Artículos Medicina y Ciencias de la Salud

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Driving research on successful aging and neuroprotection in Latin America: Insights from the inaugural symposium on brain resilience and healthy longevity
(2025) Quiroz, Yakeel; Aguillón, David; Arboleda, Joseph; Bocanegra, Yamile; Cardona, Gloria; Corrada, Maria; Diez, Ibai; Garcia, Elkin; Kosik, Kenneth; Martinez, Lusiana; Pineda, David; Posada, Rafael; Roman, Norbel; Sepulveda, Diego; Slachevsky Chonchol, Andrea; Soto, Marcio; Tabilo, Evelyn; Vasquez, Daniel; Villegas, Andrés
Introduction: Global life expectancy has steadily increased in recent decades, resulting in a significant rise in the number of individuals aged 80 years and older. This trend is also evident in Latin America, where life expectancy is improving, though at varying rates across countries and regions. Methods: Partnering with the Neurosciences Group of Antioquia (GNA), we launched a Colombian study on resilience in families with autosomal dominant Alzheimer's disease and the oldest-old population. Over the past 2 years, the project has expanded to include participants from Peru, Chile, and Costa Rica. Results: This research led to the first symposium on Brain Resilience and Healthy Longevity, held in Medellín, Colombia, in August 2024. Discussion: The article summarizes key discussions from the symposium, highlighting the most promising opportunities for brain resilience and prevention research in the region and offering recommendations for future research to promote healthy aging and dementia-free communities. Highlights: Uncovering the genetic and physiological drivers of cognitive resilience, neurodegeneration resistance, and healthy longevity is essential for maintaining brain function as we age. "Superagers" and cognitively resilient individuals from Latin American families with Alzheimer's disease offer valuable insights into brain protection mechanisms. Studying the interplay of socio-environmental and genetic factors in the oldest-old is key to understanding healthy longevity and improving dementia prevention. The inaugural Brain Resilience and Healthy Longevity Symposium highlights the need for global collaboration to uncover factors that drive cognitive resilience and healthy aging in Latin America, advancing dementia prevention.
Critical Review of the Methodological Shortcoming of Ambulatory Blood Pressure Monitoring and Cognitive Function Studies
(2025) Haghayegh, Shahab; Hermida, Ramon; Smolensky, Michael; Jimenez, Mili; Duran, Claudia; Slachevsky Chonchol, Andrea; Behrens, Maria Isabel; Aguillon, David; Santamaria, Hernando; García, Adolfo; Matallana, Diana; Ibáñez, Agustín; Hu, Kun
Growing evidence suggests that abnormal diurnal blood pressure rhythms may be associated with many adverse health outcomes, including increased risk of cognitive impairment and dementia. This study evaluates methodological aspects of research on bidirectional associations between ambulatory blood pressure monitoring (ABPM) patterns and cognitive function. By examining the 28 recent studies included in a recent systematic review on the association between ABPM patterns with cognitive function and risk of dementia, our review revealed several significant limitations in study design, sample characteristics, ABPM protocol, cognitive assessment, and data analysis. The major concerns include a lack of diversity in study populations with underrepresentation of Blacks and Latinos, a predominant focus on Alzheimer's disease or all-cause dementia without distinguishing other dementia subtypes, different and not standardized measures of cognition or dementia, prevalent use of 24 h monitoring without considering the adaption effect, inconsistent definitions of dipping status, and ignorance of individual differences in timings of daily activities such as bed and awakening times. In addition, confounding variables such as class, dose, and timing of antihypertensive medication are inadequately controlled or considered. Further, longitudinal studies were scarce examining the bidirectional relationship between ABPM patterns and cognitive decline over time. Collectively, these deficiencies undermine the reliability and generalizability of current findings. Addressing these methodological challenges is crucial for a more comprehensive understanding of diurnal blood pressure rhythms in diverse populations and for developing an evidence-based guideline for ambulatory monitoring and control of blood pressure across the sleep-wake cycle to prevent cognitive decline and dementia.
AO Spine Clinical Practice Recommendations: Reducing the Surgical Footprint of Surgery for Spinal Metastases
(2026) Silva, Alvaro; Chen, Hanbo; Disch, Alexander; Kam, Jeremy; O'Toole, John; Dea, Nicolas; Gasbarrini, Alessandro; Laufer, Ilya; Netzer, Cordula; Reynolds, Jeremy; D Rhines, Laurence; Sahgal, Arjun; Verlaan, Jorrit-Jan; Fisher, Charles; Barzilai, Ori
Study DesignLiterature review with clinical recommendations.ObjectiveSpinal metastases represent a late complication of cancer and a major factor in decreased quality of life. The role of surgery for specific indications for spinal metastases is well established. Given the significant morbidity associated with spine surgery in this frail population, efforts are ongoing to decrease the surgical footprint. The objective of this study is to provide the readers with a concise curation of the latest spine literature on reducing the surgical footprint for spine metastases and clinical recommendations for how the practicing clinician should interpret and make use of this evidence.MethodsThe latest spine literature in the topic of reducing the surgical footprint for spine metastases was reviewed and clinical recommendations were formulated. The recommendations are dichotomously graded into strong and conditional based on the integration of scientific methodology and content expert opinion. This opinion considers experience and practical issues such as risks, burdens, costs, patient values, and circumstances.ResultsFour high impact studies were selected for review. The findings suggest that surgery plays a key role in improving patients' quality of life, but incidence of adverse events remains high and hence methods to decrease surgical morbidity are necessary. The integration of radiation into the treatment algorithm allows for less extensive surgical procedures and SBRT should be strongly considered after surgery for spine metastases in appropriate patient populations. Implementation of enhanced recovery after surgery (ERAS) protocols reduce perioperative morbidity for both open and minimally invasive surgeries and should be considered on an institutional level. Utilization of minimally invasive surgical stabilization should be considered as it results in fewer post operative complications, lower infection rates, less blood loss during surgery, and a shorter hospital stay compared to open stabilization of unstable pathology thoracolumbar fractures.ConclusionsThe role and benefits of surgery for metastatic spine disease are well established, yet surgery carries significant risk for adverse events which may negatively affect overall cancer care. Methods for reducing the surgical footprint include incorporation of stereotactic radiation allowing less extensive surgery, implementation of ERAS protocols and utilization of minimally invasive surgical strategies.
Impact of burnout on turnover, medical errors, medical leave and a cross-sectional study of contributing factors among Chilean physicians
(2025) Villalón López, Francisco; Mundt, Adrian P.; Hirmas, Alejandro; Rivera, Rita M.; Guiloff, Rodrigo
Background During the COVID-19 pandemic, many physicians experienced burnout, underscoring the need to identify factors associated with this condition to develop effective prevention and treatment strategies. Objective To examine the relationship between physician burnout and individual factors, medical errors, medical leave and the work environment. Design A cross-sectional online survey conducted from November 2020 to December 2020. Participants Physicians registered with the Medical College of Chile. Setting Registered physicians working in Chile across primary, secondary and tertiary levels of healthcare. Primary outcomes Burnout was assessed using the Maslach Burnout Inventory for Human Services. Secondary outcomes Self-reported medical errors, medical leave and turnover. Independent variables Sociodemographic characteristics, personality factors, psychological well-being, mindfulness factors, self-compassion and work environment factors. Descriptive statistics, linear and logistic regressions and regression analyses with cross-validation using least absolute shrinkage and selection operator (LASSO) tests were applied. Results Of the 23 481 registered physicians, 795 (3.4%) completed the survey. The sample included 64.1% women, with a mean age of 37.7 years (SD=11.3). The prevalence of burnout syndrome was 20.4% based on strict criteria and 68.9% based on lax criteria. Burnout scores predicted days of medical leave (ß=0.086, p<0.01), turnover (ß=0.012, p<0.05) and perceived medical errors (ß=0.009, p<0.001). In contrast, burnout was inversely correlated with age (ß=−0.125, p<0.001), agreeableness as a personality trait (ß=−0.107, p<0.001), psychological well-being (ß=−0.248, p<0.001) and the mindfulness factor awareness (ß=−0.145, p<0.001). In the work environment, time pressure (ß=0.167, p<0.001) was positively associated with burnout among others. Conclusion Younger physicians may be prioritised for individual-level interventions, while addressing time pressure at the organisational level could help prevent burnout. However, longitudinal studies are needed to clarify the directionality of relationships with psychological factors.
The challenges of establishing centers for the surgical management of epilepsy in low- and middle-income countries
(2025) Vidaurre, Jorge; Pérez, Juan; Campos, Manuel; Weisleder, Pedro
Epilepsy affects over 50 million individuals globally, with more than 80 % residing in resource-limited countries. While the majority of patients achieve seizure control with antiseizure medications, approximately one-third are diagnosed with drug-resistant epilepsy (DRE). For these individuals, epilepsy surgery represents a potentially effective therapeutic option. Expert consensus from the Surgical Therapies Commission of the International League Against Epilepsy (ILAE) recommends prompt referral for surgical evaluation upon diagnosis of DRE. Nevertheless, despite substantial supporting evidence, such referrals are frequently delayed-particularly in low- and middle-income countries (LMICs). This article examines the barriers to timely surgical evaluation and explores strategies to facilitate the development of epilepsy surgery programs in resource-constrained settings.
Quality management in imaging services
(2025) Ubeda, Carlos; Soffia, Pablo; Inzulza, Alonso; Khoury, Helen; Khoury, Viviane; Wunderlen, Kevin; Donoso, Sigrid; Pérez, María; Franco, María
In an imaging procedure with ionizing radiation, different elements are involved, and each possible failure in one of them can be associated with a detriment to its quality. The loss of quality has ethical and economic implications, which is why it must be managed intentionally. Therefore, it is recommended to establish a quality management system (QMS), which represents a standard framework for the administration that ensures correct execution and the desired results through compliance with a series of requirements on the different aspects or components of the service. To guarantee the success of a QMS, actions based on quality assurance (QA) and quality control (QC) must be established. When reviewing the Chilean regulations that regulate the use of ionizing radiation in medicine, we found that there is a deficiency in the concepts and applications in the requirements that refer to QMS, QA and QC. The purpose of this narrative review is to present an updated revision for health administrators and professionals on the rationale and purpose of a QMS, and QA and QC as its essential components, in imaging services. En un procedimiento imagenológico con radiaciones ionizantes intervienen diferentes elementos, y a cada posible fallo en alguno de ellos cabe asociar un detrimento en la calidad del mismo. La pérdida de calidad tiene implicancias éticas y económicas, razón por la cual esta debe ser gestionada con intencionalidad. Así, se recomienda establecer un sistema de gestión de la calidad (SGC), que representa un marco estándar para la administración que asegura la correcta ejecución y los resultados deseados mediante el cumplimiento de una serie de requisitos sobre los diferentes aspectos o componentes de la atención. Para garantizar el éxito de un SGC se deben establecer acciones sustentadas en la garantía de calidad (GC) y el control de calidad (CC). Al revisar la normativa chilena que regula el uso de las radiaciones ionizantes en medicina, constatamos que existe un vacío de conceptos y aplicaciones en los requerimientos que hacen referencia a SGC, GC y CC. La presente revisión narrativa tiene como propósito presentar una revisión actualizada para administradores y profesionales de la salud sobre la justificación y el propósito de un SGC, y de la GC y el CC como sus componentes esenciales, en los servicios de imagenología.
Microvascular resistance reserve in relation to total and vessel-specific atherosclerotic burden
(2025) Hoshino⁠, Masahiro; Jukema, Ruurt A.; Hoek, Roel; Dahdal, Jorge; Raijmakers, Pieter; Driessen, Roel; Bom, Michiel J.; Diemen, Pepijn van; Twisk, Jos; Danad, Ibrahim; Kakuta, Tsunekazu; Knuuti, Juhani; Knaapen, Paul
Aims The relationship between coronary artery atherosclerosis and microvascular resistance remains unclear. This study aims to clarify the relationship between total atherosclerotic and vessel-specific atherosclerotic burden and microvascular resistance reserve (MRR). Methods and results In this post hoc analysis of the PACIFIC 1 trial, symptomatic patients without prior coronary artery disease (CAD) underwent [15O]H2O positron emission tomography, coronary computed tomography angiography (CCTA), and invasive fractional flow reserve (FFR). MRR was assessed across all three coronary branches, utilizing PET-derived coronary flow reserve and invasive FFR measurements. CCTA was used to assess patient and vessel-specific plaque volumes. Percentage atheroma volume (PAV) was defined as total plaque volume divided by vessel volume. The study included 142 patients (55% male, 57.5 ± 8.6 years) with 426 vessels with a mean MRR of 3.77 ± 1.64. While a significantly higher PAV was observed in the left anterior descending artery territory, MRR was similar across the three coronary branches. Generalized estimating equations without correction for cardiovascular risk factors identified that patient-specific PAV tertiles but not vessel-specific PAV tertiles were related to vessel-specific MRR. After correction for cardiovascular risk factors, compared with the first tertile of patient-specific PAV, the second tertile showed a vessel-specific MRR decrease of β = −0.362, P = 0.018, and the third tertile showed a decrease of β = −0.347, P = 0.024. Conclusion In patients without prior CAD, patient-specific plaque burden was negatively associated to vessel-specific MRR; however, vessel-specific plaque burden was not related to vessel-specific MRR. Our findings suggest that the relation between atherosclerotic burden and an impaired microcirculatory function is of systemic origin.
Infiltración vaginal para el alivio del dolor neuropático post histeropexia sacroespinosa: primer reporte exitoso a mediano plazo
(2025) Vallejos, Gabriel; Velasco Galaz, María Trinidad; Castillo Villarroel, Natalia; Quiñones San Martin, Paula Andrea; Carstens Landreau, Catalina; Barria Candell, Marcelo
El prolapso genital femenino, especialmente el prolapso apical, afecta significativamente la salud y la calidad de vida de las mujeres. La histeropexia sacroespinosa es un procedimiento quirúrgico ampliamente utilizado para abordar esta condición, presentando escasas complicaciones postoperatorias. Sin embargo, una de las complicaciones reportadas es el dolor neuropático resultante del daño a las ramas del nervio pudendo. A pesar de la frecuencia de esta complicación, existen pocas alternativas de manejo estandarizadas. Este artículo presenta un caso clínico de una paciente de 62 años que experimentó dolor neuropático persistente después de una histeropexia sacroespinosa en quien los enfoques tradicionales como la terapia física y los medicamentos resultaron ineficaces. Por ello, se decidió realizar una infiltración de corticosteroides en los sitios dolorosos por vía vaginal con anestesia local. La paciente experimentó un alivio inmediato del dolor, el cual se mantuvo durante meses sin necesidad de repetir la infiltración. La literatura disponible es escasa en cuanto a la descripción del éxito a largo plazo de esta técnica terapéutica, por lo que este caso destaca la eficacia potencial a mediano plazo de esta alternativa en el manejo del dolor neuropático postoperatorio. Este caso contribuye a la creciente evidencia de que la infiltración de corticosteroides puede ser una opción viable para el tratamiento del dolor neuropático postoperatorio, ofreciendo una mejora en la calidad de vida de las pacientes afectadas. Si bien este caso muestra una primera aproximación exitosa, se necesita más investigación para validar y establecer la aplicabilidad de la infiltración vaginal de corticosteroides en casos similares.
CCTA-Derived coronary plaque burden offers enhanced prognostic value over CAC scoring in suspected CAD patients
(2025) Dahdal, Jorge; Jukema, Ruurt; Maaniitty, Teemu; Nurmohamed, Nick; Raijmakers, Pieter; Hoek, Roel; Driessen, Roel; Twisk, Jos; Bär, Sarah; Planken, Nils; Van Royen, Niels; Nijveldt, Robin; Bax, Jeroen; Saraste, Antti; Van Rosendael, Alexander; Knaapen, Paul; Knuuti, Juhani; Danad, Ibrahim
Aims: To assess the prognostic utility of coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA)-derived quantitative plaque metrics for predicting adverse cardiovascular outcomes. Methods and results: The study enrolled 2404 patients with suspected coronary artery disease (CAD) but without a prior history of CAD. All participants underwent CAC scoring and CCTA, with plaque metrics quantified using an artificial intelligence (AI)-based tool (Cleerly, Inc). Percent atheroma volume (PAV) and non-calcified plaque volume percentage (NCPV%), reflecting total plaque burden and the proportion of non-calcified plaque volume normalized to vessel volume, were evaluated. The primary endpoint was a composite of all-cause mortality and non-fatal myocardial infarction (MI). Cox proportional hazard models, adjusted for clinical risk factors and early revascularization, were employed for analysis. During a median follow-up of 7.0 years, 208 patients (8.7%) experienced the primary endpoint, including 73 cases of MI (3%). The model incorporating PAV demonstrated superior discriminatory power for the composite endpoint (AUC = 0.729) compared to CAC scoring (AUC = 0.706, P = 0.016). In MI prediction, PAV (AUC = 0.791) significantly outperformed CAC (AUC = 0.699, P < 0.001), with NCPV% showing the highest prognostic accuracy (AUC = 0.814, P < 0.001). Conclusion: AI-driven assessment of coronary plaque burden enhances prognostic accuracy for future adverse cardiovascular events, highlighting the critical role of comprehensive plaque characterization in refining risk stratification strategies.
Dementia-related primary care training needs: a qualitative study
(2025) Leon, Tomas; Troncoso, Deiza; Barria, Soledad; Kaczmarska, Magda; Lawlor, Brian; Slachevsky Chonchol, Andrea
Background: Mostguidelinesrecommendthatpeoplelivingwithdementiaandtheir carepartners shouldbemanaged inprimary care. However, theknowledgeand confidenceof theseteams inmanagingdementiais low,andtrainingprogramsare lacking. Objective Toidentifythetrainingneedsofprimarycareteamsbyintegratinginsights fromtheseprofessionals,aswellasdementiapatientsandtheircarepartners. Methods: Qualitativeresearchmethodswereapplied,usingfocusgroupinterviews withhealthprofessionalsandindividual interviewswithpeoplelivingwithdementia andtheircarepartners.Adirectqualitativeanalysisof15recordedinterviews(3focus groupsand12individuals)wasperformedusingthetranscribeddata. Results: Primarycareprofessionalsrecognizetheimportanceofcontinuouseducationondementia andexpressed theneed formoreknowledgeabout diagnosis, symptommanagement, and interpersonal andcommunicationskills.Carepartners anddementiapatientshighlightedtheneedforabetterdiagnosticdisclosureprocess, improvedcontinuityofcare,andavailabilityofgreaterpostdiagnosissupport. Conclusion: Ourstudy,novel inLatinAmerica,stronglysupportedtheneedformore trainingindementiaforprimarycareprofessionals,aswellasforadditionalcontentand informationnotusuallyincludedinstandarddementiaeducation.
Conventional Radiotherapy Timing and Wound Complication Avoidance After Surgery for Metastatic Spine Disease. A LatAm Modified Delphi Study
(2025) Landriel, Federico; White, Kevin; Padilla Lichtenberger, Fernando; Guiroy, Alfredo; Teles, Alisson; Laos Plasier, Eduardo; Buzetti Milano, Jerônimo; Risso, Marcelo; Astur, Nelson; González, Oscar; Yurac, Ratko; Páez, Rodolfo; Teixeira, William; Toscano, Maximiliano; Hem, Santiago
Background Combining surgery and radiotherapy is the gold standard in treating spinal metastasis when spinal stabilization or surgical decompression is required. Determining the optimal timing for radiotherapy postsurgery is crucial to balance treatment efficacy minimizing wound complications. The study aimed to identify consensus and nonconsensus areas among Latin American spinal surgeons regarding the use, timing, risks, and surgical approach to conventional external beam radiotherapy (cEBRT) following spinal surgery for metastases, specifically focusing on the risk of radiotherapy-related wound complications. Methods A modified Delphi survey was conducted. The expert panel included active members of AOSpine Latin America with extensive experience in vertebral metastasis surgery. The surveys include 37 statements covering areas of interest. Inter-expert consensus was considered weak (70-79.9%), moderate (80-89.9%), and strong (≥90%). Results At least 70% consensus was reached on 32 of the 37 statements (86.5%). This included strong consensus on 10 statements, moderate on 13, and weaker on nine. There was high consensus on sutures and lower consensus on risk factors for cEBRT delay. Experts reached strong agreement on the importance of poor nutrition as a risk factor for cEBRT-related wound complications. Perception of wound risk was greater with a posterior midline approach compared to other approaches, and the highest perceived complication risks were for junctional locations and sacral spine. Conclusions We report strong agreements among the experts on important issues such as waiting times and risk factors for cEBRT. The findings underscore the significance of considering factors such as, spinal levels, surgical approaches, and sutures when making clinical decisions.
Premorbid school performance trajectories in patients with treatment-resistant schizophrenia prescribed clozapine in the public health system in Chile: a case-control study, 2007-2020
(2025) Conejeros, Jose; Vasquez, Javiera; Diaz, Camila; Mena, Cristian; Undurraga, Juan; Gonzalez, Alfonso; Claro, Susana; Undurraga, Eduardo; Crossley, Nicolas
Background: The premorbid phase of treatment-resistant schizophrenia (TRS) may reveal underlying mechanisms and inform early interventions. According to the neurodevelopmental hypothesis, treatment resistance may be linked to pronounced developmental impairments. We examined school grades and attendance trajectories in children who later developed TRS. Methods: This case-control study analyzed school grade point average and attendance among all individuals born after 1990 and started on clozapine in Chile's public health system as a proxy for TRS. Control groups included children later diagnosed with treatment-responsive schizophrenia, bipolar disorder, and unaffected classmates. Linear mixed models accounted for individual and school-level confounders. Results: We included 1072 children (9929 observations, 29.3% female) subsequently diagnosed with TRS, 323 (2802 observations, 25.7% female) with schizophrenia, 175 (1784 observations, 53.8% female) bipolar disorder, and 273,260 (533,335 observations, 47% female) unaffected classmates. Children who later developed TRS had worse grades across levels than their classmates (-0.26 SD [-0.2, -0.4]), but not treatment-responsive schizophrenia. All severe mental illness groups showed grade declines in later school levels, with TRS showing steeper linear decline than treatment-responsive schizophrenia (group×age of -0.03; 95%CI -0.04, -0.01) and steeper quadratic decline than bipolar disorder (group×age2 of -0.005; -0.01, -0.001). Attendance declined over time in the two groups developing schizophrenia compared to their classmates. Those developing TRS experienced the sharpest drop (group×age compared to schizophrenia -0.03; -0.05, -0.01 and bipolar disorder -0.027; -0.049, -0.006). Conclusions: TRS may stem from a more aggressive pathological process or pronounced late-maturation abnormality, rather than an early premorbid impairment, suggesting an intervention target
Renal angiomyolipomas: Typical and atypical features on computed tomography and magnetic resonance imaging
(2025) Labra, Andrés; Schiappacasse, Giancarlo; Constenla, Diego; Cristi, Joaquin
Angiomyolipomas (AMLs) represent the most common benign solid renal tumors. The frequency of their detection in the general population is increasing owing to advances in imaging technology. The objective of this review is to discuss computed tomography (CT) and magnetic resonance imaging findings for both typical and atypical renal AMLs, along with their associated complications. AMLs are typically defined as solid triphasic tumors composed of varying amounts of dysmorphic and tortuous blood vessels, smooth muscle components and adipose tissue. In an adult, a classical renal AML appears as a solid, heterogeneous renal cortical mass with macroscopic fat. However, up to 5% of AMLs contain minimal fat and cannot be reliably diagnosed by imaging. Fat-poor AMLs can appear as hyperattenuating masses on unenhanced CT and as hypointense masses on T2WI; other AMLs may be isodense or exhibit cystic components. Hemorrhage is the most common complication, and AMLs with hemorrhage can mimic other tumors, making their diagnosis challenging. Understanding the variable and heterogeneous nature of this neoplasm to correctly classify renal AMLs and to avoid misdiagnosis of other renal lesions is crucial.
Individualized evaluation of the total dose received by radiotherapy patients: Integrating in-field, out-of-field, and imaging doses
(2025) Romero-Expósito, Maite; Sánchez-Nieto, Beatriz; Riveira-Martin, Mercedes; Azizi, Mona; Gkavonatsiou, Angeliki; Muñoz, Isidora; López-Martínez , Ignacio N.; Espinoza, Ignacio; Zelada, Gabriel; Cordova-Bernhardt, Andrés; Norrlid, Ola; Goldkuhl, Christina; Molin, Daniel; Mosquera-Pena Sánchez, Francisco; López-Medina, Antonio; Toma-Dasu, Iuliana; Dasu, Alexandru
Purpose: To propose a methodology for integrating the out-of-field and imaging doses to the in-field dose received by radiotherapy (RT) patients. In addition, the impact of considering the total dose in planning and radiation- induced second malignancies (RISM) risk assessment will be evaluated in several scenarios comprising photon and proton treatments. Methods: The total dose is the voxel-wise sum of the doses from the different radiation sources (accounting for the radiobiological effectiveness) produced during the whole RT chain. The dose from the plan and imaging procedures were obtained by measurements for a photon prostate treatment and by calculation (combining treatment planning system, analytical models, and Monte Carlo simulations) for two lymphoma treatments, one using photons and the other, protons. Dose distributions, dose volume histograms (DVHs) metrics, mean organ doses, and RISM risks were evaluated for each radiation exposure in each treatment. Results: In general, the contribution of the imaging doses is low compared to the dose administered during RT treatment, being higher in proton therapy. However, for some organs, for instance testes in the prostate case, the maging dose becomes higher than the scattered dose from the treatment fields. Plan evaluations revealed shifts in cumulative DVHs with the inclusion of out-of-field and imaging doses, though minimal clinical impact is expected. Risk assessment showed increased estimates with total dose. Conclusions: The methodology enables accounting for the total dose for optimization of plans and imaging protocols, prospective risk predictions and retrospective epidemiological analyses.
Homogeneity of the coronary microcirculation in angina with non-obstructive coronary artery disease
(2025) Hoshino, Masahiro; Hoek, Roel; Jukema, Ruurt; Dahdal, Jorge; Van Diemen, Pepijn; Raijmakers, Pieter; Driessen, Roel; Twisk, Jos; Danad, Ibrahim; Kakuta, Tsunekazu; Knuuti, Juhani; Knaapen, Paul
Aims: The homogeneity of coronary microvascular dysfunction (CMD) across different myocardial territories in angina with non-obstructive coronary artery disease (ANOCA) patients is scarcely explored. This study investigates the variability in microvascular resistance reserve (MRR) across the 3 main perfusion territories of the coronary circulation to investigate the homogeneity or dishomogeneity of microcirculatory function. Methods and results: This post hoc analysis of the PACIFIC trials included symptomatic ANOCA patients with [15O]H2O positron emission tomography (PET) and three-vessel invasive fractional flow reserve (FFR). MRR was computed in the three main coronary branches by integrating PET-derived coronary flow reserve and invasive FFR. A total of 155 patients (50% male, age 59 ± 10 years) and 465 vessels (MRR: 3.92 ± 1.21) were included. There were no significant differences in MRR among the three coronary branches. Correlations in MRR among the three coronary branches were good (r = 0.76 to 0.86). The mean difference between MRR measurements in different arteries was small (2.4 to 7.5%), without any consistent directional bias. The overall intra-class correlation coefficient for absolute agreement was 0.80 (95% CI: 0.74-0.85), indicating good single-measure reliability. Approximately 80% (123/155) of patients showed diagnostic concordance of CMD (MRR ≤3.0) across the three vessels. Conclusion: In most ANOCA patients, microvascular function is homogeneously distributed across the three major coronary territories. Single-artery testing may suffice in many cases, aligning with guidelines. However, some patients exhibit notable inter-territorial variation, suggesting that multi-vessel evaluation may be prudent in borderline scenarios.
Fish Oil Supplementation Attenuates Offspring's Neurodevelopmental Changes Induced by a Maternal High-Fat Diet in a Rat Model
(2025) Muñoz, Yasna; Kaune, Heidy; Dagnino, Alexies; Cruz, Gonzalo; Toledo, Jorge; Valenzuela, Rodrigo; Moraga, Renato; Tabilo, Luis; Flores, Cristian; Muñoz, Alfredo; Crisosto, Nicolás; Montiel, Juan; Maliqueo, Manuel
Background/Objectives: A maternal high-fat diet (HFD) impairs brain structure in offspring. In turn, fish oil (FO) rich in n-3 polyunsaturated fatty acids (PUFAs) has neuroprotective effects. Therefore, we investigated whether maternal HFD exposure affected the neurological reflexes, neuron morphology, and n-3 PUFA levels in the cerebral cortex of the offspring and whether these effects were mitigated by maternal FO consumption. Methods: Female Sprague Dawley rats received a control diet (CD, 10% Kcal fat) or HFD (45% Kcal fat) five weeks before mating and throughout pregnancy and lactation. From mating, a subgroup of HFD was supplemented with 11.4% FO into the diet (HFD-FO). Neurological reflexes were evaluated from postnatal day (PND) 3 until PND20. Brains were removed at PND22 for neuron morphology analysis. Moreover, fatty acid composition and transcripts of genes encoding for factors associated with synapse transmission (SNAP-25), plasticity (BDNF), transport of DHA (MFSD2a), and inflammation (NF-κB and IL-1β) were quantified in prefrontal, motor, and auditory cortices. Results: FO diminished the effects of HFD on the number of thin and mushroom-shaped dendritic spines in the cerebral cortex in both sexes. It also reversed the HFD effects on the motor and auditory reflexes in female and male offspring, respectively. In males, FO up-regulated Bdnf transcript levels in the motor cortex compared with CD and HFD. In females, n-3 PUFAs were higher in HFD and HFD-FO than in CD in the auditory cortex. Conclusions: Our results highlight the protective role of maternal dietary n-3 PUFAs in counteracting the effects induced by HFD on the acquisition of neurological reflexes and neuronal morphology in the cerebral cortex of the offspring of both sexes.
Salmonella enterica Serovar Abony Outbreak Caused by Clone of Reference Strain WDCM 00029, Chile, 2024
(2025) Piña-Iturbe, Alejandro; Fredes-García, Diego; García, Patricia; Porte, Lorena; Johnson, Timothy J.; Singer, Randall S.; Toro, Magaly; Munita, José; Moreno-Switt, Andrea I.
A Salmonella enterica serovar Abony outbreak occurred during January–April 2024 in Chile. Genomic evidence indicated that the outbreak strain was a clone of reference strain WDCM 00029, which is routinely used in microbiological quality control tests. When rare or unreported serovars cause human infections, clinicians and health authorities should request strain characterization.
Acute skeletal muscle wasting in patients with acute kidney injury requiring continuous kidney replacement therapy: A prospective multicenter study
(2026) Mayer, Kirby; Teixeira, Pedro; González Seguel, Felipe; Tran, Vinh; Gross, Jessica; Horikawa, Arimitsu; Anil, Chaitanya; Shareef, Zan; Puffer, Hayley; Wen, Yuan; Griffin, Benjamin; Neyra, Javier
Purpose: Acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) has been hypothesized to increase the risk of developing intensive care unit-associated weakness (ICU-AW), but prospective data are lacking. Materials and methods: This prospective observational study evaluated critically ill adults with AKI requiring CKRT at two U.S. academic hospitals. Using ultrasonography (US), we quantified changes in rectus femoris (RF) muscle mass and quality in the first week after CKRT initiation. At hospital discharge, we assessed for ICU-AW, physical function, and frailty. Results: Twenty-three patients with median age 56 [IQR 47-60] years, BMI 29 [26-36] kg/m2, and Charlson Comorbidity Index 3 [1.5-5] were enrolled. The baseline Sequential Organ Failure Assessment (SOFA) score was 9 [7.5-11.5] and CKRT duration was 4 [1-7] days. Six (26 %) patients died in the ICU and one (4 %) transitioned to comfort measures before study completion. Substantial muscle wasting occurred between Day 1 and Day 7: RF muscle thickness (mT) decreased by 10 % [3 %-20 %]; RF cross-sectional area (CSA) decreased by 19 % [12 %-22 %]; and echo intensity (EI) increased (implying worse muscle quality) by 14 % [5 %-25 %]. A significant effect of time within subjects was observed for all three ultrasound measures (CSA: F = 66.2, p < 0.001; mT: F = 27.1, p < 0.001; EI: F = 22.5, p < 0.001). At hospital discharge, 67 % of survivors (n = 10/15) met criteria for ICU-AW. Conclusions: Patients with AKI requiring CKRT experienced significant muscle wasting in the first week following CKRT initiation and had high rate of ICU-AW at hospital discharge. Trial registration: NCT05287204, Registered 20 October 2021.
Impact of myocardial scar burden on microvascular resistance reserve in patients with coronary artery disease
(2026) Hoshino, Masahiro; Hoek, Roel; Jukema, Ruurt; Dahdal, Jorge; Van Diemen, Pepijn; Hopman, Luuk; Raijmakers, Pieter; Driessen, Roel; Twisk , Jos; Danad, Ibrahim; Kakuta, Tsunekazu; Knuuti, Juhani; Knaapen, Paul
Purpose: The impact of myocardial scar on coronary microcirculation is not well understood. This study aims to evaluate the association between microvascular resistance reserve (MRR) and scar tissue. Methods: In this post-hoc analysis of the PACIFIC 2 trial, symptomatic patients with prior myocardial infarction (MI) and/or percutaneous coronary intervention (PCI) underwent [15O]H2O positron emission tomography (PET), cardiac magnetic resonance (CMR) imaging, and fractional flow reserve (FFR). MRR was assessed utilizing PET-derived coronary flow reserve and FFR measurements. Scar quantification was assessed by CMR late gadolinium enhancement (LGE). Vessel LGE burden was defined as the scar tissue proportion in each myocardial territory. Total LGE burden was defined as the proportion of overall scar. Results: The study included 154 patients with 397 vessels with a mean MRR of 3.56 ± 1.24. Patients with any scar tissues (LGE > 0%) exhibited a lower MRR in every myocardial territory than those without scar tissues. After adjusting for cardiovascular risk factors, either vessel LGE burden (β =-0.013, P = 0.006) or total LGE burden (β =-0.039, P = 0.002) independently predicted a reduced MRR. Compared to myocardial territories without scar tissues (LGE burdens = 0%), MRR was significantly lower in myocardial territories with vessel LGE burden = 0% + total LGE burden > 0%, and in myocardial territories with both LGE burdens > 0%. Conclusion: Scar burden was negatively associated with MRR in patients with prior MI and/or PCI. Our findings indicate that both the proportion of myocardial scar in the vascular territory and the overall myocardial scar affect the microcirculation of individual vascular territories. Clinical trial number: Not applicable
Clinical neurophysiology for tremor: Common questions in clinical practice
(2025) Schwingenschuh, Petra; Van der Stouwe, Madelein; Pandey, Sanjay; Hirschbichler, Stephanie; Panyakaew, Pattamon; Kojovic, Maja; Mukherjee, Adreesh; Tijssen, Marina AJ.; Merchant, Shabbir Hussain I.; Vial Undurraga, Felipe; MDS Clinical neurophysiology Study group
Background A thorough history and physical examination may be insufficient for comprehensively studying patients with tremor. In such instances, neurophysiology serves as an adjunct to the physical examination. Objectives Our aim is to present compelling evidence supporting the utilization of neurophysiological studies in various tremor conditions. Methods A panel of global experts, convened by the Study Group on Clinical Neurophysiology for Movement Disorders, examined the application and utility of neurophysiology across diverse movement disorders. Results This manuscript provides a detailed methodology for electrophysiological studies in tremors helping to differentiate them from myoclonus, comparing tremor in parkinson vs atypical parkinsonisms, describing dystonic tremor, describing the differences between Parkinson and essential tremor and the characteristics of functional tremor. Conclusions Neurophysiological studies play a crucial role in characterizing tremor syndromes and aiding in their differentiation from other hyperkinetic movement disorders.

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