Evaluating Structural Details' Influence on Elastic Wave Propagation for Composite Structures via Ray Tracing.

This study presents a novel method based on ray tracing for analyzing wave propagation in composites specifically tailored for structural health monitoring applications. This method offers distinct advantages over the commonly used finite element method mainly in computational resource utilization, which has become a limiting factor for these kinds of analyses. The ray tracing method is evaluated against a number of example cases representing structural details such as thickness changes, stringers, or simulated damage, and the significance of ray tracing to study wave propagation under these conditions and how it can serve as a valuable tool for structural health monitoring are highlighted. This model has been developed as part of a complete SHM framework with the intention of being an efficient and simple way to calculate wave propagation and therefore it could be used as a way to determine relevant damage indicators or train an artificial intelligence model.

Innovative histological and histochemical characterization of tongue biopsies from patients with burning mouth syndrome.

OBJECTIVES: The present pilot study aims to perform an innovative histological and histochemical characterization of samples from patients with burning mouth syndrome (BMS) to correlate these findings with the clinical scenario. METHODS: To carry out this objective, the study samples were stained with the hematoxylin-eosin stain and later, an histochemical study was carried out to determine the composition of the extracellular matrix (ECM) using the stains of Alcian Blue, Picrosirius, Reticulin from Gomori and Verhoeff. RESULTS: The results of this study revealed histological patterns compatible with cellular hypertrophy in different layers of the epithelium as well as a greater keratinization in BMS cases. On the other hand, a lower amount of proteoglycans and a greater amount of collagen fibers were observed compared to the control. In addition, older patients had fewer reticular fibers and younger patients had fewer elastic fibers compared to the control. CONCLUSIONS: In conclusion, the present study shows the existence of a correlation between the histological patterns, age and symptoms of patients with BMS. Therefore, it is necessary to develop synergistic studies in order to assess and implement new classification systems that could improve the therapeutic approach of patients with BMS.

Serum CGRP, VIP, and PACAP usefulness in migraine: a case-control study in chronic migraine patients in real clinical practice.

Calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase activating polypetide-38 (PACAP-38) have relevant roles in migraine pathophysiology. Their serum levels have been proposed as biomarkers for migraine. Our aim was to assess their diagnostic value in real clinical practice in a cohort of chronic migraine (CM), episodic migraine (EM) and healthy controls (HC). We recruited subjects with CM, EM and HC at two medical centers. Blood samples were drawn under fasting conditions in the interictal period, immediately centrifuged and stored at - 80 ºC. Serum levels were determined by ELISA. Neuropeptide levels, the effect of preventatives, correlations with clinical and demographic variables, and their diagnostic value were studied among clinical categories. 296 age- and sex-matched subjects (101 CM, 98 EM and 97 HC) were included. All three neuropeptide serum levels were higher in CM [median and IQ for CGRP = 18.023 pg/ml (14.4-24.7); VIP = 121.732 pg/ml (48.72-186.72) and PACAP = 204.931 pg/ml (101.08-597.64)] vs EM [CGRP = 14.659 pg/ml (10.29-17.45); VIP = 75.603 pg/ml (28.722-107.10); and PACAP = 94.992 pg/ml (65.77-128.48)] and vs HC [CGRP = 13.988 pg/ml (10.095-17.87); VIP = 84.685 pg/ml (35.32-99.79), and PACAP = 103.142 pg/ml (59.42-123.97)]. Using multinomial modeling, only VIP (OR 1.011, 95% CI 1.003-1.018, p = 0.005) and PACAP (OR 1.003, 95% CI 1.001-1.005, p = 0.002) increased the risk for CM, but not for EM. CGRP did not predict CM or EM. This model could correctly classify only 62/101 (61.38%) of CM, 75/98 (76.53%) of EM, and 5/97 (4.12%) of HC [globally 147/296 (49.8%)]. Individually, PACAP performed the best for classifying clinical categories [global accuracy 150/296 (50.67%)]. In CM, neuropeptide levels were higher in those OnaBT-treated than in no-treated patients. Although interictal serum CGRP and VIP were higher in CM than both EM or HC, their utility to discriminate migraine categories was low. Contrary to other studies, PACAP serum levels were also higher in CM than in EM or HC and had more discriminative capability to distinguish CM from EM and HC. Further investigation is needed for determination technique standardization.

What is the real prognostic value of close margins in oral oncology?

AIM: The surgical margin is usually considered an important prognostic factor in oral oncology. However, the real value of a close surgical margin and its relationship with survival is still unclear. Thus, the present report sought to identify the relationship between close surgical margins and overall 3-year survival, whilst also analyzing the association between such margins and recurrence. MATERIALS AND METHODS: The medical records of 200 patients affected by oral squamous cell carcinoma were retrospectively reviewed. The patients were divided into three groups: positive margin (0-2 mm), close margin (2-5 mm), and negative margin (>5 mm). The relationship between surgical margins and overall survival and recurrence rate was analyzed. RESULTS: Surgical margins and reoperation were found to have no significant association with overall survival (P > 0.05). Overall survival was 63% in our sample. Specifically, this was 50%, 64.7% and 66.2% in patients with positive, close and free margins, respectively. Perineural invasion, pN, and locoregional or cervical recurrences were the factors most directly related to overall survival. DISCUSSION: The results of this study indicate that surgical margins are not directly related to overall survival and other factors might significantly influence patient outcomes. Advanced T stage, node involvement, perineural invasion, and ECS are strongly linked with patient survival (P < 0.05). These findings should be carefully evaluated in patients with close surgical margins. Our results indicate that an aggressive adjuvant treatment of patients with close surgical margins could help in obtaining a similar pattern of overall survival with patients with negative margins.

Unfavorable outcomes in microsurgery: possibilities for improvement.

The main aim of the present report is to describe our learning curve in microsurgery and how we solved the problems that frequently occur during the first phases of this learning curve. We analyzed the medical records of 69 patients that underwent head and neck reconstruction with free flaps in our department. The patients were divided into two groups. Group 1 included the patients reconstructed between January 2011 and June 2017, whilst Group 2 included those reconstructed between July 2017 and August 2018. A χ2 test was used to compare the differences between the two groups in terms of flap failure (failure and partial failure) and eventual clinical errors. The p value was set at 0.05. Flap failure and clinical errors were most frequently observed in Group 1 (p < 0.05). Greater awareness of the need for proper functioning of the anastomosis during surgery, along with more exhaustive postoperative monitoring might explain the lower number of failures and signs of vascular compromise observed in Group 2. A number of variables may influence flap survival. Postoperative care, head position, kinking, body temperature, blood pressure and the ability to recognize the sign of vascular compromise all play a fundamental role following surgery. However, microsurgery is not just a routine type of surgery, and a properly trained team with several types of professionals must be adequately prepared to obtain acceptable results.

Impact of Virtual Planning on Surgical Reposition of the Premaxilla Using an Endonasal Approach and Simultaneous Alveoloplasty.

OBJECTIVE: Describe the surgical repositioning of the premaxilla using an innovative minimally invasive endonasal approach and secondary bone graft at the same time. We want to emphasize the importance of virtual surgical planning in this technique. MATERIAL AND METHODS: A total of 6 patients with bilateral complete cleft lip and palate underwent a surgical repositioning of the premaxilla. Virtual surgical planning was performed in all cases. The ages varied between 8 and 12 years and all were male. Five patients were in the mixed dentition phase and 1 patient was in the definitive phase. Three of the patients had been prepared with presurgical nasoalveolar molding. The other 3 were not prepared for various reasons. All patients had primary repair of cleft lip and palate. INTERVENTIONS: An innovative minimally invasive endonasal approach is presented that has allowed a safe 3-D reposition of the premaxilla in patients with bilateral cleft palate. A simultaneous secondary alveoloplasty with the use of absorbable osteosynthesis is a good choice to achieve symmetry and stability. CONCLUSIONS: Virtual surgical planning is an exceptional instrument to make an appropriate presurgical selection of the patients in which combine the 2 procedures.

Is a "watch and wait strategy" safe to manage clinically N0 squamous cell carcinoma of the upper jaw?

PURPOSE: The main aim of the present study is to analyze the behavior of squamous cell carcinoma (SCC) of maxillary gingiva, alveolus, and hard palate and to determine the utility of selective neck dissection in clinically N0 patients at early stages. MATERIAL AND METHOD: Twenty-nine previously untreated patients with SCC of maxillary gingiva, alveolus, and hard palate were diagnosed and treated with at least a tumorectomy and selective neck dissection at HUVN and included in the study. RESULTS: A total of 34.4% of patients (10/29) showed nodal involvement at postoperative histopathologic exam. Several pathologic features such as N involvement, N stage, T stage, and locoregional failure all have a negative impact on overall survival. DISCUSSION: SCC of maxillary gingiva, alveolus, and hard palate shows an aggressive behavior that is comparable with other oral cavity cancers. A more aggressive treatment is thus required for improving locoregional control and overall survival. Supraomohyoid neck dissection may be useful in cT2N0M0.

Historia de la formación sanitaria especializada en España y sus claves docentes / History of medical specialty training system in Spain and its teaching milestones

La modernización de la sanidad española en las décadas del 60 al 80 del siglo XX fue paralela a la creación y desarrollo de la formación sanitaria especializada (FSE) en España (sistema MIR-Médico Interno Residente). Este sistema fue una traslación del modelo de «aprender trabajando» de EE. UU. El Hospital General de Asturias (Oviedo) en 1963 (por iniciativa de Fernando Alonso Lej de las Casas y Carles Soler Durall) y la Clínica Puerta de Hierro (Madrid) en 1964 (por iniciativa de José María Segovia de Arana), fueron los primeros hospitales en iniciar el sistema MIR en España, que se generalizó en 1972 y se consolidó en 1984 como única vía legal de especialización. Desde entonces la FSE es responsabilidad exclusiva del Sistema Nacional de Salud y está dirigida y regulada por el Ministerio de Sanidad y los Departamentos de Salud de las comunidades autónomas (gobiernos regionales). La universidad española no tiene responsabilidad en la FSE. La formación se garantiza a través de un contrato de trabajo por el que el residente tiene la obligación de prestar un trabajo y el derecho a recibir una formación acorde a lo establecido en los programas nacionales de formación de cada especialidad

The modernisation of the National Health System (NHS) in Spain occurred in parallel with the creation and development of the Postgraduate Medical Education system (medical specialty training system, the so-called "residency system") throughout the 60's to 80's of the 20th century. The system was a translation of the "to learn by working" US model. The Hospital General de Asturias (Oviedo) in 1963 (an initiative by Fernando Alonso Lej de las Casas and Carles Soler Durall), and the Clínica Puerta de Hierro (Madrid) in 1964 (initiative of José María Segovia de Arana), were the first two hospitals to start the Spanish Specialty Training system, which was extended to the whole NHS in 1972, and was legally consolidated in 1984 as the only official specialisation route. Since them, the system continues to be developed by the NHS according to the Ministry of Health and the Departments of Health (Regional Governments) instructions and criteria. The Spanish university has no responsibility in this process. The training is guaranteed through an employment contract, whereby the resident has the obligation to be provided a job and the right to receive training according to the national residency programs of each specialty

More intensive CMV-infection in chronic heart failure patients contributes to higher T-lymphocyte differentiation degree.

Immunosenescence in chronic heart failure (CHF) is characterized by a high frequency of differentiated T-lymphocytes, contributing to an inflammatory status and a deficient ability to generate immunocompetent responses. CMV is the best known inducer of T-lymphocyte differentiation, and is associated with the phenomenon of immunosenescence. In this study, we included 58 elderly chronic heart failure patients (ECHF), 60 healthy elderly controls (HEC), 40 young chronic heart failure patients (YCHF) and 40 healthy young controls (HYC). High differentiation of CD8+ T-lymphocytes was found in CMV-seropositive patients; however, the differentiation of CD4+ T-lymphocytes was increased in CMV-seropositive but also in CHF patients. Anti-CMV antibody titers showed positive correlation with more differentiated CD4+ and CD8+ subsets and inverse correlation with CD4/CD8 ratio. Immunosenescence found in CHF patients is mainly due to the dynamics of CMV-infection, since the differentiation of T-lymphocyte subsets is related not only to CMV-infection, but also to anti-CMV antibody titers.

Cherubism. A case report / Querubismo. Discusión de un caso

Cherubism is a rare disorder with autosomal dominant inheritance. It is classified as a benign fibro-osseous lesions and may involve either facial bone. Its typical dentofacial deformities are caused by mutations in the SH3BP2 gene. The protein encoded by SH3BP2 had a significant role in the regulation of osteoblasts and osteoclasts. Accordingly with the radiological findings, differential diagnoses includes fibrous dysplasia, giant cell granuloma, osteosarcoma, juvenile ossifying fibroma, fibrous osteoma, odontogenic cyst and hyperparathyroidism. The aim of the present report is twofold. First, we examine the importance of the proper management of these cases. Second, we describe this rare syndrome with the goal of proposing suitable treatments (AU)

El querubismo es una enfermedad rara. Presenta herencia autosómica dominante y es clasificada como una enfermedad fibroósea benigna. Las deformidades típicas de esta dolencia se deben a la alteración del gen SH3BP2 y pueden afectar a cualquier hueso del macizo facial. La proteína codificada por este gen es fundamental para el correcto funcionamiento de osteoblastos y osteoclastos. El diagnóstico diferencial debe incluir: displasia fibrosa, granuloma de células gigantes, osteosarcoma, fibroma osificante juvenil, fibroma osteoide e hiperparatiroidismo (AU)

Oral and oropharyngeal squamous cell carcinoma in young adults: A retrospective study in Granada University Hospital

Background: This study aims to evaluate and analyze the clinical features and outcomes of oral and oropharyngeal squamous cell carcinoma (SCC) in patients < 45-years old in our center. Material and Methods: A retrospective analysis was conducted using the records of patients diagnosed with oral and oropharyngeal SCC between 1998 and 2011 in the University Hospital of Granada (Spain). The analysis identified 33 patients with oral and oropharyngeal SCC with an age of 45 years were randomly selected from the same database. A retrospective analysis was conducted to determine specific features including sites of occurrence, risk factors, sex distribution, socio-economic status, T stage at diagnosis, nodal involvement, degree of tumor differentiation, locoregional failure and overall survival at 5 years was. Further, the results of both groups were compared. Results: The male-female ratio was 1.2:1 in the group of young adults and 2.03:1 in the group of patients with an age of >45 years. No significant differences were found in terms of site, nodal involvement, locoregional failure, and overall survival. However, there were statistically significant differences between the two groups in terms of features such as risk factors, socio-economic status, T stage at diagnosis, and degree of tumor differentiation. The overall 5-year survival rate was 62% for patients >45 years old, whilst for the group of young adults this rate was 48.4% (p= 0.17). Conclusions: The poor association between the common risk factors and oral and oropharyngeal cancers in young adults suggests that other pathogenic mechanisms should be investigated. For young patients, the data show evidence of poorer outcomes in terms of overall survival (p=0.17), and locoregional failure (p=0.23). Nevertheless, the literature shows that the results in this field are particularly inconsistent, and further research is therefore needed to provide more in-depth knowledge of the disease in this age group (AU)

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Juxtacortical Mandibular Chondrosarcoma during pregnancy: A case report.

Chondrosarcoma is one of the most common malignant bone tumors in adults. It use to affect upper arm, pelvis and thigh bone. A wide surgical extirpation represent the gold standard to treat this disorder. In fact, radiotherapy and chemotherapy are no useful. Interestingly, chondrosarcoma is rare in head and neck (HNCS) and extremely uncommon during pregnancy. Thus, there is a lack of evidence about the proper treatment in these cases. A wide surgical extirpation is also considered the most effective procedure in HNCS. There are no consistent evidences about the he role of radiation and chemotherapy. In view of that, the present study describes a case of juxtacortical mandibular chondrosarcoma affecting a 28-year-old pregnant woman. After a multidisciplinary analysis of the case, we decided to treat the patient with a wide surgical resection and and immediately reconstruction. Key words:Mandibular chondrosarcoma, pregnancy, surgical extirpation, radiotherapy, chemoteraphy.

Cervical necrotizing fasciitis and acute mediastinitis of odontogenic origin: A case series.

Necrotising fasciitis (NF) is an uncommon infection. Early signs and symptoms include fever, severe pain and swelling, and redness at the wound site. Moreover, fulminant evolution and high mortality rate are typical of this pathology. In the present report we describes three cases of cervical necrotizing fasciitis complicated by acute mediastinitis. All patients were apparently immunocompetent adults. The main aim of the present report is to show the serious consequences that a dental infection might trigger. Furthermore, we highlight the importance of a multidisciplinary approach in these cases. The constant interaction between different medical specialties is essential for ensuring a proper management of each case. Key words:Cervical necrotizing fasciitis, acute mediastinitis, odontogenic origin , multidisciplinary approach.

Cherubism. A case report.

Cherubism is a rare disorder with autosomal dominant inheritance. It is classified as a benign fibro-osseous lesions and may involve either facial bone. Its typical dentofacial deformities are caused by mutations in the SH3BP2 gene. The protein encoded by SH3BP2 had a significant role in the regulation of osteoblasts and osteoclasts. Accordingly with the radiological findings, differential diagnoses includes fibrous dysplasia, giant cell granuloma, osteosarcoma, juvenile ossifying fibroma, fibrous osteoma, odontogenic cyst and hyperparathyroidism. The aim of the present report is twofold. First, we examine the importance of the proper management of these cases. Second, we describe this rare syndrome with the goal of proposing suitable treatments.

Accidental displacement of a dental implant into the sublingual space: A Case report.

Dental implant surgery is continuously expanding. In fact, every day more and more surgeons are choosing dental implants for allowing great results in the field of oral rehabilitation. However, these procedures are not exempt from complications. This report presents the case of a 66 years old man underwent implant surgery by a specialized dentist. No problems were reported during implant placement. Despite this, three months later, it was displaced into the sublingual space at the time of uncovering. Against this backdrop, the patient was referred to an expert maxillofacial surgeon. Next day, the implant was removed using an intraoral approach to reach the sublingual space. According with our knowledge, there are no cases reported in the literature that describe this complication. Key words:Dental implant, sublingual space, bone atrophy, complications of oral surgery.

Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction.

Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words:Meningitis, subdural empyema, odontogenic infections.

Traumatic arteriovenous fistula as consequence of TMJ arthroscopic surgery. A case report.

UNLABELLED: The ocurrence of a traumatic arteriovenous fistula after arthroscopic surgery of TMJ represents an extremely rare event. Specifically, this uncommon complication has been described only in a few case reports. In this light, the most frequent symptoms showed by this disease are thrills, bruits, pulsatile tinnitus, and an expansible vascular mass. Importantly, the severity of these symptoms is also dependent on the vessels involved. With regard to the management, is important to note that the vessel ligation with surgery as well as vessel emolization with endovascular procedures have been shown to be effective in the treatment of these cases. In view of that, the present study describes a case of superficial temporal arteriovenous fistula that arose as a postoperative complication of a bilateral arthroscopic eminoplasty of TMJ. The aim of the present report is to characterize this rare syndrome with the goal of proposing suitable treatments. KEY WORDS: Arteriovenous fistula, arthroscopic surgery, eminoplasty of TMJ, temporal vessels.

Avance maxilar en pacientes fisurados labio palatinos con distractor intraoral / Maxillary advancement in cleft palate patients with intraoral distraction

Introducción. Los pacientes fisurados labio palatinos presentan con frecuencia hipoplasia maxilar. La osteogénesis por distracción (DO) de maxilar superior es una técnica alternativa para pacientes con hipoplasia maxilar severa. Se han evaluado los cambios producidos en tejidos duros y blandos y su estabilidad en el tiempo. Material y métodos. Se ha realizado DO de maxilar a 6 pacientes (5 mujeres y un hombre) fisurados labio palatinos, entre 16-25 años, con un distractor interno. Hemos evaluado mediante trazados cefalométricos en radiografías y fotografías los cambios esqueléticos y en tejidos blandos. El tiempo de seguimiento fue entre 2-8 años. Resultados. En 5 pacientes el punto A avanza entre 3-10 mm mejorando significativamente las relaciones maxilo-mandibulares. En un paciente fracasa la DO intraoral y se termina el caso con RED; en un paciente se evidencia poco avance y rotación maxilar. La recidiva observada entre 6-9 meses post DO es entre el 10 y el 15% tanto esquelética como en tejidos blandos. Conclusiones. La DO intraoral es una técnica alternativa exitosa para avance del maxilar en pacientes fisurados labio palatinos que necesiten un avance inferior a 10 mm. Produce mejoras en el perfil esquelético y blando. Los dispositivos internos no producen impacto psicológico. La contención más larga en el tiempo. La recidiva es difícil de definir y calcular (AU)

Introduction. Patients with cleft lip and palate usually present with maxillary hypoplasia. Upper jaw intraoral distraction osteogenesis (DO) is an alternative technique for patients with severe maxillary hypoplasia. An evaluation was made of the changes produced in hard and soft tissues and their stability over time. Material and methods. Six patients (5 female and 1 male) between 16 and 25 years old with cleft lip and palate underwent maxillary DO with an internal distractor. An evaluation was made of the skeletal and soft tissues changes using cephalometric studies with radiographs and photographs. Follow-up time was between 2 and 8 years. Results. There was Point A advancement between 3-10 mm in 5 patients, significantly improving maxillomandibular relationships. Intraoral DO failed in one patient, and the case was finished using rigid external distraction (RED). In another patient hardly any advancement and maxillary rotation was observed. The relapse observed between 6 and 9 months post DO was between 10-15% in both skeletal and soft tissues. Conclusions. Intraoral DO is a successful alternative technique in maxillary advancement in patients with cleft lip and palate who need an advancement less than 10 mm. It produces improvements in the skeletal and soft profile. Internal devices do not have any psychological impact and have longer consolidation phases. Relapse is difficult to determine and calculate (AU)