Impact of intraoperative colonoscopy on anastomotic leakage detection and prevention in colorectal anastomosis for rectal cancer.

INTRODUCTION AND AIM: The value of leakage testing during colorectal resections to identify anastomotic leaks or bleeding has not been established. Our aim was to compare the impact of intraoperative colonoscopy (IOC) versus insufflation with a syringe, as leakage testing in lower anterior resection (LAR) for rectal cancer, with respect to the incidence of postoperative leakage (PL). MATERIALS AND METHODS: A retrospective study utilizing a prospective database of 426 patients with rectal cancer that underwent elective LAR, within the time frame of January 2015 and December 2019, was conducted. The anastomotic leak test was chosen by the surgeon. The incidence of postoperative leakage was compared between patients that underwent IOC and those that had the syringe leak test, utilizing the logistic regression analysis. Propensity score matching was included. RESULTS: There were no significant differences in the clinical characteristics or morbidity and mortality rates between the two groups. Four patients were excluded, leaving a patient total of 422. Seventy patients with IOC were compared with 352 that had the syringe leak test. The incidence of postoperative leakage was 5.7% in the IOC group and 12.2% in the control group (p = 0.001). After propensity score matching (n = 221), balancing the characteristics between the groups, the incidence of postoperative leakage was 5.7% in the IOC group and 13.9% in the syringe leak test group (p = 0.001). CONCLUSION: IOC was shown to be a safe method for evaluating the integrity of colorectal anastomosis and was associated with a higher percentage of protective stoma use, appearing to reduce the risk for PL.

Efecto de los juegos reducidos sobre jugadoras de fútbol / Effect of Small-Sided games on football players

El objetivo ha sido analizar cómo influyen los juegos reducidos o SSGs sobre la condición física, técnica y los cambios de dirección (CODA) en jugadoras alevines de fútbol femenino. Participan 12 jugadoras de fútbol femenino. Realizaron 14 sesiones de entrenamiento basado en juegos reducidos de fútbol. La muestra presenta valores normales en la prueba de Saphiro-Wilk, además, en la prueba de t de Student muestra que existen diferencias estadísticamente muy significativas (p ≤0,00) en todas las variables físicas analizadas, menos en el caso de la fuerza explosiva. En las variables de técnica nos muestra que existen diferencias significativas en todas las variables analizadas (p ≤0,00). Por último existen correlaciones positivas y estadísticamente significativas entre las distintas variables analizadas. De esta forma podemos considerar los juegos reducidos son un método adecuado y muy ventajoso para el entrenamiento en las etapas iniciales o de formación en jugadoras de fútbol

The objective has been to analyze how small-sided games or SSGs affect physical, technical and changes of direction (CODA) in U12 female soccer players. 12 female soccer players participate. They conducted 14 training sessions based on reduced soccer games. The sample has normal values ​​in the Saphiro-Wilk test, and in the Student's t test it shows that there are statistically very significant differences (p ≤0,00) in all the analyzed physical variables, less in the case of the explosive force. In the technique variables we show that there are significant differences in all variables analyzed (p ≤0,00). Finally, there are positive and statistically significant correlations between the different variables analyzed. In this way we can consider reduced games are a suitable and very advantageous method for training in the initial stages or training in soccer players

Inflammatory proteins in nasal lavage of workers exposed to occupational agents.

BACKGROUND: Low-molecular-weight (LMW) and high-molecular-weight (HMW) agents have been recognized as causes of occupational rhinitis (OR). Immunological mechanisms underlying OR differ according to the type of exposure. While HMW agents act mainly through IgE-mediated mechanisms, LMW agents appear to act through both immunological and non-immunological mechanisms. OBJECTIVE: The objective of this study was to identify potential differences in the upper airways inflammatory response after exposure to LMW and HMW agents by specific inhalation challenge test (SIC). METHODS: Nasal lavage (NL) samples from 20 subjects who were exposed to HMW (n = 10, Group I) and LMW (n = 10, Group II) at their workplaces were collected after SIC with control and specific occupational agents. These samples were analysed for 47 inflammatory markers using multiplex bead technology. RESULTS: After exposure to specific agent, Group I exhibited higher concentrations of the following proteins compared to Group II: fibrinogen (median (interquartile range) Group I: 0.09 (0.00) µg/mL, Group II: 0.04 (0.05) µg/mL, P = .05); haptoglobin (Group I: 0.86 (0.01) µg/mL, Group II: 0.14 (0.20) µg/mL, P = .02); vascular cell adhesion molecule-1 (VCAM-1) (Group I: 0.34 (0.67) ng/mL, Group II: 0.11 (0.11) ng/mL, P = .01); vascular endothelial growth factor (VEGF) (Group I: 157.0 (154.0) pg/mL, Group II: 98.0 (20.25) pg/mL, P = .01); and vitamin D (VDBP) (Group I: 0.06 (0.13) µg/mL, Group II: 0.03 (0.03) µg/mL, P = .04). No statistically significant differences in proteins profiles were observed between the groups after exposure to control agent. Also, subjects exposed to HMW agents showed a significant increase in NL levels of C-reactive protein compared to control-day exposure. CONCLUSIONS AND CLINICAL RELEVANCE: Exposure to HMW and LMW agents by SIC induced a differential nasal airway response including acute-phase reactants proteins (fibrinogen, haptoglobin and CRP), cell adhesion molecules (VCAM-1), endothelial growth factors (VEGF) and VDBP.

Tumor fibroso solitario de la glándula tiroides con extensión intratorácica / Solitary fibrous tumor of the thyroid gland with intrathoracic extension

El tumor fibroso solitario (TFS) es una neoplasia mesenquimal de células fusiformes infrecuente descrita inicialmente en la pleura pero con localización reconocida en otros sitios. El TFS de la glándula tiroides (TFST) es aun más raro. Se describe el caso de una mujer de 65 años de edad, con masa cervical de crecimiento progresivo, a tal punto que ya la masa se hacía notable en parte inferior de su cuello, siendo este el único síntoma narrado. La paciente presentaba una gran masa tiroidea en el lóbulo derecho con extensión intratorácica. Se practicó hemitiroidectomia derecha (paciente tenia historia previa de resección del lóbulo tiroideo izquierdo por lesión benigna) Total, además de toracotomía endoscópica por la extensión de la masa la cual en la tomografía contrastada, se originaba en el lóbulo tiroideo derecho y descendía paralelo a la columna dorsal desplazando a la tráquea y el esófago. La patología reportó un tumor de 15 centímetros, con células fusiformes y patrón de crecimiento hemangiopericítico sin pleomorfismo, atipia, mitosis o necrosis. Luego de practicar diferentes estudios y marcadores tumorales, de todos estudios fueron positivos CD34, Bcl2, CD99 y vimentina. Se diagnosticó tumor fibroso solitario de glándula tiroides. El nervio vago derecho fue lesionado en la cirugía, actualmente está en terapia de voz. Al momento actual casi seis meses luego de su cirugía, no se documenta recidiva tumoral.

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm initially described as spindle cells in the pleura but recognized location elsewhere. The TFS thyroid gland (TFST) even infrequent. A case of a 65 years old woman with progressive growth of a right cervical mass without associated symptoms described other than cosmesis is described . The patient had a thyroid mass in the right lobe with intrathoracic extension. A right Hemi thyroidectomy and thoracotomy for the extent of the mass was performed. Pathology reported a 15 cm tumor with spindle cell and growth pattern hemangiopericitic without pleomorphism, atypia, mitosis or necrosis. Immunohistochemistry was positive for CD34, Bcl-2, CD99 and vimentin, making the diagnosis of solitary fibrous tumor of thyroid gland. The patient's right Vagus nerve was injured intraoperatively and she is currently under voice therapy. Currently now, almost six months after her surgery she is free of disease.

Anestesia y reanimación en un caso de placenta pércreta / Anaesthesia and recovery in a case of placenta percreta

La placenta pércreta es un subtipo de acretismo placentario, en el que este órgano invade la totalidad de la pared uterina, llegando a afectar a los órganos circundantes. Se trata de una afección de alto riesgo quirúrgico, que por lo general va a requerir una histerectomía obstétrica. Presentamos el caso de una gestante de 36 años, con diagnóstico de placenta pércreta con invasión de vejiga e intestino. Durante la intervención desarrolló un cuadro de shock hipovolémico, que precisó transfusión masiva de hemoderivados y apoyo inotrópico. Fueron necesarias 3 reintervenciones sucesivas debido a la hemorragia, realizándose, en una de ellas, embolización selectiva de las arterias hipogástricas. Precisó 13 días en Cuidados Intensivos. El volumen total de hemoderivados transfundidos fue de 43 concentrados de hematíes, 28 unidades de plasma y 8 pools de plaquetas. Se destaca la importancia del diagnóstico prenatal precoz, para poder llevar a cabo un planteamiento adecuado de la intervención, en la que se cuente con un equipo multidisciplinario (cirujanos generales, urólogos, cirujanos vasculares), además de anestesiólogos y obstetras experimentados(AU)

Placenta percreta is a sub-type of placenta accreta in which this organ invades the whole uterine wall and affects the adjacent organs. It is a condition with a high surgical risk which generally requires an obstetric hysterectomy. We present the case of a 36 year-old pregnant woman diagnosed with placenta percreta with bladder and intestinal invasion. She suffered a hypovolaemic shock during surgery which required a massive transfusion of blood products and inotropic support. Three further successive surgeries were required due to the bleeding, with selective embolisation of the hypogastric arteries being performed in one of them. She required 13 days in intensive care. The total volume of blood products transfused was, 43 units of red cells, 28 units of plasma, and 8 platelet pools. The importance of early prenatal diagnosis is emphasised in order to adequately plan the operation, and should include a multidisciplinary team (general surgeons, urologists, vascular surgeons), as well as experienced anaesthesiologists and obstetricians(AU)

Características epidemiológicas del cáncer de mama en el área metropolitana de Buenos Aires y La Plata. Estudio de una serie de 4.041 casos del Registro de Cáncer de Mama (RCM) / Epidemiological aspects of breast cancer in metropolitana area of Buenos Aires and La Plata. Study of 4.041 patients of breast cancer registry (RCM)

Introducción: En la Argentina se estima que se detectan más de 18.000 casos nuevos de cáncer de mama por año; sin embargo, en nuestro país no contamos con registros de dicha patología que posean poder estadístico adecuado. Por este motivo, desde la Sociedad Argentina de Mastología surgió el interés de crear una base de datos. Aquí presentamos el análisis de los datos recabados de la misma luego de 2 años de su implementación en distintos centros de atención de Mastología del Área Metropolitana de la Ciudad de Buenos Aires (AMBA). Objetivo: Describir las características epidemiológicas de las pacientes atendidas en los centros participantes, así como la presentación clínica, estadio y tratamiento instaurado. Material y método: Estudio descriptivo, de corte transversal, donde se analizaron los datos ingresados hasta el día 30/09/2012, en la base de web "registro de cáncer de mama" (RCM), de 4.041 pacientes. Dichos datos fueron ingresados por los dieciséis centros participantes hasta ese momento, todos ellos ubicaodos en el AMBA y la ciudad de la Plata. Resultados: El 99,6% de los pacientes fue de sexo femenino, con una media de edad 57,7±13,2 años. Se registró una media de edad de aparición para la menarca de 12,5±1,4 años y de 48,6±4,1 años para la menopausia. El 68,8% de las pacientes eran posmenopáusicas. El 20,3% de las pacientes era nulípara. El 19,3% presentó el antecedente heredo-familiar de cáncer de mama. El principal motivo de consulta registrado fue el de autodetección sospechosa 54,3%. La distribución del estadio clínico fue la siguiente: estadio 0 11,6%; estadio I 40,6%; estadio II 36,5%; estadio III 10,3% y estadio IV 1,0%. En el 69,4% se realizó resección sectorial como cirugía mamaria. Antes del año 2000 predominó la linfadenectomía axilar (67,9%), luego de esta fecha la frecuencia de indicación del ganglio centinela pasó a aplicarse al 63,6%.

Características epidemiológicas del cáncer de mama en el área metropolitana de Buenos Aires y La Plata. Estudio de una serie de 4.041 casos del Registro de Cáncer de Mama (RCM) / Epidemiological aspects of breast cancer in metropolitana area of Buenos Aires and La Plata. Study of 4.041 patients of breast cancer registry (RCM)

Introducción: En la Argentina se estima que se detectan más de 18.000 casos nuevos de cáncer de mama por año; sin embargo, en nuestro país no contamos con registros de dicha patología que posean poder estadístico adecuado. Por este motivo, desde la Sociedad Argentina de Mastología surgió el interés de crear una base de datos. Aquí presentamos el análisis de los datos recabados de la misma luego de 2 años de su implementación en distintos centros de atención de Mastología del Area Metropolitana de la Ciudad de Buenos Aires (AMBA). Objetivo: Describir las características epidemiológicas de las pacientes atendidas en los centros participantes, así como la presentación clínica, estadio y tratamiento instaurado. Material y método: Estudio descriptivo, de corte transversal, donde se analizaron los datos ingresados hasta el día 30/09/2012, en la base de web "registro de cáncer de mama" (RCM), de 4.041 pacientes. Dichos datos fueron ingresados por los dieciséis centros participantes hasta ese momento, todos ellos ubicaodos en el AMBA y la ciudad de la Plata. Resultados: El 99,6% de los pacientes fue de sexo femenino, con una media de edad 57,7±13,2 años. Se registró una media de edad de aparición para la menarca de 12,5±1,4 años y de 48,6±4,1 años para la menopausia. El 68,8% de las pacientes eran posmenopáusicas. El 20,3% de las pacientes era nulípara. El 19,3% presentó el antecedente heredo-familiar de cáncer de mama. El principal motivo de consulta registrado fue el de autodetección sospechosa 54,3%. La distribución del estadio clínico fue la siguiente: estadio 0 11,6%; estadio I 40,6%; estadio II 36,5%; estadio III 10,3% y estadio IV 1,0%. En el 69,4% se realizó resección sectorial como cirugía mamaria. Antes del año 2000 predominó la linfadenectomía axilar (67,9%), luego de esta fecha la frecuencia de indicación del ganglio centinela pasó a aplicarse al 63,6%. (AU)

[Anaesthesia and recovery in a case of placenta percreta]. / Anestesia y reanimación en un caso de placenta pércreta.

Placenta percreta is a sub-type of placenta accreta in which this organ invades the whole uterine wall and affects the adjacent organs. It is a condition with a high surgical risk which generally requires an obstetric hysterectomy. We present the case of a 36 year-old pregnant woman diagnosed with placenta percreta with bladder and intestinal invasion. She suffered a hypovolaemic shock during surgery which required a massive transfusion of blood products and inotropic support. Three further successive surgeries were required due to the bleeding, with selective embolisation of the hypogastric arteries being performed in one of them. She required 13 days in intensive care. The total volume of blood products transfused was, 43 units of red cells, 28 units of plasma, and 8 platelet pools. The importance of early prenatal diagnosis is emphasised in order to adequately plan the operation, and should include a multidisciplinary team (general surgeons, urologists, vascular surgeons), as well as experienced anaesthesiologists and obstetricians.

First Report of Canker Disease Caused by Neofusicoccum parvum and N. australe on Blueberry Bushes in Spain.

A field survey conducted in September 2009 at five plantations of six different cultivars of southern highbush blueberries (Vaccinium spp.) in Huelva, Spain, yielded 35 diseased plants. Diseased plants exhibited red-brown cankers and stem dieback. Blueberry cultivation in Huelva rose from 290 ha in 2007 to 777 ha in 2012, and the increase of these symptoms is of concern to producers. Stem pieces cut from the edge of lesions on infected plants were surface-disinfected with 5% sodium hypochlorite and cultured on potato dextrose agar (PDA). Based on colony characteristics on PDA, 18 colonies (one each from 18 different plants) were identified as Botryosphaeria spp. Species identities were confirmed by analysis of nucleotide sequences of the internal transcribed spacer (ITS), rDNA, and elongation factor 1-alpha (EF1-α) sequences, using ITS1-ITS4 (3) and EF728f-EF986r (2) as primer pairs, respectively. BLAST searches of GenBank showed a high similarity of the isolate sequences to the reference sequences. Molecular results confirmed these species as Neofusicoccum parvum, N. australe, and B. dothidea. N. parvum was the most prevalent (on 34% of the plants analyzed), followed by N. australe and B. dothidea (9% each). In phylogenetic analyses, isolates that clustered in the same group belonged to the same species with a high homogeneity index (>99%). One representative isolate of each species was selected for a pathogenicity assay. Amplified sequences from each selected isolate were deposited in GenBank with the following accession numbers: N. parvum, KC556958 (ITS) and KC556961 (EF); N. australe, KC556959 (ITS) and KC556962 (EF); and B. dothidea, KC556960 (ITS) and KC556963 (EF). The pathogenicity assay of these three isolates was conducted using two cultivars of southern highbush blueberry, 'Misty' and 'Star.' The isolates were cultured on acidified PDA at 25°C for 5 days. Stems of the plants were wounded at a height of 10 cm with a drill (5 mm diameter and ~4 mm deep). Six replicates per cultivar were inoculated per isolate by placing a colonized agar plug (4 to 5 mm diameter) in the hole and wrapping the stem with Parafilm. Plants treated identically with sterile agar plugs were used as controls. The plants were then maintained at 100% relative humidity for 2 h. This trial was conducted in a growth chamber at 28°C (night) and 30°C (day) with a 14-h photoperiod for 3 months. Disease was measured on a six-point scale: 0 = healthy plant; 1 = plant with a canker smaller than 3.5 cm; 2 = plant with a canker bigger than 3.5 cm; 3 = plant with one dry shoot; 4 = plant with some dry shoots; 5 = dead plant. At the end of the trial, disease was expressed as area under the disease progress curve. The results showed the N. parvum isolate to be the most aggressive, followed by the N. australe isolate. Espinoza et al. (1) also found that N. parvum showed more aggressiveness than N. australe on blueberries in Chile. B. dothidea was not pathogenic and behaved similarly to the controls (P < 0.05). Each pathogen was reisolated from all the inoculated plants, fulfilling Koch's postulates. To our knowledge, this is the first report of isolates of these pathogens, N. parvum and N. australe, causing stem canker and dieback on blueberry bushes in Spain. References: (1) J. G. Espinoza et al. Plant Dis. 93:1187, 2009. (2) A. J. L. Phillips et al. Mycol. 97:513, 2005. (3) T. J. White et al. Pages 315-322 in: PCR Protocols: a Guide to Methods and Amplifications. M. A. Innis et al., eds. Academic Press, San Diego, CA. 1990.

Psoriasis dorsolumbar evolucionada: ¿anestesia regional o general? / Advanced dorsolumbar psoriasis: regional or general anaesthesia?

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Upper airway symptoms among workers with work-related respiratory complaints.

BACKGROUND: Work-related rhinitis and asthma symptoms frequently co-exist. AIMS: To determine the prevalence and nature of nasal, pharyngeal, laryngeal and sinus symptoms among individuals with work-related respiratory symptoms. METHODS: Individuals referred to a tertiary occupational asthma clinic for investigations with specific inhalation challenges were evaluated using the RHINASTHMA quality of life questionnaire and a questionnaire that assessed the nature and frequency of upper airway symptoms, their relationship to the workplace and their temporal relationship with the onset of asthma symptoms. RESULTS: There were 83 study participants. At least one upper airway symptom was reported by all of these individuals: nasal in 92%; pharyngeal in 82%; laryngeal in 65% and sinus in 53% of participants. Overall, there were no significant differences in the frequencies of nasal, pharyngeal, laryngeal and sinus symptoms when comparing these with occupational asthma (OA), work-exacerbated asthma (WEA) and work-related respiratory symptoms (WRS), except that nasal bleeding was most frequent among those with WRS. The presence of laryngeal symptoms was significantly associated with rhinitis-specific quality of life impairment. Individuals with workplace exposures to high molecular weight agents had greater impaired quality of life than those who were exposed to low molecular weight agents (RHINASTMA Upper Airway sub-scores: 24.0±10.4 versus 19.8±6.8; P < 0.05). CONCLUSIONS: Individuals who were referred for work-related respiratory symptoms experienced high rates of work-related nasal, pharyngeal, laryngeal and sinus symptoms, regardless of having OA, WEA or WRS.

Occupational rhinitis caused by concurrent sensitization to two different allergens.

BACKGROUND: Exposure to wheat flour and guar gum is a well-known cause of occupational respiratory allergies among workers in the food processing industry. To date, there have been no reports of occupational rhinitis (OR) caused concurrently by two different allergens present in the workplace. AIMS: To report a case of OR likely to be induced concurrently by exposure to wheat flour and guar gum in a mid-40s male employed in the food processing industry. METHODS: Allergy tests and nasal challenge tests were performed to investigate and confirm the diagnosis of OR. We discuss potential mechanisms involved in the observed dual sensitization. RESULTS: The patient showed positive responses to wheat and guar gum extracts on skin prick testing. The total IgE was 1680 kU/l (0-100 kU/l). The diagnosis of OR was confirmed by nasal challenge tests with wheat flour and guar gum on different days. In contrast to the control day, the challenge with flour and guar gum induced an immediate clinical reaction associated with a decrease in nasal volume measured by acoustic rhinometry. The patient was advised to avoid exposure to wheat and guar gum, which resulted in a gradual resolution of nasal symptoms. CONCLUSIONS: Co-sensitization and cross-reactivity are possible mechanisms involved in cases of concurrent sensitization to related and unrelated allergens in patients complaining of work-related rhinitis symptoms.

[Control of postoperative pain in knee arthroplasty: single dose femoral nerve block versus continuous femoral block]. / Control del dolor postoperatorio en artroplastia de rodilla: bloqueo del nervio femoral con dosis única frente a bloqueo femoral continuo.

INTRODUCTION: To compare the efficacy of a multimodal analgesia with 2 different techniques (femoral nerve block with a single dose and continuous femoral nerve block) in the control of pain, use of opioids, and secondary effects in patients subjected to total knee replacement. MATERIAL AND METHODS: A prospective randomised study of patients subjected to knee replacement with subarachnoid anaesthesia. The postoperative analgesia consisted of tramadol, dexketoprofen and paracetamol, and one of the following techniques: Femoral nerve block with a single dose of 30mL of 0.5% ropivacaine, or that dose plus a continuous infusion via a femoral catheter of 0.375% ropivacaine 6ml/h for 48h. The demographic, anaesthetic and surgical variables were recorded, along with the pain intensity using a visual analogue scale, opioid use, and complications at 24 and 48h after surgery. RESULTS: A total of 104 patients were included. There no differences in the demographic data between the groups. The pain intensity was lower in the group that had continuous femoral block, particularly at 48h, compared to the single-dose block, and with a lower use of rescue analgesia in the continuous femoral block. The incidence in secondary effects was similar, with a lower long-term sensory block being observed in the femoral block with a single dose. CONCLUSIONS: The use of peripheral nerve block is accepted practice for analgesia after knee replacement surgery. Continuous femoral block is a valid alternative, decreasing the use of rescue opiates and pain intensity (particularly at 48h) compared to isolated femoral block.

Control del dolor postoperatorio en artroplastia de rodilla: bloqueo del nervio femoral con dosis única frente a bloqueo femoral continuo / Control of postoperative pain in knee arthroplasty: single dose femoral nerve block versus continuous femoral block

Introducción. Comparar la eficacia de un régimen analgésico multimodal con 2 técnicas diferentes (bloqueo del nervio femoral con dosis única y bloqueo continuo del nervio femoral) en el control del dolor, consumo de opioides y efectos secundarios en pacientes intervenidos de artroplastia total de rodilla. Material y métodos. Estudio prospectivo aleatorizado, de pacientes intervenidos de prótesis de rodilla con anestesia subaracnoidea. La analgesia postoperatoria consistió en tramadol, dexketoprofeno y paracetamol, y una de las 2 técnicas siguientes: bloqueo del nervio femoral con dosis única de 30ml de ropivacaína 0,5% o la anterior dosis más perfusión continua por un catéter femoral de ropivacaína 0,375%, 6ml/h durante 48h. Se registraron las variables demográficas, anestésicas y quirúrgicas, intensidad del dolor según escala visual analógica, consumo de opiáceos y complicaciones a las 24 y 48h. Resultados. Se incluyeó a 104 pacientes. No hubo diferencias demográficas entre los grupos. La intensidad del dolor fue menor en el grupo en el que se realizó bloqueo femoral continuo, especialmente a las 48h, frente al bloqueo con dosis única, con menor consumo de analgesia de rescate en el bloqueo femoral continuo. La incidencia de efectos secundarios fue similar, observándose un menor bloqueo sensitivo de larga duración en el bloqueo femoral con dosis única. Conclusiones. El uso de los bloqueos nerviosos periféricos está aceptado para la analgesia postoperatoria de las artroplastias de las rodillas. El bloqueo femoral continuo es una alternativa válida disminuyendo el consumo de opiáceos de rescate y la intensidad del dolor (especialmente a las 48h) respecto al bloqueo femoral aislado(AU)

Introduction. To compare the efficacy of a multimodal analgesia with 2 different techniques (femoral nerve block with a single dose and continuous femoral nerve block) in the control of pain, use of opioids, and secondary effects in patients subjected to total knee replacement. Material and methods. A prospective randomised study of patients subjected to knee replacement with subarachnoid anaesthesia. The postoperative analgesia consisted of tramadol, dexketoprofen and paracetamol, and one of the following techniques: Femoral nerve block with a single dose of 30mL of 0.5% ropivacaine, or that dose plus a continuous infusion via a femoral catheter of 0.375% ropivacaine 6ml/h for 48h. The demographic, anaesthetic and surgical variables were recorded, along with the pain intensity using a visual analogue scale, opioid use, and complications at 24 and 48h after surgery. Results. A total of 104 patients were included. There no differences in the demographic data between the groups. The pain intensity was lower in the group that had continuous femoral block, particularly at 48h, compared to the single-dose block, and with a lower use of rescue analgesia in the continuous femoral block. The incidence in secondary effects was similar, with a lower long-term sensory block being observed in the femoral block with a single dose. Conclusions. The use of peripheral nerve block is accepted practice for analgesia after knee replacement surgery. Continuous femoral block is a valid alternative, decreasing the use of rescue opiates and pain intensity (particularly at 48h) compared to isolated femoral block(AU)

1H, 13C, and 15N resonance assignments of the N-terminal domain of human Tubulin Binding Cofactor C.

Human Tubulin Binding Cofactor C (hTBCC) is a 346 amino acid protein composed of two domains, which is involved in the folding pathway of newly synthesized α and ß-tubulins. The 3D structure of the 111-residue hTBCC N-terminal domain of the protein has not yet been determined. As a previous step to that end, here we report the NMR (1)H, (15)N, and (13)C chemical shift assignments at pH 6.0 and 25°C, based on a uniformly doubly labelled (13)C/(15)N sample of the domain.

Correlation between acoustic rhinometry and subjective nasal patency during nasal challenge test in subjects with suspected occupational rhinitis; a prospective controlled study.

OBJECTIVES: To assess the correlation between acoustic rhinometry and visual analogue scale endpoints in the context of nasal challenge with occupational agents. DESIGN: Prospective controlled study. SETTING: University teaching hospital. PARTICIPANTS: Sixty-seven subjects with a history of work-related rhinitis and asthma symptoms. MAIN OUTCOMES MEASURES: Subjects underwent nasal challenge with control and specific agent on consecutive days. Nasal congestive response to challenge was monitored by acoustic rhinometry and visual analogue scale. RESULTS: Results showed no correlation between visual analogue scale and acoustic rhinometry measurements at baseline on the control (r=-0.13, P=0.3) and active (r=0.14, P=0.2) challenge days. No correlation was found between acoustic rhinometry and visual analogue scale when analysing all measurements obtained at all times after challenge with the control and active agent (control: r=0.09, P=0.04; active: r=0.001, P=0.9). The correlation between acoustic rhinometry and visual analogue scale was good and significant (r=-0.62, P=<0.01) when the analysis was restricted to cases showing a decrease in nasal volume>40% from baseline values. CONCLUSIONS: We showed that the correlation between acoustic rhinometry and subjective nasal patency was poor on steady conditions. However, a significant correlation was observed in those cases showing a greater nasal congestive response after challenge measured by acoustic rhinometry.

Occupational rhinitis in workers investigated for occupational asthma.

BACKGROUND: The links between asthma and rhinitis are now referred to as united airways disease (UAD). Current evidence shows that the UAD model seems to be applicable to occupational rhinitis (OR) and occupational asthma (OA). A study was undertaken to objectively assess, in the context of specific inhalation challenge (SIC) testing, the concomitance of bronchial and nasal reaction in the investigation of OR and OA. METHODS: 43 subjects with a history of work-related asthma symptoms underwent SIC for confirmation of OA and investigation of OR. Changes in bronchial calibre were measured by spirometry and nasal patency and airway inflammation were assessed by acoustic rhinometry and nasal lavage. RESULTS: A positive nasal challenge was observed in 25 SIC tests and a positive bronchial challenge was observed in 17 SIC tests. A concomitant positive nasal and bronchial challenge was observed in 13 instances. This association was significant (risk ratio = 1.7; 95% CI 1.0 to 2.4; p = 0.04) and more frequent in subjects challenged with high molecular weight agents (n = 11/22) than with low molecular weight agents (n = 2/21). In subjects with a positive nasal challenge, nasal lavage showed a significant increase in eosinophils 30 min after exposure which correlated with changes in nasal patency. CONCLUSION: The results of this study provide objective evidence to support the concept of UAD using OR and OA as a model to demonstrate a significant concomitant physiological reaction of the nose and lungs after challenge. This study shows that OR can be assessed by objective means; it often coexists with OA but can be present without OA.

Tubulin cofactor B regulates microtubule densities during microglia transition to the reactive states.

Microglia are highly dynamic cells of the CNS that continuously survey the welfare of the neural parenchyma and play key roles modulating neurogenesis and neuronal cell death. In response to injury or pathogen invasion parenchymal microglia transforms into a more active cell that proliferates, migrates and behaves as a macrophage. The acquisition of these extra skills implicates enormous modifications of the microtubule and actin cytoskeletons. Here we show that tubulin cofactor B (TBCB), which has been found to contribute to various aspects of microtubule dynamics in vivo, is also implicated in microglial cytoskeletal changes. We find that TBCB is upregulated in post-lesion reactive parenchymal microglia/macrophages, in interferon treated BV-2 microglial cells, and in neonate amoeboid microglia where the microtubule densities are remarkably low. Our data demonstrate that upon TBCB downregulation both, after microglia differentiation to the ramified phenotype in vivo and in vitro, or after TBCB gene silencing, microtubule densities are restored in these cells. Taken together these observations support the view that TBCB functions as a microtubule density regulator in microglia during activation, and provide an insight into the understanding of the complex mechanisms controlling microtubule reorganization during microglial transition between the amoeboid, ramified, and reactive phenotypes.

Occupational rhinitis.

The present document is the result of a consensus reached by a panel of experts from European and nonEuropean countries on Occupational Rhinitis (OR), a disease of emerging relevance, which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored to that of occupational asthma, as well as a diagnostic algorithm based on steps allowing different levels of diagnostic evidence, are proposed. The needs for future research are pointed out. Key messages are issued for each item.