Implementation of a mobile team to provide normothermic regional perfusion in controlled donation after circulatory death: Pilot study and first results

Normothermic regional perfusion (NRP) in controlled donation after circulatory death is becoming a popular method due to the favorable results of the grafts procured under this technique. This procedure requires experience, and, sometimes, the availability of extracorporeal membrane oxygenation (ECMO) machines to implement NRP is limited to tertiary hospitals. In order to provide support with NRP in controlled donation after circulatory death across the different hospitals of the Autonomous Community of Madrid, a mobile NRP team was created. In the first 18 months since its creation, the mobile NRP team participated in 33 procurements across nine different hospitals, representing 72% of all controlled donations after circulatory death in the Autonomous Community of Madrid. NRP was successfully performed in 29 (88%) cases, with a mean duration of 69 ± 27 minutes. A total of 39 kidneys, 12 livers, and 5 bilateral lungs were recovered and transplanted. None of the livers were discarded due to an elevation in transaminases during NRP. A mobile NRP team is a feasible option and, in our series, aided in the optimization and recovery of organs from donors after controlled circulatory death in centers where ECMO technology was not available.     

Indinavir plasma concentrations and resistance mutations in patients experiencing early virological failure

Virological failure under protease inhibitor (PI)-based antiretroviral regimens is often not explained by the selection of resistance mutations. The role of low indinavir (IDV) plasma levels in treatment failure was assessed in 46 subjects experiencing early virological failure to a first-line IDV-containing triple combination. Overall, 69% of patients showed subtherapeutic IDV plasma levels (it was not detected at all in 75% of them). Subjects with detectable but suboptimal IDV levels developed more IDV resistance mutations. Thus, drug monitoring may be useful to assess treatment adherence and risk of drug resistance in early virological failures. This information may be crucial for choosing the most appropriate rescue intervention.     

Prevalence and correlates of diabetes mellitus and impaired glucose tolerance among adults in Luzon, Philippines

Recognizing the problem posed by diabetes mellitus, the National Diabetes Commission was created by Republic Act 8191 in 1996. The Commission identified the need for a Second National Diabetes Survey to have an updated estimate of the magnitude of the disease in the country and to have the needed information for developing a diabetes prevention and control program. This paper reports the prevalence of diabetes mellitus and impaired glucose tolerance (IGT) in adults and the factors associated with the prevalence of these conditions. A cross-sectional population-based study assessed the occurrence of diabetes and impaired glucose tolerance among a random sample of 7044 adults, aged 20-65 years who were residents of urban and rural areas in Luzon. Blood glucose level was measured by OGTT using the current WHO criteria. The crude diabetes prevalence of 5.1% represented a 54% increase over the figure (3.3%) for a similar population in Luzon in 1982. An increase was also noted in the magnitude of IGT which almost doubled from 4.1% in 1982 to 8.1% in the present survey. Only one in three diabetics reported that they had diabetes. The frequency of diabetes and IGT in urban and rural areas were about the same, although a substantial increase from the earlier survey was noted in rural areas. Women registered a higher prevalence for both conditions than men. Aside from age and gender, the other correlates of diabetes mellitus were hypertension, family history of diabetes, WHR, BMI, and physical inactivity. IGT had similar correlates as diabetes except physical inactivity. The present findings which are consistent with those of other studies underscore the role of lifestyle behaviors in diabetes and should be the target of intervention to prevent further increase in disease frequency.     

El valor de la MAPA y de los parámetros de lesión subclínica de órgano diana en el diagnóstico de hipertensión refractaria

Introduction

We aimed to assess the effectiveness of ambulatory blood pressure monitoring (ABPM) and subclinical target organ damage parameters for diagnosis of resistant hypertension (RH).

Association of Long-Term Exposure to Traffic-Related Air Pollution with Blood Pressure and Hypertension in an Adult Population–Based Cohort in Spain (the REGICOR Study)

Background: Long-term exposure to traffic-related air pollution may increase blood pressure (BP) and induce hypertension. However, evidence supporting these associations is limited, and they may be confounded by exposure to traffic noise and biased due to inappropriate control for use of BP-lowering medications.Objectives: We evaluated the associations of long-term traffic-related air pollution with BP and prevalent hypertension, adjusting for transportation noise and assessing different methodologies to control for BP-lowering medications.Methods: We measured systolic (SBP) and diastolic BP (DBP) at baseline (years 2003–2005) in 3,700 participants, 35–83 years of age, from a population-based cohort in Spain. We estimated home outdoor annual average concentrations of nitrogen dioxide (NO₂) with a land-use regression model. We used multivariate linear and logistic regression.Results: A 10-μg/m³ increase in NO₂ levels was associated with 1.34 mmHg (95% CI: 0.14, 2.55) higher SBP in nonmedicated individuals, after adjusting for transportation noise. Results were similar in the entire population after adjusting for medication, as commonly done, but weaker when other methods were used to account for medication use. For example, when 10 mmHg were added to the measured SBP levels of medicated participants, the association was β = 0.78 (95% CI: –0.43, 2.00). NO₂ was not associated with hypertension. Associations of NO₂ with SBP and DBP were stronger in participants with cardiovascular disease, and the association with SBP was stronger in those exposed to high traffic density and traffic noise levels ≥ 55 dB(A).Conclusions: We observed a positive association between long-term exposure to NO₂ and SBP, after adjustment for transportation noise, which was sensitive to the methodology used to account for medication.Citation: Foraster M, Basagaña X, Aguilera I, Rivera M, Agis D, Bouso L, Deltell A, Marrugat J, Ramos R, Sunyer J, Vila J, Elosua R, Künzli N. 2014. Association of long-term exposure to traffic-related air pollution with blood pressure and hypertension in an adult population–based cohort in Spain (the REGICOR study). Environ Health Perspect 122:404–411; http://dx.doi.org/10.1289/ehp.1306497     

Development of the Preverbal Visual Assessment (PreViAs) questionnaire

Background

Visual cognitive functions of preverbal infants are evaluated by means of a behavioral assessment. Parents or primary caregivers may be appropriate to certify the acquisition of certain abilities.

Aims

To develop the PreViAs (Preverbal Visual Assessment) questionnaire to assess visual behavior of infants under 24 months of age and to assess the normative outcomes for each item at each age.

Study design

The process was divided into three phases: scale development (items and domains generation), pilot testing, and exploratory analysis.

Results

The final version of the PreViAs questionnaire consisted of 30 items, each related to one or more of four domains (visual attention, visual communication, visual–motor coordination, and visual processing). For the exploratory analysis, 298 children (159 boys and 139 girls) were recruited. Their ages ranged from 0.1 to 24 months (mean, 11.2 months). Internal consistency of the questionnaire was high for all domains (Cronbach's α coefficients of 0.85–0.94).

Conclusions

The PreViAs questionnaire is a useful scale for assessing visual cognitive abilities of infants under 24 months of age. It is easy and feasible to complete by primary caregivers.     

Load cycling enhances bioactivity at the resin–dentin interface

Objectives

The purpose of this study was to evaluate if mechanical loading promotes bioactivity at the resin interface after bonding with three different adhesive approaches.

Methods

Dentin surfaces were subjected to three different treatments: demineralisation by (1) 37% phosphoric acid (PA) followed by application of an etch-and-rinse dentin adhesive Single Bond (SB) (PA + SB), (2) by 0.5 M ethylenediaminetetraacetic acid (EDTA) followed by SB (EDTA + SB), (3) application of a self-etch dentin adhesive: Clearfil SE Bond (SEB). Bonded interfaces were stored in simulated body fluid during 24 h or 3 w. One half of each tooth was submitted to mechanical loading. Remineralisation of the bonded interfaces was assessed by AFM imaging/nano-indentation, Raman spectroscopy/cluster analysis, dye assisted confocal microscopy evaluation (CLSM) and Masson's trichrome staining.

Results

Loading cycling for 3 w promoted an increase of mechanical properties at the resin–dentin interface. Cluster analysis demonstrated an augmentation of the mineral–matrix ratio in SB-loaded specimens. CLSM showed an absent micropermeability and nanoleakage after loading EDTA + SB and SEB specimens. Trichrome staining reflected a narrow demineralised dentin matrix after loading, almost not observable in EDTA + SB and SEB.

Significance

In vitro mechanical loading promoted mineralization in the resin–dentin interfaces, at 24 h and 3 w of storage.