Avascular femoral necrosis as part of Cushing syndrome presentation: a case report

Background: The clinical characteristics and complications of Cushing syndrome (CS) are well known and described in the literature. Nevertheless, rare, atypical presentations may go unnoticed. Osteonecrosis is a well-documented complication of glucocorticoid therapy. However, endogenous hypercortisolism is a rare, but relevant, cause of bone avascular necrosis. We describe the case of a woman with CS undiagnosed for 2 years after presenting with femoral avascular necrosis. Case presentation: A 38-year-old Caucasian woman was referred for evaluation of secondary amenorrhea, associated with oral contraception withdrawal in the context of deep venous thrombosis (DVT). She had a previous right hip arthroplasty for treatment of avascular necrosis of the femoral head, diagnosed after 3 years of progressive right hip pain and limited mobility. She also had high blood pressure (HBP) of 5 years’ duration, and reported weight gain (4 kg in 2 years). There was no history of infertility (gravida 2, para 2). Physical examination revealed buffalo hump, truncal obesity, facial plethora, muscular atrophy and proximal myopathy, and easy bruising (under anticoagulant treatment for DVT). Workup showed abnormal overnight dexamethasone suppression test (DST) (serum cortisol 21.5 µg/dL; normal < 1.8 µg/dL), elevated 24-hour urinary free cortisol (UFC) (728.9 µg/day; reference range 36.0–137.0 µg/day), and suppressed plasma adrenocorticotropic hormone (ACTH) (< 1.0 pg/mL), findings consistent with ACTH-independent CS. Urinary metanephrines and catecholamines were normal, and the remaining analytical study showed no major changes, apart from glycated hemoglobin (HbA1c) of 6.8%. Adrenal computed tomography (CT) scan showed a 25 mm lesion in the left adrenal gland, with density non-suggestive of adenoma. The patient underwent unilateral adrenalectomy and started steroid replacement. Histology revealed an adrenal cortex adenoma. Three months after surgery the patient presented with resolution of HBP and hypercortisolism (UFC 37.4 µg/day; reference range 36.0–137.0 µg/day). Conclusion: In some cases, CS signs may go unnoticed and the diagnosis postponed. Avascular necrosis is a rare presenting feature of endogenous hypercortisolism, and, if left untreated, complete collapse of the femoral head may ensue, rendering the need for hip replacement in up to 70% of patients. Suspicion and recognition of atypical features is therefore important in avoiding complications and delay in treatment of CS

Pilot Study to Reduce Added Salt on a University Canteen through the Use of an Innovative Dosage Equipment

Background: This study aims to demonstrate the practical application of an innovative easy-to-use equipment to dosage cooking salt, and evaluate the effectiveness in reducing 30% of the added salt in meals and the impact on consumers satisfaction and food waste. Methods: Two canteens from one public university where randomized in one control arm and one intervention arm. The first step was to evaluate the salt added to food through atomic emission spectrophotometry in both canteens, and the second step was to perform gradual reductions of up to 30% of cooking salt in the intervention canteen using the Salt Control-C (SC-C) equipment. Consumer acceptability was assessed through satisfaction questionnaires and food waste was evaluated by weighing. Results: The intervention canteen achieved to a reduction of more than 30% of added salt in soup (34.3% per 100 g), fish dish (41.1% per 100 g) and meat dish (48.0% per 100 g), except for the vegetarian dish (6.1% per 100 g). There was no decrease in consumer satisfaction, with a significant satisfaction increase of 15.7% (p = 0.044) regarding the flavor of the main dish. Also, no significant differences were found in food waste. Conclusions: SC-C seems to be effective in reducing 30% of added salt levels in canteen meals, and may be a good strategy to control and reach adequate levels of added salt in meals served outside-the-home, promoting benefits to the individuals health. (c) 2022 by the authors. Licensee MDPI, Basel, Switzerland

Innovative equipment to monitor and control salt usage when cooking at home: IMC SALT research protocol for a randomised controlled trial

Introduction Excessive salt intake is a public health concern due to its deleterious impact on health. Most of the salt consumed come from those that are added when cooking. This study will improve knowledge on the effectiveness of interventions to reduce salt consumption among consumers. Methods and analysis In this randomised clinical trial, we will be evaluating the efficacy of an intervention - the Salt Control H, an innovative prototype equipment to monitor and control use of salt when cooking - among workers from a public university, with the aim of reducing their dietary salt intake. We will randomly select 260 workers who meet the eligibility criteria and who are enrolled to an occupational health appointment and randomise them into one of the two arms of the study (either control or intervention), with matched baseline characteristics (sex and hypertension). The intervention will last for 8 weeks, during which the participants will use the equipment at home to monitor and control their use of salt when cooking. The main outcome will be 24-hour urinary sodium excretion at baseline, at fourth and eighth weeks of intervention, and at 6 months after intervention. Ethics and dissemination Ethical approval for the study has been obtained from the Ethics Committee of the Centro Hospitalar Universitário São João. The results of the investigation will be published in peer-reviewed scientific papers and presented at international conferences. Trial registration number NCT03974477 Equipment provisional patent number Registered at INPI: 20191000033265. (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ

Angular relationships regulate coordination tendencies of performers in attacker–defender dyads in team sports

This study examined the continuous interpersonal interactions of performers in dyadic systems in team sports, as a function of changing information constraints. As a task vehicle, we investigated how attackers attained success in 1v1 sub-phases of basketball by exploring angular relations with immediate opponents and the basket. We hypothesized that angular relations would convey information for the attackers to dribble past defenders. Four basketball players performed as an attacker and defender in 1v1 sub-phases of basketball, in which the co-positioning and orientation of participants relative to the basket was manipulated. After video recording performance behaviors, we digitized participant movement displacement trajectories and categorized trials as successful or unsuccessful (from the attackers’ viewpoint). Results revealed that, to successfully dribble past a defender, attackers tended to explore the left hand side of the space by defenders by increasing their angular velocity and decreasing their angular variability, especially in the center of the court. Interpersonal interactions and goal-achievement in attacker–defender dyads appear to have been constrained by the angular relations sustained between participants relative to the scoring target. Results revealed the functionality of exploratory behaviors of participants attempting re-align spatial relations with an opponent in 1v1 sub-phases of team games

Multi-criteria decision analysis for bioenergy in the Centre Region of Portugal

With the consumption of fossil fuels, the resources essential to Man's survival are being rapidly contaminated. A sustainable future may be achieved by the use of renewable energies, allowing countries without non-renewable energy resources to guarantee energetic sovereignty. Using bioenergy may mean a steep reduction and/or elimination of the external dependency, enhancing the countries' capital and potentially reducing of the negative effects that outcome from the use of fossil fuels, such as loss of biodiversity, air, water, and soil pollution, … This work's main focus is to increase bioenergy use in the centre region of Portugal by allying R&D to facilitate determination of bioenergy availability and distribution throughout the study area.This analysis is essential, given that nowadays this knowledge is still very limited in the study area. Geographic Information Systems (GIS) was the main tool used to asses this study, due to its unseeingly ability to integrate various types of information (such as alphanumerical, statistical, geographical, …) and various sources of biomass (forest, agricultural, husbandry, municipal and industrial residues, shrublands, used vegetable oil and energy crops) to determine the bioenergy potential of the study area, as well as their spatial distribution. By allying GIS with multi-criteria decision analysis, the initial table-like information of difficult comprehension is transformed into tangible and easy to read results: both intermediate and final results of the created models will facilitate the decision making process. General results show that the major contributors for the bioenergy potential in the Centre Region of Portugal are forest residues, which are mostly located in the inner region of the study area. However, a more detailed analysis should be made to analyze the viability to use energy crops. As a main conclusion, we can say that, although this region may not use only this type of energy to be completely independent in terms of energy, it will certainly reduce the amount of consumed fossil fuels, leading to a substantial reduction of the importation of this product.publishe

Varying numbers of players in small-sided soccer games modifies action opportunities during training

This study examined the effects of the numbers of players involved in small-sided team games (underloading and overloading) on opportunities for maintaining ball possession, shooting at goal and passing to teammates during training. These practice constraint manipulations were assumed to alter values of key performance variables identified in previous research, such as interpersonal distances between players and time to intercept shots and passes. Fifteen male soccer players (age: 19.60±1.99 years) were grouped into three teams and played against each other in different versions of small-sided soccer games, in which the number of players was manipulated in three different conditions: 5 vs. 5, 5 vs. 4 and 5 vs. 3. Dependent variables were the values of interpersonal distance between an outfield attacker and nearest defender (ID), and the relative distance of a defender needed to intercept the trajectory of a shot (RDishot) or pass (RDipass). Statistical analyses revealed that mean ID values were significantly lower in 5 vs. 5 than in 5 vs. 4 and 5 vs. 3 conditions, and significantly lower in 5 vs. 4 than 5 vs. 3. They also revealed that mean values of RDishot were significantly higher in 5 vs. 3 than in 5 vs. 5 conditions. Finally, results showed that the mean values of RDipass were significantly higher in 5 vs. 3 than in 5 vs. 5. Findings revealed how task constraints in SSGs can be manipulated to vary values of key spatial and temporal performance variables (interpersonal distance and time to intercept) to influence the nature of interpersonal interactions between competing players during practice. We observed that these manipulations tended to decrease opportunities for maintaining ball possession during training when equal numbers of attackers and defenders existed in SSGs, and led to more shots and passes emerging when the number of defenders was decreased relative to attackers

Effects of suspension versus traditional resistance training on explosive strength in elementary school-aged boys

The aim of this study was to determine the effects of an 8-week program of resistance training (RT) or suspension training (ST) on explosive strength in prepubescent boys. Methods: Fifty-seven boys aged 10–11 years were assigned to 2 training groups, RT or ST or a control group (no training program). Boys trained twice weekly for 8 weeks. Results: A significant interaction was reported with a large (P < .001, η2p = .463), medium (P < .001, η2p = .395), and small effect sized (P ≤ .001, η2p = .218) in the 1-kg ball throw, 3-kg ball throw, and time-at-20-m test, respectively. There was no significant interaction in the countermovement vertical jump or the standing long jump. Changes from preintervention to postintervention for the 1-kg ball throw were 5.94% and 5.82% for the ST and RT, respectively, and 8.82% and 8.14% in the 3-kg ball throw for the ST and RT, respectively. The improvement in the 20-m sprint was 1.19% for the ST and 2.33% for the RT. Conclusion: Traditional RT and ST seem to be effective methods for improving explosive strength in prepubescent boys. ST could be considered as an alternative modality to optimize explosive strength training in school-based programs

Identification of a new European rabbit IgA with a serine-rich hinge region

<div><p>In mammals, the most striking IgA system belongs to Lagomorpha. Indeed, 14 IgA subclasses have been identified in European rabbits, 11 of which are expressed. In contrast, most other mammals have only one IgA, or in the case of hominoids, two IgA subclasses. Characteristic features of the mammalian IgA subclasses are the length and amino acid sequence of their hinge regions, which are often rich in Pro, Ser and Thr residues and may also carry Cys residues. Here, we describe a new IgA that was expressed in New Zealand White domestic rabbits of <i>IGHV</i>a1 allotype. This IgA has an extended hinge region containing an intriguing stretch of nine consecutive Ser residues and no Pro or Thr residues, a motif exclusive to this new rabbit IgA. Considering the amino acid properties, this hinge motif may present some advantage over the common IgA hinge by affording novel functional capabilities. We also sequenced for the first time the IgA14 CH2 and CH3 domains and showed that IgA14 and IgA3 are expressed.</p></div