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Premorbid school performance trajectories in patients with treatment-resistant schizophrenia prescribed clozapine in the public health system in Chile: a case-control study, 2007-2020
(2025) Conejeros, Jose; Vasquez, Javiera; Diaz, Camila; Mena, Cristian; Undurraga, Juan; Gonzalez, Alfonso; Claro, Susana; Undurraga, Eduardo; Crossley, Nicolas
Background: The premorbid phase of treatment-resistant schizophrenia (TRS) may reveal underlying mechanisms and inform early interventions. According to the neurodevelopmental hypothesis, treatment resistance may be linked to pronounced developmental impairments. We examined school grades and attendance trajectories in children who later developed TRS.
Methods: This case-control study analyzed school grade point average and attendance among all individuals born after 1990 and started on clozapine in Chile's public health system as a proxy for TRS. Control groups included children later diagnosed with treatment-responsive schizophrenia, bipolar disorder, and unaffected classmates. Linear mixed models accounted for individual and school-level confounders.
Results: We included 1072 children (9929 observations, 29.3% female) subsequently diagnosed with TRS, 323 (2802 observations, 25.7% female) with schizophrenia, 175 (1784 observations, 53.8% female) bipolar disorder, and 273,260 (533,335 observations, 47% female) unaffected classmates. Children who later developed TRS had worse grades across levels than their classmates (-0.26 SD [-0.2, -0.4]), but not treatment-responsive schizophrenia. All severe mental illness groups showed grade declines in later school levels, with TRS showing steeper linear decline than treatment-responsive schizophrenia (group×age of -0.03; 95%CI -0.04, -0.01) and steeper quadratic decline than bipolar disorder (group×age2 of -0.005; -0.01, -0.001). Attendance declined over time in the two groups developing schizophrenia compared to their classmates. Those developing TRS experienced the sharpest drop (group×age compared to schizophrenia -0.03; -0.05, -0.01 and bipolar disorder -0.027; -0.049, -0.006).
Conclusions: TRS may stem from a more aggressive pathological process or pronounced late-maturation abnormality, rather than an early premorbid impairment, suggesting an intervention target
Renal angiomyolipomas: Typical and atypical features on computed tomography and magnetic resonance imaging
(2025) Labra, Andrés; Schiappacasse, Giancarlo; Constenla, Diego; Cristi, Joaquin
Angiomyolipomas (AMLs) represent the most common benign solid renal tumors. The frequency of their detection in the general population is increasing owing to advances in imaging technology. The objective of this review is to discuss computed tomography (CT) and magnetic resonance imaging findings for both typical and atypical renal AMLs, along with their associated complications. AMLs are typically defined as solid triphasic tumors composed of varying amounts of dysmorphic and tortuous blood vessels, smooth muscle components and adipose tissue. In an adult, a classical renal AML appears as a solid, heterogeneous renal cortical mass with macroscopic fat. However, up to 5% of AMLs contain minimal fat and cannot be reliably diagnosed by imaging. Fat-poor AMLs can appear as hyperattenuating masses on unenhanced CT and as hypointense masses on T2WI; other AMLs may be isodense or exhibit cystic components. Hemorrhage is the most common complication, and AMLs with hemorrhage can mimic other tumors, making their diagnosis challenging. Understanding the variable and heterogeneous nature of this neoplasm to correctly classify renal AMLs and to avoid misdiagnosis of other renal lesions is crucial.
Individualized evaluation of the total dose received by radiotherapy patients: Integrating in-field, out-of-field, and imaging doses
(2025) Romero-Expósito, Maite; Sánchez-Nieto, Beatriz; Riveira-Martin, Mercedes; Azizi, Mona; Gkavonatsiou, Angeliki; Muñoz, Isidora; López-Martínez , Ignacio N.; Espinoza, Ignacio; Zelada, Gabriel; Cordova-Bernhardt, Andrés; Norrlid, Ola; Goldkuhl, Christina; Molin, Daniel; Mosquera-Pena Sánchez, Francisco; López-Medina, Antonio; Toma-Dasu, Iuliana; Dasu, Alexandru
Purpose: To propose a methodology for integrating the out-of-field and imaging doses to the in-field dose received by radiotherapy (RT) patients. In addition, the impact of considering the total dose in planning and radiation- induced second malignancies (RISM) risk assessment will be evaluated in several scenarios comprising photon and proton treatments.
Methods: The total dose is the voxel-wise sum of the doses from the different radiation sources (accounting for the radiobiological effectiveness) produced during the whole RT chain. The dose from the plan and imaging procedures were obtained by measurements for a photon prostate treatment and by calculation (combining treatment planning system, analytical models, and Monte Carlo simulations) for two lymphoma treatments, one using photons and the other, protons. Dose distributions, dose volume histograms (DVHs) metrics, mean organ doses, and RISM risks were evaluated for each radiation exposure in each treatment.
Results: In general, the contribution of the imaging doses is low compared to the dose administered during RT treatment, being higher in proton therapy. However, for some organs, for instance testes in the prostate case, the maging dose becomes higher than the scattered dose from the treatment fields. Plan evaluations revealed shifts in cumulative DVHs with the inclusion of out-of-field and imaging doses, though minimal clinical impact is expected. Risk assessment showed increased estimates with total dose.
Conclusions: The methodology enables accounting for the total dose for optimization of plans and imaging protocols, prospective risk predictions and retrospective epidemiological analyses.
Homogeneity of the coronary microcirculation in angina with non-obstructive coronary artery disease
(2025) Hoshino, Masahiro; Hoek, Roel; Jukema, Ruurt; Dahdal, Jorge; Van Diemen, Pepijn; Raijmakers, Pieter; Driessen, Roel; Twisk, Jos; Danad, Ibrahim; Kakuta, Tsunekazu; Knuuti, Juhani; Knaapen, Paul
Aims: The homogeneity of coronary microvascular dysfunction (CMD) across different myocardial territories in angina with non-obstructive coronary artery disease (ANOCA) patients is scarcely explored. This study investigates the variability in microvascular resistance reserve (MRR) across the 3 main perfusion territories of the coronary circulation to investigate the homogeneity or dishomogeneity of microcirculatory function.
Methods and results: This post hoc analysis of the PACIFIC trials included symptomatic ANOCA patients with [15O]H2O positron emission tomography (PET) and three-vessel invasive fractional flow reserve (FFR). MRR was computed in the three main coronary branches by integrating PET-derived coronary flow reserve and invasive FFR. A total of 155 patients (50% male, age 59 ± 10 years) and 465 vessels (MRR: 3.92 ± 1.21) were included. There were no significant differences in MRR among the three coronary branches. Correlations in MRR among the three coronary branches were good (r = 0.76 to 0.86). The mean difference between MRR measurements in different arteries was small (2.4 to 7.5%), without any consistent directional bias. The overall intra-class correlation coefficient for absolute agreement was 0.80 (95% CI: 0.74-0.85), indicating good single-measure reliability. Approximately 80% (123/155) of patients showed diagnostic concordance of CMD (MRR ≤3.0) across the three vessels.
Conclusion: In most ANOCA patients, microvascular function is homogeneously distributed across the three major coronary territories. Single-artery testing may suffice in many cases, aligning with guidelines. However, some patients exhibit notable inter-territorial variation, suggesting that multi-vessel evaluation may be prudent in borderline scenarios.
Fish Oil Supplementation Attenuates Offspring's Neurodevelopmental Changes Induced by a Maternal High-Fat Diet in a Rat Model
(2025) Muñoz, Yasna; Kaune, Heidy; Dagnino, Alexies; Cruz, Gonzalo; Toledo, Jorge; Valenzuela, Rodrigo; Moraga, Renato; Tabilo, Luis; Flores, Cristian; Muñoz, Alfredo; Crisosto, Nicolás; Montiel, Juan; Maliqueo, Manuel
Background/Objectives: A maternal high-fat diet (HFD) impairs brain structure in offspring. In turn, fish oil (FO) rich in n-3 polyunsaturated fatty acids (PUFAs) has neuroprotective effects. Therefore, we investigated whether maternal HFD exposure affected the neurological reflexes, neuron morphology, and n-3 PUFA levels in the cerebral cortex of the offspring and whether these effects were mitigated by maternal FO consumption. Methods: Female Sprague Dawley rats received a control diet (CD, 10% Kcal fat) or HFD (45% Kcal fat) five weeks before mating and throughout pregnancy and lactation. From mating, a subgroup of HFD was supplemented with 11.4% FO into the diet (HFD-FO). Neurological reflexes were evaluated from postnatal day (PND) 3 until PND20. Brains were removed at PND22 for neuron morphology analysis. Moreover, fatty acid composition and transcripts of genes encoding for factors associated with synapse transmission (SNAP-25), plasticity (BDNF), transport of DHA (MFSD2a), and inflammation (NF-κB and IL-1β) were quantified in prefrontal, motor, and auditory cortices. Results: FO diminished the effects of HFD on the number of thin and mushroom-shaped dendritic spines in the cerebral cortex in both sexes. It also reversed the HFD effects on the motor and auditory reflexes in female and male offspring, respectively. In males, FO up-regulated Bdnf transcript levels in the motor cortex compared with CD and HFD. In females, n-3 PUFAs were higher in HFD and HFD-FO than in CD in the auditory cortex. Conclusions: Our results highlight the protective role of maternal dietary n-3 PUFAs in counteracting the effects induced by HFD on the acquisition of neurological reflexes and neuronal morphology in the cerebral cortex of the offspring of both sexes.
Salmonella enterica Serovar Abony Outbreak Caused by Clone of Reference Strain WDCM 00029, Chile, 2024
(2025) Piña-Iturbe, Alejandro; Fredes-García, Diego; García, Patricia; Porte, Lorena; Johnson, Timothy J.; Singer, Randall S.; Toro, Magaly; Munita, José; Moreno-Switt, Andrea I.
A Salmonella enterica serovar Abony outbreak occurred during January–April 2024 in Chile. Genomic evidence indicated that the outbreak strain was a clone of reference strain WDCM 00029, which is routinely used in microbiological quality control tests. When rare or unreported serovars cause human infections, clinicians and health authorities should request strain characterization.
Acute skeletal muscle wasting in patients with acute kidney injury requiring continuous kidney replacement therapy: A prospective multicenter study
(2026) Mayer, Kirby; Teixeira, Pedro; González Seguel, Felipe; Tran, Vinh; Gross, Jessica; Horikawa, Arimitsu; Anil, Chaitanya; Shareef, Zan; Puffer, Hayley; Wen, Yuan; Griffin, Benjamin; Neyra, Javier
Purpose: Acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) has been hypothesized to increase the risk of developing intensive care unit-associated weakness (ICU-AW), but prospective data are lacking.
Materials and methods: This prospective observational study evaluated critically ill adults with AKI requiring CKRT at two U.S. academic hospitals. Using ultrasonography (US), we quantified changes in rectus femoris (RF) muscle mass and quality in the first week after CKRT initiation. At hospital discharge, we assessed for ICU-AW, physical function, and frailty.
Results: Twenty-three patients with median age 56 [IQR 47-60] years, BMI 29 [26-36] kg/m2, and Charlson Comorbidity Index 3 [1.5-5] were enrolled. The baseline Sequential Organ Failure Assessment (SOFA) score was 9 [7.5-11.5] and CKRT duration was 4 [1-7] days. Six (26 %) patients died in the ICU and one (4 %) transitioned to comfort measures before study completion. Substantial muscle wasting occurred between Day 1 and Day 7: RF muscle thickness (mT) decreased by 10 % [3 %-20 %]; RF cross-sectional area (CSA) decreased by 19 % [12 %-22 %]; and echo intensity (EI) increased (implying worse muscle quality) by 14 % [5 %-25 %]. A significant effect of time within subjects was observed for all three ultrasound measures (CSA: F = 66.2, p < 0.001; mT: F = 27.1, p < 0.001; EI: F = 22.5, p < 0.001). At hospital discharge, 67 % of survivors (n = 10/15) met criteria for ICU-AW.
Conclusions: Patients with AKI requiring CKRT experienced significant muscle wasting in the first week following CKRT initiation and had high rate of ICU-AW at hospital discharge.
Trial registration: NCT05287204, Registered 20 October 2021.
Impact of myocardial scar burden on microvascular resistance reserve in patients with coronary artery disease
(2026) Hoshino, Masahiro; Hoek, Roel; Jukema, Ruurt; Dahdal, Jorge; Van Diemen, Pepijn; Hopman, Luuk; Raijmakers, Pieter; Driessen, Roel; Twisk , Jos; Danad, Ibrahim; Kakuta, Tsunekazu; Knuuti, Juhani; Knaapen, Paul
Purpose: The impact of myocardial scar on coronary microcirculation is not well understood. This study aims to evaluate the association between microvascular resistance reserve (MRR) and scar tissue.
Methods: In this post-hoc analysis of the PACIFIC 2 trial, symptomatic patients with prior myocardial infarction (MI) and/or percutaneous coronary intervention (PCI) underwent [15O]H2O positron emission tomography (PET), cardiac magnetic resonance (CMR) imaging, and fractional flow reserve (FFR). MRR was assessed utilizing PET-derived coronary flow reserve and FFR measurements. Scar quantification was assessed by CMR late gadolinium enhancement (LGE). Vessel LGE burden was defined as the scar tissue proportion in each myocardial territory. Total LGE burden was defined as the proportion of overall scar.
Results: The study included 154 patients with 397 vessels with a mean MRR of 3.56 ± 1.24. Patients with any scar tissues (LGE > 0%) exhibited a lower MRR in every myocardial territory than those without scar tissues. After adjusting for cardiovascular risk factors, either vessel LGE burden (β =-0.013, P = 0.006) or total LGE burden (β =-0.039, P = 0.002) independently predicted a reduced MRR. Compared to myocardial territories without scar tissues (LGE burdens = 0%), MRR was significantly lower in myocardial territories with vessel LGE burden = 0% + total LGE burden > 0%, and in myocardial territories with both LGE burdens > 0%.
Conclusion: Scar burden was negatively associated with MRR in patients with prior MI and/or PCI. Our findings indicate that both the proportion of myocardial scar in the vascular territory and the overall myocardial scar affect the microcirculation of individual vascular territories.
Clinical trial number: Not applicable
Clinical neurophysiology for tremor: Common questions in clinical practice
(2025) Schwingenschuh, Petra; Van der Stouwe, Madelein; Pandey, Sanjay; Hirschbichler, Stephanie; Panyakaew, Pattamon; Kojovic, Maja; Mukherjee, Adreesh; Tijssen, Marina AJ.; Merchant, Shabbir Hussain I.; Vial Undurraga, Felipe; MDS Clinical neurophysiology Study group
Background
A thorough history and physical examination may be insufficient for comprehensively studying patients with tremor. In such instances, neurophysiology serves as an adjunct to the physical examination.
Objectives
Our aim is to present compelling evidence supporting the utilization of neurophysiological studies in various tremor conditions.
Methods
A panel of global experts, convened by the Study Group on Clinical Neurophysiology for Movement Disorders, examined the application and utility of neurophysiology across diverse movement disorders.
Results
This manuscript provides a detailed methodology for electrophysiological studies in tremors helping to differentiate them from myoclonus, comparing tremor in parkinson vs atypical parkinsonisms, describing dystonic tremor, describing the differences between Parkinson and essential tremor and the characteristics of functional tremor.
Conclusions
Neurophysiological studies play a crucial role in characterizing tremor syndromes and aiding in their differentiation from other hyperkinetic movement disorders.
SPINE20 Recommendations 2024 -Spinal Disability: Social Inclusion as a Key to Prevention and Management
(2025) Menezes, Cristiano M.; Tucci, Carlos; Tamai, Koji; Chhabra, Harvinder S.; Alhelal, Fahad H.; Bussières, André E.; Muehlbauer, Eric J.; Roberts, Lisa; Alsobayel, Hana I.; Barneschi, Guido; Campello, Marco A.; Côté, Pierre; Duchén Rodríguez, Luis Miguel; Cristante, Alexandre F.; Kamra, Komal; Kitamura, Kazuya; Meves, Robert; Risso-Neto, Marcelo I.; Vlok, Adriaan J.; Wadhwa, Sanjay; Wiechert, Karsten; Yurac, Ratko; Blattert, Thomas; Costanzo, Giuseppe; Darwono, Bambang; Nordin, Margareta; Al Athbah, Yahya S.; Alturkistany, Ahmed; Chahal, Rupinder; Franke, Joerg; Ito, Manabu; rand, Markus; Pereira, Paulo; Ruosi, Carlo; Sullivan, William J.; Andújar, André L.F.; Henrique Ribeiro, Carlos; Carelli, Luis Eduardo; Sardá, Jamir; Machado, Ana Lígia G.E.; AlEissa, Sami
Spine disorders are the leading cause of disability worldwide. To promote social inclusion, it is essential to ensure that people can participate in their societies by improving their ability, opportunities, and dignity, through access to high-quality, evidence-based, and affordable spine services for all.
To achieve this goal, SPINE20 recommends six actions.
- SPINE20 recommends that G20 countries deliver evidence-based education to the community health workers and primary care clinicians to promote best practice for spine health, especially in underserved communities.
- SPINE20 recommends that G20 countries deliver evidence-based, high-quality, cost-effective spine care interventions that are accessible, affordable and beneficial to patients.
- SPINE20 recommends that G20 countries invest in Health Policy and System Research (HPSR) to generate evidence to develop and implement policies aimed at integrating rehabilitation in primary care to improve spine health.
- SPINE20 recommends that G20 countries support ongoing research initiatives on digital technologies including artificial intelligence, regulate digital technologies, and promote evidence-based, ethical digital solutions in all aspects of spine care, to enrich patient care with high value and quality.
- SPINE20 recommends that G20 countries prioritize social inclusion by promoting equitable access to comprehensive spine care through collaborations with healthcare providers, policymakers, and community organizations.
- SPINE20 recommends that G20 countries prioritize spine health to improve the well-being and productivity of their populations. Government health systems are expected to create a healthier, more productive, and equitable society for all through collaborative efforts and sustained investment in evidence-based care and promotion of spine health.
Manual de buenas prácticas docentes: simulación en psicología
(Universidad del Desarrollo. Facultad de Psicología, 2026) Bruna Jofré, Daniela; González Montenegro, Pablo
El aprendizaje experiencial y las metodologías activas ofrecen una respuesta consistente a este desafío. Aprender haciendo, equivocarse, recibir
retroalimentación y volver a intentar constituye una vía privilegiada para el desarrollo de competencias profesionales que difícilmente se adquieren solo
escuchando o leyendo. La simulación, en este marco, ocupa un lugar central: permite recrear escenarios auténticos del ejercicio profesional en un entorno protegido, donde el error no tiene consecuencias sobre terceros y se transforma en oportunidad de aprendizaje. La seguridad psicológica de nuestros estudiantes, el acompañamiento docente y la reflexión sistemática sobre la experiencia son condiciones que hacen posible ese proceso.
Educación y niñez: la importancia de la educación emocional y la salud mental en escolares
(2026) Guesalaga, Vicente; Möller, Matías
Síntesis de un derivado de quinolina-5,8-diona y su potencial uso antineoplásico
(2026) Hoppmann, Samuel; Campos, Ignacio; Calderón, Lucas; Quinteros, Daniela; Orrego, Joaquín; Espinoza, Sofía; Suárez, Cristian
Introducción: La quimioterapia antineoplásica es una estrategia terapéutica fundamental para el tratamiento del cáncer, pero la falta de selectividad y el desarrollo de resistencia farmacológica limitan su eficacia clínica. Las quinolina-5,8-dionas emergen como farmacóforos prometedores, dado que estructuras naturales derivadas de este núcleo exhiben actividad citotóxica demostrada. La incorporación de anillos heterocíclicos adicionales mediante aza-anulación potencia dicha actividad en sistemas quinónicos relacionados. Objetivo: Sintetizar y caracterizar los derivados aza-anulados 5-cloro-3,4dihidropirido[3,2-f]quinoxalin-6(2H)-ona y 5-cloro-3,4-dihidropirido[2,3-f]quinoxalin-6(2H)-ona. Metodología: Se empleó una ruta sintética de cuatro etapas desde la 8-hidroxiquinolina, incluyendo nitrosación, reducción selectiva, cloración oxidativa e iminociclación con etilendiamina en acetonitrilo. La caracterización se realizó por RMN monodimensional (1H y 13C) y bidimensional (HMBC). Resultado: La reacción de iminociclación no condujo a los compuestos objetivo, generando, en cambio, el producto inesperado 5-cloropirido[2,3-f]quinoxalin-6-ol, con un rendimiento del 36%. Discusión: Los análisis espectroscópicos evidenciaron que el producto experimentó deshidrogenación y aromatización in situ, dando lugar a una estructura aza-anulada completamente aromatizada, en la cual el grupo hidroxilo (-OH) se encuentra unido a un carbono del sistema aromático, correspondiente al compuesto 5-cloropirido[2,3-f]quinoxalin-6-ol. Conclusión: La ruta sintética empleada no permite acceder a los compuestos objetivo bajo las condiciones evaluadas. No obstante, la obtención del compuesto 7, inédito en la literatura, lo posiciona como nueva entidad química de interés para la evaluación de actividad antineoplásica y el diseño de moléculas con actividad biológica mejorada.
Introduction: Antineoplastic chemotherapy is a fundamental therapeutic strategy for the treatment of cancer, but its lack of selectivity and the development of drug resistance limit its clinical efficacy. Quinoline-5,8-diones are emerging as promising pharmacophores, given that natural structures derived from this core exhibit proven cytotoxic activity. The incorporation of additional heterocyclic rings via aza-fusion enhances this activity in related quinone systems. Objective: The objective was to synthesize and characterize the aza-fused derivatives 5-chloro-3,4-dihydropyrido[3,2-f]quinoxalin-6(2H)-one and 5-chloro-3,4dihydropyrido[2,3-f]quinoxalin-6(2H)-one. Methodology: A four-step synthetic route was employed starting from 8hydroxyquinoline, involving nitrosation, selective reduction, oxidative chlorination, and iminocyclization with ethylenediamine in acetonitrile. Characterization was performed by one-dimensional (1H and 13C) and two-dimensional (HMBC) NMR. Results: The iminocyclization reaction did not yield the target compounds but instead generated the unexpected product 5chloropyrido[2,3-f]quinoxalin-6-ol, with a 36% yield. Discussion: Spectroscopic analyses showed that the product underwent in situ dehydrogenation and aromatization, resulting in a fully aromatized aza-annulated structure, in which the hydroxyl group (-OH) is attached to a carbon atom of the aromatic system, corresponding to compound 5-chloropyrido[2,3-f]quinoxalin-6-ol. Conclusion: The synthetic route used does not allow for the preparation of the target compounds under the conditions evaluated. However, the synthesis of compound 7, which has not been reported in the literature, establishes it as a new chemical entity of interest for the evaluation of antineoplastic activity and the design of molecules with enhanced biological activity.
Fisiopatología de las quemaduras graves: fundamentos para el manejo precoz y anticipatorio del médico general
(2026) Saintard, Marianne; Hidalgo, Valeria; Arancibia, Ignacio; Alarcón, Asunción; Paredes, Joaquín
Introducción: Las quemaduras constituyen un problema de salud pública por el impacto de su elevada morbimortalidad a nivel global. Son una patología compleja que genera daño tisular progresivo, comprometiendo la homeostasis hemodinámica y metabólica. Objetivo: Describir los mecanismos fisiopatológicos locales y sistémicos de las quemaduras graves para orientar el manejo inicial por el médico general y facilitar una anticipación estratégica de las complicaciones agudas y crónicas. Metodología: Revisión bibliográfica en las bases de datos PubMed y SciELO utilizando términos MeSH “Burns/physiopathology”, “Oxidative Stress” e “Inflammation”. Se seleccionaron artículos en inglés y español de los últimos 10 años, priorizando revisiones sistemáticas y guías clínicas internacionales. Resultado: Localmente, las quemaduras generan daño concéntrico (zonas de Jackson). La liberación masiva de patrones moleculares asociados a daño (DAMPs) y patógenos (PAMPs) desencadena una respuesta inflamatoria, estrés oxidativo y desprendimiento del glicocálix endotelial, lo que incrementa la permeabilidad capilar, favoreciendo el edema intersticial, shock hipovolémico y falla multiorgánica. Adicionalmente, inducen estrés hipermetabólico persistente con hiperglicemia y catabolismo proteico. Discusión: Rescatar la zona de estasia es el principal objetivo terapéutico en urgencias, requiriendo reanimación hídrica controlada y coberturas húmedas para evitar la pérdida tisular irreversible. La fluidoterapia debe guiarse por objetivos de perfusión para mitigar el riesgo de fluid creep (sobrecarga de volumen) y complicaciones fatales como el distrés respiratorio agudo y el síndrome compartimental. Conclusión: Comprender estos fenómenos fisiopatológicos a nivel celular y sistémico fundamenta terapias precoces dirigidas por objetivos para limitar la progresión lesional y las complicaciones orgánicas graves. Este manejo anticipatorio es esencial para estabilizar al paciente en fase aguda y atenuar secuelas metabólicas, funcionales y psiquiátricas a largo plazo.
Introduction: Burns constitute a public health problem due to the impact of their high global morbidity and mortality. They are complex pathologies that generate progressive tissue damage, compromising hemodynamic and metabolic homeostasis. Objective: To describe the local and systemic pathophysiological mechanisms of severe burns to guide initial clinical management by general practitioners and facilitate strategic anticipation of acute and chronic complications. Methodology: Literature review in PubMed and SciELO databases using MeSH terms “Burns/physiopathology”, “Oxidative Stress”, and “Inflammation”. Articles in English and Spanish from the last 10 years were selected, prioritizing systematic reviews and international clinical guidelines. Result: Locally, burns generate concentric damage (Jackson's zones). Massive release of damage-associated (DAMPs) and pathogen-associated (PAMPs) molecular patterns triggers an inflammatory response, oxidative stress, and endothelial glycocalyx shedding, increasing capillary permeability, favoring interstitial edema, hypovolemic shock, and multiorgan failure. Additionally, they induce persistent hypermetabolic stress with hyperglycemia and protein catabolism. Discussion: Rescuing the zone of stasis is the main therapeutic objective in emergency care, requiring controlled fluid resuscitation and wet dressings to prevent irreversible tissue loss. Fluid therapy must be goal-directed to mitigate the risk of fluid creep (volume overload) and fatal complications such as acute respiratory distress syndrome and compartment syndrome. Conclusion: Understanding these cellular and systemic pathophysiological phenomena provides the rationale for early goal-directed therapies to limit injury progression and severe organ complications. This anticipatory management is essential to stabilize acute patients and mitigate long-term metabolic, functional, and psychiatric sequelae.
Bone regeneration based on stem cells derived from bone marrow, iliac crest, or adipose tissue: a scoping review protocol of clinical applications for dental implant site preparation
(2025) Veloso, Valentina; Ramos-Rojas, José Tomás; Collao-Fierro, Francisca; Ogaz-Muñoz, Karla; Montero-Olivares, Camilo
Introducción: La terapia con implantes dentales es ampliamente reconocida como el estándar de oro para el reemplazo dental; sin embar-go, la atrofia ósea con frecuencia requiere procedimientos de aumento para asegurar el éxito del implante. Los métodos convencionales de injerto, aunque eficaces, presentan limitaciones como morbilidad en el sitio donante, inmunogenicidad y un potencial osteogénico inconsistente. Las células madre mesenquimales (MSCs) han surgido como una alternativa prometedora debido a su capacidad de dife-renciación osteogénica e inmunomodulación. A pesar de los rápidos avances, la traducción clínica sigue viéndose obstaculizada por la variabilidad en la fuente celular, los protocolos de procesamiento y las medidas de resultado. Esta revisión exploratoria tiene como objetivo mapear sistemáticamente las aplicaciones clínicas actuales de la regeneración ósea basada en MSCs obtenidas de médula ósea, cresta ilíaca o tejido adiposo, específicamente para la preparación del sitio de implantes dentales. Métodos: Siguiendo el marco metodológico de Arksey y O’Malley y el Manual JBI para revisiones exploratorias, este estudio se adhiere a las directrices PRISMA-ScR. Los estudios elegibles incluirán ensayos clínicos y estudios observacionales que evalúen técnicas de aumento basadas en células madre en pacientes humanos sometidos a regeneración ósea maxilar o mandibular para colocación de implantes. Se realizará una búsqueda exhaustiva de la literatura en MEDLINE, EBSCO y CENTRAL, complementada con una revisión manual de referencias y consulta a expertos. Dos revisores independientes realizarán la selección de estudios y extracción de datos, enfocándose en las características de los pacientes, la fuente y el procesamiento de las células, la aplicación quirúrgica, los resultados y los perfiles de seguridad. Resultados esperados: Los resultados proporcionarán una síntesis estructurada de la evidencia actual, destacarán tendencias metodológicas clave y vacíos existentes, y respaldarán a clínicos e investigadores en la navegación del complejo panorama de las estrategias regenerativas en implantología dental
Alternativas de fijación de tubo endotraqueal en quemaduras faciales
(2025) Estrada Cáceres, Felipe Tomás; Gayoso Vio, Carol; Daziano, José Tomás; Mancilla Uribe, Juan Felipe; Gayoso Vio, Pablo Nicolás
Se realiza una revisión de la literatura de diversas técnicas de fijación del tubo endotraqueal en pacientes con quemaduras faciales graves,
destacando la importancia de mantener la vía aérea asegurada durante el tratamiento. Las técnicas tradicionales de fijación son inapropiadas
debido al riesgo de lesiones en la piel quemada y retraso en la cicatrización. Se analizan varias alternativas, como fijación con tornillos y alambres,
férulas de resina, suturas intraorales y dispositivos acrílicos, cada una con ventajas y limitaciones en seguridad, accesibilidad y costo. La técnica
propuesta de fijación con dos tornillos IMF y alambre se destaca por su bajo costo, facilidad de ejecución y estabilidad, evitando complicaciones
dentales y garantizando una sujeción segura del tubo endotraqueal. El artículo concluye que esta técnica es una opción prometedora frente a
otras alternativas, debido a su efectividad en la prevención de extubaciones accidentales y su bajo costo.
Comparación en la Precisión de la Identificación del Primer Contacto Oclusal entre Modelos Articulados y Modelos Digitales Obtenidos con los Escáneres 3shape Trios e Itero
(2025) Sánchez-Ugarte, Fernando; Muñoz-Díaz, Alicia; Azúa-Retamal, Javiera; Valenzuela-Chaigneau, Bolivar; Belkner-Cinquemani, Mark; Valenzuela-Chaigneau, Francisco
El análisis de modelos es fundamental en el diagnóstico ortodóncico. Tradicionalmente se realizaba en
modelos de yeso, los cuales presentan limitaciones en cuanto a alteraciones volumétricas, almacenamiento y dificultad
para compartirlos. Ante esto, los escáneres intraorales han ganado relevancia al permitir la obtención de modelos digitales,
pero su precisión diagnóstica aún se discute. El objetivo de este estudio es comparar la precisión en la identificación del
primer contacto oclusal en posición céntrica de primer intento, entre modelos digitales obtenidos con escáneres intraorales
3Shape TRIOS 3 (3ST3) e iTero (iT), y modelos de yeso observados con papel articular en articulador (MA) Panadent. Se
analizaron 30 modelos de estudio escaneados con ambos dispositivos. El 63,3 % de los contactos en 3ST3 coincidieron
con los de MA, 50 % en iT y 56,6 % entre ambos escáneres. No hubo diferencias significativas en la distancia al plano
vestibular entre iT y MA, ni entre 3ST3 e iT, pero sí entre 3ST3 y MA. Se concluye que, bajo estas condiciones, los modelos
digitales no son suficientemente precisos para determinar el primer contacto oclusal en céntrica de primer intento.
Efecto del cepillado dental diferido en el desgaste dental erosivo en esmalte: Estudio In-vitro
(2025) Gómez-González, Valeria; Cabello-Ibacache, Rodrigo; Díaz-Dosque, Mario; Carmona-Jiménez, Paz; Castañeda-Espinoza, Felipe
Objetivo: Evaluar la pérdida de esmalte causada por el cepillado diferido versus inmediato, posterior a desafíos erosivos, in-vitro. Material y métodos: 52 muestras fueron divididas en dos grupos experimentales (G30, G60) y dos controles (positivo y negativo, CP, CN; n=13), las que fueron sometidas diariamente a 6 desafíos erosivos (ácido cítrico, pH 2,4), alternados con saliva artificial una hora y cepillado (15 segundos, <3N), 10 días. G30 y G60 se cepillaron 30 y 60 minutos después del primer y sexto desafío erosivo; CP y CN, inmediatamente. Se usaron pastas con fluoruro de estaño (G30, G60 y CP), y sin fluoruro (CN). La pérdida de tejido se cuantificó con perfilómetro.
Se realizó test Shapiro-Wilk, Kruskal-Wallis y Bonferroni. Resultados: G60 registró menor pérdida de tejido (-10,77 ± 2,73 μm), seguido por G30 (-11,06 ± 4,99 μm), CP (-18,79 ± 5,80 μm) y CN (-22,58 ± 5,13 μm), con diferencias significativas entre CP y CN con G30 y G60 (p<0,001) y entre CP y CN (p<0,001). Sin diferencias entre G30 y G60 (p=1). Conclusión: El cepillado diferido 30 o 60 minutos versus inmediato,
disminuye el desgaste dental erosivo en esmalte in-vitro.
IL-10 and IL-6/IL-10 as predictive biomarkers for treatment response in non-infectious uveitis
(2025) Valenzuela, Rodrigo; Vega, Fabian; Elizalde, Nathaly; Flores, Ivan; Rojas, Felipe; Goecke, Annelise; Cuitino , Loreto; Urzúa, Cristhian Alejandro
Uveitis, a group of heterogeneous diseases causing ocular inflammation, is a major contributor to vision loss globally. While systemic corticosteroids (CS) are the mainstay treatment, identifying CS-refractory patients remains a significant challenge. This study aimed to explore cytokine expression and Glucocorticoid Receptor (GR) levels as biomarkers for the early detection of CS-refractory cases in non-infectious uveitis. We assayed blood samples from 19 patients with non-infectious uveitis, for the expression of IL-6, IL-17A, TNF-α, IL-10 and GRα. The cohort included 11 refractory and 8 sensitive patients, categorized based on their clinical response to corticosteroids (prednisone 1 mg/kg/day). Blood draws were conducted at three time points (at baseline, day 7- and day 14 after CS initiation), and peripheral blood mononuclear cells (PBMCs) were isolated to measure cytokine and GRα transcript levels via real-time PCR. The expression levels of GRα and cytokines IL-6, IL-17A and TNF-α did not show significant changes between CS-sensitive and CS-refractory patients on the different days of treatment. However, IL-10 expression levels as the day14-to-day7 ratio were significantly higher in patients sensitive to CS therapy. A higher day14-to-day7 ratio was also found for the IL-6/IL-10, IL-17A/IL-10 and GRα/IL-10 ratios. ROC curve analysis demonstrated a robust predictive performance of IL-10 mRNA expression and the IL-6/IL-10 ratio for identifying CS-refractory patients. In conclusion, the expression of IL-10 and the IL-6/IL-10 ratio hold promise as early predictive biomarkers for CS treatment refractoriness in patients with non-infectious uveitis. These findings offer valuable insights into personalized treatment strategies, potentially leading to improved clinical outcomes.
Efectividad de la Fibrina Rica en Plaquetas para el cierre de comunicaciones bucosinusales post exodoncia, Protocolo de una revisión sistemática.
(2025) Borgstedt-Zavala, Stephanie; Sánchez-Rubat, Fabiana; Veloso, Valentina
Introducción: Una comunicación bucosinusal (CBS) es una conexión anómala entre el seno maxilar y la cavidad oral. Puede evolucionar a una fístula oroantral por falta de diagnóstico y manejo, la cual puede conducir a enfermedades crónicas resistentes a tratamientos convencionales, como colgajos e injertos. Ha destacado el uso de fibrina rica en plaquetas (PRF) por su capacidad de promover la regeneración y cicatrización de tejidos. Este protocolo de revisión sistemática busca determinar la efectividad del uso de PRF en comparación con otras técnicas convencionales en las CBSs post exodoncia inmediata. Materiales y Métodos: Esta revisión sistemática seguirá las directrices Cochrane. La búsqueda bibliográfica será en EMBASE, PubMed y EBSCO.Se revisarán los textos completos de los potenciales estudios, se incluirán solo ensayos clínicos aleatorios y se realizará una tabla de extracción de datos. Si los datos lo permiten y son homogéneos, se realizará un metaanálisis. Resultados esperados: Esta revisión evaluará la eficacia de la PRF en el tratamiento de las CBSs, con el objetivo de aportar evidencia clínica sólida que oriente futuras decisiones terapéuticas y líneas de investigación