Abstract In 1895, Nicolás Sáenz proposed to the Chilean government to purchase a collection of “Inca” objects brought from Lima. This acquisition was approved in 1897. Despite the difficulties caused by the War of the Pacific, the Museo Nacional de Historia Natural (Chile) continued to acquire Peruvian antiquities, following a tradition of comparative studies of material culture. Within the framework of social evolutionism, these antiquities were a measure of civilization, a reference from which to evaluate the material culture of the pre-Hispanic peoples of Chile. This article analyzes the acquisition of the Sáenz collection as the culmination of a process of transition towards an archeology that focused on the new post-war territorial acquisitions in the Pacific.

Resumen En 1895, Nicolás Sáenz propuso al gobierno chileno la venta de una colección de objetos “incaicos” traídos desde Lima; adquisición aprobada en 1897. Pese a las dificultades ocasionadas por la Guerra del Pacífico, el Museo Nacional (Chile) continuó adquiriendo antigüedades peruanas, siguiendo una tradición de estudios comparados de cultura material. Dentro del marco del evolucionismo social, estas antigüedades servían como medida de civilización, con la cual contrastar la cultura material de los pueblos prehispánicos de Chile. Este artículo analiza la adquisición de la colección Sáenz, como un punto cúlmine de un proceso de tránsito hacia a una arqueología enfocada en las nuevas adquisiciones territoriales post guerra del Pacífico.

The accelerated scientific, technological, and social advances in recent years have posed new challenges for professional training institutions, where universities play a leading role. Medical schools have not been oblivious to this process. This is how Pontificia Universidad Católica de Chile implemented in 2015 a curricular reform derived from the joint work of academics, students and graduates. For this purpose, a model consisting of stages was followed, including the identification of the problem, general assessment of needs, definition of purpose and learning objectives. We worked with surveys, focus groups and committees of academics and students to identify and map content within the mesh, review terminal learning objectives while creating and reviewing courses for the vertically and horizontally integrated delivery of content and competencies. The first cohort of the new curriculum entered in 2015, consisting of 126 students. The implementation required constant follow-up and monitoring, establishing changes and adjustments according to educational needs and unforeseen conditions such as the COVID-19 pandemic. The implementation process of the new curriculum has been positive, adjusting to the defined strategic planning and responding to unexpected events.

Abstract This article explores the belonging of books M and N to the generalprogram of Aristotle's Metaphysics. Books XIII (My) and XIV (Ny) have remained in the background of Metaphysics, as a kind of editorial aggregate, which can be dispensed with for the understanding of the Aristotelian proposal. In this article, however, a different startingpoint is assumed, which consists in integrating these books into the core of the proposal of Metaphysics, understanding that they are key to completing the panorama of the general theory of substance, or ousiology, which guides all metaphysical books. Thus, the discussion of numbers and principles within M and N concludes the question of substance as cause and principle, announced from the beginning of Metaphysics and developed in its central books.

Resumen En el presente artículo se explora la pertenencia de los libros M y N al programa general de la Metafísica de Aristóteles. Los libros XIII (My) y XIV (Ny) han quedado en el trasfondo de la Metafísica, como una suerte de agregado editorial, del cual se puede prescindir para la comprensión de la propuesta aristotélica. En el presente artículo, sin embargo, se asume un punto de partida diferente, que consiste en integrar estos libros al núcleo de la propuesta de la Metafísica, enten diendo que ellos son claves para completar el panorama de la teoría general de la sustancia, o ousiología, que guía todos los libros metafísicos. De este modo, la discusión de M y N sobre números y principios viene a concluir la cuestión de la sustancia como causa y principio, anunciada desde el inicio de la Metafísica y desarrollada en sus libros centrales.

Aim: To describe the design and creation of a high-fidelity thoracic trauma surgery simulation model incorporating 3D printing technology using a cadaveric human torso as a model. Materials and Method: This is a descriptive study that aims to illustrate the creation process of a thoracic trauma surgery simulation model throughout the incorporation of prototypes and dynamic iteration technologies. Results: A high-fidelity reusable thoracic trauma surgery simulation model was created from the digitalization of a cadaveric torso using a computed tomography scan. Throughout digital reconstruction tools, the subcutaneous, muscular, and skeletal structures were modeled from images obtained before and after an anterolateral thoracotomy. Using 3D printing and synthetic materials, a high-fidelity thoracic cavity was built so that perfused and ventilated porcine heart and lungs could be placed. A thoracotomy patch for the anterolateral thoracotomy was designed in a reusable and low-cost fashion. This simulation model is suitable for high fidelity training in the surgical management of cardiopulmonary traumatic injuries. Conclusion: The described methodology allowed the creation of a simulation model for training and assessment of surgical skills in thoracic trauma. The main components of the simulation model are made from reusable materials, broadening access to low-cost, high fidelity training.

Resumen Objetivo: Presentar la elaboración de un simulador de trauma torácico de alta fidelidad elaborado mediante modelamiento e impresión 3D a partir de un torso humano cadavérico. Materiales y Método: Estudio descriptivo del desarrollo de un simulador de trauma torácico utilizando metodología centrada en el prototipado y la iteración basada en testeos. Resultados: Se elaboró un simulador reutilizable mediante la digitalización de un torso cadavérico utilizando tomografía computada. Se realizó una reconstrucción digital del torso diseñando los planos subcutáneos, muscular y óseo en base a las imágenes del paciente pre y postoracotomía anterolateral. Utilizando impresión 3D y materiales sintéticos, se elaboró la caja torácica para luego instalar un corazón y pulmón porcino ventilado y perfundido. Los parches de la toracotomía son reemplazables y de bajo costo. En conjunto, este simulador permite el entrenamiento en manejo de lesiones traumáticas cardiacas y pulmonares de alta fidelidad. Conclusión: La metodología presentada permite la creación de un modelo para el entrenamiento y evaluación de habilidades quirúrgicas en trauma torácico. Los elementos principales del simulador son reutilizables y permiten mantener bajos los costos del entrenamiento.

Lithium manganese oxide, LiMn2O4, was synthesized in two temperature stages, where the first consisted by an ecofriendly solution combustion method at 300 °C. Finally, the as-burned powders were thermal treated at 500 and 700 °C. The structural and morphological changes were evaluated by the Rietveld method and density functional theory (DFT) calculations. The Rietveld refinement indicates obtaining the spinel cubic phase LiMn2O4 and a small amount of Mn2O3. The analyses by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) show a porous microstructure composed of nano-sized crystallites for the sample treated at 500 °C. In cyclic voltammetry, it was possible to observe that the reduction-oxidation reaction is reversible due to the shape of voltammograms and the anodic and cathodic peaks of Mn ions. The theoretical calculations considered the experimental crystallographic parameters. The unit cell volume change was evaluated according to distinct amounts of lithium ions in the structure. The removal of the Li+ cations from the oxides promotes a volume contraction. Therefore, it was possible to evaluate the participation of the Mn3+ ions in the frontier region between the valence and conduction bands. The density of states (DOS) calculation shows a predominant contribution of the O 2p and Mn 3d orbitals in the frontier orbitals.

Resumen: En este artículo se compara el presupuesto participativo en contextos de alta y baja formalización legal, como es el caso de República Dominicana y Chile. Se aporta evidencia empírica a la tesis sostenida por algunos autores, que señala que los factores determinantes para el desarrollo del presupuesto participativo no tienen que ver necesariamente con aspectos legales, sino que sigue predominando la voluntad política de alcaldes y el rol activo que juegan organizaciones de la sociedad civil. El principal resultado es que la ley de presupuestos participativos favorece su expansión, pero no provoca profundización de los procesos de participación ciudadana. La metodología utilizada fue el método comparado del diseño del presupuesto participativo, donde se tomó como referencia las variables y dimensiones de comparación propuestas por Goldfrank (2006) y Cabannes (2004). En base a esas dimensiones se realizaron entrevistas semiestructuradas y revisión de fuentes secundarias.

Abstract: In this paper, the participatory budgeting is compared in contexts of high and low legal formalization, such as the Dominican Republic and Chile. It is argued that the institutional design that they adopt, the type of participation that takes place and the determining factors in their development do not necessarily have to do with legal aspects, but that the political will of mayors and the active role played by organizations of the civil society. The main result is that the law of participatory budgeting favors its expansion but does not cause deepening of citizen participation processes. The methodology used was the Comparative Study of the institutional design of the participatory budget. The data collection tools were the interview and the literature review of the subject.

As pilhas a combustível permitem a geração de energia elétrica de forma limpa e eficiente. Dentre seus diferentes tipos destaca-se a pilha a combustível do tipo óxido sólido (PaCOS). O óxido de cério dopado com samário (SDC) tem sido amplamente estudado, visando sua aplicação como eletrólito sólido e na elaboração do anodo tipo cermet. Inicialmente, este trabalho descreve a síntese, através do método do precursor, de nanopartículas de óxido de cério dopado com 20% mol de samário (Ce0,8Sm0,2O1,9). Posteriormente, é analisado o efeito do óxido de níquel (NiO) e do óxido de níquel dopado com 10% de cobalto (CoNiO) na sinterização de pastilhas de SDC, a 1200 ºC, visando à obtenção de porcentuais de sinterização superiores a 90%. Os materiais foram caracterizados por Difração de Raios X (DRX), Espectroscopia do Infravermelho (IV), Análise Térmica (TG/DTA), Microscopia Eletrônica de Transmissão (MET) e Espectroscopia Raman. Observou-se um aumento no percentual de sinterização de 83,1 % (pastilha de SDC pura) para 98,6% (pastilha de SDC com CoNiO). Portanto, a SDC preparada pelo método do precussor permite a obtenção de pastilhas com alta densificação, o qual é um dos pré-requisitos para sua utilização na elaboração de componentes de pilhas a combustível do tipo PaCOS.

Fuel cells allow generation of electric energy in a clean and efficient way. Among the different types of fuel cells, solid oxide fuel cell (SOFC) stands out. Samarium doped cerium oxide (SDC) have been widely studied for its application as solid electrolyte and as a component of cermet type anode. Initially, this work describes synthesis of nanoparticles of 20% mol samarium doped cerium oxide (Ce0,8Sm0,2O1,9), by the precursor method. Subsequently, we analyze the effect of nickel oxide (NiO) and 10% cobalt-doped nickel oxide (CoNiO) on the sintering at 1200 °C of SDC pellets, aiming to attaining a sintering degree higher than 90%. Materials were characterized by X-ray Diffraction (XRD), Infrared Spectroscopy (IR), Thermal Analysis (TG/DTA), Transmition Electron Microscopy (TEM) and Raman Spectroscopy. We observed an increase in percentage of sintering from 83.1% (pure SDC pellet) to 98.6% (SDC pellet with CoNiO). Therefore, SDC prepared by the precursor method allows obtaining pellets with high density, which is a prerequisite for their use in preparation of components of SOFC type fuel cells.

Almidones catiónicos fueron obtenidos a partir de almidón nativo extraído de tres variedades de yuca, a diferentes condiciones de temperatura (28-50°C) y tiempos de reacción (7-24h) utilizando cloruro de 2,3-epoxipropiltrimetilamonio como reactivo cationizante y NaOH como catalizador en un proceso seco en medio etanólico. Se estudió el efecto de estos tres factores en el grado de sustitución (DS), eficiencia de la reacción (RE) y propiedades funcionales del almidón. El DS de los almidones catiónicos y las propiedades funcionales no se vieron afectados significativamente por las condiciones de reacción a excepción de la temperatura de gelatinización, la cual es afectada por la temperatura de reacción. Se obtuvieron almidones con bajos grados de sustitución, entre 0,009 y 0,023, y las propiedades funcionales estudiadas en almidones catiónicos aumentaron con respecto a los almidones nativos.

Cationic starches were obtained from native starch extracted from cassava of three different varieties at different temperatures (28-50°C) and reaction times (7-24h) using 2,3-epoxypropyltrimethylammonium (EPTAC) as cationizing reactive and NaOH as catalyst in a dry process at ethanolyc medium. The effect of these three factors in the degree of substitution (DS), the reaction efficiency (RE) and functional properties of starch were studied. Degree of substitution (DS) of the cationic starches and functional properties are not significantly affected by the reaction conditions except for the gelatinization temperature, which is affected by the reaction temperature. Starches were obtained with low degrees of substitution between 0.009 and 0.023. Further, the functional properties studied in cationic starches are better than native starches.

A bauxita do Pará é constituída pelas seguintes camadas: nodular (BN), nodular cristalizada (BNC), cristalizada (BC), cristalizada - amorfa (BCBA) e amorfa (BA). Deste perfil geológico, somente a camada BC é lavrada, beneficiada, transportada através de mineroduto e purificada no processo Bayer. As camadas BCBA e BA possuem um elevado teor de SiO2 reativa (6-7%), o que inviabiliza sua utilização no processo. Uma proposta para dobrar as reservas de bauxita, de acordo com o parâmetro comercial, depende de um estudo de caracterização e de beneficiamento que permita identificar as principais dificuldades da utilização da camada BCBA na obtenção de alumina. Assim, este trabalho consistiu na caracterização da bauxita BCBA e no estudo reológico, com o objetivo de verificar a viabilidade desta bauxita para a produção de alumina e do seu transporte por meio de mineroduto. A caracterização da bauxita BCBA utilizou as técnicas de FRX, DRX, IV, MEV, distribuição do tamanho de partículas por meio de peneiramento, potencial zeta, a análise química pelas técnicas de absorção atômica e titulação potenciométrica. Para estudar a influência da concentração de sólidos, distribuição do tamanho de partículas obtida por diferentes tempos de moagem, temperatura e pH na viscosidade, realizou-se um planejamento de experimento 2(4-1), com ponto central. A bauxita BCBA é essencialmente gibbsítica e encontra-se associada aos minerais caulinita e hematita. Após as etapas de britagem, moagem e peneiramento, verificou-se que esta bauxita contém um teor de 41,7% de Al2O3 disponível e 7,1% de SiO2 reativa. A DRX e o IV indicaram a caulinita como a fase responsável pelo alto teor de sílica reativa desta bauxita. A avaliação estatística das variáveis de preparo da polpa indicou que a concentração de sólidos é a variável de maior influência na viscosidade, seguida pela influência da distribuição de tamanho de partículas e do pH.

Bauxite from Pará is constituted by the following layers: nodular (BN), nodular crystallized (BNC), crystallized (BC), crystallized - amorphous (BCBA) and amorphous (BA). From this geological profile only the BC layer is mined, dressed, transported through pipelines and purified in the Bayer process. The BCBA and BA layers have a high content of reactive SiO2 (6-7%) which makes its use unfeasible to the process. A proposal to double bauxite reserves, in accordance with the commercial parameter, depends on a study of characterization and beneficiation to identify the main difficulties for BCBA utilization in the Bayer process. Thus, the goals of this work were the characterization of BCBA bauxite as well as the rheological study to verify the feasibility of this bauxite for alumina production and its transport through pipeline. The characterization of BCBA bauxite used the following techniques: XRF, XRD, IR, SEM/EDS, particle size distribution through wet screening, zeta potential as well as chemical analysis by atomic absorption and potentiometric titration. To study the influence of solids concentration, particle size distribution produced by different grinding times, temperature and pH on the viscosity of bauxite pulp, a matrix experiment 24-1 around mean values was performed. The BCBA bauxite is essentially gibbsitic and is associated with kaolinite and hematite. After the steps of crushing, grinding, and screening this bauxite contains 41.7% of available Al2O3 and 7.1% of reactive SiO2. The XRD and IR identified kaolinite as the phase responsible for the high level of reactive silica in this bauxite. The statistical evaluation of the variables of the pulp preparation indicated that the solid concentration is the most influential variable on viscosity, followed by the influence of particle size and pH.

Selenium (Se) has gone, in a few years, from being considered only a toxic element to attribute it remarkable benefits for the human health: from antioxidant and hormonal regulations of thyroid functions to established anticarcinogen effects. The Se is an essential microelement for humans and livestock, but not for plants, which extract it from soil incidentally. Therefore the population Se status of a area ultimately depends on its presence in soil. In the last two decades have shown that the individual Se requirements are higher than the values referenced given for Official Organism, and that should be considered not only the direct effects of deficiency, but adequate to achieve optimal health through maximize/ optimize the Se-proteins. In Spain, the few studies on healthy people show low Se levels in blood. This fact is corroborated by the low Se concentration on the main food groups. The cereals, more specifically wheat and derivative products, is one of main groups that provide greater Se contribution to the diet. However, the wheat Se concentrations in Spain are low, partly explaining the low blood levels found in the Spanish population. It would need to involve the National Public Organizations to increase the number of studies of this subject, in order to elucidate the extent of Se deficiencies in Spanish population and to evaluate possible solutions.

El selenio (Se) ha pasado, en pocos años, de ser considerado un elemento tóxico a atribuírsele notables beneficios para la salud humana, desde funciones antioxidantes y de regulación hormonal del tiroides a efectos anticancerígenos constatados. El Se es un microelemento esencial para el hombre y el ganado, sin embargo no lo es para las plantas superiores, que lo extraen del suelo de manera "fortuita". Por consiguiente el estatus de Se de una población en una región depende en último término de su presencia en el suelo. En las dos últimas décadas se ha puesto de manifiesto que las necesidades medias por individuo son más elevadas que los valores referenciados por Organismos Oficiales, y que no sólo deberían ser considerados los efectos directos de su deficiencia, sino los adecuados para alcanzar una salud óptima a través de maximizar/optimizar las Se-proteínas. En España los pocos estudios sobre población sana muestran valores bajos de Se en sangre. Este hecho ésta corroborado por el bajo contenido en Se de los principales grupos de alimentos. Los cereales, concretamente el trigo y sus derivados, es uno de los grupos que mayor aporte de Se proporciona a la dieta. Sin embargo sus concentraciones en España son bajas, explicando en parte los bajos niveles en sangre encontrados en la población. Sería necesario una implicación por parte de los Organismos Públicos Nacionales que conlleve a un mayor número de estudios para dilucidar el verdadero alcance de las deficiencias de Se en la población española y evaluar las posibles soluciones.

Os óxidos mistos SiO2/MxOy obtidos pelo processo sol-gel, designados de compósitos, normalmente aliam as propriedades mecânicas e químicas da sílica gel com as propriedades químicas do óxido metálico (MxOy), apresentando propriedades tais como: elevado grau de dispersão e homogeneidade das partículas do óxido metálico na matriz de sílica, assim como elevada resistência mecânica e química. O objetivo deste trabalho foi o de preparar e caracterizar materiais do sistema SiO2/Mn xOy, obtidos pelo processo sol-gel, utilizando diferentes concentrações dos precursores de Mn (II), acetato ou nitrato. A técnica de fluorescência de raios X (FRX) mostrou que a concentração do óxido metálico nos materiais é dependente do precursor utilizado e da sua concentração no meio reacional, variando de 9,4% até 20,9% em massa. A maior concentração de óxido de manganês foi obtida quando se utilizou como precursor o (CH3CO2)2Mn.4H2O. Os espectros de infravermelho indicam que a rede de SiO2 é pouco perturbada pelo aumento da quantidade de óxido de manganês, sugerindo que o Mn xOy está disperso na superfície da matriz de sílica. Os difratogramas de raiosX (DRX) mostram que os materiais apresentam baixa cristalinidade. No entanto, observa-se uma mudança no DRX em 2θ = 35,7º quando o material é aquecido a 400 0C, provavelmente devido à formação de cristalitos de Mn3O4. O método de síntese proposto para os materiais SiO2/Mn xOy é reprodutível. A aplicação destes materiais como eletrodos para a redução de O2 foi avaliada e observou-se que a atividade eletrocatalítica desses materiais pode ser aumentada através do seu aquecimento a 400 0C.

The mixed oxides SiO2/MxOy obtained by the sol-gel process, designated as composites, usually combine both mechanical and chemical properties of silica gel with the chemical properties of metal oxide (MxOy), showing properties such as: high degree of dispersion and homogeneity of metal oxide particles in the silica matrix, as well as high mechanical and chemical resistance. The goal of this work was to prepare and characterize materials in the system SiO2/Mn xOy obtained by the sol-gel process, using different concentrations of Mn (II) precursors (acetate or nitrate). The technique of X-ray fluorescence showed that the concentration of metal oxide in the materials is dependent on the precursor used and its concentration, ranging from 9.4% up to 20.9% by mass. The highest concentration of manganese oxide was obtained when (CH3CO2)2Mn.4H2O was used as precursor. The infrared spectra indicate that the network of SiO2 is not disturbed by the increase in the quantity of manganese oxide, suggesting that the Mn xOy is dispersed on the surface of the silica matrix. The X-ray diffraction showed the low crystallinity of these materials. However, there is a change in the XRD on 2θ = 35.7(0) when the material is heated to 400 0C, probably due to the formation of Mn3O4 crystallites. The proposed synthesis method for materials SiO2/Mn xOy is reproducible. Application of these materials as electrodes for the reduction of O2 was evaluated and it was found that the electrocatalytic activity of these materials can be increased by heating them at 400 0C.

The mineral waste studied was host rock from a chromite mine located in Andorinha/Bahia, extracted and stockpiled in yards without specific application. Host rock was submitted to chemical analysis, XRD, SEM-EDS, IR and TGA and classified according to ABNT standards for solid waste classification. Analyses confirmed that this host rock, classified as ultrabasic, consists mainly of dolomite, calcite and diopside. Hazard assessment results showed this host rock should be classified as class II B - inert waste, important for its potential application in agriculture as a soil acidity correction agent.

Density Functional Theory (DFT) calculations on the interactions of small atoms (H, C, O, and S) on first-row transition metal clusters were performed. The results show that the adsorption site may vary between the metal surface and the edge of the cluster. The adsorption energies, adatom-nearest neighbor and adatom-metal plane distances were also determined. Finally, the authors present a discussion about the performance of these metals as anodes on solid oxide fuel cells. The results obtained agree with empirical data, indicating that the theoretical model used is adequate

Samples of Kaolin from different regions in Brazil were characterized by XRD, SEM and chemical analysis. A chemical bleaching study with pH adjustment was accomplished with the fractions below 37 μm, after classification by screening. The main objective was to evaluate the conditions of chemical bleaching that most increase the brightness of these kaolin's samples. Increases between 2.63 and 2.98% in the brightness (ISO) were observed after the chemical bleaching. We could say that the reduction of Fe3+ to Fe2+ during the chemical bleaching promoted an increase in the brightness, based on the Pourbaix Diagrams.

Objectives: According to our experience, we present a proposal for the treatment of vesicoureteral reflux, based on both clinical and radiological evidences. We also describe how the introduction of endoscopic procedures has influenced the evolution of treatment indications as well as the time intervals for treatment. Methods: We have analysed all cases of vesicoureteral reflux treated in our Department in two periods of similar length: The first one (106 patients) comprised from 1995 to March 2001 (when endoscopic procedures were introduced). The second one (138 patients), comprised from March, 2001 to March 2007. Clinical, diagnostic, therapeutic and outcome-related variables were studied for all cases. Results: The number of patients was higher in the se-cond period. In this period the number of cases requiring ureteral reimplantation decreased with respect to the first one (from 24 to 7). The success rate with endoscopic treatment reached 94,9%, with no significant differences regarding age or grade of reflux, although higher rates of failures were observed in children aged less than 3 years old and in high-grade reflux. The association of reflux with other malformations was not related with a worse evolution after treatment. Conclusions: Endoscopic treatment, due to its similar efficacy and low aggressiveness, should be considered a valid alternative to open surgery (which offers good results but non-negligible comorbidity) for persistent reflux in which medical treatment has not been useful. We propose a tentative therapeutic scheme to establish the indications for each type of treatment depending on the grade of reflux and its clinical evolution.

Objetivo: Establecer, en base a nuestra experiencia, unos esquemas terapéuticos del reflujo vesicoureteral en el niño, apoyándonos en resultados clínicos y radiológicos, observando cómo han ido evolucionando las indicaciones y tiempos de tratamiento con el advenimiento de las técnicas endoscópicas. Métodos: Se han analizado los pacientes con reflujo vesicoureteral tratados en dos periodos de similar duración: el primero (106 pacientes), entre 1995 y marzo 2001 (fecha en que se introdujeron las técnicas endoscópicas); el segundo, (138 pacientes), desde esa fecha hasta marzo de 2007. En todos los pacientes se estudiaron variables clínicas, diagnósticas y terapéuticas, así como el resultado obtenido. Resultados: El número de pacientes tratados aumentó en el segundo período, en él disminuyó ostensiblemente (de 24 a 7) el número de pacientes que requirieron reimplantación vesicoureteral. La proporción de éxitos del tratamiento endoscópico ascendió al 94,9%, no apreciándose diferencias significativas en función de la edad o el grado de reflujo, aunque se observa un mayor porcentaje de fracasos en niños menores de 3 años y en reflujos de alto grado. La presencia de malformaciones asociadas no se relacionó con una peor evolución tras el tratamiento. Conclusiones: En aquellos reflujos donde el tratamiento médico no ha sido eficaz, persistiendo o empeorando el mismo, y como alternativa a la cirugía abierta (con buenos resultados pero con una morbilidad no desdeñable), el tratamiento endoscópico se convierte en una alternativa de eficacia similar y mínimamente agresiva. Proponemos un esquema orientativo para establecer las indicaciones de cada estrategia terapéutica en función del grado de reflujo y su evolución clínica.