Are the management objectives for hospital physicians ethical? / ¿Son éticos los objetivos de gestión para los médicos de nuestros hospitales?

Management objectives at times create significant value conflicts that have so far been seldom studied. This article analyses the ethical issues created by the operational objectives of management for physicians who work in Spanish hospitals. These issues are as follows: 1) the current system places quantity above quality, which represents a predominantly economist management perspective; 2) the system is hierarchical, lacks participation and deprives clinicians of decision-making authority; 3) the objectives are focused on outdated activities in terms of the current reality of the healthcare system and should therefore be updated considering, for example, chronicity and the continuity of care. After analysing these issues, we created a proposal for developing management objectives based on prioritising quality care (which ultimately results in efficient management), developing objectives in a participatory and mixed manner (with group and individual objectives) and designing new objectives in keeping with the current reality of the healthcare system. Putting this proposal into practice is not complicated because the final goal of clinicians and management is to provide optimal health care.

Optical side scattering radiometry for high resolution, wide dynamic range longitudinal assessment of optical fibers.

Current optical reflectometric techniques used to characterize optical fibers have to trade-off longitudinal range with spatial resolution and therefore struggle to provide simultaneously wide dynamic range (>20dB) and high resolution (<10cm). In this work, we develop and present a technique we refer to as Optical Side Scattering Radiometry (OSSR) capable of resolving discrete and distributed scattering properties of fibers along their length with up to 60dB dynamic range and 5cm spatial resolution. Our setup is first validated on a standard single mode telecoms fiber. Then we apply it to a record-length 11km hollow core photonic band-gap fiber (HC-PBGF) the characterization requirements of which lie far beyond the capability of standard optical reflectometric instruments. We next demonstrate use of the technique to investigate and explain the unusually high loss observed in another HC-PBGF and finally demonstrate its flexibility by measuring a HC-PBGF operating at a wavelength of 2µm. In all of these examples, good agreement between the OSSR measurements and other well-established (but more limited) characterization methods, i.e. cutback loss and OTDR, was obtained.

Relationship between orofacial function, dentofacial morphology, and bite force in young subjects.

OBJECTIVE: The aim was to evaluate the relationship between orofacial function, dentofacial morphology, and bite force in young subjects. SUBJECTS AND METHODS: Three hundred and sixteen subjects were divided according to dentition stage (early, intermediate, and late mixed and permanent dentition). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Orthodontic treatment need, bite force, lateral and frontal craniofacial dimensions and presence of sleep bruxism were also assessed. The results were submitted to descriptive statistics, normality and correlation tests, analysis of variance, and multiple linear regression to test the relationship between NOT-S scores and the studied independent variables. RESULTS: The variance of NOT-S scores between groups was not significant. The evaluation of the variables that significantly contributed to NOT-S scores variation showed that age and presence of bruxism related to higher NOT-S total scores, while the increase in overbite measurement and presence of closed lip posture related to lower scores. Bite force did not show a significant relationship with scores of orofacial dysfunction. No significant correlations between craniofacial dimensions and NOT-S scores were observed. CONCLUSION: Age and sleep bruxism were related to higher NOT-S scores, while the increase in overbite measurement and closed lip posture contributed to lower scores of orofacial dysfunction.

Dechlorane-related compounds in franciscana dolphin (Pontoporia blainvillei) from southeastern and southern coast of Brazil.

Concentrations of Dechlorane (Dec) 603 (0.75 ng/g lipid weight (lw); mean) and Dec 602 (0.38 ng/g lw; mean) were quantified in more than 95% of the franciscana (Pontoporia blainvillei) dolphin samples, whereas the frequency of detection decreased to 75% for Dechlorane Plus (DP) (1.53 ng/g lw, mean). The presence of Chlordene Plus (CP) was also observed (0.13 ng/g lw, mean) in half of the samples. On the contrary, Dec 604, decachloropentacyclooctadecadiene (aCl(10)DP), and undecachloropentacyclooctadecadiene (aCl(11)DP) concentrations were below the limit of quantifications in all cases. To the best of our knowledge, this is the first article reporting the presence of Dec 603, Dec 602, and CP in mammals. For comparative purposes, levels of Mirex, polybrominated diphenyl ethers (PBDEs), and decabromodiphenylethane (DBDPE) are also reported. Considering geographic distribution evaluation together with the strong positive correlations found between DP and PBDEs (r(s) = 0.63; p < 0.01), highly anthropogenic areas were identified as potential sources of these chemicals in this dolphin species. However, local sources for Dec 602, 603, Mirex, CP, and DBDPE were not found indicating that in this case historical use and/or atmospheric transport and deposition may play an important role in their fate.

Radiographical evaluation of bone quality after extraction of mandibular impacted and semi-impacted third molars.

AIM: The association between bone quality and fracture risk in the mandibular angle with the presence of impacted/semi-impacted third molars and after their extraction is controversial. This study aimed to assess mandibular bone quality in digital radiographies of patients after extraction of impacted/semi-impacted lower third molars. METHODS: A total of 130 sets of digital panoramic radiographies were selected and divided into the following three groups: Group 1 with 50 panoramic radiographies of patients with impacted/semi-impacted lower third molars, Group 2 with 30 panoramic radiographies of patients with lower third molar agenesis, and Group 3 with 50 panoramic radiographies of patients after extraction of impacted/semi-impacted lower third molars. The mandibular angular cortex was the anatomical structure used as parameter for bone quality assessment. ANOVA and Student's t test were applied for comparison between groups. RESULTS: Mandibular angular cortical width was significantly lower when the third molar was present in both genders (P<0.05). Agenesis of the third molar in women was associated with lower thickness of the mandibular cortex when compared with patients who had their third molar extracted (P<0.05). CONCLUSION: It can be concluded that the absence of impacted/semi-impacted lower third molars, was associated with a significant increase in cortical width.

Cell- and gene-therapy approaches to inner ear repair.

Sensorineural hearing loss is the most common sensory disorder in humans. It is primarily due to the degeneration of highly specialised mechanosensory cells in the cochlea, the so-called hair cells. Hearing problems can also be caused or further aggravated by the death of auditory sensory neurons that convey the information from the hair cells to the brain stem. Despite the discovery of stem/progenitor cells in the mammalian cochlea, no regeneration of either damaged hair cells or auditory neurons has been observed in mammals, in contrast to what is seen in avians and non-mammalian vertebrates. The reasons for this divergence have not yet been elucidated, although loss of stem cells and/or loss of their phenotypic plasticity in adult mammals have been put forward as possible explanations. Given the high incidence of this disorder and its economic and social implications, a considerable number of research lines have been set up aimed towards the regeneration of cochlear sensory cell types. This review summarizes the various routes that have been explored, ranging from the genetic modification of endogenous cells remaining in the inner ear in order to promote their transdifferentiation, to the implantation of exogenous stem or progenitor cells and their subsequent differentiation within the host tissue. Prophylactic treatments to fight against progressive sensory cell degeneration in the inner ear are also discussed.

Influencia de la técnica anestésica en el riesgo de recidiva tumoral en el cáncer de mama tras la cirugía / No disponible

La enfermedad metastásica es la principal causa de muerte relacionada con el cáncer. La técnica anestésica y los diversos fármacos empleados pueden interactuar con el sistema inmune celular y modificar los resultados a largo plazo. Hay un interés particular en la actualidad en el efecto de la anestesia regional, que pudiera ser beneficiosa en ciertas cirugías oncológicas. Análisis retrospectivos han demostrado un beneficio de la anestesia-analgesia paravertebral en los resultados tras cirugía del cáncer de mama. La evidencia disponible sugiere que los agentes anestésicos tienen efectos a corto plazo reversible en la inmunidad del huésped, y no existe todavía ninguna evidencia que sugiera que una técnica de anestesia se asocie con mejores resultados en pacientes con cáncer(AU)

Metastatic disease is the most important cause of cancer-related death. Anaesthetic technique and drug choice can interact with the cellular immune system and effect long-term outcome. There is particular interest at present in the effect of regional anaesthesia, which appears to be beneficial. Retrospective analyses have shown an outcome benefit for paravertebral analgesia for breast cancer surgery. Available evidence suggests that anaesthetic agents have short-term reversible effects on host immunity, and there is as yet no evidence to suggest that one anaesthetic technique is associated with better outcomes in cancer patients(AU)

Robust reporter system based on chalcone synthase rppA gene from Saccharopolyspora erythraea.

Industrial overproducing strains present unique hosts for expression of heterologous gene clusters encoding secondary metabolite biosynthesis. For this purpose, efficient gene expression tools and methods are needed. A robust and versatile reporter system based on the rppA gene from Saccharopolyspora erythraea is presented as the method of choice when studying gene expression in actinomycete hosts. The method is easily scalable to accommodate high-throughput procedure, and collected samples can be easily stored and re-tested when needed. The product of RppA is an inert 1,3,6,8-tetrahydroxynaphthalene which spontaneously oxidises to a dark-red quinone flaviolin providing a qualitative visual assessment of gene expression on an agar plate as well as a quantitative spectrophotometric measurement in liquid broth without the need for invasive procedures or external substrate addition. The applicability of the reporter system has been demonstrated by expressing the rppA gene under the control of the heterologous promoters actII-ORF4/PactI, ermE and its upregulated variant ermE*. The model streptomycete Streptomyces coelicolor, and three industrially important species, Streptomyces tsukubaensis (FK506), Streptomyces cinnamonensis (monensin) and Streptomyces rimosus (oxytetracycline) were used as hosts. The reporter system has shown its utility independently of cultivation conditions or composition of growth medium, from simple laboratory to complex industrial media. The simplicity and robustness of the system, demonstrated even in industrial settings, shows great potential for wider use in different microbial hosts and applications, and may thus represent a new generic and versatile tool useful to a wider scientific community.

Effects of therapeutic concentrations of diphenylhydantoin on transmembrane potentials of normal and depressed Purkinje fibers.

Standard intracellular microelectrode techniques were used to study canine Purkinje fibers (PF) which had been superfused with blood or Tyrode's solution to determine the cardiac cellular electrophysiologic changes induced by antiarrhythmic concentrations of diphenylhydantoin (DPH). Some PF were normal whereas others were depressed by stretch, exposure to ouabain (125 mug/1) or superfusion with a solution in which all Na+ was replaced by tetraethylammonium. For normal fibers, therapeutic concentrations of DPH (DPH) induced slight decreases in action potential (AP) amplitude, maximum upstroke velocity of phase O (Vmax) and membrane responsiveness and somewhat greater decreases in AP duration. For fibers moderately depressed by ouabain or stretch, with reduced AP amplitude, maximum diastolic potential and Vmax, therapeutic [DPH] increased these variables. Fibers markedly depressed by Na-free solution or stretch developed slow response AP. The amplitude and Vmax of the AP were decreased by therapeutic [DPH]. Therapeutic [DPH] also suppressed automaticity and ouabain-induced delayed afterdepolarizations. Our studies suggest that the slight depression of normal PF AP characteristics induced by therapeutic [DPH] probably is of little significance with respect to antiarrhythmic effect. In contrast, both the improvement of AP characteristics of moderately depressed fibers and further depression of severely depressed fibers caused by [DPH] might modify arrhythmias. Effects of DPH on automaticity and delayed afterdepolarizations also would contribute to its antiarrhythmic effect.