Response Assessment in Brain Metastases Managed by Stereotactic Radiosurgery: A Reappraisal of the RANO-BM Criteria.

BACKGROUND: Brain metastases (BM) are increasingly being treated using stereotactic radiosurgery (SRS). Standardized response criteria are necessary to improve research and treatment protocols. This study's goal was to validate the RANO-BM criteria thresholds for tumor progression in a cohort of patients with brain metastases managed using SRS. METHODS: We performed a retrospective analysis of patients treated at least twice with SRS for brain metastases. Local progression, as defined by RANO-BM criteria, was compared to our multidisciplinary tumor board's treatment recommendation. A ROC curve was generated using varying diameter thresholds to assess the sensitivity and specificity of current RANO-BM criteria. RESULTS: 249 metastases in 67 patients were included in the analysis. RANO-BM criteria current progression thresholds yielded a sensitivity of 38%, a specificity of 95%, a positive predictive value of 71%, and a negative predictive value of 84% relative to our tumor board's treatment recommendation. Modified RANO-BM criteria using absolute diameter differences of 2.5 mm yielded a sensitivity of 83%, a specificity of 87%, a positive predictive value of 67% and a negative predictive value of 94%. CONCLUSIONS: Current RANO-BM criteria unreliably identifies clinically relevant tumor progression. The use of absolute diameter differences thresholds appears superior in our BM cohort.

Rare Mesenchymal Tumors of the Pelvis: Imaging and Pathologic Correlation.

Most pelvic tumors originate from the organs. Less commonly, tumors can arise from the various anatomic pelvic compartments and are comprised of mesenchymal tissue: muscles, connective tissue, vessels, lymphatics, and fat. Among some of the rarer entities are benign tumors (eg, angiomyxoma, cellular angiofibroma, and desmoid fibromatosis), malignant tumors (eg, sarcoma), and tumors that can manifest as benign or malignant (eg, solitary fibrous tumor or nerve sheath tumor). Because these tumors are uncommon and often manifest with nonspecific clinical features, imaging (usually MRI) is an initial step in the evaluation. Radiologists interpreting these images are asked to help narrow the differential diagnosis and assess the likelihood of malignancy for treatment planning. Thus, the MRI report should include the imaging features that would indicate the underlying tissue histology for pathologic diagnosis as well as a description of the anatomic extent and pattern of growth. The authors describe multiple locally aggressive benign and malignant mesenchymal tumors and highlight characteristic clinical and imaging features that enable the radiologist to narrow the differential diagnosis. The anatomic spaces of the pelvis are reviewed with illustrations to aid the radiologist in describing these tumors, which often span multiple pelvic compartments. Tumor appearance at T2-weighted, diffusion-weighted, and postcontrast MRI is summarized and illustrated with correlation at CT or fluorodeoxyglucose PET/CT, when available. MRI features that correspond to specific types of tissue (eg, myxoid, fibrous, or vascular) are highlighted and correlated with images from pathologic evaluation. Online supplemental material is available for this article. ©RSNA, 2021.

Imaging Diagnosis of Adenomyosis.

Uterine adenomyosis can be diagnosed on ultrasonography (US) and magnetic resonance imaging (MRI) with a high degree of accuracy. Adenomyosis is a myometrial process that can appear as diffuse or focal on imaging. Diffuse adenomyosis typically causes uterine enlargement, while focal adenomyosis can mimic other myometrial lesions, such as leiomyomas. Imaging features frequently seen on US include a heterogenous thickened myometrium and myometrial cysts. On MRI, widening of the junctional zone, whether focal or diffuse, and the presence of myometrial cysts, either simple or hemorrhagic, support the diagnosis of adenomyosis. Despite these characteristic imaging appearances, there are several gynecologic pathologies which can mimic adenomyosis and it is important to be vigilant of these when interpreting cross-sectional imaging exams. The decision to evaluate patients with US or MRI is contingent on multiple factors, including availability of the necessary technology and expertise for the latter. However, MRI appears to offer greater specificity and positive predictive value for the diagnosis of adenomyosis.

Repeat stereotactic radiosurgery for the management of locally recurrent brain metastases.

PURPOSE: Stereotactic radiosurgery (SRS) is a well-established treatment option for brain metastases (BM). Repeat SRS for progressive BM is an increasingly used paradigm, although little data is available to support this practice. The goal of this study was to assess the safety and efficacy of a second SRS procedure on a previously treated BM. METHODS: We performed a retrospective metastasis-level analysis of patients who underwent two SRS procedures on the same lesion and for whom at least 6 months of radiological follow-up was available. The data collected included patient characteristics, clinical symptoms at time of treatment, SRS parameters, radiological response per RANO-BM criteria, clinical evolution and survival. RESULTS: Seventy-five BM in 56 patients were included in the analysis. Most frequent primary histologies were non-small-cell lung cancer (59%) and breast cancer (19%). At the second SRS, median treatment volume was 1.19 cc (range 0.07-20.6) treated with a median margin dose of 18 Gy (range 12-20) at the 50% isodose line (range 30-80%). Median follow-up was 11 months. Progression per RANO-BM criteria occurred in 31%, yielding actuarial local control at 1, 2, and 5 years of 68%, 54% and 54% respectively. At last follow-up, 10 patients (18%) had improved relative to the initial presentation, while 21 (38%) were stable and 25 (44%) were deteriorated. Radiation-induced edema and radionecrosis occurred in 8.3% and 5% respectively. The median survival from the diagnosis of BM was 30 months. CONCLUSION: Repeat SRS is a safe and effective novel therapeutic approach to consider in carefully selected patients.

Gerenciamento de conflitos na formação do enfermeiro / Conflict management in nurse training

Objetivo: identificar algumas questões relacionadas ao gerenciamento de conflitos na equipe de enfermagem a partir de revisão da literatura. Método: estudo qualitativo, do tipo análise reflexiva, desenvolvido a partir de artigos pesquisados nas bases de dados PubMed/MEDLINE e SciELO. Resultados: as situações de conflito na equipe, quando não efetivamente solucionadas, geram desorganização no serviço, desmotivação profissional, comprometimento na prática do cuidado e põe em risco à segurança do paciente e do profissional. O enfermeiro em sua formação continuada deve compreender que sua atividade profissional envolve o trabalho em equipe, sendo a ele atribuído obrigatoriamente o papel de líder de sua equipe de enfermagem ou multiprofissional. As atitudes essenciais dos enfermeiros para o gerenciamento de conflitos são liderança, comunicação e trabalho em equipe, os quais devem ser adquiridos por meio de treinamento contínuo, em que há o desenvolvimento dessas e outras habilidades capazes de pautar uma prática de enfermagem de qualidade. Conclusão: existe a necessidade de educação continuada sobre administração e gestão no processo de formação dos estudantes de enfermagem para se fortalecer suas habilidades profissionais indispensáveis para o adequado desempenho futuro no cuidado aos clientes.(AU)

Critérios de seleção para parceiros de curto e de longo prazo de universitárias paulistas

Este trabalho foi realizado com mulheres universitárias da cidade de SãoPaulo no ano de 2007 para determinar quais os critérios que estas utilizamquando selecionam parceiros para relacionamentos amorosos de curto e longo prazo. A partir de um questionário e de uma escala do tipo Lickert no qualelas deveriam atribuir valores a características específi cas em relação à suaauto-imagem e às expectativas para um relacionamento a curto e longo prazo,obtivemos resultados numéricos que nos permitiram uma análise estatísticados dados. Comparando a auto-imagem com parceiros de curto e de longoprazo as mulheres tendem a escolher parceiros diferentes delas mesmas pararelacionamentos de curto prazo e semelhantes a elas para relacionamentos delongo prazo. Para parceiros de longo prazo, as mulheres buscam característicasem categorias que possam proporcionar segurança. Por outro lado, tantopara parceiros de curto prazo, quanto parceiros de longo prazo, as exigênciasmédias das mulheres a respeito de recursos fi nanceiros também são menoresque a sua auto-imagem.(AU)

Critérios de seleção para parceiros de curto e de longo prazo de universitárias paulistas / Selection criteria for partners of short and long-term university of São Paulo

Este trabalho foi realizado com mulheres universitárias da cidade de SãoPaulo no ano de 2007 para determinar quais os critérios que estas utilizamquando selecionam parceiros para relacionamentos amorosos de curto e longo prazo. A partir de um questionário e de uma escala do tipo Lickert no qualelas deveriam atribuir valores a características específi cas em relação à suaauto-imagem e às expectativas para um relacionamento a curto e longo prazo,obtivemos resultados numéricos que nos permitiram uma análise estatísticados dados. Comparando a auto-imagem com parceiros de curto e de longoprazo as mulheres tendem a escolher parceiros diferentes delas mesmas pararelacionamentos de curto prazo e semelhantes a elas para relacionamentos delongo prazo. Para parceiros de longo prazo, as mulheres buscam característicasem categorias que possam proporcionar segurança. Por outro lado, tantopara parceiros de curto prazo, quanto parceiros de longo prazo, as exigênciasmédias das mulheres a respeito de recursos fi nanceiros também são menoresque a sua auto-imagem.