Dose-escalated SBRT for borderline and locally advanced pancreatic cancer. Feasibility, safety and preliminary clinical results of a multicenter study.

Background: Pancreatic Stereotactic Body Radiotherapy (SBRT) allows for the administration of a higher biologically effective doses (BED), that would be essential to achieve durable tumor control. Escalating treatment doses need a very accurate tumor positioning and motion control during radiotherapy.The aim of this study to assess the feasibility and safety of a Simultaneous Integrated Boost (SIB) dose-escalated protocol at 45 Gy, 50 Gy and 55 Gy in 5 consecutive daily fractions, in Border Line Resectable Pancreatic Cancer (BRCP) /Locally Advanced Pancreatic Cancer (LAPC) by means of a standard LINAC platform. Methods: Patients diagnosed of BRPC/LAPC, candidates for neoadjuvant chemotherapy and SBRT, in four university hospitals of the province of Las Palmas (Canary Islands, Spain) were included in this prospective study. Radiotherapy was administered using standard technology (LINACS) with advanced positioning (Lipiodol® and metallic stent used as fiducial markers) and tumor motion control (4D, DBH, Calypso®). There were 3 planned dose-escalated SIB groups, 45 Gy/5f (9 patients) 50 Gy/5f (9 + 9 patients) and 55 Gy/5f (9 patients). The defined primary end points of the study were the safety and feasibility of the proposed treatment protocol. Secondary endpoints included radiological tumor response after SBRT, local control and survival. Results: From June 2017 to December 2022, sixty-two patients were initially assessed for eligibility in the study in the four participating centers, and 49 were candidates for chemotherapy (CHT). Forty-one were referred to radiotherapy after CHT and 33 finally were treated by escalated-dose SIB, 45 Gy (9 patients) 50 Gy (16 patients), 55 Gy(8 patients). All patients completed the scheduled treatment and no acute or late severe (≥grade3) gastrointestinal toxicity was observed.Local response was analyzed by CT/MRI two months after the end of SBRT. Ten patients (31,25 %) achieved objective response (2/9:45 Gy, 5/15:50 Gy, 3/8:55 Gy). Follow-up was closed as July 2023. Freedom from local progression at 1-2y were 89,3% (95 %CI:83,4-95,2%) and 66 % (95 %CI:54,6-77,4%) respectively. The 1-2y survival rates were 95,7% (95 %CI:91,4-100 % and 48,6% (95 %CI:37,7-59,5%) respectively. Conclusion: These promising results should be confirmed by further studies with larger sample size and extended follow-up period.

Effect of graphite oxide electrochemically exfoliated over a multimode interference filter.

In this work, we study multimodal interference filters with a graphite oxide coating. Use of the multimodal interference filter shows a distinctive peak in the signal spectrum, and when using the exfoliated graphite coated multimodal interference filter, the signal shows different spectral changes, such as the full width at half maximum of the curve, the maximum power, and central wavelength, which indicates that graphite oxide absorbs part of the energy. In addition, microscope observations when a He-Ne laser is passed through the filter confirm that graphite oxide is adhered to the filter.

Prospective Pilot study of Quality of Life in patients with severe late-radiation-toxicity treated by Low hyperbaric-oxigen-therapy.

Background/purpose: The aim of this study is to assess for the first time the immediate and long term impact on quality-of-life of HBO treatments(HBOT) at 1.45 ATA (Absolute Atmospheric Pressure) Medical Hyperbaric chamber. Methods: Patients over 18 years-old, suffering of grade 3 Common Terminology Criteria for Adverse Events (CTCAE) 4.0 radiation induced late toxicity and progressing to standard support therapy were included in this prospective study. HBOT was given daily, sixty minutes per session by a Medical Hyperbaric Chamber Biobarica System at 1.45 ATA at 100% O2. Forty sessions were prescribed for all patients given in 8 weeks. Patients reported outcomes (PROs) was assessed by the QLQ-C30 questionnaire, before starting, in the last week of the treatment, as well as during follow up. Results: Between February-2018/June-2021, 48 patients fulfilled the inclusion criteria. A total of 37 patients (77%) completed the treatment prescribed HBOT sessions. Patients with anal fibrosis (9/37) and brain necrosis (7/37) were the most frequently treated. The most common symptoms were pain (65%) and bleeding (54%). In addition, thirty out of the 37 patients who completed the pre- and post-treatment Patients Reported Outcomes (PROs) assessment also completed the follow up European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire C30 (EORTC-QLQ-C30), and were evaluated in the present study. Mean follow up was 22,10 (6-39) months.The Median score of the EORTC-QLQ-C30, at the end of HBOT and during follow-up, was improved in all assessed domains, except in the cognitive aspect (p = 0.106). Conclusions: HBOT at 1.45 ATA is a feasible and well tolerated treatment, improving long term quality of life in terms of physical function, daily activities and general health subjective state of patients suffering severe late radiation-induced toxicity.

Impact of the RF Power on the Copper Nitride Films Deposited in a Pure Nitrogen Environment for Applications as Eco-Friendly Solar Absorber.

This material can be considered to be an interesting eco-friendly choice to be used in the photovoltaic field. In this work, we present the fabrication of Cu3N thin films by reactive radio-frequency (RF) magnetron sputtering at room temperature, using nitrogen as the process gas. Different RF power values ranged from 25 to 200 W and gas pressures of 3.5 and 5 Pa were tested to determine their impact on the film properties. The morphology and structure were exhaustively examined by Atomic Force Microscopy (AFM), Fourier Transform Infrared (FTIR) and Raman Spectroscopies and X-ray Diffraction (XRD), respectively. The AFM micrographs revealed different morphologies depending on the total pressure used, and rougher surfaces when the films were deposited at the lowest pressure; whereas FTIR and Raman spectra exhibited the characteristics bands related to the Cu-N bonds of Cu3N. Such bands became narrower as the RF power increased. XRD patterns showed the (100) plane as the preferred orientation, that changed to (111) with the RF power, revealing a worsening in structural quality. Finally, the band gap energy was estimated from transmission spectra carried out with a Perkin Elmer 1050 spectrophotometer to evaluate the suitability of Cu3N as a light absorber. The values obtained demonstrated the capability of Cu3N for solar energy conversion applications, indicating a better film performance under the sputtering conditions 5.0 Pa and RF power values ranged from 50 to 100 W.

Infarto de miocardio con elevación del segmento ST revascularizado. Tendencias temporales de los tratamientos contemporáneos y su impacto en los resultados / Revascularized ST-segment elevation myocardial infarction. Temporal trends in contemporary therapies and impact on outcomes

Introducción y objetivos Evaluar en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) sometidos a angioplastia primaria con qué ritmo se ha introducido en la práctica clínica (2010-2017) los tratamientos con stents farmacoactivos, ticagrelor, prasugrel y antiagregante plaquetario doble (TAPD) prolongado y su potencial impacto en el resultado a 2 años. Métodos Análisis retrospectivo de un registro prospectivo exhaustivo de 14.841 pacientes con IAMCEST sometidos a angioplastia primaria entre 2010 y 2017. Los eventos índice se obtuvieron del Registro de Código IAM de Cataluña y los eventos en el seguimiento, del conjunto mínimo de datos de altas hospitalarias. Se definió el TAPD a partir de la dispensación farmacéutica. Se evaluó el resultado a 24 meses. Las tendencias temporales de los factores de exposición y los resultados se analizaron mediante modelos de regresión. Resultados La edad> 65 años, la diabetes, la insuficiencia renal, la insuficiencia cardiaca previa y la necesidad de anticoagulación al alta fueron más frecuentes en periodos más tardíos (p <0,001). Entre 2010 y 2017 el implante de stents farmacoactivos aumentó del 31,1 al 69,8%; la prescripción de ticagrelor, del 0,1 al 28,6% y la de prasugrel, del 1,5 al 23,8%, y la media de meses consecutivos con TAPD, de 2 a 10 (p <0,001 en todos los casos). El análisis ajustado mostró una tendencia temporal a disminución del riesgo de la variable de resultado principal: el evento compuesto de muerte, infarto agudo de miocardio, ictus y nueva revascularización (reducción absoluta de la probabilidad, el 0,005% por trimestre; OR=0,995; IC95%, 0,99-0,999; p=0,028). Todos los componentes individuales excepto el ictus mostraron una reducción de la probabilidad, solo significativa para la aparición de nueva revascularización (AU)

Introduction and objectives To assess, in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention, the pace of introduction in clinical practice (2010-2017) of drug-eluting stents (DES), ticagrelor, prasugrel, and prolonged dual antiplatelet therapy (DAPT) duration, and their potential impact on the risk of 2-year outcomes. Methods Prospective and exhaustive community-wide cohort of 14 841 STEMI patients undergoing primary percutaneous intervention between 2010 and 2017. Index episodes were obtained from the Catalan Codi IAM Registry, events during follow-up from the Minimum Data Set and DAPT were defined by pharmacy dispensation. Follow-up was 24 months. The temporal trend for exposures and outcomes was assessed using regression models. Results Age> 65 years, diabetes, renal failure, previous heart failure, and need for anticoagulation at discharge were more frequent in later periods (P <.001). From 2010 to 2017, the use of DES increased from 31.1% to 69.8%, ticagrelor from 0.1% to 28.6%, prasugrel from 1.5% to 23.8%, and the median consecutive months on DAPT from 2 to 10 (P <.001 for all). Adjusted analysis showed a temporal trend to a lower risk of the main outcome over time: the composite of death, acute myocardial infarction, stroke and repeat revascularization (absolute odds reduction 0.005% each quarter; OR, 0.995; 95%CI, 0.99-0.999; P=.028). The odds of all individual components except stroke were reduced, although significance was only reached for revascularization. Conclusions Despite a strong increase between 2010 and 2017 in the use and duration of DAPT and the use of ticagrelor, prasugrel and DES, there was no substantial reduction in major cardiovascular outcomes (AU)

Factors associated with oropharyngeal dysphagia diagnosed by videofluoroscopy in children with cerebral palsy.

INTRODUCTION AND AIMS: Oropharyngeal dysphagia (OD) occurs in children with cerebral palsy. It is important to investigate its relationship with some variables, and the objective of this study was to identify factors associated with OD. MATERIALS AND METHODS: Case-control study in patients with cerebral palsy from 8months to 15years of age, from November 2018 to November 2019, approved by the Ethics Committee. The diagnosis of OD was made by videofluoroscopy when there was nasopharyngeal reflux, stagnation in the vallecular sinuses, in the piriformis sinuses, penetration, and aspiration. The independent variables were type of cerebral palsy, gross motor impairment classified into five levels, nutritional status and comorbidities. One case with OD was included and the next one without alterations in videofluoroscopy was control. The variables were compared with Chi square and Student's t. The association was measured with odds ratio. The confidence interval was 95%. RESULTS: Thirty patients with OD and 30without OD were studied. Sex, age, birth weight, and gestational age had a similar distribution in the two groups. From the data perceived by the mothers at the time of feeding, the greater frequency of the difficulty in the transfer of the food bolus in the group with OD showed a statistically significant difference (P<.001) and of the studied factors, the levelV of the gross motor involvement was associated with a higher frequency of OD. CONCLUSIONS: OD was associated with level V of gross motor involvement.

Factors associated with oropharyngeal dysphagia diagnosed by videofluoroscopy in children with cerebral palsy. / Factores asociados a disfagia orofaríngea diagnosticada por videofluoroscopia en niños con parálisis cerebral.

INTRODUCTION AND AIMS: Oropharyngeal dysphagia (OD) occurs in children with cerebral palsy. It is important to investigate its relationship with some variables, and the objective of this study was to identify factors associated with OD. MATERIALS AND METHODS: Case-control study in patients with cerebral palsy from 8months to 15years of age, from November 2018 to November 2019, approved by the Ethics Committee. The diagnosis of OD was made by videofluoroscopy when there was nasopharyngeal reflux, stagnation in the vallecular sinuses, in the piriformis sinuses, penetration, and aspiration. The independent variables were type of cerebral palsy, gross motor impairment classified into five levels, nutritional status and comorbidities. One case with OD was included and the next one without alterations in videofluoroscopy was control. The variables were compared with Chi square and Student's t. The association was measured with odds ratio. The confidence interval was 95%. RESULTS: Thirty patients with OD and 30without OD were studied. Sex, age, birth weight, and gestational age had a similar distribution in the two groups. From the data perceived by the mothers at the time of feeding, the greater frequency of the difficulty in the transfer of the food bolus in the group with OD showed a statistically significant difference (P<.001) and of the studied factors, the levelV of the gross motor involvement was associated with a higher frequency of OD. CONCLUSIONS: OD was associated with level V of gross motor involvement.

Reduction of atmospheric emissions due to switching from fuel oil to natural gas at a power plant in a critical area in Central Mexico.

A case study was conducted to evaluate the SO2 emission reduction in a power plant in Central Mexico, as a result of the shifting of fuel oil to natural gas. Emissions of criteria pollutants, greenhouse gases, organic and inorganic toxics were estimated based on a 2010 report of hourly fuel oil consumption at the "Francisco Pérez Ríos" power plant in Tula, Mexico. For SO2, the dispersion of these emissions was assessed with the CALPUFF dispersion model. Emissions reductions of > 99% for SO2, PM and Pb, as well as reductions >50% for organic and inorganic toxics were observed when simulating the use of natural gas. Maximum annual (993 µg/m3) and monthly average SO2 concentrations were simulated during the cold-dry period (152-1063 µg/m3), and warm-dry period (239-432 µg/m3). Dispersion model results and those from Mexico City's air quality forecasting system showed that SO2 emissions from the power plant affect the north of Mexico City in the cold-dry period. The evaluation of model estimates with 24 hr SO2 measured concentrations at Tepeji del Rio suggests that the combination of observations and dispersion models are useful in assessing the reduction of SO2 emissions due to shifting in fuels. Being SO2 a major precursor of acid rain, high transported sulfate concentrations are of concern and low pH values have been reported in the south of Mexico City, indicating that secondary SO2 products emitted in the power plant can be transported to Mexico City under specific atmospheric conditions. Implications: Although the surroundings of a power plant located north of Mexico City receives most of the direct SO2 impact from fuel oil emissions, the plume is dispersed and advected to the Mexico City metropolitan area, where its secondary products may cause acid rain. The use of cleaner fuels may assure significant SO2 reductions in the plant emissions and consequent acid rain presence in nearby populated cities and should be compulsory in critical areas to comply with annual emission limits and health standards.

Development of liquid chromatography tandem mass spectrometry method to quantify cyclobutane pyrimidine dimer photolyase activity by detection of 15mer oligonucleotide as reaction product.

Ultraviolet radiation from sunlight causes DNA damage in skin cells by formation of photoproducts, mainly cyclobutane pyrimidine dimers (CPD), which are reverted by exogenous CPD-photolyase, preventing photoaging and skin cancer. High performance liquid chromatography tandem mass spectrometry method for quantification of CPD-photolyase activity was developed to search new enzymes sources for dermatology or clinical studies. The method was based in the enzymatic conversion of a 15mer oligonucleotide, containing a center cyclobutane thymidine dimer, to the restored 15mer oligonucleotide. Three ion pair reagent were evaluated by response surface methodology to increase mass intensities. Additionally, chromatographic separation of oligonucleotides was performed. The selected mobile phase was 15 mM diisopropylethylamine/20 mM hexafluoroisopropanol in methanol. The method allowed total separation between the oligonucleotides studied (resolution of 2.3) by using the core shell technology, which reduce the diffusion time of the analyte into the column, increasing the efficiency and minimizing the analysis time at 7 min. The mass spectrometry detection allowed a high selectivity and sensitivity. This is the first time where MRM modality has been employed with this specific purpose. Oligonucleotides recovery from reaction mixture was ∼ 94% and the limit of quantification was 13.4 nM for 15mer. The method was evaluated with a recombinant CPD-photolyase from Synechococcus leopoliensis using purified and crude protein extract. CPD-photolyase could be measured in terms of activity for enzymatic kinetics studies, for evaluation of UV-R effects in (micro)organisms and to identify new enzymes.

Skeletal Anomalies in The Neandertal Family of El Sidrón (Spain) Support A Role of Inbreeding in Neandertal Extinction.

Neandertals disappeared from the fossil record around 40,000 bp, after a demographic history of small and isolated groups with high but variable levels of inbreeding, and episodes of interbreeding with other Paleolithic hominins. It is reasonable to expect that high levels of endogamy could be expressed in the skeleton of at least some Neandertal groups. Genetic studies indicate that the 13 individuals from the site of El Sidrón, Spain, dated around 49,000 bp, constituted a closely related kin group, making these Neandertals an appropriate case study for the observation of skeletal signs of inbreeding. We present the complete study of the 1674 identified skeletal specimens from El Sidrón. Altogether, 17 congenital anomalies were observed (narrowing of the internal nasal fossa, retained deciduous canine, clefts of the first cervical vertebra, unilateral hypoplasia of the second cervical vertebra, clefting of the twelfth thoracic vertebra, diminutive thoracic or lumbar rib, os centrale carpi and bipartite scaphoid, tripartite patella, left foot anomaly and cuboid-navicular coalition), with at least four individuals presenting congenital conditions (clefts of the first cervical vertebra). At 49,000 years ago, the Neandertals from El Sidrón, with genetic and skeletal evidence of inbreeding, could be representative of the beginning of the demographic collapse of this hominin phenotype.

Methodology to assess quality of estimated disturbances in active disturbance rejection control structure for mechanical system.

A methodology to assess the quality of estimation of disturbances in mechanical systems, by state observers, in the control structure with active compensation of disturbances (ADRC) is presented. Evaluation is carried out by four performance indices that depend on the steady-state error between reference signals and output of the plant. These indices are related with the accuracy and precision of the closed loop system in the sense of norms L2 and L∞, for a set of reference signals representing the typical operating conditions of the mechanism. The effectiveness of the methodology is illustrated with the quality assessment of the estimated disturbance of five state observers to control of a simple pendulum and validated on a SCARA robot arm.

Entrenamiento en habilidades de comunicación en enfermeras y percepción del paciente que recibe su cuidado / Training in communication skills for nurses, and the perception of the patients who receive their care / Treinamento em habilidades de comunicação para enfermeiras e percepção do paciente que recebe seu cuidado

Objetivo: Valorar el efecto de un entrenamiento en habilidades de comunicación para enfermeras a partir de la percepción del paciente que recibe su cuidado. Métodos: Estudio cuasiexperimental, con la implementación de un entrenamiento en habilidades de comunicación en enfermeras. Se siguió la estrategia del aprendizaje estructurado, para modelar y practicar habilidades sociales dirigidas al fomento de las condiciones facilitadoras de la relación terapéutica: empatía y respeto. La percepción de los pacientes se midió con el formulario Comportamiento de las Enfermeras en cuanto a su forma de Comunicación Observadas por los Pacientes (CECOP). Se aplicó este instrumento a 2 grupos de pacientes adultos de una institución pública de tercer nivel: el primero correspondió a pacientes atendidos por las enfermeras sin entrenamiento; el segundo a pacientes atendidos por las mismas enfermeras cuando ya recibieron el entrenamiento. También se midió la satisfacción y la deseabilidad social de los pacientes en cuanto a la comunicación, por medio de una escala análoga. Se aplicaron las pruebas de U de Mann Whitney y la prueba exacta de Fisher. Resultados: No se observaron cambios significativos en la comparación total de la escala, pero se identificaron cambios significativos con p < 0.05 en 2 comportamientos de la escala: las enfermeras lo «apapachan¼ para animarlo y las enfermeras le platican cuando se acercan a tomarle la presión. Conclusiones: La diferencia observada en 2 de los 10comportamientos evaluados por el grupo de pacientes atendido por las enfermeras entrenadas sustenta la formación de enfermeras en el área de comunicación interpersonal.

Objective: To assess the effect of a training program in communication skills for nurses through the perspective of the patients who receive their care. Method: This is a quasi-experimental study over the implementation of a communication skills-training program for nurses. The structured learning strategy for shaping and applying social skills towards facilitating the therapeutical relationship based on respect and empathy was followed. The perception of patients was measured with the Nursing Behavior regarding Communication Observed by Patients (NBCOP) scale. This instrument was applied to 2 groups of adult patients in a public institution of third level. The first group included the patients attended by nurses who did not receive the training. The second group included the patients attended by nurses who received the training. The satisfaction and social desirability of patients regarding communication was also measured by means of an analog scale. Mann Whitney U and Fisher exact tests were performed. Results: No significant changes were observed regarding the total scale, however, significant changes at P<.05 were identified in 2 behaviors: nurses cuddle the patient to encourage him/her, and nurses chat with the patient while taking his/her pressure. Conclusions: The differences observed in 2 of 10 assessed behaviors in the group of patients attended by nurses who received the training supports the importance of the nursing training in the area of inter-personal communication.

Objetivo: Valorizar o efeito de um treinamento em habilidades de comuniçacão para enfermeiras a partir da percepção do paciente que recebe seu cuidado. Métodos: Estudo quase experimental, com a implementação de um treinamento em habilidades de comunicação em enfermeiras, seguiu-se a estratégia da aprendizagem estruturada, para modelar e praticar habilidades sociais dirigidas ao fomento das condicões facilitadoras da relacão terapêutica: empatia e respeito. A percepçãodos pacientes mediu-se com o Comportamento das Enfermeiras quanto a sua forma de Comunicação, observadas pelos Pacientes (CECOP), aplicou-se este instrumento a 2 grupos de pacientes adultos de uma instituição pública de terceiro nível, o primeiro correspondeu a pacientes atendidos pelas enfermeiras sem treinamento, o segundo a pacientes atendidos pelas mesmas enfermeiras quando já receberam o treinamento. Também se mediu a satisfação e a conveniência social dos pacientes referente à comunicação, por médio de uma escala análoga. Aplicaram-se as provas de U de Mann Whitney e a prova exata de Fisher. Resultados: Não se observaram câmbios significativos na comparação total da escala,mas se identificaram câmbios significativos com p < 0.05 em dois comportamentos da escala: as enfermeiras o «paparicam¼ para o encorajar e as enfermeiras batem papo com ele quando se aproximam a medir-lhe a pressão. Conclusões: A diferença observada em 2dos 10 comportamentos avaliados pelo grupo de pacientes atendido pelas enfermeiras treinadas, sustenta a formaçcão de enfermeiras na área de comunicacção interpessoal.

[Risk factors for fetal macrosomia in patients without gestational diabetes mellitus]. / Factores de riesgo de macrosomía fetal en pacientes sin diabetes mellitus gestacional.

BACKGROUND: Fetal macrosomia is birth weight of 4,000 grams or more, regardless of gestational age, in Mexico representing about 5.4%. Associated with multiple demographic, physiological, metabolic and genetic factors of each population. OBJECTIVE: Determine the risk factors associated with the development of fetal macrosomia in patients without gestational diabetes mellitus. METHODS: Retrospective, descriptive and comparative study of patients who came to delivery from January 2012 to June 2014, 88 patients, 23 patients with diagnosis of macrosomia, and 65 patients without macrosomia without gestational diabetes mellitus were included. RESULTS: An incidence of fetal macrosomia of 18.6%. Risk factors such as parity, history of fetal macrosomia, maternal age, maternal height more to 1.70 meters showed no difference, the percentage of overweight 105% showed 69% vs 52% on the control group and gestational diabetes screening altered that present 30.4 vs 20%. CONCLUSIONS: Increased incidence of macrosomia was demonstrated in patients with metabolic factors such as the percentage of overweight and screening altered gestational diabetes mellitus, as they showed higher prevalence in the study group, all modifiable with preconception nutritional management and during pregnancy, to reduce initial weight and weight gain, improved fasting and postprandial blood glucose in patients with positive screening and negative tolerance curve carbohydrates to maintain fetal growth curve with in the percentiles.

Variation of mandibular sexual dimorphism across human facial patterns.

This study analysed how sex-specific features differed in male and female adult mandibles throughout the spectrum of vertical facial patterns (i.e., meso-, dolicho- and brachyfacial) and sagittal variations (the so-called skeletal Classes I, II and III; normal maxillo-mandibular relationship, maxillary prognathism vs. mandibular retrognathism, and maxillary retrognathism vs. mandibular prognathism, respectively). Specifically, we test the hypothesis that sexual dimorphism in the mandible is independent of such facial vertical and sagittal patterns. A sample of 187 European adults (92 males, 95 females; age range, 20-30 years; mean age 25.6 years, sd=4.2 years) from Granada (southern Spain) were randomly selected and grouped according to the standard cephalometric criteria of the sagittal and vertical patterns. Geometric morphometrics were used to analyse the size (centroid size) and shape (principal components analysis, mean shape comparisons) of the mandible. The patterns of sexual dimorphism were evaluated with a generalised linear model with interaction term. We found that sagittal and vertical facial patterns are associated with different mandibular morphologies (size and shape). Also, sexual dimorphism was present in all comparisons. The hypothesis was rejected only for vertical facial patterns. That is, the nature of sexual dimorphism was similar among the skeletal classes but different (e.g., distribution of dimorphic variables, interaction term) in meso-, dolicho-, and brachyfacial mandibles. In conclusion, sex-specific mandibular traits behave in a different way across vertical facial patterns. These results imply that an assessment of the vertical facial pattern of the individual is required before a sexual diagnosis of the mandible is proposed.

A fatal case of systemic fat embolism resulting from gluteal injections of vitamin e for cosmetic enhancement.

Recently in Mexico the number of cosmetic surgeries has increased. These procedures are often carried out by unqualified people using obsolete and contraindicated products such as injectable oil, which cause uncorrectable disfigurement or more serious complications, even death, after reaching the systemic circulation. We report the case of a fat embolism syndrome (FES) caused by injections of vitamin E (tocopherol) in order to increase the volume of the buttocks. This case of a FES caused by injections of vitamin E was confirmed by gas chromatography coupled to mass spectrometry.

A quasi-unidimensional granular chain to attenuate impact.

We study via numerical simulations a granular chain not only with decreasing radii (forward tapering) in geometric progression, but also decorated with grains positioned on the top and bottom of the chain, without altering its original length. The decorating grains act as an auxiliary chain which traps part of the energy and linear momentum, both propagating as a pulse due to disturbances produced at the end of the chain. Thus, this configuration optimizes the impact attenuation and aligns the chain naturally (by symmetry) which facilitates the construction of the experimental setup. Furtheremore, since the decorating grain radii increase along the chain, this new type of chain is necessarily short in order to avoid precompression. Nevertheless, even with short chains, it is possible to mitigate impacts almost completely.

Longstanding dental pathology in Neandertals from El Sidrón (Asturias, Spain) with a probable familial basis.

Two Neandertal specimens from El Sidrón, northern Spain, show evidence of retained left mandibular deciduous canines. These individuals share the same mitochondrial (mtDNA) haplotype, indicating they are maternally related and suggesting a potential heritable basis for these dental anomalies. Radiographs and medical CT scans provide evidence of further, more extensive dental pathology in one of these specimens. An anomalous deciduous canine crown morphology that developed before birth subsequently suffered a fracture of the crown exposing the pulp sometime after eruption into functional occlusion. This led to death of the tooth, periapical granuloma formation and arrested deciduous canine root growth at an estimated age of 2.5 years. At some point the underlying permanent canine tooth became horizontally displaced and came to lie low in the trabecular bone of the mandibular corpus. A dentigerous cyst then developed around the crown. Anterior growth displacement of the mandible continued around the stationary permanent canine, leaving it posteriorly positioned in the mandibular corpus by the end of the growth period beneath the third permanent molar roots, which, in turn, suggests a largely horizontal growth vector. Subsequent longstanding repeated infections of the expanding cyst cavity are evidenced by bouts of bone deposition and resorption of the boundary walls of the cyst cavity. This resulted in the establishment of two permanent bony drainage sinuses, one through the buccal plate of the alveolar bone anteriorly, immediately beneath the infected deciduous canine root, and the other through the buccal plate anterior to the mesial root of the first permanent molar. It is probable that this complicated temporal sequence of dental pathologies had an initial heritable trigger that progressed in an unusually complex way in one of these individuals. During life, this individual may have been largely unaware of this ongoing pathology.

Interacción enfermera-paciente y su repercusión en el cuidado hospitalario: Parte I / Nurse-patient interaction and its repercussion to hospital care: Part 1

Se realizó una amplia búsqueda en diversas bases de datos a partir de los descriptores: Interacción o comunicación enfermera-paciente, satisfacción por el cuidado de enfermería y entrenamientos en técnicas de comunicación, con el fin de profundizar en el tema de la interacción enfermera-paciente por la importancia que esta tiene en el ejercicio de la práctica profesional de las enfermeras. Se establecen tres ejes de estudio: Interacción o comunicación enfermera-paciente, calidad y satisfacción derivada del cuidado, y efectividad de los entrenamientos en habilidades para la comunicación. La revisión permite identificar que este tema ha sido analizado desde hace mucho tiempo y en diferentes países, los estudios se han relacionado con la calidad de los servicios de enfermería y han motivado el planteamiento de estrategias educativas para desarrollar y mejorar la interacción enfermera-paciente como actitud profesional esencial. Los estudios realizados ofrecen elementos de apoyo para el desarrollo de investigaciones en esta área, pero en algunos casos muestran limitaciones o carencias, así como resultados contradictorios que pueden ser tomadas en cuenta por las personas interesadas en el diseño de estudios relacionados con el tema.

In order to deepen into the highly important topic nurse-patient interaction for the professional practice of nurses, a. database search using the descriptors: nurse-patient interaction/communication, nurse healthcare satisfaction, and communication skills training, was conducted. As a result, three study axes were established; nurse-patient interaction/communication, care-derived quality and satisfaction, and communication skills training effectiveness. This review reveals that this topic has been extensively analyzed throughout time and among different countries. These studies have been related to quality in nursing services, and have motivated the design of strategies to develop and improve the nurse-patient interaction as an essential professional attitude. Furthermore, although these studies offer elements to support the research development in this area, some of them have shown limitations o deficiencies, as well as contradictory results, which should be considered by researchers interested in the design of studies related to this topic.