Systematic review and literature appraisal on methodology of conducting and reporting critical-care echocardiography studies: a report from the European Society of Intensive Care Medicine PRICES expert panel.

BACKGROUND: The echocardiography working group of the European Society of Intensive Care Medicine recognized the need to provide structured guidance for future CCE research methodology and reporting based on a systematic appraisal of the current literature. Here is reported this systematic appraisal. METHODS: We conducted a systematic review, registered on the Prospero database. A total of 43 items of common interest to all echocardiography studies were initially listed by the experts, and other "topic-specific" items were separated into five main categories of interest (left ventricular systolic function, LVSF n = 15, right ventricular function, RVF n = 18, left ventricular diastolic function, LVDF n = 15, fluid management, FM n = 7, and advanced echocardiography techniques, AET n = 17). We evaluated the percentage of items reported per study and the fraction of studies reporting a single item. RESULTS: From January 2000 till December 2017 a total of 209 articles were included after systematic search and screening, 97 for LVSF, 48 for RVF, 51 for LVDF, 36 for FM and 24 for AET. Shock and ARDS were relatively common among LVSF articles (both around 15%) while ARDS comprised 25% of RVF articles. Transthoracic echocardiography was the main echocardiography mode, in 87% of the articles for AET topic, followed by 81% for FM, 78% for LVDF, 70% for LVSF and 63% for RVF. The percentage of items per study as well as the fraction of study reporting an item was low or very low, except for FM. As an illustration, the left ventricular size was only reported by 56% of studies in the LVSF topic, and half studies assessing RVF reported data on pulmonary artery systolic pressure. CONCLUSION: This analysis confirmed sub-optimal reporting of several items listed by an expert panel. The analysis will help the experts in the development of guidelines for CCE study design and reporting.

Corrigendum to 'Serotonin syndrome in the perioperative period' [BJA Education 20 (2020) 10-17].

[This corrects the article DOI: 10.1016/j.bjae.2019.10.003.].

Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis.

BACKGROUND: Sepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock. METHODS: We conducted a systematic review (PubMed and Embase up to 26 October 2017) and meta-analysis to investigate the association between GLS and mortality at longest follow up in patients with severe sepsis and/or septic shock. In the primary analysis, we included studies reporting transthoracic echocardiography data on GLS according to mortality. A secondary analysis evaluated the association between LVEF and mortality including data from studies reporting GLS. RESULTS: We included eight studies in the primary analysis with a total of 794 patients (survival 68%, n = 540). We found a significant association between worse LV function and GLS values and mortality: standard mean difference (SMD) - 0.26; 95% confidence interval (CI) - 0.47, - 0.04; p = 0.02 (low heterogeneity, I2 = 43%). No significant association was found between LVEF and mortality in the same population of patients (eight studies; SMD, 0.02; 95% CI - 0.14, 0.17; p = 0.83; no heterogeneity, I2 = 3%). CONCLUSIONS: Worse GLS (less negative) values are associated with higher mortality in patients with severe sepsis or septic shock, while such association is not valid for LVEF. More critical care research is warranted to confirm the better ability of STE in demonstrating underlying intrinsic myocardial disease compared to LVEF.

Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis.

BACKGROUND: Myocardial dysfunction may contribute to circulatory failure in sepsis. There is growing evidence of an association between left ventricular diastolic dysfunction (LVDD) and mortality in septic patients. Utilizing echocardiography, we know that tissue Doppler imaging (TDI) variables e' and E/e' are reliable predictors of LVDD and are useful measurements to estimate left ventricular (LV) filling pressures. METHODS: We conducted a systematic review and meta-analysis to investigate the association of e' and E/e' with mortality of patients with severe sepsis or septic shock. In the primary analysis, we included studies providing transthoracic TDI data for e' and E/e' and their association with mortality. Subgroup analyses were conducted according to myocardial regional focus of TDI assessment (septal, lateral or averaged). Three secondary analyses were performed: one included data from a transoesophageal study, another excluded studies reporting data at a very early (<6 h) or late (>48 h) stage following diagnosis, and the third pooled data only from studies excluding patients with heart valve disease. RESULTS: The primary analysis included 16 studies with 1507 patients with severe sepsis and/or septic shock. A significant association was found between mortality and both lower e' [standard mean difference (SMD) 0.33; 95% confidence interval (CI): 0.05, 0.62; P=0.02] and higher E/e' (SMD -0.33; 95% CI: -0.57, -0.10; P=0.006). In the subgroup analyses, only the lateral TDI values showed significant association with mortality (lower e' SMD 0.45; 95% CI: 0.11, 0.78; P=0.009; higher E/e' SMD -0.49; 95% CI: -0.76, -0.22; P=0.0003). The findings of the primary analysis were confirmed by all secondary analyses. CONCLUSIONS: There is a strong association between both lower e' and higher E/e' and mortality in septic patients.

Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis.

BACKGROUND: Guidelines for treatment of out-of-hospital cardiac arrest (OOH-CA) with shockable rhythm recommend amiodarone, while lidocaine may be used if amiodarone is not available. Recent underpowered evidence suggests that amiodarone, lidocaine or placebo are equivalent with respect to survival at hospital discharge, but amiodarone and lidocaine showed higher hospital admission rates. We undertook a systematic review and meta-analysis to assess efficacy of amiodarone vs lidocaine vs placebo. METHODS: We included studies published in PubMed and EMBASE databases from inception until May 15th, 2016. The primary outcomes were survival at hospital admission and discharge in OOH-CA patients enrolled in randomized clinical trials (RCT) according to resuscitation with amiodarone vs lidocaine vs placebo. If feasible, secondary analysis was performed including in the analysis also patients with in-hospital CA and data from non-RCT. RESULTS: A total of seven findings were included in the metanalysis (three RCTs, 4 non-RCTs). Amiodarone was as beneficial as lidocaine for survival at hospital admission (primary analysis odds ratio-OR 0.86-1.23, p=0.40) and discharge (primary analysis OR 0.87-1.30, p=0.56; secondary analysis OR 0.86-1.27, p=0.67). As compared with placebo, survival at hospital admission was higher both for amiodarone (primary analysis OR 1.12-1.54, p<0.0001; secondary analysis OR 1.07-1.45, p<0.005) and lidocaine (secondary analysis only OR 1.14-1.58, p=0.0005). With regards to hospital discharge there were no differences between placebo and amiodarone (primary outcome OR 0.98-1.44, p=0.08; secondary outcome OR 0.92-1.33, p=0.28) or lidocaine (secondary outcome only OR 0.97-1.45, p=0.10). CONCLUSIONS: Amiodarone and lidocaine equally improve survival at hospital admission as compared with placebo. However, neither amiodarone nor lidocaine improve long-term outcome.

The role of point-of-care platelet function testing in predicting postoperative bleeding following cardiac surgery: a systematic review and meta-analysis.

This systematic review and meta-analysis appraises the utility of point-of-care platelet function tests for predicting blood loss and transfusion requirements in cardiac surgical patients, and analyses whether their use within a transfusion management algorithm is associated with improved patient outcomes. We included 30 observational studies incorporating 3044 patients in the qualitative assessment, and nine randomised controlled trials including 1057 patients in the meta-analysis. Platelet function tests demonstrated significant variability in their ability to predict blood loss and transfusion requirements. Their use within a blood transfusion algorithm demonstrated a reduction in blood loss at longest follow-up (mean difference -102.9 ml (95% CI -149.9 to -56.1 ml), p < 0.001), and transfusion of packed red cells (RR 0.86 (95% CI 0.78-0.94), p = 0.001) and fresh frozen plasma (RR 0.42 (95% CI 0.30-0.59), p < 0.001). Viscoelastic methods used in combination with other platelet function tests achieved greater reduction in blood loss (mean difference -111.8 ml (95% CI -174.9 to -49.1 ml), p = 0.0005) compared with their use alone (mean difference -90.6 ml (95% CI 166.1-15.0 ml), p = 0.02). We conclude that incorporation of point-of-care platelet function tests into transfusion management algorithms is associated with a reduction in blood loss and transfusion requirements in cardiac surgery patients.

Tumor filodes maligno: a propósito de un caso y revisión de la literatura / Malignant phyllodes tumor: Apropos of a case and a review of the literature

El tumor filodes de la mama es una neoplasia poco frecuente, representando menos del 1% de todos los tumores de mama. Su diagnóstico definitivo es anatomopatológico, siendo característicamente de estirpe fibroepitelial. Tiene una alta tendencia a la recidiva local (20%) y, aunque poco frecuente, se ha descrito su capacidad metastatizante en otros órganos. El tratamiento es quirúrgico con la extirpación amplia y con márgenes libres. Presentamos el caso de una paciente que desarrolló este tumor y que progresó la enfermedad con afectación pulmonar

Phyllodes tumor of the breast is a rare neoplasm, representing less than 1% of all breast tumors. The definitive diagnosis of these fibroepithelial tumors is histologic. Local recurrence occurs in 20% of cases. Although uncommon, these tumors can metastasize to other organs. Treatment is surgical with wide excision and disease-free margins. We present the case of a patient with phyllodes tumor who developed lung involvement

La enfermedad de Paget de la mama en nuestra área: revisión 1998-2012 / Paget disease of the breast in our setting: review 1998-2012

La enfermedad de Paget de la mama es una entidad poco frecuente y de buen pronóstico. El tratamiento clásico ha sido la mastectomía, pero es posible una cirugía conservadora de la mama, y hoy en día debe valorarse como primera opción siempre y cuando se aseguren márgenes libres con un resultado estético aceptable. Las pruebas de imagen son fundamentales para descartar un carcinoma subyacente y de cara a la planificación de una cirugía conservadora, así como para el futuro seguimiento de estas pacientes

Paget disease of the breast is a relatively rare entity with a favourable prognosis. Form any years, the gold standard treatment has been mastectomy. However, breast-conserving surgery is now feasible and should be evaluated as the first-line option whenever negative margins with acceptable cosmetic results can be achieved. Imaging techniques are essential to exclude an underlying carcinoma and play an important role in selecting candidates for breast-conserving treatment and in follow-up

Cardiac complications associated with goal-directed therapy in high-risk surgical patients: a meta-analysis.

Patients with limited cardiopulmonary reserve are at risk of mortality and morbidity after major surgery. Augmentation of oxygen delivery index (DO2I) with i.v. fluids and inotropes (goal-directed therapy, GDT) has been shown to reduce postoperative mortality and morbidity in high-risk patients. Concerns regarding cardiac complications associated with fluid challenges and inotropes may prevent clinicians from performing GDT in patients who need it most. We hypothesized that GDT is not associated with an increased risk of cardiac complications in high-risk, non-cardiac surgical patients. We performed a systematic search of Medline, Embase, and CENTRAL databases for randomized controlled trials (RCTs) of GDT in high-risk surgical patients. Studies including cardiac surgery, trauma, and paediatric surgery were excluded. We reviewed the rates of all cardiac complications, arrhythmias, myocardial ischaemia, and acute pulmonary oedema. Meta-analyses were performed using RevMan software. Data are presented as odds ratios (ORs), [95% confidence intervals (CIs)], and P-values. Twenty-two RCTs including 2129 patients reported cardiac complications. GDT was associated with a reduction in total cardiovascular (CVS) complications [OR=0.54, (0.38-0.76), P=0.0005] and arrhythmias [OR=0.54, (0.35-0.85), P=0.007]. GDT was not associated with an increase in acute pulmonary oedema [OR=0.69, (0.43-1.10), P=0.12] or myocardial ischaemia [OR=0.70, (0.38-1.28), P=0.25]. Subgroup analysis revealed the benefit is most pronounced in patients receiving fluid and inotrope therapy to achieve a supranormal DO2I, with the use of minimally invasive cardiac output monitors. Treatment of high-risk surgical patients GDT is not associated with an increased risk of cardiac complications; GDT with fluids and inotropes to optimize DO2I during early GDT reduces postoperative CVS complications.

Leiomiomatosis benigna metastatizante: a propósito de un caso / Benign metastasizing leiomyomatosis: apropos of a case

Se presenta el caso de una paciente con neumotórax bilaterales de repetición secundarios a una leiomiomatosis benigna metastatizante. Se intentó el control de su enfermedad con tratamiento médico, siendo necesario proceder a tratamiento radical mediante histerectomía más doble anexectomía ante la escasa respuesta a los procedimientos conservadores (AU)

We report the case of a patient with recurrent bilateral pneumothorax secondary to benign metastasizing leiomyomatosis. Medical treatment was administered but surgery with hysterectomy plus double annexectomy was required due to the lack of response to conservative procedures (AU)

Influence of supplemental dietary sprouted wheat on reproduction in artificially inseminated doe rabbits.

The sprouted wheat contains great amounts of 6-methoxybenzoxazolinone (6-MBOA) a phenol compound that stimulates reproduction in certain small wild herbivorous mammals. The objective of the present study was to evaluate the effect of dietary sprouted wheat as supplement on reproduction in artificially inseminated doe rabbits. Two-month-old New Zealand White doe rabbits (n = 48) were randomly allocated to one of two treatments: (1) pelleted diet plus sprouted wheat for 6 consecutive days prior to service, (2) pelleted diet only (control). First insemination occurred when does reach 3200g body weight and bred 6 days after parturition across 6 months period during summer and autumn. Records from 41 does completing the experiment accounted for 192 inseminations and 142 kindlings equivalent to 4.6 +/- 0.15 and 3.5 +/- 0.15 litters per doe, respectively. Mean daily intake of sprouted wheat on wet and dry matter bases were 196.1 +/- 7.5 and 75.4 +/- 2.9g, respectively. The number of young born produced per doe during the trail was significantly (P = 0.02) greater in does fed sprouted wheat (28.1 +/- 1.2 versus 23.6 +/ -1.3 control). Does fed sprouted wheat had 0.65 +/- 0.06 receptivity rate at AI over 28 per cent greater (P = 0.001) than does in the control treatment. Sexual receptivity was not influenced by physiological status of does and season (P > 0.05). Diet and season had no effect (P>0.05) on kindling rate. However, physiological status had an effect (P = 0.002) on this variable. Kindling rates for nulliparous, lactating and non-lactating does were 0.95 +/- 0.08, 0.63 +/- 0.04 and 0.78 +/ -0.11, respectively. Sexually receptive does had a greater (P = 0.0001) kindling rate (0.95 +/- 0.05) than non-receptive females (0.63 +/-0.05). Does fed sprouted wheat produced larger (P = 0.02) litters than those in the control group: 7.7 +/- 0.30 and 6.8 +/- 0.32, respectively. There was an effect of season (P = 0.04) on the size of the litter at birth. Largest litters were born during autumn (7.9 +/- 0.37) than during summer (6.6 +/- 0.41). Receptive does had more (P = 0.002) young in the litter (7.9 +/- 0.28) than non-receptive (6.6 +/- 0.35). Feeding sprouted wheat as a source of biological 6-MBOA enhanced sexual receptivity and prolificacy in artificially inseminated doe rabbits bred in summer and autumn.

Diffusion of (226)Ra and (40)K radionuclides reproduced in underwater sedimentary columns in laboratory.

The potential radiological impact of the increase of radioactive substances in the environment makes interesting the study of the migration of the contaminant radionuclides in soils and sediments, which are the last receiver system of these substances. By using a battery of sedimentary columns controlled in the laboratory, the diffusion of the (226)Ra and (40)K radionuclides has been studied, assessing their respective effective diffusion coefficients in a similar sedimentary medium. A decreasing temporal evolution is obtained, associated to the progressive 'fixation' of the radionuclides by the clay minerals of the sediment, followed by a constant tendency. A timescale of the 'fixation' by the sediment is determined, being of the order of days for (226)Ra and of the order of months for (40)K, so the progressive 'fixation' of (40)K by the clay minerals of the sediments is slower than in the case of (226)Ra.

Comparison of treatment planning dose calculations with measurements and Monte Carlo calculations in a RANDO phantom.

Solid tumours are often treated with external beams of photons generated by Bremsstrahlung radiation. These beams are shaped and filtered to optimise the dose to specific regions defined by the treatment plans, which may involve irradiations from multiple angles. It is important that doses to healthy tissue do not exceed tolerance doses and that the dose to the tumour is maximised. To accomplish these objectives, commercially available 3-D treatment planning software is used to calculate doses to healthy tissue and to the tumour. It is generally believed that these commercial software packages calculate doses through the patient to within a few per cent. In order to examine this claim, dose calculations obtained from ADAC software for external beam treatment to the pelvic region of a RANDO phantom are compared with 37 thermoluminescence dosemeters placed into several slices of a RANDO phantom. The phantom was irradiated to obtain a prescription dose of 180 cGy at the tumour location. Data from homogeneous regions agree within several per cent with results obtained from ADAC software, whereas this comparison is less favourable in regions of heterogeneity. Results from Monte Carlo calculations in a homogeneous phantom are comparable to results from ADAC treatment planning software.

Ionotropic glutamate receptor activated by N-methyl-D-aspartate: a key molecule of conscious life.

We want to propose that basic stereotyped integrative functions are the result of sequentially built neuronal circuits in the primitive regions of the brain in whose build-up a particular subunit composition iGluR-NMDA would play a central role. iGluR-NMDA is a multiregulated heteromeric glutamate receptor-ion channel found in plasma membranes of neurons and other cells. iGluR-NMDA may be composed of up to five subunits, depending on the type of cell involved and its location. There are three major types of subunits and there are variations within each type allowing for up to 13 possible subunits, at least in the rat, which differ from each other in amino acid sequence and thus, in tertiary structure. The actual iGluR-NMDA heteropolymer involved in a given function may thus have a great number of subunit composition possibilities which would be the result of the particular genes expressed in a given type of cell. The iGluR-NMDA is an ion channel that opens in response to glutamate in a highly regulated fashion in which different molecules and ions present in the interstitial fluid determine whether or not the channel opens upon glutamate binding. The original function of iGluR-NMDA may have been that of allowing calcium influx to cells. As the brain receives external stimuli through the senses, new circuits will be formed stepwise in the neocortex in which a particular subunit composition iGluR-NMDA will be involved. Differentiation between external stimuli generated circuits and those governing internal functions will allow distinction between self and non-self, thus generating conscious awareness. The role of the particular subunit composition iGluR-NMDA proposed would be that of providing a means of calcium influx to the synapses to be formed and, if the same stimulus is forthcoming, allowing permanent synapses formation through the membrane incorporation of calcium dependent adhesion molecules such as cadherins and cytoskeleton reorganization promoted by nectins.

Método fisicoquímico para el control de Pediculus humanus capitis / Physicochemical methods for the pediculus humanus capitis control

La pediculosis humana causada por el ectoparásito Pediculus humanus capitis, ha sido exitosamente controlada utilizando como insecticida los alcoholes presentes en las bebidas etílicas (aguardiente). La acción letal de los alcoholes de bebida sobre el parásito es atribuida al efecto neurotóxico, así como a su acción desnaturalizante de biomoléculas celulares. El tratamiento se hace cubriendo el cabello y todas las áreas del cuero cabelludo con una bolsa plástica desechable, fijada con cinta adhesiva, previo remojo con 15-50 ml de alcohol de bebida, de todo el cabello. La atmósfera circundante del parásito queda saturada de vapores etílicos, de agua y CO2, por un período de 30-60 minutos, lo cual es letal para huevos, larvas y adultos del insecto parásito. Se dan normas cautelosas para garantizar la acción insecticida de los alcoholes de bebida en el control de la pediculosis

Neurophysiologic assessment of the anal sphincters.

One hundred twenty consecutive patients with either fecal incontinence (60 patients), chronic constipation (41 patients), or idiopathic intractable pelvic pain (19 patients) were prospectively assessed. Patients underwent concentric needle electromyography (EMG), bilateral pudendal nerve terminal motor latency evaluation, anorectal manometry, and cinedefecography. The most common EMG finding in patients with fecal incontinence was decreased recruitment of motor units with squeezing and polyphasic motor unit potentials; these are consistent with an injury pattern. The most common EMG finding in the constipated patients was paradoxical puborectalis contraction. This latter abnormality was also a frequent finding in patients with rectal pain, as was prolongation of pudendal nerve latency. Paradoxical puborectalis contraction was diagnosed more frequently with EMG than with cinedefecography. Inter-examination correlation was best in the incontinent group between EMG and manometry. Cinedefecography had poor correlation with EMG in all patient groups but was valuable in the detection of additional pathology such as rectoanal intussusception and anterior rectocele. Electromyography including pudendal nerve terminal motor latency assessment is a valuable adjunct in the evaluation of disorders of evacuation. The information it yields is complementary to that offered by more routine physiologic examinations.