Delayed subaponeurotic fluid collection (DSFC): systematic review and case report.

PURPOSE: DSFC (delayed subaponeurotic fluid collection) is a benign pathology associated with the first weeks of life and scarcely described in the literature. Normally characterized by a lack of trauma and/or cranial fracture, it is associated with a history of instrumental delivery and the use of fetal electrodes. Taking it in consideration in the differential diagnosis of neonatal scalp swelling becomes important. The objective of this work is to expand knowledge on this entity: history, clinical characteristics, diagnosis, and treatment. METHODS: This article describes a new clinical case and conducts a systematic review according to the PRISMA criteria. RESULTS: Sixty-seven cases are included, they are summarized in a table. CONCLUSIONS: DSFC appears generally 15-16 weeks after birth. The diagnosis is mainly clinical, based on a history of instrumental birth, labor dystocia, or trauma, and with compatible symptoms and evolution. It may be supported by complementary tests such as ultrasound and or CT of the skull in doubtful cases. The treatment of choice is only conservative, and all cases resolve spontaneously and completely after an average of 4 weeks.

Cerebellar Hemangioblastoma with Leptomeningeal Spread and a Fatal Outcome: A Rare Case Report with MDM2 and EGFR Alterations.

Hemangioblastoma (HB) is a Central Nervous System (CNS) tumor with a generally favorable behavior and prognosis, classified as WHO grade 1. Sporadic HB is not related to any inherited disease, and it usually appears in a single location. Sporadic or VHL-related HBs show variable patterns of growth velocity. Cases of growing HB can cause mild symptoms such as headache, but some cases develop serious complications such as accumulation of cerebrospinal fluid in the brain with secondary neurological damage sometimes being irreversible when early treatment is not started. Our case showed some clinical characteristics more frequently observed in VHL-related HB rather than sporadic HB, and the presence of alterations in MDM2 and EGFR that could be related to the oncogenesis of these tumors. Even when the treatment of choice for HB is surgery, the presence of these genetic alterations could open a new window for research aimed at assessing the possibility of new therapies with TKIs-EGFR and anti-MDM2 inhibitors in those HB cases with multifocal recurrences or cases with an adverse clinical behavior.

Slope until reaching the plateau: a new predictor of valve response obtained by lumbar infusion test for idiopathic normal pressure hydrocephalus.

BACKGROUND: Diagnosis of idiopathic normal pressure hydrocephalus (iNPH) is based on clinical, radiological, and hydrodynamic data of cerebrospinal fluid (CSF) obtained by invasive methods such as lumbar infusion test, which is used to determine the resistance to CSF outflow (Rout). However, Rout has limitations, and its value as predictor of valve response is questioned. Other variables can be obtained by lumbar infusion test, such as the time to reach the plateau (TRP) and the slope until reaching the plateau (SRP). The objectives were to determine if SRP could be a predictor of response to ventriculoperitoneal shunt (VPS) and what variable (Rout versus SRP) would have greater predictive value. METHOD: Patients with probable iNPH who underwent a lumbar infusion test and were indicated for a VPS were retrospectively studied. Two groups were established, responders and non-responders. Rout, TRP (period between the start of infusion until reaching the plateau measured in seconds) and SRP ((plateau pressure-opening pressure)/TRP) were obtained. For Rout and SRP, the receiver operating curves (ROC) with its areas under the curve (AUC) were calculated. RESULTS: One hundred ten patients were included, being 86 responders (78.20%). Shunt responders had a significantly greater Rout (17.02 (14.45-20.23) versus 13.34 (12.10-16.28) mmHg/ml/min, p = 0.002) and SRP (0.049 (0.043-0.054) versus 0.031 (0.026-0.036) mmHg/sec, p < 0.001) and smaller TRP (641.28 (584.83-697.73) versus 777.65 (654.03-901.27) sec, p = 0.028) than non-responders. The AUC for SRP was greater than the AUC for Rout (0.763 (95 % CI 0.655-0.871, p < 0.001) versus 0.673 (95 % CI 0.595-0.801, p = 0.008), respectively), but the differences were not significant (p = 0.180). CONCLUSIONS: SRP could be considered predictor of response to VPS, and its accuracy tends to be better than Rout. So, this variable may be a useful tool to select shunt candidates among patients with probable iNPH.

Tumor cell and immune cell profiles in primary human glioblastoma: Impact on patient outcome.

The distribution and role of tumor-infiltrating leucocytes in glioblastoma (GBM) remain largely unknown. Here, we investigated the cellular composition of 55 primary (adult) GBM samples by flow cytometry and correlated the tumor immune profile with patient features at diagnosis and outcome. GBM single-cell suspensions were stained at diagnosis (n = 44) and recurrence following radiotherapy and chemotherapy (n = 11) with a panel of 8-color monoclonal antibody combinations for the identification and enumeration of (GFAP+ CD45- ) tumor and normal astrocytic cells, infiltrating myeloid cells -i.e. microglial and blood-derived tumor-associated macrophages (TAM), M1-like, and M2-like TAM, neutrophils. and myeloid-derived suppressor cells (MDSC)- and tumor-infiltrating lymphocytes (TIL) -i.e. CD3+ T-cells and their TCD4+ , TCD8+ , TCD4- CD8- , and (CD25+ CD127lo ) regulatory (T-regs) subsets, (CD19+ CD20+ ) B-cells, and (CD16+ ) NK-cells-. Overall, GBM samples consisted of a major population (mean ± 1SD) of tumor and normal astrocytic cells (73% ± 16%) together with a significant but variable fraction of immune cells (24% ± 18%). Within myeloid cells, TAM predominated (13% ± 12%) including both microglial cells (10% ± 11%) and blood-derived macrophages (3% ± 5%), in addition to a smaller proportion of neutrophils (5% ± 9%) and MDSC (4% ± 8%). Lymphocytes were less represented and mostly included TCD4+ (0.5% ± 0.7%) and TCD8+ cells (0.6% ± 0.7%), together with lower numbers of TCD4- CD8- T-cells (0.2% ± 0.4%), T-regs (0.1% ± 0.2%), B-lymphocytes (0.1% ± 0.2%) and NK-cells (0.05% ± 0.05%). Overall, three distinct immune profiles were identified: cases with a minor fraction of leucocytes, tumors with a predominance of TAM and neutrophils, and cases with mixed infiltration by TAM, neutrophils, and T-lymphocytes. Untreated GBM patients with mixed myeloid and lymphoid immune infiltrates showed a significantly shorter patient overall survival versus the other two groups, in the absence of gains of the EGFR gene (p = 0.02). Here we show that immune cell infiltrates are systematically present in GBM, with highly variable levels and immune profiles. Patients with mixed myeloid and T-lymphoid infiltrates showed a worse outcome.

Content analysis of the effects of palliative care learning on the perception by nursing students of dying and dignified death.

BACKGROUND: Providing care for dying people and the death of patients are stressing situations faced by nursing students during their clinical practice. Learning about palliative care improves the management of emotions and the ability to cope when caring for patients in end-of-life processes. However, there is little knowledge on the effect of this learning on the students' perceptions of their own death. OBJECTIVES: To determine the effect of a palliative care course on the thoughts of nursing students about their own death. DESIGN: A qualitative, descriptive, and comparative study was conducted based on content analysis, administering an open-ended questionnaire on dying and death at the start and end of a palliative care course. PARTICIPANTS: The study included 85 volunteers studying Palliative Care in the second year of their Nursing Degree at the University of Granada (Spain). RESULTS: Students described their perceptions in more detail after the course, with more numerous code citations, and their post-course responses evidenced a reduction in anxiety about their own death and an increased recognition of the need to respect the decisions of patients for a dignified death. CONCLUSIONS: Palliative care learning modifies the perception by nursing students of their own death and their understanding of a dignified death, which may enhance the care they deliver to patients at the end of life.

Facing death. Student's thoughts towards the feeling of their own death / La muerte ante uno mismo. Respuestas de jóvenes estudiantes ante el pensamiento de la propia muerte

Narratives produced by thinking and reflecting about death and dying may be themselves a source of new knowledge in the study of anxiety and attitudes toward death. A qualitative descriptive study aimed to explore the features of thoughts, emotions and feelings about young people's own death, (nursing students) was conducted. 85 students voluntarily answered a self-administered questionnaire with open questions based on Mortality Salience, used in the Terror Management Theory. Content analysis using Atlas.ti software was performed. When reflecting upon their own death, participants reported substantive emotions such as fear, pain, distress, sadness or loneliness. The fear of their own death was specified as the inability to achieve goals in life, to leave the family and the dying process itself. When reflecting upon been physically dead, attributes of the decomposition of the body, spiritual attributes, beliefs, denial and preferences were identified. Cultural worldview, values and beliefs of each person were remarkably present when thinking about their own death (AU)

Las narraciones sobre lo que evoca pensar en la propia muerte y describir los pensamientos y sentimientos sobre el morir, pueden ser por sí mismas una fuente de conocimiento nuevo en el estudio de la ansiedad y las actitudes ante la muerte. Se llevó a cabo un estudio cualitativo descriptivo con el objetivo de explorar las características de los pensamientos, las emociones y sentimientos sobre la propia muerte de jóvenes, estudiantes de enfermería. 85 estudiantes respondieron voluntariamente un cuestionario autoadministrado de preguntas abiertas basadas en la Mortality Salience empleada en la Teoría de la Gestión del Terror. El análisis se realizó mediante la estrategia de análisis de contenido con el programa Atlas ti. Ante el pensamiento sobre la propia muerte respondieron con los sustantivos miedo, dolor, angustia, tristeza o soledad. El miedo a la propia muerte se concretó como la imposibilidad de lograr las metas en la vida, dejar a la familia y el proceso de muerte en sí mismo. Ante las creencias sobre estar físicamente muerto señalaron atributos de la descomposición del cuerpo, atributos espirituales, creencias, negación y preferencias. La visión cultural, los valores y creencias de cada persona, se encuentran muy presentes cuando piensan en su propia muerte (AU)

Re-Evaluating Simpson Grade I, II, and III Resections in Neurosurgical Treatment of World Health Organization Grade I Meningiomas.

BACKGROUND: Since 1957, the Simpson grading system has been considered a predictive system for meningioma recurrence. However, since then, surgical equipment and neurosurgical technique have developed extensively, so this grading system should be re-evaluated. This study aims to assess if the recurrence rate and recurrence-free survival (RFS) are different after Simpson grade I, II, and III resections in World Health Organization (WHO) grade I meningiomas. METHODS: We retrospectively reviewed the data of patients who underwent surgical treatment of WHO grade I meningiomas located in the convexity (group 1), falx/parasagittal (group 2), skull base, and tentorium (group 3) between June 1991 and December 2011. We compared the recurrence rates and RFSs between Simpson grade I, II, and III resections in both overall cases and tumor subsets according to their localization. RESULTS: A total of 224 meningiomas were included in this study. There were no significant differences in recurrence rates and RFSs between Simpson grades I, II, and III. In each of the location groups, no significant differences were noted between the different degrees of Simpson. CONCLUSIONS: We have shown that complete resection of WHO grade I meningiomas achieves excellent tumor control, regardless of Simpson grades. More aggressive attempts at tumor resection (ie, Simpson grade I) must be balanced against the risks of removing dura or damaging critical neurovascular structures.

La atención centrada en la persona con demencia / No disponible

El objetivo de este trabajo es hacer una revisión teórica sobre el nuevo modelo de atención centrada en la persona (ACP), dando más importancia en las personas que padecen demencia. Empezaremos explicando que es la atención centrada en la persona y sus orígenes, comparando las diferencias entre los modelos de atención actuales y la ACP, explicando en que consiste el DCM (dementia care mapping)

The aim of this work is to make a theoretical review of the new model of care focused on the person (ACP), giving more importance in people suffering from dementia. We begin by explaining that it is the focus on the person and their origins, comparing the differences between current models of care and ACP, explaining what the DCM (dementia care mapping)

Spinal elastofibroma: a case report.

Elastofibroma is a benign fibroproliferative tumor of unknown origin and pathogenesis. It usually appears in the subscapular or infrascapular area. It is extremely rare in the spinal area, and it is most common in middle-aged women. In most cases, it is asymptomatic. Its diagnosis is based on nuclear MRI, where it presents a homogeneous lesion, similar to the skeletal muscle, hyperintense in T1-weighted sequences and hypointense in T2-weighted sequences. This finding is confirmed with anatomical pathology tests, where it appears as a nonencapsulated lesion made up of wide collagen bands from connective tissue mixed with fat and muscle tissue. The treatment of choice is surgical removal of the lesion. We present a clinical case of elastofibroma, a benign and rare pathology with few described cases in the literature, in a patient with a previous dorsal lesion.