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Jaimes J, Patiño LH, Herrera G, Cruz C, Pérez J, Correa-Cárdenas CA, Muñoz M, Ramírez JD. Prokaryotic and eukaryotic skin microbiota modifications triggered by Leishmania infection in localized Cutaneous Leishmaniasis. PLoS Negl Trop Dis 2024; 18:e0012029. [PMID: 38478569 PMCID: PMC10962849 DOI: 10.1371/journal.pntd.0012029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/25/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Cutaneous Leishmaniasis (CL) is a tropical disease characterized by cutaneous ulcers, sometimes with satellite lesions and nodular lymphangitis. Leishmania parasites, transmitted by sandfly vectors, cause this widespread public health challenge affecting millions worldwide. CL's complexity stems from diverse Leishmania species and intricate host interactions. Therefore, this study aims to shed light on the spatial-temporal distribution of Leishmania species and exploring the influence of skin microbiota on disease progression. We analyzed 40 samples from CL patients at three military bases across Colombia. Using Oxford Nanopore's Heat Shock Protein 70 sequencing, we identified Leishmania species and profiled microbiota in CL lesions and corresponding healthy limbs. Illumina sequencing of 16S-rRNA and 18S-rRNA genes helped analyze prokaryotic and eukaryotic communities. Our research uncovered a spatial-temporal overlap between regions of high CL incidence and our sampling locations, indicating the coexistence of various Leishmania species. L. naiffi emerged as a noteworthy discovery. In addition, our study delved into the changes in skin microbiota associated with CL lesions sampled by scraping compared with healthy skin sampled by brushing of upper and lower limbs. We observed alterations in microbial diversity, both in prokaryotic and eukaryotic communities, within the lesioned areas, signifying the potential role of microbiota in CL pathogenesis. The significant increase in specific bacterial families, such as Staphylococcaceae and Streptococcaceae, within CL lesions indicates their contribution to local inflammation. In essence, our study contributes to the ongoing research into CL, highlighting the need for a multifaceted approach to decipher the intricate interactions between Leishmaniasis and the skin microbiota.
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Affiliation(s)
- Jesús Jaimes
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Luz Helena Patiño
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Giovanny Herrera
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Claudia Cruz
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Julie Pérez
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Camilo A. Correa-Cárdenas
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Marina Muñoz
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
- Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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Moreira A, Santos Hernández DA, Caceros V, Barahona KC, Campos F, Reyes WA, Blanco A, Soto T, Ramirez J, Mejias R, Cruz C, Lovo EE. Dual-Target Radiosurgery for Concomitant Continuous Pain Presentation of Trigeminal Neuralgia: Radiomodulation Effect and Dose. Cureus 2024; 16:e51602. [PMID: 38313895 PMCID: PMC10836852 DOI: 10.7759/cureus.51602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 02/06/2024] Open
Abstract
OBJECTIVES Patients with trigeminal neuralgia (TN) experience concomitant continuous pain (CCP) that can be difficult to treat. A dual-target approach delivering a high dose of radiation to the nerve and the contralateral thalamus can develop a fast radiomodulation effect on lowering pain. We sought to determine if this effect was dose dependent. METHODS We retrospectively reviewed 21 patients treated with radiosurgery in CCP and severe TN pain, with a visual analog scale (VAS) score of nine out of 10 at the time of treatment. Ten patients were treated with a high dose (>120 Gy) in the thalamus 90 Gy to the nerve, and the rest with a low dose (<120 Gy) to the thalamus and >90 Gy to the nerve. RESULTS Of those who received the high dose to the thalamus, six patients (60%) received 140 Gy, and four (40%) received 120 Gy, with a median dose to the trigeminal nerve of 90 and 85 Gy, respectively. The high thalamus dose showed a radiomodulation effect from day 1. The low thalamus dose did not produce radiomodulation on any of the first four days. The percentage of VAS score reduction one month after treatment was higher in the high-thalamus dose group than in the low-thalamus dose group. At three months, VAS score was 2 in the high-dose group and 4 in the low-dose group. CONCLUSIONS The radiomodulation effect in pain and dual-target radiosurgery is dose dependent in CCP in TN; a high dose can provide a more consistent clinical result than a lower dose.
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Affiliation(s)
| | | | - Victor Caceros
- Radiation Oncology, International Cancer Center, San Salvador, SLV
| | - Kaory C Barahona
- Radiation Oncology, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Fidel Campos
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - William A Reyes
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | | | - Tatiana Soto
- Radiation, Robotic Radiosurgery Center, San Jose, CRI
| | - Juliana Ramirez
- Radiosurgery, Centro de Radiocirugia Robotica, San Jose, CRI
| | - Ricardo Mejias
- Medical Physics, Robotic Radiosurgery Center, San Jose, CRI
| | - Claudia Cruz
- Anesthesia and Pain Management, Hospital De Diagnóstico, San Salvador, SLV
| | - Eduardo E Lovo
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
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Gaspar A, Moura AL, Cruz C, Borrego LM. Polythylene glycol severe allergy and SARS-CoV-2 vaccines: usefulness of testing with PEG 1500 extract. Eur Ann Allergy Clin Immunol 2023; 55:261-270. [PMID: 36458507 DOI: 10.23822/eurannaci.1764-1489.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Summary Background. Polyethylene glycol (PEG) is being used for first time as an excipient for mRNA anti-SARS-CoV-2 vaccines containing PEG 2000, highlighting it as a potential cause of anaphylaxis. Methods. We evaluated 126 patients with moderate-high risk of allergy to SARS-CoV-2 vaccines referred to our department from March-December 2021. Skin tests were performed with PEG 1500 extract (Roxall), using a stepwise approach, with readings at 30 minutes: prick tests with 0.1%, 1% and 10% concentrations; if negative, intradermal tests with 0.0001%, 0.001% and 0.01% concentrations. The same protocol was applied to 5 healthy controls Results. Six patients had positive immediate intradermal tests with PEG 1500, all with severe PEG allergy: one with a near-fatal anaphylaxis after glucocorticoid injection containing PEG 3350 and five with systemic allergic reactions after mRNA vaccines containing PEG 2000 (Pfizer-BioNTech or Moderna). One patient developed anaphylaxis during intradermal test. These six patients were negative to polysorbate 80. The remaining 120 patients had negative tests to PEG 1500; seven had positive tests to polysorbate 80. All controls had negative tests. Conclusions. To our knowledge this is the first study describing the allergy work-up testing with PEG 1500 commercial extract in the scope of SARS-CoV-2 vaccination. The algorithm designed for skin tests revealed to be a useful tool. Severe PEG allergy was diagnosed in 5% of patients, contraindicating PEG-containing vaccines. PEG allergy was excluded in one hundred patients that afterwards took SARS-CoV-2 vaccines containing PEG 2000. Investigation should be conducted in specialized drug allergy centers..
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Affiliation(s)
- A Gaspar
- Department of Immunoallergy, Hospital da Luz Lisboa, Lisbon, Portugal
| | - A L Moura
- Department of Immunoallergy, Hospital da Luz Lisboa, Lisbon, Portugal
| | - C Cruz
- Department of Immunoallergy, Hospital da Luz Lisboa, Lisbon, Portugal
| | - L M Borrego
- Department of Immunoallergy, Hospital da Luz Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School Research, Universidade Nova de Lisboa, Lisbon, Portugal
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Tran T, Cruz C, Chan A, Awad S, Rajasingh J, Deth R, Gurusamy N. Mesenchymal Stem Cell-Derived Long Noncoding RNAs in Cardiac Injury and Repair. Cells 2023; 12:2268. [PMID: 37759491 PMCID: PMC10527806 DOI: 10.3390/cells12182268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Cardiac injury, such as myocardial infarction and heart failure, remains a significant global health burden. The limited regenerative capacity of the adult heart poses a challenge for restoring its function after injury. Mesenchymal stem cells (MSCs) have emerged as promising candidates for cardiac regeneration due to their ability to differentiate into various cell types and secrete bioactive molecules. In recent years, attention has been given to noncoding RNAs derived from MSCs, particularly long noncoding RNAs (lncRNAs), and their potential role in cardiac injury and repair. LncRNAs are RNA molecules that do not encode proteins but play critical roles in gene regulation and cellular responses including cardiac repair and regeneration. This review focused on MSC-derived lncRNAs and their implications in cardiac regeneration, including their effects on cardiac function, myocardial remodeling, cardiomyocyte injury, and angiogenesis. Understanding the molecular mechanisms of MSC-derived lncRNAs in cardiac injury and repair may contribute to the development of novel therapeutic strategies for treating cardiovascular diseases. However, further research is needed to fully elucidate the potential of MSC-derived lncRNAs and address the challenges in this field.
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Affiliation(s)
- Talan Tran
- Department of Pharmaceutical Sciences, Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, USA
| | - Claudia Cruz
- Department of Pharmaceutical Sciences, Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, USA
| | - Anthony Chan
- Department of Pharmaceutical Sciences, Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, USA
| | - Salma Awad
- Department of Pharmaceutical Sciences, Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, USA
| | - Johnson Rajasingh
- Department of Bioscience Research, University of Tennessee Health Science Center, 847 Monroe Avenue, Memphis, TN 38163, USA
| | - Richard Deth
- Department of Pharmaceutical Sciences, Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, USA
| | - Narasimman Gurusamy
- Department of Pharmaceutical Sciences, Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, USA
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Jones HE, Cruz C, Stewart C, Losken A. Decision Regret in Plastic Surgery: A Summary. Plast Reconstr Surg Glob Open 2023; 11:e5098. [PMID: 37383479 PMCID: PMC10299769 DOI: 10.1097/gox.0000000000005098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/10/2023] [Indexed: 06/30/2023]
Abstract
Patient decision regret can occur following elective healthcare decisions. The current era is focused on patient-reported outcomes, and decision regret is another metric by which surgeons can and should measure postoperative results. Patients who experience decision regret after elective procedures can often blame themselves, the surgeon, or the clinical practice, and this can lead to downstream psychological and economic consequences for all parties involved. Methods A literature search was conducted on PubMed using the following search terms: (aesthetic surgery) AND (decision regret), (rhinoplasty) AND (decision regret), (face-lift) AND (decision regret), (abdominoplasty) AND (decision regret), (breast augmentation) AND (decision regret), (breast reconstruction) AND (decision regret), (FACE-Q) AND (rhinoplasty), (BREAST-Q) AND (breast augmentation). The following article types were included in the search: randomized controlled trials, meta-analysis, and systematic reviews. Results After review of the literature, preoperative education, decisional tools, and postoperative complications were found to be the most important factors affecting decision regret after surgery. Conclusions A better understanding of the factors associated with decision regret can help surgeons provide more effective preoperative counseling and prevent postoperative decision regret. Plastic surgeons can use these tools within a context of shared decision-making and ultimately increase patient satisfaction. Decision regret for plastic surgical procedures was mainly in the context of breast reconstruction. The differences in medical necessity create unique psychological challenges, emphasizing the need for more studies and a better understanding of the topic for other elective and cosmetic surgery procedures.
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Affiliation(s)
| | - Claudia Cruz
- Department of Surgery, Florida State University College of Medicine, Tallahassee, Fla
| | | | - Albert Losken
- Department of Surgery, Florida State University College of Medicine, Tallahassee, Fla
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, Wilkinson A, Mohamed A, Clark S, Duncan L, Ahmed IM, Khatiwada D, Mccarrick A, Wanda I, Read P, Afsar A, Rivers V, Theobald T, Cercek M, Bell S, Buckman C, Francis R, Peters G, Stables R, Morgan M, Noorzadeh M, Taylor B, Twiss S, Widdows P, Brozmannová D, Wilkinson V, Black M, Clark A, Clarkson N, Currie J, George L, Mcgee C, Izzat L, Lewis T, Omar Z, Aytekin V, Phillips S, Ahmed F, Mackie S, Oommen A, Phillips H, Sherwood M, Aleti S, Charles T, Jose M, Kolakaluri L, Ingabire P, Karoudi RA, Deery J, Hazelton T, Knight A, Price C, Turney S, Kardos A, Williams F, Wren L, Bega G, Alyavi B, Scaletta D, Kunadian V, Cullen K, Jones S, Kirkup E, Ripley DP, Matthews IG, Mcleod A, Runnett C, Thomas HE, Cartasegna L, Gunarathne A, Burton J, King R, Quinn J, Sobolewska J, Munt S, Porter J, Christenssen V, Leng K, Peachey T, Gomez VN, Temple N, Wells K, Viswanathan G, Taneja A, Cann E, Eglinton C, Hyams B, Jones E, Reed F, Smith J, Beltrano C, Affleck DC, Turner A, Ward T, Wilmshurst N, Stirrup J, Brunton M, Whyte A, Smith S, Murray V, Walker R, Novas V, Weston C, Brown C, Collier D, Curtis K, Dixon K, Wells T, Trim F, Ghosh J, Mavuri M, Barman L, Dumont C, Elliott K, Harrison R, Mallinson J, Neale T, Smith J, Toohie J, Turnbull A, Parker E, Hossain R, Cheeseman M, Balparda H, Hill J, Hood M, Hutchinson D, Mellows K, Pendlebury C, Storey RF, Barker J, Birchall K, Denney H, Housley K, Cardona M, Middle J, Kukreja N, Gati S, Kirk P, Lynch M, Srinivasan M, Szygula J, Baker P, Cruz C, Derigay J, Cigalini C, Lamb K, Nembhard S, Price A, Mamas M, Massey I, Wain J, Delaney J, Junejo S, Martin K, Obaid D, Hoyle V, Brinkworth E, Davies C, Evans D, Richards S, Thomas C, Williams M, Dayer M, Mills H, Roberts K, Goodchild F, Dámaso ES, Greig N, Kundu S, Donaldson D, Tonks L, Beekes M, Button H, Hurford F, Motherwell N, Summers-Wall J, Felmeden D, Tapia V, Keeling P, Sheikh U, Yonis A, Felmeden L, Hughes D, Micklewright L, Summerhayes A, Sutton J, Panoulas V, Prendergast C, Poghosyan K, Rogers P, Barker LN, Batin P, Conway D, Exley D, Fletcher A, Wright J, Nageh T, Hadebe B, Kunhunny S, Mkhitaryan S, Mshengu E, Karthikeyan VJ, Hamdan H, Cooper J, Dandy C, Parkinson V, Paterson P, Reddington S, Taylor T, Tierney C, Adamyan M, Jones KV, Broadley A, Beesley K, Buckley C, Hellyer C, Pippard L, Pitt-Kerby T, Azam J, Hayes C, Freshwater K, Boyadjian S, Johnson L, Mcgill Y, Redfearn H, Russell M, Alyavi A, Alyavi B, Uzokov J, Hayrapetyan H, Azaryan K, Tadevosyan M, Poghosyan H, Kzhdryan H, Vardanyan A, Huber K, Geppert A, Ahmed A, Weidinger F, Derntl M, Hasun M, Schuh-Eiring T, Riegler L, Haq MM, Cader FA, Dewan MAM, Fatema ME, Hasan AS, Islam MM, Khandoker F, Mayedah R, Nizam SU, Azam MG, Arefin MM, Jahan J, Schelfaut D, De Raedt H, Wouters S, Aerts S, Batjoens H, Beauloye C, Dechamps M, Pierard S, Van Caenegem O, Sinnaeve F, Claeys MJ, Snepvangers M, Somers V, Gevaert S, Schaubroek H, Vervaet P, Buysse M, Renders F, Dumoulein M, Hiltrop N, De Coninck M, Naessens S, Senesael I, Hoffer E, Pourbaix S, Beckers J, Dugauquier C, Jacquet S, Malmendier D, Massoz M, Evrard P, Collard L, Brunner P, Carlier S, Blockmans M, Mayne D, Timiras E, Guédès A, Demeure F, Hanet C, Domange J, Jourdan K, Begic E, Custovic F, Dozic A, Hrvat E, Kurbasic I, Mackic D, Subo A, Durak-Nalbantic A, Dzubur A, Rebic D, Hamzic-Mehmedbasic A, Redzepovic A, Djokic-Vejzovic A, Hodzic E, Hujdur M, Musija E, Gljiva-Gogic Z, Serdarevic N, Bajramovic NS, Brigic L, Halilcevic M, Cibo M, Hadžibegic N, Kukavica N, Begic A, Iglica A, Osmanagic A, Resic N, Grgurevic MV, Zvizdic F, Pojskic B, Mujaric E, Selimovic H, Ejubovic M, Pojskic L, Stimjanin E, Sut M, Zapata PS, Munoz CG, Andrade LAF, Upegui MPT, Perez LE, Chavarria J, Quesada D, Alvarado K, Zaputovic L, Tomulic V, Gobic D, Jakljevic T, Lulic D, Bacic G, Bastiancic L, Avraamides P, Eftychiou C, Eteocleous N, Ioannou A, Lambrianidi C, Drakomathioulakis M, Groch L, Hlinomaz O, Rezek M, Semenka J, Sitar J, Beranova M, Kramarikova P, Pesl L, Sindelarova S, Tousek F, Warda HM, Ghaly I, Habiba S, Habib A, Gergis MN, Bahaa H, Samir A, Taha HSE, Adel M, Algamal HM, Mamdouh M, Shaker AF, Shokry K, Konsoah A, Mostafa AM, Ibrahim A, Imam A, Hafez B, Zahran A, Abdelhamid M, Mahmoud K, Mostafa A, Samir A, Abdrabou M, Kamal A, Sallam S, Ali A, Maghraby K, Atta AR, Saad A, Ali M, Lotman EM, Lubi R, Kaljumäe H, Uuetoa T, Kiitam U, Durier C, Ressencourt O, El Din AA, Guiatni A, Bras ML, Mougenot E, Labeque JN, Banos JL, Capendeguy O, Mansourati J, Fofana A, Augagneur M, Bahon L, Pape AL, Batias-Moreau L, Fluttaz A, Good F, Prieur F, Boiffard E, Derien AS, Drapeau I, Roy N, Perret T, Dubreuil O, Ranc S, Rio S, Bonnet JL, Bonnet G, Cuisset T, Deharo P, Mouret JP, Spychaj JC, Blondelon A, Delarche N, Decalf V, Guillard N, Hakme A, Roger MP, Biron Y, Druelles P, Loubeyre C, Lucon A, Hery P, Nejjari M, Digne F, Huchet F, Neykova A, Tzvetkov B, Larrieu M, Quaino G, Armangau P, Sauguet A, Bonfils L, Dumonteil N, Fajadet J, Farah B, Honton B, Monteil B, Philippart R, Tchetche D, Cottin M, Petit F, Piquart A, Popovic B, Varlot J, Maisuradze D, Sagirashvili E, Kereselidze Z, Totladze L, Ginturi T, Lagvilava D, Hamm C, Liebetrau C, Haas M, Hamm C, Koerschgen T, Weferling M, Wolter JS, Maier K, Nickenig G, Sedaghat A, Zachoval C, Lampropoulos K, Mpatsouli A, Sakellaropoulou A, Tyrovolas K, Zibounoumi N, Argyropoulos K, Toulgaridis F, Kolyviras A, Tzanis G, Tzifos V, Milkas A, Papaioannou S, Kyriazopoulos K, Pylarinou V, Kontonassakis I, Kotakos C, Kourgiannidis G, Ntoliou P, Parzakonis N, Pipertzi A, Sakalidis A, Ververeli CL, Kafkala K, Sinanis T, Diakakis G, Grammatikopoulos K, Papoutsaki E, Patialiatos T, Mamaloukaki M, Papadaki ST, Kanellos IE, Antoniou A, Tsinopoulos G, Goudis C, Giannadaki M, Daios S, Petridou M, Skantzis P, Koukis P, Dimitriadis F, Savvidis M, Styliadis I, Sachpekidis V, Pilalidou A, Stamatiadis N, Fotoglidis A, Karakanas A, Ruzsa Z, Becker D, Nowotta F, Gudmundsdottir I, Libungan B, Skuladottir FB, Halldorsdottir H, Shetty R, Iyengar S, Bs C, G S, Lakshmana S, S R, Tripathy N, Sinha A, Choudhary B, Kumar A, Kumar A, Raj R, Roy RS, Dharma S, Siswanto BB, Farhan HA, Yaseen IF, Al-Zaidi M, Dakhil Z, Amen S, Rasool B, Rajeeb A, Amber K, Ali HH, Al-Kinani T, Almyahi MH, Al-Obaidi F, Masoumi G, Sadeghi M, Heshmat-Ghahdarijani K, Roohafza H, Sarrafzadegan N, Shafeie M, Teimouri-Jervekani Z, Noori F, Kyavar M, Sadeghipour P, Firouzi A, Alemzadeh-Ansari MJ, Ghadrdoost B, Golpira R, Ghorbani A, Ahangari F, Salarifar M, Jenab Y, Biria A, Haghighi S, Mansouri P, Yadangi S, Kornowski R, Orvin K, Eisen A, Oginetz N, Vizel R, Kfir H, Pasquale GD, Casella G, Cardelli LS, Filippini E, Zagnoni S, Donazzan L, Ermacora D, Indolfi C, Polimeni A, Curcio A, Mongiardo A, De Rosa S, Sorrentino S, Spaccarotella C, Landolina M, Marino M, Cacucci M, Vailati L, Bernabò P, Montisci R, Meloni L, Marchetti MF, Biddau M, Garau E, Barbato E, Morisco C, Strisciuglio T, Canciello G, Lorenzoni G, Casu G, Merella P, Novo G, D'Agostino A, Di Lisi D, Di Palermo A, Evola S, Immordino F, Rossetto L, Spica G, Pavan D, Mattia AD, Belfiore R, Grandis U, Vendrametto F, Spagnolo C, Carniel L, Sonego E, Gaudio C, Barillà F, Biccire FG, Bruno N, Ferrari I, Paravati V, Torromeo C, Galasso G, Peluso A, Prota C, Radano I, Benvenga RM, Ferraioli D, Anselmi M, Frigo GM, Sinagra G, Merlo M, Perkan A, Ramani F, Altinier A, Fabris E, Rinaldi M, Usmiani T, Checco L, Frea S, Mussida M, Matsukawa R, Sugi K, Kitai T, Furukawa Y, Masumoto A, Miyoshi Y, Nishino S, Assembekov B, Amirov B, Chernokurova Y, Ibragimova F, Mirrakhimov E, Ibraimova A, Murataliev T, Radzhapova Z, Uulu ES, Zhanyshbekova N, Zventsova V, Erglis A, Bondare L, Zaliunas R, Gustiene O, Dirsiene R, Marcinkeviciene J, Sakalyte G, Virbickiene A, Baksyte G, Bardauskiene L, Gelmaniene R, Salkauskaite A, Ziubryte G, Kupstyte-Kristapone N, Badariene J, Balciute S, Kapleriene L, Lizaitis M, Marinskiene J, Navickaite A, Pilkiene A, Ramanauskaite D, Serpytis R, Silinskiene D, Simbelyte T, Staigyte J, Philippe F, Degrell P, Camus E, Ahmad WAW, Kassim ZA, Xuereb RG, Buttigieg LL, Camilleri W, Pllaha E, Xuereb S, Popovici M, Ivanov V, Plugaru A, Moscalu V, Popovici I, Abras M, Ciobanu L, Litvinenco N, Fuior S, Dumanschi C, Ivanov M, Danila T, Grib L, Filimon S, Cardaniuc L, Batrinac A, Tasnic M, Cozma C, Revenco V, Sorici G, Dagva M, Choijiljav G, Dandar E, Khurelbaatar MU, Tsognemekh B, Appelman Y, Den Hartog A, Kolste HJT, Van Den Buijs D, Van'T Hof A, Pustjens T, Houben V, Kasperski I, Ten Berg J, Azzahhafi J, Bor W, Yin DCP, Mbakwem A, Amadi C, Kushimo O, Kilasho M, Oronsaye E, Bakracheski N, Bashuroska EK, Mojsovska V, Tupare S, Dejan M, Jovanoska J, Razmoski D, Marinoski T, Antovski A, Jovanovski Z, Kocho S, Markovski R, Ristovski V, Samir AB, Biserka S, Kalpak O, Peovska IM, Taleska BZ, Pejkov H, Busljetik O, Zimbakov Z, Grueva E, Bojovski I, Tutic M, Poposka L, Vavlukis M, Al-Riyami A, Nadar SK, Abdelmottaleb W, Ahmed S, Mujtaba MS, Al-Mashari S, Al-Riyami H, Laghari AH, Faheem O, Ahmed SW, Qamar N, Furnaz S, Kazmi K, Saghir T, Aneel A, Asim A, Madiha F, Sobkowicz B, Tycinska A, Kazimierczyk E, Szyszkowska A, Mizia-Stec K, Wybraniec M, Bednarek A, Glowacki K, Prokopczuk J, Babinski W, Blachut A, Kosiak M, Kusinska A, Samborski S, Stachura J, Szastok H, Wester A, Bartoszewska D, Sosnowska-Pasiarska B, Krzysiek M, Legutko J, Nawrotek B, Kasprzak JD, Klosinska M, Wiklo K, Kurpesa M, Rechcinski T, Cieslik-Guerra U, Gierlotka M, Bugajski J, Feusette P, Sacha J, Przybylo P, Krzesinski P, Ryczek R, Karasek A, Kazmierczak-Dziuk A, Mielniczuk M, Betkier-Lipinska K, Roik M, Labyk A, Krakowian M, Machowski M, Paczynska M, Potepa M, Pruszczyk P, Budaj A, Ambroziak M, Omelanczuk-Wiech E, Torun A, Opolski G, Glowczynska R, Fojt A, Kowalik R, Huczek Z, Jedrzejczyk S, Roleder T, Brust K, Gasior M, Desperak P, Hawranek M, Farto-Abreu P, Santos M, Baptista S, Brizida L, Faria D, Loureiro J, Magno P, Monteiro C, Nédio M, Tavares J, Sousa C, Almeida I, Almeida S, Miranda H, Santos H, Santos AP, Goncalves L, Monteiro S, Baptista R, Ferreira C, Ferreira J, Goncalves F, Lourenço C, Monteiro P, Picarra B, Santos AR, Guerreiro RA, Carias M, Carrington M, Pais J, de Figueiredo MP, Rocha AR, Mimoso J, De Jesus I, Fernandes R, Guedes J, Mota T, Mendes M, Ferreira J, Tralhão A, Aguiar CT, Strong C, Da Gama FF, Pais G, Timóteo AT, Rosa SAO, Mano T, Reis J, Selas M, Mendes DE, Satendra M, Pinto P, Queirós C, Oliveira I, Reis L, Cruz I, Fernandes R, Torres S, Luz A, Campinas A, Costa R, Frias A, Oliveira M, Martins V, Castilho B, Coelho C, Moura AR, Cotrim N, Dos Santos RC, Custodio P, Duarte R, Gomes R, Matias F, Mendonca C, Neiva J, Rabacal C, Almeida AR, Caeiro D, Queiroz P, Silva G, Pop-Moldovan AL, Darabantiu D, Mercea S, Dan GA, Dan AR, Dobranici M, Popescu RA, Adam C, Sinescu CJ, Andrei CL, Brezeanu R, Samoila N, Baluta MM, Pop D, Tomoaia R, Istratoaie O, Donoiu I, Cojocaru A, Oprita OC, Rocsoreanu A, Grecu M, Ailoaei S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Marques C, Cabrita A, Maia Araujo P, Proenca T, Pinto R, Carvalho M, Costa C, Amador AF, Calvao J, Pinho A, Oliveira C, Santos L, Cruz C, Macedo F. Patient delay in acute myocardial infarction: a long journey still ahead. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
It is overly known that time delays in acute myocardial infarction (AMI) strongly influence its outcomes. Patient delay (PD) is repeatedly pointed out as the longer one in this context, as well as it is the less modifiable one by organizational measures. Therefore, it is crucial to understand the reasons for longer PD in our population, to define proper strategies to improve PD and, ultimately, AMI-outcomes.
Methods
In this six-month prospective study of patients (pts) admitted in a tertiary hospital due to type-1 AMI, 194 pts were consecutively enrolled between May and October 2021. Data was based on a pts well-structured interview within 48h after admission and review of medical records.
Results
Our work spotted several aspects significantly influencing PD in AMI context (Figure 1). Concerning pts cardiovascular background, a trend towards a shorter PD was found in pts with at least one cardiovascular risk factor (CVRF) (p=0,08) and with a previous history of AMI (p=0,08). Regarding clinical presentation, a significantly shorter PD was found in pts presenting with associated symptoms (p=0,02), higher chest pain intensity (chest pain intensity ≥7 vs <7 in a 0–10 scale; p=0,03) and symptoms onset on weekdays rather than weekends (p=0,003). Regarding pts knowledge, significant differences were found when pts recognized their symptoms as AMI, presenting a shorter PD in this context (p=0,006). Curiously, pts ability to correctly identify AMI symptoms, when asked, or to acknowledge their CVRF (when present), did not influence PD. Considering sociodemographic factors, higher incomes (p=0,03) and non-rural residence (p=0,03) significantly translated into shorter PD. No differences were found in PD according to pts age, gender or educational level. After this initial univariate analysis, multiple linear regression was performed to identify possible predictors of PD. Four variables were identified: pts ability to recognize their symptoms as AMI (β −0.199; 95% CI: −277 to −34,87; p=0.012), living in a non-rural residence (β 0.154; 95% CI: 0.12–161.44; p=0.05), presenting associated symptoms (β −0.194; 95% CI: −257.43 to −28.84; p=0.014) and occurrence of symptoms on weekdays (β 0.170; 95% CI: 12.73–259.49; p=0.031) predicted shorter patient delays.
Conclusion
Our study clearly points to the need for increasing public awareness and educational measures, mainly in pts living in rural areas, in order to: 1) Improve pts knowledge about AMI symptoms, clarifying that atypical symptoms can happen; 2) Reinforce the importance of shortening AMI time delays, clearly explaining the concept “time is muscle”.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Marques
- Sao Joao Hospital , Porto , Portugal
| | - A Cabrita
- Sao Joao Hospital , Porto , Portugal
| | | | - T Proenca
- Sao Joao Hospital , Porto , Portugal
| | - R Pinto
- Sao Joao Hospital , Porto , Portugal
| | | | - C Costa
- Sao Joao Hospital , Porto , Portugal
| | | | - J Calvao
- Sao Joao Hospital , Porto , Portugal
| | - A Pinho
- Sao Joao Hospital , Porto , Portugal
| | | | - L Santos
- Sao Joao Hospital , Porto , Portugal
| | - C Cruz
- Sao Joao Hospital , Porto , Portugal
| | - F Macedo
- Sao Joao Hospital , Porto , Portugal
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Haramati L, Ortiz D, Serrano M, Cruz C, Torres J, Seu R, Chudgar N, Kalnicki S, Stiles B. EP01.04-001 A Programmatic Approach to Improve Efficiency in Lung Cancer Screening. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Lovo EE, Moreira A, Cruz C, Carvajal G, Barahona KC, Caceros V, Blanco A, Mejias R, Alho E, Soto T. Radiomodulation in Mixed, Complex Cancer Pain by Triple Target Irradiation in the Brain: A Preliminary Experience. Cureus 2022; 14:e25430. [PMID: 35774662 PMCID: PMC9236678 DOI: 10.7759/cureus.25430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Up to 30% of terminally ill cancer patients experiencing intense pain might be refractory to opioid treatment. Complex cancer pain can be a mixture of somatic, visceral, and neuropathic pain with few or no effective alternatives to ameliorate pain. Radiosurgery to treat refractory pain in cancer has been reported with different degrees of success. Radiomodulation in pain could be defined as a fast (<72 h), substantial (>50%) pain relief by focal irradiation to a peripheric, and/or central mediated pain circuitry. Based on our previous experience, mixed, refractory cancer pain is usually unresponsive to single target irradiation of the hypophysis. We treated three patients using a multi-target approach. Methods Three terminally ill oncological patients experiencing refractory, complex, mixed pain from bone, abdomen, thorax, and brachial plexus were treated with triple target irradiation which consisted of irradiating with a maximum dose (Dmax) of 90 Gy to the hypophysis using either an 8 mm collimator with gamma ray (Infini) (Shenzhen, China: Masep Medical Company) or a 7.5 circular collimator with Cyberknife (Sunnyvale, CA: Accuray Inc.), the other two targets were the mesial structures of the thalamus bilaterally using a 4 mm collimator with Infini and the 5 mm circular collimator with CK delivering 90 Gy Dmax to each region. Patients had a VAS of 10 despite the best medical treatment. A correlation was made between the 45 Gy and 20 Gy isodose curves of the two different technologies to the Morel stereotactic atlas of the thalamus and basal ganglia for further understanding of dose distribution reconstructions in accordance with the São Paulo-Würzburg atlas of the Human Brain Project were performed. Lastly, a scoping review of the literature regarding radiosurgery for oncological pain was performed. Results Radiomodulation effect was achieved in all patients; case 1 had a VAS of five at 72 h, three at 15 days, and three at the time of death (21 days after treatment). Case 2 had a VAS of six at 72 h, five at 15 days, and four at the time of death (29 days after treatment). Case 3 had a VAS of five at 72 h, six at 15 days, and six at the time of death (30 days). Morphine rescues for cases 1 and 2 were reduced to 84%, and 70% for case 3. Overall, there were no adverse effects to treatment although excessive sleepiness was reported by one patient. After reading the title and abstract, only 14 studies remained eligible for full-text evaluation, and only nine studies met inclusion criteria after full-text reading. For most reports (seven), the target was the hypophysis and in two reports, the target was the thalamus either with single or bilateral irradiation. Conclusions In complex, for refractory oncological pain of mixed nature (nociceptive, neuropathic, and visceral), very few, if any, treatment alternatives are currently available. We provide a small proof of concept that multitarget intracranial radiosurgery might be effective in ameliorating pain in this population. The doses administered per target are the lowest that have shown effectiveness thus far, a different strategy might be needed as opposed to single target “large” dose approach that has been tried in the past for complex mixed refractory oncological pain. By no means, in our experience, these treatments traduce in elimination of pain, clinical results might make pain to be more bearable and respond better to pain medication.
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Chaudhry K, Geiger A, Dowlati E, Lang H, Yvon E, Holdoff M, Jones R, Savoldo B, Cruz C, Bollard C. Immunotherapy: B7H3-CAR NK CELLS AND DNR CO-TRANSDUCED NK SHOWS MAINTAIN THEIR POTENCY AGAINST TGF-B MEDIATED IMMUNE SUPPRESSION. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00148-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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11
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Geiger A, Stanojevic M, Hont A, Lazarski C, Datar A, Lang H, Hanley P, Bollard C, Nazarian J, Hwang E, Cruz C. Immunotherapy: DEVELOPING OFF THE SHELF T CELL THERAPIES FOR HIGH-GRADE GLIOMAS. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00308-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Muacevic A, Adler JR, Barahona KC, Caceros V, Cruz C, Arias J. Radioneuromodulation by Dual-Target Irradiation in Pain Crisis From Trigeminal Neuralgia. Cureus 2022; 14:e20971. [PMID: 35004092 PMCID: PMC8730795 DOI: 10.7759/cureus.20971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 01/09/2023] Open
Abstract
Background Radioneuromodulation (RNM) can explain the immediate pain relief experienced by a subgroup of patients after stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). In this study, our main objective was to demonstrate that a minimum of a 50% reduction in TN pain can be achieved consistently in under 72 hours by targeting the affected nerve, the contralateral centromedian nucleus, and parafascicular complex in patients experimenting a prolonged refractory pain crisis. Methodology We treated eight patients experiencing severe TN pain crisis in whom percutaneous procedures had failed or were unwanted with SRS with an intention to procure pain relief in under 72 hours. The affected trigeminal nerve was targeted using a 4-mm collimator with an 80 to 90-Gy dose; an additional target was defined in the mesial portions of the thalamus and irradiated using the 4-mm collimator with a 120 to 140-Gy dose. Results The median duration of TN was 60 months, the median duration of pain crisis was 10.7 weeks despite the best medical treatment, and the mean presenting visual analogue score (VAS) was 10 at the time of treatment. The median follow-up was 135 days (range, 65-210). Twenty-four hours after treatment, two (25%) patients had no pain (VAS 0), three (37.5%) had mild pain (VAS 1 to 3), and three (37.5%) had moderate pain (VAS 4 to 7). Forty-eight hours after treatment, all patients reported pain relief, seven (87.5%) reported >50%, and one (12.5%) patients reported 30% relief. The three-month median VAS score was 3 (range, 0 to 5). At the last follow-up, there were no adverse events to report. Conclusions Dual irradiation to the affected trigeminal nerve and contralateral mesial structures of the thalamus may provide fast pain relief for patients experiencing a prolonged pain crisis from TN, which veers away from the concept that the SRS pain relief effect is generally delayed and holds no place in the management of such patients. Although this is a small series with a limited follow-up duration, no adverse effects were noted. RNM can be defined as the capacity to alter neuronal activity through targeted delivery of a stimulus of radiation at a duration too brief to be explained by the development of a focal lesion. The immediate pain relief and its habitual oscillatory nature of lesser pain recurrence in most patients until enough time elapses for pain stabilization clinically demonstrates that the pain circuitry is altered and remains functional, thus accomplishing a neuromodulation effect even at the face of an apparent doses suspected to be ablative. Further research is needed to understand if this clinical effect is achieved with a suspected sub-ablative dose.
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Affiliation(s)
| | | | - Kaory C Barahona
- Radiation Oncology, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Victor Caceros
- Radiation Oncology, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Claudia Cruz
- Pain Management, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Juan Arias
- Pain Management, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
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Fox A, Widmer F, Barreiro A, Jongen M, Musyoki M, Vieira Â, Zimmermann J, Cruz C, Dimitrova-Mårtensson LM, Rasche F, Silva L, Lüscher A. Small-scale agricultural grassland management can affect soil fungal community structure as much as continental scale geographic patterns. FEMS Microbiol Ecol 2021; 97:6430861. [PMID: 34792119 PMCID: PMC8684450 DOI: 10.1093/femsec/fiab148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
A European transect was established, ranging from Sweden to the Azores, to determine the relative influence of geographic factors and agricultural small-scale management on the grassland soil microbiome. Within each of five countries (factor ‘Country’), which maximized a range of geographic factors, two differing growth condition regions (factor ‘GCR’) were selected: a favorable region with conditions allowing for high plant biomass production and a contrasting less favorable region with a markedly lower potential. Within each region, grasslands of contrasting management intensities (factor ‘MI’) were defined: intensive and extensive, from which soil samples were collected. Across the transect, ‘MI’ was a strong differentiator of fungal community structure, having a comparable effect to continental scale geographic factors (‘Country’). ‘MI’ was also a highly significant driver of bacterial community structure, but ‘Country’ was clearly the stronger driver. For both, ‘GCR’ was the weakest driver. Also at the regional level, strong effects of MI occurred on various measures of the soil microbiome (i.e. OTU richness, management-associated indicator OTUs), though the effects were largely regional-specific. Our results illustrate the decisive influence of grassland MI on soil microbial community structure, over both regional and continental scales, and, thus, highlight the importance of preserving rare extensive grasslands.
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Affiliation(s)
- A Fox
- Forage Production and Grassland Systems, Agroscope, Reckenholzstrasse 191, Zürich, Switzerland.,Molecular Ecology, Agroscope, Reckenholzstrasse 191, Zürich, Switzerland
| | - F Widmer
- Molecular Ecology, Agroscope, Reckenholzstrasse 191, Zürich, Switzerland
| | - A Barreiro
- Swedish University of Agricultural Sciences, Department of Biosystems and Technology, P.O. Box 103, SE-230 53 Alnarp, Sweden
| | - M Jongen
- Centro de Ciência e Tecnologia do Ambiente e do Mar (MARETEC), Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, 1049-001 Lisboa, Portugal
| | - M Musyoki
- University of Hohenheim, Hans-Ruthenberg-Institute, Garbenstr. 13, 70599 Stuttgart, Germany
| | - Â Vieira
- InBIO - Research Network in Biodiversity and Evolutionary Biology, Associate Laboratory, CIBIO-Açores, Faculty of Sciences and Technology, University of the Azores, Campus de Ponta Delgada, Rua da Mãe de Deus, 9500-321 Ponta Delgada, Portugal
| | - J Zimmermann
- University of Hohenheim, Hans-Ruthenberg-Institute, Garbenstr. 13, 70599 Stuttgart, Germany
| | - C Cruz
- Centro de Ecologia, Evolução e Alterações Ambientais, (cE3c), FCUL, Campo Grande, Universidade de Lisboa, 1749-016 Lisboa, Portugal
| | - L-M Dimitrova-Mårtensson
- Swedish University of Agricultural Sciences, Department of Biosystems and Technology, P.O. Box 103, SE-230 53 Alnarp, Sweden
| | - F Rasche
- University of Hohenheim, Hans-Ruthenberg-Institute, Garbenstr. 13, 70599 Stuttgart, Germany
| | - L Silva
- InBIO - Research Network in Biodiversity and Evolutionary Biology, Associate Laboratory, CIBIO-Açores, Faculty of Sciences and Technology, University of the Azores, Campus de Ponta Delgada, Rua da Mãe de Deus, 9500-321 Ponta Delgada, Portugal
| | - A Lüscher
- Forage Production and Grassland Systems, Agroscope, Reckenholzstrasse 191, Zürich, Switzerland
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Alves Pinto R, Martins Carvalho M, Proenca T, Torres S, Grilo PD, Resende CX, Calvao J, Costa C, Amador AF, Marques C, Cabrita A, Cruz C, Macedo F. The world upside down – after 20 years follow-up of dextro-transposition of the great arteries. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Congenital Heart Disease (CHD) affects under 1% of newborns and thanks to its prognosis improvement, most patients survive until adulthood. Dextro-transposition of the great arteries (dTGA) is a CHD classically palliated with atrial switch (ATS) procedure and nowadays corrected with an arterial switch (ARS), with better clinical outcomes. Nevertheless, several post-ATS patients remain alive and questions persist regarding their long-term prognosis.
Purpose
To observe a group of dTGA patients followed in an Adult CHD outpatients clinic, access their comorbidities, surgical interventions, complications and clinical outcomes.
Methods
We retrospectively analyzed a group of dTGA patients born between 1974 and 2001. Clinical features were collected and time-to-event statistics were analyzed. Adverse event was defined as at least one of the follows: death, stroke, myocardial infarction or coronary revascularization, arrhythmia and ventricular, valvular or conduct dysfunction.
Results
A total of 80 patients were enrolled with a mean follow-up of 26 years after surgery: 46% were female, median age 27 (19–57) year-old. Concerning other concomitant defects, 25% had ventricular septal defect, 12% pulmonary stenosis, 3% aortic coarctation and 1% single coronary ostium. ATS palliation was performed in 54% of patients (Senning procedure in 95%) and ARS (Jatene procedure) in 45% of patients; median age at procedure was 13 months and 10 days, respectively. During follow-up, almost all patients submitted to ARS remained in sinus rhythm (97%) versus 64% of ATS patients (p=0.037). The latter group had higher incidence of arrythmias (40% vs 3%, p=0.013), mostly atrial flutter or fibrillation (present in 28%), followed by bradyarrhythmia (10%); median time from surgery to first arrhythmic event in these patients was 23 years. Also, systemic ventricle systolic dysfunction (SVSD) and chronotropic incompetence were significantly higher in ATS (41% vs 3%, p<0.001 and 46% vs 9%, p=0.005, respectively); mean time to SVSD was 29 years. In respect to long-term outcomes in ARS, the most frequent complications were moderate to severe aortic regurgitation, pulmonary stenosis and regurgitation, occurring in 21%, 7% and 3%, respectively. Concerning both groups, mean time to first adverse-event was 21 years. Regarding gender and demographic features, there were no differences in time-to-adverse-event, comparing patients living in urban versus rural neighbourhoods and female versus male (Log Rank, p=0.368 and p=0.693). Only one patient died, submitted to ATS, at 46 years-old, from chronic heart failure.
Conclusion
After a long-term free of events, ATS patients experienced more arrhythmic complications and SVSD. ARS complications were anastomosis related. This report highlights the efforts that should be made to identify late complication is this particular population. Of note, no demographic or gender differences were observed.
Funding Acknowledgement
Type of funding sources: None. Gender analysis
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Affiliation(s)
| | | | | | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | | | | | - J Calvao
- Sao Joao Hospital, Porto, Portugal
| | - C Costa
- Sao Joao Hospital, Porto, Portugal
| | | | | | | | - C Cruz
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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Cobo B, Cruz C, Dick PC. Gender and racial inequalities in the access to and the use of Brazilian health services. Cien Saude Colet 2021; 26:4021-4032. [PMID: 34586256 DOI: 10.1590/1413-81232021269.05732021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/30/2021] [Indexed: 11/22/2022] Open
Abstract
This paper aims to evaluate gender and racial inequalities in the access and use of health services in Brazil Based on the 2019 National Health Survey (PNS). Its main objective is to understand how white, black, or brown men and women seek medical care in Primary Health Care, the gateway to the Brazilian health system. Analyses from a gender perspective show that cultural and social patterns affect individual actions and choices and mainly access to and use of health services. The results also show that men and women reproduce the expected gender behavior, socially and culturally constructed, which impacts their self-assessment of health status, care, and their exposure to the risk of disease and death. The intersectional analysis reveals that racial inequalities are aligned with those observed between men and women, exponentiating vulnerabilities for self-identified black or brown people, reflecting the structural socioeconomic inequalities of Brazilian society. In this context, the universality and integrality recommended in the Unified Health System contribute as a public policy to the guarantee of rights, equalization of opportunities, and adequate access to equal care.
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Affiliation(s)
- Barbara Cobo
- Escola Nacional de Ciências Estatísticas. R. André Cavalcanti 106, Centro. 20231-050 Rio de Janeiro RJ Brasil.
| | | | - Paulo C Dick
- Instituto Brasileiro de Geografia e Estatística. Rio de Janeiro RJ Brasil
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Serra Elizalde V, Llop-Guevara A, Pearson A, Cruz C, Castroviejo-Bermejo M, Chopra N, Tovey H, Toms C, Kriplani D, Gevensleben H, Roylance R, Chan S, Tutt A, Skene A, Evans A, Davies H, Bliss J, Nik-Zainal S, Balmaña J, Turner N. 1O Detection of homologous recombination repair deficiency (HRD) in treatment-naive early triple-negative breast cancer (TNBC) by RAD51 foci and comparison with DNA-based tests. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gorría T, Fernández-Mañas L, Auclin E, Reyes R, Castro RL, De Herreros MG, Cruz C, Viladot M, Ghiglione L, Seguí E, Ramírez J, Teixidó C, Sánchez M, Agustí C, Boada M, Antelo M, Castro P, Prat A, Viñolas N, Reguart N, Mezquita L. P09.28 Access to Intermediate and Intensive Care for Patients With Lung Cancer During the COVID-19 Period. J Thorac Oncol 2021. [PMCID: PMC7976939 DOI: 10.1016/j.jtho.2021.01.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cardoso Torres S, Resende CX, Diogo PG, Araujo P, Pinto RA, Proenca T, Carvalho JM, Amador AF, Costa C, Calvao J, Ribeiro V, Cruz C, Macedo F. Does age at aortic coarctation repair have an impact on left ventricle size and function? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Adults with repaired aortic coarctation (CoA) require lifelong follow-up due to late complications, including left ventricular (LV) myocardial dysfunction. Age at the time of CoA repair is an important prognostic factor in these patients (pts).
Purpose
To evaluate LV size, ejection fraction (EF) and global longitudinal strain (GLS) values using 2D speckle tracking echocardiography (STE) in a population of adult pts with repaired CoA and to assess the relationship between these echocardiographic parameters and age at the time of CoA repair.
Methods
Retrospective analysis of adult pts with repaired CoA, followed in a Grown Up Congenital Heart Disease Centre. Pts with hemodynamically significant concomitant cardiac lesions were ruled out. Epidemiologic and clinical data were obtained from clinical records. Transthoracic echocardiograms were reviewed in order to assess GLS using 2DSTE (Echopac Software, GE).
Results
The study population consisted of 63 pts (61.9% male), with a mean age of 35.3 years at the time of the echocardiographic evaluation. The mean age at the time of the CoA repair was 117 months (95% CI 89.8-144.1 months).
Surgical repair was performed in 46 pts (73%): resection with subclavian artery flap aortoplasty (n = 21); patch aortoplasty (n = 15) and head-to-head anastomosis (n = 10). In 10 pts there was no data regarding the type of surgical repair. Seven pts (11.1%) were submitted to percutaneous intervention (6 with aortic stent implantation and 1 with balloon aortic angioplasty).
Mean LVEF was 63.4% (CI 95% 55.6 – 71.2%) and mean LV end-diastolic diameter (LVEDD) was 50mm (CI 95% 43-57mm). Mean GLS was - 17.3 (CI 95% 14.8- 19.8), which is inferior to the mean normal values reported for the software used.
Age at the time of CoA repair had a statistically significant positive linear relationship with LVEDD (r= 0.282; p= 0.026) and a linear negative relationship with both GLS (r= -0,29; p= 0.022) and LVEF (r= -0.33; p= 0.05).
Conclusion
Older age at the time of CoA repair was associated with increased LVEDD and decreased GLS and LVEF. Also, GLS may be an important tool for the identification of subclinical LV dysfunction in adult pts with repaired CoA.
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Affiliation(s)
- S Cardoso Torres
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - CX Resende
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - PG Diogo
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - P Araujo
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - RA Pinto
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - T Proenca
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - JM Carvalho
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - AF Amador
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C Costa
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J Calvao
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - V Ribeiro
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C Cruz
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - F Macedo
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
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Moreno-González G, Mussetti A, Albasanz-Puig A, Salvador I, Sureda A, Gudiol C, Salazar R, Marin M, Garcia M, Navarro V, de la Haba Vaca I, Coma E, Sanz-Linares G, Dura X, Fontanals S, Serrano G, Cruz C, Mañez R. A Phase I/II Clinical Trial to evaluate the efficacy of baricitinib to prevent respiratory insufficiency progression in onco-hematological patients affected with COVID19: A structured summary of a study protocol for a randomised controlled trial. Trials 2021; 22:116. [PMID: 33546739 PMCID: PMC7862837 DOI: 10.1186/s13063-021-05072-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Baricitinib is supposed to have a double effect on SARS-CoV2 infection. Firstly, it reduces the inflammatory response through the inhibition of the Januse-Kinase signalling transducer and activator of transcription (JAK-STAT) pathway. Moreover, it reduces the receptor mediated viral endocytosis by AP2-associated protein kinase 1 (AAK1) inhibition. We propose the use of baricinitib to prevent the progression of the respiratory insufficiency in SARS-CoV2 pneumonia in onco-haematological patients. In this phase Ib/II study, the primary objective in the safety cohort is to describe the incidence of severe adverse events associated with baricitinib administration. The primary objective of the randomized phase (baricitinib cohort versus standard of care cohort) is to evaluate the number of patients who did not require mechanical oxygen support since start of therapy until day +14 or discharge (whichever it comes first). The secondary objectives of the study (only randomized phase of the study) are represented by the comparison between the two arms of the study in terms of mortality and toxicity at day+30. Moreover, a description of the immunological related changes between the two arms of the study will be reported. TRIAL DESIGN The trial is a phase I/II study with a safety run-in cohort (phase 1) followed by an open label phase II randomized controlled trial with an experimental arm compared to a standard of care arm. PARTICIPANTS The study will be performed at the Institut Català d'Oncologia, a tertiary level oncological referral center in the Catalonia region (Spain). The eligibility criteria are: patients > 18 years affected by oncological diseases; ECOG performance status < 2 (Karnofsky score > 60%); a laboratory confirmed infection with SARS-CoV-2 by means of real -time PCR; radiological signs of low respiratory tract disease; absence of organ dysfunction (a total bilirubin within normal institutional limits, AST/ALT≤2.5 X institutional upper limit of normal, alkaline phosphatase ≤2.5 X institutional upper limit of normal, coagulation within normal institutional limits, creatinine clearance >30 mL/min/1.73 m2 for patients with creatinine levels above institutional normal); absence of HIV infection; no active or latent HBV or HCV infection. The exclusion criteria are: patients with oncological diseases who are not candidates to receive any active oncological treatment; hemodynamic instability at time of study enrollment; impossibility to receive oral medication; medical history of recent or active pulmonary embolism or deep venous thrombosis or patients at high-risk of suffering them (surgical intervention, immobilization); multi organ failure, rapid worsening of respiratory function with requirement of fraction of inspired oxygen (FiO2) > 50% or high-flow nasal cannula before initiation of study treatment; uncontrolled intercurrent illness (ongoing or severe active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements); allergy to one or more of study treatments; pregnant or breastfeeding women; positive pregnancy test in a pre-dose examination. Patients should have the ability to understand, and the willingness to sign, a written informed consent document; the willingness to accept randomization to any assigned treatment arm; and must agree not to enroll in another study of an investigational agent prior to completion of Day +28 of study. An electronic Case Report Form in the Research Electronic Data Capture (REDCap) platform will be used to collect the data of the trial. Removal from the study will apply in case of unacceptable adverse event(s), development of an intercurrent illness, condition or procedural complication, which could interfere with the patient's continued participation and voluntary patient withdrawal from study treatment (all patients are free to withdraw from participation in this study at any time, for any reasons, specified or unspecified, and without prejudice). INTERVENTION AND COMPARATOR Treatment will be administered on an inpatient basis. We will compare the experimental treatment with baricitinib plus the institutional standard of care compared with the standard of care alone. During the phase I, we will define the dose-limiting toxicity of baricitinib and the dose to be used in the phase 2 part of the study. The starting baricitinib dose will be an oral tablet 4 mg-once daily which can be reduced to 2 mg depending on the observed toxicity. The minimum duration of therapy will be 5 days and it can be extended to 7 days. The standard of care will include the following therapies. Antibiotics will be individualized based on clinical suspicion, including the management of febrile neutropenia. Prophylaxis of thromboembolic disease will be administered to all participants. Remdesivir administration will be considered only in patients with severe pneumonia (SatO2 <94%) with less than 7 days of onset of symptoms and with supplemental oxygen requirements but not using high-flow nasal cannula, non-invasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). In the randomized phase, tocilizumab or interferon will not be allowed in the experimental arm. Tocilizumab can be used in patients in the standard of care arm at the discretion of the investigator. If it is prescribed it will be used according to the following criteria: patients who, according to his baseline clinical condition, would be an ICU tributary, interstitial pneumonia with severe respiratory failure, patients who are not on mechanical ventilation or ECMO and who are still progressing with corticoid treatment or if they are not candidates for corticosteroids. Mild ARDS (PAFI <300 mmHg) with radiological or blood gases deterioration that meets at least one of the following criteria: CRP >100mg/L D-Dimer >1,000μg/L LDH >400U/L Ferritin >700ng/ml Interleukin 6 ≥40ng/L. The use of tocilizumab is not recommended if there are AST/ALT values greater than 10 times the upper limit of normal, neutrophils <500 cells/mm3, sepsis due to other pathogens other than SARS-CoV-2, presence of comorbidity that can lead to a poor prognosis, complicated diverticulitis or intestinal perforation, ongoing skin infection. The dose will be that recommended by the Spanish Medicine Agency in patients ≥75Kg: 600mg dose whereas in patients <75kg: 400mg dose. Exceptionally, a second infusion can be assessed 12 hours after the first in those patients who experience a worsening of laboratory parameters after a first favourable response. The use of corticosteroids will be recommended in patients who have had symptoms for more than 7 days and who meet all the following criteria: need for oxygen support, non-invasive or invasive mechanical ventilation, acute respiratory failure or rapid deterioration of gas exchange, appearance or worsening of bilateral alveolar-interstitial infiltrates at the radiological level. In case of indication, it is recommended: dexamethasone 6mg/d p.o. or iv for 10 days or methylprednisolone 32mg/d orally or 30mg iv for 10 days or prednisone 40mg day p.o. for 10 days. MAIN OUTCOMES Phase 1 part: to describe the toxicity profile of baricitinib in COVID19 oncological patients during the 5-7 day treatment period and until day +14 or discharge (whichever it comes first). Phase 2 part: to describe the number of patients in the experimental arm that will not require mechanical oxygen support compared to the standard of care arm until day +14 or discharge (whichever it comes first). RANDOMISATION For the phase 2 of the study, the allocation ratio will be 1:1. Randomization process will be carried out electronically through the REDcap platform ( https://www.project-redcap.org/ ) BLINDING (MASKING): This is an open label study. No blinding will be performed. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) The first part of the study (safety run-in cohort) will consist in the enrollment of 6 to 12 patients. In this population, we will test the toxicity of the experimental treatment. An incidence of severe adverse events grade 3-4 (graded by Common Terminology Criteria for Adverse Events v.5.0) inferior than 33% will be considered sufficient to follow with the next part of the study. The second part of the study we will perform an interim analysis of efficacy at first 64 assessed patients and a definitive one will analyze 128 assessed patients. Interim and definitive tests will be performed considering in both cases an alpha error of 0.05. We consider for the control arm this rate is expected to be 0.60 and for the experimental arm of 0.80. Considering this data, a superiority test to prove a difference of 0.20 with an overall alpha error of 0.10 and a beta error of 0.2 will be performed. Considering a 5% of dropout rate, it is expected that a total of 136 patients, 68 for each study arm, will be required to complete study accrual. TRIAL STATUS Version 5.0. 14th October 2020 Recruitment started on the 16th of December 2020. Expected end of recruitment is June 2021. TRIAL REGISTRATION AEMPs: 20-0356 EudraCT: 2020-001789-12, https://www.clinicaltrialsregister.eu/ctr-search/search (Not publically available as Phase I trial) Clinical trials: BARCOVID19, https://www.clinicaltrials.gov/ (In progress) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol."
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Affiliation(s)
- G Moreno-González
- Intensive Care Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.
| | - A Mussetti
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Hematology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - A Albasanz-Puig
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Infectious Disease Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain.,Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - I Salvador
- Immunology Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain
| | - A Sureda
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Hematology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain.,Barcelona University, Barcelona, Spain
| | - C Gudiol
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Infectious Disease Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain.,Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain.,Barcelona University, Barcelona, Spain
| | - R Salazar
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Oncology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - M Marin
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Oncology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - M Garcia
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Trials Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - V Navarro
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Trials Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - I de la Haba Vaca
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Oncology Emergency Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - E Coma
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Oncology Emergency Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - G Sanz-Linares
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Hematology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - X Dura
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Infectious Disease Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain
| | - S Fontanals
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Pharmacology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - G Serrano
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Palliative Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - C Cruz
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Palliative Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - R Mañez
- Intensive Care Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain
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Correa-Cárdenas CA, Pérez J, Patino LH, Ramírez JD, Duque MC, Romero Y, Cantillo-Barraza O, Rodríguez O, Alvarado MT, Cruz C, Méndez C. Distribution, treatment outcome and genetic diversity of Leishmania species in military personnel from Colombia with cutaneous leishmaniasis. BMC Infect Dis 2020; 20:938. [PMID: 33297972 PMCID: PMC7724885 DOI: 10.1186/s12879-020-05529-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leishmaniasis is one of the most important infectious diseases affecting the Colombian National Army due to the high number of reported cases and exposure throughout military operations in endemic areas. The main aim of this study was to estimate the geographical distribution along with the genetic diversity and treatment outcome of Leishmania species in Colombian military personnel. METHODS Skin lesion samples by smear and aspirate were collected in 136 patients having parasitological cutaneous leishmaniasis (CL) diagnosis. DNA was extracted, the nuclear marker heat shock protein 70 (HSP70) was amplified by PCR and sequenced. Leishmania species were identified by BLASTn. The geo-spatial distribution of the identified parasites was determined according to the possible site of infection. Gene tree was constructed by maximum likelihood (ML), diversity indices (π, h) were estimated and haplotype network was constructed under the Templeton-Crandall-Sing algorithm in order to determine the geographic relationships of the genetic variants of Leishmania species circulating in Colombian military population. RESULTS The species were identified in 77.94% of the samples, with a predominance of L. braziliensis (65.09%), followed by L. panamensis (31.13%), L. naiffi by the first time reported in Colombia in two patients (1.89%) as well as L. lindenbergi in a single patient (0.945%) with possible infection in the municipality of Miraflores, Guaviare and L. infantum in a single patient (0.945%) notified with CL in the municipality of Tumaco, Nariño. The phylogenetic analysis was consistent according to bootstrap, showing four strongly differentiated clades. CONCLUSIONS The geo-spatial distribution suggested that L. braziliensis has a greater abundance, while L. panamensis has a greater dispersion. The phylogenetic relationships of Leishmania species in Colombian military personnel was estimated with the confirmation of two new species circulating without prior report in the country and a species with no background for CL in the Colombian army. A substantial genetic diversity of Leishmania braziliensis was defined. This study contributes through the understanding of the molecular epidemiology to the CL transmission in Colombia.
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Affiliation(s)
- Camilo A Correa-Cárdenas
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Julie Pérez
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Luz H Patino
- Grupo de Investigaciones Microbiológicas - UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Juan David Ramírez
- Grupo de Investigaciones Microbiológicas - UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Maria Clara Duque
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Yanira Romero
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Omar Cantillo-Barraza
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Omaira Rodríguez
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Maria Teresa Alvarado
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Claudia Cruz
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia
| | - Claudia Méndez
- Grupo de Investigación en Enfermedades Tropicales del Ejército (GINETEJ), Laboratorio de Referencia e Investigación, Dirección de Sanidad Ejército, Bogotá, Colombia.
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Tuca A, Viladot M, Barrera C, Chicote M, Casablancas I, Cruz C, Font E, Marco-Hernández J, Padrosa J, Pascual A, Codorniu N, Román B. Prevalence of ethical dilemmas in advanced cancer patients (secondary analysis of the PALCOM study). Support Care Cancer 2020; 29:3667-3675. [PMID: 33184713 DOI: 10.1007/s00520-020-05885-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The main aim of this study was to determine the prevalence of ethical dilemmas in the end-of-life process in advanced cancer patients. METHODS We carried out a multicenter, cross-sectional, observational, prospective study in a cohort of cancer patients whose life expectancy was ≤ 6 months. We recorded sociodemographic characteristics, diagnosis of cancer, symptom burden, cognitive and functional status, emotional impact, and sociofamilial risk factors. The main outcome measure was the detection of ethical dilemmas, based on the following definition: conflict in decision-making during the end-of-life process that involves the need to choose between morally acceptable opposing options, where none is clearly preferable to another. RESULTS We included 324 patients (mean age, 69 years; 58% men). We identified 117 dilemmas in 90 patients (27.8%). The dilemmas detected were as follows: (a) conflicts of information (adaptive denial, conspiracy of silence, information exceeding patient's desired limit), 15.7%; (b) discrepancies in proportionality (discussion on futility, rejection of treatment, withdrawal of life support measures), 16.7%; (c) unrealistic expectations about the outcome of clinical trials, 2.5%; and (d) request for euthanasia or medically assisted suicide, 1.2%. We observed a greater prevalence of ethical dilemmas in men, in patients receiving active cancer treatment, and in patients with emotional distress (p < 0.05). CONCLUSIONS The prevalence of ethical dilemmas during the end-of-life process in cancer patients is relevant. Most dilemmas were associated directly or indirectly with respect for patient autonomy. In this context, the communication skills of the health professionals and advanced care planning take on a key role.
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Affiliation(s)
- Albert Tuca
- Hospital Clínic de Barcelona, Barcelona, Spain.
| | | | | | | | | | | | - Elena Font
- Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Núria Codorniu
- Fundación Atención a la Dependencia Sant Joan de Deu, Barcelona, Spain.,Nursing School of University of Barcelona, Barcelona, Spain
| | - Begoña Román
- Faculty of Philosophy of the University of Barcelona, Barcelona, Spain
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Infante J, Cabrera J, Rayo J, Cruz C, Serrano J, Moreno M, Martínez A, Jiménez P, Cobo A. 18F-FDG PET/CT quantitative parameters as prognostic factors in localized and inoperable lung cancer. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cardoso Torres S, Vasconcelos M, Resende C, Diogo P, Pinto R, Proenca T, Carvalho J, Calvao J, Amador F, Costa C, Cruz C, Moreira J, Pinho P, Silva J, Maciel M. Coronary artery fistulas: a single-center case series. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Coronary artery fistulas (CAFs) are rare anomalous connections between a coronary artery and a major vessel or cardiac chamber. Currently they are being increasingly encountered due to the more widespread use of various imaging modalities and coronary angiography. Although the vast majority of CAFs are incidentally diagnosed and have no clinical relevance, they can cause significant morbidity such as myocardial infarction, congestive heart failure and endocarditis.
Methods
A consecutive series of 55867 coronary arteriograms performed in our Cardiology Department from 2007 to 2019 was retrospectively investigated for the presence of coronary artery fistulas. Patients clinical, angiographic and therapeutic data up to november 2019 were analyzed. Data were obtained from medical records of hospital stay and subsequent consultations.
Results
We identified 50 patients who were diagnosed with one or more CAFs, with ages between 5 and 85 years (mean 59 years). 62% (n=31) were males.
The great majority of patients had a single fistula (n=34, 68%), 11 patients had two fistulas (22%), 1 patient had 3 fistulas (2%) and 4 patients had multiple fistulas (8%).
CAFs arose more frequently from the left anterior descending artery (n=27), followed by the right coronary (n=18), left circumflex (n=15), left main (n=5) and intermediate artery (n=2). The most frequent drainage site was the pulmonary artery (n=38).
The majority of CAFs were incidentally found (n=32; 64%) and thought to have no significance for the patients' clinical status. As for the rest of the patients, CAFs were diagnosed during evaluation of: a heart murmur (n=7); exertional chest pain with no associated significant atherosclerotic coronary artery disease (n=7); exertional dyspnea (n=2); positive exercise stress test (n=1); NSTEMI and cardiac arrest (n=1).
Regarding treatment, watchful waiting was the main approach (n=40; 80%). 3 patients had their CAFs closed during surgery for another heart condition (CABG/aortic valve replacement). In 1 patient, heart surgery was specifically conducted for fistula closure. 6 patients (12%) underwent fistula transcatheter closure.
Conclusion
CAFs are rare coronary anomalies and the majority has no clinical relevance, so watchful waiting is the commonest approach. When they are hemodynamically significant or symptoms/complications arise, surgical or transcatheter closure should be considered. This study describes the angiographic, clinical and therapeutic data of CAFs detected along the last 12 years in a single tertiary care center catheterization laboratory.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Cardoso Torres
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - M Vasconcelos
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C.X Resende
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - P Diogo
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - R Pinto
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - T Proenca
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J.M Carvalho
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J Calvao
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - F Amador
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C Costa
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C Cruz
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J Moreira
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - P Pinho
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J.C Silva
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - M.J Maciel
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
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Abstract
Abstract
Background
Research in resource allocation is a need arising from State interference by the allocative function, which seeks to promote resource adjustments with the provision of certain goods and public services (Musgrave, 1974; Musgrave & Musgrave, 1980, Longo & Troster, 1993). In this perspective, a research question arises: how has international literature on the field of Business, Management and Accounting been approaching resource allocation in public health?
Methods
Systematic Literature Review through the Scopus Database. keywords: “public health” and “resource allocation”. The types were Article and Review. Language: English, since it is internationally accepted in scientific articles, and Portuguese, in order to include Brazilian research. Search period: from 1976 to 2017. Areas: “Business, Management and Accounting”. The performed analysis technique was qualitative meta-synthesis and by using the MAXQDA Analytics Pro 18 software.
Results
The first identified study was in 2000 Sweden, pulished in Health Care Management Science. The most recente in 2017 Brazil, published in Evaluation and Program Planning. Among the countries that presented the largest production, the United States is highlighted (4). Dispersion of publication among reviews was noted. Generally, publications are grouped in four perspectives: adequate allocation, resource management and effective cost; resource allocation for treating specific diseases; resource allocation for decision-making; and health evaluation and the need of informing resource allocation. The prevailing lack of theoretical grounding must be highlighted.
Conclusions
Can be inferred that this production is recent, that it does not possess a specific focus or outline, as there is a variety of approaches, most of them being geared towards healthcare and disease control, such as cancer, diabetes, overweight, rabies, malaria and infectious diseases.
Key messages
International literature indicates that the theme is yet unexplored in the field of Business, Management e Accounting and most studies are geared towards healthcare and disease control. Allocation in the public-health policy as a function of the role of the State in providing the necessary budget for financial availability and not cost-wise, suggests lack of research.
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Affiliation(s)
- E Barbosa
- Department of Accounting and Actuarial Sciences, University of Brasilia, Distrito Federal, Brazil
- Department of Accounting Sciences, State University of Paraíba, Campina Grande, Brazil
| | - A Gonçalves
- Department of Accounting and Actuarial Sciences, University of Brasilia, Distrito Federal, Brazil
| | - M Guerra
- Department of Accounting and Actuarial Sciences, University of Brasilia, Distrito Federal, Brazil
| | - C Cruz
- Department of Accounting and Actuarial Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Infante JR, Cabrera J, Rayo JI, Cruz C, Serrano J, Moreno M, Martínez A, Jiménez P, Cobo A. 18F-FDG PET/CT quantitative parameters as prognostic factor in localized and inoperable lung cancer. Rev Esp Med Nucl Imagen Mol 2020; 39:353-359. [PMID: 32605894 DOI: 10.1016/j.remn.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/25/2022]
Abstract
AIM To assess the utility of 18F-FDG PET/CT quantitative parameters as prognostic factor in patients diagnosed with localized and inoperable lung cancer treated by stereotactic body radiotherapy (SBRT). MATERIAL AND METHODS Fifty patients (42 men) diagnosed in the last 7years with early-stage lung cancer and treated with SBRT alone were assessed by a prospective study. After PET/CT study, metabolic parameters maximum SUV (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were determined at different thresholds. The prognostic factors for overall survival (OS), cause-specific survival (CS) and disease-free survival (DFS) were analysed by Cox proportional hazards model and the survival analysis by Kaplan-Meier method. RESULTS The average follow-up was 39.6months, with 21 recurrences and 24 dead. Univariate analysis determined MTV30 and MTV40 as predictors for OS; MTV30, MTV40, TLG30 and TLG40 for CS, and MTV2, MTV30, MTV40, TLG2, TLG30 and TLG40 for DFS. Survival analysis found statistically significant differences for CS and DFS depending on tumor size and for DFS considering the cut-off values of MTV2 and TLG2 (threshold SUVmax=2). SUVmax, age and sex were not shown to be significant factors. CONCLUSION Pre-treatment quantitative assessment using metabolic parameters MTV2 and TLG2 as well as tumor size proved to be prognostic factors in patients diagnosed with localized and inoperable lung cancer treated by SBRT. Results could help to personalize treatment.
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Affiliation(s)
- J R Infante
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España.
| | - J Cabrera
- Servicio de Oncología Radioterápica, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - J I Rayo
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - C Cruz
- Servicio de Oncología Radioterápica, Hospital Punta de Europa, Algeciras, Cádiz, España
| | - J Serrano
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - M Moreno
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - A Martínez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - P Jiménez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - A Cobo
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
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Rosa ACP, Cruz C, Santana WS, Brito E, Moret MA. Non-Arrhenius behavior and fragile-to-strong transition of glass-forming liquids. Phys Rev E 2020; 101:042131. [PMID: 32422727 DOI: 10.1103/physreve.101.042131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/03/2020] [Indexed: 11/07/2022]
Abstract
Characterization of the non-Arrhenius behavior of glass-forming liquids is a broad avenue for research toward the understanding of the formation mechanisms of noncrystalline materials. In this context, this paper explores the main properties of the viscosity of glass-forming systems, considering super-Arrhenius diffusive processes. We establish the viscous activation energy as a function of the temperature, measure the degree of fragility of the system, and characterize the fragile-to-strong transition through the standard Angell's plot. Our results show that the non-Arrhenius behavior observed in fragile liquids can be understood through the non-Markovian dynamics that characterize the diffusive processes of these systems. Moreover, the fragile-to-strong transition corresponds to a change in the spatiotemporal range of correlations during the glass transition process.
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Affiliation(s)
- A C P Rosa
- Grupo de Informação Quântica e Física Estatística, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - C Cruz
- Grupo de Informação Quântica e Física Estatística, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - W S Santana
- Grupo de Informação Quântica e Física Estatística, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - E Brito
- Grupo de Informação Quântica e Física Estatística, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - M A Moret
- Programa de Modelagem Computacional-SENAI-CIMATEC, 41650-010 Salvador, Bahia, Brazil.,Universidade do Estado da Bahia (UNEB), 41150-000 Salvador, Bahia, Brazil
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Miyashita H, Mikami T, Chopra N, Yamada T, Chernyavsky S, Rizk D, Cruz C. Do patients with cancer have a poorer prognosis of COVID-19? An experience in New York City. Ann Oncol 2020; 31:1088-1089. [PMID: 32330541 PMCID: PMC7172785 DOI: 10.1016/j.annonc.2020.04.006] [Citation(s) in RCA: 286] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- H Miyashita
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA.
| | - T Mikami
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - N Chopra
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - T Yamada
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - S Chernyavsky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - D Rizk
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - C Cruz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
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Schmoker AM, Perez Pearson LM, Cruz C, Colon Flores LG, Branfeild S, Pagán Torres FD, Fonseca K, Cantres YM, Salgado Ramirez CA, Melendez LM, Ballif BA, Washington AV. Defining the TLT-1 interactome from resting and activated human platelets. J Proteomics 2020; 215:103638. [PMID: 31923473 PMCID: PMC7044047 DOI: 10.1016/j.jprot.2020.103638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/14/2022]
Abstract
The triggering receptor expressed on myeloid cells (TREM) protein family forms a class of type I transmembrane proteins expressed in immune cells that play important roles in innate and adaptive immune responses. The TREM family member TREM-like transcript 1 (TLT-1, also TREML1) is expressed in megakaryocytes and packaged into platelet granules. TLT-1 binds fibrinogen and plays a role in bleeding initiated by inflammatory insults. Here, we describe a proteomics screen that maps the TLT-1 interactome in resting and activated human platelets. Several identified TLT-1 interactors are involved in cell adhesion and migration, as well as platelet activation. Select interactors, including β3-integrin, RACK1, GRB2, and Rabs 5A, 7, and 11A, were additionally characterized in co-immunoprecipitation/immunoblotting experiments. Finally, several phosphorylation sites were found on immunoprecipitated TLT-1, including Thr280, a novel, regulated site on a conserved residue near the TLT-1 ITIM regulatory sequence. SIGNIFICANCE: Platelet function relies on the secretion of active molecules from intracellular vesicles, or granules, which contain soluble and membrane-bound proteins that are essential for platelet aggregation, coagulation reactions, and pathogen defense mechanisms. TLT-1 is sequestered in α-granules and transported to the plasma membrane, where it plays a unique role in hemostasis after inflammatory insults. Despite the known importance of TLT-1 in platelet biology, our knowledge of TLT-1 mechanistic signaling is limited. This study defines the TLT-1 interactome in resting and active human platelets, identifying several novel TLT-1 interactors, as well as TLT-1 phosphorylation sites, all with likely signaling implications in platelet aggregation dynamics.
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Affiliation(s)
- Anna M Schmoker
- Department of Biology, University of Vermont, 109 Carrigan Drive, 120A Marsh Life Sciences, Burlington, VT 05405, USA.
| | - Leishla M Perez Pearson
- Department of Biology, University of Vermont, 109 Carrigan Drive, 120A Marsh Life Sciences, Burlington, VT 05405, USA; Department of Biology, University of Puerto Rico-Río Piedras, Department of Biology, San Juan, PR, USA
| | - Claudia Cruz
- Department of Biology, University of Vermont, 109 Carrigan Drive, 120A Marsh Life Sciences, Burlington, VT 05405, USA; Department of Biology, University of Puerto Rico-Río Piedras, Department of Biology, San Juan, PR, USA
| | - Luis G Colon Flores
- Department of Biology, University of Puerto Rico-Río Piedras, Department of Biology, San Juan, PR, USA
| | - Siobhan Branfeild
- Department of Biology, University of Puerto Rico-Río Piedras, Department of Biology, San Juan, PR, USA
| | - Fabiola D Pagán Torres
- Department of Biology, University of Vermont, 109 Carrigan Drive, 120A Marsh Life Sciences, Burlington, VT 05405, USA
| | - Karmen Fonseca
- Department of Biology, University of Vermont, 109 Carrigan Drive, 120A Marsh Life Sciences, Burlington, VT 05405, USA
| | - Yadira M Cantres
- Translational Proteomics Center, Comprehensive Cancer Center, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Carla A Salgado Ramirez
- Translational Proteomics Center, Comprehensive Cancer Center, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Loyda M Melendez
- Department of Microbiology and Medical Zoology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA; Translational Proteomics Center, Comprehensive Cancer Center, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Bryan A Ballif
- Department of Biology, University of Vermont, 109 Carrigan Drive, 120A Marsh Life Sciences, Burlington, VT 05405, USA.
| | - A Valance Washington
- Department of Biology, University of Puerto Rico-Río Piedras, Department of Biology, San Juan, PR, USA.
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Affiliation(s)
- C. Cruz
- Division of Nephrology & Hypertension Henry Ford Hospital 2799 West Grand Boulevard Detroit, MI 48202
| | - M.D. Faber
- Division of Nephrology & Hypertension Henry Ford Hospital 2799 West Grand Boulevard Detroit, MI 48202
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Mejia-Vilet JM, López-Hernández YJ, Santander-Vélez JI, Trujeque-Matos M, Cruz C, Carranza de la Torre CA, Espinosa-Cruz V, Espinosa-González R, Uribe-Uribe NO, Morales-Buenrostro LE. Angiotensin II receptor agonist antibodies are associated with microvascular damage in lupus nephritis. Lupus 2020; 29:371-378. [PMID: 32041505 DOI: 10.1177/0961203320904787] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Angiotensin II type 1 receptor agonist antibodies (AT1R-AAs) have been associated with hypertension, atherosclerosis and vascular inflammation in human diseases. The aim of the study was to evaluate the prevalence of AT1R-AAs in active lupus nephritis (LN) patients and their association with vascular damage. One hundred and seven active LN patients underwent a complete clinical examination, measurement of AT1R-AAs, ambulatory blood pressure monitoring, carotid intima-media thickness measurement and morphometric analysis of subintimal fibrosis and medial hyperplasia of the vessels in the kidney tissue. Plasma AT1R-AAs were positive in 58 (54.2%) patients. The Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score, complement C3 and C4 levels and titers of anti-dsDNA antibodies were higher in the group with positive AT1R-AAs compared with those with negative AT1R-AAs. The AT1R-AA titers correlated with anti-dsDNA antibody titers and with complement C3 and C4 serum levels. In the kidney biopsy, the percentage of subintimal fibrosis and the area of medial hyperplasia were greater in the AT1R-AA-positive patients. No differences in arterial pressure, carotid intima-media thickness and response to therapy were detected. In conclusion, AT1R-AAs are prevalent in active LN patients and are associated with histologic features of microvascular damage.
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Affiliation(s)
- J M Mejia-Vilet
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Y J López-Hernández
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J I Santander-Vélez
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - M Trujeque-Matos
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - C Cruz
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - C A Carranza de la Torre
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - V Espinosa-Cruz
- Department of Radiology and Imaging "Adan Pitol", Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - R Espinosa-González
- Department of Pathology and Pathologic Anatomy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - N O Uribe-Uribe
- Department of Pathology and Pathologic Anatomy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - L E Morales-Buenrostro
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Lovo EE, Torres B, Campos F, Caceros V, Reyes WA, Barahona KC, Cruz C, Arias J, Alho E, Contreras WO. Stereotactic Gamma Ray Radiosurgery to the Centromedian and Parafascicular Complex of the Thalamus for Trigeminal Neuralgia and Other Complex Pain Syndromes. Cureus 2019; 11:e6421. [PMID: 31886103 PMCID: PMC6925372 DOI: 10.7759/cureus.6421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction We report our initial series of patients treated with radiosurgery to the Centromedian (CM) and Parafascicular (Pfc) Complex (CM-Pf) of the contralateral thalamus mainly for trigeminal neuralgia that had failed most known forms of conventional treatments. The coordinates were co-registered to a three-dimensional atlas of the thalamus in order to have a better comprehension of isodose curves distribution. Methods A fully automated rotating gamma ray unit was used to deliver a high dose of radiation (140 Gy) using a 4-mm collimator to the CM-Pf of the contralateral thalamus in 14 patients suffering from refractory trigeminal pain and other complex pain syndromes. The best stereotactic coordinates were plotted in a thalamic three-dimensional atlas space along with isodose curves corresponding to 50% of the dose prescription and the dose gradient. Results From November 2016 to July 2019, 14 patients experiencing severe forms of different pain syndromes were treated, and 10 were eligible for follow-up evaluation. Pain deriving from trigeminal neuralgia was present in the majority (80%) of patients and from other complex pain syndromes in the rest (20%). Median follow-up was 384 days (range: 30-994). The Visual Analogue Scale (VAS) score before treatment was 9 (range: 7-10) and standardized to 10. Before treatment, all the patients had a Barrow Neurological Institute Pain Scale (BNI) of 5 (V). The median years suffering from pain was 4.5 years (range: 1-15), the number of procedures including radiosurgery to the trigeminal nerve before thalamotomy was four (range: 1-10). Most patients (90%) reported some form of relief, the average VAS at the time of response was 3.5 (range: 0-9), and the average time to response was 67.3 days (range: 2-210). The neuromodulation effect of radiation was seen in 60% of patients. The average BNI score at response was 2.7 (range: 1-5). The final VAS score at last follow-up was 5.5 (range: 0-10) in six patients. In four patients (40%), the procedure had failed with a final BNI of IV, and V, three patients (30%) had excellent response (BNI of I), and three patients (30%) had worthwhile results with BNI of IIIa and IIIb. The total success rate (BNI of I to IIIb) was 60%, and the number of patients experiencing more than 50% of pain reduction at final follow-up was five (50%). Excluding both patients that were treated for pain outside of trigeminal neuralgia, 75% of the patients responded. The best coordinates on average were X: 5.5 mm from the thalamic border, Y: 3.7 mm anterior to the posterior commissure, and Z: 3.7 mm from the intercomissural line. There were no complications to report. Conclusion Radiosurgery to the CM-Pf of the thalamus was demonstrated to be a safe and relatively effective alternative to treat refractory trigeminal neuralgia. Further studies are needed to optimize target dimensions based on the three-dimensional studies of isodose curves as well as coordinates. Longer follow-up is necessary to evaluate recurrence rates that could not be reached.
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Affiliation(s)
- Eduardo E Lovo
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Boheris Torres
- Neurosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Fidel Campos
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Victor Caceros
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - William A Reyes
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Kaory C Barahona
- Radiation Oncology, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Claudia Cruz
- Anesthesia and Pain Management, Hospital De Diagnóstico, San Salvador, SLV
| | - Juan Arias
- Pain Management, International Cancer Center, San Salvador, SLV
| | - Eduardo Alho
- Functional Neurosurgery, University of Sao Paulo Medical School, Sao Paulo, BRA
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Sanchez AA, Campbell HM, Ahmed MS, Albert K, Applegate C, Bekele E, Cruz C, Dalgleish J, Dudiková L, Elson C. Focht K, Genouel C, Joubert M, Kirby P, Le Bouquin R, Lerch R, McManus K, Menefee L, Moura S, Murley V, Petrova J, Rues MC, Siegel VS, Stephens B, Warrick D, Williams SM. Determination of Decoquinate in Animal Feeds by Liquid Chromatography: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/91.4.685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
The performance characteristics of a liquid chromatographic (LC) method for the analysis of decoquinate (DEC) in supplements, premixes, and complete animal feeds at medicating and trace levels were collaboratively studied. DEC is extracted from ground feed samples with 1 calcium chloridemethanol solution using mechanical agitation for 90 min. After centrifugation for 5 min and dilution (if necessary), an aliquot of the extract is diluted with water. The diluted extracts are filtered and analyzed by reversed-phase LC with fluorescence detection. Suspect positive trace-level samples are confirmed by using an alternate excitation wavelength. Fourteen test samples of medicated feeds, supplement, and medicated premix, along with 8 test samples for trace-level analysis, were sent to 13 collaborators (one in Canada, 4 in Europe, and 8 in the United States). Test samples were analyzed as blind duplicates. Acceptable results were received from 12 laboratories for the medicated test samples and from 13 laboratories for the trace-level samples. Repeatability relative standard deviation estimates ranged from 1.3 to 5.6. Reproducibility relative standard deviations estimates ranged from 2.8 to 6.1, and HorRat values ranged from 0.22 to 0.74.
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Affiliation(s)
- Anivis A Sanchez
- Canadian Food Inspection Agency, Ottawa Laboratory (Carling), 960 Carling Ave, Building 22, Ottawa, ON, Canada K1A 0C6
| | - Harold M Campbell
- Canadian Food Inspection Agency, Ottawa Laboratory (Carling), 960 Carling Ave, Building 22, Ottawa, ON, Canada K1A 0C6
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Rosa Junior ACP, Cruz C, Santana WS, Moret MA. Characterization of the non-Arrhenius behavior of supercooled liquids by modeling nonadditive stochastic systems. Phys Rev E 2019; 100:022139. [PMID: 31574742 DOI: 10.1103/physreve.100.022139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Indexed: 11/07/2022]
Abstract
The characterization of the formation mechanisms of amorphous solids is a large avenue for research, since understanding its non-Arrhenius behavior is challenging to overcome. In this context, we present one path toward modeling the diffusive processes in supercooled liquids near glass transition through a class of nonhomogeneous continuity equations, providing a consistent theoretical basis for the physical interpretation of its non-Arrhenius behavior. More precisely, we obtain the generalized drag and diffusion coefficients that allow us to model a wide range of non-Arrhenius processes. This provides a reliable measurement of the degree of fragility of the system and an estimation of the fragile-to-strong transition in glass-forming liquids, as well as a generalized Stokes-Einstein equation, leading to a better understanding of the classical and quantum effects on the dynamics of nonadditive stochastic systems.
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Affiliation(s)
- A C P Rosa Junior
- Grupo de Informação Quântica, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - C Cruz
- Grupo de Informação Quântica, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - W S Santana
- Grupo de Informação Quântica, Centro de Ciências Exatas e das Tecnologias, Universidade Federal do Oeste da Bahia, Rua Bertioga, 892, Morada Nobre I, 47810-059 Barreiras, Bahia, Brazil
| | - M A Moret
- Programa de Modelagem Computacional-SENAI-CIMATEC, 41650-010 Salvador, Bahia, Brazil.,Universidade do Estado da Bahia (UNEB), 41150-000 Salvador, Bahia, Brazil
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Pellegrino B, Llop-Guevara A, Pedretti F, Cruz C, Castroviejo M, Cedro-Tanda A, Fasani R, Mateo F, Musolino A, Pujana M, Nuciforo P, Gros A, Balmana J, O’Connor M, Serra Elizalde V. PARP inhibition increases immune infiltration in homologous recombination repair (HRR)-deficient tumors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mateo J, Lord CJ, Serra V, Tutt A, Balmaña J, Castroviejo-Bermejo M, Cruz C, Oaknin A, Kaye SB, de Bono JS. A decade of clinical development of PARP inhibitors in perspective. Ann Oncol 2019; 30:1437-1447. [PMID: 31218365 PMCID: PMC6771225 DOI: 10.1093/annonc/mdz192] [Citation(s) in RCA: 393] [Impact Index Per Article: 78.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Genomic instability is a hallmark of cancer, and often is the result of altered DNA repair capacities in tumour cells. DNA damage repair defects are common in different cancer types; these alterations can also induce tumour-specific vulnerabilities that can be exploited therapeutically. In 2009, a first-in-man clinical trial of the poly(ADP-ribose) polymerase (PARP) inhibitor olaparib clinically validated the synthetic lethal interaction between inhibition of PARP1, a key sensor of DNA damage, and BRCA1/BRCA2 deficiency. In this review, we summarize a decade of PARP inhibitor clinical development, a work that has resulted in the registration of several PARP inhibitors in breast (olaparib and talazoparib) and ovarian cancer (olaparib, niraparib and rucaparib, either alone or following platinum chemotherapy as maintenance therapy). Over the past 10 years, our knowledge on the mechanism of action of PARP inhibitor as well as how tumours become resistant has been extended, and we summarise this work here. We also discuss opportunities for expanding the precision medicine approach with PARP inhibitors, identifying a wider population who could benefit from this drug class. This includes developing and validating better predictive biomarkers for patient stratification, mainly based on homologous recombination defects beyond BRCA1/BRCA2 mutations, identifying DNA repair deficient tumours in other cancer types such as prostate or pancreatic cancer, or by designing combination therapies with PARP inhibitors.
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Affiliation(s)
- J Mateo
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona; Vall d´Hebron University Hospital, Barcelona, Spain
| | - C J Lord
- The CRUK Gene Function Laboratory; The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London
| | - V Serra
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - A Tutt
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London; The Breast Cancer Now Research Unit, Guy's Cancer Centre, Kings College, London
| | - J Balmaña
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona; Vall d´Hebron University Hospital, Barcelona, Spain
| | | | - C Cruz
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona; Vall d´Hebron University Hospital, Barcelona, Spain
| | - A Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona; Vall d´Hebron University Hospital, Barcelona, Spain
| | - S B Kaye
- The Royal Marsden NHS Foundation Trust, London; The Institute of Cancer Research, London, UK
| | - J S de Bono
- The Royal Marsden NHS Foundation Trust, London; The Institute of Cancer Research, London, UK.
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Munzi S, Branquinho C, Cruz C, Máguas C, Leith ID, Sheppard LJ, Sutton MA. δ 15N of lichens reflects the isotopic signature of ammonia source. Sci Total Environ 2019; 653:698-704. [PMID: 30759595 DOI: 10.1016/j.scitotenv.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 06/09/2023]
Abstract
Although it is generally accepted that δ15N in lichen reflects predominating N isotope sources in the environment, confirmation of the direct correlation between lichen δ15N and atmospheric δ15N is still missing, especially under field conditions with most confounding factors controlled. To fill this gap and investigate the response of lichens with different tolerance to atmospheric N deposition, thalli of the sensitive Evernia prunastri and the tolerant Xanthoria parietina were exposed for ten weeks to different forms and doses of N in a field manipulation experiment where confounding factors were minimized. During this period, several parameters, namely total N, δ15N and chlorophyll a fluorescence, were measured. Under the experimental conditions, δ15N in lichens quantitatively responded to the δ15N of released gaseous ammonia (NH3). Although a high correlation between the isotopic signatures in lichen tissue and supplied N was found both in tolerant and sensitive species, chlorophyll a fluorescence indicated that the sensitive species very soon lost its photosynthetic functionality with increasing N availability. The most damaging response to the different N chemical forms was observed with dry deposition of NH3, although wet deposition of ammonium ions had a significant observable physiological impact. Conversely, there was no significant effect of nitrate ions on chlorophyll a fluorescence, implying differential sensitivity to dry deposition versus wet deposition and to ammonium versus nitrate in wet deposition. Evernia prunastri was most sensitive to NH3, then NH4+, with lowest sensitivity to NO3-. Moreover, these results confirm that lichen δ15N can be used to indicate the δ15N of atmospheric ammonia, providing a suitable tool for the interpretation of the spatial distribution of NH3 sources in relation to their δ15N signal.
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Affiliation(s)
- S Munzi
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal.
| | - C Branquinho
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal
| | - C Cruz
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal
| | - C Máguas
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal
| | - I D Leith
- Centre for Ecology & Hydrology (CEH) Edinburgh, Bush Estate, Penicuik EH26 0QB, UK
| | - L J Sheppard
- Centre for Ecology & Hydrology (CEH) Edinburgh, Bush Estate, Penicuik EH26 0QB, UK
| | - M A Sutton
- Centre for Ecology & Hydrology (CEH) Edinburgh, Bush Estate, Penicuik EH26 0QB, UK
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Pedro PI, Maia Santos L, Braço Forte C, Dias A, Cruz C, Rodrigues F. Benefits of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease and interstitial lung disease with the same dyspnea severity. Pulmonology 2019; 25:117-118. [PMID: 30755382 DOI: 10.1016/j.pulmoe.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/11/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- P I Pedro
- Pulmonology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - L Maia Santos
- Pulmonology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Braço Forte
- Pulmonology Department, Hospital de São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - A Dias
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - C Cruz
- Pulmonary Rehabilitation Unit, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - F Rodrigues
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Pulmonary Rehabilitation Unit, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Universidade de Lisboa, Faculdade de Medicina, Instituto de Saúde Ambiental (ISAMB), Portugal
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Carvalho J, Cruz C, Figueirinhas JL, Tamba MG, Kohlmeier A, Mehl GH. Proton and Deuterium NMR Study of the CBC9CB Dimer System. J Phys Chem B 2019; 123:1442-1451. [DOI: 10.1021/acs.jpcb.8b11526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Carvalho
- Department of Physics, and CeFEMA, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - C. Cruz
- Department of Physics, and CeFEMA, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - J. L. Figueirinhas
- Department of Physics, and CeFEMA, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - M. G. Tamba
- Department of Chemistry, University of Hull, Hull HU6 7RX, United Kingdom
| | - A. Kohlmeier
- Department of Chemistry, University of Hull, Hull HU6 7RX, United Kingdom
| | - G. H. Mehl
- Department of Chemistry, University of Hull, Hull HU6 7RX, United Kingdom
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Pellegrino B, Llop-Guevara A, Cruz C, Castroviejo M, Cedro-Tanda A, Fasani R, Nuciforo P, Gros A, Balmaña J, O'Connor M, Serra Elizalde V. Dissecting the antitumor immune response upon PARP inhibition in homologous recombination repair (HRR)-deficient tumors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy493.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gomes A, Cruz C, Rocha J, Ricardo M, Vicente M, Melo A, Santos M, Carvalho L, Gonçalves F, Reis A. Pulmonary hypertension: Real-world data from a Portuguese expert referral centre. Pulmonology 2018; 24:231-240. [DOI: 10.1016/j.pulmoe.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/24/2018] [Accepted: 02/04/2018] [Indexed: 01/07/2023] Open
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Ulrey R, Albihani S, Cruz C, Bollard C, Hanley P. Efficient expansion of gene-modified t cells in a functionally-closed, semi-automated bioreactor. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Cruz C, Castroviejo-Bermejo M, Gutiérrez-Enríquez S, Llop-Guevara A, Ibrahim YH, Gris-Oliver A, Bonache S, Morancho B, Bruna A, Rueda OM, Lai Z, Polanska UM, Jones GN, Kristel P, de Bustos L, Guzman M, Rodríguez O, Grueso J, Montalban G, Caratú G, Mancuso F, Fasani R, Jiménez J, Howat WJ, Dougherty B, Vivancos A, Nuciforo P, Serres-Créixams X, Rubio IT, Oaknin A, Cadogan E, Barrett JC, Caldas C, Baselga J, Saura C, Cortés J, Arribas J, Jonkers J, Díez O, O'Connor MJ, Balmaña J, Serra V. RAD51 foci as a functional biomarker of homologous recombination repair and PARP inhibitor resistance in germline BRCA-mutated breast cancer. Ann Oncol 2018; 29:1203-1210. [PMID: 29635390 PMCID: PMC5961353 DOI: 10.1093/annonc/mdy099] [Citation(s) in RCA: 255] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background BRCA1 and BRCA2 (BRCA1/2)-deficient tumors display impaired homologous recombination repair (HRR) and enhanced sensitivity to DNA damaging agents or to poly(ADP-ribose) polymerase (PARP) inhibitors (PARPi). Their efficacy in germline BRCA1/2 (gBRCA1/2)-mutated metastatic breast cancers has been recently confirmed in clinical trials. Numerous mechanisms of PARPi resistance have been described, whose clinical relevance in gBRCA-mutated breast cancer is unknown. This highlights the need to identify functional biomarkers to better predict PARPi sensitivity. Patients and methods We investigated the in vivo mechanisms of PARPi resistance in gBRCA1 patient-derived tumor xenografts (PDXs) exhibiting differential response to PARPi. Analysis included exome sequencing and immunostaining of DNA damage response proteins to functionally evaluate HRR. Findings were validated in a retrospective sample set from gBRCA1/2-cancer patients treated with PARPi. Results RAD51 nuclear foci, a surrogate marker of HRR functionality, were the only common feature in PDX and patient samples with primary or acquired PARPi resistance. Consistently, low RAD51 was associated with objective response to PARPi. Evaluation of the RAD51 biomarker in untreated tumors was feasible due to endogenous DNA damage. In PARPi-resistant gBRCA1 PDXs, genetic analysis found no in-frame secondary mutations, but BRCA1 hypomorphic proteins in 60% of the models, TP53BP1-loss in 20% and RAD51-amplification in one sample, none mutually exclusive. Conversely, one of three PARPi-resistant gBRCA2 tumors displayed BRCA2 restoration by exome sequencing. In PDXs, PARPi resistance could be reverted upon combination of a PARPi with an ataxia-telangiectasia mutated (ATM) inhibitor. Conclusion Detection of RAD51 foci in gBRCA tumors correlates with PARPi resistance regardless of the underlying mechanism restoring HRR function. This is a promising biomarker to be used in the clinic to better select patients for PARPi therapy. Our study also supports the clinical development of PARPi combinations such as those with ATM inhibitors.
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Affiliation(s)
- C Cruz
- Experimental Therapeutics Group; High Risk and Familial Cancer, Vall d'Hebron Institute of Oncology, Barcelona; Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona
| | | | | | | | | | | | | | - B Morancho
- Growth Factors Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - A Bruna
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge
| | - O M Rueda
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge
| | - Z Lai
- AstraZeneca, Gatehouse Park, Waltham, USA
| | - U M Polanska
- DNA Damage Response Biology Area, Oncology iMed, AstraZeneca, Cancer Research UK Cambridge Institute, Cambridge, UK
| | - G N Jones
- DNA Damage Response Biology Area, Oncology iMed, AstraZeneca, Cancer Research UK Cambridge Institute, Cambridge, UK
| | - P Kristel
- Division of Molecular Pathology and Cancer Genomics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | - R Fasani
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - J Jiménez
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - W J Howat
- DNA Damage Response Biology Area, Oncology iMed, AstraZeneca, Cancer Research UK Cambridge Institute, Cambridge, UK
| | | | | | - P Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona
| | | | - I T Rubio
- Breast Surgical Unit, Breast Cancer Center, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona
| | - A Oaknin
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona; Gynecological Malignancies Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - E Cadogan
- DNA Damage Response Biology Area, Oncology iMed, AstraZeneca, Cancer Research UK Cambridge Institute, Cambridge, UK
| | | | - C Caldas
- Department of Oncology and Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cambridge Breast Unit, NIHR Cambridge Biomedical Research Centre and Cambridge Experimental Cancer Medicine Centre at Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Baselga
- Human Oncology and Pathogenesis Program (HOPP); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C Saura
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona; Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - J Cortés
- Ramón y Cajal University Hospital, Madrid; Vall d'Hebron Institute of Oncology, Barcelona
| | - J Arribas
- Growth Factors Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Department of Biochemistry and Molecular Biology, Building M, Campus UAB, Bellaterra (Cerdanyola del Vallès); Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona; CIBERONC, Barcelona
| | | | - O Díez
- Oncogenetics Group; Clinical and Molecular Genetics Area, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M J O'Connor
- DNA Damage Response Biology Area, Oncology Innovative Medicine and Early Development Biotech Unit, AstraZeneca, Cambridge, UK
| | - J Balmaña
- High Risk and Familial Cancer, Vall d'Hebron Institute of Oncology, Barcelona; Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona
| | - V Serra
- Experimental Therapeutics Group; CIBERONC, Barcelona.
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Cabrera J, Infante J, Cruz C, Moreno M, Gonzalez M, Rayo J, Simon P, Ortiz B, Muñoz J. EP-1381: Role of Metabolic Tumor Volume and Total Lesion Glycolysis on FDG-PET/CT in NSCLC treated with SBRT. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Broch K, Dieterle J, Branchi F, Hestand NJ, Olivier Y, Tamura H, Cruz C, Nichols VM, Hinderhofer A, Beljonne D, Spano FC, Cerullo G, Bardeen CJ, Schreiber F. Robust singlet fission in pentacene thin films with tuned charge transfer interactions. Nat Commun 2018; 9:954. [PMID: 29507287 PMCID: PMC5838205 DOI: 10.1038/s41467-018-03300-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/29/2018] [Indexed: 02/07/2023] Open
Abstract
Singlet fission, the spin-allowed photophysical process converting an excited singlet state into two triplet states, has attracted significant attention for device applications. Research so far has focused mainly on the understanding of singlet fission in pure materials, yet blends offer the promise of a controlled tuning of intermolecular interactions, impacting singlet fission efficiencies. Here we report a study of singlet fission in mixtures of pentacene with weakly interacting spacer molecules. Comparison of experimentally determined stationary optical properties and theoretical calculations indicates a reduction of charge-transfer interactions between pentacene molecules with increasing spacer molecule fraction. Theory predicts that the reduced interactions slow down singlet fission in these blends, but surprisingly we find that singlet fission occurs on a timescale comparable to that in pure crystalline pentacene. We explain the observed robustness of singlet fission in such mixed films by a mechanism of exciton diffusion to hot spots with closer intermolecular spacings.
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Affiliation(s)
- K Broch
- Institute of Applied Physics and Center for Light Matter Interactions, Sensors and Analytics, LISA+, University of Tübingen, Auf der Morgenstelle 10, 72076, Tübingen, Germany.
- Fritz-Haber Institute of the Max-Planck Society, Faradayweg 4-6, 14195, Berlin, Germany.
| | - J Dieterle
- Institute of Applied Physics and Center for Light Matter Interactions, Sensors and Analytics, LISA+, University of Tübingen, Auf der Morgenstelle 10, 72076, Tübingen, Germany
| | - F Branchi
- IFN-CNR, Dipartimento di Fisica, Politecnico di Milano, Milano, 20133, Italy
| | - N J Hestand
- Department of Chemistry, Temple University, Philadelphia, PA, 19122, USA
| | - Y Olivier
- Laboratory for Chemistry of Novel Materials, University of Mons, Place du Parc 20, 7000, Mons, Belgium
| | - H Tamura
- Department of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8656, Japan
| | - C Cruz
- Department of Chemistry, University of California at Riverside, 501 Big Springs Rd, Riverside, CA, 92521, USA
| | - V M Nichols
- Department of Chemistry, University of California at Riverside, 501 Big Springs Rd, Riverside, CA, 92521, USA
| | - A Hinderhofer
- Institute of Applied Physics and Center for Light Matter Interactions, Sensors and Analytics, LISA+, University of Tübingen, Auf der Morgenstelle 10, 72076, Tübingen, Germany
| | - D Beljonne
- Laboratory for Chemistry of Novel Materials, University of Mons, Place du Parc 20, 7000, Mons, Belgium
- School of Chemistry and Biochemistry and Center for Organic Photonics and Electronics, Georgia Institute of Technology, Atlanta, GA, 30332-0400, USA
| | - F C Spano
- Department of Chemistry, Temple University, Philadelphia, PA, 19122, USA
| | - G Cerullo
- IFN-CNR, Dipartimento di Fisica, Politecnico di Milano, Milano, 20133, Italy
| | - C J Bardeen
- Department of Chemistry, University of California at Riverside, 501 Big Springs Rd, Riverside, CA, 92521, USA
| | - F Schreiber
- Institute of Applied Physics and Center for Light Matter Interactions, Sensors and Analytics, LISA+, University of Tübingen, Auf der Morgenstelle 10, 72076, Tübingen, Germany
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Towers S, Chen J, Cruz C, Melendez J, Rodriguez J, Salinas A, Yu F, Kang Y. Quantifying the relative effects of environmental and direct transmission of norovirus. R Soc Open Sci 2018; 5:170602. [PMID: 29657742 PMCID: PMC5882666 DOI: 10.1098/rsos.170602] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 02/06/2018] [Indexed: 05/07/2023]
Abstract
Norovirus is a common cause of outbreaks of acute gastroenteritis in health- and child-care settings, with serial outbreaks also frequently observed aboard cruise ships. The relative contributions of environmental and direct person-to-person transmission of norovirus have hitherto not been quantified. We employ a novel mathematical model of norovirus transmission, and fit the model to daily incidence data from a major norovirus outbreak on a cruise ship, and examine the relative efficacy of potential control strategies aimed at reducing environmental and/or direct transmission. The reproduction number for environmental and direct transmission combined is [Formula: see text] [6.1,9.5], and of environmental transmission alone is [Formula: see text] [0.9,2.6]. Direct transmission is overwhelmingly due to passenger-to-passenger contacts, but crew can act as a reservoir of infection from cruise to cruise. This is the first quantification of the relative roles of environmental and direct transmission of norovirus. While environmental transmission has the potential to maintain a sustained series of outbreaks aboard a cruise ship in the absence of strict sanitation practices, direct transmission dominates. We find that intensive promotion of good hand washing practices may prevent outbreaks. Isolation of ill passengers and cleaning are beneficial, but appear to be less efficacious at outbreak control.
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Affiliation(s)
- S. Towers
- Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, AZ, USA
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Desai NV, Torous V, Cruz C, Schnitt SJ, Tung N. Abstract P2-09-25: Clinical and pathologic characteristics of breast cancers determined to be HER2-positive by fluorescence in-situ hybridization (FISH) using alternative chromosome 17 probes. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-09-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Based on updated 2013 ASCO/CAP guideline for HER2 testing, cases with a HER2/CEP17 ratio < 2.0 but with an average HER2 copy number > 4.0 and <6.0 signals/cell are considered equivocal. In such cases, HER2 testing using alternative chromosome 17 probes was proposed as one way to resolve the equivocal FISH results. Using the alternative probe method increases the number of cancers categorized as HER2 positive but brings to question if these cancers truly represent HER2 amplified breast cancers and derive the same benefit from anti-HER2 therapies.
Methods:
Since 2013, all breast cancers at our institution that were HER2 equivocal by traditional FISH but classified as HER2 positive using the alternative probe method were assessed for clinical and pathologic features including histologic type and grade, TNM stage, HER2: alternative probe ratio, treatment, and clinical outcome.
Results:
We identified 24 invasive breast cancers considered HER2 positive by the alternative probe method: 23 (96%) were estrogen receptor-positive (ER+) and 20 (83%) were progesterone receptor- positive. Histologically, only 2 were invasive lobular carcinomas; all others were ductal or had ductal and lobular features. Most cancers (63%) had low or intermediate histologic grade: Grade 1 (n=3); Grade 2 (n=12); Grade 3 (n=9). Clinical information was available for 18 patients: 2 had metastatic disease, 1 had a local recurrence after mastectomy and 15 patients had early stage disease; 9 with node negative disease and 6 with nodal involvement. HER2 IHC was equivocal (2+) in 16 (66.7%) cases, positive (3+) in 4 (16.7%) cases, and negative (0 or 1+) in 4 (16.7%) cases. The average HER2 copy number was 4.77, the average HER22:p53 ratio was 2.61. Repeat HER2 testing on a 2nd tumor sample was performed in 8 cases: HER2-positivity was confirmed in only 2 (25%) cases and by the alternative probe only. Treatment information was available for 17 patients: 1 had T1aN0M0 lesion and did not get chemotherapy, 16 received chemotherapy and 13 received trastuzumab-based chemotherapy. Eleven patients with early stage disease received chemotherapy and trastuzumab. Of these patients, 10/11 were ER+, 7/11 were node negative and 5/11 had grade 2 tumors, yet only one tumor was assessed by oncotype recurrence score ( RS = 29). Three patients received chemotherapy and trastuzumab in the neoadjuvant setting: 1 had a complete pathologic response, 1 a partial response, and 1 has not yet gone to surgery. One additional patient received neoadjuvant chemo alone and achieved a partial response.
Conclusions:
Breast cancers considered HER2+ by the alternative probe method but not by traditional FISH are almost always ER-positive and most have low or intermediate histologic grade. Repeat HER2 testing on a subsequent tumor sample did not confirm HER2-positivity in 75% of cases. Almost all patients with early stage disease received chemotherapy and trastuzumab based on the alternative probe results without molecular assessment to predict chemotherapy response. Intrinsic molecular subtyping using PAM50 analysis on these cancers is underway to determine how many are HER2-enriched by molecular assessment.
Citation Format: Desai NV, Torous V, Cruz C, Schnitt SJ, Tung N. Clinical and pathologic characteristics of breast cancers determined to be HER2-positive by fluorescence in-situ hybridization (FISH) using alternative chromosome 17 probes [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-25.
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Affiliation(s)
- NV Desai
- Beth Israel Deaconess Medical Center, Boston, MA
| | - V Torous
- Beth Israel Deaconess Medical Center, Boston, MA
| | - C Cruz
- Beth Israel Deaconess Medical Center, Boston, MA
| | - SJ Schnitt
- Beth Israel Deaconess Medical Center, Boston, MA
| | - N Tung
- Beth Israel Deaconess Medical Center, Boston, MA
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Abstract
Continuous flow peritoneal dialysis (CFPD) is a therapy originally utilized in the sixties. It was then abandoned because of technical reasons, but, today, a new interest in this technique is emerging, because of new technical solutions and new hardware capabilities. CFPD is a peritoneal dialysis technique in which a certain amount of fluid is maintained in the peritoneal cavity, while a continuous inflow and outflow is provided via twin catheters or through a double lumen catheter. In this paper a new double lumen catheter is presented. The catheter is characterized by the presence of a diffuser in the inflow lumen, while a standard coiled shape characterizes the outflow lumen. The diffuser allows the use of high dialysate flows without peritoneal damage and with an excellent distribution of the fluid. The other feature of the catheter is the removable hub which allows for an easy subcutaneous tunneling of the catheter with a subsequent connection to the y segment. The special shape also guarantees a minimum recirculation during treatment. Data obtained in the first implanted catheter showed a progressive increase in small solute clearances in relation to an increase of the flow and the tidal volume in the peritoneal cavity. In particular, urea clearances up to 48 ml/min and creatinine clearances up to 39 ml/min were obtained. No major complications were observed after one year of use of the catheter.
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Affiliation(s)
- C Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy.
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Cruz C, Amorim H, Beca G, Nunes R. Neurogenic stuttering: a review of the literature. Rev Neurol 2018; 66:59-64. [PMID: 29323402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Neurogenic stuttering is a disorder of neurologic origin in the rhythm of speech during which the patient knows exactly what he wants to say but is unable to because of an involuntary prolongation, cessation or repetition of a sound. AIM To assemble new insights regarding the epidemiology, pathophysiology, diagnosis, evaluation and treatment of neurogenic stuttering. DEVELOPMENT A review of all PubMed and Scopus published articles between January 2000 and September 2016 was performed. Thirty-three publications were analyzed. Neurogenic stuttering is a rare entity whose epidemiological incidence is yet not fully established. It is correlated with several neurological diseases and with several possible localizations within the nervous system. Notwithstanding the recent advances in the understanding of the underlying mechanism, it is not yet possible to establish a single pathophysiological mechanism of neurogenic stuttering. The differential diagnosis is complex and requires the detailed knowledge of other language disorders. The treatment is currently based on specific speech language therapy strategies. CONCLUSION Neurogenic stuttering is a complex disorder which is not fully understood. Additional studies might help to better explain the underlying pathophysiological mechanism and to open doors to novel therapeutic methods.
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Affiliation(s)
- C Cruz
- Hospital de Braga, Braga, Portugal
| | - H Amorim
- Centro Hospitalar S. Joao, Porto, Portugal
| | - G Beca
- Centro de Reabilitacao do Norte, Vila Nova de Gaia, Portugal
| | - R Nunes
- Centro de Reabilitacao do Norte, Vila Nova de Gaia, Portugal
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Cruz C, Calleja-Castillo J, Moreno-Macías H, Parra-Cabrera M, Hernández-Girón C. Long-term survival and related prognostic factors with first ever ischemic and hemorrhagic stroke, among Mexican patients. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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