Minimally invasive intraoral removal of mesiodens via a transnasal, non-endoscopic approach: a systematic review on the purpose of 10 cases.

Mesiodens, which emerge towards the nasal cavity, often require consultation in maxillofacial practice. Typically accessed through wide palatal flaps with ostectomy, this method involves limited visibility and poses the risk of damaging the roots and apex of adjacent dental structures. This study advocates a minimally invasive technique that involves vestibulotomy between the central incisors, facilitating direct and rapid access through nasal floor dissection, minimizing comorbidities. A systematic review was performed, following the PRISMA guidelines, apropos on ten clinical cases reported in this study. The MEDLINE/Pubmed and Web of Science databases were searched. Several variables were considered and are presented comprehensively in tables and figures. Additionally, 10 case reports with mesiodens in the maxilla were submitted to surgical treatment using a minimally invasive intraoral transnasal disinclusion. The initial literature search resulted in 37 articles, of which 9 met the inclusion criteria for the analysis. Regarding postoperative complications, no bone exposure, incisor root damage, extensive surgical approach, palatal or vestibular hematoma, or palatal necrosis was observed. However, 10% experienced superficial damage to the nasopalatine neurovascular, while 80% and 20% presented mild and moderate postoperative facial edema, respectively. Hypoesthesia in 20% of patients recovered in the first week, 40% in the first month and 40% at 3 months. The minimally invasive intraoral, transnasal, non-endoscopic approach emerges as a safe and predictable alternative to conventional surgical techniques. Presumes minimal postoperative complications, mitigating the risk of excessive bone removal and damage to adjacent structures.

Fetal and maternal NLRP3 signaling is required for preterm labor and birth.

Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. One of every 4 preterm neonates is born to a mother with intra-amniotic inflammation driven by invading bacteria. However, the molecular mechanisms underlying this hostile immune response remain unclear. Here, we used a translationally relevant model of preterm birth in Nlrp3-deficient and -sufficient pregnant mice to identify what we believe is a previously unknown dual role for the NLRP3 pathway in the fetal and maternal signaling required for the premature onset of the labor cascade leading to fetal injury and neonatal death. Specifically, the NLRP3 sensor molecule and/or inflammasome is essential for triggering intra-amniotic and decidual inflammation, fetal membrane activation, uterine contractility, and cervical dilation. NLRP3 also regulates the functional status of neutrophils and macrophages in the uterus and decidua, without altering their influx, as well as maternal systemic inflammation. Finally, both embryo transfer experimentation and heterozygous mating systems provided mechanistic evidence showing that NLRP3 signaling in both the fetus and the mother is required for the premature activation of the labor cascade. These data provide insights into the mechanisms of fetal-maternal dialog in the syndrome of preterm labor and indicate that targeting the NLRP3 pathway could prevent adverse perinatal outcomes.

Defining a role for Interferon Epsilon in normal and complicated pregnancies.

Interferon epsilon (IFNe) is a recently described cytokine that is constitutively expressed in the female reproductive tract. However, the role of this hormonally regulated cytokine during human pregnancy is poorly understood. Moreover, whether IFNe participates in host immune response against bacteria-driven intra-amniotic infection or cervical human papillomavirus infection during pregnancy is unknown. Herein, using a unique set of human samples derived from multiple study cohorts, we aimed to uncover the role of IFNe in normal and complicated pregnancies. We showed that IFNe is expressed in the myometrium, cervix, and chorioamniotic membranes, and may therefore represent a constitutive element of host defense mechanisms in these tissues during pregnancy. The expression of IFNe in the myometrium and cervix appeared greater in late gestation than in mid-pregnancy, but did not seem to be impacted by labor. Notably, concentrations of IFNe in amniotic fluid, but not cervical fluid, were increased in a subset of women undergoing spontaneous preterm labor with intra-amniotic infection, indicating that IFNe could participate in anti-microbial responses in the amniotic cavity. However, stimulation with Ureaplasma parvum and/or lipopolysaccharide did not enhance IFNE expression by amnion epithelial or cervical cells in vitro, implicating alternative sources of this cytokine during intra-amniotic or cervical infection, respectively. Collectively, our results represent the first characterization of IFNe expression by human reproductive and gestational tissues during normal pregnancy and suggest a role for this cytokine in intra-amniotic infection leading to preterm birth.

Uso del polietileno poroso de alta densidad como alternativa en reconstrucción de fracturas orbitarias. Serie de 22 casos / Use of high-density porous polyethylene as an alternative in orbital fracture reconstruction. 22 Case series

Introducción: las fracturas de pared de órbita pueden producir secuelas funcionales y estéticas. La indicación de reconstrucción quirúrgica, es indispensable para la recuperación de la motilidad y estética ocular. Los materiales reconstructivos más utilizados son los aloplásticos, como el titanio y el polietileno poroso de alta densidad (PPAD), el cual ha resultado exitoso en reconstrucción maxilofacial. El propósito de este estudio retrospectivo, es exponer los resultados tras el uso del PPAD en reconstrucciones orbitarias y sus posibles complicaciones. Materiales y métodos: se realizó una revisión retrospectiva de 22 pacientes donde se utilizó PPAD como material de reconstrucción en fracturas orbitarias. Se consideró para la indicación quirúrgica que el paciente presentara alguno de los siguientes signos: diplopía o síntomas vasovagales por atrapamiento muscular, restricciones en la motilidad ocular, enoftalmo mayor a 4mm. El material utilizado fue PPAD (Medpor Stryker®) puro en 17 casos y PPAD reforzado con una malla de titanio en el interior de su estructura (Medpor Titan Stryker®), en los 5 restantes. Resultados: se registraron 3 casos con complicaciones; ectropión, diplopía y ectropión con diplopía, los cuales todos fueron reversibles. No se registraron casos de infección ni complicaciones oftalmológicas postoperatoria. Discusión: los injertos autólogos fueron los primeros utilizados con resultados de compatibilidad y resistencia óptimos. El uso de PPAD como material de reconstrucción ha sido bien documentado con buenos resultados en términos de una baja incidencia de infección y óptima motilidad ocular a largo plazo.

Introduction: Orbital wall fractures can cause functional and aesthetic sequelae. When there is an indication for surgical reconstruction, this is essential for the recovery of ocular motility and aesthetics. The most commonly used reconstructive materials are alloplastics, such as titanium and porous high-density polyethylene (PPAD), which have been successful in maxillofacial reconstruction. The purpose of this retrospective study is to present the results and their possible complications in orbital reconstruction with PPAD. Materials and methods: a retrospective review of 22 patients in whom PPAD was used as reconstruction material for orbital fractures was performed. It was considered for the surgical indication that the patient presented any of the following signs: diplopia or vasovagal symptoms due to muscle entrapment, ocular motility restrictions, enophthalmos greater than 4mm. The material used was pure PPAD (Medpor Stryker®) in 17 cases, and PPAD reinforced with a titanium mesh inside its structure (Medpor Titan Stryker®), in the remaining 5. Results: 3 patients with complications were registered; ectropion, diplopia, and ectropion with diplopia, all of which were reversible. There were no cases of postoperative infection or ophthalmological complications. Discussion: Autologous grafts were the first used with optimal compatibility and resistance results. The use of PPAD as a reconstruction material has been well documented with good results in terms of a low incidence of infection and optimal long-term ocular motility

Neo Formación Ósea de Rama y Cuerpo Mandibular Tras Uso de Injerto No Vascularizado de Cresta Ilíaca en Re-construcción Inmediata tras Resección de Ameloblastoma Folicular en Paciente de 11 años. Caso Clínico

RESUMEN: El tratamiento "gold standar" para los ameloblastomas mandibulares agresivos, especialmente en aquellas lesiones cuyos márgenes de exceresis superan los 6 cm, es la resección y reconstrucción inmediata con injerto óseo autólogo microvascularizado. Esto se basa en la necesidad de aporte sanguíneo para extensiones amplias de hueso implantado. Es necesario en estos casos una correcta estabilización y fijación del injerto mediante placas de reconstrucción (de titanio), y la ausencia de tejido sometido a radioterapia en la zona a tratar; siendo estos últimos elementos de gran importancia para el éxito quirúrgico. En el caso de pacientes pediátricos, los procesos de oseointegración y reparación ósea se ven beneficiados por el crecimiento fisiológico que conlleva la presencia de multiples factores de crecimiento. El objetivo de este reporte de caso es presentar el tratamiento de un ameloblastoma mandibular en paciente pediátrico tratado mediante resección y reconstrucción con injerto de cresta ilíaca no vascularizado de 10 cm de amplitud. Logrando neoformación ósea 3D del area reconstruida.

ABSTRACT: The gold standard for aggressive mandibular ameloblastomas, with exeresis margins higher than 6 cm, is immediate resection and reconstruction with autologous microvascularized bone graft. A controversy arises because the main reason to endorse this treatment relies on the blood supply for wide extensions of implanted bone. It is necessary in these cases to use a correct stabilization and attachment of the graft employing titanium reconstruction plates and to verify the absence of tissue undergoing radiotherapy. All of the above-mentioned elements are relevant for surgical success. In pediatric patients, the osseointegration and bone repair procedures benefit from physiological growth that entails the presence of multiple growth factors. The aim of this case report is to describe the management of mandibular ameloblastoma diagnosed in a pediatric patient and treated by resection and reconstruction with a non-vascularized 10 cm iliac crest graft thus achieving 3D bone neoformation of the reconstructed area.

Telerehabilitation is Effective to Recover Functionality and Increase Skeletal Muscle Mass Index in COVID-19 Survivors.

Objective: The purpose of this study was to evaluate the effects of a telerehabilitation program for COVID-19 survivors on their functionality, aerobic capacity, upper-lower body strength and skeletal muscle mass index. Methods: Fifty patients (22 M); age 54.1±15.4 who became ill with COVID-19 during 2020 completed a 24-session telerehabilitation program. The following measures were taken: Barthel's index, two minutes step test (2MST), elbow flexion one-repetition maximal (1RM), short physical performance battery (SPPB), hand grip strength, 30-second chair stand, skeletal muscle index (SMI), body fat percentage, resting pulse, arterial blood pressure, and pulse oximetry. Results: There was a significant increase in the Barthel index (p≤0.0001), 2MST (p≤0.0001), 1RM elbow flexion (p≤0.0001), SPPB (p≤0.0001), hand grip strength (p≤0.0001), 30-second chair stand (p≤0.000l), and SMI (p≤0.0001). Conclusion: A 24 session in-home telerehabilitation program promoted the recovery of physical independence and increases in skeletal muscle mass index and physical fitness.

Prognostic Value of Serum Lactate Levels in Critically Ill Patients in an Intensive Care Unit.

INTRODUCTION: The patient in critical condition, regardless of the cause of admission, continues to be a challenge for health systems due to the high mortality that it reports. There is a need to identify some marker of early obtaining, easy to interpret and with high relevance in the prognosis of these patients. OBJECTIVE: To determine the prognostic value of serum lactate in an Intensive Care Unit (ICU). METHOD: One hundred and forty-five patients admitted to an ICU were enrolled in the study. The Acute Physiology and Chronic Health Evaluation II (APACHE) prognosis score, Sequential Organ Failure Assessment, hemodynamic support need, mechanical ventilation, cause of admission, stay in ICU, analytical and physiological variables were determined. The probability of survival of patients who had elevated and normal serum lactate levels was calculated. The risk of dying was determined using the Cox regression model. RESULTS: Twenty-eight patients died (19%) in the ICU. The serum lactate value was higher in the group of patients with trauma, infections, APACHE II and high creatinine levels; as well as with decreased mean arterial blood pressure, need for hemodynamic support and mechanical ventilation. The survival capacity was higher in patients who had normal serum lactate. Serum lactate was the sole independent predictor of mortality (AHR 1.28 [1.07-1.53], p = 0.008). CONCLUSIONS: Patient assessment through the determination of serum lactate levels provides useful information in the initial evaluation of the critical patient.

Dual-plane slightly off-axis digital holography based on a single cube beam splitter.

In order to recover the holographic object information, a method based on the recording of two digital holograms, not only at different planes but also in a slightly off-axis scheme, is presented. By introducing a π-phase shift in the reference wave, the zero-order diffracted term and the twin image are removed in the frequency domain during the processing of the recorded holograms. We show that the zero-order elimination by the phase-shifted holograms is better than working with weak-order beam and average intensity removal methods. For recording experimentally two π-shifted holograms at different planes slightly off-axis, a single cube beam splitter is used. Computer simulations and experimental results, carried out to validate our proposal, show a high accuracy of π/14 that can be comparable with phase-shifting digital holography. For high fringe spacing, our proposal could be applied in electron holography, avoiding high voltage in a biprism.

Mycophenolic acid induces differentiation of Toxoplasma gondii RH strain tachyzoites into bradyzoites and formation of cyst-like structure in vitro.

The biochemical and structural changes that occur during the conversion of Toxoplasma gondii tachyzoites to bradyzoites and the formation of tissue cyst are not well understood. Maintaining cells infected with T. gondii type II and III strains under stress conditions induces the tachyzoite-bradyzoite in vitro differentiation, along with the formation of cyst-like structures. However, due to the long exposure to such conditions required to induce the differentiation, the severe damages in the host cell and the low encystation frequency, it has been difficult to dissect in more detail these processes. Here, we successfully induced the in vitro formation of Toxoplasma cysts-like structures from tachyzoites of the type I RH strain by treating with mycophenolic acid, an inhibitor of the inosine monophosphate dehydrogenase. Mycophenolic acid is a drug widely used for HXGPRT positive selection of Toxoplasma mutant strains along with xanthine incubation in the culture medium; under such conditions, formation of tissue cysts has not been reported. We show that the exposure of extracellular tachyzoites to mycophenolic acid in absence of xanthine, followed by host cell invasion, triggered their differentiation into cyst-like structures. The differential expression of CST1, BAG1, and SAG1 molecules, as well as the structural modifications of infected cells, was characterized during the formation of cyst-like structures in vitro. These findings will allow the characterization of signaling pathways involved in tachyzoite to bradyzoite conversion and formation of tissue cysts.

Evolutionary origin of endochondral ossification: the transdifferentiation hypothesis.

The vertebrate endoskeleton results from the piecemeal assembly of bone and cartilage as well as additional types of calcified extracellular matrices produced by seemingly hybrid cell types of intermediate phenotypes between osteoblasts and chondrocytes. Hence, shedding light on the emergence and subsequent diversification of skeletal tissues represents a major challenge in vertebrate evolutionary developmental biology. A 150-year-old debate in the field was recently solved by lineage tracing experiments demonstrating that, during mouse endochondral bone development, a subset of chondrocytes evades apoptosis and transdifferentiates into osteoblasts at the chondro-osseous junction. Here, we interpret these new data from a broad phylogenetic perspective, integrating fossil, histological, cellular, and genetic evidence from a wide range of vertebrates. We propose a testable scenario according to which transdifferentiation played a fundamental role in the emergence of endochondral ossification, an osteichthyan-specific evolutionary novelty. The remarkable skeletal cell plasticity might be contingent on the similar architectures of the osteoblastic and chondrocytic gene regulatory networks, thereby providing a unifying mechanism underlying both complete transdifferentiation as well as partial cell type conversions observed in intermediate skeletal tissues such as the chondroid bone or globuli ossei.

El hábito tabáquico en el colectivo de colegiados en enfermería de la Comunidad de las Islas Baleares / The smoking habits of registered nurses in the community of the Balearic Islands

Introducción: Se pretende evidenciar las conductas, creencias y actitudes relacionadas con el hábito tabáquico, del colectivo de colegiados de enfermería de las Islas Baleares. Sujetos y métodos: Estudio descriptivo transversal, mediante entrevista telefónica personal a 430 profesionales aleatorizados a partir de una población total de 4.800 colegiados de las Islas Baleares. La entrevista constaba de una parte dirigida a todos los colegiados independientemente de su hábito tabáquico, en la que se valoraban variables demográficas y actitudes ante la problemática del tabaquismo, tanto a nivel de creencias como de conductas y actitudes ante los pacientes, y otra parte específicamente dirigida a fumadores y exfumadores con la intención de caracterizar su hábito tabáquico. Resultados: De los 430 encuestados el 80% son mujeres. La media de edad es de 38 años. El 26,7% de la población es fumador. Los fumadores preguntan menos por el hábito tabáquico, se consideran peor formados en su manejo y aconsejan menos que abandonen el tabaco a sus pacientes que los no fumadores. Fuman menos en Atención Primaria que en Atención Especializada. Conclusión: Debería incrementarse la formación académica y laboral en tabaquismo ya que la mitad de los profesionales no se sienten preparados para su manejo

Introduction: This study aims to show the conducts, beliefs and attitudes towards smoking issues held by registered nurses in the Balearic Islands. Subjects and methods: A descriptive cross-sectional study was conducted through personal phone interviews with 430 nursing professionals selected randomly from the 4,800 registered nurses in Balearic Islands. The first part of the interview was directed to all nurses, whether addicted to tobacco or not, and rated demographic variables and attitudes towards smoking issues in terms of beliefs, as well as conducts and attitudes towards patients. The second part was specifically addressed to smokers and ex-smokers in order to draw a profile of their smoking habits. Results: Women accounted for 80% of the 430 nurses surveyed and their average age was 38. Of all nurses, 26.7% were smokers, 20.5% were ex-smokers and 52.8% were non-smokers. Smokers ask their patients fewer questions about their smoking habits, consider themselves less well-informed about how to address the issue and advise their patients to quit smoking on fewer occasions than non-smoking nurses do. Primary care professionals smoke less than specialised nurses do. Conclusion: Further training in smoking issues needs to be conducted, as half the nurses do not feel properly prepared to handle smoking issues (AU)

Caso clínico: brote de enfermedad del músculo blanco o miodegeneración nutricional en terneros / Clinical case: outbreak of white muscle disease or nutritional muscular dystrophy in calves

Un brote de Enfermedades del Músculo Blanco, EMB, o miodegeneración nutricional afectó una crianza de 56 terneros Frisones Rojos. En 45 días murieron 18 animales, de aproximadamente 5 meses de edad. Los signos eran taquipnea, dificultad para caminar, sin fiebre, taquicardia e ingurgitación de venas y yugulares. Sin alteraciones nerviosas ni digestivas. Los músculos de los miembros pélvicos, de la región lumbar y glutea preentaban endurecimiento moderado y leve dolor a la presión. En el rebaño se observaron muertes súbitas de terneros o a las pocas horas de presentarse los primeros signos. En la sangre la actividad de la enzima selenio (Se) dependiente glutatión peroxidasa, GSH-Px, estaba disminuida, señalando una deficiencia marginal de selenio. La actividad de enzimas asociadas a daños musculares, aspartato aminotransferasa (AST), y creatín quinasa (CK), estaban muy aumentadas. La necropsia reveló cardiomegalia con hipertrofia del ventrículo derecho, zonas con finas estriaciones longitudinales blanquecinas en epicardio y en el miocardio múltiples áreas irregulares también de color blanquecino. Los músculos esqueléticos en general estaban pálidos y se observaron con aspecto blanquecino. El examen histopatológico del miocardio evidenció células musculares eosinofílicas e irregulares, con pérdidas de la estación, destrucción segmental, núcleos grandes y pleomórficos; las células de Purkinje presentaban intensa eosinofilia y degeneración hiana de Zenker. También se observó degeneración hialina en los músculos esqueléticos. Se diagnostica Enfermedad del Músculo Blanco. Los terneros sobrevivientes fueron tratados con solución inyectable intramuscular de Se y vitamina E, en dosis equivalente a 8 mg de Se más 340 U.I. de vitamina E, repitiéndose a los 7 días. Instaurado el tratamiento no se presentaron nuevos casos.

Síndrome de urticaria, vasculitis e hipocomplementemia: presentación de un caso / Urticaria syndrome, vasculitis and hypocomplementemia: report of a case

Se presenta el caso de un niño urticaria crónica y vasculitis leucocitoclástica, quien tuvo involucro sistémico múltiple manifestado por artralgias, mialgias, glomerulonefritis membranosa y edema laríngeo; el perfil inmunológico para lupus eritematoso sistémico fue negativo. Se observó además hipocomplementemia persistente y depósitos de C'3 e inmunoglobulinas en piel y riñon, lo cual sugiere activación de la vía clásica del complemento hemolítico. Este síndrome ha sido descrito en pacientes adultos y parece corresponder a una enfermedad de la colágena distinta a las conocidas