[Validation of a questionnaire to assess patient safety culture in healthcare managers: Psychometric properties and usability]. / Validación de un cuestionario para evaluar la cultura de seguridad del paciente en directivos de la salud: propiedades psicométricas y usabilidad.

AIM: To validate a reduced and applicable to distinct location version of the only validated questionnaire of patient safety culture in managers in Spanish language. METHOD: Questionnaire validation study. Community of Madrid 2022. Reduction/adaptation of the original questionnaire: Giménez-Aibar-Gutiérrez, 2013 Questionnaire was reduced from 85 items to 25; those local or not applicable were removed. Pre-test: Semi-structured survey on comprehension and response scale. There was no need to modify the questionnaire. VALIDATION: It was tested in 39 primary care managers without care activity. Internal consistency (α Cronbach), content validity (experts) and construct validity (factor analysis) were analysed. Usability analysis: Survey on time spent and non-response rate. RESULTS: α Cronbach=0.894. Content validity: Experts deemed questionnaire was complete. Factor analysis: five factors explain 68% of variance. The factors corresponded to the dimensions of the theoretical construct. Factors, internal consistency of each and correlation with global score were: commitment with patient safety: α Cronbach=0.793, r=0.778; P<.001; procedures/reporting: α Cronbach=0.83, r=0.806; P<.001; attitudes with patient safety: α Cronbach=0.766, r=0.596; P<.001; clinicians involving: α Cronbach=0.773, r=0.798; P<.001; patient safety communication: α Cronbach=0.615, r=0.518; P=.001; usability survey: 95% thought spent time was adequate. Non-response rate was 0%, except one item. CONCLUSION: In this work, a reduced and adapted version of questionnaire of Giménez-Aibar-Gutiérrez was validated at distinct location (Madrid region). Psychometric properties and usability, which were found, suggest that the reduced questionnaire is a reliable, valid and usable instrument to assess patient safety culture in managers of any place.

[Effectiveness of peri-articular infiltration with local anesthetic and adjuvants for post-surgical pain control in total knee replacement]. / Eficacia de la infiltración periarticular con anestésico local y adyuvantes para control del dolor postquirúrgico en la artroplastía total de rodilla.

INTRODUCTION: Total knee arthroplasty (TKA) is one of the most successful orthopedic treatments, however, it has been associated with severe postsurgical pain in 30-60% of patients. We propose that infiltration of the articular capsule of the knee during surgery will decrease postsurgical pain. MATERIAL AND METHODS: Experimental, randomized, double-blind study in patients undergoing unilateral TKA between April 2018 and January 2019. Patients were divided into two groups, the first infiltration with placebo and the second with anesthetic solution and adjuvants (fentanyl, epinephrine and ketorolac). Pain was measured with the visual analog scale (VAS) at 4, 6, 8, 12, 18, 24, 36 and 48 hours postsurgical, as well as the consumption of opioid analgesics and antiemetics. RESULTS: 20 patients in each group, with a follow-up of 4 weeks. There were no significant differences in demographic characteristics between the two groups. Better control of postsurgical pain was observed in the group that received infiltration with anesthetic and adjuvant, as well as a decrease in the consumption of opioid analgesics and antiemetics. There was no difference in bleeding or in the incidence of infections between the two groups. CONCLUSION: Peri-capsular infiltration is a safe and effective method, as part of multimodal analgesia in total knee arthroplasty, as it decreases postsurgical pain, opioid and antiemetic use and does not increase postsurgical bleeding.

INTRODUCCIÓN: La artroplastía total de rodilla (ATR) es uno de los tratamientos ortopédicos más exitosos; sin embargo, se ha asociado a dolor postquirúrgico intenso en 30-60% de los pacientes. Nosotros planteamos que la infiltración de la cápsula articular de la rodilla durante la cirugía disminuirá el dolor postquirúrgico. MATERIAL Y MÉTODOS: Estudio experimental, aleatorio, doble ciego, en pacientes sometidos a ATR unilateral entre Abril de 2018 a Enero de 2019. Los pacientes fueron divididos en dos grupos, el primero infiltración con placebo y el segundo con solución anestésica y adyuvantes (fentanilo, epinefrina y ketorolaco). Se cuantificó mediante escala visual análoga (EVA) del dolor a las cuatro, seis, ocho, 12, 18, 24, 36 y 48 horas postquirúrgicas, así como del consumo de analgésicos opioides y antieméticos. RESULTADOS: Veinte pacientes en cada grupo, con un seguimiento de cuatro semanas. No hubo diferencias significativas en las características demográficas entre ambos grupos. Se observó un mejor control del dolor postquirúrgico en el grupo que recibió infiltración con anestésico y adyuvante, además de una disminución en el consumo de analgésicos opioides y antieméticos. No hubo diferencia en sangrado ni en la incidencia de infecciones entre ambos grupos. CONCLUSIÓN: La infiltración pericapsular es un método seguro y eficaz, como parte de la analgesia multimodal en la artroplastía total de rodilla, ya que disminuye el dolor postquirúrgico, el consumo de opioides y antieméticos y no incrementa el sangrado postquirúrgico.

[Neuropsychological examination in children with intellectual disabilities]. / Exploración neuropsicológica en niños con discapacidad intelectual.

Intellectual disability is a neurodevelopmental condition characterised by cognitive deficits and functional impairments in adaptive behaviour that occur during development. It should be noted that this generates a variety of symptomatology, which is why it is considered by neuropsychology as an axis of analysis. In this regard, emphasis will be placed on why neuropsychological screening is necessary in this condition. Such relevance lies, on the one hand, in determining whether the child's disability is due to alterations in the nervous system or to unfavourable conditions of the environment in which he/she develops. On the other hand, neuropsychological examination provides information on which areas of the brain are responsible for one or the other disability. It also makes it possible to identify the individual particularities of the child's development, that is, his/her performance profile (strengths and weaknesses), but not necessarily to establish the diagnosis of intellectual disability and, from there, decide on intervention programmes adapted to the characteristics and needs of each case.

TITLE: Exploración neuropsicológica en niños con discapacidad intelectual.La discapacidad intelectual es una condición del neurodesarrollo que se caracteriza por un déficit a nivel cognitivo y alteraciones funcionales en la conducta adaptativa de las personas que se presentan durante su desarrollo. Es preciso indicar que ello genera una sintomatología variada, por lo que es considerada por la neuropsicología como eje de análisis. En ese sentido, se enfatizará en por qué es necesario realizar una exploración neuropsicológica en esta condición. Dicha relevancia radica, por un lado, en determinar si la discapacidad que presenta el niño se debe a alteraciones en el sistema nervioso o a condiciones desfavorables del medio en el que se desenvuelve; de otro lado, la exploración neuropsicológica aporta qué áreas cerebrales son responsables de una u otra discapacidad. Además, permite identificar las particularidades individuales del desarrollo del niño, es decir, su perfil de desempeño (fortalezas y debilidades), y no necesariamente establecer el diagnóstico de discapacidad intelectual, y a partir de ello establecer programas de intervención adecuados a las características y necesidades de cada caso.

Exploración neuropsicológica en niños con discapacidad intelectual / Neuropsychological examination in children with intellectual disabilities

La discapacidad intelectual es una condición del neurodesarrollo que se caracteriza por un déficit a nivel cognitivo y alteraciones funcionales en la conducta adaptativa de las personas que se presentan durante su desarrollo. Es preciso indicar que ello genera una sintomatología variada, por lo que es considerada por la neuropsicología como eje de análisis. En ese sentido, se enfatizará en por qué es necesario realizar una exploración neuropsicológica en esta condición. Dicha relevancia radica, por un lado, en determinar si la discapacidad que presenta el niño se debe a alteraciones en el sistema nervioso o a condiciones desfavorables del medio en el que se desenvuelve; de otro lado, la exploración neuropsicológica aporta qué áreas cerebrales son responsables de una u otra discapacidad. Además, permite identificar las particularidades individuales del desarrollo del niño, es decir, su perfil de desempeño (fortalezas y debilidades), y no necesariamente establecer el diagnóstico de discapacidad intelectual, y a partir de ello establecer programas de intervención adecuados a las características y necesidades de cada caso.(AU)

Intellectual disability is a neurodevelopmental condition characterised by cognitive deficits and functional impairments in adaptive behaviour that occur during development. It should be noted that this generates a variety of symptomatology, which is why it is considered by neuropsychology as an axis of analysis. In this regard, emphasis will be placed on why neuropsychological screening is necessary in this condition. Such relevance lies, on the one hand, in determining whether the child’s disability is due to alterations in the nervous system or to unfavourable conditions of the environment in which he/she develops. On the other hand, neuropsychological examination provides information on which areas of the brain are responsible for one or the other disability. It also makes it possible to identify the individual particularities of the child’s development, that is, his/her performance profile (strengths and weaknesses), but not necessarily to establish the diagnosis of intellectual disability and, from there, decide on intervention programmes adapted to the characteristics and needs of each case.(AU)

Quadratic Non-Linear Optical Properties of the poly(2,5-bis(but-2-ynyloxy) Benzoate Containing the 2-(ethyl(4-((4-nitrophenyl)buta-1,3-diynyl)phenyl)amino)ethanol) Chromophore.

Excellent quadratic non-linear optical (ONL-2) properties of the poly(2,5-bis(but-2-ynyloxy) benzoate, containing a polar diacetylene as a chromophore, were found. According with the Maker fringes method, oriented polymer films showing an order parameter of ∼0.23 can display outstanding and stable Second Harmonic Generation (SHG) effects under off-resonant conditions (SHG-532 nm). Also, the macroscopic non-linear optical (NLO)-coefficients were evaluated under the rod-like molecular approximation, obtaining: χzzz(2) and χzxx(2) in the order of 280 ± 10 and 100 ± 10 pm V-1, respectively. The mechanical and chemical properties, in addition to the large ONL-2 coefficients exhibited by this polymer, make it a promising organic material in the development of optoelectronic/photonic devices.

Correlation between preoperative serum alpha-fetoprotein levels and survival with respect to the surgical treatment of hepatocellular carcinoma at a tertiary care hospital in Veracruz, Mexico. / Correlación de los niveles de alfafetoproteína sérica preoperatoria y sobrevida en el tratamiento quirúrgico del hepatocarcinoma en una unidad médica de alta especialidad en Veracruz, México.

INTRODUCTION: Preoperative serum alpha-fetoprotein levels can have predictive value for hepatocellular carcinoma survival. AIM: Our aim was to analyze the correlation between preoperative serum alpha-fetoprotein levels and survival, following the surgical treatment of hepatocellular carcinoma. METHODS: Nineteen patients were prospectively followed (07/2005-01/2016). An ROC curve was created to determine the sensitivity and specificity of alpha-fetoprotein in relation to survival (Kaplan-Meier). RESULTS: Of the 19 patients evaluated, 57.9% were men. The mean patient age was 68.1 ± 8.5 years and survival at 1, 3, and 5 years was 89.4, 55.9, and 55.9%. The alpha-fetoprotein cutoff point was 15.1 ng/ml (sensitivity 100%, specificity 99.23%). Preoperative alpha-fetoprotein levels below 15.1, 200, 400, and 463 ng/ml correlated with better 1 and 5-year survival rates than levels above 15.1, 200, 400, and 463 ng/ml (P<.05). CONCLUSIONS: Elevated preoperative serum alpha-fetoprotein levels have predictive value for hepatocellular carcinoma survival.

Probiotic Lactobacillus Strains Stimulate the Inflammatory Response and Activate Human Macrophages.

Lactobacilli have been shown to promote health functions. In this study, we analyzed the mechanism by which four different strains of probiotics affected innate immunity, such as regulation of ROS, cytokines, phagocytosis, bactericidal activity, signaling by NF-κB pp65, and TLR2 activation. The production of ROS was dependent on the concentration and species of Lactobacillus. The results obtained from the tested strains (Lactobacillus rhamnosus GG, L. rhamnosus KLSD, L. helveticus IMAU70129, and L. casei IMAU60214) showed that strains induced early proinflammatory cytokines such as IL-8,TNF-α, IL-12p70, and IL-6. However, IL-1ß expression was induced only by L. helveticus and L. casei strains (after 24 h stimulation). Phagocytosis and bactericidal activity of macrophages against various pathogens, such as S. aureus, S. typhimurium, and E. coli, were increased by pretreatment with Lactobacillus. The nuclear translocation NF-κB pp65 and TLR2-dependent signaling were also increased by treatment with the probiotics. Taken together, the experiments demonstrate that probiotic strains of Lactobacillus exert early immunostimulatory effects that may be directly linked to the initial inflammation of the response of human macrophages.

Pet serine protease from enteroaggregative Escherichia coli stimulates the inflammatory response activating human macrophages.

BACKGROUND: Pet is a toxin from the family of Serine Protease Autotransporters of Enterobacteriaceae which was initially identified in Enteroaggregative Escherichia coli strains. This protease exhibits enterotoxin properties, damages the cell cytoskeleton and induces intestinal epithelium alterations, which are associated with a severe inflammatory process. An in-vitro study was conducted to evaluate the effect of Pet on the migration of human peripheral blood monocytes-derived macrophages and its participation in the activation of the early inflammatory response and cytokine expression. RESULTS: In the macrophage migration activation assay, Pet produced a similar effect to that induced by opsonized zymosan (ZAS). Regarding the cytokine expression, an increase of IL-8, TNF-α (pro-inflammatory) and IL-10 (anti-inflammatory) was identified. In addition to the above results, the nuclear translocation of NF-kB pp65 was also identified. These events are probably related to the inflammatory response identified in the histological examination of intestine rat samples inoculated with Pet during a ligated loop assay. CONCLUSION: The results showed that Pet participates as an immunostimulant molecule for macrophages, which activates both their mobility and cytokine expression. These observations suggest that the toxin participates in the inflammatory process that is observed during the host infection by EAEC Pet producing.

GASES SANGUÍNEOS, ELECTROLITOS Y VARIABLES METABÓLICAS DETERMINANTES DEL ESTADO ÁCIDO-BASE EN CABALLOS CRIOLLOS COLOMBIANOS / COMPARISON OF BLOOD GASES, ELECTROLYTES, AND METABOLIC DETERMINANTS OF ACID-BASE STATUS IN COLOMBIAN CRIOLLO HORSES

Se determinaron y compararon los valores de los gases sanguíneos, electrolitos, lactato, hematocrito y estado ácido-base en sangre venosa y arterial de 17 equinos criollos del Centro de Veterinaria y Zootecnia de la Universidad CES, para lo cual se utilizó el sistema Epoc Blood Analysis®, analizador portátil de sangre que permite obtener resultados de gases, iones y metabolitos. Los resultados arrojados muestran que hay diferencia estadística significativa (p < 0,05) en la glucosa arterial con respecto a la edad y en el lactato venoso con respecto al sexo; además, al comparar la sangre venosa contra la sangre arterial, se hallaron diferencias estadísticas significativas en la presión parcial de oxígeno (pO2), la presión parcial de CO2 (PCO2), la saturación de oxígeno (cSO2) sodio, calcio ionizado, glucosa, bicarbonato, base exceso sanguínea (BEb), base exceso extracelular (BE(ecf)), PCO2 y PO2 corregidas por temperatura. Se concluye que se deben tomar muestras arteriales para realizar valoraciones precisas de los pacientes y que variables, como la pO2, la pCO2 y la cTCO2, dependen en gran medida de la temperatura ambiental, la temperatura del paciente y la altitud, condiciones que modifican las presiones parciales de los gases.

We determined and compared the values of blood gases, electrolytes, lactate, hematocrit and acid-base status for both arterial and venous blood in seventeen horses from the Veterinary and Zootechnical Center at CES University. We used the Epoc Blood Analysis® portable system, which allows analyzing and obtaining information about gases, ions and metabolites. Our results show that there is a statistically significant difference (p < 0,05) in the values of arterial glucose according to the age and in the concentration of venous lactate according to the sex. Likewise, when we compared the values obtained from arterial blood with the values obtained from venous blood, we found statistically significant differences in the oxygen partial pressure (pO2), carbon dioxide partial pressure (pCO2), oxygen saturation level (cSO2), sodium, ionized calcium, glucose, bicarbonate, blood base excess (BEb), extracellular base excess (BE(ecf)), temperature-corrected PO2 and pCO2. Based on these results, we can conclude that we should take arterial blood samples in order to assess accurately the status of the patients and that variables such as oxygen partial pressure, carbon dioxide partial pressure and the oxygen saturation level are largely dependent on the environmental temperature, patient's temperature and altitude; as these conditions modify the gas partial pressures.

Dimensión vertical en edentados: relación con síntomas referidos / Vertical dimension on edentulous patient: relationship with symptoms reported

La dimensión vertical es una medida aproximada de las relaciones fisiológicas intermaxilares. Su obtención es un proceso sensible y metódico que produce efectos craneofaciales colaterales cuando es erróneamente lograda. Los conceptos individualistas de su obtención deben ser cambiados e interiorizados de una manera colectiva debido a la complejidad de la dinámica masticatoria que exige una perspectiva más amplia de esta noción. La correspondencia entre la dimensión vertical y lo funcional-disfuncional cráneo-cervical es innegable y va mas allá de una relación exclusivamente dental. Esta revisión busca situar al lector en una realidad estomatognática y no solo odontológica, que exige mayores esfuerzos y un cambio de perspectiva en la conceptualización de la importancia de la dimensión vertical en el normal funcionamiento del sistema estomatognático y de estructuras vecinas en el paciente edentado.

Vertical dimension is an approximate measure of the physiological inter-maxillary relations. Its register is a sensitive and methodical process with craniofacial side effects when wrongly achieved. Single concepts for vertical dimension register should be changed and understood in a collective manner. The complexity of the masticatory dynamics requires a broader view of this notion. The correspondence between the vertical dimension and the functional-dysfunctional cranio-cervical relations is undeniable and goes beyond an exclusively dental relation. This review seeks to place the reader in a stomatognathic functional perspective, which requires greater efforts of the prosthodontics operator. Normal functioning of the stomatognathic system and surrounding structures in the edentulous patient depends on the conceptualization about the importance of vertical inter-maxillary relations.

Antropometría del martillo en humanos: un estudio anatómico directo / Anthropometry of the malleus in humans: a direct anatomic study

El conocimiento morfométrico de las estructuras del oído medio, incluidos cada uno de los oscículos, es importante para la comprensión de su complejidad biomecánica. Las características estructurales y dimensionales del martillo son registradas en 23 martillos de población mestiza adulta Colombiana. Las medidas registradas involucran el área de la cabeza, el cuello, el manubrio, el proceso anterior y lateral y el área de la articulación incudo-maleolar. Tres de los diecinueve registros tomados en este estudio pudieron ser comparados concienzudamente con otros estudios que mostraron similitudes. El largo total del martillo fue de 8,18 mm DE 0,24, la longitud del manubrio fue de 4,91 mm DE 0,25 y la proporción del largo del manubrio y el largo total fue de 60,11 % DE 3,47. Conforme a la población estudiada no se logro encontrar variación individual o pareada en la anatomía del martillo lo que lo hace un hueso morfométricamente uniforme y estable.

Morphometric knowledge of middle ear structures, including each of the oscicles, is important for the understanding of its biomechanics complexity. The structural and dimensional characteristics of the malleus are registered in 23 samples of Colombian adult mestizo population. Registered measures involve the area of the head, neck, the manubrium, the anterior and lateral process and the area of the incudo-maleolar joint. Three of nineteen records taken in this study could be carefully compared to other studies, which showed similarities. The total length of the malleus was 8,18 mm SD 0.24, the length of the handle was 4.91 mm SD 0.25 and the ratio of the length of the manubrium and the malleus total length was 60,11% of 3.47. In accordance with the studied population, individual or paired variations were not found in the anatomy of the malleus that makes it a morphometrically uniform and stable bone.

Apixaban after hip or knee arthroplasty versus enoxaparin: efficacy and safety in key clinical subgroups.

BACKGROUND: New oral anticoagulants for thromboprophylaxis after hip or knee arthroplasty have been given as fixed-dose regimens. OBJECTIVE: To evaluate the consistency of the antithrombotic efficacy and bleeding risk of apixaban 2.5 mg twice daily compared with enoxaparin 40 mg once daily after knee or hip arthroplasty across the clinical characteristics of age, gender, body weight, body mass index (BMI) and creatinine clearance. METHODS: The pooled results of the ADVANCE-2 (knee arthroplasty) and -3 (hip arthroplasty) randomized trials were used to evaluate if treatment had a statistically significantly different effect (P < 0.10) on major venous thromboembolism (VTE) and bleeding for the characteristics of age, gender, body weight, BMI and creatinine clearance. Both univariate analysis and multivariate logistic regression were used. RESULTS: Univariate analyses identified statistically significant interactions for age and major VTE (P = 0.09); for both age (P = 0.07) and body weight (P = 0.07) and the outcome of major bleeding; and for creatinine clearance (P = 0.03) and the composite outcome of major and clinically relevant non-major bleeding. Estimates of these possible differences were not precise, with wide 95% confidence intervals (CIs) that included a zero difference for several subgroups. Multivariate logistic regression analysis did not detect a statistically significant interaction for any outcomes. CONCLUSIONS: This analysis found no convincing evidence that age, weight, gender, BMI or creatinine clearance influenced the balance of benefit to risk for apixaban compared with enoxaparin. Because only 5% of patients had a creatinine clearance between 30 and 50 mL min(-1), further data are needed in such patients.

Antropometría del Estribo en Humanos: Un Estudio Anatómico Directo / Human's Stape Anthropometry: A Direct Anatomic Study

Es modesta la base de datos morfológicos del estribo en humanos. Su caracterización morfométrica es importante cuando se compara con estribos de otras épocas ancestrales e igualmente en el estudio de una biomecánica oscicular compleja. Las características estructurales y dimensionales y pareadas del estribo fueron registradas en 23 huesos de población mestiza adulta Colombiana. Las medidas registradas involucraron el área de la articulación lenticular incudo-estapedial, la platina del estribo y los procesos anterior y posterior del estribo, en diferentes sentidos. Cinco de los dieciséis registros tomados en este estudio pudieron ser comparados concienzudamente con otros estudios. Las cinco medidas comparables fueron: el largo total de la platina con 2,87 mm DE 0,09; el ancho mayor de la platina con 1,36 mm DE 0,09; el largo del estribo con 3,18 DE 0,15 y la distancia interna interpilar con 1,65 DE 0,17; y la altura del arco con 1,82 DE 0,19. La angulación de los procesos anterior y posterior del estribo resulto en 29.01 grados DE 2.93. Conforme a la población estudiada no se logro encontrar variación individual o pareada en la anatomía del estribo, haciéndolo un hueso morfométricamente uniforme y estable.

There is a modest database about morphological data for the stapes in humans. Its preliminary characterization is important when compared with other ancestral times and also in the study of a complex oscicular biomechanics. Paired and structural characteristics of the stapes were registered in 23 bones of Colombian adult mestizo population. Registered measures involved the lenticular incudo-stapedial joint; the anterior and posterior processes of the stapes; and the footplate dimensions. Five of the sixteen records taken in this study could be carefully compared to other results. The five comparable measures were: the total length of the footplate with 2.87 SD 0.09 mm; the widest footplate zone with 1.36 SD 0.09 mm; the stape's total length with 0.15 SD 3.18 and internal interprocesses length with 1.65 SD 0.17; and the arc height with 1,82 SD 0,19. Anterior and posterior angulation of the stape processes was 29.01 SD 2.93 degrees. In accordance with the studied population the measures cannot show individually or paired variations in the anatomy of the stapes, making it a uniform and morphometrically stable bone.

Oclusión dental: ¿doctrina mecanicista o lógica morfofisiológica? / Dental occlusion: mechanistic doctrine or morphophysiological logical?

Las escuelas de oclusión han creado un constructo mecanicista que busca explicar, bajo un modelo reduccionista y determinista, una dinámica cráneo-cervical y estomatognática compleja. Estos modelos de oclusión le dedican más importancia a la morfología dental y sus geometrías interpretativas que a la morfofisiología estomatognática. La configuración musculo-esquelética cráneo-cervical tiene el poder ganado de influir concomitantemente en la ubicación espacial de la mandíbula e implícitamente en las relaciones interoclusales. La visión actual de la oclusión sigue basándose en observaciones empíricas de un siglo de antigüedad que carecen de soporte apropiado en el marco del nivel de evidencia. En la dimensión funcional los modelos de oclusión conservan los mismos vacíos que existían desde su estructuración en el siglo pasado, particularmente en sus representaciones espaciales estáticas, uniáxicas y anti-dinámicas que desestiman la individualidad de cada sujeto. Cada especialidad puede tener tantas razones como puntos de vista diferentes de "maloclusión" así como formas de tratarla.

Occlusion schools have created a mechanistic construct that seeks to explain, under a reductionist and deterministic model, a craneal-cervical and stomatognathic complex dynamic. These occlusion models dedicate more importance to dental morphology and its interpretative geometries than a stomatognathic morphophysiology. Craneocervical musculoskeletal configuration has the gained power to concomitantly influence the jaw location in the space and implicitly in the interocclusal relations. The current vision of the occlusion is based on empirical observations of almost a century that lack support in the level of evidence framework. In the functional dimension occlusion models maintain the same gaps that existed from its origins since the last century, particularly in its static, uniaxic and anti-dynamic spatial representations that dismiss the individuality of each subject. Each specialty can have as many reasons as different points of view about "malocclusion" as well as techniques to treat it.

Apixaban versus enoxaparin for thromboprophylaxis after hip or knee replacement: pooled analysis of major venous thromboembolism and bleeding in 8464 patients from the ADVANCE-2 and ADVANCE-3 trials.

In order to compare the effect of oral apixaban (a factor Xa inhibitor) with subcutaneous enoxaparin on major venous thromboembolism and major and non-major clinically relevant bleeding after total knee and hip replacement, we conducted a pooled analysis of two previously reported double-blind randomised studies involving 8464 patients. One group received apixaban 2.5 mg twice daily (plus placebo injection) starting 12 to 24 hours after operation, and the other received enoxaparin subcutaneously once daily (and placebo tablets) starting 12 hours (± 3) pre-operatively. Each regimen was continued for 12 days (± 2) after knee and 35 days (± 3) after hip arthroplasty. All outcomes were centrally adjudicated. Major venous thromboembolism occurred in 23 of 3394 (0.7%) evaluable apixaban patients and in 51 of 3394 (1.5%) evaluable enoxaparin patients (risk difference, apixaban minus enoxaparin, -0.8% (95% confidence interval (CI) -1.2 to -0.3); two-sided p = 0.001 for superiority). Major bleeding occurred in 31 of 4174 (0.7%) apixaban patients and 32 of 4167 (0.8%) enoxaparin patients (risk difference -0.02% (95% CI -0.4 to 0.4)). Combined major and clinically relevant non-major bleeding occurred in 182 (4.4%) apixaban patients and 206 (4.9%) enoxaparin patients (risk difference -0.6% (95% CI -1.5 to 0.3)). Apixaban 2.5 mg twice daily is more effective than enoxaparin 40 mg once daily without increased bleeding.

Effect of melatonin on myocardial oxidative stress induced by experimental obstructive jaundice.

OBJECTIVE: melatonin has been demonstrated to have active antioxidant properties in different tissues during experimental cholestasis. The aim of this research was to study myocardial oxidative stress on obstructive jaundice, and to analyze the effect of melatonin on myocardial oxidative lesions. MATERIAL AND METHODS: we achieved cholestasis by ligature and sectioning of the main bile duct. Melatonin was administered intraperitoneally (500 microg/kg/day). We measured malondialdehyde (MDA), reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD) and glutathione peroxydase (GPx) antioxidant enzyme levels in the heart tissue. RESULTS: obstructive cholestasis increased MDA and decreased GSH as well as all antioxidant enzymes. Melatonin administration significantly decreased MDA values, and increased GSH and antioxidant enzymes on the icteric animal myocardium. CONCLUSIONS: melatonin treatment prevents oxidative stress in the cardiac tissue as induced by experimental cholestasis.

Measuring partial body potassium in the legs of patients with spinal cord injury: a new approach.

Patients with acute spinal cord injury (SCI) with paralysis experience rapid and marked muscle atrophy below the level of the lesion. Muscle is lost above the lesion due to enforced bed rest associated with immobilization. Presently, there is no viable method to quantify muscle loss between the time of injury to the initiation of rehabilitation and remobilization. Furthermore, to assess the efficacy of any physical or pharmacological intervention necessitates the ability to accurately determine the impact of these treatments on muscle mass and function. Our results are presented from measurements of regional potassium (K) in the legs of persons with chronic SCI. The intracellular body K, comprising approximately 97% of the total body K, is indicative of the metabolically active cell mass, of which over 50% is located in the skeletal muscle (SM). To assess regional variations in SM mass in the legs, a partial body K (PBK) system designed for this purpose was placed on a potentially mobile cart. The SM mass measured by PBK in an able-bodied control cohort (n = 17) and in patients with chronic SCI (n = 21) was 17.6 +/- 0.86 and 11.0 +/- 0.65 kg, respectively, a difference of approximately 37.5%. However, the difference in the lean tissue mass of the legs obtained by dual-energy absorptiometry (DXA) in the same cohorts was 20.5 +/- 0.86 and 15.5 +/- 0.88 kg, respectively, or a difference of approximately 24.4%. PBK offers a novel approach to obtain regional K measurements in the legs, thus allowing the potential for early and serial assessment of muscle loss in SCI subjects during the acute and subacute periods following paralysis. The basic characteristics and performance of our PBK system and our calibration procedure are described in this preliminary report.

Morphological expression of the left coronary artery: a direct anatomical study.

The left coronary artery presents wide variability in its morphological expression. The purpose of this work was to determine the variations in the left coronary artery and those of its branches in heart samples taken from a group of 154 Colombian mixed-race people. Cadaveric coronary arteries were injected with synthetic resins. Left coronary artery trunks presented 6.48 +/- 2.57 mm lengths. Left coronary arteries were bifurcated in 80 hearts (52%), trifurcated in 65 hearts (42.2%) and tetrafurcated in 9 hearts (5.8%). A short circumflex branch was observed in 143 hearts (92.8%), finalising as a left marginal branch in 39 of them (25.3%). The inferior third of the posterior interventricular sulcus was the most frequently occurring segment in anterior interventricular branch finalisation (63.6%). The calibre of the left coronary artery trunk was 3.58 +/- +/- 0.59 mm, that of the anterior interventricular branch 2.94 +/- 0.5 mm and that of the circumflex branch 2.71 +/- 0.54 mm. Of the total sample 86 myocardial bridges were observed with 61 cases (70.9%) in the anterior interventricular branch, distributed amongst all segments (proximal, intermediate and distal). Average myocardial bridge length was 19.4 +/- 10.7 mm, and no gender differences were observed (p = 0.20). The most frequently occurring location of the myocardial bridges, on the anterior interventricular branch (proximal and intermediate), agreed with previous studies. Left coronary artery trunk length and calibre and that of its branches were considerably smaller than those reported in other populations. (

Topical review: temporomandibular disorders in an integral otic symptom model.

The literature has closely observed otic symptoms (and other craniofacial complaints) in temporomandibular disorders; however, there is little evidence for an association between the two. This review tries to provide an integrated biological basis for otic symptoms in temporomandibular disorders from both anatomical and physiological points of view; it also attempts to enlarge the view of one of the ranges of central and peripheral mechanisms involved. The pathophysiology of common symptoms is integrated within different health specialties through basic science. This review is not based on a structured selection of randomized controlled trials; rather, it deals with perspectives of otic symptoms triggered or exacerbated by stomatognathic dynamics.