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The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.

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The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.

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Rare earth elements (REEs) disperse from indigenous rocks to the environment, thus making sediments one of the major sinks and sources of metal pollution. The emerging use of REEs and the subsequent opening of new mining areas may contribute to their release into surrounding ecosystems. For this reason, this study was performed in a natural area with geological material abundant in ferrocarbonatites and light REE. The aim of this work was to assess the natural REE availability and (eco)toxicity in freshwater sediments. Sediments showed high REE concentrations in samples with fine grain size fractions, and low in organic-rich sediments. The enrichment in LREE was mostly from rocks and the obtained enrichment factors (EF) confirmed that the sediments are not anthropogenically polluted. To assess REE availability and ecotoxicity, four toxicity tests were performed. REEs measured as the dissolved concentration in the test media were very low compared to the potentially available total REE in sediments and showed positive or negative correlations with fine or coarse grain sizes, respectively, and positive correlations with the content in Mg, Fe and Al. In tests performed in media supplemented with salts, the availability of REEs decreased considerably. Only some toxic effects could be linked to the REE contents in the ostracodtox and luminotox tests. However, measurement of toxicity could be influenced by the sediment properties and lead to a potential overestimation of ecotoxicity if only REE are regarded. Our study reveals that the physicochemical properties of sediments are a key factor controlling both REE availability and toxicity, whereas the determination of REE effects from toxicity tests using liquid media with salt addition will decrease REE availability and could mask toxic effects. Our findings provide new knowledge about REE behaviour in sediments and are a starting point for understanding potential REE pollution around prospective mining areas.

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In order to provide reliable information about responsiveness of biomarkers during environmental monitoring, there is a need to improve the understanding of inter-population differences. The present study focused on eight populations of zebra mussels and aimed to describe how variable are biomarkers in different sampling locations. Biomarkers were investigated and summarised through the Integrated Biomarker Response (IBR index). Inter-site differences in IBR index were analysed through comparisons with morphological data, proteomic profiles and genetic background of the studied populations. We found that the IBR index was a good tool to inform about the status of sites. It revealed higher stress in more polluted sites than in cleaner ones. It was neither correlated to proteomic profiles nor to genetic background, suggesting a stronger influence of environment than genes. Meanwhile, morphological traits were related to both environment and genetic background influence. Together these results attest the benefit of using biological tools to better illustrate the status of a population and highlight the need of consider inter-population difference in their baselines.

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The growing need to evaluate the quality of aquatic ecosystems led to the development of numerous monitoring tools. Among them, the development of biomarker-based procedures, that combine precocity and relevance, is recommended. However, multi-biomarker approaches are often hard to interpret, and produce results that are not easy to integrate in the environmental policies framework. Integrative index have been developed, and one of the most used is the integrated biomarker response (IBR). However, an analysis of available literature demonstrated that the IBR suffers from a frequent misuse and a bias in its calculation. Then, we propose here a new calculation method based on both a more simple formula and a permutation procedure. Together, these improvements should rightly avoid the misuse and bias that were recorded. Additionally, a case study illustrates how the new procedure enabled to perform a reliable classification of site along a pollution gradient based on biomarker responses used in the IBR calculations.

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Introducción. La presencia de síntomas psicológicos y comportamentales en la demencia (SPCD) es altamente prevalente y los fármacos neurolépticos suelen ser frecuentemente utilizados para su control. Diferentes revisiones han señalado la equivalencia clínica de las distintas familias de neurolépticos en el control de SPCD, aunque dicha equivalencia se ha evaluado sólo indirectamente, comparando sus efectos frente a placebo, por lo que hay poca información comparativa directa de la efectividad de los distintos neurolépticos. Así, el objetivo de este estudio fue el de obtener información preliminar de la efectividad de neurolépticos típicos (haloperidol, tioridazina) y atípicos (olanzapina, risperidona) sobre el control de SPCD.Métodos. Estudio multicéntrico, observacional y retrospectivo basado en la revisión de los datos de prescripción de neurolépticos en pacientes con demencia y sus resultados a las 12 semanas de tratamiento.Resultados. No se observaron diferencias significativas en la mejora de SPCD según los distintos neurolépticos evaluados (n=78; test exacto de Kruskal-Wallis; p=0,47). Tampoco se observaron diferencias al estratificar el análisis por niveles de deterioro cognitivo (test exacto de Kruskal-Wallis; p=0,86 y 0,87, respectivamente, para los niveles moderados y graves de deterioro cognitivo). Los efectos secundarios más importantes se recogieron en el grupo de pacientes tratados con haloperidol (n=19) y fueron, fundamentalmente, rigidez (test exacto de Fisher; p=0,01), temblor (test exacto de Fisher; p=0,03) y acatisia (test exacto de Fisher; p=0,03).Conclusiones. Nuestros resultados apoyan la equivalencia en efectividad para los distintos tipos de neurolépticos habitualmente utilizados para tratar los SPCD, aunque estos resultados necesitan ser confirmados por ensayos clínicos prospectivos con adecuado poder estadístico y estudios de farmacovigilancia para evaluar su seguridad

Introduction. Presence of disruptive behavioural and psychological symptoms in dementia (BPSD) is highly prevalent and, as a consequence, neuroleptics are frequently used in these patients to control BPSD. Several reviews have shown the clinical equivalence of different classes of neuroleptics in BPSD control, although that equivalence has been only indirectly assessed by comparing the combined results of different types of active drugs versus placebo. Thus, little is known on the comparative effectiveness, head to head, of different neuroleptics on BPSD. The aim of this study was to gather preliminary information on the effectiveness of typical (haloperidol, thioridazine) and atypical (olanzapine, risperidone) neuroleptics on BPSD. ;;Methods. Multicenter, observational and retrospective study using chart reviews of patients with dementia to assess neuroleptic prescriptions and clinical outcomes at 12 weeks on treatment. Results. No significant differences on BPSD improvement were found by type of neuroleptic (n=78; Kruskal- Wallis exact test; p=0.47). There also were no differences by neuroleptics when the analysis was stratified by levels of cognitive decline (Kruskal-Wallis exact test; p=0.86 and 0.87 for moderate and severe levels of deterioration, respectively). Recorded side effects were worse in the haloperidol group (n=19) regarding rigidity (Fisher's exact; p=0.01), tremor (Fisher's exact p=0.03) and akathisia (Fisher's exact; p=0.03). Conclusions. Our findings support the equivalence in effectiveness of several classes of neuroleptics commonly used to treat BPSD. Nevertheless these results need to be confirmed by adequately powered randomized trials and further pharmacoepidemiological studies to assess their safety

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INTRODUCTION: Presence of disruptive behavioural and psychological symptoms in dementia (BPSD) is highly prevalent and, as a consequence, neuroleptics are frequently used in these patients to control BPSD. Several reviews have shown the clinical equivalence of different classes of neuroleptics in BPSD control, although that equivalence has been only indirectly assessed by comparing the combined results of different types of active drugs versus placebo. Thus, little is known on the comparative effectiveness, head to head, of different neuroleptics on BPSD. The aim of this study was to gather preliminary information on the effectiveness of typical (haloperidol, thioridazine) and atypical (olanzapine, risperidone) neuroleptics on BPSD. METHODS: Multicenter, observational and retrospective study using chart reviews of patients with dementia to assess neuroleptic prescriptions and clinical outcomes at 12 weeks on treatment. RESULTS: No significant differences on BPSD improvement were found by type of neuroleptic (n=78; Kruskal- Wallis exact test; p=0.47). There also were no differences by neuroleptics when the analysis was stratified by levels of cognitive decline (Kruskal-Wallis exact test; p=0.86 and 0.87 for moderate and severe levels of deterioration, respectively). Recorded side effects were worse in the haloperidol group (n=19) regarding rigidity (Fisher's exact; p=0.01), tremor (Fisher's exact p=0.03) and akathisia (Fisher's exact; p=0.03). CONCLUSIONS: Our findings support the equivalence in effectiveness of several classes of neuroleptics commonly used to treat BPSD. Nevertheless these results need to be confirmed by adequately powered randomized trials and further pharmacoepidemiological studies to assess their safety.

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Introducción: la enfermedad mental durante el embarazo puede tener efectos por sí misma sobre el feto. Sin embargo, las posibles reacciones adversas de los psicofármacos hacen que sea muy difícil sopesar el riesgo-beneficio antes de tomar una decisión concerniente al uso de estos medicamentos en mujeres embarazadas.Objetivos: revisar la evidencia de efectos adversos sobre el feto de los distintos tipos de psicofármacos.Fuentes, metodología y síntesis de datos: las fuentes de los datos empleados constituyen el sistema MEDLINE y diversos artículos y/o capítulos de libros. Metodológicamente, dada la heterogeneidad de los distintos tipos de estudios, no fue posible la realización de análisis estadístico. Por ello se ofrece el presente artículo de revisión.Resultados - Benzodiacepinas: el uso de diazepam y alprazolam durante el primer trimestre aumenta el riesgo de hendidura palatina y labial. En el tercer trimestre las benzodiacepinas de vida media larga pueden causar hipotonía neonatal, apnea y baja puntuación en el test de Apgar. No parece que produzcan a largo plazo secuelas neurológicas o alteraciones del comportamiento.- Antidepresivos: con los antidepresivos tricíclicos (ADT) no se han evidenciado anomalías congénitas ni alteraciones conductuales a largo plazo, sólo se ha observado algún caso aisla do de síndrome de abstinencia. Los inhibidores selectivos de la recaptación de serotonina (ISRS) no parecen incrementar el riesgo de malformaciones congénitas. Con los inhibidores de la monoamino-oxidasa (IMAOS) se recoge una alta proporción de anomalías congénitas.- Neurolépticos: con los neurolépticos de baja potencia parece existir un nesgo adicional de anomalías congénitas del 0,4 por ciento. A dosis altas producen toxicidad neonatal. No se han observado alteraciones comportamentales a largo plazo. Con los neurolépticos de alta potencia no parece existir riesgo de malformaciones mayores. Existe algún caso de toxicidad neonatal con síntomas extrapiramidales leves. Respecto a los neurolépticos atípicos no disponernos de datos suficientes sobre su seguridad.- Reguladores del humor: el litio parece incrementar el riesgo de malformaciones cardíacas usado durante el primer trimestre. La carbamazepina y el ácido valproico aumentan el riesgo de espina bífida, de defectos craneofaciales y de otras malformaciones menores.Conclusiones: las beazodiacepinas deben evitarse en lo posible durante el primer trimestre. Podrían utilizarse, con reservas, el resto de los meses, preferiblemente las benzodiazepines de vida media corta. No existe evidencia. de teratogenicidad de los ADT ni de los ISRS, por lo que son susceptibles de ser empleados. Los IMAOS están contraindicados. En cuanto a los neurolépticos, caso de ser estrictamente necesario, se recomienda utilizar haloperidol a dosis bajas. El uso del LITIO durante el embarazo no es seguro, se debe evitar durante el primer trimestre. La carbamacepina y el ácido valproico deben ser evitados.En suma, los riesgos asociados tanto al uso de psicofármacos como a la enfermedad mental per se han de ser cuidadosamente sopesados y discutidos con los futuros padres. Asimismo, algunos de estos fármacos están claramente contraindicados. (AU)

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To obtain accurate estimates of the prevalence of age-associated memory impairment, dementia, and Alzheimer's disease, a population study was carried out in Turégano, a rural community of 1011 inhabitants in the Segovia province of Spain. The study was divided into two phases: a door to door survey of the entire population aged 40 years and over (503 persons), followed by a clinical examination of suspected cases for positive and differential diagnosis of dementia and cognitive impairment. The prevalence of age-associated memory impairment was 3.6% in individuals of 40 years and over and 7.1% in individuals of 65 years and over, whereas dementia was found in 2.6% and 5.2%, respectively. The prevalence rates of both clinical conditions increased with age. The most prevalent clinical category of dementia was dementia of Alzheimer type, which represented 1.8% and 3.8% of these two age groups. The corresponding figures for vascular dementia were 0.4% and 0.9% and for secondary dementia 0.4% and 0.5%. Age-associated memory impairment is an age-dependent disorder with a high prevalence among the elderly; some of these patients may represent an early stage of Alzheimer's disease, suggesting that the prevalence of this disorder may be higher than previously estimated.

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