Paciente con xerostomía posradioterapia por cáncer de cabeza y cuello tratado con células madre mesenquimales autólogas expandidas de tejido adiposo: una nueva oportunidad terapéutica / Radiation-induced xerostomia in a patient with head and neck cancer treated with Injection of autologous expanded adipose tissue-derived mesenchymal stem cells: A new therapeutic opportunity

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Impact of Use Frequency of a Mobile Diabetes Management App on Blood Glucose Control: Evaluation Study.

BACKGROUND: Technology has long been used to carry out self-management as well as to improve adherence to treatment in people with diabetes. However, most technology-based apps do not meet the basic requirements for engaging patients. OBJECTIVE: This study aimed to evaluate the effect of use frequency of a diabetes management app on glycemic control. METHODS: Overall, 2 analyses were performed. The first consisted of an examination of the reduction of blood glucose (BG) mean, using a randomly selected group of 211 users of the SocialDiabetes app (SDA). BG levels at baseline, month 3, and month 6 were calculated using the intercept of a regression model based on data from months 1, 4, and 7, respectively. In the second analysis, the impact of low and high BG risk was examined. A total of 2692 users logging SDA ≥5 days/month for ≥6 months were analyzed. The highest quartile regarding low blood glucose index (LBGI) and high blood glucose index (HBGI) at baseline (t1) was selected (n=74 for group A; n=440 for group B). Changes in HBGI and LBGI at month 6 (t2) were analyzed. RESULTS: For analysis 1, baseline BG results for type 1 diabetes mellitus (T1DM) groups A and B were 213.61 (SD 31.57) mg/dL and 206.43 (SD 18.65) mg/dL, respectively, which decreased at month 6 to 175.15 (SD 37.88) mg/dL and 180.6 (SD 40.47) mg/dL, respectively. For type 2 diabetes mellitus (T2DM), baseline BG was 218.77 (SD 40.18) mg/dL and 232.55 (SD 46.78) mg/dL, respectively, which decreased at month 6 to 160.51 (SD 39.32) mg/dL and 173.14 (SD 52.81) mg/dL for groups A and B, respectively. This represents a reduction of estimated A1c (eA1c) of approximately 1.3% (P<.001) and 0.9% (P=.001) for T1DM groups A and B, respectively, and 2% (P<.001) for both A and B T2DM groups, respectively. For analysis 2, T1DM baseline LBGI values for groups A and B were 5.2 (SD 3.9) and 4.4 (SD 2.3), respectively, which decreased at t2 to 3.4 (SD 3.3) and 3.4 (SD 1.9), respectively; this was a reduction of 34.6% (P=.005) and 22.7% (P=.02), respectively. Baseline HBGI values for groups A and B were 12.6 (SD 4.3) and 10.6 (SD 4.03), respectively, which decreased at t2 to 9.0 (SD 6.5) and 8.6 (SD 4.7), respectively; this was a reduction of 30% (P=.001) and 22% (P=.003), respectively. CONCLUSIONS: A significant reduction in BG was found in all groups, independent of the use frequency of the app. Better outcomes were found for T2DM patients. A significant reduction in LBGI and HBGI was found in all groups, regardless of the use frequency of the app. LBGI and HBGI indices of both groups tend to have similar values after 6 months of app use.

[Treatment of uterine fibroids using high-intensity ultrasound]. / Tratamiento de los miomas uterinos mediante ultrasonidos de alta intensidad.

High-intensity ultrasound surgery is being actively introduced as an alternative treatment to conventional surgery for uterine fibroids. Numerous studies have shown that high-intensity ultrasound surgery is a safe and effective treatment, with fewer side effects than fibroidectomy and hysterectomy, and is cost-effective. It is now possible to offer this alternative therapy to patients with symptomatic uterine fibroids. We describe the technical basis of ultrasound surgery, the pretherapy selection of patients, the limiting factors and the risks of high-intensity ultrasound therapy. We describe our unit's clinical experience with 319 patients treated in an outpatient regimen, which resulted in a high rate of success (81%) and an acceptable rate of mild complications, as well as a virtually immediate return to daily activities. We comment on the follow-up of pregnancies that occurred after treatment with high-intensity focused ultrasound (HIFU) with no side effects attributable to the therapy.

Tratamiento de los miomas uterinos mediante ultrasonidos de alta intensidad / Treatment of uterine fibroids using high-intensity ultrasound

La cirugía mediante ultrasonidos de alta intensidad (HIFU, high intensity focused ultrasound) se esta introduciendo con fuerza como tratamiento alternativo a la cirugía convencional de los miomas uterinos. Múltiples estudios han demostrado que es un tratamiento efectivo y seguro, con efectos secundarios mucho menores que la miomectomía y la histerectomía, siendo además coste-efectivo. Hoy es posible ofrecer esta alternativa terapéutica a las pacientes con miomas uterinos sintomáticos. Describiremos las bases técnicas de la cirugía por ultrasonidos, la selección preterapéutica de las pacientes, los factores limitantes y los riesgos de la terapia con ultrasonidos de alta intensidad. Describimos la experiencia clínica de nuestra unidad con 319 pacientes tratadas en régimen ambulatorio con una elevada tasa de éxito, 81%, y con una tasa de complicaciones leves aceptable, además de una reincorporación a las actividades habituales prácticamente inmediata. Comentamos el seguimiento de las gestaciones que se han producido después del tratamiento con HIFU sin efectos secundarios atribuibles a la terapia (AU)

High-intensity ultrasound surgery is being actively introduced as an alternative treatment to conventional surgery for uterine fibroids. Numerous studies have shown that high-intensity ultrasound surgery is a safe and effective treatment, with fewer side effects than fibroidectomy and hysterectomy, and is cost-effective. It is now possible to offer this alternative therapy to patients with symptomatic uterine fibroids. We describe the technical basis of ultrasound surgery, the pretherapy selection of patients, the limiting factors and the risks of high-intensity ultrasound therapy. We describe our unit's clinical experience with 319 patients treated in an outpatient regimen, which resulted in a high rate of success (81%) and an acceptable rate of mild complications, as well as a virtually immediate return to daily activities. We comment on the follow-up of pregnancies that occurred after treatment with high-intensity focused ultrasound (HIFU) with no side effects attributable to the therapy (AU)

Técnicas actuales de cirugía adenoamigdalar en los trastornos respiratorios del sueño de los niños / Current techniques in tonsil surgery

En los últimos años, la consolidación de la hipertrofia amigdalar como principal indicación quirúrgica, ha originado la aparición de nuevas técnicas. La mayoría persigue una reducción de su volumen (es la llamada amigdalotomía o reducción amigdalar). Con ello, se consigue disminuir considerablemente tanto la incidencia de hemorragia intra y postoperatoria como la intensidad del dolor. Describiremos el mecanismo, las ventajas y los inconvenientes de las diferentes técnicas, incluyendo la electrodisección con bisturí eléctrico, la reducción con microdebrider, el bisturí armónico (o de ultrasonidos), la radiofrecuencia (con sus distintas variantes) y el láser CO2. Con relación a las técnicas que reducen el volumen amigdalar hay que resaltar que la posibilidad de recidiva de la hipertrofia amigdalar será alta si se elimina menos de un 85% de amígdala. Tampoco es despreciable la posibilidad de infección de los restos amigdalares, sea cual sea la técnica empleada, por lo que no serán válidas en caso de amigdalitis de repetición. Recientemente, también han aparecido alternativas a la adenoidectomía clásica con cucharilla-adenotomo. Consisten en la posibilidad de minimizar el sangrado mediante el uso del microdebrider, de la radiofrecuencia o del aspirador coagulador. También nos referiremos al concepto de adenoidectomía parcial, de preferencia en pacientes con riesgo de insuficiencia velopalatina(AU)

In recent years, consolidation of tonsillar hypertrophy as the principal surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and postoperative hemorrhages and pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO2 laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive tonsillitis. Recently, alternatives to classical adenoidectomy using adenoid curette have also appeared. Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial adenoidectomy, which is preferred in patients at risk of velopharyngeal insufficiency(AU)

A white dwarf cooling age of 8 Gyr for NGC 6791 from physical separation processes.

NGC 6791 is a well studied open cluster that it is so close to us that can be imaged down to very faint luminosities. The main-sequence turn-off age ( approximately 8 Gyr) and the age derived from the termination of the white dwarf cooling sequence ( approximately 6 Gyr) are very different. One possible explanation is that as white dwarfs cool, one of the ashes of helium burning, (22)Ne, sinks in the deep interior of these stars. At lower temperatures, white dwarfs are expected to crystallize and phase separation of the main constituents of the core of a typical white dwarf ((12)C and (16)O) is expected to occur. This sequence of events is expected to introduce long delays in the cooling times, but has not hitherto been proven. Here we report that, as theoretically anticipated, physical separation processes occur in the cores of white dwarfs, resolving the age discrepancy for NGC 6791.

[Current techniques in tonsil surgery]. / Técnicas actuales de cirugía adenoamigdalar en los trastornos respiratorios del sueño de los niños.

In recent years, consolidation of tonsillar hypertrophy as the principal surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and postoperative hemorrhages and pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO(2) laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive tonsillitis. Recently, alternatives to classical adenoidectomy using adenoid curette have also appeared. Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial adenoidectomy, which is preferred in patients at risk of velopharyngeal insufficiency.

Using self-organizing maps to identify potential halo white dwarfs.

We present the results of an unsupervised classification of the disk and halo white dwarf populations in the solar neighborhood. The classification is done by merging the results of detailed Monte Carlo (MC) simulations, which reproduce very well the characteristics of the white dwarf populations in the solar neighborhood, with a catalogue of real stars. The resulting composite catalogue is analyzed using a competitive learning algorithm. In particular we have used the so-called self-organized map. The MC simulated stars are used as tracers and help in identifying the resulting clusters. The results of such an strategy turn out to be quite satisfactory, suggesting that this approach can provide an useful framework for analyzing large databases of white dwarfs with well determined kinematical, spatial and photometric properties once they become available in the next decade. Moreover, the results are of astrophysical interest as well, since a straightforward interpretation of several recent astronomical observations, like the detected microlensing events in the direction of the Magellanic Clouds, the possible detection of high proper motion white dwarfs in the Hubble Deep Field and the discovery of high velocity white dwarfs in the solar neighborhood, suggests that a fraction of the baryonic dark matter component of our galaxy could be in the form of old and dim halo white dwarfs.