Changing Management of Type B Aortic Dissections.

The purpose of this manuscript is to review recent trends in the management of acute type B aortic dissection. Due to its efficacy and low morbidity, thoracic endografting has rapidly been adopted as the treatment of choice for most patients with malperfusion or rupture as a consequence of acute aortic dissection. This technology is increasingly applied to patients without rupture or malperfusion, so-called "uncomplicated" dissections, to reduce the incidence of late aneurysmal degeneration in the ungrafted segments of the thoracoabdominal aorta. A variety of techniques have been proposed, including intentional rupture of the dissection membrane to obliterate the false lumen as well as the candy-plug technique to eliminate retrograde flow in the false lumen.

Sintomatología depresiva y trastornos neurocognitivos en pacientes con VIH adherentes y no adherentes a TARAA: estudio transversal analítico / Depressive symptomatology and neurocognitive disorders in haart-adherent and non-adherent hiv patients: a cross-sectional analytical study

Introducción: Las personas portadoras del virus de inmunodeficiencia humana (VIH) presentan mayor comorbilidad de trastornos neurocognitivos y del ánimo que la población general. La introducción de los antirretrovirales ha disminuido significativamente la demencia asociada a VIH, relacionado a la adherencia a la terapia antirretroviral altamente activa (TARAA). Diversos estudios han demostrado la coexistencia de otros factores para explicar dicho trastorno cognitivo, tales como enfermedad neurológica previa, enfermedad psiquiátrica, consumo de drogas, nivel educativo, reserva cognitiva, entre otras. Objetivo: Determinar el grado de sintomatología depresiva, deterioro cognitivo y su relación con la adherencia a TARAA y otros factores de curso clínico en pacientes portadores de VIH en control ambulatorio. Métodos: Estudio transversal. Se incluyeron pacientes que viven con VIH adscritos al programa de infectología del Hospital Dr. Gustavo Fricke, Viña del mar, Chile. Se utilizaron datos sociodemográficos, clínicos y se aplicaron las escalas Depression in the Medicaly III Questionary, Montreal Cognitive Assesment y Morysky Green Levin Test. Resultados: Se incluyeron 29 participantes, en su mayoría hombres (86,2%) y con escolaridad técnica o profesional (86.2%). No hubo diferencias entre variables biodemográficas, depresivas ni subdimensiones cognitivos. Entre pacientes adherentes y no adherentes se encontró diferencias significativas respecto a la presencia de algún deterioro cognitivo. Conclusiones: Los resultados deben ser interpretados con cautela, dado su alcance limitado. Futuros estudios traslacionales debieran incorporar mediciones más certeras del nivel de adherencia al TARAA.

Introduction: Human immunodeficiency virus (HIV) carriers present more neurocognitive and mood disorders than the general population. The introduction of antiretrovirals has significantly lowered the incidence of HIV associated dementia, and this is related to adherence to highly active antiretroviral therapy (HAART). Several studies have shown the coexistence of other factors that could explain the cognitive disorder, such as a pre-existing neurological disease, psychiatric disease, drug consumption, level of education, cognitive reserve, and others. Objective: To determine the degree of depressive symptomatology and cognitive impairment and their relation to adherence to HAART and other factors of the clinical course of HIV carriers in outpatient supervision. Methods: Cross-sectional study. We included HIV patients in the infectious diseases program, Dr Gustavo Fricke Hospital, Viña del Mar, Chile. We used sociodemographic and clinical data and we applied the Depression in the Medically Ill questionnaire, Montreal Cognitive Assessment, and the Morysky Green Levin Test. Results: 29 patients participated, mainly men (86.2%) with technical or professional education (86.2%). There were no significant differences in sociodemographic, depressive, or cognitive subdomain variables. There were significant differences in cognitive impairment between adherents and non-adherents. Conclusions: Care should be taken with interpreting the results, given their limited scope. Future cross-sectional studies should incorporate more accurate measurements of HAART adherence.

Contrast-associated acute kidney injury following peripheral angiography.

Contrast-associated acute kidney injury (CA-AKI) is a well-known complication following angiography. Peripheral angiograms have been delayed or canceled for fear of worsening renal function leading to dialysis dependence. With the emergence of preventive measures, it is hypothesized that the risk of CA-AKI may be lower than previously observed. We performed a retrospective chart review of a single surgeon's 118 cases who underwent angiographic procedures from September 2019 through August 2020, recording patient characteristics and serum creatinine values. This cohort was comprised of 65 (55%) men and had a median age of 69 years [quartile 1 = 60, quartile 3 = 75]; 55 (47%) had diabetes mellitus and the median estimated glomerular filtration rate was 64 [45, 84] mL/min/1.73 m2. We observed a statistically significant decrease in paired serum creatinine (-0.02 mg/dL) following the procedure, and only 4 patients (3.4%) developed CA-AKI, with older age and elevated baseline creatinine being associated with reduced kidney function. We did not detect an adverse relationship between contrast volume and CA-AKI. While CA-AKI continues to be a concern for patients who require peripheral angiographic procedures, this study found the overall risk to be low. This may be partly attributable to the use of pre- and postprocedure hydration protocols and lower contrast volumes.

Disability and COVID-19: ensuring no one is left behind.

The United Nations' Sustainable Development Agenda calls for targeted attention to the needs and rights of the most vulnerable populations to ensure a life of dignity and human security for all. In this paper, we argue that persons with disabilities are in a disproportionately vulnerable situation in public health emergencies. By using the example of Coronavirus disease 2019 (Covid-19), we explain why that is and call for the systematic consideration of the needs and rights of persons with disabilities during the response to the outbreak and during the recovery phase. Otherwise, equity will continue to be merely an aspiration during this COVID-19 emergency - as it will in future health emergencies.

The Vici venous stent for treatment of renal vein entrapment.

The nutcracker syndrome results from compression of the left renal vein between the superior mesenteric artery and the aorta. We present the first reported case of symptomatic left renal vein compression treated with balloon angioplasty and stenting with the Vici stent system.

Direct access of ascending aorta for endograft delivery in the descending thoracic aorta.

First-line therapy for aneurysm, dissection, or rupture of the descending thoracic aorta is now by the endovascular approach. Retrograde insertion of the endograft, through access from the femoral arteries, is the preferred approach. This case presents a new, innovative technique for delivery of an endoprosthesis into the descending thoracic aorta when hostile anatomy prevents delivery from the femoral arteries, iliac arteries, or infrarenal abdominal aorta in a patient not suitable for open repair.

Ascending aortic thrombus with multiple emboli associated with COVID-19.

Coronavirus disease 2019 (COVID-19) initiates a hypercoagulable state and causes thrombotic complications. A presentation of multiple thromboembolic events without an underlying source should raise suspicion for COVID-19 hypercoagulability. We describe a patient with an ascending aortic thrombus resulting in multiple emboli treated by multiple modalities.

Recurrencia de fibrilación auricular posablación de venas pulmonares. Identificación de factores predictores / Atrial fibrillation recurrence post pulmonary vein ablation. Identification of predictive factors / Recorrência da fibrilação atrial pós-ablação das veias pulmonares. Identificação de fatores preditivos

Resumen: La ablación de la fibrilación auricular mediante el aislamiento de las venas pulmonares, es una estrategia ampliamente utilizada en la actualidad. La recurrencia posablación es un problema frecuente. Se han investigado varios predictores de recurrencia con el fin de optimizar la elección del paciente que más se beneficia del procedimiento. Actualmente la evidencia es controvertida, siendo necesarios más estudios al respecto.

Summary: The ablation of atrial fibrillation based on pulmonary veins isolation, is a widely used strategy nowadays. Post ablation recurrence is a frequent problem. Several recurrence predictors have been researched, with the purpose of choosing the patient that would benefit the most from this procedure. Current evidence is controversial and more research is needed.

Morphological and Immunohistochemical Description of a Lymphoma in a Two-Month-Old Lamb Using MUM1/IRF4, CD79a, CD3, CD10 and Ki67 Markers / Descripción morfológica e inmunohistoquímica de un linfoma en un cordero de dos meses de edad usando los marcadores MUM1/IRF4, CD79a, CD3, CD10 y Ki67 / Descrição morfológica e imuno-histoquímica de um linfoma em um cordeiro de dois meses de idade usando os marcadores MUM1/IRF4, CD79a, CD3, CD10 e Ki67

Abstract This article contains a morphological description of a case of early presentation lymphoma in a lamb, characterised by its unusual clinical history and advanced lesions. The primary tumour was located in the skin in the carpal region, and metastases were observed in the brain, right eye, all the pulmonary lobes, the myocardium and endocardium of the heart, left adrenal gland, abdominal portion of the vagal nerve, serosa of the rumen, the body of lumbar vertebra L3, and the submandibular, mediastinal and mesenteric lymph nodes. Histopathological examination revealed that it was a large cell lymphoma. Immunohistochemical analysis was carried out with antibodies for MUM1/IRF4, CD79a, CD3, CD10 and Ki67, used here for the first time as markers to characterise a lymphoma in this species. The result revealed that it was a B-cell lymphoma.

Resumen En este artículo se describe morfológicamente un caso de linfoma de presentación temprana en la especie ovina, el cual se caracterizó por lo inusual de su historia clínica y lo avanzado de las lesiones. El tumor primario se localizó en la piel del carpo y se observaron metástasis en el cerebro, el ojo derecho, todos los lóbulos pulmonares, el miocardio y endocardio del corazón, la glándula adrenal izquierda, el nervio vago en su porción abdominal, la serosa del rumen, el cuerpo vertebral lumbar L3, los linfonodos submandibulares, mediastínicos y mesentéricos. El examen histopatológico reveló un linfoma no Hodgkin de células grandes. El análisis inmunohistoquímico se realizó con anticuerpos para MUM-1/IRF-4, CD79a, CD3, CD10 y Ki-67, los cuales se usaron por primera vez como marcadores para caracterizar un linfoma en esta especie. El resultado reveló que se trató de un linfoma de células-B.

Resumo Neste artigo descreve-se morfologicamente um caso de linfoma de apresentação precoce na espécie ovina, caracterizado pela historia clínica incomum e as lesões avançadas. O tumor primário foi encontrado na pele do carpo e metástase foi observada no cérebro, olho direito, todos os lobos pulmonares, miocárdio e endocárdio do coração, a glándula adrenal esquerda, nervo vago na porção abdominal, a serosa do rúmen, o corpo vertebral lombar L3, linfonodos submandibulares, mediastinos e mesentéricos. O exame histopatológico revelou linfoma não-Hodgkin de células grandes. A análise imuno-histoquímica foi realizada com anticorpos para MUM-1/IRF-4, CD79a, CD3, CD10 e Ki-67, os quais usaram-se por primeira vez como marcadores para caracterizar um linfoma nessa espécie. O resultado revelou que se tratou de linfoma de células-B.

Remodelado reverso de la aurícula izquierda posablación de venas pulmonares en la fibrilación auricular: una serie de casos / Reverse remodeling of left atrium post pulmonary veins ablation in atrial fibrillation: case series / Remodelação reversa do átrio esquerdo pós-ablação de veias pulmonares na fibrilação atrial: uma série de casos

Resumen: El aislamiento de las venas pulmonares usando sistemas de navegación en tercera dimensión (3D) es una técnica de uso universal que ha demostrado tasas de éxito significativas en la ablación de la fibrilación auricular (FA). Sin embargo, el remodelado que sufre la aurícula izquierda (AI) posterior a la ablación ha sido escasamente evaluado. Ocho pacientes fueron sometidos a ablación de las venas pulmonares con sistema de mapeo electroanatómico entre marzo de 2016 y marzo de 2017. Se evaluó la AI con ecocardiograma preprocedimiento, y uno y tres meses luego de este, utilizando las siguientes variables: volumen auricular izquierdo en biplano, fracción de eyección de AI (FEAI) y strain reservorio de AI en pared lateral. Para determinar la existencia de recurrencia se realizó Holter de 24 horas e interrogatorio telefónico a los tres y seis meses posablación. Se evidenció remodelado reverso estructural y funcional de la AI en seis pacientes. Aquellos con recurrencia de FA no presentaron remodelado reverso y mostraron mayor deterioro de la función auricular previo a la ablación. Estos hallazgos permiten plantearnos algunas hipótesis a investigar sobre los predictores de recurrencia.

Summary: Electrical isolation of the pulmonary veins using third dimension navigation systems is a universal technique that has showed a significant success in atrial fibrillation ablation. Nevertheless, the reverse remodeling suffered by the left atrium after ablation has been scarcely evaluated. Eight patients underwent the ablation of the pulmonary veins with electroanatomic map system, between March 2016 to March 2017. The left atrium was evaluated by echocardiogram pre procedure, and one and three months after ablation, using the following variables: left atrial volume in biplane, ejection fraction of the left atrium and reservoir strain of the left atrium in the lateral wall. To determine the existence of recurrence, Holter of 24 hours was applied and phone calls three and six months after were made. There was evidence of a reverse remodeling structural and functional of the left atrium in six patients. Those with recurrence of atrial fibrillation did not show reverse remodel and showed higher deterioration of the auricular function prior to the ablation. These findings let us make some hypotheses and investigate about recurrence predictors.

Resumo: O isolamento das veias pulmonares, utilizando sistemas de navegação em terceira dimensão, é uma técnica de uso universal que tem sucesso significativo na ablação de fibrilação atrial. No entanto, o remodelamento do átrio esquerdo após a ablação tem sido pouco avaliado. Oito pacientes foram submetidos a ablação de veias pulmonares utilizando mapeamento eletro-anatômico entre março de 2016 e março de 2017. O átrio esquerdo foi avaliado com ecocardiograma no pré-procedimento, e um e três meses após o mesmo, usando as seguintes variáveis: volume do átrio esquerdo em biplano, fração de ejeção do átrio esquerdo e tensão do reservatório do átrio esquerdo na parede lateral. Para determinar a existência de recorrência, Holter de 24 horas e interrogatório por telefone foram realizados três e seis meses após a ablação. A remodelação reversa estrutural e funcional do átrio esquerdo foi observado em seis pacientes. Aqueles com recidiva de fibrilação atrial não apresentaram remodelamento reverso e mostraram maior deterioração da função atrial antes da ablação. Estas descobertas permitem propor algumas hipóteses para investigar sobre os preditores de recorrência.

INTELLECTUAL PROPERTY IN SPORTS: TRENDS IN PATENTS OF THE INTERNATIONAL AND COLOMBIAN SPORTS INDUSTRY / PROPRIEDADE INTELECTUAL NO ESPORTE: TENDÊNCIAS DE PATENTES NA INDUSTRIA ESPORTIVA INTERNACIONAL E COLOMBIANA / PROPIEDAD INTELECTUAL EN EL DEPORTE: TENDENCIAS EN PATENTES DE LA INDUSTRIA DEPORTIVA INTERNACIONAL Y COLOMBIANA

La propiedad intelectual en el deporte es un tema poco estudiado, por lo que se carece de información robusta para describir el panorama global de la innovación de la industria deportiva. El presente artículo tiene como propósito identificar las tendencias de la industria deportiva internacional y la realidad colombiana sobre la protección de la innovación en el mercado de patentes. Mediante un estudio exploratorio, se caracterizaron los indicadores bibliométricos para patentes en los últimos 20 años. Los resultados muestran un aumento notable desde 2007 en registros de patentes, siendo China el país más innovador, y el mercado de aparatos para el entrenamiento físico el de mayor crecimiento a nivel global. En Colombia se registran 17 familias de patentes y seis segmentos estratégicos para el desarrollo de productos altamente innovadores.

Propriedade intelectual e inovação no esporte são tópicos poucos estudados, portanto, há uma falta de informação robusta para descrever o panorama da inovação da indústria do esporte. O presente artigo tem como objetivo identificar as tendências da indústria do esporte internacional e a realidade colombiana sobre a proteção da inovação no mercado de patentes. Através de um estudo exploratório, os indicadores bibliométricos para patentes nos últimos 20 anos foram caracterizados. Os resultados revelam um aumento marcante no registro de patentes desde o 2007, sendo a China o país mais inovador, o mercado de aparelhos para o treinamento físico é o de maior crescimento global. Na Colômbia, se cadastram 17 famílias de patentes e seis segmentos estratégicos para o desenvolvimento de produtos altamente inovadores.

Intellectual property in sports is a little studied subject, therefore, there is a lack of relevant information to describe the global panorama of innovation in the sports industry. This article aims to identify the trends in the international sports industry and the Colombian reality about the protection of innovation in the patent market. Through an exploratory study, bibliometric indicators were characterized for patents in the last 20 years. The results show a remarkable increase since 2007 in patent registrations being China the most innovative country; the market of the devices for physical training devices presents the greater growth at a global level. In Colombia, 17 patent families and six strategic segments are registered for the development of highly innovative products.

Biofiltration of trimethylamine in biotrickling filter inoculated with Aminobacter aminovorans

Background: Trimethylamine (TMA) is the main responsible for the odor associated with rotting fish and other annoying odors generated in many industrial activities. Biofiltration has proved to be efficient for treating odorous gaseous emissions. The main objective of this work was to determine the removal capacity of TMA of a biotrickling filter inoculated with Aminobacter aminovorans and to evaluate the effect of H2S on its performance. Results: The maximumspecific growth rate ofA. aminovorans in a liquid culture was 0.15 h -1 , witha TMAto biomass yield of 0.10 (g g -1) and a specific consumption rate of 0.062 g·g-1·h-1 . The initial specific consumption rate of TMA was highly influenced by the presence of H2S in liquid culture at concentrations of 20 and 69 ppm in heading space oftheflasks.ABTF inoculatedwithA. aminovorans showedremoval efficiencieshigher than98%ina range ofloading rate of 0.2 to 8 g·m-3·h-1 at empty bed residence time (EBRT) of 85 and 180 s. No effect on the elimination capacity and efficiency was detected when H2S was added at 20 and 50 ppm to the inlet gaseous emission, though the fraction of A. aminovorans measured by qPCR in the biofilm decreased. Conclusions:Abiotrickling filter inoculated with A. aminovorans can remove efficiently the TMA in a gaseous stream. The elimination capacity of TMA can be negatively affected by H2S, but its effect is not notorious when it is forming part of a biofilm, due to its high specific consumption rate of TMA.

Case Report: An Innovative Endovascular Technique for Repair of Descending Thoracic Aortic Aneurysm following an Open Coarctation Repair.

It was once postulated that open surgical repair of coarctation of the aorta during childhood patients was cured. However, long-term follow-up has been significant for late problems such as an aneurysm. The incidence of such aneurysm after open surgical coarctation repair is 11-24%. If such an aneurysm is left untreated, patients are at a high risk of morbidity and mortality. Prior to the endovascular era, patients would require a redo open repair which in itself is a highly morbid operation. Currently, thoracic endovascular aortic repair (TEVAR) has been reported as a feasible and safe alternative to open surgical reprocedures in this context. However, TEVAR might be challenging due to the proximity of the pathology to supraaortic vessels and the ongoing presence of the coarctation. We are reporting a unique case of a 48-year-old male undergoing TEVAR due to aortic aneurysm after previous surgical coarctation treatment and successful closure of the coarctation with a vascular plug device.

Novel technique of selective stent deployment in complicated thoracic aortic aneurysm.

A 72-year-old woman presented with a thoracic aortic aneurysm that was found to have increased from 5.1 cm to 7.1 cm. Due to the increase in size, the aortic aneurysm required endovascular repair. After deployment of a GORE C-TAG stent graft, a distal type 1 endoleak was still present, requiring deployment of another stent to achieve total coverage. The aorta had an angled anatomical variation often associated with type 1 endoleaks causing technical difficulty with conventional deployment of the graft. By employing a novel Parachute technique, the graft was selectively deployed at the distal end, and the position was adjusted to fit the angulation of the aorta, followed by selective deployment of the proximal end. This selective deployment allowed for the adjustment necessary to effectively cover the endoleak.

Video Caso Clínico. Cierre Percutáneo de Fuga Paravalvular en Válvula Protésica Mecánica en Posición Mitral / Case report: Percutaneous Closure of Paravalvular Leak in Mitral Mechanic Prosthetic Valve

La fuga paravalvular es un fenómeno poco frecuente de gran repercusión sintomática. Es el resultado de un cierre no hermético entre el anillo de sutura y el anillo valvular. Las causas son diversas como la calcificación del anillo, infección, técnica de sutura, tamaño y forma de la prótesis (demasiado pequeña) y excentricidad del anillo. El cierre percutáneo de estos defectos en las válvulas apareció como una opción terapéutica en pacientes con riesgo quirúrgico alto y alcanzando una tasa de éxito que varía entre el 60% y el 90%.(au)

Paravalvular leakage is a rare phenomenon with great symptomatic repercussion. It is the result of a non-hermetic closure between the suture ring and the valve ring. Causes include ring calcification, infection, suture technique, size and shape of the prosthesis (too small) and ring eccentricity. Percutaneous closure of these defects in the valves appeared as a therapeutic option in patients with high surgical risk and reaching a success rate ranging from 60% to 90%. (au)

Endovascular Technique for Repair of Descending Thoracic Aortic Aneurysm After Coarctation Operation.

The incidence of aneurysm after open surgical repair of coarctation is 11% to 24%. If the condition is left untreated, fatal rupture may occur. Thoracic endovascular aortic repair (TEVAR) has been reported as a feasible and safe alternative to open surgical repeated procedures in this context. However, TEVAR might be challenging because of the proximity of the pathologic condition to the supraaortic vessels and the ongoing presence of the coarctation. We report a unique case of a 48-year old man undergoing TEVAR because of aortic aneurysm after previous surgical coarctation treatment and successful closure of the coarctation with a vascular plug device.

Aneurisma poplíteo en niño / Aneurysm of the popliteal artery in a boy

Aim: To present a true aneurysm in childhood, an uncommon pathology, even more those who affect the popliteal artery. case report: We present the case of a boy 3 years old with a true aneurysm with popliteal location. conclusion: Because of its possible complications, the treatment is surgery.

Objetivo: Presentar un caso de aneurisma verdadero en niños, patología poco frecuente, más aún aquellos que afectan a la arteria poplítea. caso clínico: Se presenta el caso de un niño de 3 años con un aneurisma verdadero de localización poplítea. conclusión: Debido a sus posibles complicaciones, el tratamiento es quirúrgico.

Treatment of epidermoid tumors with gamma knife radiosurgery: Case series.

BACKGROUND: Epidermoid tumors (ETs) are benign lesions that are treated mainly by means of surgical resection, with overall good results. External beam radiotherapy is an alternative treatment for those recurrent tumors, in which a second surgery might not be the best choice for the patient. A little information exists about the effectiveness of gamma knife radiosurgery for the treatment of newly diagnosed and recurrent ETs. We present three cases of ETs treated with gamma knife radiosurgery. CASE DESCRIPTION: Case 1 is a 21-year-old female with an ET located in the left cerebellopontine angle (CPA) with symptoms related to VIII cranial nerve dysfunction. Symptom control was achieved and maintained after single session radiosurgery with gamma knife. Case 2 is a 59-year-old female patient with the history of trigeminal neuralgia secondary to a recurrent ET located in the left CPA. Significant pain improvement was achieved after treatment with gamma knife radiosurgery. Case 3 is a 29-year-old male patient with a CPA ET causing long lasting trigeminal neuralgia, pain relief was achieved in this patient after gamma knife radiosurgery. CONCLUSION: Long-term symptom relief was achieved in all three cases proving that gamma knife radiosurgery is a good and safe alternative for patients with recurrent or nonsurgically treated ETs.

The Right to Health of Older People.

A focus on the right to the enjoyment of the highest attainable standard of health (hereinafter, "the right to health") draws attention to the health needs of older people, including the most marginalized among them. Many factors that influence vulnerability or impede the enjoyment of health and access to quality services result from an inability to freely exercise these human rights. A human rights approach can help to address the legal, social, and structural barriers to good health for older persons, clarifying the legal obligations of State and non-State actors to uphold and respect these rights. However, despite growing impetus for action, this area has historically received limited attention. Drawing on practice examples from different regions, this article unpacks the meaning of the right to health and other related human rights of older people in practice, covering both health care and underlying determinants of their health. Questions of availability, accessibility, acceptability, and quality are highlighted from the perspective of older people's health and well-being. The article brings together knowledge, principles, norms, and standards from the human rights law, health, and ageing arenas. By making links between these arenas, it is hoped that the article fills a gap in thinking on how to achieve the progressive realization of the right to health of older people and the effective promotion and protection of their other related human rights, which are crucial for the enjoyment of health.

Oligonucleotide-Mediated Genome Editing Provides Precision and Function to Engineered Nucleases and Antibiotics in Plants.

Here, we report a form of oligonucleotide-directed mutagenesis for precision genome editing in plants that uses single-stranded oligonucleotides (ssODNs) to precisely and efficiently generate genome edits at DNA strand lesions made by DNA double strand break reagents. Employing a transgene model in Arabidopsis (Arabidopsis thaliana), we obtained a high frequency of precise targeted genome edits when ssODNs were introduced into protoplasts that were pretreated with the glycopeptide antibiotic phleomycin, a nonspecific DNA double strand breaker. Simultaneous delivery of ssODN and a site-specific DNA double strand breaker, either transcription activator-like effector nucleases (TALENs) or clustered, regularly interspaced, short palindromic repeats (CRISPR/Cas9), resulted in a much greater targeted genome-editing frequency compared with treatment with DNA double strand-breaking reagents alone. Using this site-specific approach, we applied the combination of ssODN and CRISPR/Cas9 to develop an herbicide tolerance trait in flax (Linum usitatissimum) by precisely editing the 5'-ENOLPYRUVYLSHIKIMATE-3-PHOSPHATE SYNTHASE (EPSPS) genes. EPSPS edits occurred at sufficient frequency that we could regenerate whole plants from edited protoplasts without employing selection. These plants were subsequently determined to be tolerant to the herbicide glyphosate in greenhouse spray tests. Progeny (C1) of these plants showed the expected Mendelian segregation of EPSPS edits. Our findings show the enormous potential of using a genome-editing platform for precise, reliable trait development in crop plants.