Biocidal effects of organometallic materials supported on ZSM-5 Zeolite: Influence of the physicochemical and surface properties.

Antifouling coatings containing biocidal agents can be used to prevent the accumulation of biotic deposits on submerged surfaces; however, several commercial biocides can negatively affect the ecosystem. In this study, various formulations of a potential biocide product comprising copper nanoparticles and capsaicin supported on zeolite ZSM-5 were analyzed to determine the influence of the concentration of each component. The incorporation of copper was evidenced by scanning electron microscopy and energy dispersive spectroscopy. Similarly, Fourier-transform infrared spectroscopy confirmed that capsaicin was supported on the zeolite surface. The presence of capsaicin on the external zeolite surface significantly reduced the surface area of the zeolite. Finally, bacterial growth inhibition analysis showed that copper nanoparticles inhibited the growth of strains Idiomarina loihiensis UCO25, Pseudoalteromonas sp. UCO92, and Halomonas boliviensis UCO24 while the organic component acted as a reinforcing biocide.

Multiple events case-control study in a prospective cohort to identify systemic, cellular, and molecular biomarkers of obesity-induced accelerated aging in 30-years-olds: the ObAGE study protocol.

BACKGROUND: Aging is characterized by a progressive loss of capacities linked to fundamental alterations/damage in multiple cellular and molecular pathways. It is the most significant risk factor for all non-communicable diseases (NCDs). Another contributing factor to the rise in NCDs is obesity. It has been suggested that obesity not only accelerates the onset of metabolic imbalances but also decreases lifespan and impacts cellular and molecular processes in a manner similar to aging. Obesity might accelerate the pace of aging. Guided by a lifecourse approach, we will explore how exposure to obesity in critical developmental stages disrupt homeostatic resilience mechanisms that preserve physiological integrity, inducing an early expression of aging phenotypes. Also, we will determine whether exposure to early psychosocial adversity influences vulnerability to obesity as a risk factor for accelerated aging. METHODS: Multiple events case-control study embedded in a prospective cohort of Chileans at 30-31y, 50% females, of low- to-middle socioeconomic status, who participated in nutrition research since birth. At 23y, 25% had obesity and cardiometabolic risk was high. We will use a multi-layer approach including: anthropometric assessment; DXA scan for body composition; abdominal ultrasound of the liver; stool samples collection and sequencing of the ribosomal RNA 16S gene to characterize the gut microbiome; determination of age-related pro-inflammatory cytokynes and anti-inflammatory miokynes. For the first time in Chile, we will address age-related epigenetic changes using the Horvath´s epigenetic clock. In a subset we will conduct a controlled physical challenge to characterize physical resilience (autophagy). DISCUSSION: ObAGE is in an excellent position to: approach aging as a process whose expression involves multiple factors from the early stages of a person's life; understand how longitudinal changes in health trajectories impact the biological mechanisms of aging; identify potential resilience mechanisms that help prevent unhealthy aging. Because SLS participants are still young, our research setting combined with advanced scientific techniques may identify individuals or groups at risk of early onset health issues. Results from ObAGE may pave the way to address the contribution of obesity to aging through lifespan from cells to systems and might be instrumental to developing interventions to improve health span in the Chilean population. TRIAL REGISTRATION: The proposed study does not consider any health care intervention on human participants.

Dual antifungal activity against Candida albicans of copper metallic nanostructures and hierarchical copper oxide marigold-like nanostructures grown in situ in the culture medium.

AIMS: This study aimed to determine in vitro activity of copper nanoparticles and copper nanowires against Candida albicans strains and to assess their effects on morphology and submicron structure. METHODS AND RESULTS: The microdilution method determined the minimal inhibitory concentration (MIC) of copper nanoparticles (CuNPs) and copper nanowires (CuNWs) against three strains of C. albicans: ATCC 10231 and two clinical strains (C and E). Effects on the morphology and ultrastructure of C. albicans strains were examined by scanning electron microscopy and transmission electron microscopy. MIC for CuNPs was 129·7 µg ml-1 for strain ATCC 10231, 1037·5 µg ml-1 for strain C and 518·8 µg ml-1 for strain E. MIC for CuNWs was similar for all strains tested (260·3 µg ml-1 ). SEM and TEM studies showed alterations in morphology, cell wall and the complete collapse of the yeast after incubation with CuNPs. In contrast, most of the yeast cells maintained their structure with an intact cell wall, and only decreased the number and size of fimbriae when C. albicans was exposed to CuNWs. CuNPs and CuNWs formed hierarchical copper oxide nanostructures growing in situ in the culture medium. Results suggest a dual mechanism for antifungal activity: (i) free Cu2+ ions act as a biocide, (ii) sharp edges of marigold-like petal nanostructures could injure the cellular wall and membrane and cause the death of the yeast. CONCLUSIONS: CuNPs and CuNWs inhibited the growth of the three strains of C. albicans tested. Moreover, CuNPs disrupted cell wall with leakage of the cytoplasmic content. Each concentration of the series used for the determination of the activity of CuNPs and nanowires against C. albicans formed copper oxide marigold-like nanostructures. SIGNIFICANCE AND IMPACT OF THE STUDY: This study suggests that CuNPs and CuNWs are good candidates for formulating new therapeutic agents for candidiasis.

Donante vivo hepático adulto-pediátrico totalmente laparoscópico: aspectos técnicos y resultados / Fully laparoscopic adult living donor for pediatric transplantation: technical aspects and results

Resumen Introducción: La cirugía hepática laparoscópica ha presentado un desarrollo más lento debido a la complejidad que ésta posee, lo que determina una curva de aprendizaje prolongada. En relación a la hepatectomía laparoscópica para donante vivo en trasplante hepático (TH), ésta se ha retrasado aún más por las preocupaciones sobre la seguridad del donante, el resultado del injerto y la adquisición de las competencias técnicas de los cirujanos. El objetivo de este artículo, es exponer detalles técnicos de la hepatectomía izquierda laparoscópica de donantes vivos adultos para trasplante pediátrico y se presentan los resultados quirúrgicos de los casos realizados en este centro. Materiales y Método: Presentación de la técnica quirúrgica de la hepatectomía izquierda en donantes vivos para TH en receptores pediátricos, además, de realizar un estudio cohorte no concurrente de pacientes sometidos a esta cirugía en el Hospital Clínico de la Universidad Católica entre mayo de 2011 y noviembre de 2017. Resultados: La serie consta de 15 pacientes, 60% sexo femenino. Trece pacientes (86,6%) eran madre o padre del receptor. El 100% de pacientes fue sometido a hepatectomía izquierda laparoscópica sin necesidad de conversión. Morbilidad Clavien-Dindo >3,1 paciente requirió punción percutánea de bilioma. Mediana de hospitalización de 3 días (2-5). No hubo mortalidad. Conclusión: La hepatectomía izquierda por vía laparoscópica de donante vivo para TH pediátrico es un procedimiento seguro y factible de realizar en este centro, con excelentes resultados en términos de morbimortalidad y consideramos que esta técnica debe ser la vía de elección para donantes vivos adultos-pediátricos.

Introduction: Laparoscopic liver surgery has presented a slower development due to the complexity it has, which determines a prolonged learning curve. In relation to laparoscopic hepatectomy for a living donor liver transplantation (LT), this has been further delayed due to concerns about donor safety, graft results and the acquisition of the technical skills of surgeons. The objective of this article is to present technical details of the laparoscopic left hepatectomy of adult living donors for pediatric transplantation and the surgical results of the cases performed in this center. Materials and Method: Presentation of the surgical technique of left hepatectomy in living donors for LT in pediatric recipients in addition to conducting a non-concurrent cohort study of patients undergoing this surgery at the Hospital Clinico Universidad Catolica between May 2011 to November 2017. Results: The series consists of 15 patients, 60% female. Thirteen patients (86.6%) were mother or father of the recipient. 100% of patients underwent laparoscopic left hepatectomy without conversion. Clavien-Dindo Morbidity > 3, in 1 patient who required percutaneous drainage of biloma. Median hospitalization of 3 days (2-5). There was no mortality. Conclusión: Laparoscopic left hepatectomy of living donors for pediatric LT is a safe and feasible procedure to perform in this center, with excellent results in terms of morbidity and mortality and we consider that this technique should be the route of choice for adult-pediatric living donors.

COVID 19 y embarazo en Chile: Informe preliminar del estudio multicéntrico GESTACOVID / COVID-19 and pregnancy in Chile: preliminary report of the GESTACOVID multicenter study

INTRODUCCIÓN: En Chile, los efectos maternos y perinatales de la pandemia por SARS-CoV-2 son aún desconocidos. GESTACOVID es un estudio multicéntrico que incluye embarazadas y puérperas hasta el día 42 con COVID-19. El objetivo de este estudio es presentar un informe preliminar, describiendo el impacto de la enfermedad en las embarazadas, factores de riesgo asociados y resultados perinatales. MÉTODOS: Estudio de cohorte descriptivo que incluye 661 pacientes enroladas entre el 7 de marzo y el 6 de julio de 2020, en 23 centros hospitalarios del país. Se analizaron variables demográficas, comorbilidades, características clínicas y del diagnóstico de COVID-19 y resultado materno y perinatal. RESULTADOS: Las pacientes hospitalizadas por COVID-19 tuvieron mayor prevalencia de hipertensión arterial crónica [10% vs 3%; OR=3,1 (1,5-6,79); p=0,003] y de diabetes tipo 1 y 2 [7% vs 2%; OR=3,2 (1,3-7,7); p=0,009] que las pacientes manejadas ambulatoriamente. Un IMC >40 kg/mt2 se asoció con un riesgo dos veces mayor de requerir manejo hospitalizado [OR=2,4 (1,2 - 4,6); p=0,009]. Aproximadamente la mitad de las pacientes (54%) tuvo un parto por cesárea, y un 8% de las interrupciones del embarazo fueron por COVID-19. Hasta la fecha de esta publicación, 38% de las pacientes continuaban embarazadas. Hubo 21 PCR positivas en 316 neonatos (6,6%), la mayoría (17/21) en pacientes diagnosticadas por cribado universal. CONCLUSIONES: Las embarazadas con COVID-19 y comorbilidades como diabetes, hipertensión crónica y obesidad mórbida deben ser manejadas atentamente y deberán ser objeto de mayor investigación. La tasa de transmisión vertical requiere una mayor evaluación para diferenciar el mecanismo y tipo de infección involucrada.

INTRODUCTION: In Chile, effects of the SARS-CoV-2 infection in pregnant women are unknown. GESTACOVID is a multicenter collaborative study including pregnant women and those in the postpartum period (until 42 days) who have had COVID-19. The purpose of this study is to report our preliminary results describing the clinical impact of COVID-19 in pregnant women, the associated risk factors and perinatal results. METHODS: Descriptive cohort study including 661 patients between April 7th and July 6th, 2020, in 23 hospitals. Demographical, comorbidities, clinical and diagnostic characteristics of COVID-19 disease and maternal and perinatal outcomes were analyzed. RESULTS: Pregnant women with COVID-19 admitted to the hospital were more likely to have chronic hypertension [10% vs 3%; OR=3.1 (1.5-6.79); p=0,003] and diabetes type 1 and 2 [7% vs 2%; OR=3.2 (1.3-7.7); p=0.009] than those with outpatient management. A body mass index of >40 kg/mt2 was associated with two-fold higher risk of hospitalization [OR=2.4 (1.2-4.6); p=0.009]. Almost half of patients (54%) were delivered by cesarean section, and 8% of the medically indicated deliveries were due to COVID-19. So far, 38% of the patients are still pregnant. Among 316 newborns, there were 21 positive PCR tests (6.6%), mostly from asymptomatic mothers undergoing universal screening. CONCLUSIONS: Pregnant women with COVID-19 and comorbidities such as diabetes, chronic hypertension and morbid obesity need a close follow up and should be a matter for further research. Vertical transmission of COVID-19 should be thoroughly studied to define the mechanisms and type of infection involved.

Diagnóstico y manejo de Himen Imperforado en una lactante menor / Diagnosis and management of Imperforated Hymen in an infant

INTRODUCCIÓN: El himen imperforado es la malformación congénita más frecuente del tracto genital femenino. La mayoría de los casos no se pesquisan en la infancia, debido a un examen genital insuficiente. Su diagnóstico y resolución deben ser precoces y definitivas para evitar complicaciones posteriores. OBJETIVO: Presentar el caso de una lactante portadora de himen imperforado, y actualizar la información sobre las técnicas de examen genital para detectar esta patología en forma precoz y su tratamiento. CASO CLÍNICO: Lactante de 3 meses, consultó por aumento de volumen protruyente en la zona del introito. En el examen físico se realizó maniobra de valsalva que dio salida a una masa homogénea, nacarada de superficie lisa, entre los labios mayores, sugerente himen imperforado. Se complementó el estudio con ultrasonido ginecológico, el que demostró la presencia de hidrocolpos, descartando otras anomalías. Se realizó una himenotomía, que dio salida a abundante material seroso, sin mal olor, y luego se completó la himenectomía mediante la resección de la membrana himeneal. En control al 4to mes posterior a la intervención se constató un himen ampliamente permeable. CONCLUSIÓN: Los equipos de atención neonatal, requieren capacitación acerca de la técnica correcta del examen genital externo de la recién nacida y lactante. La himenectomía es la técnica que permite resolver definitiva mente el cuadro evitando complicaciones.

INTRODUCTION: Imperforated hymen is the most frequent congenital malformation of the female genital tract. Most cases are not investigated in childhood, due to an insufficient genital examination. Its diagnosis and resolution must be early and definitive to avoid subsequent complications. OBJECTIVE: A clinical case of an infant with imperforated himen is presented. To update on genital examination technique necessary to detect this pathology in the newborn and infants, and the proper treatment. CLINICAL CASE: 3-months-old infant that consulted due to an increase in bulging volume in the introitus area. In the physical examination, the Valsalva's maneuver was performed allowed the ex pulsion of a homogeneous pearly mass with a smooth surface, between the labia majora, suggesting imperforate hymen. The study was complemented with gynecological ultrasound, which demons trated the presence of hydrocolpos, ruling out other anomalies. A hymenotomy was performed, which allowed for the evacuation of abundant serous material, with no bad smell, and then the hymenectomy was completed by resection of the hymenal membrane. In follow-up monitoring 4 months after the intervention, a widely permeable hymen was found. CONCLUSION: Neonatal care teams require training on the correct technique of external genital examination of the newborn and infant. Hymenectomy is the technique that allows definitely resolving the condition, avoiding complications.

[Diagnosis and management of Imperforated Hymen in an infant]. / Diagnóstico y manejo de Himen Imperforado en una lactante menor.

INTRODUCTION: Imperforated hymen is the most frequent congenital malformation of the female genital tract. Most cases are not investigated in childhood, due to an insufficient genital examination. Its diagnosis and resolution must be early and definitive to avoid subsequent complications. OBJECTIVE: A clinical case of an infant with imperforated himen is presented. To update on genital examination technique necessary to detect this pathology in the newborn and infants, and the proper treatment. CLINICAL CASE: 3-months-old infant that consulted due to an increase in bulging volume in the introitus area. In the physical examination, the Valsalva's maneuver was performed allowed the ex pulsion of a homogeneous pearly mass with a smooth surface, between the labia majora, suggesting imperforate hymen. The study was complemented with gynecological ultrasound, which demons trated the presence of hydrocolpos, ruling out other anomalies. A hymenotomy was performed, which allowed for the evacuation of abundant serous material, with no bad smell, and then the hymenectomy was completed by resection of the hymenal membrane. In follow-up monitoring 4 months after the intervention, a widely permeable hymen was found. CONCLUSION: Neonatal care teams require training on the correct technique of external genital examination of the newborn and infant. Hymenectomy is the technique that allows definitely resolving the condition, avoiding complications.

Access to healthcare in Chilean prisons: an inmates' perspective.

OBJECTIVES: To analyze the perception of access to Chilean prisons in a representative national sample of persons deprived of liberty as well as to examine the most important covariates of such access. MATERIALS AND METHODS: This study uses secondary data from the First National Survey on the Quality of Prison Life (2014), which investigated inmates' perceptions regarding access to health services inside the prisons. To do this, it uses descriptive statistics and a logistic regression model. RESULTS: Descriptive results at the national level show that access to health services in prisons tends to be "difficult" (44.7% of cases in this category). Multivariate logistic regression results indicate that men (OR=0.43) and those who reported better infrastructure (OR=0.70) were less likely to report "difficult access to health services". On the other hand, prison inmates (OR=1.61) and those who had reported higher levels of mistreatment (OR=1.26) were associated with a higher probability of reporting "difficult access to health services". DISCUSSION: Our study suggests that access to health care is dynamically linked to other aspects of life within prisons such as the composition of the prison population (gender), some of the material aspects of prisons (infrastructure, type of facility), and even some relational aspects (level of mistreatment/abuse). Future studies could further extend the debate on healthcare in prisons, incorporating more complex both variables and analyses.

Comparative Study of the Antimicrobial Effect of Nanocomposites and Composite Based on Poly(butylene adipate-co-terephthalate) Using Cu and Cu/Cu2O Nanoparticles and CuSO4.

Nanocomposites and a composite based on poly(butylene adipate-co-terephthalate) (PBAT) were synthesized using commercial copper nanoparticles (Cu-NPs), copper/cuprous oxide nanoparticles (Cu|Cu2O-NPs), and copper sulfate (CuSO4), respectively. The Cu|Cu2O-NPs were synthesized using chemical reduction and characterized by X-ray diffraction (XRD) and transmission electron microscopy (TEM). The synthesis of Cu|Cu2O-NPs yielded a mixture of Cu and Cu2O, with metal Cu having a spherical morphology of approximately 40 nm in diameter and Cu2O with a diameter of 150 nm. To prepare the nanocomposites (NCs) and the composite material (MC), the NPs and the CuSO4 salt were incorporated into the PBAT matrix in concentrations of 1, 3, and 5% p/p via an ex situ method. Fourier transform infrared spectroscopy (FTIR), a tensile test, differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), and agar diffusion assays were used for structural, thermomechanical, and antimicrobial characterization. Results showed that the reinforcements did not modify the chemical structure of the PBAT and only slightly increased the percentage of crystallization. The mechanical and thermal properties of the PBAT did not change much with the addition of fillers, except for a slight increase in tensile strength and thermal stability, respectively. The agar diffusion antimicrobial assays showed that the NCs and MCs had good inhibitory responses against the nonresistant strains Enterococcus faecalis, Streptococcus mutans, and Staphylococcus aureus. The MCs based on CuSO4 had the highest biocidal effect, even against the resistant bacteria Acinetobacter baumannii.

Metagenomic study of bacterial microbiota in persistent endodontic infections using Next-generation sequencing.

AIM: To determine the bacterial microbiota in root canals associated with persistent apical periodontitis and their relationship with the clinical characteristics of patients using next-generation sequencing (NGS). METHODOLOGY: Bacterial samples from root canals associated with teeth having persistent apical periodontitis were taken from 24 patients undergoing root canal retreatment. Bacterial DNA was extracted, and V3-V4 variable regions of the 16S rRNA gene were amplified. The amplification was deep sequenced by Illumina technology to establish the metagenetic relationships among the bacterial species identified. The composition and diversity of microbial communities in the root canal and their relationships with clinical features were analysed. Parametric and nonparametric tests were used to analyse differences between patient characteristics and microbial data. RESULTS: A total of 86 different operational taxonomic units (OTUs) were identified and Good's nonparametric coverage estimator method indicated that 99.9 ± 0.00001% diversity was recovered per sample. The largest number of bacteria belonged to the phylum Proteobacteria. According to the medical history from the American Society of Anesthesiologists (ASA) Classification System, ASA II-III had higher richness estimates and distinct phylogenetic relationships compared to ASA I individuals (P < 0.05). Periapical index (PAI) score 5 was associated with increased microbiota diversity in comparison to PAI score 4, and this index was reduced in symptomatic patients. CONCLUSIONS: Based on the findings of this study, it is possible to suggest a close relationship between several clinical features and greater microbiota diversity with persistent endodontic infections. This work provides a better understanding on how microbial communities interact with their host and vice versa.

Synthesis of Copper Nanowires and Their Antimicrobial Activity on Strains Isolated Persistent Endodontic Infections.

Copper nanowires, Cu-NWs may have a good antimicrobial effect in endodontic treatment. The objective of this work was to synthesize, characterize and evaluate the antibacterial activity of Cu-NWs on strains obtained from human root canal. A wide distribution of Cu-NWs diameters from 30 to 90 nm was obtained with lengths ranging from 5 to 40 µm. Structural analysis of Cu-NWs showed crystalline planes, which corresponded to Cu, with preferential growth in the direction [110]. The geometric mean MICs was of 289.30 µg/mL, with a MIC50 of 256 µg/mL and a MIC90 of 512 µg/mL for Cu-NWs. Cellular viability of 28 a biofilm tends to decrease the longer it is exposed to Cu-NWs. Synthesized and characterized Cu-NWs have a good antimicrobial effect against clinical strains used in the present study and has a potential to be used for disinfection of the root canal system.

¿Mejora el estudio genético pre-implantacional la probabilidad de embarazo clínico en parejas sometidas a IVF/ICSI?: Revisión sistemática y meta análisis / Does the pre-implantation genetic study improve the probability of clinical pregnancy in couples undergoing IVF / ICSI?

Una de las principales causas de la falla de los ciclos de fecundación in vitro es la aneuploídia embrionaria. OBJETVO: determinar si las pruebas de tamizaje genético pre-implantacional favorece la posibilidad de embarazos MÉTODOS: Se realizó un revisión sistemática y meta-análisis. Buscamos en las bases PUBMED y EMBAS, estudios publicados entre 2006-2016, que compararan el número de embarazos en fecundación in vitro con y sin tamizeje genético preimplantaicon RESULTADOS: De los 115 artículos analizados, 4 cumplieron los criterios de selección. Evaluamos un total de 221 ciclos con tamizje y 592 sin. No encontramos diferencias en la posibilidad de embarazo (RR 0.88; IC95% 0.71-1.10; p=0.28). Al hacer análisis por subgrupo de técnica de tamizaje, encontramos que el uso de hibridación fluosrescente in situ se asoció a una disminución en la posibilidad de embarazo (3 estudios, RR 0.53; IC95% 0.36-0.77; p=0.0009); mientras que el uso de hibidración genómica comparativa se asoció a un aumeto (1 estudio, RR 1.58; IC 95% 1.24-2.00; p<0.001). CONCLUSION: La eficacia de las pruebas de tamizaje genñeticos son dependientes de la técnica, por lo que se deberia favorecer el uso de hibidración genómica comparativa.

Probably, the main cause in IVF failure is the transfer of aneuploid embryos. OBJECT: To determine if the use of preimplantational genetic screening improves the pregnancy rate in IVF cycles, compared to regular IVF. METHODS: We performed a systematic review and meta-analysis, searching in PUBMED and EMBASE databases studies published between 2006-2016, comparing the pregnancy rates in women undergoing IVF with PGS with that of women undergoing IVF only. RESULTS: Of the 115 articles found, 4 met the selection criteria, with a total of 734 women between 33 and 41 years: 221 with PGS and 592 controls. We found no association between the use of PGS and pregnancy (RR 0.88, 95% CI 0.71-1.10, p = 0.28). However, we performed a subgroup analysis by technique of PGS, and found that fluorescent in situ hybridization was associated with a diminished risk of pregnancy (3 studies;(RR 0.53; 95% CI 0.36-0.77; p = 0.0009), whereas comparative genomic hybridization was associated with an increase (1 study, RR 1.58, CI95% 1,24-2.00, p<0.001). CONCLUSION: The effectivity of PGS is determined by the technique for PGS; therefore, only comparative genomic hybridization should be offered.

Células madre mesenquimales orales: estado del arte en Odontología / Oral mesenchymal stem cells: state of the art in dentistry

Desde la organogénesis y hasta estadios adultos, las células madre mesenquimales participan activamente dando origen y manteniendo la homeostasis del organismo. En la cavidad oral han sido aisladas desde variadas estructuras del órgano dental tales como el ligamento periodontal, pulpa dental, tejido gingival, folículo dental y papila apical significando una prometedora fuente de células madre mesenquimales las que pueden ser caracterizadas de acuerdo a los criterios mínimos establecidos por 'The International Society for Cellular Therapy' que son: a) La adherencia al plástico; b) La expresión de marcadores CD73, CD90, CD105 y la carencia de CD34,CD45, CD14, CD11, CD79, CD19 y HLA-DR (clase II); c) Capacidad multipotencial de diferenciación hacia linajeosteogénico, condrogénico y adipogénico. El objetivo de esta revisión consiste en realizar un levantamiento de la situación actual de este tema efectuando una revisión comprensiva de la literatura en los campos de; identificación a través de marcadores de superficie, aislamiento por medio de mecanismos de digestión enzimática o explante, almacenamiento atendiendo a la necesidad de suprimir el uso de suero fetal bovino como medio de cultivo en un esfuerzo por avanzar hacia aplicaciones terapéuticas, banca o criopreservación destacando nuevas experiencia en este campo como lo es la criopreservación de piezas dentales completas gracias a la tecnología láser Nd:YAG. Y, finalmente, las aplicaciones clínicas que promete este grupo de células a través de la medicina regenerativa y la ingeniería tisular tanto en el campo de la odontología como la medicina general (AU)

Since organogenesis and even adult stages, mesenchymal stem cells actively participate starting and maintaining body homeostasis. In the oral cavity they have been isolated from various structures dental organ such as the periodontal ligament, dental pulp, gingiva, dental follicle and apical papilla meaning a promising source of mesenchymal stem cells which can be characterized according to the minimum criteria set by The International Society for Cellular Therapy that are: a) the adherence to plastic, b) expression of markers CD73, CD90, CD105 and the absence of CD34, CD45, CD14, CD11, CD79, CD19 and HLA-DR (class II ) c) multipotent differentiation capacity to osteogenic lineage, chondrogenic and adipogenic. The objective of this review is to conduct a survey of the current status of this issue by a comprehensive review of the literature in the fields; identification through surface markers, isolation through mechanisms of enzymatic or explant, storage digestion with the need to eliminate the use of fetal bovine serum as the culture medium in an effort to move towards therapeutic applications, highlighting new banking and cryopreservation experience in this field such as the cryopreservation of whole teeth thanks to the NdYAG laser technology. And finally promising clinical applications this group of cells through regenerative medicine and tissue engineering both in the field of dentistry and general medicine (AU)

Reconstrucción perineal inmediata en extensa resección abdominoperineal rectal / Immediate perineal reconstruction after vast rectal abdominoperineal resection

Background: Buschke-Lowenstein tumor is a benign skin lesion secondary to human papilloma virus infection. It usually appears as an exophytic anogenital mass and may progress to a squamous cell carcinoma. It can be treated with chemo, radio or immunotherapy and occasionally it requires radical surgery. Case report: We report a 53 years old male with a perianal lesion lasting 15 years that was treated with chemo-radiotherapy that relapsed with malignant transformation. Since the pathological study showed a squamous cell carcinoma, a rectal abdominoperineal resection was planned. The defect that left the surgical procedure was covered with musculocutaneous flaps from gracilis muscle of the thigh.

Introducción: El tumor de Buschke-Lõwenstein es una lesión cutánea benigna, secundaria a la infección por virus papiloma humano, usualmente se presenta como una gran masa exofítica genitoanal y tiene riesgo de evolucionar a carcinoma espinocelular. Dentro de su tratamiento existen varias alternativas, desde menos agresivas como quimio-radioterapia e inmunoterapia, que suelen tener alta tasa de recidiva, hasta la cirugía radical. Caso clínico: Presentamos el caso de un paciente masculino, con una lesión perianal de 15 años de evolución, inicialmente se sometió a terapias locales conservadoras y quimiorradioterapia y posteriormente recidivó con transformación maligna. Habiéndose confirmado histológicamente la presencia de carcinoma espinocelular, debió abordarse mediante una resección abdominoperineal rectal. Dicha cirugía determinó un gran defecto de cobertura perianal y perineal que fue reparado mediante colgajos músculo-cutáneos de gracilis y fasciocutáneos de muslo. Discusión: Si bien se han descrito algunos métodos de resección local, sólo la cirugía radical permite su eliminación completa disminuyendo el riesgo de recurrencia. Ello genera un defecto perianal de difícil manejo, para el cual existen varias opciones reconstructivas: injertos, colgajos locales y regionales, y, con menor frecuencia, colgajos libres. Se debe considerar que en aquellos defectos de gran tamaño, con gran pérdida de tejido, las opciones de reconstrucción del defecto con volumen y cobertura cutánea adecuada son limitadas. Presentamos nuestra experiencia con algunas de estas técnicas, entre las que destaca el colgajo de músculo gracilis, con los múltiples beneficios que posee.

Experiencia: aceptabilidad del uso de simulación clínica en educación médica: la experiencia del curso Síntesis de Conocimientos en Medicina / Experience: acceptability of clinical simulation in medical education: Course experience of Synthesis Medical knowledge

Clinical simulation is a technique with multiple benefits. Supervised professional practice results the best predictor of performance quality of a determined clinical skill. The “Summary of Medical Knowledge” course considers within its objectives enhancing necessary clinical skills before graduating, which is done through clinical simulation. Materials and methods: Voluntary participating activity was developed, considering performance in 5 clinical stations, which were assessed by Objective Structured Clinical Examination (OSCE). This activity was held at the Clinical Skill Centre, Faculty of Medicine, University of Chile. The evaluated skills were chosen based on information provided by graduates 2010-2012 about their own perception of competences. Results: 89 students and 53 teachers participated voluntarily. Over 90 percent of respondents (both teachers and students) stated that the activity was a great contribution to become aware of their own skills and limitations, resulting relevant and essential for medical training. Discussion: Simulation is feasible as a method of training in undergraduates, with a high rate of satisfaction for both students and teachers, encouraging the acquisition of clinical skills.

Resección hepática laparoscópica / Laparoscopic liver resection

Laparoscopic liver resection is a technique that has boomed over time. Published related reports have increased exponentially in the last decade, leading to comparative studies and meta-analysis. Three types of technical approaches have been identified: pure laparoscopic, hand-assisted and hybrids procedures. While no precise indications exist for each method, the choice of each will depend on the type of surgical procedure and the surgeon's experience. Primarily only benign lesions were accepted for a laparoscopic intervention. Today malignant lesions, including metastases, are being resected via minimally invasive approach. Case selection may benefit in successful operative outcomes. Ideally, single lesions, less than 5 cm, peripheral and located at lateral or peripheral segments (II-VI) are better suited for laparoscopic liver resection. In addition, these procedures will be likely to succeed under expert experienced laparoscopic liver surgeons that have the best available technology within their reach. Reported results support the use of this technique when compared with open surgery in regards to minor: blood loss, use of opioids, time to oral intake, length of stay and complications. Furthermore, total costs are at least similar to the open approach. Most importantly, results from 5-year follow up studies of patients with malignant disease, in terms of disease-free survival and overall survival were equivalent to open surgery...

La resección hepática laparoscópica constituye una técnica que ha tenido gran desarrollo con el tiempo. Los reportes publicados han aumentado, dando paso a estudios comparativos y meta análisis. Se han diferenciado tres tipos de procedimientos, los laparoscópicos puros, los mano-asistidos y los híbridos. Si bien no hay indicaciones precisas para cada técnica, la elección de cada una de ellas dependerá del procedimiento y la experiencia del cirujano. Inicialmente sólo se aceptaba la resección de lesiones benignas, mientras hoy también se acepta para lesiones malignas, incluyendo metástasis. Se ha definido que las lesiones ideales para resecar son: lesiones únicas, menores a 5 cm, de ubicación periférica y de los segmentos laterales o periféricos (II al VI). A esto se suma que sólo cirujanos expertos que cuenten con toda la tecnología necesaria disponible sean los encargados de realizar estos procedimientos. Los resultados reportados avalan el uso de esta técnica al compararla con cirugía abierta en lo que respecta a menores: pérdidas sanguíneas, uso de opioides, tiempo a la ingesta oral, estadía hospitalaria y complicaciones, considerando que los costos totales son al menos similares a la técnica abierta. Sin embargo, lo más importante es que durante el seguimiento de los pacientes con patología maligna, los resultados oncológicos a 5 años han sido equivalentes a la cirugía abierta en lo que respecta a sobrevida libre de enfermedad y sobrevida total...

Cirugía laparoscópica colorrectal en Chile / Laparoscopic colorectal surgery in Chile

The development of laparoscopic colorectal surgery began 20 years ago; however it took several years before gaining its acceptance by the international surgical community. The first report in Chile was published in 1995. However, were necessary many years, until the middle of this decade, to know the first prospective series experiences. Out of these reports, no reliable data exist regarding the development of laparoscopic colorectal surgery in Chile, related to the number of centers performing laparoscopic colorectal surgery or the number of procedures performed. For record these data, a standardized questionnaire was send to colorectal chairmans of all hospitals that had reported to be developing laparoscopic colorectal surgery in our country. Ten of 15 hospitals responded to the survey. Most of the procedures performed were hemicolectomies, principally for cancer and diverticular disease. The average conversion rate was 7 percent and hospital stay was 5 days. Morbidity and mortality rates were 12 percent and 0.4 percent respectively. In the last year was seen an increase in the number of laparoscopic procedures in relation to the previous period. In conclusion, laparoscopic colorectal surgery is a recent technique in Chile, which is being implemented progressively, with good overall results.

El desarrollo de la cirugía laparoscópica colorrectal (CLCR) se inició en la década de los 90, sin embargo, pasaron varios años antes de lograr su aceptación por la comunidad quirúrgica internacional. En Chile, los primeros relatos en congresos datan del año 1995 y las primeras experiencias de series prospectivas fueron publicadas 10 años más tarde. Fuera de estos reportes, no existe información fidedigna en relación al desarrollo de la cirugía laparoscópica colorrectal en Chile, relacionados con el número de centros que la realizan, la formación actual de los cirujanos colorrectales en esta técnica ni en cuanto al número de procedimientos realizados. Para conocer estos datos se envió una encuesta estandarizada a los jefes de equipo de los centros que habían comunicado estar desarrollando la CLCR en nuestro país. Diez de 15 centros respondieron la encuesta. La mayor parte de los procedimientos corresponden a hemicolectomías, siendo las principales indicaciones el cáncer y la enfermedad diverticular. La tasa de conversión promedio fue de 7 por ciento y la estadía hospitalaria de 5 días. La morbilidad y mortalidad fue de 12 por ciento y 0,4 por ciento respectivamente. En el último año se ha visto un aumento del número de procedimientos laparoscópicos en relación al período previo. En conclusión, La CLCR es una técnica de reciente incorporación en Chile, que está siendo implementada en forma progresiva, con buenos resultados globales.

Phenotype-assisted transcriptome analysis identifies FOXM1 downstream from Ras-MKK3-p38 to regulate in vitro cellular invasion.

The Ras oncogene is known to activate three major MAPK pathways, ERK, JNK, p38 and exert distinct cellular phenotypes, that is, apoptosis and invasion through the Ras-MKK3-p38-signaling cascade. We attempted to identify the molecular targets of this pathway that selectively govern the invasive phenotype. Stable transfection of NIH3T3 fibroblasts with MKK3(act) cDNA construct revealed similar p38-dependent in vitro characteristics observed in Ha-Ras(EJ)-transformed NIH3T3 cells, including enhanced invasiveness and anchorage-independent growth correlating with p38 phosphorylation status. To identify the consensus downstream targets of the Ras-MKK3-p38 cascade involved in invasion, in vitro invasion assays were used to isolate highly invasive cells from both, MKK3 and Ha-Ras(EJ) transgenic cell lines. Subsequently a genome-wide transcriptome analysis was employed to investigate differentially regulated genes in invasive Ha-Ras(EJ)- and MKK3(act)-transfected NIH3T3 fibroblasts. Using this phenotype-assisted approach combined with system level protein-interaction network analysis, we identified FOXM1, PLK1 and CDK1 to be differentially regulated in invasive Ha-Ras(EJ)-NIH3T3 and MKK3(act)-NIH3T3 cells. Finally, a FOXM1 RNA-knockdown approach revealed its requirement for both invasion and anchorage-independent growth of Ha-Ras(EJ)- and MKK3(act)-NIH3T3 cells. Together, we identified FOXM1 as a key downstream target of Ras and MKK3-induced cellular in vitro invasion and anchorage-independent growth signaling.

Resultados perioperatorios y sobrevida alejada de la pancreatoduodenectomía con resección vascular / Pancreaticoduodenectomy with vascular resection: perioperative results and long-term survival

Background: Pancreaticoduodenectomy (PDD) with vascular resection (VR) of the portal and superior mesenteric vein for locally advanced periampullary tumors is controversial. Aim: To evaluate the perioperative results and long-term survival of PDD with VR. Patients and Methods: Retrospective study. We included patients with periampullary tumors who underwent a PDD with VR between 1990 and 2008. We compared perioperative results and long-term survival with PDD without VR during the same period. We compared survival with non resected patients. Results: One hundred and eighty eight patients underwent a PDD, a VR was performed in 8 (4 percent) patients (Age: 58 +/- 14 years, Male: 4). Morbidity for PDD with and without VR was 75 percent and 59 percent (p = ns). Surgical mortality for PDD with and without VR was 0 percent and 8 percent (p = ns). In 6 of 8 patients the diagnosis was pancreatic cancer and histopathologic confirmation of vascular invasion was present in 4 patients. Long-term survival for patients with PDD with and without VR was similar (median 25 and 16 months; p = ns). Survival for patients with PDD with VR was superior to non resected patients (median 25 and 3 months; p = 0.0001). Conclusions: PDD with VR has similar perioperative results and long-term survival to PDD without VR. The survival reached with this type of surgery is far superior to non resected patients.

Introducción: La pancreatoduodenectomía (PDD) con resección vascular (RV) cuando existe invasión de la vena porta o mesentérica superior (VP-VMS) es controversial. Objetivo: Evaluar los resultados del perioperatorio y la sobrevida alejada de los pacientes sometidos a esta técnica. Material y Método: Estudio retrospectivo que incluyó a los pacientes con un tumor periampular en quienes se realizó una PDD con RV entre 1990 y 2008. Se compararon los resultados del perioperatorio y de sobrevida alejada con el grupo sometido a una PDD sin RV durante el mismo período. Se comparó también la sobrevida con los pacientes no resecados. Resultados: Se realizaron 188 PDD, en 8 (4 por ciento) de estos pacientes se realizó PDD con RV (Edad: 58 +/- 14 años, Hombres: 4). La morbilidad postoperatoria para la PDD con y sin RV fue de 75 por ciento y 59 por ciento (p = ns). La mortalidad postoperatoria para los grupos con y sin RV fue de 0 por ciento y 8 por ciento (p = ns). En 6 de los 8 pacientes el diagnóstico fue cáncer de páncreas y en 4 se confirmó histopatológicamente la invasión de VP-VMS. La sobrevida del grupo con y sin RV no tuvo diferencia significativa (medianas 25 y 16 meses; p = ns). La sobrevida de los pacientes sometidos a una PDD con RV fue superior a los pacientes no resecados (medianas 25 y 3 meses; p = 0,0001). Conclusiones: La PDD con RV obtiene resultados perioperatorios y de sobrevida alejada comparables a una PDD sin RV. La sobrevida alcanzada con esta técnica es ampliamente superior a la de los pacientes no resecados.