1. Investigación

Aims and Objectives: To determine the effect of immersive virtual reality (VR) on perceived pain and fear in children during vaccination and parental satisfaction with the procedure. Background: Virtual reality can reduce the perception of pain by children but only three studies have analysed its use during vaccination to date; these had small sample sizes and imperfect methodological designs. Design: A randomised controlled clinical trial. Methods: One hundred and sixty participants from the Tres Forques Health Center were randomly assigned to the intervention group (IG) (n = 82) in which distraction with immersive VR was used during the vaccination, while standard distraction techniques were used for the control group (n = 80). The primary outcome was pain (Wong–Baker FACES). Secondary outcomes included (Children's Fear Scale) and parental satisfaction with the vaccination procedure. Chi-squared tests were used for qualitative variables, relationships between quantitative variables were tested with Spearman correlations, and Mann–Whitney U- or Student t-tests were employed to assess the relationship between quantitative and qualitative variables. Results: Compared to the controls, the children in the IG reported significantly less pain and fear, while parental satisfaction was significantly higher. Reported pain and fear did not differ according to the sex of the patient. Child age was not linked to fear but was related to pain: the younger the patient, the greater the pain they described. Conclusions: Immersive VR effectively controlled pain and fear in children during vaccination and increased parent satisfaction with the vaccination process. Patient sex did not influence the level of pain and fear but age did. Relevance to clinical practice: Improving vaccination experiences can reduce perceived pain and fear in children and increase parent satisfaction, thereby enhancing vaccination schedule adherence and improving group immunity. Reporting Method: The CONSORT Statement for non-pharmacological randomised clinical trials were followed.

Purpose: To evaluate and compare the efficacy of the hands-eyes-mouth distraction technique (HEM-DT) in reducing anxiety and pain levels and improving the behaviour of pre-school children during inferior alveolar nerve block (IANB) administration to that of the covering patient's vision technique (CPV-T). Methods: This study included 52 children aged 3-5 years old with primary dentition, no history of receiving local anaesthesia, and whose treatments required an IANB. These children were randomly assigned into two groups: HEM-DT (G1; n = 26) and CPV-T (G2; n = 26). Anxiety and pain levels were assessed using the Facial Image Scale and the Wong-Baker Scale, respectively, while the patient's behaviour was evaluated using the Frankl Behaviour Scale. This study was divided into two sessions including the treatment session (administration of IANB) and the control session (7 days after anaesthesia). Chi-square test, the Mann-Whitney U test and Wilcoxon test were used for statistical analyses. Results: The patients' anxiety levels did not increase 7 days after IANB in G1 (p value = 0.798); however, higher anxiety levels were observed in the G2 group (p value = 0.039). No significant differences in pain levels and behaviour were observed between the groups during administration of anaesthesia (p value > 0.005). Conclusion: HEM-DT and CPV-T showed efficacy in terms of pain and behaviour during IANB administration. Pre-school children in the HEM-DT group exhibited lower anxiety levels in the control session.

La clusterina es una proteína multifuncional con numerosas isoformas y localizaciones que está presente en todos los fluidos del organismo, así como en el interior celular. Estudios previos de proteómica de expresión diferencial habían sugerido una posible relación entre niveles plasmáticos de clusterina y adicción a la comida, lo que nos ha llevado a profundizar en el estudio de clusterina como posible biomarcador asociado a alteraciones del sistema cerebral de refuerzo y recompensa. En un primer estudio confirmamos mediante inmunoensayos la existencia de una correlación positiva entre niveles plasmáticos de clusterina y pérdida de control sobre la ingesta en pacientes con obesidad mórbida, lo que nos aconsejó progresar utilizando modelos animales en los que las propiedades motivacionales de la comida estuvieran alterados. De esta forma, en un modelo de sobrealimentación con una dieta rica en grasa en el ratón obtuvimos una correlación entre las propiedades motivacionales de la sacarosa y los niveles plasmáticos de clusterina, junto con una sobre-expresión de esta proteína en el núcleo accumbens de los animales sobrealimentados. De la misma forma, la subnutrición crónica durante la vida perinatal y adulta provoca en la rata una sobre-expresión de clusterina en la fracción mitocondrial de núcleo accumbens, sin embargo, cuando la subnutrición se circunscribe a la vida perinatal, los adultos exhiben una reducción significativa de la expresión de clusterina en este mismo núcleo. Desarrollamos también modelos in vitro de sub- y sobre-alimentación en cultivos de neuroblastoma para avanzar en el conocimiento de los mecanismos implicados en los efectos de clusterina, observando que la proteína trasloca su posición y cambia su función para preservar la supervivencia celular de forma adaptativa y no permanente. En un último estudio observamos que la ligadura del nervio ciático, una condición que se sabe conlleva anhedonia, provoca alodinia mecánica, estrés y una marcada disminución de la expresión de clusterina en la corteza prefrontal, lo que sugiere la implicación de esta proteína en los cambios funcionales que acompañan al dolor neuropático en este área cerebral. Todos estos resultados refuerzan la idea de que clusterina estaría implicada en las alteraciones del sistema de refuerzo y recompensa, ejerciendo posiblemente un papel neuroprotector al igual que en otras patologías del sistema nervioso.