Comparison of smile attractiveness in cases with gummy smile treated with botulinum toxin and maxillary impaction surgery: A retrospective study.

This study aimed to compare the smile's attractiveness in patients submitted to the treatment of gummy smiles with botulinum toxin or maxillary impaction surgery. The retrospective sample comprised 26 patients divided into two groups: Group 1 (BTX): 13 patients (12 females and 1 male) with a mean age of 28.06 years (s.d. = 6.09) and mean gingival exposure during smile of 5.18 mm (s.d. = 1.51) treated with botulinum toxin; Group 2 (SURGICAL): 13 patients (9 females and 4 males) with a mean age of 30.59 years (s.d. = 5.72) and mean gingival exposure during smile of 5.21 mm (s.d. = 1.55) treated with orthognathic maxillary impaction surgery. The group of evaluators comprised 317 participants, divided into 143 orthodontists (85 females and 58 males) with a mean age of 41.40 (s.d. = 9.30); 62 dentists (47 female and 15 male) with a mean age of 35.44 (s.d. = 10.44), and 112 lay people (74 female and 38 male) with a mean age of 46, 91 (s.d. = 10.11) in a questionnaire on Google Forms. Without knowing the therapy used, the evaluators assigned scores to the photographs of the posed smile taken before (T1) and after (T2) treatment. Intergroup comparison of smile attractiveness was performed using the t-independent, one-way ANOVA, and Tukey tests. There was a significant improvement in smile attractiveness with treatment in both groups; however, the improvement was significantly better in the surgical group than in the BTX group. Orthodontists rated smile attractiveness significantly higher than dentists and laypersons for the final phase of the BTX and surgical groups. There was a significant improvement in the smile attractiveness with botulinum toxin application and orthodontic-surgical treatment. However, orthognathic surgery promoted a greater improvement in smile attractiveness than the application of botulinum toxin.

Detection of multidrug-resistant bacteria in the nasal cavities and evaluation of sinus disorders in patients undergoing Le Fort I osteotomy.

INTRODUCTION: Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery. METHODS: Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3-6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066). RESULTS: The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients' young and healthy condition. CONCLUSION: There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.

O desmentido da privação como sintoma do discurso capitalista / Le déni de la privation comme symptôme du discours capitaliste / The denial of deprivation as a symptom of capitalist discourse

Na esteira das lógicas da economia psíquica e da economia política desenvolvidas por Freud e Lacan, tomamos como cerne um tipo de defesa que aparece em muitos casos da clínica contemporânea - o desmentido da privação - para colocar em evidência sua relação com o discurso capitalista pensado por Lacan. O desmentido da privação é um modo de defesa subjetivo que aparece como um índice do fracasso do pai privador na passagem do segundo para o terceiro tempo do complexo de Édipo. Trata-se de uma forma de se defender da castração buscando satisfação pulsional sem mediação simbólica ­ busca essa que é fracassada e extrapola o princípio de prazer. Conclui-se que esse desmentido contemporâneo é um sintoma do próprio discurso capitalista. Se a for aclusão da castração no discurso capitalista é uma promessa igualmente fracassada, o desmentido da privação aparece na subjetividade tentando solucionar esse fracasso. Ele é um sinal de que o discurso capitalista não cumpre sua promessa - e isso por sua própria engrenagem lógica.

Dans le sillage des logiques d'économie psychique et d'économie politique développées par Freud et Lacan, nous nous concentrons sur un type de défense qui apparaît dans de nombreux cas de pratique clinique contemporaine - le déni de la privation - pour mettre en évidence sa relation avec le discours capitaliste d' accord avec ce qui fut pensé par Lacan. Le déni de la privation est une défense subjective qui apparaît comme un indice de l'échec du père qui prive dans le passage du deuxième au troisième stade du complexe d'Œdipe. C'est une manière de se défendre de la castration en recherchant une satisfaction pulsionnelle sans médiation symbolique ­ une recherche qui échoue et dépasse le principe du plaisir. Nous concluons que ce déni contemporain est un symptôme du discours capitaliste lui-même. Si la for clusion de la castration dans le discours capitaliste est une promesse également ratée, le déni de la privation apparaît dans la subjectivité qui tente de résoudre cet échec. C'est le signe que le discours capitalistene tient pas ses promesses - et cela par sa propre logique.

Following the logics of psychic economy and political economy developed by Freud and Lacan, we target a type of defense that appears in many cases of contemporary clinical practice - the denial of deprivation - to highlight its relationship with the capitalist discourse as thought by Lacan. The denial of deprivation is a subjective defense that appears as an index of the failure of the depriving father in the transition from the second to the third stage of the Oedipus complex. It is a way of defending oneself from castration by seeking instinctual satisfaction without symbolic mediation ­ a search that fails and goes beyond the pleasure principle. The conclusion is that this contemporary denial is a symptom of capitalist discourse itself. If the foreclosure of castration in capitalist discourse is an equally failed promise, the denial of deprivation appears in subjectivity trying to resolve this failure. It is a sign that capitalist discourse does not fulfill its promise - and this by its own logical perspective.

Effects of Maxillary Movements on Lips Following Orthognathic Surgery: A Retrospective Non-Randomized Clinical Trial.

Introduction Lips play a fundamental role in facial attractiveness and in decisions pertaining to orthognathic surgery. Objective To assess the upper lip changes following Le Fort I osteotomy for maxillary advancement and/or impaction. Methods In the present retrospective non-randomized clinical trial, we evaluated 3 groups of patients who underwent Le Fort I osteotomy of the maxilla. Group 1 (n = 35) underwent maxillary advancement, group 2 (n = 14), maxillary impaction, and group 3 (n = 11) was submitted to both maxillary advancement and impaction. The lip thickness of all patients was measured preoperatively, and the participants in each group were categorized into two subgroups: thin (< 12 mm) and thick (> 12 mm) lip. The primary (before orthognathic surgery) and final (after orthodontic bracket removal) lateral cephalograms of the patients were analyzed using the Dolphin software. Comparisons were made using the paired t -test and linear regression in the IBM SPSS Statistics for Windows software. Results The length of the upper lip increased by 1 mm ( p = 0.012) on average following maxillary advancement, and it decreased by 0.43 mm ( p = 0.24) on average following maxillary impaction. In the maxillary advancement group, the change in angulation of the incisors predicted the incisal display ( p = 0.03). In the maxillary impaction group, skeletal changes in the vertical dimension predicted changes in upper lip length ( p = 0.033). Conclusions Le Fort I osteotomy for maxillary advancement significantly increases the length of the upper lip. The assessment of lip thickness prior to surgery can help predict the postoperative results. Changing the angulation of the incisors can predict the incisal display. In maxillary impaction, skeletal changes in the vertical dimension can predict the changes in the length of the upper lip.

Effects of Maxillary Movements on Lips Following Orthognathic Surgery: A Retrospective Non-Randomized Clinical Trial

Abstract Introduction Lips play a fundamental role in facial attractiveness and in decisions pertaining to orthognathic surgery. Objective To assess the upper lip changes following Le Fort I osteotomy for maxillary advancement and/or impaction. Methods In the present retrospective non-randomized clinical trial, we evaluated 3 groups of patients who underwent Le Fort I osteotomy of the maxilla. Group 1 (n = 35) underwent maxillary advancement, group 2 (n = 14), maxillary impaction, and group 3 (n = 11 ) was submitted to both maxillary advancement and impaction. The lip thickness of all patients was measured preoperatively, and the participants in each group were categorized into two subgroups: thin (< 12 mm) and thick (> 12 mm) lip. The primary (before orthognathic surgery) and final (after orthodontic bracket removal) lateral cephalograms of the patients were analyzed using the Dolphin software. Comparisons were made using the paired t-test and linear regression in the IBM SPSS Statistics for Windows software. Results The length of the upper lip increased by 1 mm (p = 0.012) on average following maxillary advancement, and it decreased by 0.43 mm (p = 0.24) on average following maxillary impaction. In the maxillary advancement group, the change in angulation of the incisors predicted the incisal display (p = 0.03). In the maxillary impaction group, skeletal changes in the vertical dimension predicted changes in upper lip length (p = 0.033). Conclusions Le Fort I osteotomy for maxillary advancement significantly increases the length of the upper lip. The assessment of lip thickness prior to surgery can help

Una tumba para Alejandro. Simbolización de huellas traumáticas en eltestimonio de una madre que se enfrentóa la destrucción parcial delos restos de su hijo / A tomb for Alejandro. Symbolization of traumatic traces in the narrative of a mother who faced the partial destruction of her son's remains / Un tombeau pour Alejandro. Symbolisation des traces traumatiques dans le témoignage d'une mère confrontée à la destruction partielle de la dépouille de son fils / Um túmulo para Alejandro. Simbolização de traços traumáticos no depoimento de uma mãe que enfrentou o destruição parcial dos restos mortais de seu filho

En 2006, el Gobierno mexicano desplegó las Fuerzas Armadas para combatir el crimen organizado en la llamada guerra contra el narcotráfico. Desde entonces, la sociedad civil ha sido víctima de asesinatos, desapariciones y torturas cometidos tanto por los grupos del crimen organizado como por las fuerzas federales y estatales que supuestamente se encuentran combatiendo a estos primeros. En este artículo se muestra el análisis del testimonio de una madre que se enfrentó a la destrucción parcial de los restos de su hijo; para ello, se utilizan tres aspectos fundamentales para guiar el estudio: la relación entre las somatizaciones y la reelaboración de la experiencia traumática de la destrucción parcial de los restos de un ser querido, la creación de zonas de silencio en torno a escenas brutales, y la función que cumple el testimonio en el proceso de simbolización de huellas traumáticas.

Resumos In 2006, the Mexican government deployed the armed forces to combat organized crime in the so-called "war against narcotrafficking". Since then, civilians have been victims o of murders, disappearances, and torture carried out both by cartels and by the federal and state forces who are supposedly fighting the former. This article presents the analysis of the narrative of a mother who faced the partial destruction of her son's remains, focusing on three fundamental aspects: the relationship between somatizations and the working trough of the traumatic experience of the destruction of a beloved's remains, the creation of zones of silence around brutal events, and the role that accounts play in the process of symbolization of traumatic traces.

En 2006, le gouvernement mexicain a déployé les forces armées pour combattre le crime organisé dans le cadre de la soi-disant guerre contre la drogue. Depuis lors, la société civile est victime d'assassinats, de disparitions et de tortures commis tant par les groupes du crime organisés que par les forces gouvernementales censées les combattre. Cet article analyse le témoignage d'une mère confrontée à la destruction partielle de la dépouille de son fils. Trois aspects fondamentaux guident l'étude: la relation entre les somatisations et la réélaboration de l'expérience traumatique, la création des zones de silence autour des scènes brutales et le rôle du témoignage dans le processus de symbolisation des traces traumatiques.

Em 2006, o governo mexicano mobilizou as forças armadas para combater o crime organizado na chamada guerra contra o narcotráfico. Desde então, a sociedade civil tem sido vítima de assassinatos, desaparecimentos e torturas cometidos tanto por grupos do crime organizado quanto por forças federais e estaduais que supostamente lutam contra eles. São três os aspetos fundamentais que orientam o estudo: a relação entre as somatizações e a reelaboração da experiência traumática da destruição dos restos mortais de uma pessoa amada, a criação de zonas de silêncio em torno das cenas brutais e o papel que o testemunho desempenha no processo de simbolização dos vestígios traumáticos.

Avaliação da fixação dos avanços maxilares pela técnica de osteotomia Le Fort I / Evaluación de la fijación de avances maxilar mediante la técnica de osteotomía Le Fort I / Evaluation of the fixation of maxillary advancements by the Le Fort I osteotomy technique

Introdução: A osteotomia Le Fort I possibilita a correção de deformidades dentofaciais que envolvem o terço médio da face. Para sua fixação, convencionou-se o emprego de quatro mini-placas nos pilares zigomático-maxilar e nasomaxilar. Propôs-se então, a dispensa da fixação do segmento posterior, surgindo questionamentos relacionados à capacidade biomecânica do sistema. Objetivos: Comparar o estresse biomecânico gerado em três meios distintos de fixação da osteotomia Le Fort I frente ao movimento de avanço sagital linear maxilar de 7mm. Metodologia: Trata-se de uma pesquisa experimental laboratorial, utilizando-se da análise de elementos finitos como ferramenta analítica, a fim de constatar qual das técnicas sofrerá maior estresse biomecânico. Resultados: Constatou-se que o estresse biomecânico gerado é maior quando aplicado em 4 pontos do que quando aplicado em apenas 2 pontos. Conclusão: Os resultados obtidos fornecem informações aos cirurgiões sobre a real necessidade do uso de fixação adicional de acordo com o método de fixação planejado. No entanto, deve ser interpretado de forma cautelosa, considerando-se as limitações deste estudo. Sendo assim, uma análise incipiente, que tem como intuito o fornecimento de evidência científica de grande significância.

Introducción: La osteotomía Le Fort I permite la corrección de deformidades dentofaciales que involucran el tercio medio de la cara. Para su fijación se acordó utilizar cuatro miniplacas en los pilares cigomaticomaxilar y nasomaxilar. Entonces se propuso prescindir de la fijación del segmento posterior, planteando interrogantes relacionados con la capacidad biomecánica del sistema. Objetivos: Comparar el estrés biomecánico generado en tres medios diferentes de fijación de la osteotomía Le Fort I frente a un movimiento de avance sagital lineal maxilar de 7mm. Metodología: Se trata de una investigación experimental de laboratorio, utilizando como herramienta analítica el análisis de elementos finitos, con el fin de comprobar cuál de las técnicas sufrirá un mayor estrés biomecánico. Resultados: Se encontró que el estrés biomecánico generado es mayor cuando se aplica en 4 puntos que cuando se aplica solo en 2 puntos. Conclusión: Los resultados obtenidos brindan información a los cirujanos sobre la necesidad real de utilizar fijación adicional de acuerdo al método de fijación planificado. Sin embargo, debe interpretarse con cautela, considerando las limitaciones de este estudio. Por tanto, un análisis incipiente, que pretende aportar evidencias científicas de gran trascendencia.

Introduction: The Le Fort I osteotomy allows the correction of dentofacial deformities involving the middle third of the face. For its fixation, it was agreed to use four mini plates on the zygomaticomaxillary and nasomaxillary pillars. It was then proposed to dispense with the fixation of the posterior segment, raising questions related to the biomechanical capacity of the system. Objectives: To compare the biomechanical stress generated in three different means of fixation of the Le Fort I osteotomy against a 7mm maxillary linear sagittal advancement movement. Methodology: This is an experimental laboratory research, using finite element analysis as an analytical tool, in order to verify which of the techniques will suffer greater biomechanical stress. Results: It was found that the biomechanical stress generated is greater when applied to 4 points than when applied to only 2 points. Conclusion: The results obtained provide information to surgeons about the real need to use additional fixation according to the planned fixation method. However, it should be interpreted with caution, considering the limitations of this study. Therefore, an incipient analysis, which aims to provide scientific evidence of great significance.

Life expectancy by ethnic origin in Chile.

Background: Ethnic and racial differences in life expectancy have been well established in different societies. However, even though an important part of the population of Latin America is Indigenous, there is little knowledge about them. Objective: Determine if there are ethnic differences in life expectancy at birth and at 60 years in Chile, and if the Mapuche (largest Indigenous ethnic group) have similar life expectancy to other Indigenous peoples. Method: Life tables for the Mapuche and other Indigenous groups and non-Indigenous people were built using the 2017 census. Specifically, we used the questions of the number of live children born and the number of surviving children. With this information, using the indirect method of own children we determined infantile mortality. Then, using the relational logit model and the model life table (west), we estimated the survival function for all ages. Results: Indigenous Chileans have seven years lower life expectancy at birth than the non-Indigenous population (76.2 vs. 83.2 years). The differential at age 60 is 6 years (20.3 vs. 26.4 years). We also found that Mapuche have an even greater disadvantage in survival than other ethnic groups. This is reflected in 2 years less life expectancy, both at birth and at 60 years. Discussion: Our results ratify the existence of marked ethnic-racial inequality in the extension of life in Chile and demonstrate a greater disadvantage in terms of survival of the Mapuche compared to other Indigenous and non-Indigenous groups. It is thus of great relevance to design policies that would decrease the existing inequalities in lifespan.

Localização topográfica da emergência do condóito nasolagrimal medido em tomografia como reparação anatômica para procedimentos de cirurgia maxilofacial / Topographic location of the nasolagrimal conduit emergence measured on ct scans as an anatomical repair for maxillofacial surgery procedures / Ubicación topográfica de la emergencia del conducto nasolagrimal medida en tomografías como reparo anatómico para procedimientos de cirugía maxilofacial

Contexto: Na cirurgia maxilofacial existem procedimentos que envolvem o ducto nasolacrimal, pelo que esta medida é um ponto de referência para evitar a sua lesão. Artigos anteriores tomam como referência o fenótipo anglo-saxão e não a população latino-americana, o que é uma grande limitação quando se extrapola para a cirurgia maxilofacial. Objetivo: Medir a distância do ducto nasolacrimal às estruturas anatômicas adjacentes em uma amostra de tomografias computadorizadas do Hospital Universitário San Ignacio em Bogotá, Colômbia, em 2021. Métodos: Foi realizado um estudo observacional retrospetivo com base em tomografias computadorizadas do HUSI. Foi utilizada uma amostragem não probabilística, na qual foram identificadas 150 tomografias computadorizadas. Informações sobre sexo, idade e distância do ducto nasolacrimal em milímetros foram coletadas em um banco de dados em planilha Excel, tendo como marcos anatômicos o entalhe piriforme, o forame infraorbitário e o assoalho da fossa nasal em cortes axiais, sagitais e coronais. Resultados: A análise das medidas mostrou que nenhuma das distribuições de medidas se comportou de forma diferente da distribuição normal. Em relação à comparação das medidas por sexo, a idade foi semelhante entre homens e mulheres, enquanto nas comparações por idade foram evidenciadas diferenças significativas. Conclusão: Os resultados são consistentes com os dados publicados em estudos anteriores. Em termos de distribuição por sexo, o comprimento do ducto nasolacrimal é maior nos homens do que nas mulheres, e a distribuição por idade indica que, à medida que a idade aumenta, a distância do ducto a estas estruturas diminui... (AU)

Background: In maxillofacial surgery there are procedures that involve the nasolacrimal duct, so this measure is a reference point to avoid its injury. Previous articles take as reference the Anglo-Saxon phenotype and not the Latin American population, which is a great limitation when extrapolating it to maxillofacial surgical procedures. Objective: To measure the distance of the nasolacrimal duct to adjacent anatomical structures in a sample of CT scans from the Hospital Universitario San Ignacio in Bogotá- Colombia in 2021. Methods: A retrospective observational study was performed based on CT scans from HUSI. A non-probabilistic sampling was used in which 150 CT scans were identified. Information on sex, age and distance of the nasolacrimal duct in millimeters was collected in an Excel spreadsheet database, taking as anatomical landmarks the piriform notch, the infraorbital foramen and the floor of the nasal fossa in axial, sagittal and coronal sections. Results: The analysis of the measurements showed that none of the measurement distributions had a behavior different from the normal distribution. In relation to the comparison of the measurements by sex, age was similar in men and women, while significant differences were evidenced in the comparisons by age. Conclusion: The results coincide with the data published in previous studies. Regarding the distribution by sex, the length of the nasolacrimal duct is greater in men than in women, and the distribution by age indicates that as age increases the distance of the duct to these structures decreases... (AU)

Antecedentes: En cirugía maxilofacial existen procedimientos que involucran el conducto nasolagrimal, por lo cual esta medida es un punto de referencia para evitar su lesión. Artículos previos toman como referencia el fenotipo anglosajón y no la población Latinoamericana, lo cual supone una gran limitante al extrapolarlo a intervenciones quirúrgicas maxilofaciales. Objetivo: Medir la distancia del conducto nasolagrimal a estructuras anatómicas adyacentes en una muestra de tomografías del Hospital Universitario San Ignacio en BogotáColombia en 2021. Métodos: Se realizó un estudio observacional retrospectivo basado en tomografías del HUSI. Se utilizó un muestreo no probabilístico en el que se identificaron 150 tomografías. En una base de datos en hoja de cálculo en Excel se recolectó información sobre sexo, edad y distancia del conducto nasolagrimal en milímetros, teniendo como reparo anatómico la escotadura piriforme, el agujero infraorbitario y el piso de la fosa nasal en los cortes axial, sagital y coronal. Resultados: El análisis de las mediciones realizadas mostró que ninguna de las distribuciones de medición tuvo un comportamiento distinto a la distribución normal. En relación con la comparación de las medidas por sexo la edad fue similar en los hombres y mujeres, mientras que se evidenciaron diferencias significativas en las comparaciones por edad. Conclusión: Los resultados coinciden con los datos publicados en estudios previos. En cuanto a la distribución por sexo, la longitud del conducto nasolagrimal es mayor en hombres que en mujeres, y la distribución por edad indica que conforme aumenta la edad la distancia del conducto a estas estructuras disminuye... (AU)

Devouring and Asphyxia: Paradigm Crisis, the Depletion of the Hero and Complex Thought1.

This article deals with the profound paradigm crisis that affects modernity and threatens the destiny of humanity. This crisis results from the lack of perspective offered by the paradigm of modernity with its emphasis on unilateral rationality, scientific objectivity, and exploitation of natural resources by a hyper development of an inflated Hero archetype. The emergence of a new paradigm of complexity, C. G. Jung's complex psychology, and Ameridian perspectivism, may offer new paths to approach these serious problems lived by modern man. A clinical vignette illustrates how complex psychology may also help with individual patients suffering from psychosomatic complaints.

Cet article traite de la profonde crise de paradigme qui affecte la modernité et qui menace le destin de l'humanité. Cette crise est le résultat du manque de perspective offert par le paradigme de la modernité, qui met l'accent sur la rationalité unilatérale, l'objectivité scientifique, et l'exploitation des ressources naturelles dans un hyper-développement de l'archétype du Héros, affecté par l'inflation. L'émergence d'un nouveau paradigme de la complexité, la psychologie complexe de C.G. Jung, et le perspectivisme Amérindien peuvent offrir de nouvelles ouvertures pour aborder ces problèmes sérieux que vit l'homme moderne. Une vignette clinique illustre comment la psychologie complexe peut aussi aider en ce qui concerne les patients individuels souffrants de problèmes psychosomatiques.

Este artículo aborda la profunda crisis de paradigma que afecta a la modernidad y amenaza el destino de la humanidad. Esta crisis es el resultado de la falta de perspectiva que ofrece el paradigma de la modernidad con su énfasis en la racionalidad unilateral, la objetividad científica y la explotación de los recursos naturales mediante el hiperdesarrollo de un arquetipo de Héroe inflado. La emergencia de un nuevo paradigma de la complejidad, la psicología compleja de C.G. Jung y el perspectivismo Amerindio pueden ofrecer nuevas vías para abordar estos graves problemas que vive el hombre moderno. Una viñeta clínica ilustra cómo la psicología compleja también puede ayudar con pacientes individuales que sufren dolencias psicosomáticas.

Modified Anterior Z Le Fort III Osteotomy.

Introduction: Surgery of the midface for non-syndromic patients with maxillo-malar hypoplasia exclusively has had many breakthroughs lately. The surgical techniques for midface surgery are varied and must be selected according to the patient's problem. Purpose: The technique is a modification of the Z Osteotomy, the Modified Anterior Z Le Fort III Osteotomy (MAZLFIIIO), is used to correct posteroanterior midface deficiency of 6 mm at most. It can be combined simultaneously with a Le Fort I osteotomy if a greater maxillary advance is needed. MAZLFIIIO advances midface without grafts or distraction osteogenesis. The anterior reposition of the midface is calculated in millimetres and depends on the relation of the eye's most inferior point, as well as the orbital's hard and soft tissues. It is a predictable osteotomy, only for patients without vertical excess of the midface. The osteotomy planned is drawn over a stereolithographic model, and then Z-shaped surgical splints are fabricated over it. Transverse midface deficiencies of no more than 4 mm can also be corrected during the malar osteotomy. A great number of patients are operated exclusively with Le Fort I osteotomies, leaving behind an undesirable step between the upper part of the midface and the Le Fort I osteotomy. Methods: The Modified anterior Z Le Fort III Osteotomy (MAZLFIIIO) was performed in seven patients, from 2016 to 2018. Results: The results obtained with the proposed osteotomy notably improve the appearance of the patient and provide a better protection of the lower part of the eye, while widening the maxillary sinus. Conclusion: We consider that maxillo-malar hypoplasias are very common; the surgeon pretends not to give importance to the deformity, exclusively using an advance Le Fort type osteotomy, with both functional and aesthetic treatment being limited. In this article, we give all the elements to perform this Le Fort III Modified Osteotomy in anterior Z, and that it is a combined and routine procedure in midface surgery.

A função da mancha no caso Hans: da falta à presença do objeto / La función de la mancha en el Juanito: de la falta a la presencia del objeto / The function of the stain in little Hans: from lack to presence of the object / La fonction de la tache dans le petit Hans: du manque à la présence de l'objet

O artigo desenvolve a hipótese de que o trabalho de releitura do caso Hans, realizado por Lacan no Seminário 4, A relação de objeto (1956-1957), antecipa a formulação do conceito de objeto a em seu ensino. Dois pontos cruciais em relação ao objeto são destacados em um trabalho de leitura próxima e atenta ao texto do Seminário. Nesse percurso, a introdução da falta de objeto, modulada pelas operações de privação, frustração e castração, se contrapõe à noção de uma certa presença do objeto. O artigo propõe que em sua teorização sobre a angústia do pequeno Hans, Lacan introduz a função da mancha operando como objeto a, situando-a como um resíduo impossível de ser simbolizado, a coisa preta na boca do cavalo, objeto da fobia de Hans

El artículo desarrolla la hipótesis de que la relectura del caso Juanito realizada por Lacan en el Seminario 4, La relación de objeto (1956-1957) presenta una primera versión del concepto de objeto a en su enseñanza. Del trabajo de lectura cercana del texto del Seminario se destacan dos puntos cruciales con relación al objeto. En este recorrido, la introducción de la falta de objeto, modulada por las operaciones de privación, frustración y castración, admite la noción paradójica de una cierta presencia del objeto. El artículo propone que, a partir del desarrollo de su teorización sobre la angustia del Juanito, Lacan introduce la función de la mancha operando como objeto a, ubicándola como un residuo imposible de simbolizar, la cosa negra en la boca del caballo, objeto de la fobia de Juanito

The article develops the hypothesis that the re-reading of little Hans, carried out by Lacan in Seminar 4, The Object Relation (1956-1957), presents a primary version of the objet petit a in his teaching. In this course, two crucial points concerning the object are emphasized in a close reading of the Seminar's text. The introduction of the notion of lack of object, modulated by the operations of deprivation, frustration and castration, is then opposed to the notion of a certain presence of the object. The article proposes that with the development of a theorization on little Hans' anxiety, Lacan introduces the function of the stain working as na object a, a residue impossible to be symbolized, located in the black spot in the horse's mouth, object of Hans' phobia

L'article développe l'hypothèse qui la relecture du cas le petit Hans effectuée par Lacan dans le Séminaire 4, La relation d'objet(1956-1957) anticipe la formulation du concept d'objet (a) dans son enseignement. Deux points cruciaux par rapport à l'objet sont mis en évidence dans un travail de lecture attentive du texte du Séminaire. Dans ce parcours, l'introduction de la notion de manque d'objet, modulée par les opérations de privation, frustration et castration, s'oppose à la notion d'une certaine présence de l'objet. L'article soutient qui depuis sa théorisation sur l'angoisse du petit Hans, Lacan introduit la fonction de la tache comme un résidu impossible à symboliser, la chose noire dans la bouche du cheval, objet de la phobie de Hans. Et comme tel, la tache noire opère la fonction d'(a)

Tratamiento multidisciplinario de fractura Le Fort i

Introducción: Las fracturas del tercio medio facial constituyen un problema médico grave por su complejidad, frecuencia e impacto socioeconómico. Objetivo: Describir el manejo integral clínico-quirúrgico realizado a un paciente con fractura tipo Le Fort i. Presentación del caso: Paciente de 33 años de edad con trauma facial, pérdida ósea a nivel del nation en sentido antero-posterior, fractura nasal y dento-alveolar mandibular. Se decidió intervenir quirúrgicamente para la reducción y osteosíntesis de la fractura con miniplacas. Luego de retirada la sutura fue valorada por el equipo multidisciplinario que incluyó consulta de prótesis y ortodoncia. Conclusiones: En la planificación del tratamiento es necesario un abordaje terapéutico sistemático, centrado en objetivos para el equipo quirúrgico, el ortodoncista y el protesista, y con ello alcanzar la restauración estética y funcional del sistema estomatognático.

Introduction: Fractures of the middle third of the face are a serious medical problem due to their complexity, frequency and socioeconomic impact. Objective: To describe the comprehensive clinical-surgical management performed on a patient with a Le Fort 1 fracture. Case report: We report the case of a 33-year-old patient with facial trauma, bone loss at the nation level in the antero-posterior direction, nasal and dento-alveolar mandibular fracture. Surgery was decided for the reduction and osteosynthesis of the fracture with miniplates. After removal, the suture was assessed by the multidisciplinary team that included a prosthetic and orthodontic consultation. Conclusions: In treatment planning, a systematic therapeutic approach is necessary, focused on objectives for the surgical team, the orthodontist and the prosthetist, and thereby achieve the aesthetic and functional restoration of the stomatognathic system.

Epigenetics and the return to the great mother archetype.

Epigenetics is the study of how signals from the environment can change gene expression through the creation of molecules and chemical bonds that can last a lifetime and, therefore, determine the phenotype (the characteristics of the individual resulting from the interaction of their genotype [genes] with their environment). Research in this field began at McGill University, Canada, where it was observed that rats' mothers who were more nurturing raised more resilient pups. Since then, many studies have been carried out with animals and humans, showing the link between epigenetic changes and the experience of the great mother archetype - with potential consequences for the emotional life of the individual and for society.

L'épigénétique est l'étude de comment les signaux provenant de l'environnement peuvent changer l'expression des gènes, par la création de molécules et de liens chimiques qui peuvent durer toute la vie et qui, de ce fait, déterminent le phénotype. La recherche dans ce domaine a commencé à l'université McGill au Canada: il y a été observé que les mères de rats plus maternelles élevaient des jeunes plus résilients. Depuis, de nombreuses études ont été menées avec des animaux et des humains, montrant le lien entre les changements épigénétiques et l'expérience de l'archétype de la grande mère, avec des conséquences potentielles pour la vie émotionnelle de l'individu et pour la société.

La epigenética es el estudio de cómo señales del medio ambiente pueden modificar la expresión genética, a través de la creación de moléculas y enlaces químicos que pueden durar toda la vida y, por lo tanto, determinar el fenotipo. Las investigaciones en este campo comenzaron en la Universidad McGill, en Canadá, donde fue observado que las madres de ratas que fueron más nutricias criaban crías más resilientes. Desde entonces, se han llevado a cabo muchos estudios con animales y humanos, mostrando el vínculo entre los cambios epigenéticos y la experiencia del arquetipo de la Gran Madre - con consecuencias potenciales para la vida emocional del individuo y de la sociedad.

A epigenética é o estudo de como o ambiente pode interferir na expressão gênica, através de moléculas e ligações químicas que podem durar por toda a vida e, portanto, determinar o fenótipo. Todas as pesquisas começaram na universidade McGill, onde observou-se que ratas mais cuidadosas, maior comportamento de limpar e lamber os filhotes, acabavam por desenvolver filhotes com mais resiliência. Desde então muitas pesquisas foram realizadas com animais e seres humanos evidenciando a ligação entre epigenética e a experiência dentro do arquétipo da grande mãe e suas potenciais consequências para com os aspectos emocionais do indivíduo e da sociedade.

Marital betrayal, culture and prejudice.

In our consulting rooms we find, depending on the period, certain conditions that relate closely to current cultural prejudices. In our culture, divorce and the reconstituted family can bring both creativity but also emotional difficulty, often triggered by marital betrayal. This paper explores marital betrayal in relation to childhood experiences of fidelity, infidelity and the lack of love. It asks whether there is a cultural prejudice related to marital fidelity, and whether sexuality only belongs in a loving couple, whether this is a patriarchal contract, and what role the anima plays in a loving bond; this is related to 'altericide' and need for respect for the other, as the libido seeks 'living symbols'.

Suivant les périodes, nous retrouvons dans nos salles de consultation des situations qui ont beaucoup à voir avec les préjudices culturels en vigueur. Dans notre culture le divorce et la famille reconstituée peuvent apporter à la fois de la créativité et de la difficulté émotionnelle, souvent déclenchée par la trahison dans le couple. Cet article explore la trahison dans le couple en relation avec les expériences infantiles de fidélité, d'infidélité, et de manque d'amour. L'article s'interroge: y-a-t-il un préjudice culturel lié à la fidélité dans le couple? La sexualité appartient-elle seulement à un couple qui éprouve de l'amour? S'agit-il là d'un contrat patriarcal? Et quel rôle joue l'anima dans une relation aimante? Ceci est mis en lien avec « l'altéricide ¼ et le besoin de respect à l'égard de l'autre, alors que la libido recherche des « symboles vivants ¼.

Encontramos en nuestros consultorios, dependiendo del período, ciertas condiciones que se relacionan cercanamente con prejuicios culturales vigentes. En nuestra cultura, el divorcio y la familia reconstituida puede brindar tanto creatividad como dificultades emocionales, a menudo ambas activadas por la traición marital. El presente trabajo explora la traición marital con relación a experiencias infantiles de fidelidad, infidelidad, y de falta de amor. Pregunta si existe un prejuicio cultural respecto a la fidelidad marital, si la sexualidad solamente pertenece a la pareja amorosa, si ésta es un contrato patriarcal y que rol juega el ánima en un vínculo amoroso. Esto está relacionado al 'altericidio' y a la necesidad de respeto por el otro, a medida que la libido busca 'símbolos vivos'.

Em nossas salas de consultório encontramos, dependendo do período, certas condições que se relacionam intimamente com os preconceitos culturais atuais. Em nossa cultura, o divórcio e a família reconstituída podem trazer criatividade, mas também dificuldade emocional, muitas vezes desencadeada pela traição conjugal. Este artigo explora a traição conjugal em relação às experiências infantis de fidelidade, infidelidade e falta de amor. Pergunta se há um preconceito cultural relacionado à fidelidade conjugal e se a sexualidade pertence apenas a um casal amoroso, se este é um contrato patriarcal e qual papel a anima desempenha em um vínculo amoroso; isso está relacionado ao "altericídio" e à necessidade de respeito pelo outro, já que a libido busca "símbolos vivos".

Poly(o-methoxyaniline) Chain Degradation Based on a Heat Treatment (HT) Process: Combined Experimental and Theoretical Evaluation.

Poly(o-methoxyaniline) emeraldine-salt form (ES-POMA) was chemically synthesized using hydrochloric acid and subjected to a heat treatment (HT) process for 1 h at 100 °C (TT100) and 200 °C (TT200). The HT process promoted a progressive decrease in crystallinity. The Le Bail method revealed a decomposition from tetrameric to trimeric-folded chains after the HT process. The unheated POMA-ES presented a globular vesicular morphology with varied micrometric sizes. The heat treatment promoted a reduction in these globular structures, increasing the non-crystalline phase. The boundary length (S) and connectivity/Euler feature (χ) parameters were calculated from the SEM images, revealing that ES-POMA presented a wide distribution of heights. The TT100 and TT200 presented a narrow boundary distribution, suggesting smoother surfaces with smaller height variations. The UV-VIS analysis revealed that the transition at 343 nm (nonlocal π → π*) was more intense in the TT200 due to the electronic delocalization, which resulted from the reduced polymer chain caused by the HT process. In addition to the loss of conjugation, counter ion withdrawal reduced the ion-chain interaction, decreasing the local electron density. This result shows the influence of the chlorine counter ions on the peaks position related to the HOMO → LUMO transition, since the π → polaron transition occurs due to the creation of the energy states due to the presence of counter ions. Finally, the electrical conductivity decreased after the HT process from 1.4 × 10-4 S.cm-1 to 2.4 × 10-6 S.cm-1 as result of the polymer deprotonation/degradation. Thus, this paper proposed a systematic evaluation of the POMA molecular structure and crystallite size and shape after heat treatment.

UNA NUEVA EXPLICACIÓN DE LA HOMEOPATÍA / A NEW EXPLANATION OF HOMEOPATHY

Este artículo cubre los conceptos básicos de un nuevo modelo de homeopatía que se basa en la termodinámica química. La equivalencia entre el compuesto que causa la enfermedad en una persona saludable y el compuesto que causa la enfermedad en una persona enferma, lo que llevó a esta interpretación del nuevo modelo de homeopatía, está bien considerado. Se han considerado el mecanismo de curación, la Ley de los Similares y la Ley de los Infinitesimales. Este artículo también analiza los conceptos básicos del mecanismo de dilución y su influencia en la concentración final de moléculas de remedio en soluciones homeopáticas. El número máximo de pasos sucesivos que impliquen una molienda vigorosa y se consideró la dilución donde todavía es posible la existencia de una concentración terapéutica.

Tis article covers the basics of a new model of homeopathy that is grounded in chemical thermodynamics. Te equivalence between the disease-causing compound in a heathy person and the disease-causing compound in an ill person, which led to this interpretation of the new model of homeopathy, is well considered. Te mechanism of curing, the Law of Similars, and the Law of Infinitesimals were considered. Tis article also discusses the basics of the dilution mechanism and its influence on the final concentration of remedy molecules in homeopathic solutions. Te maximum number of succession steps involving vigorous grinding and dilution where the existence of a therapeutic concentration is still possible was considered

Schreber: an approach to soul androgyny.

Nowadays Jungian analysts are invited to understand what has been presenting as new emerging sexualities. Although we cannot find a theory of homosexuality in Jung's work, we will find references to this issue in clinical situations, interpretation of dreams, as well as his theory of anima and animus. Jung's theoretical perspective distinguishes sex and gender, anticipating contemporary gender issues and making the approach to the psyche even more complex. Jung was ahead of his time. Contemporary authors present critical reflection on the bases of innatism or culturalism as expressions of new sexualities. The paper present fragments of clinical situations and images, for a reflection on coniunctio of opposites, with their telos and psychic force, in the direction of soul androgyny. It presents a Jungian contribution to Memoirs of My Nervous Illness by Daniel Paul Schreber. Freud's Schreber Case, with his psychopathological interpretation related to paranoia and homosexuality, seems reductive and contrasts with the Jungian approach that introduces a synthetic-hermeneutic analysis.

De nos jours les analystes Jungiens sont invités à comprendre ce qui est présenté comme des sexualités émergentes. Bien que nous ne puissions pas trouver dans le travail de Jung une théorie de l'homosexualité, nous trouvons des références à cette question dans des situations cliniques, l'interprétation des rêves, ainsi que dans sa théorie de l'anima et de l'animus. La perspective théorique de Jung différencie le sexe et le genre, ce qui anticipe les questions contemporaines concernant le genre. Cela donne une approche de la psyché encore plus complexe. Jung était en avance sur son temps. Les auteurs contemporains présentent une réflexion critique sur la base de l'innéisme ou du culturalisme en tant qu'expressions de nouvelles sexualités. Cet article présente des extraits de situations cliniques, des images, pour une réflexion sur le coniunctio des opposés, avec leur télos et leur force psychique, dans la direction de l'androgynie de l'âme. Il offre une contribution Jungienne aux « Mémoires d'un névropathe ¼ de Daniel Paul Schreber. Le cas Schreber de Freud - avec son interprétation psychopathologique en lien avec la paranoïa et l'homosexualité - semble réductive et en contraste avec l'approche Jungienne qui introduit une analyse herméneutique et synthétique.

En la actualidad analistas Junguianos están siendo invitados a comprender aquello que se presenta como las nuevas sexualidades. Si bien, no encontramos una teoría acerca de la homosexualidad en la obra de Jung, encontraremos referencias, a esta temática en situaciones clínicas, interpretaciones de sueños, así como también em su teoría sobre anima y animus. La perspectiva teórica de Jung distingue sexo y género, anticipando cuestiones contemporáneas de género y haciendo aún más complejo el acercamiento a la psique. Jung se anticipó a su tiempo. Autores contemporáneos ofrecen reflexiones críticas acerca del innatismo o culturalismo como expresiones de las nuevas sexualidades. El trabajo presenta fragmentos de situaciones clínicas, imágenes, para una reflexión sobre la coniunctio de opuestos, con su telos y fuerza psíquica en la dirección del alma andrógina. Presenta una contribución Junguiana a 'Memorias de Mi Enfermedad Nerviosa' de Daniel Paul Schreber. El caso Schreber de Freud, con su interpretación psicopatológica relacionada con la paranoia y la homosexualidad, parece reductiva y contrasta con la aproximación Junguiana que introduce un análisis sintético-hermenéutico.

Hoje em dia, analistas junguianos são convidados a entender o que vem se apresentando como novas sexualidades emergentes. Embora não possamos encontrar uma teoria da homossexualidade na obra de Jung, encontraremos referências a essa questão em situações clínicas, em interpretações de sonhos, bem como em sua teoria de anima e animus. A perspectiva teórica de Jung distingue sexo e gênero, antecipando questões contemporâneas de gênero e tornando a abordagem da psique ainda mais complexa. Jung estava à frente de seu tempo. Autores contemporâneos apresentam uma reflexão crítica sobre as bases do inatismo ou do culturalismo como expressões de novas sexualidades. O artigo apresenta fragmentos de situações clínicas, imagens, para uma reflexão sobre coniunctio de opostos, com seu telos e força psíquica, na direção da androginia da alma. Apresenta uma contribuição junguiana para Memórias da Minha Doença Nervosa de Daniel Paul Schreber. O Caso Schreber de Freud, com sua interpretação psicopatológica relacionada à paranóia e homossexualidade, parece redutor e contrasta com a abordagem junguiana que introduz uma análise sintético-hermenêutica.

High-intensity interval resistance training (HIIRT) improves liver gluconeogenesis from lactate in Swiss mice.

High-intensity physical exercise favors anaerobic glycolysis and increases lactatemia. Lactate is converted back to glucose in the liver, so that the lactate threshold, an indicator of physical performance, must be related to the gluconeogenic capacity of the liver. This research assessed the effect of a high-intensity interval resistance training (HIIRT) on liver gluconeogenesis from lactate. Swiss mice were trained (groups T) on vertical ladder with overload of 90% of their maximal load. Control animals remained untrained (groups C0 and C8). In situ liver perfusion with lactate and adrenaline was performed in rested mice after 6 hours of food deprivation. There were larger outputs of glucose (T6, 71.90%; T8, 54.53%) and pyruvate (T8, 129.28%) (representative values for 4 mM lactate) in the groups trained for 6 or 8 weeks (T6 and T8), and of glucose in the presence of adrenaline in group T8 (280%). The content of PEPCK, an important regulatory enzyme of the gluconeogenic pathway, was 69.13% higher in group T8 than in the age-matched untrained animals (C8). HIIRT augmented liver gluconeogenesis from lactate and this might improve the lactate threshold. Novelty: The liver metabolizes lactate from muscle into glucose. Physical training may enhance the gluconeogenic capacity of the liver. As lactate clearance by the liver improves, lactate threshold is displaced to higher exercise intensities.

Osteotomía Le Fort III modificada en un paciente no sindrómico / Modified Le Fort III osteotomy in a non-syndromic patient

Las discrepancias dento-esqueletales severas presentan un reto para el cirujano maxilofacial, existe una versatilidad de osteotomías para las diferentes anomalías del crecimiento y desarrollo, sin embargo, son pocas las que permiten mejorar la proyección malar. La osteotomía Le Fort III modificada fue utilizada en un principio en pacientes con algún síndrome craneofacial, pero actualmente es una alternativa útil para discrepancias severas en pacientes no sindrómicos, ya que permite un avance cigomático-maxilar, favorece la proyección malar y disminuye la exposición escleral con un número limitado de complicaciones. Se presenta el caso de un paciente masculino de 33 años con antecedente de fractura orbitocigomática y piso orbitario izquierda con una discrepancia dento-esqueletal severa, la que fue tratada mediante osteotomía Le Fort III modificada, osteotomías sagitales mandibulares para un avance máxilo-malar y retroceso mandibular respectivamente y una genioplastia de avance; logrando un resultado funcional y estético adecuado.

The dento-skeletal severe discrepancies present a challenge for the maxillofacial surgeon, there is a versatility of osteotomies for the different growth and development anomalies, however, a few of them make possible to improve malar projection. The modified Le Fort III osteotomy was originally used in patients with some craniofacial syndrome, but now it is a useful alternative for severe discrepancies in non-syndromic patients, since it allows a zygomatic-maxillary advance, favors malar projection and reduces scleral exposure with a limited number of complications. The case of a 33-year-old male patient with a history of orbitozygomatic fracture and left orbital floor with a severe dento-skeletal discrepancy is presented, who was treated by modified Le Fort III osteotomy, mandibular sagittal osteotomies for maxillo-malar advancement and retrogression mandibular respectively and geniplasty for advance; achieving a suitable functional and aesthetic result.