http://hdl.handle.net/10366/3947 2026-07-20T06:29:03Z http://hdl.handle.net/10366/172194 Guía informativa dirigida a cuidadores de personas con daño cerebral adquirido (DCA). Se explica de forma sencilla qué es el DCA, sus causas más frecuentes y las principales áreas afectadas. Incluye recomendaciones para el cuidado físico y emocional de la persona con DCA; así como, pautas para el autocuidado del cuidador y el acceso a recursos especializados. Su diseño visual facilita la comprensión y la difusión de información básica sobre el cuidado integral de las personas con DCA. Se ha desarrollado dentro del proyecto NeuroMotion-USAL. 2025-01-01T00:00:00Z http://hdl.handle.net/10366/172152 [EN]Lifestyle factors may influence disability trajectories in multiple sclerosis (MS), yet prospective data linking sustained dietary adherence to objective clinical outcomes remain limited. Homocysteine, a metabolite involved in one-carbon metabolism, represents a biologically plausible mediator between nutrition and neurodegeneration, although its longitudinal clinical relevance in MS is uncertain. This study aimed to investigate whether adherence to a structured dietary intervention is associated with longitudinal changes in plasma homocysteine levels and disability progression in patients with MS over 12 months. In this prospective cohort study, 41 patients with MS were followed for 12 months. Dietary adherence was quantified using a structured follow-up scale (range 2-6). Plasma homocysteine levels and Expanded Disability Status Scale (EDSS) scores were assessed at baseline, 6 months, and 12 months. Associations between adherence, metabolic changes, and EDSS evolution were evaluated using correlation analyses and multivariate linear regression adjusting for age, sex, BMI, baseline EDSS, and treatment line. Baseline mean homocysteine was 10.91 ± 6.94 μmol/L and decreased to 8.24 ± 3.33 μmol/L at 6 months, remaining stable at 8.27 ± 2.42 μmol/L at 12 months. Between-group differences in homocysteine showed a trend toward significance at 12 months (ANOVA p = 0.059). Mean EDSS increased slightly from 1.14 to 1.23 in the overall cohort (p > 0.05). However, EDSS evolution differed according to dietary adherence (ANOVA p = 0.009): low-adherence patients showed a mean EDSS increase (+0.53 ± 0.72), whereas high-adherence patients showed a mean EDSS decrease (-0.56 ± 1.08). Given the low baseline EDSS, short follow-up, and small high-adherence subgroup, these changes should be interpreted as exploratory differences in short-term EDSS trajectory rather than confirmed clinical improvement and do not establish causality. Adherence score was inversely correlated with EDSS change (r = -0.57, p = 0.0006) and remained independently associated in multivariate analysis (β = -0.45, 95% CI -0.68 to -0.22, p = 0.0005). Higher adherence to the dietary counselling programme was associated with a more favourable short-term disability trajectory over 12 months. However, causality cannot be inferred, and the clinical significance of these modest changes remains uncertain. Because the adherence score was not formally validated and may partly reflect broader health-related behaviours or engagement with care, and because the dietary intervention was individualized, the study cannot identify specific dietary components or dietary patterns associated with disability trajectories. These exploratory findings require confirmation in larger controlled studies using validated dietary assessment instruments. 2026-07-07T00:00:00Z http://hdl.handle.net/10366/172128 [ENG]Background: Cancer cachexia and sarcopenia are highly prevalent complications affecting up to 50% of patients with cancer and are associated with increased treatment toxicity, poorer functional outcomes, and reduced survival. Early identification of muscle deterioration during hospitalization remains challenging. Objective: To evaluate the change in dominant-hand handgrip strength between hospital admission and discharge in hospitalized oncology patients. Methods: This prospective longitudinal study will evaluate hospitalized adults with confirmed malignancy and an expected hospital stay of ≥5 days. Daily handgrip strength and sEMG assessments will be performed as exploratory secondary measures to characterize temporal patterns of muscle function during hospitalization. Baseline and discharge evaluations will additionally include bioelectrical impedance analysis, validated patient-reported outcome measures (SARC-F, EORTC QLQ-C30, PSQI), and serum biomarkers related to inflammatory and nutritional status. Linear mixed models will be used to evaluate longitudinal changes and associations between functional, electrophysiological, and biochemical parameters. Expected results: The study aims to characterize trajectories of muscle function decline during hospitalization, identify candidate biomarker signatures for cachexia detection, and evaluate neuromuscular fatigue patterns using sEMG. Conclusions: This protocol proposes a feasible multimodal framework for monitoring skeletal muscle deterioration during acute oncology hospitalization and may inform future interventional strategies targeting cancer-related cachexia and sarcopenia. 2026-01-01T00:00:00Z http://hdl.handle.net/10366/172127 [ENG]Background: Central nervous system development is a rapid and highly plastic process during the first years of life. Tactile stimuli have been shown to induce cortical changes, but potential sex-related differences remain unexplored. This study aimed to investigate sex-specific differences in cortical activity and cerebral oxygenation in response to tactile stimulation via body massage. Methods: Four healthy full-term infants (two females and two males), all aged 11 weeks, were included in this prospective exploratory study. Each infant received a standardized 5 min massage protocol. Cortical activity and cerebral oxygenation were assessed using an 8-channel electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) before, during, and after the intervention, with a 5 min pre-intervention resting period used as the baseline. Results: EEG analysis focused on a single spectral band (4 Hz–30 Hz). This range was selected to capture the main cortical oscillations in infants, including theta, alpha, and beta activity, while delta activity below 4 Hz was partially excluded to reduce movement and physiological artifacts. Standard infant EEG bands were considered when defining this range. Data shows for the female subject an average PSD of −6.726 (± −4.075), and for the male subject, −12.594 (± −10.741). Although babies are of the same gestational age, they exhibited distinct basal cortical activity, which prevented comparisons from being made. Nevertheless, massage induced similar activity patterns in all subjects with increased cortical electrical activity in the left parietal region relative to baseline. fNIRS data showed that comparable HbO concentration patterns between participants were observed only during the second minute of recording. Relative to baseline, pre-intervention HbO responses displayed an opposite distribution, and the effects of the intervention differed by sex. The female participant exhibited a slight reduction in activation in the right hemisphere accompanied by a modest increase in the most ventral region of the left hemisphere. Conversely, the male participant showed an inverse response pattern, characterized by a marked increase in right hemispheric activation and a pronounced decrease in the left hemisphere during the intervention period. Conclusions: These preliminary observations suggest the presence of early variations in cortical processing that warrant further investigation in larger samples, although they cannot be considered conclusive. While baseline response patterns differed between participants, both showed increased left parietal activity during tactile stimulation. The inversion of HbO responses between the pre-intervention and intervention phases points to potential sex-related differences in hemodynamic trajectories. Nevertheless, these results remain preliminary, and larger, well-powered studies are required to determine whether these patterns reflect stable, sex-dependent developmental changes. 2026-01-01T00:00:00Z http://hdl.handle.net/10366/172126 [ENG]Background – Kinesiophobia (excessive fear of movement due to belief of injury) is highly prevalent in rheumatologic diseases, yet its prevalence and associations in psoriatic arthritis (PsA) remain unexplored. Objective – To determine the prevalence of kinesiophobia in PsA and examine its associations with central sensitization (CS), demographic characteristics, disease activity, physical function, and patient-reported outcomes. Methods – Cross-sectional study of 246 consecutive PsA patients. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia-11. CS was measured by Central Sensitization Inventory (CSI). Disease activity, functional status, physical activity, sleep quality, anxiety, depression, and fatigue were systematically evaluated. Univariate and multivariable analyses (logistic and linear regression) were performed. Results – Kinesiophobia was present in 45.5% (112/246) of patients. Patients with kinesiophobia demonstrated significantly higher CSI scores (41.5 vs. 29; p < 0.001), reduced physical activity (1619.5 vs. 2, 970 MET-minutes/week; p = 0.01), greater disease activity (cDAPSA: 13 vs. 11; p = 0.001), functional impairment (HAQ-DI; p = 0.001), and increased comorbid anxiety and depression (p = 0.001). A significant correlation existed between kinesiophobia and CSI (r = 0.39; p < 0.001). In multivariable logistic regression, central sensitization (OR: 1.03; 95% CI: 1.00–1.05; p = 0.02) and sleep quality (PSQI; OR: 1.09; 95% CI: 1.00–1.1; p = 0.03) emerged as independent predictors, explaining 20% of kinesiophobia variance. In linear regression, these variables accounted for 12% of variance (R2 = 0.12). Conclusion – Kinesiophobia functions as an amplifier of pain perception and functional disability, particularly in patients with symptom-inflammation discordance. A bidirectional pathophysiologic relationship between kinesiophobia and CS likely perpetuates chronic pain and disability. Multidimensional interventions may enhance clinical outcomes in kinesiophobic PsA patients, especially those with high perceived impact despite adequate inflammatory control. 2026-01-01T00:00:00Z http://hdl.handle.net/10366/172122 [ENG]Background: Obstructive sleep apnea (OSA) is increasingly recognized in chronic inflammatory diseases, yet its prevalence and clinical correlates in psoriatic arthritis (PsA) remain poorly characterized. Objective: The objective of this study was to evaluate OSA prevalence and its relationship with disease activity, functional impairment, and comorbidities in PsA patients. Methods: A cross-sectional analysis of 247 consecutive PsA patients was conducted. OSA diagnosis was determined through medical record review. Disease activity was assessed using cDAPSA and ASDAS-CRP. Functional disability was measured using HAQ-DI and BASFI. Sleep quality (PSQI) and psychological symptoms (HADS) were evaluated. Inflammatory markers included CRP, IL-6, and TNF-α. Multivariable logistic regression identified independent predictors of OSA. Results: OSA prevalence was found to be 8.9% (22/247). OSA+ patients had significantly higher median age (58.0 vs. 54.0 years, p = 0.02), tender joint count (2.0 vs. 1.0, p = 0.002), functional disability (1.1 vs. 0.3, p = 0.001), fatigue (30.5 vs. 38.0, p = 0.04), anxiety (7.5 vs. 5.0, p = 0.03), depression (7.0 vs. 3.0, p = 0.004), and worse sleep quality (11.5 vs. 7.0, p = 0.001). Notably, no significant differences in inflammatory markers (CRP, swollen joints) were found between groups despite substantially higher pain burden in OSA+ patients. Female sex and greater tender joint count emerged as independent predictors of OSA. Conclusions: OSA occurs in ~9% of unselected PsA patients and is independently associated with functional disability, psychological distress, and elevated tender joint counts despite comparable inflammatory markers. This dissociation suggests that OSA drives pain amplification through non-inflammatory mechanisms. These findings support the use of systematic OSA screening in PsA patients with pain or disability disproportionate to inflammatory burden, particularly in those with psychological comorbidities. 2026-01-01T00:00:00Z http://hdl.handle.net/10366/172121 Background: Displaced individuals endure challenges, including conflict, forced migration, family separation, human rights violations, limited access to essential services, and increased exposure to violence and abuse. These hardships significantly impact their mental health, often leading to heightened trauma-related symptoms. Methods: We used a cross-sectional correlational design in refugee camps, homes, and centers across Jordan and Spain. 200 refugees with confirmed status in the past ten years were recruited. Demographic data were collected via a demographic form, the PTSD-8 Inventory assessed traumatic symptoms, and data analysis included descriptive statistics, independent t-tests, one-way ANOVA, and Chi-square tests. Results: Most participants had a secondary education, were unemployed, and had low incomes. PTSD symptoms were prevalent, with rates of recurrent thoughts (63.5%), re-experiencing events (57.5%), nightmares (50.5%), sudden reactions (56.5%), activity avoidance (53.5%), avoidance of specific thoughts or feelings (56.5%), jumpiness (53.5%), hypervigilance (53.5%), feeling on guard (41.5%), and general avoidance (43.5%) rated from rarely to most of the time. All symptoms were significantly more frequent among refugees in Jordan than in Spain. Conclusions and Recommendations: Intrusive thoughts were more frequent among females, urban residents, and unemployed individuals. Avoidance behaviors were higher in married and unemployed individuals. Hypervigilance was more prevalent among females, married individuals, and those with lower incomes. Regionally, females and married individuals in Jordan exhibited more intrusive thoughts and avoidance. In Spain, intrusive thoughts and hypervigilance were more common among females and the unemployed. The findings highlight the urgent need for targeted mental health interventions, particularly in refugee camps like those in Jordan, where PTSD symptom rates were significantly higher. Programs should prioritize trauma-focused therapies, such as Cognitive Behavioral Therapy, while adopting gender-sensitive approaches to address the heightened vulnerability of women and unemployed individuals. Given the strong link between unemployment and symptom severity, livelihood support and vocational training should be integrated into psychosocial care. Policymakers in host countries like Jordan could benefit from adopting integration strategies similar to Spain’s, which may contribute to lower PTSD prevalence. Additionally, community-based awareness initiatives could improve early symptom recognition and access to care. Future research should explore longitudinal outcomes to assess the long-term impact of displacement and resettlement conditions on mental health. 2025-01-01T00:00:00Z http://hdl.handle.net/10366/172029 [EN]Many brain disorders involve mitochondrial alterations, but owing to the lack of suitable tools, the causal role of mitochondrial dysfunction in pathophysiological processes is difficult to establish. Heterotrimeric guanine nucleotide-binding (G) proteins are key regulators of cell functions, and they can be found within mitochondria. Therefore, we reasoned that the activation of stimulatory mitochondrial G proteins (Gs) could rapidly promote the activity of the organelle and possibly compensate for bioenergetic dysfunction. Here, we show that a mitochondria-targeted recombinant designer receptor exclusively activated by designer drugs (mitoDREADD-Gs) can acutely trigger intramitochondrial signaling to increase mitochondrial membrane potential and oxygen consumption. In vivo activation of mitoDREADD-Gs abolished memory alterations in cannabinoid-treated mice and in two mouse models of Alzheimer’s disease and frontotemporal dementia. Thus, mitoDREADD-Gs enables the establishment of causal relationships between mitochondria and biological or disease-related processes and represents an innovative potential therapeutic approach for disorders associated with mitochondrial impairment. 2025-01-01T00:00:00Z http://hdl.handle.net/10366/171931 [ES]Se describe el manejo inmediato y tratamiento de la muerte súbita en el deportista. 2011-01-01T00:00:00Z http://hdl.handle.net/10366/171922 [EN]The document focuses on how oxidative eustress (a moderate and beneficial level of reactive species) acts as an alternative regulatory mechanism to trigger GLUT4 trafficking and restore glucose uptake within insulin-resistant skeletal muscle. 2026-01-01T00:00:00Z http://hdl.handle.net/10366/171913 [ES] La serotonina (5-HT) es una neurohormona que regula el tono vascular por mecanismos directos e indirectos, a través del sistema nervioso autónomo y sensorial, mediante una amplia familia de receptores serotonérgicos. Los mecanismos serotonérgicos implicados en la modulación de la neurotransmisión simpática y sensorial CGRPérgica en la vasculatura sistémica han sido caracterizados por nuestro grupo y otros autores en ratas macho. Sin embargo, el sexo biológico influye tanto en el metabolismo de la 5-HT y la expresión de sus receptores, como en la neurotransmisión simpática y sensorial CGRPérgica, lo que limita la comprensión y el desarrollo de dianas farmacológicas eficaces para el sexo femenino en patologías cardiovasculares y neurovasculares. La presente Tesis Doctoral tiene como objetivo determinar si los mecanismos serotonérgicos involucrados en la regulación cardiovascular presentan diferencias dependientes del sexo biológico en ratas. Para ello, en ratas hembra pithed, se ha estudiado el papel diferencial de los distintos receptores de 5-HT sobre las respuestas vasculares obtenidas por liberación endógena de noradrenalina y del péptido relacionado con el gen de la calcitonina (CGRP), así como la posible implicación de mediadores dependientes de endotelio en la respuesta noradrenérgica. Los resultados obtenidos muestran que el sexo biológico influye en el tono vascular basal y en los mecanismos serotonérgicos que regulan tanto la neurotransmisión simpática vascular como la inervación sensorial CGRPérgica perivascular, modificando el tipo y subtipo de receptores de 5-HT implicados, su localización en la unión neuroefectora, y las vías indirectas involucradas. Estos hallazgos podrían abrir nuevas estrategias terapéuticas dependientes del sexo en el tratamiento de enfermedades cardiovasculares y neurovasculares.; [EN] Serotonin (5-HT) is a neurohormone that regulates vascular tone by direct and indirect mechanisms via the autonomic and sensory nervous systems, acting through a large family of serotonergic receptors. The serotonergic mechanisms involved in the modulation of sympathetic and sensory CGRPergic neurotransmission in the systemic vasculature have been characterised by our group and others in male rats. However, biological sex influences 5-HT metabolism and receptor expression, as well as sympathetic and sensory CGRPergic neurotransmission, which limits the understanding and development of effective pharmacological targets for the female sex in cardiovascular and neurovascular disorders. The aim of the present Doctoral Thesis was to determine whether the serotonergic mechanisms involved in cardiovascular regulation display sex-dependent differences in rats. To do so, female pithed rats were used to study the role of different 5-HT receptors on vascular responses elicited by the endogenous release of noradrenaline and calcitonin generelated peptide (CGRP), along with the possible involvement of endothelium-dependent mediators in the noradrenergic response. The results show that biological sex influences basal vascular tone and the serotonergic mechanisms regulating both vascular sympathetic neurotransmission and perivascular sensory CGRPergic outflow, modifying the 5-HT receptor types and subtypes involved, their localisation at the neuroeffector junction, and the indirect pathways implicated. Altogether, these findings may contribute to the development of novel sex-dependent therapeutic strategies for cardiovascular and neurovascular diseases. 2026-01-01T00:00:00Z http://hdl.handle.net/10366/171901 [EN] Background: Loneliness has emerged as a psychosocial issue in oncology, with implications for emotional well- being, social and daily functioning, and adaptation to illness. However, its relationship with perceived social support and functional independence in patients with cancer remains insufficiently characterized. Objective: To analyze loneliness in patients with cancer and its association with sociodemographic, psychosocial, and functional variables. Methods: We conducted a cross-sectional study in 153 adults with cancer recruited from the onco-haematology day hospital at the Complejo Asistencial Universitario de Salamanca, Spain. Global loneliness was assessed with the UCLA Loneliness Scale, and emotional and social loneliness with the De Jong Gierveld Loneliness Scale. Perceived social support was evaluated with the Duke-UNC Functional Social Support Questionnaire, quality of life with the EORTC QLQ-C30, functional independence with the Barthel Index, and anxiety and depressive symptoms with the Hospital Anxiety and Depression Scale (HADS). Correlation analyses and multivariable linear and logistic regression models were performed. Results: The median UCLA loneliness score was 36 (range 20–79), indicating variability in perceived loneliness. Higher loneliness was associated with lower perceived social support, greater depressive and anxiety symptoms, and lower functional independence. In multivariable analyses, perceived social support and functional independence remained independently associated with lower loneliness, while depressive symptoms were associated with higher loneliness only in the linear model. Conclusions: Loneliness was more closely associated with psychosocial and functional than sociodemographic variables. These findings support loneliness assessment in comprehensive cancer care and suggest that social support and functional status may be key loneliness correlates. [ES] Antecedentes: La soledad ha emergido como un problema psicosocial en oncología, con implicaciones en el bienestar emocional, el funcionamiento social y diario, y la adaptación a la enfermedad. Sin embargo, su relación con el apoyo social percibido y la independencia funcional en pacientes con cáncer sigue sin estar suficientemente caracterizada. Objetivo: Analizar la soledad en pacientes con cáncer y su asociación con variables sociodemográficas, psicosociales y funcionales. Métodos: Se realizó un estudio transversal en 153 adultos con cáncer reclutados en el hospital de día de oncohematología del Complejo Asistencial Universitario de Salamanca, España. La soledad global se evaluó con la Escala de Soledad de la UCLA, y la soledad emocional y social con la Escala de Soledad de De Jong Gierveld. El apoyo social percibido se evaluó con el Cuestionario de Apoyo Social Funcional Duke-UNC, la calidad de vida con el EORTC QLQ-C30, la independencia funcional con el Índice de Barthel, y los síntomas de ansiedad y depresión con la Escala de Ansiedad y Depresión Hospitalaria (HADS). Se realizaron análisis de correlación y modelos de regresión lineal y logística multivariante. Resultados: La mediana de la puntuación de soledad de la UCLA fue de 36 (rango 20–79), lo que indica variabilidad en la soledad percibida. Una mayor soledad se asoció con un menor apoyo social percibido, mayores síntomas de depresión y ansiedad, y una menor independencia funcional. En los análisis multivariantes, el apoyo social percibido y la independencia funcional se mantuvieron asociados de forma independiente con una menor soledad, mientras que los síntomas depresivos se asociaron con una mayor soledad solo en el modelo lineal. Conclusiones: La soledad se asoció más estrechamente con las variables psicosociales y funcionales que con las sociodemográficas. Estos hallazgos respaldan la evaluación de la soledad en la atención integral del cáncer y sugieren que el apoyo social y el estado funcional pueden ser correlatos clave de la soledad. 2026-06-13T00:00:00Z http://hdl.handle.net/10366/171882 [EN]Bread crust constitutes an important by-product of the bakery industry, and its utilization for the isolation of melanoidins to be used as a functional ingredient can enhance its added value and contribute to health. The aim of this study was to evaluate the bioaccessibility, bioactivity, and genoprotective effect of melanoidins derived from bread crust. Bioaccessibility was assessed in gastric, intestinal digestion, and colonic fermentation fractions. The results revealed a relationship between bioaccessible melanoidins and their type (common or soft bread). No cytotoxicity effects were observed for bioaccessible fractions, as assessed by MTT and RTA methods, and they did not affect the distribution of E-cadherin in Caco-2 cells, confirming their ability to maintain membrane integrity. Furthermore, our study demonstrated that the gastrointestinal and colonic fermentation fractions successfully transported across the intestinal barrier, without affecting cell permeability, and showed antioxidant activity on the basolateral side of the cell monolayer. Remarkably, both fractions displayed a significant genoprotective effect in Caco-2 cells. Our findings provide crucial insights into the relationship between the melanoidins and their bioactivity and genoprotective effect. These results demonstrated the potential of bioaccessible melanoidins as valuable bioactive compounds for the development of functional foods, without showing toxic effects on gastrointestinal cells. 2023-08-01T00:00:00Z http://hdl.handle.net/10366/171880 [EN]Background/Objectives: Helicobacter pylori is a major contributor to gastric infections; it is prevalent in humans and associated with gastrointestinal diseases. In recent years, the increase in antimicrobial resistance has contributed to the need for alternative approaches, prompting interest in natural products with antimicrobial and antivirulence properties. This study investigated the effect of bioaccessible melanoidins from common and soft bread crust against H. pylori infection. Methods: Melanoidins were extracted using dead-end ultrafiltration, and bioaccessible fractions were obtained through in vitro digestion. The bactericidal effect of melanoidins was assessed at 2% and 4% concentrations over 24 and 48 h. The effect on H. pylori adhesion of 100 μg/mL and 200 μg/mL of gastric and intestinal bioaccessible fractions of melanoidins was evaluated in Caco-2 cells. Results: The bactericidal effect of melanoidins revealed significant efficacy, with a greater effect for soft bread melanoidins. The gastric fractions exhibited a higher inhibitory effect, which is crucial for gastric mucosa, the primary site of H. pylori infection. Both bioaccessible fractions showed anti-inflammatory and antioxidant effects against H. pylori-induced inflammation, particularly in the gastric fractions. This was evidenced by a reduction in interleukin-6 and interleukin-8 release and an enhancement in interleukin-10 release. The observed reduction in reactive oxygen species (ROS) and the maintenance of glutathione levels indicate an improved redox status. Conclusions: This study emphasizes the potential of melanoidins, especially from soft bread, as bioactive compounds against H. pylori, offering insights for future functional food development 2025-02-01T00:00:00Z http://hdl.handle.net/10366/171876 [EN]Acute kidney frailty (AKF) is a condition of increased susceptibility to acute kidney injury (AKI), an abrupt impairment of renal excretory function potentially leading to severe complications. Prevention of AKI relies on the recognition of risk factors contributing to AKF. At the population level, dehydration constitutes a predisposing factor for AKI. However, renal frailty may be context-specific, with variations among patients in the types of damage and the distinct pathological mechanisms. In this regard, we studied the combined effect of dehydration with other factors on renal homeostasis, such as increasing age and hypertension. AKF status was studied in rats bearing risk factors individually and in combination and was evaluated as the level of AKI induced by a triggering dose of cisplatin, which is known to be mildly nephrotoxic for young, healthy rats. AKI was assessed through parameters of renal function (including creatinine, urea, creatinine clearance, proteinuria, and fractional excretion of sodium) and histopathology of renal tissue specimens. The hydration status was measured by bioelectric impedance and other techniques. Water deprivation induces a dehydration state characterized by reductions in body weight and urinary flow and increases in hematocrit and plasma and urine osmolality. Bioelectric impedance showed a net loss of body water after water deprivation with no relevant changes in body mass distribution. Dehydration is not sufficient to predispose young control rats to intrinsic AKI. However, the combination of dehydration with advanced age or hypertension induces AKF evidenced by a magnified response of renal dysfunction (reduced filtration and tubular function) and tubular necrosis caused by low-dose cisplatin treatment. This study highlights the relevance of addressing AKF as a premorbid condition providing prophylactic opportunities and shows that dehydration differentially predisposes to prerenal and intrinsic AKI. 2025-03-01T00:00:00Z http://hdl.handle.net/10366/171855 [ES] Introducción: La toma de decisiones ante lesiones cariosas profundas en dentición permanente constituye un punto crítico para la conservación del complejo dentino-pulpar. Tradicionalmente, la remoción completa de caries (CCR) ha buscado eliminar toda dentina reblandecida hasta alcanzar tejido “duro”; sin embargo, este enfoque puede incrementar el riesgo de exposición pulpar y desencadenar ciertas complicaciones biológicas. En contraste, la técnica de remoción selectiva de caries (SCR) se alinea con el paradigma actual de la odontología mínimamente invasiva, priorizando la eliminación periférica que asegure un sellado periférico adecuado y preservando dentina afectada en proximidad pulpar con el fin de reducir iatrogenia y favorecer la estabilidad clínica. Esta tesis evalúa comparativamente los resultados pulpares y restauradores de SCR frente a CCR en dientes posteriores permanentes con caries profundas. Material y métodos: Se desarrolló un ensayo clínico prospectivo en un entorno clínico asistencial entre enero de 2024 hasta diciembre de 2025, incluyendo 60 pacientes (18–75 años) con caries profundas en premolares y molares permanentes vitales, distribuidos en dos grupos: SCR (n=30) y CCR (n=30). El diagnóstico se basó en evaluación clínica y radiográfica, complementado con pruebas de vitalidad preoperatorias y controles postoperatorios, incluyendo seguimiento a 6 meses. Bajo aislamiento y protocolos estandarizados, se realizó la excavación según técnica asignada y se efectuó restauración adhesiva definitiva, registrándose eventos intraoperatorios (como exposición pulpar) y desenlaces clínico-radiográficos (vitalidad y éxito restaurador). El análisis estadístico se efectuó en IBM SPSS v29.0, con estadística descriptiva e inferencial, utilizando pruebas de asociación para variables categóricas (χ²), comparación de edad según supuestos y pruebas apareadas (McNemar), fijando significación en p < 0,05. Resultados: La muestra presentó una edad media de 47,55 ± 13,30 años (mediana 49,50), con predominio de molares (83,3%) y del sexo masculino (56,7%). La exposición pulpar intraoperatoria se observó en el 40,0% global, sin diferencias significativas entre técnicas (SCR 43,3% vs CCR 36,7%; p=0,598). La vitalidad preoperatoria fue positiva en el 100% de los casos, manteniéndose prácticamente estable en el postoperatorio inmediato (98,3% positiva). A los 6 meses, la vitalidad positiva global fue del 81,7%, y el éxito restaurador global alcanzó también el 81,7%. Al comparar por técnica, SCR mostró ventajas significativas: la vitalidad negativa a 6 meses fue menor en SCR que en CCR (10,0% vs 26,7%; p=0,045), y de forma concordante el fracaso restaurador fue inferior en SCR (10,0% vs 26,7%; p=0,045). No se observaron asociaciones estadísticamente significativas de edad, sexo o tipo de pieza con los desenlaces principales en esta cohorte. Conclusiones: En dientes posteriores permanentes con caries profundas, la remoción selectiva de caries se asoció con mejor preservación de la vitalidad pulpar y mayor éxito restaurador a 6 meses en comparación con la remoción completa. Estos hallazgos respaldan la SCR como estrategia clínicamente favorable dentro de un enfoque mínimamente invasivo, recomendándose ampliar el seguimiento y el tamaño muestral para robustecer la estimación del efecto y su generalización clínica. 2026-01-01T00:00:00Z