How Would I Treat My Own Chronic Thromboembolic Pulmonary Hypertension in the Perioperative Period?

Chronic thromboembolic pulmonary hypertension (CTEPH) results from an incomplete resolution of acute pulmonary embolism, leading to occlusive organized thrombi, vascular remodeling, and associated microvasculopathy with pulmonary hypertension (PH). A definitive CTEPH diagnosis requires PH confirmation by right-heart catheterization and evidence of chronic thromboembolic pulmonary disease on imaging studies. Surgical removal of the organized fibrotic material by pulmonary endarterectomy (PEA) under deep hypothermic circulatory arrest represents the treatment of choice. One-third of patients with CTEPH are not deemed suitable for surgical treatment, and medical therapy or interventional balloon pulmonary angioplasty presents alternative treatment options. Pulmonary endarterectomy in patients with technically operable disease significantly improves symptoms, functional capacity, hemodynamics, and quality of life. Perioperative mortality is <2.5% in expert centers where a CTEPH multidisciplinary team optimizes patient selection and ensures the best preoperative optimization according to individualized risk assessment. Despite adequate pulmonary artery clearance, patients might be prone to perioperative complications, such as right ventricular maladaptation, airway bleeding, or pulmonary reperfusion injury. These complications can be treated conventionally, but extracorporeal membrane oxygenation has been included in their management recently. Patients with residual PH post-PEA should be considered for medical or percutaneous interventional therapy.

Versatile Biodegradable Poly(acrylic acid)-Based Hydrogels Infiltrated in Porous Titanium Implants to Improve the Biofunctional Performance.

This research work proposes a synergistic approach to improve implants' performance through the use of porous Ti substrates to reduce the mismatch between Young's modulus of Ti (around 110 GPa) and the cortical bone (20-25 GPa), and the application of a biodegradable, acrylic acid-based polymeric coating to reduce bacterial adhesion and proliferation, and to enhance osseointegration. First, porous commercially pure Ti substrates with different porosities and pore size distributions were fabricated by using space-holder techniques to obtain substrates with improved tribomechanical behavior. On the other hand, a new diacrylate cross-linker containing a reduction-sensitive disulfide bond was synthesized to prepare biodegradable poly(acrylic acid)-based hydrogels with 1, 2, and 4% cross-linker. Finally, after the required characterization, both strategies were implemented, and the combination of 4% cross-linked poly(acrylic acid)-based hydrogel infiltrated in 30 vol % porosity, 100-200 µm average pore size, was revealed as an outstanding choice for enhancing implant performance.

Perioperative Management in Pulmonary Endarterectomy.

Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (PH), provided lesions are proximal enough in the pulmonary vasculature to be surgically accessible and the patient is well enough to benefit from the operation in the longer term. It is a major cardiothoracic operation, requiring specialized techniques and instruments developed over several decades to access and dissect out the intra-arterial fibrotic material. While in-hospital operative mortality is low (<5%), particularly in high-volume centers, careful perioperative management in the operating theater and intensive care is mandatory to balance ventricular performance, fluid balance, ventilation, and coagulation to avoid or treat complications. Reperfusion pulmonary edema, airway hemorrhage, and right ventricular failure are the most problematic complications, often requiring the use of extracorporeal membrane oxygenation to bridge to recovery. Successful PEA has been shown to improve both morbidity and mortality in large registries, with survival >70% at 10 years. For patients not suitable for PEA or with residual PH after PEA, balloon pulmonary angioplasty and/or PH medical therapy may prove beneficial. Here, we describe the indications for PEA, specific surgical and perioperative strategies, postoperative monitoring and management, and approaches for managing residual PH in the long term.

The Metagenomic Composition and Effects of Fecal-Microbe-Derived Extracellular Vesicles on Intestinal Permeability Depend on the Patient's Disease.

The composition and impact of fecal-microbe-derived extracellular vesicles (EVs) present in different diseases has not been analyzed. We determined the metagenomic profiling of feces and fecal-microbe-derived EVs from healthy subjects and patients with different diseases (diarrhea, morbid obesity and Crohn's disease (CD)) and the effect of these fecal EVs on the cellular permeability of Caco-2 cells. The control group presented higher proportions of Pseudomonas and Rikenellaceae_RC9_gut_group and lower proportions of Phascolarctobacterium, Veillonella and Veillonellaceae_ge in EVs when compared with the feces from which these EVs were isolated. In contrast, there were significant differences in 20 genera between the feces and EV compositions in the disease groups. Bacteroidales and Pseudomonas were increased, and Faecalibacterium, Ruminococcus, Clostridium and Subdoligranum were decreased in EVs from control patients compared with the other three groups of patients. Tyzzerella, Verrucomicrobiaceae, Candidatus_Paracaedibacter and Akkermansia were increased in EVs from the CD group compared with the morbid obesity and diarrhea groups. Fecal EVs from the morbid obesity, CD and, mainly, diarrhea induced a significant increase in the permeability of Caco-2 cells. In conclusion, the metagenomic composition of fecal-microbe-derived EVs changes depending on the disease of the patients. The modification of the permeability of Caco-2 cells produced by fecal EVs depends on the disease of the patients.

Toxicity tests, bioaccumulation and residuality of pyrethroid insecticides commonly used to control conifer bark beetles in Mexico.

Effectiveness of pyrethroid insecticides against pests including bark beetles (Dendroctonus spp.) is well known, but little is known about their (a) residuality and persistence in forests after application to control an outbreak and (b) ability to bioaccumulate in insects, which could cause adverse effects on the trophic chains. The 24 h lethal toxicity, bioaccumulation factors, and lethal body burdens of the pyrethroid insecticides bifenthrin, deltamethrin, and cypermethrin were evaluated in the bark beetle Dendroctonus mexicanus. The residuality and persistence of the insecticide bifenthrin in the forest ecosystem (soil, water, and sediment) was also monitored after its application in a region infested by bark beetles. We determined whether contamination of soil, water, and sediments occurred near the sanitation site. For D. mexicanus, the most toxic insecticide for adults was bifenthrin for topical application (LC50 = 0.94 mg/L) and cypermethrin for bark application (LC50 = 5.04 mg/L). The insecticide that bioaccumulated the most in the insect body was deltamethrin (622.41 µg g-1 dw) and the insecticide that bioaccumulated the least amount was cypermethrin (183.09 µg g-1 dw). However, cypermethrin was the active substance that presented the lowest body burdens, and therefore required a lower dose to cause death of D. mexicanus adults. Our results demonstrate that prolonged presence of bifenthrin in the forest ecosystem could lead to bioaccumulation in soil, sediment, and insects.

Validity, Reliability, and Sensitivity to Exercise-Induced Fatigue of a Customer-Friendly Device for the Measurement of the Brain's Direct Current Potential.

ABSTRACT: Valenzuela, PL, Sánchez-Martínez, G, Torrontegi, E, Vázquez-Carrión, J, Montalvo, Z, and Kara, O. Validity, reliability, and sensitivity to exercise-induced fatigue of a customer-friendly device for the measurement of the brain's direct current potential. J Strength Cond Res 36(6): 1605-1609, 2022-This study aimed to determine the validity, reliability, and sensitivity to exercise-induced fatigue of the brain's direct current (DC) potential measured with a commercially available and customer-friendly electroencephalography (EEG) device and Omegawave (OW). The study was composed of 3 different experiments as follows: (a) we compared the DC potential values obtained simultaneously in 31 subjects with both OW and a research-quality EEG system; (b) 3 consecutive DC potential measurements with OW were taken at rest on the same day in 25 subjects for reliability analyses; and (c) sensitivity to fatigue was assessed in 9 elite badminton players through the measurement of the DC potential with OW-as well as other fatigue-related measures (e.g., Hooper's index, heart rate variability, jump ability, and simple and complex reaction times)-24 hours after both a day of rest and of strenuous exercise, which were performed in a crossover and randomized design. The DC potential measured with OW was reliable (intraclass correlation coefficient = 0.97) and significantly correlated to that of EEG (r = 0.55, p = 0.001), although significant differences were observed between systems (p < 0.001). Compared with the rest day, strenuous exercise resulted in an impaired Hooper's index (p = 0.010) and jump ability (p = 0.008), longer simple (p = 0.038) and complex reaction times (p = 0.011), and a trend toward sympathetic dominance (standard deviation of normal to normal R-R intervals, p = 0.042; root mean square of differences between consecutive R-R intervals, p = 0.068). In turn, no significant differences were found between sessions for the DC potential (p = 0.173). In summary, the DC potential measured with OW was reliable and modestly correlated to that measured with EEG, but no differences were observed in response to the delayed fatigue (after 24 hours) elicited by strenuous exercise in elite athletes.

Endoscopic septotomy of Zenker's diverticulum with Stag-Beetle Knife™: A descriptive observational study and literature review. / Septotomía endoscópica del divertículo de Zenker mediante Stag-Beetle-KnifeTM: estudio observacional descriptivo y revisión de la literatura.

INTRODUCTION: Zenker's diverticulum (ZD) is a protrusion of the hypopharyngeal mucosa with a prevalence of 2/100,000 inhabitants. The symptoms of the patients determine the need for treatment, which can be surgical or endoscopic. The latter, known as endoscopic septotomy or diverticulotomy (ED), this involves dissecting the diverticular septum, which can be performed with different dissection devices. AIM: The aim of our study was to evaluate the efficacy and safety of ED with Stag-Beetle-Knife™ device, as well as to conduct a literature review to assess the position of the technique in the current scientific panorama. MATERIAL AND METHODS: Descriptive retrospective study that includes patients who underwent ED with SB-Knife™ between June 2017 and February 2020. Literature review of the available evidence between January 2013 and April 2020 of ED with SB-Knife™ technique and its variants. RESULTS: Twelve patients (66% male) with a median age of 70.5 years were collected. The median size of diverticular was 32.5mm and complete remission was observed in 75% of the cases. Fourteen interventions were performed with a technical success of 92.8. There were no serious complications. A literature review was carried out, finding 13 papers, of which 8 were finally included (6 retrospective studies, a series of cases and a clinical case). CONCLUSION: Based on our experience and the reviewed literature, we consider ED with SB-Knife™ is a safe, effective and reproducible technique, and may be a better alternative to surgery in patients with ZD.

Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement.

BACKGROUND: The risk of complications, including death, is substantially increased in patients with pulmonary hypertension (PH) undergoing anaesthesia for surgical procedures, especially in those with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). Sedation also poses a risk to patients with PH. Physiological changes including tachycardia, hypotension, fluid shifts, and an increase in pulmonary vascular resistance (PH crisis) can precipitate acute right ventricular decompensation and death. METHODS: A systematic literature review was performed of studies in patients with PH undergoing non-cardiac and non-obstetric surgery. The management of patients with PH requiring sedation for endoscopy was also reviewed. Using a framework of relevant clinical questions, we review the available evidence guiding operative risk, risk assessment, preoperative optimisation, and perioperative management, and identifying areas for future research. RESULTS: Reported 30 day mortality after non-cardiac and non-obstetric surgery ranges between 2% and 18% in patients with PH undergoing elective procedures, and increases to 15-50% for emergency surgery, with complications and death usually relating to acute right ventricular failure. Risk factors for mortality include procedure-specific and patient-related factors, especially markers of PH severity (e.g. pulmonary haemodynamics, poor exercise performance, and right ventricular dysfunction). Most studies highlight the importance of individualised preoperative risk assessment and optimisation and advanced perioperative planning. CONCLUSIONS: With an increasing number of patients requiring surgery in specialist and non-specialist PH centres, a systematic, evidence-based, multidisciplinary approach is required to minimise complications. Adequate risk stratification and a tailored-individualised perioperative plan is paramount.

Multiple vertebral fractures after suspension of denosumab. A series of 56 cases.

BACKGROUND: Denosumab is a monoclonal antibody approved for the treatment of postmenopausal osteoporosis. The withdrawal of denosumab produces an abrupt loss of bone mineral density and may cause multiple vertebral fractures (MVF). OBJECTIVE: The objective of this study is to study the clinical, biochemical, and densitometric characteristics in a large series of postmenopausal women who suffered MVF after denosumab withdrawal. Likewise, we try to identify those factors related to the presence of a greater number of vertebral fractures (VF). PATIENTS AND METHODS: Fifty-six patients (54 women) who suffered MVF after receiving denosumab at least for three consecutive years and abruptly suspended it. A clinical examination was carried out. Biochemical bone remodelling markers (BBRM) and bone densitometry at the lumbar spine and proximal femur were measured. VF were diagnosed by magnetic resonance imaging MRI, X-ray, or both at dorsal and lumbar spine. RESULTS: Fifty-six patients presented a total of 192 VF. 41 patients (73.2%) had not previously suffered VF. After discontinuation of the drug, a statistically significant increase in the BBRM was observed. In the multivariate analysis, only the time that denosumab was previously received was associated with the presence of a greater number of VF (P = .04). CONCLUSIONS: We present the series with the largest number of patients collected to date. 56 patients accumulated 192 new VF. After the suspension of denosumab and the production of MVF, there was an increase in the serum values of the BBRM. The time of denosumab use was the only parameter associated with a greater number of fractures.

Genetic Diversity of Xylella fastidiosa in Mexican Vineyards.

Xylella fastidiosa is a xylem-inhabiting phytopathogenic bacterium that affects diverse agriculturally relevant crops. In Mexico, X. fastidiosa has been reported in the states of Baja California, Coahuila, and Querétaro. In order to determine the genetic diversity of this bacterium in Mexico, 408 grapevine samples were collected from the main producing states in México. For X. fastidiosa identification, real-time PCR and three-loci end-point PCR were employed. The genotyping of the subspecies was carried out using multilocus sequence typing and analysis, based on seven housekeeping genes: leuA, petC, malF, cysG, holC, nuoL, and gltT. The resulting sequences were compared with those present in extant databases. The presence of X. fastidiosa subsp. fastidiosa in the states of Baja California (sequence type 1), Coahuila (sequence type 1), and Querétaro was confirmed. The isolates from northern Mexico bear high similarity to grapevine isolates from the United States. However, the isolates from Querétaro showed significant differences with currently known sequences, showing that there is genetic variability among the X. fastidiosa subsp. fastidiosa populations from grapevines in northern and central Mexico.

Ischemic Preconditioning and Muscle Force Capabilities.

ABSTRACT: Valenzuela, PL, Martín-Candilejo, R, Sánchez-Martínez, G, Bouzas Marins, JC, de la Villa, P, and Sillero-Quintana, M. Ischemic preconditioning and muscle force capabilities. J Strength Cond Res 35(8): 2187-2192, 2021-This study analyzed the effects of ischemic preconditioning (IPC) on muscle force capabilities. Sixteen male subjects participated in this randomized, crossover, sham-controlled study. They were assigned to either IPC (3 × 5 minutes at 220 mm Hg in both arms with 5-minute rests) or a sham intervention (SHAM) (occlusion pressure set at 10 mm Hg). Forty minutes later, their force capabilities on the bench press exercise were assessed (load-velocity relationship with light, moderate, and heavy loads [30, 50, and 70% body mass, respectively]; 1 repetition maximum [1RM]; and number of repetitions to failure in 3 sets with 60% RM). The skin temperature (Tsk) of the pectoral and biceps muscles was analyzed as a secondary endpoint by means of infrared thermography. A significant decrease in the Tsk of the pectoral and biceps muscles was observed after the intervention (p < 0.01) and before the warm-up (p < 0.05) in IPC, but not in SHAM. However, exercise resulted in a similar Tsk increase in the pectoral muscles in both conditions (p > 0.05). No significant differences (p > 0.05 for all) were observed between conditions in the mean velocity attained with light (1.11 ± 0.11 and 1.09 ± 0.14 m·s-1, respectively), moderate (0.83 ± 0.14 and 0.83 ± 0.16 m·s-1), nor heavy loads (0.56 ± 0.17 and 0.54 ± 0.16 m·s-1), in 1RM (75.0 ± 18.9 and 73.1 ± 15.0 kg for IPC and SHAM, respectively; p = 0.181), nor in the number of repetitions performed (52 ± 13 and 54 ± 16 repetitions, p = 0.492). In summary, IPC decreased Tsk locally (biceps) and remotely (pectoral). However, it did not alter muscle force capabilities nor the Tsk response to exercise.

A lower duodenal immune response is associated with an increase of insulin resistance in patients with morbid obesity.

OBJECTIVE: The intestinal immune response could play an important role in obesity-related comorbidities. We aim to study the profile of duodenal cytokines and chemokines in patients with morbid obesity (MO), its relation with insulin resistance (IR) and the intake of metformin, and with the evolution of MO after sleeve gastrectomy (SG). RESEARCH DESIGN AND METHODS: Duodenal levels of 24 cytokines and 9 chemokines were analyzed in 14 nonobese and in 54 MO who underwent SG: with lower IR (MO-lower-IR), with higher IR (MO-higher-IR), and with type 2 diabetes treated with metformin (MO-metf-T2DM). RESULTS: MO-lower-IR had higher levels of cytokines related to Th1, Th2, Th9, Th17, Th22, M1 macrophages, and chemokines involved in the recruitment of macrophages and T-lymphocytes (p < 0.05), and total (CD68 expression) and M1 macrophages (ITGAX expression) (p < 0.05) when compared with nonobese patients, but with a decrease in M2 macrophages (MRC1 expression) (p < 0.05). In MO-higher-IR, these chemokines and cytokines decreased and were similar to those found in nonobese patients. In MO-metf-T2DM, only IL-4 (Th2) and IL-22 (Th22) increased their levels with regard to MO-higher-IR (p < 0.05). In MO-higher-IR and MO-metf-T2DM, there was a decrease of CD68 expression (p < 0.05) while ITGAX and MRC1 were similar with regard to MO-lower-IR. We found an association between CXCL8, TNFß and IL-2 with the evolution of body mass index (BMI) after SG (p < 0.05). CONCLUSIONS: There is an association between a higher IR and a lower duodenal immune response in MO, with a slight increase in those patients with metformin treatment. Intestinal immune response could be involved in the evolution of BMI after SG.

BCL2-ASSOCIATED ATHANOGENE4 Regulates the KAT1 Potassium Channel and Controls Stomatal Movement.

Potassium (K+) is a key monovalent cation necessary for multiple aspects of cell growth and survival. In plants, this cation also plays a key role in the control of stomatal movement. KAT1 and its homolog KAT2 are the main inward rectifying channels present in guard cells, mediating K+ influx into these cells, resulting in stomatal opening. To gain further insight into the regulation of these channels, we performed a split-ubiquitin protein-protein interaction screen searching for KAT1 interactors in Arabidopsis (Arabidopsis thaliana). We characterized one of these candidates, BCL2-ASSOCIATED ATHANOGENE4 (BAG4), in detail using biochemical and genetic approaches to confirm this interaction and its effect on KAT1 activity. We show that BAG4 improves KAT1-mediated K+ transport in two heterologous systems and provide evidence that in plants, BAG4 interacts with KAT1 and favors the arrival of KAT1 at the plasma membrane. Importantly, lines lacking or overexpressing the BAG4 gene show altered KAT1 plasma membrane accumulation and alterations in stomatal movement. Our data allowed us to identify a KAT1 regulator and define a potential target for the plant BAG family. The identification of physiologically relevant regulators of K+ channels will aid in the design of approaches that may impact drought tolerance and pathogen susceptibility.

The UMAG_00031 gene from Ustilago maydis encodes a putative membrane protein involved in pH control and morphogenesis.

We report the characterization of the gene UMAG_00031 from Ustilago maydis, previously identified as upregulated at alkaline pH. This gene is located on chromosome 1 and contains an ORF of 1539 bp that encodes a putative protein of 512 amino acids with an MW of 54.8 kDa. The protein is predicted to contain seven transmembrane domains (TMDs) and a signal peptide suggesting that is located in the cell membrane. Null ΔUMAG_00031 mutants were constructed, and their phenotype was analyzed. The mutant displayed a pleiotropic phenotype suggesting its participation in processes of alkaline pH adaptation independent of the Pal/Rim pathway. Also, it was involved in the dimorphic process induced by fatty acids. These results indicate that the protein encoded by the UMAG_00031 gene possibly functions as a receptor of different signals in the cell membrane of the fungus.

Influence of baseline QRS on the left ventricular ejection fraction recovery after frequent premature ventricular complex ablation.

AIMS: Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular systolic dysfunction. We aimed to investigate the influence of the baseline QRS in the response after PVC ablation in patients with depressed left ventricular ejection fraction (LVEF). METHODS AND RESULTS: Two hundred and fifteen [59 ± 13 years old, 152 (71%) men] consecutive patients with left ventricular (LV) systolic dysfunction and frequent PVCs referred for ablation were included and followed-up for 12 months. Echocardiographic response was defined as an improvement of at least five absolute points in LVEF. Clinical, electrocardiogram, and electrophysiological characteristics were analysed. Mean baseline QRS duration was 110 ms [97-140]. Premature ventricular complex burden significantly decreased after ablation from 23% [16-33] at baseline to 1% [0-8] at 12 months, P < 0.001. Mean PVC burden reduction was 18 [8-30] points. There was a significant improvement of LVEF from 35% [29-40] at baseline to 44% [35-55] at 12 months, P < 0.001. One hundred and thirty (61%) patients were considered as echocardiographic responders. Baseline QRS duration (ms) [odds ratio (OR) 0.98 (0.97-0.99), P = 0.01] was an independent predictor of echocardiographic response. Mean LVEF improvement was 16 [10-21] points when the baseline QRS duration was <90 ms; 12 [4-20] when it was 90-110 ms; 5 [0-15] when it was 110 ± 130 ms; and 0 [0-6] points when it was >130 ms. CONCLUSIONS: In patients with LV systolic dysfunction, intrinsic QRS duration is inversely related to the probability and the degree of echocardiographic response after frequent PVC ablation. Patients with a QRS duration >130 ms at baseline have the poorer response after ablation.

The Effect of the Inflammatory Bowel Disease Classroom in Nature on the Quality of Life of Patients With Inflammatory Bowel Disease.

"The IBD Classroom in Nature" is an initiative that combines training and leisure activities in an ideal environment where families and patients can interact with each other. The objective of the present study was to quantify the effect that "The IBD Classroom in Nature" had on the health-related quality-of-life of patients with Inflammatory bowel disease (IBD). We conducted a prospective, analytical study with a pre-post design to demonstrate the impact on health-related quality-of-life (measured with the IMPACT-III questionnaire) of 3 days together in the context of The IBD Classroom in Nature. The study included 13 patients with IBD with a mean age of 12.3 years (interquartile range 11.9-14.5). After "The IBD Classroom in Nature" there was an improvement in the IMPACT-III score with significant improvements in the emotional functioning and body image domains. The present study objectively shows the beneficial effect of group activities focused on the most diverse aspects of their disease.

Opioid-Free Anesthesia for Lung Cancer Resection: A Case-Control Study.

OBJECTIVE: To assess the feasibility and effectiveness of an opioid-free anesthesia (OFA) technique in lung cancer resection surgery versus standard opioid-based techniques. DESIGN: Retrospective, propensity-matched, case-control study. SETTING: A single, specialty cardiothoracic center between January 2018 and July 2019. PARTICIPANTS: Adult patients undergoing lung cancer resection surgery. INTERVENTIONS: A cohort of 83 patients undergoing an OFA technique (OFA group) for lung cancer resection surgery was matched with 83 patients who underwent similar surgery with a standard anesthesia technique (STD group). Outcome measures compared between the 2 groups included postoperative pain scores at 0, 1, and 24 hours; 24-hour postoperative morphine patient-controlled analgesia consumption; recovery room and hospital lengths of stay; and 30-day all-cause mortality. MEASUREMENT AND MAIN RESULTS: No difference was found in median pain scores (interquartile range [IQR]) at 0 hours: STD 0 (0-1), OFA 0 (0-1); p = 0.48. Median pain scores (IQR) at 1 hour were statistically significantly greater in the STD group compared with the OFA group: STD 1 (0-1), OFA 0 (0-1); p = 0.03. There was no difference in median pain scores (IQR) at 24 hours: STD 0 (0-1), OFA 0 (0-1); p = 0.49. Mean postoperative 24-hour patient-controlled analgesia morphine consumption (standard deviation) was similar between groups: STD 21.1 (±18.8) mg, OFA 16.2 (±18.1) mg; p = 0.16. There was no difference in mean time spent in the postoperative recovery (standard deviation) area between the 2 groups: STD 116 (±49) minutes, OFA 108 (±34) minutes; p = 0.27. Median hospital length of stay (IQR) was longer in the STD group compared with the OFA group: STD 4 (2-6) days, OFA 3 (2-4) days; p = 0.002. CONCLUSIONS: This case-control study demonstrated that an OFA technique in lung cancer resection surgery offers a feasible and safe approach, resulting in similar postoperative pain scores and morphine consumption compared with standard opioid-containing techniques.

Enhanced External Counterpulsation and Recovery From a Plyometric Exercise Bout.

OBJECTIVE: To analyze the effectiveness of enhanced external counterpulsation (EECP) on recovery from exercise-induced muscle damage (EIMD). DESIGN: This study followed a crossover, placebo-controlled, counterbalanced design. PARTICIPANTS: Ten healthy active subjects (7 male; 27 ± 4 years). INTERVENTIONS: Participants performed a plyometric exercise bout (10 sets of 10 jumps interspersed with 1-minute rests) and were then assigned to recover for 30 minutes with either EECP (cuff pressure = 80 mm Hg) or a Sham intervention (0 mm Hg) immediately after exercise and at 24 hours after exercise. Two weeks later, they repeated the protocol with the other recovery intervention. MAIN OUTCOME MEASURES: Muscle soreness, creatine kinase (CK) activity, jump performance, and tensiomyographic variables were measured before exercise, and 24 and 48 hours after exercise. RESULTS: The mean jump height of the plyometric bout did not differ between EECP and Sham (P > 0.05). Exercise resulted in increased muscle soreness (P < 0.001) and CK levels (P < 0.001), as well as in impaired jump performance (P < 0.05). No changes were observed in tensiomyographic variables. No significant differences were found between interventions for any of the study outcomes. CONCLUSIONS: No benefits on recovery from EIMD after a plyometric exercise bout were observed with EECP.

Reference power values for the jump squat exercise in elite athletes: A multicenter study.

The present study aimed to provide reference values for lower-limb muscle power assessed during the incremental jump squat (JS) test in elite athletes (i.e., professional athletes competing at international level). We pooled data from all JS tests performed by elite athletes of different sports in two high-performance centres between 2015 and 2019, and computed reference values (i.e., terciles) for mean power (MP), mean propulsive power (MPP), and peak power (PP). Reference values were obtained from 684 elite athletes (458 male and 226 female) of 16 different sports (boxing, judo, karate, fencing, taekwondo, wrestling, basketball, soccer, futsal, handball, rugby union, badminton, tennis, long distance running, triathlon, and sprinting). Significant differences (p < 0.001) were found between male and female athletes for MP (7.47 ± 1.93 and 6.15 ± 1.68 W·Kg-1, respectively), MPP (10.50 ± 2.75 and 8.63 ± 2.43 W·Kg-1), and PP (23.64 ± 6.12 and 19.35 ± 5.49 W·Kg-1). However, the velocity at which these power measures was attained seemed to be independent of sex (~0.95, 1.00 and 2.00 m·s-1 for mean, mean propulsive, and peak velocity, respectively) and homogeneous across different sport disciplines (coefficient of variation <10%). These data can be used to classify athletes' power capabilities, and the optimum velocity ranges provided here could be useful for training purposes.

Antimicrobial activity of silver diamine fluoride on human periodontitis microbiota.

Silver diamine fluoride (SDF) has been used in management of dentinal hypersensitivity and dental caries. This in vitro study evaluated the antimicrobial effects of SDF on subgingival microorganisms from severe human periodontitis lesions. Subgingival biofilm specimens from 24 adults with severe periodontitis were mixed in vitro with 19% or 38% SDF or left untreated (n = 24 per group) and then inoculated on enriched Brucella blood agar with anaerobic incubation. Selected red- and orange-complex periodontal pathogens were phenotypically identified in the subgingival specimens, including Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Parvimonas micra, Campylobacter rectus, Fusobacterium nucleatum, and Streptococcus constellatus. Other microbial species recovered from SDF-treated specimens were identified using matrix-assisted laser desorption- ionization time-of-flight mass spectrometry. The SDF-treated specimens yielded significantly lower mean total viable counts and significantly lower mean total cultivable proportional levels of red- and orange-complex periodontal pathogens (0.5%-0.6%) than did untreated specimens (25.9%) (P < 0.001). The only red- and orange-complex species recovered from SDF-treated specimens were P micra (3 patients) and S constellatus (1 patient). The predominant cultivable isolates from SDF-treated specimens were Streptococcus oralis and other streptococci of relatively low periodontopathic and cariogenic potential. No statistically significant in vitro antimicrobial differences were found between 19% and 38% SDF against subgingival biofilm specimens. In this experiment, SDF exhibited substantial in vitro antimicrobial activity against putative periodontal pathogens from severe periodontitis lesions. The suppression of red- and orange-complex periodontal pathogens in subgingival biofilms by SDF treatment, along with the selection of SDF-resistant Streptococcus species that are associated with periodontal health, suggests a potential new therapeutic use for SDF in the management of human periodontal infections.