La selección de atletas élite desde edad temprana: reflexión desde la perspectiva de los sistemas complejos / A seleção de atletas de elite desde cedo: reflexão a partir da perspectiva de sistemas complexos / The selection of elite athletes from an early age: reflection from the perspective of complex systems

RESUMEN Introducción: En este estudio, se examinó la idoneidad de seleccionar atletas élite desde una edad temprana. Objetivo: El objetivo de este estudio consistió en verificar si el comportamiento identificado en investigaciones antecedentes también ocurre entre los mejores atletas mundiales de todos los tiempos que compiten en la carrera de 100 metros. Materiales y métodos: Para ello, y con base en un análisis de las clasificaciones oficiales de todos los tiempos masculinos y femeninos de la Asociación Internacional de Federaciones de atletismo en la referida prueba, se utilizó muestras en categoría absoluta (Top-1,000 hasta el 31/12/2018) y categoría sub-20 (Top-100 hasta el 31/12/2003); se aplicaron leyes de potencia y otras estrategias típicas de los sistemas complejos para analizar los datos. Resultados: los resultados muestran cómo, con demasiada frecuencia, los mejores corredores masculinos y femeninos del mundo en la categoría sub-20 no evolucionan positivamente durante el resto de su carrera deportiva mejorando sus registros en las categorías superiores. Solo 51 hombres de los 100 mejores corredores sub-20 de todos los tiempos, lograron mejorar sus registros una vez que alcanzaron la categoría sénior, y las mejoras no presentaron siempre progresiones estadísticamente significativas. En consecuencia, una inversión excesiva en recursos humanos y materiales para identificar individuos con altas capacidades atléticas, no es siempre la mejor estrategia. Conclusiones: el deporte de nivel a edades tempranas puede ser un error metodológico que debe evitarse a la hora de construir las reservas deportivas de un país o federación deportiva.

RESUMO Introdução: Neste estudo, examinou-se a adequação da seleção de atletas de elite desde tenra idade. Objetivo: O objetivo deste estudo foi verificar se o comportamento identificado em pesquisas anteriores também ocorre entre os melhores atletas do mundo de todos os tempos que competem na prova de 100 metros. Materiais e métodos: Para isso, e com base na análise das classificações oficiais de todos os tempos para homens e mulheres da Associação Internacional de Federações de Atletismo na prova supracitada, foram utilizadas amostras em categoria absoluta (Top-1.000 até 31/12 /2018) e sub-20 (Top-100 até 31/12/2003); Leis de potência e outras estratégias típicas de sistemas complexos foram aplicadas para analisar os dados. Resultados: Os resultados mostram como, muitas vezes, os melhores corredores masculinos e femininos do mundo na categoria sub-20 não evoluem positivamente durante o resto de sua carreira esportiva, melhorando seus registros nas categorias superiores. Apenas 51 homens dos 100 melhores corredores sub-20 de todos os tempos conseguiram melhorar seus tempos quando chegaram à categoria sênior, e as melhorias nem sempre mostraram progressões estatisticamente significativas. Consequentemente, um investimento excessivo em recursos humanos e materiais para identificar indivíduos com altas habilidades atléticas nem sempre é a melhor estratégia. Conclusões: o esporte de nível em idade precoce pode ser um erro metodológico que deve ser evitado na construção das reservas esportivas de um país ou federação esportiva.

ABSTRACT Introduction: In this study, the suitability of selecting elite athletes from an early age was examined. Objective: The objective of this study was to verify if the behavior identified in previous research also occurs among the world's best athletes of all time who compete in the 100-meter race. Materials and methods: For this, and based on an analysis of the official classifications of all times for men and women of the International Association of Athletics Federations in the referred test, samples were used in absolute category (Top-1,000 up to the 12/31/2018) and sub -20 category (Top - 100 until 12/31/2003); power laws and other strategies typical of complex systems will be applied to analyze the data. Results: The results show how, all too often, the best male and female runners in the world in the under-20 category do not evolve positively during the rest of their sports career. improving their records in the higher categories. Only 51 men out of the top 100 U-20 runners of all time managed to improve their times once they reached the senior category, and the improvements did not always show statistically significant progressions. Consequently, an excessive investment in human and material resources to identify individuals with high athletic abilities is not always the best strategy. Conclusions: level sport at an early age can be a methodological error that should be avoided when building the sports reserves of a country or sports federation.

The Canabrava Ring, an open ring-shaped pupil expander for cataract surgery associated with iris colobomata: a case report / Aplicação de anel expansor de pupila pequena em formato de anel aberto para cirurgia de catarata em coloboma de íris: relato de caso

ABSTRACT In this report, we describe a new pupil expander device that was used to obtain adequate pupil dilation and centering in a patient with an iris coloboma. Specifically, we describe the case of a patient with an iris coloboma; a Malyugin ring was inserted to facilitate dilation during phacoemulsifi­cation surgery. One of the scrolls did not engage which resulted in an uneven distribution of forces and an eccentric pupil. A Canabrava Ring was then implanted that promoted effective pupillary dilation and remained stable and effective throughout the surgical procedure.

RESUMO Neste relato, descrevemos um novo dispositivo expansor pupilar que foi usado obter adequada dilatação e centralização da pupila em um paciente com coloboma de íris. Especificamente, descrevemos um caso de cirurgia de facoemulsificação em um paciente com coloboma de íris associado à pupila pequena e que, previamente, tentou-se sem sucesso o uso do expansor Malyugin Ring, que provocou uma dilatação pupilar descentrada. Entretanto, com o uso do expansor de íris Canabrava Ring, a pupila permaneceu dilatada e centrada durante toda a cirurgia, permitindo a realização de um procedimento seguro.

Cuerpos extraños radiopacos con doble contorno en la vía digestiva: ¿son siempre pilas de botón? / Are strange radiopaque bodies with double contours in the digestive tract always button cell batteries?

Resumen La ingesta accidental de cuerpos extraños constituye una emergencia en los servicios de atención pediátrica y el grupo más frecuentemente afectado se encuentra en los pacientes entre los 6 meses y los 3 años. Asimismo, la ingesta de pilas de botón es un factor de riesgo importante para el desarrollo de complicaciones tempranas severas como la perforación esofágica y mediastinitis, y a largo plazo, la aparición de estenosis. Por este motivo, su identificación temprana y la extracción constituyen las estrategias más importantes de manejo. Se ha descrito como característico el hallazgo del doble contorno en la radiografía frontal cérvico-toracoabdominal en estos pacientes. Sin embargo, se ha reportado el mismo signo radiológico en cuerpos extraños diferentes. En el presente artículo se presentan dos casos con estas características.

Abstract Accidental ingestion of foreign bodies constitutes an emergency for pediatric care services especially since the group most frequently affected consists of children between 6 months and 3 years of age. Ingestion of button cell batteries has high risks for severe early complications such as esophageal perforations and mediastinitis, as well as the long term risk of stenosis. Early identification and extraction are the most important management strategies. A double contour on a frontal cervical, thoracic, or abdominal x-ray is characteristic, but this same radiological sign has been reported for other foreign bodies. We present two cases with these characteristics.

Enfrentamiento de la ingesta de cuerpo extraño en un Hospital Regional del sur de Chile / Management of foreign body ingestion at a Regional Hospital in southern Chile

Introducción: La ingesta de cuerpos extraños (ICE) es frecuente en pediatría y puede llevar a complicaciones. Nuestro objetivo es revisar la experiencia de nuestro centro en el manejo de estos pacientes y proponer un protocolo de tratamiento. Material y Método: Estudio transversal retrospectivo, observacional y descriptivo, en el cual se revisaron los informes endoscópicos y fichas de pacientes con diagnóstico de ICE manejados por la Unidad de Endoscopia Pediátrica del Hospital Clínico Regional de Concepción entre enero de 2013 y junio de 2017 (53 meses), totalizando 40 casos. El registro y análisis de los datos se realizó con Microsoft® Excel 2016® para MacOS®. Resultados: El promedio de edad fue de 3,96 ± 3,24 años. La moda estadística fue de 2 años. A todos los pacientes se les realizó una endoscopia digestiva alta. El CE más frecuente fue la moneda (61,9%). En 6 casos (14,2%) fue una pila de botón. La retención de CE fue en tercio proximal del esófago (30,9%), el cuerpo gástrico (26,2%) y el tercio distal del esófago (14,2%), extrayéndose principalmente con pinza de cuerpo extraño (90,4%). El 57,5% evidenció alguna lesión relacionada a la ubicación del CE, siendo la más grave la producida por pila de botón. Conclusión: La ICE en niños es una entidad potencialmente peligrosa, por lo que se hace necesario disponer de una unidad de endoscopia pediátrica y protocolos de manejo para evitar complicaciones, sobre todo con objetos de alto riesgo.

Introduction: Foreign body ingestion (FBI) is common in pediatrics and can lead to complications. The aim of the present study is to review the experience of our center in the management of these patients and to propose a treatment protocol. Material and Method: Retrospective, observational and descriptive cross-sectional study, in which the endoscopic reports and records of patients diagnosed with IFB managed by the Pediatric Endoscopy Unit of the Regional Clinical Hospital of Concepción between January 2013 and June 2017 (53 months) were reviewed, with a total of 40 cases. Data recording and analysis was performed with Microsoft® Excel 2016® for MacOS®. Results: The average age was 3,96 ± 3,24 years. The statistical fashion was 2 years. All patients underwent a upper gastrointestinal endoscopy. The most frequent FB was the coin (61,9%). In 6 opportunities (14,2%) was a button batery. FB retention was in the proximal third of the esophagus (30,9%), the gastric body (26,2%) and the distal third of the esophagus (14,2%), being extracted mainly with foreign body clamp (90,4%). The 57,5% showed some injury related to the location of the FB, being the most serious the produced by button batery. Conclusion: FBI in children is a potentially dangerous entity, so it becomes necessary to have a pediatric endoscopy unit and treatment protocols to avoid complications, especially with high-risk objects.

Artyfechinostomum malayanum: Metacercariae Encysted in Pila sp. Snails Purchased from Phnom Penh, Cambodia

The metacercariae of Artyfechinostomum malayanum (Leiper, 1911) Mendheim, 1943 were discovered in Pila sp. snails purchased from a market in Phnom Penh, Cambodia. They were isolated from the snails using the artificial digestion technique and were orally fed to 2 hamsters, 1 rat, and 2 mice to obtain the adult flukes. The metacercariae were round, 145–165 μm in diameter, having a cyst wall of 6–10 μm in thickness, a head collar and collar spines, and characteristic features of excretory granules. Adult flukes were recovered in the small intestines of the animals at days 14 and 32 post infection and were morphologically observed using a light microscope and a scanning electron microscope. They were plump or elongated, ventrally curved, 6.0–8.1×1.6–2.0 mm in size, and characterized by the head collar bearing 43 collar spines, including 5 end group ones on each side, a long cirrus sac extending beyond the posterior margin of the ventral sucker, a submedian ovary, and 2 deeply lobed testes. Eggs in uteri were operculate, ovoid to ellipsoid, and 120–135×68–75 μm in size. In scanning electron microscopy, the head collar was prominent with collar spines looking like horns. Scale-like tegumental spines were densely distributed on the ventral surface between the head collar and ventral sucker. Sensory papillae were distributed mainly on the tegument around suckers. By this study, it has been first confirmed that the life cycle of A. malayanum exists in Cambodia.

Induction of human MCF-7 breast cancer cell apoptosis by Inonotus obliquus and study on its mechanism / 中草药

Objective: To study the induction of human MCF-7 breast cancer cell apoptosis by inotodiol isolated from Inonotus obliquus, a traditional Chinese medicinal fungi. Methods: Inotodiol was isolated from the crude ethanol extract of I. obliquus and purified. Inotodiol at different concentration and human breast cancer MCF-7 cell line were co-incubated. Relative cell viabilities were determined by MTT method; apoptosis was analyzed by Annexin V/PI dual staining with flow cytometry; The protein expression levels of Caspase-3 and Poly ADP ribose polymerase (PARP) were detected by Western blotting. Results: Inotodiol reduced the viability of MCF-7 cells dose-and time-dependently. Moreover, inotodiol induced the apoptosis in MCF-7 cells. The data of Western blotting showed that inotodiol up-regulated the expression levels of cleaved Caspase-3 and PARP, in a time-dependent manner. Conclusion: Inotodiol could induce apoptosis in human breast cancer cells, which provides novel information for clinical application of inotodiol and its preparations for the breast cancer patients.

Triterpenoids of Inonotus obliquus / 中草药

Objective: To study the triterpenoids from the fruiting body of Inonotus obliquus. Methods: The compounds were isolated and purified by silica gel, MCI gel, Sephadex LH-20 column chromatographies, and their structures were mainly elucidated on the basis of physicochemical characteristics and spectral analysis. Results: Fifteen compounds were isolated from 95% EtOH extract of I. obliquus, and were identified as 3-oxo-lanosta-8, 24-diene-21-al (1), lanosterol (2), 3β-hydroxy-lanosta-8, 24-diene-21-al (3), betulin (4), inotodiol (5), trametenolic acid (6), 3β, 21-dihydroxy-lanosta-8, 24-diene (7), oleanic acid (8), ursolic acid (9), betulinic acid (10), inonotusane A (11), inoterpene D (12), 3-O-acetyl-11α, 12α-epoxy-oleanan-28, 13β-olide (13), ergosterol (14), and ergosta-4, 6, 8, 22-tetraene-3-one (15), respectively. Conclusion: Compound 1 is a new triterpenoid named as inonotusane D, while compounds 9, 13, and 15 are isolated from I. obliquus for the first time.

Cuerpos extraños en el esófago en los niños: Serie de casos / Foreign bodies in esophagus in children: Case series

La ingestión de cuerpos extraños es un accidente evitable que se observa principalmente en niños menores de 3 años. La mayoría de ellos atraviesan el tubo digestivo sin ocasionar manifestaciones clínicas ni complicaciones; sin embargo, un porcentaje significativo se impacta en el esófago y causa vómitos, odinofagia, disfagia y sialorrea. Los cuerpos extraños más frecuentes son las monedas. Las complicaciones ocurren por lo general cuando se demora el diagnóstico o se trata de objetos grandes, afilados o potencialmente tóxicos, como la pila botón. Es fundamental realizar el diagnóstico diferencial entre una moneda y una pila botón, ya que esta última requiere su extracción urgente debido a la precocidad de las lesiones que produce. Se describen 115 casos de cuerpos extraños en el esófago. Se subraya la importancia de realizar un diagnóstico y tratamiento oportunos, así como de asesorar a los padres para la prevención.

Ingestion of foreign bodies is an avoidable accident that is seen mainly in children under 3 years-old. Most of them pass through the digestive tract without causing clinical manifestations or complications, but a significant percentage is impacted in the esophagus causing vomiting, sore throat, dysphagia and drooling. The most common foreign bodies are coins. Complications usually occur when there is a delay in diagnosis or with large, sharp or potentially toxic objects, as the button battery. It is essential to make differential diagnosis between coin and button battery, since the latter requires urgent removal due to the earliness of the injury caused. We report 115 cases of foreign bodies in the esophagus, and we alert the pediatrician in recognizing and preventing this problem.

Cuerpos extraños (CE) en el tracto digestivo / Foreign bodies in the digestive tract

Foreign bodies can be of organic or inorganic nature. Ten to 20 percent of the foreign bodies occurring in the digestive tract require an endoscopic procedure. Public health reports identify the pediatric population, no sex-based prevalence, as the one with the highest risk. In adults, these typically correspond to men swallowing fish bones or dental prostheses. The elderly mainly swallow dental prostheses and also they are individuals with clinical pathologies. The increased risk of suspicion is relevant for diagnostic in children, because 40 percent of them swallow the foreign body on absence of adults and seem asymptomatic. Progress of the symptoms and physical examination are the base for clinical diagnostic. The locations where the foreign bodies may impact the esophagus, stomach and small intestine, are know, as well as the associated pathologies. Sixty percent of the foreign bodies are radiopaque; simple X-ray in two views (AP and lateral) is the main tool for diagnosis. Forty percent of the foreign bodies are radiolucid; the most effective tool for identification is endoscopy. Therapy, whether observation and clinical surveillance, endoscopic or surgical extraction, will depend on the type, size and shape of the foreign body, its location, time since swallowed, toxicity, capability of producing electricity or causing mechanical damage, the quantity and if it was swallowed together with other foreign bodies (batteries/magnet), radiotransparency, and the patient’s age and associated pathologies. Complications are acute obstruction, perforation, fistula and digestive hemorrhage.

Los cuerpos extraños pueden ser de naturaleza orgánica o inorgánica. El 10 a 20 por ciento de los cuerpos extraños que ingresan al tracto digestivo requieren algún procedimiento endoscópico. Informes de salud pública definen a la población pediátrica, sin prevalencia de sexo, como la de mayor riesgo. En adultos clásicamente corresponden a hombres que ingieren espinas de pescado o prótesis dentarias. Los ancianos, ingieren prótesis dentarias y son individuos con alguna patología médica. El alto índice de sospecha es relevante en la determinación del diagnóstico en niños, ya que el 40 por ciento de ellos, los ingieren en ausencia de adultos y están asintomáticos. La evaluación de la sintomatología y el examen físico son la base para el diagnóstico clínico. Son conocidos los segmentos del tracto digestivo y las patologías asociadas al lugar en que normalmente se impactan los cuerpos extraños en el esófago, estómago e intestino delgado. El 60 por ciento de los cuerpos extraños son de tipo radiopaco; la radiografía simple en dos proyecciones (AP y lateral) es la principal herramienta diagnóstica. El 40 por ciento de los cuerpos extraños es radiolúcido; la herramienta más eficiente para su identificación es la endoscopia. La conducta terapéutica, sea esta la observación y control clínico, la extracción por endoscopia o la cirugía, dependerá del tipo de cuerpo extraño, de su tamaño, forma, localización, tiempo post-ingesta, toxicidad, capacidad para generar electricidad o daño mecánico, su número o co-ingesta con otros cuerpos extraños (pilas e imanes), radiotransparencia, y la edad del paciente y sus patologías asociadas. Sus complicaciones son la obstrucción aguda, la perforación, la fistulización y la hemorragia digestiva.

¿Qué tan urgente es extraer una pila de disco alojada en el esófago? / How urgent is the extraction of a button disk battery located into the esophagus?

Introducción. La ingestión de cuerpo extraño (CE) es frecuente observarla en la consulta pediátrica; aunque el mayor porcentaje son monedas, la ingestión de pilas de disco o botón son un problema serio. Objetivos: conocer las principales lesiones esofágicas ocasionadas por la ingesta de pilas de disco (IPD), así como la respuesta al manejo y su evolución. Métodos. En un estudio retrospectivo, donde se revisaron los expedientes de pacientes con diagnóstico de IPD de diciembre 1996 a 2007, se analizó: sexo, edad, síntomas, tiempo de evolución, hallazgos radiológicos y endoscópicos, manejo, complicaciones y secuelas. Resultados. Se encontraron 21 casos de IPD; predominó el sexo masculino en relación 4:1, con edades de 3 meses a 12 años. El síntoma principal fue sialorrea. El tiempo de evolución fue en promedio de 39.6 horas. En 14 pacientes la extracción del CE se realizó con laringoscopio tipo Jackson, con esofagoscopio rígido en 2 y con panendoscopio en 4, y en 1 se utilizó red de recuperación de Roth. La mayoría de los CE estaban alojados en el tercio superior de esófago. A la endoscopia se encontraron úlceras en 8 pacientes, necrosis en 6, úlcera y necrosis en 1, perforación parcial en 1, perforación con fístula traqueoesofágica en 2, y en 3 pacientes no hubo evidencia de lesión. Sólo 5 pacientes evolucionaron a estenosis esofágica, que se resolvió con dilataciones. Dos pacientes con perforación y fístula traqueoesofágica recibieron manejo quirúrgico, falleciendo uno de ellos. Otro paciente con perforación solicitó alta voluntaria. Conclusiones. La IPD es cada vez más frecuente, su extracción en el esófago debe ser urgente para evitar complicaciones graves como la estenosis y fístula traqueoesofágica.

Introduction. Foreign body ingestion is a common cause of consultation in the pediatric practice. Even though the most frequent ingested objects are coins, the button disk batteries are becoming a serious problem. Objectives: To describe the main esophageal lesions caused by the ingestion of button disk batteries, their response to treatment and clinical evolution. Methods. Files from patients admitted to our hospital with diagnosis of button disk battery ingestion between December 1996 to December 2007 were reviewed. We analyzed sex, age, symptoms, evolution time, radiological and endoscopical findings, management, complications and long term sequels. Results. We found 21 cases, male preponderance 4:1, age rank from 3 months to 12 years. Sialorrhea was the main symptom. Average time to treatment was 39.6 hours. Battery removal was accomplished with direct esophagoscopy using Jackson laryngoscope in 14 patients, rigid esophagoscope in 2 patients, and flexible esophagoscopy in 4. In most of the cases the battery was lodged in the proximal third of the esophagus. At endoscopic exploration, esophageal ulcers were found in 8 patients, necrosis in 6, ulcers and necrosis in 1, partial perforation in 1, perforation with traqueoesophageal fistula in 2, and no injury in 3 patients. Only 5 patients evolved to esophageal stenosis that resolved with dilatations. Two patients with perforation and traqueoesophageal fistula underwent surgical treatment, one of them died. Another patient with perforation was lost to follow up because of voluntary discharge. Conclusions. Button disk battery ingestion is becoming a more frequent event; removal from the esophagus should be an urgent procedure to avoid severe complications such as stenosis and traqueoesophageal fistula.