Artículos Medicina y Ciencias de la Salud

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Test de Aprendizaje y Desarrollo Infantil (TADI): Evidencia adicional de su validez a nivel poblacional
(2025) Edwards, Marta; Armijo, Iván; Schonhaut, Luisa; Godoy, María Inés; Valdés, Antonia
El “Test de Aprendizaje y Desarrollo Infantil” (TADI) es una escala de tamizaje del desarrollo para niños/as de 6 a 72 meses construida en Chile. Objetivo: Determinar la validez de la primera edición de TADI muestra nivel poblacional. Metodología: Análisis psicométrico secundario de una muestra de 11.283 niños/as chilenos que participaron de la Encuesta Longitudinal de Primera Infancia (ELPI) 2012. Se evaluó validez convergente mediante el Análisis Factorial Confirmatorio (AFC), verificado mediante Análisis Factorial Exploratorio (AFE). Se consideraron variables sociales para la validez de constructo. Para la validez concurrente, sensibilidad, especificidad y correlación se tomaron como referencias las pruebas Battelle Developmental Inventory Segunda Edición (BDI-2) y el Test de Vo-cabulario en Imágenes Peabody (TVIP). Resultados: De los niños evaluados, 12,6% se categorizó en Retraso o Riesgo de Retraso, y 17,3% en categoría Alerta. El AFC arrojó buenos niveles de ajuste del modelo propuesto para los datos de la escala, en particular a edades mayores. El AFE reveló patrones diferentes para distintos rangos etarios. El TADI se correlacionó significativamente con los factores socioeconómicos, como la presencia de materiales de aprendizaje en el hogar, el nivel educativo del cuidador principal, el ingreso económico y la respuesta emocional de la madre. Se encontró corre-lación moderadamente positiva del TADI con el BDI-2 y el TVIP, con sensibilidad y especificidad cercanos a 0,70 al incluir la categoría Alerta. Conclusiones: Los adecuados valores psicométricos del TADI en una muestra poblacional ratifican su validez como instrumento de tamizaje del desarrollo de niños/as pequeños en Chile.
Development of an artificial intelligence powered software for automated analysis of skeletal muscle ultrasonography
(2025) Calulo, Zoe; González Seguel, Felipe; Horikawa, Arimitsu; Granger, Catherine; Sarwal, Aarti; Dha, Sanjay; Ntoumenopoulos, George; Chen, Jin; Bumgardner, V K; Parry, Selina; Mayer, Kirby; Wen, Yuan
Muscle ultrasound has high utility in clinical practice and research; however, the main challenges are the training and time required for manual analysis to achieve objective quantification of muscle size and quality. We aimed to develop and validate a software tool powered by artificial intelligence (AI) by measuring its consistency and comparability of expert manual analysis quantifying lower limb muscle ultrasound images. Quadriceps complex (QC) and tibialis anterior (TA) muscle images of healthy, intensive care unit, and/or lung cancer participants were captured with portable devices. Manual analyses of muscle size and quality were performed by experienced physiotherapists taking approximately 24 h to analyze all 180 images, while automated analyses were performed using a custom-built deep-learning model (MyoVision-US), taking 247 s (saving time = 99.8%). Consistency between the manual and automated analyses was good to excellent for all QC (ICC = 0.85-0.99) and TA (ICC = 0.93-0.99) measurements, even for critically ill (ICC = 0.91-0.98) and lung cancer (ICC = 0.85-0.99) images. The comparability of MyoVision-US was moderate to strong for QC (adj. R2 = 0.56-0.94) and TA parameters (adj. R2 = 0.81-0.97). The application of AI automating lower limb muscle ultrasound analyses showed excellent consistency and strong comparability compared with human analysis across healthy, acute, and chronic population.
Return-to-sport tests: Do they reduce risk of re-rupture after anterior cruciate ligament reconstruction?
(2025) Figueroa, David; Gonzalez, Waldo; Landea, Daniela; Tapia, Camila; Erskine, Daniela
Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. Despite the effectiveness of reconstruction, re-rupture rates of up to 15 % have been reported. Static and dynamic test of strength and movement control have been used to determine when return to sports (RTS) is appropriate. Objective: To determine whether successfully passing return to sport (RTS) tests reduces the re-rupture rate. Methods: Retrospective cohort study. Patients who underwent ACL reconstruction (ACLR) from June 2018 to May 2023, and who performed RTS tests after rehabilitation, were analyzed. Patients who, in addition to ACLR, underwent extra-articular tenodesis, osteotomy, or multiligament injuries were excluded. RTS tests included the following: repeat sprint ability, dynamic valgus, proagility, unilateral counter movement jump (CMJ), isokinetic, triple hop test, and functional movement screen (FMS). All statistical analyses were performed with STATA version 18.0. Results: Ninety five patients underwent RTS tests after ACLR, with a follow-up time of 27.8 months. 71.6 % of patients were men with a mean age of 25.15 ± 10.7 years. The overall re-rupture rate was 13.68 % (13 patients). When comparing patients who passed and did not pass the RTS tests, there were no differences by sex (p = 0.06) or age (p = 0.11). The only statistically significant difference between the groups was the mean risk score (passed: 11.5 ± 0.7 vs. not passed: 15.5 ± 2.1; p < 0.001). Patients with re-rupture were more likely to be from the non-passed group (passed: 0 % v/s not passed: 18.1 %; p = 0.03), with a statistical power of 0.70. Conclusion: Our records show that passing RTS test after an ACLR could guarantee the absence of re-rupture in the medium term.
Latin American association for the study of the liver (ALEH) guidance on postoperative care after liver transplantation
(2025) Codes, Liana; Zapata, Rodrigo; Mendizabal, Manuel; De Medeiros, Alfeu; De Lucca, Leonardo; Sá, Luiz; Andraus, Wellington; Gadano, Adrian; Padilla, Martin; Villamil, Alejandra; Silveira, Raquel; Castro, Graciela; Pages, Josefina; Terrabuio, Debora; Urzúa, Alvaro; Guimarães, Mário; Mainardi, Victoria; Pedro, Rodolpho; Imventarza, Oscar; Gerona, Solange; Wolff, Rodrigo; Abdala, Edson; Tenorio, Laura; Cerda, Eira; Cairo, Fernando; Uribe, Mario; Lisboa, Paulo; Members of ALEH Special Interest Group on Liver Transplantation
Liver transplantation (LT) is a well-established therapy for patients with decompensated cirrhosis and early-stage hepatocellular carcinoma. Liver transplantation activity varies sharply across Latin American (LATAM) countries due to differences in resources, expertise, and funding and local attitudes toward organ donation and transplantation. This current guidance of postoperative care after LT is the first position paper of the Latin American Association for the Study of the Liver (ALEH) Special Interest Group (SIG), drawing evidence-based recommendations regarding immediate and long-term postoperative care of LT recipients, taking into consideration their applicability in Latin America.
Lung recruitment maneuver improves right and left ventricular function in patients with acute respiratory distress syndrome
(2025) Lambour, Alexis; Zerbib, Yoann; Mercado, Pablo; Kontar, Loay; De Cagny, Bertrand; Maizel, Julien; Slama, Michel; Brault, Clément
BACKGROUND: Lung recruitment maneuvers (LRM) and high positive end-expiratory pressure (PEEP) may benefit some patients by reopening non- or poorly aerated alveoli. However, the effects of opening the lung with LRM on hemodynamics remain uncertain. This study aimed to evaluate the direct impact of LRM on cardiac function in patients with moderate-to-severe acute respiratory distress syndrome (ARDS). METHODS: This post-hoc analysis included 34 patients with moderate-to-severe ARDS from two prospective cohort studies. The LRM consisted in a gradual increase in PEEP, starting from 25 cmH2O (PEEPpre, before the recruitment maneuver at PEEP 25 cmH2O) until reaching 40 cmH2O. After LRM, PEEP was decreased to 25 cmH2O (PEEPpost, after the recruitment maneuver, also at PEEP 25 cmH2O) followed by a decremental PEEP titration. We compared the size and function of the right ventricle (RV) and left ventricle (LV) between PEEPpre and PEEPpost. RESULTS: The respiratory system compliance significantly increased from 21 ± 7 ml/cmH2O at PEEPpre to 24 ± 7 ml/cmH2O at PEEPpost (p < 0.001), indicating effective lung recruitment. The RV end-diastolic diameter and the RV/LV ratio decreased after LRM (51 ± 11 vs. 41 ± 9 mm; p < 0.001, and 1.05 ± 0.21 vs. 0.90 ± 0.18; p < 0.001, respectively), suggesting reduced pulmonary vascular resistance. The RV free wall strain improved from -22 ± 10 to -25 ± 8% (p = 0.040). The cardiac index significantly increased from 2.1 ± 0.6 to 2.4 ± 0.7 L/min/m2 (p < 0.001) due to improved LV function, as demonstrated by a lower LV global longitudinal strain at PEEPpost (-16 ± 4% vs. -19 ± 3%, p = 0.002). CONCLUSIONS: LRM may benefit both the lungs and the heart. The increase in transpulmonary pressure leads to an expansion in aerated lung volume, potentially reducing lung overdistension and collapse, thereby lowering RV afterload and improving RV systolic function.
New standardized five-zone lobectomy with structured assessment in robotic surgery: the French lobectomy
(2025) Mordojovich, Gerardo; Hugen, Niek; Bottet, Benjamin; Montagne, François; Bouabdallah, Ilies; Pagès, Pierre-Benoît; Sarsam, Mathieu; Thomas, Pascal; Baste, Jean-Marc
The use of the robotic approach is rapidly increasing in thoracic surgery worldwide. Mastering this new technique is challenging and teaching robotic surgery is difficult. Nevertheless, to date, no academic certified training program including a standardized approach is available for robotic lobectomy and no objective assessment scale has been proposed. Here we describe new objective criteria for robotic lobectomy including a standardised surgical technique and an objective structured assessment scale to improve educational support for thoracic surgeons. The technique, referred to as the French lobectomy, is a standardized technique, and is based on five exposure and dissection zones. Each zone contains a number of dissection steps, which all together form a complete lobectomy. The technique can be applied to all lobectomies (and segmentectomies) for both the left and right side. In parallel, an objective structured assessment scale is designed to evaluate the performance of trainee surgeons who use the technique. This scale is based on five items with a minimum score of 5 points and a maximum score of 25 points. A conduct to follow based on the score obtained is proposed. This systematic and standardized robotic approach to lobectomies and its assessment scale, may allow surgeons and trainees to improve their technical skills and efficiency.
How I Do It: Evaluating Cardiac Implantable Devices and Noncardiac Mimics on Chest Radiographs
(2025) Silva, Claudio; Christensen, Jared
Cardiac implantable electronic devices (CIEDs), including pacemakers and defibrillators, are increasingly used to manage various cardiac conditions. This article reviews the radiographic appearance, typical components, and placement of CIEDs, including newer technologies like leadless pacemakers and MRI-conditional devices. The article also highlights the imaging findings of common complications such as lead dislodgement, fracture, and perforation, emphasizing the role of imaging in early detection and intervention. Additionally, the radiographic identification of other cardiac and noncardiac devices with similar-appearing imaging features is addressed. Other cardiac devices covered in this article include those for cardiac monitoring, ventricular assistance, and cardiac repair. Noncardiac mimics include deep brain, vagal nerve, and phrenic nerve stimulators as well as breast implant radiofrequency markers. Accurately identifying these devices and their positioning on chest radiographs facilitates the early detection of complications and directs appropriate patient care.
Magnetic resonance imaging of paraurethral and paravaginal lesion: relevant diagnoses, key findings and surgical correlation
(https://doi.org/10.21037/tau-2024-726, 2025) Labra, Andrés; Cocio, Rolando; Saavedra, Álvaro; Schiappacasse, Giancarlo; Blaskovic, Fernanda
Paraurethral and paravaginal lesions are uncommon entities that often present diagnostic challenges due to their anatomical complexity, varied etiologies, and overlapping clinical presentations. Accurate identification and characterization of these lesions are essential for appropriate management and surgical planning. A structured diagnostic approach, based on clinical history, lesion location, and imaging features, is critical to avoid misdiagnosis and unnecessary interventions. Magnetic resonance imaging (MRI) has emerged as the modality of choice due to its excellent soft-tissue contrast, multiplanar capabilities, and non-invasive nature, offering superior delineation of lesion extent and relationship with adjacent pelvic structures. This pictorial review seeks to support radiologists and clinicians by offering a comprehensive yet practical guide to the imaging evaluation of paraurethral and paravaginal lesions. Through high-resolution MRI images and original anatomical illustrations, we aim to reduce the gap between imaging interpretation and clinical decision-making. We summarize the primary MRI indications for evaluating female urethral pathology, provide an overview of common and rare differential diagnoses, and highlight relevant MRI protocol considerations. Additionally, we include correlations with surgical findings when available, to enhance clinical applicability. Rather than providing an exhaustive catalog of entities, our focus is to promote standardized imaging assessment and highlight key anatomical and diagnostic considerations that may facilitate a more confident and informed multidisciplinary approach to these often-overlooked pelvic pathologies.
CCTA-Guided Selective Invasive Coronary Catheterization: A Strategy to Reduce Contrast Volume and Improve Efficiency
(2025) Dahdal, Jorge; Jukema, Ruurt; Somsen, Aernout; Kooijman, Eline; Wahedi, Ellaha; Lemkes, Jorrit; Raijmakers, Pieter; Heestermans, Ton; Van Royen, Niels; Knaapen, Paul; Danad, Ibrahim
Background: Symptomatic patients with unilateral obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA), involving either the right or left coronary artery, typically undergo per-protocol bilateral coronary visualization during invasive coronary angiography (ICA). However, a selective visualization approach may be sufficient. Objectives: The objectives of this study were to assess the accuracy of CCTA in excluding hemodynamically significant coronary stenosis in patients with unilateral CAD and to evaluate whether a CCTA-guided selective ICA strategy can reduce procedure time and contrast agent use. Methods: In this cross-sectional cohort study, 454 patients with clinically suspected stable CAD who underwent CCTA prior to ICA were included. The study population consisted of 190 patients with unilateral obstructive CAD, defined as ≥50% diameter stenosis on CCTA, and an absence of obstructive CAD on the contralateral side. ICA with invasive functional assessment was used as the reference standard. Results: CCTA demonstrated a high accuracy, 97.4% (95% CI: 94-99%), in excluding hemodynamically significant disease in the contralateral arteries without obstructive CAD. Compared to the conventional ICA approach, a CCTA-guided selective visualization strategy resulted in significant reductions in procedure time and contrast agent usage: procedure time and contrast agent usage were reduced by 27% (95% CI: 12.1-47.5%) and 46.8% (95% CI: 27.5-67.0%), respectively. Conclusions: In patients with unilateral obstructive CAD identified by CCTA, a CCTA-guided selective ICA visualization strategy is highly accurate in ruling out hemodynamically significant CAD on the contralateral side. Additionally, this unilateral ICA approach has the potential to reduce both contrast agent usage and procedure time compared to the conventional bilateral visualization strategy.
From cadaveric donation to cryopreserved total skin allografts: Transforming the Chilean skin donation model
(2025) Fonseca, Marcelo; Cañete, Aldo; Mandriaza, Luana; Gómez, Jennifer; Masiá, Jaume; Marcelain, Katherine; Ibaceta, Dino; Erazo, Cristian; Gámez, Brenda; Soto, Carolina; Valdés, Cristóbal
Background: The clinical utility of skin allografts (SA) is well established. However, the donation and procurement of cadaveric skin-historically the primary source of SA-remain limited in many countries. A skin donation model based on the use of excess surgical tissue from body contouring procedures was introduced and compared with the traditional cadaveric donation model. Methods: A retrospective review of skin donations in Chile was conducted over two periods (2017-2019 and 2022-2024), analyzing the performance and characteristics of two donation pathways: cadaveric and living donors. Results: During the first period (2017-2019), four cadaveric donors provided a total of 10,959 cm² of skin. In the second period (2022-2024), 353 donors contributed 153,585 cm² of skin, of which 348 were living donors (131,997 cm²) and five were cadaveric (21,588 cm²). Conclusions: Initially conceived as a complementary strategy, the living donor model has evolved to become the primary source of skin allografts in Chile. This approach significantly increases the availability of SA, broadens therapeutic indications, and promotes the concept of transforming excess surgical tissue into valuable therapeutic resources. Moreover, it enables the production of cryopreserved full-thickness skin allografts (CTSA), which serve not only as temporary wound coverage but also as dermal regenerative scaffolds, particularly beneficial in the treatment of burns affecting functionally and aesthetically critical areas. This new paradigm supports a more accessible and sustainable culture of skin donation while offering promising benefits for regenerative burn care.
Time to Surgery for Subaxial Cervical Fractures: A Multicenter Study
(2025) Quinteros, Guisela; Ricciardi, Guillermo; Cirillo, Ignacio; Marquez, Edgar; Cabrera, Juan; Carazzo, Charles; Yurac, Ratko; Guiroy, Alfredo
Objective: To identify delays for surgery to stabilize subaxial cervical fractures and the main reasons for them across Latin America. Methods: This is a retrospective multicenter cohort study of patients surgically treated for subaxial cervical fractures from 13 spine centers across Latin America from January 1, 2014 to January 1, 2023. Causes of delay to surgery beyond 24 hours were documented. Results: We included 529 patients from 13 institutions in Latin American countries; 408 (77.1%) males and 121 (22.9%) females with a mean age of 43.4 (standard deviation = ±16.2). Predominantly caused by traffic accident (n = 256; 48.4%), followed by fall from height (n = 233; 44%). Mostly, suffered type C fractures (n = 348; 65.8%) and/or neurological injury (n = 384; 72.6%). The time from admission to surgery was >72 hours in 70% of the patients included (n = 375; 70.9%). More than 45% waited longer than a week (n = 257; 48.6%) for spine surgery. Only 12.5% (n = 66) of the patients received surgery in the first 24 hours from admission. The primary reasons for the surgical delay were the necessity for other surgical procedures (n = 161; 34.8%), the unavailability of surgical implants (n = 60; 13.0%), patient clinical instability (n = 55; 11.9%), and delays in referral (n = 38; 8.2%). Conclusions: We documented significant and concerning delays in providing spinal decompression and stabilization surgery to patients with cervical spine fractures. Only 17% of patients have surgery in the recommended time <24 hours, more than half of the patients must wait for more than 72 hours, and nearly half of patients wait for longer than a week.
Predicting Response to Intravesical Bacillus Calmette-Guérin in High-Risk Nonmuscle-Invasive Bladder Cancer Using an Artificial Intelligence-Powered Pathology Assay: Development and Validation in an International 12-Center Cohort
(2025) Lotan, Yair; Krishna, Viswesh; Abuzeid, Waleed; Launer, Bryn; Chang, Sam; Krishna, Vrishab; Shingi, Siddhant; Gordetsk, Jennifer; Gerald, Thomas; Woldu, Solomon; Shkolyar, Eugene; Hayne, Dickon; Redfern, Andrew; Spalding, Lisa; Stewart, Courtney; Eyzaguirre, Eduardo; Imtiaz, Shamsunnahar; Narayan, Vikram; Packiam, Vignesh; O'Donnell, Michael; Li, Roger; Baekelandt, Loic; Joniau, Steven; Zuiverloon. Tahlita; Fernandez, Mario; Schultz, Marcela; Hensley, Patrick; Allison, Derek; Taylor, John; Hamza, Ameer; Kamat, Ashish; Nimgaonkar, Vivek; Sonawane, Snehal; Miller, Daniel; Watson, Drew; Vrabac, Damir; Joshi, Anirudh; Shah, Jay; Williams, Stephen
Purpose: There are few markers to identify those likely to recur or progress after treatment with intravesical bacillus Calmette-Guérin (BCG). We developed and validated artificial intelligence (AI)-based histologic assays that extract interpretable features from transurethral resection of bladder tumor digitized pathology images to predict risk of recurrence, progression, development of BCG-unresponsive disease, and cystectomy. Materials and methods: Pre-BCG resection-derived whole-slide images and clinical data were obtained for high-risk nonmuscle-invasive bladder cancer cases treated with BCG from 12 centers and were analyzed through a segmentation and feature extraction pipeline. Features associated with clinical outcomes were defined and tested on independent development and validation cohorts. Cases were classified into high or low risk for recurrence, progression, BCG-unresponsive disease, and cystectomy. Results: Nine hundred forty-four cases (development: 303, validation: 641, median follow-up: 36 months) representative of the intended use population were included (high-grade Ta: 34.1%, high-grade T1: 54.8%; carcinoma in situ only: 11.1%, any carcinoma in situ: 31.4%). In the validation cohort, "high recurrence risk" cases had inferior high-grade recurrence-free survival vs "low recurrence risk" cases (HR, 2.08, P < .0001). "High progression risk" patients had poorer progression-free survival (HR, 3.87, P < .001) and higher risk of cystectomy (HR, 3.35, P < .001) than "low progression risk" patients. Cases harboring the BCG-unresponsive disease signature had a shorter time to development of BCG-unresponsive disease than cases without the signature (HR, 2.31, P < .0001). AI assays provided predictive information beyond clinicopathologic factors. Conclusions: We developed and validated AI-based histologic assays that identify high-risk nonmuscle-invasive bladder cancer cases at higher risk of recurrence, progression, BCG-unresponsive disease, and cystectomy, potentially aiding clinical decision making
KLHL24 mutation drives intermediate filament degradation, mitochondrial dysfunction and fibrosis in heart failure patients
(2025) Ramovs, Veronika; Chen, Sophia; Patra, Athina; Tjokrodirijo, Rayman; Van Veelen, Peter; Mulder, Aat; Koning, Roman; Stöger, Lauran; Hubner, Catalina; Ibañez, Rodrigo; Morales, Bernardo; Morandé, Pilar; Dell'Oro, Rosario; Poblete, Cristian; Schuster, Andrés; Joao, María; Palisson, Francis; Has, Cristina; Jongbloed, Monique; Fuentes, Ignacia; Mummery, Christine; Raymond, Karine
Aims: A striking aspect of epidermolysis bullosa patients with a mutation in KLHL24 (KLHL24mut) is their life-threatening deterioration of heart function. KLHL24 is a component of the ubiquitin-proteasome system and acts as a substrate-specific adaptor protein for E3 ubiquitin ligase. KLHL24mut is thought to represent a gain-of-function mutation, with associated cardiac and skin pathologies arising from the excessive degradation of its target proteins. Although reduced desmin levels in cardiomyocytes (CMs) have already been documented, the potential involvement of additional mechanisms in KLHL24mut -driven heart pathology remains unexplored. Methods and results: We report on two patients with KLHL24mut who recently manifested heart failure. To gain insights into their physiopathology, we integrated clinical data with proteomic analyses of heart tissue as well as human induced pluripotent stem cell (hiPSC) models carrying KLHL24mut. Mass spectrometry analysis of CMs differentiated from patient-derived hiPSCs mirrored the proteomic profile of their corresponding left ventricle tissue samples. KLHL24mut resulted in a reduction of several intermediate filaments (IF), mitochondrial and muscle fibre proteins as well as the emergence of an early fibrotic signature. By utilising various hiPSC-derived cardiac models along with flow cytometry, immunofluorescence, and western blot analyses, we confirmed that the excessive proteasomal activity of endogenous KLHL24mut caused a decrease in levels of desmin, synemin and vimentin, IF proteins of CMs and cardiac fibroblasts. Moreover, KLHL24mut led to mitochondrial mislocalization and increased mitophagy, reduced PKA activity, and sarcomere shortening in CMs. Conclusion: The deterioration of heart function in patients with KLHL24mut is driven by excessive proteasome-dependent degradation of multiple IF proteins across various cardiac cell types. Monotypic hiPSC-derived CMs and end-stage patient-derived cardiac explants from patients exhibit similar features, uncovering early pathological mechanisms and identifying a list of potential novel KLHL24mut target proteins. Finally, our findings validate that hiPSC-derived CMs represent a relevant model for future studies.
T1b gallbladder cancer: is extended resection warranted?
(2025) Chavez, Montserrat; De Aretxabala, Xabier; Losada, Hector; Portillo, Norberto; Castillo, Felipe; Bustos, Luis; Roa, Ivan
Background: Although the prognosis for gallbladder cancer (GBCA) improves with early diagnosis and aggressive surgical treatment, the management of patients with muscle layer invasion (T1b) remains controversial. This study aimed to analyze the optimal surgical approach for these patients. Methods: A database was queried for patients with early T1b GBCA treated at four Chilean hospitals. Patients were prospectively treated and registered by the same surgical team at each hospital. Clinical outcomes, including survival rates according to the type of surgery, were analyzed. Results: Between 1988 and 2023, 129 Chilean patients were pathologically diagnosed with T1b GBCA. Simple cholecystectomy (SC) was performed in 86 patients (66.7 %), while extended cholecystectomy (EC) was performed in 43 patients. The overall 5-year survival rate was 83 %, with no significant difference between SC and EC patients. Conclusion: Simple cholecystectomy demonstrated survival rates comparable to extended cholecystectomy for patients with T1b GBCA. More extensive resections did not improve the prognosis.
Implementación de un modelo in-vitro de ciclos erosivoabrasivos para el estudio del desgaste dental erosivo.
(2025) Cabello, Rodrigo; Díaz, Mario; Gómez, Valeria
Objetivo: Generar lesiones erosivas artificiales en bloques de esmalte dental humano por medio de la implementación de un modelo de ciclos erosivo-abrasivos utilizando pasta dental sin fluoruros in-vitro. Materiales y Métodos: Se prepararon 8 muestras de esmalte dental humano y se sometieron cíclicamente a seis ataques erosivos diarios mediante la inmersión de 2 minutos en ácido cítrico al 0,5%, cuyo pH=2,4 alternando con la exposición a saliva artificial durante una hora, proceso que fue realizado durante diez días. Adicionalmente, las muestras fueron expuestas a dos cepillados diarios con una pasta de dientes sin flúor. La cuantificación de la pérdida de tejido mineral se realizó con microtomografía computarizada y perfilometría de contacto. Resultados: Luego de la aplicación del modelo, se visualiza la generación de lesiones erosivas cuya media de pérdida de tejido fue de 18,08 μm (DE 4,71 μm) observada en Micro-CT y 21,9 μm (DE 2,59 µm) cuantificada utilizando perfilometría de contacto. Conclusiones: Los resultados obtenidos demuestran la efectividad del modelo para generar lesiones erosivas artificiales in-vitro. Objective: To generate artificial erosive lesions in human dental enamel samples by implementing an erosive-abrasive cycle model using fluoride-free toothpaste in-vitro. Materials and Methods: Eight human dental enamel samples were prepared and subjected to six daily erosive challenges. These challenges involved immersing the samples in 0.5% citric acid at pH 2.4 for 2 minutes, alternating with exposure to artificial saliva for one hour, over a period of ten days. Additionally, the samples were subjected to two daily brushings with fluoride-free toothpaste. Tissue loss was measured using micro-computed tomography (Micro-CT) and contact stylus profilometry. Results: Following the application of the model, the generation of erosive lesions was observed, with a mean tissue loss of 18.08 μm (SD 4.71 µm) as seen in Micro-CT and 21.9 μm (SD 2.59 µm) as quantified using contact profilometry. Conclusions: The results demonstrate the effectiveness of the model in generating artificial erosive lesions in-vitro.
Rol de la biopsia de linfonodo centinela en el manejo del carcinoma escamoso cutáneo de cabeza y cuello
(2025) Quezada, Andrés; Molina, Luis; Araya, Cristóbal; Chang, Mauricio; Valdes, Fabio; Tapia, Mario
El cáncer de piel de tipo no melanoma corresponde al cáncer más común a nivel mundial. Dentro de ellos, el carcinoma escamoso cutáneo (CEC) representa aproximadamente el 20% de los casos, con una incidencia en aumento y mayor afectación en áreas fotoexpuestas de la cabeza y el cuello. Aunque la mayoría de los casos se trata con éxito mediante cirugía, existe un grupo de pacientes que enfrenta un mayor riesgo de recurrencia, metástasis y mortalidad. La presencia de metástasis linfática reduce significativamente la supervivencia, lo que ha impulsado el desarrollo de estrategias de evaluación y manejo en pacientes sin evidencia de compromiso linfonodal. Estas incluyen la identificación de grupos de alto riesgo, el estudio imagenológico, la observación clínica y la disección cervical electiva. En los últimos años, se ha investigado la utilidad de la biopsia de linfonodo centinela (BLC) en el manejo del CEC en cabeza y cuello. Sin embargo, actualmente no existe evidencia suficiente que permita establecer su uso generalizado. Este artículo revisa la literatura actual con objeto de ayudar a los equipos de cirugía oncológica de cabeza y cuello en su toma de decisiones. Non-melanoma skin cancer is the most common cancer worldwide. Among them, cutaneous squamous cell carcinoma (SCC) represents approximately 20% of cases, with an increasing incidence and greater impact on sun-exposed areas of the head and neck. While most cases are successfully treated with surgery, a subset of patients faces higher risks of recurrence, metastasis, and mortality. The presence of nodal metastasis significantly reduces survival, prompting the development of various management strategies for patients without clinical evidence of nodal involvement. These strategies include identifying high-risk groups, imaging evaluation, clinical observation, and elective cervical dissection. In recent years, the utility of sentinel lymph node biopsy (SLNB) has been investigated in managing SCC in the head and neck. However, there is insufficient evidence to establish its widespread use. This article reviews the current literature to assist head and neck surgical oncology teams in decision-making.
Bacterial Analysis of Hamstring Autograft With Vancomycin Presoaking in Primary Anterior Cruciate Ligament Reconstruction Shows High Incidence of Colonization Without Early Clinical Infection
(2025) Scheu, Maximiliano; Bosselin, Raimundo; Araos, Rafael; Ugalde, Juan; Tuca, María Jesús; Espinoza, Gonzalo
Purpose: To determine the incidence of autograft bacterial colonization (BC) in anterior cruciate ligament reconstruction (ACLR) and to identify any bacteria type at the genus level. Methods: This prospective descriptive study included patients aged 18 years or older undergoing ACLR with hamstring autograft. Thirty-one patients (21 male and 10 female patients), with a mean age of 32.2 years, were included, with a mean follow-up period of 150 days (range, 90-208 days). Three samples were taken from every surgical procedure: a sample from the graft at the time it was obtained, a sample from the graft after tibial fixation, and a sample from the saline solution receptacle on the instrument table (control). All grafts underwent vancomycin presoaking. Bacterial composition was determined by next-generation sequencing of the 16S ribosomal RNA coding gene. Descriptive statistics were used to summarize data. The Fisher exact test was used to compare group samples (with P<.05 considered significant). Results: BC was detected in 11 of 31 patients (35.4%). BC was found in the first sample (sample from the graft at the time it was obtained) in 1 patient and in the third sample (control) in another. All 11 patients showed BC in the second sample (sample from the graft after tibial fixation), with statistical significance (P=.003). In these samples with BC, 47 types of gram-negative bacteria (GNB)were identified, averaging 6.8 bacteria per sample, with 3.97% relative abundance per bacterium. Pseudomonas was present in 5 of 11 samples, with 6.76% relative abundance. Additionally, 33 types of gram-positive bacteria (GPB) were found, averaging 6 bacteria per sample, with 9.62% relative abundance per bacterium; Streptococcus was present in 8 of 11 samples, with 26.23% relative abundance. All colonized samples exhibited both GPB and GNB. Conclusions: Bacterial contamination during ACLR is frequent, with the presence of both GNB and GPB. Although such colonization was common, no early clinical infections were noted in our patient cohort. Level of Evidence: Level III, prospective descriptive study.
Abordando los desafíos de la EPOC en Latinoamérica: preguntas y respuestas basadas en metodología GRADE
(2025) Mendoza, Laura; Sánchez, Efraín; Torres, David; Valenzuela, Juan; Cohen, Mark; Pérez, Rogelio
Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) representa un importante desafío para la salud pública en América Latina, contribuyendo sustancialmente a la morbilidad y la mortalidad. Este documento busca brindar recomendaciones basadas en la evidencia para el diagnóstico y el tratamiento de la EPOC en América Latina, adaptadas a las necesidades y recursos específicos de la región. Su propósito es servir de guía para los profesionales de la salud en sus esfuerzos por mejorar la calidad de vida de las personas con EPOC. Metodología: Se estableció el comité ejecutivo de las recomendaciones conformado por cuatro médicos neumólogos miembros del departamento de EPOC de ALAT y dos epidemiólogos clínicos. Representantes de sociedades nacionales de Neumología y representantes de departamentos científicos de ALAT, quienes formularon preguntas clínicas; se seleccionaron 12 preguntas por su relevancia para contexto latinoamericano. Luego, se utilizó el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation) para evaluar la evidencia disponible y formular las recomendaciones. Resultados: Se obtuvieron recomendaciones en 12 preguntas PICO divididas en cuatro apartados: prevención secundaria, pronóstico I, pronóstico II y terapéutica. Conclusiones: El objetivo del presente documento es proporcionar recomendaciones de relevancia para el diagnóstico y tratamiento de la EPOC en Latinoamérica, que sean aplicables para médicos especialistas y de atención primaria con la finalidad de reducir el impacto asistencial y los costos asociados a la enfermedad. Introduction: Chronic obstructive pulmonary disease (COPD) represents a major public health challenge in Latin America, contributing substantially to morbidity and mortality. This document seeks to provide evidence-based recommendations for the diagnosis and treatment of COPD in Latin America, tailored to the specific needs and resources of the region. Its purpose is to serve as a guide for healthcare professionals in their efforts to improve the quality of life of people with COPD. Methods: An executive committee for the recommendations was established, consisting of four pulmonologists from the COPD Department of ALAT and two clinical epidemiologists. Representatives of national pulmonology societies and representatives of ALAT scientific departments formulated clinical questions, and twelve questions were selected based on their relevance to the Latin American context. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was then used to evaluate the available evidence and formulate recommendations. Results: Recommendations were obtained in 12 PICO questions divided into four sections: secondary prevention, prognosis I, prognosis II and therapeutics. Conclusions: The objective of this document is to provide recommendations for the diagnosis and treatment of COPD relevant to Latin America, applicable to specialists and primary care physicians, with the goal of reducing the healthcare impact and costs associated with the disease.
Local injection of botulinum toxin for the prevention of hypertrophic scars and keloids: an overview of reviews
(2025) Silva, Iván; Ramos, José; Peña, Javiera; Novillo, Francisco; Rada, Gabriel
Introduction: Hypertrophic scars and keloids arise from an abnormal healing process in the skin, significantly affecting the quality of life. There is a wide array of treatment options available, but they often come with high costs and yield inconsistent results. Botulinum toxin is one such option that is thought to have a preventive effect, although evidence from multiple reviews have not provided a clear answer. Our objective is to compile evidence from systematic reviews of randomized controlled trials concerning the impact of local botulinum toxin injection on preventing hypertrophic scars and keloid formation following surgical skin trauma. Methods: We conducted an overview of reviews following the Preferred Reporting Items for Overviews of Reviews (PRIOR) reporting guidelines. We searched for the Epistemonikos Database up to January 2024. Quality was assessed using the AMSTAR-2 tool. We compared reviews addressing similar questions, calculated the covered area and corrected covered area to assess overlap, and explored reasons for differences between reviews. Results: Fifteen systematic reviews were included. All were classified as having low or critically low confidence according to AMSTAR-2. The covered area was 28.38%, and the corrected covered area was 23.26%, indicating very high overlap. Findings of the included reviews showed a beneficial effect on scar appearance and patient satisfaction, but in adverse events the direction of effect varied. Conclusion: Botulinum toxin could be an alternative for preventing hypertrophic scars and keloids after surgical skin trauma, but given the low confidence of the reviews, these results should be interpreted with caution. Introducción: Las cicatrices hipertróficas y los queloides resultan de un proceso de cicatrización anómalo que puede afectar significativamente la calidad de vida. Existen diversas alternativas terapéuticas; sin embargo, suelen implicar altos costos y resultados poco predecibles. La toxina botulínica se ha propuesto como tratamiento preventivo, aunque la evidencia disponible no ha permitido establecer conclusiones definitivas. El objetivo de este estudio fue sintetizar la evidencia proveniente de revisiones sistemáticas de ensayos clínicos aleatorizados sobre el efecto de la inyección local de toxina botulínica en la prevención de cicatrices hipertróficas y queloides posteriores a trauma quirúrgico cutáneo. Métodos: Se realizó una revisión panorámica siguiendo las directrices PRIOR (Preferred Reporting Items for Overviews of Reviews). Se buscó en la base de datos Epistemonikos hasta enero de 2024. La calidad de las revisiones se evaluó mediante la herramienta AMSTAR-2. Se compararon revisiones con preguntas similares, se calcularon el área cubierta y el área cubierta corregida para determinar el grado de superposición, y se exploraron las causas de las diferencias entre las revisiones. Resultados: Se incluyeron quince revisiones, todas con nivel de confianza bajo o críticamente bajo según AMSTAR-2. El área cubierta fue de 28,38% y el área cubierta corregida del 23,26%, lo que indica una superposición elevada. Las revisiones reportaron un efecto beneficioso sobre la apariencia de las cicatrices y la satisfacción del paciente; no obstante, los resultados respecto a eventos adversos fueron variables.
Uso de toxina botulínica en pacientes con distonía laríngea y temblor vocal
(2025) Capdeville Olcese, Florencia; Leung, Jai-sen; Rosenbaum, Andrés; León, Norma; Napolitano, Carla; Lagos, Antonia
Introducción: Los trastornos del movimiento laríngeo, como la distonía laríngea (DL), el temblor vocal esencial (TVE) y distónico (TVD) generan inestabilidad vocal, afectando la funcionalidad y calidad de vida. Aunque no existe un tratamiento curativo, las inyecciones laríngeas de toxina botulínica (TB) son la terapia estándar. Objetivo: Caracterizar la población de pacientes con DL, TVD y TVE, y evaluar los resultados del tratamiento con TB. Material y Métodos: Estudio de cohorte retrospectivo. Se revisaron registros médicos de los pacientes con DL, TVD y TVE evaluados en la Unidad de Voz entre enero de 2013 y julio de 2024. Se recopilaron datos biodemográficos, clínicos y de tratamiento. Los pacientes tratados con TB completaron una encuesta de autoreporte vocal, incluyendo el Índice de Discapacidad Vocal (VHI-10). Se realizó análisis estadístico descriptivo y comparativo. Resultados: Se incluyeron 66 pacientes (edad media: 60 años y 84,9% mujeres). Los diagnósticos fueron DL (56,1%), TVD (12,1%) y TVE (31,8%). El subtipo más común de DL fue aductora (97,8%). A 40 pacientes se les indicó TB y 35 fueron tratados, con 133 inyecciones en total, principalmente por abordaje cricotiroideo. La calidad y esfuerzo vocal y el puntaje de VHI-10 mejoraron significativamente (P < 0,0001). Se reportó voz soplada en 100% y disfagia de sólidos (21,7%) y líquidos (60,1%). Conclusión: La inyección laríngea de TB es segura y efectiva en pacientes con DL, TVD y TVE, mejorando la autopercepción en todos los diagnósticos y mejorando la calidad de la voz y reduciendo el esfuerzo vocal en DL y TVD. Introduction: Laryngeal movement disorders, such as laryngeal dystonia (LD), essential voice tremor (EVT), and dystonic voice tremor (DVT) cause vocal instability, affecting functionality and quality of life. Although there is no curative treatment, laryngeal botulinumtoxin (BT) injections are the standard therapy. Objective: To characterize the population of patients with LD, DVT and EVT and assess the outcomes of laryngeal BT injections. Material and Methods: A retrospective cohort study was conducted. Medical records of patients with LD, DVT, and EVT evaluated at the Voice Unit between January 2013 and July 2024 were reviewed. Biodemographic, clinical, and treatment data were collected. Patients treated with BT completed a self-reported vocal symptoms survey, including the Voice Handicap Index (VHI-10). Descriptive and comparative statistical analyses were performed. Results: Sixty-six patients were included (mean age: 60 years, 84,9% female). Diagnoses included LD (56.1%), DVT (12.1%), and EVT (31.8%). The most common LD subtype was adductor LD (97.8%). Of the total cohort, 40 patients were prescribed BT treatment, and 35 received it at our center, totaling 133 injections, mostly administered via the cricothyroid approach. Vocal quality, vocal effort and VHI-10 scores significantly improved after treatment (P < 0.0001). Breathy voice was reported in 100% of cases, and dysphagia with solids and liquids in 21.7% and 60.1%, respectively. Conclusion: Laryngeal BT injection is a safe and effective treatment for patients with LD, DT, and EVT, improving self-perceived across all diagnoses and improving voice quality and reducing vocal effort in LD and DLT.

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