A Surgical Complexity Factor for Clefts of Primary and Secondary Palates.

The surgical treatment of patients with cleft lip and palate depends on the characteristics of the affected anatomical structures (palate, lip and nose). The objective of this work was to develop a quantified classification for these clefts, to represent their surgical complexity. This work was developed with the team of surgeons of the SUMA Cleft Leadership Center (CLC) Smile Train Mexico. The method of Multiple-Criteria Decision Analysis was applied using the Analytic Hierarchy Approach. A surgical complexity factor associated with each cleft was defined and it was validated in a sample of fifty patients treated at the SUMA-CLC.Clinical Relevance- A quantitative classification that represents the surgical complexity of clefts provides an objective unified criteria for planning the surgical treatment of patients, as well as having standardized procedures for the surgical treatment of patients.

Increased Effect Sizes in a Mindfulness- and Yoga-Based Intervention After Adjusting for Response Shift with Then-Test.

Objectives: Response shift refers to variations in self-reported evaluations at different times from changes in one's internal standards, values, and meanings. The current study explored the utility of the then-test to detect a potential mindfulness-based response shift occurrence during a mindfulness- and yoga-based intervention for student musicians, and to ascertain to what extent effect sizes could differ when adjusting for it. Method: Participants (n = 31) completed the Five Facet Mindfulness Questionnaire (FFMQ) halfway through the intervention (Time 1-FFMQ), post-intervention (Time 2-FFMQ), and immediately after Time 2-FFMQ with a then-test approach that asked participants to rate the FFMQ based on retrospective reflections on their mindfulness at Time 1 (then-test-FFMQ). Paired t-tests and Hedges' g effect sizes were computed to estimate three potential effects: response shift (Time 1-FFMQ minus then-test-FFMQ), the conventional intervention effect (Time 2-FFMQ minus Time 1-FFMQ), and the effect after adjusting for response shift (i.e., actual intervention effect = Time 2-FFMQ minus then-test-FFMQ). Results: Response shift was significant for the FFMQ Observe subscale (g = 0.41) and total scale (g = 0.37). The adjusted scores in all subscales (Observe, g = 0.47; Describe, g = 0.25; Act Aware, g = 0.40; Non-judge, g = 0.28; Non-react, g = 0.57) and total scale (g = 0.60) achieved significance and yielded larger effect sizes than the conventional results, for which only Act Aware (g = 0.28), Non-react (g = 0.36), and total scale (g = 0.28) were significant. Conclusions: Notwithstanding some methodological limitations, this study lends support to the utility of the then-test to quantify response shift. When adjusting for it, effect sizes from a mindfulness- and yoga-based intervention were generally amplified. Preregistration: This study was not preregistered.

Developing Resilience During the COVID-19 Pandemic: Yoga and Mindfulness for the Well-Being of Student Musicians in Spain.

Here, we report on a quasi-experimental study to explore the applicability and perceived benefits of the CRAFT program, which is based on mindfulness, yoga, positive psychology, and emotional intelligence, to improve higher education student musicians' health and well-being during the lockdown. A subset of student musicians at a Higher Conservatory of Music in Spain followed the CRAFT program during the academic year 2019/2020, 1 h per week as part of their curriculum. Students enrolled in CRAFT-based elective subjects formed the CRAFT program group (n = 40), while other students represented the control group (n = 53). The onset of the national lockdown elicited by the COVID-19 pandemic occurred halfway through the program, which was subsequently delivered in an online format. We administered an online survey to explore the effect that the exposure to the CRAFT program had in terms of how participants dealt with various health and well-being concerns arising from the COVID-19 lockdown. There was a significantly higher proportion of proactive participants in the CRAFT program group, 92%, than in the control group, 58%, in terms of implementing practices to improve their health and well-being during the lockdown. Additionally, significantly more participants acknowledged perceived benefits from their practices in the CRAFT program group, 78%, than in the control group, 52%. Among proactive participants, yoga/meditation was the most implemented in the CRAFT program group, followed by exercise, and other yoga/meditation practices, whereas in the control group, exercise and Alexander technique-based practices were the most applied. In the CRAFT program group, the highest rate of perceived benefits was from yoga/meditation CRAFT-based practices, 51%, followed by exercise, 32%, and other yoga/meditation practices, 27%, whereas in the control group, benefits were reported by 29% of exercising participants and 16% for those having practiced the Alexander technique. A similar pattern was observed when excluding participants with previous yoga/meditation experience. This study revealed how participants can independently apply learned skills from the CRAFT program in response to a naturally occurring life event of unprecedented global impact, suggesting that previous exposure to mindfulness and yoga is likely to have a beneficial effect on how young adults react towards exceptionally stressful conditions.

Estado del Arte de la Evaluación de Tecnologías en Salud en América Latina / State of the Art of the Evaluation of Health Technologies in Latin America

Resumen El surgimiento y desarrollo de las tecnologías en salud ha hecho que se intensifique el papel de su evaluación en los últimos años, provocando un interés creciente en la Evaluación de Tecnologías en Salud (ETES) en América Latina, a través de intentos por proporcionar información útil al tomador de decisiones. Este artículo presenta una revisión del estado del arte de ETES en Latinoamérica, a partir del análisis de publicaciones en revistas y eventos especializados. Se abordaron tres aspectos: elementos de evaluación, métodos que se aplican y políticas resultantes. Se encontraron los siguientes aspectos de evaluación: seguridad, eficacia, efectividad y eficiencia, económico-financieros, clínicos y técnicos, estos últimos con mayor desarrollo. Con respecto a los métodos, se encontraron propuestas de estrategias empíricas para el análisis de la información y la toma de decisiones. La generación de políticas públicas relacionadas con la ETES en América Latina es incipiente, apenas se están identificando las problemáticas nacionales y las estrategias a seguir para su solución. Por lo tanto, se aprecia una necesidad de seguir trabajando en el desarrollo de políticas, estrategias y métodos de ETES en la región Latinoamericana que permitan responder a las problemáticas en salud de la población de cada país.

Abstract The emergence and development of health technologies have intensified the role of their evaluation in recent years, causing a growing interest in the Evaluation of Health Technologies (ETES) in Latin America, through attempts to provide useful information to the decision-maker. This article presents a review of the state of the art of ETES in Latin America, from the analysis of publications in journals and specific events. Three aspects were addressed: evaluation elements, methods that are applied, and resulting policies. The following evaluation aspects were found: safety, efficacy, effectiveness and efficiency, economic-financial, clinical and technical, the latter with more significant development. Concerning the methods, proposals for empirical strategies for the analysis of information and decision making were found. The generation of public policies related to the HTA in Latin America is under development, national problems are hardly being identified, and the strategies to be followed for their solution. Therefore, there is a need to continue working on the development of policies, and methods of HTA in the Latin American region that allow responding to the health problems of the population of each country.

Linear and nonlinear genetic relationships between type traits and productive life in US dairy goats.

Linear or nonlinear genetic relationships between productive life and functional productive life at 72 mo, with final score (SCO), stature, strength, dairyness (DAI), teat diameter, rear legs (side view), rump angle, rump width (RUW), fore udder attachment (FUA), rear udder height, rear udder arch, udder depth (UDD), suspensory ligament (SUS), and teat placement, as well as heritabilities and correlations were estimated from multibreed US dairy goat records. Productive life was defined as the total days in production until 72 mo of age (PL72) for goats having the opportunity to express the trait. Functional productive life (FPL72) was analyzed by incorporating first lactation milk yield, fat yield, protein yield, and SCO in the statistical model. Heritabilities and correlations were estimated using linear mixed models with pedigree additive genetic relationships and ASReml software. Nonlinearity of genetic relationships was assessed based on second-degree polynomial (quadratic) regression models, with the breeding values of PL72 or FPL72 as responses and the breeding values for each type trait (linear and quadratic) as predictor variables. Heritability estimates were 0.19, 0.14, 0.18, 0.20, 0.14, 0.07, 0.28, 0.20, 0.15, 0.13, 0.25, 0.18, 0.20, 0.21, 0.21, and 0.32 for PL72, FPL72, SCO, stature, strength, DAI, teat diameter, rear legs, rump angle, RUW, FUA, rear udder height, rear udder arch, UDD, SUS, and teat placement, respectively. The type traits SCO, RUW, and FUA were the most correlated with PL72 and FPL72, so these may be used as selection criteria to increase longevity in dairy goats. An increase in the coefficient of determination >1% for the second degree, compared with that for the linear model for either PL72 or FPL72, was taken as evidence of a nonlinear genetic relationship. Using this criterion, PL72 showed maximum values at intermediate scores in DAI, UDD, and RUW, and maximum values at extreme scores in FUA and SUS, whereas FPL72 showed maximum values at intermediate scores in DAI and UDD, and maximum values at extreme scores in FUA, RUW, and SUS. Selecting for increased SCO, RUW, and FUA will lead to an increase of FPL72 in goats. Consideration of nonlinear relationships between DAI, FUA, RUW, SUS, and UDD may help in the design of more efficient breeding programs for dairy goats using conformation traits.

Timoma y carcinoma tiroideo sincrónicos en paciente con distrofia miotónica de Steinert no conocida / Undiagnosed myotonic dystrophy type 1 in a patient with synchronous thymoma and thyroid cancer

No disponible

Potential use of Bacillus thuringiensis bacteriocins to control antibiotic-resistant bacteria associated with mastitis in dairy goats.

Mastitis caused by microbial infections in dairy goats reduces milk yield, modifies milk composition, and potentially contributes to morbidity in herds and consumers of dairy products. Microorganisms associated with mastitis in dairy goats are commonly controlled with antibiotics, but it is known that continued use of these chemical agents promotes antibiotic resistance among bacterial populations. Recently, it has been shown that bacteriocins of Bacillus thuringiensis inhibit growth of food-borne pathogens and also bacteria associated with bovine mastitis. However, there is no report on their ability to inhibit microorganisms linked to mastitis in dairy goats. In this study, using 16S rDNA and ITS regions of rDNA, we identified nine bacterial isolates and an encapsulated yeast associated with mastitis in dairy goats. Enterococcus durans, Brevibacillus sp., and Staphylococcus epidermidis 2 were resistant to, respectively, 75, ~67, ~42, and ~42 % of the antibiotics screened. In addition, 60 % of the bacterial isolates were resistant to penicillin, ampicillin, vancomycin, and dicloxacillin. Importantly, 60 % of the isolates were inhibited by the bacteriocins, but S. epidermidis 1, Enterobacter sp., Escherichia vulneris, and Cryptococcus neoformans were not susceptible to these antimicrobial peptides. Using Brevibacillus sp. and Staphylococcus chromogenes as indicator bacteria, we show that peptides of ~10 kDa that correspond to the molecular mass of bacteriocins used in this study are responsible for the inhibitory activity. Our results demonstrate that multiple antibiotic-resistant bacteria associated with subclinical mastitis in dairy goats from Guanajuato, Mexico, are susceptible to bacteriocins produced by B. thuringiensis.

An assessment strategy for proposals of engineering projects in the Bachelor of Biomedical Engineering Curriculum at Universidad Autónoma Metropolitana-Iztapalapa.

Since 1974, the Bachelor of Biomedical Engineering Program (BBME) is offered at Universidad Autónoma Metropolitana-Iztapalapa, in Mexico City. By design, it must be completed in four years (12 trimesters) and, in the latter three, the senior students work on a BME project, which is done by completing three modules: Project Seminar (PS), Project on BME I and Project on BME II. In the PS module, the student must find a problem of interest in the BME field and suggest a solution through the development of an Engineering Project Proposal (EPP). Currently, the module is being taught by two faculty members of the BBME, who instruct students on how to develop their EPPs and evaluate their progress by reviewing a number of EPPs during the trimester. This generates a huge workload for the module instructors, which makes it necessary to involve more faculty members trimester-to-trimester (i.e. every 12 weeks) and, therefore, to create a set of systematic guidelines that ease the evaluation process for new instructors. Hence, the purpose of this paper is to present an assessment strategy (in the form of an assessment matrix) for the PS module as well as some preliminary results after two trimesters of its implementation.

Gorham-Stout syndrome: a case report.

Gorham-Stout syndrome, is an extremely rare disease of the bone, characterized for vascular and lymphatic channels proliferation in bony segments and consequent osseous resorption. There are around 200 cases reported around the world. Although bisphosphonates are used for symptoms relief, there is no standardized treatment established. We present a case that was diagnosed in our centre secondary to a resistant epistaxis and a literature review of this condition.

Estimation of genetic parameters for productive life, reproduction, and milk-production traits in US dairy goats.

Heritabilities and correlations for milk yield (MY), fat yield (FY), protein yield (PY), combined fat and protein yield (FPY), fat percentage (F%), protein percentage (P%), age at first kidding (AFK), interval between the first and second kidding (KI), and real and functional productive life at 72mo (FPL72) of 33,725 US dairy goats, were estimated using animal models. Productive life was defined as the total days in production until 72mo of age (PL72) for goats having the opportunity to express the trait. Functional productive life was obtained by correcting PL72 for MY, FY, PY, and final type score (FS). Six selection indexes were used, including or excluding PL72, with 6 groups of different economic weights, to estimate the responses to selection considering MY, FY, PY, and PL72 as selection criteria. The main criteria that determined the culling of a goat from the herd were low FS, MY, and FY per lactation. Heritability estimates were 0.22, 0.17, 0.37, 0.37, 0.38, 0.39, 0.54, 0.64, 0.09, and 0.16 for PL72, FPL72, MY, FY, PY, FPY, F%, P%, KI, and AFK, respectively. Most genetic correlations between the evaluated traits and PL72 or FPL72 were positive, except for F% (-0.04 and -0.06, respectively), P% (-0.002 and -0.03, respectively), and AFK (-0.03 and -0.01, respectively). The highest genetic correlations were between FPL72 and MY (0.39) and between PL72 and MY (0.33). Most phenotypic correlations between the traits evaluated and FPL72 and PL72 were positive (>0.23 and >0.26, respectively), except for F% (-0.004 and -0.02, respectively), P% (-0.05 and -0.02), KI (-0.01 and -0.07), and AFK (-0.08 and -0.08). The direct selection for PL72 increased it by 102.28d per generation. The use of MY, FY, PY, KI, or AFK as selection criteria increased PL72 by 39.21, 27.33, 35.90, -8.28, or 2.77d per generation, respectively. The inclusion of PL72 as selection criterion increased the expected response per generation from 0.15 to 17.35% in all selection indices studied.

LIM domain kinases as potential therapeutic targets for neurofibromatosis type 2.

Neurofibromatosis type 2 (NF2) is caused by mutations in the NF2 gene that encodes a tumor-suppressor protein called merlin. NF2 is characterized by formation of multiple schwannomas, meningiomas and ependymomas. Merlin loss-of-function is associated with increased activity of Rac and p21-activated kinases (PAKs) and deregulation of cytoskeletal organization. LIM domain kinases (LIMK1 and 2) are substrate for Cdc42/Rac-PAK and modulate actin dynamics by phosphorylating cofilin at serine-3. This modification inactivates the actin severing and depolymerizing activity of cofilin. LIMKs also translocate into the nucleus and regulate cell cycle progression. Significantly, LIMKs are overexpressed in several tumor types, including skin, breast, lung, liver and prostate. Here we report that mouse Schwann cells (MSCs) in which merlin function is lost as a result of Nf2 exon2 deletion (Nf2(ΔEx2)) exhibited increased levels of LIMK1, LIMK2 and active phospho-Thr508/505-LIMK1/2, as well as phospho-Ser3-cofilin, compared with wild-type normal MSCs. Similarly, levels of LIMK1 and 2 total protein and active phosphorylated forms were elevated in human vestibular schwannomas compared with normal human Schwann cells (SCs). Reintroduction of wild-type NF2 into Nf2(ΔEx2) MSC reduced LIMK1 and LIMK2 levels. We show that pharmacological inhibition of LIMK with BMS-5 decreased the viability of Nf2(ΔEx2) MSCs in a dose-dependent manner, but did not affect viability of control MSCs. Similarly, LIMK knockdown decreased viability of Nf2(ΔEx2) MSCs. The decreased viability of Nf2(ΔEx2) MSCs was not due to caspase-dependent or -independent apoptosis, but rather due to inhibition of cell cycle progression as evidenced by accumulation of cells in G2/M phase. Inhibition of LIMKs arrests cells in early mitosis by decreasing aurora A activation. Our results suggest that LIMKs are potential drug targets for NF2 and tumors associated with merlin deficiency.

[Percutaneous tenotomy and aponeurotomy (PTA) for knee flexor contracture in children with spastic cerebral palsy]. / Tenotomía y aponeurotomía percutánea (TAP) para la contractura de los flexores de rodilla en niños con parálisis cerebral espástica.

UNLABELLED: Knee flexor muscle contracture is frequent in patients with spastic cerebral palsy. The purpose of the study was to determine whether percutaneous tenotomy and aponeurotomy may decrease knee flexor contracture in children with spastic cerebral palsy. MATERIAL AND METHODS: A prospective study of consecutive cases was conducted from January to December 2009 in 24 children with a diagnosis of moderate to severe spastic cerebral palsy who had knee flexor contracture with a popliteal angle > or = 45 degrees and a gross motor function classification scale of 4 or 5; they underwent percutaneous tenotomy and aponeurotomy surgery and were followed-up for 24 months. Variance analysis with a factorial design was used for data analysis. RESULTS: The mean popliteal angle was 83.48 degrees preoperatively and 27.30 degrees by the end of the follow-up, with an improvement of 56.18 degrees (p < 0.01). Statistically significant differences were found in all measurements comparing them with the baseline values. DISCUSSION: Percutaneous aponeurotomy of knee flexor muscles is described. Compared to other procedures it provides the benefits of minimally invasive surgery, mild postoperative pain, short hospital stay -without using immobilization during the entire process- and children returned to their therapy program within five days. CONCLUSION: Percutaneous tenotomy and aponeurotomy of knee flexors was shown to be a good alternative for the treatment of knee flexor contracture in patients with spastic cerebral palsy.

Breed and breed x environment interaction effects for growth traits and survival rate from birth to weaning in crossbred lambs.

This study was conducted to estimate the effects of sire breed (Charollais, Dorper, Dorset, Hampshire, and Suffolk) and genetic group of the dam [local whiteface (Criolla), grade Hampshire, grade Suffolk, F(1) Dorper × Pelibuey, Australian composite, hair sheep (Barbados Blackbelly or Pelibuey), Dorset, Hampshire and Suffolk] on birth weight, survival rate from birth to weaning, and weaning weight adjusted to 65 d of age. Data were recorded from 2004 to 2006 on crossbreed lambs obtained by artificial insemination from 114 flocks in Central Mexico. High (above the mean) or low (below the mean) environmental categories were assigned to each record from flock-year-season effects solutions obtained in fixed-effects linear model analyses. Birth weights of lambs sired by Charollais rams (3.94 kg) were heavier (P < 0.05) than those sired by Suffolk (3.69 kg) whereas Dorper-, Dorset-, and Hampshire-sired lambs were intermediate. For weaning weight, lambs sired by Charollais were the heaviest (19.16 kg) compared with lambs sired by Hampshire (17.86 kg), Suffolk (17.79 kg), and Dorper (17.28 kg) whereas Dorset sired were the lightest (16.77 kg; P < 0.05). Lambs sired by Dorset rams had a lower survival rate (77.1%) than lambs sired by Charollais, Dorper, Hampshire, or Suffolk (81.6 to 83.3%; P < 0.05). Lambs from Australian composite, Dorset, Hampshire, and Suffolk dams were heavier for birth and weaning compared with lambs from local whiteface (Criolla), hair sheep breeds (Barbados Blackbelly or Pelibuey), or crosses (F(1) Pelibuey × Dorper) dams (P < 0.05) whereas lambs from grade Hampshire and grade Suffolk were intermediate. The genetic group of the dam had no effect (P > 0.05) on survival rate. Sire breed × environmental category interaction effect was significant for birth weight (P < 0.01) and weaning weight (P < 0.05), but relatively small changes on the ranking of sire breeds were observed between environmental categories for weaning weight. Genetic group of the dam × environmental category interaction effect was significant for birth and weaning weights (P < 0.01). Weaning weight of lambs from hair sheep breeds (Barbados Blackbelly or Pelibuey) and crosses (F(1) Pelibuey × Dorper) as well as purebred Dorset, Hampshire, and Suffolk dams were more affected when changing from the high to the low environmental category compared with the other genetic groups. No breed of the sire or genetic group of the dam × environmental category interactions were (P > 0.05) observed for survival rate.

Breed differences over time and heritability estimates for production and reproduction traits of dairy goats in the United States.

To aid in improvement of breeding programs for production and reproduction traits of US dairy goats, breed differences over time were documented and genetic parameters were estimated. Data were from herds with ≥2 breeds (Alpine, LaMancha, Nubian, Oberhasli, Saanen, or Toggenburg), but only purebred data were analyzed. Three kidding periods were examined: 1976 through 1984, 1985 through 1994, and 1995 through 2005. Univariate repeatability mixed models were used to estimate least squares means by kidding period-breed and genetic parameters for milk, fat, and protein yields, combined fat and protein yield, fat and protein percentages, protein:fat ratio, age at first kidding, and kidding interval. Trends across kidding periods were favorable for most yield traits for all breeds but generally unfavorable for reproduction traits. Saanens had the highest milk (1,063 to 1,125 kg) and protein yields (31 to 33 kg). Nubians had the highest fat yields (37 to 40 kg) and lowest milk yields (791 to 851 kg). Oberhaslis had the lowest fat (31 to 33 kg) and protein (23 to 27 kg) yields. Alpines had the largest increase in milk yield (7.4%); Oberhaslis had the largest increase in protein (17.4%) and combined fat and protein (13.2%) yields. Combined fat and protein yield was higher for Nubians, Saanens, and Alpines (65 to 72 kg) than for LaManchas, Toggenburgs, and Oberhaslis (53 to 67 kg). Nubians had the highest fat (4.7 to 4.8%) and protein (3.6 to 3.8%) percentages. Only Nubians increased in fat percentage (2.1%); protein percentage increased most for Toggenburgs (7.4%) and Alpines (7.1%). Protein:fat ratio was highest for Toggenburgs (0.84 to 0.89) and lowest for Nubians (0.76 to 0.81), but Nubians had the largest increase in protein:fat ratio (6.6%). Saanens were oldest at first kidding (509 to 589 d), and Toggenburgs and LaManchas generally were youngest (435 to 545 d); age at first kidding increased most for Alpines (21.8%) and LaManchas (21.6%). Kidding intervals generally were shorter for Oberhaslis, LaManchas, and Nubians (350 to 377 d) than for Toggenburgs, Alpines, and Saanens (373 to 387 d). Kidding interval increased most for Nubians (3.9%) and Saanens (3.8%) and decreased only for Oberhaslis (5.4%). Heritability estimates across breeds were 0.35 for milk and fat yields, 0.37 for protein yield and protein:fat ratio, 0.36 for combined fat and protein yield, 0.52 for fat percentage, 0.54 for protein percentage, 0.23 for age at first kidding, and 0.05 for kidding interval. Genetic selection within breed is feasible for production and reproduction traits of US dairy goats.

Improving the drug dispensing process at the National Institute of respiratory diseases by applying the six sigma methodology.

The purpose of this work was to improve the drug dispensing process at the National Institute of Respiratory Diseases of Mexico by applying the six sigma methodology, identifying the non-value added activities as well as the areas of opportunity, in order to make proposals to ensure the supply of prescription drugs to the patient in a timely manner. Seven variables were defined and three indicators were generated, which were implemented in three clinical services of the Institute to measure the current performance of the drug distribution process. With the obtained results, a proposed set of eight improvements were subsequently implemented in a pilot program.

Learning curves of the X Ray innovated process in the imaging Department of the National Institute of Respiratory Diseases, Mexico.

The impact within a known process due to the introduction of new technology may entail many factors such as workflow modification, increase of wait time, modification in service quality, and even cultural changes. The inclusion of these factors into a process affects its performance, but the implementation of innovations may counteract the impact and could even enhance the process. The objective of this work was to evaluate the impact of the innovations implemented in the X Ray process by the estimation of the learning curves and the estimated time in which the maximum learning may be reached.

Improvement of the health technology management process of the public Health Service in Morelos using the Six Sigma methodology.

The purpose of this study was to make a proposal to improve the management process of the health technology within the Health Service at Morelos State, México, using the five stages of Six Sigma methodology: Definition, Measurement, Analysis, Improvement and Control. Up to date these five steps have been executed resulting in a set of proposals to improve the current health technology management process. This will allow the establishment of a medical equipment control program that impacts the three levels of Health Care Service in Morelos State in Mexico.