Endocarditis caused by Neisseria bacilliformis: a case report and review of literature.

A 58-years-old male with history of previous aortic prosthetic endocarditis caused by Enterococcus faecalis was admitted due to dyspnoea and fever. The two sets of blood cultures were positive for Neisseria bacilliformis. Transoesophageal echocardiography did not demonstrate endocarditis signs, but PET-CT scan showed active infection signs in the valvular aortic tube and possible infection in the aortic prosthetic valve. A six-week course of ampicillin was prescribed; gentamicin was added during the first two weeks. The patient continued a favourable clinical course. This is the 3rd described case of N. bacilliformis endocarditis and the first one in a prosthetic valve.

Occurrence of Diastasis of the Rectus Abdominis Muscles in Patients with Medial Pectus Excavatum.

Since 1994, we have used soft silicone blocks sculpted intraoperatively to correct pectus excavatum in male patients. This technique involves a horizontal access incision in the region of the lower edge of the sternum. During the dissection to expose the sternum, we observed a constant diastasis of the rectus abdominis muscle and changes of the anatomy at its superior insertion. There is no report on this association. METHODS: Male patients with untreated medial pectus excavatum with indication for silicone block correction were enrolled. Age, weight, height, and the presence of other associated conditions were noted. Ultrasound examination was performed. During the surgery, the width of the linea alba was evaluated and the anatomical positioning of the insertion of rectus abdominis muscle was noted. RESULTS: From 2017 to 2019, 10 patients were submitted to surgery. The mean age was 27 years. All patients presented diastasis at the preoperative physical examination. Imaging examination reports showed diastasis of the rectus abdominis muscle: seven partial epigastric separations and three total separations, two of which were associated with umbilical hernia. The intraoperative findings showed the line alba with a minimum of 23 mm and a maximum of 45 mm width at 4 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches with a distance ranging from 35 mm to 60 mm. CONCLUSIONS: This study confirms the anatomical alterations of the superior portion of the rectus abdominis muscle. The authors discuss the surgical consequences and suggest that the semiology of rectus abdominis muscle is an important preoperative action in pectus excavatum patients.

[Arthroscopic assisted mini-open arthrotomy for the treatment of the femoroacetabular impingement]. / Arthroskopisch assistierte Mini-open-Arthrotomie zur Korrektur des femoroazetabulären Impingements.

OBJECTIVES: Treatment of pathologies of the central and peripheral compartment of the hip using arthroscopic assisted mini-open arthrotomy via the Smith-Petersen approach. INDICATIONS: Cam- and pincer-type femoroacetabular impingement (FAI), labral tear, loose bodies. (RELATIVE) CONTRAINDICATIONS: Osteoarthritis of the hip with Tönnis classification grade ≥ 2. SURGICAL TECHNIQUE: After mini-open approach to the hip joint via direct anterior muscular gap, the anterior capsule is split with protection of the labrum. Decompression allows the joint to be inspected using an arthroscope. Depending on the intra-articular findings, additional procedures can be performed (e.g., curettage of the cartilage, microfracturing, matrix-induced autologous chondrocyte implantation [MACI]). Cases with pincer-type FAI or labral tear can also be addressed. After partial release, the cam-type FAI can be resected using a surgical burr. POSTOPERATIVE MANAGEMENT: Partial weightbearing for 2-6 weeks with 10-20 kg or half body weight using crutches depending on the intraoperative treatment. RESULTS: Radiological analysis of the pre- and postoperative X­rays (n = 69) prove that this surgical technique is suitable to address pathologies especially FAI syndromes. The α­angle according to Nötzli could be reduced from a mean preoperative value of 72.8° to 49.4° postoperative. In combined cam-type and Pincer-type FAI syndrome (n = 16), the lateral center-edge angle could be reduced from a mean preoperative value of 50.2° to 37.6° postoperatively. The clinical follow-up (n = 29) revealed good midterm outcomes after arthroscopic assisted mini-open arthrotomy (modified Harris Hip Score [mHHS] 84.8 points after 4.9 years [range 4.2-5.7; ±0.43]).

Water requirements of beef production can be reduced by genetic selection.

Growing concerns regarding sustainability in agriculture include the availability of drinking water, which is putting pressure on livestock production, especially the beef sector, for more efficient practices. Thus, genetic parameters were estimated for traits related to water intake and water use efficiency in Senepol cattle. Senepol females (n = 925) and males (n = 191) were evaluated in performance tests carried out from 2014 to 2019. Daily dry matter intake (DMI) and water intake (WI) were recorded by electronic feed and water bunks (Intergado Ltd.). Other traits assessed included average daily gain (ADG); mid-test metabolic BW (BW0.75); residual water intake based on ADG (RWIADG), estimated as the residual of the linear regression equation of WI on ADG and BW0.75; residual water intake based on DMI (RWIDMI), estimated as the residual of the linear regression equation of WI on DMI and BW0.75 (RWIDMI); water conversion ratio (= WI/ADG); gross water efficiency (GWE = ADG/WI); residual feed intake estimated as the residual of the linear regression equation of DMI on ADG and BW0.75 (RFI); feed conversion ratio (= DMI/ADG) and gross feed efficiency. Genetic (co)variances were estimated with bivariate analyses. The heritabilities for WI, RWIADG and RWIDMI were 0.38, 0.36 and 0.33, respectively. Water conversion ratio, RWIADG and RWIDMI showed positive genetic and phenotypic correlations with WI, whereas GWE was negatively correlated with WI, suggesting that traits related to water use efficiency may be useful to identify cattle with reduced WI. Water intake showed positive genetic (r = 0.79) and phenotypic (r = 0.60) correlations with DMI, suggesting the use of WI to estimate DMI in future studies. Both RWIADG and RWIDMI were genetically correlated with RFI (0.67 and 0.57, respectively) and ADG (0.49 and 0.44, respectively), showing that RWI is positively associated with feed efficiency, but has an antagonistic relationship with growth. This antagonism, however, may be managed using selection indexes. Genetic improvement of water use efficiency in Senepol cattle is possible through selection and may reduce the water requirements of beef production systems.

Genetic parameters for performance, feed efficiency, and carcass traits in Senepol heifers.

Improving feed efficiency is a key breeding goal in the beef cattle industry. In this study, we estimated the genetic parameters for feed efficiency and carcass traits in Senepol cattle raised in tropical regions. Various indicators of feed efficiency [gain to feed ratio (G:F), feed conversion ratio (FCR), residual weight gain (RG), residual intake and body weight gain (RIG), and residual feed intake (RFI)] as well as growth [final BW, average daily gain (ADG), and DM intake (DMI)], and carcass [rib-eye area (REA), backfat thickness (BF), intramuscular fat score, and carcass conformation score] traits were included in the study. After data editing, records from 1 393 heifers obtained between 2009 and 2018 were used for the analyses. We fitted an animal model that included contemporary group (animals from the same farm that were evaluated in the same test season) as the fixed effect, and a linear effect of animal age at the beginning of the test as a covariate; in addition to random direct additive genetic and residual effects. The (co)variance components were estimated by Bayesian inference in uni- and bivariate analyses. Our results showed that feed efficiency indicators derived from residual variables such as RG, RIG, and RFI can be improved through genetic selection (h2 = 0.14 ± 0.06, 0.13 ± 0.06, and 0.20 ± 0.08, respectively). Variables calculated as ratios such as G:F and FCR were more influenced by environmental factors (h2 = 0.08 ± 0.05 and 0.09 ± 0.05), and were, therefore, less suitable for use in breeding programs. The traits with the greatest and impact on genetic progress in feed efficiency were ADG, REA, and BF. The traits with the greatest and least impact on growth and carcass traits were RG and RFI, respectively. Selection for feed efficiency will result in distinct overall effects on the growth and carcass traits of Senepol heifers. Direct selection for lower RFI may reduce DMI and increase carcass fatness at the finishing stage, but it might also result in reduced growth and muscle deposition. Residual BW gain is associated with the highest weight gain and zero impact on REA and BF, however, it is linked to higher feed consumption. Thus, the most suitable feed efficiency indicator was RIG, as it promoted the greatest decrease in feed intake concomitant with faster growth, with a similar impact on carcass traits when compared to the other feed efficiency indicators.

Anesthetic Management of Successful Extracorporeal Resuscitation After Six Hours of Cardiac Arrest Due to Severe Accidental Hypothermia.

Accidental hypothermia (AH) in Mediterranean countries often is underestimated. AH should be suspected in patients also in moderate climates throughout all seasons. Compared with other countries, the mortality rate due to AH in Spain is low, and hypothermia rarely is recognized and treated. The case of a patient who experienced cardiac arrest due to severe AH and was resuscitated for more than six hours using extracorporeal life support recently was published. Herein that case is reviewed, with the anesthetic management during cannulation detailed. In addition, the authors highlight how the application of extracorporeal cardiopulmonary resuscitation guidelines is different in AH patients, how in-hospital (HOPE score) triage criteria should be applied, and how the establishment of clear standard operating procedures and education strategies should be promoted.

Osteotomía periacetabular en el tratamiento de displasia de cadera mediante técnica mini-invasiva. Nuestros resultados a medio plazo en 131 casos / Periacetabular osteotomy for hip dysplasia treatment through a mini-invasive technique. Our results at mid-term in 131 cases

ANTECEDENTES Y OBJETIVO: La osteotomía periacetabular (OPA) es una técnica utilizada para el tratamiento de la displasia residual, incluso en caderas inestables con cobertura acetabular limitada. El objetivo de este estudio es analizar los resultados funcionales, radiológicos y las complicaciones en pacientes tratados mediante OPA mini-invasiva. MATERIALES Y MÉTODOS: Estudio retrospectivo que analiza 131 casos intervenidos con OPA en nuestro centro. Se determinó de forma prequirúrgica y al final del seguimiento el grado de degeneración articular con la escala de Tönnis, el ángulo de Wiberg, el índice acetabular, el ángulo de cobertura anterior, el espacio articular, las posibles complicaciones y el resultado funcional mediante la escala Non-Arthritic Hip Score. RESULTADOS: La edad media de 32,3±9,5 (DE) años, 102 (77,9%) fueron mujeres y 29 (22,1%) fueron hombres. El seguimiento fue de 7,7±2,8 (DE) años. Se obtuvo una mejora en los parámetros radiológicos entre el momento prequirúrgico y al final del seguimiento, ángulo de Wiberg de+18,5° (18,3° versus 36,8°, IC 95%: 17,3 a 19,7), ángulo de cobertura anterior de+13,5° (26,2° versus 39,7°, IC 95%: 11,6 a 15,4) y el índice acetabular de -11,1° (19,5° versus 8,4°; IC 95%: -12,1 a -10,1). Además, los resultados funcionales con la escala Non-Arthritic Hip Score mejoraron en+31,3 puntos (60,7 prequirúrgico versus 92 último seguimiento posquirúrgico; IC 95%: 28,7 a 33,8). La complicación más frecuente fue la disestesia transitoria del nervio fémoro-cutáneo lateral en 10 casos (7%). CONCLUSIÓN: La osteotomía periacetabular mediante el abordaje mini-invasivo es una técnica reproducible, permite restaurar la cobertura acetabular y proporciona una mejora en las escalas funcionales según confirma nuestra serie

BACKGROUND AND OBJECTIVE: Periacetabular osteotomy (PAO) is an accepted and worldwide technique recognized for residual dysplasia treatment and even in unstable hips with limited acetabular coverage. The aim of this study is to analyse the functional, radiological and complication results in patients treated with mini-invasive PAO. MATERIAL AND METHODS: We performed a retrospective study in which we analysed 131 cases undergoing mini-invasive PAO at our centre. The degree of joint degeneration was evaluated with Tönnis scale, Wiberg angle, acetabular index (AI), anterior coverage angle (AC), joint space, complications and functional outcome with the Non-Arthritic Hip Score (NAHS) were analysed preoperatively and at the end of follow-up. RESULTS: The average age was 32.3±9.5 (SD) years, 102 (77.9%) were female and 29 (22.1%) were male. 7.7±2.8 (SD) years follow up. The radiological parameters improved between the pre-surgical phase and the end of follow-up, Wiberg angle+18.5° (18.3° versus 36.8°, 95% CI 17.3 to 19.7), AC angle+13.5° (26.2° versus 39.7°, 95%CI 11.6 to 15.4) and the AI -11.1° (19.5° versus 8.4°; 95%CI -12.1 to -10,1). In addition, the functional results, with the NAHS scale, improved+31.3 points (60.7 pre-surgical versus 92 at the end of follow-up, 95% CI 28.7 to 33.8). The most common complication was transient lateral femoral cutaneous nerve hypoaesthesia in 10 cases (7%). CONCLUSION: The mini-invasive PAO approach is a reproducible technique, it allows restoration of acetabular coverage and provides an improvement in functional scales as confirmed by our series

Periacetabular osteotomy for hip dysplasia treatment through a mini-invasive technique. Our results at mid-term in 131 cases. / Osteotomía periacetabular en el tratamiento de displasia de cadera mediante técnica mini-invasiva. Nuestros resultados a medio plazo en 131 casos.

BACKGROUND AND OBJECTIVE: Periacetabular osteotomy (PAO) is an accepted and worldwide technique recognized for residual dysplasia treatment and even in unstable hips with limited acetabular coverage. The aim of this study is to analyse the functional, radiological and complication results in patients treated with mini-invasive PAO. MATERIAL AND METHODS: We performed a retrospective study in which we analysed 131 cases undergoing mini-invasive PAO at our centre. The degree of joint degeneration was evaluated with Tönnis scale, Wiberg angle, acetabular index (AI), anterior coverage angle (AC), joint space, complications and functional outcome with the Non-Arthritic Hip Score (NAHS) were analysed preoperatively and at the end of follow-up. RESULTS: The average age was 32.3±9.5 (SD) years, 102 (77.9%) were female and 29 (22.1%) were male. 7.7±2.8 (SD) years follow up. The radiological parameters improved between the pre-surgical phase and the end of follow-up, Wiberg angle+18.5° (18.3° versus 36.8°, 95% CI 17.3 to 19.7), AC angle+13.5° (26.2° versus 39.7°, 95%CI 11.6 to 15.4) and the AI -11.1° (19.5° versus 8.4°; 95%CI -12.1 to -10,1). In addition, the functional results, with the NAHS scale, improved+31.3 points (60.7 pre-surgical versus 92 at the end of follow-up, 95% CI 28.7 to 33.8). The most common complication was transient lateral femoral cutaneous nerve hypoaesthesia in 10 cases (7%). CONCLUSION: The mini-invasive PAO approach is a reproducible technique, it allows restoration of acetabular coverage and provides an improvement in functional scales as confirmed by our series.

Primeras experiencias con el dispositivo osteointegrado Ponto(TM) SuperPower / First experiences with the Ponto(TM) SuperPower osseointegrated device

Los dispositivos auditivos osteointegrados (DAO) Power y SuperPower presentan indicaciones para umbrales en vía ósea de 55 y 65dB, respectivamente. Realizamos un estudio observacional prospectivo de una serie de 6 casos con hipoacusia mixta en los que se realizó implantación del DAO Ponto(TM) SuperPower. Se realizaron previo a la implantación y 6 meses tras la adaptación valoraciones tonales y verbales sin y con ruido de fondo (HINTS). Todos los participantes mostraron mejoría en los resultados tonales y verbales, variando según el grado de hipoacusia contralateral. Cabe destacar los resultados verbales con ruido de fondo donde la mayoría de los pacientes obtuvieron una relación señal ruido entre 2 y 4 dB. Los resultados en los cuestionarios APHAB y GBI mostraron una reducción de la percepción del problema y una mejoría en la calidad de vida, respectivamente. Los resultados presentados reflejan la posibilidad de tratamiento de hipoacusias mixtas con el dispositivo DAO Ponto(TM) SuperPower

Osseointegrated hearing devices Power and SuperPower present indications for bone thresholds of 55 and 65 dB respectively. We conducted a prospective observational study of a series of six cases with mixed hearing loss for whom implantation of the DAO Ponto(TM) Super-Power was performed. Tonal and verbal evaluations without and with background noise (HINTS) were performed prior to implantation and six months after adaptation. All the participants showed improvement in tonal and verbal results, varying according to the degree of contralateral hearing loss. The verbal results with background noise were noteworthy, where most of the patients obtained a signal-to-noise ratio between 2 and 4 dB. The results in the APHAB and GBI questionnaires showed a reduction in the perception of the problem and an improvement in quality of life respectively. The results presented reflect the possibility of treatment of mixed hearing loss with the Ponto(TM) SuperPower device

[Arthroscopic-assisted mini-open technique for the treatment of femoroacetabular impingement : Video article]. / Arthroskopisch assistierte Mini-open-Arthrotomie zur Behandlung des femoroazetabulären Impingements : Videobeitrag.

INTRODUCTION: Femoroacetabular impingement of the hip is considered a prearthrotic deformity, which should be treated at an early state to prevent complications. MATERIAL: This video demonstrates the arthroscopic-assisted mini-open technique for the treatment of femoroacetabular impingement of the hip. In the case presented a combined Pincer and Cam-deformity is treated with rim trimming, translabral labral refixation with two suture anchors and reconstruction of the head-neck junction. CONCLUSION: The arthroscopic-assisted mini-open technique is a safe and reproducible procedure for treatment of femoroacetabular impingement. It provides an alternative to hip arthroscopy and an additional treatment option in the portfolio of hip surgeons.

First experiences with the Ponto™ SuperPower osseointegrated device. / Primeras experiencias con el dispositivo osteointegrado Ponto™ SuperPower.

Osseointegrated hearing devices Power and SuperPower present indications for bone thresholds of 55 and 65 dB respectively. We conducted a prospective observational study of a series of six cases with mixed hearing loss for whom implantation of the DAO Ponto™ Super-Power was performed. Tonal and verbal evaluations without and with background noise (HINTS) were performed prior to implantation and six months after adaptation. All the participants showed improvement in tonal and verbal results, varying according to the degree of contralateral hearing loss. The verbal results with background noise were noteworthy, where most of the patients obtained a signal-to-noise ratio between 2 and 4 dB. The results in the APHAB and GBI questionnaires showed a reduction in the perception of the problem and an improvement in quality of life respectively. The results presented reflect the possibility of treatment of mixed hearing loss with the Ponto™ SuperPower device.

Short communication: Tick-borne disease is associated with changes in feeding behavior in automatically fed weaned dairy calves.

Tick-borne disease is a hemolytic disease complex that causes extensive losses to the dairy industry in tropical regions. Its timely diagnosis is challenging and labor intensive. Our objective was to investigate whether tick-borne disease was associated with changes in ingestive behavior of weaned dairy calves. Weaned calves (n = 35) enrolled at 108 ± 8 d of age were group housed (n = 12, 12, and 11/group) for 4 wk in the experimental pen, which had 12 electronic feed bins and 2 electronic water bins. Data were automatically collected at each feed or water bin visit via radio frequency identification ear tags. Water and total mixed ration were provided ad libitum. Calves were examined weekly for tick-borne disease detection. A disease bout was confirmed if packed cell volume was ≤25% at any exam. Diseased calves received antimicrobial and antipyretic treatment. Data were summarized by day within bin type (feed or water) as intake (kg/d; as-fed basis), frequency of visits (visits/d), and total duration of visits (min/d). Day of detection was set as d 0; a 9-d behavioral screening period for evaluation of behavioral changes was set according to d 0 (d -4 to +4). A within-calf mean was calculated for the healthy period (HP; mean of all days between 2 consecutive negative exams) for each response variable. Data were analyzed as within-calf differences between HP and each day of the behavioral screening period. Tick-borne disease was detected in 12 calves; thus, only data referent to these animals were included in the analyses. Compared with HP, daily feed intake was reduced on d -1, 0, and +1, and daily frequency and total duration of feed bin visits were reduced from d -3 to d +4. Daily feed intake was reduced by 35% on d -1 (3.5 ± 0.4 vs. 5.4 ± 0.5 kg/d for HP), and daily frequency and duration of visits were reduced by 27% (56.3 ± 7.8 vs. 76.7 ± 8.1 visits/d for HP) and 24% (27.0 ± 3.8 vs. 35.4 ± 3.9 min/d for HP) on d -3, respectively. Daily water intake on d 0 (9.1 ± 1.4 kg/d) was lower than at HP (12.9 ± 1.6 kg/d), but other drinking behaviors were not different from healthy means during the screening period. Feeding behavior, but not drinking behavior, was different from HP means before detection at weekly exams. Therefore, feeding behavior could be further explored for the development of algorithms for tick-borne disease detection.

Warming and Inhibition of Salinization at the Ocean's Surface by Cyanobacteria.

This paper describes high-resolution in situ observations of temperature and, for the first time, of salinity in the uppermost skin layer of the ocean, including the influence of large surface blooms of cyanobacteria on those skin properties. In the presence of the blooms, large anomalies of skin temperature and salinity of 0.95°C and -0.49 practical salinity unit were found, but a substantially cooler (-0.22°C) and saltier skin layer (0.19 practical salinity unit) was found in the absence of surface blooms. The results suggest that biologically controlled warming and inhibition of salinization of the ocean's surface occur. Less saline skin layers form during precipitation, but our observations also show that surface blooms of Trichodesmium sp. inhibit evaporation decreasing the salinity at the ocean's surface. This study has important implications in the assessment of precipitation over the ocean using remotely sensed salinity, but also for a better understanding of heat exchange and the hydrologic cycle on a regional scale.

Validation of a system for monitoring individual feeding and drinking behaviour and intake in young cattle.

The objective of this study was to validate an electronic system for monitoring individual feeding and drinking behaviour and intake developed for young cattle housed in group. A total of 35 Holstein-Gyr crossbred heifers (BW: 180±52 kg; age: 121.5±32.5 days), fitted with an ear tag containing a unique passive transponder, were distributed in three groups of 12, 12 and 11 animals per period and had free access to 12 electronic feed bins and two electronic water bins (Intergado® Ltd). The dimensions of feed and water bins, as well as the sensors position were appropriate for young cattle. The system documented the visit frequency and duration, as well as the feed and water intakes, by recording the animal's identification tag, bin number, initial and final times of visits and the difference of feed/water weight at the start and end of each bin visit. Feed bins were monitored using time-lapse video recording over 4 days and the water bins were monitored over 6 days. For each feed bin, two feeding events were monitored using manual weighings with an external scale immediately before and after the animal's visit and the difference between them was assumed as feed intake (n=24 observations). For the water bins, 60 manual weighings were made. Video and manual weighing data were regressed on the electronic feeding and drinking behaviour and intake data to evaluate the system's precision and accuracy. The system showed high specificity (98.98% and 98.56% for the feed and water bins, respectively) and sensitivity (99.25% and 98.74%, respectively) for identifying an animal's presence or absence. Duration of feed and water bin visits as well as feed and water consumption per visit estimated by the system were highly correlated and precise compared with the observed video and manual weighing data (r 2=0.917, 0.963, 0.973 and 0.986, respectively). It was concluded that Intergado® system is a useful tool for monitoring feeding and drinking behaviour as well as water and feed intakes in young cattle housed in groups.

Life-threatening complications and mortality of minimally invasive pectus surgery.

The prevalence and type of life-threatening complications related to the minimally invasive repair of pectus excavatum (MIRPE) and bar removal are unknown and underreported. The purpose of this communication is to make surgeons aware of the risk of these life threatening complications as well as the modifications which have been developed to prevent them. METHODS: Data related to life-threatening complications of Pectus Excavatum (PE) patients was obtained from four sources: 1. A survey of Chest Wall International Group (CWIG) surgeons who specialize in repairing congenital chest wall malformations, 2. Papers and case reports presented at CWIG meetings, 3. Review of medico-legal cases from the USA and 4. A systematic review of the literature related to major complications post MIRPE. RESULTS: From 1998 to 2016, we identified 27 published cases and 32 unreported life-threatening complications including: cardiac perforation, hemothorax, major vessel injury, lung injury, liver injury, gastrointestinal problems, and diaphragm injury. There were seven cases of major complications with bar removal (reported and non-reported) with two lethal outcomes. Mortality data with bar placement surgery: Four published death cases and seven unpublished death cases. The overall incidence of minor & major complications post MIRPE has been reported in the literature to be 2-20%. The true incidence of life-threatening complications and mortality is not known as we do not know the overall number of procedures performed worldwide. However, based on data extrapolated from survey information, the pectus bar manufacturer in the USA, literature reports, and data presented at CWIG meetings as to the number of cases performed we estimated that approximately fifty thousand cases have been performed and that the incidence of life-threatening complications is less than 0.1% with many occurring during the learning curve. Analysis of the cases identified in our survey revealed that previous chest surgery, pectus severity and inexperience were noted to be significant risk factors for mortality. CONCLUSIONS: Published reports support the safety and efficacy of MIRPE; however major adverse outcomes are underreported. Although major complications with MIRPE and pectus bar removal surgery are very rare, awareness of the risk and mortality of life-threatening complications is essential to ensure optimal safety. Factors such as operative technique, patient age, pectus severity and asymmetry, previous chest surgery, and the surgeon's experience play a role in the overall incidence of such events. These preventable events can be avoided with proper training, mentoring, and the use of sternal elevation techniques. TYPE OF STUDY: Treatment Study. LEVEL OF EVIDENCE: Level IV.

Influenza A Virus Surveillance in the Invasive American Mink (Neovison vison) from Freshwater Ecosystems, Northern Spain.

Influenza A viruses (IAVs) are negative-sense, single-stranded and segmented RNA viruses of the Orthomyxoviridae family that may cause acute respiratory disease in a wide range of birds and mammals. Susceptibility of several species within the family Mustelidae to IAVs has been reported as a result of natural or experimental infections. The objectives of this study were to assess whether free-ranging American mink populations from Northern Spain were infected with IAV and try to define the role of this species in the epidemiology of IAV. Sera from 689 American mink from Northern Spain captured between 2011 and 2014 were tested for the presence of antibodies against IAVs using a commercial competition cELISA. Positive sera were further analysed with haemagglutination inhibition (HI) assay. Fifteen of the 689 (2.2%, 1.3-3.6 CI95% ) of the American minks analysed were ELISA positive. No significant differences were observed between years of capture, provinces, river basins, sexes or ages of the animals. All seropositive sera resulted negative to the panel strains used in the HI assay, showing that the most relevant strains circulating in swine, the most relevant avian subtypes (H5 and H7) and the H10N4 subtype isolated in minks have not been circulating in this free-ranging exotic carnivore from Spain. In the light of these results, the free-range American mink from Northern Spain do not seem to have an important role in the epidemiology of IAVs.

Genotypic tropism testing of proviral DNA to guide maraviroc initiation in aviraemic subjects: 48-week analysis of results from the PROTEST study.

OBJECTIVES: Maraviroc (MVC) is a suitable drug for aviraemic subjects on antiretroviral treatment (ART) developing toxicity. Its prescription requires prior tropism testing. It is unknown if proviral DNA genotypic tropism testing is reliable for guiding MVC initiation in aviraemic subjects, so this study was carried out to address this issue. METHODS: PROTEST was a phase 4, prospective, single-arm clinical trial carried out in 24 HIV care centres in Spain. MVC-naïve HIV-1-infected patients with HIV-1 RNA < 50 copies/mL on stable ART during the previous 6 months who required an ART change because of toxicity and who had R5 HIV, as determined by proviral DNA genotypic tropism testing, initiated MVC with two nucleoside reverse transcriptase inhibitors (NRTIs) and were followed for 48 weeks. Virological failure was defined as two consecutive viral load measurements > 50 copies/mL. RESULTS: Tropism results were available for 141 of 175 (80.6%) subjects screened: 60% had R5 and 85% of these (n = 74) were finally included in the study. Previous ART included protease inhibitors (PIs) in 62% of subjects, nonnucleoside reverse transcriptase inhibitors (NNRTIs) in 36%, and integrase inhibitors (INIs) in 2%. Main reasons for treatment change were dyslipidaemia (42%), gastrointestinal symptoms (22%) and liver toxicity (15%). MVC was given alongside tenofovir (TDF)/emtricitabine (FTC) (54%) and abacavir (ABC)/lamivudine (3TC) (40%) in most patients. Eighty-four per cent of patients maintained a viral load < 50 copies/mL to week 48, whereas 16% discontinued treatment: two withdrew informed consent, one had an R5 to X4 shift between screening and baseline, one was lost to follow-up, one developed an adverse event (rash), two died from non-study-related causes, and five developed protocol-defined virological failure. CONCLUSIONS: Initiation of MVC plus two NRTIs in aviraemic subjects based on genotypic tropism testing of proviral HIV-1 DNA is associated with low rates of virological failure for up to 1 year.

Motor and morphological profile of tennis players from 11 to 15 years old / Perfil motor y morfológico de jugadores de tenis de 11 a 15 años de edad

Determine the motor and morphological characteristics of amateur tennis players from 11 to 15 years old. Method. 11 male athletes from the Paranaense Tennis Federation were evaluated during the competition period. Anthropometric variables (total body mass, height, circumference and skinfolds) were assessed. Results. The following median values were obtained: 45.8kg of total body mass, 160cm of height, fat percentage of 14%, lean mass of 37kg, and fat mass of 5kg. Conclusion. The study concluded that athletes show a profile of body composition similar to the profile of tennis players of the same age (AU)

Objetivo. Determinar las características morfológicas y motoras de jugadores aficionados de tenis de edades de 11a15 años. Método. Fueron evaluados 11 atletas masculinos, afiliados a la Federación Paranaense de tenis, en periodo de competición. Se midieron las siguientes variables antropométricas: masa corporal total, altura, perímetros y pliegues cutáneos. Resultados. Se obtuvieron los siguientes valores medianas: masa corporal total 45.8kg; estatura 160cm; 14% de masa grasa, 37kg de masa magra y 5kg de masa grasa. Conclusión. Los atletas valorados en el presente estudio tienen un perfil de composición corporal similares al perfil de los jugadores de tenis de la misma edad (AU)

Objetivo. Determinar as características morfológicas e motoras de atletas amadores de ténis com idade de 11 a 15 anos. Método. Foram avaliados 11 atletas do sexo masculino, inscritos na Federação Paranaense de Tênis em um período de competição. Os atletas foram avaliados para as variáveis antropométricas: massa corporal total, altura, circunferência e dobras cutâneas. Resultados. Obtiveram os seguintes valores médios: 45.8kg para massa corporal total, 160 centímetros de altura, percentual de gordura de 14%, em massa magra de 37kg, e de massa de gordura de 5kg. Conclusão. O estudo concluiu que os atletas mostram um perfil de composição corporal semelhante ao perfil dos jogadores de tênis da mesma idade (AU)

Technical note: A facility for respiration measurements in cattle.

A respiration system consisting of 4 climate-controlled chambers and 1 set of flowmeters and analyzers was constructed and validated. Each chamber had volume of 21.10m(3) (3.68×2.56×2.24m) and was made from steel with double-glazed windows on either side enabling visual contact between animals. The chambers are independently climate-controlled and can maintain temperature and relative humidity in a range from 5 to 45°C and 30 to 80%, respectively. A flow generator and mass flowmeter continuously pull air from each chamber and a slight negative pressure inside the chamber is ensured. Air from all chambers and ambient air share a common gas analysis and data acquisition system for monitoring O2, CO2, and CH4 concentrations over the measurement period, with the cycle time set to 20min. Analyzers are regularly calibrated and the chambers have mean recoveries of 99.0 and 98.0% for CO2 and CH4, respectively. The chambers are equipped with infrared cameras and electronic feed and water bins for intake measurements, as well as sensors for monitoring animal position and heart rate. Data acquisition and analysis software is used to calculate the rate of consumption of O2 and production of CO2 and CH4. The dynamic respiration measurements are integrated with feed intake data and other sensors. The daily gas exchanges are estimated by integration to determine methane emission and heat production. We conducted a trial with 12 lactating 3/4 Holstein × 1/4 Gyr crossbred dairy cows (6 multiparous and 6 primiparous) under 2 feeding regimens (ad libitum or restricted) to validate the system. Two 22-h respiration measurements were obtained from each cow. Restricted-fed cows showed lower values for milk yield, methane emission, and heat production compared with ad libitum-fed animals. We found no difference between groups for CH4 produced per kilogram of dry matter intake. Repeatability for CH4 emission and heat production was high (0.97 and 0.92, respectively). The respiration system described herein is a useful tool for measuring the dynamic and accumulated data of heat production, methane emission, and feed intake.