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Silva MI, Santos P, Viegas D, Miranda M, Montes V, Pita F, Carmona C. Neurolymphomatosis as primary presentation of extra-nodal NK/T-cell lymphoma, nasal type. Neurol Sci 2024:10.1007/s10072-024-07445-4. [PMID: 38472552 DOI: 10.1007/s10072-024-07445-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/03/2024] [Indexed: 03/14/2024]
Abstract
Neurolymphomatosis (NL) describes an infiltration of cranial and peripheral nerves by lymphoma cells, most frequently in non-Hodgkin B-cell lymphoma. This clinical entity is rare and poses a challenging diagnosis. We describe a case of a 64-year-old female patient with NL associated with extra-nodal NK/T-cell lymphoma (ENKTL), nasal type, presenting as a painful progressive mononeuropathy multiplex with an oral cavity lesion. ENKTL is usually associated with Epstein-Barr virus (EBV) infection and rarely affects the central and peripheral nervous system. Lumbar puncture, magnetic resonance imaging (MRI), nerve biopsy, and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) help to establish the diagnosis. Thereby, NL should be considered in the differential diagnosis of painful progressive multiple neuropathies, even in patients without previous history of cancer.
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Affiliation(s)
- Maria Inês Silva
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal.
| | - Pedro Santos
- Department of Hematology, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - Diana Viegas
- Department of Hematology, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - Miguel Miranda
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
| | - Vera Montes
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
| | - Fernando Pita
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
| | - Cátia Carmona
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
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Elsisi GH, Quintana G, Gil D, Santos P, Fernandez D. Clinical and economic burden of systemic lupus erythematosus in Colombia. J Med Econ 2024; 27:1-11. [PMID: 38468478 DOI: 10.1080/13696998.2024.2316536] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
AIMS Our cost-of-illness (COI) model adopted payer and societal perspectives over five years to measure the economic burden of Systemic Lupus Erythematosus (SLE) in Colombia. MATERIALS AND METHODS A prevalence-based model was constructed to estimate costs and economic consequences for SLE patients in Colombia. The model included four health states: three phenotypes of SLE representing mild, moderate, and severe states and death. The clinical inputs were captured from the published literature and validated by the Delphi panel. Our model measured direct medical and indirect costs, including disease management, transient events, and indirect costs. One-way sensitivity analysis was also performed. RESULTS The number of Colombian SLE patients was 37,498. The number of SLE patients with mild, moderate, and severe phenotypes was 5343, 28757 and 3,397, respectively. SLE-patients with moderate (Colombian pesos; COP 146 billion) and severe phenotypes (COP276 billion) incurred higher costs than those with mild phenotypes (COP2 billion), over 5 years. The total SLE cost in Colombia over five years from the payer and societal perspectives was estimated to be COP 915 billion and 8 trillion, respectively. The costs per patient per year from the payer and societal perspectives were COP 4,881,902 ($3,510) and COP 46,637,054 ($33,528), respectively. CONCLUSION The burden of SLE in Colombia over five years is substantially high, mainly due to the consequences of economic loss because it affects women and men of working age, in addition to the costs of SLE management and its consequences, such as flares, infection, and organ damage. Our COI indicated that disease management costs among patients with moderate and severe SLE were substantially higher than those among patients with a mild phenotype. Therefore, more attention should be paid to limiting the progression of SLE and the occurrence of flares, with the need for further economic evaluation of novel treatment strategies that help in disease control.
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Affiliation(s)
- Gihan Hamdy Elsisi
- HTA Office, LLC, Cairo, Egypt
- Economics Department, American University in Cairo, Cairo, Egypt
| | - Gerardo Quintana
- UNAL Internal Medicine Department, Division of Rheumatology, National University of Colombia, Los Andes University, Bogotá, Colombia
| | - Diana Gil
- National University of Colombia, Artmedica SAS, Hospital Universitario Mayor MEDERI, Internal Medicina, Bogotá, Colombia
| | - Pedro Santos
- Biomab IPS, Center for Rheumatoid Arthritis, Bogota, Colombia
| | - Diana Fernandez
- Sanitas International, Data Control Committee of the GLADEL 2.0 Cohort (Latin American Lupus Study Group), Hospital Italiano de Buenos Aires, Bogotá, Colombia
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Martinho G, Santos P, Alves A, Ramos M. Indicators and characteristics of PET packaging collected in a Deposit and Refund System pilot project. Heliyon 2024; 10:e25182. [PMID: 38356606 PMCID: PMC10864888 DOI: 10.1016/j.heliyon.2024.e25182] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Countries that have a Deposit and Refund System (DRS) show high rates of selective beverage packaging waste collection, indicating that it is a powerful economic instrument for achieving the European packaging recycling targets. DRS ensure that collected material is of a sufficiently high quality to be incorporated into new products. In Portugal, the Government has decided to implement a DRS for non-reusable beverage packaging as a strategy to increase the packaging recycling rate, which is currently considerably lower than the mandatory European targets. To acquire knowledge and experience for the design and implementation of the future DRS, a pilot project was carried out with polyethylene terephthalate (PET) beverage packaging, using 23 Reverse Vending Machines (RVM) installed at supermarkets across mainland Portugal. The authors monitored the DRS pilot project between March 2020 and December 2022. The main objectives were to determine operational indicators and evaluate the characteristics and quality of the PET deposited, using both the data recorded by the RVM and a characterisation of the packages contained in a sample of 46 bags. The results provided important data for planning the Portuguese strategy, which may also support operational or political decisions in countries in similar contexts. Whilst the recycling plants that received the material collected in these RVM confirmed that its quality allows for the production of PET food-grade flakes, this research identified a need to improve the design of packaging and to communicate this with producers, to better allow for the incorporation of recycled material into food beverage packaging.
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Affiliation(s)
- Graça Martinho
- MARE – Marine and Environmental Sciences Centre / Associate Laboratory ARNET – Aquatic Research Network, Portugal
- Department of Environmental Sciences and Engineering, NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Caparica, Portugal
| | - Pedro Santos
- MARE – Marine and Environmental Sciences Centre / Associate Laboratory ARNET – Aquatic Research Network, Portugal
- Department of Environmental Sciences and Engineering, NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Caparica, Portugal
| | - Ana Alves
- MARE – Marine and Environmental Sciences Centre / Associate Laboratory ARNET – Aquatic Research Network, Portugal
- Department of Environmental Sciences and Engineering, NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Caparica, Portugal
| | - Mário Ramos
- MARE – Marine and Environmental Sciences Centre / Associate Laboratory ARNET – Aquatic Research Network, Portugal
- Department of Environmental Sciences and Engineering, NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Caparica, Portugal
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Baía CAQ, Sousa A, Sousa F, Santos P, Varelas AI, Afonso LP, Monteiro J, Fernandes JM, Santos LL, Abreu de Sousa J. Unexpected pancreatic mixed neuroendocrine-nonneuroendocrine neoplasms (MiNEN)-reflection on a case report. J Surg Case Rep 2024; 2024:rjae026. [PMID: 38322359 PMCID: PMC10838674 DOI: 10.1093/jscr/rjae026] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/08/2024] Open
Abstract
The authors present a case involving a 51-year-old male who was diagnosed with a 4-cm mass in the body of the pancreas, initially suspected to be a ductal adenocarcinoma due to an elevated Ca 19.9 during routine analysis. Subsequent imaging studies confirmed a resectable disease without suspicious lymph nodes or distant metastasis, leading to the proposal of surgery. The patient underwent a laparoscopic distal splenopancreatectomy, which was uneventful. The histopathological examination revealed a 3.7-cm pancreatic mixed neuroendocrine neoplasia (MiNEN) with a predominant high-grade ductal adenocarcinoma component and a concurrent high-grade neuroendocrine carcinoma, with negative margins. Two lymph node metastases were identified, each representing metastasis of one of the components. The tumor was classified as pT2N1M0. Currently, the patient is undergoing chemotherapy with FOLFIRINOX. This case prompts reflection on the optimal treatment strategy for pancreatic MiNEN and raises the question of how the preoperative diagnosis could influence the patient's outcome.
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Affiliation(s)
- Catarina Alexandra Quintas Baía
- Surgical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (P.CCC), 4200-072 Porto, Portugal
| | - Alexandre Sousa
- Surgical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (P.CCC), 4200-072 Porto, Portugal
| | - Fernanda Sousa
- Surgical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (P.CCC), 4200-072 Porto, Portugal
| | - Pedro Santos
- General Surgery Department, Torres Vedras Hospital, West Hospital Centre, 2560-295 Torres Vedras, Portugal
| | - Ana Isabel Varelas
- Pathology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (P.CCC), 4200-072 Porto, Portugal
| | - Luís Pedro Afonso
- Pathology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (P.CCC), 4200-072 Porto, Portugal
| | - Joana Monteiro
- Medical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (P.CCC), 4200-072 Porto, Portugal
| | - José Manuel Fernandes
- Surgical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (P.CCC), 4200-072 Porto, Portugal
| | - Lúcio Lara Santos
- Surgical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (P.CCC), 4200-072 Porto, Portugal
| | - Joaquim Abreu de Sousa
- Surgical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (P.CCC), 4200-072 Porto, Portugal
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Antunes J, Pinto CIG, Campello MPC, Santos P, Mendes F, Paulo A, Sampaio JM. Utility of realistic microscopy-based cell models in simulation studies of nanoparticle-enhanced photon radiotherapy. Biomed Phys Eng Express 2024; 10:025015. [PMID: 38237176 DOI: 10.1088/2057-1976/ad2020] [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: 06/12/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Abstract
To enhance the effect of radiation on the tumor without increasing the dose to the patient, the combination of high-Z nanoparticles with radiotherapy has been proposed. In this work, we investigate the effects of the physical parameters of nanoparticles (NPs) on the Dose Enhancement Factor (DEF), and on the Sensitive Enhancement Ratio (SER) by applying a version of the Linear Quadratic Model. A method for constructing voxelized realistic cell geometries in Monte Carlo simulations from confocal microscopy images was developed and applied to Gliobastoma Multiforme cell lines (U87 and U373). The comparison of simulations with realistic geometry and spherical geometry shows that there is significant impact on the survival curves obtained for the same irradiation conditions. Using this model, the DEF and the SER are determined as a function of the concentration, size and distribution of gold nanoparticles within the cell. For small NPs,dAuNP= 10 nm, no clear trend in the DEF and SER was observed when the number of NPs within the cell increases. Experimentally, the variable number of NPs measured inside the U373 cells (ranging between 1.48 × 105and 1.19 × 106) also did not influence much the observed cell survival upon irradiation of the cells with a Co-60 source. The same lack of trend is obtained when the Au content in the cell is kept constant, 0.897 mg/g, but the size of the NPs is changed. However, if the number of NPs is kept constant (7.91 × 105) and the size changes, there is a critical diameter above which the dose effect increases significantly. Using the realistic geometries, it was verified that the key parameter for the DEF and the SER enhancement is the volume fraction of Au in the cell, with NP size being a more important parameter than the number of NPs.
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Affiliation(s)
- Joana Antunes
- Laboratório de Instrumentação e Física Experimental de Partículas, Av. Prof. Gama Pinto 2, 1649-003 Lisboa, Portugal
- Departamento de Física da Faculdade de Ciências da Universidade de Lisboa, Rua Ernesto de Vasconcelos, 1749-016 Lisboa, Portugal
| | - Catarina I G Pinto
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal
| | - Maria Paula Cabral Campello
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal
- Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, 1749-016 Lisboa, Portugal
| | - Pedro Santos
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal
| | - Filipa Mendes
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal
- Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, 1749-016 Lisboa, Portugal
| | - António Paulo
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal
- Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, 1749-016 Lisboa, Portugal
| | - Jorge M Sampaio
- Laboratório de Instrumentação e Física Experimental de Partículas, Av. Prof. Gama Pinto 2, 1649-003 Lisboa, Portugal
- Departamento de Física da Faculdade de Ciências da Universidade de Lisboa, Rua Ernesto de Vasconcelos, 1749-016 Lisboa, Portugal
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Patel TA, Dee EC, Jain B, Vapiwala N, Fayanju O, Santos P. Disparities in Breast-Conserving Therapy vs. Mastectomy among Asian American and Pacific Islander Women. Int J Radiat Oncol Biol Phys 2023; 117:e198-e199. [PMID: 37784843 DOI: 10.1016/j.ijrobp.2023.06.1071] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Multiple randomized trials support the use of breast-conserving therapy (BCT), defined as lumpectomy followed by adjuvant radiotherapy, as an alternative to mastectomy for definitive treatment of early-stage (T1-2N0) breast cancer. However, data suggest that Asian American, Native Hawaiian, and Pacific Islander (AANHPI) may undergo mastectomy at higher rates than BCT and may experience barriers to receipt of BCT. The purpose of this study was to examine BCT utilization by disaggregated AANHPI groups to identify differences in receipt of mastectomy versus BCT. MATERIALS/METHODS The 2004-2017 National Cancer Database was queried to identify women age ≥18 years old diagnosed with cT1-2N0M0 breast cancer treated with either BCT or mastectomy without post-mastectomy radiation therapy. Women were classified based on self-reported race. Multivariable logistic regression defined adjusted odds ratios (OR) assessing the association between race and receipt of BCT versus mastectomy for all patients and separately by cT1-2 stage. All models were adjusted for relevant sociodemographic and clinical factors. RESULTS Of 794,403 women with cT1-2N0M0 breast cancer, 239,801 (30%) received mastectomy and 554,602 (70%) received BCT. After adjusting for clinical and sociodemographic factors, AANHPI women had greater odds of receiving mastectomy over BCT, compared to White women (OR [95% CI], 1.35 [1.30-1.39]; p<0.001). In contrast, Black women were less likely than White women to receive mastectomy (0.86 [0.84-0.87]; p<0.001). Upon disaggregation, Chinese, Japanese, Filipino, Korean, Vietnamese, and Asian Indian & Pakistani women were more likely to receive mastectomy over BCT compared to White women (p<0.001 for all). Treatment at academic (1.30 [1.27-1.32]), integrated (1.24 [1.21-1.27]), and comprehensive community cancer centers (1.15 [1.13-1.17]) were all associated with greater odds of mastectomy compared to treatment at community cancer programs (all p<0.001). Greater distance from treatment facility (≥50 mi. vs. 0 to <10 mi. [reference], OR 1.50 [1.47-1.53]) and cT2 disease (1.85 [1.82-1.87]) were also associated with greater odds of receiving mastectomy (all p<0.001). CONCLUSION In this evaluation of women with early-stage breast cancer, women from several AANHPI groups were more likely to receive mastectomy (as opposed to BCT) compared to White women. While sociocultural preferences, differences in access to and interest in reconstruction, as well as prevalent tumor-to-breast ratios may partially explain the disparities, collectively our data suggest an ongoing need for greater patient involvement in shared-decision making, particularly in vulnerable and understudied Asian populations.
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Affiliation(s)
- T A Patel
- University of Pennsylvania, Philadelphia, PA
| | - E C Dee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - B Jain
- Massachusetts Institute of Technology, Cambridge, MA
| | - N Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - O Fayanju
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - P Santos
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Santos P, Chakraborty N, Salz T, Curry M, Vicioso NL, Mathis NJ, Caron M, Ostroff J, Guttman D, Salner AL, Panoff JE, McIntosh AF, Pfister DG, Yang JT, Snyderman AL, Gillespie EF. Implementation Outcomes of Strategies to Promote Short-Course Radiation for Nonspine Bone Metastases in an Academic-Community Partnership: Survey Results from the ALIGNMENT Trial. Int J Radiat Oncol Biol Phys 2023; 117:S124-S125. [PMID: 37784321 DOI: 10.1016/j.ijrobp.2023.06.466] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Local treatment of nonspine bone metastases has become increasingly complex, resulting in physician practice variability nationwide. The purpose of this study was to assess physician perceptions of 3 implementation strategies to promote adoption of short course radiotherapy (RT) for nonspine bone metastases. MATERIALS/METHODS ALIGNMENT ("Alliance Group for Bone Metastasis") was a multi-institutional stepped wedge cluster randomized implementation trial testing strategies to increase use of ≤5 fractions for nonspine bone metastases conducted across 3 clinical sites in an academic-community partnership. Strategies included a) multidisciplinary consensus guidelines, b) e-Consults, an email-based consultation platform, and c) personalized audit and feedback (A&F) reports with peer comparison. Using the Proctor et al. framework and validated questions from Weiner et al., physician surveys were used to assess each strategy's usefulness, acceptability (i.e., "I welcome [strategy]"), appropriateness (i.e., "[strategy] seems like a good match"), and feasibility (i.e., "[strategy] seems implementable" or "easy to use"). Survey responses were anonymized, so Fisher's Exact test was used to compare proportions with significance set at p<0.05. RESULTS Overall, 29 of 38 and 30 of 38 physicians participated in the pre- and post-implementation surveys, respectively, with 80% completing both. Pre-implementation, guidelines was most often ranked 1st in terms of usefulness (61%), followed by eConsults (38%) and A&F (3%). Post-implementation, guidelines and eConsults had the most and least favorable acceptability, appropriateness, and feasibility scores, respectively (Table), with 77% of physicians being likely to recommend the guidelines to other oncologists. In contrast, while 43% of physicians reported having at least 1 difficult clinical question regarding bone metastases during the study, only 33% of physicians preferred eConsults, while 50% preferred reaching out to a friend/colleague. Lastly, although A&F had the lowest perceived usefulness pre-implementation, A&F had the greatest increase in acceptability (72%→90%; p = 0.10), appropriateness (66%→90%; p = 0.03) feasibility ("implementable": 59%→93%, p = 0.002; "easy to use": 45%→93%, p<0.001). CONCLUSION In this multicenter trial, all strategies were acceptable, appropriate, and feasible, with guidelines and A&F showing the most favorable outcomes post-implementation. While guidelines were assessed as the most useful, A&F had significant increases in appropriateness and feasibility.
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Affiliation(s)
- P Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Harvard T.H. Chan School of Public Health, Boston, MA
| | - N Chakraborty
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Curry
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Ledesma Vicioso
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - N J Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Caron
- Strategic Partnerships, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Guttman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A L Salner
- Hartford HealthCare Cancer Institute, Hartford, CT
| | - J E Panoff
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - A F McIntosh
- Allentown Radiation Oncology Associates, Allentown, PA, United States
| | - D G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J T Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiation Oncology, University of Washington, Seattle, WA
| | - A Lipitz Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - E F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiation Oncology, University of Washington, Seattle, WA
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Santos P, Shah K, Barnes JM, Tao A, Tsai CJ, Chino F. Disparities in Inpatient Care Including Receipt of Radiotherapy and Mortality in Unhoused Adults with Cancer in the United States. Int J Radiat Oncol Biol Phys 2023; 117:e53-e54. [PMID: 37785645 DOI: 10.1016/j.ijrobp.2023.06.765] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Cancer is the second leading cause of death among unhoused individuals in the United States. This study aims to assess inpatient care and outcomes of unhoused vs. housed adults with cancer. We hypothesize that unhoused patients receive less intensive care than housed patients during hospitalization. MATERIALS/METHODS All hospitalized adults age ≥18 with a principal cancer diagnosis were identified in the 2016-2020 National Inpatient Sample (NIS). Logistic regression models tested for associations between housing status and primary outcomes: care management (i.e., receipt of invasive procedures, systemic therapy, or radiation therapy [RT]) and inpatient death. Adjusted analyses accounted for patient demographics, socioeconomic status, comorbidities, and potential interactions between housing status and length of stay (LOS). RESULTS A total of 9,030 unhoused and 2,758,693 housed hospitalized adults with cancer were included in this study. At baseline, there were significant (p<0.05) differences in age <65 years (77% unhoused vs. 41% housed), male sex (75% vs. 53%), race (Black, 25% vs. 13%; White, 58% vs. 71%), and insurance type (Private, 6% vs. 27%; Medicaid, 53% vs. 11%) between groups. There were also differences in the prevalence of certain cancer histologies, including lung (17% vs. 14%) and liver (8% vs. 3%) cancer. Additionally, while comorbidities such as congestive heart failure (18% vs. 15%) and HIV (10% vs. 1%) were more common among unhoused patients, other conditions such as autoimmune disease (21% vs. 26%) and diabetes mellitus (38% vs. 43%) were more common among housed patients. Compared to housed patients, unhoused patients had longer LOS (median 6 vs. 4 days), with 62% hospitalized for ≥5 days (vs. 46%). On adjusted analysis, unhoused patients were less likely to undergo invasive procedures (48% vs. 58%; aOR [95% CI], 0.34 [0.27-0.42]) or receive systemic therapy (6% vs. 8%; 0.41 [0.20-0.85]) while inpatient. There were no significant differences in odds of receipt of RT (2% vs. 1%; 0.85 [0.21-3.41]) or odds of inpatient death (4% vs. 6%; 0.78 [0.52-1.15]) between groups. CONCLUSION In this first nationally representative analysis of housing status among hospitalized adults with cancer, unhoused adults were significantly less likely to receive invasive procedures or systemic therapy while inpatient, despite a higher prevalence of certain aggressive cancers and serious comorbidities compared to housed adults. Although there were no significant differences in the receipt of RT or death, disparities in inpatient management among unhoused patients highlight missed opportunities to promote equitable cancer care in this vulnerable population.
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Affiliation(s)
- P Santos
- Harvard T.H. Chan School of Public Health, Boston, MA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - K Shah
- Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY
| | - J M Barnes
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, Saint Louis, MO
| | - A Tao
- Tufts University School of Medicine, Boston, MA
| | - C J Tsai
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - F Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
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Brito D, Anacleto P, Pérez-Rodríguez A, Fonseca J, Santos P, Alves M, Cavalli A, Sharma D, Claro MS, Nicoara N, Sadewasser S. Antimony Selenide Solar Cells Fabricated by Hybrid Reactive Magnetron Sputtering. Nanomaterials (Basel) 2023; 13:2257. [PMID: 37570574 PMCID: PMC10420897 DOI: 10.3390/nano13152257] [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] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
The fabrication of Sb2Se3 thin-film solar cells deposited by a pulsed hybrid reactive magnetron sputtering (PHRMS) was proposed and examined for different growth conditions. The influence of growth temperature and Se pulse period were studied in terms of morphology, crystal structure, and composition. The Sb2Se3 growth showed to be dependent on the growth temperature, with a larger crystal size for growth at 270 °C. By controlling the Se pulse period, the crystal structure and crystal size could be modified as a function of the supplied Se amount. The solar cell performance for Sb2Se3 absorbers deposited at various temperatures, Se pulse periods and thicknesses were assessed through current-voltage characteristics. A power conversion efficiency (PCE) of 3.7% was achieved for a Sb2Se3 solar cell with 900 nm thickness, Sb2Se3 deposited at 270 °C and Se pulses with 0.1 s duration and period of 0.5 s. Finally, annealing the complete solar cell at 100 °C led to a further improvement of the Voc, leading to a PCE of 3.8%, slightly higher than the best reported Sb2Se3 solar cell prepared by sputtering without post-selenization.
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Affiliation(s)
- Daniel Brito
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
- Departamento de Física e Astronomia, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre s/n, 4169-007 Porto, Portugal
| | - Pedro Anacleto
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
| | - Ana Pérez-Rodríguez
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
- Nanotechnology Group, Department of Fundamental Physics, University of Salamanca, 37008 Salamanca, Spain
| | - José Fonseca
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
| | - Pedro Santos
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
| | - Marina Alves
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
- Centre of Physics of Minho and Porto Universities (CF-UM-UP), Azurém Campus, 4800-058 Guimarães, Portugal
| | - Alessandro Cavalli
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
| | - Deepanjan Sharma
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
| | - Marcel S. Claro
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
| | - Nicoleta Nicoara
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
| | - Sascha Sadewasser
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (D.B.); (P.A.); (A.P.-R.); (J.F.); (P.S.); (M.A.); (A.C.); (D.S.); (M.S.C.); (N.N.)
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10
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Santos P, Gonzalez M, Davis GL, Pusic AL, Rohde CH. From a Chicken Model to a Patient: Microsurgical Repair of a Brachial Artery in Mozambique. Plast Reconstr Surg Glob Open 2023; 11:e5216. [PMID: 37636328 PMCID: PMC10448937 DOI: 10.1097/gox.0000000000005216] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/12/2023] [Indexed: 08/29/2023]
Abstract
In sub-Saharan Africa, options for reconstruction of traumatic injuries are limited due to lack of access to microsurgery-trained surgeons. Recently, the Plastic Surgery Foundation-sponsored Surgeons in Humanitarian Alliance for Reconstruction, Research and Education group hosted a virtual microsurgery skills course for junior plastic surgeons in this region. In this report, we describe a case of complete brachial artery transection requiring microsurgical techniques and use of vein graft for repair at our provincial hospital in Mozambique. By highlighting this case, we aimed to describe a direct clinical application of the Surgeons in Humanitarian Alliance for Reconstruction, Research and Education virtual microsurgery skills course and to demonstrate the profound impact such courses can have on patient outcomes in low-and middle-income countries with limited or no access to microsurgery-trained surgeons. Further, through newly gained familiarity with standard microsurgery instruments used in reconstructive procedures, we were able to improvise and develop modified instruments to overcome lack of resources at our institution.
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Affiliation(s)
- Pedro Santos
- From the Department of Surgery, Matola Provincial Hospital, Matola, Mozambique
| | - Mauro Gonzalez
- From the Department of Surgery, Matola Provincial Hospital, Matola, Mozambique
| | - Greta L Davis
- Division of Plastic Surgery, University of California San Francisco Health, San Francisco, Calif
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham Health, Boston, Mass
| | - Christine H Rohde
- Division of Plastic Surgery, Columbia University Irving Medical Center, New York, N.Y
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11
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Emidio F, Pereira R, Blanco R, Santos P, Abegão T, Fitas C. An 84-year-old patient with Caroli syndrome: what is the prognosis of this condition? Eur J Case Rep Intern Med 2023; 10:003794. [PMID: 36969528 PMCID: PMC10035612 DOI: 10.12890/2023_003794] [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] [Received: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Caroli disease is a rare congenital pathology caused by mutation of the PKHD1 gene (polycystic kidney and hepatic disease 1), also responsible for autosomal recessive polycystic kidney disease. Characterized by segmental and multifocal dilatation of the large intrahepatic bile ducts, classic disease involves only malformation of the biliary tract. The association with congenital hepatic fibrosis is called Caroli syndrome. We describe the case of an 84-year-old man with Caroli syndrome diagnosed in 1997 by liver biopsy. The CT scan revealed massive hepatomegaly, extending to the pelvic region, and almost total replacement of the parenchyma by numerous cystic formations, no evidence of bile duct dilatation, and no ascites or splenomegaly suggestive of portal hypertension. The atypical clinical presentation, with no reported complications, resembles that of a space-occupying lesion with an indolent course, previously misdiagnosed as metastatic neoplasm.
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Affiliation(s)
- Fabio Emidio
- Centro Hospitalar Universitário do Algarve – Hospital de Faro, Serviço de Medicina 1; Faro, Portugal
| | - Rafaela Pereira
- Centro Hospitalar Universitário do Algarve – Hospital de Faro, Serviço de Medicina 2; Faro, Portugal
| | - Rosário Blanco
- Centro Hospitalar Universitário do Algarve – Hospital de Faro, Serviço de Medicina 2; Faro, Portugal
| | - Pedro Santos
- Centro Hospitalar Universitário do Algarve – Hospital de Faro, Serviço de Medicina 1; Faro, Portugal
| | - Teresa Abegão
- Centro Hospitalar Universitário do Algarve – Hospital de Faro, Serviço de Medicina 1; Faro, Portugal
| | - Claudia Fitas
- Centro Hospitalar Universitário do Algarve – Hospital de Faro, Serviço de Medicina 1; Faro, Portugal
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12
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Fernandes Carvalho A, Santos P, Correia G, Pacheco-Figueiredo L. Low-Intensity Extracorporeal Shock Wave Treatment (LI-ESWT) efficacy treating a cohort of real-life patients with erectile dysfunction. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01289-7] [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: 02/12/2023]
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13
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Martinho M, Calé R, Pereira AR, Ferreira F, Alegria S, Morgado G, Martins C, Ferreira M, Gomes A, Judas T, Gonzalez F, Lohmann C, Repolho D, Santos P, Pereira E, Loureiro MJ, Pereira H. Oral Presentation No. 114 Small-bore aspiration thrombectomy versus catheter-directed thrombolysis in intermediate-high risk acute Pulmonary Embolism. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.094] [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
Catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT) are treatment options in intermediate-high risk pulmonary embolism (IHRPE).
Purpose
Compare the efficacy and safety of CDT and MT in IHRPE.
Methods
Retrospective single-centre study of consecutive IHRPE patients (pts) since 2018, treated with CDT (5Fr Cragg-McNamara device) or MT (Indigo MT system, Penumbra 8Fr). Clinical success at 48h was defined as survival and haemodynamic (HD) stabilization, oxygenation improvement or decrease in pulmonary hypertension (PH)/right heart strain. MACE during follow-up (FUP) was a composite endpoint of cardiovascular mortality, PE recurrence, chronic thromboembolic PH and heart failure hospitalization. Safety endpoint was defined as Major bleeding (BARC3).
Results
Of 25 pts, 60% were submitted to MT and 40% to CDT. Age (68.6 ± 15.6 vs. 62.7 ± 16.4, P = 0.381), Charlson Comorbidity Index (4.2 ± 1.9 vs. 2.9 ± 2.0, P = 0.121) and PESI score (103.2 ± 40.6 vs. 119.8 ± 46.2, P = 0.410) were similar. MT had increased fluoroscopy time (43.0 ± 19.1 vs. 10.1 ± 6.2 min, P < 0.001) and procedure time (115 ± 63 vs. 45 ± 18 min, P = 0.009). Success at 48 h was similar (80% MT vs. 90% CDT; P = 0.626). Severe adverse events related with the technique happened in 2 pts in MT (1 death, 1 macroembolization) and 1pt in CDT developed HD instability. Haemoglobin fall was higher in MT (1.8 ± 1.3 vs. 0.7 ± 0.8 g/dL, P = 0.018), but BARC3 and transfusion were identical. In-hospital mortality was 8% (2 pts in MT, P = 0.229). Mean FUP was 229 ± 147days, with higher MACE in MT (40% vs. 0%, P = 0.051).
Conclusions
Despite similar efficacy at short-term, adverse events related to the procedure seemed higher in MT group. CDT was less time consuming.
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14
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Martinho M, Cale R, Nabais S, Briosa A, Pereira E, Pereira AR, Grade Santos J, Ferreira B, Santos Cunha D, Santos P, Vitorino S, Eusebio C, Morgado G, Martins C, Pereira H. At the outer edge of STEMI time: even after 12 hours, the clock keeps ticking. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1239] [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
Although primary percutaneous coronary intervention (pPCI) is not a class I recommendation in all patients (pts) presenting within 12 to 48h of symptom onset (late ST-segment Elevation Myocardial Infarction, STEMI), there is increasing evidence supporting its routine use in this population. Data on long-term clinical outcomes is sparse.
Objective
To evaluate long-term MACE in late-STEMI pts submitted to pPCI and compare with clinical outcomes of early reperfusion groups.
Methods
Retrospective analysis of consecutive pts submitted to pPCI due to STEMI between 2010 and 2015 in a pPCI centre. Included pts were stratified in 5 groups according to symptom-to-balloon time (SBT): <3h; 3–6h; 6–12h; 12–24h; 24–48h. Of a total of 903 pts, 19 pts were excluded due to SBT >48h. Long-term events were established as 5y mortality and 5y-MACE (a composite endpoint of death, re-infarction, heart failure hospital admission and ischemic stroke). The cumulative incidence of long-term outcomes was calculated by the Cox regression analysis and presented according to the Kaplan-Meier method.
Results
Of the 884 pts included in the study, stratification according to SBT was: pPCI<3h (47.4%), pPCI 3–6h (24.9%), pPCI 6–12h (16.5%), pPCI 12–24h (8.0%), and pPCI 24–48h (3.2%). These groups showed no significant difference in terms of demographic characteristics (age, CV risk factors, previous coronary disease or heart failure), clinical severity (systolic arterial pressure, Killip-Kimball class, left ventricle ejection fraction) and angiography findings (multivessel disease, complete revascularization and PCI success). After a median follow-up of 76 (56; 98) months, 5-year mortality was 20.6% (182 pts) and 5-year MACE was 23.3% (206 pts). MACE was associated with increased median SBT: 5.0 (2.0; 9.0) hours vs 4.0 (2.0; 6.5) hours, p<0.001. Of the MACE components, the only that showed a significant association with higher median SBT was mortality: 5.0 (2.0; 10.0) hours vs 4.0 (2.0; 6.0), p<0.001. Differences in long-term outcomes were significant when considering SBT stratified by revascularization time (Figure 1).
Conclusions
As expected, there is a clinical benefit of early reperfusion for long-term cardiovascular events. Within the late-STEMI group, there seems to be a clear distinction between pPCI<24h and >24h, although the clinical benefit of pPCI timing most probably acts a continuum.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Martinho
- Hospital Garcia de Orta , Almada , Portugal
| | - R Cale
- Hospital Garcia de Orta , Almada , Portugal
| | - S Nabais
- Faculdade de Medicina da Universidade de Lisboa , Lisboa , Portugal
| | - A Briosa
- Hospital Garcia de Orta , Almada , Portugal
| | - E Pereira
- Hospital Garcia de Orta , Almada , Portugal
| | | | | | - B Ferreira
- Hospital Garcia de Orta , Almada , Portugal
| | | | - P Santos
- Hospital Garcia de Orta , Almada , Portugal
| | - S Vitorino
- Hospital Garcia de Orta , Almada , Portugal
| | - C Eusebio
- Hospital Garcia de Orta , Almada , Portugal
| | - G Morgado
- Hospital Garcia de Orta , Almada , Portugal
| | - C Martins
- Hospital Garcia de Orta , Almada , Portugal
| | - H Pereira
- Hospital Garcia de Orta , Almada , Portugal
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15
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Teixeira M, Santos P, Bastos Furtado A, Delgado Alves J. When a Histologic Diagnosis Becomes Factitious: A Case of Munchausen Syndrome. Cureus 2022; 14:e28876. [PMID: 36225520 PMCID: PMC9540517 DOI: 10.7759/cureus.28876] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Recurrent episodes of hypoglycemia are uncommon in non-diabetic patients. The workup investigation must confirm hypoglycemia and distinguish between endogenous versus exogenous hyperinsulinism. Simultaneous measurements of plasma glucose, insulin, C-peptide, and a screen for oral hypoglycemic agents should be performed. According to the results, further imaging studies may be necessary. A 43-year-old woman suffering from recurrent hypoglycemia presented to the emergency room (ER) with a hypoglycemic coma. She has had multiple episodes of documented hypoglycemia for the last 13 years. The case was initially investigated, and laboratory studies revealed endogenous hyperinsulinism. Screening for sulfonylureas, anti-insulin and anti-insulin receptor antibodies were negative. Body imaging and positron emission tomography (PET) with 68Ga-DOTANOC did not show evidence of an insulinoma. The patient was submitted to a pancreatectomy, which revealed nesidioblastosis in the histologic examination. Since then, the patient became hyperglycemic but the insulin doses were progressively reduced until new episodes of hypoglycemia recurred and the insulin was stopped. Again, inappropriately high levels of insulin were found at the time of hypoglycemic episodes. Computed tomography (CT) and PET scans did not find evidence of an insulinoma. A C-peptide was later found to be negative and insulin ampoules were found in her possession, making a diagnosis of a factitious disorder. Although rare, factious disorders are frequently overlooked and challenging to diagnose. Since they are very resource and time-consuming, self-inflicted illnesses should always be considered and ruled out beforehand.
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16
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Roque J, Santos P, Margaça FMA, Caeiro MF, Cabo Verde S. Inactivation mechanisms of human adenovirus by e-beam irradiation in water environments. Appl Microbiol Biotechnol 2022; 106:3799-3809. [PMID: 35575914 DOI: 10.1007/s00253-022-11958-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/28/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/02/2022]
Abstract
This study aims to study the kinetics and mechanisms of human adenovirus inactivation by electron beam. Human adenovirus type 5 (HAdV-5) was inoculated in two types of aqueous substrates (phosphate-buffered saline - PBS, domestic wastewater - WW) treated by electron beam at a dose range between 3 and 21 kGy. Samples were evaluated for virus infectivity, PCR amplification of fragments of HAdV-5 genome and abundance and antigenicity of the virion structural proteins. The maximum reduction in viral titre, in plaque-forming units (PFU) per millilitre, was about 7 and 5 log PFU/mL for e-beam irradiation at 20 kGy in PBS and 19 kGy in wastewater, respectively. Among the virion structural proteins detected, the hexon protein showed the higher radioresistance. Long (10.1 kbp) genomic DNA fragments were differently PCR amplified, denoting a substrate effect on HAdV-5 genome degradation by e-beam. The differences observed between the two substrates can be explained by the protective effect that the organic matter present in the substrate may have on viral irradiation. According to the obtained results, the decrease in viral viability/infectivity may be due to DNA damage and to protein alterations. In summary, electron beam irradiation at a dose of 13 kGy is capable of reducing HAdV-5 viral titres by more than 99.99% (4 log PFU/mL) in both substrates assayed, indicating that this type of technology is effective for viral wastewater disinfection and may be used as a tertiary treatment in water treatment plants. KEY POINTS: • The substrate in which the virus is suspended has an impact on its sensitivity to e-beam treatment. • E-beam irradiation at 13 kGy is capable of reducing by 4 Log PFU/mL the HAdV-5 viral titre. • The decrease in viral viability/infectivity may be due to DNA damage and to protein alterations.
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Affiliation(s)
- Joana Roque
- Centro de Ciências E Tecnologias Nucleares (C2TN), Instituto Superior Técnico, Universidade de Lisboa, E.N. 10 ao km 139.7, 2695-066, Bobadela LRS, Portugal.,Centro de Estudos Do Ambiente E Do Mar (CESAM), Departamento de Biologia Vegetal, Faculdade de Ciências da Universidade de Lisboa, Edifício C2-Piso 4, Campo Grande, 1749-016, Lisbon, Portugal
| | - Pedro Santos
- Centro de Ciências E Tecnologias Nucleares (C2TN), Instituto Superior Técnico, Universidade de Lisboa, E.N. 10 ao km 139.7, 2695-066, Bobadela LRS, Portugal
| | - Fernanda M A Margaça
- Centro de Ciências E Tecnologias Nucleares (C2TN), Instituto Superior Técnico, Universidade de Lisboa, E.N. 10 ao km 139.7, 2695-066, Bobadela LRS, Portugal
| | - Maria Filomena Caeiro
- Centro de Estudos Do Ambiente E Do Mar (CESAM), Departamento de Biologia Vegetal, Faculdade de Ciências da Universidade de Lisboa, Edifício C2-Piso 4, Campo Grande, 1749-016, Lisbon, Portugal
| | - Sandra Cabo Verde
- Centro de Ciências E Tecnologias Nucleares (C2TN), Instituto Superior Técnico, Universidade de Lisboa, E.N. 10 ao km 139.7, 2695-066, Bobadela LRS, Portugal.
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17
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Marques A, Belchior A, Silva F, Marques F, Campello MPC, Pinheiro T, Santos P, Santos L, Matos APA, Paulo A. Dose Rate Effects on the Selective Radiosensitization of Prostate Cells by GRPR-Targeted Gold Nanoparticles. Int J Mol Sci 2022; 23:ijms23095279. [PMID: 35563666 PMCID: PMC9105611 DOI: 10.3390/ijms23095279] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 12/14/2022] Open
Abstract
For a while, gold nanoparticles (AuNPs) have been recognized as potential radiosensitizers in cancer radiation therapy, mainly due to their physical properties, making them appealing for medical applications. Nevertheless, the performance of AuNPs as radiosensitizers still raises important questions that need further investigation. Searching for selective prostate (PCa) radiosensitizing agents, we studied the radiosensitization capability of the target-specific AuNP-BBN in cancer versus non-cancerous prostate cells, including the evaluation of dose rate effects in comparison with non-targeted counterparts (AuNP-TDOTA). PCa cells were found to exhibit increased AuNP uptake when compared to non-tumoral ones, leading to a significant loss of cellular proliferation ability and complex DNA damage, evidenced by the occurrence of multiple micronucleus per binucleated cell, in the case of PC3 cells irradiated with 2 Gy of γ-rays, after incubation with AuNP-BBN. Remarkably, the treatment of the PC3 cells with AuNP-BBN led to a much stronger influence of the dose rate on the cellular survival upon γ-photon irradiation, as well as on their genomic instability. Overall, AuNP-BBN emerged in this study as a very promising nanotool for the efficient and selective radiosensitization of human prostate cancer PC3 cells, therefore deserving further preclinical evaluation in adequate animal models for prostate cancer radiotherapy.
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Affiliation(s)
- Ana Marques
- Departamento de Física, Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001 Lisbon, Portugal;
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal; (F.M.); (M.P.C.C.); (P.S.); (A.P.)
| | - Ana Belchior
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal; (F.M.); (M.P.C.C.); (P.S.); (A.P.)
- Correspondence: (A.B.); (F.S.)
| | - Francisco Silva
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal; (F.M.); (M.P.C.C.); (P.S.); (A.P.)
- Correspondence: (A.B.); (F.S.)
| | - Fernanda Marques
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal; (F.M.); (M.P.C.C.); (P.S.); (A.P.)
- Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal;
| | - Maria Paula Cabral Campello
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal; (F.M.); (M.P.C.C.); (P.S.); (A.P.)
- Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal;
| | - Teresa Pinheiro
- Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal;
- Instituto de Bioengenharia e Biociências, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
| | - Pedro Santos
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal; (F.M.); (M.P.C.C.); (P.S.); (A.P.)
| | - Luis Santos
- Laboratório de Metrologia, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal;
| | - António P. A. Matos
- Centro de Investigação Interdisciplinar Egas Moniz, Campus Universitário, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal;
| | - António Paulo
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Campus Tecnológico e Nuclear, Estrada Nacional 10, Km 139.7, 2695-066 Bobadela LRS, Portugal; (F.M.); (M.P.C.C.); (P.S.); (A.P.)
- Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal;
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Santos P, Almeida J, Carvalho I, Sousa C. Unusual complications of acute frontal rhinosinusitis. Two clinical cases. ORL 2022. [DOI: 10.14201/orl.27724] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Acute frontal rhinosinusitis is defined as an acute infection of the frontal sinus. Spreading of this infection to surrounding structures is uncommon but, when present, carries significant morbidity and mortality. Description: In this case report, we present two unusual cases of frontal rhinosinusitis complications. Firstly, we describe a case of acute rhinosinusitis with orbital complications caused by a frontoethmoidal osteoma. In the second case, the infection extended to the underlying bone and through the skull causing osteomyelitis and focal meningitis complicated with an abscess. After appropriate treatment, both patients were free of infection at follow-up, without complications. Discussion: In the first case we presented, a frontoethmoidal osteoma gave rise to rhinosinusitis with orbital complications. These benign tumors rarely cause symptoms, but when large enough, sinus outflow can be blocked, making the osteoma clinically relevant. Osteomas can induce frontal rhinosinusitis, giving rise, among other conditions, to the development of orbital complications like periorbital cellulitis or the formation of a periorbital abscess. Diagnosis of osteoma is usually straightforward on computed tomography and surgical treatment is only indicated for large tumors, rapid growth, intracranial or orbitary extension. In the second clinical case, the infection extended to the underlying bone and through the skull causing osteomyelitis and focal meningitis with abscess formation. In this patient, a Draf Type IIa procedure was performed for the frontal abscess drainage, followed by proper antibiotic and anti-inflammatory therapy. Conclusions: Complications of frontal rhinosinusitis are uncommon but require immediate attention and aggressive treatment to avoid morbidity and mortality. In these cases, our patients were properly treated with good outcomes, avoiding potentially more dangerous complications.
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Santos P, Recknagel J, Knuth M, Steinbacher K, Ritz M, Wassmann B, Fellner D. ROBBE – Robot-aided processing of assemblies during the dismantling of nuclear power plants. EPJ Nuclear Sci Technol 2022. [DOI: 10.1051/epjn/2022016] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
For a successful decommissioning and dismantling of an NPP (Nuclear Power Plant), correct and controlled processing of all components is necessary, whereby a large part of the work relates to coated (mainly painted) steel components, which make up a significant proportion of the total inventory of the power plant to be processed. The contamination of these components is reduced by removing the surface coating using UHP (Ultra-High-Pressure) water jet blasting technology. Thus, the decontaminated material is released to be recycled conventionally after receiving clearance in accordance with Chap. 3 StrlSchV (German Federal Law Gazette 2018 No. 41: StrlSchV, 2018). The manual processing of these individual parts is cost-intensive, so that an autonomous, automated solution is more economical while increasing throughput at repeatable high quality. ROBBE aims at implementing a robot-assisted, automated and autonomous decoating procedure of component groups using UHP water jet blasting technology and implements it ata German NPP in Biblis on an industrial, productive scale.
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20
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Calé R, Ferreira F, Pereira AR, Repolho D, Sebaiti D, Alegria S, Vitorino S, Santos P, Pereira H, Brenot P, Loureiro MJ. Safety and efficacy of balloon pulmonary angioplasty in a Portuguese pulmonary hypertension expert center. Rev Port Cardiol 2021; 40:727-737. [PMID: 34857110 DOI: 10.1016/j.repce.2021.05.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Balloon pulmonary angioplasty (BPA) is an alternative therapy in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual/recurrent pulmonary hypertension (PH) after surgery. The aim of this study was to assess the short-term efficacy and safety of a BPA program. METHODS This prospective single-center study included all BPA sessions performed in CTEPH patients between 2017 and 2019. Clinical assessment including WHO functional class, plasma biomarkers, 6-min walk test (6MWT) and right heart catheterization was performed at baseline and six months after the last BPA session. RESULTS A total of 57 BPA sessions were performed in 11 CTEPH patients (64% with inoperable disease, 82% under pulmonar vasodilator therapy). Nine patients completed both the BPA program and a minimum six-month follow-up period. There were significant improvements in WHO functional class (p=0.004) and 6MWT (mean increase of 42 m; p=0.050) and a trend for significant hemodynamic improvement: 25% decrease in mean pulmonary artery pressure (mPAP) (p=0.082) and 42% decrease in pulmonary vascular resistance (PVR) (p=0.056). In the group of patients with severely impaired hemodynamics (three patients with mPAP >40 mmHg), the reduction was significant: 51% in mPAP (p=0.013) and 67% in PVR (p=0.050). Prostacyclin analogs and long-term oxygen therapy were withdrawn in all patients. Minor complications were recorded in 25% of patients. There were no major complications or deaths. CONCLUSIONS A BPA strategy on top of pulmonary vasodilator therapy further improves symptoms, exercise capacity and hemodynamics with an acceptable risk-benefit ratio in patients with inoperable CTEPH or residual/recurrent PH after surgery.
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Affiliation(s)
- Rita Calé
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal.
| | - Filipa Ferreira
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Pereira
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Débora Repolho
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Daniel Sebaiti
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Sofia Alegria
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Sílvia Vitorino
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Santos
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Hélder Pereira
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal; CCUL, CAML, Universidade de Lisboa, Lisboa, Portugal
| | - Philippe Brenot
- Serviço de Radiologia, Hospital Marie Lannelongue, Le Plessis Robinson, França; Universidade Paris-Sud, Faculdade de Medicina, Universidade Paris-Saclay, Le Kremlin-Bicêtre, França
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21
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Machado R, Neto Duarte L, Gil A, Sousa‐Neves N, Pirnat J, Santos P. Supporting the spatial management of invasive alien plants through assessment of landscape dynamics and connectivity. Restor Ecol 2021. [DOI: 10.1111/rec.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Rui Machado
- MED—Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigacão e Formação Avançada Universidade de Évora Pólo da Mitra, Ap. 94 Évora 7006‐554 Portugal
| | - Liliana Neto Duarte
- Centre for Functional Ecology, Department of Life Sciences University of Coimbra Calçada Martim de Freitas Coimbra 3000‐456 Portugal
| | - Artur Gil
- IVAR—Research Institute for Volcanology and Risks Assessment University of the Azores Ponta Delgada 9500‐321 Portugal
- cE3c—Centre for Ecology, Evolution and Environmental Changes & ABG—Azorean Biodiversity Group, Faculty of Sciences and Technology University of the Azores Ponta Delgada 9500‐321 Portugal
| | - Nuno Sousa‐Neves
- Departamento de Paisagem, Ambiente e Ordenamento, Escola de Ciências e Tecnologia Instituto de Investigação e Formação Avançada, Universidade de Évora Rua Romão Ramalho, No. 59 Évora 7000‐671 Portugal
- e‐GEO—Research Centre for Geography and Regional Planning, Faculdade de Ciências Sociais e Humanas Universidade Nova de Lisboa Lisbon Portugal
| | - Janez Pirnat
- Department for Forestry and Renewable Forest Resources University of Ljubljana, Biotechnical Faculty Večna Pot 83 Ljubljana 1000 Slovenia
| | - Pedro Santos
- MED—Mediterranean Institute for Agriculture, Environment and Development and Departamento de Paisagem, Ambiente e Ordenamento, Escola de Ciências e Tecnologia, Instituto de Investigação e Formação Avançada Universidade de Évora Rua Romão Ramalho, No. 59 Évora 7000‐671 Portugal
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22
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Santos P, Imber B, Lapen K, Pike L, Moss N, Seidman A, Beal K. Heightened Sensitivity of Germline BRCA Mutant Patients Treated With Concurrent or Adjuvant PARP Inhibition and Radiotherapy for Brain Metastases. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1614] [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: 10/20/2022]
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23
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Wei J, Santos P, Lustig R, Kurtz G, Dorsey J, Shabason J, Alonso-Basanta M. Initial Report of Clinical Outcomes and Acute Toxicities Following Reirradiation of Primary Brain Tumors. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1611] [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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Dee E, Taunk N, Deville C, Mahal B, Muralidhar V, Nguyen P, Winkfield K, Vapiwala N, Santos P. Trends in Receipt of Shorter Regimens of Radiation Therapy and Treatment Noncompletion Disparities Among Breast and Prostate Cancer Patients in the United States. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1006] [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: 11/16/2022]
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Pereira AR, Cale R, Ferreira F, Alegria S, Sebaiti S, Repolho D, Santos P, Vitorino S, Pereira H, Loureiro MJ. Comparison of 2-years follow-up of optimal medical therapy versus balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1915] [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
Balloon pulmonary angioplasty (BPA) has emerged as a therapeutic option for chronic thromboembolic pulmonary hypertension (CTEPH) considered ineligible for pulmonary endarterectomy (PEA). The initial publications showed very good short-term outcomes for the technique, but there are limited data regarding medium-term outcomes and its comparison with optimal medical treatment (OMT).
Objectives
To evaluate and compare the medium-term outcomes of OMT versus (vs) BPA in inoperable CTEPH.
Methods
Retrospective study of consecutive patients (pts) with CTEPH followed in a referral centre for Pulmonary Hypertension. Selected those pts considered ineligible for PEA and with at least 2 years of follow-up. Comparison between two treatment strategies: OMT alone [maximum tolerated doses of pulmonary vasodilator drugs (PVD), as indicated] vs BPA (pts who completed the program with or without OMT). Endpoint was a composite of all-cause death and unplanned right heart failure admission at 2-year.
Results
From 62 pts, 19 pts were included (11 pts were excluded due to recent diagnosis; 32 were submitted to EAP): mean age 65.0±15.3 years, 89.5% female. At diagnosis, all pts had functional capacity limitation and elevated serum NTproBNP levels (median value 1255.0 pg/mL). Mean pulmonary arterial pressure (mPAP) was 46.2±9.3 mmHg and pulmonary vascular resistance (PVR) 15.3±8.3 Wood units (WU). Concerning treatment, 12 pts (63.2%) underwent OMT alone. These pts had higher NTproBNP levels (2670.0 vs 538.0 pg/mL, p<0.01) and PVR values (19.7±7.6 vs 9.7±5.4 WU, p=0.01) and lower CI (1.6±0.3 vs 2.4±0.5 L/min/m2, p<0.01), at baseline; the remaining basal features didn't differ among groups (Fig.A). At 2-year follow-up, pts submitted to BPA were under PVD in 71.4% of cases with a mean of 1±0.8 drugs per patient and no difference compared to OMT group (83.3%, 1.7±0.9 drugs per patient), although oxygen therapy was higher in medical group (50% vs 0%, p=0.04). A significant overall improvement was observed in BPA group (Table – A): all pts were in functional class I (p<0.01), no one had right ventricular dysfunction (p<0.01) and mPAP decreased to 25.1±6.7 mmHg (p=0.01) and RVP to 2.9±0.8 WU (p=0.01). Inversely, no change was observed in pts under OMT alone (p>0.05 in all, Table – A). Endpoint rate was 31.6% with all adverse events occurring in the OMT group (50% vs 0%, p=0.04). After adjustment by Cox regression, no difference in baseline or follow-up features besides treatment influenced the outcome. Kaplan-Meier analysis (Graphic – B) confirmed significant benefit of BPA in 2-year outcome occurrence (long rank 4.6, p=0.03).
Conclusions
BPA strategy seems to improve medium-term functional capacity, right ventricular function and haemodynamics and decrease oxygen therapy dependence in inoperable CTEPH. Pts under OMT alone have a poor prognosis. These data encourage the development and implementation of the technique for inoperable CTEPH.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A R Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - R Cale
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - F Ferreira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - S Alegria
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - S Sebaiti
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - D Repolho
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - P Santos
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - S Vitorino
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M J Loureiro
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Rocha B, Cunha G, Maltes S, Moura ANNE, Coelho F, Torres J, Santos P, Monteiro F, Monteiro F, Almeida G, Lamas T, Simoes I, Gaspar I, Mendes M, Carmo E. Cardiovascular disease in an intensive care unit: patterns of an often fatal omen. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1520] [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
Care for the critically ill patient with Cardiovascular Disease (CVD) requires a unique management approach, as the theoretical critical threshold for decompensation is lower and inherent adaptive mechanisms may be compromised. We aimed to characterize the prognostic impact of CVD in patients admitted to an Intensive Care Unit (ICU).
Methods
We performed a cohort study of consecutive patients admitted to an ICU from January to December 2019. Patients were stratified as follows: (1) established CVD – presence of either atrial fibrillation, heart failure, coronary artery disease and/or peripheral artery disease; (2) at higher risk of CVD – known arterial hypertension, dyslipidemia, diabetes mellitus and/or current smoking, in the absence of established CVD; and (3) at lower risk of CVD – i.e. none of the above. The co-primary endpoints were all-cause death in ICU and death during index hospitalization.
Results
During 2019, there were 334 admissions in ICU, comprising a total of 296 patients (mean age 67±15 years, 58.1% male). Overall, 69 (23.3%) and 108 (36.5%) died in ICU and during index hospitalization, respectively. Compared to patients at lower risk of CVD, those at higher CVD risk or with established CVD had markers of more severe disease, as noted by higher risk scores (e.g., SAPS-II 35.0±20.0 vs. 43.5±22.3 vs. 52.6±20.0; p<0.001), higher rates of mechanical ventilation (41.5 vs. 57.3 vs. 63.9%; p=0.020), shock during ICU stay (34.0 vs. 52.7 vs. 66.9%; p<0.001) and acute kidney injury (26.4 vs. 35.5 vs. 57.9%; p<0.001), respectively, as well as higher death rates in ICU (5.7 vs. 21.8 vs. 31.6%; p=0.001) and index hospitalization (9.4 vs. 37.3 vs. 46.6%; p<0.001). In multivariate analysis, adjusted for age and cause of admission, established CVD independently predicted the risk of all-cause death in ICU (HR: 2.084; 95% CI: 1.136–3.823; p=0.018) and during index hospitalization (HR 1.712; CI: 1.009–2.889; p=0.046). The analysis for the group of patients at higher risk of CVD yielded similar results to the abovementioned.
Conclusion
Roughly 4 in every 5 patients admitted in ICU were at risk of or had established CVD. The presence of either of the above independently predicted a two- to three-fold higher risk of death during hospitalization. Our findings emphasize the considerable burden of CVD in ICU and underscore the importance of comprehensive management of the complex critically ill patient.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Rocha
- Hospital de Santa Cruz, Lisbon, Portugal
| | - G Cunha
- Hospital de Santa Cruz, Lisbon, Portugal
| | - S Maltes
- Hospital de Santa Cruz, Lisbon, Portugal
| | - A N N E Moura
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
| | - F Coelho
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
| | - J Torres
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
| | - P Santos
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
| | - F Monteiro
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
| | - F Monteiro
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
| | - G Almeida
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
| | - T Lamas
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
| | - I Simoes
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
| | - I Gaspar
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Lisbon, Portugal
| | - E Carmo
- Hospital Egas Moniz, Intensive Care Unit, Lisbon, Portugal
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Martinho M, Briosa A, Cale R, Pereira E, Pereira AR, Santos J, Ferreira B, Santos P, Vitorino S, Eusebio C, Morgado G, Martins C, Pereira H. STEMI around-the-clock: how off-hours admissions impact door-to-balloon time and the long-term prognosis of ST-segment Elevation Myocardial Infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1441] [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
The outcomes of reperfusion in ST-segment Elevation Myocardial Infarction (STEMI) are time-dependent, and percutaneous coronary intervention (PCI) should be performed within 60 minutes from hospital admission in PCI centers – door-to-balloon time (D2B). The association between Off-Hours Admission (OHA) and long-term outcomes is controversial when considering contemporary organized STEMI networks.
Purpose
This study aims to analyze how OHA influences D2B and long-term mortality.
Methods
Retrospective study of consecutive STEMI patients (pts), admitted in a PCI-centre with a local Emergency Department, between 2010 and 2015. Pts submitted to rescue-PCI were excluded. OHA was defined as admission at night (8p.m. to 8a.m), weekends and nonworking holidays. Predictors of OHA and D2B were studied by logistic regression analysis. Demographic, clinical, angiographic and procedural variables were evaluated using stepwise Cox regression analysis to determine independent predictors of 5-year all-cause mortality (5yM). The cumulative incidence of 5yM stratified by hours of admission was calculated according to the Kaplan-Meier method.
Results
Of 901 pts, 472pts (52.4%) were admitted during off-hours. These pts were younger (61±13 vs 64±12, p=0.002) and had a lower median patient-delay time (128min vs 157min, p=0.014). Clinical severity at presentation, defined by systolic arterial pressure and Killip-Kimball (KK) class, did not differ between groups. OHA did not impact D2B (89 min vs 88 min, p=0.550), which was in turn influenced by age ≥75y (OR 1.85, 95% CI 1.31–2.61, p<0.001). Mean clinical follow-up (FUP) was 68±37 months, with 75.1% of pts achieving a FUP >5 years. 5yM rate was 9.7%. After multivariate cox regression analysis, independent determinants of long-term mortality were age (HR 1.05, 95% CI 1.02–1.08, p<0.001), previous history of heart failure (HR 6.76, 95% CI 1.32–34.72, p=0.022) and pulmonary disease (HR 3.79, 95% CI 1.16–12.33, p=0.027), presentation with KK ≥2 (HR 2.82, 95% CI 1.32–6.01, p=0.007) and radial artery access in catheterization (HR 0.39, 95% CI 0.18–0.83, p=0.014) – figure 1. Although there was an association between a higher D2B time and 5yM (87min vs 101min, p=0.024), neither OHA nor D2B were independent predictors of long-term mortality – figure 2.
Conclusion
OHA did not seem to influence D2B and long-term STEMI outcomes in our PCI-centre. 5yM was mostly influenced by patient characteristics and clinical severity at presentation.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Predictors of long-term mortalityFigure 2. 5-year survival stratified by OHA
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Affiliation(s)
- M Martinho
- Hospital Garcia de Orta, Almada, Portugal
| | - A Briosa
- Hospital Garcia de Orta, Almada, Portugal
| | - R Cale
- Hospital Garcia de Orta, Almada, Portugal
| | - E Pereira
- Hospital Garcia de Orta, Almada, Portugal
| | | | - J Santos
- Hospital Garcia de Orta, Almada, Portugal
| | - B Ferreira
- Hospital Garcia de Orta, Almada, Portugal
| | - P Santos
- Hospital Garcia de Orta, Almada, Portugal
| | - S Vitorino
- Hospital Garcia de Orta, Almada, Portugal
| | - C Eusebio
- Hospital Garcia de Orta, Almada, Portugal
| | - G Morgado
- Hospital Garcia de Orta, Almada, Portugal
| | - C Martins
- Hospital Garcia de Orta, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Almada, Portugal
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Pereira AR, Cale R, Ferreira F, Alegria S, Sebaiti D, Martinho M, Repolho D, Vitorino S, Santos P, Loureiro MJ, Pereira H. Contrast-induced nephropathy after staged balloon pulmonary angioplasty: lower risk compared with left-sided cardiac procedures. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1917] [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
The risk of contrast-induced nephropathy (CIN) after left-sided cardiac procedures is reported as 10–15%. When the ratio of total contrast volume in ml to glomerular filtration rate (GFR) in mL/min (ratio V/GFR) exceeds 3.7, the risk increases significantly. However, there are few reports regarding the risk of CIN in patients (pts) with right-sided cardiac interventions such as balloon pulmonary angioplasty (BPA) and ratio V/GFR is not validated for use in this procedures.
Purpose
To assess the prevalence of CIN in pts with chronic thromboembolic pulmonary disease with or without hypertension (CTEPH/CTED) undergoing BPA.
Methods
Prospective single-centre study that included all BPA sessions performed from 2017 to 2020. Serum creatinine concentration (SC) was measured and the GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) before and 48 hours after each BPA procedure and 6 months after BPA treatment completion. CIN was defined as an increase of ≥25% and/or ≥0.5 mg/dL in SC from the baseline value within 48h of contrast administration.
Results
76 consecutive BPA sessions were performed in 15 CTEPH/CTED pts: mean age 63.2±14.0 years, 60% female, 86.7% CTEPH, mean of 5.3±1.9 sessions per patient with 4.3±1.9 vessels dilated per session. Mean value of GFR before BPA program was 73.5±26.3 mL/min. All the procedures were performed using low-osmolality contrast agent with a 1:1 dilution ratio with normal saline solution. Pts received 273.0±73.0 mL of contrast per session with a ratio V/GFR 3.7±1.7 mL. SC and GFR did not change significantly within 48h after BPA (+3.1%, p=0.07 and −3.0%, p=0.13, respectively). Ratio V/GFR >3.7 occurred in 44.3% of cases (n=31), but CIN occurred in only 5.3% (n=4) with an increase in SC <0.5 mg/dL but ≥25% in 3 cases (+33% in mean) and ≥0.5 mg/dL in 1 case. None of the pts required renal replacement therapy. Higher SC and lower GFR 48h after BPA were significantly correlated with greater rato V/GFR during procedure (r=0.75, p<0.01 and r=−0.74, p<0.01, respectively) – see figure. But neither higher values of ratio V/GFR (OR 1.43; CI95% 0.84–2.41; p=0.19) nor V/GFR >3.7 (OR 1.28; CI95% 0.17–9.6; p=0.81) were predictors of CIN. GFR before procedure did not influence the contrast volume administered (p=0.901), number of vessels (p=0.63) and segments treated by session (p=0.45). At 6 months follow-up, there was a trend for SC (1.3±0.2 mg/dL vs 1.1±0.2 mg/dL, −15%, p=0.43) and GFR (44.5±8.3 mg/dL vs 53.0±12.6 mg/dL, +16%, p=0.34) improvement in pts with impaired renal function at baseline (GFR<60 mL/min).
Conclusions
These findings suggested that the occurrence of CIN after BPA was low, raising the hypothesis that the influence of contrast agent on renal function could differ in right-sided cardiac interventions. Although the ratio V/GFR may be correlated with the risk of nephropathy, it is necessary to find a new cut-off to predict CIN in BPA pts.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A R Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - R Cale
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - F Ferreira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - S Alegria
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - D Sebaiti
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M Martinho
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - D Repolho
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - S Vitorino
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - P Santos
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M J Loureiro
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Pereira AR, Cale R, Ferreira F, Alegria S, Morgado G, Martins AC, Ferreira M, Gomes A, Judas T, Gonzalez F, Lohmann C, Repolho D, Santos P, Loureiro MJ, Pereira H. One-year follow-up of continuous aspiration mechanical thrombectomy for the management of intermediate-high and high-risk pulmonary embolism: what is the line between utility and futility? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1922] [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: 11/15/2022] Open
Abstract
Abstract
Introduction
Percutaneous catheter-directed treatments have emerged at the last decade for the management of acute high- or intermediate-high-risk pulmonary embolism (PE). Good short-term efficacy and safety have been published, but there are limited data regarding medium- to long-term outcomes.
Purpose
This study aimed to evaluate 1-year all-cause mortality of acute high- and intermediate-high-risk PE patients (pts) treated with continuous aspiration mechanical thrombectomy.
Methods
Twenty-nine consecutive pts with acute central PE (mean age 67.2±14.4 years; 72.4% female; 24.1% active cancer; Charlson comorbidity index 4.5±2.1; 82.8% in class>III of original PESI score; 44.8% high-risk PE) were treated with the Indigo Mechanical Thrombectomy System (Penumbra, Inc) between 03/2018 and 03/2020. Clinical success was defined as improvement in hemodynamic and/or oxygenation parameters or pulmonary hypertension or right heart strain at 48 hours after intervention plus survival to hospital discharge. Data regarding severe adverse events potentially related to the procedure, in-hospital and 1-year all-cause mortality were collected.
Results
Clinical success was 75.9%, with a significant improvement in mean paO2/fiO2 ratio (+77.1±103.2; p<0.01), shock index (−0.4±0.4, p<0.01), need for aminergic support (−75.0%, p<0.01), right ventricular function (66.6%, p<0.01) and systolic pulmonary arterial pressure (−10.2±11.5mmHg, p<0.01) at 48 hours after procedure. In-hospital survival rate was 82.8% but severe adverse events potentially related to the procedure occurred in 3 pts (10.3%). One-year follow-up was completed in 93.1% of cases and all-cause mortality rate was 34.5% (n=10 of which half occurred during the index hospital stay). Higher scores of Charlson comorbidity index (5.8±1.9 vs 3.7±1.9, p=0.01) and de novo atrial fibrillation at admission (40% vs 0%, p<0.01) were associated with higher 1-year all-cause mortality occurrence and were identified as 2 independent risk predictors by multivariate Cox regression. Kaplan-Meier curves confirmed its significant influence in 1-year survival free of adverse event (Figure). Time among diagnosis and percutaneous treatment (p=0.99), PESI score (p=0.24) and other clinical, haemodynamic and echocardiographic features did not influence mortality and suggest similarity of the PE severity at baseline. Technical characteristics were also not associated with mortality.
Conclusions
Aspiration thrombectomy for acute high- and intermediate-high-risk PE was feasible with a high clinical success rate. One-year all-cause mortality rate was elevated and predicted by high comorbidity index and de novo atrial fibrillation at admission. This data support the national expansion of this new PE treatment, but probably and as similar to other invasive techniques, we need to take into account comorbidities and avoid futility in multimorbidity pts.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A R Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - R Cale
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - F Ferreira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - S Alegria
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - G Morgado
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A C Martins
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M Ferreira
- Hospital Garcia de Orta, Internal Medicine, Almada, Portugal
| | - A Gomes
- Hospital Garcia de Orta, Internal Medicine, Almada, Portugal
| | - T Judas
- Hospital Garcia de Orta, Internal Medicine, Almada, Portugal
| | - F Gonzalez
- Hospital Garcia de Orta, Intensive Medicine, Almada, Portugal
| | - C Lohmann
- Hospital Garcia de Orta, Intensive Medicine, Almada, Portugal
| | - D Repolho
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - P Santos
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M J Loureiro
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Pereira AR, Cale R, Ferreira F, Alegria S, Sebaiti D, Martinho M, Repolho D, Vitorino S, Santos P, Loureiro MJ, Pereira H. Complications of balloon pulmonary angioplasty for chronic thromboembolic pulmonary disease according to the classification proposed by the 6th world symposium on pulmonary hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1916] [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
Balloon pulmonary angioplasty (BPA) is a complex procedure and not risk free. In an attempt to standardize reports of BPA complications in the several centers, a classification of complications was proposed by the task force on chronic thromboembolic hypertension (CTEPH) in the 6th World Symposium on Pulmonary Hypertension (WSPH).
Purpose
To determine the prevalence of BPA complications according to the classification of 6th WSPH and to identify its predictors.
Methods
Detailed procedural and technical aspects were collected for consecutive patients (pts) with inoperable, residual/recurrent chronic thromboembolic disease, undergoing BPA at a single institution from December/2017 to December/2020. Per procedure logistic regression analysis was used to evaluate the predictive variables for complications.
Results
A total of 76 BPA sessions in 15 pts were performed (mean age 63.2±14.0 years; 60.0% women; 86.7% CTEPH). Mean pulmonary artery pressure and pulmonary vascular resistance before the first BPA session were 33.1±13.3 mmHg and 4.8±3.2 woods unit, respectively (73.3% of pts under vasodilator therapy). Femoral access was used for all pts. Mean vessels treated per procedure were 4.3±1.9 (324 vessels in total). Webs, subtotal occlusions, ring-like stenosis and total occlusions were noted in 215 (66.4%), 58 (17.9%), 31 (9.6%) and 20 (6.2%) treated vessels, respectively. We performed 21 pressure-wire-guided sessions (27.6%). Intravascular imaging was used in 6 procedures (7.9%). Average time of fluoroscopy was 60.3±14.0 minutes and volume of contrast 273.0±73.0 mL per session. Procedure-related adverse events occurred in 25.0% of the interventions (27.6% in the first two years vs 16.7% in the last two). Pulmonary artery vascular injuries were noted in 6 BPA vessels (7.9% per procedure and 1.9% per treated vessel): haemoptysis in all, but perforation was only detected angiographically in 3 of them (balloon inflation was performed for 2 distal perforations, and 1 perforation sealed without any intervention). Vascular dissection in distal lesions occurred in 4 cases (5.3%) with no need of transcatheter or surgical procedures. We had 3 lung injuries, all grade 2. None of the pts required oral intubation or mechanical ventilation. Extra-pulmonary complications were illustrated in table. Importantly, there was no peri-procedural death. The occurrence of vascular or lung injuries was 0% in pressure-wire-guided BPA versus 14.5% in non-guided (p=0.098). Multivariate analysis revealed that age (OR 1.05; CI 1.01–1.10; p=0.030) was the only independent predictor of complications.
Conclusions
In our experience, BPA can be safely performed in inoperable, residual or recurrent CTEPH or CTED pts, with 25% minor procedural-related complications but no major adverse event. Age was the strongest factor related to the occurrence of complications.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A R Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - R Cale
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - F Ferreira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - S Alegria
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - D Sebaiti
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M Martinho
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - D Repolho
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - S Vitorino
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - P Santos
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M J Loureiro
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Maltes S, Maltes S, Rocha B, Cunha G, Lopes P, Moura A, Aguiar C, Coelho F, Torres J, Santos P, Monteiro F, Lamas T, Carmo E, Ferreira J, Mendes M. Chronic heart failure in intensive care unit: can we accurately predict the risk? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0835] [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
Background
Severity of disease scoring systems, namely the Simplified Acute Physiology Score (SAPS) and Acute Physiology and Chronic Health Evaluation (APACHE), are widely used to predict mortality in Intensive Care Units (ICU). Yet, neither score includes chronic HF in their model. We aimed to evaluate whether these scores perform well in risk prediction of death of patients previously diagnosed with heart failure (HF).
Methodology
This is a single-center retrospective cohort of patients admitted to an ICU in 2019. Those whose admission lasted <24 hours were excluded from analysis. The SAPS II and APACHE II scores were calculated using data from the first 24 hours of ICU admission, imputing the worst variable obtained within this timeframe. HF was defined according to the ESC recommendations. In order to assess the performance of the scores, Receiver Operating Characteristic (ROC) Curves were used to predict the risk of death in ICU in HF compared to the non-HF population.
Results
A total of 267 patients were hospitalized in ICU for a period over 24 hours in 2019 (mean age 67±16 years; 58.8% males; 21.7% with chronic HF; 33.7% admitted for sepsis). Compared to patients without HF, those with chronic HF were older (74±13 vs. 65±16 years; p<0.001) and had higher risk scores (mean SAPS II: 43.2±21.7 vs. 56.5±20.7; p<0.001; mean APACHE II: 19.8±10.0 vs. 25.1±10.0; p<0.001). Moreover, these patients were at higher risk of meaningful events during hospitalization (e.g. acute kidney injury: 38.0 vs. 66.1%; p<0.001; shock at any time: 52.4 vs. 67.8%; p=0.036). Furthermore, patients with HF had a trend towards higher mortality rates in ICU (17.3 vs. 28.8%; p=0.051) and a significantly higher death in overall hospitalization (30.8 vs. 45.8%; p=0.032). ROC curves performed well in predicting the risk of ICU death regardless of HF (SAPS II – AUC 0.78 vs. 0.81; p=0.36; APACHE II – AUC 0.75 vs. 0.78; p=0.37).
Conclusion
Approximately 1 in every 4 patients admitted to the ICU had chronic HF. Traditional risk scoring systems (SAPS II and APACHE II) performed well regardless of HF. While these results are reassuring as far as risk stratification accuracy is concerned, HF patients remained at a higher risk for worse outcomes. Therefore, prognostic tools with a therapeutic clinical applicability are urgently needed to improve the outcome of this population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Maltes
- Hospital Santa Cruz, Lisbon, Portugal
| | - S Maltes
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | - P Lopes
- Hospital Santa Cruz, Lisbon, Portugal
| | - A Moura
- Hospital Egas Moniz, Lisbon, Portugal
| | | | - F Coelho
- Hospital Egas Moniz, Lisbon, Portugal
| | - J Torres
- Hospital Egas Moniz, Lisbon, Portugal
| | - P Santos
- Hospital Egas Moniz, Lisbon, Portugal
| | | | - T Lamas
- Hospital Egas Moniz, Lisbon, Portugal
| | - E Carmo
- Hospital Egas Moniz, Lisbon, Portugal
| | | | - M Mendes
- Hospital Santa Cruz, Lisbon, Portugal
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Calé R, Ferreira F, Pereira AR, Saraiva C, Santos A, Alegria S, Repolho D, Vitorino S, Santos P, Morgado G, Brenot P, Loureiro MJ, Pereira H. Balloon pulmonary angioplasty protocol in a Portuguese pulmonary hypertension expert center. Rev Port Cardiol 2021; 40:653-665. [PMID: 34503703 DOI: 10.1016/j.repce.2020.11.026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/02/2020] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Balloon pulmonary angioplasty (BPA) has emerged as a promising therapeutic option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not eligible for pulmonary thromboendarterectomy (PEA) or who have recurrent or persistent pulmonary hypertension after surgery. There is no standardized technique for BPA and, its complexity and high risk of severe complications, requires skills and appropriate training and should be reserved for expert CTEPH centers, as a complementary intervention to medical and surgical therapy. OBJECTIVE The purpose of this document is to describe the BPA protocol used at a high-volume center nationwide, validated by its results. METHODS The present protocol includes technical details, definition of outcomes and complications, as well as patient full diagnostic work-up and treatment algorithm, before and after BPA. RESULTS The technical, hemodynamic, and clinical results of the application of this protocol will be subject of a later publication where they will be described in detail. In conclusion, we present a percutaneous intervention protocol in the treatment of pulmonary hypertension in the context of chronic pulmonary thromboembolism, validated by its clinical, hemodynamic, and technical results.
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Affiliation(s)
- Rita Calé
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - Filipa Ferreira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Carla Saraiva
- Radiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Ana Santos
- Radiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Sofia Alegria
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Débora Repolho
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Sílvia Vitorino
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Santos
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Gonçalo Morgado
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Philippe Brenot
- Radiology Department, Hospital Marie Lannelongue, Le Plessis Robinson, France; Universidade Paris-Sud, Faculdade de Medicina, Universidade Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal; CCUL, CAML, University of Lisbon, Lisbon, Portugal
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Calé R, Ferreira F, Pereira AR, Saraiva C, Santos A, Alegria S, Repolho D, Vitorino S, Santos P, Morgado G, Brenot P, Loureiro MJ, Pereira H. Balloon pulmonary angioplasty protocol in a Portuguese pulmonary hypertension expert center. Rev Port Cardiol 2021. [PMID: 34366194 DOI: 10.1016/j.repc.2020.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/26/2022] Open
Abstract
INTRODUCTION Balloon pulmonary angioplasty (BPA) has emerged as a promising therapeutic option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not eligible for pulmonary thromboendarterectomy (PEA) or who have recurrent or persistent pulmonary hypertension after surgery. There is no standardized technique for BPA and, its complexity and high risk of severe complications, requires skills and appropriate training and should be reserved for expert CTEPH centers, as a complementary intervention to medical and surgical therapy. OBJECTIVE The purpose of this document is to describe the BPA protocol used at a high-volume center nationwide, validated by its results. METHODS The present protocol includes technical details, definition of outcomes and complications, as well as patient full diagnostic work-up and treatment algorithm, before and after BPA. RESULTS The technical, hemodynamic, and clinical results of the application of this protocol will be subject of a later publication where they will be described in detail. In conclusion, we present a percutaneous intervention protocol in the treatment of pulmonary hypertension in the context of chronic pulmonary thromboembolism, validated by its clinical, hemodynamic, and technical results.
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Affiliation(s)
- Rita Calé
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - Filipa Ferreira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Carla Saraiva
- Radiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Ana Santos
- Radiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Sofia Alegria
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Débora Repolho
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Sílvia Vitorino
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Santos
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Gonçalo Morgado
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Philippe Brenot
- Radiology Department, Hospital Marie Lannelongue, Le Plessis Robinson, France; Universidade Paris-Sud, Faculdade de Medicina, Universidade Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal; CCUL, CAML, University of Lisbon, Lisbon, Portugal
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Calé R, Ferreira F, Pereira AR, Repolho D, Sebaiti D, Alegria S, Vitorino S, Santos P, Pereira H, Brenot P, Loureiro MJ. Safety and efficacy of balloon pulmonary angioplasty in a Portuguese pulmonary hypertension expert center. Rev Port Cardiol 2021; 40:S0870-2551(21)00194-3. [PMID: 34183215 DOI: 10.1016/j.repc.2020.10.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/20/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Balloon pulmonary angioplasty (BPA) is an alternative therapy in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual/recurrent pulmonary hypertension (PH) after surgery. The aim of this study was to assess the short-term efficacy and safety of a BPA program. METHODS This prospective single-center study included all BPA sessions performed in CTEPH patients between 2017 and 2019. Clinical assessment including WHO functional class, plasma biomarkers, 6-min walk test (6MWT) and right heart catheterization was performed at baseline and six months after the last BPA session. RESULTS A total of 57 BPA sessions were performed in 11 CTEPH patients (64% with inoperable disease, 82% under pulmonary vasodilator therapy). Nine patients completed both the BPA program and a minimum six-month follow-up period. There were significant improvements in WHO functional class (p=0.004) and 6MWT (mean increase of 42 m; p=0.050) and a trend for significant hemodynamic improvement: 25% decrease in mean pulmonary artery pressure (mPAP) (p=0.082) and 42% decrease in pulmonary vascular resistance (PVR) (p=0.056). In the group of patients with severely impaired hemodynamics (three patients with mPAP >40mmHg), the reduction was significant: 51% in mPAP (p=0.013) and 67% in PVR (p=0.050). Prostacyclin analogs and long-term oxygen therapy were withdrawn in all patients. Minor complications were recorded in 25% of patients. There were no major complications or deaths. CONCLUSIONS A BPA strategy on top of pulmonary vasodilator therapy further improves symptoms, exercise capacity and hemodynamics with an acceptable risk-benefit ratio in patients with inoperable CTEPH or residual/recurrent PH after surgery.
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Affiliation(s)
- Rita Calé
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal.
| | - Filipa Ferreira
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Pereira
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Débora Repolho
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Daniel Sebaiti
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Sofia Alegria
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Sílvia Vitorino
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Santos
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Hélder Pereira
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal; CCUL, CAML, Universidade de Lisboa, Portugal
| | - Philippe Brenot
- Serviço de Radiologia, Hospital Marie Lannelongue, Le Plessis Robinson, França; Universidade Paris-Sud, Faculdade de Medicina, Universidade Paris-Saclay, Le Kremlin- Bicêtre, França
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Ramalho A, Castro P, Lobo M, Souza J, Santos P, Freitas A. Integrated quality assessment for diabetes care in Portuguese primary health care using prevention quality indicators. Prim Care Diabetes 2021; 15:507-512. [PMID: 33441264 DOI: 10.1016/j.pcd.2021.01.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 01/25/2023]
Abstract
AIMS This study evaluates the prevention quality indicators (PQI) for Diabetes Mellitus (DM) in Portugal using contemporary data and explores their variability according to Primary Health Care (PHC) quality indicators. METHODS We conducted a retrospective observational analysis of secondary data comprising Portuguese PHC indicators by health centres group (ACES) and the National Hospital Morbidity Database. We calculated and analysed age-sex-adjusted rates for each PQI. Worse-performing ACES were identified using the 2017 median PQI values as an assessment cut-off. A multivariate logistic analysis was carried to find variables associated with the likelihood of being a worse-performing ACES for the biennium. RESULTS The median values of the indicator PQI93 - Prevention Quality Diabetes Composite were 79 and 65.2 hospitalizations per 100 000 pop, in 2016 and 2017 respectively. Diabetes long term complications (PQI 03) accounted for most of the hospitalizations. The quality indicator in PHC with greater influence on PQI93 was the proportion of DM patients with <65 years with test results for HbA1c < = 6.5%. CONCLUSIONS This study shows that some PHC quality indicators are closely related to DM care, and so their monitoring is of high importance. Diabetes long term complications (PQI 03) demand greater attention from PHC professionals.
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Affiliation(s)
- A Ramalho
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; ACHE - American College of Healthcare Executives, Chicago, IL, USA.
| | - P Castro
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; USF Camélias, ACeS Gaia - Grande Porto VII (ARS Norte) - Vila Nova de Gaia, Portugal
| | - M Lobo
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - J Souza
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - P Santos
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - A Freitas
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
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Yeager D, Bryan C, Gross J, Krettek D, Santos P, Murray J, Graveling H, Johnson M, Jamieson J. A Synergistic Mindsets Intervention Protects Adolescents from Social Stress. Res Sq 2021:rs.3.rs-551170. [PMID: 34075372 PMCID: PMC8168396 DOI: 10.21203/rs.3.rs-551170/v1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Social stress poses a major threat to adolescent health via its effects on internalizing symptoms, such as anxiety and depression. Available interventions to help adolescents improve their stress responses, however, have not been effective in rigorous evaluation studies, or they have been difficult to administer widely. Here we show that replicable improvements in adolescent stress responses can be achieved with a short (~30-minute), scalable synergistic mindsets intervention. This intervention, which is a self-administered online training module, targets both growth mindsets (the idea that people's intelligence can be developed in response to challenge) and stress-can-be-enhancing mindsets (the idea that people's stress responses can be fuel for optimal performance). Its goal is to promote positive engagement with stressful events (e.g., learning from failure on a quiz or a conflict with a peer) and to encourage adolescents to use their responses to stressful events and even their bodily symptoms (e.g. racing heart, sweaty palms, butterflies in their stomach) to their advantage. In five double-blind, randomized, controlled trials (total N = 4,091 adolescents), the new synergistic mindsets intervention improved stress-related cognitions (Studies 1-2), cardiovascular reactivity (Study 3), daily internalizing symptoms and cortisol levels (Study 4), and generalized anxiety symptoms during the 2020 COVID-19 lockdowns (Study 5). Effects on downstream outcomes (in Studies 3-5) were stronger among individuals who, at baseline, held the two negative mindsets targeted by the intervention, providing evidence for the proposed mechanisms. Confidence in this conclusion comes from a conservative, Bayesian machine-learning method for detecting heterogeneity.
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Abstract
AbstractTheory predicts that allometric constraints on sound production should be stronger for the lower frequencies of vocalizations than for the higher frequencies, which could originate from an allometry for sound frequency bandwidth. Using song recordings of approximately 1,000 passerine species (from >75% passerine genera), we show a significantly steeper allometry for the lower song frequencies than for the higher song frequencies, resulting in a positive allometry of frequency bandwidth: larger species can use wider bandwidths than smaller species. The bandwidth allometry exists in songbirds (oscines) but not in nonoscine passerines, indicating that it emerges from a combination of constraints to sound frequency production or transmission and the evolved behavior of oscines: unlike the narrow bandwidths of most nonoscine songs, the learned songs of oscines often use wide bandwidths that can be limited by both lower and upper constraints to sound frequency. This bandwidth allometry has implications for several research topics in acoustic communication.
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Esteireiro AS, Santos P, Bicho A. Haematuria without diagnosis? Think about the rare causes…. BMJ Case Rep 2021; 14:14/4/e240228. [PMID: 33863767 PMCID: PMC8055149 DOI: 10.1136/bcr-2020-240228] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a case of a 17-year-old man admitted in the emergency room with a 2-month history of intermittent macroscopic haematuria and left lumbar pain. Physical examination and vital signs were normal. Investigation indicated a recurrent non-glomerular haematuria. The Doppler ultrasound revealed a compression of the left renal vein with upstream dilatation which was subsequently confirmed by CT angiography. These findings are in keeping with a case of nutcracker syndrome (NutS). Although asymptomatic in most cases, it can be a rare cause of haematuria. The teenager was referred to paediatric nephrology and was treated conservatively with spontaneous resolution of macroscopic haematuria. With this case, we would like to highlight that in children or adolescents with haematuria without an apparent cause, a high level of suspicion and appropriate imaging are necessary for the diagnosis of NutS.
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Affiliation(s)
- Ana Sofia Esteireiro
- Department of Paediatrics, Centro Hospitalar do Oeste, Unidade de Caldas da Rainha, Caldas da Rainha, Portugal
| | - Pedro Santos
- Department of Imaging, Centro Hospitalar do Oeste, Unidade de Caldas da Rainha, Caldas da Rainha, Portugal
| | - Anabela Bicho
- Department of Paediatrics, Centro Hospitalar do Oeste, Unidade de Caldas da Rainha, Caldas da Rainha, Portugal
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Petrescu ANIELA, Cvijic M, Bezy S, Santos P, Duchenne J, Orlowska M, Pedrosa J, Degtiarova G, Van Keer J, Von Bardeleben S, Droogne W, Van Cleemput J, Bogaert J, D"hooge J, Voigt JU. Can shear wave imaging distinguish between diffuse interstitial and replacement myocardial fibrosis? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.009] [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.
Background
Diffuse interstitial or myocardial replacement fibrosis are common features of a large variety of cardiomyopathies. These alterations contribute to functional changes, particularly to an increased myocardial stiffness (MS). Histological examination is the gold standard for myocardial fibrosis quantification, however, it requires endomyocardial biopsy which is invasive and not without risks. Cardiac magnetic resonance (CMR) can characterize the extent of both diffuse and replacement fibrosis and may have prognostic value in various cardiomyopathies. Echocardiographic shear wave (SW) elastography is an emerging approach for measuring MS in vivo. SWs occur after mechanical excitation of the myocardium, e.g. after mitral valve closure (MVC), and their propagation velocity is directly related to MS, thus providing an opportunity to assess stiffness at end-diastole.
Purpose
The aim was to investigate if velocities of natural SW can distinguish between interstitial and replacement fibrosis.
Methods
We prospectively enrolled 47 patients (22 patients after heart transplant [54.2 ± 15.8 years, 82.6% male] and 25 patients with established hypertrophic cardiomyopathy [54.0 ± 13.5 years, 80.0% male]) undergoing CMR during their check-up. We performed SW elastography in parasternal long axis views of the LV using a fully programmable experimental scanner (HD-PULSE) equipped with a clinical phased array transducer (Samsung Medison P2-5AC) at 1100 ± 250 frames per second. Tissue acceleration maps were extracted from an anatomical M-mode line along the midline of the LV septum. The SW propagation velocity at MVC was measured as the slope in the M-mode image. All patients underwent T1 mapping as well as late gadolinium enhancement (LGE) cardiac magnetic resonance at 1.5 T to assess the presence of diffuse or replacement fibrosis (Figure A). Therefore, patients were divided in three groups: no fibrosis, diffuse fibrosis and replacement fibrosis.
Results
Mechanical SW’s were observed in 46 subjects starting immediately after MVC and propagating from the LV base to the apex. SW propagation velocity at MVC correlated well with native myocardial T1 values (r = 0.65, p < 0.0001) and differed significantly among groups (p < 0.0001), with a significant post-test between any pair of groups (Figure B). SW velocities below a cut-off of 6.01 m/s showed the highest accuracy to identify patients without any type of fibrosis (sensitivity 88 %, specificity 89%, area under the curve = 0.93) (Figure C). A cut-off of 8.11 m/s could distinguish replacement fibrosis from diffuse fibrosis with a sensitivity and specificity of 59% and 92 %, respectively (area under the curve = 0.80) (Figure D).
Conclusions
Shear wave velocities after mitral valve closure can distinguish between normal and pathological myocardium and can detect differences between diffuse and replacement fibrosis.
Abstract Figure.
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Affiliation(s)
| | - M Cvijic
- Gasthuisberg University Hospital, Leuven, Belgium
| | - S Bezy
- Gasthuisberg University Hospital, Leuven, Belgium
| | - P Santos
- Gasthuisberg University Hospital, Leuven, Belgium
| | - J Duchenne
- Gasthuisberg University Hospital, Leuven, Belgium
| | - M Orlowska
- Gasthuisberg University Hospital, Leuven, Belgium
| | - J Pedrosa
- Gasthuisberg University Hospital, Leuven, Belgium
| | - G Degtiarova
- Gasthuisberg University Hospital, Leuven, Belgium
| | - J Van Keer
- Gasthuisberg University Hospital, Leuven, Belgium
| | | | - W Droogne
- Gasthuisberg University Hospital, Leuven, Belgium
| | | | - J Bogaert
- Gasthuisberg University Hospital, Leuven, Belgium
| | - J D"hooge
- Gasthuisberg University Hospital, Leuven, Belgium
| | - J-U Voigt
- Gasthuisberg University Hospital, Leuven, Belgium
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Cvijic M, Petrescu A, Bezy S, Santos P, Orlowska M, Duchenne J, Delforge M, Van Cleemput J, Dhooge J, Voigt J. Relationship between myocardial properties and myocardial stiffness in hearts with thick walls: a shear wave imaging study using ultra-high frame rate echocardiography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.182] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Shear wave (SW) imaging, based on high frame rate (HFR) echocardiography, is a new non-invasive approach for assessing myocardial stiffness. Operating myocardial stiffness increases with increasing wall stress, therefore measured myocardial stiffness does not necessarily reflect intrinsic myocardial properties only, but can be influenced by cavity pressure and chamber geometry.
Purpose
To explore the relationship between local myocardial geometry, cavity pressure and pathological substrate with SW velocity and to determine to which extent the above mentioned factors influence SW velocity.
Methods
We included 26 healthy controls (55 ± 14 years, 77 % male) and 61 patients with thick heart (24 patients with cardiac amyloidosis (AML) [70 ± 9 years, 52 % male], 37 patients with hypertrophic cardiomyopathy (HCM) [54 ± 14 years, 78 % male]). Left ventricular (LV) parasternal long axis views were acquired with an experimental HFR scanner at 1142 ± 282 frames per seconds. Propagation velocity of the SW occurring after mitral valve closure in the interventricular septum (IVS) served as measure of myocardial stiffness (Figure A). While conventional echocardiographic measurements were used to evaluate local myocardial geometry (LV end-diastolic diameter [EDD], IVS thickness) and LV cavity pressure (LV diastolic pressure-estimated by E/e` and LV systolic pressure-estimated by systolic blood pressure and potential LV outflow gradient in HCM).
Results
LV cavity pressure and local geometry differed significantly between controls and patients (p < 0.05, for all, Figure B). SW velocity correlated with cavity pressure (E/e`: r = 0.375, p < 0.001, LV systolic pressure: r = 0.264, p = 0.020) and local geometry (IVS thickness: r = 0.700, p < 0.001; EDD: r=-0.307, p = 0.007) and differed significantly among groups (Figure C). Multivariate analysis revealed that SW velocity was independently related only with the pathological substrate and IVS thickness (p = 0.006 and p < 0.001, respectively). In a regression model, the pathological substrate, cavity pressure and local geometry accounted for 56% of variation in SW velocity (p < 0.001), while the pathological substrate alone accounted for nearly half of the variance (R2 = 0.44, p < 0.001) (Figure D).
Conclusions
Our study demonstrated that SW velocity is related to both pathological substrate and local geometry and LV pressures. Additionally, our results suggest that variations in myocardial tissue properties had the most influence on SW velocity, while LV pressure and local geometry played a minor role. Therefore, the changes in SW velocity reflect predominantly tissue properties that are altered by underlining disease rather than cavity pressure and morphological abnormalities. Thus, SW elastography could provide useful novel diagnostic information in the evaluation of cardiomyopathies.
Abstract Figure A, B, C, D
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Affiliation(s)
- M Cvijic
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - A Petrescu
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - S Bezy
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - P Santos
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - M Orlowska
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - J Duchenne
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - M Delforge
- University Hospitals (UZ) Leuven, Leuven, Belgium
| | - J Van Cleemput
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - J Dhooge
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - J Voigt
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
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Gondima C, Palhares M, Santos P, Sousa R, Junqueira R, Souza S. DETECTION OF ACID NEUTRALIZERS IN FRAUDULENT MILK: FULL VALIDATION OF A CLASSICAL QUALITATIVE METHOD. QUIM NOVA 2021. [DOI: 10.21577/0100-4042.20170703] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neutralization with alkaline compounds is one of the most common adulterations in milk. The rosolic acid method is a classical test widely used in different countries for detection of neutralizers in milk. The official and a modified version were validated in a single laboratory validation process considering four adulterants: sodium bicarbonate(BI), sodium carbonate(CA), sodium hydroxide(HY) and sodium citrate(CI). The modified version, which presented better performance was selected for interlaboratory validation. In this process, samples of raw milk with acidities of 0.19% were neutralized with different concentrations of BI, CA, HY and C and tested for homogeneity and stability. Eight laboratories, which represented different sectors of the milk production chain, received and analysed these samples. The collaborative trial results confirmed the method performance, although sensitivity and precision were inferior to those obtained in the intralaboratory process, demonstrating its applications and limitations
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Santos P, Paul C, Silva C. Evolution of Public Knowledge About Dementia Causes and Symptoms: A Gender Perspective. Innov Aging 2020. [PMCID: PMC7740790 DOI: 10.1093/geroni/igaa057.184] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
The research objective is to monitor the evolution of public knowledge about dementia causes and symptoms, over a three-year period and by gender. The survey was made available at the Directorate-General of Health website and disseminated by email to relevant health and social stakeholders and through social networks, in 2015 and 2018. Respondents (n=1478 and 1716, respectively), included mostly women (79.4% and 83.3%). In both years, respondents showed a higher knowledge on symptoms than on causes. Total knowledge about symptoms and combined knowledge scores were higher in 2018 compared to 2015 (p=.012 and p=.0.2), respectively). “Neurological brain changes" were considered the main causes of dementia, by both genders in 2015 and in 2018 (>80% of respondents), with an increase in relative frequency being observed only for women (p=.039). “Psychiatric disease” and "drug consumption" are now less regarded as causes of dementia by both genders, with significant change over time also among women (p=.006 p=.001). On the contrary, in the last survey more women (+3.7%; p=.049) and men (+9.3%; p=.022) considered “stress” as main cause of dementia. “Confusion and disorientation”, “wandering and getting lost”, “difficulty managing and paying bills”, ”difficulty remembering things from the day before”, and “difficulty managing daily tasks”, were considered the most common symptoms, but only the last two significantly increased in 2018 (p=.018 and p=.000). Women knowledge increased regarding more causes and more symptoms compared to men. These findings will help to inform public debate and decision-making on gender-based policies to address awareness and stigma about dementia.
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Affiliation(s)
- Pedro Santos
- Biomedical Sciences, Abel Salazar Biomedical Sciences Institute - University of Oporto, Porto, Portugal
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Paul C, Sousa S, Santos P, O’Caoimh R, Molloy W. Screening Neurocognitive Disorders in Primary Care Services: The Quick Mild Cognitive Impairment Approach. Innov Aging 2020. [PMCID: PMC7740738 DOI: 10.1093/geroni/igaa057.515] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Neurocognitive Disorders (NCD) is an increasingly common condition in the community. The General Practitioner (GP) in Primary Care Services (PCS), have a crucial role in early detection of NCD and is usually the first professional to detect the signs of MCI. The objective of this study was to test the feasibility and utility of the cognitive screening instrument QMCI in Primary Care. A community sample of 436 people 65+ living in the community was randomly selected from a larger group of old people with mental health concerns (N=2734), referred by their GPs. The mean age of the sample was 75.2 years (sd 7.2), with 41.3% men and 58.7% women; 60.4% married followed by 28.7% widows. The education level was low with 21% illiterate and 69,8% people with 4 years education. The QMCI mean was 37.1/100 (sd 16.2). The amount of people screening positive for cognitive impairment QMCI (<62/100) was 94.2%. In the distribution of people with cognitive impairment by Global Deterioration Scale (GDS) three recoded categories, of the 286 people 76,1% where classified as having very mild or mild impairment, 19,4% moderate or moderately serious and 4,5% severe or very severe impairment. These results confirm the perception of GPs about their clients having mental health concerns and the ability of QMCI accurately discriminate MCI. The QMCI is very brief (3-5mins) fitting the short time of GPs to assess cognitive status and timely refer clients to nonpharmacological interventions that could postpone NCD symptoms.
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Affiliation(s)
| | | | - Pedro Santos
- Biomedical Sciences, Abel Salazar Biomedical Sciences Institute - University of Oporto, Porto, Portugal
| | - Rónán O’Caoimh
- National University of Ireland, Galway City, Galway, Ireland
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Petrescu A, Bézy S, Cvijic M, Santos P, Orlowska M, Duchenne J, Pedrosa J, Van Keer JM, Verbeken E, von Bardeleben RS, Droogne W, Bogaert J, Van Cleemput J, D'hooge J, Voigt JU. Shear Wave Elastography Using High-Frame-Rate Imaging in the Follow-Up of Heart Transplantation Recipients. JACC Cardiovasc Imaging 2020; 13:2304-2313. [PMID: 33004291 DOI: 10.1016/j.jcmg.2020.06.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate whether propagation velocities of naturally occurring shear waves (SWs) at mitral valve closure (MVC) increase with the degree of diffuse myocardial injury (DMI) and with invasively determined LV filling pressures as a reflection of an increase in myocardial stiffness in heart transplantation (HTx) recipients. BACKGROUND After orthotopic HTx, allografts undergo DMI that contributes to functional impairment, especially to increased passive myocardial stiffness, which is an important pathophysiological determinant of left ventricular (LV) diastolic dysfunction. Echocardiographic SW elastography is an emerging approach for measuring myocardial stiffness in vivo. Natural SWs occur after mechanical excitation of the myocardium, for example, after MVC, and their propagation velocity is directly related to myocardial stiffness, thus providing an opportunity to assess myocardial stiffness at end-diastole. METHODS A total of 52 HTx recipients who underwent right heart catheterization (all) and cardiac magnetic resonance (CMR) (n = 23) during their annual check-up were prospectively enrolled. Echocardiographic SW elastography was performed in parasternal long axis views of the LV using an experimental scanner at 1,135 ± 270 frames per second. The degree of DMI was quantified with T1 mapping. RESULTS SW velocity at MVC correlated best with native myocardial T1 values (r = 0.75; p < 0.0001) and was the best noninvasive parameter that correlated with pulmonary capillary wedge pressures (PCWP) (r = 0.54; p < 0.001). Standard echocardiographic parameters of LV diastolic function correlated poorly with both native T1 and PCWP values. CONCLUSIONS End-diastolic SW propagation velocities, as measure of myocardial stiffness, showed a good correlation with CMR-defined diffuse myocardial injury and with invasively determined LV filling pressures in patients with HTx. Thus, these findings suggest that SW elastography has the potential to become a valuable noninvasive method for the assessment of diastolic myocardial properties in HTx recipients.
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Affiliation(s)
- Aniela Petrescu
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Marta Cvijic
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Pedro Santos
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Marta Orlowska
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - João Pedrosa
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan M Van Keer
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Eric Verbeken
- Translational Cell and Tissue Research, Department of Imaging and Pathology, University of Leuven, Leuven, Belgium
| | | | - Walter Droogne
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jan Bogaert
- Radiology Department, University Hospitals Leuven, Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
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Santos P, Lapen K, Zhang Z, Tsai C, Yang T, Bekelman J, Gillespie E. Trends in Radiotherapy for Bone Metastases, 2015-2017: Choosing Wisely in the Era of Ablative Radiation. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Barsky A, Carmona R, Santos P, Verma V, Both S, Bekelman J, Christodouleas J, Vapiwala N, Deville C. Comparative Clinical Outcomes and Patterns of Failure of Proton-Beam Therapy (PBT) versus Intensity-Modulated Radiotherapy (IMRT) for Prostate Cancer in the Postoperative Setting. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.500] [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: 10/23/2022]
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Petrescu A, Bezy S, Cvijic M, Santos P, Duchenne J, Orlowska M, Van Keer J, Von Bardeleben S, Droogne W, Bogaert J, Van Cleemput J, D'hooge J, Voigt JU. Shear wave elastography by high frame rate echocardiography can detect diffuse myocardial fibrosis after heart transplantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0854] [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
Myocardial fibrosis is fundamental in the development of cardiac failure, regardless of ethiology. In both animal models and humans it has been shown that diffuse myocardial fibrosis (DMF) contributes to functional impairment, especially to increased passive myocardial stiffness, which is an important pathophysiological determinant of left ventricular diastolic dysfunction. Histological examination is the gold standard for myocardial fibrosis quantification, however, it requires endomyocardial biopsies which are invasive and not without risk. Echocardiographic shear wave (SW) elastography, based on high frame rate imaging, is an emerging approach for measuring myocardial stiffness in vivo. Natural SWs occur after mechanical excitation of the myocardium, e.g. after mitral valve closure (MVC) and their propagation velocity is directly related to myocardial stiffness, thus providing an opportunity to assess myocardial stiffness at end-diastole.
Purpose
The aim was to investigate if propagation velocities of natural SWs can be used to detect diffuse myocardial fibrosis in a cohort of heart transplant recipients.
Methods
We prospectively enrolled 22 patients (10.3±6.3 years after HTx) that underwent CMR during their annual check-up. We performed SW elastography in parasternal long axis views of the left ventricle using a fully programmable experimental scanner (HD-PULSE) equipped with a clinical phased array transducer (Samsung Medison P2–5AC) at 1100±250 frames per second. The SW propagation velocities at MVC were measured in the basal LV septum. Native T1 and extracellular volume (ECV) were measured at the same segment to evaluate DMF. A cut-off value for native T1 of 1040 ms and for ECV of 29% was used to define DMF in our cohort.
Results
We found good correlations between SW velocities and both myocardial T1 (r=0.80, p<0.0001, Figure A) and ECV (r=0.64, p=0.003, Figure B) measured with CMR. Further, we derived reference thresholds of natural SW velocities to identify DMF in HTx patients. The optimal cut-off value of SW velocity to identify patients with nativT1>1040 ms was 4.84 m/s (AUC 0.81, sensitivity 82%, specificity 82%, Figure C). To identify patients with ECV>0.29 the cut-off value of SW velocity was 4.74 m/s (AUC 0.74, sensitivity 73%, specificity 78%, Figure D).
Conclusions
End-diastolic shear wave propagation velocities, as measure of myocardial stiffness, showed a good correlation with CMR defined diffuse myocardial injury. Values higher than 4.74 m/s could identify diffuse myocardial injury in HTX patients with a good sensitivity and good specificity. These findings thus suggest that shear wave elastography has the potential to become a valuable non-invasive method for the detection of diffuse myocardial fibrosis.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Petrescu
- Gasthuisberg University Hospital, Leuven, Belgium
| | - S Bezy
- Gasthuisberg University Hospital, Leuven, Belgium
| | - M Cvijic
- Gasthuisberg University Hospital, Leuven, Belgium
| | - P Santos
- Gasthuisberg University Hospital, Leuven, Belgium
| | - J Duchenne
- Gasthuisberg University Hospital, Leuven, Belgium
| | - M Orlowska
- Gasthuisberg University Hospital, Leuven, Belgium
| | - J Van Keer
- Gasthuisberg University Hospital, Leuven, Belgium
| | | | - W Droogne
- Gasthuisberg University Hospital, Leuven, Belgium
| | - J Bogaert
- Gasthuisberg University Hospital, Leuven, Belgium
| | | | - J D'hooge
- Gasthuisberg University Hospital, Leuven, Belgium
| | - J.-U Voigt
- Gasthuisberg University Hospital, Leuven, Belgium
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Cvijic M, Bezy S, Petrescu A, Santos P, Orlowska M, Chakraborty B, Duchenne J, Pedrosa J, Vanassche T, Van Cleemput J, Dhooge J, Voigt J. Differentiation of hypertensive heart disease and hypertrophic cardiomyopathy with myocardial stiffness measurements: a shear wave imaging study using ultra-high frame rate echocardiography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0087] [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
Recently, cardiac shear wave (SW) elastography, based on high frame rate (HFR) echocardiography, has been proposed as new non-invasive technique for assessing myocardial stiffness. As myocardial stiffness increases with increasing wall stress, differences in measured operating myocardial stiffness do not necessarily reflect differences in intrinsic myocardial properties, but can also be caused by mere changes in loading or chamber geometry. This complicates myocardial stiffness interpretation for different types of pathologic hypertrophy.
Purpose
To explore the relationship between myocardial stiffness and underlying pathological substrates for cardiac hypertrophy.
Methods
We included 20 patients with hypertension (HT) and myocardial remodelling (59±14 years, 75% male), 20 patients with hypertrophic cardiomyopathy (HCM) (59±16 years, 60% male) and 20 healthy controls (56±14 years, 75% male). Left ventricular (LV) parasternal long axis views were acquired with an experimental HFR scanner at 1293±362 frames per seconds. Propagation velocity of SW occurring after mitral valve closure in the interventricular septum (IVS) served as measure of operating myocardial stiffness (Figure A). To compare myocardial stiffness among hearts with differing loading conditions and chamber geometry, SW velocities were normalized to end-diastolic wall stress, estimated at IVS from regional wall thickness, longitudinal and circumferential regional radii of curvature, and non-invasively estimated LV end-diastolic pressure (EDP).
Results
SW velocities differed significantly between groups (p<0.001). The controls had the lowest SW velocities (4.02±0.97 m/s), whereas values between HT and HCM group were comparable (6.46±0.99 m/s vs. 7.00±2.10 m/s; p=0.738). Considering end-diastolic wall stress, HCM patients had the same SW velocity at lower wall stress compared to HT (Figure B), indicating higher myocardial stiffness in the HCM group. SW velocities normalized for wall stress indicated significantly different myocardial stiffness among all groups (p<0.001) (Figure C). In a multiple linear regression model, the underlying pathological substrate independently influenced SW velocity (beta 1.37, 95% CI (0.78–1.96); p<0.001), while wall stress did not significantly affect its value (p=0.479).
Conclusions
Our study demonstrated that SW elastography can detect differences in myocardial stiffness in hypertensive heart and hypertrophic cardiomyopathy. Additionally, our results suggest that SW velocity is dominated by underlying myocardial tissue properties. We hypothesize that differential changes in cardiomyocytes and/or the extracellular matrix contribute to the differential myocardial stiffening in different pathologic entities of LV hypertrophy. Thus, SW elastography could provide useful novel diagnostic information in the evaluation of LV hypertrophy.
Figure A, B, C
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Cvijic
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - S Bezy
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - A Petrescu
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - P Santos
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - M Orlowska
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - B Chakraborty
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - J Duchenne
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - J Pedrosa
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - T Vanassche
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - J Van Cleemput
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - J Dhooge
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - J.U Voigt
- University Hospitals (UZ) Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
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Orlowska M, Ramalli A, Petrescu A, Cvijic M, Bezy S, Santos P, Pedrosa J, Voigt JU, D'hooge J. A Novel 2-D Speckle Tracking Method for High-Frame-Rate Echocardiography. IEEE Trans Ultrason Ferroelectr Freq Control 2020; 67:1764-1775. [PMID: 32286969 DOI: 10.1109/tuffc.2020.2985451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Speckle tracking echocardiography (STE) is a clinical tool to noninvasively assess regional myocardial function through the quantification of regional motion and deformation. Even if the time resolution of STE can be improved by high-frame-rate (HFR) imaging, dedicated HFR STE algorithms have to be developed to detect very small interframe motions. Therefore, in this article, we propose a novel 2-D STE method, purposely developed for HFR echocardiography. The 2-D motion estimator consists of a two-step algorithm based on the 1-D cross correlations to separately estimate the axial and lateral displacements. The method was first optimized and validated on simulated data giving an accuracy of ~3.3% and ~10.5% for the axial and lateral estimates, respectively. Then, it was preliminarily tested in vivo on ten healthy volunteers showing its clinical applicability and feasibility. Moreover, the extracted clinical markers were in the same range as those reported in the literature. Also, the estimated peak global longitudinal strain was compared with that measured with a clinical scanner showing good correlation and negligible differences (-20.94% versus -20.31%, p -value = 0.44). In conclusion, a novel algorithm for STE was developed: the radio frequency (RF) signals were preferred for the axial motion estimation, while envelope data were preferred for the lateral motion. Furthermore, using 2-D kernels, even for 1-D cross correlation, makes the method less sensitive to noise.
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Figueiredo M, Leão A, Moreno C, Fernandes M, Hernandez A, Correia JM, Gouveia M, Ramos P, Fonseca S, Faria T, Santos P, Oliveira R, Gomes S. Anaesthesia Department Preparedness and Response for the COVID-19 Outbreak in Portugal: A Perspective from CUF Porto Hospital. GM 2020. [DOI: 10.29315/gm.v7i2.357] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A global health emergency has been declared by the World Health Organization (WHO) as the SARS-CoV-2 outbreak spread across the world. Patients infected with SARS-CoV-2 are at risk for developing respiratory failure and requiring admission to critical care units. While providing optimal treatment for these patients, careful execution of infection control measures is necessary to prevent nosocomial transmission to other patients and to health workers providing care.1 In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here we described the measures for the outbreak adopted by the anesthesia department of a private tertiary care level hospital in Porto. These include engineering controls such as: identification and preparation of an isolation operating rooms, administrative measures such as: modification of workflow and processes, introduction of personal protective equipment, and formulation of clinical guidelines for anaesthetic management. We discuss how the hierarchy of controls should be a framework to plan, the necessary measures during each phase of a pandemic, and review the evidence of the procedures taken. [...]
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