Quality of life and persistence of COVID-19 symptoms 90 days after hospital discharge.

OBJECTIVE: We aimed to describe the persistence of symptoms in coronavirus disease 2019 (COVID-19) and quality of life (QoL) among patients 90 days after their discharge from the hospital for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to determine differences in QoL domains concerning the absence or presence of persistent symptoms. METHODS: To measure QoL, we used a validated Spanish version of the 36-item Short Form Health Survey (SF-36). RESULTS: We included 141 patients. Ninety days after discharge, COVID-19 symptoms persisted in 107 patients (75.9%), with fatigue (55.3%) and joint pain (46.8%) being the most frequent. According to the SF-36, the role-physical score was the dimension with the lowest values (median score, 25; interquartile range, 0-75). Patients with joint pain, fatigue, and dyspnea had lower scores than patients without those symptoms, with 10 of the 13 evaluated SF-36 scales showing lower levels. CONCLUSION: Ninety days after hospital discharge from COVID-19 reference centers, most patients had persistent symptoms and had lower SF-36 scores than patients without symptoms. It is important to follow-up patients discharged from the hospital after SARS-CoV-2 infection, ideally through a post-COVID-19 health care clinic and rehabilitation program, to improve QoL in these patients.

Diagnostic Accuracy of the RDW for Predicting Death in COVID-19.

Background and Objectives: An association between high red blood cell distribution width (RDW) and mortality has been found in several diseases, including infection and sepsis. Some studies have aimed at determining the association of elevated RDW with adverse prognosis in COVID-19, but its usefulness has not been well established. The objective of this study was to determine the accuracy of the RDW, measured at hospital admission and discharge, for predicting death in patients with COVID-19. Materials andMethods: An observational, retrospective, longitudinal, and analytical study was conducted in two different COVID-19 reference centers in the state of Guanajuato, Mexico. A total of 323 patients hospitalized by COVID-19 were included. Results: We found higher RDW levels at the time of hospital admission in the non-survivors group compared to levels in survivors (median = 13.6 vs. 13.0, p < 0.001). Final RDW levels were even higher in the deceased group when compared with those of survivors (median = 14.6 [IQR, 12.67−15.6] vs. 12.9 [IQR, 12.2−13.5], p < 0.001). For patients who died, an RDW > 14.5% was more common at the time of death than for patients who survived at the time of discharge (81 vs. 13 patients, p < 0.001; RR = 2.3, 95% CI 1.89−2.81). Conclusions: The RDW is an accessible and economical parameter that, together with other characteristics of the presentation and evolution of patients with COVID-19, can be helpful in determining the prognosis. An RDW that increases during hospitalization could be a more important mortality predictor than the RDW at hospital admission.

Feasibility and limitations of cultured skin fibroblasts for germline genetic testing in hematologic disorders.

To avoid acquired variants found in the blood, cultured skin fibroblasts are a recommended DNA source for germline genetic testing in patients with hematologic disorders, but data are lacking regarding practicality and limitations. We conducted a retrospective cohort study of 350 subjects with hematologic disorders who underwent skin fibroblast culture for germline genetic testing. We analyzed next-generation sequencing data from the targeted capture of 144 inherited cancer and bonemarrow failure genes to identify variants at heterozygous and subclonal variant allele frequencies. Sixteen (5%) biopsies failed to culture. Culture failure was more likely in samples with delays in culture initiation (OR = 4.3; p < 0.01) or a pathogenic variant in a telomere gene (OR = 42.6; p < 0.01). Median culture time was 28 days (IQR 22-29 days). Culture time was longer for subjects with prior allogeneic stem cell transplantation (+10.7%; p = 0.02) and shorter in subjects with a heterozygous pathogenic variant (-11.9%; p < 0.01), larger biopsy size (-10.6%; p < 0.01), or lymphoid malignancy (-8.4%; p < 0.01). Subclonal variants were identified in 10 (4%) and confirmed in five (56%) of eight with alternate samples available. Subclonal and discordant variants illustrate that germline testing from cultured skin fibroblasts requires phenotypic correlation and, in rare cases, follow-up studies for optimal interpretation.

Isolation and identification of microalgal strains with potential as carotenoids producers from a municipal solid waste landfill.

Derived from their great capacity of adaptation, microalgae have several industrial applications, including pigment production for nutraceutical sector. However, the scarcity of studies on the diversity and life histories from several environments, highlight the need for more research on new species and habitats. Based on this, the present study assessed the microalgal diversity in water bodies of a municipal solid waste (MSW) landfill in Asturias (Spain). A total of 14 strains were successfully isolated and scaled up in liquid monocultures. They were identified through a combination of morphologic features with molecular assignation by DNA barcoding via the 18S and ITS1-5.8S-ITS2 genes. The results of the genetic procedures (BLAST assignments and the 18S and ITS1-5.8S-ITS2 genealogies) showed that 10 of the 14 assayed isolates were identified at the species level. The available genetic data were not sufficient for species classifications of the remaining isolates. It is possible that some might be new species not previously studied or described. Indeed, a new species, Coelastrella cogersae, was proposed in this study. Moreover, 3 of the 14 isolates (including the newly proposed species) exhibited caretogenic activity under specific conditions during the culture. These results are a great step forward in both the screening of lesser-known environments and the discovery of new sources of bioactive compounds. The study could be of great value to the nutraceutical industries and markets.

Targeted mutational analysis of inflammatory bowel disease-associated colorectal cancers.

Inflammatory bowel disease-associated colorectal carcinomas (IBD-CRCs) develop in a background of chronic inflammation, and thus, the molecular landscape of these tumors likely differs from that of sporadic colorectal cancer. To add to emerging data on molecular alterations present in these tumors, we analyzed our institution's cohort of IBD-CRCs. CRCs resected from patients with IBD underwent molecular analysis via a 50-gene hot-spot solid tumor panel (OncoScreen ST2.0). In-house sporadic CRCs and The Cancer Genome Atlas project data were used for comparison. Fifty-five IBD-CRCs from 48 patients were successfully analyzed. Mutations in TP53 were most common and were present in 69% of IBD-CRCs; a similar percentage of TP53 mutations was detected in sporadic colorectal carcinomas (70%). APC and KRAS mutations were significantly less common in IBD-CRCs than in sporadic CRCs (15% versus 53%, P < .001 and 20% versus 38%, P = .02, respectively). Additionally, the potentially targetable IDH1 R132 mutation was present in 7% of IBD-CRCs but only 1% of sporadic CRCs and The Cancer Genome Atlas CRCs; alterations in other genes with potential targeted therapies were very rare. In conclusion, IBD-CRCs exhibit molecular differences when compared to sporadic CRCs, suggesting different pathways of carcinogenesis, although certain alterations are common to both types of tumors. IDH1 mutations are present in a subset of IBD-CRCs, which may expand therapeutic options in the future.

Ground-based detection of an extended helium atmosphere in the Saturn-mass exoplanet WASP-69b.

Hot gas giant exoplanets can lose part of their atmosphere due to strong stellar irradiation, and these losses can affect their physical and chemical evolution. Studies of atmospheric escape from exoplanets have mostly relied on space-based observations of the hydrogen Lyman-α line in the far ultraviolet region, which is strongly affected by interstellar absorption. Using ground-based high-resolution spectroscopy, we detected excess absorption in the helium triplet at 1083 nanometers during the transit of the Saturn-mass exoplanet WASP-69b, at a signal-to-noise ratio of 18. We measured line blueshifts of several kilometers per second and posttransit absorption, which we interpret as the escape of part of the atmosphere trailing behind the planet in comet-like form.

System for Informatics in the Molecular Pathology Laboratory: An Open-Source End-to-End Solution for Next-Generation Sequencing Clinical Data Management.

Next-generation sequencing (NGS) diagnostic assays increasingly are becoming the standard of care in oncology practice. As the scale of an NGS laboratory grows, management of these assays requires organizing large amounts of information, including patient data, laboratory processes, genomic data, as well as variant interpretation and reporting. Although several Laboratory Information Systems and/or Laboratory Information Management Systems are commercially available, they may not meet all of the needs of a given laboratory, in addition to being frequently cost-prohibitive. Herein, we present the System for Informatics in the Molecular Pathology Laboratory (SIMPL), a free and open-source Laboratory Information System/Laboratory Information Management System for academic and nonprofit molecular pathology NGS laboratories, developed at the Genomic and Molecular Pathology Division at the University of Chicago Medicine. SIMPL was designed as a modular end-to-end information system to handle all stages of the NGS laboratory workload from test order to reporting. We describe the features of SIMPL, its clinical validation at University of Chicago Medicine, and its installation and testing within a different academic center laboratory (University of Colorado), and we propose a platform for future community co-development and interlaboratory data sharing.

Differential Contributions of Nucleus Accumbens Subregions to Cue-Guided Risk/Reward Decision Making and Implementation of Conditional Rules.

The nucleus accumbens (NAc) is a key node within corticolimbic circuitry for guiding action selection and cost/benefit decision making in situations involving reward uncertainty. Preclinical studies have typically assessed risk/reward decision making using assays where decisions are guided by internally generated representations of choice-outcome contingencies. Yet, real-life decisions are often influenced by external stimuli that inform about likelihoods of obtaining rewards. How different subregions of the NAc mediate decision making in such situations is unclear. Here, we used a novel assay colloquially termed the "Blackjack" task that models these types of situations. Male Long-Evans rats were trained to choose between one lever that always delivered a one-pellet reward and another that delivered four pellets with different probabilities [either 50% (good-odds) or 12.5% (poor-odds)], which were signaled by one of two auditory cues. Under control conditions, rats selected the large/risky option more often on good-odds versus poor-odds trials. Inactivation of the NAc core caused indiscriminate choice patterns. In contrast, NAc shell inactivation increased risky choice, more prominently on poor-odds trials. Additional experiments revealed that both subregions contribute to auditory conditional discrimination. NAc core or shell inactivation reduced Pavlovian approach elicited by an auditory CS+, yet shell inactivation also increased responding during presentation of a CS-. These data highlight distinct contributions for NAc subregions in decision making and reward seeking guided by discriminative stimuli. The core is crucial for implementation of conditional rules, whereas the shell refines reward seeking by mitigating the allure of larger, unlikely rewards and reducing expression of inappropriate or non-rewarded actions.SIGNIFICANCE STATEMENT Using external cues to guide decision making is crucial for adaptive behavior. Deficits in cue-guided behavior have been associated with neuropsychiatric disorders, such as attention deficit hyperactivity disorder and schizophrenia, which in turn has been linked to aberrant processing in the nucleus accumbens. However, many preclinical studies have often assessed risk/reward decision making in the absence of explicit cues. The current study fills that gap by using a novel task that allows for the assessment of cue-guided risk/reward decision making in rodents. Our findings identified distinct yet complementary roles for the medial versus lateral portions of this nucleus that provide a broader understanding of the differential contributions it makes to decision making and reward seeking guided by discriminative stimuli.

TTG2 controls the developmental regulation of seed coat tannins in Arabidopsis by regulating vacuolar transport steps in the proanthocyanidin pathway.

The brown color of Arabidopsis seeds is caused by the deposition of proanthocyanidins (PAs or condensed tannins) in their inner testa layer. A transcription factor complex consisting of TT2, TT8 and TTG1 controls expression of PA biosynthetic genes, just as similar TTG1-dependent complexes have been shown to control flavonoid pigment pathway gene expression in general. However, PA synthesis is controlled by at least one other gene. TTG2 mutants lack the pigmentation found in wild-type seeds, but produce other flavonoid compounds, such as anthocyanins in the shoot, suggesting that TTG2 regulates genes in the PA biosynthetic branch of the flavonoid pathway. We analyzed the expression of PA biosynthetic genes within the developing seeds of ttg2-1 and wild-type plants for potential TTG2 regulatory targets. We found that expression of TT12, encoding a MATE type transporter, is dependent on TTG2 and that TTG2 can bind to the upstream regulatory region of TT12 suggesting that TTG2 directly regulates TT12. Ectopic expression of TT12 in ttg2-1 plants partially restores seed coat pigmentation. Moreover, we show that TTG2 regulation of TT12 is dependent on TTG1 and that TTG1 and TTG2 physically interact. The observation that TTG1 interacts with TTG2, a WRKY type transcription factor, proposes the existence of a novel TTG1-containing complex, and an addendum to the existing paradigm of flavonoid pathway regulation.

Noradrenergic modulation of risk/reward decision making.

RATIONALE: Catecholamine transmission modulates numerous cognitive and reward-related processes that can subserve more complex functions such as cost/benefit decision making. Dopamine has been shown to play an integral role in decisions involving reward uncertainty, yet there is a paucity of research investigating the contributions of noradrenaline (NA) transmission to these functions. OBJECTIVES: The present study was designed to elucidate the contribution of NA to risk/reward decision making in rats, assessed with a probabilistic discounting task. METHODS: We examined the effects of reducing noradrenergic transmission with the α2 agonist clonidine (10-100 µg/kg), and increasing activity at α2A receptor sites with the agonist guanfacine (0.1-1 mg/kg), the α2 antagonist yohimbine (1-3 mg/kg), and the noradrenaline transporter (NET) inhibitor atomoxetine (0.3-3 mg/kg) on probabilistic discounting. Rats chose between a small/certain reward and a larger/risky reward, wherein the probability of obtaining the larger reward either decreased (100-12.5 %) or increased (12.5-100 %) over a session. RESULTS: In well-trained rats, clonidine reduced risky choice by decreasing reward sensitivity, whereas guanfacine did not affect choice behavior. Yohimbine impaired adjustments in decision biases as reward probability changed within a session by altering negative feedback sensitivity. In a subset of rats that displayed prominent discounting of probabilistic rewards, the lowest dose of atomoxetine increased preference for the large/risky reward when this option had greater long-term utility. CONCLUSIONS: These data highlight an important and previously uncharacterized role for noradrenergic transmission in mediating different aspects of risk/reward decision making and mediating reward and negative feedback sensitivity.

Postoperative delirium in head and neck cancer patients: a survey of oncologic oral and maxillofacial surgeon practices.

PURPOSE: Effective delirium risk management for head and neck surgical patients has not been investigated. The present study was undertaken to determine oncologic oral and maxillofacial surgeons' postoperative delirium diagnostic and management practices. MATERIALS AND METHODS: Surgeon familiarity with the standard of care for postoperative delirium diagnosis and management was assessed through an electronic survey. Survey results were compared with published guidelines and the results of similar surveys within the critical care medical community. RESULTS: Participation was 87.5%. Although less than one third of respondents used appropriate diagnostic nomenclature to characterize the clinical manifestations of acute postoperative delirium, 89% did recognize delirium as a complication that increased morbidity. Only 58% were aware of methods to identify patients at risk. No surgeon who personally initiated pharmacologic therapy for delirium reported using a validated delirium-screening instrument. The administration of a benzodiazepine occurred more often than any other drug during the treatment of postoperative delirium. CONCLUSION: The present study highlights distinct variations in the medical management of postoperative delirium, with most surgeons prescribing medications that have been shown to potentiate or exacerbate delirium or have not been proved to have superior therapeutic benefit. Haloperidol remains the first-line drug of choice in the management of patients appropriately diagnosed with postoperative delirium. Prospective investigations for risk stratification and postoperative delirium are needed.

Overriding phasic dopamine signals redirects action selection during risk/reward decision making.

Phasic increases and decreases in dopamine (DA) transmission encode reward prediction errors thought to facilitate reward-related learning, yet how these signals guide action selection in more complex situations requiring evaluation of different reward remains unclear. We manipulated phasic DA signals while rats performed a risk/reward decision-making task, using temporally discrete stimulation of either the lateral habenula (LHb) or rostromedial tegmental nucleus (RMTg) to suppress DA bursts (confirmed with neurophysiological studies) or the ventral tegmental area (VTA) to override phasic dips. When rats chose between small/certain and larger/risky rewards, LHb or RMTg stimulation, time-locked to delivery of one of these rewards, redirected bias toward the alternative option, whereas VTA stimulation after non rewarded choices increased risky choice. LHb stimulation prior to choices shifted bias away from more preferred options. Thus, phasic DA signals provide feedback on whether recent actions were rewarded to update decision policies and direct actions toward more desirable reward.

Surgical correction of craniosynostosis. A review of 100 cases.

PURPOSE: Provide outcome data for open cranial vault reshaping at a single institution by a single craniofacial surgeon treating 100 patients. METHODS AND SUBJECTS: A total of 100 patient records were reviewed. Criteria for selection included patients less than three years of age undergoing primary surgery with open cranial vault reshaping and a minimum follow up time of 2 years. RESULTS: Of the 100 patients (27 female, 73 male) treated 6 were syndromic and 94 nonsyndromic. Average age and weight were 8.9 months and 9.51 kg, respectively. The oldest child was 30 months and the youngest 5 months at the time of surgery. The estimated blood volume lost was 42.7% of total calculated blood volume ranging from 16.6% to 336%. Average surgical time was 216.7 min. Complications included 2 hematomas, 2 wound infections, 1 subgaleal abscess, 6 dural tears, 3 patients requiring reoperation for residual deformity, 4 cases requiring coronal scar revision, 1 sagittal sinus bleed, and 1 intraoperative death. CONCLUSIONS: Our review of 100 open repairs of patients with craniosynostosis demonstrates good long-term results with an overall low complication rate. The outcome data will assist in developing future prospective studies aimed at improving the multidisciplinary care of these patients.

Conocimientos, conservación y avistamiento del manatí amazónico (Trichechus inunguis), según los pobladores de la cuenca del río Ucayali (Loreto, Perú) / Knowledge of the inhabitants from the Ucayali river basin (Peru) about the Amazonian manatee (Trichechus inunguis)

Identificar conocimientos que poseen los pobladores de la cuenca del río Ucayali sobre la biología, conservación y problemática, asi como avistamientos previos del manatí amazónico Trichechus inunguis. Materiales y métodos: Se encuestaron 421 personas de diferentes edades, sexos y ocupaciones, en diferentes localidades de la cuenca del río Ucayali. Resultados: El 88.8% reconoció a la especie, y el 80.1% conocen al manatí con el nombre de vaca marina. El 65.1% declaran haber consumido su carne de manera poco frecuente y oportunista. La principal razón que justifican para capturarlos fue su buen sabor (46.4%). Así mismo, 51.9% de los encuestados afirmó saber que su caza es ilegal y el 24% refirió haberlo avistado en el área de estudio. Asimismo, 96.7% manifestaron interés para que esta especie animal se conserve. Conclusiones: Los conocimientos de los pobladores encuestados son insuficientes sobre la situación poblacional, las amenazas y la legislación actual que rige la caza del manatí. Actualmente, con poca frecuencia, se siguen avistando ejemplares en vida silvestre dentro del área de estudio, pero también se sigue dando su captura. Se recomienda incluir la educación ambiental en estas comunidades como principal herramienta para la conservación del manatí amazónico...

To collect information about the knowledge of the inhabitants from the Ucayali River basin about the amazonian manateeÆs, Trichechus inunguis, biology, conservation and problematic as well as previous sightings. Materials and methods: 421 people were surveyed without bias of age, sex or occupation, in different localities of the Ucayali River basin. Results: 88.8% of the interviewed recognized species, most of them referring to it as ôsea cowõ (80.1%). The principal use attributed to this animal is the consumption of its meat (65.1%). Also 51.9% of the surveyed are aware that hunting is illegal. According to the surveyed, the consumption of this species is rare and opportunistic, being the good taste of its meat (46.4%) the main reason for its capture. There is a great interest from behalf the population in the conservation of this animal (96.7%). As for the sightings, 24.0% were within the study area. Conclusions: There is a lack of knowledge from the surveyed on the current population, threats and the laws regulating the hunting of the amazonian manatee. Currently, with low frequency, sightings are still occurring within the study area, but also their capture. Environmental education is the main tool required for the conservation of the amazonian manatee in these communities...

No surviving evolved companions of the progenitor of SN 1006.

Type Ia supernovae are thought to occur when a white dwarf made of carbon and oxygen accretes sufficient mass to trigger a thermonuclear explosion. The accretion could be slow, from an unevolved (main-sequence) or evolved (subgiant or giant) star (the single-degenerate channel), or rapid, as the primary star breaks up a smaller orbiting white dwarf (the double-degenerate channel). A companion star will survive the explosion only in the single-degenerate channel. Both channels might contribute to the production of type Ia supernovae, but the relative proportions of their contributions remain a fundamental puzzle in astronomy. Previous searches for remnant companions have revealed one possible case for SN 1572 (refs 8, 9), although that has been questioned. More recently, observations have restricted surviving companions to be small, main-sequence stars, ruling out giant companions but still allowing the single-degenerate channel. Here we report the results of a search for surviving companions of the progenitor of SN 1006 (ref. 14). None of the stars within 4 arc minutes of the apparent site of the explosion is associated with the supernova remnant, and we can firmly exclude all giant and subgiant stars from being companions of the progenitor. In combination with previous results, our findings indicate that fewer than 20 per cent of type Ia supernovae occur through the single-degenerate channel.

Oral maxillary squamous carcinoma: an indication for neck dissection in the clinically negative neck.

BACKGROUND: This multicenter study was undertaken to characterize the metastatic behavior of oral maxillary squamous carcinoma and to determine the role of selective neck dissection. METHODS: A retrospective, multicenter study of patients surgically treated for oral maxillary squamous carcinoma was completed. Data collected included primary tumor location, cervical lymph node status, and neck failure rate. RESULTS: The study included 146 patients. The adjusted regional metastatic rate was 31.4%. Of those N0 (clinically negative) necks treated with or without neck dissection, 14.4% developed cervical metastasis. Within the cohort, 7.5% of patients died with distant disease. The regional salvage rate was 52.9%. None of the patients with locoregional failures were salvaged. CONCLUSIONS: Maxillary palatal, alveolar, and gingival squamous carcinomas exhibit aggressive regional metastatic behavior. Surgical salvage rates for neck failure are low; therefore, selective neck dissection (levels I-III) is recommended at the time of resection of T2, T3, and T4 maxillary squamous carcinomas.

Tolerabilidad y eficacia de morfina versus hidromorfona en analgesia epidural posquirúrgica con bupivacaína: ensayo aleatorizado, doble ciego y controlado / Tolerability and efficacy of morphine vs. hydromorphone in postoperative epidural analgesia: double-blind randomized control trial

Introducción. La tolerabilidad a la analgesia epidural puede comprometerse por efectos adversos derivados del opioide usado. Este estudio compara la tolerabilidad y eficacia de hidromorfona o morfina en combinación con bupivacaína, en analgesia epidural postoperatoria. Métodos. Ensayo prospectivo, aleatorizado y doble ciego en el Hospital Universitario San Vicente de Paul; 147 pacientes fueron aleatorizadosen dos grupos: 73 pacientes del grupo MB recibieron 30 mcg/ml de morfina más bupivacaína 0,1 %, y 74 pacientes del grupo HB recibieron hidromorfona 10 mcg/ml más bupivacaína 0,1 %. Resultados. El desenlace principal fue tolerabilidad, definida por la frecuencia de náusea, vómito, sedación, retención urinaria y prurito entre los grupos a las 24 horas. Se analizaron 142 pacientes: 71 en el grupo MB y 71 en el grupo HB. La frecuencia de náusea fue de 36,6 % y 31 %, (p = 0,54); vómito, 19,7 % y 25,4 % (p = 0,42); sedación 15,5 % y 14,1 % (p = 0,81); retención urinaria 11,3 % y 7 % (p = 0,38); y prurito 43,7 % y 31 % (p = 0,11) para los grupos MB y HB, respectivamente. Cinco pacientes fueron retirados del estudio debido a migración o desconexión del catéter. No se hallaron diferencias estadísticamente significativas entre los grupos. La escala verbal numérica (EVN) de dolor dinámico a las 24 horas fue de 3,42 (+/- 2,8) y 2,82 (+/- 2,5) para los grupos MB y HB, respectivamente (p = 0,16). Conclusión. La escogencia entre morfina 30 mcg/ml o hidromorfona 10 mcg/ml no influye en la tolerabilidad o eficacia de esta técnica.

Introduction. The acceptance (tolerability) of epidural analgesia can be compromised by the side effects of opioids. This study compares theside effects and efficacy of hydromorphone or morphine combined with bupivacaine in postoperativeepidural analgesia. Methods. Double-blind prospective randomizedcontrolled trial at Hospital Universitario San Vicente de Paul; 147 patients were randomized in two groups: 73 patients of the MB Group received 30 μg per ml of morphine with bupivacaine 0.1 % and 74 patients of the HB group received10 μg per ml of hydromorphone with bupivacaine 0.1 %. Results. The main outcome was the tolerability defined by the frequency of nausea and vomitingsedation urinary retention and pruritus between the groups at 24 hours. 142 patients were analyzed: 71 in group MB and 71 in group HB. The incidence of nausea was 36.6 % and 31 % (p = 0.54); vomiting 19.7 % and 25.4 % (p = 0.42); sedation 15.5 % and 14.1 % (p = 0.81); urinary retention 11.3 % and 7 % (p = 0.38); and pruritus 43.7 % and 31 % (p = 0.11) for groups MB and HB respectively. Five patients were excluded either because of catheter migration or disconnection. No statistically significant differences werefound between the groups. The verbal numerical scale (VNS) of dynamic pain at 24 hours was 3.42 (+/- 2.8) y 2.82 (+/- 2.5) for groups MB and HBrespectively (p = 0.16) Conclusions. The choice between 30 μg per ml of morphine or 10 mcg per ml of hydromorphone does not influence the incidence of side effects or the efficacy of this technique.

La omisión de la relajación neuromuscular en pacientes ambulatorios que requieren intubación orotraqueal incrementa temporalmente la incidencia de síntomas laríngeos postoperatorios: estudio cuasi-experimental / The avoidance of neuromuscular paralysis in outpatients requiring endotracheal intubation temporarily increases the incidence of postoperative laryngeal symptoms: quasi-experimental study

Introducción. Las técnicas de intubación endotraqueal sin relajación neuromuscular han crecido en popularidad, pero su impacto en unidades quirúrgicas donde existe personal en entrenamiento es desconocido. Objetivo. Evaluar el impacto de omitir la relajación neuromuscular, en términos de incidencia de disfonía y odinofagia, en pacientes sometidos a procedimientos ambulatorios cortos que requieren intubación endotraqueal en una unidad quirúrgica académica universitaria. Método. Estudio cuasi-experimental, no aleatorizado, doble ciego, en pacientes adultos programados para cirugía ambulatoria que requerían intubación endotraqueal. El grupo de no relajación recibió lidocaína (1,5 mg kg-1), propofol (1,5-2 mg kg-1) y remifentanil 4 mcg kg-1, y el grupo de relajación recibió la misma técnica, y se adicionó rocuronio a dosis de 0,3-0,6 mg kg-1. Los desenlaces primarios se evaluaron a los días 1, 3 y 14 postoperatorios. Resultados. Se incluyeron 287 pacientes. El 51,7 % recibió relajante neuromuscular. La incidencia de disfonía fue estadísticamente mayor a las 24 horas en el grupo de no relajante (26 % frente a 15 %; valor p: 0,016); así, no fue significativa a las 72 horas de seguimiento (0,6 % frente a 0 %; valor de p 0,37). No se encontraron diferencias en la incidencia de odinofagia entre los grupos. Los síntomas habían desaparecido en toda la población estudiada a la semana de seguimiento. Conclusiones. Omitir la relajación neuromuscular se asocia con un incremento transitorio de disfonía a las 24 horas del posoperatorio, pero no de odinofagia. No existen diferencias en la incidencia de síntomas laríngeos en 72 horas. La adición de relajante neuromuscular para disminuir la incidencia de disfonía temprana puede estar justificada.

Introduction. Endotracheal intubation without neuromuscular relaxation has become more common, but its impact on surgical units of teaching hospitals is unknown. Objective. To assess the impact of avoiding neuromuscularrelaxation in terms of incidence ofhoarseness and sore throat in ambulatory surgery patients requiring endotracheal intubation in surgical unit of a teaching hospital. Method. A quasi-experimental, non-randomized, double-blind study in adult patients undergoing outpatient surgery requiring endotracheal intubation. The non muscle relaxant group received lidocaine (1.5 mg kg-1), propofol (1.5 - 2 mg kg-1) and remifentanil 4 mcg * kg-1 and the muscle relaxation group received the same technique and rocuronium 0.3 to 0.6 mg * kg-1. The primary outcomes were assessed at days 1, 3 and 14.Results. We enrolled 287 patients, where 51.7 % received rocuronium. The incidence of hoarseness was significantly higher at 24 hours in the nonrelaxant group (26 % vs. 15 %, p value: 0.016) being not significant after 72 hours of follow up (0.6 % vs. 0 %; p: 0.37). We found no differences inthe incidence of sore throat between the groups. All the study patients were asymptomatic at one week. Conclusions. Avoidance of neuromuscular relaxationis associated with a transient (First 24hours) increase in hoarseness after ambulatory surgery, but no difference in sore throat. We found no differences in the incidence of laryngeal symptoms after 72 hours. The addition of musclerelaxant to reduce the incidence of hoarseness can be justified.

Oral maxillary squamous cell carcinoma: management of the clinically negative neck.

PURPOSE: Squamous cell carcinomas of the hard palate, maxillary gingiva, and maxillary alveolus occur at relatively low rates compared with squamous cell carcinomas in other oral sites. There is little within the surgical literature to guide treatment for maxillary squamous cell carcinoma. To date, only 1 other group has addressed neck management in the oral maxillary squamous cell carcinoma patient presenting with a clinically negative neck. Adequate characterization of maxillary gingival carcinoma behavior with respect to regional cervical metastasis is wanting. PATIENTS AND METHODS: We present a retrospective review of our own clinical experience as well as a review of the existing literature. RESULTS: In our University of California San Francisco patient group, cervical disease was detected in 20% of those individuals with maxillary squamous cell carcinoma presenting for initial consultation. After ablative surgery, those individuals who presented with clinically negative necks had a 21.4% rate of regional node metastasis. Ultimately, 50% of our patients with squamous cell carcinomas of the palate, maxillary gingiva, and maxillary alveolus developed regional or metastatic distant disease; 42.9% of the patients manifested disease to the cervical lymph nodes alone. CONCLUSIONS: The cases of oral maxillary squamous cell carcinomas reviewed herein exhibit aggressive regional metastatic behavior comparable to that of such carcinomas of the tongue, floor of the mouth, and mandibular gingiva. Based on the findings presented herein, we recommend selective neck dissection in the setting of a clinically negative neck as a primary management strategy for patients with oral maxillary squamous cell carcinomas involving the palate, maxillary gingiva, and maxillary alveolus.

Diseases, lesions and malformations in the long-beaked common dolphin Delphinus capensis from the Southeast Pacific.

Miscellaneous lesions of the head, skull, teeth, trunk, appendages, skin and genital tract were observed in 120 of 930 long-beaked common dolphins Delphinus capensis taken in fisheries off Peru between 1985 and 2000. Seven subsamples were defined according to the varying field sampling protocols. Forty-two dolphins showed at least 2 types of injuries or diseases affecting 1 or more organs. The majority (5 of 7) of traumas encountered were diagnosed as caused by violent, fisheries-related interactions, and the skin in 20.4 % of specimens (n = 54) showed healed scars from such interactions. Prevalences of malformations and traumas of crania (n = 103) were 2.9 and 1.9%, respectively. Lytic cranial lesions were present in 31.1% of dolphins (n = 103) and accounted for 84.2% of all bone injuries. Skull damage diagnostic for Crassicauda sp. infestation was encountered in 26.5% of dolphins (n = 98) and did not differ among sex and age classes. Crassicauda sp. and tooth infections were responsible for, respectively, 78.8 and 6.1% of the lytic lesions. Adult dolphins showed a high prevalence of worn and broken teeth (35%, n = 20) as well as damaged alveoli (20%, n = 70). Prevalence of 'paired teeth', a congenital condition, was 9.4% (n = 32). Lesions of the head, body and appendages were present in 10 dolphins and included traumas, deformations (e.g. scoliokyphosis and brachygnathia) and chronic mastitis. Ovarian cysts suggestive of follicular cysts were observed in 1 of 24 females. Chronic orchitis affected 1 of 78 males. Of 12 dolphins 2 had vesicular lesions of the penis. Prevalence of cutaneous lesions, abnormalities and scars ranged between 1.8% (n = 56) and 48.2% (n = 27).