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Recommendations for the coordination of Neurology and Neuroradiology Departments in the management of patients with multiple sclerosis. Neurologia 2023; 38:453-462. [PMID: 37120107 DOI: 10.1016/j.nrleng.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/01/2021] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is widely used for the diagnosis and follow-up of patients with multiple sclerosis (MS). Coordination between neurology and neuroradiology departments is crucial for performing and interpreting radiological studies as efficiently and as accurately as possible. However, improvements can be made in the communication between these departments in many Spanish hospitals. METHODS A panel of 17 neurologists and neuroradiologists from 8 Spanish hospitals held in-person and online meetings to draft a series of good practice guidelines for the coordinated management of MS. The drafting process included 4 phases: 1) establishing the scope of the guidelines and the methodology of the study; 2) literature review on good practices or recommendations on the use of MRI in MS; 3) discussion and consensus between experts; and 4) validation of the contents. RESULTS The expert panel agreed a total of 9 recommendations for improving coordination between neurology and neuroradiology departments. The recommendations revolve around 4 main pillars: 1) standardising the process for requesting and scheduling MRI studies and reports; 2) designing common protocols for MRI studies; 3) establishing multidisciplinary committees and coordination meetings; and 4) creating formal communication channels between both departments. CONCLUSIONS These consensus recommendations are intended to optimise coordination between neurologists and neuroradiologists, with the ultimate goal of improving the diagnosis and follow-up of patients with MS.
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Using Machine Learning Technology (Early Artificial Intelligence-Supported Response With Social Listening Platform) to Enhance Digital Social Understanding for the COVID-19 Infodemic: Development and Implementation Study. JMIR INFODEMIOLOGY 2023; 3:e47317. [PMID: 37422854 PMCID: PMC10477919 DOI: 10.2196/47317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Amid the COVID-19 pandemic, there has been a need for rapid social understanding to inform infodemic management and response. Although social media analysis platforms have traditionally been designed for commercial brands for marketing and sales purposes, they have been underused and adapted for a comprehensive understanding of social dynamics in areas such as public health. Traditional systems have challenges for public health use, and new tools and innovative methods are required. The World Health Organization Early Artificial Intelligence-Supported Response with Social Listening (EARS) platform was developed to overcome some of these challenges. OBJECTIVE This paper describes the development of the EARS platform, including data sourcing, development, and validation of a machine learning categorization approach, as well as the results from the pilot study. METHODS Data for EARS are collected daily from web-based conversations in publicly available sources in 9 languages. Public health and social media experts developed a taxonomy to categorize COVID-19 narratives into 5 relevant main categories and 41 subcategories. We developed a semisupervised machine learning algorithm to categorize social media posts into categories and various filters. To validate the results obtained by the machine learning-based approach, we compared it to a search-filter approach, applying Boolean queries with the same amount of information and measured the recall and precision. Hotelling T2 was used to determine the effect of the classification method on the combined variables. RESULTS The EARS platform was developed, validated, and applied to characterize conversations regarding COVID-19 since December 2020. A total of 215,469,045 social posts were collected for processing from December 2020 to February 2022. The machine learning algorithm outperformed the Boolean search filters method for precision and recall in both English and Spanish languages (P<.001). Demographic and other filters provided useful insights on data, and the gender split of users in the platform was largely consistent with population-level data on social media use. CONCLUSIONS The EARS platform was developed to address the changing needs of public health analysts during the COVID-19 pandemic. The application of public health taxonomy and artificial intelligence technology to a user-friendly social listening platform, accessible directly by analysts, is a significant step in better enabling understanding of global narratives. The platform was designed for scalability; iterations and new countries and languages have been added. This research has shown that a machine learning approach is more accurate than using only keywords and has the benefit of categorizing and understanding large amounts of digital social data during an infodemic. Further technical developments are needed and planned for continuous improvements, to meet the challenges in the generation of infodemic insights from social media for infodemic managers and public health professionals.
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Tuning the conductance of carbon rings with impurities and electric fields. RSC Adv 2023; 13:22358-22366. [PMID: 37497092 PMCID: PMC10366656 DOI: 10.1039/d3ra03297c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023] Open
Abstract
We explore two mechanisms to tune the electronic conductance of carbon atom rings, namely, substitutional impurities and in-plane external electric fields. First-principles calculations and a tight-binding approach are used to model the systems. Two bond configurations are studied, cumulenic and polyynic, which can be relevant depending on the number of carbon atoms in the ring. We find that both impurity substitution and electric field mechanisms allow for modifying the electronic spectrum and transport characteristics. Interestingly, cumulenic and polyynic carbon rings present a different response to these perturbations, which can also be a way to elucidate the bond nature of these structures.
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Adaptation culturally and linguistically to the Chilean population and validation the Dry Eye Questionnaire 5. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023:S2173-5794(23)00034-8. [PMID: 36963486 DOI: 10.1016/j.oftale.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/26/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND AND OBJECTIVE There are different methods for evaluating dry eye disease (DID), including questionnaires that analyze different aspects of its symptoms, which are important for its better understanding and therapeutic management. The Dry Eye Questionnaire 5 (DEQ-5), is unique in its kind, because in addition to its simplicity, it measures symptoms in 4 dimensions. the aim of this study is to adapt culturally and linguistically and validate this instrument to the Chilean population. MATERIAL AND METHODS for the adaptation, the translation and retro-translation of the original version was carried out, its linguistic analysis, the pilot test and the expert panel review (which included a linguistics specialist) were used. For the validation, a psychometric analysis of reliability and validity of the construct was incorporated. The sample in which it was validated was constituted by 205 people with dry eye disease. RESULTS 141 (69%) of the respondents were women, the mean of age was 48 years ± 16,7, and the median of the total score DEQ-5 was 13 points (R.I 8 - 15 points). The adapted version resulted in a Cronbach alpha of 0.8085, scoring that classified it as good. DISCUSSION the questionnaire DEQ-5, which was adapted and validated, was a good instrument to be used in populations with similar characteristics of those in the study. More so, the factor analysis enriched comprehension of the way in which people with dry eye disease relate their symptoms and which questions relate more between them, representing in a better way the aspects evaluated of the symptomatology of this disease.
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Historical trends in mortality from "older" vaccine-preventable diseases, Colombia: implications for elimination and control. Public Health 2022; 213:157-162. [PMID: 36423493 DOI: 10.1016/j.puhe.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to describe the trends in mortality from eight vaccine-preventable diseases in Colombia in the last 40 years and their relationship with vaccination coverage. STUDY DESIGN It is a population-based descriptive study. METHODS The frequencies of deaths by decade, disease, sex, and the specific mortality rates by age group were calculated. Using a negative binomial regression model, the 10-year changes in mortality and their relationship with vaccination coverage were determined. RESULTS The number of deaths and the adjusted rates decreased since 1989 in all diseases (incidence rate ratio <1 when compared with the 1979-1988 decade). Vaccination coverage below 90% is associated with an increase in mortality from diphtheria, measles, mumps, neonatal tetanus, and pertussis. CONCLUSION Historical changes in mortality support the benefits of vaccination, but new efforts are required to sustain the elimination of diseases.
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Transport signatures of few-atom carbon rings. Phys Chem Chem Phys 2022; 24:15973-15981. [PMID: 35730548 DOI: 10.1039/d2cp01308h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We study the electronic transport through an all-carbon quantum ring side-coupled to a quantum wire. We employ both first-principles calculations and a tight-binding approach; the latter allows for the derivation of analytical expressions for the conductance and density of states, which facilitates the interpretation of the transport characteristics. Two bond models are employed: either all the hoppings are equal (cumulenic ring) or they have alternating bonds (polyynic ring). Assuming cumulenic bonds, if the number of atoms in the carbon ring is a multiple of four, it produces an antiresonant peak in the conductance at the Fermi level. This effect disappears for the polyynic configuration, i.e., when the hoppings in the carbon rings are alternating. Additionally, a gap opens at the Fermi energy in the polyynic rings, yielding distinct transport signatures for the two bond configurations. Comparison to first-principles calculations shows an excellent agreement on the changes of the conductance due to the carbon ring. We propose such transport measurements as a way to elucidate the character of the bonds in these novel carbon nanostructures.
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M164 Evaluation of two methods for fecal calprotectin testing: Chemiluminiscence and ELISA. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Recommendations for the coordination of Neurology and Neuroradiology Departments in the management of patients with multiple sclerosis. Neurologia 2021; 38:S0213-4853(21)00029-3. [PMID: 33744061 DOI: 10.1016/j.nrl.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/01/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is widely used for the diagnosis and follow-up of patients with multiple sclerosis (MS). Coordination between Neurology and Neuroradiology departments is crucial for performing and interpreting radiological studies as efficiently and as accurately as possible. However, improvements can be made in the communication between these departments in many Spanish hospitals. METHODS A panel of 17 neurologists and neuroradiologists from 8 Spanish hospitals held in-person and online meetings to draft a series of good practice guidelines for the coordinated management of MS. The drafting process included 4 phases: 1) establishing the scope of the guidelines and the methodology of the study; 2) literature review on good practices or recommendations on the use of MRI in MS; 3) discussion and consensus between experts; and 4) validation of the contents. RESULTS The expert panel agreed a total of 9 recommendations for improving coordination between neurology and neuroradiology departments. The recommendations revolve around 4 main pillars: 1) standardising the process for requesting and scheduling MRI studies and reports; 2) designing common protocols for MRI studies; 3) establishing multidisciplinary committees and coordination meetings; and 4) creating formal communication channels between both departments. CONCLUSIONS These consensus recommendations are intended to optimise coordination between neurologists and neuroradiologists, with the ultimate goal of improving the diagnosis and follow-up of patients with MS.
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Clinical outcomes of FOLFIRINOX and gemcitabine-nab paclitaxel for metastatic pancreatic cancer in the real world setting. Clin Transl Oncol 2020; 23:812-819. [PMID: 32857340 DOI: 10.1007/s12094-020-02473-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES The incidence of pancreatic cancer is increasing in developed countries. The incorporation of new therapies, to the first-line treatment of patients with good performance status led to better survival in clinical trials. However, there is a wide variability in their use and some concerns about the treatment of elderly patients who were not included in the clinical trials. METHODS This is a retrospective multicenter study. Data from consecutive patients diagnosed with metastatic pancreatic cancer (mPC) treated with FOLFIRINOX (FFX) or gemcitabine plus nab-paclitaxel (GnP) were analysed to evaluate efficacy (overall survival-OS) and toxicity. RESULTS A total of 119 patients were included. 49.6% were treated with FFX and 50.4% with GNP in first-line. The median OS was 12 months with no statistically significant differences between both regimens (12.7 m for FFX vs 10.2 m for GnP). Elevated Ca 19.9 levels and neutrophil-lymphocyte ratio (NLR) increased the risk of death. Patients who received both regimens in first/second line had a median OS longer than 15 months whichever the sequence. 32 patients (27%) were older than 70-y. 54% patients received a second-line treatment, 56% in the FFX group and 44% in the GnP group. The median OS for patients older than 70 was 9.5 m versus 12.3 m for patients younger than 70. Progression of the disease was the cause of death in 67.6% of the patients. CONCLUSIONS In our setting, the use of FFX and GnP for treating mPC is quite similar, but superiority could not be demonstrated for any of the schemes in the first line. OS was determined by basal levels of Ca 19.9 and NLR. Patients receiving both regimens in first/second line whichever the sequence, exhibited the best survival rates. In our series, elderly patients had poorer survival rates.
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Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals. ACTA ACUST UNITED AC 2020; 68:82-98. [PMID: 32624233 DOI: 10.1016/j.redar.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/04/2020] [Accepted: 02/18/2020] [Indexed: 01/27/2023]
Abstract
The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.
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Abstract
OBJECTIVES Sexual assault (SA) is recognized as a public health problem of epidemic proportions. Guidelines recommend the administration of post-exposure prophylaxis (PEP) after an SA. However, few data are available about the feasibility of this strategy, and this study was conducted to assess this. METHODS We conducted a retrospective, longitudinal, observational study in SA victims attending the Hospital Clinic in Barcelona from 2006 to 2015. A total of 1695 SA victims attended the emergency room (ER), of whom 883 met the PEP criteria. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180 in the out-patient clinic. The primary endpoint was PEP completion rate at day 28. Secondary endpoints were loss to follow-up, treatment discontinuation, occurrence of adverse events (AEs) and rate of seroconversion. RESULTS The median age of participants was 25 years [interquartile range (IQR) 21-33 years] and 93% were female. The median interval between exposure and presentation at the ER was 13 h (IQR 6-24 h). The level of risk was appreciable in 47% (n = 466) of individuals. Of 883 patients receiving PEP, 631 lived in Catalonia. In this group, the PEP completion rate at day 28 was 29% (n = 183). The follow-up rate was 63% (n = 400) and 38% (n = 241) at days 1 and 28, respectively. Treatment discontinuation was present in 58 (15%) of 400 patients who attended at least the day 1 visit, the main reason being AEs (n = 35; 60%). AEs were reported in 226 (56%) patients, and were mainly gastrointestinal (n = 196; 49%). Only 211 (33%) patients returned for HIV testing at day 90. A single seroconversion was observed in a men who have sex with men (MSM) patient at day 120. CONCLUSIONS Follow-up and compliance rates in SA victims were poor. In addition, > 50% of the patients experienced AEs, which were the main reason for PEP interruption. Strategies to increase follow-up testing and new better tolerated drug regimens must be investigated to address these issues.
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Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways. Br J Dermatol 2019; 182:147-155. [PMID: 31049933 DOI: 10.1111/bjd.18098] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The malignant mechanisms that control the development of cutaneous T-cell lymphoma (CTCL) are beginning to be identified. Recent evidence suggests that disturbances in specific intracellular signalling pathways, such as RAS-mitogen-activated protein kinase, T-cell receptor (TCR)-phospholipase C gamma 1 (PLCG1)-nuclear factor of activated T cells (NFAT) and Janus kinase (JAK)-signal transducer and activator of transcription (STAT), may play an essential role in the pathogenesis of CTCL. OBJECTIVES To investigate the mechanisms controlling disease development and progression in mycosis fungoides (MF), the most common form of CTCL. METHODS We collected 100 samples that were submitted for diagnosis of, or a second opinion regarding, MF between 2001 and 2018, 80% of which were in the early clinical stages of the disease. Formalin-fixed paraffin-embedded tissues were used for histological review and to measure the expression by immunohistochemistry of surrogate markers of activation of the TCR-PLCG1-NFAT, JAK-STAT and NF-κB pathways. Folliculotropism and large-cell transformation were also examined. RESULTS NFAT and nuclear factor kappa B (NF-κB) markers showed a comparable activation status in early and advanced stages, while STAT3 activation was more frequent in advanced stages and was associated with large-cell transformation. Consistently with this observation, STAT3 activation occurred in parallel with MF progression in two initially MF-negative cases. A significant association of NFAT with NF-κB markers was also found, reflecting a common mechanism of activation in the two pathways. Genomic studies identified nine mutations in seven genes known to play a potential role in tumorigenesis in T-cell leukaemia/lymphoma, including PLCG1, JAK3 and STAT3, which underlies the activation of these key cell-survival pathways. A higher mutational allele frequency was detected in advanced stages. CONCLUSIONS Our results show that STAT3 is activated in advanced cases and is associated with large-cell transformation, while the activation of NFAT and NF-κB is maintained throughout the disease. These findings could have important diagnostic and therapeutic implications. What's already known about this topic? Mycosis fungoides is characterized by a clonal expansion of T cells in the skin. The mechanisms controlling disease development and progression are not fully understood. What does this study add? An association of the nuclear factor of activated T cells and nuclear factor kappa B pathways was found, which could reflect a common mechanism of activation. These pathways were activated in early and advanced stages at the same level. Signal transducer and activator of transcription 3 activation was associated with large-cell transformation and was more frequent in advanced stages. A genomic analysis of cutaneous T-cell lymphoma-associated genes was performed. Nine mutations were detected. What is the translational message? These results could have important implications for the treatment of MF in the near future.
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Safety and efficacy of bariatric surgery in Mexico: A detailed analysis of 500 surgeries performed at a high-volume center. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2018.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Intracranial hypertension syndrome in a patient with psoriasis receiving ustekinumab. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Síndrome de hipertensión intracraneal en una paciente con psoriasis tratada con ustekinumab. Neurologia 2019; 34:281-282. [DOI: 10.1016/j.nrl.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/02/2017] [Accepted: 05/12/2017] [Indexed: 12/01/2022] Open
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Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study. Allergol Immunopathol (Madr) 2019; 47:282-288. [PMID: 30595390 PMCID: PMC7125869 DOI: 10.1016/j.aller.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. METHODS Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. RESULTS 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. CONCLUSIONS Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.
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Hospitalizations for asthma exacerbation in Chilean children: A multicenter observational study. Allergol Immunopathol (Madr) 2018; 46:533-538. [PMID: 29720350 DOI: 10.1016/j.aller.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/06/2018] [Accepted: 02/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.
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Tenofovir disoproxil fumarate/emtricitabine plus ritonavir-boosted lopinavir or cobicistat-boosted elvitegravir as a single-tablet regimen for HIV post-exposure prophylaxis. J Antimicrob Chemother 2018; 72:2857-2861. [PMID: 29091217 DOI: 10.1093/jac/dkx246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives To assess HIV-1 post-exposure prophylaxis (PEP) non-completion at day 28, comparing ritonavir-boosted lopinavir versus cobicistat-boosted elvitegravir as a single-tablet regimen (STR), using tenofovir disoproxil fumarate/emtricitabine with both of these therapies. Methods A prospective, open, randomized clinical trial was performed. Individuals attending the emergency room due to potential sexual exposure to HIV and who met criteria for PEP were randomized 1:3 into two groups receiving either 400/100 mg of lopinavir/ritonavir (n = 38) or 150/150 mg of elvitegravir/cobicistat (n = 119), with both groups also receiving 245/200 mg of tenofovir disoproxil fumarate/emtricitabine. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180. The primary endpoint was PEP non-completion at day 28. Secondary endpoints were adherence, adverse effects and rate of seroconversions. Clinical trials.gov number: NCT08431173. Results Median age was 32 years and 95% were males. PEP non-completion at day 28 was 36% (n = 57), with a trend to be higher in the lopinavir/ritonavir arm [lopinavir/ritonavir 47% (n = 18) versus elvitegravir/cobicistat 33% (n = 39), P = 0.10]. We performed a modified ITT analysis including only those patients who attended on day 1. PEP non-completion in this subgroup was higher in the lopinavir/ritonavir arm than in the elvitegravir/cobicistat arm (33% versus 15%, respectively, P = 0.04). Poor adherence was significantly higher in the lopinavir/ritonavir arm versus the elvitegravir/cobicistat arm (47% versus 9%, respectively, P < 0.0001). Adverse events were reported by 73 patients (59%), and were significantly more common in the lopinavir/ritonavir arm (90% versus 49%, P = 0.0001). A seroconversion was observed in the elvitegravir/cobicistat arm in a patient with multiple exposures before and after PEP. Conclusions A higher PEP non-completion, poor adherence and adverse events were observed in patients allocated to the lopinavir/ritonavir arm, suggesting that STR elvitegravir/cobicistat is a well-tolerated antiretroviral for PEP.
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Influence of general anaesthesia on the brainstem. ACTA ACUST UNITED AC 2016; 64:157-167. [PMID: 27887735 DOI: 10.1016/j.redar.2016.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 11/17/2022]
Abstract
The exact role of the brainstem in the control of body functions is not yet well known and the same applies to the influence of general anaesthesia on brainstem functions. Nevertheless in all general anaesthesia the anaesthesiologist should be aware of the interaction of anaesthetic drugs and brainstem function in relation to whole body homeostasis. As a result of this interaction there will be changes in consciousness, protective reflexes, breathing pattern, heart rate, temperature or arterial blood pressure to name a few. Brainstem function can be explored using three different approaches: clinically, analyzing changes in brain electric activity or using neuroimaging techniques. With the aim of providing the clinician anaesthesiologist with a global view of the interaction between the anaesthetic state and homeostatic changes related to brainstem function, the present review article addresses the influence of anaesthetic drug effects on brainstem function through clinical exploration of cranial nerves and reflexes, analysis of electric signals such as electroencephalographic changes and what it is known about brainstem through the use of imaging techniques, more specifically functional magnetic resonance imaging.
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Toxicological safety evaluation of ACM T1H by intravenously route in CENP: Beagle dogs. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.07.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Results of the safety evaluation of cancer vaccines dealing with novel targets for cancer immunotherapy. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.07.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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ID 154 – Post exercise decrement in CMAP amplitude and myotonia in Hyperkaliemic Periodic Paralysis. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Survey of hemostasis management and transfusion in liver transplantation. ACTA ACUST UNITED AC 2015; 63:84-90. [PMID: 26411596 DOI: 10.1016/j.redar.2015.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/06/2015] [Accepted: 06/09/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the management of haemostasis and transfusion practice in the field of liver transplantation in Spain. METHODS A questionnaire was developed for physicians in anaesthesiology of all centres performing liver transplantation in Spain. The information required made reference to the 12 months prior to its distribution, from January 1 to December 31, 2011. RESULTS Data were collected from 24 centres in which liver transplantation is performed in Spain. Only 46% reported that they had protocols or practice guidelines for the management of haemostasis, and 83% of hospitals responded that they knew the percentage of transfused patients, but only 57% knew the mean transfusion. Regarding the degree of satisfaction with the management of haemostasis/coagulation, 50% said they were not satisfied. Thromboelastometry was used as an additional method of preoperative monitoring in only 8% of the centres and intra-operatively in one-third. Less than half (46%) of the centres performed preoperative correction of coagulation deficits based on conventional tests. The mean number of packed red cells used was ≤4 in 57% of centres. Consumption of fresh frozen plasma was highly variable, while 100% of centres consumed less than 4 pools of platelets per patient. CONCLUSIONS There is a wide variability in the management of haemostasis and transfusion practice among Spanish centres. There are no guidelines or they are not widely used. The mean use of transfused blood products remain high. There was a decrease in centres using new methods of monitoring.
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Abstract
Vernix caseosa peritonitis is a rare complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Most cases occur after cesarean section. We discuss herein two patients, aged 33 and 29 years, who presented with vernix caseosa peritonitis seven to nine days after a cesarean delivery. Laparotomy was performed and it revealed neither uterine rupture nor other surgical emergencies, but cheesy exudates on the serosal surface of all viscera. Appendicectomy was performed. Histopathologic study revealed acute fibrinous serositis and a mixed cellular infiltrate, rich in neutrophils, around fetal desquamated anucleate squamous cells. Patients´ recovery was complete. Clinical diagnosis of vernix caseosa peritonitis should be suspected in patients presenting post-cesarean section with an acute abdomen. Distinctive histopathologic findings allow making the correct diagnosis. Vigilant monitoring after diagnosis is essential as delayed morbidities may appear.
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CLINICAL TRIALSA-01Does Feedback Adherence Predict Patient and Caregiver Satisfaction with Neuropsychological Services? Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Occurrence and ecological aspects of the two-fingered skinkChalcides mauritanicusin the Chafarinas Islands in North Africa. AFR J HERPETOL 2015. [DOI: 10.1080/21564574.2015.1034792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pentafecta outcomes after robot-assisted laparoscopic radical prostatectomy: first 100 cases in Latinoamerican Hospital. Actas Urol Esp 2015; 39:20-5. [PMID: 24974068 DOI: 10.1016/j.acuro.2013.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/10/2013] [Accepted: 12/01/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Radical prostatectomy (RP) is the standard treatment for cancer control in the long term. The rise of minimally invasive surgery and new technologies have yielded better results and enabled us to pursue more ambitious objectives. The main works still use the trifecta as classic presentation, but this does not cover all aspects of surgery. Pentafecta is a new and more comprehensive methodology to report outcomes after RP, including complications and surgical margin status with the three major outcomes classically reported. The purpose of this study is to report our experience with robot-assisted laparoscopic radical prostatectomy (RALRP) by applying the concept of pentafecta. MATERIAL AND METHOD Describe the experience in this institution from March 2009 to December 2012 of RALRP by pentafecta. RESULTS We performed 101 interventions and obtained the following results: Average age 60.89 ± 7.32 years (40-77), total PSA 8.5 ± 5.57 ng/dl (0.2-29); D'Amico classification: Low 29 (28.71%), Medium 65 (64.36%), High 7 (6.93%); Operative time 253.44 ± 51.51 min (90-540), Complications 12.9% (Clavien I-II 10.89% and Clavien IIIa 1.98%); Positive surgical margins 20.83%; Biochemistry recurrence 12.5% follow-up (6-44 months); and Continence 87.5% per year and Potency 59.52%. CONCLUSIONS RALRP is a safe and reproducible procedure with excellent results in terms of pentafecta, inclusive during the initial experience at a low volumen center for prostate cancer. A longer follow-up study and experience with higher volume of patients are required to obtain better results and data to be compared with excellence centers.
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¿Influye el deterioro cognitivo preoperatorio en los resultados de la artroplastia total de rodilla? Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:364-9. [DOI: 10.1016/j.recot.2014.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/14/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022] Open
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Is "intra-operating room" thromboelastometry useful in liver transplantation? A case-control study in 303 patients. Transplant Proc 2014; 45:3637-9. [PMID: 24314981 DOI: 10.1016/j.transproceed.2013.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Coagulation monitoring during liver transplantation (LT) is, even today, fundamental to reduce blood loss during surgery. Thromboelastometry (TEM) is a proven technique for controlling the various parameters that influence coagulation. However, there are no studies linking "intra-operating room" TEM (orTEM) with LT outcomes. We describe a case-control study in 303 liver graft recipients analyzing variables associated with operative complications and long-term LT outcomes. The results showed that orTEM reduced the use of blood products in patients with Model for End-Stage Liver Disease scores of ≥ 21, retransplantation, and high surgical difficulty and important intraoperative bleeding. In addition, results in survival and postoperative complications were better when orTEM was used. In conclusion, we confirm that use of orTEM is associated with less use of blood products and a lower rate of complications after LT.
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[Validation of APACHE II and SOFA scores in 2 cohorts of patients with suspected infection and sepsis, not admitted to critical care units]. ACTA ACUST UNITED AC 2014; 61:125-32. [PMID: 24468009 DOI: 10.1016/j.redar.2013.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/19/2013] [Accepted: 11/28/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To validate the APACHE II and SOFA scores in patients with suspected infection in clinical settings other than intensive care units. MATERIALS AND METHODS A secondary analysis was performed on 2,530 adult patients participating in 2 cohort studies, with suspected infection as admission diagnosis within the first 24 h of hospitalization. The performance of both scoring systems was studied in order to set calibration and discrimination, respectively, on the outcomes such as mortality, admission to Intensive Care Unit, development of septic shock, or multiple organ dysfunctions. RESULTS The AUC-ROC values for mortality at discharge and on day 28 in the first cohort were around 0.50 for the SOFA and APACHE II scores; whereas for the second cohort the discrimination value was around 0.70. Calibration of both scoring systems for primary outcomes, according to Hosmer-Lemeshow test, showed p>.05 in the first cohort; while in the second cohort calibration it only showed a p>.05 in the case of the SOFA for mortality at hospital discharge. CONCLUSION This validation study of SOFA and APACHE II scores in patients with suspected infection in-hospital units other than the Intensive Care Unit, showed no consistent performance for calibration and discrimination. Its application in emergency and in-hospital patients is limited.
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Modelling propofol pharmacodynamics using BIS-guided anaesthesia. Anaesthesia 2013; 68:1132-40. [PMID: 23992529 DOI: 10.1111/anae.12384] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2013] [Indexed: 11/30/2022]
Abstract
Using Schnider's pharmacokinetic model, propofol pharmacodynamics were modelled during total intravenous anaesthesia. The method involved adjusting a pharmacokinetic/pharmacodynamic model according to data obtained from 42 patients having operative procedures with remifentanil analgesia. Parameters Ce50 and γ were estimated for induction and maintenance by analysing patients' bispectral index. The pharmacodynamic models were different for induction and maintenance. The mean (95% CI) Ce50 for induction and maintenance was Ce50 = 3.35 (2.79-3.91) mg.l(-1) and 2.23 (1.95-2.51) mg.l(-1) , respectively, with a higher concentration required to achieve the same effect during induction, even during remifentanil co-administration. During induction and maintenance, γ was 1.24 (1.44-2.00) and 1.58 (1.32-1.84), respectively. As γ is related to the concentration-effect slope, patient response is accentuated during maintenance compared with induction. The influence of sex and age on the model was analysed. Sex had no significant influence on the model, although a linear relation was found between age and Ce50 .
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Selective aerobic oxidation of activated alkanes with MOFs and their use for epoxidation of olefins with oxygen in a tandem reaction. Catal Sci Technol 2013. [DOI: 10.1039/c2cy20449e] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Repeated dose (14days) rat intramuscular toxicology study of Her1 vaccine. Regul Toxicol Pharmacol 2012; 64:425-34. [DOI: 10.1016/j.yrtph.2012.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 01/27/2023]
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Repeated dose intramuscular injection of the CIMAvax-EGF vaccine in Sprague Dawley rats induces local and systemic toxicity. Vaccine 2012; 30:3329-38. [DOI: 10.1016/j.vaccine.2012.01.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 01/06/2012] [Accepted: 01/07/2012] [Indexed: 10/28/2022]
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Síndrome de Muir-Torre con expresión conservada de MLH1, MSH2 y MSH6. Rev Clin Esp 2012; 212:e14. [DOI: 10.1016/j.rce.2011.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 09/19/2011] [Accepted: 10/03/2011] [Indexed: 10/14/2022]
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Multiple sclerosis prevalence in Malaga, Southern Spain estimated by the capture–recapture method. Mult Scler 2011; 18:372-6. [DOI: 10.1177/1352458511421917] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Although not definitively proven, there is commonly accepted to be a latitudinal gradient in the distribution of multiple sclerosis (MS), which is more frequent in temperate zones. The European Mediterranean countries are situated in a zone of median frequency, although ever increasing figures have been noted in the last decades. Objective: The objective of this study was to assess the current prevalence rate of MS in the province of Malaga, Southern Spain. Methods: The capture–recapture method (CRM) uses independent sources of data and permits the number of non-registered cases of a given disease to be estimated, and by doing so, to avoid ascertainment bias. Results: Use of this method showed the estimated prevalence rate of MS in the province of Malaga, Southern Spain, to be 125/105 (95% confidence interval: 102/105–169/105), higher than the figures published previously. Conclusions: Although we recognize that these data need to be confirmed in further studies and in other areas of the country using a similar method, we believe this study is the first to find such high figure of prevalence, being very similar to the figures reported in recent years in other southern European countries.
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Phase II study of a fixed dose-rate infusion of gemcitabine associated with erlotinib in advanced pancreatic cancer. Cancer Chemother Pharmacol 2010; 67:215-21. [PMID: 20927525 DOI: 10.1007/s00280-010-1472-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 09/13/2010] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the feasibility, toxicity and efficacy of the combination regimen consisting of gemcitabine-FDR infusion plus erlotinib, in ACP patients. METHODS Forty-two patients with histologically confirmed, locally advanced or metastatic pancreatic cancer were included in this phase II trial. Main objectives were to assess the efficacy and safety of this regimen. Therapeutic regimen consisted of gemcitabine 1,200 mg/m(2) in 120-min infusion on days 1, 8 and 15, plus erlotinib 100 mg orally once daily. Cycles were repeated every 28 days. RESULTS A total of 160 courses of gemcitabine-FDR erlotinib were administered (median 3.8 courses per patient). The most common grade 3-4 AEs were neutropenia (21%), thrombocytopenia (10%), skin rash (10%) and asthenia (10%). Complete response was achieved in one patient (2%) and 11 (26%) achieved a partial response. Stable disease and progression disease were observed in 11 patients (26%) and 19 (45%), respectively. Median time to progression was 5 months (95%CI: 3.9-5.8 months) and median overall survival was 8 months (95% CI: 5.1-10.8). One-year survival rate was 35%. CONCLUSIONS A regimen consisting of gemcitabine-FDR infusion plus erlotinib is active and well tolerated in APC patients. However, the results do not justify the conduct of a Phase III trial.
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Severe Rhabdomyolysis After Allogeneic Transplantation of Facial Structures: A Case Report. Transplant Proc 2010; 42:3081-2. [DOI: 10.1016/j.transproceed.2010.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Under-recognized renal insufficiency in hospitalized patients: implications for care. Eur J Intern Med 2010; 21:327-32. [PMID: 20603046 DOI: 10.1016/j.ejim.2010.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/15/2010] [Accepted: 04/27/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The consequences of undetected low glomerular filtration rate (GFR) are important in hospitalized patients who receive potentially nephrotoxic drugs or undergo major surgery. This study estimated the prevalence of estimated GFR (eGFR) <60mL/min/1.73m(2) in hospitalized patients. METHODS This cross-sectional descriptive study included 14,658 adults hospitalized at 10 centers in Spain. Serum samples were analyzed for hemoglobin, creatinine, albumin and urea nitrogen. eGFR was estimated using Modification of Diet in Renal Disease (MDRD) 4 or MDRD IDMS, and MDRD 6 when serum albumin and BUN were included (n=8611). Individuals were classified as having GFR>or=60mL/min/1.73m(2), stages 3, 4 and 5 (GFR 30-59, 15-29 and <15mL/min/1.73m(2), respectively). Additionally, stages 3a and 3b (GFR 45-59 and 30-44mL/min/1.73m(2), respectively) were assessed. RESULTS MDRD 4 eGFR showed that 28.3% of patients had renal insufficiency stages 3-5 and 14.2% had stages 3b, 4 or 5, which represents important-severe renal deterioration. Forty-three percent of patients with stages 3-5 had hemoglobin <or=11g/dL, compared with 27.9% of patients with eGFR>or=60mL/min/1.73m(2). A good correlation was observed between eGFR MDRD 4 and MDRD 6. CONCLUSIONS A high percentage of hospitalized patients in Spain have deteriorated renal function stages 3-5. Using eGFR equations to assess eGFR could identify more hospitalized patients with renal insufficiency, potentially leading to improved care.
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Neutrophilic Dermatosis of the Hands in Rheumatoid Arthritis. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70634-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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[Neutrophilic dermatosis of the hands in rheumatoid arthritis]. ACTAS DERMO-SIFILIOGRAFICAS 2010; 101:280-281. [PMID: 20398611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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P18-07. Ex vivo production of autologous HIV-1 to be used as immunogen in autologous dendritic cell-based therapeutic vaccine (clinical trial DCV02). Retrovirology 2009. [PMCID: PMC2767822 DOI: 10.1186/1742-4690-6-s3-p316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Viral kinetics during the first month of treatment in patients with genotype 1 chronic hepatitis C. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2009; 101:671-9. [DOI: 10.4321/s1130-01082009001000002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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[Carotid stroke secondary to pituitary apoplexy. A favorable result from intravenous thrombolysis]. Neurologia 2009; 24:501-503. [PMID: 21469260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Proton MR spectroscopy improves discrimination between tumor and pseudotumoral lesion in solid brain masses. AJNR Am J Neuroradiol 2009; 30:544-51. [PMID: 19095788 DOI: 10.3174/ajnr.a1392] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating between tumors and pseudotumoral lesions by conventional MR imaging may be a challenging question. This study aims to evaluate the potential usefulness and the added value that single-voxel proton MR spectroscopy could provide on this discrimination. MATERIALS AND METHODS A total of 84 solid brain lesions were retrospectively included in the study (68 glial tumors and 16 pseudotumoral lesions). Single-voxel spectra at TE 30 ms (short TE) and 136 ms (long TE) were available in all cases. Two groups were defined: "training-set" (56 cases) and "test-set" (28 cases). Tumors and pseudotumors were compared in the training-set with the Mann-Whitney U test. Ratios between resonances were defined as classifiers for new cases, and thresholds were selected with receiver operating characteristic (ROC) curves. The added value of spectroscopy was evaluated by 5 neuroradiologists and assessed with the Wilcoxon signed-rank test. RESULTS Differences between tumors and pseudotumors were found in myo-inositol (mIns); P < .01) at short TE, and N-acetylaspartate (NAA; P < .001), glutamine (Glx; P < .01), and choline (CHO; P < .05) at long TE. Classifiers suggested tumor when mIns/NAA ratio was more than 0.9 at short TE and also when CHO/NAA ratio was more than 1.9 at long TE. Classifier accuracy was tested in the test-set with the following results: short TE, 82% (23/28); long TE, 79% (22/28). The neuroradiologists' confidence rating of the test-cases on a 5-point scale (0-4) improved between 5% (from 2.86-3) and 27% (from 2.25-2.86) with spectroscopy (mean, 17%; P < .01). CONCLUSIONS The proposed ratios of mIns/NAA at short TE and CHO/NAA at long TE provide valuable information to discriminate between brain tumor and pseudotumor by improving neuroradiologists' accuracy and confidence.
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cDNA cloning, expression levels and gene mapping of photosynthetic and non-photosynthetic ferredoxin genes in sunflower (Helianthus annuus L.). TAG. THEORETICAL AND APPLIED GENETICS. THEORETISCHE UND ANGEWANDTE GENETIK 2009; 118:891-901. [PMID: 19130032 DOI: 10.1007/s00122-008-0947-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 12/04/2008] [Indexed: 05/27/2023]
Abstract
Fatty acid desaturation in plastids and chloroplasts depends on the electron-donor activity of ferredoxins. Using degenerate oligonucleotides designed from known photosynthetic and heterotrophic plant ferredoxin sequences, two full-length ferredoxin cDNAs were cloned from sunflower (Helianthus annuus L.) leaves and developing seeds, HaFd1 and HaFd2, homologous to photosynthetic and non-photosynthetic ferredoxins, respectively. Based on these cDNAs, the respective genomic sequences were obtained and the presence of DNA polymorphisms was investigated. Complete sequencing of the HaFd1 and HaFd2 genes in different lines indicated the presence of two haplotypes for HaFd2 and their alignment showed that sequence polymorphisms are restricted to the 5'-NTR intron. In addition, specific DNA markers for the HaFd1 and HaFd2 genes were developed that enabled the genes to be mapped. Accordingly, the HaFd1 locus maps to linkage group 10 of the public sunflower map, while the HaFd2 locus maps to linkage group 11. Both ferredoxins display different spatial-temporal patterns of expression. While HaFd2 is expressed at similar levels in all tissues tested (leaves, stem, roots, cotyledons and developing seeds), HaFd1 is more strongly expressed in green tissues than in all the other tissues tested. Both photosynthetic- and heterotrophic-ferredoxins are present in sunflower seeds and may contribute to fatty acid desaturation during oil accumulation. Nevertheless, the levels of HaFd2 expression during seed formation are distinct in lines that only varied in the HaFd2 haplotypes they expressed.
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[Acute disseminated encephalomyelitis: study of factors involved in a possible development towards multiple sclerosis]. Neurologia 2008; 23:546-554. [PMID: 18802800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an uncommon disease characterized by inflammation and demyelination of the central nervous system (CNS). It typically occurs after a viral infection or vaccination and is more frequent in children. Its immediate and longterm prognosis is expected to be good (20% of cases with sequelae). Although ADEM is typically monophasic, occasional relapses may occur. Differential diagnosis, mostly in the early phases, is established with multiple sclerosis (MS), a chronic inflammatory demyelinating disease of the CNS that may have worse prognosis. Traditionally it has been believed that 10% of ADEM patients develop MS. However, this percentage could be higher according to several recently published clinical series. Some clinical and paraclinical patterns are considered to confer risk of developing MS when present in ADEM patients. Our study has aimed to: a) describe a series of 29 patients (22 children and 9 adults) admitted in our hospital and diagnosed of ADEM between 1990 and 2005; b) study those patients considered to have risk patterns of developing MS, and c) compare the child and adult populations of our series. After a median 55 month follow-up, 6 children (27%) and no adults developed MS. In our series, risk patterns for developing MS predicted conversion to MS more accurately in children than in adults. Eight patients (6 children and 2 adults) had sequelae, cognitive in 6 of them. Our work supports that also observed in recent publications: that both conversion to MS or presence of sequelae after an episode of ADEM are more frequent than traditionally considered.
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