Multiexponential T2 analyses in a murine model of hepatic fibrosis at 11.7 T MRI

This study evaluated the effects of hepatic fibrosis on the multiexponential T₂ (MET₂) relaxation of ex vivo murine liver specimens using an 11.7 T MRI. This animal study was approved by the Institutional Animal Care and Use Committee. Eighteen male C57BL/6 mice were divided into control (n = 3) and experimental (n = 15) groups; the latter group was fed a 3,5‐dicarbethoxy‐1,4‐dihydrocollidine‐supplemented diet to induce hepatic fibrosis. Ex vivo liver specimens were imaged using an 11.7 T MRI scanner. A multi‐echo spin‐echo sequence was utilized for subsequent MET₂ analysis. Degrees of fibrosis were determined by a pathologist, as well as by digital image analysis. Scatterplot graphs comparing various features of the MET₂ signal decay with the degrees of fibrosis were generated, and correlation coefficients were calculated. Two distinct peaks of the MET₂ signal decay were identified in all liver specimens: a short T₂ component with a geometric mean T₂ (GMT₂) approximating 30 ms; and a long T₂ component with GMT₂ approximating 400 ms. Strong correlation was found between the degree of hepatic fibrosis and the amplitude of the short T₂ component, with a higher degrees of fibrosis associated with a lower amplitude. Moderate correlation was also found between hepatic fibrosis and the GMT₂ values of the long T₂ component, with higher degrees of fibrosis associated with lower GMT₂ values. The study of hepatic microenvironments using MET₂ analyses offers potential utility in the ongoing development of the noninvasive assessment of hepatic fibrosis using MRI. Copyright © 2012 John Wiley & Sons, Ltd.     

Recién nacido prematuro: a propósito de un caso

A case is presented of a premature newborn of 27 weeks gestation and weighing 420 grams who was delivered as a result of a maternal pre-eclampsia and retarded intra-uterine growth. During the 125 days of hospitalisation, an individual care plan based on the Virginia Henderson model was devised and applied to both the child and her parents using NANDA diagnostics, interventions according to the NIC classification, and the expected results according to the NOC classification. The Marjory Gordon functional patterns were used for the initial assessment. By applying the pre-term newborn (PTNB) plan, all their needs were provided and were modified throughout the hospital stay, with new needs that were added to the established ones. These required a continuous assessment with the subsequent adapting of the care plan. Likewise, the care required by the parents varied from the initial grief due to the possible loss of their child to learning the alarm signs and the home care that their child would need. The child was finally discharged weighing 2900 grams and with normal neurological and psychomotor development, although with a lower weight appropriate to her age. Currently, at 2 years old, the child has a normal neurological and psychomotor development, but with weight and size lower than the P₃ percentile. She requires speech therapy treatment due to paralysis of the right vocal cord.     

Impact of Type of Intervention on Youth Reoffending: Are Gender and Risk Level Involved?

The objective of this study was to analyse the impact of the type of intervention on youth reoffending. Moreover, the possible influence that the offender's gender and level of risk could have on this relationship was also explored. Juvenile offenders from four different types of educational interventions participated in the study (N = 210): victim–offender mediation (VOM) as a diversion procedure, and case closure, reprimand, and community service as dispositions. Aged between 14-18 years, they were assessed by means of the Youth Level of Service/Case Management Inventory (YLS/CMI). Recidivism rates were evaluated as the number of new records in a follow-up period of 24 months. Results of this study showed that type of intervention (diversion versus dispositions) had no apparent effect on youth recidivism. Furthermore, an important aspect to consider in youth assessment was the different impact that risk level had on boys’ and girls’ recidivism.     

Pediatric transplantation in Europe during the COVID-19 pandemic: Early impact on activity and healthcare

The current pandemic SARS-CoV-2 has required an unusual allocation of resources that can negatively impact chronically ill patients and high-complexity procedures. Across the European Reference Network on Pediatric Transplantation (ERN TransplantChild), we conducted a survey to investigate the impact of the COVID-19 outbreak on pediatric transplant activity and healthcare practices in both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT). The replies of 30 professionals from 18 centers in Europe were collected. Twelve of 18 centers (67%) showed a reduction in their usual transplant activity. Additionally, outpatient visits have been modified and restricted to selected ones, and the use of telemedicine tools has increased. Additionally, a total of 14 COVID-19 pediatric transplanted patients were identified at the time of the survey, including eight transplant recipients and six candidates for transplantation. Only two moderate-severe cases were reported, both in HSCT setting. These survey results demonstrate the limitations in healthcare resources for pediatric transplantation patients during early stages of this pandemic. COVID-19 disease is a major worldwide challenge for the field of pediatric transplantation, where there will be a need for systematic data collection, encouraging regular discussions to address the long-term consequences for pediatric transplantation candidates, recipients, and their families.     

Hemodynamic, biochemical and morphological changes induced by aminoguanidine in normal and septic sheep

OBJECTIVE: To define the acute hemodynamic, metabolic, and morphological changes induced by aminoguanidine, a selective iNOS inhibitor, in septic sheep. DESIGN: Prospective, nonrandomized animal study. SETTING: Animal research facility in a University Hospital. INTERVENTIONS: Adult sheep, sedated and mechanically ventilated, were monitored with a pulmonary arterial catheter and an ultrasonic blood flow probe in the mesenteric artery, to measure the systemic (Q(TOT)I) and the mesenteric (Q(MES)I) blood flow indices, and an ileal tonometer. Four groups of sheep were studied: nonseptic, septic, nonseptic treated with aminoguanidine, and septic treated with aminoguanidine (100 mg kg(-1) h(-1)) (n = 6 for each group). Sepsis was induced by the intravenous administration of E. coli. Hemodynamic and biochemical parameters were measured during 300 min. Histological changes in the liver and small intestinal mucosa were analyzed at the end of the experiment. MEASUREMENTS AND MAIN RESULTS: In nonseptic animals, aminoguanidine slightly increased mean systemic arterial pressure (MAP), decreased Q(TOT)I, and increased vascular resistance index (SVRI) and pulmonary vascular resistance index. Q(MEs)I did not change and Q(MES)I/Q(ToT)I increased. Aminoguanidine also induced intestinal intramucosal hypercarbia, hyperlactatemia, acidemia, hypoglycemia, and morphological signs indicative of tissue ischemia in the small intestinal mucosa. In septic sheep, aminoguanidine increased SVRI and MAP only at 4 h after the septic challenge and thereafter, and worsened gas exchange. CONCLUSIONS: In this model, exogenous administration of aminoguanidine induces beneficial hemodynamic effects 4 h after the septic challenge. In normal animals, however, aminoguanidine was associated with hypoglycemia, acidosis, hyperlactatemia, and intestinal mucosal ischemia.     

Long-term (> 8 weeks) home inotropic therapy as destination therapy in patients with advanced heart failure or as bridge to heart transplantation

Congenital heart disease (CHD) affects approximately 250,000 adults in the UK. Most of these patients would benefit from specialized follow-up. However, there is at present a significant shortfall of specialized tertiary care expertise and facilities for this growing cardiovascular field in the UK and around the world. We aimed to report our experience with a joint adult CHD clinic run in a district general hospital with regular input from the local cardiology team and a visiting adult CHD specialist. In total, 148 patients aged 33.6+/-14.1 years were seen once or more in 12 clinics over the study period (September 1999 to January 2003). Diagnostic case mix consisted of 2.9% complex, 67.9% moderate and 29.2% minor cases of CHD. Twenty percent of patients visited the counterpart tertiary center for additional investigations (mostly MRI) and 8% for intervention (with no operative mortality). There was one death during the study period giving an overall mortality of 0.2%/year. Patients were referred to the clinic from tertiary centres, the local cardiology and paediatric clinics and with time from obstetric and community sources. Nonattendance rates were relatively low, comparing favourably with tertiary care. This model of joint care for the adult CHD patient at a general district hospital with regular onsite specialized input appears to be effective and highlights the need for additional resource allocation to provide optimal care for these patients. Our data may be useful in future planning for CHD services.