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Santos Bórnez MJ, Fernandez Castro M, Sanz J, Campos Esteban J, Godoy H, Merino Argumánez C, Rusinovich O, De la Torre Rubio N, Pavía Pascual M, Sánchez Fernández MC, Briongos Díaz PD, Garcia-Magallon B, Barbadillo Mateos C, De Villa LF, Isasi Zaragoza C, Andréu Sánchez JL, Sánchez A. AB0462 CORRELATION BETWEEN SAXON TEST AND UNSTIMULATED SALIVARY FLOW RATE IN PATIENTS WITH SUSPECTED SJÖGREN´S SYNDROME. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, which alters their function producing dryness of the mouth, eyes and other mucous membranes. The method used to quantify glandular hypofunction is by whole saliva flow stimulated and unstimulated (UWSF) [1], which takes between 5 and 15 minutes (min). The Saxon test [2], is another tool with the same objective but requires less time: 2 minutes. In the literature, we only have found one study that compares the Saxon test with other diagnostic methods although it is developed in patients without SS [3].ObjectivesTo compare the Saxon test and UWSF in a cohort of patients with suspected SS.MethodsIn a consecutive cohort of patients who attended the rheumatology department for suspected SS, UWSF was measured (mL/5 min) and the Saxon test (gr/2 min) was performed. The Index Reported by Patients with Sjögren’s Syndrome of the EULAR (ESSPRI) was collected too. This is a patient-reported index designed to assess the severity of patients’ symptoms (dryness, pain, somatic and mental fatigue) in SS through an average of single 0–10 numerical scale for each domain. To measure the UWSF, patients were asked to swallow their saliva before the start of the test and then to spit into a container for 5 min. The Saxon test was performed by calculating the difference in the weight of two pieces of sterile gauze that the patient chews for two minutes. An UWSF >0.25 mL/min, a Saxon test >2.75 g/2min and an ESSPRI<5 were considered normal. Spearman’s rank correlation coefficient (rs) was used to determine the correlation between both quantitative variables. The Chi-square test and the Gamma test were used in the comparisons between the groups (altered and normal) and the Mann-Whitney U in the comparisons of the quantitative variables based on the groups (altered and normal) previously defined. P values <0.05 were considered statistically significant.ResultsWe enrolled 70 patients (63 women/7 men), with a mean age ± standard deviation of 54±13 years. The medians (Me) and interquartile ranges (IQR) obtained were 1.500 (0.6750 – 2.5000) mL/5min for the UWSF, 2.405 (1.6775-3.4925) g/2min for the Saxon test, 6.67 (3.67-7.67) for ESSPRI and 7.00 (4.00-8.00) for ESSPRI-dryness score.A direct and significant correlation between the Saxon test and the UWSF (rs=0.325; P=0.006) was observed. Twenty-four patients (34.3%) presented an altered UWSF and forty-two patients (60%) had an altered Saxon test. When we analysed the intensity of the association between the different groups (altered/normal) of both variables, we observed a direct and significant association (Gamma value=0.583, P=0.010) between both tools.We also detected differences in the Saxon test between patients with altered UWSF (Me: 1.89 gr/2min.; IQR: 1.47-2.68) and those with normal UWSF (Me: 2.78 gr/2 min.; IQR: 1.77-3, 75) (P=0.029). Similarly, we observed significant differences in UWSF values between patients with altered Saxon test (Me: 1.30 mL/5min IQR: 0.50-2.13) and those with a normal Saxon test (Me: 2.00 mL/5min IQR: 1.5-2.88) (P=0.008).Regarding the ESSPRI, 42 (62,7%) patients presented an altered ESSPRI and 49 (73,1%) had an altered ESSPRI-dryness score. The group patients with ESSPRI-dryness score≥5 obtained significantly worse scores on the Saxon test (Me: 2.10 g/2min IQR: 1.58-3.07) and on the ESSPRI (Me:7.33 IQR:5.83-8.00) than the normal ESSPRI-dryness score group: Me:3.02 g/2min, IQR:2.20-3.84, on Saxon test (P=0.026); Me: 2.66 IQR:1, 00-4.08, on the ESSPRI (P=0.000).ConclusionIn patients with suspected SS, there is a direct and significant correlation between the Saxon test and the UWSF. Therefore, the Saxon test could be useful in the initial assessment of oral gland dysfunction, to save time and/or to select patients who require performing the UWSF.References[1]Martínez Ceballos MA et al. Rev. Colomb Reumatol.2020; 27 (S2):90-101.[2]Kohler PF & Winter ME. Arthr & Rheum. 1985;28(10):1128-32.[3]Minagi HO et al. J Oral Rehabil.2020;47:1550-6.Disclosure of InterestsNone declared
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De la Torre Rubio N, Campos Esteban J, Pavía Pascual M, Machattou M, Navarro Palomo P, Rusinovich O, Fernandez Castro M, Godoy H, Barbadillo Mateos C, Merino Argumánez C, Garcia-Magallon B, Sanz J, De Villa LF, Andréu Sánchez JL. AB1345 PREDICTIVE MODEL FOR THE DIAGNOSIS OF PSORIATIC ARTHRITIS IN DERMATOLOGY REFERRALS ACCORDING TO PURE-4 SCALE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe rate of psoriatic arthritis progression is increased in those patients presenting with established disease greater than 2 years duration, so it is necessary to find tools that allow early diagnosis to prevent joint damage1. Prevalence of psoriatic arthritis varies according to the screening strategies used. The COMPAQ study compared four screening questionnaires for psoriatic arthritis (PEST, ToPAS, PASE and EARP), whose sensitivities ranged from 44 to 91%, with the EARP questionnaire showing the highest sensitivity2. A new, shorter questionnaire, PURE-4 scale, has been developed, with a sensitivity of 85.7%3.ObjectivesTo evaluate the usefulness of PURE-4 scale in real clinical practice conditions to identify patients with psoriatic arthritis in patients with psoriasis referred from a dermatology department to a rheumatology department.MethodsRetrospective descriptive study of patients diagnosed with psoriasis who have been referred from the Dermatology Department in the last 12 months for suspected joint domain according to PURE-4 scale used by this department. The following variables were collected: age, sex, obesity, dyslipidaemia, smoking, family history of psoriasis, form of psoriasis (plaque, palmoplantar, scalp, nail), previous treatment (topical, methotrexate, other, none), PASI index, compliance with CASPAR criteria, rheumatological diagnosis (psoriatic arthritis yes/no), PURE-4 score, morning stiffness in hands, Achilles enthesitis, inflammatory low back pain and need for anti-inflammatory drugs for joint pain in the last 3 months. Descriptive statistics was performed and Chi-square test was used to compare the diagnosis of psoriatic arthritis with PURE-4 values (at the response threshold ≥ 1 it has a sensitivity of 85.7% and a specificity of 83.6%).ResultsIn the last 12 months the Dermatology Department of our hospital made 33 referrals for suspected psoriatic arthritis in patients diagnosed with psoriasis. Mean age was 46.4 ± 12.4 years, 51.5 % were men. Fifty-one percent of the patients had a BMI ≥25, 30.3% had dyslipidaemia and 45.5% were smokers; 10% of the patients had family history of psoriasis. The most prevalent form of psoriasis was plaque (18%) followed by nail (6%), palmoplantar (3%), scalp (3%) and droplet (3%) involvement; 51.5% of patients were on topical treatment, 9% on methotrexate and 39.4% on biologic treatments; mean PASI was 6.2 ± 7.5. Seventy-five percent of the referred patients did not meet CASPAR criteria; 33.3% were diagnosed with psoriatic arthritis by the rheumatologist. Of the 33 patients, 4 (12.1%) scored 0 points on PURE-4 scale; 21 (63.6%) scored 1 point; and 8 (24.3%) scored 2 points. Once assessed by a rheumatologist, 75.5% had no morning stiffness in the hands, 93.9% had no Achilles enthesitis and 87.9% had no inflammatory low back pain; only 24.2% of patients had required NSAIDs in the previous 3 months for joint pain. Finally, the diagnosis of psoriatic arthritis was analyzed against the PURE-4 cut-off point (Table 1).Table 1.Psoriatic arthritis diagnosis based on total score on PURE-4 scalePURE-4 ScoreChi-squared testp value≧ 10.250.61= 10.100.74= 20.690.41ConclusionPURE-4 scale with a score ≥ 1 does not seem to improve the diagnosis of arthritis in psoriatic patients. It would be necessary to implement other questionnaires that are more complete, but at the same time affordable, when carried out during the dermatology consultation in order to increase the sensitivity to refer or not to the rheumatologist.References[1]Gladman DD et al. Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease? Ann Rheum Dis 2011;70(12):2152-2154.[2]Mishra S et al. Comparison of four validated psoriatic arthritis screening tools in diagnosing psoriatic arthritis in patients with psoriasis (COMPAQ Study). Br J Dermatol 2017;176(3):765-770.[3]Audureau E et al. Psoriatic arthritis screening by the dermatologist: development and first validation of the ‘PURE-4 scale’. J Eur Acad Dermatol Venereol 2018;32(11):1950-1953.Disclosure of InterestsNone declared
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Pavía Pascual M, Rusinovich O, de la Torre Rubio N, Navarro Palomo P, Machattou M, Godoy H, Campos Esteban J, Barbadillo Mateos C, Sanz J, Merino Argumánez C, Espinosa M, Garcia-Magallon B, Andréu Sánchez JL, Huerta Arroyo AM, Fernandez Castro M. AB0430 EFFECTIVENESS OF RITUXIMAB TREATMENT IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe therapeutic management of Sjögren’s Syndrome remains challenging in clinical practice. Randomized clinical trials with rituximab (RTX) fail to submit primary outcomes; nevertheless, some case series show improvement with this treatment.ObjectivesTo evaluate the effectiveness of therapy with RTX in patients with primary Sjögren’s Syndrome (pSS).MethodsA retrospective chart review was conducted among patients with pSS who fulfilled 2002 AECG and 2016 ACR/EULAR criteria and had received RTX in the last 6 years. Patients with Sjögren’s Syndrome associated with other autoimmune diseases were not included. Clinical, serological and radiological variables were analyzed (prior and 6 months after RTX therapy). A descriptive statistical analysis was performed.Results18 patients were analyzed, 72.2% women, with a mean age of 60.9 years (36-83) and a mean duration of disease of 9.7 years (2-28).Reasons for treatment initiation were pulmonary involvement (n=5), renal involvement (n=4), arthritis (n=3), severe ocular/oral dryness (n=3), recurrent mumps (n=2) and autoimmune hepatitis with lymphadenopathy (n=1).Initial regimen was 2 doses of 1 g each administered 15 days apart. In 8 patients the dose was reduced in subsequent cycles to a single dose of 1 g or 500 mg. The mean number of cycles received was 3.2 (1 - 12).In 7 patients its administration persists as maintenance treatment every 6 months. In 5 patients, treatment was suspended because of clinical improvement/stability; in 2 it was stopped due to adverse effects (one for psychosis and the other for infusion reaction).; in 1 patient it was discontinued due to lack of efficacy in dryness; in 1 patient with pulmonary involvement, it was replaced by mycophenolate due to COVID-19 pandemic and clinical stability; in 1 patient it was suspended due to initiation of radiotherapy for epidermoid carcinoma of the scalp and 1 died of large cell neuroendocrine carcinoma.RTX was effective in 5 (100%) patients with pulmonary involvement (clinical, radiological and functional stability and/or improvement); in 4 (100%) patients with renal involvement (clinical and analytical improvement); in 3 (100%) patients with arthritis complete improvement was obtained; in 2 (100%) patients with recurrent mumps relapse was avoided; in 1 (100%) patient with autoimmune hepatitis and lymphadenopathy clinical and radiological improvement was obtained. Of the three patients with dryness: 1 experienced subjective clinical improvement, 1 reported improvement coinciding with the use of therapeutic contact lenses and 1 improved only at the beginning.Subjective improvement in asthenia was observed in 4 patients.Complement levels normalized in 4 of 5 patients with hypocomplementemia as well as in 4 of 4 with increased B2-microglobulin; 3 of 6 patients with hypergammaglobulinemia normalized IgG value. No changes were observed in the four patients who were rheumatoid factor positive.6 of 6 patients receiving corticosteroid treatment, reduced the dose by half and 1 achieved corticoid withdrawal.ConclusionThe observed data suggest that RTX may be useful in selected patients with pSS. Further research is needed to determine its efficacy.References[1]Chen YH, Wang XY, Jin X, Yang Z, Xu J. Rituximab Therapy for Primary Sjögren’s Syndrome. Front Pharmacol. 2021 Sep 2;12:731122[2]Ramos-Casals M, Brito-Zerón P, Bombardieri S, Bootsma H, De Vita S, Dörner T, et al. EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Ann Rheum Dis. 2020 Jan;79(1):3-18[3]Mavragani CP, Moutsopoulos HM. Sjögren’s syndrome: Old and new therapeutic targets. J Autoimmun. 2020 Jun;110:102364[4]Mariette X, Criswell LA. Primary Sjögren’s Syndrome. N Engl J Med. 2018 Mar 8;378(10):931-939Disclosure of InterestsNone declared
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Pavía Pascual M, Pérez S, Rodriguez L, Ruiz Antorán B, Rusinovich O, de la Torre Rubio N, Machattou M, Navarro Palomo P, Campos Esteban J, Fernandez Castro M, Godoy H, Barbadillo Mateos C, Merino Argumánez C, Espinosa M, Garcia-Magallon B, Calleja Panero JL, Andréu Sánchez JL, Sanz J. AB0802 PREVALENCE OF NONALCOHOLIC FATTY LIVER DISEASE IN RHEUMATOID ARTHRITIS, AXIAL SPONDYLOARTHRITIS, AND PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundNon-alcoholic fatty liver disease (NAFLD), the most common cause of liver disease, has a prevalence of about 25% in the general population. It increases mortality and comorbidity in patients with immune-mediated inflammatory diseases.ObjectivesThe main objective is to estimate the prevalence of NAFLD in three of the most common rheumatologic pathologies: rheumatoid arthritis (RA), axial spondyloarthritis (SpA-ax) and psoriatic arthritis (PsA). As a secondary objective, the possibility of finding associated risk factors in this group of subjects that may imply a higher risk of developing NAFLD is proposed.MethodsWe conducted a prospective single center observational study which included patients diagnosed with RA, EspA-ax, and PsA attended in the Rheumatology department of a tertiary hospital from January to April 2021. Anthropometric parameters, history related to cardiovascular risk factors and disease activity at the time of the visit were collected. Additionally, blood tests and transitional elastography were performed in all patients and the presence of NAFLD was assessed by the fatty liver index (FLI) scale. Different variables were considered to study their association with NAFLD.Results90 patients were included: 28 diagnosed with RA, 36 with EspA-ax and 26 with PAs. 41.1% were male (age range: 27-79 years). Patients with previous liver disease were excluded from the study. 22 (27.2%) patients had NAFLD measured by FLI ≥ 60. No significant differences in prevalence of hepatic steatosis were found between the 3 groups, although values were higher in patients with PsA.The variables that were significantly associated with the development of NAFLD in our cohort were: body mass index (BMI), abdominal perimeter, blood glucose level, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), HDL, TG, GGT, ferritin and uric acid levels. The rest of the variables studied did not show statistically significant differences (Table 1).Table 1.NO STEATOSIS (FLI<60)n=59STEATOSIS (FLI>60)n=22MeanStandard deviationMeanStandard deviationpBMI24,523,0030,292,77< 0,001Abdominal perimeter86,3410,01106,828,55< 0,001Age52,9312,8757,598,240,1185Glucose78,648,3790,6419,690,0002Insulin8,8310,1212,406,660,1302HOMA1,752,022,761,700,0500HbA1c5,350,455,690,640,0096Total cholesterol190,9829,46201,4138,530,1977HDL64,8817,6655,5911,550,0249LDL110,4428,45120,0036,210,2163TG81,1232,42128,5055,52< 0,001GPT25,8330,7337,1819,820,1116GOT27,2023,4926,8210,690,9413GGT20,8017,6649,9538,46< 0,001Creatinin0,750,190,840,180,0583Uric acid4,781,305,911,140,0007Ferritina121,75111,30208,00140,170,0050PCR2,894,552,672,330,8307ConclusionHepatic steatosis was present in 27.2% of patients vs 25% estimated prevalence in the general population. Identification of risk factors involved would allow better control of the comorbidities associated with NAFLD.The fact that the prevalence found in our sample population is so close to that of the general population, may be related to a good inflammatory control of the underlying disease.Further prospective studies with larger sample sizes are needed to find additional predictive factors for the development of NAFLD in this group of diseases.References[1]Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A. y Tiribelli, C. (2006). The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterology, 6: 33.[2]Brenner, C., Galluzzi, L., Kepp, O. y Kroemer, G. (2013). Decoding cell death signals in liver inflammation. Journal of Hepatology, 59(3): 583-594.[3]Byrne, C.D. y Targher, G. (2015). NAFLD: a multisystem disease. Journal of Hepatology, 62(1 Suppl): 47[4]Miele, L., Vallone, S., Cefalo, C., La Torre, G., Di Stasi, C., Vecchio, F.M., et al. (2009). Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. Journal of Hepatology, 51(4): 778-786.Disclosure of InterestsNone declared
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De la Torre Rubio N, Campos Esteban J, Pavía Pascual M, Navarro Palomo P, Machattou M, Rusinovich O, Fernandez Castro M, Godoy H, Merino Argumánez C, Garcia-Magallon B, Barbadillo Mateos C, Sanz J, De Villa LF, Andréu Sánchez JL. POS1548-HPR USEFULNESS OF AN ELECTRONIC CONSULTATION SYSTEM BETWEEN PRIMARY CARE HEALTH CENTERS AND RHEUMATOLOGY DEPARTMENT OF A TERTIARY HOSPITAL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe EPISER study is the first Spanish epidemiological study that has confirmed the great burden of rheumatic diseases in the general population: they consume a large quantity of health resources (doctor visits, medical products) and imply a high social impact in terms of work absenteeism. Rheumatic diseases represent almost 30% of Primary Care medical consultations in Spain1,2. Electronic consultation could be an alternative response to the increase of this demand, both to make an early diagnosis and derivation and to improve communication with Primary Care physicians3,4.ObjectivesTo analyze the demand of Primary Care and its resolution through the electronic consultation system of the Rheumatology Department of a tertiary hospital.MethodsRetrospective descriptive study of the data collected in the request and information system (Sistema de Peticiones Electrónicas, SIPE) that supports electronic consultation between primary care physicians of the health area and the Rheumatology Department of a tertiary hospital, between July 2020 and May 2021.The following variables were collected: age, sex, reason for consultation, response time in days and destination (primary care/outpatient follow-up). Descriptive statistics were used to present the results.ResultsThe last 500 consecutive electronic consultations registered in the system, referring to 496 patients, were collected. Mean age was 59.5±17.7 years; 74.2% women. Mean response time was 2 days, median response time 1 day and range 0-45. The reasons for consultation (see Graph 1) were: osteoporosis assessment 55 (11%), treatment adjustment 50 (10%), appointment request 49 (9.8%), loss to follow-up 43 (8.6%), local-regional pathology assessment 39 (7.8%), infiltration request 28 (5, 6%), suspected rheumatoid arthritis 19 (3.8%), flare 18 (3.6%), suspected polymyalgia rheumatica or giant cell arteritis 16 (3.2%), COVID vaccine consultation 14 (2.8%), Raynaud’s phenomenon 13 (2.6%), monoarthritis assessment 12 (2.4%), assessment of polyarthritis 11 (2.2%), adverse effects of treatment 11 (2.2%), suspected spondyloarthritis 11 (2.2%), suspected psoriatic arthritis 8 (1, 6%), generalized pain 7 (1.4%), suspected Sjögren’s syndrome 5 (1%), suspected systemic lupus erythematosus 1 (0.2%), suspected other systemic autoimmune diseases 9 (1.8%), others 81 (16.2%). Fifty-seven and four % (287) of the patients required an appointment at the Rheumatology outpatient clinic and in 42.6% of the patients (213) the electronic consultation was successful, so it was not necessary to refer the patient to the hospital.ConclusionForty-two and six percent of the queries were resolved thanks to the electronic consultation system in an average of two days, otherwise that patients would have been referred to specialized care. The main reasons for consultation were osteoporosis assessment and clarification of doubts about the treatment of patients who were already being followed up by the Rheumatology Department.References[1]Carmona L, Ballina J, Gabriel R, Laffon A. The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis 2001 -11;60(11):1040-1045.[2]Seoane-Mato D, Martínez Dubois C, Moreno Martínez MJ, Sánchez-Piedra C, Bustabad-Reyes S. Frequency of medical visits due to osteoarticular problems of the adult general population in Spain. EPISER2016 Study. Gac Sanit 2020 Sep - Oct;34(5):514-517.[3]Tejera Segura B, Bustabad S. A New Form of Communication Between Rheumatology and Primary Care: The Virtual Consultation. Reumatol Clin 2016 /01/01;12(1):11-14.[4]Pego-Reigosa JM, Peña-Gil C, Rodríguez-Lorenzo D, Altabás-González I, Pérez-Gómez N, Guzmán-Castro JH, et al. Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology. BMC Health Serv Res 2022 -01-12;22(1):60.Disclosure of InterestsNone declared
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Pavía Pascual M, Jarque I, Morell Hita JL, Loarce-Martos J, Montaño Tapia LF, Rusinovich O, De la Torre Rubio N, Navarro Palomo P, Machattou M, Barbadillo Mateos C, Godoy H, Sanz J, Fernandez Castro M, De Villa LF, Merino Argumánez C, Garcia-Magallon B, Andréu Sánchez JL, Campos Esteban J. POS0903 ASSOCIATION STUDY BETWEEN ANTI-TIF 1γ ANTIBODY AND DEVELOPMENT OF NEOPLASIA IN THREE TERTIARY HOSPITALS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAnti-transcriptional intermediary factor 1γ (anti-TIF 1γ) antibody is robustly linked with cancer-associated dermatomyositis (DM) in adults, but its specificity varies widely between series. TIF 1γ can act either as a tumor promoter or suppressor and may behave as an autoantigen.ObjectivesInvestigate the association between anti-TIF 1γ antibody positivity and development of neoplasia.MethodsA retrospective chart review was conducted among patients with positive anti-TIF 1γ antibodies detected by immunoblot from March 2019 to December 2021 in three tertiary hospitals. Demographic variables, creatine kinase (CK) values, other autoantibodies, associated autoimmune diseases (AIDs) and existence or not of a cancer diagnosis were analyzed. To rule out malignancy, patients had to present a PET-CT scan without pathological findings or a chest CT scan, a gynecological study and a digestive study without alterations. A descriptive statistical analysis was performed.Results29 patients with anti-TIF 1γ antibodies were analyzed, 82.7% women, with a mean age of 61 years (31-96 years).The reason for requesting this antibody was: clinical features suggestive of DM in 10 patients (34.5%), muscle weakness in 9 (31%), interstitial lung disease (ILD) in 5 (17.2%), persistent CK elevation in 3 (10.3%), constitutional syndrome in 1 (3.5%) and antiphospholipid syndrome in 1 patient (3.5%). The mean time from symptoms onset to the detection of anti-TIF 1γ was 14 months (0-60 months).10 patients (34.5%) had a diagnosis of DM; 4 patients (13.8%) systemic lupus erythematosus (SLE); one (3.5%) had a SLE/DM overlap syndrome; one patient (3.5%) subacute cutaneous lupus; one (3.5%) was diagnosed with diffuse systemic sclerosis; one patient (3.5%) limited systemic sclerosis; one patient (3.5%) antiphospholipid syndrome; one patient (3.5%) HLA-B27+ spondyloarthritis and 9 patients (31%) had no associated AIS.5 patients (17.2%) showed ILD with different patterns: UIP (n=2), NSIP (n=2) and COP (n=1). Only 9 patients (31%) had elevated CK levels at the time of antibody determination.10 patients (34.5%) were diagnosed with cancer: lung adenocarcinoma (n=2), small cell lung carcinoma (n=2), breast carcinoma (n=2), hepatocarcinoma (n=1), cervical cancer (n=1), ovarian carcinoma (n=1) and gallbladder adenocarcinoma (n=1). Of those, 7 patients (70%) had elevated CK levels and 6 (60%) had a diagnosis of DM. None of the patients diagnosed with cancer had ILD.In 4 patients (40%), the diagnosis of cancer was simultaneous with the diagnosis of anti-TIF 1γ antibodies; in 4 (40%), the diagnosis of the tumor preceded the finding of the antibodies; in the other 2 (20%), the finding of the antibodies preceded that of the tumor. 30-month survival after cancer diagnosis was 10%.In 17 patients (58.6%) no malignancy has been found so far in the annual cancer screening. In two patients (6.9%) no cancer screening was performed.ConclusionIn our study, 60% of patients with DM and anti-TIF 1γ presented neoplasia, a prevalence similar to that established in other series (60-80%). Furthermore, 21% of patients with antibodies and without DM were diagnosed with cancer, suggesting that anti-TIF 1γ antibodies could also be associated with neoplasia in patients without DM. Patients with ILD did not present cancer, supporting the observation of previous studies in which the presence of ILD is a marker of low risk for neoplasia in patients with DM. HyperCKemia might predict the association with neoplasia in patients with anti-TIF 1γ antibodies.References[1]De Vooght J, Vulsteke JB, De Haes P, Bossuyt X, Lories R, De Langhe E. Anti-TIF1-γ autoantibodies: warning lights of a tumour autoantigen. Rheumatology. 2020 Mar 1;59(3):469-477[2]Shimizu K, Kobayashi T, Kano M, Hamaguchi Y, Takehara K, Matsushita T. Anti-transcriptional intermediary factor 1-γ antibody as a biomarker in patients with dermatomyositis. J Dermatol. 2020 Jan;47(1):64-68[3]Masiak A, Kulczycka J, Czuszyńska Z, Zdrojewski Z. Clinical characteristics of patients with anti-TIF1-γ antibodies. Reumatologia. 2016;54(1):14-8Disclosure of InterestsNone declared
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de la Torre Rubio N, Campos Esteban J, Pavía Pascual M, Machattou M, Navarro Palomo P, Rusinovich O, Merino Argumánez C, Garcia-Magallon B, Godoy H, Barbadillo Mateos C, de Villa LF, Sanz J, Andréu Sánchez JL, Fernandez Castro M. AB0572 USEFULNESS OF MINOR SALIVARY GLAND BIOPSY IN THE DIAGNOSIS OF PATIENTS WITH SUSPECTED PRIMARY SJÖGREN’S SYNDROME. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe classification system for Sjögren’s syndrome (SS) proposed by the American-European Consensus Group (AECG) and the revised diagrams proposed by the American College of Rheumatology (ACR) include an altered minor salivary gland biopsy (MSGB) or positive antiRo, among other findings. Thus, an altered MSGB is a particularly important finding in patients with autoantibody-negative. A retrospective cohort study showed that a positive biopsy result led to a definitive diagnosis in 80% of patients1.ObjectivesTo assess the usefulness of MSGB in the diagnosis of SS in anti-SSA/SSB (Ro/La) negative patients.MethodsRetrospective descriptive study in patients with suspected SS in which MSGB were collected according to standard clinical practice over a consecutive period (from September 2020 to May 2021) in the Rheumatology Department of a tertiary hospital.Patients were grouped according to the reason for requesting the biopsy: 1) Dry eye/oral syndrome (DEOS), 2) DEOS + altered Saxon/Schirmer, 3) DEOS + positive antinuclear antibodies (ANA+), 4) DEOS + (ANA+) + other serological alterations (hypergammaglobulinaemia, rheumatoid factor (RF), hypocomplementemia), 5) DEOS + extraglandular manifestations (EG) + (ANA+) +/- other serological alterations. The following variables were collected: age, sex, dry eye/oral syndrome, Raynaud’s phenomenon, EG manifestations (arthritis, autoimmune hepatitis, primary biliary cirrhosis, interstitial lung disease, pleuropericarditis, autoimmune chronic nephropathy suspected or tubulointerstitial nephritis and/or neurological manifestations), ANA, hypergammaglobulinaemia, RF, hypocomplementemia, Saxon and Schirmer tests and histological result of MSGB according to its Focus Score (FS); MSGB was considered altered when FS was ≥1. Descriptive analysis was performed (means and frequencies); Chi-square test was used to compare the reasons for requesting MSGB between patients with altered and unaltered results and to compare whether any of the groups (Groups 2-5) were more frequently associated with an altered MSGB compared to patients presenting only with dry syndrome (Group 1).ResultsSeventy-eight MSGB were collected. Mean age of patients was 55 years; 90% were women. ANA were present in 17% of patients with altered MSGB. DEOS was the suspected manifestation in 83% of patients, 13% had Raynaud’s phenomenon and 47% had some EG manifestation. MSGB was compatible with a diagnosis of SS (according to 2002/2016 classification criteria) in 28% of anti-SSA/SSB negative patients. Patients with dry syndrome and positive ANA (Group 3) were significantly associated with MSGB altered (Table 1).Table 1. Comparative table of patterns inidicated in the reasons for requesting a MSGB. *Not significant (NS).Reason for request (%)MSGB alteredMSGB unalteredpp vs drynessDEOS (50)19460.65DEOS + Saxon/Schirmer (38)15340.47NSDEOS + ANA (30)11270.67NSDEOS + ANA + others (8)640.410.05DEOS + EG + ANA (14)9150.69NSConclusionMSGB was compatible with a diagnosis of SS in 28% of anti-SSA/SSB negative patients. The data suggest that patients presenting with objectified dryness with Saxon and/or Schirmer test, as well as those with extraglandular manifestations and ANA+ and/or other serological alterations, are more likely to have a compatible with SS result on MSGB. Studies with larger numbers of patients are needed.References[1]Wicheta S, Van der Groen T, Faquin WC, August M. Minor Salivary Gland Biopsy-An Important Contributor to the Diagnosis of Sjögren Syndrome. J Oral Maxillofac Surg 2017 -12;75(12):2573-2578.Disclosure of InterestsNone declared
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Rusinovich O, Sanz M, Esteban Vazquez AV, Molina Esteban N, Uyaguari Morocho MDC, Pavía Pascual M, Navarro Palomo P, Machattou M, De la Torre Rubio N, Fernandez Castro M, Godoy H, Barbadillo Mateos C, Merino Argumánez C, Garcia-Magallon B, Sanz J, Isasi Zaragoza C, De Villa LF, Cobo TI, Campos Esteban J, Andréu Sánchez JL. AB1396 MULTICENTER QUALITATIVE STUDY ON THE EXPERIENCE OF USE OF BIOLOGIC AND TARGETED SYNTHETIC DISEASE-MODIFYING DRUGS IN PATIENTS WITH RHEUMATIC DISEASES. WHAT DO OUR PATIENTS THINK? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe development of targeted biologic (bDMARDs) and targeted synthetic disease-modifying drugs (tsDMARDS) has made a substantial change in the control of our patients, and has allowed an increasing number of patients to achieve clinical remission.ObjectivesTo gain understanding of patients’ experiences of starting treatment with b/tsDMARDs, and explore their attitudes in order to improve the doctor-patient relationship, adherence to treatment, compliance, and knowledge about the experience of using b/tsDMARDs.MethodsA qualitative study was carried out. A consecutive sample of 130 patients attended in the rheumatology units of four Madrid hospitals, from August 29th, 2021 to January 21st, 2022 completed a questionnaire that consisted of 31 questions, a subsequent qualitative analysis of discourse and content through focus groups with patients was carried out. Descriptive statistical analysis was performed. Chi-squared tests were applied to explore the dependency relationship between the different qualitative variables.ResultsOne hundred and thirty questionnaires were collected (see general characteristics in the Table 1).Table 1.Baseline demographics.Sex, n (%)96 female (73.85%), 34 male (26.15%)Age, years, mean (SD)51,62±12.31 yearsEthnicity/race, n(%)74.6% White or Caucasian22.3% Hispanic or Latino2.3% Asiatic0.8% Black or African AmericanDiagnosis, (%)42.4% rheumatoid arthritis25.3% axial spondyloarthritis10% psoriatic arthritis6.9% connective tissue diseases15.4 % otherTime since diagnosis (years), mean (SD)14,7 years (+/-11,43)Time since initiation of treatment with b/tsDMARDs (years), mean (SD)5,84 years (+/-4,28)Most of the patients (68.46%) felt hope when they were informed that they were going to start treatment with b/tsDMARDs, 26.9% relief, 22.3% happiness and 27.7% fear and concern. 76% of the patients received information about why the treatment was modified, the advantages of b/tsDMARDs (60%), their mechanism of action (48.5%) and the precautions to be aware of (38.5 %). Fifty-two percent of the respondents searched for additional information on their own, with the most used sources being from internet search engines (34.2%), the corresponding drug insert (22.8%) and the page of the Spanish Society of Rheumatology (23.7%).60% of the respondents were informed about the possible risks associated with the treatment, 49.4% reported being more concerned when they contracted an infection. Most of the patients were recommended to receive influenza (81.5%) and pneumococcal (69.2%) vaccination, of which 74.6% and 54.6% received those respectively. A statistically significant dependence was observed between the recommendation of the vaccine and vaccination, since most (91,5%) of those who received the recommendation were vaccinated (p<0.001). Most of the respondents kept their scheduled appointments (87.3%) and never forgot to take their medication (37.04%).51% of the patients reported that with b/tsDMARDs they had experienced “considerable improvement”, 38.5% indicated that “their life has changed”, 10% reported little or no improvement. It was observed that men reported a maximum degree of improvement with a significantly higher frequency than women (77% vs 37% respectively), OR 5.79 (p <0.009, IC 95% 1.42, 23.67). To the question “In which aspects have you noticed the greatest changes?” the respondents answered: reduction in outbreaks of the disease (67%), emotional improvement (38.6%) and regaining work activity (31.8%).ConclusionIn our setting, education programs inform patients adequately, but it seems necessary to make a greater emphasis on therapeutic compliance, providing more safety information, and compliance to recommended vaccinations.References[1]Arkell P, et al. Patient experiences, attitudes and expectations towards receiving information about anti-TNF medication—“it could give me two heads and I’d still try it!” BMC Musculoskelet Disord. 2013;10:165. doi: 10.1186/1471-2474-14-165Disclosure of InterestsNone declared
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Devesa A, Lobo-González M, Martínez-Milla J, Oliva B, García-Lunar I, Mastrangelo A, España S, Sanz J, Mendiguren JM, Bueno H, Fuster JJ, Andrés V, Fernández-Ortiz A, Sancho D, Fernández-Friera L, Sanchez-Gonzalez J, Rossello X, Ibanez B, Fuster V. Bone marrow activation in response to metabolic syndrome and early atherosclerosis. Eur Heart J 2022; 43:1809-1828. [PMID: 35567559 PMCID: PMC9113301 DOI: 10.1093/eurheartj/ehac102] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/06/2022] [Accepted: 02/18/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Experimental studies suggest that increased bone marrow (BM) activity is involved in the association between cardiovascular risk factors and inflammation in atherosclerosis. However, human data to support this association are sparse. The purpose was to study the association between cardiovascular risk factors, BM activation, and subclinical atherosclerosis. METHODS AND RESULTS Whole body vascular 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) was performed in 745 apparently healthy individuals [median age 50.5 (46.8-53.6) years, 83.8% men] from the Progression of Early Subclinical Atherosclerosis (PESA) study. Bone marrow activation (defined as BM 18F-FDG uptake above the median maximal standardized uptake value) was assessed in the lumbar vertebrae (L3-L4). Systemic inflammation was indexed from circulating biomarkers. Early atherosclerosis was evaluated by arterial metabolic activity by 18F-FDG uptake in five vascular territories. Late atherosclerosis was evaluated by fully formed plaques on MRI. Subjects with BM activation were more frequently men (87.6 vs. 80.0%, P = 0.005) and more frequently had metabolic syndrome (MetS) (22.2 vs. 6.7%, P < 0.001). Bone marrow activation was significantly associated with all MetS components. Bone marrow activation was also associated with increased haematopoiesis-characterized by significantly elevated leucocyte (mainly neutrophil and monocytes) and erythrocyte counts-and with markers of systemic inflammation including high-sensitivity C-reactive protein, ferritin, fibrinogen, P-selectin, and vascular cell adhesion molecule-1. The associations between BM activation and MetS (and its components) and increased erythropoiesis were maintained in the subgroup of participants with no systemic inflammation. Bone marrow activation was significantly associated with high arterial metabolic activity (18F-FDG uptake). The co-occurrence of BM activation and arterial 18F-FDG uptake was associated with more advanced atherosclerosis (i.e. plaque presence and burden). CONCLUSION In apparently healthy individuals, BM 18F-FDG uptake is associated with MetS and its components, even in the absence of systemic inflammation, and with elevated counts of circulating leucocytes. Bone marrow activation is associated with early atherosclerosis, characterized by high arterial metabolic activity. Bone marrow activation appears to be an early phenomenon in atherosclerosis development.[Progression of Early Subclinical Atherosclerosis (PESA); NCT01410318].
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Chyou JY, Sanz J. Chest Computed Tomography Imaging and Cardiac Implantable Electronic Devices. J Cardiovasc Electrophysiol 2022; 33:1341-1343. [DOI: 10.1111/jce.15476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
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Martínez-Albertos P, Pedroche G, Dremel M, Pearce R, Loughlin M, Tonqueze YL, Sanz J, Juárez R. Shielding conceptual designs of ITER TCP ports to protect electronics. FUSION ENGINEERING AND DESIGN 2022. [DOI: 10.1016/j.fusengdes.2022.113016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Sanz J, Frölian A, Chisholm CS, Cabrera CR, Tarruell L. Interaction Control and Bright Solitons in Coherently Coupled Bose-Einstein Condensates. PHYSICAL REVIEW LETTERS 2022; 128:013201. [PMID: 35061464 DOI: 10.1103/physrevlett.128.013201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/27/2021] [Accepted: 11/15/2021] [Indexed: 06/14/2023]
Abstract
We demonstrate fast control of the interatomic interactions in a Bose-Einstein condensate by coherently coupling two atomic states with intra- and interstate scattering lengths of opposite signs. We measure the elastic and inelastic scattering properties of the system and find good agreement with a theoretical model describing the interactions between dressed states. In the attractive regime, we observe the formation of bright solitons formed by dressed-state atoms. Finally, we study the response of the system to an interaction quench from repulsive to attractive values, and observe how the resulting modulational instability develops into a bright soliton train.
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Jiménez-Garrido J, Sanz J, Schindl G. Equality of Ultradifferentiable Classes by Means of Indices of Mixed O-regular Variation. RESULTS IN MATHEMATICS 2021; 77:28. [PMID: 34924811 PMCID: PMC8643302 DOI: 10.1007/s00025-021-01566-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/14/2021] [Indexed: 06/14/2023]
Abstract
We characterize the equality between ultradifferentiable function classes defined in terms of abstractly given weight matrices and in terms of the corresponding matrix of associated weight functions by using new growth indices. These indices, defined by means of weight sequences and (associated) weight functions, are extending the notion of O-regular variation to a mixed setting. Hence we are extending the known comparison results concerning classes defined in terms of a single weight sequence and of a single weight function and give also these statements an interpretation expressed in O-regular variation.
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Podzamczer D, Micán R, Tiraboschi J, Portilla J, Domingo P, Llibre JM, Ribera E, Vivancos MJ, Morano L, Masiá M, Gómez C, Fanjul F, Payeras A, Inciarte A, Estrada V, Rivero A, Castro Á, Bernal E, Vinuesa D, Knobel H, Troya J, Macías J, Montero M, Sanz J, Navarro-Alcaraz A, Caicedo A, Fernández G, Martínez E, Moreno S. Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Versus Dolutegravir/Abacavir/Lamivudine in Antiretroviral-Naive Adults (SYMTRI): A Multicenter Randomized Open-Label Study (PReEC/RIS-57). Open Forum Infect Dis 2021; 9:ofab595. [PMID: 35237700 PMCID: PMC8883591 DOI: 10.1093/ofid/ofab595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) is the reference for combination therapy based on protease inhibitors due to its efficacy, tolerability, and convenience. Head-to-head randomized comparisons between D/C/F/TAF and combination therapy based on integrase inhibitors in antiretroviral-naive patients are lacking. Methods Adult (>18 years old) human immunodeficiency virus-infected antiretroviral-naive patients (HLA-B∗5701 negative and hepatitis B virus negative), with viral load (VL) ≥500 c/mL, were centrally randomized to initiate D/C/F/TAF or dolutegravir/abacavir/lamivudine (DTG/3TC/ABC) after stratifying by VL and CD4 count. Clinical and analytical assessments were performed at weeks 0, 4, 12, 24, and 48. The primary endpoint was VL <50 c/mL at week 48 in the intention-to-treat (ITT)-exposed population (US Food and Drug Administration snapshot analysis, 10% noninferiority margin). Results Between September 2018 and 2019, 316 patients were randomized and 306 patients were included in the ITT-exposed analysis (151 D/C/F/TAF and 155 DTG/3TC/ABC). Almost all (94%) participants were male and their median age was 35 years. Forty percent had a baseline VL >100 000 copies/mL, and 13% had <200 CD4 cells/μL. Median weight was 73 kg and median body mass index was 24 kg/m2. At 48 weeks, 79% (D/C/F/TAF) versus 82% (DTG/3TC/ABC) had VL <50 c/mL (difference, −2.4%; 95% confidence interval [CI], −11.3 to 6.6). Eight percent versus four percent experienced virologic failure but no resistance-associated mutations emerged. Four percent versus six percent had drug discontinuation due to adverse events. In the per-protocol analysis, 94% versus 96% of patients had VL <50 c/mL (difference, −2%; 95% CI, −8.1 to 3.5). There were no differences in CD4 cell count or weight changes. Conclusions We could not demonstrate the noninferiority of D/C/F/TAF relative to DTG/ABC/3TC as initial antiretroviral therapy, although both regimens were similarly well tolerated.
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Li X, Sanz J, Argudo N, Vernet-Tomas M, Rodríguez N, Torrent L, Fernández-Velilla E, Pera O, Huang Y, Nicolau P, Jiménez M, Segura M, Algara M. Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation. Clin Transl Oncol 2021; 24:829-835. [PMID: 34792725 PMCID: PMC9013337 DOI: 10.1007/s12094-021-02728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/30/2021] [Indexed: 12/03/2022]
Abstract
Purpose To present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes. Materials and methods Eighty patients treated with an Intrabeam® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits. Results Thirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group. Conclusion IORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.
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Romero Daza A, Chokshi A, Pardo P, Maneiro N, Guijarro Contreras A, Larrañaga-Moreira JM, Ibañez B, Fuster V, Fernández Friera L, Solís J, Sanz J. Mitral valve prolapse morphofunctional features by cardiovascular magnetic resonance: more than just a valvular disease. J Cardiovasc Magn Reson 2021; 23:107. [PMID: 34629093 PMCID: PMC8504058 DOI: 10.1186/s12968-021-00800-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Mitral valve (MV) prolapse (MVP) is a primary valvular abnormality. We hypothesized that additionally there are concomitant abnormalities of the left ventricle (LV) and MV apparatus in this entity even in the absence of significant mitral regurgitation (MR). OBJECTIVE To characterize MV and LV anatomic and functional features in MVP with preserved LV ejection fraction, with and without significant MR, using cardiovascular magnetic resonance (CMR). METHODS Consecutive MVP patients (n = 80, mean 52 years, 37% males) with preserved LV ejection fraction, and 44 controls (46 years, 52% males) by CMR were included, as well as 13 additional patients with "borderline" MVP. From cine images we quantified LV volumes, MV and LV anatomic measurements (including angle between diastolic and systolic annular planes, annular displacement, and basal inferolateral hypertrophy) and, using feature tracking, longitudinal and circumferential peak systolic strains. RESULTS Significant MR was found in 46 (56%) MVP patients. Compared with controls, MVP patients had LV enlargement, basal inferolateral hypertrophy, higher posterior annular excursion, and reduced shortening of the papillary muscles. LV basal strains were significantly increased, particularly in several basal segments. These differences remained significant in patients without significant MR, and many persisted in "borderline" MVP. CONCLUSIONS In patients with MVP and preserved LV ejection fraction there is LV dilatation, basal inferolateral hypertrophy, exaggerated posterior annular displacement and increased basal deformation, even in the absence of significant MR or overt MVP. These findings suggest that MVP is a disease not only of the MV but also of the adjacent myocardium.
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Pera O, Membrive I, Lambisto D, Quera J, Fernandez-Velilla E, Foro P, Reig A, Rodríguez N, Sanz J, Algara V, Algara M. Validation of 3D printing materials for high dose-rate brachytherapy using ionisation chamber and custom phantom. Phys Med Biol 2021; 66. [PMID: 34464938 DOI: 10.1088/1361-6560/ac226b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/31/2021] [Indexed: 11/12/2022]
Abstract
Methods.Measurements were taken with the Exradin A20 (Standard Imaging) ionisation chamber, and the 'homemade' MARM phantom was made with the 3D Ultimaker 2+ printer using PLA material. The material used for validation was ABS Medical from Smart Materials 3D. The irradiation was undertaken with a192Ir source by means of Varian's GammaMed Plus iX HDR equipment. EBT3 films were used to run additional tests. We compared different measurements for PLA, ABS Medical, and water. Additional validation methods, described in the bibliography, were also compared.Results.The measurements with the ionisation chamber that we obtained using the MARM phantom with PLA and ABS within the clinically relevant range (0.5-1.5 cm) differ with respect to the measures in the water reference, by 2.3% and 0.94%, respectively.Discussion.The literature describes highly heterogeneous validation methods, complicating the performance of systematic reviews and comparisons between materials. Thus, creating a phantom represents a single effort that will quickly pay off. This system enables comparisons, ensuring that geometric conditions remain stable-something that is not always possible with radiochromic films. The use of a calibrated ionisation chamber in the corresponding energy range, combined with the 'homemade' MARM phantom applied according to the proposed methodology, allows a differentiation between the attenuation of the material itself and the drop in the dose due to distance.Conclusion.The validation method for 3D printing materials, using an ionisation chamber and the MARM PLA phantom, represents an accessible, standardisable solution for manufacturing brachytherapy applicators.
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Stanoyevitch A, Zhang L, Sanz J, Follett RW, Bell DS. Association of Antiosteoporotic Medication Bisphosphonates and Denosumab with Primary Breast Cancer: An Electronic Health Record Cohort Study. ACTA ACUST UNITED AC 2021; 2:316-324. [PMID: 34476414 PMCID: PMC8409235 DOI: 10.1089/whr.2020.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/22/2022]
Abstract
Background: The risks of osteoporosis and breast cancer are increasing in elderly women. Bisphosphonates and denosumab are recommended for treatment of osteoporosis. They have different and overlapping pharmacodynamics and previous studies have shown conflicting results regarding their risk association with breast cancer. We intend to further look into this issue through a comparative study. Methods: Electronic health records of 91,626 women older than 50 years with no previous history of malignancy and no nonbreast cancer during follow-up were retrieved from southern California and retrospectively analyzed using univariate, bivariate, and log-rank tests. Medication use, breast cancer risk, and associated demographic and clinical history were assessed. Results: Over an average of 3.6 years follow-up, the breast cancer relative risks (RRs) counted after 365 days of latency are 1.12 (95% confidence interval [CI]: 0.64–1.97) for denosumab ever users and 0.37 (95% CI: 0.21–0.66) for bisphosphonates ever users, when covariates are comparable. The significant difference is supported by the Log-rank test (p = 0.0004). Excluding statins coprescribers, the breast cancer RR is 1.31 (0.71, 2.43) in denosumab group and 0.26 (0.11, 0.62) in bisphosphonates group. There is a reduced RR in statins ever users (0.47, 95% CI: 0.38–0.58), and the breast cancer risk difference is not significant between concomitant denosumab/statins and bisphosphonates/statins ever users with RR 0.65 (0.16, 2.58) versus 0.55 (0.26, 1.16), p = 0.692. Conclusions: Our data support an association of lower breast cancer risk with bisphosphonates use in elderly women. We did not observe a lower breast cancer risk in denosumab group; however, our data revealed a potential lower breast cancer risk in denosumab users with concurrent statins use and this requires further study.
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Pedroche G, Sauvan P, Alguacil J, Sanz J, Juárez R. Nuclear data for D1SUNED for the study of ITER planned in-situ maintenance dose scenarios. FUSION ENGINEERING AND DESIGN 2021. [DOI: 10.1016/j.fusengdes.2021.112646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Requena-Ibáñez JA, Santos-Gallego CG, Rodriguez-Cordero A, Vargas-Delgado AP, Mancini D, Sartori S, Atallah-Lajam F, Giannarelli C, Macaluso F, Lala A, Sanz J, Fuster V, Badimon JJ. Mechanistic Insights of Empagliflozin in Nondiabetic Patients With HFrEF: From the EMPA-TROPISM Study. JACC-HEART FAILURE 2021; 9:578-589. [PMID: 34325888 DOI: 10.1016/j.jchf.2021.04.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate the effect of empagliflozin, in addition to optimal medical treatment, on epicardial adipose tissue (EAT), interstitial myocardial fibrosis, and aortic stiffness in nondiabetic patients with heart failure with reduced ejection fraction (HFrEF). BACKGROUND Several randomized clinical trials have established the benefits of the inhibitors of the sodium-glucose cotransporter-2 receptor (SGLT2-i) in HFrEF, independent of their hypoglycemic effects. The mechanisms of the benefits of SGLT2-i in HFrEF have not been well defined. METHODS This study was a secondary analysis of patients enrolled in the EMPA-TROPISM [ATRU-4] (Are the cardiac benefits of Empagliflozin independent of its hypoglycemic activity?) clinical trial. It was a double-blind, placebo-controlled randomized clinical trial investigating the effect of empagliflozin in nondiabetic patients with HFrEF. Patients underwent cardiac magnetic resonance at baseline and after 6 months. Interstitial myocardial fibrosis was calculated by using T1 mapping (extracellular volume). Aortic stiffness was calculated by using pulsed wave velocity, and EAT was measured from the cine sequences. RESULTS Empagliflozin is associated with significant reductions in EAT volume (-5.14 mL; 95% CI: -8.36 to -1.92) compared with placebo (-0.75 mL; 95% CI: -3.57 to 2.06; P < 0.05); this finding was paralleled by reductions in subcutaneous adipose tissue area (-5.33 cm2 [95% CI: -12.61 to 1.95] vs 9.13 cm2 [95% CI: -2.72 to 20.99]; P < 0.05). Empagliflozin-treated patients reported a reduction in extracellular volume (-1.25% [±0.56 95% CI] vs 0.24% [±0.57 95% CI]; (P < 0.01)]; specifically, empagliflozin reduced both matrix volume (-7.24 mL [95% CI: -11.59 to -2.91] vs 0.70 mL [95% CI: -0.89 to 2.29]; P < 0.001) and cardiomyocyte volume (-11.08 mL [95% CI: -19.62 to -2.55] vs 0.80 mL [95% CI: -1.96 to 3.55]; P < 0.05). Pulsed wave velocity was also significantly reduced in the empagliflozin group (-0.58 cm/s [95% CI: -0.92 to -0.25] vs 0.60 cm/s [95% CI: 0.14 to 1.06]; P < 0.01). Using proteomics, empagliflozin was associated with a significant reduction in inflammatory biomarkers. CONCLUSIONS Empagliflozin significantly improved adiposity, interstitial myocardial fibrosis, aortic stiffness, and inflammatory markers in nondiabetic patients with HFrEF. These results shed new light on the mechanisms of action of the benefits of SGLT2-i. (Are the "Cardiac Benefits" of Empagliflozin Independent of Its Hypoglycemic Activity [ATRU-4] [EMPA-TROPISM]; NCT03485222).
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Calzavara D, Morante S, Sanz J, Noguerol F, Gonzalez J, Romandini M, Sanz M. The apically incised coronally advanced surgical technique (AICAST) for periodontal regeneration in isolated defects: a case series. QUINTESSENCE INTERNATIONAL (BERLIN, GERMANY : 1985) 2021; 53:24-34. [PMID: 34269040 DOI: 10.3290/j.qi.b1763645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this retrospective case series was to report the performance up to 5 years of an innovative surgical design (the apically incised coronally advanced surgical technique [AICAST]) for the regenerative treatment of one- or two-walled intrabony periodontal lesions. METHOD AND MATERIALS After completion of standard step I to II periodontal therapy, nine isolated periodontal defects were treated through AICAST. The following clinical outcome measurements were collected before the surgical intervention and at the last available follow-up: probing pocket depth (PPD), recession depth (REC), and clinical attachment level (CAL). Periapical radiographs of the treated teeth were also taken at baseline and at the last available follow-up (18 months or 5 years postoperatively). RESULTS A mean (± standard deviation) PPD reduction of 6.05 ± 1.76 mm (P < .01), REC reduction of 1.15 ± 1.97 mm (P = .119), and CAL gain of 7.20 ± 2.13 mm (P < .01) were attained when comparing preoperative results with the last follow-up visit. CAL gain of 6 mm or more was reached in eight out of nine treated cases (88.9%), with a residual PPD of 2 to 3 mm in all the cases. Complete radiographic fill of the intrabony component was present in all the defects, while detectable suprabony radiographic filling was identified in two cases. CONCLUSION AICAST represents an innovative surgical design for the treatment of deep intrabony defects and the eventual reduction of the associated gingival recessions. Preliminary results show good performance in terms of clinical attachment gains and maintenance of the marginal tissues.
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Paja M, Zafón C, Iglesias C, Ugalde A, Cameselle-Teijeiro JM, Rodríguez-Carnero G, Fernández-Seara P, Anda E, Povoa A, Quiceno H, Sánchez-Gómez NM, González C, García-Pascual L, Gómez de la Riva I, Blanco C, Meizoso T, Riesco-Eizaguirre G, Capel I, Ortega MV, Mancha I, Chao M, Alcázar V, Roselló E, Maravall J, López-Agulló S, Pérez-Lázaro A, Meseguer P, Sanz J, Paricio JJ, Echeverría S, Castaño Á, Bella RM. Rate of non-invasive follicular thyroid neoplasms with papillary-like nuclear features depends on pathologist's criteria: a multicentre retrospective Southern European study with prolonged follow-up. Endocrine 2021; 73:131-140. [PMID: 33484411 DOI: 10.1007/s12020-021-02610-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the rate of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in a multi-institutional series from the Iberian Peninsula and describing this NIFTP cohort. METHODS Retrospective study of papillary thyroid carcinoma (PTC) or well-differentiated tumours of uncertain malignant potential (WDT-UMP) diagnosed between 2005 and 2015 and measuring ≥5 mm in adult patients from 17 hospitals. Pathological reports were reviewed to determine the cases that fulfil the original criteria of NIFTP and histology was reassessed. Rates were correlated with the number of PTC and its follicular variant (FVPTC) of each institution. Demographic data, histology, management, and follow-up of the reclassified NIFTP cohort were recorded. RESULTS A total of 182 cases with NIFTP criteria were identified: 174/3372 PTC (rate: 5.2%; range: 0-12.1%) and 8/19 WDT-UMP (42.1%). NIFTP rate showed linear correlation with total PTC (p: 0.03) and FVPTC (p: 0.007) identified at each centre. Ultrasound findings were non-suspicious in 60.1%. Fine-needle cytology or core biopsy diagnoses were undetermined in 49.7%. Most patients were treated with total thyroidectomy. No case had nodal disease. Among patients with total thyroidectomy, 89.7% had an excellent response evaluated 1 year after surgery. There were no structural persistence or relapses. Five patients showed residual thyroglobulin after 90 months of mean follow-up. CONCLUSIONS NIFTP rate is low but highly variable in neighbouring institutions of the Iberian Peninsula. This study suggests pathologist's interpretation of nuclear alterations as the main cause of these differences. Patients disclosed an excellent outcome, even without using the strictest criteria.
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García J, Catalán JP, Sanz J. Development of the automatic void generation module in GEOUNED conversion tool. FUSION ENGINEERING AND DESIGN 2021. [DOI: 10.1016/j.fusengdes.2021.112366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alguacil J, Catalan J, De Pietri M, Sauvan P, Sanz J. A method for assessing 3D decay heat and temperature considering accurate distributions of the decay gamma fields. FUSION ENGINEERING AND DESIGN 2021. [DOI: 10.1016/j.fusengdes.2021.112610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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