Molecular and Clinical Insights in the Increasing Detection of BCR::ABL1 p190+ in Adult Acute Myeloid Leukemia Patients.

BACKGROUND/AIM: Acute myeloid leukemia (AML) is a myeloproliferative neoplasm marked by abnormal clonal expansion of hematopoietic progenitor cells, displaying karyotypic aberrations and genetic mutations as prognostic indicators. The World Health Organization (WHO) and the European LeukemiaNet guidelines categorize BCR::ABL1 p190+ AML as high risk. This study explored the identification of the increased incidence of BCR::ABL1 p190+ in our AML population. PATIENTS AND METHODS: This study included 96 AML patients stratified according to WHO guidelines. Subsequently, patients were screened for genetic abnormalities, such as BCR::ABL1 p 190+, PML::RARA, RUNX1::RUNX1T1, and CBFB::MYH11 by quantitative reverse transcription polymerase chain reaction (RT-qPCR) analysis. RESULTS: Among 96 AML patients, 36 displayed BCR::ABL1 p190+, overcoming the expected global incidence. Age variations (19 to 78 years) showed no significant laboratory differences between BCR::ABL1 p190+ and non-BCR::ABL p190+ cases. The overall survival analysis revealed no statistically significant differences among the patients (p=0.786). CONCLUSION: The analyzed population presented a higher frequency of BCR::ABL1 p190+ detection in adult AML patients when compared to what is described in the worldwide literature. Therefore, more studies are needed to establish the reason why this incidence is higher and what the best treatment approach should be in these cases.

Postoperative Time and Anatomic Location Influence Skin Graft Reperfusion Assessed With Laser Speckle Contrast Imaging.

OBJECTIVES: Under optimal conditions, afferent and efferent human skin graft microcirculation can be restored 8-12 days postgrafting. Still, the evidence about the reperfusion dynamics beyond this period in a dermato-oncologic setting is scant. We aimed to characterise the reperfusion of human skin grafts over 4 weeks according to the necrosis extension (less than 20%, or 20%-50%) and anatomic location using laser speckle contrast imaging (LSCI). METHODS: Over 16 months, all eligible adults undergoing skin grafts following skin cancer removal on the scalp, face and lower limb were enroled. Perfusion was assessed with LSCI on the wound margin (control skin) on day 0 and on the graft surface on days 7, 14, 21 and 28. Graft necrosis extension was determined on day 28. RESULTS: Forty-seven grafts of 47 participants were analysed. Regardless of necrosis extension, graft perfusion equalled the control skin by day 7, surpassed it by day 21, and stabilised onwards. Grafts with less than 20% necrosis on the scalp and lower limb shared this reperfusion pattern and had a consistently better-perfused centre than the periphery for the first 21 days. On the face, the graft perfusion did not differ from the control skin from day 7 onwards, and there were no differences in reperfusion within the graft during the study. CONCLUSION: Skin graft reperfusion is a protracted process that evolves differently in the graft centre and periphery, influenced by postoperative time and anatomic location. A better knowledge of this process can potentially enhance the development of strategies to induce vessel ingrowth into tissue-engineered skin substitutes.

Skin cancers are the most frequent cancers in fair-skinned populations, but we can prevent them.

Cancers of the skin are the most commonly occurring cancers in humans. In fair-skinned populations, up to 95% of keratinocyte skin cancers and 70-95% of cutaneous melanomas are caused by ultraviolet radiation and are thus theoretically preventable. Currently, however, there is no comprehensive global advice on practical steps to be taken to reduce the toll of skin cancer. To address this gap, an expert working group comprising clinicians and researchers from Africa, America, Asia, Australia, and Europe, together with learned societies (European Association of Dermato-Oncology, Euromelanoma, Euroskin, European Union of Medical Specialists, and the Melanoma World Society) reviewed the extant evidence and issued the following evidence-based recommendations for photoprotection as a strategy to prevent skin cancer. Fair skinned people, especially children, should minimise their exposure to ultraviolet radiation, and are advised to use protective measures when the UV index is forecast to reach 3 or higher. Protective measures include a combination of seeking shade, physical protection (e.g. clothing, hat, sunglasses), and applying broad-spectrum, SPF 30 + sunscreens to uncovered skin. Intentional exposure to solar ultraviolet radiation for the purpose of sunbathing and tanning is considered an unhealthy behaviour and should be avoided. Similarly, use of solaria and other artificial sources of ultraviolet radiation to encourage tanning should be strongly discouraged, through regulation if necessary. Primary prevention of skin cancer has a positive return on investment. We encourage policymakers to communicate these messages to the general public and promote their wider implementation.

Resveratrol-Loaded Polydimethylsiloxane-Silica Hybrid Materials: Synthesis, Characterization, and Antitumoral Activity.

In this work, hybrid materials within the polydimethylsiloxane-silica (PDMS-SiO2) system, synthesized via the sol-gel method, were developed and characterized for their potential to incorporate and release the bioactive compound resveratrol (RES). RES was incorporated into the materials with a high loading efficiency (>75%) using the rotary evaporator technique. This incorporation induced the amorphization of RES, resulting in enhanced solubility and in vitro release when compared to the free polyphenolic compound. The release profiles displayed pH dependence, exhibiting notably faster release at pH 5.2 compared to pH 7.4. The gradual release of RES over time demonstrated an initial time lag of approximately 4 h, being well described by the Weibull model. In vitro cytotoxicity studies were conducted on human osteosarcoma cells (MG-63), revealing a concentration-dependent decrease in cell viability for RES-loaded samples (for concentrations >50 µg mL-1).

Validation of Endogenous Control Genes by Real-Time Quantitative Reverse Transcriptase Polymerase Chain Reaction for Acute Leukemia Gene Expression Studies.

Reference genes are used as internal reaction controls for gene expression analysis, and for this reason, they are considered reliable and must meet several important criteria. In view of the absence of studies regarding the best reference gene for the analysis of acute leukemia patients, a panel of genes commonly used as endogenous controls was selected from the literature for stability analysis: Glyceraldehyde-3-phosphate dehydrogenase (GAPDH), Abelson murine leukemia viral oncogene human homolog 1 (ABL), Hypoxanthine phosphoribosyl-transferase 1 (HPRT1), Ribosomal protein lateral stalk subunit P0 (RPLP0), ß-actin (ACTB) and TATA box binding protein (TBP). The stability of candidate reference genes was analyzed according to three statistical methods of assessment, namely, NormFinder, GeNorm and R software (version 4.0.3). From this study's analysis, it was possible to identify that the endogenous set composed of ACTB, ABL, TBP and RPLP0 demonstrated good performances and stable expressions between the analyzed groups. In addition to that, the GAPDH and HPRT genes could not be classified as good reference genes, considering that they presented a high standard deviation and great variability between groups, indicating low stability. Given these findings, this study suggests the main endogenous gene set for use as a control/reference for the gene expression in peripheral blood and bone marrow samples from patients with acute leukemias is composed of the ACTB, ABL, TBP and RPLP0 genes. Researchers may choose two to three of these housekeeping genes to perform data normalization.

Critical analysis of the scientific production on Jean Watson's Theory of Human Care / Análisis crítico de la producción científica sobre la Teoría del Cuidado Humano de Jean Watson / Análise crítica da produção científica sobre a Teoria do Cuidado Humano de Jean Watson

ABSTRACT Objectives: to analyze current scientific production on the use of the theoretical-methodological precepts of Jean Watson's Theory of Human Care/Clinical Caritas Process. Methods: quantitative, exploratory, descriptive study using data from 1979 to 2023 in the Scopus database. Analysis was carried out using VOSviewer software. Results: the 73 studies included establish a network of collaboration among 221 authors from 155 institutions in 18 countries, who discuss the development of ethical behavior in nursing staff, through technical improvement, implementation, and validation of instrumental strategies capable of measuring and evaluating the quality of holistic and empathetic care. The Theory of Human Caring contributes to nursing training and care, and Process Clinical Caritas-Veritas is useful for the different possibilities of practice and education. Conclusions: it is important to strengthen with more empirical data a nursing work model centered on individual human care, supporting the evolution of scientific nursing knowledge.

RESUMEN Objetivos: analizar la producción científica actual sobre la utilización de los preceptos teórico-metodológicos de la Teoría del Cuidado Humano/Proceso de Cáritas Clínica de Jean Watson. Métodos: estudio cuantitativo, exploratorio y descriptivo usando datos de 1979 hasta 2023 en la base de datos Scopus. Análisis mediante el programa VOSviewer. Resultados: los 73 estudios incluidos establecen una red de colaboración entre 221 autores de 155 instituciones de 18 países, que discuten el desarrollo del comportamiento ético en el personal de enfermería, a través de la mejora técnica, implementación y validación de estrategias de instrumentos capaces de medir y evaluar la calidad del cuidado holístico y empático. La Teoría del Cuidado Humano contribuye a la formación y cuidados de enfermería y el Proceso Clínico Caritas-Veritas es útil para las diferentes posibilidades de práctica y educación. Conclusiones: es importante fortalecer con más datos empíricos un modelo de trabajo enfermero centrado en el cuidado humano individual, subsidiando la evolución del conocimiento científico enfermero.

RESUMO Objetivos: analisar a produção científica atual acerca da utilização dos preceitos teórico-metodológicos da Teoria do Cuidado Humano/Processo Clinical Caritas de Jean Watson. Método: estudo quantitativo, exploratório, descritivo, com recorte de 1979 a 2023 na base Scopus. Análise realizada com o software VOSviewer. Resultados: os 73 estudos incluídos estabelecem uma rede de colaboração entre 221 autores de 155 instituições em 18 países, que discutem o desenvolvimento do comportamento ético da equipe de enfermagem, por meio de aprimoramento técnico, implantação e validação de estratégias de instrumentos capazes de mensurar e avaliar a qualidade do cuidado holístico e empático. A Teoria do Cuidado Humano contribui para a formação e cuidado de enfermagem e Process Clinical Caritas-Veritas é útil para as diferentes possibilidades de prática e educação. Conclusões: importância em fortalecer com mais dados empíricos um modelo de trabalho de enfermagem centrado no cuidado humano individual, subsidiando a evolução do conhecimento científico da enfermagem.

European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment-Update 2023.

In order to update recommendations on treatment, supportive care, education, and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV), and the European Organisation of Research and Treatment of Cancer (EORTC) was formed. Recommendations were based on an evidence-based literature review, guidelines, and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable), and distant metastatic cSCC. For common primary cSCC, the first-line treatment is surgical excision with postoperative margin assessment or micrographically controlled surgery. Achieving clear surgical margins is the most important treatment consideration for patients with cSCCs amenable to surgery. Regarding adjuvant radiotherapy for patients with high-risk localised cSCC with clear surgical margins, current evidence has not shown significant benefit for those with at least one high-risk factor. Radiotherapy should be considered as the primary treatment for non-surgical candidates/tumours. For cSCC with cytologically or histologically confirmed regional nodal metastasis, lymph node dissection is recommended. For patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiotherapy, anti-PD-1 agents are the first-line systemic treatment, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drugs Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC, include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiotherapy. Multidisciplinary board decisions are mandatory for all patients with advanced cSCC, considering the risks of toxicity, the age and frailty of patients, and co-morbidities, including immunosuppression. Patients should be engaged in informed, shared decision-making on management and be provided with the best supportive care to improve symptom management and quality of life. The frequency of follow-up visits and investigations for subsequent new cSCC depends on underlying risk characteristics.

European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention-Update 2023.

Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. Overall, cSCC mostly has very good prognosis after treatment, with 5-year cure rates greater than 90%. Despite the overall favourable prognosis and the proportionally rare deaths, cSCC is associated with a high total number of deaths due to its high incidence. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV) and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update recommendations on cSCC, based on current literature and expert consensus. Part 1 of the guidelines addresses the updates on classification, epidemiology, diagnosis, risk stratification, staging and prevention in immunocompetent as well as immunosuppressed patients.

European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023.

Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into 'easy-to-treat' (common) and 'difficult-to-treat' according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of 'difficult-to-treat' BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.

Predictive factors of melanoma thickness

Abstract Background: Melanoma thickness is a relevant prognostic marker that is crucial for staging and its calculation relies on the histopathological examination. There is a risk of thickness underestimation with an incisional biopsy if the latter is not performed on a tumor area where the thickness is maximal. This occurrence may have an impact on a therapeutic decision, particularly regarding the excision margins and the need for sentinel lymph node biopsy. Objective: To assess the association between melanoma thickness and dermoscopic, demographic, epidemiological and clinical variables, aiming to identify predictive factors of thickness >1 mm. Methods: This was an observational and cross-sectional study, carried out on patients diagnosed with melanoma, from a single center over a time span of four years. Anatomopathological (thickness), dermoscopic, demographic, epidemiological, and clinical variables were collected. The associations between the variables with melanoma thickness were assessed. Results: A total of 119 patients were included. The presence of atypical vessels on the dermoscopic examination was an independent predictive factor of thickness >1 mm. Conversely, an atypical reticular pattern predicted melanoma thickness <1 mm. The presence of ephelides and a previous history of sunburn were also associated with melanomas thinner than 1 mm in the univariate analysis. Study limitations: The lack of data related to some variables and the absence of an optimal correlation between the dermoscopic and the anatomopathological examination constituted study limitations. Conclusion: An atypical vascular pattern on dermoscopy is associated with thickness >1 mm, helping with the choice of the optimal site to perform an incisional biopsy when an excisional biopsy is not feasible.

A inserção do enfermeiro na visita de acolhimento das gestantes em uma maternidade pública / The inclusion of nurses in welcoming visits for pregnant women in a public maternity / La inserción de enfermeras en la visita preparto de las mujeres embarazadas en maternidad pública

Objetivo: Relatar a experiência de acadêmicos de enfermagem no processo de inserção do enfermeiro na visita de acolhimento das gestantes em uma maternidade pública do município de Belém no estado do Pará. Métodos: Trata-se de um estudo descritivo com abordagem qualitativa, do tipo relato de experiência, realizado no período de abril a novembro de 2019. O cenário utilizado foi um hospital público de ensino, da rede estadual, de média e alta complexidade. Participaram do estudo enfermeiras, acadêmicos de enfermagem do quinto semestre e gestantes. Resultados: A experiência demonstrou que a inserção do profissional de enfermagem na visita de acolhimento é essencial para a criação de vínculo entre o profissional que atua no hospital e a gestante e seu acompanhante. Cabe ressaltar que esse momento revelou ser uma oportunidade importante para realização de educação em saúde. A utilização da cartilha, a roda de conversa e o "tour" foram efetivos quanto ao aumento da interação entre os envolvidos. Conclusão: A realização do acolhimento às gestantes foi de fundamental importância para garantir a gestante o acesso a informações referentes ao período gestacional, parto e assistência no ambiente hospitalar. (AU)

Objective: To report the experience of undergraduate nursing students in the process of including nurses in the welcoming visit for pregnant women in a public maternity hospital of Belém in the state of Pará. Methods: A descriptive study with a qualitative approach, of the experience report type, held from April to November 2019. The setting was a public, teaching, medium and high complexity state hospital. Participants included nurses, undergraduate nursing students, and pregnant women. Results: The experience has shown that the inclusion of nurses in the welcoming visit for pregnant women is essential to build a bond between the professional who works at the hospital and the pregnant woman and her companion. It is worth emphasizing that this initial visit proved to be an important opportunity for health education. The use of strategies such as booklets, conversation circles, and hospital tours were effective in increasing the interaction between those involved. Conclusion: The welcoming visit for pregnant women was fundamental to ensure that these patients had access to information regarding the gestational period, delivery, and assistance inside the hospital. (AU)

Objetivo: Reportar la experiencia de los académicos de enfermería en el proceso de inserción del enfermero en la visita preparto de las mujeres embarazadas al hospital público de maternidad de la ciudad de Belém en el estado de Pará. Métodos: Estudio descriptivo con abordaje cualitativo, del tipo informe de experiencia, realizado de abril a noviembre de 2019. El local fue un hospital universitario, de la red estatal, de mediana y alta complejidad. En el estudio participaron enfermeras, académicos de enfermería del quinto semestre y mujeres embarazadas. Resultados: La experiencia demostró que la inserción del profesional de enfermería en la visita preparto es fundamental para crear un vínculo entre el profesional que trabaja en el hospital, la gestante y su acompañante. Cabe mencionar que este momento resultó ser una importante oportunidad para realizar educación en salud. El uso de la cartilla, la rueda de conversación y el "tour" fueron efectivos para aumentar la interacción entre los involucrados. Conclusión: La visita preparto de las gestantes fue demasiado importante para garantizar el acceso a la información sobre el período gestacional, parto y asistencia en el ámbito hospitalario. (AU)

Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline - Update 2022.

Merkel cell carcinoma (MCC) is a rare skin cancer, accounting for less than 1% of all cutaneous malignancies. It is found predominantly in white populations and risk factors include advanced age, ultraviolet exposure, male sex, immunosuppression, such as AIDS/HIV infection, haematological malignancies or solid organ transplantation, and Merkel cell polyomavirus infection. MCC is an aggressive tumour with 26% of cases presenting lymph node involvement at diagnosis and 8% with distant metastases. Five-year overall survival rates range between 48% and 63%. Two subsets of MCC have been characterised with distinct molecular pathogenetic pathways: ultraviolet-induced MCC versus virus-positive MCC, which carries a better prognosis. In both subtypes, there are alterations in the retinoblastoma protein and p53 gene structure and function. MCC typically manifests as a red nodule or plaque with fast growth, most commonly on sun exposed areas. Histopathology (small-cell neuroendocrine appearance) and immunohistochemistry (CK20 positivity and TTF-1 negativity) confirm the diagnosis. The current staging systems are the American Joint Committee on Cancer/Union for international Cancer control 8th edition. Baseline whole body imaging is encouraged to rule out regional and distant metastasis. For localised MCC, first-line treatment is surgical excision with postoperative margin assessment followed by adjuvant radiation therapy (RT). Sentinel lymph node biopsy is recommended in all patients with MCC without clinically detectable lymph nodes or distant metastasis. Adjuvant RT alone, eventually combined with complete lymph nodes dissection is proposed in case of micrometastatic nodal involvement. In case of macroscopic nodal involvement, the standard of care is complete lymph nodes dissection potentially followed by post-operative RT. Immunotherapy with anti-PD-(L)1 antibodies should be offered as first-line systemic treatment in advanced MCC. Chemotherapy can be used when patients fail to respond or are intolerant for anti-PD-(L)1 immunotherapy or clinical trials.

Predictive factors of melanoma thickness.

BACKGROUND: Melanoma thickness is a relevant prognostic marker that is crucial for staging and its calculation relies on the histopathological examination. There is a risk of thickness underestimation with an incisional biopsy if the latter is not performed on a tumor area where the thickness is maximal. This occurrence may have an impact on a therapeutic decision, particularly regarding the excision margins and the need for sentinel lymph node biopsy. OBJECTIVE: To assess the association between melanoma thickness and dermoscopic, demographic, epidemiological and clinical variables, aiming to identify predictive factors of thickness >1mm. METHODS: This was an observational and cross-sectional study, carried out on patients diagnosed with melanoma, from a single center over a time span of four years. Anatomopathological (thickness), dermoscopic, demographic, epidemiological, and clinical variables were collected. The associations between the variables with melanoma thickness were assessed. RESULTS: A total of 119 patients were included. The presence of atypical vessels on the dermoscopic examination was an independent predictive factor of thickness >1mm. Conversely, an atypical reticular pattern predicted melanoma thickness <1mm. The presence of ephelides and a previous history of sunburn were also associated with melanomas thinner than 1mm in the univariate analysis. STUDY LIMITATIONS: The lack of data related to some variables and the absence of an optimal correlation between the dermoscopic and the anatomopathological examination constituted study limitations. CONCLUSION: An atypical vascular pattern on dermoscopy is associated with thickness >1mm, helping with the choice of the optimal site to perform an incisional biopsy when an excisional biopsy is not feasible.

European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics: Update 2022.

Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed with dermatoscopy. If a melanoma is suspected, a histopathological examination is always required. Sequential digital dermatoscopy and full body photography can be used in high-risk patients to improve the detection of early melanoma. Where available, confocal reflectance microscopy can also improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the American Joint Committee on Cancer classification. Thin melanomas up to 0.8 mm tumor thickness do not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC onwards whole-body examinations with computed tomography (CT) or positron emission tomography CT (PET-CT) in combination with brain magnetic resonance imaging are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to define the frequency and extent of examinations. A stage-based follow-up scheme is proposed which, according to the experience of the guideline group, covers the optimal requirements, but further studies may be considered. This guideline is valid until the end of 2024.

New Skin Flaps for Triangular Surgical Defects: Design, Assessment on Experimental Model, and Clinical Outcomes.

BACKGROUND: Most skin flaps are designed to repair circular surgical defects after skin tumor excisions, but few flaps have been described to reconstruct triangular defects. OBJECTIVE: The aim of this study was to describe new skin flaps for triangular surgical defects using an innovative experimental model. METHODS: We tested new flap designs in an experimental pig skin model using a tension sensor to measure maximum tension and tension augmentation when the flap is performed in an area of increased basal tension. The results were compared with those from classic flaps. Finally, the new flaps were performed on a series of patients with triangular surgical defects. RESULTS: Six new flaps with adequate levels of tension were obtained and named after their morphology: spider crab, mantis, toy windmill, nautilus, origami bird, and clover. These new flaps were successfully performed on a series of 40 patients; among them, spider crab and mantis flaps showed a better response to basal tension augmentation. CONCLUSIONS: Six new flaps for triangular surgical defects were proposed and successfully performed in a series of 40 patients, using an experimental pig skin model and a tensiometer.

European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2022.

A unique collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on the systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with one to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumor thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("tumor board"). Adjuvant therapies can be proposed in stage III/completely resected stage IV patients and are primarily anti-PD-1, independent of mutational status, or alternatively dabrafenib plus trametinib for BRAF mutant patients. In distant metastases (stage IV), either resected or not, systemic treatment is always indicated. For first-line treatment particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In stage IV melanoma with a BRAF-V600  E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harboring a BRAF-V600  E/K mutation, this therapy shall be offered as second-line therapy. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.

Clinicopathological factors influencing the number of stages of Mohs surgery for basal cell carcinoma.

BACKGROUND: Mohs Micrographic Surgery (MMS) is commonly used to treat high-risk basal cell carcinoma (BCC). OBJECTIVES: Correlate clinicopathologic preoperative features with the number of MMS stages (primary endpoint) and margins (secondary endpoint) required for BCC complete excision. METHODS: We retrospectively analyzed BCCs treated by MMS in a 2-year period at the study's institution. Variables studied included the patient gender, age, immune status, lesion size, location, if it was a primary, recurrent, or persistent tumor, histopathologic characteristics, number of surgical stages, and amount of tissue excised. RESULTS: 116 BCCs were included. The majority (61.2%, n = 71) required a single-stage surgery for complete clearance, requiring a final margins of 3.11 ± 2.35 mm. Statistically significant differences between locations in different high-risk areas (periocular, perioral, nose, ear) and the number of MMS stages required for complete excision (p = 0.025) were found, with periocular tumours requiring the highest mean of stages (2.29 ± 0.95). An aggressive histopathology significantly influenced the number of MMS stages (p = 0.012). Any significant relation between clinicopathological features and variation in the final surgical margins was found, just certain tendencies (male patients, persistent tumor, periocular location, and high-risk histopathological tumors required larger margins). Neither patient age or tumor dimension correlated significantly with both number of MMS stages and final surgical margins. STUDY LIMITATIONS: Limitations of this study include its single-center nature with a small sample size, which limits the value of conclusions. CONCLUSION: Main factors related to a greater number of MMS stages were periocular location and high-risk histopathological subtype of the tumor.

Diffuse dermal angiomatosis: a rare cause of painful ulceration in renal insufficiency.

Diffuse dermal angiomatosis is a rare, benign, reactive cutaneous vascular proliferation that has been reported in the context of end-stage renal failure and can rarely be associated with arteriovenous fistulas. We report a striking clinical resolution following prompt diagnosis and subsequent arteriovenous fistula reversal. This case further demonstrates that accurate diagnosis is particularly rewarding since correct therapeutic approach can be curative.

Temáticas editoriais da Revista Acta Paulista de Enfermagem: um estudo bibliométrico (1988-2017) / Temáticas editoriales de la Revista Acta Paulista de Enfermería: un estudio bibliométrico (1988-2017) / Editorial themes of the Acta Paulista de Enfermagem journal: a bibliometric study (1988-2017)

Resumo Objetivo Analisar as temáticas editoriais publicadas na Revista Acta Paulista de Enfermagem ao longo de seus primeiros trinta anos de existência. Métodos Pesquisa bibliométrica dos editoriais publicados entre 1988 e 2017, com o uso dos Descritores em Saúde, com análise quanti-qualitativa de termos específicos e categorias, discutidas sob a ótica da genealogia do saber de Michel Foucault. Resultados Foram coletados 129 editoriais, 389 termos padronizados e 706 categorias. Os termos específicos mais frequentes resultaram na tríade de tendência temática em (1) Editoração / Publicação Periódica, (2) Pesquisa e (3) Capacitação / Especialidade. Por sua vez, as categorias apontaram a tendência temática em Saúde Pública. Conclusão Os termos e categorias transmitiram ideias de base política de valorização da Enfermagem, evento que coincidiu com a trajetória de luta pelo desenvolvimento do sistema de saúde universal. Essa interligação social demonstra que a visão panóptica dos editoriais foi além de suas funções acadêmicas e científicas.

Resumen Objetivo Analizar las temáticas editoriales publicadas en la Revista Acta Paulista de Enfermería a lo largo de sus primeros treinta años de existencia. Métodos Investigación bibliométrica de los editoriales publicados entre 1988 y 2017, con el uso de los Descriptores en Salud, con un análisis cuali-cuantitativo de términos específicos y de categorías, discutidas bajo la óptica de la genealogía del saber de Michel Foucault. Resultados Se recopilaron 129 editoriales, 389 términos estandarizados y 706 categorías para términos específicos más frecuentes resultaron en la tríada de tendencia temática en (1) Edición / Publicación Periódica, (2) Investigación y (3) Capacitación / Especialidad. Por su lado las categorías señalaron la tendencia temática en Salud Pública. Conclusión Los términos y categorías transmitieron ideas de base política de valoración de la Enfermería, evento que coincidió con la trayectoria de lucha por el desarrollo del sistema de salud universal. Esa interconexión social demuestra que la visión panóptica de los editoriales fue más allá de sus funciones académicas y científicas.

Abstract Objective To analyze the editorial themes published in the Acta Paulista de Enfermagem journal throughout its first thirty years of existence. Methods Bibliometric study of editorials published between 1988 and 2017 using Health Descriptors and quantitative and qualitative analysis of specific terms and categories discussed from the perspective of Michel Foucault's genealogy of knowledge. Results In total, 129 editorials, 389 standardized terms and 706 categories were collected. The most frequent specific terms resulted in the triad of thematic trend in (1) Editing/Periodic publication, (2) Research and (3) Training/Specialty. In turn, the categories indicated the thematic trend in Public Health. Conclusion The terms and categories conveyed politically based ideas of valuing Nursing, an event that coincided with the struggle for the development of the National Health Service. This social interconnection demonstrates that the panoptic vision of editorials went beyond their academic and scientific functions.