The impact of the first millennial teachers on education: views held by different generations of teachers.

The first people considered digital natives, the millennials, have already entered the teaching profession. As a result, we are faced with a remarkable generational diversity. This survey aimed to explore the generational change in teachers and the beginning of the incorporation of the first millennials (digital natives) into teaching. It was carried out through a qualitative study using focus groups and interviews with a total of 147 teachers. The main results found establish a generational clash between migrants and digital natives. This difference is present in the use and understanding of ICTs in the teaching task across the different teaching generations and in a generational diversity within the educational centres that has not been seen so far. However, this difference between teachers is also a condition that facilitates exchange between teachers of different generations. Junior teachers help veteran teachers in the use of ICTs and veteran teachers provide the expertise that new recruits lack.

Expectations of Personal Life Development and Decision-Making in People with Moderate Intellectual Disabilities.

People with intellectual disabilities have a need for personal and social development that is often unknown or poorly understood. The main motivation is the fact that students belong to a group usually excluded from the ordinary educational process. That process is replaced with measures that focus on caring for students rather than promoting their development. The objective of this research is to understand the expectations for personal development and decision-making of students with intellectual disabilities. To achieve the stated objective, a qualitative research based on two complementary approaches, grounded theory and case study, has been employed. The sample (n = 28) was drawn from a specific study program for the training and development of people with intellectual disabilities at the University of Murcia, called "We are all Campus". We aim to identify the different perceptions of their reality and potential for personal development, to understand their decision-making and what motivates them. Likewise, we investigate the self-perceptions of students with intellectual disabilities have and their understanding of their future life expectations. The main conclusions show that the training program represents an opportunity for students' progression and personal development. Thus far, the expectations of the students have remained the same, focusing on their work and social inclusion.

Teachers' Perceptions of Changes in Their Professional Development as a Result of ICT.

The introduction of digital information and communication technologies has influenced many aspects of the teaching profession. In addition to their changing use in the classroom, these technologies have strongly impacted the work and professional development of teachers. In this study, which was framed within the R+D+i project DePrInEd, we analyzed the perceptions, beliefs, opinions, and attitudes of teachers on this subject. We conducted a qualitative study through interviews, with a thematic analysis addressing the duality of technology and change. The results indicated that these produced benefits and created difficulties in the teaching task, with the latter being more demanding. Teachers stated that one of the main difficulties they encountered was related to the evolution of students as a result of technology, both in the school and social contexts. This highlights the risk that its extensive use did not lead to the acquisition of other key competencies, including digital and media competencies, in the school environment. Finally, other dimensions that impacted the corporate intelligence of educational centers included the continuous adaptation and mastery of digital competence required by teachers regarding the changes in their tasks, as well as the excessive bureaucratization that technologies have necessitated.

Efficacy increase of lipid nanoparticles in vivo by inclusion of bis(monoacylglycerol)phosphate.

Aim: To investigate the effect of incorporating bis(monoacylglycerol)phosphate (BMP) lipid into a lipid nanoparticle and the functional transport of mRNA by the formulated nanoparticles in vivo. Materials & methods: The nanoparticles were prepared from ionizable lipid, 1,2-distearoyl-sn-glycerol-3-phosphocholine, cholesterol, 1,2-dimyristoyl-sn-glycerol PEG 2000, BMP and formulated mRNA encoding human erythropoietin. We measured the effect of BMP on physicochemical properties and impact on functional efficacy to transport mRNA to its target cells/tissue as measured by protein expression both in vitro and in vivo. Results: Lipid nanoparticles composed of BMP displayed increased endosomal membrane fusion and improved mRNA delivery to the cytosol. Conclusion: The results establish the foundation for future development of these nanoparticulated entities by designing new BMP derivatives and correlating structures to enhanced pharmacokinetic profiles.

Evaluation of Self-Concept in the Project for People with Intellectual Disabilities: "We Are All Campus".

The inclusion of people with disabilities, intellectual in the case that concerns this research, has been one of the main concerns of society in recent years. The University of Murcia has launched the "We are all Campus" program in order to facilitate the inclusion of this group from a training perspective. Being aware of the influence of self-concept in such inclusion, this research aims to analyze the influence of the self-concept of people with intellectual disabilities in their expectations of inclusion. For this purpose, 18 subjects were asked to carry out a SWOT analysis, assessing the situation in which they find themselves through a qualitative perspective and a phenomenological design. The research reveals, among other conclusions, how important personal development is to them, especially by generating autonomy in their daily routines, and also the relevance of their relationships to feel socially included.

El confinamiento por COVID-19 podría aumentar el riesgo de síndrome de fragilidad en adultos mayores / Confinement for COVID-19 could increase the risk of frailty in elderly

Señor editor: No es de nuevo conocimiento la situación sanitaria global actual por la pandemia de COVID-19 y el cómo esta, vino a cambiar el modo de vida de toda la población, aún a estas fechas. Como Ballena bien lo resalta en el artículo "Impacto del confinamiento por COVID-19 en la calidad de vida y salud mental", publicado en su revista, el confinamiento fue y es en algunas regiones obligatorio en los adultos mayores por ser el grupo más vulnerable ante esta enfermedad. En el contexto de la pandemia, el que los familiares o cuidadores tuvieran que alejarse de los adultos mayores aumenta el riesgo de accidentes dentro de casa como caídas, así mismo predispone a un sentimiento de soledad que puede conllevar a la aparición de síndromes geriátricos, entre ellos síndrome de fragilidad.

Mr. Editor: The current global health situation due to the COVID-19 pandemic and how it has changed the way of life of the entire population, even now, is not new knowledge. As Ballena rightly highlights in the article "Impact of COVID-19 confinement on quality of life and mental health", published in your magazine, confinement was and is in some regions mandatory in the elderly for being the most vulnerable group to this disease. In the context of the pandemic, the fact that family members or caregivers had to stay away from the elderly increases the risk of accidents at home, such as falls, and also predisposes to a feeling of loneliness that can lead to the appearance of geriatric syndromes, including frailty syndrome.

Efficacy and Safety of Sodium Hyaluronate/chondroitin Sulfate Preservative-free Ophthalmic Solution in the Treatment of Dry Eye: A Clinical Trial.

Purpose: To evaluate the efficacy of a preservative free sodium hyaluronate/chondroitin sulfate ophthalmic solution (SH/CS-PF) in patients with dry eye disease (DED).Methods: This was a randomized phase IV, multicentric, prospective, double-blind clinical trial. Intent-to-treat (ITT) and per-protocol (PP) analyses were performed. Patients were assigned to receive either SH/CS-PF, Systane® Ultra (PEG/PG) or Systane® Ultra PF (PEG/PG-PF) for 90 days. A total of 326 patients were included in the ITT, and 217 in the PP analysis. Efficacy endpoints were goblet cell density, Nelson's grades (conjunctival impression cytology), tear break-up time (TBUT), Ocular Surface Disease Index (OSDI), and Schirmer's test. Other parameters included were tolerability, measured by the ocular symptomatology; and safety, measured through corneal staining, intraocular pressure, visual acuity and adverse events.Results: In the ITT, there was a significant increase in mean goblet cell density in all treatments compared with their baseline (28.4% vs 21.4% and 30.8%), without difference between arms (p = .159). Eyes exposed to SH/CS-PF, PEG/PG and PEG/PG-PF showed Grade 0-I squamous metaplasia (85.5%, 87.9% and 93.2%, respectively). Similar improvements were observed for TBUT (1.24 ± 2.3s vs 1.27 ± 2.4s and 1.39 ± 2.3s) and OSDI scores at day 90 (-8.81 ± 8.6 vs -7.95 ± 9.2 and -8.78 ± 9.8), although no significant intergroup difference was found. Schirmer's test also presented improvement compared to baseline (1.38 ± 4.9 vs 1.50 ± 4.7 and 2.63 ± 5.9), with a significantly higher variation for PEG/PG-PF. There were no significant differences between treatments for any tolerability and safety parameter, nor between ITT and PP analyses for any outcome.Conclusions: The topical application of SH/CS-PF is as effective, safe and well tolerated as that of PEG/PG or PEG/PG-PF. The results suggest that SH/CS-PF may lead to normalization of clinical parameters and symptom alleviation in patients treated for DED.

La Voz del Silencio: Evaluación Cualitativa de Prácticas de Bullying en Personas con Discapacidad Intelectual / The Voice of Silence: Qualitative Evaluation of Bullying Practices in People with Intellectual Disability

RESUMEN: En los múltiples movimientos académicos acaecidos en pos de la inclusión del alumnado, las instituciones universitarias están abriendo sus títulos a colectivos tradicionalmente olvidados en el ámbito de la educación superior, como las personas con discapacidad intelectual. El acoso escolar es una realidad que puede afectar a todo el alumnado, siendo más complejo conforme avanza la edad de los estudiantes. El objetivo de este trabajo radica en recabar información acerca de la percepción de las personas con discapacidad intelectual sobre el bullying y reconocer las diferentes manifestaciones de acoso a personas con discapacidad intelectual. A través de una investigación biográfico-narrativa y bajo un diseño evaluativo de carácter mixto, se ha contado con la participación de 17 estudiantes que cursan el Título Universitario de Estudios Propios Todos Somos Campus para fomentar la inserción socio-laboral del colectivo de jóvenes con discapacidad intelectual. A través de un análisis cualitativo de los datos, los resultados muestran que existe una situación de acoso, tanto físico como psicológico, basada en críticas y percepciones negativas acerca de la discapacidad, lo cual les hace más sensibles a la condición de diferentes. Igualmente, se refuerza la imagen de autoridad como eje de las acciones contra el bullying, destacando el papel de la mediación en la exposición de soluciones. Se concluye que las relaciones establecidas entre las manifestaciones del acoso en el ámbito académico y sus posibles soluciones no se presentan de forma aislada, sino que se muestran como una red que facilita respuesta a dicha problemática.

ABSTRACT: In the multiple academic movements for the inclusion of students, university institutions are opening their undergraduate degrees to groups traditionally forgotten in the field of Higher Education, such as people with intellectual disabilities. Bullying is a reality that can affect all students, being more complex as the age of the students advances. The objective of this work is to gather information about the perception of people with intellectual disabilities about bullying and, thus, recognize the different manifestations of harassment to people with intellectual disabilities. Through a biographical-narrative research and a mixed evaluative design, we counted on the participation of 17 students who are attending the Título Universitario de Estudios Propios Todos Somos Campus - University Degree of Own Studies We are all Campus - to promote the social and labor insertion of the collective of young people with intellectual disabilities. Through a qualitative data analysis, the results showed that there is a situation of harassment, both physical and psychological, based on criticism and negative perceptions about the disability, which make it more sensitive to the status of different. In the same way, it reinforces the image of authority as an anti-bullying action, highlighting the role of mediation in the exposition of solutions. It is concluded that the relations established between the manifestations of bullying in the academic sphere and their possible solutions are not presented in isolation, but they are shown as a network that facilitates the answer to this problem.

Difluprednate 0.05% versus Prednisolone Acetate Post-Phacoemulsification for Inflammation and Pain: An Efficacy and Safety Clinical Trial.

BACKGROUND: The purpose of this study was to compare the efficacy and safety of difluprednate 0.05% (PRO-145) versus prednisolone acetate 1% (Prednefrin® SF), for management of postoperative inflammation and pain, after cataract surgery. METHODS: This was a Phase III, multicenter, prospective, double-blind, clinical trial. Intent-to-treat population included 178 post-phacoemulsification patients that were assigned to receive either PRO-145, or prednisolone. One day after unilateral eye surgery, patients instilled a drop 4 times a day for 14 days (then tapering the dose downward for 14 days). The primary efficacy endpoints were anterior chamber (AC) cell grade and flare. Other parameters measured included: retinal central thickness (measured via OCT), conjunctival hyperemia, edema, pain and photophobia. Tolerability and safety were assessed through burning, itching, foreign body sensation, visual acuity (VA), intraocular pressure (IOP) and incidence of adverse events (AE). RESULTS: A total of 171 subjects were randomized (1:1) and completed the study. Compared to day 1, there was a significant improvement in the AC cell count and flare in both groups by the final visit (80.2% vs 88.4%, p=1.000). Conjunctival hyperemia improved in a similar fashion (81.2% vs 79%, p=0.234) in both PRO-145 and prednisolone groups, without differences between them. This was also observed for edema (82.4% vs 82.5%, p=0.246), pain (15.3% vs 7%, p=0.497) and photophobia (16.4% vs 15.1%, p=0.246), respectively. There was no significant difference between treatments for any tolerability parameter studied. Finally, at the 4-week postoperative visit, there were no significant differences between treatments for VA, IOP and AE results (p-values; 0.095, 0.053 and 0.099, respectively). CONCLUSION: The results of this study suggest that PRO-145 is as effective and safe as prednisolone acetate in treating postoperative inflammation and pain in patients undergoing phacoemulsification. The study was registered at ClinicalTrials.gov as NCT03693989.

Serum dilutions as a predictive biomarker for peri-operative desensitization: An exploratory approach to transplanting sensitized heart candidates.

Antibody-mediated rejection (AMR) of cardiac allografts mediated by anti-HLA Donor Specific Antibodies (DSA) is one of the major barriers to successful transplantation for the treatment of end-stage heart failure. Therapeutic plasma exchange (TPE) is a first-line treatment for pre-transplant desensitization. However, indications for treatment regimens and treatment end-points have not been well established. In this study, we investigated how sera dilutions could guide TPE regimens for effective peri-operative desensitization and early AMR treatment. Our data show that 1:16 dilutions of EDTA-treated sera and 1.5 volume TPE reduce anti-HLA class I and class II antibody levels in the same manner and, therefore, allows to predict which antibodies would respond to peri-operative TPE. We successfully applied this approach to transplanting three highly sensitized cardiac recipients (CPRA 85-93%) with peri-operative desensitization based on a virtual crossmatch performed on 1:16 diluted serum. Furthermore, we have used sera dilutions to guide DSA treatment post-transplant. Although these findings have to be confirmed in a larger prospective study, our data suggest that serum dilutions can serve as a predictive biomarker to guide peri-operative desensitization and post-transplant immunologic management.

Efficacy and safety of bromfenac 0.09% and sodium hyaluronate 0.4% combination therapy, versus placebo in patients with pterygium I-III for clinical signs on ocular inflammation.

Purpose: This study evaluated the clinical efficacy and safety of bromfenac 0.09%, sodium hyaluronate 0.4% (SH) combination therapy, versus placebo and SH in a clinical model of pterygium I-III. Methods: A total of 166 eyes (99 patients) with pterygium grade I-III were randomized to bromfenac 0.09% ophthalmic solution+SH 0.4% or placebo+SH 0.4%. This was a Phase IV, prospective, parallel, double-masked, multicenter clinical trial. One drop of bromfenac or placebo was instilled two times a day (BID) for 20 days, both groups accompanied treatments with one drop of SH three times a day (TID). The primary efficacy endpoints were the conjunctival hyperemia and the Ocular Surface Disease Index (OSDI) score. Other results measured included burning, foreign body sensation, and photophobia. The safety was assessed by the tear break-up time (TBUT), visual acuity (VA), IOP, lissamine green, fluorescein stains, and the incidence of adverse events (AEs). Results: Compared with baseline, there was a significant reduction in the conjunctival hyperemia (p=0.0001) and OSDI score in both groups (p=0.0001). There was a significant improvement in ocular symptomatology for both, placebo/SH and bromfenac/SH groups (p=0.0001), the decrement in the ocular burning was 41.1% vs 24.6%, the foreign body sensation was 31.5% vs 36.2% and, for photophobia was 23.3% vs 30.5%, respectively. A statistically significant difference was observed in TBUT for bromfenac/SH (p=0.045), at day 20. There were no significant alterations in IOP (p=0.068) or VA (p=0.632). Similar improvements were observed in the fluorescein and green lissamine staining. Finally, the incidence of AE was similar between groups. Conclusion: The treatment with bromfenac 0.09% ophthalmic solution and SH 0.4% combination therapy for 3 weeks reduced clinical signs, in patients with pterygium I-III. The results suggest that bromfenac 0.09% can improve the symptomatology, reduce the presentation of clinical signs associated with superficial ocular inflammation.

Juan, uma Criança com Síndrome de Asperger: Estudo de Caso de uma Boa Prática de Inclusão Educacional por meio da Aprendizagem Cooperativa / Juan, a Child with Asperger's Syndrome: a Case Study of a Good Practice of Educational Inclusion Through Cooperative Learning

RESUMO: A atenção à diversidade para tornar a educação inclusiva eficaz é o marco teórico conceitual no qual se apresenta este trabalho sobre um aluno com Síndrome de Asperger (SA), que se chama Juan. O objetivo deste artigo é identificar, descrever, analisar, interpretar, compreender e tornar visível uma boa prática de inclusão educacional com uma criança com Síndrome de Asperger baseada na aprendizagem cooperativa. Assim, por meio de uma metodologia qualitativa com um estudo de caso único, analisa-se uma experiência de inclusão educacional relatada pelas próprias crianças, e isso representa uma experiência de aprendizagem cooperativa. Atender às necessidades específicas de apoio educacional (NEAE) de Juan para facilitar sua inclusão é a espinha dorsal deste trabalho.

ABSTRACT: Attention to diversity to make inclusive education effective is the conceptual framework in which we present this case study on a student with Asperger's Syndrome (AS), whose name is Juan. The purpose of this paper is to identify, describe, analyze, interpret, understand and make visible a good practice of educational inclusion with a child with Asperger's Syndrome based on cooperative learning. Thus, through a qualitative methodology with a single case study, we analyze an educational inclusion experience reported by children themselves, and this represents a cooperative learning experience. Meeting Juan's specific educational support needs (NEAE) to facilitate his inclusion is the backbone of this work.

[Clinical and radiological results of non-fusion by static interspinous spacer]. / Resultados clínicos y radiológicos de la no fusión por espaciador interespinoso estático.

BACKGROUND: The aim of this paper is to demonstrate the clinical and radiological results of non-fusion in patients with degenerative disc disease and lumbar by placing static interspinous spacer. METHODS: A retrospective study was made in the period between January 2010 and January 2013, 130 patients were treated by placing static interspinous spacer. Patients were divided into: Group 1 (treated for diagnosis of degenerative lumbar spinal stenosis), and group 2 (those diagnosed with lumbar disc herniation). It is improving pain by visual analog scale (VAS), functional improvement based on the Oswestry scale (ODI) and radiological outcome at 6,12 and 24 months was evaluated. RESULTS: 57 female patients and 73 male were included. The most affected segments were L4 - L5 and L5 - S1. In Group 1, there was improvement in pain (VAS) at 6 months to 2 points which was maintained through 12 months and 24 months was found in 4 points. Functional improvement (ODI) at 6 and 12 months remained 13 points and 24 points and 21 months in group 2: VAS 2.7, 3, 3.5 and ODI 15 respectively at 6 and 12 months; at 24 months was found in 20 points. There were no fatal complications in 1.5% in both groups. Regarding radiological changes increased the diameter foraminal which was held at the 6, 12 and 24 month follow-up. CONCLUSIONS: The interspinous device is an effective alternative treatment for lumbar degenerative disc disease and because it was associated with significantly improved lumbar pain and return to work activity.

Introducción: el objetivo de este trabajo es demostrar los resultados clínicos y radiológicos de la no fusión en los pacientes con enfermedad degenerativa lumbar y discal mediante la colocación de espaciador interespinoso estático. Métodos: estudio retrospectivo, de enero de 2010 a enero de 2013, con 130 pacientes tratados mediante colocación de espaciador interespinoso estático. Los pacientes se dividieron en: grupo 1 (tratados por diagnóstico de canal lumbar estrecho degenerativo) y grupo 2 (pacientes con diagnóstico de hernia discal lumbar). Se evaluó la mejoría de dolor mediante escala visual análoga (VAS), mejoría funcional con base en la escala de Oswestry (ODI) y resultado radiológico a los 6, 12 y 24 meses. Resultados: se incluyeron 57 pacientes del sexo femenino y 73 masculinos. Los segmentos más afectados fueron L4 - L5 y L5 - S1. En el grupo 1 hubo mejoría del dolor a los 6 meses a 2 puntos, la cual se mantuvo hasta los 12 meses; mientras que a los 24 meses se encontró en 4 puntos. La mejoría funcional (ODI) a los 6 y 12 meses se mantuvo el 13 puntos y a los 24 meses en 21 puntos. Mientras que en el grupo 2: VAS de 2.7, 3, 3.5 respectivamente y ODI de 15 a los 6 y 12 meses; a los 24 meses se encontró en 20 puntos. Hubo complicaciones no mortales en 1.5% en ambos grupos. En cuanto a los cambios radiológicos, se demostró un aumento en el diámetro foraminal el cual se mantuvo a los 6, 12 y 24 meses de seguimiento. Conclusiones: el dispositivo interespinoso es una alternativa de tratamiento eficaz para la enfermedad degenerativa lumbar y la enfermedad discal, ya que se asoció con mejora significativa de dolor lumbar y reincorporación a actividad laboral.

The impact of lungs from diabetic donors on lung transplant recipients†.

OBJECTIVES: We attempted to determine if transplants of lungs from diabetic donors (DDs) is associated with increased mortality of recipients in the modern era of the lung allocation score (LAS). METHODS: The United Network for Organ Sharing (UNOS) database was queried for all adult lung transplant recipients from 2006 to 2014. Patients receiving a lung from a DD were compared to those receiving a transplant from a non-DD. Multivariate Cox regression analysis using variables associated with mortality was used to examine survival. RESULTS: A total of 13 159 adult lung transplants were performed between January 2006 and June 2014: 4278 (32.5%) were single-lung transplants (SLT) and 8881 (67.5%) were double-lung transplants (DLT). The log-rank test demonstrated a lower median survival in the DD group (5.6 vs 5.0 years, P = 0.003). We performed additional analysis by dividing this initial cohort into two cohorts by transplant type. On multivariate analysis, receiving an SLT from a DD was associated with increased mortality (HR 1.28, 95% CI 1.07­1.54, P = 0.011). Interestingly, multivariate analysis demonstrated no difference in mortality rates for patients receiving a DLT from a DD (HR 1.12, 95% CI 0.97­1.30, P = 0.14). CONCLUSIONS: DLT with DDs can be performed safely without increased mortality, but SLT using DDs results in worse survival and post-transplant outcomes. Preference should be given to DLT when using lungs from donors with diabetes.

Results of treatment of cervical discopathy with peek interbody cages at three levels without plate fixation / Resultados do tratamento de discopatia cervical com cages intersomáticos em peek em três níveis sem fixação com placa / Resultado del tratamiento de discopatía cervical con cajas intersomáticas en peek en tres niveles sin fijación con placa

ABSTRACT Objective: To present the results of treatment of patients with cervical discopathy by anterior cervical approach, discectomy and placement of a PEEK interbody cage without anterior plate fixation. Methods: Retrospective, cross-sectional study from March 2013 to March 2015. Sixteen patients with radiculopathy or clinical signs of myelopathy were included; all patients underwent cervical surgery through anterior approach, discectomy, and placement of PEEK cages on three levels. Decompression levels were determined according to the correlation between preoperative radiological and clinical findings. Results: Sixteen patients predominantly male were included, with mean age of 50 years at the onset of the condition. Ten patients had involvement of C4-C5, C5-C6, C6-C7 levels, and six patients C3-C4, C4-C5 and C5-C6. Fourteen patients had cervicobrachialgia and two myelopathy. The preoperative visual analog scale average was 8/10 and the average postoperative value at 6 months was 3/10. At 6 months, there was no radiological evidence of recurrence. One patient had non-fatal complications. Conclusions: The treatment of cervical discopathy by anterior approach with interbody fusion with PEEK cage on three levels, with no plate fixation seemed to be safe and effective with better long-term results in terms of pain and myelopathy. The clinical results compare favorably with other similar series and, most importantly, the complications associated with anterior fixation plate are avoided.

RESUMO Objetivo: Apresentar os resultados do tratamento de pacientes com discopatia cervical usando acesso cervical anterior, discotomia e colocação de cage intersomático em PEEK sem fixação com placa anterior. Métodos: Estudo retrospectivo, transversal no período de março de 2013 a março de 2015. Foram incluídos 16 pacientes que apresentavam radiculopatia ou sinais clínicos de mielopatia; os pacientes foram submetidos à cirurgia cervical por acesso anterior, discotomia e colocação de cages em PEEK em três níveis. Os níveis de descompressão foram determinados de acordo com a correlação entre os achados radiológicos e clínicos pré-operatórios. Resultados: Foram incluídos 16 pacientes predominantemente do sexo masculino, com média de idade de 50 anos à apresentação da afecção, sendo 10 com envolvimento dos níveis C4-C5, C5-C6 e C6-C7 e 6 pacientes com envolvimento dos níveis C3-C4, C5-C4 e C5-C6. Catorze pacientes tinham cervicobraquialgia e 2 mielopatia. A escala visual analógica pré-operatória média foi 8/10 e o valor médio pós-operatório aos 6 meses foi 3/10. Aos 6 meses, não se encontrou evidência radiológica de recidiva. Um paciente teve complicações não fatais. Conclusões: O tratamento de discopatia cervical por acesso anterior por fusão intersomática com cage em PEEK em três níveis, sem fixação com placa parece ser seguro e eficaz, com melhores resultados a longo prazo em termos de dor e mielopatia. Os resultados clínicos são favoráveis quando comparados com outras séries semelhantes e, o mais importante, o procedimento evitou as complicações associadas à fixação anterior com placa.

RESUMEN Objetivo: Dar a conocer los resultados del manejo del paciente con discopatía cervical utilizando abordaje cervical anterior, discectomía y colocación de caja intersomática en PEEK sin fijación con placa anterior. Método: Se realizó un estudio retrospectivo, transversal, durante el periodo de marzo de 2013 a marzo de 2015. Se incluyeron 16 pacientes que se presentaron con radiculopatía o signos clínicos de mielopatía; fueron sometidos a cirugía cervical por abordaje anterior, discectomía y colocación de cajas en PEEK en tres niveles. Los niveles de descompresión se determinaron de acuerdo a la correlación entre los hallazgos radiológicos y clínicos preoperatorios. Resultados: Dieciséis pacientes con predominio del sexo masculino, con edad media de 50 años al inicio de la enfermedad, con 10 pacientes con afección en los niveles C4-C5, C5-C6, C6-C7 y 6 en los niveles C3-C4, C4-C5 y C5-C6. Catorce tenían cervicobraquialgia y 2 mielopatía. El promedio de la escala visual análoga prequirúrgica fue 8/10 y el valor postoperatorio promedio a los 6 meses fue 3/10. A los 6 meses, no hubo evidencia radiológica de reincidencia. Un paciente tuvo complicaciones no fatales. Conclusiones: El manejo de discopatía cervical con acceso anterior mediante fusión intersomática con caja en PEEK en tres niveles sin fijación con placa parece ser segura y eficaz con una mejoría en los resultados a largo plazo tanto del dolor y la mielopatía. Los resultados clínicos se comparan favorablemente con otras series similares y, lo más importante, esta técnica evitó las complicaciones asociadas con la fijación anterior con placa.

Global balance in adult spinal deformities. A study of 60 cases / Alinhamento global em deformidades da coluna vertebral do adulto. Um estudo de 60 casos / Balance global en las deformidades espinales del adulto. Un estudio de 60 casos

ABSTRACT Objectives: Determine the most prevalent type of curve in our population, to quantify the radiographic parameters such as PT, IP, SS and compare the physical function according to ODI and SRS-22r. Methods: Retrospective, observational, longitudinal, single-center study, carried out from January 2010 to May 2015 at the Centro Médico ISSEMYM Ecatepec, Spine Surgery Service. Results: A total of 60 patients were obtained, 60% female, with curvatures according to SRS-Schwab, type T (28%), TL (46.6%), D (15%), N (10%), with a mean preoperative VAS of 7 for all curves and post-surgical 2 after 6 months. The SRS-22r preoperative test was 2.1 and postoperatively was 3.75, with p<0.001. Conclusions: Deformities of the adult spine are a growing disease in our country. The surgical management of deformities requires proper clinical and radiographic planning. Patients undergoing surgical treatment in our study showed curvature type TL and demonstrated significant improvement in ODI and SRS-22r.

RESUMO Objetivos: Determinar o tipo de curva mais prevalente em nossa população, quantificar os parâmetros radiográficos, tais como PT, PI, SS e comparar a função física de acordo com ODI e SRS-22r. Métodos: Estudo retrospectivo, observacional, longitudinal, em centro único, realizado no período de janeiro de 2010 a maio de 2015 no Centro Médico ISSEMYM Ecatepec, Serviço de Cirurgia da Coluna. Resultados: Reuniu-se um total de 60 pacientes, 60% do sexo feminino, com curvaturas, de acordo com o SRS-Schwab, tipo T (28%), TL (46,6%), D (15%), N (10%), com EVA média pré-operatória de 7 para todas as curvas e pós-cirúrgica de 2 depois de 6 meses. O teste SRS-22r pré-operatório foi de 2,1 e o pós-operatório foi de 3,75, com p < 0,001. Conclusões: As deformidades da coluna vertebral do adulto são uma doença crescente em nosso país. O tratamento cirúrgico das deformidades requer planejamento clínico-radiográfico adequado. Os pacientes submetidos ao tratamento cirúrgico em nosso estudo mostraram curvatura tipo TL e apresentaram melhora significativa de ODI e SRS-22r.

RESUMEN Objetivos: Determinar el tipo de curva más frecuente en nuestra población, cuantificar los parámetros radiográficos como PT, PI, SS y comparar la función física de acuerdo al test de ODI y SRS-22r. Métodos: Estudio retrospectivo, observacional, longitudinal y unicéntrico, realizado en el periodo entre Enero de 2010 y Mayo de 2015 en el Centro Médico ISSEMYM Ecatepec, Servicio de Cirugía de Columna. Resultados: Se obtuvieron un total de 60 pacientes, 60% mujeres, con curvaturas, de acuerdo a la clasificación SRS-Schwab, tipo T (28%), tipo TL (46,6%), tipo D (15%), tipo N (10%), con una EVA prequirúrgica promedio de 7 para todo tipo de curvas y posquirúrgica de 2 a los 6 meses. El test de SRS-22r prequirúrgico fue de 2,1 y el posquirúrgico de 3,75 con p < 0,001. Conclusiones: Las deformidades espinales del adulto son una patología creciente en nuestro país. El manejo quirúrgico de las deformidades requiere una adecuada planeación clínico-radiográfica. Los pacientes sometidos a tratamiento quirúrgico en nuestro estudio mostraron una curvatura tipo TL y presentaron mejoría significativa del ODI y del SRS-22r.

Necrotizing sialometaplasia of the lacrimal sac mimicking squamous cell carcinoma: Necrotizing dacyocystometaplasia.

INTRODUCTION: Necrotizing sialometaplasia is thought to represent an inflammatory reaction directed against an ischemic insult or local trauma within a glandular tissue and is most commonly observed in the minor salivary glands of the oral mucosa. The importance of this condition arises from the fact that its clinical and histological aspects may raise issues of differential diagnosis with malignant neoplasms. The authors present a case of necrotizing sialometaplasia involving the lacrimal sac simulating a well-differentiated squamous cell carcinoma. CASE: A 52-year-old man presented with epiphora in the left eye after having sustained an orbital blowout fracture during a motor vehicle accident. During subsequent external dacryocystorhinostomy, an abnormal lacrimal sac mucosa was observed and analyzed histologically revealing a well-differentiated squamous cell carcinoma. However, the subsequent biopsies of the lacrimal sac were negative for malignancy; in view of these findings, two pathologists reviewed the first specimen and immunohistochemical staining was performed allowing us to arrive at a diagnosis of necrotizing sialometaplasia. We suggest the term necrotizing dacryocystometaplasia for the involvement at this site. CONCLUSION: Although exceedingly unusual, necrotizing dacryocystomeplasia should be considered in patients presenting with epiphora in the appropriate clinical context. Notably, this condition can be mistaken for a malignant disease, presenting a diagnostic challenge both clinically and histopathologically.

Fidaxomicin inhibits toxin production in Clostridium difficile.

OBJECTIVES: Fidaxomicin, which was recently approved for the treatment of Clostridium difficile-associated diarrhoea, demonstrates narrow-spectrum bactericidal activity via inhibition of RNA polymerase. In this study we evaluated its inhibitory activity versus C. difficile toxin gene expression and toxin production by quantifying toxin mRNA and protein. METHODS: The effects of fidaxomicin, its major metabolite (OP-1118), vancomycin and metronidazole on toxin A and toxin B production were determined by assaying culture supernatants of two C. difficile isolates (ATCC 43255, a high-level toxin-producing strain, and UK-14, a NAP1/027/BI epidemic strain) using a commercial ELISA. The effects of the drugs on toxin gene expression were assessed in stationary-phase cells of C. difficile strain UK-1 (NAP1/027/BI type epidemic strain) and in the closely related non-epidemic strain CD196 by quantitative RT-PCR. RESULTS: Subinhibitory levels (1/4× MIC) of fidaxomicin or OP-1118 (but not vancomycin or metronidazole) strongly suppressed toxin production in C. difficile (≥ 60%) through at least 1 week of culture. Additionally, transcripts from the pathogenicity loci (tcdR, tcdA and tcdB) were nearly completely inhibited by both fidaxomicin (2× MIC) and OP-1118 (2.5× MIC), but not vancomycin (2.5× MIC). CONCLUSIONS: Both fidaxomicin and OP-1118 are able to inhibit toxin production in vitro, which may explain prior post-treatment observations of less frequent detectable toxin in fidaxomicin-treated patients (27 subjects) than those treated with vancomycin (8 patients).

Fidaxomicin inhibits spore production in Clostridium difficile.

Fidaxomicin (FDX) is a novel antimicrobial agent with narrow-spectrum and potent bactericidal activity against Clostridium difficile. In recent clinical trials, FDX was superior to vancomycin in preventing recurrences of C. difficile infection. A possible mechanism of reducing recurrence may be through an inhibitory effect on sporulation. The effect of FDX and its major metabolite, OP-1118, on C. difficile growth and sporulation kinetics was compared with that of vancomycin, metronidazole, and rifaximin. Drugs at subminimum inhibitory concentrations (sub-MICs) were added to cells at an early stationary phase of growth; this was followed by collection of cells at various intervals for quantitation of total viable cell and heat-resistant spore counts on taurocholate-containing media. The effect of the drugs at 2-2.5× MIC on the expression of sporulation genes in C. difficile was also compared using quantitative reverse-transcriptase polymerase chain reaction. Both FDX and OP-1118 (1/4× MIC) inhibited sporulation when added to early-stationary-phase cells in C. difficile strains, including the epidemic NAP1/BI/027 strain. In contrast, vancomycin, metronidazole, and rifaximin (at similar sub-MICs) did not inhibit sporulation. The number of spores following treatment with comparator drugs increased to the same level as the no-drug control treatment. Expression of mother cell-specific (spoIIID) and forespore-specific (spoIIR) sporulation genes also was inhibited by FDX and OP-1118 but not significantly by vancomycin. Both FDX and OP-1118 (unlike vancomycin, rifaximin, and metronidazole) effectively inhibited sporulation by C. difficile. The inhibitory effect of FDX on C. difficile sporulation may contribute to its superior performance in sustaining clinical response and reducing recurrences and may also be beneficial in decreasing shedding and transmission of this pathogen.

Postantibiotic effect of fidaxomicin and its major metabolite, OP-1118, against Clostridium difficile.

Fidaxomicin (FDX), a narrow-spectrum antibiotic recently shown to be superior to vancomycin in providing sustained clinical response to Clostridium difficile infection, was investigated along with its major metabolite, OP-1118, with regard to their postantibiotic effects (PAE). FDX was found to have a prolonged PAE (10 h versus ATCC strains and 5.5 h versus a clinical isolate), and OP-1118's PAE was longer than that of the standard comparator, vancomycin (3 versus 0 to 1.5 h, respectively).