Resumen: Consenso internacional para la nomenclatura y clasificación de la válvula aórtica bicúspide congénita y su aortopatía, con fines clínicos, quirúrgicos, intervencionistas y de investigación / Summary: International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes

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Abstract This consensus of nomenclature and classification for congenital bicuspid aortic valve and its aortopathy is evidence-based and intended for universal use by physicians (both pediatricians and adults), echocardiographers, advanced cardiovascular imaging specialists, interventional cardiologists, cardiovascular surgeons, pathologists, geneticists, and researchers spanning these areas of clinical and basic research. In addition, as long as new key and reference research is available, this international consensus may be subject to change based on evidence-based data1.

[Summary: International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes]. / Resumen: Consenso internacional para la nomenclatura y clasificación de la válvula aórtica bicúspide congénita y su aortopatía, con fines clínicos, quirúrgicos, intervencionistas y de investigación.

This consensus of nomenclature and classification for congenital bicuspid aortic valve and its aortopathy is evidence-based and intended for universal use by physicians (both pediatricians and adults), echocardiographers, advanced cardiovascular imaging specialists, interventional cardiologists, cardiovascular surgeons, pathologists, geneticists, and researchers spanning these areas of clinical and basic research. In addition, as long as new key and reference research is available, this international consensus may be subject to change based on evidence-based data1.

Este consenso de nomenclatura y clasificación para la válvula aórtica bicúspide congénita y su aortopatía está basado en la evidencia y destinado a ser utilizado universalmente por médicos (tanto pediatras como de adultos), médicos ecocardiografistas, especialistas en imágenes avanzadas cardiovasculares, cardiólogos intervencionistas, cirujanos cardiovasculares, patólogos, genetistas e investigadores que abarcan estas áreas de investigación clínica y básica. Siempre y cuando se disponga de nueva investigación clave y de referencia, este consenso internacional puede estar sujeto a cambios de acuerdo con datos basados en la evidencia1.

Impacto del sitio de extracción en la incidencia de hernias incisionales en pacientes sometidos a cirugía laparoscópica por cáncer colorrectal

Introducción: El objetivo de este estudio fue comparar la tasa de hernia incisional (HI) tras la extracción de piezas operatorias por mini-laparatomia media periumbilical (MM) versus mini-laparotomía transversa suprapúbica (MTS) en pacientes sometidos a cirugía laparoscópica por cáncer colorrectal (CLCC), y evaluar los factores asociados a su ocurrencia. Material y Método: Estudio de cohorte no concurrente. Se incluyen todos los pacientes consecutivos sometidos a CLCC en nuestro centro entre septiembre 2006 y diciembre 2017, cuya pieza operatoria fuese extraída por una MM o MTS y que contaran con un control tomográfico en el seguimiento. El diagnóstico de HI se realizó mediante tomografía computada, evaluada por dos radiólogos de forma independiente. Se agruparon los pacientes en MM y MTS, y se evaluaron las tasas de HI según sitio de extracción. Además, se realizó una regresión logística para identificar factores asociados a HI. Resultados: Se identificaron 1090 pacientes que tuvieron resecciones colorrectales lapa-roscópicas durante el período estudiado. De estos, 254 cumplieron con los criterios de inclusión. La edad media de la serie fue de 63 años (53,5% son hombres) con un IMC de 26,4 kg/m2. El sitio de extracción fue una MTS en un 53,1% y una MM en un 46,9%. Se identificó un total de 41 (34,5%) HI en el grupo de MM versus 17 (12,6%) en MTS (p = 0,001) en la TC de seguimiento realizado en una mediana de 18 meses (RIC 12-32) postoperatorios. En la regresión logística, el sitio de extracción (OR = 3,33, IC 95% 1,72-7,14, p < 0,001) y la presencia de patología bronquial obstructiva se asociaron de manera independiente con HI (OR = 3,45, IC 95% 1,11-11,11, p = 0,03). Conclusión: La MTS se asocia a una menor tasa de HI que la MM en pacientes sometidos a CLCC. Esto se debe tener en consideración al momento de elegir el sitio de extracción de pieza operatoria en CLCC.

Aim: To compare the rate of incisional hernia (IH) according to the extraction site in patients undergoing laparoscopic colorectal cancer surgery (LCCS), and to evalúate the risk factors associated with its occurrence. Material and Method: Cohort study including all consecutive patients undergoing LCCS in our center between September 2006 and December 2017, where the specimen was extracted through a median mini-laparotomy (MM) or transverse suprapubic mini-laparotomy (TSM) and have a tomographic control during follow-up. The diagnosis of IH was made by computed tomography evaluated by two radiologists, independently. The rate of IH was calculated for both groups and a regression analysis were performed to identify factors associated with IH. Results: Some 1090 patients undergoing laparoscopic colorectal resections were identified during the study period; of these, 254 met the inclusion criteria. The mean age of the series was 63 years (53.5% are men) with a BMI of 26.4 kg/m2. The extraction site was a TSM in 53.1% and a MM in 46.9%. A total of 41 (34.5%) IH were identified in the MM group versus 17 (12.6%) in TSM (p = 0.001) in the follow-up CT performed at a median of18 months (IQR 12-32) postoperative. In logistic regression, the extraction site (OR = 3.33, 95% CI 1.72-7.14, p < 0.001) and the presence of obstructive bronchial pathology were independently associated with IH (OR = 3, 45, 95% CI 1.11-11.11, p = 0.03). Conclusión: A TSM is associated with a lower rate of IH compared to a MM as extraction site in patients undergoing LCCS. This must be taken into account when choosing the extraction site in patients having LCCS.

Exactitud diagnóstica de la tomografía computarizada en la estadificación del cáncer de colon / Diagnostic accuracy of computed tomography in colon cancer staging

Resumen Introducción: Una terapia emergente para el cáncer de colon es la neoadyuvancia, en casos seleccionados. Dicha selección se basa en el análisis preoperatorio de imágenes mediante tomografía computada. Objetivo: Nuestro objetivo es determinar la exactitud diagnóstica del examen para estadificar el cáncer de colon y su correlación entre radiólogos expertos. Materiales y Método: Estudio de exactitud diagnóstica. Previo cálculo muestral se seleccionaron aleatoriamente 47 pacientes con adenocarcinoma colónico resecado con intención curativa e imágenes hasta 60 días previo cirugía. Se evaluó profundidad de invasión tumoral e invasión linfonodal por 2 radiólogos expertos y ciegos entre sí. Las diferencias fueron auditadas por un tercer radiólogo experto. Se compararon resultados con la biopsia, calculando la sensibilidad, especificidad, valor predictivo negativo, valor predictivo positivo y exactitud diagnóstica del examen. Se calculó la concordancia entre radiólogos mediante el índice de kappa. Resultados: La exactitud para diferenciar tumores T3-T4 de T1-T2 fue del 89,4%. En cambio, la capacidad para diferenciar tumores T4 de los T3 fue de un 65,9%. La exactitud para determinar un N (+) fue de un 66%. La concordancia entre radiólogos fue de 0,929 para identificar tumores T1-2, de 0,602 para T3, de 0,584 para T4. Para determinar un N (+), la concordancia fue de 0,521. Conclusión: La exactitud diagnóstica de la tomografía computada en cáncer de colon es adecuada para distinguir tumores avanzados. Sin embargo, su capacidad para discriminar entre T3 y T4, los N (+) y la baja concordancia entre radiólogos, sugiere la necesidad de buscar técnicas imagenológicas complementarias.

Introduction: Neoadjuvant therapy is an emerging treatment for selected cases of colon cancer. The decision is based on the analysis of preoperative images taken by computed tomography. However, its ability to discriminate those who could benefit from this therapy is unknown. Aim: Our objective is to determine the diagnostic accuracy of computed tomography to evaluate the colon cancer stage and its correlation among expert radiologists. Materials and Method: Diagnostic accuracy study. After sample size calculation, we randomly selected 47 patients who underwent a colonic adenocarcinoma resection with curative intent and had available images up to 60 days after surgery. The depth of tumor and lymph nodal invasion were evaluated by two expert radiologists, blinded to each other. The differences between radiologists were audited by a third one. The results were correlated with biopsy as the gold standard. We calculated sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy of computed tomography. The agreement between radiologists was calculated using the kappa index. Results: The accuracy to differentiate T3-T4 tumors from T1-T2 was 89.4%. In contrast, ability to differentiate T4 tumors from T3 tumors was 65.9%. The accuracy to determine an N (+) was 66%. Agreement between radiologists was 0.929 to identify T1-2, 0.602 for T3, 0.584 for T4 tumors. To determine an N (+), the concordance was 0.521. Conclusion: Diagnostic computed tomography accuracy in colon cancer is adequate to differentiate advanced tumors. However, its ability to discriminate between T3 and T4, N (+) and the low agreement between radiologists suggests the need for complementary imaging techniques.

Large diameter Advanta V12 covered stent trial for coarctation of the aorta: COARC Study

BACKGROUND: Covered stent implantation for treatment of coarctation of the aorta (CoA) is effective and can prevent aortic wall injury. Prospective studies with long-term follow-up, including imaging, are lacking. We report the acute and long-term outcomes for use of the Large Diameter Advanta V12 covered stent for treatment of native and recurrent CoA. METHODS: A prospective, multicenter, nonrandomized study was performed including 70 patients (43 male), median age 17 years, median weight 57.4 kg with CoA who underwent implantation of the Large Diameter Advanta V12 covered stent. Annual follow-up for 5 years included Doppler echocardiography to calculate diastolic velocity: systolic velocity ratio. RESULTS: CoA diameter increased from 5.6±3.6 to 14.9±3.9 mm (P<0.0001) and the pressure gradient decreased from 35.8±16.2 to 5.6±7.9 mm Hg (P<0.0001). Preimplantation diastolic velocity: systolic velocity of 0.6±0.16 dropped to 0.34±0.13 (P<0.0001) and was maintained at 5 years. Computed tomography angiograms at 12 months post implantation demonstrated the stent: transverse arch diameter to be similar, 0.91±0.09 to post procedure 0.86±0.14. Major adverse vascular events at 30 days and 12 months were 1.4% and 4.3%, respectively. Significant adverse events included three patients who required stent implantation to treat infolding. There were no mortalities. CONCLUSIONS: The Large Diameter Advanta V12 covered stent is safe and effective for the treatment of CoA with an immediate and sustained reduction of the pressure gradient over 12 months and 5 years as assessed by preimplantation and post implantation Doppler echocardiography and 12-month computed tomography angiography.

Photobiomodulation Therapy is Able to Modulate PGE2 Levels in Patients With Chronic Non-Specific Low Back Pain: A Randomized Placebo-Controlled Trial.

BACKGROUND AND OBJECTIVES: Non-specific low back pain (LBP) is responsible for triggering increased biomarkers levels. In this way, photobiomodulation therapy (PBMT) may be an interesting alternative to treat these patients. One of the possible biological mechanisms of PBMT involved to decrease pain intensity in patients with musculoskeletal disorders is modulation of the inflammatory mediators' levels. The aim of this study was to evaluate the effects of PBMT compared with placebo on inflammatory mediators' levels and pain intensity in patients with chronic non-specific LBP. STUDY DESIGN/MATERIALS AND METHODS: A prospectively registered, randomized triple-blinded (volunteers, therapists, and assessors), placebo-controlled trial was performed. Eighteen patients with chronic non-specific LBP were recruited and treated with a single session of active PBMT or placebo PBMT. The primary outcome of the study was serum prostaglandin E2 levels and the secondary outcomes were tumor necrosis factor-α, interleukin-6 levels, and pain intensity. All outcomes were measured before and after 15 minutes of treatment session. RESULTS: PBMT was able to decrease prostaglandin E2 levels at post-treatment compared with placebo, with a mean difference of -1470 pg/ml, 95% confidence interval -2906 to -33.67 in patients with LBP. There was no difference between groups in the other measured outcomes. Patients did not report any adverse events. CONCLUSION: Our results suggest that PBMT was able to modulate prostaglandin E2 levels, indicating that this may be one of the mechanisms involved in the analgesic effects of PBMT in patients with LBP. Trial registration number (ClinicalTrials.gov): NCT03859505. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

Potential Influence of Olfactory, Gustatory, and Pharyngolaryngeal Sensory Dysfunctions on Swallowing Physiology in COVID-19.

Persistent smell and taste disorders have been reported as some of the most common symptoms after COVID-19 (coronavirus disease 2019). Sensory, olfactory, and gustatory functions perform an important role in the initiation and modulation of oropharyngeal swallow biomechanics and salivation as well as in mealtime enjoyment and appetite. Yet, the details of this interaction remain relatively unknown in patients who are infected with and recovering from COVID-19. In this commentary, we discuss the possible impacts of SARS-CoV-2 on the central and peripheral nervous system and consider the pathophysiology of olfactory, gustatory, and pharyngolaryngeal sensory deficits and its influence on deglutition, describing hypotheses and offering guidance for future research.

Society of Critical Care Medicine's International Consensus Conference on Prediction and Identification of Long-Term Impairments After Critical Illness.

BACKGROUND: After critical illness, new or worsening impairments in physical, cognitive, and/or mental health function are common among patients who have survived. Who should be screened for long-term impairments, what tools to use, and when remain unclear. OBJECTIVES: Provide pragmatic recommendations to clinicians caring for adult survivors of critical illness related to screening for postdischarge impairments. PARTICIPANTS: Thirty-one international experts in risk-stratification and assessment of survivors of critical illness, including practitioners involved in the Society of Critical Care Medicine's Thrive Post-ICU Collaboratives, survivors of critical illness, and clinical researchers. DESIGN: Society of Critical Care Medicine consensus conference on post-intensive care syndrome prediction and assessment, held in Dallas, in May 2019. A systematic search of PubMed and the Cochrane Library was conducted in 2018 and updated in 2019 to complete an original systematic review and to identify pre-existing systematic reviews. MEETING OUTCOMES: We concluded that existing tools are insufficient to reliably predict post-intensive care syndrome. We identified factors before (e.g., frailty, preexisting functional impairments), during (e.g., duration of delirium, sepsis, acute respiratory distress syndrome), and after (e.g., early symptoms of anxiety, depression, or post-traumatic stress disorder) critical illness that can be used to identify patients at high-risk for cognitive, mental health, and physical impairments after critical illness in whom screening is recommended. We recommend serial assessments, beginning within 2-4 weeks of hospital discharge, using the following screening tools: Montreal Cognitive Assessment test; Hospital Anxiety and Depression Scale; Impact of Event Scale-Revised (post-traumatic stress disorder); 6-minute walk; and/or the EuroQol-5D-5L, a health-related quality of life measure (physical function). CONCLUSIONS: Beginning with an assessment of a patient's pre-ICU functional abilities at ICU admission, clinicians have a care coordination strategy to identify and manage impairments across the continuum. As hospital discharge approaches, clinicians should use brief, standardized assessments and compare these results to patient's pre-ICU functional abilities ("functional reconciliation"). We recommend serial assessments for post-intensive care syndrome-related problems continue within 2-4 weeks of hospital discharge, be prioritized among high-risk patients, using the identified screening tools to prompt referrals for services and/or more detailed assessments.

Assessment, Diagnosis, and Treatment of Dysphagia in Patients Infected With SARS-CoV-2: A Review of the Literature and International Guidelines.

Purpose Speech-language pathologists are playing a crucial role in the assessment and management of patients infected with severe acute respiratory syndrome coronavirus 2. Our goal was to synthesize peer-reviewed literature and association guidelines from around the world regarding dysphagia assessment and management for this specific population. Method A review of publications available in the PubMed database and official guidelines of international groups was performed on May 23, 2020. The information was synthesized and categorized into three content areas for swallowing: clinical evaluation, instrumental assessment, and rehabilitation. Results Five publications were identified in the PubMed database. Following title, abstract, and full-text review, only three publications met inclusion criteria: two reviews and one narrative report. Additionally, 19 international guidelines were reviewed. To assess swallowing, a modified clinical evaluation was recommended and only following a risk assessment. Instrumental assessments were often considered aerosol generating, especially transnasal procedures such as endoscopy and manometry. For this reason, many associations recommended that these examinations be performed only when essential and with appropriate personal protective equipment. Guidelines recommended that intervention should focus on compensatory strategies, including bolus modification, maneuvers/postural changes, and therapeutic exercises that can be conducted with physical distancing. Respiratory training devices were not recommended during rehabilitation. Conclusions International associations have provided extensive guidance regarding the level of risk related to the management of dysphagia in this population. To date, there are no scientific papers offering disease and/or recovery profiling for patients with dysphagia and coronavirus disease 2019. As a result, research in this area is urgently needed.

Infective endocarditis following transcatheter aortic valve replacement: comparison of balloon- versus self-expandable valves

BACKGROUND: No data exist about the characteristics of infective endocarditis (IE) post-transcatheter aortic valve replacement (TAVR) according to transcatheter valve type. We aimed to determine the incidence, clinical characteristics, and outcomes of patients with IE post-TAVR treated with balloon-expandable valve (BEV) versus self-expanding valve (SEV) systems. METHODS: Data from the multicenter Infectious Endocarditis After TAVR International Registry was used to compare IE patients with BEV versus SEV. RESULTS: A total of 245 patients with IE post-TAVR were included (SEV, 47%; BEV, 53%). The timing between TAVR and IE was similar between groups (SEV, 5.5 [1.2-15] months versus BEV, 5.3 [1.7-11.4] months; P=0.89). Enterococcal IE was more frequent in the SEV group (36.5% versus 15.4%; P<0.01), and vegetation location differed according to valve type (stent frame, SEV, 18.6%; BEV, 6.9%; P=0.01; valve leaflet, SEV, 23.9%; BEV, 38.5%; P=0.01). BEV recipients had a higher rate of stroke/systemic embolism (20.0% versus 8.7%, adjusted OR: 2.46, 95% CI: 1.04-5.82, P=0.04). Surgical explant of the transcatheter valve (SEV, 8.7%; BEV, 13.8%; P=0.21), and in-hospital death at the time of IE episode (SEV, 35.6%; BEV, 37.7%; P=0.74) were similar between groups. After a mean follow-up of 13±12 months, 59.1% and 54.6% of the SEV and BEV recipients, respectively, had died (P=0.66). CONCLUSIONS: The characteristics of IE post-TAVR, including microorganism type, vegetation location, and embolic complications but not early or late mortality, differed according to valve type. These results may help to guide the diagnosis and management of IE and inform future research studies in the field. (AU)

Prevalence and risk factors related to haloperidol use for delirium in adult intensive care patients: the multinational AID-ICU inception cohort study.

PURPOSE: We assessed the prevalence and variables associated with haloperidol use for delirium in ICU patients and explored any associations of haloperidol use with 90-day mortality. METHODS: All acutely admitted, adult ICU patients were screened during a 2-week inception period. We followed the patient throughout their ICU stay and assessed 90-day mortality. We assessed patients and their variables in the first 24 and 72 h in ICU and studied their association together with that of ICU characteristics with haloperidol use. RESULTS: We included 1260 patients from 99 ICUs in 13 countries. Delirium occurred in 314/1260 patients [25% (95% confidence interval 23-27)] of whom 145 received haloperidol [46% (41-52)]. Other interventions for delirium were benzodiazepines in 36% (31-42), dexmedetomidine in 21% (17-26), quetiapine in 19% (14-23) and olanzapine in 9% (6-12) of the patients with delirium. In the first 24 h in the ICU, all subtypes of delirium [hyperactive, adjusted odds ratio (aOR) 29.7 (12.9-74.5); mixed 10.0 (5.0-20.2); hypoactive 3.0 (1.2-6.7)] and circulatory support 2.7 (1.7-4.3) were associated with haloperidol use. At 72 h after ICU admission, circulatory support remained associated with subsequent use of haloperidol, aOR 2.6 (1.1-6.9). Haloperidol use within 0-24 h and within 0-72 h of ICU admission was not associated with 90-day mortality [aOR 1.2 (0.5-2.5); p = 0.66] and [aOR 1.9 (1.0-3.9); p = 0.07], respectively. CONCLUSIONS: In our study, haloperidol was the main pharmacological agent used for delirium in adult patients regardless of delirium subtype. Benzodiazepines, other anti-psychotics and dexmedetomidine were other frequently used agents. Haloperidol use was not statistically significantly associated with increased 90-day mortality.

Standardized definition of structural valve degeneration for surgical and transcatheter bioprosthetic aortic valves

ABSTRACT: Bioprostheses are prone to structural valve degeneration, resulting in limited long-term durability. A significant challenge when comparing the durability of different types of bioprostheses is the lack of a standardized terminology for the definition of a degenerated valve. This issue becomes especially important when we try to compare the degeneration rate of surgically inserted and transcatheter bioprosthetic valves. This document, by the VIVID (Valve-in-Valve International Data), proposes practical and standardized definitions of valve degeneration and provides recommendations for the timing of clinical and imaging follow-up assessments accordingly. Its goal is to improve the quality of research and clinical care for patients with deteriorated bioprostheses by providing objective and strict criteria that can be utilized in future clinical trials. We hope that the adoption of these criteria by both the cardiological and surgical communities will lead to improved comparability and interpretation of durability analyses.

First molecular characterisation of a Brazilian Burkholderia mallei strain isolated from a mule in 2016.

We present the first molecular characterisation based on MLVA and SNP analysis of a strain of Burkholderia mallei isolated from a mule found dead in Brazil in 2016.

Long-term results of a randomized, controlled, double-blind study of low-level laser therapy before exercises in knee osteoarthritis: laser and exercises in knee osteoarthritis.

OBJECTIVES: To assess the long-term effects of low-level laser therapy (LLLT), in combination with strengthening exercises in patients with osteoarthritis of the knee. DESIGN: Follow-up results at three and six months in a previously published randomized, double-blind, placebo-controlled trial. SETTING: Specialist Rehabilitation Services. SUBJECTS: Forty participants of both genders, aged 50-75 years with knee osteoarthritis grade 2-4 on Kellgren-Lawrence scale. INTERVENTION: The LLLT group received 10 LLLT treatments with invisible infrared laser (904 nm, 3 Joules/point) over three weeks followed by an eight-week supervised strengthening exercise program. The placebo LLLT group received identical treatment, but the infrared laser output was disabled. MAIN MEASURES: Pain on a visual analogue scale, paracetamol consumption, and osteoarthritis severity measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne Index. RESULTS: The new data obtained during the follow-up period showed that all outcomes remained stable and there were no significant differences between the groups at three and six months. However, daily consumption of rescue analgesics (paracetamol) was significantly lower in the LLLT group throughout the follow-up period, ending at a group difference of 0.45 vs. 3.40 units ( P < 0.001) at six months follow-up. We conclude that within the limitations of this small study, the previously reported improvement after LLLT plus exercise was maintained for a period of six months. CONCLUSION: We find that the immediate post-intervention improvements from LLLT plus strengthening exercises were maintained for six months.

First Draft Genome for a Burkholderia mallei Isolate Originating from a Glanderous Mule from Brazil.

Burkholderia mallei is the etiological agent of glanders. Here, we present the draft genome sequence of Burkholderia mallei strain 16-2438_BM#8 that was isolated from a mule found dead in Pernambuco, northeast Brazil. It is the first available genomic sequence from a strain isolated on the American continent.

Single-laboratory validation of an LC-MS/MS method for determining florfenicol (FF) and florfenicol amine (FFA) residues in chicken feathers and application to a residue-depletion study.

A suitable analytical method is required to study the behaviour of florfenicol (FF) and its metabolite florfenicol amine (FFA) in broiler's feathers. An LC-MS/MS method was developed, assessed and intra-laboratory-validated for FF and FFA analyses. We chose cloramphenicol-d5 as an internal standard, acetone as a solvent for the extraction of the analytes and dichloromethane for the clean-up. Through LC-MS/MS analysis, we established a detection limit of 20 µg kg-1, as well as calculated quantification limits of 24.4 and 24.5 µg kg-1 for FF and FFA, respectively. Validation parameters such as linearity, recovery and precision were calculated following Commission Decision 2002/657/EC. For linearity, all standard curves showed a standard coefficient greater than 0.99. Recoveries ranged from 99% to 102% for all studied concentrations. The results show that this analytical method is precise and reliable. For the depletion study, 64 Ross 308 broilers were treated with a therapeutic dosage of 10% FF during 5 consecutive days and their feathers were then analysed. Samples were drawn on days 5, 10, 15, 20, 25, 30, 35 and 40 post-treatments. As for the control group, 16 broiler chickens were raised under the same regime. Throughout the whole study, the detected concentrations of FF and FFA in feather samples were above 100 µg kg-1. In fact, even on day 30 post-treatment we detected concentrations of 221.8 and 28.8 µg kg-1 for FF and FFA, respectively. Based on these results, we conclude that these analytes will persist for a long time and will deplete slowly in feathers of treated broiler chickens.

Residue depletion of oxytetracycline (OTC) and 4-epi-oxytetracycline (4-epi-OTC) in broiler chicken's claws by liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Antibiotics are widely used in poultry production for the treatment of bacterial diseases. However, residues may remain in products and by-products destined for human consumption or animal feeding. The claws of chickens, which are a by-product of the poultry industry, can directly or indirectly enter the food chain as meals destined to feed other productive animals. Thus, it becomes necessary to determine and quantify antimicrobial residues present in this matrix. The objective of the study was to assess the depletion of oxytetracycline (OTC) and its metabolite 4-epi-OTC in broiler chicken's claws. Claws of 32 broilers treated with a therapeutic dosage of 10% OTC during 7 days were analysed. Samples were taken at days 3, 9, 15 and 19 post-treatment. As for the control group, eight broiler chickens were raised under the same conditions. Extraction was carried out through EDTA-McIlvaine buffer, and clean-up employed a SPE C-18 Sep-Pak®. Instrumental analysis was performed through LC-MS/MS. The concentrations of both analytes were determined in claw samples until day 19 post-treatment. Average concentrations were within the LOD (20 µg kg-1) and LOQ (22 µg kg-1) for OTC and 84 µg kg-1 for 4-epi-OTC. Withdrawal times (WDTs) of 39 days for OTC and 54 days for 4-epi-OTC were established in claws based on 95% confidence. These findings demonstrate that claws can be a source of antimicrobial residue entry into the food chain, since the results showed that OTC and its metabolite can be found in chicken's claws for long periods, even exceeding the average lifespan of a broiler chicken.

Prevalencia y trascendencia de los hallazgos extracardíacos encontrados en resonancia magnética de corazón / Prevalence and significance of extracardiac findings in cardiac magnetic resonance imaging

Objetivos: Valorar el número de lesiones incidentales detectadas por resonancia magnética (RM) cardíaca, establecer el porcentaje de hallazgos incluidos en el informe y definir el porcentaje de lesiones extracardíacas con implicancia en el manejo del paciente. Materiales y métodos: Se revisaron retrospectivamente 918 RM de corazón, realizadas desde mayo de 2006 hasta marzo de 2015, en busca de hallazgos extracardíacos. Estos fueron clasificados en nada/poco relevantes o relevantes, y en relación causa-efecto con la sintomatología cardíaca. Resultados: Se encontraron 271 hallazgos extracardíacos. El 35,7% resultó relevante y el 18,8% tenía una relación de causa-efecto con la sintomatología cardíaca. Los hallazgos extracardíacos relevantes fueron informados en el 58,4% de los casos y los poco/nada relevantes en el 26,6%. Discusión: Diferentes muestras poblacionales y protocolos de RM cardíaca pueden condicionar los porcentajes de los hallazgos extracardíacos detectados. Además, el análisis de estas imágenes tiene peculiaridades que requieren conocimiento y entrenamiento para una correcta valoración. Conclusión: Se detectaron hallazgos extracardíacos de diversa relevancia en un 26,4% de los pacientes. Analizar estos hallazgos y establecer su valoración es parte fundamental del informe radiológico de la RM cardíaca.

Objectives: To assess the number of incidental lesions detected on cardiac magnetic resonance imaging (MRI), in order to establish the percentage of findings included in the report and evaluate the percentage of extracardiac lesions that have implications on patient management. Materials and methods: A retrospective review was conducted on 918 cardiac MRI (performed from May 2006 to March 2015) to search for extracardiac findings. These were classified in not relevant or relevant, and in relation with cause-effect cardiac symptoms. Results: A total of 271 extracardiac findings were observed, of which 35.7% were relevant, and 18.8% had a cause-effect relationship with the cardiac symptoms. Relevant extracardiac findings were reported in 58.4% of cases, and not relevant findings in 26.6% of cases. Discussion: Different sample populations and protocols (performing cardiac MRI) can determine differences when establishing percentage of extracardiac findings. Furthermore, analysis of cardiac MR images has peculiarities that require knowledge and training for proper assessment. Conclusión: Extracardiac findings of distinct relevance were detected in 26.4% of patients. To analyse and to assess the importance of these findings is a fundamental part of the cardiac MRI report.

A four-year survey in the farming region of Chile, occurrence and human exposure to polychlorinated dibenzo-p-dioxins and dibenzofurans, and dioxin -like polychlorinated biphenyls in different raw meats.

For the first time in South America, a four-year survey (2011-2014) was conducted to assess the occurrence of polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (dl-PCBs) in different raw meats (bovine, pork, ovine, chicken, and turkey) sampled from ten of the fifteen regions of Chile. When expressed as pg World Health Organization Toxic Equivalent (WHO-TEQ2005)g-1 fat, the highest PCDD/F values for each species were 0.54 (bovine-2012), 0.27 (pork-2013), 0.23 (ovine-2011), 0.61 (chickens-2013), and 0.34 (turkey-2012). The highest mean dl-PCBs levels were 0.18 (bovine-2011), 0.05 (pork-2014), 0.13 (ovine-2011), 0.1 (chicken-2014), and 0.21 (turkey-2013). Penta- and tetra-chlorinated congeners dominated PCDD/F WHO-TEQ2005 profiles during the survey, while PCB 126 dominated dl-PCBs profiles. Statistically significant interspecies differences were found. Dietary intake was also estimated, and the highest total PCDD/F and dl-PCBs values, found in poultry meat, were 0.09pgWHO-TEQ2005kg-1bwd-1 (2013) for adults and 0.36pgWHO-TEQ2005kg-1bwd-1 (2013) for children. The concentrations and dietary intakes for the studied compounds in raw meat were below international and national maximum permitted limits.