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Objective: To estimate, in a cohort of young Portuguese adults, the environmental impact (greenhouse gas (GHG) emissions, land use, energy used, acidification and potential eutrophication) of diet according to adherence to the Mediterranean Diet (MD)., Methods: Data from 1554 participants of the Epidemiologic Health Investigation of Teenagers in Porto (EPITeen) were analysed. Food intake and MD adherence were determined using validated questionnaires. The environmental impact was evaluated with the EAT-Lancet Commission tables, and the link between MD adherence and environmental impact was calculated using adjusted multivariate linear regression models., Results: Higher adherence (high vs. low) to the MD was associated with lower environmental impact in terms of land use (7.8 vs. 8.5 m 2 , p = 0.002), potential acidification (57.8 vs. 62.4 g SO2-eq, p = 0.001) and eutrophication (21.7 vs. 23.5 g PO4-eq, p < 0.001). Energy use decreased only in the calorie-adjusted model (9689.5 vs. 10,265.9 kJ, p < 0.001), and GHG emissions were reduced only in a complementary model where fish consumption was eliminated (3035.3 vs. 3281.2 g CO2-eq, p < 0.001). Meat products had the greatest environmental impact for all five environmental factors analysed: 35.7% in GHG emissions, 60.9% in energy use, 72.8% in land use, 70% in acidification and 61.8% in eutrophication., Conclusions: Higher adherence to the MD is associated with lower environmental impact, particularly in terms of acidification, eutrophication, and land use. Reducing meat consumption can contribute to greater environmental sustainability., (© 2024. The Author(s).)

Objective: To estimate the environmental impact of a dietary intervention based on an energy-reduced Mediterranean diet (MedDiet) after one year of follow-up., Methods: Baseline and 1-year follow-up data were used for 5800 participants aged 55-75 years with metabolic syndrome in the PREDIMED-Plus study. Food intake was estimated through a validated semiquantitative food consumption frequency questionnaire, and adherence to the MedDiet was estimated through the Diet Score. Using the EAT-Lancet Commission tables we assessed the influence of dietary intake on environmental impact (through five indicators: greenhouse gas emissions (GHG), land use, energy used, acidification and potential eutrophication). Using multivariable linear regression models, the association between the intervention and changes in each of the environmental factors was assessed. Mediation analyses were carried out to estimate to what extent changes in each of 2 components of the intervention, namely adherence to the MedDiet and caloric reduction, were responsible for the observed reductions in environmental impact., Results: We observed a significant reduction in the intervention group compared to the control group in acidification levels (-13.3 vs. -9.9 g SO2-eq), eutrophication (-5.4 vs. -4.0 g PO4-eq) and land use (-2.7 vs. -1.8 m2). Adherence to the MedDiet partially mediated the association between intervention and reduction of acidification by 15 %, eutrophication by 10 % and land use by 10 %. Caloric reduction partially mediated the association with the same factors by 55 %, 51 % and 38 % respectively. In addition, adherence to the MedDiet fully mediated the association between intervention and reduction in GHG emissions by 56 % and energy use by 53 %., Conclusions: A nutritional intervention based on consumption of an energy-reduced MedDiet for one year was associated with an improvement in different environmental quality parameters., Competing Interests: Declaration of competing interest J.S.-S. reported receiving research support from the Instituto de Salud Carlos III, Ministerio de Educación y Ciencia, the European Commission, the USA National Institutes of Health; receiving consulting fees or travel expenses from Eroski Foundation and Instituto Danone, receiving nonfinancial support from Hojiblanca, Patrimonio Comunal Olivarero, the California Almond Board of California, Pistachio Growers and Borges S.A; serving on the board of and receiving grant support through his institution from the International Nut and Dried Foundation and the Eroski Foundation; and personal fees from Instituto Danone Spain; Serving in the Board of Danone Institute International. D·C. reported receiving grants from Instituto de Salud Carlos III. R.E. reported receiving grants from Instituto de Salud Carlos III, Fundación Dieta Meditarránea and Cerveza y Salud and olive oil for the trial from Fundación Patrimonio Comunal Olivarero and personal fees from Brewers of Europe, Fundación Cerveza y Salud, Interprofesional del Aceite de Oliva, Instituto Cervantes in Albuquerque, Milano and Tokyo, Pernod Ricard, Fundación Dieta Mediterránea (Spain), Wine and Culinary International Forum and Lilly Laboratories; nonfinancial support from Sociedad Española de Nutrición and Fundación Bosch y Gimpera; and grants from Uriach Laboratories. The rest of the authors have declared that no competing interests exist. The funders had no role in the design of the study; in the collection, analysis, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The search for natural food additives makes propolis an exciting alternative due to its known antimicrobial activity. This work aims to investigate propolis' behavior as a nitrite substitute ingredient in cooked ham (a ready-to-eat product) when confronted with pathogenic microorganisms of food interest. The microbial evolution of Listeria monocytogenes , Staphylococcus aureus , Bacillus cereus , and Clostridium sporogenes inoculated at known doses was examined in different batches of cooked ham. The design of a challenge test according to their shelf life (45 days), pH values, and water activity allowed the determination of the mesophilic aerobic flora, psychotropic, and acid lactic bacteria viability. The test was completed with an organoleptic analysis of the samples, considering possible alterations in color and texture. The cooked ham formulation containing propolis instead of nitrites limited the potential growth (δ < 0.5 log 10 ) of all the inoculated microorganisms until day 45, except for L. monocytogenes , which in turn exhibited a bacteriostatic effect between day 7 and 30 of the storage time. The sensory analysis revealed the consumer's acceptance of cooked ham batches including propolis as a natural additive. These findings suggest the functionality of propolis as a promising alternative to artificial preservatives for ensuring food safety and reducing the proliferation risk of foodborne pathogens in ready-to-eat products.

Objective: To determine if the addition of the assessment of levator ani muscle (LAM) avulsion to the measurement of the difference in the pubis-uterine fundus distance between rest and with the Valsalva maneuver could increase the diagnostic capacity of ultrasound for uterine prolapse (UP)., Methods: This multicenter, observational and prospective study included 145 patients. Ultrasound assessment was performed, establishing the diagnosis of UP as a difference between the pubic-uterine fundus distance at rest and during the Valsalva maneuver ≥15 mm (standard technique), while LAM avulsion was defined as an abnormal LAM insertion in three central slices using multislice ultrasound. A binary multivariate logistic regression model was made using nonautomated methods to predict surgical UP (general population, premenopausal, and postmenopausal patients), including the difference between the pubis-uterine fundus distance at rest and with the Valsalva maneuver as well as LAM avulsion., Results: A total of 143 patients completed the study. The addition of LAM avulsion criteria to the standard dynamic distance-based protocol for the diagnosis of UP resulted in a higher sensitivity for the general population (79.7 vs 68.1%) as well as for premenopausal (89.3 vs 79.9%) and postmenopausal patients (76 vs 66.1%). In contrast, the standard technique showed a higher specificity than the model based on the standard technique associated with LAM avulsion for the general population (89.2 vs 74.3%) and premenopausal women (91.7 vs 63.2%). For postmenopausal patients, the model based on the standard technique associated with LAM avulsion had a higher sensitivity (76 vs 66.1%) and specificity (91.7 vs 86.8%) than the ultrasound diagnosis of UP., Conclusion: The implementation of the assessment of LAM avulsion in the ultrasound diagnosis of UP is useful in postmenopausal patients, increasing sensitivity and specificity relative to the ultrasound assessment based only on the difference between the pubis-uterine fundus distance at rest and with the Valsalva maneuver., (© 2023 The Authors. Journal of Ultrasound in Medicine published by Wiley Periodicals LLC on behalf of American Institute of Ultrasound in Medicine.)

Background: Caesarean section is necessary to save the lives of mothers and newborns at times, but it is important to perform it only when it is essential due to all the risks involved. This study aimed to examine the rate of caesarean sections performed at a tertiary hospital using the Robson classification to detect methods for the detection of and/or reduction in these caesarean section rates., Methods: A descriptive, cross-sectional study of a retrospective database was carried out., Results: A total of 10,317 births were assessed. The Robson classification was used to assess these interventions and verify whether the indication for performed caesarean sections was appropriate. In total, 2036 births by caesarean section were performed in the whole sample. The annual caesarean section rate varied between 18.67% and 21.18%., Conclusions: Caesarean sections increased by about 20% in 2021 compared to 2020 even though the trend over the years of study was decreasing. Vaginal delivery after caesarean section is a reasonable and safe option. Caesarean section rates could be improved, mostly in Robson's Group 2. The Robson classification facilitated progress in the implementation of measures aimed at improving care and adjusting caesarean section rates.

The antioxidant, anti-inflammatory, and antimicrobial characteristics of propolis, a bioactive compound collected from hives, have prompted its use in the food sector in recent times. This study investigated the physicochemical characteristics, phenolic profile, and antioxidant capacity of 31 propolis extracts collected from Northern Spain. The physicochemical composition (resins, waxes, ashes mineral content, and heavy metals) was within the allowable regulatory limits. The analysis of bioactive compounds enabled the identification of 51 constituents: flavonoids (apigenin, catechin, chrysin, quercetin, and pinocembrin) and phenolic acids (caffeic, ferulic, and coumaric). The mean value of total polyphenols was 42.72 ± 13.19 Pinocembrin-Galangin Equivalents/100 g, whereas a range between 1.64 ± 0.04 and 4.95 ± 0.36 Quercetin Equivalents (QE) g/100 g was found for total flavonoids content. The determination of bioactivities revealed significant antioxidant capacity using DPPH (1114.28 ± 10.39 µM Trolox Equivalents and 3487.61 ± 318.66 µM Vitamin C Equivalents). Resin content in propolis samples was positively and significantly correlated with both polyphenols (rho = 0.365; p = 0.043) and flavonoid composition (rho = 0.615; p = 0.000) as well as the antioxidant capacity TEAC DPPH (rho = 0.415; p = 0.020). A multiple regression analysis modeled the correlation between resin composition, flavonoids, and TEAC DPPH values, yielding a significant regression equation (R 2 = 0.618; F (2,28) = 22.629; p < 0.000; d = 2.299). Therefore, evaluating physicochemical parameters and biological activities provides a promising framework for predicting propolis' quality and antioxidant properties, thus suggesting its potential as a functional and bioactive compound for the food industry.

Objectives: To validate an ultrasound software that uses transperineal ultrasound to diagnose uterine prolapse (UP)., Methods: Multicenter, observational and prospective study with 155 patients that had indications for surgical intervention for dysfunctional pelvic floor pathology. Each patient underwent an examination with Pozzi tenaculum forceps was performed in the operating room with the patient anesthetized, followed by surgical correction of stages II-IV UP. Transperineal ultrasound was used to assess the difference in the pubis-uterine fundus measurement. With a multivariate logistic regression binary model (with the measurement ultrasound at rest, the Valsalva maneuver and age) using nonautomated methods to predict UP. With the purpose of evaluating the model, a table with coordinates of the receiver operating characteristic (ROC) curve, after which sensitivity and specificity were assessed., Results: A total of 153 patients were included (73 with a diagnosis of surgical UP). It was obtained from the AUC (0.89) of the probabilities predicted by the model (95% confidence interval, 0.84-0.95; P < .0005). Based on the ROC curve for the model, obtaining a sensitivity of 91.8% and a specificity of 72.7%, values that were superior to those for the clinical exam for surgical UP (sensitivity: 80.8%; specificity: 71.3%)., Conclusions: We validated software that uses transperineal ultrasound of the pelvic floor and patient age to generate a more reliable diagnosis of surgical UP than that obtained from clinical examinations., (© 2023 The Authors. Journal of Ultrasound in Medicine published by Wiley Periodicals LLC on behalf of American Institute of Ultrasound in Medicine.)

Objectives: It is unknown whether diagnosing uterine prolapse (UP) via ultrasound or surgical criteria is superior. Our objective is to determine whether the diagnostic capacity of ultrasound with surgical criteria differs from that of surgical criteria only., Methods: This was a multicenter prospective observational study with 54 premenopausal patients with surgical criteria for a dysfunctional pelvic floor pathology who were consecutively recruited for 1 year. Clinical UP with surgical criteria was defined when UP stage II-IV was identified (during pelvic floor consultation), and UP diagnosed by ultrasound with surgical criteria was established when a difference ≥15 mm was found between rest and Valsalva applied to the pubis-uterine fundus. The sensitivity, specificity and positive and negative predictive values were determined to evaluate clinical and ultrasound methodologies as diagnostic tests., Results: UP diagnosed by ultrasound with surgical criteria presented better sensitivity (78.57 vs 35.71%), specificity (92.11 vs 81.58%), positive predictive value (61.83 vs 23.99%), and negative predictive value (96.35 vs 11.37%) than UP diagnosed by surgical criteria only., Conclusion: Ultrasound with surgical criteria is superior to surgical criteria alone when diagnosing UP., (© 2023 The Authors. Journal of Ultrasound in Medicine published by Wiley Periodicals LLC on behalf of American Institute of Ultrasound in Medicine.)

The prevalence of Listeria monocytogenes in 30 samples of poultry was determined using culture-dependent (isolation on OCLA and confirmation by conventional polymerase chain reaction -PCR-, OCLA&PCR) and culture-independent (real-time polymerase chain reaction, q-PCR) methods. L. monocytogenes was detected in 15 samples (50.0%) by OCLA&PCR and in 20 (66.7%) by q-PCR. The concentrations (log 10 cfu/g) of L. monocytogenes (q-PCR) ranged from 2.40 to 5.22 (total cells) and from <2.15 to 3.93 (viable cells). The two methods, q-PCR using a viability marker (v-PCR) and OCLA&PCR (gold standard), were compared for their capacity to detect viable cells of L. monocytogenes , with the potential to cause human disease. The values for sensitivity, specificity and efficiency of the v-PCR were 100%, 66.7% and 83.3%, respectively. The agreement between the two methods (kappa coefficient) was 0.67. The presence of nine virulence genes ( hlyA , actA , inlB , inlA , inlC , inlJ , prfA , plcA and iap ) was studied in 45 L. monocytogenes isolates (three from each positive sample) using PCR. All the strains harbored between six and nine virulence genes. Fifteen isolates (33.3% of the total) did not show the potential to form biofilm on a polystyrene surface, as determined by a crystal violet assay. The remaining strains were classified as weak (23 isolates, 51.1% of the total), moderate (one isolate, 2.2%) or strong (six isolates, 13.3%) biofilm producers. The strains were tested for susceptibility to a panel of 15 antibiotics. An average of 5.11 ± 1.30 resistances per isolate was observed. When the values for resistance and for reduced susceptibility were taken jointly, this figure rose to 6.91 ± 1.59. There was a prevalence of resistance or reduced susceptibility of more than 50.0% for oxacillin, cefoxitin, cefotaxime, cefepime ciprofloxacin, enrofloxacin and nitrofurantoin. For the remaining antibiotics tested, the corresponding values ranged from 0.0% for chloramphenicol to 48.9% for rifampicin. The high prevalence and level of L. monocytogenes with numerous virulence factors in poultry underline how crucial it is to follow correct hygiene procedures during the processing of this foodstuff in order to reduce the risk of human listeriosis.

Objective: To evaluate the use of intraoperative ultrasound (IUS) to achieve a postoperative optimal placement of the tension-free vaginal tape-obturator (TVT-O)., Methods: A cohort study was performed among women who underwent TVT-O placement. In 25 women, ultrasound was used for the placement, and based on current evidence, the optimal intraoperative and postoperative ultrasound pattern was selected. They were compared with 25 women where IUS was not used., Results: IUS increased operative time (by 7.5 min), and in 36% (9/25) of cases it was necessary to perform some corrections based on the ultrasound findings. After 1 month, in patients of the IUS group, the tapes were more frequently placed at a distance of 3-5 mm (P = 0.01), and it was more common for it to be placed between 40% and 70% relative to the urethral length (P = 0.011). Of tapes placed with IUS, 76% (met the optimal postoperative ultrasound pattern, as opposed to only 48% placed without IUS (P = 0.041). No differences were found in the complications or the functional results at 1 month post-surgery., Conclusion: The use of IUS for the placement of TVT-O allows us to position them optimally and avoid erroneous placements, although IUS increases the operative time without improving the functional results and the rate of complications., (© 2023 International Federation of Gynecology and Obstetrics.)

When selecting effective doses of antimicrobials, be they biocides or antibiotics, it is essential to know the minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of these substances. The present research determined the MICs and MBCs for three biocides, sodium hypochlorite (SH), benzalkonium chloride (BC), and peracetic acid (PAA), and nine antibiotics in eight strains of Listeria monocytogenes of varying serotypes. Marked intra-species differences were observed in the resistance of L. monocytogenes to the biocides and antibiotics. The MICs (ppm) for the biocides ranged between 1750 and 4500 for SH, 0.25 and 20.00 for BC, and 1050 and 1700 for PAA. Their MBCs (ppm) ranged from 2250 to 4500 for SH, 0.50 to 20.00 for BC, and 1150 to 1800 for PAA. The MICs (ppm) for antibiotics lay between 1 and 15 for ampicillin, 8 and 150 for cephalothin, 20 and 170 for cefoxitin, 0.05 and 0.20 for erythromycin, 4 and 50 for chloramphenicol, 3 and 100 for gentamicin, 2 and 15 for tetracycline, 2 and 80 for vancomycin, and 160 and 430 for fosfomycin. The corresponding MBCs (ppm) were from 5 to 20 for ampicillin, 9 to 160 for cephalothin, 70 to 200 for cefoxitin, 4 to 5 for erythromycin, 9 to 70 for chloramphenicol, 5 to 100 for gentamicin, 3 to 30 for tetracycline, 3 to 90 for vancomycin, and 160 to 450 for fosfomycin. Notably, erythromycin showed considerable efficacy, demonstrated by the low values for both MIC and MBC. Based on EUCAST and the CLSI criteria, all strains were susceptible to erythromycin. All strains were resistant to cephalothin, cefoxitin, gentamicin, and fosfomycin. Further values for resistance were 87.50% for ampicillin and vancomycin, 75.00% for tetracycline, and 62.50% for chloramphenicol. The high prevalence of antibiotic resistance is a matter for concern. A positive correlation was found between MIC and MBC values for most of the biocides and antibiotics. The higher the hydrophobicity of the cell surface, the higher the susceptibility to biocides, suggesting that surface characteristics of bacterial cells influence resistance to these compounds.

The objective of this study was to characterize the biofilms formed by Salmonella enterica serotype Agona, Listeria monocytogenes, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE) after 12, 48, 72, 120 and 240 h of incubation at 10 °C. Biofilms containing a single species, together with dual-species biofilms in which S. enterica and a Gram-positive bacterium existed in combination, were formed on polystyrene and evaluated by using confocal laser scanning microscopy (CLSM). All strains were able to form biofilm. The greatest biovolume in the observation field of 14,161 μm 2 was observed for mono-species biofilms after 72 h, where biovolumes of 94,409.0 μm 3  ± 2131.0 μm 3 (S. enterica), 58,418.3 μm 3  ± 5944.9 μm 3 (L. monocytogenes), 68,020.8 μm 3  ± 5812.3 μm 3 (MRSA) and 59,280.0 μm 3  ± 4032.9 μm 3 (VRE) were obtained. In comparison with single-species biofilms, the biovolume of S. enterica was higher in the presence of MRSA or VRE after 48, 72 and 120 h. In dual-species biofilms, the bacteria showed a double-layer distribution pattern, with S. enterica in the top layer and Gram-positive bacteria in the bottom layer. This spatial disposition should be taken into account when effective strategies to eliminate biofilms are being developed., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The coupling of biological and thermal technologies allows for the complete conversion of wastes into energy and biochar eliminating the problem of sludge disposal. The valorisation of fatty residues as co-substrate in a mesophilic digester of a wastewater treatment plant was studied considering an integrated approach of co-digestion and pyrolysis. Four digested samples obtained from co-digestion of sewage sludge and butcher's fat waste were studied by thermogravimetric analysis. The activation energy corresponding to the sludge pyrolysis was calculated by a non-isothermal kinetic. Arrhenius activation energy was lower for the pyrolysis of a digested grease sample (92 kJ mol -1 obtained by OFW and 86 kJ mol -1 obtained by Vyazovkin) than for the pyrolysis of sewage sludge and its blends (164-190 kJ mol -1 obtained by OFW and 162-190 kJ mol -1 obtained by Vyazovkin). The analysis of the integrated approach of anaerobic co-digestion and pyrolysis of digestates demonstrated that the addition of 3% (w/v) of fat to the feeding sludge results in a 25% increase in the electricity obtained from biogas (if a combined heat and power unit is considered for biogas valorisation) and increasing the fat content to 15% allows for covering all thermal needs for drying of digestate and more than doubles (2.4 times) the electricity production when the scenario of digestion and pyrolysis is contemplated.

Objetive: To investigate the prevalence and potential risk factors for postpartum voiding dysfunction (PPVD)., Methods: A retrospective observational study was performed in a university hospital center between January 2018 and April 2019. Women with PPVD criteria postpartum were diagnosed and treated. Gestational, delivery, and puerperium characteristics were compared between women with and without PPVD., Results: A total of 1894 out of 2308 deliveries (81%) were vaginal, 73 (9.85%) had PPVD and 13.7% were severe. Epidural analgesia (odds ratio [OR] 7.72, 95% confidence interval [CI],1.02-58.37), operative vaginal delivery (OR 2.23, 95% CI,1.01-4.93), birthweight >4000g (OR 3.7, 95%CI,1.4-9.73), and previous cesarean delivery (OR 6.54, 95% CI, 2.2-19.2) were independent risk factors for PPVD., Conclusion: PPVD is a relatively common finding that complicates around 10% of vaginal deliveries. Epidural analgesia, birthweight, operative vaginal birth, and having a previous cesarean delivery are independent risk factors for PPVD. In order to prevent PPVD, more research on PPVD risk factors is needed., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The prognostic value of a prolonged QT interval in SARS-Cov2 infection is not well known., Objective: To determine whether the presence of a prolonged QT on admission is an independent factor for mortality in SARS-Cov2 hospitalized patients., Methods: Single-center cohort of 623 consecutive patients with positive polymerase-chain-reaction test (PCR) to SARS Cov2, recruited from 27 February to 7 April 2020. An electrocardiogram was taken on these patients within the first 48 h after diagnosis and before the administration of any medication with a known effect on QT interval. A prolonged QT interval was defined as a corrected QT (QTc) interval >480 milliseconds. Patients were followed up with until 10 May 2020., Results: Sixty-one patients (9.8%) had prolonged QTc and only 3.2% had a baseline QTc > 500 milliseconds. Patients with prolonged QTc were older, had more comorbidities, and higher levels of immune-inflammatory markers. There were no episodes of ventricular tachycardia or ventricular fibrillation during hospitalization. All-cause death was higher in patients with prolonged QTc (41.0% vs. 8.7%, p < 0.001, multivariable HR 2.68 (1.58-4.55), p < 0.001)., Conclusions: Almost 10% of patients with COVID-19 infection have a prolonged QTc interval on admission. A prolonged QTc was independently associated with a higher mortality even after adjustment for age, comorbidities, and treatment with hydroxychloroquine and azithromycin. An electrocardiogram should be included on admission to identify high-risk SARS-CoV-2 patients.

In this paper, response surface methodology (RSM) designs and an artificial neural network (ANN) are used to obtain the optimal conditions for the oxy-combustion of a corn-rape blend. The ignition temperature ( T e ) and burnout index ( D f ) were selected as the responses to be optimised, while the CO 2 /O 2 molar ratio, the total flow, and the proportion of rape in the blend were chosen as the influencing factors. For the RSM designs, complete, Box-Behnken, and central composite designs were performed to assess the experimental results. By applying the RSM, it was found that the principal effects of the three factors were statistically significant to compute both responses. Only the interactions of the factors on D f were successfully described by the Box-Behnken model, while the complete design model was adequate to describe such interactions on both responses. The central composite design was found to be inadequate to describe the factor interactions. Nevertheless, the three methods predicted the optimal conditions properly, due to the cancellation of net positive and negative errors in the mathematical adjustment. The ANN presented the highest regression coefficient of all methods tested and needed only 20 experiments to reach the best predictions, compared with the 32 experiments needed by the best RSM method. Hence, the ANN was found to be the most efficient model, in terms of good prediction ability and a low resource requirement. Finally, the optimum point was found to be a CO 2 /O 2 molar ratio of 3.3, a total flow of 108 mL/min, and 61% of rape in the biomass blend., Competing Interests: The authors declare no conflict of interest.

Introduction: Levator ani avulsion rates after assisted vaginal delivery have been reported in the literature. However, there are no definitive data regarding the association between overdistention and assisted vaginal delivery. Therefore, our aim is to report overdistention rates after assisted vaginal delivery with a postpartum ultrasound examination., Materials and Methods: This multicenter study involved a retrospective analysis of data from primiparous women (n = 602) who had previously been recruited at three tertiary hospitals between January 2015 and January 2017. Overdistention was assessed at 6 months postpartum using three-/four-dimensional transperineal ultrasound. Patients with levator ani muscle avulsion were excluded. Overdistention was defined as a levator hiatal area ≥ 25 cm 2 on Valsalva., Results: Of the 602 primiparous patients, 250 patients who satisfied the inclusion criteria (139 patients who underwent forceps delivery and 111 patients who underwent vacuum delivery) were evaluated. Overdistention occurred in 20% (50 of 250) of these patients. Overdistention was observed for 1% (1/111) of vacuum deliveries and 35.3% (49 of 139) of forceps deliveries. We found an increased risk of overdistention following forceps delivery compared to vacuum delivery, with a crude odds ratio (OR) of 59.9 (95% confidence interval [CI]: 8.1, 442.2) and an adjusted OR (adjusted for maternal age, second-stage duration, and head circumference) of 17.6 (95% CI: 2.3, 136.7)., Conclusions: Postpartum overdistention occurred for 20% of assisted vaginal deliveries, with an increased risk of overdistention following forceps delivery compared to vacuum delivery., (© 2020 Wiley Periodicals, Inc.)

Objective: To assess the impact of Triepi-45-a tool that enables an episiotomy angle of 45° to be marked on the perineum at rest-on the incidence of obstetric anal sphincter injuries (OASIS) during operative vaginal delivery (OVD)., Method: A retrospective-prospective cohort study was performed among successive women who underwent OVD at Complejo Asistencial Universitario de de León, Spain, between 2011 and 2013 (preintervention cohort, n=986) and between 2014 and 2016 (intervention cohort, n=986) after implementation of an interventional programme in 2013 to improve the episiotomy angle, including use of Triepi-45, in OVD., Results: The intervention cohort had a lower incidence of OASIS than the preintervention cohort (70/986 [7.1%] vs 93/986 [9.4%]), but the difference was not significant, owing to the low use of Triepi-45 in the intervention cohort (n=375). However, the OASIS incidence was significantly lower in the Triepi-45 cohort than in the preintervention cohort (18/375 [4.8%] vs 93/986 [9.4%]; odds ratio, 0.47; 95% confidence interval, 0.26-0.86)., Conclusion: Use of Triepi-45 had a positive impact on reducing OASIS in OVD. It remains essential to raise obstetricians' awareness of the importance of the episiotomy angle and to implement the systematic use of tools to reduce the incidence of OASIS., (© 2019 International Federation of Gynecology and Obstetrics.)

Objectives: The objective of this study is to investigate a multicenter study to establish if differences exist in the levator ani muscle avulsion (LAM) rates between deliveries performed with Malmstrom's vacuum and the Kiwi vacuum., Study Design: A prospective, multicenter observational study with 199 primiparous subjects was performed. All patients had undergone vaginal delivery by vacuum (Malmstrom's or Kiwi). Avulsion was defined as an abnormal insertion of LAM in the lower pubic branch in the multiplanar mode, as identified in the three central sections by transperineal 3/4D echography 6 months after delivery. The area of ​​the levator hiatus was measured in the plane of minimum dimensions at rest, during the Valsalva maneuver and during contraction., Results: LAM avulsion occurred in 33.1% of cases in which Malmstrom's vacuum was used and in 29.4% of cases in which the Kiwi vacuum was used (the difference was not statistically significant), which resulted in a crude odds ratio (OR) of 0.977 (0.426, 2.241; P = .957) and an adjusted OR of 2.90 (0.691; 12.20; P = .146). Women in the Malmstrom's vacuum group had a larger LHA at rest 14.77 vs 12.64 cm 2 ; P = .001) and at maximum contraction (13.41 vs 10.83 cm 2 ; P < 0.001) in comparison with the Kiwi group, although the difference did not reach statistical significance under Valsalva maneuver (18.71 vs 17.21 cm 2 ; P = .051).Differences between both groups were detected in the measurements of the hiatus area levator at rest (14.77 vs 12.64 cm 2 ), during the Valsalva maneuver (18.71 vs 17.21 cm 2 ) and during maximum contraction (13.41 vs 10.83 cm 2 )., Conclusions: In the present study, Malmstrom's vacuum was not associated with a higher risk of LAM in comparison with Kiwi's Omnicup., (© 2019 Wiley Periodicals, Inc.)

Beef preparations (meatballs, minced meat, hamburgers, white sausages, and red sausages) from northwest Spain were tested. Microbial counts ranged from 0.70 ± 0.00 log 10 cfu/g (enterococci) to 9.57 ± 0.37 log 10 cfu/g (psychrotrophs). In 73.3% of cases, total aerobic counts were higher than the microbiological limits set for the end of the manufacturing process in the European Union (EU Regulation 2073/2005). Forty Escherichia coli isolates were tested against thirteen clinically important antibiotics (disk diffusion method; CLSI). Three of the strains (7.5%) were susceptible to all the antibiotics, four (10.0%) showed resistance or reduced susceptibility to one antibiotic, and 33 (82.5%) were multiresistant (with resistance or reduced susceptibility to between two and eight antibiotics), with an average of 1.85 resistances per strain. The highest rates of resistance were observed for two antimicrobials widely used on cattle farms (cefalotin and tetracycline). The findings in this research emphasize the need to correctly handle beef preparations with the aim of reducing risks to consumers., Competing Interests: The authors declare that there is no conflict of interest., (© 2019 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc.)

The susceptibility of Cronobacter sakazakii ATCC 29544 (CS) and Yersinia enterocolitica ATCC 9610 (YE) to sodium hypochlorite (10% of active chlorine; SHY), peracetic acid (39% solution of peracetic acid in acetic acid; PAA) and benzalkonium chloride (BZK) was tested. Minimum inhibitory concentration (MIC) values (planktonic cells; microdilution broth method) of 3,800 ppm (SHY), 1,200 ppm (PAA) and 15 ppm (BZK) for CS, and 2,500 ppm (SHY), 1,275 ppm (PAA) and 20 ppm (BZK) for YE, were found. In some instances, an increase in growth rate was observed in presence of sub-MICs (0.25MIC, 0.50MIC or 0.75MIC) of biocides relative to the samples without biocides. The cultures exhibited an acquired tolerance to biocides and an increase in antibiotic resistance after exposure to sub-MICs of such disinfectants. Strains were able to form strong biofilms on polystyrene after 48 hours (confocal laser scanning microscopy), with average biovolumes in the observation field (14,161 µm 2 ) of 242,201.0 ± 86,570.9 µm 3 (CS) and 190,184.5 ± 40,860.3 µm 3 (YE). Treatment of biofilms for 10 minutes with disinfectants at 1MIC or 2MIC reduced the biovolume of live cells. PAA (YE) and BZK (CS and YE) at 1MIC did not alter the percentage of dead cells relative to non-exposed biofilms, and their effect of countering biofilm was due principally to the detachment of cells. These results suggest that doses of PAA and BZK close to MICs might lead to the dissemination of live bacteria from biofilms with consequent hazards for public health.

Using agglutination techniques, 118 Listeria monocytogenes isolates from red meat and poultry were serotyped. Strains were ascribed to the serotypes 4b/4e (44.1% of the strains), 1/2 (a, b or c; 28.0%), 4c (6.8%), 4d/4e (5.9%) and 3 (a, b or c; 2.5%). Among these are the serotypes most frequently involved in cases of human listeriosis. The susceptibility of 72 strains to 26 antibiotics of clinical importance was determined by disc diffusion (Clinical and Laboratory Standards Institute; CLSI). High levels of resistance were observed to cefoxitin (77.8% of the strains showed resistance), cefotaxime (62.5%), cefepime (73.6%), and nalidixic acid (97.2%), nitrofurantoin (51.4%) and oxacillin (93.1%). Less than 3% of the strains showed resistance to the antibiotic classes used in human listeriosis therapy (i.e., ampicillin, gentamicin, rifampicin, chloramphenicol, enrofloxacin, vancomycin, trimethoprim-sulfamethoxazole, erythromycin, and tetracycline). The influence of species and serotype on the growth kinetics (modified Gompertz equation) and on the adhesion ability (crystal violet staining) of nine isolates of L. monocytogenes (serotypes 1/2a, 1/2b, 1/2c, 3a, 3b, 3c, 4a, 4b, and 4d), and one strain of Listeria ivanovii were investigated. The maximum growth rate (ΔOD 420 - 580 /h) varied between 0.073 ± 0.018 ( L. monocytogenes 1/2a) and 0.396 ± 0.026 ( L. monocytogenes 4b). The isolates of L. monocytogenes belonging to serotypes 3a and 4a, as well as L. ivanovii , showed a greater ( p < 0.05) biofilm-forming ability than did the remaining strains, including those that belong to the serotypes commonly implied in human listeriosis (1/2a, 1/2b, 1/2c and 4b). The need for training in good hygiene practices during the handling of meat and poultry is highlighted to reduce the risk of human listeriosis.

An expansion in the consumption of pigeon meat has occurred in recent years. However, little is known about microbial load and antibiotic resistance of this foodstuff. The hygiene status and the antibiotic resistance patterns (disc diffusion; Clinical and Laboratory Standards Institute, CLSI) of Escherichia coli and Enterococcus faecalis isolates from wild and domestic pigeon carcasses were investigated. Average microbial loads (log 10 cfu/cm 2 ) ranged from 1.40 ± 1.17 (fecal coliforms) to 3.68 ± 1.40 (psychrotrophs). The highest ( p < 0.05) microbial loads were observed in domestic pigeons. No substantial differences were found between isolates from domestic and wild pigeons with regard to the prevalence of antibiotic resistance. Of the E. coli strains, 20.00% were susceptible, 25.00% showed resistance or reduced susceptibility to one antimicrobial and 55.00% were multi-resistant. Among the E. faecalis isolates, 2.22% were susceptible and 97.78% were multi-resistant. The greatest prevalence of resistance or reduced susceptibility among E. coli was observed for amoxicillin-clavulanic acid (20.00% strains), ampicillin (26.67%), streptomycin (55.00%) and tobramycin (20.00%). The prevalence of resistance or reduced susceptibility among E. faecalis ranged from 31.11% (trimethoprim/sulfamethoxazole) to 97.78% (erythromycin). Meat from pigeons is a major reservoir of antibiotic-resistant bacteria. The need for the correct handling of this foodstuff in order to reduce risks to consumers is underlined.

Introduction: Forceps use is the main risk factor for levator ani muscle (LAM) injuries. We believe that the disengagement of the forceps branches before delivery of the fetal head could influence LAM injuries, so we aimed to determine the influence of the disengagement of the forceps on the occurrence of LAM avulsion during forceps delivery., Material and Methods: A prospective, observational, multicenter study was conducted with 261 women who underwent forceps delivery. The women were classified according to whether the branches of the forceps had been disengaged before delivery of the fetal head. LAM avulsion was defined using a multislice mode (3 central slices)., Results: In all, 255 women completed the study (160 without disengagement and 95 with disengagement). LAM avulsions were observed in 37.9% of women in the group with disengagement and in 41.9% of women in the group without disengagement. The crude OR (without disengagement vs with disengagement) for avulsion was 0.90 (95% CI 0.49-1.67, P = 0.757) and an adjusted OR of 0.82 (95% CI 0.40-1.69, P = 0.603)., Conclusions: We did not observe a statistically significant reduction in the LAM avulsion rate with disengagement of the forceps branches before delivery of the fetal head., (© 2019 Nordic Federation of Societies of Obstetrics and Gynecology.)

The susceptibility of four L. monocytogenes isolates from pork to sodium hypochlorite (SHY) and benzalkonium chloride (BZK) was tested. Minimum inhibitory concentration (MIC) values of 3500 ppm (SHY), or between 3 ppm and 13 ppm (BZK), were found. Minimum bactericidal concentration (MBC) values ranged from 3500 ppm to 4500 ppm (SHY), and from 3 ppm to 14 ppm (BZK). The effect of SHY and BZK on the architecture and cellular viability of 24-h-old biofilms formed by such strains on polystyrene was determined through confocal laser scanning microscopy (CLSM) in conjunction with fluorescent dyes for live cells (SYTO 9) and dead cells (propidium iodide). Strains were able to form biofilm (biovolume values in the observation field of 14,161 μm 2 ranged between 103,928.3 ± 6730.2 μm 3 and 276,030.9 ± 42,291.9 μm 3 ). Treatment of biofilms for 10 min with SHY (1MIC or 1.5MIC) or BZK (0.5MIC, 1MIC or 1.5MIC) decreased the biovolume of live (potentially dangerous) cells. SHY reduced the cellular viability of biofilms by more than 90%. On the other hand, BZK was able to remove most biofilm mass (live and dead cells), but decreased cellular viability only to a lesser extent, this suggesting strong biofilm detachment and dissemination of live cells., (Copyright © 2019. Published by Elsevier Ltd.)

Objetive: Operative vaginal delivery (OVD) is the most important risk fact for obstetric anal sphincter injury (OASI). Knowledge of possible risk factors for their occurrence may therefore reduce the likelihood of faecal incontinence. The aim is to analyse the effect of mediolateral episitomy and perineum characteristics on the occurrence of OASI in OVD., Study Design: Case-control study, which included 958 OVD that were reviewed in Pelvic Floor and Puerperium Clinic. The episiotomy and perineum characteristics of those women who experienced OASIs (n = 150) were compared with those who had no evidence of anal sphincter injury (n = 788)., Results: In multivariate logistic regression analysis the factors which were independently associated were nulliparity, persistent occipitoposterior position, birthweight >3500 g, an angle of episiotomy <30°, a distance episiotomy-fourchette <5 mm and a distance of perineal body <30 mm. The analysis of subgroups show that only the multiparous women does not benefit from any feature of the episiotomy, and an angle greater than 30° and a distance episiotomy-fourchette >5 mm are associated with a risk reduction of OASI in nulliparous, perineal bodies ≤30 mm and occipitoanterior position., Conclusions: Two modifiable risk factors at the time of performing the episiotomy, the angle and distance episiotomy-fourchette, have been identified as the risk modification of OASI. It is necessary to achieve an adequate angle to reduce the probability of OASIs in OVD, and in nulliparous women with an anterior position and a distance of perineal body ≤30 mm could benefit from increasing the episiotomy-fourchette distance., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Because listeriosis is one of the deadliest foodborne diseases, controlling and eradicating Listeria monocytogenes biofilms is a serious challenge for food safety. Biofilms (24 h old) formed on polystyrene by a L. monocytogenes strain of food origin were exposed for a further 24 h to 12 different concentrations (from 10 0 to 10 11 PFU/mL) of the bacteriophage P100 (Listex P100). The structural parameters of biofilms were studied by using confocal laser scanning microscopy and digital image analysis. The biovolume in the observation field (14,121 μm 2 ) of control (untreated) biofilms was 237,333.1 ± 2,692.6 μm 3 . The biomass of treated biofilms ranged from 164.7 ± 89.0 μm 3 (biofilms exposed to 10 10 PFU/mL) to 231,170.5 ± 15,142.0 μm 3 (10 0 PFU/mL). The lowest biomass was achieved after treatment with 10 8 PFU/mL, with no further decrease in biovolume when higher phage concentrations were used. A strong ( P < 0.001) correlation was found between phage concentration (log units) and biovolume (-0.965), surface coverage (-0.939), roughness (0.976), maximum thickness (-0.853), and average thickness (-0.965). Findings from this research suggest that bacteriophage P100 at concentrations equal to or greater than 8 log PFU/mL successfully removes L. monocytogenes biofilms from polystyrene surfaces.

The biofilms formed by Salmonella Hadar (SH174), Listeria monocytogenes (LM6), methicillin-resistant Staphylococcus aureus (MRSA125) and vancomycin-resistant Enterococcus faecium (VRE61s) on polystyrene and glass after 24 h and 72 h of incubation at 37 °C were examined by confocal laser scanning microscopy (CLSM) after staining with SYTO9 and propidium iodide (PI). A lower average biovolume (P < 0.05) was observed for SH174 biofilms (73,073.61 ± 52,365.90 μm 3 in the observation field of 14,161 μm 2 ) than for LM6 (180,804.50 ± 32,554.62 μm 3 ), MRSA125 (208,605.34 ± 57,534.93 μm 3 ) and VRE61s (212,543.91 ± 39,718.62 μm 3 ) biofilms. SH174 showed the greatest (P < 0.05) biovolume on glass, as compared with polystyrene. Biofilms of LM6, MRSA125 and VRE61s were produced at comparable levels on both contact surfaces. After 24 h, SH174 formed small scattered cell clusters, and biovolume of biofilms increased (P < 0.05) after 72 h. By contrast, LM6, MRSA125 and VRE61s formed compact biofilms quickly (24 h) on both contact surfaces. Seventy-two-hour-old biofilms showed the largest biovolumes of dead or damaged (PI-stained) cells, except for MRSA125 (polystyrene) and VRE61s (polystyrene and glass). Appropriate procedures for the disinfection of food processing surfaces immediately after use are required to prevent the formation of biofilm by pathogenic bacteria., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The anaerobic digestion process of swine manure was studied when char was used as supplement for improving performance. The use of pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) was proposed for assessing the organic matter degradation. The assessment on biogas production was carried out using samples of swine manure (SM) supplemented with char in one case and pre-treated by microwave irradiation in the other. This experimental set-up allows for the comparison of the biological degradation observed under these two different configurations and therefore aids in understanding the effect of char particles on the process. Results showed similar performance for both systems, with an average improvement of 39% being obtained in methane production when compared to the single digestion of SM. The analysis of digestate samples by Fourier transform infrared (FTIR) spectroscopy and Py-GC/MS showed improved degradation of proteins, with the Py-GC/MS technique also capable of identifying an increase in microbial-derived material when char was added, therefore highlighting the relevant role of carbon conductive particles on biological systems. Py-GC/MS along with the use of FTIR spectroscopy has proven to be useful tools when evaluating anaerobic digestion.

Aim: To determine the impact of the type of hospital kitchen on the dietary intake of patients., Methods: A cross-sectional, two-centre study, of cooking in a traditional kitchen (TK) and in a chilled kitchen (CK). Subjective global assessment (SGA) was used for nutritional diagnosis. Before study start, a dietician performed a nutritional assessment of the menus of each hospital. All dishes were weighed upon arrival to the ward and at the end of the meal., Results: 201 and 41 patients from the centres with TK and CK respectively were evaluated. Prevalence of malnutrition risk was 50.2% at the hospital with TK and 48.8% at the hospital with CK (p=0.328). Forty-eight and 56 dishes were nutritionally evaluated at the hospitals with TK and CK respectively. Intake analysis consisted of 1993 and 846 evaluations in the hospitals with TK and CK respectively. Median food consumption was 76.83% at the hospital with TK (IQR 45.76%) and 83.43% (IQR 40.49%) at the hospital with CK (p<0.001). Based on the prevalence of malnutrition, a higher protein and energy intake was seen in malnourished patients from the CK as compared to the TK hospital, but differences were not significant after adjustment for other factors., Conclusions: Cooking in a chilled kitchen, as compared to a traditional kitchen, may increase energy and protein intake in hospitalized patients, which is particularly beneficial for malnourished patients., (Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Hypothesis: The aim of this study was to describe perineum deformation during the final part of delivery and suggest a modification of the episiotomy cut to increase accuracy for obtaining a suitable angle (45°) for surgical wound suture., Methods: This prospective study enrolled 45 primiparous women. The perineum at rest was marked with five lines (0°, 30°, 45°, 60°, 90°), and each line was marked with two dots (point A-B: to 2-3 cm from initial point in fourchette, respectively). Two digital pictures were taken: one with the women at rest and the second during fetal head crowning; displacements were calculated for each point and angle., Results: When the perineum is distending, the initial point of every line in the posterior fourchette moves laterally in introitus (only the 0° line remains at midline). The angle and the distance to points A and B of each line drawn do not change significantly from at rest to crowning. However, comparing original line configuration with an imaginary line from the fourchette to points A and B before expulsion, the angle and the distance is increased statistically significantly., Conclusions: Perineal distension at the moment of fetal head crowning causes a linear displacement of the perineum, which causes the difference in angle between the incision and episiotomy suture. Therefore, to obtain an episiotomy suture from fourchette with an angle of 45°, theoretically, we would have several angle incision options (between 45° and 60°), with a less acute angle when the introitus cut is closer to the fourchette (45° to 6 mm and ∼60° in the fourchette) and a sharper angle with a longer episiotomy.

We evaluated the effects of glucomannan or glucomannan plus spirulina-restructured pork (RP) on liver fatty acid profile, desaturase/elongase enzyme activities and oxidative status of Zucker fa/fa rats for seven weeks. Control (C), glucomannan (G) and glucomannan/spirulina (GS)-RP; HC (cholesterol-enriched control), HG and HGS (cholesterol-enriched glucomannan and glucomannan/spirulina-RP) experimental diets were tested. Increased metabolic syndrome markers were found in C, G and GS rats. Cholesterol feeding increased liver size, fat, and cholesterol and reduced antioxidant enzyme levels and expressions. Cholesterolemia was lower in HG and HGS than in HC. GS vs. G showed higher stearic but lower oleic levels. SFA and PUFA decreased while MUFA increased by cholesterol feeding. The arachidonic/linoleic and docosahexaenoic/alpha-linolenic ratios were lower in HC, HG, and HGS vs. C, G, and GS, respectively, suggesting a delta-6-elongase-desaturase system inhibition. Moreover, cholesterol feeding, mainly in HGS, decreased low-density-lipoprotein receptor expression and the delta-5-desaturase activity and increased the delta-9-desaturase activity. In conclusion, the liver production of highly unsaturated fatty acids was limited to decrease their oxidation in presence of hypercholesterolaemia. Glucomannan or glucomannan/spirulina-RP has added new attributes to their functional properties in meat, partially arresting the negative effects induced by high-fat-high-cholesterol feeding on the liver fatty acid and antioxidant statuses.

The objective of this research was to determine the behavior of Listeria monocytogenes in three types of sliced ready-to-eat meat products packaged under vacuum or modified atmosphere conditions and stored at three temperatures. Slices of about 25 g of chorizo (a fermented dry pork sausage), jamón (cured ham), and cecina (a salted, dried beef product) were inoculated with L. monocytogenes NCTC 11994. Slices were packaged in a vacuum or in a modified atmosphere (20% CO2, 80% N2). After packaging, samples were stored for 6 months at three temperatures: 3, 11, or 20°C. Microbiological analyses were performed after 0, 1, 7, 15, 30, 45, 90, and 180 days of storage. The type of meat product, the type of packaging, the temperature, and the day of storage all influenced microbial levels (P < 0.001). L. monocytogenes counts decreased throughout the course of storage in samples of chorizo (quick decrease) and jamón (gradual decrease). In cecina samples, counts of L. monocytogenes increased from day 0 to day 1 of storage and then remained constant until day 90 of the study. These results may be of use for enhancing the safety of these ready-to-eat meat product types. Additional evaluation of the behavior of L. monocytogenes in cecina is needed.

The production of H2 was studied using a packed bed reactor with polyurethane foam acting as support material. Experiments were performed using mixed microflora under non sterile conditions. The system was initially operated with synthetic wastewater as the sole substrate. Subsequently, cheese whey permeate was added to the system at varying organic loading rates (OLR). The performance of the reactor was evaluated by applying a continuous decrease in OLR. As a result, a significant decrease in H2 yields (HY) was observed with the decrease in OLR from 18.8 to 6.3 g chemical oxygen demand (COD)/L d. Microbial analysis demonstrated that the prevalence of non-hydrogen producers, Sporolactobacillus sp. and Prevotella, was the main reason for low HYs obtained. This behavior indicates that the fermentation under non-sterile conditions was favored by high concentrations of substrate by creating an adverse environment for nonhydrogen producer organisms.

Objective: To assess the value of the six-minute walk test (6MWT) to predict outcome in non-group 1 pulmonary hypertension (PH)., Background: Distance walked during 6MWT has been widely used as a prognostic test in pulmonary arterial hypertension (group 1 pulmonary hypertension); however, little is known regarding its prognostic value in other groups of PH., Methods: This was a retrospective study of 60 patients diagnosed of PH, Dana Point classification groups 2-5. 6MWT and echocardiography were performed in all cases., Results: Forty patients (66.6%) were females. Mean age was 70.8 ± 10.7 years (range: 32-85). Seven patients died after a mean follow-up of 23.2 ± 16.7 months. Distance <400 m during 6MWT was associated with a higher risk for death (RR: 4.39; 95% CI: 1.13-17.05; p = 0.03) and for clinical deterioration (death or need for hospitalization) (RR: 2.76; 95% CI: 1.18-6.42; p = 0.02)., Conclusions: 6MWT is useful to predict outcome in non-group 1 PH., (Copyright © 2014 Elsevier Inc. All rights reserved.)

A total of 226 chicken samples (carcasses, legs, wings, necks and breasts) were obtained (73 in 1993 and 153 in 2006) from 10 retail outlets in North-Western Spain and screened for the presence of Salmonella. Isolates were subjected to serotyping, phage typing (Salmonella Enteritidis and Salmonella Typhimurium) and antimicrobial susceptibility testing (15 antimicrobials; disk diffusion method). Salmonella was detected in 40 (55%) samples in 1993 and 19 (12.4%) in 2006 (P<0.001). The serotypes (S. Enteritidis, Salmonella Poona, Salmonella Infantis, Salmonella Newport and S. Typhimurium) and phage types (1, 4, 14b and 35 in the case of S. Enteritidis and 193 for S. Typhimurium) detected are among the main types responsible for human salmonellosis in Spain. All strains were multi-resistant (resistant to 3-13 antimicrobials). The average number of resistances per strain increased (P<0.05) from 3.98 in 1993 to 5.00 in 2006. An increase in the incidence of resistance was observed between 1993 and 2006 for cephalothin (P<0.01), enrofloxacin (P<0.001) and tetracycline (P<0.01). The decreases in the prevalence of Salmonella between 1993 and 2006 suggest that the mandatory measures introduced over the last decade in the European Union to reduce the incidence of Salmonella in poultry have apparently been successful. However, the increase in antibiotic resistance rates is of concern and constitutes a threat to public health. Because the data in this study demonstrated that chicken in North-Western Spain is a potential source of antibiotic-resistant Salmonella strains, the need of consumer education on good sanitary practices is highlighted., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The microbiological quality of retail chicken parts (legs, wings and giblets) and processed chicken products (hamburgers and sausages) in Spain was investigated. Mean counts (log(10) cfu/g) ranged from 5.56 to 7.28, 5.96 to 7.87, 3.49 to 5.42, 2.60 to 4.33 and 2.47 to 3.48 for mesophiles, psychrotrophs, coliforms, Escherichia coli and Staphylococcus aureus, respectively. Chicken parts were generally regarded as being of unacceptable quality, since psychrotrophs, E. coli and S. aureus counts were higher than the maximum limits established in the guidelines for poultry meat. On the basis of Spanish Microbiological Standards, 80% of the samples of hamburgers and sausages were also regarded as being of unacceptable quality. The main reason for the lack of acceptability was excessive counts of mesophiles. The results in this study indicate that chicken by-products (especially those made with ground meat) could represent notable hazards to humans and are a cause of public health concern.