Cirugía transoral robótica en síndrome de apnea e hipoapnea obstructiva del sueño

Resumen El síndrome de apnea e hipoapnea obstructiva del sueño (SAHOS) es una condición frecuente, que se asocia a importantes consecuencias negativas. El tratamiento inicial suele ser médico, pero en pacientes seleccionados la cirugía tiene excelentes resultados. En los últimos años se ha desarrollado la cirugía robótica transoral para tratar a pacientes con obstrucción anatómicas a nivel retrolingual, hipofaríngeo o supraglótico, mediante amigdalectomía lingual, reducción de base de lengua y/o supraglotoplastía. En pacientes seleccionados, esta técnica ha mostrado iguales o mejores resultados funcionales que las técnicas clásicas, junto con una baja tasa de complicaciones posoperatorias, sin embargo, implica un mayor costo asociado. A pesar de esto último, es una técnica válida y prometedora en el campo del SAHOS.

Abstract Obstructive sleep apnea and hypopnea syndrome (OSAHS) is a common condition that is associated with many negative consequences. First line treatment is usually medical management, but surgery is indicated for selected patients with retrolingual, hipopharyngeal or supraglottic obstruction. Transoral robotic surgery has been developed in the last years for the surgical treatment, through tongue base reduction and/or supraglottoplasty. In selected patients, this technique has shown equal or better functional outcomes than conventional techniques, along with a low rate of postoperative complications, however it implies a higher associated cost. Despite the latter, it is a valid and promising technique in the field of OSAHS.

Ultrasonido realizado por el otorrinolaringólogo-cirujano de cabeza y cuello: revisión de la literatura

Resumen El ultrasonido realizado por el otorrinolaringólogo-cirujano de cabeza y cuello permite realizar evaluaciones y diagnósticos en tiempo real, tomar decisiones en un menor tiempo y realizar intervenciones, lo que aumenta la eficiencia de una consulta. A pesar del profundo conocimiento de la anatomía de cabeza y cuello del otorrinolaringólogo, esta técnica aún no es muy difundida en nuestro país. Se recomienda la acreditación en un curso impartido por una entidad conocida y realizar una evaluación en informe estructurado. El ultrasonido realizado por el otorrinolaringólogo-cirujano de cabeza y cuello ha demostrado excelentes resultados para diferenciar masas cervicales benignas de aquellas malignas, y muy importantemente para tomar muestras de punción con agua fina o biopsias core. Se presenta una revisión de la literatura sobre el ultrasonido realizado por el cirujano, sus indicaciones, utilidad y recomendaciones al momento de realizarla.

Abstract Head and neck surgeon-performed ultrasound allows evaluations and diagnoses in real time, make faster decisions and carry out interventions, which increases the efficiency of the medical appointment. Despite otolaryngologists have a deep knowledge about head and neck anatomy, this technique is still not widespread in Chile. It is recommended to take an accreditation program given by a well-known entity and to perform structured evaluations and reports. Head and neck surgeon-performed ultrasound has shown excellent results to differentiate benign from certain malignant cervical masses, as well as to perform fine needle aspiration biopsies and core biopsies. We present a literature review on surgeon-performed ultrasound, its indications, efficacy and recommendations at the time of performing it.

Superconducting Nanowire Spiking Element for Neural Networks.

As the limits of traditional von Neumann computing come into view, the brain's ability to communicate vast quantities of information using low-power spikes has become an increasing source of inspiration for alternative architectures. Key to the success of these largescale neural networks is a power-efficient spiking element that is scalable and easily interfaced with traditional control electronics. In this work, we present a spiking element fabricated from superconducting nanowires that has pulse energies on the order of ∼10 aJ. We demonstrate that the device reproduces essential characteristics of biological neurons, such as a refractory period and a firing threshold. Through simulations using experimentally measured device parameters, we show how nanowire-based networks may be used for inference in image recognition and that the probabilistic nature of nanowire switching may be exploited for modeling biological processes and for applications that rely on stochasticity.

La auscultación pulmonar en el siglo 21 / Lung auscultation in the 21th century

La auscultación pulmonar es parte fundamental del examen físico para el diagnóstico de las enfermedades respiratorias. La estandarización que ha alcanzado la nomenclatura de los ruidos respiratorios, sumado a los avances en el análisis computacional de los mismos, han permitido mejorar la utilidad de esta técnica. Sin embargo, el rendimiento de la auscultación pulmonar ha sido cuestionado por tener una concordancia variable entre profesionales de la salud. Aun cuando la incorporación de nuevas herramientas diagnósticas de imágenes y función pulmonar han revolucionado la precisión diagnóstica en enfermedades respiratorias, no existe tecnología que permita reemplazar la técnica de auscultación pulmonar para guiar el proceso diagnóstico. Por una parte, la auscultación pulmonar permite seleccionar a aquellos pacientes que se beneficiarán de una determinada técnica diagnóstica, se puede repetir cuantas veces sea necesario para tomar decisiones clínicas, y frecuentemente permite prescindir de exámenes adicionales que no siempre son fáciles de realizar o no se encuentran disponibles. En esta revisión se presenta el estado actual de la técnica de auscultación pulmonar y su rendimiento objetivo basado en la nomenclatura actual aceptada para los ruidos respiratorios, además de resumir la evidencia principal de estudios de concordancia de auscultación pediátrica y su análisis objetivo a través de nueva tecnología computacional.

Lung auscultation is an essential part of the physical examination for diagnosing respiratory diseases. The terminology standardization for lung sounds, in addition to advances in their analysis through new technologies, have improved the use of this technique. However, traditional auscultation has been questioned due to the limited concordance among health professionals. Despite the revolu tionary use of new diagnostic tools of imaging and lung function tests allowing diagnostic accuracy in respiratory diseases, no technology can replace lung auscultation to guide the diagnostic process. Lung auscultation allows identifying those patients who may benefit from a specific test. Moreover, this technique can be performed many times to make clinical decisions, and often with no need for- complicated and sometimes unavailable tests. This review describes the current state-of-the-art of lung auscultation and its efficacy based on the current respiratory sound terminology. In addition, it describes the main evidence on respiratory sound concordance studies among health professionals and its objective analysis through new technology.

[Lung auscultation in the 21th century]. / La auscultación pulmonar en el siglo 21.

Lung auscultation is an essential part of the physical examination for diagnosing respiratory diseases. The terminology standardization for lung sounds, in addition to advances in their analysis through new technologies, have improved the use of this technique. However, traditional auscultation has been questioned due to the limited concordance among health professionals. Despite the revolu tionary use of new diagnostic tools of imaging and lung function tests allowing diagnostic accuracy in respiratory diseases, no technology can replace lung auscultation to guide the diagnostic process. Lung auscultation allows identifying those patients who may benefit from a specific test. Moreover, this technique can be performed many times to make clinical decisions, and often with no need for- complicated and sometimes unavailable tests. This review describes the current state-of-the-art of lung auscultation and its efficacy based on the current respiratory sound terminology. In addition, it describes the main evidence on respiratory sound concordance studies among health professionals and its objective analysis through new technology.

Synchronization dynamics on the picosecond time scale in coupled Josephson junction neurons.

Conventional digital computation is rapidly approaching physical limits for speed and energy dissipation. Here we fabricate and test a simple neuromorphic circuit that models neuronal somas, axons, and synapses with superconducting Josephson junctions. The circuit models two mutually coupled excitatory neurons. In some regions of parameter space the neurons are desynchronized. In others, the Josephson neurons synchronize in one of two states, in-phase or antiphase. An experimental alteration of the delay and strength of the connecting synapses can toggle the system back and forth in a phase-flip bifurcation. Firing synchronization states are calculated >70 000 times faster than conventional digital approaches. With their speed and low energy dissipation (10^{-17}J/spike), this set of proof-of-concept experiments establishes Josephson junction neurons as a viable approach for improvements in neuronal computation as well as applications in neuromorphic computing.