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Understanding long-term dynamics of past socio-ecological systems is essential for their future management. The southern Atlantic Forest coast of Brazil with its biodiverse littoral zone and artisanal fishing communities, is a priority for conservation. Traditional maritime knowledge is thought to have a deep-history and indeed, marine exploitation can be traced back to the middle Holocene. As part of one of South America's largest diasporas, Guarani groups reached the southern Brazilian coast at around 1000 years ago. Their impact on the long-standing coastal economy is unknown, due to poor preservation of organic remains. Through the first organic residue study on Guarani pottery, we show that maize rather than aquatic foods was the most dominant product in pottery at this time. By developing a mixing model based on carbon isotope values of saturated and mono-unsaturated fatty acids we propose new criteria for the identification of maize, opening up avenues for future research. Our data confirms the importance of maize to the pre-colonial Guarani, even in a highly productive coastal environment. The Guarani occupation of this region marks a significant departure from previous socio-economic systems, potentially leading to loss of traditional knowledge and alleviating anthropogenic pressure, albeit temporarily, on the marine environment.

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During the Late Holocene, hunter-gatherer interaction networks significantly grew in intensity and extension across Patagonia. Although this growth is evidenced by the increased flow of exotic items across the region, the mechanisms behind these strengthening social networks remain unclear. Since evidence suggests that some individuals might have performed long-distance trips, this article aims to address the potential relationship between these individuals and the flows of exotic items in North Patagonia. We analyzed 54 enamel teeth for strontium isotopes and reconstructed their probable mobility using mixed-effect models and isotope-based geographic assignments. We inferred population and individual mobility trends and compared them against the flow of exotic items built from a standardized compilation. Our results indicate that most individuals have isotopic composition compatible with residence within their burial and surrounding areas. However, a few individuals show isotopic composition incompatible with their burial areas, which suggests axes -from the burial location to the most likely isotope integration area- of extraordinary mobility. At the same time, the flows of exotic items overlap with these axes around the eastern sector of the study area suggesting that this location could have been a central point of convergence for people and items. We argue that small-scale socially driven mobility could have played a relevant role as a general mechanism of interaction that fostered and materialized Patagonian interaction networks during the Late Holocene.

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Resumen: El cambio en el modelo asistencial odontológico en España ha supuesto la proliferación de grandes franquicias dentales o clínicas dentales low cost. Este tipo de establecimientos suelen realizar la captación de pacientes mediante agresivas campañas de publicidad, establecen financiaciones de los presupuestos directamente con entidades bancarias y rebajan los presupuestos inicialmente marcados. En los últimos años, la Comisión de Ética y Deontología del Ilustre Colegio Oficial de Odontólogos y Estomatólogos de Aragón ha comprobado un notable aumento de las reclamaciones de pacientes procedentes de este tipo de clínicas. Uno de los casos más llamativos ha sido el cierre de la franquicia iDental, que dejó a miles de personas sin terminar sus tratamientos odontológicos. Se pretende realizar una puesta al día de las repercusiones deontológicas que estas clínicas tienen en la deontología dental de la Comunidad Autónoma de Aragón.

Abstract: The change in deontological health care model in Spain has led to the proliferation of huge dental franquises or low cost dental clinics. This type of settings generally engages customers by aggressive advertising campaigns, establishing financing with banks and reducing the agreed initial budget. In the last years, the Ethical and Deontological Commission of the Official College of Dentists and Stomatologists of Aragon has noticed a significant increase of claims by patients attending this type of clinics. One of the most striking cases has been the closing of iDental, which led thousands of patients without finishing dental treatment. This study pretends updating the deontological repercussions that these clinics have in the Autonomous Community of Aragon.

Resumo: A mudança no modelo assistencial odontológico na Espanha implicou na proliferação de grandes franquias dentais ou clínicas dentais de baixo custo. Estes tipos de estabelecimentos habitualmente realizam a captação de pacientes mediante agressivas campanhas publicitárias, estabelecem financiamento dos orçamentos diretamente com instituições bancárias e abaixam os orçamentos inicialmente apresentados. Nos últimos anos, a Comissão de Ética e Deontologia do Ilustre Colégio Oficial de Odontólogos e Estomatólogos de Aragão comprovou um notável aumento de reclamações de pacientes procedentes deste tipo de clínica. Um dos casos mais chamativos foi o encerramento da franquia iDental, que deixou milhares de pessoas sem terminar seus tratamentos odontológicos. Se pretende realizar uma atualização das repercussões deontológicas que estas clínicas têm na deontologia dental da Comunidade Autônoma de Aragão.

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INTRODUCTION: The last two decades have seen an exponential growth in the distribution and availability of child pornographic material on the Internet and social networks. The medical community is involved in assisting the investigating authorities in relation to estimating the age and sexual maturity of the alleged victims. OBJECTIVE: To determine the efficacy of using Tanner stages as a method for esti mating chronological age in alleged child pornography cases based on published evidence. MATERIAL AND METHOD: Systematic review study in PubMed and Scopus databases following PRISMA guideli nes. Articles describing the outcome of using Tanner stages to estimate chronological age in alleged child pornography cases were identified. For screening, those written in English or Spanish published from January 1, 2000, to April 30, 2020, were considered. The following data were extracted from the articles included: type of study; material and methods used; Tanner items examined; evaluators' characteristics; results; estimated chronological age versus real age; observer-dependent variations (bias); and conclusions. RESULTS: Seven studies were included. Three were literature reviews and four were case studies with expert testimony and observer bias. This method is ineffective when the alleged victim, in both sexes, shows sexual maturation in Tanner stages 3-5. In stages 1-2, it may be useful to state that the victim is under 18 years old, but not to determine their chronological age. CONCLUSION: Scientific evidence discourages the use of Tanner stages to estimate the chronological age of the vic tim from images in alleged child pornography cases. Pediatricians, and other medical professionals, should avoid making a testimony that is not scientifically based.

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Multiple carpometacarpal fracture dislocations are rare lesions despite the increased number of high-energy traumatic injuries. These lesions result from high-energy traumas or, even more frequently, from fall mechanisms involving palmar flexion of the hand. The diagnosis usually requires specific X-ray views to prevent overlooking those lesions. A 27-year-old male presented at the emergency room in our hospital after sustaining a direct trauma on the right hand, in palmar flexion, resulting from a stair fall. The patient had severe inflammation of the dorsal aspect of the hand, pain, limitation, and complete functional disability. X-rays led to diagnosing fracture dislocation of the hamate, capitate and base of the 3rd, 4th, and 5th metacarpal bones. Treatment consisted of closed reduction under fluoroscopic control, fixation with Orthofix threaded nails and placement of a fiberglass cast in functional position for six weeks. The patient's clinical and radiological course was appropriate; healing of the hamate, capitate, and base of the 3rd, 4th and 5th metacarpal bones was attained without necrosis of the carpal bones. The Orthofix threaded nails were removed. After a period of functional rehabilitation the patient course was appropriate, without any functional limitation of the hand joints. This is an unusual lesion with only a few bibliographic references. We think that a specific X-ray study is fundamental to prevent overlooking these lesions. In this case our priority was reconstructing the base to assure articular continuity and stabilization with threaded Orthofix nails, given the high degree of instability of the lesion.

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INTRODUCTION: classical osteosarcoma is defined as a very malignant spindle cell sarcoma, characterized by the production of osteoid matrix, it is the most common primary malignant bone tumor. It is most common among males in their twenties. Factors involved include those related with the skeletal growth and development, pathological fractures, and very young patients who are still growing. Conservative surgery is inappropriate; however, preoperative chemotherapy and a good choice of conservative treatment are an alternative. MATERIAL AND METHODS: a 15-year-old male patient presented at the orthopedics service with a diagnosis of a pathological fracture in the distal third of the right femur and a tumor in the lateral aspect of the knee, with pain and limitation of gait. Based on X-rays, a bone scan and a biopsy, the diagnosis of a fibroblastic osteosarcoma, an Enneking IIB lesion, was made. Treatment consisted of conservative surgery with broad tumor resection involving 18 cm of the femur, resection of the vastus medialis and vastus lateralis, release of the femoral bundle, the popliteal and sciatic nerves, as well as placement of a modular stryker tumor prosthesis, with knee replacement. RESULTS: the clinical and radiological course was appropriate. After a 3-week rehabilitation period the patient was able to walk and the lower limb was salvaged. At 5 months there is no evidence of tumor relapse, the patient can walk properly and has recovered the strength. DISCUSSION: this is a case salvage surgery to treat a pathological fracture resulting from a malignant bone tumor. We think that staging is essential to select the treatment. In the case presented herein a comprehensive management is fundamental to the success of conservative treatment.

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