Microplastic pollution and nutrient enrichment shift the diet of freshwater macroinvertebrates.

Microplastic pollution poses a global threat to freshwater ecosystems, with laboratory experiments indicating potential toxic impacts through chemical toxicity, physical abrasion, and false satiation. Bioplastics have emerged as a potential greener alternative to traditional oil-based plastics. Yet, their environmental effects remain unclear, particularly at scales relevant to the natural environment. Additionally, the interactive impacts of microplastics with other environmental stressors, such as nutrient enrichment, are poorly understood and rarely studied. Under natural conditions organisms might be able to mitigate the toxic effects of microplastics by shifting their diet, but this ability may be compromised by other stressors. This study combines an outdoor mesocosm experiment and stable isotope analysis to determine changes in the trophic niches of three freshwater invertebrate species exposed to conventional (HDPE) and bio-based biodegradable (PLA) microplastics at two concentrations, both independently and combined with nutrient enrichment. Exposure to microplastics altered the isotopic niches of two of the invertebrate species, with nutrient enrichment mediating this effect. Moreover, the effects of microplastics were consistent regardless of their type or concentration. Under enriched conditions, two of the species exposed to microplastics shifted to a specialised diet compared with controls, whereas little difference was observed between the isotopic niches of those exposed to microplastic and controls under ambient nutrient conditions. Additionally, PLA was estimated to support 24 % of the diet of one species, highlighting the potential assimilation of bioplastics by biota and possible implications. Overall, these findings suggest that the toxic effects of microplastics suggested from laboratory studies might not manifest under real-world conditions. However, this study does demonstrate that subtle sublethal effects occur even at environmentally realistic microplastic concentrations. The crucial role of nutrient enrichment in mediating microplastic effects underscores the importance of considering microplastic pollution in the context of other environmental stressors.

Hydroxytyrosol, a Promising Supplement in the Management of Human Stroke: An Exploratory Study.

Hydroxytyrosol (HT) is a bioactive olive oil phenol with beneficial effects in a number of pathological situations. We have previously demonstrated that an HT-enriched diet could serve as a beneficial therapeutic approach to attenuate ischemic-stroke-associated damage in mice. Our exploratory pilot study examined this effect in humans. Particularly, a nutritional supplement containing 15 mg of HT/day was administered to patients 24 h after the onset of stroke, for 45 days. Biochemical and oxidative-stress-related parameters, blood pressure levels, serum proteome, and neurological and functional outcomes were evaluated at 45 and 90 days and compared to a control group. The main findings were that the daily administration of HT after stroke could: (i) favor the decrease in the percentage of glycated hemoglobin and diastolic blood pressure, (ii) control the increase in nitric oxide and exert a plausible protective effect in oxidative stress, (iii) modulate the evolution of the serum proteome and, particularly, the expression of apolipoproteins, and (iv) be beneficial for certain neurological and functional outcomes. Although a larger trial is necessary, this study suggests that HT could be a beneficial nutritional complement in the management of human stroke.

Intestinal microbiota modulation at the strain level by the olive oil polyphenols in the diet.

Introduction: Previously we have reported a r16S gene next generation sequencing study on the effect of high fat diets in the intestinal microbiota using a murine model. However, many important microbial traits occur at strain level and, in order to detect these population changes, culture-dependent approaches need to be applied. With this goal, we decided to study a very well-known commensal genus, Enterococcus, and therefore, intestinal enterococci methodically isolated during the above-mentioned experiment were analyzed. Materials and methods: A collection of 75 distinct enterococcal strains isolated from feces of mice fed a standard diet or high-fat diets enriched with butter, refined olive oil, or extra virgin olive oil and after 0, 6 or 12 weeks of diet, were genetically and phenotypically characterized in search of virulence factors, biogenic amine production and antibiotic resistance. All strains were tested for the susceptibility in vitro to two virgin olive oil polyphenols, oleuropein (the bitter principle of olives) and hydroxytyrosol (derived from oleuropein by enzymatic hydrolysis and responsible for the high stability of olive oil). Results: No drastic polyphenol effect was found except at high concentrations. However, when carrying out a comparative statistical study in the 75 strains of the collection according to the different diets, we have detected significant differences between the strains isolated from mice fed with a diet enriched with virgin olive oil and the rest of the diets. EVOO strains also presented less resistance to antibiotics and a more beneficial profile overall. Discussion: These results support the prebiotic role of polyphenols, showing how they are able to modulate the set of strains that comprises a genus in the gut, allowing them to adapt to a changing environment in the host's intestine and possibly exerting effects on its physiology.

Nutrient enrichment mediates the effect of biodegradable and conventional microplastics on macroinvertebrate communities.

There is growing concern regarding the lack of evidence on the effects bioplastics may have on natural ecosystems, whilst their production continues to increase as they are considered as a greener alternative to conventional plastics. Most research is limited to investigations of the response of individual taxa under laboratory conditions, with few experiments undertaken at the community or ecosystem scale, either investigating microplastics independently or in combination with other pollutants, such as nutrient enrichment. The aim of this study is to experimentally compare the effects of oil-based (high density polyethylene - HDPE) with those of bio-based biodegradable (polylactic acid - PLA) microplastics and their interaction with nutrient enrichment on freshwater macroinvertebrate communities under seminatural conditions. There were no significant differences in total abundance, alpha and beta diversities, or community composition attributable to the type of microplastics, their concentration, or nutrient enrichment compared with the control. However, there was a significant difference in macroinvertebrate alpha diversity between high concentrations of both microplastic types under ambient nutrient conditions, with lower diversity in communities exposed to HDPE compared with PLA. Nutrient enrichment mediated the effect of microplastic type, such that the diversity of macroinvertebrate communities exposed to HDPE were similar to those communities exposed to PLA. These findings suggest that the effects of microplastic pollution on macroinvertebrate communities are very weak at large-scale settings under seminatural conditions and that these effects might be mediated by the nutrient status of freshwater ecosystems. More research under large-scale, long-term, seminatural settings are needed in order to elucidate the impact of both conventional plastics and bioplastics on natural environments and their interactive effect with other occurring stressors and pollutants.

Analyzing the Role of Fe0 and Fe3+ in the Formation of Expanded Clay Aggregates.

The effect of the addition of Fe0 and Fe3+ on the formation of expanded clay aggregates was studied using iron-free kaolin as an aluminosilicates source. Likewise, the incorporation of cork powder as a source of organic carbon and Na2CO3 as a flux in the mixtures was investigated in order to assess its effect in combination with the iron phases. An experimental protocol, statistically supported by a mixture experiments/design of experiments approach, was applied to model and optimize the bloating index, density, absorption capacity, and mechanical strength. The process of expansion and pore generation and the associated decrease in density required the addition of iron, such that the optimum mixtures of these properties presented between 25 and 40 wt.% of Fe0 or Fe3+, as well as the incorporation of 3.5-5 wt.% of organic carbon. The addition of Fe3+ produced a greater volumetric expansion (max. 53%) than Fe0 (max. 8%), suggesting that the formation of the FeO leading to this phenomenon would require reducing and oxidizing conditions in the former and the latter, respectively. The experimental and model-estimated results are in good agreement, especially in the aggregates containing Fe0. This reinforces the application of statistical methods for future investigations.

Construction of nursing knowledge in commodified contexts: Views and experiences of nurses regarding primary care.

The commodification of health care, particularly primary care, presents challenges to care and knowledge development. The purpose of this study is to examine how nurses perceive and develop their knowledge in a commodified context. A mixed-methods study was conducted that included a closed-question survey and in-depth interviews with nurses in public primary care in Catalonia. There were 104 valid responses to the questionnaire and 10 in-depth interviews. The main findings of the survey were related to workload and limited time for nursing care. Six themes emerged from the in-depth interviews: (1) limited time for nursing, (2) feelings of burnout, (3) awareness of patient and family satisfaction, (4) organizational factors that favor nurses' needs, (5) organizational factors that hinder nurses' needs, and finally (6) public administration requirements. Participants perceive excessive workload and time constraints and feel that this affects their nursing care and their physical and mental health. However, nurses purposefully use knowledge patterns to cope with the problems associated with commodification. Nurses have multidimensional, contextualized, and integrated knowledge that allows them to optimize their care based on the needs of their patients. This research examines many challenges related to nursing practice and the nursing discipline and opens the door for further research that encompasses all areas of nursing.

Real-World Use of Highly Sensitive Liquid Biopsy Monitoring in Metastatic Breast Cancer Patients Treated with Endocrine Agents after Exposure to Aromatase Inhibitors.

Endocrine-resistant, hormone receptor-positive, and HER2-negative (HR+/HER2-) metastatic breast cancer (mBC) is largely governed by acquired mutations in the estrogen receptor, which promote ligand-independent activation, and by truncal alterations in the PI3K signaling pathway, with a broader range of gene alterations occurring with less prevalence. Circulating tumor DNA (ctDNA)-based technologies are progressively permeating the clinical setting. However, their utility for serial monitoring has been hindered by their significant costs, inter-technique variability, and real-world patient heterogeneity. We interrogated a longitudinal collection of 180 plasma samples from 75 HR+/HER2- mBC patients who progressed or relapsed after exposure to aromatase inhibitors and were subsequently treated with endocrine therapy (ET) by means of highly sensitive and affordable digital PCR and SafeSEQ sequencing. Baseline PIK3CA and TP53 mutations were prognostic of a shorter progression-free survival in our population. Mutant PIK3CA was prognostic in the subset of patients receiving fulvestrant monotherapy after progression to a CDK4/6 inhibitor (CDK4/6i)-containing regimen, and its suppression was predictive in a case of long-term benefit with alpelisib. Mutant ESR1 was prognostic in patients who did not receive concurrent CDK4/6i, an impact influenced by the variant allele frequency, and its early suppression was strongly predictive of efficacy and associated with long-term benefit in the whole cohort. Mutations in ESR1, TP53, and KRAS emerged as putative drivers of acquired resistance. These findings collectively contribute to the characterization of longitudinal ctDNA in real-world cases of HR+/HER2- mBC previously exposed to aromatase inhibitors and support ongoing studies either targeting actionable alterations or leveraging the ultra-sensitive tracking of ctDNA.

Evidence Supporting the Involvement of the Minority Compounds of Extra Virgin Olive Oil, through Gut Microbiota Modulation, in Some of the Dietary Benefits Related to Metabolic Syndrome in Comparison to Butter.

Extra virgin olive oil (EVOO) has proven to yield a better health outcome than other saturated fats widely used in the Western diet, including a distinct dysbiosis-preventive modulation of gut microbiota. Besides its high content in unsaturated fatty acids, EVOO also has an unsaponifiable polyphenol-enriched fraction that is lost when undergoing a depurative process that gives place to refined olive oil (ROO). Comparing the effects of both oils on the intestinal microbiota of mice can help us determine which benefits of EVOO are due to the unsaturated fatty acids, which remain the same in both, and which benefits are a consequence of its minority compounds, mainly polyphenols. In this work, we study these variations after only six weeks of diet, when physiological changes are not appreciated yet but intestinal microbial alterations can already be detected. Some of these bacterial deviations correlate in multiple regression models with ulterior physiological values, at twelve weeks of diet, including systolic blood pressure. Comparison between the EVOO and ROO diets reveals that some of these correlations can be explained by the type of fat that is present in the diet, while in other cases, such as the genus Desulfovibrio, can be better understood if the antimicrobial role of the virgin olive oil polyphenols is considered.

Contrasting the effects of microplastic types, concentrations and nutrient enrichment on freshwater communities and ecosystem functioning.

Microplastics are now ubiquitous in freshwater environments. As most previous research has focused on species-specific effects of microplastics under controlled laboratory conditions, little is known about the impact of microplastics at higher levels of ecological organisation, such as freshwater communities and their associated ecosystem functions. To fill this knowledge gap, an outdoor experiment using 40 freshwater mesocosms, each 1.57 m3, was used to determine the effects of (i) microplastic type: traditional oil-based high-density polyethylene versus bio-based biodegradable polylactic acid, (ii) concentration of microplastic particles and (iii) nutrient enrichment. The two concentrations of microplastics used were equivalent to measured environmentally occurring concentrations and concentrations known to cause toxicological effects under laboratory conditions. Freshwater communities are also at increasing risk from nutrient enrichment, which can alter community composition in favour of competitively dominant taxa. The independent and interactive effects of these treatments on pelagic community structure (phytoplankton standing stock, taxonomic richness, and composition) and ecosystem functioning (periphyton productivity and leaf litter decomposition) were assessed. Taxonomic richness and community composition were not affected by exposure to the experimental treatments and there were no significant treatment effects on phytoplankton standing stock, periphyton productivity, total or microbial leaf litter decomposition. Overall, multiple microplastic exposures, crossed with nutrient addition had little impact on the structure and functioning of semi-natural freshwater ecosystems. These findings indicate that the negative impacts of microplastics predicted from species-specific studies may not be readily realised at the ecosystem scale.

Risk of thromboembolic events in relation to the management of anticoagulant and antiagregant therapy in patients subjected to endoscopic retrograde cholangiopancreatography. / Riesgo de eventos tromboembólicos en función del manejo de la terapia anticoagulante y antiagregante en pacientes sometidos a colangiopancreatografía retrógrada endoscópica.

BACKGROUND AND OBJECTIVES: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. PATIENTS AND METHODS: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. RESULTS: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). CONCLUSIONS: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.

From microbes to ecosystems: a review of the ecological effects of biodegradable plastics.

Biodegradable plastics have been proposed as a potential solution to plastic pollution, as they can be biodegraded into their elemental components by microbial action. However, the degradation rate of biodegradable plastics is highly variable across environments, leading to the potential for accumulation of plastic particles, chemical co-contaminants and/or degradation products. This paper reviews the toxicological effects of biodegradable plastics on species and ecosystems, and contextualises these impacts with those previously reported for conventional polymers. While the impacts of biodegradable plastics and their co-contaminants across levels of biological organisation are poorly researched compared with conventional plastics, evidence suggests that individual-level effects could be broadly similar. Where differences in the associated toxicity may arise is due to the chemical structure of biodegradable polymers which should facilitate enzymatic depolymerisation and the utilisation of the polymer carbon by the microbial community. The input of carbon can alter microbial composition, causing an enrichment of carbon-degrading bacteria and fungi, which can have wider implications for carbon and nitrogen dynamics. Furthermore, there is the potential for toxic degradation products to form during biodegradation, however understanding the environmental concentration and effects of degradation products are lacking. As global production of biodegradable polymers continues to increase, further evaluation of their ecotoxicological effects on organisms and ecosystem function are required.

High fat diets induce early changes in gut microbiota that may serve as markers of ulterior altered physiological and biochemical parameters related to metabolic syndrome. Effect of virgin olive oil in comparison to butter.

Butter and virgin olive oil (EVOO) are two fats differing in their degree of saturation and insaponifiable fraction. EVOO, enriched in polyphenols and other minority components, exerts a distinct effect on health. Using next generation sequencing, we have studied early and long-term effects of both types of fats on the intestinal microbiota of mice, finding significant differences between the two diets in the percentage of certain bacterial taxa, correlating with hormonal, physiological and metabolic parameters in the host. These correlations are not only concomitant, but most noticeably some of the changes detected in the microbial percentages at six weeks are correlating with changes in physiological values detected later, at twelve weeks. Desulfovibrionaceae/Desulfovibrio/D. sulfuricans stand out by presenting at six weeks a statistically significant higher percentage in the butter-fed mice with respect to the EVOO group, correlating with systolic blood pressure, food intake, water intake and insulin at twelve weeks. This not only suggests an early implication in the probability of developing altered physiological and biochemical responses later on in the host lifespan, but also opens the possibility of using this genus as a marker in the risk of suffering different pathologies in the future.

Prevalence of an Intestinal ST40 Enterococcus faecalis over Other E. faecalis Strains in the Gut Environment of Mice Fed Different High Fat Diets.

E. faecalis is a commensal bacterium with specific strains involved in opportunistic and nosocomial infections. Therefore, it is important to know how the strains of this species are selected in the gut. In this study, fifteen E. faecalis strains, isolated over twelve weeks from the faeces of mice fed standard chow or one of three high fat diets enriched with extra virgin olive oil, refined olive oil or butter were subjected to a genetic "Multilocus Sequence Typing" study that revealed the presence of mainly two genotypes, ST9 and ST40, the latter one prevailing at the end of the research. A V3-V5 sequence comparison of the predominant ST40 strain (12B3-5) in a metagenomic study showed that this sequence was the only E. faecalis present in the mouse cohort after twelve weeks. The strain was subjected to a comparative proteomic study with a ST9 strain by 2D electrophoresis and mass spectrometry. After comparing the results with a E. faecalis database, unshared entries were compared and 12B3-5 showed higher antimicrobial production as well as greater protection from environmental factors such as xenobiotics, oxidative stress and metabolite accumulation, which could be the reason for its ability to outcompete other possible rivals in an intestinal niche.

Construction of nursing knowledge in commodified contexts: A discussion paper.

This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted a literature search and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse-patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge.

Influence of the Type of Diet on the Incidence of Pathogenic Factors and Antibiotic Resistance in Enterococci Isolated from Faeces in Mice.

A comparative study on potential risks was carried out in a collection of 50 enterococci isolated from faeces of mice fed a standard or a high-fat diet enriched with extra virgin olive oil, refined olive oil or butter, at the beginning, after six weeks and after twelve weeks of experiments. Strains were biochemically assessed and genetically characterized. E. faecalis and E. casseliflavus were the most frequently isolated species in any diet and time points. Apart from the fact of not having isolated any strain from the virgin olive oil group during the last balance, we found statistically significant differences p < 0 . 05 among the diets in the percentage of antibiotic resistance and in the presence of the enterococcal surface protein gene (esp), as well as a tendency p < 0 . 1 for the presence of the tyrosine decarboxylase gene (tdc) to increase over time in the group of isolates from the standard diet. When the resistance of the strains to virgin or refined olive oil was studied, only the group of enterococci from high fat diets showed a significantly higher percentage of resistance to refined olive oil p < 0 . 05 , while both types of oil equally inhibited those isolated from the standard diet p > 0 . 05 .

Refined versus Extra Virgin Olive Oil High-Fat Diet Impact on Intestinal Microbiota of Mice and Its Relation to Different Physiological Variables.

Extra virgin olive oil (EVOO) has been reported to have a distinct influence on gut microbiota in comparison to other fats, with its physiological benefits widely studied. However, a large proportion of the population consumes olive oil after a depurative process that not only mellows its taste, but also deprives it of polyphenols and other minority components. In this study, we compare the influence on the intestinal microbiota of a diet high in this refined olive oil (ROO) with other fat-enriched diets. Swiss Webster mice were fed standard or a high-fat diet enriched with EVOO, ROO, or butter (BT). Physiological parameters were also evaluated. At the end of the feeding period, DNA was extracted from feces and the 16S rRNA was pyrosequenced. The group fed ROO behaved differently to the EVOO group in half the families with statistically significant differences among the diets, with higher comparative levels in three families-Desulfovibrionaceae, Spiroplasmataceae, and Helicobacteraceae-correlating with total cholesterol. These results are again indicative of a link between specific diets, certain physiological parameters and the prevalence of some taxa, but also support the possibility that polyphenols and minor components of EVOO are involved in some of the proposed effects of this fat through the modulation of the intestinal microbiota.

Influence of a diet enriched with virgin olive oil or butter on mouse gut microbiota and its correlation to physiological and biochemical parameters related to metabolic syndrome.

The type of fat in the diet determinates the characteristics of gut microbiota, exerting a major role in the development of metabolic syndrome. We hypothesize that a diet enriched with extra virgin olive oil (EVOO) has a distinctive effect on the intestinal microbiome in comparison with an enriched butter diet (BT) and this effect is related to the physiological benefits exerted by EVOO. Swiss Webster mice were fed standard (SD) or two high fat diets enriched with EVOO or butter. Hormonal, physiological and metabolic parameters were evaluated. At the end of the feeding period, DNA was extracted from faeces and the 16S rRNA genes were pyrosequenced. Among the main significant differences found, BT triggered the highest values of systolic blood pressure, correlating positively with the percentage of Desulfovibrio sequences in faeces, which in turn showed significantly higher values in BT than in EVOO. EVOO had the lowest values of plasmatic insulin, correlating inversely with Desulfovibrio, and had the lowest plasmatic values of leptin which correlated inversely with Sutterellaceae, Marispirillum and Mucilaginibacter dageonensis, the three showing significantly higher percentages in EVOO. The lowest total cholesterol levels in plasma were detected in SD, correlating positively with Prevotella and Fusicatenibacter, both taxa with significantly greater presence in SD. These results may be indicative of a link between specific diets, certain physiological parameters and the prevalence of some taxa, supporting the possibility that in some of the proposed effects of virgin olive oil the modulation of intestinal microbiota could be involved.

Estrategia pedagógica para la superación de los docentes / Pedagogic strategy for the upgrading of professors

Los resultados en la labor docente del profesional se materializan en la evaluación profesoral anual, el profesor es evaluado según los indicadores que la rigen. En correspondencia con lo antes planteado es necesario que el trabajo metodológico de los centros universitarios se proyecte en función de dar solución a las dificultades detectadas en los procesos de evaluación, para que se propicie el correcto desarrollo del proceso docente en este sentido y se pueda cumplir el fin y el objetivo que se plantea en este nivel de enseñanza. Se realizó un estudio descriptivo cualitativo de corte pedagógico, en el que se hace un análisis documental actualizado sobre las principales dificultades metodológicas de los profesores del Área VI en la evaluación profesoral correspondiente al curso 2013-2014, con el objetivo de diseñar una estrategia pedagógica para la superación de los docentes del Policlínico Área VI, perteneciente al municipio de Cienfuegos, que permita obtener mejores resultados en las evaluaciones profesorales y elevar el desempeño profesional pedagógico de los docentes que intervienen en este proceso. La estrategia metodológica diseñada se corresponde con el diagnóstico realizado y los problemas que se afrontan y contribuye al desarrollo de las competencias docentes.

The results in the professional's educational work are materialized in the annual professorial evaluation; the professor is evaluated according to the indicators that govern it. In correspondence with the before outlined it is necessary that the methodological work of the university centers is projected in function of giving solution to the difficulties detected in the evaluation processes, so that the correct development of the educational process is propitiated in this sense and you can complete the end and the objective that he/she thinks about in this teaching level. He/she was carried out a qualitative descriptive study of pedagogic court, in which one makes an up-to-date documental analysis on the main methodological difficulties of the professors of the Area VI in the professorial evaluation corresponding to the course 2013 - 2014, with the objective of designing a pedagogic strategy for the superation of the educational ones of the Policlinic Área VI, belonging to the municipality of Cienfuegos that allows to obtain better results in the professorial evaluations and the pedagogic professional acting of the educational ones that you/they intervene in this process to rise. The designed methodological strategy belongs together with the carried out diagnosis and the problems that are confronted and it contributes to the development of the educational competitions.

Surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft.

BACKGROUND: A coronally advanced flap with subepithelial connective tissue graft is the gold standard surgical treatment of gingival recessions, since it offers a higher probability of achieving complete root coverage compared with other techniques. However, optimum short- and middle-term clinical results have also been obtained with coronally advanced flaps alone. The aim of the present study was to evaluate the results obtained by the surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft. MATERIAL AND METHODS: The reduction of recession height was assessed, together with the gain in gingival attachment apical to the recession, and total reduction of recession, in a comparative study of two techniques. Twenty-two gingival recessions were operated upon: 13 in the control group (coronally advanced flap) and 9 in the test group (coronally advanced flap associated to subepithelial connective tissue graft). RESULTS: After 18 months, the mean reduction of recession height was 2.2 ± 0.8 mm in the control group and 2.3 ± 0.7 mm in the test group, with a mean gain in gingival attachment of 1.3 ± 0.9 mm and 2.3 ± 1.3 mm, respectively. In percentage terms, the mean reduction of recession height was 84.6 ± 19.6% in the control group and 81.7 ± 17.8% in the test group, with a mean gain in gingival attachment of 20.5 ± 37.4% and 184.4 ± 135.5%, respectively. CONCLUSIONS: Significant reduction of gingival recession was achieved with both techniques, though the mean gain in gingival attachment (in mm and as a %) was greater in test group.

Simultaneous Bilateral Functional Radiography in Ulnar Collateral Ligament Lesion of the Thumb: An Original Technique.

In any thumb injury, particularly one caused by hyperabduction, an ulnar collateral ligament lesion (gamekeeper's or skier's thumb) must be considered. If the diagnosis is suspected, and radiographs show no fracture, comparative radiographs should be obtained in forced valgus. This examination, which uses a stress test to cause joint tilt, is crucial in making an accurate diagnosis and deciding on the most appropriate therapeutic approach. The forced valgus maneuver typically is performed by the examiner, who must stay with the patient in the radiography room and wear radiologic protection. We report on a simple, reliable, reproducible method that allows the patient's thumbs to be compared, under the same force application conditions, on a single radiograph. This technique reduces the patient's and examiner's exposure to x-rays and is well tolerated by the patient. Anesthesia for the thumb is usually not necessary.