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Herniation of bowel contents between the peritoneal cavity proper and the omental bursa, through the foramen of Winslow, can present diagnostic challenges that can potentially delay necessary surgical intervention. This case describes a 49-year-old female with a past medical history of hiatal hernia and biliary dyskinesia who presented to the emergency department with severe epigastric and right lower quadrant abdominal pain one day after a reported gastrointestinal illness of unknown etiology. Initial emergency department workup demonstrated an elevated white blood cell count without lactic acidosis. Computed tomography imaging was interpreted as gastric distension with volvulus around the mesentery and second portion of the duodenum. Intraoperatively, the entirety of the right colon was noted to have passed through the foramen of Winslow into the lesser sac. This led to twisting of the mesocolon causing compression of the duodenum and a gastric outlet obstruction. After surgical reduction of the herniation, the patient noted great improvement in pain and other symptoms.
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BACKGROUND: Antimicrobial stewardship programmes are a critical tool for addressing the rising threat of antimicrobial resistance. AIM: To determine changes in patterns of antimicrobial use in Queensland public hospitals following introduction of the National Safety and Quality Health Service antimicrobial stewardship standard. METHODS: A retrospective pre/post intervention study was conducted across Queensland public hospitals at the ecological level using Queensland Health's MedTRx database. An interrupted time-series analysis was performed using linear regression models to determine rates of antimicrobial use by quarterly aggregated defined daily dose per 1000 patient-days, for groups of hospitals stratified by peer group classification. Pre-defined time-periods for antimicrobial stewardship programme implementation in response to the introduction of the standard were analysed. FINDINGS: In the post-intervention period, there was a decrease in overall use of systemic antimicrobials, glycopeptides, carbapenems and fluoroquinolones in principal referral and public acute group A hospitals. A decrease in overall use was also observed for smaller regional and remote public acute group C and D hospitals; however, increases in glycopeptide and fluoroquinolone use were observed. Third-generation cephalosporin use was unchanged for all hospital peer groups. The proportion of overall use that was accounted for by narrow-spectrum penicillin was low for all facilities, with modest improvements in the post-intervention period observed in principal referral facilities only. CONCLUSION: These findings add to current knowledge on the effectiveness of legislative quality standards on antimicrobial stewardship at the macro level and highlight gaps to target for future programmes.
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Peptide amphiphiles (PAs) are highly tunable molecules that were recently found to exhibit aggregation-induced emission (AIE) when they self-assemble into nanofibers. Here, we leverage decades of molecular design and self-assembly study of PAs to strategically tune their molecular motion within nanofibers to enhance AIE, making them a highly useful platform for applications such as sensing, bioimaging, or materials property characterization. Since AIE increases when aggregated molecules are rigidly and closely packed, we altered the four most closely packed amino acids nearest to the hydrophobic core by varying the order and composition of glycine, alanine, and valine pairs. Of the six PA designs studied, C16VVAAK2 had the highest quantum yield at 0.17, which is a more than 10-fold increase from other PA designs including the very similar C16AAVVK2, highlighting the importance of precise amino acid placement to anchor rigidity closest to the core. We also altered temperature to increase AIE. C16VVAAK2 exhibited an additional 4-fold increase in maximum fluorescence intensity when the temperature was raised from 5 to 65 °C. As the temperature increased, the secondary structure transitioned from ß-sheet to random coil, indicating that further packing an already aligned molecular system makes it even more readily able to transfer energy between the electron-rich amides. This work both unveils a highly fluorescent AIE PA system design and sheds insights into the molecular orientation and packing design traits that can significantly enhance AIE in self-assembling systems.
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Nanofibras , Nanofibras/química , Fluorescência , Peptídeos/química , Estrutura Secundária de Proteína , AmidasRESUMO
Functional interactions between the prefrontal cortex and hippocampus, as revealed by strong oscillatory synchronization in the theta (6-11 Hz) frequency range, correlate with memory-guided decision-making. However, the degree to which this form of long-range synchronization influences memory-guided choice remains unclear. We developed a brain machine interface that initiated task trials based on the magnitude of prefrontal hippocampal theta synchronization, then measured choice outcomes. Trials initiated based on strong prefrontal-hippocampal theta synchrony were more likely to be correct compared to control trials on both working memory-dependent and -independent tasks. Prefrontal-thalamic neural interactions increased with prefrontal-hippocampal synchrony and optogenetic activation of the ventral midline thalamus primarily entrained prefrontal theta rhythms, but dynamically modulated synchrony. Together, our results show that prefrontal-hippocampal theta synchronization leads to a higher probability of a correct choice and strengthens prefrontal-thalamic dialogue. Our findings reveal new insights into the neural circuit dynamics underlying memory-guided choices and highlight a promising technique to potentiate cognitive processes or behavior via brain machine interfacing.
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NASN, with generous funding from Kaiser Permanente (KP) and partnered with the Institute for Educational Leadership, developed and implemented the Champions for School Health (CSH) grant initiative. The CSH initiative awarded 54 Implementation Grants in two funding cycles in 2022, funding school districts and community-based organizations (CBOs) to increase access to the pediatric COVID-19 vaccine as well as school-required immunizations and to increase vaccine confidence among underserved populations in KP's footprint: California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and the District of Columbia. These grantees administered a total of 17,630 COVID-19 vaccines to individuals ages 5 or older and 34,025 routine immunizations, of which 8,233 school-required vaccinations went to children of ages 5-11 years. Over 851,000 people were reached by vaccine education events in all nine KP markets. A notable takeaway from the project's results was the new partnerships created and the continuation of existing partnerships by the grantees. NASN's implementation of the CSH initiative and results provides a model and a source of critical data on how school health services and community-based organizations can partner to provide hyper-local responses to community/public health crises. This Part 2 article provides an overview of the key results of the project.
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COVID-19 , Serviços de Enfermagem Escolar , Vacinas , Humanos , Criança , Vacinas contra COVID-19 , COVID-19/prevenção & controle , VacinaçãoRESUMO
Identifying ways to enable people to reach their creative potential is a core goal of creativity research with implications for education and professional attainment. Recently, we identified a potential barrier to creative achievement: creativity anxiety (i.e., anxiety specific to creative thinking). Initial work found that creativity anxiety is associated with fewer real-world creative achievements. However, the more proximal impacts of creativity anxiety remain unexplored. In particular, understanding how to overcome creativity anxiety requires understanding how creativity anxiety may or may not impact creative cognitive performance, and how it may relate to state-level anxiety and effort while completing creative tasks. The present study sought to address this gap by measuring creativity anxiety alongside several measures of creative performance, while concurrently surveying state-level anxiety and effort. Results indicated that creativity anxiety was, indeed, predictive of poor creative performance, but only on some of the tasks included. We also found that creativity anxiety predicted both state anxiety and effort during creative performance. Interestingly, state anxiety and effort did not explain the associations between creativity anxiety and creative performance. Together, this work suggests that creativity anxiety can often be overcome in the performance of creative tasks, but likewise points to increased state anxiety and effort as factors that may make creative performance and achievement fragile in more demanding real-world contexts.
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Ansiedade , Criatividade , Humanos , Ansiedade/psicologia , Transtornos de Ansiedade , Motivação , LogroRESUMO
Pancreatic cancer is one of the most aggressive forms of cancer and is the seventh leading cause of cancer deaths worldwide. Pancreatic ductal adenocarcinoma (PDAC) accounts for over 90% of pancreatic cancers. Most pancreatic cancers are recalcitrant to radiation, chemotherapy, and immunotherapy, highlighting the urgent need for novel treatment options for this deadly disease. To this end, we screened a library of kinase inhibitors in the PDAC cell lines PANC-1 and BxPC-3 and identified two highly potent molecules: Aurora kinase inhibitor AT 9283 (AT) and EGFR kinase inhibitor WZ 3146 (WZ). Both AT and WZ exhibited a dose-dependent inhibition of viability in both cell lines. Thus, we conducted an in-depth multilevel (cellular, molecular, and proteomic) analysis with AT and WZ in PANC-1 cells, which harbor KRAS mutation and exhibit quasimesenchymal properties representing pancreatic cancer cells as having intrinsic chemoresistance and the potential for differential response to therapy. Elucidation of the molecular mechanism of action of AT and WZ revealed an impact on the programmed cell death pathway with an increase in apoptotic, multicaspase, and caspase 3/7 positive cells. Additionally, the key survival molecule Bcl-2 was impacted. Moreover, cell cycle arrest was observed with both kinase inhibitors. Additionally, an increase in superoxide radicals was observed in the AT-treated group. Importantly, proteomic profiling revealed differentially regulated key entities with multifaceted effects, which could have a deleterious impact on PDAC. These findings suggest potential targets for efficacious treatment, including a possible increase in the efficacy of immunotherapy using PD-L1 antibody due to the upregulation of lactoferrin and radixin. Furthermore, combination therapy outcomes with gemcitabine/platinum drugs may also be more effective due to an increase in the NADH dehydrogenase complex. Notably, protein-protein interaction analysis (STRING) revealed possible enrichment of reactome pathway entities. Additionally, novel therapy options, such as vimentin-antibody--drug conjugates, could be explored. Therefore, future studies with the two kinases as monotherapy/combination therapy are warranted.
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Quick-scanning X-ray absorption fine structure (QXAFS) measurements were used to characterize the exchanges of ethylene and CO ligands in a zeolite HY-supported single-site Rh complex at a sampling rate of 1.0 Hz. The two ligands were reversibly exchanged on the rhodium, with quantitative results determined for the C2H4-for-CO exchange that are consistent with a first-order process. The apparent rate constant for the exchange decreased with increasing temperature. Fourier-transform infrared spectra characterizing the C2H4 sorbed in the zeolite showed that the amount decreased with increasing temperature, consistent with the decrease in the exchange rate with increasing temperature. The results, illustrating the dynamics of ligand exchanges on a single-site supported metal catalyst, demonstrate the broad emerging applicability of the QXAFS technique for characterizing the dynamics of reactive intermediates on catalysts.
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BACKGROUND AND OBJECTIVES: Bone resection and endoprosthetic reconstruction (EPR) in the setting of soft tissue sarcoma (STS) management is rare and incurs unique challenges. We aim to report on the surgical and oncological outcomes of this relatively previously undocumented cohort. METHODS: This is a single-center retrospective review of prospectively collected data for patients who required EPRs following resection of STSs of the lower extremity. Following inclusion criteria, we assessed 29 cases of EPR for primary STS of the lower limb. RESULTS: The mean age was 54 years (range 18-84). Of the 29 patients, there were 6 total femur, 11 proximal femur, 4 intercalary, and 8 distal femur EPRs. Fourteen of 29 patients (48%) underwent re-operations for surgical complications, with 9 relating to infection (31%). When a matched cohort analysis was performed comparing our cohort to STSs that did not necessitate EPR, a reduced rate of overall survival and metastasis-free survival was found in those requiring EPR. CONCLUSION: This series identifies a high rate of complication from EPRs performed for STS. Patients should be cautioned about the high rate of infection, surgical complications, and lower overall survival in this setting.
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Neoplasias Ósseas , Procedimentos de Cirurgia Plástica , Sarcoma , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/cirurgia , Resultado do Tratamento , Sarcoma/cirurgia , Extremidade Inferior/cirurgia , Estudos RetrospectivosRESUMO
The National Association of School Nurses (NASN) received a U.S.$2 million grant from Kaiser Permanente in January 2022 to increase confidence, equity, and uptake in the COVID-19 vaccine and other school required vaccinations in children ages 5 to 11 in Kaiser's nine markets (eight states and the District of Columbia). NASN was partnered with the Institute of Educational Leadership (IEL) in this initiative to examine ways both organizations could learn how school nurses (SNs) and community schools (CSs) could collaborate to address the goals of this project. NASN gave 54 Implementation Grants in two funding cycles in 2022 and is co-funding two SN-CS collaboration projects with IEL. The Part 1 article provides an overview of the project's goals, grant strategy and processes, grantee information, NASN created tools that resulted from this funding, and successful implementation of the project, which demonstrates NASN's capacity for future similar projects.
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COVID-19 , Serviços de Enfermagem Escolar , Criança , Humanos , Estados Unidos , Pré-Escolar , Vacinas contra COVID-19 , COVID-19/prevenção & controle , Sociedades de Enfermagem , VacinaçãoRESUMO
BACKGROUND: The Covid-19 crisis sparked service reconfigurations in healthcare systems worldwide. With postgraduate medical education sitting within these systems, service reconfigurations substantially impact trainees and their training environment. This study aims to provide an in-depth qualitative understanding of the impact of service reconfiguration on doctors' training during the pandemic, identifying opportunities for the future as well as factors that pose risks to education and training and how these might be mitigated. METHODS: Qualitative parallel multi-centre case studies examined three Trusts/Health Boards in two countries in the United Kingdom. Data were collected from online focus groups and interviews with trainees and supervisors using semi-structured interview guides (September to December 2020). A socio-cultural model of workplace learning, the expansive-restrictive continuum, informed data gathering, analysis of focus groups and coding. RESULTS: Sixty-six doctors participated, representing 25 specialties/subspecialties. Thirty-four participants were male, 26 were supervisors, 17 were specialty trainees and 23 were foundation doctors. Four themes described the impact of pandemic-related service reconfigurations on training: (1) Development of skills and job design, (2) Supervision and assessments, (3) Teamwork and communication, and (4) Workload and wellbeing. Service changes were found to both facilitate and hinder education and training, varying across sites, specialties, and trainees' grades. Trainees' jobs were redesigned extensively, and many trainees were redeployed to specialties requiring extra workforce during the pandemic. CONCLUSIONS: The rapid and unplanned service reconfigurations during the pandemic caused unique challenges and opportunities to doctors' training. This impaired trainees' development in their specialty of interest, but also presented new opportunities such as cross-boundary working and networking.
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COVID-19 , Médicos , Humanos , Masculino , Feminino , COVID-19/epidemiologia , Reino Unido , Grupos Focais , Aprendizagem , Pesquisa QualitativaRESUMO
Telomerase is a specialized reverse transcriptase that synthesizes telomeric repeats at the ends of linear chromosomes. Telomerase is transiently expressed in germ and stem cells, but nearly all somatic cells silence it after differentiating. However, the vast majority of cancer cells reactivate and constitutively express telomerase to maintain replicative immortality. Because of this, telomerase has remained a promising broad-spectrum chemotherapeutic target for over 30 years. However, various challenges associated with obtaining high-resolution structural data for telomerase have limited the development of rationally designed structure-based therapeutics. Various techniques and model systems have been utilized to advance our understanding of the structural biology of telomerase. In particular, multiple high-resolution cryogenic electron microscopy (cryo-EM) structures published within the past few years have revealed new components of the telomerase complex with near atomic resolution structural models. Additionally, these structures have provided details for how telomerase is recruited to telomeres and its mechanism of telomere synthesis. With these new pieces of evidence, and the promising outlook for future refinements to our current models, the possibility of telomerase specific chemotherapeutics is becoming more tangible than ever. This review summarizes these recent advancements and outlines outstanding questions in the field.
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The APOE4 allele increases the risk for Alzheimer's disease (AD) in a dose-dependent manner and is also associated with cognitive decline in non-demented elderly controls. In mice with targeted gene replacement (TR) of murine APOE with human APOE3 or APOE4, the latter show reduced neuronal dendritic complexity and impaired learning. APOE4 TR mice also show reduced gamma oscillation power, a neuronal population activity which is important to learning and memory. Published work has shown that brain extracellular matrix (ECM) can reduce neuroplasticity as well as gamma power, while attenuation of ECM can instead enhance this endpoint. In the present study we examine human cerebrospinal fluid (CSF) samples from APOE3 and APOE4 individuals and brain lysates from APOE3 and APOE4 TR mice for levels of ECM effectors that can increase matrix deposition and restrict neuroplasticity. We find that CCL5, a molecule linked to ECM deposition in liver and kidney, is increased in CSF samples from APOE4 individuals. Levels of tissue inhibitor of metalloproteinases (TIMPs), which inhibit the activity of ECM-degrading enzymes, are also increased in APOE4 CSF as well as astrocyte supernatants brain lysates from APOE4 TR mice. Importantly, as compared to APOE4/wild-type heterozygotes, APOE4/CCR5 knockout heterozygotes show reduced TIMP levels and enhanced EEG gamma power. The latter also show improved learning and memory, suggesting that the CCR5/CCL5 axis could represent a therapeutic target for APOE4 individuals.
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Doença de Alzheimer , Apolipoproteína E4 , Camundongos , Humanos , Animais , Idoso , Apolipoproteína E4/genética , Memória de Curto Prazo , Apolipoproteína E3/genética , Camundongos Transgênicos , Doença de Alzheimer/genética , Apolipoproteínas E/genética , Receptores CCR5RESUMO
Telomere biology disorders (TBDs) are a spectrum of diseases that arise from mutations in genes responsible for maintaining telomere integrity. Human telomerase reverse transcriptase (hTERT) adds nucleotides to chromosome ends and is frequently mutated in individuals with TBDs. Previous studies have provided insight into how relative changes in hTERT activity can lead to pathological outcomes. However, the underlying mechanisms describing how disease-associated variants alter the physicochemical steps of nucleotide insertion remain poorly understood. To address this, we applied single-turnover kinetics and computer simulations to the Tribolium castaneum TERT (tcTERT) model system and characterized the nucleotide insertion mechanisms of six disease-associated variants. Each variant had distinct consequences on tcTERT's nucleotide insertion mechanism, including changes in nucleotide binding affinity, rates of catalysis, or ribonucleotide selectivity. Our computer simulations provide insight into how each variant disrupts active site organization, such as suboptimal positioning of active site residues, destabilization of the DNA 3' terminus, or changes in nucleotide sugar pucker. Collectively, this work provides a holistic characterization of the nucleotide insertion mechanisms for multiple disease-associated TERT variants and identifies additional functions of key active site residues during nucleotide insertion.
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Telomerase , Humanos , Telomerase/genética , Nucleotídeos , Telômero/metabolismo , DNA/química , MutaçãoRESUMO
BackgroundObstructive sleep apnea (OSA) portends increased morbidity and mortality following acute ischemic stroke (AIS). Evaluation of OSA in the setting of AIS treated with endovascular mechanical thrombectomy (MT) has not yet been evaluated in the literature. METHODS: The National Inpatient Sample from 2010 to 2018 was utilized to identify adult AIS patients treated with MT. Those with and without OSA were compared for clinical characteristics, complications, and discharge disposition. Multivariable logistic regression analysis and propensity score adjustment (PA) were employed to evaluate independent associations between OSA and clinical outcome. RESULTS: Among 101 093 AIS patients treated with MT, 6412 (6%) had OSA. Those without OSA were older (68.5 vs 65.6 years old, p<0.001), female (50.5% vs 33.5%, p<0.001), and non-caucasian (29.7% vs 23.7%, p<0.001). The OSA group had significantly higher rates of obesity (41.4% vs 10.5%, p<0.001), atrial fibrillation (47.1% vs 42.2%, p=0.001), hypertension (87.4% vs 78.5%, p<0.001), and diabetes mellitus (41.2% vs 26.9%, p<0.001). OSA patients treated with MT demonstrated lower rates of intracranial hemorrhage (19.1% vs 21.8%, p=0.017), treatment of hydrocephalus (0.3% vs 1.1%, p=0.009), and in-hospital mortality (9.7% vs 13.5%, p<0.001). OSA was independently associated with lower rate of in-hospital mortality (aOR 0.76, 95% CI 0.69 to 0.83; p<0.001), intracranial hemorrhage (aOR 0.88, 95% CI 0.83 to 0.95; p<0.001), and hydrocephalus (aOR 0.51, 95% CI 0.37 to 0.71; p<0.001). Results were confirmed by PA. CONCLUSIONS: Our findings suggest that MT is a viable and safe treatment option for AIS patients with OSA.
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Isquemia Encefálica , Hidrocefalia , AVC Isquêmico , Apneia Obstrutiva do Sono , Acidente Vascular Cerebral , Humanos , Adulto , Feminino , Idoso , Isquemia Encefálica/cirurgia , Isquemia Encefálica/complicações , AVC Isquêmico/cirurgia , Acidente Vascular Cerebral/etiologia , Pacientes Internados , Resultado do Tratamento , Estudos Retrospectivos , Trombectomia/métodos , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/complicações , Hemorragias Intracranianas/etiologia , Hidrocefalia/etiologiaRESUMO
Telomeres at the ends of linear chromosomes are essential for genome maintenance and sustained cellular proliferation, but shorten with each cell division. Telomerase, a specialized reverse transcriptase with its own integral RNA template, compensates for this by lengthening the telomeric 3' single strand overhang. Mammalian telomerase has the unique ability to processively synthesize multiple GGTTAG repeats, by translocating along its product and reiteratively copying the RNA template, termed repeat addition processivity (RAP). This unusual form of processivity is distinct from the nucleotide addition processivity (NAP) shared by all other DNA polymerases. In this review, we focus on the minimally active human telomerase catalytic core consisting of the telomerase reverse transcriptase (TERT) and the integral RNA (TR), which catalyzes DNA synthesis. We review the mechanisms by which oxidatively damaged nucleotides, and anti-viral and anti-cancer nucleotide drugs affect the telomerase catalytic cycle. Finally, we offer perspective on how we can leverage telomerase's unique properties, and advancements in understanding of telomerase catalytic mechanism, to selectively manipulate telomerase activity with therapeutics, particularly in cancer treatment.
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TelomeraseRESUMO
Relational reasoning is a complex form of human cognition involving the evaluation of relations between mental representations of information. Prior studies have modified stimulus properties of relational reasoning problems and examined differences in difficulty between different problem types. While subsets of these stimulus properties have been addressed in separate studies, there has not been a comprehensive study, to our knowledge, which investigates all of these properties in the same set of stimuli. This investigative gap has resulted in different findings across studies which vary in task design, making it challenging to determine what stimulus properties make relational reasoning-and the putative formation of mental models underlying reasoning-difficult. In this article, we present the Multidimensional Relational Reasoning Task (MRRT), a task which systematically varied an array of stimulus properties within a single set of relational reasoning problems. Using a mixed-effects framework, we demonstrate that reasoning problems containing a greater number of the premises as well as multidimensional relations led to greater task difficulty. The MRRT has been made publicly available for use in future research, along with normative data regarding the relative difficulty of each problem.
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BACKGROUND: Radiographic markers of skeletal maturity are vital to the prediction and interpretation of skeletal growth patterns. Accurate predictions of skeletal maturity factor into the management of common musculoskeletal disorders. Bone age is conventionally measured using hand and wrist radiographs. The primary study objective was to optimize skeletal maturity estimates based on the morphology of markers at the hip, knee, and foot rather than conventional upper extremity radiographs. METHODS: This was a retrospective analysis of children from the Bolton-Brush collection with anteroposterior radiographs of the hip and anteroposterior and lateral radiographs of the knee and foot, and heights recorded at the time of each radiograph. The percent growth achieved (%GA) was calculated as a function of final patient height. Poor quality radiographs were excluded, leaving 50 patients-32 females and 18 males-and 1068 radiographs for analysis. Skeletal maturity was evaluated using the Oxford bone, O'Connor knee, and calcaneal apophyseal scores. Interrater and intrarater reliability analyses were performed for hip and knee scores. Multiple linear regressions were conducted on these scores and chronologic age as predictors of %GA. Mean differences were calculated between actual and estimated %GAs. All analyses were performed in Prism 8.0. RESULTS: Each lower extremity skeletal maturity score served as statistically significant, independent predictors of %GA, the accuracy and strength of which increased with the addition of chronologic age. The integration of all 3 systems and chronologic age yielded the most predictive, accurate model predictive of %GA, which can be used to determine percent growth remaining. However, this fully integrated system was not statistically superior to the combination of knee and foot scores and knee score and chronologic age, which yield similarly accurate %GA predictions. The hip and knee systems demonstrated good to excellent interrater and intrarater reliability. CONCLUSIONS: Integration of bone age scores across different regions of the lower extremity has the potential to facilitate orthopaedic decision-making using radiographs already obtained in the treatment of pediatric musculoskeletal conditions. LEVEL OF EVIDENCE: Level IV.
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Determinação da Idade pelo Esqueleto , Desenvolvimento Ósseo , Osso e Ossos/diagnóstico por imagem , Estatura , Calcâneo/diagnóstico por imagem , Criança , Feminino , Fêmur/diagnóstico por imagem , Fíbula/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Extremidade Inferior , Masculino , Variações Dependentes do Observador , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tíbia/diagnóstico por imagemRESUMO
INTRODUCTION: A meningeal solitary fibrous tumor (SFT), also called hemangiopericytoma, is a rare mesenchymal malignancy. Due to anatomic constrains, even after macroscopic complete surgery with curative intent, the local relapse risk is still relatively high, thus increasing the risk of dedifferentiation and metastatic spread. This study aims to better define the role of postoperative radiotherapy (RT) in meningeal SFTs. PATIENTS AND METHODS: A retrospective study was performed across seven sarcoma centers. Clinical information was retrieved from all adult patients with meningeal primary localized SFT treated between 1990 and 2018 with surgery alone (S) compared to those that also received postoperative RT (S + RT). Differences in treatment characteristics between subgroups were tested using independent samples t-test for continuous variables and chi-square tests for proportions. Local control (LC) and overall survival (OS) rates were calculated as time from start of treatment until progression or death from any cause. LC and OS in groups receiving S or S + RT were compared using Kaplan-Meier survival curves. RESULTS: Among a total of 48 patients, 7 (15%) underwent S and 41 (85%) underwent S + RT. Median FU was 65 months. LC was significantly associated with treatment. LC after S at 60 months was 60% versus 90% after S + RT (p = 0.052). Furthermore, R1 resection status was significantly associated with worse LC (HR 4.08, p = 0.038). OS was predominantly associated with the mitotic count (HR 3.10, p = 0.011). CONCLUSION: This retrospective study, investigating postoperative RT in primary localized meningeal SFT patients, suggests that combining RT to surgery in the management of this patient population may reduce the risk for local failures.