The genus Gautieria (Gomphales) in Europe and the Mediterranean Basin: a morphological and phylogenetic taxonomic revision.

Type material and additional collections of 11 taxa of Gautieria described in Europe and North Africa have been studied, namely G. dubia, G. graveolens, G. morchelliformis var. globispora, G. morchelliformis var. magnicellaris, G. morchelliformis var. morchelliformis, G. morchelliformis var. stenospora, G. otthii, G. pseudovestita, G. retirugosa, G. trabutii and G. villosa. At the same time, morphological and genetic studies on recent and herbarium collections from several European countries have been carried out. This enabled clarification of sections within Gautieria and differentiation of 28 taxa, of which 21 are new to science. However, the deeper relationships and nomenclature changes related to the phylogenetic position of the genus Gautieria within Gomphaceae will not be addressed in this study because they would require a more complete molecular analysis together with that of related genera, e.g., Gomphus, Turbinellus, and the four subgenera of Ramaria. In addition, a lectotype for G. villosa var. villosa and reference specimens for G. graveolens and G. morchelliformis var. morchelliformis are selected, and the new combination G. morchelliformis var. dubia is proposed. Detailed descriptions, macro- and microphotographs and distribution maps of all taxa are provided, as well as extensive information on their ecology, chorology and phylogeny. A key is included to facilitate identification of taxa. Citation: Vidal JM, Cseh P, Merényi Z, et al. 2023. The genus Gautieria (Gomphales) in Europe and the Mediterranean Basin: a morphological and phylogenetic taxonomic revision. Persoonia 50: 48 -122. https://doi.org/10.3767/persoonia.2023.50.03.

A phylogenetic and taxonomic revision of sequestrate Russulaceae in Mediterranean and temperate Europe.

A comprehensive morphological and genetic study of type material and new collections of sequestrate Russulales species formerly belonging to the genera Arcangeliella, Elasmomyces, Gymnomyces, Hydnangium, Hymenogaster, Macowanites, Martellia, Secotium and Zelleromyces is here undertaken, for the purpose of providing a complete taxonomical revision of sequestrate Russulaceae species in the Mediterranean and temperate regions of Europe. As a result, seven distinct taxa in the genus Lactarius and 18 in the genus Russula are identified. Six of them are new species: L. populicola, L. subgiennensis, R. bavarica, R. candidissima, R. hobartiae and R. mediterraneensis, and seven represent new combinations: L. josserandii (≡ Zelleromyces josserandii), L. soehneri (≡ Hydnangium soehneri), R. candida (≡ Hydnangium candidum), R. cerea (≡ Hydnangium cereum), R. messapica var. messapicoides (≡ Macowanites messapicoides), R. meridionalis (≡ Zelleromyces meridionalis) and R. neuhoffii (≡ Hydnangium neuhoffii). Twenty-two of the 25 taxa are illustrated, while descriptions, microscopy images, as well as extensive information on the ecology, chorology and phylogeny for all taxa are provided. A key is further included to facilitate their identification.

[Assessment of concordance between CAM-ICU scale and nursing delirium scale in postoperative period of ICU patients after cardiac surgery]. / Valoración de la concordancia entre la escala CAM-ICU y la nursing delirium screening scale en el postoperatorio de cirugía cardiaca en una unidad de críticos.

OBJECTIVE: To evaluate concordance between the scale of delirium assessment CAM-ICU and the Nursing Delirium Screening Scale (NDSS) in postoperative cardiac surgery. MATERIAL AND METHODS: Prospective study in tertiary hospital with consecutive selection of patients after cardiac surgery. During the stay in the Intensive Care Unit, CAM-ICU and NDSS were administered by the same researcher. For demographic and preoperative risk factors of delirium, descriptive statistical analysis was performed. Concordance was assessed using kappa index. RESULTS: 106 patients were included, performing 214 evaluations. Incidence of delirium with the CAM-ICU scale was of 8.4%, and of 16.8% with NDSS. The concordance expressed by the index Kappa was of 0.541. CONCLUSIONS: The concordance between the CAM-ICU scale and the NDSS in the postoperative cardiac surgery and during the stay in the Intensive Care Unit is low. Currently, the use of the CAM-ICU was recommended in this context, but it must not be replaced for the NDSS.

Guidelines for inhaled sedation in the ICU.

INTRODUCTION AND OBJECTIVES: Sedation is used in intensive care units (ICU) to improve comfort and tolerance during mechanical ventilation, invasive interventions, and nursing care. In recent years, the use of inhalation anaesthetics for this purpose has increased. Our objective was to obtain and summarise the best evidence on inhaled sedation in adult patients in the ICU, and use this to help physicians choose the most appropriate approach in terms of the impact of sedation on clinical outcomes and the risk-benefit of the chosen strategy. METHODOLOGY: Given the overall lack of literature and scientific evidence on various aspects of inhaled sedation in the ICU, we decided to use a Delphi method to achieve consensus among a group of 17 expert panellists. The processes was conducted over a 12-month period between 2022 and 2023, and followed the recommendations of the CREDES guidelines. RESULTS: The results of the Delphi survey form the basis of these 39 recommendations - 23 with a strong consensus and 15 with a weak consensus. CONCLUSION: The use of inhaled sedation in the ICU is a reliable and appropriate option in a wide variety of clinical scenarios. However, there are numerous aspects of the technique that require further study.

[Agreement between verbal numerical scale and visual analog scale assessments in monitoring acute postoperative pain]. / Concordancia entre la escala verbal numérica y la escala visual analógica en el seguimiento del dolor agudo postoperatorlo.

OBJECTIVE: To determine the agreement between verbal numerical and visual analog scale assessments of acute postoperative pain on 3 consecutive days. METHODS: Pain data were recorded for 2 months for sequentially enrolled patients receiving parenteral opioids or neuraxial blocks for analgesia after major surgery in a tertiary level hospital. Each patient was asked to assess pain on the visual analog and verbal numerical scales every 24 hours for 3 consecutive days. Agreement was estimated by the intraclass correlation coefficient and the Spearman correlation coefficient. The results were analyzed in 2 age strata: age 65 years or younger and older than 65 years. RESULTS: Data for 159 patients (105 < or =65 years; 54 >65 years) were analyzed. The visual analog scale could not be used with 12 patients; all patients were able to assess pain on the verbal numerical scale. The intraclass correlation coefficient was > 0.70 for all 3 days; the highest coefficients were for patients over 65 years of age. CONCLUSIONS: Agreement between pain assessments on the visual analog and verbal numerical scales can be considered good or very good on all 3 days, with stronger agreement when the scales are used in patients over the age of 65 years. Cooperation was better for the numerical scale than for the visual analog scale. Scores on the verbal numerical scale were consistently higher than scores on the visual analog scale.

[Evaluation of a protocol for predicting difficult airway in routine practice: interobserver agreement]. / Evaluación de un protocolo de predicción de vía aérea difícil en la práctica habitual: estudio de concordancia.

OBJECTIVES: To evaluate a protocol for routine assessment of potential risk factors for difficult airway intubation in an anesthesia department, by measuring interobserver agreement and the behavior of the factors in a predictive model. MATERIAL AND METHODS: A cross-sectional study group of 320 consecutive patients undergoing major surgery requiring orotracheal intubation was assessed for possible difficult airway. We calculated interrater agreement for recording of the Mallampati score, thyromental distance less than 6 cm, thick neck, kyphosis, small mouth, macroglossia, and dental prosthesis during the preanesthesia examination (by an anesthetist) and on the day of the operation (by an anesthetist and a resident). We constructed a model to predict difficult intubation (requiring 3 or more attempts). RESULTS: The kappa indices of agreement between the anesthetists at the preoperative examination and in the operating room or the resident were all less than 0.6. Factors like thyromental distance, small mouth, and kyphosis had kappa indices less than 0.21. The kappa index between the resident and the anesthetist in the operating room was over 0.55. The only factor that had a different level of agreement was the presence or not of a dental prosthesis. None of the studied individual factors, nor these factors in association with the Mallampati score, achieved significance in a bivariate regression model to predict difficult intubation. CONCLUSIONS: There is poor interobserver agreement on factors for predicting difficult airway in comparisons between preoperative and operating room assessment by an anesthetist or a resident. The individual predictive factors and their association with the Mallampati score did not prove useful for predicting difficult intubation.

[Supreme laryngeal mask airway vs the I-gel supraglottic airway in patients under general anesthesia and mechanical ventilation with no neuromuscular block: a randomized clinical trial]. / Estudio comparativo entre las mascarillas laríngeas Supreme e I-gel en pacientes con anestesia general sin bloqueo neuromuscular, con ventilación mecánica.

OBJECTIVE: The Supreme Laryngeal Mask Airway (SLMA) and the I-gel Supraglottic Airway (IGSA) are recently introduced devices incorporating a gastric channel. This study assessed the ease of insertion of the devices and their efficacy in mechanical ventilation. MATERIAL AND METHODS: Eighty-five patients undergoing major outpatient surgery under general anesthesia were randomized to 2 groups for intubation using the SLMA or the IGSA. After induction of general anesthesia, the assigned mask was inserted and positioning was checked with a fiberoptic scope. Ease of insertion was evaluated. Seal pressure was measured and the following ventilatory parameters were recorded 10, 30, and 60 minutes after the start of surgery: peak pressure, mean pressure, compliance, and the ratio of tidal volume to respiratory frequency. Conditions at the moment of inserting the nasogastric tube were also noted. RESULTS: First-attempt placement of the airway was possible in 95.2% of patients using the SLMA and in 86% using the IGSA (P = .147). The mean times required for placement were 27.1 seconds for the SLMA and 32.5 seconds for the IGSA (P = .195). The nasogastric tube was inserted on the first attempt in 97.6% of patients with an SLMA and in 85.7% of patients with an IGSA. The mean times required for tube insertion were 9.5 seconds through the SLMA and 22.1 seconds through the IGSA (P < .001). Seal pressure and compliance were similar in the 2 groups at the start of surgery and at 10, 30, and 60 minutes. The incidences of complications during surgery and at 90 minutes were likewise similar (P = .945 and P = .698, respectively). CONCLUSIONS: The SLMA and the IGSA are easy to put into position on the first attempt. It is easier to insert the nasogastric tube through the gastric channel of the SLMA. Both devices provide an effective seal and the incidences of complications were similar for both in the patients we studied.

[Assessment of training in the control of acute postoperative pain based on analysis of pretraining and posttraining measures]. / Evaluación de una intervención educativa en el control del dolor agudo postoperatorio: estudio antes-después.

OBJECTIVE: To assess the efficacy of an acute pain unit's training on postoperative pain control for staff of trauma-orthopedic and general surgery departments. METHODS: Prospective pretest-posttest study in a tertiary care hospital. Physicians and nurses in the 2 surgical departments were given training sessions that included discussion with visual support and presentation of the acute pain unit's treatment protocols. Outcome measures used were visual analog scale (VAS) scores, patient satisfaction scores, number of days of treatment in accordance with the acute pain unit's protocol, and reasons for stopping treatment. Data for the year before and after the training program were analyzed. RESULTS: Data for 854 patients before training and 971 after training were analyzed. There were no differences between surgical specialties in the mean number of days of treatment. Nor did patient satisfaction scores differ (trauma-orthopedic surgery, -0.379, P = .352; general surgery, -0.927, P = .177). VAS score differences of less than 0.5 points were found in active and resting pain from the second and third days, respectively. There was improvement in both specialties in terms of the number of patients who completed the treatment initially prescribed by the acute pain unit. CONCLUSIONS: The staff training in postoperative pain control did not affect patient satisfaction, though a small improvement in active and resting VAS scores was noted. The training did have an effect on significantly improving overall compliance with the acute pain unit's treatment protocols.

Anaphylactic shock versus Kounis syndrome in cardiac surgery: Differential diagnosis. / Shock anafiláctico versus síndrome de Kounis durante el intraoperatorio de cirugía cardiaca: diagnóstico diferencial.

Although Kounis syndrome was described almost 3 decades ago, there has been a notable increase in the reports of cases of acute coronary syndromes developed in the context of allergic reactions, also known as Kounis syndrome. This article discusses the diagnostic possibility in the face of an acute biventricular failure in the course of an anaphylactic reaction during the intra-operative period of a cardiac valve surgery.

[Comparison of intrathecal fentanyl and bupivacaine in combined spinal-epidural obstetric analgesia]. / Comparación del efecto de fentanilo frente a bupivacaína intratecal en una técnica anestésica combinada durante la analgesia obstétrica.

OBJECTIVES: To compare intrathecal injection of the opioid fentanyl to injection of bupivacaine, in terms of their effect of labour in the context within the combined spinal-epidural analgesia. METHODS: Prospective single-blind trial in primiparas randomized to 2 groups for sedation with 25 microg of fentanyl or 2.5 mg of bupivacaine, followed in both cases by epidural infusion of ropivacaine. We measured time from puncture to delivery of the neonate, rescue analgesia, pain assessed on a visual analog scale (VAS), motor block, side effects, sensory level, Apgar score, and maternal satisfaction. RESULTS: Sixty-four women were studied. The mean time elapsed between puncture and birth was 168.59 minutes (95% confidence interval [CI], 134.16 to 203.03 minutes) in the bupivacaine group and 189.13 minutes (95% CI, 151.93 to 226.32 minutes) in the fentanyl group. The mean difference was -20.53 minutes (95% CI, -70.21 to 29.15 minutes). Survival analysis applied to duration of labor, using type of delivery as the final outcome, also failed to show a significant between-group difference (chi2=0.59, P=.447). No significant differences in use of rescue analgesia, VAS scores, or motor block were observed. The incidence of pruritus in the fentanyl group was 34.37%, but there were no differences in maternal satisfaction. CONCLUSIONS: Our findings do not support the use of intradural fentanyl with the aim of shortening labor. Fentanyl leads to more pruritus, although this side effect does not affect maternal satisfaction.

Development and characterization of anti-inflammatory activity of curcumin-loaded biodegradable microspheres with potential use in intestinal inflammatory disorders.

This research addresses the development and in vitro evaluation of a microparticulate system intended for intestine-targeted delivery of curcumin (CRM), a natural polyphenol with anti-inflammatory properties. Microspheres (Ms) based on zein (ZN) and Gantrez® AN119 (PVMMA) were prepared by spray-drying and coated with a pH-sensitive polymer (Eudragit® FS30D). An experimental design was performed to optimize the microparticulate formulation. A detailed characterization of systems was carried out by SEM, DSC, FTIR, particle size, ζ potential measurements and in vitro CRM release. The optimized formulation was evaluated in LPS-stimulated RAW 264.7 macrophages to investigate its anti-inflammatory activity. FTIR and DSC studies suggest a predominant presence of α-helix structure for ZN when formulated and also, a strong interaction between components. The stabilization of α-helix by PVMMA or CRM would take place by hydrogen bonds. Although the encapsulation efficiency was high (89%) for ZN/PVMMA Ms, the coating process with Eudragit® led to an EE decrease of 62%. Coating of Ms was found to retain a 20% of drug within 6h of release, although a strong initial burst release was observed. Cells viability and apoptosis were not affected when cells were co-incubated with coated Ms with CRM. The exposure of unstimulated cells to Ms did not show any effect on NO and PGE2 production. However, a reduction in NO and PGE2 production was obtained when CRM-loaded Ms were co-incubated with stimulated macrophages. Further, this inhibition was significantly higher compared to the decrease obtained when Ms with pure CRM were used in culture, which suggested a synergistic effect of CRM and Ms. Finally, CRM-loaded Ms caused a significant inhibition of analysed pro-inflammatory cytokines (TNFα, IL-1ß, NOS2, COX-2) in macrophages stimulated with LPS. All these results confirm the advantageous features of ZN/PVMMA microspheres as a serious alternative for delivering CRM to reduce the inflammatory activity at intestinal regions affected by inflammatory bowel diseases.

EMF radiation at 2450 MHz triggers changes in the morphology and expression of heat shock proteins and glucocorticoid receptors in rat thymus.

AIMS: Electromagnetic fields (EMFs) can act as inducers or mediators of stress response through the production of heat shock proteins (HSPs) that modulate immune response and thymus functions. In this study, we analyzed cellular stress levels in rat thymus after exposure of the rats to a 2.45 GHz radio frequency (RF) using an experimental diathermic model in a Gigahertz Transverse Electromagnetic (GTEM) chamber. MAIN METHODS: In this experiment, we used H&E staining, the ELISA test and immunohistochemistry to examine Hsp70 and Hsp90 expression in the thymus and glucocorticoid receptors (GR) of 64 female Sprague­Dawley rats exposed individually to 2.45 GHz (at 0, 1.5, 3.0 or 12.0 W power). The 1 g averaged peak and mean SAR values in the thymus and whole body of each rat to ensure that sub-thermal levels of radiation were being reached. KEY FINDINGS: The thymus tissue presented several morphological changes, including increased distribution of blood vessels along with the appearance of red blood cells and hemorrhagic reticuloepithelial cells. Levels of Hsp90 decreased in the thymus when animals were exposed to the highest power level (12 W), but only one group did not show recovery after 24 h. Hsp70 presented no significant modifications in any of the groups. The glucocorticoid receptors presented greater immunomarking on the thymic cortex in exposed animals. SIGNIFICANCE: Our results indicate that non-ionizing sub-thermal radiation causes changes in the endothelial permeability and vascularization of the thymus, and is a tissue-modulating agent for Hsp90 and GR.