Alejandro Majerson

PURPOSE: Germ cell tumors (GCTs) are the most common malignancies among young men. In Latin America and the Caribbean, including Chile, population-based data remain limited; however, mortality is consistently reported to be higher than that in other regions. This study aimed to describe the clinical characteristics and survival outcomes of a cohort of Chilean patients with GCT and to assess the performance of established prognostic factors. METHODS: A retrospective cohort analysis was conducted among patients with GCT treated at two Chilean institutions. Clinical characteristics, recurrence, and survival outcomes were analyzed according to the stage and histological subtype. Established prognostic factors for stage I disease were evaluated for their association with recurrence-free survival. RESULTS: In total, 628 patients were included in this study. The 5-year overall survival (OS) rate was 98.8% (95% CI, 91.8 to 99.8) for stage I seminoma and 98.0% (95% CI, 92.0 to 99.5) for stage I nonseminomatous disease. Patients with advanced-stage disease had inferior outcomes compared with the International Germ Cell Cancer Collaborative Group reference cohorts. In stage I seminoma, lymphovascular invasion (LVI) and preorchiectomy β-human chorionic gonadotropin levels are associated with relapse. The Harrell C-index was 0.76 (95% CI, 0.6 to 0.9). No evidence of an association was found between internationally recognized risk factors and relapse in the stage I nonseminomatous cohort. CONCLUSION: The outcomes for stage I GCT in Chile are consistent with the global experience; however, survival in advanced-stage disease remains suboptimal. These findings highlight structural challenges, including a lack of centralized care. Strengthening referral pathways, consolidating specialized management, and expanding national registries are critical steps for improving outcomes.

Introduction The adequate preservation of the allograft prior to kidney transplant is key for a good outcome after transplantation. Currently, there are two main methods: hypothermic machine perfusion and static cold preservation. The main objective of this summary is to compare both preservation systems. Methods We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions We identified 10 systematic reviews including 34 primary studies, of which 13 were randomized trials. We concluded preservation by hypothermic machine perfusion probably decreases the risk of delayed graft function and could lead to a slight increase in graft survival. However, there are no differences in patient survival between the two methods.

Transurethral resection is currently considered as standard endoscopic treatment for lower urinary tract obstruction due to benign hyperplasia under 80 cc. Monopolar resection loops has been traditionally used but bipolar energy has recently displaced precedent technology. The purpose of this summary is to evaluate the efficacy and safety of both technologies. To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We identified 13 systematic reviews including 32 primary studies, among them 31 randomized trials. We concluded although there may be no difference in terms of efficacy among both techniques, the use of bipolar energy reduces the incidence of transurethral resection syndrome and probably reduces the risk of bleeding that requires red blood cell transfusion.