Inteligencia artificial en otorrinolaringología: estado actual y perspectivas a futuro / Artificial intelligence in otolaryngology: current status and future perspectives

La inteligencia artificial posee una larga historia, llena de innovaciones que han dado como resultado diferentes recursos diagnósticos de alto rendimiento, que se encuentran disponibles actualmente. En este artículo se presenta una revisión sobre la inteligencia artificial y sus aplicaciones en medicina. El trabajo se centra en la especialidad de otorrinolaringología con el objetivo de informar a la comunidad médica la importancia y las aplicaciones más destacadas en los diferentes procesos diagnósticos dentro de la especialidad. Incluimos una sección para el análisis del estado actual de la inteligencia artificial en otorrinolaringología en Chile, así como los desafíos a enfrentar a futuro para utilizar la inteligencia artificial en la práctica médica diaria.

Artificial intelligence has a long history full of innovations that have resulted in different high-performance diagnostic resources currently available. This work has reviewed the artificial intelligence definition and its applications to medicine. We focused our review on otolaryngology's specialty to inform the medical community of the importance and the most relevant applications in the different diagnostic processes. We include an analysis of the current state of artificial intelligence in otolaryngology in Chile, and the challenges to be faced in the future to use artificial intelligence into daily medical practice.

Apical Polarization of SVCT2 in Apical Radial Glial Cells and Progenitors During Brain Development.

During brain development, radial glial (RG) cells and the different progenitor subtypes are characterized by their bipolar morphology that includes an ovoid cell body and one or two radial processes that span across the developing cerebral wall. Different cells transport the reduced form of vitamin C, ascorbic acid (AA), using sodium-dependent ascorbic acid cotransporters (SVCT1 or SVCT2). SVCT2 is mainly expressed in the nervous system (CNS); however, its localization in the central nervous system during embryonic development along with the mechanism by which RG take up vitamin C and its intracellular effects is unknown. Thus, we sought to determine the expression and localization of SVCT2 during CNS development. SVCT2 is preferentially localized in the RG body at the ventricular edge of the cortex during the neurogenic stage (E12 to E17). The localization of SVCT2 overexpressed by in utero electroporation of E14 embryos is consistent with ventricular polarization. A similar distribution pattern was observed in human brain tissue sections at 9 weeks of gestation; however, SVCT2 immunoreaction was also detected in the inner and outer subventricular zone (SVZ). Finally, we used C17.2 neural stem cell line, J1ES cells and primary cell cultures derived from the brain cortex to analyze functional SVCT2 activity, AA effects in progenitor cells bipolar morphology, and SVCT2 expression levels in different culture conditions. Our results indicate that basal RG cells and apical intermediate and subapical progenitors are the main cell types expressing SVCT2 in the lissencephalic brain. SVCT2 was mainly detected in the apical region of the ventricular zone cells, contacting the cerebrospinal fluid. In gyrencephalic brains, SVCT2 was also detected in progenitor cells located in the inner and outer SVZ. Finally, we defined that AA has a strong radializing (bipolar morphology) effect in progenitor cells in culture and the differentiation condition modulates SVCT2 expression.

Antitropical distributions and species delimitation in a group of ophiocomid brittle stars (Echinodermata: Ophiuroidea: Ophiocomidae).

In this paper we examine the phylogeny and biogeography of the temperate genera of the Ophiocomidae (Echinodermata: Ophiuroidea) which have an interesting asymmetrical anti-tropical distribution, with two genera (Ophiocomina and Ophiopteris) previously considered to have a separate species in both the North and South hemispheres, and the third (Clarkcoma) diversifying in the southern Australian/New Zealand region. Our phylogeny, generated from one mitochondrial and two nuclear markers, revealed that Ophiopteris is sister to a mixed Ophiocomina/Clarkcoma clade. Ophiocomina was polyphyletic, with O. nigra and an undescribed species from the South Atlantic Ocean sister to a clade including Clarkcoma species and O. australis. The phylogeny also revealed a number of recently diverged lineages occurring within Clarkcoma, some of which are considered to be cryptic species due to the similarity in morphology combined with the apparent absence of interbreeding in a sympatric distribution, while the status of others is less certain. The phylogeny provides support for two transequatorial events in the group under study. A molecular clock analysis places both events in the middle to late Miocene. The analysis excludes a tectonic vicariance hypothesis for the antitropical distribution associated with the breakup of Pangaea and also excludes the hypothesis of more recent gene flow associated with Plio/Pleistocene glacial cycling.

Role of Wnt signaling in tissue fibrosis, lessons from skeletal muscle and kidney.

Several studies have provided clear evidence of the importance of Wnt signaling in the function of several tissues. Wnt signaling has been related to several cellular processes including pre-natal development, cell division, regeneration and stem cell generation. By contrast, deregulation of this pathway has been associated with several diseases such as cancer, Alzheimer's disease, diabetes and, in recent years, fibrotic diseases in tissues such as skeletal muscle and kidney. Fibrotic diseases are characterized by an increase in the production and accumulation of extracellular matrix (ECM) components leading to the loss of tissue architecture and function. In a classical view, several molecules are related to the establishment of the fibrotic condition, including angiotensin II, transforming growth factorß(TGF-ß) and the connective tissue growth factor (CTGF) and a crosstalk has been suggested between these signaling molecules and the Wnt pathway. Skeletal muscle fibrosis, the most common disease, is typical of muscle dystrophies, where deregulation of the regenerative process in postnatal muscle leads to fibrotic differentiation and eventually to the failure of skeletal muscle. The fibrotic condition is also present in kidney pathologies such as polycystic kidney disease (PKD), in which fibrosis leads to a loss of tubule architecture and to a loss of function, which in almost all cases requires kidney surgery. A new actor in the pro-fibrotic effect of Wnt signaling in the kidney has been described, the primary cilium, an organelle that plays an important role in the onset of fibrosis. The aim of this review is to discuss the pro-fibrotic effect of Wnt signaling in both skeletal muscle and kidney, and to try to understand how this pathway is associated with the TGF-ß, CTGF and angiotensin II pro-fibrotic pathway.

Evaluation of dental restorations: a comparative study between clinical and digital photographic assessments.

UNLABELLED: The aim of this study was to compare the efficacy of a direct clinical evaluation method with an indirect digital photographic method in assessing the quality of dental restorations. Seven parameters (color, occlusal marginal adaptation, anatomy form, roughness, occlusal marginal stain, luster, and secondary caries) were assessed in 89 Class I and Class II restorations from 36 adults using the modified US Public Health Service/Ryge criteria. Standardized photographs of the same restorations were digitally processed by Adobe Photoshop software, separated into the following four groups and assessed by two calibrated examiners: Group A: The original photograph displayed at 100%, without modifications (IMG100); Group B: Formed by images enlarged at 150% (IMG150); Group C: Formed by digital photographs displayed at 100% (mIMG100), with digital modifications (levels adjustment, shadow and highlight correction, color balance, unsharp Mask); and Group D: Formed by enlarged photographs displayed at 150% with modifications (mIMG150), with the same adjustments made to Group C. Photographs were assessed on a calibrated screen (Macbook) by two calibrated clinicians, and the results were statistically analyzed using Wilcoxon tests (SSPS 11.5) at 95% CI. RESULTS: The photographic method produced higher reliability levels than the direct clinical method in all parameters. The evaluation of digital images is more consistent with clinical assessment when restorations present some moderate defect (Bravo) and less consistent when restorations are clinically classified as either satisfactory (Alpha) or in cases of severe defects (Charlie). CONCLUSION: The digital photographic method is a useful tool for assessing the quality of dental restorations, providing information that goes unnoticed with the visual-tactile clinical examination method. Additionally, when analyzing restorations using the Ryge modified criteria, the digital photographic method reveals a significant increase of defects compared to those clinically observed with the naked eye. Photography by itself, without the need for enlargement or correction, provides more information than clinical examination and can lead to unnecessary overtreatment.

Prevalencia de caries, pérdida de dientes y necesidad de tratamiento en población adulta Mapuche-Huilliche de Isla Huapi / Prevalence of caries, teeth loss and treatment needs in adult Mapuche-Huilliche population in Isla Huapi

Objetivo: El objetivo de este estudio transversal fue evaluar el estado de salud oral y cuantificar la prevalencia de caries dental, pérdida de dientes y necesidad de tratamiento en la población adulta de etnia Mapuche-Huilliche que habita la Isla Huapi. Método: Se examinó una muestra representativa de 64 habitantes adultos de la Isla Huapi, constituida por 31 hombres y 33 mujeres de entre 25 a 82 años de edad, que tenían a lo menos un apellido de origen Mapuche-Huilliche. Todos los individuos, previa firma de un consentimiento informado, fueron examinados por un solo dentista calibrado durante el mes de agosto 2009. Los datos fueron registrados en una ficha diseñada especialmente y analizados estadísticamente usando los test T de Student y ANOVA. Resultados: El promedio del índice COPD de la muestra fue 14.59. Todos los individuos tenían historia de caries. De los que conservaban dientes, el 71.43 por ciento tenían caries sin tratar, con un promedio de 1.25. El 98.43 por ciento de los individuos de la muestra presentaban algún grado de desdentamiento, el 12.5 por ciento eran edéntulos. El 100 por ciento de la población necesitaba atención odontológica, ya fuera para operatoria o prótesis. Conclusiones: Esta población presenta un gran daño en cuanto a su salud oral, especialmente debido a pérdida de dientes. La magnitud del daño e importancia del entorno social como determinante en la generación de éste, obliga a enfrentar el problema y buscar soluciones desarrollando y aplicando programas gubernamentales de promoción y atención en salud oral a toda la población.

Objectives: The aim of this cross- sectional study was to assess oral health status and quantify prevalence of dental caries, teeth loss and treatment needs in an ethnic group of Mapuche-Huilliche adult population in Isla Huapi. Method: A representative sample of 64 adult inhabitants of Isla Huapi was selected. 31 men and 33 women aged 25 to 82 years of age who had at least one Mapuche-Huilliche surname, after signing an informed consent, individuals were examined by a calibrated examiner during August 2009. Data were recorded and analyzed statistically using T Student and ANOVA tests. Results: The DMFT index average of the sample was 14.59. All individuals had caries experience. Untreated caries were found in a 71.43 percent of individuals retaining teeth, with an average of 1.25 each. 98.43 percent of the individuals had some degree of edentulism, 12.5 percent were edentulous. 100 percent of the population needed either restorative or prosthetic dental care. Conclusions: This population has a high degree of damage in their oral health, especially due to teeth loss, which could be explained by their limited access to preventive and restorative dental care. The extent of the damage and the importance of the social environment as a determiner in the generation of it, will mean addressing the problem and seeking solutions by developing and implementing government programs for the promotion and oral health care to the entire population.

Evolution of larval form in the sea star genus Patiriella: conservation and change in the larval nervous system.

The organization of the peptidergic system in the larvae of Patiriella species with divergent ontogenies was compared to determine which aspects of neurogenesis are conserved and which are altered in the evolution of development in these sea stars. P. regularis has ancestral-type feeding bipinnaria and brachiolaria larvae and the organization of the nervous system, in association with feeding structures, paralleled the bilateral larval body plan. P. calcar and P. exigua have non-feeding planktonic and benthic brachiolariae, respectively, and there was no trace of the neuronal architecture involved with feeding. The nervous system in the attachment stage brachiolaria was similar in all three species and neuronal organization reflected larval symmetry. Delayed expression of peptidergic lineages to the brachiolaria stage in the lecithotrophs indicates heterochronic change in the timing of neurogenesis or deletion of the ancestral early neurogenic program. The bipinnarial program is suggested to be a developmental module autonomous from the brachiolar one. With a divergence time of less than 10 Ma, the evolution of development in Patiriella has resulted in extensive reduction in the complexity of the larval nervous system in parallel with simplification in larval form. There is, however, strong conservation in the morphology and neuronal architecture of structures involved with settlement.

Immune system cell markers in the northern brown bandicoot, Isoodon macrourus.

This is the first study to report the presence of T and B lymphocyte markers and antigen presenting-like molecules in a marsupial bandicoot. Intra-cytoplasmic markers for CD3 and CD5, as well as surface Thy-1.1 and CD1a molecules were located in lymphocytes of T dependent regions of immuno-lymphoid tissue in the northern brown bandicoot using immunohistochemical techniques. Similarly, intra-cytoplasmic domains of CD79a, CD79b molecules and surface IgG molecules enabled characterisation of B lymphocytes and plasma cells. The phenotypic expression of these molecules parallels findings in eutherians, suggesting firstly the conservation of lineage epitopes for T and B subsets and secondly, the potential for similar functional properties of immune system cells between marsupials and eutherians. In addition, the presence of MHC class II and CD1a molecules on dendritic-like cells may indicate similar mechanisms for antigen processing and presentation as reported in eutherians. The use of such immune system cell markers will enable functional studies to characterise the marsupial immune system as well as ontogeny studies of immune competence.

Development of the thymus, spleen, lymph nodes and liver in the marsupial, Isoodon macrourus (Northern brown bandicoot, Peramelidae).

We report for the first time the development and morphological characteristics of the spleen thymus, lymph nodes and liver of the northern brown bandicoot, Isoodon macrourus. To date few marsupial species have been studied. The development and morphological characteristics of the organs shared the typical features of those few other marsupials studied as well as those of eutherians. These suggest comparative functional properties with the eutherian immune system. The thymus differentiated within the first week of pouch life and showed evidence of immunolymphopoiesis up to juvenile stages. The spleen, though seeded by lymphocytes within the first week of pouch life, was slower to mature, but differentiated and showed signs of immunocompetency by the time young left the pouch. The mature spleen displayed the same anatomical blood filtering and immunosurveillance properties as that of the eutherian spleen, with evidence of erythrocyte destruction, thrombopoietic activity, activation and differentiation of immunocompetent lymphocytes. However, the absence of sheathed capillary structures in the spleen may indicate differences in the humoral response to circulating antigens. Similarly, lymph nodes also mature by this stage with anterior nodes appearing before posterior nodes. The mature lymph nodes displayed structural features of secondary immuno-lymphoid organs consistent with production of immune responses. Finally, the liver displayed haemopoietic activity for the first four weeks of pouch life. The pattern of development in the bandicoot appears to parallel the pattern reported for other marsupials, yet the thymus matures considerably earlier than previously reported and may be of significance in the development and onset of cell-mediated immunity. Current studies to characterise cellular components, such as T/B lymphocyes and accessory cells of these organs will help to define the mechanisms of immune recognition, activation and hence outline the basis of the marsupial humoral and cellular immunity.

Maternal factors and the evolution of developmental mode: evolution of oogenesis in Heliocidaris erythrogramma.

Evolutionary change in developmental mode in sea urchins is closely tied to an increase in maternal provisioning. We examined the oogenic modifications involved in production of a large egg by comparison of oogenesis in congeneric sea urchins with markedly different sized oocytes and divergent modes of development. Heliocidaris tuberculata has small eggs (95 microm diameter) and the ancestral mode of development through feeding larvae, whereas H. erythrogramma has large eggs (430 microm diameter) and highly modified non-feeding lecithotrophic larvae. Production of a large egg in H. erythrogramma involved both conserved and divergent mechanisms. The pattern and level of vitellogenin gene expression is similar in the two species. Vitellogenin processing is also similar with the gonads of both species incorporating yolk protein from coelomic and hemal stores into nutritive cells with subsequent transfer of this protein into yolk granules in the developing vitellogenic oocyte. Immunocytology of the eggs of both Heliocidaris species indicates they incorporate similar levels of yolk protein. However, H. erythrogramma has evolved a highly divergent second phase of oogenesis characterised by massive deposition of non-vitellogenic material including additional maternal protein and lipid. Maternal provisioning in H. erythrogramma exhibits recapitulation of the ancestral vitellogenic program followed by a novel oogenic phase with hypertrophy of the lipogenic program being a major contributor to the increase in egg size.

[Dietary ingestion of fluoride and caries prevalence in preschool and school children in cities with different fluoride content in the drinking water and diet]. / Ingesta dietaria de fluor y prevalencia de caries en preescolares y escolares de ciudades con distinto aporte de fluor en el agua de bebida y dieta.

The consumption of dietary fluoride and its relationship with dental caries prevalence was determined in 780 preschool children and 802 school children from quique, Arica, Santiago and San Antonio, where drinking water has different fluoride concentration. Dietary fluoride was determined from dietary records and fluoride content of foods. The fluoride consumption from drinking water was calculated by Galagan and Vermillion formula. The total fluoride consumption was obtained. The dental caries prevalence was established by the evaluation of dental caries index in deciduous (dmft) and permanent (DMFT) dentition. Significantly lower DMFT values were founded in cities with lower fluoride levels in drinking water. The exception was San Antonio, where high dietary fluoride explained the lower DMFT values relative to Santiago. Our results suggest that not only fluoride in water but also the consumption of fluoride rich foods has a significant impact on the prevalence of caries.

Prevalencia de caries, higiene oral y cariogenicidad de la dieta en preescolares y escolares de ciudades con y sin fluor natural en su agua de bebida / Caries prevalence, oral hygiene and diet cariogenety in preschool and school children from cities with and without natural fluor in drink water

Con el propósito de determinar la influencia de las variables higiene oral, consumo de alimentos cariogénicos y contenido de flúor natural en el agua de bebida sobre la variable prevalencia de caries, se realizó un estudio descriptivo y de corte transversal en una muestra constituida por 780 preescolares de 5 años de edad y 802 escolares de 15 años de edad, de ambos sexos, seleccionados de ciudades con distinta concentración de flúor, en su agua de abastecimiento: Arica (0,88), Iquique (2,20), San Antonio (0,19) y Santiago (0,19). En general se encontró menor prevalencia de caries en los preescolares y escolares de ciudades con mayor concentración de flúor en su agua de bebida, aunque éstos consumían una dieta cariogénica y presentaban una deficiente higiene oral. No se encontró relación clara entre higiene oral, consumo de alimentos cariogénicos y prevalencia de caries, sin embargo, se observó significativo menor daño dentario por caries en niños cuyas de consumo tenían mayor concentración de flúor

[Caries prevention through a nutritional vehicle]. / La prevención de caries a través de un vehículo nutricional.

In order to evaluate the efficacy of fluoridated milk as a cariostatic nutritional product, the biological and technical possibilities of adding fluoride (F) as monofluorophosphate (MFP) to milk were studied, together with a preliminary cost estimation for this procedure. F ingestion by preschool children pertaining to the low and medium-low levels of population was estimated through polls and chemical analyses. The values of F ingestion obtained were in the range of 0.15-0.30 mg/day. The bioavailability of F in those dietary elements which have the highest F concentration was determined. Taking a value of 1.00 for F absorption from sodium fluoride (NaF) in water, relative values of 0.58 and 0.32 were obtained for tea ingestion on a fasting stomach, and together with solid food, respectively. The corresponding value for fish was 0.34. Through another bioavailability experiment it was shown that the absorption of F (from MFP) in milk, is as high as that of F (from NaF) in water. By means of a comparative cost estimation study, it was found that, for the Chilean situation, milk fluoridation is, at least, 1,000 times more economic than water fluoridation. It is concluded that milk fluoridation is an economical and viable alternative for some less developed countries.

[Effect of a participatory method on nutrition education in dentistry]. / Efecto de un metodo participativo en el aprendizaje de nutrición en odontologia.

Based on results of a diagnostic test which measured the knowledge that University of Chile students of 5 different health careers have a food and nutrition (1982), the nutrition program of the school of Dentistry was modified from a traditional system of education (formal classes) to a participative methodology in 1984, a didactic material on nutritional recommendations. An increased level of knowledge as well as motivation was observed in those graduating in 1984, particularly the area of nutritional recommendation and diet, to which the students spent more extra time. We can conclude that the educational methodology that stresses participation and is centered around one person is very effective to teach nutrition in the school of Dentistry.

Fluoride bioavailability from disodium monofluorophosphate fluoridated milk in children and rats.

The aim of the present work was to study the usefulness of disodium monofluorophosphate (MFP) as a milk-fluoridating agent by measuring the bioavailability of F from MFP in milk relative to that of F from NaF in water. Long-term (multiple-dose) studies were performed on rats measuring F bone uptake. The relative F absorption from MFP in milk was also determined in preschool children by means of 24-hour F urinary excretion. In both studies F absorption was determined either under fasting conditions or when F ingestion occurred together with food intake. The results show that F absorption from MFP in milk is as high as that of NaF in water under fasting conditions and that the F bioavailability decrease from NaF in water is more important than that of MFP in milk when F ingestion occurs simultaneously with food intake.

Contenido de fluor de las aguas naturales de Chile y recomendaciones para la suplementacion. / Fluoride contents in natural waters in Chile and recommendations for the suplementation

Diferentes investigadores han encontrado que la prevalencia de caries dentarias es mayor en las zonas donde el agua no contiene fluor. Este trabajo, se propuso medir la concentracion de fluoruros en las aguas naturales chilenas; calcular la proporcion de la poblacion nacional que recibe fluor natural y sugerir recomendaciones para suplementar a su dieta dicho elemento. Para ello, se realizo un catastro del contenido de fluor de las fuentes naturales de agua que en forma centralizada abastecen a la poblacion del pais. Se tomaron 380 muestras de 300 cc cada una, evitando su contaminacion. El contenido de fluoruros, se analizo utilizando el metodo potenciometrico. Los valores fluctuan entre 0.00 ppm hasta 2.2 ppm (Iquique, Canchones), encontrandose un promedio de 0.2 ppm en las regiones restantes. El contenido de fluor de las aguas naturales, es inferior al minimo recomendado para la prevencion de caries. Solo un 4.2% de la muestra alcanza el optimo recomendado. Aparece fundamental suplementar la dieta con fluor como una de las medidas mas importantes para la prevencion de caries. Se hacen recomendaciones para suplementacion diaria con fluor segun edad y contenido de fluor del agua