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Bertanha M, Mellucci Filho PL, Genka CA, de Camargo PAB, Grillo VTRDS, Sertório ND, Rodrigues LDS, Sobreira ML, Lourenção PLTDA. Quantitative analysis validation for sclerotherapy treatment of lower limb telangiectasias. J Vasc Surg Venous Lymphat Disord 2023; 11:708-715. [PMID: 37030450 DOI: 10.1016/j.jvsv.2023.03.010] [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: 01/07/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND The evaluation of sclerotherapy efficacy for lower limb telangiectasias, which is the standard treatment for such condition, is commonly assisted by scores based on before and after pictures. This method is marked by its subjectivity, which impairs the precision of studies on the subject, making it unfeasible to evaluate and compare different interventions. We hypothesize that a quantitative method for evaluating the effectiveness of sclerotherapy for lower limb telangiectasias may present more reproducible results. Reliable measurement methods and new technologies may become part of the clinical practice in the near future. METHODS Before and after treatment photographs were analyzed using a quantitative method and compared with a validated qualitative method based on improvement scores. Reliability analysis of the methods was performed, applying the intraclass correlation coefficient (ICC) and kappa coefficient with quadratic weights (Fleiss Cohen), for analysis of inter-examiner and intra-examiner agreement in both evaluation methods. Convergent validity was evaluated by applying the Spearman test. To assess the applicability of the quantitative scale, the Mann-Whitney test was used. RESULTS A better agreement between examiners is shown for the quantitative scale, with a mean kappa of .3986 (.251-.511) for qualitative analysis and a mean kappa of .788 (.655-.918) for quantitative analysis (P < .001 for all examiners). Convergent validity was achieved by correlation coefficients of .572 to .905 (P < .001). The quantitative scale results obtained between the specialists with different degrees of experience did not show statistical difference (seniors: 0.71 [-0.48/1.00] × juniors: 0.73 [-0.34/1.00]; P = .221). CONCLUSIONS Convergent validity between both analyses has been achieved, but quantitative analysis has been shown to be more reliable and can be applied by professionals of any degree of experience. The validation of quantitative analysis is a major milestone for the development of new technology and automated, reliable, applications.
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Affiliation(s)
- Matheus Bertanha
- Department of Surgery and Orthopedics, Sao Paulo State University (UNESP), Botucatu, Sao Paulo, Brazil.
| | | | - Caroline Araujo Genka
- Department of Surgery and Orthopedics, Sao Paulo State University (UNESP), Botucatu, Sao Paulo, Brazil
| | | | | | - Nathalia Dias Sertório
- Department of Surgery and Orthopedics, Sao Paulo State University (UNESP), Botucatu, Sao Paulo, Brazil
| | - Lenize da Silva Rodrigues
- Department of Surgery and Orthopedics, Sao Paulo State University (UNESP), Botucatu, Sao Paulo, Brazil
| | - Marcone Lima Sobreira
- Department of Surgery and Orthopedics, Sao Paulo State University (UNESP), Botucatu, Sao Paulo, Brazil
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Mellucci Filho PL, Bertanha M, Jaldin RG, Yoshida WB, Sobreira ML. Grayscale median (GSM) post-processing, posterizing, and color mapping for carotid ultrasound. J Vasc Bras 2023. [DOI: 10.1590/1677-5449.202200812] [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: 02/12/2023] Open
Abstract
Abstract Factors related to atherosclerotic plaques may indicate instability, such as ulcerations, intraplaque hemorrhages, lipid core, thin or irregular fibrous cap, and inflammation. The grayscale median (GSM) value is one of the most widespread methods of studying atherosclerotic plaques and it is therefore important to comprehensively standardize image post-processing. Post-processing was performed using Photoshop 23.1.1.202. Images were standardized by adjusting the grayscale histogram curves, setting the darkest point of the vascular lumen (blood) to zero and the distal adventitia to 190. Posterization and color mapping were performed. A methodology that presents the current state of the art in an accessible and illustrative way should contribute to the dissemination of GSM analysis. This article describes and illustrates the process step by step.
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Bertanha M, Rodrigues LDS, Mellucci Filho PL, Moroz A, Pardini MIDMC, Sobreira ML, Durigon EL, Machado RRG, Grotto RMT, de Lima MA, Nader HB, de Moraes ML, Barbosa AN, Medolago NB, Cardoso FF, Magro AJ, Carvalho CRG, de Moraes LN, Alvarado RDC, Nunes HC, de Campos GC, Grillo VTRDS, Sertorio ND, Fortaleza CMCB. Nebulized enriched heparin to treat no critical patients with Sars-Cov-2: Triple-blind clinical trial. Medicine (Baltimore) 2021; 100:e28288. [PMID: 34941114 PMCID: PMC8702290 DOI: 10.1097/md.0000000000028288] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a viral respiratory disease that spreads rapidly, reaching pandemic status, causing the collapse of numerous health systems, and a strong economic and social impact. The treatment so far has not been well established and there are several clinical trials testing known drugs that have antiviral activity, due to the urgency that the global situation imposes. Drugs with specific mechanisms of action can take years to be discovered, while vaccines may also take a long time to be widely distributed while new virus variants emerge. Thus, drug repositioning has been shown to be a good strategy for defining new therapeutic approaches. Studies of the effect of enriched heparin in the replication of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) in vitro assays justify the advance for clinical tests. METHODS AND ANALYSIS A phase I/II triple-blind parallel clinical trial will be conducted. Fifty participants with radiological diagnosis of grade IIA pneumonia will be selected, which will be allocated in 2 arms. Participants allocated in Group 1 (placebo) will receive nebulized 0.9% saline. Participants allocated in Group 2 (intervention) will receive nebulized enriched heparin (2.5 mg/mL 0.9% saline). Both groups will receive the respective solutions on a 4/4 hour basis, for 7 days. The main outcomes of interest will be safety (absence of serious adverse events) and efficacy (measured by the viral load).Protocols will be filled on a daily basis, ranging from day 0 (diagnosis) until day 8.
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Affiliation(s)
- Matheus Bertanha
- Department of Surgery and Orthopedics, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
- Applied Biotechnology Laboratory, Research Nucleus of Clinical Hospital, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Lenize da Silva Rodrigues
- Department of Surgery and Orthopedics, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Pedro Luciano Mellucci Filho
- Department of Surgery and Orthopedics, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Andrei Moroz
- Department of Bioprocess and Biotechnology, São Paulo State University – UNESP, School of Pharmaceutical Sciences, Araraquara, SP, Brazil
| | - Maria Inês de Moura Campos Pardini
- Applied Biotechnology Laboratory, Research Nucleus of Clinical Hospital, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
- Internal Medicine Division, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Marcone Lima Sobreira
- Department of Surgery and Orthopedics, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Edison Luiz Durigon
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo – USP, São Paulo, SP, Brazil
- Scientific Platform Pasteur, University of São Paulo – USP, São Paulo, SP, Brazil
| | | | - Rejane Maria Tommasini Grotto
- Applied Biotechnology Laboratory, Research Nucleus of Clinical Hospital, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
- Bioprocessing and Biotechnology Department, São Paulo State University – UNESP, School of Agriculture, Botucatu, SP, Brazil
| | - Marcelo Andrade de Lima
- Molecular & Structural Biosciences, School of Life Sciences, Keele University, Newcastle-Under-Lyme, Staffordshire, UK
| | - Helena Bonciani Nader
- Department of Biochemistry, Federal University of São Paulo – UNIFESP, São Paulo, SP, Brazil
| | - Marli Leite de Moraes
- Institute of Science and Technology, Federal University of São Paulo – UNIFESP, São José dos Campos, SP, Brazil
| | - Alexandre Naime Barbosa
- Department of Infectious Diseases, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Natália Bronzatto Medolago
- Clinical Research Unit, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | | | - Angelo José Magro
- Biosciences Institute, São Paulo State University – UNESP, Botucatu, SP, Brazil
| | | | - Leonardo Nazário de Moraes
- Applied Biotechnology Laboratory, Research Nucleus of Clinical Hospital, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
- Bioprocessing and Biotechnology Department, São Paulo State University – UNESP, School of Agriculture, Botucatu, SP, Brazil
| | - Rita de Cássia Alvarado
- Applied Biotechnology Laboratory, Research Nucleus of Clinical Hospital, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Helga Caputo Nunes
- Quality control laboratory, Cellavita Scientific Research, Valinhos, SP, Brazil
| | - Gustavo Constantino de Campos
- Department of Orthopedics and Traumatology, University of Campinas – UNICAMP, School of Medical Sciences, Campinas, SP, Brazil
| | | | - Nathalia Dias Sertorio
- Department of Surgery and Orthopedics, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
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Grillo VTRDS, Mellucci Filho PL, Jaldin RG, Bertanha M, Pimenta REF, Sobreira ML. Agenesia de segmento infra-hepático de veia cava inferior associada a trombose venosa profunda de repetição: relato de caso. J Vasc Bras 2021; 20:e20210006. [PMID: 35515086 PMCID: PMC9045531 DOI: 10.1590/1677-5449.210006] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/19/2021] [Indexed: 11/21/2022] Open
Abstract
Agenesis of the inferior vena cava (IVC) has been described in less than 1% of the population; a rare occurrence caused by embryonic abnormalities. Its correlation with deep vein thrombosis (DVT) is certainly underestimated, since this change is hard to detect using ultrasound. The aim of the article is to report the case of a 41-year-old female patient with pain and edema up to the top of the right thigh after plastic surgery. Bilateral venous duplex ultrasound revealed bilateral DVT involving iliac-femoral-popliteal and distal segments. Venous angiotomography was requested because the IVC was not visible on ultrasound, revealing thrombosis of the right lumbar plexus and iliofemoral segment bilaterally and agenesis of the infrahepatic segment of the inferior vena cava, with ectasia and compensatory tortuosity of paravertebral veins and the azygos-hemiazygos system, and bilateral pelvic varices. Systemic and oral anticoagulation were administered, with a satisfactory clinical response.
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