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Limb salvage surgeries utilizing endoprostheses and allografts are performed for a variety of oncologic conditions. These reconstructions can fail and require revision for many reasons, which are outlined and classified into mechanical failures (soft tissue failures, aseptic loosening, structural failure), non-mechanical failures (infection, tumor progression), and pediatric failures (physeal arrest, growth dysplasia). Distinct radiologic and clinical findings define specific failure subtypes but are sparsely illustrated in the radiology literature. Specifically, an understanding of the organizational structure of the failure modes can direct radiologists’ search for post-reconstruction complications, enhance an appreciation of their prognostic significance, and facilitate research by standardizing the language and conceptual framework around outcomes. The purpose of this review is to highlight the key radiologic findings and imaging studies of each failure mode in orthopedic oncologic reconstructive surgery in the context of risk factors, failure rates, prognosis and survival statistics, and clinical decision-making regarding chemotherapy, radiation, and revision surgery.

Abstract The use of Virtual Reality (VR) in education is getting more and more common, especially when hands-on learning experiences have to be delivered. With VR it becomes possible, e.g., to simulate dangerous or costly procedures that could hardly be implemented in real settings. However, engaging large classes in immersive laboratory activities may be difficult, since VR kits are still rather expensive for quantity purchases and may require powerful PCs as well as proper spaces to work. A possible way to deal with these issues could be to combine VR with so-called asymmetric Collaborative Learning (CL). CL is a particularly interesting pedagogical approach, as it make learners work in team to achieve a common educational goal, promoting critical thinking and active learning. In asymmetric CL, in particular, learners use different technologies to interact. When combined with VR, asymmetric CL could be used, e.g., to let some learners get immersed in a virtual environment, while some others actively participate in the experience using a desktop interface. This configuration could allow, in principle, to involve more learners in the same amount of time and with the same number of VR kits, while also letting them benefit of the advantages of CL. Based on these considerations, this paper investigates the impact of CL on VR-based education by leveraging an immersive virtual environment designed to support a laboratory experience in a Chemistry course. A user study was conducted by involving 46 university students enrolled in the course. Objective and subjective metrics were used to compare two education methods, i.e. one in which the students experienced the VR environment in isolation, another one in which pairs of students collaborated with an asymmetric approach. Students’ knowledge acquisition was assessed by means of theoretical quizzes, whereas practical performance was automatically measured during the VR experience. The experimental results showed that trading off VR-based, individual learning for CL may have positive effects on the acquisition of theoretical knowledge, but may be detrimental to the achievement of practical abilities if sufficient exposure to technology cannot be guaranteed.

Abstract Systemic light chain (LC) amyloidosis (AL) is a disease where organs are damaged by an overload of a misfolded patient-specific antibody-derived LC, secreted by an abnormal B cell clone. The high LC concentration in the blood leads to amyloid deposition at organ sites. Indeed, cryogenic electron microscopy (cryo-EM) has revealed unique amyloid folds for heart-derived fibrils taken from different patients. Here, we present the cryo-EM structure of heart-derived AL amyloid (AL59) from another patient with severe cardiac involvement. The double-layered structure displays a u-shaped core that is closed by a β-arc lid and extended by a straight tail. Noteworthy, the fibril harbours an extended constant domain fragment, thus ruling out the variable domain as sole amyloid building block. Surprisingly, the fibrils were abundantly concatenated with a proteinaceous polymer, here identified as collagen VI (COLVI) by immuno-electron microscopy (IEM) and mass-spectrometry. Cryogenic electron tomography (cryo-ET) showed how COLVI wraps around the amyloid forming a helical superstructure, likely stabilizing and protecting the fibrils from clearance. Thus, here we report structural evidence of interactions between amyloid and collagen, potentially signifying a distinct pathophysiological mechanism of amyloid deposits.

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) are broad diagnoses that encompass a range of sudden-onset neuropsychiatric symptoms in children, which can include obsessive-compulsive disorder (OCD), tics, anxiety, emotional instability, and cognitive difficulties. Unlike PANDAS, PANS is not strictly linked to group A streptococcal infections but can be triggered by various infectious or environmental factors. Lights and shadows remain upon the management of children with PANS and PANDAS and there is no clear consensus regarding definition, diagnostic criteria, treatment, and follow-up. The aim of the present study was to evaluate the level of agreement on PANS and PANDAS definition, diagnostic criteria, treatment and follow-up and to assess on the basis of recent studies whether there is a need to modify the current recommendations used by primary care pediatricians and hospital pediatricians in clinical practice in order to improve outcomes. Using the Delphi method, this consensus provides shared indications on PANS and PANDAS management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date information on the diagnosis of PANS and PANDAS, as well as consensus statements about several aspects of clinical care. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best management, also in terms of adequate follow-up examinations and period of observation.

El canino permanente, considerado pieza angular de la arcada dentaria al constituir la denominada guía canina, es la última pieza en erupcionar del sector anterior, por lo que suele enfrentarse a problemas de espacio, siendo obligada a cambiar de trayecto eruptivo y ocupar una posición incorrecta o ectópica. Objetivo general. Determinar la prevalencia de la erupción ectópica de canino superior en escolares de 11 a 14 años de edad que acuden a la unidad educativa Rina Ortiz de Bucaram, en Durán-Ecuador durante el periodo lectivo 2024- 2025. Materiales y Métodos: de enfoque cuantitativo, de tipo descriptivo. Se realizó la aplicación de fichas de observación clínica en la escuela Unidad Educativa Rina Ortiz Bucaram en el cantón Durán- Ecuador, con un universo de 500 estudiantes y una muestra de 98 alumnos estudiados. Resultados: Se halló que 16,32% de la muestra estudiada, tenía el canino superior permanente en posición ectópica (pieza 13 con 10,20% y pieza 23 con 6,12%). Conclusión: La prevalencia de erupción ectópica de canino superior permanente de la muestra fue de 16,32%, siendo más frecuente en el sexo femenino con edad promedio de 13 años.

A propagação da palmeira jerivá (Syagrus romanzoffiana) ocorre por meio de sementes, cuja germinação se dá de forma desuniforme e lenta. Assim, as sementes encontram-se sujeitas a múltiplos estresses, como o hídrico e o salino, que limitam a embebição e suas chances de germinação. Objetivou-se avaliar a germinação de sementes da palmeira jerivá submetidas aos estresses hídrico e salino. O delineamento utilizado foi o inteiramente casualizado, com quatro repetições, em esquema fatorial (2 × 5), sendo dois agentes osmocondicionantes (NaCl e PEG 6000) e cinco potenciais osmóticos (0,0 - controle, -0,3, -0,6, -0,9 e -1,2 MPa). Ao final do experimento, calculou-se: porcentagem de germinação, índice de velocidade de germinação e tempo médio de germinação. Com relação aos potenciais osmóticos, para porcentagem de germinação, houve efeito significativo de maneira isolada somente para NaCl, com diminuição na porcentagem de acordo com a redução do potencial osmótico da solução. A partir do potencial -0,6 MPa, houve redução significativa na germinação das sementes. O índice de velocidade e o tempo médio de germinação das sementes foram afetados negativamente pelos potenciais osmóticos das soluções, independente do agente osmocondicionante. No estresse hídrico simulado pelo PEG 6000, as sementes começaram a germinar mais tarde e por um período mais prolongado, quando comparado àquelas submetidas ao estresse de NaCl. Concluiu-se que as sementes da palmeira jerivá apresentam tolerância aos estresses hídrico e salino, pois conseguiram germinar até mesmo no potencial osmótico mais negativo (-1,2 MPa).

Abstract The pericellular matrix (PCM), with its hallmark proteins collagen type VI (COLVI) and fibronectin (FN), surrounds chondrocytes and is critical in transducing the biomechanical cues. To identify genetic variants that change protein function, exome sequencing is performed in a patient with symptomatic OA at multiple joint sites. A predicted damaging variant in COL6A3 is identified and introduced by CRISPR‐Cas9 genome engineering in two established human induced pluripotent stem cell‐derived in‐vitro neocartilage organoid models. The downstream effects of the COL6A3 variant on the chondrocyte phenotypic state are studied by a multi‐omics (mRNA and lncRNA) approach in interaction with hyper‐physiological mechanical loading conditions. The damaging variant in COL6A3 results in significantly lower binding between the PCM proteins COLVI and FN and provokes an osteoarthritic chondrocyte state. By subsequently exposing the neocartilage organoids to hyperphysiological mechanical stress, it is demonstrated that the COL6A3 variant in chondrocytes abolishes the characteristic inflammatory signaling response after mechanical loading with PTGS2, PECAM1, and ADAMTS5, as central genes. Finally, by integrating epigenetic regulation, the lncRNA MIR31HG is identified as key regulator of the characteristic inflammatory signaling response to mechanical loading.

BackgroundDynapenic obesity (DO) is the coexistence of excess adipose tissue/body weight and low muscle strength. This condition is associated with an increased risk of suffering from various chronic diseases and physical deterioration in older people.AimTo analyze the association between DO phenotypes and physical performance in middle-aged women living in the community.MethodsThis cross-sectional study was conducted on middle-aged and older women (≥50 years) residing in Guayaquil, Ecuador. Dynapenia was diagnosticated by a handgrip strength (HGS)

Background: The diagnosis of amyotrophic lateral sclerosis (ALS) is primarily clinical, supported by the electromyographic examination to reveal signs of lower motor neuron damage. Identifying reliable markers of upper motor neuron (UMN) involvement is challenging. On this regard, the role of transcranial magnetic stimulation-induced motor-evoked potentials (TMS-MEPs), and its relationship with UMN burden, is still under investigation. Objective: To evaluate the ability of TMS-MEPs in delineating the neurophysiological UMN damage, and to determine the relationship between TMS-MEPs and [18F]FDG-PET measures of neural dysfunction. Methods: We retrospectively selected 13 ALS patients who underwent, during the diagnostic process, the TMS-MEPs and [18F]FDG-PET scans. Demographic and clinical data were collected. For the MEP evaluation, we considered normal MEP, absent MEP, or significantly increased central-motor-conduction-time. For [18F]FDG-PET, we conducted voxel-wise analyses, both at single-subject and group levels, exploring hypometabolism and hypermetabolism patterns in comparison with a large dataset of healthy controls (HC). Results: Based on TMS-MEPs, we identified 4/13 patients with normal MEP in all limbs (GROUP-NO), while 9/13 had an abnormal MEP in at least one limb (GROUP-AB). Despite the [18F]FDG-PET single-subject analysis revealed heterogenous expression of regional hypo- and hyper-metabolism patterns in the patients, the group-level analysis revealed a common hypometabolism, involving the precentral gyrus and the supplementary motor area, the paracentral lobule and the anterior cingulate cortex in the GROUP-AB. Moreover, exclusively for the GROUP-AB compared with HC, a relative hypermetabolism was observed in the right cerebellum, right inferior and middle temporal gyrus. The GROUP-NO showed no specific cluster of hypo- and hyper-metabolism compared to HC. Conclusion: This study showed altered brain metabolism only in the ALS group with abnormal MEPs, suggesting an association between the two biomarkers in defining the UMN damage.

Abstract Background Pheochromocytoma is a rare catecholamine-producing tumour originating from adrenal chromaffin cells. Classic clinical presentation includes headache, diaphoresis and palpitation. Syncope is uncommon and may result from hypotension or arrhythmia. We report a case of neurally mediated syncope in pheochromocytoma associated with cardiac repolarization abnormalities, a unique presentation of the disease. Case presentation This case report presents a 28 year-old woman, describing recurrent syncope usually preceded by prodromes such as headache, visual blurring, heart palpitations and psychomotor agitation. Firstly she was diagnosed with anxiety and depression, but there was no improvement of symptoms with psychiatric treatment. Previous Holter revealed long QT interval. Echocardiogram showed normal dimensions, preserved left ventricular function and no valvopathies. The patient was referred for a Head-up tilt test (HUTT) in order to investigate reflex syncope. The electrocardiogram (ECG) exhibited normal sinus rhythm and diffuse cardiac repolarisation abnormalities. HUTT was positive for vasodepressor type neurally mediated syncope and ECG showed U waves after a syncope episode. This electrocardiographic finding motivated further clinical investigation. The patient also described abdominal pain, increased abdominal volume, weight loss and blood pressure instability. Based on clinical history and ventricular repolarisation abnormalities uncovered by HUTT, pheochromocytoma was suspected. Urinary test was positive for catecholamines and the abdominal imaging revelead expansive lesion. She underwent surgery to remove the pheochromocytoma, confirmed by immunohistochemistry. Conclusions After surgery she had no recurrency of symptoms, remaining asymptomatic after six years of follow-up, suggesting a cause-effect relationship between neurally mediated syncope and pheochromocytoma.

Abstract Background Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P

Abstract The concept of resilience has gained immense popularity as a way to frame social and environmental challenges. However, its empirical operationalization and the integration of social and ecological dimensions continue to present difficulties. In this paper, we conduct a systematic review of existing empirical studies of resilience in social, ecological and social‐ecological systems (SESs) and examine how and to what extent these studies have achieved the operationalization of the concept of resilience. We evaluate the operationalization of resilience in 463 papers based on whether they define the system of interest and disturbances, whether they define resilience, whether they evaluate resilience, and for papers focusing on SESs, whether that evaluation integrates social and ecological dimensions. We find that 51% of empirical studies do not meet at least one of these operationalization criteria, and that even those that do often lack key features for effective operationalization, such as clear system boundaries and baseline state or an effective integration of social and ecological dimensions. Of the papers examining SESs and evaluating resilience, only 54% integrate social and ecological dimensions in that evaluation. Building on these findings, we propose some design guidelines for operationalizing future empirical studies of resilience. Read the free Plain Language Summary for this article on the Journal blog.

The paper presents results of gas-geochemical studies of bottom sediments and petroleum potential assessment of Baikal Rift Basin. During the expeditions of the Class@Baikal project in 2014–2019, gases from the Lake Baikal bottom sediments were analyzed. The results showed a clear difference in chemical and isotopic composition of the seeping gases collected in the northwestern and southeastern parts of the lake. The seepage released from northwest part were relatively enriched by methane and had a low concentration of C2+ compounds. The seepage gases had relatively lighter carbon isotopes composition of CH4 (from -72,7 to -50,1 ‰ VPDB) and the high variability of δ13C in C2 H6 (from -65 to -22 ‰ VPDB). The gases released from southeastern part of the lake had an increase in C2+ compounds and had relatively lighter carbon isotopes composition of methane (from –57,2 to –41,0 ‰ VPDB). The carbon isotopes composition of ethane varies from -32 to -25 ‰ VPDB. Asymmetric structure of the Baikal rift basin and various processes of gas migration within it might cause the variations. Diffusive process led to the lighter carbon isotopes composition of the seepage gases from the northwestern part of lake and the gas molecular composition enrichment by methane. Such molecular and isotopic fractionations caused by geochemical processes helps to understand the migration of gas from source rocks to the earth’s surface. Similar geochemical indicators of fractionation should be taken into consideration when assessing oil and gas source rocks and basin potential from gas geochemical studies data.

Delirium, a multifactorial condition with an acute onset and diverse clinical manifestations, poses a significant challenge in the care of hospitalized individuals aged 65 years and older. This study aimed to evaluate the level of knowledge among nursing healthcare personnel regarding the diagnosis, recognition of complications, and treatment of delirium. A paper questionnaire consisting of 18 multiple-choice questions was distributed to nurses in twelve operational units located in four facilities within a local hospital in a specific geographical region under the jurisdiction of the Romagna Local Health Authority in Italy. Out of 194 respondents, the overall acceptance rate was 64.2%. The findings revealed an insufficient understanding of delirium among the nursing staff, with more than 40% of respondents answering incorrectly to five out of nine questions related to delirium knowledge, diagnosis, prevention, and treatment. Notably, gender emerged as a significant determinant, with female participants exhibiting a substantial odds ratio (OR) of 3.50 (p = 0.011 and CI95% = 1.34–9.16) compared to their male counterparts, indicating a higher likelihood of receiving delirium training among females. Furthermore, prolonged tenure within the same work context was associated with a reduced likelihood of receiving delirium training compared to those with less than two years of experience (OR = 0.21, p = 0.034, and CI95% = 0.05–0.89 for 6–10 years of tenure; OR = 0.22, p = 0.038, and CI95% = 0.05–0.92 for over 10 years of tenure). This study underscores the urgent need for enhanced delirium education and improved strategies among nurses to effectively manage patients with delirium. The results advocate regular educational sessions utilizing diverse formats to comprehensively address knowledge gaps among nursing staff. This study was not registered.

El artículo explora la recepción creativa de cuatro métodos de Teología Práctica en América Latina, destacando la interacción dinámica entre las tradiciones teológicas locales y los enfoques metodológicos desarrollados en otras partes del mundo. En concreto, se presenta el modo en que cuatro métodos originarios “del norte” (Razonamiento de la Escritura, Teología de la Correlación, Estudios en Espiritualidad y Teología Empírica) han sido creativamente recibidos y transformados dentro del contexto teológico latinoamericano. Cada método se examina en términos de su desarrollo original y su reinterpretación en América Latina, mostrando cómo el diálogo con las tradiciones teológicas locales ha dado lugar a nuevas expresiones metodológicas. Este estudio no solo refleja la capacidad de adaptación e innovación en la Teología Práctica hecha en América Latina, sino que también subraya la contribución significativa de estos métodos al desarrollo continuo de la disciplina en la región. El artículo concluye discutiendo la relevancia de estos enfoques metodológicos para el avance de una Teología Práctica a su vez profundamente contextual pero abierta a las oportunidades y los desafíos del panorama teológico internacional.

Para la OMS las maloclusiones ocupan el tercer lugar de los problemas de salud oral y por su prevalencia son consideradas un problema de salud pública. El amamantamiento representa un factor de armonía del desarrollo dentofacial y neuromuscular, como es conocido casi todo en la naturaleza es simétrico y no solo por estética sino por funcionalidad. Así es como se busca a través de las investigaciones devolver este complejo idóneo. Objetivo: Analizar el desarrollo craneofacial y neuromuscular a través de la lactancia materna exclusiva. Metodología: descriptiva, bibliográfica, cuantitativa, no experimental. El estudio cuenta con una muestra aleatoria por conveniencia, donde se obtuvieron los datos de 61 pacientes del rango de edad de 15 a 52 años, atendidos por 3 estudiantes de la Cohorte #1 paralelo #1, en la clínica de posgrado del programa de Especialización en Ortodoncia de la Facultad Piloto de Odontología de la Universidad de Guayaquil durante el periodo 2021-2024, datos que fueron analizados en hojas de cálculo de Excel, los resultados fueron expuestos en tablas estadísticas. Resultados: los lactantes alimentados exclusivamente por el seno materno con una duración mayor a 6 meses muestran un buen desarrollo craneofacial con grados de apiñamiento leve e incluso diastemas; perfiles convexos, clase II esqueletal, biotipos faciales braquifacial, un correcto desarrollo neuromuscular con menos aparición de hábitos. Conclusión: la duración de la lactancia materna exclusiva superior a los 6 meses tiene un efecto de sobre-estimulación de las estructuras orofaciales especialmente en el maxilar superior (clase II esqueletal), siendo una desventaja.

La maloclusión es el segundo problema más recurrente en la salud bucal, la etiología de las maloclusiones es multifactorial, relacionándose con factores de riesgo ambiental y genético, el desarrollo del análisis cefalométrico que permite evaluar el desarrollo y crecimiento para determinar el diagnóstico y la planificación del tratamiento, los análisis cefalométricos usados en esta investigación son los análisis de Ricketts, Jaraback y Steiner. Objetivo: Determinar la fiabilidad de los análisis cefalométricos en el diagnóstico de la malformación óseo dentaria. Metodología: Se ha recopilado información de las radiografías laterales de cráneo de los pacientes que asistieron al Posgrado de Ortodoncia, para ser empleados en tres tipos de análisis cefalométricos con el fin de obtener información de las malformaciones óseo dentales y poder verificar si existe fiabilidad de los análisis utilizados en esta investigación para su análisis y comparación siendo cuantitativa, descriptiva, correlacional y estadística. Resultados: Clase Esqueletal: Clase I, A. Riquetts 50,56%, A. Jaraback 48.89%, A. Steiner 48.89%. Clase II, A. Riquetts 37.78%, A. Jaraback 42.22%, A. Steiner 42.22% Clase III, A. Riquetts 6.67%, A. Jaraback 8.89%, A. Steiner 8.89%, Inclinación de los Incisivos Inferiores: normal, Riquetts 33,33%, A. Jaraback 33.33%, A. Steiner 0% proinclinado Riquetts 62.22%, A. Jaraback 55.56%, A. Steiner 80%, retroinclinado Riquetts 4.44%, A. Jaraback 11.11%, A. Steiner 20.00% Conclusiones: Los datos en clase esqueletal, posición de los maxilares superior e inferior y las inclinaciones dentales presenta coincidencia entre los resultados, persiste una variación que no interfiere la planificación del tratamiento.

Durante siglos el Apiñamiento dental es una maloclusión muy frecuente que afecta la salud bucal, repercutiendo en varios aspectos como la estética facial, dental y la funcionalidad del Complejo Maxilo-mandibular de los pacientes. Objetivo: Describir la Expansión Rápida Bimaxilar con hyrax en paciente con dentición mixta tardía. Metodología: Tipo Descriptivo, Longitudinal, No experimental, Cualitativo, Analítico e Inductivo. Descripción del Caso clínico: Paciente femenina de 13 años, Clase II esqueletal por Retrognatismo, crecimiento vertical, apiñamiento severo superior/ inferior, desviación de línea media superior, mordida profunda anterior, perfil recto ligeramente convexo. Se planificó el tratamiento en dos fases; primera fase confección de Hyrax híbrido asistido con Tads en Maxilar Superior y Expansión mandibular de Williams modificado sin el arco de alambre de NiTi, la segunda fase con aparatología fija. Resultados: La Expansión Rápida del Maxilar fue de 7.5 mm, se logró modificaciones esqueletales en los tres planos del espacio consiguiendo una alineación dental con cambios oclusales y faciales favorables; en la Expansión mandibular se consiguió 7.5 mm de espacio, con inclinación vestibular de dientes posteriores acompañado de un remodelado dentoalveolar sin alteración de inclinaciones dentales iniciales de los dientes anteriores. Conclusiones: La fuerza de los Tads en la Expansión Rápida Maxilar se direccionó hacia la sutura media palatina y produjo su separación sin generar efectos dentoalveolares negativos y el Expansor mandibular de William modificado demostró resultados favorables a pesar de la fusión temprana de la sincondrosis mandibular.

La giroversión dental es un tipo de maloclusión dental que se puede generar por diferentes factores; entre ellos tenemos los factores genéticos, tumorales, funcionales o por la falta de espacio en las arcadas dentarias producidas por extracciones prematuras, presencia de caries interproximales o arcadas estrechas. Objetivo. Describir la corrección de la giroversión dental en un paciente clase I esqueletal mediante el uso del sistema de Cupla. Metodología. Investigación de enfoque cualitativo, tipo descriptivo, no experimental. Descripción del caso clínico. Paciente de sexo masculino de 14 años de edad, sin antecedentes médicos relevantes, atendido en la clínica de posgrado del programa de Especialización en Ortodoncia de la Facultad Piloto de Odontología de la Universidad de Guayaquil, periodo 2023-2024, con maloclusión clase I y giroversión de la pieza 11. Se utilizó aparatología MBT Orthometric, con arcos termo activados, y aplicación de sistema de cupla mediante resortes, botones y cadenas elásticas. Conclusiones. La corrección de la giroversión dental se la puede realizar mediante una técnica llamada sistema de Cupla, que consiste en aplicar dos fuerzas paralelas, pero con la misma intensidad, que dará como resultado, una rotación pura respecto al eje longitudinal del diente.

The necessity of production of energy from waste treatment has increased the capability of existing a/o new establishments for the biogas production. The dangerous elements of the biogas production installation, that may be subject to the Seveso III Directive (2012/18/EU), are tanks (bio-digesters), compression stations and decompression cabins, transfer point and fixed piping. The scope of this works is clarifying how the gas mixture contained within the bio-digesters should be classified, in order to consider the main safety issues for the prevention of major accidents. The biogas is in fact classified flammable gas, with thresholds range more restrictive than thresholds range applied to upgraded biogas, also referred to as biomethane, if it has been processed in accordance with applicable standards for purified biogas. The biogas upgrading and purification process takes place downstream of the digestion tanks and therefore the gas retained by the tank covers is not to be considered purified or upgraded. The gas mixture contained within biodigesters must be classified according to the Regulation (EC) No 1272/2008 on the classification, labelling and packaging of substances and mixtures (CLP Regulation), considering the hazard characteristics of the components of the mixture, not of the methane component only and considering the total quantity of biogas present in the plant, including the hold up of equipment used to transfer the biogas. It is finally possible to indicate some elements for the possible identification of dangers and the evaluation of risk in these installations, characterized by a relative low plant complexity and standardization, based on typical technical literature of the sector.

La caries dental es una enfermedad multifactorial, no transmisible y dinámica, determinada por factores biológicos, conductuales, psicosociales y ambientales. Esta situación puede tener un impacto significativo en la calidad de vida de los niños, ya que puede resultar en dolor, infecciones y dificultades para comer y hablar. Uno de los factores que se ha identificado como contribuyente clave a la caries dental es la alta ingesta de alimentos procesados, especialmente cuando estos son consumidos de manera frecuente y en cantidades excesivas. Objetivo Evaluar la asociación entre caries dental y el consumo de alimentos procesados y no procesados en las loncheras de niños preescolares. Metodología, diseño de investigación cuantitativa, tipo descriptivo, bibliográfica, de campo y conjunta utilizando de instrumento la historian clínica 033, la historia de dieta de la ficha clínica de Odontopediatría y la encuesta validada por expertos de la Facultad. Resultados: de los 50 niños que asistieron a la clínica de la facultad de Odontología, 36 tienen un moderado riesgo de caries, 14 en un alto riesgo y no se encontraron niños con bajo riesgo en la historia dietética que consta en la historia clínica utilizada en la clínica. En el índice ceod de los 50 niños 35 presentan dientes cariados, 6 dientes extraídos y 0 dientes obturados, observando solo 15 niños sanos. Conclusión: lamayoría de los padres envían alimentos procesados que contienen una alta cantidad de azúcares por ello la alta prevalencia de caries debido al poco conocimiento de los padres sobre la relación de las dos variables ya mencionadas.

La maloclusión clase III esquelética, dentaria y funcional, está asociada a una desviación en la relación sagital de los maxilares ya sea por deficiencia, retrusión maxilar, por prognatismo o macrognatismo mandibular, caracterizada por alteración de un solo componente o una posible combinación, su etiología es multifactorial debido a una interacción de factores tanto hereditarios como ambientales. Objetivo: Analizar sobre la maloclusión clase III, su diagnóstico y opciones de tratamiento en niños y adultos que permitan mejorar la estética y función. Metodología: Investigación de tipo descriptivo, con enfoque cualitativo, por medio de recopilación de fuentes bibliográficas en revistas científicas indexadas en bases de datos regionales. Resultados: Identificar los posibles tratamientos en pacientes clase III esquelética es el desafío ya que no solo se finaliza con un tratamiento, es necesario la combinación de estos, donde independientemente del tratamiento existe recidiva después del periodo del tratamiento, Determinar el tiempo es ideal para tratar una maloclusión clase III, ya que el tratamiento de esta varía dependiendo la edad del paciente y la severidad de la maloclusión. Conclusión: Es necesario realizar un diagnóstico y plan de tratamiento individualizado las mismas que se pueden conseguir a través de auxiliares de diagnóstico, como las radiografías cefalométricas, ortopantomografías, y modelos de estudio.

Although Barrett's metaplasia of the esophagus (BE) is the only known precursor lesion to esophageal adenocarcinomas (EACs), drivers of cellular transformation in BE remain incompletely understood. We use an artificial intelligence-guided network approach to study EAC initiation and progression. Key predictions are subsequently validated in a human organoid model, in patient-derived biopsy specimens of BE, a case-control study of genomics of BE progression, and in a cross-sectional study of 113 patients with BE and EACs. Our model classified healthy esophagus from BE and BE from EACs in several publicly available gene expression data sets (n = 932 samples). The model confirmed that all EACs must originate from BE and pinpointed a CXCL8/IL8↔neutrophil immune microenvironment as a driver of cellular transformation in EACs and gastroesophageal junction adenocarcinomas. This driver is prominent in White individuals but is notably absent in African Americans (AAs). Network-derived gene signatures, independent signatures of neutrophil processes, CXCL8/IL8 expression, and an absolute neutrophil count (ANC) are associated with risk of progression. SNPs associated with changes in ANC by ethnicity (e.g., benign ethnic neutropenia [BEN]) modify that risk. Findings define a racially influenced immunological basis for cell transformation and suggest that BEN in AAs may be a deterrent to BE→EAC progression.