Squamous Cell Carcinoma with Prominent Eosinophils.

Eosinophils are often encountered in the stroma and peritumoral microenvironment of squamous cell carcinomas. Because eosinophils are readily identified on routine hematoxylin and eosin stained sections, researchers have explored multiple ways in which identifying the extent of eosinophil infiltration on routine biopsy and excisional specimens might provide diagnostic and prognostic information. We review the literature on this evolving topic.

Pseudoendocrine sarcoma: a rare new entity with unique radiologic and pathologic/molecular characteristics.

Pseudoendocrine sarcoma is a rare, recently described intermediate grade sarcoma of uncertain phenotype that most commonly affects the paraspinal location in older patients with a distinctive endocrine/paraganglioma-like morphology and unique CTNNB1 point mutation. While these tumors appear as epithelial or even benign endocrine tumors, these lack markers for such and are highlighted by nuclear expression of beta-catenin. This case is the first among the previously reported only twenty-five cases of this entity, including one original series and a few case reports, to correlate the radiologic imaging with the pathologic features. Furthermore, this case illustrates the oldest-to-date patient with this unique location as a palpable painful chest wall/paraspinal location, with new morphologic observations and, finally, this is only the second case to have this specific CTNNB1 hotspot point mutation for this rare entity.

Standardization of the Verification Nurse Role in the Delivery of Chemotherapy and Biotherapy.

After a chemotherapy overdose in 1994 resulted in the death of one patient and the permanent injury of another, the role of the verification nurse was created at a National Cancer Institute-designated comprehensive cancer c.

Successful Crizotinib-targeted Therapy of Pediatric Unresectable ERC1::ALK Fusion Sarcoma.

Anaplastic lymphoma kinase ( ALK )-fusion sarcomas are rare part of the emerging theoretically targetable tyrosine kinase RAS::MAPK pathway fusion myopericytic-ovoid sarcomas. We report our clinicopathologic and treatment experience with an ALK fusion sarcoma. A novel ELKS/RAB6-interacting/CAST family member 1 - unaligned ALK fusion infiltrative nonmetastatic low-grade sarcoma of the right hand of a 15-month-old male was treated with crizotinib, an ALK tyrosine kinase inhibitor as oral monotherapy, inducing complete radiographic and clinical resolution by 10 months and sustained response now over 12 months after elective discontinuation. Crizotinib can successfully be used to treat unresectable novel ALK fusion sarcomas.

Strategies to Mitigate the Drug-Drug Interaction between Nirmatrelvir/Ritonavir and Tacrolimus in Allogeneic Hematopoietic Stem Cell Transplant Recipients on Azole Antifungals: Results of a Case Series.

INTRODUCTION: Nirmatrelvir/ritonavir (NIM/r) inhibits tacrolimus metabolism resulting in a profound drug-drug interaction that is further complicated by the use of azole antifungals. CASE PRESENTATIONS: We describe three strategies, in 4 patient cases, for the initiation of NIM/r in allogeneic hematopoietic stem cell transplant (alloHSCT) recipients on tacrolimus at the time of diagnosis. Patients 1 and 2 (strategy 1) experienced prolonged, elevated tacrolimus concentrations after an empiric 33% reduction in tacrolimus dose and adjustment of azole antifungal at NIM/r initiation (strategy 1) and with complete discontinuation of tacrolimus and azole antifungal at NIM/r initiation (strategy 2). Patients 3 and 4 (strategy 3) did not experience elevated tacrolimus concentrations on NIM/r treatment with complete discontinuation of tacrolimus and azole antifungal and a 12-24-h delay in NIM/r initiation. Reinitiation of tacrolimus after NIM/r completion resulted in variable tacrolimus concentrations. CONCLUSION: NIM/r-tacrolimus is a serious drug-drug interaction which can be mitigated by early discontinuation of tacrolimus and azole antifungals, close monitoring, and reinitiation of tacrolimus and antifungal 48-72 h after completion of therapy.

Outcomes After Preoperative Chemoradiation With or Without Pazopanib in Non-Rhabdomyosarcoma Soft Tissue Sarcoma: A Report From Children's Oncology Group and NRG Oncology.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.ARST1321 was a phase II study designed to compare the near complete pathologic response rate after preoperative chemoradiation with/without pazopanib in children and adults with intermediate-/high-risk chemotherapy-sensitive body wall/extremity non-Rhabdomyosarcoma Soft Tissue Sarcoma (ClinicalTrials.gov identifier: NCT02180867). Enrollment was stopped early following a predetermined interim analysis that found the rate of near complete pathologic response to be significantly greater with the addition of pazopanib. As a planned secondary aim of the study, the outcome data for this cohort were analyzed. Eight-five eligible patients were randomly assigned to receive (regimen A) or not receive (regimen B) pazopanib in combination with ifosfamide and doxorubicin + preoperative radiotherapy followed by primary resection at week 13 and then further chemotherapy at week 25. As of December 31, 2021, at a median survivor follow-up of 3.3 years (range, 0.1-5.8 years), the 3-year event-free survival for all patients in the intent-to-treat analysis was 52.5% (95% CI, 34.8 to 70.2) for regimen A and 50.6% (95% CI, 32 to 69.2) for regimen B (P = .8677, log-rank test); the 3-year overall survival was 75.7% (95% CI, 59.7 to 91.7) for regimen A and 65.4% (95% CI, 48.1 to 82.7) for regimen B (P = .1919, log-rank test). Although the rate of near complete pathologic response was significantly greater with the addition of pazopanib, outcomes were not statistically significantly different between the two regimens.

Intravascular fasciitis of the scalp as a complication of ICP monitor placement: a case report and review of the literature.

BACKGROUND/IMPORTANCE: There are only 56 documented cases of intravascular fasciitis, a rare variant of nodular fasciitis. Of these cases, only 2 involved the scalp. This lesion is amenable to surgical resection, making it important to differentiate it from soft tissue malignancies of the scalp. CLINICAL PRESENTATION: We report an unusual case of intravascular fasciitis involving the scalp at the site of an intracranial pressure (ICP) monitor of a 13-year-old male patient. The lesion was surgically excised with no recurrence upon 1-month follow-up. CONCLUSION: Intravascular fasciitis is a benign, reactive proliferation of soft tissue that may arise at sites of prior trauma. It appears as a soft, painless, mobile lesion, and immunohistochemical studies are required to differentiate it from malignant lesions. The standard of care is surgical resection of the lesion.

Acceptability and Preferences of Dry HR HPV Self-Sampling Mailed Kits Among Canadian Women: A Cross-Sectional Study.

Human papillomavirus (HPV), a sexually transmitted disease, is identified as the source of 99.7% of cervical cancers. Screening for cervical cancer using oncogenic HPV (high-risk [HR] HPV) detection is more sensitive than traditional cytology. However, few Canadian data exist on HR HPV self-sampling. OBJECTIVE: To evaluate the acceptability of HR HPV self-sampling by patients, the percentage of correctly collected samples, the return rate of mailed kits, and the HPV positivity rate in a population sample based on different cervical cancer risk factors. METHODS: We conducted an observational cross-sectional study on HPV primary cervical cancer screening with self-collected cervicovaginal samples through mail service. RESULTS: A total of 400 kits were mailed and 310 kits were returned, making a return rate of 77.5%. Of these, 84.2% of patients were very satisfied with this method and 95.8% (297/310) of patients would choose self-sampling over cytology as their primary screening method. All patients would recommend this screening method to their friends or family members. Of the samples, 93.8% could be analyzed correctly and the HPV positivity rate was 11.7%. CONCLUSION: In this large and random sample, there was a strong interest in self-testing. Offering HR HPV self-sampling could increase access to cervical cancer screening. The self-screening method could also be a part of the solution to reaching under-screened populations, in particular, those who do not have a family doctor or avoid gynaecologic exams because of pain or anxiety.

Cutaneous VCL::ALK fusion ovoid-spindle cell neoplasm.

Cutaneous VCL::ALK fusion spindle (ovoid) cell tumor is unique. Recently emerged RAS::MAP tyrosine kinase fusion sarcomas more commonly involve subcutis, skeletal muscle and even bone. We share our experience with a novel cutaneous VCL::ALK spindle cell tumor. An 11-year-old male presented with a back pedunculated pink-red papule thought to be a pyogenic granuloma. Biopsy histopathology revealed an epithelial collarette with pedunculated tumor extending to deep dermis/subcutis interface. The combination of spindled and epithelioid cells, an ovoid myopericytoid appearance within myxoid to collagenous stroma, low to moderate MIB1 and focal S100 protein without SOX10 immunostaining, were suggestive of a novel RAS::MAPK tyrosine kinase fusion sarcoma that is well described. ALK immunostain being positive, a next-generation sequencing comprehensive fusion panel was performed to reveal a VCL::ALK fusion. While epithelioid fibrous histiocytoma shares this fusion and similar dermal location and collarette pedunculation, this and other entities were excluded by older patient age, deeper dermal involvement, ovoid-to-spindled morphology, central pericytoid vasculature, myxoid stroma, moderate cellularity with low to moderate MIB1 expression, superficial ulceration, and focal S100 protein expression. Complete excision was performed with favorable follow-up to date. This novel VCL::ALK fusion spindle (ovoid) cell tumor of the dermis is best considered as part of the recently emerged RAS::MAP tyrosine kinase fusion sarcomas.

Unsuspected gastric glomus tumour.

Gastric glomus tumours (GGTs) are rare predominantly benign, mesenchymal neoplasms that commonly arise from the muscularis or submucosa of the gastric antrum and account for <1% of gastrointestinal soft-tissue tumours. Historically, GGT has been difficult to diagnose preoperatively due to the lack of unique clinical, endoscopic and CT features. We present a case of an incidentally identified GGT in an asymptomatic man that was initially considered a neuroendocrine tumour (NET) by preoperative fine-needle aspiration biopsy with focal synaptophysin reactivity. An elective robotic distal gastrectomy and regional lymphadenectomy were performed. Postoperative review by pathology confirmed the diagnosis of GGT. GGTs should be considered by morphology as a differential diagnosis of gastric NET on cytology biopsy, especially if there is focal synaptophysin reactivity. Additional staining for SMA and BRAF, if atypical/malignant, can help with this distinction. Providers should be aware of the biological behaviour and treatment of GGTs.

An 8-year pragmatic observation evaluation of the benefits of allogeneic HCT in older and medically infirm patients with AML.

We designed a prospective, observational study enrolling patients presenting for treatment of acute myeloid leukemia (AML) at 13 institutions to analyze associations between hematopoietic cell transplantation (HCT) and survival, quality of life (QOL), and function in: the entire cohort, those aged ≥65 years, those with high comorbidity burden, intermediate cytogenetic risk, adverse cytogenetic risk, and first complete remission with or without measurable residual disease. Patient were assessed 8 times over 2 years. Time-dependent regression models were used. Among 692 patients that were evaluable, 46% received HCT with a 2-year survival of 58%. In unadjusted models, HCT was associated with reduced risks of mortality most of the subgroups. However, after accounting for covariates associated with increased mortality (age, comorbidity burden, disease risks, frailty, impaired QOL, depression, and impaired function), the associations between HCT and longer survival disappeared in most subgroups. Although function, social life, performance status, and depressive symptoms were better for those selected for HCT, these health advantages were lost after receiving HCT. Recipients and nonrecipients of HCT similarly ranked and expected cure as main goal of therapy, whereas physicians had greater expectations for cure than the former. Accounting for health impairments negates survival benefits from HCT for AML, suggesting that the unadjusted observed benefit is mostly owing to selection of the healthier candidates. Considering patients' overall expectations of cure but also the QOL burdens of HCT motivate the need for randomized trials to identify the best candidates for HCT. This trial was registered at www.clinicaltrials.gov as #NCT01929408.

Diagnostic errors in musculoskeletal oncology and possible mitigation strategies.

The objective of this paper is to explore sources of diagnostic error in musculoskeletal oncology and potential strategies for mitigating them using case examples. As musculoskeletal tumors are often obvious, the diagnostic errors in musculoskeletal oncology are frequently cognitive. In our experience, the most encountered cognitive biases in musculoskeletal oncologic imaging are as follows: (1) anchoring bias, (2) premature closure, (3) hindsight bias, (4) availability bias, and (5) alliterative bias. Anchoring bias results from failing to adjust an early impression despite receiving additional contrary information. Premature closure is the cognitive equivalent of "satisfaction of search." Hindsight bias occurs when we retrospectively overestimate the likelihood of correctly interpreting the examination prospectively. In availability bias, the radiologist judges the probability of a diagnosis based on which diagnosis is most easily recalled. Finally, alliterative bias occurs when a prior radiologist's impression overly influences the diagnostic thinking of another radiologist on a subsequent exam. In addition to cognitive biases, it is also important for radiologists to acknowledge their feelings when making a diagnosis to recognize positive and negative impact of affect on decision making. While errors decrease with radiologist experience, the lack of application of medical knowledge is often the primary source of error rather than a deficiency of knowledge, emphasizing the need to foster clinical reasoning skills and assist cognition. Possible solutions for reducing error exist at both the individual and the system level and include (1) improvement in knowledge and experience, (2) improvement in clinical reasoning and decision-making skills, and (3) improvement in assisting cognition.

Reinfection with SARS-CoV-2 in a patient undergoing chemotherapy for lymphoma: Case report.

BACKGROUND: COVID-19 is usually a time-limited disease. However, prolonged infections and reinfections can occur among immunocompromised patients. It can be difficult to distinguish a prolonged infection from a new one, especially when reinfection occurs early. METHODS: We report the case of a 57-year-old man infected with SARS-CoV-2 while undergoing chemotherapy for follicular lymphoma. He experienced prolonged symptomatic infection for 3 months despite a 5-day course of remdesivir and eventually deteriorated and died. RESULTS: Viral genome sequencing showed that his final deterioration was most likely due to reinfection. Serologic studies confirmed that the patient did not seroconvert. CONCLUSIONS: This case report highlights that reinfection can occur rapidly (62-67 d) among immunocompromised patients after a prolonged disease. We provide substantial proof of prolonged infection through repeated nucleic acid amplification tests and positive viral culture at day 56 of the disease course, and we put forward evidence of reinfection with viral genome sequencing.

HISTORIQUE: La COVID-19 est généralement une maladie limitée dans le temps. Toutefois, des infections et réinfections prolongées peuvent survenir chez des patients immunodéprimés. Il peut être difficile de distinguer une infection prolongée d'une nouvelle infection, particulièrement lorsque la réinfection se produit rapidement. MÉTHODOLOGIE: Les auteurs rendent compte du cas d'un homme de 57 ans infecté par le SRAS-CoV-2 alors qu'il était sous chimiothérapie pour soigner un lymphome folliculaire. Il a souffert d'une infection symptomatique prolongée de trois mois, malgré un traitement de cinq jours au remdésivir. Son état s'est finalement détérioré et il est décédé. RÉSULTATS: Le séquençage du génome viral a démontré que la détérioration finale de son état a probablement été causée par une réinfection. Les études sérologiques ont confirmé qu'il n'avait pas présenté de séroconversion. CONCLUSIONS: Le présent rapport de cas établit la possibilité d'une réinfection rapide (au bout de 62 à 67 jours) chez les patients immunodéprimés après une longue maladie. Les auteurs fournissent des preuves substantielles d'une infection prolongée par des tests répétés d'amplification des acides nucléiques et par des cultures virales positives au 56e jour de l'évolution de la maladie, et ils présentent des preuves de réinfection grâce au séquençage du génome viral.

Escuta do Sofrimento Mental Estudantil: Relato de Experiência do Atendimento Psicológico aos Estudantes da UFRJ / Listening to Student Mental Suffering: Experience Report of Psychological Care to UFRJ Students / Escuchando el sufrimiento Mental de los Estudiantes: Experiencia Informe de Atención Psicológica de la UFRJ

Relato de experiência acadêmica de três estagiários de graduação em Psicologia da Universidade Federal do Rio de Janeiro (UFRJ) no atendimento psicológico para estudantes da universidade. O objetivo é destacar as principais questões de sofrimento psíquico relatadas pelos estudantes atendidos e elucidar a importância da escuta clínica no campo acadêmico. Analisaram-se os aspectos recorrentes emergidos durante os atendimentos e presentes na discussão dos casos durante as supervisões com a professora orientadora. Do total de 24 estudantes atendidos, as principais queixas sintomatológicas dos participantes foram crises de ansiedade, sintomas de depressão e de ideação suicida. Buscou-se realizar um paralelo entre as dificuldades acadêmicas e emocionais com a implicação subjetiva dos estudantes na instituição UFRJ. Além disso, a questão do suicídio também foi destacada como o maior desafio clínico pelos estagiários nos atendimentos. Ao final verificou-se a importância do atendimento psicológico para os estudantes dentro do espaço acadêmico, pois esse lugar também de escuta é uma forma de acolhimento integral do estudante.

Report of academic experience from a team of graduate students in Psychology at the Federal University of Rio de Janeiro (UFRJ) providing psychological assistance to other students at this university. The objective is to highlight the main issues of psychological suffering reported by the students assisted and to elucidate the importance of clinical listening in the academic field. The recurrent aspects that emerged during the consultations and were present in the discussion of cases during the supervisions with the mentor teacher were analysed. Of the total of 24 students attended, the main symptomatological complaints of the participants were anxiety crises, symptoms of depression and suicidal ideation. We sought to make a parallel between academic and emotional difficulties, and the subjective implication of UFRJ students. In addition, the issue of suicide was also highlighted as the greatest clinical challenge by trainees in care. It was found that psychological assistance for students within the academic space is of huge importance, for the provision of a careful listening is also a kind of integral reception.

Informe de experiencia académica de tres pasantes de licenciatura en Psicología en la Universidad Federal de Río de Janeiro (UFRJ) en atención psicológica a estudiantes universitarios. El objetivo es resaltar los principales problemas del sufrimiento psicológico reportados por los estudiantes atendidos y dilucidar la importancia de la escucha clínica en el ámbito académico. Se analizaron aspectos recurrentes que surgieron durante las consultas y presentes en las discusiones de casos durante las supervisiones con el profesor guía. Del total de 24 estudiantes atendidos, las principales quejas sintomáticas de los participantes fueron crisis de ansiedad, síntomas de depresión e ideación suicida. Se buscó establecer un paralelismo entre las dificultades académicas y emocionales con la participación subjetiva de los estudiantes en UFRJ. Además, también se destacó el tema del suicidio como el mayor desafío clínico al que se enfrentan los internos en las consultas. En conclusión, se verificó la importancia del cuidado psicológico para los estudiantes dentro del espacio académico, ya que este lugar de escucha es también una forma de acogida integral para el estudiante.

Revisiting the Case of Sarah Newbury's Death from Mollities Ossium.

Multiple myeloma and its precursor and variant types represent some of the most common hematologic malignancies in adults. These plasma cell dyscrasias are well-known in modern medicine. There are well-established clinical, laboratory, and pathologic criteria for diagnosis and staging. There is debate about the diagnosis of some of the earliest cases of myeloma described in the literature. We present a critical review of one such case.

Resilience and recovery from total knee arthroplasty (TKA): a pathway for optimizing patient outcomes.

Identifying and promoting resilience factors may offer novel strategies for optimizing the recovery of patients following orthopedic surgery. Prior research has suggested that self-efficacy, positive affect, vigor, and vitality may function as resilience factors in the face of chronic pain. The present study examines these resilience factors in a prospective, cognitive-affective-behavioral pathway to recovery. Patients (n = 110) undergoing unilateral, total knee replacement surgery completed self-report assessments of study variables. Self-efficacy was assessed 2 ½ weeks prior to surgery, positive affect the day after surgery, vitality and vigor one-month following surgery, and post-operative pain at one- and three-months following surgery. Control variables included gender, pain, and depressive symptoms prior to surgery. Path analysis revealed significant coefficients from pre-operative self-efficacy to positive affect during hospitalization (ß = .246, p = .017), as well as to vitality (ß = .323, p = .001) and vigor (ß = .387, p < .001) at one-month following surgery. Both indicators of energy predicted better post-operative recovery (one-month: vitality ß = -.254, p = .016; vigor ß = -.329, p = .002); three-months: vitality ß = -.192, p = .047, vigor ß = -.201, p = .044). Findings support a cognitive-affective-behavioral pathway to recovery.

Addressing smoking in sheltered homelessness with intensive smoking treatment (ASSIST project): A pilot feasibility study of varenicline, combination nicotine replacement therapy and motivational interviewing.

BACKGROUND: This pilot study aimed to test the feasibility of providing varenicline in combination with nicotine replacement therapy (NRT) and motivational interviewing (MI) to adult male smokers attending a clinic in a hostel for homeless people. METHODS: A single group pre- and post-treatment (12 weeks following intervention commencement) design with embedded process evaluation (at weekly counselling and fortnightly safety check-ins). Participants were 20 male smokers attending a health clinic within a homelessness service in Sydney, Australia, between December 2019 and March 2020. Participants set a target quit date 7-days post intervention commencement. Adverse events, self-reported abstinence, cigarettes per day, treatment adherence and acceptability of the study interventions were assessed 12 weeks post intervention commencement. Abstinence was biochemically verified. Results are complete cases. RESULTS: Retention was 65% at 12-weeks post-intervention commencement (n = 13). No related adverse events were reported. Three participants (15%) reported continuous abstinence. Two participants self-reported 30-day point prevalence abstinence (10%), confirmed by CO level. Participants who did not quit smoking (n = 10), reported a significant reduction in the number of cigarettes smoked per day (19.4 vs 4.7, p < .01). Cravings, withdrawal symptoms, and psychological distress significantly decreased from baseline to 12-week follow-up (all < 0.01). Adherence to the pharmacological interventions was good, most used combination NRT and varenicline. Adherence to the counselling sessions was low, attending three of 12 sessions. Both NRT and MI were rated as highly acceptable. Some participants expressed concerns about the safety of varenicline. CONCLUSIONS: The intervention was feasible and acceptable and associated with short-term smoking cessation and significant reductions in the number of cigarettes smoked-per-day.

ALK rearrangements in infantile fibrosarcoma-like spindle cell tumours of soft tissue and kidney.

AIMS: Recurrent alterations in receptor tyrosine kinase (RTK) and downstream effectors are described in infantile fibrosarcoma (IFS)/cellular congenital mesoblastic nephroma (cCMN) and a subset of spindle cell sarcomas, provisionally designated 'NTRK-rearranged' spindle cell neoplasms. These two groups of tumours demonstrate overlapping morphologies and harbour alterations in NTRK1/2/3, RET, MET, ABL1, ROS1, RAF1 and BRAF, although their relationship is not fully elucidated. We describe herein a cohort of paediatric tumours with clinicopathological features not typical for inflammatory myofibroblastic tumour, but rather with similarities to cCMN/IFS harbouring ALK fusions. METHODS AND RESULTS: Clinicopathological features were assessed and partner agnostic targeted RNA sequencing on clinically validated platforms were performed. Tumours occurred in patients aged from 2 to 10 years (median age 2 years) with a 2:2 male to female ratio and an average size of 8.4 cm. Two tumours arose in soft tissues and two in the kidney. Morphological features included spindle to ovoid cells arranged in long fascicles or haphazardly within a myxoid to collagenised stroma; a subset of cases had either dilated, ectatic vessels or focal perivascular hyalinosis. By immunohistochemistry, all cases tested showed cytoplasmic expression of anaplastic lymphoma kinase (ALK) and one case demonstrated co-expression of CD34 and S100. CONCLUSIONS: This series of ALK-rearranged IFS-like tumours expands the spectrum of targetable kinases altered in these tumours and reinforces the potential overlap between IFS/cCMN-like tumours and the provisional entity of 'NTRK-rearranged' spindle cell neoplasms.

O cuidado que não se deixa limitar: um olhar sobre as práticas profissionais em terapia intensiva neonatal / Care that does not allow itself to be limited: a look at professional practices in neonatal intensive care

Os trabalhadores das Unidades de Terapia Intensiva Neonatal (UTIN) são cada vez mais convocados a lidar com situações de limitação à vida de bebês em sua prática cotidiana. Sejam elas as malformações congênitas, a prematuridade extrema ou pioras advindas de quadros clínicos complexos. Esses momentos são entendidos como de grande impacto para os profissionais, uma vez que é necessário manejar seus próprios sentimentos e sensações, auxiliar a família do bebê e, por vezes, intervir tecnicamente. Deste modo, a presente pesquisa teve como objetivo analisar, a partir das memórias dos profissionais de saúde do campo da neonatologia, as práticas de cuidado empreendidas diante de situações limitantes à vida. Visamos contribuir para esse campo de conhecimento a partir das experiências concretas dos trabalhadores, buscando compreender suas dificuldades e ações empreendidas para assim, ajudar a direcionar estratégias de assistência, gestão, capacitação e formação em saúde. Por nos interessarem as práticas concretas desses profissionais, o estudo teve delineamento qualitativo e utilizou para coleta e análise dos dados o método das Narrativas de Vida de Daniel Bertaux (2010). A amostra foi acionada por meio da rede de universos particulares da pesquisadora e orientadoras. Participaram da pesquisa 12 profissionais atuantes em UTIN, sendo 2 assistentes sociais, 2 enfermeiras, 1 fisioterapeuta, 1 fonoaudióloga, 2 médicos neonatologistas, 1 nutricionista, 2 psicólogas, 1 técnica de enfermagem e todos com mais de 3 anos de atuação. A partir das análises, foram criadas duas sessões de discussão: (1) Cuidado neonatal, condições materiais e fricções entre poder, assimetrias, hierarquias e exigências; e (2) Cuidado neonatal e produção de sofrimento. Observamos que as práticas de cuidado empreendidas diante de situações limitantes à vida de bebês são produzidas em contextos que reafirmam a lógica biomédica, hierárquica e que aparta complexidade técnica e afetos, o que produz relações assimétricas entre os profissionais da equipe e sofrimento emocional. Faz-se necessário reconhecer outras tensões escamoteadas, mas que permeiam a organização do trabalho do cuidado neonatal. Para tal, propomos a articulação dos achados com o conceito de circuitos de cuidado, que coloca em pauta a desvalorização das práticas relacionais e nas quais os afetos circulam, enfatizando a proposta do cuidado como um valor moral a fim de que assistência em saúde seja de fato integral.

The staff of Neonatal Intensive Care Units (NICU) are constantly called to deal with babies' life-limiting situations in their current practice. These may be congenitous malformations, extreme prematurity or worsen consequences resulting from complex clinical conditions. These moments cause a great impact on the professionals, since they have to manage their own feelings, help the babies' families and sometimes intervene technically. Therefore this research aims to analyze the practices of caring regarding life-limiting situations, based on reports from the neonatology healthcare team. Our target is to contribute to this field of knowledege taking into consideration staff's concrete experiences, trying to understand their difficulties and actions in order to help with assistence, management, capacitation and health care formation strategies. Once we are interested in the staff's concrete practices, this reasearch had a qualitative design and used the Daniel Bertaux's (2010) method of Lives Narratives for collection and data analysis. The sample was taken from the researchers' private contacts net. 12 professionals of NICU took part in the research. They were: 02 social assistants, 2 nurses, 1 fisiotherapist, 1 speech therapist, 2 neonatologists, 1 nutritionist, 2 psychologists and 1 nursing technician. All of the professionals had been working in the field for more than 3 years. After the analysis, 2 lines of discussion were created: (1) Neonatal Care, material conditions and frictions among power, assymetries, hierarquies and demands; and (2) Neonatal Care and suffering production. We noticed that caring practices developed in life-limiting situations regarding babies' lives are produced in contexts that reassure the hierarquical and biomedical logics, separating technical complexity from feelings, producing assimetric relations among the staff members and emotional suffering. It is necessary to acknowledge other hidden tensions that permeate the work organization in the neonatal care field. Therefore, we propose the articulation of this research results with the concept of the caring circuits, which talks about the undervaluation of relational practices in which feelings circulate, emphasizing the proposal of care as a moral value, so that health assistance can provide truly integrated care.