Restauraciones fototermocuradas en dentición temporal

La restauración de lesiones proximales en molares deciduos es problemática, no existe un material ideal para reparar este tipo de lesiones. Por otra parte en dientes temporales debilitados tras una pulpotomía, la restauración de elección es la corona metálica preformada. Con la introducción de los nuevos sistemas de adhesión una posible alternativa en el tratamiento de estas situaciones en dentición temporal, serian las incrustaciones para molares y las coronas para incisivos confeccionadas con material composite fototennocurado. En este arüculo se analiza la técnica de preparación de estas restauraciones, sus indicaciones, ventajas e inconvenientes.

MP2RAGE provides new clinically-compatible correlates of mild cognitive deficits in relapsing-remitting multiple sclerosis.

Despite that cognitive impairment is a known early feature present in multiple sclerosis (MS) patients, the biological substrate of cognitive deficits in MS remains elusive. In this study, we assessed whether T1 relaxometry, as obtained in clinically acceptable scan times by the recent Magnetization Prepared 2 Rapid Acquisition Gradient Echoes (MP2RAGE) sequence, may help identifying the structural correlate of cognitive deficits in relapsing-remitting MS patients (RRMS). Twenty-nine healthy controls (HC) and forty-nine RRMS patients underwent high-resolution 3T magnetic resonance imaging to obtain optimal cortical lesion (CL) and white matter lesion (WML) count/volume and T1 relaxation times. T1 z scores were then obtained between T1 relaxation times in lesion and the corresponding HC tissue. Patient cognitive performance was tested using the Brief Repeatable Battery of Neuro-psychological Tests. Multivariate analysis was applied to assess the contribution of MRI variables (T1 z scores, lesion count/volume) to cognition in patients and Bonferroni correction was applied for multiple comparison. T1 z scores were higher in WML (p < 0.001) and CL-I (p < 0.01) than in the corresponding normal-appearing tissue in patients, indicating relative microstructural loss. (1) T1 z scores in CL-I (p = 0.01) and the number of CL-II (p = 0.04) were predictors of long-term memory; (2) T1 z scores in CL-I (β = 0.3; p = 0.03) were independent determinants of long-term memory storage, and (3) lesion volume did not significantly influenced cognitive performances in patients. Our study supports evidence that T1 relaxometry from MP2RAGE provides information about microstructural properties in CL and WML and improves correlation with cognition in RRMS patients, compared to conventional measures of disease burden.

Distribución espacio-temporal de los desprendimientos de rocas en la Montaña de Montserrat

La montaña de Montserrat se encuentra afectada por desprendimientos de rocas. Estos desprendimientos conforman un peligro importante para todas las estructuras expuestas en la montaña. Entre ellas el Monasterio de Montserrat y sus accesos por carretera y ferrocarril. En el presente estudio se analiza la distribución espacial y temporal de los desprendimientos en la montaña a partir de la identificación de indicadores geomorfológicos de desprendimientos antecedentes (como canchales y conos de derrubios, bloques caídos de más de 3 m3 y trayectorias) en fotografías aéreas y ortofotos de diferentes años (1978, 1992, 2009). En cuanto al análisis espacial los resultados muestran que hay ciertos sectores de la montaña con un claro alto nivel de afección, mientras que existen otros con una afección casi nula, y que por lo tanto la distribución de la peligrosidad en la montaña es bastante heterogénea. Por otra parte, el análisis temporal muestra como el número de desprendimientos de rocas ha aumentado en las dos últimas décadas.

Incidencia de la incapacidad temporal por contingencia común y profesional en la muestra continua de vidas laborales en 2009

Objetivo: Describir la incidencia de la incapacidad temporal por contingencia común (ITcc) y profesional (ITcp) iniciada en 2009 en afiliados a la Seguridad Social (SS) que forman parte de la Muestra Continua de Vida Laboral.Métodos: Cohorte formada por 873.008 afiliados a la SS en España que registraron 163.008 episodios de IT con un tiempo acumulado total en riesgo de 675.923,6 trabajadores-año. Se estimó la tasa de incidencia de todos los primeros episodios de IT y por trastornos musculo-esqueléticos (TME) según variables demográficas y laborales. Posteriormente se calcularon las razones de tasas crudas (RTc) y ajustadas (RTa) mediante un modelo de regresión Poisson.Resultados: La incidencia de la ITcc e ITcp fue de 23,1 y 1,0 casos por 100 trabajadores-año, respectivamente. La incidencia por ITcc fue superior en mujeres, en menores de 26 años y en Navarra (32,8 casos por 100 trabajadores-año), y por ITcp las mayores incidencias se observaron en hombres y en Galicia. Por diagnóstico, los TME presentaron 424,7 casos y 3,6 casos por 10.000 trabajadores-año según contingencia común y profesional respectivamente. Por otra parte, los trabajadores temporales tuvieron más riesgo de desarrollar ITcp (RTa=1,09;IC95%=1,04-1,15) e ITcc (RTa=1,02;IC95%=1,01-1,03) respecto a los permanentes.Conclusiones: La incidencia de la IT sigue un mismo patrón según edad, régimen de afiliación y relación laboral. Por tipo de contingencia se observaron diferencias en la ocupación, sexo, tamaño de empresa, comunidad autónoma y actividad económica. Es necesario estudiar con más detenimiento las diferencias observadas por actividad económica y tipo de relación contractual.

Reincorporación al trabajo tras una incapacidad temporal por trastornos músculo-esqueléticos: Revisión sistemática de guías de buenas prácticas

Objetivo: identificar las guías de retorno al trabajo (GRAT) después de un proceso de Incapacidad temporal (IT) por trastorno músculo esquelético (TME) para evaluar su calidad metodológica.Método: Se realizó una búsqueda sistemática de guías específicas de retorno al trabajo en inglés, castellano y catalán cuyo contenido tenía en forma total o parcial información sobre TME. 6 guías fueron identificadas (3 específicas sobre TME) las cuales fueron evaluadas por 7 expertos utilizando el método validado AGREE. Para cada dominio de cada una de las guías se calcularon las puntuaciones estandarizadas y para cada ítem las medianas de puntajes de los evaluadores. Además, cada evaluador hizo un juicio cualitativo de la calidad de la guía.Resultados: De las 6 guías seleccionadas para su valoración cualitativa y cuantitativa, sólo dos: Official disability guidelines (ODG) y Work related Muskuloskequeletal disorders Guide &Tools for modified work (WRGT), podrían utilizarse sin modificaciones. El resto de guías deben ser revisadas y modificadas antes de utilizarse sistemáticamente. En general, todas las guías definen bien sus objetivos y a quien van dirigidas, además, las opciones de manejo de retorno al trabajo se presentan en forma clara y precisa. Sin embargo, todas excepto una (ODG) tienen limitaciones en los criterios para seleccionar la evidencia científica y ni se comentan potenciales conflictos de interés.Conclusiones: Solo dos guías identificadas serían recomendables su uso sin modificaciones. Si nuestro objetivo es proponer la utilización de una guía en nuestro entorno es necesario complementar la evaluación de la calidad metodológica de estas dos GRAT, con una evaluación basada en la evidencia de la calidad de las recomendaciones incluidas en ellas.

Calling and career preparation: Investigating developmental patterns and temporal precedence

The presence of a calling and career development are assumed to be closely related. However, the nature of and reason for this relationship have not been thoroughly investigated. We hypothesized the existence of reciprocal effects between calling and three dimensions of career preparation and assessed the change of the presence of a calling, career planning, decidedness, and self-efficacy with three waves of a diverse sample of German university students (N = 846) over one year. Latent growth analyses revealed that the intercepts of calling showed a significant positive correlation with the intercepts of all career preparation measures. The slope of calling was positively related to those of decidedness and self-efficacy but not to planning. Cross-lagged analyses showed that calling predicted a subsequent increase in planning and self-efficacy. Planning and decidedness predicted an increase in the presence of a calling. The results suggest that calling and career preparation are related due to mutual effects but that effects differ for different career preparation dimensions.

A pipeline approach with spatial information for segmenting multiple sclerosis lesions on brain magnetic resonance imaging

Background: Conventional magnetic resonance imaging (MRI) techniques are highly sensitive to detect multiple sclerosis (MS) plaques, enabling a quantitative assessment of inflammatory activity and lesion load. In quantitative analyses of focal lesions, manual or semi-automated segmentations have been widely used to compute the total number of lesions and the total lesion volume. These techniques, however, are both challenging and time-consuming, being also prone to intra-observer and inter-observer variability.Aim: To develop an automated approach to segment brain tissues and MS lesions from brain MRI images. The goal is to reduce the user interaction and to provide an objective tool that eliminates the inter- and intra-observer variability.Methods: Based on the recent methods developed by Souplet et al. and de Boer et al., we propose a novel pipeline which includes the following steps: bias correction, skull stripping, atlas registration, tissue classification, and lesion segmentation. After the initial pre-processing steps, a MRI scan is automatically segmented into 4 classes: white matter (WM), grey matter (GM), cerebrospinal fluid (CSF) and partial volume. An expectation maximisation method which fits a multivariate Gaussian mixture model to T1-w, T2-w and PD-w images is used for this purpose. Based on the obtained tissue masks and using the estimated GM mean and variance, we apply an intensity threshold to the FLAIR image, which provides the lesion segmentation. With the aim of improving this initial result, spatial information coming from the neighbouring tissue labels is used to refine the final lesion segmentation.Results:The experimental evaluation was performed using real data sets of 1.5T and the corresponding ground truth annotations provided by expert radiologists. The following values were obtained: 64% of true positive (TP) fraction, 80% of false positive (FP) fraction, and an average surface distance of 7.89 mm. The results of our approach were quantitatively compared to our implementations of the works of Souplet et al. and de Boer et al., obtaining higher TP and lower FP values.Conclusion: Promising MS lesion segmentation results have been obtained in terms of TP. However, the high number of FP which is still a well-known problem of all the automated MS lesion segmentation approaches has to be improved in order to use them for the standard clinical practice. Our future work will focus on tackling this issue.

Neutralizing antibodies in Multiple Sclerosis a model-based analysis of Interferon beta signaling pathway in macrophages

Multiple Sclerosis is the most common non-traumatic cause of neurologicaldisability in young people. There is no cure yet, and until recently, few long-termtherapies existed. Interferon beta (IFNβ) was the first treatment, and remains the mostcommonly prescribed. One of the most significant problems of IFNβ therapy is theproduction of drug specific antibodies. Up to 45% of patients develop neutralizingantibodies (NAbs) to IFNβ products. The neutralizing antibody binds to the biologicalagent preventing its interaction with its receptor, inhibiting the biological action of theprotein, which abrogates the clinical efficacy of IFNβ treatment. Interferon-betamediates its response by binding to its high affinity cell surface receptor and initiatingthe JAK/STAT signalling cascade. In this project we have analyzed the IFNβ signalingpathway in macrophages when neutralizing antibodies are present. The response tothis pathway after IFNβ stimulation shows a transient oscillatory rhythm of STAT1phosphorylation, which varies as NAbs concentration increases. To improve ourunderstanding of that behavior, we extended an existing mathematical model based onnonlinear ordinary differential equations of JAK/STAT pathway by including IFN-NAbassociation and IFN-activation receptor. Combining our theoretical model withexperimental data we could study the role of neutralizing antibodies on the molecularresponse and determine its lifetime after cytokine stimulation.

Análise espectral e temporal da cultura do café em imagens Landsat

A definição da resposta espectral da cultura do café é uma das etapas na identificação de lavouras cafeeiras em imagens de satélites de sensoriamento remoto, para fins de mapeamento e estimativa de área plantada. O objetivo deste trabalho foi avaliar o potencial das imagens adquiridas pelos satélites da série Landsat, no mapeamento da cultura do café para a previsão de safras. Foi feita uma análise temporal do comportamento espectral de lavouras de café-formação e café-produção por meio de imagens livres de nuvens adquiridas nos anos de 1999 e 2001. Também foi analisado o comportamento espectral das classes pastagem e mata, que compõem os alvos de maior ocupação na área de estudo. As imagens do período seco foram mais eficientes no mapeamento de lavouras de café-formação e café-produção. As imagens da banda 4 dos dois sensores apresentaram melhor diferenciação espectral entre café e os demais alvos da cena. A reflectância do café-produção apresentou grande variabilidade entre lavouras, que pode ser atribuída à idade, espaçamento de plantas, cultivar, indicando a necessidade de trabalho em campo para a correta identificação das lavouras de café nas imagens Landsat.

Valoració de la capacitat de salt i sincronització temporal intergrupal en la Gimnàstica Estètica de Grup

La Gimnàstica Estètica de Grup (GEG) és un esport emergent del qual no existeix gairebé cap treball de camp i/o publicació. En relació al codi de puntuació d’aquesta modalitat, tant les capacitats de salt com la unitat de moviment del cos i la sincronització entre els membres del conjunt, tenen un pes molt important en la puntuació del valor tècnic i de l’execució. En aquest estudi s’ha realitzat la mesura, avaluació i comparació de les manifestacions de la força explosiva, elàstica i reactiva d’un grup de gimnàstica d’estètica d’alt nivell al principi i al final del període competitiu, mitjançant la bateria de tests de salts verticals de Bosco, concretament SJ, CMJ, CMJas i RJ (15” CMJas). També s’ha analitzat la sincronització i/o coordinació temporal intergrupal d’execució de les dificultats tècniques de salt de les coreografies competitives, al llarg del període competitiu d’un conjunt de gimnàstica estètica d’alt nivell, tenint en compte la sincronització en començar la dificultat i en acabar-la. Els resultats obtinguts demostren que la manifestació de força elàsticoexplosiva en CMJ ha disminuït un 0,46 % i la força explosiva SJ (sense reutilització d'energia elàstica ni aprofitament del reflex miotàtic) ha augmentat un 4,63 %. Durant el període competitiu del conjunt sènior de gimnàstica estètica del Club Muntanyenc Sant Cugat, la influència dels braços en la capacitat de salt ha augmentat un 1,32% i la potència anaeròbica alàctica un 4,76%. Tot i que en la majoria de tests, els resultats han estat positius, no es considera que la mostra hagi assolit una millora significativa, atès que no ha superat el 10% proposat en començar l’estudi, i els valors obtinguts són totalment inestables. S’ha vist que en un mateix test el % de pèrdues i de guanys ha estat molt variat, de manera que no es pot establir una relació de millora de la capacitat de salt en funció de l’entrenament. Pel que fa a la sincronització temporal intergrupal, ha millorat entre un 37,50% (sincronització temps inicial) i un 50,00% (sincronització temps final) en relació a les dificultats tècniques. Fet que és relaciona directament amb l’automatització de mecanismes d’execució al llarg de la temporada competitiva. Tot i així no s’ha igualat o superat la millora d’un 70% proposada per les hipòtesis inicials de l’estudi.

Outcome evaluation of ankle osteoarthritis treatments using spatio-temporal gait parameters and plantar pressure during unconstrained long distance walking : P25

Introduction: Ankle arthrodesis (AD) and total ankle replacement (TAR) are typical treatments for ankle osteoarthritis (AO). Despite clinical interest, there is a lack of their outcome evaluation using objective criteria. Gait analysis and plantar pressure assessment are appropriate to detect pathologies in orthopaedics but they are mostly used in lab with few gait cycles. In this study, we propose an ambulatory device based on inertial and plantar pressure sensors to compare the gait during long-distance trials between healthy subjects (H) and patients with AO or treated by AD and TAR. Methods: Our study included four groups: 11 patients with AO, 9 treated by TAR, 7 treated by AD and 6 control subjects. An ambulatory system (Physilog®, CH) was used for gait analysis; plantar pressure measurements were done using a portable insole (Pedar®-X, DE). The subjects were asked to walk 50 meters in two trials. Mean value and coefficient of variation of spatio-temporal gait parameters were calculated for each trial. Pressure distribution was analyzed in ten subregions of foot. All parameters were compared among the four groups using multi-level model-based statistical analysis. Results: Significant difference (p <0.05) with control was noticed for AO patients in maximum force in medial hindfoot and forefoot and in central forefoot. These differences were no longer significant in TAR and AD groups. Cadence and speed of all pathologic groups showed significant difference with control. Both treatments showed a significant improvement in double support and stance. TAR decreased variability in speed, stride length and knee ROM. Conclusions: In spite of a small sample size, this study showed that ankle function after AO treatments can be evaluated objectively based on plantar pressure and spatio-temporal gait parameters measured during unconstrained walking outside the lab. The combination of these two ambulatory techniques provides a promising way to evaluate foot function in clinics.

Syndrome of birt-hogg-dubé, a histopathological pitfall with similarities to tuberous sclerosis: a report of three cases.

: Birt-Hogg-Dubé Syndrome (BHD) is a rare condition, transmitted as an autosomal-dominant trait. The etiology is due to a mutation in the BHD gene, which encodes folliculin (FLCN), located on chromosome 17p. The skin changes observed are benign skin tumors consisting of hamartomas of the hair follicle with dermal changes. Patients with BHD have an increased risk of spontaneous pneumothorax due to rupture of lung cysts and an increased risk of kidney tumors. We report 3 new cases of BHD and discuss their clinical features, histopathological findings, and molecular diagnostics. We highlight the importance of genetic analysis to confirm the diagnosis because of the clinical pitfalls involved in establishing a diagnosis. Finally, we discuss the histopathological features in BHD and tuberous sclerosis complex and focus on their overlapping criterias. A correct diagnosis is essential as it can be life saving for patients.

Auditory spatio-temporal brain dynamics and their consequences for multisensory interactions in humans.

Recent multisensory research has emphasized the occurrence of early, low-level interactions in humans. As such, it is proving increasingly necessary to also consider the kinds of information likely extracted from the unisensory signals that are available at the time and location of these interaction effects. This review addresses current evidence regarding how the spatio-temporal brain dynamics of auditory information processing likely curtails the information content of multisensory interactions observable in humans at a given latency and within a given brain region. First, we consider the time course of signal propagation as a limitation on when auditory information (of any kind) can impact the responsiveness of a given brain region. Next, we overview the dual pathway model for the treatment of auditory spatial and object information ranging from rudimentary to complex environmental stimuli. These dual pathways are considered an intrinsic feature of auditory information processing, which are not only partially distinct in their associated brain networks, but also (and perhaps more importantly) manifest only after several tens of milliseconds of cortical signal processing. This architecture of auditory functioning would thus pose a constraint on when and in which brain regions specific spatial and object information are available for multisensory interactions. We then separately consider evidence regarding mechanisms and dynamics of spatial and object processing with a particular emphasis on when discriminations along either dimension are likely performed by specific brain regions. We conclude by discussing open issues and directions for future research.