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Bhattasali O, Torres F, Rahimian J, Scharnweber R, Beighley A, Kesbeh Y, Chen JCT, Miller M, Lodin K, Girvigian MR. Risk Factors Associated with Development of Peritumoral Edema Following Stereotactic Radiosurgery and Radiotherapy for Intracranial Meningioma. Int J Radiat Oncol Biol Phys 2023; 117:e88-e89. [PMID: 37786205 DOI: 10.1016/j.ijrobp.2023.06.844] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Peritumoral edema (PTE) is a potential adverse effect following radiotherapy for intracranial meningioma. The purpose of this study is to identify which baseline factors may increase risk for PTE. MATERIALS/METHODS A retrospective chart review was conducted of 431 patients who underwent primary radiotherapy to 480 radiographically-defined intracranial meningiomas between January 2008 and December 2021 within an integrated health care system. Patients with prior surgical management were excluded. Patients were treated with frameless LINAC-based image-guided single fraction stereotactic radiosurgery (SRS) (32.9%), 5 fraction SRS (FSRS) (30.8%), or fractionated stereotactic radiotherapy (FSRT) (36.3%). Pre- and post-radiotherapy MRI studies were reviewed to evaluate for PTE following treatment. An event was defined as new or worsening PTE compared to pre-radiotherapy imaging or development of new symptoms post-radiotherapy. Univariate and stepwise logistics regression analyses were performed to compare the risk of PTE between groups. RESULTS Median follow-up was 85.8 months (IQR: 49.4-125.4). Median patient age was 66 years (IQR: 56-73). Patients treated with SRS (median age: 61 years) were younger than those treated with FSRS/FSRT (median age: 68 years) (p<0.001). Lesions treated with SRS (median volume: 1.33cc) were smaller than those treated with FSRS/FSRT (median volume: 6.36cc) (p<0.001). For all-comers, 68 (14.2%) lesions developed any PTE, and 27 (5.6%) developed symptomatic PTE (SPTE). Of these, 4 patients developed symptoms post-treatment without radiographic evidence of new or worsening PTE. Incidence of PTE/SPTE by site was as follows: base of skull (BOS): 10.3%/6.1%, convexity: 22.7%/7.6%, falcine: 17.6%/4.1%, parasagittal: 27.8%/8.3%, posterior fossa/tentorium 7.0%/0.0%. Incidence of PTE/SPTE by technique was as follows: SRS: 6.3%/3.8%, FSRS: 20.9%/7.4%, FSRT: 15.5%/5.7%. On univariate analysis, age >65 (OR = 2.17 (95% CI: 1.26-3.77) p = 0.006), tumor volume (OR = 1.05 (1.02-1.08), p = 0.003), pre-treatment PTE (OR = 6.82 (95% CI: 3.59-12.94) p<0.001), and convexity/falcine/parasagittal (CFPS) location (OR = 2.52 (95% CI: 1.49-4.23) p<0.001) were associated with increased incidence of PTE. On multivariate analysis, age >65 (OR = 1.91 (95% CI: 1.05-3.45) p<0.03), tumor volume (OR = 1.04 (95% CI: 1.00-1.08) p = 0.03), pre-treatment PTE (OR = 4.64 (95% CI: 2.33-9.24) p<0.001), and CFPS location (OR = 2.53 (95% CI: 1.41-4.52) p = 0.002) were associated with increased incidence of PTE. Two patients with PTE underwent resection for local failure which revealed atypical meningioma. CONCLUSION Age >65, larger tumor volume, presence of pre-treatment PTE, and CFPS location were associated with increased incidence of PTE following radiotherapy. Patients with these risk factors should be counseled regarding post-treatment effects. Infrequently, PTE following treatment may be an indicator of higher-grade meningioma.
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Affiliation(s)
- O Bhattasali
- Southern California Permanente Medical Group, Los Angeles, CA
| | - F Torres
- Southern California Permanente Medical Group, Los Angeles, CA
| | - J Rahimian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - R Scharnweber
- Southern California Permanente Medical Group, Los Angeles, CA
| | - A Beighley
- Southern California Permanente Medical Group, Los Angeles, CA
| | - Y Kesbeh
- Southern California Permanente Medical Group, Los Angeles, CA
| | | | - M Miller
- Southern California Permanente Medical Group, Los Angeles, CA
| | - K Lodin
- Southern California Permanente Medical Group, Los Angeles, CA
| | - M R Girvigian
- Southern California Permanente Medical Group, Los Angeles, CA
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Beighley A, Rahimian J, Wong A, Torres F, Fong C, Rajamohan A, Vinci JP, Miller M, Lodin K, Girvigian MR, Bhattasali O. Impact of Concurrent Targeted Therapy and Immunotherapy on the Incidence of Radiation Necrosis Following Stereotactic Radiosurgery for Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e86. [PMID: 37786200 DOI: 10.1016/j.ijrobp.2023.06.839] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The management of metastatic disease has evolved with the advent of immunotherapy (IT) and targeted therapies (TT). Yet, there is limited understanding of the toxicity associated with combining these agents with stereotactic radiosurgery (SRS). We retrospectively evaluated the impact of concurrent systemic therapy (ST) on the risk of radiation necrosis (RN) following LINAC-based SRS for brain metastases (BM). MATERIALS/METHODS A retrospective study was conducted within an integrated health care system from March 2017 to December 2021 of 313 patients who underwent SRS or fractionated SRS in 3 or 5 treatments to a total of 1,644 intact BM. Post-operative cavity SRS and re-irradiated lesions were excluded. RN was diagnosed using perfusion MRI, contrast clearance MRI, or serial standard MRI and graded using CTCAE (v.5). Concurrent ST was defined as administration within 1 month preceding or following SRS. Overall survival (OS) and risk of RN were estimated by the Kaplan-Meier method. Logistics regression analyses were performed to compare risk of RN in patients who received concurrent systemic therapy to those who did not, adjusted for PTV volume and receipt of whole brain radiotherapy (WBRT). RESULTS Median follow-up was 12.2 months. Median age was 64 years (range: 24-92). Primary sites per patient included lung (48.9%), breast (18.2%), melanoma (11.5%), kidney (6.1%), and other (15.3%). Median total lesions treated was 3 (range: 1-44); 65.9% of patients underwent 1 course of SRS, 23.4% underwent 2 courses, 6.2% underwent 3 courses, 4.5% underwent >4 courses. Seventy-six (24.2%) patients received WBRT. Overall, 70.6% of lesions received concurrent ST including chemotherapy (CT) (32.5%), IT (26.8%), and TT (27.6%); 16.4% received a combination of ST. Median OS was 12.9 months (95% CI: 10.4-15.5). RN was observed in 50 (3.0%) lesions in 42 (13.4%) patients. The 1-year risk of RN was 4.0% per lesion and 15.4% per patient. Symptomatic RN (SRN) was observed in 31 (1.9%) lesions in 24 (7.7%) patients. The 1-year risk of SRN was 2.7% per lesion and 10.1% per patient. When compared to lesions treated without concurrent systemic therapy, there was no increased risk of RN observed in lesions treated with concurrent CT (adjusted OR = 0.86 (95% CI: 0.43-1.73) p = 0.68), concurrent IT (adjusted OR = 0.84 (95% CI: 0.41-1.71) p = 0.84), or concurrent TT (adjusted OR = 0.57 (95% CI: 0.25-1.30) p = 0.18). Treatments of SRN included dexamethasone (96.8%), bevacizumab (22.6%), and laser interstitial thermal therapy (6.5%). CONCLUSION Concurrent IT and TT appears well-tolerated in patients who undergo SRS for treatment of BM. No increased risk of RN was observed in lesions treated with concurrent IT or TT compared to lesions treated in the absence of concurrent ST. Further prospective and agent-specific evaluation is necessary to confirm these findings.
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Affiliation(s)
- A Beighley
- Southern California Permanente Medical Group, Los Angeles, CA
| | - J Rahimian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - A Wong
- Southern Kaiser Permanente Medical Group, Los Angeles, CA
| | - F Torres
- Southern California Permanente Medical Group, Los Angeles, CA
| | - C Fong
- Southern Kaiser Permanente Medical Group, Los Angeles, CA
| | - A Rajamohan
- Southern Kaiser Permanente Medical Group, Los Angeles, CA
| | - J P Vinci
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - M Miller
- Southern California Permanente Medical Group, Los Angeles, CA
| | - K Lodin
- Southern California Permanente Medical Group, Los Angeles, CA
| | - M R Girvigian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - O Bhattasali
- Southern California Permanente Medical Group, Los Angeles, CA
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Bing M, Shedd C, Lwin H, Kaza V, Bollineni S, Mahan L, Mohanka M, Lawrence A, Joerns J, Wait M, Peltz M, Huffman L, Hackmann A, Iacono A, Heid C, Torres F, Pham S, Timofte I. Clinical Implications of Microbiome on Acute Rejection in Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1416] [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: 04/05/2023] Open
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Venishetty N, Mahan L, Schellinger J, Bollineni S, Mohanka M, Joerns J, Torres F, Lawrence A, Timofte I, Almandoz J, Kaza V. Impact of Collaborative Weight Management: Single Center Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1385] [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: 04/05/2023] Open
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Chamorro Á, Torres F. Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke-Reply. JAMA 2022; 327:2456. [PMID: 35763000 DOI: 10.1001/jama.2022.7430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ángel Chamorro
- Department of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ferrán Torres
- Biostatistics Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
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Villagómez A, Borja T, Pontón P, Ramos P, Robayo P, Arteaga M, Suquillo D, Barba D, Zambrano K, Karolys G, Barba P, Pavón D, Gomez X, Torres F, Khoury M, Luz-Crawford P, Maron T, Segnini G, Diaz R, Cabrera F, Caicedo A. Mesenchymal Stem/Stromal Cells: MSC AND THEIR ISOLATED MITOCHONDRIA IMPROVE THE REGENERATION OF MICE CUTANEOUS SURGICAL WOUNDS BY IN-SITU INJECTION. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Varghese A, Ryan A, Wells C, Li G, Baer D, Parker E, Buko A, Kaza V, Banga A, Bollineni S, Mahan L, Mohanka M, Lawrence A, Joerns J, Torres F, Wait M, Iacono A, Verceles A, Terada L, Terrin M, Timofte I. Post-Transplant Metabolomics Profiles in Patients Undergoing Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.115] [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: 12/01/2022] Open
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Halverson Q, Batra K, Mahan L, Mohanka M, Lawrence A, Joerns J, Bollineni S, Kaza V, Timofte I, Kershaw C, Terada L, Torres F, Banga A. CARE Score on Chest Radiograph at Diagnosis Predicts Early and Late Outcomes Among Lung Transplant Patients with COVID-19. J Heart Lung Transplant 2022. [PMCID: PMC8988563 DOI: 10.1016/j.healun.2022.01.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the ability of an objective radiographic scoring system to predict outcomes among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19). Methods We included all LT patients diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021; n=54; median age: 60, 20-73 years; M:F 37:17) in our program. Patient characteristics and laboratory values during the acute illness were reviewed. Chest radiographs at time of COVID-19 diagnosis were scored by extent of ground-glass opacity and consolidation using the CARE score (0-18 for each lung). The CARE score was calculated using only the allograft in single LT and the average of both lungs in bilateral LT. Primary outcome was six-month survival after COVID-19. Hospital complications and one-month survival were secondary outcomes. Results A minority of patients had a clear allograft (CARE=0, n=12, 22.2%) at presentation. The median score was 2 (interquartile range 0.5-4.625), indicating mild abnormalities. Demographics, underlying diagnosis, comorbidities, symptoms, and spirometry changes were not associated with the baseline CARE score. Baseline CARE score >5 was strongly associated with development of respiratory failure (91.7% vs 35.7%; OR, 95% CI: 19.8, 2.3-168.7; p=0.001), ICU admission (p<0.001), need for ventilator support (p<0.001), and one-month mortality (41.7% vs 2.4%; OR, 95% CI: 29.4, 2.96-333.3; p=0.001). Overall six-month survival was 81.5%. The CARE score was significantly higher among non-survivors (7.7±4.1 vs 2.2±2.7; p=0.002). Patients with a CARE score>5 at diagnosis were significantly less likely to survive at six-month follow-up (41.7%.vs 92.3%; p<0.001). The CARE score had an excellent area under the curve (86.8%, 74.4%-99.2%; p<0.001) on the Receiver operating characteristic curve for predicting six-month survival after COVID-19. Conclusion The CARE score at time of COVID-19 diagnosis provides useful prognostic information among patients with LT.
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Rizo Topete MD L, Paola B, Bruno S, Torres F. POS-868 THE USE OF OXIRIS MEMBRANE IN CRITICAL ILL PATIENTS WITH SARS COV-2 PNEUMONIA. Kidney Int Rep 2022. [PMCID: PMC8854869 DOI: 10.1016/j.ekir.2022.01.906] [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: 11/02/2022] Open
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Berger Z, Orellana F, Cocio R, Torres F, Simian D, Araneda G, Toledo P. Pancreatic steatosis: A frequent finding in a Chilean population. Rev Gastroenterol Mex (Engl Ed) 2021; 88:118-124. [PMID: 34974993 DOI: 10.1016/j.rgmxen.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND AIMS Pancreatic steatosis is an incidental radiologic finding in asymptomatic patients, and its clinical importance is unclear. Primary aim: to study the prevalence of pancreatic steatosis (PS) in consecutive patients registered at our hospital, that underwent computed axial tomography (CAT) scanning of the abdomen and pelvis, excluding known pancreatic diseases. Secondary aim: to review the association of PS with the demographic and clinical data of the patients, as well as with hepatic steatosis (HS). MATERIALS AND METHODS An observational study was conducted on adult patients that had CAT scans of the abdomen and pelvis. DEFINITIONS a) tissue density was measured in Hounsfield units (HU) in five 1 cm2 areas of the pancreas, three areas of the spleen, and in segments VI and VII of the liver; b) fatty pancreas: a difference < -10 HU between the mean pancreas and mean spleen densities; and c) fatty liver: density < 40 HU. We registered the epidemiologic and laboratory data of the patients. The association of those factors with the presence of PS was analyzed using SPSS version 24.0 software, and statistical significance was set at a p < 0.05. RESULTS Of the 203 patients, PS was found in 61 (30%). The patients with PS were significantly older and had a higher body mass index. We found no significant association with the rest of the parameters studied, nor with HS (55 patients). None of the patients had symptoms attributable to a disease of the exocrine pancreas. CONCLUSIONS Fatty infiltration of the pancreas is a frequent finding in CAT scans, and its clinical importance is unclear. Aging of the population and the increase in obesity underline the need for future studies on PS.
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Affiliation(s)
- Z Berger
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - F Orellana
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - R Cocio
- Departamento de Imagenología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - F Torres
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - D Simian
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - G Araneda
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - P Toledo
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
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Ramírez M, Toledo BA, Torres F, Rogan J, Valdivia JA, Correa-Burrows P. Pedestrian flow in two dimensions: Optimal psychological stress leads to less evacuation time and decongestion. Phys Rev E 2021; 104:024312. [PMID: 34525611 DOI: 10.1103/physreve.104.024312] [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] [Received: 09/11/2020] [Accepted: 07/16/2021] [Indexed: 11/07/2022]
Abstract
Collective motion is an innate ability of all living systems, which depends on physiological and psychosocial factors in the case of humans. Such a collective organization is becoming of great interest in collective motion in human crowds. Using a cellular automaton (CA) simulation model, we demonstrate that emergency egress from a two-dimensional corridor with optimal stress leads to less evacuation time and efficient mass evacuations. We study how three types of stress (i.e., mild stress, optimal stress, and anxiety) described in the literature have a significant impact on the collective dynamics. We found that low-stress levels could decrease the evacuation time in an entire occupied room since agents choose alternative routes rather than the shortest path to the exit and display cooperative behavior. Therefore, the combination of mild and optimal stress can lead to efficient evacuations. Also CA simulations may be used to find safer and more efficient ways to conduct mass evacuation procedures.
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Affiliation(s)
- M Ramírez
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Casilla 653, Santiago, Chile 7800024 and Centro para el Desarrollo de la Nanociencia y la Nanotecnología (CEDENNA), Avda. Ecuador 3493, Santiago, 9170124 Chile
| | - B A Toledo
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Casilla 653, Santiago, Chile 7800024 and Centro para el Desarrollo de la Nanociencia y la Nanotecnología (CEDENNA), Avda. Ecuador 3493, Santiago, 9170124 Chile
| | - F Torres
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Casilla 653, Santiago, Chile 7800024 and Centro para el Desarrollo de la Nanociencia y la Nanotecnología (CEDENNA), Avda. Ecuador 3493, Santiago, 9170124 Chile
| | - J Rogan
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Casilla 653, Santiago, Chile 7800024 and Centro para el Desarrollo de la Nanociencia y la Nanotecnología (CEDENNA), Avda. Ecuador 3493, Santiago, 9170124 Chile
| | - J A Valdivia
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Casilla 653, Santiago, Chile 7800024 and Centro para el Desarrollo de la Nanociencia y la Nanotecnología (CEDENNA), Avda. Ecuador 3493, Santiago, 9170124 Chile
| | - P Correa-Burrows
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, El Líbano 5524, Santiago, 7830490 Chile
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Díaz-González Á, Sapena V, Boix L, Torres F, Sanduzzi-Zamparelli M, Da Fonseca LG, LLarch N, Iserte G, Guedes C, Muñoz-Martínez S, Darnell A, Belmonte E, Rimola J, Forner A, Ayuso C, Bruix J, Reig M. Early diarrhoea under sorafenib as a marker to consider the early migration to second-line drugs. United European Gastroenterol J 2021; 9:655-661. [PMID: 34228394 PMCID: PMC8280813 DOI: 10.1002/ueg2.12111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/14/2021] [Accepted: 03/31/2021] [Indexed: 12/24/2022] Open
Abstract
Background Despite atezolizumab and bevacizumab (A + B) is currently the first‐line treatment for hepatocellular carcinoma (HCC) patients, some patients will not be adequate for this combination. In the setting of sorafenib some adverse events have been proposed as prognostic factors. Objective To characterize the early diarrhoea development as prognostic factor in 344 HCC patients. Methods The development of early diarrhoea in sorafenib treatment defined as patients who developed diarrhoea and needed dose modification within the first 60 days of treatment (e‐diarrhoea) and 3‐grouping variables were analysed: Patients with e‐diarrhoea, patients who developed diarrhoea after the first 60 days of treatment (L‐diarrhoea) and patients that never developed diarrhoea (never diarrhoea). Results The median overall survival in sorafenib treated patients was significantly different across groups (6.8 months for e‐diarrhoea, 26.7 months for L‐diarrhoea and 13.3 months for never‐diarrhoea). The emergence of e‐diarrhoea was associated with poor outcomes (hazard ratio [HR] 1.84 [95%CI 1.15–2.95]), while there was no increased/decreased risk of dismal evolution in patients with L‐diarrhoea (HR 0.66 [95%CI 0.42–1.03]). Conclusion The emergence of e‐diarrhoea in HCC patients treated with sorafenib is an early predictor of dismal evolution under this therapy. Thus, prompt identification of these non‐responders may be useful for an early switch to second‐line therapies. Established knowledge on this subjectDiarrhoea is a frequent adverse event of sorafenib and its emergence has been associated to better outcomes.
What are the significant and/or new findings of this study?Early diarrhoea (e‐diarrhoea) in hepatocellular carcinoma patients treated with sorafenib is an early predictor of dismal evolution. Diarrhoea under sorafenib should not be taken as a predictive parameter of lack of benefit. E‐diarrhoea could be used as clinical biomarker for switching to second‐line therapies.
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Affiliation(s)
- Álvaro Díaz-González
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Víctor Sapena
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Loreto Boix
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Ferrán Torres
- Medical Statistics Core Facility, IDIBAPS. Hospital Clínic de Barcelona. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marco Sanduzzi-Zamparelli
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Leonardo G Da Fonseca
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Neus LLarch
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Gemma Iserte
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Cassia Guedes
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Sergio Muñoz-Martínez
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Anna Darnell
- Barcelona Clinic Liver Cancer (BCLC) Group. Radiology Department, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Ernest Belmonte
- Barcelona Clinic Liver Cancer (BCLC) Group. Radiology Department, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Jordi Rimola
- Barcelona Clinic Liver Cancer (BCLC) Group. Radiology Department, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Alejandro Forner
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Carmen Ayuso
- Barcelona Clinic Liver Cancer (BCLC) Group. Radiology Department, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - Jordi Bruix
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
| | - María Reig
- Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Barcelona, Spain
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Orci L, Caballol B, Sanduzzi-Zamparelli M, Sapena V, Colucci N, Torres F, Bruix J, Reig M, Toso C. Incidence of hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: A meta-analysis and meta-regression. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.022] [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]
Abstract
Abstract
Objective
Nonalcoholic fatty liver disease (NAFLD) may be a risk factor for hepatocellular carcinoma (HCC), but the extent of this association still needs to be addressed. Pooled-incidence rates of HCC across the disease spectrum of NAFLD have never been estimated by meta-analysis.
Methods
In this systematic review, we searched Web of Science, Embase, Pubmed, and the Cochrane library from January 1st, 1950 through July 30th, 2020. We included studies reporting on HCC incidence in patients with NAFLD. The main outcomes were pooled HCC incidences in patients with NAFLD at distinct severity stages. Summary estimates were calculated with random-effects models. Sensitivity analyses and meta-regression analyses were carried out to address heterogeneity. The protocol for this review was registered in Prospero (CRD42018092861).
Results
Eighteen studies, with a total of 470,404 patients were included. In patients with NAFLD at a stage earlier than liver cirrhosis, HCC incidence was of 0.03 per 100 person-years (PYs) (95% confidence interval 0.01-0.07, I2=98%). This rate rose to 3.78 per 100PYs (2.47-5.78, I2=93%) when considering studies that only included patients with liver cirrhosis. Among the latter patients, those undergoing regular HCC screening displayed an incidence of 4.62 per 100PYs (2.77-7.72, I2= 77%).
Conclusion
Patients with NAFLD-related liver cirrhosis have a risk of developing HCC similar to that reported for patients with cirrhosis from other etiologies. Evidence documenting the risk in patients with NASH or simple steatosis is limited, but HCC incidence in these populations may lie below thresholds used to recommend HCC screening. Well-designed prospective studies in these subsets of patients are needed.
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Affiliation(s)
- L Orci
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - B Caballol
- Department of Hepatology, Barcelona Clinic For Liver Cancer, Barcelona, Spain
| | | | - V Sapena
- Department of Hepatology, Barcelona Clinic For Liver Cancer, Barcelona, Spain
| | - N Colucci
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - F Torres
- Department of Hepatology, Barcelona Clinic For Liver Cancer, Barcelona, Spain
| | - J Bruix
- Department of Hepatology, Barcelona Clinic For Liver Cancer, Barcelona, Spain
| | - M Reig
- Department of Hepatology, Barcelona Clinic For Liver Cancer, Barcelona, Spain
| | - C Toso
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
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Diago-Sempere E, Bueno JL, Sancho-López A, Rubio EM, Torres F, de Molina RM, Fernández-Cruz A, de Diego IS, Velasco-Iglesias A, Payares-Herrera C, Flecha IC, Avendaño-Solà C, Palomino RD, Ramos-Martínez A, Ruiz-Antorán B. Evaluation of convalescent plasma versus standard of care for the treatment of COVID-19 in hospitalized patients: study protocol for a phase 2 randomized, open-label, controlled, multicenter trial. Trials 2021; 22:70. [PMID: 33472681 PMCID: PMC7816149 DOI: 10.1186/s13063-020-05011-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/31/2020] [Accepted: 12/29/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND COVID-19 is a respiratory disease caused by a novel coronavirus (SARS-CoV-2) and causes substantial morbidity and mortality. At the time this clinical trial was planned, there were no available vaccine or therapeutic agents with proven efficacy, but the severity of the condition prompted the use of several pharmacological and non-pharmacological interventions. It has long been hypothesized that the use of convalescent plasma (CP) from infected patients who have developed an effective immune response is likely to be an option for the treatment of patients with a variety of severe acute respiratory infections (SARI) of viral etiology. The aim of this study is to assess the efficacy and safety of convalescent plasma in adult patients with severe COVID-19 pneumonia. METHODS/DESIGN The ConPlas-19 study is a multicenter, randomized, open-label controlled trial. The study has been planned to include 278 adult patients hospitalized with severe COVID-19 infection not requiring mechanical ventilation (invasive or non-invasive). Subjects are randomly assigned in a 1:1 ratio (139 per treatment arm), stratified by center, to receive intravenously administered CP (single infusion) plus SOC or SOC alone, and are to be followed for 30 days. The primary endpoint of the study is the proportion of patients that progress to category 5, 6, or 7 (on the 7-point ordinal scale proposed by the WHO) at day 15. Interim analyses for efficacy and/or futility will be conducted once 20%, 40%, and 60% of the planned sample size are enrolled and complete D15 assessment. DISCUSSION This clinical trial is designed to evaluate the efficacy and safety of passive immunotherapy with convalescent plasma for the treatment of adult patients hospitalized with COVID-19. The results of this study are expected to contribute to establishing the potential place of CP in the therapeutics for a new viral disease. TRIAL REGISTRATION ClinicalTrials.gov NCT04345523 . Registered on 30 March, 2020. First posted date: April 14, 2020.
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Affiliation(s)
- Elena Diago-Sempere
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
| | - José Luis Bueno
- Hemotherapy & Apheresis Units, Hematology and Hemotherapy Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Aránzazu Sancho-López
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
| | - Elena Múñez Rubio
- Internal Medicine Department, Infectious diseases unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ferrán Torres
- Clinical Pharmacology Department, Hospital Clínic Barcelona, Medical Statistics core facility – IDIBAPS, Barcelona, Spain
| | - Rosa Malo de Molina
- Pneumology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Fernández-Cruz
- Internal Medicine Department, Infectious diseases unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Isabel Salcedo de Diego
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
| | | | - Concepción Payares-Herrera
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
| | - Inmaculada Casas Flecha
- Flu and Respiratory Virus Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Avendaño-Solà
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
| | - Rafael Duarte Palomino
- Hematology and Hemotherapy Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Internal Medicine Department, Infectious diseases unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Belén Ruiz-Antorán
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
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Díaz-González Á, Sapena V, Boix L, Brunet M, Torres F, LLarch N, Samper E, Millán O, Corominas J, Iserte G, Sanduzzi-Zamparelli M, da Fonseca LG, Darnell A, Belmonte E, Forner A, Ayuso C, Bruix J, Reig M. Pharmacokinetics and pharmacogenetics of sorafenib in patients with hepatocellular carcinoma: Implications for combination trials. Liver Int 2020; 40:2476-2488. [PMID: 33021346 DOI: 10.1111/liv.14587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Sorafenib and lenvatinib are the first-line treatments approved in hepatocellular carcinoma (HCC), but information is lacking about the relationships between their pharmacokinetics, patients pharmacogenetic profiles, adverse events (AE) and overall survival. We aimed to elucidate these relationships of tyrosine Kinase Inhibitors, such as sorafenib, in order to improve the design of trials testing it in combination with checkpoint inhibitors. METHODS We assessed the pharmacokinetics of sorafenib and its N-oxide metabolite at day-0, day-7, day-30, day-60, day-90, day-120, day-150 and day-180 and nine single-nucleotide polymorphisms (SNP) in five genes related to sorafenib metabolism/transport to identify the best point for starting the combination between tyrosine kinases and checkpoint inhibitors. RESULTS We prospectively included 49 patients (96% cirrhotic, 37% hepatitis-C, 82% Child-Pugh-A and 59% BCLC-C). Pharmacokinetic values peaked at day-7 and progressively declined until day-60. In the 16 patients without further dose modifications after day-60, pharmacokinetic values remained stable through day-180 (sorafenib P = .90; N-oxide P = .93). Pharmacokinetic values were higher in patients with early dermatological adverse events and lower in patients with early diarrhoea. Sorafenib and N-oxide pharmacokinetic values varied linearly with different alleles of MRP2*3972. CONCLUSIONS Sorafenib's pharmacokinetics is heterogeneous across HCC patients. This heterogeneity affects adverse events development and must be taken into account in setting the dose and timing of its combination with checkpoint inhibitors.
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Affiliation(s)
- Álvaro Díaz-González
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Víctor Sapena
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Loreto Boix
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Mercè Brunet
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Ferrán Torres
- Medical Statistics Core Facility, IDIBAPS. Hospital Clínic de Barcelona. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Neus LLarch
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Esther Samper
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Olga Millán
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Josep Corominas
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Gemma Iserte
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Marco Sanduzzi-Zamparelli
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Leonardo G da Fonseca
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Anna Darnell
- BCLC group. Radiology department, Hospital Clínic de Barcelona. IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ernest Belmonte
- BCLC group. Radiology department, Hospital Clínic de Barcelona. IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alejandro Forner
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Carmen Ayuso
- BCLC group. Radiology department, Hospital Clínic de Barcelona. IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi Bruix
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - María Reig
- BCLC group. Liver Unit, Hospital Clínic de Barcelona. IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
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Kanade R, Mohanka M, Bollineni S, Joerns J, Kaza V, Murala J, Peltz M, Wait M, Torres F, Banga A. Characteristics and Outcomes Among Patients With Early Venous Thromboembolic Events After Lung Transplant. Transplant Proc 2020; 53:303-310. [PMID: 32951862 DOI: 10.1016/j.transproceed.2020.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite several previous studies reporting a high frequency of venous thromboembolism (VTE) after lung transplant (LT), few actionable risk factors have been identified. There are limited data regarding the practice patterns of anticoagulation use among patients with LT. METHODS All adult patients with single or bilateral LT between 2012 and 2016 were included (n = 324; mean age, 56.3 ± 13.3 years; male, 61.1%). Demographic, clinical, and laboratory variables before and after LT were recorded. Follow-up data included survival up to 3 years post-transplant. Development of VTE during the first 30 days after LT was the primary outcome variable. RESULTS The overall incidence of VTE during the first 30 days after LT was 29.9% (n = 97), among which the majority were upper extremity thromboses. Female sex, personal history of VTE, hospitalization at the time of transplant, and use of 3 or more central venous catheters during index hospitalization were independently associated with VTE. The use of anticoagulants was independently associated with a reduced risk of VTE. Despite increased morbidity, the development of VTE was not associated with worse post-transplant survival. CONCLUSIONS A significant proportion of patients develop early VTE after LT. Limiting the number of central catheters to < 3 during the post-transplant period, along with the early institution of thromboprophylaxis, may lower the risk of VTE.
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Affiliation(s)
- R Kanade
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - M Mohanka
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - S Bollineni
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - J Joerns
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - V Kaza
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - J Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - M Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - M Wait
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - F Torres
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - A Banga
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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Seguí E, Alonso-Orduna V, Sesma A, Martin-Richard M, Salud A, Fernández-Montes A, Fernández-Martos C, Ruiz-Casado A, Gallego J, Aparicio J, Gálvez E, Manzano H, Alcaide-Garcia J, Gallego R, Falco E, Esposito F, Oliveres H, Torres F, Feliu J, Maurel J. 471P Identification and validation of a new prognostic score in metastatic colorectal cancer (mCRC): GEMCAD score. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Gil-López F, Boget T, Manzanares I, Donaire A, Conde-Blanco E, Baillés E, Pintor L, Setoaín X, Bargalló N, Navarro J, Casanova J, Valls J, Roldán P, Rumià J, Casanovas G, Domenech G, Torres F, Carreño M. External trigeminal nerve stimulation for drug resistant epilepsy: A randomized controlled trial. Brain Stimul 2020; 13:1245-1253. [PMID: 32534250 DOI: 10.1016/j.brs.2020.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 07/31/2019] [Revised: 02/10/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND External trigeminal nerve stimulation (ETNS) is an emergent, non-invasive neurostimulation therapy delivered bilaterally with adhesive skin electrodes. In previous studies, ETNS was associated to a decrease in seizure frequency in patients with focal drug-resistant epilepsy (DRE). OBJECTIVE To determine the long-term efficacy and tolerability of ETNS in patients with focal DRE. Moreover, to explore whether its efficacy depends on the epileptogenic zone (frontal or temporal), and its impact on mood, cognitive function, quality of life, and trigeminal nerve excitability. METHODS Forty consecutive patients with frontal or temporal DRE, unsuitable for surgery, were randomized to ETNS or usual medical treatment. Participants were evaluated at 3, 6 and 12 months for efficacy, side effects, mood scales, neuropsychological tests and trigeminal nerve excitability. RESULTS Subjects had a median of 15 seizures per month and had tried a median of 12.5 antiepileptic drugs. At 12 months, percentage of responders was 50% in ETNS group and 0% in control group. Seizure frequency in ETNS group decreased by -43.5% from baseline. Temporal epilepsy subgroup responded better than frontal epilepsy subgroup (55.56% vs. 45.45%, respectively). Median stimulation intensity was 6.2 mA. ETNS improved quality of life, but not anxiety or depression. Long-term ETNS affected neither neuropsychological function, nor trigeminal nerve excitability. No relevant adverse events were observed. CONCLUSIONS ETNS is an effective and well-tolerated therapy for focal DRE. Patients with temporal epilepsy showed a better response than those with frontal epilepsy. Future studies with larger populations may define its role compared to other neurostimulation techniques. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that ETNS reduces seizure frequency in patients with focal DRE.
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Affiliation(s)
- Francisco Gil-López
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
| | - Teresa Boget
- Epilepsy Unit, Department of Neuropsychology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Isabel Manzanares
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Estefanía Conde-Blanco
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Eva Baillés
- Epilepsy Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis Pintor
- Epilepsy Unit, Department of Psychiatry, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xavier Setoaín
- Epilepsy Unit, Department of Nuclear Medicine, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Núria Bargalló
- Epilepsy Unit, Department of Neurorradiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Judith Navarro
- Electromyography Unit, Neurophysiology, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Casanova
- Electromyography Unit, Neurophysiology, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Valls
- Electromyography Unit, Neurophysiology, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pedro Roldán
- Epilepsy Unit, Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Rumià
- Epilepsy Unit, Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Georgina Casanovas
- Medical Statistics Core Facility, IDIBAPS-Hospital Clínic, Barcelona, Spain
| | - Gema Domenech
- Medical Statistics Core Facility, IDIBAPS-Hospital Clínic, Barcelona, Spain
| | - Ferrán Torres
- Medical Statistics Core Facility, IDIBAPS-Hospital Clínic, Barcelona, Spain
| | - Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Vanegas A, Torres F, Muñoz C, Jaramillo D, Hernandez L, Vásquez G, Restrepo Escobar M, González LA, Velásquez I. AB0538 PREGNANCY OUTCOMES IN PATIENTS WITH TAKAYASU’S ARTERITIS: CASE SERIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1246] [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:Takayasu’s arteritis (TA) is most prevalent in women of childbearing age. Although its activity and risk of relapse are low during pregnancy, up to 40% of patients may have unfavorable obstetric outcomes and therefore it is important to know their clinical behavior.Objectives:To describe the clinical features and obstetric outcomes of pregnant women with TA treated in a tertiary center.Methods:Retrospective evaluation of medical records of 6 pregnancies in 6 women with TAs treated in a tertiary center in Medellin, Colombia between 2011-2018.Results:Six women who were 17.5 (RI 9.25) years old at diagnosis and 24 (RI 8.25) years old at delivery, their disease duration were 5.5 (RI 10.5) years. Three patients had extensive aortic involvement classified as Numano type V, two as type IIB and one as type I. At delivery, three patients were active and required immunosuppressants, five had high blood pressure, one developed preeclampsia in the second trimester, one had severe mitral and tricuspid insufficiency with decreased ejection fraction of the left ventricle; two had aneurysms (left subclavian artery and ascending aorta). There were two fetal deaths, one due to intrauterine growth restriction and placental insufficiency and another of unknown etiology; both patients with disease activity, extensive aortic condition and arterial hypertension; no pregnancy resulted in abortion or preterm birth. Five deliveries were by caesarean section by maternal indication; there was no aortic dissection, aneurismal rupture or cerebral hemorrhage (table).TablePatient’s characteristicsPatientAge at diagnosisAge at deliveryClinical featuresHata-Numano classificationMaternal outcomeFetal outcome1617HT, absence of left brachial and radial pulses, L carotid and subclavian murmurs, LVEF 47%VHT, C-sectionTerm delivery, SGA22226HT, abscence of L brachial and radial pulses, L carotid and subclavian murmurs, dyspnea, anginaV(plus pulmonary)HT, vaginal birthPlacental insufficiency, IUGR, fetal death31438HT, abscence of L brachial and radial pulses, L carotid and subclavian murmurs, intermittent claudication, dyspnea, aortic regurgitationIIBHT, C-sectionTerm delivery, SGA41824HT, malaise,, abscence of L brachial and radial pulses, intermittent claudication, arthralgiaIIBPreeclampsia, C-sectionTerm delivery, SGA51722Fever, malaise, intermittent claudication, arthralgiaIC-sectionTerm delivery, SGA62124HT, abscense of bilateral femoral, popliteal, tibial and pedial pulses, headache, dizziness, amaurosisVHT, C-sectionFetal deathHT: hypertension; L: left; LVEF: left ventricular ejection fraction; C-section: cesarean section; SGA: small for gestational age; IUGR: intrauterine growth restrictionConclusion:Pregnant women with active disease and extensive aortic condition presented unfavorable obstetric results, suggesting that an inadequate control of vasculitis may lead to greater maternal-fetal complications.References:[1]Assad APL, da Silva TF, Bonfa E, Pereira RMR. Maternal and Neonatal Outcomes in 89 Patients with Takayasu Arteritis (TA): Comparison Before and After the TA Diagnosis. J Rheumatol. 2015 Oct;42(10):1861–4.[2]Hidaka N, Yamanaka Y, Fujita Y, Fukushima K, Wake N. Clinical manifestations of pregnancy in patients with Takayasu arteritis: experience from a single tertiary center. Arch Gynecol Obstet. 2012 Feb;285(2):377–85.Disclosure of Interests:None declared
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Torres F, Jaramillo Arroyave D, Muñoz C, Hernandez L, Vásquez G, Restrepo Escobar M, González LA, Vanegas A. AB0487 TAKAYASU’S ARTERITIS: RECOGNIZING AN OLD ENEMY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6605] [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: 11/04/2022]
Abstract
Background:Takayasu’s arteritis (AT) is a systemic vasculitis that affects large vessels, mainly the aorta, its branches and the pulmonary arteries. There are few data on their behavior in our region.Objectives:to describe the clinical and angiographic characteristics and outcomes of a group of patients with AT.Methods:a cross-sectional, retrospective study based on a secondary source taken from two high complexity hospitals in Medellin - Colombia between August 2011 and December 2018.Results:medical records of 41 patients were evaluated, 87.5% met the 1990 ACR criteria of AT. The majority were women (95.1%), with a median age at the time of diagnosis of 22 years (IR 52), 11 patients (26.8%) were over 40 years old at debut. The median delay in diagnosis was 12 months (IR: 167). Systemic symptoms included general malaise (29.3%), weight loss (29.3%) and fever (19.5%); the main vascular manifestations were hypertension and blood pressure difference (61%), headache (39%), upper limb claudication (31.7%), dyspnea (29.3%), angina (26.8%) and carotidinia (22%). Most frequent findings on physical examination were pulse absence or decrease (78%) and subclavian murmur (53.7%). ESR and CRP were found high in 85.3% and 22%, respectively. Angiographic studies revealed stenosis or occlusion in multiple arterial territories, being the stenosis of the left subclavian artery the most frequent lesion (68.3%), followed by the involvement of the abdominal aorta (58.5%) and thoracic (51%). The distribution according to Hata-Numano classification was: type V (58.5%), type I (17.1%) and type IIa (7.3%), indicating complex vascular lesions and associated serious complications. Abnormalities of the renal arteries, pulmonary arteries involvement, and aortic insufficiency were present in 39%, 14.6%, and 7.3% respectively. Seventy-five percent of patients had active disease, glucocorticoids were the main treatment in 90.2% of the cases, used isolated (2.4%) or in combination with other immunosuppressants (87.8%), including methotrexate (75.6%), azathioprine (26.8%) and cyclophosphamide (14.6%); vascular interventions were performed in 11 patients (26.8%). Most relevant vascular complications were renovascular hypertension (26.8%), stroke (19.5%), chronic kidney disease (19.5%) and chronic heart failure (17.1%). From the clinical point of view, our findings were similar to those shown in series from Brazil, Japan, and Turkey. Contrary to what was reported in other series, carotidinia was a finding that occurred in almost a quarter of our patients (23%) and maybe one of the initial symptoms of the disease. The findings of the vascular physical examination are similar to those reported by the IRAVAS group, where the asymmetry of the pulses was most frequent, followed by the presence of murmurs and the difference in blood pressure, claudication being less frequent in the upper and lower limbs.Conclusion:patients in this series are characterized by having an extensive disease partly due to a late diagnosis, with a high percentage of complications associated with vascular stenotic compromise, which generates morbidity and impact on the quality of life.References:[1]Sato EI, et al. Takayasu arteritis. Treatment and prognosis in a university center in Brazil, Int J Cardiol. 2000; 75 Suppl 1: S163-6.[2]Arnaud L, et al. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine (Baltimore). 2010; 89(1): 1-17.Disclosure of Interests: :None declared
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Torres F, Leon L, Vanegas A, Muñoz C, González LA, Jaramillo D. AB0535 ARE THE NEUTROPHIL/LYMPHOCYTE RATIO (NLR) AND PLATELET/LYMPHOCYTE RATIO (PLR) USEFUL TO COMPARED WITH ACUTE PHASE REACTANTS (ESR/CRP) FOR DIAGNOSIS AND PROGNOSIS OF PATIENTS WITH ACTIVE TAKAYASU’S ARTERITIS (TAK)?: AN ANALYSIS BASED ON ROC AND KAPLAN-MEIER CURVES IN A LATIN AMERICAN POPULATION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3418] [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: 11/04/2022]
Abstract
Background:The NIH criteria are the main measure to determine activity in TAK. NLR and PLR appear promising to predict disease activity(1). TAK is one of the most frequent vasculitis in Colombia with a prevalence of 13.3%; however, in more recent years the information is sparse about TAK clinical behavior in our region, which leads to a late diagnosis. Although survival has improved with immunosuppressive treatment, relapses remain high especially in the first year of diagnosisObjectives:Compare NLR and PLR with ESR/CRP to predict TAK activityShow survival and relapse in patients with TAK followed to 7 yMethods:Retrospective cohort of 43 patients with TAK between 2011-2018 with prospective follow-up of relapses and mortality. 88% fulfilled the ACR 1990 criteria. The disease activity was determined according to NIH criteria: active disease (n=34) and inactive disease (n=9). Through bivariate analysis, we compared the clinical and radiologic characteristics between age groups (table 1) using the Pearson test and Wilcoxon range test. Value of p <0.05 was statistically significant. Survival and relapse analysis were performed using Kaplan-Meier plots. Sensitivity (Sn), specificity (Sp) and area under the curve (AUC) were determined for NLR, PLR, ESR and CRP by receiver-operating curves (ROC) compared to NIH criteria.Table 1.Comparison of Clinical Features in Patients with TAKNo (%) of PatientsAge at diagnosis≤40 y (n=32)Age at diagnosis≥40 y(n=11)P valueFemale30 (94)11 (100)0.39Age at symptom onset (years), median: (Interquartile range –IQR-)20 (17-25)52 (47-57)0.110Time from symptom onset to diagnosis (months) median (IQR)9.5 (2-15)36 (1.5-24)0.774Smoking2 (6)6 (54)0.002Dyslipidemia7 (22)6 (54)0.042ACR Criteria 1990Claudication of extremities14 (43)5 (45)0.922Upper extremities blood pressure discrepancy > 10 mmHg19 (59)6 (54)0.779Decreased brachial artery pulse24 (75)9 (82)0.644Subclavian artery or aorta bruit19 (59)6 (54)0.774Arteriographic abnormality27/27 (100)11/11 (100)1.0ESR (mm/h), median (IQR)56 (23-115)38 (33-76)0.011CRP (mg/dL), median (IQR)1.35 (0.4-3.4)3 (1.49-18.5)0.020Creatinine (mg/dL), median (IQR)0.72 (0.6-0.83)0.84 (0.75-1)0.007Hata-Numano classification I15%18% IIa6%9% IIb6% III6% IV3%9% V59%64%Results:41 patients were women (96%) with a median age at diagnosis of 22 y and an interval from the onset of disease to diagnosis of 12 months (IR:1-168 m). The population over 40 years had a greater comorbidities burden (54% had history of smoking and dyslipidemia) and a major interval between the onset of disease and the diagnosis (36 months vs 9.5 months). Most frequent vascular phenotypes were types V (62%) and I (16%). NLR and PLR showed poor performance to predict activity compared with CRP; NLR level of 1.74 showed to be the predictive cut-off value for active TAK (Sn: 85.3%, Sp: 37.5%, AUC = 0.563). PLR level of 112.5 was found to be the predictive cut-off value for active TAK (Sn: 76.5%, Sp: 50%, AUC = 0.517). The CRP was the most accurate biomarker (Sn: 79.4%, Sp: 75%, AUC = 0.761) while the ESR was lower to predict activity (Sn: 63.6%, Sp: 75%, AUC = 0.598) (figure 1). At 5 years, survival was 83% and 50% of patients had presented at least one relapse (figure 2)Conclusion:Our data does not support the use of NLR or PLR to differentiate relapse and remission in TAK. CRP had better diagnostic performance than ESR in the prediction of activity compared to NIH criteria. The 5-year survival in this cohort is below that reported after 1985 (reported survival: 90-96%)(2)References :[1]Pan L, et al. Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio associated with disease activity in patients with Takayasu’s arteritis: a case-control study. BMJ Open 2017; 7: e014451[2]Schmidt J, et al. Diagnostic features, treatment, and outcomes of Takayasu arteritis in a US cohort of 126 patients, Mayo Clin Proc. 2013; 88(8): 822-30Disclosure of Interests:None declared
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Torres F, Velasquez M, Ramirez L, Leon L, Martinez M. AB1005 BULLOUS LUPUS (BSLE) AS THE FIRST MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS IN THE PEDIATRIC POPULATION (PSLE): A DIAGNOSTIC CHALLENGE IN DAILY PRACTICE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6359] [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: 11/04/2022]
Abstract
Background:Cutaneous manifestations are observed in 59–85% of patients with SLE but less than 5% developed BSLE. In the GLADEL cohort, the prevalence is 0.41%. BSLE literature in children is scarceObjectives:to describe the clinical characteristics of the patients with BSLEMethods:series of cases between 2010-2019 of two reference centers. The cases met Camisa and Grimwood criteria for BSLEResults:5 cases had bullous lesions that resolved with residual hypopigmentation. One case had focal seizure and other patient had arthritis with leukopenia and thrombocytopenia. 2 patients had proteinuria <500 mg/24 hours. There were no cases of lupus nephritis. The median SLEDAI-2K score was 12 (IR: 8-17). All had ANAs in titers greater than 1:160 and four had anti-DNA (+). 5 patients had anti-RNP and 4 had anti-Sm. One case had anti-Ro/anti-La. All presented low C3 and 80% had low C4. 80% had ESR ≥20 mm/hour and CRP greater than 0.5 mg/dl in 60%. All presented clinical response with glucocorticoids and dapsone; one patient had methemoglobinemia that improved. At 3 months, the blisters did not recur in 4 patients except one case that presented relapse due to inadherence.Histologically, the most common finding was subepidermal blisters with neutrophils in the papilar dermis. DIF showed linear deposits of Igs and complement in 4 cases and granular deposits in one case; IgG/IgM were in 5 of the samples. IgA was positive in 60% and C3 in 80%Conclusion:In this series, BSLE was associated with neuropsychiatric, joint and haematological involvement in 40% of patients, without lupus nephritis. Such abnormalities had a parallel course to skin involvement, without recurrences. BSLE tends to have a single-phase behavior and in children unlike adults, severe renal involvement is uncommonReferences:[1]Pons-Estel GJ, et al. Lupus 2018; 27(10): 1753-1754Disclosure of Interests:None declared
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Rudilosso S, Laredo C, Vera V, Vargas M, Renú A, Llull L, Obach V, Amaro S, Urra X, Torres F, Jiménez-Fàbrega FX, Chamorro Á. Acute Stroke Care Is at Risk in the Era of COVID-19: Experience at a Comprehensive Stroke Center in Barcelona. Stroke 2020; 51:1991-1995. [PMID: 32438895 PMCID: PMC7258755 DOI: 10.1161/strokeaha.120.030329] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center. METHODS On February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision to refrain from reallocating the Stroke Team and Stroke Unit to the care of patients with COVID-19. From March 1 to March 31, 2020, we measured the number of emergency calls to the Emergency Medical System in Catalonia (7.5 million inhabitants), and the Stroke Codes dispatched to Hospital Clinic of Barcelona. We recorded all stroke admissions, and the adequacy of acute care measures, including the number of thrombectomies, workflow metrics, angiographic results, and clinical outcomes. Data were compared with March 2019 using parametric or nonparametric methods as appropriate. RESULTS At Hospital Clinic of Barcelona, 1232 patients with COVID-19 were admitted in March 2020, demanding 60% of the hospital bed capacity. Relative to March 2019, the Emergency Medical System had a 330% mean increment in the number of calls (158 005 versus 679 569), but fewer Stroke Code activations (517 versus 426). Stroke admissions (108 versus 83) and the number of thrombectomies (21 versus 16) declined at Hospital Clinic of Barcelona, particularly after lockdown of the population. Younger age was found in stroke admissions during the pandemic (median [interquartile range] 69 [64-73] versus 75 [73-80] years, P=0.009). In-hospital, there were no differences in workflow metrics, angiographic results, complications, or outcomes at discharge. CONCLUSIONS The COVID-19 pandemic reduced by a quarter the stroke admissions and thrombectomies performed at a Comprehensive Stroke Center but did not affect the quality of care metrics. During the lockdown, there was an overload of emergency calls but fewer Stroke Code activations, particularly in elderly patients. Hospital contingency plans, patient transport systems, and population-targeted alerts must act concertedly to better protect the chain of stroke care in times of pandemic.
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Affiliation(s)
- Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.)
| | - Carlos Laredo
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.)
| | - Víctor Vera
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.)
| | - Martha Vargas
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.)
| | - Arturo Renú
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.)
| | - Laura Llull
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.)
| | - Víctor Obach
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.)
| | - Sergio Amaro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.)
| | - Xabier Urra
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.)
| | - Ferrán Torres
- Biostatistics Unit, Autonomous University of Barcelona, Spain (F.T.)
| | | | - Ángel Chamorro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Spain (S.R., C.L., V.V., M.V., A.R., L.L., V.O., S.A., X.U., Á.C.)
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Esteban M, Ponce E, Torres F. A direct transition to chaos in hysteretic systems with focus dynamics. Chaos 2019; 29:103111. [PMID: 31675810 DOI: 10.1063/1.5115101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023]
Abstract
A specific transition to chaos is detected in the study of periodic orbits of hysteretic systems with symmetry and dynamics of focus type. The corresponding bifurcation is rigorously justified by resorting to the analysis of transition maps, whose mathematical expressions are adequately derived. It is shown that, depending on a parameter related to the location of equilibria, such transition maps can pass from being a smooth function to a discontinuous, piecewise-smooth function. We deal with the intermediate situation for which the transition map is continuous but nonsmooth. Using a second parameter, and previous known results on chaotic maps, we show in a rigorous way the existence of a chaos boundary crisis bifurcation, where the transition from a configuration without periodic orbits to another with bounded chaotic solutions occurs.
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Affiliation(s)
- M Esteban
- Dept. Matemática Aplicada II and Instituto de Matemáticas (IMUS), Escuela Técnica Superior de Ingeniería de la Universidad de Sevilla, Camino de los Descubrimientos s/n, 41092 Sevilla, Spain
| | - E Ponce
- Dept. Matemática Aplicada II and Instituto de Matemáticas (IMUS), Escuela Técnica Superior de Ingeniería de la Universidad de Sevilla, Camino de los Descubrimientos s/n, 41092 Sevilla, Spain
| | - F Torres
- Dept. Matemática Aplicada II and Instituto de Matemáticas (IMUS), Escuela Técnica Superior de Ingeniería de la Universidad de Sevilla, Camino de los Descubrimientos s/n, 41092 Sevilla, Spain
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Santibáñez M, Fuentealba M, Torres F, Vargas A. Experimental determination of the gadolinium dose enhancement in phantom irradiated with low energy X-ray sources by a spectrophotometer -Gafchromic-EBT3 dosimetry system. Appl Radiat Isot 2019; 154:108857. [PMID: 31434044 DOI: 10.1016/j.apradiso.2019.108857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/29/2018] [Revised: 08/10/2019] [Accepted: 08/12/2019] [Indexed: 01/22/2023]
Abstract
This work reports the experimental determination of dose enhancement produced in phantoms containing target volumes doped with Gadolinium and irradiated with low-energy X-ray beams. EBT3 Gafchromic films were immersed into 5 ml target volumes to simulate tumor filling with 100% ultra-pure water (blank sample) and ultra-pure water infused with Gd solution (Omniscan®) in different concentration (9-24 mg/ml). The dose enhancement due to excitation of Gd K-edge (50.2 keV) was evaluated in terms of the increment in optical density, obtained by a Spectrophotometer-Gafchromic-EBT3 dosimetry system calibrated in terms of the dose-response for 1-8 Gy range. The dose enhancement was evaluated in two condition: a beam quality with spectrum above the absorption edge in a medium with and without Gd; and two beam qualities (above and below the absorption edge) in a medium with a fixed Gd concentration (18 mg/ml). The obtained results confirmed increments in relative dose enhancement according to Gd concentrations up to 18 mg/ml, with a dose enhancement of 1.1 Gy and an average percentage enhancement of 28.4%. For higher values of concentration, the attenuation interaction of the primary beam is more relevant instead of dose enhancement process. On the other hand, the dose enhancement obtained to comparison the spectra above and below the absorption edge, shown results up to 3.3 Gy of enhancement and average percentage enhancement of 88%.
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Affiliation(s)
- M Santibáñez
- Departamento de Ciencias Físicas, Universidad de La Frontera, F. Salazar, 01145, Temuco, Chile; Centro de Física e Ingeniería en Medicina (CFIM), Facultad de Ingenieria y Ciencias, Universidad de La Frontera, Temuco, Chile.
| | - M Fuentealba
- Departamento de Ciencias Físicas, Universidad de La Frontera, F. Salazar, 01145, Temuco, Chile
| | - F Torres
- Departamento de Ciencias Físicas, Universidad de La Frontera, F. Salazar, 01145, Temuco, Chile
| | - A Vargas
- Departamento de Ciencias Físicas, Universidad de La Frontera, F. Salazar, 01145, Temuco, Chile
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Hessheimer AJ, Coll E, Torres F, Ruíz P, Gastaca M, Rivas JI, Gómez M, Sánchez B, Santoyo J, Ramírez P, Parrilla P, Marín LM, Gómez-Bravo MÁ, García-Valdecasas JC, López-Monclús J, Boscá A, López-Andújar R, Fundora-Suárez J, Villar J, García-Sesma Á, Jiménez C, Rodríguez-Laíz G, Lladó L, Rodríguez JC, Barrera M, Charco R, López-Baena JÁ, Briceño J, Pardo F, Blanco G, Pacheco D, Domínguez-Gil B, Sánchez Turrión V, Fondevila C. Normothermic regional perfusion vs. super-rapid recovery in controlled donation after circulatory death liver transplantation. J Hepatol 2019; 70:658-665. [PMID: 30582980 DOI: 10.1016/j.jhep.2018.12.013] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/14/2018] [Accepted: 12/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although there is increasing interest in its use, definitive evidence demonstrating a benefit for postmortem normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) liver transplantation is lacking. The aim of this study was to compare results of cDCD liver transplants performed with postmortem NRP vs. super-rapid recovery (SRR), the current standard for cDCD. METHODS This was an observational cohort study including all cDCD liver transplants performed in Spain between June 2012 and December 2016, with follow-up ending in December 2017. Each donor hospital determined whether organ recovery was performed using NRP or SRR. The propensity scores technique based on the inverse probability of treatment weighting (IPTW) was used to balance covariates across study groups; logistic and Cox regression models were used for binary and time-to-event outcomes. RESULTS During the study period, there were 95 cDCD liver transplants performed with postmortem NRP and 117 with SRR. The median donor age was 56 years (interquartile range 45-65 years). After IPTW analysis, baseline covariates were balanced, with all absolute standardised differences <0.15. IPTW-adjusted risks were significantly improved among NRP livers for overall biliary complications (odds ratio 0.14; 95% CI 0.06-0.35, p <0.001), ischaemic type biliary lesions (odds ratio 0.11; 95% CI 0.02-0.57; p = 0.008), and graft loss (hazard ratio 0.39; 95% CI 0.20-0.78; p = 0.008). CONCLUSIONS The use of postmortem NRP in cDCD liver transplantation appears to reduce postoperative biliary complications, ischaemic type biliary lesions and graft loss, and allows for the transplantation of livers even from cDCD donors of advanced age. LAY SUMMARY This is a propensity-matched nationwide observational cohort study performed using livers recovered from donors undergoing cardiac arrest provoked by the intentional withdrawal of life support (controlled donation after circulatory death, cDCD). Approximately half of the livers were recovered after a period of postmortem in situ normothermic regional perfusion, which restored warm oxygenated blood to the abdominal organs, whereas the remainder were recovered after rapid preservation with a cold solution. The study results suggest that the use of postmortem normothermic regional perfusion helps reduce rates of post-transplant biliary complications and graft loss and allows for the successful transplantation of livers from older cDCD donors.
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Affiliation(s)
- Amelia J Hessheimer
- Department of General & Digestive Surgery, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Ferrán Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clínic Barcelona & Biostatistics Unit, Faculty of Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | | | | | - Manuel Gómez
- Complejo Hospitalario Universitario La Coruña, La Coruña, Spain
| | | | - Julio Santoyo
- Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Pablo Ramírez
- Hospital Clínico Universitario Virgen de la Arrixaca (IMIB), Murcia, Spain
| | - Pascual Parrilla
- Hospital Clínico Universitario Virgen de la Arrixaca (IMIB), Murcia, Spain
| | | | | | - Juan Carlos García-Valdecasas
- Department of General & Digestive Surgery, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Andrea Boscá
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Jesús Villar
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | - Gonzalo Rodríguez-Laíz
- Department of General & Digestive Surgery, ISABIAL, Hospital General Universitario de Alicante, Alicante, Spain
| | - Laura Lladó
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | | | - Manuel Barrera
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Ramón Charco
- Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | | | | | | | | | - David Pacheco
- Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - Constantino Fondevila
- Department of General & Digestive Surgery, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
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Miller D, Wrenn N, Tran M, Murala J, Gaskie K, Banga A, Torres F, Wait M. Establishing a Nursing-Led Ex-Vivo Lung Perfusion Program: A Primer. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Torres F, Montoya F, Caro J, Pinto C, Bravo E. Anatomy of the External Carotid Artery and Its Branches Using Flat-Panel Angiography. ACTA ACUST UNITED AC 2018. [DOI: 10.3174/ng.1700065] [Citation(s) in RCA: 1] [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: 11/07/2022]
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Hervás-García JV, Ramió-Torrentà L, Brieva-Ruiz L, Batllé-Nadal J, Moral E, Blanco Y, Cano-Orgaz A, Presas-Rodríguez S, Torres F, Capellades J, Ramo-Tello C. Comparison of two high doses of oral methylprednisolone for multiple sclerosis relapses: a pilot, multicentre, randomized, double-blind, non-inferiority trial. Eur J Neurol 2018; 26:525-532. [PMID: 30351511 DOI: 10.1111/ene.13851] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/18/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Oral or intravenous methylprednisolone (≥500 mg/day for 5 days) is recommended for multiple sclerosis (MS) relapses. Nonetheless, the optimal dose remains uncertain. We compared clinical and radiological effectiveness, safety and quality of life (QoL) of oral methylprednisolone [1250 mg/day (standard high dose)] versus 625 mg/day (lesser high dose), both for 3 days] in MS relapses. METHODS A total of 49 patients with moderate to severe MS relapse within the previous 15 days were randomized in a pilot, double-blind, multicentre, non-inferiority trial (ClinicalTrial.gov, NCT01986998). The primary endpoint was non-inferiority of the lesser high dose by Expanded Disability Status Scale (EDSS) score improvement on day 30 (non-inferiority margin, 1 point). The secondary endpoints were EDSS score change on days 7 and 90, changes in T1 gadolinium-enhanced and new/enlarged T2 lesions on days 7 and 30, and safety and QoL results. RESULTS The primary outcome was achieved [mean (95% confidence interval) EDSS score difference, -0.26 (-0.7 to 0.18) at 30 days (P = 0.246)]. The standard high dose yielded a superior EDSS score improvement on day 7 (P = 0.028). No differences were observed in EDSS score on day 90 (P = 0.352) or in the number of T1 gadolinium-enhanced or new/enlarged T2 lesions on day 7 (P = 0.401, 0.347) or day 30 (P = 0.349, 0.529). Safety and QoL were good at both doses. CONCLUSIONS A lesser high-dose oral methylprednisolone regimen may not be inferior to the standard high dose in terms of clinical and radiological response.
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Affiliation(s)
- J V Hervás-García
- Neuroscience Department, Hospital Germans Trias-i-Pujol, Badalona, Spain
| | - L Ramió-Torrentà
- Neurology Department, Hospital Doctor Josep Trueta, Girona, Spain
| | - L Brieva-Ruiz
- Neurology Department, Hospital Arnau Vilanova, Lleida, Spain
| | - J Batllé-Nadal
- Neurology Department, Xarxa Sanitaria i Social Santa Tecla, Tarragona, Spain
| | - E Moral
- Neurology Department, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Y Blanco
- Institut Biomedical Research August-Pi-Sunyer, Hospital Clinic, Barcelona, Spain
| | - A Cano-Orgaz
- Neurology Department, Hospital Mataro, Mataro, Spain
| | - S Presas-Rodríguez
- Neuroscience Department, Hospital Germans Trias-i-Pujol, Badalona, Spain
| | - F Torres
- Institut Biomedical Research August-Pi-Sunyer, Hospital Clinic, Barcelona, Spain
| | - J Capellades
- Neuroradiology department, Hospital Mar, Barcelona, Spain
| | - C Ramo-Tello
- Neuroscience Department, Hospital Germans Trias-i-Pujol, Badalona, Spain
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Fonseca L, Díaz A, Sapena V, Díaz-González Á, Boix L, Sanduzzi-Zamparelli M, Fuster C, Llarch N, Iserte G, Torres F, Bruix J, Reig M. Clinicopathological evaluation of skin lesions (SL) in patients with hepatocellular carcinoma (HCC) treated with sorafenib. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.088] [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: 11/13/2022] Open
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Gil-López FJ, Montoya J, Falip M, Aparicio J, López-González FJ, Toledano R, Gil-Nagel A, Molins A, García I, Serrano P, Domenech G, Torres F, Donaire A, Carreño M. Retrospective study of perampanel efficacy and tolerability in myoclonic seizures. Acta Neurol Scand 2018; 138:122-129. [PMID: 29573400 DOI: 10.1111/ane.12931] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Perampanel is an antiepileptic drug (AED) approved for add-on treatment of focal seizures (with or without generalization) and primary generalized tonic-clonic (GTC) seizures. Our objective was to explore the effectiveness and tolerability of adjunctive perampanel in patients with drug-resistant myoclonic seizures, after failure of other AEDs. MATERIALS AND METHODS Retrospective, multicenter, observational study. Data were collected from individual patient clinical files and analysed using appropriate descriptive statistics and inferential analyses. RESULTS Data are reported for 31 patients with mean age 36.4 years, who had an average epilepsy duration of 18 years, previously taken an average of 5.03 AEDs, and were taking an average of 2.4 AEDs on perampanel initiation. Patients exhibited myoclonic, GTC, absence, tonic and focal seizures, and most had associated cognitive decline and/or ataxia. Median time on perampanel was 6 months, most common dose was 6 mg, and overall retention rate was 84%. The responder rate for myoclonic seizures was defined via reduction of days with myoclonic seizures per month. At 6 months, 15 (48.4%) of the 31 patients were classed as myoclonic seizure responders, 10 (32.3%) were myoclonic seizure free, and 39% saw improvements in functional ability. Of 17 patients with GTC seizures at baseline, 9 (53%) were responders at 6 months, and 8 (47.1%) were seizure free. The most frequent side effects were psychiatric disorders, instability, dizziness and irritability, and mostly resolved with dose reduction. Five patients discontinued perampanel due to side effects. CONCLUSIONS Perampanel caused clinically meaningful improvements in patients with drug-resistant myoclonic seizures. It was generally well tolerated, but psychiatric and neurological side effects sometimes required follow-up and dose reduction.
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Affiliation(s)
- F. J. Gil-López
- Epilepsy Unit; Department of Neurology; Hospital Clínic de Barcelona; Barcelona Spain
| | - J. Montoya
- Department of Neurology; Hospital Lluis Alcanyís; Xàtiva Spain
| | - M. Falip
- Epilepsy Unit; Department of Neurology; Hospital Universitari de Bellvitge; Hospitalet de Llobregat; Barcelona Spain
| | - J. Aparicio
- Epilepsy Unit; Department of Neurology; Hospital Sant Joan de Déu; Barcelona Spain
| | - F. J. López-González
- Epilepsy Unit; Department of Neurology; Complexo Hospitalario Universitario de Santiago de Compostela; A Coruña Spain
| | - R. Toledano
- Epilepsy Unit; Department of Neurology; Hospital Ruber Internacional; Madrid Spain
| | - A. Gil-Nagel
- Epilepsy Unit; Department of Neurology; Hospital Ruber Internacional; Madrid Spain
| | - A. Molins
- Department of Neurology; Hospital Josep Trueta de Girona; Girona Spain
| | - I. García
- Epilepsy Unit; Hospital Clínico Universitario San Carlos; Madrid Spain
| | - P. Serrano
- Department of Neurology; Hospital Carlos Haya; Málaga Spain
| | - G. Domenech
- Medical Statistics Core Facility; IDIBAPS-Hospital Clínic; Barcelona Spain
| | - F. Torres
- Medical Statistics Core Facility; IDIBAPS-Hospital Clínic; Barcelona Spain
| | - A. Donaire
- Epilepsy Unit; Department of Neurology; Hospital Clínic de Barcelona; Barcelona Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - M. Carreño
- Epilepsy Unit; Department of Neurology; Hospital Clínic de Barcelona; Barcelona Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
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Benomar K, Chetboun M, Espiard S, Jannin A, Le Mapihan K, Gmyr V, Caiazzo R, Torres F, Raverdy V, Bonner C, D'Herbomez M, Pigny P, Noel C, Kerr-Conte J, Pattou F, Vantyghem MC. Purity of islet preparations and 5-year metabolic outcome of allogenic islet transplantation. Am J Transplant 2018; 18:945-951. [PMID: 28941330 DOI: 10.1111/ajt.14514] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/23/2017] [Accepted: 09/04/2017] [Indexed: 01/25/2023]
Abstract
In allogenic islet transplantation (IT), high purity of islet preparations and low contamination by nonislet cells are generally favored. The aim of the present study was to analyze the relation between the purity of transplanted preparations and graft function during 5 years post-IT. Twenty-four patients with type 1 diabetes, followed for 5 years after IT, were enrolled. Metabolic parameters and daily insulin requirements were compared between patients who received islet preparations with a mean purity <50% (LOW purity) or ≥50% (HIGH purity). We also analyzed blood levels of carbohydrate antigen 19-9 (CA 19-9)-a biomarker of pancreatic ductal cells-and glucagon, before and after IT. At 5 years, mean hemoglobin A1c (HbA1c levels) (P = .01) and daily insulin requirements (P = .03) were lower in the LOW purity group. Insulin independence was more frequent in the LOW purity group (P < .05). CA19-9 and glucagon levels increased post-IT (P < .0001) and were inversely correlated with the degree of purity. Overall, our results suggest that nonislet cells have a beneficial effect on long-term islet graft function, possibly through ductal-to-endocrine cell differentiation. ClinicalTrial.gov NCT00446264 and NCT01123187.
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Affiliation(s)
- K Benomar
- Department of Endocrinology and Metabolism, CHRU Lille, Lille, France.,UMR 1190, Translational Research in Diabetes INSERM, Lille, France.,EGID (European Genomic Institute for Diabetes), Univ Lille, Lille, France
| | - M Chetboun
- UMR 1190, Translational Research in Diabetes INSERM, Lille, France.,EGID (European Genomic Institute for Diabetes), Univ Lille, Lille, France.,Department of Endocrine Surgery, CHRU Lille, Lille, France
| | - S Espiard
- Department of Endocrinology and Metabolism, CHRU Lille, Lille, France
| | - A Jannin
- Department of Endocrinology and Metabolism, CHRU Lille, Lille, France
| | - K Le Mapihan
- Department of Endocrinology and Metabolism, CHRU Lille, Lille, France
| | - V Gmyr
- UMR 1190, Translational Research in Diabetes INSERM, Lille, France.,EGID (European Genomic Institute for Diabetes), Univ Lille, Lille, France
| | - R Caiazzo
- UMR 1190, Translational Research in Diabetes INSERM, Lille, France.,EGID (European Genomic Institute for Diabetes), Univ Lille, Lille, France.,Department of Endocrine Surgery, CHRU Lille, Lille, France
| | - F Torres
- UMR 1190, Translational Research in Diabetes INSERM, Lille, France.,EGID (European Genomic Institute for Diabetes), Univ Lille, Lille, France.,Department of Endocrine Surgery, CHRU Lille, Lille, France
| | - V Raverdy
- UMR 1190, Translational Research in Diabetes INSERM, Lille, France.,EGID (European Genomic Institute for Diabetes), Univ Lille, Lille, France.,Department of Endocrine Surgery, CHRU Lille, Lille, France
| | - C Bonner
- UMR 1190, Translational Research in Diabetes INSERM, Lille, France.,EGID (European Genomic Institute for Diabetes), Univ Lille, Lille, France
| | - M D'Herbomez
- Department of Biology, CHRU Lille, Lille, France
| | - P Pigny
- Department of Biology, CHRU Lille, Lille, France
| | - C Noel
- Department of Nephrology and Transplantation, CHRU Lille, Lille, France
| | - J Kerr-Conte
- UMR 1190, Translational Research in Diabetes INSERM, Lille, France.,EGID (European Genomic Institute for Diabetes), Univ Lille, Lille, France
| | - F Pattou
- UMR 1190, Translational Research in Diabetes INSERM, Lille, France.,EGID (European Genomic Institute for Diabetes), Univ Lille, Lille, France.,Department of Endocrine Surgery, CHRU Lille, Lille, France
| | - M C Vantyghem
- Department of Endocrinology and Metabolism, CHRU Lille, Lille, France.,UMR 1190, Translational Research in Diabetes INSERM, Lille, France.,EGID (European Genomic Institute for Diabetes), Univ Lille, Lille, France
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Kaza V, Rao U, Sharma M, Mohanka M, Banga A, Bollineni S, Mullins J, Torres F, Mohanakumar T. Antibodies to Lung Self-antigens in Lung Transplant Recipients and Implications for Outcomes. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.536] [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] Open
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Benza R, Zhang J, Parsley E, Klassen P, Torres F, Gomberg-Maitland M, Sitbon O, Ghofrani H. Ralinepag, an Oral, Selective, Prostacyclin (IP) Receptor Agonist Consistently Improved Mortality Risk Scores Derived From PAH Registries Across Three Regions: Phase 2 Study Analysis. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.505] [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] Open
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Mohanka M, Kanade R, Garcia H, Mullins J, Bollineni S, Kaza V, Torres F, Banga A. “My Best Spirometry Numbers- What Do They Mean?”. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1163] [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: 10/17/2022] Open
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36
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Gottlieb J, Torres F, Haddad T, Dhillon G, Dilling D, Knoop C, Rampolla R, Walia R, Ahya V, Kessler R, Mason D, Budev M, Neurohr C, Glanville A, Jordan R, Porter D, McKevitt M, German P, Guo Y, Chien J, Watkins T, Zamora M. A Phase 2b Randomized Controlled Trial of Presatovir, an Oral RSV Fusion Inhibitor, for the Treatment of Respiratory Syncytial Virus (RSV) in Lung Transplant (LT) Recipients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.375] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Aragó Sorrosal S, Rodas Marín LM, Torres F, Villegas Jiménez V, Poch López de Briñas E. Dos métodos de anticoagulación en técnicas continuas de depuración extrarrenal. Enferm Nefrol 2018. [DOI: 10.4321/s2254-28842018000100002] [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: 11/11/2022] Open
Abstract
Introducción: Las técnicas continuas de depuración extrarrenal son la terapia de elección en pacientes críticos. Pero, no están exentas de complicaciones como la coagulación del circuito extracorpóreo. El fármaco usado tradicionalmente para la anticoagulación, es la heparina sódica. Aunque también son empleados otros métodos de anticoagulación, como el citrato.
Objetivo: Evaluar la eficacia y seguridad de dos métodos de anticoagulación en pacientes tratados con terapias continuas, en unidades de cuidados intensivos del Hospital Clínic.
Material y Método: Estudio observacional, retrospectivo de 54 sujetos. Se aplicaron los criterios de Insuficiencia renal aguda, descritos en el protocolo “Guía para el tratamiento sustitutivo renal en la insuficiencia renal aguda del Hospital Clínic”. Tratados mediante hemodiafiltración, combinando terapias de convección y difusión. Con fracción de filtración < 25%, y dosis de efluente de 30 ml/kg/h. 27 sujetos realizaron hemodiafiltración, reposición pre-filtro y anticoagulación con heparina sódica. El resto, hemodiafiltración, reposición post-filtro y anticoagulación con citrato. Se valoraron episodios de sangrado y duración en horas de los circuitos extracorpóreos, durante 72 horas de terapia. Resultados: El citrato demostró una mayor supervivencia de filtros (95% IC, MD 65, 44.00-72.00 vs MD 36.00, 15.00-22.00, p=0,02). Los pacientes tratados con heparina presentaron más episodios de sangrado, sin diferencias estadísticamente significativas (95% IC, n=6 vs n=9, p=0.537). Hubo un episodio de hipocalcemia en el grupo citrato, corregido según protocolo. En el grupo heparina, no se presentaron casos de trombocitopenia inducida por heparina.
Conclusiones: El presente estudio, demuestra una mayor eficacia en la supervivencia de los filtros en el grupo citrato.
PALABRAS CLAVE: citrato; heparina; anticoagulación regional; terapia continua depuración extrarrenal; fracaso renal agudo.
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Ubeda A, Del Vecchio A, Sartori M, Puente ST, Torres F, Azorin JM, Farina D. Electromechanical delay in the tibialis anterior muscle during time-varying ankle dorsiflexion. IEEE Int Conf Rehabil Robot 2018; 2017:68-71. [PMID: 28813795 DOI: 10.1109/icorr.2017.8009223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We evaluated the electromechanical delay (EMD) for the tibialis anterior (TA) muscle during the performance of time-varying ankle dorsiflexions. Subjects were asked to track a sinusoidal trajectory, for a range of amplitudes and frequencies. Motor unit (MU) action potential trains were identified from surface electromyography (EMG) decomposition and summed to generate the cumulative spike train (CST). CST and the exerted force were cross-correlated to identify the delay between the CST and force, which was considered as an estimate of the EMD. The results showed that the EMD decreased logarithmically with the increase in the slope of the force produced.
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Blasi A, Sabate A, Beltran J, Costa M, Reyes R, Torres F. Correlation between plasma fibrinogen and FIBTEM thromboelastometry during liver transplantation: a comprehensive assessment. Vox Sang 2017; 112:788-795. [DOI: 10.1111/vox.12598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/24/2017] [Accepted: 09/11/2017] [Indexed: 01/16/2023]
Affiliation(s)
- A. Blasi
- Department of Anesthesia; Hospital Clinic de Barcelona, IDIBAPS; Barcelona Spain
| | - A. Sabate
- Department of Anesthesia; Hospital Universitari Bellvitge Barcelona, IDIBELL; L'Hospitalet de Llobregat Spain
| | - J. Beltran
- Department of Anesthesia; Hospital Clinic de Barcelona, IDIBAPS; Barcelona Spain
| | - M. Costa
- Department of Anesthesia; Hospital Universitari Bellvitge Barcelona, IDIBELL; L'Hospitalet de Llobregat Spain
| | - R. Reyes
- Department of Anesthesia; Hospital Universitari Bellvitge Barcelona, IDIBELL; L'Hospitalet de Llobregat Spain
| | - F. Torres
- Biostatistics Unit; Faculty of Medicine; Medical Statistics Core Facility; IDIBAPS-Hospital Clinic; Universitat Autonoma de Barcelona; Barcelona Spain
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Banga A, Mohanka M, Mullins J, Bollineni S, Kaza V, Torres F. Predictors of Early Mortality After Lung Transplantation in the Lung Allocation Score Era. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1177] [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: 11/24/2022] Open
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41
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Sullivan D, Torres F, Banga A, Mohanka M, Bollineni S, Mullins J, Rao U, Lacelle C, Duddupudi P, Surapaneni D, Ring W, Wait M, Kaza V. Outcomes of Treatment of Donor Specific Antibodies: A Single Center Experience. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1173] [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: 11/28/2022] Open
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42
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Banga A, Mohanka M, Bollineni S, Mullins J, Kaza V, Torres F. Characteristics and Outcome of Patients with Stroke After Lung Transplant Surgery in the Lung Allocation Score Era. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ohmann C, Canham S, Demotes J, Chêne G, Lauritsen J, Martins H, Mendes R, Nicolis E, Svobodnik A, Torres F. Raising standards in clinical research - The impact of the ECRIN data centre certification programme, 2011-2016. Contemp Clin Trials Commun 2017; 5:153-159. [PMID: 29740631 PMCID: PMC5936703 DOI: 10.1016/j.conctc.2017.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/09/2017] [Accepted: 02/04/2017] [Indexed: 12/03/2022] Open
Abstract
The nature and the purpose of the ECRIN Data Centre Certification Programme are summarised, and a very brief description is given of the underlying standards (129 in total, divided into 19 separate lists). The certification activity performed so far is described. In a pilot phase 2 centres were certified in 2012. Calls in 2014 and 2015 resulted in a further 8 certified centres, with 2 certifications still in progress, and the 2016 call has generated several additional applications. The impact and benefits of the programme are listed, divided into a) the effects of the introduction of the standards, b) the effects of the certification programme in general, and c) the effects of the certification programme on individual units. The discussion emphasises the generally positive impact of the programme so far but stresses the need to better clarify the perspective and role of the programme.
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Affiliation(s)
- C. Ohmann
- Chair of ECRIN Independent Certification Board and Network Committee, ECRIN, Düsseldorf, Germany
| | - S. Canham
- Scientific Secretary of ECRIN Independent Certification Board, ECRIN, Surrey, UK
| | - J. Demotes
- Director-General of ECRIN, ECRIN, Paris, France
| | - G. Chêne
- Member of ECRIN Independent Certification Board, Centre d’Investigation Clinique-Epidémiologie Clinique, Bordeaux, France
| | - J. Lauritsen
- Member of ECRIN Independent Certification Board, Department of Clinical Medicine, Odense University Hospital, Odense, Denmark
| | - H. Martins
- Member of ECRIN Independent Certification Board, Serviços Partilhados do Ministério da Saúde, Lisboa, Portugal
| | - R.V. Mendes
- Member of ECRIN Independent Certification Board, Shared Services of Ministry of Health, Lisboa, Portugal
| | - E.B. Nicolis
- Member of ECRIN Independent Certification Board, Cardiovascular Research, Clinical Drug Evaluation, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - A. Svobodnik
- Member of ECRIN Independent Certification Board, St. Ann’s University Hospital, Brno, Czechia
| | - F. Torres
- Member of ECRIN Independent Certification Board, Medical Statistics Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona, Spain
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Martínez-Santiago O, Cabrera R, Marrero-Ponce Y, Barigye S, Le-Thi-Thu H, Torres F, Zambrano C, Yaber-Goenaga I, Cruz-Monteagudo M, López Y, Giménez F, Torrens F. Generalized Molecular Descriptors Derived From Event-Based Discrete Derivative. Curr Pharm Des 2016; 22:5095-5113. [DOI: 10.2174/1381612822666160610114148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/27/2016] [Indexed: 11/22/2022]
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Sabate A, Gutierrez R, Beltran J, Mellado P, Blasi A, Acosta F, Costa M, Reyes R, Torres F. Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. Am J Transplant 2016; 16:2421-9. [PMID: 26880105 DOI: 10.1111/ajt.13752] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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: 10/19/2015] [Revised: 01/20/2016] [Accepted: 02/05/2016] [Indexed: 01/25/2023]
Abstract
We hypothesized that preemptive fibrinogen administration to obtain an initial plasma level of 2.9 g/L would reduce transfusion requirements in liver transplantation. A randomized, multicenter, hemoglobin-stratified, double-blind, fibrinogen-versus-saline-controlled trial was conducted. The primary end point was the percentage of patients requiring red blood cells. We evaluated 51 patients allocated to fibrinogen and 48 allocated to saline; the primary end point was assessed using data for 92 patients because the electronic record forms were offline for three patients in the fibrinogen group and four in the saline group. We injected a median of 3.54 g fibrinogen preemptively in the fibrinogen group. Nine patients in the saline group (20.9%) required fibrinogen at graft reperfusion (compared with one patient [2.1%] in the fibrinogen group; p = 0.005). Blood was transfused to 52.9% (95% confidence interval [CI] 42.5-63.3%) in the fibrinogen group and 42.74% (95% CI 28.3-57.2%) in the saline group (p = 0.217). Relative risk for blood transfusion was 0.80 (95% CI 0.57-1.13). Thrombotic events occurred in one patient (2.1%) and five patients (11.4%) in the fibrinogen and saline groups, respectively. Seven patients (14.6%) in the fibrinogen group and nine (20.3%) in the saline group required reoperation. Preemptive administration of fibrinogen concentrate did not influence transfusion requirements.
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Affiliation(s)
- A Sabate
- Department of Anesthesiology, Hospital Universitari de Bellvitge, University of Barcelona Health Campus, Idibell, Barcelona, Spain
| | - R Gutierrez
- Department of Anesthesiology, Hospital Universitario de Cruces, Bilbao, Spain
| | - J Beltran
- Department of Anesthesiology, Hospital Clinic Universitari, University of Barcelona Health Campus, Idibaps, Barcelona, Spain
| | - P Mellado
- Department of Anesthesiology, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - A Blasi
- Department of Anesthesiology, Hospital Clinic Universitari, University of Barcelona Health Campus, Idibaps, Barcelona, Spain
| | - F Acosta
- Department of Anesthesiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Costa
- Department of Anesthesiology, Hospital Universitari de Bellvitge, University of Barcelona Health Campus, Idibell, Barcelona, Spain
| | - R Reyes
- Department of Anesthesiology, Hospital Universitari de Bellvitge, University of Barcelona Health Campus, Idibell, Barcelona, Spain
| | - F Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic Barcelona, Spain. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
In this paper we study a Volterra integral equation of the second kind, including two arbitrary continuous functions, in order to determine first-passage-time probability density functions through time-dependent boundaries for time-non-homogeneous one-dimensional diffusion processes with natural boundaries. These results generalize those which were obtained for time-homogeneous diffusion processes by Giorno et al. [3], and for some particular classes of time-non-homogeneous diffusion processes by Gutiérrez et al. [4], [5].
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Arévalo Salaet M, Aparicio M, Pontes C, Torres F, Salman T, Blanco F, Sellas A, Sanmarti R, Gratacos J. SAT0404 Evaluation of The Clinical Usefulness of A Standardized Dose Reduction Protocol for Maintenance of Remission in Patients with As under anti-TNF Treatment: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4049] [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]
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Lens S, Torres F, Puigvehi M, Mariño Z, Londoño MC, Martinez SM, García-Juárez I, García-Criado Á, Gilabert R, Bru C, Solà R, Sanchez-Tapias JM, Carrión JA, Forns X. Predicting the development of liver cirrhosis by simple modelling in patients with chronic hepatitis C. Aliment Pharmacol Ther 2016; 43:364-74. [PMID: 26582599 DOI: 10.1111/apt.13472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/09/2015] [Accepted: 10/21/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Data are scarce on the natural history of chronic hepatitis C (CHC) in patients with mild hepatitis C who did not respond to anti-viral therapy. AIM To predict the risk of progression to cirrhosis, identifying patients with the more urgent need for therapy with effective anti-virals. METHODS A cohort of 1289 noncirrhotic CHC patients treated with interferon-based therapy between 1990 and 2004 in two referral hospitals were followed up for a median of 12 years. RESULTS Overall, SVR was achieved in 46.6% of patients. Data from a randomly split sample (n = 832) was used to estimate a model to predict outcomes. Among nonresponders (n = 444), cirrhosis developed in 123 (28%) patients. In this group, the 3, 5 and 10-year cumulative probabilities of cirrhosis were 4%, 7% and 22%, respectively, compared to <1% in the SVR-group (P < 0.05). Baseline factors independently associated with progression to cirrhosis in nonresponders were: fibrosis ≥F2, age >40 years, AST >100 IU/L, GGT >40 IU/L. Three logistic regression models that combined these simple variables were highly accurate in predicting the individual risk of developing cirrhosis with areas under the receiving operating characteristic curves (AUC) at 5, 7 and 10 years of ~0.80. The reproducibility of the models in the validation cohort (n = 457, nonresponders = 244), was consistently high. CONCLUSIONS Modelling based on simple laboratory and clinical data can accurately identify the individual risk of progression to cirrhosis in nonresponder patients with chronic hepatitis C, becoming a very helpful tool to prioritise the start of oral anti-viral therapy in clinical practice.
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Affiliation(s)
- S Lens
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - F Torres
- Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Barcelona, Spain.,Biostatistics Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Puigvehi
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Z Mariño
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - M-C Londoño
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - S M Martinez
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - I García-Juárez
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, Barcelona, Spain
| | | | - R Gilabert
- CDIC, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - C Bru
- CDIC, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - R Solà
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - J A Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - X Forns
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, Barcelona, Spain
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Torres F, Santamaria R, Jimenez M, Menjón R, Ibanez A, Collell M, Azlor O, Fraile L. Pharmacokinetics of tildipirosin in pig tonsils. J Vet Pharmacol Ther 2015; 39:199-201. [DOI: 10.1111/jvp.12258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- F. Torres
- Departament de Producció Animal; ETSEA; University de Lleida; Lleida Spain
| | | | - M. Jimenez
- Technical Service MSD Animal Health; Madrid Spain
| | - R. Menjón
- Technical Service MSD Animal Health; Madrid Spain
| | - A. Ibanez
- Marketing Manager MSD Animal Health; Madrid Spain
| | | | | | - L. Fraile
- Departament de Producció Animal; ETSEA; University de Lleida; Lleida Spain
- Agrotecnio Center; Lleida Spain
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50
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Pontes C, Fontanet J, Gomez-Valent M, Rios Guillermo J, Vives Vilagut R, Morros R, Martinalbo J, Torrent-Farnell J, Torres F. Clustering of rare medical conditions based on clinical features which determine applicability of investigative designs and methods to their study. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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