Ultrasound-guided botulinum toxin for the treatment of chronic anal fissure: technical notes.

We are thrilled to present a new technique for treating chronic anal fissures using ultrasound-guided botulinum toxin injections. Our approach involves injecting botulinum toxin into the internal anal sphincter (IAS) guided by ultrasound for maximum effectiveness. We believe that our technique has significant potential to improve outcomes. We could not find any studies where ultrasound-guided TB puncture was used to treat chronic anal fissures.

[Electrocardiographic interval as a predictor of life-threatening arrhythmias in dilated cardiomyopathy patients]. / Intervalo electrocardiográfico como predictor de arritmias graves en pacientes con miocardiopatía dilatada.

Background: The Tpe interval (Tp-e) in the surface electrocardiogram represents ventricular repolarization, a key phase in the pathogenesis of severe ventricular arrhythmias. However, there are few studies evaluating changes in this electrocardiographic interval as a risk factor for serious arrhythmias in patients with dilated cardiomyopathy. Objective: To determine whether the Tp-e interval prolongation predicts the presence of life-threatening arrhythmias in patients with dilated cardiomyopathy (DCM) with implantable cardioverter-defibrillator (ICD). Material and methods: Analytical, cross-sectional study in patients with DCM with ICDs. The Tp-e interval was measured in the V2 electrocardiographic lead and correlated with the incidence of life-threatening arrhythmias identified by the ICD. Results: 53 patients were recruited, 10 (18.8%) presented life-threatening arrhythmias. Prolongation of Tp-e interval was related to an increase in the incidence of ventricular tachycardia/fibrillation tachycardia (VT/FT) with a mean of 93 ± 20.5 ms (p = 0.003), using ROC curves to determine the thereshold of 90 ms for increased risk of VT/VF with sensitivity of 70% and specificity of 84%, with an area under the curve of 0.798. Conclusion: The prolongation of the ITp-e interval greater than 90 ms in a population with dilated cardiomyopathy predicts the presence of arrhythmic episodes, such as VT and/or VT/FT.

Introducción: el intervalo Tpe (ITp-e) en el electrocardiograma de superficie representa la repolarización ventricular, fase clave en la patogénesis de arritmias ventriculares graves. Sin embargo, existen pocos estudios que evalúen la alteración de este intervalo electrocardiográfico como factor de riesgo de arritmias graves en pacientes con miocardiopatía dilatada. Objetivo: determinar si la prolongación del ITp-e predice la presencia de arritmias potencialmente mortales en pacientes con miocardiopatía dilatada (MCD) portadores de desfibrilador automático implantable (DAI). Material y métodos: estudio, transversal analítico en pacientes con MCD portadores de DAI. Se midió el ITp-e en la derivación electrocardiográfica V2 y se correlacionó con la incidencia de arritmias potencialmente letales identificadas por el DAI. Resultados: se incluyeron 53 pacientes, 10 (18.8%) presentaron arritmias potencialmente mortales. La prolongación del ITp-e se relacionó con aumento de incidencia de taquicardia ventricular/fibrilación ventricular (TV/FV) con media de 93 ± 20.5 ms (p = 0.003), por lo que se determinó mediante curvas ROC el punto de corte de 90 ms para el aumento de riesgo de TV/FV con sensibilidad de 70% y especificidad de 84%, con área bajo la curva de 0.798. Conclusión: la prolongación del intervalo ITp-e > 90 ms en población con miocardiopatía dilatada predice la presencia de episodios arrítmicos como TV o FV.

Ira y Personalidad como dos factores relacionados en el deporte: una revisión sistemática / A raiva e a personalidade como dois factores relacionados no desporto: uma revisão sistemática / Anger and personality as two related factors in sport: a systematic review

La ira en el deporte parece ser, aparentemente, una característica intrínseca en el desarrollo de este, sobre todo cuando es la competición la que marca el contexto en el que se desarrolla. Se inicia así, un trabajo de revisión sistemática cuyo objetivo fue conocer el estudio de la ira en deportistas y su relación con variables de personalidad, que pudiesen estar en el origen de aquella o que en cierta medida pudiesen explicar comportamientos violentos. En primer lugar, se seleccionaron las palabras clave (ira, personalidad y deporte) y a continuación se buscaron y seleccionaron en las bases de datos “Web of Science”, “SCOPUS”, “Dialnet”, PsycInfo”, “Psicodoc”, “PubMed” y “SPORTDiscus” aquellos artículos que tuvieran relación con esa temática, obteniendo tras la depuración descrita en el apartado de metodología, un total de 10 artículos, pudiendo señalar como más relevante la conclusión de que, entre otras, existe una estrecha relación entre determinados patrones de personalidad y comportamientos agresivos en el contexto deportivo. A partir de ahí se han discutido las principales aportaciones que han realizado los investigadores pudiendo establecer, como futuras líneas de investigación y aplicación práctica, la utilización de muestra femenina con el fin de generalizar a la totalidad de la población, la creación de cuestionarios estándar que midan las variables de la misma forma y, sobre todo, la instauración de programas de gestión emocional para controlar esos patrones desadaptativos. (AU)

Anger in sport seems to be, apparently, an intrinsic characteristic in the development of sport, especially when it is the competition that marks the context in which it develops. I began a systematic review of the study of anger in athletes and its relationship with personality variables, which could be at the origin of this explain violent behavior. The procedure we followed was firstly, selection of the key words (anger, personality and sport) and then we searched and selected in the databases "Web of Science", "SCOPUS", "Dialnet", "PsycInfo", "Psicodoc", "PubMed" and "SPORTDiscus" those articles that were related to this topic. After thefiltering described in the methodology section, a total of 10 articles were obtained. The most relevant conclusion was that there is a close relationship between certain personality patterns and aggressive and/or unsportsmanlike behavior in the sports context. The main contributions made by the researchers have been establishing as future lines of research and practical application the use of a female sample to be able to generalize to the whole population, the creation of standard questionnaires that measure the variables in the same way and, above all, the creation of emotional management programs to control these maladaptive patterns. (AU)

A raiva no desporto parece ser, aparentemente, uma característica intrínseca no desenvolvimento do desporto, especialmente quando é a competição que marca o contexto em que este se desenvolve. Assim, eu comencei uma revisão sistemática do estudo da raiva nos atletas e da sua relação com as variáveis de personalidade que poderiam estar na origem da mesma ou que, até certo ponto, poderiam explicar comportamentos violentos. Primeiro, foram selecionadas as palavras-chave (raiva, personalidade e desporto) e depois as bases de dados "Web of Science", "SCOPUS", "Dialnet", "PsycInfo", "Psicodoc", "PubMed" e "SPORTDiscus" foram pesquisadas e selecionadas para os artigos relacionados com este assunto, Após a filtragem descrita na secção de metodologia, foi obtido um total de 10 artigos, sendo a conclusão mais relevante que, entre outros, existe uma relação estreita entre certos padrões de personalidade e comportamentos agressivos no contexto desportivo. A partir daí, foram discutidas as principais contribuições feitas pelos investigadores, estabelecendo como linhas futuras de investigação e aplicação prática a utilização de uma amostra feminina a fim de generalizar a toda a população, a criação de questionários padrão que medem as variáveis da mesma forma e, sobretudo, o estabelecimento de programas de gestão emocional para controlar estes padrões maladaptados. (AU)

Continuous Positive Airway Pressure Effect on Albuminuria Progression in Patients with Obstructive Sleep Apnea and Diabetic Kidney Disease: A Randomized Clinical Trial.

Rationale: Obstructive sleep apnea (OSA) is associated with impaired glycemic control and a higher risk of vascular complications, such as diabetic kidney disease (DKD). However, the effect of apnea-hypopnea suppression on DKD progression is unclear. Objectives: To assess the effect of continuous positive airway pressure (CPAP) on the urinary albumin-to-creatinine ratio (UACR) in patients with DKD and OSA. Methods: In a 52-week, multicentric, open-label, parallel, and randomized clinical trial, 185 patients with OSA and DKD were randomized to CPAP and usual care (n = 93) or usual care alone (n = 92). Measurements and Main Results: UACR, estimated glomerular filtration rate, serum concentrations of creatinine and glycated hemoglobin, insulin resistance, lipid concentrations, sleepiness, and quality of life. A 52-week change in UACR from baseline did not differ significantly between the CPAP group and the usual-care group. However, in per-protocol analyses that included 125 participants who met prespecified criteria for adherence, CPAP treatment was associated with a great reduction in UACR (mean difference, -10.56% [95% confidence interval, -19.06 to -2.06]; P = 0.015). CPAP effect on UACR was higher in nonsleepy patients with more severe OSA, worse renal function, and a more recent diagnosis of DKD. CPAP treatment also improved glycemic control and insulin resistance, as well as sleepiness and health-related quality of life. Conclusions: In patients with OSA and DKD, the prescription of CPAP did not result in a statistically significant reduction in albuminuria. However, good adherence to CPAP treatment in addition to usual care may result in long-term albuminuria reduction compared with usual care alone. Clinical trial registered with www.clinicaltrials.gov (NCT02816762).

Relationship between resilience, optimism, and burnout in Pan-American athletes.

Aim: A series of knowledge has been developed on burnout syndrome in the sports context that has allowed to generate a solid theoretical structure that requires new contributions to delve into those aspects that have been less addressed, as is the case of optimism and resilience when it comes to linking them to the syndrome in top-performance athletes. For this purpose, the Burnout Inventory for Athletes (IBD-r), the Resilience Scale adapted to Spanish, and the Life Orientation Scale-Revised (LOT-R) for optimism were used. Methods: From this perspective, the study was approached with 121 Uruguayan athletes who participated in the last Pan-American Games, assuming practically all the subjects who have this level of sport (142) considering gender and type of sport. Results: The results indicate that 67% of the sample presents burnout symptoms for the emotional exhaustion dimension, and moderate resilience and optimism. Although there are no significant differences attributable to gender or type of sport, this contribution allows us to continue focusing on future work and further analysis. The type of sport presented statistically significant differences in relation to the personal competence dimension and the type of sport. Conclusion: Resilience and optimism obtained a clear influence on the occurrence of burnout, in a statistically negative sense, showing themselves as interesting prevention strategies for future lines of research, where it is essential to design interventions that teach emotional skills to manage adversity and prevent burnout.

Efficacy of a transdiagnostic guided internet-delivered intervention for emotional, trauma and stress-related disorders in Mexican population: study protocol for a randomized controlled trial.

BACKGROUND: Emotional and stress-related disorders show high incidence, prevalence, morbidity, and comorbidity rates in Mexico. In recent decades, research findings indicate that cognitive behavioral interventions, from a disorder-specific perspective, are the effective front-line treatment for anxiety and depression care. However, these treatments are not often used. Reasons include limited access and low availability to effective interventions and comorbidity between mental disorders. Emotional deregulation of negative affectivity has been found to be a mediating factor in addressing emotional disorders from a transdiagnostic perspective, aimed at two or more specific disorders. In addition, technological advancement has created alternatives for psychological assistance, highlighting the possibilities offered by technologies since Internet-supported intervention programs have been empirically tested for effectiveness, efficiency and efficacy and can be key to ensuring access to those who are inaccessible. The aim of the study is to evaluate the efficacy, moderators of clinical change and acceptability of a transdiagnostic guided Internet-delivered intervention versus a transdiagnostic self-guided Internet-delivered intervention for emotional, trauma and stress-related disorders, and waiting list in community sample. METHODS: A three-armed, parallel group, superiority randomized controlled clinical trial with repeated measurements at four times: pretest, posttest, follow-up at 3, 6 and 12 months. Outcomes assessor, participant, care provider and investigator will be blinded. Participants aged 18 to 70 years will be randomly allocated 1:1:1 to one of three study arms: a) Transdiagnostic guided internet-delivered intervention with synchronous assistance, b) Transdiagnostic self-guided internet-delivered intervention, c) Waiting list group. Based on sample size estimation, a minimum of 207 participants (69 in each intervention group) will be included. DISCUSSION: The study could contribute to improving the efficacy of transdiagnostic internet-delivered interventions to promote the dissemination of evidence-based treatments and eventually, to decrease the high prevalence of emotional and trauma-related disorders in the Mexican population. TRIAL REGISTRATION: ClinicalTrial.gov: NCT05225701 . Registered February 4, 2022.

Síndrome de Edorexia: un posible problema mental de la autorregulación del apetito en obesidad / Edorexia syndrome: a possible mental problem of appetite autoregulation in obesity

Fundamentos: En este trabajo, se aborda el problema de la obesidad desde una perspectiva biopsicosocial. Definiendo la obesidad como una consecuencia de la autorregulación del apetito y cuyas conductas tienen una finalidad psicológica relacionada con el alivio de emociones y situaciones aversivas. Basándose en la autorregulación del apetito, se observa el Síndrome de Edorexia y se analiza su relación con la obesidad, personalidad y estilos de afrontamiento. Métodos: La muestra se constituyó por 111 individuos universitarios (29 individuos con edoréxicos y 82 sinedoréxicos) que no realizaban actividad física intensa en gimnasios y no presentaban un trastorno mental severo. Se administraron a todos los participantes el Cuestionario del Síndrome de Edorexia (CSE), el Cuestionario de Personalidad (BFQ) y el Cuestionario de Respuesta de afrontamiento (CRI-A).Resultados: Se observa que el Síndrome de Edorexia guarda relación con el abuso y evitación de los alimentos. Además, predice mejor la obesidad en comparación con otras conductas. Conclusiones: Los estudios recientes vinculan la obesidad con un problema relacionado con la autorregulación del apetito y desde este enfoque, el Síndrome de Edorexia parece ser un buen predictor de la obesidad. Según estos trabajos, la inhibición y la desinhibición del consumo de alimentos pueden ser la estrategia empleada por el organismo para solventar una situación aversiva. Por este motivo, la obesidad puede entenderse como una consecuencia del conjunto de síntomas y conductas al que se denomina Síndrome de Edorexia y resultado de una situación en la cual el individuo no dispone de otras conductas, habilidades y recursos para afrontarlo de una manera más saludable. (AU)

Background: In this article, we approach the problem of obesity from a biopsychosocial perspective. Obesity is defined as a consequence of self-regulation of appetite and such that its’ behaviors have a psychological purpose related to the relief of emotions and aversive situations. Based on self-regulation of appetite, we describe Edorexia Syndrome and we analyze its relationship with obesity, personality and coping. Methods: The sample was constituted by 111 university students (29 edorexic and 82 non-edorexic) who didn’t practice intense physical activity in gyms and didn’t present a severe mental disorder. A battery of psychological tests was applied to the whole sample. This battery consisted of Edorexia Syndrome Questionnaire (CSE), Big Five Personality Questionnaire (BFQ) and the Coping Response Inventory (CRI-A). Results: The results showed that the Edorexia Syndrome is related to the abuse and avoidance of food. It also showed that Edorexia predicts obesity better than other behaviors. Conclusions: Recent studies related obesity with a problem of self-regulation of appetite and from this perspective, Edorexia Syndrome seems to be a good predictor of obesity. According to these articles, the inhibition and disinhibition of food consumption may be the strategy used by the organism to resolve an aversive situation. For this reason, obesity can be comprehended as a consequence of the set of symptoms and behaviors called Edorexia Syndrome and the result of a situation in which the individual does not have other behaviors, skills and resources to confront it in a healthier way. (AU)

La creatividad en el deporte: una revisión sistemática / Criatividade no desporto: uma revisão sistemática / Creativity in Sports: A Systematic Review

El deporte, a través del recurso psicológico de la creatividad, se ha ido innovando y adaptando a los cambios en los últimos años. Esta fortaleza cognitiva y afectiva está ahora más presente tanto en deportistas como en clubs. Tras una revisión sistemática de la bibliografía aportada por diversas bases de datos en los últimos 25 años, se ha realizado un cribado manual basado en unos criterios de selección previos, donde se han obtenido 39 estudios con una temática de ‘creatividad y deporte’ de un total de 5.174. Pese a que 14 de los 39 trabajos presentan limitaciones que podrían afectar a la replicabilidad de sus estudios o, incluso, ala calidad de sus resultados, se puede observar un creciente interés de la comunidad científica por esta materia, dándose un aumento en las publicaciones de artículos que se han centrado en esta temática. No obstante, se concluye que la investigación publicada hasta la fecha, aunque ha abierto excelentes líneas de trabajo y posibilidades, no puede ofrecerse todavía como un conjunto de contenidos, estructura o relaciones que configure un dominio específico deportivo o motriz, dentro de los recursos de creatividad. (AU)

Thanks to the psychological resource of creativity, sports have innovated and adapted to changes in recent years. This cognitive and affective strength is now more present in both athletes and clubs. After a systematic review of the bibliography published over the last 25 years through various databases, a manual screening was carried out based on specific selection criteria. This search provided 39 studies addressing the theme of 'creativity and sport' out of a total of 5.174 papers. Although 14 of these 39 studies have limitations that could affect their replicability, or even the quality of their results, it is possible to observe a growing interest of the scientific community in this topic, as well as an increase in the number of articles published that have focused on this subject. Thus, it is possible to conclude that, although the research published to date has opened excellent lines of work and possibilities, it cannot yet be considered as a set of content, structure or relationships shaping a specific sports or motor domain, within the resources of creativity. (AU)

O desporto, atravésdo recurso psicológico da criatividade, tem vindo a inovar e a adaptar-se às mudanças nos últimos anos. Esta força cognitiva e afectiva está agora mais presente tanto nos atletas como nos clubes. Após uma revisão sistemática da bibliografia fornecida por várias bases de dados ao longo dos últimos 25 anos, foi efectuada uma análise manual baseada em critérios de selecção anteriores, que resultou em 39 estudos com um tema de "criatividade e desporto" de um total de 5.174. Apesar de 14 dos 39 estudos terem limitações que podem afectar a reprodutibilidade dos seus estudos, ou mesmo a qualidade dos seus resultados, observa-se um interesse crescente da comunidade científica por este tema, bem como um aumento do número de artigos publicados que incidiram sobre este tópico. Contudo, conclui-se que a investigação publicada até à data, embora tenha aberto excelentes linhas de trabalho e possibilidades, ainda não pode ser oferecida como um conjunto de conteúdos, estrutura ou relações que configurem um determinado desporto ou domínio motor, dentro dos recursos da criatividade. (AU)

Obstructive sleep apnea is associated with impaired renal function in patients with diabetic kidney disease.

Obstructive sleep apnea (OSA) is a recognized risk factor for the development of diabetic kidney disease (DKD). Our objectives were to compare the urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) of patients with DKD according to OSA severity, and to evaluate the contribution of sleep parameters to their renal function. In a multicenter, observational, cross-sectional study, 214 patients with DKD were recruited. After a sleep study, UACR and eGFR were measured, as well as serum creatinine, fasting glucose, glycated hemoglobin, insulin resistance, lipid profile and C-reactive protein. UACR was higher in severe OSA patients (920 ± 1053 mg/g) than in moderate (195 ± 232 mg/g, p < 0.001) or mild OSA/non-OSA subjects (119 ± 186 mg/g, p < 0.001). At the same time, eGFR showed an OSA severity-dependent reduction (48 ± 23 vs. 59 ± 21 vs. 73 ± 19 ml/min per 1.73 m2, respectively; p < 0.001). Apnea-hypopnea index (AHI and desaturation index (ODI) were identified as independent predictors for UACR and eGFR, respectively. Therefore, in patients with DKD under optimized treatment, severe OSA is associated with a higher UACR and a lower eGFR, reflecting an additional contribution to the impairment of their renal function, although no causality can be inferred.

The impact of frailty in aortic valve surgery.

BACKGROUND: Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty in cardiac aortic valve surgery. METHODS: Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. RESULTS: Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3 s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51, 14 and 28%. Mortality 4%. Survival at 6 m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 s were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. CONCLUSIONS: Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up.

Dietary Squalene Induces Cytochromes Cyp2b10 and Cyp2c55 Independently of Sex, Dose, and Diet in Several Mouse Models.

SCOPE: To investigate the effects of squalene, the main hydrocarbon present in extra virgin olive oil, on liver transcriptome in different animal models and to test the influence of sex on this action and its relationship with hepatic lipids. METHODS AND RESULTS: To this purpose, male C57BL/6J Apoe-deficient mice are fed a purified Western diet with or without squalene during 11 weeks and hepatic squalene content is assessed, so are hepatic lipids and lipid droplets. Hepatic transcriptomic changes are studied and confirmed by RT-qPCR. Dietary characteristics and influence of squalene doses are tested in Apoe-deficient on purified chow diets with or without squalene. These diets are also given to Apoa1 and wild-type mice on C57BL/6J background and to C57BL/6J xOla129 Apoe-deficient mice. Squalene supplementation increases its hepatic content without differences among sexes and hormonal status. The Cyp2b10 and Cyp2c55 gene expressions are significantly up-regulated by the squalene intake in all models, with independence of sex, sexual hormones, dietary fat content, genetic background and dose, and in Apoe-deficient mice consuming extra-virgin olive oil. CONCLUSION: Hepatic squalene increases the expression of these cytochromes and their changes in virgin olive oil diets may be due to their squalene content.

Competition Seriousness and Competition Level Modulate Testosterone and Cortisol Responses in Soccer Players.

This study aimed to analyze the modulating effect of competition seriousness and competition level in the testosterone and cortisol responses in professional soccer player. Ninety five (95) soccer players were included in this study (professional, n = 39; semiprofessional, n = 27; amateur, n = 29) before and after training, friendly game and official games. Repeated measures ANOVA showed higher testosterone levels (F(1,89) = 134, p < 0.0001, η2p = 0.75) in professional soccer players, when compared with semiprofessional (p < 0.0001) or amateur athletes (p < 0.0001). After winning a competition game an increase in testosterone levels was observed in professionals (t = -3.456, p < 0.001), semiprofessionals (t = -4.400, p < 0.0001), and amateurs (t = -2.835, p < 0.009). In contrast, this momentary hormonal fluctuation was not observed after winning a friendly game or during a regular training day. Additionally, statistical analysis indicated that cortisol levels were lower in professional (t = -3.456, p < 0.001) and semiprofessional athletes (t = -4.400, p < 0.0001) than in amateurs (t = -2.835, p < 0.009). In soccer players a rise in testosterone was only observable when the team was faced with an actual challenge but did not support a different response between categories. Thus, the desire to achieve a goal (and keep the social status) may be one of the key reasons why testosterone levels rise promptly. Conversely, testosterone did not change after friendly games, which suggests these situations are not real goals and the players do not perceive an actual threat (in terms of dominance) more than the preparation for their next competitive game.

Revisión sistemática de modelos de entrenamiento en rinoplastia / Sistematic review of training models in rhinoplasty

Antecedentes y Objetivo. La rinoplastia es uno de los procedimientos más frecuentes y más complejos de la Cirugía Plástica. Residentes de todo el mundo concuerdan en que su entrenamiento en rinoplastia es deficiente y en algunas ocasiones nulo. Algunos dicen no contar con la confianza suficiente para realizarla al finalizar su formación especializada. No todos los países establecen un método de entrenamiento estandarizado para la adquisición de experiencia y habilidades en rinoplastia, y si bien existen algunos modelos, no han sido evaluados y se desconoce su efectividad. Realizamos una revisión sistemática de las publicaciones que describen modelos de entrenamiento para aprendizaje, adquisición y/o mejora de habilidades en rinoplastia. Material y método. Llevamos a cabo una revisión sistemática mediante búsqueda electrónica de la literatura en las diferentes bases de datos: MEDLINE Pubmed (1980 a junio de 2016), EMBASE Ovid (1946 a segunda semana de junio de 2016), LILACS Scielo (1982 a junio de 2016) usando como criterio de selección: estudios descriptivos sobre uso de modelos de entrenamiento en rinoplastia. Resultados. Revisamos 6 modelos de entrenamiento publicados entre 2005-2014; 3 con tejido animal, 1 en cadáveres y 2 con material sintético. Ninguno contaba con evaluación y validación de los modelos propuestos, por lo cual no es posible determinar si funcionan para mejorar las habilidades quirúrgicas durante la formación especializada en Cirugía Plástica. Conclusiones. Aunque está demostrada la eficacia de los modelos de entrenamiento quirúrgico en otras especialidades y su uso es requisito para acreditación en EE. UU., no encontramos evidencia de la existencia de modelos eficaces en rinoplastia. Es por ello que nuestra revisión abre la puerta para la búsqueda de un modelo validado en nuestra especialidad

Background and Objective. Rhinoplasty is one of the most frequent and complex surgeries performed within the Plastic Surgery field. Residents around the world agree on a general deficiency from their rhinoplasty training and, in some cases, the absence of it. Someone, by the end of their training, still feel lack of confidence when performing a rhinoplasty. Currently, not all the countries have established a standardized training method for the acquisition of expertise and skills in rhinoplasty, and although there are several models, they have not been evaluated and therefore their efficiency as a training model is unknown. Methods. We conduct a systematic review performing a systematic review of published articles about the theme. Search strategy included the following database: MEDLINE Pubmed (1980 to June 2016), EMBASE Ovid (1946 to second week of June 2016), LILACS Scielo (1982 to June 2016). Selection criteria used was: descriptive studies reporting the use of training models for rhinoplasty. Results. Six training models, during a period from 2005-2014, were evaluated. Three were based on animal tissue, 2 on synthetic materials and 1 on a cadaveric model. No one had been evaluated or validated as to whether they improve surgical skills of residents in training. Conclusions. Even do, in other medical specialties the effectiveness of surgical training models has been proven and such training is considered a requirement in the USA, within the rhinoplasty field no evidence of the effectiveness from these models was found. This revision delivers a path to continue with their effectiveness evaluation and skills improvement in Plastic Surgery

Extra virgin olive oil diet intervention improves insulin resistance and islet performance in diet-induced diabetes in mice.

Dietary composition plays an important role in the pathophysiology of type 2 diabetes. Monounsaturated fatty acid consumption has been positively associated with improved insulin sensitivity and ß-cell function. We examined whether an extra virgin olive oil (EVOO) high fat diet (HFD) can improve glucose homeostasis. C57BL/6J mice were fed a standard diet or a lard-based HFD to induce type 2 diabetes. Then, HFD mice were fed with three different based HFD (lard, EVOO and EVOO rich in phenolic compounds) for 24 weeks. HFD-EVOO diets significantly improved glycemia, insulinemia, glucose tolerance, insulin sensitivity and insulin degradation. Moreover, EVOO diets reduced ß-cell apoptosis, increased ß-cell number and normalized islet glucose metabolism and glucose induced insulin secretion. No additional effects were observed by higher levels of phenolic compounds. Thus, EVOO intake regulated glucose homeostasis by improving insulin sensitivity and pancreatic ß-cell function, in a type 2 diabetes HFD animal model.

A comparison of the isometric force fatigue-recovery profile in two posterior chain lower limb tests following simulated soccer competition.

AIM: To evaluate the reliability of isometric peak force (IPF) in a novel "long-length" 90°Hip:20°Knee (90:20) strength test and to compare the simulated soccer match induced fatigue-recovery profile of IPF in this test with that of an isometric 90°Hip:90°Knee (90:90) position test. METHODS: Twenty semi-professional soccer players volunteered for the study of which 14 participated in the first part of the study which assessed 90:20 reliability (age = 21.3 ± 2.5 years, height = 1.79 ± 0.07 m, body mass = 73.2 ± 8.8 kg), while 17 completed the second part of the study evaluating fatigue-recovery (age 21.2±2.4 yrs., height = 180 ± 0.09 m, body mass 73.8 ± 8.9 kg). We evaluated the inter-session reliability of IPF in two 90:20 test protocols (hands on the wall (HW); and hands on chest (HC)) both performed on two occasions, 7 days apart. We then assessed 90:20 (HC) and 90:90 IPF immediately before (PRE) and after (POST) after a simulated soccer match protocol (BEAST90mod) and 48 (+48 h) and 72 hours (+72 h) later. RESULTS: Part one: the 90:20 showed moderate to high overall reliability (CV's of 7.3% to 11.0%) across test positions and limbs. CV's were lower in the HW than HC in the dominant (7.3% vs 11.0%) but the opposite happened in the non-dominant limb where CV's were higher in the HW than HC (9.7% vs 7.3%). Based on these results, the HC position was used in part two of the study. Part two: 90:20 and 90:90 IPF was significantly lower POST compared to PRE BEAST90mod across all testing positions (p<0.001). IPF was significantly lower at +48 h compared to PRE in the 90:20 in both limbs (Dominant: p<0.01,Non-dominant: p≤0.05), but not in the 90:90. At +72 h, IPF was not significantly different from PRE in either test. CONCLUSIONS: Simple to implement posterior IPF tests can help to define recovery from competition and training load in football and, potentially, in other multiple sprint athletes. Testing posterior chain IPF in a more knee extended 90:20 position may provide greater sensitivity to fatigue at 48 h post simulated competition than testing in the 90:90 position, but also may require greater degree of familiarization due to more functional testing position.

Double-orifice mitral valve repair.

We present the case of a 6-year-old patient with double-orifice mitral valve and severe regurgitation, which was successfully repaired. We demonstrate that mitral valve repair may be attempted even in complex anatomy such as the double-orifice mitral valve, where it can offer excellent results.

Incidencia de infección de sitio quirúrgico y factores de riesgo en cirugía de recto. Estudio de cohortes prospectivo / Incidence of surgical site infection and risk factors in rectal surgery: A prospective cohort study

INTRODUCCIÓN: La infección de sitio quirúrgico (ISQ) es la principal causa de infección nosocomial. El objetivo de este trabajo fue estudiar la incidencia de ISQ y evaluar los factores de riesgo que la determinan en pacientes intervenidos de cirugía de recto. MÉTODOS: Estudio de cohortes prospectivo, realizado de enero del 2013 a diciembre del 2016. Se recogieron variables relacionadas con el paciente, la intervención quirúrgica y la infección. Se calculó la incidencia de infección tras un periodo máximo de 30 días de incubación. Se evaluó el efecto de los diferentes factores de riesgo en la infección con la odds ratio ajustada con un modelo de regresión logística. RESULTADOS: El estudio incluyó a 154 pacientes, con una edad media de 69,5±12 años. Las comorbilidades más habituales fueron diabetes mellitus (24,5%), enfermedad pulmonar obstructiva crónica (17%) y obesidad (12,6%). La incidencia global de ISQ durante el periodo de seguimiento fue de 11,9% (IC95%: 7,8-17,9) y el microorganismo más frecuente fue Escherichia coli (57,9%). Los factores de riesgo asociados a la infección quirúrgica en el análisis univariante fueron la transfusión sanguínea, el uso de drenajes y la administración de fármacos vasoactivas (p < 0,05). CONCLUSIONES: La incidencia de ISQ en cirugía de recto fue baja. Es muy importante evaluar la incidencia de infección y tratar de identificar los posibles factores de riesgo de infección. Recomendamos la implantación de programas prospectivos de vigilancia y control de la infección hospitalaria

INTRODUCTION: Surgical site infection (SSI) is the main cause of nosocomial infection in Spain. The aim of this study was to analyze the incidence of SSI and to evaluate its risk factors in patients undergoing rectal surgery. METHODS: Prospective cohort study, conducted from January 2013 to December 2016. Patient, surgical intervention and infection variables were collected. Infection rate was calculated after a maximum period of 30 days of incubation. The effect of different risk factors on infection was assessed using the odds ratio adjusted by a logistic regression model. RESULTS: The study included 154 patients, with a mean age of 69.5 ± 12 years. The most common comorbidities were diabetes mellitus (24.5%), chronic obstructive pulmonary disease (17%) and obesity (12.6%). The overall incidence of SSI during the follow-up period was 11.9% (CI95%: 7.8-17.9) and the most frequent microorganism was Escherichia coli (57.9%). Risk factors associated with surgical wound infection in the univariate analysis were blood transfusion, drain tubes and vasoactive drug administration (P<.05). CONCLUSIONS: The incidence of SSI in rectal surgery was low. It is crucial to assess SSI incidence rates and to identify possible risk factors for infection. We recommend implementing surveillance and hospital control programs

Validation of the EuroSCORE model in patients undergoing heart surgery in Regional Hospital of High Speciality of Bajio / Validación del modelo EuroSCORE en pacientes sometidos a cirugía cardiaca en el Hospital Regional de Alta Especialidad del Bajío

Abstract: Introduction: EuroSCORE is a probabilistic model with good performance in the prognosis of mortality in heart surgery in many latitudes. It is recommendable to validate it in hospitals where it is employed. Objective: To validate the EuroSCORE model in adult patients at the Hospital Regional de Alta Especialidad del Bajío (HRAEB) of León, Guanajuato, Mexico. Material and methods: We conducted an observational transversal, and retrospective study, accomplishing this through the review of the clinical files of patients submitted to heart surgery with and without extracorporeal circulation pump from 01/01/2008 to 12/31/2013 at the HRAEB. This included mortality up to hospital discharge, utilizing the on-line calculator of the EuroSCORE program to estimate risk of death. In order to validate the EuroSCORE model, we assessed discrimination and calibration through the Area Under the receiver operating characteristics (ROC) curve and χ2 test with Hosmer-Lemeshow (H-L) goodness-of-fit, respectively. Results: A total of 342 patients, aged 50.02 ± 16.66 years, 181 males (52.9%) and 161 women (47.1%). The area under the ROC curve of the additive model was 0.763, and of the Hosmer-Lemeshow test was 5.30, with p = 0.62. The area under the ROC curve of the logistic model was 0.761 and of the Hosmer-Lemeshow test, 8.78, with p = 0.36. Conclusion: The EuroSCORE model is a reliable score for estimating the probabilities of death in adult patients submitted to heart surgery with or without the pump at the HRAEB.

Resumen: Introducción: EuroSCORE es un modelo probabilístico con buen desempeño en el pronóstico de mortalidad en cirugía cardiaca en muchas latitudes. Es recomendable validarlo en los hospitales donde se emplea. Objetivo: Validar el modelo EuroSCORE en pacientes adultos en el Hospital Regional de Alta Especialidad del Bajío (HRAEB) de León, Guanajuato, México. Material y métodos: Se realizó un estudio observacional transversal y retrospectivo, que se completó con la revisión de los expedientes clínicos de pacientes sometidos a cirugía cardiaca con y sin bomba de circulación extracorpórea desde el 01/01/2008 hasta el 31/12/2013 en el HRAEB. Esto incluyó la mortalidad hasta el alta hospitalaria, utilizando la calculadora en línea del programa EuroSCORE para estimar el riesgo de muerte. Para validar el modelo EuroSCORE, evaluamos la discriminación y la calibración a través de la curva de características de operación del receptor (ROC) y la prueba de χ2 con la efectividad de ajuste de Hosmer-Lemeshow (H-L), respectivamente. Resultados: Un total de 342 pacientes, de 50.02 ± 16.66 años, 181 hombres (52.9%) y 161 mujeres (47.1%). El área bajo la curva ROC del modelo aditivo fue de 0.763, y la de la prueba Hosmer-Lemeshow fue de 5.30, con p = 0.62. El área bajo la curva ROC del modelo logístico fue 0.761 y de la prueba Hosmer-Lemeshow, 8.78, con p = 0.36. Conclusión: El modelo EuroSCORE es una herramienta confiable para estimar las probabilidades de muerte en pacientes adultos sometidos a cirugía cardiaca con o sin bomba en el HRAEB.

Prevalencia de burnout a través de dos medidas y su relación con variables sociodeportivas / Burnout's Prevalence through two Measures and its Relation with Sociodemographic's Variables

Resumen Se estudia la prevalencia del síndrome de burnout en deportistas y su relación con variables sociodeportivas. Se aplicaron los dos instrumentos de medida disponibles en España que miden el constructo: IBD-R y versión española del ABQ, en una muestra de 646 deportistas. Los resultados obtenidos muestran una prevalencia del 4.2 % para el IBD-R y 3.3 % para el ABQ, así como diferencias estadísticamente significativas para sexo, presentando los varones una realización personal más reducida que las mujeres, y niveles competitivos más altos de prevalencia general y de la subescala agotamiento físico/emocional en el nivel nacional que en el local. Estos datos son similares a los hallados en investigaciones anteriores, tanto en prevalencia como en diferencias según variables sociodeportivas.

Abstract This study aims to investigate the prevalence of burnout syndrome in athletes and their relation with different social and sporting variables. They have implemented the two instruments available in Spain for measuring burnout in athletes: IBD-R and the Spanish version of ABQ in a sample of 646 athletes with an average age of 19.73 years. The results show a prevalence of 4.2% for IBD-R and 3.3% for the ABQ and statistically significant differences for sex, presenting the smaller male self-fulfillment than women; and competitive, presenting higher prevalence levels overall and subscale physical/emotional exhaustion at the national level as home. These data are similar to those found in previous investigations, both prevalence and differences according social and sporting variables.