1
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Vazquez R, Arriaga AF, Pimentel MPT. Taming the Wild West of Procedural Safety: Assessing Interprofessional Teams in Non-Operating Room Anesthesia. Jt Comm J Qual Patient Saf 2024; 50:303-304. [PMID: 38490944 DOI: 10.1016/j.jcjq.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
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2
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Graur A, Mercaldo ND, Simon J, Alici C, Saenger JA, Cahalane AM, Vazquez R, Fintelmann FJ. High-Frequency Jet Ventilation Versus Spontaneous Respiration for Percutaneous Cryoablation of Lung Tumors: Comparison of Adverse Events and Procedural Efficiency. AJR Am J Roentgenol 2024; 222:e2330557. [PMID: 38264999 DOI: 10.2214/ajr.23.30557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND. High-frequency jet ventilation (HFJV) facilitates accurate probe placement in percutaneous ablation of lung tumors but may increase risk for adverse events, including systemic air embolism. OBJECTIVE. The purpose of this study was to compare major adverse events and procedural efficiency of percutaneous lung ablation with HFJV under general anesthesia to spontaneous respiration (SR) under moderate sedation. METHODS. This retrospective study included consecutive adults who underwent CT-guided percutaneous cryoablation of one or more lung tumors with HFJV or SR between January 1, 2017, and May 31, 2023. We compared major adverse events (Common Terminology Criteria for Adverse Events grade ≥ 3) within 30 days postprocedure and hospital length of stay (HLOS) of 2 days or more using logistic regression analysis. We compared procedure time, room time, CT guidance acquisition time, CT guidance radiation dose, total radiation dose, and pneumothorax using generalized estimating equations. RESULTS. Overall, 139 patients (85 women, 54 men; median age, 68 years) with 310 lung tumors (82% metastases) underwent 208 cryoablations (HFJV, n = 129; SR, n = 79). HFJV showed greater rates than SR for the treatment of multiple tumors per session (43% vs 19%, respectively; p = .02) and tumors in a nonperipheral location (48% vs 24%, p < .001). Major adverse event rate was 8% for HFJV and 5% for SR (p = .46). No systemic air embolism occurred. HLOS was 2 days or more in 17% of sessions and did not differ significantly between HFJV and SR (p = .64), including after adjusting for probe number per session, chronic obstructive pulmonary disease, and operator experience (p = .53). Ventilation modalities showed no significant difference in procedure time, CT guidance acquisition time, CT guidance radiation dose, or total radiation dose (all p > .05). Room time was longer for HFJV than SR (median, 154 vs 127 minutes, p < .001). For HFJV, the median anesthesia time was 136 minutes. Ventilation modalities did not differ in the frequencies of pneumothorax or pneumothorax requiring chest tube placement (both p > .05). CONCLUSION. HFJV appears to be as safe as SR but had longer room times. HFJV can be used in complex cases without significantly impacting HLOS of 2 days or more, procedure time, or radiation exposure. CLINICAL IMPACT. Selection of the ventilation modality during percutaneous lung ablation should be based on patient characteristics and anticipated procedural requirements as well as operator preference.
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Affiliation(s)
- Alexander Graur
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
- Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Judit Simon
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Cagatay Alici
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Jonathan A Saenger
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexis M Cahalane
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Florian J Fintelmann
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
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3
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Piersa AP, Vazquez R. A comparison between nonoperating room anesthesia versus operating room anesthesia in quality assurance events. Can J Anaesth 2023; 70:1542-1543. [PMID: 37160821 DOI: 10.1007/s12630-023-02486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 05/11/2023] Open
Affiliation(s)
- Anastasia P Piersa
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
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4
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Joseph N, Sun VH, Som A, Di Capua J, Elsamaloty L, Huang J, Vazquez R. Evaluation of paravertebral blocks in improving post-procedural pain and decreasing hospital admission after microwave ablation of liver tumors. Sci Rep 2023; 13:13854. [PMID: 37620391 PMCID: PMC10449898 DOI: 10.1038/s41598-023-36607-1] [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: 11/30/2022] [Accepted: 06/07/2023] [Indexed: 08/26/2023] Open
Abstract
Although ablations are performed with conscious sedation or general anesthesia, microwave ablations can be painful post procedure. Newer analgesic modalities, including regional blocks, have promoted the proliferation of less invasive anesthesia care for ablative procedures. This study evaluates whether bilateral paravertebral blocks reduce the need for additional analgesics in comparison to unilateral blocks in microwave ablations. In this retrospective study, individuals undergoing microwave ablation who underwent unilateral versus bilateral nerve blocks at a single institution from 2017 to 2019 were compared. Categorical variables were analyzed using Pearson's chi-squared tests. Comparisons of means were completed using multiple T-tests corrected using the Holm-Sidak method with α = 0.05. Regression modeling was used to identify factors related to increased MME (milligram morphine equivalent) usage and post-procedure admission rates. A total of 106 patients undergoing 112 liver MWA procedures were included in this analysis, with patients receiving either a bilateral or unilateral block. Pre-procedural characteristics demonstrated no significant differences in age or gender. Bilateral blocks were associated with decreased usage of gabapentin (14% vs. 0%, p = 0.01) and a lower rate of post-procedure admissions (OR 0.23, p = 0.003). Therefore, when using paravertebral blocks, bilateral blocks are superior to unilateral blocks, as demonstrated by decreased rates of hospital admission and reduced use of systemic neuropathic pain medication. Additionally, reducing post-procedural MME may reduce the rate of admission to the hospital.
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Affiliation(s)
- Nicholos Joseph
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - Virginia H Sun
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - Avik Som
- Division of Vascular and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - John Di Capua
- Division of Vascular and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Lina Elsamaloty
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Junjian Huang
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, USA
| | - Rafael Vazquez
- Department of Anesthesiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
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5
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Rhee J, Vazquez R, Ma H. Pro-Con Debate: Judicious Benzodiazepine Administration for Preoperative Anxiolysis in Older Patients. Anesth Analg 2023; 137:280-288. [PMID: 37450906 PMCID: PMC10358369 DOI: 10.1213/ane.0000000000006337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
In this Pro-Con commentary article, we discuss the risks and benefits of administering preoperative benzodiazepines to older patients to decrease preoperative anxiety. The Pro side first focuses on the critical importance of treating preoperative anxiety and that benzodiazepines are the best tool to achieve that goal. The competing argument presented by the Con side is that myriad options exist to treat preoperative anxiety without simultaneously increasing the risk for devastating complications such as postoperative delirium. Both sides call for more high-quality investigations to determine the most effective strategies for decreasing preoperative anxiety in older adults while improving outcomes and reducing morbidity.
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Affiliation(s)
- James Rhee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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6
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Rhee J, Vazquez R, Ma H. Does Beers Put Preoperative Benzos on the Brink? Anesth Analg 2023; 137:277-279. [PMID: 37450905 DOI: 10.1213/ane.0000000000006522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- James Rhee
- From the Department of Anesthesia, Critical Care and Pain Medicine
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Rafael Vazquez
- From the Department of Anesthesia, Critical Care and Pain Medicine
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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7
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Grignano E, Cantero-Aguilar L, Tuerdi Z, Chabane T, Vazquez R, Johnson N, Zerbit J, Decroocq J, Birsen R, Fontenay M, Kosmider O, Chapuis N, Bouscary D. Dihydroartemisinin-induced ferroptosis in acute myeloid leukemia: links to iron metabolism and metallothionein. Cell Death Discov 2023; 9:97. [PMID: 36928207 PMCID: PMC10020442 DOI: 10.1038/s41420-023-01371-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
Artemisinin is an anti-malarial drug that has shown anticancer properties. Recently, ferroptosis was reported to be induced by dihydroartemisinin (DHA) and linked to iron increase. In the current study, we determined the effect of DHA in leukemic cell lines on ferroptosis induction and iron metabolism and the cytoprotective effect triggered in leukemic cells. We found that treatment of DHA induces early ferroptosis by promoting ferritinophagy and subsequent iron increase. Furthermore, our study demonstrated that DHA activated zinc metabolism signaling, especially the upregulation of metallothionein (MT). Supportingly, we showed that inhibition MT2A and MT1M isoforms enhanced DHA-induced ferroptosis. Finally, we demonstrated that DHA-induced ferroptosis alters glutathione pool, which is highly dependent on MTs-driven antioxidant response. Taken together, our study indicated that DHA activates ferritinophagy and subsequent ferroptosis in AML and that MTs are involved in glutathione regenerating and antioxidant response.
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Affiliation(s)
- E Grignano
- INSERM U1016, Institut Cochin, Paris, France. .,CNRS UMR8104, Paris, France. .,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France. .,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France.
| | - L Cantero-Aguilar
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France
| | - Z Tuerdi
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France
| | - T Chabane
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France
| | - R Vazquez
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - N Johnson
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France
| | - J Zerbit
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Pharmacie, Paris, France
| | - J Decroocq
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France
| | - R Birsen
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France
| | - M Fontenay
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - O Kosmider
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - N Chapuis
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - D Bouscary
- INSERM U1016, Institut Cochin, Paris, France.,CNRS UMR8104, Paris, France.,Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.,Equipe Labellisée Ligue Nationale Contre le Cancer (LNCC), Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France.,Member of OPALE Carnot Institute, The Organization for Partnerships in Leukemia, Paris, France
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8
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Calo CG, Velez O, Bosque K, Consuegra D, Vazquez R, Jimenez‐Rivera CA. Intermittent Cocaine Self‐Administration Infusions Increases Subthreshold Activity in Putative Dopaminergic Neurons of The Ventral Tegmental Area. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r6213] [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: 11/11/2022]
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9
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Vazquez R, Hamilton C. Abstract No. 447 Quality improvement: creation and sustainability of an enhanced recovery after procedure initiative for hepatic microwave ablation. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.256] [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: 10/21/2022] Open
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10
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Abstract
Erector spinae plane block (ESPB) is a fascial plane block that targets the dorsal and ventral branches of the primary dorsal root ganglion. We report a case of a 76-year-old woman who presented for percutaneous posterior interspinous decompression spacer at the L3-L4 level in the setting of neurogenic claudication from severe spinal stenosis. We describe the novel performance of bilateral ESPBs under ultrasound guidance for postprocedural analgesia. Throughout the recovery period, the patient experienced sustained pain relief. ESPB may be a useful adjunct for periprocedural analgesia and recovery in patients undergoing interspinous spacer placements.
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Affiliation(s)
- David Hao
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Vwaire Orhurhu
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Joshua Hirsch
- Neuroradiology, Massachusetts General Hospital, Boston, USA
| | - Zubin Irani
- Neuroradiology, Massachusetts General Hospital, Boston, USA
| | - Rafael Vazquez
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
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11
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Munoz-Montano W, Alvarado A, Cabrera P, Lara F, Fany PR, Perez-Sanchez V, Mohar A, Arrieta O, Vazquez R, Bargallo-Rocha JE. Prognosis, biological characteristics and importance of treatment's delay of breast cancer diagnosed during pregnancy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12545 Background: Breast cancer in pregnancy is that diagnosed during pregnancy or in the first year after birth (1), is the most frequent malignant neoplasms during pregnancy, (2,3); however, only 0.2% to 2.9% of all breast cancers occur during pregnancy(4), the incidence of breast cancer during pregnancy (BCDP) has increased the last few decades probably because of the delayed childbearing and the rise of maternal age (5,6). Because of the rarity of cases and the impracticability of conducting randomized controlled studies in this setting, several studies are retrospective, whilst some studies suggest outcomes for women are similar to non-pregnant patients with breast cancer(8–11), others (12–17) have demonstrated that pregnancy in itself is an adverse prognostic factor for survival. To contribute with the existing literature, we aimed to perform a cohort to analyze if there is a difference prognosis of patients with BCDP who started treatment during pregnancy or waited for delivery. Methods: We analyzed the baseline characteristics distribution in the BCP using the chi-square test and the Fisher’s exact test for categorical variables. We considered a statistically significant association when p value was < 0.05. DFS and OS analyses were conducted using the Kaplan–Meier method, and the log-rank test was used to determine if there were any differences in the survival curves by the variables of interest. We performed the statistical analysis using the SPSS 25.0 software for Windows (SPSS Inc., Chicago, IL, USA). Results: Among 8037 breast cancer patients enrolled in the database at Instituto Nacional de Cancerología, Mexico (INCan), within the social security program named “Seguro Popular”, between January 2007 and June 2018, we identified and included 61 women, median maternal age at diagnosis in our BCP group was 35 years (range 21-47), triple negative and her2 comprised 50.8% and 49.2% of BCP is comprised by luminal tumors. Conclusions: We strongly believe that the treatment of breast cancer during pregnancy should be started as soon as possible, since we have seen that its delay in childbirth translates into worse disease-free and overall survival. [Table: see text][Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - Oscar Arrieta
- Instituto Nacional de Cancerologia, Mexico City, Mexico
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12
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Huang J, Vazquez R. 4:21 PM Abstract No. 41 Unilateral thoracic paravertebral regional anesthesia reduces intraprocedure opioid administration for microwave ablation of liver tumors. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.063] [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: 10/25/2022] Open
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13
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Vazquez R, Beermann SL, Fintelmann FJ, Mullen EM, Chitilian H. High-Frequency Jet Ventilation in the Prone Position to Facilitate Cryoablation of a Peridiaphragmatic Pulmonary Neoplasm: A Case Report. A A Pract 2020; 13:169-172. [PMID: 31045587 DOI: 10.1213/xaa.0000000000001024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Percutaneous cryoablation of pulmonary tumors at the posterior lung base is challenging due to diaphragmatic motion and the requirement for prone positioning. High-frequency jet ventilation allows oxygenation and ventilation with minimal diaphragmatic movement. In this case report, we describe the use of high-frequency jet ventilation in the prone position to facilitate the cryoablation of a peridiaphragmatic pulmonary neoplasm.
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Affiliation(s)
- Rafael Vazquez
- From the Departments of Anesthesia, Critical Care, and Pain Medicine
| | | | | | - Eleanor M Mullen
- From the Departments of Anesthesia, Critical Care, and Pain Medicine
| | - Hovig Chitilian
- From the Departments of Anesthesia, Critical Care, and Pain Medicine
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14
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Chamadia S, Pedemonte JC, Hahm EY, Mekonnen J, Ibala R, Gitlin J, Ethridge BR, Qu J, Vazquez R, Rhee J, Liao ET, Brown EN, Akeju O. Delta oscillations phase limit neural activity during sevoflurane anesthesia. Commun Biol 2019; 2:415. [PMID: 31754645 PMCID: PMC6858348 DOI: 10.1038/s42003-019-0664-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022] Open
Abstract
Understanding anesthetic mechanisms with the goal of producing anesthetic states with limited systemic side effects is a major objective of neuroscience research in anesthesiology. Coherent frontal alpha oscillations have been postulated as a mechanism of sevoflurane general anesthesia. This postulate remains unproven. Therefore, we performed a single-site, randomized, cross-over, high-density electroencephalogram study of sevoflurane and sevoflurane-plus-ketamine general anesthesia in 12 healthy subjects. Data were analyzed with multitaper spectral, global coherence, cross-frequency coupling, and phase-dependent methods. Our results suggest that coherent alpha oscillations are not fundamental for maintaining sevoflurane general anesthesia. Taken together, our results suggest that subanesthetic and general anesthetic sevoflurane brain states emerge from impaired information processing instantiated by a delta-higher frequency phase-amplitude coupling syntax. These results provide fundamental new insights into the neural circuit mechanisms of sevoflurane anesthesia and suggest that anesthetic states may be produced by extracranial perturbations that cause delta-higher frequency phase-amplitude interactions.
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Affiliation(s)
- Shubham Chamadia
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Juan C. Pedemonte
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eunice Y. Hahm
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Jennifer Mekonnen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Reine Ibala
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Jacob Gitlin
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Breanna R. Ethridge
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Jason Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - James Rhee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Erika T. Liao
- Tulane University of Medicine, New Orleans, LA 70112 USA
| | - Emery N. Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- Department of Brain and Cognitive Science, Institute for Medical Engineering and Sciences, Picower Institute for Learning and Memory, Institute for Data Systems and Society, Massachusetts Institute of Technology, Cambridge, MA 02139 USA
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
- McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
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15
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Frenk NE, Salazar GM, Vazquez R, Irani Z. Intravascular Cement Leak after Vertebroplasty Treated with Stent Graft Placement in the Inferior Vena Cava. J Vasc Interv Radiol 2019; 30:74-75. [PMID: 30580814 DOI: 10.1016/j.jvir.2018.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Nathan E Frenk
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02119
| | - Gloria M Salazar
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02119
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02119
| | - Zubin Irani
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02119.
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Rahman S, Variyam D, Vazquez R, Yamada K. 03:18 PM Abstract No. 405 Utilizing high frequency jet ventilation in treating pulmonary arteriovenous malformations. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.482] [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: 10/27/2022] Open
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17
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Munoz Montano WR, Cabrera-Galeana P, Alvarado Miranda A, Lara F, Vazquez R, Bargallo E, Esparza N, Olvera A, Villarreal-Garza C, Zinser JW, Meneses A. Clinicopathological features and prognosis of pregnancy associated breast cancer at Instituto Nacional de Cancerología of Mexico. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13099] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | - Fernando Lara
- National Cancer Institute México, Mexico City, Mexico
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Wu V, Cui J, Vazquez R, Schainfeld R, Irani Z. Abstract No. 455 The arteriovenous dialysis circuit: an underappreciated factor in ESRD patients with heart failure. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.500] [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: 11/15/2022] Open
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19
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Gutierrez-Barrios A, Medina F, Camacho H, Shorbaji L, Oneto J, Sanchez I, Agarrado A, Alba M, Garrido F, Vazquez R. P4276Eficient radiation dose reduction in the cathlab. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4276] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Sole Gonzalez E, Ferrero-Gregori A, Puig T, Alvarez-Garcia J, Vives-Borras M, Vazquez R, Delgado J, Pascual-Figal D, Gonzalez-Juanatey J, Bardaji A, Bascompte R, Roig E, Cinca J. P5256Role of pathophysiological cardiac substrate on prognosis of ambulatory patients with chronic heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5256] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E. Sole Gonzalez
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - A. Ferrero-Gregori
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - T. Puig
- Hospital de la Santa Creu i Sant Pau, Epidemiology and Public Health Department, Barcelona, Spain
| | - J. Alvarez-Garcia
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - M. Vives-Borras
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - R. Vazquez
- University Hospital Puerta del Mar, Cardiology Department, Cadiz, Spain
| | - J. Delgado
- University Hospital 12 de Octubre, Cardiology Department, Madrid, Spain
| | - D. Pascual-Figal
- Hospital Clínico Univeristario Virgen de la Arrixaca, Cardiology Department, Murcia, Spain
| | - J.R. Gonzalez-Juanatey
- University Hospital of Santiago de Compostela, Cardiology Department, Santiago de Compostela, Spain
| | - A. Bardaji
- Hospital Universitario Joan XXIII, Cardiology Department, Tarragona, Spain
| | - R. Bascompte
- Hospital Arnau de Vilanova, Cardiology Department, Lleida, Spain
| | - E. Roig
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - J. Cinca
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
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21
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Pavone KJ, Su L, Gao L, Eromo E, Vazquez R, Rhee J, Hobbs LE, Ibala R, Demircioglu G, Purdon PL, Brown EN, Akeju O. Lack of Responsiveness during the Onset and Offset of Sevoflurane Anesthesia Is Associated with Decreased Awake-Alpha Oscillation Power. Front Syst Neurosci 2017; 11:38. [PMID: 28611601 PMCID: PMC5447687 DOI: 10.3389/fnsys.2017.00038] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 02/15/2017] [Accepted: 05/10/2017] [Indexed: 11/24/2022] Open
Abstract
Anesthetic drugs are typically administered to induce altered states of arousal that range from sedation to general anesthesia (GA). Systems neuroscience studies are currently being used to investigate the neural circuit mechanisms of anesthesia-induced altered arousal states. These studies suggest that by disrupting the oscillatory dynamics that are associated with arousal states, anesthesia-induced oscillations are a putative mechanism through which anesthetic drugs produce altered states of arousal. However, an empirical clinical observation is that even at relatively stable anesthetic doses, patients are sometimes intermittently responsive to verbal commands during states of light sedation. During these periods, prominent anesthesia-induced neural oscillations such as slow-delta (0.1–4 Hz) oscillations are notably absent. Neural correlates of intermittent responsiveness during light sedation have been insufficiently investigated. A principled understanding of the neural correlates of intermittent responsiveness may fundamentally advance our understanding of neural dynamics that are essential for maintaining arousal states, and how they are disrupted by anesthetics. Therefore, we performed a high-density (128 channels) electroencephalogram (EEG) study (n = 8) of sevoflurane-induced altered arousal in healthy volunteers. We administered temporally precise behavioral stimuli every 5 s to assess responsiveness. Here, we show that decreased eyes-closed, awake-alpha (8–12 Hz) oscillation power is associated with lack of responsiveness during sevoflurane effect-onset and -offset. We also show that anteriorization—the transition from occipitally dominant awake-alpha oscillations to frontally dominant anesthesia induced-alpha oscillations—is not a binary phenomenon. Rather, we suggest that periods, which were defined by lack of responsiveness, represent an intermediate brain state. We conclude that awake-alpha oscillation, previously thought to be an idling rhythm, is associated with responsiveness to behavioral stimuli.
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Affiliation(s)
- Kara J Pavone
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States.,School of Nursing, University of PennsylvaniaPhiladelphia, PA, United States
| | - Lijuan Su
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States.,Department of Computer Science, Zhejiang UniversityHangzhou, China
| | - Lei Gao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States
| | - Ersne Eromo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States
| | - James Rhee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States
| | - Lauren E Hobbs
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States
| | - Reine Ibala
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States
| | - Gizem Demircioglu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States
| | - Patrick L Purdon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States
| | - Emery N Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States.,Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of TechnologyCambridge, MA, United States
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, United States
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22
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Pascual-Figal DA, Ferrero-Gregori A, Gomez-Otero I, Vazquez R, Delgado-Jimenez J, Alvarez-Garcia J, Gimeno-Blanes JR, Worner-Diz F, Bardají A, Alonso-Pulpon L, Gonzalez-Juanatey JR, Cinca J. Mid-range left ventricular ejection fraction: Clinical profile and cause of death in ambulatory patients with chronic heart failure. Int J Cardiol 2017; 240:265-270. [PMID: 28318662 DOI: 10.1016/j.ijcard.2017.03.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/01/2017] [Accepted: 03/07/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The intermediate group of patients with heart failure (HF) and mid-range left ventricular ejection fraction (HFmrEF) may constitute a specific phenotype, but a direct evidence is lacking. This study aimed to know whether this HF category is accompanied by a particular clinical phenotype and prognosis. METHODS AND RESULTS This study includes 3446 ambulatory patients with chronic HF from two national registries. According to EF at enrollment, patients were classified as reduced (HFrEF, <40%), mid-range (HFmrEF, 40-49%) or preserved (HFpEF, ≥50%). Patients were followed-up for a median of 41months and the specific cause of death was prospectively registered. Patients with HFmrEF represented 13% of population and they exhibited a phenotype closer to HFrEF, except for a higher rate of coronary revascularization and diabetes, and a less advanced HF syndrome. The observed all-cause mortality was higher among HFrEF (33.0%), and similar between HFmrEF (27.8%) and HFpEF (28.0%) (p=0.012); however, the contribution of each cause of death differed significantly between categories (p<0.001). After propensity score matching, the risk of cardiovascular death, HF death or sudden cardiac death did not differ between HFmrEF and HFrEF in paired samples; however, patients with HFmrEF were at higher risk of cardiovascular death (sHR 1.71, 95% CI 1.13-2.57, p=0.011) and sudden cardiac death (sHR 2.73, 95% CI 1.07-6.98, p=0.036) than patients with HFpEF. CONCLUSIONS Patients in the intermediate category of HFmrEF conform a phenotype closer to the clinical profile of HFrEF, and associated to higher risk of sudden cardiac death and cardiovascular death than patients with HFpEF.
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Affiliation(s)
- Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, CIBERCV, Murcia, Spain.
| | - Andreu Ferrero-Gregori
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Ines Gomez-Otero
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Rafael Vazquez
- Servicio de Cardiologia, Hospital Puerta del Mar, Cadiz, Spain
| | - Juan Delgado-Jimenez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, CIBERCV, Madrid, Spain
| | - Jesus Alvarez-Garcia
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Juan R Gimeno-Blanes
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, CIBERCV, Murcia, Spain
| | | | - Alfredo Bardají
- Servico de Cardiologia, Hospital Juan XXIII, Tarragona, Spain
| | - Luis Alonso-Pulpon
- Servico de Cardiologia, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Jose Ramon Gonzalez-Juanatey
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Juan Cinca
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
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23
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Typhaine P, Dompnier M, Vazquez R, Guerrault-Moro MN, Durand A. Réalisation d’un audit sur le circuit de la nutrition parentérale : de la prescription à l’administration. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2016.10.010] [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: 11/25/2022]
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24
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Akeju O, Kim SE, Vazquez R, Rhee J, Pavone KJ, Hobbs LE, Purdon PL, Brown EN. Spatiotemporal Dynamics of Dexmedetomidine-Induced Electroencephalogram Oscillations. PLoS One 2016; 11:e0163431. [PMID: 27711165 PMCID: PMC5053525 DOI: 10.1371/journal.pone.0163431] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 09/08/2016] [Indexed: 12/19/2022] Open
Abstract
An improved understanding of the neural correlates of altered arousal states is fundamental for precise brain state targeting in clinical settings. More specifically, electroencephalogram recordings are now increasingly being used to relate drug-specific oscillatory dynamics to clinically desired altered arousal states. Dexmedetomidine is an anesthetic adjunct typically administered in operating rooms and intensive care units to produce and maintain a sedative brain state. However, a high-density electroencephalogram characterization of the neural correlates of the dexmedetomidine-induced altered arousal state has not been previously accomplished. Therefore, we administered dexmedetomidine (1mcg/kg bolus over 10 minutes, followed by 0.7mcg/kg/hr over 50 minutes) and recorded high-density electroencephalogram signals in healthy volunteers, 18–36 years old (n = 8). We analyzed the data with multitaper spectral and global coherence methods. We found that dexmedetomidine was associated with increased slow-delta oscillations across the entire scalp, increased theta oscillations in occipital regions, increased spindle oscillations in frontal regions, and decreased beta oscillations across the entire scalp. The theta and spindle oscillations were globally coherent. During recovery from this state, these electroencephalogram signatures reverted towards baseline signatures. We report that dexmedetomidine-induced electroencephalogram signatures more closely approximate the human sleep onset process than previously appreciated. We suggest that these signatures may be targeted by real time visualization of the electroencephalogram or spectrogram in clinical settings. Additionally, these signatures may aid the development of control systems for principled neurophysiological based brain-state targeting.
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Affiliation(s)
- Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Seong-Eun Kim
- Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - James Rhee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kara J. Pavone
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lauren E. Hobbs
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Patrick L. Purdon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Emery N. Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
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25
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Ladino L, Vazquez R, Bagés C, Quintero O, Ramos N. SUN-P232: A Survey Of Complementary Feeding Practices Recommended Among Health Professionals. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30575-1] [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: 11/26/2022]
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26
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Cygankiewicz I, Corino V, Vazquez R, Bayes-Genis A, Mainardi L, Zareba W, de Luna AB, Platonov PG. Reduced Irregularity of Ventricular Response During Atrial Fibrillation and Long-term Outcome in Patients With Heart Failure. Am J Cardiol 2015; 116:1071-5. [PMID: 26298305 DOI: 10.1016/j.amjcard.2015.06.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 11/16/2022]
Abstract
Reduced heart rate variability (HRV) is associated with poor outcome in patients with heart failure (HF). However, the data on predictive value of RR variability during atrial fibrillation (AF) are limited. Therefore, the aim of this study was to evaluate the association between ventricular response characteristics and long-term clinical outcome in the population of ambulatory patients with mild-to-moderate HF and AF at baseline. The study included 155 patients (mean age 69 ± 10 years) with AF at 20-minute Holter electrocardiographic (ECG) recordings at enrollment. HRV analysis included SDNN, rMSSD, and pNN50, whereas irregularity indexes included 2 nonlinear parameters: approximate entropy (ApEn) and Shannon entropy. After median 41 months of follow-up, 54 patients died, including 21 HF related and 16 sudden deaths. Patients with ApEn ≤1.68 (lower tertile) had 40% mortality versus 12% in others (p <0.001) at 2 years of follow-up. Only nonlinear HRV parameters (irregularity but not variability indexes) identified patients at higher risk during follow-up. Decreased ApEn ≤1.68 was an independent predictor of total mortality (hazard ratio [HR] 2.81, 95% confidence interval [CI] 1.61 to 4.89, p <0.001), sudden cardiac death (HR 3.83, 95% CI 1.31 to 11.25, p = 0.014), and HF death (HR 3.45, 95% CI 1.42 to 8.38, p = 0.006) in a multivariate Cox analysis. In conclusion, in a post hoc analysis of Muerte Subita en Insufficiencia Cardiaca study AF cohort, reduced irregularity of RR intervals during AF, likely caused by autonomic dysfunction, was an independent predictor of all-cause mortality and sudden death and HF progression in patients with mild-to-moderate HF, whereas traditional HRV indexes did not predict outcome.
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Affiliation(s)
- Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland.
| | - Valentina Corino
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Rafael Vazquez
- Cardiology Service, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | | | - Luca Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Wojciech Zareba
- Heart Research Follow Up Program, University of Rochester Medical Center, Rochester, New York
| | - Antoni Bayes de Luna
- Catalan Institute of Cardiovascular Sciences, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; Center for Integrative Electrocardiology at Lund University and Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
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Lee A, Vazquez R. Venous gas embolism caused by fibrin sealant application to the prostate during greenlight laser photoselective vaporization. ACTA ACUST UNITED AC 2015; 4:100-2. [PMID: 25867193 DOI: 10.1213/xaa.0000000000000138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Venous gas embolism is a complication of fibrin sealant application and is a well-described event during various modes of prostate resection. We describe the case of a nitrogen venous gas embolism during Greenlight laser photovaporization of the prostate during the application of fibrin sealant to the operative site for hemostasis. Fibrin sealant application by a compressed gas applicator is a cause of venous air embolism, and this case highlights the need to keep venous gas embolism in mind when compressed gas applicators are used.
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Affiliation(s)
- Alexander Lee
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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28
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Adam C, Klähn T, Naya C, Sanchez-Guillen J, Vazquez R, Wereszczynski A. Baryon chemical potential and in-medium properties of BPS skyrmions. Int J Clin Exp Med 2015. [DOI: 10.1103/physrevd.91.125037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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29
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Shaw E, Gomila A, Piriz M, Obradors F, Escofet R, Vazquez R, Badia JM, Martin L, Fraccalvieri D, Brugués M, Nicolás MC, Espejo E, Castro A, Cruz A, Limón E, Gudiol F, Pujol M. Cost of organ/space infection in elective colorectal surgery. Is it just a problem of rates? Antimicrob Resist Infect Control 2015. [PMCID: PMC4474843 DOI: 10.1186/2047-2994-4-s1-p77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Vazquez R, Vazquez-Guillamet M, Suarez J, Mooney J, Montoya J, Dhillon G. Invasive mold infections in lung and heart-lung transplant recipients: Stanford University experience. Transpl Infect Dis 2015; 17:259-66. [DOI: 10.1111/tid.12362] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/20/2014] [Accepted: 01/19/2015] [Indexed: 01/01/2023]
Affiliation(s)
- R. Vazquez
- Department of Medicine; University of New Mexico; Albuquerque New Mexico USA
| | | | - J. Suarez
- Universidad de la Sabana; Bogota Colombia
| | - J. Mooney
- Department of Medicine; Stanford University School of Medicine; Stanford California USA
| | - J.G. Montoya
- Department of Medicine; Stanford University School of Medicine; Stanford California USA
| | - G.S. Dhillon
- Department of Medicine; Stanford University School of Medicine; Stanford California USA
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31
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Akeju O, Loggia ML, Catana C, Pavone KJ, Vazquez R, Rhee J, Contreras Ramirez V, Chonde DB, Izquierdo-Garcia D, Arabasz G, Hsu S, Habeeb K, Hooker JM, Napadow V, Brown EN, Purdon PL. Disruption of thalamic functional connectivity is a neural correlate of dexmedetomidine-induced unconsciousness. eLife 2014; 3:e04499. [PMID: 25432022 PMCID: PMC4280551 DOI: 10.7554/elife.04499] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/26/2014] [Indexed: 12/17/2022] Open
Abstract
Understanding the neural basis of consciousness is fundamental to neuroscience research. Disruptions in cortico-cortical connectivity have been suggested as a primary mechanism of unconsciousness. By using a novel combination of positron emission tomography and functional magnetic resonance imaging, we studied anesthesia-induced unconsciousness and recovery using the α2-agonist dexmedetomidine. During unconsciousness, cerebral metabolic rate of glucose and cerebral blood flow were preferentially decreased in the thalamus, the Default Mode Network (DMN), and the bilateral Frontoparietal Networks (FPNs). Cortico-cortical functional connectivity within the DMN and FPNs was preserved. However, DMN thalamo-cortical functional connectivity was disrupted. Recovery from this state was associated with sustained reduction in cerebral blood flow and restored DMN thalamo-cortical functional connectivity. We report that loss of thalamo-cortical functional connectivity is sufficient to produce unconsciousness. DOI:http://dx.doi.org/10.7554/eLife.04499.001 Although we are all familiar with the experience of being conscious, explaining precisely what consciousness is and how it arises from activity in the brain remains extremely challenging. Indeed, explaining consciousness is so challenging that it is sometimes referred to as ‘the hard question’ of neuroscience. One way to obtain insights into the neural basis of consciousness is to compare patterns of activity in the brains of conscious subjects with patterns of brain activity in the same subjects under anesthesia. The results of some experiments of this kind suggest that loss of consciousness occurs when the communication between specific regions within the outer layer of the brain, the cortex, is disrupted. However, other studies seem to contradict these findings by showing that this communication can sometimes remain intact in unconscious subjects. Akeju, Loggia et al. have now resolved this issue by using brain imaging to examine the changes that occur as healthy volunteers enter and emerge from a light form of anesthesia roughly equivalent to non-REM sleep. An imaging technique called PET revealed that the loss of consciousness in the subjects was accompanied by reduced activity in a structure deep within the brain called the thalamus. Reduced activity was also seen in areas of cortex at the front and back of the brain. A technique called fMRI showed in turn that communication between the cortex and the thalamus was disrupted as subjects drifted into unconsciousness, whereas communication between cortical regions was spared. As subjects awakened from the anesthesia, communication between the thalamus and the cortex was restored. These results suggest that changes within distinct brain regions give rise to different depths of unconsciousness. Loss of communication between the thalamus and the cortex generates the unconsciousness of sleep or light anesthesia, while the additional loss of communication between cortical regions generates the unconsciousness of general anesthesia or coma. In addition to explaining the mixed results seen in previous experiments, this distinction could lead to advances in the diagnosis of patients with disorders of consciousness, and even to the development of therapies that target the thalamus and its connections with cortex. DOI:http://dx.doi.org/10.7554/eLife.04499.002
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Affiliation(s)
- Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Marco L Loggia
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Ciprian Catana
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Kara J Pavone
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - James Rhee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Violeta Contreras Ramirez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Daniel B Chonde
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - David Izquierdo-Garcia
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Grae Arabasz
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Shirley Hsu
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Kathleen Habeeb
- Clinical Research Center, Massachusetts General Hospital, Boston, United States
| | - Jacob M Hooker
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Vitaly Napadow
- MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Charlestown, United States
| | - Emery N Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Patrick L Purdon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
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Riveiro M, Astorgues-Xerri L, Ijaz N, Bekradda M, Vazquez R, Frapolli R, Rinaldi A, Kwee I, Cvitkovic E, Raymond E. 564 OTX015, a novel BET-BRD inhibitor is active in non-small-cell lung cancer cell (NSCLC) lines harboring different oncogenic mutations. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70690-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bengali R, Vazquez R. Inferior Vena Cava Filter Embolus to the Right Ventricle: Anesthesia and High-Risk Percutaneous Procedures. J Cardiothorac Vasc Anesth 2014; 29:1322-7. [PMID: 25304888 DOI: 10.1053/j.jvca.2014.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Raheel Bengali
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
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Álvarez-Garcia J, Ferrero A, Puig T, Vazquez R, Delgado J, Figal DP, Alonso-Pulpon L, Juanatey JRG, Rivera M, Worner F, Ruiz AB, Cinca J. PREDICTORS OF 1-MONTH AND 1-YEAR READMISSION FOR WORSENING OF HEART FAILURE IN AMBULATORY PATIENTS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60536-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Puig T, Ferrero-Gregori A, Roig E, Vazquez R, Gonzalez-Juanatey JR, Pascual-Figal D, Delgado J, Alonso-Pulpon L, Borras X, Mendez A, Cinca J. Valor pronóstico del índice de masa corporal y el perímetro de cintura en los pacientes con insuficiencia cardiaca crónica (Registro Español REDINSCOR). Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Kulkarni M, O'Loughlin A, Vazquez R, Mashayekhi K, Rooney P, Greiser U, O'Toole E, O'Brien T, Malagon MM, Pandit A. Use of a fibrin-based system for enhancing angiogenesis and modulating inflammation in the treatment of hyperglycemic wounds. Biomaterials 2013; 35:2001-10. [PMID: 24331702 DOI: 10.1016/j.biomaterials.2013.11.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/01/2013] [Indexed: 02/08/2023]
Abstract
The complex pathophysiology of chronic ulceration in diabetic patients is poorly understood; diabetes-related lower limb amputation is a major health issue, which has limited effective treatment regimes in the clinic. This study attempted to understand the complex pathology of hyperglycemic wound healing by showing profound changes in gene expression profiles in wounded human keratinocytes in hyperglycemic conditions compared to normal glucose conditions. In the hyper-secretory wound microenvironment of hyperglycemia, Rab18, a secretory control molecule, was found to be significantly downregulated. Using a biomaterial platform for dual therapy targeting the two distinct pathways, this study aimed to resolve the major dysregulated pathways in hyperglycemic wound healing. To complement Rab18, and promote angiogenesis eNOS was also targeted, and this novel Rab18-eNOS therapy via a dynamically controlled 'fibrin-in-fibrin' delivery system, demonstrated enhanced wound closure, by increasing functional angiogenesis and reducing inflammation, in an alloxan-induced hyperglycemic preclinical ear ulcer model of compromised wound healing.
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Affiliation(s)
- M Kulkarni
- Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland
| | - A O'Loughlin
- Regenerative Medicine Institute, National University of Ireland, Galway, Ireland
| | - R Vazquez
- Department of Cell Biology, Physiology, and Immunology, IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, 14014-Cordoba, Spain
| | - K Mashayekhi
- Regenerative Medicine Institute, National University of Ireland, Galway, Ireland
| | - P Rooney
- Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland
| | - U Greiser
- Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland; Regenerative Medicine Institute, National University of Ireland, Galway, Ireland
| | - E O'Toole
- Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - T O'Brien
- Regenerative Medicine Institute, National University of Ireland, Galway, Ireland
| | - Maria M Malagon
- Department of Cell Biology, Physiology, and Immunology, IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, 14014-Cordoba, Spain
| | - A Pandit
- Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland.
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Puig T, Ferrero-Gregori A, Roig E, Vazquez R, Gonzalez-Juanatey JR, Pascual-Figal D, Delgado J, Alonso-Pulpon L, Borras X, Mendez A, Cinca J. Prognostic value of body mass index and waist circumference in patients with chronic heart failure (Spanish REDINSCOR Registry). ACTA ACUST UNITED AC 2013; 67:101-6. [PMID: 24795116 DOI: 10.1016/j.rec.2013.06.022] [Citation(s) in RCA: 6] [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: 03/08/2013] [Accepted: 06/28/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES To analyze the association between higher body mass index and waist circumference, and the prognostic values of both indicators in total and cardiac mortality in patients with chronic heart failure. METHODS The study included 2254 patients who were followed up for 4 years. Obesity was classified as a body mass index ≥30 and overweight as a body mass index of 25.0-29.9. Central obesity was defined as waist circumference ≥88 cm for women and ≥102cm for men. Independent predictors of total and cardiac mortality were assessed in a multivariate Cox model adjusted for confounding variables. RESULTS Obesity was present in 35% of patients, overweight in 43%, and central obesity in 60%. Body mass index and waist circumference were independent predictors of lower total mortality: hazard ratio=0.84 (P<.001) and hazard ratio=0.97 (P=.01), respectively, and lower cardiac death (body mass index, hazard ratio=0.84, P<.001; waist circumference, hazard ratio=0.97, P=.01). The interaction between body mass index and waist circumference (hazard ratio=1.001, P<.01) showed that the protective effect of body mass index was lost in patients with a waist circumference >120cm. CONCLUSIONS Mortality was significantly lower in patients with a high body mass index and waist circumference. The results also showed that this protection was lost when these indicators over a certain limit.
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Affiliation(s)
- Teresa Puig
- Servicio de Epidemiología Clínica, Hospital de la Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Andreu Ferrero-Gregori
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eulalia Roig
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rafael Vazquez
- Servicio de Cardiología, Hospital Puerta del Mar, Cádiz, Spain
| | | | | | - Juan Delgado
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
| | - Luis Alonso-Pulpon
- Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Xavier Borras
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Mendez
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Cinca
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Pascual-Figal DA, Caballero L, Bayes-Genis A, Gonzalez-Juanatey JR, Vazquez R, Bayes de Luna A, Cinca J. Spironolactone in mild chronic heart failure: Insights from a propensity-matched analysis of the MUSIC study cohort. Int J Cardiol 2013; 168:4525-7. [DOI: 10.1016/j.ijcard.2013.06.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 06/30/2013] [Indexed: 12/18/2022]
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Vazquez R. Commentary on: Plasma protein denaturation with heat exposure. Perfusion 2013; 28:560. [PMID: 23935035 DOI: 10.1177/0267659113500756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
During cardiopulmonary bypass (CPB), perfusion at tepid temperatures (33-35 °C) is recommended to avoid high temperature cerebral hyperthermia during and after the operation. However, the ideal temperature for uncomplicated adult cardiac surgery is an unsettled question. Typically, the heat exchanger maximum temperature is monitored between 40-42 °C to prevent denaturation of plasma proteins, but studies have not been performed to make these conclusions. Therefore, our hypothesis was to determine the temperature in which blood plasma protein degradation occurs after 2 hours of heat exposure. As a result, blood plasma proteins were exposed to heat in the 37-50 °C range for 2 hours. Plasma protein samples were loaded onto an 8-12% gradient gel for SDS-PAGE and low molecular weight plasma protein degradation was detected with graded heat exposure. Protein degradation was first detected between 43-45 °C of heat exposure. This study supports the practice of monitoring the heat exchanger between 40-42 °C to prevent denaturation of plasma proteins.
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Affiliation(s)
- R Vazquez
- Sarver Heart Center, College of Medicine, The University of Arizona, Tucson, AZ
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Roig E, Puig T, Ferrero Gregori A, Vazquez R, Gonzalez-Juanatey JR, Pascual-Figal D, Delgado J, Borras X, Mendez A, Cinca J. Prognostic value of body mass index and waist circumference in patients with chronic heart failure (Spanish REDINSCOR Registry). Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1536] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bogle X, Vazquez R, Greenbaum S, Cresce AVW, Xu K. Understanding Li(+)-Solvent Interaction in Nonaqueous Carbonate Electrolytes with (17)O NMR. J Phys Chem Lett 2013; 4:1664-1668. [PMID: 26282976 DOI: 10.1021/jz400661k] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [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: 06/04/2023]
Abstract
To understand how Li(+) interacts with individual carbonate molecules in nonaqueous electrolytes, we conducted natural abundance (17)O NMR measurements on electrolyte solutions of 1 M LiPF6 in a series of binary solvent mixtures of ethylene carbonate (EC) and dimethyl carbonate (DMC). It was observed that the largest changes in (17)O chemical shift occurred at the carbonyl oxygens of EC, firmly establishing that Li(+) strongly prefers EC over DMC in typical nonaqueous electrolytes, while mainly coordinating with carbonyl rather than ethereal oxygens. Further quantitative analysis of the displacements in (17)O chemical shifts renders a detailed Li(+)-solvation structure in these electrolyte solutions, revealing that maximum six EC molecules can coexist in the Li(+)-solvation sheath, while DMC association with Li(+) is more "noncommittal" but simultaneously prevalent. This discovery, while aligning well with previous fragmental knowledge about Li(+)-solvation, reveals for the first time a complete picture of Li(+) solvation structure in nonaqueous electrolytes.
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Affiliation(s)
| | - Rafael Vazquez
- ‡Graduate Center of the City University of New York, New York, New York 10065 and 10016, United States
| | - Steven Greenbaum
- ‡Graduate Center of the City University of New York, New York, New York 10065 and 10016, United States
| | - Arthur von Wald Cresce
- §Electrochemistry Branch, U.S. Army Research Laboratory, Adelphi, Maryland 20783, United States
| | - Kang Xu
- §Electrochemistry Branch, U.S. Army Research Laboratory, Adelphi, Maryland 20783, United States
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Velasquez MC, Vazquez R, Sanabria P, Jimenez‐Rivera CA. Alpha‐1 adrenoreceptors modulate GABA release onto ventral tegmental area dopamine neurons. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.933.5] [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: 11/11/2022]
Affiliation(s)
- Maria Carolina Velasquez
- Department of PhysiologyUniversity of Puerto RicoSan JuanPR
- Departamento de Ciencias BasicasUniversidad Industrial de SantanderBucaramangaColombia
| | - Rafael Vazquez
- Department of PhysiologyUniversity of Puerto RicoSan JuanPR
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Cinca J, Mendez A, Puig T, Ferrero A, Roig E, Vazquez R, Gonzalez-Juanatey JR, Alonso-Pulpon L, Delgado J, Brugada J, Pascual-Figal D. Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure. Eur J Heart Fail 2013; 15:877-84. [PMID: 23512097 PMCID: PMC3721573 DOI: 10.1093/eurjhf/hft042] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIMS Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. METHODS AND RESULTS Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. CONCLUSION LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted.
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Affiliation(s)
- Juan Cinca
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain.
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Matheron A, Vazquez R, Guerrault-Moro MN, Brossard D, Crauste-Manciet S. TCH-044 Sterility Testing Using a Rapid Microbiological Method For Batch Production of Cytotoxic Drugs in a Hospital Pharmacy: Abstract TCH-044 Table 1. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Tereshchenko LG, Cygankiewicz I, McNitt S, Vazquez R, Bayes-Genis A, Han L, Sur S, Couderc JP, Berger RD, de Luna AB, Zareba W. Predictive value of beat-to-beat QT variability index across the continuum of left ventricular dysfunction: competing risks of noncardiac or cardiovascular death and sudden or nonsudden cardiac death. Circ Arrhythm Electrophysiol 2012; 5:719-27. [PMID: 22730411 DOI: 10.1161/circep.112.970541] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [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: 12/14/2022]
Abstract
BACKGROUND The goal of the present study was to determine the predictive value of beat-to-beat QT variability in heart failure patients across the continuum of left ventricular dysfunction. METHODS AND RESULTS Beat-to-beat QT variability index (QTVI), log-transformed heart rate variance, normalized QT variance, and coherence between heart rate variability and QT variability have been measured at rest during sinus rhythm in 533 participants of the Muerte Subita en Insuficiencia Cardiaca heart failure study (mean age, 63.1±11.7; men, 70.6%; left ventricular ejection fraction >35% in 254 [48%]) and in 181 healthy participants from the Intercity Digital Electrocardiogram Alliance database. During a median of 3.7 years of follow-up, 116 patients died, 52 from sudden cardiac death (SCD). In multivariate competing risk analyses, the highest QTVI quartile was associated with cardiovascular death (subhazard ratio, 1.67 [95% CI, 1.14-2.47]; P=0.009) and, in particular, with non-SCD (subhazard ratio, 2.91 [1.69-5.01]; P<0.001). Elevated QTVI separated 97.5% of healthy individuals from subjects at risk for cardiovascular (subhazard ratio, 1.57 [1.04-2.35]; P=0.031) and non-SCD in multivariate competing risk model (subhazard ratio, 2.58 [1.13-3.78]; P=0.001). No interaction between QTVI and left ventricular ejection fraction was found. QTVI predicted neither noncardiac death (P=0.546) nor SCD (P=0.945). Decreased heart rate variability rather than increased QT variability was the reason for increased QTVI in the present study. CONCLUSIONS Increased QTVI because of depressed heart rate variability predicts cardiovascular mortality and non-SCD but neither SCD nor extracardiac mortality in heart failure across the continuum of left ventricular dysfunction. Abnormally augmented QTVI separates 97.5% of healthy individuals from heart failure patients at risk.
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Affiliation(s)
- Larisa G Tereshchenko
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Platonov PG, Cygankiewicz I, Stridh M, Holmqvist F, Vazquez R, Bayes-Genis A, McNitt S, Zareba W, de Luna AB. Low atrial fibrillatory rate is associated with poor outcome in patients with mild to moderate heart failure. Circ Arrhythm Electrophysiol 2012; 5:77-83. [PMID: 22235036 DOI: 10.1161/circep.111.964395] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 12/20/2022]
Abstract
BACKGROUND Atrial fibrillatory rate (AFR) is a measure of atrial remodeling caused by atrial fibrillation (AF), and its acceleration negatively affects outcome of interventions for persistent AF. However, the prognostic value of AFR in patients with congestive heart failure (CHF) has not been studied. We sought to evaluate whether AFR can predict outcome in patients with mild to moderate (New York Health Association II-III) CHF. METHODS AND RESULTS High-resolution 20-minute long Holter ECGs obtained from 169 CHF patients with AF at enrollment were analyzed. AFR was estimated using spatiotemporal QRST cancellation and time-frequency analysis. The patients were followed for a median of 44 months, with primary end point defined as total mortality and secondary end points as sudden death and heart failure death. Atrial signal quality was sufficient for AFR estimation in 142 patients (mean age 69±11 years, 101 male). Of those, 48 patients died during follow-up, including 18 because of CHF progression. Mean AFR was 390±60 fpm and decreased with age (r=-0.3, P<0.001). Patients with AFR ≤371 fpm (lower tertile) had 44% 3-year mortality as compared with 26% with higher AFR. Lower AFR was an independent predictor of all cause mortality (HR=1.99, 95% CI=1.09-3.63, P=0.025) and CHF death (HR=3.74, 95% CI=1.38-10.14, P=0.010) after adjustment for significant clinical covariates in multivariable Cox analysis. CONCLUSIONS In CHF patients with AF, reduced AFR assessed using noninvasive approach is associated with increased risk of death because of heart failure progression, and may be considered a predictor of outcome.
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Affiliation(s)
- Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Sweden.
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Desilva S, Vazquez R, Stallworth PE, Reddy TB, Lehnes JM, Guo R, Gan H, Muffoletto BC, Greenbaum SG. Solid-State Nuclear Magnetic Resonance Studies of Electrochemically Discharged CF(x). J Power Sources 2011; 196:5659-5666. [PMID: 21528019 PMCID: PMC3081640 DOI: 10.1016/j.jpowsour.2011.02.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Electrochemical studies of three types of CF(x) (F - Fiber based, C - Petroleum coke based, G - Graphite based) have demonstrated different electrochemical performances types in previous work, with fiber based CF(x) delivering superior performance over those based on petroleum coke and graphite. (13)C and (19)F MAS (Magic Angle Spinning) NMR techniques are employed to identify the atomic/molecular structural factors that might account for differences in electrochemical performance among the different types of CF(x). Small quantitative variations of covalent CF and LiF are noted as a function of discharge and sp(3) bonded carbons are detected in discharged F type of CF(x).
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Affiliation(s)
- Sohan Desilva
- Department of Physics and Astronomy, Hunter College of CUNY, New York, NY 10065, and Ph.D. Program in Physics, CUNY Graduate Center, New York, NY 10016 USA
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Ielpo B, Lapuente F, Martin P, Acedo F, San Roman J, Corripio R, Vazquez R, Fernandez-Nespral V. First cases of giant pseudocyst complicating inguinal hernia repair. Hernia 2011; 16:589-91. [PMID: 21259028 DOI: 10.1007/s10029-011-0786-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 01/09/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Giant pseudocyst is a rare type of complication following incisional hernia repair and its correct management is still unknown. MATERIALS AND METHODS Herein, we describe two unreported cases of giant pseudocyst after inguinal hernia repair. Both patients underwent surgical treatment with partial excision of the pseudocapsule. The two patients were free from recurrence after 6 and 10 months of follow up, respectively. CONCLUSION Subtotal surgical removal of the pseudocapsule is a definitive treatment.
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Affiliation(s)
- B Ielpo
- General Surgery, University Hospital Madrid Montepricipe, Avenida de Monteprincipe, 25, 28660 Boadilla del Monte, Madrid, Spain.
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