The 2022 European Union report on pesticide residues in food.

Under European Union legislation (Article 32, Regulation (EC) No 396/2005), the European Food Safety Authority provides an annual report assessing the pesticide residue levels in foods on the European market. In 2022, 96.3% of the overall 110,829 samples analysed fell below the maximum residue level (MRL), 3.7% exceeded this level, of which 2.2% were non-compliant, i.e. results in a given sample exceeded the MRL after taking into account the measurement uncertainty. For the EU-coordinated multiannual control programme subset, 11,727 samples were analysed of which 0.9% were non-compliant. To assess acute and chronic risk to consumer health, dietary exposure to pesticide residues was estimated and compared with available health-based guidance values (HBGV). Continuation of the probabilistic assessment methodology was consolidated to all pesticides listed in the 2022 EU Regulation providing the probability of a consumer being exposed to an exceedance of the HBGV. Overall, the assessed risk to EU consumer's health is low. Recommendations to risk managers are given to increase the effectiveness of European control systems and to ensure a high level of consumer protection throughout the EU.

TC-4D como prueba de localización preoperatoria de segunda línea en la evaluación del hiperparatiroidismo primario / 4D-CT as a second line preoperative localization test for the evaluation of primary hyperparathyroidism

Introducción: La tomografía computarizada en cuatro dimensiones (TC-4D) ofrece buena sensibilidad para localizar la glándula patológica responsable del hiperparatiroidismo primario. El objetivo fue evaluar su rendimiento como estudio de segunda línea tras ausencia de localización o resultado no concordante de los estudios habituales. Material y métodos: Estudio observacional retrospectivo que incluyó todos los pacientes intervenidos por hiperparatiroidismo primario con TC-4D como estudio preoperatorio, del 1 de octubre de 2016 al 1 de octubre de 2021, en un centro hospitalario de tercer nivel. Se compararon los resultados de la TC-4D, la ecografía y las exploraciones de medicina nuclear (gammagrafía, SPECT y SPECT-TC) con el gold standard de la exploración quirúrgica y el resultado anatomopatológico, analizando los porcentajes de lateralización correcta y localización aproximada de la glándula patológica. Resultados: El análisis incluyó 64 pacientes, con una curación del 93,8% (60/64). La TC-4D mostró una lateralización correcta del 57,8% (37/64) y reveló la localización aproximada de la glándula en el 48,4% (31/64). La ecografía tuvo unos porcentajes del 31,1% (19/61) y del 18% (11/61) para la lateralización correcta y la localización aproximada, respectivamente, vs. un 34,9% (22/63) y un 28,6% (18/63) de los estudios de medicina nuclear y un 32,7% (16/49) y un 24,5% (12/49) de la SPECT-TC. Estas diferencias fueron estadísticamente significativas. Conclusiones: La TC-4D ofrece un rendimiento aceptable para localizar las lesiones responsables del hiperparatiroidismo primario, por lo que debería considerarse su uso ante la ausencia de localización en los estudios habituales. (AU)

Introduction: Four-dimensional computerized tomography (4D-CT) offers a good sensitivity for the localization of the pathological gland responsible of primary hyperparathyroidism. The aim was to evaluate its results as a second line preoperative localization test after inconclusive or discordant results of usual preoperative studies. Material and methods: Observational retrospective study that included all patients intervened for primary hyperparathyroidism with 4D-CT scan as preoperative study, from 1st October 2016 to 1st October 2021, in a tertiary referral centre. The results of 4D-CT, cervical ultrasound, and nuclear medicine explorations (scintigraphy, SPECT and SPECT-CT) were compared with the gold standard of the surgical exploration and the pathological result. The correct lateralization and the approximate localization rates of the pathological gland were evaluated. Results: A total of 64 patients were analysed, with a 93,8% (60/64) remission rate. 4D-CT showed a correct lateralization in 57,8% (37/64) of the cases and revealed the approximate localization of the gland in 48,4% (31/64) of the cases. The cervical ultrasound had a rate of 31,1% (19/61) and 18% (11/61) for the correct lateralization and approximate localization, respectively, compared to 34,9% (22/63) and 28,6% (18/63) in nuclear medicine explorations, and 32,7% (16/49) and 24,5% (12/49) in SPECT-CT. These differences were statistically significant. Conclusion: 4D-CT demonstrated acceptable results for the localization of the lesions responsible of primary hyperparathyroidism, thus its use should be considered with the absence of localization in routinely studies. (AU)

The 2021 European Union report on pesticide residues in food.

Under European Union legislation (Article 32, Regulation (EC) No 396/2005), EFSA is to provide an annual report assessing the pesticide residue levels in foods on the European market. In 2021, 96.1% of the overall 87,863 samples analysed fell below the maximum residue level (MRL), 3.9% exceeded this level, of which 2.5% were non-compliant, i.e. samples exceeding the MRL after accounting for the measurement uncertainty. For the EU-coordinated multiannual control programme subset, 13,845 samples were analysed of which 2.1% exceeded the MRL and 1.3% were non-compliant. To assess acute and chronic risk to consumer health, dietary exposure to pesticide residues was estimated and compared with available health-based guidance values (HBGVs). A new pilot methodology based on probabilistic assessment was introduced to provide the probability of subjects being expose to an exceedance of the HBGV. Recommendations to risk manager are given to increase the effectiveness of European control systems and to ensure a high level of consumer protection throughout the EU.

4D-CT as a second line preoperative localization test for the evaluation of primary hyperparathyroidism.

INTRODUCTION: Four-dimensional computerized tomography (4D-CT) offers a good sensitivity for the localization of the pathological gland responsible of primary hyperparathyroidism. The aim was to evaluate its results as a second line preoperative localization test after inconclusive or discordant results of usual preoperative studies. MATERIAL AND METHODS: Observational retrospective study that included all patients intervened for primary hyperparathyroidism with 4D-CT scan as preoperative study, from 1st October 2016 to 1st October 2021, in a tertiary referral centre. The results of 4D-CT, cervical ultrasound, and Nuclear Medicine explorations (scintigraphy, SPECT and SPECT-CT) were compared with the gold standard of the surgical exploration and the pathological result. The correct lateralization and the approximate localization rates of the pathological gland were evaluated. RESULTS: A total of 64 patients were analysed, with a 93,8% (60/64) remission rate. 4DCT showed a correct lateralization in 57,8% (37/64) of the cases and revealed the approximate localization of the gland in 48,4% (31/64) of the cases. The cervical ultrasound had a rate of 31,1% (19/61) and 18% (11/61) for the correct lateralization and approximate localization, respectively, compared to 34,9% (22/63) and 28,6% (18/63) in Nuclear Medicine explorations, and 32,7% (16/49) and 24,5% (12/49) in SPECT-CT. These differences were statistically significant. CONCLUSION: 4D-CT demonstrated acceptable results for the localization of the lesions responsible of primary hyperparathyroidism, thus its use should be considered with the absence of localization in routinely studies.

Adhesion molecule Amigo2 is involved in the fasciculation process of the fasciculus retroflexus.

BACKGROUND: The fasciculus retroflexus is the prominent efferent pathway from the habenular complex. Medial habenular axons form a core packet whereas lateral habenular axons course in a surrounding shell. Both groups of fibers share the same initial pathway but differ in the final segment of the tract, supposedly regulated by surface molecules. The gene Amigo2 codes for a membrane adhesion molecule with an immunoglobulin-like domain 2 and is selectively expressed in the medial habenula. We present it as a candidate for controlling the fasciculation behavior of medial habenula axons. RESULTS: First, we studied the development of the habenular efferents in an Amigo2 lack of function mouse model. The fasciculus retroflexus showed a variable defasciculation phenotype. Gain of function experiments allowed us to generate a more condensed tract and rescued the Amigo2 knock-out phenotype. Changes in Amigo2 function did not alter the course of habenular fibers. CONCLUSION: We have demonstrated that Amigo2 plays a subtle role in the fasciculation of the fasciculus retroflexus.

The 2020 European Union report on pesticide residues in food.

Under European Union legislation (Article 32, Regulation (EC) No 396/2005), the EFSA provides an annual report which examines pesticide residue levels in foods on the European market. This report is based on data from the official national control activities carried out by EU Member States, Iceland and Norway and includes a subset of data from the EU-coordinated control programme, which uses a randomised sampling strategy. For 2020, 94.9% of the overall 88,141 samples analysed fell below the maximum residue level (MRL), 5.1% exceeded this level, of which 3.6% were non-compliant, i.e. samples exceeding the MRL after taking the measurement uncertainty into account. For the subset of 12,077 samples analysed as part of the EU-coordinated multiannual control programme, 1.7% exceeded the MRL and 0.9% were non-compliant. To assess acute and chronic risk to consumer health, dietary exposure to pesticide residues was estimated and compared with health-based guidance values. Dietary exposure to pesticides for which health-based guidance values were available is unlikely to pose a risk to EU consumer health. In the rare cases where dietary exposure for a specific pesticide/product combination was calculated to exceed the health-based guidance value, and for those pesticides for which no health-based guidance value could be established, the competent authorities took appropriate and proportionate corrective measures to address potential risks to consumers. Recommendations are proposed to increase the effectiveness of European control systems, thereby continuing to ensure a high level of consumer protection throughout the EU.

Choledochal cysts surgical management: Retrospective and historical comparative analysis.

INTRODUCTION: Choledochal cysts are rare bile duct dilatations, which have higher prevalence in Asian population. The aim of the study was to analyze clinical and surgical results about biliary cysts management. In addition, a comparative historical analysis was performed. METHODS: Patients who underwent surgery between January 1988 and December 2019 in a single tertiary level center were retrospectively included. Demographic and clinical patient data; cyst types; diagnostic methods and surgical technique were analyzed, as well as short and long-term follow-up complications. A comparative descriptive study focus on the main historical series was also carried out. RESULTS: A total of seventeen patients were identified; 58.8% were men. The mean age at diagnosis was 39.9 years (SD: 20.54). The median follow-up was 5 years (IQR 1-15). The most frequent cysts were type I (41.2%). Abdominal pain was the most common presenting symptom (58.8%). Cystic excision with bilio-enteric anastomosis was the main procedure, it was underwent in 85, 7% type I cysts. 29.4% postoperative complications were recorded. Malignancy was not documented in any pathology specimen. CONCLUSIONS: Choledochal cysts are an uncommon disorder whose diagnosis requires a high level of suspicion. Surgical treatment depends on type of cyst. In most patients with choledochal cysts disease, complete cyst excision with bilio-enteric anastomotic reconstruction is the treatment of choice.

Baja incidencia y alta mortalidad por COVID-19 en Cirugía General durante la primera ola de la pandemia / Low incidence and high COVID-19 mortality in a General Surgery during the first wave of the pandemia

Resumen Introducción y objetivo: La infección por coronavirus (COVID-19) en pacientes intervenidos es causa de importante mortalidad posoperatoria, aunque su incidencia es variable. El objetivo primario fue evaluar la incidencia de COVID-19 en los pacientes intervenidos en nuestro Servicio de Cirugía General y Digestiva, durante el máximo impacto de la pandemia en España. El objetivo secundario fue evaluar la mortalidad perioperatoria y determinar los factores de riesgo para la infección por COVID-19. Materiales y Método: Estudio observacional retrospectivo de pacientes consecutivos sometidos a Cirugía General y Digestiva con ingreso superior a 24 h, del 1 de febrero de 2020 al 30 de abril de 2020 en un hospital terciario de Madrid, España. Resultados: Se analizaron 441 pacientes: 423 sin COVID-19 y 18 con COVID-19. Las características preoperatorias y operatorias fueron similares para ambos grupos, salvo por el grado ASA (American Society of Anesthesiologists). La incidencia de COVID-19 en los pacientes intervenidos fue del 4,1%. La mortalidad posoperatoria fue elevada, del 22,2% en pacientes con COVID-19, frente a un 2,8% en pacientes no COVID-19 (p: 0,003). Los factores de riesgo para la infección por COVID-19 en los pacientes intervenidos fueron una estancia hospitalaria prolongada (OR: 1,035 [95% CI: 1,007-1,065]) y la reintervención quirúrgica (OR: 5,025 [95% CI: 1,650-15,311]). Conclusión: Las intervenciones durante la pandemia de COVID-19 causaron una baja tasa de infección con elevada mortalidad posoperatoria. La intervención quirúrgica debe valorarse frente al riesgo adicional para el paciente en contextos de alta transmisión.

The impact of coronavirus disease (COVID-19) in intervened patients seems to cause large postoperative mortality, although its incidence varies among centres. Primary aim was to evaluate the incidence of COVID-19 on the patients intervened in our General and Digestive Surgery Department, during the maximum impact of the pandemia in Spain. Secondary outcomes were evaluating perioperative mortality, and determining the risk factors for COVID-19 infection. Materials and Method: Retrospective single centre study of consecutive patients undergoing general and gastrointestinal surgical procedures with more than 24 hours of inhospital stay, from February 1, 2020 to April 30, 2020 in a tertiary referral centre in Madrid, Spain. Results: A total of 441 patients were analysed: 423 were non-COVID-19 patients while 18 of them had COVID-19. Preoperative and operative characteristics were similar for both groups, unless for the American Society of Anesthesiologists grade. The incidence of COVID-19 in our intervened patients was 4.1%. Postoperative mortality was high among surgical patients with COVID-19, with a mortality rate of 22.2% compared to a 2.8% in non COVID-19 patients. The risk factors for COVID-19 infection were a prolonged postoperative stay (OR: 1.035 [95% CI: 1.007-1.065]) and the need of a reintervention (OR: 5.025 [95% CI: 1.650-15.311]). Conclusion: Surgical interventions during the COVID-19 pandemia resulted in a low infection rate but a high postoperative COVID-19 mortality. The decision to intervene must be carefully balanced against the additional risk for patients in a high transmission setting.

The 2019 European Union report on pesticide residues in food.

Under European Union legislation (Article 32, Regulation (EC) No 396/2005), the EFSA provides an annual report which examines pesticide residue levels in foods on the European market. This report is based on data from the official national control activities carried out by EU Member States, Iceland and Norway and includes a subset of data from the EU-coordinated control programme which uses a randomised sampling strategy. For 2019, 96.1% of the overall 96,302 samples analysed fell below the maximum residue level (MRL), 3.9% exceeded this level, of which 2.3% were non-compliant, i.e. samples exceeding the MRL after taking the measurement uncertainty into account. For the subset of 12,579 samples analysed as part of the EU-coordinated control programme, 2.0% exceeded the MRL and 1.0% were non-compliant. To assess acute and chronic risk to consumer health, dietary exposure to pesticide residues was estimated and compared with health-based guidance values. The findings suggest that the residue levels for the food commodities analysed are unlikely to pose any concern for consumer health. However, a number of recommendations are proposed to increase the effectiveness of European control systems, thereby continuing to ensure a high level of consumer protection throughout the EU.

Choledochal cysts surgical management: Retrospective and historical comparative analysis. / Manejo quirúrgico de los quistes de colédoco: análisis retrospectivo y comparativa histórica.

INTRODUCTION: Choledochal cysts are rare bile duct dilatations, which have higher prevalence in Asian population. The aim of the study was to analyze clinical and surgical results about biliary cysts management. In addition, a comparative historical analysis was performed. METHODS: Patients who underwent surgery between January 1988 and December 2019 in a single tertiary level center were retrospectively included. Demographic and clinical patient data; cyst types; diagnostic methods and surgical technique were analyzed, as well as short and long-term follow-up complications. A comparative descriptive study focus on the main historical series was also carried out. RESULTS: A total of seventeen patients were identified; 58.8% were men. The mean age at diagnosis was 39.9 years (SD: 20.54). The median follow-up was 5 years (IQR 1-15). The most frequent cysts were tipe I (41.2%). Abdominal pain was the most common presenting symptom (58.8%). Cystic excision with bilio-enteric anastomosis was the main procedure, it was underwent in 85, 7% type I cysts. 29.4% postoperative complications were recorded. Malignancy was not documented in any pathology specimen. CONCLUSIONS: Choledochal cysts are an uncommon disorder whose diagnosis requires a high level of suspicion. Surgical treatment depends on type of cyst. In most patients with choledochal cysts disease, complete cyst excision with bilio-enteric anastomotic reconstruction is the treatment of choice.

The 2018 European Union report on pesticide residues in food.

Under EU legislation (Article 32, Regulation (EC) No 396/2005), EFSA provides an annual report which analyses pesticide residue levels in foods on the European market. The analysis is based on data from the official national control activities carried out by EU Member States, Iceland and Norway and includes a subset of data from the EU-coordinated control programme which uses a randomised sampling strategy. For 2018, 95.5% of the overall 91,015 samples analysed fell below the maximum residue level (MRL), 4.5% exceeded this level, of which 2.7% were non-compliant, i.e. samples exceeding the MRL after taking into account the measurement uncertainty. For the subset of 11,679 samples analysed as part of the EU-coordinated control programme, 1.4% exceeded the MRL and 0.9% were non-compliant. Table grapes and sweet peppers/bell peppers were among the food products that most frequently exceeded the MRLs. To assess acute and chronic risk to consumer health, dietary exposure to pesticide residues was estimated and compared with health-based guidance values. The findings suggest that the assessed levels for the food commodities analysed are unlikely to pose concern for consumer health. However, a number of recommendations are proposed to increase the efficiency of European control systems (e.g. optimising traceability), thereby continuing to ensure a high level of consumer protection.

Comparative study of the main top-down approaches for the estimation of measurement uncertainty in multiresidue analysis of pesticides in fruits and vegetables.

Practical "top-down" approaches appear to be the most suitable for the evaluation of measurement uncertainty in pesticide residue testing laboratories, where analytical procedures are routinely applied to a large number of pesticide/food combinations. The opposite approach, "bottom-up" evaluation of measurement uncertainty, leads to great difficulties in evaluating all of the pesticides in a consistent way. Among the top-down approaches, there are two main ways in which measurement uncertainty can be estimated: One is based on default values, which are based on previous extensive interlaboratory experience and the proven accuracy of the laboratory; these include the Horwitz equation or the fit-for-purpose relative standard deviation (FFP-RSD). The other is based on experimental data from the quality control work of the laboratory: within-laboratory reproducibility, interlaboratory validation, or a combination of results obtained in proficiency tests. The principal existing guidelines from various bodies (Eurachem, Nordtest, and Eurolab) all propose different approaches for calculating measurement uncertainty. In this paper, the main top-down approaches are evaluated and compared using the data from the European Proficiency Test Database for Fruits and Vegetables and the Multiresidue Method validation databases obtained from the National Reference and Official Laboratories in Europe. The main conclusion of the comparative study is that a default expanded measurement uncertainty value of 50% could satisfy all of the requirements for facilitating and harmonizing, worldwide, the intercomparability of the pesticide residue confidence results between laboratories.