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Introducción: La sedación con propofol por no anestesiólogos es una práctica creciente en áreas fuera de quirófano resultado del incremento de procedimientos diagnóstico-terapéuticos mínimamente invasivos que precisan sedación y de la dificultad de los servicios de anestesiología para responder adecuadamente a esta demanda. Objetivo: El objetivo principal de este estudio es valorar la seguridad de un programa de sedación para colonoscopias administrada por enfermería formada y tutelada por anestesiólogos, aplicando un protocolo de sedación con sistemas Target Controlled Infusion. Material y métodos: Durante un periodo de 6 meses se incluyeron en el estudio todos los pacientes ASA I y II que precisaron la realización de una colonoscopia programada y cumplían los criterios de inclusión. Se realizaron 381 colonoscopias. En el procedimiento se analizaron los episodios de desaturación, hipo- o hipertensión, bradicardia o taquiarritmia y la necesidad de asistencia por anestesiología. Tras el procedimiento se evaluó en una escala de 1 a 5 el nivel de satisfacción y el dolor mediante escala verbal numérica de 0 a 10. Resultados: El 5% de los pacientes presentó una saturación de oxígeno menor del 90% sin requerir ventilación con máscara; el 7,35% presentó hipotensión, el 3,94% bradicardia y fue necesario consultar al anestesiólogo responsable en el 22% de los casos. El grado de satisfacción alcanzado por los pacientes al final del proceso fue de 4,27 sobre 5. Conclusión: La sedación durante colonoscopias, en pacientes ASA I y II, siguiendo un protocolo consensuado puede ser administrada de forma segura por personal de enfermería tutelado por anestesiología.(AU)

Introduction: Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. Objective: The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion of propofol in colonoscopies supervised by anaesthesiologists. Material and methods: Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1 to 5, and pain was assessed on a numerical verbal scale of 1 to 5. Results: A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. Conclusion: Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.(AU)

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INTRODUCTION: Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol: NAAP) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. OBJECTIVE: The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion (TCI) of propofol in colonoscopies supervised by anaesthesiologists. MATERIAL AND METHODS: Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1-5, and pain was assessed on a numerical verbal scale of 1-5. RESULTS: A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. CONCLUSION: Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.

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BACKGROUND: It remains uncertain whether individualization of pneumoperitoneum pressures during laparoscopic surgery improves postoperative recovery. This study compared an individualized pneumoperitoneum pressure (IPP) strategy with a standard pneumoperitoneum pressure (SPP) strategy with respect to postoperative recovery after laparoscopic colorectal surgery. METHODS: This was a multicentre RCT. The IPP strategy comprised modified patient positioning, deep neuromuscular blockade, and abdominal wall prestretching targeting the lowest intra-abdominal pressure (IAP) that maintained acceptable workspace. The SPP strategy comprised patient positioning according to the surgeon's preference, moderate neuromuscular blockade and a fixed IAP of 12 mmHg. The primary endpoint was physiological postoperative recovery, assessed by means of the Postoperative Quality of Recovery Scale. Secondary endpoints included recovery in other domains and overall recovery, the occurrence of intraoperative and postoperative complications, duration of hospital stay, and plasma markers of inflammation up to postoperative day 3. RESULTS: Of 166 patients, 85 received an IPP strategy and 81 an SPP strategy. The IPP strategy was associated with a higher probability of physiological recovery (odds ratio (OR) 2·77, 95 per cent c.i. 1·19 to 6·40, P = 0·017; risk ratio (RR) 1·82, 1·79 to 1·87, P = 0·049). The IPP strategy was also associated with a higher probability of emotional (P = 0·013) and overall (P = 0·011) recovery. Intraoperative adverse events were less frequent with the IPP strategy (P < 0·001) and the plasma neutrophil-lymphocyte ratio was lower (P = 0·029). Other endpoints were not affected. CONCLUSION: In this cohort of patients undergoing laparoscopic colorectal surgery, an IPP strategy was associated with faster recovery, fewer intraoperative complications and less inflammation than an SPP strategy. Registration number: NCT02773173 ( http://www.clinicaltrials.gov).

ANTECEDENTES: No se sabe con certeza si individualizar las presiones del neumoperitoneo durante la cirugía laparoscópica mejora la recuperación postoperatoria. Comparamos una estrategia con individualización de la presión del neumoperitoneo (individualised pneumoperitoneum pressure, IPP) frente a una estrategia con presión estándar del neumoperitoneo (standard pneumoperitoneum pressure, SPP) respecto a la recuperación postoperatoria tras cirugía colorrectal laparoscópica. MÉTODOS: Ensayo clínico aleatorizado multicéntrico. La estrategia IPP consistió en una modificación de la posición, bloqueo neuromuscular profundo, y una distensión de la pared abdominal conseguida con la presión intraabdominal (intra-abdominal pressure, IAP) más baja en la que el espacio quirúrgico operativo siguiera siendo aceptable. La estrategia SPP consistió en una posición de acuerdo con la preferencia del cirujano, bloqueo neuromuscular moderado, e IAP fija de 12 mm Hg. El resultado primario fue la recuperación fisiológica postoperatoria, evaluada mediante la escala de calidad en la recuperación postoperatoria (Postoperative Quality of Recovery Scale, PQRS). Los resultados secundarios incluyeron la recuperación en otros dominios y la recuperación global, la aparición de complicaciones intraoperatorias y postoperatorias, duración de la estancia hospitalaria, y los valores de los marcadores inflamatorios séricos durante tres días postoperatorios. RESULTADOS: De un total de 166 pacientes, 85 recibieron una estrategia IPP y 81 una estrategia SPP. La estrategia IPP se asoció con una elevada probabilidad de recuperación fisiológica (razón de oportunidades, odds ratio OR, 2,8 (i.c. del 95% 1,2-6,4); P = 0,017, razón de riesgo, 1,8 (i.c. del 95% 1,7-1,9), P = 0,05)). La estrategia IPP también se asoció con una elevada probabilidad de recuperación emotiva (P = 0,013) y global (P = 0,011). Los eventos adversos intraoperatorios fueron menos frecuentes con la estrategia IPP (P < 0,001) y la tasa neutrófilo-linfocito fue más baja (P = 0,029). No se observaron cambios en otras variables. CONCLUSIÓN: En esta cohorte de pacientes sometidos a cirugía colorrectal laparoscópica, una estrategia IPP se asoció con una recuperación más rápida, menos complicaciones intraoperatorias y menos inflamación en comparación con una estrategia SPP.

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After publication of our article [1] the authors have notified us that there are changes in the primary outcome and the statistical analysis plan of the study.

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BACKGROUND: A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery. METHODS: The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes. DISCUSSION: The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02773173 . Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016.

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Passive elastic behavior of tendon tissue from rats subjected to different dietary treatments was characterized. For that purpose, twenty-four weanling Wistar rats (41.02 ± 0.16 g) were randomly distributed into four groups. During 88 days each group was fed on different diets: control diet and diets containing advanced glycation end products (AGEs) from glucose-lysine model system, from bread crust and bread dough, respectively. After the trial animals were sacrificed and tendon samples were extracted and tested mechanically to fracture in a uniaxial tensile test machine. A transversely-hyperelastic model was formulated based on stress-strain relationships and its parameters were fit to the experimental data using the Levenberg-Marquardt optimization algorithm. Material parameters were incorporated in a finite element model to study different stress-strain distributions in a muscle-tendon unit. Results show higher strains and stresses in the muscle belly when properties of a stiffer tendon associated with a diet rich in AGEs are included in the model. A real increase in this mechanical response of the tissue could imply possible pain in joint mobility.

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Thermal processing of milk is a common practice. As milk is the main source of dietary calcium, this study aimed to assess the effects of overheating milk on calcium availability. Thus, thermally damaged milk (overheated, OH, milk; 3 cycles of sterilization at 116 °C, 16 min) was compared with UHT milk (150 °C, 6s) in 2 types of assays: in vitro and in vivo (rats). In addition, the greater Maillard reaction rate associated with thermal treatment in OH milk was confirmed by determining specific (furosine) and unspecific markers (CieLab color). A negative effect on calcium solubility was observed after in vitro digestion of OH milk compared with UHT milk. Feeding rats the diet containing OH milk as the protein source led to significantly lower values of apparent calcium absorption and retention than those found among animals fed the UHT milk diet. Whereas reducing the absorption appears to result mainly from the decreased food intake, the negative effect on retention seems to be due to factors derived from milk thermal damage, such as the formation of Maillard reaction products. It was concluded that milk-processing conditions warrant special attention to prevent impaired dietary calcium utilization. This may be especially important in situations where milk and dairy products are the main dietary components, such as in early infancy.

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Adolescence constitutes a period of nutritional vulnerability due to increased dietary requirements for growth and development and special dietary habits. A pilot trial was performed to evaluate the dietary calcium utilization among a sample of Spanish boys on their usual diets, in which the calcium intake and consumption of dairy products were as well examined. Nutrient and food intake was recorded using a 24-h dietary recall and a 2-d food consumption record for 21 subjects aged 11-14 years. Dietary calcium utilization was assessed by means of calcium intake in food and calcium output in faeces and urine as measured by flame atomic absorption spectrophotometry. Overall intake of dairy products was 399.3 +/- 22.1 g/d, and the single most consumed item was milk (72% of the total). An inverse relationship was found between dairy product consumption at breakfast (55% of the total) and BMI (p = 0.016, r = -0.5168). Dairy products contributed the majority of dietary calcium (66.9%). Mean calcium intake was 881.7 +/- 39.9 mg/d, 88% of the recommended value for Spanish adolescents. Net calcium absorption (271.7 +/- 51.7 mg/d) and retention (170.6 +/- 50.9 mg/d) seemed not to be sufficient to meet growth demands during puberty. The results shown that adolescents of the study absorbed 31% of dietary calcium and retained nearly 20% of the total intake, but dietary calcium intake and consumption of dairy products failed to meet recommended values. Optimizing calcium intake is of crucial importance among adolescents, to maximize calcium retention and to help prevent osteoporosis in later life.

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The purpose of this project was to study the modifications in nutrient composition, amino acid content, and protein quality of white tuna preserves after each of the thermal treatments involved in the canning process. Also the influence that a three years storage period at room temperature has on the nutritional quality of canned tuna was studied. The biological assays used for the study of the protein utilization were carried out on Wistar rats, fed on semi-synthetic diets for 12 days varying only the protein source, casein or tuna provided as follows: raw, cooked in brine, steamed, sterilized tuna, and canned tuna stored for three years. The sterilization process and storage time led to a great increase in the lipid content of the canned tuna and to a porcentual decrease in protein, and moisture content. Amino acid composition of canned and cooked tuna did not show great modifications compared to raw tuna. Neither protein digestibility nor biological value of the cooked, canned, and stored tuna showed any deterioration. The protein quality of white tuna meat preserves has been compared with preserves made up of red and white tuna meat.

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Sediment borne pesticides are one of the major routes of transport of pesticides into the aquatic environment and could affect biota living closely in contact with it. Sediment residues of DDT were found to be easily adsorbed (95.0%) and were released in hard water (8.4%) and seawater (0.1%). DDT and DDE sediment residues were released into sterile and nonsterile brackish water indicating minimal role of micro-organisms. DDT was detected in oyster and in mussel with an average of 46-62% in the shell, 19-31% in the tissues and 19-23% in the fluids. Most of the sediment residues were extractable and released residues in water were in the form of DDT. In the presence oysters, bound was transformed into extractable DDT in sediment after 30 days equivalent to 26% of the total concentration. Most biota residues were extractable and an average of 46% was transformed to DDE. Uptake of residues depend on whether the source of contamination was by direct addition to the water or through sediment residues, if food was given or not, if the source of sediment residues were either aged or freshly treated and if residues were extractable or non-extractable.

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The effect of the heat treatment of casein in presence of reducing sugars on some aspects of Zn availability was investigated. Samples were prepared by mixing casein with glucose-fructose, and were used unprocessed (C) or heated (HC). Changes in Zn speciation after the in vitro digestion of the samples, both as part of a diet and in isolation, were studied. The uptake of soluble Zn from the digested samples was investigated in Caco-2 cells. After in vitro digestion, the percentage of precipitated Zn was significantly higher with the HC sample, both when digested alone and as a part of the diet. In assays with Caco-2 cells, a significant decrease in Zn uptake was observed when the uptake buffer contained the sample C digest, by comparison with the control buffer, without casein digest. When the digested heated mixture was added, Zn uptake by the cells was significantly lower than in either of the two other cases. It may be concluded that the heat treatment of casein in the presence of glucose-fructose has a negative effect on Zn availability because, after in vitro digestion, Zn insolubilization was enhanced and Zn uptake by the enterocyte was impaired, compared with the unheated mixture. In addition, the usefulness of Caco-2 cells in this kind of research has been shown.

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This study was undertaken to monitor Fe, Zn and Cu contents in several maternal tissues and the products of conception of rats submitted to moderate food restriction during pregnancy. Two groups of female rats, nonpregnant (NP) and pregnant (P1), were fed ad libitum. A second group of pregnant rats (restricted diet, P2) was fed for 14 days with the same intake as NP, then the intake was increased by 5% from day 14 to day 21. A significant decrease in liver Fe content was noted in P1 and P2 pregnant rats on day 21, being more marked in livers of P2. Increases in Cu and Zn contents in liver were induced during pregnancy, but the values were significantly lower in P2 than in P1. On day 21, no significant differences due to food restriction were noted in serum concentrations of these trace elements, placental weight and placental Fe. However, dam body weight gain, placental Zn and Cu contents were reduced in P2. Foetuses of undernourished dams exhibited at term lower weight and smaller amounts of Fe, Zn and Cu than those in P1. These results confirm that moderate food restriction during pregnancy produces intrauterine growth retardation and that newborns have low trace element contents (particularly in Cu), which make them dependent on correct postnatal supply.

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The influence of the consumption of diets containing oil from either fresh sardines or fried sardines, under domestic conditions, on the dietary iron metabolism of rats has been investigated. Three groups of rats were fed, over 28 d, semipurified diets containing 8% of: olive oil (OO), fresh sardine (Clupea pilchardus) oil (SO) and oil from sardines previously fried in olive oil (FSO). Body mass and food intake were monitored and, during the periods 5-12 d and 21-28 d, faeces and urine were collected. At the end of the experiment, the animals were killed and blood, liver, spleen and a segment of skin were stored. Food intake and body mass decreased markedly in the SO rats. These parameters were slightly increased in the FSO group compared with OO. Iron absorption and retention were lower in SO than in OO or FSO. This was primarily caused by the poor food intake but also by the lower efficiency of absorption and high urinary Fe losses. Liver and spleen iron contents were reduced by half in SO compared with the other groups, partly owing to the smaller size of the organs, and liver Fe concentration also decreased. These results, together with the high total iron binding capacity, the decreased level of hemoglobin and total erythrocytic iron found in the SO animals, indicate that the consumption of fresh sardine oil as the only dietary fat resulted in iron depletion. The SO animals showed a higher Fe accumulation in skin than OO or FSO. It was concluded that a diet high in sardine fatty acid administered as a unique source of fat, can cause metabolic alterations including iron depletion, but these negative effects of sardine oil disappear with frying, probably owing to the exchange that takes place between fatty acids in the olive oil used in frying and those in the sardine oil.

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A study was made of the influence of the consumption of white tuna (subjected to various thermal treatments) on the bioavailability of dietary iron. Biological assays were carried out on Wistar rats fed semi-synthetic diets varying only in the protein source, casein-methionine, or tuna provided in the following forms: raw, cooked in brine, sterilized with or without soybean oil, and canned and stored for a period of 1 or 3 years. Feed intake, the fecal and urinary excretion of iron, and the iron content of the liver were monitored. Absorption of iron was enhanced by consuming the diet containing raw white tuna. However, the beneficial effect of raw tuna was greatly reduced by cooking it in brine, and even more so by sterilization, especially in the presence of oil. The benefit was partly restored by storing the conserves for a period of 1 or 3 years. It is hypothesized that structural alterations to the protein caused by thermal processes can affect the solubility and bioavailability of iron.

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The isolated ACTH deficiency is a scarcely diagnosed disease of heterogeneous nature. Two patients with isolated deficiency of ACTH in whom the initial diagnosis was of primary suprarrenal failure are reported. In the first case this diagnosis was performed after hospital admission for deterioration of the level of consciousness and the development of an acute suprarrenal crisis in the course of nosocomial pneumonia. In the second case the clinical manifestations began as weakness, anorexia, weight loss and lymphocytosis with eosinophilia. In both patients an increase in the thyrotropic hormone was detected leading to suspicion of the existence of associated primary hypothyroidism. Finally, several studies were carried out (basal measurements of cortisol and ACTH, stimulation with continual perfusion of ACTH, insulinic hypoglycemia, global study of adenohypophysary function, ACTH CRF release factor test, computerized tomography of the pituitary region) in both patients leading to the definitive diagnosis of isolated ACTH deficiency of idiopathic cause of possible pituitary origin without the existence of other associated hormonal deficiencies.

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The objective of this study was to investigate the dietary zinc bioavailability in diets containing raw, cooked, steamed, and canned tuna as a protein source in the diet, and to evaluate different means of preparation, as well as various storage periods of the canned tuna, which was prepared according to industrial standards. Sterilized oil-free canned tuna was also made. The biological assays used for the study of the zinc utilization were carried out on Wistar rats fed with semi-synthetic diets for 12 days varying only in the protein source, which was casein-methionine or tuna provided as follows: raw, cooked in brine, steamed, sterilized with or without soybean oil, canned and stored for one or three years. Body weight, food intake, faecal and urinary zinc excretion, and zinc content in rat liver were monitored. No modifications were shown in food efficiency when diets including tuna were used, compared with those values from the casein-methionine diet. Thus, final body weight results were similar in all groups tested. Dietary zinc absorption was enhanced by consuming a raw white tuna diet. This beneficial effect disappeared after steaming or cooking in brine, but it was slightly recovered after sterilization with oil and storage of the canned tuna. Animals fed on the diets including the oil-free canned tuna, showed two or three times higher faecal and urinary zinc excretion than those fed on casein and canned tuna stored for 0, 1 or 3 years, reaching a negative balance. A negative effect was therefore found in both dietary and endogenous zinc utilization due to the consumption of oil-free canned tuna.

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Two groups of female rats, non-pregnant (NP) and pregnant (P1), were fed ad libitum. A second group of pregnant rats (restricted diet, P2) were restricted for 14 d to the same intake as NP, and their ration was then increased by 5% from d 14 to d 21. For the first 3 d P1 and P2 absorbed a higher percentage of calcium than NP. During the final wk of pregnancy serum calcium decreased and 1,25-dihydroxycholecalciferol increased regardless of the dietary regimen. In both P1 and P2, femur calcium was higher than in NP on d 7 and apparent bone density increased during the 2nd wk of pregnancy and decreased from then on, this decrease being more pronounced in P2. On d 21, P2 fetuses were smaller and contained a smaller amount of calcium than those in P1, although the calcium concentration in the body remained similar in both groups of fetuses.

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