Percutaneous Balloon Compression for the Treatment of Trigeminal Neuralgia: A Review of 10 Years of Clinical Experience.

BACKGROUND: Trigeminal neuralgia (TN) is defined as a spontaneous painful sensation in the trigeminal nerve territory. The pain intensity of TN is classified into different grades of suffering that affect a patient's quality of life. Percutaneous balloon compression of the ganglion is a neurosurgical option that is easy, reproducible, and can reduce the morbidity of TN. METHODS: We retrospectively analyzed all patients treated with trigeminal nerve percutaneous balloon compression at the Clinical Hospital of the University of Chile between January 2012 and May 2022. Data collected from electronic records included demographic information, medical and surgical history, type of anesthesia and drugs used during surgery, balloon inflation time, surgery time, operative room time, intraoperative events, postoperative complications, duration of hospitalization, and duration of follow-up.  Results: We identified 63 patients who met our inclusion criteria. The median patient age was 62 years (interquartile range [IQR] 57-69 years). Sixty-five percent of the patients were female. The simultaneous involvement of the second and third branches of the trigeminal nerve was the most frequent symptom. Before surgery, the patients experienced an average of 6.6 years of pain (IQR 2-10 years). Right neuralgia was the most frequent laterality type (69%). Forty percent of the patients had a previous surgical procedure for neuralgia, with treatment failure being the most frequent surgical indication (63%). According to the procedure, the mean balloon insufflation volume was 0.89±0.12 mL with a median compression time of 2.5 min (IQR 2.1-4.0 min). No hemorrhagic complications were observed. Furthermore, during follow-up, there were no surgical complications among any of the patients; however, 6.4% of patients required a second intervention. The pain-free period was two years in 60% of patients and five years in 23% of patients. CONCLUSIONS: TN is a painful condition. Although there are multiple surgical approaches, we believe that percutaneous balloon compression is an excellent alternative treatment option that offers high effectiveness, low morbidity, and low hospital stay.

Influencia del uso de injertos óseos asociados a corticotomía. Revisión Sistemática

Introducción: La corticotomía corresponde a un procedimiento quirúrgico, basado en el Fenómeno de Aceleración Regional (RAP), que tiene por objetivo disminuir hasta en un tercio el tiempo del tratamiento ortodóncico. Esta técnica se puede ejecutar agregando un injerto óseo que aumenta el grosor alveolar, lo que se conoce como Ortodoncia Osteogénica Acelerada Periodontalmente (PAOO) permitiendo un movimiento más amplio y rápido. Objetivo: Determinar la condición final del tejido óseo vestibular en pacientes tratados con corticotomía que recibieron injerto óseo versus pacientes que no recibieron. Materiales y métodos: Se realiza una búsqueda electrónica en la Biblioteca Nacional de Medicina PUBMED bajo la estrategia: "orthodontics" OR "orthodontic treatment" and "osteotomy" OR "corticotomy" OR "periodontally accelerated" and "bone graft" OR "bone grafting" OR "augmented corticotomy" AND "tooth movement". Se realizó el análisis de riesgo de sesgo con la herramienta ROBINS-I. Resultados: La búsqueda arrojo un total de 92 artículos de los cuales 4 fueron elegidos para el análisis Conclusión: Existe una cantidad limitada de estudios sobre el tema, presentando riesgo de sesgo de moderado a alto. Considerando esto, la evidencia indica que la utilización de injerto óseo y membrana contribuye a mejorar las condiciones anatómicas, especialmente si esta última se utiliza fijada.

Introduction: Corticotomy is a surgical procedure based on the Regional Acceleratory Phenomenon (RAP), whose objective is to reduce up to a third the time of orthodontic treatment. This technique can be performed adding a bone graft for the augmentation of the alveolar width and allowing a broader movement. This is known as Periodontally accelerated osteogenic orthodontics (PAOO). Objective: To determine the final condition of the buccal bone tissue after treatment in patients who received corticotomy and bone graft versus corticotomy alone. Materials and methods: An electronic search in the National Library of Medicine PUBMED was performed utilizing the following strategy: "orthodontics" OR "orthodontic treatment" and "osteotomy" OR "corticotomy" OR "periodontally accelerated" and "bone graft" OR "bone grafting" OR "augmented corticotomy" AND "tooth movement". Risk of bias analysis was done utilizing the ROBINS-I tool. Results: The search yielded a total of 92 articles, of which 4 were considered for analysis. Conclusion: There is a limited number of studies regarding this topic and their risk of bias is moderate to high. Thus, the available evidence suggests that the use of bone graft and a resorbable membrane contributes to the improvement of the anatomical conditions, especially if the latter is fixed.

Complete Lipopolysaccharide of Piscirickettsia salmonis Is Required for Full Virulence in the Intraperitoneally Challenged Atlantic Salmon, Salmo salar, Model.

Bacterial cell envelopes play a critical role in host-pathogen interactions. Macromolecular components of these structures have been closely linked to the virulence of pathogens. Piscirickettsia salmonis is a relevant salmonid pathogen with a worldwide distribution. This bacterium is the etiological agent of piscirickettsiosis, a septicemic disease that causes a high economic burden, especially for the Chilean salmon farming industry. Although P. salmonis has been discovered long ago, its pathogenicity and virulence mechanisms are not completely understood. In this work, we present a genetic approach for producing in-frame deletion mutants on genes related to the biosynthesis of membrane-associated polysaccharides. We provide a detailed in vitro phenotype description of knock-out mutants on wzx and wcaJ genes, which encode predicted lipopolysaccharide (LPS) flippase and undecaprenyl-phosphate glucose phosphotransferase enzymes, respectively. We exhibit evidence that the wzx mutant strain carries a defect in the probably most external LPS moiety, while the wcaJ mutant proved to be highly susceptible to the bactericidal action of serum but retained the ability of biofilm production. Beyond that, we demonstrate that the deletion of wzx, but not wcaJ, impairs the virulence of P. salmonis in an intraperitoneally infected Atlantic salmon, Salmo salar, model of piscirickettsiosis. Our findings support a role for LPS in the virulence of P. salmonis during the onset of piscirickettsiosis.

Análisis de los fundamentos biológicos del Sistema Ertty Gap III®

RESUMEN: Las maloclusiones clase III durante muchos años han sido un reto en ortodoncia, siendo reconocidas como un desafío diagnóstico y terapéutico para el clínico. En la mayoría de los casos, si no se realiza un tratamiento temprano, la cirugía ortognática se transforma en la única opción para establecer una oclusión correcta y mejorar las caracterÍsticas faciales. El objetivo principal de la intervención temprana, es crear un entorno más favorable para el crecimiento. A lo largo de la historia se han utilizado distintos aparatos ortopédicos para el tratamiento temprano de esta maloclusión, sin embargo se ha observado que muchas veces sus resultados son insuficientes o ineficaces. El Sistema Ertty Gap III® , viene a revolucionar el enfoque con el cual se trataban las maloclusiones Clase III, orientando los efectos terapéuticos a la premaxila, la cual se pensaba inactiva como sitio de crecimiento. La evidencia actual respecto a este sistema es escasa, sin embargo, el uso de ortopedia de fácil manejo a un bajo costo económico, ofrece una alternativa terapéutica en etapas tempranas que permitiría crear un entorno más favorable para el crecimiento, la oclusión y la estética facial.

ABSTRACT: Class III malocclusions have been a challenge in orthodontics for many years, recognized as a diagnostic and therapeutic challenge for the clinician. In most cases, if early treatment is not performed, orthognathic surgery becomes the only option to achieve a correct occlusion and improve facial characteristics. The main goal of early intervention is to create a more favorable environment for growth. Throughout history, different orthopedic devices have been used for the early treatment of this malocclusion. However, it has been observed that their results are often insufficient or ineffective. The Ertty Gap III System comes to revolutionize the approach to the treatment of Class III malocclusions, directing the therapeutic effects to the premaxilla, which was thought to be an inactive growth site. The current evidence regarding this system is scarce; however, easy-to-use orthopedics at a low cost offers a therapeutic alternative in early stages that would allow a more favorable environment for craniofacial growth, occlusion and facial aesthetics.

Relación entre el patrón dactiloscópico epidérmico y dérmico / Relationship between the epidermal and the dermal dactyloscopic pattern

El método más utilizado en identificación humana es el dactiloscópico, que registra, analiza y coteja los tipos fundamentales y puntos característicos de las figuras presentes en el dactilograma, determinando el grado de coincidencia, entre un patrón de identidad dubitada y uno de identidad indubitada. Debido a los procesos que afectan la piel de cadáveres, como la putrefacción entre otros, se utilizan las técnicas necropapiloscópicas que ocupan los patrones dérmicos para la identificación humana. El objetivo del presente trabajo es comparar registros epidérmicos con dérmicos, y validar científicamente, este método de identificación (epidérmico - dérmico). Para ello se utilizaron 32 dedos de cadáveres de individuos chilenos, de ambos sexos y de entre 40 y 80 años. Para obtener el registro físico artificial epidérmico y dérmico se utilizó la técnica de obtención de impresiones necrodactilares y se comparó a través de la técnica de cotejo dactiloscópico. Estos procedimientos fueron realizados por peritos criminalísticos de Carabineros de Chile. Se logró evidenciar diferencias importantes entre epidermis y dermis en cuanto a cantidad y calidad de puntos característicos y presencia de líneas seniles. En relación a tipos fundamentales, se evidenció que en dermis es difícil la observación de tipos fundamentales (borrosos) pero no se encontró ningún dígito que presentara tipo fundamental diferente entre epidermis y dermis. También se constataron diferencias por sexo y edad. Finalmente se pudo evidenciar, que existe una relación morfológica semejante entre registros físicos artificiales de patrones papiloscópicos epidérmicos con dérmicos provenientes del mismo individuo. Esto permite utilizar los registros dérmicos para la identificación humana positiva. Los resultados de este trabajo son importantes al aportar evidencia científica para la identificación humana en base al patrón dactiloscópico dérmico.

The most used method in human identification is the dactyloscopy, which registers, analyzes and collates the fundamental types and characteristic points of figures present in the dactylogram determining the degree of coincidence, between a pattern of identity that is dubious, and one that is indubious. Due to the processes that affect the skin of corpses, such as putrefaction, the necropapiloscopy techniques that occupy the dermal patterns for human identification are used. The objective of the present work is to compare epidermal with dermal records and validate scientifically, this method of identification (epidermal - dermal). For this purpose, 32 cadaveric fingers of Chilean individuals, of both sexes and between 40 and 80 years were used. In order to obtain the epidermal and dermal artificial physical record, the technique of obtaining necrodactyle impressions was used and compared through of the technique of dactyloscopic comparison. These procedures were carried out by criminalistic experts of Carabineros de Chile. It was possible to show important differences between epidermis and dermis in terms of quantity and quality of characteristic points and presence of senile lines. In relation to fundamental types, it was evidenced that in the dermis it is difficult to observe fundamental types (blurred) but no digit was found that presented a different of fundamental type between epidermis and dermis. There were also differences by sex and age. Finally, it was possible to demonstrate that there is a similar morphological relationship between artificial physical records of epidermal papiloscopic patterns with dermal patterns from the same individual. This allows the use of dermal records for positive human identification. The results of this work are important in providing scientific evidence for human identification based on the dermal fingerprint pattern.

First Complete Genome Sequence of Piscine Orthoreovirus Variant 3 Infecting Coho Salmon (Oncorhynchus kisutch) Farmed in Southern Chile.

We report here the complete genome of an isolate of piscine orthoreovirus variant 3 sequenced from a moribund coho salmon with jaundice that was reared in a seawater farm in southern Chile. The genome consists of 23,627 bp, including 10 segments that range from 1,052 bp (segment S4) to 4,014 bp (segment L1).

Isolation, Functional Characterization and Transmissibility of p3PS10, a Multidrug Resistance Plasmid of the Fish Pathogen Piscirickettsia salmonis.

Antibiotic resistance is a major public health concern due to its association with the loss of efficacy of antimicrobial therapies. Horizontal transfer events may play a significant role in the dissemination of resistant bacterial phenotypes, being mobilizable plasmids a well-known mechanism. In this study, we aimed to gain insights into the genetics underlying the development of antibiotic resistance by Piscirickettsia salmonis isolates, a bacterial fish pathogen and causative agent of salmonid piscirickettsiosis, and the main target of antibiotics used in Chilean salmon farming. We provide experimental evidence that the plasmid p3PS10, which harbors multidrug resistance genes for chloramphenicol (cat2), tetracyclines [tet(31)], aminoglycosides (sat1 and aadA1), and sulfonamides (sul2), is carried by a group of P. salmonis isolates exhibiting a markedly reduced susceptibility to oxytetracycline in vitro (128-256 µg/mL of minimal inhibitory concentration, MIC). Antibiotic susceptibility analysis extended to those antibiotics showed that MIC of chloramphenicol, streptomycin, and sulfamethoxazole/trimethoprim were high, but the MIC of florfenicol remained at the wild-type level. By means of molecular cloning, we demonstrate that those genes encoding putative resistance markers are indeed functional. Interestingly, mating assays clearly show that p3PS10 is able to be transferred into and replicate in different hosts, thereby conferring phenotypes similar to those found in the original host. According to epidemiological data, this strain is distributed across aquaculture settings in southern Chile and is likely to be responsible for oxytetracycline treatment failures. This work demonstrates that P. salmonis is more versatile than it was thought, capable of horizontally transferring DNA, and probably playing a role as a vector of resistance traits among the seawater bacterial population. However, the low transmission frequency of p3PS10 suggests a negligible chance of resistance markers being spread to human pathogens.

The Genome Sequence of an Oxytetracycline-Resistant Isolate of the Fish Pathogen Piscirickettsia salmonis Harbors a Multidrug Resistance Plasmid.

The amount of antibiotics needed to counteract frequent piscirickettsiosis outbreaks is a major concern for the Chilean salmon industry. Resistance to antibiotics may contribute to this issue. To understand the genetics underlying Piscirickettsia salmonis-resistant phenotypes, the genome of AY3800B, an oxytetracycline-resistant isolate bearing a multidrug resistance plasmid, is presented here.

First Complete Genome Sequence of Tenacibaculum dicentrarchi, an Emerging Bacterial Pathogen of Salmonids.

Tenacibaculum-like bacilli have recently been isolated from diseased sea-reared Atlantic salmon in outbreaks that took place in the XI region (Región de Aysén) of Chile. Molecular typing identified the bacterium as Tenacibaculum dicentrarchi. Here, we report the complete genome sequence of the AY7486TD isolate recovered during those outbreaks.

Analysis of Y-chromosome STRs in Chile confirms an extensive introgression of European male lineages in urban populations.

We analyzed the Y chromosome haplotypes (Yfiler) of 978 non-related Chilean males grouped in five sampling regions (Iquique, Santiago de Chile, Concepción, Temuco and Punta Arenas) covering main geo-political regions. Overall, 803 different haplotypes and 688 singletons were observed. Molecular diversity was moderately lower than in other neighboring countries (e.g. Argentina); and AMOVA analysis on Y-STR haplotypes showed that among variation within Chile accounted for only 0.25% of the total variation. Punta Arenas, in the southern cone, showed the lowest haplotype diversity, and discrimination capacity, and also the highest matching probability of the five Chilean samples, probably reflecting its more marked geographic isolation compared to the other regions. Multidimensional scaling (MDS) analysis based on RST genetic distances suggested a close proximity of Chilean Y-chromosome profiles to European ones. Consistently, haplogroups inferred from Y-STR profiles revealed that the Native American component constituted only 8% of all the haplotypes, and this component ranged from 5% in the Centre of the country to 9-10% in the South and 13% in the North, which is in good agreement with the distribution of Native American communities in these regions. AMOVA computed on inferred haplogroups confirmed the very low among variation observed in Chilean populations. The present project provides the first Chilean dataset to the international Y-chromosome STR Haplotype Reference Database (YHRD) and it is also the first reference database for Y-chromosome forensic casework of the country.

Revealing latitudinal patterns of mitochondrial DNA diversity in Chileans.

The territory of Chile is particularly long and narrow, which combined with its mountainous terrain, makes it a unique scenario for human genetic studies. We obtained 995 control region mitochondrial DNA (mtDNA) sequences from Chileans representing populations living at different latitudes of the country from the North to the southernmost region. The majority of the mtDNA profiles are of Native American origin (∼88%). The remaining haplotypes are mostly of recent European origin (∼11%), and only a minor proportion is of recent African ancestry (∼1%). While these proportions are relatively uniform across the country, more structured patterns of diversity emerge when examining the variation from a phylogeographic perspective. For instance, haplogroup A2 reaches ∼9% in the North, and its frequency decreases gradually to ∼1% in the southernmost populations, while the frequency of haplogroup D (sub-haplogroups D1 and D4) follows the opposite pattern: 36% in the southernmost region, gradually decreasing to 21% in the North. Furthermore, there are remarkable signatures of founder effects in specific sub-clades of Native American (e.g. haplogroups D1j and D4p) and European (e.g. haplogroups T2b3 and K1a4a1a+195) ancestry. We conclude that the magnitude of the latitudinal differences observed in the patterns of mtDNA variation might be relevant in forensic casework.

A reference frequency database of 15 autosomal STRs in Chile.

We estimated the allele frequencies for the 15 autosomal STR loci included in the AmpFlSTR(®) Identifiler (Applied Biosystems, USA) in a sample of 986 unrelated non-Native American individuals collected at five different localities from Chile, namely, Iquique, Santiago, Concepción, Temuco and Punta Arenas. Frequency distributions and several forensic parameters were estimated at each recruitment site. In addition, analyses were carried out merging the data into five sample locations. No significant statistical differences could be detected between different regions in Chile. These data represent one of the very few studies performed on autosomal STRs in Chile and therefore provide a useful tool for forensic casework carried out in the country.

Comparative Genome Analysis of Two Isolates of the Fish Pathogen Piscirickettsia salmonis from Different Hosts Reveals Major Differences in Virulence-Associated Secretion Systems.

Outbreaks caused by Piscirickettsia salmonis are one of the major threats to the sustainability of the Chilean salmon industry. We report here the annotated draft genomes of two P. salmonis isolates recovered from different salmonid species. A comparative analysis showed that the number of virulence-associated secretion systems constitutes a main genomic difference.

Draft Genome Sequence of the Fish Pathogen Yersinia ruckeri Strain 37551, Serotype O1b, Isolated from Diseased, Vaccinated Atlantic Salmon (Salmo salar) in Chile.

We sequenced the genome of a motile O1b Yersinia ruckeri field isolate from Chile, which is causing enteric redmouth disease (ERM) in vaccinated Atlantic salmon (Salmo salar). The draft genome has 3,775,486 bp, a G+C content of 47.1%, and is predicted to contain 3,406 coding sequences.

High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock.

We report the successful treatment of two patients with aneurismal subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemofiltration. These rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental effects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemofiltration is a non-conventional hemodynamic support that has several potential mechanisms for improving septic shock. In this manuscript, we briefly review these therapies and the related evidence. When other conventional treatments are insufficient for providing safe limits of oxygenation and perfusion as part of basic neuroprotective care in subarachnoid hemorrhage patients, these rescue therapies should be considered on a case-by-case basis by an experienced critical care team.

Hemofiltração de alto volume e ventilação em posição prona em hemorragia subaracnóidea complicada por grave síndrome do desconforto respiratório agudo e choque séptico refratário / High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock

Relatamos o tratamento bem-sucedido de dois pacientes com hemorragia subaracnóidea complicada com grave falência respiratória e choque séptico refratário, utilizando, simultaneamente, ventilação em posição prona e hemofiltração de alto volume. Esses tratamentos de resgate permitiram que os pacientes superassem a grave situação sem complicações associadas ou efeitos deletérios na pressão intracraniana e de perfusão cerebral. A ventilação em posição prona é, hoje, um tratamento aceito para síndrome de desconforto respiratório agudo grave, e a hemofiltração de alto volume é um suporte hemodinâmico não convencional, que tem diversos mecanismos potenciais para melhorar o choque séptico. Neste artigo revisamos brevemente esses tratamentos e as evidências relacionadas. Quando outras terapias convencionais são insuficientes para proporcionar oxigenação e perfusão como parte do cuidado neuroprotetor básico dentro de limites seguros em pacientes com hemorragia subaracnóidea, esses tratamentos de resgate podem ser considerados caso a caso por uma equipe com experiência em cuidados críticos.

We report the successful treatment of two patients with aneurismal subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemofiltration. These rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental effects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemofiltration is a non-conventional hemodynamic support that has several potential mechanisms for improving septic shock. In this manuscript, we briefly review these therapies and the related evidence. When other conventional treatments are insufficient for providing safe limits of oxygenation and perfusion as part of basic neuroprotective care in subarachnoid hemorrhage patients, these rescue therapies should be considered on a case-by-case basis by an experienced critical care team.

[Spondylodiscitis. Analysis of 25 cases]. / Espondilodiscitis. Análisis de una serie de 25 casos.

BACKGROUND: Spondylodiscitis is a rare but prolonged inflammation of two adjacent vertebral bodies and the disk in between. AIM: To report the clinical features of a series of patients with spondylodiscitis. MATERIAL AND METHODS: A retrospective analysis of medical records of patients with spondylitis, identified between 1989 and 2002. RESULTS: A total of 25 cases were identified, 15 female, aged 49.8 years as a mean. Their mean evolution before admission was 4.3 months. Main complaints were back or radicular pain. Mild anemia was present in most patients. Mean erythrocyte sedimentation rate and C reactive protein values were 66 mm/h and 60 mg/L, respectively. Forty four percent of patients had neurological complications. Vertebral computed tomography and scintigraphic studies were done in 72% of patients, but magnetic resonance imaging was done only in 4 (16%). In 18 patients, a tissue sample for pathological and microbiological analysis, was obtained by imaging guiding or surgically. Tuberculosis, diagnosed on pathology, was the leading cause of spondylitis in nine cases (36%), followed by Staphylococcus aureus infection in five (20%). Other agents found were E coli and group D Streptococcus (one each). Age, symptoms, evolution time and different laboratory parameters did not differ between patients with tuberculosis and patients with other causes. A microbiological cause was not established in 36% of cases. Most patients evolved satisfactorily and recovered from neurological complications (88%). One patient with tuberculosis did not improve after prolonged treatment and 2 patients infected with S aureus died (8%). CONCLUSIONS: Spondylodiscitis is associated to a diversity of microbial agents and in most cases has a favorable prognosis.

Abordaje alternativo para tumores del clivus / Alternative approach for clivus tumors

La zona del clivus se encuentra entre la región selar y la apófisis basilar del hueso occipital, en estrecha relación con la fosa craneana posterior. En un sitio relativamente poco frecuente de lesiones benignas y malignas, ya sea tumorales, vasculares, etc. Debido a su localización, representa un desafío para el abordaje quirúrgico y se asocia a menudo a una morbilidad significativa. Diversas vías, tanto neuroquirúrgicas como otorrinolaringológicas, se han postulado para el abordaje de esta zona con el fin de conseguir un campo operatorio expedito, con mínima lesión de estructuras nobles y tejidos. La siguiente publicación propone el abordaje transeptal-subesfenoidal como una vía de acceso al clivus, que puede realizar el otorrinolaringológo con conocimiento de la cirugía de base de cráneo