Pre-Surgical Factors Influencing Post-Surgical Outcomes in Orthognathic Surgery Patients: A Longitudinal Study.

Background/Objectives: This study aims to assess the relationship between physical and psychosocial pre-surgical factors and post-surgical evolution in patients undergoing orthognathic surgery. Methods: A cohort study with 3 months of follow-up after maxillofacial surgery was conducted. Participants were recruited from the Maxillofacial Surgery Unit of Hospital Universitario La Paz in Madrid, Spain. Primary variables included the range of motion of mouth opening, protrusion tongue force, anxiety, depression and kinesiophobia. Assessments were realised on-site or via video call. Statistical analysis was conducted using mixed-effects models. Results: The initial recruitment yielded 22 patients, with 19 ultimately eligible for analysis. The study found significant impacts of pre-surgical factors on post-surgical evolution. Both ranges of motion and anxiety showed influences from baseline measures, with the range of motion affected by a pre-surgical range of motion (estimate: 3.89) and positive expectations (estimate: 4.83). Anxiety was influenced by both pre-surgical (estimate: 0.48) and baseline anxiety levels (estimate: 0.64). Kinesiophobia demonstrated a trend toward significance, with baseline levels affecting post-surgical evolution (estimate: 0.77). Conclusions: Our results highlight the relationship between pre-surgical factors and post-surgical outcomes in orthognathic surgery patients. Pre-surgical range of motion and positive expectations were found to influence post-surgical range of motion, while pre-surgical anxiety levels impacted post-surgical anxiety evolution. Pre-surgical kinesiophobia also showed potential as a post-surgical kinesiophobia predictor, but further investigation is needed to confirm this relationship.

In vitro response of sugarcane (Saccharum spp. Hybrid) plantlets to flooding stress.

Flooding caused by climate change puts the productivity of sugarcane cultivation at risk. The objective of this study was to evaluate the effect of in vitro flooding stress on sugarcane plantlets. Sugarcane plantlets were grown in test tubes containing Murashige and Skoog semi-solid medium without growth regulators as a control treatment and two stress levels using a double layer with sterile distilled water to simulate hypoxia and anoxia. After 15 d of culture, the number of new shoots, plantlet height, number of leaves, number of roots, root length, stomatal density, percentage of closed stomata and percentage of dry matter were evaluated. In addition, biochemical variables such as chlorophylls, carotenoids, phosphoenolpyruvate (PEP), Rubisco, total proteins (TP), proline (Pr), glycine-betaine (GB), phenols, antioxidant capacity and lipid peroxidation were determined in all treatments. Results showed a higher number of new shoots, leaves and percentage of closed stomata in the flooded plantlets, while plantlet height, number of roots, stomatal density, and dry matter were higher in the control treatment. Regarding, chlorophyll, carotenoid, PEP and Rubisco contents decreased in the flooded treatments, while TP and phenol contents were higher in the partially submerged treatment. Antioxidant capacity and lipid peroxidation increased in the fully submerged treatment. Pr and GB contents did not show changes in any of the evaluated treatments. Stress induced by excess water in a double layer in vitro is an alternative method to determining physiological and biochemical mechanisms of tolerance to hypoxia and anoxia caused by flooding for breeding programs in sugarcane.

Temporary immersion systems induce photomixotrophism during in vitro propagation of agave Tobalá.

This study aimed to determine the photomixotrophic and physiological responses using different temporary immersion systems (TIS) during in vitro multiplication of agave Tobalá. The culture systems were SETIS™ bioreactor, Temporary Immersion Bioreactor (TIB), Monobloc Advance Temporary Immersion System, and semisolid culture medium as the control. At six weeks of culture, different physiological variables were evaluated: chlorophyll content, stomatal index, percentage of closed stomata, Phosphoenolpyruvate (PEP) and Rubisco during the multiplication stage, and survival percentage in the acclimatization stage. TIS increased multiplication rate (41%), stomatal index (44%), percentage of closed stomata (11%) and chlorophyll content (45%) with respect to the semisolid culture medium system. The highest PEP content (> 35%) was observed in temporary immersion (TI), whereas, Rubisco content, showed no differences among the culture systems evaluated. Regarding survival percentage during acclimatization, the highest shoot survival was obtained in TI, and all regenerate shoots were rooted ex vitro. This study shows that in vitro photomixotrophism was induced in TIS during the multiplication stage. In conclusion, SETIS™ bioreactor and TIB systems are an alternative for mass multiplication of A. potatorum; however, all TIS evaluated guarantee a high survival rate during acclimatization.

Temporary Immersion Bioreactors for Sugarcane Multiplication and Rooting.

Sugarcane is used to produce sugar, ethanol, and other by-products, so it is considered one of the most important crops worldwide. Using temporary immersion systems for sugarcane micropropagation represents an alternative to reduce the labor force, increase plant development, and improve plant quality. Temporary immersion systems are semi-automated bioreactors designed for the large-scale propagation of tissues, embryos, and organs. These are temporarily exposed in a liquid culture medium under a specific time and immersion frequency. Using this protocol and a temporary immersion bioreactor, it is possible to achieve multiplication and rooting. The use of temporary immersion bioreactors improves the multiplication rate and the rooting of sugarcane, reducing the culture time, labor force, and reagents needed while maintaining high survival rates during acclimatization.

In-House 3D Printed Positioning and Cutting Guide System for Mandibular Reconstruction. Protocol and case report.

Maxillofacial surgery planning has been improved by technological advances in 3D printing. The use of customized cutting and positioning guides allows intraoperative reproduction of pre-planned osteotomy cuts, resulting in increased surgical accuracy, reduced surgical time and improved esthetic and functional outcomes. Our paper presents a new method for creating and printing in-house cutting and positioning guides. A computer program (Brainlab iPlan) was used to segment the mandible for three-dimensional planning from imported conventional computed tomography (CT) scans. The virtual model of the mandible was printed on a stereolithography (SLA) 3D printer and a reconstruction plate was adapted to the printed model. The surface of the model and the screw-retained plate was scanned using a structured light surface 3D scanner (Artec Eva). The obtained scan of the jaw and plate in position was processed and transformed into an STL file. Free software (Autodesk Meshmixer) superimposes the initial jaw on the scanned jaw with the plate, designing a customized hybrid cutting guide that allows accurate intraoperative positioning, knowing the exact position of the reconstruction plate screws in the jaw. The total design, fabrication and 3D printing time for the in-house hybrid guide was 595 min. The average total printing cost was EUR 16. We found the technique to be simple and repeatable. We present and describe here a novel and simple technique for in-house 3D printed positioning and cutting guide system which can be applied to overall maxillofacial area. In cases of mandibular reconstruction, this protocol guarantees an adequate esthetic and functional result. Key words:Oral cancer, 3D surgery, CAD/CAM, personalized medicine, surgical guides, in house.

Dynamic Trends in Surgical Oromaxillofacial Trauma Epidemiology: A Comparative Study of Pre-COVID-19 and COVID-19 Periods in Tertiary Referral Hospitals in Madrid.

Introduction: The COVID-19 pandemic has induced profound societal and healthcare transformations globally. Material and methods: This multicenter retrospective study aimed to assess potential shifts in the epidemiology and management of oromaxillofacial trauma requiring surgical intervention over a 1-year period encompassing the onset of the COVID-19 pandemic, in comparison to the preceding year. The parameters investigated included age, sex, injury mechanisms, fractured bones, and treatment modalities. The statistical significance was set at p < 0.05. Results: A notable 39.36% reduction in oromaxillofacial fractures was identified (p < 0.001), with no significant alterations in sex distribution, types of fractured bones, or treatment modalities. An appreciable increase in mean age was observed (35.92 vs. 40.26) (p = 0.006). Analysis of the causes of oromaxillofacial trauma revealed diminished incidents of interpersonal violence (41% vs. 35%) and sports-related injuries (14% vs. 8%), alongside an escalation in cases attributed to falls (27% vs. 35%), precipitation events (2% vs. 5%), and traffic accidents (12% vs. 13%). The mandible emerged as the most frequently fractured bone. Conclusion: In conclusion, the COVID-19 pandemic has decreased the number of maxillofacial fractures treated surgically and has changed the epidemiology and the etiology of facial traumas.

Diagnostic utility of transcranial magnetic stimulation for neurodegenerative disease: a critical review.

Neurodegenerative diseases pose significant challenges due to their impact on brain structure, function, and cognition. As life expectancy rises, the prevalence of these disorders is rapidly increasing, resulting in substantial personal, familial, and societal burdens. Efforts have been made to optimize the diagnostic and therapeutic processes, primarily focusing on clinical, cognitive, and imaging characterization. However, the emergence of non-invasive brain stimulation techniques, specifically transcranial magnetic stimulation (TMS), offers unique functional insights and diagnostic potential. TMS allows direct evaluation of brain function, providing valuable information inaccessible through other methods. This review aims to summarize the current and potential diagnostic utility of TMS in investigating neurodegenerative diseases, highlighting its relevance to the field of cognitive neuroscience. The findings presented herein contribute to the growing body of research focused on improving our understanding and management of these debilitating conditions, particularly in regions with limited resources and a pressing need for innovative approaches.

As doenças neurodegenerativas representam desafio significativo por seu impacto na estrutura cerebral, função e cognição. À medida que a expectativa de vida aumenta, a prevalência dessas doenças cresce rapidamente, resultando em substanciais encargos pessoais, familiares e sociais. Esforços têm sido feitos para otimizar os processos diagnósticos e terapêuticos, com foco principal na caracterização clínica, cognitiva e de imagem. No entanto, o surgimento de técnicas de estimulação cerebral não invasivas, especificamente a estimulação magnética transcraniana (EMT), oferece compreensão funcional e potencial diagnóstico únicos. A TMS permite a avaliação direta da função cerebral, fornecendo informações valiosas inacessíveis por outros métodos. Esta revisão teve como objetivo resumir a utilidade diagnóstica atual e potencial da EMT na investigação de doenças neurodegenerativas, destacando sua relevância para o campo da neurociência cognitiva. As conclusões aqui apresentadas contribuem para o crescente corpo de investigação centrado na melhoria da nossa compreensão e gestão dessas condições debilitantes, particularmente em regiões com recursos limitados e necessidade premente de abordagens inovadoras.

Diagnostic utility of transcranial magnetic stimulation for neurodegenerative disease: a critical review / Utilidade diagnóstica da estimulação magnética transcraniana para doenças neurodegenerativas: uma revisão crítica

ABSTRACT. Neurodegenerative diseases pose significant challenges due to their impact on brain structure, function, and cognition. As life expectancy rises, the prevalence of these disorders is rapidly increasing, resulting in substantial personal, familial, and societal burdens. Efforts have been made to optimize the diagnostic and therapeutic processes, primarily focusing on clinical, cognitive, and imaging characterization. However, the emergence of non-invasive brain stimulation techniques, specifically transcranial magnetic stimulation (TMS), offers unique functional insights and diagnostic potential. TMS allows direct evaluation of brain function, providing valuable information inaccessible through other methods. This review aims to summarize the current and potential diagnostic utility of TMS in investigating neurodegenerative diseases, highlighting its relevance to the field of cognitive neuroscience. The findings presented herein contribute to the growing body of research focused on improving our understanding and management of these debilitating conditions, particularly in regions with limited resources and a pressing need for innovative approaches.

RESUMO. As doenças neurodegenerativas representam desafio significativo por seu impacto na estrutura cerebral, função e cognição. À medida que a expectativa de vida aumenta, a prevalência dessas doenças cresce rapidamente, resultando em substanciais encargos pessoais, familiares e sociais. Esforços têm sido feitos para otimizar os processos diagnósticos e terapêuticos, com foco principal na caracterização clínica, cognitiva e de imagem. No entanto, o surgimento de técnicas de estimulação cerebral não invasivas, especificamente a estimulação magnética transcraniana (EMT), oferece compreensão funcional e potencial diagnóstico únicos. A TMS permite a avaliação direta da função cerebral, fornecendo informações valiosas inacessíveis por outros métodos. Esta revisão teve como objetivo resumir a utilidade diagnóstica atual e potencial da EMT na investigação de doenças neurodegenerativas, destacando sua relevância para o campo da neurociência cognitiva. As conclusões aqui apresentadas contribuem para o crescente corpo de investigação centrado na melhoria da nossa compreensão e gestão dessas condições debilitantes, particularmente em regiões com recursos limitados e necessidade premente de abordagens inovadoras.

Encefalopatía subaguda en una paciente con policondritis recidivante: caso clínico / Subacute encephalopathy associated with relapsing polychondritis: report of one case

Relapsing polychondritis (RP) is a rare multisystemic autoimmune disorder characterized by the inflammation and destruction of cartilages, with preference for auricular, nasal and laryngotracheal cartilages. RP may also affect proteoglycan-rich structures, such as, blood vessels, eyes, kidneys, and heart. The central nervous system (CNS) is involved in less than 3% of patients. We report a 32-year-old female with RP associated with a progressive subacute encephalopathy characterized by behavioral disturbances, auditory and visual hallucinations. The EEG showed generalized slow activity and a mononuclear pleocytosis with increased protein was found in the cerebrospinal fluid. The brain magnetic resonance imaging showed multiple supra and infratentorial nodular inflammatory lesions. After initiating treatment with corticosteroids and cyclophosphamide, a significant improvement in chondritis and neurological status was observed.

Posibles Factores de Riesgo Asociados a Seropositividad y Seronegatividad de IgM para Toxoplasmosis en Tamaulipas / Possible Risk Factors Associated with Seropositivity and Seronegativity of IgM for Toxoplasmosis in Tamaulipas

Objetivos: Identificar la seropositividad y seronegatividad de IgM para Toxoplasmosis, así como los posibles factores de riesgo asociados a las mismas, en mujeres en edad reproductiva de Tampico, Madero y Altamira, con la finalidad de aportar nueva información contextualizada que permita llevar a cabo acciones de prevención. Material y Métodos: Se determinó la seropositividad y seronegatividad para IgM anti-Toxoplasma gondii mediante muestras de punción dactilar en casetes de TORCH en 50 pacientes femeninas en edad reproductiva de 22 a 35 años de edad de Tampico, Madero y Altamira. Así como su relación con los posibles factores de riesgo asociados a Toxoplasmosis mediante un cuestionario elaborado por los investigadores. Resultados: La seronegatividad y seropositividad de tipo IgM anti-Toxoplasma gondii en 50 mujeres en edad reproductiva de 22 a 35 años de edad en la zona conurbada fue de 100% y 0% respectivamente. Los factores de riesgo asociados a Toxoplasmosis que se presentaron con mayor frecuencia en la población seronegativa fueron el consumo de carne mal cocinada (36%) y la convivencia con gatos (26%).Discusión y Conclusiones: Se encontró una seropositividad nula a IgM anti-Toxoplasma gondii, y una baja frecuencia de exposición y/o contacto con los posibles factores de riesgo asociados a Toxoplasmosis. Se sugiere estudiar poblaciones que acudan al sector público de salud y realizar la búsqueda de anticuerpos anti-Toxoplasma gondii mediante la determinación de ambas pruebas: IgM e IgG.(AU)

Objectives: Identify the seropositivity and seronegativity of IgM for Toxoplasmosis, as well as the possible risk factors associated with them, in women of reproductive age from Tampico, Madero and Altamira, in order to provide new contextualized information that allows carrying out prevention actions. Material and Methods: The seropositivity and seronegativity for IgM anti-Toxoplasma gondii were determined by the fingerprint puncture samples in TORCH cassettes in 50 female patients of reproductive age (22-35 years) from Tampico, Madero and Altamira. As well as its relationship with the possible risk factors associated with Toxoplasmosis through a questionnaire prepared by researchers. Results: Seronegativity and seropositivity of IgM anti-Toxoplasma gondii in 50 women of reproductive age between 22 and 35 years old in the metropolitan area was 100% and 0% respectively. The risk factors associated to Toxoplasmosis with higher frequency in the seronegative population were the consumption of poorly cooked meat (36%) and the coexistence with cats (26%). Discussion and Conclusions: A nule seropositivity to anti-Toxoplasma Gondii IgM and a low frequency of exposure and/or contact with possible risk factors associated with Toxoplasmosis was found.(AU)

Electroencefalograma cuantitativo en la predicción precoz de la isquemia cerebral tardía en hemorragia subaracnoidea aneurismática: reporte de un caso / Quantitative electroencephalogram for prediction of delayed ischemia in subarachnoid haemorrhage: report of one case

Subarachnoid hemorrhage (SAH) is a devastating disease, with a mortality rate of 35%. Among patients who survive the initial bleeding, the leading cause of morbidity and mortality is delayed cerebral ischemia (DCI). Electroencephalography (EEG) can detect cerebral ischemia in the early stages. We report a 66-year-old female patient who consulted for ictal headache and impaired consciousness. On admission, she was confused, dysarthric, and with meningeal signs. Brain angio-CT showed SAH FISHER IV and an aneurysm of the left posterior cerebral artery. After excluding the aneurysm (by coiling), the patient recovered the altered consciousness. Continuous EEG monitoring was initiated. On the sixth day of follow up, she had a transient headache and apathy. The brain MRI showed low cerebral blood flow in the left frontotemporal area, without ischemic lesions. On the seventh day, she presented expression aphasia and right facial-brachial paresis. Angiography confirmed severe vasospasm in M1 and M2 segments bilaterally. Pharmacological angioplasty with nimodipine was performed, with an excellent radiological response, although not clinical. A second MRI was carried out on the eighth day, which showed a left insular infarction and generalized vasospasm. A second therapeutic angiography was performed; the patient persisted with aphasia and left central facial paresis. The quantitative EEG analysis performed retrospectively showed a generalized reduction in the spectral edge frequency 95 (SEF95; meaning slowing in the EEG signal) at the fourth day of follow up, three days earlier than the clinical and imaging diagnosis of DCI was established.

Bisphosphonate-related osteonecrosis. Application of adipose-derived stem cells in an experimental murine model

Background: Bisphosphonate-related osteonecrosis of the jaw is a pathological condition without effective established treatment and preventive strategies. The aim of this study was to analyse the effect of adipose-derived stem cells (ASC) in an experimental murine model of osteonecrosis. Material and Methods: 38 Wistar rats were injected intraperitoneally with zoledronic acid. After treatment, upper jaw molars were extracted. The animals were randomly assigned to one of two groups. In the control group, saline solution was applied over the alveolar sockets after the tooth extractions. In the treatment group, ASCs were applied instead of saline solution. The control and treatment groups were subdivided based on the time of euthanasia. A clinical and histological analysis was performed. Results: The presence of osteonecrosis in alveolar bone was observed in a similar distribution in both groups. In the ASC-treated group, new bone formation was greater than in controls. Conclusions: In this study, application of ASCs showed greater new bone formation in an osteonecrosis-like murine model. Previous inhibited post-extraction bone remodelling could be reactivated, and these findings appeared to be secondary to implantation of ASCs

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Derivación de pacientes con síndrome de disfunción temporomandibular desde Atención Primaria / Referral of patients with temporomandibular joint dysfunction from Primary Care

Introducción: El síndrome de disfunción temporomandibular (SDTM) engloba un amplio abanico de síntomas que van desde molestias a la palpación de la musculatura masticadora hasta episodios de imposibilidad para la apertura o el cierre oral e incluso degeneración articular irreversible. El manejo de los pacientes con sintomatología propia de esta enfermedad es controvertido; generalmente los episodios inflamatorios agudos son susceptibles de tratamiento conservador y no precisan, en principio, valoración por un especialista. Como centro de referencia de la Comunidad de Madrid nuestra impresión es que la derivación de esta dolencia desde Atención Primaria es masiva y poco orientada, lo que, de ser cierto, ocasionaría un aumento de los costes sanitarios directos e indirectos, así como una saturación de las consultas de especialidad. Material y métodos: En este trabajo realizamos un análisis prospectivo de la derivación de los pacientes con SDTM desde Atención Primaria al Hospital Universitario La Paz en un período de 6 meses mediante un sistema de cuestionarios anónimos cumplimentados por el especialista y el paciente. Resultados: La muestra del estudio la constituyen 101 pacientes. El 35,6% de los pacientes derivados presentan una evolución crónica (mayor de 6 meses) de la enfermedad, con una sintomatología leve y en el 65,3% de los casos no se había instaurado ningún tipo de tratamiento por un médico/dentista antes de acudir a nuestra consulta. El gasto extra total anual provocado por la incorrecta derivación desde Atención Primaria asciende a 54.309,024 euros anuales. Conclusiones: Por su elevada prevalencia, el SDTM constituye un foco interesante de acción a la hora de optimizar los tratamientos y minimizar el gasto dentro de las entidades maxilofaciales. Este trabajo pone de manifiesto la situación actual y alerta sobre la necesidad de elaborar protocolos de derivación en consenso con Atención Primaria

Introduction: Temporomandibular joint syndrome (TMJS) includes a wide range of signs and symptoms that vary from mild pain in masticatory muscles to inability to open and close the mouth, and even irreversible joint derangement. Management is controversial, with the more acute inflammatory episodes being good candidates for conservative treatment. These patients do not need, at least initially, to be evaluated by a maxillofacial surgeon. As a maxillofacial referral centre in the Madrid area, it seems that patients affected by this syndrome are referred to our centre from Primary Care on a large scale, and are completely uninformed about their disorder. If this is the case, unnecessary direct and indirect health care costs would be increased, as well as contribute to medical consultation overload. Material and methods: A prospective analysis was performed on TMJS patient referral from Primary care to the Hospital Universitario La Paz during a 6 months period. A self-report anonymous questionnaire was also completed by the professional and the patient in order to collect data. Results: Of the101 patients evaluated, 35.6% had chronic onset (more than 6 months) and with mild symptoms. Almost two-thirds (65.3%) of patients had not received any kind of treatment before coming to the centre. Annual additional costs due to incorrect patient referral were 54,309.024 euros. Conclusions: Due to its high prevalence, TMJS is an interesting focus for action when it comes to controlling extra costs and medical consultation overload. This report shows the present situation, and stressed the need for a consensus referral protocol in Primary Care

Acuerdo entre los hallazgos de la cinedeglución con esofagograma con respecto a la evaluación funcional endoscópica de la deglución, en pacientes con disfagia / Agreement between the findings in barium swallow pharyngoesophagography and fiberoptic endoscopic evaluation of swallowing, in patients with dysphagia

Introducción: La disfagia y sus complicaciones son una consulta frecuente en nuestra práctica clínica. En nuestro medio y en la literatura, el trago de bario ha sido tradicionalmente considerado el patrón de oro en la evaluación de los trastornos de la deglución; sin embargo, hemos observado que existen casos donde la sintomatología del paciente no concuerda con los resultados reportados en el examen. Revisando la literatura no encontramos un estudio comparativo entre la evaluación endoscópica y radiológica de la disfagia que soporte la necesidad de realizar ambas pruebas de forma no exclusiva. Objetivo: Determinar el nivel de acuerdo entre los hallazgos en la Evaluación Euncional Endoscópica de la Deglución (EFED) y la Cinedeglución con Esofagograma (CE) en pacientes con disfagia. Diseño: Estudio de evaluación de la concordancia. Materiales y Métodos: Estudio de evaluación de la concordancia con 47 pacientes, donde por medio de la revisión de historias clínicas se analizó la presencia o no de vertimiento, residuo faríngeo, penetración o aspiración en los reportes de CE y EFED, así como las características de la población estudiada. Resultados: El nivel de acuerdo (coeficiente de kappa) para residuo faríngeo fue de 0,123 (IC 95% -0.075; 0.321), para el hallazgo de penetración fue de 0,382 (IC 95% 0.158; 0.605) y para aspiración fue de 0,356 (IC 95% 0.086; 0.626). Para vertimiento no pudo ser calculado. Conclusiones: Reconociendo las limitaciones del estudio y conociendo las ventajas y desventajas de estos exámenes, consideramos que el no acuerdo justifica la realización de ambos exámenes porque según lo observado no hay un nivel de concordancia suficiente para realizar uno solo como método diagnóstico en algunos pacientes.

Background: Dysphagia and its complications are a frequent chief complaint in our clinical practice. Barium Swallow Pharyngoesophagography (BSP) has been traditionally considered the gold standard for the diagnosis of swallowing disorders. However, we have observed that in some cases the symptoms referred by the patient do not match the results reported by this test. As far as we know, there is no study that compares the endoscopic and radiological evaluation of swallowing disorders, in order to explain the importance of performing both tests in a non-exclusive way. Objectives: To determine the level of agreement between the findings in Fiberoptic endoscopic evaluation of swallowing (FEES) and BSP when evaluating patients with dysphagia. Methods: Agreement evaluation study, of medical records form 47 patients. An analysis of the reports for BSP and FEES was made, evaluating the presence or not of premature spillage, pharyngeal residue, penetration and aspiration. The characteristics of the population studied were also analyzed. Results: The level of agreement (kappa's coefficient) for pharyngeal residue was 0.123 (CI 95% -0.075; 0.321), for penetration was 0.382 (CI 95% 0.158; 0.605) and for aspiration was 0.356 (CI 95% 0.086; 0.626). The value for premature spillage could not be calculated. Conclusion: Recognizing the limitations of the study and acknowledging the advantages and disadvantages of both exams, we believe the non-agreement supports the fact of performing both exams, because according to the results, there is not enough concordance between the findings on FEES and the BSP in order to perform only one of them in some patients.

Evaluación de levaduras nativas productoras de etanol presentes en el bagazo de caña de azúcar / Evaluation of producing ethanol native yeasts present in sugar cane bagasse

RESUMEN La hidrólisis química o enzimática del bagazo de caña de azúcar permite la obtención de azúcares fermentables, utilizados en la producción biotecnológica de etanol, mediante el empleo de levaduras comerciales o autóctonas obtenidas de diferentes materiales lignocelulósicos. El objetivo de este trabajo fue valorar la capacidad de producción de e tanol de cepas de levaduras nativas, aisladas en medio YPD e hidrolizado de bagazo de caña de azúcar, concentrado hasta un 75 %. Utilizando como variables de estudio el tipo de cepa y el tiempo de proceso, se realizó un análisis multifactorial (ANOVA) para su evaluación. Los resultados obtenidos con la cepa seleccionada UAT-3, fueron para Yp/s de 0.441 7 g/g y QP de 0.076 7 g/L-h a las 120 h. Las condiciones de proceso utilizadas en el presente estudio permitieron aislar y seleccionar cepas nativas de Sacharomyces cereviseae, con características adecuadas para ser utilizadas en procesos biotecnológicos industriales de producción de etanol, utilizando como sustrato residuos o subproductos derivados de la in dustria azucarera como el bagazo de caña de azúcar.

ABSTRACT The chemical or enzymatic hydrolysis of sugar cane bagasse, allows the obtaining of fermentable sugars used in the biotechnological production of ethanol by using commercial or native yeasts obtained from different lignocellulosic materials. The purpose of this study was to assess the production capacity of ethanol from a native yeast strain isolated in YPD and hydrolyzed sugar cane bagasse concentrated up to 75 %. Using as study variables the type of strain and processing time, a multivariate analysis (ANOVA) was performed for its evaluation. The results achieved with the selected strain UAT-3, were 0.441 7 g/g for Yp/s and 0.076 7 g/L-h to 120 h for QP. The process conditions used in the present study allowed to isolate and select native strains of Sacharomyces cereviseae, with characteristics suitable to be used in industrial biotechnological proceses of ethanol production, using as substrate residues or by-products derived from the sugar industry such as bagasse of sugar.

El prejuicio de profesionales que trabajan con personas en exclusión social en Andalucía: un enfoque de proceso dual / Prejudice in practitioners who work with socially excluded people in Andalusia: A dual process approach

Se presupone que el perfil de los profesionales que trabajan con personas en exclusión social es incompatible con el mantenimiento de prejuicios hacia el colectivo al que sirven y, en todo caso, la elevada homogeneidad en los niveles de prejuicio y sus causas apenas permitiría confirmar modelos explicativos. El presente estudio puso a prueba esta hipótesis en relación con el modelo cognitivo-motivacional de proceso dual de Duckitt (2001) y Duckitt y Sibley (2010). Se recogieron datos de 565 profesionales andaluces en un estudio transversal basado en encuesta en el que se midieron variables sociodemográficas, de personalidad, valores, actitudes ideológicas, posicionamiento político y prejuicio. El modelo ajustado a los datos reprodujo las relaciones más básicas del modelo hipotético, si bien su capacidad explicativa fue limitada. Por otra parte, las vías del autoritarismo y la dominancia incidieron significativamente sobre el prejuicio, lo que sugiere que el ligero sesgo identificado en los profesionales correspondería a la percepción de las personas en exclusión social como pertenecientes a un colectivo disidente. Se sugiere la introducción de la identidad profesional como un macroconstructo modulador de la varianza explicada de prejuicio, así como, en el plano aplicado, la conveniencia de avanzar en el desarrollo profesional de estos trabajadores

It is assumed that the professional profile of those who work with socially excluded people is not compatible with the maintenance of prejudices against the group they help. The current study tested this hypothesis regarding the Dual Process Cognitive-Motivational Model of Duckitt (2001) and Duckitt and Sibley (2010). Data from 565 Andalusian professionals were collected in a cross-sectional survey, using measures of socio-demographics, personality, values, ideological attitudes, political position, and prejudice. The model fitted to data reproduced the basic relations in the hypothesized model, although its explanatory power was limited. Prejudice was significantly explained by both paths (authoritarianism and dominance), leading to the conclusion that the reduced level of prejudice held by professionals corresponds to the perception of socially excluded people as a dissident group. This suggests that professional identity as a broad construct may moderate the variance in prejudice. Finally, these findings also suggest that the professional development of social workers should be promoted

Uso de customer relationship management para mejorar la atención sanitaria de la ciudadanía. Servicio Salud Andalucía 24 horas. Salud Responde / Use of customer relationship management to improve healthcare for citizens. The 24h Andalusian Health Service: Healthline

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Complicaciones en reconstrucción craneal con prótesis de polieteretercetona / Complications in cranial reconstruction using PEEK prosthesis

Introducción. Los defectos craneales tienen una repercusión importante en el paciente desde un punto de vista estético, psicológico y funcional. Actualmente no existe acuerdo sobre el material ideal para la reconstrucción de estos defectos. Material y métodos. Realizamos un estudio retrospectivo incluyendo a los pacientes con reconstrucción craneal con prótesis de polieteretercetona (PEEK) a medida entre los años 2008 y 2014 en el Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario La Paz, Madrid. Las prótesis son diseñadas de manera específica para cada paciente con el sistema CAD-CAM. Resultados. Se reconstruyó a un total de 7 pacientes con defectos craneales con prótesis de PEEK. Solo en un caso, la resección y reconstrucción fueron realizadas en el mismo acto quirúrgico. En el resto de los casos se realizó una reconstrucción diferida. Las complicaciones que se presentaron fueron: un seroma y una fístula de LCR, que se resolvieron con tratamiento conservador; y una dehiscencia de la herida y un caso con episodios de infecciones repetidas, cuyo defecto estaba próximo al seno frontal, que terminaron con la retirada definitiva de la prótesis. Conclusión. El material ideal para la reconstrucción de defectos craneales no existe. Las prótesis de PEEK están obteniendo buenos resultados estética y funcionalmente. Cuando el hueso autógeno no esté disponible o en determinados casos con defectos grandes, las prótesis de PEEK pueden ser una buena opción. Sin embargo, si el defecto está en comunicación directa con los senos paranasales, debemos valorar bien la indicación (AU)

Introduction. Cranial defects tend to carry functional and aesthetic consequences for the patient. The most suitable material to be used remains controversial. Methods. We report a retrospective review of patients whose cranial defects were reconstructed using a computer designed polyetheretherketone (PEEK)-patient specific implant) between 2008 and 2014 at the Oral and Maxillofacial Surgery Department, in Hospital Universitario La Paz, Madrid. Implants are designed individually to each patient with CAD-CAM system. Results. Seven patients underwent cranial reconstruction using a PEEK-patient specific implant. One case involved a one-step primary reconstruction and the rest of cases underwent a delayed reconstruction. Complications were: one seroma and one CSF leak, resolved with conservative treatment, and a wound dehiscence and an infection case whose defect was near the frontal sinus, resolved with removal of the implant. Conclusion. The ideal material for reconstructing cranial defects does not exist, but PEEK has demonstrated good outcomes. When autologous bone is not available or in selected cases with large defects, PEEK is a good option to reconstruct these defects. However, if the defect is related with paranasal sinuses, indication must be evaluated (AU)

Variations in the anatomical relationship between the common carotid artery and the internal jugular vein:: An ultrasonographic study / Variaciones de la relación anatómica de la arteria carótida común y la vena yugular interna:: Estudio ecográfico

Introduction: The internal jugular vein locates anterior or anterolateral to the common carotid artery in two-thirds of the subjects studied by ultrasound when the head is in a rotated position. Aim:To identify variables associated with the anterior location of the internal jugular vein. Methods: Ultrasound examinations were performed with the patients in the supine position, with the head rotated to the opposite side. The proximal third of the neck was visualized transversely with a 7.5-mHz transducer. The relationship between the vessels was described in accordance with the proportion of the artery overlapped by the vein. Univariate comparisons and a multivariate analysis of potential variables that may affect the anatomic relationships were performed. Results: Seventy-eight patients were included, 44 of whom were men. The patients' ages ranged from 17 to 90 years (median= 64.0, interquartile range 41-73). The right and left sides were studied 75 and 73 times, respectively. The vein was located lateral to the artery in 24.3% (95%CI= 17.4-32.2) of the studies, anterolateral in 33.8% (95%CI= 26.2-41.4) and anterior in 41.9% (95%CI 33.9-49.8). The multivariate analysis identified age group (OR= 3.7, 95%CI= 2.1-6.4) and, less significantly, the left side (OR= 1.7, 95%CI 0.8-3.5) and male gender (OR= 1.2, 95%CI= 0.6-2.7) as variables associated with the anterior position of the vein. Conclusion: The anterior position of the internal jugular vein relative to the common carotid artery increases gradually with age. Additionally, left-sided localization and male sex further increased the probability of an anterior position.

Introducción: La vena yugular interna es anterior o anterolateral a la arteria carótida común en las dos terceras partes de los sujetos estudiados sonográficamente, con la cabeza rotada. Objetivo:Se examinó la asociación de diferentes variables con la ubicación anterior de la vena. Métodos: Las ecografías se realizaron en posición supino, con la cabeza rotada hacia el lado contrario al examinado. Se visualizó transversalmente el tercio proximal del cuello, con un transductor de 7.5 mHz. La relación entre los vasos se describió de acuerdo con la proporción de la arteria cubierta por la vena. Se hicieron comparaciones univariadas con la prueba Chi2 de Pearson y un análisis multivariado de las variables candidatas a afectar las relaciones anatómicas estudiadas Resultados: Se incluyeron 78 individuos, 44 hombres, con edad entre 17-90 años (mediana 64.0, rango= 41-73 años). Se estudió el lado derecho en 75 ocasiones y el izquierdo en 73. La vena se localizó lateral en el 24.3% (IC95%= 17.4-32.2) de los vasos estudiados, anterolateral en el 33.8% (IC95%= 26.2-41.4) y anterior en el 41.9% (IC95%= 33.9-49.8). El análisis multivariado identificó: el grupo etáreo (OR= 3.7, IC95%= 2.1-6.4) y sugiere el lado izquierdo (OR= 1.7, IC95%= 0.8-3.5) y el género masculino (OR= 1.2, IC95%= 0.6-2.7), como variables asociadas con la posición anterior de la vena. Conclusión: La ubicación anterior de la vena yugular interna respecto a la arteria carótida común aumenta gradualmente con la edad. La localización izquierda y el género masculino pueden aumentar adicionalmente esta probabilidad.