Virtual Surgical Planning for Temporomandibular Joint Reconstruction with Stock TMJ Prostheses: Pilot Study.

The temporomandibular joint (TMJ) is one of the most complex joints in the human anatomy. In advanced degenerative stages, conservative or minimally invasive surgical therapies have failed to restore joint function, and joint replacement with prostheses has been required. Stock prostheses, compared to custom-made prostheses, are much less expensive and require less pre-operative preparation time. Four patients followed for years for temporomandibular dysfunction and previously operated on by arthroscopy or open joint surgery that have been reconstructed with stock TMJ prostheses (STMJP) through virtual surgical planning (VSP) and an STL model with surgical and positioning guides were included. The median follow-up was 15 months; the median number of previous TMJ surgeries was 2. The mean preoperative MIO was 24.6 mm and at longest follow-up was 36.4 mm. The median preoperative TMJ pain score was 8, and the median postoperative TMJ pain was 3. All patients have improved their mandibular function with a clear improvement of their initial situation. In conclusion, we believe that stock TMJ prostheses with virtual surgical planning and surgical guides are a good alternative for TMJ reconstruction at the present time. Nonetheless, prospective and randomized trials are required with long-term follow up to assess their performance and safety.

Two-year Skeletal Effects of Sleeve Gastrectomy in Adolescents with Obesity Assessed with Quantitative CT and MR Spectroscopy.

Background Sleeve gastrectomy (SG) is effective in the treatment of cardiometabolic complications of obesity but is associated with bone loss. Purpose To determine the long-term effects of SG on vertebral bone strength, density, and bone marrow adipose tissue (BMAT) in adolescents and young adults with obesity. Materials and Methods This 2-year prospective nonrandomized longitudinal study enrolled adolescents and young adults with obesity who underwent either SG (SG group) or dietary and exercise counseling without surgery (control group) at an academic medical center from 2015 to 2020. Participants underwent quantitative CT of the lumbar spine (L1 and L2 levels) to assess bone density and strength, proton MR spectroscopy to assess BMAT (L1 and L2 levels), and MRI of the abdomen and thigh to assess body composition. Student t and Wilcoxon signed-rank tests were used to compare 24-month changes between and within groups. Regression analysis was performed to evaluate associations between body composition, vertebral bone density, strength, and BMAT. Results A total of 25 participants underwent SG (mean age, 18 years ± 2 [SD], 20 female), and 29 underwent dietary and exercise counseling without surgery (mean age, 18 years ± 3, 21 female). Body mass index (BMI) decreased by a mean of 11.9 kg/m2 ± 5.21 [SD] after 24 months in the SG group (P < .001), while it increased in the control group (mean increase, 1.49 kg/m2 ± 3.10; P = .02). Mean bone strength of the lumbar spine decreased after surgery compared with that in control subjects (mean decrease, -728 N ± 691 vs -7.24 N ± 775; P < .001). BMAT of the lumbar spine increased after SG (mean lipid-to-water ratio increase, 0.10 ± 0.13; P = .001). Changes in vertebral density and strength correlated positively with changes in BMI and body composition (R = 0.34 to R = 0.65, P = .02 to P < .001) and inversely with vertebral BMAT (R = -0.33 to R = -0.47, P = .03 to P = .001). Conclusion SG in adolescents and young adults reduced vertebral bone strength and density and increased BMAT compared with those in control participants. Clinical trial registration no. NCT02557438 © RSNA, 2023 See also the editorial by Link and Schafer in this issue.

Long-term effectiveness and safety of bladder augmentation in spina bifida patients.

AIMS: To establish the long-term efficacy and safety of bladder augmentation in spina bifida patients. MATERIAL AND METHODS: Sixteen patients were operated on using the Bramble technique. Preoperative and postoperative evaluation included clinical history, blood tests, urine cultures, cystography, pyelography, ultrasound, and filling cystometry. In the final review a standardized quality of life questionnaire was applied. RESULTS: Median follow-up was 20 years (15-26). Kidney function was stabilized except for one case that required a kidney transplant. Hydronephrosis disappeared or improved (p = 0.03). Vesicoureteral reflux grades I-II was cured without reimplantation and grades III-IV responded better with reimplantation than without (p = 0.03). Quality of life improved in all patients, with all stating they would undergo the procedure again. After surgery, 94% of the patients exhibited diurnal continence but 25% exhibited nocturnal incontinence. Pressure at capacity decreased and bladder capacity increased (p < 0.001). One patient presented ureteral fistula with another presenting hemorrhage. Both required immediate surgical review. Late complications included urinary sphincter cuff erosion, renal lithiasis, four instances of bladder lithiasis and repeated pyelonephritis in one 24-year-old patient. All required surgery. The mean of urinary infections fell, from 2.5 per year (0.7) to 1 (0.5) (p = 0.03). CONCLUSION: Augmentation cystoplasty (AC) maintains its efficacy and improves quality of life in the long term. However, serious surgical complications can ensue, along with minor or major subsequent complications. This should be considered before surgery and makes lifelong monitoring of patients necessary.

Pelvic floor: vaginal or caesarean delivery? A review of systematic reviews.

INTRODUCTION AND HYPOTHESIS: In recent years the number of caesarean sections has increased worldwide for different reasons. to review the scientific evidence relating to the impact of the type of delivery on pelvic floor disorders (PFDs) such as urinary and faecal incontinence and pelvic organ prolapse. METHODS: A review of systematic reviews and meta-analysis, drawn from the following databases: MEDLINE (via PubMed), Scopus, Web of Science, The Cochrane Library and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud/Latin American and Caribbean Health Sciences Literature) prior to January 2019. The directives of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in assessing article quality. RESULTS: Eleven systematic reviews were evaluated, 6 of which found a significantly decreased risk of urinary incontinence associated with caesarean section and 3 meta-analyses showed a significant reduction in POP for caesarean section, compared with vaginal delivery. Of 5 reviews that examined delivery type and faecal incontinence, only one indicated a lower incidence of faecal incontinence associated with caesarean delivery. However, most of the studies included in these reviews were not adjusted for important confounding factors and the risk of PFDs was not analysed by category of caesarean delivery (elective or urgent). CONCLUSION: When compared with vaginal delivery, caesarean is associated with a reduced risk of urinary incontinence and pelvic organ prolapse. These results should be interpreted with caution and do not help to address the question of whether elective caesareans are protective of the maternal pelvic floor.

Primary Maxillary Reconstruction With Fibula Flap and Dental Implants: A Comparative Study Between Virtual Surgical Planning and Standard Surgery in Class IIC Defects.

PURPOSE: Oncological patients who undergo bilateral subtotal maxillectomies develop functional and esthetic sequelae that require immediate reconstruction. The purpose of this study is to evaluate the primary reconstruction of maxillary defects with fibula flap and dental implants assisted by virtual surgical planning (VSP) and to assess the postoperative outcomes compared with standard surgery. MATERIAL AND METHODS: A retrospective study was designed between January 2016 and April 2020 with 12 oncologic patients who underwent subtotal bilateral maxillectomy. Six consecutive patients were treated by standard surgical procedure (SS) at the beginning of the study. In 2018, the VSP was implemented, and 6 consecutive patients were treated using this technique. All patients were rehabilitated with Ticare implants and implant prostheses. Anatomic position of the bone, bone apposition, change of vertical distance, and horizontal shift, the operative and ischemia time, the esthetic results, and the functional rehabilitation were evaluated and compared. RESULTS: The position of the bone in anatomical position was 100% in the VSP group vs 66% in the SS group. The bone apposition was 100% in the VSP group vs 83.3%. The change of vertical distance and the horizontal shift were lower in the VSP group (P < .05). The ischemia time and operative time were shorter in the VSP group (P < .05). A good esthetic result was achieved in 83.3% in the VSP group vs 33.3% in the SS group; 81 dental implants and 1 zygomatic implant were placed. The success rate was 95% in the VSP group and 92.6% in the SS group. All patients were rehabilitated with implant prosthesis. CONCLUSIONS: VSP improves the accuracy of midface reconstruction (class IIC defect) with a better anatomical position of the bone, a higher rate of bone contact, and a lower change in vertical distance compared with standard surgery. It significantly improves the esthetic result, reduces ischemia time, and operation time.

First Report of Stem Canker of Tomato Caused by Fusarium striatum in Mexico.

Tomato (Solanum lycopersicum L.) is an important vegetable crop in Mexico. During 2015 and 2016, symptoms of stem canker were observed on tomato plants in two greenhouses located in the states of Sinaloa and San Luis Potosi, Mexico. Symptomatic plants exhibited dark brown cankers on stems and brown discoloration of the pith, as well as chlorosis, senescence of leaves, and wilting. At the base of diseased plants, orange-red perithecia were developed. Disease incidence ranged 1-5% in the two greenhouses. Pieces from symptomatic stems were surface disinfested by immersion in a 1% sodium hypochlorite solution for 2 min, rinsed in sterile distilled water, and placed in Petri plates containing acidified potato dextrose agar (APDA). The plates were incubated at 25 ºC for 6 days under a 12-h photoperiod. Fusarium-like colonies were consistently isolated and 10 monoconidial isolates were obtained. A representative isolate of each site was selected for morphological characterization, phylogenetic analysis, and pathogenicity tests. The two isolates were deposited in the Culture Collection of Phytopathogenic Fungi at the Research Center for Food and Development (accession nos. CCLF11 and CCLF12). Colonies on PDA at 25°C for 7 days exhibited moderate and cream aerial mycelium. Microscopic examination showed falciform, hyaline macroconidia (n= 100), 4- to 5-septate, measuring 40 to 75 × 4 to 6 µm. Microconidia (n= 100) were cylindrical, hyaline, 0- to 1-septate, measuring 7.8 to 9.5 × 3.1 to 4.8 µm. Chlamydospores were absent. To further identify the pathogen, total DNA was extracted, and the RNA polymerase's second largest subunit (RPB2) and a portion of the translation elongation factor 1-alpha (TEF1-α) were amplified by polymerase chain reaction (PCR) using the primers 5f2 (Liu et al. 1999)/7cr (Reeb et al. 2004) and EF1-728F/EF1-986R (Carbone and Kohn 1999), respectively. The sequences were deposited in GenBank (accession nos. RPB2: MT263727, MT263728; and TEF1-α: MT249025, MT249026). A phylogenetic analysis was performed by the Maximum Likelihood method with a combined dataset of RPB2 and TEF-1α sequences for Fusarium and Neocosmospora species (Sandoval-Denis and Crous 2018). The phylogenetic tree grouped the two isolates CCLF11 and CCLF12 within the F. striatum clade with 99% of bootstrap support. Pathogenicity of the two isolates was verified by inoculation of colonized PDA plugs (5 mm diameter) on the wounded stem surface of 10 2-month-old tomato plants from cv. Sun 6200. Ten control plants were inoculated with PDA plugs without mycelia. All plants were kept under greenhouse conditions at 25 to 35°C and regularly watered. Symptoms of stem canker were observed on all inoculated plants after 15 days, whereas stems from control plants remained healthy. After 45 days, perithecia were observed on stem cankers. Koch´s postulates were fulfilled when the fungus was re-isolated from the stems of inoculated plants and not from control plants. Fusarium striatum has been previously reported causing stem canker of tomato in greenhouses in Canada and the USA (Moine et al. 2014). To our knowledge, this is the first report of F. striatum causing stem canker of tomato in Mexico. This fungal pathogen represents a severe threat and has the potential to cause significant yield losses in tomato greenhouses, so further research is required to define effective management strategies.

[Treatment of attention-deficit/hyperactivity disorder in clinical practice. A retrospective study]. / Tratamiento del trastorno por déficit de atención con hiperactividad en la práctica clínica habitual. Estudio retrospectivo.

Attention deficit hyperactivity disorder (ADHD) is a complex and heterogeneous neurodevelopmental disorder, of a chronic nature, of multifactorial etiology, mainly due to genetic and environmental factors. We conducted a retrospective analytical study of the t herapeutic management of children diagnosed with ADHD. A sample of 82 children diagnosed with ADHD (74.4% children and 25.6% girls) was studied. 96.3% of the cases presented some associated disorder. Pharmacological treatment was the treatment of choice (90.2%). 46.0% received immediate release methylphenidate, 51.4% sustained release methylphenidate and atomoxetine was only prescribed in 2.7% of patients. 20.3% of the sample abandoned pharmacological treatment at some point. Pharmacological treatment was the most frequent option in our sample, and methylphenidate immediate release the drug of choice for treatment initiation. The alternatives to stimulants are used in very low percentage of the patient. No significant differences were found between the type of treatment regarding the subtype of ADHD or gender, but we found significant difference in relation with the age of onset of treatment.

El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno del neurodesarrollo complejo y heterogéneo, de carácter crónico, de etiología multifactorial, principalmente debida a factores genéticos y ambientales. Realizamos un estudio analítico retrospectivo del tratamiento de niños diagnosticados de TDAH. Se estudió una muestra de 82 niños diagnosticados de TDAH (74.4% niños y 25.6% niñas). El 96.3% de los casos presentaba algún trastorno asociado. El tratamiento farmacológico fue el tratamiento de elección (90.2%). El 46.0% recibía metilfenidato de liberación inmediata, un 51.4% metilfenidato de liberación sostenida y la atomoxetina solo se recetó en un 2.7% de los casos. El 20.3% de la muestra abandonó en algún momento el tratamiento farmacológico. El tratamiento farmacológico fue la opción más utilizada en nuestra muestra, y el metilfenidato de liberación inmediata el fármaco de elección para inicio del tratamiento. Se utilizan poco las alternativas a los estimulantes. No se encontraron diferencias significativas entre el tipo de tratamiento y el subtipo de TDAH o el género, aunque sí en cuanto a la edad de inicio del tratamiento.

The level of acceptance of spanish medical students of the transplantation of solid organs from animals: a stratified and multicentre study.

INTRODUCTION: Research into the transplantation of solid organs from animals (xenotransplantation) is generating interest and curiosity given that this could be a way of resolving the shortage in transplant organs. However, the fact is that currently xenotransplantation is far from becoming a clinical practice. OBJECTIVE: To analyse the attitude of medical students from Spanish universities towards the donation of organs from animals and to determine the factors affecting their attitudes. TYPE OF STUDY: A sociological, interdisciplinary, observational and multicentre study in Spain. STUDY POPULATION: Students enrolled on the medical degree in Spain (n = 34 000). SAMPLE SIZE: A sample of 9598 students (a confidence level of 99% and precision of ± 1%) stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ xenotransplantation (PCID-XenoTx RIOS) which was self-administered and completed anonymously. RESULTS: A completion rate of 95.7% (n = 9275) was obtained. If the results of xenotransplantation were as good as in human donation, 81% (n = 7491) would be in favour, 3% (n = 308) against and 16% (n = 1476) undecided. The following variables affected this attitude: sex (P < 0.001); academic year (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); the opinion of one's partner (P < 0.001); the respondent's attitude towards organ donation (P < 0.001); religion (P < 0.001); and participation in altruistic activities (P < 0.001). The following variables persisted in the multivariate analysis: (1) being a female (OR = 1.794; P < 0.001); (2) academic year (OR = 2.487; P < 0.001); (3) having spoken about the issue with one's family (OR = 1.200; P = 0.019); (4) the favourable opinion of one's partner (OR = 1.526; P = 0.028); (5) an attitude in favour of donation (OR = 2.087; P < 0.001); (6) being an atheist/agnostic, (OR = 2.5; P < 0.001); and (7) a belief that one's religion is in favour of transplantation (OR = 1.317; P = 0.005). CONCLUSIONS: Spanish medical students have a favourable attitude towards xenotransplantation. This willingness and interest could be a decisive platform for the development and strengthening of research, both for centres with a pre-clinical xenotransplantation programme and new healthcare centres.

Bioassay-guided chemical study of the anti-inflammatory effect of Senna villosa (Miller) H.S. Irwin & Barneby (Leguminosae) in TPA-induced ear edema.

Senna villosa (Miller) is a plant that grows in México. In traditional Mexican medicine, it is used topically to treat skin infections, pustules and eruptions and to heal wounds by scar formation. However, studies of its potential anti-inflammatory effects have not been performed. The aim of the present study was to determine the anti-inflammatory effect of extracts from the leaves of Senna villosa and to perform a bioassay-guided chemical study of the extract with major activity in a model of ear edema induced by 12-O-tetradecanoylphorbol 13-acetate (TPA). The results reveal that the chloroform extract from Senna villosa leaves has anti-inflammatory and anti-proliferative properties. Nine fractions were obtained from the bioassay-guided chemical study, including a white precipitate from fractions 2 and 3. Although none of the nine fractions presented anti-inflammatory activity, the white precipitate exhibited pharmacological activity. It was chemically characterized using mass spectrometry and infrared and nuclear magnetic resonance spectroscopy, resulting in a mixture of three aliphatic esters, which were identified as the principal constituents: hexyl tetradecanoate (C20H40O2), heptyl tetradecanoate (C21H42O2) and octyl tetradecanoate (C22H44O2). This research provides, for the first time, evidence of the anti-inflammatory and anti-proliferative properties of compounds isolated from Senna villosa.

Two-Year Study on the Impact of Sleeve Gastrectomy on Depressive and Anxiety Symptoms in Adolescents and Young Adults with Moderate to Severe Obesity.

PURPOSE: Sleeve gastrectomy (SG), the most commonly performed weight loss surgery in adolescents and young adults with moderate to severe obesity, is highly effective for weight loss. Current literature regarding depressive and anxiety symptomatology following SG in youth is sparse and conflicting. We evaluated changes in depressive and anxiety symptoms in adolescents and young adults with moderate to severe obesity 2 years following SG compared with non-surgical controls (NS) followed for a similar duration. MATERIALS AND METHODS: Forty-six youth 13-25 years old with moderate-severe obesity (33 female) were followed for 2 years; 21 underwent SG, and 25 were NS. Subjects underwent anthropometric measurements and completed self-report questionnaires. Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms and the State-Trait Anxiety Inventory (STAI)-X2 for anxiety symptoms. RESULTS: Groups did not differ for age (18.4 ± 0.4 vs. 17.8 ± 0.5 years, p = 0.456). The SG group had a higher mean BMI vs. NS (47.5 (42.1, 52.4) vs. 41.6 (37.8, 46.5) kg/m2; p = 0.011). At 2-year follow-up, SG had greater reductions in weight and BMI vs. NS (p < 0.0001). Groups did not differ for changes in BDI-II and STAI scores (BDI-II: - 1.0 (- 6.0, 10.0) in SG vs. - 1.0 (- 6.0, 3.5) in NS, p = 0.37; STAI: 3.1 ± 3.2 in SG vs. - 1.1 ± 1.5 in NS, p = 0.24). CONCLUSION: No change was found in depressive and anxiety symptomatology following surgery despite marked weight reduction over a 2-year period, underscoring the need to better evaluate psychopathology in youth undergoing SG to develop supportive therapeutic strategies. GOV IDENTIFIER: NCT02557438 https://clinicaltrials.gov/ct2/show/NCT02557438?id=NCT02557438&draw=2&rank=1 ; The study was registered on 23 September 2015.

Reconstruction of Segmental Mandibular Defects with Double-Barrel Fibula Flap and Osseo-Integrated Implants: A Systematic Review.

Background: Mandibular defects resulting from oncological treatment pose significant aesthetic and functional challenges due to the involvement of bone and soft tissues. Immediate reconstruction is crucial to address complications such as malocclusion, mandibular deviation, temporomandibular joint (TMJ) changes, and soft tissue retraction. These issues can lead to functional impairments, including difficulties in chewing, swallowing, and speech. The fibula flap is widely used for mandibular reconstruction due to its long bone segment and robust vascular supply, though it may not always provide adequate bone height for optimal dental rehabilitation. This systematic review aims to determine if the double-barreled fibula flap (DBFF) configuration is a viable alternative for mandibular reconstruction and to evaluate the outcomes of dental implants placed in this type of flap. Materials and Methods: This study adhered to the Cochrane Collaboration criteria and PRISMA guidelines and was registered on the International Platform of Registered Systematic Review and Meta-Analysis Protocols Database (INPLASY2023120026). We included clinical studies published in English, Spanish, or French that focused on adult patients undergoing segmental mandibulectomy followed by DBFF reconstruction and dental rehabilitation. Data sources included Medline/PubMed, the Cochrane Library, EMBASE, Scopus, and manual searches. Two reviewers independently screened and selected studies, with discrepancies resolved by a third reviewer. Data extraction captured variables such as publication year, patient demographics, number of implants, follow-up duration, flap survival, implant failure, and aesthetic outcomes. The risk of bias was assessed using the JBI appraisal tool, and the certainty of evidence was evaluated using the GRADE approach. Results: A total of 17 clinical studies were included, evaluating 245 patients and 402 dental implants. The average patient age was 43.7 years, with a mean follow-up period of 34.3 months. Flap survival was high, with a 98.3% success rate and only four flap losses. The implant failure rate was low at 1.74%. Esthetic outcomes were varied, with only three studies using standardized protocols for evaluation. The overall certainty of evidence for flap survival was moderate, low for implant failure, and very low for aesthetics due to the subjective nature of assessments and variability in reporting. Conclusions: The primary limitations of the evidence included in this review are the observational design of the studies, leading to an inherent risk of bias, inconsistency in reporting methods, and imprecision in outcome measures. Additionally, the subjective nature of aesthetic evaluations and the variability in assessment tools further limit the reliability of the findings. The DBFF technique demonstrates excellent outcomes for mandibular reconstruction, with high flap survival and low implant failure rates, making it a viable option for dental rehabilitation. However, the evidence for aesthetic outcomes is less certain, highlighting the need for more rigorous and standardized research. This review supports the DBFF as a good alternative for mandibular reconstruction with successful dental implant integration, although further studies are needed to enhance the reliability of aesthetic evaluations.

Hepatitis C virus fitness can influence the extent of infection-mediated epigenetic modifications in the host cells.

Introduction: Cellular epigenetic modifications occur in the course of viral infections. We previously documented that hepatitis C virus (HCV) infection of human hepatoma Huh-7.5 cells results in a core protein-mediated decrease of Aurora kinase B (AURKB) activity and phosphorylation of Serine 10 in histone H3 (H3Ser10ph) levels, with an affectation of inflammatory pathways. The possible role of HCV fitness in infection-derived cellular epigenetic modifications is not known. Methods: Here we approach this question using HCV populations that display a 2.3-fold increase in general fitness (infectious progeny production), and up to 45-fold increase of the exponential phase of intracellular viral growth rate, relative to the parental HCV population. Results: We show that infection resulted in a HCV fitness-dependent, average decrease of the levels of H3Ser10ph, AURKB, and histone H4 tri-methylated at Lysine 20 (H4K20m3) in the infected cell population. Remarkably, the decrease of H4K20m3, which is a hallmark of cellular transformation, was significant upon infection with high fitness HCV but not upon infection with basal fitness virus. Discussion: Here we propose two mechanisms ─which are not mutually exclusive─ to explain the effect of high viral fitness: an early advance in the number of infected cells, or larger number of replicating RNA molecules per cell. The implications of introducing HCV fitness as an influence in virus-host interactions, and for the course of liver disease, are warranted. Emphasis is made in the possibility that HCV-mediated hepatocellular carcinoma may be favoured by prolonged HCV infection of a human liver, a situation in which viral fitness is likely to increase.

Changes in Hepatic Fat Content by CT 1 Year After Sleeve Gastrectomy in Adolescents and Young Adults With Obesity.

CONTEXT: Obesity is associated with nonalcoholic fatty liver disease (NAFLD). Sleeve gastrectomy (SG) is an effective means of weight loss and improvement of NAFLD in adults; however, data regarding the efficacy of SG in the early stages of pediatric NAFLD are sparse. OBJECTIVE: To assess the impact of SG on hepatic fat content 1 year after SG in youth with obesity compared with nonsurgical controls with obesity (NS). DESIGN: A 12-month prospective study in 52 participants (mean age, 18.2 ± .36 years) with obesity, comprising 25 subjects who underwent SG (84% female; median body mass index [BMI], 44.6 [42.1-47.9] kg/m2) and 27 who were NS (70% female; median BMI, 42.2 [38.7-47.0] kg/m2). MAIN OUTCOME MEASURES: Hepatic fat content by computed tomography (liver/spleen ratio), abdominal fat by magnetic resonance imaging. RESULTS: Mean 12-month decrease in BMI was greater in SG vs NS (-12.5 ± .8 vs -.2 ± .5 kg/m2, P < .0001). There was a within-group increase in the liver-to-spleen (L/S) ratio in SG (.13 ± .05, P = .014) but not NS with a trend for a difference between groups (P = .055). All SG participants with an L/S ratio <1.0 (threshold for the diagnosis of NAFLD) before surgery had a ratio of >1.0 a year after surgery, consistent with resolution of NAFLD. Within SG, the 12-month change in L/S ratio was negatively associated with 12-month change in visceral fat (ρ = -.51 P = .016). CONCLUSIONS: Hepatic fat content as assessed by noncontrast computed tomography improved after SG over 1 year in youth with obesity with resolution of NAFLD in all subjects. This was associated with decreases in visceral adiposity.

Depth of Invasion: Influence of the Latest TNM Classification on the Prognosis of Clinical Early Stages of Oral Tongue Squamous Cell Carcinoma and Its Association with Other Histological Risk Factors.

BACKGROUND: The American Joint Committee on Cancer (AJCC), in its 8th edition, introduces modifications to the previous TNM classification, incorporating tumour depth of invasion (DOI). The aim of this research is to analyse the prognosis (in terms of disease-free survival and overall survival) of clinical early stage (I and II) squamous cell carcinomas of the oral tongue according to the DOI levels established by the AJCC in its latest TNM classification to assess changes to the T category and global staging system and to evaluate the association between DOI and other histological risk factors. METHODS: A retrospective longitudinal observational study of a series of cases was designed. All patients were treated with upfront surgery at our institution between 2010 and 2019. The variables of interest were defined and classified into four groups: demographic, clinical, histological and evolutive control. Univariate and multivariate analyses were carried out and survival functions were calculated using the Kaplan-Meier method. Statistical significance was established for p values below 0.05. RESULTS: Sixty-one patients were included. The average follow-up time was 47.42 months. Fifteen patients presented a loco-regional relapse (24.59%) and five developed distant disease (8.19%). Twelve patients died (19.67%). Statistically significant differences were observed, with respect to disease-free survival (p = 0.043), but not with respect to overall survival (p = 0.139). A total of 49.1% of the sample upstaged their T category and 29.5% underwent modifications of their global stage. The analysis of the relationship between DOI with other histological variables showed a significant association with the presence of pathological cervical nodes (p = 0.012), perineural invasion (p = 0.004) and tumour differentiation grade (p = 0.034). Multivariate analysis showed association between depth of invasion and perineural invasion. CONCLUSIONS: Depth of invasion is a histological risk factor in early clinical stages of oral tongue squamous cell carcinoma. Depth of invasion impacts negatively on patient prognosis, is capable per se of modifying the T category and the global tumour staging, and is associated with the presence of cervical metastatic disease, perineural invasion and tumoural differentiation grade.

Assessment of Quality of Life in Head-and-Neck Oncologic Patients with Intraoral Soft-Tissue Defects Reconstructed with Buccinator Myomucosal Flap.

The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a buccinator myomucosal flap during a six-year period. Patients completed the European Organization for Research and Treatment of Cancer questionnaires, the standard questionnaire (QLQ-C30) and the head-and-neck specific module (QLQ-H&N35). Thirty-nine patients with a mean age of 61.23 ± 15.80 years were included in the study. Thirty-three patients were diagnosed with an oncological condition (84.61%). Six patients (15.38%) developed orosinusal communication and underwent extensive debridement. The median global-health-status score was 79.27 and emotional performance was the lowest scoring, with a mean score of 76.93. As for the symptom items, the most outstanding were dental problems (33.33), oral opening (31.62) and dry mouth (37.61), followed by sticky saliva (24.79), problems with social eating (21.15) and pain (19.87). The most significant symptoms were radiotherapy-related adverse effects such as pain, fatigue, dental problems and dry mouth. Patients reconstructed with the buccinator myomucosal flap develop a good quality of life for all types of activities, and a correct function and aesthetics. Postoperative radiotherapy is associated with a poorer quality of life, and can lead to impairment of several symptoms such as swallowing, oral opening and dry mouth.

Sleep deprivation induces oxidative stress in the liver and pancreas in young and aging rats.

The aging process is characterized by a gradual impairment generally caused by oxidative stress and, more specifically, sleep deprivation, which induces oxidative stress in the brain. The objective of this study was to assess the effect of three types of paradoxical sleep deprivation (PSD): 96 h of PSD (96PSD group); 192 h of PSD (192PSD group); 192 h of PSD followed by a recovery period of 20 days (192PSD + Recovery group) on an oral glucose tolerance test (OGTT), lipid peroxidation (LPO), and superoxide dismutase (SOD) and catalase (CAT) activities in the liver and pancreas of young (3-month-old) and adult (14-month-old) rats. The 96PSD and 192PSD groups of young rats showed lower glucose levels on the OGTT than the control group. In the adult rats, only the 96PSD group had lower glucose levels than the control group. However, the areas under the curve for the young and adult 192 and 192PSD + Recovery groups showed significant differences. Both LPO and SOD increased in the 192PSD and 192PSD + Recovery groups, but CAT decreased in the liver of young rats in the 192PSD group. Regarding the pancreas, LPO and SOD levels increased after 96 h of PSD. In adult animals, CAT decreased in the liver after 96 and 192 h of PSD, while LPO and SOD increased in the pancreas of the 192PSD and PSD + Recovery groups. Differences in the SOD and CAT activities in the liver and SOD activities in the pancreas were also observed between the young and adult rats and maintained across all the PSD groups. In conclusion, PSD induced differential responses that appeared to depend on the duration of the induced condition, the animals' age, and the tissue analyzed. It was found that adult rats were more susceptible to the effects of PSD than young rats.

Overweight and obesity in children and adolescents with chronic autoimmune thyroiditis.

Background: An association between overweight and thyroid dysfunction, including chronic autoimmune thyroiditis (CAT), has been previously described. Patients with overweight and obesity have a higher risk of increased thyroid-stimulating hormone (TSH) and anti-thyroid antibodies. Weight gain may also be a clinical sign of hypothyroidism. This study aimed to describe the frequency of overweight and obesity in children with CAT and to compare thyroid function and antibody titles according to body weight. Methods: Clinical records from 78 patients with CAT who were followed up at a children's hospital in Mexico City were assessed. We collected demographic, anthropometric, and biochemical data, including thyroid function tests and antibodies. According to body mass index (BMI) percentiles, patients were classified as normal weight, overweight or obese according to BMI percentiles. Also, BMI changes at 6 and 12 months of follow-up were analyzed. Results: We observed 19.2% of the patients with overweight and 15.4% with obesity. Patients with obesity showed high TSH and low thyroid hormone levels. Also, the frequency of hypothyroidism at presentation was higher in this group. No significant difference was found in antibody titles between groups. A significant BMI percentile reduction was observed during follow-up of patients independently of thyroid function at diagnosis and treatment. Conclusions: Obesity is related to hypothyroidism in patients with chronic autoimmune thyroiditis, although causality cannot be established through this observational study.

Introducción: Previamente se ha identificado una asociación entre el sobrepeso y las alteraciones tiroideas, incluyendo la tiroiditis crónica autoinmunitaria (TCA). Los pacientes con sobrepeso y obesidad presentan elevación de la hormona estimulante de la tiroides (TSH) y mayor frecuencia de anticuerpos antitiroideos. Por otro lado, el incremento de peso es un síntoma clásico de hipotiroidismo. El objetivo del trabajo es describir la frecuencia de sobrepeso y obesidad en pacientes con TCA, y comparar la función tiroidea y los anticuerpos antitiroideos según el peso corporal. Métodos: Se recolectaron datos demográficos, antropométricos y bioquímicos, pruebas de función tiroidea y anticuerpos antitiroideos, de 78 pacientes con TCA atendidos en un hospital pediátrico en la Ciudad de México. Se clasificaron en subgrupos, de acuerdo con el percentil del índice de masa corporal (IMC), como peso normal, sobrepeso y obesidad. Se analizó el comportamiento del IMC a los 6 y 12 meses de los pacientes incluidos. Resultados: El 19.2% de los pacientes presentaron sobrepeso y el 15.4% obesidad. Se encontraron valores mayores de TSH y menores de hormonas tiroideas en los pacientes con obesidad, quienes presentaron con mayor frecuencia hipotiroidismo al diagnóstico. No se encontraron diferencias significativas en el título de anticuerpos entre los grupos. Durante el seguimiento se observó una disminución significativa en el percentil del IMC en los pacientes, sin diferencias según el tratamiento recibido ni la función tiroidea al diagnóstico. Conclusiones: La obesidad se asocia con hipotiroidismo como patrón bioquímico inicial en los pacientes con TCA.

A Systematic Review of Clinical Trials Assessing Sexuality in Hysterectomized Patients.

In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic approach, as it is less invasive, faster and less costly. However, the quality of sexual life has not been systematically reviewed in terms of the approach adopted. Through a systematic review, we analyzed (CRD42020158465 in PROSPERO) the impact of hysterectomy on sexual quality and whether there are differences according to the surgical procedure (abdominal or vaginal) for noncancer patients. MEDLINE (through PubMed), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Scopus were reviewed to find randomized clinical trials assessing sexuality in noncancer patients undergoing total hysterectomy, comparing vaginal and abdominal (laparoscopic and/or open) surgery. Three studies that assessed the issue under study were finally included. Two of these had a low risk of bias (Cochrane risk of bias tool); one was unclear. There was significant variability in how sexuality was measured, with no differences between the two approaches considered in the review. In conclusion, no evidence was found to support one procedure (abdominal or vaginal) over another for non-oncological hysterectomized patients regarding benefits in terms of sexuality.

Vertical Ridge Augmentation of Fibula Flap in Mandibular Reconstruction: A Comparison between Vertical Distraction, Double-Barrel Flap and Iliac Crest Graft.

Double-barrel flap, vertical distraction and iliac crest graft are used to reconstruct the vertical height of the fibula. Twenty-four patients with fibula flap were reconstructed comparing these techniques (eight patients in each group) in terms of height of bone, bone resorption, implant success rate and the effects of radiotherapy. The increase in vertical bone with vertical distraction, double-barrel flap and iliac crest was 12.5 ± 0.78 mm, 18.5 ± 0.5 mm, and 17.75 ± 0.6 mm, (p < 0.001). The perimplant bone resorption was 2.31 ± 0.12 mm, 1.23 ± 0.09 mm and 1.43 ± 0.042 mm (p < 0.001), respectively. There were significant differences in vertical bone reconstruction and bone resorption between double-barrel flap and vertical distraction and between iliac crest and vertical distraction (p < 0.001). The study did not show significant differences in implant failure (p = 0.346). Radiotherapy did not affect vertical bone reconstruction (p = 0.125) or bone resorption (p = 0.237) but it showed higher implant failure in radiated patients (p = 0.015). The double-barrel flap and iliac crest graft showed better stability in the height of bone and less bone resorption and higher implant success rates compared with vertical distraction. Radiation therapy did not affect the vertical bone reconstruction but resulted in a higher implant failure.

[Hand-assisted laparoscopic nephroureterectomy for the treatment of upper urinary tract transitional cancer]. / Nefroureterectomía laparoscópica mediante laparoscopia asistida por la mano para el tratamiento del carcinoma transicional del tracto urinario superior.

OBJECTIVE: To report our series of patients undergoing hand-assisted laparoscopic nephroureterectomy (HALNU) using the pluck-off procedure. MATERIALS AND METHODS: Twenty patient undergoing HALMU for upper urinary tract urothelial tumors from November 2002 to December 2007 were assessed. Demographic, clinical, surgical, and oncological data were assessed. RESULTS: Mean patient age was 69 years. Mean operating time and mean intraoperative bleeding were 176 min and 381 mL respectively. Twenty percent of patients required transfusion of blood products. Conversion to open surgery was not required in any patient. Major and minor complications occurred in 25% and 30% of patients respectively.Mean time to oral intake was 48 hours, and mean hospital stay was 5 days.Pathological study revealed transitional cell carcinoma in all cases: grade I in 5%, grade II in 60%, and grade III in 35% of patients. Clinical stage was pTa in 5%, pT1 in 20%, pT2 in 25%, pT3 in 40%, and pT4 in 10% of patients. A bladder recurrence rate of 30% and a 49% overall survival were seen after a mean follow-up of 33 months (5-73). Six-year cancer-specific survival was 67%. No patient developed either peritoneal or surgical bed recurrence. CONCLUSIONS: HALMU using the pluck-off procedure is a feasible, safe, and effective surgery. Both surgical and oncological results are similar to those of open surgery and pure laparoscopy.