Moderate-intensity constant or high-intensity interval training? Metabolic effects on candidates to undergo bariatric surgery.

BACKGROUND & AIMS: Bariatric surgery is highly effective against obesity. Pre-surgical exercise programs are recommended to prepare the candidate physically and metabolically for surgery-related rapid weight loss. However, the ideal exercise prescription in this population is unknown. This study aimed to compare the metabolic effects of moderate-intensity constant (MICT) vs. a high-intensity interval training (HIIT) program in candidates to undergo bariatric surgery. METHODS AND RESULTS: Twenty-five candidates (22 women) to undergo sleeve gastrectomy aged from 18 to 60 years old were recruited. At baseline, we measured body composition, physical activity levels, grip strength, and aerobic capacity. Further, we assessed metabolic function through glycemia and insulinemia (both fasting and after oral glucose tolerance test (OGTT)), homeostatic model assessment for insulin resistance (HOMA-IR), lipid profile, glycated haemoglobin (HbA1c), transaminases, fibroblast growth factor 21 (FGF21), growth differentiation factor 15 (GDF15), apelin, and adiponectin. Afterward, participants were randomized into MICT (n = 14) or HIIT (n = 11). Both training programs consisted of 10 sessions (2-3 times/week, 30 min per session) distributed during 4 weeks before the surgery. After this, all outcomes were measured again at the end of the training programs and 1 month after the surgery (follow-up). A mixed effect with Tukey's post-hoc analysis was performed to compare values at baseline vs. post-training vs. postsurgical follow-up. Both training programs increased aerobic capacity after training (p < 0.05), but only after MICT these changes were kept at follow-up (p < 0.05). However, only MICT decreased fat mass and increased total muscle mass and physical activity levels (p < 0.05). Metabolically, MICT decreased insulinemia after OGTT (p < 0.05), whereas HIIT increased adiponectin after training and GDF15 at follow-up (both p < 0.05). CONCLUSIONS: Both MICT and HIIT conferred benefits in candidates to undergo bariatric surgery, however, several of those effects were program-specific, suggesting that exercise intensity should be considered when preparing these patients. Future studies should explore the potential benefits of prescribing MICT or HIIT in a customized fashion depending on a pretraining screening, along with possible summatory effects by combining these two exercise programs (MICT + HIIT). CLINICAL TRIAL REGISTRATION: International Traditional Medicine Clinical Trial Registry, N° ISRCTN42273422.

Cross-cultural adaptation and validation of the Spanish version of the Orthognathic Quality of Life Questionnaire for patients with dentofacial deformities.

OBJECTIVE: The aim of this study was to develop a Spanish version of the Orthognathic Quality of Life Questionnaire (OQLQ) that is conceptually equivalent to the original questionnaire, as well as acceptable, reliable, valid, and responsive for use in Chilean patients with dentofacial deformities. MATERIAL AND METHODS: The recommended standard methodology, with direct and back-translation, was used. A prospective longitudinal multicenter study of adult patients diagnosed with dentofacial deformity was carried out, self-administrating OQLQ, OHIP-14 (Oral Health Impact Profile), and SF-36 (Short Form 36 Health Survey) during the presurgery visit in order to examine construct validity. To evaluate reproducibility, questionnaires were re-administered 4 weeks later to subjects with a stable dental condition. Responsiveness was assessed among subjects followed up until 3 months after surgery. RESULTS: Of the 230 patients under presurgical orthodontic treatment included in the study, 216 completed the questionnaire, 142 formed the reliability sub-sample, and 30 were evaluated 3 months after surgery. Cronbach's alpha ranged from 0.78 to 0.94 and test-retest intraclass correlation coefficients ranged from 0.84 to 0.91 (p = 0.001) by dimension. The correlation matrix between OQLQ dimensions and SF-36 and OHIP-14 confirmed most of the associations previously hypothesized as moderate (rs > 0.4). Confirmatory factor analysis supported the same structure as the original instrument, considering four dimensions. Responsiveness was demonstrated by the large improvement observed in the global score 3 months after surgery: mean change ±SD = -15.1 ± 18.05 and standard response mean = -0.84 (p < 0.001). CONCLUSIONS: The Spanish version of OQLQ has demonstrated good levels of reliability, validity, and responsiveness - similar to those of the original questionnaire.

Resumen estructurado de Revisiones Sistemáticas (FRISBEE) / Summary of the Body of Evidence (FRISBEE)

RESUMEN: Las revisiones sistemáticas corresponden al máximo nivel de evidencia y son la principal herramienta para resolver incertidumbres clínicas(1). Sin embargo, dado sus características, presentan desventajas para su aplicación rápida y sencilla(2). Dado lo anterior es que se han creado nuevos formatos dentro de los que se incluyen los resúmenes estructurados de revisiones sistemáticas, dentro de los que se incluyen los Friendly Summary Of The Body Of Evidence (FRISBEE) (4). El proceso de elaboración de un FRISBEE comienza, como toda búsqueda de evidencia, con el planteamiento de una pregunta clínica estructurada y específica con la cual se desarrollará una búsqueda en la base de datos Epistemonikos que arrojará todas las revisiones sistemáticas atingentes. De ellas, se deben seleccionar las que respondan la pregunta clínica planteada y, a partir de ellas, se analizarán los estudios primarios de manera tal que se pueda obtener un resultado global de la evidencia, el grado de certeza de la misma, una conclusión y mensajes claves al respecto. El resultado final es un resumen de la evidencia en relación a una pregunta determinada que contempla la información contenida en todas las revisiones sistemáticas publicadas. Su utilidad e importancia está determinada debido a que facilitan la aplicabilidad clínica de la evidencia disminuyendo la complejidad de lectura e incorporando aspectos prácticos tanto para el clínico como el paciente.

ABSTRACT: Systematic reviews are the highest level of evidence and the main tool for resolving clinical uncertainties(1). However, due to their characteristics, their quick and easy application(2) presents disadvantages. That is why new formats have been created, comprising the structured summaries of systematic reviews, including the Friendly Summary Of The Body Of Evidence (FRISBEE) (4). The process of elaboration of a FRISBEE begins, like any search of evidence, with the approach of a structured and specific clinical question and the development of a search in the Epistemonikos database that will yield all the pertinent systematic reviews. Of these, those that answer the clinical question should be selected and, based on them, the primary studies will be analyzed to get a global result of the evidence, its degree of certainty, conclusions and key messages in this regard. The final result is a summary of the evidence related to a specific question that includes the information contained in all published systematic reviews. Its usefulness and importance is determined because it facilitates the clinical applicability of the evidence, decreasing the reading complexity and incorporating practical aspects for both the clinician and the patient.

Espectro de dismorfosis dentofaciales: estudio restrospectivo de 23 años en hospital tipo I de alta complejidad Chile / 23 years of dentofacial deformities patients treated in a tertiary referral hospital in chile. retrospective study

RESUMEN: Objetivo: Determinar los tipos de dismorfosis dentofaciales (DDF) operados en el Hospital Clínico San Borja Arriarán, Santiago, Chile (HCSBA) entre los años 1993 - 2015 y su distribución por sexo y edad al momento de la intervención quirúrgica. Material y Método: Estudio retrospectivo, el criterio de inclusión fue diagnóstico de DDF (clases II o III esqueletal) no asociado a síndrome. La edad de los pacientes se describió con promedio y desviación estándar y el sexo con porcentajes. Análisis estadístico se realizó mediante test de Proporciones, T de Student, prueba Exacta de Fisher y modelo multivariado. Se consideró un valor p<0,05 como significativo. Resultados: De 1.008 pacientes operados por el equipo de cirugía oral y máxilofacial entre 1993 - 2015, 570 (56,5%) fueron intervenidos por cirugía ortognática para corrección de DDF. 76 (13,3%) por DDF tipo II y 494 (86,7%) por DDF tipo III. El mayor porcentaje fueron 366 mujeres (64,2%), la edad promedio fue 26,9 (DS 10,8) años en clase II y 22,8 (DS 6,8) años en clase III. Todas estas diferencias fueron estadísticamente significativas. El rango de edad con mayor porcentaje de operaciones fue entre los 20 - 30 años (55,6%). Conclusión: La DDF más frecuentemente operada es la DDF III y el mayor porcentaje son mujeres entre los 20 - 30 años.

ABSTRACT: Objective: To determine main characteristics of dentofacial deformities (DDF) patients treated with orthognathic surgery at San Borja Arriarán Clinical Hospital, Santiago, Chile (HCSBA) during the last 23 years. Materials and methods: This is a retrospective study, the cases are registered in the electronic database of the oral and maxillofacial service of the HCSBA between 1993 - 2015. Inclusion criteria were patients with a diagnosis of DDF (skeletal class II or III) - not associated with syndromes- who went under orthognathic surgery since 1993 to 2015. Characteristics analysed included: type of DDF, sex and age. Results were described using percentage, mean and standard deviation. Proportion, Student's Ttest, Exact Fisher Test and a multivariate model were utilized for statistical analysis. A p-value <0.05 was considered significant. Results: A total of 1.008 patients were surgically treated. During this period 570 (56,5%) patients underwent orthognathic surgery to correct DDF, 76 (13.3%) for DDF type II and 494 (86.7%) for DDF type III. Most patients intervened were women 366 (64.2%). The mean age was of 23.3 years; 26.9 (SD 10.8) years in class II and 22.8 SD (6.8) years in class III. All differences were statistically significant. The age range with the highest percentage of operations was between 20 - 30 years (55.6%). Conclusion: The most frequently operated DDF is type III, the highest percentage being women and young adults between 20 - 30 years.

Relación entre apiñamiento dentario y terceros molares / Relationship between anterior crowding and third molars

RESUMEN: Introducción: La relación entre terceros molares y el desarrollo o reincidencia de maloclusión y apiñamiento dental tras el tratamiento de ortodoncia, especialmente en el segmento anterior del arco dental, es un tema que ha sido discutido y presentado en la literatura, el cual aún permanece sin resolver. Métodos: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, preparamos tablas de resumen de los resultados utilizando el método GRADE. Resultados: Identificamos 7 revisiones sistemáticas que en conjunto incluyen 31 estudios primarios, de los cuales, 2 son ensayos aleatorizados. Conclusiones: El limitado desarrollo de estudios que relacionan los terceros molares con apiñamiento dental y el bajo nivel de evidencia de éstos no permiten tener claridad respecto a la posible asociación. Son necesarios nuevos estudios sobre el tema.

ABSTRACT: Introduction: The relationship between third molars and the development or recurrence of malocclusion and dental crowding after orthodontic treatment, especially in the anterior segment of the dental arch, is a subject that has been discussed and presented in the literature, which still remains unsolved. Methods: To answer this question we used Epistemonikos, the largest database of systematic health reviews, which combines searches in multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted the data from the identified reviews, reanalyzed them from the primary studies and prepared summary tables of the results using the GRADE method. Results: We identified 7 systematic reviews that together included 31 primary studies, 2 of which were randomized trials. Conclusion: The limited development of studies that relate third molars to dental crowding and their low level of evidence does not allow us to be certain about the possible association. New studies are necessary.

Revisiones Sistemáticas: definición y nociones básicas / Systematic Reviews: definition and basic notions

RESUMEN: El desarrollo de la Odontología Basada en Evidencia ha generado la necesidad constante de actualización e información por parte de los profesionales(1). Ante esto, los artículos actualizados que sintetizan información y poseen altos estándares, son las mejores fuentes de evidencia, siendo para ello las revisiones sistemáticas las mejores herramientas(2). Éstas, corresponden a resúmenes claros y estructurados de la información disponible orientada a responder una pregunta clínica específica(3). Poseen un proceso de elaboración estructurado que comienza con el planteamiento de una pregunta clínica específica, con los cuales se realizará la búsqueda en las bases de datos. Una vez obtenida la información se deben seleccionar los artículos y, a partir de los seleccionados, se obtendrán los datos y se realizarán los análisis críticos y estadísticos de la información, finalmente exponiendo los resultados del trabajo.

ABSTRACT: The development of Evidence Based Dentistry has generated the constant need for updating and information from professionals (1). Given this, updated articles synthesizing information and with high standards are the best sources of evidence, being systematic reviews the best tools (2). Systematic reviews are clear and structured summaries of the available information aimed at answering a specific clinical question(3). They have a structured elaboration process that begins with the presentation of a specific clinical question, which will be used for the search in the databases. Once the information has been obtained, the articles must be selected and, starting from the selected ones, the data will be obtained and the critical and statistical analysis of the information will be carried out. Finally, the results of the work will be exposed.