Reproducibility Study of Nocturnal Blood Pressure Dipping in Patients with High Cardiovascular Risk

It has been shown that in most people there is a physiological reduction in blood pressure during nighttime sleep, it falling by approximately 10% compared to daytime values (dippers). On the other hand, in some people, there is no nighttime reduction (non-dippers). Various studies have found an association between being a non-dipper and a higher risk of cardiovascular disease, but few have assessed whether the nocturnal pattern is maintained over time. From the database of the TAHPS study, data were available on 225 patients, each of whom underwent 24-hour ambulatory blood pressure monitoring (ABPM) on four occasions over a period of 5 months. We studied the reproducibility of the nocturnal BP dipping pattern with mixed linear analysis and also calculated the concordance in the classification of patients as dippers or non-dippers. The intraclass correlation coefficients between the different ABPM recordings were 0.482 and 0.467 for systolic and diastolic blood pressure, respectively. Two-thirds (67%) and 70% of the patients classified, respectively, as dippers or non-dippers based on systolic and diastolic blood pressure readings in the first ABPM recording were found to have the same classification based on the subsequent recordings. We conclude that the reproducibility of nocturnal dipping patterns and concordance of dipper vs non-dipper status in individual patients is modest and therefore that we should be cautious about recommending treatments or interventions based on these patterns.A grant was received from the Department of Pharmacy of the Spanish Health Ministr

Limited Probiotic Effect of Enterococcus gallinarum L1, Vagococcus fluvialis L21 and Lactobacillus plantarum CLFP3 to Protect Rainbow Trout against Saprolegniosis

[EN] Previous studies have demonstrated that the strains Enterococcus gallinarum L1, Vagococcus fluvialis L21 and Lactobacillus plantarum CLFP3 are probiotics against vibriosis or lactococosis in sea bass or rainbow trout. In this study, the utility of these bacterial strains in the control of saprolegniosis was evaluated. For this purpose, both in vitro inhibition studies and competition for binding sites against Saprolegnia parasitica and in vivo tests with experimentally infected rainbow trout were carried out. In the in vitro tests, the three isolates showed inhibitory activity upon mycelium growth and cyst germination and reduced the adhesion of cysts to cutaneous mucus; however, this effect depended on the number of bacteria used and the incubation time. In the in vivo test, the bacteria were administered orally at 108 CFU g−1 in the feed or at 106 CFU ml−1 in the tank water for 14 days. None of the three bacteria showed protection against S. parasitica infection either through water or feed, and the cumulative mortality reached 100% within 14 days post infection. The obtained results show that the use of an effective probiotic against a certain disease in a host may not be effective against another pathogen or in another host and that the results obtained in vitro may not always predict the effects when used in vivo.SIWe are grateful for the assistance provided by the laboratory technician Gloria Fernández–Bayón; the fish farm Los Leoneses in León, which supplied the rainbow trout; the “Servicio Territorial de Medio Ambiente de León” of the “Junta de Castilla y León”, which supplied the brown trout; and Skretting España S.A., which donated some of the feed.This study was funded through research project AGL2014-54683-R of the Spanish “Ministerio de Economía y Competitividad” and cofinanced through the European Regional Development Fund (ERDF). C.G.P. was awarded a predoctoral contract by the “Consejería de Educación” of the regional government “Junta de Castilla y León” cofinanced through the European Social Fund

Intravenous single dose of tranexamic acid safely reduces blood loss and the need for transfusion in elderly patients with hip fracture. A randomized double-blinded controlled trial at 1-year follow-up

Background: A hip fracture usually presents significant blood loss in the perioperative period, with a transfusion rate of 20-60%. In order to reduce the complications associated with this procedure, the administration of Tranexamic Acid (TXA) has been implemented in the treatment of perioperative anemia. The objectives were to evaluate the effectiveness and safety of a single dose of intravenous Tranexamic Acid (TXA) in reducing perioperative blood loss and the requirement for transfusion in elderly patients undergoing hip fracture surgery within one postoperative year. Methods: A double-blind randomized controlled trial was conducted on 129 patients with hip fractures. After randomization, at the start of the surgery, 65 patients received a single dose of 1 gram of intravenous TXA (TXA group), and 64 received a placebo (placebo group). The primary effectiveness outcomes were the total blood loss and transfusion rate. The primary safety outcome was the rate of thromboembolic events. Data on surgical or medical infection, readmission and death were also collected. Results: The TXA group had a significant decrease in blood loss (p = 0.006) and requirement for transfusion (p < 0.001) compared with the placebo group. Likewise, there were no thromboembolic events in the TXA group and seven in the placebo group (p = 0.006). Mortality within 1-year postoperatively was not significantly different (p = 0.115). Conclusion: Using a single dose of intravenous TXA at the start of the surgery significantly reduces blood loss and the requirement for transfusion without increasing the risk of thromboembolic events or mortality within 1-year postoperatively in patients with hip fracture undergoing surgery. Registration number: NCT03211286. https://clinicaltrials.gov/ct2/show/NCT03211286. Level of evidence: I

Immediate breast reconstruction with a ‘modified fleur-de-lis’ abdominal-free flap in a patient with previous abdominal surgery

DIEP flap has become the gold standard method for patients undergoing autologous breast reconstruction; however, previous surgery or scars in the abdominal area have been considered a relative contraindication for the use of abdominal tissue. Longitudinal midline abdominal scars may be specially problematic because of the poor midline crossover of blood and the high risk of necrosis of the distal flap. Patients with small breast may be easily reconstructed with hemi-DIEP flap; however, patients with large breast need more tissue available. Our aim is to report a modification of a ‘fleur-de-lis pattern’ for a breast reconstruction in a patient with previous abdominal surgery and large breast. The post-operative course was uneventful, flap did not show blood supply compromise, volume and symmetry are preserved after 6 months post-operative and donor site morbidity has not been observed. This modification may be very useful to avoid complications related to poor blood supply associated with scar tissues. Careful pre-operative planning and the transfer of only well-vascularised tissue are essential for a successful reconstruction