Helicopter Air Transport of a Patient Using High Flow Nasal Cannula: A Case Report.

The classic out-of-hospital approach to a patient with severe acute respiratory failure involves both orotracheal intubation and invasive mechanical ventilation. The use of non-invasive methods for respiratory support has been shown to be beneficial in managing both acute and chronic respiratory failure. However, its use had not been previously considered for air medical transport due to concerns related to airway safety during flight, limited oxygen availability, and limited experience in this setting. We describe the successful inter-hospital helicopter transport of a patient with end-stage lung disease to a transplantation unit while utilizing a high-flow oxygen cannula, which was performed without significant complications. Our successful case report raises the possibility that high-flow nasal cannulas may be safely employed in the management of respiratory failure in specific patient populations during air medical transport.

Out-of-hospital cardiac arrest in the Algarve region of Portugal: a retrospective registry trial with outcome data.

BACKGROUND AND IMPORTANCE: Out-of-hospital cardiac arrest is a leading cause of death in Europe. An understanding of region-specific factors is essential for informing strategies to improve survival. DESIGN: This retrospective observational study included all out-of-hospital cardiac arrest patients attended by the Emergency Medical Service of the Algarve in 2019. Outcome data were derived from hospital records. MAIN RESULTS: In 2019, there were 850 out-of-hospital cardiac arrests treated with cardiopulmonary resuscitation in the Algarve, representing a population incidence of 189/100 000. Return of spontaneous circulation occurred in 83 patients (9.8%), of whom 17 (2.0%) had survival to hospital discharge and 15 (1.8%) had survival with good neurologic outcome. Among patients in the Utstein comparator group, survival to hospital discharge was 21.4%. Predictors of return of spontaneous circulation were age, witnessed arrest, initial shockable rhythm, time of year, time to cardiopulmonary resuscitation, and time to advanced life support. Predictors of survival to hospital discharge were age, initial shockable rhythm, time to rhythm analysis, and time to advanced life support. Predictors of survival with good neurologic outcome were age, initial shockable rhythm, and time to return of spontaneous circulation. CONCLUSIONS: The incidence of out-of-hospital cardiac arrest with cardiopulmonary resuscitation in the Algarve was higher than in other jurisdictions while return of spontaneous circulation, survival to hospital discharge, and survival with good neurologic outcome were comparatively low. An aging population, a geographically diverse region, and a low incidence of bystander cardiopulmonary resuscitation may have contributed to these outcomes. These results confirm the importance of early cardiopulmonary resuscitation, early rhythm assessment, and early advanced life support, all of which are potentially modifiable through public education, broadening of the defibrillator network and increased availability of advanced life support teams.

A Neuroprotective Bovine Colostrum Attenuates Apoptosis in Dexamethasone-Treated MC3T3-E1 Osteoblastic Cells.

Glucocorticoid-induced osteoporosis (GIO) is one of the most common secondary forms of osteoporosis. GIO is partially due to the apoptosis of osteoblasts and osteocytes. In addition, high doses of dexamethasone (DEX), a synthetic glucocorticoid receptor agonist, induces neurodegeneration by initiating inflammatory processes leading to neural apoptosis. Here, a neuroprotective bovine colostrum against glucocorticoid-induced neuronal damage was investigated for its anti-apoptotic activity in glucocorticoid-treated MC3T3-E1 osteoblastic cells. A model of apoptotic osteoblastic cells was developed by exposing MC3T3-E1 cells to DEX (0-700 µM). Colostrum co-treated with DEX was executed at 0.1-5.0 mg/mL. Cell viability was measured for all treatment schedules. Caspase-3 activation was assessed to determine both osteoblast apoptosis under DEX exposure and its potential prevention by colostrum co-treatment. Glutathione reduced (GSH) was measured to determine whether DEX-mediated oxidative stress-driven apoptosis is alleviated by colostrum co-treatment. Western blot was performed to determine the levels of p-ERK1/2, Bcl-XL, Bax, and Hsp70 proteins upon DEX or DEX plus colostrum exposure. Colostrum prevented the decrease in cell viability and the increase in caspase-3 activation and oxidative stress caused by DEX exposure. Cells, upon colostrum co-treated with DEX, exhibited higher levels of p-ERK1/2 and lower levels of Bcl-XL, Bax, and Hsp70. Our data support the notion that colostrum may be able to reduce DEX-induced apoptosis possibly via the activation of the ERK pathway and modulation of the Hsp70 system. We provided preliminary evidence on how bovine colostrum, as a complex and multi-component dairy product, in addition to its neuroprotective action, may affect osteoblastic cell survival undergoing apoptosis.

Tratamento do sorriso gengival / Treatment of the gummy smile

Este estudo constitui-se de uma revisão da literatura referente às principaisopções de tratamento para a correção do sorriso gengival, baseado em sua etiologia. Aexposição de mais de 2 mm de gengiva durante o sorriso é denominada de sorriso gengivale sua etiologia está atribuida a vários fatores como: erupção passiva alterada, hiperfunçãodos músculos levantadores do lábio superior, excesso vertical da maxila ou uma combinaçãodestes. Por esta razão, é essencial desenvolver um diagnóstico diferencial, baseado emconhecimentos sobre altura facial, espaço interlabial em repouso, comprimento do incisivocentral superior, comprimento do lábio superior e quantidade de exposição da gengivaqueratinizada durante o sorriso, para definir o correto planejamento da correção do sorrisogengiva I. As alternativas de tratamento incluem ortodontia, cirurgia ortognática, aplicaçãode toxina botulínica, terapia periodontal ou cirúrgica, dependendo da etiologia do sorrisogengival. Para o sorriso gengiva I por erupção passiva alterada, o tratamento de escolha éa cirurgia plástica periodontal. Diante do diagnóstico de hiperfunção dos músculos levantadoresdo lábio superior, a opção de tratamento é a cirurgia de tecido mole ou a aplicaçãode toxina botulínica; para o tratamento de excesso vertical da maxila, o tratamento deescolha é ortodontia associada à cirurgia ortognática. No caso de etiologia combinada, otratamento inicial é a correção do comprimento dental (diante de erupção passiva alterada),com posterior correção da alteração esquelética ou de tecido mole.

This study consisted af a literature review an the major treatment aptians forcarrectian af gummy smile, based an its etialagy. Twamillimeters ar more af maxillary gingival expasure while full smiling can be treated as gummy smile. The etialagical factars includes altered passive eruptian, hyper functianal upper lip elevatar muscles, vertical maxillary excess,skeletal and dental, ar a cambinatian af any af these, which requires a differential diagnasis based an clinical knowledge af facial height, interlabial gap at rest, maxillary incisar height,upper lip length and amaunt af the marginal gingival during smiling, in arder to define themast appropriate treatment plan for correction af the gummy smile. Therapeutic options include orthodontics, orthognatic surgery, botulinum toxin, surgical ar periodontal therapy, depending an the causative agent af the gummy smile. The periodontal plastic surgery is the treatment af chaice for the gingival smile by altered passive eruptian. The surgery af sotttissue ar the application af batulinum taxin is indicated for the treatment for hyperactivity af upper lip elevatar muscles. For the treatment af vertical maxillary excess, the treatment of choice is assaciated with arthagnathic surgery. In case af combined etiology, the initialtreatment is the carrectian af taath length (if in the presence af altered passive eruptian)with subsequent correction af skeletal change ar soft tissue.

Jejunal Dieulafoy's lesion: case report and literature review.

Dieulafoy's lesions are rare and usually present in the stomach. There are only 18 cases of jejunal Dieulafoy's lesion reported. It can present as a massive gastrointestinal bleed and a high grade of suspicion is necessary for a quick and effective approach. The authors present the case of a 14-year-old adolescent with a sudden onset of hematochezia and shock. The high and low endoscopies as well as the arteriography were all inconclusive. An exploratory laparotomy was undertaken in the first 24 h of hospital admission. A review of the small bowel by advancing soft bowel clamps in a sequential manner revealed a bleeding lesion in the jejunum. The histological exam showed a Dieulafoy's lesion.

Influência do tratamento superficial da porcelana, do tipo de cimento resinoso e da termociclagem na resistência à traçäo da interface porcelana/dentina / Influence of porcelain surface treatment, type of resin cement and thermocycling on the tensile strength of the porcelain-dentin interface

O objetivo principal deste estudo foi avaliar o efeito do tratamento superficial da porcelana jateada com óxido de alumínio, seguido ou näo de condicionamento com ácido hidrofluorídrico (HF) ou de asperizaçäo com pontas diamantadas, quando da uniäo da porcelana à dentina por dois sistemas de cimentaçäo - Scotchbond Resin Cement (SB) e Panavia 21 (PN) - sendo o conjunto submetido à termociclagem (500 ciclos) e a forças de traçäo. Os resultados foram submetidos à análise estatística (ANOVA e Tukey), na qual se observou que o número de ciclos utilizado näo influenciou os resultados: o condicionamento com HF aumentou a resistência à traçäo das amostras para os dois cimentos, e o cimento SB revelou maior resistência média que o cimento PN, independentemente do tratamento térmico e do tratamento da porcelana aplicados. Portanto, conclui-se que os melhores resultados ocorreram com as amostras condicionadas com HF e cimentadas com SB