Transcaval approach for aortic endoprosthesis insertion. A new anesthetic challenge.

The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach. The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence. We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.

Matching times: Trying to improve the correlation between heavy metal levels in mosses and bulk deposition.

The relationship between the concentrations of metals in moss tissues and atmospheric deposition is highly complex, resulting in a general lack of correlations between these two matrices. Here, we tried to improve the significance of the moss-bulk deposition (BD) relationship by eliminating the mismatch between the time that the moss tissue selected for analysis is exposed to atmospheric deposition, and the time during which BD is collected. For this, we analysed the concentrations of Cd, Hg and Pb in new grown tissue of Pseudoscleropodium purum and BD collected monthly, for one year, in 21 sampling sites (SS) under different degrees of pollution. Additionally, we assessed how different moss tissues, including native moss (green parts and new grown tissues of P. purum) and moss transplants of Sphagnum denticulatum, reflect BD to find out which moss tissues provide a better estimate of the atmospheric deposition of heavy metals. First of all, our results showed that eliminating the mismatch between native moss exposure time and BD collection period is not enough to improve their correlation. Environmental variation emerged as the main driver of tissue content variation altering the moss-BD relationship unpredictably. Secondly, native P. purum represents BD values better than devitalized transplants by displaying a greater number of significant correlations with BD. Specifically, green parts of P. purum generally represent better BD than new grown tissues. Overall, we conclude that neither native mosses nor transplants are good estimators of atmospheric heavy metal deposition rates. However, they are good qualitative indicators of the atmospheric deposition, by allowing us to differentiate SS subject to a wide range of pollution levels. Additionally, green parts of P. purum, and likely of other mosses with similar growth forms, should be used in passive biomonitoring studies to make results from different studies comparable.

Simultaneous determination of 20 drugs of abuse in oral fluid using ultrasound-assisted dispersive liquid-liquid microextraction.

Drugs of abuse and new psychoactive substances (NPS) for recreational purposes are in constant evolution, and their consumption constitutes a significant risk to public health and road safety. The development of an analytical methodology to confirm the intake of illicit drugs in biological fluids is required for an effective control of these substances. An ultra-performance liquid chromatography-tandem mass spectrometry method (UPLC-MS/MS) was developed for simultaneous determination of 10 synthetic cathinones and 10 illicit drugs in oral fluid easily sampled through non-invasive maneuvers. The UPLC-MS/MS method was coupled to an ultrasound-assisted dispersive liquid-liquid microextraction (US-DLLME), which is a miniaturized and inexpensive technique that uses reduced volumes of solvents and samples. The US-DLLME was optimized by using a 213441//18 asymmetric screening design and a Doehlert design. Sample volume, dispersion and extraction solvent volumes, pH, US time, and amount of sodium chloride were evaluated. The US-DLLME-UPLC-MS/MS method was validated according to international guidelines. Limits of quantitation (LOQs) ranged from 0.25 to 5 ng mL-1, and the linear range spanned from LOQ to 500 ng mL-1 with R2 higher than 0.9907, for most of the target drugs. Precision ranged from 1.7 to 14.8 %RSD. Accuracy, i.e., extraction recovery, ranged from 74 to 129%. The proposed method was successfully applied to the analysis of 15 samples from patients on a drug detoxification program.

Characterization of Pseudomonas syringae pv. actinidiae biovar 3 on kiwifruit in north-west Portugal.

AIMS: Bacterial kiwifruit canker disease, caused by Pseudomonas syringae pv. actinidiae (Psa) was detected in north-west Portugal in 2010, and has since caused significant losses. The objectives of this work were to characterize the Portuguese population(s) of Psa and to define the actual prevalence of Psa biovars in the most productive kiwifruit region in Portugal. METHODS AND RESULTS: Isolates obtained from Actinidia deliciosa orchards were characterized by morphological, biochemical, physiological, fatty acids and molecular tests (PCR, BOX-PCR, duplex-PCR, multiplex-PCR and RFLP), phaseolotoxin, housekeeping and effector genes and pathogenicity. Results established that only Psa biovar 3 is present in the north-west of Portugal, despite phenotypic and genetic variability among the isolates. CONCLUSIONS: This work provides new information on P. syringae pv. actinidiae (Psa) genetic profile in Portugal, indicating for the first time, that two genetically different subpopulations of Psa biovar 3 are present. SIGNIFICANCE AND IMPACT OF THE STUDY: A new subpopulation of Psa biovar 3 was found for the first time in Portugal, contributing to increase knowledge about this population worldwide and to support further understanding of the impact of Psa.

A fast bioanalytical method based on microextraction by packed sorbent and UPLC-MS/MS for determining new psychoactive substances in oral fluid.

The emergence in recent years of potentially dangerous new psychoactive substances (NPS) that are not under international control has led to the development of multi-analyte procedures for their unequivocal quantification. A fast ultra-performance liquid chromatography-tandem mass spectrometry method (UPLC-MS/MS), in combination with a sample pretreatment based on microextraction by packed sorbent (MEPS), was for the first time used in this work for the simultaneous determination of NPS in oral fluid. This matrix is an effective alternative to typical biological samples for drug control in substitution therapy programs, and also for the prevention and reduction of traffic accidents. The proposed method allowed the separation and quantification of eleven synthetic cathinones, six opiates, scopolamine, cocaine and two metabolites in less than 3.0min by using appropriate isotope-labelled internal standards. The MEPS procedure, which is a miniaturized version of the SPE technique, is completed within 15min. The influence of variables such as the washing solution and eluent volumes, phase type, number of aspirate-dispense cycles and pH was investigated by using a 3441//16 asymmetric screening design and a response surface methodology based on a Doehlert design. The MEPS process performed optimally with a mixed-mode C8/SCX sorbent and a sample pH of 9. The proposed method was validated according to major guidelines and found to span the linear concentration range 0.5-500ngmL-1 (R2 ≥ 0.9903), and to be selective and precise (within- and between-day precision as %RSD were both lower than 13.7%). The accuracy, in terms of analyte extraction recovery, ranged from 75% to 125% for most of the analytes. The MEPS-UPLC-MS/MS method was successfully used to analyse twelve real samples from patients on a drug detoxification programme and proved an effective tool for drug monitoring.

Analysis of drugs of abuse in human plasma using microextraction by packed sorbents and ultra-high-performance liquid chromatography.

A miniaturized and simple method based on digitally programmed microextraction by packed sorbent (eVol®-MEPS) coupled to ultra-performance liquid chromatography (UPLC) has been developed for quantitative determination of three synthetic cathinones and seven conventional drugs of abuse and metabolites. The influence of several extraction parameters, such as washing and elution solvents were tested. In addition important variables affecting MEPS performance, namely sample volume, sorbent drying time, washing solvent volume, elution volume, number of extraction cycles, sorbent phase and pH, were evaluated using an asymmetrical screening design. The optimal experimental conditions involved 300µL of plasma, loading 10×100µL of sample through a C8/SCX sorbent in a MEPS syringe placed in the semi-automatic eVol® system, washing using 150µL H2O:MeOH (90:10, v/v), drying for 0.5min and elution using 200µL dichloromethane:2-propanol:ammonium hydroxide (78:20:2, v/v/v). The drugs separation was achieved using an ACQUITY BEH Shield RP18 column (2.1mm×100mm×1.7µm) in 3min. Under optimized conditions the proposed method was validated in terms of selectivity, linearity, limits of detection (LOD) and quantitation (LOQ), precision and matrix effect, using standard addition calibration. The combination of MEPS and UPLC provides a method for the primary screening of the analytes in 18min with excellent recoveries at three concentration levels, ranging between 80 and 104% (relative standard deviation <11%). The developed methodology has been successfully applied to plasma samples from polydrug abusers.

Fibrosis pulmonar idiopática, tenemos alteranativas / No disponible

Presentamos un paciente con diagnóstico de fibrosis pulmonar idiopática (FPI) de grado moderado, en el que se inicia tratamiento con pirfenidona. Ante los efectos secundarios cutáneos recidivantes, a pesar de correctas medidas preventivas de protección solar, se suspende dicho fármaco y se inicia tratamiento alternativo con nintedanib, con efectos gastrointestinales leves que se controlan con tratamiento sintomático. A los 4 meses se observa mejoría clínica y leve mejoría funcional

We present a patient diagnosed with idiopathic pulmonary fibrosis (IPF) of moderate degree, in which treatment is initiated with pirfenidone. Given the recurrent cutaneous side effects, although correct sunscreen preventive measures, the drug is discontinued and alternative treatment begins with nintedanib with mild gastrointestinal effects that are controlled with symptomatic treatment. At 4 months mild clinical improvement and functional improvement is observed

Active biomonitoring with the moss Pseudoscleropodium purum: Comparison between different types of transplants and bulk deposition.

Active biomonitoring with terrestrial mosses can be used to complement traditional air pollution monitoring techniques. Several studies have been carried out to compare the uptake capacity of different types of moss transplants. However, until now the relationship between the uptake of elements in devitalized moss bags and in irrigated transplants has not been explored. In this study, the final concentrations of Cd, Cu, Hg, Pb and Zn were determined in irrigated and devitalized moss transplants in the surroundings of a steelworks. The concentrations were also compared with those of the same elements in the bulk deposition to determine which type of moss transplant yields the closest correlations. Devitalized moss retained higher concentrations of all of the elements (except Hg) than the irrigated moss. Both irrigated and devitalized moss transplants appear to detect the same type of contamination (i.e. particulate matter and dissolved metals rather than gaseous forms) as significant correlations were found for Cu, Hg, Pb and Zn, whereas, neither type of the moss transplant was sensitive enough to detect changes in the soluble fraction load of bulk deposition. Further studies will be needed to a better understanding of the correlation between the concentrations of elements in moss transplants with the particulate fraction of the bulk deposition. This will enable the establishment of a more robust and accurate biomonitoring tool.

Rotura de bronquio principal izquierdo por tubo de doble luz en paciente con antecedentes de radioterapia / Rupture of left main bronchus due to a left double-lumen tube in patient with a history of radiotherapy

La lesión de vía aérea causada por tubos de doble luz es una complicación infrecuente pero potencialmente muy grave. Describimos el caso de una paciente que presentó una rotura bronquial durante la ventilación unipulmonar con un tubo de doble luz izquierdo, complicándose con una parada cardíaca secundaria de la que se recuperó sin secuelas. Causas intrínsecas de la paciente, como el antecedente de radioterapia externa, y un posible sobreinflado del neumotaponamiento pudieron contribuir al desarrollo de esta complicación. La posible lesión de vía aérea debe ser considerada por todos los profesionales que empleen tubos de doble luz durante el cuidado de sus pacientes (AU)

Airway injury caused by double-lumen tubes is a rare but potentially serious complication. We describe the case of a patient who had a bronchial rupture during one-lung ventilation with left double-lumen tube, complicated with a secondary cardiac arrest. She had a full recovery without sequelae. Underlying causes of the patient were a history of radiotherapy, and a possible overinflation of bronchial cuff, that it could contribute to the development of this complication. The possible airway injury should be considered by all practitioners who employ double-lumen tubes for the care of their patients (AU)

Respuesta de los autores: Comentarios al artículo: «Tratamiento de la rotura traumática del bronquio izquierdo por asta de toro con stent endobronquial. Implicaciones anestésicas» / Reply to authors: Comments to the article: «Endobronchial stent for the treatment of atraumatic rupture of the left bronchial dueto a bull horn. Anesthetic implications»

No disponible

Réplica a «Algoritmos de seguridad para bloqueos guiados por ecografía: el próximo reto» / Reply to 'Safety algorithm for ultrasound-guided blocks: the next challenge'

No disponible

Detection and characterization of Pseudomonas syringae pv. actinidifoliorum in kiwifruit in Spain.

AIMS: Bacterial canker of kiwifruit caused by Pseudomonas syringae pv. actinidiae (Psa) is currently the major threat to its commercial production worldwide. In 2011, the most virulent type (Psa3) was detected for the first time in Northwest-Spain, in the province of Pontevedra. In 2013 surveys, leaves and flower buds with mild symptoms were observed in Actinidia deliciosa 'Hayward' vines in an orchard at the province of A Coruña, suggesting the presence of P. syringae pv. actinidifoliorum (Psaf). METHODS AND RESULTS: Isolates obtained from such orchard were characterized by morphological, biochemical and physiological tests, fatty acids (FA) profile and molecular tests (PCR, BOX-PCR, duplex PCR, multiplex PCR, real-time PCR, PCR-C, phytotoxins, housekeeping and effector genes). Pathogenicity tests were also carried out on plants and fruits of A. deliciosa 'Hayward' and on different cultivated plants and fruits. Results demonstrated the presence of P. syringae pv. actinidifoliorum in Spain. CONCLUSIONS: The work provides new information on the pathovar P. syringae pv. actinidifoliorum, which has only been found previously in New Zealand, Australia and France. SIGNIFICANCE AND IMPACT OF STUDY: The results are relevant for taxonomy of isolates of P. syringae from kiwifruit, especially those of low virulence not belonging to pathovar actinidiae.

[Rupture of left main bronchus due to a left double-lumen tube in patient with a history of radiotherapy]. / Rotura de bronquio principal izquierdo por tubo de doble luz en paciente con antecedentes de radioterapia.

Airway injury caused by double-lumen tubes is a rare but potentially serious complication. We describe the case of a patient who had a bronchial rupture during one-lung ventilation with left double-lumen tube, complicated with a secondary cardiac arrest. She had a full recovery without sequelae. Underlying causes of the patient were a history of radiotherapy, and a possible overinflation of bronchial cuff, that it could contribute to the development of this complication. The possible airway injury should be considered by all practitioners who employ double-lumen tubes for the care of their patients.

Anestesia inhalatoria en cirugía ambulatoria / Inhaled anesthesia for ambulatory surgery

La técnica anestésica elegida durante la cirugía mayor ambulatoria tendrá su influencia en el periodo postoperatorio. Las diferencias fundamentales entre la técnica endovenosa y la inhalatoria se basan en una menor incidencia de náuseas y vómitos en el postoperatorio (NVPO) y un mínimo ahorro del tiempo de estancia hospitalaria a favor de la anestesia total endovenosa. El análisis de los costes asociados a cada técnica es difícil de determinar. En relación a las diferencias entre los dos anestésicos inhalatorios de empleo común, el sevoflurano y desflurano, destaca un menor tiempo de despertar con el uso de desflurano (entre 1,2 y 4,2 minutos), sin aumentarse esas diferencias en los casos de cirugías de duración mayor a 2 horas o pacientes obesos. Se describen mínimas diferencias entre ambos fármacos en relación al tiempo de recuperación de las actividades diarias de los pacientes. Existe una mayor irritabilidad de la vía aérea asociada al uso de desflurano que se minimiza añadiendo opioides endovenosos. La incidencia de NVPO es similar entre ambos agentes, así como la intensidad del dolor postoperatorio. De especial relevancia son las consideraciones económicas, ya que con los actuales precios en nuestro país, ante un mismo flujo de gas fresco el gasto en desflurano sería sustancialmente mayor al de sevoflurano. Tanto el sevoflurano como el desflurano son fármacos útiles para su empleo en cirugía mayor ambulatoria. Ambos presentan características comunes pero también diferencias específicas que podrían condicionar su uso en determinados pacientes (AU)

The anesthetic technique chosen for the ambulatory surgery will influence on the postoperative period. The following article discusses the results of several recently published works in this field. The main differences between intravenous and inhalation techniques are based on a lower incidence of postoperative nausea and vomiting and a minimum saving of hospital stay for total intravenous anesthesia. The analysis of the costs associated with each technique is difficult to determine. Regarding to the differences between the two most common inhalation anesthetic, sevoflurane and desflurane, there is less time for awakening with desflurane (between 1.2 and 4.2 minutes), and these differences don't increase in cases of surgeries longer than 2 hours or in obese patients. Minimal differences between the two drugs in relation to the recovery time for the daily activities of the patients are described. There is an increased airway irritability associated with the use of desflurane but it is minimized by adding intravenous opioids. The incidence of PONV and the intensity of postoperative pain are similar between the two agents. The economical matters are extremely relevant, since with the same fresh gas flow the amount of desflurane spent is considerably bigger than sevoflurane. Sevoflurane and desflurane are useful drugs for ambulatory surgery. Both have common features but also specific differences that could influence their use in certain patients (AU)