The Impact of Candida albicans in the Development, Kinetics, Structure, and Cell Viability of Biofilms on Implant Surfaces-An In Vitro Study with a Validated Multispecies Biofilm Model.

This study aimed to evaluate the impact of Candida albicans on subgingival biofilm formation on dental implant surfaces. Scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) were used to compare biofilm structure and microbial biomass in the presence and absence of the fungus after periods of 24, 48, and 72 h. Quantitative polymerase chain reaction (qPCR) was used to quantify the number of viable and total micro-organisms for each of the biofilm-forming strains. A general linear model was applied to compare CLSM and qPCR results between the control and test conditions. The biofilm developed with C. albicans at 72 h had a higher bacterial biomass and a significantly higher cell viability (p < 0.05). After both 48 and 72 h of incubation, in the presence of C. albicans, there was a significant increase in counts of Fusobacterium nucleatum and Porphyromonas gingivalis and in the cell viability of Streptococcus oralis, Aggregatibacter actinomycetemcomitans, F. nucleatum, and P. gingivalis. Using a dynamic in vitro multispecies biofilm model, C. albicans exacerbated the development of the biofilm grown on dental implant surfaces, significantly increasing the number and cell viability of periodontal bacteria.

Agronomic Evaluation and Chemical Characterization of Lavandula latifolia Medik. under the Semiarid Conditions of the Spanish Southeast.

Lavandula latifolia is one of the main rainfed crops of aromatic and medicinal plants produced in Spain. As a global concern, the agronomic productivity of this aromatic crop is also threatened by the consequences of imminent climate change. On this basis, the study of the agronomic production of two drought-tolerant ecotypes, after three years of cultivations practices, constitutes the main objective of the present study. For this trial, clones of the two pre-selected ecotypes, along with clones from two commercial plants (control), were grown in an experimental plot. The main results confirmed an increase in biomass and essential oil production with plant age. The essential oil chemotype defined by 1,8-cineol, linalool, and camphor was maintained over time, but a decrease in 1,8-cineol in the benefit of linalool was detected. In the phenolic profile, 14 components were identified, with salvianic acid and a rosmarinic acid derivate being the main compounds quantified. These phenolic extracts showed potent in vitro antioxidant capacity, and after the second year of cultivation practices, both phenolic compounds and antioxidant capacity remained stable. Thus, under semiarid conditions, L. latifolia drought-tolerant ecotypes reach a good level of production after the second year of crop establishment.

Estimulación ovárica en síndrome de Mayer-Rokitansky: reporte de caso y revisión de la literatura / Controlled ovarian stimulation in Mayer-Rokitansky syndrome: case report and literature review

Resumen El síndrome de Mayer-Rokitansky-Küster-Hauser (SMRKH) es una anomalía del tracto genital femenino caracterizada por ausencia congénita del útero y porción superior de la vagina. Ocurre en uno de cada 4,500 nacimientos y se diagnostica normalmente durante la adolescencia al presentarse amenorrea primaria. Su función ovárica está preservada, pero la información actual respecto al potencial reproductivo de estas pacientes es limitada. Se presenta el caso de una mujer con diagnóstico de SMRKH sometida a estimulación ovárica para transferencia de embriones a útero subrogado y se discute su potencial reproductivo: técnicas de reproducción asistida, intervenciones e impacto psicológico.

Abstract Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a congenital anomaly of the female genital tract characterized by congenital absence of the uterus and upper part of the vagina. It occurs in 4,500 female births and diagnosis is usually made during adolescence when primary amenorrhea presents. They have functioning ovaries but data regarding their reproductive potential is limited. We hereby report the case of a woman diagnosed with MRKH syndrome in whom assisted reproductive techniques were used to try to achieve pregnancy by gestational surrogacy and their reproductive potential is discussed: assisted reproductive techniques, procedures, and psychological impact.

Biofilm formation on dental implants with a hybrid surface microtopography: An in vitro study in a validated multispecies dynamic biofilm model.

OBJECTIVES: The objective of this study is to qualitatively and quantitatively evaluate biofilm formation on hybrid titanium implants (HS), with moderately rough and turned surface topographies. MATERIALS AND METHODS: A validated dynamic in vitro multispecies biofilm model, based on bacterial growth under flow and shear conditions resembling the oral cavity, was used to evaluate biofilm formation on the tested implant surfaces. Scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) were used to compare the biofilm structure and microbial biomass deposited on either the moderately rough or the turned surface of HS. Quantitative polymerase chain reaction (qPCR) was used to evaluate the total bacterial counts and counts of each specific bacterium in biofilms formed on implants with either the moderately rough or the turned surfaces, as in the hybrid titanium implants, after 24, 48 and 72 h. A general linear model was applied to compare the CLSM and qPCR results between the tested implant surfaces. RESULTS: A significantly higher bacterial biomass grew on the moderately rough implant surfaces, compared to the turned surface area of HS implants (p < .05), at all incubation times, as evidenced with both CLSM and SEM. qPCR analysis also demonstrated an important increase in the total and specific bacterial counts in moderately rough surface implants at the three incubation times. CONCLUSIONS: Implant surface topography (moderately rough versus turned) significantly influenced in vitro biofilm formation in terms of biofilm structure, bacterial biomass and quantity of the specific species selected for the model used.

The Antimicrobial Activity of Curcumin and Xanthohumol on Bacterial Biofilms Developed over Dental Implant Surfaces.

In search for natural products with antimicrobial properties for use in the prevention and treatment of peri-implantitis, the purpose of this investigation was to evaluate the antimicrobial activity of curcumin and xanthohumol, using an in vitro multi-species dynamic biofilm model including Streptococcus oralis, Actinomyces naeslundii, Veillonella parvula, Fusobacterium nucleatum, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. The antimicrobial activities of curcumin (5 mM) and xanthohumol (100 µM) extracts, and the respective controls, were evaluated with 72-h biofilms formed over dental implants by their submersion for 60 seconds. The evaluation was assessed by quantitative polymerase chain reaction (qPCR), confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). For the data analysis, comparisons were tested applying ANOVA tests with post-hoc Bonferroni corrections to evaluate the antimicrobial activity of both extracts. With qPCR, statistically significant reductions in bacterial counts were observed for curcumin and xanthohumol, when compared to the negative control. The results with CLSM and SEM were consistent with those reported with qPCR. It was concluded that both curcumin and xanthohumol have demonstrated antimicrobial activity against the six bacterial species included in the dynamic in vitro biofilm model used.

Live Birth Rate Following Bed Rest Versus Early Mobilization After Embryo Transfer: A Systematic Review And Meta-Analysis.

Embryo transfer (ET) is the final step of in vitro fertilization (IVF). Different strategies have been proposed to increase the likelihood of implantation, such as post-transfer bed rest. The objective of this manuscript was to compare the clinical outcomes of embryo transfers after IVF of patients offered rest vs. early ambulation. The patient, intervention, comparison, and outcome(s) (PICO) model was used to select the study population, which included women/couples submitted to IVF and prescribed bed rest or early ambulation. Only studies including live birth (LB) as an outcome were included (www.crd.york.ac.uk/PROSPERO/CRD42020188716) A systematic search for studies was conducted on MEDLINE, ClinicalTrials.gov, PubMed, and the Cochrane Library. A librarian coordinated the searches in May 2020, which considered articles published since 1995. All original peer-reviewed articles in English were included, regardless of study design. The search retrieved 27 citations, of which 14 were eligible for full-text analysis and four accepted for inclusion. The studies included data on 21,598 patients/cycles (rest: 20,138; early ambulation: 1,460). Patients prescribed bed rest had an LB rate of 43.6% vs. 52.5% in the individuals not offered bed rest. The meta-analysis yielded an odds ratio of 0.77 (95% CI 0.5-1.2), which means patients on bed rest were 23% less likely to have a LB; nevertheless, this difference was not statistically significant. Considering that there is no difference between the two strategies, there is no evidence to recommend bed rest after embryo transfer.

Diastereoselective synthesis of new zwitterionic bicyclic lactams, scaffolds for construction of 2-substituted-4-hydroxy piperidine and its pipecolic acid derivatives.

The synthesis of new chiral highly functionalized zwitterionic bicyclic lactams starting from acyclic ß-enaminoesters derived from (R)-(-)-2-phenylglycinol is described. The key step involved an intramolecular non-classical Corey-Chaykovsky ring-closing reaction of the corresponding sulfonium salts derived from ß-enaminoesters. This methodology permits the generation of two or three new stereogenic centers with high diastereoselectivity. The utility of these intermediates was demonstrated by the stereocontrolled total synthesis of cis-4-hydroxy-2-methyl piperidine and its corresponding pipecolic acid derivative.

El Microbioma del tracto reproductivo: una revisión narrativa de la literatura / The reproductive Microbiome: a narrative review of the literature

Antecedentes: Históricamente, el enfoque de la investigación en torno al microbioma se ha centrado en patología, mientras que su fisiología se ha ignorado en gran medida. La importancia de este papel fi- siológico se demostró cuando el proyecto del genoma humano se publicó en 2001. Objetivo: Discutir la investigación actual sobre el microbioma del tracto reproductivo femenino, con el fin de proporcionar una opinión experta sobre cómo utilizar este conocimiento en la práctica clínica del diagnóstico y tra- tamiento en el área de la ginecología, la obstetricia y la infertilidad. Material y metodos: En septiembre de 2020, se realizó una búsqueda electrónica en las bases de datos: PubMed y Google Scholar. La es- trategia de búsqueda incluyó palabras clave relacionadas con la literatura científica sobre el microbioma del tracto reproductivo femenino, como (sólo o en combinación): microflora, microbiota, tracto genital, reproducción, semen, vagina, útero, cervical, placenta, concepción, reproducción asistida y microbioma urogenital. La búsqueda se limitó a ensayos clínicos, estudios de cohorte (prospectivos y retrospectivos) y transversales, revisiones sistemáticas y revisiones de la literatura publicados entre 2000 y agosto de 2020. Resultados: Se reunieron 109 artículos de los que se eliminaron 73 por duplicidad y 4 no cum- plieron los criterios de inclusión; al final se analizaron 32 artículos. Tras la revisión de la literatura, se exponen los conceptos más relevantes para entender el impacto de la microbiota y su microbioma tanto en el área de la obstetricia, como de la ginecología y de la medicina reproductiva. AU)

Background:Historically, the focus of research around the microbiome has been on pathology, while its physiology hasbeen largely ignored. The importance of this physiological role was demonstrated when the Human Genome Project waspublished in 2001. Objective:To discuss current research on the female reproductive tract microbiome, in order to providean expert opinion on how to use this knowledge in the clinical practice in the area of gynecology, obstetrics and infertility.Material and methods:In September ‘20, an electronic search was carried out in PubMed and Google Scholar. Thesearch strategy included keywords related to the scientific literature on the female reproductive tract microbiome, such as(alone or in combination): microflora, microbiota, genital tract, reproduction, semen, vagina, uterus, cervical, placenta,conception, assisted reproduction and the urogenital microbiome. The search was limited to clinical trials, cohort studies(prospective and retrospective) and cross-sectional, systematic reviews, and reviews of the literature published between2000 and August 2020. Results:A total of 109 articles were identified after the search, of which 73 were eliminated dueto duplication, and 4 did not meet the inclusion criteria. In the end, 32 articles were analyzed. After thoroughly reviewingthe literature, the most relevant concepts are exposed to understand the impact of the microbiota and its microbiome bothin the area of obstetrics, gynecology and reproductive medicine. Conclusions:A comprehensive understanding of therole of the reproductive microbiome guarantees improvements in fertility treatments and of the reproductive health in ge-neral. Although the field is new, there are already ways to use what is known to improve clinical practice and achievebetter results in the different facets of a woman's life. (AU)

Association of ovarian stimulation and embryonic aneuploidy in in vitro fertilization cycles with preimplantation genetic testing: A narrative systematic review.

The impact of gonadotropins used for COS on the rate of embryo aneuploidy in patients without the negative effects of age as a confounding factor, is still a subject of lively debate. We ran a systematic search for studies in MEDLINE, PubMed, Google Scholar and the Cochrane Library. A librarian coordinated the search in December of 2020. We included all original peer-reviewed papers in English, irrespective of study-design. There were no restrictions concerning method of amplification or platform used to analyze the amplified DNA. We used the PICO model to select the study population. We included women/couples submitted to COS for IVF with the intention to genetically analyze her/their embryos through PGT. The primary outcome was the rate of aneuploidy. We used the Newcastle-Ottawa scale (NOS) score to evaluate the quality of the studies included. The search yielded 73 citations, and 14 were eligible for analysis, which included data on 4805 cycles. Media quality NOS score was 8. Although it has been demonstrated that natural cycles are associated with aneuploidy, it does seem that more robust stimulations are indeed associated with a higher proportion of aneuploidy. Nevertheless, a higher response is associated with an increased number of euploid embryos available for transfer, which translates into more embryo-transfer cycles with a prospective higher cumulative live birth rate. Further evidence is needed to ascertain if there is a negative impact of COS, especially at the cellular level.

Conceptos básicos en inmunología de la reproducción: revisión narrativa de la bibliografía / Basic concepts in reproductive immunology: a narrative review of the literature

Resumen: ANTECEDENTES: La inmunología de la reproducción no es un área nueva: siempre ha estado relacionada con el aborto recurrente y con la falla repetida en la implantación, sobre todo en el contexto de una fertilización in vitro. Recientemente emergieron nuevos conceptos importantes que los ginecoobstetras deben considerar. OBJETIVO: Interrelacionar los conceptos básicos de inmunología, embriología y reproducción asistida para comprender mejor lo que la primera puede resolver y lo que no. METODOLOGÍA: Estudio retrospectivo efectuado con base en la búsqueda electrónica, llevada a cabo en febrero de 2020 en las bases de datos: PubMed y Google Scholar con los siguientes términos (MeSH): abortion, spontaneous/immunology; embryo implantation/immunology; HLA-c antigens/immunology; immune tolerance/immunology; immunity, maternally-acquired/immunology; uterus/immunology; killer cells, natural/immunology; placentation/immunology; receptors, kir/immunology; antigen presentation/genetics; antigen presentation/immunology; maternal-fetal exchange/genetics; maternal-fetal exchange/immunology. RESULTADOS: Se reunieron 289 artículos y se eliminaron 248 por no cumplir con los criterios de inclusión; solo se analizaron 41. Los artículos identificados sirvieron de base para actualizar la situación de la inmunología en el contexto de la medicina de la reproducción. Durante el proceso se revisaron otros artículos que sirvieran de soporte bibliográfico a los conceptos descritos en esta revisión. CONCLUSIONES: Debido al destacado interés en el estudio de la genética de los embriones, la medicina de la reproducción se enfocó más en ella y dejó de lado a la inmunología. Sin embargo, como la genética sigue sin poder explicar de manera adecuada las fallas en la implantación, la inmunología de la reproducción vuelve a cobrar impulso.

Abstract: BACKGROUND: Reproductive immunology is not a new area in reproductive medicine, it has always been related to recurrent miscarriage and repeated implantation failure, especially in the context of IVF. Recently, new concepts have emerged that are important for OBGYN specialists to keep in mind. OBJECTIVE: Interrelating the basic concepts of immunology, embryology and assisted reproduction to better understand what the former can and cannot solve. METHODOLOGY: Retrospective study based on the electronic search, carried out in February 2020, in the databases: PubMed and Google Scholar with the following terms (MeSH) The following MeSH terms were used: Abortion, Spontaneous/immunology; Embryo Implantation/immunology; HLA-C Antigens/immunology; Immune Tolerance/immunology; Immunity, Maternally-Acquired/immunology; Uterus/immunology; Killer Cells, Natural/immunology; Placentation/immunology; Receptors, KIR/immunology; Antigen Presentation/genetics; Antigen Presentation/immunology; Maternal-Fetal Exchange/genetics; Maternal-Fetal Exchange/immunology. RESULTS: 289 articles were collected, and 248 articles were deleted because they did not meet the inclusion criteria; only 41 were analyzed. The articles identified served as a basis for updating the status of immunology in the context of reproductive medicine. During the process, other articles were reviewed to serve as bibliographic support for the concepts described in this review. CONCLUSIONS: Due to the outstanding interest in the study of embryo genetics, reproductive medicine focused more on it and left immunology aside. However, since genetics still cannot adequately explain implantation failures, reproductive immunology is gaining momentum again.

A novel connection between the Cell Wall Integrity and the PKA pathways regulates cell wall stress response in yeast.

Fungal cells trigger adaptive mechanisms to survive in situations that compromise cell wall integrity. We show here that the global transcriptional response elicited by inhibition of the synthesis of ß-1,3-glucan by caspofungin, encompasses a set of genes that are dependent on Slt2, the MAPK of the Cell Wall Integrity (CWI) pathway, and a broad group of genes regulated independently of Slt2. Genes negatively regulated by the cyclic AMP/Protein Kinase A (PKA) signaling pathway were overrepresented in the latter group. Moreover, cell wall stress mediated by inhibition of ß-1,3-glucan synthesis, but not by other cell wall interfering compounds, negatively regulated PKA signaling as indicated by the nuclear localisation of Msn2, cellular glycogen accumulation, a decrease of intracellular cAMP levels and a severe decrease in both the activation of the small GTPase Ras2 and the phosphorylation of known substrates of PKA. All these effects relied on the plasma membrane-spanning sensor of the CWI pathway Wsc1. In addition, caspofungin induced a reduction in the cytosolic pH, which was dependent on the extracellular region of Wsc1. Therefore, alterations of the ß-1,3-glucan network in the fungal cell wall, induce, through Wsc1, the activation of the CWI pathway and parallel inhibition of PKA signaling.

Automatic segmentation of Potyviridae family polyproteins.

We describe an automatic segmentation method for polyproteins of the viruses belonging to the Potyviridae family. It uses machine learning techniques in order to predict the cleavage site which define the segments in which said polyproteins are cut in their process of functional maturation. The segmentation application is publicly available for use on a website and it can be accessed through the web service interface too. The prediction models have an average sensitivity of 0.79 and a Matthews correlation coefficient average of 0.23. This method is capable of predicting correctly (coinciding with previously published segmentation) the segmentation of sequences which come from Potyvirus and Rymovirus, genera. However accurate prediction capabilities are affected when faced with either atypical sequences or viruses belonging to less common genera in the Potyviridae family. Future work will focus on establishing greater flexibility in this sense.

Evaluación de la mutagenicidad causada por metales pesados presentes en agua del río Cauca en la ciudad de Cali, Colombia / Mutagenicity evaluation caused by heavy metals found in Cauca river water in the city of Cali, Colombia / Avaliação de mutagenicidade causados por metais pesados encontrados na água do rio de água Cauca na cidade de Cali, Colômbia

Se evaluó la mutagenicidad del agua del río Cauca debida a la presencia de metales pesados en la zona urbana de la Ciudad de Santiago de Cali, a partir de muestras tomadas en la temporada seca y lluviosa en el año 2013. Los metales se extrajeron pasando el agua por la resina Amberlite XAD-16. Las concentraciones de los metales pesados se midieron por absorción atómica y la mutagenicidad se evaluó por medio del test de Ames, con las cepas TA98 y TA100 de Salmonella typhimurium con y sin activador enzimático S9. Los resultados mostraron índices de mutagenicidad (IM) positivos (IM > 2,0) para muestras colectadas en temporada lluviosa en tres de los cinco puntos evaluados: puente El Hormiguero (IM = 3,6), desembocadura del Canal Colector Sur (IM = 2,9) y desembocadura del río Cali (IM = 2,7), todos con la cepa TA98 sin S9. Estos sitios presentaron a su vez las mayores concentraciones totales de metales pesados en sus extractos. El análisis de la variación espacio-temporal del índice mutagénico se realizó haciendo un análisis de varianza multifactorial del IM. Los resultados encontrados indican que la época de muestreo contribuye significativamente a la variabilidad del IM , mientras que los puntos de muestreo no.

The mutagenicity of the Cauca River water due to the presence of heavy metals was evaluated in the urban area of the city of Santiago de Cali, from samples taken during the rainy and dry season of 2013. The metals were extracted from water samples using the resin Amberlite XAD-16. The concentrations of heavy metals were measured by atomic absorption and mutagenicity was evaluated by the Ames test, using the TA98 and TA100 strains of Salmonella typhimurium with and without the S9 enzymatic activator. The results showed mutagenicity indices (MI > 2.0) in three of the five points evaluated: El Hormiguero Bridge (MI = 3.6), the mouth of southern collector channel (MI = 2.9) and the mouth of Cali River (MI = 2.7), all with strain TA98 without S9. These sampling points in turn presented the highest total concentrations of heavy metals in the extracts. The determination and analysis of spatio-temporal variation of the mutagenic effects obtained was done by conducting multifactorial variance analysis of MI, finding that the effect of sampling season contributes significantly to the variability of MI unlike the sampling points.

A mutagenicidade da água do rio Cauca, devido à presença de metais pesados foi avaliada-na área urbana da cidade de Santiago de Cali, a partir de amostras coletadas durante as estaçãoes chuvosa e seca em 2013. Os metais foram extraídos, passando a água pela a resina Amberlite XAD-16. As concentrações de metais pesados foram medidas por Absorção Atômica e a mutagenicidade foi avaliada através do teste de Ames, com TA98 e TA100 de Salmonella typhimurium estirpes com e sem S9 activador da enzima. Os resultados mostraram índices de mutagenicidade positiva (MI > 2,0) para amostras coletadas na estação chuvosa em três dos cinco pontos avaliados: El Hormiguero ponte (MI = 3,6), foz do canal coletor (IM = 2, 9) e foz do rio Cali (MI = 2,7), todos com a linhagen TA98 sem S9. Esses locais, a presentaram as maiores concentrações totais de metais pesados em seus extratos. A determinação e análise da variação espaço-temporal do índice mutagénico foi realizada utilizando-se a análise de variância multivariada do IM, sendo encontrado que o efeito da época de amostragem contribui significativamente na a variabilidade de IM ao contrário dos pontos de amostragem.

Ustilago maydis killer toxin as a new tool for the biocontrol of the wine spoilage yeast Brettanomyces bruxellensis.

Brettanomyces bruxellensis is one of the most damaging species for wine quality, and tools for controlling its growth are limited. In this study, thirty-nine strains belonging to Saccharomyces cerevisiae and B. bruxellensis have been isolated from wineries, identified and then tested against a panel of thirty-nine killer yeasts. Here, for the first time, the killer activity of Ustilago maydis is proven to be effective against B. bruxellensis. Mixed cultures in winemaking conditions show that U. maydis CYC 1410 has the ability to inhibit B. bruxellensis, while S. cerevisiae is fully resistant to its killer activity, indicating that it could be used in wine fermentation to avoid the development of B. bruxellensis without undesirable effects on the fermentative yeast. The characterization of the dsRNAs isolated and purified from U. maydis CYC 1410 indicated that this strain produces a KP6-related toxin. Killer toxin extracts were active against B. bruxellensis at pH values between 3.0 and 4.5 and temperatures comprised between 15 °C and 25 °C, confirming their biocontrol activity in winemaking and wine aging conditions. Furthermore, small amounts (100 AU/ml) of killer toxin extracts from U. maydis significantly reduced the amount of 4-ethylphenol produced by B. bruxellensis, indicating that in addition to the growth inhibition observed for high killer toxin concentrations (ranging from 400 to 2000 AU/ml), small amounts of the toxin are able to reduce the production of volatile phenols responsible for the aroma defects in wines caused by B. bruxellensis.

Screening for osteoporosis: a survey of older psychiatric inpatients at a tertiary referral centre.

BACKGROUND: Osteoporosis causes much morbidity and mortality among elderly people. Older inpatients with severe mental illness may be at particular risk of osteoporosis because of factors including immobility, vitamin D deficiency and psychotropic medication. METHOD: We screened predominantly older inpatients with severe mental illness for osteoporosis using a peripheral DEXA scanner. Associations were examined between patient variables and osteoporosis as detected by DEXA scan, Z-scores and history of fragility fractures. Patients were followed up to see how many subsequently received drug treatment for osteoporosis. Patient acceptability of the scanning technique was also assessed. RESULTS: It was possible to scan 72/89 (81%) of patients. Mean T-score was -2.79 (SD 1.50) and mean Z-score -0.76 (SD 1.34). Forty-two (58%) patients had osteoporosis and 23 (32%) osteopenia. Twelve (17%) patients with a history of fragility fractures had osteoporosis on DEXA scan. A scan suggestive of osteoporosis and a history of fragility fractures were both associated with age of 75 years and over and thoracic kyphosis. Low Z-scores were associated with longer hospital stay and osteoporosis-predisposing drugs. Patient acceptability of scanning was high. At follow-up, only 7/16 (44%) patients were suitable for central scanning and 9/40 (23%) for bisphosphonates. CONCLUSION: Older institutional patients with severe mental illness are likely to be at high risk of developing osteoporosis. Peripheral DEXA scanning is acceptable to these patients and identifies those at high risk of fractures. Some behaviorally disturbed patients are not suitable for central scans or for some osteoporosis drug treatments.

[Evolution of children one year post liver transplant]. / Evolución de niños post-trasplante hepático luego del primer año de sobrevida.

Orthotopic liver transplantation is the only definitive mode of therapy for children with end-stage liver disease. However, it remains challenging because of the necessity to prevent long-term complications. The aim of this study was to analyze the evolution of transplanted patients with more than one year of follow up. Between November 1992 and November 2001, 238 patients underwent 264 liver transplantations. A total of 143 patients with more than one year of follow up were included. The median age of patients +/- SD was 5.41 years +/- 5.26 (r: 0.58-21.7 years). All children received primary immunosuppression with cyclosporine. The indications for liver replacement were: fulminant hepatic failure (n: 50), biliary atresia (n: 38), cirrhosis (n: 37), chronic cholestasis (n: 13) and miscellaneous (n: 5). The indications for liver re-transplantation were: biliary cirrhosis (n: 7), hepatic artery thrombosis (n: 4) and chronic rejection (n: 3). Reduced-size liver allografts were used in 73/157 liver transplants, 14 of them were from living-related donors and 11 were split-livers. Patient and graft survival rates were 93% and 86% respectively. Death risk was statistically higher in retransplanted and reduced-size grafted patients. Growth retardation and low bone density were recovered before the first 3 years post-transplant. The incidence of lymphoproliferative disease was 7.69%. De novo hepatitis B was diagnosed in 7 patients (4.8%). Social risk did not affect the outcome of our population. The prevention, detection and early treatment of complications in the long-term follow up contributed to improve the outcome.

Alternativa quirúrgica de ayuda al ortodoncista en pacientes con FLAP bilateral / Aiding surgical alterantive for the orthodontist in bilateral cleft patients

El tratamiento del paciente que presenta FLAP bilateral con un avance extramadamente pronunciado es un tema controvertido en el que se presentan diversas alterantivas para su solución de acuerdo con los distintos autores. En este trabajo presentamos la vía de Prevomerectomía como resolución al caso de la premaxila avanzada por delante del apex nasal. Describimos la técnica quirúrgica, algunos detalles importantes en cuanto al manejo del paciente, habida cuenta de lo que significa resolver esta seria malformación que afecta funcional y estéticamente además del efecto psicológico para el paciente y su entorno.