Abstract In this article, we point out an interesting solution for the dynamics of a racecar in a banked circular track with banking angle well over 90°. We call this track configuration an Inverted Track, at which a racecar can drive partially upside-down. We show an experimental setup, where we made a toy car to circulate upside-down held only by its friction to the track. We discuss the viability to perform the aforementioned stunt with a real racecar in terms of the velocities required, dimensions of the track and safety; provided a passionate motorsport related company to commission it. For most racecars, the aerodynamic down-force is significant and it is included in our analysis.

ABSTRACT Objective The aim of the present study was to evaluate parameters of bone and mineral metabolism after bariatric surgery. Subjects and methods This sectional study included data from medical records from 61 bariatric surgery (BS) patients (minimum period of 6 months after the procedure) and from 30 class II and III obese patients as a control group (Cont), consisting of daily dietary intake of macronutrients, calcium and sodium, serum 25(OH)D and parathyroid hormone (PTH) and other biochemical serum and urinary parameters. Bone alkaline phosphatase (BAP), leptin, fibroblast growth factor-23 (FGF-23) and deoxypyridinoline (DPYD) were determined from available banked serum and urinary samples. Results Mean body mass index (BMI), median energy, carbohydrate, protein and sodium chloride consumption were significantly lower in the BS versus Cont, but calcium and lipids were not. No significant differences were found in ionized calcium, 25(OH)D, PTH and fibroblast growth factor 23 (FGF-23) between groups. Mean serum BAP was significantly higher for BS versus Cont and had a positive correlation with time after the surgical procedure. Mean serum leptin was significantly lower and median urinary DPYD higher in BS versus Cont. Conclusion The present study showed an increase in bone markers of both bone formation and resorption among bariatric patients up to more than 7 years after the surgical procedure, suggesting that an increased bone turnover persists even at a very long-term follow-up in such patients.

Deceased donor skin possesses many of the properties of the ideal biological dressing, and a well-stocked skin bank has become a critically important asset for the modern burn surgeon. Without it, managing patients with extensive burns and wounds becomes far more challenging, and outcomes are significantly worse. With the recent establishment of such a bank in South Africa, the challenge facing the medical fraternity is to facilitate tissue donation so that allograft skin supply can match the enormous demand.

Retrograde autologous priming (RAP) has been routinely applied in cardiac pediatric cardiopulmonary bypass (CPB). However, this technique is performed in pediatric patients weighing more than 20 kg, and research about its application in pediatric patients weighing less than 20 kg is still scarce. This study explored the clinical application of RAP in CPB in pediatric patients undergoing cardiac surgery. Sixty pediatric patients scheduled for cardiac surgery were randomly divided into control and experimental groups. The experimental group was treated with CPB using RAP, while the control group was treated with conventional CPB (priming with suspended red blood cells, plasma and albumin). The hematocrit (Hct) and lactate (Lac) levels at different perioperative time-points, mechanical ventilation time, hospitalization duration, and intraoperative and postoperative blood usage were recorded. Results showed that Hct levels at 15 min after CPB beginning (T2) and at CPB end (T3), and number of intraoperative blood transfusions were significantly lower in the experimental group (P<0.05). There were no significant differences in CPB time, aortic blocking time, T2-Lac value or T3-Lac between the two groups (P>0.05). Postoperatively, there were no significant differences in Hct (2 h after surgery), mechanical ventilation time, intensive care unit time, or postoperative blood transfusion between two groups (P>0.05). RAP can effectively reduce the hemodilution when using less or not using any banked blood, while meeting the intraoperative perfusion conditions, and decreasing the perioperative blood transfusion volume in pediatric patients.

Objetivo:Avaliar o perfil plasmático do aminoácido fenilalanina em recém-nascidos pré-termo alimentados com diferentes dietas de leite humano.Métodos:Foram estudados 24 recém-nascidos pré-termo de muito baixo peso, distribuídos em três grupos com diferentes dietas: Grupo I: leite humano de banco com 5% de aditivo comercial para leite humano com proteína de origem bovina (LHB-AC); Grupo II: leite humano de banco com aditivo de leite humano modificado evaporado (LHB-E); e Grupo III: leite humano de banco com aditivo de leite humano modificado liofilizado (LHB-L). Os recém-nascidos receberam a dieta definida para o grupo quando alcançaram dieta plena por 15 ± 2 dias. A análise do aminoácido plasmático foi feita no primeiro e último dias da dieta. A comparação entre os grupos foi realizada por meio do teste ANOVA de uma via, seguido pelo pós-teste de Tukey, utilizando-se o software SPSS (IBM Corp, NY, EUA), versão 20.0, e considerando um nível de significância de 5%.Resultados:As concentrações plasmáticas do aminoácido fenilalanina na primeira e segunda análises foram, respectivamente, no Grupo I (LHB-AC) 11,9±1,22 e 29,72±0,73; no Grupo II (LHB-E) 11,72±1,04 e 13,44±0,61; e no Grupo III 11,3±1,18 e 15,42±0,83 umol/L.Conclusão:Os resultados encontrados demonstram que o leite humano com aditivos do próprio leite humano comportou-se como um bom substrato para alimentação do recém-nascido pré-termo, tanto na forma evaporada como liofilizada, sem levar a aumentos significativos na concentração plasmática de fenilalanina em comparação ao leite humano com aditivo comercial.

Objective:To evaluate phenylalanine plasma profile in preterm newborns fed different human milk diets.Methods:Twenty-four very-low weight preterm newborns were distributed randomly in three groups with different feeding types: Group I: banked human milk plus 5% commercial fortifier with bovine protein, Group II: banked human milk plus evaporated fortifier derived from modified human milk, Group III: banked human milk plus lyophilized fortifier derived from modified human milk. The newborns received the group diet when full diet was attained at 15 ± 2 days. Plasma amino acid analysis was performedon the first and last day of feeding. Comparison among groups was performed by statistical tests: one way ANOVA with Tukey's post-test using SPSS software, version 20.0 (IBM Corp, NY, USA), considering a significance level of 5%.Results:Phenylalanine levels in the first and second analysis were, respectively, in Group I: 11.9 ± 1.22 and 29.72 ± 0.73; in Group II: 11.72 ± 1.04 and 13.44 ± 0.61; and in Group III: 11.3 ± 1.18 and 15.42 ± 0.83 μmol/L.Conclusion:The observed results demonstrated that human milk with fortifiers derived from human milk acted as a good substratum for preterm infant feeding both in the evaporated or the lyophilized form, without significant increases in plasma phenylalanine levels in comparison to human milk with commercial fortifier.

OBJETIVOS: Descrever a metodologia de preparo de dois aditivos, líquido e em pó, derivados do leite humano e comparar a constituição com aditivo comercial FM85®. MÉTODOS: Foram utilizadas 40 amostras de leite humano para o preparo dos suplementos líquido e em pó. Ambos passaram por três fases de preparo: desnate, evaporação e retirada da lactose. Após essas fases, o suplemento líquido está pronto, e o em pó necessita da quarta fase - a liofilização. Em cada amostra dos suplementos líquido e em pó, foram adicionados, respectivamente, 80 mL (grupo I) e 100 mL (grupo II) de pool de leite humano de banco. Para comparação, 20 amostras de 100 mL do pool foram acrescidas de 5 g do suplemento FM85® (Nestlé) (grupo III). Realizaram-se análises de hidratos de carbono, proteína, lipídios, cálcio, fósforo, sódio, osmolalidade e conteúdo calórico, considerando diferença significativa p < 0,05. RESULTADOS: Os grupos I, II e III mostraram, respectivamente, os seguintes resultados: proteínas = 1,81, 2,38 e 1,96 g/dL (p < 0,001); hidratos de carbono = 6,70, 7,25 e 10,06 g/dL (p = 0,006); gordura = 3,75, 3,75 e 3,73 g/dL (p = 0,96); cálcio = 36,92, 44,75 e 79,37 mg/dL (p = 0,001); fósforo = 20,02, 23,28 e 56,30 mg/dL (p = 0,02); sódio = 14,32, 14,40 e 20,33 mEq/L (p = 0,143); osmolalidade = 391,45, 412,47 e 431, 00 mOsmol/kgH2O (p = 0,074); e conteúdo calórico = 67,78, 72,27 e 81,65 kcal (p = 0,001). CONCLUSÃO: Os aditivos estudados diferem significativamente do aditivo comercial FM85® em alguns de seus constituintes, e a sua constituição pode ou não atender às quantidades de nutrientes propostas pelas recomendações mais recentes.

OBJECTIVES: To describe the methodology for the preparation of two additives derived from human milk, liquid and powdered, and to compare this composition with the commercial additive FM85®. METHODS: For the preparation of the liquid and powdered supplements, 40 samples of human milk were used. Both supplements have been through three preparation phases: skimming, evaporation and lactose removal. After these phases, the liquid supplement is ready, and the powdered requires a fourth phase - lyophilization. To each sample of the liquid and powdered supplements were added, respectively, 80 mL (group I) and 100 mL (group II) of pooled banked human milk. For comparison, 20 samples of 100 mL of the pool were added to 5 g of the FM85® supplement (Nestlé) (group III). Analyses of carbohydrates, protein, lipids, calcium, phosphorus, sodium, osmolality and caloric content were performed, considering a significant difference p < 0.05. RESULTS: Groups I, II, and III showed, respectively, the following results: protein = 1.81, 2.38 and 1.96 g/dL (p < 0.001); carbohydrates = 6.70, 7.25 and 10.06 g/dL (p = 0.006); fat = 3.75, 3.75 and 3.73 g/dL (p = 0.96); calcium = 36.92, 44.75 and 79.37 mg/dL (p = 0.001); phosphorus = 20.02, 23.28 and 56.30 mg/dL (p = 0.02); sodium = 14.32, 14.40 and 20.33 mEq/L (p = 0.143); osmolality = 391.45, 412.47 and 431.00 mOsmol/kgH2O (p = 0.074); and caloric content = 67.78, 72.27 and 81.65 kcal (p = 0.001). CONCLUSION: The studied additives differ significantly from the commercial additive FM85® in some of its components, and its composition may or may not meet the quantity of nutrients suggested by the most recent recommendations.

PURPOSE: Report the characteristics of cryopreserved semen from a cohort of male cancer patients, attitudes towards cryopreservation and outcomes of semen samples based on a 12-year cryopreservation program. MATERIAL AND METHODS: Data from 98 male cancer patients whose sperm samples were banked were evaluated. Demographic parameters, semen characteristics, destination of sperm banked samples and questionnaires answered by the patients regarding cryopreservation time were evaluated. RESULTS: The cancer diagnoses were testicle (56.1%), prostate (15.3%), Hodgkin’s lymphomas (9.2%), non-Hodgkin’s lymphomas (7.1%), leukemia (3.1%) and other malignancies (9.2%). The patients with testicular cancer presented lower sperm concentration (p < 0.001); however, there were no differences with the percentage of normozoospermic patients among cancer type groups (p = 0.185). A shorter time between cancer diagnosis and sperm banking was observed for testicular and prostate cancer patients (p < 0.001). Most of the patients (89.5%) favored sperm banking as a fertility preservation method. CONCLUSIONS: Although less than 20% of banked sperm samples were disposed of, the majority of patients related sperm banking with safe for fertility preservation. Our results show that all male cancer patients of reproductive age facing cancer treatment could be offered sperm banking.

Enterococcus spp bacteremia is associated with high mortality and the appearance of high-level gentamicin resistance (HLGR) created additional challenges for the treatment of these infections. We evaluated the epidemiological and clinical characteristics of patients with bacteremias caused by HLGR and non_HLGR Enterococcus faecalis isolates at a teaching hospital in the State of São Paulo, Brazil. Patients with bacteremia due to E. faecalis diagnosed between January 1999 and December 2003 were included in the study. We collected clinical, epidemiological, and microbiological data from medical records. Banked isolates were typed using pulsed-field gel electrophoresis. We identified 145 cases of E. faecalis bacteremia: 66 (45.5%) were caused by HLGR isolates and 79 (54.5%) by non_HLGR. In the univariate analysis, patients with HLGR infection were older, had higher rates of bladder catheterization, and more often had treatment with cephalosporin, quinolone, and/or carbapenem compared with patients with non_HLGR infection (P < 0.05). Multivariate analysis indicated that older age, hematological malignancy, and previous use of vancomycin were independently associated with HLGR (P < 0.05). Mortality rates were not significantly different among patients with HLGR (50%) and non_HLGR (43%) infections (P = 0.40). Of the 32 genotyped isolates, 16 were distributed into 6 main electrophoresis patterns and 16 others had distinct patterns. E. faecalis bacteremia is associated with high mortality and is frequently caused by HLGR isolates at this teaching hospital. The variability among genotyped isolates suggests that endogenous infections, rather than patient-to-patient transmission of E. faecalis, are more common at this institution.

OBJETIVO: Esta pesquisa teve como objetivo investigar, em recém-nascidos prematuros, os efeitos renais da adição de suplemento ao leite humano de banco. MÉTODO: Ensaio clínico de intervenção, tipo antes e após, envolvendo 28 recém-nascidos prematuros distribuídos em dois grupos conforme a idade pós-concepção no início do estudo: GI < 34 semanas (n = 14) e GII > 34 semanas (n = 14), avaliados em três momentos: M1 = uso do leite humano de banco sem suplemento; M2 = após 3 dias e; M3 = 10-13 dias de uso do leite com suplemento. Foram comparadas oferta alimentar, evolução ponderal, fração de excreção de sódio, osmolaridade e densidade urinária pela análise estatística two-way ANOVA para medidas repetidas. RESULTADOS: A oferta hídrica, energética e de sódio foi similar nos dois grupos, e a evolução ponderal foi satisfatória. Nos prematuros < 34 semanas de idade pós-concepção, o sódio sérico diminuiu ao final do estudo e a fração de excreção de sódio foi elevada no início e final do estudo (M1 = 2,11±1,05; M2 = 1,25±0,64; M3 = 1,62±0,88), com diferença significante em relação ao GII (M1 = 1,34±0,94; M2 = 0,90±0,54; M3 = 0,91±0,82). Osmolaridade e densidade urinária foram normais, sem diferenças entre grupos e momentos. CONCLUSÃO: Não foi detectado efeito adverso na função renal dos prematuros com o uso de leite humano de banco suplementado.

OBJECTIVE: This research was performed with the objective of investigating the renal effects on premature newborn infants of fortifying banked donor human milk. METHODS: Clinical intervention trial, of the before-and-after type, involving 28 premature newborn infants split into two groups by postconceptional age at the start of the study: GI < 34 weeks (n = 14) and GII > 34 weeks (n = 14), and assessed at three sample points: S1, on unfortified donor human milk, S2, after 3 days, and S3, after 10-13 days on fortified donor human milk. Nutrient intake, weight gain, fractional sodium excretion, urinary osmolality and specific density were compared with two-way ANOVA for repeated measures. RESULTS: Fluids, energy and sodium intakes were similar for both groups, and weight gain was satisfactory. Among the preterms with < 34 weeks postconceptional age, serum sodium was lower at the end of the study and the fractional sodium excretion was elevated at the start and at the end of the study (S1 = 2.11±1.05; S2 = 1.25±0.64; S3 = 1.62±0.88), with a significant difference in relation to GII (S1 = 1.34±0.94; S2 = 0.90±0.54; S3 = 0.91±0.82). Osmolality and urinary specific density were normal, with no differences between groups or collection dates. CONCLUSIONS: No adverse effects on the renal function of these preterms were detected as a result of being fed fortified donor human milk.