Hospital Angeles Clinica Londres

New therapies are improving outcomes even in advanced stages of multiple myeloma. To describe the experience of bispecific antibodies (BsAbs) in Mexico. The study included 41 patients with triple-class refractory (88%) and penta-drug refractory (61%) myeloma. The median number of prior treatment lines was 3, and the median time to response was 2 months. Step-up dosages were administered on an outpatient basis in 34 patients (83%). BsAbs were administered every 2 weeks to 19 patients (46%) and monthly to 17 patients (41.5%). Thirteen of these (31.5%) switched to monthly doses early in treatment and maintained their response. Twenty-five of 38 evaluated patients (66%) achieved a complete response or better, and 84% were negative for minimal residual disease. The median response duration was 10 months, while median progression-free survival and overall survival were 12 and 13 months, respectively. Extramedullary disease, no complete response, positivity for minimal residual disease, and penta-refractoriness were associated with poor outcomes. The adverse events were lower than those reported in clinical trials. In conclusion, using outpatient step-up dosing followed by planned de-escalation to monthly doses of BsAbs in responding patients with MM is feasible, safe, and effective, and may improve access to this novel therapy.

Abstract: INTRODUCTION: There is an ongoing controversy on the predictive value of the disperse variables involved in cerebral aneurysm rupture. A better understanding of how such variables interact with each other is needed. OBJECTIVES: The initial aim of the study was to propose how exactly, into a hemodynamic model, such morphologic variables might work together to optimize such predictive rupture value. METHODS: We hypothesized, based on previous research, that the aneurysm rupture phenomenon might be related to hemodynamic interference. Hence, we selected the Helmholtz’s resonator equation because its resemblance to aneurysm morphology and that it may also be used on elastic walls. We collected the morphologic data (transverse area of the neck diameter, the length of the neck, the aneurysm height, length, and width radius) from the unique large enough published series ( n = 425) for ruptured ( n = 140) and no ruptured ( n = 285) aneurysms that included all the required variables by the equation on the same sample. Given that the Helmholtz’s equation also requires as an input variable the speed of the pulse wave (PW), we collected these data from the published series that provides this information by age. This proposed arrangement provided the cerebral aneurysm resonance frequency (the hemodynamic vibratory frequency range, in Hertz, where aneurysms might adsorb most of the oscillating PW energy) for ruptured and no ruptured aneurysms (RAs) by age. Hence, at this point, the working hypothesis was to figure out the predictive value for rupture when the aneurysm resonant frequency (maximal vibratory energy absorption) in Hertz equals the PW frequency range of maximal vibratory energy transmission of 225–275 Hz. RESULTS: What we found is that the mean of the resonance frequency values of the RA series almost entirely matches into the PW frequency range of 225–275 Hz (α < 0.016, β = 0.4, and power = 0.6). Interestingly, the mean of the resonance frequency values for the no RA series barely intersects such PW frequency range (α < 0.024, β = 0.4, and power 0.6). In synthesis, we propose a novel multivariate hemodynamic vibratory interference phenomenon for aneurysm rupture that is activated when the PW frequency matches the resonant frequency of a cerebral aneurysm. The results turned out to have a 99.04% of negative predictive value. DISCUSSION: We hope that a better understanding of this phenomenon might preclude superior treatment strategies. This manuscript aims to provide additional predictive value to better detect patients on a crash course with aneurysm rupture. The required input parameters may be swiftly acquired during an individualized assessment. With this model, PW frequency and hemodynamic interference seem to emerge as novel arterial-damaging factors. CONCLUSION: The Specifity of 97.54%, reflects the ability of the model to correctly identify individuals with lower risk of cerebral aneurysm rupture.

Artificial intelligence (AI) is increasingly transforming health care, particularly in solid organ transplantation, where it addresses complex challenges such as organ allocation, graft rejection prediction, and immunosuppressive management. This bibliometric analysis evaluated the scientific impact and evolution of AI applications in kidney, liver, heart, and lung transplantation. A comprehensive search across PubMed, Scopus, and Web of Science identified 2384 publications from 1989 to 2025, of which 815 met inclusion criteria after double-blind screening with Rayyan AI. Coauthorship, keyword co-occurrence, and collaboration networks were analyzed using VOSviewer and Bibliometrix. The United States led in publications, citations, and collaboration strength, with Mayo Clinic emerging as the most productive institution, followed by China. Machine learning, expert systems, and deep learning were the most frequently applied AI techniques, whereas kidney and liver transplantation were the most extensively studied. Thematic clusters included rejection prediction, patient survival, organ allocation, postoperative monitoring, and immunosuppression personalization. Artificial intelligence–driven models integrate clinical, immunological, histological, and imaging data to enhance predictive accuracy, support clinical decision making, and improve graft and patient outcomes. Although many of these models remain under validation, early findings indicate strong potential to optimize patient care and surgical outcomes. This study highlights global research trends and emphasizes the need for interdisciplinary collaboration to develop context-specific AI tools. Moreover, promoting bibliometric literacy among health care professionals may strengthen evidence-based research and accelerate the responsible integration of AI into transplant medicine.

This paper presents two cases of bilateral atypical femoral fractures in postmenopausal women who underwent prolonged bisphosphonate therapy for osteoporosis. Both patients, aged 83 and 76, experienced fractures after long-term bisphosphonate treatment, highlighting concerns about suppressed bone turnover. Each case was treated with intramedullary nailing, and bisphosphonates were discontinued in favor of alternative therapies. These cases underscore the risks of atypical femoral fractures linked to extended bisphosphonate use, emphasizing the need for careful patient monitoring and further research to optimize osteoporosis treatment strategies and prevent such complications.

Objectives: To provide a comprehensive review of post-cholecystectomy complications, including their classification, diagnostic approaches, and clinical management, with a focus on imaging modalities and their role in improving patient outcomes.Design: This review integrates current evidence from relevant studies and clinical guidelines to categorize and describe early and late complications after cholecystectomy. Imaging findings, management strategies, and multidisciplinary considerations are emphasized.Setting: Data were synthesized from peer-reviewed literature and case studies involving post-cholecystectomy patients in diverse clinical settings.Participants: Patients undergoing laparoscopic or open cholecystectomy and subsequently presenting with complications such as bile duct injuries, bile leaks, vascular injuries, or stone-related conditions.Methods: A systematic approach was employed to identify common and rare complications. Each complication was categorized by anatomical location, timing of presentation, and severity. The diagnostic utility of imaging modalities, including ultrasound, computed tomography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography was critically evaluated.Results: Post-cholecystectomy complications significantly impact morbidity. Early complications include bile duct injuries, bile leaks, vascular injuries, and infectious processes. Late complications, such as bile duct strictures, retained stones, and Mirizzi syndrome are associated with higher diagnostic complexity. Imaging modalities play a crucial role in early detection and management, with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography offering superior diagnostic and therapeutic potential.Conclusion: Post-cholecystectomy complications require timely recognition and multidisciplinary management. Imaging studies are indispensable for accurate diagnosis and treatment planning. This review highlights key complications and their imaging characteristics, aiding clinicians in optimizing patient outcomes.

Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure, but it poses challenges in patients with surgically altered gastrointestinal anatomy (SAGA). Alternative techniques like single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or push enteroscopy (PE) have been used, albeit with potential complications. Limited Latin American data exists on ERCP complications in SAGA patients. Our goal is to describe complications of ERCP in SAGA at a national referral institution. Retrospective, single-center cohort study. All SAGA ERCP procedures performed at the Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán from January 2008 to May 2023 were included. Extracted data from records included procedure specifics, endoscope type, success, and complications. Complications were evaluated during procedure and 28-day post-procedure and classified using the AGREE system. A total of 266 procedures in 174 patients were included, 74% were women, and the median age was 44years. Predominant modified anatomy was Roux-en-Y biliary reconstruction (79%), followed by Whipple procedure (13%) and subtotal gastrectomy with Roux-en-Y reconstruction (6.0%). The main indications were cholangitis with stricture (31%), stricture (19%), and cholangitis (19%). DBE was used in 89%, PE in 7.5%, and SBE in 3.4%. Success rates were 77% endoscopic, 72% technical, and 69% therapeutic; in 30%, the procedure was unsuccessful. Complications happened in 18% of cases, most commonly cholangitis (7.5%), followed by perforation (2.6%) and hemorrhage (1.9%). According to the AGREE classification, 10.9% were grades 1 and 2, 6.4% were grade 3, and 0.4% were grade 4 complications. No significant differences emerged between groups with and without complications. Procedures increased over time, but complications and unsuccessful procedures remained stable. ERCP complications align with international data, often not requiring invasive treatment. Enhanced exposure to such cases correlates with fewer complications and failures. Prospective studies are essential to identify complication and failure predictors.