Atualização das Recomendações da Sociedade Brasileira de Hepatologia para o Tratamento Sistêmico do Carcinoma Hepatocelular / Brazilian society of hepatology updated recommendations for systemic treatment of hepatocellular carcinoma

ABSTRACT Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time. The SBH board conducted an online single-topic meeting to discuss and review the recommendations on the systemic treatment of HCC. The invited experts were asked to conduct a systematic review of the literature on each topic related to systemic treatment and to present the summary data and recommendations during the meeting. All panelists gathered together for discussion of the topics and elaboration of the updated recommendations. The present document is the final version of the reviewed manuscript containing the recommendations of SBH and its aim is to assist healthcare professionals, policy-makers, and planners in Brazil and Latin America with systemic treatment decision-making of patients with HCC.

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2020 a atualização das recomendações da SBH para o diagnóstico e tratamento do CHC. Desde então, novas evidências científicas sobre o tratamento sistêmico do CHC foram relatadas na literatura médica, incluindo novos medicamentos aprovados que não estavam disponíveis na época do último consenso, levando a diretoria da SBH a promover uma reunião monotemática on-line para discutir e rever as recomendações sobre o tratamento sistêmico do CHC. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização, baseada em evidências científicas, sobre cada tópico relacionado ao tratamento sistêmico e a apresentar os dados e recomendações resumidas durante a reunião. Todos os painelistas se reuniram para discutir os tópicos e elaborar as recomendações atualizadas. O presente documento é a versão final do manuscrito revisado, contendo as recomendações da SBH, e seu objetivo é auxiliar os profissionais de saúde, formuladores de políticas e planejadores no Brasil e na América Latina na tomada de decisões sobre o tratamento sistêmico de pacientes com CHC.

Basic and Clinical Research Progress of Immunotherapy for Hepatocellular Carcinoma / 肿瘤防治研究

Primary liver cancer, especially hepatocellular carcinoma, poses a serious threat to the life and health of the Chinese people. Given the insidious onset of liver cancer, less than 30% of hepatocellular carcinoma patients are considered for radical treatment at the initial diagnosis. Systemic anti-tumor therapy plays an important role in the treatment of advanced hepatocellular carcinoma. Immunotherapy of hepatocellular carcinoma has developed rapidly, and an increasing number of immunotherapy drugs, which can better control the progress of hepatocellular carcinoma and prolong the survival of patients, have become first- and second-line treatment options. This article reviews briefly the progress of immunotherapy for hepatocellular carcinoma in recent years.

Reform and Prospect of Systemic Therapy on HER2-positive Early-stage Breast Cancer / 肿瘤防治研究

In the past two decades, the survival of HER2-positive early-stage breast cancer patients has significantly improved with the development of HER2-targeted therapies. The focus has been placed on maximizing the clinical benefit of HER2-positive early-stage breast cancer by optimizing the treatment frameworks and therapeutic strategies in this field. In this paper, several important clinical studies of HER2-positive early-stage breast cancer in the neoadjuvant or adjuvant settings will be summarized and analyzed to provide clues for the development of personalized treatment strategies in the future.

Efficacy of first-line tyrosine kinase inhibitors plus immune checkpoint inhibitors in metastatic fumarate hydratase-deficient renal cell carcinoma / 中华泌尿外科杂志

Objective:To evaluate the efficacy of first-line tyrosine kinase inhibitors (TKI) plus immune checkpoint inhibitors (ICI) in metastatic fumarate hydratase-deficient renal cell carcinoma (FH-deficient RCC).Methods:The data of 87 metastatic FH-deficient RCC patients from West China Hospital ( n=44), Renji Hospital ( n=27) and Sun Yat-sen University Cancer Center (n=16) from Mar 2019 to Aug 2022 were retrospectively analyzed. The median age was 37(30, 47) years, the male to female ratio was 1.9∶1. The median size of tumor was 7.5(5.0, 10.0) cm. Sixty-one patients (70.1%) had germline FH mutations, and 26 patients (29.9%) had somatic FH mutations. Forty-nine patients (56.3%) metastasis disease at initial diagnosis, and 38 patients (43.7%) had metachronous metastasis. The most common site of metastasis was lymph node (41/87, 47.1%), followed by bone (33/87, 37.9%), liver (22/87, 25.3%), and lung (14/87, 16.1%). Fifteen patients (17.2%) had weak expression of FH protein and 59 patients (67.8%) had positive PD-L1 expression. The most common treatments were sintilimab plus axitinib (52/87, 59.8%), followed by pembrolizumab plus cabozantinib (7/87, 8.0%), tirelizumab plus axitinib (6/87, 6.9%), pembrolizumab plus axitinib (5/87, 5.7%), and toripalimab plus axitinib (4/87, 4.6%). Thirteen patients (13/87, 14.9%) received other ICI plus TKI combination treatments. Statistical analysis was conducted using R 4.2.3 software. Kaplan Meier survival curve was used to evaluate survival data, and log-rank test was used to compare differences between treatment groups. Results:The overall objective response rate (ORR) and disease control rate (DCR) of first-line TKI + ICI were 39.1% and 89.7%, respectively. The median progression-free survival (PFS) and overall survival (OS) were 16.5 months and 71.0 months, respectively. For first-line sintilimab plus axitinib, the ORR and DCR were 44.2% and 92.3%, respectively. The median PFS was 17.3 months and the median OS was not reached for this combination treatment. The efficacy of first-line tirelizumab plus axitinib was inferior to other treatment strategies (median PFS: 4.0 vs. 16.6 months, P<0.001; median OS: 22.0 vs. 71.0 months, P=0.043). Subgroup analyses further showed that the efficacy of ICI+ TKI combination therapy was consistent in patients with different clinicopathologic and genomic features. However, patients with liver metastasis had shorter OS than those without liver metastasis (median OS: 26.3 vs. 71.0 months, P=0.021). Conclusion:First-line TKI + ICI is effective for metastatic FH-deficient RCC and can significantly prolong the survival of the patients.

The efficacy of different treatment modes for locoregional recurrence after nephrectomy in patients with renal cell carcinoma / 中华泌尿外科杂志

Objective:To investigate the efficacy of different treatment modes for locoregional recurrence after nephrectomy in patients with renal cell carcinoma.Methods:A total of 106 patients with locoregional recurrence after nephrectomy without distant metastasis (77 males and 29 females) admitted to Sun Yat-sen University Cancer Center from October 2001 to July 2020 were retrospectively analyzed. The median age was 51 (40, 60) years old. Radical nephrectomy was performed in 90 patients with primary tumor and partial nephrectomy was performed in 16 patients. Pathological diagnosis showed that 54 cases were clear cell carcinoma and 52 cases were non-clear cell carcinoma. 53 cases were in stage T 1-2 and 53 cases in stage T 3-4. The median diameter of recurrent lesions was 3.2 (2.0, 6.3) cm, and the median number was 2 (1, 4). The recurrence sites were divided into renal fossa recurrence (33 cases), renal fossa±retroperitoneal lymph node recurrence (38 cases), and intra-abdominal spread (35 cases). The median duration from primary surgery to local recurrence was 14.8 (7.3, 35.8) months. Two treatment groups were identified as systemic therapy alone (Group A) and local therapy with or without systemic therapy (Group B). The Kaplan-Meier method was used to compare the progression free survival (PFS) and overall survival (OS) between Group A and Group B. The Cox model was used to perform univariate and multivariate analysis. Results:Of all the 106 patients, 33 patients were in Group A and 73 patients were in Group B. In Group A, 29 patients (87.9%) received targeted therapy, and 4 patients (12.1%) received targeted therapy combined with immunotherapy. In Group B, 34 patients (46.6%) received surgery or ablation and 39 patients (53.4%) received SBRT, of which 62 patients (84.9%) received concurrent systemic therapy. Among them, 58 patients (93.5%) received targeted therapy, and 4 patients (6.5%) received targeted therapy combined with immunotherapy. The median follow-up period was 29.0 (15.4, 45.9) months, 64 patients progressed on tumor including 28 patients died. The median PFS and OS were 15.6 (7.1, 35.2) months and 66.9 (37.8, not reached) months. The median PFS of Group A and Group B were 7.6(5.0, 17.2)months and 22.2(9.6, 63.9)months respectively ( P=0.001), median OS of Group A and Group B were 45.7 (23.4, 62.8)months and 71.0(50.6, not reached)months respectively, and the 2-year OS were 70.6% and 85.5% in Group A and Group B respectively ( P=0.023). The univariate analysis showed local therapy with or without systemic therapy was significantly reduced 56% risk of tumor progression ( HR=0.44, P=0.003) and reduced 60% risk of death ( HR=0.40, P=0.028). The multivariate analysis showed that the OS was associated with ECOG score( HR=10.20, 95% CI 4.13-25.30, P<0.001)and local therapy( HR=0.23, 95% CI 0.09-0.58, P=0.002). Conclusion:Compared with systemic therapy alone, local therapy with or without systemic therapy can effectively improve the PFS and OS of patients with locoregional recurrence after nephrectomy.

Hot topics in perioperative immune combination therapy for liver cancer / 中华肝胆外科杂志

Most patients with primary hepatocellular carcinoma (HCC) are already in advanced stage when they are diagnosed, with a short survival period and an extremely poor prognosis. HCC seriously threatens the life and health of Chinese people. In recent years, breakthroughs have been made in systemic treatment of HCC, especially in immunotherapy represented by immune checkpoint inhibitors, which has broken the single therapy situation of molecular targeted drugs. And the strategy of immunotherapy combined with anti-angiogenic therapy has shown superiority and profoundly changed the treatment strategy of HCC. This article focuses on several hotspots of immune checkpoint inhibitors combined with anti-angiogenic targeted drugs in the perioperative scenario of HCC, and takes stock of the latest research progress of immunotherapy combined with anti-angiogenic drugs regimens in the perioperative application of HCC.

Prognostic Factors in Lung Adenocarcinoma with Brain Metastasis

Introduction: Brain metastasis (BM) is significantly seen in lung adenocarcinoma and adversely affects survival. We aimed to evaluatethe factors affecting the prognosis in patients with BM diagnosed with lung adenocarcinoma. Materials and Methods: Patients with BM between 2012 and 2022 were reviewed retrospectively. Demographic characteristics of the patients, primary tumor characteristics,presence of mutation, BM number, localization, size, development time, and treatment characteristics were evaluated. Inflammatoryindices at the time of BM were examined. The overall survival time was calculated. Results: About 92.9% of 113 patients were male, the median age was 62 years (54.5–68.5), and follow‑up was 8 months (3–18). BM was detected at the time of diagnosis in 62 (54.9%)of the patients, whereas BM developed later in 51 (45.1%) patients. Systemic treatment was applied to 72.5% of the patients. Survivalwas lower in patients with BM at diagnosis (4 vs. 14 months, P < 0.001). Primary tumor maximum standardized uptake value level was higher on fluorodeoxyglucose‑positron emission tomography‑computed tomography at diagnosis in patients with late BM (P = 0.004). The development time of BM was 9 months (4–16), and the median survival was 8 months (6.2–9.8). There was no difference betweentumor localization or inflammatory indices and the development of BM and prognosis. The presence of BM at diagnosis and lack of systemic treatment were found to be factors that independently reduced survival (P < 0.001, P = 0.007). Conclusion: The presence of BM at diagnosis significantly reduces survival. It has been observed that systemic treatments applied in addition to local treatments have a positive effect on the prognosis.

Oral valganciclovir in human immunodeficiency virus-positive patients suffering from cytomegalovirus retinitis at a tertiary care hospital in North India

Purpose: To study clinical efficacy of valganciclovir in cytomegalovirus retinitis (CMVR) in human immunodeficiency virus (HIV)?positive?positive patients in a tertiary care clinic in a developing nation. Methods: In a retrospective study, systemic and ocular records of HIV patients suffering from CMVR and treated with valganciclovir, were analyzed. Primary outcome measures were involvement of the other eye, incidence of retinal detachment, systemic involvement, and mortality encountered. Secondary outcome measures included change in BCVA. Results: Out of nine patients who were included, two patients developed CMVR in the other eye and only one patient (11.11%) developed retinal detachment during the course of the study. No patient developed any systemic manifestations or had mortality during the course of the study. The change in BCVA was not statistically significant. Conclusion: Use of oral valganciclovir showed good outcome and was found to be a better alternative compared to the use of intravitreal ganciclovir in the literature. Introduction of valganciclovir at an affordable price in developing nations can decrease disease burden

Expert guidance on overall management of liver cancer during the COVID-19 / 中华消化外科杂志

The pandemic of Corona Virus Disease 2019 (COVID-19) continues, which shows the concentrated or sporadic cases in multiple places. Current COVID situation is still complex. During the COVID-19, routine diagnosis and treatment of liver cancer patients has been affected in different degrees. Under the premise of following the treatment guidelines, how to reduce the risk of infection of patients and medical staff, utilize limited medical resources to maximally ensure anti-tumor treatment and related emergency treatment, and help patients get through the epidemic period is a problem for liver oncologists. Thus, experts of liver cancer treatment related disciplines of Zhongshan Hospital, Fudan University have written the Expert guidance on overall management of liver cancer during the COVID-19, which aims to provide references for liver oncolo-gists to conduct clinical work safely and effectively under the epidemic prevention and control, and to help patients fight against the epidemic smoothly.

New progress of hepatocellular carcinoma treatment / 中华消化外科杂志

Hepatocellular carcinoma (HCC) is common in China. With the large number of HCC patients, experienced clinicians in managing this disease and the huge amounts of resources by the government to put into researches on HCC, the treatment of HCC in China has reached to the forefront of international standards in many aspects. The treatment of HCC can roughly be divided into three levels: (1) local treatment which includes liver resection, local ablative therapy and liver transplantation. The technical aspect of liver resection has become very matured. A recent study indicated that in HCC patients with microvascular invasion (MVI), anatomic liver resection resulted in significantly better long-term survival than non-anatomic liver resection. However, no significant difference could be found in HCC patients without MVI. As there are now models using preoperative data to predict presence or absence of MVI after surgery, surgeons can now decide on whether to use anatomic resection for a particular patient before surgery. Furthermore, medical evidences are accumulating on the effective and safe use of laparoscopic and robotic liver resection for selected HCC patients, which has less trauma and faster recovery compared with open hepatectomy. As the ability in predicting HCC recurrence improves, HCC patients predicted to have high risks of developing HCC recurrence can now be put into studies to investigate the treatment strategy for reducing recurrence after R 0 liver resection. There are now a lot of high level evidence studies on the use of local ablative therapy in treating HCC. Size of lesion is an important factor in choosing radiofrequency ablation (RFA) treatment alone (for diameter of HCC <2 cm), or RFA combined with transcatheter arterial chemoembolization (TACE) or percutaneous ethanol injection (for diameter of HCC with 3 to 5 cm), or to use surgery instead of RFA (for diameter of HCC >5 cm). Liver transplanta-tion has progressed rapidly in China. To supplement the Milan criteria, other criteria have been reported in China to select suitable candidates for liver transplantation beyond the Milan criteria. Furthermore, a lot of basic and clinical researches have been carried out attempting to improve the clinical outcomes of liver transplantation. (2) Regional therapies. The recent developments in TACE has focused on the use of increasingly highly selective canalization of branches of the hepatic artery to achieve bitter treatment outcomes and to decrease adverse treatment effects. Resin yttrium 90 microsphere has just been approved for clinical use in China. The indications of yttrium 90 microspheres are treatment for patients who are unsuitable to undergo TACE, failure of TACE, bridging therapy for HCC patients waiting for liver transplantation, and tumor downstaging followed by salvage liver resection. Recent developments in yttrium 90 microsphere therapies include radiation hepatectomy and ablative transarterial radioembolization. These two procedures can offer a chance of cure to patients who cannot undergo curative treatment because of poor general status, compromised liver function and unfavorable locations of HCC. (3) Systemic therapy. This is a rapidly advancing field in HCC management, which includes the use of chemotherapy, targeted therapy and immunotherapy. These therapies when used either alone, or in combination, have improved the long-term survival outcomes of patients with intermediate or late stages of HCC. A major hurdle to overcome for systemic therapy is related to the multiple gene mutations in HCC, which even with successful blockade of a tumor signal pathway, can lead to an alternate signal pathway being opened for tumor progression. In conclusions, management of HCC has rapidly improved through the enormous efforts put in by researchers in China and all around the world. It is my sincere hope that in the near future, HCC will become a very healable disease through tireless efforts of researchers.

Caracterização da clientela da clínica-escola de um instituto de terapia relacional sistêmica / Characterization of the clinic-school clientele of a system of relational systemic therapy

Este estudo teve por objetivo caracterizar o perfil clínico e sociodemográfico da clientela de uma clínica-escola de um instituto de Terapia Relacional Sistêmica, localizado na região Sul do Brasil. Foram analisadas 315 fichas de triagem dos atendimentos que ocorreram entre janeiro de 2016 e dezembro de 2017. Os dados foram analisados através de estatística descritiva por meio do programa SPSS. Os resultados mostraram que houve predomínio de atendimentos individuais, pessoas do gênero feminino, com ensino superior completo, solteiros e com idade entre 20-29 anos. As famílias que procuraram psicoterapia estavam na fase do ciclo de vida denominada família com filhos pequenos e os casais encontravam-se na faixa etária entre 30-39 anos. As principais queixas foram: dificuldades nas relações familiares, sintomas depressivos e ansiedade, as quais somaram 44,4% do total. Este estudo permitiu refletir sobre o planejamento dos serviços de psicologia e a adequação das ações voltadas às especificidades da clientela.

This study aimed to characterize clinical and demographic profile of clients of a Psychology Clinic School of an institute of Relational Systemic Therapy, located in the South region of Brazil. A number of 315 files was analyzed from the screening process occurred between January 2016 and December 2017. Data were analyzed through descriptive statistics through the SPSS program. The results showed that there was a predominance of individual patients, female, with higher education, single and age 20-29 years old. The families that searched for psychotherapy were in the stage of family with children in life cycle and couples were in the age group between 30-39 years old. The main complaints were: difficulties in family relationships, depressive and anxiety symptoms, which accounted for 44.4% of the total. This study allows reflecting about the planning of the Psychology Services and the adequacy of actions to the specifics of the clients.

Micro-fenomenología de la subjetividad del psicoterapeuta sistémico / Micro-phenomenology of the subjectivity of the systemic psychotherapist / Micro-fenomenologia da subjetividade do psicoterapeuta sistêmico

La terapia psicológica sistémica acontece en un contexto relacional, donde interactúan las subjetividades de los consultantes y los terapeutas. Las investigaciones tradicionales han focalizado más las características de los consultantes, que la subjetividad del terapeuta. De ahí que hayan privilegiado perspectivas de "tercera persona". Los pocos estudios que indagan la subjetividad del terapeuta recurren a metodologías introspectivas, interpretativas y prescriptivas. ¿Cómo acceder a la subjetividad del terapeuta desde perspectivas distintas a las que ofrecen la observación en "tercera persona" y la introspección en "primera persona"? El propósito del artículo es explorar, mediante el método micro-fenomenológico, cómo se muestra la subjetividad del terapeuta en la primera impresión de un consultante. Para ello, se realizaron entrevistas a seis terapeutas. Los resultados evidencian que la emocionalidad en-activa aparece como una invariante de la subjetividad del terapeuta; y que esta invariante opera como una "motivación inteligente", la cual entra "en acción" en el trascurso de la relación intersubjetiva misma y, permanentemente, monitorea y orienta el proceso terapéutico. Los resultados permiten considerar, por un lado, que las investigaciones tradicionales han subvalorado la importancia de la emocionalidad en-activa en el proceso terapéutico; y, por otro, que el mejoramiento cualitativo de la terapia implica no sólo reconocer esta invariante, sino también cultivarla.

Systemic psychological therapy takes place in a relational context, where the subjectivities of the consultants and the therapists interact. Traditional research has focused more on the characteristics of the consultants than on the subjectivity of the therapist. Hence, "third person" perspectives have been privileged. The few studies that investigate the subjectivity of the therapist resort to introspective, interpretive and prescriptive methodologies. How to access the subjectivity of the therapist from different perspectives than those offered by "third person" observation and "first person" introspection? The purpose of the article is to explore, through the micro-phenomenological method, how the subjectivity of the therapist is shown in the first impression of a consultant. To do this, interviews were conducted with six therapists. The results show that en-active emotionality appears as an invariant of the therapist's subjectivity; and that this invariant operates as an "intelligent motivation", which enters "into action" in the course of the intersubjective relationship itself and permanently monitors and guides the therapeutic process. The results allow us to consider, on the one hand, that traditional research has undervalued the importance of en-active emotions in the therapeutic process; and, on the other, that the qualitative improvement of therapy implies not only recognizing this invariant, but also cultivating it.

A terapia psicológica sistêmica ocorre em um contexto relacional, onde as subjetividades das pessoas que consultam interagem. A pesquisa tradicional se concentrou mais nas características das pessoas que consultam do que na subjetividade do terapeuta. Portanto, as perspectivas da "terceira pessoa" foram privilegiadas. Os poucos estudos que investigam a subjetividade do terapeuta recorrem a metodologias introspectivas, interpretativas e prescritivas. Como acessar a subjetividade do terapeuta sob perspectivas diferentes daquelas oferecidas pela observação em "terceira pessoa" e introspecção em "primeira pessoa"? O objetivo do artigo é explorar, através do método micro-fenomenológico, como a subjetividade do terapeuta é mostrada na primeira impressão de um consultor. Para isso, foram realizadas entrevistas com seis terapeutas. Os resultados mostram que a emocionalidade em-ativa aparece como um invariante da subjetividade do terapeuta; e que esse invariante opera como uma "motivação inteligente", que entra em "ação" no curso da própria relação intersubjetiva e monitora e guia permanentemente o processo terapêutico. Os resultados permitem considerar, por um lado, que a pesquisa tradicional subvalorizou a importância das emoções em-ativas no processo terapêutico; e, por outro lado, que a melhoria qualitativa da terapia implica não apenas reconhecer esse invariável, mas também cultivá-lo.

Clinical efficacy of hepatic artery infusion chemotherapy combined with immunotherapy plus target therapy for advanced hepatocellular carcinoma / 中华消化外科杂志

Primary liver cancer is one of the common malignant tumors and its mortality ranks third in the world. Because there are no obvious symptoms in the early stage of liver cancer, most patients are diagnosed as advanced stage, without the opportunity of surgical resection. The authors report a case of hepatocellular carcinoma with portal vein tumor thrombus, which reduced significantly after hepatic artery infusion chemotherapy combined with bevacizumab and atezolizumab, showing the safety and efficacy.

Sequence selection of postoperative radiotherapy and systemic treatment for breast cancer patients / 中华放射医学与防护杂志

The role of postoperative adjuvant therapy is crucial for breast cancer. Also, there is no doubt that the combination of effective postoperative radiotherapy and adjuvant systemic therapy can not only reduce the local recurrence rate, but also improve the survival rate of patients. Although the timing of postoperative radiotherapy and part of systemic therapy is clear, some part of treatment regimens still remain elusive. In particular, the safety of concurrent therapy of postoperative consolidation chemotherapy and postoperative radiotherapy in patients with neoadjuvant chemotherapy, the safety of concurrent therapy of postoperative dual-targeted therapy and postoperative radiotherapy in HER2-positive patients, and the safety of simultaneous radiotherapy of small molecule inhibitors need to be further clarified. This article reviews the related papers on the sequence selection of postoperative radiotherapy and postoperative adjuvant systemic therapy for breast cancer.

Cuidados inconsistentes durante a infância e relações de apego na adolescência: um estudo de caso / Inconsistent childhood care and adolescent attachment relationships: a case study

O presente trabalho consiste em um estudo de caso clínico de uma adolescente, realizado em um serviço de atendimento psicológico. Ao longo da terapia sistêmica individual foram abordados aspectos da história da paciente, como negligência, perdas, adoção intrafamiliar e apego inseguro. O processo terapêutico considerou a paciente no contexto da sua história, rede de relacionamentos e experiências, enfatizando os significados que ela atribuía a esses eventos. Assim, dentro das particularidades do caso, trabalhou-se para compreender o impacto na relação entre o tipo de cuidado recebido na infância e o apego na adolescência e construção de self. Entende-se que esse estudo pode contribuir para se pensar em estratégias de intervenção sistêmica que auxiliem a mudança na visão de pais ou cuidadores com relação ao apego de adolescentes.

This work consists in a clinical case study of a female teenager, held in a psychological service. Throughout the individual systemic therapy aspects of the patient's history were addressed, such as negligence, losings, intra-family adoption and insecure attachment. The therapeutic process considered the patient in the context of her history, relationships' network and experiences, emphasizing the meanings that she attributed to these events. Thus, within the particularities of the case, the clinical work aimed to understand the impact on the relationship between the type of care received in childhood, attachment in adolescence and self-construction. This study may contribute to elaborate strategies of strategies of systemic intervention that help change the vision of parents or caregivers with regard to attachment of adolescents.

Problemas de comportamento infantil no contexto da família em crise conjugal: contribuições da terapia sistêmica / Problems of children's behavior in the family context: contributions from systemic therapy

O presente artigo pretende articular elementos de um atendimento clínico familiar à luz do referencial sistêmico, buscando entender as influências do sistema familiar, especificamente do subsistema conjugal, para o surgimento e a perpetuação de sintomas desafiadores infantis. O estudo caracteriza-se como qualitativo e utiliza a abordagem metodológica do estudo de caso clínico, descrevendo o processo de terapia sistêmica familiar da criança de cinco anos identificada como Maiara. Foram oferecidos sete atendimentos, mas a família só compareceu em quatro deles. Os resultados evidenciam que a criança, através de suas crises convulsivas e de suas atitudes desafiadoras, expressa uma dificuldade do grupo familiar, mais especificamente uma crise conjugal que vinha se agravando após a chegada dos filhos. Considera-se que as sessões realizadas auxiliaram a família nas mudanças que necessitava realizar, evitando a sobrecarga emocional de seus membros, bem como a somatização da paciente identificada.

The present article aims to articulate elements of a clinical family service using the systemic referential. The aim is to understand the influences of the family system, specifically the conjugal subsystem, for the outbreak of and perpetuation of children's challenging symptoms. This qualitative study uses the methodological approach of the clinical case study, it describes the process of systemic family therapy of the five-year-old child identified as Maiara. Seven appointments were offered, but the family only attended four of them. The results show that the child, with her convulsive crisis and challenging attitudes, expresses a difficulty of the family group, more specifically a marital crisis that was getting worse after the arrival of the children. It is considered that the sessions performed helped the family to deal with the necessary changes in their lives and this avoided the emotional overload of the family members, as well as the somatization of the identified patient.

A importância do pai no tratamento sistêmico da anorexia nervosa / The importance of father in systemic treatment of anorexia nervosa

Este artigo visa a tratar dos aspectos relacionados à função paterna na anorexia nervosa e da sua potencial importância dentro da terapia familiar sistêmica, após uma breve contextualização no desenvolvimento histórico do seu conceito nosológico, bem como relacionar com a figura e a função paterna na literatura científica. Há bastante informação teórica a respeito das relações intrafamiliares na anorexia, porém análises específicas da função paterna são escassas, prevalecendo os aspectos da relação mãe-filha. Abordaremos também um exemplo de caso da paciente R., diagnosticada com anorexia nervosa e tratada no grupo de Transtornos Alimentares no Centro de Atenção Psicossocial da Infância (CAPSi) do Hospital de Clínicas de Porto Alegre (HCPA), vinculado à Universidade Federal do Rio Grande do Sul (UFRGS), no qual consideramos o papel desempenhado pelo pai como fundamental para uma recuperação mais rápida e eficaz.

This article aims to address the issues related to the paternal function in anorexia nervosa and its potential importance within its systemic treatment, after a brief background on the historical development of its nosological concept and relate it to the image and the role of the father in the scientific literature. There is a lot of information about the intra-family relationships in anorexia, but specific analysis of the paternal role are scarce, prevailing aspects of the mother-daughter relationship. We will also explore the case example of patient "R"., diagnosed with anorexia nervosa and treated in the Eating Disorders Group in the Center for Psychosocial Care for Children (CAPSi) of Porto Alegre Clinical Hospital (HCPA), linked to the Federal University of Rio Grande do Sul (UFRGS), where we consider the role of the father as a main instrument in her quick recovery.

Respuesta del tumor primario a la quimioterapia en cáncer colorrectal etapa IV con metástasis hepáticas sincrónicas: serie de casos / Response of the primary tumor to chemotherapy in stage IV colorectal cancer with synchronous liver metastases: serie of cases

Resumen Introducción: El cáncer colorrectal se ha convertido en el tercer cáncer a nivel mundial en cuanto a incidencia y cuarto en mortalidad. Al diagnóstico, aproximadamente el 25% de los pacientes tendrán metástasis hepáticas. Con tratamiento adecuado el pronóstico de los pacientes etapa IV alcanza una sobrevida de 40% a 5 años. Con nuestro trabajo queremos evaluar la respuesta del tumor primario de colon desde el punto de vista imagenológico y anatomopatológico en pacientes con cáncer colorrectal con metástasis hepáticas tratados con quimioterapia y que luego fueron a resección del colon. Materiales y Método: Se trata un estudio retrospectivo y descriptivo, de pacientes con cáncer colorrectal con metástasis hepáticas. Los criterios de inclusión fueron que presentaran cáncer de colon o recto superior, con metástasis hepáticas sincrónicas, recibieran al menos 4 ciclos de quimioterapia neoadyuvante y que posteriormente fueran a resección del tumor primario. Resultados: Se reclutaron 9 pacientes, 4 hombres y 5 mujeres. Todos recibieron 4 o más ciclos de quimioterapia previo a la cirugía del tumor primario. De ellos, 8 tuvieron control imagenológico posquimioterapia. Según criterios RECIST, 3 pacientes presentaron respuesta completa, 1 paciente respuesta parcial y 4 enfermedad estable. El estudio anatomopatológico del colon resecado mostró desaparición tumoral macroscópica en 2 pacientes y microscópica en 1 paciente. Conclusiones: La regresión patológica completa en nuestros casos tratados con quimioterapia neoadyuvante es un hecho poco frecuente. Esto nos permite indicar la resección del sitio del tumor colorrectal en todos estos casos.

Introduction: Colorectal cancer has become the third cancer worldwide in terms of incidence and fourth in mortality. At diagnosis approximately 25% of patients will have liver metastases. With adequate treatment, the prognosis of stage IV patients reaches a survival of 40% at 5 years. We want to evaluate the response of the primary tumor of the colon from imaging and anatomopathological point of view in patients with colorectal cancer with liver metastases treated with chemotherapy and who then went to colon resection. Materials and Method: It is a retrospective and descriptive study of patients with stage IV colorectal cancer. The inclusion criteria were that they had cancer of the colon or upper rectum, with synchronous liver metastases, who have received at least 4 cycles of neoadjuvant chemotherapy and that subsequently went to resection of the primary tumor. Results: We recruited 9 patients, 4 men and 5 women. All received 4 or more cycles of chemotherapy prior to primary surgery. Of these, 8 had imaging control after chemotherapy. According to RECIST criteria, 3 patients presented complete response, 1 patient partial response and 4 stable disease. The anatomopathological study of the resected colon showed a macroscopic tumor disappearance in 2 patients, and microscopic in 1 patient. Conclusions: The complete pathological regression in our cases treated with neoadjuvant chemotherapy is a rare occurrence. This allows us to indicate the resection of the colorectal tumor site in all these cases.

Retrospective Analysis of Risk Factors for Venous Thromboembolism in 283 Patients with Lung Cancer during Systemic Therapy / 中国肺癌杂志

BACKGROUND@#Patients with lung cancer have high risk of developing venous thromboembolism (VTE), which has been shown to have a significant impact on mortality. This study was to identify the incidence of VTE in lung cancer patients during systemic therapy and to analyze the risk factors associated with it.@*METHODS@#We retrospectively analyzed the cases of 283 patients with lung cancer who received systemic therapy in the Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, from January 2016 to December 2018. Chi-square test and multivariate analyses were used to assess the correlation between clinical features and VTE.@*RESULTS@#Of the patients we observed, 34 developed VTE, with an incidence of 12.01% (34/283). In patients with lower extremity varicose vein (LVV), there was an increase in the incidence of VTE (50.00% vs 9.89%, P=0.001). The incidence VTE in patients with distant metastasis was higher than that in patients without distant metastasis, and higher than that in patients with tumor-free (14.05% vs 14.00% vs 2.08%, P=0.024). The incidence of VTE in patients with active tumor was also significantly higher than that in patients without it (16.93% vs 8.18%, P=0.025). Patients with hypoalbuminemia (albumin 0.3 µg/mL) developed more VTE than those without did (17.93% vs 5.80%, P=0.006). There were no significant correlations between pathological types, blood cell count before systemic therapy including leukocyte, hemoglobin and platelet, or antiangiogenic drugs and VTE. Multivariate analysis showed that LVV, hypoalbuminemia and elevated level of D-dimer were independent risk factors of VTE.@*CONCLUSIONS@#LVV, serum albumin and D-dimer level may be potential and more effective predictors of VTE in lung cancer patients during systemic therapy. Basing on these factors, new predictive model can be built, and further study to validate its efficacy is required.

Systemic Therapy for Advanced and Metastatic Colon Cancer / 대한소화기학회지

Colon cancer is one of the three most common cancers in both men and women in Organization for Economic Cooperation and Development countries. Approximately one-quarter of colon cancer patients have a metastasis at the time of diagnosis, and systemic therapy is used in many of them as a first line therapy. In addition to existing cytotoxic drugs, target therapy has been introduced in colon cancer and immunotherapy has shown clinical benefits in the treatment of metastatic colon cancer. The purpose of this review was to briefly summarize the National Comprehensive Cancer Network guidelines for systemic therapy in colon cancer with special reference to targeted agents and novel agents.