Joseph Rodríguez Sánchez

Liquid biopsy has rapidly emerged as one of the most promising innovations in precision oncology by providing minimally invasive access to tumor-derived biomarkers throughout the clinical course of cancer. This review analyzes the current evidence regarding the clinical applications of liquid biopsy beyond early cancer detection, emphasizing its role in molecular profiling, therapeutic selection, treatment monitoring, minimal residual disease assessment, identification of resistance mechanisms, and evaluation of tumor heterogeneity in patients with solid tumors. A comprehensive literature review was conducted using major biomedical databases, selecting high-quality publications focused on circulating tumor DNA, circulating tumor cells, extracellular vesicles, circulating RNA, and other emerging biomarkers. The available evidence demonstrates that circulating tumor DNA currently represents the most clinically validated biomarker because of its high analytical performance and increasing incorporation into precision oncology protocols. Liquid biopsy has shown particular utility in lung, colorectal, breast, and prostate cancers, where molecular information directly contributes to personalized treatment decisions. Nevertheless, several barriers continue to limit universal implementation, including high costs, limited molecular infrastructure, methodological variability, and unequal access to advanced genomic technologies, particularly in developing countries. Ongoing technological improvements, international collaboration, and methodological standardization are expected to further expand the clinical applications of liquid biopsy and facilitate its incorporation into routine oncology practice. Overall, liquid biopsy represents a transformative strategy that complements conventional tissue biopsy and supports more personalized, dynamic, and evidence-based management of solid tumors.

Brain-computer interfaces (BCIs) have emerged as one of the most significant technological innovations in modern neurosurgery, integrating neuroscience, biomedical engineering, artificial intelligence, and clinical neurology to establish direct communication between the brain and external devices. This review provides a comprehensive analysis of the current scientific evidence regarding the neurophysiological foundations, technological evolution, clinical applications, limitations, and future perspectives of BCIs in neurosurgical practice. A qualitative documentary review was conducted following the Scientific Method, using peer-reviewed literature retrieved from internationally recognized databases, including PubMed, Scopus, Web of Science, ScienceDirect, IEEE Xplore, and Google Scholar. The analyzed evidence indicates that current clinical applications are primarily focused on motor restoration, neurorehabilitation, communication recovery, speech neuroprostheses, and adaptive neuromodulation for neurological disorders such as spinal cord injury, stroke, Parkinson's disease, amyotrophic lateral sclerosis, and drug-resistant epilepsy. Recent advances in machine learning, implantable electrodes, wireless technologies, and closed-loop therapeutic systems have substantially improved neural decoding performance and expanded the potential clinical utility of BCIs. However, important challenges remain regarding long-term signal stability, biocompatibility, surgical safety, economic accessibility, regulatory frameworks, and equitable implementation across different healthcare systems. The available evidence suggests that continued multidisciplinary collaboration and technological innovation will facilitate the progressive integration of BCIs into routine neurosurgical care, supporting personalized therapeutic strategies aimed at improving functional recovery, communication, and quality of life in patients with complex neurological disorders.

Stroke remains a major cause of long-term neurological disability worldwide, creating a growing need for rehabilitation strategies capable of promoting functional recovery through intensive, repetitive, task-oriented, and personalized interventions. Digital neurorehabilitation has emerged as a multidisciplinary approach that integrates neuroscience, physical and rehabilitation medicine, neurology, and biomedical engineering through technologies such as virtual reality, robot-assisted rehabilitation, brain-computer interfaces, wearable sensors, artificial intelligence, and telerehabilitation. This review analyzed international scientific evidence regarding the application of these technologies after stroke, with particular attention to their relationship with experience-dependent neuroplasticity, functional outcomes, implementation challenges, and applicability across different healthcare environments, including Latin America. Scientific evidence was identified and critically synthesized from internationally recognized databases, prioritizing randomized controlled trials, systematic reviews, meta-analyses, clinical guidelines, and relevant contemporary studies. The reviewed literature showed that virtual reality and robot-assisted rehabilitation constitute the most extensively investigated technological approaches, with favorable findings particularly in upper-limb motor function, balance, gait, functional mobility, and activities of daily living. Telerehabilitation and wearable technologies provide additional opportunities for extending therapeutic continuity and objective monitoring beyond specialized rehabilitation facilities, while brain-computer interfaces and artificial intelligence represent emerging approaches for neural feedback and personalized rehabilitation. Despite these advances, considerable heterogeneity remains regarding intervention protocols, technological platforms, therapeutic intensity, outcome measures, and patient characteristics. Furthermore, acquisition costs, infrastructure requirements, professional training, accessibility, connectivity, and digital literacy continue to influence implementation, particularly in resource-constrained healthcare systems. Current evidence supports digital technologies as complementary components of multidisciplinary stroke rehabilitation rather than substitutes for conventional therapy. Future research should prioritize standardized protocols, multicenter studies, long-term functional outcomes, cost-effectiveness, equitable accessibility, and greater representation of Latin American populations to advance toward evidence-based precision neurorehabilitation.

The vaginal microbiome has emerged as a fundamental determinant of female reproductive health and a promising therapeutic target for the prevention and management of gynecological and obstetric complications. This review aimed to critically analyze the current scientific evidence regarding emerging microbiome-targeted therapeutic approaches, emphasizing their biological mechanisms, clinical effectiveness, therapeutic potential, and future applications in personalized reproductive medicine. A structured narrative review based on the Scientific Method was conducted using publications retrieved from internationally recognized databases, including PubMed, Scopus, Web of Science, ScienceDirect, SpringerLink, Nature Portfolio, and Google Scholar. Recent evidence demonstrates that vaginal dysbiosis is strongly associated with bacterial vaginosis, recurrent vulvovaginal candidiasis, infertility, recurrent urinary tract infections, preterm birth, and other adverse pregnancy outcomes. The analyzed literature indicates that probiotics currently possess the strongest clinical evidence, while live biotherapeutic products, vaginal microbiota transplantation, postbiotics, prebiotics, and advanced vaginal drug delivery systems represent rapidly evolving therapeutic alternatives with considerable potential for restoring microbial homeostasis. These interventions extend beyond pathogen elimination by promoting immune regulation, epithelial barrier integrity, long-term microbial stability, and personalized therapeutic strategies. Although important methodological limitations remain, including heterogeneity among studies and limited long-term clinical data, microbiome-directed therapies are expected to play an increasingly significant role in precision reproductive medicine. Continued multidisciplinary research and high-quality clinical trials will be essential to facilitate their safe and effective integration into routine gynecological and obstetric practice.

Imaging biomarkers have progressively transformed modern radiology by providing quantitative, functional, and molecular information capable of improving early disease detection, diagnostic precision, therapeutic monitoring, and clinical decision-making in systemic diseases. The present review aimed to analyze the current role of imaging biomarkers in oncology and internal medicine, emphasizing their contribution to precision medicine and multidisciplinary healthcare management. A structured documentary review was conducted using peer-reviewed scientific literature indexed in internationally recognized databases, including PubMed, Scopus, ScienceDirect, and SpringerLink. The analyzed evidence focused on advanced imaging modalities such as computed tomography, magnetic resonance imaging, positron emission tomography, hybrid imaging systems, radiomics, and artificial intelligence-assisted imaging analysis. The reviewed studies demonstrated that imaging biomarkers possess broad applicability in oncology, neurological disorders, cardiovascular diseases, inflammatory conditions, chronic hepatic disease, pulmonary pathology, and metabolic disorders. Functional and molecular imaging techniques showed particular relevance for evaluating metabolism, tissue perfusion, angiogenesis, fibrosis, inflammation, cellular density, and tumor heterogeneity. Radiomics and artificial intelligence were identified as emerging technologies capable of improving predictive analysis, treatment response assessment, and individualized therapeutic planning.

Neuroinflammation has emerged as a fundamental pathophysiological mechanism linking neurological disorders with systemic inflammatory diseases. Increasing evidence demonstrates that chronic immune activation contributes significantly to neuronal dysfunction, cognitive impairment, neurodegeneration, and multisystem clinical manifestations through complex interactions involving microglial activation, cytokine signaling, oxidative stress, endothelial dysfunction, mitochondrial injury, and blood–brain barrier disruption. The objective of this review was to analyze the role of neuroinflammation as an interdisciplinary bridge between neurology, immunology, and internal medicine while evaluating its clinical, molecular, and translational implications. A narrative review methodology based on the Scientific Method and Process-Based Methodology was employed. Scientific literature indexed in international databases including PubMed, Scopus, ScienceDirect, SpringerLink, and Frontiers was analyzed. The review prioritized peer-reviewed studies published primarily between 2020 and 2025 addressing neuroimmune communication, neurodegeneration, metabolic disorders, autoimmune diseases, infectious syndromes, and gut–brain axis interactions. The analyzed evidence demonstrated that neuroinflammatory mechanisms are strongly associated with metabolic diseases such as obesity and type 2 diabetes mellitus, autoimmune disorders including systemic lupus erythematosus, infectious conditions such as sepsis and long COVID syndrome, and neurodegenerative diseases. Persistent inflammatory activation was consistently related to cognitive impairment, chronic fatigue, depression, autonomic dysfunction, chronic pain, and progressive neuronal injury. Furthermore, the gut–brain axis emerged as a major regulator of neuroimmune communication, reinforcing the systemic nature of neuroinflammation.

Cancer is currently recognized as a systemic and multifactorial disease involving complex interactions between metabolism, immunity, endocrinology, inflammation, and the tumor microenvironment. The objective of this review was to analyze the metabolic and immune interactions involved in tumor progression from an integrative systemic perspective. A narrative review methodology was employed using scientific literature indexed in PubMed, Scopus, Web of Science, and ScienceDirect between 2020 and 2025. The analyzed evidence demonstrated that tumor progression depends not only on genetic alterations but also on metabolic reprogramming, chronic inflammatory signaling, endocrine dysfunction, immune suppression, and adaptive modifications within the tumor microenvironment. Malignant cells exhibit metabolic flexibility characterized by increased glycolysis, glutamine dependency, altered lipid metabolism, and mitochondrial adaptations that promote survival under hypoxic and nutrient-deprived conditions. Simultaneously, metabolic competition and accumulation of immunosuppressive metabolites impair cytotoxic immune responses and favor immune evasion. Obesity, insulin resistance, hyperinsulinemia, adipokine imbalance, and chronic low-grade inflammation were identified as important systemic contributors to carcinogenesis and tumor dissemination. The review additionally highlighted the relevance of cancer-associated cachexia, chronic inflammation, and therapeutic resistance as systemic manifestations of malignant disease. Current evidence supports the development of integrated therapeutic strategies combining metabolic modulation, immunotherapy, endocrine intervention, and anti-inflammatory approaches. Overall, this review reinforces the concept that cancer progression results from continuous communication between malignant cells and host physiology, emphasizing the importance of multidisciplinary and systemic perspectives in contemporary oncology.

Anesthesia is a complex physiological intervention capable of producing significant neurophysiological and systemic alterations that influence perioperative and postoperative patient outcomes. Contemporary evidence suggests that anesthetic agents affect cortical connectivity, thalamocortical communication, neurotransmitter regulation, cardiovascular stability, respiratory physiology, inflammatory pathways, and metabolic homeostasis. The objective of this review was to analyze the neurophysiological and systemic effects of anesthesia and evaluate their implications for perioperative recovery, postoperative complications, and patient-centered outcomes. A narrative review methodology supported by the Scientific Method framework was employed. Scientific literature indexed in internationally recognized databases including PubMed, Scopus, ScienceDirect, and specialized anesthesiology journals was analyzed. The review focused on studies published between 2015 and 2025 involving neurophysiological mechanisms of anesthesia, postoperative neurocognitive disorders, hemodynamic instability, systemic physiological alterations, perioperative brain health, and individualized anesthetic management strategies. The analyzed evidence demonstrated that anesthesia produces coordinated alterations involving neural networks, organ perfusion, inflammatory activation, respiratory dynamics, and metabolic regulation. Excessive anesthetic depth was associated with increased postoperative delirium and cognitive dysfunction, particularly among elderly and vulnerable patients. Intraoperative hypotension demonstrated a strong relationship with postoperative organ dysfunction and perioperative morbidity. Furthermore, individualized strategies such as electroencephalography-guided anesthesia, regional anesthesia, multimodal analgesia, and precision-based hemodynamic management were associated with improved recovery profiles and better postoperative outcomes.