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Abstract Single immune checkpoint blockade in advanced neuroendocrine neoplasms (NENs) shows limited efficacy; dual checkpoint blockade may improve treatment activity. Dune (NCT03095274) is a non-randomized controlled multicohort phase II clinical trial evaluating durvalumab plus tremelimumab activity and safety in advanced NENs. This study included 123 patients presenting between 2017 and 2019 with typical/atypical lung carcinoids (Cohort 1), G1/2 gastrointestinal (Cohort 2), G1/2 pancreatic (Cohort 3) and G3 gastroenteropancreatic (GEP) (Cohort 4) NENs; who progressed to standard therapies. Patients received 1500 mg durvalumab and 75 mg tremelimumab for up to 13 and 4 cycles (every 4 weeks), respectively. The primary objective was the 9-month clinical benefit rate (CBR) for cohorts 1-3 and 9-month overall survival (OS) rate for Cohort 4. Secondary endpoints included objective response rate, duration of response, progression-free survival according to irRECIST, overall survival, and safety. Correlation of PD-L1 expression with efficacy was exploratory. The 9-month CBR was 25.9%/35.5%/25% for Cohorts 1, 2, and 3 respectively. The 9-month OS rate for Cohort 4 was 36.1%, surpassing the futility threshold. Benefit in Cohort 4 was observed regardless of differentiation and Ki67 levels. PD-L1 combined scores did not correlate with treatment activity. Safety profile was consistent with that of prior studies. In conclusion, durvalumab plus tremelimumab is safe in NENs and shows modest survival benefit in G3 GEP-NENs; with one-third of these patients experiencing a prolonged OS.

Se reporta el nacimiento de la primera foca común en Cuba. Se describe la metodología de manejo de la gestante, así como las características del parto y de la cría.

Proanthocyanidins (PAC) can modulate the fatty acid (FA) profile of animal products and make them healthier for human consumption, but their effects are highly variable depending on several factors such as PAC chemical structure or dose. The present experiment aimed to evaluate the effect of PAC on the milk FA profile of Rasa Aragonesa ewes fed fresh sainfoin (PAC-containing forage legume) during the rearing period of suckling lambs (4 weeks postlambing). Twenty lactating ewes rearing a single male lamb were fed fresh sainfoin ad libitum plus 200 g/d of barley. Half the ewes were orally dosed with 100 mL of water (Sainfoin Group; n = 10) and the other half with polyethylene glycol (50 g PEG4000/100 mL water, Sainfoin + PEG Group; n = 10) to block PAC effects. Sainfoin and milk samples were collected weekly to determine their FA profile by gas chromatography. Fresh sainfoin contents of C18:3n-3 decreased from week 1 to week 2, C16:0 and C18:0 increased from week 1 to week 3, and C18:2n-6 did not change. Regarding milk FA, there were minor effects of PAC on milk-saturated FA. During the whole study, the presence of PAC increased C18:0, C18:2n-6, C18:3n-3 and total polyunsaturated FA (PUFA) n-6 and n-3, and decreased C18:1 t11, branched- and odd-chain FA. However, the decrease of milk concentrations of trans-monounsaturated FA, C18:1 t10, and total conjugated linoleic acid (CLA) and the increase of total PUFA due to the presence of PAC occurred only in week 1, while CLA c9,t11 was lower during weeks 1 and 2. The canonical analyses confirmed the differences between treatments in the FA profile of milk. Overall, the use of fresh sainfoin in the diet of lactating ewes resulted in a beneficial modification of the concentration of several milk FAs, suggesting some changes in ruminal biohydrogenation.

Short-term nutrient restrictions can occur naturally in extensive beef cattle production systems due to low feed quality or availability. The aims of the study were to (1) model the curves of milk yield, plasma non-esterified fatty acids (NEFAs) and β-hydroxybutyrate (BHB) contents of beef cows in response to short nutritional challenges throughout lactation; (2) identify clusters of cows with different response profiles; (3) quantify differences in cows’ response between the clusters and lactation stages. Data of BW, body condition score (BCS), milk yield, NEFA, and BHB plasma concentration from 31 adult beef cows (626 ± 48 kg at calving) were used to study the effect of 4-day feed restriction repeated over months 2, 3 and 4 of lactation. On each month, all cows received a single diet calculated to meet the requirements of the average cow: 100 % requirements for 4 days (d-4 to d-1, basal period), 55 % requirements on the next 4 days (d0 to d3, restriction period) and 100 % requirements for 4 days (d4 to d7, refeeding period). Natural cubic splines were used to model the response of milk yield, NEFA and BHB to restriction and refeeding in the 3 months. The new response variables [baseline value, peak value, days to peak and to regain baseline, and areas under the curve (AUC) during restriction and refeeding] were used to cluster cows according to their metabolic response (MR) into two groups: Low MR and High MR. The month of lactation affected all the traits, and basal values decreased as lactation advanced. Cows from both clusters had similar BW and BCS values, but those in the High MR cluster had higher basal milk yield, NEFA and BHB contents, and responded more intensely to restriction, with more marked peaks and AUCs. Reaction times were similar, and baseline values recovered during refeeding in both clusters. Our results suggest that the response was driven by cows’ milk potential rather than size or body reserves, and despite high-responding cattle’s higher milk yield, they were able to activate metabolic pathways to respond to and recover from the challenge.

Indicators are key tools used to assess the ecological status of the environment for ecosystem based management. Anthropogenic disturbances produce changes to habitat condition, which include modifications in species composition and their functions. Monitoring a group of sentinel species (from a taxonomic and functional point of view) provides useful insights into benthic habitat condition. Here, a new indicator, Sentinels of the Seabed (SoS) is proposed to assess state of benthic habitats using “sentinel” species (species which are characteristic of a habitat and sensitive to a given pressure). The selection of these sentinel species has two stages. First, a ‘typical species set’ is computed using intra-habitat similarity and frequency under reference conditions. Second, the ‘sentinel species set’ is generated by selecting the most sensitive species from the typical species set. This selection is made using specific indexes able to assess species sensitivity to a particular pressure. The SoS indicator method was tested on six case studies and two different pressure types (trawling disturbance and pollution), using data from otter trawl, box-corer and Remote Operate Vehicle images. In each scenario, the SoS indicator was compared to the Shannon-Wiener diversity index, Margalef index and total biomass, being the only metric, which showed the expected significant negative response to pressure in all cases. Our results shows that SoS was highly effective in assessing benthic habitats status under both physical and chemical pressures, regardless of the sampling gear, the habitat, or the case study, showing a great potential to be a useful tool in the management of marine ecosystems.

Introduction Conversion disorder (a term that describes what was previously called hysteria) refers to motor or sensory symptoms, or both, that resemble a neurological disease, but that do not originate from or cannot be explained by a known physical disease. Objectives To find reliable tools that can guide the difficult diagnosis of conversion disorder. Methods Bibliographic review Results The exact prevalence of the disorder is unknown. It is estimated that approximately 5% of referrals to neurology are for this disorder. Approximately one third of patients referred to the neurologist have symptoms that cannot be explained by an organic disease. Involuntary movements are the most common motor manifestations of the conversive syndrome, being tremor one of the most frequent manifestations. The first differential diagnosis of conversion disorder is neurological disease. It is currently not necessary for the diagnosis to assess whether or not the symptoms are produced intentionally, as the assessment of conscious intentionality is unreliable. The neurological examination is the fundamental tool for the diagnostic approach, being even more enlightening than the complementary tests. Hoover’s sign, Babinski’s combined leg flexion, plantar flexion of the ankle, tremor and its distraction and synchronisation manoeuvres, as well as the clinical differences between epileptic seizures and non-epileptic seizures of psychogenic origin, are some of the reliable tools for a correct diagnosis. Conclusions The diagnosis of the disease should be one of exclusion. There must be clinical data showing clear evidence of incompatibility with a neurological disease and conversion symptoms do not correspond to known physiological mechanisms and anatomical pathways. Disclosure No significant relationships.

Introduction The lack of a standardised definition for the concept of TRD and an adequate criteria for therapeutic response make difficult the management of patients with MDD who do not achieve remission with one or more courses of treatment. All classifications suggested to define TRD are arbitrary, partially evidence-based, subordinated to the pharmacological findings of the time in which they are written and with serious inconsistencies, making it difficult to construct a universal and enduring diagnostic system. Objectives Considering that the most important goal in treating a patient with Major Depressive Disorder (MDD) should be remission and return to previous functionality, the search for a standardised, evidence-based classification system will allow timely and effective interventions leading to the reduction of this devastating condition. Methods Bibliographic review Results The proposed therapeutic algorithm arises from the combination of several fundamental principles for the management of treatment-resistant depression: the different classification systems of the concept, as well as the concepts of response, relapse, recurrence and remission; the scientific evidence found in the current literature, routine clinical practice, knowledge of switching and augmentation strategies, the new pharmacological targets and neurobiological hypothesis discovered, without forgetting finally the different clinical profiles of depressive symptomatology and the specific indications of each antidepressant. Conclusions Resistant depression is difficult to treat successfully and is not a uniform entity. Recently there has been a move to characterise treatment-resistant depression as ‘difficult-to-treat’ depression on the basis that the former description implies that depression treatments are normally effective and that non-response is therefore somehow abnormal. Disclosure No significant relationships.

Resumen: Antecedentes y objetivo: El prurigo nodular (PN) es una dermatosis inflamatoria crónica caracterizada por la presencia de lesiones nodulares, intensamente pruriginosas, con gran impacto en la calidad de vida. El intenso prurito y el rascado son rasgos constantes en esta enfermedad, que se ha descrito en el contexto de diversos procesos dermatológicos —fundamentalmente dermatitis atópica—, metabólicos, neurológicos o psiquiátricos, aunque la fisiopatogenia es en buena parte desconocida. La fototerapia, en diversas de sus variantes, se ha propuesto como una opción terapéutica adecuada en el control clínico y sintomático, con un buen perfil de seguridad. En el presente estudio describimos nuestra experiencia con el uso de fototerapia en el tratamiento del PN. Material y método: Estudio observacional retrospectivo en el que se incluyeron pacientes que habían recibido su primer ciclo de fototerapia entre marzo de 2011 y octubre de 2019 para el tratamiento de su PN. Se recogieron las siguientes variables: características epidemiológicas y clínicas de los pacientes, tratamientos concomitantes, tipo de fototerapia, duración y dosis alcanzadas, y respuesta obtenida. Resultados: Incluimos un total de 44 pacientes (30 mujeres y 14 hombres, con mediana de edad de 65,5 años). La variante de fototerapia más empleada fue UVBBE (34 ciclos, 77,27%), seguida de la combinación de UVB + UVA (8 ciclos). La respuesta se consideró satisfactoria (respuestas ≥ 75%) en 24 pacientes (55,4%). Conclusiones: La fototerapia es una opción terapéutica adecuada en un porcentaje considerable de pacientes con PN; puede emplearse en monoterapia o combinada con diversos tratamientos. Abstract: Background and objective: Prurigo nodularis is a chronic inflammatory skin disease characterized by highly pruritic nodular lesions that cause constant itching and scratching and significant quality-of-life impairment. It has been described in a range of conditions, including skin diseases (mainly atopic dermatitis) and metabolic, neurological, and psychiatric disorders. The pathophysiological mechanisms are largely unknown. Various modalities of phototherapy have been described as appropriate and safe treatments for achieving clinical control and alleviating symptoms. In this article, we describe our experience with phototherapy in patients with prurigo nodularis. Material and methods: Retrospective observational study of patients who received their first cycle of phototherapy to treat prurigo nodularis between March 2011 and October 2019. Information was collected on epidemiological and clinical characteristics, concomitant treatments, type and duration of phototherapy, maximum dose reached, and response to treatment. Results: We studied 44 patients (30 women and 14 men) with a median age of 65.5 years. The most common form of phototherapy used was narrowband UV-B phototherapy (34 cycles, 77.27%) followed by a combination of UV-B and UV-A phototherapy (8 cycles). Response to treatment was considered satisfactory (clearance rate of ≥ 75%) in 24 patients (55.4%). Conclusions: Phototherapy is a suitable treatment for prurigo nodularis in a considerable proportion of patients. It can be used as monotherapy or combined with other treatments.

Introduction: Carotid artery stenosis influences CT perfusion (CTP) studies, sometimes manifesting as a false ischaemic penumbra (FIP). This study aims to estimate the incidence of FIP in patients with carotid artery stenosis, establish their relationship with the degree of stenosis, and measure quantitative and qualitative changes in CTP after carotid angioplasty and stenting (CAS). Methods: Between October 2013 and June 2015, we prospectively selected 26 patients with carotid stenosis who underwent CAS, with CTP being performed 2-10 days before and after CAS. Results: Sixteen patients had unilateral stenosis (11 in the subgroup displaying

Resumen: Introducción: La estenosis carotídea tiene una influencia en la TC de perfusión (TCP), que en ocasiones se manifiesta como una falsa penumbra isquémica (FPI). El objetivo de nuestro estudio es estimar la incidencia de FPI en pacientes con estenosis carotídea, establecer su relación con el grado de estenosis y medir los cambios cuantitativos y cualitativos de la TCP después de la angioplastia carotídea y stenting (ACS). Métodos: Entre octubre del 2013 y junio del 2015 se seleccionó prospectivamente a 26 pacientes con estenosis carotídea que fueron sometidos a una ACS, realizándose un TCP 2-10 días antes y después de la ACS. Resultados: Dieciséis pacientes tenían una estenosis unilateral (11 en el subgrupo de < 90% de estenosis y 5 en el de ≥ 90%) y 10 pacientes una estenosis bilateral. La incidencia de FPI en pacientes con estenosis carotídea es del 38,5%. El riesgo de FPI aumenta en relación directa con el grado de estenosis, con un riesgo relativo de 11 en el grupo de ≥ 90% respecto al grupo de < 90% (IC del 95%: 1,7-71,3; p = 0,0005). Existen cambios estadísticamente significativos en los parámetros CBF, TTP, MTT y Tmáx de la TCP que revierten tras la ACS. No hay cambios significativos en CBV. Conclusiones: La estenosis carotídea implica cambios en los parámetros de la TCP, condicionando un alto riesgo de FPI en estenosis ≥ 90% y, por tanto, una posible interpretación equivocada de estos estudios. Estos cambios se revierten tras la ACS. Abstract: Introduction: Carotid artery stenosis influences CT perfusion (CTP) studies, sometimes manifesting as a false ischaemic penumbra (FIP). This study aims to estimate the incidence of FIP in patients with carotid artery stenosis, establish their relationship with the degree of stenosis, and measure quantitative and qualitative changes in CTP after carotid angioplasty and stenting (CAS). Methods: Between October 2013 and June 2015, we prospectively selected 26 patients with carotid stenosis who underwent CAS, with CTP being performed 2-10 days before and after CAS. Results: Sixteen patients had unilateral stenosis (11 in the subgroup displaying

There is increasing interest in using sainfoin (Onobrychis viciifolia) to feed sheep, but it contains proanthocyanidins (PACs), and the associated effects of PAC on sheep production are not well-known. The aim of the study was to assess the effect of the presence of PAC from sainfoin, through the inclusion of polyethylene glycol (PEG), on the intake and productive parameters of local ewes bearing one male lamb. For the experiment, 20 ewes and their newborn male lambs were placed in individual indoor cages. All ewes were fed ad libitum fresh sainfoin plus 200 g/d barley. Twice daily, half of the ewes were orally dosed with only water (Sainfoin Group; n = 10), and the other half were orally dosed with 100 g/d PEG 4000 per ewe (Sainfoin + PEG Group; n = 10). Sucking lambs were permanently housed with their dams until they reached 10–12 kg BW. The intake of sainfoin was recorded daily, and its chemical composition was analysed. Weekly, the BW, body condition score (BCS), milk yields and individual milk and blood samples were recorded. At the beginning and end of the experiment, faecal samples were collected from ewes and analysed for the anthelmintic role of PAC. The chemical composition, polyphenol content and antioxidant capacity of the diet and milk were analysed. The presence of PAC did not affect the intake, BW, BCS or milk yield of the dams (P > 0.05); however, all parameters were affected by the week of lactation (P 0.05). The presence of PAC had no effect on parasitism (P > 0.05). In conclusion, the presence of PAC had no relevant effects on milk production, although it affected protein metabolism, as indicated by the urea contents in milk and plasma.

We describe what is to our knowledge the first case of aneurysm regrowth and rupture after the nine years, of a complete occlusion of an aneurysm of the left middle cerebral treated of Leo Plus Stent.

Introduction Among medical students the rate of depression varies between 5-32% and it is known that the suicide rate is higher than in the general population. Objectives Clear and current data are needed to design studies for the diagnosis and treatment of students and residents of Medicine with psychological and psychiatric disorders in order to reduce rates of suicidal behavior in this population group. Methods A systematic search for articles on the UpToDate, PubMed and Mendeley platforms has been conducted with the keywords “suicide”, “suicidal behavior”, “suicidal ideation”, “medicalschool” and “medical students”. We found 435 items from which a total of 42 items were selected. Results The prevalence of depression is 27.2%, of which only 15.7% of them are under treatment. Burnout, has a high prevalence of 45-50%. The prevalence of suicidal ideation in the last year is 11.1%. The most commonly used method is medication overdose. Suicidal behavior is greater among students who choose to choose Psychiatry or Family and Community Medicine as a specialty. Conclusions The rate of suicidal ideation among medical students is 11.1%. Nearly one out of every three medical students suffers from depression in some degree, and only one in five is treated. The similar prevalence of burnout at all levels supposes poor management of stress from the faculty. Medical schools should reduce the associated stigma and should encourage depressed students to seek treatment.

Introduction Telecommuting is defined as “a work practice that involves members of an organization substituting a portion of their typical work hours to work away from a central workplace, using technology to interact with others as needed to conduct work tasks”. The prevalence rate of telecommuting in Sapin in 2019 was 5%, while this rate grew up to 34% during de COVID-19 pandemic. Objectives The purpose of this poster is to make a review about how telecommuting affects the employees’ mental health. Methods A review os the available literature on employees’ menthal health. Results Most employers who offer telecommuting consider it a strategic decision for their businesses: it could reduce the expenses of physically accommodating the employees, and it might help employers to contact their subordinates anytime, if needed. Many articles in the popular press about telecommuting extol the benefits of this practice on employees’ health (work-life balance, reduction of travel expenses). However, only a handful of empirical studies substantiate these claims (job satisfaction, quality of life, and role-related stress). Less discussed is the potential of telecommuting to have a negative impact on employees’ health. It may increase both social and professional isolation, which in turn is associated with higher levels of emotional exhaustion, cynicism, cognitive stress complaints and lower levels of work engagement. Conclusions Finally, although it is not as effective as personal contact, organizations may stimulate qualitative virtual interaction with coworkers by providing robust online meeting tools and infrastructure, so users can seamlessly collaborate regardless of their physical location.

Introduction The exposure to child maltreatment increases the lifetime risk for many psychopathological symptoms: depression, anxiety disorders, bipolar disorder, schizophrenia, post-traumatic stress disorder, personality disorder and dissociation. Besides, adopted children, especially those with a history of institutional living before adoption, are at greater risk for a range of developmental, behavioral and attachment concerns. The case report is of a 17-year-old male, with reactive attachment disorder (RAD). He suffered child maltreatment in his family of origin before the international adoption. Objectives The aim of this study is to present a case-report illustrating the relationship between chil maltreatment, adopted children and the reactive attachment disorder. Methods A bibliographic search was performed about reactive attachment disorder. Information regarding the clinical case was obtained by consulting the patient’s file. Results A 17-years-old male who was adopted at age of 9 from Spain. According to reports from the orphanage, the patient suffered severe maltreatment by his family of origin, with scars on his back. The patient presents impulse control disorder, with verbal and physical heteroaggressiveness in situations of frustration, hunger and sleep. He stopped attending the institute at the age of 12, with marked isolation and reversal of the sleep-wake cycle. His treatment plan are partial hospitalization, psychotherapy and pharmacotherapy. Conclusions Both child maltreatment and adoption are risk factors for the presence of psychopathology during the lifetime. Especially during the pre-adoption process and the first years after adoption, both the family and the child should be able to use specialized Mental Health services. Disclosure No significant relationships.

Introduction Borderline personality disorder (BPD) is characterized by instability of interpersonal relationships, self-image, and emotions, and by impulsivity. Although patients with BPD are misdiagnosed, some of them receive mental health treatment. Even if the first-line treatment of this disorder is psycotherapy, the patients with BPD may be highly symptomatic and are often prescribed multiple medications in a manner unsupported by evidence. Objectives The aim of this study is to study the available evidence about the pharmacotherapy for borderline personality disorder. Methods A review of the available literature about the management of borderline personality disorder and de pharmacotherapy for personality disorders was performed. Results First-line treatment of the personality disorders is psycotherapy. The treatment plan for BPD may include individual and group therapy, medication, self-education, specialized substance use disorder treatment, partial hospitalization, or brief hospitalization during times of crises. Medications are generaly used only as adjuncts to psychotherapy and the adjunctive use of symptom targeted medications has been found to be useful. There is limited information to guide pharmacotherapy; preliminary evidence limits the practice of polypharmacy. Sympton-domain focused medication treatment is recommeded by some guidelines: cognitive-perceptual symtoms (low-dose antipsychotic drugs), impulsive-behavioral dyscontrol (mood stabilizers), affective dysregulation (mood stabilizers and low-dose antipsychotic drugs) and self-harm (omega-3 fatty acids). Conclusions BPD cause significant distress and impariment of social, occupational and role functioning. The first-line treatment for BPD is psychotherapy; however symptom-focused, medication treatment of BPD is generally considered to be an adjunct to psychotherapy. The data support the efficacy of low dose antipsychotic drugs and mood stabilizers.

Introduction Electroconvulsive therapy (ECT) is today one of the main treatments available and used in psychiatry for serious mental illnesses. Eighty years after its introduction, the ECT procedure has evolved to become a safe option based on scientific evidence. Nowadays there are no absolute contraindications for ECT, regardless of the type of population and clinical situation. Objectives To illustrate the electroconvulsive therapy in medical comorbidities context with a case report. Methods Descriptive case study. Results We present a 66 years old patient who suffers from a psychiatric decompensation with a diagnosis of major depressive disorder with psychotic symptoms. Due to her cardiological history (prolongation of the QT interval of possible psycopharmacological origin and a 2:1 AV block, that required the implantation of a definitive pacemaker) and partial response to psychotropic medication, the initiation of electroconvulsive therapy is proposed as the best alternative. The pacemaker was previously studied by cardiology for a very complete analysis before the procedure. It was recommended to convert it to fixed rate pacing by using a magnet. To do this, we placed it over the pacemaker during the technique. While waiting for a clinical improvement, no incidence has been produced during the sessions. Conclusions ECT should not be postponed as a last resort. Numerous studies conclude that ECT is globally the treatment of choice (70-85% response) in severe depressive conditions, over and above antidepressant drugs. The incidence of relevant cardiac complications on ECT is relatively rare (0.9%). Regarding the use of pacemakers, electroconvulsive therapy represents an effective and safe option for the patient. Disclosure No significant relationships.

In intermetallic compounds with zero orbital momentum (L=0) the magnetic anisotropy and the electronic band structure are interconnected. Here, we investigate this connection in divalent Eu and trivalent Gd intermetallic compounds. We find by x-ray magnetic circular dichroism an out-of-plane easy magnetization axis in two-dimensional atom-thick EuAu_{2}. Angle-resolved photoemission spectroscopy and density-functional theory prove that this is due to strong f-d band hybridization and Eu^{2+} valence. In contrast, the easy in-plane magnetization of the structurally equivalent GdAu_{2} is ruled by spin-orbit-split d bands, notably Weyl nodal lines, occupied in the Gd^{3+} state. Regardless of the L value, we predict a similar itinerant electron contribution to the anisotropy of analogous compounds.

The influence of the Al content on the phase transformations in Cu-Al-Ag alloys was studied by classical differential thermal analysis (DTA), optical microscopy (OM) and X-ray diffractometry (XRD). The results indicated that the increase in the Al content and the presence of Ag decrease the rate of the β1 phase decomposition reaction and contribute for the raise of this transition temperature, thus decreasing the stability range of the perlitic phase resulted from the b1 decomposition reaction.

The main purpose of this study is to evaluate the effect of total replacement of soybean meal and corn with triticale and faba bean or field pea on rumen fermentation, protozoa counts, and gas production of lactating ewes. A total of 30 Sicilo-Sarde ewes were randomly allocated into three groups and were fed 1.8 kg drymatter of oat hay plus 500 g of one of three concentrates: the first concentrate (CS) was mainly composed of soybean meal, corn, and barley; the second (TFB) was formed by triticale and faba bean; and the third (TFP) was composed of triticale and field pea. The type of concentrate did not affect ruminal pH or ammonia nitrogen concentration (P > 0.05). The individual concentrations of volatile fatty acids showed a significant interaction between the type of concentrate and sampling time (P P Isotricha species (P Entodinium, Ophryoscolex, and Polyplastron were similar among concentrates (P > 0.05). The cumulative gas production from the in vitro fermentation, the time of incubation, and their interaction was affected by concentrate (P

Resumen: Introducción: La Estrategia del Ictus del Sistema Nacional de Salud (EISNS) fue un documento de consenso entre las distintas administraciones y sociedades científicas que se desarrolló con el objetivo de mejorar la calidad del proceso asistencial y garantizar la equidad territorial. Nuestro objetivo fue analizar los recursos asistenciales existentes y si se había cumplido el objetivo de la EISNS. Material y métodos: La encuesta sobre los recursos disponibles se realizó por un comité de neurólogos de cada una de las comunidades autónomas (CC.AA), los cuales también realizaron la encuesta de 2008. Los ítems incluidos fueron el número de Unidades de Ictus (UI), su dotación (monitorización, neurólogo 24 h/7 días, ratio enfermería, protocolos), ratio cama UI/100.000 habitantes, recursos diagnósticos (ecografía cardíaca y arterial cerebral, neuroimagen avanzada), realización de trombolisis intravenosa, intervencionismo neurovascular (INV), cirugía del infarto maligno de la arteria cerebral media (ACM) y disponibilidad de la telemedicina. Resultados: Se incluyeron datos de 136 hospitales. Existen 45 UI distribuidas de un modo desigual. La relación cama de UI por habitantes y comunidad autónoma osciló entre 1/74.000 a 1/1.037.000 habitantes, cumpliendo el objetivo solo Cantabria y Navarra. Se realizaron por neurólogos 3.237 trombolisis intravenosas en 83 hospitales, con un porcentaje respecto del total de ictus isquémico entre el 0,3 y el 33,7%. Los hospitales sin UI tenían una disponibilidad variable de recursos. Se realiza INV en todas las CC.AA salvo La Rioja, la disponibilidad del INV 24 h/7 días solo existe en 17 ciudades. Hay 46 centros con cirugía del infarto maligno de la ACM y 5 con telemedicina. Conclusión: La asistencia al ictus ha mejorado en cuanto al incremento de hospitales participantes, la mayor aplicación de trombolisis intravenosa y procedimientos endovasculares, también en la cirugía del infarto maligno de la ACM, pero con insuficiente implantación de UI y de la telemedicina. La disponibilidad de recursos diagnósticos es buena en la mayoría de las UI, e irregular en el resto de hospitales. Las distintas CC.AA deben avanzar para garantizar el mejor tratamiento y equidad territorial, y así conseguir el objetivo de la EISNS. Abstract: Introduction: The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. Material and methods: The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24 h/7d, nurse ratio, protocols), SU bed ratio/100 000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability. Results: We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24 h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine. Conclusion: Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives. Palabras clave: Unidad de ictus, Tratamiento ictus, Encuesta recursos, Trombolisis, Keywords: Stroke unit, Stroke treatment, Stroke facilities survey, Thrombolysis

Introduction: The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. Material and methods: The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24 hours/7 days, nurse ratio, protocols), SU bed ratio/100 000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing intravenous thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability. Results: We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74 000 to 1/1 037 000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3% to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24 hours/7 days basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine. Conclusion: Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives. Resumen: Introducción: La Estrategia del Ictus del Sistema Nacional de Salud (EISNS) fue un documento de consenso entre las distintas administraciones y sociedades científicas que se desarrolló con el objetivo de mejorar la calidad del proceso asistencial y garantizar la equidad territorial. Nuestro objetivo fue analizar los recursos asistenciales existentes y si se había cumplido el objetivo de la EISNS. Material y métodos: La encuesta sobre los recursos disponibles se realizó por un comité de neurólogos de cada una de las comunidades autónomas (CC.AA), los cuales también realizaron la encuesta de 2008. Los ítems incluidos fueron el número de Unidades de Ictus (UI), su dotación (monitorización, neurólogo 24 h/7 días, ratio enfermería, protocolos), ratio cama UI/100.000 habitantes, recursos diagnósticos (ecografía cardíaca y arterial cerebral, neuroimagen avanzada), realización de trombolisis intravenosa, intervencionismo neurovascular (INV), cirugía del infarto maligno de la arteria cerebral media (ACM) y disponibilidad de la telemedicina. Resultados: Se incluyeron datos de 136 hospitales. Existen 45 UI distribuidas de un modo desigual. La relación cama de UI por habitantes y comunidad autónoma osciló entre 1/74.000 a 1/1.037.000 habitantes, cumpliendo el objetivo solo Cantabria y Navarra. Se realizaron por neurólogos 3.237 trombolisis intravenosas en 83 hospitales, con un porcentaje respecto del total de ictus isquémico entre el 0,3 y el 33,7%. Los hospitales sin UI tenían una disponibilidad variable de recursos. Se realiza INV en todas las CC.AA salvo La Rioja, la disponibilidad del INV 24 h/7 días solo existe en 17 ciudades. Hay 46 centros con cirugía del infarto maligno de la ACM y 5 con telemedicina. Conclusión: La asistencia al ictus ha mejorado en cuanto al incremento de hospitales participantes, la mayor aplicación de trombolisis intravenosa y procedimientos endovasculares, también en la cirugía del infarto maligno de la ACM, pero con insuficiente implantación de UI y de la telemedicina. La disponibilidad de recursos diagnósticos es buena en la mayoría de las UI, e irregular en el resto de hospitales. Las distintas CC.AA deben avanzar para garantizar el mejor tratamiento y equidad territorial, y así conseguir el objetivo de la EISNS. Keywords: Stroke unit, Stroke treatment, Stroke facilities survey, Thrombolysis, Palabras clave: Unidad de ictus, Tratamiento ictus, Encuesta recursos, Trombolisis

Resumen: En España se estima que aproximadamente un 28% de los ictus isquémicos son de etiología aterotrombótica y mayoritariamente se deben a una estenosis carotídea. La ultrasonografía es la técnica más habitual para el diagnóstico de la estenosis carotídea. Las alteraciones de la velocidad de flujo en el punto de máxima estenosis junto con los cambios hemodinámicos en regiones proximales (arteria carótida común) y distales (carótida interna postestenótica, arteria oftálmica y polígono de Willis) permiten cuantificar con precisión la estenosis carotídea. En esta revisión se detalla la metodología para la evaluación de la estenosis carotídea desde el punto de vista ultrasonográfico, siguiendo las recomendaciones de consenso establecidas por la Sociedad Española de Neurosonología (SONES). Se revisan los hallazgos que permiten cuantificar el grado de estenosis carotídea extracraneal utilizando tanto el estudio ultrasonográfico carotídeo como el transcraneal, con un especial énfasis en la importancia de la valoración de signos indirectos. Abstract: In Spain, approximately 28% of ischaemic strokes have an atherothrombotic cause, and most are due to carotid stenosis. Ultrasound is the most commonly used technique for diagnosing carotid stenosis. Changes in blood flow velocity at the point of maximum stenosis, together with haemodynamic changes in proximal regions (common carotid artery) and distal regions (poststenotic internal carotid, ophthalmic artery, and the circle of Willis), allow us to measure carotid stenosis precisely. This review explains the methodology to be followed when evaluating carotid stenosis ultrasonographically, according to the recommendations from the Spanish Society of Neurosonology (SONES). We review the findings that permit us to measure the degree of extracranial carotid stenosis using both carotid and transcranial ultrasound, with particular emphasis on the importance of assessing indirect signs. Palabras clave: Arteria carótida interna, Estenosis, Doppler, Transcraneal, Dúplex-color, Ultrasonografía, Keywords: Internal carotid artery, Stenosis, Doppler ultrasound, Transcranial Doppler, Colour-flow duplex, Ultrasonography

In Spain, approximately 28% of ischaemic strokes have an atherothrombotic cause, and most are due to carotid stenosis. Ultrasound is the most commonly used technique for diagnosing carotid stenosis. Changes in blood flow velocity at the point of maximum stenosis, together with haemodynamic changes in proximal regions (common carotid artery) and distal regions (poststenotic internal carotid, ophthalmic artery, and the circle of Willis), allow us to measure carotid stenosis precisely. This review explains the methodology to be followed when evaluating carotid stenosis ultrasonographically, according to the recommendations from the Spanish Society of Neurosonology (SONES). We review the findings that permit us to measure the degree of extracranial carotid stenosis using both carotid and transcranial ultrasound, with particular emphasis on the importance of assessing indirect signs. Resumen: En España se estima que aproximadamente un 28% de los ictus isquémicos son de etiología aterotrombótica y mayoritariamente se deben a una estenosis carotídea. La ultrasonografía es la técnica más habitual para el diagnóstico de la estenosis carotídea. Las alteraciones de la velocidad de flujo en el punto de máxima estenosis junto con los cambios hemodinámicos en regiones proximales (arteria carótida común) y distales (carótida interna postestenótica, arteria oftálmica y polígono de Willis) permiten cuantificar con precisión la estenosis carotídea. En esta revisión se detalla la metodología para la evaluación de la estenosis carotídea desde el punto de vista ultrasonográfico, siguiendo las recomendaciones de consenso establecidas por la Sociedad Española de Neurosonología (SONES). Se revisan los hallazgos que permiten cuantificar el grado de estenosis carotídea extracraneal utilizando tanto el estudio ultrasonográfico carotídeo como el transcraneal, con un especial énfasis en la importancia de la valoración de signos indirectos. Keywords: Internal carotid artery, Stenosis, Doppler ultrasound, Transcranial Doppler, Colour-flow duplex, Ultrasonography, Palabras clave: Arteria carótida interna, Estenosis, Doppler, Transcraneal, Dúplex-color, Ultrasonografía

Introduction: Surgical lung biopsy is a technique that presents a morbi-mortality rate of considerable importance. We analyze our experience with surgical lung biopsies for the diagnosis of diffuse lung disease and the effect produced on the indications for surgical biopsy in these pathologies after the publication of the consensus of the ATS (American Thoracic Society) and ERS (European Respiratory Society) for Idiopathic Pulmonary Fibrosis (IPF). Patients and methods: We performed a retrospective review of 171 patients operated between January 1997 and December 2011. We divided the series into 2 groups: group 1 (operated between 1997 and 2002) and group 2 (operated between 2003 and 2011). Suspected preoperative diagnosis, respiratory status, pathological postoperative diagnoses, percentage of thoracotomies, mean postoperative stay and perioperative morbidity and mortality were analyzed. Results: Group 1 consisted of 99 patients and group two 72. The most frequent postoperative diagnoses were: usual interstitial pneumonia and extrinsic allergic alveolitis. There were ten (5.84%) deaths. Death was caused by progressive respiratory failure that was related to interstitial lung disease in 7 (70%) of 10 cases, alveolar haemorrhage in 2 (20%) and heart failure in 1 (10%). Conclusions: Since the publication of the ATS and ERS consensus on the IPF, we have observed a noticeable decrease in the number of indications for surgical lung biopsy. This technique, though simple, has a considerable morbidity and mortality. Resumo: Introdução: A biópsia pulmonar cirúrgica é uma técnica com uma morbimortalidade não negligenciável. Este trabalho resulta da experiência adquirida na realização de biópsias pulmonares cirúrgicas para o diagnóstico da doença pulmonar intersticial difusa, bem como pelo efeito provocado sobre as indicações da biópsia cirúrgica nesta entidade, após a publicação do consenso da ATS (American Thoracic Society) e da ERS (European Respiratory Society, para Fibrose Pulmonar Idiopática (FPI), em 2000 e 2002. Métodos: Revisão retrospectiva de 171 doentes intervencionados entre Janeiro de 1997 e Dezembro de 2011. A série de doentes foi dividida em dois grupos: o grupo 1 (operados entre 1997 e 2002) e o grupo 2 (operados entre 2003 e 2011). Os registos efectuados foram a suspeita diagnóstica pré-operatória, o estado respiratório, o diagnóstico patológico pós-operatório, a percentagem de toracotomias, a média de internamento hospitalar, além da morbilidade e mortalidade intra-hospitalares. Resultados: Grupo 1 constituído por 99 doentes e o grupo 2 por 72. Os diagnósticos pós-operatórios mais frequentes foram a pneumonia intersticial usual e a alveolite alérgica extrínseca. Houve 10 mortes (5,84%). Em 7 (70%) dos 10 casos, a morte foi causada por progressão da insuficiência respiratória provocada pela doença subjacente, em 2 (20%) por hemorragia alveolar, e em um caso (10%) por insuficiência cardíaca. Conclusões: Desde a publicação do consenso da ATS e da ERS na FPI, observou-se uma clara diminuição no número de indicações para a biópsia pulmonar cirúrgica. Esta técnica, apesar de simples, tem uma considerável morbilidade e mortalidade. Keywords: Diffuse lung disease, Lung biopsy, Surgical mortality, Palavras-chave: Doença pulmonar difusa, Biópsia pulmonar, Mortalidade cirúrgica

The aim of this paper was to identify pre-slaughter factors that modify total and insoluble collagen contents in bovine muscle to construct a model of collagen dynamics. The meta-analyses were performed with primary data of total (n = 1165) and insoluble (n = 1145) collagen contents from INRA experiments obtained from different muscles in young bulls, cows and steers. According to both the bibliography and meta-analyses, total collagen content and solubility were greatly affected by the muscle (type). Moreover, the pattern of the evolution of collagen characteristics was similar among Longissimus, Semitendinosus and Triceps brachii muscles in young bulls. In cows, collagen contents in the Triceps brachii muscle had delayed dynamics compared with the other muscles. Collagen characteristics differed among breeds because of variation in the maturity of the breed. Similarly, according to the meta-analyses, total and insoluble collagen content evolutions with the degree of maturity (DOM; proportion of adult weight reached at slaughter) were different in dairy and rustic breeds from those of beef breeds, especially in bulls. Although the relationships between collagen content and DOM were quantified in different muscles and sexes, the precision of the fitted equations was not sufficient for prediction. Consequently, relying on the hypotheses raised by the meta-analysis and the literature, an approach to further develop a dynamic mechanistic model of soluble and insoluble collagen content is proposed.

Summary: We report an extraordinary case of collision tumor consisting of a lung adenocarcinoma and a metastatic adenoid cystic carcinoma in a 56 year-old man. He was diagnosed with a pulmonary nodule 11 years after treatment of an adenoid cystic carcinoma of the right maxillary sinus. A non-small cell carcinoma was observed when a transbronchial biopsy was performed. The other component of the nodule was only diagnosed with pathological examination of the resection specimen. Resumo: Descrevemos um caso único de tumor de colisão constituído por um adenocarcinoma de pulmão e uma metástase dum carcinoma adenóide cístico em um homem de 56 anos de idade. Ao doente foi diagnosticado um nódulo pulmonar 11 anos após o tratamento de um carcinoma adenóide cístico do seio maxilar direito. O carcinoma de pulmão de não pequenas células foi observado no momento da realização de uma biópsia transbrônquica. O outro componente do nódulo foi diagnosticado depois do exame histológico do material ressecado. Keywords: Bronchogenic carcinoma, Collision tumor, Adenoid cystic carcinoma, Palavras-chave: Carcinoma broncogénico, Tumor de colisão, Carcinoma adenóide cístico

Three fattening systems were evaluated from weaning to slaughter in order to find alternatives to grain feeding in young bulls, and to test the reliability of carcass subcutaneous fat colour to discriminate among them. After weaning (224 kg), one group of animals was fed concentrates and straw until they reached the target slaughter weight (450 kg; Feedlot), another group grazed rotationally on lucerne supplemented with 1.8 kg DM/day barley until slaughter (LUC), and the third group had the same management as LUC animals for 3 months (period 1) and thereafter was finished on concentrates and straw until slaughter (period 2; LUC + Feedlot). Animals were weighed weekly and sampled monthly for serum IGF-I and leptin, and plasma non-esterified fatty acids and carotenoid pigment concentration analyses. Carcass characteristics and subcutaneous fat colour were recorded after slaughter. In period 1, Feedlot animals had slightly greater weight gains than their grazing counterparts (P < 0.10), and at the end of period 1 they had 66% greater IGF-I and 35% greater leptin concentration (P < 0.01). Plasma carotenoid pigments were undetectable in Feedlot animals, but increased during grazing in LUC and LUC + Feedlot treatments. In period 2, weight gains were lowest for LUC, intermediate for Feedlot and greatest for LUC + Feedlot animals (P < 0.001), conditioning the time taken to reach slaughter weight (73, 58 and 47 days, respectively; P < 0.05). Leptin and IGF-I concentrations increased in all management systems during period 2. Plasma carotenoid pigment concentration reached its maximum at the end of period 2 in LUC animals, but it decreased sharply in LUC + Feedlot animals in this period. Management did not affect carcass traits except for subcutaneous fat colour. Yellowness, Chroma (C*) and the value of the integral of the translated reflectance spectrum (SUM), estimator of carotenoid pigment content in fat, were higher in LUC than in LUC + Feedlot and Feedlot animals (P < 0.001). Two logistic regressions were obtained to discriminate carcasses from LUC treatment: P (LUC) = (1 + e18.8–5.6 × lightness–36.9 × redness + 0.3 × SUM + 29.8 × C*)−1 and LUC + Feedlot treatment: P (LUC + Feedlot)=(1 + e833.7–11.8 × lightness + 4.7 × redness + 0.2 × SUM−2.5 × C*)−1. The economic margin, calculated as income achieved minus costs, was greatest for LUC, intermediate for LUC + Feedlot and lowest for Feedlot treatment. Therefore, grazing lucerne supplemented with barley was an interesting alternative for fattening young bulls in these conditions, producing carcasses of similar quality, which could be accurately traced by measuring subcutaneous fat colour.

The study was conducted to evaluate the effect of age at weaning and breed on the stress response of calves to weaning and their temperament. At calving, 14 Parda de Montaña calves and 14 Pirenaica calves were randomly assigned to either early weaning (at 90 days) or traditional weaning (at 150 days) treatment. During nursing, calves were allowed to suckle their dams twice a day for 30 min. After weaning, calves were placed in an adjacent barn without access to their dams, where they remained for 7 days. On day 8 after weaning, they were transported to a feedlot where they received an intensive diet. Blood samples were taken 168 h before weaning (baseline) and 6, 24, 48 and 168 h after weaning for cortisol, fibrinogen and haematology analyses, and temperament was measured 90 and 180 days after weaning with the flight speed test. Cortisol concentration increased after weaning, irrespective of age at weaning. Early-weaned calves had a lower fibrinogen baseline and a greater increase in fibrinogen concentrations 48 h after weaning than traditionally weaned calves. Moreover, fibrinogen concentration returned to baseline values 168 h after weaning in traditionally weaned calves, whereas it remained high in early-weaned calves. Concerning breed effects, Pirenaica calves had higher cortisol concentration and fibrinogen increments after weaning than Parda de Montaña calves. Slight alterations occurred after weaning in haematology, but all parameters returned to baseline values 168 h after weaning, with no significant effects of age at weaning or breed. Despite the absence of clinical signs, early-weaned calves of both breeds suffered marginal anaemia, according to haemoglobin values. Regardless of age at weaning, Pirenaica calves had greater reactivity to human presence than Parda de Montaña calves, according to their higher flight speed values measured. Finally, early-weaned calves were lighter than traditionally weaned calves at weaning, but had similar weight gains in the feedlot. Consequently, they needed an additional 40 days to reach the target weight, irrespective of breed. Therefore, age at weaning had no major effects on the stress response to weaning or temperament, but early weaning increased the length of the feedlot period. On the other hand, Pirenaica calves were more reactive than Parda de Montaña calves to the stress of weaning and human presence.

A study was conducted to evaluate the effect of pre-weaning concentrate feeding in early-weaned (EW, day 90) or traditionally weaned (TW, day 150) autumn-born beef calves on growth, feed intake and feed efficiency, and carcass and meat quality. Twenty-eight male calves were either EW or TW, and offered a starter concentrate (S) or no additional feed (NS) during the pre-weaning period. Therefore, four management strategies were tested: EWS, EWNS, TWS and TWNS. Growth patterns were affected by management strategy. From day 90 to 150, TWNS calves presented a substantially lower average daily gain (ADG) than their counterparts, which had similar performance. During the finishing phase (from day 150 to slaughter at 450 kg live weight), EWS calves had the lowest ADG. Daily feed intake or efficiency in the finishing phase was unaffected by previous management. Serum IGF-I concentrations at day 90 and slaughter did not differ with management strategy, but early weaning and pre-weaning concentrate feeding increased IGF-I concentrations at day 150. Circulating leptin concentrations were unaffected by age at weaning and pre-weaning concentrate feeding, except for leptin concentrations at slaughter, which were higher in S calves than in NS calves. Total concentrate intake from birth to slaughter and the concomitant feed costs were higher for EWS and EWNS calves than for TWNS and TWS ones. However, cow feed costs were lower for cows whose calves had been early weaned. Concerning carcass quality, early weaning improved dressing percentage and increased fatness score, and particularly TWNS calves presented a poorer conformation. Meat quality was not affected by management strategy. Considering the economic performance, TWS, EWNS and EWS strategies yielded a similar economic margin, whereas TWNS would be the least advisable strategy when calves are fattened in the farm until slaughter.

Lagunas de estabilización de aguas residuales domésticas en Nicaragua diseñadas para que el efluente no contenga un NMP de CF mayor que el indicado en el Decreto 33-95 “Normativas para el control de la contaminación proveniente de las descargas de aguas residuales domésticas, industriales y agropecuarias” no producen un efluente con esa calidad. Se realizaron estudios, para conocer el por qué de esta situación, en dos lagunas secundarias de estabilización de la ciudad de Masaya. Una laguna cuenta con pantallas deflectoras y por tanto un número de dispersión mucho menor que la segunda. Los resultados son: a) La laguna secundaria con pantallas deflectoras produce un efluente con menos variaciones y menor NMPCF/100 ml; b) El valor del coeficiente de extinción bacterial es menor que el reportado en la literatura; c) No se encontró evidencia que este valor estuviera influido por el número de dispersión de flujo de la laguna.

Video-assisted thoracoscopic surgery (VATS) is an approach to resection of bronchogenic cysts (BC) which is effective and viable. There may be complications as a result of pericystic adhesions to neighboring structures during dissection. This report describes an unusual case of an operative complication, the rupture of the main left bronchus. The initial VATS approach was converted into a right thoracotomy to remove the cyst and suture the bronchus once adequate exposure was obtained. Bronchus reconstruction failed and a few hours later, it was necessary to perform a left thoracotomy. A left pneumonectomy was required after the attempt to reconstruct the anastomosis was ruled out. The conclusion is that great care should be taken when using VATS approach for BC with adhesions. Resumo: A cirurgia torácica vídeo-assistida (VATS) é uma abordagem eficaz e viável na ressecção de cistos broncogénicos (BC). As complicações durante a dissecção podem dever-se a aderências pericisticas a estruturas vizinhas. Este artigo descreve um caso pouco comum de uma complicação operatória que consiste na rutura do brônquio principal esquerdo. A abordagem inicial VATS foi convertida a uma toracotomia direita para remover o cisto e proceder a sutura do brônquio uma vez obtida a exposição adequada. A reconstrução bronquial fracassou e algumas horas mais tarde foi necessário realizar a toracotomia esquerda. A pneumonectomia esquerda foi inevitável após a tentativa de reconstruir a anastomose ter sido descartada. Em conclusão, a abordagem VATS para o BC com adesões deve ser realizada/planificada com extremo cuidado. Keywords: Bronchogenic cyst, Complications, Thoracoscopy, Palavras-chave: Quisto broncogénico, Complicações, Toracoscopia