Underdiagnosis, Undertreatment, and Noncompliance With Treatment in People Who Died by Suicide.

Background: This study explored the characteristics of people who die by suicide, comparing those who had depression with those who did not.Methods: Clinical data were collected through a postmortem proxy-based semistructured interview (psychological autopsy). Postmortem toxicological analysis provides data on the presence of substances or drugs in the blood of suicides. Participants were adults who died by suicide in the province of Seville, Spain, during 2006-2016. The main independent variables were previous diagnosis, postmortem diagnosis, prescribed treatment, and treatment found in blood. The primary outcome was the postmortem diagnosis of depression, after which the sample was divided into 2 groups according to DSM IV criteria to the presence or absence of major depressive episode (MDE).Results: Our sample is composed of 313 people, of which 200 (63.9%) had a diagnosis of MDE according to the psychological autopsy. Predeath diagnosis of depression was more frequent in MDE suicides than in non-MDE suicides (18.6% vs 3.5%, respectively; Χ2 = 23.420; df = 9; P = .005) and had more access to mental health treatment previous to death (67.7% vs 35.6%, respectively; Χ2 = 27.572; df = 1; P < .001). Antidepressants were prescribed in 21.5% of the MDE suicides, but only 8.5% of them were taking them at the time of death according to the toxicology exam.Conclusions: The underdiagnosis of depression in people who die by suicide is striking, as is the undertreatment. Further efforts must be made to train primary care physicians in the proper identification of persons at risk of suicide, as they are one of the main gatekeepers in the fight for suicide prevention.

Development of bone surrogates by material extrusion-based additive manufacturing to mimic flexural mechanical behaviour and fracture prediction via phase-field approach.

BACKGROUND AND OBJECTIVE: The limited availability of human bone samples for investigation leads to the demand for alternatives. Bone surrogates are crucial in promoting research on the intricate mechanics of osseous tissue. However, solutions are restricted to commercial brands, which frequently fail to faithfully replicate the mechanical response of bone, or oversimplified customised simulants designed for a specific application. The manufacturing and assessment of reliable bone surrogates made of polylactic acid via material extrusion-based additive manufacturing are presented in this work. METHODS: An experimental and numerical study with 3D-printed dog-bone and prismatic specimens was carried out to characterise the polymeric feedstock and analyse the influence of process parameters under three-point bending and quasi-static conditions. Besides, three porcine rib samples were considered as a reference for the development of the artificial bones. Bone surrogates were manufactured from the 3D-scanned real bone geometries. In order to reproduce the trabecular and cortical bone, a lattice structure for the infill and a compact shell surrounding the core were employed. Infill density and shell thickness were evaluated through different printing configurations. Additionally, a computational analysis based on the phase-field approach was conducted to simulate the experimental tests and predict fracture. The modelling considered homogenisation of the infill material. RESULTS: Outcomes demonstrated the potential of the presented methodology. Maximum force and flexural stiffness were compared to real bone properties to find the optimal printing configuration, replicating the flexural mechanical behaviour of bone tissue. Certain configurations accurately reproduce the studied properties. Regarding the numerical model, strength and stiffness prediction was validated with experimental results. CONCLUSIONS: The presented methodology enables the manufacturing of artificial bones with accurate geometries and tailored mechanical properties. Furthermore, the described modelling strategy offers a powerful tool for designing bone surrogates.

Genome organization around nuclear speckles drives mRNA splicing efficiency.

The nucleus is highly organized, such that factors involved in the transcription and processing of distinct classes of RNA are confined within specific nuclear bodies1,2. One example is the nuclear speckle, which is defined by high concentrations of protein and noncoding RNA regulators of pre-mRNA splicing3. What functional role, if any, speckles might play in the process of mRNA splicing is unclear4,5. Here we show that genes localized near nuclear speckles display higher spliceosome concentrations, increased spliceosome binding to their pre-mRNAs and higher co-transcriptional splicing levels than genes that are located farther from nuclear speckles. Gene organization around nuclear speckles is dynamic between cell types, and changes in speckle proximity lead to differences in splicing efficiency. Finally, directed recruitment of a pre-mRNA to nuclear speckles is sufficient to increase mRNA splicing levels. Together, our results integrate the long-standing observations of nuclear speckles with the biochemistry of mRNA splicing and demonstrate a crucial role for dynamic three-dimensional spatial organization of genomic DNA in driving spliceosome concentrations and controlling the efficiency of mRNA splicing.

ΔNp63 regulates MDSC survival and metabolism in triple-negative breast cancer.

Triple-negative breast cancer (TNBC) contributes greatly to mortality of breast cancer, demanding new targetable options. We have shown that TNBC patients have high ΔNp63 expression in tumors. However, the function of ΔNp63 in established TNBC is yet to be explored. In current studies, targeting ΔNp63 with inducible CRISPR knockout and Histone deacetylase inhibitor Quisinostat showed that ΔNp63 is important for tumor progression and metastasis in established tumors by promoting myeloid-derived suppressor cell (MDSC) survival through tumor necrosis factor alpha. Decreasing ΔNp63 levels are associated with decreased CD4+ and FOXP3+ T-cells but increased CD8+ T-cells. RNA sequencing analysis indicates that loss of ΔNp63 alters multiple MDSC properties such as lipid metabolism, chemotaxis, migration, and neutrophil degranulation besides survival. We further demonstrated that targeting ΔNp63 sensitizes chemotherapy. Overall, we showed that ΔNp63 reprograms the MDSC-mediated immunosuppressive functions in TNBC, highlighting the benefit of targeting ΔNp63 in chemotherapy-resistant TNBC.

Denaturing purifications demonstrate that PRC2 and other widely reported chromatin proteins do not appear to bind directly to RNA in vivo.

Polycomb repressive complex 2 (PRC2) is reported to bind to many RNAs and has become a central player in reports of how long non-coding RNAs (lncRNAs) regulate gene expression. Yet, there is a growing discrepancy between the biochemical evidence supporting specific lncRNA-PRC2 interactions and functional evidence demonstrating that PRC2 is often dispensable for lncRNA function. Here, we revisit the evidence supporting RNA binding by PRC2 and show that many reported interactions may not occur in vivo. Using denaturing purification of in vivo crosslinked RNA-protein complexes in human and mouse cell lines, we observe a loss of detectable RNA binding to PRC2 and chromatin-associated proteins previously reported to bind RNA (CTCF, YY1, and others), despite accurately mapping bona fide RNA-binding sites across others (SPEN, TET2, and others). Taken together, these results argue for a critical re-evaluation of the broad role of RNA binding to orchestrate various chromatin regulatory mechanisms.

Venopulmonary Artery Extracorporeal Life Support (VPa ECMO): A Novel Strategy for Refractory Hypoxemia Complicating VV ECMO.

Refractory hypoxemia (RH) during venovenous extracorporeal membrane oxygenation (VV ECMO) support is a complex problem that limits the benefit of this therapy. The need for sustained deep sedation and delays in active rehabilitation are considered as a direct consequence of RH. Changing from VV ECMO to a configuration that returns the flow to pulmonary artery, such as venopulmonary extracorporeal membrane oxygenation (VPa ECMO) may decrease recirculation and improve systemic oxygen delivery. We present a retrospective report that describes the impact of VPa ECMO on oxygenation during sedation withdrawal in 41 patients who received VV ECMO for coronavirus disease 2019 (COVID-19). We evidenced that arterial oxygen pressure (PaO 2 ) increased from 68 to 112.3 mm Hg ( p = 0.001) with a reduction of ECMO flow (5.7-4.8 L/m; p = 0.001). Other findings included lower rates of depth sedation (Richmond Agitation Sedation Scale [RASS] ≤3, 37-63%; p = 0.007) and lower requirement inotropic support assessed by LVIS score (4.7-1.1; p = 0.005). Discharge survival was 54% with a sustained benefit until day 79. This cannulation strategy improved effectively PaO 2 in this cohort, it may be an alternative in patients with RH in VV ECMO.

Invited review: Ketone biology-The shifting paradigm of ketones and ketosis in the dairy cow.

Ketosis is currently regarded as a major metabolic disorder of dairy cows, reflective of the animal's efforts to adapt to energy deficit while transitioning into lactation. Currently viewed as a pathology by some, ketosis is associatively implicated in milk production losses and peripartal health complications that increase the risk of early removal of cows from the herd, thus carrying economic losses for dairy farmers and jeopardizing the sustainability of the dairy industry. Despite decades of intense research in the mitigation of ketosis and its sequelae, our ability to lessen its purported effects remains limited. Moreover, the association of ketosis to reduced milk production and peripartal disease is often erratic and likely mired by concurrent potential confounders. In this review, we discuss the potential reasons for these apparent paradoxes in the light of currently available evidence, with a focus on the limitations of observational research and the necessary steps to unambiguously identify the effects of ketosis on cow health and performance via controlled randomized experimentation. A nuanced perspective is proposed that considers the dissociation of ketosis-as a disease-from healthy hyperketonemia. Furthermore, in consideration of a growing body of evidence that highlights positive roles of ketones in the mitigation of metabolic dysfunction and chronic diseases, we consider the hypothetical functions of ketones as health-promoting metabolites and ponder on their potential usefulness to enhance dairy cow health and productivity.

ChIP-DIP: A multiplexed method for mapping hundreds of proteins to DNA uncovers diverse regulatory elements controlling gene expression.

Gene expression is controlled by the dynamic localization of thousands of distinct regulatory proteins to precise regions of DNA. Understanding this cell-type specific process has been a goal of molecular biology for decades yet remains challenging because most current DNA-protein mapping methods study one protein at a time. To overcome this, we developed ChIP-DIP (ChIP Done In Parallel), a split-pool based method that enables simultaneous, genome-wide mapping of hundreds of diverse regulatory proteins in a single experiment. We demonstrate that ChIP-DIP generates highly accurate maps for all classes of DNA-associated proteins, including histone modifications, chromatin regulators, transcription factors, and RNA Polymerases. Using these data, we explore quantitative combinations of protein localization on genomic DNA to define distinct classes of regulatory elements and their functional activity. Our data demonstrate that ChIP-DIP enables the generation of 'consortium level', context-specific protein localization maps within any molecular biology lab.

Manejo de fracturas abiertas de tibia en Cuba / Management of Open Tibial Fractures in Cuba

Introducción: Las fracturas abiertas de tibia son un subconjunto de la carga de traumatismos en América Latina. Se examinaron cuestiones relacionadas con el tratamiento potencialmente críticas en Cuba, país con recursos limitados, pero con un programa nacional de salud estandarizado, coherencia en educación y similitudes de programas de posgrado. Objetivos: Describir los patrones de tratamiento de la fractura abierta de tibia en Cuba, y comparar las características del manejo agudo y tardío en siete provincias del país. Métodos: Se encuestaron 67 cirujanos ortopédicos para evaluar cuatro aspectos en el tratamiento de la fractura abierta: profilaxis antibiótica, irrigación y desbridamiento, estabilización y tratamiento de heridas. Se utilizó el método de muestreo por conveniencia para identificar a los cirujanos y el análisis se realizó mediante la prueba exacta de Fisher (p < 0,05). Resultados: Se administraron antibióticos posoperatorios durante más de 72 horas para las fracturas GA-I/II (49 por ciento) y las fracturas GA-III (70 por ciento). Los cirujanos de La Habana (n= 32) utilizaron con más frecuencia la fijación interna primaria para las fracturas GA-I/II, que los cirujanos en las restantes provincias (n= 35) (64,3 porciento vs. 30,3 por ciento, p= 0,008). Los cirujanos de otras provincias realizaron cierre primario en el momento de la fijación definitiva de fracturas GA-I /II con más frecuencia que los de La Habana (62,9 por ciento vs. 32,3 por ciento, p= 0,013). Para fracturas GA-III, la mayoría de los cirujanos habaneros (88,6 %), al igual que los de las restantes provincias (96,8 por ciento) prefirieron realizar cierre diferido.Conclusiones: El tratamiento de fracturas abiertas de tibia en Cuba es generalmente consistente con otros países de América Latina. Se describen las características del manejo de fracturas abiertas de tibia en Cuba y se comparan las diferencias en los métodos de estabilización y tratamiento de heridas entre provincias, lo cual resulta útil para evaluar si son resultado de diferencias en la práctica quirúrgica, o en la disponibilidad de recursos. Esto representa una ayuda al abordar las formas de optimizar la atención al paciente, a través de la capacitación especializada y la asignación de los recursos(AU)

Introduction: Open tibia fractures are a significant subset of the overall trauma burden in Latin America. Latin American countries vary in their access to orthopaedic care resources, and country-specific orthopaedic recommendations are necessary. Cuba, a country with limited resources, has a standardized national health program, consistencies in education, and similarities across post-graduate training programs. This study aimed to identify management preferences for open tibia factures in Cuba. Objectives: To describe the treatment of open tibial fractures in Cuba, and to compare the characteristics of acute and delayed management across seven Cuban provinces. Methods: Sixty-seven orthopaedic surgeons were surveyed to evaluate four aspects of open fracture management, regarding antibiotic prophylaxis, irrigation and debridement, stabilization, and wound management. The convenience sampling method was used to identify surgeons and the analysis was performed using Fisher's exact test (p <0.05). Results: Postoperative antibiotics were administered for more than 72 hours for GA-I / II fractures (49 pecent) and GA-III fractures (70 percent). Surgeons in Havana (n = 32) used primary internal fixation for GA-I / II fractures more frequently than surgeons in the remaining provinces (n = 35) (64.3 pecent vs. 30.3 percent p = 0.008). Surgeons from other provinces performed primary closure at the time of definitive fixation of GA-I / II fractures more frequently than those from Havana (62.9 percent vs. 32.3 percent, p = 0.013). For GA-III fractures, the majority of Havana surgeons (88.6 percent), as well as those of the remaining provinces (96.8 percent) preferred to perform deferred closure. Conclusions: The treatment of open tibial fractures in Cuba is generally consistent with other Latin American countries. The characteristics of the management of open tibial fractures in Cuba are described and differences in wound stabilization and treatment methods between provinces are compared, which is useful to assess whether they are the result of differences in surgical practice, or in availability of resources. This is helpful in addressing ways to optimize patient care through specialized training and resource allocation(AU)

Artrodesis transcalcánea con injerto libre del peroné por seudoartrosis de tibia distal / Transcalcaneal Arthrodesis with Free Fibula Graft for Distal Tibial Nonunion

RESUMEN Introducción: Las fracturas abiertas del tercio distal de tibia o pilón son poco frecuentes, en nuestro medio se producen por traumas de alta energía como los accidentes de tránsito, y pueden ser de distintos grados según su envergadura. Entre las complicaciones frecuentes están la seudoartrosis, deformidades y artritis postraumática. Cuando el dolor es refractario a los analgésicos están indicadas las artrodesis. Objetivo: Presentar los resultados del tratamiento realizado en un paciente con seudoartrosis distal de tibia y artritis postraumática del tobillo, dolorosa, con gran lesión de partes blandas, por lo que fue imposible realizar los procedimientos quirúrgicos habituales. Presentación del caso: Se realizó artrodesis de las articulaciones tibio-peronea-astragalina-calcánea, mediante un injerto libre del peroné autólogo, compresión, y estabilización con un fijador externo RALCA®; se asoció un campo electromagnético pulsátil para acelerar la formación del callo óseo y disminuir el dolor posquirúrgico. Durante dos años se le hizo seguimiento. Conclusiones: Se logró el objetivo del tratamiento al fusionar la articulación tibiotarsiana, comenzar el apoyo precoz y su capacidad funcional. Los resultados demuestran además los beneficios de la compresión realizada con los fijadores externos en las artrodesis; el uso del campo electromagnético asociado aceleró la osteogénesis, se consiguió la consolidación ósea, la estabilización, disminuyó el edema y el dolor, además la reincorporación del paciente a la sociedad. No se encontró en la bibliografía revisada otra técnica quirúrgica similar(AU)

ABSTRACT Introduction: Open fractures of the distal third of the tibia or pilon are rare, in our environment they are caused by high-energy traumas such as traffic accidents, and can be of different degrees depending on their size. Common complications include nonunion, deformities, and post-traumatic arthritis. When pain is refractory to analgesics, arthrodesis is indicated. Objective: To report the results of the treatment carried out in a patient with distal tibial pseudoarthrosis and post-traumatic arthritis of the ankle, painful, with a large soft tissue injury, which made it impossible to perform the usual surgical procedures. Case report: Arthrodesis of the tibiofibular-talar-calcaneal joints was performed, using a free graft of the autologous fibula, compression, and stabilization with a RALCA® external fixator. A pulsatile electromagnetic field was associated to accelerate bone callus formation and reduce postoperative pain. This patient was followed up for two years. Conclusions: The treatment objective was achieved by fusing the tibiotarsal joint, by starting early support and functional capacity. The results also prove the benefits of compression performed with external fixators in arthrodesis. The use of the associated electromagnetic field accelerated osteogenesis, bone consolidation and stabilization were achieved, edema and pain decreased, as well as the patient's reincorporation into society. No other similar surgical technique was found in the reviewed literature(AU)

Guía práctica para la confección del expediente de Especialista de Segundo grado / Practical Guide for Preparing the File for Second Degree Specialist

El especialista de Segundo grado es un profesional de las ciencias de la salud que demuestra un dominio de excelencia en su especialidad con alto nivel de conocimientos y competencia profesional lo que debe quedar demostrado ante un tribunal de especialización de segundo grado. En este sentido, por Acuerdo del Consejo de Estado de fecha 29 de junio de 2009 se emite la resolución 132, que aprobó el Reglamento para la obtención del Segundo grado en las ciencias de la salud, y que dispone en cuatro capítulos los siguientes aspectos: los requisitos y formalidades para la obtención del título, la tramitación de las solicitudes, la constitución y funcionamiento de los tribunales y las reclamaciones ante el viceministro para la Docencia y la Investigación en el caso de desacuerdo del aspirante con el dictamen del tribunal evaluado....

Evaluación de resultados de la osteotomía en cuña cerrada de Coventry para corregir el genus valgum / Results of Coventry closing wedge osteotomy in the correction of genu valgum

Fundamento: los pacientes con deformidad en genus valgum asociada o no a osteoartritis unicompartimental lateral, son candidatos para una osteotomía varizante del fémur distal. Objetivo: evaluar los resultados con la osteotomía en cuña cerrada del fémur distal para el genus valgum. Métodos: se realizó un estudio descriptivo prospectivo a un grupo de pacientes con el diagnóstico de genus valgum, operados con la osteotomía de Coventry MB en el Hospital Militar Universitario Octavio de la Concepción y de la Pedraja de Camagüey, desde enero de 2009 hasta diciembre de 2013 y el tiempo promedio de seguimiento de los pacientes fue de 26 meses. El universo lo conformaron 39 pacientes con el diagnóstico de genus valgum operados con la técnica de Coventry MB. La muestra no probabilística la conformaron 36 pacientes. Las variables de estudio fueron edad, sexo, tiempo de consolidación, las complicaciones, el ángulo femorotibial y la evaluación según escala evaluativa para la rodilla. Resultados: predominó el grupo de edades entre 51 y 60 años para un 50 %; el sexo más afectado fue el femenino con un 58,3 %; el tiempo de consolidación fue de 14 a 24 semanas en el 66,6 %; al finalizar el trabajo se logró un ángulo tibiofemoral promedio de 4,5 grados de valgo y la escala para la rodilla mejoró 33 puntos; los resultados de la osteotomía en cuña cerrada fueron excelentes en el 97,2 % del total de pacientes operados. Conclusiones: la osteotomía de Coventry MB demostró ser excelente para corregir el genus valgum.

Background: patients with genu valgum associated or not to lateral unicompartmental osteoarthritis are candidates for distal femoral varus osteotomy. Objective: to evaluate the results of distal femoral Coventry closing wedge osteotomy in the correction of genu valgum. Methods: a descriptive, prospective study was conducted in a group of patients with the diagnosis of genu valgum who underwent a Coventry osteotomy in Octavio de la Concepción y de la Pedraja Teaching Military Hospital, Camagüey from January 2009 to December 2013. The average time of monitoring of the patients was 26 months. The universe was composed of 39 patients with the diagnosis of genu valgum who underwent a Coventry osteotomy. The sample consisted of 36 patients. The variables of the study were the following: age, sex, knitting time, complications, femorotibial angle and the evaluation according to the evaluative scale for the knee. Results: the age group 51-60 years old predominated for a 50 %. Female was the most affected sex for a 58, 3 %. The knitting time was from 14 to 24 weeks in the 66, 6 % of the patients. At the end of the treatment, an average femorotibial angle of 4, 5 degrees was achieved and the scale for the knee improved on 33 points. The results of closing wedge osteotomy were excellent in the 97, 2 % of the patients who underwent the operation.

Evaluación de resultados de la osteotomía en cuña cerrada de Coventry para corregir el genus valgum / Results of Coventry closing wedge osteotomy in the correction of genu valgum

Fundamento: los pacientes con deformidad en genus valgum asociada o no a osteoartritis unicompartimental lateral, son candidatos para una osteotomía varizante del fémur distal.Objetivo: evaluar los resultados con la osteotomía en cuña cerrada del fémur distal para el genus valgum.Métodos: se realizó un estudio descriptivo prospectivo a un grupo de pacientes con el diagnóstico de genus valgum, operados con la osteotomía de Coventry MB en el Hospital Militar Universitario Octavio de la Concepción y de la Pedraja de Camagüey, desde enero de 2009 hasta diciembre de 2013 y el tiempo promedio de seguimiento de los pacientes fue de 26 meses. El universo lo conformaron 39 pacientes con el diagnóstico de genus valgum operados con la técnica de Coventry MB. La muestra no probabilística la conformaron 36 pacientes. Las variables de estudio fueron edad, sexo, tiempo de consolidación, las complicaciones, el ángulo femorotibial y la evaluación según escala evaluativa para la rodilla.Resultados: predominó el grupo de edades entre 51 y 60 años para un 50 por ciento; el sexo más afectado fue el femenino con un 58,3 por ciento; el tiempo de consolidación fue de 14 a 24 semanas en el 66,6 por ciento; al finalizar el trabajo se logró un ángulo tibiofemoral promedio de 4,5 grados de valgo y la escala para la rodilla mejoró 33 puntos; los resultados de la osteotomía en cuña cerrada fueron excelentes en el 97,2 por ciento del total de pacientes operados.Conclusiones: la osteotomía de Coventry MB demostró ser excelente para corregir el genus valgum(AU)

Background: patients with genu valgum associated or not to lateral unicompartmental osteoarthritis are candidates for distal femoral varus osteotomy.Objective: to evaluate the results of distal femoral Coventry closing wedge osteotomy in the correction of genu valgum.Methods: a descriptive, prospective study was conducted in a group of patients with the diagnosis of genu valgum who underwent a Coventry osteotomy in Octavio de la Concepción y de la Pedraja Teaching Military Hospital, Camagüey from January 2009 to December 2013. The average time of monitoring of the patients was 26 months. The universe was composed of 39 patients with the diagnosis of genu valgum who underwent a Coventry osteotomy. The sample consisted of 36 patients. The variables of the study were the following: age, sex, knitting time, complications, femorotibial angle and the evaluation according to the evaluative scale for the knee.Results: the age group 51-60 years old predominated for a 50 percent. Female was the most affected sex for a 58, 3 percent. The knitting time was from 14 to 24 weeks in the 66, 6 percent of the patients. At the end of the treatment, an average femorotibial angle of 4, 5 degrees was achieved and the scale for the knee improved on 33 points. The results of closing wedge osteotomy were excellent in the 97, 2 percent of the patients who underwent the operation(AU)

Las bandas de Liesegang como origen de los patrones simétricos del esmalte / Liesegang rings as origin of enamel symmetrical patterns

INTRODUCCIÓN:en los dientes existen variadas estructuras visibles que tienen formas y patrones simétricos repetitivos como los prismas, los penachos, los husillos del esmalte, las bandas de Hunter-Schreger y las líneas incrementales de Retzius. Por otro lado, los anillos de Liesegang, estudiados y aplicados desde hace más de cien años por los geólogos y otras disciplinas, son bandas simétricas repetitivas incrementales halladas en minerales naturales que se asemejan a los observados en el esmalte dental. El objetivo de este artículo es revisar los procesos, ampliamente conocidos, de formación de los anillos de Liesegang en la naturaleza y relacionarlos con la mineralización del esmalte dental y con la conformación de su anatomía característica. MÉTODOS: para este efecto se hizo una revisión bibliográfica, delimitada al período comprendido entre 1970 y 2013 en las bases de datos Science Direct, Springer, Medline y Pubmed, de donde se seleccionaron 51 referencias con información original y/o datos relevantes del tema estudiado. RESULTADOS Y CONCLUSIONES: un análisis detallado del proceso de formación de estas bandas y la similitud de los casos del mineral rocoso y del mineral dental, llevan a pensar que los procesos que se desarrollan en las rocas y en tejidos dentales duros serían los mismos.

INTRODUCTION: teeth contain various visible structures that have repeating shapes and symmetrical patterns such as prisms, crests, enamel spindles, Hunter-Schreger bands, and Retzius incremental lines. On the other hand, Liesegang rings, studied and applied for over a hundred years by geologists and other specialists, are incremental repetitive symmetrical bands found in natural minerals which are similar to those observed in tooth enamel. This article aims to review the widely known processes of formation of Liesegang rings in nature and relate them with dentin mineralization and the conformation of their characteristic anatomy. METHODS: to this end, a bibliographic review was conducted, restricted to the 1970-2013 period, in the Science Direct, Springer, Medline, and Pubmed databases, finally selecting 51 references with original information or relevant data on the subject. RESULTS AND CONCLUSIONS: a detailed analysis of the processes of formation of these rings and the similarity of rocky and dental minerals lead to think that the processes developed in rocks and hard dental tissues would be the same.

Resultados a corto plazo con la osteotomía de Mitchell en el hallux valgus / Short-term results with Mitchell osteotomy in hallux valgus

Se han propuesto múltiples técnicas quirúrgicas para el metatarso primo varo en el hallux valgus, pero la sola acción sobre la articulación metatarsofalángica es insuficiente en presencia de un metatarso primo varo.Objetivo: evaluar los resultados con la osteotomía de Mitchell en pacientes con hallux valgus.Método: se realizó un estudio observacional, de tipo descriptivo prospectivo a un grupo de pacientes con el diagnóstico de hallux valgus, operados con la osteotomía de Mitchell en el Hospital Militar Universitario Octavio de la Concepción y de la Pedraja de Camagüey, durante 36 meses desde octubre de 2009 hasta septiembre de 2012 y el tiempo de seguimiento de los pacientes fue de 12 meses. El universo lo conformaron 102 pies de 60 enfermos y la muestra no probabilística quedó constituida por 84 pies de 48 pacientes. Las variables de estudio fueron la edad, sexo, si fue bilateral o unilateral y las complicaciones.Resultados: predominó el grupo de edades entre 30 y 50 años para un 58, 3 por ciento; el sexo más afectado fue el femenino con un 79,1 por ciento; fueron bilaterales un total de 36 pacientes para un 75, 1 por ciento; y los resultados de la osteotomía de Mitchell fueron excelentes y buenos en el 90, 6 por ciento del total de pacientes operados.Conclusiones: la osteotomía de Mitchell demostró ser excelente y aún es una de las preferidas para corregir el hallux valgus...

Multiple surgical techniques have been proposed for metatarsus primus varus in hallux valgus; but the action by itself on the metatarsophalangeal articulation is not enough in the presence of a metatarsus primus varus.Objective: to asses the results with Mitchell osteotomy in patients with hallux valgus.Method: an observational study, descriptive-prospective type, was made to a group of patients with the diagnosis of hallux valgus who underwent a Mitchell osteotomy at Octavio de la Concepción y de la Pedraja Military Teaching Hospital of Camagüey during 36 months from October, 2009 to September, 2012. The follow-up of the patients was of 12 months. The universe was composed of 102 feet of 60 patients and the non-probabilistic sample was of 84 feet of 48 patients. The study variables were age, sex; if it was bilateral or unilateral; and complications.Results: the age group that predominated was between 30 and 50 years old for a 58, 3 percent; female sex was the most affected with a 79, 1 percent; a total of 36 patients were bilateral for a 75, 1 percent; finally, the results of Mitchell osteotomy were excellent and good in the 90, 6 percent of the total of patients that had the operation.Conclusions: Mitchell osteotomy proved to be excellent and it is still one of the preferred to correct hallux valgus...

Resultados a corto plazo con la osteotomía de Mitchell en el hallux valgus / Short-term results with Mitchell osteotomy in hallux valgus

Fundamento: se han propuesto múltiples técnicas quirúrgicas para el metatarso primo varo en el hallux valgus, pero la sola acción sobre la articulación metatarsofalángica es insuficiente en presencia de un metatarso primo varo.Objetivo: evaluar los resultados con la osteotomía de Mitchell en pacientes con hallux valgus.Método: se realizó un estudio observacional, de tipo descriptivo prospectivo a un grupo de pacientes con el diagnóstico de hallux valgus, operados con la osteotomía de Mitchell en el Hospital Militar Universitario Octavio de la Concepción y de la Pedraja de Camagüey, durante 36 meses desde octubre de 2009 hasta septiembre de 2012 y el tiempo de seguimiento de los pacientes fue de 12 meses. El universo lo conformaron 102 pies de 60 enfermos y la muestra no probabilística quedó constituida por 84 pies de 48 pacientes. Las variables de estudio fueron la edad, sexo, si fue bilateral o unilateral y las complicaciones.Resultados: predominó el grupo de edades entre 30 y 50 años para un 58, 3 por ciento; el sexo más afectado fue el femenino con un 79,1 por ciento; fueron bilaterales un total de 36 pacientes para un 75, 1 por ciento; y los resultados de la osteotomía de Mitchell fueron excelentes y buenos en el 90, 6 por ciento del total de pacientes operados.Conclusiones: la osteotomía de Mitchell demostró ser excelente y aún es una de las preferidas para corregir el hallux valgus(AU)

Background: multiple surgical techniques have been proposed for metatarsus primus varus in hallux valgus; but the action by itself on the metatarsophalangeal articulation is not enough in the presence of a metatarsus primus varus.Objective: to asses the results with Mitchell osteotomy in patients with hallux valgus.Method: an observational study, descriptive-prospective type, was made to a group of patients with the diagnosis of hallux valgus who underwent a Mitchell osteotomy at Octavio de la Concepción y de la Pedraja Military Teaching Hospital of Camagüey during 36 months from October, 2009 to September, 2012. The follow-up of the patients was of 12 months. The universe was composed of 102 feet of 60 patients and the non-probabilistic sample was of 84 feet of 48 patients. The study variables were age, sex; if it was bilateral or unilateral; and complications.Results: the age group that predominated was between 30 and 50 years old for a 58, 3 percent; female sex was the most affected with a 79, 1 percent; a total of 36 patients were bilateral for a 75, 1 percent; finally, the results of Mitchell osteotomy were excellent and good in the 90, 6 percent of the total of patients that had the operation.Conclusions: Mitchell osteotomy proved to be excellent and it is still one of the preferred to correct hallux valgus(AU)

Aportaciones de la medicina forense a la investigación de la conducta suicida / Contributions of forensic medicine to research of suicidal behaviour

El suicidio es la principal causa de muerte violenta en España, por delante de los accidentes de tráfico, y se estima que cada año se suicidan cerca de 3.500 personas. Los factores de riesgo identificados de la conducta suicida se basan, principalmente, en estudios de intentos de suicidio. La centralización de las autopsias en los Institutos de Medicina Legal facilita la homogenización del método de trabajo y la consistencia de los resultados a nivel práctico-judicial y de investigación. La medicina forense debe proyectarse en la investigación en general y de la conducta suicida en particular, en colaboración con otros equipos de investigación. La investigación debe efectuarse según la normativa ética y administrativa vigente y ser aprobada por el Comité Ético de referencia. Con respecto a la investigación de los factores de riesgo del suicidio, el reclutamiento de casos y controles, la obtención de muestras biológicas, la colaboración en la realización de autopsias psicológicas y los estudios epidemiológicos, son aportaciones esenciales de la medicina forense(AU)

In Spain, suicide is the leading cause of violent death, ahead of motor vehicle accidents, with about 3,500 people dying by this mean in Spain. The risk factors identified are primarily based on studies of suicide attempts. The centralization of autopsies in the Institutes of Legal Medicine allows the homogenization of working methods and the consistency of results for both research and legal purposes. Forensics should focus on medical research in general and on suicidal behaviour in particular, in collaboration with other research teams. Research must be conducted according to existing ethical and administrative legislation. All must be approved by the Ethics Committee of reference. With regard to the investigation of risk factors for suicide, forensics are essential in the recruitment of cases and controls-obtaining biological samples, collaborating in conducting psychological autopsies and epidemiological studies(AU)

Fractura abierta de tibia: aspectos básicos / Open fracture of tibia: basic aspects

La fractura abierta de la tibia constituye un verdadero azote en la actualidad debido al incremento paulatino de la velocidad del transporte automotor y la práctica de deporte de alto riesgo. Desarrollo: se realizó una revisión bibliográfica sobre fractura abierta de tibia específicamente en su clasificación, antibioticoterapia temprana, manejo de la herida, cuando estabilizar y que método utilizar y por último qué decisión tomar de acuerdo a la viabilidad de la extremidad. Conclusiones: el tratamiento ante un paciente con fractura abierta de la tibia debe ser agresivo mediante toilette y desbridamiento temprano, uso de antibióticos y fijación intramedular mediante clavos auto-bloqueantes en los grados uno y dos según la clasificación de Gustilo y Anderson, por otro lado generalmente la fracturas tipo tres son manejadas mediante fijación externa (AU)

Open fracture of tibia currently constitutes a true scourge due to the gradual increase of motor transportation speed and the practice of high risk sports. Development: a bibliographical review on open fracture of tibia was conducted, specifically in its classification, early antibiotic-therapy, injury management, when stabilizing, what method to use and finally what decision make according to viability of the extremity. Conclusions: The treatment, facing a patient with open fracture of tibia must be aggressive by means of toilette and early dèbridement, use of antibiotics and intramedullary fixation through auto-blocker pins in one and two grades according to Gustilo and Anderson classification; on the other hand, type three fractures generally are managed by external fixation (AU)

Fractura abierta de tibia: aspectos básicos / Open fracture of tibia: basic aspects

La fractura abierta de la tibia constituye un verdadero azote en la actualidad debido al incremento paulatino de la velocidad del transporte automotor y la práctica de deporte de alto riesgo. Desarrollo: se realizó una revisión bibliográfica sobre fractura abierta de tibia específicamente en su clasificación, antibioticoterapia temprana, manejo de la herida, cuando estabilizar y que método utilizar y por último qué decisión tomar de acuerdo a la viabilidad de la extremidad. Conclusiones: el tratamiento ante un paciente con fractura abierta de la tibia debe ser agresivo mediante toilette y desbridamiento temprano, uso de antibióticos y fijación intramedular mediante clavos auto-bloqueantes en los grados uno y dos según la clasificación de Gustilo y Anderson, por otro lado generalmente la fracturas tipo tres son manejadas mediante fijación externa.

Open fracture of tibia currently constitutes a true scourge due to the gradual increase of motor transportation speed and the practice of high risk sports. Development: a bibliographical review on open fracture of tibia was conducted, specifically in its classification, early antibiotic-therapy, injury management, when stabilizing, what method to use and finally what decision make according to viability of the extremity. Conclusions: The treatment, facing a patient with open fracture of tibia must be aggressive by means of toilette and early dèbridement, use of antibiotics and intramedullary fixation through auto-blocker pins in one and two grades according to Gustilo and Anderson classification; on the other hand, type three fractures generally are managed by external fixation.

Osteoartritis unicompartimental de la rodilla: enfoque actual / Uncompartmental osteoarthritis of the knee: current approach

Se realizó una revisión bibliográfica sobre el manejo quirúrgico actual de la Osteoartritis Unicompartimental de la Rodilla. Desarrollo: se realizó una comparación de los métodos quirúrgicos actuales, así como las indicaciones de cada uno de ellos. En la sección de Osteotomías se realizó la comparación entre las Osteotomías abiertas y cerradas. Se expusieron las indicaciones actuales de la artroplastia unicompartimental (AU)

Osteoarthritis is a health problem in progressive increase conditioned by the every time bigger raise of life expectancy in developed countries and to the demand of this population of a better quality of life. Development: a bibliographical review on the current surgical handling of uncompartmental osteoarthritis of the knee was performed. A comparison of current surgical methods, as well as indications of each one of them was carried out. Arthroscopy is the less invasive method and in spite of being a treatment method it is also very useful for diagnosis and prognosis. In the osteotomy section was carried out the comparison among the open and closed osteotomy based fundamentally on its advantages and disadvantages, besides showing indications and contraindications of this procedure and its complications. Conclusions: current indications on uncompartmental arthroplasty and a brief comparison in relation to osteotomy are exposed (AU)