Understanding How Chemical Pollutants Arise and Evolve in the Brewing Supply Chain: A Scoping Review.

In this study, a critical review was carried out using the Web of ScienceTM Core Collection database to analyse the scientific literature published to date to identify lines of research and future perspectives on the presence of chemical pollutants in beer brewing. Beer is one of the world's most popular drinks and the most consumed alcoholic beverage. However, a widespread challenge with potential implications for human and animal health is the presence of physical, chemical, and/or microbiological contaminants in beer. Biogenic amines, heavy metals, mycotoxins, nitrosamines, pesticides, acrylamide, phthalates, bisphenols, microplastics, and, to a lesser extent, hydrocarbons (aliphatic chlorinated and polycyclic aromatic), carbonyls, furan-derivatives, polychlorinated biphenyls, and trihalomethanes are the main chemical pollutants found during the beer brewing process. Pollution sources include raw materials, technological process steps, the brewery environment, and packaging materials. Different chemical pollutants have been found during the beer brewing process, from barley to beer. Brewing steps such as steeping, kilning, mashing, boiling, fermentation, and clarification are critical in reducing the levels of many of these pollutants. As a result, their residual levels are usually below the maximum levels allowed by international regulations. Therefore, this work was aimed at assessing how chemical pollutants appear and evolve in the brewing process, according to research developed in the last few decades.

Flexible metallic core-shell nanostructured electrodes for neural interfacing.

Electrodes with nanostructured surface have emerged as promising low-impedance neural interfaces that can avoid the charge-injection restrictions typically associated to microelectrodes. In this work, we propose a novel approximation, based on a two-step template assisted electrodeposition technique, to obtain flexible nanostructured electrodes coated with core-shell Ni-Au vertical nanowires. These nanowires benefit from biocompatibility of the Au shell exposed to the environment and the mechanical properties of Ni that allow for nanowires longer and more homogeneous in length than their only-Au counterparts. The nanostructured electrodes show impedance values, measured by electrochemical impedance spectroscopy (EIS), at least 9 times lower than those of flat reference electrodes. This ratio is in good accordance with the increased effective surface area determined both from SEM images and cyclic voltammetry measurements, evidencing that only Au is exposed to the medium. The observed EIS profile evolution of Ni-Au electrodes over 7 days were very close to those of Au electrodes and differently from Ni ones. Finally, the morphology, viability and neuronal differentiation of rat embryonic cortical cells cultured on Ni-Au NW electrodes were found to be similar to those on control (glass) substrates and Au NW electrodes, accompanied by a lower glial cell differentiation. This positive in-vitro neural cell behavior encourages further investigation to explore the tissue responses that the implantation of these nanostructured electrodes might elicit in healthy (damaged) neural tissues in vivo, with special emphasis on eventual tissue encapsulation.

Clinical practice guidelines for the diagnosis and management of Charcot-Marie-Tooth disease.

INTRODUCTION: Charcot-Marie-Tooth disease (CMT) is classified according to neurophysiological and histological findings, the inheritance pattern, and the underlying genetic defect. The objective of these guidelines is to offer recommendations for the diagnosis, prognosis, follow-up, and treatment of this disease in Spain. MATERIAL AND METHODS: These consensus guidelines were developed through collaboration by a multidisciplinary panel encompassing a broad group of experts on the subject, including neurologists, paediatric neurologists, geneticists, physiatrists, and orthopaedic surgeons. RECOMMENDATIONS: The diagnosis of CMT is clinical, with patients usually presenting a common or classical phenotype. Clinical assessment should be followed by an appropriate neurophysiological study; specific recommendations are established for the parameters that should be included. Genetic diagnosis should be approached sequentially; once PMP22 duplication has been ruled out, if appropriate, a next-generation sequencing study should be considered, taking into account the limitations of the available techniques. To date, no pharmacological disease-modifying treatment is available, but symptomatic management, guided by a multidiciplinary team, is important, as is proper rehabilitation and orthopaedic management. The latter should be initiated early to identify and improve the patient's functional deficits, and should include individualised exercise guidelines, orthotic adaptation, and assessment of conservative surgeries such as tendon transfer. The follow-up of patients with CMT is exclusively clinical, and ancillary testing is not necessary in routine clinical practice.

Evolución a largo plazo de la hidrocefalia crónica del adulto idiopática tratada con válvula de derivación ventrículo-peritoneal / Long-term outcomes of adult chronic idiopathic hydrocephalus treated with a ventriculo-peritoneal shunt

Introducción. La hidrocefalia crónica del adulto idiopática (HCAI) es considerada una causa de demencia tratable mediante la implantación de una válvula de derivación ventrículo-peritoneal (VDVP). Nos planteamos estudiar la evolución clínica y funcional de la HCAI tratada con VDVP, así como los factores asociados con una mejor evolución a largo plazo. Sujetos y métodos. Estudio observacional de pacientes con diagnóstico de HCAI probable (según criterios de la Sociedad Japonesa de Neurocirugía) y tratados con VDVP entre 2008 y 2013 en un hospital de tercer nivel español. Se establecieron 4 grupos de respuesta clínica (normalización, mejoría parcial, mejoría dudosa y empeoramiento) y la situación funcional se evaluó mediante la escala de Rankin modificada (ERm). Resultados. Se incluyó a 29 pacientes con una edad media de 73,9 años. El 62,1% eran hombres y el 65,5% presentaban HTA. Se observó una respuesta clínica al menos parcial en el 58 y el 48% al año y al final del seguimiento (seguimiento medio de 37,8 meses), respectivamente. La edad, la frecuencia de HTA y las complicaciones quirúrgicas fueron superiores en el grupo con mala respuesta. Un paciente falleció, el 20,7% presentó complicaciones graves y el 69% era dependiente (ERm ≥ 3) al final del seguimiento. La edad se asoció de manera independiente a peor respuesta clínica al año y una mayor dependencia al final del seguimiento. Conclusión. El beneficio de la VDVP fue parcial y transitorio, con una alta frecuencia de complicaciones y dependencia funcional en el seguimiento a largo plazo, especialmente en los pacientes de mayor edad (AU)

Introduction. Adult chronic idiopathic hydrocephalus (ACIH) is a cause of dementia that can be treated by implanting a ventriculo-peritoneal shunt (VPS). We aim to study clinical and functional outcomes in patients with ACIH corrected with a VPS. Subjects and methods. Observational cohort study of patients diagnosed with probable ACIH (Japan Neurosurgical Society guidelines) and undergoing shunt placement between 2008 and 2013 in a centre of reference for neurosurgery in Spain. Clinical improvement was classified in 4 categories (resolution, partial improvement, equivocal improvement, and no improvement); functional outcome was assessed on the modified Rankin scale (mRS). Results. The study included 29 patients with a mean age of 73.9 years; 62.1% were male and 65.5% had hypertension. Clinical improvement (complete or partial) was observed in 58% after one year and in 48% by the end of the follow-up period (mean follow-up time was 37.8 months). Older age, presence of hypertension, and surgery-related complications were more prevalent in the group responding poorly to treatment. One patient died, 20.7% experienced severe complications, and 69% were dependent (mRS ≥ 3) by the end of the follow-up period. Age at diagnosis was independently associated with poorer clinical response at one year and a higher degree of dependency by the end of follow-up. Conclusion. Symptomatic benefits offered by VPS were partial and transient; treatment was associated with a high complication rate and poor functional outcomes in the long term, especially in the oldest patients (AU)

Aplicaciones de la ultrasonografía en el sistema nervioso central para Neuroanestesia y cuidado neurocrítico / Ultrasound applications in the central nervous system for neuroanaesthesia and neurocritical care

Ultrasonography performed by non-radiologist specialists is a tool that contributes to the diagnosis and monitoring of neurocritical patients. It is a non-invasive, low-cost, accurate and fast method that helps improve safety and timeliness in settings where prompt decision-making is imperative, such as in the operating room, critical care units or the emergency room. The objective is to conduct a narrative review, presenting ultrasound applications focused on the central nervous system that may be useful in neuroanaesthesia and neurocritical care. A search was performed of related terms on databases in the medical literature. Relevant papers where selected and reviewed to perform a non-systematic review focusing on the visualization of the midline and lateral ventricles, the measurement of the optic nerve sheath as a surrogate marker of intracranial hypertension, and the use of colour Doppler for visualizing the middle cerebral artery. It is expected that the use of ultrasound examination of the central nervous system will continue to evolve given its advantages, good correlation with studies considered as the gold standard, and the growing availability of the device. Advancements in this field are expected to improve timeliness and provide objective guidance for decision-making. We recognize the importance of developing skills in the use of this method of exploration in those services where it is required.

La ultrasonografía realizada por especialistas no radiólogos es una herramienta que contribuye al diagnóstico y monitoreo de los pacientes neurocríticos. Adicionalmente es económica, precisa, no invasiva y rápida, lo que mejora la seguridad y oportunidad en escenarios donde la toma inmediata de decisiones es imperativa tales como salas de cirugía, unidades de cuidado crítico o servicios de urgencias. El objetivo es realizar una revisión narrativa presentando las aplicaciones ultrasonográficas enfocadas al sistema nervioso central (SNC) que pueden ser útiles en neuroanestesia y cuidado neurocrítico. Se realizó una búsqueda en bases de datos de los términos relacionados en la literatura médica. Se seleccionaron y revisaron artículos de relevancia para realizar una revisión no sistemática que se centró en la visualización de la línea media, ventrículos laterales, medición de la vaina del nervio óptico como subrogador de hipertensión endocraneana y en la visualización de la arteria cerebral media a través de doppler color. Se prevé que continuarán los avances en la exploración ultrasonográfica del SNC debido a sus ventajas, la buena correlación con los estudios considerados como estándar de oro y la creciente disponibilidad de ecógrafo. Es de esperar que se mejore la oportunidad y ayude a dirigir la toma de decisiones objetivamente. Se reconoce la importancia del desarrollo de habilidades en el manejo de este método de exploración para aplicarlo en los servicios donde sea requerido.

Validación de la versión española del Test Stroop de Alcohol / Validation of the Spanish Version of the Alcohol Stroop Test

El sesgo atencional para el alcohol se ha mostrado útil para identificar a personas con consumo patológico así como a personas dependientes con altas probabilidades de recaída. El objetivo de este trabajo fue validar la versión española del Test Stroop de Alcohol diseñado para evaluar el sesgo atencional en pacientes dependientes del alcohol. La muestra estuvo compuesta por 173 participantes divididos en dos grupos: Un grupo de pacientes (n = 88) cumpliendo criterios de dependencia alcohólica y un grupo control (n = 85) con riesgo bajo de consumo de alcohol, que realizaron el Test de palabras y colores de Stroop (Stroop clásico), el Test de Stroop neutro y el Test de Stroop de Alcohol. Se observaron diferencias estadísticamente significativas en las interferencias para el Stroop Clásico y el Stroop de Alcohol. Los pacientes con dependencia, en comparación a los participantes control, mostraron mayores interferencias para estímulos de contenido alcohólico que para estímulos de contenido neutro. Este efecto fue explicado por un sesgo atencional para información relacionada con el alcohol en pacientes con dependencia. Se calcularon curvas COR, observándose áreas bajo la curva estadísticamente significativas para las interferencias del Stroop clásico y del Stroop de alcohol. Este trabajo sirvió para validar la versión española del Test Stroop de Alcohol para evaluar sesgos atencionales hacia el alcohol en personas con problemas de consumo y dependencia alcohólica

Attention bias for alcohol has proved useful to distinguish people with a pathological consumption of people who do not, and dependents who are more likely to fall in consumption. The aim of this study was to validate the Spanish version of the Alcohol Stroop test, designed to evaluate attention biases for alcohol in alcohol-dependent patients. The sample was composed by 173 participants divided into 2 groups: 1) “Patients” (n = 88) meeting criteria for alcohol dependence; and 2) “Control” (n = 85) having a low risk for alcohol consumption, that completed the Stroop color naming Task (Classic Stroop), the Neutral Stroop test and the alcohol Stroop test. Statistically significant differences were found in the interference effects calculated for the Classic and Alcohol Stroop tests. Patients compared to control participants showed a higher interference effect for alcohol-related stimuli than for neutral stimuli. These effects were accounted by an attention bias for alcohol-related information in patients. ROC curves were calculated for the three interference effects, showing an area under the curve statistically significant in the Classic Stroop interference and the Alcohol Stroop interference. This study provides the validation of the Spanish version of the Alcohol Stroop test that allows to evaluate attention biases for alcohol stimuli in individuals with both pathologic alcohol consumption and alcohol dependence

Factores psicológicos en mujeres que padecen pelvialgia crónica grave operadas por laparoscopia o laparotomía / Psychological factors in women with severe chronic pelvic pain undergoing open or laparoscopic surgery

Propósito del trabajo Analizar la importancia del factor psicológico, entendido como niveles de ansiedad y depresión, en mujeres que padecen dolor pélvico crónico y discutir la posible relación que existe entre estos factores psicológicos y la permanencia del dolor posquirúrgico. Material y métodos Se estudió a un grupo de 41 mujeres que padecían dolor pélvico crónico durante más de 6 meses y a las cuales se les realizó como método diagnóstico-terapéutico laparoscopia o laparotomía. Los resultados fueron comparados con el grupo control constituido por 86 mujeres que acudían a consulta para ligadura tubárica bilateral quirúrgica. Estas pacientes fueron entrevistadas previamente a la cirugía para evaluar sus niveles de depresión mediante el test de Beck y de ansiedad mediante la escala de STAI. Tras la cirugía, se evaluó la permanencia del dolor mediante una encuesta telefónica. Resultados Las pacientes del grupo algia pélvica mostraron unos mayores niveles de depresión y de ansiedad estado respecto al grupo control sin diferencias significativas en cuanto a la ansiedad rasgo. Un alto porcentaje de pacientes del grupo algia pélvica permanece con dolor poscirugía en comparación con el grupo control cuando se las entrevista a los 3 meses de la intervención. Conclusión Las mujeres con dolor pélvico de más de 6 meses de duración ven afectada su calidad de vida por un aumento en los niveles de depresión y ansiedad estado, lo que podría influir en la permanencia del dolor tras la eliminación de la causa ginecológica que supuestamente lo provoca, hasta 3 meses pasada la cirugía

Purpose To analyze the importance of psychological factors, understood as levels of anxiety and depression, among women with chronic pelvic pain and to evaluate the possibility of a relationship between these psychological factors and the persistence of pain after surgery. Material and methods We studied 41 women with chronic pelvic pain for more than 6 months who had undergone laparoscopy or laparotomy as a diagnostic-therapeutic method. The results in these women were compared with those in a control group of 86 women attending the clinic for bilateral tubal ligation. These patients were interviewed before surgery to evaluate their depression and anxiety levels using the Beck test and the STAI scale. The persistence of pain after surgery was assessed through a telephone survey. Results Levels of depression and anxiety were higher in the chronic pelvic pain group than in the control group but no differences were found in the trait anxiety variable. When interviews were carried out 3 months after surgery, the percentage of patients who continued to have postoperative pain was significantly higher in the chronic pelvic pain group than in the control group. Conclusion Quality of life is impaired in women experiencing pelvic pain for more than 6 months, due to increased levels of depression and state anxiety. Persistence of pain 3 months after surgery, despite elimination of its apparent gynecological cause, could be influenced by anxiety and depression

Actualización del protocolo de tratamiento de la hemorragia obstétrica: respuesta de los autores / An update of the obstetrics hemorrhage treatment protocol: Author's reply

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Actualización del protocolo de tratamiento de la hemorragia obstétrica / An update of the obstetrics hemorrhage treatment protocol

La hemorragia obstétrica es aún hoy día una importante causa de morbimortalidad maternofetal en los países desarrollados. Se trata de un problema infraestimado, que generalmente aparece de forma impredecible. La morbimortalidad de la hemorragia obstétrica se considera evitable en una elevada proporción si el manejo es adecuado. Las guías clínicas de mayor difusión mundial recomiendan por consenso protocolizar el manejo, adaptarlo al ámbito local y mantenerlo actualizado en función de la experiencia y de las nuevas publicaciones científicas. Exponemos un protocolo actualizado conforme a las últimas recomendaciones y a nuestra propia experiencia, para que pueda ser utilizado como elemento base por aquellos anestesiólogos que así lo deseen, adaptado a su ámbito local de trabajo diario. Este último aspecto es muy importante para que sea eficaz, y es una labor que debe realizarse en cada centro conforme a la disponibilidad de medios, personal y características arquitectónicas (AU)

Obstetric hemorrhage is still a major cause of maternal and fetal morbimortality in developed countries. This is an underestimated problem, which usually appears unpredictably. A high proportion of the morbidity of obstetric hemorrhage is considered to be preventable if adequately managed. The major international clinical guidelines recommend producing consensus management protocols, adapted to local characteristics and keep them updated in the light of experience and new scientific publications. We present a protocol updated, according to the latest recommendations, and our own experience, in order to be used as a basis for those anesthesiologists who wish to use and adapt it locally to their daily work. This last aspect is very important to be effective, and is a task to be performed at each center, according to the availability of resources, personnel and architectural features (AU)

Malformación arteriovenosa uterina como causa de hemorragia puerperal tardía / Uterine arteriovenous malformation as a cause of delayed postpartum hemorrhage

La malformación arteriovenosa (MAV) uterina debe incluirse en el diagnóstico diferencial de pacientes con hemorragia posparto que no cede con medidas habituales y que, incluso, empeora tras el legrado. La ecografía con Doppler color puede ayudar al diagnóstico y al manejo clínico. Aunque el tratamiento clásico ha sido la histerectomía, en la actualidad el tratamiento conservador con la embolización de la arteria uterina debería considerarse la primera opción terapéutica de estas lesiones ya que resulta seguro y efectivo. Presentamos el caso de una paciente con hemorragia puerperal tardía y MAV resuelta exitosamente con la embolización selectiva de la arteria uterina izquierda (AU)

Arteriovenous malformation (AVM) of the uterus should be included in the differential diagnosis of patients with postpartum hemorrhage that does not yield to routine measures and may even worsen after curettage. Color Doppler sonography can aid in the diagnosis and clinical management of this entity. Although the classical treatment has been hysterectomy, conservative treatment with uterine artery embolization should currently be considered the first therapeutic option for these lesions because of its safety and effectiveness. We report the case of a patient with delayed postpartum hemorrhage and AVM successfully resolved with selective embolization of the left uterine artery (AU)