Understanding the geometry and thus the possibility of repairing the aortic valve (AV) has evolved over time thanks to the integration of historical insights and technological advances. The aortic root geometry has proven to be central to understanding valve function. Today, with modern finite element models and flow studies supported by fourdimensional magnetic resonance imaging, we have provided a better understanding of the importance of the sinuses of Valsalva in blood flow dynamics. Their presence reduces cusp stress, improves repair durability, and promotes the adoption of valve prostheses with incorporated sinuses. Looking to the future, the scientific community must push towards a better fusion of currently available technologies to address AV repair, towards personalizing procedures to fit the unique anatomy of each patient. New technologies, including artificial intelligence, can provide personalized surgical simulations. The goal is to make techniques more standardized, reproducible and accessible, while maintaining flexibility to address anatomical variability. Additionally, new materials and tools are being explored to further improve outcomes.
El implante cardíaco de mioblastos y células madre autólogas de la médula ósea da una perspectiva de estímulo y posibilidad para tratar de reparar el corazón. A pesar de la experiencia en animales lograda con el fin de analizar la seguridad y la eficacia de este nuevo tratamiento, los resultados clínicos todavía se presentan inconclusos. Un tema fundamental es la plasticidad por la cual estas células pueden llegar a mejorar la función como la viabilidad del corazón. En este trabajo se efectúa una revisión de la regeneración natural que nos ofrece la naturaleza y de la experiencia clínica que la sustenta hasta el momento. Una amplia colaboración entre las ciencias básicas y las clínicas en todo el mundo es crucial para progresar en los problemas que actualmente presenta este intento de regenerar áreas fibróticas del corazón.
BACKGROUND:Dynamic indices and maneuvers are widely used to predict fluid responsiveness in mechanically ventilated patients, yet their relative performance remains uncertain. METHODS:We conducted an umbrella review of diagnostic accuracy meta-analyses published up to August 2025. Eligible reviews evaluated pulse pressure variation (PPV), stroke volume variation (SVV), passive leg raising (PLR), end-expiratory occlusion test (EEOT), tidal volume challenge (TVC), pleth variability index (PVI), or respiratory variation in inferior vena cava diameter (ΔIVC) in mechanically ventilated adults. Redundancy across reviews was assessed using the Corrected Covered Area (CCA), with pairwise overlap explored using Jaccard coefficients. The primary umbrella-level comparative metric was pooled area under the receiver operating characteristic curve (AUC) as reported by the included meta-analyses. Pooled sensitivity, specificity, and hierarchical ROC information were extracted when available. Secondary analyses included cumulative meta-analysis, subgroup and meta-regression analyses, prediction intervals, and assessment of small-study effects/publication bias. RESULTS:Seven meta-analyses were included, synthesizing 123 primary diagnostic studies and 10,300 patients. Global CCA was approximately 5.5% to 5.6%, consistent with borderline slight-to-moderate overlap across the included meta-analyses. TVC showed the highest comparative diagnostic performance (AUC 0.96, 95% CI, 0.94-0.97), followed by EEOT (AUC 0.95, 95% CI, 0.92-0.96). Passive leg raising (PLR) achieved good accuracy (AUC 0.91, 95% CI, 0.88-0.93), whereas pulse pressure variation (PPV) and stroke volume variation (SVV) showed only moderate performance (AUC 0.87-0.88). Pleth variability index (PVI) and inferior vena cava variation (ΔIVC) were the least reliable (AUC 0.82-0.83). Subgroup and moderator analyses indicated that tidal volume was the main effect modifier: TVC and EEOT remained comparatively robust. CONCLUSIONS:Among dynamic predictors of fluid responsiveness, TVC and EEOT appear to be the most accurate and robust indices. PLR retains intermediate utility, PPV and SVV show moderate reliability, whereas PVI and ΔIVC should not be used in isolation.
In the context of fixed upper-limb deformities, percutaneous tendon lengthening procedures are particularly relevant when the limb is non-functional. The therapeutic goals will be to relieve pain and improve passive mobility, thereby facilitating nursing care. While these procedures can easily be performed using simple anatomical landmarks on superficial tendons, ultrasound guidance is necessary for deeper muscles. Among the various muscles targeted, we detail the ultrasound-guided technique for sectioning the subscapularis and brachialis tendons. Deep tenotomies are performed in the operating room under general or regional anesthesia, whereas simple tenotomies can be performed using the WALANT (Wide Awake Local Anesthesia No Tourniquet) technique in a dedicated suite, predominantly on an outpatient basis. They have the advantage of simplifying the management of postoperative care for patients-often in institutional settings-who have cognitive impairments.
