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The indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm.
A prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap.
Twenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent).
The combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.
On 16 March 2018, a nursing home notified a possible acute gastroenteritis outbreak that affected 11 people. Descriptive and case–control studies and analysis of clinical and environmental samples were carried out to determine the characteristics of the outbreak, its aetiology, the transmission mechanism and the causal food. The extent of the outbreak in and outside the nursing home was determined and the staff factors influencing propagation were studied by multivariate analysis. A turkey dinner on March 14 was associated with the outbreak (OR 4.22, 95% CI 1.11–16.01). Norovirus genogroups I and II were identified in stool samples. The attack rates in residents, staff and household contacts of staff were 23.49%, 46.22% and 22.87%, respectively. Care assistants and cleaning staff were the staff most frequently affected. Cohabitation with an affected care assistant was the most important factor in the occurrence of cases in the home (adjusted OR 6.37, 95% CI 1.13–36.02). Our results show that staff in close contact with residents and their household contacts had a higher risk of infection during the norovirus outbreak.
The Coneybury ‘Anomaly’ is an Early Neolithic pit located just south-east of Stonehenge, Wiltshire. Excavations recovered a faunal assemblage unique in its composition, consisting of both wild and domestic species, as well as large quantities of ceramics and stone tools, including a substantial proportion of blades/bladelets. We present a suite of new isotope analyses of the faunal material, together with ancient DNA sex determination, and reconsider the published faunal data to ask: What took place at Coneybury, and who was involved? We argue on the basis of multiple lines of evidence that Coneybury represents the material remains of a gathering organised by a regional community, with participants coming from different areas. One group of attendees provided deer instead of, or in addition to, cattle. We conclude that the most likely scenario is that this group comprised local hunter-gatherers who survived alongside local farmers.
Supplementation with copper (Cu) improves deer antler characteristics, but it could modify meat quality and increase its Cu content to levels potentially harmful for humans. Here, we studied the effects of Cu bolus supplementation by means on quality and composition of sternocephalicus (ST) and rectus abdominis (RA) muscles (n=13 for each one) from yearling male red deer fed with a balanced diet. Each intraruminal bolus, containing 3.4 g of Cu, was administered orally in the treatment group to compare with the control group. Meat traits studied were pH at 24 h postmortem (pH24), colour, chemical composition, cholesterol content, fatty acid (FA) composition, amino acid (AA) profile and mineral content. In addition, the effect of Cu supplementation on mineral composition of liver and serum (at 0 and 90 days of treatment) was analysed. No interactions between Cu supplementation and muscle were observed for any trait. Supplementation with Cu increased the protein content of meat (P<0.01). However, Cu content of meat, liver and serum was not modified by supplementation. In fact, Cu content of meat (1.20 and 1.34 mg/kg for Cu supplemented and control deer, respectively) was much lower in both groups than 5 mg/kg of fresh weight allowed legally for food of animal origin. However, bolus of Cu tended to increase the meat content of zinc and significantly increased (P<0.05) the hepatic contents of sodium and lead. Muscles studied had different composition and characteristics. The RA muscle had significantly higher protein content (P<0.001), monounsaturated FA content (P<0.05) and essential/non-essential AA ratio (P<0.01) but lower pH24 (P<0.01) and polyunsaturated FA content (P=0.001) than the ST muscle. In addition, RA muscle had 14.4% less cholesterol (P=0.001) than ST muscle. Also, mineral profile differed between muscles with higher content of iron, significantly higher (P<0.001) content of zinc and lower content of calcium, magnesium and phosphorus (P<0.05) for ST muscle compared with RA. Therefore, supplementation with Cu modified deer meat characteristics, but it did not increase its concentration to toxic levels, making it a safe practice from this perspective. Despite the lower content of polyunsaturated FA, quality was better for RA than for ST muscle based on its higher content of protein with more essential/non-essential AA ratio and lower pH24 and cholesterol content.
Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013–14 and 2014–15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1–53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15–1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25–2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1–56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03–7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.
The deposition of uniform, reproducible and compact Sb2S3 thin films were obtained by chemical bath deposition using tartaric acid as a complexing agent. It was found that the thickness of the films increases with the pH of the solution, reaching values of 130 and 170 nm for pH values of 9.5 and 10, respectively. XRD, as well as Raman analysis, showed amorphous Sb2S3 films formed directly from the chemical bath, which crystallized into stibnite after a thermal treatment in N2 with crystallite sizes between 31 and 39 nm. On the other hand, the optical band gap of the Sb2S3 films decreased with an increase in pH, with values of 1.82-2.03 eV for the crystalline ones. An n-type photo-conductivity of 10-6 Ω-1 cm-1 was obtained for the heated films. The evaluation of these films for solar cell applications using CdS as the window layer gave a Voc of 656 mV and a Jsc of 2.66 mA/cm2 under AM1.5G radiation.
The clinical and pathologic characterisation of two fatal cases of tick-borne rickettsiosis in rural (El Valle) and urban (City of Panama) Panama are described. Clinical and autopsy findings were non-specific, but the molecular analysis was used to identify Rickettsia rickettsii in both cases. No ticks were collected in El Valle, while in the urban case, R. rickettsii was detected in Rhipicephalus sanguineus s.l., representing the first molecular finding in this tick in Panama and Central America.
We investigated the predictors of neuraminidase inhibitor (NAI) treatment in severe hospitalised influenza cases and the association between antiviral treatment and mortality. An observational epidemiological study was carried out in Catalonia (Spain) during 2010–2016 in patients aged ⩾18 years. Severe hospitalised cases of laboratory-confirmed influenza requiring hospitalisation were included. We collected demographic, virological and clinical characteristics. Mixed-effects logistic regression was used to estimate crude and adjusted odds ratio (aOR). We included 1727 hospitalised patients, of whom 1577 (91.3%) received NAI. Receiving NAI ⩽48 h after onset of clinical symptoms (aOR 0.37, 95% confidence interval (CI) 0.22–0.63), ⩽3 days (aOR 0.49, 95% CI 0.30–0.79) and ⩽5 days (aOR 0.50, 95% CI 0.32–0.79) was associated with a reduction in deaths. In patients admitted to the intensive care unit (ICU) (595; 34.5%), treatment ⩽48 h (aOR 0.32, 95% CI 0.14–0.74), ⩽3 days (aOR 0.44, 95% CI 0.20–0.97) and ⩽5 days (aOR 0.45, 95% CI 0.22–0.96) was associated with a reduction in deaths. Receiving treatment >5 days after onset of clinical symptoms was not associated with the reduction in deaths in hospitalised patients or those admitted to the ICU. NAI treatment of hospitalised patients with severe confirmed influenza was effective in avoiding death, mainly when administered ⩽48 h after symptom onset, but also when no more than 5 days had elapsed.
In order to improve foal carcass quality, it is necessary in particular to improve the carcass dressing percentage and tissue composition. Thus, it is important to establish relationships between grading systems and these parameters. This research was conducted to study the effect of slaughter age (13 v. 26 months) and finishing feed (standard v. linseed feed) on carcass characteristics such as subcutaneous fat colour plus classification of foals for the degree of fatness and conformation. For this study, 46 foals of crossbred genotype (Galician Mountain×Burguete) were used. Finishing feed did not affect any parameter, whereas slaughter age influenced all parameters (P<0.05). The oldest foals had higher carcass measurements, 13% more of meat, 4% more of bone, 12% more of fat, and 4% and 9% bigger fore- and hindquarter, respectively. Consequently, bigger valuable prime cuts were obtained. Nevertheless, the meat : bone ratio was very similar for both 13- and 26-month-old foals (2.88). Most of 26-month-old foals were classified in ‘E’ (Extra) and ‘5’ (Complete fat cover) categories of conformation and degree of fatness. Most of the carcasses showed subcutaneous fat described as yellowish-white irrespective of age or diet. A regression model found that conformation (36%) and degree of fatness (33%) in live animals was positively linked with carcass tissue composition. It is therefore suggested that producers aim for older slaughter ages than 13 months and that the foal meat industry establishes grading systems to predict carcass quality. Further studies should be necessary to find the optimal slaughter age to obtain carcasses in the best categories of degree of fatness and conformation. New studies should be recommended to improve the meat : bone ratio of foal carcasses as it estimates the aptitude for meat production.