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Importance: An intraoperative higher level of positive end-expiratory positive pressure (PEEP) with alveolar recruitment maneuvers improves respiratory function in obese patients undergoing surgery, but the effect on clinical outcomes is uncertain. Objective: To determine whether a higher level of PEEP with alveolar recruitment maneuvers decreases postoperative pulmonary complications in obese patients undergoing surgery compared with a lower level of PEEP. Design, Setting, and Participants: Randomized clinical trial of 2013 adults with body mass indices of 35 or greater and substantial risk for postoperative pulmonary complications who were undergoing noncardiac, nonneurological surgery under general anesthesia. The trial was conducted at 77 sites in 23 countries from July 2014-February 2018; final follow-up: May 2018. Interventions: Patients were randomized to the high level of PEEP group (n = 989), consisting of a PEEP level of 12 cm H2O with alveolar recruitment maneuvers (a stepwise increase of tidal volume and eventually PEEP) or to the low level of PEEP group (n = 987), consisting of a PEEP level of 4 cm H2O. All patients received volume-controlled ventilation with a tidal volume of 7 mL/kg of predicted body weight. Main Outcomes and Measures: The primary outcome was a composite of pulmonary complications within the first 5 postoperative days, including respiratory failure, acute respiratory distress syndrome, bronchospasm, new pulmonary infiltrates, pulmonary infection, aspiration pneumonitis, pleural effusion, atelectasis, cardiopulmonary edema, and pneumothorax. Among the 9 prespecified secondary outcomes, 3 were intraoperative complications, including hypoxemia (oxygen desaturation with Spo2 ≤92% for >1 minute). Results: Among 2013 adults who were randomized, 1976 (98.2%) completed the trial (mean age, 48.8 years; 1381 [69.9%] women; 1778 [90.1%] underwent abdominal operations). In the intention-to-treat analysis, the primary outcome occurred in 211 of 989 patients (21.3%) in the high level of PEEP group compared with 233 of 987 patients (23.6%) in the low level of PEEP group (difference, -2.3% [95% CI, -5.9% to 1.4%]; risk ratio, 0.93 [95% CI, 0.83 to 1.04]; P =.23). Among the 9 prespecified secondary outcomes, 6 were not significantly different between the high and low level of PEEP groups, and 3 were significantly different, including fewer patients with hypoxemia (5.0% in the high level of PEEP group vs 13.6% in the low level of PEEP group; difference, -8.6% [95% CI, -11.1% to 6.1%]; P

Introduction: Patients experience preoperative anxiety. The objective of this study was to assess patients’ fears concerning anaesthesia and evaluate possible associations with sociodemographic background and previous anaesthesia. Methods: A survey was filled preoperatively, for 6 months, including anaesthesia-related fears, sociodemographic data, previous anaesthesia and surgery, current surgical and anaesthetic procedure, and preferred anaesthesia technique. Descriptive statistics, principal component analysis, Chi-square test, t-test and ANOVA were used for statistical analysis. Results: 153 questionnaires were collected. The mean age was 58 years, 61.4% were female and 59.5% employed. 47.1% had an anaesthesia consultation before. 49.7% were ASA II. 78.4% had been submitted to surgery before, 81.7% to anaesthesia and 14.5% had regional anaesthesia. In 73.5% general anaesthesia preferred. Half of patients with previous regional anaesthesia favoured this technique. The most relevant fears were “being paralysed because of anaesthesia”, “not waking up” and “waking up during surgery”. The least relevant were “fasting incapacity”, “having nightmares” and “speaking of personal matters”. A statistically significant relation was observed between the fear of “feeling pain after surgery” and having a previous anaesthetic experience. Female and unemployed patients were more concerned with general complications, while male patients gave more importance to awareness and paralysis. Conclusion: Paralysis after anaesthesia, intraoperative awareness and death were the main concerns of our inquiries.&nbsp

[Excerpt] Introduction: Bacterial vaginosis (BV) is a common vaginal disorder that affects women in reproductive age. This condition is characterized by a shift in the vaginal microflora from the dominant beneficial Lactobacillus to an overgrowth of strictly and anaerobic bacteria. It is noteworthy that BV involves the presence of multispecies biofilm, mainly composed by Gardnerella spp.. A major issue related to BV is the recurrent failure of conventionally antibiotic therapies. Therefore, essential oils (EOs) have been considered as a possible treatment option. Thymbra capitata EO has already demonstrated a good potential to eradicate bacteria. [...], info:eu-repo/semantics/publishedVersion

Several Seseli L. (Apiaceae) species are used in folk medicine for several healing effects, namely herbal remedy for human inflammation, swelling, rheumatism, pain and common cold. In Portugal, there are two taxa usually used in traditional medicine: Seseli tortuosum L. and Seseli montanum subsp. peixotoanum (Samp.). The aim of the present research was to evaluate the anti-inflammatory activity of S. tortuosum and to assess their safety profile in several mammalian cell types at concentrations presenting strong bioactivity. This oil is characterized by high percentage of α-pinene (21.1%), β-pinene (22.6%) and cis-β-ocimene (11.8). The anti-inflammatory potential was investigated in lipopolysaccharide (LPS)-triggered nitric oxide (NO) production by macrophages and microglia concomitantly treated with S. tortuosum essential oil. Our results demonstrated a significant decrease of LPS-induced NO production at concentrations up to 0.16 μL/mL, without affecting cell viability. Our findings confirm the safety of S. tortuosum oil in doses with anti-inflammatory activity. These results support further studies envisaging the use of S. tortuosum oil in pharmaceutical formulations for inhalation, topical application or oral administration., Arabian Journal of Medicinal and Aromatic Plants, Vol 1, No 1 (2015)

Peribulbar block for corneal transplantation: Efficacy and Safety. BACKGROUND:Corneal transplantation (CT) requires complete akinesia of the extra-ocular muscles and deep anaesthesia of the surgical site. This can be achieved with general (GA) or regional anaesthesia (RA). In our institution, CT has usually been performed under GA, due to fear of the u2018open-skyu2019 situation. In the last few years, there has been a growing trend towards using peribulbar block. Evidence regarding the comparative merits of each technique is scarce. We believe that peribulbar block (PBB) can achieve good surgical conditions with a low complication rate and minimal post-operative analgesic requirement. The aim of our study was to evaluate the efficacy and safety of peribulbar block for CT.METHODS:We conducted a retrospectively audit to evaluate CT under PBB in our institution between June and November 2016. Clinical data collected on each patient included age, sex and American Society of Anesthesiologists physical status (ASA). Surgery-specific data included procedure and anaesthesia lengths, characteristics of peribulbar block and analgesic drug administration. Postoperative data included analgesic need in the postanesthesia care unit and within 24 hours of stay and clinical outcome at 15 days.RESULTS:Between June and November 2016, 76 CT were carried out, 20 under PBB. Of these, 1 was a penetrating keratoplasty and 19 were lamellar keratoplasties. All patients received an inferotemporal injection and 14 (70%) received an additional injection, either superomedial or caruncular. 1% ropivacaine was the only local anaesthetic used, with a mean dose of 65mg (40-90mg). Most patients received additional systemic analgesia, usually paracetamol 1g (90%) and/or fentanyl 0.05mg (35%), mostly to provide perioperative comfort. There was 1 case of partial block failure, requiring significant systemic analgesia (paracetamol 1g, tramadol 200mg and fentanyl 0.05mg) during the intra-operative period. 1 patient suffered an episode of bradycardia and hypotension shortly after the block injections, which resolved with the administration of 30mg ephedrine. No patients required conversion to GA. The incidence of perioperative nausea or vomiting was 0%. No serious complications were observed at 15-day follow-up.CONCLUSIONS:PBP appears to be a safe and effective technique for CT. Further evidence from prospective and randomised trials is required to compare PBP with GA.

Peribulbar block vs. general anaesthesia for corneal transplantation: analgesic requirements and pain controlBackground and Goal of Study: Effective anaesthesia for corneal transplantation (CT) can be achieved with general (GA) or regional anaesthesia (RA). Evidence regarding the comparative merits of each technique is scarce. CT has usually been performed under GA, due to fear of the u2018open-skyu2019 situation. Peribulbar block (PBB) is an increasingly used technique for CT. We believe that PBB can achieve effective surgical anaesthesia and postoperative analgesia with lower analgesic requirements and similar surgical conditions, compared to GA. The aim of this study was to compare the analgesic efficacy of PBB and GA for CT.Materials and Methods:We conducted a prospective observational study to compare CT surgery in adults under BPB and GA. After local ethics committee approval, CT performed between August and November 2017 were studied. Exclusion criteria included refusal to participate. Data collected on each patient included age, gender, American Society of Anesthesiologists physical status (ASA), procedure and anaesthesia lengths, analgesic drug administration, pain on arrival in the operating theatre and 30 minutes after surgery, postoperative analgesic needs and the opinion of the ophthalmologist regarding surgical conditions. Data was analysed using Statistical Package for the Social Sciences version 22. The statistical tests used were Chi-squared and Mann-Whitney U. Statistical significance was assumed for p < 0.05.Results and Discussion: The study included a total of 39 patients. PBB was used for 20 CTs, 16 of which were lamelar keratoplasty. GA was used for 19 CTs, 15 of which were PK. Age, gender and ASA status in the two populations were similar, although there was a trend (p = 0.057) towards GA use in younger patients. Total fentanyl dose (p < 0.001), paracetamol (p < 0.05) use, tramadol use (p < 0.05) and non-steroidal anti-inflammatory use (p < 0.05) were significantly lower in the PBB group. There were no differences in pain score on arrival, although there was a trend towards lower pain scores 30 minutes after surgery in the PBB group (p = 0.077). No difference was observed regarding the surgeonu2019s opinion of surgical conditions.Conclusion: In this study, CT under PBB provided comparable pain control and surgical conditions to GA, with much lower systemic analgesic requirements. Further evidence from randomised trials is required to minimise potential confounders in prospective trials such as this.

1 página._ Resumen del póster presentado en el Simposio que bajo el lema “Weed management in changing environments", tuvo lugar en Montpellier, Francia, entre el 23 y el 26 de junio de 2015., Our results demonstrate that V. faba aerial biomass incorporated into the soil as green manure can contribute to early weed control in maize crops through several mechanisms. This ability for weed control, together with its additional agroecosystem services, makes V. faba a valuable tool to be included as a part of broader integrated weed management strategies in sustainable maize-based cropping systems in temperate regions.

2 páginas.-Comunicación oral presentada en el Simposio que bajo el título "Plant proteins for the future" se celebró en Pontevedra entre el 4 y el 7 de mayo de 2015.

CONTEXT: Effective drugs to treat osteoarthritis (OA) and inflammatory bowel disease (IBD) are needed. OBJECTIVE: To identify essential oils (EOs) with anti-inflammatory activity in cell models of OA and IBD. MATERIALS AND METHODS: EOs from Eryngium duriaei subsp. juresianum (M. Laínz) M. Laínz (Apiaceae), Laserpitium eliasii subsp. thalictrifolium Sennen & Pau (Apiaceae), Lavandula luisieri (Rozeira) Rivas-Martínez (Lamiaceae), Othantus maritimus (L.) Hoff. & Link (Asteraceae), and Thapsia villosa L. (Apiaceae) were analyzed by GC and GC/MS. The anti-inflammatory activity of EOs (5-200 μg/mL) was evaluated by measuring inducible nitric oxide synthase (iNOS) and nuclear factor-κB (NF-κB) activation (total and phosphorylated IκB-α), in primary human chondrocytes and the intestinal cell line, C2BBe1, stimulated with interleukin-1β (IL-1β) or interferon-γ (IFN-γ), IL-1β and tumor necrosis factor-α (TNF-α), respectively. RESULTS: The EO of L. luisieri significantly reduced iNOS (by 54.9 and 81.0%, respectively) and phosphorylated IκB-α (by 87.4% and 62.3%, respectively) in both cell models. The EO of E. duriaei subsp. juresianum caused similar effects in human chondrocytes, but was inactive in intestinal cells, even at higher concentrations. The EOs of L. eliasii subsp. thalictrifolium and O. maritimus decreased iNOS expression by 45.2 ± 8.7% and 45.2 ± 6.2%, respectively, in C2BBe1 cells and were inactive in chondrocytes. The EO of T. villosa was inactive in both cell types. DISCUSSION AND CONCLUSION: This is the first study showing anti-inflammatory effects of the EOs of L. luisieri and E. duriaei subsp. juresianum. These effects are specific of the cell type and may be valuable to develop new therapies or as sources of active compounds with improved efficacy and selectivity towards OA and IBD.

Introdução e Objetivos: A desnervação simpática renal seletiva (DSRS) é um procedimento endovascular minimamente invasivo, seguro, recentemente desenvolvido para o tratamento da hipertensão resistente (HR). Até 6 ablações por radiofrequência (RF), com 2 minutos cada são aplicadas em ambas as artérias renais, estando associadas a dor abdominal visceral difusa, muito intensa1,2. Não foi encontrada literatura sobre o manuseamento anestésico deste procedimento. O nosso objetivo é descrever a experiência do nosso departamento na DSRS e sugerir uma abordagem anestésica (AA) adequada para o procedimento. Metodologia: Foram colhidos, retrospetivamente, os dados dos doentes com HR submetidos a DSRS na nossa instituição até novembro de 2012. Variáveis analisadas: dados demográficos, co-morbilidades, estadio físico da American Society of Anesthesiology (ASA-EF), abordagem anestésica e complicações peri-procedimento. Foi também realizada uma revisão bibliográfica na PubMed sobre DSRS e outros procedimentos endovasculares para identificar uma AA apropriada e eficiente para DSRS. Resultados: 16 doentes (9 homens/7 mulheres), idade 59,7 ± 10 anos. ASA-EF II 25%, III 75%. 14 doentes foram submetidos a cuidados anestésicos monitorizados (MAC): 6 com perfusão remifentanil (0.05 a 0.15μg/Kg/min com bólus até 1μ/Kg durante as ablações), 8 com bólus de propofol (até 150mg) associado a bólus de fentanil (até 150μg) e midazolam (1 a 2 mg). 1 doente foi sujeito a anestesia geral balanceada e 1 doente a bloqueio subaracnoideu. O procedimento anestésico durou 75 ± 16 minutos. O procedimento foi considerado bem sucedido em todos os doentes. Não foram observadas complicações. Discussão e Conclusão: Os 2 principais estudos publicados sobre DSRS (Simplicity trials) referem o uso de opiáceos e sedativos intravenosos para o tratamento da dor associada às ablações. Os fármacos usados e respetivas doses não são descritos. As várias AA usadas na nossa instituição refletem a ausência de literatura anestésica sobre a DSRS. A AA mais adequada depende das caraterísticas dos doentes e do tipo de dor associada (intensa, aguda e intermitente) e deve assegurar o máximo conforto do doente, segurança e sucesso técnico do procedimento. Pela nossa análise, a literatura revista e a experiência adquirida noutros procedimentos com dor semelhante consideramos que o remifentanil, pelas suas propriedades farmacológicas únicas, é adequado para o AA da DSRS. Remifentanil nas doses de 0.05 a 0.15μg/Kg/min com bólus até 1μ/Kg durante as ablações parece apropriado. São necessários mais estudos para melhor avaliação.

Nuclear factor-kappaB is a key transcription factor activated by pro-inflammatory signals, like interleukin-1beta (IL-1), being required for the expression of many inflammatory and catabolic mediators, such as nitric oxide (NO), that play an important role in arthritic diseases. This work aimed at screening and identifying natural inhibitors of IL-induced NF-kappaB activation and NO production in human articular chondrocytes. Five essential oils obtained from four plants of the Iberian flora, Mentha x piperita L. (Lamiaceae), Origanum virens L. (Lamiaceae), Lavandula luiseri L. (Lamiaceae), and Juniperus oxycedrus L. subsp. oxycedrus (Cupressaceae), were screened for their ability to prevent IL-1-induced NO production. The oil showing higher inhibitory activity was fractionated, concentrated, analyzed for composition elucidation and prepared for further assays. For this purpose, the human chondrocytic cell line C-28/I2 was used to evaluate NF-kappaB activation by determining the cytoplasmic levels of the total and phosphorylated forms of the inhibitory protein, I kappaB-alpha, and the NF-kappaB-DNA binding activity. The essential oil from the leaves of J. oxycedrus in a concentration of 0.02 % (v/v) achieved the greatest inhibition (80 +/- 8%) of IL-1-induced NO production. Chemical analysis showed that this essential oil is predominantly composed of monoterpene hydrocabons, being alpha-pinene [2,6,6-trimethyl-bicyclo(3.1.1)hept-3-ene] the major constituent (76 %). Similarly to the effect of the whole oil, a fraction containing 93% alpha-pinene reduced significantly IL-1-induced I kappaB-alpha degradation. Moreover, alpha-pinene also decreased I kappaB-alpha phosphorylation, NF-kappaB-DNA binding activity, and NO production. Another fraction containing oxygenated mono- and sesquiterpenes was nearly as effective as alpha-pinene. The ability of the alpha-pinene-containing fraction to reduce IL-1-induced NF-kappaB activation and NO production warrants further studies to demonstrate the usefulness of alpha-pinene in the treatment of arthritic diseases and other conditions in which NF-kappaB and NO play pathological roles.

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