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RESUMEN: El presente trabajo tiene como principal objetivo presentar la teoría polivagal como un modelo bio-comportamental del comportamiento emocional e interpersonal, con la finalidad de identificar ámbitos de contribución de la teoría al estudio de la psicoterapia en torno al estatus clínico de los consultantes, el proceso terapéutico y el cambio. La revisión del modelo neurofisiológico muestra una reconceptualización las relaciones recíprocas entre sistema nervioso autónomo y la emocionalidad en el contexto interpersonal, lo cual permite distinguir condiciones de activación normal y patológica de las estrategias comportamentales defensivas (lucha/huida e inmovilización), así como su inhibición a través del sistema de enganche prosocial. Las investigaciones revisadas muestran evidencia a favor de las hipótesis derivadas del modelo tanto en población normal como clínica. De particular interés clínico resulta el sistema de enganche prosocial, pues habilita la emergencia del comportamiento interpersonal confiable, lo cual resulta ser un elemento pivotal para la psicoterapia por su potencial valor diagnóstico, así como sus efectos sobre el desarrollo y consolidación de la relación terapéutica y los resultados benéficos en el consultante. Finalmente, es posible identificar un cuerpo emergente de estudios de psicoterapia que evalúan la actividad del sistema de enganche prosocial mediante la variabilidad de la frecuencia cardiaca de alta frecuencia, vinculándolo tanto al proceso (p. ej., alianza de trabajo) como al resultado (p. ej., nivel de síntomas), evidenciando el valor de profundizar en esta línea interdisciplinaria de investigación y, eventualmente, incorporar estas mediciones al arsenal clínico de evaluación.

ABSTRACT The present work presents the polivagal theory as a bio-behavioral model of emotional and interpersonal behavior, aiming to identify its theoretical contributions to the study of psychotherapy regarding client's clinical status, therapeutic process as well as change. A review of the model shows a reconceptualization of interactions among autononomic nervous system and emotionality within interpersonal context, allowing for identifying normal and pathological activation of defensive behavioral strategies (figh-or-flight and immobilization), as well as their inhibition through the social engagement system. Empirical research shows evidence in favor of hypotheses derived from the model in normal and clinical populations. In clinical contexts, the social engagement system is of particular interest as it allows the emergence of interpersonal trustworthy behavior, being a cornerstone in psychotherapy due to its potential diagnostic value for clients, the development of the therapeutic relationships, as well as beneficial outcomes. Lastly, a nascent body of psychotherapy studies assessing the social engagement system (through high frequency heart rate variability-) and its relation with the therapeutic process (i.e. working alliance) and outcomes (i.e. symptom level) are identified. The evidence supports the value of further developing this interdisciplinary line of research and, eventually, incorporating these measurements into the clinical assessment arsenal.

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RESUMEN: Las fracturas panfaciales son aquellas que afectan de forma simultánea al tejido óseo de dos o más tercios del rostro. El manejo inicial de estos pacientes es resolver o estabilizar las urgencias médico - quirúrgicas que puedan presentar, debido a que la gran mayoría de estas fracturas están asociadas a traumatismos de alta energía cinética, las que determinan la presencia de lesiones concomitantes que pueden comprometer la vida del paciente. El tratamiento quirúrgico de las fracturas panfaciales puede abarcar desde la intervención quirúrgica inicial de control de daños, estabilización, reducción y fijación quirúrgica de los segmentos fracturados mediante osteosíntesis hasta intervenciones mediatas para la reconstrucción de los tejidos afectados por el traumatismo. Para el tratamiento de las fracturas panfaciales existe una sistemática quirúrgica que tiene por objeto contener y/o minimizar daños agudos y permitir una reducción morfológica y funcional. Reportamos un caso clínico de fractura panfacial cuyo tratamiento siguió esta sistemática terapeútica.

ABSTRACT: Panfacial fractures affect bone tissue in two or more thirds of the face simultaneously. The initial management of these patients is to resolve or stabilize the medical-surgical emergencies that they may present. Most of these fractures are associated to trauma of high kinetic energy, which determine the presence of concomitant inju- ries that can compromise the life of the patient. The surgical treatment of panfacial fractures may include from the initial surgical intervention of damage control, stabilization, reduction and surgical fixation of fractured segments through osteosynthesis, to mediate the reconstruction of tissues affected by the trauma. For the treatment of panfacial fractures there is a surgical approach that aims to contain and/or minimize acute damage and allow for morphological and functional reduction. We report a clinical case of panfacial fracture whose treatment followed this therapeutic approach.

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INTRODUCTION: The number of patients who have a cardiac implantable electronic device (CIEDs) that undergo a course of radiotherapy is increasing due to the ageing population. The majority of clinical studies only evaluate any CIED malfunction at the end of a course of irradiation or in a case of there being symptoms of possible malfunction. As a result, little data has been collected on CIED status acquired during an active course of irradiation. MATERIAL AND METHODS: We aimed to evaluate the correct functioning of a CIED during a course of radiotherapy. So, a retrospective analysis was made of all patients having CIEDS in a single institution during their course of radiotherapy. All CIEDs were systematically checked before and during the course of radiotherapy according to the risk of device failure and patient dependence. RESULTS: Data was analysed from 56 patients (43 men, 13 women) with a mean age of 78.2 years, of whom 87.5% of the patients carried a pacemaker (PM), the 39% of the patients were PM dependent, and the remaining patients carried an implantable cardioverter-defibrillator (ICD). An observable dose of irradiation was evident in only 10 cases. 69.1% of the CIEDs were checked daily and the remainder were checked weekly. During the radiotherapy course, 82% of the patients did not complain of any cardiological event. The CIED of five patients experienced an increase in the threshold and, in another case, a sudden reduction in the duration of the battery was reported. Another patient with a CIED experienced a cardiac insufficiency episode triggered by a ventricular tachycardia. CONCLUSION: In conclusions, although adverse clinical events from exposure of a CIED to irradiation are rare, they can appear in any group of risk. No dose-dependency was observed on the malfunction of the CIED.

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PURPOSE: The aim of the current survey was to describe the functioning of cardio-oncology (C-O) units in Spain. METHODS: All members of the Spanish Society of Cardiology pertaining to scientific communities related to C-O received questionnaires on the existence of specific programs at their institutions. A second, more extensive questionnaire was sent to the centers which reported C-O organization. RESULTS: We identified 56 centers with C-O programs of which 32 (62.5%) replied to the extended questionnaire. 28% of all centers reported having a multidisciplinary unit involving specialists in several areas. More than 80% of the centers developed surveillance protocols locally adapted which included advanced echocardiographic techniques (68%) or troponin (82%). CONCLUSIONS: The number of institutions with C-O programs is still limited but higher than reported in a survey in 2017. Development of multidisciplinary units of C-O should be promoted to improve the cardiovascular health of cancer patients.

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One of the most common side effects of cancer treatment is cardiovascular disease, which substantially impacts long-term survivor's prognosis. Cardiotoxicity can be related with either a direct side effect of antitumor therapies or an accelerated development of cardiovascular diseases in the presence of preexisting risk factors. Even though it is widely recognized as an alarming clinical problem, scientific evidence is scarce in the management of these complications in cancer patients. Consequently, current recommendations are based on expert consensus. This Guideline represents SEOM's ongoing commitment to progressing and improving supportive care for cancer patients.

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BACKGROUND: There is an increasing number of patients with cardiac implantable electronic devices (CIED), either pacemakers or defibrillators, who are receiving a course of radiotherapy. Several guidelines have been published by national societies, but no Spanish national guidelines for management of these patients have been published. More importantly, national clinical practice regarding these patients is not standardised. MATERIALS AND METHODS: Members of the Spanish Breast Cancer Radiation Oncology Group (GEORM in Spanish) were surveyed through an online questionnaire on behalf of the Spanish radiation oncology departments. RESULTS: Only 39.3% of the Spanish radiation oncology departments have policies aimed at CIED carrier patients. Regardless of that, 96.4% of those who responded to the survey refer these patients to their Cardiology department before the start of the course of radiotherapy, and 17.8% of respondents said to manipulate the CIED without any cardiology department direction. A wide range of responses was obtained related to concepts such as "distance from the irradiation field to the CIED" or "safe accumulated doses". CONCLUSIONS: Our results demonstrate the need for national guidelines for CIED patients and the need to promote educational activities addressed to standardise clinical management of these patients in the radiation oncology departments.

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Correction to: Clin Transl Oncol https://doi.org/10.1007/s12094-017-1801-4.

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The increased incidence and decreased mortality of breast cancer have produced an increased number of breast cancer survivors. The type of sequelae and comorbidities that these patients present call for a collaborative follow-up by hospital-based specialized care and primary care. In this document, we present a guideline drafted and agreed among scientific societies whose members care for breast cancer survivors. The purpose of this guideline is to achieve the shared and coordinated follow-up of these patients by specialized care and primary care professionals. In it, we review the health issues derived from the treatments performed, with recommendations about the therapeutic approach to each of them, as well as a proposal for joint follow-up by primary and specialized care.

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Pancreatic ductal adenocarcinoma (PDAC) is a tumor with a very poor prognosis. Most of the patients are diagnosed in advanced stages of the disease, and 5-year survival rates in these patients remains <10%. Surgery still remains the only radical treatment option, although only 15-20% of patients are candidates for surgical resection at the time of the diagnosis. Patients who undergo radical surgery still have a limited survival rate, being the average of 23 months. Three clinical trials have shown that adjuvant chemotherapy therapy after surgery may improve survival: CONKO-1, ESPAC-3, and ESPAC-4. Adjuvant therapy is recommended in patients with R0/R1, T1-4/N1-0 tumors and with ECOG 0-1. In patients with ECOG-2, the decision needs to be individualized. Treatment schemes that have demonstrated efficacy include gemcitabine alone, 5-fluorouracil, or the combination of gemcitabine and capecitabine for six months. Prior to adjuvant treatment, the following test are recommended: Complete blood tests, including CA19.9 biomarker; imaging studies to rule out early disease relapse (preferable thorax-abdomen-pelvic CT). Studies that have evaluated the efficacy of radiation therapy in the adjuvant setting have presented conflicting results. Its use should be considered in patients with R1 or R2 tumors or in those with lymph nodes involved.

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The management of patients with pancreatic cancer has advanced over the last few years. We convey a multidisciplinary group of experts in an attempt to stablish practical guidelines for the diagnoses, staging and management of these patients. This paper summarizes the main conclusions of the working group. Patients with suspected pancreatic ductal adenocarcinoma should be rapidly evaluated and referred to high-volume centers. Multidisciplinary supervision is critical for proper diagnoses, staging and to frame a treatment plan. Surgical resection together with chemotherapy offers the highest chance for cure in early stage disease. Patients with advanced disease should be classified in treatment groups to guide systemic treatment. New chemotherapeutic regimens have resulted in improved survival. Symptomatic management is critical in this disease. Enrollment in a clinical trial is, in general, recommended.

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El quiste epidermoide es un quiste de tejido blando de origen ectodérmico que se encuentra con poca frecuencia en la cavidad oral. Clínicamente se caracteriza por ser una lesión asintomática, de larga evolución, recubierta con mucosa normal, y usualmente se diagnostica cuando el aumento de volumen genera molestias en el paciente. El tratamiento varía de acuerdo a su tamaño y localización anatómica. Presentamos el caso de una paciente de 29 años de edad con un quiste epidermoide de gran tamaño, en reloj de arena, del piso de boca. Se describen las características específicas histológicas y clínicas, y se discute la conducta terapéutica seguida.

The epidermoid cyst is a soft tissue cyst of ectodermal origin found infrequently in the oral cavity. Clinically, it is characterized by an asymptomatic lesion, of long evolution, covered with normal mucosa, and is usually diagnosed when the volume increases and generates patient discomfort. Treatment varies according to its size and anatomical location. We report the case of a 29 year old patient with a large, hourglass shaped, epidermoid cyst in the floor of the mouth. Specific histological and clinical characteristics are described and the therapeutic behavior followed is discussed.

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El cáncer de mama ocurre cuando las células mamarias crecen sin control, debido a que éstas escapan de los exquisitos controles que regulan la multiplicación celular, ocasionando una proliferación celular sin respuesta a la regulación. La mayoría de los casos de cáncer de mama no tienen una causa identificable, pero aproximadamente del 5 al 10% son causados por mutaciones genéticas hereditarias. A pesar de que se conocen otros genes como causantes del cáncer de mama hereditario, la mayor parte de los estudios que evalúan las estrategias de manejo clínico se han centrado en mujeres con mutaciones en los genes BRCA1 o BRCA2 (BReast CAncer, por sus siglas en inglés). Los individuos portadores de mutaciones en estos genes tienen un aumento significativo del riesgo a lo largo de su vida de padecer esta patología, comparado con el riesgo de la población general.

Breast cancer occurs when breast cells grow out of control, because these exquisite escape controls that regulate cell proliferation, cell proliferation without causing a response to regulation. Most cases of breast cancer have no identifiable cause, but about 5 to 10% are caused by inherited genetic mutations. Although other genes as the cause of hereditary breast cancer, known most studies evaluating clinical management strategies have focused on women with mutations in BRCA1 or BRCA2 genes. Individuals carrying mutations in these genes have a significantly increased risk throughout his life of suffering this disease, compared to the risk of the general population.

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Studies of rare genetic variation have identified molecular pathways conferring risk for developmental neuropsychiatric disorders. To date, no published whole-exome sequencing studies have been reported in obsessive-compulsive disorder (OCD). We sequenced all the genome coding regions in 20 sporadic OCD cases and their unaffected parents to identify rare de novo (DN) single-nucleotide variants (SNVs). The primary aim of this pilot study was to determine whether DN variation contributes to OCD risk. To this aim, we evaluated whether there is an elevated rate of DN mutations in OCD, which would justify this approach toward gene discovery in larger studies of the disorder. Furthermore, to explore functional molecular correlations among genes with nonsynonymous DN SNVs in OCD probands, a protein-protein interaction (PPI) network was generated based on databases of direct molecular interactions. We applied Degree-Aware Disease Gene Prioritization (DADA) to rank the PPI network genes based on their relatedness to a set of OCD candidate genes from two OCD genome-wide association studies (Stewart et al., 2013; Mattheisen et al., 2014). In addition, we performed a pathway analysis with genes from the PPI network. The rate of DN SNVs in OCD was 2.51 × 10(-8) per base per generation, significantly higher than a previous estimated rate in unaffected subjects using the same sequencing platform and analytic pipeline. Several genes harboring DN SNVs in OCD were highly interconnected in the PPI network and ranked high in the DADA analysis. Nearly all the DN SNVs in this study are in genes expressed in the human brain, and a pathway analysis revealed enrichment in immunological and central nervous system functioning and development. The results of this pilot study indicate that further investigation of DN variation in larger OCD cohorts is warranted to identify specific risk genes and to confirm our preliminary finding with regard to PPI network enrichment for particular biological pathways and functions.

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La enfermedad benigna de la mama incluye nódulos o anomalías del estado de la glándula mamaria. Constituyen un grupo heterogéneo de lesiones que incluyen anormalidades del desarrollo, lesiones inflamatorias, proliferaciones epiteliales y estromales, y neoplasias. El objetivo de esta investigación documental es realizar una descripción clínico-patológica de las lesiones benignas de mama más frecuentes, para dar a conocer el riesgo implícito que tienen cada una de ellas en el desarrollo del cáncer de mama. Cabe destacar, que algunas de estas lesiones están asociadas a un riesgo para desarrollar la enfermedad, sin embargo, sólo la hiperplasia ductal y lobulillar atípica y el papiloma, han mostrado una clara tendencia a elevar el mismo, no así otras lesiones que necesitan de la concurrencia de enfermedad proliferativa con o sin atipia, para ocasionar un incremento del riesgo.

Benign breast disease including lumps or abnormalities state of the mammary gland. They are a heterogeneous group of lesions that include developmental abnormalities, inflammatory lesions, epithelial and stromal proliferation, and neoplasia. The objective of the research is to perform a clinical and pathological description of benign breast lesions frequently, to publicize the risk involved with each; in the development of breast cancer. Remarkably, some of these lesions are associated with a risk for developing the disease, however, only the ductal hyperplasia and lobular atypical papilloma, have sh own a clear tendency to increase it, but not other injuries that require the concurrent with or proliferative disease without atypia, to cause an increased risk.

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Multidrug resistance is the major cause of cancer chemotherapy failure. This phenotype is mainly due to the overexpression of the human ABCB1 gene. Several studies have shown that the transcriptional regulation of this gene is complex. Yet, the impact of this transcriptional regulation has not been well studied in a clinical setting. The acquired expression of ABCB1 is associated with the genomic instability of cancer cells. This includes the occurrence of mutational events that alter chromatin structures through epigenetic modifications such as promoter methylation. Therefore, it is important to introduce new clinical methods to monitor the methylation status of ABCB1 and determine its association with gene expression in order to be able to predict response to therapies. The high-resolution melting (HRM) method has emerged as a highly accurate and sensitive method to quantify methylation status at specific sites of DNA. Here, we established HRM parameters to evaluate the promoter methylation status of the ABCB1 gene. Our study is the first to standardize the HRM dissociation curve to evaluate ABCB1 gene methylation. The association between ABCB1 methylation status and gene expression in established cancer cell lines shows that this method is accurate and reliable.

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Ex vivo expansion and manipulation of human mesenchymal stem cells are important approaches to immunoregulatory and regenerative cell therapies. Although these cells show great potential for use, issues relating to their overall nature emerge as problems in the field. The need for extensive cell quantity amplification in vitro to obtain sufficient cell numbers for use, poses a risk of accumulating genetic and epigenetic abnormalities that could lead to sporadic malignant cell transformation. In this study, we have examined human mesenchymal stem cells derived from bone marrow, over extended culture time, using cytogenetic analyses, mixed lymphocyte reactions, proteomics and gene expression assays to determine whether the cultures would retain their potential for use in subsequent passages. Results indicate that in vitro cultures of these cells demonstrated chromosome variability after passage 4, but their immunomodulatory functions and differentiation capacity were maintained. At the molecular level, changes were observed from passage 5 on, indicating initiation of differentiation. Together, these results lead to the hypothesis that human mesenchymal stem cells cultures can be used successfully in cell therapy up to passage 4. However, use of cells from higher passages would have to be analysed case by case.

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Objetivo. Evaluar la producción de carne del ganado Criollo Patagónico respecto al Angus y cruzas entre ambas razas. Materiales y métodos. Se dispuso de una muestra de 42 animales de los genotipos Criollo Patagónico, Angus y cruza entre ambos, clasificados en novillitos o vaquillonas, terminados en feed lot durante un período de 114 y 156 días, a partir de los cuales se conformaron ocho grupos de análisis desbalanceados. Para la parte exploratoria se empleó análisis factorial. Se usaron modelos lineales mixtos para contemplar las correlaciones entre las mediciones sobre un mismo animal. Resultados. Se pudo constatar diferencias entre las medias de los pesos a faena de los dos períodos de engorde y que esta ganancia de peso se depositó en los cortes de menor valor comercial. Con relación al rendimiento de los cortes de alto valor económico, se detectó interacción entre éstos y los grupos, identificándose diferencias entre grupos para algunos de los cortes. Conclusiones. En virtud de los resultados obtenidos, se considera promisoria la producción de carne del ganado Criollo Patagónico con relación al rendimiento de los cortes de alto valor económico, pues sus rendimientos medios sólo se vieron superados en bife ancho por su cruza con Angus.

Objective. Evaluate the production of meat from the Criollo Patagónico cattle with resect to Angus and the cross breading between these two breeds. Materials and methods. A sample of 42 animals of the following cattle genotypes was used: Criollo Patagónico, Angus and the cross breed between these two breeds, classified in steers or heifers, finished in feedlot for a period of 114 and 156 days, after which eight groups of unbalanced analysis were formed. A factorial analysis was used during the exploratory stage. Linear mixed models were used to see the correlations between measurements on the same animal. Results. The findings suggest differences between the means of slaughter weights of the two fattening periods as well a the fact that this weight gain was deposited in the cuts of less commercial value. Regarding the productivity of cuts of high economic value, interaction was detected between them and the groups, allowing for an identification of differences amongst the groups in the case of some of the cuts. Conclusions. In virtue of the obtained results, the production of Criollo Patagónico cattle meat is considered promising in relation to the productivity of the high economic value cuts, as their average yields were only surpassed in "bife ancho" in its cross with Angus.

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Fundamento: Los meningiomas son tumores originados de las cubiertas aracnoideas. La localización intraventricular es rara especialmente los originados en el trígono ventricular derecho. Objetivo: Reportar un caso de localización atípica de un meningioma intracraneal. Presentación de caso: Paciente femenina de 68 años con historia de crisis convulsivas focales y cefalea de un mes de evolución. Las imágenes de Resonancia Nuclear Magnética convencionales, con secuencias en T1 y T2 axial y sagital, muestran una lesión localizada en el trígono ventricular derecho. Se realizó abordaje quirúrgico directo y excéresis total. El estudio anatomopatológico demostró un Meningioma fibroblástico. Discusión: Los meningiomas intraventriculares a nivel de trígono son infrecuentes y sólo se reportan series de pocos pacientes en la literatura. El abordaje y excéresis quirúrgica es el método de tratamiento de elección. Conclusiones: El abordaje y excéresis de meningiomas intraventriculares puede ser llevado a cabo exitosamente y en ausencia de complicaciones importantes.

Fundaments: Intraventricular meningiomas are rare often histologically benign tumors, especially those arisingfrom the right ventricular trigonal region. Objective: Report an unusual growth of intracranial meningioma. Case report: Authors present a clinical case of a 68 years old female with focal crisis and cephalea. Magnetic Resonance Imaging showed globular small hypo intense mass located in the right trigone. Surgical approach consisted in parietal craniotomy followed by dural opening and resection of the Intraventricular tumor. Post operatory evolution was adequate. Histological diagnosis was fibroblastic meningioma. Discussion: Meningiomas of the right lateral ventricule are rare and not widely reported. Surgical treatment is often successfully performed. Conclusion: Meningiomas of the lateral ventricles can be successfully diagnosed and surgically treated.

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El trauma máxilo facial corresponde a todas las lesiones de origen traumático que afectan al macizo facial, incluyendo tejidos óseos, blandos y las estructuras alveolo dentarias. El trauma en el territorio facial representa uno de los problemas de salud más importantes a nivel mundial, particularmente por su alta prevalencia, diversidad etiológica y alta morbilidad. Reflejándose en importantes alteraciones funcionales y estéticas, que determinan un alto costo social y económico. El diagnóstico y tratamiento del trauma máxilo facial debe realizarse de forma oportuna por un profesional competente, para minimizar las secuelas de esta patología. En el presente artículo se revisan, a modo general, los principales diagnósticos de trauma máxilo facial incluyendo el traumatismo alveolo dentario, con sus respectivos manejos y tratamientos de urgencia.

The maxillo facial trauma corresponds to all injuries of a traumatic origin that affects the facial components, including bones and soft tissues and the alveolo dental structures. The trauma in the facial area represents one of the most important problems of health at a world wide level, particularly for its high prevalence, etiologic diversity and high morbidity. Being reflected as an important functional and aesthetic alteration, that can determine a high social and economic cost. The diagnosis and treatment of the maxillo facial trauma must be realized in an opportune form by a competent professional to diminish the sequels of this patology. In this article they are reviewed, in a general way, the main diagnosis of maxillo facial trauma including alveolar dental traumatism, with its respective handlings and emergency treatments.

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