[Autism spectrum disorder: the impact of an online training strategy on the knowledge of the healthcare staff of a tertiary care hospital]

INTRODUCTION

Autism spectrum disorder (ASD) often presents related medical disorders that require specialised healthcare. Professionals in the health sector therefore face difficulties that require specific training in the healthcare needs of this population.

AIM

The aim of this study is to quantify paediatric healthcare professionals' knowledge about ASD and to assess the impact of online training.

SUBJECTS AND METHODS

It is a quasi-experimental, longitudinal, prospective before-and-after study; study subjects: health professionals; independent variable: online training in ASD; dependent variable: knowledge about ASD. An online training course was held for paediatric professionals to address the core characteristics of diagnosis, as well as the needs they present in the hospital context and the adaptations it is recommended that should be carried out. Fifty-eight healthcare professionals took part.

RESULTS

An increase in knowledge about ASD was observed at the end of the intervention (from 73.9% to 85% according to the ASD background knowledge questionnaire), which showed that more than 90% of the participants had the highest level of knowledge about ASD.

CONCLUSIONS

Online training courses are a useful and effective way to increase knowledge about ASD and the adaptations that are recommended in the hospital setting. More training in ASD should be made available in these settings.

The association between iron deficiency and outcomes: a secondary analysis of the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial

In the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial, the use of intravenous iron did not reduce the need for blood transfusion or reduce patient complications or length of hospital stay. As part of the trial protocol, serum was collected at randomisation and on the day of surgery. These samples were analysed in a central laboratory for markers of iron deficiency. We performed a secondary analysis to explore the potential interactions between pre-operative markers of iron deficiency and intervention status on the trial outcome measures. Absolute iron deficiency was defined as ferritin <30 μg.l^-1 ; functional iron deficiency as ferritin 30-100 μg.l^-1 or transferrin saturation < 20%; and the remainder as non-iron deficient. Interactions were estimated using generalised linear models that included different subgroup indicators of baseline iron status. Co-primary endpoints were blood transfusion or death and number of blood transfusions, from randomisation to 30 days postoperatively. Secondary endpoints included peri-operative change in haemoglobin, postoperative complications and length of hospital stay. Most patients had iron deficiency (369/452 [82%]) at randomisation; one-third had absolute iron deficiency (144/452 [32%]) and half had functional iron deficiency (225/452 [50%]). The change in pre-operative haemoglobin with intravenous iron compared with placebo was greatest in patients with absolute iron deficiency, mean difference 8.9 g.l^-1 , 95%CI 5.3-12.5; moderate in functional iron deficiency, mean difference 2.8 g.l^-1 , 95%CI -0.1 to 5.7; and with little change seen in those patients who were non-iron deficient. Subgroup analyses did not suggest that intravenous iron compared with placebo reduced the likelihood of death or blood transfusion at 30 days differentially across subgroups according to baseline ferritin (p = 0.33 for interaction), transferrin saturation (p = 0.13) or in combination (p = 0.45), or for the number of blood transfusions (p = 0.06, 0.29, and 0.39, respectively). There was no beneficial effect of the use of intravenous iron compared with placebo, regardless of the metrics to diagnose iron deficiency, on postoperative complications or length of hospital stay.

Novel amino analogs of the trimethoxyphenyl ring in potent colchicine site ligands improve solubility by the masked polar group incorporation (MPGI) strategy

The low aqueous solubility of colchicine site antimitotic agents, of which the trimethoxyphenyl (A ring) is a heavy contributor, is a serious drawback in their clinical development. We have designed new A ring analogs with chameleonic masked polar amino groups able to increase aqueous solubility and also behave as non-polar through intramolecular hydrogen bonds when bound to tubulin. We have incorporated these new A rings in several scaffolds (sulfonamides, combretastatins, phenstatins, isocombretastatins), synthesized, and assayed 43 representatives. The amino analogs show improved aqueous solubility and some of them (8, 60Z, and 67) nanomolar anti-proliferative potencies against human cancer cell lines, with the most favorable substituent being a 3-methylamino group. The antiproliferative effect relates to tubulin inhibition as shown by in vitro tubulin polymerization inhibition, immunofluorescence microscopy, and cell cycle and apoptosis analysis by flow cytometry. The compounds arrest the cell cycle of treated cells in G₂/M and later develop an apoptotic response. Docking studies suggested binding at the colchicine site of tubulin with good agreement with the DFT models of the new structural variations made. The 3-methylamino-4,5‑dimethoxyphenyl moiety is an example of the masked polar group incorporation (MPGI) strategy for soluble ligands binding to hydrophobic sites and a good trimethoxyphenyl ring replacement for the development of new colchicine site ligands.

Distraction by deviant sounds is modulated by the environmental context

Evidence shows that participants performing a continuous visual categorization task respond slower following the presentation of a task-irrelevant sound deviating from an otherwise repetitive or predictable auditory context (deviant sound among standard sounds). Here, for the first time, we explored the role of the environmental context (instrumentalized as a task-irrelevant background picture) in this effect. In two experiments, participants categorized left/right arrows while ignoring irrelevant sounds and background pictures of forest and city scenes. While equiprobable across the task, sounds A and B were presented with probabilities of .882 and .118 in the forest context, respectively, and with the reversed probabilities in the city context. Hence, neither sound constituted a deviant sound at task-level, but each did within a specific context. In Experiment 1, where each environmental context (forest and city scene) consisted of a single picture each, participants were significantly slower in the visual task following the presentation of the sound that was unexpected within the current context (context-dependent distraction). Further analysis showed that the cognitive system reset its sensory predictions even for the first trial of a change in environmental context. In Experiment 2, the two contexts (forest and city) were implemented using sets of 32 pictures each, with the background picture changing on every trial. Here too, context-dependent deviance distraction was observed. However, participants took a trial to fully reset their sensory predictions upon a change in context. We conclude that irrelevant sounds are incidentally processed in association with the environmental context (even though these stimuli belong to different sensory modalities) and that sensory predictions are context-dependent.

Pyrite ore cargo spills as a source of soil pollution and ecological risk along the abandoned railway corridors of the Tharsis and Rio Tinto mines (Spain)

Abandoned mining railways are a prominent legacy environmental issue facing many metalliferous regions with a long mining history. However, there is a general lack of information on potentially hazardous trace elements occurring in soils alongside railroad lines as a result of hazmat cargo spills. This paper explores for the first time the effects of pyrite ore transportation on soil pollution along the old railways of Tharsis and Rio Tinto, two historical mining districts of world-class importance in the Iberian Pyrite Belt. The railroad-side topsoil was found to be extremely acidic in reaction and contains abundant pyrite, spilled on the tracks during transit, and its oxidation products (jarosite, iron oxyhydroxides, and efflorescent sulfate minerals). Compared to local background concentrations, highly elevated levels of Pb, Zn, Cu, As, Hg, Sb, Bi, Cd, Ag, and Tl were detected in both railroad lines, indicating serious anthropogenic contamination. Exposure to soil contaminants, notably Pb, As, and Tl, could pose hazards to human health and the environment. Accordingly, a specific-site risk assessment is needed before the mining railway lines are converted into recreational trails.

Effects of maternal age and offspring sex on milk yield, composition and calf growth of red deer (Cervus elaphus)

Differential maternal allocation theory states that mothers will invest more heavily in the offspring sex that will secure higher reproductive output. Senescence theory is concerned with the gradual deterioration of physiological function with age. We analysed the offspring sex-dependent response of calf growth and milk traits to mother age in an Iberian population of captive red deer (Cervus elaphus) using a 22 year time series longitudinal data set. Previous studies revealed that there was little evidence for the differential allocation theory on milk traits and that most studies lacked proper control for confounding factors. Our results indicated that (i) calf growth was offspring male-biased, negatively affected by mother age and positively influenced by mother weight and parity, and (ii) there was no support for differential allocation offspring sex-dependence in milk traits (yield, energy density, fat, protein and lactose content). Our findings suggest that maternal allocation responds to offspring energy requirements, which are mainly driven by offspring body weight, and contingent on mother age and weight and previous maternal reproductive effort.

Water sprinkling as a tool for heat abatement in farmed Iberian red deer: Effects on calf growth and behaviour

Climatic models predict scenarios in which ambient temperature will continue increasing worldwide. Under these climatic conditions, fitness and animal welfare of many populations are expected to suffer, especially those that live in captive or semi-natural conditions, where opportunities of heat abatement are limited. We undertook an experimental design to assess the effect of heat abatement that water sprinkling might have on Iberian red deer calf growth and behaviour from birth to weaning (135 days). One group of ten mother-calf pairs lived on plots with water sprinkling (treatment) available during summer’s hottest time of the day, while the control group (nine mother-calf pairs) occupied plots with no available water sprinkling. Treatment and control groups were fed ad libitum and swapped between plots every seven days to minimise any plot effect. Body weight was monitored weekly and individual behaviour was recorded once or twice a week at mid-day. We observed that calves had showers under the sprinklers and wallowed in mud puddles. The results clearly indicated that calves of the treatment group showed a significant increase in body weight at weaning in comparison with the control group, with no differences between sexes (treatment: male = 56.5 kg, female = 50.3 kg; control: male = 50.3 kg, female = 46.5 kg). Mother weight and mother age effects were negligible on calf body weight at weaning. The heavier the mother the faster was the rate of growth of its offspring, irrespective of calf sex. The model indicated that although males grew significantly slower than female calves in the control group, males grew faster than females when exposed to the treatment. Calves of the treatment group spent less time drinking, less time in the shade, similar time eating and more time in motion than calves of the control group. There were no behavioural differences between calf sexes of treatment and control groups. The results indicate the importance of providing animals with opportunities of heat abatement in hot environments to improve animal growth and welfare in farmed Iberian red deer.

Patients with substance use disorder who have higher alexithymia levels present more suicidality history: Preliminary results in an outpatient addiction treatment center in Spain

Introduction

Patients with substance use disorders (SUD) have higher alexithymia levels and present frequently suicidal ideation (SI) and suicide (SA) [1,2]. Beside, alexithymia has been related to suicidal behaviors in several psychiatric disorders[3]. Although, there are some studies on alexithymia and suicidality in SUD patients, to our knowledge there are no studies on this issue in Spanish population.

Objectives

To compare the alexithymia levels in SUD patients with and without SI and SA in an outpatient addiction treatment center in Spain.

Methods

This is a cross-sectional study performed on 110 patients (74.3%males; mean age 43.6±14.5years old) for whom we had information from the Toronto Alexithymia Scale(TAS-20) and the presence or not of lifetime SI and SA.

Results

Lifetime SI and SA were present in 55.5% and 35.5% of the sample respectively. The mean score of TAS-20, difficulties identifying feelings (DIF), difficulties describing feelings (DDT), and externally-oriented thinking(EOT) were 57.2±13.3, 20.0±7.0, 14.7±4.5, and 22.5±4.5 respectively.

Conclusions

SI and SA may be related to alexithymia levels. Hence, alexithymia should be further analyzed in SUD patients in longitudinal studies in order to analyze the bilateral association with suicidal spectrum behaviors. REFERENCES Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-5. Morie KP, et al. Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. Curr Addict Rep. 2016;3(2):239-48. Hemming L, et al. A systematic review and meta-analysis of the association between alexithymia and suicide ideation and behaviour. J Affect Disord. 2019;254:34-48.

Efficacy of complementary treatment with autologous platelet concentrates and/or mesenchymal stem cells in chemical osteonecrosis of the jaw. Systematic review of the literature

The aim of this systematic review was to establish the current status of the subject and find out what scientific evidence we have on the use of autologous plasma concentrates (APCs) and mesenchymal stem cells (MSCs) as complementary therapies at the management of Medication-related Osteonecrosis of the jaw (MRONJ). We performed a literature search of articles published between December 2019 to January 2020 in electronic databases, in accordance to PRISMA system. The variables analyzed were: the number of patients, age, sex, medical history, origin of MRONJ, imaging studies, treatment performed, and evolution of MRONJ. The articles included in the review were grouped into two groups (Group A "Therapy with APCs" and Group B "Therapy with APCs and MSCs"). Newcastle-Ottawa scale (NOS) was used to assess the quality of the articles. Fisher's exact test was used to evaluate eventual differences between groups. Of the 306 patients who were included, 297 belonged to Group A and 9 to Group B. In our sample, women predominated against men and no significant differences in age were observed. Osteoporosis was the most frequent underlying disease in both groups. The most common origin of MRONJ was oral surgery in group A. Conservative surgery was performed in all patients, but complementary treatment was applied in different ways in each group. The resolution of the pathology was achieved in 90% of cases in both groups without significant differences between them. The mean score of the reviewed studies at NOS was 4. There are currently no published scientific data that can sufficiently support the use of APCs and MSCs for the treatment of established MRONJs.

Heat stress reduces growth rate of red deer calf: Climate warming implications

Climate models agree in predicting scenarios of global warming. In endothermic species heat stress takes place when they are upper their thermal neutral zone. Any physiological or behavioural mechanism to mitigate heat stress is at the cost of diverting energy from other physiological functions, with negative repercussions for individual fitness. Tolerance to heat stress differs between species, age classes and sexes, those with the highest metabolic rates being the most sensitive to stressing thermal environments. This is especially important during the first months of life, when most growth takes place. Red deer (Cervus elaphus) is supposedly well adapted to a wide range of thermal environments, based on its worldwide distribution range, but little is known about the direct effect that heat stress may have on calf growth. We assessed the effect that heat stress, measured by heat stress indices and physical environment variables (air temperature, relative air humidity, wind speed and solar radiation), have on calf and mother body weights from calf´s birth to weaning. We used 9265 longitudinal weekly body weight records of calf and mother across 19 years in captive Iberian red deer. We hypothesised that (i) heat stress in hot environments has a negative effect on calf growth, especially in males, as they are more energetically demanding to produce than females; and that (ii) the body weight of the mother through lactation should be negatively affected by heat stress. Our results supported hypothesis (i) but not so clearly hypothesis (ii). By weaning (day 143) calves growing under low heat stress environment grew up to 1.2 kg heavier than those growing in high heat stress environment, and males were more affected by heat stress than females. The results have implications in animal welfare, geographical clines in body size and adaptation to climate change.

What do rates of deposition of dental cementum tell us? Functional and evolutionary hypotheses in red deer

Cementum is a bone connective tissue that provides a flexible attachment for the tooth to the alveolar bone in many mammalian species. It does not undergo continuous remodelling, unlike non-dental bone, which combined with its growth pattern of seasonal layering makes this tissue uniquely suitable as a proxy for tracking changes in body repair investment throughout an animal´s life. We tested functional and sexual selection hypotheses on the rate of cementum deposition related to the highly polygynous mating strategy of red deer. We used a sample of 156 first lower molars from wild Scottish red deer of known age between 1 and 17 years old, approximately balanced by sex and age class. Cementum deposition on the inter-radicular pad increased with age at a constant average rate of 0.26 mm per year, with no significant differences between sexes. Cementum deposition was independent of (i) tooth wear, other than that associated with age, and (ii) enamel and dentine micro-hardness. The results partially supported the hypothesis that the main function of cementum is the repositioning of the tooth to maintain opposing teeth in occlusion. However, teeth that had more wear or males´ teeth that had faster rates of tooth wear than those of females did not present the expected higher rates of cementum deposition.

Short communication: Red deer (Cervus elaphus) colostrum during its transition to milk

We studied changes in chemical composition, somatic cell count, and immunoglobulin G (IgG) and M (IgM) content in red deer (Cervus elaphus) colostrum during the transition to milk at different times after parturition (<5 h, 24 h, 48 h, 2 wk, and 4 wk). The production level was higher at 2 and 4 wk of lactation than during the first day after parturition, with intermediate values at 48 h postpartum. Fat content did not vary during the study period. However, total protein and casein contents were particularly high in the initial 5 h after parturition, decreasing to approximately 50% after 24 h postpartum. Conversely, lactose concentration was low in the beginning (<5 h), increasing gradually throughout the study. Similarly, dry matter dropped during the first 24 h and then remained constant throughout the study. Urea content decreased during the study, showing a slight recovery at 4 wk. Somatic cell count was higher during the first hours after parturition and gradually decreased throughout the study period. The IgG content was higher before 5 h postpartum than at 24 h postpartum. After 5 h, the level of IgG decreased progressively until it reached 0.18 mg/mL at 4 wk of lactation. We observed a similar pattern for IgM content, but it decreased more quickly than IgG and was not detected after 2 wk. In the case of deer, milk should be considered transitional from 24 to 48 h after parturition, and samples collected after 2 wk can be considered mature milk.

Perceived and anticipating stigma in schizophrenia in relationship with depressive symptoms and functionality degree

Introduction

Perceived and anticipated stigma is relevant issues in patients with schizophrenia. Stigma has negative consequences both in quality of life and in the course of illness.

Objectives

To analyze the degree of perceived and anticipated stigma and discrimination in patients with schizophrenia and their relationship with clinical and socio-demographic variables.

Methods

A cross-sectional study was carried out in a sample of 100 patients with diagnosis of schizophrenia, 18 or more years old, clinically stabilized, without axis I DSM-IV comorbidity. Patients received treatment in the outpatient services of a catchment area in Madrid. Perceived and anticipated discrimination was evaluated trough the DISC-12 (Discrimination and Stigma scale). Other study variables were: socio-demographic characteristics, symptoms of depression (Calgary Scale) and functionality degree measured by Global Assessment of Function (GAF).

Results

The presence of symptoms of depression evaluated by the Calgary Scale and low degree of functionality measured by GAF are associated with greater feelings of discrimination and stigma, especially in the sub-scales of experienced and anticipated discrimination of the DISC 12. Anticipated stigma is higher in men than in women while the rest sub scales of the DISC-12 do not correlate with gender or other sociodemographic variables.

Conclusions

Preventive strategies to avoid the stigma in schizophrenia should consider some characteristics associated with disease, especially the degree of functionality and presence of depressive symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Effect of size, seasoning and toasting level of Quercus pyrenaica Willd. wood on wine phenolic composition during maturation process with micro-oxygenation

Seasoning and toasting treatments carried out in cooperage influence the chemical composition of the oak, and these treatments affect different oak species in different ways. For this reason, numerous studies have focused on the evaluation of both the oak wood materials and the resulting aged wines in order to optimize the different cooperage processes. Seasoning involves immobilizing the wood for long periods of time, leading to an increase in the price of the final product. When using alternative products instead of barrels, in addition to the seasoning and toasting of the wood, the size of the wood pieces is a determining factor in the characteristics of the final wine. Therefore, the objective of this work was to evaluate the polyphenolic composition of the same red wine aged with different alternative products and a small amount of oxygen for 120 days. Specifically, the effect of 2 types of seasoning and 3 types of toasting of chips and staves made from the wood of Q. pyrenaica Willd. was studied. The results showed that the size of the alternative product was the factor that determines the phenolic composition of the wines over the entire ageing process, independent of the seasoning or toasting method carried out on the wood.

Antlers - Evolution, development, structure, composition, and biomechanics of an outstanding type of bone

Antlers are bony appendages of deer that undergo periodic regeneration from the top of permanent outgrowths (the pedicles) of the frontal bones. Of the "less familiar" bone types whose study was advocated by John Currey to gain a better understanding of structure-function relationships of mineralized tissues and organs, antlers were of special interest to him. The present review summarizes our current knowledge about the evolution, development, structure, mineralization, and biomechanics of antlers and how their formation is affected by environmental factors like nutrition. Furthermore, the potential role of antlers as a model in bone biology and several fields of biomedicine as well as their use as a monitoring tool in environmental studies are discussed.

Evolution of blood serum mineral composition during antler growth and rut as consequence of Cu supplementation in captive red deer and its effects in mature antler composition

In the present study we assessed the effects of Cu supplementation and antler growth stage on mineral composition of serum and hard antler in red deer fed a balanced diet. Correlations between minerals were analysed for serum, for antlers, and between serum versus mature antler. Blood samples were drawn at Days –36, 54, 132 and 197 of the start of antler growth (SAG). Hard antlers were cut at Day 165 from SAG. The Cu supplemented group (n = 9) was injected with 0.83 mg Cu/kg of bodyweight, whereas the control group (n = 9) was injected with a physiological saline solution, both every 42 days between Days –36 (Cu supplied after blood sampling) and 132 from SAG. Supplementation with Cu increased (P &lt; 0.05) the contents of P and Cu in serum but did not affect the antler mineral profile. Serum contents of Mg, Na, S, B and Cu increased during the antler growth, whereas contents of K, Al and Fe decreased in the same period (P &lt; 0.001). At Day 54 from SAG in Cu group, serum P content correlated negatively with antler Ca content whereas Zn of serum and antler correlated positively (P &lt; 0.05). The maximum number of correlations between the mineral profile of serum and hard antler was achieved at Day 132 from SAG (3.3, 4.7 and 12.9% for Days –36, 54 and 132, respectively). In conclusion, the analysis of specific minerals in serum could be used to detect in advance some mineral deficiencies in the antler.

Effects of Mn supplementation in late-gestating and lactating red deer (Cervus elaphus hispanicus) on milk production, milk composition, and calf growth

This study describes the effects of Mn supplementation of 20 late-gestating and lactating Iberian red deer (Cervus elaphus hispanicus) females (hinds) fed a balanced diet on milk production and milk composition over the lactation period. Body weight of their calves at birth and at weaning was also evaluated. In addition, the effect of lactation stage was studied. For these purposes, 2 groups of hinds, one composed by 12 individuals (experimental) and the other by 8 individuals (control) were compared. Experimental hinds were s.c. injected weekly with Mn (2 mg Mn/kg BW) from day 140 of gestation until the end of lactation (week 18; forced weaning by physical separation). Control hinds were injected with a physiological saline solution with the same volume and at the same frequency as the experimental group. Serum Mn content of hinds was assessed just before the first Mn injection and at week 10 of lactation to assess whether the injected Mn increased Mn concentrations in blood. No differences were observed for BW of calves at birth but calves whose mothers were injected with Mn tended (P = 0.07) to have greater gain of BW from birth to weaning in proportion of BW at birth compared to calves from control hinds. In addition, supplementation with Mn increased (P ≤ 0.05) daily milk production by 10.2%, milk fat content by 11.2%, and total fat yield by 17.8%. Also, milk from hinds supplemented with Mn had more Ca (P < 0.001) and P (P < 0.05) than milk from control hinds. Manganese supplementation did not influence Mn serum content when blood was analyzed at week 10 of lactation, but increased the Mn content of milk by 18.3% (P < 0.001). Lactation stage affected (P < 0.001) fat, protein, lactose, and DM. Their contents increased as lactation proceeded, and protein was substituted by fat. Therefore, results suggest that Mn supplementation of hinds is recommended, even when they are fed a balanced diet, to increase milk production and the content of fat, Ca, P, and Mn of milk.

Perceived and anticipated stigma in patients with schizophrenia according with the length of illness

Introduction

Perceived and anticipated stigma are relevant issues in patients with schizophrenia. Stigma has negative consequences both in quality of life and in the course of illness.

Objectives

To analyze differences in perceived and anticipated discrimination in two groups of patients with schizophrenia: one with a recent diagnosis of illness and another with a long course of disease.

Methods

A cross-sectional study was carried out in a sample of 100 patients with diagnosis of schizophrenia, 18 or more years old, clinically stabilized, without axis I DSM-IV comorbidity. Patients received treatment in the outpatient services of a catchment area in Madrid. Perceived and anticipated discrimination was evaluated trough the DISC-12 (Discrimination and Stigma scale). Other study variables were: socio-demographic status, length of disease, symptoms of depression (Calgary Scale) and functionality degree measured by Global Assessment of Function (GAF). Two sub-groups of patients were compared: one with a length of illness below 5 years and a second one with a length of illness over 5 years.

Results

Patients with a length of illness longer than 5 years showed elevated degree of perceived and anticipated discrimination compared with patients with less than 5 years of illness course. In the same way, patients with a recent diagnosis of illness showed increased scores in the measure of face the stigma.

Conclusions

Preventive strategies to avoid the stigma in schizophrenia should consider some differences in patients in relationship with the length of evolution of illness in order to be more accurate. Early intervention programs about stigma are necessary.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Gender differences in right ventricular function in patients with non-ischaemic cardiomyopathy

AIM

To evaluate sex-related differences in right ventricular (RV) function, assessed with cardiac magnetic resonance imaging, in patients with stable non-ischaemic dilated cardiomyopathy.

METHODS

Prospective multicentre study. We included 71 patients (38 men) and 14 healthy volunteers.

RESULTS

Mean age was 60.9 ± 12.2 years. Men presented higher levels of haemoglobin and white blood cell counts than women, and performed better in cardiopulmonary stress testing. A total of 24 patients (12 women) presented severe left ventricular (LV) systolic dysfunction, 32 (13 female) moderate and 15 (8 women) mild LV systolic dysfunction. In the group with severe LV systolic dysfunction, average right ventricular ejection fraction (RVEF) was normal in women (52 ± 4 %), whereas it was reduced in men (39 ± 3 %) p = 0.035. Only one woman (8 %) had severe RV systolic dysfunction (RVEF < 35 %) compared with 6 men (50 %) p < 0.001. In patients with moderate and mild LV dysfunction , the mean RVEF was normal in both men and women. In the 14 healthy volunteers, the lowest value of RVEF was 48 % and mean RVEF was normal in women (56 ± 2 %) and in men (51 ±  1 %), p = 0.08.

CONCLUSIONS

In patients with dilated cardiomyopathy, RV systolic dysfunction is found mainly in male patients with severe LV systolic dysfunction.

Renal and hepatic integrity in long-term sevoflurane sedation using the anesthetic conserving device: a comparison with intravenous propofol sedation in an animal model

INTRODUCTION

Critically ill patients are sedated with intravenous agents because the use of inhaled agents is limited by their potential risk of toxicity. Increasing levels of inorganic fluorides after the metabolism of these agents have been considered potentially nephrotoxic. However, hepatic involvement after prolonged administration of sevoflurane has not yet been studied. The present study evaluated the potential renal and hepatic toxicity caused by prolonged administration (72h) of sevoflurane.

METHODS

For this experimental, prospective, randomized, controlled trial, 22 Landrace x Large-White female pigs were randomly assigned to two groups: intravenous propofol (P) or inhaled sevoflurane via the AnaConDa™ device (S, end-tidal 2.5 vol%). The P group remained sedated for 108h with propofol. In the S group, sevoflurane was administered for 72h and then changed to propofol for the remaining 36h in order to observe the kinetics of fluoride after discontinuation of sevoflurane. Serum creatinine was the primary outcome variable, but inorganic fluoride concentrations and other renal, hepatic, and cardiorespiratory variables were also measured.

RESULTS

Both groups of animals were comparable at baseline. No differences were found between the two groups for plasma creatinine and urea or creatinine clearance throughout the study. Fluoride levels were significantly higher in the sevoflurane group. No correlation was found between inorganic fluoride and serum creatinine values. No significant differences were observed for hepatic function. Hemodynamic, respiratory, and blood gas variables were comparable between the groups.

CONCLUSIONS

Long-term sedation with sevoflurane using AnaConDa™ or propofol does not negatively affect renal or hepatic function.

Comparison of related complications: sentinel node biopsy versus elective neck dissection

Sentinel node biopsy (SNB) is considered a feasible neck staging tool in early oral squamous cell carcinoma. The aim of this study was to compare postoperative morbidity in patients who had undergone SNB and elective neck dissection (END). Seventy-three consecutive patients were included between the years 2005 and 2009. The patients were divided into two groups according to neck management: SNB and END groups. Kaplan-Meier survival analysis was used to compare disease-free survival (DFS) and overall survival (OS) between the groups. Shoulder function, length of the surgical scar, and the degree of cervical lymphoedema were assessed. Neck haematoma and the presence of oro-cervical communication were also analyzed. Thirty-two patients underwent SNB and 41 underwent an END (levels I-III). Seven regional recurrences were recorded in the END group. Three neck recurrences occurred in the SNB group. No significant differences were found in DFS or OS between the groups. There were statistically significant differences between the groups in shoulder function and average scar length. However, differences in degree of lymphoedema were not statistically significant. Neck hematomas and oro-cervical communications occurred only in the END group. From this study, it can be concluded that SNB presents less postoperative morbidity than END.

Habituating to handling: factors affecting preorbital gland opening in red deer calves

The preorbital gland plays not only an olfactory role in cervids but also a visual one. Opening this gland is an easy way for the calf to communicate with the mother, indicating hunger/satiety, stress, pain, fear, or excitement. This information can be also useful for farm operators to assess how fast the calves habituate to handling routines and to detect those calves that do not habituate and may suffer chronic stress in the future. Thirty-one calves were subjected to 2 consecutive experiments to clarify if observing preorbital gland opening is related to habituation to handling in red deer calves (Cervus elaphus). Calves were born in 3 different paddocks, handled as newborns (Exp. 1), and then subjected to the same routine handling but with different periodicity: every 1, 2, or 3 wk (Exp. 2). In Exp. 1, preorbital gland opening was recorded in newborns during an initial handling (including weighing, ear tagging, and sex determination). Preorbital gland opening occurred in 93% of calves during this procedure and was not affected by sex, time since birth, or birth weight. Experiment 2 consisted of measuring preorbital opening during the same routine handling (weighing, blood sampling, and rump touching to assess body condition) when calves were 1, 3, and 5 mo old. Binary logistic regression showed that gland opening was associated with habituation to handling, since at 1 and 3 mo the probability of opening the gland decreased with the number of handlings that a calf experienced before (P = 0.008 and P = 0.028, respectively). However, there were no further changes in preorbital gland opening rate in the 5-mo-old calves (P = 0.182). The significant influence of the number of previous handlings on the probability of opening the preorbital gland was confirmed through generalized linear model with repeated measures (P = 0.007). Preorbital gland opening decreased along the phases of the study. Nevertheless, we found a significant trend in individuals to keep similar opening patterns (intraclass correlation coefficient = 0.807, P < 0.001), which suggests that the more stressed individuals can be detected with this method. Therefore, we conclude that preorbital gland opening during routine handlings is related to the number of previous handlings, and thus it can be used as an indicator of lack of habituation to handling in farmed cervids.

Labeling studies on cortical bone formation in the antlers of red deer (Cervus elaphus)

The formation and mineralization process of antlers, which constitute the fastest growing bones in vertebrates, is still not fully understood. We used oxytetracycline injections to label different stages of bone formation in antlers of 14 red deer between days 28 and 156 of antler growth. Results show that initially a trabecular scaffold of woven bone is formed which largely replaces a pre-existing scaffold of mineralized cartilage. Lamellar bone is then deposited and from about day 70 onwards, primary osteons fill in the longitudinal tubes lined by the scaffold in a proximal to distal sequence. Mineral apposition rate (MAR) in early stages of primary osteon formation is very high (average 2.15 μm/d). Lower MARs were recorded for later stages of primary osteon formation (1.56 μm/d) and for the smaller secondary osteons (0.89 μm/d). Results suggest a peak in mineral demand around day 100 when the extent of mineralizing surfaces is maximal. A few secondary osteons were formed in a process of antler modeling rather than remodeling, as it occurred simultaneously with formation of primary osteons. The degree of cortical porosity reflects a reduction in MAR during later stages of osteonal growth, whereas cortical thickness is determined earlier. Injections given when the antlers were largely or completely clean from velvet produced no labels in antler bone, strongly suggesting that antlers are dead after velvet shedding. The rapidity of antler mineralization and the short lifespan of antlers make them an extraordinary model to assess the effects of chemicals impairing or promoting bone mineralization.

Phenolic compounds and sensorial characterization of wines aged with alternative to barrel products made of Spanish oak wood (Quercus pyrenaica Willd.)

Wood of Quercus pyrenaica has suitable properties for the wine ageing process. However, the forest available for the barrel making from this particular type of tree is very limited. Nevertheless, it is highly advisable to use this kind of wood in order to manufacture alternative oak products. This study presents the results of ageing the same red wine using different pieces of wood (chips and staves) of Spanish oak (Q. pyrenaica), American oak (Quercus alba) and French oak (Quercus petraea) in conjunction with small, controlled amounts of oxygen. In addition, the phenolic parameters, colour and sensory analysis point out that wines aged with Q. pyrenaica pieces have similar enological characteristics to those aged with American or French oak pieces of wood (chips and staves). Furthermore, the total oxygen consumed and its relation with sensory properties also has been studied in this article in order to know how the oxygen behaves in these processes. Besides, it is going to put forward the fact that chips and staves from Q. pyrenaica oak are suitable for the ageing of red wines and better considered than American or French ones, showing higher aromatic intensity, complexity, woody, balsamic and cocoa. Finally, the tasters valued highly the wines with staves, pointing out its flavour and roundness in mouth.

The use of pedicled buccal fat pad combined with sequestrectomy in bisphosphonate-related osteonecrosis of the maxilla

The use of pedicled buccal fat pad flap (BFP) has proved of value for the closure of oroantral and oronasal communications and is a well-established tool in oral and maxillofacial surgery. Otherwise, the perceived limitations of surgical therapy for bisphosphonate-related osteonecrosis of the jaws (BRONJ) have been widely discussed, and recommendations have largely been made to offer aggressive surgery only to stage 3 patients refractary to conservative management. Oroantral communication may be a common complication after sequestrectomy and bone debridement in upper maxillary BRONJ. We report a case series of stage 3 recalcitrant maxillary BRONJ surgically treated with extensive sequestrectomy and first reconstruction using pedicled BFP. All the cases presented an uneventful postoperative healing was uneventful without dehiscence, infection, necrosis or oroantral communication. We postulate that managing initially the site with BFP and primary closure may ensure a sufficient blood supply and adequate protection for an effective bone-healing response to occur. This technique may represent a mechanic protection and an abundant source of adipose-derived adult stem cells after debridement in upper maxillary BRONJ. We evaluate in this work results, advantages and indications of this technique.

Key words: Buccal fat pad flap, bisphosphonate-related osteonecrosis of the jaws, oroantral communications, sequestrectomy.

Does nutrition affect bone porosity and mineral tissue distribution in deer antlers? The relationship between histology, mechanical properties and mineral composition

It is well known that porosity has an inverse relationship with the mechanical properties of bones. We examined cortical and trabecular porosity of antlers, and mineral composition, thickness and mechanical properties in the cortical wall. Samples belonged to two deer populations: a captive population of an experimental farm having a high quality diet, and a free-ranging population feeding on plants of lower nutritive quality. As shown for minerals and mechanical properties in previous studies by our group, cortical and trabecular porosity increased from the base distally. Cortical porosity was always caused by the presence of incomplete primary osteons. Porosity increased along the length of the antler much more in deer with lower quality diet. Despite cortical porosity being inversely related to mechanical properties and positively with K, Zn and other minerals indicating physiological effort, it was these minerals and not porosity that statistically better explained variability in mechanical properties. Histochemistry showed that the reason for this is that Zn is located around incomplete osteons and also in complete osteons that were still mineralizing, whereas K is located in non-osteonal bone, which constitutes a greater proportion of bone where osteons are incompletely mineralized. This suggests that, K, Zn and other minerals indicate reduction in mechanical performance even with little porosity. If a similar process occurred in internal bones, K, Zn and other minerals in the bone may be an early indicator of decrease in mechanical properties and future osteoporosis. In conclusion, porosity is related to diet and physiological effort in deer.

Factors affecting antler investment in Iberian red deer

Antler constitutes such a costly trait that the skeleton of the deer undergoes a process similar to osteoporosis to meet the high demands of mineral deposition in the antler. The allometric relationship between antler and body size is one of the oldest known. However, no study has assessed the proportion that antlers constitute with regard to the skeleton (from which most of the material is drawn), nor which factors influence this investment. To assess this, we studied 171 males (aged 1–5 years), determined their antler and bodyweights and scored their body condition. Then we calculated antler investment as antler weight relative to estimated skeletal weight. Results showed that antler investment in males ≥2 years old (i.e. excluding yearlings) depended on age rather than the whole bodyweight or body condition. Antler investment increased from 6% in yearlings to 35% in 5-year-old males, with a mean of 19%. A GLMM showed that in males ≥2 years old, within age, the heavier the male and the better the body condition at the start of antler growth, the greater the investment in antlers. In yearlings, antler investment did not depend on bodyweight or body condition. In conclusion, antler weight relative to skeleton weight is a good method to assess antler investment. This investment is influenced by age and, in males ≥2 years old, also by bodyweight or condition at the start of antler growth.

Determination of low-molecular mass phenols in red wines: The influence of chips, staves and micro-oxygenation aging tank

The aim of this study is to assess the use of polymeric cartridges with diode array detection to extract the main low-molecular mass phenolic compounds from red wine samples. This method expanded and improved permitted to quantify 20 compounds in red wines made and aged under different conditions. These conditions included aging in barrels and in tanks with chips or staves as well as micro-oxygenation. The study of wine development during its wood storage period and the compounds transferred from the wood to the wine during this period provide useful important information concerning the impact of wine aging methods on the chemical makeup of the resulting wines. The main compounds that differentiated wine aging systems were identified to be 5-hydroxymethyl-2 furaldehyde, gallic acid, p-hydroxybenzoic aldehyde, syringic acid and sinapic acid.

Do drastic weather effects on diet influence changes in chemical composition, mechanical properties and structure in deer antlers?

We attempted to determine why after an exceptionally hard winter deer antlers fractured more often than usual. We assessed mechanical properties, structural variables and mineral composition of deer antlers grown in a game estate (LM) after freezing temperatures (late winter frosts, LWF), which resulted in high incidence of antler fractures despite being grown later in the year, and those grown after a standard winter (SW). Within each year, specimens from broken and intact antlers were assessed. LWF was associated with reduced impact energy (U) and somewhat reduced work to peak force (W), Young's modulus (E) and physical density, as well as cortical thickness. LWF was associated with considerably increased Si and reduced Na. In each year, broken antlers had lower Mn, P and physical density, and they had more Na and B than unbroken antlers. Because no such effect was found in farmed deer fed whole meal, and because freezing in plants usually produces an increase in Si content, which in turn reduces Mn, it is likely that LWF produced a diet rich in Si and low in Mn. Because antlers are grown transferring calcium phosphate from the own skeleton and Ca/P levels were slightly reduced, it seems likely that Mn reduction may have increased antler fractures. A comparison between farm deer and those in another game estate (LI) also shows a link between lower Mn content and lower W. Thus, small changes in minor bone minerals, probably induced by diet, may have marked effects in mechanical properties of bone.

Seasonal variations in plant mineral content and free-choice minerals consumed by deer

The aim of this study was to assess the seasonal differences in mineral contents of plants often consumed by wild red deer located in a fenced game estate, south-eastern Spain. Forage plants were sampled throughout 1 year and analysed for macro and trace mineral concentrations. We also offered a cafeteria set of supplemented minerals to assess whether: (i) intake reflected seasonal reductions in plant content of specific minerals; or (ii) intake of mineral supplements responded to increased deer demand of minerals as a result of greater seasonal needs likely arising from lactation, antler growth or skeletal growth. Although no significant seasonal trend was found in mineral distributions of plants, our study suggested that concentrations of K, Mg, Mn, Na, P, Cu and Zn were usually low in plants available to, and consumed by, deer in the study area. In addition, Cu concentration was marginally deficient when compared with the published requirements for other subspecies of red deer. The cafeteria study showed that free-ranging deer had a strong preference for sodium compounds and zinc sulfate, a much weaker attraction to calcium iodate, and no intake in calcium phosphates, Mg and Fe. Consumption of supplemented minerals by deer was maximum in spring and summer and moderate during autumn and winter. Rather than increasing intake of minerals in response to their content in plants, deer may be responding to increased metabolic requirements during antler growth, late gestation and early lactation. Supplementation of mineral compounds is recommended, particularly in the spring–summer period, when the physiological activity is high.

The mechanical properties of red deer antler bone when used in fighting

We assessed the hydration state of antlers and its effect on antler mechanical properties compared with wet femur. Red deer antlers were removed from the head at various times, from a few days after velvet shedding till late in the season, and weighed weekly until after casting time. Antlers cut just after losing their velvet lost weight rapidly in the first few weeks, then settled down and changed weight very little, the latter changes correlating with air relative humidity. Antlers cut later showed little weight change at any time. The water content of cortical and trabecular parts of the contralateral antler was assessed after cutting. Most of the weight loss was from the cancellous, not the cortical, part of the antler. Wet and dry specimens from the antlers, and wet specimens from deer femora, were tested mechanically. Compared with wet bone, wet antler had a much lower modulus of elasticity and bending strength, but a higher work to fracture. Compared with wet bone, dry antler showed a somewhat lower Young's modulus, but a considerably higher bending strength and a much higher work to fracture. The impact energy absorption of dry antler was much greater than that of wet bone. In red deer, the antler is effectively dry during its use in fights, at least in southern Spain. In addition, dry antler, compared with ordinary bone, shows mechanical properties that suit it admirably for its fighting function.

Effect of milk minerals on calf gains and sex differences in mineral composition of milk from Iberian red deer (Cervus elaphus hispanicus)

Milk mineral content has received little attention in studies focusing on milk nutrient effects on offspring growth. This study examines calf growth in Iberian deer and compares the influence of milk minerals, other nutrients, and lactation variables relevant for growth to discern the relative weight of each factor. In addition, because Iberian deer hinds are the first mammal found to produce different milk for sons and daughters, the present study examines whether there are also sex differences in milk mineral composition. Concentrations and yields of Ca, P, Mg, Na, K, Fe, and Zn in milk of 46 red deer hinds were monitored through 18 weeks of lactation. Calf growth was influenced by Ca and P percent, and total Fe production. Milk for males had a lower content in Ca and P, a greater content of K, and Mg, whereas no sex effects were found in Na, Fe, or Zn percentages. Higher percentages in Ca and P for daughters might constitute a compensatory response, as daily production was not biased towards females in Ca or P, whereas in the latter and all the other minerals daily production was greater for heavier calves, which are usually males. In conclusion, milk mineral content and production influence calf growth even after controlling for other important lactation variables and nutrients, and they show effects and interactions more complicated than expected.

Oral bisphosphonates-associated osteonecrosis in rheumatoid arthritis

Adverse effects associated with the use of bisphosphonates are infrequent and consist of pyrexia, renal function impairment, and hypocalcemia. Bisphosphonates-associated osteonecrosis of the jaws is an uncommon but potentially serious complication of intravenous bisphosphonate therapy in cancer patients. The degree of risk for osteonecrosis in patients taking oral bisphosphonates, such as alendronate, is uncertain and warrants careful monitoring. Oral bisphosphonates-associated osteonecrosis can occur in patients with rheumatoid arthritis. We report a case of mandibular osteonecrosis in a patient who received alendronate for 3.8 years. The pathology improved after bisphosphonate therapy discontinuation and sequestrectomy. To our knowledge there are only three cases published in the literature relating bisphosphonates-associated osteonecrosis of the jaws in patients with rheumatoid arthritis. All the cases published, including our case, have reported association between methotrexate, prednisone and alendronate sodium (Fosamax) therapy. Corticosteroid therapy and dental surgery could increase the risk of developing bisphosphonates-associated osteonecrosis of the jaws in these patients.

Age-related body weight constraints on prenatal and milk provisioning in Iberian red deer (Cervus elaphus hispanicus) affect allocation of maternal resources

Maternal phenotypic characteristics can influence key life history variables of their offspring through maternal effects. In this study, we examined how body size constraints on maternal weight in yearling and subadult compared to adult hinds (age class effects) affected prenatal (calf birth weight, calf to hind weight ratio) and postnatal (milk) provisioning of Iberian red deer calves. Age correlated with all prenatal and postnatal investment traits except calf gains, although correlations were weaker than those with maternal weight. Once the effect of linear increase in weight with age was removed from models, yearlings showed additional reductions in calf birth weight, calf gains, and milk provisioning. The low-calf birth weight might increase the risk of calf mortality during lactation, as this occurs primarily during the first day of life and is strongly related to birth weight. Yearlings showed a greater prenatal allocation of resources in terms of greater calf to hind weight ratio probably as an extra effort by yearling mothers to balance calf neonatal mortality. It might compensate young mothers to produce low-quality calves while still growing rather than waiting for the uncertain possibility of surviving to the next reproductive season.