Lipid fingerprint-based histology accurately classifies nevus, primary melanoma, and metastatic melanoma samples.

Probably, the most important factor for the survival of a melanoma patient is early detection and precise diagnosis. Although in most cases these tasks are readily carried out by pathologists and dermatologists, there are still difficult cases in which no consensus among experts is achieved. To deal with such cases, new methodologies are required. Following this motivation, we explore here the use of lipid imaging mass spectrometry as a complementary tool for the aid in the diagnosis. Thus, 53 samples (15 nevus, 24 primary melanomas, and 14 metastasis) were explored with the aid of a mass spectrometer, using negative polarity. The rich lipid fingerprint obtained from the samples allowed us to set up an artificial intelligence-based classification model that achieved 100% of specificity and precision both in training and validation data sets. A deeper analysis of the image data shows that the technique reports important information on the tumor microenvironment that may give invaluable insights in the prognosis of the lesion, with the correct interpretation.

Melanoma Clinical Decision Support System: An Artificial Intelligence-Based Tool to Diagnose and Predict Disease Outcome in Early-Stage Melanoma Patients.

This study set out to assess the performance of an artificial intelligence (AI) algorithm based on clinical data and dermatoscopic imaging for the early diagnosis of melanoma, and its capacity to define the metastatic progression of melanoma through serological and histopathological biomarkers, enabling dermatologists to make more informed decisions about patient management. Integrated analysis of demographic data, images of the skin lesions, and serum and histopathological markers were analyzed in a group of 196 patients with melanoma. The interleukins (ILs) IL-4, IL-6, IL-10, and IL-17A as well as IFNγ (interferon), GM-CSF (granulocyte and macrophage colony-stimulating factor), TGFß (transforming growth factor), and the protein DCD (dermcidin) were quantified in the serum of melanoma patients at the time of diagnosis, and the expression of the RKIP, PIRIN, BCL2, BCL3, MITF, and ANXA5 proteins was detected by immunohistochemistry (IHC) in melanoma biopsies. An AI algorithm was used to improve the early diagnosis of melanoma and to predict the risk of metastasis and of disease-free survival. Two models were obtained to predict metastasis (including "all patients" or only patients "at early stages of melanoma"), and a series of attributes were seen to predict the progression of metastasis: Breslow thickness, infiltrating BCL-2 expressing lymphocytes, and IL-4 and IL-6 serum levels. Importantly, a decrease in serum GM-CSF seems to be a marker of poor prognosis in patients with early-stage melanomas.

Impact of the COVID-19 pandemic on care and psychological impact on cancer patients.

PURPOSE OF REVIEW: To summarize the current literature on the psychological impact of COVID-19 on patients with cancer, both in terms of the impact of the virus itself and of changes in the healthcare system; and to describe current recommendations for supporting patients with cancer during the pandemic. RECENT FINDINGS: Multiple studies have shown that patients with cancer experience high levels of psychological distress during COVID-19. Factors of greater vulnerability have been described as: being young, being female, low socioeconomic status, lower educational level, having low levels of hope or optimism, lower social support, and having cancer with curative intent. The severe acute respiratory syndrome-coronavirus-2pandemic has accelerated the healthcare digitization process. All departments involved in the diagnosis and treatment of cancer have made contingency plans to minimize the impact on patients. SUMMARY: Psychological distress is one of the most frequently occurring symptoms in patients with cancer during the pandemic. The COVID-19 pandemic has led to a restructuring of the healthcare system. The paradigm shift may pose a challenge for both healthcare professionals and patients.

Prevention and Harm Reduction Interventions for Adult Gambling at the Local Level: An Umbrella Review of Empirical Evidence.

Concerns about negative consequences of gambling diffusion are increasing. Prevention and harm reduction strategies play a crucial role in reducing gambling supply and harms. This study aims to conduct an umbrella review of the effectiveness of gambling preventive and harm reduction strategies, which can be implemented at a local level and targeted at adults. It was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Sixteen reviews were analyzed, and 20 strategies were selected and classified in 4 areas with different targets and aims. Reducing the supply of gambling is an effective strategy both for the general population and for risky or problematic gamblers. Demand reduction interventions have been found to have limited effects but most of them are mainly focused on knowledge about risks and odds ratios. Risk reduction strategies aim to reduce contextual risk factors of the area where gambling is provided, change the gambling locations' features, and modify individual behaviors while gambling. Smoking and alcohol bans or restrictions are considered one of the most effective strategies. Finally, harm reduction strategies targeted at problematic gamblers are potentially effective. Some relevant implementation conditions are identified and the results show inconsistent effects across different targets.

RKIP Regulates Differentiation-Related Features in Melanocytic Cells.

Raf Kinase Inhibitor Protein (RKIP) has been extensively reported as an inhibitor of key signaling pathways involved in the aggressive tumor phenotype and shows decreased expression in several types of cancers. However, little is known about RKIP in melanoma or regarding its function in normal cells. We examined the role of RKIP in both primary melanocytes and malignant melanoma cells and evaluated its diagnostic and prognostic value. IHC analysis revealed a significantly higher expression of RKIP in nevi compared with early-stage (stage I-II, AJCC 8th) melanoma biopsies. Proliferation, wound healing, and collagen-coated transwell assays uncovered the implication of RKIP on the motility but not on the proliferative capacity of melanoma cells as RKIP protein levels were inversely correlated with the migration capacity of both primary and metastatic melanoma cells but did not alter other parameters. As shown by RNA sequencing, endogenous RKIP knockdown in primary melanocytes triggered the deregulation of cellular differentiation-related processes, including genes (i.e., ZEB1, THY-1) closely related to the EMT. Interestingly, NANOG was identified as a putative transcriptional regulator of many of the deregulated genes, and RKIP was able to decrease the activation of the NANOG promoter. As a whole, our data support the utility of RKIP as a diagnostic marker for early-stage melanomas. In addition, these findings indicate its participation in the maintenance of a differentiated state of melanocytic cells by modulating genes intimately linked to the cellular motility and explain the progressive decrease of RKIP often described in tumors.

BRAF V600E mutational load as a prognosis biomarker in malignant melanoma.

Analyzing the mutational load of driver mutations in melanoma could provide valuable information regarding its progression. We aimed at analyzing the heterogeneity of mutational load of BRAF V600E in biopsies of melanoma patients of different stages, and investigating its potential as a prognosis factor. Mutational load of BRAF V600E was analyzed by digital PCR in 78 biopsies of melanoma patients of different stages and 10 nevi. The BRAF V600E load was compared among biopsies of different stages. Results showed a great variability in the load of V600E (0%-81%). Interestingly, we observed a significant difference in the load of V600E between the early and late melanoma stages, in the sense of an inverse correlation between BRAF V600E mutational load and melanoma progression. In addition, a machine learning approach showed that the mutational load of BRAF V600E could be a good predictor of metastasis in stage II patients. Our results suggest that BRAF V600E is a promising biomarker of prognosis in stage II patients.

Physical Performance and Quality of Life in Older Adults: Is There Any Association between Them and Potential Drug Interactions in Polymedicated Octogenarians.

Older adults are at increased risk of several cytochrome P450 (CYP) drug interactions that can result in drug toxicity, reduced pharmacological effect, and adverse drug reactions. This study aimed to assess the prevalence of potential CYP interactions referring to the most clinically relevant drugs and exploring the relationship between them and quality of life and physical performance in Spanish octogenarians. Institutionalized and community-dwelling octogenarians (n = 102) treated at three primary care centers, were recruited by a research nurse. Anthropometric measurements, chronic diseases, prescribed drugs, quality of life, physical performance, mobility skills, hand grip strength and cognitive status data were collected. Potential CYP drug-drug interactions (DDIs) were selected referring to the main CYP implicated in their metabolism. The 72.2% of recruited octogenarians presented potentially inappropriate CYP inhibitor-substrate or CYP inductor-substrate combinations. Analyzing the EuroQol Visual Analogue scale (EQ-VAS) results, patients with a potential CYP DDI perceived worse health status than patients without it (p = 0.004). In addition, patients with a potential CYP DDI presented worse exercise capacity, kinesthetic abilities, or mobility than those who didn't present a potential interaction (p = 0.01, p = 0.047, and p = 0.02, respectively). To investigate and control factors associated with loss of muscle strength and poor quality of life, polypharmacy and DDIs could help institutions in the management of physical frailty.

The perceptions of the causes of cardiac diseases: a taxonomy.

OBJECTIVE: This study verifies whether the open-ended question of the B-IPQ can collect causal attributions of patients with cardiac diseases, define the more frequent causal attributions reported, classify them and describe the relation between the classification of the causes and patients' characteristics. DESIGN: A group of 2011 patients with cardiac diseases was recruited during the first week of cardiac rehabilitation. PRIMARY OUTCOME MEASURES: Every participant filled in the B-IPQ and the HADS. The qualitative and quantitative analyses of the text using T-LAB identified the most frequent causal attributions and their co-occurrences. RESULTS: Among the patients, 26% did not recognise any causal attribution. The likelihood that the patients did not provide an answer was increased in older patients, females, patients with lower levels of education and higher levels of depression. Smoking and stress emerged as the most important attributions, followed by genetics, metabolic syndrome, work and nutrition. Four thematic clusters were identified: 'work and stress', 'metabolic syndrome and hypertension', 'displeasures and body care' and 'heredity and other related diseases'. CONCLUSIONS: This study suggests a classification of the causal attributions in patients with cardiac diseases and identifies thematic patterns and unknown attributions. The themes identified can serve as categories for future closed-ended questions.

Improving the gamma analysis comparison using an unbinned multivariate test.

In this study, we present a new procedure for the comparison of two dose matrices by means of a statistical test. A statistical distance is proposed to decide whether the difference between the two matrices is statistically significant. This statistical test is based on the square difference between the experimental and expected gamma matrix results. The expected gamma matrix is calculated by simulating the measurement process. For comparison purposes, the significance level of the test was chosen to give the same statistical significance as 90% of gamma-pass rate. The performance of the statistical distance is checked against 53 VMAT. The power of the presented test was compared using simulations with the 90% gamma-pass rate criteria for two cases in which intentional errors are introduced. In both cases, the test is uniformly more powerful. According to the test, two of the measured plans have a significant difference with calculated matrices, although the gamma pass rate measured was always greater than 90%.

Preventing Adolescent Substance Use Through an Evidence-Based Program: Effects of the Italian Adaptation of Life Skills Training.

Evidence-based preventive interventions for adolescent substance use, violence, and mental health issues are increasingly being adapted and disseminated internationally. In the present paper, we report the results of an effectiveness study that was part of a comprehensive initiative by a coalition of health promotion organizations in the Lombardy region of Italy to select, culturally adapt, implement, evaluate, and sustain an evidence-based drug abuse prevention program developed in the USA. Findings are presented from a large-scale effectiveness study of the Life Skills Training prevention program among over 3000 students attending 55 middle schools in Italy. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills. Relative to comparison group students, students who received the prevention program were less likely to initiate smoking at the post-test and 2-year follow-up, and less likely to initiate weekly drunkenness at the 1-year follow-up. The program had direct positive effects on several cognitive, attitudinal, and skill variables believed to play a protective role in adolescent substance use. The findings from this study show that a drug abuse prevention program originally designed for adolescents in the USA is effective in a sample of Italian youth when a rigorous and systematic approach to cultural adaptation is followed that incorporates the input of multiple stakeholders.

A large-scale initiative to disseminate an evidence-based drug abuse prevention program in Italy: Lessons learned for practitioners and researchers.

Across developed countries, experimentation with alcohol, tobacco, and other drugs often begins in the early adolescent years. Several evidence-based programs have been developed to prevent adolescent substance use. Many of the most rigorously tested and empirically supported prevention programs were initially developed and tested in the United States. Increasingly, these interventions are being adopted for use in Europe and throughout the world. This paper reports on a large-scale comprehensive initiative designed to select, adapt, implement, and sustain an evidence-based drug abuse prevention program in Italy. As part of a large-scale regionally funded collaboration in the Lombardy region of Italy, we report on processes through which a team of stakeholders selected, translated and culturally adapted, planned, implemented and evaluated the Life Skills Training (LST) school-based drug abuse prevention program, an evidence-based intervention developed in the United States. We discuss several challenges and lessons learned and implications for prevention practitioners and researchers attempting to undertake similar international dissemination projects. We review several published conceptual models designed to promote the replication and widespread dissemination of effective programs, and discuss their strengths and limitations in the context of planning and implementing a complex, large-scale real-world dissemination effort.

Efectividad de dos medicamentos utilizados como antisépticos y desinfectantes en diferentes especies del género cándida en pacientes con estomatitis sub-protésica / Effectiveness of two drugs used as antiseptics and disinfectants in different species of the genus Candida in patients with sub-prosthetic stomatitis

Objetivo: Determinar la efectividad del Gluconato de Clorhexidina al 0.12% y del Bicarbonato de Sodio al 0.12% como desinfectantes de prótesis dentales y antiséptico de la mucosa bucal sobre las diferentes especies del género Cándida presentes en los pacientes con Estomatitis Sub-Protésica. Metodología: La investigación fue desarrollada en el periodo comprendido del 19 de julio al 2 de septiembre de 2011, en las clínicas de la Facultad de Odontología y el Laboratorio Microbiológico del Centro de Investigaciones Científicas y Desarrollo en Salud (CENSALUD) de la Universidad de El Salvador con un total de 30 pacientes portadores de prótesis dentales removibles totales o parciales, con diagnostico de Estomatitis Sub-Protésica tipo I, II, III de Newton. Para la identificación de las diferentes especies de Cándida se utilizo el medio de cultivo selectivo CHROMagar Cándida. Se tomaron muestras de la mucosa bucal de soporte y del aparato protésico antes y después de la aplicación de los fármacos para efectuar los recuentos de Unidades Formadoras de Colonias (U.F.C.) y evaluar la efectividad del tratamiento administrado en un periodo de 14 días. Resultados: Los resultados de este estudio demostraron que los porcentajes de colonización de las especies del genero Cándida en mucosa bucal fueron: C. albicans 52.01% C. krusei 46.93% C. Tropicalis 1.06%; en prótesis dental fueron: C. albicans 47.8% C. krusei 51.56% C. Tropicalis 0.64% utilizando el método estadístico de Dunn se obtuvo que en ambas superficies C. albicans y C. krusei colonizan de forma similar. Conclusión: Ambos fármacos resultaron tener similar efectividad como antiséptico sobre las diferentes especies del género Cándida presentes en mucosa bucal y desinfectante en prótesis dental en el tratamiento de Estomatitis Sub-Protésica.

Objective: To determine the effectiveness of 0.12% Chlorhexidine Gluconate and 0.12% Sodium Bicarbonate as disinfectants for dental prostheses and antiseptic for the oral mucosa on the different species of the genus Candida present in patients with Sub-Prosthetic Stomatitis. Methodology: The research was developed in the period from July 19 to September 2, 2011, in the clinics of the Faculty of Dentistry and the Microbiological Laboratory of the Center for Scientific Research and Development in Health (CENSALUD) of the University of El Salvador with a total of 30 patients with partial or total removable dental prostheses, with a diagnosis of Newton's Sub-Prosthetic Stomatitis type I, II, III. For the identification of the different Candida species, the selective culture medium CHROMagar Candida was used. Samples of the supporting buccal mucosa and the prosthetic apparatus were taken before and after the application of the drugs to carry out the counts of Colony Forming Units (CFU) and evaluate the effectiveness of the treatment administered in a period of 14 days. Results: The results of this study showed that the colonization percentages of the species of the genus Candida in the buccal mucosa were: C. albicans 52.01% C. krusei 46.93% C. Tropicalis 1.06%; in dental prostheses they were: C. albicans 47.8% C. krusei 51.56% C. Tropicalis 0.64% using Dunn's statistical method, it was obtained that C. albicans and C. krusei colonize in a similar way on both surfaces. Conclusion: Both drugs were found to have similar effectiveness as antiseptic on the different species of the genus Candida present in oral mucosa and disinfectant in dental prostheses in the treatment of Sub-Prosthetic Stomatitis.

Ascites, elevated CA 125, and a large adnexal mass with an enteroovarian fistula.

BACKGROUND: Rectovaginal and vesicovaginal fistulae occur commonly in human immunodeficiency virus (HIV)-positive women and typically present with a characteristic vaginal discharge. CASE: We report a case of a jejunal-ovarian fistula presenting as suspected malignancy in a 38-year-old woman with HIV. The patient presented with ascites, moderately elevated CA 125, and a 12-cm adnexal mass. She was expedited to surgery secondary to a persistent pelvic mass and the patient's desire for definitive treatment. We believe the patient's immunocompromised state caused a microperforation in the small bowel, which subsequently formed a fistula to the ovary. The patient's left adnexa was removed, along with a 3-cm portion of small bowel. CONCLUSION: Uncommon entities should be included in the differential diagnosis of pelvic masses in immunocompromised women.

Absceso retrofaringeo y osteomielitis cervical en una paciente: reporte de un caso / Retropharyngeal abscess and cervical vertebral osteomyelitis in a patient: a case report

El absceso retrofaríngeo como una manifestación de osteomielitis cervical en adultos ha sido descrita muy raramente en la literatura; cuatro de los 5 casos descritos hasta 1994 han sido hombres. Reportamos el caso de una paciente femenina de 34 años embarazada, quien presentó un absceso retrofaríngeo y desarrolló posteriormente clínica de monoparesia branquial izquierda evidenciándose la presencia de Osteomielitis de C4 y C5, con compresión del saco dural. Se describe el manejo médico y neuroquirúrgico del caso. Se hacen algunas consideraciones en torno al papel del embarazo y la anemia asociados a una depresión del sistema inmune como factor de riesgo para esta infección

Heridas por arma de fuego en cordón medular y cauda equina / Gunshot wounds to the spinal cord and cauda equina

Estudio restrospectivo de 53 casos de heridas por arma de fuego en cordón medular y cauda equina, en un período de 6 años con predominio de edad fue de 22,7 años predominio del sexo masculino. Se reportaron 18,87 por ciento lesiones cervicales, 41,51 por ciento dorsales y 39,62 por ciento lumbosacra; 29 pacientes presentaron lesión completa (54,72 por ciento) y 24 pacientes presentaron lesión incompleta. 31 pacientes (58,49 por ciento) presentaron lesiones asociadas por trayecto abdominal torácico o cervicofacial del proyectil. 22 pacientes (41,50 por ciento) fueron intervenidos quirúrgicamente dentro de las primeras 72 horas de ocurrida la injuria, practicándose laminectomía, extracción de fragmentos óseos o metálicos, drenaje de hematomas y reparación en lo posible de la duramadre. Se intervinieron los pacientes con lesión incompleta, hallazgos radiológicos de compromiso del canal raquideo, deterioro de funciones neurológicas, fístulas de líquido cefelorraquídeo e inestabilidad de la columna, 19 de los pacientes intervenidos (86,36 por ciento) presentaron mejoría neurológica. Podemos concluir que todo paciente con lesiones incompletas o en cauda equina, debe ser intervenido tempranamente, independientemente del nivel de la lesión. El amnejo de estos pacientes debe ser multidisciplinario, debido al elevado porcentaje de lesiones asociadas

Aproximación a la salud comunitaria en Tiara / Aproximation at the communitary health in Tiara

El objetivo del siguiente estudio fue el de propiciar en la comunidad de Tiara cambios de actitudes que le permitan, a través de la participación activa, mayor autonomía para generar acciones que conlleven a optimizar la salud comunitaria. La investigación se condujo bajo el enfoque investigación-acción participativa, abarcando cuatro fases, la exploratoria, la organizativa, la de elaboración de estrategías y acciones y la evaluativa. Se obtuvieron alcances significativos no sólo a nivel de los investigadores comunitarios (comunidad propiamente dicha), sino también del equipo coordinador investigador. La conclusión más relevante señala la evidencia de un cambio de actidud de la población manifestada a través de su organización para enfrentar los problemas de salud comunitaria. Entre las recomendaciones se proponen la creación del "Proyecto Tiara" para darle continuidad al trabajo iniciado y garantizar la dotación del ambulatorio según el programa de medicina simplificada.