Jorge Carvalho

Impaired resolution of inflammation in human chronic heart failure.

Lipoxins (LXs) are proresolving and anti‐inflammatory eicosanoids whose role in chronic heart failure (CHF) pathogenesis has never been investigated. This study evaluated levels of LXs in CHF patients, its relationship with disease severity and correlation with established CHF biomarkers. The effect of low‐dose aspirin [acetylsalicylic acid (ASA)] on the levels of LXs was also studied.

Soft tissue injuries after direct laryngoscopy.

STUDY OBJECTIVE The study objective is to determine the incidence of oral soft tissue trauma during classic direct laryngoscopy for tracheal intubation and the risk factors associated with it. DESIGN This is a prospective observational study. SETTING The setting is at a ward. PATIENTS The patients are adults submitted to elective interventions in general surgery requiring tracheal intubation by classic direct laryngoscopy. INTERVENTIONS During 6 months, all patients were interviewed 12-24 hours before anesthesia and after surgery and underwent a detailed oral examination performed by an anesthesiology blind to anesthetic management details and preoperative patient care. MEASUREMENTS Evaluation of oral soft tissue injuries includes oral mucosa including the gums; the alveolar mucosa in the edentulous patient, palate, and the buccal mucosa; lips (mucosa and skin); and the tongue. Injury severity was assessed using the severity scale presented routinely in Portuguese legal medicine research: grade 0, no injuries had; grade 1, mild severity injuries; grade 2, medium severity injuries; and grade 3, major severity injuries. MAIN RESULTS Soft tissue trauma was observed in 278 (52.1%) patients. Soft tissue injury occurred once in 204 (38.2%) patients, 2 in 64 (38.2%) patients, and 3 times in 10 (1.9%) patients. Tongue injury was the most common type of soft tissue trauma (36.3%) followed by lower lip injury (22.3%), upper lip injury (7.1%), and oral mucosa injury (2.1%). All the lesions were grade 1 or 2. Only oral mucosa injury was found to be associated with age group (P = .021). CONCLUSIONS Our study reveals a high incidence of lesions grade 1 or 2 in soft tissue.

Resolving Inflammation in Heart Failure: Novel Protective Lipid Mediators

Inflammation is an important pathogenic mechanism in chronic heart failure (HF). The perpetuation of the inflammatory response in this syndrome may result either from excessive activation of proinflammatory cascades or disturbances in the resolution of inflammation. However, although cardiovascular research has extensively investigated the proinflammatory processes involved in chronic HF pathophysiology, the mechanisms responsible for inflammation resolution in this disease remain largely disregarded. The resolving response is currently considered an active process involving specific effectors that limit the progression of inflammation and promote tissue regeneration. This article aims at reviewing the major classes of lipid mediators of inflammation resolution, their cardiovascular, metabolic and renal protective effects that might putatively delay the onset and progression of chronic HF, and their therapeutic modulation. Furthermore, it also aims to emphasize the importance of adopting therapeutic strategies that stimulate the resolution of inflammation in chronic HF.

Current uses of ground penetrating radar in groundwater-dependent ecosystems research

Ground penetrating radar (GPR) is a high-resolution technique widely used in shallow groundwater prospecting. This makes GPR ideal to characterize the hydrogeological functioning of groundwater-dependent ecosystems (GDE). This paper reviews current uses of GPR in GDE research through the construction of a database comprising 91 worldwide GPR case studies selected from the literature and classified according to (1) geological environments favouring GDE; (2) hydrogeological research interests; and (3) field technical and (4) hydrogeological conditions of the survey. The database analysis showed that inland alluvial, colluvial, and glacial formations were the most widely covered geological environments. Water-table depth was the most repeated research interest. By contrast, weathered-marl and crystalline-rock environments as well as the delineation of salinity interfaces in coastal and inland areas were less studied. Despite that shallow groundwater propitiated GDE in almost all the GPR case studies compiled, only one case expressly addressed GDE research. Common ranges of prospecting depth, water-table depth, and volumetric water content deduced by GPR and other techniques were identified. Antenna frequency of 100MHz and the common offset acquisition technique predominated in the database. Most of GPR case studies were in 30-50° N temperate latitudes, mainly in Europe and North America. Eight original radargrams were selected from several GPR profiles performed in 2014 and 2015 to document database classes and identified gaps, as well as to define experimental ranges of operability in GDE environments. The results contribute to the design of proper GPR surveys in GDE research.

Reconstruction of a near total ear amputation with a neurosensorial radial forearm free flap prelaminated with porous polyethylene implant and delay procedure

When an auricular defect is caused by high‐energy trauma that causes damage to the surrounding tissues, the patient may be not a candidate for reconstruction with local flaps and free tissue transfer may be necessary. Here we present a case of total auricular reconstruction in a 27 year‐old man who had total loss of the left ear and traumatized temporal skin and fascia. A radial forearm flap prelaminated by a porous polyethylene implant was employed. A “printed” ear made of silicone, based on the patients CT‐scan of the contralateral ear, was used for intraoperative molding of the future reconstruction. Prolonged prelamination time and surgical delay (three months) were performed to reduce edema, distortion and loss of definition of the framework after revascularization. After subsequent integration and neovascularization of the added tissue, the prelaminated flap was transferred. Flap reinnervation was also performed by direct coaption of the great auricular nerve to the lateral antebrachial cutaneous nerve. The flap fully survived and there were no complications in the early postoperative period. Between 3 and 6 months, the patient returned to normal ranges in terms of warmth and cold, and recovered the discriminative facial sensibility. After one year the auricular reconstruction was intact and satisfactory aesthetic results were achieved. This method may offer a satisfactory solution for a difficult problem and may be considered for acquired total ear defects.

Correlation Between Sonic and Mechanical Test Results on Stone Masonry Walls

Heritage constructions are the inheritance of the society and must be preserved because of their historical and cultural value. To preserve and rehabilitate these structures, an extensive knowledge of its mechanical properties is required. To obtain this information priority should be given to the use of non-destructive techniques. In this work, it is proposed to use the correlation of sonic and mechanical tests, performed in seven double-leaf stone masonry walls constructed in the laboratory. Four types of two leaves masonry walls were constructed, with variations in its structural configuration. Based on uniaxial compression tests performed on these stone masonry walls, mechanical properties were obtained. These data were correlated with sonic test results. Two sonic test sequences were performed. In the first sequence, direct and indirect tests were performed before and after the damaging mechanical compression tests. For the second sequence of sonic tests, direct and indirect tests were implemented at each loading level during the compression test, for which fewer acquisition points were defined, to avoid loading redistribution and relaxation during the sonic data acquisition. Several difficulties were encountered in this process. Despite these difficulties, both used tests presented coherent and correlated results. For the sonic tests, as expected, the higher wave velocity locations are those from the direct test across the walls header blocks. With the sonic tests performed during the compression tests, it was possible to monitor the varying sonic behavior of the walls, and the accuracy of the sonic test results when compared with the compression test results.

Reconstruction of a postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure-A case report.

Radial club hand may be congenital or acquired; radial deviation of the hand is usually found, associated with palmar flexion–pronation and treatment of severe forms of radial club hand is often difficult. Here we present a case of reconstruction of a severe postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve–Kapandji procedure in a 28‐year‐old man. The patient had a radial deviation of the wrist and right upper limb shortening as a result of an infected pseudarthrosis of the radius. This deformity was reconstructed with a free fibular osteoseptocutaneous flap associated to arthrodesis of the distal radioulnar joint and an ulnar resection osteotomy proximal to the arthrodesis in order to restore rotation of the forearm (Sauvé–Kapandji procedure). The flap fully survived and no complications were seen in the early postoperative period at both recipient and donor sites. Radius alignment was restored. At 5‐month follow‐up, the skeleton was healed. There was minimal osteopenia at the distal radial segment. Wrist extension was 48 degrees, flexion 24 degrees, and pronation–supination was 58–0–48 degrees, with full finger flexion. The patient could hold a 4 kg dumbbell with the elbow flexed without discomfort. His DASH score—Disabilities of the Arm, Shoulder, and Hand Questionnaire was 15.83. Combined free fibular osteoseptocutaneous flap and Sauve–Kapandji procedure may be considered in severe forms of postraumatic radial club hand, however, further data are necessary.

Multi-staged flap reconstruction for complex radiation thoracic ulcer.

INTRODUCTION Chest wall reconstruction due to previous radiation therapy can be challenging and complex, requiring a multidisciplinary approach. PRESENTATION OF CASE The authors present the case of a 84-year-old woman with a right chest wall radionecrosis ulcer, that was submitted to an ablative surgery resulting in a full-thickness defect of 224 cm2, firstly reconstructed with a pedicled omental flap. Due to partial flap necrosis, other debridements and chest wall multi-staged flap reconstruction were performed. DISCUSSION This case highlights that the reconstructive choice should be individualized and dependent on patient and local factors. The authors advise that surgical team should work closely and be well versed in chest wall reconstruction with a variety of pedicled flaps, when a complication occurs. CONCLUSION A multi-staged flap reconstruction could be a salvage procedure for the coverage of complex, great and complicated chest wall defects due to previous radiation therapy.