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Acevedo J, Diaz-Molina I. Learning organizations in emerging economies: the effect of knowledge management on innovative culture in Chilean companies. TLO 2022. [DOI: 10.1108/tlo-01-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to explore the impact of knowledge management (KM) on the development of an innovative culture in learning organizations from emerging economies.
Design/methodology/approach
A quantitative study using a survey was carried out, achieving a pooled cross-sectional sample of 10,567 workers, made up of 69 larger Chilean companies.
Findings
Results were analyzed using the exploratory factor analysis and multilevel regression analysis techniques. The findings provide insights into the positive and significant effect of KM – as acquisition, dissemination and responsiveness to knowledge – on innovative culture.
Practical implications
The findings suggest that managers become more successful in their overall innovative efforts when implementing routines of knowledge or know-how practices that generate a learning culture characterized through discovery skills, creativity, empowerment and cooperation.
Originality/value
This is an original study that introduces valuable information on learning organizations in emerging markets, contrasting to traditional literature and frequently focusing on developed countries. This study explains the cultural change in learning organizations through KM’s role, which offers routinization of learning practices to facilitate an innovative culture.
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Muñoz‐Martínez S, Sapena V, Forner A, Bruix J, Sanduzzi‐Zamparelli M, Ríos J, Bouattour M, El‐Kassas M, Leal CRG, Mocan T, Nault J, Alves RCP, Reeves HL, da Fonseca L, García‐Juárez I, Pinato DJ, Varela M, Alqahtani SA, Alvares‐da‐Silva MR, Bandi JC, Rimassa L, Lozano M, González Santiago JM, Tacke F, Sala M, Anders M, Lachenmayer A, Piñero F, França A, Guarino M, Elvevi A, Cabibbo G, Peck‐Radosavljevic M, Rojas Á, Vergara M, Braconi C, Pascual S, Perelló C, Mello V, Rodríguez‐Lope C, Acevedo J, Villani R, Hollande C, Vilgrain V, Tawheed A, Ferguson Theodoro C, Sparchez Z, Blaise L, Viera‐Alves DE, Watson R, Carrilho FJ, Moctezuma‐Velázquez C, D'Alessio A, Iavarone M, Reig M. Outcome of liver cancer patients with SARS-CoV-2 infection: An International, Multicentre, Cohort Study. Liver Int 2022; 42:1891-1901. [PMID: 35608939 PMCID: PMC9347559 DOI: 10.1111/liv.15320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/03/2022] [Accepted: 05/21/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Information about the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with liver cancer is lacking. This study characterizes the outcomes and mortality risk in this population. METHODS Multicentre retrospective, cross-sectional, international study of liver cancer patients with SARS-CoV-2 infection registered between February and December 2020. Clinical data at SARS-CoV-2 diagnosis and outcomes were registered. RESULTS Two hundred fifty patients from 38 centres were included, 218 with hepatocellular carcinoma (HCC) and 32 with intrahepatic cholangiocarcinoma (iCCA). The median age was 66.5 and 64.5 years, and 84.9% and 21.9% had cirrhosis in the HCC and iCCA cohorts respectively. Patients had advanced cancer stage at SARS-CoV-2 diagnosis in 39.0% of the HCC and 71.9% of the iCCA patients. After a median follow-up of 7.20 (IQR: 1.84-11.24) months, 100 (40%) patients have died, 48% of the deaths were SARS-CoV-2-related. Forty (18.4%) HCC patients died within 30-days. The death rate increase was significantly different according to the BCLC stage (6.10% [95% CI 2.24-12.74], 11.76% [95% CI 4.73-22.30], 20.69% [95% CI 11.35-31.96] and 34.52% [95% CI 17.03-52.78] for BCLC 0/A, B, C and D, respectively; p = .0017). The hazard ratio was 1.45 (95% CI 0.49-4.31; p = .5032) in BCLC-B versus 0/A, and 3.13 (95% CI 1.29-7.62; p = .0118) in BCLC-C versus 0/A in the competing risk Cox regression model. Nineteen out of 32 iCCA (59.4%) died, and 12 deaths were related to SARS-CoV-2 infection. CONCLUSIONS This is the largest cohort of liver cancer patients infected with SARS-CoV-2. It characterizes the 30-day mortality risk of SARS-CoV-2 infected patients with HCC during this period.
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Affiliation(s)
- Sergio Muñoz‐Martínez
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- CIBEREHDBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
| | - Victor Sapena
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
- Medical Statistics Core Facility, Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic BarcelonaBarcelonaSpain
| | - Alejandro Forner
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- CIBEREHDBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
| | - Jordi Bruix
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- CIBEREHDBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
| | - Marco Sanduzzi‐Zamparelli
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- CIBEREHDBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
| | - José Ríos
- Department of Clinical Farmacology Hospital Clinic and Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Mohamed El‐Kassas
- Endemic Medicine DepartmentFaculty of MedicineHelwan UniversityCairoEgypt
| | - Cassia R. G. Leal
- GastroenterologyHospital Universitário Antônio Pedro, Universidade Federal FuminenseRio de JaneiroBrazil
- GastroenterologyHospital Federal do Servidores do EstadoRio de JaneiroBrazil
| | - Tudor Mocan
- 3rd Medical Department"Octavian Fodor" Institute for Gastroenterology and HepatologyCluj‐NapocaRomania
| | - Jean‐Charles Nault
- Liver unitHôpital Avicenne, Hôpitaux Universitaires Paris‐Seine‐Saint‐Denis, Assistance‐Publique Hôpitaux de ParisBobignyFrance
- Unité de Formation et de Recherche Santé Médecine et Biologie HumaineUniversité Paris Nord, Communauté d'Universités et Etablissements Sorbonne Paris CitéParisFrance
- Centre de Recherche des CordeliersSorbonne UniversitéInserm, Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology. Université de Paris, team « Functional Genomics of Solid TumorsParisFrance
| | - Rogerio C. P. Alves
- GastroenterologyHospital do Servidor Publico Estadual de São PauloSao PauloBrazil
- Bp Beneficência Portuguesa de São PauloSao PauloBrazil
| | - Helen L. Reeves
- Liver UnitNewcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
- Newcastle University Translational and Clinical Research InstituteNewcastle upon TyneUK
| | - Leonardo da Fonseca
- Clinical OncologySao Paulo Clinicas Liver Cancer Group. Instituto do Cancer do Estado de Sao Paulo. Hospital das Clínicas. University of Sao Paulo School of MedicineSao PauloBrazil
| | - Ignacio García‐Juárez
- Gastroenterology DepartmentNational Institute of Medical Sciences and Nutrition Salvador ZubiránMexico CityMexico
| | - David J. Pinato
- Department of Surgery and CancerImperial College LondonLondonUK
| | - María Varela
- Liver Unit, Department of Digestive DiseaseHospital Universitario Central de Asturias, IUOPA, ISPA, Universidad de OviedoOviedoSpain
| | - Saleh A. Alqahtani
- Liver TransplantKing Faisal Specialist Hospital & Research CenterRiyadhSaudi Arabia
| | - Mario R. Alvares‐da‐Silva
- GI/Liver UnitHospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Juan C. Bandi
- Hepatology UnitHospital ItalianoBuenos AiresArgentina
| | - Lorenza Rimassa
- Department of Biomedical SciencesHumanitas UniversityRozzanoItaly
- Medical Oncology and Hematology UnitHumanitas Cancer Center, IRCCS, Humanitas Research HospitalRozzanoItaly
| | - Mar Lozano
- Aparato DigestivoHospital Universitario Infanta LeonorMadridSpain
| | - Jesús M. González Santiago
- Department of Gastroenterology and HepatologySalamanca University Clinic HospitalIBSAL, CIBERehdSalamancaSpain
| | - Frank Tacke
- Department of Gastroenterology and HepatologySalamanca University Clinic HospitalIBSAL, CIBERehdSalamancaSpain
- Department of Hepatology and GastroenterologyCharité‐UniversitätsmedizinCampus Virchow‐Klinikum and Campus Charité MitteBerlinGermany
| | - Margarita Sala
- GastroenterologyHepatology UnitHospital Doctor Josep Trueta, IDIBGI (Institut d'Investigació Biomèdica de Girona)CIBERehdGironaSpain
| | | | - Anja Lachenmayer
- Department of Visceral Surgery and MedicineInselspital, Bern University Hospital, University of BernBernSwitzerland
| | | | - Alex França
- MedicineFederal University of SergipeAracajuBrazil
| | - Maria Guarino
- Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINapoliItaly
| | - Alessandra Elvevi
- Division Gastroenterology and Center for Autoimmune Liver Diseases San Gerardo Hospital University of Milano ‐ Bicocca School of MedicineMonzaItaly
| | - Giuseppe Cabibbo
- Section of Gastroenterology and HepatologyPROMISE, University of PalermoPalermoItaly
| | | | - Ángela Rojas
- SeLiver group. Institute of Biomedicine of SevilleHospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla‐CIBERehdSevilleSpain
| | - Mercedes Vergara
- Unitat d'Hepatologia, Servei d'Aparell Digestiu, Parc Taulí Sabadell Hospital Universitari, Institut d'Investigació i Innovació I3PT, Universitat Autònoma de Barcelona, Barcelona, Departament de Medicina, Universitat Autònoma de Barcelona, CIBERehd. Instituto Carlos IIIMadridSpain
| | - Chiara Braconi
- Medical OncologyBeatson West of Scotland Cancer CentreUniversity of GlasgowGlasgowUK
| | - Sonia Pascual
- Liver Unit. HGU Dr. Balmis. CIBERehd. ISABIALAlicanteSpain
| | - Christie Perelló
- Gastroenterology and HepatologyUniversity Hospital Puerta de HierroMajadahondaSpain
| | | | - Carlos Rodríguez‐Lope
- Servicio de Aparato DigestivoHospital Universitario Marqués de ValdecillaIDIVALSantanderSpain
| | - Juan Acevedo
- South West Liver UnitUniversity Hospitals Plymouth NHS TrustPlymouthUK
| | | | | | - Valérie Vilgrain
- Université de ParisParisFrance
- Department of RadiologyHôpital Beaujon, AP‐HP. NordClichyFrance
| | - Ahmed Tawheed
- Endemic Medicine DepartmentFaculty of MedicineHelwan UniversityCairoEgypt
| | - Carmem Ferguson Theodoro
- Department of GastroenterologyHospital Universitário Antônio Pedro, Universidade Federal FluminenseNiteroiBrazil
| | - Zeno Sparchez
- 3rd Medical DepartmentInstitute for Gastroenterology and HepatologyUniversity of Medicine and PharmacyCluj‐NapocaRomania
| | - Lorraine Blaise
- Liver unitHôpital Avicenne, Hôpitaux Universitaires Paris‐Seine‐Saint‐Denis, Assistance‐Publique Hôpitaux de ParisBobignyFrance
- Unité de Formation et de Recherche Santé Médecine et Biologie HumaineUniversité Paris Nord, Communauté d'Universités et Etablissements Sorbonne Paris CitéParisFrance
- Centre de Recherche des CordeliersSorbonne UniversitéInserm, Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology. Université de Paris, team « Functional Genomics of Solid TumorsParisFrance
| | - Daniele E. Viera‐Alves
- GastroenterologyHospital do Servidor Publico Estadual de São PauloSao PauloBrazil
- Bp Beneficência Portuguesa de São PauloSao PauloBrazil
| | - Robyn Watson
- Newcastle University Translational and Clinical Research InstituteNewcastle upon TyneUK
| | - Flair J. Carrilho
- Sao Paulo Clínicas Liver Cancer Group. Instituto do Cancer do Estado de Sao Paulo. Division of Clinical Gastroenterology and HepatologyHospital das Clínicas, Department of GastroenterologyUniversity of Sao Paulo School of MedicineSao PauloBrazil
| | - Carlos Moctezuma‐Velázquez
- Gastroenterology DepartmentNational Institute of Medical Sciences and Nutrition Salvador ZubiránMexico CityMexico
| | - Antonio D'Alessio
- Department of Surgery and CancerImperial College LondonLondonUK
- Department of Biomedical SciencesHumanitas UniversityRozzanoItaly
| | - Massimo Iavarone
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico – Division of Gastroenterology and HepatologyMilanItaly
| | - Maria Reig
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- CIBEREHDBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
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Acevedo J, Díaz-Molina I. The Role of Absorptive Capacity in Innovation and Productivity in Chilean Companies: An Adapted CDM Model Across Industries. Journal of Technology Management & Innovation 2021. [DOI: 10.4067/s0718-27242021000400022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Yomayusa N, Acevedo J, Abello Polo V, Izaguirre R, Ramírez C, Solano MH, Ramírez S, Rodríguez P, Morón L, De la Hoz I, Rocio Chacón K, Gutiérrez P, Agudelo C, Hernández S, León G, Accini J, Ortíz G, Concha-Mejia A, Contreras R, Escobar B, Espinosa T, González C, Yama E, Aroca G, Guillermo C, Hamann O, Horlandy L, Moreno C, Mejía N, Mendoza F, Castellanos J, Rozo J, Montero C, Navarro J, Oñate J, Pinto D, Restrepo N, Saenz O, Triana L, Correa L, Sabbagh L, Castillo A, Torres R, Lineros A. Recommendations for the diagnosis and management of persons with suspected vaccine-induced immune thrombotic thrombocytopenia (VITT). Infect 2021. [DOI: 10.22354/in.v26i1.987] [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: 11/23/2022] Open
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Trebicka J, Fernandez J, Papp M, Caraceni P, Laleman W, Gambino C, Giovo I, Uschner FE, Jansen C, Jimenez C, Mookerjee R, Gustot T, Albillos A, Bañares R, Jarcuska P, Steib C, Reiberger T, Acevedo J, Gatti P, Shawcross DL, Zeuzem S, Zipprich A, Piano S, Berg T, Bruns T, Danielsen KV, Coenraad M, Merli M, Stauber R, Zoller H, Ramos JP, Solé C, Soriano G, de Gottardi A, Gronbaek H, Saliba F, Trautwein C, Kani HT, Francque S, Ryder S, Nahon P, Romero-Gomez M, Van Vlierberghe H, Francoz C, Manns M, Garcia-Lopez E, Tufoni M, Amoros A, Pavesi M, Sanchez C, Praktiknjo M, Curto A, Pitarch C, Putignano A, Moreno E, Bernal W, Aguilar F, Clària J, Ponzo P, Vitalis Z, Zaccherini G, Balogh B, Gerbes A, Vargas V, Alessandria C, Bernardi M, Ginès P, Moreau R, Angeli P, Jalan R, Arroyo V, Semela D, Elkrief L, Elsharkawy A, Tornai T, Tornai I, Altorjay I, Antognoli A, Baldassarre M, Gagliardi M, Bertoli E, Mareso S, Brocca A, Campion D, Saracco GM, Rizzo M, Lehmann J, Pohlmann A, Brol MJ, Chang J, Schierwagen R, Solà E, Amari N, Rodriguez M, Nevens F, Clemente A, Janicko M, Markwardt D, Mandorfer M, Welsch C, Welzel TM, Ciraci E, Patel V, Ripoll C, Herber A, Horn P, Bendtsen F, Gluud LL, Schaapman J, Riggio O, Rainer F, Moritz JT, Mesquita M, Alvarado-Tapias E, Akpata O, Aamann L, Samuel D, Tresson S, Strnad P, Amathieu R, Simón-Talero M, Smits F, van den Ende N, Martinez J, Garcia R, Rupprechter H, Engelmann C, Özdogan OC. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis. J Hepatol 2021; 74:1097-1108. [PMID: 33227350 DOI: 10.1016/j.jhep.2020.11.019] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes. METHODS The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome. RESULTS Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90-day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality. CONCLUSIONS This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis. LAY SUMMARY Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes.
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Affiliation(s)
- Jonel Trebicka
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany.
| | - Javier Fernandez
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Maria Papp
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | | | - Wim Laleman
- Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic disorders, University of Leuven, Leuven, Belgium
| | | | - Ilaria Giovo
- A.O.U. Città della Salute e della Scienza Torino, Torino, Italy
| | - Frank Erhard Uschner
- Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Cesar Jimenez
- Liver Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | | | | | - Agustin Albillos
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, University of Alcalá, CIBEREHD, Madrid, Spain
| | - Rafael Bañares
- Hospital General Universitario Gregorio Marañón. Facultad de Medicina (Universidad Complutense of Madrid), CIBERehd, Madrid, Spain
| | - Peter Jarcuska
- Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Christian Steib
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU, Munich, Germany
| | | | - Juan Acevedo
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Pietro Gatti
- Internal Medicine PO Ostuni, ASL Brindisi, Italy
| | | | - Stefan Zeuzem
- Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany
| | | | | | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University, Medical Center, Leipzig, Germany
| | - Tony Bruns
- Jena University Hospital, Jena, Germany; Aachen University Hospital, Aachen, Germany
| | - Karen Vagner Danielsen
- Gastrounit, Medical Section, Hvidovre Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Heinz Zoller
- Medical University of Innsbruck, Innsbruck, Austria
| | | | - Cristina Solé
- Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Germán Soriano
- Hospital de la Santa Creu i Sant Pau and CIBERehd, Barcelona, Spain
| | - Andrea de Gottardi
- University Clinic of Visceral Surgery and Medicine-Inselspital, Bern and Ente Ospedaliero Cantonale, Universita della Svizzera Italiana, Lugano, Switzerland
| | | | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Universite Paris Saclay, INSERM Unit 1193, Villejuif, France
| | | | | | | | - Stephen Ryder
- NIHR Biomedical Research Centre at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", Saint-Denis, France; Inserm, UMR-1162, "Génomique fonctionnelle des tumeurs solides", Paris, France
| | | | | | - Claire Francoz
- APHP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur L´Inflammation, Paris, France
| | | | | | | | - Alex Amoros
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Marco Pavesi
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Cristina Sanchez
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Anna Curto
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Carla Pitarch
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | | | - Esau Moreno
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | | | - Ferran Aguilar
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Joan Clària
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Paola Ponzo
- A.O.U. Città della Salute e della Scienza Torino, Torino, Italy
| | - Zsuzsanna Vitalis
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | | | - Boglarka Balogh
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | - Alexander Gerbes
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU, Munich, Germany
| | - Victor Vargas
- Liver Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | | | | | - Pere Ginès
- Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Richard Moreau
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; APHP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur L´Inflammation, Paris, France
| | - Paolo Angeli
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; University of Padova, Padova, Italy
| | - Rajiv Jalan
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; UCL Medical School,Royal Free Hospital, London, UK
| | - Vicente Arroyo
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
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Muñoz-Martínez S, Sapena V, Forner A, Nault JC, Sapisochin G, Rimassa L, Sangro B, Bruix J, Sanduzzi-Zamparelli M, Hołówko W, El Kassas M, Mocan T, Bouattour M, Merle P, Hoogwater FJH, Alqahtani SA, Reeves HL, Pinato DJ, Giorgakis E, Meyer T, Villadsen GE, Wege H, Salati M, Mínguez B, Di Costanzo GG, Roderburg C, Tacke F, Varela M, Galle PR, Alvares-da-Silva MR, Trojan J, Bridgewater J, Cabibbo G, Toso C, Lachenmayer A, Casadei-Gardini A, Toyoda H, Lüdde T, Villani R, Matilla Peña AM, Guedes Leal CR, Ronzoni M, Delgado M, Perelló C, Pascual S, Lledó JL, Argemi J, Basu B, da Fonseca L, Acevedo J, Siebenhüner AR, Braconi C, Meyers BM, Granito A, Sala M, Rodríguez-Lope C, Blaise L, Romero-Gómez M, Piñero F, Gomez D, Mello V, Pinheiro Alves RC, França A, Branco F, Brandi G, Pereira G, Coll S, Guarino M, Benítez C, Anders MM, Bandi JC, Vergara M, Calvo M, Peck-Radosavljevic M, García-Juárez I, Cardinale V, Lozano M, Gambato M, Okolicsanyi S, Morales-Arraez D, Elvevi A, Muñoz AE, Lué A, Iavarone M, Reig M. Assessing the impact of COVID-19 on liver cancer management (CERO-19). JHEP Rep 2021; 3:100260. [PMID: 33644725 PMCID: PMC7901294 DOI: 10.1016/j.jhepr.2021.100260] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023] Open
Abstract
Background & Aims The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic. Methods An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. Results Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37). Conclusions The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making. Lay summary The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes.
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Affiliation(s)
- Sergio Muñoz-Martínez
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Victor Sapena
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Alejandro Forner
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Jean-Charles Nault
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Gonzalo Sapisochin
- Abdominal Transplant & HPB Surgical Oncology, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Bruno Sangro
- Unidad de Hepatología, Clínica Universidad de Navarra, IDISNA, CIBERehd, Pamplona, Spain
| | - Jordi Bruix
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Marco Sanduzzi-Zamparelli
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Tudor Mocan
- 3rd Medical Department, 'Octavian Fodor' Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Mohamed Bouattour
- AP-HP, Hôpital Beaujon, Department of Digestive Oncology, Clichy, France
| | - Philippe Merle
- Department of Hepatology, Groupement Hospitalier Lyon Nord, Lyon, France
| | - Frederik J H Hoogwater
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, the Netherlands
| | - Saleh A Alqahtani
- Department of Liver Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Helen L Reeves
- Liver Unit, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Emmanouil Giorgakis
- Division of Transplantation, Department of Surgery, UAMS Medical Center, Winthrop P. Rockefeller Cancer Institute, Little Rock, AK, USA
| | - Tim Meyer
- Department of Oncology, Royal Free Hospital, London, UK
| | | | - Henning Wege
- Department of Internal Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Massimiliano Salati
- Department of Clinical and Experimental Medicine, University Hospital of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Beatriz Mínguez
- Liver Unit, Hospital Universitari Vall d'Hebron, Liver Diseases Research Group, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus. Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Christoph Roderburg
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - María Varela
- Department of Gastroenterology and Hepatology. Hospital Universitario Central de Asturias, IUOPA, ISPA, Universidad de Oviedo, Oviedo, Spain
| | - Peter R Galle
- I. Department of Internal Medicine, University Medical Center Mainz, Mainz, Germany
| | - Mario Reis Alvares-da-Silva
- GI/Liver Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jörg Trojan
- Medical Clinic 1, Goethe University Hospital, Frankfurt, Germany
| | - John Bridgewater
- Department of Oncology, University College of London, London, UK
| | - Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy
| | - Christian Toso
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Tom Lüdde
- Clinic for Gastroenterology, Hepatology and Infectious Disease, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Rosanna Villani
- Liver Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Monica Ronzoni
- Medical Oncology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Manuel Delgado
- Department of Digestive Disease, University Hospital La Coruña, La Coruña, Spain
| | - Christie Perelló
- Department of Gastroenterology and Hepatology, University Hospital Puerta de Hierro, Majadahonda, Spain
| | | | - José Luis Lledó
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Josepmaria Argemi
- Internal Medicine - Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain
| | - Bristi Basu
- Department of Oncology, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Leonardo da Fonseca
- Department of Clinical Oncology, Sao Paulo Clinicas Liver Cancer group, Insitituto do Cancer do Estado de São Paulo, University of São Paulo, San Paulo, Brazil
| | - Juan Acevedo
- South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Alexander R Siebenhüner
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chiara Braconi
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - Brandon M Meyers
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Alessandro Granito
- Division of Internal Medicine, Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Margarita Sala
- Department of Gastroenterology, Hepatology Unit, Hospital Doctor Josep Trueta, CIBERehd, Girona, Spain
| | - Carlos Rodríguez-Lope
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Lorraine Blaise
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Manuel Romero-Gómez
- SeLiver group, UGC de Enfermedades Digestivas, Instituto de Biomedicina de Sevilla, Hospital Virgen del Rocío, CIBERehd, Seville, Spain
| | - Federico Piñero
- Liver Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Dhanny Gomez
- HPB Surgery and Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Alex França
- Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
| | | | - Giovanni Brandi
- Division of Oncology - Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gustavo Pereira
- Gastroenterology and Hepatology Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Susanna Coll
- Hepatology Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Maria Guarino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carlos Benítez
- Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Juan C Bandi
- Department of Hepatology, Hospital Italiano, Buenos Aires, Argentina
| | - Mercedes Vergara
- Unitat d'Hepatologia, Servei d'Aparell Digestiu, Parc Taulí Sabadell Hospital Universitari, Institut d'Investigació i Innovació I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Mariona Calvo
- Oncología Médica, Institut Català d'Oncologia, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Markus Peck-Radosavljevic
- Innere Medizin & Gastroenterologie, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Ignacio García-Juárez
- Gastroenterology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy
| | - Mar Lozano
- Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Martina Gambato
- Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.,Multivisceral Transplant Unit, Gastroenterology, Padua University Hospital, Padua, Italy
| | - Stefano Okolicsanyi
- Department of Surgical Disciplines, Gastroenterology and Digestive Endoscopy, Umberto Parini Hospital, Aosta, Italy
| | - Dalia Morales-Arraez
- Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Alessandra Elvevi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital University of Milano-Bicocca School of Medicine, Monza, Italy
| | - Alberto E Muñoz
- Sección Hepatología, Hospital Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Alberto Lué
- Gastroenterology, Hepatology and Nutrition Unit, San Jorge General Hospital, Huesca, Spain
| | - Massimo Iavarone
- Foundation IRCCS Ca' Granada Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC 'A.M. and A. Migliavacca' Center for Liver Disease, Milan, Italy
| | - Maria Reig
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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Zavala G, González F, Hidalgo C, Kunze M, Khoury M, Acevedo J. Injectable functionalized-gelatin derived from cold-adapted species balances between arthroscopic extrudability prerequisite, chondrocompatibility and biomechanical requirements for precise arthroscopic restoration. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.357] [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: 10/24/2022]
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Acevedo J, Díaz-Molina I. Exploration and Exploitation in Latin American Firms: The Determinants of Organizational Ambidexterity and The Country Effect. Journal of Technology Management & Innovation 2019. [DOI: 10.4067/s0718-27242019000400006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Akinboro O, Nwabudike S, Charlot M, Acevedo J. P2.16-10 Advances in Diagnosis and Treatment of Non-Small Cell Lung Cancer Are Translating into Real-World Survival Gains in the United States. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1877] [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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10
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Fernández J, Clària J, Amorós A, Aguilar F, Castro M, Casulleras M, Acevedo J, Duran-Güell M, Nuñez L, Costa M, Torres M, Horrillo R, Ruiz-Del-Árbol L, Villanueva C, Prado V, Arteaga M, Trebicka J, Angeli P, Merli M, Alessandria C, Aagaard NK, Soriano G, Durand F, Gerbes A, Gustot T, Welzel TM, Salerno F, Bañares R, Vargas V, Albillos A, Silva A, Morales-Ruiz M, Carlos García-Pagán J, Pavesi M, Jalan R, Bernardi M, Moreau R, Páez A, Arroyo V. Effects of Albumin Treatment on Systemic and Portal Hemodynamics and Systemic Inflammation in Patients With Decompensated Cirrhosis. Gastroenterology 2019; 157:149-162. [PMID: 30905652 DOI: 10.1053/j.gastro.2019.03.021] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND & AIMS We investigated the effect of albumin treatment (20% solution) on hypoalbuminemia, cardiocirculatory dysfunction, portal hypertension, and systemic inflammation in patients with decompensated cirrhosis with and without bacterial infections. METHODS We performed a prospective study to assess the effects of long-term (12 weeks) treatment with low doses (1 g/kg body weight every 2 weeks) and high doses (1.5 g/kg every week) of albumin on serum albumin, plasma renin, cardiocirculatory function, portal pressure, and plasma levels of cytokines, collecting data from 18 patients without bacterial infections (the Pilot-PRECIOSA study). We also assessed the effect of short-term (1 week) treatment with antibiotics alone vs the combination of albumin plus antibiotics (1.5 g/kg on day 1 and 1 g/kg on day 3) on plasma levels of cytokines in biobanked samples from 78 patients with bacterial infections included in a randomized controlled trial (INFECIR-2 study). RESULTS Circulatory dysfunction and systemic inflammation were extremely unstable in many patients included in the Pilot-PRECIOSA study; these patients had intense and reversible peaks in plasma levels of renin and interleukin 6. Long-term high-dose albumin, but not low-dose albumin, was associated with normalization of serum level of albumin, improved stability of the circulation and left ventricular function, and reduced plasma levels of cytokines (interleukin 6, granulocyte colony-stimulating factor, interleukin 1 receptor antagonist, and vascular endothelial growth factor) without significant changes in portal pressure. The immune-modulatory effects of albumin observed in the Pilot-PRECIOSA study were confirmed in the INFECIR-2 study. In this study, patients given albumin had significant reductions in plasma levels of cytokines. CONCLUSIONS In an analysis of data from 2 trials (Pilot-PRECIOSA study and INFECIR-2 study), we found that albumin treatment reduced systemic inflammation and cardiocirculatory dysfunction in patients with decompensated cirrhosis. These effects might be responsible for the beneficial effects of albumin therapy on outcomes of patients with decompensated cirrhosis. ClinicalTrials.gov, Numbers: NCT00968695 and NCT03451292.
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Affiliation(s)
- Javier Fernández
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain; Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain.
| | - Joan Clària
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain; Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Alex Amorós
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Ferrán Aguilar
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Miriam Castro
- Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain
| | | | - Juan Acevedo
- South West Liver Unit, Derriford Hospital, Plymouth, United Kingdom
| | | | - Laura Nuñez
- Bioscience Research Group, Grifols, Barcelona, Spain
| | | | - Mireia Torres
- Bioscience Research Group, Grifols, Barcelona, Spain
| | | | - Luis Ruiz-Del-Árbol
- Department of Gastroenterology, Hospital Ramón y Cajal and CIBERehd, Madrid, Spain
| | - Cándido Villanueva
- Department of Gastroenterology, Hospital de Sant Pau and CIBERehd, Barcelona, Spain
| | | | | | - Jonel Trebicka
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain; Department of Internal Medicine, University Hospital of Bonn, Bonn, Germany
| | - Paolo Angeli
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain; Unit of Internal Medicine and Hepatology, Department of Medicine, DIMED, University of Padova, Padova, Italy
| | - Manuela Merli
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Alessandria
- Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Torino, Italy
| | - Niels Kristian Aagaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - German Soriano
- Department of Gastroenterology and Hepatology, Hospital of Santa Creu i Sant Pau and CIBERehd, Barcelona, Spain
| | - François Durand
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Alexander Gerbes
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU Munich, Munich, Germany
| | - Thierry Gustot
- Liver Transplant Unit, Erasme Hospital (ULB), Brussels, Belgium
| | - Tania M Welzel
- Medical Department I, Goethe University, Frankfurt, Germany
| | - Francesco Salerno
- Department of Internal Medicine, Policlinico IRCCS San Donato, Milano, Italy
| | - Rafael Bañares
- Department of Gastroenterology, Hospital Gregorio Marañon, and CIBERehd, Madrid, Spain
| | - Victor Vargas
- Department of Internal Medicine, Hospital Vall d'Hebron and CIBERehd, Barcelona, Spain
| | - Agustin Albillos
- Department of Gastroenterology, Hospital Ramón y Cajal and CIBERehd, Madrid, Spain
| | - Aníbal Silva
- Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain
| | | | | | - Marco Pavesi
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver Disease Health, University College London, Royal Free Hospital, London, United Kingdom
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Richard Moreau
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain; Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France; Inserm, Université Paris Diderot-Paris 7, Centre de Recherche sur l'Inflammation, Paris, France
| | - Antonio Páez
- Bioscience Research Group, Grifols, Barcelona, Spain
| | - Vicente Arroyo
- EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
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Fernández J, Prado V, Trebicka J, Amoros A, Gustot T, Wiest R, Deulofeu C, Garcia E, Acevedo J, Fuhrmann V, Durand F, Sánchez C, Papp M, Caraceni P, Vargas V, Bañares R, Piano S, Janicko M, Albillos A, Alessandria C, Soriano G, Welzel TM, Laleman W, Gerbes A, De Gottardi A, Merli M, Coenraad M, Saliba F, Pavesi M, Jalan R, Ginès P, Angeli P, Arroyo V. Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe. J Hepatol 2019. [PMID: 30391380 DOI: 10.1016/j.jhep.2018.10.02710.1016/j.jhep.2018.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND & AIMS Antibiotic resistance has been increasingly reported in patients with decompensated cirrhosis in single-center studies. Prospective investigations reporting broad epidemiological data are scarce. We aimed to analyze epidemiological changes in bacterial infections in patients with decompensated cirrhosis. METHODS This was a prospective evaluation of 2 series of patients hospitalized with decompensated cirrhosis. The Canonic series included 1,146 patients from Northern, Southern and Western Europe in 2011. Data on epidemiology, clinical characteristics of bacterial infections, microbiology and empirical antibiotic schedules were assessed. A second series of 883 patients from Eastern, Southern and Western Europe was investigated between 2017-2018. RESULTS A total of 455 patients developed 520 infections (39.7%) in the first series, with spontaneous bacterial peritonitis, urinary tract infections and pneumonia the most frequent infections. Nosocomial episodes predominated in this series. Nearly half of the infections were culture-positive, of which 29.2% were caused by multidrug-resistant organisms (MDROs). MDR strains were more frequently isolated in Northern and Western Europe. Extended-spectrum beta-lactamase-producing Enterobacteriaceae were the most frequent MDROs isolated in this series, although prevalence and type differed markedly among countries and centers. Antibiotic resistance was associated with poor prognosis and failure of antibiotic strategies, based on third-generation cephalosporins or quinolones. Nosocomial infection (odds ratio [OR] 2.74; p < 0.001), intensive care unit admission (OR 2.09; p = 0.02), and recent hospitalization (OR 1.93; p = 0.04) were identified as independent predictors of MDR infection. The prevalence of MDROs in the second series (392 infections/284 patients) was 23%; 38% in culture-positive infections. A mild increase in the rate of carbapenem-resistant Enterobacteriaceae was observed in this series. CONCLUSIONS MDR bacterial infections constitute a prevalent, growing and complex healthcare problem in patients with decompensated cirrhosis and acute-on-chronic liver failure across Europe, negatively impacting on prognosis. Strategies aimed at preventing the spread of antibiotic resistance in cirrhosis should be urgently evaluated. LAY SUMMARY Infections caused by bacteria resistant to the main antibiotic families are prevalent in patients with cirrhosis. This study demonstrates that this healthcare problem is increasing and extends through all European regions. Infections caused by these difficult to treat bacteria resolve less frequently and often cause the death of the patient. The type of resistant bacteria varies markedly among different hospitals.
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Affiliation(s)
- Javier Fernández
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain; European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain.
| | - Verónica Prado
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jonel Trebicka
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain; University of Bonn, Germany
| | - Alex Amoros
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
| | - Thierry Gustot
- Liver Transplant Unit, Erasme Hospital, Brussels, Belgium
| | - Reiner Wiest
- Department of Medicine and Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Carme Deulofeu
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
| | - Elisabet Garcia
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
| | | | | | | | - Cristina Sánchez
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
| | - Maria Papp
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Hungary
| | | | - Victor Vargas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain; Hospital Vall d'Hebron, Barcelona, Spain
| | - Rafael Bañares
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain; Hospital Gregorio Marañon, Madrid, Spain
| | | | | | | | | | - German Soriano
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain; Hospital of Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Alexander Gerbes
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU Munich, Germany
| | - Andrea De Gottardi
- Department of Medicine and Surgery, Inselspital, University of Bern, Bern, Switzerland
| | | | | | - Faouzi Saliba
- Centre Hepato-Biliare, Hòpital Paul Brousse, Paris, France
| | - Marco Pavesi
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
| | - Rajiv Jalan
- ILDH, Division of Medicine, University College London Medical School, London, United Kingdom
| | - Pere Ginès
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain
| | | | - Vicente Arroyo
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
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Fernández J, Prado V, Trebicka J, Amoros A, Gustot T, Wiest R, Deulofeu C, Garcia E, Acevedo J, Fuhrmann V, Durand F, Sánchez C, Papp M, Caraceni P, Vargas V, Bañares R, Piano S, Janicko M, Albillos A, Alessandria C, Soriano G, Welzel TM, Laleman W, Gerbes A, De Gottardi A, Merli M, Coenraad M, Saliba F, Pavesi M, Jalan R, Ginès P, Angeli P, Arroyo V. Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe. J Hepatol 2019; 70:398-411. [PMID: 30391380 DOI: 10.1016/j.jhep.2018.10.027] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Antibiotic resistance has been increasingly reported in patients with decompensated cirrhosis in single-center studies. Prospective investigations reporting broad epidemiological data are scarce. We aimed to analyze epidemiological changes in bacterial infections in patients with decompensated cirrhosis. METHODS This was a prospective evaluation of 2 series of patients hospitalized with decompensated cirrhosis. The Canonic series included 1,146 patients from Northern, Southern and Western Europe in 2011. Data on epidemiology, clinical characteristics of bacterial infections, microbiology and empirical antibiotic schedules were assessed. A second series of 883 patients from Eastern, Southern and Western Europe was investigated between 2017-2018. RESULTS A total of 455 patients developed 520 infections (39.7%) in the first series, with spontaneous bacterial peritonitis, urinary tract infections and pneumonia the most frequent infections. Nosocomial episodes predominated in this series. Nearly half of the infections were culture-positive, of which 29.2% were caused by multidrug-resistant organisms (MDROs). MDR strains were more frequently isolated in Northern and Western Europe. Extended-spectrum beta-lactamase-producing Enterobacteriaceae were the most frequent MDROs isolated in this series, although prevalence and type differed markedly among countries and centers. Antibiotic resistance was associated with poor prognosis and failure of antibiotic strategies, based on third-generation cephalosporins or quinolones. Nosocomial infection (odds ratio [OR] 2.74; p < 0.001), intensive care unit admission (OR 2.09; p = 0.02), and recent hospitalization (OR 1.93; p = 0.04) were identified as independent predictors of MDR infection. The prevalence of MDROs in the second series (392 infections/284 patients) was 23%; 38% in culture-positive infections. A mild increase in the rate of carbapenem-resistant Enterobacteriaceae was observed in this series. CONCLUSIONS MDR bacterial infections constitute a prevalent, growing and complex healthcare problem in patients with decompensated cirrhosis and acute-on-chronic liver failure across Europe, negatively impacting on prognosis. Strategies aimed at preventing the spread of antibiotic resistance in cirrhosis should be urgently evaluated. LAY SUMMARY Infections caused by bacteria resistant to the main antibiotic families are prevalent in patients with cirrhosis. This study demonstrates that this healthcare problem is increasing and extends through all European regions. Infections caused by these difficult to treat bacteria resolve less frequently and often cause the death of the patient. The type of resistant bacteria varies markedly among different hospitals.
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Affiliation(s)
- Javier Fernández
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain; European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain.
| | - Verónica Prado
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jonel Trebicka
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain; University of Bonn, Germany
| | - Alex Amoros
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
| | - Thierry Gustot
- Liver Transplant Unit, Erasme Hospital, Brussels, Belgium
| | - Reiner Wiest
- Department of Medicine and Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Carme Deulofeu
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
| | - Elisabet Garcia
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
| | | | | | | | - Cristina Sánchez
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
| | - Maria Papp
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Hungary
| | | | - Victor Vargas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain; Hospital Vall d'Hebron, Barcelona, Spain
| | - Rafael Bañares
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain; Hospital Gregorio Marañon, Madrid, Spain
| | | | | | | | | | - German Soriano
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain; Hospital of Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Alexander Gerbes
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU Munich, Germany
| | - Andrea De Gottardi
- Department of Medicine and Surgery, Inselspital, University of Bern, Bern, Switzerland
| | | | | | - Faouzi Saliba
- Centre Hepato-Biliare, Hòpital Paul Brousse, Paris, France
| | - Marco Pavesi
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
| | - Rajiv Jalan
- ILDH, Division of Medicine, University College London Medical School, London, United Kingdom
| | - Pere Ginès
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), ISCIII, Spain
| | | | - Vicente Arroyo
- European Foundation of Chronic Liver Failure (EF-Clif), Barcelona, Spain
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13
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Fernández J, Acevedo J, Wiest R, Gustot T, Amoros A, Deulofeu C, Reverter E, Martínez J, Saliba F, Jalan R, Welzel T, Pavesi M, Hernández-Tejero M, Ginès P, Arroyo V. Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis. Gut 2018; 67:1870-1880. [PMID: 28847867 DOI: 10.1136/gutjnl-2017-314240] [Citation(s) in RCA: 331] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/14/2017] [Accepted: 06/16/2017] [Indexed: 02/06/2023]
Abstract
UNLABELLED Bacterial infection is a frequent trigger of acute-on-chronic liver failure (ACLF), syndrome that could also increase the risk of infection. This investigation evaluated prevalence and characteristics of bacterial and fungal infections causing and complicating ACLF, predictors of follow-up bacterial infections and impact of bacterial infections on survival. PATIENTS 407 patients with ACLF and 235 patients with acute decompensation (AD). RESULTS 152 patients (37%) presented bacterial infections at ACLF diagnosis; 46%(n=117) of the remaining 255 patients with ACLF developed bacterial infections during follow-up (4 weeks). The corresponding figures in patients with AD were 25% and 18% (p<0.001). Severe infections (spontaneous bacterial peritonitis, pneumonia, severe sepsis/shock, nosocomial infections and infections caused by multiresistant organisms) were more prevalent in patients with ACLF. Patients with ACLF and bacterial infections (either at diagnosis or during follow-up) showed higher grade of systemic inflammation at diagnosis of the syndrome, worse clinical course (ACLF 2-3 at final assessment: 47% vs 26%; p<0.001) and lower 90-day probability of survival (49% vs 72.5%;p<0.001) than patients with ACLF without infection. Bacterial infections were independently associated with mortality in patients with ACLF-1 and ACLF-2. Fungal infections developed in 9 patients with ACLF (2%) and in none with AD, occurred mainly after ACLF diagnosis (78%) and had high 90-day mortality (71%). CONCLUSION Bacterial infections are extremely frequent in ACLF. They are severe and associated with intense systemic inflammation, poor clinical course and high mortality. Patients with ACLF are highly predisposed to develop bacterial infections within a short follow-up period and could benefit from prophylactic strategies.
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Affiliation(s)
- Javier Fernández
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.,EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure; EF CLIF, Barcelona, Spain
| | | | - Reiner Wiest
- Department of Medicine and Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Thierry Gustot
- Liver Transplant Unit, Erasme Hospital, Brussels, Belgium
| | - Alex Amoros
- EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure; EF CLIF, Barcelona, Spain
| | - Carme Deulofeu
- EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure; EF CLIF, Barcelona, Spain
| | - Enric Reverter
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Javier Martínez
- Department of Gastroenterology and Hepatology, Hospital Ramon y Cajal, Madrid, Spain
| | - Faouzi Saliba
- Centre Hépato-Biliaire,Hôpital Paul Brousse, Paris, France
| | - Rajiv Jalan
- ILDH, Division of Medicine, University College London Medical School, London, UK
| | - Tania Welzel
- Department of Medicine, JW Goethe University, Frankfurt, Germany
| | - Marco Pavesi
- EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure; EF CLIF, Barcelona, Spain
| | | | - Pere Ginès
- Liver ICU, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.,EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure; EF CLIF, Barcelona, Spain
| | - Vicente Arroyo
- EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure; EF CLIF, Barcelona, Spain
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14
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Akentjew T, Terraza C, Suazo C, Wilkens C, Blaker J, Garcia C, Valenzuela L, Khoury M, Acevedo J. Rapid, automated and bio-inspired fabrication of cell-patterned small diameter vascular graft with coronary artery mechanics. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.229] [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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15
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Acevedo J, Ros E, Encina M, González F, Khoury M. Rapid assessment of directed migration: A novel Microtechnology-based 3D device for therapeutic quality screening of stem cells (SC). Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.213] [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: 11/29/2022]
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16
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Carballal S, Maisterra S, López-Serrano A, Gimeno-García AZ, Vera MI, Marín-Garbriel JC, Díaz-Tasende J, Márquez L, Álvarez MA, Hernández L, De Castro L, Gordillo J, Puig I, Vega P, Bustamante-Balén M, Acevedo J, Peñas B, López-Cerón M, Ricart E, Cuatrecasas M, Jimeno M, Pellisé M. Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD. Gut 2018; 67:70-78. [PMID: 27612488 DOI: 10.1136/gutjnl-2016-312332] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Outside clinical trials, the effectiveness of chromoendoscopy (CE) for long-standing IBD surveillance is controversial. We aimed to assess the effectiveness of CE for neoplasia detection and characterisation, in real-life. DESIGN From June 2012 to 2014, patients with IBD were prospectively included in a multicentre cohort study. Each colonic segment was evaluated with white light followed by 0.4% indigo carmine CE. Specific lesions' features were recorded. Optical diagnosis was assessed. Dysplasia detection rate between expert and non-expert endoscopists and learning curve were ascertained. RESULTS Ninety-four (15.7%) dysplastic (1 cancer, 5 high-grade dysplasia, 88 low-grade dysplasia) and 503 (84.3%) non-dysplastic lesions were detected in 350 patients (47% female; mean disease duration: 17 years). Colonoscopies were performed with standard definition (41.5%) or high definition (58.5%). Dysplasia miss rate with white light was 40/94 (57.4% incremental yield for CE). CE-incremental detection yield for dysplasia was comparable between standard definition and high definition (51.5% vs 52.3%, p=0.30). Dysplasia detection rate was comparable between expert and non-expert (18.5% vs 13.1%, p=0.20). No significant learning curve was observed (8.2% vs 14.2%, p=0.46). Sensitivity, specificity, and positive and negative predictive values for dysplasia optical diagnosis were 70%, 90%, 58% and 94%, respectively. Endoscopic characteristics predictive of dysplasia were: proximal location, loss of innominate lines, polypoid morphology and Kudo pit pattern III-V. CONCLUSIONS CE presents a high diagnostic yield for neoplasia detection, irrespectively of the technology and experience available in any centre. In vivo, CE optical diagnosis is highly accurate for ruling out dysplasia, especially in expert hands. Lesion characteristics can aid the endoscopist for in situ therapeutic decisions. TRIAL REGISTRATION NUMBER NCT02543762.
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Affiliation(s)
- Sabela Carballal
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Sandra Maisterra
- Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - María Isabel Vera
- Gastroenterology Department, Hospital Puerta del Hierro, Madrid, Spain
| | | | - José Díaz-Tasende
- Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lucía Márquez
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
| | | | - Luis Hernández
- Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain
| | - Luisa De Castro
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica. Estructura Organizativa de Xestión Integrada de Vigo, Vigo, Spain
| | - Jordi Gordillo
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ignasi Puig
- Gastroenterology Department, Althaia, Xarxa Assistencial Universitària de Manresa, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pablo Vega
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Juan Acevedo
- Gastroenterology Department, Hospital Comarcal de Calella, Barcelona, Spain
| | - Beatriz Peñas
- Gastroenterology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - María López-Cerón
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Centre de Diagnostic Biomèdic (CDB), Hospital Clínic, University of Barcelona and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain
| | - Mireya Jimeno
- Pathology Department, Centre de Diagnostic Biomèdic (CDB), Hospital Clínic, University of Barcelona and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain
| | - María Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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17
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Akentjew T, Khoury M, Acevedo J, Wilkens C. Automated micro-fabrication of a vascular graft mimicking the structure of human coronary arteries based on layer deposition, nanofibers and dipping-spinning technologies. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Fernández J, Acevedo J, Arroyo V. Response to the clinical course and short-term mortality of cirrhotic patients with non-spontaneous bacterial peritonitis infections. Liver Int 2017; 37:623. [PMID: 28371103 DOI: 10.1111/liv.13283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/13/2023]
Affiliation(s)
- Javier Fernández
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain.,EASL-CLIF Consortium-Efclif, Barcelona, Spain
| | - Juan Acevedo
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain
| | - Vicente Arroyo
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain.,EASL-CLIF Consortium-Efclif, Barcelona, Spain
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19
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Fernández J, Acevedo J, Prado V, Mercado M, Castro M, Pavesi M, Arteaga M, Sastre L, Juanola A, Ginès P, Arroyo V. Clinical course and short-term mortality of cirrhotic patients with infections other than spontaneous bacterial peritonitis. Liver Int 2017; 37:385-395. [PMID: 27558198 DOI: 10.1111/liv.13239] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 08/11/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Clinical course and risk factors of death in non-spontaneous bacterial peritonitis (SBP) infections are poorly known. We assessed the prevalence of acute kidney injury (AKI) and type-1 hepatorenal syndrome (HRS), hospital, 30-day and 90-day mortality and risk factors of death in 441 decompensated patients. METHODS Analysis of 615 non-SBP infections (161 urinary infections (UTI), 95 cellulitis, 92 suspected infections, 92 bacteraemias, 84 pneumonias, 21 bronchitis, 18 cholangitis, 15 spontaneous empyema, 13 secondary peritonitis, 24 other). RESULTS Ninety-six percent of infections solved. AKI and type-1 HRS were developed in 37% and 9% of infections respectively. Overall hospital, 30-day and 90-day mortality rates were 11%, 12% and 18% respectively. Clinical course and mortality differed markedly across infections. Endocarditis, osteoarticular infections, pneumonia, spontaneous bacteraemia, cholangitis, secondary peritonitis and UTI showed higher rates of AKI. Prevalence of type-1 HRS was not significantly different among infections. Endocarditis, secondary peritonitis, pneumonia and bacteraemia showed lower rates of renal impairment resolution and higher hospital mortality associated with AKI (42% vs 12%, P<.0001) or type-1 HRS (71% vs 27%, P=.003) than the rest of infections. Age (HR: 1.04), serum sodium (HR: 0.91), serum bilirubin (HR: 1.06), INR (HR: 1.91), hepatic encephalopathy (HR: 2.44), ascites (HR: 3.06) and multidrug-resistant isolation (HR: 2.27) at infection diagnosis were independent predictors of death during hospitalization. CONCLUSIONS Non-SBP infections constitute a heterogeneous group regarding clinical course and prognosis. Endocarditis, secondary peritonitis, pneumonia and bacteraemia show worse prognosis. The combination of data of liver and renal dysfunction and of the type of infection allows the identification of patients with poor prognosis.
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Affiliation(s)
- Javier Fernández
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain.,EASL-CLIF Consortium-Efclif, Barcelona, Spain
| | - Juan Acevedo
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain
| | - Verónica Prado
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain
| | | | - Miriam Castro
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain
| | | | - Mireya Arteaga
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain
| | - Lydia Sastre
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain
| | | | - Pere Ginès
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain.,EASL-CLIF Consortium-Efclif, Barcelona, Spain
| | - Vicente Arroyo
- Liver Unit, Hospital Clinic, Barcelona, Spain.,IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHED, Barcelona, Spain.,EASL-CLIF Consortium-Efclif, Barcelona, Spain
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Abstract
Early diagnosis and adequate empirical antibiotic treatment of bacterial infections in advanced cirrhosis is essential to improve outcomes given the high risk of developing severe sepsis, multiple organ failure and death. β-lactams and quinolones are nowadays frequently ineffective in nosocomial and healthcare associated infections, due to the increasing prevalence of multidrug resistant (MDR) bacteria reported across different geographical areas. Recent antibiotic exposure also increases the risk of developing MDR bacterial infections. Initial antibiotic strategies should therefore be tailored according to the presence or absence of risk factors of MDR bacteria and to the severity of infection and should consider the local epidemiology. Empirical treatment in the population at high risk of MDR bacterial infections requires the use of broad-spectrum antibiotics (carbapenems or tigecycline) and of drugs active against specific resistant bacteria (glycopeptides, linezolid, daptomycin, amikacin, colistin). Early de-escalation policies are recommended to prevent the spread of MDR bacteria in cirrhosis.
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Affiliation(s)
- Javier Fernández
- a Liver Unit, Hospital Clínic Barcelona , University of Barcelona , Barcelona, Spain.,b Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS).,c Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED)
| | - Juan Acevedo
- d The South West Liver Unit , Plymouth Hospital , Plymouth, UK
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21
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Acevedo J, Ros E, Khoury M. A New Tool for the Assessment of Stem Cells (SC) Potency Using Microfluidic-Based 3D Directed Migration. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Nocetti D, Ubeda C, Calcagno S, Acevedo J, Pardo D. Comparison of image quality among three X-ray systems for chest radiography: first step in optimisation. Radiat Prot Dosimetry 2015; 165:386-391. [PMID: 25821212 DOI: 10.1093/rpd/ncv081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study was to compare the performance of three digital X-ray systems [one flat-panel (DR) and two computed radiography (CR)] for chest radiography in terms of the entrance surface air kerma (ESAK) delivered to a polymethyl methacrylate phantom of 20 cm (equivalent to an adult patient) and image quality through of numerical evaluations using a test object (TO). The tube charge applied was ranged from 0.6 to 32 mAs, to a fixed tension of 125 kVp. The DR system presented the highest mean values of ESAK (615.9 µGy) along with the highest signal-to-noise ratio values, whereas CR systems showed a better high-contrast spatial resolution. Differences were statistically significant in both cases regarding the tube charge used. Thus, this parameter should be mainly considered to optimise the radiological protection through exposure settings selected. This survey represents the first effort to achieve optimisation in digital radiology for Chile.
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Affiliation(s)
- D Nocetti
- Medical Technology Department, Faculty of Health Sciences, Tarapaca University, Arica, Chile
| | - C Ubeda
- Medical Technology Department, Faculty of Health Sciences, Tarapaca University, Arica, Chile
| | - S Calcagno
- Medical Image Service, Ernesto Torres Galdames Regional Hospital, Iquique, Chile
| | - J Acevedo
- Medical Image Service, Ernesto Torres Galdames Regional Hospital, Iquique, Chile
| | - D Pardo
- Field Service Engineer DXR-IXR-CT-MR Service, Philips HealthCare, Latam, Chile
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Acevedo J. Multiresistant bacterial infections in liver cirrhosis: Clinical impact and new empirical antibiotic treatment policies. World J Hepatol 2015; 7:916-21. [PMID: 25954474 PMCID: PMC4419095 DOI: 10.4254/wjh.v7.i7.916] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/13/2015] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Recently, important changes have been reported regarding the epidemiology of bacterial infections in liver cirrhosis. There is an emergence of multiresistant bacteria in many European countries and also worldwide, including the United States and South Korea. The classic empirical antibiotic treatment (third-generation cephalosporins, e.g., ceftriaxone, cefotaxime or amoxicillin-clavulanic acid) is still effective in infections acquired in the community, but its failure rate in hospital acquired infections and in some health-care associated infections is high enough to ban its use in these settings. The current editorial focuses on the different epidemiology of bacterial infections in cirrhosis across countries and on its therapeutic implications.
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Affiliation(s)
- Juan Acevedo
- Juan Acevedo, Department of Gastroenterology and Hepatology, Queen Alexandra Hospital, PO6 3LY Portsmouth, United Kingdom
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Acevedo J, Fernández J. New determinants of prognosis in bacterial infections in cirrhosis. World J Gastroenterol 2014; 20:7252-7259. [PMID: 24966596 PMCID: PMC4064071 DOI: 10.3748/wjg.v20.i23.7252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/09/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
Despite major advances in the knowledge and management of liver diseases achieved in recent decades, decompensation of cirrhosis still carries a high burden of morbidity and mortality. Bacterial infections are one of the main causes of decompensation. It is very important for clinical management to be aware of the population with the highest risk of poor outcome. This review deals with the new determinants of prognosis in patients with cirrhosis and bacterial infections reported recently. Emergence of multiresistant bacteria has led to an increasing failure rate of the standard empirical antibiotic therapy recommended by international guidelines. Moreover, it has been recently reported that endothelial dysfunction is associated with the degree of liver dysfunction and, in infected patients, with the degree of sepsis. It has also been reported that relative adrenal insufficiency is frequent in the non-critically ill cirrhotic population and it is associated with a higher risk of developing infection, severe sepsis, hepatorenal syndrome and death. We advise a change in the standard empirical antibiotic therapy in patients with high risk for multiresistant infections and also to take into account endothelial and adrenal dysfunction in prognostic models in hospitalized patients with decompensated cirrhosis.
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Abstract
OPINION STATEMENT Bacterial infections are more frequent and severe in cirrhosis. Most prevalent infections are spontaneous bacterial peritonitis (SBP) and urinary infections followed by pneumonia, cellulitis and bacteremia. Cirrhosis increases the risk of sepsis, severe sepsis and death. Early diagnosis and adequate treatment of infections is essential in the management of cirrhotic patients. Recent data show that currently recommended empirical antibiotic therapy, mainly based on the use of β-lactams, is effective in community-acquired infections, but frequently fails in nosocomial and healthcare-associated infections. A marked increase in the prevalence of multidrug resistant (MDR) bacteria in the healthcare environment explains this finding. Patients developing nosocomial infections or with extended lengths of hospitalization are at higher risk for second infections that are associated with poor prognosis. Antibiotic strategies should therefore be selected according to the type, severity and site of acquisition of infection, and be adapted to the local epidemiological pattern of antibiotic resistance. Treatment of MDR bacteria requires the use of broader spectrum antibiotics (carbapenems) or those active against specific resistant bacteria (glycopeptides, linezolid, daptomycin, amikacin, colistin). Restriction of antibiotic prophylaxis to the high-risk populations, prevention of antibiotic overuse, and early de-escalation policies are also mandatory to prevent the spread of MDR bacteria in cirrhosis.
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Affiliation(s)
- Juan Acevedo
- Gastroenterology and Hepatology Department, Hospital Sant Jaume de Calella, Sant Jaume 209-217, 08370, Catalunya, Barcelona, Spain,
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Pigem R, Cairó M, Martínez-Lacasa X, Irigoyen D, Miró JM, Acevedo J, Fernández J, Alsina-Gibert M. Disseminated infection with cutaneous involvement caused by Mycobacterium malmoense in an immunocompromised patient. J Am Acad Dermatol 2013; 69:e192-3. [PMID: 24034397 DOI: 10.1016/j.jaad.2013.04.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/25/2013] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Ramon Pigem
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Acevedo J, Fernández J, Prado V, Silva A, Castro M, Pavesi M, Roca D, Jimenez W, Ginès P, Arroyo V. Relative adrenal insufficiency in decompensated cirrhosis: Relationship to short-term risk of severe sepsis, hepatorenal syndrome, and death. Hepatology 2013; 58:1757-65. [PMID: 23728792 DOI: 10.1002/hep.26535] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [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] [Received: 02/19/2013] [Revised: 05/09/2013] [Accepted: 05/15/2013] [Indexed: 12/13/2022]
Abstract
UNLABELLED The prevalence of relative adrenal insufficiency (RAI) in critically ill cirrhosis patients with severe sepsis is over 60% and associated features include poor liver function, renal failure, refractory shock, and high mortality. RAI may also develop in noncritically ill cirrhosis patients but its relationship to the clinical course has not yet been assessed. The current study was performed in 143 noncritically ill cirrhosis patients admitted for acute decompensation. Within 24 hours after hospitalization adrenal function, plasma renin activity, plasma noradrenaline and vasopressin concentration, and serum levels of nitric oxide, interleukin-6 and tumor necrosis factor alpha were determined. RAI was defined as a serum total cortisol increase <9 μg/dL after 250 μg of intravenous corticotropin from basal values <35 μg/dL. Patients were followed for 3 months. RAI was detected in 26% of patients (n = 37). At baseline, patients with RAI presented with lower mean arterial pressure (76 ± 12 versus 83 ± 14 mmHg, P = 0.009) and serum sodium (131 ± 7 versus 135 ± 5 mEq/L, P = 0.007) and higher blood urea nitrogen (32 ± 24 versus 24 ± 15 mg/dl, P = 0.06), plasma renin activity (7.1 ± 9.9 versus 3.4 ± 5.6 ng/mL*h, P = 0.03), and noradrenaline concentration (544 ± 334 versus 402 ± 316 pg/mL, P = 0.02). During follow-up, patients with RAI exhibited a higher probability of infection (41% versus 21%, P = 0.008), severe sepsis (27% versus 9%, P = 0.003), type-1 hepatorenal syndrome (HRS) (16% versus 3%, P = 0.002), and death (22% versus 7%, P = 0.01). CONCLUSION RAI is frequent in noncritically ill patients with acute decompensation of cirrhosis. As compared with those with normal adrenal function, patients with RAI have greater impairment of circulatory and renal function, higher probability of severe sepsis and type-1 HRS, and higher short-term mortality.
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Affiliation(s)
- Juan Acevedo
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Barcelona, Spain
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Acevedo J, Haro D, Dalla Rosa L, Aguayo-Lobo A, Hucke-Gaete R, Secchi E, Plana J, Pastene LA. Evidence of spatial structuring of eastern South Pacific humpback whale feeding grounds. ENDANGER SPECIES RES 2013. [DOI: 10.3354/esr00536] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Salazar L, González P, Armijo R, Maffud P, Seguel D, Acevedo J, Figueroa F, Bartolucci J, Khoury M. Evaluation of different sources of birth-tissue-derived mesenchymal stem cells for their cardiovascular regenerative potential. Cytotherapy 2013. [DOI: 10.1016/j.jcyt.2013.01.121] [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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Lee O, Oliveros S, Diaz R, Berbeo M, Acevedo J, Zorro O, Uribe R, Becerra J, Diaz L, Perez J, Avila M. Endoscopic Transsphenoidal Surgery for Acromegaly and Cushing's Disease: 6-Year Experience. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336358] [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]
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Diaz R, Berbeo M, Oliveros S, Becerra J, Acevedo J, Lee O, Zorro O, Uribe R, Diaz L, Perez J, De Leon-Benedetti A. Minimally Invasive Occipitocervical Decompression Preserving Posterior Muscular-Ligamentous Tension Band for Surgical Management of Type I Chiari Malformation: A Prospective Clinical and Radiological Study. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336220] [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]
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Diaz R, Berbeo M, Oliveros S, Acevedo J, Lee O, Zorro O, Uribe R, Becerra J, Diaz L, Perez J, Ordoñez E. Minimally Invasive Direct Transcondylar Approach to the Foramen Magnum: Surgical Anatomy and Presentation of Two Clinical Cases. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336332] [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]
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Abstract
Cirrhotic patients are at increased risk of developing infection, sepsis and death. Enterobacteriaceae and nonenterococcal streptococci are the main bacteria responsible for spontaneous and urinary infections in this population. Prompt and appropriate treatment is basic in the management of cirrhotic patients with infection. Third-generation cephalosporins continue to be the gold-standard antibiotic treatment of the majority of infections acquired in the community because responsible strains are usually susceptible to β-lactams. By contrary, nosocomial infections are nowadays frequently caused by multiresistant bacteria (extended-spectrum β-lactamase-producing Enterobacteriaceae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci among others) that are nonsusceptible to the main antibiotics. Treatment of these infections requires the use of broader spectrum antibiotics (carbapenems) or of antibiotics that are active against specific resistant bacteria (glycopeptides, linezolid, daptomycin, amikacin and colistin). Empirical antibiotic schedules must be adapted to the local epidemiological pattern of antibiotic resistance. Careful restriction of antibiotic prophylaxis to the high-risk population is also mandatory to reduce the spread of multiresistant bacteria in cirrhosis.
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Affiliation(s)
- Juan Acevedo
- Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital Sant Jaume de Calella, Calella, Spain
| | - Aníbal Silva
- Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Verónica Prado
- Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Javier Fernández
- Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain.
- Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
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Fernández J, Acevedo J, Castro M, Garcia O, de Lope CR, Roca D, Pavesi M, Sola E, Moreira L, Silva A, Seva-Pereira T, Corradi F, Mensa J, Ginès P, Arroyo V. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology 2012; 55:1551-61. [PMID: 22183941 DOI: 10.1002/hep.25532] [Citation(s) in RCA: 392] [Impact Index Per Article: 32.7] [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] [Received: 06/10/2011] [Accepted: 11/25/2011] [Indexed: 12/12/2022]
Abstract
UNLABELLED Epidemiology, risk factors, and clinical effect of infections by multiresistant bacteria in cirrhosis are poorly known. This work was a prospective evaluation in two series of cirrhotic patients admitted with infection or developing infection during hospitalization. The first series was studied between 2005 and 2007 (507 bacterial infections in 223 patients) and the second between 2010 and 2011 (162 bacterial infections in 110 patients). In the first series, 32% of infections were community acquired (CA), 32% healthcare associated (HCA), and 36% nosocomial. Multiresistant bacteria (92 infections; 18%) were isolated in 4%, 14%, and 35% of these infections, respectively (P < 0.001). Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E; n = 43) was the main multiresistant organism identified, followed by Pseudomonas aeruginosa (n = 17), methicillin-resistant Staphylococcus aureus (n = 14), and Enterococcus faecium (n = 14). The efficacy of currently recommended empirical antibiotic therapy was very low in nosocomial infections (40%), compared to HCA and CA episodes (73% and 83%, respectively; P < 0.0001), particularly in spontaneous bacterial peritonitis, urinary tract infection, and pneumonia (26%, 29%, and 44%, respectively). Septic shock (26% versus 10%; P < 0.0001) and mortality rate (25% versus 12%; P = 0.001) were significantly higher in infections caused by multiresistant strains. Nosocomial origin of infection (hazard ratio [HR], 4.43), long-term norfloxacin prophylaxis (HR, 2.69), recent infection by multiresistant bacteria (HR, 2.45), and recent use of β-lactams (HR, 2.39) were independently associated with the development of multiresistant infections. Results in the second series were similar to those observed in the first series. CONCLUSIONS Multiresistant bacteria, especially ESBL-producing Enterobacteriaceae, are frequently isolated in nosocomial and, to a lesser extent, HCA infections in cirrhosis, rendering third-generation cephalosporins clinically ineffective. New antibiotic strategies tailored according to the local epidemiological patterns are needed for the empirical treatment of nosocomial infections in cirrhosis.
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Affiliation(s)
- Javier Fernández
- Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Corradi F, Brusasco C, Fernández J, Vila J, Ramirez MJ, Seva-Pereira T, Fernández-Varo G, Mosbah IB, Acevedo J, Silva A, Rocco PRM, Pelosi P, Gines P, Navasa M. Effects of pentoxifylline on intestinal bacterial overgrowth, bacterial translocation and spontaneous bacterial peritonitis in cirrhotic rats with ascites. Dig Liver Dis 2012; 44:239-44. [PMID: 22119621 DOI: 10.1016/j.dld.2011.10.014] [Citation(s) in RCA: 16] [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] [Received: 04/19/2011] [Revised: 10/12/2011] [Accepted: 10/16/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prophylaxis of spontaneous bacterial peritonitis with norfloxacin has been associated to development of antibiotic resistance. We investigated whether pentoxifylline compared to norfloxacin reduces bacterial translocation and spontaneous bacterial peritonitis in rats with CCl(4)-induced cirrhosis and ascites. METHOD After development of cirrhosis and ascites, animals were randomly allocated to receive pentoxifylline (16 mg/kg/d every 8h, oral route, n=13) or placebo (n=12) for 15 days. An additional group of 8 cirrhotic rats was given norfloxacin (5mg/kg/d for 15 days). Six healthy rats served as controls. Cecal flora and the prevalence of bacterial translocation and spontaneous bacterial peritonitis were analysed. Serum and ascitic fluid levels of TNF-alpha and cecal levels of malondialdehyde were also measured. RESULTS Pentoxifylline in comparison to placebo reduced intestinal bacterial overgrowth (21% vs. 67%, p=0.04), bacterial translocation to cecal lymph nodes (23% vs. 75%, p=0.03) and prevented spontaneous bacterial peritonitis (0% vs. 33%, p=0.04) by Enterobacteriaceae. Norfloxacin administration induced similar results. Pentoxifylline (0.18 ± 0.10 nmol/mg), but not norfloxacin (0.25 ± 0.13; p=0.02), significantly reduced cecal mucosal levels of malondialdehyde compared to placebo (0.33 ± 0.16; p=0.03). CONCLUSION In cirrhotic rats with ascites: (a) pentoxifylline as well as norfloxacin reduced intestinal bacterial overgrowth and bacterial translocation and prevented spontaneous bacterial peritonitis; (b) pentoxifylline, but not norfloxacin, reduced oxidative stress in cecal mucosal.
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Affiliation(s)
- Francesco Corradi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
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Kupferman ME, Acevedo J, Hutcheson KA, Lewin JS. Addressing an unmet need in oncology patients: rehabilitation of upper aerodigestive tract function. Ann Oncol 2011; 22:2299-303. [PMID: 21321090 PMCID: PMC3968308 DOI: 10.1093/annonc/mdq733] [Citation(s) in RCA: 7] [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] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Laryngeal dysfunction in the oncology population is common and may detract from quality of life (QoL) due to vocal restriction and aspiration. Therapies to address this complex issue have not been explored to date. We examined the outcomes among oncology patients treated with a minimally invasive office-based surgical approach for the rehabilitation of laryngeal dysfunction. PATIENTS AND METHODS A retrospective analysis was carried out of oncology patients referred for laryngeal dysfunction. Patients who underwent minimally invasive injection laryngoplasty (IL) were selected. Subjective outcome measures, objective voice analysis parameters, and swallowing studies were annotated. RESULTS Sixty-one patients underwent IL for the management of laryngeal dysfunction. Lung cancer was the most common cancer diagnosis (39.3%), and 52% of patients had thoracic malignancies. All patients had a self-reported improvement in vocal function with a single injection, and 55 patients (90%) reported lasting effects at 3 months. In patients with pre- and postoperative voice analysis, phonatory function increased from 5.0 to 10.5 s, more than twofold improvement compared with baseline functioning. Seventy-one percent of patients who aspirated before injection no longer required a modified diet. There were no major complications. CONCLUSIONS Interventions to improve the QoL in oncology patients continue to evolve. We report significant improvements in both subjective and objective measures of laryngeal function after IL for vocal fold dysfunction that are both immediate and sustained. We conclude that IL is a safe and efficacious procedure for the treatment of laryngeal dysfunction in oncology patients, resulting in palliation and improved QoL.
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Affiliation(s)
- M. E. Kupferman
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston,Correspondence to: Dr M. E. Kupferman, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit Number: 1445, Houston, TX 77030, USA. Tel: +1 713-794-1910; Fax: +1 713-794-4662; E-mail:
| | - J. Acevedo
- Department of Otolaryngology, Head and Neck Surgery, National Capitol Consortium, Washington
| | - K. A. Hutcheson
- Department of Speech Pathology, MD Anderson Cancer Center, Houston, USA
| | - J. S. Lewin
- Department of Otolaryngology, Head and Neck Surgery, National Capitol Consortium, Washington
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Acevedo J, Fernández J, Castro M, Roca D, Ginès P, Arroyo V. 139 IMPACT OF RELATIVE ADRENAL INSUFFICIENCY ON CIRCULATORY FUNCTION AND MORTALITY IN ADVANCED CIRRHOSIS. J Hepatol 2011. [DOI: 10.1016/s0168-8278(11)60141-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
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Abstract
Cortisol is a pluripotent hormone that is vital in the host adaptation to stress. It is essential to maintain the normal vascular tone, endothelial integrity and vascular permeability. Consequently, the failure of an appropriate adrenal response in the setting of critical illness, alteration known as relative adrenal insufficiency, may have important clinical consequences. The diagnosis of this entity is not possible on clinical grounds and relies on the measurement of plasma cortisol levels prior and after adrenal stimulation with synthetic corticotrophin. Several studies performed in the general population have shown that relative adrenal insufficiency contributes to vascular hyporesponsiveness in septic shock and increases mortality. However, contradictory data exist regarding the effects of hydrocortisone administration in these patients. Moreover, recent studies indicate that relative adrenal insufficiency is very frequent in patients with advanced cirrhosis and septic shock and in fulminant hepatic failure. This chapter summarizes the main aspects of the physiopathology, diagnosis and treatment of this entity in patients with acute or chronic liver disease.
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Affiliation(s)
- Javier Fernández
- IMDiM, IDIBAPS, Hospital Clínic, Universidad de Barcelona, Ciberehd, Barcelona, España.
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Au-Alvarez O, Puschmann H, Howard JAK, Martinez H, Acevedo J. Structure of 2-[4-(Dimethylamino)phenyl]-4,5-diphenyl-1H-imidazole isopropanol solvate. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305087489] [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: 11/10/2022] Open
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Cornier AS, Ramírez N, Arroyo S, Acevedo J, García L, Carlo S, Korf B. Phenotype characterization and natural history of spondylothoracic dysplasia syndrome: a series of 27 new cases. Am J Med Genet A 2005; 128A:120-6. [PMID: 15214000 DOI: 10.1002/ajmg.a.30011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [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: 11/12/2022]
Abstract
Spondylothoracic dysplasia (STD, MIM#277300) is an autosomal recessive disorder with high prevalence in the Puerto Rican population. It is generally regarded as a lethal condition. Since Jarcho and Levin described it in 1938, it has been referred to as spondylocostal dysplasia, costovertebral dysplasia, Jarcho-Levin syndrome and STD. We have prospectively characterized 27 patients with STD by detailed physical examination, pedigree analysis, thoracic CT scans, and pulmonary function tests (PFTs). Diagnoses were established using spinal radiographs and 3-D reconstructive CT scans to demonstrate fusion of the ribs at the costo-vertebral junction with a fan-like (crab-like) configuration of the thorax. Vertebral segmentation and formation defects were seen throughout the spine with a decrease in the number of vertebral bodies. Characteristic vertebral shape consisted of a decrease in antero-posterior diameter and an increase in lateral length, giving the vertebra a sickle shape. Eight out of 18 prospectively follow patients died within the first 6 months of life, a 44% mortality rate. Cause of death was respiratory insufficiency secondary to pneumonia and pulmonary restriction. This is an important finding since the vast majority of STD syndrome patients cited in the medical literature have died in the newborn and early childhood periods. Age of the remaining patients ranged from 4 months to 47 years. This represents the largest collection of patients with STD reported and it has allowed us to determine a detailed phenotype. Given 56% survival at 6 months, we show that STD is not a lethal syndrome.
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Affiliation(s)
- A S Cornier
- Genetic Division, Department of Biochemistry, Ponce School of Medicine, Ponce, Puerto Rico.
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Abstract
Osteotomy of the first metatarsal is a common procedure for correction of hallucal disease. Metatarsals are unique in that they are the only long bones in the human body that support load perpendicular to their longitudinal axis during standing. Thus, osteotomy of the first metatarsal may be complicated by loss of fixation, resulting in nonunion or malunion. The authors review the forces that must be resisted by the osteotomy of the first metatarsal as postoperative weight bearing is initiated, and explore the principles of osteotomy geometry and different fixation techniques to maximize stability of the final construct and to minimize the risk of displacement.
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Affiliation(s)
- V J Sammarco
- Center for Orthopaedic Care, Inc, Cincinnati, Ohio, USA
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García-Fernández MA, Torrecilla E, San Román D, Hernández JM, Esturau R, Moreno M, Jiménez J, Bueno H, Echevarría T, Acevedo J. [Transesophageal echocardiography in mitral prosthesis dysfunction: usefulness and limitations in the evaluation of mitral insufficiency]. Rev Esp Cardiol 1993; 46:267-74. [PMID: 8516533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study was performed to test the usefulness of transesophageal echocardiography in the diagnosis and assessment of pathological mitral regurgitation in patients with mitral valve prostheses. Doppler color flow imaging by transesophageal echocardiography was compared to the transthoracic echocardiography and angiographic and surgical assessment. We analyzed the influence of the spatial configuration of the jet on the semiquantitative assessment of mitral regurgitation. We studied 71 patients with prostheses in mitral position which were submitted for transesophageal echocardiography examination. 51 of these patients were found to have a pathological prosthetic regurgitation that was confirmed in 21 cases by left ventriculography and in 4 during cardiac surgery. Transesophageal echocardiography Doppler color flow imaging identified a regurgitant jet in 31 patients (60.7%). There was complete agreement with the quantitative assessment of regurgitation by angiography or surgery in 36% of the cases. All patients with prosthetic insufficiency observed by angiography or during cardiac surgery were confirmed by transesophageal echocardiography. Complete agreement in grade of severity by transthoracic echocardiography was found in 84% of cases. There was a difference in grade of severity of mitral regurgitation in only 4 patients. Regurgitant jets were classified by transesophageal echocardiography color Doppler in two groups: free jets and impinging wall jets. 21 cases presented a free jet and 31 excentrically directed impinging wall jet of mitral regurgitation. There was complete agreement with hemodynamic assessment of severity in all patients with regurgitant free jets (11/11). In presence of jet wall there was understimation of mitral regurgitation in 28.5% (4/13).(ABSTRACT TRUNCATED AT 250 WORDS)
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Coles J, Marrero H, Acevedo J, Orkand P, Orkand R. An effect of nerve impulses on glial cells of the prog optic nerve. Exp Eye Res 1992. [DOI: 10.1016/0014-4835(92)90272-t] [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: 10/26/2022]
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Ksander BR, Acevedo J, Streilein JW. Local T helper cell signals by lymphocytes infiltrating intraocular tumors. J Immunol 1992; 148:1955-63. [PMID: 1531848] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Tumor-infiltrating lymphocytes from mice bearing minor histoincompatible tumor cells in the anterior chamber (AC) or subconjunctival (SCon) space of the eye have been shown to contain large numbers of tumor-specific precursor cytotoxic T cells. Because SCon tumors eventually acquire directly cytotoxic, tumor-specific T cells and are rejected by their hosts and because AC tumors never acquire cytotoxic effector cells and are not rejected, we have examined tumor-infiltrating lymphocytes from both types of ocular tumors for the capacity to secrete lymphokines in response to in vitro stimulation with tumor cells. The results indicate that T "helper" cells were able to infiltrate both SCon and AC tumors. In the former, T cells capable of secreting IL-2 and IL-4 were found whereas in the latter only IL-2-secreting T cells were detected. These findings implicate a defect in local delivery of appropriate T cell help as the reason why AC tumors are not rejected. The failure of AC tumor-bearing mice to destroy their tumors correlates not only with defective delivery of local help but with a systemic inability to produce tumor-specific T cells that can secrete IL-2 and IL-4. Because these mice also generate down-regulatory T cells that suppress the expression of tumor-specific delayed hypersensitivity, they appear to have an immunologically mediated block in T helper cell differentiation which renders them unable to generate either T helper 1 or T helper 2 cells. This immunologic abnormality is discussed in terms of tumor rejection and the phenomenon of immunologic privilege.
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Affiliation(s)
- B R Ksander
- Department of Microbiology and Immunology, University of Miami Medical School, FL 33101
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Ksander BR, Acevedo J, Streilein JW. Local T helper cell signals by lymphocytes infiltrating intraocular tumors. The Journal of Immunology 1992. [DOI: 10.4049/jimmunol.148.6.1955] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Tumor-infiltrating lymphocytes from mice bearing minor histoincompatible tumor cells in the anterior chamber (AC) or subconjunctival (SCon) space of the eye have been shown to contain large numbers of tumor-specific precursor cytotoxic T cells. Because SCon tumors eventually acquire directly cytotoxic, tumor-specific T cells and are rejected by their hosts and because AC tumors never acquire cytotoxic effector cells and are not rejected, we have examined tumor-infiltrating lymphocytes from both types of ocular tumors for the capacity to secrete lymphokines in response to in vitro stimulation with tumor cells. The results indicate that T "helper" cells were able to infiltrate both SCon and AC tumors. In the former, T cells capable of secreting IL-2 and IL-4 were found whereas in the latter only IL-2-secreting T cells were detected. These findings implicate a defect in local delivery of appropriate T cell help as the reason why AC tumors are not rejected. The failure of AC tumor-bearing mice to destroy their tumors correlates not only with defective delivery of local help but with a systemic inability to produce tumor-specific T cells that can secrete IL-2 and IL-4. Because these mice also generate down-regulatory T cells that suppress the expression of tumor-specific delayed hypersensitivity, they appear to have an immunologically mediated block in T helper cell differentiation which renders them unable to generate either T helper 1 or T helper 2 cells. This immunologic abnormality is discussed in terms of tumor rejection and the phenomenon of immunologic privilege.
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Affiliation(s)
- B R Ksander
- Department of Microbiology and Immunology, University of Miami Medical School, FL 33101
| | - J Acevedo
- Department of Microbiology and Immunology, University of Miami Medical School, FL 33101
| | - J W Streilein
- Department of Microbiology and Immunology, University of Miami Medical School, FL 33101
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Ksander BR, Bando Y, Acevedo J, Streilein JW. Infiltration and accumulation of precursor cytotoxic T-cells increase with time in progressively growing ocular tumors. Cancer Res 1991; 51:3153-8. [PMID: 1904003] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Precursors of cytotoxic T-cells (pTc) infiltrate P815 tumors growing progressively within the immunologically privileged anterior chamber (AC) of BALB/c mouse eyes, but directly cytotoxic T-cells cannot be detected in these eyes. To determine if the failure to reject these tumors is due to a relative inability of tumor-specific pTc to gain access to, or be retained by, the tumor-containing eye, we have assayed through time the frequency of pTc in eyes that received P511 tumor cells in the AC or subconjunctival space (SC; a site where the tumors are rejected). P511 tumor cells, a hypoxanthine-amethopterin-thymine medium-sensitive derivative of P815 cells, were selected for these studies because P511 tumor cells can be eliminated from in vitro lymphocyte cultures containing hypoxanthine-amethopterin-thymine medium, permitting us to make accurate estimates of pTc frequencies. To ensure that P511 cells are similar biologically and immunologically to P815 tumor cells, we demonstrated that both P511 and P815 cells form progressively growing tumors when injected into the AC of BALB/c eyes and that recipients of both tumor cell lines develop DBA/2-specific anterior chamber-associated immune deviation. Using cell suspensions harvested from eyes of mice bearing AC or SC P511 tumors, we found that tumor-specific pTc appeared first (day 8) in SC tumor-bearing eyes, compared to their appearance in AC tumor-bearing eyes (day 11). Thereafter, however, the number of pTc detected was significantly greater in eyes bearing progressively growing AC tumors than in SC tumor-injected eyes. The number and frequency of pTc we found in these eyes appeared to correlate directly with the size of the ocular tumor burden. We conclude that failure to reject P511 tumor from the AC can be ascribed neither to a quantitative deficiency in infiltrating tumor-specific pTc nor to an inability to retain pTc at the site. Our findings suggest that immune acceptance of allogeneic ocular tumor grafts may result from failure of infiltrating pTc to differentiate terminally in situ into cytotoxic effector cells.
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Affiliation(s)
- B R Ksander
- Department of Microbiology and Immunology, University of Miami Medical School, Florida 33101
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Abstract
Amebiasis is the acute and chronic disease produced by Entamoeba histolytica, an entity which occurs in endemic fashion in many of the tropical and subtropical areas of the world, capable of affecting diverse organs of the body, especially the colon. Amebiasis has different clinical forms of presentation, varying from the asymptomatic carrier state to severe, although not frequent, fulminant or necrotizing colitis, characteristically associated with high morbidity and mortality. We hereby report a series of 50 adult patients with fulminating amebic colitis managed at our institution between January, 1971 and July, 1989, with a global mortality of 60%. Early diagnosis, treatment with effective antiamebic agents--specifically metronidazole--and opportune aggressive surgical intervention have resulted in better survival rates. We had no survivors prior to 1970; our current survival rate is still a dismal 40%, indicating the very severe nature of the disease.
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Affiliation(s)
- H Aristizábal
- Department of Surgery, University of Antioquia School of Medicine, Medellín, Colombia
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