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Pilgrimage to sacrifice: Mechanisms, causes, and time of death of the Western Andean Capacocha of the Southern Tawantinsuyu
(American Association for the Advancement of Science (AAAS), 2026-07-15) Silva-Pinto, Verónica; Sepúlveda, Marcela; Gayo, Eugenia M; Mendez-Quiros, Pablo; Castro, Mario; Menéndez, Lumila Paula; Rojas-Costa, Gonzalo M; Cerón, María L; Wilson, Andrew S; Catalán, Verónica; Silva, Claudio; Stecher, Ximena; Soffia, Pablo; Salazar-García, Domingo C
Capacocha was a key Inca state rite that intertwined pilgrimage, sacrifice, and imperial incorporation across the Andes. We present a multianalytical investigation into two Capacocha cases from the western slope of the Andes: Cerro Esmeralda, located in the coastal Atacama Desert of northern Chile, and Cerro El Plomo, in the high mountains of central Chile. Stable isotope analysis reveals commensality practices during the pilgrimage, integrating local communities into the imperial order. Furthermore, computed tomography, dermatoscopy, and skin histology provide new evidence regarding the causes and mechanisms of death, identifying violent acts associated with sacrifice. Last, we present a pair of radiocarbon dates to discuss the chronology of both Capacocha contexts. In sum, these practices specify the materialization of Inca statecraft and contribute to characterizing the complexity and diversity of Capacocha ritual as an extension of the Inca biopolitical conquest.
Automated and Interpretable Detection of Hippocampal Sclerosis in Temporal Lobe Epilepsy: AID-HS
(Wiley Periodicals LLC, 2024-11-14) Ripart, Mathilde; DeKraker, Jordan; Eriksson, Maria H; Piper, Rory J; Gopinath, Siby; Parasuram, Harilal; Mo, Jiajie; Likeman, Marcus; Ciobotaru, Georgian; Sequeiros-Peggs, Philip; Hamandi, Khalid; Xie, Hua; Cohen, Nathan T; Su, Ting-Yu; Kochi, Ryuzaburo; Wang, Irene; Rojas-Costa, Gonzalo M; Gálvez, Marcelo; Parodi, Constanza; Riva, Antonella; D'Arco, Felipe; Mankad, Kshitij; Clark, Chris A; Carbó, Adrián Valls; Toledano, Rafael; Taylor, Peter; Napolitano, Antonio; Rossi-Espagnet, Maria Camilla; Willard, Anna; Sinclair, Benjamin; Pepper, Joshua; Seri, Stefano; Devinsky, Orrin; Pardoe, Heath R; Winston, Gavin P; Duncan, John S; Yasuda, Clarissa L; Scárdua-Silva, Lucas; Walger, Lennart; Rüber, Theodor; Khan, Aali R; Baldeweg, Torsten; Adler, Sophie; Wagstyl, Konrad; MELD HS study group
Objective: Hippocampal sclerosis (HS), the most common pathology associated with temporal lobe epilepsy (TLE), is not always visible on magnetic resonance imaging (MRI), causing surgical delays and reduced postsurgical seizure-freedom. We developed an open-source software to characterize and localize HS to aid the presurgical evaluation of children and adults with suspected TLE. Methods: We included a multicenter cohort of 365 participants (154 HS; 90 disease controls; 121 healthy controls). HippUnfold was used to extract morphological surface-based features and volumes of the hippocampus from T1-weighted MRI scans. We characterized pathological hippocampi in patients by comparing them to normative growth charts and analyzing within-subject feature asymmetries. Feature asymmetry scores were used to train a logistic regression classifier to detect and lateralize HS. The classifier was validated on an independent multicenter cohort of 275 patients with HS and 161 healthy and disease controls. Results: HS was characterized by decreased volume, thickness, and gyrification alongside increased mean and intrinsic curvature. The classifier detected 90.1% of unilateral HS patients and lateralized lesions in 97.4%. In patients with MRI-negative histopathologically-confirmed HS, the classifier detected 79.2% (19/24) and lateralized 91.7% (22/24). The model achieved similar performances on the independent cohort, demonstrating its ability to generalize to new data. Individual patient reports contextualize a patient's hippocampal features in relation to normative growth trajectories, visualise feature asymmetries, and report classifier predictions. Interpretation: Automated and Interpretable Detection of Hippocampal Sclerosis (AID-HS) is an open-source pipeline for detecting and lateralizing HS and outputting clinically-relevant reports.
Neurocognitive correlates of semantic memory navigation in Parkinson’s disease
(Nature Portfolio, 2024-01-09) Toro-Hernández, Felipe Diego; Migeot, Joaquín; Marchant, Nicolás; Olivares, Daniela; Ferrante, Franco; González-Gómez, Raúl; González Campo, Cecilia; Fittipaldi, Sol; Rojas-Costa, Gonzalo M; Moguilner, Sebastian; Slachevsky, Andrea; Chaná Cuevas, Pedro; Ibáñez, Agustín; Chaigneau, Sergio; García, Adolfo M
Cognitive studies on Parkinson’s disease (PD) reveal abnormal semantic processing. Most research, however, fails to indicate which conceptual properties are most affected and capture patients’ neurocognitive profiles. Here, we asked persons with PD, healthy controls, and individuals with behavioral variant frontotemporal dementia (bvFTD, as a disease control group) to read concepts (e.g., ‘sun’) and list their features (e.g., hot). Responses were analyzed in terms of ten word properties (including concreteness, imageability, and semantic variability), used for group-level comparisons, subject-level classification, and brain-behavior correlations. PD (but not bvFTD) patients produced more concrete and imageable words than controls, both patterns being associated with overall cognitive status. PD and bvFTD patients showed reduced semantic variability, an anomaly which predicted semantic inhibition outcomes. Word-property patterns robustly classified PD (but not bvFTD) patients and correlated with disease-specific hypoconnectivity along the sensorimotor and salience networks. Fine-grained semantic assessments, then, can reveal distinct neurocognitive signatures of PD.
Intracranial volume variation in Chinchorro mummies: a comparative study with prehispanic farmers and contemporary Chilean populations
(Nature, 0002-11-25) Rojas-Costa, Gonzalo M; Silva-Pinto, Verónica; Valenzuela, Yanis; de la Iglesia-Vayá, María; Molina-Mateo, José; Salazar-García, Domingo C; Valdes-Sosa, Pedro A; Gálvez, Marcelo
The Chinchorro culture inhabited the coastal Atacama Desert between 7,500 and 3,500 years BP, maintaining a hunter-gatherer-fisher lifestyle and practicing complex mortuary rituals. With the later adoption of agriculture, shifts in subsistence strategies and burial customs emerged. This study investigated long-term biological variation across three diachronic populations from northern Chile: Archaic-period Chinchorro individuals, pre-Hispanic agriculturalists, and contemporary Chileans. Using computed tomography (CT) and 3D reconstruction techniques, we analyzed intracranial volume (ICV) and estimated stature to assess morphological differences. The results show that both ICV and stature are significantly greater in the present-day Chilean population than in the pre-Hispanic groups. The average ICV was 1,321.26 cc in Chinchorro individuals, 1,336.57 cc in pre-Hispanic agriculturalists, and 1,481.22 cc in modern Chileans—representing a 12.05% increase between the earliest and most recent groups. Males and females exhibited 14.62% and 10.81% increases, respectively. Sexual dimorphism in the ICV was lower among agriculturalists (8.97%) than among Chinchorro (10.84%) and modern individuals (13.68%). Notably, the transition to agriculture did not result in significant changes in either ICV or stature. Instead, the marked increases observed in modern individuals have been associated primarily with improved nutrition, healthcare, and overall living conditions since the 20th century.
Vitamin D Supplementation, Total Testosterone, and Androgen Bioavailability Markers in Adult Men: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
(MPDI, 2026) Paez-Allendes, Loreto
Background: Vitamin D has traditionally been recognized for its role in calcium homeostasis and skeletal health, but vitamin D receptor expression and vitamin D-metabolizing enzymes have also been identified in extra-skeletal tissues, including components of the male reproductive tract. Observational evidence has suggested associations between vitamin D status and androgen-related markers; however, whether vitamin D supplementation has a measurable effect on androgen bioavailability remains uncertain. Objective: This systematic review and meta-analysis evaluated the effects of vitamin D supplementation on total testosterone (TT) and androgen bioavailability markers in adult men, including sex hormone-binding globulin (SHBG), free androgen index (FAI), calculated free testosterone (calculated FT), and bioactive testosterone (BAT) where methodologically compatible. Methods: The review was registered in PROSPERO (CRD420261365005) and conducted according to PRISMA 2020 and Cochrane methodological guidance. Searches were conducted from database inception to April 2026 in PubMed, Web of Science, Scopus, ClinicalTrials.gov, and the WHO ICTRP. Embase was initially planned but was not searched because institutional access was unavailable; this amendment was made before screening, extraction, risk-of-bias assessment, and synthesis. Records were deduplicated in Zotero, screened in a structured matrix, and converted from report-level records into independent comparison-level datasets where appropriate. Meta-analyses used random-effects REML models with Hartung–Knapp adjustment. Results: The official search set comprised 2854 records, of which 703 duplicates were removed, leaving 2151 records for title and abstract screening. The full-text screening file was reconciled to 162 PRISMA-countable reports/records: 135 reports were assessed, 27 reports could not be assessed because the full text was unavailable or had not been obtained for review, and 27 reports/studies were retained for qualitative synthesis. Eighteen reports were considered candidate sources for quantitative synthesis and were operationalized into 21 comparison-level records. The primary TT model included 11 comparisons and showed no clear effect of vitamin D supplementation on final TT (MD 0.47 nmol/L, 95% CI −0.50 to 1.44; $I^2$ = 24.1%). No clear effects were observed for SHBG (MD 0.27 nmol/L, 95% CI −2.14 to 2.68), FAI (MD −0.37, 95% CI −4.28 to 3.55), calculated FT sensitivity evidence (MD −0.0096 nmol/L, 95% CI −0.0525 to 0.0332), or BAT exploratory evidence (MD −0.47 nmol/L, 95% CI −1.77 to 0.83). GRADE certainty was low for TT, SHBG, and FAI, and very low for calculated FT and BAT. Conclusions: Current randomized evidence does not demonstrate a statistically clear or reproducible effect of vitamin D supplementation on total testosterone or androgen bioavailability markers in adult men. GRADE certainty was low for total testosterone, SHBG, and FAI, and very low for calculated free testosterone and bioactive testosterone. Because directly measured and calculated free testosterone are not analytically equivalent, free testosterone was not pooled as a primary outcome; method-compatible calculated FT was handled as sensitivity evidence and BAT as exploratory evidence.
Occipitalization of the atlas: prevalence, functional and anatomical considerations. A systematic review and meta-analysis
(Elsevier, 2026) Bruna-Mejias, Alejandro
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
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
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
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
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
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
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
(Elsevier, 2026) Valenzuela-Fuenzalida, Juan Jose
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.
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
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
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
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
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
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
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.

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