Cirugía guiada y reconstrucción tisular luego de un fracaso: la importancia del diagnóstico y la planificación. Reporte de caso clínico / Guided surgery and tissue reconstruction after failure: the importance of diagnosis and planning. Report of a clinical case

La realización de un nuevo tratamiento luego de un fracaso con implantes dentarios representa un gran desafío para el profesional especialistas en implan-tología, así como para el paciente que debe someter-se a un nuevo procedimiento para rehabilitarse. En estos casos, el diagnóstico y la planificación exhaus-tiva previa nos permiten optimizar el tiempo y los re-cursos, arribando al resultado esperado de forma eficiente. En este reporte de caso se presenta la re-habilitación de una paciente que acude a la consulta con un fracaso implantario previo y con alta deman-da estética. Se diseñó una guía quirúrgica de preci-sión para la colocación de un implante Straumann®Bone Level Tapered 3,3 NC ­ Narrow CrossFit® ø 3,3 mm 8 mm junto a la regeneración ósea guiada para compensar la deficiencia de los tejidos circundantes. La rehabilitación protésica consistió en una corona cemento atornillada en disilicato de litio. En el control al año pudo valorarse la estabilidad de la rehabilita-ción protésica, así como de los tejidos circundantes y el contorno estético junto al perfil de emergencia mimético logrado al final del tratamiento (AU)

Carrying out a new treatment after a failure with dental implants represents a great challenge for the implantology specialist professional, as well as for the patient who must undergo a new procedure to rehabilitate. In these cases, the diagnosis and prior exhaustive planning allow us to optimize time and resources, arriving at the expected result efficiently. This case report presents the rehabilitation of a patient who comes to the clinic with a previous implant failure and with high aesthetic demand. A precision surgical guide was designed for the placement of a Straumann® Bone Level Tapered 3.3 NC ­ Narrow CrossFit® ø 3.3 mm 8 mm implant together with guided bone regeneration to compensate for the deficiency of the surrounding tissues. The prosthetic rehabilitation consisted of a screw-retained cement crown in lithium disilicate. In the one-year control, the stability of the prosthetic rehabilitation, as well as the surrounding tissues and the aesthetic contour, together with the mimetic emergence profile achieved at the end of the treatment, could be assessed (AU)

Bottom-up effects of woodland eutrophication: Interacting limiting nutrients determine herbivory frequency in northwestern Patagonia.

Nutrient enrichment disrupts plant-animal interactions and ecosystem functioning globally. In woodland systems, the mechanisms of bottom-up turnover on plant-herbivore interactions remain understudied. Here, we performed a full-factorial field experiment to evaluate the interactive effects of nutrient addition (nitrogen, phosphorus, and/or potassium) on the assemblage of foliar herbivores and the interaction frequency with Berberis microphylla, a dominant shrub species in Patagonian woodlands. Additionally, we assessed whether these effects could be mediated by changes in vegetative traits and microhabitat characteristics (i.e., canopy cover) that may ultimately influence the foraging behavior of herbivores. The addition of nitrogen reduced the herbivory frequency by 41%, yet this effect was diluted in the presence of potassium. We found no effects of phosphorus addition. Our results suggest that the impact of multiple nutrient additions (N and K) on herbivory patterns could be mediated by changes in two important foliar traits, leaf size and leaf density. This study shows how multiple nutrient addition can change the magnitude of antagonistic plant-animal interactions in woodlands. Since herbivory by arthropods has a relevant role in net primary productivity, our results highlight the importance of buffering human-driven woodland eutrophication to maintain important ecological functions (e.g., herbivory) associated with antagonistic plant-animal interactions and avoiding ecosystem dysfunction.

Dynamic associations between Ips sexdentatus (Coleoptera: Scolytinae) and its phoretic mites in a Pinus pinaster forest in northwest Spain.

The relationship between the pine bark beetle Ips sexdentatus and its phoretic mites in a Pinus pinaster forest in northwest Spain was studied during 2014. Four species of mites were collected, three of them from the body of the beetle-Histiostoma ovalis, Dendrolaelaps quadrisetus and Trichouropoda polytricha-the fourth, Cercoleipus coelonotus, was collected from the sediments. The main aims of this study were to explore (1) mite diversity and related parameters, (2) the location on the body of the (male and female) beetle, as well as mite assemblages, and (3) the seasonal dynamic association between mite species and the beetle. Results indicated that the diversity oscillated around 0.71 through the study period and the most dominant, frequent and abundant mite was H. ovalis. Histiostoma ovalis was found attached to almost all parts of the body (mainly on the elytral declivity and ventral thorax), whereas D. quadrisetus was exclusively found under the elytra, and T. polytricha displayed affinity towards the elytral declivity as well as the ventral thorax. None of the mite species displayed any preference for the sex of the beetle and the most frequent mite assemblage was H. ovalis, T. polytricha and D. quadrisetus all together. Maximum abundance of each phoretic mite species was related with each of the flight peaks of the beetle that would indicate that these mite species use phoresy as a primary method of transport for colonizing new food sources.

Multiionic effects on the capacitance of porous electrodes.

The rapid and reversible ionic electrosorption in the electrical double layers (EDLs) of moderately charged micropores in contact with a solution is the main concept underlying capacitive energy and desalination devices. For the usual operating conditions, the ion concentration is large enough for the confinement of ions to play an important role in their distribution in the EDL. On the other hand, although most laboratory experiments have been carried out with simple salt solutions, realistic applications require a proper analysis of the effect of the different ionic species existing in natural waters. Here we focus on the role of multiionic solutions on the double layer structure. For this purpose, a model is presented in which the EDL overlap and the existence of a Stern layer are considered. It is also taken into account that the ions can be tightly packed by using the Carnahan-Starling model. This model is applied to analyze the structure of the EDL with multiionic solutions containing divalent ions. The predictions of this model are found to largely differ from those of the better known Bikerman equation, and are more realistic. It is demonstrated that the presence of tiny amounts of divalent ions in the bulk is enough to dominate the EDL behavior, and hence, its capacitance, energy storage, and desalination properties.

Characterization of small RNAs originating from mitoviruses infecting the conifer pathogen Fusarium circinatum.

Deep sequencing of small RNAs has proved effective in the diagnosis of mycovirus infections. In this study, the presence of mycoviruses in ten isolates of the phytopathogenic fungus Fusarium circinatum was investigated by high-throughput sequencing (HTS) of small RNAs. The contigs resulting from de novo assembly of the reads were aligned to viral genome sequences. The presence of each mycovirus detected in the isolates was confirmed by RT-PCR analysis with four previously described primer pairs and seven new pairs designed on the basis of sequencing data. The findings demonstrate the potential use of HTS for reconstructing previously identified mitoviruses infecting F. circinatum.

Association of physical fitness with health-related quality of life in early postmenopause.

OBJECTIVE: To assess the association of different components of physical fitness with HRQoL in early postmenopause and to test which physical fitness components are independently associated with the physical and mental components of HRQoL. METHODS: The final sample comprised 67 early postmenopausal women. Physical fitness was assessed with the Senior Fitness Test battery (additionally including handgrip strength test), and HRQoL was evaluated with the Short-Form Health Survey-36 (SF-36). We also analyzed plasma gonadotropic hormones and estradiol. RESULTS: Overall, most of the fitness components were positively associated with HRQoL. Lower-body flexibility, upper-body muscle strength and cardiorespiratory fitness were the fitness components more strongly associated with HRQoL (r range from 0.28 to 0.56). Static balance was especially associated with mental health (r = -0.46, P < 0.001). Lower-body flexibility (assessed with the chair sit-and-reach test) and upper-body muscle strength (assessed with handgrip dynamometry) were independently associated with the SF-36 Physical Component Summary (both, P < 0.001). Upper-body muscle strength (P < 0.01) and cardiorespiratory fitness (assessed with the 6-min walk test, P < 0.05) were independently associated with the SF-36 Mental Component Summary. CONCLUSIONS: Higher physical fitness is associated with better HRQoL in early postmenopause. Lower-body flexibility and upper-body muscle strength were the most important independent fitness indicators, explaining ~30 % of HRQoL.

Multi-ionic effects on energy production based on double layer expansion by salinity exchange.

It has been recently shown that the free energy change upon salinity mixing in river mouths can be harvested taking advantage of the fact that the capacitance of charged solid/liquid interfaces (electrical double layers, EDLs) depends strongly on the ionic composition of the liquid medium. This has led to a new generation of techniques called Capmix technologies, one of them (CDLE or capacitive energy extraction based on DL expansion) based precisely on such dependence. Despite the solution composition playing a crucial role on the whole process, most of the research carried out so far has mainly focused on pure sodium chloride solutions. However, the effect of other species usually present in river and seawaters should be considered both theoretically and experimentally in order to succeed in optimizing a future device. In this paper, we analyse solutions of a more realistic composition from two points of view. Firstly, we find both experimentally and theoretically that the presence of ions other than sodium and chloride, even at low concentrations, may lead to a lower energy extraction in the process. Secondly, we experimentally consider the possible effects of other materials usually dispersed in natural water (mineral particles, microbes, shells, pollutants) by checking their accumulation in the carbon films used, after being exposed for a long period to natural sea water during CDLE cycles.

Polyelectrolyte-coated carbons used in the generation of blue energy from salinity differences.

In this work we present a method for the production of clean, renewable electrical energy from the exchange of solutions with different salinities. Activated carbon films are coated with negatively or positively charged polyelectrolytes using well-established adsorption methods. When two oppositely charged coated films are placed in contact with an ionic solution, the potential difference between them will be equal to the difference between their Donnan potentials, and hence, energy can be extracted by building an electrochemical cell with such electrodes. A model is elaborated on the operation of the cell, based on the electrokinetic theory of soft particles. All the features of the model are experimentally reproduced, although a small quantitative difference concerning the maximum open-circuit voltage is found, suggesting that the coating is the key point to improve the efficiency. In the experimental conditions used, we obtain a power of 12.1 mW m(-2). Overall, the method proves to be a fruitful and simple approach to salinity-gradient energy production.

Predictions of the maximum energy extracted from salinity exchange inside porous electrodes.

Capacitive energy extraction based on double layer expansion (CDLE) is the name of a new method devised for extracting energy from the exchange of fresh and salty water in porous electrodes. It is based on the change of the capacitance of electrical double layers (EDLs) at the electrode/solution interface when the concentration of the bulk electrolyte solution is modified. The use of porous electrodes provides huge amounts of surface area, but given the typically small pore size, the curvature of the interface and EDL overlap should affect the final result. This is the first aspect dealt with in this contribution: we envisage the electrode as a swarm of spherical particles, and from the knowledge of their EDL structure, we evaluate the stored charge, the differential capacitance and the extracted energy per CDLE cycle. In all cases, different pore radii and particle sizes and possible EDL overlap are taken into account. The second aspect is the consideration of finite ion size instead of the usual point-like ion model: given the size of the pores and the relatively high potentials that can be applied to the electrode, excluded volume effects can have a significant role. We find an extremely strong effect: the double layer capacitance is maximum for a certain value of the surface potential. This is a consequence of the limited ionic concentration at the particle-solution interface imposed by the finite size of ions, and leads to the presence of two potential ranges: for low electric potentials the capacitance increases with the ionic strength, while for large potentials we find the opposite trend. The consequences of these facts on the possibility of net energy extraction from porous electrodes, upon changing the solution in contact with them, are evaluated.

[Use of nutrition marketing in products advertised on TV in Spain]. / Uso del marketing nutricional en productos anunciados por televisión en España.

BACKGROUND: Nutrition marketing has generated a great amount of consumer interest; however, improper use of this type of marketing could mislead consumers. OBJECTIVES: To describe the frequency and proper use in Spain of nutrition marketing for products advertised on television while analyzing their nutrient profile for comparison. METHODS: Advertised food and drink products included in the study were selected after watching 80 hours of broadcasting of 4 Spanish television channels during May and June 2008. Upon purchase of the selected items, we estimated the frequency of use of the different nutrition marketing approaches, the proportion of nutritional and health claims meeting European regulations, and the proportion of less healthy products according to the United Kingdom Nutrient Profile Model UKNPM. RESULTS: Of the 88 products examined, 74% used nutrition marketing approaches. Half of the advertisements made nutrition claims and 42% health claims. The majority (89%) of the 83 nutrition claims met European regulations, with the category of "light products" being the least compliant with only 25% of products meeting regulations. Of the 37 product advertisements making health claims, 43% used authorized statements, of which, however, 75% also included unauthorized claims. Nutrient profile was less healthy in 55% of the products resorting to nutrition marketing. CONCLUSION: Lack of compliance with European regulations regarding nutrition and health claims, combined with the "less healthy" nutrient profile of many of the products marketed using these claims, may mislead Spanish consumers. To avoid this misinformation, it would be beneficial to: a) monitor level of adherence to regulations systematically; and b) introduce the use of nutrient profiles to approve these types of claims.

Fitness, fatness and cardiovascular profile in South Spanish and North Moroccan women.

INTRODUCTION: We studied the differences on physical fitness, fatness and cardiovascular profile in Spanish and Moroccan women. MATERIAL AND METHODS: The study comprised 63 and 58 women aged 45-65 years from South of Spain and North of Morocco, respectively. We assessed fitness and body composition using standard procedures. We also assessed resting heart rate (RHR), blood pressure, fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. RESULTS AND DISCUSSION: Moroccan women had a better performance in the main health-related physical fitness components, i.e. higher levels of cardiorespiratory fitness (P=0.01) and (lower-body) muscular strength (P<0.001). Diastolic blood pressure (P=0.004), RHR and total cholesterol (both P=0.04) were lower in Moroccan women. No differences were observed in the prevalence of metabolic syndrome. CONCLUSIONS: The women from Morocco had a healthier fitness and cardiovascular profile than the women from Spain. Further research on physical fitness and other health indicators in understudied populations is needed.

ECG as a part of the preparticipation screening programme: an old and still present international dilemma.

INTRODUCTION: Long-term Italian experience has provided evidence that preparticipation screening in competitive athletes with 12-lead ECG, history and physical examination is effective in identifying potentially lethal cardiovascular diseases. However, it is not being routinely practised in other countries. OBJECTIVES: To evaluate the usefulness of a preparticipation screening programme in a sample of players belonging to different disciplines. MATERIAL AND METHODS: From September 2006 to June 2008, 1220 young athletes from different sports disciplines underwent a cardiovascular examination that included personal and family history, physical examination and a resting 12-lead ECG. Those with abnormal findings were referred for additional tests. RESULTS: 1220 Athletes were screened: 96% males; mean age 23 (4) years. 90 (7.4%) players were referred for additional tests because of abnormal findings on baseline examination: 11 (0.9%) personal or family history, 4 (0.08%) physical examination and 75 (6.14%) 12-lead ECG. Echocardiographic assessment fulfilled left ventricular hypertrophy criteria in 8 of the 90 players. Of those, one case was considered an athlete's heart and one case was diagnosed with hypertrophic cardiomyopathy (septal thickness 23 mm). Further tests were needed in the remaining six, included in the "grey area", with one additional case of hypertrophic cardiomyopathy (apical variant) suggested by cardiac MRI. CONCLUSION: Given the ability of 12-lead ECG to detect individuals with structural heart disease, we suggest its inclusion as a part of preparticipation screening programmes.

El paciente, elemento clave en la mejora de la seguridad de los servicios sanitarios / No disponible

La participación de los pacientes en su seguridad parece jugar un papel esencial en la prevención de los eventos adversos. Sin embargo, las organizaciones sanitarias aún no han adquirido la madurez necesaria para facilitar que esto ocurra. En este trabajo se hace una reflexión sobre el estado de situación de la participación de los pacientes en su seguridad, barreras identificadas y propuestas de mejora. La falta de formación de los pacientes y la escasa cultura de la organización sanitaria destacan como barreras principales en la participación de los pacientes. La formación de los profesionales es un elemento esencial para mejorar la cultura en seguridad y un paso previo para la implantación de estrategias dirigidas a los pacientes. Dichas estrategias deberían basarse en un análisis previo de las necesidades y expectativas de los pacientes sobre su papel en la mejora de la seguridad. Las barreras y recomendaciones identificadas alertan sobre los retos que las organizaciones sanitarias deben afrontar para fomentar la participación de los pacientes en su seguridad (AU)

Patient’s participation in patient safety seems to play an essential role in the prevention of adverse events. Nevertheless, the healthcare organizations have not acquired the maturity to facilitate that this happens. In this paper a reflection is done on the state of situation of patient’s participation, identified barriers and proposals for improvement. Patient’s low health literacy and the scanty on patient safety culture of the healthcare organization are the main barriers identified. Professional’s education is an essential element to improve patient safety culture and a previous step for the implantation of strategies directed to patients These strategies should be based on a previous analysis of the needs and expectations of the patients about their role on patient safety. The barriers and identified recommendations alert on the challenges that the healthcare organizations must confront to promote the patients participation in patient safety (AU)

Structure, morphology, and bioactivity of biocompatible systems derived from functionalized acrylic polymers based on 5-amino-2-naphthalene sulfonic acid.

New therapeutic strategies for the treatment of neoplastic pathologies and, in particular, metastasis processes are based on the inhibitory effect of angiogenic processes. The present article deals with the design, preparation, and application of new "polymer drugs" with a clear inhibitory effect of the activation of fibroblast growth factors, which plays an important role in the proliferation of vascular cells and, consequently, in tumor angiogenesis. Two different copolymer systems based on 5-methacrylamide-2-naphthalenesulfonic acid (MANSA) and butylacrylate (BA) or vinylpyrrolidone (VP) were prepared by free radical copolymerization and exhaustively characterized. The molecular weight of the copolymers was moderate but both families presented very homogeneous macromolecular populations with a polydispersity index very close to unity, which indicates that MANSA presents a noticeable effect on the polymerization processes. The system poly(BA-co-MANSA) provides amphiphilic copolymers that give rise to the formation of oriented micelles with a core of the hydrophobic BA segments and a shell of MANSA components. The average size of these self-assembling nanoparticles is between 20 and 100 nm, depending on the composition of the copolymer system. However, poly(VP-co-MANSA) systems are more hydrophilic and give more homogeneous and water-soluble macromolecules. The bioactivity of both systems was studied by the analysis of proliferation of Balb/c 3T3 fibroblasts in the presence of acidic fibroblast growth factor (aFGF) as a function of the concentration of poly(BA-co-MANSA) or poly(VP-co-MANSA), and the results obtained demonstrated that the MANSA-containing polymers were not toxic for cells, but induced a clear inhibition of cell proliferation in the presence of aFGF. The effect was polymer-concentration dependent, but the activity was noticeably higher for poly(BA-co-MANSA) copolymers, owing to the self-assembled micellar morphology of the nanoparticles, which placed the sulfonic groups in the more adequate position to interact with the growth factor. These systems offer a good alternative for low toxicity treatments of angiogenic, processed based on inhibition of the activity of growth factors.

Performance tests of two portable mini gamma cameras for medical applications.

We have developed two prototypes of portable gamma cameras for medical applications based on a previous prototype designed and tested by our group. These cameras use a CsI(Na) continuous scintillation crystal coupled to the new flat-panel-type multianode position-sensitive photomultiplier tube, H8500 from Hamamatsu Photonics. One of the prototypes, mainly intended for intrasurgical use, has a field of view of 44 x 44 mm2, and weighs 1.2 kg. Its intrinsic resolution is better than 1.5 mm and its energy resolution is about 13% at 140 keV. The second prototype, mainly intended for osteological, renal, mammary, and endocrine (thyroid, parathyroid, and suprarenal) scintigraphies, weighs a total of 2 kg. Its average spatial resolution is 2 mm; it has a field of view of 95 x 95 mm2, with an energy resolution of about 15% at 140 keV. The main advantages of these gamma camera prototypes with respect to those previously reported in the literature are high portability and low weight, with no significant loss of sensitivity and spatial resolution. All the electronic components are packed inside the mini gamma cameras, and no external electronic devices are required. The cameras are only connected through the universal serial bus port to a portable PC. In this paper, we present the design of the cameras and describe the procedures that have led us to choose their configuration together with the most important performance features of the cameras. For one of the prototypes, clinical tests on melanoma patients are presented and images are compared with those obtained with a conventional camera.

Partial characterization of enterocin MR99 from a corn silage isolate of Enterococcus faecalis.

AIMS: To assess the inhibitory activity on Gram-positive and Gram-negative bacteria of several species of enterococci recovered from a natural corn silage. METHODS AND RESULTS: The inhibitory activity of strains of Enterococcus faecalis (58), Enterococcus faecium (35), Enterococcus gallinarum (3) and Enterococcus casseliflavus (4) were studied employing indicator strains from various sources (clinical, food and ATCC). Enterococcus faecalis MR99, the only strain with inhibitory activity, inhibited other enterococci, Listeria spp., Staphylococcus aureus, Clostridium spp., Bacillus spp., Escherichia coli, Shigella sonnei and Shigella flexneri. The bacterium contained only one conjugative pheromone-responsive plasmid. The partially chromatography-purified MR99 enterocin (PPE) had a molecular weight of approx. 5000 Da and a pI of 6.2, was sensitive to proteolytic enzymes and could be extracted in benzene and butanol. It appeared stable to adjustment of pH 4.0, 5.0, 6.0, 7.0 and 8.0 and was resistant to heat. Inactivation was at 15 min at 121 degrees C. Enterocin MR99 was bactericidal on strains of Listeria monocytogenes, Staph. aureus, and bovine mastitis agents, it was bacteriostatic on E. coli. Although enterocins MR99 and AS48 have inhibitory activity on Gram-negative bacilli, PCR studies demonstrated a lack of relationship between them. CONCLUSIONS: The active component had a protein nature, was resistant to heat and presented a wide inhibitory spectrum. SIGNIFICANCE AND IMPACT OF THE STUDY: The biological properties of Ent. faecalis MR99 suggest that this strain merits further investigations so it can be applied in human and veterinary health programmes.