Comparison of Muscle Energy Technique, Myofascial Release, and Combined Techniques for Glenohumeral Internal-Rotation Deficit. An Interventional Study / Comparación de Técnica de Energía Muscular, Liberación Miofascial y Técnicas Combinadas para el Déficit de Rotación Interna Glenohumeral. Un Estudio Intervencionista

SUMMARY: This study aimed to determine the benefits of a combined technique of muscle energy with and myofascial release more effective than using each in isolation in glenohumeral internal rotator deficits. An interventional study was designed for this study. Thirty-eight patients were diagnosed with painful shoulder syndrome. Patients were randomly allocated into 4 groups where Group A was treated with combined muscle energy and myofascial release; Group B with muscle energy technique; Group C with myofascial release and Group D used as control. The evaluation of the passive joint range of the glenohumeral internal rotation and sociodemographic data for each of the groups were measured, before and after interventions. Despite the use of myofascial release and muscle energy techniques being significantly beneficial in their respective groups, when both were combined; it outcomes were highly successful. A combination therapy treatment applied with the Muscle Energy and Myofascial Release Techniques in patients with painful shoulder syndrome will be more effective in increasing the range of motion of the glenohumeral internal rotation joint than any of the techniques applied individually.

Este estudio tuvo como objetivo determinar los beneficios de una técnica combinada de energía muscular con liberación miofascial más efectiva que usar cada una de manera aislada en los déficits de los músculos rotadores internos glenohumerales. Para este estudio se diseñó un protocolo de intervención. En 38 pacientes se diagnosticó síndrome de hombro doloroso. Los pacientes fueron asignados aleatoriamente a 4 grupos; el grupo A fue tratado con energía muscular combinada y liberación miofascial; Grupo B con técnica de energía muscular; Grupo C con liberación miofascial y Grupo D utilizado como control. Se midió la evaluación del rango articular pasivo de la rotación interna de la articulación glenohumeral y datos sociodemográficos de cada uno de los grupos, antes y después de las intervenciones. A pesar de que el uso de técnicas de liberación miofascial y energía muscular resultó significativamente beneficioso en sus respectivos grupos, cuando ambas se combinaron; Sus resultados fueron muy exitosos. Un tratamiento de terapia combinada aplicado con las Técnicas de Energía Muscular y Liberación Miofascial en pacientes con síndrome de hombro doloroso será más efectivo para aumentar el rango de movimiento de la articulación de rotación interna glenohumeral que cualquiera de las técnicas aplicadas individualmente.

¿Efectividad de la técnica de liberación miofacial en el aumento del rango articular en restricción glenohumeral? Una comparación con la kinesioterapia tradicional / Effectiveness of the myofascial release technique in increasing joint range in glenohumeral restriction? A comparison with traditional kinesiotherapy

OBJETIVO: comparar la kinesioterapia tradicional con la técnica miofacial en pacientes con restricción articular interna glenohumeral. MÉTODO: estudio comparativo de 8 pacientes en un grupo de intervención (GI) y kinésico (GC), durante 8 semanas. Se comparó el pre y post test del ROM interno glenohumeral en ambos grupos mediante t de student. RESULTADOS: el grupo de la técnica miofascial demostró una amento significativo de ROM interno glenohumeral de 15,2º (p < 0,001), mientras que el grupo control no fue significativo (p > 0,05) sólo de de 6,4º. CONCLUSIONES:Un tratamiento de terapia con la Técnicas Liberación Miofascial en pacientes con déficit rotacional interno de hombro es más eficaz para aumentar el rango de movimiento articular de rotación interna glenohumeral que una técnica tradicional y conservadora.

OBJETIVE: to compare traditional kinesiotherapy with myofacial technique in patients with glenohumeral internal joint restriction. METHODS: comparative study of 8 patients in an intervention (IG) and kinesiotherapy (CG) group for 8 weeks. The pre- and post-test of glenohumeral internal ROM in both groups was compared using Student's t-test. RESULTS: the myofascial technique group showed a significant increase in glenohumeral internal ROM of 15.2º (p < 0.001), while the control group was not significant (p > 0.05) only 6.4º. CONCLUSIONS: A therapy treatment with Myofascial Release Techniques in patients with shoulder internal rotational deficit is more effective in increasing glenohumeral internal rotational joint range of motion than a traditional, conservative technique.

Efectividad de la máscara laríngea Ambu® Aura40TM para anestesia general en cirugía ortopédica pediátrica / Effectiveness of Ambu® Aura40TM laryngeal mask for general anesthetic in pediatric orthopedic surgery

RESUMEN Introducción: las máscaras laríngeas son dispositivos supraglóticos utilizadas ampliamente en anestesia para el abordaje y mantenimiento de la vía respiratoria. Una de ellas, la Ambu® Aura 40TM, tiene un diseño que le permite ajustarse al entorno de la hipofaringe con su lumen dirigido a la apertura laríngea. Ha demostrado ser adecuada para procedimientos quirúrgicos donde no es necesaria la intubación endotraqueal. Objetivo: determinar la efectividad dicha máscara laríngea para anestesia general en cirugía ortopédica pediátrica. Materiales y métodos: se realizó un estudio descriptivo, prospectivo, transversal, en 135 pacientes intervenidos quirúrgicamente de forma electiva en el Hospital Pediátrico Eliseo Noel Caamaño, de Matanzas, en el periodo enero de 2015- junio 2017. Se tuvo en cuenta el número de intentos y el tiempo para insertar la máscara laríngea, la necesidad de reemplazarla por un tubo endotraqueal y las complicaciones relacionadas con su uso. Resultados: la ML Ambu® Aura 40TM fue efectiva en la mayoría de los pacientes ya que permitió realizar la cirugía sin necesidad de sustituirla por el tubo endotraqueal y la aparición de complicaciones relacionada con su uso fue baja. Conclusiones: la ML Ambu® Aura 40TM fue efectiva ya que en la mayoría de los pacientes fue insertada correctamente en el primer intento y un tiempo inferior a los 20 segundos. Solo una minoría necesitó que fuera reemplazada por el tubo endotraqueal, y la aparición de complicaciones relacionada con su uso fue baja (AU).

ABSTRACT Introduction: laryngeal mask are supra glottal devices widely used in anesthetics for approaching and maintaining the airway. One of them, the Ambu® Aura 40TM, has a design allowing to adjust to the surroundings of hypo-pharynx with its lumen directed to the pharyngeal opening. It has demonstrated to be adequate for surgical procedures when there is no need of endotracheal intubation. Objective: to determine the effectiveness of that laryngeal mask for general anesthetic in pediatric orthopedic surgery. Materials and methods: a cross-sectional, prospective, descriptive study was carried out in 135 patients who underwent elective surgical intervention in the Pediatric Hospital ?Eliseo Noel Caamaño?, of Matanzas, in the period January 2015- June 2017. The number of attempts and the time needed to insert laryngeal mask, the necessity of changing it for an endotracheal tube, and complications related to its usage were taking into account. Results: Ambu® Aura 40TM laryngeal mask was effective in most patients, due to it allowed to perform the surgery without need of changing it for an endotracheal tube, and the low appearance of complications related to its use. Conclusions: Ambu® Aura 40TM laryngeal mask was effective because it was inserted correctly at the first attempt, in a time less than 20 seconds. Only a minority needed to replace it by endotracheal tube, and the appearance of complications related to its use were low (AU).

Edema pulmonar por presión negativa con máscara laríngea clásica. Presentación de un caso pediátrico / Pulmonary edema due to negative pressure with classical laryngeal mask. Presentation of a pediatric case

RESUMEN El edema pulmonar por presión negativa es una complicación rara y dramática en la anestesia general. Habitualmente ocurre como consecuencia de un laringoespasmo u otra causa de obstrucción de la vía aérea. Se presentó un caso con el objetivo de mostrar los elementos usados para el diagnóstico y tratamiento del edema pulmonar por presión negativa. Paciente de 7 años de edad, femenina, ASA I, operada de metatarso varo funcional con anestesia general balanceada y máscara laríngea clásica # 3. Desarrolló dicho evento adverso durante la recuperación anestésica. El diagnóstico se basó en la disociación toraco abdominal al restablecer la ventilación espontanea, crepitantes en ambos hemitórax, cianosis central, hipoxemia y la presencia de infiltrado difuso bilateral alveolar. Se intubó la tráquea, se controló la ventilación con presión positiva al final de la espiración y se administró furosemida. La paciente fue trasladada a la Unidad de Cuidados Intensivos donde evolucionó satisfactoriamente. Este es un síndrome cuya verdadera incidencia se desconoce debido a la escasa familiarización con el mismo. La evolución de los pacientes es favorable siempre que se establezca el diagnóstico y el tratamiento oportuno (AU).

ABSTRACT Pulmonary edema due to negative pressure is a rare and dramatic complication in general anesthetic. It usually occurs as a consequence of a laryngeal spasm or another cause of respiratory tract obstruction.A case was presented with the aim of showing the elements used for the diagnosis and treatment of the pulmonary edema due to negative pressure. An ASA I, 7-year-old female patient, was operated on a functional metatarsus varus with balanced general anesthetic and classical laryngeal mask number 3. She developed this adverse event during the anesthetic recovery. The diagnosis was based on the thoracoabdominal dissociation when recovering spontaneous ventilation, crepitation in hemithoraxes, central cyanosis, hypoxemia, and alveolar bilateral diffused infiltrate. The trachea was intubated, ventilation was controlled with positive pressure at the end of the expiration and furosemide was administered. The patient was transferred to the Intensive Care Unit where she evolved satisfactorily. This is a syndrome whose true incidence is unknown as a result of the lack of familiarization with it. Patients' evolution is favorable whenever the right diagnosis and treatment are timely established (AU).

Edema pulmonar por presión negativa con máscara laríngea clásica. Presentación de un caso pediátrico / Pulmonary edema due to negative pressure with classical laryngeal mask. Presentation of a pediatric case

RESUMEN El edema pulmonar por presión negativa es una complicación rara y dramática en la anestesia general. Habitualmente ocurre como consecuencia de un laringoespasmo u otra causa de obstrucción de la vía aérea. Se presentó un caso con el objetivo de mostrar los elementos usados para el diagnóstico y tratamiento del edema pulmonar por presión negativa. Paciente de 7 años de edad, femenina, ASA I, operada de metatarso varo funcional con anestesia general balanceada y máscara laríngea clásica # 3. Desarrolló dicho evento adverso durante la recuperación anestésica. El diagnóstico se basó en la disociación toraco abdominal al restablecer la ventilación espontanea, crepitantes en ambos hemitórax, cianosis central, hipoxemia y la presencia de infiltrado difuso bilateral alveolar. Se intubó la tráquea, se controló la ventilación con presión positiva al final de la espiración y se administró furosemida. La paciente fue trasladada a la Unidad de Cuidados Intensivos donde evolucionó satisfactoriamente. Este es un síndrome cuya verdadera incidencia se desconoce debido a la escasa familiarización con el mismo. La evolución de los pacientes es favorable siempre que se establezca el diagnóstico y el tratamiento oportuno (AU).

ABSTRACT Pulmonary edema due to negative pressure is a rare and dramatic complication in general anesthetic. It usually occurs as a consequence of a laryngeal spasm or another cause of respiratory tract obstruction.A case was presented with the aim of showing the elements used for the diagnosis and treatment of the pulmonary edema due to negative pressure. An ASA I, 7-year-old female patient, was operated on a functional metatarsus varus with balanced general anesthetic and classical laryngeal mask number 3. She developed this adverse event during the anesthetic recovery. The diagnosis was based on the thoracoabdominal dissociation when recovering spontaneous ventilation, crepitation in hemithoraxes, central cyanosis, hypoxemia, and alveolar bilateral diffused infiltrate. The trachea was intubated, ventilation was controlled with positive pressure at the end of the expiration and furosemide was administered. The patient was transferred to the Intensive Care Unit where she evolved satisfactorily. This is a syndrome whose true incidence is unknown as a result of the lack of familiarization with it. Patients' evolution is favorable whenever the right diagnosis and treatment are timely established (AU).

Safety evaluation and lipid-lowering effects of food-grade biopolymer complexes (ε-polylysine-pectin) in mice fed a high-fat diet.

ε-Polylysine (ε-PL) is a potent cationic antimicrobial, but its application as a food additive is currently limited because it tends to precipitate with anionic species in food matrices. Previous research has shown that the formation of an electrostatic complex between cationic ε-PL and anionic pectin (P) improved the physical stability of ε-PL while maintaining its antimicrobial activity. However, the impact of complexation on the effects of ε-PL on health is currently unknown. A subchronic toxicity study was therefore carried out to determine the safety of ingested ε-PL-P complexes using high-fat diet-fed male and female mice. After a 13-week dietary treatment with P, ε-PL, or ε-PL-P complexes, no significant toxicological effects were observed on the survival, mean body weight, food consumption, and organ weights of the animals, suggesting that the complexes were safe for oral consumption. Interestingly, the ε-PL-P complexes were found to have several beneficial health effects: suppression of high-fat diet-induced elevation of serum aspartate aminotransferase and alanine aminotransferase activities, reduction in serum total triglyceride and cholesterol levels, and an increase in fecal excretion of triglycerides. These effects were much stronger in female mice than in male mice. Moreover, the lipid-lowering effects were observed only for the ε-PL-P complexes but not for ε-PL or P alone at the same doses. Overall, our results demonstrate the oral safety of ε-PL-P complexes and their gender-specific lipid-lowering effects in high-fat diet-fed mice, which provide an important basis for the utilization of ε-PL-P complexes in food systems as functional ingredients.

Food-grade cationic antimicrobial ε-polylysine transiently alters the gut microbial community and predicted metagenome function in CD-1 mice.

Diet is an important factor influencing the composition and function of the gut microbiome, but the effect of antimicrobial agents present within foods is currently not understood. In this study, we investigated the effect of the food-grade cationic antimicrobial ε-polylysine on the gut microbiome structure and predicted metagenomic function in a mouse model. The relative abundances of predominant phyla and genera, as well as the overall community structure, were perturbed in response to the incorporation of dietary ε-polylysine. Unexpectedly, this modification to the gut microbiome was experienced transiently and resolved to the initial basal composition at the final sampling point. In addition, a differential non-random assembly was observed in the microbiomes characterized from male and female co-housed animals, although their perturbation trajectories in response to diet remain consistent. In conclusion, antimicrobial ε-polylysine incorporated into food systems transiently alters gut microbial communities in mice, as well as their predicted function. This indicates a dynamic but resilient microbiome that adapts to microbial-active dietary components.

Impact of ε-polylysine and pectin on the potential gastrointestinal fate of emulsified lipids: In vitro mouth, stomach and small intestine model.

ε-Polylysine (ε-PL) is a broad-spectrum antimicrobial biopolymer, suitable for use in foods; however, some studies suggest that it may also inhibit lipid digestion. We therefore examined the effect of polylysine on the digestion of corn oil-in-water emulsions, using a simulated gastrointestinal tract (GIT) that included oral, gastric, and intestinal phases. Both mucin and polylysine had pronounced influences on the particle size, charge, and aggregation state throughout the GIT. However, surprisingly, we found that ε-polylysine did not have a significant impact on lipid digestion, either in the presence or absence of anionic mucin. However, it did form strong electrostatic complexes with mixed micelles, which could decrease the transport and absorption of lipids in the small intestine. These results have important implications for the incorporation of polylysine into food systems, particularly those containing lipophilic nutrients.

Impact of a food-grade cationic biopolymer (ε-polylysine) on the digestion of emulsified lipids: In vitro study.

ε-Polylysine (ε-PL) is a cationic biopolymer that may be used as a food ingredient because of its strong antimicrobial activity and potential to inhibit pancreatic lipase. We examined the effect of polylysine on the digestion of corn oil-in-water emulsions stabilized by either a natural anionic surfactant (quillaja saponin) or a synthetic non-ionic surfactant (Tween 20). Emulsions were prepared using high pressure homogenization (microfluidization) and then subjected to in vitro digestion in the absence or presence of polylysine at the maximum level allowed in foods by the FDA. Samples were characterized before and after in vitro digestion using electrophoresis, confocal microscopy, and static light scattering. The presence of polylysine decreased the hydrolytic activity of pancreatic lipase by around 53% and 28% in the Tween 20- and saponin-stabilized emulsions, respectively. The lipase-inhibiting properties of cationic polylysine were attributed to its electrostatic interaction with anionic components, such as bile salts, free fatty acids, and digestive enzymes. These results have important implications for the incorporation of polylysine into food systems, particularly those containing lipophilic nutrients.

Potential impact of biopolymers (ε-polylysine and/or pectin) on gastrointestinal fate of foods: In vitro study.

Food-grade biopolymers, such as proteins and polysaccharides, may impact the gastrointestinal fate of foods through various mechanisms. In this study, we examined the influence of ε-polylysine (an antimicrobial) and pectin (a thickening agent) on the behavior of a standard rodent diet (full-fat and fat-free) in a simulated gastrointestinal tract that included mouth, stomach, and small intestine phases. Powdered biopolymers were incorporated into the standard diet in either individual or complexed form. The presence of the biopolymers altered the microstructure and charge characteristics of the gastrointestinal contents. In particular, the presence of pectin appeared to increase the rate and extent of lipid digestion, which may have been due to its ability to inhibit protein aggregation. Our results do not support the hypothesis that polylysine inhibits lipid digestion, as has been reported previously. Overall, the results of this study may be useful for interpreting animal feeding studies of the influence of biopolymers on the gastrointestinal fate of foods.

Optimizing delivery systems for cationic biopolymers: competitive interactions of cationic polylysine with anionic κ-carrageenan and pectin.

Polylysine is a cationic biopolymer with a strong antimicrobial activity against a wide range of microorganisms, however, its functional performance is influenced by its interactions with anionic biopolymers. We examined the stability of polylysine-pectin complexes in the presence of carrageenan, and vice versa. Polylysine-pectin or polylysine-carrageenan complexes were formed at mass ratios of 1:0 to 1:32 (pH 3.5), and then micro-electrophoresis, turbidity, microscopy, and isothermal titration calorimetry (ITC) were used to characterise them. Solutions containing polylysine-pectin complexes were slightly turbid and relatively stable to aggregation at high mass ratios, whereas those containing polylysine-carrageenan complexes were turbid and unstable to aggregation and precipitation. Pectin did not strongly interact with polylysine-carrageenan complexes, whereas carrageenan displaced pectin from polylysine-pectin complexes, which was attributed to differences in electrostatic attraction between polylysine, carrageenan, and pectin. These results have important implications for the design of effective antimicrobial delivery systems for foods and beverages.

Family protection and prevention of alcohol use among Hispanic youth at high risk.

Research regarding prevention strategies for Hispanic youth stress the importance of family interventions because of the particular importance of family as a protective factor within the Hispanic community. Starting in 1995, the Center for Substance Abuse Prevention conducted the National Cross-Site Evaluation of High Risk Youth Programs, a 5-year drug and alcohol prevention study with a sample of approximately 10,500 youth, including nearly 3,000 Hispanic youth. Youth were surveyed regarding their alcohol use patterns and risk and protective factors, with several measures of family relationships, including family connectedness, family supervision, and parental attitudes toward their child's alcohol use. Analyses indicate that family factors are highly linked to alcohol use among Hispanics, particularly among Hispanic females. Longitudinal growth curve analyses indicate that improving the connections that young Hispanic females have to their parents can have positive long-term effects on delaying or reducing their alcohol use.