Neoadjuvant immunotherapy in microsatellite stability or mismatch repair proficient colorectal cancer / 中华胃肠外科杂志

Immunotherapy has become an important treatment option for microsatellite instability-high (MSI-H) and mismatch repair deficient (dMMR) colorectal cancer. From late-line to first-line treatment, and even in neoadjuvant setting for early stage colorectal cancer, promising efficacy was observed with immunotherapy. In microsatellite stability (MSS) or mismatch repair proficient (pMMR) colorectal cancer, the researches of neoadjuvant immunotherapy have been conducted constantly. This paper focuses on the recent researches and progress of neoadjuvant immunotherapy for MSS or pMMR colorectal cancer. Neoadjuvant immunotherapy alone led to a good pathological response in a subset of patients. Studies of induction or consolidation immunotherapy before or after neoadjuvant chemoradiotherapy or concurrent immunotherapy during radiotherapy showed higher pathological complete remission (pCR) rates as compared to standard chemoradiotherapy. Studies on sequential dual immunotherapy after radiochemotherapy and targeted therapy combined with neoadjuvant immunotherapy are ongoing. At present, most of these are pilot studies with small sample size. More researches and long-term follow-up are needed to prove the efficacy of neoadjuvant immunotherapy in MSS or pMMR colorectal cancer.

Short-term outcome of programmed cell death protein1 (PD-1) antibody combined with total neoadjuvant chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer with high risk factors / 中华胃肠外科杂志

Objective: Total neoadjuvant chemoradiotherapy is one of the standard treatments for locally advanced rectal cancer. This study aims to investigate the safety and feasibility of programmed cell death protein 1 (PD-1) antibody combined with total neoadjuvant chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer with high-risk factors. Methods: A descriptive cohort study was conducted. Clinicopathological data of 24 patients with locally advanced middle-low rectal cancer with high-risk factors receiving PD-1 antibody combined with neoadjuvant chemoradiotherapy in Gastrointestinal Cancer Center, Unit III, Peking University Cancer Hospital between January 2019 and April 2021 were retrospectively analyzed. Inclusion criteria: (1) rectal adenocarcinoma confirmed by pathology; patient age of ≥ 18 years and ≤ 80 years; (2) the distance from low margin of tumor to anal verge ≤ 10 cm under sigmoidoscopy; (3) ECOG performance status score 0-1; (4) clinical stage T3c, T3d, T4a or T4b, or extramural venous invasion (EMVI) (+) or mrN2 (+) or mesorectal fasciae (MRF) (+) based on MRI; (5) no evidence of distant metastases; (6) no prior pelvic radiation therapy, no prior chemotherapy or surgery for rectal cancer; (7) no systemic infection requiring antibiotic treatment and no immune system disease. Exclusion criteria: (1) anticipated unresectable tumor after neoadjuvant treatment; (2) patients with a history of a prior malignancy within the past 5 years, or with a history of any arterial thrombotic event within the past 6 months; (3) patients received other types of antitumor or experimental therapy; (4) women who were pregnant or breast-feeding; (5) patients with any other concurrent medical or psychiatric condition or disease; (6) patients received immunotherapy (PD-1 antibody). The neoadjuvant therapy consisted of three stages: PD-1 antibody (sintilimab 200 mg, IV, Q3W) combined with CapeOx regimen for three cycles; long-course intensity modulated radiation therapy (IMRT) with gross tumor volume (GTV) 50.6 Gy/CTV 41.8 Gy/22f; CapeOx regimen for two cycles after radiotherapy. After oncological evaluation following the end of the third stage of treatment, surgery or watch and wait would be carried out. Surgical safety, histopathological changes and short-term oncological outcome were analyzed. Results: There were 15 males and 9 females with a median age of 65 (47-78) years. Median distance from the lower margin of the tumor to the anal verge was 4 (3-7) cm. The median maximal diameter of the tumor was 5.1 (2.1-7.5) cm. Twenty patients were cT3, 4 were cT4, 8 were cN1, 5 were cN2a, 11 were cN2b. Ten cases were MRF (+) and 10 were EMVI (+). All the patients were mismatch repair proficient (pMMR). During the neoadjuvant treatment period, 6 patients (25.0%) developed grade 1-2 treatment-related adverse events, including 3 immune-related adverse events. As of April 30, 2021, 20 patients (83.3%, 20/24) had received surgical resection, including 19 R0 resections and 16 sphincter-preservation operations. Morbidity of postoperative complication was 25.0% (5/20), including 2 cases of Clavien-Dindo grade II (1 of anastomotic bleeding and 1 of pseudomembranous enteritis), 3 cases of grade I anastomotic stenosis. Pathological complete response (pCR) rate was 30.0% (6/20) and major pathological response rate was 20.0% (4/20). None of Ras/Raf mutants had pCR or cCR (0/5), while 6 of 17 Ras/Raf wild-type patients had pCR and 3 had cCR, which was significantly higher than that of Ras/Raf mutants (P<0.01). Nine of 16 patients with Ras/Raf wild-type and differentiated adenocarcinoma had pCR or cCR. Among other 4 patients without surgery, 3 patients preferred watch and wait strategy because their tumors were assessed as clinical complete response (cCR), while another one patient refused surgery as the tumor remained stable. After a median follow-up of 11 (6-24) months, only 1 patient with signet ring cell carcinoma had recurrence. Conclusions: PD-1 antibody combined with total neoadjuvant chemoradiotherapy in the treatment of locally advanced rectal cancer has quite good safety and histopathological regression results. Combination of histology and genetic testing is helpful to screen potential beneficiaries.

Dictamen médico legal de un análisis de voz, ¿cómo hacerlo? / Medical legal opinion of a voice analysis, how to do it?

La acústica forense es una disciplina de la criminalística que ha alcanzado una ma-durez analítica que obliga a que el perito en análisis de voz se especialice en adquirir conocimientos en fonética, tecnologías de sonido, habla, voz, lenguaje, patologías del habla y la voz, así como procesamiento de la señal sonora. Cuando un dictamen deba ser realizado por un profesional de la salud completamente ajeno a la técnica legal, se tropieza con una falta de protocolos, métodos y procedimientos de trabajo que le permitan entregar un informe técnico, válido y validado para la realización de una entrevista y su posterior análisis comparativo de voces, lo que promueve la necesidad de elaborar una ruta o guía metodológica a través de medios académicos físicos o electrónicos para el desarrollo de este conocimiento y su difusión profesional y científica

Forensic acoustics is a criminalistics discipline that has reached an analytical maturity that requires the expert in voice analysis to specialize in acquiring knowledge in pho-netics, sound technologies, speech, voice, language, speech, and voice pathologies, as well as sound signal processing. When an opinion must be made by a health profes-sional completely unrelated to the legal technique, he encounters a lack of protocols, methods, and work procedures that allow him to deliver a technical, valid, and vali-dated report for conducting an interview and its subsequent comparative analysis of voices, which promotes the need to develop a methodological route or guide through physical or electronic academic means for the development of this knowledge and its professional and scientific dissemination

What are the proficient nurses view on and attitudes toward their position during nursing position management reform: a qualitative study in a public hospital of Beijing / 中国实用护理杂志

Objective To explore what are the proficient nurses view on and attitudes toward their position during nursing position management reform, in order to promote development of nursing stratified management and position management. Methods The semi-structure review was utilized for 50 proficient nurses work in different specialist area in a three-level general hospital. Data was analyzed based on Colaizzi analysis method. Results 4 themes were refined: (1) clearly view on position, stratified management is meaningful (2) feeling of acceptance and pressure (3) unclear of job content, unsatisfied between effort and reward (4) desire for communication and official support. Conclusions Proficient nurses have clear view on and positive attitudes towards their position. Nursing management should formulate more detailed job content and job responsibility, provide more opportunity of communication, which could promote these proficient nurses′career developments.

Medicina legal, peritos y peritaciones / Legal Medicine, experts and surveys

En el presente trabajo se expone la evolución histórica de Medicina Legal y cómo ha sido aplicada en diversos contextos. Se resalta la labor del perito como un experto, separándolo de lo que habitualmente es considerado cuando declara en un juicio: un simple testigo. Precisamente existen marcadas diferencias entre éste y un perito, el cual debe poseer una gran cantidad de valores éticos, morales y sociales para no deformar la verdad de los hechos. Asimismo, se sugiere cuáles deben ser las partes que deben poseer una peritación médico legal para que tenga un adecuado valor como instrumento probatorio durante un proceso judicial. Todo lo anterior siempre con el fin de mejorar la Administración de Justicia...