Post-diagnosis serum 25-hydroxyvitamin D concentrations in women treated for breast cancer participating in a lifestyle trial in Italy.

OBJECTIVE: To report cross-sectionally serum levels of 25-hydroxyvitamin D [25(OH)D] in women living in Italy within 12 months from breast cancer (BC) diagnosis. METHODS: Baseline data were obtained from 394 women diagnosed with primary BC, enrolled from 2016 to 2019 in a lifestyle trial conducted in Italy. Subjects' characteristics were compared between two 25(OH)D concentrations (hypovitaminosis D<20 and ≥20 ng/mL) with the Chi-squared test or Fisher's exact test for small-expected counts. Using multiple logistic regression-adjusted models, we estimated odds ratios (ORs) of hypovitaminosis D with 95% confidence intervals (CIs) in the total sample and in the unsupplemented subgroup. RESULTS: Hypovitaminosis D was found in 39% of all subjects, 60% in unsupplemented subjects, and 10% in supplemented subjects. Increasing ORs of hypovitaminosis D were found with increasing body mass index, 25-30, >30, and ≥35 versus <25 kg/m2 (ORs: 2.50, 4.64, and 5.81, respectively, in the total cohort and ORs: 2.68, 5.38, and 7.08 in the unsupplemented); living in the most southern Italian region (OR 2.50, 95%CI 1.22-5.13); and with hypertriglyceridemia (OR 2.46; 95%CI 1.16-5.22), chemotherapy history (OR 1.86, 95%CI 1.03-3.38), and inversely with anti-estrogenic therapy (OR 0.43, 95%CI 0.24-0.75) in the total sample. CONCLUSIONS: Hypovitaminosis D in women recently diagnosed with BC and participating in a lifestyle trial in Italy was widespread and highest with obesity, hypertriglyceridemia, and chemotherapy use. Considering that hypovitaminosis D is a risk factor for lower efficacy of bone density treatments and possibly BC mortality, our results suggest the need to promptly address and treat vitamin D deficiency.

Mitochondrial quinone redox states as a marker of mitochondrial metabolism.

Mitochondrial and thus cellular energetics are highly regulated both thermodynamically and kinetically. Cellular energetics is of prime importance in the regulation of cellular functions since it provides ATP for their accomplishment. However, cellular energetics is not only about ATP production but also about the ability to re-oxidize reduced coenzymes at a proper rate, such that the cellular redox potential remains at a level compatible with enzymatic reactions. However, this parameter is not only difficult to assess due to its dual compartmentation (mitochondrial and cytosolic) but also because it is well known that most NADH in the cells is bound to the enzymes. In this paper, we investigated the potential relevance of mitochondrial quinones redox state as a marker of mitochondrial metabolism and more particularly mitochondrial redox state. We were able to show that Q2 is an appropriate redox mediator to assess the mitochondrial quinone redox states. On isolated mitochondria, the mitochondrial quinone redox states depend on the mitochondrial substrate and the mitochondrial energetic state (phosphorylating or not phosphorylating). Last but not least, we show that the quinones redox state response allows to better understand the Krebs cycle functioning and respiratory substrates oxidation. Taken together, our results suggest that the quinones redox state is an excellent marker of mitochondrial metabolism.

Spatial analysis of the risk for canine visceral leishmaniasis in an urban area in the State of Sergipe.

Visceral Leishmaniasis is included among the neglected tropical diseases, being directly related to conditions of social vulnerability, in urban environments, dogs act as important reservoirs. The aim of the study was to evaluate the distribution of dogs, related risk factors and identify of volatile organic compounds from infected dogs. Peripheral blood samples from 72 dogs were collected for detection using the ELISA test, in addition to hair samples for analysis by GC-MS. Of the evaluated dogs, 13 (18.05%/72) were reactive for canine VL, seven in Aracaju and six in Propriá. Factors related to vegetation, age, place where the dog stays and free access to the street, were associated with a greater chance of the dog becoming infected. Fifty-three compounds were identified from ten canine hair samples, among which 2-butoxyethanol, benzaldehyde, decane, 2-phenylacetaldehyde, nonan-1-ol, 2-phenoxyethanol, nonanoic acid, 8-heptadecene and eicosane were found in seropositive dogs for leishmaniasis. The guardian's posture has been increasingly important, requiring more attention to the dog's health and actions aimed at environmental management in an attempt to reduce cases of canine VL in the state. Even though the identified VOCs have not been associated with leishmanial infection, it is of great use for understanding canine hair substances.

Semi-automated sequence curation for reliable reference datasets in ITS2 vascular plant DNA (meta-)barcoding.

One of the most critical steps for accurate taxonomic identification in DNA (meta)-barcoding is to have an accurate DNA reference sequence dataset for the marker of choice. Therefore, developing such a dataset has been a long-term ambition, especially in the Viridiplantae kingdom. Typically, reference datasets are constructed with sequences downloaded from general public databases, which can carry taxonomic and other relevant errors. Herein, we constructed a curated (i) global dataset, (ii) European crop dataset, and (iii) 27 datasets for the EU countries for the ITS2 barcoding marker of vascular plants. To that end, we first developed a pipeline script that entails (i) an automated curation stage comprising five filters, (ii) manual taxonomic correction for misclassified taxa, and (iii) manual addition of newly sequenced species. The pipeline allows easy updating of the curated datasets. With this approach, 13% of the sequences, corresponding to 7% of species originally imported from GenBank, were discarded. Further, 259 sequences were manually added to the curated global dataset, which now comprises 307,977 sequences of 111,382 plant species.

Measles seroprevalence in adolescents and young adults living with HIV and response to MMR booster in seronegative ones.

OBJECTIVE: The study analyzed people with HIV (PWH) measles seroprevalence and response to MMR booster given to seronegative individuals. DESIGN: A prospective cohort study with four groups: vertically (v-HIV), horizontally infected (h-HIV) individuals, and two control groups. An MMR booster was offered to seronegative individuals. RESULTS: Measles seropositivity and IgG antibodies were significantly lower in v-HIV than in the other groups. All measles seronegative patients responded to booster. CONCLUSION: An MMR booster must be sought during adolescence in vertically PWH.

A2A adenosine receptor-driven cAMP signaling in olfactory bulb astrocytes is unaffected in experimental autoimmune encephalomyelitis.

Introduction: The cyclic nucleotide cyclic adenosine monophosphate (cAMP) is a ubiquitous second messenger, which is known to play an important anti-inflammatory role. Astrocytes in the central nervous system (CNS) can modulate inflammation but little is known about the significance of cAMP in their function. Methods: We investigated cAMP dynamics in mouse olfactory bulb astrocytes in brain slices prepared from healthy and experimental autoimmune encephalomyelitis (EAE) mice. Results: The purinergic receptor ligands adenosine and adenosine triphosphate (ATP) both induced transient increases in cAMP in astrocytes expressing the genetically encoded cAMP sensor Flamindo2. The A2A receptor antagonist ZM241385 inhibited the responses. Similar transient increases in astrocytic cAMP occurred when olfactory receptor neurons were stimulated electrically, resulting in ATP release from the stimulated axons that increased cAMP, again via A2A receptors. Notably, A2A-mediated responses to ATP and adenosine were not different in EAE mice as compared to healthy mice. Discussion: Our results indicate that ATP, synaptically released by afferent axons in the olfactory bulb, is degraded to adenosine that acts on A2A receptors in astrocytes, thereby increasing the cytosolic cAMP concentration. However, this pathway is not altered in the olfactory bulb of EAE mice.

Eosinophilic granulomatosis with polyangiitis: sequential use of mepolizumab following rituximab for inadequate asthma control despite vasculitis remission.

We report the case of a 54-year-old woman with antineutrophilic cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis presenting with mononeuritis multiplex, intestinal hemorrhage, cardiomyopathy, fever, and worsening asthma symptoms. She was initially treated with steroids and cyclophosphamide but eventually required rituximab to control a vasculitis flare. However, her asthmatic symptoms did not improve, despite attaining vasculitis remission. Symptoms abated only after the treatment transition to mepolizumab. After a 1-year interval, there were no further episodes of asthma exacerbation and no requirement for systemic steroid therapy. This report reinforces the use of rituximab for induction and maintenance of remission in patients with eosinophilic granulomatosis with polyangiitis and predominant vasculitic manifestations, whereas mepolizumab demonstrated better control of the persistent eosinophilic manifestations, ensuing sustained remission and improved quality of life.

Modeling chronic oil pollution from ships.

Stochastic simulations of virtual oil spills from ships were performed for the Adriatic Sea over 2017-2020, applying the European Marine Observation and Data Network vessel densities as a proxy for starting locations of operational spillage. The MEDSLIK-II oil spill model was run using high-resolution currents provided by the Copernicus Marine Service and the European Centre for Medium-Range Weather Forecasts winds. Chronic exposure to operational oil spills was reported in terms of hazard indices for five vessel groups: pleasure and passenger ships, cargo and service vessels, the fishing fleet, tankers, and other ships. The northernmost Adriatic expectedly showed the highest hazard values, including the areas of Trieste and Venice, where cargo and service ships were the dominant polluters. The Croatian coastal waters were more chronically polluted than the Italian coastal waters; the predominant contribution was from coastwise pleasure and passenger ships.

Demography and spatial distribution of a threatened species from the Atlantic Forest in southern Brazil: differences between urban and rural remnants.

Logging and agricultural exploitation have led to the degradation of Araucaria Forest remnants and the alteration of its last preserved patches. This forest typology contains many endangered plant species, as is the case of the tree Oreopanax fulvus Marchal. To support conservation of this species and understand how different landscape matrices can influence its populations, we evaluated the demographic structure and spatial distribution of O. fulvus in two Araucaria Forest remnants in Paraná state. We delimited two plots (urban and rural population), each with 1 ha, subdivided them into 100 subplots (10 x 10 m), and recorded diameter at ground level (DGL), height, and coordinates of two post-germinative developmental stage of individuals. In each subplot, we measured slope, luminosity, and canopy height. We used Ripley's K function analysis to describe distribution patterns of the species and the spatial relationship between mature and juvenile trees. We performed correlations between abundance and environmental and structural variables of the O. fulvus populations. Abundance varied between remnants, from 183 individuals/ha (12 mature and 171 juvenile) to 1306 individuals/ha (10 and 1296). The remnants varied in abundance and plant frequency. The species showed an investment in seedling banks. Most juvenile had DGL up to 3.0 cm and height up to 1.0 m and presented aggregated spatial distribution, while adults had random distribution. In the rural population juvenile abundance were correlated with canopy height (positively) and distance to mature trees (negatively). The slope was correlated for both sites, but oppositely, indicating that other factors might have interfered in the regeneration abundance. The urban remnant showed a high abundance of this endangered species, calling attention for potential studies in urban arborization, management and conservation of these remnants.

Frequent Parasitism of Apis mellifera by Trypanosomatids in Geographically Isolated Areas with Restricted Beekeeping Movements.

Trypanosomatids form a group of high prevalence protozoa that parasitise honey bees, with Lotmaria passim as the predominant species worldwide. However, the knowledge about the ecology of trypanosomatids in isolated areas is limited. The Portuguese archipelagos of Madeira and Azores provide an interesting setting to investigate these parasites because of their geographic isolation, and because they harbour honey bee populations devoid of two major enemies: Varroa destructor and Nosema ceranae. Hence, a total of 661 honey bee colonies from Madeira and the Azores were analysed using different molecular techniques, through which we found a high prevalence of trypanosomatids despite the isolation of these islands. L. passim was the predominant species and, in most colonies, was the only one found, even on islands free of V. destructor and/or N. ceranae with severe restrictions on colony movements to prevent the spread of them. However, islands with V. destructor had a significantly higher prevalence of L. passim and, conversely, islands with N. ceranae did not shown any significant correlation with the trypanosomatid. Crithidia bombi was detected in Madeira and on three islands of the Azores, almost always coincident with L. passim. By contrast, Crithidia mellificae was not detected in any sample. A high-throughput sequencing analysis distinguished two main haplotypes of L. passim, which accounted for 98% of the total sequence reads. This work suggests that L. passim and C. bombi are parasites that have been associated with honey bees predating the spread of V. destructor and N. ceranae.

Lack of fitness costs in dsRNA-resistant Leptinotarsa decemlineata ([Coleoptera]: [Chrysomelidae]).

The Colorado potato beetle, Leptinotarsa decemlineata (Say) ([Coleoptera]: [Chrysomelidae]), is the most important defoliator of solanaceous plants worldwide. This insect displays a notorious ability in adapting to biological and synthetic insecticides, although in some cases this adaptation carries relevant fitness costs. Insecticidal gene silencing by RNA interference is a novel mode of action pesticide against L. decemlineata that is activated by ingestion of a double stranded RNA (dsRNA) targeting a vital L. decemlineata gene. We previously reported laboratory selection of a > 11,000-fold resistant strain of L. decemlineata to a dsRNA delivered topically to potato leaves. In this work, we tested the existence of fitness costs in this dsRNA-resistant colony by comparing biological parameters to the parental strain and an additional susceptible reference strain. Biological parameters included length of egg incubation period, number of eggs per clutch, egg viability, larval viability, length of larval and pupal periods, adult emergence, number of eggs laid per day, sex ratio, and adult longevity. Comparisons between the 3 beetle strains detected no fitness costs associated with resistance to dsRNA. This information is important to guide effective insect resistance management plans for dsRNA insecticides against L. decemlineata applied topically to potato leaves.

Variante rara de RNF213 en adolescente con enfermedad de moyamoya / Rare RNF213 variant in adolescent with moyamoya disease

Introducción: La enfermedad de moyamoya es una enfermedad estenooclusiva progresiva de las principales arterias intracraneales. Los individuos afectados corren el riesgo de sufrir un accidente cerebrovascular hemorrágico o isquémico intracraneal, deterioro cognitivo y retrasos en el desarrollo. Se han identificado varios genes de susceptibilidad. La variante p.R4810K en el gen RNF213 se ha identificado en el 95% de los pacientes con enfermedad de moyamoya familiar. Caso clínico: Presentamos el caso de una adolescente de 15 años que se presentó con quejas principales de disgrafía y falta de coordinación en la mano derecha con dos meses de evolución. La resonancia magnética cerebral reveló varias lesiones isquémicas con diferentes ritmos de evolución y la angiorresonancia magnética mostró múltiples estenosis suboclusivas. En el estudio de las secuencias de las regiones codificantes y de las regiones intrónicas flanqueantes (±8 pb) del gen RNF213, se detectó la variante c.12185G>A, p.(Arg4062Gln) en heterocigosidad en el gen RNF213. Este resultado indica que la paciente es heterocigota para la variante c.12185G>A, p.(Arg4062Gln) en el gen RNF213. La variante detectada ya ha sido descrita en la bibliografía como una variante fundadora en la población asiática, asociada a síndrome de moyamoya. Esta variante está descrita en ClinVar como una variante de significado clínico desconocido. Además, no está descrita en las bases de datos poblacionales (dbSNP, ESP y gnomAD). Conclusión: Hasta donde sabemos, la variante p.(Arg4062Gln) se ha notificado en tres pacientes japoneses con enfermedad de moyamoya y en uno europeo. Por lo tanto, nuestro paciente fue el segundo europeo con enfermedad de moyamoya con esta variante identificada.(AU)

Introduction: Moyamoya disease is a progressive steno-occlusive disease of the major intracranial arteries. Affected individuals are at risk for intracranial hemorrhagic or ischemic stroke, cognitive impairment, and developmental delays. Several susceptibility genes have been identified. The p.R4810K variant in the RNF213 gene has been identified in 95% of patients with familial moyamoya disease. Case report: We present the case of a 15-year-old adolescent girl who presented with chief complaints of dysgraphia, lack of coordination in the right hand, with two months of evolution. Cerebral magnetic resonance imaging revealed several ischemic lesions with different rates of evolution and magnetic resonance angiography showed multiple subocclusive stenoses. In the study of the sequences of the coding regions and intronic flanking regions (±8 bp) of the RNF213 gene, the variant c.12185G>A, p.(Arg4062Gln) was detected in heterozygosity in the RNF213 gene. This result indicates that the patient is heterozygous for the c.12185G>A, p.(Arg4062Gln) variant in the RNF213 gene. The detected variant has already been reported in the literature as a founder variant in the Asian population, associated with moyamoya syndrome. This variant is described in ClinVar as a variant of unknown clinical significance? Furthermore, it is not described in population databases (dbSNP, ESP, gnomAD). Conclusion: To our knowledge, the p.(Arg406262Gln) variant has been reported in three Japanese moyamoya disease patients and one European. Therefore, our patient was the second European moyamoya disease patient with this variant identified.(AU)

Comorbilidades neurocognitivas y psicológicas en pacientes con epilepsia de la infancia con puntas centrotemporales. Un estudio de casos y controles / Neurocognitive and psychological comorbidities in patients with self-limited centrotemporal spike epilepsy. A case-control study

Introducción: La epilepsia de la infancia con puntas centrotemporales (EIPCT) es la epilepsia focal autolimitada más frecuente. Este estudio tenía como objetivo evaluar los aspectos cognitivos, conductuales y otros aspectos neuropsicológicos de niños con EIPCT, y compararlos con un grupo de control. Sujetos y métodos: Se realizó un estudio de casos y controles entre enero y mayo de 2022. Se seleccionó para su inclusión en el estudio a pacientes con EIPCT, con edades comprendidas entre 6 y 18 años, en seguimiento en nuestro hospital. Por cada caso, se reclutó, de forma aleatoria, a dos controles de la misma edad. Todos los participantes realizaron la prueba EpiTrack Junior®, y sus padres rellenaron la lista de verificación del comportamiento infantil (CBCL). Resultados: Se incluyó a 18 pacientes (edad media: 8,7 ± 1,7 años). En el momento del diagnóstico de EIPCT, el 83% de los casos presentaba un desarrollo psicomotor adecuado, y el 17%, un trastorno del neurodesarrollo. Las puntuaciones del EpiTrack-Junior® y de la escala total de problemas de la CBCL no se vieron influidas por la lateralidad del foco epiléptico ni por el número de crisis. El 61% de los casos mostró un trastorno leve o significativo en la prueba EpiTrack-Junior® frente al 44% de los controles (p = 0,712), y el 39% de los casos frente al 14% de los controles tuvieron puntuaciones ‘clínicamente significativas’ en la escala total de problemas de la CBCL. Conclusiones: Aunque este estudio no encontró diferencias estadísticamente significativas entre casos y controles, cabe señalar que la mayor parte de los pacientes con EIPCT presentaba un deterioro leve o significativo en las funciones ejecutivas. Un porcentaje considerable de casos se encontraba en el rango patológico en cuanto a problemas emocionales/conductuales. Este estudio destaca la importancia de examinar los problemas cognitivos, conductuales y emocionales de los pacientes con EIPCT.(AU)

Introduction: Self-limited epilepsy with centrotemporal spikes (SeLECTS) is the most frequent self-limited focal epilepsy. This study aimed to assess the cognitive, behavioral, and other neuropsychological aspects of children with SeLECTS, and compare them with a control group. Subjects and methods: A case-control study was carried out between January and May 2022. Patients with SeLECTS, aged between 6 and 18 years, and followed-up at our hospital were selected for inclusion in the study. For each case, two age-matched controls were opportunistically recruited. All the participants performed the EpiTrack Junior® test, and their parents filled out the Child Behavior Checklist (CBCL). Results: Eighteen patients were included (mean age: 8.7 ± 1.7 years). At SeLECTS’ diagnosis, 83% of cases had adequate psychomotor development, and 17% had a neurodevelopmental disorder. The EpiTrack-Junior® and the Total Problems CBCL scores were not influenced by the laterality of the epileptic focus nor by the number of seizures. 61% of cases showed mild or significant impairment in the EpiTrack-Junior® test versus 44% of controls (p = 0.712), and 39% of cases vs. 14% of controls had ‘clinically significant’ scores on the Total Problems CBCL scale (p = 0.087). Conclusions: Although this study did not find statistically significant differences between cases and controls, it should be noted that most patients with SeLECTS had a mild or significant disability in executive functions. A considerable percentage of cases were in the pathological range regarding emotional/behavioral problems. This study highlights the importance of screening the cognitive, behavioral, and emotional problems in all patients with SeLECTS.(AU)

Longitudinal effects of ketamine on cell proliferation and death in the CNS of zebrafish.

Zebrafish is known for its widespread neurogenesis and regenerative capacity, as well as several biological advantages, which turned it into a relevant animal model in several areas of research, namely in toxicological studies. Ketamine is a well-known anesthetic used both in human as well as veterinary medicine, due to its safety, short duration and unique mode of action. However, ketamine administration is associated with neurotoxic effects and neuronal death, which renders its use on pediatric medicine problematic. Thus, the evaluation of ketamine effects administration at early stages of neurogenesis is of pivotal importance. The 1-41-4 somites stage of zebrafish embryo development corresponds to the beginning of segmentation and formation of neural tube. In this species, as well as in other vertebrates, longitudinal studies are scarce, and the evaluation of ketamine long-term effects in adults is poorly understood. This study aimed to assess the effects of ketamine administration at the 1-4 somites stage, both in subanesthetic and anesthetic concentrations, in brain cellular proliferation, pluripotency and death mechanisms in place during early and adult neurogenesis. For that purpose, embryos at the 1-4 somites stage (10.5 h post fertilization - hpf) were distributed into study groups and exposed for 20 min to ketamine concentrations at 0.2/0.8 mg/mL. Animals were grown until defined check points, namely 50 hpf, 144 hpf and 7 months adults. The assessment of the expression and distribution patterns of proliferating cell nuclear antigen (PCNA), of sex-determining region Y-box 2 (Sox 2), apoptosis-inducing factor (AIF) and microtubule-associated protein 1 light chain 3 (LC3) was performed by Western-blot and immunohistochemistry. The results evidenced the main alterations in 144 hpf larvae, namely in autophagy and in cellular proliferation at the highest concentration of ketamine (0.8 mg/mL). Nonetheless, in adults no significant alterations were seen, pointing to a return to a homeostatic stage. This study allowed clarifying some of the aspects pertaining the longitudinal effects of ketamine administration regarding the CNS capacity to proliferate and activate the appropriate cell death and repair mechanisms leading to homeostasis in zebrafish. Moreover, the results indicate that ketamine administration at 1-4 somites stage in the subanesthetic and anesthetic concentrations despite some transitory detrimental effects at 144 hpf, is long-term safe for CNS, which are newly and promising results in this research field.

Resistencia a los anestésicos locales: ¿verdad o mito? / Resistance to local anesthetics: Truth or myth?

Es esencial reportar el fracaso de la técnica anestésica, y debe determinarse por tanto la etiología del problema. Describimos un caso de fracaso de la anestesia locorregional en el que, tras excluir sus causas más comunes, se consideró la resistencia a los anestésicos locales como la hipótesis clínica más probable. Por tal motivo, se realizó una prueba genética, y también se evaluó la eficacia de otros anestésicos locales, lo cual constituyó un enfoque diferente en los casos de fracaso de la anestesia locorregional. La resistencia real a los anestésicos locales es difícil de diagnosticar, por lo que la información acerca de ello en la literatura es escasa. Una de las causas propuestas es que se produce una mutación en los canales del sodio, en los que se unen los anestésicos locales. De no reconocerse, la aplicación de anestesia locorregional en la situación de estos pacientes puede causar experiencias desagradables y riesgos innecesarios, relacionados con los niveles tóxicos de anestésicos locales. Por tal motivo, deberá descartarse siempre la resistencia a los anestésicos locales en casos de fuerte sospecha clínica, pudiendo aplicarse este enfoque en casos similares.(AU)

The report of anesthetic technique failure is crucial and the etiology of the problem should be determined. We describe a case of locoregional anesthesia failure, in which, after excluding its most common causes, the resistance to local anesthetics was considered as the most probable clinical hypothesis. For this reason, a genetic test was performed, as well as the efficacy of other local anesthetics was evaluated, constituting a different approach in the cases of locoregional anesthesia failure. True resistance to local anesthetics is difficult to diagnose so information about this is scarce in the literature. One of the proposed causes is a mutation of sodium channels where local anesthetics bind. If not recognized, the application of locorregional anesthesia in this patient's condition can lead to unpleasant experiences and unnecessary risks, related to toxic levels of local anesthetics. For this reason, the resistance to local anesthetics should be always precluded in cases of strong clinical suspicion. This approach could be applied in similar cases.(AU)

Manejo anestésico de las pacientes embarazadas tetrapléjicas durante el parto: una revisión sistemática / Anaesthetic management of tetraplegic pregnant patients during child delivery: A systematic review

Introducción: El embarazo en pacientes con lesión de la médula espinal tiene unas características específicas. Sin embargo, las guías para orientar su manejo son escasas. Métodos: Se realizó una revisión sistemática de la literatura sobre el manejo anestésico durante el parto de pacientes embarazadas con lesión de la médula espinal cervical. Resultados: Se observó una mayor incidencia de parto prematuro y cesárea. El manejo anestésico fue diverso, aunque la mayoría de las pacientes embarazadas recibieron analgesia epidural. Los síntomas de disreflexia autónoma se observaron en el 51% de las mujeres. Conclusión: El manejo adecuado de estas pacientes podría reducir posiblemente la tasa de cesáreas y partos prematuros, y minimizar las complicaciones comunes, reduciendo al mismo tiempo los costes. Se recomienda una derivación precoz a la consulta de anestesiología y un enfoque multidisciplinario.(AU)

Introduction: Pregnancy in spinal cord injured patients has specific issues that must be carefully addressed. However, guidelines for their management are scarce. Methods: A systematic review of the literature regarding the anaesthetic management during delivery of pregnant patients with cervical spinal cord injury was performed on the electronic databases of PubMed (Medline) and Cochrane. Results: A higher incidence of preterm birth and caesarean delivery were seen. Anaesthetic management was diverse, although most pregnant patients received epidural analgesia. Autonomic dysreflexia symptoms were present in 51% of pregnancies. Conclusion: Timely management of these patients could possibly reduce caesarean and preterm delivery rates, avoid or minimize common complications, as well as reduce costs. An early reference to anaesthesiology consultation and a multidisciplinary approach is recommended.(AU)

Resistance to local anesthetics: Truth or myth?

The report of anesthetic technique failure is crucial and the etiology of the problem should be determined. We describe a case of locoregional anesthesia failure, in which, after excluding its most common causes, the resistance to local anesthetics was considered as the most probable clinical hypothesis. For this reason, a genetic test was performed, as well as the efficacy of other local anesthetics was evaluated, constituting a different approach in the cases of locoregional anesthesia failure. True resistance to local anesthetics is difficult to diagnose so information about this is scarce in the literature. One of the proposed causes is a mutation of sodium channels where local anesthetics bind. If not recognized, the application of locorregional anesthesia in this patient's condition can lead to unpleasant experiences and unnecessary risks, related to toxic levels of local anesthetics. For this reason, the resistance to local anesthetics should be always precluded in cases of strong clinical suspicion. This approach could be applied in similar cases.

Multitraits evaluation of a Solanum pennellii introgression tomato line challenged by combined abiotic stress.

Rising daily temperatures and water shortage are two of the major concerns in agriculture. In this work, we analysed the tolerance traits in a tomato line carrying a small region of the Solanum pennellii wild genome (IL12-4-SL) when grown under prolonged conditions of single and combined high temperature and water stress. When exposed to stress, IL12-4-SL showed higher heat tolerance than the cultivated line M82 at morphological, physiological, and biochemical levels. Moreover, under stress IL12-4-SL produced more flowers than M82, also characterized by higher pollen viability. In both lines, water stress negatively affected photosynthesis more than heat alone, whereas the combined stress did not further exacerbate the negative impacts of drought on this trait. Despite an observed decrease in carbon fixation, the quantum yield of PSII linear electron transport in IL12-4-SL was not affected by stress, thereby indicating that photochemical processes other than CO2 fixation acted to maintain the electron chain in oxidized state and prevent photodamage. The ability of IL12-4-SL to tolerate abiotic stress was also related to the intrinsic ability of this line to accumulate ascorbic acid. The data collected in this study clearly indicate improved tolerance to single and combined abiotic stress for IL12-4-SL, making this line a promising one for cultivation in a climate scenario characterized by frequent and long-lasting heatwaves and low rainfall.