Stress distribution for mandibular extra-alveolar anchorage at different angles and force magnitudes: a finite element study.

The aim of this study was to evaluate the stress distribution in cortical and cancellous bones and within the screw when a stainless steel extra-alveolar screw (EA-S) is inserted into the retromolar region of the mandible using the finite element method (FEM). The stress values in the EA-S were highest at 60° with horizontal (shear) force and lowest at 90° with axial force. In the bones (cortical and cancellous), the stress value was greatest at 90° with horizontal force. Greater stability of the screw may be achieved by tilting it to the force when horizontal loads are applied.

Author Correction: Computer keyboard interaction as an indicator of early Parkinson's disease.

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Computer keyboard interaction as an indicator of early Parkinson's disease.

Parkinson's disease (PD) is a slowly progressing neurodegenerative disease with early manifestation of motor signs. Objective measurements of motor signs are of vital importance for diagnosing, monitoring and developing disease modifying therapies, particularly for the early stages of the disease when putative neuroprotective treatments could stop neurodegeneration. Current medical practice has limited tools to routinely monitor PD motor signs with enough frequency and without undue burden for patients and the healthcare system. In this paper, we present data indicating that the routine interaction with computer keyboards can be used to detect motor signs in the early stages of PD. We explore a solution that measures the key hold times (the time required to press and release a key) during the normal use of a computer without any change in hardware and converts it to a PD motor index. This is achieved by the automatic discovery of patterns in the time series of key hold times using an ensemble regression algorithm. This new approach discriminated early PD groups from controls with an AUC = 0.81 (n = 42/43; mean age = 59.0/60.1; women = 43%/60%;PD/controls). The performance was comparable or better than two other quantitative motor performance tests used clinically: alternating finger tapping (AUC = 0.75) and single key tapping (AUC = 0.61).

Diseño de una rúbrica para evaluar las competencias del Prácticum del Grado en Fisioterapia. Percepción de su utilidad por los estudiantes / Designing a rubric to assess the competences of the practicum course of the physiotherapy degree. Students’ perception on its usefulness

Objetivo: Presentar el diseño de 3 rúbricas para evaluar las prácticas clínicas del Prácticum del Grado en Fisioterapia y conocer la percepción de los estudiantes sobre la utilidad de dichas herramientas. Material y método: Las rúbricas se elaboraron a partir de las competencias transversales y específicas contempladas en la asignatura Prácticum del Grado en Fisioterapia de la Universidad Europea de Madrid, y están adaptadas a las exigencias del Real Decreto 1707/2011 y perfil de egreso según la ANECA. La percepción de los estudiantes fue evaluada mediante una encuesta que incluía 11 afirmaciones con las que los estudiantes debían mostrar su grado de acuerdo o desacuerdo (escala Likert 1-4) sobre la utilidad de dicha rúbrica para valorar las prácticas clínicas, evaluar de forma integral y constatar los niveles de competencia adquiridos en la práctica asistencial de una forma sencilla, objetiva y equitativa. Resultados: Se presentan los criterios evaluables y los niveles de logro de las 3 rúbricas diseñadas (Práctica Clínica, Historia Clínica de Fisioterapia y Diario Reflexivo Académico). Los resultados de las encuestas mostraron una percepción positiva de los estudiantes acerca de las rúbricas. En 8 de los 11 ítems evaluados, la respuesta más frecuente fue «bastante de acuerdo». Conclusiones: Las rúbricas presentadas facilitan una evaluación de las competencias correspondientes a las prácticas clínicas del Grado en Fisioterapia. La percepción de los estudiantes fue positiva en aspectos como su utilidad para la evaluación de las prácticas clínicas, permitir una evaluación más objetiva, evaluar de forma integral y constatar el nivel de competencias

Aim: To present the design of 3 rubrics to evaluate the clinical practices of the Practicum course of the Physiotherapy Degree and to know the students’ perception on the usefulness of these tools. Material and method: The rubrics were developed according to the cost-sectional and specific competences included in the Practicum course of Degree in Physiotherapy at the Universidad Europea de Madrid, and adapted to the requirements of Royal Decree 1707/2011 and graduate profile requirements given by ANECA. The students’ perception was evaluated through an 11-item questionnaire. The students had to show their level of agreement or disagreement (Likert scale 1-4) on the usefulness of the rubric used to assess the students’ performance during the clinical practices, verifying their level of competency acquired. Results: The evaluable criteria and achievement levels of the 3 rubrics designed (Clinical Practice, Clinical Records in Physiotherapy and Academic Reflective Diary) are presented. The questionnaire results showed that students’ perceptions about the rubrics were positive. In 8 of the 11 evaluated items, the most frequent response was 'medium-high level of agreement'. Conclusions: The 3 rubrics presented provide an assessment of the competencies included in the clinical practices of Physiotherapy Degree. The students’ perceptions were positive in aspects as the usefulness for evaluation, in allowing a more objective evaluation, comprehensively assessing and verifying the level of competences

Rudimentary coronary artery in Syrian hamsters (Mesocricetus auratus).

Congenital underdevelopment of one or more main branches of the coronary arteries has been reported in man, but not in non-human mammals. In man, this defective coronary artery arrangement may cause myocardial ischaemia and even sudden death. The main goal of this study was to describe the coronary artery distribution patterns associated with the presence of a markedly underdeveloped (rudimentary) coronary artery in Syrian hamsters. Moreover, an attempt was made to explain the morphogenesis of these patterns, according to current knowledge on coronary artery development. Eleven affected hamsters belonging to a laboratory inbred family were examined by means of internal casts of the heart, great arterial trunks and coronary arteries. The aortic valve was tricuspid (normal) in seven hamsters and bicuspid in the other four. A rudimentary coronary artery arose from the right side of the aortic valve in four specimens, from the left side of the aortic valve in a further three, and from the dorsal aortic sinus in the remaining four. In all cases, a second, well-developed coronary artery provided for all the coronary blood flow. Except for the existence of a rudimentary coronary artery, the present anomalous coronary artery distribution patterns are similar to coronary artery patterns reported in Syrian hamsters, dogs and humans in association with a solitary coronary ostium in aorta. We suggest that an unusual prolonged time interval in the development of the embryonic coronary stems might be a key factor in the formation of coronary arteries displaying significantly dissimilar developmental degrees.

The coronary arteries of the C57BL/6 mouse strains: implications for comparison with mutant models.

There are few detailed descriptions of the coronary arterial patterns in the mouse. Some recent reports on coronary anomalies in mutant mouse models have uncovered the importance of several genes (i.e. iv and connexin43) in coronary morphogenesis. These mutations spontaneously appeared (iv) or were generated (connexin43) in a C57BL/6 background, which is widely used for the development of mutant mice. We have studied the origin and course of the main coronary arteries of two C57BL/6 mouse strains. Unusual anatomical coronary arterial patterns were found, including: solitary ostium in aorta, accessory ostium, high take-off, aortic intramural course, slit-like ostium, sinus-like ostium and origin of a septal artery from the left coronary artery. In humans, some of these conditions are clinically relevant. Most of these patterns, which differ from those observed in wild mice and Swiss albino mice, coincide with those previously found in iv/iv and connexin43 knockout mice. The results indicate that there is variability in the coronary arterial arrangement of the laboratory mouse. Care should be taken when analysing coronary phenotypes of mutant mouse models.

Number of coronary ostia in Syrian hamsters (Mesocricetus auratus) with normal and anomalous coronary arteries.

Little attention is being paid to the presence of accessory coronary artery ostia in man and non-human mammals due to their limited clinical relevance. However, information about their frequency and the cardiac territories irrigated by the vessels arising from them is of interest to obtain an accurate survey of the establishment of the coronary artery system in each species. The aim here was to compare the incidence and significance of the accessory coronary ostia in Syrian hamsters with normal coronary arteries and several coronary anomalies characterized by the absence of a left coronary artery originating from the left aortic sinus. The hearts from 2829 hamsters were examined using a corrosion-cast technique, micro-dissection, histochemical techniques, and scanning electron microscopy. Overall, 148 specimens displayed accessory ostia. A limited number of them belonged to the conal artery which supplies the wall of the right ventricular outflow tract. The other accessory ostia led to the septal artery, a vessel which irrigates the most part of the interventricular septum. The incidence of accessory ostia in normal and anomalous coronary artery patterns was quite similar. This suggests that the morphogenetic deviations producing the coronary artery anomalies reported in this study do not alter the connections of the septal and conal arteries to the aorta. The present observations lead to the notion that in the Syrian hamster, the septal artery should be regarded as a third coronary artery.

Separate origin of the main components of the left coronary artery in Syrian hamsters (Mesocricetus auratus).

This study describes a rare congenital coronary artery anomaly in the Syrian hamster; namely, the separate origin of the obtuse marginal and left circumflex arteries which are the main components of the left coronary artery. The hearts of nine affected animals were examined by means of a corrosion-cast technique and histology. The hamsters belonged to a laboratory inbred family with a high incidence of coronary artery anomalies and bicuspid aortic valve. The aortic valve was tricuspid in three hamsters and bicuspid in the other six hamsters. In all cases, the right coronary artery was normal, whereas the left coronary artery main trunk was absent. The present anomalous coronary artery patterns could be classified into two main entities: (i) ectopic origin of the obtuse marginal artery from the right aortic sinus or from the right coronary artery, with the left circumflex artery arising from the left side of the aortic valve; and (ii) ectopic origin of both the obtuse marginal artery from the right aortic sinus or from the right coronary artery and left circumflex artery from the dorsal aortic sinus. In all cases, the obtuse marginal artery coursed to the right side of the heart through the ventral wall of the right ventricular outflow tract. When the left circumflex artery arose from the dorsal aortic sinus, it formed an acute angle with the aortic wall. This report seems to be the first to describe the separate origin of the main components of the left coronary artery in a non-human mammalian species. In man, the congenital coronary artery and aortic valve defects reported herein may entail the risk of clinical complications. However, none of the affected hamsters showed signs of disease.

Anomalous origin of the left coronary artery from the right side of the aortic valve in Syrian hamsters (Mesocricetus auratus).

This study describes the coronary artery distribution patterns associated with the anomalous origin of the left coronary artery from the right side of the aortic valve in Syrian hamsters. The hearts of 15 affected animals were examined by means of a corrosion-cast technique, histology and scanning electron microscopy. The hamsters belonged to a laboratory inbred colony with a high incidence of coronary artery anomalies and bicuspid aortic valves. The aortic valve was tricuspid in eight hamsters and bicuspid in the other seven. In all cases, the right coronary artery was normal, whereas the left main coronary artery trunk arose from the right aortic sinus or from the right side of the ventral aortic sinus when the aortic valve was bicuspid. In 12 specimens, the left main trunk crossed the infundibular septum and then divided into the left circumflex branch and the obtuse marginal branch. In another specimen, the course of the left main trunk was ventral to the right ventricular outflow tract; in the remaining two, it surrounded the aorta dorsally. In man, some of these distribution patterns may cause myocardial ischaemia and sudden death. The present findings prove that the origin of the left coronary artery from the right aortic sinus occurs in primitive mammals such as the Syrian hamster, suggesting that the defect may occur in other mammalian species. Its possible occurrence should be borne in mind in domestic animals, especially in those with signs of myocardial ischaemia after strenuous activity.

Formation of cartilage in congenital bicuspid aortic valves of Syrian hamsters (mesocricetus auratus).

The formation, topographical location and calcification of cartilage in congenital bicuspid aortic valves of 235 Syrian hamsters aged 0--173 days were studied by histological, histochemical and immunohistochemical techniques. In all animals the aortic valve was bicuspid; it had two leaflets, ventral and dorsal, each supported by its own aortic sinus. In 141 valves, a more or less developed raphe was located in the ventral sinus. The remaining 94 valves were devoid of any raphe. The first sign of valvular chondrogenesis was the presence of small groups of cells embedded in a type II collagen-positive extracellular matrix. These cellular groups, which appeared as early as 2 days after birth, became converted into hyaline cartilage or fibrocartilage. A considerable proportion (67%) of the valvular cartilages developed within the first 6 weeks of life. The cartilaginous tissue was capable of forming anywhere along the attachments of the valve leaflets to their supporting sinuses. However, statistical analyses substantiated the observation that the bases of the sinuses and raphes were the valvular regions particularly prone to the development of cartilage. At these sites, the cartilage was usually hyaline and often became calcified. The findings were consistent with the assumption that intense mechanical stimulation plays an important role in the formation of the valvular cartilage. Moreover, these findings supplied new evidence that in the cardiac semilunar valves of Syrian hamsters, cartilage formation does not involve the aggregation of large numbers of cells before their differentiation into chondrocytes. The valvular hyaline cartilages appear to act as competent pivots, resisting mechanical tensions generated during the cardiac cycle. Deposition of calcium in the matrix can be regarded as a reinforcement process of the cartilaginous tissue. Finally, it is hypothesized that the formation of cartilage in the aortic valves of hamsters prevents dystrophic calcification of the valve, a pathological change that causes aortic stenosis in man, especially in patients with a bicuspid aortic valve.

Prosthetic mesh used for inguinal and ventral hernia repair: normal appearance and complications in ultrasound and CT.

The use of prosthetic mesh has now become accepted practice in the treatment of patients with both inguinal and ventral hernias. This pictorial review illustrates the various radiological appearances of these meshes and also demonstrates the post-operative complications associated with their implantation.

[Peritoneal equilibrium test using icodextrin and glucose at different concentrations]. / Test de equilibrio peritoneal con icodextrina y glucosa a distintas concentraciones.

UNLABELLED: The aim of this study was to compare, under standard conditions (Peritoneal Equilibrium Test, "PET"), the peritoneal permeability to water and several solutes using icodextrin and glucose (3.86% and 1.36%) dialysates. The study includes 14 patients (3 women and 11 men), mean age 64 +/- 13 years, average time on peritoneal dialysis 23.5 +/- 17 months. PETs with icodextrin were performed in all of them (n = 14); PETs with 3.86% glucose were carried out in 7, and PETs with all the three solutions were performed in 5 patients. Samples were taken at 0, 30, 60, 120, 240 minutes, and after the rinsing procedure using 1.36% glucose in order to calculate the residual volume. RESULTS: Sodium concentration in the effluent and D/P sodium did not change significantly from minute 0 to 240 with icodextrin and 1.36% glucose; but with 3.86% glucose both sodium and D/P sodium decreased at thirty minutes, remained at the same levels till the 120 minutes and then had a tendency to increase. Glucose concentration and osmolarity in the effluent did not vary throughout the time with icodextrin, but progressively decreased during the 4-hour period with 3.86% and 1.36% glucose solutions. The drainage after the 4-hour period was higher for the 3.86% glucose (2,608 +/- 388 ml, p = 0.03) than for the 1.36% glucose (2,070 +/- 120 ml) or the icodextrin (2,212 +/- 213 ml). Low molecular weight permeability: D/P creatinine after the 4-hour dwell was significantly lower for the icodextrin (0.66 +/- 0.1, p = 0.05) than for the 3.86% glucose (0.71 +/- 0.1) or the 1.36% glucose (0.72 +/- 0.1). The creatinine clearance for 3.86% glucose (7.4 +/- 0.4 ml/min p = 0.007) was higher than for icodextrin (5.6 +/- 0.5 ml/min) or for 1.36% glucose (5.8 +/- 0.6 ml/min). The clearances for total protein, albumin and beta 2-microglobulin did not show significant differences between the solutions. CONCLUSIONS: Our study confirms that the icodextrin solution remains iso-osmolar with plasma during the 4-hour dwell. The sodium profile suggests that the ultrafiltration induced by icodextrin and 1.36% glucose depends on small pore-mediated sodium and water transport; on the other hand, 3.86% glucose also induces transport of water without solutes throughout the ultra-small aquaporin-mediated, pores, producing sodium dilution in the effluent. Ultrafiltration and solute clearances for icodextrin are lower than for 3.86 glucose during a 4-hour dwell.

[Frecuency of adverse events during the hygiene of the critical care patient]. / Frecuencia de eventos adversos durante el aseo del paciente crítico.

The hygiene of the patient in critical condition is a common nursing technique in the intensive care unit, which does not mean that doing it is exempt of risk for the patient's state. We carry out a study to measure the frequency of the appearance of certain adverse events during the hygiene care and their clinical repercussion.Hygiene of the critical patients was monitored, measuring the appearance of certain events at the time of hygiene and until one hour after to assess if the complications were at the moment or had a greater repercussion on the state of the patient.During the study period, some adverse event appeared in 48% (CI 95%: 43-52) of the hygiene performed while none appeared in 52% (CI 95%: 48-56) of it. The events that appeared most frequently were: desaturation in 18% (CI 95%: 15-21) of the hygiene performed, the deadaptation of the mechanical ventilation in 11% (CI 95%: 9-14), arterial hypertension in 21% (CI 95%: 18-25) and arterial hypotension in 11% (CI 95%: 9-14). The intracranial hypertension appeared in 42% (CI 95%: 26-61) of the hygiene performed to patients who were carriers of intraventricular catheter, 9% (CI 95%: 2-25) continued with elevated values 1 hour after concluding the hygiene. The rest of the events monitored presented a lower frequency, although the appearance of one episode of cardiorespiratory arrest and two of auricular fibrillation with rapid ventricular response, one of which required cardioversion, stand out. We conclude that it is an essential job of the nursing staff to correctly assess the risks that the performance of hygiene means for the critical patient, so that the technique should be applied rationally and under strict monitoring and control.

Test de equilibrio peritoneal con icodextrina y glucosa a distintas concentraciones / Peritoneal equilibrium test with icodextrin and glucose dialysates

El propósito de este trabajo ha sido comparar en condiciones estándar (test de equilibrio peritoneal) la permeabilidad para el agua y distintos solutos usando soluciones de Icodextrina y glucosa a las concentraciones de 3,86 por ciento y 1,36 por ciento. La muestra estaba formada por 14 pacientes (3 mujeres/11 hombres), edad 64 ñ 13 años, tiempo en diálisis peritoneal 23,5 ñ 17 meses. A los 14 pacientes se les realizó test de equilibrio peritoneal con Icodextrina, a 7 de estos también con 3,86 por ciento y a 5 de ellos el estudio completo con las tres soluciones. Se tomaron muestras en los minutos 0, 30, 60, 120, 240 y tras infusión de lavado de glucosa 1,36 por ciento para medir el volumen residual. Resultados: Tanto la concentración de Na como la relación D/P Na no varían desde el minuto 0 al 240 para la Icodextrina y glucosa 1,36 por ciento. Con la glucosa 3,86 por ciento bajan ya a los 30 minutos y permanece así hasta el minuto 120 que tiende a subir de nuevo. La glucosa y osmolaridad se mantienen a niveles similares al inicial con Icodextrina (y similares al plasma); en contraste, con ambas soluciones de glucosa va disminuyendo a lo largo de las 4 horas. El volumen de drenaje a las 4 horas fue superior (p = 0,03) con 3,86 por ciento (2.608 ñ 338 cc) al obtenido con 1,36 por ciento (2.070 ñ 120 cc) y con Icodextrina (2.212 ñ 213 cc). Referente a la permeabilidad para solutos de bajo peso molecular: D/P 4.ªh Cr inferior con Icodextrina (0,66 ñ 0,1 versus 0,71 ñ 0,1 (3,86 por ciento) versus 0,72 ñ 0,1 (1,36 por ciento) p = 0,05; ClCr superior con 3,86 por ciento (7,4 ñ 0,4 cc/m p = 0,007) en comparación con Icodextrina (5,6 ñ 0,5 cc/m) y con 1,36 por ciento (5,8 ñ 0,6 cc/m). Los aclaramientos de proteínas totales, albúmina y B2 microglobulina no mostraron diferencias. Conclusiones: Nuestro estudio confirma que la solución de Icodextrina es y permanece isoosmolar con el plasma a lo largo de un intercambio de 4 horas. El perfil de Na sugiere que la Icodextrina actúa a través del poro pequeño, con paso simultáneo de agua y Na, igual que la solución de glucosa 1,36 por ciento y distinta de la glucosa 3,86 por ciento que, al producir el transporte de agua sin solutos, diluye la concentración de Na del líquido de diálisis en las primeras dos horas. El aclaramiento de solutos y la UF con Icodextrina son inferiores a los obtenidos con glucosa 3,86 por ciento en un intercambio de 4 horas (AU)

Frecuencia de eventos adversos durante el aseo del paciente crítico / Frecuency of the adverse events during the hygiene of the critical care patients

El aseo del paciente en estado crítico es una técnica de enfermería habitual en la unidad de cuidados intensivos, lo que no implica que su realización esté exenta de riesgos para el estado del paciente. Elaboramos un estudio para medir la frecuencia de aparición de determinados eventos adversos durante el aseo y la repercusión clínica de éstos. Se monitorizó el aseo de los pacientes críticos, midiendo la aparición de determinados eventos en el momento del aseo y hasta una hora después, para valorar si las complicaciones eran puntuales o tenían mayor repercusión en el estado del paciente. Durante el período de estudio apareció algún evento adverso en el 48% (IC 95%: 43-52) de los aseos realizados, mientras que en el 52% (IC 95%: 48-56) no. Los eventos que aparecieron con mayor frecuencia fueron: la desaturación en el 18% (IC 95%: 15-21) de los aseos realizados, la desadaptación de la ventilación mecánica en el 11% (IC 95%: 9-14), la hipertensión arterial en el 21% (IC 95%: 18-25) y la hipotensión arterial 11% (IC 95%: 9-14). La hipertensión intracraneal apareció en los 42% (IC 95%: 26-61) de los aseos realizados a pacientes portadores de catéter intraventricular, un 9% (IC 95%: 2-25) continuaba con valores elevados una hora después de concluir el aseo. El resto de eventos monitorizados presentaron menor frecuencia, aunque destaca la aparición de un episodio de parada cardiorrespiratoria y dos de fibrilación auricular con respuesta ventricular rápida, uno de los cuales precisó cardioversión. Concluimos que es labor fundamental del personal de enfermería valorar correctamente los riesgos que para el paciente crítico supone la realización del aseo, por lo que la técnica debe aplicarse de forma racional y bajo estricta monitorización y control (AU)

The hygiene of the patient in critical condition is a common nursing technique in the intensive care unit, which does not mean that doing it is exempt of risk for the patient's state. We carry out a study to measure the frequency of the appearance of certain adverse events during the hygiene care and their clinical repercussion. Hygiene of the critical patients was monitored, measuring the appearance of certain events at the time of hygiene and until one hour after to assess if the complications were at the moment or had a greater repercussion on the state of the patient. During the study period, some adverse event appeared in 48% (CI 95%: 43-52) of the hygiene performed while none appeared in 52% (CI 95%: 48-56) of it. The events that appeared most frequently were: desaturation in 18% (CI 95%: 15-21) of the hygiene performed, the deadaptation of the mechanical ventilation in 11% (CI 95%: 9-14), arterial hypertension in 21% (CI 95%: 18-25) and arterial hypotension in 11% (CI 95%: 9-14). The intracranial hypertension appeared in 42% (CI 95%: 26-61) of the hygiene performed to patients who were carriers of intraventricular catheter, 9% (CI 95%: 2-25) continued with elevated values 1 hour after concluding the hygiene. The rest of the events monitored presented a lower frequency, although the appearance of one episode of cardiorespiratory arrest and two of auricular fibrillation with rapid ventricular response, one of which required cardioversion, stand out. We conclude that it is an essential job of the nursing staff to correctly assess the risks that the performance of hygiene means for the critical patient, so that the technique should be applied rationally and under strict monitoring and control (AU