Differences in heart rate variability and body composition in breast cancer survivors and women without cancer.

The aim of this study was to explore cardiac autonomic changes assessed by linear and nonlinear indexes of heart rate variability (HRV) and body composition modifications in breast cancer survivors and cancer-free control women. Women who were breast cancer survivors (BCS, n = 27) and without cancer with similar characteristics (Control, n = 31) were recruited for this study. We calculated some relevant linear and nonlinear parameters of 5 min of RR interval time series such as mean RR interval (RRave), the corrected Poincaré index (cSD1/SD2), the sample entropy (SampEn), the long-term fractal scaling exponent (α2) and 2UV from symbolic dynamics. Additionally, we indirectly assessed body composition measures such as body weight, fat mass, visceral fat rating (VFR), normalized VRF (nVFR), muscle mass, metabolic age, and total body water. We found that diverse HRV indexes and only one body composition measure showed statistical differences (p < 0.05) between the BCS and Control groups. RRave: 729 (648-802) vs. 795 (713-852) ms; cSD2/SD1: 3.4 (2.7-5.0) vs. 2.9 (2.3-3.5); SampEn: 1.5 (1.3-1.8) vs. 1.7 (1.5-1.8); α2: 0.6 (0.3-0.6) vs. 0.5 (0.4-0.5); 2UV: 7.1 (4.3-11.5) vs. 10.8 (6.4-15.7) and nVFR 0.12 (0.11-0.13) vs. 0.10 (0.08-0.12) points/kg, respectively. The nVFR was strongly significantly correlated with several indexes of HRV only in the BCS group.Our findings suggest that BCS exhibit lower parasympathetic cardiac activity and changes in HRV patterns compared to Controls. A concomitant increase of visceral fat, among other factors, may contribute to cardiac autonomic disturbances and changes in HRV patterns in BCS.

Neuroautonomic activity evidences parturition as a complex and integrated neuro-immune-endocrine process.

Parturition in mammals demands a precise coordination of several neuro-immune-endocrine interactions including: a sterile inflammatory response that involves secretion of inflammation mediators like cytokines/chemokines; changes in the secretion of hormones such as progestogen, estrogens, cortisol, and oxytocin; as well as adjustments of the neuroautonomic function. Specifically, the so-called cholinergic anti-inflammatory pathway seems to play a key role in the homeostasis of the neuro-immune-endocrine axis by adjusting the vagus nerve activity during parturition. Here, we provide insights into the importance of the vagus during parturition from an autonomic, endocrine, and immune interplay perspective, and describe the potential role of heart rate variability analysis to explore these interactions noninvasively, economically, and accessibly.

Utilidad de la electrohisterografía como técnica de monitorización uterina en el ámbito clínico: revisión bibliográfica / Usefulness of the electrohysterography in the clinical field as a technique for uterine monitoring: a literature review

Resumen ANTECEDENTES: El análisis del registro de superficie de la actividad mioeléctrica uterina, o electrohisterograma, es uno de los marcadores biofísicos más prometedores para evaluar las contracciones y el estado electrofisiológico del útero. A pesar de las evidencias derivadas de la información clínica que proporciona el análisis electrohisterográfico, hasta la fecha no se ha logrado el esfuerzo significativo para introducir esta técnica en la práctica médica. OBJETIVO: Mostrar la evidencia disponible acerca de la utilidad de la electrohisterografía como técnica alternativa para la monitorización de la actividad uterina en el ámbito clínico. METODOLOGÍA: Búsqueda bibliográfica en las bases de datos de PubMed, Google Scholar y Scopus, con las palabras clave: electrohysterogram, uterine electromyography y electrohysterography. RESULTADOS: Se seleccionaron 65 artículos originales, 5 de revisión y 1 capítulo de libro con metodología adecuada, claridad y relevancia clínica, enfocados en la aplicación clínica del electrohisterograma. CONCLUSIÓN: Las técnicas de monitoreo convencional de la actividad uterina tienen limitaciones para establecer, oportunamente, el diagnóstico de distocias durante el trabajo de parto. El análisis de registros electrohisterográficos permite explicar las alteraciones detectadas en la actividad eléctrica uterina, mediante el aporte de información del estado funcional, incluso predecir posibles complicaciones durante el trabajo de parto.

Abstract BACKGROUND: The analysis of the surface myoelectric activity of the uterus electrohysterogram (EHG) has proved to be one of the most promising biophysical markers for the evaluation of uterine contractions and the electrophysiological state of the uterus. However, despite the emerging evidence that the analysis of EHG provides valuable clinical information, there has not been a meaningful effort to apply this technique for clinical monitoring. OBJECTIVE: To show the available evidence of the usefulness of electrohysterography in the clinical field as a technique for uterine monitoring. METHODOLOGY: a literature search was performed in PubMed, Google Scholar and Scopus databases with the following keywords: electrohysterogram, uterine electromyography and electrohysterography. RESULTS: 65 original research papers, 5 review papers and 1 book chapter with adequate methodology, clarity and clinical relevance were selected according to the focus of the clinical application of the EHG. CONCLUSION: Conventional monitoring of uterine activity lack the ability to accurately diagnose dystocias during labor. On the other hand, the analysis of electrohysterographic recordings has made possible to elucidate alterations in the uterine electrical activity by providing information of the functional state of the uterus, and even, to predict possible complications during labor.

Anestesia regional mandibular con modificación de tacher / Regional anesthesia with tacher modification

La anestesia dental es un tema importante en la práctica cotidiana enlas diversas especialidades odontológicas, motivo por el que nace lanecesidad de hacer una revisión de las técnicas anestésicas actuales. Con base en nuestra experiencia nos dimos cuenta de que la practicidad de utilizar referencias anatómicas confiables nos sirven de guía para obtener una mejor efi cacia al momento de anestesiar el nervio alveolar mandibular. Lo anterior se traduce en menor dolor posterior a la punción, menor dosis anestésica y una profundidad anestésica adecuada en tejidos blandos y duros, del mismo modo nos permite llevar a cabo diversos tratamientos con un margen de seguridad más amplio y disminuir losriesgos de toxicidad. Cabe mencionar que dicha técnica se ha incluido enla práctica clínica cotidiana en nuestra práctica privada en el Postgradode Ortodoncia del Instituto universitario Franco Inglés de México yen el Servicio de Cirugía Oral y Maxilofacial del Centro Médico Lic.Adolfo López Mateos en la ciudad de Toluca, Estado de México.

Dental anesthesia is an important issue in daily practice in the variousdental specialties, which is why the need for a review of the anesthetictechnique arises. Based on our experience, we realized the practicalityof using reliable anatomical references that serve as a guide, to obtaina better effi cacy when anesthetizing the mandibular alveolar nerve,resulting in less pain after puncture, lower anesthetic dose and anadequate anesthetic depth in soft and hard tissues, which allows us tocarry out various treatments with a wider margin of safety and reducethe risks of toxicity. It is worth mentioning that this technique hasbeen included in daily clinical practice in our private practice, in theorthodontic postgraduate course of the Instituto Franco in Mexico andin the oral and maxillofacial surgery service of the Licensed MedicalCenter «Adolfo Lopez Mateos¼ in the City of Toluca, State of Mexico.

Cardiometabolic health among gastric bypass surgery patients with polycystic ovarian syndrome.

AIM: To examine the effect of gastric bypass surgery on cardiometabolic health among women with polycystic ovarian syndrome (PCOS). METHODS: Retrospective medical chart review identified women (n = 389) with PCOS who underwent Roux-en-Y gastric bypass surgery from 2001-2009 in one surgical practice. Separate repeated measures linear mixed models were fit using the MIXED procedure to assess mean change in cardiometabolic disease risk factors from before to 1-year after surgery and were evaluated by ethnicity [Hispanic, non-Hispanic black (NHB) and white (NHW)]. RESULTS: The majority of the sample was Hispanic (66%, 25% NHB, 9% NHW). Mean body mass index significantly improved 1 year post-surgery for all ethnic groups (45.5 to 35.5 kg/m(2) for Hispanics, 46.8 to 37.7 kg/m(2) for NHB and 45.7 to 36.7 kg/m(2) for NHW, P < 0.001). Among Hispanic women mean total cholesterol (198.1 to 160.2 mg/dL), low-density lipoproteins (LDL) cholesterol (120.9 to 91.0 mg/dL), triglycerides (148.6 to 104.8 mg/dL), hemoglobin A1c (6.2% to 5.6%), alanine aminotransferase (28.1 to 23.0 U/L) and aspartate aminotransferase (23.5 to 21.6 U/L) decreased significantly (P < 0.001). Among NHB, mean total cholesterol (184.5 to 154.7 mg/dL), LDL cholesterol (111.7 to 88.9 mg/dL) and triglycerides (99.7 to 70.0 mg/dL) decreased significantly (P < 0.05). Among NHW, mean total cholesterol (200.9 to 172.8 mg/dL) and LDL cholesterol (124.2 to 96.6 mg/dL), decreased significantly (P < 0.05). Pairwise ethnic group comparisons of all cardiometabolic outcomes adjusted for age and type of surgery before and 1 year after surgery showed no statistical difference between the three groups for any outcome. CONCLUSION: Cardiometabolic disease risk improvements vary by ethnicity and obesity may impact glucose tolerance and liver function changes more in Hispanic women with PCOS vs non-Hispanic women.

Web-based family intervention for overweight children: a pilot study.

BACKGROUND: Research has shown the efficacy of family-based behavioral interventions for overweight children, but a major difficulty is access to effective treatment programs. The objective of this study was to develop and test the initial feasibility and efficacy of a web-based family program for overweight 8- to 12-year-old children. METHODS: A website was created using concepts from effective family-based behavioral programs and input from focus groups with overweight children, parents, and pediatricians. The website provided information about obesity and healthy lifestyles, assessment of dietary and physical activity habits, interactive dietary and physical activity games, and instruction in goal-setting and monitoring of goals. Children selected a dietary and physical activity goal and a daily step goal with pedometers. Feasibility and pilot testing over 4 weeks was conducted with 24 overweight children referred by a physician. Outcomes were z-BMI, healthy eating and physical activity, and intrinsic motivation and self-efficacy for weight control. RESULTS: Mean number of logins over the study period was 11.4 for the study sample. Eighteen families (75%) returned for the follow-up assessment. Pre-post analyses for these participants showed improvements in intrinsic motivation, (p=0.05), self-efficacy (p=0.025), physical activity (p=0.005), and healthy lifestyle behaviors (p=0.001). Comparisons between high and low users of the program indicated that high users reduced their BMI while low users increased their BMI over time (p=0.02); high users also improved their dietary intake relative to low users (p=0.04). Consumer satisfaction ratings were high. CONCLUSION: These pilot findings suggest this is a feasible approach for treatment of overweight children and that children who used the web program frequently improved their BMI and dietary intake.

Can the consequences of universal cholesterol screening during childhood prevent cardiovascular disease and thus reduce long-term health care costs?

The National Heart, Lung, and Blood Institute (NHLBI) Expert Panel in the United States (US) recently published its report, Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. The Panel's goals were to develop comprehensive, evidence-based strategies for use by general practitioners in the primary and primordial prevention of cardiovascular disease (CVD). These Guidelines have been endorsed by the American Academy of Pediatrics. Many of the recommendations restate existing lifestyle guidance similar to those proposed by the Committee on Nutrition in 2008. However a debate has emerged because for the first time, universal and comprehensive childhood dyslipidemia screening and treatment is now recommended by these new Guidelines. Because of universal screening, dyslipidemia attributed to both lifestyle and genetic factors could potentially be ascertained. The recommendations to screen for serum lipids and glucose have stimulated heated discussions among pediatricians, subspecialists, and policy-makers. This commentary discusses the medical, psychosocial and economic benefits and risks of universal cholesterol screening in children.

Cambios acetabulares en las osteotomías de Pemberton y Salter

Con el fin de conocer los cambios que suceden en el acetábulo al realizar las acetabuloplastias de Salter y Pemberton se realiza un experimento clínico prospectivo en 29 caderas de pacientes entre los 18 meses y los 3 años de edad quienes son sometidos a reducción abierta y acetabuloplastia de (Salter o Pemberton). Una vez expuesto el acetábulo se toma un molde con coltoflaz y posteriormente una vez realizada la acetabuloplastia se toma un segundo molde. Un observador quien desconoce el tipo de acetabuloplastia realizada y si el molde es anterior o posterior a la osteotomía del iliaco realiza las mediciones de los diámetros longitudinal y anteroposterior del acetábulo y realizando un molde positivo mide la profundidad y capacidad del acetábulo. Los resultados indican que las osteotomías de tipo Pamberton produce una disminución del 17 por ciento en el diámetro longitudinal y una disminución del 26 por ciento de la capacidad del acetábulo. La osteotomía de Salter produce un aumento en el diámetro anteroposterior de 9.1 por cienro y un aumento en la capacidad del 11.84 por ciento. Las consecuencias de estas alteraciones deben ser aclaradas mediante la realización de nuevos estudios que permitan precisar con mayor exactitud las indicaciones de cada procedimiento