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Occipitalization of the atlas: prevalence, functional and anatomical considerations. A systematic review and meta-analysis
(Elsevier, 2026) Bruna-Mejias, Alejandro; Salazar-Ferrari, Martina; Silva-Garay, Antonia; Chacon Valdebenito, Ignacia Belen; Ortiz-Ahumada, Cynthia; Trujillo-Riveros, Martin; Loaiza-Giraldo, Jessica Paola; Nova-Baeza, Pablo; Orellana-Donoso, Mathias; Santana-Machuca, Andres; Cifuentes-Suazo, Gloria; Oyanedel-Amaro, Gustavo; Paton, Glen; Nalla, Shahed; Valenzuela-Fuenzalida, Juan José; Sanchis-Gimeno, Juan
Background: Occipitalization of the atlas, defined as a congenital fusion between the first cervical vertebra (C1) and the occipital bone, is an uncommon anatomical variant of the craniovertebral junction. Reported prevalence in the general population varies widely, and the condition is often identified incidentally during imaging or anatomical assessment. Objective: To synthesize available evidence on the prevalence of atlas occipitalization and to describe its anatomical characteristics across different populations and study designs. Methods: A comprehensive literature search was conducted in MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS from inception to January 2025. Study selection and data extraction were performed independently by four reviewers. Methodological quality was assessed using the Anatomical Quality Assessment (AQUA) tool. A random-effects meta-analysis was applied to estimate pooled prevalence values and explore predefined subgroups. Results: Twenty-five studies met the inclusion criteria for qualitative synthesis, of which eleven were included in the meta-analysis, encompassing a total of 4219 subjects. The pooled prevalence of atlas occipitalization was 0.64% (95% confidence interval: 0.00–1.00%). Variability in prevalence estimates was observed across populations and assessment methods. Conclusion: Atlas occipitalization is a rare congenital anatomical variant of the craniovertebral junction. Although often asymptomatic, its identification is anatomically relevant due to potential associations with other craniovertebral anomalies. Awareness of this variant is important for accurate anatomical interpretation and for planning procedures involving the craniovertebral junction.
GLP-1RA- and Incretin-Based Therapies Within Lifestyle Interventions for Adults with Overweight or Obesity: A Systematic Review and Meta-Analysis
(MPDI, 2026) Bruna-Mejias, Alejandro; Valenzuela-Fuenzalida, Juan José; Oyanedel, Gustavo; Figueroa-Puig, Julio; Cabezas-Salgado, Juan José; Orellana-Donoso, Mathias; Cifuentes-Suazo, Gloria; Loro-Ferrer, Juan Francisco
Background/Objectives: Glucagon-like peptide-1 receptor agonist (GLP-1RA)- and incretin-based therapies are now central to obesity management. Their clinical value, however, should be interpreted beyond total weight loss, because changes in fat mass, lean mass, physical function, and cardiometabolic risk may depend on the accompanying dietary, behavioral, and exercise co-interventions. This systematic review and meta-analysis evaluated GLP-1RA- and incretin-based therapies delivered within lifestyle interventions in adults with overweight or obesity. Methods: The protocol was registered in PROSPERO (CRD420261360837). PubMed/MEDLINE, Web of Science, Scopus, CINAHL, SPORTDiscus, and CENTRAL were searched from inception to the final search dates. Records were deduplicated in Zotero. Risk of bias was assessed using the Cochrane RoB 2 tool. Random-effects meta-analyses were estimated using restricted maximum likelihood with Hartung–Knapp adjustment when pooling was appropriate. Results: Across all database sources, 1651 records were identified. After removing 113 duplicate records and 212 records with an ineligible publication type before screening, 1326 records were screened. Seventy-seven reports were sought for retrieval, five were not retrieved, 72 were assessed at full text, and 48 reports corresponding to 35 independent parent trials or trial clusters were retained for qualitative synthesis. The primary kilogram-scale meta-analysis included eight independent comparisons and showed greater body-weight reduction with GLP-1RA/incretin-based therapy delivered within a lifestyle background than with placebo/control (mean difference [MD] −10.08 kg, 95% confidence interval [CI] −12.76 to −7.39; 95% prediction interval [PI] −17.86 to −2.29; $I^2 = 95.6\%$). Percentage body-weight change was analyzed separately across 11 independent comparisons and also favored GLP-1RA/incretin-based therapy (MD −9.53 percentage points, 95% CI −11.92 to −7.14; 95% PI −17.58 to −1.48; $I^2 = 95.4\%$). Conclusions: GLP-1RA- and incretin-based therapies delivered within lifestyle interventions are associated with clinically meaningful reductions in body weight in adults with overweight or obesity. Absolute and relative body-weight change metrics should remain analytically separate. The magnitude of benefit varies across trial contexts, and certainty remains limited by risk-of-bias concerns and considerable heterogeneity. Future trials should standardize the reporting of lifestyle co-interventions, body composition, adherence, physical-function outcomes, and safety monitoring.
Effectiveness of arthrocentesis versus other therapeutic modalities in patients with temporomandibular disorders. Systematic review and meta-analysis
(Elsevier, 2026-12) Valenzuela-Fuenzalida, Juan José; Araya-Gonzalez, Florencia; Katz-Figols, Ursula; Ruiz-Jorquera, Victoria; Diaz-Barahona, Joaquin; Loaiza-Giraldo, Jessica Paola; Pino-Henriquez, Cristobal; Niklander, Sven; Rodriguez-Luengo, Macarena; Cariseo-Avila, Carolina; Cifuentes-Suazo, Gloria; Orellana-Donoso, Mathias; Nova-Baeza, Pablo; Moya Daza, María P.; Konschake, Marko; Sanchis-Gimeno, Juan
Background: Temporomandibular disorders (TMD) are a heterogeneous group of conditions frequently associated with pain and functional impairment. Arthrocentesis has been proposed as a minimally invasive therapeutic option; however, its comparative effectiveness versus other treatments remains uncertain. Objective: To evaluate the effectiveness of arthrocentesis compared with other therapeutic modalities in patients with TMD, focusing on pain relief and mandibular functional outcomes. Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Randomized controlled trials comparing arthrocentesis with other therapeutic interventions for TMD were included. Primary outcomes were pain intensity assessed by visual analogue scale (VAS) and mandibular functional outcomes, including maximum mouth opening, maximum incisal opening, masticatory efficiency, mandibular movements, and overall joint mobility. Results: Thirty-two randomized controlled trials were included in the quantitative synthesis. No statistically significant difference in pain reduction was observed between arthrocentesis and comparator interventions, with very high heterogeneity. Masticatory efficiency showed a small statistically significant improvement favoring arthrocentesis, based on very low-certainty evidence. Overall, the certainty of evidence ranged from low to very low across outcomes. Conclusions: Arthrocentesis may provide modest symptomatic improvement in selected patients with TMD; however, it does not demonstrate superiority over alternative therapeutic modalities for most functional outcomes. Further well-designed randomized controlled trials with standardized diagnostic criteria, clearly defined comparators, and longer follow-up are required to better define the role of arthrocentesis in the management of temporomandibular disorders.
Compresión traqueal extrínseca en un lactante durante ventilación mecánica invasiva. Una aproximación fisiopatológica basada en la mecánica respiratoria.
(Andes Pediatrica, 2026-07-01) Bravo Pinares, Oscar; Cruces, Pablo; Díaz, Franco; Villavicencio Moscoso, Diego
Las anomalías congénitas del arco aórtico, como los anillos vasculares, son causas infrecuentes de obstrucción extrínseca de vía aérea central. Su diagnóstico es complejo debido a una presentación clínica inespecífica y superposición con patologías respiratorias frecuentes. Objetivo: Describir los hallazgos de la mecánica respiratoria que orientaron a la sospecha de una obstrucción fija de la vía aérea central secundaria a un anillo vascular en lactante críticamente enfermo. Caso Clínico: Lactante de 7 meses, gemelar monocigótico, previamente sano, ingresó por falla respiratoria aguda en el contexto de una infección viral respiratoria baja, requiriendo ventilación mecánica invasiva (VMI). Durante su evolución presentó episodios súbitos de hipoxemia, hipoventilación y aumento marcado de las presiones inspiratorias. El análisis detallado de la mecánica respiratoria evidenció un aumento significativo del componente resistivo inspiratorio y espiratorio, con incremento del gradiente entre presión inspiratoria pico (PIP) y presión meseta (PPLAT), asociado a un aumento de presión positiva al final de la espiración intrínseca (iPEEP). Estas mediciones cambiaban abruptamente al desplazar distalmente el tubo endotraqueal, lo que hizo sospechar de obstrucción fija de la vía aérea central. La angiografía tomográfica computada de tórax confirmó la presencia de un anillo vascular completo secundario a arco aórtico derecho con divertículo de Kommerell. Tras resolución del cuadro agudo, fue sometido a corrección quirúrgica sin complicaciones. Conclusiones: En lactantes con falla respiratoria aguda de evolución inhabitual, el análisis fisiopatológico de la mecánica respiratoria durante la VMI puede contribuir a la sospecha de obstrucción fija de la vía aérea central y orientar el estudio anatómico dirigido. Congenital anomalies of the aortic arch, such as vascular rings, are uncommon causes of extrinsic central airway obstruction. Diagnosis is often challenging due to a nonspecific clinical presentation and overlap with common respiratory diseases. Objective: To describe the respiratory mechanics findings that led to the suspicion of fixed central airway obstruction secondary to a vascular ring in a critically ill infant. Clinical Case: A previously healthy 7-month-old monozygotic twin infant was admitted due to acute respiratory failure associated with a lower respiratory tract viral infection, requiring invasive mechanical ventilation (IMV). During the clinical course, the patient developed sudden episodes of hypoxemia, hypoventilation, and a marked increase in inspiratory pressures. A detailed analysis of respiratory mechanics revealed a significant increase in both inspiratory and expiratory resistive components, with an increased gradient between peak inspiratory pressure (PIP) and plateau pressure (PPLAT), associated with an increase in intrinsic positive end-expiratory pressure (iPEEP). These abnormalities abruptly improved when the endotracheal tube was moved distally, raising suspicion of a fixed central airway obstruction. Chest computed tomography angiography confirmed a complete vascular ring aused by a right aortic arch with a Kommerell’s diverticulum. After resolution of the acute condition, the patient underwent surgical correction without complications. Conclusions: In infants with acute respiratory failure and unusual clinical course, pathophysiological analysis of respiratory mechanics during IMV may help to rise the suspicion of fixed central airway obstruction and guide targeted anatomical evaluation.
Balancing lung recruitment and venous congestion in ARDS: rethinking the systemic effects of PEEP
(Springer Nature, 2026-06-22) Benites, Martín Hernán; Papazian, Laurent; Retamal, Jaime
La presión positiva al final de la espiración (PEEP) mejora la oxigenación y la estabilidad alveolar en el síndrome de distrés respiratorio agudo (SDRA), pero los ensayos clínicos no han logrado traducir este beneficio fisiológico en una mejora consistente de la supervivencia. Los autores proponen que esta discordancia se explica por un efecto sistémico poco caracterizado de la PEEP: la congestión venosa. Según el marco de Guyton, la PEEP altera simultáneamente la resistencia vascular pulmonar y la transmisión de presión pleural, afectando el retorno venoso y elevando la presión venosa central, con repercusiones renales, hepáticas, esplácnicas y cerebrales. El artículo describe tres fenotipos mecánicos pulmonares (baja distensibilidad con pobre reclutabilidad, alta distensibilidad con transmisión pleural preferencial, y buena reclutabilidad alveolar) que determinan respuestas hemodinámicas distintas ante un mismo nivel de PEEP, incluyendo casos donde el reclutamiento alveolar efectivo puede preservar el retorno venoso al descargar el ventrículo derecho. Los autores concluyen que la titulación de PEEP debería replantearse como una decisión sistémica y no puramente respiratoria, integrando signos clínicos de congestión venosa (diuresis, presión venosa central, hallazgos ecográficos tipo VExUS) junto con la oxigenación, hacia un enfoque individualizado guiado por la fisiología pulmonar y circulatoria conjunta.
Subnational analysis of pediatric sepsis incidence and mortality from official records in Chile and Mexico: a longitudinal study from 2014 to 2024
(Springer Nature, 2026-05-02) Gatica, Sebastian; Caporal, Paula; Díaz, Franco; Jabornisky, Roberto; Simon, Felipe; Kisson, Niranjan
Background: Pediatric sepsis is a leading cause of global morbidity and mortality, yet high-resolution, granular subnational assessments remain scarce. Chile and Mexico are the only countries in Latin America that possess robust vital registration systems and open access databases with marginal levels of missing cases. This offers a unique opportunity to quantify the subnational burden of pediatric sepsis, identify healthcare system constrictions, and guide targeted public health interventions. Methods: This retrospective longitudinal study analyzed official hospital discharge and non-fetal death records of pediatrics (<10 years old) from Chile and Mexico between 2014 and 2024. Age-standardized incidence (ASIR) and mortality (ASMR) rates, standardized ratios, and the mortality-to-incidence ratio (MIR), were calculated to assess mortality relative to subnational hospital output. A novel dynamic risk stratification matrix was developed to classify ICD-10 sepsis-related causes into four risk/severity quadrants based on year-specific ASIR and MIR indicators. Results: A total of 656,234 discharges and 2,035 deaths in Chile, and 964,452 discharges and 77,252 deaths in Mexico were analyzed. Subnational trends were highly heterogeneous. Chile exhibited a predominantly low pediatric MIR (median <1%) with isolated hotspots with significant structural deviations to the North. High-everity sepsis causes in Chile were relatively rare. Conversely, Mexico displayed an alarmingly high MIR (median 7.2%), with systemic persistency in States such as Chiapas and Nuevo León. Strikingly, high-severity causes in Mexico (e.g., unspecified septicaemia, bacterial meningitis) were highly frequent, accounting for 88–97% of pediatric sepsis deaths. Furthermore, systemic instances of code-specific MIR > 1.0 in Mexico suggest significant health system fragmentation and decoupling of hospital discharge from vital statistic registries. Conclusions: Pediatric sepsis in Latin America encompasses distinct realities, ranging from localized critical care gaps to high lethality persistency. One-size-fits-all national policies may be inadequate. These findings advocate for precision public health, urging the deployment of decentralized, data-driven interventions and specialized resource allocation based on high-risk subnational hotspot identification.
Educación de postgrado en pediatría en Chile: desafíos para la calidad formativa en un sistema en expansión.
(Andes Pediatrica, 2026-06-01) Díaz, Franco; Riderelli, Jocelyn
La formación de especialistas en pediatría constituye un componente esencial para garantizar una atención de salud segura, integral y equitativa a niños, niñas y adolescentes. En Chile, la educación de postgrado en pediatría ha experimentado un crecimiento sostenido durante las últimas décadas, lo que se ha reflejado en el aumento del número de programas universitarios y de médicos en formación. Este proceso ha respondido a la necesidad de fortalecer el recurso humano en salud infantil; sin embargo, dicha expansión cuantitativa no siempre ha estado acompañada de mecanismos equivalentes y sistemáticos de aseguramiento de la calidad. El objetivo de este manuscrito es analizar críticamente la educación de postgrado en pediatría en Chile, con énfasis en la capacidad formadora de los programas, la organización curricular, el rol de los campos clínicos y de los tutores, y los mecanismos de certificación y de aseguramiento de la calidad del egresado. La brecha de especialistas, la distribución territorial y el contexto demográfico se incorporan como elementos analíticos complementarios, en la medida en que influyen en el diseño, el funcionamiento y los resultados del sistema formador, sin constituir el foco central del análisis. Desde una perspectiva educativa, se examinan las tensiones derivadas de la expansión de cupos formativos en escenarios donde la capacidad docente de los campos clínicos y la disponibilidad de tutores no siempre se han desarrollado de manera proporcional. Asimismo, se analizan los desafíos asociados a la transición hacia modelos de formación basados en competencias, el impacto de las tecnologías de la información y de la inteligencia artificial en el aprendizaje clínico, y el riesgo de implementaciones reduccionistas que privilegien las conductas automáticas por sobre el razonamiento clínico reflexivo. A partir de la experiencia internacional comparada, exponemos que no existen modelos universales directamente transferibles, sino principios de calidad que deben adaptarse a los contextos locales. Se identifican dos enfoques predominantes: modelos centralizados, característicos de Europa continental, con currículos nacionales estructurados y evaluación progresiva; y modelos anglosajones basados en la acreditación independiente y la certificación final estandarizada. Ambos ofrecen lecciones relevantes para el contexto chileno. Fortalecer la educación de postgrado en pediatría en Chile requiere avanzar hacia una mayor coherencia entre el rol profesional, el currículo, la acreditación de programas y la certificación del egresado. Asegurar una formación pediátrica de excelencia no constituye únicamente un desafío académico, sino una responsabilidad ética y de salud pública fundamental para garantizar el derecho a la salud de la infancia y adolescencia.
Occurrence of myocarditis in patients Immunized with different types of COVID-19 vaccines: A systematic review and meta-analysis
(Elservier, 2026) Valenzuela-Fuenzalida, Juan Jose; Moyano Valarezo, Laura; Silva, Vicente; Delgado, Fernanda; Nazar-Izquierdo, Diego; Bruna-Mejias, Alejandro; Nova-Baeza, Pablo; Orellana Donoso, Mathias; Oyanedel-Amaro, Gustavo; Cifuentes-Suazo, Gloria; Moya, Maria; Sanchis-Gimeno, Juan; Konschake, Marko; Loaiza-Giraldo, Jessica Paola
Background: Myocarditis has emerged as a rare but clinically relevant adverse event reported after COVID-19 vaccination, particularly following widespread use of vaccines based on novel molecular platforms. Given variability in vaccine technologies, population characteristics, and surveillance Methodologies, a comprehensive quantitative synthesis is required to better characterize the occurrence of post-vaccination myocarditis. This study aimed to characterize the distribution of reported myocarditis cases among individuals receiving COVID-19 vaccines, including mRNA, viral vector, and protein-subunit platforms, and to synthesize available evidence on reported post-vaccination myocarditis across different demographic and geographic subgroups. Methods: This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251118332). MEDLINE, Web of Science, Scopus, CINAHL, Google Scholar, and LILACS were searched from inception to January 2024 for observational studies reporting myocarditis following COVID-19 vaccination. Cohort, case-control, cross-sectional studies, and case series were eligible. Study quality was assessed using the ROBINS-I tool. Random-effects models were applied to estimate pooled proportions with 95% confidence intervals (CIs). Statistical heterogeneity was quantified using the I² statistic, and prespecified subgroup analyses were performed by sex, age, geographic region, and vaccine platform. Publication bias was explored using funnel plot analysis. Results: Fifty-nine studies comprising 196,478,861 vaccinated individuals and 13,348 reported myocarditis cases were included. Due to substantial heterogeneity in study designs and denominators, pooled estimates represent the proportion of myocarditis cases within reported samples rather than population-level incidence or risk. Across all included studies, the pooled proportion of myocarditis cases within reported study samples was 34% (95% CI: 19–50%), with considerable heterogeneity (I² = 100%). These estimates should not be interpreted as population-level incidence or risk. Reported myocarditis cases were more frequently observed among males (72%, 95% CI: 58–86%) than females (56%, 95% CI: 35–77%) and were predominantly identified in individuals younger than 40 years. Subgroup analyses by region and vaccine platform should be interpreted cautiously due to methodological variability and potential selection bias. Funnel plot asymmetry suggested possible small-study effects. Conclusions: This systematic review and meta-analysis aimed to characterize the distribution of reported myocarditis cases following COVID-19 vaccination rather than to estimate population-level incidence or risk. Although pooled proportions within reported samples were substantial, these estimates do not reflect populationlevel incidence. Available evidence suggests that myocarditis following COVID-19 vaccination remains uncommon at the population level, predominantly affecting younger males and more commonly reported after mRNAbased vaccines. Most reported cases appear to follow a benign and self-limited clinical course. These findings support the overall favorable benefit–risk profile of COVID-19 vaccines while underscoring the need for continued pharmacovigilance and more robust epidemiological studies to better characterize the epidemiology of vaccine-associated myocarditis.
Prevalence and clinical implications of median nerve variants within the carpal tunnel: A systematic review and meta-analysis
(Elsevier, 2026) Nova Baeza, P; Navia-Ramirez, M. F; Lobos-Ortiz, M; Alvial Ahumada, F; Riveros, A; Orellana-Donoso, Mathias; Moya, M. P; Estrada-Hernandez, A. C; Angarita-Arevalo, L. A; Casanova-Martinez, D; Piagkou, M; Triantafyllou, G; Valenzuela Fuenzalida, J. J; Sanchis-Gimeno, J; Loaiza-Giraldo, J. P; Konschake, M; Granite, G
The study develops computer vision (CV) models to rapidly predict acrylamide (AA) and 5-hydroxymethylfurfural (HMF) levels in crackers, comparing CV estimates with conventional analytical methods. Five baking temperatures (160–200°C) and times (15–35 min) were tested, showing CV accuracy with average errors of 3.10% for AA and 3.28% for HMF. Consumer preference tests (CATA) revealed that crackers baked at 180°C for 25 min, with the lowest AA and HMF levels, were most accepted.
Anterior tibial translation versus rotational instability in ACL reconstruction: Defining the problem before choosing the procedure
(Wiley, 2026) Pineda, Tomás; Dejour, David H.; Musahi, Volker; Seil, Romain; Zaffagnini, Stefano; Ollivier, Matthieu
The expanding use of lateral extra‐articular procedures (LEAPs) and tibial deflexion osteotomy (TDO)—also referred to as slope‐reducing anterior closing wedge high tibial osteotomy—in anterior cruciate ligament (ACL) reconstruction reflects meaningful progress in our understanding of mechanisms of graft failure. However, as their use expands, an important distinction just be maintained: they do not address the same problem.
Association between posterior tibial slope and graft survival in high-risk anterior cruciate ligament reconstruction with lateral extra-articular tenodesis
(SAGE Publications, 2026) Pineda, Tomás; Mazy, Davis; Ramos-Rojas, José; Cance, Nicolás; Dan, Michael J.; Demey, Guillaume; Dejour, David H.
Background: Posterior tibial slope (PTS) is a well-established anatomic risk factor for anterior cruciate ligament (ACL) graft failure.Lateral extra-articular tenodesis (LET) is increasingly used as an adjunctive procedure in high-risk patients to reduce rerupture rates; however, how its protective effect varies across the continuum of slope values remains insufficiently characterized. Purpose: To determine how PTS modifies the protective effect of LET in high-risk patients and to evaluate the influence of PTS on graft failure across different risk profiles. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort of 585 patients who underwent primary ACL reconstruction (ACLR) with hamstring tendon autografts between 2014 and 2017 was analyzed at a minimum follow-up of 6 years. Patients were nonrandomly allocated according to predefined clinical risk criteria into a low-risk group (isolated ACLR) and a high-risk group (ACLR 1 LET). A graft rerupture was defined clinically and confirmed by imaging. Multivariable logistic regression was used to assess the association between PTS and graft failure. Restricted cubic spline regression was also used to explore nonlinear relationships and identify slope ranges associated with low and high failure probabilities. Results: PTS independently predicted a graft rerupture in both groups, with a stronger effect in the high-risk group (adjusted odds ratio, 1.63; P = .005) compared with the low-risk group (adjusted odds ratio, 1.21; P = .029). The relationship between PTS and graft failure was nonlinear. In the high-risk group, the lowest failure probabilities were observed within a PTS range of 5 to 9, below which the risk of failure plateaued. In contrast, PTS values exceeding 11 to 12 were associated with high failure probabilities in both groups. Conclusion: PTS was independently associated with graft failure in both groups. Although LET was associated with lower failure probabilities within a moderate slope range, increasing PTS values were linked to a progressively higher risk of reruptures in both groups. The association between a steeper slope and failure observed in the ACLR with LET group suggests that an elevated PTS may attenuate the relative protective effect of LET.
Preoperative dynamic anterior tibial translation is not predictive of graft rupture after anterior cruciate ligament reconstruction
(Wiley, 2026) Pineda, Tomás; Mazy, David; Cance, Nicolas; Lucia Angelelli; Pineda, Tomás; Dan, Michel James; Dejour, David Henri
Purpose: This study aimed to determine whether higher preoperative dynamic anterior tibial translation (DATT) using laximetry is a risk factor for graft rupture after anterior cruciate ligament reconstruction (ACLR). Methods: This retrospective study included all patients who underwent primary ACLR with hamstring autograft between January 2014 and December 2017. Demographic data, absolute DATT on the injured side and ΔDATT (side‐to‐side difference), posterior tibial slope (PTS), static anterior tibial translation (SATT), concomitant lateral extra‐articular tenodesis (LET) and meniscal tears were collected. Subgroup analysis was performed using a ΔDATT threshold of 6 mm. Univariate and multivariable logistic regression analyses were conducted to identify independent risk factors for ACL graft rupture. Results: Among the 680 patients included with a minimum follow‐up of 6 years, 41 (6%) experienced graft rupture at a mean of 45 ± 30 months postoperatively. The median DATT on the injured side was 9 mm [interquartile range, IQR, 5], and the median ΔDATT was 6 mm [IQR, 4]. Graft rupture occurred in 5.8% for patients with ΔDATT < 6 mm and in 6.3% for patients with ΔDATT ≥ 6 mm (p = 0.787). Patients with ΔDATT ≥ 6 mm demonstrated a higher prevalence of medial meniscal tears (31% vs. 24%, p = 0.026). Independent risk factors for graft rupture included PTS ≥ 12° (odds ratio [OR] 3.1; 95% confidence interval [CI], 1.6–6.3; p < 0.001) and SATT ≥ 5 mm (OR 2.6; 95% CI, 1.2–5.5; p = 0.027), whereas neither ΔDATT nor absolute DATT was significantly associated with graft rupture. Conclusion: Preoperative DATT is not predictive of graft rupture following ACLR using hamstring autograft. PTS and SATT remain stronger predictors and should be prioritised for preoperative risk stratification.
Posterior tibial slope and static anterior tibial translation are not associated with increased cyclops syndrome after anterior cruciate ligament reconstruction
(Wiley, 2026) Mazy, David; Cance, Nicolas; Angelelli, Lucia; Pineda, Tomás; Pintore, Andrea; Dejour, David Henri
Purpose: Posterior tibial slope (PTS) and static anterior tibial translation (SATT) are established risk factors for anterior cruciate ligament (ACL) graft rupture and may also be associated with cyclops syndrome. This study aimed to assess whether these anatomical parameters influence the prevalence of cyclops syndrome after ACL reconstruction (ACLR). The hypothesis of the present study was that increased PTS and SATT would facilitate the development of cyclops syndrome. Methods: Patients aged ≥14 years with a minimum follow-up of 6 years who underwent primary ACLR with hamstring autograft between January 2015 and December 2017 were included. Demographic data, PTS, SATT, concomitant lateral extra-articular tenodesis (LET) and reoperation for cyclops syndrome were recorded. Time from index surgery to arthrolysis was documented, with a minimum follow-up of 6 years. Subgroup analysis regarding PTS, SATT and gender was performed. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors. Results: Of 530 patients included for analysis, 18 (3.4%) developed cyclops syndrome at a mean of 14 ± 9 months postoperatively (range, 6–33 months). Patients with a PTS ≥ 12° had a 4.3% rate of cyclops syndrome compared with 3.2% in those with a PTS < 12° (p = 0.536). Patients with a SATT ≥ 5 mm had a 5.6% rate compared with 2.7% for SATT < 5 mm (p = 0.154). Female patients presented a statistically significant higher prevalence (5.9%) compared with males (1.8%, p = 0.024). Concomitant LET did not demonstrate a protective effect (p = 0.807). Female sex was the only independent predictor of cyclops syndrome (OR, 3.3; 95% CI, 1.2–9.1; p = 0.018). Conclusion: This study found no evidence that increased PTS or SATT predisposes to cyclops syndrome after ACLR with hamstring autograft. These preoperative parameters should not alert clinicians to an increased risk of postoperative cyclops syndrome.
No association detected between posterior tibial slope, static anterior tibial translation and medial meniscus repair failure after anterior cruciate ligament reconstruction
(Wiley, 2026) Mazy, David; Cance, Nicolas; Angelelli, Lucia; Pineda, Tomás; Dan, Michael James; Dejour, David Henri
Purpose: This study aimed to evaluate the influence of the posterior tibial slope (PTS) and static anterior tibial translation (SATT) on the success of medial meniscus (MM) repair performed concomitantly with anterior cruciate ligament reconstruction (ACLR). Methods: In this retrospective study, all patients who underwent primary ACLR using hamstring autograft combined with isolated MM repair between January 2014 and December 2017, and a minimum follow‐up of 6 years, were included. Patients who had undergone meniscectomy or lateral meniscus repair were excluded. Demographic data, PTS, SATT, dynamic anterior tibial translation (DATT), the need for reoperation (at the same location) for MM repair failure (MMRF), and time to failure were recorded. Comparative analyses were performed using thresholds of 12° for PTS and 5 mm for SATT. Univariate logistic regression analyses were used to identify independent risk factors for MMRF. Results: Among the 148 patients included, 14 (9.4%) experienced a MMRF at a mean of 24 ± 16 months post‐operatively (range 7–60 months). Twenty‐ eight percent of patients had undergone concomitant lateral extra‐articular tenodesis (LET). There were no significant differences between the MMRF and non‐failure groups in terms of age, sex, presence of LET, PTS, SATT or DATT. Patients with PTS ≥ 12° (odds ratio, 2.9; 95% confidence interval, 0.8–11.6; p = 0.11) or SATT ≥ 5 mm did not demonstrate a higher rate of MMRF. No variable from the univariate analysis met the criteria for inclusion in the multivariate analysis. Limited number of MMRF events increase potential risk of type II error. Conclusion: No statistically significant association was detected between PTS, SATT, DATT, age or the presence of LET and MMRF after hamstring ACLR. However, larger studies are needed, particularly in high‐slope subgroups. Increased PTS or SATT alone should not discourage MM repair in the setting of ACLRMedial meniscus
Diagnostic accuracy of PCT, IL-6, and MR-ProADM for early identification of sepsis in the emergency department
(Sociedad Española de Quimioterapia, 2026-05-29) Tejada, Sofía; Clemente, Antonio; Socias, Antonia; Giglio, Andrés; Aranda, María; del Castillo, Alberto; Mena, Joana; Ribas, Joana María; Martín, Luisa; Llerena, Karla Milagritos; Arellano, María Magdalena; Agudo, Miguel; de la Rica, Roberto; Borges, Marcio
Objective: To evaluate the diagnostic accuracy of the biomarkers procalcitonin (PCT), interleukin-6 (IL-6), and mid-regional pro-adrenomedullin (MR-ProADM), individually and in combination, for early detection of sepsis and septic shock during emergency department (ED) triage. Materials and methods: A retrospective observational study was conducted in adults presenting to the ED with triage levels 2 and 3 between December 2021 and July 2023. Blood samples were collected at admission, prior to any therapeutic intervention. Plasma concentrations of PCT, IL-6, and MR-ProADM were measured using CMIA or ELISA. Diagnostic accuracy was assessed using ROC curves and AUC analysis. Results: A total of 248 patients were included (214 with sepsis and 34 non-septic controls). Simultaneous elevation of PCT, IL-6, and MR-ProADM was observed in 70% of septic patients compared with 3% of controls. Each biomarker showed high diagnostic accuracy for sepsis (AUROC >0.90). The combined assessment increased specificity and was strongly associated with sepsis and septic shock, with progressively higher odds as the number of elevated biomarkers increased. Higher biomarker burden was also associated with indicators of greater clinical severity, including higher SOFA scores and ICU admission. Conclusions: Combined measurement of PCT, IL-6, and MR-ProADM at ED triage, before therapeutic intervention, improves early identification of patients with sepsis and provides relevant information on initial disease severity. This multiplex platform approach may support clinical prioritization and protocol activation in the ED.
Risk of cervical metastasis in primary parotid gland malignancies: A Yo-IFOS multicenter retrospective longitudinal study: a Yo-IFOS multicenter retrospective longitudinal study
(Head & Neck, 2026-05-08) Kalfert, David; Palacios-Garcia, Jose; Tel, Alessandro; Vaira, Luigi Angelo; Maniaci, Antonino; Silva-Figueroa, Angelica; Boscolo-Rizzo, Paolo; Salzano, Giovanni; Consorti, Giuseppe; Enver, Necati; Dequanter, Didier; Melkane, Antoine; Cobanoglu, H. Bengu; Petrocelli, Marzia; Andueza-Guembe, Maider; Lentini, Mario; Toledo-Villegas, Karina; Tirelli, Giancarlo; Tramontano, Sara; Cirignaco, Giulio; Lechien, Jerome R.; İncaz, Sefa; De Riu, Giacomo
Background: Cervical lymph node metastasis is a major adverse prognostic factor in primary parotid gland malignancies. However, the incidence, level-specific distribution, and independent predictors of nodal metastasis remain incompletely defined in large contemporary multicenter cohorts. Methods: A retrospective longitudinal multicenter study was conducted across 17 tertiary referral centers. Adult patients with histopathologically confirmed primary parotid gland carcinoma who underwent parotidectomy with concurrent neck dissection were included. The primary outcome was pathologically confirmed cervical lymph node metastasis. Secondary outcomes included level-specific nodal distribution, identification of independent risk factors, overall survival (OS), and disease-specific survival (DSS). Results: A total of 380 patients were included. Pathological cervical lymph node metastasis was identified in 94 patients (24.7%). Metastases most frequently involved Level II (IIa 17.1%; IIb 11.1%). Salivary duct carcinoma demonstrated the highest rate of nodal metastasis (58.7%). On multivariate analysis, high histological grade and lymphovascular invasion (LVI) were independent predictors of nodal metastasis (p<0.05). Five-year OS for the entire cohort was 64.4%. Patients with nodal metastasis had significantly worse survival compared with node-negative patients (p<0.001). Conclusions: Cervical lymph node metastasis occurs in approximately one-quarter of surgically staged primary parotid gland malignancies and predominantly involves Levels II–III. High-grade histology and LVI independently predict nodal involvement. These findings support a risk-adapted approach to elective neck management ased on histological and pathological risk stratification.
Vacunación profiláctica contra el VPH en adultos: inmunogenicidad, eficacia y prevención de lesiones orofaríngeas. Revisión estructurada y recomendaciones basadas en evidencia. Parte I
(Sociedad de Cirujanos de Chile, 2026-04-30) Silva-Figueroa, Angelica; Carvajal-Villarroel, Felipe; Correa-Vega, Francisca; Gallego-Cifuentes, Alejandra; Leon-Ramirez, Augusto; Veloso-Olivares, Marcelo
Antecedentes: Esta recomendación técnica en dos partes evalúa la vacunación profiláctica contra el VPH y su posible impacto en enfermedad de cabeza y cuello en adultos, mediante revisión estructurada y calificación de certeza con GRADE. Parte 1 (alcance): métodos; lesiones orales/orofaríngeas benignas y ADN-VPH oral; esquemas de dosis (una vs dos/tres); grupos especiales (p. ej., PVVIH, trasplante, inmunomodulación). Parte 2 (alcance): prevención de carcinoma escamoso orofaríngeo VPH-positivo (CEOF); vacunación posdiagnóstico en CEOF; proyecciones a largo plazo de modelos de transmisión/eficiencia; recomendaciones y prioridades de investigación. Métodos: Búsquedas (2009-2025) en MEDLINE y bases complementarias; criterios predefinidos; tamizaje/extracción por duplicado; síntesis narrativa y tabular por eje; evaluación de sesgo y GRADE. Hallazgos: No existe evidencia comparativa directa que la vacunación reduzca incidencia o recurrencia de lesiones orales/orofaríngeas benignas en adultos; las señales de menor prevalencia de ADN-VPH oral son indirectas e imprecisas (certeza muy baja). La monodosis muestra inmunogenicidad duradera y protección frente a infección anogenital persistente; su extrapolación a desenlaces orales en adultos es indirecta (certeza baja). En inmunosuprimidos, la vacuna es inmunógena y segura; la evidencia para desenlaces orales es muy limitada (baja–muy baja). Aún no hay cohortes con estado vacunal individual y confirmación tumoral por VPH que demuestren menor incidencia de CEOF en adultos; los modelos predicen beneficio poblacional a largo plazo con programas tempranos, neutros en género y de alta cobertura (baja certeza para modelos). No hay evidencia de beneficio oncológico posdiagnóstico en CEOF. Recomendaciones: Preferir esquemas de dos–tres dosis; considerar monodosis según contexto programático. Vacunar a inmunosuprimidos y a pacientes con CEOF incompletamente vacunados por beneficio preventivo. Mantener programas de alta cobertura y priorizar cohortes enlazadas vacuna–cáncer con ≥ 10 años y confirmación tumoral por VPH.
Weight management interventions before IVF in overweight and obese women: a scoping review
(Springer Nature, 2026-05-11) Arancibia, Constanza; Giglio, Andres; Camus, Adela; Mondion, Mauricio; Jesam, Cristian
Background: Overweight and obesity are associated with reduced fertility outcomes in assisted reproduction. This scoping review maps available evidence on pre-IVF weight management interventions. Methods: We searched PubMed/MEDLINE (2008–2025) for studies evaluating weight management interventions (dietary, exercise, pharmacological, surgical) before or during IVF in women with BMI ≥ 25 kg/m². We included randomized controlled trials, quasi-xperimental studies, and cohorts with interventions. Two reviewers independently screened records and extracted data on interventions and outcomes. Supplementary searches included reference screening and citation tracking. Results: From 230 records, 19 studies met inclusion criteria: 17 evaluating IVF-specific outcomes — lifestyle or dietary interventions (n = 10), pharmacological therapies (n = 3), and bariatric surgery (n = 4) — and 2 examining preconception interventions before other ART modalities included exclusively to inform implementation challenges. Weight loss was achieved across intervention categories, though the magnitude varied substantially. Improvements in reproductive outcomes were inconsistent. Some studies reported improved pregnancy rates following lifestyle interventions, while well-designed trials showed no significant differences despite weight reduction. Orlistat showed no reproductive benefit; GLP-1 agonist combination therapy showed preliminary promise in PCOS. Bariatric surgery produced substantial weight loss but inconsistent live birth outcomes. High attrition rates (> 20%), treatment delays, and variable adherence were common challenges. Conclusions: Pre-IVF weight management interventions demonstrate substantial outcome heterogeneity. While weight loss is achievable, reproductive benefits are inconsistent. Evidence does not support rigid BMI cutoffs. Clinical decisions should be individualized. Future research should identify predictive factors and optimize intervention protocols.
Tibial slope in ACL reconstruction: When should it be corrected?
(Elsevier, 2026) Pineda, Tomás; Dejour, D. H.
The tibial slope has been identified as a key anatomical factor influencing anteroposterior knee stability. Increased slope values have been linked to greater anterior tibial translation, higher stress on the anterior cruciate ligament and an elevated risk of graft failure following reconstruction. This review aims to examine the current evidence and ongoing controversies regarding the clinical relevance of tibial slope, measurement methods, and surgical correction indications.
Extracorporeal membrane oxygenation in pediatric septic shock: A single-center experience in Chile
(SAGE Publications, 2026-01) Godoy, Loreto; Yunge, Mauricio; Rufs, Jorge; Gatica, Alejandra; Muñoz, Carlos; Valverde, Cristian
Background: Refractory septic shock (RSS) in children carries high mortality despite advances in critical care. Extracorporeal membrane oxygenation (ECMO) is a rescue therapy when conventional management fails. Evidence from Latin America remains limited, with no detailed reports from Chile. Methods: We conducted a retrospective single-center study (2009–2024) in a Chilean Pediatric ICU. Patients aged 1 month to 17 years with septic shock unresponsive to maximal conventional therapy were included. We analyzed demographics, illness severity, ECMO modality, complications, and outcomes. Primary endpoint was survival to hospital discharge. Results: Nine patients received ECMO (median age=6.3 years). All had RSS, frequently associated with severe ARDS. Configurations included venoarterial (VA; n=4), venovenous (VV; n=4), and venoarteriovenous (VAV; n=1), all via peripheral cannulation. Pre-ECMO median vasoactive-inotropic score was 117, and 78% required renal replacement therapy during ECMO. Overall survival was 55% (5/9). Survivors had longer ECMO runs (median 11 days vs 3 days) and ICU stays (median 63 days vs 5 days). Hemorrhage was the most frequent complication (intracranial n=3; gastrointestinal n=1). One survivor developed hemiparesis; no cognitive impairment was observed at 1-year follow-up. Conclusions: ECMO can be an effective rescue therapy for pediatric RSS, even without central cannulation capability. Distinguishing cardiogenic from vasoplegic phenotypes and identifying severe ARDS guided configuration selection (VA vs VV). These findings highlight the feasibility of peripheral ECMO in carefully selected patients within resource-limited settings, achieving survival comparable to international reports.

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