[An enjoyable 23-year career as a hematologist in metropolitan emergency hospitals, a researcher of post-transplant survivorship, and a community hematologist-oncologist].

I would like to express my sincere gratitude to be given such an honorable opportunity. I am more than happy to share my personal experience as one example of the diversity of women in hematology. After graduating from Tohoku University, I began my residency training at Japanese Red Cross Musashino Hospital and Tokyo Metropolitan Bokutoh Hospital, which are extremely busy designated hospitals in Tokyo. Both had highly active emergency care centers, and I believe that the rigorous training I received there not only honed my basic patient care skills, but also increased my physical and mental strength. Since I referred many patients to National Cancer Center Hospital, I found it amusing that Dr. Fukuda recruited me based on the recommendation of those patients. I was so fortunate to have many opportunities to contribute as a primary investigator in meaningful nationwide clinical studies. At present, I appreciate my country life as a community hematologist-oncologist. I also did not expect that I would have continuing opportunities to collaborate with researchers nationwide thanks to rapid progress in remote communications, and nothing would make me happier than to continue participating in projects on cancer survivorship.

Acting on past lessons and learning new ones.

eLife has published a special issue containing articles that examine how cancer prevention, control, care and survivorship were impacted by the COVID-19 pandemic.

Assessing the Efficacy of a 28-Day Comprehensive Online Prostate Cancer Patient Empowerment Program (PC-PEP) in Facilitating Engagement of Prostate Cancer Patients in Their Survivorship Care: A Qualitative Study.

A 28-day Prostate Cancer-Patient Empowerment Program (PC-PEP) developed through patient engagement was successful at promoting mental and physical health. Thirty prostate cancer patients from Halifax, Canada participated in the 28-day PC-PEP intervention in early 2019. PC-PEP encompassed daily patient education and empowerment videos, prescribed physical activities (including pelvic floor exercises), a mostly plant-based diet, stress reduction techniques, intimacy education, social connection, and support. Quantitative exit surveys and semi-structured interviews (conducted in focus groups of ten) were used to assess perceived factors that facilitated or impeded adherence to the program. The program received high praise from the patients and was deemed extremely useful by the participating men, who rated it 9 out of 10. Patients expressed that the multifaceted, online, home-based nature of the program helped them adhere to it better than they would have had to a single or less comprehensive intervention. Feedback from the participants indicated that the program, when viewed as a whole, was perceived as greater than the sum of its individual parts. Furthermore, the program addressed various issues, including emotional vulnerability and distress, physical fitness, urinary incontinence, challenges in expressing emotions, perceived lack of control over healthcare decisions, emotional fragility, and hesitancy to discuss prostate cancer-related matters in social settings. Patients highly (9.6/10) endorsed integrating the program into the standard care regimen from the very beginning of diagnosis. However, challenges such as work commitments were noted. Patients' high endorsement of PC-PEP suggests that its implementation into the standard of care from day one of diagnosis may be warranted.

Post-Operative Care of the Cancer Patient: Emphasis on Functional Recovery, Rapid Rescue, and Survivorship.

A cancer diagnosis and its subsequent treatments are life-changing events, impacting the patient and their family. Treatment options available for cancer care are developing at pace, with more patients now able to achieve a cancer cure. This is achieved through the development of novel cancer treatments, surgery, and modern imaging, but also as a result of better understanding treatment/surgical trauma, rescue after complications, perioperative care, and innovative interventions like pre-habilitation, enhanced recovery, and enhanced post-operative care. With more patients living with and beyond cancer, the role of survivorship and quality of life after cancer treatment is gaining importance. The impact cancer treatments can have on patients vary, and the "scars" treatments leave are not always visible. To adequately support patients through their cancer journeys, we need to look past the short-term interactions they have with medical professionals and encourage them to consider their lives after cancer, which often is not a reflection of life before a cancer diagnosis.

Healthcare providers' perceptions about the unmet needs of their patients with cancer across healthcare systems: results of the International Psycho-Oncology Society survivorship survey.

OBJECTIVE: Systematic understanding of patients' unmet needs is essential for providing effective supportive care. This study sought to compare the unmet needs of patients with cancer identified by health care providers (HCPs) among four major healthcare systems. METHODS: HCPs (n = 247) participated in the International Psycho-Oncology Society (IPOS) Survivorship Online Survey, evaluating their patients' unmet needs. The country of HCPs was grouped into four major healthcare systems: Beveridge model, Bismarck model, National Health Insurance model, and out-of-pocket model. RESULTS: Most HCPs were from countries with the Bismarck model. Substantial levels (> 50%) of unmet needs in all domains are reported across the four healthcare systems. Pediatric patients/survivors living in countries under out-of-pocket healthcare model were evaluated to have less unmet needs for managing decline in physical or cognitive functioning and insomnia/sleep difficulty/fatigue, than those in countries under Beveridge, Bismarck, and National Health Insurance models. Moreover, middle-aged patients/survivors under Beveridge and National Health Insurance models were likely to have greater unmet needs for dealing with cancer-related financial concerns than those under Bismarck model. CONCLUSION: This study provides valuable insights into the unmet needs of patients with cancer in different healthcare systems, highlighting the significance of targeted interventions to address the unique needs of patients across diverse healthcare systems. Further investigation is warranted to identify the system factors associated with patients' unmet needs, enabling the development of effective healthcare policies and interventions to comprehensively address the multifaceted needs of patients with cancer.

[Clinical study of induction chemotherapy followed by allogeneic hematopoietic stem cell transplantation in the treatment of FLT3-ITD(+) acute myeloid leukemia with normal karyotype].

Objective: To assess the efficacy of induction chemotherapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of FLT3-ITD(+) acute myeloid leukemia (AML) with normal karyotype. Methods: The clinical data of FLT3-ITD(+) AML patients with normal karyotype in the First Affiliated Hospital of Nanjing Medical University from Jan 2018 to March 2021 were retrospectively analyzed. Results: The study included 49 patients with FLT3-ITD(+)AML, 31 males, and 18 females, with a median age of 46 (16-59) years old. All patients received induction chemotherapy, and 24 patients received sequential allo-HSCT (transplantation group) . The median follow-up time was 465 days, the one-year overall survival (OS) from diagnosis was (70.0 ± 7.4) %, and one-year disease-free survival (DFS) was (70.3±7.4) %. The one-year OS was significantly different between the transplantation group and the non-transplantation group [ (85.2 ± 7.9) % vs (52.6 ± 12.3) %, P=0.049]. but one-year DFS [ (84.7 ± 8.1) % vs (55.2 ± 11.9) %, P=0.061] was not. No significance was found in one-year OS between patients with low-frequency and high-frequency FLT3-ITD(+) (P>0.05) . There were 12 patients with high-frequency FLT3-ITD(+) in the transplantation and the non-transplantation groups, respectively. The one-year OS [ (68.8 ± 15.7) % in the transplantation group vs (26.2 ± 15.3) % in the non-transplantation group, P=0.027] and one-year DFS [ (45.5 ± 21.3) % in the transplantation group vs (27.8±15.8) % in the non-transplantation group, P=0.032] were significantly different between the two groups. Conclusion: Induction chemotherapy followed by allo-HSCT can enhance the prognosis of FLT3-ITD(+) patients, particularly those with FLT3-ITD high-frequency mutation.

Diagnóstico y tratamiento de los tumores de la unión esofagogástrica. Experiencia en el Instituto Nacional de Cancerología / Diagnosis and treatment of esophagogastric junction tumors. Experience at the National Cancer Institute

Introducción. El diagnóstico adecuado de los tumores de la unión esofagogástrica es esencial para el tratamiento de estos pacientes. La clasificación propuesta por Siewert-Stein define las características propias, factores de riesgo y estrategias quirúrgicas según la localización. El objetivo de este estudio fue describir las características de los pacientes con adenocarcinoma de la unión esofagogástrica tratados en nuestra institución. Métodos. Estudio retrospectivo, descriptivo, de corte longitudinal, que incluyó los pacientes con diagnóstico de adenocarcinoma de la unión esofagogástrica intervenidos quirúrgicamente en el Instituto Nacional de Cancerología, Bogotá, D.C., Colombia, entre enero de 2012 y mayo de 2017. Resultados. Se operaron 59 pacientes (84,7 % hombres), con una edad media de 62,5 años. En su orden de frecuencia los tumores fueron tipo II (57,6 %), tipo III (30,7 %) y tipo I (11,9 %). El 74,6 % recibieron neoadyuvancia y se realizó gastrectomía total en el 73 % de los pacientes. La concordancia diagnóstica moderada con índice Kappa fue de 0,56, difiriendo con la endoscópica en 33,9 %. El 10,2 % de los pacientes presentó algún tipo de complicación intraoperatoria. La supervivencia a tres años en los tumores tipo II fue del 89,6 % y del 100 % en aquellos con respuesta patológica completa. Conclusión. Es necesario el uso de diferentes estrategias para un proceso diagnóstico adecuado en los tumores de la unión esofagogástrica. En esta serie, los pacientes Siewert II, aquellos que recibieron neoadyuvancia y los que obtuvieron una respuesta patológica completa, tuvieron una mejor supervivencia a tres años

Introduction: Proper diagnosis of gastroesophageal junction tumors is essential for the treatment of these patients. The classification proposed by Siewert-Stein defines its own characteristics, risk factors and surgical strategies according to the location. This study describes the characteristics of patients with adenocarcinoma of the esophagogastric junction treated at our institution. Methods. Retrospective, descriptive, longitudinal study, which includes patients diagnosed with adenocarcinoma of the esophagogastric junction who underwent surgery at the National Cancer Institute in Bogotá, Colombia, between January 2012 and May 2017. Results. Fifty-nine patients (84.7% men) were operated on, with a mean age of 62.5 years. In their order of frequency, the tumors were type II (57.6%), type III (30.7%) and type I (11.9%). 74.6% received neoadjuvant therapy and total gastrectomy was performed in 73% of the cases. The moderate diagnostic concordance with the Kappa index was 0.56, differing from the endoscopic one in 33.9%. 10.2% of the patients presented some type of intraoperative complication. Three-year survival in type II tumors was 89.6% and 100% in those with complete pathologic response. Conclusion. The use of different strategies is necessary for an adequate diagnostic process in tumors of the esophagogastric junction. In this series, Siewert II patients, those who received neoadjuvant therapy, and those who obtained a complete pathological response had a better three-year survival

History of the term 'appeasement': a response to Bailey et al. (2023).

This letter to the editor aims to address claims made by Bailey et al. [2023. Appeasement: Replacing Stockholm syndrome as a definition of a survival strategy. European Journal of Psychotraumatology, 14(1), 2161038] about the history of the concept of appeasement in relation to mammalian survival responses as well as the fawn response, by offering a brief overview and analysis of the literature.

Appeasement in political and foreign policy, social justice, ethology, psychology, and communication studies (multiple mammalian and avian species) feature elements of coregulation.The original conceptualisation of the fawn response may result in the misperception that it is unrelated to coregulation.Appeasement and coregulation can occur whether the vulnerable party initiating the appeasement is in a state that supports affiliative, distress, or shutdown behaviour.

'Climate change concerns human survival and justice in our international community': A corpus-based positive discourse analysis (PDA) of the largest developing nation's global involve/engagement discourses (re)told in interpreting.

Contributing to a much-needed 'outward turn' in interpreting studies, this intervention examines the role of interpreting and interpreters in (re)articulating the welcome 'voice' of a developing nation in the global South. Against the backdrop of reform and opening-up (ROU), China, the world's largest developing country, is increasingly open and keen to engage globally. Such elements as openness, integration, and international engagement represent vital components of the overarching ROU metadiscourse that justifies China's sociopolitical system and multifarious policies and decisions. As part of a series of digital humanities (DH) informed empirical studies exploring the part played by interpreting in rendering China's ROU metadiscourse, this study zooms in on the government interpreters' mediation of Beijing's international engagement and global involvement discourses. Unlike CDA which often foregrounds the negative themes (e.g. injustice, oppression, dominance, and hegemony), an innovative corpus-based positive discourse analysis (PDA) is introduced and applied, drawing on 20 years of China's press conferences. This article points to the interpreters' visibility and agency in facilitating and strengthening China's discourse through (over)producing core lexical items and salient collocational patterns. Following the trends of interdisciplinarity and digital humanities, this corpus-based PDA study illustrates ultimately how a major non-Western developing country from the global South communicates its discourse bilingually in front of the international community. The potential impact and implications of the interpreter-in(tro)duced discursive changes are discussed vis-à-vis the ever shifting and delicate East-West power balance from the perspective of (geo)politics.

Provision and delivery of survivorship care for adult patients with haematological malignancies: A scoping review protocol.

INTRODUCTION: Haematological malignancies are a heterogenous group of blood and lymphatic cancers. Survivorship care is a similarly diverse term concerning patients' health and wellbeing from diagnosis to end of life. Survivorship care for patients with haematological malignancies has traditionally been consultant-led and secondary care-based, although shifts away from this model have been occurring, largely via nurse-led clinics and interventions with some remote monitoring. However, there remains a lack of evidence regarding which model is most appropriate. Although previous reviews exist, patient populations, methodologies, and conclusions are varied, and further high-quality research and evaluation has been recommended. AIMS: The aim of the scoping review this protocol describes is to summarise current evidence on the provision and delivery of survivorship care for adult patients diagnosed with a haematological malignancy, and to identify existing gaps to inform future research. METHODOLOGY: A scoping review will be carried out utilising Arksey and O'Malley's guidelines as its methodological framework. Studies published in the English language from December 2007 to the present will be searched on bibliographic databases, including Medline, CINAHL, PsycInfo, Web of Science, and Scopus. Papers' titles, abstracts, and full text will predominantly be screened by one reviewer with a second reviewer blind screening a proportion. Data will be extracted using a customised table developed in collaboration with the review team, and presented in tabular and narrative format, arranged thematically. Studies included will contain data regarding adult (25+) patients diagnosed with any haematological malignancy in combination with aspects related to survivorship care. The survivorship care elements could be delivered by any provider within any setting, but should be delivered pre- or post-treatment, or to patients on a watchful waiting pathway. REGISTRATION: The scoping review protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/rtfvq; DOI: 10.17605/OSF.IO/RTFVQ).

Ventajas de la secuenciación de próxima generación sobre la hibridación fluorescente in situ para detectar la codeleción 1p/19q en oligodendrogliomas / Advantages of next generation sequencing over fluorescent in situ hybridization to detect 1p/19q codeletion in oligodendroglioma / Vantagens do sequenciamento de próxima geração sobre a hibridização fluorescente in situ para detectar codeleção 1p/19q em oligodendrogliomas

El perfil molecular de los gliomas permite garantizar la precisión del diagnóstico, informar el pronóstico e identificar opciones de tratamiento. Esta revisión tiene como objetivo exponer que con la secuenciación de próxima generación (NSG) el diagnóstico de los pacientes con oligodendrogliomas puede ser más exacto. Además, con un dispositivo de diagnóstico in vitro, basado en la NSG (F1CDx), en el que se utilizan los bloques de parafina de gliomas para analizar hasta 395 genes relacionados con cáncer (incluido IDH 1 y 2), se puede también informar la pérdida de la totalidad del brazo corto del cromosoma 1 y del brazo largo del cromosoma 19 (codeleción 1p/19q), a diferencia de la hibridación fluorescente in situ (FISH) que detecta desde la más mínima deleción, lo cual los hace sensibles pero no específicos ya que el FISH es incapaz de distinguir entre la pérdida de la totalidad del brazo del cromosoma y una deleción focal. Esta distinción es importante ya que la sobrevida es inferior en tumores con deleción parcial en rela­ción con los oligodendrogliomas, que tienen por definición la pérdida total de ambos cromosomas. Se hace también alusión a otras plataformas genómicas como GlioSeq y GLIO-DNA panel, que pueden cumplir la misma función. En conclusión, la F1CDx puede determinar con precisión 1p/19q con una concordancia del 96.7% frente a FISH. Los casos en que el FISH dio positivo y no concordaban con F1CDx, era porque no se trataba de oligodendrogliomas. F1CDx también analiza todos los genes que permiten la aproximación más exacta al diagnóstico de oligodendroglioma.

Molecular profiling of gliomas helps ensure diagnostic accuracy, inform prognosis, and identify treatment options. This review aims to show that with next generation sequencing (NGS) the diagnosis of patients with oligodendrogliomas can be more accurate. In addition, with an in vitro diagnostic device, based on NSG (F1CDx), in which glioma paraffin blocks are used to analyze up to 395 cancer-related genes (including IDH 1 and 2), it is also possible to report the loss of the entire short arm of chromosome 1 and the long arm of chromosome 19 (1p/19q codeletion), unlike fluorescence in situ hybridization (FISH) that detects even the slightest deletion, making them sensitive but not specific, as FISH is unable to distinguish between the loss of the entire arm of the chromosome and a focal deletion. This distinction is important since survival is lower in tumors with partial deletion compared to oligodendrogliomas, which by definition have the total loss of both chromosomes. Reference is also made to other genomic platforms such as GlioSeq and GLIO-DNA panel, which can fulfill the same function. In conclusion, the F1CDx can accurately determine 1p/19q with a concordance of 96.7% against FISH. The cases in which the FISH was positive and did not agree with F1CDx, it was because they were not oligodendrogliomas. F1CDx also analyzes all the genes that allow the most accurate approach to the diagnosis of oligodendroglioma.

O perfil molecular de gliomas ajuda a garantir a precisão do diagnóstico, informar o prognóstico e identificar as opções de tratamento. Esta revisão tem como objetivo mostrar que com o sequenciamento de próxima geração (NSG) o diagnóstico de pacientes com oligodendrogliomas pode ser mais preciso. Além disso, com um dispositivo de diagnóstico in vitro baseado em NSG (F1CDx), no qual blocos de parafina de glioma são usados para analisar até 395 genes relacionados ao câncer (incluindo IDH 1 e 2), também é possível relatar a perda do todo o braço curto do cromossomo 1 e o braço longo do cromossomo 19 (codeleção 1p/19q), ao contrário da hibridização fluorescente in situ(FISH) que detecta desde a menor deleção, o que os torna sensíveis, mas não específicos, pois o FISH é incapaz de distinguir entre a perda de todo o braço do cromossomo e uma deleção focal. Essa distinção é importante, pois a sobrevida é menor nos tumores com deleção parcial em relação aos oligodendrogliomas, que por definição apresentam a perda total de ambos os cromossomos. Também é feita referência a outras plataformas genômicas, como GlioSeq e painel GLIO-DNA, que podem cumprir a mesma função. Em conclusão, o F1CDx pode determinar com precisão 1p/19q com uma concordância de 96,7% versus FISH. Os casos em que FISH foi positivo e não concordaram com F1CDx, foi porque não eram oligodendrogliomas. O F1CDx também analisa todos os genes que permitem a abordagem mais precisa para o diagnóstico de oligodendroglioma.

Sobrevida en población pediátrica con leucemia linfoblástica aguda tratada con protocolo ALLIC-BFM de quimioterapia. Revisión sistemática / Survival of pediatric population with acute lymphoblastic leukemia treated with ALLIC-BFM chemotherapy protocol. Systematic review

La leucemia linfoblástica aguda constituye la neoplasia infantil más frecuente. Los tratamientos actuales posibilitan más del 80% de supervivencia libre de enfermedad por cinco años. En el 2000, se probó un protocolo de quimioterapia llamado leucemia linfoblástica intercontinental Berlín-Frankfurt-Münster (ALLIC BFM). El proceso investigativo se realizó mediante la metodología PRISMA, con el propósito de sistematizar la información acerca de la supervivencia de los pacientes pediátricos con leucemia linfoblástica aguda tratados con el uso del protocolo de quimioterapia ALLIC BFM en sus versiones de 2002 o 2009. La supervivencia global en pacientes donde se utilizó el protocolo de 2002 fue del 52% al 91,7% y la libre de enfermedad fue del 45% a 83,3%; mientras que, con el uso del protocolo 2009 se reportó una supervivencia global del 71,1% al 90% y la libre de enfermedad fue del 69,4% al 90,3%. Los principales factores que afectaron la supervivencia fueron las complicaciones relacionadas con el tratamiento, los pacientes de alto riesgo y la medicación insuficiente.

Acute lymphoblastic leukemia is the most common childhood neoplasia. Current treatments allow more than 80% disease-free survival for five years. In 2000, a chemotherapy protocol called Berlin-Frankfurt-Münster intercontinental lymphoblastic leukemia (ALLIC BFM) was tested. The investigative process was carried out using the PRISMA methodology. This study aimed to systematize the information about the survival of pediatric patients with acute lympho-blastic leukemia treated with the ALLIC BFM chemotherapy protocol in its 2002 or 2009 versions. 52% to 91.7% of patients showed an overall survival in patients where the 2002 proto-col was used, and disease-free was from 45% to 83.3%; while, with the use of the 2009 protocol, an overall survival of 71.1% to 90% was reported, and disease-free survival was 69.4% to 90.3%. The main factors affecting survival were treatment-related complications, high-risk patients, and insufficient medication.

Rethinking Vision and Action.

Action is an important arbitrator as to whether an individual or a species will survive. Yet, action has not been well integrated into the study of psychology. Action or motor behavior is a field apart. This is traditional science with its need for specialization. The sequence in a typical laboratory experiment of see → decide → act provides the rationale for broad disciplinary categorizations. With renewed interest in action itself, surprising and exciting anomalous findings at odds with this simplified caricature have emerged. They reveal a much more intimate coupling of vision and action, which we describe. In turn, this prompts us to identify and dwell on three pertinent theories deserving of greater notice.

Experiencia de downstaging versus criterios de Milán para trasplante hepático por carcinoma hepatocelular en una cohorte prospectiva / Experience with downstaging versus Milan criteria for liver transplantation in patients with hepatocellular carcinoma in a prospective cohort

Introducción. El acceso al trasplante hepático (TH) en pacientes con carcinoma hepatocelular (CHC) se basa en la aplicación de criterios morfológicos rigurosos estipulados desde 1996, co-nocidos como criterios de Milán. Una de las estrategias descritas para expandir estos criterios se conoce como downstaging (reducción del estadiaje tumoral mediante terapias locorregionales). El objetivo de este estudio fue describir el comportamiento postrasplante de pacientes con CHC que ingresaron dentro de los parámetros de Milán, comparado con el de aquellos pacientes llevados a terapia de downstaging en un centro colombiano. Metodología. Se incluyeron pacientes adultos con cirrosis hepática (CH) y CHC que fueron llevados a TH en el Hospital Pablo Tobón Uribe, entre julio de 2012 a septiembre de 2021. Como desenlace principal se definió recurrencia y tiempo de recurrencia de la enfermedad tumoral, muerte por todas las causas y tiempo al fallecimiento. Se evaluaron las características sociodemográficas y clínicas de cada grupo. Se incluyeron scores pronósticos de recurrencia de la enfermedad tumoral. Resultados. Se trasplantaron 68 pacientes con CH y CHC, 50 (73,5 %) eran hombres y la edad promedio fue 59 años; 51 pacientes (75 %) cumplían con los criterios de Milán y 17 (25 %) fueron llevados a terapia de downstaging previo al TH. No hubo diferencias significativas en la supervivencia global y supervivencia libre de trasplante entre los dos grupos evaluados, p=0,479 y p=0,385, respectivamente. Tampoco hubo diferencia significativa en la recurrencia de la enfermedad tumoral entre ambos grupos (p=0,81). En total hubo 7 casos de recurrencia tumoral (10,2 %) y 11 casos de muerte (16,2 %). Conclusiones. No se encontraron diferencias significativas en recurrencia y mortalidad entre los pacientes que cumplían los criterios de Milán y los trasplantados luego de la terapia de downstaging, en un tiempo de se-guimiento de 53 meses hasta el último control posterior al trasplante hepático. Esta sería la primera evaluación prospectiva de un protocolo de downstaging para CHC en Colombia.

Introduction. Access to liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) is based on the application of rigorous morphological criteria stipulated since 1996, known as the Milan criteria. One of the strategies described to expand these criteria is known as downstaging (tu-mor staging reduction through locoregional therapies). The objective of this study was to describe the post-transplant performance of patients with HCC who were admitted within the Milan parameters, compared with those of patients taken to downstaging therapy, in a Colombian center. Methodolo-gy. Adult patients with cirrhosis and HCC that received LT between July 2012 and September 2021 at the Pablo Tobón Uribe Hospital were included. The main outcome was defined as recurrence and time to recurrence of the tumor disease, death from all causes, and time to death. The socio-demographic and clinical characteristics of each group were evaluated. Tumor disease recurrence prognostic scores were included. Results. Sixty-eight patients with cirrhosis and HCC received LT in the time frame, 50 (73.5%) were men and the mean age was 59 years. Fifty-one patients were trans-planted (75%) fulfilling Milan criteria, and 17 (25%) patients received downstaging therapies before LT. There were no significant differences in overall survival and transplant-free survival between the two groups, p=0.479 and p=0.385, respectively. There was also no significant difference in the recurrence of the tumor disease between both groups (p=0.81). In total there were 7 tumoral recurrences (10.2%) and 11 deaths (16.2%). Conclusions. There were no differences in recurrence and survival between patients transplanted fulfilling Milan criteria and those receiving downstaging therapies, following a mean time of 53 months after LT. This is the first prospective evaluation of the downstaging protocol in Colombia.

Desafios do HIV/AIDS em país de baixa renda: sobrevida e retenção de pacientes em TARV nos cuidados de HIV na 'Era' de "Testar e Iniciar" o tratamento no Município de Maputo, Moçambique / HIV/AIDS challenges in low-income country: survival and retention of patients on ART in the 'Era' of "Test and Treat" treatment in Maputo Municipality, Mozambique

Introdução: Considerando as evidências segundo as quais o início precoce do TARV, independentemente da contagem do CD4 ou do estágio clínico da OMS, aumenta a sobrevida e a retenção de pacientes em TARV; diminui a morbidade e mortalidade; e reduz a incidência do HIV, a OMS propôs a ETI para países de baixa renda fortemente afetados por HIV/AIDS, no entanto, estudos que avaliam o seu efeito sobre indicadores clínicos e programáticos ainda são escassos em Moçambique. Objetivos: (i) Estimar taxas de mortalidade e de perda no seguimento clínico e psicossocial nas coortes de pacientes submetidos à ETI (DTI) e não submetidos à estratégia (ATI), respectivamente, e compará-las; (ii) Estimar as medianas do tempo e as probabilidades de sobrevida e de retenção nos cuidados de HIV nas duas coortes (ATI e DTI) e compará-las; (iii) Analisar a influência da ETI na sobrevida e na retenção de pacientes em TARV nos cuidados de HIV, após ajuste para potenciais confundidores. Método: Estudo de coorte retrospectivo de pacientes em TARV, com idades entre 15 e 49 anos, inscritos nos serviços públicos de saúde do município de Maputo, Moçambique. As variáveis estudadas foram sociodemográficas (sexo, idade, escolaridade, região de residência); clínicas (data do diagnóstico de HIV; óbito; estádio clínico da OMS; contagem de CD4; carga viral; data de início do TARV; perda no seguimento; regime de tratamento; co-infecção HIV/TB; indice de massa corporal); programáticas (serviço de diagnóstico/testagem de HIV; participação nos grupos de apoio para a adesão comunitária; exposição à ETI) e os desfechos de interesse foram óbito e perda no seguimento clínico e psicossocial. Utilizou-se o estimador produto limite de Kaplan-Meier, o modelo de riscos proporcionais de Cox e as estimativas das razões de "Hazard" (HR), com respectivos intervalos de confiança a 95%. Estimou-se a FAP para a exposição à ETI, como medida de impacto da estratégia na população. Resultados: A taxa média de mortalidade na coorte ATI foi de 28,1/1000 pessoas-ano, enquanto na coorte DTI foi de 24,5/1000 pessoas-ano. A taxa média de perdas no seguimento clínico e psicossocial na coorte ATI foi de 17,3/1000 pessoas-ano e na coorte DTI de 15,0/1000 pessoas-ano. A MTS na coorte ATI foi de 43,1 meses e na coorte DTI de 50,6 meses. A MTR na coorte ATI foi de 39,8 meses e na coorte DTI de 49,0 meses. Mostraram-se associadas ao tempo de sobrevida, independentemente das demais covariáveis: pertencer à faixa etária de 25-39 (HR=1,52; IC 95% 1,37 - 1,69) e 40-49 (HR=2,16; IC 95% 1,94 - 2,41); ser residente de região suburbana (HR=1,45; IC 95% 1,36 - 1,54); ser do sexo masculino (HR=1,41; IC 95% 1,33 - 1,49); estar em TARV com a II linha (HR=1,19; IC 95% 1,13 - 1,26); estar co-infectado HIV/TB (HR=1,16; IC 95% 1,10 - 1,23); pertencer ao estágio clínico IV da OMS (HR=1,93; IC 95% 1,70 - 2,17), ter IMC <18,5 Kg/m2 (HR=1,18; IC 95% 1,07 - 1,29); não estar exposto à ETI (HR=1,16; IC 95% 1,10 - 1,22). Mostraram-se associadas ao tempo de retenção nos cuidados, independentemente das outras covariáveis: estar em regime de TARV da II linha (HR = 1,48; IC 95% 1,40 - 1,56); pertencer ao estágio III (HR = 1,28; IC 95% 1,19 - 1,36) e IV (HR = 3,51; IC 95% 3,17 - 3,88) da OMS; não estar exposto à ETI (HR = 1,75; IC 95% 1,65 - 1,85); estar co-infectado HIV/TB (HR = 1,18; IC 95% 11,11 - 1,24); ser do sexo masculino (HR = 1,17; IC 95% 1,11 - 1,24); pertencer aos GAAC (HR = 1,21; IC 95% 1,12 - 1,30). A fração atribuível na população para o grupo exposto à ETI (DTI) foi de 6,4% em relação à sobrevida e 20,0% para a retenção nos cuidados de HIV. Conclusões: No contexto de um país de baixa renda fortemente afetado por HIV/AIDS e situado na região Austral de África, a ETI mostrou impacto relevante no aumento da sobrevida e a retenção de pacientes em TARV nos cuidados de HIV, bem como na redução da mortalidade e das perdas no seguimento clínico e psicossocial. O estudo também confirmou o papel de fatores associados aos dois desfechos, também identificados em outras regiões da África Subsaariana e do mundo. Estes resultados fortalecem a importância da ETI para países de baixa e média renda fortemente afetados pelo HIV, para acelerar a resposta local e global do HIV/AIDS por via de intervenções nacionais.

Background: Considering the evidence that early initiation of ART, regardless of CD4 count or WHO clinical stage, increases survival and retention of patients on ART, decreases morbidity and mortality, and reduces HIV incidence, WHO proposed the test-and-treat strategy for low-income countries with a high burden of HIV/AIDS, however, studies evaluating the effect of this strategy on survival and retention of patients on ART are still scarce in Mozambique. Objectives: (i) Estimate the mean rates of mortality and loss in clinical and psychosocial follow-up among the cohorts, respectively, of patients submitted to the strategy (DTI) and not submitted to the strategy (ATI) and compare them; (ii) Estimate the median time and probabilities of survival and retention in HIV care in the two cohorts (ATI and DTI) and compare them; (iii) Analyze the influence of the test-and-start strategy on survival and retention of patients on ART in HIV care, after adjusting for potential confounders. Method: Retrospective cohort study of patients on ART, aged between 15 and 49 years old, enrolled in public health services of Maputo municipality. Variables studied were: sociodemographic (gender, age, education, region of residence); clinical (date of HIV diagnosis; death; WHO clinical stage; CD4 count; viral load; ART initiation date; loss to follow-up; treatment regimen; HIV/TB co-infection; body mass index); programmatic (HIV diagnosis/testing service; participation in support groups for community adherence; exposure to the "test and treat" strategy) and the outcomes of interest were death and loss of clinical and psychosocial follow-up. Kaplan-Meier estimator, Cox proportional hazards model and Hazard ratio (HR) estimates were used, with 95% confidence intervals. Attributable fraction in the population for the exposure to the "test and treat" strategy was estimated as a measure of the strategy's impact on the population. Results: Mean mortality rate in ATI cohort was 28.1/1000 person-years, while in DTI cohort it was 24.5/1000 person-years. Mean rate of loss to clinical and psychosocial follow-up in ATI cohort was 17.3/1000 person-years and in DTI cohort was 15.0/1000 person-years. Median survival time (MTS) in ATI cohort was 43.1 months and in DTI cohort was 50.6 months. Median retention time (MTR) in ATI cohort was 39.8 months and in DTI cohort was 49.0 months. Regardless of the other covariates, the predictors of death were the following: belonging to the age group 25-39 (HR=1.52; CI 95% 1.37 - 1.69) and 40-49 (HR=2.16; CI 95% 1.94 - 2.41); be resident of a suburban region (HR=1.45; 95%CI 1.36 - 1.54); be male (HR=1.41; 95% CI 1.33 - 1.49); be on second-line ART regime (HR=1.19; 95% CI 1.13 - 1.26); be co-infected HIV/TB (HR=1.16; 95% CI 1.10 - 1.23); belonging to WHO clinical stage IV (HR=1.93; 95% CI 1.70 - 2.17), having a BMI <18.5 Kg/m2 (HR=1.18; 95% CI 1.07 - 1 ,29); not being exposed to the test-and-treat strategy (HR=1.16; 95% CI 1.10 - 1.22). Regardless of the other covariates, the predictors of the loss in clinical and psychosocial follow-up were: be on second-line ART regime (HR = 1.48; 95% CI 1.40 - 1.56); belonging to WHO stage III (HR = 1.28; 95% CI 1.19 - 1.36) and IV (HR = 3.51; 95% CI 3.17 - 3.88); not being exposed to the test-and-start strategy (HR = 1.75; 95% CI 1.65 - 1.85); be co-infected with HIV/TB (HR = 1.18; 95% CI 11.11 - 1.24); be male (HR = 1.17; 95% CI 1.11 - 1.24); belonging to the GAAC (HR = 1.21; 95% CI 1.12 - 1.30). Population attributable fraction for the group exposed to the test-and-treat (DTI) strategy was 6.4% for survival and 20.0% for retention in HIV care. Conclusions: In the context of a low-income country strongly affected by HIV/AIDS and located at southern Africa region, the test-and-treat strategy showed a relevant impact on increasing survival and retention time of patients on ART in HIV care, as well as on reducing of mortality and losses in clinical and psychosocial follow-up. The study confirmed, as well, the role of factors associated with the two studied outcomes, also identified in other regions of sub-Saharan Africa and worldwide. These results strengthen the importance of the test-and-treat strategy for low- and middle-income countries heavily affected by HIV, to accelerate local and global HIV/AIDS response through national interventions.

Prise en charge du cancer du col utérin métastatique au CHU de Treichville et résultas/ / Management of metastatic cervical cancer at the University Hospital of Treichville and results

la prise en charge du cancer col métastatique s'est enrichie depuis 2017 par la disponibilité des thérapies ciblées dans notre pays. Cette étude avait pour objectifs de déterminer les caractéristiques épidémiologiques, cliniques et thérapeutiques des patientes prises en charge pour cancer du col métastatique dans notre structure. Methodes. il s'agit d'une étude rétrospective à visé descriptive menée dans les services de gynécologie et d'oncologie du CHUT, du janvier 2018 ­ octobre 2021. Elle a concerné les dossiers de patientes traitées pour un cancer du col de l'utérus métastatique confi rmé. Ont été inclus les dossiers des patientes qui ont reçu au moins 06 cures de chimiothérapie associées ou non à la thérapie ciblée, et dont la dernière cure a été réalisée 24 mois avant la fi n de l'étude. Resultats. Nous avons colligé 47 dossiers dont les patientes avaient un âge moyen de 54 ans. Elles avaient toutes déjà accouché, et étaient sans activités dans 57% des cas. La tumeur initiale était un carcinome épidermoïde dans la majorité des cas (87%). Les sites métastatiques les plus fréquents étaient lespoumons (39%), le foie (26%), les os (15%). Elles ont toutes bénéfi cié de la combinaison PaclitaxelCisplatine ­Bévacizumab comme traitement spécifi que. La survie globale a été de 52 % à 24 mois, et était meilleur chez les patientes qui ont reçu le Bévacizumab dans leur traitement.

Is there a survival processing effect in metacognition?

Memory systems serve an adaptive function for the fitness of organisms. A good example of this is the Survival Processing Effect (SPE) which points to increased retention of information when it is processed in a survival context compared to other contexts. Survival processing may also affect metacognitive processes, by increasing confidence judgments as well as increasing metacognitive sensitivity. No previous study, however, has directly examined whether processing information for survival also has an effect on metacognitive processes. Here we ask whether SPE extends to the metacognitive system in terms of both metacognitive sensitivity and confidence bias. In Experiment 1 participants were asked to rate a list of words in terms of relevance in a survival scenario or a moving scenario. In a surprise old/new recognition test, they were given one word at a time and asked to indicate if they have rated the presented word before and state how confident they are in that choice. Surprisingly, the results did not reveal a SPE, which may have been due to high overall performance in the recognition task. In Experiment 2 we increased the level of difficulty of the memory task, which resulted in a robust SPE, but could not find this effect in metacognitive monitoring. Together, these results suggest that survival processing may not affect metacognitive processes in a reliable fashion.