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Pimenta A, Azevedo L, Ramos I, Santos J. Establishment of Diagnostic Reference Levels in Portuguese Interventional Radiology departments. Eur J Radiol 2024; 173:111377. [PMID: 38382425 DOI: 10.1016/j.ejrad.2024.111377] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To establish Portuguese Diagnostic Reference Levels (DRLs), for six body fluoroscopy guided interventional procedures (FGIP). METHOD A retrospective study was conducted in five interventional departments most representative of Interventional Radiology (IR) practice. Dose values, in terms of air kerma area product (PKA in Gy.cm2), air kerma at the patient entrance reference point (Ka,r in mGy), and exposure parameters (fluoroscopy time (FT) and number of cine runs) were collected. Examinations were selected per procedure (at least 20), according to the antero-posterior and lateral diameter mean value (±5 cm), measured on previous Computed Tomography (CT) examinations. RESULTS Data of 489 body FGIP show a large variation on dose values per procedure and per department. National DRLs in terms of PKA were 20.2 Gy.cm2 for Percutaneous transhepatic biliary drainage (PTBD), 98.2 Gy.cm2 for Bronchial artery embolisation (BAE), 247.7 Gy.cm2 for Transarterial chemoembolisation (TACE), 331.6 Gy.cm2 for Inferior epigastric arteries embolisation (IEAE), 312.0 Gy.cm2 for Transjugular intrahepatic portosystemic shunt (TIPS) and 19.3 Gy.cm2 for Endovascular treatment of femoral popliteal arteries (ETFPA). CONCLUSIONS This is the first study reporting Interventional Radiology DRLs in Portugal and we propose preliminary national estimates for the six more common body FGIP. The results of this study will be presented and discussed with all Portuguese IR departments, to promote procedures optimisation.
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Affiliation(s)
- Andrea Pimenta
- University Hospital of St. John (CHUSJ), Radiology Department - Porto, Portugal.
| | - Luís Azevedo
- CINTESIS@RISE Department of Community, Information and Health Decision Sciences- MEDCIDS, Faculty of Medicine University of Porto, Porto, Portugal.
| | | | - Joana Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Portugal.
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Ramos I, Benítez-Cano A, Luque S, Sorlí L, Adalia R. [Penetration in cerebrospinal fluid and use of ceftaroline in ventriculitis associated with external ventricular drainage]. Rev Esp Quimioter 2024; 37:189-190. [PMID: 38348486 PMCID: PMC10945108 DOI: 10.37201/req/131.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/05/2024] [Accepted: 02/01/2024] [Indexed: 03/08/2024]
Affiliation(s)
| | - A Benítez-Cano
- Adela Benítez-Cano, Hospital del Mar, Barcelona, Pº Marítimo 25-29, 08003 Barcelona, Spain.
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Pimenta M, Vassalou EE, Klontzas ME, Dimitri-Pinheiro S, Ramos I, Karantanas AH. Ultrasound-guided hydrodilatation for adhesive capsulitis: capsule-preserving versus capsule-rupturing technique. Skeletal Radiol 2024; 53:253-261. [PMID: 37400605 PMCID: PMC10730627 DOI: 10.1007/s00256-023-04392-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/17/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To compare the clinical efficacy of capsule-rupturing versus capsule-preserving ultrasound-guided hydrodilatation in patients with shoulder adhesive capsulitis (AC). To determine potential factors affecting the outcome over a 6-month follow-up. MATERIALS AND METHODS Within a 2-year period, 149 consecutive patients with AC were prospectively enrolled and allocated into (i) group-CR, including 39 patients receiving hydrodilatation of the glenohumeral joint (GHJ) with capsular rupture and (ii) group-CP, including 110 patients treated with GHJ hydrodilatation with capsular preservation. Demographics, affected shoulder, and AC grade were recorded. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and visual analog scale (VAS) were used for clinical assessment at baseline/1/3/6 months. Comparisons were performed with Mann-Whitney U test and Kolmogorov-Smirnov test. Linear regression was used to identify predictors of outcome. P value < 0.05 defined significance. RESULTS DASH and VAS scores in both groups improved significantly compared to baseline (P < 0.001) and were significantly lower in the CP compared to CR group at all time-points following intervention (P < 0.001). Capsule rupture was a significant predictor of DASH score at all time-points (P < 0.001). DASH scores correlated to initial DASH score at all time-points (P < 0.001). DASH/VAS scores at 1 month were correlated to the AC grade (P = 0.025/0.02). CONCLUSION GHJ hydrodilatation results in pain elimination and functional improvement till the mid-term in patients with AC, with improved outcome when adopting the capsule-preserving compared to the capsule-rupturing technique. Higher initial DASH score is predictive of impaired functionality in the mid-term.
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Affiliation(s)
- Madalena Pimenta
- Oporto Armed Forced Hospital, University Clinical Center D. Pedro V, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Evangelia E Vassalou
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Crete, Greece
| | - Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71110, Heraklion, Greece
| | - Sofia Dimitri-Pinheiro
- Faculty of Medicine, University of Porto, Porto, Portugal
- Biomedicine Department, Unit of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal
- Radiology Department, Portuguese Institute of Oncology of Porto - Francisco Gentil EPE, Porto, Portugal
| | - Isabel Ramos
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Crete, Greece.
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71110, Heraklion, Greece.
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Grávalos C, Pereira F, Vera R, Arjona-Sánchez A, Losa F, Ramos I, García-Alfonso P, Gonzalez-Bayón L, Cascales-Campos PA, Aranda E. Recommendations for the optimal management of peritoneal metastases in patients with colorectal cancer: a TTD and GECOP-SEOQ expert consensus statement. Clin Transl Oncol 2023; 25:3378-3394. [PMID: 37140736 DOI: 10.1007/s12094-023-03204-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Abstract
Peritoneal metastases (PM) occur when cancer cells spread inside the abdominal cavity and entail an advanced stage of colorectal cancer (CRC). Prognosis, which is poor, correlates highly with tumour burden, as measured by the peritoneal cancer index (PCI). Cytoreductive surgery (CRS) in specialized centres should be offered especially to patients with a low to moderate PCI when complete resection is expected. The presence of resectable metastatic disease in other organs is not a contraindication in well-selected patients. Although several retrospective and small prospective studies have suggested a survival benefit of adding hyperthermic intraperitoneal chemotherapy (HIPEC) to CRS, the recently published phase III studies PRODIGE-7 in CRC patients with PM, and COLOPEC and PROPHYLOCHIP in resected CRC with high-risk of PM, failed to show any survival advantage of this strategy using oxaliplatin in a 30-min perfusion. Final results from ongoing randomized phase III trials testing CRS plus HIPEC based on mitomycin C (MMC) are awaited with interest. In this article, a group of experts selected by the Spanish Group for the Treatment of Digestive Tumours (TTD) and the Spanish Group of Peritoneal Oncologic Surgery (GECOP), which is part of the Spanish Society of Surgical Oncology (SEOQ), reviewed the role of HIPEC plus CRS in CRC patients with PM. As a result, a series of recommendations to optimize the management of these patients is proposed.
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Affiliation(s)
- Cristina Grávalos
- Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Fernando Pereira
- Departamento de Cirugía, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - Ruth Vera
- Medical Oncology Department, Navarra University Hospital, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Alvaro Arjona-Sánchez
- Unit of Surgical Oncology and GE09 Research in Peritoneal and Retroperitoneal Oncology Surgery, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Ferran Losa
- Medical Oncology Department, Sant Joan Despí - Moisés Broggi Hospital/ICO-Hospitalet, Barcelona, Spain
| | - Isabel Ramos
- Surgery Department, Sant Joan Despí - Moisés Broggi Hospital, Hospitalet de Llobregat, Spain
| | - Pilar García-Alfonso
- Medical Oncology Department, Gregorio Marañón General University Hospital, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Luis Gonzalez-Bayón
- Surgery Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | | | - Enrique Aranda
- Medical Oncology Department, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Center for Biomedical Research in Cancer Network (CIBERONC), Carlos III Health Institute, Córdoba, Spain
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Aguilera LG, Gallart L, Ramos I, Duran X, Escolano F. Effects of midline laparotomy on cough strength: a prospective study measuring cough pressure. Minerva Anestesiol 2023; 89:1092-1098. [PMID: 38019173 DOI: 10.23736/s0375-9393.23.17519-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Laparotomy is assumed to decrease cough strength due to three factors: abdominal muscle trauma, postoperative pain, and diaphragmatic dysfunction. However, the effect of trauma from laparotomy itself on strength (net of the other two factors) has not been measured to our knowledge. The aim of this study was to measure the effect of laparotomy on cough strength after first measuring the effect of epidural analgesia. METHODS In 11 patients scheduled for open midline laparotomy, cough pressure (PCOUGH), a proxy for strength, was measured with a rectal balloon at three moments: before the procedure, at baseline; before surgery, under epidural bupivacaine to T6; and postoperatively, under epidural bupivacaine to the same analgesic level (T6). Continuous variables were compared using the Wilcoxon signed-rank test. The repeatability of PCOUGH measurements was confirmed with the intraclass correlation coefficient (ICC). Pain on coughing, hand grip strength, and the Ramsay and modified Bromage scores were also recorded. RESULTS Median (interquartile range) PCOUGH decreased from a baseline of 103 (89-137) to 71 (56-116) cmH2O under presurgical epidural bupivacaine (P=0.003). Postoperative PCOUGH remained unchanged at 76 (46-85) cmH2O under epidural analgesia (P=0.131). The ICCs indicated excellent repeatability of the PCOUGH measurements (P<0.001). Pain on coughing was 0 to 1 in all subjects. Hand grip strength and the Ramsay and Bromage scores were unchanged. CONCLUSIONS Although thoracic epidural bupivacaine reduces cough strength as measured by PCOUGH, midline laparotomy does not further reduce strength in the presence of adequate epidural analgesia.
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Affiliation(s)
- Lluís G Aguilera
- Department of Anesthesiology, Parc de Salut MAR, Barcelona, Spain
- Perioperative Medicine and Pain Research Group, Neurosciences Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Lluís Gallart
- Department of Anesthesiology, Parc de Salut MAR, Barcelona, Spain -
- Perioperative Medicine and Pain Research Group, Neurosciences Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- Universitat Autònome de Barcelona, Bellaterra, Spain
| | - Isabel Ramos
- Department of Anesthesiology, Parc de Salut MAR, Barcelona, Spain
| | - Xavier Duran
- Service of Methodological and Biostatistical Advisory, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Fernando Escolano
- Department of Anesthesiology, Parc de Salut MAR, Barcelona, Spain
- Perioperative Medicine and Pain Research Group, Neurosciences Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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Benítez-Cano A, Bermejo S, Luque S, Sorlí L, Carazo J, Zaragoza I, Ramos I, Vallès J, Horcajada JP, Adalia R. Clinical, Microbiological and Treatment Characteristics of Severe Postoperative Respiratory Infections: An Observational Cohort Study. J Pers Med 2023; 13:1482. [PMID: 37888093 PMCID: PMC10608667 DOI: 10.3390/jpm13101482] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
Respiratory infections are frequent and life-threatening complications of surgery. This study aimed to evaluate the clinical, microbiological and treatment characteristics of severe postoperative pneumonia (POP) and tracheobronchitis (POT) in a large series of patients. This single-center, prospective observational cohort study included patients with POP or POT requiring intensive care unit admission in the past 10 years. We recorded demographic, clinical, microbiological and therapeutic data. A total of 207 patients were included, and 152 (73%) were men. The mean (SD) age was 70 (13) years and the mean (SD) ARISCAT score was 46 (19). Ventilator-associated pneumonia was reported in 21 patients (10%), hospital-acquired pneumonia was reported in 132 (64%) and tracheobronchitis was reported in 54 (26%). The mean (SD) number of days from surgery to POP/POT diagnosis was 6 (4). The mean (SD) SOFA score was 5 (3). Respiratory microbiological sampling was performed in 201 patients (97%). A total of 177 organisms were cultured in 130 (63%) patients, with a high proportion of Gram-negative and multi-drug resistant (MDR) bacteria (20%). The most common empirical antibiotic therapy was a triple-drug regimen covering MDR Gram-negative bacteria and MRSA. In conclusion, surgical patients are a high-risk population with a high proportion of early onset severe POP/POT and nosocomial bacteria isolation.
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Affiliation(s)
- Adela Benítez-Cano
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
- Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (S.L.); (L.S.); (J.P.H.)
| | - Silvia Bermejo
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
| | - Sonia Luque
- Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (S.L.); (L.S.); (J.P.H.)
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
| | - Luisa Sorlí
- Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (S.L.); (L.S.); (J.P.H.)
- Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - Jesús Carazo
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
| | - Irene Zaragoza
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
| | - Isabel Ramos
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
| | - Jordi Vallès
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
| | - Juan P. Horcajada
- Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (S.L.); (L.S.); (J.P.H.)
- Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - Ramón Adalia
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (S.B.); (J.C.); (I.Z.); (I.R.); (J.V.); (R.A.)
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Martin JZ, Onieva JL, Roman A, Garrido M, Oliver J, Martinez-Galvez B, Dubbelman J, Mesas A, Villatoro R, Ramos I, Rueda-Dominguez A, Perez-Ruiz E, Benitez JC, Medina JA, Alba E, Sett RC, Barragan I. Dynamic Exosome Analysis to Predict Response to the Combination of SABR and Immunotherapy in Oligoprogressive Disease. Int J Radiat Oncol Biol Phys 2023; 117:e274-e275. [PMID: 37785033 DOI: 10.1016/j.ijrobp.2023.06.1247] [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) Up to 80% of metastatic patients face resistance to immune checkpoint inhibitors (ICI). Combined SABR and ICI (I-SABR) can unleash antitumor immune cascades to overcome resistance and improve response with minimal toxicity. This synergy is particularly interesting in the oligoprogressive setting to extend the clinical benefit (CB) of ICI. However, there are no current biomarkers for patient selection. We hypothesize that differential expression of exosomal RNA in liquid biopsy may predict response to I-SABR. MATERIALS/METHODS Ongoing prospective multicenter study in two cohorts. Cohort A consists of metastatic patients in oligoprogression to ICI (1-5 extracranial sites) but maintaining the same ICI due to CB and who receive concomitant SABR (35 Gy in 5 fractions, fx) to oligoprogressive sites. Cohort B is a comparative group of oligometastatic patients receiving only SABR in ablative doses. Blood samples are extracted before SABR (T1), after the first (T2) and last (T3) fx, two months post-SABR (T4) and at further progression (TP). Response is evaluated by iRECIST and defined by the objective response rate (ORR) in all lesions (in and out-of-field)- complete and partial responses. For exosome analysis, we perform RNA isolation and small RNA sequencing from plasma. We use Cutadapt, Bowtie and featureCounts to quantify the number of reads of miRNA, small nuclear RNA (snRNA) and small nucleolar RNA (snoRNA). Pairwise differences in expression in responders and non-responders are examined by DESeq2 differential expression analysis. Differentially expressed transcripts are consulted in Ingenuity Pathway Analysis (IPA). RESULTS Of 22 patients recruited, we present preliminary results of the first 10 (8 from cohort A and 2 from B) that had undergone re-evaluation after SABR. Most frequent cancer types were lung (60%) and renal cell (20%). Seventy percent were polymetastatic (>5 lesions) and 90% had a single progressing site. Pembrolizumab (40%) and Nivolumab (30%) were the most frequent ICI. Most lesions for SABR were lung (45%). With a median follow-up of 7.1 months (95% CI, 3.7-10.6) ORR at two months was 60% (6 partial responses, 1 stable disease and 3 progressions). Median progression-free survival was 10.3 months (95% CI, 3.7-not reached) and median overall survival was not reached. Seven patients in cohort A were available for small RNA analysis. We identified 3 miRNA, 24 snRNA and 9 snoRNA that were significantly differentially expressed at T1. Hsa-miR-493, marker of tumor progression, was upregulated in non-responders. RN7SK inhibits LAS1L (a known inductor of metastasis in lung cancer) and was upregulated in responders. SNORD71, which is inhibited by ILF3 (promotor of progression), was also upregulated in responders. CONCLUSION I-SABR is an effective approach for extending CB of ICI in oligoprogressive patients. Exosomal RNA expression analysis in liquid biopsy is a novel and non-invasive technique that may predict response to this combination and aid in patient selection.
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Affiliation(s)
- J Zafra Martin
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Department of Radiation Oncology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - J L Onieva
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - A Roman
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - M Garrido
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - J Oliver
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - B Martinez-Galvez
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - J Dubbelman
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - A Mesas
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - R Villatoro
- Department of Medical Oncology, Costa del Sol Hospital, Marbella, Spain
| | - I Ramos
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - A Rueda-Dominguez
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - E Perez-Ruiz
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - J C Benitez
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - J A Medina
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - E Alba
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - R Chicas Sett
- Department of Radiation Oncology, La Fe University Hospital, Valencia, Spain; Department of Radiation Oncology, ASCIRES Grupo Biomedico, Valencia, Spain
| | - I Barragan
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Group of Pharmacoepigenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Berni M, Mota J, Bressan D, Ribeiro L, Martins G, Pereira J, Ramos I, Nunes-da-Fonseca R, Araujo H. A pro-BMP function exerted by Rhodnius prolixus short gastrulation reveals great diversity in the role of BMP modulators during embryonic patterning. Open Biol 2023; 13:230023. [PMID: 37403495 DOI: 10.1098/rsob.230023] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Dorsal-ventral (DV) patterning is regulated by the bone morphogenetic pathway (BMP) in Bilateria. In insect DV patterning, the Toll pathway also plays a role, in addition to BMPs. Variations in the relative importance of each pathway for DV patterning have been reported using single species of coleopteran, hymenopteran, hemipteran and orthopteran insects. To investigate if the molecular control of DV patterning is conserved inside an insect order, the emergent model hemiptera species Rhodnius prolixus was studied. We found that R. prolixus BMP pathway controls the entire DV axis, with a broader effect respective to Toll, as shown for the hemiptera Oncopeltus fasciatus. Different from O. fasciatus, the unique R. prolixus short gastrulation (sog) and the twisted gastrulation (tsg) orthologues do not antagonize, but rather favour embryonic BMP signalling. Our results reinforce the hypothesis that hemiptera rely preferentially on BMPs for DV patterning but that, surprisingly, in R. prolixus Sog and Tsg proteins exert only a positive role to establish a dorsal-to-ventral BMP gradient. Since sog has been reported to be lost from orthopteran and hymenopteran genomes, our results indicate that Sog's role to modify BMP activity varies greatly in different insect species.
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Affiliation(s)
- M Berni
- Institute for Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular, Brazil (INCT-EM)
| | - J Mota
- Institute for Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Post-graduate Program in Morphological Sciences (PCM), Federal University of Rio de Janeiro
| | - D Bressan
- Institute for Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L Ribeiro
- Institute of Biodiversity and Sustainability (NUPEM), Federal University of Rio de Janeiro, Campus Macaé, Rio de Janeiro
| | - G Martins
- Institute for Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Post-graduate Program in Morphological Sciences (PCM), Federal University of Rio de Janeiro
| | - J Pereira
- Institute for Medical Biochemistry, Federal University of Rio de Janeiro
| | - I Ramos
- Institute for Medical Biochemistry, Federal University of Rio de Janeiro
- Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular, Brazil (INCT-EM)
| | - R Nunes-da-Fonseca
- Institute of Biodiversity and Sustainability (NUPEM), Federal University of Rio de Janeiro, Campus Macaé, Rio de Janeiro
- Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular, Brazil (INCT-EM)
| | - H Araujo
- Institute for Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular, Brazil (INCT-EM)
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Richard RM, Maziashvili G, Tran M, Ramos I, Laxman AS, Didbaridze N. Breast Milk Conferred Immunity to Infants Against COVID-19. Cureus 2023; 15:e42075. [PMID: 37602015 PMCID: PMC10434728 DOI: 10.7759/cureus.42075] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has notably impacted healthcare systems and everyday life worldwide. Regulatory authorities have approved the emergency use of SARS-CoV-2 vaccines due to the rapid spread of the virus. However, during vaccination testing, pregnant and breastfeeding women were initially excluded, leading to a lack of evidence-based recommendations. When taking the COVID-19 pandemic into account, breastfeeding has emerged as a potential defense mechanism against this infection due to its numerous benefits for newborns. Human breast milk contains immunoglobulins (IgA, IgG, and IgM), lactoferrin, and various cells that play an inevitable role in the newborn's protection against respiratory infections and immune system development. Various studies have highlighted that the onset and severity of respiratory infections in infants can be reduced through breastfeeding, and the effects are noticeable during the first six months of life and that breast milk also has the potential to enhance mucosal immunity and promote a diverse microbiome, reducing the risk of asthma, allergies, and enteric diseases through the provision of specific antibodies and immunological factors. Researchers have indicated that breastfeeding mothers who contracted and recovered from COVID-19 or received vaccination passed protective antibodies to their infants through breast milk. Although rare cases of detection of SARS-CoV-2 RNA in breast milk have been reported, the virus has not been cultured from these samples, suggesting a low risk of transmission to the breastfed baby. However, further research is essential to understand the extent of protection provided by breast milk against COVID-19 and the potential effect of distinct phases of lactation. Nonetheless, the current evidence supports the benefits and safety of breastfeeding during the pandemic. With appropriate safety measures, promoting breastfeeding can contribute to the overall health and well-being of infants during the phase of COVID-19.
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Affiliation(s)
- Riya Mary Richard
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, GEO
| | | | - Mai Tran
- Faculty of Medicine, Washington University of Health and Science, San Pedro, BLZ
| | - Isabel Ramos
- Facultad de Medicina y Cirugía, Universidad Católica de Honduras, Tegucigalpa, HND
| | | | - Nino Didbaridze
- Department of Immunology, Tbilisi State Medical University, Tbilisi, GEO
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Pimenta A, Azevedo L, Ramos I, Santos J. Radiation protection measures used in Portuguese interventional radiology departments: A national survey. Radiography (Lond) 2023; 29:597-603. [PMID: 37075489 DOI: 10.1016/j.radi.2023.04.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION This study aimed to characterise radiation protection (RP) measures used in interventional radiology (IR) departments in Portugal with respect to European and national recommendations. METHODS An online national survey was created to characterise the fluoroscopy technology as well as analyse the frequency of body fluoroscopy-guided intervention procedures (FGIP), RP education and training of the staff, and RP measures used daily. RESULTS In Portugal, most equipment for FGIP are single-sourced and have a flat panel detector (70%). The most commonly FGIP are percutaneous biliary drainage, percutaneous arterial and venous thrombolysis/thrombectomy, arteriovenous malformations embolization, and percutaneous transluminal balloon angioplasty for arteriovenous fistulas. Only a few staff members had received postgraduate education and training in RP (30%), with most nurses having not received RP education and training (40%). Some of the recommended RP measures lacked harmonisation. Additionally, >50% of the IR departments do not consider examination dose values to identify patients eligible for tissue reactions follow-up. CONCLUSION This is the first study to examine the characteristics of IR departments in Portugal. We observed a lack of RP education and training among staff members; further, there was a need to update some RP measures in some IR departments according to the recommendations. IMPLICATIONS FOR PRACTICE Our findings will be presented to the participating IR departments in order to update and promote RP best practices. Moreover, our findings will be presented to the national societies of the different professional groups in order to inform strategies for harmonising RP education and training of the staff.
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Affiliation(s)
- A Pimenta
- University Hospital of St. John, (CHUSJ) Radiology Department, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Oporto Medical School, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - L Azevedo
- CINTESIS@RISE Department of Community, Information and Health Decision Sciences - MEDCIDS, Faculty of Medicine University of Porto, Clinical and Health Services Research - PDICSS, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal; Oporto Medical School, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - I Ramos
- Oporto Medical School, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - J Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854, Coimbra, Portugal.
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11
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Fuentes P, Ramos I, Stuardo A, Diaz F, Sánchez F, Torres C, Rojas A, Maldonado R, Córdova L, Burgos P, Pavicic F, Figueroa C, Ehrenfeld P. P034 KLK4 in luminal breast cancer progression. Breast 2023. [DOI: 10.1016/s0960-9776(23)00153-4] [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: 03/16/2023] Open
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Pimenta M, Vassalou EE, Dimitri-Pinheiro S, Klontzas ME, Ramos I, Karantanas AH. Ultrasound-Guided Hydrodistension for Adhesive Capsulitis: Is There Any Adjunct Effect of Immediate Post-Procedural Manipulation Over Instructed Physical Therapy? J Ultrasound Med 2023; 42:665-674. [PMID: 35869694 DOI: 10.1002/jum.16063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To compare the additive value of immediate post-procedural manipulation versus physiotherapy, following ultrasound (US)-guided hydrodistention of the glenohumeral joint (GHJ) in patients with adhesive capsulitis (AC) and define predictors of outcome. METHODS Within a 19-month period, 161 consecutive patients with AC were prospectively enrolled and allocated to two groups according to treatment, based on patients' individual preferences: 1) group-I, US-guided hydrodistension plus immediate post-procedural manipulations and 2) group-II, US-guided hydrodistension plus supervised physiotherapy program. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and a visual analog scale (VAS) were used for clinical assessment at baseline (immediately after treatment), 1, 3, and 6 months. Comparisons were performed with Mann-Whitney U test and Kolmogorov-Smirnov test. Linear regression was used to identify predictors of outcome. P value <.05 defined significance. RESULTS GHJ hydrodistension with manipulation or physiotherapy was linked to clinical improvement at all follow-up time-points. DASH scores of group-I remained constantly lower than DASH scores of group-II at all time-points (P < .001). VAS scores were lower in group-I than group-II at 1 and 3 months (P < .001 and P = .0019, respectively). Both groups had improved to a similar degree with respect to pain at 6 months (P = .29). The performance of post-interventional manipulations was predictive of improved shoulder functionality (as assessed with DASH scores) at all time-points, while low-grade disease and milder symptoms at presentation were associated with improved short-term pain. CONCLUSIONS Immediate post-procedural manipulations appeared to be superior to physiotherapy following GHJ hydrodistension for AC in terms of shoulder functionality during a 6-month follow-up period. Post-interventional manipulations, the stage of AC and lower DASH and VAS scores at presentations were predictive of improved outcome.
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Affiliation(s)
| | | | - Sofia Dimitri-Pinheiro
- Radiology Department, Portuguese Institute of Oncology of Porto - Francisco Gentil EPE, Porto, Portugal
- Biomedicine Department, Unit of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece
| | - Isabel Ramos
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece
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Restrepo J, Webster EG, Ramos I, Valverde RA. Recent decline of the green turtle (Chelonia mydas) nesting trend at Tortuguero, Costa Rica. ENDANGER SPECIES RES 2023. [DOI: 10.3354/esr01237] [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: 03/17/2023] Open
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14
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Castro MC, Ramos I, Carvalho IP. The Influence of Patient-Centered Communication on Children's Anxiety and Use of Anesthesia for MR. Int J Environ Res Public Health 2022; 20:414. [PMID: 36612736 PMCID: PMC9819401 DOI: 10.3390/ijerph20010414] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Background: The aim of this study was to inspect the influence of patient-centered communication (PCC) with 4- to 10-year-old children on the use of anesthesia for magnetic resonance imaging exams (MRs). Methods: A total of thirty children received the PCC and pre-simulated the exam with an MR toy. Another 30 children received routine information about the MR and pre-simulated the exam with the toy. Anesthesia use in these two groups was additionally compared with a previously existing group of children (n = 30) who had received only routine information about the exam (CG). Children’s anxiety was assessed with a self-report question plus heartbeat frequency. Children’s satisfaction was assessed through several questions. The analyses were based on group comparisons and regression. Results: A total of two children (7%) in the PCC + simulation group used sedation compared with 14 (47%) in the simulation group and 21 (70%) in the CG. Differences between the PCC + simulation and the other two groups were significant (p < 0.001), although not between the simulation and the CG. The decrease in anxiety was significantly greater (self-reported p < 0.001; heart rate p < 0.05) and satisfaction was higher (p = 0.001) in the PCC + simulation, when compared with the simulation group. Reduced anxiety was associated with less anesthesia use (OR 1.39; CI 1.07−1.79; p = 0.013). Conclusions: PCC + simulation was more effective than simulation and routine practice in decreasing children’s anxiety, increasing satisfaction, and reducing the use of anesthesia for MRs.
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Affiliation(s)
- M. Conceição Castro
- Department of Radiology, Centro Hospitalar Universitário de São João–Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Isabel Ramos
- Faculty of Medicine, University of Porto-Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Irene Palmares Carvalho
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto-Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto-Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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15
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Schetter CD, Rahal D, Ponting C, Julian M, Ramos I, Hobel C, Coussons-Read M. Anxiety in pregnancy and length of gestation: Findings from the healthy babies before birth study. Health Psychol 2022; 41:894-903. [PMID: 36154104 PMCID: PMC9885848 DOI: 10.1037/hea0001210] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Anxiety is prevalent in pregnancy and predicts risk of adverse birth outcomes. Many instruments measure anxiety in pregnancy, some of which assess pregnancy anxiety defined as maternal concerns about a current pregnancy (e.g., baby, childbirth). The present study examined covariance among four anxiety or distress measures at two times in pregnancy and tested joint and individual effects on gestational length. We hypothesized that the common variance of the measures in each trimester would predict earlier delivery. METHOD Research staff interviewed 196 women in first and third trimester utilizing a clinical screener of anxiety severity/impairment, two instruments measuring pregnancy anxiety, and one on prenatal distress. Birth outcomes and medical risk factors were obtained from medical records after birth. Structural equation modeling fit latent factors for each trimester from the four measures. Subsequent models tested whether the latent factors predicted gestational length, and unique effects of each measure. RESULTS The third-trimester pregnancy anxiety latent factor predicted shorter gestational length adjusting for mother's age, education, parity, and obstetric risk. Scores on a four-item pregnancy-specific anxiety measure (PSAS) in third trimester added uniquely to prediction of gestational length. In first trimester, scores on the clinical screener (OASIS) uniquely predicted shorter gestational length whereas the latent factor did not. CONCLUSION These results support existing evidence indicating that pregnancy anxiety is a reliable risk factor for earlier birth. Findings point to possible screening for clinically significant anxiety symptoms in the first trimester, and pregnancy-specific anxiety thereafter to advance efforts to prevent earlier delivery. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Danny Rahal
- Departments of Psychology University of California, Los Angeles
| | - Carolyn Ponting
- Departments of Psychology University of California, Los Angeles
| | - Melissa Julian
- Department of Psychological and Brain Sciences, George Washington University
| | - Isabel Ramos
- Department of Chicano/Latino Studies, University of California, Irvine
| | - Calvin Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, Qureshi A, Sawhney R, Sigurdson B, Stephenson L, Vora K, Zacken A, Cope P, Di Traglia R, Ferarrio I, Hackett N, Healicon R, Horseman L, Lam LI, Meerdink M, Menham D, Murphy R, Nimmo I, Ramaesh A, Rees J, Soame R, Dilaver N, Adebambo D, Brown E, Burt J, Foster K, Kaliyappan L, Knight P, Politis A, Richardson E, Townsend J, Abdi M, Ball M, Easby S, Gill N, Ho E, Iqbal H, Matthews M, Nubi S, Nwokocha JO, Okafor I, Perry G, Sinartio B, Vanukuru N, Walkley D, Welch T, Yates J, Yeshitila N, Bryans K, Campbell B, Gray C, Keys R, Macartney M, Chamberlain G, Khatri A, Kucheria A, Lee STP, Reese G, Roy choudhury J, Tan WYR, Teh JJ, Ting A, Kazi S, Kontovounisios C, Vutipongsatorn K, Amarnath T, Balasubramanian N, Bassett E, Gurung P, Lim J, Panjikkaran A, Sanalla A, Alkoot M, Bacigalupo V, Eardley N, Horton M, Hurry A, Isti C, Maskell P, Nursiah K, Punn G, Salih H, Epanomeritakis E, Foulkes A, Henderson R, Johnston E, McCullough H, McLarnon M, Morrison E, Cheung A, Cho SH, Eriksson F, Hedges J, Low Z, May C, Musto L, Nagi S, Nur S, Salau E, Shabbir S, Thomas MC, Uthayanan L, Vig S, Zaheer M, Zeng G, Ashcroft-Quinn S, Brown R, Hayes J, McConville R, French R, Gilliam A, Sheetal S, Shehzad MU, Bani W, Christie I, Franklyn J, Khan M, Russell J, Smolarek S, Varadarassou R, Ahmed SK, Narayanaswamy S, Sealy J, Shah M, Dodhia V, Manukyan A, O'Hare R, Orbell J, Chung I, Forenc K, Gupta A, Agarwal A, Al Dabbagh A, Bennewith R, Bottomley J, Chu TSM, Chu YYA, Doherty W, Evans B, Hainsworth P, Hosfield T, Li CH, McCullagh I, Mehta A, Thaker A, Thompson B, Virdi A, Walker H, Wilkins E, Dixon C, Hassan MR, Lotca N, Tong KS, Batchelor-Parry H, Chaudhari S, Harris T, Hooper J, Johnson C, Mulvihill C, Nayler J, Olutobi O, Piramanayagam B, Stones K, Sussman M, Weaver C, Alam F, Al Rawi M, Andrew F, Arrayeh A, Azizan N, Hassan A, Iqbal Z, John I, Jones M, Kalake O, Keast M, Nicholas J, Patil A, Powell K, Roberts P, Sabri A, Segue AK, Shah A, Shaik Mohamed SA, Shehadeh A, Shenoy S, Tong A, Upcott M, Vijayasingam D, Anarfi S, Dauncey J, Devindaran A, Havalda P, Komninos G, Mwendwa E, Norman C, Richards J, Urquhart A, Allan J, Cahya E, Hunt H, McWhirter C, Norton R, Roxburgh C, Tan JY, Ali Butt S, Hansdot S, Haq I, Mootien A, Sanchez I, Vainas T, Deliyannis E, Tan M, Vipond M, Chittoor Satish NN, Dattani A, De Carvalho L, Gaston-Grubb M, Karunanithy L, Lowe B, Pace C, Raju K, Roope J, Taylor C, Youssef H, Munro T, Thorn C, Wong KHF, Yunus A, Chawla S, Datta A, Dinesh AA, Field D, Georgi T, Gwozdz A, Hamstead E, Howard N, Isleyen N, Jackson N, Kingdon J, Sagoo KS, Schizas A, Yin L, Aung E, Aung YY, Franklin S, Han SM, Kim WC, Martin Segura A, Rossi M, Ross T, Tirimanna R, Wang B, Zakieh O, Ben-Arzi H, Flach A, Jackson E, Magers S, Olu abara C, Rogers E, Sugden K, Tan H, Veliah S, Walton U, Asif A, Bharwada Y, Bowley D, Broekhuizen A, Cooper L, Evans N, Girdlestone H, Ling C, Mann H, Mehmood N, Mulvenna CL, Rainer N, Trout I, Gujjuri R, Jeyaraman D, Leong E, Singh D, Smith E, Anderton J, Barabas M, Goyal S, Howard D, Joshi A, Mitchell D, Weatherby T, Badminton R, Bird R, Burtle D, Choi NY, Devalia K, Farr E, Fischer F, Fish J, Gunn F, Jacobs D, Johnston P, Kalakoutas A, Lau E, Loo YNAF, Louden H, Makariou N, Mohammadi K, Nayab Y, Ruhomaun S, Ryliskyte R, Saeed M, Shinde P, Sudul M, Theodoropoulou K, Valadao-Spoorenberg J, Vlachou F, Arshad SR, Janmohamed AM, Noor M, Oyerinde O, Saha A, Syed Y, Watkinson W, Ahmadi H, Akintunde A, Alsaady A, Bradley J, Brothwood D, Burton M, Higgs M, Hoyle C, Katsura C, Lathan R, Louani A, Mandalia R, Prihartadi AS, Qaddoura B, Sandland-Taylor L, Thadani S, Thompson A, Walshaw J, Teo S, Ali S, Bawa JH, Fox S, Gargan K, Haider SA, Hanna N, Hatoum A, Khan Z, Krzak AM, Li T, Pitt J, Tan GJS, Ullah Z, Wilson E, Cleaver J, Colman J, Copeland L, Coulson A, Davis P, Faisal H, Hassan F, Hughes JT, Jabr Y, Mahmoud Ali F, Nahaboo Solim ZN, Sangheli A, Shaya S, Thompson R, Cornwall H, De Andres Crespo M, Fay E, Findlay J, Groves E, 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H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Pereira F, Serrano A, Manzanedo I, Pérez-Viejo E, González-Moreno S, González-Bayón L, Arjona-Sánchez A, Torres J, Ramos I, Barrios ME, Cascales P, Morales R, Boldó E, García-Fadrique A, Arteaga X, Gutierrez-Calvo A, Sánchez-García S, Asensio E, Ramírez CP, Artiles M, Vaqué J, Parra PA, Villarejo P, Muñoz-Casares C, Turienzo E, Calero A, Torrejimeno IJ, Prieto I, Galindo J, Borrego V, Marcello ME, Rihuete C, Carrasco J, Gomez-Quiles L. GECOP-MMC: phase IV randomized clinical trial to evaluate the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) with mytomicin-C after complete surgical cytoreduction in patients with colon cancer peritoneal metastases. BMC Cancer 2022; 22:536. [PMID: 35549912 PMCID: PMC9097342 DOI: 10.1186/s12885-022-09572-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/19/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The French PRODIGE 7 trial, published on January 2021, has raised doubts about the specific survival benefit provided by HIPEC with oxaliplatin 460 mg/m2 (30 minutes) for the treatment of peritoneal metastases from colorectal cancer. However, several methodological flaws have been identified in PRODIGE 7, specially the HIPEC protocol or the choice of overall survival as the main endpoint, so its results have not been assumed as definitive, emphasizing the need for further research on HIPEC. It seems that the HIPEC protocol with high-dose mytomicin-C (35 mg/m2) is the preferred regime to evaluate in future clinical studies. METHODS GECOP-MMC is a prospective, open-label, randomized, multicenter phase IV clinical trial that aims to evaluate the effectiveness of HIPEC with high-dose mytomicin-C in preventing the development of peritoneal recurrence in patients with limited peritoneal metastasis from colon cancer (not rectal), after complete surgical cytoreduction. This study will be performed in 31 Spanish HIPEC centres, starting in March 2022. Additional international recruiting centres are under consideration. Two hundred sixteen patients with PCI ≤ 20, in which complete cytoreduction (CCS 0) has been obtained, will be randomized intraoperatively to arm 1 (with HIPEC) or arm 2 (without HIPEC). We will stratified randomization by surgical PCI (1-10; 11-15; 16-20). Patients in both arms will be treated with personalized systemic chemotherapy. Primary endpoint is peritoneal recurrence-free survival at 3 years. An ancillary study will evaluate the correlation between surgical and pathological PCI, comparing their respective prognostic values. DISCUSSION HIPEC with high-dose mytomicin-C, in patients with limited (PCI ≤ 20) and completely resected (CCS 0) peritoneal metastases, is assumed to reduce the expected risk of peritoneal recurrence from 50 to 30% at 3 years. TRIAL REGISTRATION EudraCT number: 2019-004679-37; Clinicaltrials.gov: NCT05250648 (registration date 02/22/2022, ).
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Affiliation(s)
- Fernando Pereira
- Hospital Universitario de Fuenlabrada, Camino del Molino 2, Fuenlabrada, 28942, Madrid, Spain.
| | - Angel Serrano
- Hospital Universitario de Fuenlabrada, Camino del Molino 2, Fuenlabrada, 28942, Madrid, Spain
| | - Israel Manzanedo
- Hospital Universitario de Fuenlabrada, Camino del Molino 2, Fuenlabrada, 28942, Madrid, Spain
| | - Estibalitz Pérez-Viejo
- Hospital Universitario de Fuenlabrada, Camino del Molino 2, Fuenlabrada, 28942, Madrid, Spain
| | | | - Luis González-Bayón
- Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46 -, 28007, Madrid, Spain
| | | | - Juan Torres
- Hospital Universitario Torrecárdenas, Calle Hermandad de Donantes de Sangre s/n, 04009, Almería, Spain
| | - Isabel Ramos
- Hospital Sant Joan Despi Moises Broggi, Carrer de Jacint Verdaguer, 90, 08970 Sant Joan Despí, Barcelona, Spain
| | - Maria E Barrios
- Hospital Clinico Universitario de Valencia, Avenida de Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Pedro Cascales
- Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120, El Palmar, Murcia, Spain
| | - Rafael Morales
- Hospital Universitario Son Espases, Carretera de Valldemossa, 79. 07210 Palma, Mallorca, Spain
| | - Enrique Boldó
- Consorcio Hospitalario Provincial De Castellón, Avenida del Doctor Clarà 19, 12006, Castellón de la Plana, Spain
| | | | - Xabier Arteaga
- Hospital Universitario Donostia, Begiristain Doktorea Pasealekua 109, 20014, Donostia, Gipuzkoa, Spain
| | - Alberto Gutierrez-Calvo
- Hospital Universitario Principe de Asturias, Carretera Alcalá-Meco, s/n - 28805 Alcalá de Henares, Madrid, Spain
| | - Susana Sánchez-García
- Hospital General Universitario de Ciudad Real, C/ Obispo Rafael Torija s/n - Pol. Larache, 13005, Ciudad Real, Spain
| | - Enrique Asensio
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Cesar P Ramírez
- Hospital Quirónsalud Málaga, Avenida de Imperio Argentina, 1, 29004, Málaga, Spain
| | - Manuel Artiles
- Hospital Universitario de Gran Canaria Doctor Negrín, Barranco de la Ballena, 0, 35010, Las Palmas de Gran Canaria, Spain
| | - Javier Vaqué
- Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Pedro A Parra
- Hospital General Universitario Reina Sofía, Avda. Intendente Jorge Palacios, 1, 30003, Murcia, Spain
| | - Pedro Villarejo
- Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040, Madrid, Spain
| | | | - Estrella Turienzo
- Hospital Universitario Central de Asturias, Avenida de Roma, 0, 33011, Oviedo, Spain
| | - Alicia Calero
- Hospital General Universitario de Elche, Camí de la Almazara, 11, 03203 Elche, Alicante, Spain
| | | | - Isabel Prieto
- Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Julio Galindo
- Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9,100, 28034, Madrid, Spain
| | - Vicente Borrego
- Hospital Clínico Universitario "Lozano Blesa", Avda. San Juan Bosco, 15, 50009, Zaragoza, Spain
| | - Manuel E Marcello
- Hospital Universitario Fundación Alcorcón, Calle de Budapest, 1, 28922 Alcorcón, Madrid, Spain
| | - Cristina Rihuete
- Hospital Universitario Infanta Elena, Avenida de los Reyes Católicos 21, 28340 Valdemoro, Madrid, Spain
| | - Joaquin Carrasco
- Hospital Regional Universitario de Málaga, Avda. Carlos Haya 82-88, 29010, Málaga, Spain
| | - Luis Gomez-Quiles
- Hospital General Universitario De Castellón, Avenida de Benicassim, 128, 12004, Castellón, Spain
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Silva F, Pereira T, Neves I, Morgado J, Freitas C, Malafaia M, Sousa J, Fonseca J, Negrão E, Flor de Lima B, Correia da Silva M, Madureira AJ, Ramos I, Costa JL, Hespanhol V, Cunha A, Oliveira HP. Towards Machine Learning-Aided Lung Cancer Clinical Routines: Approaches and Open Challenges. J Pers Med 2022; 12:jpm12030480. [PMID: 35330479 PMCID: PMC8950137 DOI: 10.3390/jpm12030480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/07/2022] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
Advancements in the development of computer-aided decision (CAD) systems for clinical routines provide unquestionable benefits in connecting human medical expertise with machine intelligence, to achieve better quality healthcare. Considering the large number of incidences and mortality numbers associated with lung cancer, there is a need for the most accurate clinical procedures; thus, the possibility of using artificial intelligence (AI) tools for decision support is becoming a closer reality. At any stage of the lung cancer clinical pathway, specific obstacles are identified and “motivate” the application of innovative AI solutions. This work provides a comprehensive review of the most recent research dedicated toward the development of CAD tools using computed tomography images for lung cancer-related tasks. We discuss the major challenges and provide critical perspectives on future directions. Although we focus on lung cancer in this review, we also provide a more clear definition of the path used to integrate AI in healthcare, emphasizing fundamental research points that are crucial for overcoming current barriers.
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Affiliation(s)
- Francisco Silva
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FCUP—Faculty of Science, University of Porto, 4169-007 Porto, Portugal
- Correspondence: (F.S.); (T.P.)
| | - Tania Pereira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- Correspondence: (F.S.); (T.P.)
| | - Inês Neves
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- ICBAS—Abel Salazar Biomedical Sciences Institute, University of Porto, 4050-313 Porto, Portugal
| | - Joana Morgado
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
| | - Cláudia Freitas
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Mafalda Malafaia
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FEUP—Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Joana Sousa
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
| | - João Fonseca
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FEUP—Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Eduardo Negrão
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Beatriz Flor de Lima
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Miguel Correia da Silva
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - António J. Madureira
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Isabel Ramos
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - José Luis Costa
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135 Porto, Portugal
| | - Venceslau Hespanhol
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - António Cunha
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- UTAD—University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal
| | - Hélder P. Oliveira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (I.N.); (J.M.); (M.M.); (J.S.); (J.F.); (A.C.); (H.P.O.)
- FCUP—Faculty of Science, University of Porto, 4169-007 Porto, Portugal
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Lopes M, Ferreira M, Ramos I, Melo Freitas P. Neurocysticercosis: a contemporary presentation of the neuroimaging main stages. BMJ Case Rep 2022; 15:e247927. [PMID: 35140100 PMCID: PMC8830162 DOI: 10.1136/bcr-2021-247927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mariana Lopes
- Department of Infectious Diseases, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Mafalda Ferreira
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isabel Ramos
- Department of Infectious Diseases, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Pedro Melo Freitas
- Neuroradiology Unit - Medical Imaging Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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Zattera L, Veliziotis I, Benitez-Cano A, Ramos I, Larrañaga L, Nuñez M, Román L, Adalid I, Ferrando C, Muñoz G, Arruti E, Minini A, Bassas E, Hernández M, Taccone FS, Peluso L, Adalia R. Early procalcitonin to predict mortality in critically ill COVID-19 patients: a multicentric cohort study. Minerva Anestesiol 2022; 88:259-271. [PMID: 35072432 DOI: 10.23736/s0375-9393.22.15942-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND High levels of procalcitonin (PCT) have been associated with a higher risk of mortality in COVID-19 patients. We explored the prognostic role of early PCT assessment in critically ill COVID-19 patients and whether PCT predictive performance would be influenced by immunosuppression. METHODS Retrospective multicentric analysis of prospective collected data in COVID-19 patients consecutively admitted to 36 intensive care units (ICUs) in Spain and Andorra from March to June 2020. Adult (>18 years) patients with confirmed COVID-19 and available PCT values (<72 hours from ICU admission) were included. Patients were considered as "No Immunosuppression" (NI), "Chronic Immunosuppression" (CI) and "Acute Immunosuppression" (AIT if only tocilizumab; AIS if only steroids, AITS if both). The primary outcome was the ability of PCT to predict ICU mortality. RESULTS Of the 1079 eligible patients, 777 patients were included in the analysis. Mortality occurred in 227 (28%) patients. In the NI group 144 (19%) patients were included, 67 (9%) in the CI group, 66 (8%) in the AIT group, 262 (34%) in the AIS group and 238 (31%) in the AITS group; PCT was significantly higher in non-survivors when compared with survivors (0.64 [0.17-1.44] vs. 0.23 [0.11-0.60] ng/mL; p<0.01); however, in the multivariable analysis, PCT values was not independently associated with ICU mortality. PCT values and ICU mortality were significantly higher in patients in the NI and CI groups. CONCLUSIONS PCT values are not independent predictors of ICU mortality in COVID-19 patients. Acute immunosuppression significantly reduced PCT values, although not influencing its predictive value.
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Affiliation(s)
- Luigi Zattera
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain - .,Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium -
| | - Ioannis Veliziotis
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Adela Benitez-Cano
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Isabel Ramos
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Leire Larrañaga
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria Nuñez
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lorena Román
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Irina Adalid
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlos Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clinic, Barcelona, Spain.,Institut D'investigació August Pi i Sunyer, Barcelona, Spain
| | - Guido Muñoz
- Department of Anesthesiology and Critical Care, Hospital Clinic, Barcelona, Spain
| | | | - Andrea Minini
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Eva Bassas
- Department of Anesthesiology and Critical Care, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Maria Hernández
- Department of Anesthesiology and Critical Care, Hospital Universitario Cruces, Barakaldo, Spain
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Ramon Adalia
- Department of Anesthesiology and Critical Care, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
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Barros VF, Ramos I. Organizational mindfulness to innovation at an organization in the cork sector. ITP 2022. [DOI: 10.1108/itp-05-2020-0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of the research described in this paper is to provide empirical evidence pointing to IT artifacts' contribution to organizational mindfulness.Design/methodology/approachTo accomplish the specified aim, the authors studied how a leading company in the cork industry uses a platform to support the innovation process's ideation phase. This case study took two and a half years, and the research information was collected in documents, meetings, observations and interviews.FindingsThe study provides empirical evidence pointing to the funneling of collective attention induced by the studied platform. The use of an innovation platform was engaging the collective attention to the incremental innovation of processes to the detriment of products' disruptive innovation.Originality/valueThe authors’ findings contribute to developing an IS mindfulness theory and designing sociotechnical arrangements that expand organizational mindfulness. The analysis of the gathered research information resulted in a first explanation for the impact of using IT artifacts on organizational mindfulness. The resulting framework emerged as a first step in the effort to develop an IS mindfulness theory, paving the way for developing a methodological approach to support CIOs in addressing the challenges of the digital age.
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Garagarza C, Valente A, Caetano C, Ramos I, Sebastião J, Pinto M, Oliveira T, Ferreira A, Guerreiro CS. Do dietary patterns influence survival in hemodialysis patients? Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.344] [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]
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23
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Miranda M, Ramos I, Cerol F. Nutritional risk screening and nutritional intervention in a paediatric service. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.516] [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: 10/19/2022]
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Pereira T, Morgado J, Silva F, Pelter MM, Dias VR, Barros R, Freitas C, Negrão E, Flor de Lima B, Correia da Silva M, Madureira AJ, Ramos I, Hespanhol V, Costa JL, Cunha A, Oliveira HP. Sharing Biomedical Data: Strengthening AI Development in Healthcare. Healthcare (Basel) 2021; 9:healthcare9070827. [PMID: 34208830 PMCID: PMC8303863 DOI: 10.3390/healthcare9070827] [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] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 01/17/2023] Open
Abstract
Artificial intelligence (AI)-based solutions have revolutionized our world, using extensive datasets and computational resources to create automatic tools for complex tasks that, until now, have been performed by humans. Massive data is a fundamental aspect of the most powerful AI-based algorithms. However, for AI-based healthcare solutions, there are several socioeconomic, technical/infrastructural, and most importantly, legal restrictions, which limit the large collection and access of biomedical data, especially medical imaging. To overcome this important limitation, several alternative solutions have been suggested, including transfer learning approaches, generation of artificial data, adoption of blockchain technology, and creation of an infrastructure composed of anonymous and abstract data. However, none of these strategies is currently able to completely solve this challenge. The need to build large datasets that can be used to develop healthcare solutions deserves special attention from the scientific community, clinicians, all the healthcare players, engineers, ethicists, legislators, and society in general. This paper offers an overview of the data limitation in medical predictive models; its impact on the development of healthcare solutions; benefits and barriers of sharing data; and finally, suggests future directions to overcome data limitations in the medical field and enable AI to enhance healthcare. This perspective is dedicated to the technical requirements of the learning models, and it explains the limitation that comes from poor and small datasets in the medical domain and the technical options that try or can solve the problem related to the lack of massive healthcare data.
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Affiliation(s)
- Tania Pereira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
- Correspondence:
| | - Joana Morgado
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
- FCUP—Faculty of Science, University of Porto, 4169-007 Porto, Portugal
| | - Francisco Silva
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
| | - Michele M. Pelter
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Vasco Rosa Dias
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
| | - Rita Barros
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
| | - Cláudia Freitas
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Eduardo Negrão
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Beatriz Flor de Lima
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Miguel Correia da Silva
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - António J. Madureira
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Isabel Ramos
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Venceslau Hespanhol
- CHUSJ—Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - José Luis Costa
- FMUP—Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- i3S—Institute for Research and Innovation in Health of the University of Porto, 4200-135 Porto, Portugal
- IPATIMUP—Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135 Porto, Portugal
| | - António Cunha
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
- UTAD—University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal
| | - Hélder P. Oliveira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal; (J.M.); (F.S.); (V.R.D.); (R.B.); (A.C.); (H.P.O.)
- FCUP—Faculty of Science, University of Porto, 4169-007 Porto, Portugal
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Luque S, Benítez-Cano A, Larrañaga L, Sorlí L, Navarrete ME, Campillo N, Carazo J, Ramos I, Adalia R, Grau S. Pharmacokinetics and Pharmacodynamics of Meropenem by Extended or Continuous Infusion in Low Body Weight Critically Ill Patients. Antibiotics (Basel) 2021; 10:antibiotics10060666. [PMID: 34204943 PMCID: PMC8228202 DOI: 10.3390/antibiotics10060666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Pathophysiological changes such as extreme body weights in critically ill patients with severe infections may alter the pharmacokinetics (PK) of antimicrobials, leading to treatment failure or toxicity. There are almost no PK data on meropenem in critically ill patients with low body weight (LwBW) and therefore information is lacking on the most appropriate dosing regimens, especially when administered by extended infusion. Objectives: To assess if the current administered doses of meropenem could lead to supratherapeutic concentrations in LwBW patients and to identify the factors independently associated with overexposure. Methods: A matched case-control 1:1 study of surgical critically ill patients treated with meropenem administered by extended or continuous infusion and undergoing therapeutic drug monitoring was conducted. Cases (patients with LwBW (body mass index (BMI) < 18.5 kg/m2)) were matched with normal body weight controls (NBW) (patients with BMI ≥ 18.5 kg/m2 and ≤30 kg/m2)) by age, gender, baseline renal function and severity status (APACHE II score). A 100% fT > MIC was considered an optimal pharmacokinetic/pharmacodynamic (PK/PD) target and 100% fT > 10 × MIC as supratherapeutic exposure. Results: Thirty-six patients (18 cases and 18 controls) were included (median (range) age, 57.5 (26–75) years; 20 (55.6% male)). Meropenem was administered by 6 h (extended) or 8 h (continuous) infusion at a median (range) daily dose of 5 (1–6) g/day. Similar median meropenem trough plasma concentrations (Cmin,ss), measured pre-dose on day three to four of treatment) were observed in the two groups (19.9 (22.2) mg/L vs 22.4 (25.8) mg/L, p > 0.999). No differences in the proportion of patients with an optimal or a supratherapeutic PKPD target between cases and controls were observed. A baseline estimated glomerular filtration rate (eGFR) < 90 mL/min was the only factor independently associated with a supratherapeutic PK/PD target. Conclusions: LwBW seems not to be a risk factor for achieving a supratherapeutic PK/PD target in critically ill patients receiving meropenem at standard doses by extended or continuous infusion.
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Affiliation(s)
- Sonia Luque
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autonoma de Barcelona, 08003 Barcelona, Spain; (M.E.N.); (N.C.); (S.G.)
- Correspondence: (S.L.); (A.B.-C.); Tel.: +34-932-483-824 (S.L.); +34-932-483-350 (A.B.-C.)
| | - Adela Benítez-Cano
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), 08003 Barcelona, Spain; (L.L.); (J.C.); (I.R.); (R.A.)
- Correspondence: (S.L.); (A.B.-C.); Tel.: +34-932-483-824 (S.L.); +34-932-483-350 (A.B.-C.)
| | - Leire Larrañaga
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), 08003 Barcelona, Spain; (L.L.); (J.C.); (I.R.); (R.A.)
| | - Luisa Sorlí
- Department of Infectious Diseases, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autonoma de Barcelona, 08003 Barcelona, Spain;
| | - María Eugenia Navarrete
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autonoma de Barcelona, 08003 Barcelona, Spain; (M.E.N.); (N.C.); (S.G.)
| | - Nuria Campillo
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autonoma de Barcelona, 08003 Barcelona, Spain; (M.E.N.); (N.C.); (S.G.)
| | - Jesús Carazo
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), 08003 Barcelona, Spain; (L.L.); (J.C.); (I.R.); (R.A.)
| | - Isabel Ramos
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), 08003 Barcelona, Spain; (L.L.); (J.C.); (I.R.); (R.A.)
| | - Ramón Adalia
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), 08003 Barcelona, Spain; (L.L.); (J.C.); (I.R.); (R.A.)
| | - Santiago Grau
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autonoma de Barcelona, 08003 Barcelona, Spain; (M.E.N.); (N.C.); (S.G.)
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Bijelic L, Ramos I, Goeré D. The Landmark Series: Surgical Treatment of Colorectal Cancer Peritoneal Metastases. Ann Surg Oncol 2021; 28:4140-4150. [PMID: 33969466 DOI: 10.1245/s10434-021-10049-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Peritoneal metastases (PM) are a form of metastatic spread affecting approximately 5-15% of colon cancer patients. The attitude towards management of peritoneal metastases has evolved from therapeutic nihilism towards a more comprehensive and multidisciplinary approach, in large part due to the development of cytoreductive surgery (CRS), usually coupled with heated intraperitoneal chemotherapy (HIPEC), along with the constant improvement of systemic chemotherapy of colorectal cancer. Several landmark studies, including 5 randomized controlled trials have marked the development and refinement of surgical approaches to treating colorectal cancer peritoneal metastases. METHODS This review article focuses on these landmark studies and their influence in 4 key areas: the evidence supporting surgical resection of peritoneal metastases, the identification and standardization of important prognostic variables influencing patient selection, the role of surgery and intraperitoneal chemotherapy in prevention of colorectal PM and the role of intraperitoneal chemotherapy as an adjuvant to surgical resection. RESULTS These landmark studies indicate that surgical resection of colorectal PM should be considered as a therapeutic option in appropriately selected patients and when adequate surgical expertise is available. Standardized prognostic variables including the Peritoneal Cancer Index and the Completeness of Cytoreduction Score should be used for evaluating both indications and outcomes. CONCLUSIONS Current evidence does not support the use of second look surgery with oxaliplatin HIPEC or prophylactic oxaliplatin HIPEC in patients with high risk colon cancer nor the use of oxaliplatin HIPEC with CRS of colorectal PM.
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Affiliation(s)
- Lana Bijelic
- Peritoneal Malignancies Unit, Department of Surgery, Hospital Moises Broggi, Consorci Sanitari Integral, Barcelona, Spain.
| | - Isabel Ramos
- Peritoneal Malignancies Unit, Department of Surgery, Hospital Moises Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Diane Goeré
- Department of Digestive and Oncological Surgery, Hôpital Saint-Louis - APHP, Université de Paris, Paris, France
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de Coo A, Cruz R, Quintela I, Herrera D, Sanz M, Diz P, Rodríguez Grandío S, Vallcorba N, Ramos I, Oteo A, Serrano C, Esmatges A, Enrile F, Mateos L, García R, Álvarez-Novoa P, Noguerol B, Zabalegui I, Blanco-Moreno J, Alonso Á, Lorenzo R, Carracedo A, Blanco J. Genome-wide association study of stage III/IV grade C periodontitis (former aggressive periodontitis) in a Spanish population. J Clin Periodontol 2021; 48:896-906. [PMID: 33745150 DOI: 10.1111/jcpe.13460] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 01/18/2021] [Accepted: 03/09/2021] [Indexed: 12/21/2022]
Abstract
AIM To identify loci associated with stages III/IV, grade C periodontitis (PIII/IV-C) through a genome-wide association study (GWAS). MATERIALS AND METHODS 441 Caucasian Spanish PIII/IV-C cases from the SEPA Network of Research Clinics and 1141 controls from the Banco Nacional de ADN were genotyped with "Axiom Spain Biobank Array," which contains 757836 markers, including rare and low-frequency Spanish variants. The analysis of the individual association and subsequently the gene-level analysis with Sequence Kernel Association Test (SKAT) were carried out adjusting for age, sex and PC1 covariates. Pathway Analysis was additionally performed with Ingenuity Pathway Analysis (IPA) software on the top associated genes. RESULTS In the individual analyses, no genome-wide significant signals were detected. However, 8 SNPs of 8 loci reached suggestive evidence of association with PIII/IV-C, including FAT3 rs35709256, CSNK1G2 rs4807188, MYH13 rs2074872, CNTN2 rs116611488, ANTXR1 rs4854545, 8p23.2 rs78672540, ANGPT1 rs13439823 and PLEC rs11993287 (p < 5 × 10-6 ). SKAT analysis identified other interesting signals at CNTN2, FBXO44, AP1M2, RSPO4, KRI1, BPIFB1 and INMT, although their probability does not exceed the multiple-test correction. IPA indicated significant enrichment of pathways related to cAMP, IL-2, CD28, VDR/RXR and PI3K/Akt. CONCLUSIONS: GWAS found no SNPs significantly associated with PIII/IV-C.
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Affiliation(s)
- Alicia de Coo
- Grupo de Medicina Xenómica, Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Raquel Cruz
- Grupo de Medicina Xenómica, Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,CIBERER-Instituto de Salud Carlos III, Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Inés Quintela
- Grupo de Medicina Xenómica, Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Centro Nacional de Genotipado - Plataforma de Recursos Biomoleculares - Instituto de Salud Carlos III (CeGen-PRB3-ISCIII), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain.,SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Pedro Diz
- Grupo de Investigación en Odontología Médico-Quirúrgica (OMEQUI), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Segundo Rodríguez Grandío
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Nuria Vallcorba
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Isabel Ramos
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Alfonso Oteo
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Cristina Serrano
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Alejandro Esmatges
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Francisco Enrile
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Leopoldo Mateos
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Roberto García
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Pablo Álvarez-Novoa
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Blas Noguerol
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Ion Zabalegui
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - José Blanco-Moreno
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Ángel Alonso
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Ramón Lorenzo
- SEPA Network of Research Clinics (Red de Clínicas de Investigación de la Sociedad Española de Periodoncia y Osteointegración, SEPA), Madrid, Spain
| | - Angel Carracedo
- Grupo de Medicina Xenómica, Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,CIBERER-Instituto de Salud Carlos III, Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Centro Nacional de Genotipado - Plataforma de Recursos Biomoleculares - Instituto de Salud Carlos III (CeGen-PRB3-ISCIII), Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Fundación Pública Galega de Medicina Xenómica- SERGAS, Santiago de Compostela, Spain
| | - Juan Blanco
- Grupo de Investigación en Odontología Médico-Quirúrgica (OMEQUI), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Barrios P, Ramos I, Crusellas O, Sabia D, Mompart S, Bijelic L. Safe Anastomoses without Ostomies in Cytoreductive Surgery with Heated Intraperitoneal Chemotherapy: Technical Considerations and Modifications. Ann Surg Oncol 2021; 28:7784-7792. [PMID: 33852097 DOI: 10.1245/s10434-021-09842-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gastrointestinal complications, predominantly anastomotic leak (AL), are the most frequent source of severe morbidity after cytoreductive surgery (CRS). OBJECTIVE The aim of this study was to present the technical standards for colorectal anastomoses developed and systematically applied to all patients undergoing CRS in a high-volume tertiary center, and the associated AL rates. METHODS This was a descriptive study reporting the technical characteristics of a standardized protocol for three types of colorectal anastomoses (colorectal, ileorectal, and ileocolic) in CRS with heated intraperitoneal chemotherapy (HIPEC), and a retrospective analysis of prospectively collected data on anastomotic outcomes. All patients (1172) undergoing CRS with HIPEC from September 2006 to September 2020 were included. The anastomotic complications were classified according to the International Study Group of Rectal Cancer Surgery (ISGRCS) classification. RESULTS Overall, 1172 patients underwent 1300 procedures and 1359 gastrointestinal anastomoses. An ileocolic anastomosis was performed in 408 patients, colorectal anastomosis in 469 patients, and ileorectal anastomosis in 16 patients, none with diverting ileostomy; 345 other gastrointestinal reconstructions and 82 urinary reconstructions were performed in these patients. The AL rate was 1% (4/408) for the ileocolic anastomosis, 0.85% (4/469) for the colorectal anastomosis, and 0% (0/16) for the ileorectal anastomosis. One patient died postoperatively due to AL. CONCLUSIONS Systematic application of standardized techniques adapted to ensure optimal tissue healing (stapled anastomoses avoiding overlap, accurate staple deployment, and hand-sewn reinforcement) are associated with a very high level of anastomotic safety in a large cohort of patients undergoing CRS and HIPEC.
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Affiliation(s)
- Pedro Barrios
- Peritoneal Malignancies Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Isabel Ramos
- Peritoneal Malignancies Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Oriol Crusellas
- Peritoneal Malignancies Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Domenico Sabia
- Peritoneal Malignancies Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Sergio Mompart
- Colorectal Surgery Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Lana Bijelic
- Peritoneal Malignancies Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain.
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Barrios P, Ramos I, Bijelic L. A Near-Zero Anastomotic Leak Rate in Cytoreductive Surgery with Heated Intraperitoneal Chemotherapy is Achievable. Ann Surg Oncol 2021; 28:7793-7794. [PMID: 33835303 DOI: 10.1245/s10434-021-09956-2] [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: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/18/2022]
Abstract
Gastrointestinal complications are the main source of severe morbidity after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), mainly in the form of anastomotic leak. Reducing the rate of anastomotic leaks is of paramount importance and should be approached both through risk factor understanding and reduction, as well as optimization of surgical team performance. We performed a study that describes the details of a technical protocol for the creation of anastomoses after colorectal resections in CRS and HIPEC and the anastomotic outcomes associated with its systematic application in a high-volume peritoneal surface malignancy center. An extremely low, near-zero anastomotic leak rate (0.85% in colorectal anastomoses, 1% in ileo-colic anastomoses, and 0% in ileo-rectal anastomoses) was observed among 1172 patients. Extremely low, near-zero rates of anastomotic leak after colorectal resections in CRS and HIPEC could be achievable in high-volume peritoneal malignancy centers. The described techniques could be adopted and validated in other high-volume peritoneal malignancy centers.
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Affiliation(s)
- Pedro Barrios
- Peritoneal Malignancies Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Isabel Ramos
- Peritoneal Malignancies Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Lana Bijelic
- Peritoneal Malignancies Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain.
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Ramos I, Figueiredo-Braga M. Microbiome - a (FUTURE) marker for the differential diagnosis for autism spectrum disorder and attention-deficit/hyperactivity disorder? Eur Psychiatry 2021. [PMCID: PMC9528417 DOI: 10.1192/j.eurpsy.2021.546] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The differential diagnosis between Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD) is often challenging and detrimental to early and timely treatment. Co-current and overlapping symptoms contribute to erode differential diagnostic accuracy, based mainly on clinical assessment supported by standardized instruments and reports from parents and teachers. The microbiota was recently considered a valuable resource in the search for biological markers in neurodevelopmental disorders. Objectives Our objective was to examine the published literature in order to clarify the role of the microbiome as a possible differential biomarker between ASD and ADHD. Methods Five hundred and sixteen articles were reviewed in order to contextualize the role of Gut- Brain Axis in neurodevelopment and neurodevelopmental disorders, the microbiome as a biomarker and ultimately to unravel microbiome abnormalities reported in patients diagnosed with ASD and/or ADHD. Results Although gut microbiome appears to be involved in the pathogenesis of ASD with several reports identifying changes in gut populations and functions, a “microbial signature” is still not reached. In ADHD patients, research confirms that the composition and predicted functions of gut microbiome are also altered, but identically controversial results were found. Conclusions Future studies are needed to confirm the relationship between the composition and function of the microbiome and the occurrence or presentation of each of the disorders. A specific signature of the microbiota could then constitute itself as a differential biomarker in ASD and ADHD.
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González-Jartín JM, Rodríguez-Cañás I, Alfonso A, Sainz MJ, Vieytes MR, Gomes A, Ramos I, Botana LM. Multianalyte method for the determination of regulated, emerging and modified mycotoxins in milk: QuEChERS extraction followed by UHPLC-MS/MS analysis. Food Chem 2021; 356:129647. [PMID: 33813202 DOI: 10.1016/j.foodchem.2021.129647] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/18/2022]
Abstract
A simple method for the quantification of 40 mycotoxins in milk was developed. This method is based on a QuEChERS extraction followed by the ultra-high liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) detection, and allows the simultaneous analysis of regulated, emerging, and modified mycotoxins. A sample treatment procedure was optimized to include a concentration step for the analysis of some compounds such as aflatoxin M1. The method was in-house validated in terms of limits of detection (LODs), limits of quantification (LOQs), linearity, recoveries, and precision. LOQs lower than 10 ng/mL were obtained, and recoveries ranged from 61% to 120% with a precision, expressed as the relative standard deviation, lower than 15%. Therefore, acceptable performance characteristics were obtained fulfilling European regulations. The method was successfully applied for the quantification of mycotoxins in raw milk. It can be highlighted high occurrence of beauvericin and enniatins were found in low amounts.
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Affiliation(s)
- Jesús M González-Jartín
- Departamento de Farmacología, Facultad de Veterinaria, Universidade de Santiago de Compostela, 27002 Lugo, Spain.
| | - Inés Rodríguez-Cañás
- Departamento de Farmacología, Facultad de Veterinaria, Universidade de Santiago de Compostela, 27002 Lugo, Spain.
| | - Amparo Alfonso
- Departamento de Farmacología, Facultad de Veterinaria, Universidade de Santiago de Compostela, 27002 Lugo, Spain.
| | - María J Sainz
- Departamento de Producción Vegetal y Proyectos de Ingeniería, Facultad de Veterinaria, Universidade de Santiago de Compostela, 27002 Lugo, Spain.
| | - Mercedes R Vieytes
- Departamento de Fisiología, Facultad de Veterinaria, Universidade de Santiago de Compostela, 27002 Lugo, Spain.
| | - Ana Gomes
- Cooperativa Agrícola de Vila do Conde, R. da Lapa 293, 4480-848 Vila do Conde, Portugal.
| | - Isabel Ramos
- Cooperativa Agrícola de Vila do Conde, R. da Lapa 293, 4480-848 Vila do Conde, Portugal.
| | - Luis M Botana
- Departamento de Farmacología, Facultad de Veterinaria, Universidade de Santiago de Compostela, 27002 Lugo, Spain.
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Pedrosa J, Aresta G, Ferreira C, Atwal G, Phoulady HA, Chen X, Chen R, Li J, Wang L, Galdran A, Bouchachia H, Kaluva KC, Vaidhya K, Chunduru A, Tarai S, Nadimpalli SPP, Vaidya S, Kim I, Rassadin A, Tian Z, Sun Z, Jia Y, Men X, Ramos I, Cunha A, Campilho A. LNDb challenge on automatic lung cancer patient management. Med Image Anal 2021; 70:102027. [PMID: 33740739 DOI: 10.1016/j.media.2021.102027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/18/2021] [Accepted: 02/26/2021] [Indexed: 12/21/2022]
Abstract
Lung cancer is the deadliest type of cancer worldwide and late detection is the major factor for the low survival rate of patients. Low dose computed tomography has been suggested as a potential screening tool but manual screening is costly and time-consuming. This has fuelled the development of automatic methods for the detection, segmentation and characterisation of pulmonary nodules. In spite of promising results, the application of automatic methods to clinical routine is not straightforward and only a limited number of studies have addressed the problem in a holistic way. With the goal of advancing the state of the art, the Lung Nodule Database (LNDb) Challenge on automatic lung cancer patient management was organized. The LNDb Challenge addressed lung nodule detection, segmentation and characterization as well as prediction of patient follow-up according to the 2017 Fleischner society pulmonary nodule guidelines. 294 CT scans were thus collected retrospectively at the Centro Hospitalar e Universitrio de So Joo in Porto, Portugal and each CT was annotated by at least one radiologist. Annotations comprised nodule centroids, segmentations and subjective characterization. 58 CTs and the corresponding annotations were withheld as a separate test set. A total of 947 users registered for the challenge and 11 successful submissions for at least one of the sub-challenges were received. For patient follow-up prediction, a maximum quadratic weighted Cohen's kappa of 0.580 was obtained. In terms of nodule detection, a sensitivity below 0.4 (and 0.7) at 1 false positive per scan was obtained for nodules identified by at least one (and two) radiologist(s). For nodule segmentation, a maximum Jaccard score of 0.567 was obtained, surpassing the interobserver variability. In terms of nodule texture characterization, a maximum quadratic weighted Cohen's kappa of 0.733 was obtained, with part solid nodules being particularly challenging to classify correctly. Detailed analysis of the proposed methods and the differences in performance allow to identify the major challenges remaining and future directions - data collection, augmentation/generation and evaluation of under-represented classes, the incorporation of scan-level information for better decision-making and the development of tools and challenges with clinical-oriented goals. The LNDb Challenge and associated data remain publicly available so that future methods can be tested and benchmarked, promoting the development of new algorithms in lung cancer medical image analysis and patient follow-up recommendation.
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Affiliation(s)
- João Pedrosa
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal.
| | - Guilherme Aresta
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal; Faculty of Engineering of the University of Porto (FEUP), Porto, Portugal
| | - Carlos Ferreira
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal; Faculty of Engineering of the University of Porto (FEUP), Porto, Portugal
| | - Gurraj Atwal
- Department of Computer Science, California State University, Sacramento, USA
| | | | - Xiaoyu Chen
- Department of Computer Science, School of Informatics, Xiamen University, China
| | - Rongzhen Chen
- Department of Computer Science, School of Informatics, Xiamen University, China
| | - Jiaoliang Li
- Department of Computer Science, School of Informatics, Xiamen University, China
| | - Liansheng Wang
- Department of Computer Science, School of Informatics, Xiamen University, China
| | - Adrian Galdran
- Department of Computing and Informatics, Bournemouth University, UK
| | - Hamid Bouchachia
- Department of Computing and Informatics, Bournemouth University, UK
| | | | | | | | | | | | | | - Ildoo Kim
- Kakao Brain, Seongnam-si, South Korea
| | | | - Zhenhuan Tian
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | | | - Yizhuan Jia
- Mediclouds Medical Technology, Beijing, China
| | - Xuejun Men
- Mediclouds Medical Technology, Beijing, China
| | - Isabel Ramos
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal; Department of Radiology, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - António Cunha
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal; University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Aurélio Campilho
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal; Faculty of Engineering of the University of Porto (FEUP), Porto, Portugal
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Bijelic L, Ramos I, Sabia D, Crusellas O, Martin M, Barrios P. Defining optimal selection criteria to improve prognosis and avoid futility in surgical resection of colorectal peritoneal metastases. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.36] [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: 11/20/2022] Open
Abstract
36 Background: Surgical resection of peritoneal metastases of colorectal cancer (CRC PM) may benefit some patients similar to hepatic metastases. This approach remains controversial in part due to inconsistent selection criteria and reported outcomes. The impact of preoperative clinical characteristics and tumor molecular profiles on survival among surgically treated patients is incompletely understood. The aim of this study was to investigate the relationship between possible predictive variables and survival in a large cohort of patients treated on a standardized clinical pathway and to develop a clinically useful patient selection tool. Methods: This retrospective cohort study utilized the database of the Catalonian peritoneal metastases regional program, established in 2006. The program provides treatment for all PM patients within an autonomous region with a population of 7.5 million and includes a single dedicated high volume surgical unit. We included all adult patients with surgically resected CRC PM. The clinical pathway includes the administration of perioperative (neoadjuvant and adjuvant) systemic chemotherapy and has historically included a dose of heated intraoperative intraperitoneal chemotherapy (HIPEC) at the time of surgery. Demographic and clinical data was analyzed with descriptive statistics. Survival and the associated predictors were analyzed with the Cox proportional hazard model with HRs used to create a predictive nomogram. Results: A total of 538 patients (mean age 59) have been treated with surgery and a complete resection (CC0) was achieved in 94% of cases. Planned preoperative systemic chemotherapy was delivered in 95% of cases, consistent with the clinical pathway. Surgical morbidity was low (urgent reoperation 6.1%, postoperative return to the ICU 2.4%, 30-day readmission 4.3%) as was 30-day mortality (0.4%). After a median follow up of 27.5 months, the median overall survival (OS) was 43.1 months. It varied considerably by subgroup: patients with low peritoneal tumor burden had the highest OS (median 49 months) and those with signet ring cell subtype the lowest (median 19 months). Factors independently associated with survival were: N stage at diagnosis, histological subtype, quantified peritoneal tumor burden (PCI score) and presence of visceral involvement. A selection tool and predictive nomogram were designed incorporating the results of the multivariable analysis. Conclusions: A set of clinical variables can be identified that independently influences patient survival after surgical resection of CRC PM that should be used as selection criteria when considering surgery. With optimized patient selection and treatment within a specialized center, excellent survival and low morbidity can be anticipated following surgery for CRC PM.
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Affiliation(s)
- Lana Bijelic
- Department of Oncological Surgery, Hospital Sant Joan Despí, Moises Broggi, Catalonian Regional Peritoneal Surface Malignancy Program, Barcelona, Spain
| | - Isabel Ramos
- Hospital Moises Broggi, Catalonian Regional Peritoneal Surface Malignancy Program, Barcelona, Spain
| | - Domenico Sabia
- Hospital Moises Broggi, Catalonian Regional Peritoneal Surface Malignancy Program, Barcelona, Spain
| | - Oriol Crusellas
- Hospital Moises Broggi, Catalonian Regional Peritoneal Surface Malignancy Program, Barcelona, Spain
| | - Montse Martin
- Department of Epidemiology, Hospital Sant Joan Despi Moises Broggi, Barcelona, Spain
| | - Pedro Barrios
- Department of Oncological Surgery, Hospital Sant Joan Despí, Moises Broggi, Catalonian Regional Peritoneal Surface Malignancy Program, Barcelona, Spain
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Pereira T, Freitas C, Costa JL, Morgado J, Silva F, Negrão E, de Lima BF, da Silva MC, Madureira AJ, Ramos I, Hespanhol V, Cunha A, Oliveira HP. Comprehensive Perspective for Lung Cancer Characterisation Based on AI Solutions Using CT Images. J Clin Med 2020; 10:E118. [PMID: 33396348 PMCID: PMC7796087 DOI: 10.3390/jcm10010118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 12/16/2022] Open
Abstract
Lung cancer is still the leading cause of cancer death in the world. For this reason, novel approaches for early and more accurate diagnosis are needed. Computer-aided decision (CAD) can be an interesting option for a noninvasive tumour characterisation based on thoracic computed tomography (CT) image analysis. Until now, radiomics have been focused on tumour features analysis, and have not considered the information on other lung structures that can have relevant features for tumour genotype classification, especially for epidermal growth factor receptor (EGFR), which is the mutation with the most successful targeted therapies. With this perspective paper, we aim to explore a comprehensive analysis of the need to combine the information from tumours with other lung structures for the next generation of CADs, which could create a high impact on targeted therapies and personalised medicine. The forthcoming artificial intelligence (AI)-based approaches for lung cancer assessment should be able to make a holistic analysis, capturing information from pathological processes involved in cancer development. The powerful and interpretable AI models allow us to identify novel biomarkers of cancer development, contributing to new insights about the pathological processes, and making a more accurate diagnosis to help in the treatment plan selection.
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Affiliation(s)
- Tania Pereira
- Institute for Systems and Computer Engineering, Technology and Science, INESC TEC, 4200-465 Porto, Portugal; (J.M.); (F.S.); (A.C.); (H.P.O.)
| | - Cláudia Freitas
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- Faculty of Medicine, University of Porto, FMUP, 4200-319 Porto, Portugal;
| | - José Luis Costa
- Faculty of Medicine, University of Porto, FMUP, 4200-319 Porto, Portugal;
- Institute for Research and Innovation in Health of the University of Porto, i3S, 4200-135 Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto, IPATIMUP, 4200-135 Porto, Portugal
| | - Joana Morgado
- Institute for Systems and Computer Engineering, Technology and Science, INESC TEC, 4200-465 Porto, Portugal; (J.M.); (F.S.); (A.C.); (H.P.O.)
- Faculty of Science, University of Porto, FCUP, 4169-007 Porto, Portugal
| | - Francisco Silva
- Institute for Systems and Computer Engineering, Technology and Science, INESC TEC, 4200-465 Porto, Portugal; (J.M.); (F.S.); (A.C.); (H.P.O.)
| | - Eduardo Negrão
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Beatriz Flor de Lima
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Miguel Correia da Silva
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - António J. Madureira
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
| | - Isabel Ramos
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- Faculty of Medicine, University of Porto, FMUP, 4200-319 Porto, Portugal;
| | - Venceslau Hespanhol
- Centro Hospitalar e Universitário de São João, CHUSJ, 4200-319 Porto, Portugal; (C.F.); (E.N.); (B.F.d.L.); (M.C.d.S.); (A.J.M.); (I.R.); (V.H.)
- Faculty of Medicine, University of Porto, FMUP, 4200-319 Porto, Portugal;
| | - António Cunha
- Institute for Systems and Computer Engineering, Technology and Science, INESC TEC, 4200-465 Porto, Portugal; (J.M.); (F.S.); (A.C.); (H.P.O.)
- Department of Engineering, University of Trás-os-Montes and Alto Douro, UTAD, 5001-801 Vila Real, Portugal
| | - Hélder P. Oliveira
- Institute for Systems and Computer Engineering, Technology and Science, INESC TEC, 4200-465 Porto, Portugal; (J.M.); (F.S.); (A.C.); (H.P.O.)
- Faculty of Science, University of Porto, FCUP, 4169-007 Porto, Portugal
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Moreira IC, Ventura SR, Ramos I, Fougo JL, Rodrigues PP. Preoperative localisation techniques in breast conservative surgery: A systematic review and meta-analysis. Surg Oncol 2020; 35:351-373. [DOI: 10.1016/j.suronc.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 01/20/2023]
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Ponting C, Chavira DA, Ramos I, Christensen W, Guardino C, Schetter CD. Postpartum depressive symptoms in low-income Latinas: Cultural and contextual contributors. Cultur Divers Ethnic Minor Psychol 2020; 26:544-556. [PMID: 32105108 PMCID: PMC7483184 DOI: 10.1037/cdp0000325] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Using a conceptual model of postpartum depression risk in Latinas including both contextual and cultural stressors, we tested contributions to depressive symptom levels and trajectories over the course of 1 year following birth in a community sample of Latinas. METHOD A multisite sample of low-income U.S.-born and foreign-born Latinas (n = 537; M age = 25.70) was interviewed on many topics including measures of stress and maternal health at 1, 6, and 12 months postpartum. Nested multilevel growth curve models were implemented to test associations of contextual stressors (poverty, domestic violence) with trajectories of depressive symptoms, adjusting for confounds. This model was compared to 1 that added cultural stress variables (everyday discrimination, foreign-born status, language preference, age at immigration) measured 1-month postpartum. RESULTS The best fitting model provided evidence for the independent effects of cultural and contextual stressors. Discrimination (β = .13 SE = .02, p = < .001) and domestic violence (β = .39 SE = .09, p = < .001) predicted trajectories with higher levels of depressive symptoms 1 month postpartum, but not linear change in symptoms over the year. CONCLUSIONS The present study provides evidence that discrimination, a cultural factor, and domestic violence, a contextual factor, each predict higher levels of early postpartum depressive symptoms. Interventions addressing discrimination and maternal safety are recommended. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Carolyn Ponting
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
| | - Denise A. Chavira
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
| | - Isabel Ramos
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
| | - Wendy Christensen
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
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Benítez-Cano A, de Antonio-Cuscó M, Luque S, Sorlí L, Carazo J, Ramos I, Bermejo S, Campillo N, Horcajada JP, Samsó E, Grau S. Systemic pharmacokinetics and safety of high doses of nebulized colistimethate sodium in critically ill patients with hospital-acquired and ventilator-associated pneumonia. J Antimicrob Chemother 2020; 74:3268-3273. [PMID: 31495877 DOI: 10.1093/jac/dkz356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the pharmacokinetics of formed colistin in plasma and the safety of two different high doses of colistimethate sodium administered via nebulization in critically ill surgical patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). PATIENTS AND METHODS Formed colistin plasma concentrations were measured in critically ill surgical patients with pneumonia treated with two different doses of nebulized colistimethate sodium (3 MIU/8 h versus 5 MIU/8 h). Adverse events possibly related to nebulized colistimethate sodium were recorded. RESULTS Twenty-seven patients (15 in the 3 MIU/8 h group and 12 in the 5 MIU/8 h group) were included. Colistin plasma concentrations were unquantifiable (<0.1 mg/L) in eight (53.3%) patients in the 3 MIU/8 h group and in seven patients (58.3%) in the 5 MIU/8 h group. Median (IQR) quantifiable colistin plasma concentrations before nebulization and at 1, 4 and 8 h were 0.17 (0.12-0.33), 0.20 (0.11-0.24), 0.17 (0.12-0.23) and 0.17 (0.11-0.32) mg/L, respectively, in the 3 MIU/8 h group and 0.20 (0.11-0.35), 0.24 (0.12-0.44), 0.24 (0.10-0.49) and 0.23 (0.11-0.44) mg/L, respectively, in the 5 MIU/8 h group, with no differences between the two groups at any time. Renal impairment during nebulized treatment was observed in three patients in each group, but was unlikely to be related to colistimethate sodium treatment. Nebulized colistimethate sodium therapy was well tolerated and no bronchospasms or neurotoxicity events were observed. CONCLUSIONS In this limited observational case series of critically ill patients with HAP or VAP treated with high doses of nebulized colistimethate sodium, systemic exposure was minimal and the treatment was well tolerated.
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Affiliation(s)
- Adela Benítez-Cano
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Marta de Antonio-Cuscó
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Sonia Luque
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autònoma de Barcelona, Paseo Marítimo 25-29, Barcelona, Spain
| | - Luisa Sorlí
- Department of Infectious Diseases, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autònoma de Barcelona, Paseo Marítimo 25-29, Barcelona, Spain
| | - Jesús Carazo
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Isabel Ramos
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Silvia Bermejo
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Nuria Campillo
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Juan P Horcajada
- Department of Infectious Diseases, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autònoma de Barcelona, Paseo Marítimo 25-29, Barcelona, Spain
| | - Enric Samsó
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Pompeu Fabra, Paseo Marítimo 25-29, Barcelona, Spain
| | - Santiago Grau
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autònoma de Barcelona, Paseo Marítimo 25-29, Barcelona, Spain
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Jacob M, Romano J, Araújo D, Pereira JM, Ramos I, Hespanhol V. Predicting lung nodules malignancy. Pulmonology 2020; 28:454-460. [PMID: 32739327 DOI: 10.1016/j.pulmoe.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/24/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is critical to developing an accurate method for differentiating between malignant and benign solitary pulmonary nodules. This study aimed was to establish a predicting model of lung nodules malignancy in a real-world setting. METHODS The authors retrospectively analysed the clinical and computed tomography (CT) data of 121 patients with lung nodules, submitted to percutaneous CT-guided transthoracic biopsy, between 2014 and 2015. Multiple logistic regression was used to screen independent predictors for malignancy and to establish a clinical prediction model to evaluate the probability of malignancy. RESULTS From a total of 121 patients, 75 (62%) were men and with a mean age of 64.7 years old. Multivariate logistic regression analysis identified six independent predictors of malignancy: age, gender, smoking status, current extra-pulmonary cancer, air bronchogram and nodule size (p<0.05). The area under the curve (AUC) was 0.8573. CONCLUSIONS The prediction model established in this study can be used to assess the probability of malignancy in the Portuguese population, thereby providing help for the diagnosis of lung nodules and the selection of follow-up interventions.
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Affiliation(s)
- M Jacob
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - J Romano
- Physical Medicine and Rehabilitation Department, Unidade de Saúde Local de Matosinhos, Porto, Portugal
| | - D Araújo
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - J M Pereira
- Radiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
| | - I Ramos
- Radiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
| | - V Hespanhol
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
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Aresta G, Ferreira C, Pedrosa J, Araujo T, Rebelo J, Negrao E, Morgado M, Alves F, Cunha A, Ramos I, Campilho A. Automatic Lung Nodule Detection Combined With Gaze Information Improves Radiologists' Screening Performance. IEEE J Biomed Health Inform 2020; 24:2894-2901. [PMID: 32092022 DOI: 10.1109/jbhi.2020.2976150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Early diagnosis of lung cancer via computed tomography can significantly reduce the morbidity and mortality rates associated with the pathology. However, searching lung nodules is a high complexity task, which affects the success of screening programs. Whilst computer-aided detection systems can be used as second observers, they may bias radiologists and introduce significant time overheads. With this in mind, this study assesses the potential of using gaze information for integrating automatic detection systems in the clinical practice. For that purpose, 4 radiologists were asked to annotate 20 scans from a public dataset while being monitored by an eye tracker device, and an automatic lung nodule detection system was developed. Our results show that radiologists follow a similar search routine and tend to have lower fixation periods in regions where finding errors occur. The overall detection sensitivity of the specialists was 0.67±0.07, whereas the system achieved 0.69. Combining the annotations of one radiologist with the automatic system significantly improves the detection performance to similar levels of two annotators. Filtering automatic detection candidates only for low fixation regions still significantly improves the detection sensitivity without increasing the number of false-positives.
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de Melo Carvalho R, Nunes AL, Sa R, Ramos I, Valente C, Saraiva da Cunha J. Mycobacterium chimaera Disseminated Infection. J Med Cases 2020; 11:35-36. [PMID: 34434356 PMCID: PMC8383628 DOI: 10.14740/jmc3420] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
The incidence and prevalence of nontuberculous mycobacterial disease is increasing due to enhanced clinician awareness and improved detection methods. The species identification using molecular microbiology techniques allows a better understanding of the differences in pathogenicity and treatment response. A 57-year-old man with a history of B-cell lymphoma in remission was transferred from the hematology department due to fever of unknown origin, night sweats and asthenia. The empirical antibiotic therapy was initiated with no clinical response, and he developed a subacute pneumonia, severe anemia and hepatosplenomegaly. After positive blood, bronchoalveolar lavage and bone marrow cultures, a disseminated Mycobacterium avium-intracellulare complex infection was diagnosed, and the patient began treatment with clarithromycin, rifabutin and ethambutol. Two weeks later, a fourth antibiotic was added, amikacin at first and then linezolid, with slow but gradual improvement. Due to amikacin-related severe kidney injury and linezolid-related severe myelosuppression, the fourth antibiotic was changed to moxifloxacin, which the patient tolerated. After 6 months of therapy, the sensitivity to the regimen was confirmed and the species was identified as Mycobacterium chimaera (MC), using the molecular genetic test GenoType NTM-DR. The blood and tissue cultures were negative after 4 months of therapy, and treatment was continued for 12 months. Although the infection was being treated successfully, the patient’s B-cell lymphoma relapsed after 12 months and the patient died. This is a case report of a confirmed severe and disseminated MC infection in an immunocompromised patient using a molecular genetic test, successfully treated using a four-drug regimen.
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Affiliation(s)
- Ruben de Melo Carvalho
- Servico de Doencas Infeciosas do Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - Ana Luisa Nunes
- Servico de Medicina Interna do Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - Rosa Sa
- Servico de Doencas Infeciosas do Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - Isabel Ramos
- Servico de Doencas Infeciosas do Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - Cristina Valente
- Servico de Doencas Infeciosas do Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - Jose Saraiva da Cunha
- Servico de Doencas Infeciosas do Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
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Bernardes M, Madureira A, Oliveira A, Martins MJ, Lucas R, Costa L, Pereira JG, Ventura F, Ramos I, Martins E. Coronary artery calcium score in female rheumatoid arthritis patients: Associations with apolipoproteins and disease biomarkers. Int J Rheum Dis 2019; 22:1841-1856. [DOI: 10.1111/1756-185x.13685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 06/02/2019] [Accepted: 08/05/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Miguel Bernardes
- Department of Rheumatology São João Hospital Center Porto Portugal
- Department of Medicine, Faculty of Medicine University of Porto Porto Portugal
| | - António Madureira
- Department of Medicine, Faculty of Medicine University of Porto Porto Portugal
- Department of Radiology São João Hospital Center Porto Portugal
| | - Ana Oliveira
- Department of Nuclear Medicine São João Hospital Center Porto Portugal
| | - Maria João Martins
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina Universidade do Porto Porto Portugal
- Instituto de Investigação e Inovação em Saúde (i3s) Universidade do Porto Porto Portugal
| | - Raquel Lucas
- EPI Unit‐Institute of Public Health University of Porto Porto Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine University of Porto Porto Portugal
| | - Lúcia Costa
- Department of Rheumatology São João Hospital Center Porto Portugal
| | - Jorge G. Pereira
- Department of Nuclear Medicine São João Hospital Center Porto Portugal
| | | | - Isabel Ramos
- Department of Medicine, Faculty of Medicine University of Porto Porto Portugal
- Department of Radiology São João Hospital Center Porto Portugal
| | - Elisabete Martins
- Department of Medicine, Faculty of Medicine University of Porto Porto Portugal
- Instituto de Investigação e Inovação em Saúde (i3s) Universidade do Porto Porto Portugal
- Department of Cardiology São João Hospital Center Porto Portugal
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Aresta G, Jacobs C, Araújo T, Cunha A, Ramos I, van Ginneken B, Campilho A. iW-Net: an automatic and minimalistic interactive lung nodule segmentation deep network. Sci Rep 2019; 9:11591. [PMID: 31406194 PMCID: PMC6690893 DOI: 10.1038/s41598-019-48004-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 01/02/2019] [Accepted: 06/28/2019] [Indexed: 11/09/2022] Open
Abstract
We propose iW-Net, a deep learning model that allows for both automatic and interactive segmentation of lung nodules in computed tomography images. iW-Net is composed of two blocks: the first one provides an automatic segmentation and the second one allows to correct it by analyzing 2 points introduced by the user in the nodule’s boundary. For this purpose, a physics inspired weight map that takes the user input into account is proposed, which is used both as a feature map and in the system’s loss function. Our approach is extensively evaluated on the public LIDC-IDRI dataset, where we achieve a state-of-the-art performance of 0.55 intersection over union vs the 0.59 inter-observer agreement. Also, we show that iW-Net allows to correct the segmentation of small nodules, essential for proper patient referral decision, as well as improve the segmentation of the challenging non-solid nodules and thus may be an important tool for increasing the early diagnosis of lung cancer.
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Affiliation(s)
- Guilherme Aresta
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal. .,Faculty of Engineering of University of Porto, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal.
| | - Colin Jacobs
- Radboud University Medical Center, 6525, Nijmegen, The Netherlands
| | - Teresa Araújo
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal.,Faculty of Engineering of University of Porto, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal
| | - António Cunha
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal.,University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5001-801, Vila Real, Portugal
| | - Isabel Ramos
- Faculty of Medicine of University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | | | - Aurélio Campilho
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal.,Faculty of Engineering of University of Porto, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal
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Felipe-Medina N, Gómez-H L, Condezo YB, Sanchez-Martín M, Barbero JL, Ramos I, Llano E, Pendás AM. Ubiquitin-specific protease 26 (USP26) is not essential for mouse gametogenesis and fertility. Chromosoma 2019; 128:237-247. [PMID: 30887115 DOI: 10.1007/s00412-019-00697-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/18/2019] [Accepted: 02/22/2019] [Indexed: 12/19/2022]
Abstract
Ubiquitin-specific protease 26 (USP26) is a deubiquitylating enzyme belonging to the USPs family with a transcription pattern restricted to the male germline. Since protein ubiquitination is an essential regulatory mechanism during meiosis, many efforts have been focused on elucidating the function of USP26 and its relationship with fertility. During the last decade, several studies have reported the presence of different polymorphisms in USP26 in patients with non-obstructive azoospermia (NOA) or severe oligozoospermia suggesting that this gene may be associated with human infertility. However, other studies have revealed the presence of these and novel polymorphisms, including nonsense mutations, in men with normal spermatogenesis as well. Thus, the results remain controversial and its function is unknown. In the present study, we describe the in vivo functional analysis of mice lacking USP26. The phenotypic analysis of two different Usp26-null mutants showed no overt-phenotype with both males and females being fertile. Cytological analysis of spermatocytes showed no defects in synapsis, chromosome dynamics, DNA repair, or recombination. Histopathological analysis revealed a normal distribution and number of the different cell types in both male and female mice. Finally, normal counts were observed in fertility assessments. These results represent the first in vivo evidence showing that USP26 is not essential for mouse gametogenesis.
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Affiliation(s)
- Natalia Felipe-Medina
- Molecular Mechanisms Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (CSIC-Universidad de Salamanca), 37007, Salamanca, Spain
| | - Laura Gómez-H
- Molecular Mechanisms Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (CSIC-Universidad de Salamanca), 37007, Salamanca, Spain
| | - Yazmine B Condezo
- Molecular Mechanisms Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (CSIC-Universidad de Salamanca), 37007, Salamanca, Spain
| | - Manuel Sanchez-Martín
- Departamento de Medicina, Universidad de Salamanca, Salamanca, 37007, Spain
- Transgenic Facility, Nucleus platform, Universidad de Salamanca, Salamanca, 37007, Spain
| | - José Luis Barbero
- Departamento de Biología Celular y Molecular, Centro de Investigaciones Biológicas (CSIC), Madrid, 28040, Spain
| | - Isabel Ramos
- Molecular Mechanisms Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (CSIC-Universidad de Salamanca), 37007, Salamanca, Spain
| | - Elena Llano
- Molecular Mechanisms Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (CSIC-Universidad de Salamanca), 37007, Salamanca, Spain
- Departamento de Fisiología y Farmacología, Universidad de Salamanca, Salamanca, 37007, Spain
| | - Alberto M Pendás
- Molecular Mechanisms Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (CSIC-Universidad de Salamanca), 37007, Salamanca, Spain.
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Sánchez-Fdez A, Ortiz-Ruiz MJ, Re-Louhau MF, Ramos I, Blanco-Múñez Ó, Ludeña D, Abad M, Sánchez-Martín M, Pandiella A, Esparís-Ogando A. MEK5 promotes lung adenocarcinoma. Eur Respir J 2019; 53:13993003.01327-2018. [PMID: 30442718 PMCID: PMC6393765 DOI: 10.1183/13993003.01327-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/16/2018] [Accepted: 11/05/2018] [Indexed: 11/05/2022]
Abstract
Lung cancer represents the leading cause of cancer death worldwide [1]. Because of that, intense efforts are being devoted to the development of novel therapeutic strategies to fight the disease [2]. In this respect, identification of new oncogenic drivers offers therapeutic opportunities in tumours in which those molecules or other cooperating elements play a pathophysiological role. Here, we show that the MEK5 mitogen-activated protein kinase kinase has a pivotal role in lung cancer. MEK5 acts as an oncogenic driver in mice lung cancer and is pivotal for human lung adenocarcinomahttp://ow.ly/M9e830mZb8N
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Affiliation(s)
- Adrián Sánchez-Fdez
- Instituto de Biología Molecular y Celular del Cáncer-CSIC, Salamanca, Spain.,IBSAL, Salamanca, Spain.,CIBERONC, Salamanca, Spain
| | - María Jesús Ortiz-Ruiz
- Instituto de Biología Molecular y Celular del Cáncer-CSIC, Salamanca, Spain.,IBSAL, Salamanca, Spain
| | - María Florencia Re-Louhau
- Instituto de Biología Molecular y Celular del Cáncer-CSIC, Salamanca, Spain.,IBSAL, Salamanca, Spain
| | - Isabel Ramos
- Instituto de Biología Molecular y Celular del Cáncer-CSIC, Salamanca, Spain
| | - Óscar Blanco-Múñez
- IBSAL, Salamanca, Spain.,Pathology Service, University Hospital, Salamanca, Spain
| | - Dolores Ludeña
- IBSAL, Salamanca, Spain.,Pathology Service, University Hospital, Salamanca, Spain
| | - Mar Abad
- IBSAL, Salamanca, Spain.,Pathology Service, University Hospital, Salamanca, Spain
| | - Manuel Sánchez-Martín
- CIBERONC, Salamanca, Spain.,Transgenic Facility of the Nucleus Platform, University of Salamanca, Salamanca, Spain
| | - Atanasio Pandiella
- Instituto de Biología Molecular y Celular del Cáncer-CSIC, Salamanca, Spain.,IBSAL, Salamanca, Spain.,CIBERONC, Salamanca, Spain
| | - Azucena Esparís-Ogando
- Instituto de Biología Molecular y Celular del Cáncer-CSIC, Salamanca, Spain.,IBSAL, Salamanca, Spain.,CIBERONC, Salamanca, Spain
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Zugazagoitia J, Ramos I, Trigo JM, Palka M, Gómez-Rueda A, Jantus-Lewintre E, Camps C, Isla D, Iranzo P, Ponce-Aix S, García-Campelo R, Provencio M, Franco F, Bernabé R, Juan-Vidal O, Felip E, de Castro J, Sanchez-Torres JM, Faul I, Lanman RB, Garrido P, Paz-Ares L. Clinical utility of plasma-based digital next-generation sequencing in patients with advance-stage lung adenocarcinomas with insufficient tumor samples for tissue genotyping. Ann Oncol 2019; 30:290-296. [PMID: 30535340 DOI: 10.1093/annonc/mdy512] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Approximately 30% of tumor biopsies from patients with advanced-stage lung adenocarcinomas yield insufficient tissue for successful molecular subtyping. We have analyzed the clinical utility of next-generation sequencing (NGS) of cell-free circulating tumor DNA (ctDNA) in patients with inadequate tumor samples for tissue genotyping. PATIENTS AND METHODS We conducted the study in a multi-institutional prospective cohort of clinically unselected patients with advanced-stage lung adenocarcinomas with insufficient tissue for EGFR, ALK or ROS1 genotyping across 12 Spanish institutions (n = 93). ctDNA NGS was carried out by Guardant Health (Guardant360, Redwood City, CA), using a hybrid-capture-based 73-gene panel. Variants were deemed actionable if they were part of the OncoKB precision oncology knowledge database and classified in four levels of actionability based on their clinical or preclinical evidence for drug response. RESULTS Eighty-three out of 93 patients (89%) had detectable levels of ctDNA. Potentially actionable level 1-4 genomic alterations were detected in 53 cases (57%), of which 13 (14%) had level 1-2A alterations (Food and Drug Administration-approved and standard-care biomarkers according to lung cancer guidelines). Frequencies of each genomic alteration in ctDNA were consistent with those observed in unselected pulmonary adenocarcinomas. The majority of the patients (62%), particularly those with actionable alterations (87%), had more than one pathogenic variant in ctDNA. The median turnaround time to genomic results was 13 days. Twelve patients (13%) received genotype-matched therapies based on ctDNA results, deriving the expected clinical benefit. Patients with co-occurring pathogenic alterations had a significantly shorter median overall survival as compared with patients without co-occurring pathogenic alteration (multivariate hazard ratio = 5.35, P = 0.01). CONCLUSION Digital NGS of ctDNA in lung cancers with insufficient tumor samples for tissue sequencing detects actionable variants that frequently co-occur with other potentially clinically relevant genomic alterations, allowing timely initiation of genotype-matched therapies.
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Affiliation(s)
- J Zugazagoitia
- Medical Oncology Department, Hospital Universitario 12 de Octubre and i+12 Research Institute, Madrid, Spain; Lung Cancer Group, Clinical Research Program, Spanish National Cancer Research Center (CNIO), Madrid, Spain; CIBERONC, Madrid, Spain
| | - I Ramos
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J M Trigo
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - M Palka
- Medical Oncology Department, IRYCIS Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Gómez-Rueda
- Medical Oncology Department, IRYCIS Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Jantus-Lewintre
- CIBERONC, Madrid, Spain; Molecular Oncology Laboratory, Fundación para la Investigación del Hospital General Universitario de Valencia, Valencia, Spain; Biotechnology Department, Universitat Politècnica de València, Valencia, Spain
| | - C Camps
- CIBERONC, Madrid, Spain; Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain; Medicine Department, Universidad de Valencia, Valencia, Spain
| | - D Isla
- Medical Oncology Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - P Iranzo
- Medical Oncology Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - S Ponce-Aix
- Medical Oncology Department, Hospital Universitario 12 de Octubre and i+12 Research Institute, Madrid, Spain; Lung Cancer Group, Clinical Research Program, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - R García-Campelo
- Medical Oncology Department, Hospital Universitario Da Coruña, A Coruña, Spain
| | - M Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - F Franco
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - R Bernabé
- Medical Oncology Department, Hospital Universitario Vírgen del Rocío, Sevilla, Spain
| | - O Juan-Vidal
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - E Felip
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J de Castro
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - J M Sanchez-Torres
- Medical Oncology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - I Faul
- Medical Affairs, Guardant Health, Barcelona, Spain
| | - R B Lanman
- Medical Affairs, Guardant Health, Redwood City, USA
| | - P Garrido
- CIBERONC, Madrid, Spain; Medical Oncology Department, IRYCIS Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - L Paz-Ares
- Medical Oncology Department, Hospital Universitario 12 de Octubre and i+12 Research Institute, Madrid, Spain; Lung Cancer Group, Clinical Research Program, Spanish National Cancer Research Center (CNIO), Madrid, Spain; CIBERONC, Madrid, Spain; Complutense University, Madrid, Spain.
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Moreira IC, Ramos I, Rua Ventura S, Pereira Rodrigues P. Learner’s perception, knowledge and behaviour assessment within a breast imaging E-Learning course for radiographers. Eur J Radiol 2019; 111:47-55. [DOI: 10.1016/j.ejrad.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 11/02/2018] [Accepted: 12/05/2018] [Indexed: 12/22/2022]
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Duruisseaux M, Martínez-Cardús A, Calleja-Cervantes M, Moran S, Castro De Moura M, Davalos V, Piñeyro D, Girard N, Brevet M, Giroux-Leprieur E, Dumenil C, Pradotto M, Bironzo P, Capelletto E, Novello S, Cortot A, Copin M, Karachaliou N, Gonzalez-Cao M, Peralta S, Montuenga L, Gil-Bazo I, Baraibar I, Lozano M, Varela M, Ruffinelli J, Ramon P, Nadal E, Moran T, Perez L, Ramos I, Xiao Q, Fernandez A, Fraga M, Gut M, Gut I, Teixidó C, Vilariño N, Prat A, Reguart N, Benito A, Garrido P, Barragan I, Emile J, Rosell R, Brambilla E, Esteller M. Prédiction épigénétique du bénéfice clinique avec les anti-PD-1 dans le traitement des cancers du poumon non à petites cellules avancées : une étude internationale multicentrique rétrospective. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.072] [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: 11/27/2022]
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Barcelona M, García-Borgoñón L, Escalona M, Ramos I. CBG-Framework: A bottom-up model-based approach for Collaborative Business Process Management. COMPUT IND 2018. [DOI: 10.1016/j.compind.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bernardes M, Durães C, Oliveira A, Martins MJ, Lucas R, Costa L, Pereira JG, Ramos I, Machado JC, Simões-Ventura F. LRP5 gene polymorphisms and radiographic joint damage in rheumatoid arthritis patients. Osteoporos Int 2018; 29:2355-2368. [PMID: 30019084 DOI: 10.1007/s00198-018-4625-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/27/2018] [Indexed: 01/01/2023]
Abstract
UNLABELLED Rheumatoid arthritis (RA) is characterized by increased bone resorption and impaired bone formation. Osteoblast function is regulated by the canonical LRP5/Wnt/β-catenin pathway. Bone mineral density and RA joint destruction are partially inherited. In line with this, we found significant associations between LRP5 SNPs (p.A1330V, p.N740N, p.V667M) and RA radiographic damage severity. INTRODUCTION Increased bone resorption and impaired bone formation characterize rheumatoid arthritis (RA). Canonical Wnt/β-catenin pathway, signalled by lipoprotein receptor-related protein-5 (LRP5), regulates osteoblast function. Since bone mineral density (BMD) and RA joint destruction are partially inherited, we studied their association with LRP5 single nucleotide polymorphisms (SNPs). METHODS Clinical data and peripheral blood for biomarkers assessment and LRP5 genotyping were collected from 208 RA patients. Hands and feet X-rays were scored [modified Sharp/van der Heijde Score (SHS), joint space narrowing (JSN), and erosion scores]. Lumbar spine, total left proximal femur, and left hand BMD were assessed by dual-energy X-ray absorptiometry (DXA). RESULTS TT genotypes for p.A1330V and p.N740N LRP5 SNPs associated with total SHS, erosion score, and hands erosion score; the same for p.A1330V with feet JSN score and p.N740N with hands total score. AG genotype for p.V667M associated with sclerostin and hands JSN score. Femoral BMD associated with TC genotype for p.N740N. Multiple test correction precluded a few of these associations. Among V667M-N740N-A1330V haplotypes: GTT associated with higher feet JSN score (OR = 3.80; p = 0.016) and ATT with higher JSN score (OR = 4.60; p = 0.032), hands total score (OR = 5.65; p = 0.022), and total SHS (OR = 6.74; p = 0.024). CONCLUSION Significant associations between LRP5 SNPs (p.A1330V, p.N740N, and p.V667M) and the severity of radiographic damage reinforce the evidence of bone destruction heritability in RA.
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Affiliation(s)
- M Bernardes
- Department of Rheumatology, São João Hospital Centre, Porto, Portugal.
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - C Durães
- IPATIMUP - Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3s), University of Porto, Porto, Portugal
| | - A Oliveira
- Department of Nuclear Medicine, São João Hospital Centre, Porto, Portugal
| | - M J Martins
- Instituto de Investigação e Inovação em Saúde (i3s), University of Porto, Porto, Portugal
- Unit of Biochemisty, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Lucas
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - L Costa
- Department of Rheumatology, São João Hospital Centre, Porto, Portugal
| | - J G Pereira
- Department of Nuclear Medicine, São João Hospital Centre, Porto, Portugal
| | - I Ramos
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Radiology, São João Hospital Centre, Porto, Portugal
| | - J C Machado
- IPATIMUP - Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
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Cruz C, Pinho T, Madureira AJ, Dias CC, Ramos I, Silva Cardoso J, Maciel MJ. Is it important to assess the ascending aorta after tetralogy of Fallot repair? Rev Port Cardiol 2018; 37:773-779. [PMID: 30150103 DOI: 10.1016/j.repc.2017.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/30/2017] [Accepted: 11/05/2017] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Aortic dilatation can develop late after tetralogy of Fallot repair. Its extension beyond the aortic root is not clearly understood. We aimed to assess the prevalence and predictors of ascending aorta dilatation to set up an imaging protocol. METHODS In this prospective study including adult patients after tetralogy of Fallot repair followed at a referral center, we assessed the aorta by cardiovascular magnetic resonance and defined ascending aorta dilatation as an observed-to-expected ratio >1.5. RESULTS We included 78 adults (mean age 31±10 years; 56% female), with a mean follow-up of 23±7 years since tetralogy of Fallot repair. The prevalence of ascending aorta dilatation was 11.5%. The ascending aorta was larger than the sinuses of Valsalva in 12.8% of cases. Patients with ascending aorta dilatation were older, predominantly male, with later repair and larger left ventricular mass and volumes. By multivariate analysis left ventricular mass index (LVMI) was the only factor independently associated with ascending aorta dilatation (odds ratio 1.10, 95% confidence interval 1.01-1.20, p=0.03). A cut-off value of ≥57.9 g/m2 for LVMI had 89% sensitivity and 71% specificity for ascending aorta dilatation. CONCLUSIONS Ascending aorta assessment as part of a routine cardiovascular magnetic resonance study after tetralogy of Fallot repair is recommended to screen for future aortic complications, particularly in males and older patients, and those with later repair and larger left ventricles. LVMI assessment has potential as a screening tool for ascending aorta dilatation with future clinical implications.
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Affiliation(s)
- Cristina Cruz
- Centro Hospitalar São João, Department of Cardiology, Porto, Portugal; University of Porto, Faculty of Medicine, Porto, Portugal.
| | - Teresa Pinho
- Centro Hospitalar São João, Department of Cardiology, Porto, Portugal; University of Porto, Faculty of Medicine, Porto, Portugal
| | - António José Madureira
- University of Porto, Faculty of Medicine, Porto, Portugal; Centro Hospitalar São João, Department of Radiology, Porto, Portugal
| | - Cláudia Camila Dias
- University of Porto, Faculty of Medicine, Department of Community Medicine, Information and Decision in Health, Porto, Portugal
| | - Isabel Ramos
- University of Porto, Faculty of Medicine, Porto, Portugal; Centro Hospitalar São João, Department of Radiology, Porto, Portugal
| | - José Silva Cardoso
- Centro Hospitalar São João, Department of Cardiology, Porto, Portugal; University of Porto, Faculty of Medicine, Porto, Portugal
| | - Maria Júlia Maciel
- Centro Hospitalar São João, Department of Cardiology, Porto, Portugal; University of Porto, Faculty of Medicine, Porto, Portugal
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