Liquid Biopsies for Monitoring Medulloblastoma: Circulating Tumor DNA as a Biomarker for Disease Progression and Treatment Response.

Pediatric brain tumors, including medulloblastoma (MB), represent a significant challenge in clinical oncology. Early diagnosis, accurate monitoring of therapeutic response, and the detection of minimal residual disease (MRD) are crucial for improving outcomes in these patients. This review aims to explore recent advancements in liquid biopsy techniques for monitoring pediatric brain tumors, with a specific focus on medulloblastoma. The primary research question is how liquid biopsy techniques can be effectively utilized for these purposes. Liquid biopsies, particularly the analysis of circulating tumor DNA (ctDNA) in cerebrospinal fluid (CSF), are investigated as promising noninvasive tools. This comprehensive review examines the components of liquid biopsies, including ctDNA, cell-free DNA (cfDNA), and microRNA (miRNA). Their applications in diagnosis, prognosis, and MRD assessment are critically assessed. The review also discusses the role of liquid biopsies in categorizing medulloblastoma subgroups, risk stratification, and the identification of therapeutic targets. Liquid biopsies have shown promising applications in the pediatric brain tumor field, particularly in medulloblastoma. They offer noninvasive means of diagnosis, monitoring treatment response, and detecting MRD. These biopsies have played a pivotal role in subgroup classification and risk stratification of medulloblastoma patients, aiding in the identification of therapeutic targets. However, challenges related to sensitivity and specificity are noted. In conclusion, this review highlights the growing importance of liquid biopsies, specifically ctDNA analysis in CSF, in pediatric brain tumor management, with a primary focus on medulloblastoma. Liquid biopsies have the potential to revolutionize patient care by enabling early diagnosis, accurate monitoring, and MRD detection. Nevertheless, further research is essential to validate their clinical utility fully. The evolving landscape of liquid biopsy applications underscores their promise in improving outcomes for pediatric brain tumor patients.

Use of Chitosan-Based Polyelectrolyte Complexes for Its Potential Application in Active Food Packaging: A Review of Recent Literature.

The current challenges in the food packaging field are, on one side, replacing plastic from non-renewable sources with biopolymers and, on the other hand, generating a packaging material with attractive properties for the consumer. Currently, the consumer is ecologically concerned; the food packaging industry must think ahead to satisfy their needs. In this context, the utilization of polyelectrolyte complexes (PECs) in this industry presents itself as an excellent candidate for fulfilling these requirements. PECs possess enticing characteristics such as encapsulation, protection, and transportation, among others. On the other hand, diverse types of biopolymers have been used in the formation of PECs, such as alginate, cellulose, gelatin, collagen, and so on. Hence, this paper reviews the use of PECs in food packaging where chitosan forms polyelectrolyte complexes.

Geographic variation in the altitudinal migration patterns, body size, oxidative status and exploratory behavior in a neotropical bird.

To cope with life in the mountains, populations of the same species can exhibit substantial variability in their altitudinal migration patterns and phenotypes in response to local weather conditions. Studying such variability can provide valuable insights into how local populations respond to environmental challenges, and this information can be useful for conservation efforts in mountain ecosystems. Here, we used δ2H values of feathers and blood to evaluate latitudinal variation in altitudinal migration patterns and its possible links with body size, oxidative status, and exploratory behavior in 72 individuals of rufous-collared sparrow (Zonotrichia capensis) that breed at low and high elevations in the center (~33°) and south (~38°) of Chile. Our results show that both altitudinal migration patterns and oxidative status were significantly influenced by the latitude of breeding sites, while exploratory behavior was associated with elevation. Notably, we found that fast-explorer birds inhabiting low elevations in central Chile displayed higher levels of oxidative damage than slow-explorer birds. These outcomes underscore the possibility of local adaptations in response to diverse local environmental conditions in the Andes. We discuss the implications of latitude, elevation, and environmental temperature in shaping the observed patterns and highlight the significance of identifying local adaptations in mountain birds for better predicting their response to climate change and other challenges stemming from anthropogenic activities.

Association between maternal obesity, essential fatty acids and biomarkers of fetal liver function.

Maternal obesity and the imbalance in linoleic acid (C18:2 n-6, LA) and alpha-linolenic acid (C18:3 n-3, ALA) levels are related with hepatic disturbances in the offspring. However, whether these alterations are present during fetal life is not well understood. Obese and normal weight pregnant women were recruited to determine fatty acids (FAs) consumption, FAs profile (in maternal erythrocytes, placenta and neonatal very low-density lipoproteins VLDL) and biomarkers of fetal liver function, such as gamma-glutamyl transferase (GGT), alpha-fetoprotein (AFP) and albumin, in umbilical cord blood. Stearic acid (C18:0, ST) was lower, and total n-3 FAs tended to be lower in umbilical cord VLDLs of obese women compared to controls. Independently of maternal obesity, GGT levels in umbilical cord blood was positively correlated with the LA content and negatively correlated with the ALA content in maternal erythrocytes. We conclude that maternal obesity and its imbalance of LA and ALA are associated with changes in biomarkers of fetal liver function.

Cardiac metabolism in HFpEF: from fuel to signalling.

Heart failure (HF) is marked by distinctive changes in myocardial uptake and utilization of energy substrates. Among the different types of HF, HF with preserved ejection fraction (HFpEF) is a highly prevalent, complex, and heterogeneous condition for which metabolic derangements seem to dictate disease progression. Changes in intermediate metabolism in cardiometabolic HFpEF-among the most prevalent forms of HFpEF-have a large impact both on energy provision and on a number of signalling pathways in the heart. This dual, metabolic vs. signalling, role is played in particular by long-chain fatty acids (LCFAs) and short-chain carbon sources [namely, short-chain fatty acids (SCFAs) and ketone bodies (KBs)]. LCFAs are key fuels for the heart, but their excess can be harmful, as in the case of toxic accumulation of lipid by-products (i.e. lipotoxicity). SCFAs and KBs have been proposed as a potential major, alternative source of energy in HFpEF. At the same time, both LCFAs and short-chain carbon sources are substrate for protein post-translational modifications and other forms of direct and indirect signalling of pivotal importance in HFpEF pathogenesis. An in-depth molecular understanding of the biological functions of energy substrates and their signalling role will be instrumental in the development of novel therapeutic approaches to HFpEF. Here, we summarize the current evidence on changes in energy metabolism in HFpEF, discuss the signalling role of intermediate metabolites through, at least in part, their fate as substrates for post-translational modifications, and highlight clinical and translational challenges around metabolic therapy in HFpEF.

Multidisciplinary analysis of a mummy from the War of the Pacific.

The War of the Pacific (1879-1884) was a big scale war between Chile against the alliance of Peru and Bolivia. One of the most important battles, the "Batalla del Campo de la Alianza" was situated in the desert near Tacna, Peru. The conditions of this environment favored the conservation of the dead soldiers after many years. Decades ago, the Natural History Museum of Concepción in Chile, received a naturally mummified individual of a probably Chilean soldier as a donation; its uncertain context was never studied nor confirmed. Considering this, our investigation analyzed this body under exploratory methods, ballistic analysis, archaeological contrast, 14C radiocarbon dating, ancient DNA, and isotopic analysis to reconstruct the biological profile of this mummy. The results indicated that the mummy belongs to an adult man between 33-39 years of age (> 1.50 m) and has a perimortem wound in the left flank of the abdomen. CT scan and X-rays revealed the presence of a bullet (Comblain II or Gras) hosted near the L2 vertebra. It is possible that the individual died of bleeding from a gunshot wound done by a long-distance firearm projectile from an inferior level, whose trajectory was from left to right, with slight inclination towards the top, and without a projectile exit. Other analyses confirmed the historical context and suggests the Chilean origin of the mummy. Despite the passage of time and other factors, it was possible to reconstruct the death of this individual thanks to technology and approaches from different disciplines.

Microvascular dysfunction of the non-culprit circulation predicts poor prognosis in patients with ST-segment elevation myocardial infarction.

Background: Endothelial and microvascular dysfunction are frequently found in the non-culprit territory in patients with acute myocardial infarction (AMI). We aimed to determine whether an impaired coronary physiology of the non-culprit territory impacts long-term prognosis. Methods: FISIOIAM was an observational single-center study which included patients with AMI and another coronary artery lesion in a different territory. Intracoronary physiology of the non-culprit artery was analyzed early after primary percutaneous coronary intervention of the culprit artery, using fractional flow reserve (FFR), index of microcirculatory resistance (IMR), coronary flow reserve (CFR), endothelium-dependent CFR (eCFR) and macrovascular endothelial function . Patients were followed for a composite outcome of cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and hospitalization due to heart failure or unstable angina. Results: A total of 84 patients (mean age: 62 ± 10 years) were included and functional abnormalities were detected in 93% of them. During follow-up (median of 1422 days; interquartile range, 1287-1634), 13.1% of the patients experienced at least one adverse cardiovascular event. Kaplan-Meier analysis revealed that patients with a CFR < 2 had a higher risk of events (Hazard Ratio, HR: 4.97, 95% Confidence Interval, CI, 1.32-18.75), whereas other parameters such as FFR, IMR, eCFR, and macrovascular endothelial function had no effect. A low CFR was an independent predictor of cardiovascular events, even after adjustment for age and traditional cardiovascular risk factors (adjusted HR: 6.62, 95% CI, 1.30-33.70). Conclusions: The presence of abnormal coronary microvascular function as measured by a CFR < 2 in the non-culprit territory predicts future risk of adverse cardiovascular events.

Photophysical study and in vitro approach against Leishmania panamensis of dicloro-5,10,15,20-tetrakis(4-bromophenyl)porphyrinato Sn(IV).

Background: Photodynamic therapy activity against different biological systems has been reported for porphyrins. Porphyrin modifications through peripheral groups and/or by metal insertion inside the ring are main alternatives for the improvement of its photo-physical properties. In this study, we synthesized and characterized 5,10,15,20-tetrakis(4-bromophenyl)porphyrin and the dicloro-5,10,15,20-tetrakis(4-bromophenyl)porphyrinato Sn(IV). Methods: Metal-free porphyrin was synthesized using the Alder method, while the Sn(IV)-porphyrin complex was prepared by combining metal-free porphyrin with stannous chloride in DMF; the reaction yields were 47% and 64% respectively. Metal-free porphyrin was characterized by UV-Vis, FT-IR, ESI-mass spectrometry and 13C-NMR. Additionally, the Sn(IV) -porphyrin complex was characterized using UV-Vis and FT-IR. Cyclic voltammetry tests in four different solvents. The fluorescence quantum yield (Φ f) was measured using fluorescein as a standard, the singlet oxygen quantum yield (Φ D) was estimated using the standard 5,10,15,20-(tetraphenyl)porphyrin (H2TPP) and the quencher of singlet oxygen 1,3-diphenylisobenzofuran (DPBF). Results: UV-Vis assay showed typical Q and Soret bands for porphyrin and its metallo-porphyrin complex. Compounds showed photoluminescence at the visible range of electromagnetic spectrum. The inclusion of the metal in the porphyrin core changed the Φ f from 0.15 to 0.05 and the Φ D increased from 0.55 to 0.59. Finally, the effect of the compounds on the viability of L. panamensis was evaluated by means of the MTT test. The results showed that both compounds decreased the viability of the parasite; this inhibitory activity was greater under light irradiation; the porphyrin compound had IC 50 of 16.5 µM and the Sn(IV)-porphyrin complex had IC 50 of 19.2 µM. Conclusion: The compounds were synthesized efficiently, their characterization was carried out by different spectroscopy techniques and their own signals were evidenced for both structures, both compounds decreased the cell viability of L. panamensis.

Two Fascinating Polysaccharides: Chitosan and Starch. Some Prominent Characterizations for Applying as Eco-Friendly Food Packaging and Pollutant Remover in Aqueous Medium. Progress in Recent Years: A Review.

The call to use biodegradable, eco-friendly materials is urgent. The use of biopolymers as a replacement for the classic petroleum-based materials is increasing. Chitosan and starch have been widely studied with this purpose: to be part of this replacement. The importance of proper physical characterization of these biopolymers is essential for the intended application. This review focuses on characterizations of chitosan and starch, approximately from 2017 to date, in one of their most-used applications: food packaging for chitosan and as an adsorbent agent of pollutants in aqueous medium for starch.

PKD2/polycystin-2 induces autophagy by forming a complex with BECN1.

Macroautophagy/autophagy is an intracellular process involved in the breakdown of macromolecules and organelles. Recent studies have shown that PKD2/PC2/TRPP2 (polycystin 2, transient receptor potential cation channel), a nonselective cation channel permeable to Ca2+ that belongs to the family of transient receptor potential channels, is required for autophagy in multiple cell types by a mechanism that remains unclear. Here, we report that PKD2 forms a protein complex with BECN1 (beclin 1), a key protein required for the formation of autophagic vacuoles, by acting as a scaffold that interacts with several co-modulators via its coiled-coil domain (CCD). Our data identified a physical and functional interaction between PKD2 and BECN1, which depends on one out of two CCD domains (CC1), located in the carboxy-terminal tail of PKD2. In addition, depletion of intracellular Ca2+ with BAPTA-AM not only blunted starvation-induced autophagy but also disrupted the PKD2-BECN1 complex. Consistently, PKD2 overexpression triggered autophagy by increasing its interaction with BECN1, while overexpression of PKD2D509V, a Ca2+ channel activity-deficient mutant, did not induce autophagy and manifested diminished interaction with BECN1. Our findings show that the PKD2-BECN1 complex is required for the induction of autophagy, and its formation depends on the presence of the CC1 domain of PKD2 and on intracellular Ca2+ mobilization by PKD2. These results provide new insights regarding the molecular mechanisms by which PKD2 controls autophagy.Abbreviations: ADPKD: autosomal dominant polycystic kidney disease; ATG: autophagy-related; ATG14/ATG14L: autophagy related 14; Baf A1: bafilomycin A1; BCL2/Bcl-2: BCL2 apoptosis regulator; BCL2L1/BCL-XL: BCL2 like 1; BECN1: beclin 1; CCD: coiled-coil domain; EBSS: Earle's balanced salt solution; ER: endoplasmic reticulum; GAPDH: glyceraldehyde-3-phosphate dehydrogenase; GFP: green fluorescent protein; GOLGA2/GM130: golgin A2; GST: glutathione s-transferase; LAMP1: lysosomal associated membrane protein 1; MAP1LC3/LC3: microtubule associated protein 1 light chain 3; MTORC1: mechanistic target of rapamycin kinase complex 1; NBR1: NBR1 autophagy cargo receptor; PIK3C3/VPS34: phosphatidylinositol 3-kinase catalytic subunit type 3; PKD2/PC2: polycystin 2, transient receptor potential cation channel; RTN4/NOGO: reticulon 4; RUBCN/RUBICON: rubicon autophagy regulator; SQSTM1/p62: sequestosome 1; UVRAG: UV radiation resistance associated; WIPI2: WD repeat domain, phosphoinositide interacting 2.

DNA methylation in promoter regions of genes involved in the reproductive and metabolic function of children born to women with PCOS.

Clinical and experimental evidences indicate that epigenetic modifications induced by the prenatal environment are related to metabolic and reproductive derangements in polycystic ovary syndrome (PCOS). Alterations in the leptin and adiponectin systems, androgen signalling and antimüllerian hormone (AMH) levels have been observed in PCOS women and in their offspring. Using a targeted Next-Generation Sequencing (NGS), we studied DNA methylation in promoter regions of the leptin (LEP), leptin receptor (LEPR), adiponectin (ADIPOQ), adiponectin receptor 1 and 2 (ADIPOR1 and ADIPOR2), AMH and androgen receptor (AR) genes in 24 sons and daughters of women with PCOS (12 treated with metformin during pregnancy) and 24 children born to non-PCOS women during early infancy (2-3 months of age). Genomic DNA was extracted from whole blood, bisulphite converted and sequenced by NGS. Girls showed differences between groups in 1 CpG site of LEPR, 2 of LEP, 1 of ADIPOR2 and 2 of AR. Boys showed differences in 5 CpG sites of LEP, 3 of AMH and 9 of AR. Maternal metformin treatment prevented some of these changes in LEP, ADIPOR2 and partially in AR in girls, and in LEP and AMH in boys. Maternal BMI at early pregnancy was inversely correlated with the methylation levels of the ChrX-67544981 site in the whole group of girls (r = -0.530, p = 0.008) and with the global Z-score in all boys (r = -0.539, p = 0.007). These data indicate that the intrauterine PCOS environment predisposes the offspring to acquire certain sex-dependent DNA methylation patterns in the promoter regions of metabolic and reproductive genes.

Angiotensin-(1-9) prevents cardiomyocyte hypertrophy by controlling mitochondrial dynamics via miR-129-3p/PKIA pathway.

Angiotensin-(1-9) is a peptide from the noncanonical renin-angiotensin system with anti-hypertrophic effects in cardiomyocytes via an unknown mechanism. In the present study we aimed to elucidate it, basing us initially on previous work from our group and colleagues who proved a relationship between disturbances in mitochondrial morphology and calcium handling, associated with the setting of cardiac hypertrophy. Our first finding was that angiotensin-(1-9) can induce mitochondrial fusion through DRP1 phosphorylation. Secondly, angiotensin-(1-9) blocked mitochondrial fission and intracellular calcium dysregulation in a model of norepinephrine-induced cardiomyocyte hypertrophy, preventing the activation of the calcineurin/NFAT signaling pathway. To further investigate angiotensin-(1-9) anti-hypertrophic mechanism, we performed RNA-seq studies, identifying the upregulation of miR-129 under angiotensin-(1-9) treatment. miR-129 decreased the transcript levels of the protein kinase A inhibitor (PKIA), resulting in the activation of the protein kinase A (PKA) signaling pathway. Finally, we showed that PKA activity is necessary for the effects of angiotensin-(1-9) over mitochondrial dynamics, calcium handling and its anti-hypertrophic effects.

Polycystin-2-dependent control of cardiomyocyte autophagy.

AIMS: Considerable evidence points to critical roles of intracellular Ca2+ homeostasis in the modulation and control of autophagic activity. Yet, underlying molecular mechanisms remain unknown. Mutations in the gene (pkd2) encoding polycystin-2 (PC2) are associated with autosomal dominant polycystic kidney disease (ADPKD), the most common inherited nephropathy. PC2 has been associated with impaired Ca2+ handling in cardiomyocytes and indirect evidence suggests that this protein may be involved in autophagic control. Here, we investigated the role for PC2 as an essential regulator of Ca2+ homeostasis and autophagy. METHODS AND RESULTS: Activation of autophagic flux triggered by mTOR inhibition either pharmacologically (rapamycin) or by means of nutrient depletion was suppressed in cells depleted of PC2. Moreover, cardiomyocyte-specific PC2 knockout mice (αMhc-cre;Pkd2F/F mice) manifested impaired autophagic flux in the setting of nutrient deprivation. Stress-induced autophagy was blunted by intracellular Ca2+ chelation using BAPTA-AM, whereas removal of extracellular Ca2+ had no effect, pointing to a role of intracellular Ca2+ homeostasis in stress-induced cardiomyocyte autophagy. To determine the link between stress-induced autophagy and PC2-induced Ca2+ mobilization, we over-expressed either wild-type PC2 (WT) or a Ca2+-channel deficient PC2 mutant (PC2-D509V). PC2 over-expression increased autophagic flux, whereas PC2-D509V expression did not. Importantly, autophagy induction triggered by PC2 over-expression was attenuated by BAPTA-AM, supporting a model of PC2-dependent control of autophagy through intracellular Ca2+. Furthermore, PC2 ablation was associated with impaired Ca2+ handling in cardiomyocytes marked by partial depletion of sarcoplasmic reticulum Ca2+ stores. Finally, we provide evidence that Ca2+-mediated autophagy elicited by PC2 is a mechanism conserved across multiple cell types. CONCLUSION: Together, this study unveils PC2 as a novel regulator of autophagy acting through control of intracellular Ca2+ homeostasis.

Acceso vascular intraóseo: evaluación de los conocimientos anatómicos de los sitios de abordaje en profesionales de la salud / Intraosseous vascular access: evaluation of the anatomical knowledge of the boarding sites in health professionals

Introducción: El acceso intraóseo es considerado actualmente como una alternativa rápida y eficaz en situaciones en las cuales no es posible lograr un acceso intravenoso en un tiempo preestablecido, principalmente en pacientes que presenten shock grave o paro cardiorrespiratorio, siendo de vital importancia los conocimientos relacionados con su colocación, desde los reparos anatómicos hasta los dispositivos utilizados para su realización. Objetivos: Determinar los conocimientos que poseen los profesionales de la salud acerca del acceso intraóseo. Material y Metodo: Estudio descriptivo y transversal. Encuestas al personal de la salud que concurre a la institución. Resultados: Se realizaron 222 encuestas a enfermeros (37), estudiantes de enfermería (86), médicos (46) y estudiantes de medicina (53). El rango etario fue de 21-59 años. 27, 03% (60) conoce la vía intraósea como acceso vascular; 25, 22% (56) han recibido algún tipo de formación acerca de la colocación de accesos intraóseos, siendo la misma cantidad de profesionales los que pudieron enumerar los sitios anatómicos correspondientes. Sólo un 13, 06% pudieron indicar precisamente los reparos anatómicos necesarios para su colocación y, por último, únicamente 23, 42% de los encuestados conocía si su lugar de desempeño disponía de sets para la colocación de dicha vía. Conclusión: Son muy pocos los profesionales de la salud que tienen conocimientos acerca de la colocación del acceso vascular intraóseo, siendo escasamente promovidos durante su formación. Es de suma importancia promover programas de instrucción para la utilización de dicho acceso, ya que es bien sabido la gran utilidad que presenta el mismo, más aún en casos de riesgo de vida en el que no es posible contar con otro acceso vascular.

Introduction: Intraosseous access is currently considered a quick and effective alternative in situations in which it is not possible to achieve intravenous access in a pre-established time, mainly in patients presenting with severe shock or cardiorespiratory arrest, being of vital importance the knowledge related to its placement, from the anatomical repairs to the devices used for its realization. Objectives: To determine the knowledge held by health professionals about intraosseous access. Material and Method: Descriptive and transversal study. Surveys to health personnel who attend the institution. Results: 222 surveys were carried out to nurses (37), nursing students (86), doctors (46) and medical students (53). The age range was 21-59 years. 27, 03% (60) know the intraosseous route as vascular access; 25, 22% (56) have received some type of training about the placement of intraosseous accesses, with the same number of professionals being able to list the corresponding anatomical sites. Only 13, 06% could precisely indicate the anatomical repairs necessary for their placement and, finally, only 23, 42% of the respondents knew if their place of performance had sets for the placement of said route. Conclusion: Very few health professionals have knowledge about the placement of intraosseous vascular access, being poorly promoted during their training. It is very important to promote instructional programs for the use of such access, since it is well known that it is very useful, especially in cases of life risk in which it is not possible to have another vascular access.

Experiencia en el diagnóstico del cáncer de pulmón avanzado mediante punción ecoguiada / Experience in diagnosis of advanced lung cancer using echoguided puncture

Introducción: Los avances tecnológicos han facilitado el desarrollo de nuevas opciones de diagnóstico, permitiendo refinamientos en las técnicas existentes, mejorando la seguridad de los procedimientos. La ecografía torácica es una herramienta eficaz y sencilla en la evaluación de lesiones en pared torácica, pleura, mediastino y pulmón. Ha sido poco utilizada como guía en las biopsias percutáneas con aguja gruesa durante los últimos años en comparación con otros métodos diagnósticos invasivos (PAAF bajo TAC, VATS, mediastinos copia, FBC, etc). Ante la necesidad de realizar un diagnóstico quirúrgico, debe considerarse la realización de un procedimiento mínimamente invasivo, como la punción ecoguiada diagnostica para aquellos pacientes con alto riesgo quirúrgico. Objetivos: Destacar las ventajas de la ecografía como guía de las punciones percutáneas, y el alto valor redituable de las punciones con aguja gruesa en el diagnóstico de tumores de pulmón Material y Método: Diseño Retrospectivo, descriptivo, observacional. Se analizaron 197 pacientes con tumores torácico en contacto con pared, irresecables o avanzados tanto por clínica e imagenología, mal performance status y alto riesgo neumonológico y cardiológico. Se utilizaron ecógrafos con transductores lineales y convexos, agujas tipo Trucut semiautomáticas de 14 y 18 G de espesor que permite tomar cilindros de tejido para su análisis histológico, incluyendo técnicas técnicas histoquímicas o inmunohistoquimicas y para marcadores biológicos. Resultados: En el período de 2005-2014 se han punzado 197 casos, correspondiendo a 130 (66%) hombres y 67 (34%) mujeres, con edad media de 69.4 años. Del total 173 han sido neoplasias primarias y metástasis pulmonares y 24 casos de ubicación mediastinal. Las complicaciones que se presentaron fueron en 11 casos leves y 10 moderadas Conclusiones: El abordaje ecográfico es en tiempo real y dinámico, permitiendo realizar guías de accesos complejos y disminuir la tasa de complicaciones. Los procedimientos son ambulatorios logrando evitar internaciones innecesarias. Es la técnica de elección para pacientes en mal estado general con bajo performance status, compresión de vía respiratoria, riesgo de hemorragia

Introduction: Technological advances have facilitated the development of new diagnostic options, allowing refinements in existing techniques, improving procedures safety. Thoracic ultrasonography is an effective and simple tool in the evaluation of thoracic wall injuries, pleura, mediastinum and lung. It has been shortly used as a guide in percutaneous needle biopsies during the last years compared with other invasive diagnostic methods (FNA under CT, VATS, mediastinoscopy, FBC, etc). As a result of the need to perform a surgical diagnosis, a minimally invasive procedure should be considered, such as diagnostic ultrasound-guided puncture for those patients with high surgical risk. Objective: Highlighting the advantages of ultrasound as a guide for percutaneous punctures, and the high cost-effectiveness of needle punctures in the diagnosis of lung tumors. Material and method: Retrospective, descriptive, observational design. 197 patients with thoracic cavity tumors in contact with the wall were analyzed; clinical and imaging unresectable or advanced, bad performance status and high pulmonary and cardiological risk. Ultrasound with linear and convex probe, 14 and 18 G semi-automatic Tru-cut type needles were used. This needle allows taking tissue cylinders samples for histological analysis, including histochemical or immunohistochemical techniques and for biological markers. Results: In the period between 2005-2014, 197 cases have been punctured, 130 (66%) men and 67 (34%) women, with an average age of 69.4 years old. 173 out of 197 cases were primary and pulmonary metastases and 24 had mediastinal location. 11and 10 cases presented mild and moderate complications, respectively. Conclusions: Ultrasound approach is real-time and dynamic, allowing to perform complex access guidelines and to decrease the rate of complications. It is the technique recommended for patients in bad general condition, with low performance status, respiratory tract compression, and bleeding risk

Calidad del consentimiento informado y consideraciones éticas / Informed consent quality and ethic considerations

Introducción: El consentimiento informado es la expresión máxima de la autonomía, siendo esta un proceso de autogestión que comenzó a ganar espacio en el siglo XVII y XVIII tanto en aspecto orgánico como psicológico. La evolución tecnológica y en este caso médica con un acceso a la información cada vez más al alcance de la mano, la beneficencia sin autonomía (relación paternalista) se va dejando de lado. Pero aun considerándolo un marco adecuado, los fallos son posibles.Disponer de documentos estandarizados en entornos asistenciales sobrecargados, puede convertirse en la principal fuente de información al paciente. Motivo suficiente para considerar la necesidad de analizar al consentimiento informado dentro de diferentes criterios de calidad.Objetivos: Evaluar según estándares de calidad el proceso de consentimiento informado de nuestro servicio de Cirugía General.Material y Método: Estudio descriptivo, observacional. Se analizaron 770 consentimientos informados para intervenciones quirúrgicas dentro del periodo 01/01/2016 ­31/05/2017. Se utilizó una tabla de estándares de calidad.Resultados: Se encuentra una adherencia absoluta al 73.68% (14) de los 19 criterios de calidad analizados. Adherencia parcial al 21.05% (4) y falta al 5.26% (1).Conclusión: El consentimiento informado es un proceso dinámico fundamental en la relación médico-paciente. Para contribuir a mejorar la calidad de ambos, la introducción de estándares de calidad resulta una herramienta válida y útil. Aplicar estándares de calidad no solo implica a la calidad por si misma, sino que al mismo tiempo genera una mejora en el proceso de seguridad del paciente

ntroduction: Informed consent is the maximum expression of autonomy, becoming a process of self-management that began to gain space in the seventeenth and eighteenth centuries in both organic and psychological aspects. Technological and medical evolution with an increasing availability to information, charity without autonomy (paternalistic relationship) is left aside. But even considering it an adequate framework, failures are possible.Having standardized documents in overloaded healthcare environments may become the main source of information for the patient. Enough reason to consider the need to analyze informed consent within different quality criteria.Objectives: Evaluate, according to quality standards, the informed consent process of our General Surgery service.Material and method: Descriptive, observational study. 770 informed consent for surgical interventions within the period 01/01/2016 -05/31/2017 were analyzed. A table of quality standards was used.Results: There is an absolute adherence of 73.68% (14) of the 19 quality criteria analyzed. Partial adherence of 21.05% (4) and absence of 5.26% (1).Conclusion: Informed consent is a essential dynamic process in the doctor-patient relationship. To help improve the quality of both, the introduction of quality standards is a valid and useful tool. Applying quality standards not only implies quality by itself, as it can generates an improvement in the process of patient safety at the same time

Historia del acceso venoso central / Central venous access history

Introducción: Los accesos venosos han sido empleados desde hace varias décadas. La utilización de estas vías para la administración de fluidos, fármacos, nutrición parenteral o determinación de constantes fisiológicas; ha dependido tanto del conocimiento anatómico como de la disponibilidad de material adecuado. Repasaremos los hitos más importantes de la historia de la cateterización venosa que hicieron posible la base para la colocación de accesos venosos centrales en la actualidad.Metodologia: Se realizo una búsqueda bibliográfica entre Enero y Abril de 2018 utilizando escritura científica con lectura critica a base de fuentes de información como libros de texto y búsquedas avanzadas con filtros selectivos en Pubmed. Desarrollo: Antes del conocimiento y la utilización de equipos de punción percutáneo había que proceder a la exposición quirúrgica del vaso para introducir un catéter venoso. La descripción de la Técnica de Seldinger represento una importante ventaja respecto a la venodisección y el advenimiento de la ultrasonografia (US) facilito su inserción y disminuyo las complicaciones. Conclusión:El cateterismo venoso central es un procedimiento frecuente efectuado por primera vez a principios del siglo XX; convirtiéndose en un pilar de la medicina moderna.

Introduction: Venous access has been used since several decades ago. The use of these venous lines in order to dispense fluids, drugs, parenteral nutrition or monitoring physiological parameters has depended on the anatomical knowledge, as well as on the availability of the appropriate material. We will go through the most important facts along the history of the venous catheterization that created the basis of the actual procedure of central venous access.Methods: A bibliographic search has been made, taking into account the period from January to April 2018, using scientific literature and applying critical reading. The sources of information included textbooks and advanced search applying selective filtering in Pubmed.Development: Before the expertise and the use of equipment for the percutaneous puncture it was necessary to perform a surgical exposure of the vessel in order to introduce a venous catheter. The Seldinger Technique represented a major advantage over venousection, and the advent of ultrasonography improved the placement and decreased complications.Results: The central venous catheterization is a frequent procedure, introduced for the first time in the early twentieth century and it became a fundamental pillar in modern medicine.