Effect of the anode material, applied current and reactor configuration on the atenolol toxicity during an electrooxidation process.

Atenolol (ATL) is a beta-blocker pharmaceutical product which is excreted mainly unchanged and may represent a long-term risk for organisms present in the sea and in fresh water. Due to its low biodegradation rate, electrochemical advanced oxidation processes (EAOPs) can be used to remove this compound. In this work, ATL ecotoxicity was analyzed in the presence of sodium sulfate (Na2SO4), which is widely used as supporting electrolyte in EAOPs. Ecotoxicity values were expressed as the pollutant concentration that leads to a 50% inhibition of the root elongation of Lactuca sativa seeds in relation to the control (EC50(5 days)). The obtained values for ATL showed an EC50(5 days) of 1377 mg L-1 towards Lactuca sativa. When Na2SO4 was added, the toxicity of the sample increased but no synergy was detected between both compounds. With 2 g L-1 Na2SO4, ATL showed an EC50(5 days) of 972 mg L-1; and with 4 g L-1 Na2SO4 and higher concentrations, EC50 value for ATL was 0 mg L-1. Statistical tools were used to obtain the zones of the [ATL]-[Na2SO4] plane which are toxic towards Lactuca sativa. Solutions containing ATL and Na2SO4 were treated by electrooxidation. Two anode materials (a boron-doped diamond electrode and a microporous Sb-doped SnO2 ceramic one); three operation currents (0.4, 0.6 and 1 A); and two reactor configurations (one-compartment reactor and two-compartment reactor separated by a cation exchange membrane) were used. Lactuca sativa seeds and Vibrio fischeri bacterium tests were employed to evaluate the toxicity of the solutions before and after applying the electrooxidation process. In all the tests, the ecotoxicity of the treated sample increased. This fact is owing to the persulfate presence in the solution due to the sulfate electrochemical oxidation. Nevertheless, none of the final samples were toxic towards Vibrio fischeri because ecotoxicity values were lower than 10 TU; and, in the case of the one-compartment reactor, practically all of them were also non-toxic towards Lactuca sativa. The toxicity of the treated samples increased when using the two-compartment reactor in the presence of the BDD anode, and when the operation current was increased. This is attributed to the highest formation of persulfates. Amongst all the tests performed in this work, the lowest toxicity value (i.e., 3 TU) together with the complete mineralization and degradation degrees was achieved with the two-compartment reactor using the BDD anode and operating at 0.6 A.

Dysphagia in patients undergoing esophageal atresia surgery: Assessment using a functional scale. / Disfagia en pacientes intervenidos de atresia de esófago: valoración con una escala funcional.

INTRODUCTION: Dysphagia is defined as difficulty swallowing. Up to 84% of patients undergoing esophageal atresia surgery have dysphagia beyond the neonatal period. MATERIALS AND METHODS: A retrospective study of patients undergoing esophageal atresia surgery from 2005 to 2021 was carried out. The Functional Oral Intake Scale (FOIS) was used to assess dysphagia in 4 age groups (< 1 year old, 1-4 years old, 5-11 years old, and > 11 years old). FOIS scores < 7 or symptoms of choking, impaction, or food aversion were regarded as dysphagia. RESULTS: 63 patients were analyzed. 74% (47/63) had dysphagia during follow-up. Prevalence was 50% in patients < 1 year old (FOIS mean 4.32), 77% in patients aged 1-4 (FOIS mean 5.61), 45% in patients aged 5-11 (FOIS mean 5.87), and 38% in patients > 11 years old (FOIS mean 6.8). The most frequent causes of dysphagia were stenosis, which occurred in 38% of the patients (n=24), and gastroesophageal reflux (n=18), which was present in 28% of the patients. Both conditions were associated with significantly lower mean FOIS scores (p< 0.05) in the patients under 11 years of age. Differences (p< 0.05) were found in the dysphagia-associated perinatal factors in the various age groups, with longer ventilation assistance times, parenteral nutrition, and hospital stays. CONCLUSIONS: Dysphagia is an extremely frequent symptom at any given age in patients undergoing esophageal atresia surgery. A standardized, cross-disciplinary follow-up is key to improve quality of life.

INTRODUCCION: La disfagia se define como dificultad en el proceso de alimentación. Hasta un 84% de pacientes intervenidos de atresia de esófago tienen disfagia más allá del periodo neonatal. MATERIAL Y METODOS: Estudio retrospectivo de serie de casos intervenidos por atresia de esófago 2005-2021. Se utilizó la escala FOIS (Functional Oral Intake Scale) para cuantificar la disfagia en 4 grupos de edad (menores de 1 año, 1-4 años, 5-11 años y mayores de 11 años). Se consideró disfagia cualquier valor de FOIS < 7 o síntomas de atragantamiento, impactación o aversión alimentaria. RESULTADOS: Se obtuvieron datos de 63 pacientes. El 74% (47/63) presentó disfagia durante el seguimiento. La prevalencia fue del 50% < 1 año (media FOIS 4.32), 77% 1-4 años (media FOIS 5.61), 45% 5-11 años (media FOIS 5.87) y 38% > 11 años (media FOIS 6.8). Las causas más frecuentes de disfagia fueron la estenosis, que presentó un 38% de los pacientes (n= 24) y el reflujo gastroesofágico (n= 18), que presentó a su vez un 28% de los pacientes. Ambas condiciones se asociaron con unos valores medios de FOIS significativamente menores (p< 0,05) en los pacientes menores de 11 años. Se encontraron diferencias (p< 0,05) en factores perinatales asociados a disfagia en los distintos periodos de edad, a destacar mayor tiempo medio de: asistencia ventilatoria, nutrición parenteral e ingreso hospitalario. CONCLUSIONES: La disfagia es un síntoma extremadamente frecuente a cualquier edad en los pacientes intervenidos de atresia de esófago. Un seguimiento estandarizado y multidisciplinar es esencial para mejorar la calidad de vida de estos pacientes.

Disfagia en pacientes intervenidos de atresia de esófago: valoración con una escala funcional / Dysphagia in patients undergoing esophageal atresia surgery: Assessment using a functional scale

Introducción: La disfagia se define como dificultad en el procesode alimentación. Hasta un 84% de pacientes intervenidos de atresia deesófago tienen disfagia más allá del periodo neonatal.Material y métodos: Estudio retrospectivo de serie de casos intervenidos por atresia de esófago 2005-2021. Se utilizó la escala FOIS(Functional Oral Intake Scale) para cuantificar la disfagia en 4 gruposde edad (menores de 1 año, 1-4 años, 5-11 años y mayores de 11 años).Se consideró disfagia cualquier valor de FOIS < 7 o síntomas de atragantamiento, impactación o aversión alimentaria.Resultados: Se obtuvieron datos de 63 pacientes. El 74% (47/63)presentó disfagia durante el seguimiento. La prevalencia fue del 50%< 1 año (media FOIS 4.32), 77% 1-4 años (media FOIS 5.61), 45% 5-11años (media FOIS 5.87) y 38% > 11 años (media FOIS 6.8). Las causasmás frecuentes de disfagia fueron la estenosis, que presentó un 38% delos pacientes (n= 24) y el reflujo gastroesofágico (n= 18), que presentóa su vez un 28% de los pacientes. Ambas condiciones se asociaron conunos valores medios de FOIS significativamente menores (p< 0,05) enlos pacientes menores de 11 años. Se encontraron diferencias (p< 0,05)en factores perinatales asociados a disfagia en los distintos periodosde edad, a destacar mayor tiempo medio de: asistencia ventilatoria,nutrición parenteral e ingreso hospitalario. Conclusiones: La disfagia es un síntoma extremadamente frecuentea cualquier edad en los pacientes intervenidos de atresia de esófago. Unseguimiento estandarizado y multidisciplinar es esencial para mejorarla calidad de vida de estos pacientes(AU)

Introduction: Dysphagia is defined as difficulty swallowing. Up to84% of patients undergoing esophageal atresia surgery have dysphagiabeyond the neonatal period. Materials and methods: A retrospective study of patients undergoing esophageal atresia surgery from 2005 to 2021 was carried out. TheFunctional Oral Intake Scale (FOIS) was used to assess dysphagia in 4age groups (< 1 year old, 1-4 years old, 5-11 years old, and 11 years old). FOIS scores < 7 or symptoms of choking, impaction, or food aversionwere regarded as dysphagia. Results: 63 patients were analyzed. 74% (47/63) had dysphagiaduring follow-up. Prevalence was 50% in patients < 1 year old (FOISmean 4.32), 77% in patients aged 1-4 (FOIS mean 5.61), 45% in patientsaged 5-11 (FOIS mean 5.87), and 38% in patients > 11 years old (FOISmean 6.8). The most frequent causes of dysphagia were stenosis, whichoccurred in 38% of the patients (n=24), and gastroesophageal reflux(n=18), which was present in 28% of the patients. Both conditions wereassociated with significantly lower mean FOIS scores (p< 0.05) in thepatients under 11 years of age. Differences (p< 0.05) were found in thedysphagia-associated perinatal factors in the various age groups, withlonger ventilation assistance times, parenteral nutrition, and hospital stays. Conclusions: Dysphagia is an extremely frequent symptom at anygiven age in patients undergoing esophageal atresia surgery. A standardized, cross-disciplinary follow-up is key to improve quality of life.(AU)

Study of the chlorfenvinphos pesticide removal under different anodic materials and different reactor configuration.

The present manuscript focuses on the study of the electrochemical oxidation of the insecticide Chlorfenvinphos (CVP). The assays were carried out under galvanostatic conditions using boron-doped diamond (BDD) and low-cost tin dioxide doped with antimony (Sb-doped SnO2) as anodes. The influence of the operating variables, such as applied current density, presence or absence of a cation-exchange membrane and concentration of supporting electrolyte, was discussed. The results revealed that the higher applied current density the higher degradation and mineralization of the insecticide for both anodes. The presence of the membrane and the highest concentration of Na2SO4 studied (0.1 M) as a supporting electrolyte benefited the oxidation process of CVP using the BDD electrode, while with the ceramic anode the elimination of CVP was lower under these experimental conditions. Although the BDD electrode showed the best performance, ceramic anodes appear as an interesting alternative as they were able to degrade CVP completely for the highest applied current density values. Toxicity tests revealed that the initial solution of CVP was more toxic than the samples treated with the ceramic electrode, while using the BDD electrode the toxicity of the sample increased.

Microencapsulation of zinc plating waste using silicone polymers.

This paper deals with the treatment of hazardous zinc-bearing waste using hydraulic binders and silicone polymers, with the aim to allow its safe disposal into landfill. The waste was solidified using hydraulic binders in the first step and then encapsulated using silicone polymers. Samples were characterised using x-ray fluorescence, x-ray diffraction, and scanning electron microscopy. The effectiveness of the process was evaluated by leaching tests in distilled water and in an acidic environment according to Toxicity Characteristic Leaching Procedure. The effect of porosity and pH on the release of pollutants was also studied. Zinc and chloride were identified as the most significant pollutants in the waste. Portland cement did not stabilize them efficiently. The two-step treatment with Portland cement and silicone binders decreased, in the best case, the concentration of zinc and chloride in acidic extracts from 12,400 mg/L and 38,300 mg/L to 21.9 mg/L and 74 mg/L, respectively, and the treated waste complied with regulatory requirements for hazardous waste disposal into landfills. The two-step treatment was also found as a more effective method than microencapsulation using a silicone binder alone. The factor that most affects leachability appears to be the porosity of the encapsulated waste.

Wolff Parkinson white pattern in Danon disease: When preexcitation is not what it seems.

Danondisease is a rare genetic disorder with an X-linked dominant inheritance affecting both skeletal and cardiac muscle. Its characteristic cardiac phenotype consists on a severe, non-obstructive and concentric hypertrophic cardiomyopathy (HCM) usually associated with a Wolff-Parkinson-White (WPW) type preexcitation pattern. Whether this corresponds to the presence of an AV or another type of accessory pathways, such as fasciculoventricular pathways (FVP) remains controversial in the literature. However, we describe the case of a teenager with Danon disease and preexcitation who develops a first degree AV block without any change in his QRS morphology, fact that favors the hypothesis of the presence of a FVP. This finding has important clinical implications in the management and prognosis of these complex patients. The absence of an AV accessory pathway decreases their risk of potential SCD in the context of a fast atrial arrhythmia and their chances of having a reentrant AV tachycardia.

Correction to: An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study.

After publication of our article [1] the authors have notified us that there are changes in the primary outcome and the statistical analysis plan of the study.

Analysis of norfloxacin ecotoxicity and the relation with its degradation by means of electrochemical oxidation using different anodes.

In this work, ecotoxicological bioassays based on Lactuca sativa seeds and bioluminescent bacterium (Vibrio fischeri) have been carried out in order to quantify the toxicity of Norfloxacin (NOR) and sodium sulfate solutions, before and after treating them using electrochemical advanced oxidation. The effect of some process variables (anode material, reactor configuration and applied current) on the toxicity evolution of the treated solution has been studied. A NOR solution shows an EC50(5 days) of 336 mg L-1towards Lactuca sativa. This threshold NOR concentration decreases with sodium sulfate concentration, in solutions that contain simultaneously Norfloxacin and sodium sulfate. In every case considered in this work, the electrochemical advanced oxidation process increased the toxicity (towards both Lactuca sativa and Vibrio fischeri) of the solution. This toxicity increase is mainly due to the persulfate formation during the electrochemical treatment. From a final solution toxicity point of view, the best results were obtained using a BDD anode in a divided reactor applying the lowest current intensity.

An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study.

BACKGROUND: A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery. METHODS: The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes. DISCUSSION: The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02773173 . Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016.

Electrochemical recognition and quantification of cytochrome c expression in Bacillus subtilis and aerobe/anaerobe Escherichia coli using N,N,N',N'-tetramethyl-para-phenylene-diamine (TMPD).

The colorimetric identification of pathogenic and non-pathogenic bacteria in cell culture is commonly performed using the redox mediator N,N,N',N'-tetramethyl-para-phenylene-diamine (TMPD) in the so-called oxidase test, which indicates the presence of bacterial cytochrome c oxidases. The presented study demonstrates the ability of electrochemistry to employ TMPD to detect bacteria and quantify the activity of bacterial cytochrome c oxidases. Cyclic voltammetry studies and chronoamperometry measurements performed on the model organism Bacillus subtilis result in a turnover number, calculated for single bacteria. Furthermore, trace amounts of cytochrome c oxidases were revealed in aerobically cultured Escherichia coli, which to our knowledge no other technique is currently able to quantify in molecular biology. The reported technique could be applied to a variety of pathogenic bacteria and has the potential to be employed in future biosensing technology.

Stabilization/solidification of hot dip galvanizing ash using different binders.

This study focuses on solidification of hot dip-galvanizing ash with a high content of zinc and soluble substances. The main purpose of this paper is to immobilize these pollutants into a matrix and allow a safer way for landfill disposal of that waste. Three different binders (Portland cement, fly ash and coal fluidized-bed combustion ash) were used for the waste solidification. Effectiveness of the process was evaluated using leaching test according to EN 12457-4 and by using the variance analysis and the categorical multifactorial test. In the leaching test, four parameters were observed: pH, zinc concentration in leachate, and concentration of chlorides and dissolved substances in leachate. The acquired data was then processed using statistical software to find an optimal solidifying ratio of the addition of binder, water, and waste to the mixture, with the aim to fulfil the requirement for landfill disposal set by the Council Decision 2003/33/EC. The influence on the main observed parameters (relative amount of water and a binder) on the effectiveness of the used method and their influence of measured parameters was also studied.

Circulating NK-cell subsets in renal allograft recipients with anti-HLA donor-specific antibodies.

Detection of posttransplant donor-specific anti-HLA antibodies (DSA) constitutes a risk factor for kidney allograft loss. Together with complement activation, NK-cell antibody-dependent cell mediated cytotoxicity (ADCC) has been proposed to contribute to the microvascular damage associated to humoral rejection. In the present observational exploratory study, we have tried to find a relationship of circulating donor-specific and non donor-specific anti-HLA antibodies (DSA and HLA non-DSA) with peripheral blood NK-cell subsets and clinical features in 393 renal allograft recipients. Multivariate analysis indicated that retransplantation and pretransplant sensitization were associated with detection of posttransplant DSA. Recipient female gender, DR mismatch and acute rejection were significantly associated with posttransplant DSA compared to HLA non-DSA. In contrast with patients without detectable anti-HLA antibodies, DSA and HLA non-DSA patients displayed lower proportions of NK-cells, associated with increased CD56(bright) and NKG2A(+) subsets, the latter being more marked in DSA cases. These differences appeared unrelated to retransplantation, previous acute rejection or immunosuppressive therapy. Although preliminary and observational in nature, our results suggest that the assessment of the NK-cell immunophenotype may contribute to define signatures of alloreactive humoral responses in renal allograft recipients.

The effectiveness of the stabilization/solidification process on the leachability and toxicity of the tannery sludge chromium.

A stabilization/solidification (S/S) process by using cement was applied to tannery sludge in order to find a safer way of landfilling this waste. The effects of three parameters on the process effectiveness were analysed in terms of leachate toxicity and chromium retention (%). The parameters studied were the relative amount of added water (30-50 wt.%), cement (10-60 wt.% in the solid components), and the use of three different types of cement (clinker with additions of limestone, with additions of limestone and fly ashes, and with additions of pozzolans). Statistical analysis performed by variance analysis and categorical multifactorial tests reveals that all the studied parameters significantly influence the effectiveness of the process. Results showed that chromium retention decreases as the relative amount of cement and water increases, probably due to additional chromium provided by cement and increased in the porosity of the mixtures. Leachate toxicity showed the same minimum value for mixtures with 30% or 40% cement, depending on the type of cement, showing that clinker is the main material responsible for the process effectiveness, and additives (pozzolans or fly ashes) do not improve it. The volume increase is lower as less sludge is replaced by cement and the relative amount of water decreases, and for the cement without additions of fly ashes or pozzolans. Therefore, the latter seems to be the most appropriate cement in spite of being more expensive. This is due to the fact that the minimum toxicity value is achieved with a lower amount of cement; and moreover, the volume increase in the mixtures is lower, minimizing the disposal cost to a landfill.

Changes in the brain and plasma Aß peptide levels with age and its relationship with cognitive impairment in the APPswe/PS1dE9 mouse model of Alzheimer's disease.

Double transgenic mice expressing mutant amyloid precursor protein (APPswe) and mutant presenilin 1 (PS1dE9) are a model of Alzheimer-type amyloidosis and are widely used in experimental studies. In the present work, the relationships between brain and plasma amyloid-ß peptide (Aß) levels and cognitive impairments were examined in male APPswe/PS1dE9 double transgenic mice at different ages. When compared with non-transgenic littermates, APPswe/PS1dE9 mice exhibited significant learning deficits from the age of 6months (M6), which were aggravated at later stages of life (M8 and M12). Sporadic brain amyloid plaques were observed in mice as early as M3 and progressively increased in number and size up to M12. A similar increase was observed in brain insoluble Aß levels as assessed by enzyme-linked immunosorbent assay (ELISA). In particular, the levels of brain insoluble Aß peptides rose steeply from M4 to M6. Interestingly, this pronounced amyloid deposition was accompanied by a temporary fall in the concentration of brain soluble and membrane-bound Aß peptides at M6 that rose again at M8 and M12. The plasma levels of Aß40 and Aß42 decreased with advancing age up to M8, when they stabilized at M12. This decrease in plasma Aß levels coincided with the observed increase in insoluble brain Aß levels. These results could be useful for developing plasma Aß levels as possible biomarkers of the cerebral amyloidosis and provide advances in the knowledge of the Aß peptide biochemical changes that occur in the brain of Alzheimer's disease patients.

Preeclampsia grave. Propuesta de actuación basada en la evidencia / Severe pre-eclampsia. An evidence-based practice proposal

Objetivos. Aunque hay numerosas pautas de tratamiento de la preeclampsia en la paciente obstétrica, hay escasa evidencia acerca de lo adecuado del tratamiento estándar. Por otra parte, organismos sanitarios internacionales recomiendan que haya disponibles recomendaciones, protocolos o guías escritas para la atención de situaciones frecuentes o graves por parte de hospitales o servicios de anestesia. Nuestro objetivo fue elaborar recomendaciones basadas en la evidencia sobre el abordaje terapéutico de la paciente con preeclampsia grave. Material y métodos. Se realizó una revisión de la bibliografía obtenida de diversas fuentes, bases de datos, recomendaciones de sociedades y revisiones. Se llevó a cabo por 4 anestesiólogos expertos que plantearon preguntas clínicas (extraídas de la lectura de revisiones recientes sobre preeclampsia). Para la selección final se requirió consenso de al menos 3 de los 4 expertos. Se siguieron los criterios de asignación de evidencia de Oxford y se aplicó la escala de Jadad a los estudios seleccionados. Resultados. Se eligieron 50 preguntas clínicas que fueron respondidas. Se clasificaron en: medidas generales, influencia de la forma de parto, evaluación preanestésica, tratamiento periparto (incluyendo la analgesia y anestesia), eclampsia, posparto y tratamiento intensivo y traslado. La mayoría de las respuestas presentan una evidencia científica baja que las avale. Conclusiones. Se proponen unas recomendaciones basadas en la evidencia para el tratamiento de la preeclampsia grave, especialmente enfocadas a los anestesiólogos(AU)

Objectives. There are several treatment proposals for the obstetric patient with pre-eclampsia, but there is limited evidence on the adequacy of standard treatment. International healthcare organisations recommend that hospitals or anaesthesia departments have written guidelines, protocols or recommendations for dealing with common or severe situations. We propose evidence-based recommendations for the treatment of pre-eclampsia. Material and methods. A literature review was performed using several sources, bibliography databases, recommendations made by specialist societies, and reviews. Four anaesthesiologists reviewed the references selected, in order to design clinical questions (these were obtained from recent pre-eclampsia review articles). Consensus of at least 3 out of 4 experts was required. The Oxford criteria for evidence were chosen to classify the scientific articles, and the Jadad score was applied to the final articles selected. Results. A total of 50 clinical questions were designed and answered. These were classified into: general questions, influence of the type of delivery, pre-anaesthesia evaluation, peripartum treatment (including analgesia and anaesthesia), eclampsia, post-delivery period, and intensive care and transport. Most of the responses showed low scientific evidence. Conclusions. Evidence-based recommendations for severe pre-eclampsia treatment were provided with special emphasis on the anaesthesiologist point of view(AU)

[Severe pre-eclampsia. An evidence-based practice proposal]. / Preeclampsia grave. Propuesta de actuación basada en la evidencia.

OBJECTIVES: There are several treatment proposals for the obstetric patient with pre-eclampsia, but there is limited evidence on the adequacy of standard treatment. International healthcare organisations recommend that hospitals or anaesthesia departments have written guidelines, protocols or recommendations for dealing with common or severe situations. We propose evidence-based recommendations for the treatment of pre-eclampsia. MATERIAL AND METHODS: A literature review was performed using several sources, bibliography databases, recommendations made by specialist societies, and reviews. Four anaesthesiologists reviewed the references selected, in order to design clinical questions (these were obtained from recent pre-eclampsia review articles). Consensus of at least 3 out of 4 experts was required. The Oxford criteria for evidence were chosen to classify the scientific articles, and the Jadad score was applied to the final articles selected. RESULTS: A total of 50 clinical questions were designed and answered. These were classified into: general questions, influence of the type of delivery, pre-anaesthesia evaluation, peripartum treatment (including analgesia and anaesthesia), eclampsia, post-delivery period, and intensive care and transport. Most of the responses showed low scientific evidence. CONCLUSIONS: Evidence-based recommendations for severe pre-eclampsia treatment were provided with special emphasis on the anaesthesiologist point of view.

Cloning, sequencing and expression in the dog of the main amyloid precursor protein isoforms and some of the enzymes related with their processing.

Alzheimer's disease (AD) is characterized by neuronal loss and the presence of both neurofibrillary tangles and senile plaques in the brain. These plaques arise from the deposition of beta-amyloid (Aß) peptides (38-43 amino acids), which are generated from enzymatic cleavage of the amyloid precursor protein (APP) by ß- and γ-secretases. In the present work, we cloned the principal APP isoforms as well as some enzymes that have been implicated in their amyloidogenic and non-amyloidogenic processing in dogs. Additionally, the main proteases implicated in the degradation of Aß were also studied. We also investigated the level of expression of these APP isoforms and enzymes in different brain regions and in peripheral tissues. Our data demonstrate that these canine proteins are highly homologous to their human counterparts. In addition, the expression pattern of these proteins in dogs is consistent with previous data reported in human beings. Thus, dogs may be a natural model to study the biology of AD and could also serve as an animal model for Aß-targeted drugs against this devastating disease.

An open clinical study assessing the efficacy and safety of Factor IX Grifols, a high-purity Factor IX concentrate, in patients with severe haemophilia B.

SUMMARY: Factor IX Grifols is a new high-purity plasma-derived FIX concentrate with two specific pathogen elimination steps. Until this study was performed, there were no detailed reports with an adequate number of patients on the clinical evaluation of this product. To determine the efficacy and safety of Factor IX Grifols for replacement therapy in previously treated patients with severe haemophilia B, this open, multicentre and non-randomized study included 25 male subjects over the age of 12 with severe haemophilia B. Patients underwent prophylaxis and treatment of bleeding episodes with Factor IX Grifols for 1 year. The clinical efficacy and safety of this product were assessed. Forty percent of the patients were children and adolescents (12-17 years old). During the 12 months follow-up, 1 446 000 IU of Factor IX Grifols were administered in 961 infusions (range 12-83 infusions per patient): 31% for prophylaxis and 69% for bleeding episodes. Only five major bleeding events were reported in two patients. These haemorrhages were successfully treated with a mean of 2900 IU per bleed (range 1500-4000 IU), and 1-3 infusions per bleed. The average time elapsed from the first infusion to resolution of bleeding was 43 h (median). Overall, haemostasis was rated as excellent or good by the investigator in 96% of the infusions. No product-related adverse events were reported. Factor IX Grifols is an effective and safe Factor IX concentrate and can be considered as a first line option for replacement therapy in haemophilia B patients.

Manejo del drenaje recuperador y autotransfusor de sangre tipo Bellovac ABT / Handling of a Bellovac ABT drainage recuperation-blood auto transfusion device

Se exponen las características del drenaje recuperador-autotransfusor de sangre tipo Bellovac ABT, así como su manejo adecuado y los cuidados de enfermería requeridos con el fin de minimizar los riesgos y proporcionar una óptima seguridad al paciente. También se exponen las complicaciones potenciales y se discuten las principales ventajas e incovenientes de este tipo de drenaje(AU)

The authors describe the characteristics of the Bellovac ABT drainage recuperation - blod auto transfusion device along with its proper handling and the required nurses´ care in order to minimize the risks and to provide optimun safety for patients. The authors also explain the potential complications and they discuss the main advantages this type of drainage has(AU)

Pharmacokinetic study of a high-purity factor IX concentrate (Factor IX Grifols) with a 6-month follow up in previously treated patients with severe haemophilia B.

Optimal replacement treatment in haemophilia B patients requires a good understanding of the pharmacokinetics of factor IX (FIX). The aim of this study was to compare the pharmacokinetic profile of Factor IX Grífols, a highly purified human FIX concentrate with two specific pathogen inactivation/removal steps, to that of available FIX preparations. The study was an open, non-randomized trial including 25 male subjects older than 12 years of age with severe haemophilia B. Pharmacokinetic profile of the FIX preparation regularly used by the subjects was determined as control. Pharmacokinetic profile of Factor IX Grifols was determined twice, one 7-15 days after control assessment and second after a 6 months period had elapsed. Results showed that all products had peak plasma levels of FIX:C within 30 min. Mean recovery was 1.3 +/- 0.3 IU dL(-1) per IU kg(-1) for Factor IX Grifols and 1.0 +/- 0.3 IU dL(-1) per IU kg(-1) for control products (P < 0.001). The mean terminal half-life (t(1/2)) for Factor IX Grifols was 26.7 h and 26.8 h for control product. Pharmacokinetic parameters after 6 months of treatment with Factor IX Grifols did not statistically differ from the parameters obtained with the first infusion. There were no adverse events related to Factor IX Grifols for the duration of the study. In conclusion, Factor IX Grifols has adequated pharmacokinetic properties comparable to the control plasma-derived FIX and these parameters remain stable after 6 months of treatment. Factor IX Grifols can be an effective and safe plasma-derived FIX concentrate for replacement therapy in haemophilia B patients.