Case report: Efficacy of immunotherapy as conversion therapy in dMMR/MSI-H colorectal cancer: a case series and review of the literature.

Immunotherapy has demonstrated a role in the therapeutic landscape of a small subset of patients with colorectal carcinoma (CRC) that harbor a microsatellite instability (MSI-H) status due to a deficient DNA mismatch repair (dMMR) system. The remarkable responses to immune checkpoint inhibitors (ICIs) are now being tested in the neoadjuvant setting in localized CRC, where the dMMR/MSI-H status can be found in up to 15% of patients, with remarkable results obtained in NICHE2 and 3 trials, among others. This case series aims to report our experience at a tertiary center and provide a comprehensive analysis of the possible questions and challenges to overcome if ICIs were established as standard of care in a neoadjuvant setting, as well as the potential role they may have as conversion therapy not only in locoregional advanced CRC but also in oligometastatic disease.

Dermoscopy of inflamed seborrheic keratosis: A great mimic of malignancy.

BACKGROUND: Clinical and dermoscopic recognition of seborrheic keratoses (SKs) is often straightforward, and biopsy might not be required. However, inflamed SKs (iSKs) can pose a diagnostic challenge. Dermoscopic features of iSKs have not yet been evaluated to date. OBJECTIVES: To assess the diagnostic ability of a group of dermatologists to diagnose iSKs by dermoscopy. To evaluate the dermoscopic findings of a long series of inflamed seborrheic keratoses. METHODS: Clinical and dermoscopic images of 100 difficult-to-diagnose skin tumours, including 29 iSKs, were presented to 33 clinicians (24 dermatologists and 9 dermatology residents), who were blinded to the diagnosis. The dermoscopic features of a series of 219 iSKs were retrospectively analysed. RESULTS: iSKs were correctly identified in a 37.6% of cases. Classic dermoscopic criteria were present in only 47% of iSKs. The most frequent dermoscopic feature in iSKs was the presence of vascularization (91.3%), but only a 44.5% showed predominance of hairpin vessels. A bluish hue was observed in 18.3% of lesions. Seven dermoscopic patterns were identified, based on the dermoscopic similarity to other tumours: seborrheic keratosis-like (28.8%); squamous cell carcinoma-like (25.6%); melanoma-like (17.8%); keratoacanthoma-like (6.8%); basal cell carcinoma-like (5.9%); verruca vulgaris-like (5.9%); nevus-like (2.3%). CONCLUSIONS: The diagnosis of iSKs can be challenging even with dermoscopy. They may behave as authentic mimics of other cutaneous tumours, including squamous cell carcinoma or melanoma. For this reason, histopathological examination should be mandatory in these cases.

Malignant peripheral nerve sheath tumor in a child.

Among the diverse causes of posterior mediastinal masses, malignant peripheral nerve sheath tumors is a very rare neurogenic tumor. Imaging features tend to be variable. A 20-month-old toddler presented with a 3-month history of persistent diffuse thoracic and abdominal pain. A chest magnetic resonance imaging was taken and shown a posterior mediastinal lesion. Histopathology and immunohistochemical analysis confirmed the diagnosis of a malignant peripheral nerve sheath tumor with myxoid areas. Malignant peripheral nerve sheath tumors are an uncommon entity in the children with a poor prognosis. Magnetic resonance imaging is the preferred technique in children to limit the use of ionizing radiation and because has a higher contrast resolution; however, all suspicious tumors should be biopsied to make an appropriate diagnosis. Treatment is radical surgery with excision of the entire mass; however, there is a high incidence of local recurrence.

Model for gas-hydrate equilibrium in porous media that incorporates pore-wall properties.

Naturally-occurring gas hydrates (in permafrost and marine sediments) have the potential to contribute as a carbon-based source to the increasing energy demand. Precise estimates of gas-hydrate global inventory, development of strategies for their exploitation, and evaluation of their environmental impact require models that accurately describe gas-hydrate stability in marine sediments. A model for gas-hydrate equilibrium in porous media, developed from fundamental thermodynamic principles, is proposed and validated against available experimental data. The derivation of the model allowed for the natural incorporation of sediment properties into equilibrium conditions, such as interfacial energies and contact angles between different phases. Model parameters were obtained from independent experiments and fundamental calculations reported in the literature. For the range of pore sizes (3.4-24.75 nm) of different materials reported in the literature, the absolute average deviations (AAD%) between the model predictions and the experimental data are between 0.04% and 2.07%. The wettability of the pore surface affects the shape of the hydrate phase inside the pore and consequently influences the equilibrium pressures of gas-hydrate formed in porous media.

Aging and Postintensive Care Syndrome- Family: A Critical Need for Geriatric Psychiatry.

Postintensive care syndrome-family (PICS-F) describes the psychological symptoms that affect the family members of patients hospitalized in the intensive care unit (ICU) or recently discharged from the ICU. Geriatric psychiatrists should be concerned about PICS-F for several reasons. First, ICU hospitalization in older adults is associated with higher rates of cognitive and physical impairment compared with older adults hospitalized in non-ICU settings or dwelling in the community. This confers a special burden on the caregivers of these older ICU survivors compared with other geriatric populations. Second, as caregivers themselves age, caring for this unique burden can be more challenging compared with other geriatric populations. Third, evidence for models of care centered on patients with multimorbidity and their caregivers is limited. A deeper understanding of how to care for PICS and PICS-F may inform clinical practice for other geriatric populations with multimorbidity and their caregivers. Geriatric psychiatrists may play a key role in delivering coordinated care for PICS-F by facilitating timely diagnosis and interdisciplinary collaboration, advocating for the healthcare needs of family members suffering from PICS-F, and leading efforts within healthcare systems to increase awareness and treatment of PICS-F. This clinical review will appraise the current literature about the impact of critical illness on the family members of ICU survivors and identify crucial gaps in our knowledge about PICS-F among aging patients and caregivers.

Utilidad de las secuencias funcionales por resonancia magnética en el estudio de los tumores óseos y de partes blandas. Revisión imaginológica / Difusion and Functional Sequences: Utility in the Study of Bone and Soft Tissue Tumors. Pictorial Review

La resonancia magnética es la técnica de imagen de elección para diagnosticar, caracterizar, estadificar, realizar el seguimiento y valorar la respuesta al tratamiento de los tumores musculoesqueléticos. Para estos fines se utilizan las secuencias convencionales. Desde hace algunos años se han comenzado a implementar nuevas técnicas avanzadas, como la secuencia en fase y fase opuesta, difusión, perfusión y espectroscopia, que en conjunto se denominan técnicas funcionales, las cuales proporcionan información más específica del comportamiento, fisiología, metabolismo y biología molecular del tumor. Estas secuencias son no invasivas, aportan información adicional cualitativa, cuantitativa, metabólica y vascular por lo que deberían utilizarse de manera rutinaria en el momento de realizar el diagnóstico y, especialmente, en el seguimiento de los tumores óseos y de partes blandas. En este artículo se revisa la técnica de dichas secuencias, particularmente la secuencia de difusión, mediante casos ilustrativos de nuestros hospitales: Hospital Pablo Tobón Uribe y Hospital Universitario Quirón Salud de Madrid. También se revisarán las aplicaciones e importancia de un análisis combinado de estas nuevas herramientas, que aportarán información adicional para adecuada caracterización, enfoque diagnóstico y respuesta al tratamiento de las lesiones tumorales en el sistema musculoesquelético

Magnetic resonance imaging (MR) is the preferred technique for the diagnosis, characterization, staging, follow-up and assessment of response to treatment of musculoskeletal tumors. Conventional sequences help to classify these lesions. Recently new evolving functional MR sequences with advanced techniques have been implemented, such as phase sequence, opposite phase, diffusion, perfusion and spectroscopy, which provide specific information about the behavior, physiology, metabolism and molecular biology of the tumor. These sequences are non-invasive and provide additional qualitative, quantitative, metabolic and vascular information, making them important for the diagnosis and monitoring of bone and soft tissue tumors. This article reviews the technique of these sequences, particualrly the diffusion technique, using illustrative cases from the Hospital Pablo Tobon Uribe (Medellin ­ Colombia) and the University Hospital Quirón Salud (Madrid ­ Spain). We aim to review the utility and importance of a combined analysis of these new tools, which will provide additional information for adequate characterization, diagnosis and response to treatment of tumor lesions in the musculoskeletal system.

Titanium Dioxide Nanotubes as Model Systems for Electrosorption Studies.

Highly ordered titanium dioxide nanotubes (TiO2 NTs) were fabricated through anodization and tested for their applicability as model electrodes in electrosorption studies. The crystalline structure of the TiO2 NTs was changed without modifying the nanostructure of the surface. Electrosorption capacity, charging rate, and electrochemical active surface area of TiO2 NTs with two different crystalline structures, anatase and amorphous, were investigated via chronoamperometry, cyclic voltammetry, and electrochemical impedance spectroscopy. The highest electrosorption capacities and charging rates were obtained for the anatase TiO2 NTs, largely because anatase TiO2 has a reported higher electrical conductivity and a crystalline structure that can potentially accommodate small ions within. Both electrosorption capacity and charging rate for the ions studied in this work follow the order of Cs⁺ > Na⁺ > Li⁺, regardless of the crystalline structure of the TiO2 NTs. This order reflects the increasing size of the hydrated ion radii of these monovalent ions. Additionally, larger effective electrochemical active surface areas are required for larger ions and lower conductivities. These findings point towards the fact that smaller hydrated-ions experience less steric hindrance and a larger comparative electrostatic force, enabling them to be more effectively electrosorbed.

Short version of the "instrument for assessment of stress in nursing students" in the Brazilian reality.

GOAL: validate a short version of the Instrument for assessment of stress in nursing students in the Brazilian reality. METHOD: Methodological study conducted with 1047 nursing students from five Brazilian institutions, who answered the 30 items initially distributed in eight domains. Data were analyzed in the R Statistical Package and in the latent variable analysis, using exploratory and confirmatory factor analyses, Cronbach's alpha and item-total correlation. RESULTS: The short version of the instrument had 19 items distributed into four domains: Environment, Professional Training, Theoretical Activities and Performance of Practical Activities. The confirmatory analysis showed absolute and parsimony fit to the proposed model with satisfactory residual levels. Alpha values ​​per factor ranged from 0.736 (Environment) to 0.842 (Performance of Practical Activities). CONCLUSION: The short version of the instrument has construct validity and reliability for application to Brazilian nursing undergraduates at any stage of the course.

Sarcoma sinovial monofásico de tipo fibroblástico. Evaluación diagnóstica por RM y postratamiento mediante ADC: Presentación de un caso / Monophasic Fibroblastic Synovial Sarcoma. Diagnostic and Post-Treatment Assessment by MRI and ADC: Case Report

El sarcoma sinovial representa entre el 2 al 10 % de todas las malignidades primarias de tejidos blandos, situándose en el cuarto lugar en frecuencia de los sarcomas de tejidos blandos. Es una neoplasia clasificada por la WHO (World Health Organization) bajo la categoría de tumores de diferenciación incierta, considerándose una malignidad entre intermedio y alto grado. El tratamiento estándar es la escisión quirúrgica, sin embargo, por su alta recurrencia y en los casos en que se asocia a metástasis o márgenes positivos después de la resección, se han planteado otros tratamientos como la quimio y radioterapia. La imaginología juega un papel importante en el diagnóstico, la estadificación y evaluación de la respuesta al tratamiento. Nuevas técnicas como el uso de difusión y mapas de ADC (Apparent Diffusion Coefficient, o coeficiente de difusión aparente) en resonancia magnética (RM) son útiles para evaluar las lesiones tumorales y la respuesta al tratamiento. En este artículo se presenta el caso de un paciente con un sarcoma sinovial monofásico, el diagnóstico por imágenes y evaluación del tratamiento mediante técnicas avanzadas de resonancia magnética como la difusión

Synovial sarcomas represent 2 to 10% of all the primary tissue malignancies and occupy the fourth place in the list of most common soft tissue sarcomas. According to the World Health Organization (WHO), this neoplasm is classified under the category of tumors of uncertain differentiation and is considered an intermediate to high-grade malignancy. Although the standard treatment is surgical excision, alternative treatments such as radiotherapy and chemotherapy have been proposed due to its high rate of recurrence in cases when it is associated with metastasis or positive resection margins. Imaging plays a key role in the diagnosis, staging and assessment of treatment of this disease. New techniques in Magnetic Resonance Imaging such as diffusion and Apparent Diffusion Coefficient (ADC) mapping are useful to further characterize these neoplastic lesions and to assess treatment response. In this article we present a patient with monophasic synovial sarcoma in which the use of these new imaging techniques was essential for the diagnosis and evaluation post-treatment.

Short version of the "instrument for assessment of stress in nursing students" in the Brazilian reality / Versão reduzida do "instrumento de avaliação de estresse em estudantes de enfermagem" na realidade brasileira / Versión reducida del "instrumento de evaluación de estrés en estudiantes de enfermería" en la realidad brasilera

ABSTRACT Goal: validate a short version of the Instrument for assessment of stress in nursing students in the Brazilian reality. Method: Methodological study conducted with 1047 nursing students from five Brazilian institutions, who answered the 30 items initially distributed in eight domains. Data were analyzed in the R Statistical Package and in the latent variable analysis, using exploratory and confirmatory factor analyses, Cronbach's alpha and item-total correlation. Results: The short version of the instrument had 19 items distributed into four domains: Environment, Professional Training, Theoretical Activities and Performance of Practical Activities. The confirmatory analysis showed absolute and parsimony fit to the proposed model with satisfactory residual levels. Alpha values ​​per factor ranged from 0.736 (Environment) to 0.842 (Performance of Practical Activities). Conclusion: The short version of the instrument has construct validity and reliability for application to Brazilian nursing undergraduates at any stage of the course.

RESUMO Objetivo: validar uma versão reduzida do Instrumento de avaliação de estresse em estudantes de enfermagem, na realidade brasileira. Método: Estudo metodológico realizado com 1047 universitários de enfermagem de cinco instituições brasileiras, que responderam aos 30 itens do instrumento distribuídos inicialmente em oito domínios. Analisou-se os dados no Pacote estatístico R e no latent variable analysis empregando-se análises fatoriais exploratória e confirmatória, alfa de Cronbach e correlação item-total. Resultados: A versão reduzida do instrumento apresentou 19 itens distribuídos em quatro domínios: Ambiente, Formação profissional, Atividades Teóricas e Realização de Atividades Práticas. A análise confirmatória demonstrou ajuste absoluto e de parcimônia ao modelo proposto, com níveis de resíduos satisfatórios. Os valores de Alfa por fator variaram de 0,736 (Ambiente) a 0,842 (Realização de Atividades Práticas). Conclusão: A versão reduzida do instrumento apresenta validade de constructo e confiabilidade para aplicação em universitários de enfermagem brasileiros que estão presentes em qualquer fase do curso.

RESUMEN Objetivo: validar una versión reducida del Instrumento de evaluación de estrés en estudiantes de enfermería, en la realidad brasilera. Método: Estudio metodológico realizado con 1047 universitarios de enfermería de cinco instituciones brasileras, que respondieron a los 30 ítems del instrumento distribuidos inicialmente en oito dominios. Se analizaron los datos en el Paquete estadístico R y en el latent variable analysis empleándose análisis factoriales exploratorios y confirmatorios, alfa de Cronbach y correlación ítem-total. Resultados: La versión reducida del instrumento presentó 19 ítems distribuidos en cuatro dominios: Ambiente, Formación profesional, Actividades Teóricas y Realización de Actividades Prácticas. El análisis confirmatorio demostró ajuste absoluto y de parsimonia al modelo propuesto, con niveles de residuos satisfactorios. Los valores de Alfa por factor variaron de 0,736 (Ambiente) a 0,842 (Realización de Actividades Prácticas). Conclusión: La versión reducida del instrumento presenta validad de constructo y confiabilidad para aplicación en universitarios de enfermería brasileros que están presentes en cualquier fase del curso.

Dermoscopy of Nodular Hidradenoma, a Great Masquerader: A Morphological Study of 28 Cases.

BACKGROUND: Nodular hidradenoma is an uncommon, benign, adnexal neoplasm of apocrine origin which is a clinical simulator of other tumours. OBJECTIVE: The aim of this study was to evaluate the morphological findings of a large series of nodular hidradenomas under dermoscopic observation. METHODS: Dermoscopic examination of 28 cases of nodular hidradenomas was performed to evaluate specific dermoscopic criteria and patterns. RESULTS: The most frequently occurring dermoscopic features were: (1) in 96.4% of cases, a homogeneous area that covered the lesion partially or totally, the colour of which was pinkish in 46.4% of cases, bluish in 28.6%, red-blue in 14.3%, and brownish in 10.7%; (2) white structures were found in 89.3% of cases; (3) in 82.1% of cases, vascular structures were also observed, especially arborising telangiectasias (39.3%) and polymorphous atypical vessels (28.6%). CONCLUSION: Nodular hidradenomas represent a dermoscopic pitfall, being difficult to differentiate clinically and dermoscopically from basal cell carcinomas and melanomas.

Síndrome del ligamento arcuato medio concomitante con síndrome de cascanueces. Presentación de un caso / Concomitant Medium Arcuate Ligament Syndrome with Nutcracker Syndrome. A Case Report

El síndrome del ligamento arcuato medio y el síndrome de cascanueces son entidades raras, con baja prevalencia, a menudo subdiagnosticadas y asintomáticas en la mayoría de las ocasiones. Se presenta el caso de una paciente con ambas entidades, lo cual probablemente le genera dolor abdominal como síntoma común.

The Arcuate ligament syndrome and the Nutcracker syndrome are rare disorders, with low prevalence, commonly underdiagnosed and asymptomatic in most cases. We present the case of a female patient with both syndromes, which probably causes her abdominal pain as a common symptom.

Hardy personality and burnout syndrome among nursing students in three Brazilian universities-an analytic study.

BACKGROUND: Nursing students may exhibit the characteristics of resistance to stress, such as hardiness, which can reduce the risk of burnout. However, we found only one published study about these phenomena among nursing students. Thus, we investigated the association between hardiness and burnout in such students. METHODS: An analytic, cross-sectional study was conducted among 570 nursing students from three Brazilian universities. Data were collected relating to sociodemographic characteristics, hardiness, and burnout, which we analyzed using inferential statistics. RESULTS: We observed that 64.04% of nursing students in the sample had a high level of emotional exhaustion, 35.79% had a high level of cynicism, and 87.72% had a low level of professional efficacy: these are dimensions of burnout. We also found that 48.77% had a high level of control, 61.40% a high level of commitment, and 35.44% a high level of challenge: these are dimensions of hardiness. Only 24.74% of the students experienced burnout, and 21.93% met the criteria for a hardy personality. There was a statistically significant difference between the frequency of hardiness and burnout (p = 0.033), with 68.00% of hardy students not exhibiting burnout. CONCLUSIONS: Although nursing students live with educational stressors, burnout was not preponderant in our sample students; this may be linked to hardiness. Thus, given its benefits to student life and health, we recommend the development of strategies to promote hardiness among nursing students.

Estresse e hardiness entre residentes multiprofissionais de uma universidade pública / Estrés y hardiness entre los residentes multidisciplinares de unauniversidad pública / Stress and hardiness among public university multiprofessionals residents

Objetivos: verificar a associação entre estresse e Hardiness em Residentes Multiprofissionais de uma Universidade pública do Rio Grande do Sul. Método: trata-se deum estudo analítico, transversal, quantitativo. Aplicou-se um formulário de dados sociodemográficos, a Escala de Estresse no Trabalho e a Escala de Hardiness em 37residentes entre abril e junho de 2011. Valores de p<0,05 foram considerados significativos. Resultados: observou-se que 51,35% dos residentes apresentam baixo estresse e 48,65% alto estresse. A Personalidade Hardiness foi verificada em 24,32% dos profissionais, e desses, 21,62% apresentavam baixa intensidade de estresse. Houve correlação significativa e negativa (p= 0,001, r = - 0,5105) entre Hardiness e a intensidade de estresse. Conclusões: confirma-se a hipótese de que indivíduos Hardy apresentam menor intensidade de estresse. Sugere-se a elaboração de estratégias de promoção de Hardiness visto seus benefícios à saúde do residente.

Aim: to verify the association between stress and Hardiness amongMultidisciplinary Residents of a Rio Grande do Sul public University. Method: this is ananalytical, cross-sectional and quantitative study. We applied a sociodemographic dataform, the Work Stress Scale and Hardiness Scale in 37 residents between April and June2011. P values <0,05 were considered significant. Results: we observed that 51,35% ofresidents presented low stress and 48,65% high stress. Hardiness Personality was observedin 24,32% of professionals, and, of these, 21,62% had low stress intensity. There wassignificant and negative correlation (p = 0,001, r = - 0,5105) between Hardiness and stressintensity. Conclusions: these results confirm the hypothesis that Hardy individuals have lower stress intensity. We suggest the development of strategies to promote Hardinessconsidering its benefits to the resident’s health.

Objetivos: verificar la asociación entre estrés y Hardiness en los residentesmultiprofesionales de universidad pública del Rio Grande do Sul. Método: estudio analítico,transversal y cuantitativo. Fue aplicado un formulario de datos sociodemográficos, con la Escalade Estrés en el trabajo y la Escala de Hardiness en 37 residentes entre abril y junio de 2011.Valores de p <0,05 fueron considerados significativos. Resultados: fue observado que el 51,35% delos residentes tienen bajo estrés y el 48,65% alto estrés. La Personalidad Hardiness fue verificadaen el 24.32% de los profesionales y el 21,62% de estos presentaron baja intensidad de estrés. Hubocorrelación significativa y negativa (p = 0,001, r = - 0,5105) entre Hardiness y la intensidad deestrés. Conclusiones: se confirma la hipótesis de que individuos Hardy tienen menor intensidadde estrés. Proponemos el desarrollo de estrategias para promover el Hardiness visto sus beneficiospara la salud del residente.

Studying regression of seborrheic keratosis in lichenoid keratosis with sequential dermoscopy imaging.

BACKGROUND: Lichenoid keratosis (LK) is a well-described entity that has been proposed to represent a regressive response to a pre-existent epidermal lesion. AIMS: To evaluate the natural evolution of a series of cases showing the intermediate stage of the regression of seborrheic keratosis in LK using sequential dermoscopy imaging over time. MATERIAL AND METHODS: A series of lesions with dermoscopic areas of seborrheic keratosis and LK in the same tumor were consecutively collected for over 3 years at the Dermatology Department of the Hospital de Sant Pau i Santa Tecla, Tarragona, Spain. Sequential dermoscopic images of each case were collected quarterly for 1 year. At the end of the follow-up, all the lesions were biopsied. RESULTS: A total of 22 cases were collected. At the end of the follow-up, the LK part increased in all the lesions. In 11 cases (50%), the seborrheic keratosis part disappeared completely, and in another 5 cases (22.7%), seborrheic keratosis comprised only 10% of the remaining area. CONCLUSIONS: These dermoscopic study findings support the proposal that LK represents a regressive response to a pre-existent epidermal lesion, in this case seborrheic keratosis.

Pyogenic granuloma clinically and dermoscopically mimicking pigmented melanoma.

Pyogenic granuloma is a common, benign, acquired, vascular growth of skin and mucous membranes that usually presents as a solitary, rapidly, growing, papule or polyp that bleeds easily after minor trauma. The clinical diagnosis of this lesion is usually straightforward. Moreover, the dermoscopic features associated with pyogenic granulomas have been described recently. However, occasionally this tumor can be difficult to differentiate clinically and dermoscopically from other pigmented and vascular lesions. We report the case of an 18-year-old male who presented with a round, purple-black nodule with hemorrhagic crust, 1 cm in diameter, located on the lower part of the thorax. Dermoscopic evaluation revealed the presence of a blue-white veil, a black blotch, polymorphous atypical vessels, milky-red areas, and hemorrhagic crusts. The subsequent histopathological examination revealed a pyogenic granuloma. We present a case of pyogenic granuloma clinically and dermoscopically indistinguishable from a pigmented malignant melanoma.