other. None of the patients developed grade 3 primary graft dysfunction, no in-hospital mortality was recorded and 1-year survival was 100%. These initial results, and international experience, should help to develop similar protocols to encourage the use of controlled non-heart beating donors.