Multidisciplinary approach for locally advanced non-small cell lung cancer (NSCLC): 2023 expert consensus of the Spanish Lung Cancer Group GECP.

INTRODUCTION: Recent advances in the treatment of locally advanced NSCLC have led to changes in the standard of care for this disease. For the selection of the best approach strategy for each patient, it is necessary the homogenization of diagnostic and therapeutic interventions, as well as the promotion of the evaluation of patients by a multidisciplinary oncology team. OBJECTIVE: Development of an expert consensus document with suggestions for the approach and treatment of locally advanced NSCLC leaded by Spanish Lung Cancer Group GECP. METHODS: Between March and July 2023, a panel of 28 experts was formed. Using a mixed technique (Delphi/nominal group) under the guidance of a coordinating group, consensus was reached in 4 phases: 1. Literature review and definition of discussion topics 2. First round of voting 3. Communicating the results and second round of voting 4. Definition of conclusions in nominal group meeting. Responses were consolidated using medians and interquartile ranges. The threshold for agreement was defined as 85% of the votes. RESULTS: New and controversial situations regarding the diagnosis and management of locally advanced NSCLC were analyzed and reconciled based on evidence and clinical experience. Discussion issues included: molecular diagnosis and biomarkers, radiologic and surgical diagnosis, mediastinal staging, role of the multidisciplinary thoracic committee, neoadjuvant treatment indications, evaluation of response to neoadjuvant treatment, postoperative evaluation, and follow-up. CONCLUSIONS: Consensus clinical suggestions were generated on the most relevant scenarios such as diagnosis, staging and treatment of locally advanced lung cancer, which will serve to support decision-making in daily practice.

Improving Waiting Time for Chemotherapy with Ahead-of-Time Drug Preparation.

Waiting time for chemotherapy infusion is a fundamental factor to measure quality of care. It has been shown that a prolonged waiting time is related to a higher incidence of anticipatory nausea and poor patient adherence to scheduled appointments and recommended oncology treatment programs. Some chemotherapy regimens can be prepared hours ahead-of-time, due to long stability. We aimed to study the effect of an informatic-led workflow redesign intervention, facilitating workflow changes in the Oncology Pharmacy, on patient waiting time. This intervention included changes on EHR processes and the chemotherapy CPOE. Their main effect was allowing ahead-of-time preparation of selected chemotherapy regimes. We conducted a cross sectional study, comparing waiting times pre and post intervention periods. A total of 4600 programmed chemotherapy episodes were included. We found a 26.5 % decrease in the mean wait time in the post intervention period (p > 0.02). We were able to show a decrease in waiting time and a measurable impact of the intervention. This evaluation produced valuable and actionable data for Oncology units and adds a valuable, Latin American experience to the literature.

The role of sex and gender in the diagnosis and treatment of lung cancer: the 6th ICAPEM Annual Symposium.

The incidence and mortality of lung cancer in women are rising, with both increasing by 124% between 2003 and 2019. The main risk factor for lung cancer is tobacco use, but indoor radon gas exposure is one of the leading causes in nonsmokers. The most recent evidence demonstrates that multiple factors can make women more susceptible to harm from these risk factors or carcinogens. For this consensus statement, the Association for Lung Cancer Research in Women (ICAPEM) invited a group of lung cancer experts to perform a detailed gender-based analysis of lung cancer. Clinically, female patients have different lung cancer profiles, and most actionable driver alterations are more prevalent in women, particularly in never-smokers. Additionally, the impact of certain therapies seems to be different. In the future, it will be necessary to carry out specific studies to improve the understanding of the role of certain biomarkers and gender in the prognosis and evolution of lung cancer.

Outcomes and Associated Extracardiac Malformations in Neonates from Colombia with Severe Congenital Heart Disease.

Congenital heart disease (CHD) is a common structural anomaly, affecting ~ 1% of live births worldwide. Advancements in medical and surgical management have significantly improved survival for children with CHD, however, extracardiac malformations (ECM) continue to be a significant cause of morbidity and mortality. Despite clinical significance, there is limited literature available on ECM in neonates with CHD, especially from Latin America. A cross-sectional study of neonates with severe CHD evaluated by the medical-surgical board team at Fundación Cardiovascular de Colombia from 2014 to 2019 was completed to characterize morbidity, mortality, surgical outcomes, and ECM. Demographics and surgical outcomes were compared between neonates with and without ECM. Medical record data were abstracted and descriptive statistical analysis was performed. Of 378 neonates with CHD, 262 had isolated CHD (69.3%) and 116 had ECM (30.7%). The most common ECM was gastrointestinal (n = 18, 15.5%) followed by central nervous system (n = 14, 12%). Most neonates required a biventricular surgical approach (n = 220, 58.2%). Genetic testing was performed more often for neonates with ECM (n = 65, 56%) than neonates with isolated CHD (n = 14, 5.3%). Neonates with ECM had lower birth weight, longer hospital stays, and higher postsurgical complications rates. There was no difference in survival between groups. Overall, Screening for ECM in neonates with CHD is important and identification of ECM can guide clinical decision-making. These findings have important implications for pediatric healthcare providers, especially in low- and middle-income countries, where the burden of CHD is high and resources for managing CHD and extracardiac malformations may be limited.

Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease / Endarterite infecciosa na coarctação da aorta: dois espectros de uma doença pouco frequente

ABSTRACT Objective: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. Case description: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. Comments: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

RESUMO Objetivo: Descrever dois diferentes graus de comprometimento clínico e resultados na evolução de endarterite infecciosa em pacientes sem diagnóstico prévio de coarctação da aorta. Descrição do caso: Dois pacientes do sexo masculino com idades entre 13 e nove anos foram internados. O primeiro por febre durante dois meses, iniciada após limpeza dentária. O segundo por hipertensão arterial. Ambos com astenia e perda de peso. No primeiro caso, o ecocardiograma transtorácico mostrou coarctação da aorta e o ecocardiograma transesofágico revelou vegetações na área pós-coarctação, sem pseudoaneurismas. A hemocultura foi positiva para de Streptococcus mitis. Este paciente foi tratado por seis semanas com penicilina cristalina, resolvendo a infecção sem complicações. O segundo caso foi avaliado pela presença de hipertensão arterial, com história de febre tratada com antibióticos. Ao realizar o ecocardiograma transtorácico, observou-se coarctação da aorta com imagem sacular classificada como pseudoaneurisma pela angiografia e tomografia. A hemocultura foi negativa. O paciente desenvolveu um episódio de hematêmese, cuja etiologia inicial não pôde ser determinada. Antes da correção cirúrgica, apresentou um segundo episódio de hematêmese profusa, com choque hipovolêmico e óbito. Comentários: Devemos ter um alto índice de suspeição clínica para poder estabelecer o diagnóstico de coarctação da aorta complicada com endarterite e iniciar o tratamento antibiótico adequado. É preciso manter a vigilância para a detecção precoce de pseudoaneurismas.

Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease.

OBJECTIVE: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. CASE DESCRIPTION: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. COMMENTS: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

RGD Peptide-Functionalized Polyether Ether Ketone Surface Improves Biocompatibility and Cell Response.

Polyether ether ketone (PEEK) is a biocompatible polymer used in maxillofacial and orthopedic applications because of its mechanical properties and chemical stability. However, this biomaterial is inert and requires surface modification to make it bioactive, enhancing implant-tissue integration and giving the material the ability to interact with the surrounding microenvironment. In this paper, surface of PEEK was activated by oxygen plasma treatment and this resulted in increasing reactivity and surface hydrophilicity. Then, a polydopamine (PDA) coating was deposited over the surface followed by biofunctionalization with an RGD peptide. The plasma effect was studied by contact angle measurements and scanning electron microscopy. X-ray photoelectron spectroscopy confirmed the presence of PDA coating and RGD peptide. Crystallinity and phase identification were carried out through X-ray diffraction. Quantification of the immobilized peptide over the PEEK surface was reached through UV-vis spectroscopy. In addition, in vitro tests with fibroblast cell line (NIH/3T3) determined the viability, attachment, spreading, and proliferation of these cells over the modified PEEK surfaces. According to the results, PEEK surfaces functionalized with peptides demonstrated an increased cellular response with each successive surface modification.

A Delphi consensus panel about clinical management of early-stage EGFR-mutated non-small cell lung cancer (NSCLC) in Spain: a Delphi consensus panel study.

PURPOSE: This Delphi panel study assessed the level of consensus between medical oncologists on the clinical management of patients with early-stage EGFR-mutated non-small cell lung cancer (NSCLC). METHODS: A modified two-round Delphi approach was used. A scientific committee comprised of medical oncologists developed an online questionnaire. Delphi panel experts rated their level of agreement with each questionnaire statement on a 9-point Likert scale. The questionnaire included 36 statements from 3 domains (clinical management of early-stage NSCLC: 15 statements; role of adjuvant therapy in early-stage NSCLC: 9 statements; and role of adjuvant therapy in early-stage NSCLC with sensitizing EGFR mutation: 12 statements). RESULTS: In round 1, consensus was reached for 24/36 statements (66.7%). Nine statements that did not achieve consensus after the first round were evaluated in round 2, and none of them reached consensus. Overall, 84.4% of the panelists agreed that EGFR mutation testing should be done after surgery. Consensus was not achieved on whether the implementation of EGFR mutation testing in resected early-stage NSCLC could limit the use of adjuvant osimertinib. The panelists recognized the rationale for the use of osimertinib in the adjuvant scenario (88%) and 72% agreed that it may change the treatment paradigm in stage IB-IIIA EGFR-mutated NSCLC. Consensus was not reached on the inconvenience of prolonged duration of osimertinib. CONCLUSIONS: This Delphi study provides valuable insights into relevant questions in the management of early-stage EGFR-mutated NSCLC. However, specific issues remain unresolved. The expert consensus emphasizes the role of adjuvant treatment with osimertinib in this scenario.

New update to the guidelines on testing predictive biomarkers in non-small-cell lung cancer: a National Consensus of the Spanish Society of Pathology and the Spanish Society of Medical Oncology.

Non-small cell lung cancer (NSCLC) presents the greatest number of identified therapeutic targets, some of which have therapeutic utility. Currently, detecting EGFR, BRAF, KRAS and MET mutations, ALK, ROS1, NTRK and RET translocations, and PD-L1 expression in these patients is considered essential. The use of next-generation sequencing facilitates precise molecular diagnosis and allows the detection of other emerging mutations, such as the HER2 mutation and predictive biomarkers for immunotherapy responses. In this consensus, a group of experts in the diagnosis and treatment of NSCLC selected by the Spanish Society of Pathology and the Spanish Society of Medical Oncology have evaluated currently available information and propose a series of recommendations to optimize the detection and use of biomarkers in daily clinical practice.

Design of a mobile application for home monitoring of babies with complex congenital heart disease / Diseño de una aplicación móvil para la monitorización domiciliaria de bebés con cardiopatías congénitas complejas / Projeto de um aplicativo móvel para monitoramento domiciliar de bebês com cardiopatias congênitas complexas

Introduction: Congenital heart diseases are related to heart defects that develop during pregnancy and are present at birth. Children must regularly attend specialized clinical centers for treatment, which includes medical check-ups, hemodynamic procedures, and surgery. Nevertheless, the success of interventions largely depends on the education of parents and caregivers about the symptoms and warning signs that babies with complex congenital heart disease may present during the period between stages. Likewise, it is necessary for caregivers to have tools to face the barriers of the health system, such as, obstacles or delays in obtaining healthcare services. This facilitates timely health care for patients and avoids fatal outcomes or deterioration in quality of life. Materials and Methods: This document presents a system that provides support to patients with complex congenital heart disease in follow-up by a home monitoring program. The system consists of a mobile application that allows parents/caregivers to monitor physiological variables of the patients (weight, intake, and oximetry). The information registered in the application is sent for real-time evaluation by the medical team. Results:The application provides an effective means for sending data and communicating with the medical control center, in addition to offering educational and informative material. In this way, parents/caregivers get constant help and feedback about their baby's condition. Conclusions: The mobile application could help mitigate the costs of medical care and overcome the limitations of follow-up at home, giving doctors the possibility to see the patient's evolution and give timely recommendations.

Introducción: Las cardiopatías congénitas están relacionadas con defectos cardíacos que se desarrollan durante el embarazo y están presentes al nacer. El éxito de las intervenciones depende en gran medida de la educación de los padres/cuidadores sobre los signos y síntomas de alerta. Los cuidadores necesitan tener herramientas para hacer frente a las barreras del sistema de salud. Objetivo: crear un sistema como herramienta de seguimiento para los bebés con cardiopatías congénitas complejas que ayude a los padres/cuidadores y a los profesionales médicos a observar las variables fisiológicas del paciente y a brindar una retroalimentación oportuna y profesional a los padres/cuidadores desde la atención domiciliaria. Materiales y métodos:se presenta un sistema que proporciona apoyo a los pacientes que necesitan seguimiento de cardiopatías congénitas complejas mediante un programa de monitoreo en casa. El sistema consiste en una aplicación móvil que permite a los padres/cuidadores controlar las variables fisiológicas del paciente (peso, ingesta de alimento y oximetría). La información registrada en la aplicación se envía para ser evaluada en tiempo real por el equipo médico. Resultados: la aplicación proporciona un medio eficaz para enviar datos y comunicarse con el centro de control médico, además de ofrecer material educativo e informativo. De este modo, los padres/cuidadores reciben constantemente ayuda e información acerca del estado de su bebé. Conclusiones: la aplicación móvil podría ayudar a minimizar los costos de la atención médica y superar las limitaciones del seguimiento domiciliario, dando a los médicos la posibilidad de ver la evolución del paciente y dar recomendaciones oportunas.

Introdução: as doenças cardíacas congênitas estão relacionadas a defeitos cardíacos que se desenvolvem durante a gravidez e estão presentes no nascimento. O sucesso das intervenções depende em grande parte da educação dos pais/responsáveis sobre os sinais e sintomas de alerta. Os cuidadores precisam ter ferramentas para lidar com as barreiras do sistema de saúde. Objetivo: Criar uma ferramenta de sistema de monitoramento para bebês com doenças cardíacas congênitas complexas, que ajude pais/cuidadores e profissionais médicos a observar as variáveis fisiológicas do paciente e manter um feedback profissional e oportuno para os pais/cuidadores dos cuidados domiciliares. Materiais e Métodos: é apresentado um sistema que fornece suporte aos pacientes com cardiopatias congênitas complexas em acompanhamento através de um programa de monitoramento domiciliar. O sistema consiste em uma aplicação móvel que permite aos pais/responsáveis pelo acompanhamento das variáveis fisiológicas do paciente (peso, ingestão e oximetria). As informações registradas no aplicativo são enviadas para serem avaliadas em tempo real pela equipe médica. Resultados: a aplicação fornece um meio eficiente para enviar dados e se comunicar com o centro de controle médico, além de oferecer material educativo e informativo. Desta forma, os pais/responsáveis recebem ajuda constante e feedback sobre a condição de seu bebê. Conclusões: a aplicação móvel pode ajudar a minimizar os custos do atendimento médico e superar as limitações do acompanhamento domiciliar, dando aos médicos a possibilidade de ver a evolução do paciente e dar recomendações oportunas.

Transcriptional epigenetic regulation of Fkbp1/Pax9 genes is associated with impaired sensitivity to platinum treatment in ovarian cancer.

BACKGROUND: In an effort to contribute to overcoming the platinum resistance exhibited by most solid tumors, we performed an array of epigenetic approaches, integrating next-generation methodologies and public clinical data to identify new potential epi-biomarkers in ovarian cancer, which is considered the most devastating of gynecological malignancies. METHODS: We cross-analyzed data from methylome assessments and restoration of gene expression through microarray expression in a panel of four paired cisplatin-sensitive/cisplatin-resistant ovarian cancer cell lines, along with publicly available clinical data from selected individuals representing the state of chemoresistance. We validated the methylation state and expression levels of candidate genes in each cellular phenotype through Sanger sequencing and reverse transcription polymerase chain reaction, respectively. We tested the biological role of selected targets using an ectopic expression plasmid assay in the sensitive/resistant tumor cell lines, assessing the cell viability in the transfected groups. Epigenetic features were also assessed in 189 primary samples obtained from ovarian tumors and controls. RESULTS: We identified PAX9 and FKBP1B as potential candidate genes, which exhibited epigenetic patterns of expression regulation in the experimental approach. Re-establishment of FKBP1B expression in the resistant OVCAR3 phenotype in which this gene is hypermethylated and inhibited allowed it to achieve a degree of platinum sensitivity similar to the sensitive phenotype. The evaluation of these genes at a translational level revealed that PAX9 hypermethylation leads to a poorer prognosis in terms of overall survival. We also set a precedent for establishing a common epigenetic signature in which the validation of a single candidate, MEST, proved the accuracy of our computational pipelines. CONCLUSIONS: Epigenetic regulation of PAX9 and FKBP1B genes shows that methylation in non-promoter areas has the potential to control gene expression and thus biological consequences, such as the loss of platinum sensitivity. At the translational level, PAX9 behaves as a predictor of chemotherapy response to platinum in patients with ovarian cancer. This study revealed the importance of the transcript-specific study of each gene under potential epigenetic regulation, which would favor the identification of new markers capable of predicting each patient's progression and therapeutic response.

Análisis multigrupo por sexo y fiabilidad del Cuestionario de Regulación Emocional (ERQ) en jóvenes Ecuatorianos / Multigroup analysis by sex and reliability of the Emotional Regulation Questionnaire (ERQ) in Ecuadorians / Análise multigrupo por sexo e confiabilidade do Emotional Regulation Questionnaire (ERQ) em jovens Equatorianos

El objetivo de este estudio fue investigar la invarianza factorial y la fiabilidad con respecto al sexo del Cuestionario de Regulación Emocional (ERQ) en una muestra de jóvenes ecuatorianos. Se trata de un estudio instrumental de la equivalencia de medida o invarianza factorial del ERQ y de la fiabilidad. Participaron 435 estudiantes de bachillerato (53,8% mujeres), con edades comprendidas entre 14 y 20 (X̅= 16.7; s= 1.4). El modelo de dos factores es confirmado con χ²= 145.4 gl (68); p< .001;χ²/gl= 2.1; GFI= .94; CFI= .91 y RMSEA= .05 [.03 - .06]. Las restricciones al modelo en la equivalencia de medida muestran que este es invariante con respecto al sexo. Además, la fiabilidad muestra que las magnitudes son aceptables con ωSE= .636; ωRC= .762 en hombres y ωSE= .694; ωRC= .742 en mujeres. Se evidencia que el modelo del ERQ es invariante con respecto al sexo y que, a su vez, es fiable. (AU)

This study aimed to determine the factorial invariance by gender and the reliability of the Emotional Regulation Questionnaire (ERQ) in a sample of young Ecuadorians. A Measurement Equivalence or factorial invariance Instrumental study of the ERQ and its reliability was performed. Participants were 435 high school students (53.8% female), aged 14 to 20 (X̅= 16.7, s= 1.4). The ERQ's bifactor model was confirmed with χ²= 145.4; df (68); p <.001; χ²/df= 2.1; GFI=.94; CFI=.91 & RMSEA=.05 [.03-.06]. The restrictions to the model in the measure equivalence show that it is invariant regarding gender. In addition, the reliability showed that the magnitudes are acceptable with ωSE= .636; ωRC= .762 in men and ωSE= .694; ωRC= .742 in women. The ERQ model was found to be invariant by gender and reliable. (AU)

O objetivo deste estudo foi investigar a invariância e a confiabilidade do fator em relação ao sexo do Questionário de Regulação Emocional (ERQ) em uma amostra de jovens equatorianos. Trata-se de um estudo instrumental da equivalência de medida ou invariância fatorial do ERQ e da confiabilidade. Participaram 435 estudantes do ensino médio (53,8% mulheres), com idades entre 14 e 20 anos (X̅ = 16,7; s = 1,4). O modelo de dois fatores do ERQ é confirmado com χ² = 145,4 gl (68); p < 0,001; χ²/gl = 2,1; GFI = 94; CFI = 0,91 e RMSEA = 0,05 [0,03-0,06]. As restrições do modelo na equivalência de mensuração mostram que isso é invariável em relação ao sexo. Além disso, a confiabilidade mostra que as quantidades são aceitáveis com ωSE = 0,636; ωRC = 0,762 em homens e ωSE = 0,694; ωRC = 0,742 em mulheres. É evidente que o modelo ERQ é invariável em relação ao sexo e que, por sua vez, é confiável. (AU)

The Netrin-1-Neogenin-1 signaling axis controls neuroblastoma cell migration via integrin-ß1 and focal adhesion kinase activation.

Neuroblastoma is a highly metastatic tumor that emerges from neural crest cell progenitors. Focal Adhesion Kinase (FAK) is a regulator of cell migration that binds to the receptor Neogenin-1 and is upregulated in neuroblastoma. Here, we show that Netrin-1 ligand binding to Neogenin-1 leads to FAK autophosphorylation and integrin ß1 activation in a FAK dependent manner, thus promoting neuroblastoma cell migration. Moreover, Neogenin-1, which was detected in all tumor stages and was required for neuroblastoma cell migration, was found in a complex with integrin ß1, FAK, and Netrin-1. Importantly, Neogenin-1 promoted neuroblastoma metastases in an immunodeficient mouse model. Taken together, these data show that Neogenin-1 is a metastasis-promoting protein that associates with FAK, activates integrin ß1 and promotes neuroblastoma cell migration.

Peripheral artery disease in outpatients with a recent history of acute coronary syndrome or at high atherothrombotic risk.

OBJECTIVES: The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk. METHODS: We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age >18 years, and ACS within 30 days, or age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ). RESULTS: ABI <0.8 was found in 10.5%, <0.9 in 22.5%, >1.3 in 4.8%, and >1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI <0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI >27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI <0.9 and ABI <0.8, the six-month case-fatality rates were 2.5% (p = 0.27) and 5.4% (p = 0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI <0.8, and ACS. CONCLUSIONS: Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk.

Sesgo Cognitivo de Optimismo y Percepción de Bienestar en una Muestra de Universitarios Ecuatorianos / Cognitive Bias of Optimism and Perception of Wellbeing in a Sample of Ecuadorian University Students / Viés Cognitivo de Otimismo e Percepção de Bem-Estar em uma Amostra de Universitários Equatorianos

Resumen El propósito de esta investigación fue determinar la relación del sesgo cognitivo de optimismo en el bienestar subjetivo y psicológico en una muestra de universitarios del Ecuador. Para ello, se implementó un estudio descriptivo, correlacional y de corte transversal, a través de la aplicación de cuestionarios de satisfacción con la vida, afectos positivos y negativos, bienestar psicológico, orientación de vida y visión del futuro, en una muestra de 400 participantes (67% mujeres y 33% hombres), con edad media de 21,3 años, estudiantes de una universidad pública (66.5%) y una cofinanciada (37.5%) de la ciudad de Ambato, Ecuador. Según los resultados, el optimismo disposicional se correlaciona con la satisfacción con la vida (r=.378), los afectos positivos (r =.357) y los negativos (r =-.413), y el bienestar psicológico (r=.616), mientras que los sesgos de optimismo ilusorio (r=.221) e ilusión de invulnerabilidad (r=-.235) lo hacen únicamente con el bienestar psicológico. Como conclusión se adelanta que existe evidencia de racionalidad limitada a través de los sesgos que estimulan el bienestar.

Abstract The purpose of our research was to determine the relation between the cognitive bias of optimism and subjective and psychological wellbeing in a sample of Ecuadorian university students. To that effect, a cross-cutting, correlational, descriptive study was implemented. Questionnaires regarding life satisfaction, positive and negative affects, psychological wellbeing, life orientation, and vision for the future were applied in sample of 400 participants (67% women and 33% men), average age 21.3, studying in a public university (66.5%) and a co-financed university (37.5%) in the city of Ambato, Ecuador. According to the results, dispositional optimism is correlated with life satisfaction (r=.378), positive affects (r=.357) and negative affects (r=-.413), and psychological wellbeing (r=.616), while the illusory optimism (r=.221) and the illusion of invulnerability biases (r=-.235) are correlated only with psychological wellbeing. We conclude that there is evidence of bounded rationality as a result of biases that promote wellbeing.

Resumo Esta pesquisa tem o objetivo de determinar a relação do viés cognitivo de otimismo no bem-estar subjetivo e psicológico em uma amostra de universitários do Equador. Para isso, foi realizado um estudo descritivo, correlacional e de corte transversal, por meio da aplicação de questionários de satisfação com a vida, afetos positivos e negativos, bem-estar psicológico, orientação de vida e visão do futuro, em uma amostra de 400 participantes (67% mulheres e 33% homens), com idade média de 21,3 anos, estudantes de uma universidade pública (66.5%) e uma cofinanciada (37.5%) da cidade de Ambato, Equador. Segundo os resultados, o otimismo disposicional se correlaciona com a satisfação com a vida (r=.378), com os afetos positivos (r=.357) e os negativos (r=-.413), e com o bem-estar psicológico (r=.616), enquanto os vieses de otimismo ilusório (r=.221) e ilusão de invulnerabilidade (r=-.235) acontecem unicamente com o bem-estar psicológico. Como conclusão, existe evidência de racionalidade limitada por meio dos vieses que estimulam o bem-estar.

Análisis de la deserción temprana y sus factores explicativos en la universidad de los llanos con datos de ingreso, 2015-2

Esta investigación tiene como principal propósito analizar la probabilidad de deserción temprana de los estudiantes de la Universidad de los Llanos mediante un modelo de regresión logística. Además, identificar cuáles son las variables de mayor incidencia en la deserción temprana. Para la construcción del modelo se tomó como muestra la información de 574 estudiantes que ingresaron en la cohorte 2015-2 y que para el periodo 2018-1 eran registrados como vigentes o reportaban como último periodo matriculado cualquiera de los cuatro primeros semestres. Los resultados dan cuenta de que un buen puntaje en la prueba Saber 11, el ser mujer, no haber reprobado años durante el bachillerato, el haber cursado estudios antes y si los padres conviven, disminuye la probabilidad de deserción; así mismo, el haber egresado de un colegio privado aumenta esta probabilidad. De todas las facultades en las que se puede matricular el estudiante, las que mayor riesgo tienen de deserción temprana son la de Ciencias Básicas e Ingeniería y la Facultad de Ciencias de la Salud.

The main purpose of this study is to analyze the early dropout probability in the University of Los Llanos students using a logistic regression model and to identify which are the variables with a higher incidence value. To build the model, data were taken from 574 students who had been admitted in the 2015 second semester and were registered as active or whose last semester was one of the last four. As result, the dropout factor decreases if the student had a high score in Saber 11 test, is a woman, had not to fail any school year, had taken some courses before and his parents are alive and increase if the student comes from a private school. The faculties with the high dropout index are Basic Sciences and Engineering, and Health Sciences.

Head and Neck Microvascular Reconstruction in Puerto Rico: Developing a Two-team approach to Microvascular Reconstructive Surgery.

Hypopharyngeal carcinoma as a subsite of head and neck cancer, carries with it the lowest 5-year relative survival rate. Treatment of hypopharyngeal cancer relies on single therapy or multimodality treatment: surgery, radiation and/or chemotherapy. When surgical intervention is chosen, the type of operation depends on the extent of the lesion and the regions involved and will often require some form of reconstruction. We present the case of a 69-year-old male patient with T4aN3M0 hypopharyngeal carcinoma treated in Puerto Rico utilizing a two-team approach for removal of the primary tumor as well as harvesting of the free-flap for reconstruction. This approach allows for decreased operative time by having two surgical teams operating at the same time. The benefits of free flap reconstruction include: larger resection margins, better functional outcomes in terms of swallowing, and decreased post-operative morbidity in irradiated patients.

Análisis de la deserción temprana y sus factores explicativos en la Universidad de los Llanos con datos de ingreso 2015-2 / Analysis of early dropout and its explanatory factors at Universidad de los Llanos with 2015-2 entry data / Análise do abandono precoce e dos seus factores explicativos na Universidad de los Llanos com dados de entrada de 2015-2

Esta investigación tiene como principal propósito analizar la probabilidad de deserción temprana de los estudiantes de la Universidad de los Llanos mediante un modelo de regresión logística. Además, identificar cuáles son las variables de mayor incidencia en la deserción temprana. Para la construcción del modelo se tomó como muestra la información de 574 estudiantes que ingresaron en la cohorte 2015-2 y que para el periodo 2018-1 eran registrados como vigentes o reportaban como último periodo matriculado cualquiera de los cuatro primeros semestres. Los resultados dan cuenta de que un buen puntaje en la prueba Saber 11, el ser mujer, no haber reprobado años durante el bachillerato, el haber cursado estudios antes y si los padres conviven, disminuye la probabilidad de deserción; asimismo, el haber egresado de un colegio privado aumenta esta probabilidad. De todas las facultades en las que se puede matricular el estudiante, las que mayor riesgo tienen de deserción temprana son la de Ciencias Básicas e Ingeniería y la Facultad de Ciencias de la Salud.

The main purpose of this research is to analyze the probability of early dropout of students at the Universidad de los Llanos using a logistic regression model. In addition, to identify which are the variables of greater incidence in early desertion. For the construction of the model, the information of 574 students who entered in the 2015-2 cohort and who for the 2018-1 period were registered as current or reported as the last period enrolled any of the first four semesters was taken as a sample. The results show that a good score on the Saber 11 test, being a woman, not having failed years during high school, having studied before and if the parents live together, decreases the probability of dropping out; likewise, having graduated from a private school increases this probability. Of all the faculties in which students can enroll, those with the highest risk of early dropout are Basic Sciences and Engineering and the Faculty of Health Sciences.

O principal objetivo desta investigação é analisar a probabilidade de abandono escolar precoce dos estudantes da Universidad de los Llanos utilizando um modelo de regressão logística. Além disso, identificar quais as variáveis que têm maior impacto na desistência precoce. Para a construção do modelo, foram tomadas como amostra as informações de 574 alunos que ingressaram na coorte 2015-2 e que, no período 2018-1, foram registrados como atuais ou relatados como o último período matriculado em qualquer um dos quatro primeiros semestres. Os resultados mostram que uma boa pontuação no teste Saber 11, ser do sexo feminino, não ter reprovado anos durante o bacharelado, ter estudado antes e se os pais moram juntos, diminui a probabilidade de abandono; da mesma forma, ter se formado em uma escola pública aumenta essa probabilidade. De todas as faculdades em que os estudantes se podem inscrever, as que apresentam maior risco de abandono precoce são a Faculdade de Ciências Básicas e Engenharia e a Faculdade de Ciências da Saúde.