Glosectomía parcial. Una técnica quirúrgica para tratamiento de macroglosia.

La macroglosia se describe desde el siglo II como una patología congénita o adquirida. Que se debe al aumento de la cantidad de tejido lingual, en el cual se observa un alargamiento y ensanchamiento de la lengua de una manera desproporcionada hacia las estructuras dentoalveolares produciendo desplazamientos dentales, indentaciones y traumas a nivel lingual, además podemos encontrar características funcionales como obstrucciones de la vía aérea, lo que puede conducir a hipoventilación alveolar que luego pasa a hipoxia e hipercapnia. Sialorrea y capacidad para llevar la lengua al mentón o a la punta de la nariz. En la mayoría de los casos se presenta en los pacientes que están relacionados con otras patologías como linfangiomas, síndrome de Beckwith-Wiedemann y pacientes con trisomía 21 o síndrome de Down. Como una forma de corregir esta patología muchos autores describen diversos tratamientos quirúrgicos que permitan mejorías de funciones vitales como la deglución, fonación y respiración; como tratamiento adicional a la corrección de anomalías dento- musculo- esqueléticas, que permita darle estabilidad al tratamiento ortodontico que algunos de estos pacientes requieren, además de una mejoría estética.El objetivo de este artículo es presentar la glosectomia parcial por medio de un caso  que tuvo un adecuado resultado clínico, sin ninguna complicación

Phase II Trial of Allogeneic Transplantation Plus Novel Drugs in Multiple Myeloma: Effect of Intensifying Reduced-Intensity Conditioning with Bortezomib and Adding Maintenance Treatment

The use of reduced-intensity conditioning (RIC) regimens has decreased the risk of nonrelapse mortality (NRM) after allogeneic stem cell transplantation (alloSCT). In contrast, disease relapse remains the most frequent cause of treatment failure and death. Owing to both their antimyeloma effect and immunomodulatory properties, novel drugs could improve outcomes after alloSCT. This phase II European Myeloma Network trial was designed to evaluate the combination of alloSCT with novel agents. The study was conducted to evaluate the toxicity and efficacy of RIC intensified with bortezomib (Bz) prior to alloSCT for high-risk (HR) multiple myeloma (MM) patients, as well as the efficacy of post-transplantation maintenance with Bz and lenalidomide (Len). Patients received RIC with Bz on days -9 and -2, fludarabine on days -6 to -4, and melphalan on day -3. Patients who were in complete response (CR) or near CR at day +100 post-transplantation received 6 cycles of Bz every 56 days, and the remaining received Bz, Len, and dexamethasone. Len maintenance was started on day +180 at a dose of 5 mg and continued until relapse or toxicity occurred. Of the 24 patients included, 21 were evaluable on day +100, including 12 in CR, 4 in very good partial response, 3 in partial response, and 2 with relapse or progression. The cumulative incidence (CuI) of relapse was 13.6% (95% confidence interval [CI], 3.2% to 31.3%) at 1 year and 28.5% (95% CI, 11.1% to 48.9%) at 2 years. The CuI of NRM was 21.1% (95% CI, 7.4% to 39.4%) at 2 years. With a median follow-up of 39 months (range, 1 to 67 months), the median event-free survival (EFS) was 29 months, and median overall survival (OS) was not reached. EFS and OS at 3 years were 42.5% (95% CI, 21.9% to 61.7%) and 74.01% (95% CI, 50.9% to 87.5%), respectively. The use of Bz within an RIC regimen allows for a high response rate after alloSCT. Maintenance with Bz and Len is feasible and provides remarkable results in terms of EFS and OS in HR MM patients

Tratamiento de las fracturas del fémur distal en ancianos

Presentamos los resultados comparativos del tratamiento con dos métodos diferentes de 55 casos de fractura del fémur distal en pacientes ancianos. Hugo 27 pacientes que fueron tratados con el tornillo dinámico condilar (grupo A) y 28 con tracción esquelética (grupo B). Se obtuvieron resultados excelentes y buenos en el 70% del grupo quirúrgico y en el 30% del grupo no intervenido. Hubo más complicaciones en este último. Cinco pacientes fallecieron, todos ellos en el grupo B.We report the comparative results of treatment of 55 cases of fractures of the distal femur in elderly patients using two different methods. There were 27 patients treated with the dynamic condylar screw (group A), and 28 with skeletal traction (group B). excellent or good results were achieved in 70% of the operated and in 30% of the non-operated group. There were more complications in the latter. Five patients died, all of them in group B

Malacofauna del Banco Chella y alrededores (Mediterráneo occidental)

Molluscs of Chella Bank and its surroundings were studied from 21 samples collected with a van Veen grab in the depth range 95-729 m. A total of 299 taxa were identified (77 live-taken), thus increasing by more than 95% the species of molluscs reported in the recently declared site of community importance “Sur de Almería-Seco de los Olivos”. Two of the species are new records to Spanish waters and one to the Alboran Sea. The high species richness observed could be related to the location, the hydrological characteristics and the topographical heterogeneity of the area within the Alboran Sea. Four significant groups of samples were discriminated through multivariate analysis of quantitative data of live-taken molluscs: (I) bathyal muddy bottoms with buried rhodoliths; (II) bathyal muddy bottoms with coral rubble; (III) bathyal hemipelagic muddy bottoms and (IV) bathyal sandy bottoms. Molluscs were more diverse on coral framework bottoms than on sedimentary bottoms around Chella Bank. Most of the live-taken species are widely distributed along the Atlantic and Mediterranean Sea, and a few are strictly Mediterranean. The most striking feature was the occurrence of two species with planktotrophic larval development for which Chella Bank is the sole recorded locality in the Mediterranean (Episcomitra angelesae and Mitrella templadoi) and which elsewhere extremely rare (Mathilda spp.).Se estudiaron los moluscos del banco Chella y sus fondos adyacentes a partir de veintiuna muestras cogidas con draga Van Veen entre 95 y 729 m de profundidad. Un total de 299 taxones fueron identificados (77 vivos), incrementando en un 95% el total de moluscos citados en el reciente Lugar de Importancia Comunitaria “Sur de Almería-Seco de los Olivos”. Dos especies son nuevas citas para aguas españolas y una para el mar de Alborán. La elevada riqueza específica puede estar relacionada con la localización, las características hidrológicas y la heterogeneidad topográfica de esta zona situada dentro del mar de Alborán. Mediante análisis multivariantes usando datos cuantitativos de la taxocenosis se han diferenciado cuatro grupos de muestras: (I) fangos del batiales con rodolitos enterrados, (II) fangos batiales con restos de corales, (III) fangos hemipelágicos batiales, y (IV) arenas batiales. La mayor diversidad se encontró en los fondos con restos de corales, a diferencia de los fondos sedimentarios situados alrededor del banco Chella. La mayoría de las especies vivas están ampliamente distribuidas por el Atlántico y el Mediterráneo, y muy pocas son estrictamente mediterráneas. Cabe destacar la ocurrencia de algunas especies con desarrollo planctotrófico (Episcomitra angelesae, Mitrella templadoi) en el banco Chella como única localidad registrada en el Mediterráneo o especies extremadamente raras en otros lugares (Mathilda spp.)

Origin and driving mechanisms of marine litter in the shelf-incised Motril, Carchuna, and Calahonda canyons (northern Alboran Sea)

Introduction and methodsMarine litter density, distribution and potential sources, and the impact on canyon seafloor habitats were investigated in the Motril, Carchuna and Calahonda canyons, located along the northern margin of the Alboran Sea. During the ALSSOMAR-S2S oceanographic survey carried out in 2019, canyon floor imagery was collected by a Remotely Operated Vehicle along 5 km in the Motril Canyon, 10 km in the Carchuna Canyon, and 3 km in Calahonda Canyon, together with 41 surficial sediment samples. Additionally, coastal uses, maritime traffic and fishing activity data were analyzed. A 50 m resolution multibeam bathymetry served as base map. ResultsIn the Motril and Calahonda canyons, the density of marine litter was low and the material was dispersed, very degraded and partially buried. In contrast, the Carchuna Canyon contained a greater amount and variety of litter. The Carchuna Canyon thalweg exhibited a density of marine litter up to 8.66 items center dot 100 m(-1), and litter hotspots with a density of up to 42 items center dot m(2) are found along the upper reaches of the canyon thalweg. DiscussionLow litter abundances found in the studied canyons most likely reflect low population densities and the absence of direct connections with streams in the nearby coasts. The high shelf incision of the Carchuna Canyon and its proximity to the coastline favor littoral sediment remobilization and capture as well as the formation of gravity flows that transport the marine litter along the thalweg toward the distal termination of the channel. Litter hotspots are favored by the canyon morphology and the occurrence of rocky outcrops. Most debris is of coastal origin and related to beach occupation and agricultural practices in the adjacent coastal plain. A third origin was represented by fishing gear in the study area. Fishing activity may be producing an impact through physical damage to the skeletons of the colonial scleractinians located in the walls of the Carchuna Canyon. In contrast, the Motril and Calahonda canyons can be considered passive systems that have mainly acted as depositional sinks in the recent past, as evidenced by buried marine litter.18-ESMARES2-CIRCA project of the Instituto Español de Oceanografıa; DL57/2016/CP1361/CT0009info:eu-repo/semantics/publishedVersio

Caspase-8 inhibition represses initial human monocyte activation in septic shock model

In septic patients, the onset of septic shock occurs due to the over-activation of monocytes. We tested the therapeutic potential of directly targeting innate immune cell activation to limit the cytokine storm and downstream phases. We initially investigated whether caspase-8 could be an appropriate target given it has recently been shown to be involved in microglial activation. We found that LPS caused a mild increase in caspase-8 activity and that the caspase-8 inhibitor IETD-fmk partially decreased monocyte activation. Furthermore, caspase-8 inhibition induced necroptotic cell death of activated monocytes. Despite inducing necroptosis, caspase-8 inhibition reduced LPS-induced expression and release of IL-1β and IL-10. Thus, blocking monocyte activation has positive effects on both the pro and anti-inflammatory phases of septic shock. We also found that in primary mouse monocytes, caspase-8 inhibition did not reduce LPS-induced activation or induce necroptosis. On the other hand, broad caspase inhibitors, which have already been shown to improve survival in mouse models of sepsis, achieved both. Thus, given that monocyte activation can be regulated in humans via the inhibition of a single caspase, we propose that the therapeutic use of caspase-8 inhibitors could represent a more selective alternative that blocks both phases of septic shock at the source.Unión Europea, Ministerio de Economía y Competitividad SAF2012-39029Unión Europea, Ministerio de Economía y Competitividad SAF2015-64171REspaña,Junta de Andalucía P10-CTS-649

Oropharyngeal Colostrum Positively Modulates the Inflammatory Response in Preterm Neonates

During the first days of life, premature infants have physiological difficulties swallowing, thereby missing out on the benefits of breastfeeding. The aim of this study is to assess the effects of oropharyngeal mother’s milk administration in the inflammatory signaling of extremely premature infants. Neonates (n = 100) (<32 week’s gestation and/or <1500 g) were divided into two groups: mother’s milk group (n = 48), receiving 0.2 mL of oropharyngeal mother’s milk every 4 h for the first 15 days of life, and a control group (n = 52), not receiving oropharyngeal mother’s milk. Serum concentrations of interleukin (IL) IL-6, IL-8, IL-10, IL-1ra, tumor necrosis factor alpha (TNF-a), and interferón gamma (IFN- y) were assessed at 1, 3, 15, and 30 days of postnatal life. Maternal and neonatal outcomes were collected. The rate of common neonatal morbidities in both groups was similar. The mother’s milk group achieved full enteral feeding earlier, and showed a decrease in Il-6 on days 15 and 30, in IL-8 on day 30, and in TNF-a and INF- y on day 15, as well as an increase in IL-1ra on days 3 and 15 and in IL-10 on day 30. Oropharyngeal mother’s milk administration for 15 days decreases the pro-inflammatory state of preterm neonates and provides full enteral nutrition earlier, which could have a positive influence on the development of the immune system and inflammatory response, thereby positively influencing other developmental outcomes

Perception of the professional nursing environment in Primary Care in the Valencian Community, in departments with public and private management

Fundamento. Los entornos para la práctica profesional enfermera (EPE) mejoran la calidad del cuidado, la satisfacción y los resultados en salud, no existiendo ninguna medición en Atención Primaria (AP) según su modelo de gestión. Pretendemos estimar y comparar la percepción de la calidad de dichos ERE en AP en tres departamentos de salud (DS) de la Comunidad Valenciana con modelos de gestión pública y privada (concesión administrativa). Material y métodos. Estudio transversal en profesionales de Enfermería de AP de tres DS, uno de gestión pública y dos de gestión privada. Se utilizó el cuestionario Practice Environment Scale-Nursing Work Index validado en España y se recogieron variables sociodemográficas y profesionales. Se determinaron las variables relacionadas con la puntuación mediante regresión lineal múltiple. Resultados. Se obtuvieron 269 respuestas (80,3%). Todos los DS percibieron la calidad de los EPE de forma positiva, tanto global como para las distintas dimensiones (excepto D4). La puntuación global fue más alta en los DS de gestión privada; la misma tendencia que se observó para D1 y D2, opuesta a la observada en D4. La puntuación global se relacionó con la edad, la experiencia profesional, ejercer un cargo de coordinación y el modelo de gestión, pero tan solo la edad y ejercer un cargo de coordinación mantuvo la relación en el modelo multivariante. Conclusiones. Los EPE de AP en la Comunidad Valenciana son positivos, y su calidad no se ve afectada por el modelo de gestión. Ejercer un cargo de coordinación y, especialmente, la edad son los factores que se relacionan de forma independiente con la puntuación obtenida.Background. Nursing practice environments (NPE) improve the quality of care, satisfaction and heath results; there are no studies that compare the Primary Health Care (PHC) environments according to their management model. Our aim is to estimate and compare the perception of the quality of the NPE in the PHC in Health Departments (HD) of the Valencian Community (Spain) with management model public or indirect-private (Administrative concession). Method. Transversal study on PHC nurses from three HD, one with direct public management and two with indirect-private management. The Practice Environment Scale-Nursing Work Index questionnaire, validated in Spain, was administered. Sociodemographic and professional variables were recorded. Variables related to test score were analyzed by multiple linear regression. Results. Two hundred and sixty-nine answers (80.3%). All HD perceived NPE quality in a positive way, both globally and for the different dimensions (except D4). Indirect private management model HD obtained higher global scores, the same tendency was observed for D1 and D2, and the opposite for D4. Global score was related to age, professional experience, being a coordinator and management model; only the age of the nurses and being a coordinator showed a significant relationship with the score in the multivariate regression model. Conclusions. The NPE of the PHC of the Valencian Community are of good quality, without significant differences according to different management models of the HD. Being a coordinator and, particularly, the age of the nurses are variables that are independently related to the global score obtained

Qualitative Analysis by Experts of the Essential Elements of the Nursing Practice Environments Proposed by the TOP10 Questionnaire of Assessment of Environments in Primary Health Care

Background: A short TOP10 scale based on the Practice Environment Scale-Nursing Work Index questionnaire measures the characteristics of nursing work environments. Positive environments result in better quality care and health outcomes. Objective: To identify a small number of core elements that would facilitate more effective interventions by nurse managers, and compare them with the essential elements proposed by the TOP10. Method: Qualitative research by a nominal group of eight experts. The content analysis was combined with descriptive data. Results: Ten most important items were selected and analyzed by the expert group. A high level of consensus in four items (2, 15, 20, 31) and an acceptable consensus in five items was reached (6, 11, 14, 18, 26). The tenth item in the top ten was selected from content analysis (19). The expert group agreed 90% with the elements selected as essential to the TOP10. Conclusion: The expert group achieved a high level of consensus that supports 90% of the essential elements of primary care settings proposed by the TOP10 questionnaire. Organizational changes implemented by managers to improve working environments must be prioritized following our results, so care delivery and health outcomes can be further improved

Development of a short questionnaire based on the Practice Environment Scale-Nursing Work Index in primary health care

Background: Professional nursing environments determine the quality of care and patient outcomes. Assessing the quality of environments is essential to improve and obtain better health outcomes. Simplifying and shortening the way to evaluate environments reliably is also important to help nurses better understand the strengths and weaknesses of their environments. In that sense, identifying essential elements of nursing environments would allow the construction of short assessment tools to improve such environments. Objective: To construct a short tool to assess primary health care (PHC) nursing environments based on the Practice Environment Scale-Nursing Work Index (PES-NWI) questionnaire. Methods: Observational, cross-sectional, analytical study (data collection February–April 2015). Tool: PES-NWI (31 items). Population: PHC nurses (three health districts in Valencia, Spain) with more than 3 months in the organization. The nurses were asked to select the 10 elements of the questionnaire (items) that they considered key to facilitate and improve professional care, establishing as a final selection criterion that they obtain a global election >40%. Variables: sociodemographic and 31 questionnaire items. Analysis: descriptive statistics, reliability, multidimensional scaling (ALSCAL), factor analysis, multiple linear regression. Finally, we have analyzed the concordance between both measurements (TOP10 score on the full scale score) using the Bland–Altman method. Results: Study sample = 269 (Response rate = 80.29%). A total of 10 elements were identified based on selection frequency of the questionnaire PES-NWI. A factorial analysis explained 62.1% of variance, internal structure of three dimensions: (1) Participation in leadership and management, (2) Nursing foundations for quality of care, (3) Adequacy of resources, with Accumulate Variance explained: Component (1): 24%; Component (2): 43.1%; Component (3): 62.1%. Reliability (Cronbach’s Alpha) was 0.816 for short questionnaire, and >0.8 for all measurements. Stress = 0.184 and RSQ = 0.793. Bland–Altman method: the scaling tends to be 1.92 points higher (equivalent to a maximum deviation of 1.54%) than the full-scale PES-NWI score (max score on PES-NWI = 124 points). Conclusions: It is possible to identify essential elements of environments to construct a short tool that simplifies the study of PHC environments. Conducting rapid studies of environments will provide managers with information about specific elements that require prioritization to enhance quality of care and safety