Development of Spatio-Temporal Land Use Regression Models for Fine Particulate Matter and Wood-Burning Tracers in Temuco, Chile.

Biomass burning is common in much of the world, and in some areas, residential wood-burning has increased. However, air pollution resulting from biomass burning is an important public health problem. A sampling campaign was carried out between May 2017 and July 2018 in over 64 sites in four sessions, to develop a spatio-temporal land use regression (LUR) model for fine particulate matter (PM) and wood-burning tracers levoglucosan and soluble potassium (Ksol) in a city heavily impacted by wood-burning. The mean (sd) was 46.5 (37.4) µg m-3 for PM2.5, 0.607 (0.538) µg m-3 for levoglucosan, and 0.635 (0.489) µg m-3 for Ksol. LUR models for PM2.5, levoglucosan, and Ksol had a satisfactory performance (LOSOCV R2), explaining 88.8%, 87.4%, and 87.3% of the total variance, respectively. All models included sociodemographic predictors consistent with the pattern of use of wood-burning in homes. The models were applied to predict concentrations surfaces and to estimate exposures for an epidemiological study.

Acute toxicity and quality of life in prostate cancer patients treated with definitive hypofractionated pelvic radiation therapy: a single-center report.

Background: The objective was to report acute toxicity and quality of life in prostate cancer patients treated with definitive hypofractionated pelvic radiation therapy. Materials and methods: Patients were designated candidates for hypofractionated pelvic radiation therapy if biopsy or imaging studies evidenced unfavorable intermediate-risk, high-risk or node-positive disease. Patients were treated using a regimen of 44 Gy to the nodal areas and simultaneous integrated boost of 60 Gy to the prostate in 20 fractions with CBCT-based imaging and volumetric arc therapy (VMAT). Patient data was obtained retrospectively; acute gastrointestinal (GI) and genitourinary (GU) toxicity was classified per Common Terminology Criteria for Adverse Events (CTCAE) v5.0 and obtained from clinical records. Quality of life was surveyed via phone call using the European Organization for Research and Treatment of Cancer (EORTC) questionnaire QLQ-PR25. Results: 78 patients were treated between May and December 2021. 83.33% of patients had high-risk disease, 16.67% had intermediate-risk disease, and 34.62% patients had node-positive disease. Median follow-up was 10.6 months. No patients presented acute grade >3 GI toxicity, and one patient presented grade 3 GU toxicity. 25.64% patients presented acute G2 GI toxicity and 17.95% patients presented acute G2 GU toxicity. 60.26% of patients responded to the EORTC-PR25 questionnaire. Mean scores for symptom scales were 11.26, 4.96 and 9.57 for Urinary Symptoms, Bowel Symptoms and Hormonal Treatment-Related Symptoms; mean scores for Sexual Activity and Functioning were 19.86 and 31.08, respectively. Conclusion: Definitive hypofractionated pelvic radiation therapy has an acceptable acute toxicity and QoL profile in this series of patients, although longer follow-up is needed to properly evaluate short and long-term toxicity. Further follow-up and patient recruitment is ongoing.

Murine leukemia virus (MLV) P50 protein induces cell transformation via transcriptional regulatory function.

BACKGROUND: The murine leukemia virus (MLV) has been a powerful model of pathogenesis for the discovery of genes involved in cancer. Its splice donor (SD')-associated retroelement (SDARE) is important for infectivity and tumorigenesis, but the mechanism remains poorly characterized. Here, we show for the first time that P50 protein, which is produced from SDARE, acts as an accessory protein that transregulates transcription and induces cell transformation. RESULTS: By infecting cells with MLV particles containing SDARE transcript alone (lacking genomic RNA), we show that SDARE can spread to neighbouring cells as shown by the presence of P50 in infected cells. Furthermore, a role for P50 in cell transformation was demonstrated by CCK8, TUNEL and anchorage-independent growth assays. We identified the integrase domain of P50 as being responsible for transregulation of the MLV promoter using luciferase assay and RTqPCR with P50 deleted mutants. Transcriptomic analysis furthermore revealed that the expression of hundreds of cellular RNAs involved in cancerogenesis were deregulated in the presence of P50, suggesting that P50 induces carcinogenic processes via its transcriptional regulatory function. CONCLUSION: We propose a novel SDARE-mediated mode of propagation of the P50 accessory protein in surrounding cells. Moreover, due to its transforming properties, P50 expression could lead to a cellular and tissue microenvironment that is conducive to cancer development.

Is Nonoperative Management of Rectal Cancer Feasible?

During the past decade, the treatment of locally advanced rectal cancer (LARC) has become more complex. Total neoadjuvant treatment (TNT) has increased the rates of both clinical and pathologic complete response, resulting in improved long-term oncological outcomes. The feasibility to implement nonoperative management (NOM) depends on solving current challenges such as how to correctly identify the best candidates for a NOM without compromising oncologic safety. NOM should be part of the treatment discussion of LARC, considering increasing rates of clinical complete response, potential quality of life gains, avoidance of surgical morbidity, and patient preferences.

Validation of the Dominican system for measuring early childhood development.

Background: The purpose of the study was to determine the psychometric properties of the Dominican System for Measuring Early Childhood Development (SIMEDID, for its Spanish acronym), to adjust the sequence of item presentation, and to provide age-standardized norms for each item, to enable policy and program managers to make decisions based on specific and structured data. Methods: After approval from an ethics committee, a total of 948 children from 0 to 60 months participated in this study. Participants were evaluated on four early childhood development domains (gross motor, fine motor, language development, and socio-emotional development). The data were collected from November 2021 to February 2022, either at early childhood care centers or at home, using mobile devices that guided the evaluators through the screener. Data were later synced to a global database. Psychometric properties were calculated using Cronbach's alpha and split-half parallel reliability. For reorganizing item presentation and to obtain age-standardized norms, we conducted a logistic regression analysis for each item on dependent variable item success, and independent variable age. Results: The instrument showed excellent reliability and additional evidence of validity. The item presentation order was rearranged according to the probability of item success progression. In addition, the study characterized the expected evolution of item success probability across participants' age. Conclusions: SIMEDID is a valid and reliable instrument for depicting childhood development in national evaluations. Its integration with electronic platforms for national monitoring represents a cost-effective, time-efficient screening tool adapted to the Dominican sociocultural context. This represents a promising tool to strengthen strategies that support early childhood development.

Metodología para la preparación profesional del defectólogo comunitario

Introducción: El defectólogo comunitario constituye uno de los profesionales fundamentales para la atención del niño con discapacidad intelectual severa, además de ofrecer sus servicios, debe mantenerse a tono con los adelantos científicos en su área del saber para solucionar de manera acertada los problemas profesionales. Objetivo: Ofrecer una metodología para la preparación del defectólogo comunitario en la atención de niños con discapacidad intelectual severa. Método: Se realizó un estudio cualitativo de enero 2019 a diciembre de 2022 con la participación de la Universidad de Guantánamo y del Policlínico Universitario "Asdrúbal López Vázquez". El universo estuvo constituido por defectólogos y directivos del policlínico antes referido; la muestra intencional la conformaron 40 defectólogos y 4 directivos. Se aplicaron la encuesta y la observación participante para la obtención del dato primario. Se determinó la variable preparación profesional del defectólogo comunitario en la atención de niños con discapacidad intelectual severa, sus dimensiones e indicadores. Resultados: Se hallaron limitaciones en la concepción teórico-metodológica de la preparación profesional del defectólogo comunitario en la atención a la discapacidad antes referida y los planes de formación de pregrado y posgrado de estos profesionales no contemplaron la formación asistencial en la problemática objeto de estudio. Se aplicó la metodología contentiva de acciones formativas, como: curso, talleres y la autopreparación en función de la actualización del tema. Conclusiones: La metodología que se presenta satisface las limitaciones en lo teórico-metodológico diagnosticadas, corroborada durante el desempeño profesional de los defectólogos comunitarios, los talleres de socialización y el criterio de los especialistas consultados.

Introduction: The community defectologist is one of the fundamental professionals for the care of children with severe intellectual disabilities. In addition to offering their services, they must stay in tune with scientific advances in their area of knowledge to correctly solve professional problems. Objective: To offer a methodology for the preparation of the community defects specialist in the care of children with severe intellectual disabilities. Method: A qualitative study was carried out from January 2019 to December 2022 with the participation of the Universidad de Guantánamo and the Policlínico Universitario "Asdrúbal López Vázquez". The universe was made up of defects specialists and managers of the aforementioned polyclinic. The intentional sample was made up of 40 defects specialists and 4 managers. The survey and participant observation were applied to obtain primary data. The variable professional preparation of the community defects specialist in the care of children with severe intellectual disabilities, its dimensions and indicators, was determined. Results: Limitations were found in the theoretical-methodological conception of the professional preparation of the community defectologist in the care of the aforementioned disability and the undergraduate and postgraduate training plans of these professionals did not contemplate care training in the problem under study. The methodology containing training actions was applied, such as: course, workshops and self-preparation based on updating the topic. Conclusions: The methodology presented satisfies the theoretical-methodological limitations diagnosed, corroborated during the professional performance of the community defectologists, the socialization workshops and the criteria of the consulted specialists.

Introdução: O defectologista comunitário é um dos profissionais fundamentais para o atendimento de crianças com deficiência intelectual grave, além de oferecer seus serviços, deve estar atento aos avanços científicos de sua área de conhecimento para solucionar corretamente os problemas profissionais. Objetivo: Oferecer uma metodologia para a preparação do especialista comunitário em defeitos no atendimento de crianças com deficiência intelectual grave. Método: Estudo qualitativo foi realizado de janeiro de 2019 a dezembro de 2022 com a participação da Universidad de Guantánamo e da Policlínico Universitario "Asdrúbal López Vázquez". O universo foi formado por especialistas em defeitos e gestores da referida policlínica; A amostra intencional foi composta por 40 especialistas em defeitos e 4 gestores. Aplicou-se o inquérito e a observação participante para obtenção de dados primários. Foi determinada a variável preparação profissional do especialista comunitário em defeitos no atendimento de crianças com deficiência intelectual grave, suas dimensões e indicadores. Resultados: Foram encontradas limitações na concepção teórico-metodológica do preparo profissional do defectologista comunitário no cuidado da referida deficiência e os planos de formação de graduação e pós-graduação desses profissionais não contemplaram a formação assistencial na problemática em estudo. Foi aplicada a metodologia contendo ações de capacitação, tais como: curso, oficinas e autopreparação a partir da atualização do tema. Conclusões: A metodologia apresentada satisfaz as limitações teórico-metodológicas diagnosticadas, corroboradas durante a atuação profissional dos defectologistas comunitários, nas oficinas de socialização e nos critérios dos especialistas consultados.

An Interleaved Segmented Spectrum Analysis: A Measurement Technique for System Frequency Response and Fault Detection.

A frequency spectrum segmentation methodology is proposed to extract the frequency response of circuits and systems with high resolution and low distortion over a wide frequency range. A high resolution is achieved by implementing a modified Dirichlet function (MDF) configured for multi-tone excitation signals. Low distortion is attained by limiting or avoiding spectral leakage and interference into the frequency spectrum of interest. The use of a window function allowed for further reduction in distortion by suppressing system-induced oscillations that can cause severe interference while acquiring signals. This proposed segmentation methodology with the MDF generates an interleaved frequency spectrum segment that can be used to measure the frequency response of the system and can be represented in a Bode and Nyquist plot. The ability to simulate and measure the frequency response of the circuit and system without expensive network analyzers provides good stability coverage for reliable fault detection and failure avoidance. The proposed methodology is validated with both simulation and hardware.

Development of a Portland Cement-Based Material with Agave salmiana Leaves Bioaggregate.

Depending on the morphology of the natural fibers, they can be used as reinforcement to improve flexural strength in cement-based composites or as aggregates to improve thermal conductivity properties. In this last aspect, hemp, coconut, flax, sunflower, and corn fibers have been used extensively, and further study is expected into different bioaggregates that allow diversifying of the raw materials. The objective of the research was to develop plant-based concretes with a matrix based on Portland cement and an aggregate of Agave salmiana (AS) leaves, obtained from the residues of the tequila industry that have no current purpose, as a total replacement for the calcareous aggregates commonly used in the manufacturing of mortars and whose extraction is associated with high levels of pollution, to improve their thermal properties and reduce the energy demand for air conditioning in homes. Characterization tests were carried out on the raw materials and the vegetal aggregate was processed to improve its compatibility with the cement paste through four different treatments: (a) freezing (T/C), (b) hornification (T/H), (c) sodium hydroxide (T/NaOH), and (d) solid paraffin (T/P). The effect of the treatments on the physical properties of the resulting composite was evaluated by studying the vegetal concrete under thermal conductivity, bulk density, and compressive strength tests with a volumetric ratio between the vegetal aggregate and the cement paste of 0.36 and a water/cement ratio of 0.35. The hornification treatment showed a 15.2% decrease in the water absorption capacity of the aggregate, resulting in a composite with a thermal conductivity of 0.49 W/mK and a compressive strength of 8.66 MPa, which allows its utilization as a construction material to produce prefabricated blocks.

Non-Operative Management of Patients with Rectal Cancer: Lessons Learnt from the OPRA Trial.

Over the past decade, the management of locally advanced rectal cancer (LARC) has progressively become more complex. The introduction of total neoadjuvant treatment (TNT) has increased the rates of both clinical and pathological complete response, resulting in excellent long-term oncological outcomes. As a result, non-operative management (NOM) of LARC patients with a clinical complete response (cCR) after neoadjuvant therapy has gained acceptance as a potential treatment option in selected cases. NOM is based on replacement of surgical resection with safe and active surveillance. However, the identification of appropriate candidates for a NOM strategy without compromising oncologic safety is currently challenging due to the lack of an objective standardization. NOM should be part of the treatment plan discussion with LARC patients, considering the increasing rates of cCR, patient preference, quality of life, expectations, and the potential avoidance of surgical morbidity. The recently published OPRA trial showed that organ preservation is achievable in half of rectal cancer patients treated with TNT, and that chemoradiotherapy followed by consolidation chemotherapy may an appropriate strategy to maximize cCR rates. Ongoing trials are investigating optimal algorithms of TNT delivery to further expand the pool of patients who may benefit from NOM of LARC.

Nonoperative Management for Rectal Cancer.

The treatment algorithm for locally advanced rectal cancer (LARC) has increased in complexity over the past 10 years. Nonoperative management (NOM) for rectal cancer in patients with clinical complete response (cCR) after neoadjuvant therapy has been gaining acceptance as a potential treatment option for selected LARC patients. The current challenge is to accurately select the patients with an apparent cCR, thereby correctly identifying those would-be appropriate candidates for a NOM strategy. NOM should be part of the treatment discussion of LARC, considering increasing rates of cCR, patient preference, potential quality of life gains, and the potential avoidance of surgical morbidity.

A Chilean Experience of Telestroke in a COVID-19 Pandemic Year.

BACKGROUND AND PURPOSE: Telemedicine for stroke patients' care (telestroke [TS]) has grown notably in recent decades and may offer advantages during health crisis. Hospital admissions related to stroke have decreased globally during the COVID-19 pandemic, but scarce information is available regarding the effect of COVID-19 in TS. Using a population-based TS registry, we investigated the impact of the first year of the COVID-19 pandemic throughout our TS network in Santiago, Chile. METHODS: Stroke codes evaluated after the onset of COVID-19 restrictions in Chile (defined as March 15, 2020) were compared with those evaluated in 2019. We analyzed differences between number of stroke codes, thrombolysis rate, stroke severity, and time from the stroke onset to hospital admission. RESULTS: We observed that the number of stroke codes and the number of patients undergoing reperfusion therapy did not change significantly (p = 0.669 and 0.415, respectively). No differences were found with respect to the median time from the stroke onset to admission (p = 0.581) or in National Institutes of Health Stroke Scale (NIHSS) scores (p = 0.055). The decision-making-to-needle time was significantly shorter in the COVID-19 period (median 5 min [IQR 3-8], p < 0.016), but no significant changes were found at the other times. CONCLUSIONS: This study demonstrates the potential of adapting TS to extreme situations such as the COVID-19 pandemic, as well as the importance of establishing networks that facilitate patient access to quality treatments.

Neoadjuvant Therapy for Rectal Cancer.

The treatment of locally advanced rectal cancer is challenging and requires a multidisciplinary approach. Neoadjuvant treatment has improved local control by the combination of radiotherapy, surgery, and chemotherapy. However, neoadjuvant treatment has not yet been shown to improve overall survival and is associated with toxicities and late sequelae that impair the quality of life of patients. Currently, different types of neoadjuvant strategies have raised the question about which one is the optimal strategy for rectal cancer treatment. In this article, we explore the different neoadjuvant treatment regimens currently available, their associated benefits and toxicities, and novel approaches in this area.

La ambientación escolar y la educación para la salud en el enfrentamiento a la COVID-19

RESUMEN Introducción: En la actualidad uno de los problemas que se presenta a nivel mundial es la salud, Cuba no es la excepción, constituye una gran preocupación el comportamiento de la infestación por motivo del rebrote de la COVID-19 que a nivel nacional se produce. Objetivo: Ofrecer algunas reflexiones didácticas y pedagógicas como parte de una adecuada ambientación escolar, que posibiliten la preparación de los docentes en la educación para la salud de los estudiantes y mitigar el contagio progresivo de la COVID-19. Método: Se realizó una investigación en la Universidad de Guantánamo, la de Ciencias Médicas y el Instituto Politécnico Agropecuario de Yateras en el periodo comprendido abril de 2020 y enero de 2021. El universo fue constituido por 30 docentes y 30 estudiantes de estas instituciones, 10 de cada uno en los mismos. Se empleó como variable principal el nivel de preparación de los docentes en ambientación escolar y educación para la salud. Resultados: Los indicadores obtenidos permitieron elaborar los instrumentos de medición. Se hizo un análisis de datos cualitativo atendiendo a: reducción de datos, disposición y transformación de los mismos, así como obtención de resultados y verificación de conclusiones. Conclusiones: Las reflexiones didácticas y pedagógicas que se ofrecen se concretan en un conjunto de orientaciones con enfoque metodológico que guían al docente y ayudan a la creación de una ambientación escolar positiva para el fortalecimiento de la educación para la salud de los estudiantes, sobre la base del análisis exhaustivo de los componentes del proceso formativo.

ABSTRACT Introduction: At present, one of the world's problems it is the health situation. Cuba is not an exception, and the behavior of infestation due to the new outbreak of COVID-19 that is occurring at national level is a great concern. Objective: To provide some didactic and pedagogical reflections as part of an adequate school environment that make possible the correct preparation of faculty to teach students in health knowledge and thus mitigating the progressive spread of COVID-19. Method: It was conducted a research at the Universidad de Guantánamo, Universidad de Ciencias Médicas de Guantánamo, and the Instituto Politécnico Agrícola de Yateras, from April 2020 throughout January 2021. A total of 30 professors and 30 students (as universe) were involved in this research (10 of each institution). The main variable used was the level of preparation of faculty in school environment and health education. Results: The indicators obtained made it possible to develop the measurement instruments. A qualitative data analysis was made attending to: data reduction, layout and transformation data, as well as the obtained outcomes and conclusions verified. Conclusions: The didactic and pedagogical reflections offered are materialized in a set of guidelines with a methodological approach that guide faculty staff and help to create a positive school environment to strengthen students' health education, based on an exhaustive analysis of the components in the teaching process.

RESUMO Introdução: Atualmente um dos problemas que ocorre em todo o mundo é a saúde, Cuba não é exceção, o comportamento da infestação é de grande preocupação devido ao ressurgimento do COVID-19 que ocorre em nível nacional. Objetivo: Oferecer algumas reflexões didático-pedagógicas como parte de um ambiente escolar adequado, que possibilite a preparação de professores em educação para a saúde dos alunos e mitigação do contágio progressivo da COVID-19. Método: Uma investigação foi realizada na Universidad de Guantánamo, na Universidade de Ciencias Médicas e no Instituto Politécnico Agrícola Yateras no período entre abril de 2020 e janeiro de 2021. O universo foi composto por 30 professores e 30 alunos dessas instituições, 10 de cada um deles. O nível de preparação dos professores no ambiente escolar e a educação em saúde foram utilizados como variável principal. Resultados: Os indicadores obtidos permitiram a elaboração dos instrumentos de medida. Realizou-se uma análise qualitativa dos dados tendo em conta: redução dos dados, disposição e transformação dos mesmos, bem como a obtenção de resultados e verificação das conclusões. Conclusões: As reflexões didático-pedagógicas que são oferecidas são especificadas em um conjunto de diretrizes com uma abordagem metodológica que orienta o professor e ajuda a criar um ambiente escolar positivo para o fortalecimento da educação em saúde para os alunos, a partir da análise exaustiva dos componentes do processo formativo.

Organ Preservation in Patients with Rectal Cancer Treated with Total Neoadjuvant Therapy.

BACKGROUND: Retrospective studies suggest that watch-and-wait is a safe alternative to total mesorectal excision in selected patients with a clinical complete response after chemoradiotherapy. OBJECTIVE: This study aimed to determine the proportion of patients with rectal cancer who may benefit from watch-and-wait. DESIGN: This study is a retrospective analysis of data from prospectively maintained databases. SETTING: This study was conducted at a comprehensive cancer center. PATIENTS: Consecutive patients with stage II or III rectal adenocarcinoma who were treated with total neoadjuvant therapy using induction chemotherapy between 2012 and 2019 under the care of the same surgeon were included. INTERVENTION: Induction-type total neoadjuvant therapy consisted of 8 cycles of leucovorin-fluorouracil-oxaliplatin or 5 cycles of capecitabine-oxaliplatin before chemoradiotherapy. Patients with a clinical complete response were offered watch-and-wait, and patients with residual tumor were offered total mesorectal excision. MAIN OUTCOMES AND MEASURES: Tumor response was assessed with a digital rectal examination, endoscopy, and MRI. Patient characteristics and recurrence-free survival were compared between the watch-and-wait group and the total mesorectal excision group. RESULTS: A total of 88 patients were included in the analysis. One (1%) died during neoadjuvant therapy. Fifty-five patients (62.5%) had an incomplete clinical response and underwent surgery, 10 (18%) of the 55 developed distant metastasis, and 3 (5%) developed local recurrence. The remaining 32 patients (36.3%) had a clinical complete response and underwent watch-and-wait. On average, patients in the watch-and-wait group were older and had smaller, more distal tumors compared with patients in the surgery group. The median radiation dose, number of chemotherapy cycles, rate of adverse events, and length of follow-up did not differ substantively between the total mesorectal excision group and the watch-and-wait group. In the watch-and-wait group, 2 (6%) patients developed tumor regrowth, and one of them had distant metastasis. Recurrence-free survival was significantly higher in the watch-and-wait group. LIMITATIONS: Generalizability, sample size, and follow-up duration were limitations of this study. CONCLUSIONS: Approximately one-third of patients with stage II or III rectal cancer can benefit from a watch-and-wait approach with the aim of preserving the rectum if treated with induction-type total neoadjuvant therapy and followed by an experienced multidisciplinary team. See Video Abstract at http://links.lww.com/DCR/B688. CONSERVACIN DE RGANOS EN PACIENTES CON CNCER DE RECTO TRATADOS CON TERAPIA NEOADYUVANTE TOTAL: ANTECEDENTES:Estudios retrospectivos sugieren que observar y esperar es una alternativa segura a la escisión mesorrectal total en pacientes seleccionados con una respuesta clínica completa después de la quimiorradioterapia.OBJETIVO:Determinar la proporción de pacientes con cáncer de recto que pueden beneficiarse de observar y esperar.DISEÑO:Análisis retrospectivo de datos de bases de datos mantenidas de forma prospectiva.ESCENARIO:Centro Oncológico Integral.PACIENTES:Pacientes consecutivos con adenocarcinoma de recto en estadio II o III tratados con TNT utilizando quimioterapia de inducción entre 2012 y 2019 bajo el cuidado del mismo cirujano.INTERVENCIÓN:La terapia neoadyuvante total de tipo inducción consistió en ocho ciclos de leucovorín-fluorouracilo-oxaliplatino o cinco ciclos de capecitabina-oxaliplatino antes de la quimiorradioterapia. A los pacientes con una respuesta clínica completa se les ofreció observar y esperar, y a los pacientes con tumor residual se les ofreció la escisión mesorrectal total.PRINCIPALES RESULTADOS Y MEDIDAS:La respuesta del tumor se evaluó con un tacto rectal, endoscopia y resonancia magnética. Se compararon las características de los pacientes y la supervivencia libre de recurrencia entre el grupo de observación y espera y el grupo de escisión mesorrectal total.RESULTADOS:Se incluyó en el análisis a un total de 88 pacientes. Uno (1%) murió durante la terapia neoadyuvante. Cincuenta y cinco pacientes (62.5%) tuvieron una respuesta clínica incompleta y se sometieron a cirugía; 10 (18%) de los 55 desarrollaron metástasis a distancia y 3 (5%) desarrollaron recidiva local. Los 32 pacientes restantes (36.3%) tuvieron una cCR (respuesta clínica completa) y se sometieron a observar y esperar. En promedio, los pacientes del grupo de observación y espera eran mayores y tenían tumores más pequeños y distales en comparación con el grupo de cirugía. La dosis mediana de radiación, el número de ciclos de quimioterapia, la tasa de eventos adversos y la duración del seguimiento no difirieron sustancialmente entre el grupo de escisión mesorrectal total y el grupo de observación y espera. En el grupo de observación y espera, 2 (6%) pacientes desarrollaron recrecimiento del tumor y uno de ellos tuvo metástasis a distancia. La supervivencia libre de recurrencia fue significativamente mayor en el grupo de observación y espera.LIMITACIONES:Generalizabilidad, tamaño de la muestra, duración del seguimiento.CONCLUSIONES:Aproximadamente un tercio de los pacientes con cáncer de recto en estadio II o III pueden beneficiarse de un abordaje de observación y espera con el objetivo de preservar el recto si se tratan con terapia neoadyuvante total de tipo inducción y son seguidos por un equipo multidisciplinario experimentado. Consulte Video Resumen en http://links.lww.com/DCR/B688.

Options for Low Rectal Cancer: Robotic Total Mesorectal Excision.

Low rectal cancers (LRCs) may offer a difficult technical challenge even to experienced colorectal surgeons. Although laparoscopic surgery offers a superior exposure of the pelvis when compared with open approach, its role in rectal cancer surgery has been controversial. Robotic platforms are well suited for difficult pelvic surgery due to its three-dimensional visualization, degree of articulation of instruments, precise movements, and better ergonomics. The robot may be suitable especially in the anatomically narrow pelvis such as in male and obese patients. Meticulous dissection in critical steps, such as splenic flexure takedown, nerve-sparing mesorectal excision, and distal margin clearance, are potential technical advantages. In addition, robotic rectal resections are associated with lower conversion rates to open surgery, less blood loss, and shorter learning curve with similar short-term quality of life outcomes, similar rates of postoperative complications, and equivalent short-term surrogate outcomes compared with conventional laparoscopy. Robotic surgery approach, if used correctly, can enhance the skills and the capabilities of the well-trained surgeon during minimally invasive procedures for LRC.

Propiedades Psicométricas de una Escala de Bienestar Subjetivo (BMSLSS) En Primera Infancia

Resumen El presente artículo analiza las propiedades psicométricas de un indicador de bienestar subjetivo infantil, la Escala Breve Multidimensional de Satisfacción de los Estudiantes con la Vida (BMSLSS, por sus siglas en inglés), en niñas y niños chilenos de primera infancia. El instrumento mide bienestar subjetivo a través de la satisfacción con la vida de los estudiantes, para lo cual se consideran cinco ítems: familia, amigos/as, colegio, cuerpo y barrio. La escala fue aplicada a 1854 estudiantes de seis a ocho años pertenecientes a todas las regiones del país a través de cuestionarios de tipo autoinforme (Edad promedio de 7.35 años (DT=0.66), 46.9% niñas). El análisis de correlación ítem-ítem e ítem-puntaje total mostró un adecuado nivel de asociación entre las variables (Coeficiente de Pearson entre .56 y .69). El análisis factorial confirmatorio, realizado a través de modelos de ecuaciones estructurales, mostró buenos niveles de ajuste, confirmando la estructura monofactorial de la escala, mientras que la confiabilidad resultó aceptable (alpha ordinal = .66). De acuerdo a ello, la investigación fundamenta el uso de la escala en Chile en población infantil, aportando así con herramientas de medición de bienestar para primera infancia, en un campo que actualmente posee escaso desarrollo. Se discute la importancia del desarrollo de este tipo de instrumentos, los cuales permiten considerar la percepción subjetiva de niños y niñas sobre sus vidas, convirtiéndolos en agentes activos en el proceso de construcción social.

Abstract This article analyzes the psychometric properties of a measure of subjective wellbeing in childhood, the Brief Multidimensional Students' Life Satisfaction Scale (BMSLSS), in Chilean early childhood. The instrument measures subjective well-being through student satisfaction with their lives based on five items: family, friends, school, body and neighborhood. The scale was applied to 1854 students from six to eight years belonging to all regions of the country through self-report questionnaires (average age of 7.35 years (SD = 0.66), 46.9% girls). The item-item and item-total score correlation showed an adequate level of association between the variables (Pearson's coefficient from 0.56 to 0.69). The confirmatory factor analysis, carried out through structural equations models, showed good levels of adjustment, confirming the monofactorial structure of the scale, while the reliability was acceptable (ordinal alpha = .66). The research bases the use of this scale in this context, thus contributing with means to measure well-being in early childhood, in a field that currently has little development. The discussion focuses on the importance of the development of this type of instruments, which allow considering the subjective perception of boys and girls about their lives, making them active agents in the process of social construction.

Malakoplakia mimicking a locally advanced colorectal neoplasm.

Malakoplakia is a rare disease. Clinical presentation is non-specific, making its diagnosis an incidental finding on histopathological analysis. The aim of this case report is to describe a patient diagnosed with colon, renal and soft tissue malacoplakia mimicking a locally advanced colorectal cancer. A 75-year-old man was admitted due to intense abdominal pain. No relevant findings at the physical examination. Computed tomography showed parietal thickening of the descending colon with left kidney, iliopsoas muscle and retroperitoneum involvement. An elevated blood serum creatinine, elevated glycated hemoglobin and urinary infection were detected. Surgery was decided for suspicious symptomatic colonic neoplasm. Left segmental colectomy with left partial nephrectomy and retroperitoneal soft tissue resection was performed. Pathology report was compatible with malakoplakia. Malakoplakia is a rare disease and may affect multiple organs. Because there are no clinical-specific findings, diagnosis is usually made with histopathological study of the surgical specimen.

Anorectal Mucosal Melanoma in the Era of Immune Checkpoint Inhibition: Should We Change Our Surgical Management Paradigm?

BACKGROUND: The advent of immune checkpoint inhibition therapy has dramatically improved survival in patients with skin melanoma. Survival outcomes after resection of anorectal melanoma treated with immune checkpoint inhibition have not been reported. OBJECTIVE: This study aimed to compare survival outcomes following surgical resection of anorectal melanoma between patients who received immune checkpoint inhibition and patients who did not. DESIGN: This study is a retrospective analysis of data from a prospectively maintained database. SETTING: This study was conducted at a comprehensive cancer center. PATIENTS: Patients who underwent surgery for anorectal melanoma between 2006 and 2017 were included. They were stratified according to the use of immune checkpoint inhibition. MAIN OUTCOME MEASURES: The primary outcomes measured were overall and disease-specific survival. RESULTS: Of the 47 patients included in the analysis, 29 (62%) received immune checkpoint inhibition therapy. Twenty-two (76%) of the 29 patients received immune checkpoint inhibition after detection of metastasis or disease progression rather than in the neoadjuvant or adjuvant setting. Overall survival did not differ significantly between patients who received immune checkpoint inhibition therapy and patients who did not (median, 52 and 20 months; 5-year rate, 41% vs 35%; p = 0.25). Disease-specific survival also did not differ significantly. Our analysis did not identify any clinical or pathological features associated with response to immune checkpoint inhibition therapy or with survival. LIMITATIONS: This study was limited by its relatively small sample and retrospective design and by the heterogeneous treatment regimen in the immune checkpoint inhibition group. CONCLUSIONS: Immune checkpoint inhibition therapy by itself does not appear to improve survival in patients who undergo resection or excision of anorectal melanoma. Combinations of immune checkpoint inhibition with other therapeutic modalities warrant further investigation. See Video Abstract at http://links.lww.com/DCR/B499. MELANOMA DE LA MUCOSA ANORRECTAL EN LA ERA DE LOS INHIBIDORES DEL PUNTO DE CONTROL INMUNOLÓGICO: ¿DEBEMOS DE CAMBIAR NUESTRO PARADIGMA DEL MANEJO QUIRÚRGICO: El advenimiento de la terapia de los inhibidores del punto de control inmunológico, han mejorado dramáticamente la supervivencia en pacientes con melanoma de piel. No se han informado los resultados de supervivencia después de la resección del melanoma anorrectal, tratado con inhibidores del punto de control inmunológico.Comparar los resultados de supervivencia después de la resección quirúrgica de melanoma anorrectal entre pacientes que recibieron y no recibieron inhibidores del punto de control inmunológico.Análisis retrospectivo de una base de datos mantenida prospectivamente.Centro oncológico integral.Pacientes que se sometieron a cirugía por melanoma anorrectal entre 2006 y 2017. Los pacientes fueron estratificados según el uso de inhibidores del punto de control inmunológico.Supervivencia global y específica de la enfermedad.De los 47 pacientes incluidos en el análisis, 29 (62%) recibieron terapia de inhibidores del punto de control inmunológico. Veintidós (76%) de los 29 pacientes recibieron inhibidores del punto de control inmunológico después de la detección de metástasis o progresión de la enfermedad, en vez de administración adyuvante o neoadyuvante. La supervivencia global no varió significativamente entre los pacientes que recibieron o no recibieron terapia de inhibidores del punto de control inmunológico (mediana, 52 y 20 meses, respectivamente; tasa a 5 años, 41% frente a 35%, respectivamente; p = 0,25). La supervivencia específica de la enfermedad tampoco varió significativamente. Nuestro análisis no identificó ninguna característica clínica o patológica, asociada con la respuesta a la terapia de inhibidores del punto de control inmunológico o con la supervivencia.Muestra relativamente pequeña y diseño retrospectivo. Régimen de tratamiento heterogéneo en el grupo de inhibidores del punto de control inmunológico.La terapia por sí sola, de inhibidores del punto de control inmunológico, no parece mejorar la supervivencia en pacientes que se someten a resección o escisión de melanoma anorrectal. Las combinaciones de inhibidores del punto de control inmunológico con otras modalidades terapéuticas, merecen una mayor investigación. Consulte Video Resumen en http://links.lww.com/DCR/B499. (Traducción-Dr. Fidel Ruiz Healy).

Comparative analysis of the Memorial Sloan Kettering Bowel Function Instrument and the Low Anterior Resection Syndrome Questionnaire for assessment of bowel dysfunction in rectal cancer patients after low anterior resection.

AIM: Neoadjuvant therapy and total mesorectal excision (TME) for rectal cancer are associated with bowel dysfunction symptoms known as low anterior resection syndrome (LARS). Our study compared the only two validated instruments-the LARS Questionnaire (LARS-Q) and the Memorial Sloan Kettering Bowel Function Instrument (MSK-BFI)-in rectal cancer patients undergoing sphincter-preserving TME. METHODS: One hundred and ninety patients undergoing sphincter-preserving TME for Stage I-III rectal cancer completed the MSK-BFI and LARS-Q simultaneously at a median time of 12 (range 1-43) months after restoration of bowel continuity. Associations between the MSK-BFI total/subscale scores and the LARS-Q score were investigated using Spearman rank correlation (r s ). Discriminant validity for the two questionnaires was assessed, and the questionnaires were compared with the European Quality of Life Instrument. RESULTS: Major LARS was identified in 62% of patients. The median MSK-BFI scores for no LARS, minor LARS and major LARS were 76.5, 70 and 57, respectively. We found a strong association between MSK-BFI and LARS-Q (r s -0.79). The urgency/soilage subscale (r s -0.7) and the frequency subscale (rs -0.68) of MSK-BFI strongly correlated with LARS-Q. Low correlation was observed between the MSK-BFI diet subscale and LARS-Q (r s -0.39). On multivariate analysis, both questionnaires showed worse bowel function in patients with distal tumours. A low to moderate correlation with the European Quality of Life Instrument was observed for both questionnaires. CONCLUSIONS: The MSK-BFI and LARS-Q showed good correlation and similar discriminant validity. As the LARS-Q is easier to complete, it may be considered the preferred tool to screen for bowel dysfunction.