Anatomical dissection of the mimic facial musculature: iconographic review as a support to the complementary treatments in facial rejuvenation

A la hora de valorar las múltiples técnicas empleadas en el rejuvenecimiento facial y centrándonos de manera particular en aquellos procedimientos mínimamente invasivos complementarios a las intervenciones habituales en Cirugía Plástica-Estética, cobra especial relevancia el conocimiento exhaustivo de las estructuras musculares implicadas en la mímica facial. A tal efecto, se ha realizado un estudio anatómico en cadáveres frescos, en los que se han disecado las principales estructuras referidas. Se presenta un resumen iconográfico de los músculos faciales implicados, haciendo hincapié en su anatomía descriptiva y funcional, así como un recuerdo de las principales áreas problemáticas por alguna circunstancia especial (presencia de un nervio sensitivo o motor).To value the multiple technologies involved in facial rejuvenation and focusing in those minimally invasive complementary procedures to the usual Plastic and Aesthetic Surgeries, it´s very important the exhaustive knowledge of the muscular structures involved in the facial movements. To such an effect, an anatomical study has been realized in fresh corpses, dissecting the principal above-mentioned structures. We present an iconographic summary of the facial implied muscles, emphasizing in his descriptive and functional anatomy, as well as a recollection of the principal problematic areas for some special circumstance (presence of a sensory or motor nerv

Combined use of vacuum assisted device and dermal monolayer substitutes

Artículo previamente publicado en Cirugia Plástica Iberolatinoamericana Vol. 36 - Nº 4. 2010 / Pag. 321-326El método de elección para la cobertura de algunos defectos cutáneos es el autoinjerto de piel parcial; sin embargo, sufre retracciones que pueden adquirir gran relevancia sobre áreas especiales. Diferentes autores han intentado evitar estos déficits funcionales mediante la interposición de matrices de regeneración dérmica monocapa e injerto en un solo tiempo quirúrgico. Diseñamos un estudio para comparar la tasa de integración de los injertos sobre una matriz monocapa con y sin la aplicación de terapia de vacío tipo VAC® sobre ellos. Se aleatorizaron 20 pacientes con defectos cutáneos sobre áreas especiales en 2 grupos. Recogimos los datos epidemiológicos y la etiología del defecto (quemadura aguda, secuelas de quemadura o defectos secundarios a extracción de colgajo fasciocutáneo). En 10 casos (Grupo I) se aplicó matriz dérmica monocapa Matriderm ® más un injerto cutáneo de piel parcial, realizando un cambio de vendaje a los 7 días y luego cada 3- 4 días hasta su estabilización. En otros 10 pacientes (Grupo II), tras realizar el mismo protocolo quirúrgico se aplicó VAC ® durante una semana y se cambió hasta la estabilización del injerto. La evaluación del prendimiento del injerto y su estabilidad la realizó un observador ciego. Se recogieron todas las complicaciones surgidas en el postoperatorio hasta 3 meses después de la estabilidad del injerto. Comprobamos la homogeneidad de ambos grupos para las variables epidemiológicas de los pacientes, así como para la etiología de los defectos. La media de tiempo hasta el prendimiento fue de 17,6 ± 8 días, de forma global con una tasa de complicaciones del 20%. Al estratificar en 2 grupos encontramos que las diferencias en la tasa de complicaciones no eran estadísticamente significativas. El tiempo hasta el prendimiento era de 21,4 ± 9 días en el grupo I, frente a 13,9 ± 4 días en el grupo II. Estas diferencias sí eran estadísticamente significativas. Como conclusión, la aplicación de matrices de regeneración dérmica monocapa es segura, con una tasa de prendimiento de los injertos sobre ella del 85%. El uso del VAC ® sobre las láminas monocapa de dermis sintética acorta el tiempo de integración de las mismas y el prendimiento de los injertos sobre ellas, con una tasa de complicaciones similarSplit thickness autografts are the gold standard for wound coverage. However, scars and retractions are frequent after skin grafts, and would be severe over special regions. Different authors avoid these complications using a dermal substitute interposed between the wound and the skin graft in the first surgical time. A prospective study was designed to evaluate the split thickness skin graft uptake time over a monolayer matrix, with and without a vacuum assisted therapy device (VAC®). Twenty patients with a full thickness wound over a special region were randomized between 2 groups. Epidemiological data and wound etiology (acute burn, burn sequelae or donor site after a fasciocutaneous flap raised) were collected. Matriderm ® (mono layer dermal substitute) and a split thickness skin graft was applied over 10 cases (Group I). The dressing was changed after 7 days, and every 3-4 days until the skin graft was uptake and stable. Another 10 cases were treated with the same surgical strategy (Group II). After surgery, a vacuum assisted therapy device (VAC®) was applied until the graft was uptake. The skin graft evaluation was done by a blind observer. All complications were reported until 3 months after the skin graft was stable. The homogeneity between groups was assessed. Averaged uptake time was 17, 6 ± 8 days, and the total complication rate was 20%. Statistically differences were not found between the 2 groups for the complication rate. The uptake time was 21,4 ± 9 days in the Group I and 13,9 ± 4 days in the Group II. These differences was statically significative. As a conclusion, the use of monolayer dermal substitutes is safe, with skin graft uptake rate of 85%. Time for skin graft uptake over a monolayer dermal matrix is shorter using a VAC ® device over the skin graft, with similar complication rat

Promoting dignified end-of-life care in the emergency department: a qualitative study

Background: Preservation of a dying person’s dignity in the emergency department (ED) is fundamental for the patient, his/her relatives and healthcare professionals. The aim of this study was to explore and interpret physicians’ and nurses’ experiences regarding conservation of dignity in end-of-life care in dying patients in the ED. Methods: A qualitative study based on the hermeneutic phenomenological approach, was carried out in the emergency department of two general hospitals. A total of 16 nurses and 10 physicians participated in the study. Data collection included 12 individual in-depth interviews and 2 focus groups. Results: The findings revealed that two themes represent the practices and proposals for the conservation of dignity in the emergency department: dignified care in hostile surroundings and the design of a system focused on the person’s dignity. Conclusion: Dignifying treatment, redesigning environmental conditions, and reorienting the healthcare system can contribute to maintaining dignity in end-of-life care in the ED

Cost-effectiveness analysis of antipsychotics in reducing schizophrenia relapses

BACKGROUND: Schizophrenia is a severe form of mental illness which is associated with significant and long-lasting health, social and financial burdens. The aim of this project is to assess the efficiency of the antipsychotics used in Spain in reducing schizophrenia relapses under the Spanish Health System perspective. MATERIAL AND METHODS: A decision-analytic model was developed to explore the relative cost-effectiveness of five antipsychotic medications, amisulpride, aripiprazole, olanzapine, paliperidone Extended-Release (ER) and risperidone, compared to haloperidol, over a 1-year treatment period among people living in Spain with schizophrenia. The transition probabilities for assessed therapies were obtained from the systemic review and meta-analysis performed by National Institute for Health and Clinical Excellence (NICE). RESULTS: Paliperidone ER was the option that yielded more quality-adjusted life years (QALYs) gained per patient (0.7573). In addition, paliperidone ER was the least costly strategy (€3,062), followed by risperidone (€3,194), haloperidol (€3,322), olanzapine (€3,893), amisulpride (€4,247) and aripiprazole (€4,712). In the incremental cost-effectiveness (ICE) analysis of the assessed antipsychotics compared to haloperidol, paliperidone ER and risperidone were dominant options. ICE ratios for other medications were €23,621/QALY gained, €91,584/QALY gained and €94,558/QALY gained for olanzapine, amisulpride and aripiprazole, respectively. Deterministic sensitivity analysis showed that risperidone is always dominant when compared to haloperidol. Paliperidone ER is also dominant apart from the exception of the scenario with a 20% decrease in the probability of relapses. CONCLUSIONS: Our findings may be of interest to clinicians and others interested in outcomes and cost of mental health services among patients with schizophrenia. Paliperidone ER and risperidone were shown to be dominant therapies compared to haloperidol in Spain. It is worthwhile to highlight that schizophrenia is a highly incapacitating disease and choosing the most appropriate drug and formulation for a particular patient is crucial. The availability of more accurate local epidemiological data on schizophrenia would allow a better adaptation of the model avoiding some of the assumptions taken in our work. Future research could be focused on this

Different Psychophysiological Responses to a High-intensity Repetition Session Performed Alone or in a Group by Elite Middle-distance Runners

Internal training load refers to the degree of disturbance in psychophysiological homeostasis provoked by a training session and has been traditionally measured through session-RPE, which is the product of the session Rate of Perceived Exertion (RPE) and the duration. External training load refers to the actual physical work completed, and depends on session volume, intensity, frequency and density. Drafting, which is achieved by running closely behind another runner has been demonstrated to reduce the energy cost of running at a fixed speed and to improve performance. Therefore, it is hypothesized that psychophysiological responses might reflect different levels of internal load if training is performed individually or collectively. 16 elite middle-distance runners performed two high-intensity training sessions consisting of 4 repetitions of 500 m separated by 3 minutes of active recovery. Sessions were performed individually and collectively. Times for each repetition, RPE, core affect (valence and felt arousal) and blood lactate concentrations [BLa] were measured after each repetition. Main time effect was significant and increased across repetitions for [BLa] and RPE (p <0.001), and decreased for valence (p =0.001). Main group effect was significant and values were higher when training individually for [BLa] (p =0.003) and RPE (p =0.001), and lower for valence (p =0.001). No differential responses were found between conditions in terms of repeat time or felt arousal. Findings demonstrate that elite middle-distance athletes running collectively display lower levels of internal training load compared to running alone, despite external training load being similar

Undetectable Levels of CSF Amyloid-β Peptide in a Patient with 17β-Hydroxysteroid Dehydrogenase Deficiency

17β-hydroxysteroid dehydrogenase 10 (HSD10) deficiency is a rare X-linked inborn error of isoleucine catabolism. Although this protein has been genetically implicated in Alzheimer's disease pathogenesis, studies of amyloid-β peptide (Aβ) in patients with HSD10 deficiency have not been previously reported. We found, in a severely affected child with HSD10 deficiency, undetectable levels of Aβ in the cerebrospinal fluid, together with low expression of brain-derived neurotrophic factor, α-synuclein, and serotonin metabolites. Confirmation of these findings in other patients would help elucidating mechanisms of synaptic dysfunction in this disease, and highlight the role of Aβ in both early and late periods of life

Implementation and Performance of the tau trigger in the ATLAS experiment

Triggering on hadronic taus at the LHC is a difficult task due to the high rate and occupancy of the events. On the other hand, the tau trigger increases the discovery potential of ATLAS in many physics channels, among others the Standard Model or SuperSymmetric Higgs (charged or neutrals) production. In order to cope with the rate and optimize the efficiency on important physics channels, the results of the current simulation studies indicate that the ATLAS tau trigger should be used either with relatively high transverse momentum thresholds alone, or with more relaxed threshold requirements in combination with other triggers, like the missing transverse energy trigger or a leptonic or jet trigger. In this contribution we describe the ATLAS tau trigger, and we present some of the current results from the simulation studies, focusing both on early physics and on physics at high luminosity

Una revisión sistemática de las intervenciones para empoderar al paciente con insuficiencia cardiaca crónica en el entorno hospitalario

El empoderamiento del paciente con insuficiencia cardiaca crónica (ICC) es clave para mejorar su calidad de vida, autonomía, autoestima, nivel de satisfacción y los costes sanitarios. El objetivo fue identificar las intervenciones de enfermería más efectivas para favorecer el empoderamiento del paciente con ICC en el medio hospitalario. Se seleccionaron ocho artículos para revisión (cuatro experimentales, dos cuasi-experimentales y dos revisiones sistemáticas). De su análisis se identificaron tres tipos de intervenciones: educativas, cognitivo-comportamentales y combinadas, siendo estas últimas las más efectivas. Se recomienda el uso del Empowerment Questionnaire como un instrumento válido y fiable para medir el empoderamiento del paciente con ICC hospitalizado. Dada la escasez de estudios, esta revisión aboga por futuras investigaciones que potencien e incluyan intervenciones combinadas mediante una escala válida, fiable y específica para medir el empoderamiento de los pacientes hospitalizados con ICC.The empowerment of patients with chronic heart failure (CHF) is key to improving their quality of life, autonomy, self-esteem, level of satisfaction and healthcare costs. The aim was to identify the most effective nursing interventions to promote the empowerment of patients with CHF in the hospital context. Eight articles were selected for review (four experimental, two quasiexperimental and two systematic reviews). From their analysis, three types of interventions were identified: educational, cognitive-behavioral and combined, the latter being the most effective. The use of the Empowerment Questionnaire is recommended as a valid and reliable instrument to measure the empowerment of chronic hospitalized patients. Given the lack of studies on the phenomenon of interest, this review advocates for future research including combined interventions to empower hospitalized patients with chronic heart failure using a valid, reliable and specific scal

Fracture experience among participants from the FROCAT study: what thresholding is appropriate using the FRAX tool?

ObjectiveTo perform an external validation of FRAX algorithm thresholds for reporting level of risk of fracture in Spanish women (low &lt;5%; intermediate ?5% and &lt;7.5%; high ?7.5%) taken from a prospective cohort “FRIDEX”.MethodsA retrospective study of 1090 women aged ?40 and ?90 years old obtained from the general population (FROCAT cohort). FRAX was calculated with data registered in 2002. All fractures were validated in 2012. Sensitivity analysis was performed.ResultsWhen analyzing the cohort (884) excluding current or past anti osteoporotic medication (AOM), using our nominated thresholds, among the 621 (70.2%) women at low risk of fracture, 5.2% [CI95%: 3.4–7.6] sustained a fragility fracture; among the 99 at intermediate risk, 12.1% [6.4–20.2]; and among the 164 defined as high risk, 15.9% [10.6–24.2]. Sensitivity analysis against model risk stratification FRIDEX of FRAX Spain shows no significant difference. By including 206 women with AOM, the sensitivity analysis shows no difference in the group of intermediate and high risk and minimal differences in the low risk group.ConclusionsOur findings support and validate the use of FRIDEX thresholds of FRAX when discussing the risk of fracture and the initiation of therapy with patients