Adenosine A2A receptor regulation of microglia morphological remodeling-gender bias in physiology and in a model of chronic anxiety.

Developmental risk factors, such as the exposure to stress or high levels of glucocorticoids (GCs), may contribute to the pathogenesis of anxiety disorders. The immunomodulatory role of GCs and the immunological fingerprint found in animals prenatally exposed to GCs point towards an interplay between the immune and the nervous systems in the etiology of these disorders. Microglia are immune cells of the brain, responsive to GCs and morphologically altered in stress-related disorders. These cells are regulated by adenosine A2A receptors, which are also involved in the pathophysiology of anxiety. We now compare animal behavior and microglia morphology in males and females prenatally exposed to the GC dexamethasone. We report that prenatal exposure to dexamethasone is associated with a gender-specific remodeling of microglial cell processes in the prefrontal cortex: males show a hyper-ramification and increased length whereas females exhibit a decrease in the number and in the length of microglia processes. Microglial cells re-organization responded in a gender-specific manner to the chronic treatment with a selective adenosine A2A receptor antagonist, which was able to ameliorate microglial processes alterations and anxiety behavior in males, but not in females.

Peak Vertical Jump Power as a Marker of Bone Health in Children.

The objective of this investigation was to evaluate the accuracy of peak vertical jump power (VJP) to identify children with bone mineral density (BMD) below average, defined as BMD measured by DXA and adjusted for body height at the whole body less head≤- 1.0 standard deviation (SD). The sample included 114 boys and girls aged 8.5±0.4 years old. VJP was estimated from a countermovement jump performed on a contact mat using the measured flight time to calculate the height of rise of the center of gravity. Logistic regression analysis revealed that the odds ratio of having BMD≤1.0 SD decreased 1.2% per watt of power and the probability of BMD below average was 75.6% higher in boys than in girls with the same peak power jump. Receiver operating characteristic analysis showed that the best trade-off between sensitivity and specificity to identify children with BMD<- 1.0 SD was 635 watts in boys (sensitivity=63.3%; specificity=69.2%; AUC=0.816, 95% CI: 0.681-0.95; p<0.001) and 515 watts in girls (sensitivity=75.0%; specificity=77.0%; AUC=0.849, 95% CI: 0.698-0.999; p=0.002). These cut-off values correspond to a vertical jump of 19.9 cm and 20.5 cm in 8-year-old boys and girls, respectively. The VJP showed a reasonable sensitivity and specificity as well good discriminant ability to identify children with BMD below average.

Human proximal femur bone adaptation to variations in hip geometry.

The study of bone mass distribution at proximal femur may contribute to understand the role of hip geometry on hip fracture risk. We examined how bone mineral density (BMD) of proximal femur adapts to inter individual variations in the femoral neck length (FNL), femoral neck width (FNW) and neck shaft angle (NSA). A parameterized and dimensionally scalable 3-D finite element model of a reference proximal femur geometry was incrementally adjusted to adopt physiological ranges at FNL (3.90-6.90cm), FNW (2.90-3.46cm), and NSA (109-141º), yielding a set of femora with different geometries. The bone mass distribution for each femur was obtained with a suitable bone remodelling model. The BMDs at the integral femoral neck (FN) and at the intertrochanteric (ITR) region, as well as the BMD ratio of inferomedial to superolateral (IM:SL) regions of FN and BMD ratio of FN:ITR were used to represent bone mass distribution. Results revealed that longer FNLs present greater BMD (g/cm(3)) at the FN, mainly at the SL region, and at the ITR region. Wider FNs were associated with reduced BMD at the FN, particularly at the SL region, and at the ITR region. Larger NSAs up to 129° were associated with BMD diminutions at the FN and ITR regions and with increases of the IM:SL BMD ratio while NSAs larger than 129° resulted in decrease of the IM:SL BMD ratio. These findings suggest hip geometry as moderator of the mechanical loading influence on bone mass distribution at proximal femur with higher FNL favoring the BMD of FN and ITR regions and greater FNW and NSA having the opposite effect. Augmented values of FNL and FNW seem also to favor more the BMD at the superolateral than at the inferomedial FN region.

Influence of physical activity and skeleton geometry on bone mass at the proximal femur in 10- to 12-year-old children--a longitudinal study.

UNLABELLED: Physical activity (PA) have long been identified as a determining factor of the mineralization of the skeleton, particularly in children. Our research supports the hypothesis that the geometry of the pelvis and proximal femur (PF) might moderate the effect of PA in the relative mineralization of the PF subregions. INTRODUCTION: Using a longitudinal observational study with two evaluations and a 1-year follow-up interval, we investigated the influence of PA and skeletal geometry in bone mineral density (BMD) and bone mass distribution at the PF in 96 girls and 81 boys (10-12 years). It is plausible that the geometry of the pelvis-PF structure moderates mechanical forces exerted at the hip and therefore creates different degrees of mineralization among PF subregions. METHODS: Whole body and left hip dual X-ray absorptiometry scans were used to derive geometric measures of the pelvis-inter-acetabular distance (IAD) and PF abductor lever arm (ALA). BMD was measured at the integral, superolateral (SL), and inferomedial (IM) femoral neck (FN), and at the trochanter (TR). These subregions were used to represent bone mass distribution via three BMD ratios: FN/PF, IM/SL, and TR/PF. PA was measured using accelerometry and a bone-specific PA questionnaire (BPAQ). RESULTS: A longitudinal data approach revealed BPAQ as a positive predictor for all BMD variables (p < 0.05) except TR BMD in girls and FN BMD in boys. Comparing the most active with the less-active participants, the greatest benefits of PA were observed at the FN of the girls with the lowest IAD (p < 0.001), at the FN of the boys with the highest IAD (p < 0.001) and at the TR of the boys with the lowest ALA (p < 0.01). CONCLUSIONS: Geometric measures of IAD and ALA seem to moderate the effect of PA role in the relative mineralization of the PF regions. On the other hand, absolute BMD levels appear to be determined by mechanical loading.

Femoral neck bone adaptation to weight-bearing physical activity by computational analysis.

Individual differences in bone mass distribution at the proximal femur may be determined by daily weight-bearing physical activity (PA) since bone self-adapts according to the mechanical loads that is submitted. The aim of this study was to analyse computationally the effect of different weight-bearing PA types in the adaptation of the femoral neck (FN) by analysing regional differences in bone mineral density (BMD) at the integral FN and its superior, inferior, anterior and posterior subregions. To achieve this, it was adopted a 3-D femoral finite element (FE) model coupled with a suitable bone remodeling model. Different PA types were determined based both on ordinary lifestyle and mechanically more demanding PA as low magnitude impacts (L-I), moderate-magnitude impacts from odd directions (O-I) and high-magnitude vertical impacts (H-I). It was observed that as time spent in weight-bearing PA increases, BMD augment around the integral FN, but with different bone mass gain rates between subregions depending on the magnitude and directions of the hip contact forces; H-I was the type of weight-bearing PA which structurally most favor the gain of bone mass superiorly at the FN while both the H-I and the O-I types of PA promoted the largest bone mass gain rates at the anterior and posterior subregions of the FN. Because these types of weight-bearing PA were associated with a more uniform bone mass spatial distribution at the FN, they should provide a potential basis for targeted PA-based intervention programs for improving hip strength.

Elevated glucose concentration changes the content and cellular localization of AMPA receptors in the retina but not in the hippocampus.

Diabetic retinopathy and diabetic encephalopathy are two common complications of diabetes mellitus. The impairment of glutamatergic neurotransmission in the retina and hippocampus has been suggested to be involved in the pathogenesis of these diabetic complications. In this study, we investigated the effect of elevated glucose concentration and diabetes on the protein content and surface expression of AMPA receptor subunits in the rat retina and hippocampus. We have used two models, cultured retinal and hippocampal cells exposed to elevated glucose concentration and an animal model of streptozotocin-induced type 1 diabetes. The immunoreactivity of GluA1, GluA2 and GluA4 was evaluated by Western blot and immunocytochemistry. The levels of these subunits at the plasma membrane were evaluated by biotinylation and purification of plasma membrane-associated proteins. Elevated glucose concentration increased the total levels of GluA2 subunit of AMPA receptors in retinal neural cells, but not of the subunits GluA1 or GluA4. However, at the plasma membrane, elevated glucose concentration induced an increase of all AMPA receptor subunits. In cultured hippocampal neurons, elevated glucose concentration did not induce significant alterations in the levels of AMPA receptor subunits. In the retinas of diabetic rats there were no persistent changes in the levels of AMPA receptor subunits comparing to aged-matched control retinas. Also, no consistent changes were detected in the levels of GluA1, GluA2 or GluA4 in the hippocampus of diabetic rats. We demonstrate that elevated glucose concentration induces early changes in AMPA receptor subunits, mainly in GluA2 subunit, in retinal neural cells. Conversely, hippocampal neurons seem to remain unaffected by elevated glucose concentration, concerning the expression of AMPA receptors, suggesting that AMPA receptors are more susceptible to the stress caused by elevated glucose concentration in retinal cells than in hippocampal neurons.

Evaluation of the antibacterial residue surveillance programme in Danish pigs using Bayesian methods.

Residues of pharmacological active substances or their metabolites might be found in food products from food-producing animals. Maximum Residue Limits for pharmacological active substances in foodstuffs of animal origin are established to assure high food safety standards. Each year, more than 20,000 samples are analysed for the presence of antibacterial residues in Danish pigs. This corresponds to 0.1% of the size of the slaughter pig population and more than 1% of the sows slaughtered. In this study, a Bayesian model was used to evaluate the Danish surveillance system accuracy and to investigate the impact of a potential risk-based sampling approach to the residue surveillance programme in Danish slaughter pigs. Danish surveillance data from 2005 to 2009 and limited knowledge about true prevalence and test sensitivity and specificity were included in the model. According to the model, the true antibacterial residue prevalence in Danish pigs is very low in both sows (∼0.20%) and slaughter pigs (∼0.01%). Despite data constraints, the results suggest that the current screening test used in Denmark presents high sensitivity (85-99%) and very high specificity (>99%) for the most relevant antibacterial classes used in Danish pigs. If high-risk slaughter pigs could be identified by taking into account antibacterial use or meat inspection risk factors, a potential risk-based sampling approach to antibacterial residue surveillance in slaughter pigs would allow reducing the sample size substantially, while increasing or maintaining the probability of detection. Hence, the antibacterial residue surveillance programme in Danish pigs would be more cost-effective than today.

Variation of the different attributes that support the physical function in community-dwelling older adults.

AIM: This study investigated the variation with age of different attributes that support the physical functioning in community-dwelling older adults having as reference scores from young adults. METHODS: The study was a cross-sectional study. Participants were 559 older adults and 79 young adults grouped according to gender and age (Y:20-29, A:60-64, B:65-69, C:70-74, D:75-79 and E:≥ 80 years). Strength, flexibility, agility, aerobic endurance, and balance were evaluated by Fullerton tests. RESULTS: ANOVA and Bonferroni post-hoc tests showed that compared to young, the 60-64 years group showed decreased values in almost all attributes of physical function. In older adults, additional differences were observed in females mainly between the 60-64 years group and the 70-74 years, 75-79 years, and:≥ 80 years groups, and in males between the 60-64 years group and the ≥ 80 years group (P<0.05). Comparisons between standardized physical function attributes (T-scores) done by repeated measures and contrasts demonstrated that, across age groups, agility and dynamic balance showed the highest rate loss in both genders, and lower body flexibility showed the lowest (P<0.01). CONCLUSION: Physical function reduction seems to occur earlier in women than in men and abilities involving multiple structures such as balance, agility, and aerobic endurance showed the most loss.

Modelling food safety and economic consequences of surveillance and control strategies for Salmonella in pigs and pork.

Targets for maximum acceptable levels of Salmonella in pigs and pork are to be decided. A stochastic simulation model accounting for herd and abattoir information was used to evaluate food safety and economic consequences of different surveillance and control strategies, based among others on Danish surveillance data. An epidemiological module simulated the Salmonella carcass prevalence for different scenarios. Cost-effectiveness analysis was used to compare the costs of the different scenarios with their expected effectiveness. Herd interventions were not found sufficient to attain Salmonella carcass prevalence <1%. The cost-effectiveness of abattoir interventions changed with abattoir size. The most cost-effective strategy included the use of steam vacuum and steam ultrasound. Given uncertainty of the effect of steam vacuum and steam ultrasound, model results should be updated as more information becomes available. This framework contributes to informed decision-making for a more cost-effective surveillance and control of Salmonella in pigs and pork.

Use of herd information for predicting Salmonella status in pig herds.

Salmonella surveillance-and-control programs in pigs are highly resource demanding, so alternative cost-effective approaches are desirable. The aim of this study was to develop and evaluate a tool for predicting the Salmonella test status in pig herds based on herd information collected from 108 industrial farrow-to-finish pig herds in Portugal. A questionnaire including known risk factors for Salmonella was used. A factor analysis model was developed to identify relevant factors that were then tested for association with Salmonella status. Three factors were identified and labelled: general biosecurity (factor 1), herd size (factor 2) and sanitary gap implementation (factor 3). Based on the loadings in factor 1 and factor 3, herds were classified according to their biosecurity practices. In total, 59% of the herds had a good level of biosecurity (interpreted as a loading below zero in factor 1) and 37% of the farms had good biosecurity and implemented sanitary gap (loading below zero in factor 1 and loading above zero in factor 3). This implied that they, among other things, implemented preventive measures for visitors and workers entering the herd, controlled biological vectors, had hygiene procedures in place, water quality assessment, and sanitary gap in the fattening and growing sections. In total, 50 herds were tested for Salmonella. Logistic regression analysis showed that factor 1 was significantly associated with Salmonella test status (P = 0.04). Herds with poor biosecurity had a higher probability of testing Salmonella positive compared with herds with good biosecurity. This study shows the potential for using herd information to classify herds according to their Salmonella status in the absence of good testing options. The method might be used as a potentially cost-effective tool for future development of risk-based approaches to surveillance, targeting interventions to high-risk herds or differentiating sampling strategies in herds with different levels of infection.

Long-term exposure to high glucose induces changes in the content and distribution of some exocytotic proteins in cultured hippocampal neurons.

A few studies have reported the existence of depletion of synaptic vesicles, and changes in neurotransmitter release and in the content of exocytotic proteins in the hippocampus of diabetic rats. Recently, we found that diabetes alters the levels of synaptic proteins in hippocampal nerve terminals. Hyperglycemia is considered the main trigger of diabetic complications, although other factors, such as low insulin levels, also contribute to diabetes-induced changes. Thus, the aim of this work was to evaluate whether long-term elevated glucose per se, which mimics prolonged hyperglycemia, induces significant changes in the content and localization of synaptic proteins involved in exocytosis in hippocampal neurons. Hippocampal cell cultures were cultured for 14 days and were exposed to high glucose (50 mM) or mannitol (osmotic control; 25 mM plus 25 mM glucose), for 7 days. Cell viability and nuclear morphology were evaluated by MTT and Hoechst assays, respectively. The protein levels of vesicle-associated membrane protein-2 (VAMP-2), synaptosomal-associated protein-25 (SNAP-25), syntaxin-1, synapsin-1, synaptophysin, synaptotagmin-1, rabphilin 3a, and also of vesicular glutamate and GABA transporters (VGluT-1 and VGAT), were evaluated by immunoblotting, and its localization was analyzed by immunocytochemistry. The majority of the proteins were not affected. However, elevated glucose decreased the content of SNAP-25 and increased the content of synaptotagmin-1 and VGluT-1. Moreover, there was an accumulation of syntaxin-1, synaptotagmin-1 and VGluT-1 in the cell body of some hippocampal neurons exposed to high glucose. No changes were detected in mannitol-treated cells. In conclusion, elevated glucose per se did not induce significant changes in the content of the majority of the synaptic proteins studied in hippocampal cultures, with the exception of SNAP-25, synaptotagmin-1 and VGluT-1. However, there was an accumulation of some proteins in cell bodies of hippocampal neurons exposed to elevated glucose, suggesting that the trafficking of these proteins to the synapse may be compromised. Moreover, these results also suggest that other factors, in addition to hyperglycemia, certainly contribute to alterations detected in synaptic proteins in diabetic animals.

Soropositividade e lesões sugestivas de brucelose em bovinos abatidos no estado de Tocantins, Brasil / Serumpositivity and lesions suggestive of brucellosis in cattle slaughtered in Tocantins state, Brazil

De outubro a dezembro de 2007, 845 amostras de sangue foram coletadas de 836 vacas (98,9%) e nove touros (1,1%), em um matadouro com inspeção federal no Estado do Tocantins. Cento e quarenta e duas amostras [(16,8%) IC 95% 14,3-19,4] tiveram reação positiva ao teste do antígeno acidificado e tamponado de Brucella abortus. Um touro foi positivo ao teste. Quinhentos e sessenta e um bovinos (66,3%) procederam do Estado do Pará e 284 (33,7%) do Estado do Tocantins. A prevalência de soropositividade foi de 17,2% [IC (95%) 13,6 - 19,9] e de 16,6% [IC (95%) 13,0 - 22,2] para o gado do Pará e Tocantins, respectivamente. Estas prevalências não são significativamente diferentes (p > 0,05). Nenhuma das vacas tinha registro de vacinação contra brucelose. Os exames "ante e post-mortem" não detectaram qualquer sinal ou lesão sugestiva à brucelose, como descargas vaginais, orquites, artrites ou bursites [(0,00%) IC 95% 0,00-0,43] em todos os bovinos da amostra. Esta situação, associada às altas prevalências da doença e à falta de diagnóstico da brucelose nos rebanhos, aumenta o número de bovinos infectados abatidos sob condições sanitárias inadequadas, o risco de contaminação dos trabalhadores e a colocação no mercado, sem restrição, de carne de animais infectados.

From October to December 2007, 845 blood samples were collected from 836 cows (98.9%) and nine bulls (1.1%), in a slaughterhouse with federal inspection in the state of Tocantins. One hundred and forty-two samples [(16.8%) 95% CI 14.3-19.4] had positive reaction to the plate agglutination test carried out with acidified and buffered antigen of Brucella abortus. One bull was positive to the test. Five hundred and sixty one bovines came from the State of Pará (66.3%) and 284 (33.7%) came from the State of Tocantins. The prevalence of serum positivity was 17.2% [CI (95%) 13.6 ­ 19.9] and 16.6% [CI (95%) 13.0 ­ 22.2] for cattle came from Pará and Tocantins, respectively, with no significant difference between these frequencies (p > 0.05). None of the cows had record of vaccination against brucellosis. "Ante and post-mortem" examinations could not find any sign or lesion attributable to brucellosis, such as vaginal discharges, joint inflammation or bursitis [(0.00%) 95% CI 0.00-0.43] in all bovines sampled. This situation, coupled with the high prevalence of the disease and the lack of brucellosis diagnostic at herds, increases the number of infected cattle slaughtered under inadequate sanitary conditions, the risk of contamination of workers and placing on the market, without restriction, the meat from infected animals.

Diabetes differentially affects the content of exocytotic proteins in hippocampal and retinal nerve terminals.

Diabetes has been associated with cognitive and memory impairments, and with alterations in color and contrast perception, suggesting that hippocampus and retina are particularly affected by this disease. A few studies have shown that diabetes differentially affects neurotransmitter release in different brain regions and in retina, and induces structural and molecular changes in nerve terminals in both hippocampus and retina. We now detailed the impact over time of diabetes (2, 4 and 8 weeks of diabetes) on a large array of exocytotic proteins in hippocampus and retina.The exocytotic proteins density was evaluated by immunoblotting in purified synaptosomes and in total extracts of hippocampus and retina from streptozotocin-induced diabetic and age-matched control animals. Diabetes affected differentially the content of synaptic proteins (VAMP-2, SNAP-25, syntaxin-1, synapsin-1 and synaptophysin) in hippocampal and retinal nerve terminals. Changes were more pronounced and persistent in hippocampal nerve terminals. In general, the alterations in retina occurred earlier, but were transitory, with the exception of synapsin-1, since its content decreased at all time points studied. The content of synaptotagmin-1 and rabphilin 3a in nerve terminals of both tissues was not affected. In total extracts, no changes were detected in the retina, whereas in hippocampus SNAP-25 and syntaxin-1 content was decreased, particularly when more drastic changes were also detected in nerve terminals. These results show that diabetes affects the content of several exocytotic proteins in hippocampus and retina, mainly at the presynaptic level, but hippocampus appears to be more severely affected. These changes might influence neurotransmission in both tissues and may underlie, at least partially, previously detected physiological changes in diabetic humans and animal models. Since diabetes differentially affects exocytotic proteins, according to tissue and insult duration, functional studies will be required to assess the physiological impairment induced by diabetes on the exocytosis in central synapses.

Factors influencing Salmonella carcass prevalence in Danish pig abattoirs.

The Danish Salmonella Surveillance-and-Control Programme in finisher pigs includes both herd and carcass surveillance. Herd surveillance consists of serological testing of meat-juice samples and classification of herds into three Salmonella seroprevalence levels. At the abattoirs, carcass swabs from five pigs are collected daily and analysed as a pooled sample to evaluate the Salmonella carcass prevalence. This study aimed to investigate factors associated with Salmonella carcass prevalence in Denmark. A total of 20,196 pooled carcass swabs collected in 23 Danish abattoirs were included in the analysis. A multilevel logistic regression model was used taking into account the two-level data structure (abattoir, carcass pool) and adjusting the parameter estimates to the random variation at the abattoir level. Study results indicated that carcass contamination was mainly influenced by the probability that at least one pig contributing to the pool was seropositive, the log-transformed number of seropositive pigs delivered to the abattoir on the same day and weekday. No other factors were found to be significant (P>0.05). Large reductions in the number of seropositive pigs delivered to slaughter are unlikely to result in large reductions of the Salmonella carcass prevalence, unless the number of seropositive pigs can be kept below approximately 200. On average, individual Salmonella carcass prevalence can be kept below 1% by keeping a Salmonella input to the abattoir below approximately 50 seropositive pigs. Variation between abattoirs suggested that improved hygiene practices in some of the abattoirs would reduce the Salmonella carcass prevalence further.

Factors affecting persistence of high Salmonella serology in Danish pig herds.

In 1995, Denmark implemented a National Surveillance-and-Control Programme for Salmonella in finisher pigs. It was based on serological surveillance that enabled assignment of pig herds into three prevalence levels. Herds in levels 2 and 3 (corresponding to moderate and high Salmonella seroprevalence) were subjected to control measures, compulsory pen faecal sampling for bacteriological examination and serotyping. The initial dataset contained all herds that had mandatory bacteriological samples taken (N=3691 samples), out of which 44.4% were negative. Data from January 2005 to November 2007 obtained from the Danish programme were used to investigate the persistence of high serology (Salmonella index > or =40, corresponding to levels 2 or 3) for herds infected with one of the four most common Salmonella serotypes found in pig herds, S. Typhimurium, S. Derby, S. Infantis or S. Livingstone, using survival analysis. The effects of other potential factors, such as season, year, herd size and herd health status were also evaluated. An event was defined as return to low serology measured by a Salmonella index <40, for at least 6 consecutive months. A total of 1242 pig herds positive for one of the four serotypes of interest and 1433 events were included in the preliminary analysis using the Kaplan-Meyer method. The median high serology time (survival time) was 8 months and all explanatory variables were found to be significant (p<0.05), except the herd health status (p=0.49). Cox proportional hazards regression was used for herds infected with S. Typhimurium (N=1066) or S. Derby (N=314). Herds infected with S. Typhimurium presented a lower probability for returning to low serology (HR=0.69, p<0.001), compared to S. Derby, indicating longer high serology periods. Herds that started having high seroprevalence in Summer and Fall had a higher probability of returning to low serology compared to those starting in Winter and Spring (p<0.001). Compared to 2005, periods with high Salmonella serology were fewer and shorter in 2006 and 2007 (p<0.001). A positive impact of herd size was found, with larger herds being associated with shorter high serology periods, compared to smaller herds (p=0.012). This might indicate effective implementation of biosecurity measures in large herds. The health status of the herds was not found to be a significant factor (p=0.87), which might reflect that biosecurity measures in place in SPF herds are not effective for clearing Salmonella infections.

Weekly training hours are associated with molecular and cellular body composition levels in adolescent athletes.

AIM: We aimed to explore associations between hours per week of sports training and molecular and cellular body composition components in adolescent athletes. METHODS: A total of 33 female athletes (13.3+/-3.5 years; 47.8+/-12.6 kg; 154+/-14.0 cm) and 90 male athletes (14.1+/-2.7 years; 60.6+/-17.8 kg; 167+/-16.2 cm) were measured. Based on the total of hours per week of training, athletes were divided into tertiles: <4.5 h/week; 4.5-8.9 h/week; 9 h/week. Dual-energy X-ray absorptiometry (DXA) was used to assess lean mass (lean), body fat (BF), percent body fat (%BF), bone mineral content (BMC) and density (BMD). Total body water (TBW), intracellular (ICW) and extracellular water (ECW) were assessed using bioelectrical impedance spectroscopy (BIS). Extracellular fluids (ECF), solids (ECS), body cell mass (BCM) and body fluid distribution (E/I) were calculated. Total hours per week of sports training (h/week), habitual physical activity (PA) and dietary were assessed by questionnaire. Statistics included analysis of covariance (ANCOVA) and simple regression analyses. RESULTS: Athletes training 9 h/week presented greater levels of TBW, lean, bone mass, BCM, and ECF and a lower %BF, independently of confounders. No significant differences in body composition estimates were found between athletes training <9 h/week. Hours per week of sports training were positively associated with fat free components, only in the group exercising 9 h/week CONCLUSIONS: In this group of Portuguese athletes from different sports we observed that training 9 h/week significantly improved body composition, especially fat free components, which may be important for a healthy growth and sports performance.

Manejo de la insuficiencia respiratoria aguda con ventilación mecánica no invasiva en urgencias y emergencias / Management of acute respiratory failure with non invasive ventilation in the emergency department

La ventilación mecánica no invasiva (VMNI) es un instrumento terapéutico que puesto en manos del urgenciólogo como apoyo inicial al paciente con insuficiencia respiratoria aguda (IRA) puede marcar de forma definitiva la evolución de ese cuadro clínico. Múltiples ventajas que avalan la VMNI frente a las formas invasivas de ventilación: preserva mecanismos como la tos, permiten al paciente hablar o alimentarse, sin invadir la vía aérea y evita las complicaciones que ello comporta. En los últimos años han aparecido multitud de estudios que apoyan su aplicación precoz en pacientes adecuadamente seleccionados. Tras los documentos de consenso de 2001 de la American Thoracic Society, y en 2002 de la British Thoracic Society en que consideraban la VMNI como un elemento más en el manejo inicial de la IRA, tanto hipoxémica como hipercápnica, en sus diferentes modos ventilatorios, cada vez se encuentra más extendido su uso en los servicios de urgencias hospitalarios, en los equipos de emergencias, así como su aplicación domiciliaria en pacientes crónicos. En un futuro inmediato el reto es la formación de los profesionales que integran los equipos asistenciales de urgencias y emergencias, adiestrándolos en manejo de la IRA y sus bases fisiopatológicas, sin dejara un lado el desarrollo y consolidación de la cadena asistencial en ventilación no invasiva, mediante el establecimiento de documentos de consenso interservicios (AU)

Non invasive ventilation (NIV) offers the emergency physician a way to provide initial support for the patient with acute respiratory failure. Application of NIV in emergency care settings can have a decisive effect on clinical course. Clear advantages that conclusively support the use of NIV over invasive mechanical ventilation include the preservation of the cough reflex and the patient’s ability to talk and eat; further more, NIV avoids invasion of the airway, with all the associated complications that implies. Recent years have seen the publication of many studies whose results encourage the early application of NIV in appropriately selected patients. Following the appearance of the consensus statements of the American Thoracic Society in 2001 and the British Thoracic Society in 2002, in which various modes of NIV were included in the therapeutic arsenal for managing either hypoxemic or hypercapnic acute respiratory failure, NIV use has spread in hospital emergency and ambulance services. Likewise, it is being used increasingly for home treatment of patients with chronic respiratory failure. In the immediate future, the challenge will be to train emergency department staff, to equip them with essential pathophysiologic concepts and the skills formanaging acute respiratory failure, while preserving the chain of care by creating consensus on protocols to governinter departmental responsibilities (AU)

Recomendaciones de buena práctica clínica: atención inicial al paciente politraumatizado / Good clinical practice recomendations: Initial care to the polytraumatized patient

El manejo inicial del paciente politraumatizado implica el conocimiento y puesta en práctica de una metodología sistemática de valoración y tratamiento, con el fin de lograr dos objetivos principales: 1) La detección y solución inmediata de los procesos que pueden acabar con la vida del paciente en muy corto espacio de tiempo. 2) El desarrollo de una sistemática de evaluación pormenorizada que evite que alguna lesión pueda pasar desapercibida. Aceptando el método universal desarrollado por el Advanced Trauma Life Support (ATLS), el manejo del paciente debe consistir en 6 etapas claramente diferenciadas: - Valoración primaria y resucitación. - Valoración secundaria. - Categorización y triage. - Derivación y transporte. - Reevaluación continua. - Cuidados definitivos. La revisión constante de las recomendaciones en la atención al politraumatizado, así como de esta metodología, en función de la evidencia existente, será la única manera válida de mantener la excelencia clínica necesaria para el adecuado abordaje de un tipo de paciente tan complicado como este (AU)

The initial management of the polytraumatized patient involves knowledge and establishment of a systematic methodology of evaluation and treatment in order to achieve two principal objectives: 1) Detection and immediate solution of the processes that are life-threatening to the patient in a very short time period. 2) Development of a detailed evaluation systematic analysis that will avoid any lesion from going undetected. Accepting the universal method developed by the Advanced Trauma Life Support (ATLS), the management of the patient should consist in six clearly defined stages: - Primary survey and resuscitation. - Secondary survey. - Categorization and Triage. - Referral and Transfer. - Continuous re-evaluation. - Definitive cares. The continuous review of the recommendations in care for polytraumatized patients and of this methodology based on the existing evidence will be the only valid way to maintain the necessary clinical excellence for adequate approach of a typology of such as complicated patient as this one (AU)

Manejo de una vía aérea difícil en el medio prehospitalario / No disponible

El manejo óptimo de la vía aérea y ventilación de pacientes críticos sigue siendo un pilar básico en la supervivencia, evolución y pronóstico; la intubación orotraqueal (IOT) es el gold standard en estas situaciones. Conocer la posición, lasmaniobras y el material “facilitador” de la IOT, así como realizar una oxigenación-ventilación previa y una sedorrelajación adecuadas, aumentará de forma significativa las posibilidades de éxito.Hay ocasiones en las que, aun siendo ortodoxos en la realización de la técnica, no conseguimos el fin deseado (no intubación, no ventilación), definiéndose tal situación como vía aérea difícil (VAD). Los médicos y enfermeros de Atención Primaria deben estar preparados ante tal eventualidad y disponer del material y la formación necesarios para hacer frente a este momento crítico en el manejo de pacientes graves.Basándonos en las directrices y guía clínicas de las principales sociedades científicas en el manejo de la vía aérea (Grupo Español para el Manejo de la Vía Aérea [GEMVA], Sociedad Americana de Anestesiología [ASA] y el Colegio Americano de Cirujanos), presentamos una revisión de las alternativas recomendadas, centrándonos en una somera descripción del material y una más amplia exposición de la técnica

Optimum management of the airway and ventilation incritical patients continues to be a basic cornerstone in survival, evolution and prognosis. orotracheal intubation (OTI) is the “gold standard” in these situations. Knowing the position, maneuvers and material that “facilitate” the OTI and how to perform previous adequate oxygen-ventilation and sedoanalgesia will significantly increase the possibilities ofsuccess.There are times when, although being orthodox in thetechnique performance, we do not achieve the desired purpose (no intubation, no ventilation), defining such a situation as difficult airway (DAW). Primary Health Care physicians and nurses should be prepared for this and have the necessary material and training to face this critical moment in the management of severe patients.Taking the clinical guidelines of the principal scientific societies into account in the management of the airway (Spanish Group for the Management of the Airway [GEMVA], American Society of Anesthesiology [ASA], and the American College of Surgeons), we present a review of the alternatives recommended, focusing on a brief description of the material and a more extensive presentation of the technique