Search

La reanimación cardiopulmonar (RCP) es una maniobra que ha demostrado salvar vidas cuando se aplica correcta y tempranamente a personas que han sufrido un paro cardiorrespiratorio. Las enfermeras, como profesionales del área de la salud y miembros de la cadena de supervivencia, deben estar capacitadas y actualizadas respecto de estas técnicas, ya que tienen un mayor contacto con el paciente durante su estancia hospitalaria y suelen identificar y ser las primeras en responder a las emergencias de los pacientes bajo su cuidado. Por ello, una correcta evaluación en el grado de enfermería implica no solo la evaluación de los conocimientos teóricos, sino también de las habilidades y las actitudes. La simulación clínica se revela así como una herramienta pedagógica de primer orden para entrenar y aprender, permitiendo al estudiante de enfermería la participación en intervenciones clínicas controladas, de las cuales podrá obtener un aprendizaje significativo de situaciones futuras que desempeñará en su rol profesional, orientadas a lograr que el estudiante consiga competencias clínicas, no sólo para ser un buen profesional, sino para alcanzar a ser un profesional excelente. OBJETIVOS El propósito del presente estudio es evaluar la calidad de la Resucitación Cardiopulmonar Básica (RCP-B) que realiza el alumnado de enfermería, comparando la eficacia de dos metodologías docentes utilizadas (Simulación con retroalimentación visual por ordenador vs Simulación sin retroalimentación) en dos grupos de estudiantes: experimental y control, mediante la evaluación práctica de las maniobras de RCP-B, lo que nos permitirá poner de relieve los puntos débiles del aprendizaje del alumnado y, de esta manera, poder aportar mejoras en el proceso de enseñanza-aprendizaje. METODOLOGÍA El estudio se ha desarrollado en la Facultad de Enfermería, Fisioterapia y Podología de la Universidad de Sevilla. Concretamente, han participado 186 estudiantes de 2º Grado de Enfermería divididos en dos grupos de 93 estudiantes, en función de la metodología docente utilizada: Grupo experimental(Simulación con retroalimentación visual por ordenador) y grupo control(Simulación sin retroalimentación). Todo el alumnado recibió 4 horas de formación práctica en RCP-B. Al finalizar el módulo de entrenamiento, el alumnado de ambos grupos realizaron un examen teórico con preguntas de elección múltiple y se les pidió que rellenaran un cuestionario de opinión, para evidenciar el grado de dificultad percibido durante la realización de las maniobras de RCP. Las habilidades prácticas fueron evaluadas utilizando un maniquí ResusciAnne SkillReporter Laerdal®, que proporciona una impresión informatizada de los datos cuantificables durante la secuencia de RCP, al objeto de evidenciar la calidad del masaje cardíaco externo y de las ventilaciones realizadas, obteniendo dos registros de evaluación(Prestest y Postest);esta evaluación se complementó con la observación directa de la profesora utilizando una lista verificación o "Checklist". RESULTADOS El perfil del alumnado objeto de nuestro estudio es preferentemente femenino, tiene una edad comprendida entre 20 y 22 años, proceden en su mayoría de bachillerato y tiene una carencia de formación en RCP; así lo refleja el que el 70% de los estudiantes de enfermería no hubiera recibido ningún curso en RCP-B previo a su ingreso en la Universidad siendo, por tanto, el inicio de esta formación muy tardío. Realidad que contrasta con la opinión del alumnado que considera en un 90% imprescindibles estos conocimientos, identificando los 10 a 13 años como la edad más adecuada para su inicio y colegios (41%) e institutos de secundaria(57%) como los lugares ideales para iniciar su enseñanza. Las mayores dificultades que percibe el alumnado en el desarrollo de las prácticas de RCP se refieren a la realización del masaje cardiaco externo(58%) y la ventilación(43%), existiendo una relación directa entre el grado de dificultad percibida y los resultados objetivos de la práctica en el grupo control(perciben gran dificultad y los resultados son malos) e inversa en el grupo experimental (perciben igualmente gran dificultad, pero realizan bien las maniobras).Las maniobras de apertura de la vía aérea y localización del pulso carotídeo, a pesar de que el alumnado las considerara como fáciles de realizar, son las que han conllevado un mayor grado de error (89% y 66%respectivamente), debido a una apertura incompleta de la vía y una ubicación incorrecta del pulso. Los estudiantes de enfermería del grupo experimental que se entrenaron en el maniquí con retroalimentación visual por ordenador realizaron un mayor porcentaje de compresiones correctas (71,5% vs. 33%) con profundidad adecuada(72,7% vs. 45 %) y con buen posicionamiento de manos(88,3 % vs. 73%) que los estudiantes del grupo control, que practicaron las maniobras de RCP Básica en un maniquí sin retroalimentación; asimismo, obtuvieron mejor porcentaje de ventilaciones correctas (64,8 % vs. 50,9%). El error que se produce con mayor frecuencia en el Masaje cardiaco externo (grupo experimental vs grupo control) es el elevado porcentaje de compresiones incorrectas (75% vs. 33%), debido sobre todo a una frecuencia cardíaca elevada(24,7 % vs. 82,8 %) y compresiones poco profundas (27% vs. 54,4%), especialmente en el grupo control, por lo que debemos insistir en la importancia de la calidad de esta maniobra, ya que puede ser éste uno de los puntos claves para proponer mejoras en la docencia. Los errores cometidos en la ventilación en ambos grupos ( experimental vs. control) han sido, fundamentalmente, la administración de volúmenes excesivos(19,8% vs. 17,5%) e insuficientes (15,4% vs. 33%) de aire, produciéndose un mayor porcentaje de ventilaciones nulas en el grupo control (0% vs. 21 %), relacionadas con la apertura incompleta de la vía aérea y las fugas por un mal sellado de la nariz y la boca durante las insuflaciones. La calificación media obtenida en el examen teórico en ambos grupos (8,28 vs. 8,24) no se correlaciona con la evaluación práctica de la RCP, sobre todo en el grupo control, lo que nos demuestra que esta calificación no refleja la adquisición de habilidades en RCP- Básica y, por tanto, no es un buen método para la valoración de las competencias adquiridas. El alumnado de ambos grupos refiere un altísimo grado de satisfacción con las metodologías docentes utilizadas en la asignatura “Soporte vital”. Destacan, principalmente, la utilización de la simulación con retroalimentación visual al permitir, no sólo el entrenamiento de las maniobras de resucitación, sino también muy especialmente, la integración de la teoría con la práctica, la autoevaluación y el aprendizaje a través de los errores cometidos, lo que redunda en una mejora de la calidad de la enseñanza. CONCLUSIONES: La enseñanza de la reanimación mediante software de retroalimentación visual en tiempo real, guiado por una instructora, se asoció con una mejor calidad en las maniobras de RCP Básica, al obtener el alumnado que se entrenó con el mismo (grupo experimental) mejores resultados, y por tanto, mayores habilidades técnicas, en las maniobras de ventilación y masaje cardíaco que el grupo control, entrenado con simulación tradicional, sin retroalimentación. El entrenamiento con retroalimentación visual en tiempo real e informe inmediato, mejora notablemente el rendimiento de la RCP, como lo demuestra el que el grupo control obtuviera un incremento, en los resultados relativos a las compresiones correctas y ventilaciones correctas, de más del doble con respecto al primer registro. Esta metodología, y su evaluación, propone una serie de desafíos para la docencia de la RCP en enfermería, siendo imprescindible replantear la formación del alumnado para desarrollar un modelo de buenas prácticas, con el fin de lograr profesionales competentes en el desempeño de la RCP que, a su vez, tendrá un impacto significativo sobre la supervivencia de un paro cardiaco.

Recent studies on splenic marginal zone lymphoma identified distinct mutations in genes belonging to the B-cell receptor and Toll-like receptor signaling pathways, thus pointing to their potential implication in the biology of the disease. However, limited data is available regarding the exact role of TLRs. We aimed at characterizing the expression pattern of TLRs in splenic marginal zone lymphoma cells and their functional impact on the activation, proliferation and viability of malignant cells in vitro. Cells expressed significant levels of TLR1, TLR6, TLR7, TLR8, TLR9 and TLR10 mRNA; TLR2 and TLR4 showed a low, variable pattern of expression among patients whereas TLR3 and TLR5 mRNAs were undetectable; mRNA specific for TLR signaling molecules and adapters was also expressed. At the protein level, TLR1, TLR6, TLR7, TLR9 and TLR10 were detected. Stimulation of TLR1/2, TLR2/6 and TLR9 with their respective ligands triggered the activation of IRAK kinases, MAPK and NF-κB signaling pathways, and the induction of CD86 and CD25 activation molecules, although in a heterogeneous manner among different patient samples. TLR-induced activation and cell viability were also inhibited by a specific IRAK1/4 inhibitor, thus strongly supporting the specific role of TLR signaling in these processes. Furthermore, TLR2/6 and TLR9 stimulation also significantly increased cell proliferation. In conclusion, we demonstrate that splenic marginal zone lymphoma cells are equipped with functional TLR and signaling molecules and that the stimulation of TLR1/2, TLR2/6 and TLR9 may play a role in regulating disease pathobiology, likely promoting the expansion of the neoplastic clone.

The concept of anaplastic large-cell lymphoma (ALCL) has changed over the years because of a stream of new information and novel understanding regarding the cell of origin, biology, genetics, and clinical features of these neoplasms. This new information has led to the current classification proposed by the expert reviewers of the World Health Organization. The objective of this review is to present the most updated information on the cytologic and histologic features of these entities, with a special reference to diagnostic algorithms. A detailed description of the genetic aberrations and the pathogenetic mechanisms leading to transformation is presented. The clinical features of ALCL and novel tailored strategies are briefly illustrated

P>Despite recent therapeutic improvements, the clinical course of diffuse large B-cell lymphoma (DLBCL) still differs considerably among patients. We conducted this retrospective multi-centre study to evaluate the impact of genomic aberrations detected using a high-density genome wide-single nucleotide polymorphism-based array on clinical outcome in a population of DLBCL patients treated with R-CHOP-21 (rituximab, cyclophosphamide, doxorubicine, vincristine and prednisone repeated every 21 d). 166 DNA samples were analysed using the GeneChip Human Mapping 250K NspI. Genomic anomalies were analysed regarding their impact on the clinical course of 124 patients treated with R-CHOP-21. Unsupervised clustering was performed to identify genetically related subgroups of patients with different clinical outcomes. Twenty recurrent genetic lesions showed an impact on the clinical course. Loss of genomic material at 8p23.1 showed the strongest statistical significance and was associated with additional aberrations, such as 17p- and 15q-. Unsupervised clustering identified five DLBCL clusters with distinct genetic profiles, clinical characteristics and outcomes. Genetic features and clusters, associated with a different outcome in patients treated with R-CHOP, have been identified by arrayCGH.

Despite its recognition as a distinct, extremely rare entity, no large studies of intravascular lymphoma (IVL) have been reported. The clinico-pathological characteristics of 38 human immunodeficiency virus-negative patients with IVL diagnosed in Western countries were reviewed to better delineate clinical presentation, clinical variants, natural history and optimal therapy. The IVL is an aggressive and usually disseminated disease (Ann Arbor stage IV in 68% of cases) that predominantly affects elderly patients (median age 70 years, range: 34-90; male:female ratio 0.9), resulting in poor Eastern Cooperative Oncology Group Performance Status (ECOG-PS >1 in 61%), B symptoms (55%), anaemia (63%) and high serum lactate dehydrogenase level (86%). The brain and skin are the most common sites of disease. In contrast to previous reports, hepatosplenic involvement (26%) and bone marrow infiltration (32%) were found to be common features in IVL, while nodal disease was confirmed as rare (11% of cases). Patients with disease limited to the skin ('cutaneous variant'; 26% of cases) were invariably females with a normal platelet count, and exhibited a significantly better outcome than the remaining patients, which deserves further investigation. Overall survival was usually poor; however, the early use of intensive therapies could improve outcome in young patients with unfavourable features. ECOG-PS >1, 'cutaneous variant', stage I and chemotherapy use were independently associated with improved survival.

A case of a 43-year-old male patient with lym-phoepithelioid lymphoma is discussed. During the 10-year follow-up of this patient, different biopsy specimens were obtained. Immunohistochemical studies with a complete paraffin panel determined a T-cell nature of the specimens. Electron microscopy showed a peculiar finding in the cytoplasms of the tumoral cells that correlated with optical inclusions observed in optical imprints; these imprints corresponded to lysosomic multivesicular bodies, whose significance is discussed.

Neoplasms of histiocytes and dendritic cells are rare, and their phenotypic and biological definition is incomplete. Seeking to identify antigens detectable in paraffin-embedded sections that might allow a more complete, rational immunophenotypic classification of histiocytic/dendritic cell neoplasms, the International Lymphoma Study Group (ILSG) stained 61 tumours of suspected histiocytic/dendritic cell type with a panel of 15 antibodies including those reactive with histiocytes (CD68, lysozyme (LYS)), Langerhans cells (CD1a), follicular dendritic cells (FDC: CD21, CD35) and S100 protein. This analysis revealed that 57 cases (93%) fit into four major immunophenotypic groups (one histiocytic and three dendritic cell types) utilizing six markers: CD68, LYS, CD1a, S100, CD21, and CD35. The four (7%) unclassified cases were further classifiable into the above four groups using additional morphological and ultrastructural features. The four groups then included: (i) histiocytic sarcoma (n=18) with the following phenotype: CD68 (100%), LYS (94%), CD1a (0%), S100 (33%), CD21/35 (0%). The median age was 46 years. Presentation was predominantly extranodal (72%) with high mortality (58% dead of disease (DOD)). Three had systemic involvement consistent with 'malignant histiocytosis'; (ii) Langerhans cell tumour (LCT) (n=26) which expressed: CD68 (96%), LYS (42%), CD1a (100%), S100 (100%), CD21/35 (0%). There were two morphological variants: cytologically typical (n=17) designated LCT; and cytologically malignant (n=9) designated Langerhans cell sarcoma (LCS). The LCS were often not easily recognized morphologically as LC-derived, but were diagnosed based on CD1a staining. LCT and LCS differed in median age (33 versus 41 years), male:female ratio (3.7:1 versus 1:2), and death rate (31% versus 50% DOD). Four LCT patients had systemic involvement typical of Letterer-Siwe disease; (iii) follicular dendritic cell tumour/sarcoma (FDCT) (n=13) which expressed: CD68 (54%), LYS (8%), CD1a (0%), S100 (16%), FDC markers CD21/35 (100%), EMA (40%). These patients were adults (median age 65 years) with predominantly localized nodal disease (75%) and low mortality (9% DOD); (iv) interdigitating dendritic cell tumour/sarcoma (IDCT) (n=4) which expressed: CD68 (50%), LYS (25%), CD1a (0%), S100 (100%), CD21/35 (0%). The patients were adults (median 71 years) with localized nodal disease (75%) without mortality (0% DOD). In conclusion, definitive immunophenotypic classification of histiocytic and accessory cell neoplasms into four categories was possible in 93% of the cases using six antigens detected in paraffin-embedded sections. Exceptional cases (7%) were resolvable when added morphological and ultrastructural features were considered. We propose a classification combining immunophenotype and morphology with five categories, including Langerhans cell sarcoma. This simplified scheme is practical for everyday diagnostic use and should provide a framework for additional investigation of these unusual neoplasms.

Este proyecto surge de la necesidad de disponer de un instrumento que facilitara la evaluación teórico-práctica de la asignatura Enfermería Médico-Quirúrgica, en los alumnos de segundo y tercer curso de la diplomatura de Enfermería. Para ello, en la primera fase del proyecto elaboramos dos vídeos que simularan una misma situación de una forma correcta y otra incorrectamente: el vídeo correcto lo utilizamos para la formación teórica. y el vídeo incorrecto ''con gazapos'' lo utilizamos para la evaluación teórico-práctica. En esta segunda fase hemos utilizado este instrumento de 248 alumnos experimentando distintas formas de aplicaciones tanto en el aula como en los talleres. Los resultados obtenidos han sido muy satisfactorios, lo que nos anima a elaborar una guía didáctica que facilite su uso. This project came because of the necessity to dispose of an instrument that will help the Nursing Medico Surgical teachers for the second and third course of Nursing Diploma students. We elaborated two videos that simulated, in a same situation, one in a correct way and one in a wrong way: we used the correct video for the theoretical formation and we used the wrong video for the theoretical and practical evaluation. In the second step we used this tool in 248 students experimenting several forms of application in theory and in practice. The results obtained have been very satisfactory. This will estimulate the elaboration of a didactic guide that will help the use of the videos.

Anaplastic large cell lymphoma (ALCL) is a mature T-cell lymphoma that can present as a systemic or primary cutaneous disease. Systemic ALCL represents 2% to 5% of adult lymphoma but up to 30% of all pediatric cases. Two subtypes of systemic ALCL are currently recognized on the basis of the presence of a translocation involving the anaplastic lymphoma kinase ALK gene. Despite considerable progress, several questions remain open regarding the pathogenesis of both ALCL subtypes. To investigate the molecular pathogenesis and to assess the relationship between the ALK(+) and ALK(-) ALCL subtypes, we performed a genome-wide DNA profiling using high-density, single nucleotide polymorphism arrays on a series of 64 cases and 7 cell lines. The commonest lesions were losses at 17p13 and at 6q21, encompassing the TP53 and PRDM1 genes, respectively. The latter gene, coding for BLIMP1, was inactivated by multiple mechanisms, more frequently, but not exclusively, in ALK(-)ALCL. In vitro and in vivo experiments showed that that PRDM1 is a tumor suppressor gene in ALCL models, likely acting as an antiapoptotic agent. Losses of TP53 and/or PRDM1 were present in 52% of ALK(-)ALCL, and in 29% of all ALCL cases with a clinical implication.

Marginal zone B-cell lymphomas (MZLs) have been divided into 3 distinct subtypes (extranodal MZLs of mucosa-associated lymphoid tissue [MALT] type, nodal MZLs, and splenic MZLs). Nevertheless, the relationship between the subtypes is still unclear. We performed a comprehensive analysis of genomic DNA copy number changes in a very large series of MZL cases with the aim of addressing this question. Samples from 218 MZL patients (25 nodal, 57 MALT, 134 splenic, and 2 not better specified MZLs) were analyzed with the Affymetrix Human Mapping 250K SNP arrays, and the data combined with matched gene expression in 33 of 218 cases. MALT lymphoma presented significantly more frequently gains at 3p, 6p, 18p, and del(6q23) (TNFAIP3/A20), whereas splenic MZLs was associated with del(7q31), del(8p). Nodal MZLs did not show statistically significant differences compared with MALT lymphoma while lacking the splenic MZLs-related 7q losses. Gains of 3q and 18q were common to all 3 subtypes. del(8p) was often present together with del(17p) (TP53). Although del(17p) did not determine a worse outcome and del(8p) was only of borderline significance, the presence of both deletions had a highly significant negative impact on the outcome of splenic MZLs.

Contains fulltext : 136658.pdf (Publisher’s version ) (Closed access) In order to address the debatable prognostic role of MYC rearrangements in diffuse large B-cell lymphoma patients treated with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone, we evaluated MYC rearrangements by fluorescence in situ hybridization in 563 cases using break-apart probes and IGH/MYC dual-fusion probes. Concurrent BCL2 and BCL6 aberrations were also assessed. Data were correlated with clinicopathological variables and prognostic parameters. MYC rearrangements were observed in 39/432 evaluable cases (9%), including 4 rearrangements detectable only with the dual-fusion probes, 15 detectable only with the break-apart probes and 20 detectable with both dual-fusion probes and break-apart probes. MYC rearrangements correlated with germinal center B-cell origin (P=0.02), MYC protein expression (P=0.032), and larger tumor mass size (P=0.0003). Patients with MYC rearrangements were more likely to be treatment resistant (P

Purpose: Prompted by the extensive biases in the immunoglobulin (IG) gene repertoire of splenic marginal-zone lymphoma (SMZL), supporting antigen selection in SMZL ontogeny, we sought to investigate whether antigen involvement is also relevant post-transformation. Experimental Design: We conducted a large-scale subcloning study of the IG rearrangements of 40 SMZL cases aimed at assessing intraclonal diversification (ID) due to ongoing somatic hypermutation (SHM). Results: ID was identified in 17 of 21 (81%) rearrangements using the immunoglobulin heavy variable (IGHV)1-2*04 gene versus 8 of 19 (40%) rearrangements utilizing other IGHV genes (P = 0.001). ID was also evident in most analyzed IG light chain gene rearrangements, albeit was more limited compared with IG heavy chains. Identical sequence changes were shared by subclones from different patients utilizing the IGHV1-2*04 gene, confirming restricted ongoing SHM profiles. Non-IGHV1-2*04 cases displayed both a lower number of ongoing SHMs and a lack of shared mutations (per group of cases utilizing the same IGHV gene). Conclusions: These findings support ongoing antigen involvement in a sizable portion of SMZL and further argue that IGHV1-2*04 SMZL may represent a distinct molecular subtype of the disease. Clin Cancer Res; 22(8); 2032–40. ©2015 AACR.

Mantle cell lymphoma (MCL) is typically a very aggressive disease with poor outcomes, but some cases display an indolent behavior that might not necessitate treatment at diagnosis. To define molecular criteria that might permit recognition of such cases, we compared the clinicopathologic features, gene expression, and genomic profile of patients who had indolent or conventional disease (iMCL or cMCL). Patients with iMCL displayed nonnodal leukemic disease with predominantly hypermutated IGVH and noncomplex karyotypes. iMCL and cMCL shared a common gene expression profile that differed from other leukemic lymphoid neoplasms. However, we identified a signature of 13 genes that was highly expressed in cMCL but underexpressed in iMCL. SOX11 was notable in this signature and we confirmed a restriction of SOX11 protein expression to cMCL. To validate the potential use of SOX11 as a biomarker for cMCL, we evaluated SOX11 protein expression in an independent series of 112 cases of MCL. Fifteen patients with SOX11-negative tumors exhibited more frequent nonnodal presentation and better survival compared with 97 patients with SOX11-positive MCL (5-year overall survival of 78% versus 36%, respectively; P = 0.001). In conclusion, we defined nonnodal presentation, predominantly hypermutated IGVH, lack of genomic complexity, and absence of SOX11 expression as qualities of a specific subtype of iMCL with excellent outcomes that might be managed more conservatively than cMCL. Cancer Res; 70(4); 1408–18

Richter's syndrome (RS) represents the transformation of chronic lymphocytic leukaemia (CLL) to aggressive lymphoma and is mostly represented by diffuse large B-cell lymphoma (DLBCL), with a post-germinal centre (GC) phenotype, clonally related to the pre-existing CLL. RS has a very poor prognosis and its pathogenetic mechanisms are poorly understood. In order to gain additional hints in RS pathogenesis, we performed a genome-wide DNA profiling study of 13 RS phases and eight matched CLL phases using the Affymetrix Human Mapping 250K NspI SNP arrays. Individual genomic profiles were heterogeneous, with no individual lesions occurring in more than half of the cases. However, several observations suggest that MYC pathway might be involved in RS. The 13q13.3-qter region containing MIRHG1 (MIR-17-92), a cluster of microRNA interacting with c-MYC, was acquired at the time of transformation. The 13q gain was coupled with the gain of c-MYC and loss of TP53. Translocation of c-MYC was acquired at transformation in a fraction of cases and this event appeared mutually exclusive with gain of MIRHG1. MYCN, a c-MYC homologue, was also recurrently gained. By comparing RS with 48 de nova DLBCL, RS presented a significantly lower prevalence of deletions affecting the PRDM1 and TNFAIP3, genes on 6q, known to be associated with a post-GC phenotype. In conclusion, the genomic profile of RS seems to differ from what observed in de novo DLBCL and in other transformed DLBCL. Genomic lesions occurring in RS are heterogeneous suggesting the existence of different RS subsets, possibly due to different transforming mechanisms. A deregulation of MYC pathway might represent one of the main transformation events in the pathogenesis of a subset of RS clonally related to the previous CLL. Copyright (C) 2009 John Wiley & Sons, Ltd.