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Neuroworsening (NW) after traumatic brain injury (TBI) is a life-threatening complication affecting at least one in five patients. The current definition remains heterogeneous and does not integrate contemporary neuromonitoring tools that could help reduce this variability. Current diagnostic approaches are predominantly reactive, identifying deterioration only after brain herniation has occurred. To establish an expert consensus to update the definition of NW in TBI by proposing a stratified diagnostic framework aligned with precision and personalized medicine principles, aiming to shift a paradigm that has been in use for the past 50 years. A formal Delphi consensus process was conducted involving 25 experts from the Latin American Brain Injury Consortium (LABIC) and the Latin American Federation of Neurosurgical Societies (FLANC). A pre-consensus systematic literature review was performed, followed by structured electronic surveys with Likert-scale and multiple-choice items. Consensus was predefined as ≥80
The exponential growth of cancer survivors represents a major healthcare challenge, with more than 23 million people in Europe and 2.2 million in Spain requiring long-term specialized follow-up. Five-year survival has reached 60
Background: Uterine sarcomas represent a small and heterogeneous subgroup of uterine malignancies (accounting for less than 5%), characterized by high biological aggressiveness, high recurrence rates, and diagnostic complexity; surgical management remains the cornerstone of treatment and, consequently, the primary determinant of patient prognosis. Objective: This review synthesizes current evidence regarding the accurate diagnosis and appropriate surgical management of the main histological subtypes of uterine sarcoma across different stages, within a multidisciplinary therapeutic framework. Methods: A comprehensive narrative review was conducted using recent publications from major biomedical databases, with an emphasis on studies exploring surgical outcomes, molecular profiling, therapeutic strategies, and survival patterns. Results: Leiomyosarcoma and endometrial stromal sarcoma represent more than 80% of histological subtypes, with histological grade being the factor of greatest prognostic significance. Complete disease resection, without tumor fragmentation and with negative surgical margins, is the undisputed standard objective. Variations from the standard treatment—en bloc total hysterectomy with bilateral salpingo-oophorectomy—exist depending on histology and tumor staging. Conclusions: Individualized surgical treatment tailored to the specific histological subtype, combined with multimodal treatment strategies based on accurate tumor staging, molecular characterization, and recurrence patterns, is essential to improve survival. Such management should be conducted in referral centers with expertise in treating these rare and fearsome malignancies.
Antecedentes: Aunque la quimioembolización transarterial (TACE) es el tratamiento más utilizado en el carcinoma hepatocelular (CHC) en estadio intermedio, existe evidencia limitada que demuestre su superioridad frente a la embolización transarterial blanda (TAE). Objetivo: Comparar la efectividad y las complicaciones hepáticas de TACE y TAE. Método: Se analizó retrospectivamente una cohorte de pacientes con CHC tratados con TACE o TAE como primera línea. El desenlace primario fue la supervivencia global (SG). Se empleó un modelo de riesgos proporcionales de Cox tras ajuste mediante emparejamiento por puntaje de propensión (PSM). Resultados: Se incluyeron 114 pacientes (73 TACE, 41 TAE). Todos presentaban hepatopatía crónica, con Child-Pugh A en el 72.8%. La mediana de seguimiento fue de 17.9 meses. Tras el ajuste por PSM, no se observaron diferencias significativas en la SG entre ambos procedimientos (HR 1.19; IC 95%: 0.64–1.96; p = 0.69). En el análisis multivariante, solo la puntuación Child-Pugh se asoció de forma independiente con la SG. Las complicaciones hepáticas fueron similares entre grupos (OR TACE vs. TAE: 3.7; IC 95%: 0.90–14.62; p = 0.06). Conclusiones: Tras el ajuste por PSM, TACE y TAE muestran resultados comparables en supervivencia y complicaciones hepáticas en pacientes con CHC.
Importance:Severe burn injury triggers systemic inflammation that can lead to multiple organ dysfunctions and death. High-dose intravenous vitamin C has been proposed to mitigate these effects, but strong evidence in patients with burn injury is lacking. Objective:To evaluate the efficacy of high-dose intravenous vitamin C in patients with severe burn injury. Design, Setting, and Participants:Randomized, double-blind, placebo-controlled phase 3 trial conducted across 24 burn centers in North, Central, and South America; Europe; and Asia. Adults (≥18 years) with deep second- and/or third-degree burns covering 20% or more of total body surface area and requiring skin grafting were enrolled between August 18, 2020, and September 12, 2025. Final follow-up was completed in March 2026. The trial was stopped early after the first prespecified interim analysis for futility/harm. Interventions:Patients were randomly assigned (1:1) to receive intravenous vitamin C (50 mg/kg every 6 hours for 96 hours) or matched placebo. Main Outcomes and Measures:The primary outcome was a composite of 28-day mortality and persistent organ dysfunction (defined as dependence on mechanical ventilation, kidney replacement therapy, or vasopressor/inotrope support at day 28). The main secondary outcome was time to discharge alive from hospital within 90 days. Results:Among 238 patients enrolled (mean age, 48.9 [SD, 19.1] years; 79% male; mean total body surface area, 37.0% [SD, 14.6%]), 120 were assigned to vitamin C and 118 to placebo. The primary composite outcome occurred in 49 patients (40.8%) in the vitamin C group and 35 patients (29.7%) in the placebo group (adjusted risk ratio [RR], 1.28 [95% CI, 0.99-1.65]; P = .06), crossing the prespecified futility/harm threshold and prompting early trial termination. Time to discharge alive from hospital within 90 days was not improved (adjusted subdistribution hazard ratio, 0.85 [95% CI, 0.62-1.16]; P = .31). Twenty-eight-day mortality was higher in the vitamin C group (15.0% vs 7.6%; adjusted RR, 1.96 [95% CI, 1.32-2.90]; P = .001), as was hospital mortality (23.3% vs 16.1%; adjusted RR, 1.44 [95% CI, 1.03-2.00]; P = .03). Conclusions and Relevance:Among patients with severe burn injury, high-dose intravenous vitamin C did not reduce 28-day mortality and persistent organ dysfunction and is possibly harmful. Trial Registration:ClinicalTrials.gov Identifier: NCT04138394.
