Self-Assessment Tool and Clinical Audits: A Way to Manage Organ Donation and Transplantation in Hospital Settings.

The self-assessment tool (SAT) of hospital management in donation and transplantation is a systematic instrument that allows reaching a situation status on Procurement and Transplantation with emphasis on the management and cultural change of Health Personnel in each care center. The SAT allows reflection on institutionalization, achievements, and the cultural change generated by donation and transplantation in Health Personnel. It also allows the evaluation of the culture of hospital donation and the formulation of plans and goals for the future.

Prediction of the Evolution to Brain Death in the Neurocritical Patient: SPN Model Showed Better Performance Than Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II.

The detection of brain death (BD) plays a fundamental role in the management of hospital donation. Delayed diagnosis of BD is the main cause of donor loss. A tool for monitoring and prognosis in the neurocritical patient is essential to meet these objectives.

Intensive Care Unit Approach to the Diagnosis of Brain Death in Infratentorial Neurologic Pathology: Case Reports.

The ischemic and primary vascular injury of the brainstem (BS) can determine, among other serious conditions, the brain death (BD) of the individual. We present 2 cases of individuals with primary ischemic vascular disease of the BS who evolved to BD and were donors of solid organs and tissues. In both cases, the clinical examination was positive for the diagnosis of BD, and transcranial Doppler did not confirm the pattern of cerebral circulatory arrest that accompanies BD.

Addressing a Diagnosis of Brain Death in Hypernatremia Situation.

Hypernatremia and the state of plasma hypertonia are part of the alterations of insipid diabetes that are integrated to the brain death (BD) syndrome. Hypernatremia should be corrected as early as possible to make the clinical diagnosis of BD and to avoid its potential deleterious effect on the subsequent operation of the liver graft. Transcranial Doppler is a very valuable tool for the diagnosis of cerebral circulatory arrest associated with BD.

Organ Use Rate: A New Indicator of Donation and Transplantation Efficiency.

The conversion rate has emerged as a good indicator of the effectiveness of the transplantation process by showing the percentage of potential donors who become real donors, but it overestimates the number of organs that are actually used for transplantation in recipients. The incorporation of organ use rate, a new quality indicator that reflects the actual number of organs used for transplantation excluding those that are discarded in the surgical block, provides complementary information of great value when comparing transplantation in different regions. This new variable allows more accurate prediction of the waiting time for the transplantation of a certain organ in patients with nonreversible organic insufficiencies, while providing the national authorities a real response in relation to the percentage of the demand for organs that can be satisfied.

Organ Donation and Primary Central Nervous System Tumors.

Primary central nervous system tumors can be the cause of brain death. Not all of them contraindicate the donation of organs and tissues for transplant. A survey of cases was carried out in our country in which it was observed that the number of brain deaths caused by primary tumors was low, of the order of 2%, with an ẋ (media) of 3 by year, which would increase the potential for donation.

Exercise training during hemodialysis sessions: Physical and biochemical benefits.

Chronic inflammation, protein-energy wasting, and poor physical functioning are highly prevalent among patients with chronic kidney disease (CKD). These factors are associated with disability and increase of cardiovascular risk. The aim of this study is to evaluate the effects of exercise training during hemodialysis (HD) sessions on physical functioning, body composition, and nutritional and inflammatory status.

Systodiastolic Separation Expresses Cerebral Circulatory Arrest?

There is a situation before the cerebral circulatory cessation phase, the systodiastolic separation in transcranial Doppler (TCD), which may raise doubts to the operator technician who performs it. A total of 266 studies were performed in 188 neurocritical patients over a 9-year period: 88 cases (77%) corresponded to cerebral circulatory arrest (CCA) which accompanies brain death (BD); 9 (5%) presented the systodiastolic separation pattern. In 1 of those 9 there was persistence of cough reflex and spontaneous breathing; in 5, CCA was not reached; only 3 evolved to CCA.

Utility of Transcranial Doppler in the Coordination of Transplants: 10 Years of Experience.

Transcranial Doppler (TCD) integrated to multimodal neuromonitoring of neurocritical patients is a useful tool in the clinical follow-up. A retrospective and descriptive study of 194 patients who were admitted into the intensive care unit (ICU) was carried out from December 2007 to February 2017. We analyzed the distribution of study frequencies with respect to the pathologies that motivated them, the characteristics of patients who evolved to brain death (BD), and most frequent patterns of cerebral circulatory arrest.

Does Traumatic Brain Injury by Firearm Injury Accelerates the Brain Death Cascade? Preliminary Results.

Brain death (BD) triggers a series of pathophysiological events similar to multiple-organ dysfunction. Traumatic brain injury (TBI) due to firearm injury (FAI) causes lesions that could lead to BD. Patients admitted to the ICU due to severe TBI that evolved to BD were studied, including those caused by FAI; the 2 groups were compared with the objective of demonstrating that the support of the deceased donor by TBI due to FAI is more unstable and of shorter duration than the one related to TBI by another cause.

Test repositioning for functional assessment of neurological outcome after experimental stroke in mice.

Stroke is a cerebrovascular pathology for which the only approved treatment is fibrinolysis. Several studies have focused on the development of new drugs but none has led to effective therapies to date, due, among others, to the difficulty to evaluate clinical deficits in experimental animal models. The present study aims to explore the applicability of known behavioral tests not commonly used in ischemia for the neurological assessment of mice after experimental stroke in different brain areas.

Whole-exome sequencing analysis in twin sibling males with an anterior cruciate ligament rupture.

Familial predisposition is among the major genetic risk factors for non-contact musculoskeletal tissue injuries. Personal genome sequence shows that different polymorphism profiles may account for the number and the degree of injuries and the recovery time. Genotyping studies allow investigation into genome factors with potential impact on pathogenesis of non-contact ligament injuries.

Postoperative complications of anterior cruciate ligament reconstruction after ambulatory surgery.

Objective: To study postoperative complications of arthroscopic anterior cruciate ligament (ACL) reconstruction performed as an outpatient compared with same surgery performed as a regular admission (inpatient).

Material And Method: A study was conducted on a historical cohort of 342 patients (115 outpatients vs 227 inpatients) who underwent arthroscopic ACL primary ligamentoplasty (2004-2012). A review was performed on the demographic, surgical and hospital variables.

A model to predict progression in brain-injured patients.

Introduction: The study of brain death (BD) epidemiology and the acute brain injury (ABI) progression profile is important to improve public health programs, organ procurement strategies, and intensive care unit (ICU) protocols. The purpose of this study was to analyze the ABI progression profile among patients admitted to ICUs with a Glasgow Coma Score (GCS) ≤8, as well as establishing a prediction model of probability of death and BD.

Materials And Methods: This was a retrospective analysis of prospective data that included all brain-injured patients with GCS ≤8 admitted to a total of four public and private ICUs in Uruguay (N = 1447).

Transcranial Doppler in the diagnosis of cerebral circulatory arrest: cases of the National Institute of Donation and Transplantation of Uruguay.

Background: Transcranial Doppler (TCD) is an auxiliary method for the diagnosis of cerebral circulatory arrest (CCA). The objective of this work was to appreciate the efficiency of the method in the diagnosis of the CCA and its outcome in situations such as decompressive craniectomy (DC).

Methods: In this descriptive, retrospective study, conducted between 2000 and 2012, variables considered were causes of brain death (BD), age, sex, application reason, CCA patterns, and CCA patterns in DC.

Donation rates: what matters?

Introduction: The increase in the number of donors is the main objective of all transplantation organizations around the world. Further understanding of the factors involved in increasing donation rates is very important for planning future strategies to improve outcomes in each country.

Objective And Method: With this purpose we analyzed the relationship between social and economic factors of the countries and organizational aspects of health systems and institutions dedicated to transplantation in relation to the number of actual donors per million population.

Traumatic dislocation of posterior tibial tendon by avulsion of flexor retinacular release. Reconstruction with suture anchors.

Introduction: Traumatic dislocation of the posterior tibial tendon (PTT) has a very low prevalence. It presents with pain and recurrent snapping on the posterior side of the medial malleolus after an ankle sprain while practicing sports. The diagnosis is based on clinical examination, supported by imaging techniques.

[Bankart repair. Comparative study with and without suction drainage to assess shoulder pain and functional limitation].

Unlabelled: The purpose of this study is to compare two patient cohorts with Bankart lesion, one with intraarticular drainage after surgery and another group without drainage.

Material And Methods: We designed a study cohort for patients with Bankart repair due to relapsing shoulder dislocation; they underwent arthroscopy and were stabilized with suture anchors; intraarticular drainage was used in one group and no drainage was used in a control patient cohort. Thirty-one consecutive patients were operated by the same team.

β-Adrenergic receptors activate exchange protein directly activated by cAMP (Epac), translocate Munc13-1, and enhance the Rab3A-RIM1α interaction to potentiate glutamate release at cerebrocortical nerve terminals.

The adenylyl cyclase activator forskolin facilitates synaptic transmission presynaptically via cAMP-dependent protein kinase (PKA). In addition, cAMP also increases glutamate release via PKA-independent mechanisms, although the downstream presynaptic targets remain largely unknown. Here, we describe the isolation of a PKA-independent component of glutamate release in cerebrocortical nerve terminals after blocking Na(+) channels with tetrodotoxin.

Amelioration of ischemic brain damage by peritoneal dialysis.

Ischemic stroke is a devastating condition, for which there is still no effective therapy. Acute ischemic stroke is associated with high concentrations of glutamate in the blood and interstitial brain fluid. The inability of the tissue to retain glutamate within the cells of the brain ultimately provokes neuronal death.

Binding and removal of sulfate, phosphate, arsenate, tetrachloromercurate, and chromate in aqueous solution by means of an activated carbon functionalized with a pyrimidine-based anion receptor (HL). Crystal structures of [H3L(HgCl4)]·H2O and [H3L(HgBr4)]·H2O showing anion-π interactions.

Binding of anions of great environmental concern such as SO(4)(2-), PO(4)(3-), AsO(4)(3-), HgCl(4)(2-), and CrO(4)(2-) by the protonated forms of a tren-like (tren = tris(2-aminoethyl)amine) ligand (HL) functionalized with a pyrimidine residue was studied by means of potentiometric measurements and isothermal titration calorimetry (ITC) affording log K, ΔH°, and TΔS° values for the formation of the relevant complexes. The complexes show high to very high stability due to the particular topology and electronic properties of the ligand which is able to use two separated coordination environments to host the anions, the protonated tren site where electrostatic and hydrogen bond interactions are operating, and the pyrimidine ring which may act via anion-π interaction. A contribution of -8.

Ventricular dysfunction associated with brain trauma is cause for exclusion of young heart donors.

Objective: Ventricular dysfunction (VD) in the context of brain death (BD) is one medical cause that may be reversed to extend the range of donors for cardiac transplant programs. The aim of this study was to identify and quantify the causes for exclusion of potential heart donors and to define risk factors for VD among the BD population.

Materials And Methods: This study of 100 heart-beating potential donors defined subjects as those younger than 50 years.

Study of the internal morphology of cation-exchange membranes by means of electroosmotic permeability relaxations.

The effect of an ac sinusoidal perturbation of known amplitude and frequency superimposed to the usual dc applied electric voltage difference on the electroosmotic flow through three cation-exchange membranes with different morphology has been studied. A dispersion of the electroosmotic permeability on the frequency of the applied ac signal has been found for the three membranes investigated, observing that the electroosmotic permeability reaches maximum values for some characteristic values of the frequency. These characteristic frequency values, which are related to relaxation processes in heterogeneous media, depend on the membrane system and permit to obtain information about the different structures of the membrane system.

Experimental estimation of equilibrium and transport properties of sulfonated cation-exchange membranes with different morphologies.

Solvent uptake, hydraulic and electroosmotic permeabilities, true cation transport number, effective fixed charge concentration, and limiting current values have been determined in aqueous LiCl solutions for three commercial cation-exchange membranes with different morphologies and similar electric properties. The differences found in the equilibrium and transport properties of the membranes have been analyzed on the basis of their different structures. The experimental results show that the membrane morphology has an influence on the effect that the presence of an electrolyte has in the solvent uptake and in the liquid permeation.