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Resumen Introduccion Los tumores primarios de vena cava inferior son tumores raros de origen mesenquimal que surgen de la musculatura lisa de la pared. Debido a su escasa prevalencia, existen pocos datos definitivos sobre su tratamiento y pronostico. Su tratamiento se basa en principios oncologicos generales. Metodos Se ha analizado una serie de 6 casos intervenidos desde 2010 a 2020, evaluando distintos parametros relacionados con las caracteristicas demograficas del tumor, del tratamiento recibido y de los resultados obtenidos en supervivencia y morbilidad. Ademas, se ha llevado a cabo una revision bibliografica de la evidencia disponible actualmente. Resultados En todos los pacientes se llevo a cabo una reseccion quirurgica optima con R0 en 4/6 y R1 en 2/6. La mayor morbilidad sucedio en un paciente fallecido en periodo intraoperatorio. Se realizo cavorrafia en un paciente y cavoplastia en 5/6 utilizando injerto criopreservado en 3/6 y protesis en 2/6. Al final del seguimiento de nuestra serie (con una media de seguimiento de 10,7 meses), el 50% de los pacientes continuan vivos. La media de supervivencia fue de 11,3 ± 9,07 meses. De los 6 pacientes, 3 presentaron recidivas hematogenas con un intervalo libre de enfermedad de 9 ± 2 meses. Conclusion El diagnostico y tratamiento del leiomiosarcoma de vena cava inferior continua siendo un reto. Debido a su baja prevalencia, resultara dificil establecer un tratamiento totalmente estandarizado, y se recomienda su abordaje en centros especializados. Por otra parte, se deberian intentar aunar los casos intervenidos de cara a avanzar en el conocimiento del abordaje de esta enfermedad.

The risk of neoplasia in gallbladder polyps seems to be low, but the evidence from populations at high-risk of gallbladder cancer is limited. We aimed to estimate the risk and to identify the factors associated with neoplastic polyps in a high-risk Hispanic population.A retrospective cohort was recruited between January 2010 and December 2019 at a Chilean university center. Multivariate survival analyses were conducted. Fine-Gray models were fitted to account for competing risks. Covariate adjustment was conducted using propensity scores. The main outcome was the development of gallbladder adenomas or adenocarcinoma.Overall, 748 patients were included, 59.6% underwent cholecystectomy. The median follow-up of patients not subjected to cholecystectomy was 54.7 months (12-128.6 months). Seventeen patients (2.27%) developed the outcome. After adjustment by age, sex, intralesional blood flow, lithiasis and gallbladder wall thickening, only polyp size (≥10 mm, adjusted-HR: 15.01, 95%CI: 5.4-48.2) and number of polyps (≥3 polyps, adjusted-HR: 0.11, 95%CI: 0.01-0.55) were associated with neoplasia.In a Hispanic population at high-risk for gallbladder cancer, gallbladder polyps seem to have a low risk of neoplasia. Polyp size was the main risk factor, while having multiple polyps was associated with an underlying benign condition.

La integración monetaria corresponde al proceso mediante el cual un conjunto de países previamente integrados adoptan una moneda común. Desde 1987, antes de la creación del Mercado Común del Sur (Mercosur), se plantea la necesidad de avanzar en los acuerdos que permitan lograr la unificación monetaria de esta región y se han sugerido distintos enfo-ques teóricos acerca de cómo lograrlo. En este sentido, el presente artí-culo tiene como propósito ampliar las contribuciones teóricas realizadas acerca del tema y contribuir al debate sobre las alternativas a seguir para la construcción de la moneda única en el mercado común suramericano. Para ello se realiza una revisión de la literatura sobre el origen y los en-foques teóricos planteados a la integración monetaria del Mercosur y se analizan las lecciones que ha dejado la integración europea al acuerdo re-gional suramericano.

La inclusión de las personas en el trabajo es un fenómeno que ha tomado auge en los últimos tiempos, se ha desarrollado en torno al tema, un marco político y normativo a escala mundial al cual las organizaciones deben dar respuestas y adaptarse. La presente investigación busca diseñar un instrumento que permita medir la cultura inclusiva en organizaciones educativas, en el marco de la ley 21.015 de inclusión laboral en Chile. En atención a lo anterior, se presenta un instrumento que le facilite a las instituciones evaluar con base en la opinión de sus colaboradores la realidad de la organización, en cuanto a sus aspectos a mejorar y las situaciones que deben permanecer. La metodología utilizada es de carácter cuantitativa y se tomó como referencia una universidad pública del estado de Chile, espacio que permitió evaluar la confiabilidad del instrumento en la aplicación a sus funcionarios y se aspira sirva de insumo para tomar decisiones argumentadas. Se concluye que el instrumento presentado es confiable y válido a partir de los análisis realizados, y si bien, fue validado para el caso específico de una universidad estatal, se considera que el mismo podría ser aplicable a cualquier institución educativa en Chile.

Objetivo: describir el caso de una paciente con Síndrome de Li-Fraumeni (SLF) y cáncer de mama, en quien se cuestionó el beneficio en la supervivencia de la mastectomía profiláctica contralateral (MPC); asimismo, se pretende hacer una discusión crítica acerca de la evidencia que soporta este procedimiento en esta población. Presentación del caso: mujer de 37 años con cáncer de mama y múltiples antecedentes familiares de cánceres de temprana aparición del espectro del SLF, en quien, durante la adyuvancia hormonal, se confirmó una variante patogénica en el gen TP53. La paciente fue presentada en la Junta Multidisciplinaria del Servicio de Mama de un Centro Oncológico de referencia en Colombia, con el fin de discutir el beneficio de la MPC. La decisión de la junta fue no realizar la MPC. Después de 30 meses de seguimiento la paciente se encuentra libre de enfermedad. Conclusión: no existe evidencia que analice, de forma particular, el impacto de la MPC en la supervivencia de las pacientes con SLF y cáncer de mama. Sin embargo, a la luz del conocimiento actual no es posible generalizar la conducta de omitir esta cirugía profiláctica. Es importante reportar los casos en los que se decida realizar u omitir este procedimiento con el fin de incrementar el cuerpo de la evidencia, dado que existen limitaciones para construir grandes cohortes o estudios experimentales exclusivos para esta alteración genética.

Postmortem normothermic regional perfusion (NRP) is a rising preservation strategy in controlled donation after circulatory determination of death (cDCD). Herein, we present results for cDCD liver transplants performed in Spain 2012-2019, with outcomes evaluated through December 31, 2020. Results were analyzed retrospectively and according to recovery technique (abdominal NRP [A-NRP] or standard rapid recovery [SRR]). During the study period, 545 cDCD liver transplants were performed with A-NRP and 258 with SRR. Median donor age was 59 years (interquartile range 49-67 years). Adjusted risk estimates were improved with A-NRP for overall biliary complications (OR 0.300, 95% CI 0.197-0.459, p

While Merkel cell carcinoma (MCC) of the head and neck is highly malignant, it remains poorly characterized due to its rarity. The purpose of this study was to examine prognostic factors for overall survival (OS) and disease-specific survival (DSS) in patients with MCC of the head and neck region. The Surveillance, Epidemiology and End Results registry was reviewed for patients diagnosed between 1984 and 2016 with histologically confirmed, primary MCC of the head and neck region. A total of 2818 patients met the inclusion criteria, with a median age at diagnosis of 77 years. At five and 10 years, respectively, the OS was 42.4% and 25.1% and the DSS was 67.9% and 64.1%. Multivariate Cox analysis indicated that predictors of decreased DSS included age at diagnosis ≥75 years, white race, increasing tumor spread, lymph node involvement and either the lip or the scalp/neck as a primary site. When adjusting for the aforementioned factors, tumor depth was not found to be a prognostic factor for DSS. We anticipate these results will help clinicians to counsel patients regarding expectations and potential prognosis.

Introduction There is subgroup analysis suggesting a lack of benefit of daratumumab use in multiple myeloma (MM) and hepatic disease (HD). The objectives of this study were to conduct a systematic review and interpretation of daratumumab-based regimen efficacy in transplant-ineligible patients with untreated MM and HD. Methods A systematic search in Pubmed® database about randomized clinical trials (RCTs) with subgroup analysis regarding hepatic function for overall survival (OS) or progression-free survival (PFS) were developed. Two methodologies were applied. One of them considered statistical interaction, prespecification, biological support and consistency of subgroup results. Second methodology was two-part validated tool: preliminary questions to reject subset analysis without minimal relevance, and a checklist relating a recommendation for applicability in clinical practice. Results It was included three records. About first methodology, statistical interaction among subgroups was found for PFS in one RCT. Subsets were prespecified in all RCTs. Biological support of efficacy differences could be reasonable. Inconsistent results were found. Second methology directly rejected applicability of subset analysis in two records. Checklist recommended “null” application of results in the remaining RCT. Conclusions No consistent heterogeneity for daratumumab-based regimen efficacy was observed among subgroups regarding hepatic function in transplant-ineligible patients with untreated MM. Patients with normal hepatic function and HD could benefit from these treatments.

OBJECTIVE To summarize the principal findings of all available studies that have evaluated the use of inhaled corticosteroids (ICS) on an intermittent or as-needed basis as an add-on therapy to short-acting β2-agonists (SABAs) or fast-acting β2-agonists (FABAs) in pediatric asthmatic patients. Studies could either include or omit the use of ICS during stable periods of the disease. DATA SOURCES Electronic databases MEDLINE, EMBASE, CINAHL, SCOPUS, and the Cochrane Database of Systematic Reviews from inception to February 2021. STUDY SELECTIONS Relevant articles in the literature published by February 2021. RESULTS Of 294 references identified, 14 studies were included. The use of ICS on an intermittent or as-needed basis (as an add-on therapy to SABAs) has been shown to be more effective than treatment with SABA alone and to be similarly or less effective compared to regular daily ICS administration. Furthermore, strategies involving increasing the dose of ICS only when needed (as an add-on therapy to formoterol, a FABA) and keeping it low during stable stages of the disease (i.e. single maintenance and reliever therapy, SMART) have been shown to be similarly or more effective than comparators. CONCLUSION The use of ICS on an intermittent or as-needed basis as an add-on therapy to SABAs or FABAs, with or without ICS use during stable periods of the disease in pediatric asthmatic patients, encompasses several effective treatment strategies.

The calcined clay bricks are the second most used materials in construction that, after the demolition processes, tends to become rubble, generating a negative visual and environmental impact, in addition to the fact that the brick-making process has not been industrialized in Ecuador, for that, its properties are deficient; in this way, the present research aims to study the physical, chemical and mineralogical characteristics of brick waste from the Southern part of ​​this country, for the elaboration of ecological bricks through geopolymerization processes, using as alkaline activator Sodium Hydroxide at temperature ranged between 90 °C and 200 °C, obtaining an optimal mixture at the combination 12.5 M, 26 wt% Cs, 150 °C. The mechanical properties of bricks as simple compression and flexural strength, respectively, applying the experimental Griffith criterion method by finite element simulation method. These ecological bricks obtained are suitable for use in construction.

Short-chain fatty acids (SCFAs) can have pro- or anti-inflammatory properties, but their relationship with multiple sclerosis (MS) relapses during pregnancy remains unknown. This study aimed to explore SCFA profiles in MS patients during pregnancy and to assess their association with the appearance of relapses during pregnancy and postpartum.We prospectively included 53 pregnant MS patients and 21 healthy control women. Patients were evaluated during pregnancy and puerperium. SCFAs were measured by liquid chromatography-mass spectrometry.Sixteen patients (32%) had relapses during pregnancy or puerperium, and 37 (68%) did not. All MS patients showed significant increases in acetate levels during pregnancy and the postpartum period compared to non-MS women. However, propionate and butyrate values were associated with disease activity. Their values were higher in nonrelapsing patients and remained similar to the control group in relapsing patients. The variable that best identified active patients was the propionate/acetate ratio. Ratios of0.36 during the first trimester were associated with higher inflammatory activity (odds ratio = 165, 95% confidence interval = 10.2-239.4, p 0.01). Most nonrelapsing patients showed values of0.36, which were similar to those in healthy pregnant women.Low propionate/acetate ratio values during the first trimester of gestation identified MS patients at risk of relapses during pregnancy and the postpartum period.

Background: Meta-analyses of individuals’ cognitive data are increasing to investigate the biomedical, lifestyle, and sociocultural factors that influence cognitive decline and dementia risk. Pre-statistical harmonization of cognitive instruments is a critical methodological step for accurate cognitive data harmonization, yet specific approaches for this process are unclear. Objective: To describe pre-statistical harmonization of cognitive instruments for an individual-level meta-analysis in the blood pressure and cognition (BP COG) study. Methods: We identified cognitive instruments from six cohorts (the Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Coronary Artery Risk Development in Young Adults study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study) and conducted an extensive review of each item’s administration and scoring procedures, and score distributions. Results: We included 153 cognitive instrument items from 34 instruments across the six cohorts. Of these items, 42%were common across ≥2 cohorts. 86%of common items showed differences across cohorts. We found administration, scoring, and coding differences for seemingly equivalent items. These differences corresponded to variability across cohorts in score distributions and ranges. We performed data augmentation to adjust for differences. Conclusion: Cross-cohort administration, scoring, and procedural differences for cognitive instruments are frequent and need to be assessed to address potential impact on meta-analyses and cognitive data interpretation. Detecting and accounting for these differences is critical for accurate attributions of cognitive health across cohort studies.

The purpose of this essay is to share the good practices installed in the virtual postgraduate programs of the Universidad Arturo Prat (UNAP), Chile associated with the continuous evaluation of quality processes. Our focus is on the continuous improvement of good practices through the accreditation process with the Latin American and Caribbean Institute for Quality in Distance Education (CALED) and the self-evaluation that the institution carries out to deliver quality service. The methodology used in this work is the documentary review and description of experiences under a qualitative approach. The results reveal that the UNAP has promoted the self-evaluation and international certification of its programs, in a context of normative change in Chile, which establishes new criteria and standards under the new Law of Higher Education Nº v 21.091, in wich are recognized as good practices: the institutional policies, the planning of the self-evaluation process, the updates of the technological platform, the virtual education enviroment, the virtualization adequate to the context, the active-participative academic actions, the rol of the teacher and the student, the academic training, as well as the components of the self-evaluation process, that must be constantly monitored and evaluated, in order to deliver quality services in the training of people participating in graduate programs under the virtual learning modality.

The most common cause of both unilateral and bilateral proptosis in adults is thyroid eye disease (TED), and the diagnosis in typical cases is made without imaging. However, many other orbital diseases, including inflammatory, infectious, and neoplastic processes, can mimic the symptoms of thyroid eye disease, highlighting the importance of imaging and biopsy in challenging cases. There are limited reports in the literature of orbital lymphoma being diagnosed in patients with a history of thyroid eye disease. Here, we present the case of a patient with long-standing TED who developed new asymmetric proptosis and was subsequently diagnosed with systemic follicular lymphoma.

Objectives:To standardize and validate a western blot test for the diagnosis of human immunodeficiency virus.Methods:A prospective observational study was carried out during 2017 and 2018. The western blot test was standardized, using the polyacrylamide gel electrophoresis technique with sodium dodecyl sulfate (SDS PAGE), being the nitrocellulose blot strips prepared with an Optimal HIV-1 antigen concentration of 2.71 µg / mm. The western blot was validated in the laboratory against 400 reference samples (300 sera and 100 plasmas): 200 positive and 200 negatives for antibodies against HIV-1, being the reference test the Immunoblot of the Fujirebio brand. Diagnostic performance parameters were estimated using Epidat v3.1 and Excel.Results:Eight important bands of the HIV-1 antigen were identified: p17, p24, p31, p39, gp41, p55, p66, and gp120. According to the Consortium for the normalization of serology for retroviruse, those that were taken as specific diagnostic bands were: p24, p31, gp41, and gp120. The sensitivity, specificity, positive and negative predictive value and validity index against sera were: 96.7%, 96.0%, 96.0%, 96.6%, 96.3%; and against plasmas: 98.0%, 100.0%, 100.0%, 98.0%, 99.0% respectively. No false positives and negatives were found, but some were undetermined.Conclusion:The development of this western blot test with proprietary technology presented similar diagnostic performance to the reference test, without showing cross-reactions, being useful for confirming HIV. Objetivos:Estandarizar y validar una prueba de western blot para el diagnóstico del virus de inmunodeficiencia humana.Métodos:Se realizó un estudio observacional prospectivo durante el 2017 y 2018. Se estandarizó la prueba de western blot, usando la técnica de electroforesis en gel de poliacrilamida con dodecil sulfato de sodio (SDS PAGE), siendo las tiras blot de nitrocelulosa preparadas con una concentración óptima de antígeno de VIH-1 de 2,71 µg/mm. Se validó el western blot en laboratorio, frente a 400 muestras referentes (300 sueros y 100 plasmas): 200 positivas y 200 negativas a anticuerpos contra VIH-1, siendo la prueba de referencia el Inmunoblot de la marca Fujirebio. Se estimaron los parámetros de rendimiento diagnóstico usando el programa Epidat v3.1 y Excel.Resultados:Se logró identificar ocho bandas importantes del antígeno de VIH-1: p17, p24, p31, p39, gp41, p55, p66 y gp120. De ellas, las que se tomaron como bandas diagnósticas específicas según el Consorcio de normalización de serología para los retrovirus, fueron: p24, p31, gp41 y gp120. La sensibilidad, especificidad, valor predictivo positivo y negativo e índice de validez frente a sueros fueron: 96,7%, 96,0%, 96,0%, 96,6%, 96,3%; y frente a plasmas: 98,0%, 100,0%, 100,0%, 98,0%, 99,0% respectivamente. No se encontraron falsos positivos y negativos, pero si algunos indeterminados.Conclusión:El desarrollo de esta prueba western blot con tecnología propia, presentó similar rendimiento diagnóstico a la prueba de referencia, sin mostrar reacciones cruzadas; siendo útil para la confirmación del VIH.

Objectives Although the efficacy of the addition of ipratropium bromide (IB) to short-acting β2-agonists (SABAs) for treating children with moderate to severe asthma exacerbations has been demonstrated, evidence of its cost-effectiveness is scarce. The aim of the present study was to evaluate the cost-effectiveness of treatment with a combination of SABAs and IB compared with SABAs alone for the treatment of children with moderate to severe asthma exacerbations. Methods To achieve the objectives of the study, a decision-analysis model was adapted. Effectiveness parameters were obtained from a systematic review of the literature with meta-analysis. Cost data were obtained from hospital bills and from the national manual of drug prices in Colombia. The study was carried out from the perspective of the national healthcare system in Colombia. The main outcome of the model was avoidance of hospital admission. Results In children with moderate to severe asthma exacerbations, the base-case analysis showed that compared to SABAs alone, treatment with a combination of SABAs and IB was associated with lower overall treatment costs (US$126.24 vs. US$170.69 mean cost per patient) and a higher probability of hospital admission avoided (0.7999 vs. 0.7100), thus leading to dominance. For children with severe asthma exacerbations, these values were US$132.99 versus US$170.69 and 0.7883 versus 0.7100, respectively. Conclusions In Colombia, when compared to therapy with SABAs alone, therapy with a combination of SABAs and IB for treating pediatric patients with moderate to severe asthma exacerbations involves a lower probability of hospital admission at lower treatment costs.

Introduction The presence of stones in the urinary tract is a condition that has accompanied humans since ancient times. In colonial times, this condition was known as “stone pain” and its non-surgical management was based on the use of medicines derived from plants, animals and minerals. Objective To contextualize a medical prescription used to modulate stone pain in the 18th century in the New Kingdom of Granada. Additionally, to analyze its components and evaluate the basis of its possible phytotherapeutic effects on the disease and pain. Material and method Document search in the Cipriano Rodriguez Santamaria Historical Archive of the Octavio Arizmendi Posada Library at Universidad de La Sabana. The document entitled “Prescription for bladder or kidney stone pain” was analyzed, and a complementary review of current scientific literature and original texts was performed with no time limits, in order to compare this prescription to related findings in the history of medicine. Results The transcription of the source document revealed several phytotherapeutic agents such as chamomile (Matricaria recutita), lilies (Lilium lancifolium), clover (Trifolium pratense), and mallow roots (Malva sylvestris), accompanied by a large amounts of water. Conclusions There is scientific evidence that could explain the anti-inflammatory and antioxidant effects of all plant-derived medicines used in this prescription. Abundant water intake to increase urine volume was an essential part of treatment. However, the lack of more precise data related to the prescription and the evolution of the patients makes it difficult to analyze its therapeutic efficacy.

Background The aim of this systematic review is to evaluate the current evidence in the context of clinical prediction model for post-hepatectomy liver failure (PHLF). Methods A systematic search of the English literature for a period from December 2005 to September 2020 was conducted. Primary outcome was defined using the three common PHLF criteria (50-50 criteria, peak bilirubin>7 mg/dl criteria, and ≥ grade B PHLF criteria by the International Study Group of Liver Surgery). Studies that reported the value of area under receiver operative characteristic curve (AUC) for the occurrence of PHLF were included. Results Twenty eight of 1327 screened articles were eligible for inclusion. Eighteen studies developed the prediction models. The median AUC was found to be 0.79 (0.65–0.933). The parameters related to the amount of future liver remnant volume were most commonly identified as significant predictors for PHLF in statistical analysis (24 studies) and were most frequently incorporated in the prediction models (18 studies). The parameters associated with portal hypertension were significant for predicting PHLF in 16 studies and were adopted in the prediction models in 14 studies. Conclusion Parameters related to future liver remnant volume and portal hypertension seem to be facilitating in predicting PHLF.

Resumen Introduccion La presencia de calculos en el tracto urinario es una afeccion que acompana al ser humano desde la antiguedad. En la epoca colonial, esta se denominaba «dolor de piedra» y su manejo no quirurgico se basaba en el uso de medicinas de origen vegetal, animal o mineral. Objetivo Contextualizar una receta medica que data del siglo xviii en el Nuevo Reino de Granada, utilizada para modular el dolor de piedra. Adicionalmente, analizar sus componentes para evaluar el fundamento de sus posibles efectos fitoterapeuticos sobre la enfermedad y el dolor. Material y metodo Busqueda documental en el Archivo Historico Cipriano Rodriguez Santamaria de la Biblioteca Octavio Arizmendi Posada de la Universidad de La Sabana. Se analizo el documento denominado «Receta para el dolor de piedra de la vejiga o rinones». Posteriormente, se realizo una revision de la literatura cientifica actual y textos originales, sin limite de tiempo. Resultados La transcripcion del documento fuente revelo diversos agentes fitoterapeuticos como la Manzanilla (Matricaria recutita), la azucena (Lilium lancifolium), el trebol (Trifolium pratense) y raices de malva (Malva sylvestris), acompanados para su consumo de gran cantidad de agua. Conclusiones Existe evidencia cientifica que podria explicar efectos antiinflamatorios y antioxidantes del conjunto de las sustancias medicinales de origen vegetal utilizadas en la presente receta. La ingesta abundante de agua era parte esencial para el tratamiento de la enfermedad al aumentar el volumen urinario. Sin embargo, la ausencia de datos mas precisos relacionados con la receta y la evolucion de los pacientes dificulta el analisis de su eventual eficacia terapeutica.

En cáncer de mama, el ganglio centinela (GC) es el primer ganglio que recibe el drenaje linfático del área de la mama que contiene el tumor, siendo capaz de predecir el estado de los demás ganglios axilares. En los últimos años, múltiples estudios han demostrado el poco impacto que tiene el vaciamiento axilar (VA) en términos de la supervivencia libre de enfermedad (SLE) y la supervivencia global (SG), lo que a su vez ha permitido establecer algunos criterios para omitir la linfadenectomía axilar en pacientes con cáncer de mama en estadios tempranos. Las mujeres con cáncer de mama infiltrante y tumores T1 y T2, con axila clínicamente negativa, son candidatas a la realización del GC. Si el GC es positivo, puede omitirse el VA sólo si se cumplen los siguientes requisitos: 1) manejo quirúrgico del tumor primario con cirugía conservadora o mastectomía, 2) bordes de resección quirúrgicos negativos para malignidad y 3) reporte de patología del GC que muestre hasta dos GC positivos para micro o macrometástasis, sin extensión extracapsular, o con una dimensión de la extensión extracapsular

El 16.9% de las pacientes con cáncer de mama, que ingresan a la Unidad Funcional de Mama y Tejidos Blandos del Instituto Nacional de Cancerología (INC), se presentan con enfermedad metastásica. El desarrollo de las terapias blanco ha modificado radicalmente el enfoque terapéutico en este grupo de pacientes. Se realizó una búsqueda de la literatura seleccionando los ensayos clínicos controlados y aleatorizados fase 3, las revisiones sistemáticas y los metaanálisis, sobre el tratamiento sistémico para el cáncer de mama metastásico con receptores hormonales positivos (RH+) y receptor HER2 negativo (HER2).Se pusieron filtros a la búsqueda para identificar únicamente los artículos publicados a noviembre de 2020 y en idioma inglés. Posteriormente, se socializó la revisión de la evidencia al interior de las Unidades Funcionales (UF) de Mama y Tejidos Blandos y Oncología clínica. Finalmente, se realizó una discusión académica en la cual se establecieron los cambios en el abordaje terapéutico de las pacientes con cáncer de mama luminal, HER2 negativo, metastásico. En los últimos años, el conocimiento de la biología molecular del cáncer de mama ha permitido el desarrollo de múltiples terapias blanco (iCDK4/6, iPI3KCA, inhibidores del mTOR), que combinadas con la terapia hormonal, mejoran los desenlaces oncológicos de las pacientes con enfermedad metastásica (supervivencia libre de progresión y supervivencia global).

El cáncer de mama es el cáncer más frecuentemente diagnosticado en las mujeres alrededor del planeta. Según GLOBOCAN 2020, su incidencia y mortalidad a nivel mundial están calculadas en 47.8 y 13.6 por cada 100 mil mujeres, respectivamente; para Colombia, la incidencia estimada es de 48.3 por cada 100 mil mujeres y la mortalidad de 13.1 por cada 100 mil mujeres. Cerca del 70% del cáncer de mama expresa receptores hormonales (RH+) y es suceptible de manejo con terapia hormonal, la cual mejora los desenlaces clínicos de las pacientes en los escenarios adyuvante y metastásico. Específicamente, en la adyuvancia los estudios han demostrado que la hormonoterapia disminuye en casi un 50% el riesgo de recaída y en un 30% el riesgo de muerte después de 10 años de seguimiento. Para esta actualización, se realizó una búsqueda de la literatura en dos de las bases de datos bibliográficas más influyentes, seleccionando posteriormente los ensayos clínicos, revisiones sistemáticas y metaanálisis más relevantes sobre el tema. Finalmente, se realizaron reuniones conjuntas entre las Unidades Funcionales de Seno y Tejidos Blandos y Oncología Clínica del Instituto Nacional de Cancerología de Colombia (INC), logrando establecer el abordaje terapéutico en el escenario adyuvante para las pacientes pre y posmenopáusicas con cáncer de mama RH+, discriminando cada recomendación en relación al riesgo de recidiva.

Pseudomyxoma peritonei (PMP) is a rare malignancy, classified according to the Peritoneal Surface Oncology Group International (PSOGI) classification, whose response to treatment remains highly heterogeneous within the high-grade (HG) category. Molecular profiling of PMP cases might help to better categorize patients and predict treatment responses. We studied the Ki-67 proliferation rate and P53 overexpression in tissue samples from our historical cohort of HG-PMP patients. We established as cut-off levels the third quartile of each marker to perform univariate and multivariate Cox regression survival analyses. According to these results, the HG-PMP category was divided into subcategories and a new survival analysis was performed. A total of 90/117 patients with PMP undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) were selected for secondary analysis. The survival analysis of the HG-PMP category for preoperative variables showed that a proliferation index defined by Ki-67 >15% is a bad prognostic factor, with a hazard ratio (HR) of 3.20 (95% confidence interval [CI] 1.24–8.25). Accordingly, the HG-PMP group was divided using the Ki-67 15% cut-off. The new PSOGI/Ki-67 variable was an independent prognostic factor for overall survival (OS), with an HR of 3.74 (95% CI 1.88–7.47), and disease-free survival (DFS), with an HR of 4.184 (95% CI 1.79–9.75). The estimated 5-year OS rate was 100%, 70% and 24% for the LG-PMP, HG-PMP ≤15% and HG-PMP >15% groups, respectively (p = 0.0001), while the 5-year DFS rate was 90%, 44% and 0%, respectively (p = 0.0001). Division of the HG-PMP category of the PSOGI classification, according to the Ki-67 proliferation index, provides two well-defined subcategories, with significant differences in terms of OS and DFS, and hence high prognostic value.

El presente artículo explora la experiencia del uso del dinero en las personas de bajos ingresos en Bogotá comprendiendo los niveles de bancarización que tiene esta población y la importancia de la educación financiera en el rol de la economía y el mercado. En Colombia son pocas las instituciones y los estudios que han revisado la experiencia del uso del dinero y su relación con la bancarización y la inclusión financiera, especialmente en las personas de bajos ingresos. Por ello, este artículo explora la siguiente conjetura: mientras no se haga una indagación juiciosa que describa cualitativamente las motivaciones y contextos que viven las personas de bajos ingresos en sus realidades y necesidades cotidianas frente a la oferta de productos y servicios financieros no habrá una información adecuada y suficiente que les permita a las entidades gubernamentales y privadas del sector financiero construir estrategias eficaces y pertinentes para que esta población sea efectivamente bancarizada. Mediante entrevistas en profundidad se exploran estas motivaciones y decisiones demostrando con esta investigación que una adecuada educación financiera desde la niñez, así como políticas de inclusión financiera adecuadas a este tipo de población teniendo como premisa el conocimiento profundo de su actuar cotidiano, contexto y estilo de vida llevará a implementar mejores estrategias.

Introduction Multiple sclerosis (MS) is an immunological, degenerative and chronic neurological disease that is frequently diagnosed in young adults. Medical care might be challenging as MS symptoms are heterogenic and sometimes medical-care team requirements might not meet MS patients’ needs. Objectives To learn the experience of patients and their caregivers of the medical care received in the Gregorio Maranon Hospital Demyelinating Unit. Method we designed a focus group with 26 participants incidentally recruited from the Gregorio Maranon Hospital Demyelinating Unit: 8 with low physical disability, 8 with high physical disability and 10 caregivers. Information was collected regarding three main topics: information, clinical care and medical team. Results High satisfaction was found among all participants with most of the medical care and with the professionals of the MS Unit. They agreed with the interventions they were offered but they considered that physical rehabilitation and psychological support must be offered, not only to MS patients but also to their caregivers and family. They also asked to emphasize transdisciplinary care. Conclusions This information defined the aspects of medical care that participants perceived as quality-care and the goals the Unit needs to achieve in the future.

Purpose We hypothesized that dose-intensified chemoradiation therapy targeting adversely prognostic hypercellular (TVHCV) and hyperperfused (TVCBV) tumor volumes would improve outcomes in patients with glioblastoma. Methods and Materials This single-arm, phase 2 trial enrolled adult patients with newly diagnosed glioblastoma. Patients with a TVHCV/TVCBV >1 cm3, identified using high b-value diffusion-weighted magnetic resonance imaging (MRI) and dynamic contrast-enhanced perfusion MRI, were treated over 30 fractions to 75 Gy to the TVHCV/TVCBV with temozolomide. The primary objective was to estimate improvement in 12-month overall survival (OS) versus historical control. Secondary objectives included evaluating the effect of 3-month TVHCV/TVCBV reduction on OS using Cox proportional-hazard regression and characterizing coverage (95% isodose line) of metabolic tumor volumes identified using correlative 11C-methionine positron emission tomography. Clinically meaningful change was assessed for quality of life by the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire C30, for symptom burden by the MD Anderson Symptom Inventory for brain tumor, and for neurocognitive function (NCF) by the Controlled Oral Word Association Test, the Trail Making Test, parts A and B, and the Hopkins Verbal Learning Test–Revised. Results Between 2016 and 2018, 26 patients were enrolled. Initial patients were boosted to TVHCV alone, and 13 patients were boosted to both TVHCV/TVCBV. Gross or subtotal resection was performed in 87% of patients; 22% were O6-methylguanine-DNA methyltransferase (MGMT) methylated. With 26-month follow-up (95% CI, 19-not reached), the 12-month OS rate among patients boosted to the combined TVHCV/TVCBV was 92% (95% CI, 78%-100%; P = .03) and the median OS was 20 months (95% CI, 18-not reached); the median OS for the whole study cohort was 20 months (95% CI, 14-29 months). Patients whose 3-month TVHCV/TVCBV decreased to less than the median volume (3 cm3) had superior OS (29 vs 12 months; P = .02). Only 5 patients had central or in-field failures, and 93% (interquartile range, 59%-100%) of the 11C-methionine metabolic tumor volumes received high-dose coverage. Late grade 3 neurologic toxicity occurred in 2 patients. Among non-progressing patients, 1-month and 7-month deterioration in quality of life, symptoms, and NCF were similar in incidence to standard therapy. Conclusions Dose intensification against hypercellular/hyperperfused tumor regions in glioblastoma yields promising OS with favorable outcomes for NCF, symptom burden, and quality of life, particularly among patients with greater tumor reduction 3 months after radiation therapy.

Mexican Americans (MA) are more likely to have cognitive impairment and dementia (CID), be diagnosed at an earlier age and live with CID longer, compared to non-Hispanic Whites (NHW). While studies have examined unmet needs of individuals with CID and their caregivers, few have focused on MA populations in the U.S. This paper examines the needs of community-residing individuals with CID and their caregivers in Nueces County, Texas, a county with one of the largest MA populations in the U.S., while exploring ethnic differences in needs identified.Using concept mapping, a mixed-method approach, qualitative input on perceived needs by informal caregivers and health professionals was collected. Participants then sorted and rated perceived needs. Using this information, multidimensional scaling and cluster analyses were conducted to map the relationship between perceived needs and determine their importance and priority.Five clusters were derived for caregivers and four for the health professionals. Themes across both caregivers and health professionals highlighted the need for specialized and team-based medical care, caregiver support and training, along with socio-economic and physical needs that help with day-to-day care of individuals with CID. Among caregivers, MA rated financial resources as more important and of higher priority compared to NHW. The health professionals' perspectives were aligned with those of all caregivers.By understanding the needs of caregivers and individuals with CID, we can help families deal with this disease and let caregivers thrive. This is especially important for minority populations like MAs.

La bronquiolitis aguda es una condición respiratoria frecuente en los niños menores de 2 años. Representa la principal causa de hospitalización infantil y se caracteriza por la presencia de sibilancias asociada a signos de una infección respiratoria alta. El agente etiológico más común es el virus respiratorio sincicial. Existe una falta de consenso con respecto a su definición clínica; y por ello, su tratamiento varía en todo el mundo. El diagnóstico es clínico, sin necesidad de emplear laboratorio o imágenes en forma rutinaria. Diversas revisiones han demostrado que los broncodilatadores, adrenalina, corticoides y antibióticos, entre otros, carecen de eficacia por lo que no se sugiere su empleo. El tratamiento sigue siendo de soporte, mediante la administración de oxígeno y manteniendo una adecuada hidratación. Cuando no se logra disminuir el trabajo respiratorio o corregir la hipoxemia se puede utilizar la presión positiva en la vía aérea para prevenir y controlar la insuficiencia respiratoria. Este artículo desarrolla una breve revisión de las principales características clínicas, epidemiológicas, radiológicas, así como algunos de los diferentes tratamientos publicados en las últimas dos décadas.

Introduction A laparoscopic approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (L-CRS+HIPEC) in highly selected patients has been reported in small cohorts with a demonstrable reduction in length of stay and post-operative morbidity. This study aims to analyse individual patient data from these international centres collected through the Peritoneal Surface Oncology Group International (PSOGI) L-CRS+HIPEC registry. Methods An international registry was designed through a networking database (REDCAP®). All centres performing L-CRS+HIPEC were invited through PSOGI to submit data on their cases. Patient's characteristics, postoperative outcomes and survival were analysed. Results Ten international centres contributed a total of 143 L-CRS+HIPEC patients during the study period. The most frequent indication was low grade pseudomyxoma peritonei in 79/143 (55%). Other indications were benign multicyst mesothelioma in 21/143(14%) and peritoneal metastasis from colon carcinoma in 18/143 (12,5%) and ovarian carcinoma in 13/143 (9%). The median PCI was 3 (2-5). The median length of stay was 6 (5-10) days, with 30-day major morbidity rate of 8.3% and 30-day mortality rate of 0.7%. At a median follow-up of 37 (16-64) months 126/143 patients (88.2%) were free of disease. Conclusions Analysis of these data demonstrates that L-CRS+HIPEC is a safe and feasible procedure in highly selected patients with limited peritoneal disease when performed at experienced centres. While short to midterm outcomes are encouraging in patients with less invasive histology, longer follow up is required before recommending it for patients with more aggressive cancers with peritoneal dissemination.

BACKGROUND Surgical resection and radiofrequency ablation (RFA) represent two possible strategy in treatment of hepatocellular carcinoma (HCC) in Milan criteria. AIM To evaluate short- A nd long-term outcome in elderly patients (70 years) with HCC in Milan criteria, which underwent liver resection (LR) or RFA. METHODS The study included 594 patients with HCC in Milan criteria (429 in LR group and 165 in RFA group) managed in 10 European centers. Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching (PSM) and Cox regression. RESULTS After PSM, we compared 136 patients in the LR group with 136 patients in the RFA group. Overall survival at 1, 3, and 5 years was 91%, 80%, and 76% in the LR group and 97%, 67%, and 41% in the RFA group respectively (P = 0.001). Diseasefree survival at 1, 3, and 5 years was 84%, 60% and 44% for the LR group, and 63%, 36%, and 25% for the RFA group (P = 0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group (1% vs 11%, P = 0.001) in association with a shorter length of stay (2 d vs 7 d, P = 0.001).In multivariate analysis, Model for End-stage Liver Disease (MELD) score (10) [odds ratio (OR) = 1.89], increased value of international normalized ratio (1.3) (OR = 1.60), treatment with radiofrequency (OR = 1.46) ,and multiple nodules (OR = 1.19) were independent predictors of a poor overall survival while a high MELD score (10) (OR = 1.51) and radiofrequency (OR = 1.37) were independent factors associated with a higher recurrence rate. CONCLUSION Despite a longer length of stay and a higher rate of severe postoperative complications, surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients (70 years) with HCC in Milan criteria. © 2021 The Author(s). Published by Baishideng Publishing Group Inc. All rights reserved.