1
|
Morales-Caba L, Lylyk I, Vázquez-Añón V, Bleise C, Scrivano E, Perez N, Lylyk PN, Lundquist J, Bhogal P, Lylyk P. The pCONUS2 and pCONUS2 HPC Neck Bridging Devices : Results from an International Multicenter Retrospective Study. Clin Neuroradiol 2023; 33:129-136. [PMID: 35819477 PMCID: PMC10014770 DOI: 10.1007/s00062-022-01191-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bifurcation aneurysms represent an ongoing endovascular challenge with a variety of techniques and devices designed to address them. We present our multicenter series of the pCONUS2 and pCONUS2 HPC devices when treating bifurcation aneurysms. METHODS We performed a retrospective review of our prospectively maintained databases at 3 tertiary neurointerventional centers to identify all patients who underwent coil embolization with the pCONUS2 or pCONUS2 HPC device between February 2015 and August 2021. We recorded baseline demographics, aneurysm data, complications, immediate and delayed angiographic results. RESULTS We identified 55 patients with 56 aneurysms, median age 63 years (range 42-78 years), 67.3% female (n = 37). The commonest aneurysm location was the MCA bifurcation (n = 40, 71.4%). Average dome height was 8.9 ± 4.2 mm (range 3.2-21.5 mm), average neck width 6.4 ± 2.5 mm (range 2.6-14 mm), and average aspect ratio 1.3 ± 0.6 (range 0.5-3.3). The pCONUS2 was used in 64.3% and the pCONUS2 HPC in 35.7%. The procedural technical success rate was 98.2%. Intraoperative complications occurred in 5 cases (8.9%), 4 of which were related to the coils with partial thrombus formation on the pCONUS2 HPC seen in 1 case that was resolved with heparin. In relation to the procedure and treatment of the aneurysm the overall permanent morbidity was 1.8% (n = 1/55) and mortality 0%. Delayed angiographic follow-up (48 aneurysms) at median 12 months postprocedure (range 3-36 months) demonstrated adequate occlusion of 83.4% of aneurysms. CONCLUSION The pCONUS2 and pCONUS2 HPC devices carry a high technical success rate, low complication and retreatment rate, and good rates of adequate occlusion. Larger prospective confirmatory studies are required.
Collapse
Affiliation(s)
- L Morales-Caba
- Department of Neuroradiology, Hospital Universitari i Politècnic La Fe, València, Spain
- Department of Radiology, Hospital Universitari La Ribera, Alzira, Spain
| | - I Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - V Vázquez-Añón
- Department of Neuroradiology, Hospital Universitari i Politècnic La Fe, València, Spain
- Department of Radiology, Hospital Universitari La Ribera, Alzira, Spain
| | - C Bleise
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - E Scrivano
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - N Perez
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P N Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - J Lundquist
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, Whitechapel Road, E1 1BB, London, UK.
| | - P Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| |
Collapse
|
2
|
Marcos Garces V, Gabaldon-Perez A, Gavara J, Lopez-Lereu MP, Monmeneu JV, Perez N, Rios-Navarro C, De Dios E, Merenciano-Gonzalez H, Chorro FJ, Valente F, Lorenzatti D, Ortiz-Perez JT, Rodriguez-Palomares JF, Bodi V. Prognostic value of cardiac magnetic resonance in elderly patients soon after ST-segment elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Elderly patients with ST-segment elevation myocardial infarction (STEMI) represent a very high-risk population. Data on the prognostic value of cardiac magnetic resonance (CMR) in this scenario are scarce.
Purpose
We aim to study the prognostic value of an early (1-week) CMR in elderly patients after STEMI and to create a simple risk score including clinical and CMR variables.
Methods
The registry comprised 247 patients over 70 years of age discharged for a first STEMI treated with percutaneous intervention and included in a multicenter registry. Baseline characteristics, echocardiographic parameters and CMR-derived left ventricular ejection fraction (LVEF, %), infarct size (% of left ventricular mass) and microvascular obstruction (MVO, number of segments) were prospectively collected. The additional prognostic power of CMR was assessed using adjusted C-statistic, net reclassification index (NRI) and integrated discrimination improvement index (IDI).
Results
During a 4.8-year mean follow-up, 66 (26.7%) first major adverse cardiac events (MACE) occurred (27 all-cause deaths and 39 re-admissions for acute heart failure). Higher GRACE score (HR 1.03 [1.02–1.04], p<0.001), more depressed CMR-LVEF (HR 0.97 [0.95–0.99] per increased %, p=0.006) and more extensive MVO (HR 1.24 [1.09–1.4] per segment, p=0.001) predicted MACE occurrence. The addition of CMR data significantly improved MACE prediction compared to the model with baseline and echocardiographic characteristics (C-statistic 0.759 [0.694–0.824] vs. 0.685 [0.613–0.756], NRI=0.6, IDI=0.08, p<0.001). The best cut-offs for independent variables were GRACE score >155, LVEF <40%, and MVO ≥2 segments. A simple score (0, 1, 2, and 3) based on the number of altered factors accurately predicted the MACE per 100 person-years: 0.78, 5.53, 11.51 and 78.79, respectively (p<0.001).
Conclusions
CMR data contribute valuable prognostic information in elderly patients submitted to undergo CMR soon after STEMI.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Instituto de Salud Carlos III and “Fondos Europeos de Desarrollo Regional FEDER” and Conselleria de Educaciόn – Generalitat Valenciana.
Collapse
Affiliation(s)
- V Marcos Garces
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - A Gabaldon-Perez
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - M P Lopez-Lereu
- ERESA Medical Group, Cardiovascular Magnetic Resonance Unit , Valencia , Spain
| | - J V Monmeneu
- ERESA Medical Group, Cardiovascular Magnetic Resonance Unit , Valencia , Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - E De Dios
- Center for Networked Biomedical Research – Cardiovascular (CIBER-CV) , Madrid , Spain
| | | | - F J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - F Valente
- University Hospital Vall d'Hebron, Department of Cardiology , Barcelona , Spain
| | - D Lorenzatti
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS) , Barcelona , Spain
| | - J T Ortiz-Perez
- Barcelona Hospital Clinic, Department of Cardiology , Barcelona , Spain
| | | | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| |
Collapse
|
3
|
Bertolin-Boronat C, Marcos Garces V, Perez N, Gavara J, Lopez-Lereu MP, Monmeneu JV, Rios-Navarro C, De Dios E, Merenciano-Gonzalez H, Gabaldon-Perez A, Iraola Viana D, Bonanad C, Moratal D, Chorro FJ, Bodi V. Cardiac magnetic resonance characterization and prediction of left ventricular thrombus after ST-segment elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left ventricular thrombus (LVTh) is an uncommon yet serious complication after ST-segment elevation myocardial infarction (STEMI). Late gadolinium enhancement (LGE) sequences in cardiac magnetic resonance (CMR) imaging allows for accurate detection of LVTh. However, the implications of CMR to predict and characterize LVTh occurrence is this population is unclear.
Purpose
We aim to characterize the incidence, outcomes, and predictors of LVTh after STEMI by CMR imaging.
Methods
Our registry comprised 455 patients admitted for a first reperfused STEMI in our university hospital. Baseline characteristics were recorded. All patients underwent early (1-week) and late (6-month) CMR. Left ventricular ejection fraction (LVEF, %), infarct size (% of left ventricular mass) and microvascular obstruction (MVO, number of segments) were measured. LGE sequences were used to analyze the presence of LVTh. Patients with LVTh at 6-month CMR underwent an additional CMR 1 year after admission. Univariate and multivariate comparisons were performed to study the ocurrence of LVTh in the first 6 months after STEMI.
Results
Mean age was 58.24±11.69 years, most patients were male (82.6%) and anterior infarction occurred in more than half of the cohort (52.7%). LVTh was detected in 36 (7.9%) patients in the first 6 months after STEMI. Anticoagulation was initiated in all cases. Of these, 27 patients had LVTh at early (1-week) CMR, but 9 had LVTh at late (6-month) CMR with no prior evidence of LVTh at early CMR. A total of 6 patients had persisting LVTh at 1-year CMR (37.5% of patients with 6-month LVTh). In multivariable analysis, anterior infarction (HR 6.6 [1.91–22.83], p<0.001) and 1-week CMR-LVEF (HR 0.97 [0.93–0.99], p=0.04) and MVO (HR 1.19 [1.02–1.39], p=0.03) independently predicted the occurrence of LVTh in the first 6 months after STEMI. We computed a risk score of LVTh assigning 1 point to each of these variables (anterior infarction, CMR-LVEF <50% and MVO >3.5 segments), which allowed us to stratify the risk of LVTh in the first 6 months after STEMI (0.6% if 0 points, 3.8% if 1 point, 14.4% if 2 points, and 31.2% if 3 points).
Conclusions
CMR imaging soon after STEMI can contribute relevant prognostic value regarding LVTh occurrence after the acute event. Patients with anterior infarction, LVEF <50% and MVO in >3.5 segments at early (1-week) CMR have the highest risk of LVTh in the first 6 months after STEMI.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Instituto de Salud Carlos III and “Fondos Europeos de Desarrollo Regional FEDER” and Conselleria de Educaciόn – Generalitat Valenciana.
Collapse
Affiliation(s)
- C Bertolin-Boronat
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - V Marcos Garces
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - M P Lopez-Lereu
- ERESA Medical Group, Cardiovascular Magnetic Resonance Unit , Valencia , Spain
| | - J V Monmeneu
- ERESA Medical Group, Cardiovascular Magnetic Resonance Unit , Valencia , Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - E De Dios
- Center for Networked Biomedical Research – Cardiovascular (CIBER-CV) , Madrid , Spain
| | | | - A Gabaldon-Perez
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - D Iraola Viana
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - C Bonanad
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - D Moratal
- Polytechnic University of Valencia, Center for Biomaterials and Tissue Engineering , Valencia , Spain
| | - F J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| |
Collapse
|
4
|
Marcos Garces V, Perez N, Gavara J, Lopez-Lereu MP, Monmeneu JV, Rios-Navarro C, De Dios E, Merenciano-Gonzalez H, Gabaldon-Perez A, Chorro FJ, Valente F, Lorenzatti D, Ortiz-Perez JT, Rodriguez-Palomares JF, Bodi V. A novel clinical and cardiac magnetic resonance risk score for early risk prediction after ST-segment elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac magnetic resonance (CMR) performed early after ST-segment elevation myocardial infarction (STEMI) can improve major adverse cardiac event (MACE) risk prediction. However, predictive models including clinical and CMR variables are scarce and not routinely implemented in clinical practice.
Purpose
We aimed to create a simple clinical-CMR risk score for early MACE risk stratification in STEMI patients.
Methods
We performed a multicenter prospective registry in three Spanish university hospitals of reperfused STEMI patients (n=1118) in whom early (1-week) CMR-derived left ventricular ejection fraction (LVEF), infarct size and microvascular obstruction (MVO) were quantified. MACE was defined as a combined clinical endpoint of cardiovascular (CV) death, non-fatal myocardial infarction (NF-MI) or re-admission for acute decompensated heart failure (HF), whichever occurred first. Univariate and multivariate analyses were performed and a risk score was computed using the variables which independently predicted the risk of MACE.
Results
During a median follow-up of 5.52 [2.63–7.44] years, 216 first MACE (58 CV deaths, 71 NF-MI and 87 HF) were registered. Mean age was 59.3±12.3 years and most patients (82.8%) were male. Based on the four variables independently associated with MACE, we computed an 8-point risk score: time to reperfusion >4.15h (1 point), GRACE risk score >155 (3 points), CMR-LVEF <40% (3 points), and MVO >1.5 segments (1 point). This score permitted MACE risk stratification: MACE per 100 person-years was 1.96 in the low-risk category (0–2 points), 5.44 in the intermediate-risk category (3–5 points), and 19.7 in the high-risk category (6–8 points): p<0.001 in multivariable Cox survival analysis.
Conclusions
A novel risk score including clinical (time to reperfusion >4.15h and GRACE risk score >155) and CMR (LVEF <40% and MVO >1.5 segments) variables allows for simple and straightforward MACE risk stratification early after STEMI. External validation should confirm the applicability of the risk score.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Instituto de Salud Carlos III and Fondo Europeo de Desarrollo Regional (FEDER) and Sociedad Española de Cardiología.
Collapse
Affiliation(s)
- V Marcos Garces
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - M P Lopez-Lereu
- ERESA Medical Group, Cardiovascular Magnetic Resonance Unit , Valencia , Spain
| | - J V Monmeneu
- ERESA Medical Group, Cardiovascular Magnetic Resonance Unit , Valencia , Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - E De Dios
- Center for Networked Biomedical Research – Cardiovascular (CIBER-CV) , Madrid , Spain
| | | | - A Gabaldon-Perez
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - F J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - F Valente
- University Hospital Vall d'Hebron, Department of Cardiology , Barcelona , Spain
| | - D Lorenzatti
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS) , Barcelona , Spain
| | - J T Ortiz-Perez
- Barcelona Hospital Clinic, Department of Cardiology , Barcelona , Spain
| | | | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| |
Collapse
|
5
|
Merenciano-Gonzalez H, Marcos Garces V, Gabaldon-Perez A, Gavara J, Lopez-Lereu MP, Monmeneu JV, Perez N, Rios-Navarro C, De Dios E, Chorro FJ, Valente F, Lorenzatti D, Ortiz-Perez JT, Rodriguez-Palomares JF, Bodi V. Cardiac magnetic resonance predictors of readmission for heart failure in elderly vs not elderly patients after ST-segment elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with ST-segment elevation acute myocardial infarction (STEMI) have an increased risk of re-admission for acute heart failure (AHF). However, identification of patients at higher risk of AHF is challenging, especially in elderly individuals. The implications of cardiac magnetic resonance (CMR) imaging soon after the acute event for this specific purpose are unknown.
Purpose
We aim to study the clinical and CMR predictors of AHF in elderly and not elderly patients after STEMI.
Methods
STEMI patients treated with percutaneous coronary intervention and discharged from three university hospitals were included in a multicenter registry. We registered baseline clinical characteristics, echocardiographic parameters and early (1-week) CMR parameters - left ventricular ejection fraction (LVEF, %), infarct size (% of left ventricular mass) and microvascular obstruction (MVO, number of segments). Univariate and multivariate comparisons were performed in elderly (>70 years) and not elderly (≤70 years) patients to predict AHF during follow-up.
Results
The cohort was comprised of 759 patients, of which 177 (23.3%) were elderly (>70 years). During a mean follow-up of 5.23±3.54 years, 79 (10.4%) patients presented AHF. In not elderly patients, Killip class at admission (HR 2.05 [1.32–3.17], p=0.001), anterior infarction (HR 3.43 [1.13–10.36], p=0.03) and CMR-LVEF (HR 0.94 [0.91–0.98] per increased %, p=0.001) independently predicted AHF. However, a combined risk score comprising these variables was not superior to CMR-LVEF alone to predict AHF during follow-up (AUC 0.81 [0.74–0.88] vs. 0.81 [0.73–0.88], p=NS). In elderly patients, CMR-LVEF was the only predictor of AHF in the final multivariable model (HR 0.94 [0.91–0.97], p<0.001), although its predictive power was moderate (AUC 0.68 [0.56–0.80], p=0.001). Most AHF events in the not elderly subgroup occurred in patients with reduced (≤40%) CMR-LVEF (71%), while in the elderly subgroup AHF occurred more frequently in patients with preserved (≥50%, 30%) or mildly reduced (40–49%, 32%) CMR-LVEF than reduced (≤40%) CMR-LVEF (38%).
Conclusions
LVEF quantified by CMR soon after STEMI can accurately predict the risk of AHF in not elderly (≤70 years) patients and identify those individuals at higher risk (i.e. CMR-LVEF ≤40%). However, in elderly (>70 years) patients most AHF occur in patients with CMR-LVEF >40%, emphasizing the need for better predictive strategies in this population.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Instituto de Salud Carlos III and “Fondos Europeos de Desarrollo Regional FEDER” and Conselleria de Educaciόn – Generalitat Valenciana.
Collapse
Affiliation(s)
| | - V Marcos Garces
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - A Gabaldon-Perez
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - M P Lopez-Lereu
- ERESA Medical Group, Cardiovascular Magnetic Resonance Unit , Valencia , Spain
| | - J V Monmeneu
- ERESA Medical Group, Cardiovascular Magnetic Resonance Unit , Valencia , Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - E De Dios
- Center for Networked Biomedical Research – Cardiovascular (CIBER-CV) , Madrid , Spain
| | - F J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - F Valente
- University Hospital Vall d'Hebron, Department of Cardiology , Barcelona , Spain
| | - D Lorenzatti
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS) , Barcelona , Spain
| | - J T Ortiz-Perez
- Barcelona Hospital Clinic, Department of Cardiology , Barcelona , Spain
| | | | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| |
Collapse
|
6
|
Marcos Garces V, Rios-Navarro C, Gomez-Torres F, Gavara J, De Dios E, Perez N, Diaz A, Minana G, Chorro FJ, Bodi V, Ruiz-Sauri A. Collagen bundle orientation by Fourier analysis in myocardial infarction scarring. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” and Conselleria de Educación – Generalitat Valenciana.
Introduction
After acute myocardial infarction (AMI), the lack of oxygen and nutrients leads to cardiomyocyte necrosis and eventually to the formation of a collagen-based scar. Infarct scar characteristics, such as collagen bundle orientation, have a relevant influence on scar mechanics, the occurrence of cardiac arrhythmias, left ventricular dilation or aneurysm formation, wall stiffness, and the development of wall rupture or heart failure. However, the most adequate method for collagen bundle orientation (CBO) measurement in myocardial scar is not established.
Purpose
We aim to compare the measurement of collagen bundle orientation in infarct scar by Fourier analysis in three different histopathological techniques.
Methods
Juvenile swine (n=21) were subjected, by means of percutaneous balloon inflation, to a transient 90-min occlusion of mid left anterior descending artery followed by one month of reperfusion (chronic AMI group). Samples were obtained from the infarcted zone and stained with Masson’s trichrome, Picrosirius red and Haematoxylin-Eosin (H-E) standard protocols. Five microphotographs of the myocardial scar were taken at 200x magnification with light, polarised and confocal microscopy, respectively. A single observer measured CBO by means of Fast Fourier Transform analysis using a semi-automated protocol. Comparability between techniques was studied by the Intraclass Correlation Coefficient (ICC), the coefficient of variation (CV) and the Bland-Altman (B&A) plots and limits of agreement.
Results
Measurement of CBO in Masson’s trichrome tended to show higher (more "random-oriented") values than in Picrosirius and H-E+confocal techniques (ICC 0.79 and 0.7, p=0.001 and 0.005; B&A 0.29 to -0.02 and 0.43 to 0.01; CV 6.97% and 12.98%, respectively). However, measurement of CBO in Picrosirius and H-E+confocal techniques showed an "almost perfect" agreement (ICC 0.84, p<0.001; B&A 0.28 to -0.09; CV 17.33%). Selective staining and/or visualization of collagen in these latter techniques may underlie our findings, contrary to non-selective Masson’s trichrome.
Conclusion
Picrosirius red staining (visualized with polarised microscopy) and Haematoxylin-Eosin (visualized with confocal microscopy) are comparable in terms of collagen bundle orientation measurement by Fourier analysis in an animal model of chronic infarct scar. Masson’s trichrome (visualized with light microscopy) tends to show more "random-oriented" values, potentially due to non-specific staining and visualization of non-collagenous structures such as cells, and should not be recommended for this specific purpose.
Collapse
Affiliation(s)
- V Marcos Garces
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - F Gomez-Torres
- Faculty of Medicine and Odontology, University of Valencia, Department of Pathology , Valencia , Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - E De Dios
- Center for Networked Biomedical Research – Cardiovascular (CIBER-CV) , Madrid , Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA , Valencia , Spain
| | - A Diaz
- University of Valencia, Central Unit for Research in Medicine (UCIM) , Valencia , Spain
| | - G Minana
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - FJ Chorro
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology , Valencia , Spain
| | - A Ruiz-Sauri
- Faculty of Medicine and Odontology, University of Valencia, Department of Pathology , Valencia , Spain
| |
Collapse
|
7
|
Marcos Garces V, Minana G, Nunez J, Monmeneu JV, Lopez-Lereu MP, Gavara J, Rios-Navarro C, Perez N, De Dios E, Fernandez-Cisnal A, Nunez E, Chorro FJ, Sanchis J, Bodi V. Sex differences in mortality in stable patients undergoing vasodilator stress cardiovascular magnetic resonance. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The prognostic value and therapeutic implications of ischemia as derived from vasodilator stress cardiovascular magnetic resonance (CMR) could differ in men and women, but it has not been stablished.
Purpose
We assessed the influence of the ischemic burden as derived from CMR on the risk of death and the effect of revascularization across sex.
Methods
We evaluated 6,237 consecutive patients with known or suspected chronic coronary syndrome (CCS). Extensive ischemia was defined as >5 segments with perfusion deficit. Multivariate Cox proportional hazard regression models were used.
Results
A total of 2,371 (38.0%) patients were women and 583 (9.3%) underwent CMR-related revascularization. During a median follow-up of 5.13 years, 687 (11.0%) deaths were reported. We found an adjusted differential effect of CMR-derived ischemic burden across sex (p-value for interaction=0.039). Women exhibited an adjusted lower risk of death along most of the continuous ischemic burden but equalled men's risk when extensive ischemia was present. Likewise, CMR-related revascularization was shown to be differentially associated with the risk of mortality across sex (p-value for interaction=0.025). In patients with non-extensive ischemia, revascularization was related to a higher risk of death, with a greater extent in women. At higher ischemic burden, revascularization was associated with a lower risk in men, with more uncertain results in women.
Conclusions
CMR-derived ischemic burden allows predicting the risk of death and gives insight into the potential effect of revascularization in men and women with CCS. Compared to men, women with nonextensive ischemia displayed a lower risk and a similar risk with a higher ischemic burden. The impact of CMR-related revascularization on mortality risk was also significantly different according to ischemic burden and sex.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by the Instituto de Salud Carlos III and cofunded by the European Regional Development Fund (ERDF).
Collapse
Affiliation(s)
- V Marcos Garces
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - G Minana
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J Nunez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J V Monmeneu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - M P Lopez-Lereu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - E De Dios
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - A Fernandez-Cisnal
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - E Nunez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - F J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J Sanchis
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| |
Collapse
|
8
|
Lorenzo Hernandez M, Nunez J, Minana G, Palau P, Lopez-Lereu M, Monmeneu J, Marcos V, Rios-Navarro C, Gavara J, Perez N, De Dios E, Nunez G, Nunez E, Chorro F, Bodi V. Sex differences on new-onset heart failure in patients with known or suspected chronic coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The impact of sex in patients with chronic coronary syndrome (CCS) has been widely reported, but little is known about the influence of sex on the risk of new-onset HF in patients with CCS.
Objectives
We aimed to examine sex-related differences and new-onset heart failure (HF) risk in patients with known or suspected CCS undergoing vasodilator stress cardiac magnetic resonance (CMR).
Methods
We prospectively evaluated 5,899 consecutive HF-free patients submitted to stress CMR for known or suspected CCS. Ischemic burden (number of segments with stress-induced perfusion deficit) and left ventricular ejection fraction (LVEF) were assessed by CMR. The association between sex and new-onset HF (including outpatient diagnosis or acute HF hospitalization) was evaluated using a Cox proportional-hazards regression model adjusted for competing events (death, myocardial infarction, and non-CMR-related revascularization).
Results
A total of 2,289 (38.8%) patients were women, and 539 (9.1%) underwent CMR-related revascularization. During a median follow-up of 4.5 years, 610 (10.3%) patients died, 191 (3.2%) suffered a myocardial infarction, 420 (7.1%) underwent CMR-non-related revascularization, and 314 (5.3%) developed new-onset HF. Unadjusted new-onset HF rates were higher in women than in men (1.25 vs 0.83 per 100 person/years, p=0.002) (Figure 1). After comprehensive multivariate adjustment, women showed an increased risk of new-onset HF (HR=1.61, 95% CI: 1.21–2.13, p=0.001). Compared with men, the risk of new-onset HF was higher in women with LVEF >53%.
Conclusions
Compared with men, women with CCS are at a higher risk of new-onset HF. Further studies are needed to unravel the mechanisms behind these sex-related differences.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III and Fondo Europeo de Desarrollo Regional (FEDER) Figure 1
Collapse
Affiliation(s)
| | - J Nunez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - G Minana
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - P Palau
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | | | | | - V Marcos
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - E De Dios
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - G Nunez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - E Nunez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - F.J Chorro
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - V Bodi
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| |
Collapse
|
9
|
Merenciano Gonzalez H, Marcos-Garces V, Gabaldon-Perez A, Lorenzo-Hernandez M, Nunez-Marin G, Gavara J, Perez N, Rios-Navarro C, De Dios E, Bonanad C, Racugno P, Lopez-Lereu MP, Monmeneu JV, Chorro FJ, Bodi V. Exercise ECG testing in patients without known ischemic heart disease: predictors of ischemia of downstream vasodilator stress cardiac magnetic resonance. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In routine clinical practice, patients with chest pain and suspected stable ischemic heart disease (SIHD) usually undergo an exercise ECG stress test (ExECG) for ischemia detection. However, since the sensitivity of this technique is relatively low, concerns exist that many patients could remain underdiagnosed. We intend to assess the clinical and ExECG predictors of ischemia on subsequent vasodilator stress cardiac magnetic resonance (vs-CMR) to help select which patients should undergo downstream testing after an initial ExECG.
Material and methods
We retrospectively included 197 patients without previous history of ischemic heart disease who underwent an ExECG and a subsequent vs-CMR in the year after this test and who didn't undergo a revascularization procedure in this time frame. Clinical, ExECG and vs-CMR variables were included in the registry. vs-CMR was considered positive if ischemia was evident in at least one myocardial segment on stress first-pass perfusion without concomitant necrosis on late gadolinium enhancement imaging. We performed univariate and multivariate analysis to check for the association of variables with the risk of ischemia on vs-CMR.
Results
Mean time from ExECG to vs-CMR was 88.69±84.32 days and 37 vs-CMR were positive for ischemia. Male sex, less exercise time, less % of maximum predicted exercise capacity, less maximum double product (heart rate x systolic blood pressure) and less double product reserve (DPR = maximum double product - basal double product) were associated with ischemia on vs-CMR on univariate analyses. However, the only independent predictors of ischemia on vs-CMR on multivariate binary logistic regression were male sex (HR 2.62 [CI 95%: 1.13–5.76], p=0.016) and less DPR (HR 0.90 [CI 95%: 0.84–0.97] per 1000 increase, p=0.006). The risk score derived from these two variables had a moderate predictive power (ROC curves, AUC 0.657, p=0.003). The best cut-off point for the DPR was 12400, as derived from the Youden index. It allowed stratification of the risk of ischemia on vs-CMR, which ranged from 9% in women with >12400 DPR, 18.8% in men with >12400 DPR, 24.1% in women with ≤12400 DPR to 42.9% in men with ≤12400 DPR (p=0.005, Figure 1).
Conclusions
Male sex and less double product reserve on ExECG can moderately predict the risk of ischemia on subsequent vs-CMR in patients presenting with chest pain and without previous SIHD. This can help select patients who benefit most from vs-CMR for diagnostic purposes.
Funding Acknowledgement
Type of funding sources: None. Figure 1
Collapse
Affiliation(s)
| | - V Marcos-Garces
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - A Gabaldon-Perez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - M Lorenzo-Hernandez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - G Nunez-Marin
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - E De Dios
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - C Bonanad
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - P Racugno
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - M P Lopez-Lereu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - J V Monmeneu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - F J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| |
Collapse
|
10
|
Merenciano Gonzalez H, Gavara J, Marcos-Garces V, Pedro-Tudela A, Gabaldon-Perez A, Perez N, Rios-Navarro C, De Dios E, Monmeneu JV, Lopez-Lereu MP, Racugno P, Bonanad C, Chorro FJ, Bodi V. Residual ST-segment elevation at pre-discharge ECG after STEMI: association with long-term prognosis and structural consequences at 6-month CMR. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Residual ST-segment elevation after ST-segment elevation myocardial infarction (STEMI) has been traditionally interpreted as a predictor of left ventricular dysfunction and ventricular aneurism. More recently, it has also been associated with more severe structural consequences in cardiac magnetic resonance (CMR) performed soon after STEMI. However, the implications in terms of long-term prognosis of patients and structural consequences in CMR performed late after STEMI are unclear.
Methods
Data was obtained from a prospective registry of reperfused STEMI patients. At pre-discharge ECG, sum and maximum ST-segment elevation (mm), ST-segment resolution (%) and the number of Q-leads with residual ST-segment elevation >1 mm (Q-STE) were assessed. 6-month CMR parameters were quantified: left ventricular ejection fraction (LVEF, %), left ventricular end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI, mL/m2), infarct size (IS, % left ventricular mass) and microvascular obstruction (MVO, % left ventricular mass). The primary end-point was major adverse cardiac events (MACE), defined as all-cause death and/or re-admission for acute heart failure, whichever occurred first.
Results
488 patients were included. Mean age was 58±12 years, 80.3% were males and smoking was the most prevalent cardiovascular risk factor. During a 7-year mean and median follow-up, 92 MACE were registered (19%), 39 all-cause deaths and 53 re-admission for acute heart failure. Q-STE >1 lead was detected in 172 patients (35%) and it was the most potent ECG predictor of MACE (26% vs 15%, p=0.002). Q-STE was also associated with structural changes at 6-month CMR: larger LVEDVI (87,39±27,47 mL/m2 vs 74,31±24,13 mL/m2) and LVESVI (45,45±25,24 mL/m2 vs 32,53±20,85 mL/m2), less LVEF (50,48±13,95% vs 58,75±12,3%) and larger infarct size (24,91±11,6% vs 14,38±11,41%) (p<0.001 for all comparisons, Figure 1). After adjustment for baseline and ECG characteristics, Q-STE (per lead with >1 mm) was independently associated with a higher risk of long-term MACE (HR 1.24 [CI 95%: 1.09–1.40], p=0.001), depressed (<40%) LVEF (HR 1.26 [CI 95%: 1.02–1.56], p=0.03) and large (>30% left ventricular mass) infarct size (HR 1.34 [CI 95%: 1.08–1.67], p=0.008) at 6-month CMR. Survival free from MACE was lower in patients with >1 lead Q-STE (log-rank=9.07, p=0.003) (Figure 2).
Conclusions
Residual ST-segment elevation after STEMI represents a widely available predictor of adverse long-term prognosis and late CMR-derived left ventricular remodelling. It could contribute to select patients who would benefit of close monitoring.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Fondos Europeos de Desarrollo Regional FEDERInstituto de Salud Carlos III Figure 1. Structural changes at 6-month CMRFigure 2. Survival free from MACE
Collapse
Affiliation(s)
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - V Marcos-Garces
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - A Pedro-Tudela
- University of Valencia, Faculty of Medicine, Valencia, Spain
| | - A Gabaldon-Perez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - E De Dios
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - J V Monmeneu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - M P Lopez-Lereu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - P Racugno
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - C Bonanad
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - F J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| |
Collapse
|
11
|
Fong ZV, Hashimoto DA, Jin G, Haynes AB, Perez N, Qadan M, Ferrone CR, Castillo CFD, Warshaw AL, Lillemoe KD, Traeger LN, Chang DC. Simulated Volume-Based Regionalization of Complex Procedures: Impact on Spatial Access to Care. Ann Surg 2021; 274:312-318. [PMID: 31449139 PMCID: PMC7032992 DOI: 10.1097/sla.0000000000003574] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study simulates the regionalization of pancreatectomies to assess its impact on spatial access in terms of patient driving times. BACKGROUND Although policies to regionalize complex procedures to high-volume centers may improve outcomes, the impact on patient access is unknown. METHODS Patients who underwent pancreatectomies from 2005 to 2014 were identified from California's statewide database. Round-trip driving times between patients' home ZIP code and hospital addresses were calculated via Google Maps. Regionalization was simulated by eliminating hospitals performing <20 pancreatectomies/yr, and reassigning patients to the next closest hospital that satisfied the volume threshold. Sensitivity analyses were performed for New York and Medicare patients to assess for influence of geography and insurance coverage, respectively. RESULTS Of 13,317 pancreatectomies, 6335 (47.6%) were performed by hospitals with <20 cases/yr. Patients traveled a median of 49.8 minutes [interquartile range (IQR) 30.8-96.2] per round-trip. A volume-restriction policy would increase median round-trip driving time by 24.1 minutes (IQR 4.5-53.5). Population in-hospital mortality rates were estimated to decrease from 6.7% to 2.8% (P < 0.001). Affected patients were more likely to be racial minorities (44.6% vs 36.5% of unaffected group, P < 0.001) and covered by Medicaid or uninsured (16.3% vs 9.8% of unaffected group, P < 0.001). Sensitivity analyses revealed a 17.8 minutes increment for patients in NY (IQR 0.8-47.4), and 27.0 minutes increment for Medicare patients (IQR 6.2-57.1). CONCLUSIONS A policy that limits access to low-volume pancreatectomy hospitals will increase round-trip driving time by 24 minutes, but up to 54 minutes for 25% of patients. Population mortality rates may improve by 1.5%.
Collapse
Affiliation(s)
- Zhi Ven Fong
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Ginger Jin
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Alex B Haynes
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Numa Perez
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Lara N Traeger
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
12
|
Dapeña JM, Serrano ER, Bande JM, Medina MA, Klajn DS, Caracciolo JA, Castro C, Morbiducci J, Mercé AL, Tralice R, Espasa GV, Yessika Jackeline S, Leguizamón ML, Pera MA, Bellomio VI, Yacuzzi MS, Machado Escobar M, Cosentino M, Garcia L, García M, Aeschlimann C, Gomez G, Perez N, Papasidero S. POS0763 PERFORMANCE OF THE NEW ACR/EULAR 2019 CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) IN A COHORT OF ARGENTINIAN PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In 2019 ACR and EULAR published in joint collaboration the new classification criteria for Systemic Lupus Erythematosus (SLE). Compared to the previous ones, these criteria have shown higher sensitivity and specificity in multiple cohorts. To our knowledge, its performance has not been evaluated in a cohort of patients with rheumatological diseases living in Argentina.Objectives:The aim of this study was to evaluate the sensitivity and specificity of the ACR/ EULAR 2019 criteria in a cohort of patients with connective tissue diseases residing in Argentina. Secondary objectives were to determine the Likelihood Ratio (LR) of these criteria and the correlation of their global score with activity and damage indexes of the disease.Methods:Multicentre, retrospective and analytical study. Patients ≥ 18 years old with diagnosis of SLE (ACR 1997/SLICC 2012) without other associated collagen diseases (case group), and patients with other non-SLE connective tissue diseases (control group) were included. Those with active infectious disease, oncohematological disease, drug-induced lupus and overlap syndrome were excluded. Sociodemographic data, characteristics of the disease and treatment were recorded. In addition, activity and damage indexes were recorded in the group with SLE.Three SLE experts, blinded to the diagnosis determined, for every individual if the patient had SLE or another rheumatological disease. An interrater agreement of 100% (including the 3 evaluators) was considered “defined SLE” and used as gold standard. In all cases, ACR 1997/SLICC 2012/ACR / EULAR 2019 criteria were applied and compared with the gold standard. Statistical analysis: Descriptive statistics was estimated. Sensitivity, specificity, positive and negative LR of the criteria were determined. The association between the final score of the ACR-EULAR 2019 criteria and the disease activity and damage indexes were estimated with Spearman correlation test. STATA 15.0 was used for data analysis.Results:A total of 365 patients from 7 centres in Argentina were included. A One hundred and eighty-three belonged to the SLE group: 92.3% women, mean age 39 years (SD 13.3), median disease duration 92 months (IQR 37-150). The most frequent manifestations of the disease were mucocutaneous (94%), musculoskeletal (82.5%) and haematological (69%). All patients presented ANA +, 88% hypocomplementemia, 69.4% Anti-DNA and 19.5% antiphospholipid antibodies. Median SLEDAI and SLICC were 2 (IQR 0-6) and 0 (IQR 0-1), respectively.In the control group, 182 patients were recruited: 84% women, mean age 53.6 years (SD 14.2) and median disease duration 82.5 months (IQR 38-151). The most frequent diseases were Rheumatoid Arthritis (46.1%), Scleroderma (18.1%) and Sjögren’s Syndrome (16.5%) and most common manifestations were musculoskeletal (81.9%), immunological (73.6%) and constitutional (25.3%). A total of 62.6% of patients presented ANA+, 8.6% hypocomplementemia, and 1.3% Antiphospholipid antibodies.Ninety-one percent of patients in the case group were classified as defined SLE and 3.8% in the control group.The ACR / EULAR 2019 Criteria showed a 99.4% sensitivity and an 89.1% specificity, with a LR+ of 9.1 and a LR- of 0.007. The sensitivity and specificity of SLICC 2012 criteria were 98.3% and 88%, respectively with a LR+ of 8.2 and a LR- of 0.02; and the ACR 1997 criteria showed a 93.96% sensitivity and 90.1% specificity, with LR + of 8.21 and LR - of 0.07.The correlations between the ACR/EULAR 2019 Criteria global score, and activity and damage indexes were 0.19 and -0.006, respectively.Conclusion:The new ACR / EULAR 2019 criteria have shown high sensitivity, a specificity comparable to its predecessors, and a higher ability to distinguish SLE from other diseases and to exclude it in non-SLE patients. No correlation was observed between the criteria scores and activity and damage indexes.References:[1]Aringer M, Costenbader K, Daikh D, et al 2019 EULAR/ACR classification criteria for SLE. Ann Rheum 2019; 78: 1151-1159.Disclosure of Interests:None declared
Collapse
|
13
|
Maurer LR, Rahman S, Perez N, Allar BG, Witt E, Moya J, Pichardo MS, Romero Arenas MA, Uribe-Leitz T, Dey T, Bergmark RW, Peck G, Ortega G. Differences in outcomes after emergency general surgery between Hispanic subgroups in the New Jersey State Inpatient Database (2009-2014): The Hispanic population is not monolithic. Am J Surg 2021; 222:492-498. [PMID: 33840445 DOI: 10.1016/j.amjsurg.2021.03.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Our aim was to examine differences in clinical outcomes between Hispanic subgroups who underwent emergency general surgery (EGS). METHODS Retrospective cohort study of the HCUP State Inpatient Database from New Jersey (2009-2014), including Hispanic and non-Hispanic White (NHW) adult patients who underwent EGS. Multivariable analyses were performed on outcomes including 7-day readmission and length of stay (LOS). RESULTS 125,874 patients underwent EGS operations. 22,971 were Hispanic (15,488 with subgroup defined: 7,331 - Central/South American; 4,254 - Puerto Rican; 3,170 - Mexican; 733 - Cuban). On multivariable analysis, patients in the Central/South American subgroup were more likely to be readmitted compared to the Mexican subgroup (OR 2.02; p < 0.001, respectively). Puerto Rican and Central/South American subgroups had significantly shorter LOS than Mexican patients (Puerto Rico -0.58 days; p < 0.001; Central/South American -0.30 days; p = 0.016). CONCLUSIONS There are significant differences in EGS outcomes between Hispanic subgroups. These differences could be missed when data are aggregated at Hispanic ethnicity.
Collapse
Affiliation(s)
- Lydia R Maurer
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Rahman
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Numa Perez
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin G Allar
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Witt
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jackelyn Moya
- David Geffen School of Medicine, Los Angeles, CA, USA
| | - Margaret S Pichardo
- Howard University College of Medicine, Washington, DC, USA; Yale School of Public Health, New Haven, CT, USA
| | | | - Tarsicio Uribe-Leitz
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Tanujit Dey
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Regan W Bergmark
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory Peck
- Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA; Rutgers School of Public Health, Piscataway, NJ, USA
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
14
|
Morrison ZD, Reyes-Ferral C, Mansfield SA, Alemayehu H, Bowen-Jallow K, Tran S, Santos MC, Bischoff A, Perez N, Lopez ME, Langham MR, Newman EA. Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association. J Pediatr Surg 2021; 56:641-647. [PMID: 33309300 DOI: 10.1016/j.jpedsurg.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 01/10/2023]
Affiliation(s)
| | | | | | - Hanna Alemayehu
- Children's and Women's Hospital, University of South Alabama Health System, Mobile, AL, USA
| | | | - Sifrance Tran
- University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Numa Perez
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Erika A Newman
- CS Mott Children's Hospital, The University of Michigan, Ann Arbor, MI, USA.
| | | |
Collapse
|
15
|
Perez N, Delplace P, Venaille A. Manifestation of the Berry curvature in geophysical ray tracing. Proc Math Phys Eng Sci 2021. [DOI: 10.1098/rspa.2020.0844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Geometrical phases, such as the Berry phase, have proven to be powerful concepts to understand numerous physical phenomena, from the precession of the Foucault pendulum to the quantum Hall effect and the existence of topological insulators. The Berry phase is generated by a quantity named the Berry curvature, which describes the local geometry of wave polarization relations and is known to appear in the equations of motion of multi-component wave packets. Such a geometrical contribution in ray propagation of vectorial fields has been observed in condensed matter, optics and cold atom physics. Here, we use a variational method with a vectorial Wentzel–Kramers–Brillouin ansatz to derive ray- tracing equations for geophysical waves and to reveal the contribution of the Berry curvature. We detail the case of shallow-water wave packets and propose a new interpretation of their oscillating motion around the equator. Our result shows a mismatch with the textbook scalar approach for ray tracing, by predicting a larger eastward velocity for Poincaré wave packets. This work enlightens the role of the geometry of wave polarization in various geophysical and astrophysical fluid waves, beyond the shallow-water model.
Collapse
Affiliation(s)
- N. Perez
- Univ. Lyon, ENS de Lyon, Univ. Claude Bernard, CNRS, Laboratoire de Physique (UMR CNRS 5672), 69342 Lyon, France
| | - P. Delplace
- Univ. Lyon, ENS de Lyon, Univ. Claude Bernard, CNRS, Laboratoire de Physique (UMR CNRS 5672), 69342 Lyon, France
| | - A. Venaille
- Univ. Lyon, ENS de Lyon, Univ. Claude Bernard, CNRS, Laboratoire de Physique (UMR CNRS 5672), 69342 Lyon, France
| |
Collapse
|
16
|
Karanasiou A, Panteliadis P, Perez N, Minguillón MC, Pandolfi M, Titos G, Viana M, Moreno T, Querol X, Alastuey A. Evaluation of the Semi-Continuous OCEC analyzer performance with the EUSAAR2 protocol. Sci Total Environ 2020; 747:141266. [PMID: 32777506 DOI: 10.1016/j.scitotenv.2020.141266] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/09/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
This work evaluates the applicability of the reference protocol EUSAAR2 in the Semi-Continuous OCEC analyzer under two environments, an urban background site influenced by traffic emissions and a regional background site. The comparison of the 24-h averaged OC and EC measurements of the Semi-Continuous analyzer with the OC and EC concentrations determined offline in PM2.5 24 h filters yielded very good agreement for both denuded and undenuded samples. In the urban background site, the regression for EC yielded a slope of 0.93 and 1.04 (b = 0.07 and 0.05, R2 = 0.83 and 0.84), for denuded and undenuded samples respectively. The slopes of OC regressions were 0.99 (b = -0.18, R2 = 0.81) for the low volume and 0.93 (b = 0.12, R2 = 0.84) for the high volume samples. In the regional background site, the slopes of the EC regression with the denuded and undenuded samples was 0.91 and 1.02 correspondingly (b = 0 and - 0.03, R2 = 0.77 and 0.89). The regression of OC had slopes close to 1; 1.03 for the high volume and 0.95 for the low volume sampler (b = 0.08 and 0.26, R2 = 0.78 and 0.78). BC measurements obtained by an aethalometer and MAAP were in very good agreement with EC at both sampling sites. BC levels were consistently higher than EC (slope of the regression aethalometer BC vs EC slope a = 1.2, intercept b = 0.19, R2 = 0.79, for the urban background site and a = 1.9, b = -0.04, R2 = 0.94, for the regional site, slope MAAP BC vs EC a = 1.2, b = 0.06, R2 = 0.94, for the urban background site and 1.7, b = -0.03, R2 = 0.96, for the regional site). This confirms the need of using the site-specific mass absorption cross section (MAC) instead of the ones provided by manufacturers for the conversion of absorption units into BC mass concentration. BC data correlated very well with the optical EC obtained from the semi-continuous OCEC analyzer (a = 1.3, b = 0.16, R2 = 0.80 for the urban background site and a = 1.7, b = 0.009, R2 = 0.94 for the regional site, respectively). The comparison of OC concentrations by the Semi-Continuous Sunset analyzer with organic aerosol online measurements by ACSM showed strong correlations. The ratio OA/OC was 1.9 and 2.3 for the urban background and regional sites. The accumulation of refractory material on the filter, because of prolonged periods of sampling, caused a shift of the split point to the inert mode and changes on PC formation and evolution. Extreme dust outbreaks lead to the overestimation of OC due to the evolution of carbonate in the He mode. Generally, the Sunset Semi-Continuous OCEC analyzer with EUSAAR2 provided robust and consistent measurements with offline thermal-optical analysis.
Collapse
Affiliation(s)
- A Karanasiou
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC), Barcelona, Spain.
| | - P Panteliadis
- GGD, Department of Air Quality, Public Health Service Amsterdam, 1018WT, the Netherlands
| | - N Perez
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC), Barcelona, Spain
| | - M C Minguillón
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC), Barcelona, Spain
| | - M Pandolfi
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC), Barcelona, Spain
| | - G Titos
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC), Barcelona, Spain; Department of Applied Physics, University of Granada, Granada 18071, Spain
| | - M Viana
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC), Barcelona, Spain
| | - T Moreno
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC), Barcelona, Spain
| | - X Querol
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC), Barcelona, Spain
| | - A Alastuey
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC), Barcelona, Spain
| |
Collapse
|
17
|
Gabaldon-Perez A, Bonanad C, Marcos-Garces V, Gavara J, Merenciano-Gonzalez H, Nunez-Marin G, Lorenzo-Hernandez M, Perez N, Rios-Navarro C, De Dios E, Racugno P, Lopez-Lereu M, Monmeneu J, Chorro F, Bodi V. Prognostic value of vasodilator stress CMR in elderly patients with known or suspected chronic coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In recent guidelines, non-invasive imaging techniques play a pivotal role in the management of chronic coronary syndrome (CCS). The elderly represent a large percentage of our routine CCS population and risk stratification in this scenario is challenging. The potential of vasodilator stress cardiovascular magnetic resonance (vs-CMR) for this purpose is unknown.
Purpose
We explored the prognostic value of the ischemic burden, as derived from vs-CMR, in elderly patients with known or suspected CCS.
Methods
From the general cohort of 6389 patients with known or suspected CCS submitted to undergo vs-CMR in our health department from 2001 to 2016, we performed a subanalysis of the 1225 patients >70 year-old (mean age 77±5 years, 51% male). Clinical and vs-CMR characteristics were prospectively recorded. The ischemic burden (at stress first-pass perfusion imaging) was computed (using the 17-segment model). The occurrence of major adverse cardiac events (MACE) defined as all-cause death and/or non-fatal myocardial infarction (whichever occurred first) was retrospectively revised using the electronic regional health system registry.
Results
During a median follow-up of 2.7 years, 203 MACEs were registered (17%). Age (77±4 vs. 76±5 years) was not significantly different in patients with and without MACE. Larger left ventricular (LV) end-diastolic and end-systolic volume indexes, more depressed LV ejection fraction, more extensive areas with late gadolinium enhancement and ischemic burden were detected in patients with MACE (p<0.001 for all comparisons). In non-revascularized patients (n=1118), the MACE rate ranged from 13% (in patients with 0–1 ischemic segments) to 35% (in those with >8 ischemic segments, p<0.001 for the trend). In the small subset of revascularized patients (n=107), revascularization exerted a non-significant protective effect only in patients with extensive ischemic burden (>5 segments).
Conclusions
Vasodilator stress CMR represents a valuable tool to stratify risk in elderly patients with known or suspected CCS and might be helpful to guide decision-making.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- A Gabaldon-Perez
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - C Bonanad
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - V Marcos-Garces
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - J Gavara
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | | | - G Nunez-Marin
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - M Lorenzo-Hernandez
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - N Perez
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | | | - E De Dios
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - P Racugno
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | | | | | - F.J Chorro
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - V Bodi
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| |
Collapse
|
18
|
Marcos Garces V, Gavara J, Perez N, Rios-Navarro C, De Dios E, Gabaldon-Perez A, Merenciano-Gonzalez H, Racugno P, Bonanad C, Canoves J, Lopez-Fornas F, Lopez-Lereu M, Monmeneu J, Chorro F, Bodi V. A novel clinical and stress cardiac magnetic resonance score to predict long-term all-cause mortality in patients with known or suspected chronic coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Vasodilator stress cardiac magnetic resonance (stressCMR) has shown robust diagnostic and prognostic value in patients with known or suspected chronic coronary syndrome (CCS). However, it is unknown whether integration of several prognostic stressCMR parameters, such as the ischemic burden (number of segments with first-pass stress-induced perfusion defects -PD-) and left ventricular ejection fraction (LVEF), with clinical variables can improve risk prediction in this population.
Purpose
We aim to explore the usefulness of a clinical-stressCMR score to predict the risk of all-cause mortality in patients with known or suspected CCS submitted to undergo a stressCMR.
Methods
We included 6187 patients in a large prospective multicenter registry (mean age 65.18±11.51 years, 37.3% female) which underwent stressCMR for known or suspected CCS. Several clinical and stressCMR variables were collected, such as LVEF, end-diastolic and end-systolic volume indices, ischemic burden and segments with necrosis (with late gadolinium enhancement imaging).
Results
During a mean and median follow-up of 5.85±3.82 years we registered 682 (11%) all-cause deaths. Several clinical and all stressCMR variables were associated with all-cause mortality in univariate analysis. However, the only independent predictors of all-cause mortality in multivariate analysis were age (HR 1.07 [1.06–1.08] per year, p<0.001), male sex (HR 1.36 [1.15–1.61], p<0.001), diabetes mellitus (HR 1.6 [1.37–1.87], p<0.001), LVEF (0.98 [0.97–0.98] per %, p<0.001) and ischemic burden (HR 1.04 [1.02–1.06] per segment with stress-induced PD, p=0.001). By means of the chi-square increase at each step of the stepwise multiparametric Cox regression we created a clinical-stressCMR score that included these variables (age, male sex, diabetes mellitus, LVEF and ischemic burden) kept in their continuous state if possible. This score showed a good performance to predict all-cause mortality (area under the curve = 0.716 [0.697–0.735], p<0.001). Dividing the population into quintiles according to the clinical-stressCMR score allowed for a stratification of the annualized risk of all-cause mortality (0.39%/year, 0.94%/year, 1.62%/year, 2.63%/year and 3.83%/year, respectively; log-rank 420.33 and p<0.001 for Kaplan-meier curves).
Conclusions
A novel clinical-stressCMR, which includes clinical (age, male sex, and diabetes mellitus) and stressCMR (LVEF and ischemic burden) variables, can provide robust prediction and stratification of the risk of all-cause mortality in a population of patients with know or suspected CCS.
Figure 1. Clinical-stress CMR score
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (PIE15/00013, PI17/01836, and CIBERCV16/11/00486 grants) and by Generalitat Valenciana (GV/2018/116).
Collapse
Affiliation(s)
- V Marcos Garces
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J Gavara
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - N Perez
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | | | - E De Dios
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - A Gabaldon-Perez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | | | - P Racugno
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - C Bonanad
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J Canoves
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - F.J Lopez-Fornas
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - M.P Lopez-Lereu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - J.V Monmeneu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - F.J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| |
Collapse
|
19
|
Marcos Garces V, Merenciano-Gonzalez H, Gabaldon-Perez A, Nunez-Marin G, Lorenzo-Hernandez M, Gavara J, Perez N, Rios-Navarro C, De Dios E, Bonanad C, Racugno P, Lopez-Lereu M, Monmeneu J, Chorro F, Bodi V. Chest pain of unknown coronary origin: can exercise ECG testing contribute to long-term risk prediction on top of vasodilator stress cardiac magnetic resonance? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prognostic value of both exercise ECG testing (ExECG) and vasodilator stress cardiac magnetic resonance (VS-CMR) is well-known in patients with chest pain of unknown coronary origin. However, it is unknown whether performing both techniques can improve the risk stratification of these patients.
Purpose
We aim to confirm the additive prognostic value of ExECG and VS-CMR in a real-world cohort of patients with chest pain of unknown coronary origin.
Methods
We retrospectively included 288 patients in which ExECG and VS-CMR had been subsequently performed within one year. Clinical, ExECG and VS-CMR variables were registered. We performed univariate and multivariate analysis to check for the association of variables with the risk of MACE, defined as a combined endpoint of acute coronary syndrome (ACS), admission for heart failure (aHF) or all-cause death.
Results
During a mean follow-up of 4.2±2.15 years, we registered 27 MACE (15 ACS, 8 aHF and 8 all-cause deaths). The history of hypertension, previous coronary artery disease and/or coronary artery bypass grafting, lower maximal heart rate during ExECG (maxHR) and more extensive ischemic burden (segments with perfusion defects -PD- on stress first-pass perfusion) and myocardial necrosis (number of segments with necrosis at late gadolinium enhancement imaging) associated with the MACE endpoint. However, the only independent predictors of MACE were maxHR during ExECG (HR 0.98 [0.96–0.99], p=0.01) and more extensive segments with PD in the VS-CMR (HR 1.2 [1.07–1.34], p=0.002). We identified the best cut-off using the Youden index derived from receiver operating characteristics (ROC) analysis to predict MACE - it was ≤130bpm for maxHR during ExECG and ≥2 segments with PD on VS-CMR. These cathegories allowed us to stratify the annualized rate of MACE, which was very low (0.97%/year) in patients with normal maxHR and no PD on VS-CMR, intermediate in patients with only abnormal maxHR (1.98%/year) or PD on VS-CMR (3.24%/year) and high in patients with both abnormal maxHR and segments with PD (6.26%/year). Adding maxHR to the multivariable model including stress-induced PD by VS-CMR significantly improved the predictive power of MACE as derived from the continuous reclassification improvement index (0.47 [0.10–0.81], p<0.05).
Conclusions
ExECG and VS-CMR can have an additive prognostic value to predict the long-term risk of MACE in patients with chest pain of unknown coronary origin. Patients with maxHR during ExECG ≤130bpm and ≥2 segments with PD on VS-CMR are at the highest risk of MACE.
Figure 1. MACE risk stratification.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (PIE15/00013, PI17/01836, and CIBERCV16/11/00486 grants) and by Generalitat Valenciana (GV/2018/116).
Collapse
Affiliation(s)
- V Marcos Garces
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | | | - A Gabaldon-Perez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - G Nunez-Marin
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - M Lorenzo-Hernandez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J Gavara
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - N Perez
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | | | - E De Dios
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - C Bonanad
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - P Racugno
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - M.P Lopez-Lereu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - J.V Monmeneu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - F.J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| |
Collapse
|
20
|
Calvo M, Guzman J, Perez P, Ortega L, Mendieta G, Lorenzatti D, Perez N, Gavara J, Marcos Garces V, Brugaletta S, Sabate M, Bodi V, Ortiz Perez J. Complete revascularization of non-culprit lesions in stemi is associated with improved myocardial salvage and reduced microvascular obstruction: a cardiac magnetic resonance study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The COMPLETE trial showed that routine and complete Percutaneous Coronary Intervention (PCI) of non-infarct related artery (non-IRA) lesions in STEMI was associated with a significant reduction in the rates of death or new myocardial infarction. However, whether this benefit is related to improved myocardial salvage and left ventricular (LV) function is unknown.
Methods
We prospectively included 465 patients with first STEMI reperfused by primary PCI. Late gadolinium-enhanced Cardiac Magnetic Resonance (CMR) was obtained during admission to measure the area at risk (AAR), IRA-infarct size (IS) as % LV mass, and myocardial salvage index (MSI) as % of AAR. The study was repeated in 392 of them at 6 months follow-up to compute LV volumes and ejection fraction (EF).
Results
Patients with three-vessel disease had larger IS than those with two or single vessel disease (25.4±14.5% vs 19.0±13.1% vs 19.0±12.8% LV mass respectively, p<0.05), despite no differences in AAR (33±11% LV mass for all). Accordingly, MSI decreased progressively for one, two or three-vessel disease (42.4±31.4 vs 41.5±30.6 vs 25.1±31.3% AAR respectively, p<0.01). The number of myocardial segments with microvascular obstruction (MVO) was also higher for three-vessel disease (1.9±1.9) than for two (1.1±1.7) or single-vessel disease (1.2±1.8), p<0.05. Mean follow-up EF also decreased progressively with the number of vessels involved (50.7±9.4, 49.1±11.4 and, 44.4±11.2% respectively, p<0.01). A total of 183 patients had multivessel disease. Among them, those with complete revascularization (n=51) had larger MSI (46.4±35.2 vs 34.5±29.3% AAR, p<0.04) and were less likely to have MVO phenomenon (28.6 vs 49.2%, p<0.05). However, no significant differences in the change in EF was observed between both groups (ΔEF:+4.4±6.2 vs +4.3±6.2%, p=0.985 for the interaction).
Conclusion
The presence and extent of multivessel disease influence myocardial salvage and MVO following primary PCI in STEMI. Improvement in myocardial salvage in the IRA territory and a reduction in microvascular obstruction may mediate the beneficial effects of complete revascularization.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fundaciό La Marato TV3 2015303132, FIS PI15/00531. Partially funded with FEDER funds.
Collapse
Affiliation(s)
- M Calvo
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - J Guzman
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - P Perez
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - L.G Ortega
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - G Mendieta
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - D Lorenzatti
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - V Marcos Garces
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - S Brugaletta
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - M Sabate
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - V Bodi
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - J.T Ortiz Perez
- Clinic Cardiovascular Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| |
Collapse
|
21
|
Abstract
COVID-19 has resulted in a dramatic increase in the use of telemedicine but this could worsen disparities. We review recent telemedicine policy changes and their implications regarding disparities. We also discuss what systems can do to improve access to telemedicine and to best meet the needs of underserved patients.
While the rapid expansion of telemedicine in response to the COVID-19 pandemic highlights the impressive ability of health systems to adapt quickly to new complexities, it also raises important concerns about how to implement these novel modalities equitably. As the healthcare system becomes increasingly virtual, it risks widening disparities among marginalized populations who have worse health outcomes at baseline and limited access to the resources necessary for the effective use of telemedicine. In this article, we review recent policy changes and outline important recommendations that governments and health care systems can adopt to improve access to telemedicine and to tailor the use of these technologies to best meet the needs of underserved patients. We suggest that by making health equity integral to the implementation of telemedicine now, it will help to ensure that all can benefit from its use going forward and that this will be increasingly integral to care delivery.
Collapse
Affiliation(s)
- Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jorge A Rodriguez
- Department of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lydia R Maurer
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Numa Perez
- Department of Surgery, Healthcare Transformation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda Reich
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, BC3-2M, Boston, MA 02120-1613, USA
| |
Collapse
|
22
|
Malone SK, Peleckis AJ, Pack AI, Perez N, Yu G, Rickels MR, Goel N. 1020 Sleep and Glycemic Control in Adults With Long-Standing Type 1 Diabetes and Hypoglycemia Unawareness. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Nocturnal hypoglycemia is life threatening for individuals with type 1 diabetes (T1D) due to loss of hypoglycemia symptom recognition (hypoglycemia unawareness) and impaired glucose counterregulation. These individuals also show disturbed sleep, which may result from glycemic dysregulation. Whether use of a hybrid closed loop (HCL) insulin delivery system with integrated continuous glucose monitoring (CGM) designed for improving glycemic control, relates to better sleep across time in this population remains unknown.
Methods
Six adults (median age=58y,T1D duration=41y) participated in an 18-month ongoing clinical trial assessing the effectiveness of an HCL system. Sleep and glycemic control were measured concurrently using wrist actigraphs and CGM at baseline (1 week) and months 3 and 6 (3 weeks) following HCL initiation. BMI and hemoglobin A1c (HbA1c) were collected at all timepoints. Spearman’s correlations modeled associations between sleep, BMI, and glycemic control at each time point. Repeated ANOVAs modeled sleep and glycemic control changes from baseline to 3 months and to 6 months.
Results
Sleep and glycemic control indices showed significant associations at baseline and 3 months. More time-in-bed and later sleep offset related to higher HbA1c levels at baseline. Later sleep onset, midpoint and offset, and greater sleep efficiency associated with greater %time with hyperglycemia (glucose >180 mg/dL) or hypoglycemia (glucose <70 mg/dL) at baseline and 3 months. Longer sleep duration and greater sleep efficiency related to greater %time with hyperglycemia at 3 months. At 3 months, more wake after sleep onset associated with lower HbA1c levels and longer nocturnal awakenings and more sleep fragmentation associated with less glycemic variability. While both sleep and glycemic control improved from baseline to 3 and 6 months, these were not statistically significant.
Conclusion
Various dimensions of actigraphic sleep related to concurrently estimated glycemic indices indicative of poorer glycemic control and HbA1c across time in adults with long-standing T1D and hypoglycemia unawareness.
Support
This work was supported by NIH R01DK117488 (NG), R01DK091331 (MRR), and K99NR017416 (SKM).
Collapse
Affiliation(s)
- S K Malone
- Rory Meyers College of Nursing, New York University, New York, NY
| | - A J Peleckis
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - A I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - N Perez
- Rory Meyers College of Nursing, New York University, New York, NY
| | - G Yu
- Rory Meyers College of Nursing, New York University, New York, NY
| | - M R Rickels
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - N Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| |
Collapse
|
23
|
Bhogal P, Lylyk I, Chudyk J, Perez N, Bleise C, Lylyk P. The Contour-Early Human Experience of a Novel Aneurysm Occlusion Device. Clin Neuroradiol 2020; 31:147-154. [PMID: 31993679 DOI: 10.1007/s00062-020-00876-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Endosaccular flow disruption is a recognized treatment options for treating both unruptured and ruptured aneurysms. The Contour device is designed to target the neck of an aneurysm and cause flow disruption within the aneurysm hence promoting thrombosis and neo-endothelialization at the neck. This article presents initial experiences with the Contour. METHODS The prospectively maintained database was retrospectively reviewed to identify patients treated with the Contour device. Demographic data, aneurysm characteristics, clinical result, and clinical and radiological follow-up information were recorded. RESULTS The review identified 3 patients (2 female), with 3 unruptured aneurysms, of average age 67 ± 8.7 years (range 62-77 years). The aneurysms were all located in the anterior circulation including one pericallosal, one at the A1-2 junction and one on the ICA bifurcation. The mean average dome height was 7.6 ± 0.62 mm (range 7.1-8.3 mm), dome width 5.7 ± 2 mm (range 3.5-7.5 mm), and neck width 3.6 ± 0.95 mm (range 2.5-4.2 mm). At follow-up angiography two of the aneurysms were completely occluded and one device had displaced into the aneurysm sac due to inappropriate positioning of the device. Of the patients one had minor stroke during the postoperative period but returned to baseline neurology. All patients were mRS 0 at last follow-up. CONCLUSION The Contour is a promising new aneurysm occlusion device. Further studies with longer term follow-up are required to determine the efficacy of this novel device.
Collapse
Affiliation(s)
- P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Whitechapel Road, E1 1BB, London, UK.
| | - I Lylyk
- Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - J Chudyk
- Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - N Perez
- Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - C Bleise
- Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P Lylyk
- Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| |
Collapse
|
24
|
Perez N, Westfal M, Chang D, Griggs C, Pratt J, Gee D. A204 Pediatric Metabolic and Bariatric Surgery – Impact of Adult Surgeon Volume on Postoperative Outcomes. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
25
|
Ordoobadi AJ, Perez N, Westfal M, Chang DC, Kelleher C. Social Network Analysis of Authors in Scientific Journals. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.362] [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: 11/30/2022]
|
26
|
Bhogal P, Bleise C, Chudyk J, Lylyk I, Viso R, Perez N, Henkes H, Lylyk P. The p48MW Flow Diverter-Initial Human Experience. Clin Neuroradiol 2019; 31:135-145. [PMID: 31435722 PMCID: PMC7943536 DOI: 10.1007/s00062-019-00827-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023]
Abstract
Background and Purpose The use of flow diverters to treat aneurysms arising from small caliber parent vessels has been reported. This article reports the results of the first in experiences with the p48MW (p48 Movable Wire) in humans, a device specifically designed to target vessels 1.75–3 mm in diameter. Methods This monocentric study retrospectively reviewed the prospectively maintained database to identify all patients treated with the p48MW device between January 2017 and January 2019 at this institution. Patient demographics, aneurysm characteristics, angiographic and clinical follow-up were recorded as well as complications. Results A total of 25 patients (20 female) with an average age of 55 ± 12.9 years (range 34–84) with 25 aneurysms were identified. The majority of the aneurysms was located in the anterior circulation (19/25, 76%). The average aneurysm dome width was 3.98 ± 3.6 mm (range 1.2–13 mm). Complete occlusion was seen in 18/24 (75%) aneurysms with neck remnants in 1/24 (4.2%) and continued aneurysm filling seen in the remaining cases (5/24, 20.8%). Adequate occlusion was seen in 79.2% of aneurysms (Raymond Roy Classification [RRC] grade I or II) during the follow-up period. There was a single technical complication with inappropriate deployment of the first p48MW. There was a single clinical complication (4%); however, the patient made a complete recovery (modified Rankin Scale [mRS] 0) and one patient died secondary to uncontrollable status epilepticus following acute subarachnoid hemorrhage unrelated to the treatment. Conclusion The p48MW is safe and effective for the treatment of aneurysms including those arising from distal vessels.
Collapse
Affiliation(s)
- P Bhogal
- The Royal London Hospital, Whitechapel Road, E1 1BB, London, UK.
| | - C Bleise
- Neuroradiological Clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - J Chudyk
- Neuroradiological Clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - I Lylyk
- Neuroradiological Clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - R Viso
- Neuroradiological Clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - N Perez
- Neuroradiological Clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - H Henkes
- Medical Faculty, University Duisburg-Essen, Essen, Germany.,Neuroradiological Clinic, Klinikum Stuttgart, Stuttgart, Germany
| | - P Lylyk
- Neuroradiological Clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| |
Collapse
|
27
|
Amendola B, Perez N, Qureshi I, Melotek J, Amendola M, Wu X. P2.01-07 Safety and Efficacy of LATTICE Radiotherapy in Voluminous Non-Small Cell Lung Cancer: A Retrospective Study of 10 Patients Over 7 Year Period. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1061] [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]
|
28
|
Kluyts HL, le Manach Y, Munlemvo DM, Madzimbamuto F, Basenero A, Coulibaly Y, Rakotoarison S, Gobin V, Samateh AL, Chaibou MS, Omigbodun AO, Amanor-Boadu SD, Tumukunde J, Madiba TE, Pearse RM, Biccard BM, Abbas N, Abdelatif AI, Abdoulaye T, Abd-rouf A, Abduljalil A, Abdulrahman A, Abdurazig S, Abokris A, Abozaid W, Abugassa S, Abuhdema F, Abujanah S, Abusamra R, Abushnaf A, Abusnina S, Abuzalout T, Ackermann H, Adamu Y, Addanfour A, Adeleke D, Adigun T, Adisa A, Adjignon SV, Adu-Aryee N, Afolabi B, Agaba A, Agaba P, Aghadi K, Agilla H, Ahmed B, Ahmed EZ, Ahmed AJ, Ahmed M, Ahossi R, Aji S, Akanyun S, Akhideno I, Akhter M, Akinyemi O, Akkari M, Akodjenou J, AL Samateh A, al Shams E, Alagbe-Briggs O, Alakkari E, Alalem R, Alashhab M, Alatise O, Alatresh A, Alayeb Alayeb M, Albakosh B, Albert F, Alberts A, Aldarrat A, Alfari A, Alfetore A, Algbali M, Algddar A, Algedar H, Alghafoud I, Alghazali A, Alhajj M, Alhendery Alhendery A, Alhoty F, Ali A, Ali Y, Ali A, Alioune BS, Alkassem M, Alkchr M, Alkesa T, Alkilani A, Alkobty Alkobty F, Allaye T, Alleesaib S, Alli A, Allopi K, Allorto N, Almajbery A, Almesmary R, Almisslati S, Almoraid F, Alobeidi H, Swaleh A, Swayeb E, Szpytko A, Taiwo N, Tarhuni A, Tarloff D, Tchaou B, Tchegnonsi C, Tchoupa M, Teeka M, Alomami M, Thakoor B, Theunissen M, Thomas B, Thomas M, Thotharam A, Tobiko O, Torborg A, Tshisekedi S, Tshisola S, Tshitangano R, Alphonsus CS, Tshivhula F, Tshuma H, Tumukunde J, Tun M, Udo I, Uhuebor D, Umeh K, Usenbo A, Uwiteyimbabazi J, Van der Merwe D, Alqawi O, van der Merwe F, van der Walt J, van Dyk D, Van Dyk J, van Niekerk J, van Wyk S, van Zyl H, Veerasamy B, Venter P, Vermeulen A, Alraheem A, Villarreal R, Visser J, Visser L, Voigt M, von Rahden RP, Wafa A, Wafula A, Wambugu P, Waryoba P, Waweru E, Alsabri S, Weideman M, Wise RD, Wynne E, Yahya A, Yahya A, Yahya R, Yakubu Y, Yanga J, Yangazov Y, Yousef O, Alsayed A, Yousef G, Youssouf C, Yunus A, Yusuf A, Zeiton A, Zentuti H, Zepharine H, Zerihun A, Zhou S, Zidan A, Alsellabi B, Zimogo Zié S, Zinyemba C, Zo A, Zomahoun L, Zoobei N, Zoumenou E, Zubia N, Al-Serksi M, Alshareef M, Altagazi A, Aluvale J, Alwahedi H, Alzahra E, Alzarouk M, Al-Zubaidy K, Amadou M, Amadou M, Amanor-Boadu SD, Amer AA, Amisi B, Amuthenu M, Anabah T, Anani F, Anderson P, Andriamampionona A, Andrianina L, Anele A, Angelin R, Anjar N, Antùnez O, Antwi-Kusi A, Anyanwu L, Aribi A, Arowolo O, Arrey O, Ashebir DZ, Assefa S, Assoum G, Athanse V, Athombo J, Atiku M, Atito-Narh E, Atomabe A, Attia A, Aungraheeta M, Aurélia D, Ayandipo O, Ayebale A, Azzaidey H, Babajee N, Badi H, Badianga E, Baghni R, Bahta M, Bai M, Baitchu Y, Baloyi A, Bamuza K, Bamuza M, Bangure L, Bankole O, Barongo M, Barow M, Basenero A, Bashiya L, Basson C, Bechan S, Belhaj S, Ben Mansour M, Benali D, Benamour A, Berhe A, Bertie J, Bester J, Bester M, Bezuidenhout J, Bhagwan K, Bhagwandass D, Bhat K, Bhuiyan M, Biccard BM, Bigirimana F, Bikuelo C, Bilby B, Bingidimi S, Bischof K, Bishop DG, Bitta C, Bittaye M, Biyase T, Blake C, Blignaut E, Blignaut F, BN Tanjong B, Bogoslovskiy A, Boloko P, Boodhun S, Bori I, Boufas F, Brand M, Brouckaert NT, Bruwer J, Buccimazza I, Bula Bula I, Bulamba F, Businge B, Bwambale Y, Cacala S, Cadersa M, Cairns C, Carlos F, Casey M, Castro A, Chabayanzara N, Chaibou M, Chaibva T, Chakafa N, Chalo C, Changfoot C, Chari M, Chelbi L, Chibanda J, Chifamba H, Chikh N, Chikumba E, Chimberengwa P, Chirengwa J, Chitungo F, Chiwanga M, Chokoe M, Chokwe T, Chrirangi B, Christian M, Church B, Cisekedi J, Clegg-Lamptey J, Cloete E, Coltman M, Conradie W, Constance N, Coulibaly Y, Cronje L, Da Silva M, Daddy H, Dahim L, Daliri D, Dambaki M, Dasrath A, Davids J, Davies GL, De Lange J, de Wet J, Dedekind B, Degaulle M, Dehal V, Deka P, Delinikaytis S, Desalu I, Dewanou H, Deye MM, Dhege C, Diale B, Dibwe D, Diedericks B, Dippenaar J, Dippenaar L, Diyoyo M, Djessouho E, Dlamini S, Dodiyi-Manuel A, Dokolwana B, Domoyyeri D, Drummond LW, du Plessis D, du Plessis W, du Preez L, Dube K, Dube N, Dullab K, Duvenhage R, Echem R, Edaigbini S, Egote A, Ehouni A, Ekwen G, Ekwunife N, El Hensheri M, Elfaghi I, Elfagieh M, Elfallah S, Elfiky M, Elgelany S, Elghallal A, Elghandouri M, Elghazal Z, Elghobashy A, Elharati F, Elkhogia AM, Elkhwildi R, Ellis S, Elmadani L, Elmadany H, Elmehdawi H, Elmgadmi A, Eloi H, Elrafifi D, Elsaadi G, Elsaity R, Elshikhy A, Eltaguri M, Elwerfelli A, Elyasir I, Elzoway A, Elzufri A, Enendu E, Enicker B, Enwerem E, Esayas R, Eshtiwi M, Eshwehdi A, Esterhuizen J, Esterhuizen TM, Etuk E, Eurayet O, Eyelade O, Fanjandrainy R, Fanou L, Farina Z, Fawzy M, Feituri A, Fernandes N, Ford L, Forget P, François T, Freeman T, Freeman Y, Gacii V, Gadi B, Gagara M, Gakenia A, Gallou P, Gama G, Gamal M, Gandy Y, Ganesh A, Gangaly D, Garcia M, Gatheru A, Gaya S, Gbéhadé O, Gerbel G, Ghnain A, Gigabhoy R, Giles D, Girmaye G, Gitau S, Githae B, Gitta S, Gobin V, Goga R, Gomati A, Gonzalez M, Gopall J, Gordon CS, Gorelyk O, Gova M, Govender K, Govender P, Govender S, Govindasamy V, Green-Harris J, Greenwood M, Grey-Johnson S, Grobbelaar M, Groenewald M, Grünewald K, Guegni A, Guenane M, Gueye S, Guezo M, Gunguwo T, Gweder M, Gwila M, Habimana L, Hadecon R, Hadia E, Hamadi L, Hammouda M, Hampton M, Hanta R, Hardcastle TC, Hariniaina J, Hariparsad S, Harissou A, Harrichandparsad R, Hasan S, Hashmi H, Hayes M, Hdud A, Hebli S, Heerah H, Hersi S, Hery A, Hewitt-Smith A, Hlako T, Hodges S, Hodgson RE, Hokoma M, Holder H, Holford E, Horugavye E, Houston C, Hove M, Hugo D, Human C, Hurri H, Huwidi O, Ibrahim A, Ibrahim T, Idowu O, Igaga I, Igenge J, Ihezie O, Ikandi K, Ike I, Ikuku J, Ilbarasi M, Ilunga I, Ilunga J, Imbangu N, Imessaoudene Z, Imposo D, Iraya A, Isaacs M, Isiguzo M, Issoufou A, Izquirdo P, Jaber A, Jaganath U, Jallow C, Jamabo S, Jamal Z, Janneh L, Jannetjies M, Jasim I, Jaworska MA, Jay Narain S, Jermi K, Jimoh R, Jithoo S, Johnson M, Joomye S, Judicael R, Judicaël M, Juwid A, Jwambi L, Kabango R, Kabangu J, Kabatoro D, Kabongo A, Kabongo K, Kabongo L, Kabongo M, Kady N, Kafu S, Kaggya M, Kaholongo B, Kairuki P, Kakololo S, Kakudji K, Kalisa A, Kalisa R, Kalufwelu M, Kalume S, Kamanda R, Kangili M, Kanoun H, Kapesa, Kapp P, Karanja J, Karar M, Kariuki K, Kaseke K, Kashuupulwa P, Kasongo K, Kassa S, Kateregga G, Kathrada M, Katompwa P, Katsukunya L, Kavuma K, Khalfallah, Khamajeet A, Khetrish S, Kibandwa, Kibochi W, Kilembe A, Kintu A, Kipng’etich B, Kiprop B, Kissoon V, Kisten TK, Kiwanuka J, Kluyts HL, Knox M, Koledale A, Koller V, Kolotsi M, Kongolo M, Konwuoh N, Koperski W, Koraz M, Kornilov A, Koto MZ, Kransingh S, Krick D, Kruger S, Kruse C, Kuhn W, Kuhn W, Kukembila A, Kule K, Kumar M, Kusel BS, Kusweje V, Kuteesa K, Kutor Y, Labib M, Laksari M, Lanos F, Lawal T, Le Manach Y, Lee C, Lekoloane R, Lelo S, Lerutla B, Lerutla M, Levin A, Likongo T, Limbajee M, Linyama D, Lionnet C, Liwani M, Loots E, Lopez AG, Lubamba C, Lumbala K, Lumbamba A, Lumona J, Lushima R, Luthuli L, Luweesi H, Lyimo T, Maakamedi H, Mabaso B, Mabina M, Maboya M, Macharia I, Macheka A, Machowski A, Madiba TE, Madsen A, Madzimbamuto F, Madzivhe L, Mafafo S, Maghrabi M, Mahamane DD, Maharaj A, Maharaj A, Maharaj A, Mahmud M, Mahoko M, Mahomedy N, Mahomva O, Mahureva T, Maila R, Maimane D, Maimbo M, Maina S, Maiwald DA, Maiyalagan M, Majola N, Makgofa N, Makhanya V, Makhaye W, Makhlouf N, Makhoba S, Makopa E, Makori O, Makupe AM, Makwela M, Malefo M, Malongwe S, Maluleke D, Maluleke M, Mamadou KT, Mamaleka M, Mampangula Y, Mamy R, Mananjara M, Mandarry M, Mangoo D, Manirimbere C, Manneh A, Mansour A, Mansour I, Manvinder M, Manyere D, Manzini V, Manzombi J, Mapanda P, Marais L, Maranga O, Maritz J, Mariwa F, Masela R, Mashamba M, Mashava DM, Mashile M, Mashoko E, Masia O, Masipa J, Masiyambiri A, Matenchi M, Mathangani W, Mathe R, Matola CY, Matondo P, Matos-Puig R, Matoug F, Matubatuba J, Mavesere H, Mavhungu R, Maweni S, Mawire C, Mawisa T, Mayeza S, Mbadi R, Mbayabu M, Mbewe N, Mbombo W, Mbuyi T, Mbuyi W, Mbuyisa M, Mbwele B, Mehyaoui R, Menkiti I, Mesarieki L, Metali A, Mewanou S, Mgonja L, Mgoqo N, Mhatu S, Mhlari T, Miima S, Milod I, Minani P, Mitema F, Mlotshwa A, Mmasi J, Mniki T, Mofikoya B, Mogale J, Mohamed A, Mohamed A, Mohamed A, Mohamed S, Mohamed S, Mohamed T, Mohamed A, Mohamed A, Mohamed A, Mohamed P, Mohammed I, Mohammed F, Mohammed M, Mohammed N, Mohlala M, Mokretar R, Molokoane F, Mongwe K, Montenegro L, Montwedi O, Moodie Q, Moopanar M, Morapedi M, Morulana T, Moses V, Mossy P, Mostafa H, Motilall S, Motloutsi S, Moussa K, Moutari M, Moyo O, Mphephu P, Mrara B, Msadabwe C, Mtongwe V, Mubeya F, Muchiri K, Mugambi J, Muguti G, Muhammad A, Mukama I, Mukenga M, Mukinda F, Mukuna P, Mungherera A, Munlemvo DM, Munyaradzi T, Munyika A, Muriithi J, Muroonga M, Murray R, Mushangwe V, Mushaninga M, Musiba V, Musowoya J, Mutahi S, Mutasiigwa M, Mutizira G, Muturi A, Muzenda T, Mvwala K, Mvwama N, Mwale A, Mwaluka C, Mwamba J, Mwanga H, Mwangi C, Mwansa S, Mwenda V, Mwepu I, Mwiti T, Mzezewa S, Nabela L, Nabukenya M, Nabulindo S, Naicker K, Naidoo D, Naidoo L, Naidoo L, Naidoo N, Naidoo R, Naidoo R, Naidoo S, Naidoo T, Naidu T, Najat N, Najm Y, Nakandungile F, Nakangombe P, Namata C, Namegabe E, Nansook A, Nansubuga N, Nantulu C, Nascimento R, Naude G, Nchimunya H, Ndaie M, Ndarukwa P, Ndasi H, Ndayisaba G, Ndegwa D, Ndikumana R, Ndonga AK, Ndung’u C, Neil M, Nel M, Neluheni E, Nesengani D, Nesengani N, Netshimboni L, Ngalala A, Ngari B, Ngari N, Ngatia E, Ngcobo G, Ngcobo T, Ngorora D, Ngouane D, Ngugi K, Ngumi ZW, Nibe Z, Ninise E, Niyondiko J, Njenga P, Njenga M, Njoroge M, Njoroge S, Njuguna W, Njuki P, Nkesha T, Nkuebe T, Nkuliyingoma N, Nkunjana M, Nkwabi E, Nkwine R, Nnaji C, Notoane I, Nsalamba S, Ntlhe L, Ntoto C, Ntueba B, Nyassi M, Nyatela-Akinrinmade Z, Nyawanda H, Nyokabi N, Nziene V, Obadiah S, Ochieng O, Odia P, Oduor O, Ogboli-Nwasor E, Ogendo S, Ogunbode O, Ogundiran T, Ogutu O, Ojewola R, Ojujo M, Ojuka D, Okelo O, Okiya S, Okonu N, Olang P, Omigbodun AO, Omoding S, Omoshoro-Jones J, Onyango R, Onyegbule A, Orjiako O, Osazuwa M, Oscar K, Osinaike B, Osinowo A, Othin O, Otman F, Otokwala J, Ouanes F, Oumar O, Ousseini A, Padayachee S, Pahlana S, Pansegrouw J, Paruk F, Patel M, Patel U, Patience A, Pearse RM, Pembe J, Pengemale G, Perez N, Aguilera Perez M, Peter AM, Phaff M, Pheeha R, Pienaar B, Pillay V, Pilusa K, Pochana M, Polishchuk O, Porrill OS, Post E, Prosper A, Pupyshev M, Rabemazava A, Rabiou M, Rademan L, Rademeyer M, Raherison R, Rajah F, Rajcoomar M, Rakhda Z, Rakotoarijaona A, Rakotoarisoa A, Rakotoarison SR, Rakotoarison R, Ramadan L, Ramananasoa M, Rambau M, Ramchurn T, Ramilson H, Ramjee RJ, Ramnarain H, Ramos R, Rampai T, Ramphal S, Ramsamy T, Ramuntshi R, Randolph R, Randriambololona D, Ras W, Rasolondraibe R, Rasolonjatovo J, Rautenbach R, Ray S, Rayne SR, Razanakoto F, Reddy S, Reed AR, Rian J, Rija F, Rink B, Robelie A, Roberts C, Rocher A, Rocher S, Rodseth RN, Rois I, Rois W, Rokhsi S, Roos J, Rorke NF, Roura H, Rousseau F, Rousseau N, Royas L, Roytowski D, Rungan D, Rwehumbiza S, Ryabchiy B, Ryndine V, Saaiman C, Sabwa H, Sadat S, Saed S, Salaheddin E, Salaou H, Saleh M, Salisu-Kabara H, Doles Sama H, Samateh AL, Sam-Awortwi W, Samuel N, Sanduku D, Sani CM, Sanyang L, Sarah H, Sarkin-Pawa A, Sathiram R, Saurombe T, Schutte H, Sebei M, Sedekounou M, Segooa M, Semenya E, Semo B, Sendagire C, Senoga S, Senusi F, Serdyn T, Seshibe M, Shah G, Shamamba R, Shambare C, Shangase T, Shanin S, Shefren I, Sheshe A, Shittu O, Shkirban A, Sholadoye T, Shubba A, Sigcu N, Sihope S, Sikazwe D, Sikombe B, Simaga Abdoul K, Simo W, Singata K, Singh A, Singh S, Singh U, Sinoamadi V, Sipuka N, Sithole N, Sitima S, Skinner DL, Skinner G, Smith O, Smits C, Sofia M, Sogoba G, Sohoub A, Sookun S, Sosinska O, Souhe R, Souley G, Souleymane T, Spicer J, Spijkerman S, Steinhaus H, Steyn A, Steyn G, Steyn H, Stoltenkamp HL, Stroyer S. The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications. Br J Anaesth 2018; 121:1357-1363. [PMID: 30442264 DOI: 10.1016/j.bja.2018.08.005] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. METHODS ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. RESULTS The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. CONCLUSIONS This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. CLINICAL TRIAL REGISTRATION NCT03044899.
Collapse
Affiliation(s)
- H-L Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
| | - Y le Manach
- Department of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON, Canada
| | - D M Munlemvo
- University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - F Madzimbamuto
- Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - A Basenero
- Ministry of Health and Social Services Namibia, Windhoek, Namibia
| | - Y Coulibaly
- Department, Faculté de médicine de Bamako, Bamako, Mali
| | | | - V Gobin
- Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Grand Port, Mauritius
| | - A L Samateh
- Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - M S Chaibou
- Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey, Niger
| | - A O Omigbodun
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - S D Amanor-Boadu
- Department of Anaesthesia, University College Hospital, Ibadan, Oyo State, Nigeria
| | - J Tumukunde
- Makerere University, Makerere, Kampala, Uganda
| | - T E Madiba
- Department of Surgery, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - R M Pearse
- Intensive Care Medicine, Queen Mary University of London, London, UK
| | - B M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape, South Africa.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Bhogal P, Chudyk J, Bleise C, Lylyk I, Perez N, Henkes H, Lylyk P. Treatment of Unruptured, Tandem Aneurysms of the ICA with a Single Flow Diverter. Clin Neuroradiol 2018; 29:725-731. [PMID: 30167711 DOI: 10.1007/s00062-018-0723-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial adjacent tandem lesions of the internal carotid artery (ICA) are rare and the optimal treatment strategy is unknown. This study was carried out to determine whether a single flow diverter stent (FDS) could be successfully used to treat these lesions. METHODS The prospectively maintained database was retrospectively carried out to identify patients treated between February 2009 and February 2018 with multiple unruptured, tandem ICA aneurysms and treated with a single FDS. Demographic data, clinical presentation, aneurysm characteristics, treatment data, clinical result and clinical and radiological follow-up information were recorded. RESULTS A total of 69 patients (62 female, 89.8%) with average age 55 ± 14.8 years were identified. In total there were 169 aneurysms and the majority of patients (n = 47, 68.1%) had only 2 tandem aneurysms. The largest aneurysms measured 7.69 ± 5.3 mm (range 1.5-26 mm) in height, 6.64 ± 4.71 mm (range 1.5-23 mm) in width and the smaller aneurysm measured 2.61 ± 1.32 mm (range 0.8-9.5 mm) in height and 2.32 ± 1.12 mm (range 0.7-8 mm) in width. In 36 patients the p64 was used, the PED in 28 patients and Surpass in 5 patients. Follow-up was available in 54 patients (130 aneurysms). At initial follow-up (7.2 ± 4.2 months) 45 (83.3%) of the larger aneurysms and 66 (86.8%) of the smaller aneurysms were satisfactorily occluded (Raymond-Roy classification RRC 1 or 2). At delayed follow-up (18 ± 14.6 months) 48 of the larger aneurysms (88.9%) and 71 of the smaller aneurysms (93.4%) were satisfactorily occluded. There were three complications including one death. CONCLUSION A single FDS can be used to successfully treat multiple tandem aneurysms of the ICA with a high rate of aneurysm exclusion and an acceptable risk profile.
Collapse
Affiliation(s)
- P Bhogal
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
| | - J Chudyk
- Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - C Bleise
- Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - I Lylyk
- Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - N Perez
- Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - H Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - P Lylyk
- Neuroradiological clinic, Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| |
Collapse
|
30
|
Marcos V, Gavara J, Perez N, Rios-Navarro C, Bonanad C, Racugno P, Lopez-Lereu MP, Monmeneu JV, Chorro FJ, Bodi V. P266Vasodilator stress cardiovascular magnetic resonance imaging predicts long-term cardiac death and all-cause death in patients with known or suspected coronary artery disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Marcos
- University Hospital Clinic of Valencia, Dept. of Cardiology, Valencia, Spain
| | - J Gavara
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - N Perez
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | | | - C Bonanad
- University Hospital Clinic of Valencia, Dept. of Cardiology, Valencia, Spain
| | - P Racugno
- University Hospital Clinic of Valencia, Dept. of Cardiology, Valencia, Spain
| | | | | | - F J Chorro
- University Hospital Clinic of Valencia, Dept. of Cardiology, Valencia, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Dept. of Cardiology, Valencia, Spain
| |
Collapse
|
31
|
Ruiz M, Torra M, Sola L, Perez N, Carrillo M, Guma M, Mateu D, Garreta R. Changes in physical function and isokinetic muscular strength of quadriceps and hamstrings three months after a rapid recovery total knee arthroplasty. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.285] [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]
|
32
|
Alvarez-Rincón DA, Perez N. 1054 Physical workload exposure threshold in cumulative-trauma disorders useful for primary prevention and for causal assessment: a 12.5 y follow-up cohort study. Epidemiology 2018. [DOI: 10.1136/oemed-2018-icohabstracts.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
33
|
Martinez-Useros J, Moreno I, Fernandez-Aceñero MJ, Rodriguez-Remirez M, Borrero-Palacios A, Cebrian A, Gomez del Pulgar T, del Puerto-Nevado L, Li W, Puime-Otin A, Perez N, Soengas MS, Garcia-Foncillas J. The potential predictive value of DEK expression for neoadjuvant chemoradiotherapy response in locally advanced rectal cancer. BMC Cancer 2018; 18:144. [PMID: 29409457 PMCID: PMC5801838 DOI: 10.1186/s12885-018-4048-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 01/24/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Limited data are available regarding the ability of biomarkers to predict complete pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Complete response translates to better patient survival. DEK is a transcription factor involved not only in development and progression of different types of cancer, but is also associated with treatment response. This study aims to analyze the role of DEK in complete pathological response following chemoradiotherapy for locally advanced rectal cancer. METHODS Pre-treated tumour samples from 74 locally advanced rectal-cancer patients who received chemoradiation therapy prior to total mesorectal excision were recruited for construction of a tissue microarray. DEK immunoreactivity from all samples was quantified by immunohistochemistry. Then, association between positive stained tumour cells and pathologic response to neoadjuvant treatment was measured to determine optimal predictive power. RESULTS DEK expression was limited to tumour cells located in the rectum. Interestingly, high percentage of tumour cells with DEK positiveness was statistically associated with complete pathological response to neoadjuvant treatment based on radiotherapy and fluoropyrimidine-based chemotherapy and a marked trend toward significance between DEK positiveness and absence of treatment toxicity. Further analysis revealed an association between DEK and the pro-apoptotic factor P38 in the pre-treated rectal cancer biopsies. CONCLUSIONS These data suggest DEK as a potential biomarker of complete pathological response to treatment in locally advanced rectal cancer.
Collapse
Affiliation(s)
- J. Martinez-Useros
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - I. Moreno
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | | | - M. Rodriguez-Remirez
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - A. Borrero-Palacios
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - A. Cebrian
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - T. Gomez del Pulgar
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - L. del Puerto-Nevado
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - W. Li
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - A. Puime-Otin
- Department of Pathology, University Hospital “Fundación Jiménez Díaz”-UAM, Madrid, Spain
| | - N. Perez
- Department of Pathology, University Hospital “Fundación Jiménez Díaz”-UAM, Madrid, Spain
| | - M. S. Soengas
- Melanoma Research Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - J. Garcia-Foncillas
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| |
Collapse
|
34
|
Frejo L, Martin-Sanz E, Teggi R, Trinidad G, Soto-Varela A, Santos-Perez S, Manrique R, Perez N, Aran I, Almeida-Branco MS, Batuecas-Caletrio A, Fraile J, Espinosa-Sanchez JM, Perez-Guillen V, Perez-Garrigues H, Oliva-Dominguez M, Aleman O, Benitez J, Perez P, Lopez-Escamez JA. Extended phenotype and clinical subgroups in unilateral Meniere disease: A cross-sectional study with cluster analysis. Clin Otolaryngol 2017; 42:1172-1180. [PMID: 28166395 DOI: 10.1111/coa.12844] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To define clinical subgroups by cluster analysis in patients with unilateral Meniere disease (MD) and to compare them with the clinical subgroups found in bilateral MD. DESIGN A cross-sectional study with a two-step cluster analysis. SETTINGS A tertiary referral multicenter study. PARTICIPANTS Nine hundred and eighty-eight adult patients with unilateral MD. MAIN OUTCOME MEASURES best predictors to define clinical subgroups with potential different aetiologies. RESULTS We established five clusters in unilateral MD. Group 1 is the most frequently found, includes 53% of patients, and it is defined as the sporadic, classic MD without migraine and without autoimmune disorder (AD). Group 2 is found in 8% of patients, and it is defined by hearing loss, which antedates the vertigo episodes by months or years (delayed MD), without migraine or AD in most of cases. Group 3 involves 13% of patients, and it is considered familial MD, while group 4, which includes 15% of patients, is linked to the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by a comorbid AD. We found significant differences in the distribution of AD in clusters 3, 4 and 5 between patients with uni- and bilateral MD. CONCLUSIONS Cluster analysis defines clinical subgroups in MD, and it extends the phenotype beyond audiovestibular symptoms. This classification will help to improve the phenotyping in MD and facilitate the selection of patients for randomised clinical trials.
Collapse
Affiliation(s)
- L Frejo
- Otology & Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain
| | - E Martin-Sanz
- Department of Otolaryngology, Hospital Universitario de Getafe, Getafe, Spain
| | - R Teggi
- Department of Otolaryngology, San Raffaelle Scientific Institute, Milan, Italy
| | - G Trinidad
- Division of Otoneurology, Department of Otorhinolaryngology, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - A Soto-Varela
- Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | - S Santos-Perez
- Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | - R Manrique
- Department of Otolaryngology, Clinica Universidad de Navarra, Pamplona, Spain
| | - N Perez
- Department of Otolaryngology, Clinica Universidad de Navarra, Pamplona, Spain
| | - I Aran
- Department of Otolaryngology, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
| | - M S Almeida-Branco
- Department of Otolaryngology, Hospital de Poniente, El Ejido, Almería, Spain
| | - A Batuecas-Caletrio
- Department of Otolaryngology, Hospital Universitario Salamanca, Salamanca, Spain
| | - J Fraile
- Department of Otolaryngology, Hospital Miguel Servet, Zaragoza, Spain
| | - J M Espinosa-Sanchez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Department of Otorhinolaryngology, Hospital San Agustin, Linares, Jaen, Spain
| | - V Perez-Guillen
- Department of Otorhinolaryngology, Hospital Universitario La Fe, Valencia, Spain
| | - H Perez-Garrigues
- Department of Otorhinolaryngology, Hospital Universitario La Fe, Valencia, Spain
| | - M Oliva-Dominguez
- Department of Otorhinolaryngology, Hospital Costa del Sol, Marbella, Malaga, Spain
| | - O Aleman
- Department of Otolaryngology, Hospital General Universitario de Alicante, Alicante, Spain
| | - J Benitez
- Department of Otolaryngology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Spain
| | - P Perez
- Department of Otorhinolaryngology, Hospital Universitario de Cabueñes, Gijon, Spain
| | - J A Lopez-Escamez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universidad de Granada (CHUGRA), Granada, Spain
| | | |
Collapse
|
35
|
Abstract
Purpose: To evaluate long-term results of infrapopliteal percutaneous transluminal angioplasty (PTA) for limb salvage. Material and Methods: A retrospective study of 71 consecutive infrapopliteal PTAs in 49 patients with rest pain (n = 20) or ulceration (n = 29) was conducted. In 18 patients, surgical minor amputation or debridment was also performed. Results: Technical success was achieved in 45 patients. Four failures necessitated 2 amputations. One patient died in the postoperative course. Global morbidity rate was 16%, including minor complications in 5 patients and major vascular complications in 3 patients. After technical success during the follow-up (median duration 21 months), restenoses occurred in 4 patients, of whom 3 had a successful re-PTA (clinical success rate 72%). Survival, primary patency, secondary patency and limb salvage rates were, respectively, 75%, 81%, 88% and 87% after 3 years. The only positive predictive factor for primary patency was the presence of diabetes mellitus. Conclusion: Infrapopliteal PTA is a safe and effective procedure, allowing good patency and limb salvage rates with low mortality and morbidity.
Collapse
Affiliation(s)
- L. Boyer
- Department of Radiology, University Hospital, Clermont-Ferrand, France
| | - T. Therre
- Department of Vascular Surgery, University Hospital, Clermont-Ferrand, France
| | - J.M. Garcier
- Department of Radiology, University Hospital, Clermont-Ferrand, France
| | - N. Perez
- Department of Radiology, University Hospital, Clermont-Ferrand, France
| | - A. Ravel
- Department of Radiology, University Hospital, Clermont-Ferrand, France
| | - C. Privat
- Department of Radiology, University Hospital, Clermont-Ferrand, France
| | - J.-F. Viallet
- Department of Radiology, University Hospital, Clermont-Ferrand, France
| |
Collapse
|
36
|
Ramudo L, Outeta M, Martín I, Perez N. PS-028 Electronic prescribing systems in outpatient care. Source of information or source of errors? Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
37
|
Moreno Romero JA, Campoy A, Perez N, Garcia F, Grimalt R. Rapidly-growing squamous cell carcinoma shortly after treatment with ingenol mebutate for actinic keratoses: report of two cases. Br J Dermatol 2015; 173:1514-7. [PMID: 26227007 DOI: 10.1111/bjd.14054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 11/26/2022]
Abstract
Actinic keratoses (AKs) are defined as cutaneous areas of atypical squamous transformation that are regarded as an early step in the continuum of alterations leading from normal skin to invasive and metastatic squamous cell carcinoma (SCC). AKs are classified as precancerous lesions by some authors and in situ SCC by others. The rate of evolution of a given AK to an invasive SCC has been estimated as 0·075-0·096% per lesion per year. These rates are similar to those estimated for gynaecological intraepithelial neoplasia. We describe two cases of SCC with rapid onset that developed after the application of ingenol mebutate gel for the treatment of AKs.
Collapse
Affiliation(s)
- J A Moreno Romero
- Department of Dermatology, Quirónsalud Hospital General de Catalunya, Barcelona, Spain
| | - A Campoy
- Department of Dermatology, Quirónsalud Hospital General de Catalunya, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - N Perez
- Department of Pathology, Quirónsalud Hospital General de Catalunya, Barcelona, Spain
| | - F Garcia
- Department of Pathology, Quirónsalud Hospital Quirón de Barcelona, Barcelona, Spain
| | - R Grimalt
- Universitat Internacional de Catalunya, Barcelona, Spain
| |
Collapse
|
38
|
Martinez-Useros J, Georgiev-Hristov T, Borrero-Palacios A, Fernandez-Aceñero MJ, Rodríguez-Remírez M, Del Puerto-Nevado L, Cebrian A, Gomez Del Pulgar MT, Cazorla A, Vega-Bravo R, Perez N, Celdran A, Garcia-Foncillas J. Identification of Poor-outcome Biliopancreatic Carcinoma Patients With Two-marker Signature Based on ATF6α and p-p38 "STARD Compliant". Medicine (Baltimore) 2015; 94:e1972. [PMID: 26559273 PMCID: PMC4912267 DOI: 10.1097/md.0000000000001972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Biliopancreatic cancer is one of the most aggressive solid neoplasms, and incidence is rising worldwide. It is known that ATF6α is one of the transmembrane proteins that acts crucially in endoplasmic reticulum stress response, and knockdown induces apoptosis of pancreatic cells. Apart from this, p-p38 has been previously correlated with better outcome in pancreatic cancer. Interestingly, ATF6α knockdown pancreatic cells showed increased p-p38. The aim of this study was to evaluate the expression of these 2 proteins, p-p38 and ATF6α, and their correlation with the outcome of biliopancreatic adenocarcinoma patients. Samples from patients with biliopancreatic adenocarcinoma that underwent pancreaticoduodenectomy from 2007 to 2013 were used to construct a tissue microarray to evaluate p-p38 and ATF6α proteins by immunohistochemistry. We observed that both markers showed a tendency to impact in the time to recurrence; then a combination of these 2 proteins was analyzed. Combination of ATF6α(high) and p-p38(low) was strongly associated with a higher risk of recurrence (hazard ratio 2.918, P = 0.013). This 2-protein model remained significant after multivariate adjustment.We proposed a 2-protein signature based on ATF6α(high) and p-p38(low) as a potential biomarker of risk of recurrence in resected biliopancreatic adenocarcinoma patients.
Collapse
Affiliation(s)
- J Martinez-Useros
- From the Translational Oncology Division, OncoHealth Institute, University Hospital Fundacion Jimenez Diaz (JM-U, AB-P, MR-R, L.P-N, AC, MTGP, JG-F); Hepatobiliary and Pancreatic Surgery Unit, General and Digestive Tract Surgery Department, University Hospital Fundacion Jimenez Diaz (TG-H, AC); Department of Pathology, University Hospital Clinico San Carlos (MJF-A); and Department of Pathology, University Hospital Fundacion Jimenez Diaz, Madrid, Spain (AC, RV-B, NP)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Iribarren JL, Jiménez J, Perez N, Brouard M, Perez R, Hurtado E, Diosdado S, Buitrago M, Arbesu A, Martinez R, Mora M. Vasoplegic syndrome in cardiac surgery: role of synergism between polymorphism of tumor necrosis factor beta and plasminogen activator inhibitor type 1. Crit Care 2015. [PMCID: PMC4472815 DOI: 10.1186/cc14279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
40
|
Iribarren JL, Jimenez JJ, Perez N, Brouard M, Perez R, Gonzalez O, Arbesu A, Martinez R, Mora ML. Interaction between etomidate and beta tumoral necrosis factor on hemodynamic response after cardiac surgery. Crit Care 2015. [PMCID: PMC4472917 DOI: 10.1186/cc14576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
41
|
Htv Z, de Bruin M, Guillaumie L, Moisan J, Gregoire JP, Perez N, Vézina-Im LA, Guenette L. Content Analysis And Effectiveness Of Interventions To Enhance Oral Antidiabetic Drug (Oad) Adherence In Adults With Type 2 Diabetes: A Systematic Review And Meta-Analysis. Value Health 2014; 17:A748. [PMID: 27202708 DOI: 10.1016/j.jval.2014.08.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Zomahoun Htv
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | | | | | - J Moisan
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - J P Gregoire
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| | - N Perez
- Laval University, Québec, QC, Canada
| | | | - L Guenette
- Laval University Faculty of Pharmacy, Québec, QC, Canada
| |
Collapse
|
42
|
Gil Polo C, Delgado E, Cachorro A, Posadas J, Perez N, Formoso D. I09 Energy Balance In Huntington's Disease. J Neurol Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.171] [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: 11/04/2022]
|
43
|
Contreras GA, Bell CS, Del Bianco GP, Perez N, Kleinosky MT, Murphy JR, Heresi GP. Prevalence and risk factors associated with resistance-associated mutations to etravirine in a cohort of perinatally HIV-infected children. J Antimicrob Chemother 2013; 68:2344-8. [DOI: 10.1093/jac/dkt198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
44
|
Malhotra R, Usyvat L, Raimann J, Thijssen S, Levin N, Kotanko P, Hilderman M, Qureshi AR, Al-Abed Y, Anderstam B, Bruchfeld A, Minco M, Argentino G, Grumetto L, Postiglione L, Memoli B, Riccio E, Striker G, Yubero-Serrano E, Uribarri J, Vlassara H, do Sameiro-Faria M, Ribeiro S, Kohlova M, Rocha-Pereira P, Fernandes J, Nascimento H, Reis F, Miranda V, Bronze-da-Rocha E, Quintanilha A, Costa E, Belo L, Santos-Silva A, Modilca M, Margineanu M, Gluhovschi G, Vernic C, Velciov S, Petrica L, Barzuca E, Gluhovschi C, Balgradean C, Kaycsa A, Stockler-Pinto M, Dornelles S, Cozzolino S, Malm O, Mafra D, Cobo G, Rodriguez I, Oliet A, Hinostroza J, Vigil A, Di Gioia M, Gallar P, Drechsler C, Wanner C, Blouin K, Pilz S, Tomaschitz A, Krane V, Marz W, Ritz E, van der Harst P, de Boer R, Carrero JJ, Cabezas-Rodriguez I, Zoccali C, Qureshi A, Ketteler M, Gorriz J, Rutkowski B, Teplan V, Kramar R, Pavlovic D, Goldsmith D, Benedik M, Fernandez-Martin J, Cannata-Andia J, Guido G, Loiacono E, Serriello I, Camilla R, Coppo R, Amore A, Schiller A, Munteanu M, Schiller O, Mihaescu A, Olariu N, Andrei C, Anton C, Ivacson Z, Roman V, Berca S, Bansal V, Marcelli D, Grassmann A, Bayh I, Scatizzi L, Marelli C, Etter M, Usvyat L, Kooman J, Sande F, Levin N, Kotanko P, Canaud B, Quiroga B, Villaverde M, Abad S, Vega A, Reque J, Yuste C, Barraca D, Perez de Jose A, Lopez-Gomez JM, Castellano Gasch S, Palomares I, Dominguez J, Ramos R, Schmidt J, Hafer C, Clajus C, Hadem J, Schmidt B, Haller H, Kielstein J, Katagiri M, Kamada Y, Kobayashi N, Moriguchi I, Ito Y, Kamekawa D, Akiyama A, Ishii H, Tanaka S, Kamiya K, Hamazaki N, Kato M, Shimizu R, Hotta K, Masuda T, Veronesi M, Mancini E, Valente F, Righetti F, Brunori G, Santoro A, Bal Z, Tutal E, Erkmen Uyar M, Guliyev O, Sayin B, Sezer S, Mikami S, Hamano T, Tanaka T, Iba O, Toki M, Mikami H, Takamitsu Y, Inoue T, Fujii M, Hirayama A, Ueda A, Watanabe R, Matsui H, Nagano Y, Nagase S, Aoyagi K, Owada S, Tutal E, Bal Z, Erkmen Uyar M, Sayin B, Tot U, Sezer S, Onec K, Erten Y, Pasaoglu O, Ebinc F, Uludag K, Okyay G, Inal S, Pasaoglu H, Deger S, Arinsoy T, Arias-Guillen M, Masso E, Perez E, Herrera P, Romano B, Perez N, Maduell F, Jung YS, Kim YN, Shin HS, Rim H, Al Ismaili Z, Hassan M, Dastoor H, Bernieh B, Ismael A, Marcelli D, Richards N, Khil M, Sheiman B, Dudar I, Gonchar Y, Khil V, Kim HL, Ryu HH, Kim SH, Bosch Benitez-Parodi E, Baamonde Laborda E, Perez Suarez G, Ramirez JI, Garcia Canton C, Guerra R, Ramirez Puga A, Toledo A, Lago Alonso MM, Checa Andres MD, Hwang WM, Yun SR, Molsted S, Andersen JL, Eidemak I, Harrison AP, Kose E, Turgutalp K, Kiykim A, Celik F, Gok Oguz E. Protein-energy wasting. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft153] [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: 11/14/2022] Open
|
45
|
Nakamura SN, Matsumura A, Okayasu Y, Seva T, Rodriguez VM, Baturin P, Yuan L, Acha A, Ahmidouch A, Androic D, Asaturyan A, Asaturyan R, Baker OK, Benmokhtar F, Bosted P, Carlini R, Chen C, Christy M, Cole L, Danagoulian S, Daniel A, Dharmawardane V, Egiyan K, Elaasar M, Ent R, Fenker H, Fujii Y, Furic M, Gan L, Gaskell D, Gasparian A, Gibson EF, Gogami T, Gueye P, Han Y, Hashimoto O, Hiyama E, Honda D, Horn T, Hu B, Hungerford EV, Jayalath C, Jones M, Johnston K, Kalantarians N, Kanda H, Kaneta M, Kato F, Kato S, Kawama D, Keppel C, Lan KJ, Luo W, Mack D, Maeda K, Malace S, Margaryan A, Marikyan G, Markowitz P, Maruta T, Maruyama N, Miyoshi T, Mkrtchyan A, Mkrtchyan H, Nagao S, Navasardyan T, Niculescu G, Niculescu MI, Nomura H, Nonaka K, Ohtani A, Oyamada M, Perez N, Petkovic T, Randeniya S, Reinhold J, Roche J, Sato Y, Segbefia EK, Simicevic N, Smith G, Song Y, Sumihama M, Tadevosyan V, Takahashi T, Tang L, Tsukada K, Tvaskis V, Vulcan W, Wells S, Wood SA, Yan C, Zhamkochyan S. Observation of the (Λ)(7)He hypernucleus by the (e, e'K+) reaction. Phys Rev Lett 2013; 110:012502. [PMID: 23383783 DOI: 10.1103/physrevlett.110.012502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Indexed: 06/01/2023]
Abstract
An experiment with a newly developed high-resolution kaon spectrometer and a scattered electron spectrometer with a novel configuration was performed in Hall C at Jefferson Lab. The ground state of a neutron-rich hypernucleus, (Λ)(7)He, was observed for the first time with the (e, e'K+) reaction with an energy resolution of ~0.6 MeV. This resolution is the best reported to date for hypernuclear reaction spectroscopy. The (Λ)(7)He binding energy supplies the last missing information of the A = 7, T = 1 hypernuclear isotriplet, providing a new input for the charge symmetry breaking effect of the ΛN potential.
Collapse
Affiliation(s)
- S N Nakamura
- Graduate School of Science, Tohoku University, Sendai, Miyagi 980-8578, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Alonso J, Sosa C, Perez N, Brum C, Sotero G, Rodriguez G, Silvera J. W071 PROCALCITONIN AND ROUTINE BIOMARKERS IN THE DIAGNOSIS OF MATERNAL AND FETAL INFLAMMATORY RESPONSE IN PREGNANT WOMEN WITH PPROM. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61796-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
Perez N, Oholeguy P, Zubiaurre V, Alonso C, Guirado M, Cora M, Stevenazzi M, Liard GV, Conselo E, Leonardo S. W194 CASUISTRY OF PREGNANT PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) AT THE HOSPITAL DE CLINICAS BETWEEN 2008 AND 2011. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61919-5] [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]
|
48
|
Donadio C, Kanaki A, Martin-Gomez A, Garcia S, Palacios-Gomez M, Donadio C, Calia D, Colombini E, DI Francesco F, Ghimenti S, Kanaki A, Onor M, Tognotti D, Fuoco R, Marka-Castro E, Torres Zamora MI, Giron-Mino J, Jaime-Solis MA, Arteaga LM, Romero H, Marka-Castro E, Akonur A, Leypoldt K, Asola M, Culleton B, Eloot S, Glorieux G, Nathalie N, Vanholder R, Perez de Jose A, Verdalles Guzman U, Abad Esttebanez S, Vega Martinez A, Barraca D, Yuste C, Bucalo L, Rincon A, Lopez-Gomez JM, Bataille P, Celine P, Raymond A, Francois G, Herve L, Michel D, Jean Louis R, Zhu F, Kotanko P, Thijssen S, Levin NW, Papamichail N, Bougiakli M, Gouva C, Antoniou S, Gianitsi S, Vlachopanou A, Chachalos S, Naka K, Kaarsavvidou D, Katopodis K, Michalis L, Sasaki K, Yasuda K, Yamato M, Surace A, Rovatti P, Steckiph D, Bandini R, Severi S, Dellacasa Bellingegni A, Santoro A, Arias M, Arias M, Sentis A, Perez N, Fontsere N, Vera M, Rodriguez N, Arcal C, Ortega N, Uriza F, Cases A, Maduell F, Abbas SR, Abbas SR, Zhu F, Kotanko P, Levin NW, Georgianos P, Sarafidis P, Nikolaidis P, Lasaridis A, Ahmed A, Ahmed A, Kaoutar H, Mohammed B, Zouhir O, Balter P, Ginsberg N, Taylor P, Sullivan T, Usvyat LA, Levin NW, Kotanko P, Zabetakis P, Moissl U, Ferrario M, Garzotto F, Wabel P, Cruz D, Tetta C, Signorini MG, Cerutti S, Brendolan A, Ronco C, Heaf J, Axelsen M, Pedersen RS, Ahmed A, Ahmed A, Amine H, Oualim Z, Ammirati AL, Guimaraes de Souza NK, Nemoto Matsui T, Luiz Vieira M, Alves de Oliveira WA, Fischer CH, Dias Carneiro F, Iizuka IJ, Aparecida de Souza M, Mallet AC, Cruz Andreoli MC, Cardoso Dos Santos BF, Rosales L, Dou Y, Carter M, Thijssen S, Kotanko P, Testa A, Sottini L, Giacon B, Prati E, Loschiavo C, Brognoli M, Marseglia C, Tommasi A, Sereni L, Palladino G, Bove S, Bosticardo G, Schillaci E, Detoma P, Bergia R, Park JW, Moon SJ, Choi HY, Ha SK, Park HC, Liao Y, Zhang L, Fu P, Igarashi H, Suzuki N, Esashi S, Masakane I, Panichi V, De Ferrari G, Saffiotti S, Sidoti A, Biagioli M, Bianchi S, Imperiali P, Gabrielli C, Conti P, Patrone P, Rombola G, Falqui V, Mura C, Icardi A, Rosati A, Santori F, Mannarino A, Bertucci A, Steckiph D, Jeong J, Jeong J, Kim OK, Kim NH, Bots M, Den Hoedt C, Grooteman MP, Van der Weerd NC, Mazairac AHA, Levesque R, Ter Wee PM, Nube MJ, Blankestijn P, Van den Dorpel MA, Park Y, Jeon J, Tessitore N, Tessitore N, Bedogna V, Girelli D, Corazza L, Jacky P, Guillaume Q, Julien B, Marcinkowski W, Drozdz M, Milkowski A, Rydzynska T, Prystacki T, August R, Benedyk-Lorens E, Bladek K, Cina J, Janiszewska G, Kaczmarek A, Lewinska T, Mendel M, Paszkot M, Trafidlo E, Trzciniecka-Kloczkowska M, Vasilevsky A, Konoplev G, Lopatenko O, Komashnya A, Visnevsky K, Gerasimchuk R, Neivelt I, Frorip A, Vostry M, Racek J, Rajdl D, Eiselt J, Malanova L, Pechter U, Selart A, Ots-Rosenberg M, Krieter DH, Seidel S, Merget K, Lemke HD, Wanner C, Krieter DH, Canaud B, Lemke HD, Rodriguez A, Morgenroth A, Von Appen K, Dragoun GP, Wanner C, Fluck R, Fouque D, Lockridge R, Motomiya Y, Uji Y, Hiramatsu T, Ando Y, Furuta M, Furuta M, Kuragano T, Kida A, Yahiro M, Otaki Y, Hasuike Y, Nonoguchi H, Nakanishi T, Sain M, Sain M, Kovacic V, Ljutic D, Radic J, Jelicic I, Yalin SF, Yalin SF, Trabulus S, Yalin AS, Altiparmak MR, Serdengecti K, Ohtsuka A, Fukami K, Ishikawa K, Ando R, Kaida Y, Adachi T, Sugi K, Okuda S, Nesterova OB, Nesterova OB, Suglobova ED, Golubev RV, Vasiliev AN, Lazeba VA, Smirnov AV, Arita K, Kihara E, Maeda K, Oda H, Doi S, Masaki T, Hidaka S, Ishioka K, Oka M, Moriya H, Ohtake T, Nomura S, Kobayashi S, Wagner S, Gmerek A, Wagner J, Wizemann V, Eftimovska - Otovic N, Spaseska-Gjurovska K, Bogdanovska S, Babalj - Banskolieva E, Milovanceva M, Grozdanovski R, Pisani A, Riccio E, Mancini A, Ambuhl P, Astrid S, Ivana P, Martin H, Thomas K, Hans-Rudolf R, Daniel A, Denes K, Marco M, Wuthrich RP, Andreas S, Andrulli S, Altieri P, Sau G, Bolasco P, Pedrini LA, Basile C, David S, Feriani M, Nebiolo PE, Ferrara R, Casu D, Logias F, Tarchini R, Cadinu F, Passaghe M, Fundoni G, Villa G, DI Iorio BR, Zoccali C, Locatelli F, Kihara E, Arita K, Hamamoto M, Maeda K, Oda H, Doi S, Masaki T, Lee DY, Kim B, Moon KH, LI Z, Fu P, Ahrenholz P, Ahrenholz P, Winkler RE, Waitz G, Wolf H, Grundstrom G, Alquist M, Holmquist M, Christensson A, Bjork P, Abdgawad M, Ekholm L, Segelmark M, Corsi C, Santoro A, De Bie J, Mambelli E, Mortara D, Santoro A, Severi S, Arroyo D, Arroyo D, Panizo N, Quiroga B, Reque J, Melero R, Rodriguez-Ferrero M, Rodriguez-Benitez P, Anaya F, Luno J, Ragon A, James A, Brunet P, Ribeiro S, Faria MS, Rocha S, Rodrigues S, Catarino C, Reis F, Nascimento H, Fernandes J, Miranda V, Quintanilha A, Belo L, Costa E, Santos-Silva A, Arund J, Tanner R, Fridolin I, Luman M, Clajus C, Clajus C, Kielstein JT, Haller H, David S, Basile C, Basile C, Libutti P, Lisi P, Vernaglione L, Casucci F, Losurdo N, Teutonico A, Lomonte C, Krisp C, Gmerek A, Wagner J, Wolters DA, Pedrini LA, Matsuyama M, Tomo T, Ishida K, Matsuyama K, Nakata T, Kadota J, Caiazzo M, Monari E, Cuoghi A, Bellei E, Bergamini S, Palladino G, Tomasi A, Baranger T, Seniuta P, Berge F, Drouillat V, Frangie C, Rosier E, Labonia W, Lescano A, Rubio D, Von der Lippe N, Jorgensen JA, Osthus TB, Waldum B, Os I, Bossola M, DI Stasio E, Antocicco M, Tazza L, Griveas I, Karameris A, Pasadakis P, Savica V, Santoro D, Saitta S, Tigano V, Bellinghieri G, Gangemi S, Daniela R, Checherita IA, Ciocalteu A, Vacaroiu IA, Niculae A, Bladek K, Stefaniak E, Pietrzak I, Krupa D, Garred L, Santoro A, Mancini E, Corrazza L, Atti M, Afsar B, Stamopoulos D, Mpakirtzi N, Gogola B, Zeibekis M, Stivarou D, Panagiotou M, Grapsa E, Vega Vega O, Barraca Nunez D, Abad Esttebanez S, Bucalo L, Yuste C, Lopez-Gomez JM, Fernandez-Lucas M, Gomis A, Teruel JL, Elias S, Quereda C, Hignell L, Humphrey S, Pacy N, Stamopoulos D, Mpakirtzi N, Afentakis N, Grapsa E. Extracorporeal dialysis: techniques and adequacy. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Cormier H, Perez N, Blanchet D, Couppié P, Carme B, Aznar C. Fatal histoplasmosis in a non-HIV patient in French Guiana. J Mycol Med 2012; 22:189-91. [PMID: 23518023 DOI: 10.1016/j.mycmed.2012.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/17/2012] [Accepted: 01/22/2012] [Indexed: 10/28/2022]
Abstract
Histoplasmosis is an endemic fungal infection that causes no symptoms or minor self-limited illnesses in most cases. Severe forms are commonly reported in patients with immunodeficiency disorders; histoplasmosis is considered to be an opportunistic infection in patients with AIDS. We report a case of disseminated histoplasmosis in a patient with no induced active suppression of the immune response. The infection was fulminant, and antifungal treatment was delayed because of a misdiagnosis of tuberculosis.
Collapse
Affiliation(s)
- H Cormier
- Laboratoire hospitalo-universitaire de parasitologie mycologie, centre hospitalier de Cayenne, avenue des flamboyants, Cayenne, French Guiana.
| | | | | | | | | | | |
Collapse
|
50
|
Furia GU, Kostelijk EH, Vergouw CG, Lee H, Lee S, Park D, Kang H, Lim C, Yang K, Lee S, Lim C, Park Y, Shin M, Yang K, Lee H, Beyhan Z, Fisch JD, Sher G, Keskintepe L, VerMilyea MD, Anthony JT, Graham JR, Tucker MJ, Tucker MJ, Freour T, Lattes S, Lammers J, Mansour W, Jean M, Barriere P, El Danasouri I, Gagsteiger F, Rinaldi L, Selman H, Antonova I, Milachich T, Valkova L, Shterev A, Barcroft J, Dayoub N, Thong J, Abdel Reda H, Khalaf Y, El Touky T, Cabry R, Brzakowski R, Lourdel E, Brasseur F, Copin H, Merviel P, Yamada M, Takanashi K, Hamatani T, Akutsu H, Fukunaga T, Inoue O, Ogawa S, Sugawara K, Okumura N, Chikazawa N, Kuji N, Umezawa A, Tomita M, Yoshimura Y, Van der Jeught M, Ghimire S, O'Leary T, Lierman S, Deforce D, Chuva de Sousa Lopes S, Heindryckx B, De Sutter P, Herrero J, Tejera A, De los Santos MJ, Castello D, Romero JL, Meseguer M, Barriere P, Lammers J, Lattes S, Leperlier F, Mirallie S, Jean M, Freour T, Schats R, Al-Nofal M, Vergouw CG, Lens JW, Rooth H, Kostelijk EH, Hompes PG, Lambalk CB, Hreinsson J, Karlstrom PO, Wanggren K, Lundqvist M, Vahabi Z, Eftekhari-Yazdi P, Dalman A, Ebrahimi B, Daneshzadeh MT, Rajabpour Niknam M, Choi EG, Rho YH, Oh DS, Park LS, Cheon HS, Lee CS, Kong IK, Lee SC, Liebenthron J, Montag M, Koster M, Toth B, Reinsberg J, van der Ven H, Strowitzki T, Morita H, Hirosawa T, Watanabe S, Wada T, Kamihata M, Kuwahata A, Ochi M, Horiuchi T, Fatemeh H, Eftekhari-Yazdi P, Karimian L, Fazel M, Fouladi H, Johansson L, Ruttanajit T, Chanchamroen S, Sopaboon P, Seweewanlop S, Sawakwongpra K, Jindasri P, Jantanalapruek T, Charoonchip K, Vajta G, Quangkananurug W, Yi G, Jo JW, Jee BC, Suh CS, Kim SH, Zhang Y, Zhao HJ, Cui YG, Gao C, Gao LL, Liu JY, Sozen E, Buluc B, Vicdan K, Akarsu C, Tuncay G, Hambiliki F, Bungum M, Agapitou K, Makrakis E, Liarmakopoulou S, Anagnostopoulou C, Moustakarias T, Giannaris D, Wang J, Andonov M, Linara E, Charleson C, Ahuja KK, Ozsoy S, Morris MB, Day ML, Cobo A, Castello D, Viloria T, Campos P, Vallejo B, Remohi J, Roldan M, Perez-Cano I, Cruz M, Martinez M, Gadea B, Munoz M, Garrido N, Meseguer M, Mesut N, Ciray HN, Mesut A, Isler A, Bahceci M, Munoz M, Fortuno S, Legidos V, Muela L, Roldan M, Galindo N, Cruz M, Meseguer M, Gunasheela S, Gunasheela D, Ueno S, Uchiyama K, Kondo M, Ito M, Kato K, Takehara Y, Kato O, Edgar DH, Krapez JA, Bacer Kermavner L, Virant-Klun I, Pinter B, Tomazevic T, Vrtacnik-Bokal E, Lee SG, Kang SM, Lee SW, Jeong HJ, Lee YC, Lim JH, Bochev I, Valkova L, Kyurkchiev S, Shterev A, Wilding M, Coppola G, Di Matteo L, Dale B, Hormann-Kropfl M, Kastelic D, Montag M, Schenk M, Fourati Ben Mustapha S, Khrouf M, Braham M, Kallel L, Elloumi H, Merdassi G, Chaker A, Ben Meftah M, Zhioua F, Zhioua A, Kocent J, Neri QV, Rosenwaks Z, Palermo GD, Best L, Campbell A, Fishel S, Calimlioglu N, Sahin G, Akdogan A, Susamci T, Bilgin M, Goker ENT, Tavmergen E, Cantatore C, Ding J, Depalo R, Smith GD, Kasapi E, Panagiotidis Y, Papatheodorou A, Goudakou M, Pasadaki T, Nikolettos N, Asimakopoulos B, Prapas Y, Soydan E, Gulebenzer G, Karatekelioglu E, Budak E, Pehlivan Budak T, Alegretti J, Cuzzi J, Negrao PM, Moraes MP, Bueno MB, Serafini P, Motta ELA, Elaimi A, Harper JC, Stecher A, Baborova P, Wirleitner B, Schwerda D, Vanderzwalmen P, Zech NH, Stanic P, Hlavati V, Gelo N, Pavicic-Baldani D, Sprem-Goldstajn M, Radakovic B, Kasum M, Strelec M, Simunic V, Vrcic H, Khan I, Urich M, Abozaid T, Ullah K, Abuzeid M, Fakih M, Shamma N, Ayers J, Ashraf M, Milik S, Pirkevi C, Atayurt Z, Yazici S, Yelke H, Kahraman S, Dal Canto M, Coticchio G, Brambillasca F, Mignini Renzini M, Novara P, Maragno L, Karagouga G, De Ponti E, Fadini R, Resta S, Magli MC, Cavallini G, Muzzonigro F, Ferraretti AP, Gianaroli L, Barberi M, Orlando G, Sciajno R, Serrao L, Fava L, Preti S, Bonu MA, Borini A, Varras M, Polonifi A, Mantzourani M, Mavrogianni D, Stefanidis K, Griva T, Bletsa R, Dinopoulou V, Drakakis P, Loutradis D, Campbell A, Hickman CFL, Duffy S, Bowman N, Gardner K, Fishel S, Sati L, Zeiss C, Demir R, McGrath J, Yelke H, Atayurt Z, Yildiz S, Unal S, Kumtepe Y, Kahraman S, Atayurt Z, Yelke H, Unal S, Kumtepe Y, Kahraman S, Aljaser F, Hernandez J, Tomlinson M, Campbell B, Fosas N, Redondo Ania M, Marina F, Molfino F, Martin P, Perez N, Carrasco A, Garcia N, Gonzalez S, Marina S, Redondo Ania M, Marina F, Molfino F, Fosas N, Martin P, Perez N, Carrasco A, Garcia N, Gonzalez S, Marina S, Scaruffi P, Stigliani S, Tonini GP, Venturini PL, Anserini P, Guglielmo MC, Coticchio G, Albertini DF, Dal Canto M, Brambillasca F, Lain M, Caliari I, Mignini Renzini M, Fadini R, Oikonomou Z, Chatzimeletiou K, Sioga A, Oikonomou L, Kolibianakis E, Tarlatzis B, Nottola SA, Bianchi V, Lorenzo C, Maione M, Macchiarelli G, Borini A, Gomez E, Gil MA, Sanchez-Osorio J, Maside C, Martinez MJ, Torres I, Rodenas C, Cuello C, Parrilla I, Molina G, Garcia A, Margineda J, Navarro S, Roca J, Martinez EA, Avcil F, Ozden H, Candan ZN, Uslu H, Karaman Y, Gioacchini G, Giorgini E, Carnevali O, Bianchi V, Ferraris P, Vaccari L, Borini A, Choe S, Tae J, Kim C, Lee J, Hwang D, Kim K, Suh C, Jee B, Ozden H, Candan ZN, Avcil F, Uslu H, Karaman Y, Catt SL, Sorenson H, Vela M, Duric V, Chen P, Temple-Smith PD, Pangestu M, Yoshimura T, Fukunaga N, Nagai R, Kitasaka H, Tamura F, Hasegawa N, Kato M, Nakayama K, Takeuchi M, Aoyagi N, Yasue K, Watanabe H, Asano E, Hashiba Y, Asada Y, Iwata K, Yumoto K, Mizoguchi C, Sargent H, Kai Y, Ueda M, Tsuchie Y, Imajo A, Iba Y, Mio Y, Els-Smit CL, Botha MH, Sousa M, Windt-De Beer M, Kruger TF, Muller N, Magli C, Corani G, Giusti A, Castelletti E, Gambardella L, Gianaroli L, Seshadri S, Sunkara SK, El-Toukhy T, Kishi I, Maruyama T, Ohishi M, Akiba Y, Asada H, Konishi Y, Nakano M, Kamei K, Yoshimura Y, Lee JH, Lee KH, Park IH, Sun HG, Kim SG, Kim YY, Choi EM, Lee DH, Chavez SL, Loewke KE, Behr B, Han J, Moussavi F, Reijo Pera RA, Yokota H, Yokota Y, Yokota M, Sato S, Nakagawa M, Sato M, Anazawa I, Araki Y, Virant-Klun I, Knez K, Pozlep B, Tomazevic T, Vrtacnik-Bokal E, Lim JH, Vermilyea MD, Graham JR, Levy MJ, Tucker MJ, Carvalho M, Cordeiro I, Leal F, Aguiar A, Nunes J, Rodrigues C, Soares AP, Sousa S, Calhaz-Jorge C, Braga DPAF, Setti AS, Figueira RCS, Aoki T, Iaconelli A, Borges E, Ozkavukcu S, Sonmezer M, Atabekoglu C, Berker B, Ozmen B, Isbacar S, Ibis E, Menezes J, Lalitkumar PGL, Borg P, Ekwurtzel E, Nordqvist S, Vaegter K, Tristen C, Sjoblom P, Azevedo MC, Figueira RCS, Braga DPAF, Setti AS, Iaconelli A, Borges E, Remohi Gimenez J, Cobo A, Castello D, Gamiz P, Albert C, Ferreira RC, Braga DPAF, Figueira RCS, Setti AS, Resende S, Iaconelli A, Borges E, Colturato SS, Braga DPAF, Figueira RCS, Setti AS, Resende S, Iaconelli A, Borges E, Ferrer Buitrago M, Ferrer Robles E, Munoz Soriano P, Ruiz-Jorro M, Calatayud Lliso C, Rawe VY, Wanggren K, Hanrieder J, Hambiliki F, Gulen-Yaldir F, Bergquist J, Stavreus-Evers A, Hreinsson J, Grunskis A, Bazarova A, Dundure I, Fodina V, Brikune J, Lakutins J, Pribenszky C, Cornea M, Reichart A, Uhereczky G, Losonczy E, Ficsor L, Lang Z, Ohgi S, Nakamura C, Hagiwara C, Kawashima M, Yanaihara A, Jones GM, Biba M, Kokkali G, Vaxevanoglou T, Chronopoulou M, Petroutsou K, Sfakianoudis K, Pantos K, Perez-Cano I, Gadea B, Martinez M, Muela L, Cruz M, Galindo N, Munoz M, Garrido N, Romano S, Albricci L, Stoppa M, Cerza C, Sanges F, Fusco S, Capalbo A, Maggiulli R, Ubaldi F, Rienzi L, Ulrick J, Kilani S, Chapman M, Losada C, Ortega I, Pacheco A, Bronet F, Aguilar J, Ojeda M, Taboas E, Perez M, Munoz E, Pellicer A, Meseguer M, Boumela I, Assou S, Haouzi D, Monzo C, Dechaud H, Hamamah S, Dechaud H, Boumela I, Assou S, Haouzi D, Monzo C, Hamamah S, Nakaoka Y, Hashimoto S, Amo A, Yamagata K, Nakano T, Akamatsu Y, Mezawa T, Ohnishi Y, Himeno T, Inoue T, Ito K, Morimoto Y. EMBRYOLOGY. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|