Experiencias de aprendizaje en la formación virtual de docentes durante el confinamiento por COVID-19 / Learning experiences in virtual teacher training during confinement by COVID-19. A qualitative approach

Resumen La formación universitaria de docentes durante el confinamiento provocado por la pandemia de COVID-19 ha estado influida por diferentes factores. El objetivo de este estudio es analizar las experiencias de aprendizaje de un grupo de estudiantes de la carrera de licenciatura en Educación Básica de una universidad ecuatoriana. Se utilizó un enfoque cualitativo a través de un análisis del contenido temático de narrativas escritas a manera de reportes reflexivos. La investigación se organizó en el contexto del proyecto de perfeccionamiento de la formación docente atendiendo a las seis categorías que influyen directamente en la formación del estudiante y que delimitan el desafío didáctico y pedagógico de quienes se ocupan de formar docentes. Los resultados aluden a la brecha tecnológica que hace cada vez más visible la desigualdad social, pero a la vez la capacidad de reestructuración, adaptación al contexto virtual tanto de estudiantes en formación como de sus docentes. Todo ello, pese a que no hubo una preparación oportuna y suficiente en las estrategias de afrontamiento para el aprendizaje virtual de forma saludable en condiciones de confinamiento. Las experiencias contadas en voz de los y las estudiantes confirman las distintas percepciones sobre categorías que influyen en su formación y la necesidad de avanzar en una estrategia integradora entre los profesionales de la educación y la salud que incorpore las particularidades descritas para un enfoque más inclusivo de la formación docente.

Abstract Teachers' university training during the confinement caused by the COVID-19 pandemic has been influenced by various factors. This research's main objective was to analyse the learning experiences of undergraduate students in Basic Education at an Ecuadorian university. The current study involves a qualitative approach using a thematic content analysis of narratives written as reflective reports. The sample was composed by 5th semester students of the Basic Education career. They were between 19 and 38 years old, and their narratives were selected taking into account these selection parameters: the stories were set up in a reasonable and meaningful way, followed the structure: introduction, development, conclusion; and they were deep, but very clear in the reflections made that direct the future perspective of the subject in question. This study was organized as part of a project for the improvement of teachers' training, taking into account the six categories that have a direct influence on student education and that define a didactic and pedagogical challenge of those who are in charge of university processes. According to the previous argument, some of these categories are the use of electronic devices and access to learning technologies; the adaptation and use of teaching strategies in the virtual context; the development of students' creativity during virtual learning; learning environment and family coexistence at home; and physical and emotional well-being. The findings indicate: greater relevance of information and communication technologies (ICT) as a platform for teaching and receiving classes; improvement of the teaching-learning process; means of social interaction; resources for research on the internet. Moreover, the training of future teachers currently depends on the possession of devices to be able to access training activities; this technological gap makes social inequality increasingly visible. Another important result is that the pandemic tested the capacity of both, students and teachers to restructure and adapt to the virtual context. This is related to the status of most teachers as digital migrants and of students as digital natives. In the case of teachers, they have not yet managed to adapt to the use of teaching strategies in the virtual context, while students mastered ICTs. For those who found their applications and tools for the first time in the context of the pandemic, it was a welcomed learning opportunity. The development of students' creativity during virtual learning was marked by the role assumed by teachers, as a consequence of the intensive use of ICTs that has allowed young people to keep busy and learn while having fun. Teachers have focused more on their use in order to enhance their emotional intelligence to face new and stressful situations in their professional practice. Regarding the family environment, beyond the leading role that families have assumed as facilitators of the teaching-learning process, members may hinder attention, concentration, comprehension, and memorization of knowledge due to the different distractions generated at home. According to some of the teachers in training consulted for this research, student and teacher communication was flexible, and many students have been able to pass every subject. The teachers in training consulted recognized the practices that threaten their physical and emotional well-being and the need to rethink new styles of healthcare for themselves and their families. Finally, it is concluded that the experiences manifested were presented bearing in mind the fundamental categories of the study. Students confirmed the different perceptions on categories that influence their training and the need to advance in an integrative strategy between education and health professionals that incorporates the particularities described for a more inclusive approach to teacher training.

Detention and mapping of iron and toxic environmental elements in human ovarian endometriosis: A suggested combined role.

BACKGROUND: Endometriosis is a disease affecting 10-15 % of women worldwide, consisting in the ectopic growth of endometrial cells outside the uterine cavity. Whist the pathogenetic mechanisms of endometriosis remain elusive and contemplating even environmental causes, iron deposits are common in endometrial lesions, indicating an altered iron metabolism at this level. This study was undertaken to reveal a possible relationship between iron dysmetabolism and accumulation of environmental metals. METHODS: By combining histological and histochemical analysis (H&E and Perl's staining) with µ- and nano- synchrotron-based (SR-based) X-ray Fluorescence (XRF) microscopy, we investigated the distribution of iron and other elements in the ovarian endometriomas of 12 endometriosis patients and in 7 healthy endometrium samples. RESULTS: XRF microscopy expanded the findings obtained by Perl's staining, revealing with an exceptional sensitivity intracellular features of iron accumulation in the epithelial endometrium, stroma and macrophages of the endometriotic lesions. XRF evidenced that iron was specifically accumulated in multiple micro aggregates, reaching concentrations up to 10-20 % p/p. Moreover, by XRF analysis we revealed for the first time the retention of a number of exogenous and potentially toxic metals such as Pb, Br, Ti, Al Cr, Si and Rb partially or totally co-localizing with iron. CONCLUSION: µXRF reveals accumulation and colocalization of iron and environmental metals in human ovarian endometriosis, suggesting a role in the pathogenesis of endometriosis.

CANVAS: A New Genetic Entity in the Otorhinolaryngologist's Differential Diagnosis.

OBJECTIVE: The biallelic inheritance of an expanded intronic pentamer (AAGGG)exp in the gene encoding replication factor C subunit 1 (RFC1) has been found to be a cause of cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS). This study describes clinical and genetic features of our patients with clinical suspicion of the syndrome. STUDY DESIGN: A retrospective descriptive study from an ataxia database comprising 500 patients. SETTING: The study was performed at the Otorhinolaryngology Department of a hospital in the north of Spain. METHODS: Specific genetic testing for CANVAS was performed in 13 patients with clinical suspicion of complete or incomplete syndrome. The clinical diagnosis was supported by quantitative vestibular hypofunction, cerebellar atrophy, and abnormal sensory nerve conduction testing. RESULTS: Nine of 13 (69%) patients met clinical diagnostic criteria for definite CANVAS disease. The first manifestation of the syndrome was lower limb dysesthesia in 8 of 13 patients and gait imbalance in 5 of 13. Eleven of 13 (85%) patients were carriers of the biallelic (AAGGG)exp in RFC1. CONCLUSION: A genetic cause of CANVAS has recently been discovered. We propose genetic screening for biallelic expansions of the AAGGG pentamer of RFC1 in all patients with clinical suspicion of CANVAS, since accurate early diagnosis could improve the quality of life of these patients.

Correlative transmission electron microscopy and high-resolution hard X-ray fluorescence microscopy of cell sections to measure trace element concentrations at the organelle level.

Metals are essential for life and their concentration and distribution in organisms are tightly regulated. Indeed, in their free form, most transition metal ions are toxic. Therefore, an excess of physiologic metal ions or the uptake of non-physiologic metal ions can be highly detrimental to the organism. It is thus fundamental to understand metal distribution under physiological, pathological or environmental conditions, for instance in metal-related pathologies or upon environmental exposure to metals. Elemental imaging techniques can serve this purpose, by allowing the visualization and the quantification of metal species in tissues down to the level of cell organelles. Synchrotron radiation-based X-ray fluorescence (SR-XRF) microscopy is one of the most sensitive techniques to date, and great progress was made to reach nanoscale spatial resolution. Here we propose a correlative method to couple SR-XRF to electron microscopy (EM), with the possibility to quantify selected elemental contents in a specific organelle of interest with 50 × 50 nm2 raster scan resolution. We performed EM and SR-XRF on the same section of hepatocytes exposed to silver nanoparticles, in order to identify mitochondria through EM and visualize Ag co-localized with these organelles through SR-XRF. We demonstrate the accumulation of silver in mitochondria, which can reach a 10-fold higher silver concentration compared to the surrounding cytosol. The sample preparation and experimental setup can be adapted to other scientific questions, making the correlative use of SR-XRF and EM suitable to address a large panel of biological questions related to metal homeostasis.

Distribution and Chemical Speciation of Exogenous Micro- and Nanoparticles in Inflamed Soft Tissue Adjacent to Titanium and Ceramic Dental Implants.

Degradation of the implant surface and particle release/formation as an inflammation catalyst mechanism is an emerging concept in dental medicine that may help explain the pathogenesis of peri-implantitis. The aim of the present study was a synchrotron-based characterization of micro- and nanosized implant-related particles in inflamed human tissues around titanium and ceramic dental implants that exhibited signs of peri-implantitis. Size, distribution, and chemical speciation of the exogenous micro- and nanosized particle content were evaluated using synchrotron µ-X-ray fluorescence spectroscopy (XRF), nano-XRF, and µ-X-ray absorption near-edge structure (XANES). Titanium particles, with variable speciation, were detected in all tissue sections associated with titanium implants. Ceramic particles were found in five out of eight tissue samples associated with ceramic implants. Particles ranged in size from micro- to nanoscale. The local density of both titanium and ceramic particles was calculated to be as high as ∼40 million particles/mm3. µ-XANES identified titanium in predominantly two different chemistries, including metallic and titanium dioxide (TiO2). The findings highlight the propensity for particle accumulation in the inflamed tissues around dental implants and will help in guiding toxicological studies to determine the biological significance of such exposures.

Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry.

Introduction There is scarce real-world experience regarding direct oral anticoagulants (DOACs) perioperative management. No study before has linked bridging therapy or DOAC-free time (pre-plus postoperative time without DOAC) with outcome. The aim of this study was to investigate real-world management and outcomes. Methods RA-ACOD is a prospective, observational, multicenter registry of adult patients on DOAC treatment requiring surgery. Primary outcomes were thrombotic and hemorrhagic complications. Follow-up was immediate postoperative (24-48 hours) and 30 days. Statistics were performed using a univariate and multivariate analysis. Data are presented as odds ratios (ORs [95% confidence interval]). Results From 26 Spanish hospitals, 901 patients were analyzed (53.5% major surgeries): 322 on apixaban, 304 on rivaroxaban, 267 on dabigatran, 8 on edoxaban. Fourteen (1.6%) patients suffered a thrombotic event, related to preoperative DOAC withdrawal (OR: 1.57 [1.03-2.4]) and DOAC-free time longer than 6 days (OR: 5.42 [1.18-26]). Minor bleeding events were described in 76 (8.4%) patients, with higher incidence for dabigatran (12.7%) versus other DOACs (6.6%). Major bleeding events occurred in 17 (1.9%) patients. Bridging therapy was used in 315 (35%) patients. It was associated with minor (OR: 2.57 [1.3-5.07]) and major (OR: 4.2 [1.4-12.3]) bleeding events, without decreasing thrombotic events. Conclusion This study offers real-world data on perioperative DOAC management and outcomes in a large prospective sample size to date with a high percentage of major surgery. Short-term preprocedural DOAC interruption depending on the drug, hemorrhagic risk, and renal function, without bridging therapy and a reduced DOAC-free time, seems the safest practice.

Cirugía de rescate en las recidivas locales del carcinoma de nasofaringe / Salvage surgery in the treatment of local recurrences of nasopharyngeal carcinomas

INTRODUCCIÓN Y OBJETIVOS: La quimiorradioterapia es el tratamiento de elección del carcinoma de nasofaringe. Las recurrencias locales son una de las principales causas de mortalidad en estos pacientes: el rescate quirúrgico o la reirradiación son el tratamiento de elección, según la disponibilidad. El objetivo fue evaluar y comparar los resultados de la cirugía de rescate en el tratamiento de las recidivas locales de los carcinomas nasofaríngeos mediante abordajes abiertos vs. endoscópicos. MÉTODOS: Veinte pacientes con recidivas locales de carcinomas nasofaríngeos fueron intervenidos quirúrgicamente: 12 pacientes fueron intervenidos mediante cirugía abierta y 8 mediante un abordaje endoscópico endonasal transpterigoideo. Un paciente fue estadiado como rT1; 3 como rT2; 2 como rT3 y 6 como rT4 en el grupo de abordajes abiertos; en la serie endoscópica, 2 pacientes fueron rT1, 5 fueron rT2 y uno fue rT3. RESULTADOS: En 3 de los pacientes (25%) intervenidos mediante cirugía abierta (un rT4, un rT3 y un rT2) no se logró una resección macroscópica completa). En el grupo endoscópico la resección fue completa en todos los pacientes. La tasa de complicaciones en el grupo intervenido mediante abordajes abiertos fue del 92% (5 complicaciones leves, 5 complicaciones moderadas y una complicación grave) y en el grupo intervenido mediante endoscopia fue del 100% (7 sufrieron complicaciones leves y un paciente una complicación grave). La supervivencia a los 3 y 5 años fue del 53 y del 42% en el abordaje abierto y del 100 y del 75% en el abordaje endoscópico, respectivamente. CONCLUSIONES: Los abordajes endoscópicos disminuyen la morbilidad asociada a los abordajes abiertos y permiten obtener un control oncológico favorable

INTRODUCTION AND OBJECTIVES: Chemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches. METHODS: Twenty patients with local recurrence of nasopharyngeal carcinomas underwent surgery: 12 patients underwent open surgery and 8 endoscopic endonasal transpterygoid nasopharyngectomy. One patient was classified as rT1; 3 as rT2;2 as rT3; and 6 as rT4 in the group of open approaches; in the endoscopic series, 2 patients were rT1, 5 rT2 and one rT3. RESULTS: In 3 patients (25%) operated by an open approach (one rT4, one rT3 and one rT2) a complete gross resection was not achieved. Gross total resection was achieved in patients operated by endoscopic surgery. The complication rate in the group operated by an open approach was 92% (5 minor complications, 5 moderate complications, and one serious complication) and in the group that underwent endoscopic surgery all patients had some complication (7 had minor complications and one patient developed a severe complication). Survival at 3 and 5 years was 53% and 42% with the open approach and 100% and 50% with the endoscopic approach, respectively. CONCLUSIONS: Endoscopic approaches decrease the morbidity associated with open approaches and allow for favourable oncological control

Salvage surgery in the treatment of local recurrences of nasopharyngeal carcinomas. / Cirugía de rescate en las recidivas locales del carcinoma de nasofaringe.

INTRODUCTION AND OBJECTIVES: Chemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches. METHODS: Twenty patients with local recurrence of nasopharyngeal carcinomas underwent surgery: 12 patients underwent open surgery and 8 endoscopic endonasal transpterygoid nasopharyngectomy. One patient was classified as rT1; 3 as rT2;2 as rT3; and 6 as rT4 in the group of open approaches; in the endoscopic series, 2 patients were rT1, 5 rT2 and one rT3. RESULTS: In 3 patients (25%) operated by an open approach (one rT4, one rT3 and one rT2) a complete gross resection was not achieved. Gross total resection was achieved in patients operated by endoscopic surgery. The complication rate in the group operated by an open approach was 92% (5 minor complications, 5 moderate complications, and one serious complication) and in the group that underwent endoscopic surgery all patients had some complication (7 had minor complications and one patient developed a severe complication). Survival at 3 and 5 years was 53% and 42% with the open approach and 100% and 50% with the endoscopic approach, respectively. CONCLUSIONS: Endoscopic approaches decrease the morbidity associated with open approaches and allow for favourable oncological control.

Impact of a Model Soil Microorganism and of Its Secretome on the Fate of Silver Nanoparticles.

Sulfidation is a key process for silver nanoparticles released from consumer products in the environment. This study focuses on the impact of a model soil microorganism, Bacillus subtilis, on the fate of pristine and already sulfidized Ag-NPs. The nanoparticles were incubated with the initial growth medium, isolated secretome, and living bacteria, and characterized for their size and morphology, agglomeration state, structure, and Ag speciation. No Ag internalization or sorption on the cell wall was detected. A partial sulfidation, leading to an Ag-Ag2S core-shell structure, was observed in the presence of the secretome, and the rate limiting step of the reaction was the oxidation of Ag0, and it was favored near the crystal dislocations. The sulfidation was complete in the presence of the living bacteria and followed an indirect pathway. Both crystalline Ag2S and amorphous Ag2S and/or Ag-thiol were identified. At the opposite, the bacteria had no impact on Ag2S. These results suggest that microorganisms participate in the sulfidation of Ag-NPs in aerobic systems such as unsaturated soils, and thus affect the bioavailability of Ag. It is important to take these transformations into account during exposure experiments, since they drastically change the exposure conditions. Finally, the secretome of B. subtilis might be used for the green synthesis of Ag-Ag2S core-shell nanoparticles.

Tumores primarios del espacio parafaríngeo / Parapharyngeal space primary tumours

Introducción y objetivos: El objetivo de este estudio es presentar nuestra experiencia en el diagnóstico y tratamiento de los tumores parafaríngeos. Pacientes y método: Realizamos un estudio retrospectivo de 90 pacientes, diagnosticados y tratados quirúrgicamente de una tumoración parafaríngea entre 1984 y 2015. Fueron excluidos los pacientes cuyos tumores no eran primarios, sino que invadían esta región por contigüidad, los tumores originados en el lóbulo profundo de la parótida y las metástasis de otros tumores de cabeza y cuello. Resultados: El 74% de las neoplasias del espacio parafaríngeo fueron de naturaleza benigna y el 26% maligna. Los adenomas pleomorfos fueron los tumores más frecuentes (27%), seguido por los paragangliomas (25%), un grupo de tumores de origen misceláneo de naturaleza maligna (16%), los tumores de origen neurogénico (12%), un grupo de tumores de origen misceláneo de naturaleza benigna (10%) y los tumores malignos de glándulas salivales (10%). El tratamiento fue quirúrgico en todos los casos. Se realizó un abordaje transcervical en 56 pacientes, un abordaje cervical-transparotídeo en 15 pacientes, un abordaje infratemporal tipo A en 13 pacientes, un abordaje transmandibular en 4 pacientes y en 2 casos un abordaje transoral. Las complicaciones más frecuentes fueron las derivadas de lesiones de estructuras nerviosas. Conclusiones: La mayoría de los tumores localizados en el espacio parafaríngeo son subsidiarios de ser tratados de forma quirúrgica con una baja tasa de complicaciones y recurrencias. El abordaje transcervical es el más utilizado (AU)

Introduction and objectives: The aim of this study is to present our experience with the diagnostic and therapeutic approaches for parapharyngeal space tumours. Patients and method: This study is a retrospective review of 90 patients diagnosed with tumours of the parapharyngeal space and treated surgically between 1984 and 2015. Patients whose tumours were not primary but invaded the parapharyngeal space expanding from another region, tumours originating in the deep lobe of the parotid gland and head and neck metastasis were excluded from this study. Results: 74% percent of the parapharyngeal space neoplasms were benign and 26% were malignant. Pleomorphic adenoma was the most common neoplasm (27%), followed by paragangliomas (25%), miscellaneous malignant tumours (16%), neurogenic tumours (12%), miscellaneous benign tumours (10%), and malignant salivary gland tumours (10%). The transcervical approach was used in 56 cases, cervical-transparotid approach in 15 cases, type A infratemporal fossa approach in 13 cases, transmandibular approach in 4 cases and transoral approach in 2 cases. The most common complications were those deriving from nervous injuries. Conclusions: Most parapharyngeal space tumours can be removed surgically with a low rate of complications and recurrence. The transcervical approach is the most frequently used (AU)

Parapharyngeal space primary tumours. / Tumores primarios del espacio parafaríngeo.

INTRODUCTION AND OBJECTIVES: The aim of this study is to present our experience with the diagnostic and therapeutic approaches for parapharyngeal space tumours. PATIENTS AND METHOD: This study is a retrospective review of 90 patients diagnosed with tumours of the parapharyngeal space and treated surgically between 1984 and 2015. Patients whose tumours were not primary but invaded the parapharyngeal space expanding from another region, tumours originating in the deep lobe of the parotid gland and head and neck metastasis were excluded from this study. RESULTS: 74% percent of the parapharyngeal space neoplasms were benign and 26% were malignant. Pleomorphic adenoma was the most common neoplasm (27%), followed by paragangliomas (25%), miscellaneous malignant tumours (16%), neurogenic tumours (12%), miscellaneous benign tumours (10%), and malignant salivary gland tumours (10%). The transcervical approach was used in 56 cases, cervical-transparotid approach in 15 cases, type A infratemporal fossa approach in 13 cases, transmandibular approach in 4 cases and transoral approach in 2 cases. The most common complications were those deriving from nervous injuries. CONCLUSIONS: Most parapharyngeal space tumours can be removed surgically with a low rate of complications and recurrence. The transcervical approach is the most frequently used.

Current management of sinonasal undifferentiated carcinoma.

BACKGROUND: The management of sinonasal undifferentiated carcinoma (SNUC) remains unclear. Low incidence and poor outcomes make treatment standardization difficult. The objective of this study was to review the used treatment and our outcomes. METHODS: From 2001 to 2013, 17 cases of SNUC were treated at our department. Charts were reviewed for standard demographic, tumour size and extension, histological features, treatment strategies, surgical approach, adjuvant therapies, outcomes and complications. RESULTS: All patients presented with extensive local disease and 2 patients also had neck metastases. All patients were treated using a multimodality approach: 10 patients underwent surgery and postoperative chemoradiation, 1 patient was treated with surgery and adjuvant radiotherapy, 3 patients were treated with neoadjuvant chemotherapy, surgery and postoperative chemoradiation and the remaining 3 patients were treated with chemoradiotherapy. After median follow-up of 39 months 6 patients developed recurrences. The 3-year local control rate was 76% and the 5-year rate of overall survival was 58%. CONCLUSIONS: Management and outcomes of SNUC have improved due to advances in surgery and radiotherapy. Gross tumour resection followed by postoperative radiotherapy should be the standard of care in patients with SNUC. High-precision high-dose radiotherapy should be implemented to try to improve the outcomes.

Reconstrucción de cabeza y cuello mediante colgajos libres microvascularizados. Indicaciones, aspectos técnicos y resultados / Free flap reconstruction in the head and neck. Indications, technical aspects and outcomes

Introducción y objetivos: La utilización de colgajos libres microvascularizados (CLM) se ha convertido en un método de reconstrucción frecuente en el área de cabeza y cuello debido a sus elevadas tasas de éxito y a sus mejores resultados funcionales. Presentamos nuestra experiencia en la reconstrucción de defectos complejos con CLM. Métodos: Se presenta una serie de 246 pacientes que requirieron una reconstrucción con CLM entre 1991 y 2013. Resultados: Se realizaron 259 intervenciones en 246 pacientes. El motivo más frecuente para la realización de la cirugía fue la presencia de una recidiva tumoral (46%), seguido de la resección primaria del tumor (25%). Las regiones más frecuentemente reconstruidas fueron la hipofaringe (52%) y la región craneofacial (22%). Los CLM más usados fueron el colgajo antebraquial radial (41%) y el anterolateral de muslo (35%). El 92% de los CLM fue un éxito y la tasa de complicaciones fue del 20%. Conclusiones: La utilización de CLM es un método fiable y útil para la reconstrucción de defectos complejos de cabeza y cuello, y su uso sigue siendo la modalidad reconstructiva de elección en estos casos (AU)

Introduction and objectives: The use of microvascular free flaps (MFF) has become a common method of head and neck reconstruction because of its high success rates and better functional results. We report our experience in reconstructing complex defects with MFF. Methods: We analysed a series of 246 patients who underwent reconstruction using MFF in our Department from 1991 to 2013. Results: A total of 259 interventions were performed in 246 patients. The most common reason for surgery was tumour recurrence (46%), followed by primary tumour resection (25%). The hypopharynx (52%) and the craniofacial region (22%) were the most frequently reconstructed sites. The free flaps most commonly used were the radial forearm free flap (41%) and the anterolateral thigh free flap (35%). Overall success and complication rates of 92% and 20% respectively were reported. Conclusions: The microvascular free flap is a reliable and useful tool for reconstructing complex head and neck defects and continues to be the reconstructive modality of choice for these defects (AU)

[Free flap reconstruction in the head and neck. Indications, technical aspects and outcomes]. / Reconstrucción de cabeza y cuello mediante colgajos libres microvascularizados. Indicaciones, aspectos técnicos y resultados.

INTRODUCTION AND OBJECTIVES: The use of microvascular free flaps (MFF) has become a common method of head and neck reconstruction because of its high success rates and better functional results. We report our experience in reconstructing complex defects with MFF. METHODS: We analysed a series of 246 patients that underwent reconstruction using MFF in our Department from 1991 to 2013. RESULTS: There were 259 interventions performed in 246 patients. The most common reason for surgery was tumour recurrence (46%), followed by primary tumour resection (25%). The hypopharynx (52%) and the craniofacial region (22%) were the most frequently reconstructed sites. The free flaps most commonly used were the radial forearm free flap (41%) and the anterolateral thigh free flap (35%). Overall success and complication rates of 92% and 20% respectively were reported. CONCLUSIONS: The microvascular free flap is a reliable and useful tool for reconstructing complex head and neck defects and continues to be the reconstructive modality of choice for these defects.

Tratamiento endoscópico de la atresia de coanas / Endoscopic treatment of choanal atresia

Introducción: La atresia de coanas (AC) es una obliteración congénita y poco frecuente de la vía aérea, resultante de la ausencia de conexión entre la cavidad nasal y el tracto aerodigestivo. Presentamos nuestra experiencia en el manejo de la AC mediante endoscopia nasal sin utilización de stents. Material y método: Se presenta una serie de 10 casos consecutivos de AC tratados en nuestro servicio mediante cirugía endoscópica entre 2006 y 2012. Exponemos nuestra experiencia y la técnica quirúrgica utilizada. Resultados: La muestra se componía de 5 varones y 5 mujeres. La edad media de los pacientes era de 8 años (5 días-32 años). El 50% de los pacientes eran casos de reestenosis posquirúrgicas. En 7 casos la AC era bilateral y en 3 unilateral. Todas la AC eran mixtas. El 50% de los pacientes tenía una malformación asociada. Todos los pacientes fueron intervenidos mediante cirugía endoscópica nasal sin colocación de stents. Tras un seguimiento medio de 27 meses (11-78 meses) la tasa de éxito es del 100%. No se observaron complicaciones. Conclusiones: El tratamiento de la AC mediante endoscopia nasal, tanto unilateral como bilateral, sin implantación de stents es un procedimiento eficaz y seguro. Consideramos que la cirugía endoscópica nasal debería ser considerada actualmente la cirugía estándar en el tratamiento de las AC (AU)

Introduction: Choanal atresia (CA) is an infrequent congenital obliteration of the airway at the level of the posterior nasal aperture resulting in the absence of connection between the nasal cavity and the aerodigestive tract. We present our experience with an endoscopic technique for congenital CA without the use of intranasal stents. Material and method: We analysed a series of 10 patients with CA treated in our department from 2006 to 2012 through endoscopic surgery. We present a description of the sample and the surgical technique used. Results: The sample consisted of 5 men and 5 women. Mean patient age was 8 years (range: 5 days-32 years). Fifty percent of patients were cases with re-stenosis requiring revision surgery. Bilateral presentation was 7 and unilateral was 3. All CA were mixed (bony-membranous). Fifty per cent of patients had an associated malformation. All patients underwent nasal endoscopic surgery without stenting. After a mean follow up of 27 months (range: 11-78 months), the success rate was 100%. No complications were observed. Conclusion: Transnasal endoscopic repair for both unilateral and bilateral CA without intranasal stenting was found to be a safe, expedient procedure that afforded minimal complications with a high success rate. Endoscopic endonasal surgery may be considered as the mainstay of treatment (AU)

Endoscopic treatment of choanal atresia.

INTRODUCTION: Choanal atresia (CA) is an infrequent congenital obliteration of the airway at the level of the posterior nasal aperture resulting in the absence of connection between the nasal cavity and the aerodigestive tract. We present our experience with an endoscopic technique for congenital CA without the use of intranasal stents. MATERIAL AND METHOD: We analysed a series of 10 patients with CA treated in our department from 2006 to 2012 through endoscopic surgery. We present a description of the sample and the surgical technique used. RESULTS: The sample consisted of 5 men and 5 women. Mean patient age was 8 years (range: 5 days-32 years). Fifty percent of patients were cases with re-stenosis requiring revision surgery. Bilateral presentation was 7 and unilateral was 3. All CA were mixed (bony-membranous). Fifty per cent of patients had an associated malformation. All patients underwent nasal endoscopic surgery without stenting. After a mean follow up of 27 months (range: 11-78 months), the success rate was 100%. No complications were observed. CONCLUSION: Transnasal endoscopic repair for both unilateral and bilateral CA without intranasal stenting was found to be a safe, expedient procedure that afforded minimal complications with a high success rate. Endoscopic endonasal surgery may be considered as the mainstay of treatment.

Portal hypertensive biliopathy: A single center experience and literature review.

Portal hypertensive biliopathy (PHB) is characterized by anatomical and functional abnormalities of the intrahepatic, extrahepatic and pancreatic ducts, in patients with portal hypertension associated to extrahepatic portal vein obstruction and less frequently to cirrhosis. These morphological changes, consisting in dilatation and stenosis of the biliary tree, are due to extensive venous collaterals occurring in an attempt to decompress the portal venous blockage. It is usually asymptomatic until it progresses to more advanced stages with cholestasis, jaundice, biliary sludge, gallstones, cholangitis and finally biliary cirrhosis. Imaging modalities of the biliary tree such as Doppler ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are essential to establish the diagnosis and the need of therapeutical interventions. Once the diagnosis is established, treatment with ursodesoxycholic acid seems to be beneficial. Decompression of the biliary tree to dilate, remove stones or implant biliary prosthesis by endoscopic or surgical procedures (hepato-yeyunostomy) usually resolves the cholestatic picture and prevents septic complications. The ideal treatment is the decompression of the portal system, with transjugular intrahepatic porto-systemic shunt or a surgical porto-systemic shunt. Unfortunately, few patients will be candidates for these procedures due to the extension of the thrombotic process. The purpose of this paper is to report the first 3 cases of PHB seen in a Colombian center and to review the literature.

Inoculation of Treixadura musts with autochthonous Saccharomyces cerevisiae strains: fermentative performance and influence on the wine characteristics.

The fermentative ability of five autochthonous Saccharomyces cerevisiae strains (XG1, XG2, XG3, XG4 and XG5) and their influence on the chemical composition and sensory properties of Treixadura wines were evaluated. The inoculated strains have successfully led and completed the fermentations. Wines obtained from different yeasts showed significant differences in total and volatile acidity. Regarding volatile compounds, significant differences among wines were found for acetates, ethyl esters, acetoin, 1-hexanol, and fatty acids. Wines from spontaneous fermentation and those made with yeasts XG3 and XG4 were clearly separated through principal component analysis. Chemical composition influenced sensory properties of wines, especially at the olfactory level. Different connotations of fruity notes predominated depending on the strain. The wine from strain XG4 was the most appreciated by panelists. Our results confirmed that autochthonous S. cerevisiae strains are useful tools in winemaking because they allow obtaining singular wines from a given variety.

Multimodality approach for advanced-stage juvenile nasopharyngeal angiofibromas.

BACKGROUND: Juvenile nasopharyngeal angiofibromas (JNAs) with significant skull base involvement and intracranial extension are challenging tumors. We evaluated our experience in the treatment of extensive JNAs through resection followed by radiosurgery. METHODS: From 1999 to 2007, 10 advanced JNAs (Andrews grade IV) were treated by primary surgical resection followed by gamma knife radiosurgery of residual tumor. Tumor control and treatment morbidity were evaluated. RESULTS: Six months after radiosurgery and annually thereafter, an imaging study was done that revealed decrement in tumor size in 3 patients and no change in 7 patients, after a 3-year minimum follow-up. Clinically, patients are asymptomatic. CONCLUSION: An efficient strategy in the management of extensive JNAs is the use of a multimodality approach, in which surgical resection is followed by the treatment with radiosurgery in critical locations. These therapeutic schemes are safe and offer long-term tumor control.

Resección craneofacial endoscópica. Indicaciones y aspectos técnicos / Endoscopic craniofacial resection. Indications and technical aspects

Introducción: La resección craneofacial (RCF) anterior es un procedimiento bien establecido para el tratamiento de los tumores que afectan la base del cráneo anterior. Exponemos la técnica empleada en el tratamiento endoscópico de estos tumores. Material y método: Se realiza un análisis retrospectivo de los tumores tratados en nuestro servicio entre los años 2004 y 2011 mediante una RCF endoscópica. Resultados: Fueron analizados 32 pacientes. El seguimiento medio fue de 28 meses (rango: 6-84 meses). Los tumores más frecuentes fueron los adenocarcinomas de etmoides (60%) seguido de los carcinomas indiferenciados (13%). El 9% de los tumores de origen epitelial pertenecían a la categoría T3, el 53% eran T4a y el 19% T4b. La tasa de complicaciones fue del 6% y la resección fue completa en el 91% de los pacientes. Durante el seguimiento de los pacientes, el 9% presentaron una recidiva a nivel local. La supervivencia media y la supervivencia libre de enfermedad fue del 70 y del 85% a los 5 años, respectivamente. Conclusiones: Los resultados obtenidos permiten afirmar que, en casos seleccionados, la RCF endoscópica es una alternativa válida a los tradicionales abordajes abiertos en términos oncológicos y funcionales (AU)

Introduction: Anterior craniofacial resection (CFR) is a standardised procedure for the treatment of tumours involving the anterior skull base. We present our experience in the endoscopic treatment of these tumours. Material and method: A retrospective analysis was performed of patients treated by endoscopic anterior CFR in our Department from 2004 until 2011. Results: Thirty-two patients were analysed. Mean follow-up was 28 months (range: 6-84 months). The most frequent pathological entity was adenocarcinoma (60%), followed by undifferentiated carcinoma (13%). According to TNM classification, malignant epithelial tumour staging was T3 in 9%, T4a in 53% and T4b in 19% of the malignant epithelial tumours. The complication rate was 6% and the resection was complete in 91% of cases. During follow-up, 9% of patients developed recurrence. The 5-year overall survival rate was 70% and the 5-year disease-free survival rate was 85%. Conclusion: These results seem to indicate that properly planned endoscopic CFR may be a valid alternative to traditional open approaches for the management of malignancies of the anterior skull base (AU)