A new ring nematode, Xenocriconemella costaricense sp. nov., (Nematoda: Criconematidae) from Costa Rica.

During nematode surveys of natural vegetation in forests of La Cima de Copey de Dota, San José, San José province, Costa Rica, a Xenocriconemella species closely resembling X. macrodora and related species was found. Integrative taxonomical approaches demonstrated that it is a new species described herein as X. costaricense sp. nov. The new species is parthenogenetic (only females have been detected) and characterised by a short body (276-404 µm); lip region with two annuli, not offset, not separated from body contour; first lip annulus partially covering the second lip annulus. Stylet thin, very long (113-133 µm) and flexible, occupying 30.5-47.8% of body length. Excretory pore located from one or two annuli anterior to one or two annuli posterior to level of stylet knobs, at 42 (37-45) µm from anterior end. Female genital tract monodelphic, prodelphic, outstretched, and occupying 35-45% of body length, with vagina slightly ventrally curved (14-18 µm long). Anus located 6-11 annuli from the tail terminus. Tail conoid and bluntly rounded terminus, the last 2-3 annuli oriented dorsally. Results of molecular characterisation and phylogenetic analyses of D2-D3 expansion segments of 28S rRNA, ITS, and partial 18S rRNA, as well as cytochrome oxidase c subunit 1 gene sequences further characterised the new species and clearly separated it from X. macrodora and other related species (X. iberica, X. paraiberica, and X. pradense).

The more we search, the more we find: discovering and expanding the biodiversity in the ring nematode genus Xenocriconemella De Grisse and Loof, 1965 (Nematoda: Criconematidae).

The ring nematode genus Xenocriconemella De Grisse and Loof, 1965 comprises only one nominal species, Xenocriconemella macrodora (Taylor, 1936) De Grisse and Loof, 1965. The initial objective of the present study was to investigate the morphological-morphometric and molecular diversity of 28 X. macrodora populations in the Iberian Peninsula associated with tree forests (mainly Quercus spp.). However, a detailed integrative taxonomic analysis (morphological-morphometric and molecular data) from each population and analysis of this data using principal component analysis (PCA) for morphometric data (including these 28 populations and other 25 X. macrodora populations around the world) and molecular and phylogenetic species delimitation methods revealed that X. macrodora forms a species complex. This species complex is composed by species that are morphometricly and morphologically similar, but clearly different at the molecular level. Three new species are described applying integrative taxonomy, namely as Xenocriconemella iberica sp. nov., Xenocriconemella paraiberica sp. nov. and Xenocriconemella pradense sp. nov. However, the molecular diversity of this species in USA and Italy confirmed that additional species are likely present in this species complex, and the diversity of this group may be higher than expected. The study of X. macrodora topotypes can clarify the position of this species using molecular markers under an integrative approach.

Anatomical and molecular characterization of some rhigonematid parasites of millipedes in Nigeria, with new insights into their phylogeny.

Parasitic nematodes of millipedes from Nigeria are molecularly characterized for the first time. During nematode surveys on live giant African millipedes from several localities in Nigeria, 4 species of rhigonematids were identified by application of integrative taxonomical approaches (morpho-anatomy and molecular markers), including Brumptaemilius sp., Gilsonema gabonensis, Obainia pachnephorus, and Rhigonema disparovis. The results of morphometric and molecular analyses of D2-D3 28S, ITS, partial 18S rRNA, and cytochrome oxidase c subunit 1 (COI) gene sequences further characterized the rhigonematid species, and clearly separated them from other related species. Phylogenetic relationships based on 28S and 18S rRNA genes suggest that genera within Ransomnematoidea (Ransomnema, Heth, Carnoya, Brumptaemilius, Cattiena, Insulanema, Gilsonema) and Rhigonematoidea (Rhigonema, Obainia, Xystrognathus, Trachyglossoides, Ichthyocephaloides) clustered rather closer than could be expected in view of their morphological differences. Phylogenetic relationships based on ITS and COI are congruent with those of other ribosomal genes; however, they are not conclusive due to the scarcity of available sequences of these genes for these genera in NCBI.

A new needle nematode, Longidorus maginicus n. sp. (Nematoda: Longidoridae) from southern Spain.

During nematode surveys in natural vegetation in Sierra Mágina, Jaén province, southern Spain, a Longidorus species closely resembling Longidorus carpetanensis was found, but application of integrative taxonomic approaches clearly demonstrated that it is a new species described herein as Longidorus maginicus n. sp. The new species is amphimictic, characterized by a moderately long body (4.2-5.2 mm); lip region anteriorly flattened, slightly separated from the rest of body by a depression, 9.0-11.0 µm wide and 3.5-6.0 µm high; amphidial fovea not lobed; relatively short odontostyle (61.0-70.5 µm); guiding ring located 23.5-27.0 µm from anterior end; vulva located at 42.0%-51.3% of body length; female tail 39.0-61.0 µm long, conoid, dorsally convex with rounded terminus (c' = 1.3-2.1), with two or three pairs of caudal pores; and males common (1:2 ratio males:females), with moderately long spicules (39.0-48.5 µm) and 1 + 6-9 ventromedian supplements and three juvenile developmental stages. According to the polytomous key, codes for the new species are (codes in parentheses are exceptions): A2-B1-C2-D2-E1-F2(3)-G2-H5(4)-I2-J1-K6. The results of molecular analysis of D2-D3 28S, internal transcribed spacer region, partial 18S rDNA, and cytochrome oxidase c subunit 1 (coxI) gene sequences further characterized the new species status, and separated it from L. carpetanensis and other related species.

Predictores de éxito del tratamiento con cánula nasal de alto flujo en el fallo respiratorio agudo hipoxémico / Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure

Introducción: La terapia con cánula nasal de alto flujo (CNAF) se ha introducido recientemente en el tratamiento del fallo respiratorio agudo (FRA), siendo una técnica segura, confortable y eficaz que logra revertir la hipoxemia en estos pacientes. Es necesario disponer de herramientas que nos permitan detectar precozmente el fallo de este tipo de tratamiento para evitar el incremento de la mortalidad que puede conllevar. El objetivo primario de este estudio ha sido analizar el impacto que la frecuencia respiratoria (FR), la saturación periférica de oxígeno (SpO2), la fracción inspirada de oxígeno (FiO2) y el índice ROX (IROX=[SpO2/FiO2]/FR) tienen sobre el éxito de la CNAF en los pacientes con FRA hipoxémico. Los objetivos secundarios han sido analizar la estancia y la mortalidad en la UCI y la necesidad de ventilación mecánica (VM). Material y métodos Se trata de un estudio retrospectivo efectuado en una UCI polivalente del Hospital Comarcal de Montilla (Córdoba). Se incluyeron los pacientes tratados con CNAF por FRA hipoxémico desde enero de 2016 hasta enero de 2018.ResultadosDesde enero de 2016 hasta enero de 2018 se trataron 27 pacientes con FRA, de los cuales 19 (70,37%) presentaban FRA hipoxémico. De estos, 15 (78,95%) respondieron bien al tratamiento y 4 (21,05%) fracasaron. A las 2h de tratamiento la FR demostró ser el mejor predictor (área bajo la curva ROC [AUROC] 0,858; IC95%: 0,63-1,05; p=0,035). La FiO2 y el IROX fueron buenos predictores a las 8h de tratamiento (FiO2: AUROC 0,95; IC95%: 0,85-1,04; p=0,007, e IROX: AUROC 0,967; IC95%: 0,886-1,047; p=0,005). El mejor punto de corte de la FR a la segunda hora fue de 29 respiraciones/min (sensibilidad 75%, especificidad 87%). El mejor punto de corte de la FiO2 a las 8h de tratamiento fue de 0,59 (75% sensibilidad, 93% especificidad). El mejor punto de corte para IROX a las 8h de tratamiento fue de 5,98 (sensibilidad 100%, especificidad 75%). ... (AU)

Background: High-flow nasal cannula (HFNC) therapy is used in the treatment of acute respiratory failure (ARF) and is both safe and effective in reversing hypoxemia. In order to minimize mortality and clinical complications associated to this practice, a series of tools must be developed to allow early detection of failure. The present study was carried out to: (i)examine the impact of respiratory rate (RR), peripheral oxygen saturation (SpO2), ROX index (ROXI=[SpO2/FiO2]/RR) and oxygen inspired fraction (FiO2) on the success of HFNC in patients with hypoxemic ARF; and (ii)analyze the length of stay and mortality in the ICU, and the need for mechanical ventilation (MV).MethodsA retrospective study was carried out in the medical-surgical ICU of Hospital de Montilla (Córdoba, Spain). Patients diagnosed with hypoxemic ARF and treated with HFNC from January 2016 to January 2018 were included.ResultsOut of 27 patients diagnosed with ARF, 19 (70.37%) had hypoxemic ARF. Fifteen of them (78.95%) responded satisfactorily to HFNC, while four (21.05%) failed. After two hours of treatment, RR proved to be the best predictor of success (area under the ROC curve [AUROC] 0.858; 95%CI: 0.63-1.05; P=.035). For this parameter, the optimal cutoff point was 29rpm (sensitivity 75%, specificity 87%). After 8hours of treatment, FiO2 and ROXI were reliable predictors of success (FiO2: AUROC 0.95; 95%CI: 0.85-1.04; P=.007 and ROXI: AUROC 0.967; 95%CI: 0.886-1.047; P=.005). In the case of FiO2 the optimal cutoff point was 0.59 (sensitivity 75%, specificity 93%), while the best cutoff point for ROXI was 5.98 (sensitivity 100%, specificity 75%). Using a Cox regression model, we found RR<29rpm after two hours of treatment, and FiO2<0.59 and ROXI>5.98 after 8hours of treatment, to be associated with a lesser risk of MV (RR: HR 0.103; 95%CI: 0.11-0.99; P=.05; FiO2: HR 0.053; 95%CI: 0.005-0.52; P=.012; and ROXI: HR 0.077; 95%CI: 0.008-0.755; P=.028, respectively). ... (AU)

Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure. / Predictores de éxito del tratamiento con cánula nasal de alto flujo en el fallo respiratorio agudo hipoxémico.

BACKGROUND: High-flow nasal cannula (HFNC) therapy is used in the treatment of acute respiratory failure (ARF) and is both safe and effective in reversing hypoxemia. In order to minimize mortality and clinical complications associated to this practice, a series of tools must be developed to allow early detection of failure. The present study was carried out to: (i)examine the impact of respiratory rate (RR), peripheral oxygen saturation (SpO2), ROX index (ROXI=[SpO2/FiO2]/RR) and oxygen inspired fraction (FiO2) on the success of HFNC in patients with hypoxemic ARF; and (ii)analyze the length of stay and mortality in the ICU, and the need for mechanical ventilation (MV). METHODS: A retrospective study was carried out in the medical-surgical ICU of Hospital de Montilla (Córdoba, Spain). Patients diagnosed with hypoxemic ARF and treated with HFNC from January 2016 to January 2018 were included. RESULTS: Out of 27 patients diagnosed with ARF, 19 (70.37%) had hypoxemic ARF. Fifteen of them (78.95%) responded satisfactorily to HFNC, while four (21.05%) failed. After two hours of treatment, RR proved to be the best predictor of success (area under the ROC curve [AUROC] 0.858; 95%CI: 0.63-1.05; P=.035). For this parameter, the optimal cutoff point was 29rpm (sensitivity 75%, specificity 87%). After 8hours of treatment, FiO2 and ROXI were reliable predictors of success (FiO2: AUROC 0.95; 95%CI: 0.85-1.04; P=.007 and ROXI: AUROC 0.967; 95%CI: 0.886-1.047; P=.005). In the case of FiO2 the optimal cutoff point was 0.59 (sensitivity 75%, specificity 93%), while the best cutoff point for ROXI was 5.98 (sensitivity 100%, specificity 75%). Using a Cox regression model, we found RR<29rpm after two hours of treatment, and FiO2<0.59 and ROXI>5.98 after 8hours of treatment, to be associated with a lesser risk of MV (RR: HR 0.103; 95%CI: 0.11-0.99; P=.05; FiO2: HR 0.053; 95%CI: 0.005-0.52; P=.012; and ROXI: HR 0.077; 95%CI: 0.008-0.755; P=.028, respectively). CONCLUSIONS: RR after two hours of treatment, and FiO2 and ROXI after 8hours of treatment, were the best predictors of success of HFNC. RR<29rpm, FiO2<0.59 and ROXI>5.98 were associated with a lesser risk of MV.

Analysis of alternariol and alternariol monomethyl ether in foodstuffs by molecularly imprinted solid-phase extraction and ultra-high-performance liquid chromatography tandem mass spectrometry.

Molecularly imprinted porous polymer microspheres selective to Alternaria mycotoxins, alternariol (AOH) and alternariol monomethyl ether (AME), were synthesized and applied to the extraction of both mycotoxins in food samples. The polymer was prepared using 4-vinylpiridine (VIPY) and methacrylamide (MAM) as functional monomers, ethylene glycol dimethacrylate (EDMA) as cross-linker and 3,8,9-trihydroxy-6H-dibenzo[b,d]pyran-6-one (S2) as AOH surrogate template. A molecularly imprinted solid phase extraction (MISPE) method has been optimized for the selective isolation of the mycotoxins from aqueous samples coupled to HPLC with fluorescence (λex=258nm; λem=440nm) or MS/MS analysis. The MISPE method was validated by UPLC-MS/MS for the determination of AOH and AME in tomato juice and sesame oil based on the European Commission Decision 2002/657/EC. Method performance was satisfactory with recoveries from 92.5% to 106.2% and limits of quantification within the 1.1-2.8µgkg-1 range in both samples.

The utility of mtDNA and rDNA for barcoding and phylogeny of plant-parasitic nematodes from Longidoridae (Nematoda, Enoplea).

The traditional identification of plant-parasitic nematode species by morphology and morphometric studies is very difficult because of high morphological variability that can lead to considerable overlap of many characteristics and their ambiguous interpretation. For this reason, it is essential to implement approaches to ensure accurate species identification. DNA barcoding aids in identification and advances species discovery. This study sought to unravel the use of the mitochondrial marker cytochrome c oxidase subunit 1 (coxI) as barcode for Longidoridae species identification, and as a phylogenetic marker. The results showed that mitochondrial and ribosomal markers could be used as barcoding markers, except for some species from the Xiphinema americanum group. The ITS1 region showed a promising role in barcoding for species identification because of the clear molecular variability among species. Some species presented important molecular variability in coxI. The analysis of the newly provided sequences and the sequences deposited in GenBank showed plausible misidentifications, and the use of voucher species and topotype specimens is a priority for this group of nematodes. The use of coxI and D2 and D3 expansion segments of the 28S rRNA gene did not clarify the phylogeny at the genus level.

Mitochondrial genome diversity in dagger and needle nematodes (Nematoda: Longidoridae).

Dagger and needle nematodes included in the family Longidoridae (viz. Longidorus, Paralongidorus, and Xiphinema) are highly polyphagous plant-parasitic nematodes in wild and cultivated plants and some of them are plant-virus vectors (nepovirus). The mitochondrial (mt) genomes of the dagger and needle nematodes, Xiphinema rivesi, Xiphinema pachtaicum, Longidorus vineacola and Paralongidorus litoralis were sequenced in this study. The four circular mt genomes have an estimated size of 12.6, 12.5, 13.5 and 12.7 kb, respectively. Up to date, the mt genome of X. pachtaicum is the smallest genome found in Nematoda. The four mt genomes contain 12 protein-coding genes (viz. cox1-3, nad1-6, nad4L, atp6 and cob) and two ribosomal RNA genes (rrnL and rrnS), but the atp8 gene was not detected. These mt genomes showed a gene arrangement very different within the Longidoridae species sequenced, with the exception of very closely related species (X. americanum and X. rivesi). The sizes of non-coding regions in the Longidoridae nematodes were very small and were present in a few places in the mt genome. Phylogenetic analysis of all coding genes showed a closer relationship between Longidorus and Paralongidorus and different phylogenetic possibilities for the three Xiphinema species.

Multi-residue analysis of 36 priority and emerging pollutants in marine echinoderms (Holothuria tubulosa) and marine sediments by solid-liquid extraction followed by dispersive solid phase extraction and liquid chromatography-tandem mass spectrometry analysis.

Marine echinoderms are filter-feeding invertebrates widely distributed along the coasts, and which are therefore extensively exposed to anthropogenic xenobiotics. They can serve as good sentinels for monitoring a large variety of contaminants in marine ecosystems. In this context, a multi-residue analytical method has been validated and applied to Holothuria tubulosa specimens and marine sediments for the determination of 36 organic compounds, which belong to some of the most problematic groups of emerging and priority pollutants (perfluoroalkyl compounds, estrogens, parabens, benzophenones, plasticizers, surfactants, brominated flame retardants and alkylphenols). Lyophilization of samples prior to solvent extraction and clean-up of extracts with C18, followed by liquid chromatography-tandem mass spectrometry analysis, is proposed. A Box-Behnken design was used for optimization of the most influential variables affecting the extraction and clean-up steps. For validation, matrix-matched calibration and recovery assay were applied. Linearity (% r2) higher than 99%, recoveries between 80% and 114% (except in LAS and NP1EO), RSD (precision) lower than 15% and limits of quantification between 0.03 and 12.5ngg-1 dry weight (d.w.) were achieved. The method was applied to nine samples of Holothuria collected along the coast of Granada (Spain), and to marine sediments around the animals. The results demonstrated high bioaccumulation of certain pollutants. A total of 25 out of the 36 studied compounds were quantified, being surfactants, alkylphenols, perfluoroalkyl compounds, triclocarban and parabens the most frequently detected. Nonylphenol was found in the highest concentration (340 and 323ngg-1 d.w. in sediment and Holothuria samples, respectively).

Acute physiological responses to castration-related pain in piglets: the effect of two local anesthetics with or without meloxicam.

Methods to reduce castration-related pain in piglets are still issues of concern and interest for authorities and producers. Our objectives were to estimate the effectiveness of two protocols of local anesthesia (lidocaine and the combination of lidocaine+bupivacaine) as well as the use of meloxicam as a postoperative analgesic in alleviating castration-related pain, measured by acute physiological responses. Eight groups (15 piglets/group) were included in the study: (1) castration without anesthesia or analgesia, without meloxicam (TRAD WITHOUT), (2) castration without anesthesia or analgesia, but with meloxicam (TRAD WITH), (3) handling without meloxicam (SHAM WITHOUT), (4) handling with meloxicam (SHAM WITH), (5) castration after local anesthesia with lidocaine but without meloxicam (LIDO WITHOUT), (6) castration after local anesthesia with lidocaine and meloxicam (LIDO WITH), (7) castration after local anesthesia with lidocaine+bupivacaine without meloxicam (LIDO+BUPI WITHOUT), (8) castration after local anesthesia with lidocaine+bupivacaine and meloxicam (LIDO+BUPI WITH). Acute physiological responses measured included skin surface temperature and serum glucose and cortisol concentrations. On days 4 and 11 post-castration BW was recorded and average daily gain was calculated over this period. Furthermore, piglet mortality was recorded over the 11-day post-castration period. Administration of local anesthetic or meloxicam did not prevent the decrease in skin surface temperature associated with castration. Lidocaine reduced the increase in glucose concentration associated with castration. For castrated pigs, the joint use of lidocaine and meloxicam caused a significant decrease in cortisol concentration; the combination of intratesticular lidocaine and bupivacaine did not seem to be more effective than lidocaine alone. No effect of treatments on mortality and growth were detected.

Síndrome coronario agudo sintomático en el seguimiento de una cohorte en el postoperatorio de cirugía no cardiaca / Symptomatic acute coronary syndrome in a cohort of patients followed after noncardiac surgery

Objetivo: Determinar la incidencia del síndrome coronario agudo (SCA) sintomático con y sin elevación del ST, los factores con los que se relacionó, la estancia media y la mortalidad atribuible en el periodo postoperatorio en pacientes de cirugía no cardiaca. Material y métodos: Se registraron prospectivamente los datos de una cohorte de pacientes intervenidos de cirugía no cardíaca que pasaron por la unidad de reanimación postoperatoria del Hospital General de Ciudad Real en el periodo comprendido entre abril de 2006 y diciembre de 2009. Se evaluó la incidencia de SCA sintomático. Resultados: Treinta y dos de 1.919 pacientes presentaron SCA (incidencia 1,7%). Los factores asociados fueron: sexo varón (p = 0,046), edad (p = 0,001), hipertensión arterial (68,8%; p = 0,012) y cardiopatía isquémica previa (34,4% p = 0,001). Los pacientes que sufrieron intervenciones quirúrgicas que presentaron SCA postoperatorio de forma significativa (p < 0,004) fueron cirugía general (37,5%), ortopedia-traumatología (28,1%) y cirugía vascular (15,6%). Fueron transfundidos el 20% de los pacientes en general, y el 50% de los que tuvieron SCA (p = 0,001). El tratamiento fue médico en el 87,5% de los pacientes. La estancia media de los pacientes en la unidad fue de 2,96 ± 6,3 días frente a 3,88 ± 5 días en los pacientes con SCA (p = 0,39) y la mortalidad del 5% frente al 6% respectivamente (p = 0,45). El análisis multivariante mostró como variables independientes para presentar SCA en el periodo postoperatorio: antecedentes de cardiopatía isquémica (OR = 4,59; IC 95% 1,98-10,62), y sangrado quirúrgico (OR =3,18; IC 95%, 1,51-6,71). La cirugía ginecológica (OR = 0,063; IC 95%, 0,004-1,09) mostró la menor probabilidad de presentar dicha alteración en el postoperatorio. Conclusión: La incidencia de SCA en nuestra cohorte en el postoperatorio de cirugía no cardiaca es del 1,7%. Son factores de riesgo la edad, el sexo masculino, los antecedentes de hipertensión arterial y cardiopatía isquémica, el tipo de cirugía y la hemorragia operatoria que precisó transfusión de concentrados de hematíes. Dada la gravedad de esta complicación es importante estratificar el riesgo de estos pacientes preoperatoriamente(AU)

Objetives: To determine the incidence of acute coronary syndrome (ACS) with and without ST-segment elevation, factors related to the development of ACS, mean hospital stay, and attributable mortality. Material and methods: In a noncardiac surgery cohort attended in the postoperative critical care unit of Hospital General de la Ciudad Real, Spain, data were recorded prospectively between April 2006 and December 2009. The incidence of symptomatic ACS was calculated. Results: Thirty-two of 1919 patients developed ACS (incidence, 1.7%). Patient factors related to developing the syndrome were male sex (P=.046), age (P=.001), arterial hypertension (68.8%, P=.012), and a history of ischemic heart disease (34.4%, P=.001). Types of surgery that were significantly related to developing ACS were general surgery (37.5%), orthopedic or trauma surgery (28.1%), and vascular surgery (15.6%) (P<.004). Twenty percent of the cohort received transfusions; 50% of those who developed ACS were transfused (P=.001). The condition was treated medically in 87.5% of the cases. The mean (SD) duration of hospital stay was 2.96 (6.3) days for the cohort and 3.88 (5) days for patients who developed ACS (P=.39); mortality rates were 5% and 6%, respectively (P=.45). Multivariate analysis confirmed that the following independent variables were associated with developing postoperative ACS: a history of ischemic heart disease (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.98-10.62) and intraoperative bleeding (OR, 3.18; 95% CI, 1.51-6.71). Gynecologic surgery patients were the least likely to develop postoperative ACS (OR, 0.063; 95% CI, 0.004-1.09). Conclusions: The incidence of postoperative ACS in this noncardiac surgery cohort was 1.7%. Age, male sex, a history of arterial hypertension or ischemic heart disease, type of surgery, and intraoperative bleeding requiring transfusion of packed red blood cells are factors that are associated with developing this complication. Given the seriousness of ACS it is important to classify patients by risk before surgery(AU)

[Symptomatic acute coronary syndrome in a cohort of patients followed after noncardiac surgery]. / Síndrome coronario agudo sintomático en el seguimiento de una cohorte en el postoperatorio de cirugía no cardiaca.

OBJECTIVES: To determine the incidence of acute coronary syndrome (ACS) with and without ST-segment elevation, factors related to the development of ACS, mean hospital stay, and attributable mortality. MATERIAL AND METHODS: In a noncardiac surgery cohort attended in the postoperative critical care unit of Hospital General de la Ciudad Real, Spain, data were recorded prospectively between April 2006 and December 2009. The incidence of symptomatic ACS was calculated. RESULTS: Thirty-two of 1919 patients developed ACS (incidence, 1.7%). Patient factors related to developing the syndrome were male sex (P=.046), age (P=.001), arterial hypertension (68.8%, P=.012), and a history of ischemic heart disease (34.4%, P=.001). Types of surgery that were significantly related to developing ACS were general surgery (37.5%), orthopedic or trauma surgery (28.1%), and vascular surgery (15.6%) (P<.004). Twenty percent of the cohort received transfusions; 50% of those who developed ACS were transfused (P=.001). The condition was treated medically in 87.5% of the cases. The mean (SD) duration of hospital stay was 2.96 (6.3) days for the cohort and 3.88 (5) days for patients who developed ACS (P=.39); mortality rates were 5% and 6%, respectively (P=.45). Multivariate analysis confirmed that the following independent variables were associated with developing postoperative ACS: a history of ischemic heart disease (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.98-10.62) and intraoperative bleeding (OR, 3.18; 95% CI, 1.51-6.71). Gynecologic surgery patients were the least likely to develop postoperative ACS (OR, 0.063; 95% CI, 0.004-1.09). CONCLUSIONS: The incidence of postoperative ACS in this noncardiac surgery cohort was 1.7%. Age, male sex, a history of arterial hypertension or ischemic heart disease, type of surgery, and intraoperative bleeding requiring transfusion of packed red blood cells are factors that are associated with developing this complication. Given the seriousness of ACS it is important to classify patients by risk before surgery.

Bloqueo paravertebral torácico. Resultados a corto plazo en relación con la recidiva del cáncer de mama después de la cirugía / No disponible

Objetivo: Existen estudios en animales con cáncer de mama y estudios retrospectivos en humanos que sugieren una reducción de riesgo de metástasis tras realizar una anestesia regional en la cirugía de mama. Hemos estudiado si la realización de bloqueo paravertebral torácico (BPVT) asociado a una anestesia general comparado con una anestesia general sin BPVT reduce la incidencia de metástasis a corto plazo en las pacientes sometidas a cirugía oncológica de mama. Métodos: Se recogieron retrospectivamente 138 pacientes sometidas a cirugía de mama (bien cirugía conservadora, o bien mastectomía, en ambos casos con o sin linfadenectomía) en el periodo entre enero de 2008 hasta junio de 2009. Se consideraron las siguientes variables: edad, peso, antecedentes personales, tipo de tumor, grado histológico, TNM, índice de Nottingham, si recibió o no terapia sistémica, tipo de cirugía, tipo de anestesia, metástasis a 6 meses y a 12 meses, y la supervivencia libre de enfermedad. Resultados: En 40 pacientes se practicó un BPVT más anestesia general, y en 98 anestesia general solamente. En cuanto al grado histológico, clasificación TNM, índice de Nottingham y terapia sistémica no presentaban diferencias entre los dos grupos. La aparición de metástasis a 6 meses fue de 2,5% en el grupo de anestesia con BPVT y de un 6,1% en el grupo de anestesia general (p = 0,673), y a 12 meses, un 2,5% en el grupo de anestesia general con BPVT, y un 9,2% en el de anestesia general (p = 0,281). El consumo intraoperatorio de fentanilo y remifentanilo y de analgesia postoperatoria fue mayor en el grupo con anestesia general. Conclusiones: En este estudio retrospectivo el porcentaje de metástasis fue menor tanto a 6 como a 12 meses en las pacientes en las que se realizó un bloqueo paravertebral con respecto a las que se realizó anestesia general exclusivamente, sin que la diferencia fuera estadísticamente significativa(AU)

Objectives: A reduction in risk of metastasis after performing regional anesthesia in breast surgery has been suggested in both animal studies and retrospectives human studies with breast cancer. We studied whether thoracic paravertebral block (TPVB) associated with general anesthesia compared with general anesthesia reduces the metastases incidence in short term in patients undergoing breast cancer surgery. Methods: 138 patients undergoing breast surgery (either conservative breast surgery or mastectomy, both of them with or without lymphadenectomy) were retrospectively examined between January 2008 and June 2009. The following variables were recorded: age, weight, medical history, type of tumor, histological grade, TNM, Nottingham Index, adjuvant therapy, type of surgery, type of anesthesia, metastasis at 6 and 12 months and disease-free survival. Results: In 40 patients a TPVB combined with general anesthesia were performed, and 98 patients had general anesthesia alone. There were no differences in histological grade, TNM classification, Nottingham index and adjuvant therapy between the two groups. Metastasis at 6 months was 2.5% in the group of anesthesia combined with TPVB and 6.1% in the General Anesthesia group (p = 0.673). At 12 months was 2.5% and 9.2%, respectively (p = 0.281). The intraoperative consumption of fentanyl and remifentanil and postoperative analgesia requirements were higher in the group with general anesthesia. Conclusions: In this retrospective study, the rate of metastasis was lower at both 6 and 12 months in patients who underwent the paravertebral block combined with general anesthesia compared to general anesthesia. However, differences between both groups were not found to be significant(AU)

Spinal anesthesia for emergency abdominal surgery in uncontrolled hyperthyroidism.

Patients with uncontrolled hyperthyroidism presenting as an emergency are at considerable risk. The anesthetic management of a thyrotoxic patient undergoing incidental emergency surgery is discussed. We focus on the intraoperative problems and, above all, postoperative pain management with regional anesthesia.

[Acute pain in "Don Quixote"]. / El dolor agudo en El Quijote.

OBJECTIVE: A descriptive analysis of references to pain symptoms in Don Quixote based on linguistic, literary, clinical, and mannerist features. METHODS AND MATERIAL: Don Quixote was read and an entry was created for each description of an injury or illness (group I/I). A second group of entries was created for each medical commentary (group C). This information was complemented using a computer search for the roots of words referring to pain symptoms, with an asterisk placed after each root to locate all word forms used. Data entries with pain references were analyzed in group I/I by examining patient, location, characteristics, causes, associated disorders, remedies, caregivers, and recovery times and in group C by examining the full text. RESULTS: Ninety-one entries were made (64 in group I/I, 27 in group c). References to pain were found in 37 entries (29 in group I/I, 8 in group C). The most commonly used words came from the roots dol (the Spanish root for dolor, or pain, among other related words) (52) and moli (for forms related to Spanish idiomatic uses of molido, suggesting severe injury) (19). All pains were due to injuries. Forty-two occasions of injury (Don Quixote 14, Sancho 9, others 19) and 51 lesions (ribs 5, back 5, other 15, unspecified 26) were mentioned. Known remedies and caregivers of the period were described, but other invented ones were also present. Associated disorders were insomnia, anxiety, rage, melancholy, functional impotence and other sexual dysfunctions. Recovery times ranged from 0 to 8 days. CONCLUSION: Pain references are subject to literary considerations. The style is simple and the descriptions are credible for the period depicted but do not meet clinical standards. Issues of current interest are treated: pain threshold and sensitivity, social influences, the placebo effect, and affective disorders.

El dolor agudo en El Quijote / Acute pain in Don Quixote

JUSTIFICACIÓN Y OBJETIVOS: Análisis descriptivo de las referencias al síntoma dolor en El Quijote desde el punto de vista lingüístico, literario, clínico y costumbrista. MATERIAL Y MÉTODOS: Lectura del texto haciendo una ficha de cada traumatismo o enfermedad descrito (grupo T) y de los comentarios relativos a la medicina (grupo C). Se completó la información con una búsqueda informática, utilizando la raíz de las palabras que designaban el síntoma dolor seguida de asterisco para incluir todas las variaciones gramaticales. Se analizaron las fichas que incluían alusiones al dolor; en el grupo T se recogió en cada caso: pacientes, localización, características, causas, trastornos asociados, remedios, sanadores y tiempos de recuperación, en el grupo C el texto completo. RESULTADOS: Total 91 fichas (64 T, 27 C). Referencias al dolor en 37 (29 T, 8 C). Las palabras más utilizadas provienen de las raíces: dol (52) y moli (19). Todos los dolores son de causa traumática. Lesionados 42 (Don Quijote: 14, Sancho: 9, otros: 19). Lesiones 51 (costillas: 5, espalda: 5, varios: 15, no precisado: 26). Se citan remedios y sanadores de la época y otros fantásticos. Trastornos asociados: insomnio, ansiedad, furor, hipoventilación, melancolía, impotencia funcional y sexual. Tiempos de recuperación: 0 a 8 días. CONCLUSIONES: Las referencias al dolor se supeditan a consideraciones literarias, el lenguaje es sencillo y son verosímiles para la época, pero no se ajustan a criterios clínicos. Se tratan aspectos de interés científico actual: umbral y sensibilidad, sociología, efecto placebo, trastornos afectivos (AU)

Hodgkin's disease. Prognostic value of Gallium-67 scintigraphy.

AIM: The aim of this study is to assess the clinical impact of gallium-67 scintigraphy, before and after treatment, in patients with Hodgkin's disease, and to compare the overall survival between the patients whose gallium studies after treatment were negative and those whose studies remained positive. METHODS: We have studied 75 patients (40 women, 35 men) with Hodgkin's disease. All the patients underwent (67)Ga scintigraphy at the moment of the diagnosis (basal study) and in the case that basal study was positive (abnormal hyper-uptake focus) we performed follow-up studies after the treatment. We have calculated the overall survival among patients whose studies after treatment were negative (1(st) group) and those whose studies remained positive (2(nd) group) and between patients whose studies were negative at diagnosis (3(rd) group). RESULTS: Gallium scintigraphy was positive at diagnosis in 47 patients (62.6%). In 39 of them we were able to perform the follow-up study after treatment. The follow-up study was negative in 31 patients while in 8 patients the gallium scintigraphy remained positive. The overall survival was significantly higher (p<0.001) in the 1(st) group compared with the 2(nd) group. The overall survival was higher in the 1(st) group compared with the 3(rd) but statistic significance level was not reached. CONCLUSION: Our data suggest that: 1) in Hodgkin's disease (67)Ga scintigraphy is useful to establish the diagnosis of complete remission; 2) if the gallium scan remains positive after treatment, the prognosis of patients is worse than the prognosis of patients with a negative scan.