Management of high-risk and post-operative non-metastatic prostate cancer in Catalonia: an expert Delphi consensus.

BACKGROUND: To reach a consensus on recommendations for the management of high-risk and post-operative non-metastatic prostate cancer by a group of Radiation Oncologists in Catalonia dedicated to prostate cancer. METHODS: A modified Delphi approach was employed to reach consensus on controversial topics in Radiation Oncology on high-risk non-metastatic (eight questions) and post-operative (eight questions) prostate cancer. An agreement of at least 75% was considered as consensus. The survey was electronically sent 6 weeks before an expert meeting where topics were reviewed and discussed. A second-round survey for the controversial questions only was sent and answered by participants after the meeting. RESULTS: After the first round of the survey, 19 experienced Radiation Oncologists attended the meeting and 74% fulfilled the second-round online questionnaire. An agreement of 9 of the 16 questions was accounted for the first round. After the meeting, an additional agreement was reached in 3 questions leading to a final consensus on 12 of the 16 questions. There are still controversial topics like the use of PET for staging of high-risk and post-operative non-metastatic prostate cancer and the optimal dose to the prostate bed in the salvage setting. CONCLUSION: This consensus contributes to establish recommendations and a framework to help in prostate cancer radiation therapy and pharmacological management in daily clinical practice of high-risk and post-operative non-metastatic prostate cancer.

Estimated projection of oral cavity and oropharyngeal cancer deaths in Spain to 2044.

BACKGROUND: Oral cavity cancer (OCC) and oropharyngeal cancer (OPC) are two common malignancies whose mortality is worryingly increasing worldwide. However, few studies have estimated the mortality trends for these cancers in the coming years. This study analysed the mortality rates for OCC and OPC observed between 1980 and 2019 to generate a predictive model for the next 25 years in Spain. METHODS: Mid-year population data and death certificates for the period 1980-2019 were obtained from the Spanish National Institute of Statistics. The Nordpred program (Norwegian Cancer Registry, Oslo, Norway) was used to calculate adjusted mortality rates as well as estimated mortality projections with an age-period-cohort model for the period 2020-2044. RESULTS: The specific mortality rate per 100,000 inhabitants for OCC decreased from 2.36 (1980-1984) to 2.17 (2015-2019) and is expected to decline to 1.68 (2040-2044), particularly in males. For OPC, mortality rates rose from 0.67 (1980-1984) to 1.23 (2015-2019) and are projected to drop to 0.71 (2040-2044). In the group of females > 65 years predictions showed rising mortality rates for both OCC and OPC. The predictive model projects more deaths in females than in males for OCC in the period 2040-2044, while deaths for OPC will decrease in males and gradually increase in females. CONCLUSIONS: Although OCC mortality rates have been found to decrease in males in the last observed decades, there is still room to improve them in females > 65 years in the future by promoting campaigns against smoking and alcohol consumption. OPC mortality will become a growing health problem. Vaccination campaigns for the prevention of human papillomavirus-associated cancers may have a long-term impact on the mortality of these cancers, which should be evaluated in upcoming studies. CLINICAL RELEVANCE: Our findings highlighted the importance of closely monitoring OCC and OPC mortality rates in the coming years by age group and sex, and the need to continue preventive measures against the main known risk factors, such as tobacco, alcohol, and human papillomavirus infection.

La integración de cuidados de enfermería en el anciano en estado de necesidad desde la perspectiva comunitaria / Integration of Nursing Care in the Elderly in Need from the Community Perspective

Introducción: El cuidado en enfermería se aborda desde una perspectiva holística que permita cubrir las necesidades reales de los pacientes en su entorno, que tienen entre sus funciones la de ayudar al anciano enfermo o sano a realizar las actividades que contribuyen a su salud, recuperación o una muerte tranquila en la comunidad. Objetivo: Exponer algunas consideraciones sobre la integración de los cuidados de enfermería en el anciano en estado de necesidad desde la perspectiva comunitaria. Métodos: Se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo sobre la integración cuidados de enfermería en el anciano en estado de necesidad desde la perspectiva comunitaria, en documentos, artículos originales y de revisión disponible en Google Académico y Medline en el período de marzo a junio de 2018, las palabras clave utilizadas fueron Cuidado de enfermería; cuidados comunitarios; Enfermería; integración de cuidados de enfermería, identificadas a través del DECs o de MeSH. Se utilizaron los métodos de análisis, síntesis y sistematización, que posibilitaron la interpretación y la organización de los conocimientos. Tras la identificación de los estudios preseleccionados se llevó a cabo la lectura de los títulos, resumen y palabras clave, y se comprobó la pertinencia con el estudio. Conclusiones: La integración de los cuidados de enfermería permitió contextualizar este fenómeno desde la perspectiva de la comunidad, mediante el aporte de elementos puntuales en el manejo, seguimiento y control de los ancianos en estado de necesidad(AU)

Introduction: Nursing care is approached from a holistic perspective that allows meeting the real needs of patients in their settings, whose functions include helping the sick or healthy elderlies carry out activities that contribute to their health, recovery or having a quiet death in the community. Objective: To present some considerations about the integration of nursing care in the elderly in need from the community perspective. Methods: A systematic bibliographic review was carried out to develop a critical-reflective analysis about the integration of nursing care in the elderly in need from the community perspective, using documents, original articles and review available in Google Scholar and Medline, in the period from March to June 2018. The keywords used were Cuidado de enfermería [Nursing care], cuidados comunitarios [community care], Enfermería [Nursing] and integración de cuidados de enfermería [integration of nursing care], identified through DECs or MeSH. Analysis, synthesis and systematization methods were used, which made the interpretation and organization of knowledge possible. After the identification of the preselected studies, the titles, abstract and keywords were read, and the relevance to the study was checked. Conclusions: The integration of nursing care allowed contextualizing this phenomenon from the community perspective, through the contribution of specific elements to the management, follow-up and control of the elderly in need(AU)

Validación de instrumento de integración de cuidados en el adulto mayor en la comunidad / Validation of an Integration Instrument for the Care of the Community Elderly

Introducción: El envejecimiento poblacional, movido por cambios demográficos, hace imprescindible el desarrollo de instrumentos de trabajo como estrategias para mejorar la integración de los cuidados de los ancianos a nivel sanitario y social. Objetivo: Validar un instrumento para la integración de los cuidados formales y no formales en el adulto mayor en la comunidad. Métodos: Se realizó la validación del contenido, la evaluación de concordancia y validación de juicio de expertos a un instrumento, mediante consulta a 22 expertos del municipio Santiago de Cuba, Cuba, durante el año 2019, diseñada mediante revisión teórica y metodológica del contenido. Se utilizaron como métodos teóricos: el análisis y síntesis, el sistémico estructurado y la modelación; y como métodos empíricos: la entrevista, la encuesta y los criterios de expertos y estadísticos matemáticos para procesar los datos mediante el IBM SPSS Statistics 21,0. Resultados: A criterio de los expertos el grado de estimación de acuerdo y la validación del contenido del instrumento se comportó por encima del 0,60 por ciento con valor en la escala de bueno y muy bueno, lo que está a favor de la pertinencia del instrumento desde el punto de vista del diseño. Los expertos lo validaron y reconocieron como un instrumento útil para la evaluación de la integración de cuidados en la comunidad. Conclusiones: El instrumento permitió tener una validez buena y una representación adecuada del contenido a través de la apreciación de expertos respecto a la validez del contenido, la evaluación de concordancia y validación de juicio de expertos(AU)

Introduction: Population aging, driven by demographic changes, makes it essential to develop work instruments as strategies to improve integration of care for the elderly at a health and social level. Objective: To validate an instrument for integration of formal and nonformal cares in the community elderly. Methods: Content validation, concordance assessment and expert judgment validation of an instrument were performed by consulting 22 experts from Santiago de Cuba Municipality, Cuba, during 2019. The consultation was designed by means of theoretical and methodological content review. Theoretical methods were used: analysis and synthesis, the structured systemic method and modeling. Empirical methods were used: interview, survey and expert criteria. Statistical mathematical methods were used to process the data using the IBM SPSS Statistics 21.0. Results: According to expert criteria, the degree of estimation of concordance and the validation of the instrument's content was above 0.60 percent, with a value of good and very good on the scale, which is in favor of the instrument's relevance from the point of view of design. The experts validated and recognized it as a useful instrument for assessing the integration of care in the community. Conclusions: The instrument allowed to have a good validation and an adequate representation of the content through expert assessment with respect to the validity of the content, assessment of concordance and validation of expert judgment(AU)

La humanización del cuidado enfermero del anciano en estado de necesidad en la comunidad / Humanization of Nursing Care for the Community Elderly in Needs

Introducción: La enfermería tiene como esencia el cuidado humanizado desde una perspectiva holística, orientada hacia la búsqueda de soluciones específicas para cubrir las necesidades de los ancianos en estado de necesidad en la comunidad. Objetivo: Sistematizar el alcance y la naturaleza de la literatura científica existente sobre la humanización del cuidado enfermero del anciano en estado de necesidad en la comunidad. Métodos: Revisión integrativa realizada en 2019 para desarrollar un análisis crítico reflexivo, en documentos, artículos originales y de revisión disponibles en SciELO, Redalyc, Medigraphic y Medline, publicados en español, portugués e inglés entre 2005 y 2019. La pregunta guía se elaboró a través del acrónimo CPC. La estrategia de búsqueda se realizó mediante las palabras clave "cuidado enfermero en la comunidad"; "cuidados humanizado en ancianos"; "humanización de la atención", identificadas en DeCS o MeSH enlazados por los operadores booleanos AND y OR. Se utilizó el diagrama de flujo (PRISMA). El análisis, síntesis y sistematización de contenido permitió interpretar los referentes teóricos y la organización del conocimiento de las 13 bibliografías seleccionadas. Conclusiones: Mediante la sistematización de las bibliografías científicas se abordó el alcance y la naturaleza del cuidado humanizado del anciano en estado de necesidad en la comunidad, con una visión integradora desde una perspectiva holística en la atención comunitaria, a través de la relación del profesional de enfermería en las instituciones de salud(AU)

Introduction: Nursing's essence is humanized care from a holistic perspective, oriented towards searching for specific solutions to meet the needs of community elderlies. Objective: To systematize the scope and nature of the existing scientific literature about humanization of nursing care for the community elderlies in needs. Methods: Integrative review carried out in 2019 to develop a reflective-critical analysis in documents, as well as in original and review articles, available in SciELO, Redalyc, Medigraphic and Medline, published in Spanish, Portuguese and English between 2005 and 2019. The guiding question was elaborated through the CPC acronym. The search strategy was carried out using the keywords cuidado enfermero en la comunidad [community nursing care], cuidados humanizado en ancianos [humanized care for elderlies], and humanización de la atención [humanization of care], identified in DeCS or MeSH and linked using the Boolean operators AND and OR. A flow chart (PRISMA diagram) was used. The analysis, synthesis and systematization of content allowed to interpret the theoretical references and the organization of knowledge from the thirteen selected bibliographies. Conclusions: Through the systematization of the scientific bibliographies, the scope and nature of humanized care for community elderlies in needs was addressed, with an integrative vision, from a holistic perspective oriented towards community care, and through the relationship of the nursing professional in health institutions(AU)

Glioblastoma TCGA Mesenchymal and IGS 23 Tumors are Identifiable by IHC and have an Immune-phenotype Indicating a Potential Benefit from Immunotherapy.

PURPOSE: Molecular subtype classifications in glioblastoma may detect therapy sensitivities. IHC would potentially allow the identification of molecular subtypes in routine clinical practice. EXPERIMENTAL DESIGN: Formalin-fixed, paraffin-embedded tumor samples of 124 uniformly treated, newly diagnosed patients with glioblastoma were submitted to RNA sequencing, IHC, and immune-phenotyping to identify differences in molecular subtypes associated with treatment sensitivities. RESULTS: We detected high molecular and IHC overlapping of the The Cancer Genome Atlas (TCGA) mesenchymal subtype with instrinsic glioma subtypes (IGS) cluster 23 and of the TCGA classical subtype with IGS cluster 18. IHC patterns, gene fusion profiles, and immune-phenotypes varied across subtypes. IHC revealed that the TCGA classical subtype was identified by high expression of EGFR and low expression of PTEN, while the mesenchymal subtype was identified by low expression of SOX2 and high expression of two antibodies, SHC1 and TCIRG1, selected on the basis of RNA differential transcriptomic expression. The proneural subtype was identified by frequent positive IDH1 expression and high Olig2 and Ki67 expression. Immune-phenotyping showed that mesenchymal and IGS 23 tumors exhibited a higher positive effector cell score, a higher negative suppressor cell score, and lower levels of immune checkpoint molecules. The cell-type deconvolution analysis revealed that these tumors are highly enriched in M2 macrophages, resting memory CD4+ T cells, and activated dendritic cells, indicating that they may be ideal candidates for immunotherapy, especially with anti-M2 and/or dendritic cell vaccination. CONCLUSIONS: There is a subset of tumors, frequently classified as mesenchymal or IGS cluster 23, that may be identified with IHC and could well be optimal candidates for immunotherapy.

Profesora Caridad Llanes Betancourt, 50 años dedicados al arte del cuidado

Se destaca la vida y obra de una enfermera que ha dedicado 50 años de su existencia a la ciencia del cuidado, así como a la formación de los recursos humanos encargados de darle continuidad a su obra. De procedencia humilde, fundó una familia en la que la mayoría de sus integrantes están vinculados a las ciencias médicas. Centró su trabajo en la atención al adulto mayor, etapa de la vida donde se requieren cuidados especiales llenos de amor y humanismo, sobre este tema deja una obra de reciente publicación que constituye su principal legado a la profesión. Profesor Auxiliar y Consultante en la Facultad de Ciencias Médicas "General Calixto García". Cuenta en su haber con múltiples reconocimientos y condecoraciones, la más reciente, la Distinción Frank País de Primer Grado otorgada por el Consejo de Estado en el año 2017. El principal objetivo de este trabajo es destacar parte de la vida y obra de esta distinguida figura de la Enfermería cubana contemporánea.

The life and work of a female nurse who has devoted 50 years of her existence to the science of nursing care and the formation of human resources for giving continuity to her work is highlighted. From social humble origin, she founded a family where most of its members are related to the medical science. She focused her attention on the elderly care, stage of life in which those people need to receive a special care with much love and humanism. There is a recent publication on this topic, which is her main legacy to the profession. She is an Associate Professor and Consultant in "Calixto García" Faculty of Medical Sciences. She has earned many awards and recognitions, being the newest one the "Orden Frank País de Segundo Grado", awarded by the Council of State in 2017. The main objective of this work is to highlight part of the life and work of this leading figure of the contemporary Cuban nursing.

El curso Básico en Educación Médica. Experiencias de la Facultad de Ciencias Médicas "General Calixto García" / Basic Course in Medical Education. Experiences in Calisto Garcia Medical School

Introducción: La preparación como docentes de los profesionales de la salud es una necesidad a la que la universidad médica cubana ha dado su atención y prioridad como respuesta al encargo social de la formación de sus recursos humanos, dado la correspondencia entre la preparación científica de los docentes en el área de las ciencias de la educación con la pertinencia, calidad y eficiencia de la enseñanza. A este fin ha contribuido el desarrollo del Curso Básico en Educación Médica en la Facultad de Ciencias Médicas "General Calixto García". Objetivo: Caracterizar el desarrollo del Curso Básico en Educación Médica en la Facultad de Ciencias Médicas "General Calixto García" en el periodo de 2014-2017, y las experiencias acumuladas para su continuo perfeccionamiento. Métodos: Se realizó un estudio descriptivo de las 6 últimas ediciones comprendidas en el período 2012-2017, considerándose las variables de: programa de estudio, categoría docente de los participantes al iniciar el curso, satisfacción con su desarrollo y resultados de la promoción docente. Para las indagaciones empíricas se aplicaron dos encuestas a los cursistas y la técnica de PNI como parte de la valoración general del curso. Resultados: Se obtuvo que se capacitaron un total de 313 profesionales de la salud vinculados a las actividades docentes, de ellos un 40 percent no tenían categoría docente, el 1 percent eran Instructores, y el 1 9 percent con categoría de Asistente, todos inmersos en el proceso de obtención o promoción de categorización docente. La valoración general del curso fue muy satisfactoria, destacándose como opiniones positivas la calidad y preparación de los profesores del claustro, satisfacción sobre los temas y contenidos tratados y la aplicación a su práctica docente, la amplia bibliografía ofrecida, así como el intercambio producido en los trabajos grupales. Conclusiones: El Curso Básico en Educación Médica facilita a los profesores sin preparación docente, apropiarse de herramientas fundamentales que les permitan aplicar los fundamentos científicos y pedagógicos en los procesos de formación de profesionales en Ciencias de la Salud y ha sido muy bien valorado por los cursistas y otros actores del proceso. Los criterios obtenidos contribuirán a su continuo perfeccionamiento en función de lograr transformación de los profesionales de la salud vinculados con las ciencias de la educación(AU)

Introduction: The health professionals' training as further professors is a necessity to which the Cuban medical university has given attention and priority as a response to the social mission of training its human resources, given the correspondence between scientific preparation of professors in the field of ​​educational sciences with the relevance, quality and efficiency of teaching. The development of the Basic Course in Medical Education has contributed to this aim in General Calixto García Medical School. Objective: To characterize the development of the Basic Course in Medical Education in General Calixto García Medical School, in the period 2014-2017, and the accumulated experiences for its continuous improvement. Methods: A descriptive study was carried out of the last sex editions within the period 2012-2017, considering the variables study program, teaching category of the participants at the beginning of the course, satisfaction with their development, and outcomes of the teaching promotion. For the empirical investigations, two surveys were applied to the course students. The PNI technique was applied as part of the general assessment of the course. Results: It was obtained that a total of 313 health professionals associated to the teaching activities were trained, of which 40 percent did not have a teaching category, 1 percent were Instructors, and 1 percent had the category of Assistant, all immersed in the process of obtaining or promoting teaching categorization. The general evaluation of the course was very satisfactory, highlighting with positive opinions the quality and preparation of the faculty, the satisfaction with the topics and contents treated and their application to their teaching practice, the wide bibliography offered, as well as the exchange produced in the group work. Conclusions: The Basic Course in Medical Education facilitates professors without teaching training the appropriation of fundamental tools that allow them to apply the scientific and pedagogical foundations in the training processes of professionals in Health Sciences and has been highly valued by the students and other actors in the process. The criteria obtained will contribute to its continuous improvement, in order to achieve the transformation of health professionals associated with education sciences(AU)

Pseudoprogression as an adverse event of glioblastoma therapy.

We explored predictive factors of pseudoprogression (PsP) and its impact on prognosis in a retrospective series of uniformly treated glioblastoma patients. Patients were classified as having PsP, early progression (eP) or neither (nP). We examined potential associations with clinical, molecular, and basal imaging characteristics and compared overall survival (OS), progression-free survival (PFS), post-progression survival (PPS) as well as the relationship between PFS and PPS in the three groups. Of the 256 patients studied, 56 (21.9%) were classified as PsP, 70 (27.3%) as eP, and 130 (50.8%) as nP. Only MGMT methylation status was associated to PsP. MGMT methylated patients had a 3.5-fold greater possibility of having PsP than eP (OR: 3.48; 95% CI: 1.606-7.564; P = 0.002). OS was longer for PsP than eP patients (18.9 vs. 12.3 months; P = 0.0001) but was similar for PsP and nP patients (P = 0.91). OS was shorter-though not significantly so-for PsP than nP patients (OS: 19.5 vs. 27.9 months; P = 0.63) in methylated patients. PPS was similar for patients having PsP, eP or nP (PPS: 7.2 vs. 5.4 vs. 6.7; P = 0.43). Neurological deterioration occurred in 64.3% of cases at the time they were classified as PsP and in 72.8% of cases of eP (P = 0.14). PsP confounds the evaluation of disease and does not confer a survival advantage in glioblastoma.

Caracterización del examen estatal teórico ordinario de Licenciatura en Enfermería / Characterization of the ordinary theoretical state exam of Licentiate in Infirmary

Introducción: el examen estatal teórico constituye el último ejercicio evaluativo en la formación del estudiante de la carrera de Licenciatura en Enfermería, en el mismo ha de mostrar el dominio de la base científico técnica de su actuación profesional. Objetivos: caracterizar el examen estatal teórico ordinario de la carrera de Llicenciatura en Enfermería en el curso 2014-2015, con el propósito de identificar las principales dificultades de este y realizar sugerencias para incrementar su calidad. Métodos: se utilizó la revisión documental y la consulta a especialistas. La muestra estuvo conformada por los 33 exámenes estatales realizados por estudiantes del año terminal de la carrera en la Facultad "General Calixto García" en dicho curso. Resultados: la totalidad de las preguntas estuvieron bien conformadas, la frecuencia de errores estuvo relacionada con el dominio del contenido por los estudiantes, no así con los tipos de preguntas y su elaboración, la incidencia de mayores dificultades fueron las preguntas de tipo Selección Múltiple, Complemento Simple y Agrupado. No hubo preguntas con enfoque de promoción, y las de prevención, representadas en porcientos, no acordes con la importancia que ello reviste por constituir este un importante principio del Sistema de Salud Cubano. Predominaron los resultados desfavorables en temáticas relacionadas con la Enfermería Clínico Quirúrgica y Enfermería Ginecobstétrica. La asignación del número de preguntas, según tipo de estas por especialidad, se realizó equitativamente. Conclusiones: a través de la caracterización del examen, se logró identificar dificultades y realizar sugerencias para el mejoramiento de la calidad del mismo en futuras ediciones(AU)

Introduction: The theoretical state exam constitutes the last exercise evaluative in the formation of the student of the career of Licentiate in Iinfirmary; in the same one it must show the domain of the base scientist technique of its professional performance. Objectives: To characterize the ordinary theoretical state exam of the career of Licentiate in Infirmary in the course 2014-2015, with the purpose of identifying the main difficulties of this, and to carry out suggestions to increase their quality. Methods: It was used the documental revision and the consultation to specialists. The sample was conformed by the 33 state exams carried out by the students of the terminal year of the career in the General Faculty Calixto García in this course. Results: The entirety of the questions was well conformed, the frequency of errors was related with the domain of the content for the students, I didn't seize with the types of questions and its elaboration, the incidence of more difficulties was the questions of type Selection Multiple Simple and Contained Complement. There were not questions with promotion focus, and those of prevention represented by percents non chords with the importance that you had it to constitute this an important principle of the Cuban System of Health. The unfavorable results prevailed in thematic related with the Surgical Clinical Infirmary and Infirmary Ginecobstétrica. The assignment of the number of questions, according to type of these for specialty, was carried out equally. Conclusions: It was achieved through the characterization of the exam, to identify difficulties and to carry out suggestions for the improvement of the quality of the same one in their future editions(AU)

Brain damage following prophylactic cranial irradiation in lung cancer survivors.

Long-term toxic effects of prophylactic cranial irradiation (PCI) on cognition in small cell lung cancer (SCLC) patients have not yet been well-established. The aim of our study was to examine the cognitive toxic effects together with brain structural changes in a group of long-term SCLC survivors treated with PCI. Eleven SCLC patients, who underwent PCI ≥ 2 years before, were compared with an age and education matched healthy control group. Both groups were evaluated using a neuropsychological battery and multimodal structural magnetic resonance imaging. Voxel-based morphometry and Tract-based Spatial Statistics were used to study gray matter density (GMD) and white matter (WM) microstructural changes. Cognitive deterioration was correlated with GMD and Fractional Anisotropy (FA). Finally, we carried out a single-subject analysis in order to evaluate individual structural brain changes. Nearly half of the SCLC met criteria for cognitive impairment, all exhibiting a global worsening of cognitive functioning. Patients showed significant decreases of GMD in basal ganglia bilaterally (putamen and caudate), bilateral thalamus and right insula, together with WM microstructural changes of the entire corpus callosum. Cognitive deterioration scores correlated positively with mean FA values in the corpus callosum. Single-subject analysis revealed that GMD and WM changes were consistently observed in nearly all patients. This study showed neuropsychological deficits together with brain-specific structural differences in long-term SCLC survivors. Our results suggest that PCI therapy, possibly together with platinum-based chemotherapy, was associated to permanent long-term cognitive and structural brain effects in a SCLC population.

Neoadjuvant Chemoradiotherapy Treatment for a Classic Biphasic Pulmonary Blastoma with High PD-L1 Expression.

Pulmonary blastomas are rare malignant tumors, comprising only 0.25-0.5% of all malignant lung neoplasms. The prognosis of pulmonary blastoma is very poor, with an overall five-year survival of 16%. No standard treatment has been defined for unresectable disease. We present the case of a 25-year-old woman with unresectable locally advanced classic biphasic pulmonary blastoma (CBPB) successfully treated with neodjuvant chemoradiotherapy based on two chemotherapy induction cycles of cisplatin plus etoposide, followed by concurrent weekly cisplatin to 50.4 Gy radiotherapy treatment. The patient had a significant reduction in tumor size, allowing for complete resection by pneumonectomy. Molecular study for epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK), proto-oncogene receptor tyrosine kinase (ROS1) and rearranged during transfection (RET) rearrangements, and programmed death ligand 1 (PD-L1) expression was performed in the pre-treatment tumor sample. Our patient presented a high expression (>90% of tumor cells) of PD-L1. To our knowledge, this is the first report of PD-L1 expression in CBPB. This could lead to new treatment options based on new immunotherapy agents blocking the PD-1/PD-L1 pathway for this rare disease with poor prognosis.

Maxillomandibular osteomyelitis associated with osteopetrosis.

Osteopetrosis is a heterogeneous disorder characterized by abnormal bone remodeling and increased bone density primarily due to defective osteoclast resorption. The diagnosis is based on a history of numerous fractures and radiological findings indicative of osteosclerosis, usually sufficient for a definitive diagnosis. We present a quite rare case of osteopetrosis complicated by recurrent episodes of maxillomandibular osteomyelitis associated with cutaneous fistulization and purulent nasal discharge. We used intravenous antibiotic therapy and necrotic bone debridement that prevented the appearance of acute infections over a 3-year follow-up, but the complete healing of the case was not achieved.

Treatment of recurrent mandibular ameloblastoma.

Ameloblastoma is a locally invasive benign odontogenic tumor with a high rate of recurrence in the long term. The authors conducted a retrospective study of patients with mandibular ameloblastoma in order to evaluate recurrent ameloblastoma management. The study included data from 31 patients over a period of 10 years. Data collected included age, gender, tumor location, histological findings, initial treatment, number of recurrences and year of onset, type of treatment of recurrence, reconstruction and follow-up. Recurrences were detected in nine patients (29%). Tumor recurrences appeared at 32 months on average following the initial surgical procedure. Recurrences were associated mainly to inadequate initial therapeutic approach and were treated by bone resection with a safety margin of at least 1 cm beyond the radiographically visible margins. Immediate reconstruction of bone defects was performed with grafts or free flaps.

Phase I study of concurrent chemoradiation with pemetrexed and cisplatin followed by consolidation pemetrexed for patients with unresectable stage III non-small cell lung cancer.

PURPOSE: Although concurrent chemotherapy and radiation is the standard approach for good risk unresectable stage III non-small cell lung cancer (NSCLC) patients, there is no optimal concurrent chemotherapy regimen. Administration of chemotherapy at full dose with maximal activity against local and micrometastatic disease is highly desirable. This study tested the feasibility of 3 cycles of full dose cisplatin and pemetrexed concurrent with definitive thoracic radiotherapy followed by consolidation pemetrexed, without the dose-limiting toxicity (DLT) exceeding 33% of the patients. METHODS: Patients with unresectable stage III NSCLC, good performance status and no serious comorbidity were eligible. Patients received thoracic radiation to a dose of 66 Gy concurrently with three 21-day cycles of pemetrexed 500 mg/m(2), and cisplatin at escalating doses from 60 to 75 mg/m(2). Consolidation chemotherapy of pemetrexed 500 mg/m(2) was provided for 3 more 21-day cycles. Cisplatin doses were escalated as far as no more than 1/3 of the patients in a level developing dose limiting toxicities (DLT). RESULTS: Fifteen eligible patients were enrolled: nine in the first dose level and 3 in the second and third dose levels respectively. Two out of 9 patients in the first dose level experienced DLT (grade 3 esophagitis resulting in delay in treatment administration). The major serious acute toxicities were esophagitis (40%) and febrile neutropenia (20%). With a median follow up time of 22 months, median time to progression and overall survival has not been reached. The rate of survival at 24 months was 57.5% (95% CI: 27.5-87.4%) of the patients. CONCLUSIONS: Three systemic dose levels of pemetrexed and cisplatin could be administered concurrently with radiotherapy. The rate of survival at 24 months was encouraging.

Myxofibroma of the maxilla. Reconstruction with iliac crest graft and dental implants after tumor resection.

Odontogenic fibromyxomas are benign odontogenic tumors of mesenchymal origin of rare presentation in the oral cavity, which exhibit locally aggressive behavior and are prone to local recurrence. The controversy has mainly been on therapeutic management with recommendations varying, depending on the clinical cases, from simple curettage of lesion to segmental bone resection. We present a case report describing the reconstruction of an osseous defect in the maxilla and the restoration with dental implants in a 32 year old female patient after radical surgical excision due to an odontogenic fibromyxoma with locally aggressive behavior. The primary reconstruction of maxillary discontinuity defect was carried out by an immediate non-vascularized cortico-cancellous iliac crest graft. Using a computer-guided system for the implant treatment-planning, three dental implants were secondary placed in the bone graft by means of flapless implant surgery. The patient was subsequently restored with an implant-supported fixed prosthesis that has remained in continuous function for a period of three years. The surgical, reconstructive and restorative treatment sequence and techniques are discussed.

Hermanas fenton tait, dos enfermeras excepcionales / Fenton tait sister's, two exceptional nurses

Se aborda la vida de dos hermanas que han devenido en paradigmas de la Enfermería cubana, pues han dedicado de manera destacada su vida entera al arte de cuidar. Se brindan elementos relacionados con su niñez en el seno de una familia humilde en Guantánamo, sus inquietudes, aspiraciones, estudios, vida profesional y familia, así como la imagen que una hermana tiene de la otra(AU)

The life of two sisters is approached that have become in paradigms of the Cuban infirmary, because they have dedicated in an outstanding way its whole life to the art of taking care. Elements related with their childhood are offered in the breast of a humble family in Guantánamo, their restlessness, aspirations, studies, professional life and family, as well as the image that a sister has of the other one(AU)