Aplicabilidad de la herramienta “Prácticas seguras en pacientes con medicamentos de uso crónico” en el ámbito sociosanitario / Applicability of the tool “Safe practices in patients with chronic medicines” in social healthcare

Objetivo: Describir la aplicabilidad de la herramienta “Prácticas seguras en pacientes con medicamentos de uso crónico” en el ámbito de la atención sociosanitaria. Métodos: Estudio observacional transversal (junio 2018) de pacientes institucionalizados en residencia de pacientes asistidos, cuya atención sociosanitaria se realiza desde el Servicio de Farmacia de un hospital de primer nivel. Se aplicaron 18 prácticas seguras a cada tratamiento. Resultados: 153 pacientes incluidos, 69,3% mujeres, mediana edad 83 años (51-101), mediana medicamentos prescritos 12 (1-28). No fueron de aplicación a nuestra población 4 criterios de 18: PG10 (bifosfonatos), PO2 (fentanilo liberación rápida), PG11 (teriparatida por un tiempo superior a 2 años) y PG03 (buprenorfina como deshabituación en pacientes a tratamiento con otros opioides). 14 criterios de 18 detectan prescripciones relacionadas con los criterios de seguridad (monitorizar) y 8 de 18 criterios detectan prescripciones de riesgo en la población, siguiendo la siguiente distribución: 3 PG2 (AAS dosis >150 mg), 2 PG5 (AINE+antitrombótico), 2 PG6 (Triple Whammy), 3 PG7 (2 SRRA), 4 PG8 (2 o más anticolinérgicos), 1 PG9.1 (R/G/D+ anticolinérgicos), 2 PG9.2 (memantina+anticolinérgicos), 1 PO1 (opioide menor+mayor).Conclusiones: La utilización de esta herramienta garantiza la continuidad asistencial de los pacientes, constituye un punto de partida para el desarrollo de un programa de atención farmacéutica sociosanitaria y fomenta la colaboración entre los diferentes niveles asistenciales. A la vista de los resultados, existe una oportunidad de mejora a la hora de rediseñar estos criterios para ser aplicados a esta población institucionalizada.(AU)

Objetive: To describe the applicability of the tool “Safe practices in patients with chronic medicines” in social healthcare.Method: Cross-sectional observational study (June 2018) that included all patients admitted to a care home, whose social healthcare is provided by the Pharmacy Service at a top-tier hospital. Results: The study included 153 patients, 69.3% of whom were female. The average age was 38 (51-101) years. The mean medicines prescribed were 12 (1-28). A total of 4 criteria out of 18 did not apply to our study population: PG10 (biphosphonates), PO2 (rapid release fentanyl), PG11 (teriparatide for a period greater than 2 years) and PG03 (buprenorphine as detoxification in patients treated with other opioids). 14 criteria out of 18 detect treatments related to safety criteria (monitor) and 8 of 18 criteria detect high-risk prescriptions in the population according to the following distribution: 3 PG2 (AAS dose >150 mg), 2 PG5 (NSAID + antithrombotic), 2 PG6 (Triple Whammy), 3 PG7 (2 SSRI), PG8 (2 or more anticholinergics), 1 PG9.1 (R/G/D+anticholinergics), 2 PG9.2 (memantine+anticholinergics), 1 PO1 (strong+weak opioids). Conclusions: The use of this tool guarantees the continuity of care of patients, constitutes a starting point for the development of a pharmaceutical care programme in care homes. and encourages collaboration between the different levels of care. In view of the results, there is an opportunity for improvement when it comes to redesigning these criteria to be applied to this institutionalized population.(AU)

Chronic Pain-Related Jaw Muscle Motor Load and Sensory Processing.

Chronic pain associated with temporomandibular disorders (TMDs) may reflect muscle mechanoreceptor afferent barrage and dysregulated sensory processing. This observational study tested for associations between Characteristic Pain Intensity (CPI), physical symptoms (Patient Health Questionnaire-15 [PHQ-15]), and cumulative jaw muscle motor load (mV*s). In accordance with institutional review board oversight and Strengthening the Reporting of Observational Studies in Epidemiology guidelines, adult subjects gave informed consent and were identified via Diagnostic Criteria for TMD (DC-TMD) examination and research protocols. Subjects were assigned to ±Pain groups using DC-TMD criteria for myalgia. CPI scores characterized pain intensity. PHQ-15 scores were surrogate measures of dysregulated sensory processing. Laboratory tests were performed to quantify masseter and temporalis muscle activities (mV) per bite force (N) for each subject. In their natural environments, subjects recorded day- and nighttime electromyography from which cumulative jaw muscle motor loads (mV*s) were determined for activities consistent with bite forces of >1 to ≤2 and >2 to ≤5 N. Data were assessed using univariate analysis of variance, simple effects tests, K-means cluster classification, and 3-dimensional regression analyses. Of 242 individuals screened, 144 enrolled, and 125 with complete data from study protocols, there were 35 females and 15 males for +Pain and 35 females and 40 males for -Pain. Subjects produced 324 daytime and 341 nighttime recordings of average duration 6.9 ± 1.7 and 7.6 ± 1.7 h, respectively. Overall, +Pain compared to -Pain subjects had significantly higher (all P ≤ 0.002) CPI and PHQ-15 scores. Cumulative jaw muscle motor loads showed significant between-subject effects for time, diagnostic group, and sex (all P < 0.003), where motor loads tended to be higher for daytime versus nighttime, +Pain versus -Pain groups, and males versus females. Two clusters were identified, and regression relations showed associations of low-magnitude daytime masseter motor load, PHQ-15, and CPI scores for cluster 1 (n = 105, R2 = 0.44) and cluster 2 (n = 18, R2 = 0.80). Furthermore, these regression relations showed thresholds of motor load and PHQ-15 scores, above which there were nonlinear increases in reported pain.

Effect of Sustained Joint Loading on TMJ Disc Nutrient Environment.

The temporomandibular joint (TMJ) disc nutrient environment profoundly affects cell energy metabolism, proliferation, and biosynthesis. Due to technical challenges of in vivo measurements, the human TMJ disc extracellular nutrient environment under load, which depends on metabolic rates, solute diffusion, and disc morphometry, remains unknown. Therefore, the study objective was to predict the TMJ disc nutrient environment under loading conditions using combined experimental and computational modeling approaches. Specifically, glucose consumption and lactate production rates of porcine TMJ discs were measured under varying tissue culture conditions (n = 40 discs), and mechanical strain-dependent glucose and lactate diffusivities were measured using a custom diffusion chamber (n = 6 discs). TMJ anatomy and loading area were obtained from magnetic resonance imaging of healthy human volunteers (n = 11, male, 30 ± 9 y). Using experimentally determined nutrient metabolic rates, solute diffusivities, TMJ anatomy, and loading areas, subject-specific finite element (FE) models were developed to predict the 3-dimensional nutrient profiles in unloaded and loaded TMJ discs (unloaded, 0% strain, 20% strain). From the FE models, glucose, lactate, and oxygen concentration ranges for unloaded healthy human TMJ discs were 0.6 to 4.0 mM, 0.9 to 5.0 mM, and 0% to 6%, respectively, with steep gradients in the anterior and posterior bands. Sustained mechanical loading significantly reduced nutrient levels (P < 0.001), with a critical zone in which cells may die representing approximately 13.5% of the total disc volume. In conclusion, this study experimentally determined TMJ disc metabolic rates, solute diffusivities, and disc morphometry, and through subject-specific FE modeling, revealed critical interactions between mechanical loading and nutrient supply and metabolism for the in vivo human TMJ disc. The results suggest that TMJ disc homeostasis may be vulnerable to pathological loading (e.g., clenching, bruxism), which impedes nutrient supply. Given difficulties associated with direct in vivo measurements, this study provides a new approach to systematically investigate homeostatic and degenerative mechanisms associated with the TMJ disc.

Patterns of helminth infections in Rattus rattus and Mus musculus from two Mayan communities in Mexico.

The black rat Rattus rattus and the house mouse Mus musculus are two commensal rodent species that harbour and shed zoonotic pathogens, including helminths. The aim of this survey was to study the helminth community and the patterns of infections in R. rattus and M. musculus from two Mayan communities in Mexico. Gastrointestinal helminths were isolated from 322 M. musculus and 124 R. rattus, including Gongylonema neoplasticum, Hassalstrongylus aduncus, Hassalstrongylus musculi, Hydatigera taeniaeformis metacestode, Hymenolepis diminuta, Nippostrongylus brasiliensis, Oligacanthorhynchidae gen. sp., Syphacia muris, Syphacia obvelata, Rodentolepis microstoma and Trichuris muris. The overall richness of helminths was seven in R. rattus and six in M. musculus. The results of generalized linear models showed that juvenile rodents had lower probabilities of being infected with G. neoplasticum, H. taeniaeformis and H. musculi than adult rodents. A positive association between the prevalence of S. muris and rat abundance was found. The intensity of infection with S. muris was higher in the rainy season than in the dry season; the opposite result was found for H. musculi infection. Male R. rattus harboured more S. muris specimens. The intensity of infection with T. muris was inversely associated with mouse abundance. The presence of the zoonotic H. diminuta, as well as H. taeniaeformis and R. microstoma in rodent populations indicates that there is risk of transmission, and that their entire life cycle occurs in the study area.

Mechanobehavior and Ontogenesis of the Temporomandibular Joint.

Craniofacial secondary cartilages of the mandibular condyle and temporomandibular joint (TMJ) eminence grow in response to the local mechanical environment. The intervening TMJ disc distributes normal loads over the cartilage surfaces and provides lubrication. A better understanding of the mechanical environment and its effects on growth, development, and degeneration of the TMJ may improve treatments aimed at modifying jaw growth and preventing or reversing degenerative joint disease (DJD). This review highlights data recorded in human subjects and from computer modeling that elucidate the role of mechanics in TMJ ontogeny. Presented data provide an approximation of the age-related changes in jaw-loading behaviors and TMJ contact mechanics. The cells of the mandibular condyle, eminence, and disc respond to the mechanical environment associated with behaviors and ultimately determine the TMJ components' mature morphologies and susceptibility to precocious development of DJD compared to postcranial joints. The TMJ disc may be especially prone to degenerative change due to its avascularity and steep oxygen and glucose gradients consequent to high cell density and rate of nutrient consumption, as well as low solute diffusivities. The combined effects of strain-related hypoxia and limited glucose concentrations dramatically affect synthesis of the extracellular matrix (ECM), which limit repair capabilities. Magnitude and frequency of jaw loading influence this localized in situ environment, including stem and fibrocartilage cell chemistry, as well as the rate of ECM mechanical fatigue. Key in vivo measurements to characterize the mechanical environment include the concentration of work input to articulating tissues, known as energy density, and the percentage of time that muscles are used to load the jaws out of a total recording time, known as duty factor. Combining these measurements into a mechanobehavioral score and linking these to results of computer models of strain-regulated biochemical events may elucidate the mechanisms responsible for growth, maintenance, and deterioration of TMJ tissues.

Jaw closing movement and sex differences in temporomandibular joint energy densities.

Energy densities (ED, mJ/mm3 ) quantify mechanical work imposed on articular cartilages during function. This cross-sectional study examined differences in temporomandibular joint (TMJ) ED during asymmetric versus symmetric jaw closing in healthy females versus males. ED component variables were tested for differences between and within sexes for two types of jaw closing. Seventeen female and 17 male subjects gave informed consent to participate. Diagnostic criteria for temporomandibular disorders and images (magnetic resonance (MR), computed tomography) were used to confirm healthy TMJ status. Numerical modelling predicted TMJ loads (Fnormal ) consequent to unilateral canine biting. Dynamic stereometry combined MR imaging and jaw-tracking data to measure ED component variables during 10 trials of each type of jaw closing in each subject's TMJs. These data were then used to calculate TMJ ED during jaw closing asymmetrically and symmetrically. Paired and Student's t tests assessed ED between jaw closing movements and sexes, respectively. Multivariate data analyses assessed ED component variable differences between jaw closing movements and sexes (α = 0.05). Contralateral TMJ ED were 3.6-fold and significantly larger (P < .0001) during asymmetric versus symmetric jaw closing, due to significantly larger (P ≤ .001) distances of TMJ stress-field translation in asymmetric versus symmetric movement. During asymmetric jaw closing, contralateral TMJ ED were twofold and significantly larger (P = .036) in females versus males, due to 1.5-fold and significantly smaller (P ≤ .010) TMJ disc cartilage volumes under stress fields in females versus males. These results suggest that in healthy individuals, asymmetric compared to symmetric jaw closure in females compared to males has higher TMJ mechanical fatigue liabilities.

A pilot study of nocturnal temporalis muscle activity in TMD diagnostic groups of women.

Temporomandibular disorder (TMD) incidences are believed to be related to parafunctional behaviours like teeth clenching. This pilot study aimed to (i) develop an automated clench-detection algorithm, and (ii) apply the algorithm to test for differences in nocturnal clenching in women with and without TMD. Subjects gave informed consent to participate. Adult women were categorised using Diagnostic Criteria for TMD according to presence/absence (+/-) of both TM joint disc placement (DD) and chronic pain (P) into two groups (+DD+P, -DD-P) with 12 subjects each. Surface temporalis electromyography was recorded during oral tasks performed by subjects at two laboratory sessions. The data were used to characterise muscle activity per N of bite force (µV/N) for each subject, develop the clench-detection algorithm and test its accuracy. Ambulatory surface temporalis electromyography was self-recorded by each subject over three nights and analysed using the algorithm and bite force (N) versus muscle activity µV/N calibrations. Bonferroni-adjusted homoscedastic t-tests assessed for significant between-group differences in clenching (P < 0·05). Sensitivity, specificity and accuracy of algorithm-detected laboratory clenches were all ≥96%. During self-recordings 95% of clenches had durations of <4 s and peak forces of <10 N in both groups. Mean clench durations were significantly longer (P = 0·042) in +DD+P (1·9 ± 0·8 s) than -DD-P subjects (1·4 ± 0·4 s). Mean temporalis duty factors (%clench time/total recording time) were significantly larger (P = 0·041) in +DD+P (0·47 ± 0·34%) than -DD-P (0·26 ±0·22%) subjects. Nocturnal temporalis muscle activities detected by a validated algorithm were longer per clench and recording time in +DD+P compared to -DD-P women.

Mechanobehavioral Scores in Women with and without TMJ Disc Displacement.

Cartilage fatigue may be a factor in the precocious development of degenerative changes in the temporomandibular joint (TMJ). This cross-sectional study estimated potential for cartilage fatigue via TMJ energy densities (ED) and jaw muscle duty factors (DF), which were combined to calculate mechanobehavioral scores (MBS) in women with (+) and without (-) bilateral TMJ disc displacement (DD). All subjects gave informed consent to participate and were examined using Diagnostic Criteria (DC) for Temporomandibular Disorders (TMD) and magnetic resonance (MR) and computed tomography (CT) images. Forty-seven subjects were categorized into +DD ( n = 29) and -DD ( n = 18) groups. Dynamic stereometry (MR images combined with jaw-tracking data) characterized individual-specific data of TMJ stress-field mechanics to determine ED (ED = W/ Q mJ/mm3, where W = work done, Q = volume of cartilage) during 10 symmetrical jaw-closing cycles with a 20-N mandibular right canine load. Subjects were trained to record masseter and temporalis electromyography over 3 days and 3 nights. Root mean square electromyography/bite-force calibrations determined subject-specific masseter and temporalis muscle activities per 20-N bite-force (T20 N, µV), which defined thresholds. Muscle DF (DF = % duration of muscle activity/total recording time) were determined for a range of thresholds, and MBS (ED2 × DF) were calculated. Intergroup differences in ED, DF, and MBS were assessed via analyses of variance with Bonferroni and Tukey honest significant difference post hoc tests. Average ED for contralateral TMJs was significantly larger ( P = 0.012) by 1.4-fold in +DD compared to -DD subjects. Average DF were significantly larger (all P < 0.01) for +DD compared to -DD subjects by 1.7-, 2.5-, and 1.9-fold for day, night, and overall, respectively. Daytime MBS were significantly larger (all P < 0.04) by up to 8.5-fold in +DD compared to -DD subjects. Significantly larger ED, DF, and MBS were shown in women with compared to women without bilateral TMJ DD.

TMJ energy densities in healthy men and women.

OBJECTIVE: Cartilage fatigue, due to mechanical work, may account for the early development of degenerative joint disease (DJD) in the temporomandibular joint (TMJ), and why women are three times more likely to be afflicted. This study tested for gender differences in mechanical energy densities in women and men with healthy TMJs. DESIGN: Eighteen women and eighteen men gave informed consent. Research diagnostic criteria including imaging were used to ensure that subjects' TMJs were normal, without disc displacement or signs of DJD. Numerical modeling determined TMJ loads (Fnormal). Jaw tracking and three-dimensional dynamic stereometry characterized individual-specific data of stress-field dynamic mechanics during 10 symmetrical jaw closing cycles. These data were used to estimate tractional forces (Ftraction). Energy densities were then calculated, where: Energy Density = W/Q (W = work done or mechanical energy input = Ftraction*distance of stress-field translation, Q = volume of cartilage). Two-way analysis of variance (ANOVA) and follow-up two-group comparisons tested mean energy densities for ipsilateral and contralateral TMJs in women vs men. RESULTS: Mean energy densities ± standard deviations in ipsilateral and contralateral TMJs in women were 9.0 ± 9.7 and 8.4 ± 5.5 mJ/mm3, respectively, and were significantly larger (P = 0.004 and 0.001, respectively) compared to ipsilateral and contralateral TMJs in men, which were 5.6 ± 4.2 and 6.3 ± 4.2 mJ/mm3, respectively. CONCLUSIONS: Energy densities were significantly larger in healthy TMJs of women than men. Larger TMJ energy densities during normal jaw functions could predispose earlier mechanical fatigue of the TMJ disc.

Longitudinal Stability of Common TMJ Structural Disorders.

The longitudinal course of temporomandibular joint (TMJ) disc displacement (DD) and degenerative joint disease (DJD) has never been conclusively described with magnetic resonance imaging and computed tomography, respectively. This 8-y observational study's objective was to assess the longitudinal stability of DD and DJD among 401 subjects. The Validation Project provided baseline measures; follow-up was performed in the TMJ Impact Project. With magnetic resonance imaging, 2 radiologists rendered a consensus diagnosis of normal/indeterminate, DD with reduction, or DD without reduction. Computed tomography consensus diagnoses included normal/indeterminate, grade 1 DJD, or grade 2 DJD. Radiologist reliability was assessed by kappa; a Hui-Walter model was used to estimate, after accounting for diagnostic disagreement, the frequency of diagnostic progression and reversal. Permutation tests were used to test the statistical influence of concurrent baseline diagnoses on diagnostic changes at follow-up. Of 789 baseline joint-specific soft tissue diagnoses of DD, 598 (76%) joints showed no change; 109 (14%) demonstrated progression; and 82 (10%) had reversal. Of 794 joints with baseline joint-specific hard tissue diagnoses of DJD, progression was observed in 122 (15%) joints, no change in 564 (71%), and reversal in 108 (14%). Radiologist reliability (kappa) was 0.73 (95% CI, 0.64 to 0.83) for DD and 0.76 (95% CI, 0.68 to 0.83) for DJD. After accounting for the influence of diagnostic disagreement, progression of hard tissue diagnoses in the right TMJ occurred in 15.2% of subjects (95% CI, 10.5% to 20.8%) and reversal in 8.3% (95% CI, 4.9% to 12.3%); results were similar for soft tissue diagnoses and the left TMJ. Concurrent baseline soft tissue diagnoses were associated with hard tissue diagnostic changes at follow-up ( P < 0.0001). Baseline hard tissue diagnoses showed no statistical association with soft tissue changes at follow-up ( P = 0.11). Longitudinally, 76% of baseline TMJ soft tissue diagnoses and 71% of the baseline hard tissue diagnoses remained stable. Diagnostic reversal and progression were confirmed for both soft and hard tissues.

A pilot study of ambulatory masticatory muscle activities in temporomandibular joint disorders diagnostic groups.

OBJECTIVE: To determine differences in masticatory muscle usage between temporomandibular joint disorders diagnostic groups. SETTING AND SAMPLE POPULATION: Seventy-one informed and consented subjects (27 men; 44 women) participated at the University at Buffalo. MATERIAL AND METHODS: Research diagnostic criteria and imaging data were used to categorize subjects according to the presence/absence +/- of TMJ disc placement (DD) and chronic pain (P) (+DD+P, n=18; +DD-P, n=14; -DD-P, n=39). Electromyographic (EMG)/bite-force calibrations determined subject-specific masseter and temporalis muscle activities per 20 N bite-force (T20N , µV). Over 3 days and nights, subjects collected EMG recordings. Duty factors (DFs, % of recording time) were determined based on threshold intervals (5-9, 10-24, 25-49, 50-79, ≥80% T20N ). anova and Tukey-Kramer post hoc tests identified 1) diagnostic group differences in T20N and 2) the effects of diagnostic group, gender, time and interval on muscle DFs. RESULTS: Mean (±SE) temporalis T20N in +DD+P subjects was significantly higher (71.4±8.8 µV) than masseter T20N in these subjects (19.6±8.8 µV; p=0.001) and in -DD-P subjects (25.3±6.0 µV, p=0.0007). Masseter DFs at 5-9% T20N were significantly higher in +DD-P women (3.48%) than +DD-P men (0.85%) and women and men in both other diagnostic groups (all p<0.03), and in +DD+P women (2.00%) compared to -DD-P men (0.83%; p=0.029). Night-time DFs at 5-9% T20N in +DD-P women (1.97%) were significantly higher than in -DD-P men (0.47%) and women (0.24%; all p<0.01). CONCLUSIONS: Between-group differences were found in masticatory muscle activities in both laboratory and natural environmental settings.

Diagnostic group differences in temporomandibular joint energy densities.

OBJECTIVES: Cartilage fatigue, due to mechanical work, may account for precocious development of degenerative joint disease in the temporomandibular joint (TMJ). This study compared energy densities (mJ/mm³) in TMJs of three diagnostic groups. SETTING AND SAMPLE POPULATION: Sixty-eight subjects (44 women, 24 men) gave informed consent. Diagnostic criteria for temporomandibular disorders (DC/TMD) and imaging were used to group subjects according to presence of jaw muscle or joint pain (+P) and bilateral disk displacement (+DD). MATERIAL AND METHODS: Subjects (+P+DD, n=16; -P+DD, n=16; and -P-DD, n=36) provided cone-beam computed tomography and magnetic resonance images, and jaw-tracking data. Numerical modeling was used to determine TMJ loads (Fnormal). Dynamic stereometry was used to characterize individual-specific data of stress-field dynamics during 10 symmetrical jaw-closing cycles. These data were used to estimate tractional forces (Ftraction). Energy densities were then calculated as W/Q (W=work done or mechanical energy input=tractional force×distance of stress-field translation, Q=volume of cartilage). anova and Tukey-Kramer post hoc analyses tested for intergroup differences. RESULTS: Mean±standard error energy density for the +P+DD group was 12.7±1.5 mJ/mm³ and significantly greater (all adjusted p<0.04) when compared to -P+DD (7.4±1.4 mJ/mm³) and -P-DD (5.8±0.9 mJ/mm³) groups. Energy densities in -P+DD and -P-DD groups were not significantly different. CONCLUSION: Diagnostic group differences in energy densities suggest that mechanical work may be a unique mechanism, which contributes to cartilage fatigue in subjects with pain and disk displacement.

Modeling of muscle forces in humans with and without temporomandibular joint disorders.

OBJECTIVES: Subjects with/without temporomandibular joint disorders (TMJD) were tested for differences in muscle forces. SETTING AND SAMPLE POPULATION: School of Dental Medicine, University at Buffalo. Ninety-one subjects were classified in four groups based on the presence/absence (±) of chronic myofascial and/or TMJ pain (P) and bilateral disc displacement (DD). MATERIAL AND METHODS: Validated numerical models employed an organizational objective and subjects' anatomy to calculate masticatory muscle forces during static biting. anova and Holm's step-down procedure post hoc tests assessed group differences. Theoretical geometries, representing the range of subjects' muscle orientations, were surveyed via numerical models to identify key combinations resulting in high muscle forces. Effect size (Cohen's d) and anova/post hoc tests assessed group differences in key muscle orientations. RESULTS: +P-DD subjects had significantly higher muscle forces, especially for lateral pterygoid muscles, compared to the other groups (p<0.01) for bite forces that were directed posteromedially or posterolaterally on mandibular molars and posteriorly and slightly medially on mandibular incisors. Key muscle orientations for peak lateral pterygoid muscle forces were identified, and group comparisons showed mean orientation in +P-DD compared to other diagnostic groups was ≥5° more upright for masseter and ≥3° more posteriorly directed for temporalis muscles (all Cohen's d≥0.8). CONCLUSION: Predicted lateral pterygoid muscle forces were significantly higher in +P-DD compared to other groups for specific biting conditions and were attributable, in part, to differences in masseter and temporalis muscle orientations.

Optimizing CIGB-300 intralesional delivery in locally advanced cervical cancer.

BACKGROUND: We conducted a phase 1 trial in patients with locally advanced cervical cancer by injecting 0.5 ml of the CK2-antagonist CIGB-300 in two different sites on tumours to assess tumour uptake, safety, pharmacodynamic activity and identify the recommended dose. METHODS: Fourteen patients were treated with intralesional injections containing 35 or 70 mg of CIGB-300 in three alternate cycles of three consecutive days each before standard chemoradiotherapy. Tumour uptake was determined using (99)Tc-radiolabelled peptide. In situ B23/nucleophosmin was determined by immunohistochemistry. RESULTS: Maximum tumour uptake for CIGB-300 70-mg dose was significantly higher than the one observed for 35 mg: 16.1 ± 8.9 vs 31.3 ± 12.9 mg (P = 0.01). Both, AUC24h and biological half-life were also significantly higher using 70 mg of CIGB-300 (P < 0.001). Unincorporated CIGB-300 diffused rapidly to blood and was mainly distributed towards kidneys, and marginally in liver, lungs, heart and spleen. There was no DLT and moderate allergic-like reactions were the most common systemic side effect with strong correlation between unincorporated CIGB-300 and histamine levels in blood. CIGB-300, 70 mg, downregulated B23/nucleophosmin (P = 0.03) in tumour specimens. CONCLUSION: Intralesional injections of 70 mg CIGB-300 in two sites (0.5 ml per injection) and this treatment plan are recommended to be evaluated in phase 2 studies.

Muscle organization in individuals with and without pain and joint dysfunction.

Central nervous system organization of masticatory muscles determines the magnitude of joint and muscle forces. Validated computer-assisted models of neuromuscular organization during biting were used to determine organization in individuals with and without temporomandibular disorders (TMD). Ninety-one individuals (47 women, 44 men) were assigned to one of four diagnostic groups based on the presence (+) or absence (-) of pain (P) and bilateral temporomandibular joint disc displacement (DD). Electromyography and bite-forces were measured during right and left incisor and molar biting. Two three-dimensional models employing neuromuscular objectives of minimization of joint loads (MJL) or muscle effort (MME) simulated biting tasks. Evaluations of diagnostic group and gender effects on choice of best-fit model were by analysis of variance (ANOVA) and Tukey-Kramer post hoc tests, evaluations of right-left symmetry were by Chi-square and Fisher's exact statistics, and evaluations of model accuracy were by within-subject linear regressions. MME was the best-fit during left molar biting in +DD individuals and incisor biting in men (all p < 0.03). Incisor biting symmetry in muscle organization was significantly higher (p < 0.03) in healthy individuals compared with those with TMD. Within-subject regressions showed that best-fit model errors were similar among groups: 8 to 15% (0.68 ≤ R(2) ≤ 0.74). These computer-assisted models predicted muscle organization during static biting in humans with and without TMDs.

[Intracranial injury caused by captive bolt gun]. / Lesiones intracraneales originadas con pistola de bala cautiva.

Guns bullet or captive bolt is used as a weapon for stunning animals as a prelude to sacrifice. Placed in front of it induce an immediate loss of consciousness, thus achieving a "humanization" of process. It's use for suicide is rare, almost exclusively of people who have access to them because of their occupation, causing severe injuries to the brain. We analyse three cases presented in our service. One of them dies as a result of injuries.

Modified drug release of poloxamer matrix by including water-soluble and water-insoluble polymer.

BACKGROUND: The ability of poloxamer 407 to control drug release was investigated along with the effect of incorporation of a second polymer with poloxamer on dissolution behavior. METHODS: Tablets made of 30% w/w/ theophylline and 15%, 25%, 50%, or 69% poloxamer were prepared. Additionally, tablets containing mixture of poloxamer with carbomer or hypromellose in a 1:1 ratio and at different total levels (15%, 30%, and 50%) were also tested. RESULTS: Data show that as the level of poloxamer increased, drug release decreased. Formulations containing poloxamer: hypromellose 1:1 at 50% level and formulations containing poloxamer: carbomer 1:1 at 30% level produced controlled release matrices over 24 hours of testing dissolution. The mechanism of drug release follows anomalous relaxation non-Fickian diffusion model. CONCLUSIONS: These results suggest that the combination of poloxamer 407 with hypromellose or carbomer is feasible and has potential to offer the formulator control over drug release.

Hepatocyte ultrastructural alterations in cocaine users.

The ultrastructural examination of liver biopsies from five male cocaine users showed hepatocytes presenting diverse alterations in rough and smooth endoplasmic reticulum, mitochondria, nuclei and microvilli. Lipid deposition and an increase of autophagic vacuoles were also observed. This study demonstrates that the hepatocyte is an important target cell for cocaine toxic effects in some patients.

Treatment of peri-implantitis: longitudinal clinical and microbiological findings--a case report.

Failing implants can be successfully treated by surgical procedures that use either bone fillers or membranes combined with an antimicrobial treatment. In this report, we present a case of failing implants with the corresponding treatment and results of 8 years of follow-up.

Occupational diseases in dentistry. Introduction and epidemiology.

Health care workers are exposed to a wide range of physical, chemical, biological and psychological hazards. However, since blood and airborne pathogens represent a tangible risk, infectious diseases are of greater importance to health care workers.