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Chylopericardium is a rare complication after cardiac transplantation. We report a case of a 69-year-old woman with persistent chylopericardium after a heart transplantation due to Chagas disease. Failure of conservative treatment led to dynamic contrast-enhanced magnetic resonance lymphangiography and percutaneous radiologic intervention of the lymphatic leakage and symptoms resolution.

Rationale and objectives: Increased central (aortic) arterial stiffness has hemodynamic repercussions that affect the incidence of cardiovascular and renal disease. In chronic kidney disease (CKD) there may be an increase in aortic stiffness secondary to multiple metabolic alterations including calcification of the vascular wall (VC).The objective of this study was to analyze the association of central aortic pressures and aortic stiffness with the presence of VC in abdominal aorta (AAC) and coronary arteries(CAC). Materials and methods: We included 87 pacientes with CKD stage 3 and 4. Using applanation tonometry, central aortic pressures and aortic stiffness were studied. We investigated the association of aortic pulse wave velocity (Pvc-f) and Pvc-f adjusted for age, blood pressure, sex and heart rate (Pvc-f index) with AAC obtained on lumbar lateral radiography and CAC assessed by multidetector computed tomography. AAC and CAC were scored according to Kauppila and Agatston methods, respecti-vely. For the study of the association between Pvc-f index, Kauppila score, Agatston score, central aortic pressures, clinical parameters and laboratory data, multiple and logistic regression were used. We investigated the diagnosis performance of the Pvc-f index for prediction of VC using receiver-operating characteristic (ROC). Results: Pvc-f and Pvc-f index were 11.3 ± 2.6 and 10.6 m/s, respectively. The Pvc-f index was higher when CKD coexisted with diabetes mellitus (DM). AAC and CAC were detected in 77% and 87%, respectively.Albuminuria (β = 0.13, p = 0.005) and Kauppila score (β = 0.36, p = 0.001) were independently associated with Pvc-f index. In turn, Pvc-f index (β = 0.39, p = 0.001), DM (β = 0.46, p = 0.01), and smoking (β = 0.53; p = 0.006) were associated with Kauppila score, but only Pvc-f index predicted AAC [OR: 3.33 (95% CI: 1.6−6.9; p = 0.001)].The Kauppila score was independently associated with the Agatston score (β = 1.53, p = 0.001). The presence of AAC identified patients with CAC with a sensitivity of 73%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 38%.The Vpc-f index predicted the presence of CAC [OR: 3.35 (95% CI: 1.04−10.2, p = 0.04)]. In the ROC curves, using the Vpc-f index, the AUC for AAC and CAC was 0.82 (95%CI: 0.71−0.93, p = 0.001) and 0.81 (95% CI: 0.67–0.96, p = 0.02), respectively. Conclusions: When stage 3–4 CKD coexists with DM there is an increase in aortic stiffness determined by the Vpc-f index. In stage 3–4 CKD, AAC and CAC are very prevalent and both often coexist. The Vpc-f index is independently associated with AAC and CAC and may be useful in identifying patients with VC in these territories. Resumen: Fundamento y objetivos: El aumento de la rigidez arterial central (aórtica) tiene repercusiones hemodinámicas con efectos nocivos cardiovasculares y renales. En la enfermedad renal crónica (ERC) puede existir un aumento de la rigidez aórtica secundaria a múltiples alteraciones metabólicas entre ellas la calcificación de la pared vascular (CV).El objetivo de este estudio fue analizar la asociación de la rigidez aórtica y de la hemodinámica central con la presencia de CV en dos territorios, aorta abdominal (CAA) y arterias coronarias (CC). Material y métodos: Se incluyeron 87 pacientes con ERC estadio 3 y 4. Usando tonometría de aplanamiento se estudiaron la hemodinámica central y la rigidez aórtica. Esta se determinó mediante la velocidad de pulso carótida-femoral (Vpc-f). A partir de la Vpc-f se calculó el índice de la VPc-f (iVpc-f) que considera otras variables que influyen en la Vpc-f como edad, presión arterial, sexo y frecuencia cardiaca.La presencia de CAA se valoró mediante radiográfía lateral de columna lumbar calculándose el índice de Kauppila (iKauppila) y las CC mediante tomografía computarizada multidetección por el método de Agatston calculándose su índice (iAgatston).Para el estudio de la asociación entre iVpc-f, iKauppila, iAgatston, presión aórtica central, parámetros clínicos y datos de laboratorio se usaron la regresión múltiple y la regresión logística. La capacidad discrimitativa del iVpc–f para evaluar la presencia de CAA y CC se determinó mediante el área bajo la curva (ABC) de ROC (receiver-operating characteristic). Resultados: La Vpc-f y el iVpc-f fueron 11,3 ± 2,6 y 10,6 m/s, respectivamente. El iVpc-f fue mayor cuando la ERC coexistía con diabetes mellitus (DM). Se detectaron CAA y CC en 77% y 87%, respectivamente.La albuminuria (β = 0,13, p = 0,005) y el iKauppila (β = 0,36, p = 0,001) se asociaron de forma independiente con la magnitud del iVpc-f. A su vez, el iVpc-f (β = 0,39, p = 0,001), la DM (β = 0,46, p = 0,01) y el tabaquismo (β = 0,53; p = 0,006) se asociaron con la intensidad del iKauppila, pero solo el iVpc-f predijo la existencia de CAA [(OR: 3,33 (IC 95%: 1,6-6,9; p = 0,001)].El iKauppila se asoció de forma independiente con el iAgatston (β = 1,53, p = 0,001). La presencia de CAA identificó pacientes con CC con una sensibilidad del 73%, una especificidaddel 100%, un valor predictivo positivo del 100% y un valor predictivo negativo del 38%.El iVpc-f predecía la presencia de CC [OR: 3,35 (IC 95%:1,04-10,2, p = 0,04)]. En las curvasROC, usando el iVpc-f, el ABC para las CAA y CC fue 0,82 (IC 95%: 0,71–0,93, p = 0,001) y 0,81(IC 95%: 0,67-0,96, p = 0,02), respectivamente. Conclusiones: Cuando la ERC se asocia con DM hay un aumento de la rigidez aórtica determinada por el iVpc-f. En la ERC estadios 3-4 son muy prevalentes las CAA y CC que, con mucha frecuencia, coexisten. El iVpc-f se asocia de forma independiente con las CAA y CC, y puede ser útil para identificar pacientes con CV en estos territorios.

Resumen: Fundamento y objetivos: El aumento de la rigidez arterial central (aórtica) tiene repercusiones hemodinámicas con efectos nocivos cardiovasculares y renales. En la enfermedad renal crónica (ERC) puede existir un aumento de la rigidez aórtica secundaria a múltiples alteraciones metabólicas, entre ellas la calcificación de la pared vascular (CV).El objetivo de este estudio fue analizar la asociación de la rigidez aórtica y de la hemodinámica central con la presencia de CV en dos territorios: aorta abdominal (CAA) y arterias coronarias (CC). Material y métodos: Se incluyeron 87 pacientes con ERC estadios 3 y 4. Usando tonometría de aplanamiento se estudiaron la hemodinámica central y la rigidez aórtica. Esta se determinó mediante la velocidad de pulso carótida-femoral (Vpc-f). A partir de la Vpc-f se calculó el índice de la VPc-f (iVpc-f) que considera otras variables que influyen en la Vpc-f, como edad, presión arterial, sexo y frecuencia cardiaca.La presencia de CAA se valoró mediante radiografía lateral de columna lumbar calculándose el índice de Kauppila (iKauppila) y las CC mediante tomografía computarizada multidetección por el método de Agatston, calculándose su índice (iAgatston).Para el estudio de la asociación entre iVpc-f, iKauppila, iAgatston, presión aórtica central, parámetros clínicos y datos de laboratorio se usaron la regresión múltiple y la regresión logística. La capacidad discriminativa del iVpc-f para evaluar la presencia de CAA y CC se determinó mediante el área bajo la curva (ABC) de ROC (receiver-operating characteristic). Resultados: La Vpc-f y el iVpc-f fueron 11,3 ± 2,6 m/s y 10,6 m/s, respectivamente. El iVpc-f fue mayor cuando la ERC coexistía con diabetes mellitus (DM). Se detectaron CAA y CC en el 77% y el 87%, respectivamente.La albuminuria (β = 0,13, p = 0,005) y el iKauppila (β = 0,36, p = 0,001) se asociaron de forma independiente con la magnitud del iVpc-f. A su vez, el iVpc-f (β = 0,39, p = 0,001), la DM (β = 0,46, p = 0,01) y el tabaquismo (β = 0,53; p = 0,006) se asociaron con la intensidad del iKauppila, pero solo el iVpc-f predijo la existencia de CAA [(OR: 3,33 (IC 95%: 1,6-6,9; p = 0,001)].El iKauppila se asoció de forma independiente con el iAgatston (β = 1,53, p = 0,001). La presencia de CAA identificó pacientes con CC con una sensibilidad del 73%, una especificidad del 100%, un valor predictivo positivo del 100% y un valor predictivo negativo del 38%.El iVpc-f predecía la presencia de CC [OR: 3,35 (IC 95%:1,04-10,2, p = 0,04)]. En las curvas ROC, usando el iVpc-f, el ABC para las CAA y CC fue 0,82 (IC 95%: 0,71-0,93, p = 0,001) y 0,81 (IC 95%: 0,67-0,96, p = 0,02), respectivamente. Conclusiones: Cuando la ERC se asocia con DM hay un aumento de la rigidez aórtica determinada por el iVpc-f. En la ERC estadios 3-4 son muy prevalentes las CAA y CC que, con mucha frecuencia, coexisten. El iVpc-f se asocia de forma independiente con las CAA y CC, y puede ser útil para identificar pacientes con CV en estos territorios. Abstract: Rationale and objectives: Increased central (aortic) arterial stiffness has hemodynamic repercussions that affect the incidence of cardiovascular and renal disease. In chronic kidney disease (CKD) there may be an increase in aortic stiffness secondary to multiple metabolic alterations including calcification of the vascular wall (VC).The objective of this study was to analyze the association of central aortic pressures and aortic stiffness with the presence of VC in abdominal aorta (AAC) and coronary arteries (CAC). Materials and methods: We included 87 patients with CKD stage 3 and 4. Using applanation tonometry, central aortic pressures and aortic stiffness were studied. We investigated the association of aortic pulse wave velocity (Pvc-f) and Pvc-f adjusted for age, blood pressure, sex and heart rate (Pvc-f index) with AAC obtained on lumbar lateral radiography and CAC assessed by multidetector computed tomography. AAC and CAC were scored according to Kauppila and Agatston methods, respectively. For the study of the association between iPvc-f index, Kauppila score, Agatston score, central aortic pressures, clinical parameters and laboratory data, multiple and logistic regression were used. We investigated the diagnosis performance of the Pvc-f index for prediction of VC using receiver-operating characteristic (ROC). Results: Pvc-f and Pvc-f index were 11.3 ± 2.6 m/s and 10.6 m/s, respectively. The Pvc-f index was higher when CKD coexisted with diabetes mellitus (DM). AAC and CAC were detected in 77% and 87%, respectively.Albuminuria (β = 0.13, p = 0.005) and Kauppila score (β = 0.36, p = 0.001) were independently associated with Pvc-f index. In turn, Pvc-f index (β = 0.39, p = 0.001), DM (β = 0.46, p = 0.01), and smoking (β = 0.53; p = 0.006) were associated with Kauppila score, but only Pvc-f index predicted AAC [OR: 3.33 (95% CI: 1.6–6.9; p = 0.001)].The Kauppila score was independently associated with the Agatston score (β = 1.53, p = 0.001). The presence of AAC identified patients with CAC with a sensitivity of 73%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 38%.The Vpc-f index predicted the presence of CAC [OR: 3.35 (95% CI: 1.04–10.2, p = 0.04)]. In the ROC curves, using the Vpc-f index, the AUC for AAC and CAC was 0.82 (95% CI: 0.71–0.93, p = 0.001) and 0.81 (95% CI: 0.67–0.96, p = 0.02), respectively. Conclusions: When stage 3–4 CKD coexists with DM there is an increase in aortic stiffness determined by the Vpc-f index. In stage 3–4 CKD, AAC and CAC are very prevalent and both often coexist. The Vpc-f index is independently associated with AAC and CAC and may be useful in identifying patients with VC in these territories.

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

Steel cross-sections with thin walls are vulnerable to fire-induced buckling instability, which reduces their load-bearing capacity. Eurocode 3 design provisions have been found inadequate, leading to alternative methods such as effective design strategies and advanced structural models built mostly with shell FE, which can be complex. For Class 4 steel beam-columns subjected to fire conditions, beam-type modelling to predict the Flexural-Torsional Buckling (FTB) strength has been proposed as an alternative approach, but it has not yielded satisfactory results for large compressive load eccentricities. This paper presents two new low computational cost modelling strategies based on Timoshenko's beam FE to address this issue: the Single beam-column Model (SbcM) and the Cruciform beam-column Model (CbcM). The first consists of a single line of beam FE, while the second uses a grid of beam FE for more flexibility. Both strategies effectively simulate the FTB behaviour in Class 4 steel beam-column during a fire, offering quicker computations compared to shell models. Still, the single-line model is favoured for its simplicity, making it more efficient in analysing complex fire engineering problems.

Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports. Resumen: Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro pais. El control adecuado de las alteraciones del metabolismo lipidico es un reto clave en prevencion cardiovascular que esta lejos de alcanzarse en la practica clinica real. Existe una gran heterogeneidad en los informes del metabolismo lipidico de los laboratorios clinicos españoles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades cientificas implicadas en la atencion de los pacientes de riesgo vascular hemos elaborado este documento con una propuesta basica de consenso sobre la determinacion del perfil lipidico basico en prevencion cardiovascular, recomendaciones para su realizacion y unificacion de criterios para incorporar los objetivos de control lipidico adecuados al riesgo vascular de los pacientes en los informes de laboratorio.

Resumen: Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro país. El control adecuado de las alteraciones del metabolismo lipídico es un reto clave en prevención cardiovascular que está lejos de alcanzarse en la práctica clínica real. Existe una gran heterogeneidad en los informes del metabolismo lipídico de los laboratorios clínicos españoles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades científicas implicadas en la atención de los pacientes de riesgo vascular hemos elaborado este documento con una propuesta básica de consenso sobre la determinación del perfil lipídico básico en prevención cardiovascular, recomendaciones para su realización y unificación de criterios para incorporar los objetivos de control lipídico adecuados al riesgo vascular de los pacientes en los informes de laboratorio. Abstract: Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.

Introdução/Objetivos: As infecções do trato urinário (ITU) são infecções bacterianas comuns e o uso empírico de antimicrobianos na comunidade é crescente, principalmente da fosfomicina oral. Para determinar os principais uropatógenos, avaliamos os resultados de uroculturas de pacientes atendidos em UBS, a suscetibilidade à fosfomicina e aos carbapenêmicos e a frequência da prescrição de fosfomicina oral. Métodos: Os dados da cultura de urina foram obtidos do Programa Matrix Diagnosis durante janeiro a dezembro de 2021. A identificação foi realizada por sistema automatizado BD Phoenix e os antibiogramas interpretados de acordo com BrCAST. A detecção de carbapenemases foi confirmada por método imunocromatográfico RESIST-3 Coris BioConcept. O método de disco-difusão para fosfomicina foi comparado à diluição em ágar. Os dados epidemiológicos e clínicos foram avaliados usando EpiInfo. Resultados: Foram realizadas 56.949 uroculturas em 2021 em 34 UBS, localizadas na cidade de São Bernardo do Campo/SP. Resultados positivos foram detectados em 12,9% de 6.033 pacientes (87,3% mulheres; idade média 49,3; mediana 50). Entre 7.264 culturas positivas, 61,4% apresentaram crescimento de E. coli, 8,6% de K. pneumoniae e 8% de E. faecalis. Um total de 1,1% de isolados bacterianos resistentes à fosfomicina foi obtido de diferentes pacientes (75% mulheres; idade média 57,7). K. pneumoniae foi identificada em 38,75% e E. coli em 30%. 22,5% de Enterobacterales foram resistentes a pelo menos um carbapenêmico, sendo 10% produtores de carbapenemase KPC e 12,5% ESBL positivos. As CIMs da fosfomicina variaram de 0,25 a 256 ug/mL. Apenas 8,75% de erros graves foram encontrados no método de difusão em disco (nenhum erro muito grave). Durante o ano de 2021, foram prescritos 1.917 sachês de fosfomicina oral em dose única em todas as UBS (média de 161,5/mês). Sete isolados resistentes à fosfomicina foram detectados na UBS Alvarenga, onde foram dispensados 161 sachês. Entre 44 pacientes que responderam a um questionário, 68,2% relataram ITU recorrente e 50% usaram antimicrobianos nos últimos 6 meses. Apenas um paciente recebeu fosfomicina oral devido a ITU recorrente. Conclusões: E. coli ainda é o uropatógeno mais frequente e a resistência aos carbapenêmicos foi detectada nas UBS. A triagem para resistência à fosfomicina pode ser feita por difusão em disco, uma técnica boa e simples. A resistência à fosfomicina é incomum e ainda pode ser usada para tratamento de ITU em UBS brasileiras.

Resumen: La lectura de los parches de pruebas epicutáneas no es sencilla, presenta una gran variabilidad inter- e intraobservador y requiere experiencia. En ocasiones es realmente difícil determinar si se trata de una reacción alérgica de intensidad leve o si estamos ante una reacción irritativa. Recientemente se han publicado algunos trabajos que han estudiado las características dermatoscópicas de las distintas reacciones que se producen tras realizar pruebas epicutáneas. La característica dermatoscópica más frecuentemente observada en los parches alérgicos es el eritema homogéneo, si bien vasos puntiformes, vesículas o costras y áreas amarillo-anaranjadas también parecen indicar una reacción alérgica, guardando cierta similitud con lo observado en patología inflamatoria como en el eccema. Por otro lado, en cuanto a las reacciones irritativas, el patrón más indicativo sería el «patrón del poro», acompañado de eritema perifolicular. Estos hallazgos dermatoscópicos pueden ser de utilidad al clínico en su toma de decisiones ante una reacción dudosa. Abstract: Interpreting patch test reactions is not easy. It requires experience and is characterized by high intraobserver and interobserver variability. It can sometimes be truly difficult to discern between a weak allergic reaction and an irritant reaction. A number of recent studies have investigated the dermoscopic features of patch test reactions. Homogeneous erythema is the main feature observed in patients with a positive allergic reaction, although dotted vessels, vesicles, crusts and yellow-orange areas may also provide clues. These features are somewhat similar to those observed in inflammatory conditions, such as eczema. In patients with an irritant reaction, the most common dermoscopic findings are the pore reaction pattern and perifollicular erythema. Dermoscopy could be useful for establishing a diagnosis in the case of doubtful patch test reactions.

Summary: Background: Isolated pulmonary embolism (PE) appears to be associated with a specific clinical profile and sequelae compared to deep vein thrombosis (DVT)-associated PE. The objective of this study was to identify clinical characteristics that discriminate both phenotypes, and to characterize their differences in clinical outcome. Methods: We performed a systematic review and meta-analysis of studies comparing PE phenotypes. A systematic search of the electronic databases PubMed and CENTRAL was conducted, from inception until January 27, 2023. Exclusion criteria were irrelevant content, inability to retrieve the article, language other than English or German, the article comprising a review or case study/series, and inappropriate study design. Data on risk factors, clinical characteristics and clinical endpoints were pooled using random-effects meta-analyses. Findings: Fifty studies with 435,768 PE patients were included. In low risk of bias studies, 30% [95% CI 19–42%, I2 = 97%] of PE were isolated. The Factor V Leiden [OR: 0.47, 95% CI 0.37–0.58, I2 = 0%] and prothrombin G20210A mutations [OR: 0.55, 95% CI 0.41–0.75, I2 = 0%] were significantly less prevalent among patients with isolated PE. Female sex [OR: 1.30, 95% CI 1.17–1.45, I2 = 79%], recent invasive surgery [OR: 1.31, 95% CI 1.23–1.41, I2 = 65%], a history of myocardial infarction [OR: 2.07, 95% CI 1.85–2.32, I2 = 0%], left-sided heart failure [OR: 1.70, 95% CI 1.37–2.10, I2 = 76%], peripheral artery disease [OR: 1.36, 95% CI 1.31–1.42, I2 = 0%] and diabetes mellitus [OR: 1.23, 95% CI 1.21–1.25, I2 = 0%] were significantly more frequently represented among isolated PE patients. In a synthesis of clinical outcome data, the risk of recurrent VTE in isolated PE was half that of DVT-associated PE [RR: 0.55, 95% CI 0.44–0.69, I2 = 0%], while the risk of arterial thrombosis was nearly 3-fold higher [RR: 2.93, 95% CI 1.43–6.02, I2 = 0%]. Interpretation: Our findings suggest that isolated PE appears to be a specific entity that may signal a long-term risk of arterial thrombosis. Randomised controlled trials are necessary to establish whether alternative treatment regimens are beneficial for this patient subgroup. Funding: None.

Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.

Interpreting patch test reactions is not easy. It requires experience and is characterized by high intraobserver and interobserver variability. It can sometimes be truly difficult to discern between a weak allergic reaction and an irritant reaction. A number of recent studies have investigated the dermoscopic features of patch test reactions. Homogeneous erythema is the main feature observed in patients with a positive allergic reaction, although dotted vessels, vesicles, crusts and yellow-orange areas may also provide clues. These features are somewhat similar to those observed in inflammatory conditions, such as eczema. In patients with an irritant reaction, the most common dermoscopic findings are the pore reaction pattern and perifollicular erythema. Dermoscopy could be useful for establishing a diagnosis in the case of doubtful patch test reactions. Resumen: La lectura de los parches de pruebas epicutáneas no es sencilla, presenta una gran variabilidad inter- e intraobservador y requiere experiencia. En ocasiones es realmente difícil determinar si se trata de una reacción alérgica de intensidad leve o si estamos ante una reacción irritativa. Recientemente se han publicado algunos trabajos que han estudiado las características dermatoscópicas de las distintas reacciones que se producen tras realizar pruebas epicutáneas. La característica dermatoscópica más frecuentemente observada en los parches alérgicos es el eritema homogéneo, si bien vasos puntiformes, vesículas o costras y áreas amarillo-anaranjadas también parecen indicar una reacción alérgica, guardando cierta similitud con lo observado en patología inflamatoria como en el eccema. Por otro lado, en cuanto a las reacciones irritativas, el patrón más indicativo sería el «patrón del poro», acompañado de eritema perifolicular. Estos hallazgos dermatoscópicos pueden ser de utilidad al clínico en sutoma de decisiones ante una reacción dudosa.

Plutonium is a radioactive element widely used as an energy source and further employed in military applications. Although global stockpiles of plutonium have increased with time, the toxicological profile of this metal has only been partially characterized. The vast majority of studies have focused on either the biodistribution of plutonium following internal contamination, or the identification of important proteins involved in plutonium uptake within the body. Thus, an enhanced knowledge of the metal biology may improve future therapeutic approaches to mitigate uncontrolled releases of plutonium. Herein, we have employed genome-wide toxicogenomics to assess the biological functions and response mechanisms disrupted by plutonium in vivo. Microarray gene expression was used to identify the differentially expressed genes in liver, kidneys and lungs after internal contamination of Swiss-Webster mice with plutonium. Functional analysis revealed that plutonium altered immune and inflammatory responses and lipid homeostasis, likely as a consequence of radiation-induced damage and the disruption of metal-regulated processes. Moreover, protein-protein interaction network analysis identified several key proteins associated with cellular responses to plutonium-induced damage, including ribosome biosynthesis, cell proliferation inhibition, DNA repair and glycolysis upregulation. Lastly, real-time quantitative polymerase chain reaction was used to corroborate microarray results and analyze the effects of plutonium dosing and time of exposure. This study provides substantial context for the further development of novel therapeutics and prophylactics targeting the effects of Pu isotopes by identifying the key genes and proteins that are important to specific biological functions and cellular mechanisms.

Resumen: Introducción: Existen vacíos de información respecto a la relación entre las tecnologías y el burnout en los médicos residentes. Objetivo: Evaluar el uso de dispositivos móviles y redes sociales, y su incidencia en el burnout. Material y métodos: Estudio transversal multicéntrico. La muestra integró 212 residentes de 15 especialidades médicas. Se aplicó un cuestionario, validado mediante juicio de expertos y análisis de consistencia interna, obteniéndose un α de Cronbach de 0,94. El instrumento integró 28 variables simples: 6 respecto al uso de dispositivos móviles y redes sociales, y 22 del burnout (agotamiento emocional, despersonalización y baja realización personal) obtenidas del Maslach Burnout Inventory. Se evaluaron con escala Likert 0-6. La información se analizó mediante 3 análisis estadísticos: descriptivo, correlacional y prueba T, utilizando SPSS v.22. Resultados: Los médicos residentes muy frecuentemente utilizan dispositivos móviles durante el horario laboral (5,04), y con frecuencia redes sociales (3,97). Respecto al burnout, los residentes presentan una puntuación de 23,51 en agotamiento emocional, 7,7 en despersonalización y 32,79 en realización personal. Asimismo, se observó correlación significativa (p ≤ 0,01) entre el uso de redes sociales, agotamiento emocional (22,2%) y despersonalización (20%). El uso de dispositivos móviles mostró una relación significativa con la realización personal (50%). La prueba T respecto a género mostró diferencias significativas (p ≤ 0,05) en endurecimiento emocional (despersonalización) (t = 1,99). Los hombres lo presentan más. Discusión: Existe una correlación significativa entre el uso de redes sociales y la presencia de sintomatología de burnout. También, entre el uso de dispositivos móviles y una alta realización personal, lo cual pudiera ser una paradoja. Abstract: Introduction: There are information gaps regarding the relationship between technologies and burnout in medical residents. Objective: To evaluate the use of mobile devices, social networks and their incidence in burnout. Material and methods: Multicentric cross-sectional study. The sample included 212 residents of 15 medical specialties. A questionnaire was applied and validated by: expert judgment and internal consistency analysis, obtaining a Cronbach's α of 0.94. The instrument integrated 28 simple variables: 6 regarding the use of mobile devices, social networks and 22 of burnout (emotional exhaustion, despersonalization and low personal accomplishment) obtained from Maslach Burnout Inventory. They were evaluated with Likert scale 0-6. The information was analyzed through 3 statistical analyzes: descriptive, correlational and T test; using SPSS v.22. Results: Medical residents frequently use mobile devices during working hours (5.04), and often use social networks (3.97). Regarding burnout, medical residents show a score of 23.51 in emotional exhaustion, 7.7 in despersonalization and 32.79 in personal accomplishment. There is significant correlation (P ≤ .01) between the use of social networks, emotional exhaustion (22.2%) and despersonalization (20%). The use of mobile devices showed a significant relationship with personal accomplishment (50%). The T test with respect to gender showed significant differences (P ≤ .05) in emotional hardening (despersonalization) (t = 1.99). Men present it more. Discussion: There is a significant correlation between the use of social networks and the presence of burnout symptomatology. Also, between the use of mobile devices and high personal accomplishment, which could be a paradox.

Introduction: One of the challenges for teachers in the health area is competency assessment. The OSCE is designed to assess the performance of students in specific clinical situations. The objective of this study was to assess the level of achievement of the competencies proposed in the graduates' profile by applying the OSCE with socioformative rubrics and assessing their relationship with the written final exam and the general average of the degree. Method: A cross-sectional study was carried out with graduates of the career of medicine; in which an OSCE was applied as part of its degree exam. The rubrics were the instrument that was applied to assess competencies. Results: The significant differences between the students who applied the OSCE in the month of January compared to May, were also observed in the results of the written exam, which indicates that the students of the 4th. OSCE developed in better way their skills during their training process. The correlational analysis highlights a significant positive correlation between the average of the OSCE and the average of the written exam of the students, which makes it clear that an adequate performance in the written exam that assesses the theoretical knowledge is related to an adequate performance in the clinical skills demonstrated in the OSCE. Conclusion: The OSCE, is an objective and reliable test, suitable as part of the professional exam of the career of medicine; with the use of the rubric, it is possible to determine the level of achievement with which the student graduates. Resumen: Introducción: uno de los retos para los docentes en el área de la salud es la evaluación de las competencias. La ECOE se diseñó para evaluar el desempeño de los estudiantes en situaciones clínicas específicas. El objetivo de este estudio es evaluar el nivel de logro de las competencias propuestas en el perfil de egreso a través de la aplicación del ECOE con rubricas socioformativas y evaluar su relación con el examen final escrito y el promedio general de la carrera. Método: Se realizó un estudio transversal con egresados de la carrera de medicina. Se aplicó una ECOE como parte de su examen de grado. Las rúbricas socioformativas fueron el instrumento que se aplicó para evaluar las competencias. Resultados: Las diferencias significativas entre los estudiantes que realizaron la ECOE en el mes de enero respecto a mayo, también se observaron en los resultados del examen escrito, lo que indica que los estudiantes del 4to. ECOE desarrollaron mejor sus competencias durante su proceso formativo. El análisis correlacional destaca una correlación positiva significativa entre la media de la ECOE y la media del examen escrito de los estudiantes, lo que deja claro que un desempeño adecuado en el examen escrito que evalúa los conocimientos teóricos se relaciona con un desempeño adecuado en las habilidades clínicas demostradas en la ECOE. Conclusión: La ECOE, es una prueba objetiva y confiable, idónea como parte del examen profesional de la carrera de medicina. Con el uso de la rúbrica socioformativa se puede determinar el nivel de logro con el que egresa el estudiante.

Summary: Overlapping clinical phenotypes and an expanding breadth and complexity of genomic associations are a growing challenge in the diagnosis and clinical management of Mendelian disorders. The functional consequences and clinical impacts of genomic variation may involve unique, disorder-specific, genomic DNA methylation episignatures. In this study, we describe 19 novel episignature disorders and compare the findings alongside 38 previously established episignatures for a total of 57 episignatures associated with 65 genetic syndromes. We demonstrate increasing resolution and specificity ranging from protein complex, gene, sub-gene, protein domain, and even single nucleotide-level Mendelian episignatures. We show the power of multiclass modeling to develop highly accurate and disease-specific diagnostic classifiers. This study significantly expands the number and spectrum of disorders with detectable DNA methylation episignatures, improves the clinical diagnostic capabilities through the resolution of unsolved cases and the reclassification of variants of unknown clinical significance, and provides further insight into the molecular etiology of Mendelian conditions.

Objectives: This study aimed to evaluate the susceptibility of clinical isolates of Enterobacterales and Pseudomonas aeruginosa to fosfomycin and to determine the concordance of disk diffusion (DD) and broth microdilution (BMD) with agar dilution (AD) for fosfomycin susceptibility testing. Methods: The activity of fosfomycin against 225 clinical isolates of Escherichia coli (n = 64), Klebsiella pneumoniae (n = 68), Enterobacter spp. (n = 28) and P. aeruginosa (n = 65) was tested by AD, DD and BMD. For DD, results were recorded considering and not considering colonies growing within the inhibition halo as recommended by the CLSI and EUCAST, respectively. Escherichia coli breakpoints were used for all Enterobacterales. Results were reported as categorical agreement (CA), major error (ME; false-resistant), very major error (VME; false-susceptible) and minor error (any other discrepancies). Results: Fosfomycin susceptibility of all tested species was >90% by AD. Following CLSI guidelines, DD was the only method reaching ≥90% CA with AD for E. coli and K. pneumoniae, albeit yielding 6% ME. Neither DD nor BMD achieved acceptable CA percentages for Enterobacter spp. Following EUCAST guidelines, none of the methods had CA ≥ 90%. For Enterobacterales, the best performance of DD is achieved when read as indicated by EUCAST but interpreted according the CLSI breakpoints (>97% CA; 0% VME; ≤2% ME). For P. aeruginosa, BMD yielded the best results (89% CA; 0% VME; 11% ME). Conclusion: Neither DD or BMD provide accurate results owing to unacceptable ME and VME percentages even when performed as intended by the guidelines.

Purpose: We report the case of a 33-year-old male who presented with unilateral central serous retinopathy three days after the injection of a COVID-19 vaccine. Observations: A 33-year-old healthy Hispanic male referred to the ophthalmology service due to blurry vision and metamorphopsia in the right eye without any flashes, floaters, eye redness or pain. The patient reported that 69 hours prior to presentation he received the first dose of the Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine. He denied any past ocular history or pertinent medical history. He does not take any medicines and denies stressful factors in his life. The clinical examination and imaging tests were consistent with central serous retinopathy that resolved in three months. Conclusions and importance: This is the first report of an ocular complication potentially associated with a COVID-19 vaccination. Our case contributes information of a side effect potentially related to this new vaccine.

Background: Recent studies suggest that sustained use of generic antibiotics may be associated with clinical failure and emergence of antibacterial resistance. The present study was designed to determine the clinical outcome between the use of generic meropenem (GM) and brand-name meropenem (BNM). Additionally, this study evaluated the economic impact of GM and BNM to determine if the former represents a cost-effective alternative to the latter. Methods: Patients treated between January 2011 and May 2014 received GM while patients treated between June 2014 and March 2017 received BNM. Mortality was compared between groups. Total infection cost was defined by the cost of antimicrobial consumption, length of stay, and laboratory and imaging exams until infection resolution. Findings: A total of 168 patients were included; survival rate for the 68 patients treated with GM was 38% compared to 59% in the patients treated with BNM. Multivariate analysis showed that the variables most strongly-associated with mortality were cardiovascular disease (OR 18.18, 95% CI 1.25–262.3, p = 0.033) and treatment with generic meropenem (OR 18.45, 95% CI 1.45–232.32, p = 0.024). On the other hand, total infection cost did not show a significant difference between groups (BNM $10,771 vs. GM $11,343; p = 0.91). Interpretation: The present study suggests that patients treated with GM have a risk of death 18 times higher compared to those treated with BNM. Furthermore, economic analysis shows that GM is not more cost effective than BNM. Summary: More studies measuring clinical outcomes are needed to confirm the clinical equivalence of brand-name versus generic antibiotics, not only for meropenem but also for other molecules. Keywords: Generic drugs, Meropenem, Mortality, Costs, Critical care, Gram negative bacteria

This article describes the effect of the oxidative stress inducers Angiotensin II and 6-hydroxydopamine (6-OHDA) on different cell lines. The levels of expression Angiotensin type 1 and type 2 receptors in different dopaminergic cell lines are shown. The data indicate that treatment with Angiotensin II and 6-OHDA increases the production of reactive oxygen species (ROS) and decreases cell viability. NRF2 is a transcription factor induced by ROS. We provide data that NRF2 overexpression increases cell viability in response to oxidative stress inducers compared to control cells, and that these inducers can, both separately and in combination, enhance the expression of NRF2-regulated genes heme oxygenase 1 (Hmox1), NAD(P)H quinone dehydrogenase 1 (Nqo1) and Kruppel like factor 9 (Klf9). Interpretation of these data and additional information is presented in the research article “Angiotensin II induces oxidative stress and upregulates neuroprotective signaling from the NRF2 and KLF9 pathway in dopaminergic cells“ (Parga et al., 2018) [1]. Keywords: NRF2, KLF9, Dopaminergic, Redox signaling, Oxidative stress, Renin-angiotensin system

Intratumoral heterogeneity in non–small cell lung cancer (NSCLC) has been appreciated at the histological and cellular levels, but the association of less differentiated pathology with poor clinical outcome is not understood at the molecular level. Gene expression profiling of intact human tumors fails to reveal the molecular nature of functionally distinct epithelial cell subpopulations, in particular the tumor cells that fuel tumor growth, metastasis, and disease relapse. We generated primary serum-free cultures of NSCLC and then exposed them to conditions known to promote differentiation: the air-liquid interface (ALI) and serum. The transcriptional network of the primary cultures was associated with stem cells, indicating a poorly differentiated state, and worse overall survival of NSCLC patients. Strikingly, the overexpression of RNA splicing and processing factors was a prominent feature of the poorly differentiated cells and was also observed in clinical datasets. A genome-wide analysis of splice isoform expression revealed many alternative splicing events that were specific to the differentiation state of the cells, including an unexpectedly high frequency of events on chromosome 19. The poorly differentiated cells exhibited alternative splicing in many genes associated with tumor progression, as exemplified by the preferential expression of the short isoform of telomeric repeat-binding factor 1 (TERF1), also known as Pin2. Our findings demonstrate the utility of the ALI method for probing the molecular mechanisms that underlie NSCLC pathogenesis and provide novel insight into posttranscriptional mechanisms in poorly differentiated lung cancer cells.

A series of 1 wt.% Ag–TiO2 photocatalysts were obtained by photodeposition using different organic (acetylacetonate, Ag-A) and inorganic (nitrate, Ag-N, and perchlorate, Ag-C) silver precursors in order to determinate the influence of the silver precursor on final properties of the photocatalysts. The resulting photocatalytic materials were characterized by different techniques (UV–Vis DRS, TEM/HRTEM and XPS) and their photocatalytic activity was evaluated in the degradation of rhodamine B (used as model pollutant) in aqueous solution under simulated solar light. The photocatalytic reduction of Ag species to Ag0 on TiO2 was higher with silver nitrate as precursor compared to acetylacetonate or perchlorate. All the Ag-modified TiO2 photocatalysts exhibited a surface plasmon resonance effect in the visible region (400–530 nm) indicating different metal particle sizes depending on the Ag precursor used in their synthesis. A higher photocatalytic activity was obtained with all the Ag/TiO2 samples compared with non-modified TiO2. The descending order of photocatalytic activity was as follows: Ag-A/TiO2 ≈ Ag-N/TiO2 > Ag-C/TiO2 > TiO2-P25. The enhanced photoactivity was attributed to the presence of different amounts Ag0 nanoparticles homogeneously distributed on Ag2O and TiO2, trapping the photogenerated electrons and avoiding charge recombination.

Following the entry into force of the IPPC directive, the activities that it affects, which include the ceramic sector, have needed to control fugitive particle emissions by implementing corrective measures that often entail significant economic costs. In the most demanding cases, the Integrated Environmental Authorisations (IEA) awarded to companies in the ceramic industry require total enclosure of the raw materials handling operations. This paper evaluates the technical, economic, and environmental feasibility of the implementation of a total enclosure or containment system as a way of reducing fugitive particle emissions, as this is considered one of the Best Available Techniques (BAT). The study was carried out on the raw materials reception, handling, and storage operations at a ceramic company that manufactures spray-dried powder granules.Tras la entrada en vigor de la Directiva de Prevención y Control Integrados de la Contaminación (Directiva IPPC) las actividades afectadas por la misma, incluidas las del sector cerámico, se han visto obligadas a controlar la emisión de partículas difusas mediante la implantación de medidas correctoras, que en muchos casos suponen un impacto económico significativo. En los casos más exigentes, las Autorizaciones Ambientales Integradas (AAIs) otorgadas a empresas del sector cerámico requieren el cerramiento total de las operaciones de gestión de materias primas. En el presente trabajo se evalúa la viabilidad técnica, económica y ambiental de la implantación de un sistema de cerramiento o confinamiento total como medida de reducción de emisiones difusas al considerarse una de las Mejores Técnicas Disponibles (MTDs). El estudio se ha realizado sobre una instalación de fabricación de gránulo atomizado considerando las operaciones de recepción, gestión y almacenamiento de materias primas.

Background. It has been suggested that liver cirrhosis (LC), regardless of etiology, may be associated with anatomical cardiac alterations.Objective. To describe the frequency and type of macroscopical anatomic cardiac abnormalities present in alcoholic and non-alcoholic cirrhotic patients in an autopsy series.Material and methods. The autopsy records performed at our institution during a 12-year period (1990-2002) were reviewed. All cases with final diagnosis of LC were included, their demographic characteristics as well as cirrhosis etiology and macroscopic anatomical cardiac abnormalities (MACA) analyzed. Patients with any known history of heart disease prior to diagnosis of cirrhosis were excluded.Results. A total of 1,176 autopsies were performed, of which 135 cases (11.5%) were patients with LC. Two patients with cardiac cirrhosis were excluded. Chronic alcohol abuse (29%) and chronic hepatitis due to hepatitis C virus (HCV) infection (20%) were the most common causes of cirrhosis. The etiology was not identified in 35% of the cases, even after exhaustive clinical, serological and/or radiological assessment. In the postmortem analysis, 43% of the cases were informed to have MACA (47% in the group of patients with alcoholic cirrhosis and 41% in other types of cirrhosis); this rate increased to 62% in patients with ascites. The most frequent alterations were cardiomegaly and left ventricular hypertrophy (LVH).Conclusion. The results confirm the high frequency of cardiac abnormalities in patients with cirrhosis, regardless of cirrhosis etiology.

Angiotensin II (AII) plays a major role in the progression of inflammation and NADPH-derived oxidative stress (OS) in several tissues. The brain possesses a local angiotensin system, and OS and inflammation are key factors in the progression of Parkinson's disease. In rat mesencephalic cultures, AII increased 6-OHDA-induced dopaminergic (DA) cell death, generation of superoxide in DA neurons and microglial cells, the expression of NADPH-oxidase mRNA, and the number of reactive microglial cells. These effects were blocked by AII type-1 (AT1) antagonists, NADPH inhibitors, or elimination of glial cells. DA degeneration increased angiotensin converting enzyme activity and AII levels. In rats, 6-OHDA-induced dopaminergic cell loss and microglial activation were reduced by treatment with AT1 antagonists. The present data suggest that AII, via AT1 receptors, increases the dopaminergic degeneration process by amplifying the inflammatory response and intraneuronal levels of OS, and that glial cells play a major role in this process.

Competing Interests: Declaration of competing interest The authors declare no conflicts of interest.

The Mediterranean Iberian pigs are obese genotypes, due to a leptin resistance syndrome related to leptin receptor gene polymorphisms. The Iberian pig is affected by a lower prolificacy when compared to lean breeds, and thus may constitute a good animal model for adverse effects of obesity in reproductive performance. The present study determined possible differences in rates of ovulation and embryo implantation and later incidence of embryo mortality and intrauterine growth retardation (IUGR) in sows of Iberian breed (n = 23) and highly-prolific lean commercial crosses (Large White × Landrace, n = 17) at two critical periods of swine pregnancy: Day 21 (just after achievement of trophoblast attachment) and Day 35 (just after completion of the transition from late embryo to early foetal stage). Two different reproductive performances were identified in the Iberian breed; 58.3% of the females had lower ovulation rates than LWxL (13.2 ± 2.3 vs 22.5 ± 1.6, P < 0.05), but 41.7% had a similar number of ovulations (18.2 ± 3.9). However, those Iberian sows having high ovulatory rates showed a high incidence of regression of corpora lutea and embryo losses between Days 21 and 35, which was not found in Iberian females with low ovulation rates; therefore, the number of viable embryos was similar in both Iberian groups (8.2 ± 1.0 and 8.4 ± 1.0) and lower that in highly-prolific LWxL (14.8 ± 1.8, P < 0.05). At Day 35, a total of 167 conceptuses (73 LWxL and 94 IB) were evaluated for IUGR. The LWxL conceptuses were longer and wider than Iberian (69.5 ± 0.1 and 64.4 ± 0.1 vs 49.9 ± 0.1 and 41.9 ± 0.1 mm, P < 0.0001). However, Iberian conceptuses were heavier than LWxL (107.4 ± 6.6 vs 68.6 ± 2.4 g) due to a lower quantity of fluids and a higher development of the placental tissues in comparison to the embryo itself. In conclusion, current study indicates a bimodal effect of obese genotypes on reproductive performances, either by lowering ovulation rate or by increased embryo losses in the first third of pregnancy., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The goal of the current was to elucidate if treatment with gonadotrophins and leptin can circumvent infertility in obese mice and to establish whether reproductive effects of leptin are influenced at the hypothalamus-hypophysis or ovarian level by using a leptin deficient mouse model of obesity/type 2 diabetes (ob/ob) treated with leptin. The ovulatory response and the fertilization success were compared with the results obtained in ob/ob dams pretreated with a gonadotrophin-replacement therapy or in two groups (ob/ob and wild-type) of control non-pretreated females. The number of corpora lutea was significantly lower in control ob/ob mice than in wild-type dams. Treatment with gonadotrophin-replacement therapy did not increase significantly the ovulation rate in ob/ob, but the administration of leptin-replacement treatment allowed the authors to obtain a number of corpora lutea and oocytes/zygotes similar to those obtained in wild-type females. Furthermore, the leptin supply succeeded in producing fertilized zygotes, although in a lower number than found in the wild-type control. Thus, the hypogonadotrophic state in obese mice may be circumvented by the administration of a gonadotrophin-replacement therapy combined with a protocol for controlled ovarian stimulation, but fertile ovulations are only obtained after applying leptin-replacement therapy. Current results strongly support the existence of direct local effects of leptin on the ovary., ((c) 2010 Elsevier Inc. All rights reserved.)

This study aimed to determine phenotypic changes during embryo development in the mouse, and the influence of genetic background, by non-invasive real-time ultrasonography. Serial scannings were performed from Day 4.5 after the appearance of the vaginal plug in a total of 34 adult mice of different strains (9BALB/c, 10C57BL/6 and 15 CD1). Embryonic vesicle diameter was measurable from Day 4.5 of pregnancy. Images of embryos were obtainable from Day 5.5 of gestation onwards, and crown-rump length and trunk parameters (diameter and area) were measured. At more advanced stages, the positions of fetuses prevented accurate measurement of crown-rump length; therefore, head diameters (occipito-snout length and biparietal diameter) were used as an alternative index of fetal size. All measurements correlated highly with gestational age (P<0.0005). No significant differences were observed between genotypes in early pregnancy, but during the last week of gestation trunk measurements were larger in CD1 embryos (P<0.05) while head diameters were larger in C57BL/6 conceptuses (P<0.05). There was a significant effect of genetic background on heart rate throughout pregnancy; although heart rate was similar in CD1 and C57BL/6 embryos (154.5+/-2.8 and 147.8+/-4.5 beats/min, respectively), it was significantly lower in BALB/c mice (127.0+/-2.1; P<0.005 vs. CD1 and C57BL/6).