Thrombotic Event Prevention in Patients Undergoing Posterior Lumbar Arthrodesis: our experiencie. A retrospective case series study. / Prevención de eventos trombóticos en pacientes sometidos a cirugía de artrodesis lumbar por vía posterior: experiencia en nuestro centro. Estudio retrospectivo de casos.

INTRODUCTION: There is no generalized consensus regarding perioperative prophylaxis of venous thromboembolism (VTE), either on using or timing it in patients undergoing spine surgery. VTE is a current concern because, even though being an uncommon event, it can cause serious complications. The aim of the present study is to propose guidelines for the prevention of thrombotic events in posterior spinal surgery, either as deep vein thrombosis or pulmonary thromboembolism. If the number of patients getting prophylaxis drugs is reduced a subsequent reduction of the incidence of epidural hematoma can be expected. MATERIALS AND METHODS: A number of 235 patients who had undergone posterior spinal arthrodesis in the previous five years were studied. Mechanical thromboprophylaxis measures consisting of compression stockings were applied in all of them. Anticoagulant drugs were also applied whenever risk factors for thrombosis were observed. Early weight-bearing was resumed immediately after surgery. Demographic, clinical, and surgical variables were collected, as well as complications appearing during the follow-up period, that was scheduled at one, two, four, six and twelve months after the surgery. Thrombotic events, if present, were diagnosed by clinical and imaging tests such as ultrasound and CT angiography. RESULTS: From the total 235 patients of this series, one hundred and fifty-three cases met the study inclusion criteria. A total of four thrombotic events appeared, one in the form of deep vein thrombosis and other three in the form of pulmonary thromboembolism. These last patients suffering an embolism died because of it. None of the variables studied had statistical significance for the occurrence of a thrombotic event. All four patients who suffered thrombotic events were receiving anticoagulant drugs, in addition to mechanical compression stockings, because of the presence of risk factors for thrombosis. CONCLUSIONS: By applying the fore mentioned protocol, adequate prevention of thromboembolic events was achieved in this study population of patients undergoing posterior spinal surgery.

Association of the superior semicircular canal and tegmen tympani dehiscences and its relationship with the pneumatisation of the temporal bone.

PURPOSE: To analyse the degree of pneumatisation of the temporal bone when there is an association between dehiscence of the superior semicircular canal and dehiscence of the tegmen tympani. MATERIALS AND METHODS: We analysed a retrospective CT study of 124 selected cases. A single inclusion criterion was applied: the presence of a dehiscence of the tegmen tympani. On the other hand, the degree of temporal pneumatisation was assessed by axial and coronal planes, and has been divided into the following grades O, I, II and III, according to the status and relationship of the mastoid, the bony labyrinth, the petrous segment of the carotid canal and sigmoid sinus. RESULTS: Of the 124 cases studied, 35 (28.2%) presented both dehiscences. In 26 of the 35 (47.3%), grade II pneumatisation, 4 (14,8%), grade I, and 5 (11,9%) grade III was observed, with a statistically significant relationship (p < 0.001). On the other hand, we did not find a significant relationship when relating both dehiscences in any age or sex group. However, when relating the degree of pneumatisation to sex, among those with grade III pneumatisation, the proportion of men (52.4%) was significantly higher than that of women (47.6%) (p = 0.017). CONCLUSION: We have detected a statistically significant relationship between the coexistence of grade II pneumatisation and the presence of both dehiscences in the temporal bone.

100 Years since Robert Barany's visit to the Zaragoza medical faculty.

In December 1923, a twelve-day course took place at the University of Zaragoza, specifically at the Faculty of Medicine, given by Professor Róbert Bárány, who was awarded the Nobel Prize for Medicine in 1914 for his discoveries on the vestibular apparatus.Professor Robert Bárány came to the faculty at the invitation of Professor Victor Fairén through the University Exchange programme. This course consisted of four lectures and twelve lessons a day in which he presented his knowledge of the physiopathology of the vestibule and cerebellum, as well as practical demonstrations of the physical examination of nystagmus and cerebellar pathology.Lorente de Nó, a doctorate student of medicine, was one of the most outstanding students on the course. His intellect was already outstanding in those years, which helped him to discuss the physiopathology of nystagmus with Professor Bárány. The relationship he forged with the Nobel laureate in Zaragoza would be decisive for his future as a researcher.The aim of this work is to compile and integrate the available information on the course that Professor Bárány took in the city of Zaragoza, consulting official documents from the university and the city, articles, books and the press of the time.

Neurophobia among resident physicians in the emergency service. / Neurofobia entre médicos residentes en los servicios de urgencias.

INTRODUCTION: Neurophobia is defined as the fear towards clinical neurology caused by the inability to apply theoretical knowledge to practical clinical situations. This phenomenon is not restricted to medical students and has never been studied before in the Emergency Department. We aimed to study how resident doctors perceive their knowledge in neurology and urgent neurological conditions as well as possible causes for said fears. MATERIALS AND METHODS: Cross-sectional multicentric study using self-administered surveys sent to medical residents within the Aragon Health Service. They were questioned about their fear of neurology and other medical specialties, possible causes, and perception of knowledge in neurological pathologies and subareas in the emergency service. RESULTS: We obtained 134 responses. 27.6% (37) suffered from neurophobia. Despite neurology being considered the most difficult discipline, it did also arouse the third most interest among the students. The areas where they showed the most confidence were headaches and vascular pathology. The areas where they felt the most insecure were neuromuscular diseases, neuro-ophthalmology, and spinal cord injury. In none of the areas surveyed, the percentage of respondents who felt secure exceeded 50%. CONCLUSIONS: Neurophobia is prevalent among trainee doctors working in the emergency department. Their confidence correlates with the degree of exposure to patients. Neurologist must play an active role in the education of new specialist and promote the collaboration with emergency departments.

TITLE: Neurofobia entre médicos residentes en los servicios de urgencias.Introducción. La neurofobia se define como el miedo hacia la neurología que surge de la incapacidad para aplicar los conocimientos teóricos a situaciones clínicas prácticas. Este fenómeno parece no limitarse únicamente a estudiantes de medicina, pero no se dispone de estudios previos en el ámbito de urgencias. Este trabajo valora la percepción de conocimientos en las distintas patologías neurológicas urgentes por parte de médicos en formación y posibles motivos de neurofobia. Material y métodos. Se trata de un estudio transversal multicéntrico mediante encuestas autoadministradas a médicos en formación de todo el Servicio Aragonés de Salud. Se interrogó sobre su miedo a la neurología y otras especialidades médicas, posibles causas y percepción de conocimientos en patologías neurológicas en el servicio de urgencias. Resultados. Se obtuvieron 134 respuestas. El 27,6% (37) sufría neurofobia. La neurología fue la tercera disciplina que mayor interés despertó, pero se considera la de mayor dificultad. Las áreas en las que mayor seguridad mostraron fueron las cefaleas y la patología vascular. Donde mayor inseguridad existía fue en la neuromuscular, la neurooftalmología y la lesión medular aguda. En ninguna de las áreas hubo un porcentaje mayor del 50% que se sintiera seguro o muy seguro. Conclusiones. La neurofobia está presente entre los médicos en formación que desempeñan su labor en los servicios de urgencias. Su distribución depende del grado de exposición a los pacientes. Los neurólogos debemos desempeñar un papel activo en la formación de nuevos especialistas y promover la colaboración con los servicios de urgencias.

Neurophobia among undergraduate medical students: a European experience beyond the Anglosphere. / Neurofobia entre los estudiantes de medicina de una universidad española: experiencias más allá de la anglosfera.

INTRODUCTION: Neurophobia is defined as the fear of the neural sciences and clinical neurology that is due to the students' inability to apply their knowledge of basic sciences to clinical situations. This phenomenon, well documented in the Anglosphere, has seldom been studied in other European countries and never in our country. Our study aimed to determine whether said fear existed among Spanish medical students. MATERIAL AND METHODS: A self-administered questionnaire with 18 items was sent to medical students in the second, fourth and sixth years of medical school at a Spanish university during the academic years 2020-2021 and 2021-2022. They were questioned about their fears regarding neurology and neurosciences, causes and potential solutions. RESULTS: Out of 320 responses, 34.1% suffered from neurophobia and only 31.2% felt confident they knew what neurologists do. Despite Neurology being considered the most difficult discipline, it did also arouse the most interest among the students. Main reasons identified for neurophobia were too theoretical lectures (59.4%), neuroanatomy (47.8%), and a lack of integration between neuroscience subjects (39.5%). Solutions considered most important by the students to reverse this situation went along those lines. CONCLUSION: Neurophobia is prevalent among Spanish medical students too. Having identified the teaching methodology as one of its fundamental causes, neurologists have the opportunity and obligation to reverse this situation. We should strive for more proactive involvement of neurologists at earlier stages of medical education.

TITLE: Neurofobia entre los estudiantes de medicina de una universidad española: experiencias más allá de la anglosfera.Introducción. Definimos neurofobia como el miedo a las neurociencias y la neurología clínica, fundamentalmente asociado a la falta de capacidad del estudiante para aplicar sus conocimientos teóricos. Esta sensación, bien contrastada en el sistema anglosajón, ha sido poco estudiada en otros territorios europeos y nunca en nuestro país. Nuestro objetivo es analizar si este miedo hacia la neurología también existe entre estudiantes de una universidad española. Material y métodos. Estudio mediante encuestas autoadministradas a estudiantes de segundo, cuarto y sexto año de medicina de la Universidad de Zaragoza durante los cursos académicos 2020-2021 y 2021-2022. Cuestionario de 18 preguntas que recoge la percepción hacia la neurología y el resto de las neurociencias y su comparación con respecto a otras especialidades médicas. Resultados. De los 320 encuestados, el 34,1% sufriría neurofobia y tan sólo el 31,2% tendría claro a qué se dedica un neurólogo. A pesar de ser la especialidad considerada más difícil, es también la que mayor interés despierta. Los principales motivos para ese miedo son una enseñanza eminentemente teórica (59,4%), la neuroanatomía (47,8%) y una falta de integración entre las asignaturas de neurociencias (39,5%). Las soluciones consideradas de mayor peso por los alumnos para revertir esta situación irían en esa línea. Conclusiones. La neurofobia es también un problema en la formación universitaria española. Identificada la metodología docente como una de sus causas fundamentales, los neurólogos tenemos la oportunidad y la obligación de intentar revertir esta situación. Para ello, será necesario participar activamente en la formación de los futuros médicos desde las etapas más tempranas del grado.

Crop year, harvest date and clone effects on fruit characteristics, chemical composition and olive oil stability from an Empeltre clonal selection grown in Aragon.

BACKGROUND: In this study, the effects of crop year, harvest date and clone on the fruit characteristics and chemical composition of Empeltre olive oils were evaluated. For this purpose, the weight and oil content of fruit and the fatty acid composition, polyphenol content and oxidative stability of the olive oil was analysed throughout ripening during three successive seasons. RESULTS: The weight and moisture in the fruit, as well as the fatty acids and polyphenol content in the olive oil, were mainly affected by crop year. In contrast, the stability was strongly influenced by the harvest date. Both factors had an influence on the fruit's oil content. The clone was not a substantial component in terms of variability, although the interaction with crop year was notable for some of the characteristics. The oil content increased significantly along with the harvest date and reached maximum values in the last period (44.9%). Conversely, stability and polyphenols decreased significantly (depending on the year, by 30-70%) from October to December, reaching the highest mean values between 1 October and 10 November (15.5 h; 500 mg caffeic acid kg-1 ). Oleic acid and monounsaturated/polyunsaturated fatty acids (MUFA/PUFA) did not show significant differences depending on the harvest date, but between years, with 2018 having the highest percentage of oleic acid (72.72%) and MUFA/PUFA (8.38). CONCLUSION: Early harvesting of Empeltre olives would provide considerably more stable olive oils, regardless of the clone selected, with higher phenolic content. It would not affect the MUFA/PUFA ratio, mainly influenced by the crop year. © 2022 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Impact of Sepsis Flow Chip, a novelty fast microbiology method, in the treatment of bacteremia caused by Gram-negative bacilli.

OBJECTIVE: The aim of this study was to assess the impact of the information provided by the new Sepsis Chip Flow system (SFC) and other fast microbiological techniques on the selection of the appropriate antimicrobial treatment by the clinical researchers of an antimicrobial stewardship team. METHODS: Two experienced clinical researchers performed the theoretical exercise of independently selecting the treatment for patients diagnosed by bacteremia due to bacilli gram negative (BGN). At first, the clinicians had only available the clinical characteristics of 74 real patients. Sequentially, information regarding the Gram stain, MALDI-TOF, and SFC from Vitro were provided. Initially, the researchers prescribed an antimicrobial therapy based on the clinical data, later these data were complementing with information from microbiological techniques, and the clinicians made their decisions again. RESULTS: The data provided by the Gram stain reduced the number of patients prescribed with combined treatments (for clinician 1, from 23 to 7, and for clinician 2, from 28 to 12), but the use of carbapenems remained constant. In line with this, the data obtained by the MALDI-TOF also decreased the combined treatment, and the use of carbapenems remained unchanged. By contrast, the data on antimicrobial resistance provided by the SFC reduced the carbapenems treatment. CONCLUSIONS: From the theoretical model the Gram stain and the MALDI-TOF results achieved a reduction in the combined treatment. However, the new system tested (SFC), due to the resistance mechanism data provided, not only reduced the combined treatment, it also decreased the prescription of the carbapenems.

[How to organize a Fetal Medicine Unit in the context of COVID-19 pandemic. Safe measures for obstetric scans and equipment cleaning]. / Cómo reestructurar una Sección de Medicina Fetal en tiempos de pandemia COVID-19. Medidas de seguridad y limpieza de los equipos ecográficos.

During a pandemic, the three basic principles are. to prioritize medical resources, ensure patients' lockdown in order to avoid community transmission and prevent healthcare collapse, and keep the number of visits to an absolute minimum to avoid patient exposure and safeguard healthcare workers. Antenatal care must be maintained during a health crisis, regardless of the COVID-19 state of alert. Routine and specialist obstetric ultrasound scans are essential for clinical decision-making during pregnancy, as it has a direct impact on the management of mothers and fetuses and on the perinatal outcome. In an attempt to minimize in-person visits, these will be organized according to the established ultrasound schedule. Based on scientific evidence, and on existing main national and international guidelines, this document has been prepared, in which proposals and options are provided for managing pregnant women in the context of the SARS-CoV-2 pandemic. It includes how a Fetal Medicine Unit facing this health crisis should be restructured, what safety measures should be followed in the performance of obstetric scans and invasive procedures, and how ultrasound rooms, equipment and transducers should be cleaned and disinfected. These recommendations should be adapted to different units based on their resources and infrastructure.

Point-of-care lung ultrasound in three neonates with COVID-19.

Since March 2020, the world is involved in the COVID-19 pandemic, a disease caused by a novel virus called SARS-CoV-2. Some authors have described the ultrasonographic findings of COVID-19 pneumonia in adults and children, but data on neonates are lacking. Our objective was to describe the ultrasonographic lung pattern on newborns with SARS-CoV-2 infection during the COVID-19 pandemic. Newborns who tested positive for SARS-CoV-2 PCR in respiratory samples and were evaluated with point-of-care lung ultrasound (LU) from March to April 2020 were included. LU was performed bedside by a single investigator at the time of diagnosis and every 48 h during the first week following diagnosis. Six areas were studied. Three neonates were included. Infants' comorbidities included meconium aspiration syndrome, bronchopulmonary dysplasia, and Hirschsprung's disease. One required mechanical ventilation. No deaths occurred. LU showed B-lines, consolidation, and spared areas. No pneumothorax or pleural effusion was observedConclusions: LU could be of value when managing COVID-19 neonates. We describe the findings of lung ultrasound monitoring during the first week following diagnosis in three neonates with SARS-CoV-2 infection. What is known: • Lung ultrasound (LU) is a useful tool in COVID-19 management in adults. To date, no report on LU and neonates with SARS-CoV-2 infection has been published. What is new: • This study adds evidence about LU findings in neonates with SARS-CoV-2 infection.

Etiology of bloodstream infections at a population level during 2013-2017 in the Autonomous Community of Valencia, Spain.

OBJECTIVE: Bloodstream Infections has become in one of the priorities for the antimicrobial stewardship teams due to their high mortality and morbidity rates. Usually, the first antibiotic treatment for this pathology must be empirical, without microbiology data about the microorganism involved. For this reason, the population studies about the etiology of bacteremia are a key factor to improve the selection of the empirical treatment, because they describe the main microorganisms associated to this pathology in each area, and this data could facilitate the selection of correct antibiotic therapy. METHODS: This study describes the etiology of bloodstream infections in the Southeast of Spain. The etiology of bacteremia was analysed by a retrospective review of all age-ranged patients from every public hospital in the Autonomous Community of Valencia (approximately 5,000,000 inhabitants) for five years. RESULTS: A total of 92,097 isolates were obtained, 44.5% of them were coagulase-negative staphylococci. Enterobacteriales was the most prevalent group and an increase in frequency was observed along the time. Streptococcus spp. were the second microorganisms more frequently isolated. Next, the most prevalent were Staphylococcus aureus and Enterococcus spp., both with a stable incidence along the study. Finally, Pseudomonas aeruginosa was the fifth microorganism more frequently solated. CONCLUSIONS: These data constitute a useful tool that can help in the choice of empirical treatment for bloodstream infections, since the knowledge of local epidemiology is key to prescribe a fast and appropriate antibiotic therapy, aspect capital to improve survival.

From laboratory to the field: biological control of Fusarium graminearum on infected maize crop residues.

AIM: To evaluate biological control agents (BCAs) against Fusarium graminearum on infected maize stalks as a means to reduce Fusarium head blight (FHB) in subsequently grown wheat. METHODS AND RESULTS: In the laboratory, BCAs were applied against F. graminearum on maize stalk pieces. Clonostachys rosea inhibited the perithecia development and ascospore discharge when applied before, simultaneously with and after the pathogen. In the field, we simulated a system with high disease pressure, that is, a maize-wheat rotation under no-tillage, by preparing maize stalks inoculated with F. graminearum. The infected stalks were treated with formulations of C. rosea selected in vitro or the commercial BCA strain Trichoderma atrobrunneum ITEM908 and exposed to field conditions over winter and spring between winter wheat rows. Monitoring with spore traps and of FHB symptoms, as well as quantification of F. graminearum incidence and DNA in harvested grain revealed significant reductions by C. rosea by up to 85, 91, 69 and 95% compared with an inoculated but untreated positive control, respectively. Deoxynivalenol (DON) and zearalenone (ZEN) contents were reduced by up to 93 and 98%, respectively. Treatments with T. atrobrunneum were inconsistent, with significant reductions of DON and ZEN under warm and wet climatic conditions only. CONCLUSIONS: The findings support the application of C. rosea against F. graminearum on residues of maize to suppress the primary inoculum of FHB. SIGNIFICANCE AND IMPACT OF THE STUDY: As sustainable agriculture requires solutions to control FHB, hence, the application of C. rosea during the mulching of maize crop residues should be evaluated in on-farm experiments.

[Palatal myoclonus associated with myotonic dystrophy type 1]. / Mioclonia palatina asociada a distrofia miotonica de tipo 1.

TITLE: Mioclonia palatina asociada a distrofia miotonica de tipo 1.

Impact of a stewardship program on bacteraemia in adult inpatients.

OBJECTIVE: Bloodstream infections (BSIs) are associated with considerable morbidity and mortality among inpatients. The aim of this study was to evaluate the impact of a stewardship program on clinical and antimicrobial therapy-related outcomes in patients with bacteraemia. METHODS: Single-centre, before-and-after quasi-experimental study in adult inpatients. Over 1 January 2013 to 31 June 2013 all patients aged 18 years or older with a bacteraemia (interven-tion group, N=200) were compared to a historical cohort (1 Janu-ary 2012 to 31 December 2012) (control group, N=200). RESULTS: Following blood culture results and adjusting for potential confounders, the stewardship program was associated with more changes to antibiotic regimens (adjusted odds ratio [ORa]: 4.6, 95% CI 2.9, 7.4), more adjustments to antimicrobial therapy (ORa: 2.4, 95% CI 1.5, 3.8), and better source control in the first five days (ORa 1.6, 95% CI: 1.0, 2.7). In the subgroup that initially received inappropriate empiric treatment (n=138), the intervention was associated with more antibiotic changes (OR: 3.9, 95% CI: 1.8, 8.5) and a better choice of definitive antimicrobial therapy (OR 2.3 95% CI: 1.2, 4.6). There were also more antibiotic changes in the subgroups with both Gram-negative (OR: 2.8, 95% CI: 1.6, 4.9; n=217) and Gram-positive (OR: 4.6, 95% CI: 1.8, 9.9; n=135) bacteraemia among those receiving the intervention, while the Gram-positive subgroup also received more appropriate definitive antimicrobial therapy (OR: 3.9, 95% CI: 1.8, 8.8). CONCLUSIONS: The stewardship program improved treatment of patients with bacteraemia and appropriateness of therapy.

[Treatment of relapsing-remitting multiple sclerosis with fingolimod in routine clinical practice]. / Tratamiento de la esclerosis multiple remitente recurrente con fingolimod en la practica clinica habitual.

INTRODUCTION: Fingolimod is a selective immunosuppressant that targets the S1P receptor, and is indicated in the treatment of aggressive relapsing-remitting multiple sclerosis (RRMS) and following treatment failure with first-order drugs. AIM: To investigate the safety and effectiveness of fingolimod under the conditions of routine clinical practice. PATIENTS AND METHODS: We conducted an observational study with prospective follow-up of patients with RRMS who received fingolimod from January 2011 until February 2014. Data assessed were the annualised relapse rate (ARR), disability measured by the Expanded Disability Status Scale (EDSS), magnetic resonance activity and the appearance of side effects. RESULTS: Our sample consisted of 122 patients, 79.5% of them females and with a mean age of 26.8 years. They were classified, according to the last treatment received, as being: naive (aggressive RRMS; n = 17), previous treatment failure (n = 67) and withdrawal of natalizumab due to risk of progressive multifocal leukoencephalopathy (n = 38). After a mean follow-up of 29.9 ± 15.9 months, the ARR and the appearance of new lesions with gadolinium enhancement were reduced in both the naive and the previous treatment failure groups. There were no differences between the various subgroups as regards the progression of EDSS or the time elapsed until the first attack or treatment failure. The risk of treatment failure is higher with a baseline EDSS > 3 (hazard ratio: 4.24; p = 0.001) and presence of IgM oligoclonal bands (hazard ratio: 2.45; p < 0.022). CONCLUSIONS: Fingolimod is an effective and well-tolerated drug under conditions of routine clinical practice. Having a baseline EDSS > 3 and IgM oligoclonal bands is predictive of a poor response to fingolimod.

TITLE: Tratamiento de la esclerosis multiple remitente recurrente con fingolimod en la practica clinica habitual.Introduccion. El fingolimod es un inmunosupresor selectivo dirigido contra el receptor SP-1, indicado en el tratamiento de la esclerosis multiple remitente recurrente (EMRR) agresiva y tras el fracaso del tratamiento con farmacos de primera linea. Objetivo. Investigar la seguridad y efectividad del fingolimod en condiciones de practica clinica habitual. Pacientes y metodos. Estudio observacional con seguimiento prospectivo de pacientes con EMRR que recibieron fingolimod desde enero de 2011 hasta febrero de 2014. Se evaluo la tasa anual de brotes (TAB), la discapacidad medida por la escala expandida del estado de discapacidad (EDSS), la actividad en la resonancia magnetica y la aparicion de efectos adversos. Resultados. Incluimos 122 pacientes, el 79,5% mujeres y con una edad media de 26,8 antilde;os. Se clasificaron segun el ultimo tratamiento recibido en: naive (EMRR agresiva; n = 17), fracaso a terapias previas (n = 67) y retirada de natalizumab por riesgo de leucoencefalopatia multifocal progresiva (n = 38). Tras un seguimiento medio de 29,9 ± 15,9 meses, se redujo de forma significativa la TAB y la aparicion de nuevas lesiones con realce de gadolinio en el grupo naive y el de fracaso a terapias previas. No ha habido diferencias en la evolucion de la EDSS ni en el tiempo hasta el primer brote o el fracaso terapeutico entre los diferentes subgrupos. El riesgo a fracaso terapeutico es mayor con la EDSS basal > 3 (hazard ratio: 4,24; p = 0,001) y presencia de bandas oligoclonales IgM (hazard ratio: 2,45; p < 0,022). Conclusiones. El fingolimod es un farmaco eficaz y seguro en la EMRR en condiciones de practica clinica habitual. Tener una EDSS basal > 3 y bandas oligoclonales IgM predice una mala respuesta al fingolimod.

Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75 mg) for hip fracture repair surgery in the elderly. A randomized, double blinded study.

PURPOSE: Single shot spinal anesthesia is used worldwide for hip fracture repair surgery in the elderly. Arterial hypotension is a frequent adverse effect. We hypothesized that lowering local anesthetics dose could decrease the incidence of arterial hypotension, while maintaining quality of surgical anesthesia. METHODS: In a randomized double blinded study, 66 patients over the age of 65 years, with hip fracture needing surgical repair, were assigned to B0.5 group 7.5mg hyperbaric bupivacaine 5mg/ml (control group), and B0.25 group 3.75mg hyperbaric bupivacaine 2.5mg/ml (study group). Sensory and motor block level, and hemodynamic parameters including blood presure, heart rate and vasopressor dose administration were registered, along with rescue anesthesia needs, the feasibility of surgery, its duration, and regression time of sensory anesthesia to T12. RESULTS: After exclusions, 61 patients were included in the final analysis. Arterial hypotension incidence was lower in the B0.25 group (at the 5, 10, and 15min determinations), and a lower amount of vasopressor drugs was needed (mean accumulated ephedrine dose 1.6mg vs. 8.7mg in the B0.5 group, p<0.002). Sensory block regression time to T12 was shorter in the B0.25 group, mean 78.6±23.6 (95% CI 51.7-110.2)min vs. 125.5±37.9 (95% CI 101.7-169.4)min in the B0.5 group, p=0.033. All but one patient in the B0.25 group were operated on under the anesthetic procedure first intended. No rescue anesthesia was needed. CONCLUSION: Lowering bupivacaine dose for single shot spinal anesthesia for hip fracture repair surgery in elderly patients was effective in decreasing the occurrence of arterial hypotension and vasopressor use, while intraoperative quality remained.

Spectral-domain OCT in anti-VEGF treatment of myopic choroidal neovascularization.

PURPOSE: To evaluate changes in macular morphology due to myopic choroidal neovascularization (CNV), using spectral-domain optical coherence tomography (SD-OCT). METHODS: In all, 22 eyes with recent-onset untreated CNV underwent 1 intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), followed by a pro-re-nata regimen. SD-OCT was performed at baseline (before first administration of anti-VEGF treatment) and month 1, and 2; macular morphologic changes and outer retina characteristics (SD-OCT findings) associated with CNV activity were evaluated. Sensitivity and specificity were calculated for SD-OCT findings using fluorescein angiography (FA) as standard reference. RESULTS: Mean central retinal thickness (CRT) showed no significant reduction from baseline (284±98 µm) to month 1 (257±74 µm) and month 2 (263±72 µm). A hyper-reflective lesion with fuzzy borders (fuzzy area), and 'absent or altered' IS/OS junction were the only SD-OCT findings associated with CNV activity (P<0.0001). Both these SD-OCT findings showed good sensitivity and specificity (95.1 and 96.0% (95% CI: 0.87-0.89), respectively, for the fuzzy area; 87.9 and 66.7% (95% CI: 0.65-0.87), respectively, for 'absent or altered' IS/OS junction) when compared with FA leakage (standard reference). CONCLUSIONS: Outer retina characteristics (ie, hyper-reflective lesion with fuzzy borders, and 'absent or altered' IS/OS junction) appear more meaningful than CRT in the evaluation of myopic CNV activity. These SD-OCT findings show overall good sensitivity and specificity when compared with FA leakage (standard reference), and could be considered as an alternative diagnostic tool to FA for myopic CNV monitoring.

Remediation trials for hydrocarbon-contaminated sludge from a soil washing process: evaluation of bioremediation technologies.

The usual fate of highly contaminated fine products (silt-clay fractions) from soil washing plants is disposal in a dump or thermal destruction (organic contaminants), with consequent environmental impacts. Alternative treatments for these fractions with the aim of on-site reuse are needed. Therefore, the feasibility of two technologies, slurry bioremediation and landfarming, has been studied for the treatment of sludge samples with a total petroleum hydrocarbon (TPH) content of 2243 mg/kg collected from a soil washing plant. The treatability studies were performed at the laboratory and pilot-real scales. The bioslurry assays yielded a TPH reduction efficiency of 57% and 65% in 28 days at the laboratory and pilot scale, respectively. In the landfarming assays, a TPH reduction of 85% in six months was obtained at laboratory scale and 42% in three months for the bioremediation performed in the full-scale. The efficiency of these processes was evaluated by ecotoxicity assessments. The toxic effects in the initial sludge sample were very low for most measured parameters. After the remediation treatments, a decrease in toxic effects was observed in earthworm survival and in carbon mineralisation. The results showed the applicability of two well known bioremediation technologies on these residues, this being a novelty.