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Pulsando la opinión de los alumnos que tuve en el centro de secundaria donde en el curso 2011/2012 realicé el prácticum, pude comprobar que la metodología utilizada en las asignaturas de Tecnología e Informática debería actualizarse. El alumnado me transmitió consciente e inconscientemente desmotivación y desinterés por las clases, pero sin embargo tuve alumnos que me pidieron recursos para aprender programación por cuenta propia. El objetivo del presente trabajo es investigar si existen metodologías que resulten atractivas para el alumno de secundaria, más concretamente para enseñar conocimientos básicos de programación e informática. Tras un repaso histórico por teorías del aprendizaje precursoras al aprendizaje basado en juegos, se analiza la visión de Marc Prensky sobre los Nativos Digitales y las metodologías que son más apropiadas para este tipo de alumnado. En el documento se analizan y discuten los beneficios y riesgos que pueden aportar los videojuegos, y si los mismos tienen aspectos positivos que pueden aportar en los procesos de aprendizaje presentes en nuestras escuelas. Asimismo en la memoria se plasma un trabajo de investigación y recopilación de diferentes herramientas y videojuegos que se ajustan al objetivo de enseñar programación a alumnos de secundaria de manera entretenida y ajustada al aprendizaje basado en juegos

Contribuição ao estudo dos elementos vasculares, arteriais e venosos, do hilo renal em cães da raça Pastor Alemão

In this paper we studied the number, distribution, the entry and exit sites of arterial branches and venous roots in 30 pairs of kidneys obtained from 15 male and 15 female German Shepherddogs. The paper was done not only to improve our knowledge of the kidney morphology but also to bring some data to comparative anatomy. The kidneys were dissected, at least 48 hours, after being fixed in a 10% formalin solution. Concerning the right kidney the arterial branches numbered 7 to 14 were localized in the craniodorsal and cranioventral quadrants while the venous roots numbered from 3 to 5 predominated in the cranioventral and caudoventral quadrants. Most of the vessels showed peripheral situation. In relation to the left kidney the arterial branches numbered from 8 to 15 were seen in the craniodorsal quadrant and the venous roots numbered 2 to 4 in the caudoventral quadrant. We found an exclusive peripherical situation for the arterial branches and venous roots in almost all kidneys examined.Procurou-se analisar na região hilar o número, a disposição e os locais de entrada e saída, respectivamente dos ramos arteriais e raízes venosas em 30 pares de rins de cães da raça Pastor Alemão, 15 machos e 15 fêmeas, objetivando, não apenas melhor conhecer a morfologia destes animais, como também fornecer dados para a Anatomia Comparativa. Os referidos órgãos foram dissecados depois de fixados em solução aquosa de formol a 10%, durante no mínimo 48 horas. Examinados os dados obtidos para o rim direito, relativamente aos ramos arteriais, computados de 7 a 14;verificou-se que o maior povoamento vascular corresponde aos quadrantes craniodorsal e cranioventral. Para as raízes venosas, anotadas de 3 a 5, a maior concentração foi registrada nos quadrantes cranioventral e caudoventral. No concernente à situação global dos ramos arteriais e raízes venosas, encontrou-se a maioria dos vasos em situação exclusivamente periférica. No rim esquerdo, quanto aos ramos arteriais que variam de 8 a 15, observou-se maior povoamento vascular no quadrante craniodorsal. No tocante às raízes venosas, contadas de 2 a 4, viu-se maior concentração no quadrante caudoventral. Tanto para os ramos arteriais como para as raízes venosas encontrou-se, na quase totalidade das peças, disposição exclusivamente periférica

Innovative therapeutic approaches for the treatment of myocardial ischemia and angina

Cardiac energy metabolism is complex and has three main components: 1. Substrate utilisation, 2 Oxydative phosphorilation and 3. Transfer of high energy phosphates. Substrate utilization involves the cellular uptake of free fatty acids, glucose and amino acids, their breakdown by beta-oxidation and glycolysis, and the entry of Acetyl Coenzyme A into the Krebs cycle. Oxidative phosphorylation involves the production of energy by the mitochondrial respiratory chain and the production of high-energy phosphates. Until recent it was not known that it was possible to delimitate the infarct size through therapeutic interventions. Likely, the improvement to understand the mechanisms of cellular survivor occurs in that year, when Murry et al. discovered an intrinsic mechanism of myocardial protection, which they denominated as ischemic preconditioning. In that experiment, it was observed that four cycles of five minutes of ischemia, with intermittent reperfusion, before 40 min of ischemia period, resulted in reduction of 75% of the infarct size. Also, it was demonstrated by these researches that this protection it was not resulted by collateral overture and that protective effect of the ischemic preconditioning was abolished in the presence of prolonged ischemia, with duration of 3 h. Two phenomenons, the walk-through angina and the warm up phenomenon could represent a clinical manifestation of preconditioning. The phenomenon of walk-through angina was first related in the end of century XVIII in a patient that developed angina during the effort, but experimented the paradox disappearing of the pain with the exercise continuation. The exact molecular mechanisms involved in ischemic preconditioning are not fully elucidated. Therefore, due to the high prevalence of risk factors to cardiovascular diseases and the high morbidity and mortality associated with coronary artery disease, there is a needed to understand even better the cardiac metabolism during ischemia and the strategies to reduce the consequences of the ischemia, to preserve the viability of the ischemic myocardium

Correção cirúrgica de defeitos do pavilhão auricular. Emprego de malha de polipropileno

A surgical technique to correct faulty ears by polyprolylene mesh implantation was studied in 8 dogs. Satisfactory results were obtained in 7 dogs which showed erectness and proper movements of the ears. No retraction or thickning at the surgical site were observed.Foi estudada, em 8 animais da espécie canina, uma técnica operatória para correção de defeitos do pavilhão auricular, mediante  implantação de malha de polipropileno. Os resultados foram satisfatórios em 7 cães, que mostraram posição ereta e movimentação adequada das orelhas e ausência de retrações ou espessamento dos pavilhões auriculares.

Inverse association of circulating SIRT1 and adiposity. A study on underweight, normal weight, and obese patients

Context: Sirtuins (SIRTs) are NAD+-dependent deacetylases, cellular sensors to detect energy availability, and modulate metabolic processes. SIRT1, the most studied family member, influences a number of tissues including adipose tissue. Expression and activity of SIRT1 reduce with weight gain and increase in conditions of starvation. Objective: To focus on SIRT1 plasma concentrations in different conditions of adiposity and to correlate SIRT1 with fat content and distribution, energy homeostasis and inflammation in under-weight, normal-weight, and obese individuals. Materials and Methods: 21 patients with anorexia nervosa, 26 normal-weight and 75 patients with obesity were evaluated. Body fat composition by dual-energy X-ray absorptiometry, ultrasound liver adiposity, echocardiographic epicardial fat thickness (EFT), inflammatory (ESR, CRP, and fibrinogen), and metabolic (FPG, insulin, LDL- and HDL-cholesterol, triglycerides) parameters, calculated basal metabolic rate (BMR) and plasma SIRT1 (ELISA) were measured. Results: SIRT1 was significantly higher in anorexic patients compared to normal-weight and obese patients (3.27 ± 2.98, 2.27 ± 1.13, and 1.36 ± 1.31 ng/ml, respectively). Linear regression models for each predictor variable adjusted for age and sex showed that SIRT1 concentration was inversely and significantly correlated with EFT, fat mass %, liver fat content, BMR, weight, BMI, WC, LDL-cholesterol, insulin, ESR. Stepwise multiple regression analysis revealed that age and EFT were the best independent correlates of SIRT1 (β = -0.026 ± 0.011, p = 0.025, and β = -0.516 ± 0.083, p < 0.001, respectively). Conclusions: Plasma SIRT1 shows a continuous pattern that inversely follows the whole spectrum of adiposity. SIRT1 significantly associates with EFT, a strong index of visceral fat phenotype, better than other indexes of adiposity studied here

Trends in avoidable hospitalization rates in Italy, 2001-2008

Background: hospitalization for Ambulatory Care Sensitive Conditions (AC SC), also known as avoidable hospitalization (AH) has been proposed as effect measure of the accessibility and effectiveness of primary care. In the last years in developed countries, including Italy, hospitalization rates have decreased as well as the rates of AH. The decline of AH-rates could be just an effect of the general trend of hospitalization. The objective of our study was to examine the adjusted trend of AH rates and to test possible associations with measures of primary care (re)organization. Methods: hospital discharges from 2001 to 2008 were analyzed. Main outcome measures were hospitalization rates, both as inpatient and day hospital. ACSCs were grouped in acute conditions, preventable through early diagnoses and treatment and chronic conditions, preventable through good ongoing control and management. Expected time-series rates of AH, estimated on the hypothesis of same time trends of Total Hospitalization (TH), were compared with observed ones using a Chi Square test. Adjusted hospitalization rates were analyzed in conjunction with indicators of primary care. Results: in the studied period, in Italy, the TH rates declined with an average decrease of 19.6%, while the decrease for AH was 16.4%. The rates of AH adjusted for the trend of TH significantly decreased only for chronic conditions. Decreasing trend of AH was correlated with the impact of reorganization of primary care in associative forms. Conclusions: the presented methodology can be used to evaluate the real effectiveness of policies aimed at reducing hospitalization for ACSCs

Social relationships and HRQL: A cross-sectional survey among older Italian adults

BACKGROUND: The aim of this study is to investigate the association between social relationships and Health Related Quality of Life (HRQL) among the elderly in Italy. METHODS: A sample of 33,744 Italian residents, representing the non-institutionalised population aged 60 years and over was extracted from the national ISTAT cross-sectional survey during 1999-2000. HRQL was measured with the SF-12, from which the Physical Component Score (PCS) and Mental Component Score (MCS) were obtained. Data were subjected to descriptive analysis and multiple logistic regression models with adjustment for the main confounders. RESULTS: Our analysis shows a gradient in PCS and MCS among the terziles in seeing/meeting "friends" and "family" and, for PCS, a North-South gradient among the Italian regions. Females, the elderly who reported a lower household income, those who spent less time in recreational and religious activities, who lived too far from their relatives and had few relationships with friends and relatives, were significantly less likely to have an MCS above the median value. For PCS, an increase in HRQL was likely to be associated with a higher educational level, while lower PCS scores were associated with: age 75+, inadequate household income, unmarried status, infrequency of seeing/meeting friends, too high a mean distance from own home to relatives' homes, lack of leisure time spent in recreational activities, living in the Centre-South of Italy, chronic diseases, reduced autonomy, and use of drugs during the previous two days. Significant interactions between suffering from one chronic disease and the use of drugs were also found for both MCS and PCS. CONCLUSION: Some dimensions of social relationships were significantly associated with HRQL. These findings are crucial for devising welfare strategies at both the regional and the European level, i.e. in countries such as Italy where the primacy of family support of the elderly has declined in recent year

Effect of external PEEP in patients under controlled mechanical ventilation with an auto-PEEP of 5 cmH2O or higher.

In some patients with auto-positive end-expiratory pressure (auto-PEEP), application of PEEP lower than auto-PEEP maintains a constant total PEEP, therefore reducing the inspiratory threshold load without detrimental cardiovascular or respiratory effects. We refer to these patients as complete PEEP-absorbers. Conversely, adverse effects of PEEP application could occur in patients with auto-PEEP when the total PEEP rises as a consequence. From a pathophysiological perspective, all subjects with flow limitation are expected to be complete PEEP-absorbers, whereas PEEP should increase total PEEP in all other patients. This study aimed to empirically assess the extent to which flow limitation alone explains a complete PEEP-absorber behavior (i.e., absence of further hyperinflation with PEEP), and to identify other factors associated with it.One hundred patients with auto-PEEP of at least 5 cmH2O at zero end-expiratory pressure (ZEEP) during controlled mechanical ventilation were enrolled. Total PEEP (i.e., end-expiratory plateau pressure) was measured both at ZEEP and after applied PEEP equal to 80 % of auto-PEEP measured at ZEEP. All measurements were repeated three times, and the average value was used for analysis.Forty-seven percent of the patients suffered from chronic pulmonary disease and 52 % from acute pulmonary disease; 61 % showed flow limitation at ZEEP, assessed by manual compression of the abdomen. The mean total PEEP was 7 ± 2 cmH2O at ZEEP and 9 ± 2 cmH2O after the application of PEEP (p < 0.001). Thirty-three percent of the patients were complete PEEP-absorbers. Multiple logistic regression was used to predict the behavior of complete PEEP-absorber. The best model included a respiratory rate lower than 20 breaths/min and the presence of flow limitation. The predictive ability of the model was excellent, with an overoptimism-corrected area under the receiver operating characteristics curve of 0.89 (95 % CI 0.80-0.97).Expiratory flow limitation was associated with both high and complete PEEP-absorber behavior, but setting a relatively high respiratory rate on the ventilator can prevent from observing complete PEEP-absorption. Therefore, the effect of PEEP application in patients with auto-PEEP can be accurately predicted at the bedside by measuring the respiratory rate and observing the flow-volume loop during manual compression of the abdomen

How cardiologists can manage excess body weight and related cardiovascular risk. An expert opinion

Obesity is an important independent cardiovascular (CV) risk factor and a chronic inflammatory disease related to the development of insulin resistance, type 2 diabetes, dyslipidaemia, coronary artery disease, hypertension, heart failure, atrial fibrillation and obstructive sleep apnoea. Body Mass Index (BMI) values >27 Kg/m2 are associated with an exponential increase in the risk for Major Adverse Cardiac Events (MACE). On the other hand, weight reduction can significantly reduce metabolic, CV and oncological risk. Orlistat, bupropion/naltrexone, liraglutide and semaglutide, combined with lifestyle changes, have proven to be effective in weight loss; the last two have been tested in randomized clinical trials (RCTs) with CV outcomes only in diabetic patients, and not in obese patients. To fill a fundamental gap of knowledge, the SELECT trial on patients with obesity and CV disease treated with semaglutide is ongoing, aiming at MACE as the primary endpoint. The battle against the social and clinical stigma towards obesity must be counteracted by promoting an awareness that elevates obesity to a complex chronic disease. Several actions should be implemented to improve the management of obesity, and cardiologists have a key role for achieving a global approach to patients with excess weight also through the correct implementation of available treatment strategies