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El cáncer de vejiga es una patología frecuente del tracto genitourinario, cuyo tratamiento acarrea morbilidad y alteración de la calidad de vida y en particular en el subgrupo de pacientes con tumores vesicales clasificados como invasores de músculo. En los últimos años se han venido buscando alternativas terapéuticas para la cistectomía radical + linfadenectomía pélvica extendida, que es en la actualidad el estándar de manejo para los pacientes con carcinoma de vejiga invasor de músculo. Con el advenimiento de perfiles de manejo oncológico menos ablativos pero sin sacrificar resultados oncológicos y con las nuevas técnicas de radioterapia y quimioterapia, las modalidades terapéuticas preservadoras de órgano como la terapia trimodal (resección transuretral de tumor vesical + quimioterapia + radioterapia) se convierte en una alternativa terapéutica viable y con resultados oncológicos satisfactorios a largo plazo. Objetivo y metodología: Con esta revisión se pretende mostrar la actualidad de la terapia trimodal en el manejo de los tumores vesicales con invasión muscular, definir los mejores pacientes a considerar para recibir esta terapia, exponer los resultados oncológicos comparados con el estándar de manejo y los resultados en calidad de vida. También se propone un algoritmo de manejo y se presentar las recomendaciones al respecto en guías de práctica clínica. Conclusiones: La terapia trimodal es una alternativa al estándar de manejo que conduce a resultados oncológicos aceptables y puede considerarse una opción de tratamiento en pacientes bien seleccionados.

Introduction: Bladder cancer is a frequent pathology of the genitourinary tract, whose treatment causes morbidity and impaired quality of life, particularly in the subgroup of patients with bladder tumors classified as muscle invaders. In recent years, therapeutic alternatives have been sought for radical cystectomy + extended pelvic lymphadenectomy, which is currently the standard of care for patients with muscle-invasive bladder carcinoma. With the advent of less ablative oncological management profiles but without sacrificing oncological results and with new radiotherapy and chemotherapy techniques, organ-sparing therapeutic modalities such as trimodal therapy (transurethral resection of bladder tumor + chemotherapy + radiotherapy) becomes a viable therapeutic alternative with satisfactory long-term oncological results. Objective and methodology: This review aims to show the current status of trimodal therapy in the management of muscle-invasive bladder tumors, define the best patients to consider for receiving this therapy, present the oncological results compared with the management standard and the results in quality of life. A management algorithm is also proposed and recommendations in this regard are presented in clinical practice guidelines. Conclusions: Trimodal therapy is an alternative to standard management that leads to acceptable oncological outcomes and can be considered a treatment option in well-selected patients.

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BACKGROUND: In the Tropical Eastern Pacific (TEP), four species of parrotfishes with complex phylogeographic histories co-occur in sympatry on rocky reefs from Baja California to Ecuador: Scarus compressus, S. ghobban, S. perrico, and S. rubroviolaceus. The most divergent, S. perrico, separated from a Central Indo-Pacific ancestor in the late Miocene (6.6 Ma). We tested the hypothesis that S. compressus was the result of ongoing hybridization among the other three species by sequencing four nuclear markers and a mitochondrial locus in samples spanning 2/3 of the latitudinal extent of the TEP. RESULTS: A Structure model indicated that K = 3 fit the nuclear data and that S. compressus individuals had admixed genomes. Our data could correctly detect and assign pure adults and F1 hybrids with > 0.90 probability, and correct assignment of F2s was also high in some cases. NewHybrids models revealed that 89.8% (n = 59) of the S. compressus samples were F1 hybrids between either S. perrico × S. ghobban or S. perrico × S. rubroviolaceus. Similarly, the most recently diverged S. ghobban and S. rubroviolaceus were hybridizing in small numbers, with half of the admixed individuals assigned to F1 hybrids and the remainder likely > F1 hybrids. We observed strong mito-nuclear discordance in all hybrid pairs. Migrate models favored gene flow between S. perrico and S. ghobban, but not other species pairs. CONCLUSIONS: Mating between divergent species is giving rise to a region-wide, multispecies hybrid complex, characterized by a high frequency of parental and F1 genotypes but a low frequency of > F1 hybrids. Trimodal structure, and evidence for fertility of both male and female F1 hybrids, suggest that fitness declines sharply in later generation hybrids. In contrast, the hybrid population of the two more recently diverged species had similar frequencies of F1 and > F1 hybrids, suggesting accelerating post-mating incompatibility with time. Mitochondrial genotypes in hybrids suggest that indiscriminate mating by male S. perrico is driving pre-zygotic breakdown, which may reflect isolation of this endemic species for millions of years resulting in weak selection for conspecific mate recognition. Despite overlapping habitat use and high rates of hybridization, species boundaries are maintained by a combination of pre- and post-mating processes in this complex.

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In recent years, there have been important additions to the classical model of speech processing as originally depicted by the Broca-Wernicke model consisting of an anterior, productive region and a posterior, perceptive region, both connected via the arcuate fasciculus. The modern view implies a separation into a dorsal and a ventral pathway conveying different kinds of linguistic information, which parallels the organization of the visual system. Furthermore, this organization is highly conserved in evolution and can be seen as the neural scaffolding from which the speech networks originated. In this chapter we emphasize that the speech networks are embedded in a multimodal system encompassing audio-vocal and visuo-vocal connections, which can be referred to an ancestral audio-visuo-motor pathway present in nonhuman primates. Likewise, we propose a trimodal repertoire for speech processing and acquisition involving auditory, visual and motor representations of the basic elements of speech: phoneme, observation of mouth movements, and articulatory processes. Finally, we discuss this proposal in the context of a scenario for early speech acquisition in infants and in human evolution.

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PURPOSE: To determine the effectiveness and harms of bladder-preserving trimodal therapy (TMT) as a first-line treatment versus radical cystectomy (RC) plus radical pelvic lymphadenectomy in the treatment of muscle-invasive bladder cancer in terms of overall survival. METHODS: We included parallel clinical trials and prospective and retrospective cohort studies that included patients older than 18 years old, diagnosed with muscle-invasive bladder cancer, who underwent TMT compared with RC. The planned comparison was TMT versus RC plus pelvic lymphadenectomy as first-line treatment. The primary outcome was overall survival (OS) and secondary outcomes were salvage cystectomy and cancer-specific survival and progression-free survival. A search strategy was designed for MEDLINE, CENTRAL, Embase, and LILACS. We saturated information with conference abstracts, in progress clinical trials, literature published in non-indexed journals, and other sources of gray literature. Standardized tools assessed the risk of bias independently. We performed the statistical analysis in R v3.4.1 and effect sizes were reported in terms of hazard ratios (HR) and the corresponding 95% confidence intervals (95%CI). Accordingly, we used a random effect model due to the statistical heterogeneity found in included studies. RESULTS: We found 2682 records with the search strategies and, finally, 11 studies were included in the quantitative analysis. The summary HR for OS was 1.06 95%CI (0.85-1.31) I2 = 77%, showing no statistical difference. Regarding cancer-specific survival, the summary HR was 1.23 95%CI (1.04-1.46) I2 = 14%. On the other side, for the progression-free survival, the summary HR was 1.11 95%CI (0.63-1.95) I2 = 78%. Only one study described HR for adverse events (1.37 95%CI 1.16-1.59). CONCLUSION: We found no differences in overall survival and progression-free survival between these two interventions. Nonetheless, we found that cancer-specific survival favored patients who received radical cystectomy.

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