Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with early breast cancer.

The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with early breast cancer were updated and published online in 2023, and adapted, according to previously established standard methodology, to produce the Pan-Asian adapted (PAGA) ESMO consensus guidelines for the management of Asian patients with early breast cancer. The adapted guidelines presented in this manuscript represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with breast cancer representing the oncological societies of China (CSCO), Indonesia (ISHMO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO), co-ordinated by ESMO and KSMO. The voting was based on scientific evidence and was independent of the current treatment practices, drug access restrictions and reimbursement decisions in the different Asian regions represented by the 10 oncological societies. The latter are discussed separately in the manuscript. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with early breast cancer across the different regions of Asia, drawing on the evidence provided by both Western and Asian trials, whilst respecting the differences in screening practices, molecular profiling, as well as the age and stage at presentation. Attention is drawn to the disparity in the drug approvals and reimbursement strategies, between the different regions of Asia.

Host availability affects the interaction between pupal parasitoid Coptera haywardi (Hymenoptera: Diiapridae) and larval-pupal parasitoid Diachasmimorpha longicaudata (Hymenoptera: Braconidae).

The use of multiple species in biological control programmes is controversial when interactions among them are not fully understood. We determined the response of the pupal parasitoid Coptera haywardi (Oglobin) to different availability of Anastrepha ludens (Loew) pupae previously parasitized or not by larval-pupal Diachasmimorpha longicaudata (Ashmead). The two types of pupae were exposed at different ages and proportions to different numbers of C. haywardi females for 48 h. The performance of C. haywardi adults emerging from parasitized and unparasitized pupae was measured. Coptera haywardi prefers to attack unparasitized A. ludens pupae rather than pupae parasitized by D. longicaudata. However, when the availability of unparasitized pupae was low or the number of foraging females was high, C. haywardi competed against early immature stages of the D. longicaudata, or hyperparasitized, feeding directly on the advanced-immature developmental stages of the early acting species. Adults of C. haywardi emerging as hyperparasitoids were no different in size, fecundity and longevity from those emerging as primary parasitoids. Our data suggest that simultaneous use of these species in augmentative biological control projects may be feasible but should be carefully planned in order to avoid any detrimental effect of its interaction.

Best Timing to Determine Field Parasitism by Released Diachasmimorpha longicaudata (Hymenoptera: Braconidae) Against Anastrepha (Diptera: Tephritidae) Pest Populations.

Our objective was to determine the timing of the highest parasitic activity by released Diachasmimorpha longicaudata (Ashmead) (Hymenoptera: Braconidae) in areas with fruits of sour orange and hog plums infested by Anastrepha ludens (Loew) and Anastrepha obliqua (McQuart) (Diptera: Tephritidae), under shaded and sunny conditions. Percent parasitism along fruit sampling period was related to host availability, which was influenced by the fruit size rather than environmental conditions. The highest parasitism in sour orange was obtained just the first day after release, but in hog plums this was observed during the first 3 days without significant differences between them. The levels of fruit infestation and parasitism were higher in shaded trees in sour orange as in hog plums. The high availability of larvae and the small size of hog plums were decisive for obtaining high levels of parasitism and keeping parasitoids near the release points. By contrast, the size and thick rind of sour orange provided to the larvae a physical refuge that was associated with lower parasitism, causing that parasitoids spread out in search of hosts more accessible. In sour orange, parasitism was exclusively by D. longicaudata, while in hog plums, we additionally found the coexistence of four native parasitoid species. This information suggests that in sour orange, the sampling should be performed 1 day after release, while in hog plums, the samplings can be extended to within the first 3 days. Such sampling can serve to better estimate the effect of D. longicaudata releases against Anastrepha pest populations in different fruit types.

Two different R gene loci co-evolved with Avr2 of Phytophthora infestans and confer distinct resistance specificities in potato.

Late blight, caused by the oomycete pathogen Phytophthora infestans, is the most devastating disease in potato. For sustainable management of this economically important disease, resistance breeding relies on the availability of resistance (R) genes. Such R genes against P. infestans have evolved in wild tuber-bearing Solanum species from North, Central and South America, upon co-evolution with cognate avirulence (Avr) genes. Here, we report how effectoromics screens with Avr2 of P. infestans revealed defense responses in diverse Solanum species that are native to Mexico and Peru. We found that the response to AVR2 in the Mexican Solanum species is mediated by R genes of the R2 family that resides on a major late blight locus on chromosome IV. In contrast, the response to AVR2 in Peruvian Solanum species is mediated by Rpi-mcq1, which resides on chromosome IX and does not belong to the R2 family. The data indicate that AVR2 recognition has evolved independently on two genetic loci in Mexican and Peruvian Solanum species, respectively. Detached leaf tests on potato cultivar 'Désirée' transformed with R genes from either the R2 or the Rpi-mcq1 locus revealed an overlapping, but distinct resistance profile to a panel of 18 diverse P. infestans isolates. The achieved insights in the molecular R - Avr gene interaction can lead to more educated exploitation of R genes and maximize the potential of generating more broad-spectrum, and potentially more durable control of the late blight disease in potato.

Safety and Efficacy of Dolutegravir Plus Rilpivirine in Treatment-Experienced HIV-Infected Patients: The DORIVIR Study.

OBJECTIVES: To analyze the efficacy and safety of dolutegravir/rilpivirine (DTG/RPV) in HIV-infected patients who switched from any other antiretroviral therapy (ART). METHODS: Open-label, multicenter study including patients who switched to DTG/RPV between February 2015 and February 2016. Efficacy (HIV RNA <50 copies/mL), adverse events, and metabolic changes at 24 weeks were analyzed. RESULTS: A total of 104 participants were included, who switched for the following reasons: toxicity/intolerance (42.3%), convenience (27.8%), and drug interactions (17.3%). Prior regimens are protease inhibitor (56.7%), integrase strand transfer inhibitor (26.9%), and non-nucleoside reverse transcriptase inhibitor (16.3%). Efficacy at 24 weeks was 88.4% (intention to treat) and 96.8% (per protocol). Triglyceride levels were reduced, on average, by 12.7% and a mean decrease of 9.0% in the glomerular filtration rate was observed as well ( P values of .003 and .002, respectively), whereas total cholesterol, HDL cholesterol, LDL cholesterol, creatinine, and glutamic-pyruvic transaminase remained unchanged. No patient discontinued due to adverse events. CONCLUSIONS: Dolutegravir/RPV is effective and safe in long-term HIV-infected patients under any prior ART. Toxicity, convenience, and interactions were the main reasons for changing. At 24 weeks, the lipid profile improved with a decrease in triglycerides.

Regulation of immunophenotype modulation of monocytes-macrophages from M1 into M2 by prostate cancer cell-culture supernatant via transcription factor STAT3.

BACKGROUND: Transcription factor STAT3 has a prominent innate immunity effect on cancer progression. We determined the regulation of STAT3 in the immunophenotype modulation of macrophages from M1 into M2 induced by the cell-culture supernatant of the Prostate-Cancer line PC3. METHODS: Monocytes-macrophages from healthy donors were cultured in the supernatant of PC3 cells, membrane proteins, and intracytoplasmic and phosphorylated STAT3 were measured using flow cytometry, while cytokines and growth factors were studied using luminescence. Cytotoxicity and nitric oxide were evaluated via colorimetric assays. RESULTS: The supernatant of PC3 prostate-tumor cells effectively induced macrophages toward an M2 profile, and the expression of phosphorylated STAT3 in the monocytes-macrophages notably increased, and mainly related to IL-10. In the group of monocytes-macrophages treated with a STAT3 inhibitor, the macrophages were induced toward an M1 phenotype. CONCLUSIONS: In this study, we showed that the secretion profile of PC3 prostate-cancer cells induces a change in macrophage phenotype from M1 into M2, and that the phenomenon is related to phosphorylation of transcription factor STAT3 and IL-10.

Vaginal Cuff Dehiscence Presenting with Free Air 60 Days after Robotic-Assisted Hysterectomy.

INTRODUCTION: The vast majority of patients presenting with pneumoperitoneum have visceral organ perforation and require urgent diagnostic laparoscopy. Nonsurgical causes are relatively rare and may be attributed to multiple etiologies. CASE PRESENTATION: Here we describe the case of a 38-year-old Caucasian female who presented to the emergency department with three days of cramping, epigastric abdominal pain. Her physical exam was notable for tenderness to palpation in the epigastric area and abdominal and chest X-rays showed free air under the diaphragm. Free air around the porta hepatis was verified on CT scan. Approximately 90% of pneumoperitoneum cases are due to perforation of visceral organs and therefore require operative management. An urgent exploratory laparoscopy revealed no clear source of free air, but postoperatively the patient developed a large volume of watery discharge from her vagina. Subsequent workup revealed a 1 cm vaginal cuff dehiscence which was later repaired with no postoperative complications. CONCLUSION: Although the majority of patients with pneumoperitoneum require urgent exploratory laparoscopy, a careful diagnostic workup may reveal sources of free air that are not related to hollow viscous perforation. Vaginal cuff dehiscence represents a rare yet nonurgent source of pneumoperitoneum. This differential should be considered in light of the possible intra- and postoperative complications of surgery.

Identification of Interleukin-27 (IL-27)/IL-27 Receptor Subunit Alpha as a Critical Immune Axis for In Vivo HIV Control.

Intact and broad immune cell effector functions and specific individual cytokines have been linked to HIV disease outcome, but their relative contribution to HIV control remains unclear. We asked whether the proteome of secreted cytokines and signaling factors in peripheral blood can be used to discover specific pathways critical for host viral control. A custom glass-based microarray, able to measure >600 plasma proteins involved in cell-to-cell communication, was used to measure plasma protein profiles in 96 HIV-infected, treatment-naive individuals with high (>50,000) or low (<10,000 HIV RNA copies/ml) viral loads. Univariate and regression model analysis demonstrate that plasma levels of soluble interleukin-27 (IL-27) are significantly elevated in individuals with high plasma viremia (P < 0.0001) and are positively correlated with proviral HIV-DNA copy numbers in peripheral blood mononuclear cells (PBMC) (Rho = 0.4011; P = 0.0027). Moreover, soluble IL-27 plasma levels are negatively associated with the breadth and magnitude of the total virus-specific T-cell responses and directly with plasma levels of molecules involved in Wnt/ß-catenin signaling. In addition to IL-27, gene expression levels of the specific IL-27 receptor (IL27RA) in PBMC correlated directly with both plasma viral load (Rho = 0.3531; P = 0.0218) and the proviral copy number in the peripheral blood as an indirect measure of partial viral reservoir (Rho = 0.4580; P = 0.0030). These results were validated in unrelated cohorts of early infected subjects as well as subjects before and after initiation of antiretroviral treatment, and they identify IL-27 and its specific receptor as a critical immune axis for the antiviral immune response and as robust correlates of viral load and proviral reservoir size in PBMC.IMPORTANCE The detailed knowledge of immune mechanisms that contribute to HIV control is a prerequisite for the design of effective treatment strategies to achieve HIV cure. Cells communicate with each other by secreting signaling proteins, and the blood is a key conduit for transporting such factors. Investigating the communication factors promoting effective immune responses and having potentially antiviral functions against HIV using a novel focused omics approach ("communicome") has the potential to significantly improve our knowledge of effective host immunity and accelerate the HIV cure agenda. Including 140 subjects with variable viral loads and measuring the plasma levels of >600 soluble proteins, our data highlight the importance of Th17 cells and Wnt/ß-catenin signaling in HIV control and especially identify the IL-27/IL-27 receptor subunit alpha (IL-27RA) axis as a predictor of plasma viral load and proviral copy number in the peripheral blood. These data may provide important guidance to therapeutic approaches in the HIV cure agenda.

Cirugía torácica asistida por vídeo uniportal en paciente despierto / Single-port video-assisted thoracic surgery in an awake patient

La cirugía torácica asistida por vídeo se realiza tradicionalmente bajo anestesia general e intubación endotraqueal con tubo de doble luz. Sin embargo, en los últimos años se están llevando a cabo procedimientos que incluyen desde toracoscopias diagnósticas a cirugía de resección pulmonar en pacientes despiertos en ventilación espontánea bajo anestesia locorregional con o sin sedación, evitando así los riesgos inherentes a la anestesia general, a la intubación con tubos de doble luz y a la ventilación mecánica. Este tipo de aproximación se ha mostrado efectiva para permitir un adecuado abordaje quirúrgico, garantizando un idóneo nivel de analgesia, una correcta oxigenación de los pacientes, y facilitando su precoz recuperación postoperatoria. Presentamos 2 casos clínicos de cirugía torácica asistida por vídeo, una biopsia pulmonar y una resección pulmonar, realizados bajo anestesia epidural manteniendo al paciente despierto en ventilación espontánea, como parte de un proyecto de evaluación preliminar para la aplicación de dicha técnica anestésica en este tipo de cirugía en nuestro centro (AU)

Video-assisted thoracic surgery is traditionally carried out with general anaesthesia and endotracheal intubation with double lumen tube. However, in the last few years procedures, such as lobectomies, are being performed with loco-regional anaesthesia, with and without sedation, maintaining the patient awake and with spontaneous breathing, in order to avoid the inherent risks of general anaesthesia, double lumen tube intubation and mechanical ventilation. This surgical approach has also shown to be effective in that it allows a good level of analgesia, maintaining a correct oxygenation and providing a better post-operative recovery. Two case reports are presented in which video-assisted thoracic surgery was used, a lung biopsy and a lung resection, both with epidural anaesthesia and maintaining the patient awake and with spontaneous ventilation, as part of a preliminary evaluation of the anaesthetic technique in this type of surgery (AU)

[Single-port video-assisted thoracic surgery in an awake patient]. / Cirugía torácica asistida por vídeo uniportal en paciente despierto.

Video-assisted thoracic surgery is traditionally carried out with general anaesthesia and endotracheal intubation with double lumen tube. However, in the last few years procedures, such as lobectomies, are being performed with loco-regional anaesthesia, with and without sedation, maintaining the patient awake and with spontaneous breathing, in order to avoid the inherent risks of general anaesthesia, double lumen tube intubation and mechanical ventilation. This surgical approach has also shown to be effective in that it allows a good level of analgesia, maintaining a correct oxygenation and providing a better post-operative recovery. Two case reports are presented in which video-assisted thoracic surgery was used, a lung biopsy and a lung resection, both with epidural anaesthesia and maintaining the patient awake and with spontaneous ventilation, as part of a preliminary evaluation of the anaesthetic technique in this type of surgery.

Biotipos periodontales, un resumen actualizado / Periodontal biotypes, an updated review

El interés por los biotipos periodontales se ha acrecentado en el último tiempo, por lo cual en los años recientes el estudio de las dimensiones de los diferentes tejidos periodontales se ha desarrollado desde un punto de vista epidemiológico, estético y terapéutico en varias áreas de la odontología, especialmente en periodoncia. Esta revisión bibliográfica tiene por objetivo mostrar las últimas evidencias relacionadas con esta temática.

Biotipos periodontales, un resumen actualizado / Periodontal biotypes, an updated review

El interés por los biotipos periodontales se ha acrecentado en el último tiempo, por lo cual en los años recientes el estudio de las dimensiones de los diferentes tejidos periodontales se ha desarrollado desde un punto de vista epidemiológico, estético y terapéutico en varias áreas de la odontología, especialmente en periodoncia. Esta revisión bibliográfica tiene por objetivo mostrar las últimas evidencias relacionadas con esta temática.(AU)

Hábitos alimentarios, actividad física y nivel socioeconómico en estudiantes universitarios de Chile / Eating habits, physical activity and socioeconomic level in university students of Chile

Introducción: Los estudiantes universitarios son vulnerables a una mala nutrición, no consumen meriendas entre las comidas, no desayunan, ayunan por largas horas, prefieren la comida rápida y además no realizan ejercicios físicos. La población universitaria es considerada la población adulto joven clave para la promoción y prevención de salud para las futuras generaciones, por lo que es trascendental identificar la situación actual nutricional y la frecuencia de actividad física de los universitarios. Objetivos: Determinar los factores que intervienen en la elección de los alimentos y la frecuencia de actividad física en estudiantes universitarios. Métodos: Se evaluaron 799 voluntarios de cuatro universidades de la quinta región de Chile. Se aplicó un instrumento para determinar el nivel de actividad física y de hábitos alimentarios, el test kidmed para determinar la adherencia a la dieta mediterránea y un instrumento Adimark para determinar el nivel socioeconómico de los sujetos. Finalmente se realizó una evaluación antropométrica para determinar IMC, masa grasa y masa muscular. Resultados: La inactividad física es mayor en mujeres que en hombres y plantean que la principal razón para no hacer ejercicio es la falta de tiempo y la pereza. En ambos sexos no leen las etiquetas nutricionales y tienen una media adherencia a la dieta mediterránea. Discusión: Existen bajos conocimientos de nutrición que provocan una mala calidad en la alimentación de los sujetos y no existe motivación para realizar mayor actividad física. El nivel socioeconómico no tiene relación con los hábitos alimentarios ni con la actividad física, por lo que es necesario integrar programas regulares y permanentes de vida sana en todas las universidades (AU)

Introduction: University students are vulnerable to poor nutrition; they don't eat snacks between meals, don't eat breakfast or fast for long hours, prefer fast food and don't exercise. University students is considered the key young adult population group for health promotion and prevention for future generations, so it's crucial identify the current nutritional status and frequency of physical activity. Objectives: To determine the factors involved in the choice of food and frequency of physical activity in university students. Methods: 799 volunteers were evaluated from four universities of the fifth region of Chile. Instrument was applied to determine the level of physical activity and eating habits, KIDMED test to determine adherence to the Mediterranean diet and Adimark instrument to determinate the socioeconomic status of the subjects. Finally, anthropometric evaluation to determinate BMI, fat mass and muscle mass. Results: Physical inactivity is higher in women than in men and that the main reason for not exercising is lack of time and laziness. In both sexes don't read nutrition labels and have a low and average adherence to the Mediterranean diet. Discussion: The low knowledge of nutrition is the cause of the poor food quality of subjects and there isn't greater motivation to perform physical activity. Socioeconomic status isn't related to eating habits and physical activity. It's necessary to integrate programs regular and permanent healthy lifestyle in all universities (AU)

Towards on line monitoring the evolution of the myocardium infarction scar with an implantable electrical impedance spectrum monitoring system.

The human heart tissue has a limited capacity for regeneration. Tissue and cellular therapies based on the use of stem cells may be useful alternatives to limit the size of myocardial infarction. In this paper, the preliminary results from an experimental campaign for on-line monitoring of myocardium scar infarction are presented. This study has been carried out under a research project that has as main objective the development and application of a bioactive patch implant for regeneration of myocardial infarction. Electrical Impedance Spectroscopy (EIS) has been chosen as a tissue state monitoring technique. What is presented in this communication is the first results of an implantable EIS measurement system which has been implanted in a subset of the animals corresponding to the control group, along one month. In all the animals, the myocardial infarction was induced by the ligation of the first circumflex marginal artery. In the animal group presented, the bioactive patch scaffold and the electrodes were implanted without the stem cells load. The scaffold is a piece of decellularized human pericardium, lyophilized and rehydrated with hydrogel RAD16-I. Nanogold particles were also placed near the electrodes to improve the electrode area conductivity. The results presented correspond to the subset of animals (n = 5), which had implanted the bioimpedance system monitoring the electrical impedance spectrum in vivo during 1 month. Two electrodes were connected to the bioactive patch implant. A total of 14 logarithmically spaced frequencies were measured every 5 minutes, from 100 Hz to 200 kHz. Results show a convergence of low-frequency and high frequency impedance magnitudes along the measurement period, which is coherent with the scar formation.

Hábitos de alimentación y actividad física en estudiantes universitarios / Eating habits and physical activity in university students

During university life s tudents should consolidate healthy habits, presumably acquired during formal education, which should eventually be reflected in the professional adult life. This study aims to determine the influence of the universities on eating habits and physical activity of students. Food habits and physical activity were evaluated in a convenience sample of 169 students of the Pontificia Universidad Católica de Valparaíso attending different courses. The students in this study had been attending the fundamental studies "Autocuidado y Vida Saludable" (Self-care and Healthy Life) given in 2010. Two surveys were taken: Quality of the Food Service (CASEDA) and Quality of the Service of University Sports (CASEDU). They also completed basic anthropometric measurements, blood pressure tests, resting heart rate and blood glucose and triglycerides. The results showed that students have a poor perception of the quality offood service and although they indicated that there is a wide range of healthy and unhealthy foods; they tend to choose foods rich in carbohydrates andfats. This situation adds to their lack of physical activity data. It also shows that in women predominated high levels of triglyceride levels (161mg/dl) and in the male group predominated high blood pressure (132 mmHg). These facts underscore the need to take action at the university to enable students to acquire proper eating habits and provide a range ofphysical activities which will allow students to better use of their free time at college.

Durante la vida universitaria debieran consolidarse los hábitos saludables, supuestamente adquiridos durante la enseñanza escolar, los que finalmente deberían verse reflejados en el profesional adulto. En este estudio se pretende determinar la influencia de los centros universitarios, en los hábitos de alimentación y actividad física de los estudiantes. Se valúan los hábitos alimentarios y de actividad física de una muestra intencionada de 169 estudiantes de diferentes carreras de la Pontificia Universidad Católica de Valparaíso, que asisten a la asignatura de estudios fundamentales "Autocuidado y vida saludable", dictada durante el año 2010. Se aplicaron dos encuestas: Calidad del Servicio de Alimentación (CASEDA) y Calidad de Servicio de Deporte Universitario (CASEDU). Además se realizaron antropométrica básica, determinación de la presión arterial, frecuencia cardíaca de reposo y pruebas sanguíneas para la determinación de glicemia y trigliceridemia. Los resultados arrojaron que los estudiantes tienen una mala percepción de la calidad del servicio de alimentación y aunque señalan que existe una amplia oferta de alimentos saludables y no saludables, tienden a elegir alimentos ricos en carbohidratos y lípidos. Esta situación se suma a su escaza práctica de actividad física. Se aprecia además que en el grupo femenino predominan niveles de triglicéridos elevados (161,7 mg/dL) y en el grupo masculino, hipertensión arterial elevada (132,1 mmHg). Estos antecedentes ponen de manifiesto la necesidad tomar acciones a nivel universitario que permitan a los alumnos adquirir hábitos alimentarios adecuados y entregar una oferta de actividades físicas que permitan a los estudiantes ocupar sus tiempos libres dentro de la universidad.

[Mandibular distraction osteogenesis in patients with craniofacial malformation]. / Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales.

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy may be necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, minimum.

Discrimination of organic solid materials by LIBS using methods of correlation and normalized coordinates.

The methods of linear and rank correlation and normalized coordinates (MNC) have been applied to the identification of organic solid materials with a very similar chemical composition by laser-induced breakdown spectroscopy (LIBS). The present study evaluated these three statistical methods using an Echelle spectrometer coupled with an intensified charge-coupled device (ICCD). Moreover, three instrumental parameters (laser pulse energy, delay time and integration time) were evaluated in terms of their influence on the signal-to-noise ratio of carbon and hydrogen emission lines. The probability of a right identification can be estimated by means the described methods in this paper. Methods of correlation provide better identification and discrimination than normalized coordinates at a 95% confidence level.

Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales / Mandibular distraction osteogenesis in patients with craniofacial malformation

Las malformaciones craneofaciales (secuencia de Pierre Robin, síndrome de Threacher Collins, síndrome de Nager, etc.) con frecuencia van asociadas a hipoplasia mandibular severa, que puede causar obstrucción de la vía aérea superior por retroposición de la base de la lengua dentro del espacio faríngeo posterior. La mayoría de los pacientes responden al tratamiento postural; ende cúbito prono puede ser necesario monitorizar la saturación de oxígeno ,insertar un tubo nasofaríngeo e incluso endotraqueal. En casos más severos con pausas prolongadas y frecuentes de apnea la traqueostomía puede ser necesaria, pero se asocia a una alta morbilidad y ocasional mente mortalidad. En los últimos dos años, en la Unidad Multidisciplinar de Labio y Fisura Palatina del Hospital Virgen de las Nieves, se ha tratado a 4 niños con apnea obstructiva grave secundaria a hipoplasia mandibular severa mediante distracción mandibular osteogénica, mostrándose este procedimiento eficaz en la resolución del problema. Ha evitado la traqueostomía, se ha elongado la mandíbula en el plazo de 2-3 semanas, en este tiempo han desaparecido los problemas respiratorios obstructivos y también de la deglución, siendo los resultados estéticos obtenidos excelentes y las complicaciones, por el momento, mínimas (AU)

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy maybe necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, mínimum (AU)

Generación de un sustituto de mucosa oral humana y comprobación de su viabilidad mediante ingeniería tisular / Generation of a substitute for human oral mucosa and verification of its viability by tissue-engineering

La reconstrucción de grandes defectos de mucosa oral a menudo es desafiante, por la escasez de mucosa oral sana para reemplazar tejidos dañados. De esta forma, las técnicas de ingeniería tisular pueden suponer una fuente de tejidos autólogos disponible para trasplantar a estos pacientes. En este trabajo hemos desarrollado un nuevo modelo de mucosa oral artificial generada mediante ingeniería tisular usando un soporte de fibrina-agarosa. Para ello, se han generado cultivos primarios de fibroblastos de la mucosa oral humana y queratinocitos a partir de pequeñas biopsias de mucosa oral normal y aplicándoles tratamiento senzimáticos. Después, se ha determinado la viabilidad de las células cultivadas mediante microanálisis por rayos-X, demostrando que la mayoría de las células de los cultivos primarios estaban vivas y tenían elevados K/Na ratios. Una vez que la viabilidad celular fue determinada, se usaron los fibroblastos y queratinocitos cultivados para desarrollar un constructo de mucosa oral sobre una matriz extracelular de (..) (AU)

Reconstruction of large oral mucosa defects is often challenging, since the shortage of healthy oral mucosa to replace the excised tissues. This way, tissue ingineering techniques may provide a source of autologoustissues available for transplant in these patients. In this work, wehave developed a new model for artificial oral mucosa generated by tissue engineering using a fibrin-agarosa scaffold. For that purpose, we have generated primary cultures of human oral mucosa fibroblasts and keratinocytes from small biopsies of normal mucosa oral using enzymatic treatments. Then, we have determined the viability of cultured cells by electron probe quantitative X-ray microanalysis, and we have demonstrated that most of the cells in the primary cultures were alive and hd high K/Na ratios. Once cell viability was determined, we used cultured fibroblasts and keratinocytes to develop an artificial oral mucosaconstruct by using a fibrin-agarosa extracellular matrix and a sequential culture technique using porous culture inserts. Histological analysis of the artificial tissues showed high similarities with normal oral (..) (AU)