The Pivotal Role of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Hypertension Management and Cardiovascular and Renal Protection: A Critical Appraisal and Comparison of International Guidelines.

Arterial hypertension is the main preventable cause of premature mortality worldwide. Across Latin America, hypertension has an estimated prevalence of 25.5-52.5%, although many hypertensive patients remain untreated. Appropriate treatment, started early and continued for the remaining lifespan, significantly reduces the risk of complications and mortality. All international and most regional guidelines emphasize a central role for renin-angiotensin-aldosterone system inhibitors (RAASis) in antihypertensive treatment. The two main RAASi options are angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs). Although equivalent in terms of blood pressure reduction, ACEis are preferably recommended by some guidelines to manage other cardiovascular comorbidities, with ARBs considered as an alternative when ACEis are not tolerated. This review summarizes the differences between ACEis and ARBs and their place in the international guidelines. It provides a critical appraisal of the guidelines based on available evidence from randomized controlled trials (RCTs) and meta-analyses, especially considering that hypertensive patients in daily practice often have other comorbidities. The observed differences in cardiovascular and renal outcomes in RCTs may be attributed to the different mechanisms of action of ACEis and ARBs, including increased bradykinin levels, potentiated bradykinin response, and stimulated nitric oxide production with ACEis. It may therefore be appropriate to consider ACEis and ARBs as different antihypertensive drugs classes within the same RAASi group. Although guideline recommendations only differentiate between ACEis and ARBs in patients with cardiovascular comorbidities, clinical evidence suggests that ACEis provide benefits in many hypertensive patients, as well as those with other cardiovascular conditions.

Arabinoxylan-based substrate preferences and predicted metabolic properties of Bifidobacterium longum subspecies as a basis to design differential media.

Arabinoxylan (AX) and arabinoxylo-oligosaccharides (AXOS) derived therefrom are emergent prebiotics with promising health promoting properties, likely linked to its capacity to foster beneficial species in the human gut. Bifidobacteria appear to be one taxa that is frequently promoted following AX or AXOS consumption, and that is known to establish metabolic cross-feeding networks with other beneficial commensal species. Therefore, probiotic bifidobacteria with the capability to metabolize AX-derived prebiotics represent interesting candidates to develop novel probiotic and synbiotic combinations with AX-based prebiotics. In this work we have deepen into the metabolic capabilities of bifidobacteria related to AX and AXOS metabolization through a combination of in silico an in vitro tools. Both approaches revealed that Bifidobacterium longum and, particularly, B. longum subsp. longum, appears as the better equipped to metabolize complex AX substrates, although other related subspecies such as B. longum subsp. infantis, also hold some machinery related to AXOS metabolization. This correlates to the growth profiles exhibited by representative strains of both subspecies in AX or AXOS enriched media. Based on these results, we formulated a differential carbohydrate free medium (CFM) supplemented with a combination of AX and AXOS that enabled to recover a wide diversity of Bifidobacterium species from complex fecal samples, while allowing easy discrimination of AX metabolising strains by the appearance of a precipitation halo. This new media represent an appealing alternative to isolate novel probiotic bifidobacteria, rapidly discriminating their capacity to metabolize structurally complex AX-derived prebiotics. This can be convenient to assist formulation of novel functional foods and supplements, including bifidobacterial species with capacity to metabolize AX-derived prebiotic ingredients.

Clostridioides difficile: Characterization of the circulating toxinotypes in an Argentinean public hospital / Clostridioides difficile: caracterización de los toxinotipos circulantes en un hospital público de Argentina

Abstract Clostridioides difficile is a spore-forming anaerobe microorganism associated to nosocomial diarrhea. Its virulence is mainly associated with TcdA and TcdB toxins, encoded by their respective tcdA and tcdB genes. These genes are part of the pathogenicity locus (PaLoc). Our aim was to characterize relevant C. difficile toxinotypes circulating in the hospital setting. The tcdA and tcdB genes were amplified and digested with different restriction enzymes: EcoRI for tcdA; HincII and AccI for tcdB. In addition, the presence of the cdtB (binary toxin) gene, TcdA and TcdB toxins by dot blot and the cytotoxic effect of culture supernatants on Vero cells, were evaluated. Altogether, these studies revealed three different circulating toxinotypes according to Rupnik's classification: 0, I and VIII, being the latter the most prevalent one. Even though more studies are certainly necessary (e.g. sequencing analysis), it is worth noting that the occurrence of toxinotype I could be related to the introduction of bacteria from different geographical origins. The multivariate analysis conducted on the laboratory values of individuals infected with the most prevalent toxinotype (VIII) showed that the isolates associated with fatal outcomes (GCD13, GCD14 and GCD22) are located in regions of the biplots related to altered laboratory values at admission. In other patients, although laboratory values at admission were not correlated, levels of urea, creatinine and white blood cells were positively correlated after the infection was diagnosed. Our study reveals the circulation of different toxinotypes of C. difficile strains in this public hospital. The variety of toxinotypes can arise from pre-existing microorganisms as well as through the introduction of bacteria from other geographical regions. The existence of microorganisms with different pathogenic potential is relevant for the control, follow-up, and treatment of the infections.

Resumen Clostridioides difficile es un anaerobio esporulado que se asocia con episodios de diarreas hospitalarias. Su virulencia se encuentra vinculada, principalmente, a las toxinas TcdA y TcdB, codificadas por sus respectivos genes, tcdA y tcdB, que son parte de un locus de patogenicidad (PaLoc). Nuestro objetivo fue caracterizar los toxinotipos de C. difficile circulantes en un hospital público. Los genes tcdA y tcdB fueron amplificados y digeridos con diferentes enzimas de restricción: EcoRI para tcdA; HincII y AccI para tcdB. Además, se evaluó la presencia de cdtB (gen de la toxina binaria B) y de las toxinas A y B (por dot blot), así como el efecto citotóxico de sobrenadantes de cultivo sobre células Vero. En conjunto, estos estudios revelaron tres toxinotipos circulantes según la clasificación de Rupnik: 0, I y VIII; el más prevalente fue el último. Aunque son necesarios más estudios (ej., secuenciación), es interesante notar que la presencia del toxinotipo I podría estar relacionada con la introducción de bacterias de diferente origen geográfico. En los pacientes infectados con el toxinotipo VIII, el análisis multivariante de los resultados de laboratorio mostró que los aislamientos asociados a decesos (GCD13, GCD14 y GCD22) estaban situados en regiones de los biplots relacionados con valores de laboratorio alterados al momento de la internación. En los otros pacientes, aunque no se observó correlación entre los valores de laboratorio al momento de la internación y la evolución clínica, los niveles de urea, creatinina y recuento de glóbulos blancos estuvieron correlacionados positivamente entre sí una vez diagnosticada la infección. Nuestro estudio revela la circulación de diferentes toxinotipos de C. difficile en un mismo hospital público. La variedad de toxinotipos puede originarse a partir de microorganismos preexistentes en la región, así como también por la introducción de bacterias provenientes de otras regiones geográficas. La existencia de microorganismos con diferente potencial patogénico es relevante para el control, el seguimiento y el tratamiento de las infecciones.

Didactic platform for DC motor speed and position control in Z-plane.

This paper describes how to implement a low-cost didactic platform designed to teach or reinforce discrete control theory concepts. The controllers used in this work (P, PI, PD, and PID) are suitable for undergraduate students but the same platform could be used to explain and test advanced controllers to graduate students. This document shows, step by step, how to control a DC motor speed and position, along with the most common problems and its solutions, commonly overlooked in the literature. It also explains how to simulate the system behavior and compares the simulations with the real data, showing an average correlation coefficient of ρ=0.983.

SARS-CoV-2 infections and antibody responses among health care workers in a Spanish hospital after a month of follow-up

BackgroundAt the peak of the COVID-19 pandemic in Spain, cumulative prevalence of SARS-CoV-2 infection in a cohort of 578 randomly selected health care workers (HCW) from Hospital Clinic de Barcelona was 11.2%. MethodsA follow-up survey one month after the baseline (April-May 2020) measured SARS-CoV-2 infection by real time reverse-transcriptase polymerase chain reaction (rRT-PCR) and IgM, IgA, IgG and subclasses to the receptor-binding domain of the SARS-CoV-2 spike protein by Luminex. Prevalence of infection was defined by a positive SARS-CoV-2 rRT-PCR and/or antibody seropositivity. ResultsThe cumulative prevalence of infection at month 1 was 14.9% (84/565) and the seroprevalence 14.5% (82/565) for IgM and/or IgG and/or IgA. We found 25 (5%) new infections in participants without previous evidence of infection at baseline (501) and two participants seroreverted for IgM and/or IgG and/or IgA. Among seropositive participants at baseline, IgM and IgA levels generally declined at month 1 (antibody decay rates of 0.49 (95% CI, 0.40-0.60) and 0.34 (95% CI, 0.26-0.44)), respectively. Eight percent of the participants seroreverted for IgM and 11% for IgA. Subjects reporting COVID-19-like symptoms and laboratory and other technicians had higher risk of infection. The most frequent subclass responses were IgG1 and IgG2, followed by IgG3, with higher levels of IgG1, and only IgA1 but no IgA2 was detected. ConclusionsOur findings highlight the importance of a continuous and improved surveillance of SARS-CoV-2 infections in HCW, particularly in high risk groups. The decay of IgA and IgM levels have implications for seroprevalence studies using these isotypes.

Hydrolysis and transgalactosylation catalysed by ß-galactosidase from brush border membrane vesicles isolated from pig small intestine: A study using lactulose and its mixtures with lactose or galactose as substrates.

Enzymatic transgalactosylation, in different concentrated carbohydrate solutions, was investigated using brush border membrane vesicles (BBMV) from the pig small intestine. When lactulose was incubated with BBMV, the hydrolytic activity of the enzyme towards the disaccharide was observed to be very low compared to that towards the lactose, but the linkage specificity ß-(1 â†’ 3), previously observed in lactose solutions, was not significantly affected. As in the case of lactose, lactulose transgalactosylation by BBMV synthesizes the corresponding 3'-galactosyl derivative (ß-Gal-(1 â†’ 3)-ß-Gal-(1 â†’ 4)-ß-Fru). Fructose released during lactulose hydrolysis was found to be good acceptor for the transgalactosylation reaction, giving rise to the synthesis of the disaccharide ß-Gal-(1 â†’ 5)-Fru. When incubating an 80/20 mixture of lactulose/galactose, the presence of galactose did not affect the qualitative composition of the transglycosylated substrate but enhanced the synthesis of ß-Gal-(1 â†’ 5)-Fru and decreased the synthesis of ß-(1 â†’ 3) glycosidic bonds. The marked tendency for synthesizing this linkage indicates that under hydrolytic conditions, ß-Gal-(1 â†’ 3)-Gal- and ß-Gal-(1 â†’ 5)-Fru glycosidic bonds would be preferentially digested.

Unravelling the carbohydrate specificity of MelA from Lactobacillus plantarum WCFS1: An α-galactosidase displaying regioselective transgalactosylation.

This comprehensive work addresses, for the first time, the heterologous production, purification, biochemical characterization and carbohydrate specificity of MelA, a cold-active α-galactosidase belonging to the Glycoside Hydrolase family 36, from the probiotic organism Lactobacillus plantarum WCFS1. The hydrolytic activity of MelA α-galactosidase on a wide range of p-nitrophenyl glycoside derivatives and carbohydrates of different molecular-weights showed its high selectivity and efficiency towards the α(1 â†’ 6) glycosidic bonds involving the anomeric carbon of galactose and the C6-hydroxyl group of galactose or glucose units. MelA α-galactosidase also presented a high regioselectivity, efficiency and diversity in accommodating donor and acceptor substrates for the synthesis of α-GOS through transgalactosylation reactions. The catalytic mechanism of MelA for the production of α-GOS was elucidated, revealing its great preference for the transfer of galactosyl residues to the C6-hydroxyl group of galactose units to elongate the chain of α-GOS having either a terminal sucrose (raffinose family oligosaccharides, RFOS) or a terminal glucose (melibiose, manninotriose and verbascotetraose). Our findings indicate the feasibility of using MelA α-galactosidase from Lactobacillus plantarum WCFS1 in the hydrolysis of RFOS and in the efficient and versatile synthesis of α-GOS with appealing functional properties in the context of food and nutraceutical applications.

Effect on hyperglycemia and pancreas cells of chaya aqueous extracts from two different regions in streptozotocin-induced diabetes rats

Cnidoscolus chayamansa is a native plant of the Mayan region, which is also cultivated in other places like northern Mexico, Tunisia and India. Many properties are attributed to Mayan Chaya, such as aid in the control of glycemia in diabetics. Thus this study aimed to evaluate the hypoglycemic effects of chaya aqueous extracts in a model of streptozotisin-induced diabetic Wistar rats. Chaya aqueous extracts were collected from plants cultivated in Quinta Roo (Mayan region) and Durango (northern Mexico), and in this study we compare their effect with metformin (as a control). Additionally, we compared the extracts mass profiles from both regions by high-resolution liquid chromatography coupled to a triple quadrupole tandem mass detector (HPLC-MS/MS QQQ). Finally, a study of the pancreatic tissue was carried out to evaluate the effects of the extracts on the Langerhans islets. Both extracts showed a good hypoglycemic effect after two weeks of treatment, and the Langerhans islets showed a partial recovery due to the effect of the treatment. Although the plants were cultivated at a distance of 2,350 km and under different weather, the compounds found in both did not show significant differences.

Erythroderma and Chronic Lichenification Due to Metformin.

We present the case of a 62-year-old man with a 4-year history of pruritus and erythroderma. The patient had been taking metformin for 5 years, so after contact allergies, contact with toxic products, and autoimmune diseases were ruled out, the condition was treated as erythroderma secondary to metformin. A skin biopsy subsequently confirmed the diagnosis and lichenification of some areas of the patient's skin. LEARNING POINTS: Erythroderma induced by drugs, even very common drugs, should be ruled out in all cases.Other causes of erythroderma should be investigated with exhaustive clinical history taking, specific tests and skin biopsy.Erythroderma should be treated as soon as possible once the cause is known.

Genomics of experimental adaptation of Staphylococcus aureus to a natural combination of insect antimicrobial peptides.

Antimicrobial peptides (AMP) are highly conserved immune effectors across the tree of life and are employed as combinations. In the beetle Tenebrio molitor, a defensin and a coleoptericin are highly expressed in vivo after inoculation with S. aureus. The defensin displays strong in vitro activity but no survival benefit in vivo. The coleoptericin provides a survival benefit in vivo, but no activity in vitro. This suggests a potentiating effect in vivo, and here we wanted to investigate the effects of this combination on resistance evolution using a bottom-approach in vitro starting with a combination of two abundant AMPs only. We experimentally evolved S. aureus in the presence of the defensin and a combination of the defensin and coleoptericin. Genome re-sequencing showed that resistance was associated with mutations in either the pmt or nsa operons. Strains with these mutations show longer lag phases, slower Vmax, and nsa mutants reach lower final population sizes. Mutations in the rpo operon showed a further increase in the lag phase in nsa mutants but not in pmt mutants. In contrast, final MICs (minimum inhibitory concentrations) do not differ according to mutation. All resistant lines display AMP but not antibiotic cross-resistance. Costly resistance against AMPs readily evolves for an individual AMP as well as a naturally occurring combination in vitro and provides broad protection against AMPs. Such non-specific resistance could result in strong selection on host immune systems that rely on cocktails of AMPs.

Comparison of two commercial embryo culture media (SAGE-1 step single medium vs. G1-PLUSTM/G2-PLUSTM sequential media): Influence on in vitro fertilization outcomes and human embryo quality.

OBJECTIVE: To compare embryo quality, fertilization, implantation, miscarriage and clinical pregnancy rates for embryos cultured in two different commercial culture media until D-2 or D-3. METHODS: In this retrospective study, we analyzed 189 cycles performed in 2016. Metaphase II oocytes were microinjected and allocated into single medium (SAGE 1-STEP, Origio) until transferred, frozen or discarded; or, if sequential media were used, the oocytes were cultured in G1-PLUSTM (Vitrolife) up to D-2 or D-3 and in G2-PLUSTM (Vitrolife) to transfer. On the following day, the oocytes were checked for normal fertilization and on D-2 and D-3 for morphological classification. Statistical analysis was performed using the chi-square and Mann-Whitney tests in PASW Statistics 18.0. RESULTS: The fertilization rates were 70.07% for single and 69.11% for sequential media (p=0.736). The mean number of embryos with high morphological quality (class A/B) was higher in the single medium than in the sequential media: D-2 [class A (190 vs. 107, p<0.001), B (133 vs. 118, p=0.018)]; D-3 [class A (40 vs. 19, p=0.048) but without differences in class B (40 vs. 49)]. Consequently, a higher number of embryos cultured in single medium were frozen: 197 (21.00%) vs. sequential: 102 (11.00%), p<0.001. No differences were found in implantation rates (30.16% vs. 25.57%, p=0.520), clinical pregnancy rates (55.88% vs. 41.05%, p=0.213), or miscarriage rates (14.29% vs. 9.52%, p=0.472). CONCLUSION: Embryo culture in single medium yields greater efficiency per cycle than in sequential media. Higher embryo quality and quantity were achieved, resulting in more frozen embryos. There were no differences in clinical pregnancy rates.

Fever of Unknown Origin: Don't Forget Kala-Azar Even in Europe.

We present the case of a 70-year-old male patient with fever of unknown origin after a long period of convalescence from a previous admission to a chronic care hospital. During the admission, multiple combinations of antibiotic and antifungal treatments were prescribed, but with persistent fever and, eventually, neutropenia (200 lymphocytes, 0 neutrophils). Given the suspicion of infection at bone marrow level, a biopsy was performed as was serology of Leishmania, both diagnostic determinations. Treatment with amphotericin B liposomal resulted in a good outcome. LEARNING POINTS: Visceral leishmaniasis is a rare aetiology of neutropenia, which causes an important constitutional syndrome and long-standing fever.However, this pathology is endemic in areas of the Mediterranean Sea, which is well known for migratory flows.High clinical suspicion of leishmaniasis is necessary in patients with fever of long evolution, hepatomegaly or splenomegaly, fever and constitutional syndrome, and from endemic areas.

Food-induced IgA Vasculitis (Henoch-Schönlein Purpura).

Immunoglobulin A (IgA) vasculitis is a rare entity in adults. It can be triggered by allergens such as drugs, food, or insect bites. We present a case of an adult male with a cutaneous IgA vasculitis of palpable purpura after eating canned sardines. LEARNING POINTS: IgA vasculitis with skin involvement is rare in adults.It can manifest after exposure to allergens such as drugs and food.A good clinical history and thorough anamnesis can lead to a quick diagnosis.

Kojibiose ameliorates arachidic acid-induced metabolic alterations in hyperglycaemic rats.

Herein we hypothesise the positive effects of kojibiose (KJ), a prebiotic disaccharide, selected for reducing hepatic expression of inflammatory markers in vivo that could modulate the severity of saturated arachidic acid (ARa)-induced liver dysfunction in hyperglycaemic rats. Animals were fed daily (20 d) with ARa (0·3 mg) together or not with KJ (22 mg approximately 0·5 %, w/w diet). Glucose, total TAG and cholesterol contents and the phospholipid profile were determined in serum samples. Liver sections were collected for the expression (mRNA) of enzymes and innate biomarkers, and intrahepatic macrophage and T-cell populations were analysed by flow cytometry. ARa administration increased the proportion of liver to body weight that was associated with an increased (by 11 %) intrahepatic macrophage population. These effects were ameliorated when feeding with KJ, which also normalised the plasmatic levels of TAG and N-acyl-phosphatidylethenolamine in response to tissue damage. These results indicate that daily supplementation of KJ significantly improves the severity of ARa-induced hepatic alterations.

Inmigración, sanidad, crisis económica y politización de la inmigración en España

La transformación de España en país de inmigración ha tenido un considerable impacto social y demográfico. El Estado de bienestar se ha adaptado razonablemente bien a esta evolución de la población,proporcionando un alto grado de protección a las poblaciones de origen inmigrante asentadas en España. En el actual contexto de crisis económica y fiscal que atraviesan los países de la periferia sur de la zonaEuro, las autoridades sanitarias españolas han adoptado una serie de medidas que amenazan con desvirtuar el funcionamiento del Sistema Nacional de Salud como un sistema sanitario de carácter universalista. La exclusión de los inmigrantes indocumentados del ámbito de cobertura del sistema sanitario público constituye la más grave de dichas medidas. Sin que existan argumentos claros de naturaleza económica o sanitariaque justifiquen la adopción de dicha medida, cabe categorizarla como una iniciativa de carácter fundamentalmente político, destinada a enviar un mensaje de dureza ante el fenómeno migratorio. La complejaarticulación de responsabilidades políticas y financieras en el ámbito sanitario ha supuesto una desigual aplicación de dicha medida, vetada en algunas regiones, implementada con celo en otras. El resultado es una situación extremadamente confusa por la que se amplían los márgenespara la discrecionalidad burocrática, así como para el surgimiento de desigualdades en salud en el seno de la sociedad española.(AU)

The transformation of Spain into an immigration country has had a considerable social and demographical impact. The welfare state has adapted well to this population change, providing a high degree of protection to the population with immigrant origin settled in Spain. In the current context of economic and fiscal crisis experienced by the countries from the southern periphery of the Euro zone,which strongly affects the economy of Spain, the Spanish health authorities have adopted a series of measures that threaten to undermine the functioning of the National Health System as one of universal character. The exclusion of undocumented immigrants from the coverage of the public health system is one of the most serious of these measures. Since there are no clear arguments of economic or health-related nature that justify the adoption of this measure, it is classified it as an initiative of fundamentally political character, destined to send a message of strictness to the migration phenomenon. The complex articulation of political and financial responsibilities in the health care context, a result of the multilevel governmental structure of the Spanish State, leads to an unequal application of this measure, which is vetoed in some regions, but implemented in others. The result is an extremely confuse situation in which there is moreroom for bureaucratic discretion, as well as for health inequalities within the Spanish society.(AU)

Periodic 17ß-estradiol pretreatment protects rat brain from cerebral ischemic damage via estrogen receptor-ß.

Although chronic 17ß-estradiol (E2) has been shown to be a cognition-preserving and neuroprotective agent in animal brain injury models, concern regarding its safety was raised by the failed translation of this phenomenon to the clinic. Previously, we demonstrated that a single bolus of E2 48 hr prior to ischemia protected the hippocampus from damage in ovariectomized rats via phosphorylation of cyclic-AMP response element binding protein, which requires activation of estrogen receptor subtype beta (ER-ß). The current study tests the hypothesis that long-term periodic E2-treatment improves cognition and reduces post-ischemic hippocampal injury by means of ER-ß activation. Ovariectomized rats were given ten injections of E2 at 48 hr intervals for 21 days. Hippocampal-dependent learning, memory and ischemic neuronal loss were monitored. Results demonstrated that periodic E2 treatments improved spatial learning, memory and ischemic neuronal survival in ovariectomized rats. Additionally, periodic ER-ß agonist treatments every 48 hr improved post-ischemic cognition. Silencing of hippocampal ER-ß attenuated E2-mediated ischemic protection suggesting that ER-ß plays a key role in mediating the beneficial effects of periodic E2 treatments. This study emphasizes the need to investigate a periodic estrogen replacement regimen to reduce cognitive decline and cerebral ischemia incidents/impact in post-menopausal women.

Laser lipolysis using a 924- and 975-nm laser diode in the lower extremities.

BACKGROUND: Laser technology provides the desired destruction of adipose tissue, hemostasis, and good skin retraction with a minimum of discomfort and a quick return to normal life for the patient. Here we present our experience with the use of laser-assisted liposuction (LAL) with a 924- and 975-nm laser diode and compare it with traditional liposuction alone. METHODS: A total of 430 patients were reviewed for this study. Three hundred thirty patients were treated with the 924- and 975-nm laser diode for laser lipolysis and 100 patients were treated with traditional liposuction of the anterior and inner thigh, the knee, the calf, and the trochanter. Patients were assessed by means of ultrasound. Pictures were taken and the degree of satisfaction was assessed. All complications were recorded. RESULTS: A total of 521 laser lipolysis procedures were performed at different areas: anterior thigh (86), inner thigh (122), trochanter (204), knee (67), and calf (42). The mean energy was area-dependent and evaluated in kJ: anterior thigh (15), inner thigh (14), trochanter (22), knee (5), and calf (4.5). The mean reduction of subcutaneous tissue with LAL in the anterior part of the thigh, the inner thigh, the calf, the knees, and the trochanter was 1.45, 1.9, 1.15, 1.2, and 3.6 cm, respectively. One hundred traditional liposuction procedures were performed for different areas: anterior thigh (27), inner thigh (38), trochanter (72), knee (21), and calf (12). The mean reduction of subcutaneous tissue in the anterior part of the thigh, the inner thigh, the calf, the knees, and the trochanter was 1.2, 1.6, 0.9, 0.6, and 3.2 cm, respectively. All patients who underwent LAL had superior satisfaction compared to those who had liposuction alone. CONCLUSION: Laser lipolysis with 924- and 975-nm diodes is adequate treatment for removal of adipose deposits and to obtain aesthetically good skin results, with a minimum of recovery time and high patient satisfaction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Relationship between motor variability, accuracy, and ball speed in the tennis serve.

The main objective of this study was to analyze the motor variability in the performance of the tennis serve and its relationship to performance outcome. Seventeen male tennis players took part in the research, and they performed 20 serves. Linear and non-linear variability during the hand movement was measured by 3D Motion Tracking. Ball speed was recorded with a sports radar gun and the ball bounces were video recorded to calculate accuracy. The results showed a relationship between the amount of variability and its non-linear structure found in performance of movement and the outcome of the serve. The study also found that movement predictability correlates with performance. An increase in the amount of movement variability could affect the tennis serve performance in a negative way by reducing speed and accuracy of the ball.

Evaluation of clinical improvement in acne scars and active acne in patients treated with the 1540-nm non-ablative fractional laser.

INTRODUCTION: Acne is a characteristic condition of puberty; however, adults who continue to have acne outbreaks frequently attend dermatology clinics. Two conditions-active acne and residual scarring-often co-occur in these patients. The objective of the present study was to evaluate the improvement in scarring and active acne after treatment with a 1540-nm erbium: glass fractional laser. MATERIAL AND METHODS: The authors treated 20 patients with acne and scarring. Each patient received panfacial treatment in four sessions with a 1-month interval between sessions. Patients, the treating physician and a blinded observer evaluated the results in four areas: improvement in scars, improvement in pores, improvement in acne, and improvement in sebum secretion. Improvements were graded using the Global Aesthetic Improvement Scale. The evaluation was made 12 weeks after treatment finished. RESULTS: Patients presented an improvement in both acne and scars. In 80 percent of cases, patients felt that the appearance of the scars had improved, and the improvement was classified as very much improved in 40 percent. In 85 percent of cases, patients felt that active acne had improved, and the improvement was classified as very much improved in 45 percent. Pore size was evaluated as improved by 75 percent of patients. Sebum secretion improved in 80 percent of cases. CONCLUSION: A 1540-nm non-ablative fractional laser provides effective treatment of acne scars. Patient satisfaction is high and active acne lesions improve significantly. Treatment of this mixed condition (scarring and active acne) with a single device is reliable, with a favorable safety profile and a high degree of patient acceptance.