El tema relacionado con las prácticas de crianza de la familia y los cuidadores adultos de niños y niñas menores de 6 años es un campo de estudio que ha generado muchas diferencias y que ha sido investigado desde diversas disciplinas, evidenciándose que la cultura es transversal al proceso de crianza. El presente artículo hace referencia al estado actual en Colombia de las tendencias que se han dado a partir de las prácticas de crianza de la familia y los cuidadores adultos, haciendo referencia a las investigaciones realizadas en el periodo 2003 - 2013. Este artículo es el condensado de una exhaustiva y rigurosa labor de revisión bibliográfica que proporciona elementos suficientes para determinar avances y vacíos conceptuales, que servirán para futuras investigaciones en relación con la temática.
W e read with great interest the article on "Quality and Safety in Healthcare: Consequences and More Solutions Regarding Poor Well-being in Medical Students," by Harolds 1 published in the April 2021 issue. This issue was ignored for many years but is currently considered to be of great importance because of the implications that it entails, both positive and negative. However, the article refers only to medical students, and we consider it worth noting that this also affects our residents, fellows, specialists, and colleagues and that the strategies you propose to im-
Background
99mTc-MAA accumulation within the tumor representing pulmonary arterial perfusion, which is variable and may have a clinical significance. We evaluated the prognostic significance of 99mTc-MAA distribution within the tumor in non-small cell lung cancer (NSCLC) patients in terms of detecting occult nodal metastasis and lymphovascular invasion, as well as predicting the recurrence-free survival (RFS).
Methods
Two hundred thirty-nine NSCLC patients with clinical N0 status who underwent preoperative lung perfusion SPECT/CT were retrospectively evaluated and classified according to the visual grading of 99mTc-MAA accumulation in the tumor. Visual grade was compared with the quantitative parameter, standardized tumor to lung ratio (TLR). The predictive value of 99mTc-MAA accumulation with occult nodal metastasis, lymphovascular invasion, and RFS was assessed.
Results
Eighty-nine (37.2%) patients showed 99mTc-MAA accumulation and 150 (62.8%) patients showed the defect on 99mTc-MAA SPECT/CT. Among the accumulation group, 45 (50.5%) were classified as grade 1, 40 (44.9%) were grade 2, and 4 (4.5%) were grade 3. TLR gradually and significantly increased from grade 0 (0.009 ± 0.005) to grade 1 (0.021 ± 0.005, P < 0.05) and to grade 2–3 (0.033 ± 0.013, P < 0.05). The following factors were significant predictors for occult nodal metastasis in univariate analysis: central location, histology different from adenocarcinoma, tumor size greater than 3 cm representing clinical T2 or higher, and the absence of 99mTc-MAA accumulation within the tumor. Defect in the lung perfusion SPECT/CT remained significant at the multivariate analysis (Odd ratio 3.25, 95%CI [1.24 to 8.48], p = 0.016). With a median follow-up of 31.5 months, the RFS was significantly shorter in the defect group (p = 0.008). Univariate analysis revealed that cell type of non-adenocarcinoma, clinical stage II-III, pathologic stage II-III, age greater than 65 years, and the 99mTc-MAA defect within tumor as significant predictors for shorter RFS. However, only the pathologic stage remained statistically significant, in multivariate analysis.
Conclusion
The absence of 99mTc-MAA accumulation within the tumor in preoperative lung perfusion SPECT/CT represents an independent risk factor for occult nodal metastasis and is relevant as a poor prognostic factor in clinically N0 NSCLC patients. 99mTc-MAA tumor distribution may serve as a new imaging biomarker reflecting tumor vasculatures and perfusion which can be associated with tumor biology and prognosis.
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