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BACKGROUND: Mandibular third molar (MTM) extraction is one of the most frequently performed surgeries in the oral cavity. Establishing the level of surgical difficulty pre-operatively is an essential step to ensure correct treatment planning. In Spain, MTM extraction - especially in cases presenting greater difficulty - is normally performed by doctors specializing in oral and maxillofacial surgery, or by dentists with postgraduate qualifications in oral surgery. The present work set out to analyze the extent to which perceptions of surgical difficulty of the said intervention vary in relation to professional training. MATERIAL AND METHODS: This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Non-parametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied. RESULTS: A total of 213 surveys were available for analysis. Both groups awarded the greatest importance to clinical experience, followed by anatomical and radiographic factors, root morphology obtaining the highest score among anatomical factors (9.01±1.42), while proximity of the MTM to the inferior alveolar nerve was regarded as the least important anatomical factor (8.11±2.54). Significant differences were only found for patient age, whereby maxillofacial surgeons awarded this factor more importance than dentists. CONCLUSIONS: The different training received by dentists specialized in oral surgery and maxillofacial surgeons did not influence either perceptions of surgical difficulty of MTM extraction, or opinions as to the factors influencing surgical difficulty.

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INTRODUCTION: Portal vein thrombosis (PVT) is a relatively common finding in patients undergoing liver transplantation. Although the recommendation to prevent its recurrence is anticoagulation for a duration of 3 to 6 months, this is controversial. AIM: The aim of our study was to determine the efficacy of oral anticoagulants (OAC) as prophylaxis for recurrent PVT after liver transplantation. MATERIALS AND METHODS: Our study included 215 liver transplant patients who underwent surgery in our center from January 2012 to August 2017. We selected all patients diagnosed with PVT either pre-transplantation (using Doppler echography or Angio-CT) or during transplant surgery. All patients with PVT were initially anticoagulated with low-molecular-weight heparin in the postoperative period; at discharge they received OAC for a duration of six months. Control Doppler ultrasound was performed at 3, 6, and 12 months post-transplantation. RESULTS: PVT was identified in 37 out of 215 patients (17.2%). PVT was diagnosed with a pre-transplant vascular study in 17 out of 37 cases (45.9%). All patients were anticoagulated with OAC (warfarin) for at least 6 months. There were no cases of recurrent thrombosis and no complications associated with anticoagulant treatment throughout the follow-up period. CONCLUSIONS: The prevalence of portal thrombosis in liver transplant patients in our study was fairly high, at 17.2%. PVT was identified in nearly 50% of patients using high-quality vascular studies prior to transplant surgery. Anticoagulation with OAC for 6 months was effective in preventing a recurrence of thrombosis and there were no associated complications.

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BACKGROUND: Direct-acting antivirals (DAAs) have revolutionized the treatment of hepatitis C, including transplant recipients with an advanced fibrosis stage. Our aim in this study was to assess the clinical and functional benefits and improvement in liver fibrosis after treatment with DAAs in liver transplant recipients with chronic hepatitis C virus who achieved sustained virologic response (SVR). METHODS: We retrospectively analyzed 42 patients who underwent liver transplantation (LT) at our institution and were treated with DAAs from June 2014 to December 2015. Two patients died, so we ultimately included 40 transplant patients with chronic hepatitis C who received DAAs and achieved SVR. We assessed liver function, fibrosis stage, and clinical features at the start of the treatment, and then at 6 and 12 months after SVR. The indication for LT was hepatocellular carcinoma in 8 patients (20%) and Child-Pugh score B/C in 32 patients (80%). RESULTS: The DAAs regimens were sofosbuvir plus daclatasvir (45.0%), simeprevir plus sofosbuvir (42.5%), sofosbuvir plus ledipasvir (7.5%), and ombitasvir/paritaprevir/ritonavir (5%). The mean Modified End-stage Liver Disease (MELD) score pretreatment was 10.78, and was 8.46 at 1 year after treatment (P < .05). In addition, fibrosis stage decreased significantly from 14.81 kPa to 9.07 kPa (FibroScan) at 12 months after SVR. Clinically, there was a significant improvement, including control of ascites and chronic hepatic encephalopathy. CONCLUSION: DAAs were used successfully in the treatment of hepatitis C after orthotopic liver transplantation and resulted in significant improvement in liver function as measured by MELD score, fibrosis level, and cirrhotic clinical condition, even in patients with very advanced disease.

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BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the effect of radiotherapy on the osseointegration of dental implants in the tibia and the action of platelet-rich plasma (PRP) as an adjuvant therapy. MATERIAL AND METHODS: A total of 18 rabbits received two implants in each tibial epiphysis, totalizing 72 implants. The control group (group I) was composed by six rabbits and did not receive radiotherapy. The test groups (II and III) received a single dose of 1727 cGy. Group II was composed by six irradiated animals and group III by six animals that received irradiation and PRP during implant placement. The implant success rate, the bone-implant contact (BIC), and the bone volume were analyzed. RESULTS: There was no osseointegration in four of the implants, three in group II and one in group III. Total BIC was significantly higher in group I, when compared to the other groups. There was a significant difference of osteoid BIC only between irradiated animals (group II, 8.5%; group III, 4.7%; p = 0.001). On the other hand, the mineralized BIC was significantly higher in group I. Furthermore, group II had a lower mineralized BIC than group III (p = 0.002). Bone volume was higher in the control group (41.3%), followed by group III (33.4%) and II (25.1%), with differences between groups I and II (p = 0.001) and groups II and III (p = 0.022). CONCLUSIONS: The present study showed that both the bone volume and BIC were higher in the control group. However, the failure rates of the implants were low in both irradiated groups. The PRP was a positive adjuvant in the osseointegration process.

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Survival after orthotopic liver transplantation (OLT) has increased over the last decades, focusing on the metabolic complications that contribute to patient morbidity and mortality. The aim of our study was to describe the prevalence of metabolic syndrome (MS), its components, and its associated factors in patients who underwent OLT in a hospital in Spain. From November 2001 to January 2014, we performed 415 transplantations in 386 patients. We analyzed 204 patients with a minimum follow-up of 1 year (77.6% were male and the mean age was 54.2+/-9.5 years). The most frequent etiology was alcohol (41%), followed by hepatitis C virus (29.1%). The indication was decompensated cirrhosis in 51.8% and hepatocellular carcinoma in 34%. According to modified National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATP III) criteria, 5 years post-transplantation MS was diagnosed in 38.2% of patients. Significant independent predictors of post-transplantation MS on logistic regression analysis were as follows: pretransplantation obesity (odds ratio [OR], 3.09; P = .056), 1-year post-transplantation obesity (OR, 3.95; P = .009), pretransplantation diabetes (OR, 4.63; P = .001), 1-year post-transplantation diabetes (OR, 3.01; P = .015), 1-year post-transplantation hypertension (OR, 1.85; P = .176), and hypertriglyceridemia at the first year after transplantation (OR, 2.32; P = .063). In our center the prevalence of MS at 5 years after OLT is slightly lower than published. The most important risk factors were obesity and diabetes (both pretransplantation and the first year post-transplantation).

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Cytomegalovirus (CMV) is the most common viral pathogen that negatively affects the outcome of liver transplantation. CMV causes febrile illness often accompanied by bone marrow suppression, and in some cases it invades tissues, including the transplanted allograft. In addition, CMV has been significantly associated with an increased predisposition to allograft rejection, accelerated hepatitis C recurrence, and other opportunistic infections, as well as reduced overall patient and allograft survivals. We carried out a study on a Spanish adult liver transplant recipient who rapidly presented anemia and was diagnosed as having Coomb negative (nonimmune) hemolytic anemia, gastric ulcer, pneumonitis, and cholangitis associated with a CMV infection.

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Objetivo: Conocer la calidad de vida profesional de los trabajadores del área sanitaria de Toledo y analizar sus componentes. Material y métodos: Estudio descriptivo transversal realizado entre los profesionales de atención primaria del área sanitaria de Toledo, mediante encuesta anónima autocumplimentada online. Variables principales: edad, sexo, centro de salud, categoría profesional, antigüedad en el puesto de trabajo, desempeño en tareas directivas, pertenencia a comisiones de trabajo, situación laboral y cuestionario de calidad de vida profesional CVP-35. Resultados: Se obtuvieron 430 respuestas (45,3%). Un 68,4% fueron mujeres. Edad media 47,7 ± 8,6 años, experiencia profesional media 21,5 ± 9,7. Los resultados del CVP-35 fueron: apoyo directivo 4,8 ± 1,5; carga de trabajo 6,2 ± 1,3; motivación intrínseca 7,9 ± 1,1; desconexión tras la jornada laboral 6,3 ± 2,6; calidad de vida laboral global 5,2 ± 2,1. Se encontraron diferencias por sexo en percepción de apoyo directivo (4,5 ± 1,5 en varones vs. 4,9 ± 1,5 en mujeres; p = 0,031) y calidad de vida laboral global (4,9 ± 2,0 vs. 5,3 ± 2,1; p = 0,044). Por categoría profesional se hallaron diferencias en la percepción global de la carga de trabajo (6,4 ± 1,1 en facultativos, 6,3 ± 1,3 en enfermería, 5,9 ± 1,6 en no sanitarios y 5,3 ± 1,2 en unidades de apoyo; p < 0,001). Se registraron diferencias por tipo de contrato en motivación intrínseca (propietarios 7,8 ± 1,1, interinos 8,3 ± 1,1 y eventuales 8,2 ± 1,1; p = 0,002). Conclusiones: La calidad de vida profesional entre los trabajadores del área sanitaria de Toledo es similar a la de otras áreas sanitarias nacionales, aun en una situación de crisis económica. La motivación intrínseca de los profesionales es muy alta, contrastando con la alta percepción de carga de trabajo y la baja percepción de apoyo directivo que manifiestan (AU)

Objective: To determine the professional quality of life in the workers of the Toledo Primary Care Health Area and to analyse its components. Material and methods: Descriptive, cross-sectional study, performed on workers of the Toledo Primary Care Health Area with an online self-administered questionnaire. Main variables: age, sex, health centre, professional group, seniority, management experience, collaboration in working groups, employment situation, and the PQL-35 professional quality of life questionnaire. Results: A total of 430 completed questionnaires were received (45.3%), of which 68.4% were women. The mean age was 47.7 ± 8.6 years old. Mean seniority was 21.5 ± 9.7 years. PQL-35 results were: perception of management support 4.8 ± 1.5; perception of workload 6.2 ± 1.3; intrinsic motivation 7.9 ± 1.1; job disconnection capacity 6.3 ± 2.6; and professional quality of life 5.2 ± 2.1. Gender differences were found in perception of management support (4.5 ± 1.5 in males vs 4.9 ± 1.5 in females; P = .031) and professional quality of life (4.9 ± 2.0 vs 5.3 ± 2.1; p=.044). Depending on the professional group, differences were found in the perception of workload (6.4 ± 1.1 in physicians, 6.3 ± 1.3 in nurses, 5.9 ± 1.6 in non-sanitary professionals, and 5.3 ± 1.2 in support units professionals;P < .001). Depending on the employment situation, differences were found in the intrinsic motivation (7.8 ± 1.1 in proprietors, 8.3 ± 1.1 in temporary workers, and 8.2 ± 1.1 in substitutes; P = .002). Conclusions: The professional quality of life in the workers of the Toledo Primary Care Health Area is similar to that of other Spanish Health Areas, even in a time of economic crisis. The intrinsic motivation of the professionals is very high, in contrast with their high perception of workload and their low perception of management support (AU)

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OBJECTIVE: To determine the professional quality of life in the workers of the Toledo Primary Care Health Area and to analyse its components. MATERIAL AND METHODS: Descriptive, cross-sectional study, performed on workers of the Toledo Primary Care Health Area with an online self-administered questionnaire. MAIN VARIABLES: age, sex, health centre, professional group, seniority, management experience, collaboration in working groups, employment situation, and the PQL-35 professional quality of life questionnaire. RESULTS: A total of 430 completed questionnaires were received (45.3%), of which 68.4% were women. The mean age was 47.7±8.6 years old. Mean seniority was 21.5±9.7 years. PQL-35 results were: perception of management support 4.8±1.5; perception of workload 6.2±1.3; intrinsic motivation 7.9±1.1; job disconnection capacity 6.3±2.6; and professional quality of life 5.2±2.1. Gender differences were found in perception of management support (4.5±1.5 in males vs 4.9±1.5 in females; P=.031) and professional quality of life (4.9±2.0 vs 5.3±2.1; p=.044). Depending on the professional group, differences were found in the perception of workload (6.4±1.1 in physicians, 6.3±1.3 in nurses, 5.9±1.6 in non-sanitary professionals, and 5.3±1.2 in support units professionals; P<.001). Depending on the employment situation, differences were found in the intrinsic motivation (7.8±1.1 in proprietors, 8.3±1.1 in temporary workers, and 8.2±1.1 in substitutes; P=.002). CONCLUSIONS: The professional quality of life in the workers of the Toledo Primary Care Health Area is similar to that of other Spanish Health Areas, even in a time of economic crisis. The intrinsic motivation of the professionals is very high, in contrast with their high perception of workload and their low perception of management support.

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This work compares two miniaturised sample preparation methods, solid phase microextraction (SPME) and hollow fiber liquid phase microextraction (HF-LPME), in combination with gas chromatography coupled to tandem mass spectrometry with a triple quadrupole analyzer for the determination of 77 pesticides in drinking water. In the case of SPME, extraction temperature and time were optimized by experimental design, although other parameters, as desorption time, pH, and ionic strength, were also evaluated. The extraction and desorption solvents [octanol/dihexyl ether (75:25, v/v) and cyclohexane, respectively], as well as the extraction and desorption time, ionic strength, and pH, were studied for the HF-LPME procedure. Under the optimal conditions, recoveries (70.2-113.5% for SPME and 70.0-119.5% for HF-LPME), intra-day precision (2.1-19.4% for SPME and 4.3-22.5% for HF-LPME), inter-day precision (5.2-21.5% for SPME and 8.4-27.3% for HF-LPME), and limits of detection, between 0.1 and 28.8 ng/L for SPME and 0.2 and 47.1 ng/L for HF-LPME and overall uncertainty (9.6-25.2% for SPME and 13.3-27.5% for HF-LPME) were established for both extraction procedures. Finally, the proposed methods were successfully applied to the analysis of 41 drinking water samples, and similar results were obtained with both extraction approaches.

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Camu-camu, es un árbol frutal, oriundo de la amazonía sudamericana que crece en las orillas anegables de ríos amazónicos. Pertenece al género Myrciaria, especie dubia. Presenta gran importancia nutritiva. Su alto contenido en ácido ascórbico (2780 mg/100 g de pulpa) le confieren propiedades antioxidantes. Objetivo: Evaluar la toxicidad subaguda (30 días) del Camu-camu. Material y método: Utilizamos 33 ratas albinas, macho, Holtzman, distribuidas en 3 grupos equitativos: Grupo I (grupo control), se le administró agua destilada, Grupo II y Grupo III, se les administró por vía oral el extracto seco de Camu-camu a las dosis de 100 y 200mg/Kg, respectivamente. Al inicio del experimento (basal), a las 15 y a los 30 días, se determinó: hemoglobina, WBC, urea, albúmina, creatinina, proteínas GGT, TGP, TGO, en sangre, y peso corporal; además, se realizó el examen histológico de hígado, riñones, bazo y estómago al finalizar el estudio (30 días). Resultados: Los valores de hemoglobina, albúmina y proteínas, fueron mayores que las del grupo control (p<0.05); a su vez, los valores de GGT fueron menores que los del grupo control (p<0.05). No encontramos evidencias de toxicidad sub-aguda, en ninguno de los 2 grupos expuestos, en el examen histopatológico. Conclusión: El Camu-camu, a las dosis y formas de administración, del presente trabajo, carece de efectos tóxicos para las ratas.

Camu-camu, is a native fruit tree of the South American jungle and grows at the borders of amazonian rivers. It belongs to Myrciaria generous and dubia specie and has a great nutritional importance. Contains a high amounts of ascorbic acid, (2780mg/100g of pulp), that is why it is good antioxidant. Objective: To evaluate the subacute toxicity of the atomized Camu-camu. Material and method: We used 33 Holtzman albino male rats, distributed in 3 equitable groups: Group I, the control group, only received distilled water, Groups II and III received 100 and 200 mg/Kg of Camu-camu, respectively. Blood samples were taken for biochemical analysis at the beginning, 15th and 30th days (at the end), to determinate Hb, WBC, urea, albumin, total proteins, creatinine, GGT, TGP, TGO and the weight of the animals; we also do the histological examination of liver, kidneys, spleen and stomach at the end of the experiments (day 30th). Results: The values of albumin, total proteins and hemoglobin were higher than the control group (p<0.05) while the values of GGT were lower that control group (p<0.05). We didnÆt find evidences of subacute toxicity in any of the 2 groups exposed to Camu-camu in the histopathological examination. Conclusion: Camu camu hadn´t toxic effect, in rats, with oral administration during 30 days.

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We report an experimental study of the temporal and spatial dynamics of shock waves, cavitation bubbles, and sound waves generated in water during laser shock processing by single Nd:YAG laser pulses of nanosecond duration. A fast ICCD camera (2 ns gate time) was employed to record false schlieren photographs, schlieren photographs, and Mach-Zehnder interferograms of the zone surrounding the laser spot site on the target, an aluminum alloy sample. We recorded hemispherical shock fronts, cylindrical shock fronts, plane shock fronts, cavitation bubbles, and phase disturbance tracks.

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We report the observation of a net spin polarization in the n=1 image-potential state at the Cu(001) surface. The spin polarization is achieved by spin-selective multiphoton excitation of electrons from the spin-orbit split Cu d bands to the image-potential state using circularly polarized ultrafast light pulses. We show that by tuning the exciting photon energy, we can adjust the resonant coupling of the image-potential state to d bands of different double-group symmetry. This allows us to tune the spin polarization injected into the image-potential state.

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We have measured the transverse thermal conductivity kappa(xy) of twinned and untwinned YBa(2)Cu(3)O(7) single crystals as a function of angle theta between the magnetic field applied parallel to the CuO(2) planes and the heat current direction. For both crystals we observed a clear twofold variation in the field-angle dependence of kappa(xy)(theta) = -kappa(0)(xy)(T,B)sin(2 theta). We have found that the oscillation amplitude kappa(0)(xy) depends on temperature and magnetic field. Our results show that kappa(0)(xy) = aBln(1/bB) with the temperature- and sample-dependent parameters a and b. We discuss our results in terms of Andreev scattering of quasiparticles by vortices and a recently proposed theory based on the Doppler shift in the quasiparticle spectrum.

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Presentamos el caso de un paciente de 88 años aquejado de febrícula de 30 días de evolución. Aunque no se cumplieran de forma estricta los criterios clínicos de fiebre de origen desconocido (FOD), se procedió a estudiarlo como tal, dada la falta de diagnóstico y respuesta al tratamiento antibioterápico tras una semana de ingreso. El objetivo de la presentación es comentar un caso que recuerda cómo la patología del paciente de edad avanzada suele presentarse de forma atípica y poco específica.Se recuerda brevemente las principales causas de FOD en el anciano (AU)

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STUDY OBJECTIVE: The objective of this paper is to introduce a different approach, called the ecological-longitudinal, to carrying out pooled analysis in time series ecological studies. Because it gives a larger number of data points and, hence, increases the statistical power of the analysis, this approach, unlike conventional ones, allows the complementation of aspects such as accommodation of random effect models, of lags, of interaction between pollutants and between pollutants and meteorological variables, that are hardly implemented in conventional approaches. DESIGN: The approach is illustrated by providing quantitative estimates of the short-term effects of air pollution on mortality in three Spanish cities, Barcelona, Valencia and Vigo, for the period 1992-1994. Because the dependent variable was a count, a Poisson generalised linear model was first specified. Several modelling issues are worth mentioning. Firstly, because the relations between mortality and explanatory variables were non-linear, cubic splines were used for covariate control, leading to a generalised additive model, GAM. Secondly, the effects of the predictors on the response were allowed to occur with some lag. Thirdly, the residual autocorrelation, because of imperfect control, was controlled for by means of an autoregressive Poisson GAM. Finally, the longitudinal design demanded the consideration of the existence of individual heterogeneity, requiring the consideration of mixed models. MAIN RESULTS: The estimates of the relative risks obtained from the individual analyses varied across cities, particularly those associated with sulphur dioxide. The highest relative risks corresponded to black smoke in Valencia. These estimates were higher than those obtained from the ecological-longitudinal analysis. Relative risks estimated from this latter analysis were practically identical across cities, 1.00638 (95% confidence intervals 1.0002, 1.0011) for a black smoke increase of 10 microg/m(3) and 1.00415 (95% CI 1.0001, 1.0007) for a increase of 10 microg/m(3) of sulphur dioxide. Because the statistical power is higher than in the individual analysis more interactions were statistically significant, especially those among air pollutants and meteorological variables. CONCLUSIONS: Air pollutant levels were related to mortality in the three cities of the study, Barcelona, Valencia and Vigo. These results were consistent with similar studies in other cities, with other multicentric studies and coherent with both, previous individual, for each city, and multicentric studies for all three cities.

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The aim of this study is to Mortality show the protocol of analysis which was set out as part of the EMECAM Project, illustrating the application thereof to the effect of pollution has on the mortality in the city of Valencia. The response variables considered will be the daily deaths rate resulting from all causes, except external ones. The explicative variables are the daily series of different pollutants (black smoke, SO2, NO2, CO, O3). As possible confusion variables, weather factors, structural factors and weekly cases of flu are taken into account. A Poisson regression model is built up for each one of the four deaths series in two stages. In the first stage, a baseline model is fitted using the possible confusion variables. In the second stage, the pollution variables or the time legs thereof are included, controlling the residual autocorrelation by including mortality time lags. The process of fitting the baseline model is as follows: 1) Include the significant sinusoidal terms up to the sixth order. 2) Include the significant temperature or temperature squared terms with the time lags thereof up to the 7th order. 3) Repeat this process with the relative humidity. 4) Add in the significant terms of calendar years, daily tendency and tendency squared. 5) The days of the week as dummy variables are always included in the model. 6) Include the holidays and the significant time lags of up to two weeks of flu. Following the reassessment of the model, each one of the pollutants and the time lags thereof up to the fifth order are proven out. The impact is analyzed by six-month periods, including interaction terms.

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