Bronchoscopist's perception of the quality of the single-use bronchoscope (Ambu aScope4™) in selected bronchoscopies: a multicenter study in 21 Spanish pulmonology services.

BACKGROUND: The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated. METHODS: To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis. RESULTS: The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score. CONCLUSIONS: The aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.

Effects of Enterococcus faecalis UGRA10 and the enterocin AS-48 against the fish pathogen Lactococcus garvieae. Studies in vitro and in vivo.

The aim of this study was to evaluate the effects of Enterococcus faecalis UGRA10 and its enterocin AS-48 against the fish pathogen Lactococcus garvieae. The minimum bactericidal concentrations of AS-48 against L. garvieae CECT 5807, 5806, and 5274 were 15.62, 15.62, and 7.81 µg/ml respectively. In broth cultures, enterocin at 100, 50, and 25 µg/ml reduced 108 CFU/ml lactococci after 2, 5, and 10 h, respectively. In co-cultures of UGRA10/L. garvieae at a 1/10 CFU/ml ratio, lactococci were eliminated after 24 h. Studies on UGRA10 biosafety and AS-48 toxicity in R1 cells and in rainbow trout have shown a lack of adverse effects from both the strain and bacteriocin. Trout challenged with L. garvieae and UGRA10 administered in diet 30 days before infection had a cumulative survival rate of 50% compared with 0% for control fish. Trout inoculated with the pathogen and treated by regular dipping in AS-48 baths had a survival rate of 60% after 20 days compared with that of untreated fish (0%). These results indicate the protective effect of the UGRA10 strain and the bacteriocin AS-48 against L. garvieae and the potential of these natural products as alternatives to antibiotics for controlling diseases in aquaculture.

Influence of supplemental canola or soybean oil on milk yield, fatty acid profile and postpartum weight changes in grazing dairy goats.

OBJECTIVE: This experiment was designed to evaluate the effect of supplementation with soybean or canola oil on milk production and the composition of long chain fatty acids as well as weight changes in the goats and their kids. METHODS: Thirty nine mulitparous crossed Alpine×Nubian goats (initial body weight [BW] 43.5±1.7 kg) from the day of parturition were assigned to the treatments: grazing control (n = 15); grazing plus 20 mL/goat/d of supplemental soybean oil (n = 12); and grazing plus 20 mL/goat/d of supplemental canola oil (n = 12) from November 26, 2014 to March 7, 2015. The planned contrasts were: CI (control vs supplemented with oils); CII (soybean vs canola oil) to compare the treatment effects. RESULTS: The vegetable oil supplementation reduced weight losses in lactating goats (CI: -0.060 vs 0.090 kg/d; p = 0.03) but did not improve milk production or affect kids' growth. The content of C4, C6, C8, C10, C11, C14, and C18:1n9t in the milk was increased (p<0.05) with respect to control. However, C12, C14, C16, C18, C18:1n9c, C18:2n6c, and C18:3n3 were reduced (p<0.05) in supplemented goats. Conjugated linoleic acid (CLA) was increased (p<0.05) in goats supplemented with oils compared to the control group. CONCLUSION: Supplementation with 20 mL/d of soybean or canola oil did not affect milk production or kids' performance; however, it increased CLA concentration and reduced the reduced weight losses in lactating goats.

Effects of increasing amount of dietary Prosopis laevigata pods on performance, meat quality and fatty acid profile in growing lambs.

A study with finishing lambs assessed the effect of dietary inclusion of Prosopis laevigata pods (PLPs) on performance, carcass characteristics, meat traits and fatty acid profile of subcutaneous fat. Twenty-one Rambouillet lambs (27.0 ± 3.0 kg BW) were assigned to one of three experimental diets with 0, 150 and 300 g PLP/kg DM. Evaluation of growth performance lasted 49 days. The experimental design was completely randomized and analysed with a mixed model. Lambs fed diets with 0, 150 and 300 g PLP had similar growth performance. Lambs fed diets with 300 g PLP/kg DM had better (p < 0.05) carcass yield and classification, less (p < 0.05) fat deposition and lower lightness (L*) value (p < 0.05) in meat than lambs fed diets with 0 and 150 g PLP/kg DM. Saturated fatty acids (palmitic and stearic) decreased (p < 0.05) and unsaturated fatty acids (oleic and linoleic) increased (p < 0.05) in subcutaneous fat of lambs fed diets with 150 and 300 g pods as compared with lambs not fed PLP. Prosopis laevigata pods are a safe feedstuff that can replace a third of conventional ingredients and reduce feed costs in growing lambs. Addition of PLP reduced (p < 0.05) total feed cost by 21%.

Characterization of pediatric microtia cartilage: a reservoir of chondrocytes for auricular reconstruction using tissue engineering strategies.

The external ear is composed of elastic cartilage. Microtia is a congenital malformation of the external ear that involves a small reduction in size or a complete absence. The aim of tissue engineering is to regenerate tissues and organs clinically implantable based on the utilization of cells and biomaterials. Remnants from microtia represent a source of cells for auricular reconstruction using tissue engineering. To examine the macromolecular architecture of microtia cartilage and behavior of chondrocytes, in order to enrich the knowledge of this type of cartilage as a cell reservoir. Auricular cartilage remnants were obtained from pediatric patients with microtia undergoing reconstructive procedures. Extracellular matrix composition was characterized using immunofluorescence and histological staining methods. Chondrocytes were isolated and expanded in vitro using a mechanical-enzymatic protocol. Chondrocyte phenotype was analyzed using qualitative PCR. Microtia cartilage preserves structural organization similar to healthy elastic cartilage. Extracellular matrix is composed of typical cartilage proteins such as type II collagen, elastin and proteoglycans. Chondrocytes displayed morphological features similar to chondrocytes derived from healthy cartilage, expressing SOX9, COL2 and ELN, thus preserving chondral phenotype. Cell viability was 94.6 % during in vitro expansion. Elastic cartilage from microtia has similar characteristics, both architectural and biochemical to healthy cartilage. We confirmed the suitability of microtia remnant as a reservoir of chondrocytes with potential to be expanded in vitro, maintaining phenotypical features and viability. Microtia remnants are an accessible source of autologous cells for auricular reconstruction using tissue engineering strategies.

Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure.

BACKGROUND: In staged liver resections, associating liver partition and portal ligation for staged hepatectomy (ALPPS) achieves sufficient hypertrophy of the future liver remnant (FLR) in 7 days. This is based on portal vein ligation and transection, and on occlusion of intrahepatic collaterals. This article presents a new surgical technique for achieving rapid hypertrophy of the FLR, which also involves adding intrahepatic collateral occlusion to portal vein transection. METHODS: Patients scheduled for two-stage liver resection for primary or secondary liver tumours, in whom the FLR was considered too small, were enrolled prospectively. In the first stage, a tourniquet was placed around the parenchymal transection line, and the right portal vein was ligated and cut (associating liver tourniquet and portal ligation for staged hepatectomy, ALTPS). The tourniquet was placed on the umbilical ligament if a staged right trisectionectomy was planned, and on Cantlie's line for staged right hepatectomy. RESULTS: From September 2011, 22 ALTPS procedures were carried out (right trisectionectomy in 15, right hepatectomy in 7). Median FLR at 7 days increased from 410 to 700 ml (median increase 61 (range 33-189) per cent). The median duration of the first stage was 125 min and no patient received a blood transfusion. The median duration of the second stage was 150 min and five patients required a blood transfusion. Fourteen patients had complications, most frequently infected collections, and five patients developed postoperative liver failure. Two patients died. CONCLUSION: The ALTPS technique achieved adequate hypertrophy of the FLR after 7 days. It may provide a less aggressive modification of the ALPPS procedure.

The use of velodrome tests to evaluate aerodynamic drag in professional cyclists.

The purpose of this study was to analyse the validity, reliability and sensitivity of velodrome tests to detect small changes in aerodynamic drag in cycling. 12 professional cyclists were assessed to obtain the drag area (SCx) during wind tunnel and velodrome tests. Incremental and steady-state protocols were performed in the velodrome with a portable power meter, and 6 bicycle positions were analysed and compared that involved lowering the handlebars and advancing the pads between 2-5 cm. A significant relationship (r=0.88, p<0.001) between the SCx in the wind tunnel and velodrome tests was found (0.240 ± 0.007 and 0.237 ± 0.008 m2, respectively). The velodrome tests underestimated the SCx (0.0035 ± 0.0038 m2 and p<0.01), which decreased (p<0.001) when the bicycle speed increased (0.0013 m2 each 1 km · h(-1)). The SCx values showed high reliability during the steady-state (r=0.99, p<0.001) and incremental protocols (r=0.94, p<0.001). Small changes in the aerodynamic position affected the SCx (p<0.001), which decreased by 0.011 ± 0.007 m2 (4.6 ± 2.9%, 95% CI=2.7-6.4%). In conclusion, the validity, reliability and sensitivity of velodrome tests to detect small changes in aerodynamic drag in cycling were demonstrated. Although SCx values were not interchangeable between different studies, the velodrome tests presented advantages with respect to the wind tunnel tests.

Veno-venal extracorporeal membrane oxygenation to support whole-lung lavage in a severe case of pulmonary alveolar proteinosis.

We present the case of a 71-year-old woman with severe bilateral primary alveolar proteinosis admitted for bilateral whole lung lavage (WLL) with a double-lumen endotracheal tube. She had a cardiac arrest of respiratory origin during the procedure and recovered after one minute of advanced resuscitation. A second LLP was scheduled under respiratory support with veno-venous extracorporeal membrane oxygenation (VV-ECMO). During this second WLL the patient was completely VV-ECMO-dependent, and the procedure was successfully completed. She was gradually weaned over the next 48 h. The patient was finally discharged after clinical improvement and home oxygen therapy was discontinued. WLL is the treatment of choice for severe cases of alveolar proteinosis. In rare cases the intervention may be poorly tolerated due to the degree of lung involvement. This case illustrates how VV-ECMO support is an option that may benefit this subgroup of at-risk patients.

Genomic Characterization of Piscicolin CM22 Produced by Carnobacterium maltaromaticum CM22 Strain Isolated from Salmon (Salmo salar).

Carnobacterium maltaromaticum is a species of lactic acid bacteria (LAB) that has been isolated from various natural environments. It is well-known for producing a diverse spectrum of bacteriocins with potential biotechnological applications. In the present study, a new psychrotolerant strain of C. maltaromaticum CM22 is reported, isolated from a salmon gut sample and producing a variant of the bacteriocin piscicolin 126 that has been named piscicolin CM22. After identification by 16S rRNA gene, this strain has been genomically characterized by sequencing and assembling its complete genome. Moreover, its bacteriocin was purified and characterized. In vitro tests demonstrated that both the strain and its bacteriocin possess antimicrobial activity against several Gram-positive bacteria of interest in human and animal health, such as Listeria monocytogenes, Clostridium perfringens, or Enterococcus faecalis. However, this bacteriocin did not produce any antimicrobial effect on Gram-negative species. The study of its genome showed the genetic structure of the gene cluster that encodes the bacteriocin, showing a high degree of homology to the gene cluster of piscicolin 126 described in other C. maltaromaticum. Although more studies are necessary concerning its functional properties, this new psychrotolerant strain C. maltaromaticum CM22 and its bacteriocin could be considered an interesting candidate with potential application in agri-food industry.

[Translated article] Subtalar dislocations: Analysis of a case series. Our urgent treatment algorithm.

INTRODUCTION AND OBJECTIVES: Subtalar dislocations are a rare entity (<1%) in traumatic foot injuries. There is a loss of anatomical relationship between the talus, calcaneus and scaphoid. There are only small-published series. MATERIAL AND METHODS: We present a series of patients (N=13) with subtalar dislocations in which a descriptive analysis of the main epidemiological, clinical and radiological variables was carried out, from which an urgent treatment algorithm is proposed. Cases with fractures of the neck of the talus, body of the calcaneus, or isolated Chopart fracture-dislocations were excluded. RESULTS: The median age was 48.5 years with a predominance of males (69.23%). Five patients suffered falls or sprained ankles and the other eight suffered high-energy mechanisms. The medial dislocations (nine) predominated over the lateral ones (four). In addition, four patients presented open dislocations, two of them type IIIC that required amputation. CT scans were requested in 76.93% of patients and 10 presented associated bone lesions of the foot. Open reduction surgery was performed in all open lesions and in one case in which closed reduction failed. Five patients required a delta-type external fixator. Subchondral articular sclerosis was observed in 77.77% of cases; although only one required subtalar arthrodesis. CONCLUSIONS: Subtalar dislocations are a traumatic emergency that require early reduction and subsequent immobilisation. Transarticular temporary external fixation is a good immobilisation option in open dislocations. They are serious lesions with a high probability of early osteoarthritis.

Subtalar dislocations: Analysis of a case series. Our urgent treatment algorithm. / Luxaciones periastragalinas: análisis de una serie de casos. Nuestro algoritmo de tratamiento urgente.

INTRODUCTION AND OBJECTIVES: Subtalar dislocations are a rare entity (<1%) in traumatic foot injuries. There is a loss of anatomical relationship between the talus, calcaneus and scaphoid. There are only small-published series. MATERIAL AND METHODS: We present a series of patients (N=13) with subtalar dislocations in which a descriptive analysis of the main epidemiological, clinical and radiological variables was carried out, from which an urgent treatment algorithm is proposed. Cases with fractures of the neck of the talus, body of the calcaneus, or isolated Chopart fracture-dislocations were excluded. RESULTS: The median age was 48.5 years with a predominance of males (69.23%). Five patients suffered falls or sprained ankles and the other eight suffered high-energy mechanisms. The medial dislocations (nine) predominated over the lateral ones (four). In addition, four patients presented open dislocations, two of them type IIIC that required amputation. CT scans were requested in 76.93% of patients and 10 presented associated bone lesions of the foot. Open reduction surgery was performed in all open lesions and in one case in which closed reduction failed. Five patients required a delta-type external fixator. Subchondral articular sclerosis was observed in 77.77% of cases; although only one required subtalar arthrodesis. CONCLUSIONS: Subtalar dislocations are a traumatic emergency that require early reduction and subsequent immobilization. Transarticular temporary external fixation is a good immobilization option in open dislocations. They are serious lesions with a high probability of early osteoarthritis.

Gamma-ray sources imaging and test-beam results with MACACO III Compton camera.

Hadron therapy is a radiotherapy modality which offers a precise energy deposition to the tumors and a dose reduction to healthy tissue as compared to conventional methods. However, methods for real-time monitoring are required to ensure that the radiation dose is deposited on the target. The IRIS group of IFIC-Valencia developed a Compton camera prototype for this purpose, intending to image the Prompt Gammas emitted by the tissue during irradiation. The system detectors are composed of Lanthanum (III) bromide scintillator crystals coupled to silicon photomultipliers. After an initial characterization in the laboratory, in order to assess the system capabilities for future experiments in proton therapy centers, different tests were carried out in two facilities: PARTREC (Groningen, The Netherlands) and the CNA cyclotron (Sevilla, Spain). Characterization studies performed at PARTREC indicated that the detectors linearity was improved with respect to the previous version and an energy resolution of 5.2 % FWHM at 511 keV was achieved. Moreover, the imaging capabilities of the system were evaluated with a line source of 68Ge and a point-like source of 241Am-9Be. Images at 4.439 MeV were obtained from irradiation of a graphite target with an 18 MeV proton beam at CNA, to perform a study of the system potential to detect shifts at different intensities. In this sense, the system was able to distinguish 1 mm variations in the target position at different beam current intensities for measurement times of 1800 and 600 s.

A new bottom-up methodology to produce silicon layers with a closed porosity nanostructure and reduced refractive index.

A new approach is presented to produce amorphous porous silicon coatings (a-pSi) with closed porosity by magnetron sputtering of a silicon target. It is shown how the use of He as the process gas at moderated power (50-150 W RF) promotes the formation of closed nanometric pores during the growth of the silicon films. The use of oblique-angle deposition demonstrates the possibility of aligning and orientating the pores in one direction. The control of the deposition power allows the control of the pore size distribution. The films have been characterized by a variety of techniques, including scanning and transmission electron microscopy, electron energy loss spectroscopy, Rutherford back scattering and x-ray photoelectron spectroscopy, showing the incorporation of He into the films (most probably inside the closed pores) and limited surface oxidation of the silicon coating. The ellipsometry measurements show a significant decrease in the refractive index of porous coatings (n(500 nm) = 3.75) in comparison to dense coatings (n(500 nm) = 4.75). The capability of the method to prepare coatings with a tailored refractive index is therefore demonstrated. The versatility of the methodology is shown in this paper by preparing intrinsic or doped silicon and also depositing (under DC or RF discharge) a-pSi films on a variety of substrates, including flexible materials, with good chemical and mechanical stability. The fabrication of multilayers of silicon films of controlled refractive index in a simple (one-target chamber) deposition methodology is also presented.

Experimental implementation of a biometric laser synaptic sensor.

We fabricate a biometric laser fiber synaptic sensor to transmit information from one neuron cell to the other by an optical way. The optical synapse is constructed on the base of an erbium-doped fiber laser, whose pumped diode current is driven by a pre-synaptic FitzHugh-Nagumo electronic neuron, and the laser output controls a post-synaptic FitzHugh-Nagumo electronic neuron. The implemented laser synapse displays very rich dynamics, including fixed points, periodic orbits with different frequency-locking ratios and chaos. These regimes can be beneficial for efficient biorobotics, where behavioral flexibility subserved by synaptic connectivity is a challenge.

Use of two autochthonous bacteriocinogenic strains as starter cultures in the production of salchichónes, a type of Spanish fermented sausages.

In this work, two autochthonous LAB strains (Lactiplantibacillus paraplantarum BPF2 and Pediococcus acidilactici ST6), isolated from spontaneously fermented sausages produced in Spain, were tested to produce Spanish fermented sausages (salchichón) in pilot plants, due to their promising technological and anti-listerial activity. These products were compared with a sample obtained with a commercial starter (RAP) and a spontaneously fermented control sample. Physico-chemical parameters, microbial counts, metagenomic analysis, biogenic amines content and organoleptic profile of the obtained samples were studied to assess the performances of the native starters. In fact, traditional and artisanal products obtained through spontaneous fermentations can represent an important biodiversity reservoir of strains to be exploited as new potential starter cultures, to improve the safety, quality and local differentiation of traditional products. The data underlined that ST6 strain resulted in a final lower percentage if compared with the other LAB used as starter cultures. The use of starters reduced the BA concentration observed in the sausages obtained with spontaneous fermentation and the BPF2 and ST6 strains were able to decrease the level of products rancidity. Moreover, a challenge test against L. monocytogenes were performed. The data confirmed the effectiveness in the inhibition of L. monocytogenes by the two bacteriocinogenic strains tested, with respect to RAP and control samples, highlighting their ability to produce bacteriocins in real food systems. This work demonstrated the promising application in meat industry of these autochthonous strains as starter cultures to improve sensory differentiation and recognizability of typical fermented sausages.

Acute effects of small changes in antero-posterior shoe-cleat position on physiological and biomechanical variables in road cycling.

The aim of this study was to investigate the effect of changes in cycling shoe-cleat position on pedalling biomechanics, physiological variables, and performance in road cycling. Twelve competitive road cyclists performed three pedalling trials with the cleat positioned at the first metatarsal head, 15-mm anterior and 15-mm posterior. Each trial included three sets of 5 min performed at 35%, 50%, and 65% of maximal aerobic power (MAP) followed by a 10-s sprint. Results showed no significant changes in physiological variables, pedalling kinetics, muscular activity of six lower limb muscles, sprint performance and perceived exertion. However, significant differences were found regarding joint kinematics: hip, knee, and ankle angles during both extension and flexion were reduced in the anterior cleat position. Therefore, this study suggests that cleat position does not affect sprint performance, physiological variables, pedalling kinetics, muscle activity, and perceived exertion regardless of the cycling intensity. However, joint kinematics, and particularly knee extension angle which could be related to the risk of overuse injuries, was affected by the shoe-cleat position.

Intrapersonal HbA(1c) variability and the risk of progression of nephropathy in patients with Type 2 diabetes.

AIM: To investigate the association between nephropathy and HbA(1c) variability (assessed as the standard deviation of each patient's HbA(1c) measurements) among patients with Type 2 diabetes. METHODS: Albumin excretion rate and HbA(1c) were measured in 2103 patients followed up for a mean 6.6 years. Multivariate Cox regression analysis was used to determine the influence of HbA(1c) variability on the risk of progression of nephropathy after adjustment for age, sex, duration of diabetes, baseline condition (two cohorts defined by duration of diabetes, retinopathy and albumin excretion rate), baseline HbA(1c) , insulin use, BMI, use of anti-hypertensive agents, smoking, lipid status, retinopathy, updated mean HbA(1c) and number of HbA(1c) measurements. RESULTS: Nephropathy progressed in 18.3% of subjects. HbA(1c) variability was significantly greater among progressors than among non-progressors (12 vs. 10 mmol/mol; 1.12 vs. 0.90%; P < 0.0001) and was a significant predictor of progression of nephropathy even after adjustment for updated mean HbA(1c) and other risk factors (hazard ratio 1.37, 95% CI 1.12-1.69). CONCLUSION: In patients with Type 2 diabetes, the risk of progression of nephropathy increases significantly with HbA(1c) variability, independently of the influence of updated mean HbA(1c) .

Dual-lag synchronization between coupled chaotic lasers due to path-delay interference.

We study experimentally the synchronization dynamics of two semiconductor lasers coupled unidirectionally via two different delayed paths. The emitter laser operates in a chaotic regime characterized by low-frequency fluctuations due to optical feedback and induces a synchronized dynamical activity in the receiver laser, which operates in the continuous-wave regime when uncoupled. Different delays in the two coupling paths lead to the coexistence of two time lags in the synchronized dynamics of the oscillators. This dual-lag synchronization degrades the average synchronization quality of the system of coupled lasers and hinders the transmission of information between them. Numerical simulation results agree with the experimental observations, and allow us to explore this phenomenon in a wide parameter range, and quantify the degree of signal transmission degradation caused by this chaotic path-delay interference.

Physical and thermal strain of firefighters according to the firefighting tactics used to suppress wildfires.

The aim of this study was to analyse the physiological strain of firefighters, using heart rate (HR) and core temperature, during real wildfire suppression according to the type of attack performed (direct, indirect or mixed). Three intensity zones were established according to the HR corresponding to the ventilatory threshold (VT) and respiratory compensation threshold (RCT): zone 1, RCT. The exercise workload (training impulse (TRIMP)), the physiological strain index (PSI) and the cumulative heat strain index(CHSI) were calculated using the time spent in each zone, and the HR and core temperature, respectively. Significantly higher mean HR, time spent in Z2 and Z3 and TRIMP h(-1) were found in direct and mixed versus indirect attacks. The highest PSI and CHSI were observed in the direct attack. In conclusion, exercise strain and combined thermal strain, but not core temperature during wildfire suppression, are related to the type of attack performed. STATEMENT OF RELEVANCE: Our findings demonstrated that wildfire firefighting is associated with high physiological demands, which vary significantly depending on the tactics chosen for performing the task. These results should be kept in mind when planning programmes to improve wildland firefighters' physical fitness, which will allow improvement in their performance.

[Comparison of 2 methods of clinical data collection, one using the PAINOUT questionnaire (a European database for the management of postoperative pain)]. / Comparación de dos métodos para la recogida de datos clínicos utilizando el cuestionario de PAINOUT (base de datos europea para la gestión del dolor postoperatorio).

OBJECTIVE: To compare postoperative pain intensity and incidence of adverse events when the evaluation is performed by a visual numerical scale completed by the patient (PAINOUT), or using a verbal numerical scale completed by ward nurses or the staff of the acute pain unit. METHODS: Fifty-two postsurgical patients of both sexes (age range 31-80 years) admitted to the general surgery ward were sequentially recruited and evaluated on postoperative day 1. All patients were assessed using both questionnaires, which measure postoperative outcomes using scales of 0 to 10; values > or =4 were considered clinically relevant. The test and Cohen coefficient were used for statistical analysis. RESULTS: Using the PAINOUT questionnaire, the mean maximum intensity of referred pain was 5.40 (range, 0-10) and the minimum intensity was 1.83 (range, 0-5). Mean values obtained with the verbal numerical scales used by staff on the ward and in the pain clinic were 3.76 (range, 0-10) and 0.97 (range, 0-5), respectively. The differences between the 2 methods of pain assessment were statistically (P = .006) and clinically significant. When evaluating nausea with PAINOUT questionnaire, all patients provided a response; in 88.5% the intensity was less than 4. Six patients reported nausea on the PAINOUT but not in the UDA questionnaire. Moreover, 61% of patients reported drowsiness/sedation in PAINOUT instrument, whereas none reported that effect on the verbal scale. CONCLUSIONS: The intensity of pain and adverse events is significantly higher when the patient evaluates and records its intensity on visual numerical scales compared with verbal numerical scales.