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INTRODUCTION: Patient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems. OBJECTIVE: To identify the quality of care in the Urology outpatient department of a third-level hospital. MATERIALS AND METHODS: The NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico. RESULTS: According to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2h in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11-20min in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good. CONCLUSIONS: The use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.

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Methods: We analyzed the secretion of cytokines, chemokines, and growth factors in 22Rv1, LNCaP, and DU145 cells. In these cells, we also evaluated the expression of NK ligands, IL6R, STAT-3, and phosporylated STAT-3. In NK-92 cells, we evaluated the effects of Stattic (Stt) and tocilizumab (Tcz) on NK receptors. In addition, we assessed if the disruption of the IL6R/STAT-3 pathway and blockade of TIGIT potentiated the cytotoxicity of NK-92 cells versus DU145 cells. Results: DU145 abundantly secretes M-CSF, VEGF, IL-6, CXCL8, and TGF-ß. Furthermore, the expression of CD155 was found to increase in accordance with aggressiveness and metastatic status in the prostate cancer cells. Stt and Tcz induce a decrease in STAT-3 phosphorylation in the DU145 cells and, in turn, induce an increase of NKp46 and a decrease of TIGIT expression in NK-92 cells. Finally, the disruption of the IL6R/STAT-3 axis in prostate cancer cells and the blocking of TIGIT on NK-92 were observed to increase the cytotoxicity of NK-92 cells against DU145 cells through an increase in sFasL, granzyme A, granzyme B, and granulysin. Conclusions: Our results reveal that the combined use of inhibitors directed against the IL6R/STAT-3 axis and TIGIT enhances the functional activity of NK cells against castration-resistant prostate cancer cells.

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Resumen Introducción: La resección duodenal distal (RDD) es una técnica quirúrgica compleja e infrecuente usada para el tratamiento de patologías duodenales o extraduodenales, que no comprometen la papila duodenal mayor, siendo su indicación más frecuente la patología neoplásica. Objetivo: Dar a conocer nuestra experiencia con esta técnica quirúrgica. Materiales y Método: Serie de pacientes sometidos a RDD entre 2009-2020 en el Hospital Clínico UC. Resultados: Total 12 pacientes, mediana de edad 56 años. Diagnóstico preoperatorio: tumores primarios duodenales (4), tumores con compromiso duodenal por contigüidad (5) y patologías de urgencia (3). El abordaje fue abierto en 9 pacientes y laparoscópico en 3 (1 caso convertido). En 9 pacientes se resecó D3-D4, en 1 paciente incluyó parte de D2 y en 2, sólo D4. La anastomosis duodenoyeyunal fue manual en 10 casos, todas con ascenso transmesocólico del asa yeyunal. Hubo 33% (n: 4) de morbilidad, todos Clavien Dindo II y 8% de mortalidad (n: 1). No hubo filtración de la anastomosis duodenoyeyunal. En el seguimiento ninguno presentó complicaciones y 4 pacientes fallecieron por progresión oncológica. Conclusión: La principal indicación quirúrgica fue patología neoplásica y en nuestra serie no hubo morbilidad mayor ni filtración anastomótica.

Introduction: Distal duodenal resection is a complex and infrequent surgical technique used for the treatment of duodenal or extraduodenal pathologies that do not compromise the greater duodenal papilla, the most frequent indication being the neoplastic cause. Aim: To publicize our experience with this surgical technique. Materials and Method: Series of patients undergoing a distal duodenal resection between 2009-2020 at the UC Clinical Hospital. Results: Total 12 patients, median age 56 years. Preoperative diagnosis: primary duodenal tumors (4), tumors with duodenal involvement due to contiguity (5), and emergency pathologies (3). The approach was open in 9 patients and laparoscopic in 3 (1 converted). D3-D4 was resected in 10 patients, 1 included part of D2 and 2 only D4. The duodenojejunal anastomosis was manual in 10 cases, all with transmesocolic ascending of the jejunal loop. There were 33% (n: 4) morbidity, all Clavien Dindo II, and 8% mortality (n: 1). There was no leakage of the duodenojejunal anastomosis. During followup, none presented complications and 4 patients died of oncological progression. Conclusion: The main surgical indication was neoplastic pathology and in our series, there was no major morbidity or anastomotic leak.

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Resumen Objetivo: Presentar la implementación del primer modelo porcino de trasplante hepático (TH) en Chile y sus resultados. Material y Método: Se implementó un protocolo quirúrgico y anestésico en el contexto de una investigación en perfusión normotérmica hepática financiada por un Fondo Nacional de Desarrollo Científico y Tecnológico. Los cerdos fueron seleccionados por peso (35-40 kilos), en cada experimento se utilizó dos, donante y receptor, sometidos a procura y trasplante respectivamente. El análisis se realizó con estadística descriptiva. Resultados: Se realizaron 26 experimentos (marzo de 2018-octubre de 2019). El protocolo consta de 7 etapas: Preparación, Instrumentalización, Procura o Hepatectomía, Tiempo Anhepático, Etapa de Isquemia-Reperfusión, Monitorización y Eutanasia. Las primeras tres son similares en ambos cerdos, y desde la cuarta en adelante corresponde sólo al receptor. La supervivencia a la cirugía fue de 92,3% (24/26) y al seguimiento de 76,9% (20/26). La mortalidad se produjo por inestabilidad cardiovascular postreperfusión portal. El tiempo quirúrgico promedio fue de 170 min, y el tiempo anhepático de 33 min. La PAM cursó una baja postreperfusión con recuperación al final de la monitorización (67,4 mmHg media) y la tendencia en ph fue a acidosis al final del seguimiento (7,21 media). Se requirió drogas vasoactivas en 12 casos. Discusión: Logramos implementar un modelo experimental simplificado y reproducible de TH sin necesidad de circulación extracorpórea ni puente veno-venoso gracias a la estandarización de la técnica quirúrgica y de los cuidados perioperatorios. Conclusiones: La consolidación de un modelo experimental significa el primer paso en investigación preclínica de nuevas tecnologías asociadas al TH en Chile.

Objective: To Present the implementation of the first porcine model of liver transplant in Chile and its results. Materials and Methods: In the context of an investigation based on normothermic perfusion that was subsidized by the National Fund for Scientific and Technological Development, surgical and anesthetic protocols were implemented. Two pigs were selected by weight (35-40 kg), in which one was a donor and the other a receptor; submitted to procure and as a transplant recipient, respectively. The analysis was executed with descriptive statistics. Results: 26 experiments (June 2018-October 2019) were performed. The protocol includes 7 stages: Preparation, Instrumentalization, Procure or Hepatectomy, Anhepatic Time, Phase of Ischemia-Reperfusion, Monitoring and Euthanasia. The first three stages are similar in both pigs; meanwhile the last four are exclusive to the receptor. 92.3% (24/26) survived the surgery and 76.9% (20/26) survived the follow up, including the pilots. Average surgical time was 170 minutes, and the anhepatic time was 33 minutes. The mean arterial pressure decreased after the reperfusion and it improved towards the end of the monitorization (67,4 mmHg average) In the follow up, pigs presented acidosis (7.21 average). Vasoactive drugs were necessary in 12 experiments. Discussion: We managed to implement a simple and reproducible model of porcine liver transplant without extracorporeal circulation or veno-venous by-pass. This was possible due to the standardization of surgical technique and perioperative cares. Conclusions: The consolidation of porcine liver transplant model is the first step in pre-clinical research for the development of new technologies in liver transplant in Chile.

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Resumen El cáncer colorrectal es de las principales causas de muerte por cáncer a nivel mundial. Una proporción importante de los casos desarrolla metástasis hepáticas. Gracias a los avances diagnósticos y tratamientos oncológicos, la sobrevida ha ido en aumento, sin embargo, para ello es fundamental lograr la resección quirúrgica completa de las lesiones primarias y metastásicas con márgenes microscópicos negativos (R0). Existen numerosos procedimientos y técnicas diseñadas para este objetivo como la quimioterapia neoadyuvante, embolización portal, cirugía en etapas, etc. A pesar de ello, hay casos no resecables por compromiso hepático bilobar, multisegmentario y/o compromiso de vasos arteriales, portales o venosos que en caso de resección, no permiten mantener hígado remanente funcional compatible con la vida del paciente. El trasplante hepático surge como alternativa radical para el tratamiento de casos no resecables. Dado la escasez de donantes y mortalidad en la lista de espera nacional, no es aceptable ocupar hígados del pool de donantes para patologías con criterios expandidos como metástasis colorrectales. Sin embargo, con el recurso del donante vivo de adulto a adulto, hoy en día es posible indicar trasplante en casos seleccionados, que cumplan con todos los criterios establecidos.

Colorectal cancer is one of the leading causes of cancer death worldwide. A significant proportion of cases develop liver metastases. Thanks to diagnostic advances and oncologic treatments, survival has been increasing, however, it is essential to achieve complete surgical resection of primary and metastatic lesions with negative microscopic margins (R0). There are many procedures and techniques designed for this purpose such as neoadjuvant chemotherapy, portal embolization, stage surgery, etc. Despite this, there are non-resectable cases due to bilobar, multisegmental and/or hepatic involvement of arterial, portal or venous vessels that, in case of resection, do not allow the maintenance of functional remnant liver compatible with the patient's life. Liver transplantation emerges as a radical alternative for the treatment of unresectable cases. Given the shortage of donors and mortality on the national waiting list, it is not acceptable to occupy donor pool livers for pathologies with expanded criteria such as colorectal metastases. However, with the resource of the living donor from adult to adult, today it is possible to indicate transplantation in selected cases, which meet all established criteria.

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This research aims to compare the culturing conditions for enterohepatic Helicobacter, evaluating culture media, incubation atmosphere and susceptibility to antimicrobials used to generate selective conditions. Four common media for the closely related genus Campylobacter (Columbia, Bolton, Brucella and CCDA agar), as well as the need for hydrogen in the microaerobic incubation atmosphere, were evaluated. Serial dilutions of 13 strains belonging to six species (H. apodemus, H. bilis, H. canicola, H. canis, H. equorum and Helicobacter sp.) were inoculated in each media and incubated at 37°C for 48 to 96 h using CampyGen (OXOID) and gaseous exchange (including hydrogen) in parallel. Columbia or Brucella agars were the most appropriate for culturing EHH (P < 0·05). However, there was no significant difference between the atmospheres evaluated (P = 0·13). In addition, minimal inhibitory concentration for six antibiotics showed that all isolates were resistant to trimethoprim, whereas for the rest of the antibiotics (cephalothin, cefoperazone, cefsulodin, teicoplanin and vancomycin) the inhibition range was between 8 and 64 µg ml- 1 . Our findings suggest that Columbia or Brucella media, regardless of the use of hydrogen, can be used for the EHH isolation. In addition, the concentration of antibiotics included in commercial campylobacteria supplements is suitable for EHH species recovery. SIGNIFICANCE AND IMPACT OF THE STUDY: Enterohepatic Helicobacter (EHH) infections have been associated with several diseases in humans such as acute gastroenteritis, inflammatory bowel disease and hepatobiliary diseases. Although they are frequently detected in clinical samples by molecular methods, only occasionally they are isolated using culture conditions described for the taxonomic related pathogen Campylobacter sp. This is because the optimal conditions for the isolation of EHH have not yet been described, which results in an underestimation of the prevalence and clinical importance of these emerging pathogens. Therefore, this study provides insight for culturing EHH species.

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BACKGROUND: In order to develop new larvicidal agents derived from phytochemicals, the larvicidal activity of fifty molecules that are constituent of essential oils was evaluated against Culex quinquefasciatus Say. Terpenes, terpenoids and phenylpropanoids molecules were included in the in vitro evaluation, and QSAR models using genetic algorithms were built to identify molecular and structural properties of biological interest. Further, to obtain structural details on the possible mechanism of action, selected compounds were submitted to docking studies on sterol carrier protein-2 (SCP-2) as possible target. RESULTS: Results showed high larvicidal activity of carvacrol and thymol on the third and fourth larval stage with a median lethal concentration (LC50) of 5.5 and 11.1 µg/mL respectively. Myrcene and carvacrol were highly toxic for pupae, with LC50 values of 31.8 and 53.2 µg/mL. Structure-activity models showed that the structural property π-bonds is the largest contributor of larvicidal activity while ketone groups should be avoided. Similarly, property-activity models attributed to the molecular descriptor LogP the most contribution to larvicidal activity, followed by the absolute total charge (Qtot) and molar refractivity (AMR). The models were statistically significant; thus the information contributes to the design of new larvicidal agents. Docking studies show that all molecules tested have the ability to interact with the SCP-2 protein, wherein α-humulene and ß-caryophyllene were the compounds with higher binding energy. CONCLUSIONS: The description of the molecular properties and the structural characteristics responsible for larvicidal activity of the tested compounds were used for the development of mathematical models of structure-activity relationship. The identification of molecular and structural descriptors, as well as studies of molecular docking on the SCP-2 protein, provide insight on the mechanism of action of the active molecules, and the information can be used for the design of new structures for synthesis as potential new larvicidal agents.

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Human immunodeficiency virus type-1 (HIV-1) has infected more than 40 million people around the world. HIV-1 treatment still has several side effects, and the development of a vaccine, which is another potential option for decreasing human infections, has faced challenges. This work presents a computational study that includes a quantitative structure activity relationship(QSAR) using density functional theory(DFT) for reported peptides to identify the principal quantum mechanics descriptors related to peptide activity. In addition, the molecular recognition properties of these peptides are explored on major histocompatibility complex I (MHC-I) through docking and molecular dynamics (MD) simulations accompanied by the Molecular Mechanics Generalized Born Surface Area (MMGBSA) approach for correlating peptide activity reported elsewhere vs. theoretical peptide affinity. The results show that the carboxylic acid and hydroxyl groups are chemical moieties that have an inverse relationship with biological activity. The number of sulfides, pyrroles and imidazoles from the peptide structure are directly related to biological activity. In addition, the HOMO orbital energy values of the total absolute charge and the Ghose-Crippen molar refractivity of peptides are descriptors directly related to the activity and affinity on MHC-I. Docking and MD simulation studies accompanied by an MMGBSA analysis show that the binding free energy without considering the entropic contribution is energetically favorable for all the complexes. Furthermore, good peptide interaction with the most affinity is evaluated experimentally for three proteins. Overall, this study shows that the combination of quantum mechanics descriptors and molecular modeling studies could help describe the immunogenic properties of peptides from HIV-1.

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Introducción: La prueba Visual Subjetiva Vertical (SVV por sus siglas en inglés) corresponde a una prueba de bajo costo y complejidad que permite el estudio de la función vestibular "estática". En el año 2009 se valida la Prueba del Balde con igual confianza, sensibilidad y especificidad, que la prueba de domo. Sin embargo, diversos factores impresionan disminuir su precisión. Objetivo: Proponer un nuevo método utilizando un programa computacional y una interfaz pantalla-paciente, que permita disminuir la influencia de variables y aumentar la precisión de la evaluación. Material y método: En 43 voluntarios sin historia de patología vestibular y en 32 pacientes con patología vestibular se compararon los resultados de la aplicación de SVV en dos modalidades: prueba del balde tradicionalyuna prueba computarizada propuesta en el presente artículo. Resultados: En nuestro estudio el SVV con balde muestra 57% de sensibilidad y 90% de especificidad, mientras el SVV digital tiene 74% de sensibilidad y 93% de especificidad, el cual también presentó significativamente una menor desviación estándar. Conclusión: En suma, el SVV computarizado arroja un resultado más preciso que SVV con balde, con mejor utilidad clínica al tener mayor de discriminación con mejores perfiles de sensibilidad/especificidad.

Background: Subjective Visual Vertical Test (SVV) is a low-cost and simple evaluation that allows the physician to study the static vestibular function of a patient. In 2009 the Bucket Test was validated as a high confidence, sensitivity and specificity comparable to the hemispheric dome testing device. Although, its result can be affected by multiple variables. Aim: To propose a new method to evaluate SVV using a computer software interface, that allows a reduction ofvariables therefore increasing its precision. Material and method: In a sample of 43 volunteers with no previous history of vestibular pathologies and 32 patients with diagnosed vestibular pathologies we compared the results of 2 different modules of SVV testing: a traditional bucket test and a computerized test proposed in the present article. Results: Bucket test SVV for this research showed a sensitivity of 57% and a specificity of 90%, meanwhile Computerized SVV had a sensitivity of 74% and a specificity of 93%, which also presented a significant smaller standard deviation. Conclusion: In summary, digital SVV testing grants more accurate result in comparison to the Bucket Test, with a better clinical performance due to an improved discriminatory capacity with better Sensitivity/Specificity profiles.

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