Drug testing of monodisperse arrays of live microdissected tumors using a valved multiwell microfluidic platform.

Cancer drug testing in animals is an extremely poor predictor of the drug's safety and efficacy observed in humans. Hence there is a pressing need for functional testing platforms that better predict traditional and immunotherapy responses in human, live tumor tissue or tissue constructs, and at the same time are compatible with the use of mouse tumor tissue to facilitate building more accurate disease models. Since many cancer drug actions rely on mechanisms that depend on the tumor microenvironment (TME), such platforms should also retain as much of the native TME as possible. Additionally, platforms based on miniaturization technologies are desirable to reduce animal use and sensitivity to human tissue scarcity. Present high-throughput testing platforms that have some of these features, e.g. based on patient-derived tumor organoids, require a growth step that alters the TME. On the other hand, microdissected tumors (µDTs) or "spheroids" that retain an intact TME have shown promising responses to immunomodulators acting on native immune cells. However, difficult tissue handling after microdissection has reduced the throughput of drug testing on µDTs, thereby constraining the inherent advantages of producing numerous TME-preserving units of tissue for drug testing. Here we demonstrate a microfluidic 96-well platform designed for drug treatment of hundreds of similarly-sized, cuboidal µDTs ("cuboids") produced from a single tumor sample. The platform organizes a monodisperse array of four cuboids per well in 384 hydrodynamic traps. The microfluidic device, entirely fabricated in thermoplastics, features 96 microvalves that fluidically isolate each well after the cuboid loading step for straightforward multi-drug testing. Since our platform makes the most of scarce tumor tissue, it can potentially be applied to human biopsies that preserve the human TME while minimizing animal testing.

Cross-Training and Resistance Training in Adults with Type B Acute Lymphoblastic Leukemia during the Induction Phase: A Randomized Blind Pilot Study.

Patients with acute lymphoblastic leukemia (ALL) undergoing induction decrease their physical capacity, lose muscle mass, and decrease their quality of life (QOL). The safety, feasibility, and benefits of exercise during chemotherapy have been proven, but the effects of cross-training activities have yet to be analyzed. To measure the effects of cross-training on body composition, physical performance, and QOL, a blind randomized clinical trial was carried out. A total of 33 patients were included and randomized into a cross-training exercise group (CEG), a resistance exercise group (REG), and a control group (CG). During induction, patients received an exercise routine three to five days a week for 30 to 50 min each. Body composition, QOL, and physical performance were measured at baseline, up to discharge, and at a follow-up of two months. Body composition improved in the REG and CEG. In the CG, muscle mass decreased and fat mass increased (p = 0.020 and 0.020, respectively). The REG and CEG had significant positive improvements in physical performance compared to the CG. QOL showed no differences in any group (p = 0.340). Cross-training and resistance exercise are essential to improve body composition and physical performance during induction. Considering the prognostic value of physical performance, we propose integrated training exercises as adjuvant therapy in adult patients with ALL.

Obesidad y riesgo de recaídas en pacientes con Leucemia Linfoblástica Aguda: Estudio retrospectivo

Antecedentes: La obesidad se ha asociado con estado proinflamatorio de bajo grado que se ha relacionado con el desarrollo del cáncer en general incluyendo el hematológico. Objetivos: El presente trabajo tiene el objetivo de identificar la asociación del diagnóstico de obesidad acorde al índice de masa corporal (IMC) con indicadores pronóstico de pacientes adultos con Leucemia Linfoblástica Aguda (LAL). Pacientes y Método: Se trata de un estudio observacional, retrospectivo que incluyó pacientes hospitalizados con diagnóstico de LAL de linaje de células B. Se estimó el IMC con base al peso y talla registrado al ingreso de los pacientes. Se determinó el riesgo de recaídas, recaídas a médula ósea y supervivencia. Se utilizó el método de Kaplan-Meier mediante el test log-Rank en el análisis estadístico. Resultados: Se incluyeron 128 pacientes. El peso y el IMC no mostraron una asociación significativa con el riesgo de recaídas. La frecuencia de recaída a médula ósea fue del 43,8%. La obesidad no impactó con la supervivencia global (p = 0,640) ni en la supervivencia libre de enfermedad (p = 0,527). La presencia de obesidad no se comportó como una variable de riesgo de recaída (p = 0,873). El IMC con punto de corte de 30 kg/m2 no se comportó como un factor de riesgo de recaída (OR 1.078). Conclusión: La obesidad no es un factor de riesgo independiente para el pronóstico de los pacientes adultos portadores de Leucemia Linfoblástica Aguda de linaje B.

Background: Obesity has been associated with a low-grade proinflammatory state, and it has been related to the development of cancer in general, including hematologic cancer. Aim: The present work aimed to identify the association of the diagnosis of obesity according to the body mass index (BMI) with prognostic factors of adult patients with Acute Lymphoblastic Leukemia (ALL). Patients and Method: This observational, retrospective study included hospitalized patients diagnosed with ALL of the B-cell lineages. BMI was estimated based on the weight and height registered on clinical records at the admission of the patients. The relapse risk and bone marrow relapse were determined, and the survival rate was measured. The statistical analysis included the Kaplan-Meier method using the log-Rank test. Results: This study included 128 clinical records of patients. Weight had no significant association with relapse risk. The frequency of bone marrow relapse was 43.8%. Obesity did not impact overall survival (p = 0.640) or disease-free survival (p = 0.527). The presence of obesity does not behave as a relapse risk variable (p = 0.873). BMI with a 30 kg/m2 cut-off point did not influence relapse risk (OR 1.078). Conclusion: Obesity is not an independent risk factor for the prognosis of adult patients with Acute Lymphoblastic Leukemia B-lineage.

Principales modificaciones asociadas a la esplenectomía / Main modifications associated with splenectomy

Introducción. El bazo es un órgano linfoide implicado en el reconocimiento antigénico, la depuración de patógenos y la remoción de eritrocitos envejecidos o con inclusiones citoplasmáticas. La esplenectomía es una técnica utilizada tanto para el diagnóstico (linfomas), el tratamiento (trombocitopenia inmune, anemia hemolítica adquirida) y la curación (microesferocitosis hereditaria) de diversas enfermedades. Métodos. Describir los principales cambios hematológicos y complicaciones asociadas al procedimiento de esplenectomía. Discusión. Los cambios posteriores a la esplenectomía pueden ser inmediatos, como la aparición de cuerpos de Howell-Jolly, la trombocitosis y la presencia de leucocitosis durante las primeras dos semanas. Otras complicaciones tempranas incluyen la presencia de trombosis, en especial en pacientes con factores de riesgo secundarios (edad, sedentarismo, manejo hospitalario, obesidad) o un estado hipercoagulable (diabetes, cáncer, trombofilia primaria), siendo tanto el flujo de la vena porta como el volumen esplénico los principales factores de riesgo para su aparición. Las complicaciones tardías incluyen la alteración en la respuesta inmune, aumentando el riesgo de infecciones por bacterias encapsuladas, en conjunto con una reducción en los niveles de IgM secundario a la ausencia de linfocitos B a nivel de bazo. Debido al riesgo de infecciones, principalmente por Streptococcus pneumoniae, la esplenectomía parcial se ha considerado una opción. Conclusión. Una adecuada valoración de la indicación de esplenectomía y la identificación precoz de complicaciones posoperatorias son fundamentales para reducir la mortalidad asociada a la esplenectomía

Introduction. The spleen is a lymphoid organ involved in antigen recognition, pathogen clearance, and removal of aged erythrocytes or those with cytoplasmic inclusions. Splenectomy is a technique used for diagnosis (lymphomas), treatment (immune thrombocytopenia, acquired hemolytic anemia), and cure (hereditary microspherocytosis) of various diseases. Methods. To describe the main hematological changes and complications associated with the splenectomy procedure. Discussion. Changes after splenectomy can be considered immediate: the appearance of Howell-Jolly bodies, thrombocytosis, and leukocytosis during the first two weeks. Other complications include the presence of thrombosis, especially in patients with risk factors (age, sedentary lifestyle, long hospital stay, obesity) or a hypercoagulable state (diabetes, cancer, primary thrombophilia), with both portal vein flow and splenic volume being the main risk factors for its appearance. Late complications include altered immune response, increased risk of infections by encapsulated bacteria, and a reduction in IgM levels secondary to the absence of B lymphocytes in the spleen; due to the risk of diseases mainly by Streptococcus pneumoniae, partial splenectomy has been considered an option. Conclusion. An adequate assessment of the indication for splenectomy and the early identification of complications are essential to reduce the mortality associated with splenectomy

Leucemia promielocítica aguda durante el embarazo: reporte de 17 casos de un país en desarrollo / Acute promyelocytic leukemia during pregnancy: report of 17 cases from a developing country

Resumen OBJETIVO: Recopilar casos atendidos en centros oncológicos de México y reportar los tratamientos exitosos, con respuestas completas y las complicaciones del embarazo. MATERIALES Y MÉTODOS: Estudio retrospectivo de serie de casos que incluyó a pacientes con leucemia promielocítica aguda asociada con el embarazo atendidas en diferentes hospitales de la zona metropolitana de la Ciudad de México entre 1999 y 2021. RESULTADOS: Se identificaron 17 pacientes con leucemia promielocítica aguda asociada con el embarazo, con mediana de edad de 23 años (14-40 años); 7 correspondieron a madres menores de 20 años. En relación con su entorno social 9 tenían baja escolaridad, 12 se dedicaban al hogar y 13 tenían una pareja al momento de la concepción. Por último, 11 eran originarias de una zona urbana. Las pacientes atendidas entre 1999-2010 se trataron con interferón plus citarabina (7 de 17) o mediante soporte transfusional y esteroide (2 de 17), en 8 de los 17 casos el tratamiento se inició con tretinoína en combinación con quimioterapia (daunorrubicina) como tratamiento de inducción. CONCLUSIONES: El tratamiento de pacientes embarazadas y con leucemia promielocítica aguda representa un reto debido al riesgo trombótico y hemorrágico. Si bien la adición de tretinoína ha modificado el pronóstico de las pacientes con esta leucemia, su indicación a las embarazadas sigue siendo motivo de controversia, sobre todo por el riesgo de teratogenicidad.

Abstract OBJECTIVE: To collect cases attended in oncology centers in Mexico and to report successful treatments, with complete responses and complications around gestation. MATERIALS AND METHODS: Retrospective case series study including patients with pregnancy-associated acute promyelocytic leukemia attended in different hospitals in the metropolitan area of Mexico City between 1999 and 2021. RESULTS: Seventeen patients with pregnancy-associated acute promyelocytic leukemia were identified, with a median age of 23 years (14-40 years); 7 corresponded to mothers younger than 20 years. In relation to their social environment, 9 had low schooling, 12 were homebased and 13 had a partner at the time of conception. Finally, 11 were originally from an urban area. Patients seen between 1999-2010 were treated with interferon plus cytarabine (7 of 17) or by transfusion support and steroid (2 of 17), in 8 of the 17 cases treatment was initiated with tretinoin in combination with chemotherapy (daunorubicin) as induction therapy. CONCLUSIONS: Treatment of pregnant patients and patients with acute promyelocytic leukemia represents a challenge due to thrombotic and hemorrhagic risk. Although the addition of tretinoin has modified the prognosis of patients with this leukemia, its indication in pregnant women remains controversial, especially because of the risk of teratogenicity.

[Obesity and risk of relapse in patients with Acute Lymphoblastic Leukemia: A retrospective study]. / Obesidad y riesgo de recaídas en pacientes con Leucemia Linfoblástica Aguda: Estudio retrospectivo.

BACKGROUND: Obesity has been associated with a low-grade proinflammatory state, and it has been related to the development of cancer in general, including hematologic cancer. AIM: The present work aimed to identify the association of the diagnosis of obesity according to the body mass index (BMI) with prognostic factors of adult patients with Acute Lymphoblastic Leukemia (ALL). PATIENTS AND METHOD: This observational, retrospective study included hospitalized patients diagnosed with ALL of the B-cell lineages. BMI was estimated based on the weight and height registered on clinical records at the admission of the patients. The relapse risk and bone marrow relapse were determined, and the survival rate was measured. The statistical analysis included the Kaplan-Meier method using the log-Rank test. RESULTS: This study included 128 clinical records of patients. Weight had no significant association with relapse risk. The frequency of bone marrow relapse was 43.8%. Obesity did not impact overall survival (p = 0.640) or disease-free survival (p = 0.527). The presence of obesity does not behave as a relapse risk variable (p = 0.873). BMI with a 30 kg/m2 cut-off point did not influence relapse risk (OR 1.078). CONCLUSION: Obesity is not an independent risk factor for the prognosis of adult patients with Acute Lymphoblastic Leukemia B-lineage.

Effect of a Cross-Training and Resistance Exercise Routine on IL-15 in Adults with Type B Acute Lymphoblastic Leukemia during the Induction Phase: Randomized Pilot Study.

IL-15 is a proinflammatory myokine essential for activating NK cells and CD8+ T lymphocytes, and its overexpression has been related to reducing overall survivorship in patients with acute lymphoblastic leukemia (ALL). Physical exercise has been shown to be safe, feasible, and beneficial in hematological cancers. Exercise requires the activation of muscles that secrete cytokines, such as IL-15, causing immune mobilization. The objective was to compare the outcomes of two training routines on IL-15 and survival prognosis in adult patients diagnosed with ALL. A blind randomized clinical study was carried out where twenty-three peripheral blood samples were obtained pre and postexercise intervention from patients categorized into three types of intervention: the resistance exercise group (REG), the cross-training exercise group (CEG), and the control group (CG). Changes in IL-15 levels during the intervention were not significant in any of the groups (CG p = 0.237, REG p = 0.866, and CEG p = 0.678). However, 87.5% of patients who received an exercise intervention achieved remission, while only 21.73% experienced a relapse. There were no deaths during the study. Although IL-15 level adaptation in the REG and the CG performed similarly, the REG induced a better clinical outcome. Resistance exercises may help improve survival prognosis and reduce relapses in patients with ALL.

Leucemia y Covid-19 (Leucovid-19): efecto de la pandemia sobre el diagnóstico de leucemia aguda en la Ciudad de México previo a Ómicron.

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Microdissected "cuboids" for microfluidic drug testing of intact tissues.

As preclinical animal tests often do not accurately predict drug effects later observed in humans, most drugs under development fail to reach the market. Thus there is a critical need for functional drug testing platforms that use human, intact tissues to complement animal studies. To enable future multiplexed delivery of many drugs to one small biopsy, we have developed a multi-well microfluidic platform that selectively treats cuboidal-shaped microdissected tissues or "cuboids" with well-preserved tissue microenvironments. We create large numbers of uniformly-sized cuboids by semi-automated sectioning of tissue with a commercially available tissue chopper. Here we demonstrate the microdissection method on normal mouse liver, which we characterize with quantitative 3D imaging, and on human glioma xenograft tumors, which we evaluate after time in culture for viability and preservation of the microenvironment. The benefits of size uniformity include lower heterogeneity in future biological assays as well as facilitation of their physical manipulation by automation. Our prototype platform consists of a microfluidic circuit whose hydrodynamic traps immobilize the live cuboids in arrays at the bottom of a multi-well plate. Fluid dynamics simulations enabled the rapid evaluation of design alternatives and operational parameters. We demonstrate the proof-of-concept application of model soluble compounds such as dyes (CellTracker, Hoechst) and the cancer drug cisplatin. Upscaling of the microfluidic platform and microdissection method to larger arrays and numbers of cuboids could lead to direct testing of human tissues at high throughput, and thus could have a significant impact on drug discovery and personalized medicine.

Microfluidics for interrogating live intact tissues.

The intricate microarchitecture of tissues - the "tissue microenvironment" - is a strong determinant of tissue function. Microfluidics offers an invaluable tool to precisely stimulate, manipulate, and analyze the tissue microenvironment in live tissues and engineer mass transport around and into small tissue volumes. Such control is critical in clinical studies, especially where tissue samples are scarce, in analytical sensors, where testing smaller amounts of analytes results in faster, more portable sensors, and in biological experiments, where accurate control of the cellular microenvironment is needed. Microfluidics also provides inexpensive multiplexing strategies to address the pressing need to test large quantities of drugs and reagents on a single biopsy specimen, increasing testing accuracy, relevance, and speed while reducing overall diagnostic cost. Here, we review the use of microfluidics to study the physiology and pathophysiology of intact live tissues at sub-millimeter scales. We categorize uses as either in vitro studies - where a piece of an organism must be excised and introduced into the microfluidic device - or in vivo studies - where whole organisms are small enough to be introduced into microchannels or where a microfluidic device is interfaced with a live tissue surface (e.g. the skin or inside an internal organ or tumor) that forms part of an animal larger than the device. These microfluidic systems promise to deliver functional measurements obtained directly on intact tissue - such as the response of tissue to drugs or the analysis of tissue secretions - that cannot be obtained otherwise.

Calidad de vida en pacientes con accidente cerebrovascular que acudieron a consultorio externo de neurología del Hospital Regional de Ica, Perú 2010-2011 / Quality of life in patients with stroke who wnt to outpatient clinic of neurology of the Regional Hospital in Ica, Perú 2010-2011

Objetivo: Determinar, la percepción de calidad de vida de los pacientes que padecieron accidente cerebrovascular y que acudieron a consulta externa del servicio de Neurología en el Hospital Regional de Ica, durante los años 2010­2011, a través de la aplicación de la encuesta SF-36 V.2.Material y Métodos: Se realizó una investigación aplicada, no experimental, transversal, cualitativa, de nivel descriptivo. La población estuvo constituida por pacientes con diagnóstico de enfermedad cerebrovascular, los años 2010­2011.Resultados: Muestra de 56 pacientes, donde 52% eran de sexo masculino, con una media de edad de72,66 años, el factor de riesgo más frecuente fue la hipertensión arterial (69,64%); se encontró un mayor compromiso del rol emocional (38,99 puntos) y el rol físico (32,26 puntos), mientras una mejor percepción en la dimensión del dolor corporal (53,49 puntos) y función social (55,37 puntos). Conclusiones: El rol físico fue la dimensión más afectada en ambos sexos, presentando rasgos cercanos al cero dentro del cuestionario SF-36 V.2. Las dimensiones Dolor Corporal y Función Social mostraron mejores condiciones con respecto a las otras. Los hombres obtuvieron mejores resultados, superando a las mujeres en casi la totalidad de los ítems evaluados por el test de calidad de vida. (AU)

Objective: To determine, the quality perception of life in patients who suffered stroke disease and who went to the outpatient department of the Neurologyinthe Regional Hospital in Ica, during the years 2010-2011, through the application of the SF-36 survey V. 2 Material and Methods: It was realized an applied, not experimental, transverse, qualitative research, of descriptive level. The population was constituted by patients by diagnosis of stroke disease, during the period 2010-2011. Results: Sample of 56 patients, where 52% were male, with a mean age of 72.66 years, the most frequent risk factor was highblood pressure (69.64 % ); found a greater commitment of the emotional role (38.99 points) and the physical role (32.26points), while a better perception in the dimension of the body pain (53.49 points) and social function (55.37 points). Conclusion: The role physical dimension was the most affected in both sexes, presenting traits close to zero within the questionnaire SF-36 V. 2. Body pain and Social Function showed better conditions with respect to the other. The men gotbetter results, exceeding to women in almost all of the items evaluated by the test of quality of life. (AU)

Percepción sobre el consumo de sustancias psicoactivas por estudiantes de medicina de la provincia de Ica, Perú 2010 / Perception over intake of phychoactive substances by medical students of the province of Ica, Peru 2010

Con el objetivo de determinar la percepción sobre el consumo de sustancias psicoactivas en estudiantes de la provincia de Ica se realizo un estudio de tipo descriptivo transversal, para el cual se aplicó una encuesta estructurada a una muestra no probabilística estratificada, para todos los años de estudios, en la Facultad de Medicina de la Universidad San Luis Gonzaga de Ica. Para el análisis de los datos se usó estadística descriptiva en el software Excel 2007. El número de encuestados fue de 195, con una edad promedio de 22 ±3 años. La percepción: peligro o muy peligroso, sobre el consumo de sustancias psicoactivas, fue del 78,5% para fumar cigarrillos, 83,6% para el consumo de bebidas alcohólicas frecuentemente; un 80% considera nada peligroso o poco peligroso al consumo de café. Concluimos que existe una alta percepción de peligro sobre el consumo de sustancias psicoactivas; sin embargo, un gran porcentaje de estos estudiantes, ha consumido alguna vez un tipo de ellas.

The objective is to determine the perception over intake of psychoactive substances used among medical students in the province of Ica. A descriptive- transversal study was made, for which a structured survey was applied to a non-probabilistic stratified sample, for all years of study at the Faculty of Medicine of the San Luis Gonzaga de Ica University. For data analysis, descriptive statistics were used SPSS v.17 software and Excel 2007 software. The number of respondents was 195, with an average age of 22 ± 3 years. Perception: Dangerous or Very dangerous, for psychoactive substances intake, was 78.50% for smoking, 83.60% for the use of alcoholic beverages frequently. 80% consider non-dangerous or little dangerous coffee intake. There is a high perception of danger over the intake of psychoactive substances, but a large percentage of these students had ever used one type of these.

Enseñanza de la lectura y la escritura en quechua L1: Unidad Central del Núcleo de Rodeo / teaching reading and writing quechua L1

A través de este trabajo de investigación se encuentra un desarrollo pedagógico basado en los programas del CAPIB. En este marco la organización de los alumnos no promueve un trabajo participativo ni constructivo, el aula muestra la presencia de carteles con silabarios, por tanto la enseñanza del área de Lenguaje y Comunicación prioriza las letras, sílabas y palabras. Sin embargo en este proceso se ven indicios de cambio pedagógico

Enseñanza de la lectura y la escritura en quechua (L1); Unidad Central del nucleo de Rodeo (11)

Se da cuenta de como marcha la implementacion de la educacion intercultural bilingue en el marco de la reforma educativa boliviana, en una escuela de la region quechua de Bolivia y en el primer ciclo de la educacion primaria

Enseñanza de la alectura y la escritura en quechua (L1), en la Unidad Central de Nucleo de Rodeo / sss

Este trabajo de investigacion pretende encontrar algunas respuestas a la pregunta de como esta enseñando la lectura y la escritura en lengua materna quechua en el primer ciclo de una unidad educativa, a partir de la implementacion de la propuesta de la Reforma Educativa en su modalidad bilingue. Se trata de una investigacion descriptiva a partir del enfoque etnografico, por tanto, hace uan descripcion densa del proceso de enseñanza de la lectura y la escritura, tomando como punto de partida los elementos y conceptos de la organizacion pedagogica...

Hallazgos citológicos en pacientes que toman anticonceptivos orales / Citologic study in patients with contraceptives oral consumption

Se estudiaron 45 pacientes entre 15 y 32 años con un promedio de 22.8 años, que asistieron por primera vez a la consulta de planificación familiar del centro de salud Egidio Montesinos, durante el periodo agosto 1984 a enero 1986. Las pacientes seleccionadas para el estudio, no debián estar planificada con otro método anticonceptivo, nunca haber tomado anticonceptivo oral y no tener contraindicación médica para el uso de estas sustancias hormonales. a cada paciente seleccionada, se le tomó una citología previa al inicio de la medicación y una citología de control al año de tomar el anticonceptivo oral. Toda paciente admitida en el estudio, recibió durante un año y mensualmente el mismo anticonceptivo oral, el cual contenía: Levonorgestel 0,15 mg, Etinilestradiol 0,03 mg. Los hallazgos citológicos se reportaron según el tipo de célula observada en la coloración de PAP-MAR. Comparando las dos muestras citológicas, antes y después de la medicación, se encontró un aumento en la inflamación, de un 68,8// antes del inicio de la toma del anticonceptivo, paso a un 87,18 al año de iniciada la medicación. Al año de iniciada la medicación una paciente desarrolla una displasia leve, lo que corresponde en nuestro a un 2,56//, incidencia parecida encontrada por Kline y colaboradores, quienes consiguieron una incidencia del 2,2// de citologías atípicas en las usuarias de anticonceptivos orales comparadas con un 1// en las no usuarias. En nuestro estudio se encontró un aumento de la metaplasia escamosa, de un 43,89// en las citologías previas paso a un 84,61// en las citologías al año de la medicación, estos hallazgos tienen relación con los encontrados por BOYCE y colaboradores, por THOMAS D.B y en trabajo Cervicalneoplasia and the pill. Estos trabajos demostraron que hay un aumento en la actividad metaplasica escamosa en las mujeres que toman anticonceptivos orales. En las citologías al año de estar tomando el anticonceptivo, se encontraron 3 VPH y ninguno de estos casos esta asociado con la displasia encontrada

Memoria del Foro: ¿A dónde vamos?. Progreso en diferentes culturas

¿A dónde vamos? ¿Cuál es el concepto de progreso en las diferentes culturas de Bolivia?, son algunas de las preguntas lanzadas en el Foro organizado por la GTZ, el Goethe-Institut y el PIEB en mayo de 2004. La actividad formó parte de una discusión a nivel internacional, y sus resultados integran este libro que llega a sus manos como una invitación para continuar con el debate