Secuestro broncopulmonar fetal con resolución espontánea intraútero

We present a case of bronchopulmonary sequestration suspected in the morphological ultrasound at 20 weeks of gestation based on the finding of a homogeneous hyperechoic triangular image in the left lung of the fetus, which was confirmed 2 weeks later with the observation of a blood vessel from the aorta feeding the mass. Due to the absence of poor prognostic factors, an expectant attitude was adopted, with a progressive decrease of the mass until its complete disappearance on ultrasound at 37 weeks.     

The prevention of injuries in contact flag football

Purpose

American flag football is a non-tackle, contact sport with many moderate to severe contact-type injuries reported. A previous prospective injury surveillance study by the authors revealed a high incidence of injuries to the fingers, face, knee, shoulder and ankle. The objectives of the study were to conduct a pilot-prospective injury prevention study in an attempt to significantly reduce the incidence and the severity of injuries as compared to a historical cohort, as well as to provide recommendations for a future prospective injury prevention study.

Methods

A prospective injury prevention study was conducted involving 724 amateur male (mean age: 20.0 ± 3.1 years) and 114 female (mean age: 21.2 ± 7.2 years) players. Four prevention measures were implemented: the no-pocket rule, self-fitting mouth guards, ankle braces (for those players with recurrent ankle sprains) and an injury treatment information brochure. An injury surveillance questionnaire was administered to record all time-loss injuries sustained in game sessions.

Results

There was a statistically significant reduction in the number of injured players, the number of finger/hand injuries, the incidence rate and the incidence proportion between the two cohorts (p < 0.05).

Conclusions

This one-season pilot prevention study has provided preliminary evidence that finger/hand injuries can be significantly reduced in flag football. Prevention strategies for a longer, prospective, randomised-controlled injury prevention study should include the strict enforcement of the no-pocket rule, appropriate head gear, the use of comfortable-fitting ankle braces and mouth guards, and changing the blocking rules of the game.

Level of evidence

II.     

Effects of hydrazine derivatives on vascular smooth muscle contractility,blood pressure and cGMP production in rats: comparison with hydralazine

Hydralazine is a hydrazine derivative used clinically as a vasodilator and antihypertensive agent. Despite numerous studies with the drug, its mechanism of action has remained unknown; guanylate cyclase activation and release of endothelial relaxing factors are thought to be involved in its vasodilator effect. Other hydrazine derivatives are known to stimulate guanylate cyclase and could therefore share the vasodilator activity of hydralazine, although such possibility has not been assessed systematically. In the present study, hydralazine, hydrazine, phenylhydrazine, and isoniazid were evaluated for vascular smooth muscle relaxation in rat aortic rings with and without endothelium, as well as after incubation with the guanylate cyclase inhibitor methylene blue. They were also tested for enhancement of cyclic guanosine monophosphate (cGMP) production by cultured rat aortic smooth muscle cells and for hypotension in the anesthetized rat. All hydrazines relaxed aortic rings, an action unaffected by endothelium removal and, in all cases except hydralazine, antagonized by methylene blue. Only phenylhydrazine increased cGMP production and only hydralazine markedly lowered blood pressure. It was concluded that hydralazine vascular relaxation is independent of endothelium and is not related to guanylate cyclase activation. The other hydrazines studied also elicit endothelium-independent relaxation, but the effect is related to guanylate cyclase. The marked hypotensive effect of hydralazine contrasts with its modest relaxant activity and is not shared by the other hydrazines. The fact that hydrazine and isoniazid produce methylene blue-sensitive relaxation, yet do not enhance cGMP production suggests the need for activating factors present in aortic rings but not in isolated cells.     

Right ventricular beneficial effects of beta adrenergic receptor kinase inhibitor (βARKct) gene transfer in a rat model of severe pressure overload

Heart failure is associated with abnormalities in βAR cascade regulation, calcium cycling, expression of inflammatory mediators and apoptosis. Adenoviral mediated gene transfer of βARKct has beneficial indirect effects on these pathologic processes upon the left ventricular myocardium. The concomitant biochemical changes that occur in the right ventricle have not been well characterized. Sprague–Dawley rats underwent aortic banding and were followed by echocardiography. After a decrease in fractional shortening of 25% from baseline, intracoronary injection of adenoviral-βARKct (n = 14) or adenoviral-β-galactosidase (control, n = 13) was performed. Rats were randomly euthanized on post-operative day 7, 14 or 21. Protein analysis including RV myocardial levels of βARKct, βARK1, SERCA_2a, inflammatory tissue mediators (IL-1, IL-6 and TNF-α), apoptotic markers (bax and bak), and MAP kinases (jnk, p38 and erk) was performed. ANOVA was employed for group comparison. Adenoviral-βARKct treated animals showed increased expression of βARKct and decreased levels of βARK1 compared with controls. This treatment group also demonstrated normalization of SERCA_2a expression and decreased levels of the inflammatory markers IL-1, IL-6 and TNF-α. The pro-apoptotic markers bax and bak were similarly improved. Ventricular levels of the MAP kinase jnk were increased. Differences were most significant 7 days after gene transfer, but the majority of these changes persisted at 21 days. These results suggest that attenuation of the pathologic mechanisms of beta adrenergic receptor desensitization, SERCA_2a expression, inflammation and apoptosis, not only occur in the left ventricle but also in the right ventricular myocardium after intracoronary gene transfer of βARKct during heart failure.     

Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty: a Detailed Review and Guide to Management

Purpose of Review8.5 to 50% of total joint arthroplasty (TJA) patients are reported to have preoperative malnutrition. The narrative review identifies the relationship between preoperative malnutrition for TJA patients and postoperative outcomes as well as the use of perioperative nutritional intervention to improve postoperative complications.Recent FindingsBiochemical/laboratory, anthropometric, and clinical measures have been widely used to identify preoperative nutritional deficiency. Specifically, serum albumin is the most prevalent used marker in TJA because it has been proven to be correlated with protein-energy malnutrition due to the surgical stress response. However, there remains a sustained incidence of preoperative malnutrition in total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients due to a lack of agreement among the available nutritional screening tools and utilization of isolated laboratory, anthropometric, and clinical variables. Previous investigations have also suggested preoperative malnutrition to be a prognostic indicator of complications in general, cardiac, vascular, and orthopaedic surgery specialties.SummarySerum albumin, prealbumin, transferrin, and total lymphocyte count (TLC) can be used to identify at-risk patients. It is important to employ these markers in the preoperative setting because malnourished TKA and THA patients have shown to have worse postoperative outcomes including prolonged length, increased reoperation rates, increased infection rates, and increased mortality rates. Although benefits from high-protein and high-anti-inflammatory diets have been exhibited, additional research is needed to confirm the use of perioperative nutritional intervention as an appropriate treatment for preoperative TJA patients.     

Perception of Portuguese Consumers Regarding Food Labeling

Food labels are the first information tool used by consumers in the purchase and consumption of food products. Food labeling is a tool that can influence the consumers’ perception of quality and, in turn, their food choice. This study characterizes and demonstrates the importance of labeling and the degree of consumers’ perception and literacy about food labels through the application of an online questionnaire. The results obtained, in a sample of n = 467, showed that Portuguese consumers have the habit of reading the label and recognizing its importance but do not understand all the information contained in the label. They have an easier time understanding the front-of-pack labeling systems, especially those presented through symbols/colors. Thus, it demonstrates the need for greater education and literacy in the areas of food and nutrition so that through the reading and interpretation of labels, consumers can make informed food choices.