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Epidermal growth factor receptor 2 (HER2) is the second target molecule most commonly used in breast cancer treatment. Both recurrence and metastasis are still deadly for HER2+ breast cancer patients. Hydrogels can be an option for developing three-dimensional (3D) cell culture systems that resemble tumor features better than monolayer cultures and could be used for preclinical screening for new biotherapeutics. Biopolymers (gelatin and alginate) were used to develop a hydrogel capable of encapsulating living HER2+ breast cancer cells BT-474/GFP. The hydrogel was physicochemically characterized, and the viability of embedded cells was evaluated. The hydrogel developed had suitable physical properties, with swelling of 38% of its original mass at 20 h capacity and pore sizes between 20 and 125 µm that allowed cells to maintain their morphology in a 3D environment, in addition to being biocompatible and preserving 90% of cell viability at 10 days. Furthermore, encapsulated BT-474/GFP cells maintained HER2 expression that could be detected by the Trastuzumab-fluorescent antibody, so this hydrogel could be used to evaluate new HER2-targeted therapies.

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La resección quirúrgica con márgenes negativos de las metástasis hepáticas de cáncer colorectal, representa la única opción de tratamiento con potencial curativo, sin embargo, el 85% de estos pacientes son considerados irresecables a la evaluación inicial, ya sea por número, tamaño y localización de las metástasis o por un remanente hepático futuro insuficiente. ALPPS es una técnica quirúrgica compleja, que permite en dos tiempos operatorios, la resección de extensas porciones de parénquima hepático tras un periodo de incremento volumétrico del remanente, que alcanza el 80% en un periodo de 9 días, lo que supera ampliamente a otras técnicas como la embolización/ligadura portal preoperatoria. Pese a cuestionamientos iniciales relativos a la morbimortalidad asociada, la significativa ganancia de masa hepatocelular lograda con ALPPS, ha permitido el tratamiento exitoso de pacientes con alta carga tumoral metastásica hepática, tensionando principios fundamentales clásicamente considerados para la realización de hepatectomías mayores en forma segura. El objetivo de este trabajo es presentar la experiencia inicial con la aplicación de la técnica de ALPPS llevado al extremo de dejar un remanente hepático constituido por un único segmento.

R0 resection of colorectal liver metastases is the main curative treatment option; however, 85% of patients are considered initially unresectable, either due to number, size and location of metastases or insufficient future liver remnant. ALPPS is a complex surgical technique, which allows, in two operative times, the resection of extensive portions of liver parenchyma after a period of volumetric remnant increase, which reaches 80% in 9 days, far exceeding other techniques as well as preoperative portal embolization / ligation. Despite initial doubts regarding the associated morbidity and mortality, the significant gain in hepatocellular mass achieved with ALPPS has allowed the successful treatment of patients with high hepatic metastatic tumor burden, questioning fundamental principles classically considered for safely performing major hepatectomies. The aim of this article is to show the initial experience with the ALPPS technique application taken to the extreme of leaving a liver remnant made up of a single segment.

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Introducción: La pandemia por COVID-19 obligó a los gobiernos a implementar medidas de restricción social para proteger la salud de la población, afectando la calidad de vida de las personas, especialmente en grupos vulnerables como los niños, niñas y adolescentes (NNA). El objetivo de esta revisión sistemática (RS) fue evaluar el efecto de las medidas de restricción sobre la actividad física (AF) y conducta sedentaria (CS) de los NNA. Adicionalmente, se exploraron posibles factores determinantes de estos cambios. Métodos: Se realizó una RS, utilizando tres bases de datos. Se incluyeron estudios observacionales en donde se hubiera analizado la AF y CS de los participantes, utilizando cualquier método de evaluación. Dos investigadores analizaron los estudios, extrajeron los datos y evaluaron la calidad metodológica de los artículos primarios. El metaanálisis se realizó utilizando el modelo de efectos aleatorios, considerando un valor p < 0,05 como estadísticamente significativo. Resultados: Se incluyeron 19 artículos, con una muestra total de 15.095 NNA. La mayoría de los estudios reveló una reducción de la AF y un incremento de la CS en los sujetos, durante los confinamientos por COVID-19. El metaanálisis mostró una caída en la AF total, la AF moderada a vigorosa y un incremento del tiempo de sedentarismo. Diversos factores biodemográficos, familiares y ambientales exacerbaron las variaciones en la AF y la CS de los NNA. Conclusión: Las medidas de restricción aplicadas durante pandemia por COVID-19 redujo la AF e incrementó la CS de los NNA. Factores biodemográficos, familiares y ambientales determinaron estas variaciones.

Introduction: The COVID-19 pandemic forced governments to implement social restriction measures to protect the health of the population, affecting the quality of life of people, especially in vulnerable groups, such as children and adolescents (CA). The objective of this systematic review (SR) was to evaluate the effect of restriction measures on physical activity (PA) and sedentary behavior (SB) of CA. Additionally, possible determining factors of these changes were explored. Methods: An SR was carried out, using three databases. Observational studies were included in which the PA and SB of the participants were analyzed, using any evaluation method. Two investigators analyzed the studies, extracted data, and assessed the methodological quality of the primary articles. The meta-analysis was performed using the random effects model, considering a value of p < 0.05 as statistically significant. Results: 19 articles were included, with a total sample of 15,095 subjects. Most studies revealed a reduction in PA and an increase in SB in subjects during COVID-19 lockdowns. The meta-analysis showed a drop in total PA, moderate to vigorous PA, and an increase in sedentary time. Various biodemographic, family and environmental factors exacerbated the variations in the PA and SB of the CA. Conclusion: The restriction measures applied during the COVID-19 pandemic reduced the PA and increased the SB of the CA. Biodemographic, family and environmental factors determined these variations.

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Baseline data on concentration, fractionation, pollution level and ecological risk index for seventeen beach sediments from Santa Rosalia mining region of Baja California Sur, Mexico were assessed. Higher concentrations of Rare Earth Elements (REEs) (mean. 341.49 µg/g) indicated that it is higher than most of the mining regions around the world. Normalization pattern showed enrichment of Eu (>4) and calculated geochemical indices revealed that light and middle REEs are moderately polluted with most of the sampling points located closer to the river discharge. Potential Ecological Risk Index (PERI) showed that Eu (20.2), Tb (20.88), and Lu (28.57) pose moderate ecological risk to the soil at selected stations (10, 11, 15 and 16) with a risk index value ranging from 245 to 359. Pearson's correlation matrix suggested that all REEs are highly correlated (r2 0.95) with each other having similar geochemical characteristics and indicating identical source due to continuous mining activity.

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Resumen La acalasia es un trastorno motor primario de la musculatura lisa esofágica que se caracteriza por disfagia, pseudorregurgitación y baja de peso. El tratamiento puede ser endoscópico o quirúrgico. Sólo se conocen los resultados a largo plazo de la cirugía, mientras que los endoscópicos tienen aún un seguimiento muy corto y no permiten sacar conclusiones valederas. La acalasia es una lesión que tiene una probabilidad significativamente mayor de desarrollar un cáncer esofágico, ya sea de tipo epidermoide, por inflamación crónica y retención de comida en el esófago, o un adenocarcinoma, secundario a reflujo gastroesofágico, que aparece posterior a cualquier tratamiento. Las publicaciones muestran que alrededor de 3% a 4% de los pacientes presentan a largo plazo, sobre 10 a 15 años postratamiento, el desarrollo de un cáncer avanzado del esófago. Se concluye que es indispensable un seguimiento clínico y endoscópico en forma rutinaria a estos pacientes.

Achalasia is a primary motor disorder of the esophageal smooth muscle characterized by dysphagia, pseudoregurgitation, and weight loss. Treatment can be endoscopic or surgical. The long-term results are only known from surgery, while endoscopic results still have a very short follow-up and do not allow us to draw valid conclusions. Achalasia is a lesión that has a significantly higher probability of developing esophageal cancer, whether of the epidermoid type, due to chronic inflammation and food retention in the esophagus, or an adenocarcinoma, secondary to gastroesophageal reflux, which appears after any treatment. Publications show that about 3 to 4% of patients present in time, about 10 to 15 years after treatment, the development of advanced cancer of the esophagus. It is concluded that clinical and endoscopic follow-up is essential in these patients on a routine basis.

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INTRODUCTION: Painful pronation (PD), also known as "nursemaid's elbow", is a common injury caused by abrupt longitudinal traction of the hand while the forearm is pronated and the elbow extended. OBJECTIVE: to describe a sample of patients diagnosed with painful pronation and the different reduction tech niques used for this pathology. PATIENTS AND METHOD: retrospective study of patients who visited the emergency department of a referral hospital, from January 2018 to September 2019. Patients under 7 years of age consulting due to a condition compatible with PD were included. We recorded demogra phic data, sex, and age, number of previous episodes (defining recurrent as three or more episodes), affected extremity, mechanism of injury, diagnostic images, reduction maneuver used, and success obtained measured through the presence of "click" and decrease in pain. Patients who presented any sign of trauma or fractures were excluded from the study. RESULTS: 172 patients were included, 57.6% were female, and a median age of 25.5 months. The most affected side was the left one and the main mechanism was traction of the extremity, followed by a same-level fall. The hyperpronation method was effective in 66% of the cases, and the remaining 34% required a supination maneuver. CONCLUSIONS: PD is a frequent reason for consultation in pediatric patients around the age of 2 years. The hyperpronation method was the most commonly used for its management. It is important to be aware of this pathology in the context of emergency care.

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Resumen Introducción: La hernia hiatal (HH) de tipo I por deslizamiento es el tipo más frecuente, siendo difícil de definir objetivamente, por lo que el principal foco de controversia es su diagnóstico. El objetivo del presente trabajo es reportar los resultados respecto de la precisión diagnóstica del estudio preoperatorio y confirmarlo con el diagnóstico laparoscópico de este tipo de HH. Materiales y Método: Estudio prospectivo descriptivo de serie que incluyen pacientes con síntomas típicos de enfermedad por reflujo gastroesofágico, los cuales se sometieron a estudio con esófago-gastro-duodenoscopía, estudio manométrico y radiológico de esófago, estómago y duodeno con bario. Se incluyen sólo los pacientes en los cuales la endoscopía revela la existencia de HH por deslizamiento ≪ 5 cm. Estos pacientes se sometieron a tratamiento quirúrgico confirmándose o no la existencia de HH al momento de la exploración laparoscópica. Resultados: El valor predictivo positivo y sensibilidad para manometría fue de un 51,2% y 70%, para la radiología 91,7% y 80,5% y para endoscopia 80,3% y 70,7% respectivamente. Conclusión: Para el diagnóstico confiable de HH antes del tratamiento, las tres investigaciones mencionadas deben ser obligatorias antes de la cirugía.

Introduction: Being type I hiatal hernia (HH) the most frequent, is difficult to define objectively and therefore, the main focus of controversy is the diagnosis. The aim of this paper is to report the results regarding the diagnostic accuracy of the preoperative study and to confirm it with the laparoscopic diagnosis of hiatal hernia. Materials and Method: This descriptive and prospective study includes patients with typical symptoms of gastroesophageal reflux disease who underwent esophageal-gastro-duodenoscopy, manometry and radiological study of esophagus with barium swallow. Only patients in whom endoscopy reveals the existence of HH by sliding ≪ 5 cm are included. These patients underwent surgical treatment confirming or not the existence of HH at the time of laparoscopic exploration. Results: The positive pre- dictive value and sensibility for manometry was 51.2% and 70%, for radiology 91.7% and 80.5%, and for endoscopy 85.3% and 70.7% respectively. Conclusion: For the reliable diagnosis of HH before treatment, the three mentioned investigations must be mandatory before the surgery.

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INTRODUCCIÓN: Las infecciones osteoarticulares agudas pediátricas constituyen patologías poco frecuentes, siendo de suma importancia realizar un diagnóstico precoz y tratamiento adecuado para evitar las compli caciones agudas o a largo plazo. El absceso de Brodie (AB) es una forma de osteomielitis subaguda de baja incidencia y de difícil diagnóstico, por lo que es imprescindible la sospecha clínica. OBJETIVO: Presentar un caso de AB y describir las características etiológicas y clínicas de esta patología. CASO CLÍNICO: Paciente 14 años, evaluado por dolor de muslo derecho de un mes de evolución, afebril y sin antecedente de trauma. Al examen físico no presentaba aumento de volumen, el rango de movimiento (ROM) de cadera derecha era doloroso y la sensibilidad estaba aumentada a la palpación su perficial de banda iliotibial (BIT) derecha. Estudio radiológico sin alteraciones. Por persistir síntomas se solicitó ecografía de muslo que mostró irregularidad ósea cortical. Resonancia Magnética (RM) evidenció lesión en diáfisis de fémur derecho de probable origen tumoral o infeccioso. Parámetros inflamatorios sin alteraciones. Se realizó toma de biopsia y cultivos, aislando Staphylococcus aureus multisensible. Se procedió a aseo quirúrgico y terapia antibiótica endovenosa, evolucionando favo rablemente. CONCLUSIONES: La presentación clínica y laboratorio en AB pueden ser inespecíficas. El clínico no especialista debe tener un alto índice de sospecha de esta patología como posible diagnós tico diferencial en pacientes que persisten con dolor y presentan una alteración radiológica, incluso ante la ausencia de otros síntomas y parámetros inflamatorios normales. Es importante realizar una biopsia ósea para el diagnóstico diferencial de patologías tumorales.

INTRODUCTION: Acute osteoarticular infections in children are rare pathologies, therefore early diagnosis and prompt treatment are crucial to avoid acute and long-term complications. Brodie's abscess (BA) is an un common type of subacute osteomyelitis, difficult to diagnose, so clinical suspicion is essential. OBJECTIVE: To describe a case of Brodie's abscess and its etiological and clinical features. CLINICAL CASE: A 14-year-old patient was seen at our clinic, who reported a one-month pain in the right thigh, with no history of fever or trauma. Physical examination revealed no volume increase, painful right hip range of motion, and increased sensitivity on superficial palpation of the right iliotibial band. X-rays where normal. Because of the pain persistence, an ultrasound was requested which showed a cortical irregularity. Magnetic resonance imaging (MRI) was performed and revealed a right femoral diaphysis, due to a possible bone tumor or an infectious process. Lab tests were normal. Biopsy and cultures were collected, identifying multi-sensitive Staphylococcus aureus. He was managed with debridement and intravenous antibiotics, responding positively. CONCLUSIONS: The BA's clinical features and lab tests are unspecific, therefore the non-specialist physician should strongly suspect this pathology as a possible differential diagnosis in patients who persist with pain and present imaging alterations, even when there are no other symptoms or normal inflammatory parameters. A bone biopsy is essential for the differential diagnosis of tumor pathologies.

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INTRODUCCIÓN: El tabaquismo es una de las pandemias que afecta en mayor proporción a la población mundial. Una de las medidas para controlarlo es la aplicación de consejerías de cesación tabáquica (CCT). OBJETIVO: Determinar y evaluar la técnica de CCT más empleada por profesionales de APS de Peñalolén. METODOLOGÍA: Estudio observacional de corte transversal basado en encuesta y simulación clínica en atención primaria de salud. RESULTADOS: De los 39 participantes, un 55,3% declaró utilizar la consejería breve como CCT y un 42,1% indicó no utilizar ninguna técnica específica. De los 13 profesionales que participaron de la simulación clínica, el 50% incluyó 5 o menos de un total de 7 aspectos claves durante la realización de la consejería breve. CONCLUSIONES: La estrategia de CCT más utilizada por los encuestados es la consejería breve, aunque no siempre se consideran todos los aspectos claves cuando se realiza.

INTRODUCTION: Smoking is one of the pandemics that affects the world's population in a large proportion. One of the measures to control it is the application of smoking cessation counselling (SCC). OBJECTIVE: To determine and evaluate the SCC technique most used by primary health care professionals in Peñalolén a commune of Santiago, Chile. METHODOLOGY: Cross-sectional observational study based on survey and clinical simulation in primary health care professionals. RESULTS: Of the 39 participant professionals, 55.3% declared using brief counselling as SCC and 42.1% indicated they did not use any specific technique. Of the 13 professionals who participated in the clinical simulation, 50% included 5 or less of a total of 7 key aspects during the brief counselling. CONCLUSIONS: Brief smoking cessation counselling is the most used tobacco cessation counselling strategy by the professionals surveyed. Although not all key aspects are always considered when it is done.

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INTRODUCTION AND AIMS: Helicobacter pylori (H. pylori) is associated with a higher risk of peptic ulcer and gastric cancer. The sole presence of the bacterium is not a determinant of clinical outcome, but rather the interaction of strain type and host factors determines the risk of disease. Our aim was to study the association between bacterial load, strain type, and gastric symptoms in H. pylori-positive subjects. MATERIALS AND METHODS: In a community survey, a diagnostic 13C-urea breath test for H. pylori was performed on 302 volunteers that were not taking antibiotics, antacids, or proton pump inhibitors one month prior to the test. The breath test produced 25 H. pylori-positive subjects, between 25-74 years of age, who then took a gastric symptoms survey and were tested for the presence of the cagA genotype in gastric juice, using the Entero-test®. Bacterial load was determined as a measure of urease activity, utilizing the delta over baseline value, obtained in the 13C-urea breath test. RESULTS: A total of 48% of the H. pylori-positive subjects were cagA+. A positive association was found between cagA status and high gastric urease activity (P<.0001) and the latter was significantly associated with the presence of symptoms (P<.0001). CONCLUSION: Gastric urease activity was strongly associated with dyspeptic symptoms and cagA+ H. pylori. Elevated 13C-delta over baseline values could be used as indicators of a higher risk for gastric disease.

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