Awareness and Self-Reported Knowledge and Training on Nutrition in Older People among Primary Care Practitioners.

OBJECTIVES: To assess the awareness and training of primary care physicians on nutrition in older patients. DESIGN: Observational, real-world data survey. SETTING: Primary Care. PARTICIPANTS: One hundred sixty-two physicians, generalists and specialists, working in primary care. MEASUREMENTS: Participants received an online questionnaire with 18 questions concerning the importance of nutrition, degree of knowledge, needs, and training in nutrition. The results were evaluated using univariate descriptive analysis, with a percentage for each chosen answer. Logistic regression models were used to evaluate if answers were related to training in nutrition and professional experience. RESULTS: 43.2% of participants reported that nutrition is very important in individuals over 65 years old, and 90% were aware of the importance of nutrition in healthy aging. Nutritional problems affect 30 to 50% of patients, according to 44.7% of participants. 89.2% agree about the need for nutritional assessment in older patients; however, the professionals believe they should be better prepared. Two out of three respondents consider the training received in nutrition during their undergraduate course or continuing medical education as deficient. Time of professional practice was mainly associated with conceptual facts, while continuing medical education did with practical issues, mainly the use of screening and diagnostic tools [FRAIL (OR: 3.16; 95%IC: 1.55-6.46), MNA-SF (OR: 6.455; 95%IC: 2.980-13.981) and SARC-F (OR: 3.063; 95%IC: 1.284-7.309)]. CONCLUSION: Although primary care professionals are aware of the importance of nutrition in older patients, there are still gaps in daily practice that could be improved by developing educational strategies.

[Ethics of care: Assessment of the ethical issues in the protocols or consensuses on mechanical restraint in force in Spain]. / Ética de los cuidados: valoración de los contenidos éticos en los protocolos o consensos de contención mecánica vigentes en España.

INTRODUCTION: Mechanical restraints are widely used in health care practice, despite the numerous ethical conflicts they raise. The aim of this study is to evaluate the ethical considerations contemplated in the current protocols on mechanical restraint in Spain. METHOD: Systematic review in PubMed, WOS and Scopus, Google and Google Scholar. An ad hoc list of 30 items was used to evaluate the ethical content of the protocols. The quality of guidelines was assessed with AGREE II. RESULTS: The need for informed consent (IC) is reflected in 72% of the documents, the IC model sheet is included in only 41% of them, the rest of the analyzed characteristics on IC are fulfilled in percentages between 6% (the document includes the need to reevaluate the indication for IC) and 31% (the document contemplates to whom it should be requested). More than 20 ethical contents are reflected in 31% of them and less than 10 in 19% of the guidelines. The quality of the guides, according to AGREE II, ranged from 27 to 116 points (maximum possible 161), with a mean score of 68.7. Only 9% of the documents were classified as high quality. Finally, the correlation between ethical content and quality measured with AGREE II was 0.75. CONCLUSIONS: The variability of ethical contents in guidelines on mechanical restraints is very high. The ethical requirements to be included in protocols, consensus or Clinical Practice Guidelines should be defined.

Resultados clínicos de artroplastia total de cadera asistida por brazo robótico en España: estudio preliminar / Clinical results of total hip arthroplasty assisted by robotic arm in Spain: Preliminary study

Objetivos: Resultados clínicos, radiológicos y funcionales de la primera serie española de pacientes intervenidos de artroplastia total de cadera (ATC) asistida mediante brazo robótico Mako® (Stryker) del Hospital Clínico San Carlos (HCSC) de Madrid. Material y métodos: Estudio descriptivo prospectivo que analiza los primeros 25 pacientes intervenidos de ATC asistida por robot (ATCaR) en el HCSC, con un seguimiento mínimo de 4meses. Se evaluaron la demografía, los estudios de imagen (procesamiento Mako®, Rx y TAC), los parámetros clínicos, la funcionalidad (Harris modificada) y las complicaciones asociadas. Resultados: La edad media fue 67,2años (min 47, max 88), siendo el 56% varones. El 88% corresponden a coxartrosis primaria, el 4% postraumática, el 4% secundaria a NAV y el 4% secundaria a choque femoroacetabular. El tiempo medio de cirugía fue de 116,9minutos (min 92, max 150). La media de las cinco primeras intervenciones fue 122,6minutos, y la de las cinco últimas, de 108,2minutos. Como complicaciones intraoperatorias se cuantificaron 4 pérdidas de marcadores intraoperatorios. El tiempo de ingreso medio fue 4,4días (min 3, max 7), con una disminución de hemoglobina posquirúrgica media de 3,08±1,08g/dl, requiriendo transfusión en el 12% de los casos. Se registran tres complicaciones médicas durante el ingreso, destacando un síndrome confusional con caída y fractura periprotésica AG1 no desplazada. El análisis del posicionamiento de los implantes registrados con sistema Mako® fueron 40,55±1,53 grados de inclinación y 12,2±3,6 grados de anteversión acetabular. El estudio de imagen posquirúrgico realizado a los pacientes, en concordancia con Mako®, muestra valores de inclinación acetabular de 41,2±1,7 en Rx y versión acetabular de 16±4,6 en TAC. La discrepancia de longitud de cadera varía de valores preoperatorios de −3,91mm (DE: 3,9; min −12, max 3) a 1,29mm (DE: 1,96) tras la cirugía registrados con Mako...(AU)

Objectives: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. Material and methods: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. Results: Average age was 67.2years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative hemoglobin decrease of 3.08±1.08g/dL, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® s results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min −12, max 3) to 1.29mm (SD: 1.96) after surgery registered with...(AU)

[Translated article] Clinical results of total hip arthroplasty assisted by robotic arm in Spain: Preliminary study / Resultados clínicos de la artroplastia total de cadera asistida por brazo robótico en España: estudio preliminar

Objetivos: Resultados clínicos, radiológicos y funcionales de la primera serie española de pacientes intervenidos de artroplastia total de cadera (ATC) asistida mediante brazo robótico Mako® (Stryker) del Hospital Clínico San Carlos (HCSC) de Madrid. Material y métodos: Estudio descriptivo prospectivo que analiza los primeros 25 pacientes intervenidos de ATC asistida por robot (ATCaR) en el HCSC, con un seguimiento mínimo de 4meses. Se evaluaron la demografía, los estudios de imagen (procesamiento Mako®, Rx y TAC), los parámetros clínicos, la funcionalidad (Harris modificada) y las complicaciones asociadas. Resultados: La edad media fue 67,2años (min 47, max 88), siendo el 56% varones. El 88% corresponden a coxartrosis primaria, el 4% postraumática, el 4% secundaria a NAV y el 4% secundaria a choque femoroacetabular. El tiempo medio de cirugía fue de 116,9minutos (min 92, max 150). La media de las cinco primeras intervenciones fue 122,6minutos, y la de las cinco últimas, de 108,2minutos. Como complicaciones intraoperatorias se cuantificaron 4 pérdidas de marcadores intraoperatorios. El tiempo de ingreso medio fue 4,4días (min 3, max 7), con una disminución de hemoglobina posquirúrgica media de 3,08±1,08g/dl, requiriendo transfusión en el 12% de los casos. Se registran tres complicaciones médicas durante el ingreso, destacando un síndrome confusional con caída y fractura periprotésica AG1 no desplazada. El análisis del posicionamiento de los implantes registrados con sistema Mako® fueron 40,55±1,53 grados de inclinación y 12,2±3,6 grados de anteversión acetabular. El estudio de imagen posquirúrgico realizado a los pacientes, en concordancia con Mako®, muestra valores de inclinación acetabular de 41,2±1,7 en Rx y versión acetabular de 16±4,6 en TAC. La discrepancia de longitud de cadera varía de valores preoperatorios de −3,91mm (DE: 3,9; min −12, max 3) a 1,29mm (DE: 1,96) tras la cirugía registrados con Mako...(AU)

Objectives: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. Material and methods: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. Results: Average age was 67.2years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative hemoglobin decrease of 3.08±1.08g/dL, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® s results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min −12, max 3) to 1.29mm (SD: 1.96) after surgery registered with...(AU)

[Translated article] Validation of the Spanish version of the modified Harris score / Validación de la versión española de la escala de Harris modificada

Objetivos: Resultados clínicos, radiológicos y funcionales de la primera serie española de pacientes intervenidos de artroplastia total de cadera (ATC) asistida mediante brazo robótico Mako® (Stryker) del Hospital Clínico San Carlos (HCSC) de Madrid. Material y métodos: Estudio descriptivo prospectivo que analiza los primeros 25 pacientes intervenidos de ATC asistida por robot (ATCaR) en el HCSC, con un seguimiento mínimo de 4meses. Se evaluaron la demografía, los estudios de imagen (procesamiento Mako®, Rx y TAC), los parámetros clínicos, la funcionalidad (Harris modificada) y las complicaciones asociadas. Resultados: La edad media fue 67,2años (min 47, max 88), siendo el 56% varones. El 88% corresponden a coxartrosis primaria, el 4% postraumática, el 4% secundaria a NAV y el 4% secundaria a choque femoroacetabular. El tiempo medio de cirugía fue de 116,9minutos (min 92, max 150). La media de las cinco primeras intervenciones fue 122,6minutos, y la de las cinco últimas, de 108,2minutos. Como complicaciones intraoperatorias se cuantificaron 4 pérdidas de marcadores intraoperatorios. El tiempo de ingreso medio fue 4,4días (min 3, max 7), con una disminución de hemoglobina posquirúrgica media de 3,08±1,08g/dl, requiriendo transfusión en el 12% de los casos. Se registran tres complicaciones médicas durante el ingreso, destacando un síndrome confusional con caída y fractura periprotésica AG1 no desplazada. El análisis del posicionamiento de los implantes registrados con sistema Mako® fueron 40,55±1,53 grados de inclinación y 12,2±3,6 grados de anteversión acetabular. El estudio de imagen posquirúrgico realizado a los pacientes, en concordancia con Mako®, muestra valores de inclinación acetabular de 41,2±1,7 en Rx y versión acetabular de 16±4,6 en TAC. La discrepancia de longitud de cadera varía de valores preoperatorios de −3,91mm (DE: 3,9; min −12, max 3) a 1,29mm (DE: 1,96) tras la cirugía registrados con Mako...(AU)

Objectives: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. Material and methods: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. Results: Average age was 67.2years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative hemoglobin decrease of 3.08±1.08g/dL, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® s results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min −12, max 3) to 1.29mm (SD: 1.96) after surgery registered with...(AU)

Cognitive rehabilitation program in patients with multiple sclerosis: A pilot study / Programa de rehabilitación cognitiva para pacientes con esclerosis múltiple: estudio piloto

Introduction In recent years, there has been an increase of studies dedicated to cognitive rehabilitation in patients with multiple sclerosis (MS); however, few of these analyze the impact on such variables as cognitive reserve. The study aims to explore the effects of a cognitive rehabilitation program comprising a combination of cognitive and physical exercises, as well as group sessions to improve cognitive performance, emotional state, and cognitive reserve index. Method Fifty patients with MS were subdivided into 2 groups: the control group, which performed aerobic exercise (n = 25), and the experimental group (n = 25), which participated in the integrated cognitive rehabilitation program (ICRP). All participants were evaluated 3 times (baseline, post-treatment, and long-term) with the Brief Repeatable Battery of Neuropsychological Tests, Cognitive Reserve Scale, Beck Depression Inventory, and a scale evaluating trait and state anxiety. Results Compared with the control group, patients in the experimental group showed improvements in cognitive function, with significant changes in measures of information processing speed, attention, memory, cognitive reserve index, and long-term mood. Conclusions The ICRP was effective in improving cognitive and emotional function in MS, and increased the cognitive reserve index. (AU)

Introducción En los últimos años se ha observado un interés creciente por la rehabilitación cognitiva en pacientes con esclerosis múltiple. Sin embargo, pocos estudios han analizado su impacto en variables como la reserva cognitiva. Analizamos el efecto de un programa de rehabilitación cognitiva que incluye ejercicios físicos y cognitivos, así como sesiones en grupo enfocadas a mejorar el rendimiento cognitivo, el estado emocional y el índice de reserva cognitiva. Métodos Nuestro estudio incluyó a 50 pacientes con esclerosis múltiple, divididos en 2 grupos: un grupo control (n = 25), en el que los pacientes realizaban ejercicio aeróbico, y un grupo experimental (n = 25), al que se administró un programa integral de rehabilitación cognitiva. Evaluamos a todos los pacientes en 3 momentos diferentes (al inicio, tras el tratamiento, y a largo plazo) con la Batería Neuropsicológica Breve, la Escala de Reserva Cognitiva, el Inventario de Depresión de Beck y una escala para medir la ansiedad rasgo y la ansiedad estado. Resultados Los pacientes del grupo experimental mostraron un mejor rendimiento cognitivo que los controles, con cambios significativos en medidas de velocidad de procesamiento de la información, atención, memoria, índice de reserva cognitiva y estado de ánimo a largo plazo. Conclusión Nuestros resultados demuestran la eficacia del programa de rehabilitación cognitiva para mejorar las funciones cognitiva y emocional de los pacientes con esclerosis múltiple y aumentar el índice de reserva cognitiva. (AU)

Cognitive rehabilitation program in patients with multiple sclerosis: A pilot study.

INTRODUCTION: In recent years, there has been an increase of studies dedicated to cognitive rehabilitation in patients with multiple sclerosis (MS); however, few of these analyze the impact on such variables as cognitive reserve. The study aims to explore the effects of a cognitive rehabilitation program comprising a combination of cognitive and physical exercises, as well as group sessions to improve cognitive performance, emotional state, and cognitive reserve index. METHOD: Fifty patients with MS were subdivided into 2 groups: the control group, which performed aerobic exercise (n=25), and the experimental group (n=25), which participated in the integrated cognitive rehabilitation program (ICRP). All participants were evaluated 3 times (baseline, post-treatment, and long-term) with the Brief Repeatable Battery of Neuropsychological Tests, Cognitive Reserve Scale, Beck Depression Inventory, and a scale evaluating trait and state anxiety. RESULTS: Compared with the control group, patients in the experimental group showed improvements in cognitive function, with significant changes in measures of information processing speed, attention, memory, cognitive reserve index, and long-term mood. CONCLUSIONS: The ICRP was effective in improving cognitive and emotional function in MS, and increased the cognitive reserve index.

Fumadores y riesgo de muerte hospitalaria por COVID calculado con el procesamiento de lenguaje natural de SAVANA en el ámbito de Castilla-La Mancha / Smokers and risk of hospital death by COVID calculated with SAVANA's natural language processing in the Castilla-La Mancha area

Introducción Durante la pandemia de COVID se especuló que los pacientes con el virus que tenían relación con el tabaco podrían tener una menor probabilidad de agravamiento de la enfermedad o muerte. Para evaluar si existe una asociación entre el tabaquismo y el riesgo de mortalidad intrahospitalaria se utiliza la tecnología de Big Data y Procesamiento del Lenguaje Natural (PLN) de SAVANA. Método Se llevó a cabo un estudio de cohortes retrospectivo, observacional y sin intervención basado en datos de vida real extraídos de registros médicos de toda Castilla-La Mancha utilizando las técnicas de PLN e inteligencia artificial desarrolladas por SAVANA. El estudio abarcó toda la población de esta Comunidad con historia clínica electrónica en SESCAM que presentara diagnóstico de COVID desde el 1 de marzo de 2020 al 28 de febrero de 2021. Resultados Los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular (hipertensión arterial, dislipemia y diabetes), EPOC, asma, EPID, CI, ECV, TEP, cáncer en general y cáncer de pulmón en particular, bronquiectasias, insuficiencia cardíaca y antecedentes de neumonía, de forma significativa (p<0,0001). Los pacientes exfumadores, fumadores y no fumadores tienen una diferencia de edad significativa. En cuanto a las muertes hospitalarias, fueron más frecuentes en el caso de los exfumadores, siguiendo los fumadores y luego los no fumadores (p<0,0001). Conclusión Existe un mayor riesgo de mortalidad intrahospitalaria en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado. (AU)

Introduction During the COVID pandemic, it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death. To assess whether there is an association between smoking and risk of in-hospital mortality, SAVANA's big data and natural language processing (NLP) technology is used. Method A retrospective, observational, non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla-La Mancha using natural language processing and artificial intelligence techniques developed by SAVANA. The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1, 2020 to February 28, 2021. Results Smokers had a significantly higher percentage of cardiovascular risk factors (hypertension, dyslipidemia and diabetes), COPD, asthma, IDP, IC, CVD, PTE, cancer in general and lung cancer in particular, bronchiectasis, heart failure and a history of pneumonia (P<.0001). Former smokers, current smokers and non-smokers have a significant age difference. As for in-hospital deaths, they were more frequent in the case of ex-smokers, followed by smokers and then non-smokers (P<.0001). Conclusion There is an increased risk of dying in hospital in SARS-CoV-2-infected patients who are active smokers or have smoked in the past. (AU)

Fumadores y riesgo de muerte hospitalaria por COVID calculado con el procesamiento de lenguaje natural de SAVANA en el ámbito de Castilla-La Mancha / Smokers and risk of hospital death by COVID calculated with SAVANA's natural language processing in the Castilla-La Mancha area

Introducción Durante la pandemia de COVID se especuló que los pacientes con el virus que tenían relación con el tabaco podrían tener una menor probabilidad de agravamiento de la enfermedad o muerte. Para evaluar si existe una asociación entre el tabaquismo y el riesgo de mortalidad intrahospitalaria se utiliza la tecnología de Big Data y Procesamiento del Lenguaje Natural (PLN) de SAVANA. Método Se llevó a cabo un estudio de cohortes retrospectivo, observacional y sin intervención basado en datos de vida real extraídos de registros médicos de toda Castilla-La Mancha utilizando las técnicas de PLN e inteligencia artificial desarrolladas por SAVANA. El estudio abarcó toda la población de esta Comunidad con historia clínica electrónica en SESCAM que presentara diagnóstico de COVID desde el 1 de marzo de 2020 al 28 de febrero de 2021. Resultados Los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular (hipertensión arterial, dislipemia y diabetes), EPOC, asma, EPID, CI, ECV, TEP, cáncer en general y cáncer de pulmón en particular, bronquiectasias, insuficiencia cardíaca y antecedentes de neumonía, de forma significativa (p<0,0001). Los pacientes exfumadores, fumadores y no fumadores tienen una diferencia de edad significativa. En cuanto a las muertes hospitalarias, fueron más frecuentes en el caso de los exfumadores, siguiendo los fumadores y luego los no fumadores (p<0,0001). Conclusión Existe un mayor riesgo de mortalidad intrahospitalaria en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado. (AU)

Introduction During the COVID pandemic, it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death. To assess whether there is an association between smoking and risk of in-hospital mortality, SAVANA's big data and natural language processing (NLP) technology is used. Method A retrospective, observational, non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla-La Mancha using natural language processing and artificial intelligence techniques developed by SAVANA. The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1, 2020 to February 28, 2021. Results Smokers had a significantly higher percentage of cardiovascular risk factors (hypertension, dyslipidemia and diabetes), COPD, asthma, IDP, IC, CVD, PTE, cancer in general and lung cancer in particular, bronchiectasis, heart failure and a history of pneumonia (P<.0001). Former smokers, current smokers and non-smokers have a significant age difference. As for in-hospital deaths, they were more frequent in the case of ex-smokers, followed by smokers and then non-smokers (P<.0001). Conclusion There is an increased risk of dying in hospital in SARS-CoV-2-infected patients who are active smokers or have smoked in the past. (AU)

Is it possible to predict neurosensory alterations in impacted lower third molar removal based on preoperative imaging procedures? A prospective cohort study.

BACKGROUND: Surgical extraction of the lower third molar (LTM) may trigger neurosensory injury of the inferior alveolar nerve, making extraction a real challenge. This study set out to assess whether is it possible to predict neurosensory alterations from preoperative imaging. MATERIAL AND METHODS: A total of 99 patients underwent 124 impacted lower third molar (ILTM) surgeries. Prior to surgery, panoramic and CBCT images were evaluated in an attempt to predict a neurosensory disturbance. Preoperative data (ILTM position, panoramic radiograph signs, inferior alveolar nerve (IAN) location and its contact with the ILTM roots) and intra/postoperative findings (extraction difficulty and sensitivity alterations) were recorded. Descriptive and bivariate data analysis was performed. Statistical comparison applied the chi-square test, Fisher test, and one-way ANOVA test. Statistical significance was established with a confidence interval (CI) of 95%. RESULTS: In 4.03% of cases, patients experienced neurosensory alterations. Of 124 ILTM positions in panoramic radiographs, 76 cases were considered to exhibit a potential neurosensory risk as they presented two or more types of superimposed relationships between ILTM and mandibular canal. Of these, alterations were reported in only three cases (3.95%). Of the 48 remaining ILTM images presenting only one sign, neurosensory alterations were observed in two cases (4.17%). No permanent alterations were recorded in any of the five cases observed. CONCLUSIONS: Within the limitations of the present study, prediction of neurosensory alterations prior to ILTM extraction by means of preoperative imaging did not show a significant statistical correlation with post-surgical incidence. Nevertheless, interruption of the canal´s white line (ICWL) or a diversion of the canal (DC) may predict an increased risk of IAN injury.

Gamma-ray sources imaging and test-beam results with MACACO III Compton camera.

Hadron therapy is a radiotherapy modality which offers a precise energy deposition to the tumors and a dose reduction to healthy tissue as compared to conventional methods. However, methods for real-time monitoring are required to ensure that the radiation dose is deposited on the target. The IRIS group of IFIC-Valencia developed a Compton camera prototype for this purpose, intending to image the Prompt Gammas emitted by the tissue during irradiation. The system detectors are composed of Lanthanum (III) bromide scintillator crystals coupled to silicon photomultipliers. After an initial characterization in the laboratory, in order to assess the system capabilities for future experiments in proton therapy centers, different tests were carried out in two facilities: PARTREC (Groningen, The Netherlands) and the CNA cyclotron (Sevilla, Spain). Characterization studies performed at PARTREC indicated that the detectors linearity was improved with respect to the previous version and an energy resolution of 5.2 % FWHM at 511 keV was achieved. Moreover, the imaging capabilities of the system were evaluated with a line source of 68Ge and a point-like source of 241Am-9Be. Images at 4.439 MeV were obtained from irradiation of a graphite target with an 18 MeV proton beam at CNA, to perform a study of the system potential to detect shifts at different intensities. In this sense, the system was able to distinguish 1 mm variations in the target position at different beam current intensities for measurement times of 1800 and 600 s.

[Translated article] Clinical results of total hip arthroplasty assisted by robotic arm in Spain: Preliminary study.

OBJECTIVES: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. MATERIAL AND METHODS: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4 months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. RESULTS: Average age was 67.2 years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative haemoglobin decrease of 3.08±1.08g/dl, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min -12, max 3) to 1.29mm (SD: 1.96) after surgery registered with Mako®, with an increase of an average hip length of 5.64mm (SD: 3.35). Rx simple study results show a postoperative difference between both hips of 0.5±3.08mm, which is consistent with Mako® results. Native femoral offset was stable after surgery with a showing difference both pre and post operative of the intervened hip of 0.1mm (SD: 3.7), registered with Mako®. Preoperatory modified Harris punctuation was 41.6±13.3, improving to postoperative values of 74.6±9.7 after four months since the surgery. No complications were registered in immediate postoperative (4 months). CONCLUSIONS: Total hip arthroplasty robot-assisted achieves an adequate precision and repeatability of the implant positioning and the postoperative hip dysmetry without showing an increase of associated complications to the technique applied. Surgery time, complications and functional results in a short-time period are similar to conventional techniques applied to great series previously published.

Fitting parameters and therapies of ODE tumor models with senescence and immune system.

This work is devoted to introduce and study two quasispecies nonlinear ODE systems that model the behavior of tumor cell populations organized in different states. In the first model, replicative, senescent, extended lifespan, immortal and tumor cells are considered, while the second also includes immune cells. We fit the parameters regulating the transmission between states in order to approximate the outcomes of the models to a real progressive tumor invasion. After that, we study the identifiability of the fitted parameters, by using two sensitivity analysis methods. Then, we show that an adequate reduced fitting process (only accounting to the most identifiable parameters) gives similar results but saving computational cost. Three different therapies are introduced in the models to shrink (progressively in time) the tumor, while the replicative and senescent cells invade. Each therapy is identified to a dimensionless parameter. Then, we make a fitting process of the therapies' parameters, in various scenarios depending on the initial tumor according to the time when the therapies started. We conclude that, although the optimal combination of therapies depends on the size of initial tumor, the most efficient therapy is the reinforcement of the immune system. Finally, an identifiability analysis allows us to detect a limitation in the therapy outcomes. In fact, perturbing the optimal combination of therapies under an appropriate therapeutic vector produces virtually the same results.

[ICU admission for cancer patients with respiratory failure: An ethical dilemma]. / Admission aux soins intensifs du patient cancéreux avec une atteinte respiratoire : un dilemme éthique.

In medicine, each decision is the result of a trade-off between medical scientific data, the rights of individuals (protection of persons, information, consent), individual desires, collective values and norms, and the economic constraints that guide our society. Whether or not to admit a cancer patient to an intensive care unit is very often an ethical dilemma. It is necessary to distinguish patients who would benefit from admission to an intensive care unit (ICU) from those for whom it would be futile. In this review, we will discuss the appropriateness of ICU admission and the concept of unreasonable admission, along with the different levels of intensity of ICU care and the alternatives to intensive care. We will then consider how and when to initiate reflection leading to a reasonable decision for the patient.

La señal de la cruz: un automatismo muy poco frecuente en la epilepsia del lóbulo temporal. Descripción de dos casos / The sign of the cross: a very rare automatism in temporal lobe epilepsy. Two case reports

Introducción: En la evaluación de la epilepsia farmacorresistente, el análisis detallado de la semiología es fundamental para establecer una hipótesis diagnóstica de la localización de la zona epileptógena. La señal de la cruz es un automatismo manual complejo muy infrecuente descrito por primera vez en 2008 y poco referido en la bibliografía. Caso clínico: Presentamos dos casos con presencia de la señal de la cruz de nuestra serie de pacientes monitorizados mediante videoelectroencefalograma, uno de ellos estudiado también con electrodos profundos, en los que describimos la localización de la descarga en el momento de realizar la señal de la cruz. Se realiza también una revisión bibliográfica para intentar establecer un valor localizador y/o lateralizador de este signo.(AU)

Introduction: In the evaluation of drug-resistant epilepsy, a detailed analysis of the semiology is essential to establish a diagnostic hypothesis of the location of the epileptogenic zone. Cross-sign (CS) is a very infrequent complex manual automatism described for the first time in 2008 and rarely reported in the literature. Case report: We present two cases from our series of patients monitored by video-EEG, one of whom also studied with deep electrodes, in which we describe the location of the discharge while performing the CS. A bibliographic review is also carried out to try to establish a localizing and/or lateralizing value of this sign. Conclusion: The sign of the cross is a rare ictal automatism that occurs in patients with temporal lobe epilepsy. The hand used to make the sign of the cross is the dominant one, regardless of the origin of the crises.(AU)

[The sign of the cross: a very rare automatism in temporal lobe epilepsy. Two case reports]. / La señal de la cruz: un automatismo muy poco frecuente en la epilepsia del lóbulo temporal. Descripción de dos casos.

INTRODUCTION: In the evaluation of drug-resistant epilepsy (DRF), a detailed analysis of the semiology is essential to establish a diagnostic hypothesis of the location of the epileptogenic zone. Cross-sign (CS) is a very infrequent complex manual automatism described for the first time in 2008 and rarely reported in the literature. CASE REPORT: We present two cases from our series of patients monitored by videoEEG, one of whom also studied with deep electrodes, in which we describe the location of the discharge while performing the CS. A bibliographic review is also carried out to try to establish a localizing and/or lateralizing value of this sign. CONCLUSION: The sign of the cross is a rare ictal automatism that occurs in patients with temporal lobe epilepsy. The hand used to make the sign of the cross is the dominant one, regardless of the origin of the crises.

TITLE: La señal de la cruz: un automatismo muy poco frecuente en la epilepsia del lóbulo temporal. Descripción de dos casos.Introducción. En la evaluación de la epilepsia farmacorresistente, el análisis detallado de la semiología es fundamental para establecer una hipótesis diagnóstica de la localización de la zona epileptógena. La señal de la cruz es un automatismo manual complejo muy infrecuente descrito por primera vez en 2008 y poco referido en la bibliografía. Caso clínico. Presentamos dos casos con presencia de la señal de la cruz de nuestra serie de pacientes monitorizados mediante videoelectroencefalograma, uno de ellos estudiado también con electrodos profundos, en los que describimos la localización de la descarga en el momento de realizar la señal de la cruz. Se realiza también una revisión bibliográfica para intentar establecer un valor localizador y/o lateralizador de este signo. Conclusión. La señal de la cruz es un raro automatismo ictal que ocurre en pacientes con epilepsia del lóbulo temporal. La mano empleada para la señal de la cruz es la dominante, independientemente del origen de las crisis.

Improvement of photocatalytic activity in the degradation of 4-chlorophenol and phenol in aqueous medium using tin-modified TiO2 photocatalysts.

In this work, we present the synthesis of TiO2 photocatalysts modified with different % mol of tin using the sol-gel method. The materials were characterized using different analytical techniques. The Rietveld refinement, XPS, Raman and UV-Vis techniques confirm the substitution of tin in the TiO2 structural lattice due to changes in crystal lattice parameters, the low-energy shift of the Sn 3d5/2 orbital, generation of oxygen vacancies and the decreased band gap and increased BET surface area. The material with 1 mol% tin shows superior catalytic activity compared to the references for the degradation of 40 ppm 4-chlorophenol (3 hours of reaction) and 50 ppm phenol (6 hours of reaction). Reactions fit pseudo first order kinetics in both instances. The increase in photodegradation efficiency was attributed to the generation of energy levels below the TiO2 conduction band caused by the incorporation of 1% mol of tin, oxygen vacancies, and the heterojunction formed between the brookite-anatase-rutile, causing inhibition of the recombination of the electron (e-) and hole (h+) photogenerated species. The easy synthesis, low cost and increased photodegradation efficiency of the photocatalyst with 1 mol% tin have the potential to favor the remediation of recalcitrant compounds in water.