Stages of change: Strategies to promote use of a Pediatric Early Warning System in resource-limited pediatric oncology centers.

BACKGROUND: Pediatric Early Warning Systems (PEWS) assist early detection of clinical deterioration in hospitalized children with cancer. Relevant to successful PEWS implementation, the "stages of change" model characterizes stakeholder support for PEWS based on willingness and effort to adopt the new practice. METHODS: At five resource-limited pediatric oncology centers in Latin America, semi-structured interviews were conducted with 71 hospital staff involved in PEWS implementation. Purposive sampling was used to select centers requiring variable time to complete PEWS implementation, with low-barrier centers (3-4 months) and high-barrier centers (10-11 months). Interviews were conducted in Spanish, professionally transcribed, and translated into English. Thematic content analysis explored "stage of change" with constant comparative analysis across stakeholder types and study sites. RESULTS: Participants identified six interventions (training, incentives, participation, evidence, persuasion, and modeling) and two policies (environmental planning and mandates) as effective strategies used by implementation leaders to promote stakeholder progression through stages of change. Key approaches involved presentation of evidence demonstrating PEWS effectiveness, persuasion and incentives addressing specific stakeholder interests, enthusiastic individuals serving as models for others, and policies enforced by hospital directors facilitating habitual PEWS use. Effective engagement targeted hospital directors during early implementation phases to provide programmatic legitimacy for clinical staff. CONCLUSION: This study identifies strategies to promote adoption and maintained use of PEWS, highlighting the importance of tailoring implementation strategies to the motivations of each stakeholder type. These findings can guide efforts to implement PEWS and other evidence-based practices that improve childhood cancer outcomes in resource-limited hospitals.

Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals.

Background: Pediatric Early Warning Systems (PEWS) aid in identification of deterioration in hospitalized children with cancer but are underutilized in resource-limited settings. Proyecto EVAT is a multicenter quality improvement (QI) collaborative in Latin America to implement PEWS. This study investigates the relationship between hospital characteristics and time required for PEWS implementation. Methods: This convergent mixed-methods study included 23 Proyecto EVAT childhood cancer centers; 5 hospitals representing quick and slow implementers were selected for qualitative analysis. Semi-structured interviews were conducted with 71 stakeholders involved in PEWS implementation. Interviews were recorded, transcribed and translated to English, then coded using a priori and novel codes. Thematic content analysis explored the impact of hospital characteristics and QI experience on time required for PEWS implementation and was supplemented by quantitative analysis exploring the relationship between hospital characteristics and implementation time. Results: In both quantitative and qualitative analysis, material and human resources to support PEWS significantly impacted time to implementation. Lack of resources produced various obstacles that extended time necessary for centers to achieve successful implementation. Hospital characteristics, such as funding structure and type, influenced PEWS implementation time by determining their resource-availability. Prior hospital or implementation leader experience with QI, however, helped facilitate implementation by assisting implementers predict and overcome resource-related challenges. Conclusions: Hospital characteristics impact time required to implement PEWS in resource-limited childhood cancer centers; however, prior QI experience helps anticipate and adapt to resource challenges and more quickly implement PEWS. QI training should be a component of strategies to scale-up use of evidence-based interventions like PEWS in resource-limited settings.

The COVID-19 Pandemic's impact on sustainability and expansion of a Pediatric Early Warning System in resource-limited hospitals.

BACKGROUND: The COVID-19 pandemic impacted healthcare delivery worldwide, including pediatric cancer care, with a disproportionate effect in resource-limited settings. This study evaluates its impact on existing quality improvement (QI) programs. METHODS: We conducted 71 semi-structured interviews of key stakeholders at five resource-limited pediatric oncology centers participating in a collaborative to implement Pediatric Early Warning System (PEWS). Interviews were conducted virtually using a structured interview guide, recorded, transcribed, and translated into English. Two coders developed a codebook of a priori and inductive codes and independently coded all transcripts, achieving a kappa of 0.8-0.9. Thematic analysis explored the impact of the pandemic on PEWS. RESULTS: All hospitals reported limitations in material resources, reduction in staffing, and impacts on patient care due to the pandemic. However, the impact on PEWS varied across centers. Identified factors that promoted or limited ongoing PEWS use included the availability of material resources needed for PEWS, staff turnover, PEWS training for staff, and the willingness of staff and hospital leaders to prioritize PEWS. Consequently, some hospitals were able to sustain PEWS; others halted or reduced PEWS use to prioritize other work. Similarly, the pandemic delayed plans at all hospitals to expand PEWS to other units. Several participants were hopeful for future expansion of PEWS post-pandemic. CONCLUSION: The COVID-19 pandemic created challenges for sustainability and scale of PEWS, an ongoing QI program, in these resource-limited pediatric oncology centers. Several factors mitigated these challenges and promoted ongoing PEWS use. These results can guide strategies to sustain effective QI interventions during future health crises.

Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals.

Background: Pediatric Early Warning Systems (PEWS) reduce clinical deterioration, improve interdisciplinary communication, and provide cost savings; however, little is known about how these impacts are achieved or related. This study evaluates the multi-level impacts of PEWS in resource-limited pediatric oncology centers. Methods: We conducted 71 semi-structured interviews including physicians (45%), nurses (45%), and administrators (10%) from 5 resource-limited pediatric oncology centers in 4 Latin American countries. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed using a priori and inductively derived codes. Transcripts were independently coded by 2 coders, achieving a kappa of 0.8-0.9. Thematic content analysis explored perceived impacts of PEWS at the level of the patient, clinician, healthcare team, and institution. Results: PEWS improved the quality of attention for patients, reducing morbidity and mortality. Clinicians felt more knowledgeable, confident, and empowered providing patient care, resulting in greater job satisfaction. PEWS affected team dynamics by improving interdisciplinary (ward and intensive care unit) and interprofessional (physicians and nurses) relationships and communication. This ultimately led to institutional culture change with emphasis on patient safety, collaboration with other centers, and receipt of institutional awards. Together, these impacts led to hospital-wide support of ongoing PEWS use. Conclusions: In resource-limited hospitals, PEWS use results in multi-level positive impacts on patients, clinicians, teams, and institutions, creating a feedback loop that further supports ongoing PEWS use. These findings can guide advocacy for PEWS to various stakeholders, improve PEWS effectiveness, and inform assessment of other interventions to improve childhood cancer outcomes.

Granuloma eosinofílico cervical en el adolescente: reporte de un caso y revisión de la literatura / Cervical eosinophilic granuloma in adolescents: case report and literature review

INTRODUCCIÓN El granuloma eosinofílico (GE) es una patología infrecuente, sobre todo en adultos, que puede afectar la columna cervical. A pesar de la vasta literatura, esta enfermedad afecta principalmente a la población infantil, y no hay un consenso sobre el manejo en adultos. Con el objetivo de aportar conocimiento respecto a esta patología poco frecuente, se presenta un caso clínico de GE cervical en un paciente de 16 años, a quien se trató de manera conservadora, con buenos resultados y retorno completo a sus actividades. CASO CLÍNICO Un hombre de 16 años, seleccionado de rugby, consultó por dolor cervical axial persistente y nocturno de 6 semanas de evolución, sin trauma evidente. Al examen, destacó dolor a la compresión axial sin compromiso neurológico asociado. Los exámenes de tomografía computarizada (TC) y resonancia magnética (RM) revelaron lesión lítica en el cuerpo de C3 de características agresivas, de presentación monostótica en tomografía por emisión de positrones-tomografía computada (TEP-TC) compatible con tumor primario vertebral. Se decidió realizar biopsia percutánea bajo TC, para definir el diagnóstico y manejo adecuado, la cual fue compatible con células de Langerhans. Al no presentar clínica ni imagenología de inestabilidad ósea evidente o compromiso neurológico, se manejó con tratamiento conservador, inmovilización cervical, analgesia oral, y seguimiento estrecho. A los cuatro meses de evolución, se presentó con una TC con cambios reparativos del cuerpo vertebral y sin dolor, y logró retomar sus actividad habituales. CONCLUSIONES El diagnóstico de GE es infrecuente a esta edad, y se debe plantear entre diagnósticos diferenciales de lesiones líticas agresivas primarias vertebrales. Es necesario el uso de imágenes, y la biopsia vertebral es fundamental para confirmar el diagnóstico. Su manejo va a depender de la sintomatología, del compromiso de estructuras vecinas, y de la estabilidad de la vértebra afectada. El manejo conservador con seguimiento clínico e imagenológico es una opción viable.

INTRODUCTION Eosinophilic granuloma (EG) is a rare, tumor-like lesion, infrequently affecting the cervical spine, particularly in adults. Although vastly described in literature, this pathology mainly affects children, and there is still no consensus on its treatment in older patients. With the goal of contributing to increase the knowledge regarding this infrequent pathology, we present a case of a C3 eosinophilic granuloma in a 16-year-old patient, who was treated conservatively, with good results, including complete return to his previous activities. CLINICAL CASE a 16-year-old male, elite rugby player, presented with a history of persistent neck pain, mainly at night, with no previous trauma. Upon physical examination, he reported neck pain with axial compression of the head, without neurological impairment. Both computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed an aggressive lytic lesion in the C3 vertebral body, a with monostotic presentation on positron emission tomography-computed tomography (PET-CT) compatible with a primary spine tumor. A CT-guided percutaneous biopsy was obtained to establish the diagnosis and provide the proper management. The results were compatible with Langerhans cells. As he presented no symptoms or imaging findings of evident bone instability, as well as no neurological impairment, the patient was treated conservatively, with a cervical brace, oral pain medication and close followup. A CT obtained after four months of treatment showed reparative changes of the C3 vertebral body; at this point, the patient reported no neck pain, so he was able to return to his previous activities. CONCLUSIONS Although an EG is rare at this age, it should be considered in the differential diagnosis of primary vertebral aggressive lytic lesions. Imaging and a vertebral biopsy are paramount to confirm the diagnosis. The treatment modality depends on the symptoms, the involvement of adjacent structures, and the stability of the affected vertebra. Conservative management including clinical and imaging followup is a viable option.

Artes escénicas como metodología de enseñanza para la comunicación efectiva en estudiantes de Enfermería en la Universidad de La Frontera, Chile / Performing arts as a teaching methodology for effective communication in Nursing students, Universidad de La Frontera, Chile

Introducción: La capacidad comunicativa es factible de mejorar en sujetos que reciben preparación sociopsicológica. Las escuelas de Enfermería han recurrido a variadas formas de arte, entre ellas las escénicas, como parte de esta instrucción. Los objetivos son: desvelar la vivencia con respecto a los talleres basados en artes escénicas, descubrir los aportes de éstos para la formación y la competencia de comunicación, e indagar aspectos que deben mejorar posterior a la experiencia.Material y métodos.Es una investigación cualitativa exploratoria, mediante sistematización de experiencia, con una muestra no probabilística, intencionada de casos por criterio, conveniencia, conformada por 36 estudiantes. La intervención se basó en la pedagogía de Jacques Lecoq, y se desarrollaron 11 talleres en el primer semestre de 2019. La recolección de datos se hizo con un instrumento con preguntas abiertas, y el análisis, mediante comparación constante y reducción progresiva de forma manual. El estudio fue aprobado por Coordinación de Desarrollo Docente e Innovación Tecnológica, Vicerrectoría de Pregrado, Universidad de La Frontera.Resultados.En el primer nivel, se obtuvieron 400 unidades de significado agrupadas en 58 categorías emergentes que originaron un dominio cualitativo en el tercer nivel: 'representa opiniones de estudiantes en relación con la potenciación del desarrollo personal y de la competencia de comunicación asociada a metodología de aprendizaje basado en artes escénicas en el ámbito personal y académico para los cuidados'.Conclusiones.Los participantes reconocen el desarrollo de competencias genéricas, especialmente comunicación, e identifican los beneficios de la experiencia en el ámbito personal, académico y futuro profesional. (AU)

Introduction: The communicative ability is feasible to improve in subjects receiving socio-psychological training. Nursing schools have used a variety of art forms, including theatrical skills, as part of this instruction. The objectives are: to reveal the experience concerning the workshops based on performing arts, to discover its contributions to training and communication skills, and to investigate aspects that should be improved after the experience.Material and methods.Exploratory qualitative research, through the systematization of experience. Non-probabilistic, intentional sample of cases by criterion, convenience, made up of 36 students. The intervention was based on the pedagogy of Jacques Lecoq, developing 11 workshops in the first semester of 2019. Data collection with an instrument with open questions. Analysis by constant comparison and manual progressive reduction. Study approved by the Coordination of Teaching Development and Technological Innovation, Undergraduate Vice-Rectory, Universidad de La Frontera.Results.First level, 400 units of meaning grouped into 58 emerging categories that originated a qualitative domain in the third level: 'represents students' opinions about the enhancement of personal development and communication competence associated with learning methodology based on performing arts in the personal and academic sphere for care'.Conclusions.Participants recognize the development of generic skills, especially communication, identify the benefits of the experience in the personal, academic, and professional future. (AU)

Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings.

Importance: Pediatric early warning systems (PEWS) aid with early identification of clinical deterioration and improve outcomes in children with cancer hospitalized in resource-limited settings; however, there may be barriers to implementation. Objective: To evaluate stakeholder-reported barriers and enablers to PEWS implementation in resource-limited hospitals. Design, Setting, and Participants: In this qualitative study, semistructured stakeholder interviews were conducted at 5 resource-limited pediatric oncology centers in 4 countries in Latin America. Hospitals participating in a multicenter collaborative to implement PEWS were purposefully sampled based on time required for implementation (fast vs slow), and stakeholders interviewed included physicians, nurses, and administrators, involved in PEWS implementation. An interview guide was developed using the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted virtually in Spanish, audiorecorded, and professionally transcribed and translated into English. A codebook was developed a priori using the CFIR and supplemented with codes inductively derived from transcript review. Two coders independently analyzed all transcripts, achieving a κ of 0.8 to 0.9. The study was conducted from June 1 to August 31, 2020. Main Outcomes and Measures: Thematic analysis was conducted based on CFIR domains (inner setting, characteristics of individuals, outer setting, intervention characteristics, and implementation process) to identify barriers and enablers to PEWS implementation. Results: Seventy-one staff involved in PEWS implementation were interviewed, including 32 physicians (45%), 32 nurses (45%), and 7 administrators (10%). Of these, 50 were women (70%). Components of the 5 CFIR domains were mentioned by participants as barriers and enablers to PEWS implementation at both fast- and slow-implementing centers. Participants emphasized barriers at the level of the clinical staff, hospital, external factors, and PEWS intervention. These barriers included staff resistance to change, inadequate resources, components of health systems, and the perceived origin and complexity of PEWS. At all centers, most barriers were successfully converted to enablers during the implementation process through targeted strategies, such as early stakeholder engagement and adaptation, including adapting PEWS to better fit the local context and changing the hospital setting to support ongoing use of PEWS. Conclusions and Relevance: To date, this is the first multicenter, multinational study describing barriers and enablers to PEWS implementation in resource-limited settings. Findings suggest that many barriers are not immutable and can be converted to enablers during the implementation process. This work can serve as a guide for clinicians looking to implement evidence-based interventions to reduce global disparities in patient outcomes.

Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America.

Background: Sustainability, or continued use of evidence-based interventions for long-term patient benefit, is the least studied aspect of implementation science. In this study, we evaluate sustainability of a Pediatric Early Warning System (PEWS), an evidence-based intervention to improve early identification of clinical deterioration in hospitalized children, in low-resource settings using the Clinical Capacity for Sustainability Framework (CCS). Methods: We conducted a secondary analysis of a qualitative study to identify barriers and enablers to PEWS implementation. Semi-structured interviews with PEWS implementation leaders and hospital directors at 5 Latin American pediatric oncology centers sustaining PEWS were conducted virtually in Spanish from June to August 2020. Interviews were recorded, professionally transcribed, and translated into English. Exploratory thematic content analysis yielded staff perceptions on PEWS sustainability. Coded segments were analyzed to identify participant perception about the current state and importance of sustaining PEWS, as well as sustainability successes and challenges. Identified sustainability determinants were mapped to the CCS to evaluate its applicability. Results: We interviewed 71 staff including physicians (45%), nurses (45%), and administrators (10%). Participants emphasized the importance of sustaining PEWS for continued patient benefits. Identified sustainability determinants included supportive leadership encouraging ongoing interest in PEWS, beneficial patient outcomes enhancing perceived value of PEWS, integrating PEWS into the routine of patient care, ongoing staff turnover creating training challenges, adequate material resources to promote PEWS use, and the COVID-19 pandemic. While most identified factors mapped to the CCS, COVID-19 emerged as an additional external sustainability challenge. Together, these challenges resulted in multiple impacts on PEWS sustainment, ranging from a small reduction in PEWS quality to complete disruption of PEWS use and subsequent loss of benefits to patients. Participants described several innovative strategies to address identified challenges and promote PEWS sustainability. Conclusion: This study describes clinician perspectives on sustainable implementation of evidence-based interventions in low-resource settings, including sustainability determinants and potential sustainability strategies. Identified factors mapped well to the CCS, however, external factors, such as the COVID pandemic, may additionally impact sustainability. This work highlights an urgent need for theoretically-driven, empirically-informed strategies to support sustainable implementation of evidence-based interventions in settings of all resource-levels.

Galectin-3 immunolabelling correlates with BCL2 expression in canine cutaneous mast cell tumours.

Mast cell tumour (MCT) is the most frequent skin neoplasm in dogs. These tumours are characterised by variable behaviour and clinical presentation that make prognosis an important and challenging task in the veterinary practice. Galectin-3 (Gal-3) is known to influence several biological processes that are important in the cancer context and has been described as a prognostic marker for several human cancers. The aim of the present work was to characterise Gal-3 immunolabelling in canine cutaneous MCTs and to investigate its value as a prognostic marker for the disease. Thirty-four random cases of canine cutaneous MCT that were surgically treated with wide margins were included in this study. Gal-3 expression was evaluated using immunohistochemistry and the results were compared with the expression of apoptosis-related proteins, Ki67 index, histopathological grades, mortality due to the disease and post-surgical survival. The majority of the MCTs (65.8%) were positive for Gal-3. Gal-3 immunolabelling was variable among the samples (2.7%-86.8% of the neoplastic cells). The protein was located in the cytoplasm or in the cytoplasm and the nucleus. Gal-3 positivity was correlated with BCL2 expression (P < 0.001; r = 0.604), but not with Ki67 and BAX. No significant differences were detected between histological grades or in the survival analysis. Gal-3 expression correlates with BCL2 expression in MCTs. Although an efficient marker for several human neoplasms, the results presented herein suggest that Gal-3 immunolabelling is not an independent prognostic indicator for this disease.

Eletroquimioterapia como tratamento de carcinoma espinocelular em felino: relato de caso / Electrochemotherapy as treatment of squamous cell carcinoma in feline: case report / Electroquimioterapia como tratamiento del carcinoma de células escamosas en felino: relato de caso

O carcinoma de células escamosas (CCE) é uma neoplasia maligna resultante da diferenciação de ceratinócitos, que acomete principalmente animais de pelagem clara e pouco pigmentados, decorrente da exposição à radiação ultravioleta. Apresentam evolução lenta e baixo caráter metastático, porém, em alguns mais avançados pode ocorrer acometimento metastático de órgãos adjacentes. Os tratamentos utilizados no CCE incluem cirurgia, radioterapia, quimioterapia, crioterapia e eletroquimioterapia (EQT). A eletroquimioterapia se mostra bastante eficaz no tratamento desse tumor, dentre outros e comumente não apresenta efeito colateral. O presente trabalho tem como objetivo relatar o caso de um felino atendido na Clínica Veterinária Bichos S.A. no município de Foz do Iguaçu, diagnosticado com Carcinoma de Células Escamosas e portador do vírus da imunodefiência felina. O tratamento adotado para a neoplasia foi a eletroquimioterapia, resultando em remissão parcial das lesões, após vinte dias da EQT. Com objetivo de investigar possível acometimento ósseo, foi realizada radiografia de face, onde a mesma apresentou área de lise óssea em arco zigomático e maxila esquerda, indicativo de infiltração neoplásica. A radiografia torácica apontou presença de área nodular sobrepondo lobo pulmonar caudal direito, indicativo de processo metastático. Em virtude do prognóstico reservado, os tutores optaram pela eutanásia do mesmo.(AU)

Squamous cell carcinoma (SCC) is a malignant neoplasm resulting from the differentiation of keratinocytes, which mainly affects light-colored and non-pigmented animals due to exposure to ultraviolet radiation. Although they present slow evolution and low metastatic character, in some more advanced cases, metastatic involvement of adjacent organs may occur. The treatments used in SCC include surgery, radiotherapy, chemotherapy, cryotherapy and electrochemotherapy (ECT). Electrochemotherapy is quite effective in the treatment of this type of tumor, among others, and it usually has no side effect. This work aims at reporting the case of a feline treated at the Veterinary Clinic Bichos S.A. in the city of Foz do Iguaçu diagnosed with Squamous Cell Carcinoma and carrying the feline immunodefense virus (FIV). Electrochemotherapy was the treatment of choice for the neoplasia, resulting in partial remission of the lesions after twenty days of treatment. In order to investigate possible bone involvement, an X-ray of the face was performed, where it presented area of bone lysis in the zygomatic arch and left maxilla, signs of neoplastic infiltration. The chest X-ray showed a nodular area overlapping the right caudal pulmonary lobe, an indication of metastatic process. Due to the reserved prognosis, the tutors chose euthanasia of the subject.(AU)

El carcinoma de células escamosas (CEC) es una neoplasia maligna resultante de la diferenciación de queratinocitos, que afecta principalmente a animales de pelaje claro y de poca pigmentación, resultado de la exposición a la radiación ultravioleta. Tienen una evolución lenta y un carácter metastásico bajo, sin embargo, en algunos más avanzados puede producirse afectación metastásica de órganos adyacentes. Los tratamientos utilizados en el CEC incluyen cirugía, radioterapia, quimioterapia, crioterapia y electroquimioterapia (EQT). La electroquimioterapia es muy eficaz en el tratamiento de ese tumor, entre otros y no suele tener efectos secundarios. Este trabajo tiene como objetivo reportar el caso de un felino atendido en la Clínica Veterinária Bichos S.A. de la ciudad de Foz do Iguaçu, diagnosticado con Carcinoma de Células Escamosas y con el virus de la inmunodeficiencia felina. El tratamiento adoptado para la neoplasia fue la electroquimioterapia, resultando en remisión parcial de las lesiones luego de veinte días de EQT. Con el fin de investigar la posible afectación ósea se realizó una radiografía de rostro, donde se presentó un área de lisis ósea en arco cigomático y maxilar izquierdo, indicativo de infiltración neoplásica. La radiografía de tórax mostró la presencia de un área nodular superpuesta al lóbulo pulmonar caudal derecho, lo que indicaba un proceso metastásico. Debido al pronóstico reservado, los tutores optaron por la eutanasia.(AU)

Identification of two molecular subtypes in canine mast cell tumours through gene expression profiling.

Mast cell tumours (MCTs) are common neoplasms in dogs and are usually regarded as potentially malignant. Several studies have attempted to identify biomarkers to better predict biological behaviours for this tumour. The aim of this study was to identify pathways connected to clinical and histopathological malignancies, shorter survival times, and poor prognoses associated with MCTs. We performed genome-wide gene expression analyses on tissues obtained from 15 dogs with single MCTs, and identified two distinct tumour subtypes-high-risk and low-risk-associated with differences in histological grades, survival times, Ki67 indices, and occurrence of death due the disease. Comparative analyses of RNA sequence profiles revealed 71 genes that were differentially expressed between high- and low-risk MCTs. In addition to these analyses, we also examined gene co-expression networks to explore the biological functions of the identified genes. The network construction revealed 63 gene modules, of which 4 were significantly associated with the more aggressive tumour group. Two of the gene modules positively correlated with high-risk MCTs were also associated with cell proliferation and extracellular matrix-related terms. At the top of the extracellular matrix module category, genes with functions directly related to those of cancer-associated fibroblasts (CAFs) were identified. Immunohistochemical analyses also revealed a greater number of CAFs in high-risk MCTs. This study provides a method for the molecular characterisation of canine MCTs into two distinct subtypes. Our data indicate that proliferation pathways are significantly involved in malignant tumour behaviours, which are known to be relevant for the induction and maintenance of MCTs. Finally, animals presenting high-risk MCTs overexpress genes associated with the extracellular matrix that can be robustly linked to CAF functions. We suggest that CAFs in the MCT stroma contribute to cancer progression.

Intratumoral collagen index predicts mortality and survival in canine cutaneous mast cell tumours.

BACKGROUND: Mast cell tumours (MCTs) constitute almost 25% of cutaneous neoplasms in dogs. Their biological behaviour is predicted using histopathological grading which is based on several subjective criteria that are vulnerable to intra- and interobserver variability. To improve the prediction of the biological behaviour, several complementary markers have been studied. The integrity of the extracellular matrix (ECM) may play a protective role against tumoral progression, and favour cellular proliferation, angiogenesis, invasion and metastases when altered. HYPOTHESIS/OBJECTIVES: To evaluate the quantification of collagen and elastic fibres as prognostic markers for MCTs. ANIMALS: Thirty-eight random cases of canine cutaneous MCT surgically treated with wide margins were included. METHODS AND MATERIALS: Intratumoral collagen and elastic fibres were identified and quantified on histological sections stained with Masson's trichrome, Picrosirius red and Verhoeff; the results were compared with histopathological grades, mortality due to the disease and postsurgical survival. RESULTS: Morphometric analysis revealed a significant relationship between histopathological grade and intratumoral collagen index (CoI). In addition, the CoI was considered an independent indicator for mortality and postsurgical survival. CONCLUSIONS AND CLINICAL IMPORTANCE: These results support the importance of the CoI in the grading and prognosis of MCTs, suggesting that preservation and/or synthesis of collagen have the potential to become targets for MCT therapeutics.

Nanog Expression and Proliferation Indices in Canine Cutaneous Mast Cell Tumors.

Mast cell tumors are one of the most frequent skin tumors in dogs. Treatment decisions often depend on a wide range of clinical information and the main criteria for prognostic formulation are histological grade, mitotic count, Ki67 index, and KIT immunostaining pattern. NANOG is a pluripotency factor expressed by normal and cancer stem cells, which is a prognostic marker and a potential therapeutic target for several human tumors. In the present study, mast cell tumor samples from 41 dogs were evaluated for NANOG and Ki67 by immunohistochemistry. All samples were positive for NANOG but its expression was not correlated with Ki67 index and no significant differences were found with respect to histopathological grades, disease-related mortality, or survival. Our results suggest that, although related to pluripotency, NANOG expression does not correlate with proliferative activity, and is not a reliable prognostic factor for canine cutaneous mast cell tumors.

Enfermedad quística de la adventicia, arteria poplítea / Cystic disease of the adventitial layer of the popliteal artery

La enfermedad quística de la adventicia es una rara alteración de las arterias periféricas, caracterizada por la acumulación de contenido mucoso en la adventicia del vaso. Tiene predilección por la arteria poplítea, donde se localiza en cerca de 85 % de los casos. La mayoría de los afectados son hombres entre los 40 y los 50 años de edad, que presentan claudicación intermitente de inicio brusco y rápida progresión, sin evidencia de enfermedad ateroesclerótica. Se describe el caso un hombre de 57 años de edad en el que se diagnosticó esta entidad, con énfasis en las imágenes diagnósticas y el abordaje quirúrgico

Cystic adventitial disease is a rare vascular disorder of the peripheral arteries characterized by the collection of a mucinous substance inside the adventitia of the vessel. It has a predilection for the popliteal artery, being this localization about 85% of cases. Most of those affected are male between 40 to 50 years old, presenting with intermittent claudication of sudden onset and rapid progression without evidence of atherosclerotic disease. We describe the case of a 57 years old male who was diagnosed with this entity, with emphasis on the diagnostic imaging and surgical approach