Variation in blood mercury concentrations in brown skuas (Stercorarius antarcticus) is related to trophic ecology but not breeding success or adult body condition.

Mercury is a pervasive environmental contaminant that can negatively impact seabirds. Here, we measure total mercury (THg) concentrations in red blood cells (RBCs) from breeding brown skuas (Stercorarius antarcticus) (n = 49) at Esperanza/Hope Bay, Antarctic Peninsula. The aims of this study were to: (i) analyse RBCs THg concentrations in relation to sex, year and stable isotope values of carbon (δ13C) and nitrogen (δ15N); and (ii) examine correlations between THg, body condition and breeding success. RBC THg concentrations were positively correlated with δ15N, which is a proxy of trophic position, and hence likely reflects the biomagnification process. Levels of Hg contamination differed between our study years, which is likely related to changes in diet and distribution. RBC THg concentrations were not related to body condition or breeding success, suggesting that Hg contamination is currently not a major conservation concern for this population.

Organosilane-functionalization of nanostructured indium tin oxide films.

Fabrication and organosilane-functionalization and characterization of nanostructured ITO electrodes are reported. Nanostructured ITO electrodes were obtained by electron beam evaporation, and a subsequent annealing treatment was selectively performed to modify their crystalline state. An increase in geometrical surface area in comparison with thin-film electrodes area was observed by atomic force microscopy, implying higher electroactive surface area for nanostructured ITO electrodes and thus higher detection levels. To investigate the increase in detectability, chemical organosilane-functionalization of nanostructured ITO electrodes was performed. The formation of 3-glycidoxypropyltrimethoxysilane (GOPTS) layers was detected by X-ray photoelectron spectroscopy. As an indirect method to confirm the presence of organosilane molecules on the ITO substrates, cyclic voltammetry and electrochemical impedance spectroscopy (EIS) were also carried out. Cyclic voltammograms of functionalized ITO electrodes presented lower reduction-oxidation peak currents compared with non-functionalized ITO electrodes. These results demonstrate the presence of the epoxysilane coating on the ITO surface. EIS showed that organosilane-functionalized electrodes present higher polarization resistance, acting as an electronic barrier for the electron transfer between the conductive solution and the ITO electrode. The results of these electrochemical measurements, together with the significant difference in the X-ray spectra between bare ITO and organosilane-functionalized ITO substrates, may point to a new exploitable oxide-based nanostructured material for biosensing applications. As a first step towards sensing, rapid functionalization of such substrates and their application to electrochemical analysis is tested in this work. Interestingly, oxide-based materials are highly integrable with the silicon chip technology, which would permit the easy adaptation of such sensors into lab-on-a-chip configurations, providing benefits such as reduced size and weight to facilitate on-chip integration, and leading to low-cost mass production of microanalysis systems.

A symmetric, triply interlaced 3-D anionic MOF that exhibits both magnetic order and SMM behaviour.

A newly prepared 3-D polymer of cobalt citrate cubanes bridged by high-spin Co(ii) centres displays both single-molecule magnet (SMM) behaviour and magnetic ordering. Triple interpenetration of the 3-D diamondoid polymers yields a crystalline solid with channels that host cations and free water molecules, with the SMM behaviour of the Co4O4 cores preserved. The octahedrally coordinated Co(ii) bridges are implicated in the onset of magnetic order at an experimentally accessible temperature.

Análisis comparativo de la incidencia de cáncer de vejiga en las comunidades de Andalucía, Cataluña y Comunidad de Madrid en el año 2011 / Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011

Objetivos: Estimar la incidencia del cáncer de vejiga (CAV) en las comunidades autónomas que incluyeron mayor número de casos en el registro nacional hospitalario de CAV (Andalucía, Cataluña y Comunidad de Madrid) y describir las diferencias y similitudes clínicas, patológicas y diagnósticas del CAV en estas regiones. Material y métodos: Estudio observacional epidemiológico realizado en el año 2011 en 12 hospitales públicos con área de población de referencia según el Sistema Nacional de Salud. Se recogieron variables sociodemográficas y clínicas de nuevos casos y recidivas con confirmación histopatológica de CAV. La tasa bruta de incidencia se calculó mediante el número de casos diagnosticados en todos los centros participantes respecto al total agregado de población adscrita de cada uno de ellos. Las tasas brutas por edad y sexo se obtuvieron ponderando la población adscrita con la distribución por edad y sexo del Instituto Nacional de Estadística (INE) 2011. Resultados: Las 3 comunidades autónomas registraron el 51% de los 4.285 casos incluidos en el registro nacional, correspondiendo el 42,8% de estos a recidivas. La tasa de incidencia bruta anual para los nuevos episodios fue de 22,6 (IC 95%: 20,7; 24,6) en Andalucía, de 23,5 (IC 95%: 20,9; 26,0) en Cataluña y de 22,0 (IC 95%: 19,9; 24,1) en la Comunidad de Madrid. Conclusiones: Salvo la mayor proporción de fumadores y el menor grado tumoral de las lesiones en Andalucía, las 3 comunidades autónomas estudiadas presentan similitudes en cuanto a características clínicas, comorbilidades, sintomatología de los pacientes y procesos diagnósticos del CAV

Objectives: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. Material and methods: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. Results: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. Conclusions: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC

Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011.

OBJECTIVES: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. MATERIAL AND METHODS: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. RESULTS: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. CONCLUSIONS: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC.

[Efficacy of low-dose oxytocin during elective cesarean section]. / Eficacia de la oxitocina a dosis bajas en cesáreas electivas.

BACKGROUND AND OBJECTIVE: In cesarean section, the optimal dose of oxytocin to reduce the risk of hemorrhage with the least risk of adverse effects has yet to be defined. We studied the effects of using 2 different doses of oxytocin in women undergoing elective cesarean section under spinal anesthesia. The women had had no prior labor. MATERIAL AND METHODS: Randomized multicenter trial enrolling 104 patients classified as ASA 1. Following fetal extraction and coinciding with umbilical cord clamping, a group of 52 women received 1 IU of oxytocin followed by an infusion of 2.5 IU x h(-1); a second group of 52 women received a continuous infusion of 20 IU at a rate of 700 mlU x min(-1) followed by 10 IU x min(-1). We compared uterine contractility (assessed as absent, moderate, satisfactory), postoperative vaginal bleeding (absent, light, moderate, heavy), hemodynamics, and adverse effects after administration of oxytocin and fetal extraction (electrocardiographic abnormalities, nausea, vomiting, discomfort, headache, blushing, trembling, chills, or chest pain). RESULTS: No significant between-group differences in patient, obstetric, or anesthetic variables were detected. Uterine contraction was satisfactory in over 90% of the patients in both groups on initial assessment during surgery. After surgery, vaginal bleeding was absent or light in over 90% of the women. No significant differences in adverse events were detected between groups. CONCLUSIONS: The incidence of obstetric bleeding is not higher when a lower dose of oxytocin is used; the rate of postoperative adverse events also does not increase.

¿Es realmente necesaria y útil la oxigenoterapia suplementaria en lacesárea programada bajo anestesia subaracnoidea? / Is oxygen therapy truly useful and necessary during elective cesarean section under spinal anesthesia?

OBJETIVOS: Analizar el bienestar maternofetal enfunción de la administración o no de oxígeno suplementario.MATERIAL Y MÉTODOS: Estudio prospectivo y aleatorizadode gestantes a término con embarazo controlado,ASA I, sin patologías maternofetales, programadas paracesárea bajo anestesia subaracnoidea, divididas en 2grupos cuya única diferencia metodológica fue la respiraciónde aire ambiente (grupo AA) o la administraciónde oxígeno con mascarilla facial (FiO2 40%) (grupo MF).Valoramos el bienestar neonatal postparto inmediatocon la gasometría del cordón umbilical y el test deApgar.RESULTADOS: Se incluyeron 130 gestantes. Ambos gruposresultaron homogéneos, sin diferencias demográficas,hemodinámicas, en el tiempo incisión uterinaextracciónfetal, peso de los recién nacidos, presencia deanomalías del cordón umbilical, tipo de reanimación delrecién nacido o Apgar al 1º y 5º min. La saturación periféricade oxígeno materna fue mayor (p < 0,001) a partirde los 10 min en el grupo MF. Observamos diferenciasestadísticamente significativas en la sangre arterialumbilical en la pCO2 (51,14 vs 54,33 mm Hg) (p=0,016),bicarbonato (22,19 vs 23,23 mEq.L-1) (p=0,012) y lactato(1,85 vs 1,64 mmol.L-1) (p=0,038) y en la pO2 venosa(25,53 vs 28,13 mm Hg) (p=0,033) en los grupos AA vsMF respectivamente.CONCLUSIONES: En la cesárea bajo anestesia subaracnoideade pacientes sanas, la administración de oxígenosuplementario no se acompaña de diferencias en el estadode bienestar final neonatal (AU)

OBJECTIVE: To analyze maternal and fetal well-beingwith and without the application of oxygen therapy.MATERIAL AND METHODS: Randomized trial of full-termparturients who had received prenatal care duringpregnancy. The women were healthy and classified as ASA1.They were scheduled for delivery by cesarean sectionunder spinal anesthesia and randomized to 2 groups tobreathe room air or air providing an inspired oxygenfraction of 40% through a face mask. We assessed thewell-being of the neonate immediately after birth with theApgar test and by measuring umbilical cord blood gases.RESULTS: One hundred thirty women were enrolled.Both groups were similar, with no differences indemographic or hemodynamic variables, time fromuterine incision to fetal extraction, neonatal birth weight,presence of umbilical cord abnormalities, type ofresuscitation required by the neonate, or Apgar score inthe first or fifth minute. Oxygen saturation in maternalblood by pulse oximetry was higher after 10 minutes inthe group of women who received supplemental oxygenthrough face masks. We also observed significantdifferences in umbilical cord arterial blood between theroom air and supplemental oxygen groups, respectively,as follows: PaCO2, 51.14 mm Hg vs 54.33 mm Hg(P=.016); bicarbonate, 22.19 mEq·L-1 vs 23.23 mEq·L-1(P=.012); lactate, 1.85 mmol·L-1 vs 1.64 mmol·L-1 (P=.038).The PO2 in venous blood also differed significantly: 25.53mm Hg vs 28.13 mm Hg, respectively (P=0.33).CONCLUSIONS: Breathing supplemental oxygen or notduring elective cesarean delivery of healthy parturientsunder spinal anesthesia does not have a significant effecton neonatal well-being (AU)

[Continuous subarachnoid analgesia and anesthesia for labor and cesarean section in a patient who had previously undergone surgery for ependymoma]. / Analgoanestesia subaracnoidea continua para trabajo de parto y cesárea en paciente intervenida de ependimoma.

We report the case of a 38-year-old primipara who had undergone surgery 2 years earlier for an intradural ependymoma at L2-L3 and who was currently asymptomatic. A combined epidural-subarachnoid block was performed for analgesia during labor but this technique was only effective for the first 2 hours. When analgesia via epidural cannula was no longer adequate, it was decided to perform a continuous subarachnoid block. Later, the fetus's head was seen to be too large to fit through the pelvis; for cesarean section, the mother was administered fractionated doses of local anesthetic via the subarachnoid cannula until analgesia reached T4. The patient did not develop postdural puncture headache. Continuous subarachnoid anesthesia may be considered the technique of choice where the patient has a history of spinal surgery.

[Air embolism during elective cesarean section, and uterine atony due to fetal macrosomia]. / Embolia aérea durante cesáirea electiva y atonía uterina por feto macrosómico.

We report the case of a paradoxical air embolism during a scheduled cesarean section for fetal macrosomia (7.010 kg) in a 38-year-old woman with a history of gestational diabetes and preeclampsia. Spinal anesthesia was satisfactory and well tolerated. After approximately 30 minutes (coinciding with uterine exteriorization), the patient presented a sudden episode of dyspnea, confusion, hypotension, and ST segment depression. The episode lasted approximately 10 minutes and resolved spontaneously with no sequelae. Neurological status and the electrocardiogram were normal at the end of surgery and no postoperative lesions were observed. In the immediate postoperative period, the patient presented a massive hemorrhage due to uterine atony. Echocardiography revealed a patent foramen ovale. The clinical signs in this patient are highly suggestive of a paradoxical cerebral and coronary air embolism.

[Remifentanil bolus for cesarean section in high-risk patients: study of 12 cases]. / Uso del remifentanilo en bolus en la cesárea de la paciente de alto riesgo: estudio sobre 12 casos.

OBJECTIVES: To evaluate the utility and safety of remifentanil for hemodynamic control during cesarean section in high-risk patients ineligible for spinal anesthesia. METHODS: One minute before induction we injected a bolus of 1 microg x kg(-1) of remifentanil, followed by propofol (2.5 mg x kg(-1)), succinylcholine (1 mg x kg(-1)), cisatracurium, sevoflurane in oxygen and nitrous oxide, and fentanyl (5 microg x kg(-1)) after clamping the umbilical cord. We recorded maternal hemodynamic variables, pulse oximetry, capnography, bispectral index, and presence of muscular rigidity. In the neonate we assessed fetal wellbeing, weight, and requirement for naloxone. Hemodynamic stability was defined as no more than 15% variation in arterial pressure with respect to baseline. RESULTS: Twelve patients undergoing surgery because of placenta abruptio, subarachnoid hemorrhage, HELLP syndrome, or preeclampsia were enrolled. Hemodynamic variables were consistently stable during surgery in all patients. No cases of neonatal rigidity were noted and there was no need for naloxone. The mean Apgar score was 6.42 (1.5) at 1 minute and 8.42 (0.9) at 5 minutes. CONCLUSION: Bolus injection of 1 microg x kg(-1) of remifentanil may be useful for maintaining maternal hemodynamic stability in high-risk obstetric cases. Given the risk of neonatal depression, this resource should be used selectively and the means for neonatal resuscitation should be available.

[Experience with uterine artery embolization in the treatment of massive postpartum hemorrhage]. / Experiencia con la embolización arterial en el tratamiento de la hemorragia masiva obstétrica.

OBJECTIVE: To analyze our experience with uterine artery embolization in the management of massive hemorrhage in obstetric patients. PATIENTS AND METHODS: This observational, retrospective study analyzed all deliveries requiring a blood transfusion that were performed in the maternity unit of Hospital Universitario La Paz between January 1, 2000 and December 31, 2005. RESULTS: A total of 57,835 deliveries were performed with an incidence of postpartum hemorrhage of 0.7% (406 episodes). Uterine artery embolization was performed on 51 patients and 45 patients underwent obstetric hysterectomy. Both procedures were performed on 11 patients. Ten of the patients who underwent obstetric hysterectomy subsequently required uterine artery embolization, whereas only 1 patient required an obstetric hysterectomy following embolization because the hemorrhage was not resolved. The mean consumption of blood products for patients who underwent obstetric hysterectomy was twice that for patients who underwent uterine artery embolization. There were no complications secondary to embolization. CONCLUSIONS: Uterine artery embolization is a safe and effective procedure for managing massive postpartum hemorrhage.

[Is oxygen therapy truly useful and necessary during elective cesarean section under spinal anesthesia?]. / Es realmente necesaria y útil la oxigenoterapia suplementaria en la cesárea programada bajo anestesia subaracnoidea?

OBJECTIVE: To analyze maternal and fetal well-being with and without the application of oxygen therapy. MATERIAL AND METHODS: Randomized trial of full-term parturients who had received prenatal care during pregnancy. The women were healthy and classified as ASA 1. They were scheduled for delivery by cesarean section under spinal anesthesia and randomized to 2 groups to breathe room air or air providing an inspired oxygen fraction of 40% through a face mask. We assessed the well-being of the neonate immediately after birth with the Apgar test and by measuring umbilical cord blood gases. RESULTS: One hundred thirty women were enrolled. Both groups were similar, with no differences in demographic or hemodynamic variables, time from uterine incision to fetal extraction, neonatal birth weight, presence of umbilical cord abnormalities, type of resuscitation required by the neonate, or Apgar score in the first or fifth minute. Oxygen saturation in maternal blood by pulse oximetry was higher after 10 minutes in the group of women who received supplemental oxygen through face masks. We also observed significant differences in umbilical cord arterial blood between the room air and supplemental oxygen groups, respectively, as follows: PaCO2, 51.14 mm Hg vs 54.33 mm Hg (P=.016); bicarbonate, 22.19 mEq L(-1) vs 23.23 mEq L(-1) (P=.012); lactate, 1.85 mmol L(-1) vs 1.64 mmol L(-1) (P=.038). The PO2 in venous blood also differed significantly: 25.53 mm Hg vs 28.13 mm Hg, respectively (P=033). CONCLUSIONS: Breathing supplemental oxygen or not during elective cesarean delivery of healthy parturients under spinal anesthesia does not have a significant effect on neonatal well-being.

[Emergency cesarean in a patient with Coffin-Siris syndrome]. / Cesárea urgente en una paciente con síndrome de Coffin-Siris.

Coffin-Siris syndrome is a rare genetic disease characterized by coarse facial features, sparse scalp hair, hirsutism, hypoplasia of the distal phalanges, hypoplastic nail in the fifth digit, and mental retardation and delayed growth evident in both weight and height. Most cases are sporadic, but the possibility of recessive or dominant autosomal inheritance has been suggested. Facial abnormalities that make intubation difficult and mental retardation that interferes with cooperation are aspects of this disease that can affect the choice of type of anesthesia. We report the case of a parturient with Coffin-Siris syndrome who refused epidural analgesia for labor pain and for whom the obstetrician later decided that an emergency cesarean was necessary due to fetal distress.

Síndrome de Horner secundario a anestesia epidural / Horner's syndrome secondary to epidural anesthesia

Introducción. El síndrome de Horner asociado a la anestesia se produce por un bloqueo de las fibras simpáticas del ganglio estrellado. Esta complicación se produce por la migración no esperada del anestésico local administrado en el espacio epidural durante una anestesia epidural o dentro del paquete aponeurótico vasculonervioso en un bloqueo del plexo braquial. Es un cuadro de rápida evolución, benigno, que desparece en horas, sin dejar secuelas y que puede ocurrir en pacientes sin ningún antecedente patológico. Caso clínico. Describimos el caso de una embarazada de 28 años, con un índice de masa corporal de 40,6 sin antecedentes neurológicos previos, que ingresa para el parto. Se le administró analgesia epidural y después de 2 h se realizó una cesárea. Veinte minutos después de la administración de una dosis epidural de anestésicos locales la paciente desarrolló un síndrome de Horner completo izquierdo, junto con paresia braquial ipsilateral que duró 3 h, con recuperación completa. Conclusiones. Se discuten diversas posibilidades etiopatogénicas como una posible migración subdural o paravertebral de los anestésicos locales, la influencia del decúbito de la paciente y la posible existencia de tabiques epidurales

Introduction. The Horner's syndrome in association with the anesthetic techniques is produced by a blockade of the stellate ganglion sympathetic fibers. This complication is produced by the local anesthetic non-expected migration when it is administered either in the epidural space while performing an epidural block or inside the aponeurosis vascular elements during the performance of a brachial plexus block. Its evolution is quick, with benign incident that disappears in a few hours, without leaving any sequels. It can occur in patients without any previous clinical condition. Clinical case. We described the case of 28 years old pregnant woman, with a body mass index of 40.6, without any previous neurological background, who was admitted into hospital for labour. She had epidural analgesia and needed a caesarean section 2 hours later. Twenty minutes after the administration of an epidural dose of local anesthetic, the patient developed a completed left side Horner's Syndrome, as well as ipsi-lateral brachial paresis, that lasted for three hours, with complete recovery. Conclusions. Several etiopathologenic options were considered at the time, such as a possible subdural or paravertebral migration of the local anesthetic, the influence of the patient's position (decubitus) and the possible existence of fibrotic compartments in the epidurals space

[Horner's syndrome secondary to epidural anesthesia]. / Síndrome de Horner secundario a anestesia epidural.

INTRODUCTION: The Horner's syndrome in association with the anesthetic techniques is produced by a blockade of the stellate ganglion sympathetic fibers. This complication is produced by the local anesthetic non-expected migration when it is administered either in the epidural space while performing an epidural block or inside the aponeurosis vascular elements during the performance of a brachial plexus block. Its evolution is quick, with benign incident that disappears in a few hours, without leaving any sequels. It can occur in patients without any previous clinical condition. CLINICAL CASE: We described the case of 28 years old pregnant woman, with a body mass index of 40.6, without any previous neurological background, who was admitted into hospital for labour. She had epidural analgesia and needed a caesarean section 2 hours later. Twenty minutes after the administration of an epidural dose of local anesthetic, the patient developed a completed left side Horner's Syndrome, as well as ipsi-lateral brachial paresis, that lasted for three hours, with complete recovery. CONCLUSIONS: Several etiopathologenic options were considered at the time, such as a possible subdural or paravertebral migration of the local anesthetic, the influence of the patient's position (decubitus) and the possible existence of fibrotic compartments in the epidurals space.

[Cesarean section in a woman with acute blood-stage malaria]. / Cesárea en una gestante con crisis aguda de paludismo.

Malaria infection during pregnancy is a serious health problem in most of the world's tropical regions. The disease has also been imported into Western countries, however, as an increasing number of infected women, who may become pregnant, emigrate from areas where malaria is endemic. Infection during pregnancy can have serious repercussions for both mother and fetus. Early diagnosis and multidisciplinary management are essential. We report the case of a woman from Guinea who debuted with severe, acute blood-stage malaria in the 32nd week of pregnancy and was admitted to the recovery care unit.