Efficacy and safety of preoperative preparation with Lugol''s iodine solution in euthyroid patients with Graves’ disease (LIGRADIS Trial): Study protocol for a multicenter randomized trial

Background: Currently, both the American Thyroid Association and the European Thyroid Association recommend preoperative preparation with Lugol''s Solution (LS) for patients undergoing thyroidectomy for Graves’ Disease (GD), but their recommendations are based on low-quality evidence. The LIGRADIS trial aims to provide evidence either to support or refute the systematic use of LS in euthyroid patients undergoing thyroidectomy for GD. Methods: A multicenter randomized controlled trial will be performed. Patients =18 years of age, diagnosed with GD, treated with antithyroid drugs, euthyroid and proposed for total thyroidectomy will be eligible for inclusion. Exclusion criteria will be prior thyroid or parathyroid surgery, hyperparathyroidism that requires associated parathyroidectomy, thyroid cancer that requires adding a lymph node dissection, iodine allergy, consumption of lithium or amiodarone, medically unfit patients (ASA-IV), breastfeeding women, preoperative vocal cord palsy and planned endoscopic, video-assisted or remote access surgery. Between January 2020 and January 2022, 270 patients will be randomized for either receiving or not preoperative preparation with LS. Researchers will be blinded to treatment assignment. The primary outcome will be the rate of postoperative complications: hypoparathyroidism, recurrent laryngeal nerve injury, hematoma, surgical site infection or death. Secondary outcomes will be intraoperative events (Thyroidectomy Difficulty Scale score, blood loss, recurrent laryngeal nerve neuromonitoring signal loss), operative time, postoperative length of stay, hospital readmissions, permanent complications and adverse events associated to LS. Conclusions: There is no conclusive evidence supporting the benefits of preoperative treatment with LS in this setting. This trial aims to provide new insights into future Clinical Practice Guidelines recommendations. Trial registration: ClinicalTrials.gov identifier: NCT03980132. © 202

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event

Characterization of an unclassified Mycovirus from Verticillium Dahliae and analysis of its transmision between defoliating and non-defoliating isolates

Póster presentado en el XVIII Congreso de la Sociedad Española de Fitopatología (SEF), celebrado en Palencia del 20 al 23 de septiembre de 2016.The soilborne pathogen Verticillium dahliae causes vascular wilts in a wide variety of crops. Isolates infecting olive can be classified into defoliating (D) or non-defoliating (ND). The spread of the D pathotype have greatly increased the impact of this disease on olive production. Fungal viruses (mycoviruses) from pathogenic species have potential as biocontrol agents as some reduce the virulence of their fungal host. The successful application of micoviruses to the control of fungi is dependent on their efficient transmission among isolates in natural fungal populations. Mycoviruses are thought to be transmitted horizontally mainly between somatically compatible isolates during hyphal anastomosis. In V. dahliae all D isolates belong to the same VCG while ND isolates conform different VCGs. In our aim to explore the potential of mycovirus to control Verticillium wilt, we have tested 200 isolates of V. dahliae from different areas of the Guadalquivir Valley and sampled in different years, revealing that only three exhibited viral infection. All three isolates harbored the same unclassified mycovirus with similarity to plant viruses of the family Tombusviridae which we designated VdUV1. Intriguingly, the VdUV1-infected isolates did not belong to the same VCG; two were ND and one D. An analysis of VdUV1 transmission by hyphal anastomosis using hygR-tagged D and ND recipient isolates showed that, as expected, it was readily transmitted among isolates of the same VCG while somatic incompatibility generally acted as a barrier for this transmission. However, we also found that the presence of “bridge” isolates can add complexity to this simple scenario. Thus, the two ND isolates transmitted VdUV1 only to other compatible ND isolates. By contrast the VdUV1-infected D isolate transmitted it to both D and ND isolates, although with clearly different efficiencies, 100% and 30%, respectively. Currently, we are investigating the putative effect of VdUV1 in virulence.Peer Reviewe

Detection of the nondefoliating pathotype of Verticillium dahliae in infected olive plants by nested PCR

11 páginas, 4 figurasAn increasing incidence and distribution of verticillium wilt has occurred in the last few years in newly established olive orchards in southern Spain. This spread of the disease may result from use of Verticillium dahliae-infected planting material. The early in planta detection of the pathogen would aid the implementation of certification schemes for pathogen-free planting material. In this work, a nested polymerase chain reaction (PCR) method was developed for the in planta detection of the nondefoliating (ND) V. dahliae pathotype, aimed especially at nurseryproduced olive plants. For this purpose, specific primers were designed from the sequence of a 1958-bp random amplified polymorphic DNA (RAPD) marker of ND V. dahliae, and a procedure for the extraction of PCR-quality total genomic DNA from infected root and stem tissues of young olive plants was tested and further optimized. Nested PCR assays detected ND V. dahliae in 4- to 14-month-old artificially infected plants of three olive cultivars. The ND-specific PCR product was not amplified from total genomic DNA extracted from olive plants infected with the defoliating V. dahliae pathotype. Detection of the ND pathotype was effective from the very earliest moments following artificial inoculation of olive plants with a V. dahliae conidial suspension. Also, detection was achieved in inoculated, though symptomless, olive plants as well as in plants that were symptomatic but became symptomless by 217 days after inoculation.Comisión Interministerial de Ciencia y Tecnología (CICYT), España. 1FD97-0763-C03-01; Comunidad Europea, contrato no. QLK5-CT1999-01523.Peer reviewe

Astrocyte-mediated switch in spike timing-dependent plasticity during hippocampal development

Presynaptic spike timing-dependent long-term depression at hippocampal CA3-CA1 synapses is evident until the third postnatal week in mice. The authors show that maturation beyond four weeks is associated with a switch to long-term potentiation in which astrocytes play a central role