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Danys D, Marcinkeviciute K, Cereska V, Miknevicius P, Poskus T, Osorio J. Telementoring Experience for Complex Bariatric Operation-Laparoscopic Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S). Obes Surg 2024; 34:1983-1986. [PMID: 38530550 DOI: 10.1007/s11695-024-07200-w] [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: 02/15/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
In a groundbreaking surgical collaboration, a team of surgeons in Lithuania successfully performed the first single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) operation under the remote telemonitoring guidance of a highly experienced surgeon from Spain.The Lithuanian surgical team, comprising skilled bariatric surgeons, meticulously prepared for the SADI-S operation under the remote guidance of their Spanish proctor. Utilizing video conferencing and real-time communication, the mentor provided step-by-step instructions, shared insights, and addressed any concerns during the procedure. The mentor's extensive experience and guidance ensured a safe and successful surgical outcome.This innovative approach not only demonstrates the potential of telemedicine in the field of complex bariatric surgeries but also highlights the power of international cooperation in advancing surgical techniques and patient care by using modern methods of telemedicine and proctorship.
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Affiliation(s)
- Donatas Danys
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania.
| | | | - Vaidas Cereska
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Povilas Miknevicius
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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Hernández-Montoliu L, Rodríguez-Peña MM, Puig R, Astiarraga B, Guerrero-Pérez F, Virgili N, López-Urdiales R, Osorio J, Monseny R, Lazzara C, Sobrino L, Pérez-Maraver M, Pérez-Prieto M, Pellitero S, Fernández-Veledo S, Vendrell J, Vilarrasa N. A specific gut microbiota signature is associated with an enhanced GLP-1 and GLP-2 secretion and improved metabolic control in patients with type 2 diabetes after metabolic Roux-en-Y gastric bypass. Front Endocrinol (Lausanne) 2023; 14:1181744. [PMID: 37916149 PMCID: PMC10616869 DOI: 10.3389/fendo.2023.1181744] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023] Open
Abstract
Objective To determine changes in incretins, systemic inflammation, intestinal permeability and microbiome modifications 12 months after metabolic RYGB (mRYGB) in patients with type 2 diabetes (T2D) and their relationship with metabolic improvement. Materials and methods Prospective single-center non-randomized controlled study, including patients with class II-III obesity and T2D undergoing mRYGB. At baseline and one year after surgery we performed body composition measurements, biochemical analysis, a meal tolerance test (MTT) and lipid test (LT) with determination of the area under the curve (AUC) for insulin, C-peptide, GLP-1, GLP-2, and fasting determinations of succinate, zonulin, IL-6 and study of gut microbiota. Results Thirteen patients aged 52.6 ± 6.5 years, BMI 39.3 ± 1.4 kg/m2, HbA1c 7.62 ± 1.5% were evaluated. After mRYGB, zonulin decreased and an increase in AUC after MTT was observed for GLP-1 (pre 9371 ± 5973 vs post 15788 ± 8021 pM, P<0.05), GLP-2 (pre 732 ± 182 vs post 1190 ± 447 ng/ml, P<0.001) and C- peptide, as well as after LT. Species belonging to Streptococaceae, Akkermansiacea, Rickenellaceae, Sutterellaceae, Enterobacteriaceae, Oscillospiraceae, Veillonellaceae, Enterobacterales_uc, and Fusobacteriaceae families increased after intervention and correlated positively with AUC of GLP-1 and GLP-2, and negatively with glucose, HbA1c, triglycerides and adiposity markers. Clostridium perfringens and Roseburia sp. 40_7 behaved similarly. In contrast, some species belonging to Lachnospiraceae, Erysipelotricaceae, and Rumnicocaceae families decreased and showed opposite correlations. Higher initial C-peptide was the only predictor for T2D remission, which was achieved in 69% of patients. Conclusions Patients with obesity and T2D submitted to mRYGB show an enhanced incretin response, a reduced gut permeability and a metabolic improvement, associated with a specific microbiota signature.
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Affiliation(s)
- Laura Hernández-Montoliu
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - M-Mar Rodríguez-Peña
- Hospital Universitari Joan XXIII de Tarragona, Institut d’Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Rocío Puig
- Department of Endocrinology and Nutrition Hospital de la Santa Creu i Sant Pau, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Brenno Astiarraga
- Hospital Universitari Joan XXIII de Tarragona, Institut d’Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael López-Urdiales
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Osorio
- Department of General and Gastrointestinal Surgery. Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Monseny
- Clinical Nutrition Unit. Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Claudio Lazzara
- Department of General and Gastrointestinal Surgery. Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Lucía Sobrino
- Department of General and Gastrointestinal Surgery. Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Pérez-Maraver
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - María Pérez-Prieto
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia Pellitero
- Department of Endocrinology and Nutrition and Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Sonia Fernández-Veledo
- Hospital Universitari Joan XXIII de Tarragona, Institut d’Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Joan Vendrell
- Hospital Universitari Joan XXIII de Tarragona, Institut d’Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Medicine and Surgery, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-Institut d'Investigació Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Admella V, Lazzara C, Sobrino L, Acrich E, Biondo S, Pujol-Gebellí J, Osorio J. Patient-Reported Outcomes and Quality of Life After Single-Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): a Cross-Sectional Study with 283 Patients from a Single Institution. Obes Surg 2023:10.1007/s11695-023-06554-x. [PMID: 36920683 PMCID: PMC10016163 DOI: 10.1007/s11695-023-06554-x] [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: 01/30/2023] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a safe and effective technique with good short- and mid-term weight control and associated medical problems remission for patients with a body mass index (BMI) > 45 kg/m2. The aim of this study was to analyze patient-reported symptoms, specifically symptomatic gastroesophageal reflux disease symptoms (GERD), depositional habit, and quality of life (QOL) following SADI-S, using telemedicine and validated tests. METHODS A prospective unicentric cross-sectional study was conducted including all patients submitted to SADI-S in the University Hospital of Bellvitge from May 2014 to September 2019. A baseline control group was composed of 67 patients who were planning to undergo SADI-S in the following 4 months. Patients were divided into four groups: pre-SADIS, < 2 years, 2-3 years, and > 3 years after surgery. The information gathered via a telematic questionnaire was analyzed and compared with its presence in patients' clinical history derived from the last presential visit. RESULTS The response rate to telematic tests was 86.9%. The mean BMI exhibited significant differences depending on the moment of evaluation: 50.8 kg/m2, 30.0 kg/m2, 31.1 kg/m2, and 32.7 kg/m2 at pre-SADIS, < 2, 2-3, and > 3 years follow-up, respectively (p < 0.001). The proportion of GERD symptoms increased over time (17.9%, 18.8%, 26.9%, and 30.2%, p = 0.320). After SADIS, the percentage of patients with loose stools was progressively higher (17.4% vs 25.4% vs 30.2%, p = 0.04). Patients with < 2-year follow-up presented an improvement in both physical component (PCS) and mental component (MCS) summaries compared to the baseline group (PCS = 51.3, and MCS = 49.4). The mean BMI of patients with PCS ≥ 50 was 31.9 kg/m2, compared with 41.7 kg/m2 in the PCS < 50 group (p < 0.001). In the MCS ≥ 50 group, there were more patients with a BMI < 35 kg/m2 than the MCS < 50 group (66.7% vs 48.7%, p = 0.004). Telematic follow-up offered a more systemic and detailed information: in the last presential visit only, 13.9% of patients had complete data regarding weight evolution, remission of associated medical problems, GERD symptoms, and depositional habit in comparison with the 82.9% of patients with telematic follow-up (p < 0.001). CONCLUSION Weight control is the main factor related to long-term QOL after SADI-S. The incidence of GERD symptoms and diarrhea was up to 30% in patients with > 3-year follow-up. Monitoring postoperative patient-related symptoms with validated objective tests seems a feasible and useful resource for the long-term follow-up of patients submitted to SADI-S.
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Affiliation(s)
- Victor Admella
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Claudio Lazzara
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Lucia Sobrino
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Elias Acrich
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Jordi Pujol-Gebellí
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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Jericó C, Puértolas N, Osorio J, Miranda C, Santamaría M, Artigau E, Galofré G, Garsot E, Luna A, Aldeano A, Olona C, Pulido L, Pera M. Cost analysis of a patient blood management program for patients undergoing gastric cancer surgery. Eur J Surg Oncol 2023; 49:293-297. [PMID: 36163062 DOI: 10.1016/j.ejso.2022.09.007] [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: 08/10/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 01/24/2023] Open
Abstract
Patient Blood Management (PBM) programs have probed to reduce blood transfusions and postoperative complications following gastric cancer resection, but evidence on their economic benefit is scarce. A recent prospective interventional study of our group described a reduction in transfusions, infectious complications and length of stay after implementation of a multicenter PBM program in patients undergoing elective gastric cancer resection with curative intent. The aim of the present study was to analyze the economic impact associated with these clinical benefits. The mean [and 95% CI] of total healthcare cost per patient was lower (-1955 [-3764, -119] €) after the PBM program implementation. The main drivers of this reduction were the hospital stay (-1847 [-3161, -553] €), blood transfusions (-100 [-145, -56] €), and post-operative complications (-162 [-718, 411] €). Total societal cost was reduced by -2243 [-4244, -210] € per patient. These findings highlight the potential economic benefit of PBM strategies.
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Affiliation(s)
- Carlos Jericó
- Service of Internal Medicine, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
| | - Noelia Puértolas
- Department of Surgery, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
| | - Javier Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain.
| | - Coro Miranda
- Service of Surgery, Hospital Universitario de Navarra, Pamplona, Spain.
| | - Maite Santamaría
- Service of Surgery, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
| | - Eva Artigau
- Service of Surgery, Hospital Universitari Josep Trueta, Girona, Spain.
| | - Gonzalo Galofré
- Service of Surgery, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
| | - Elisenda Garsot
- Service of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
| | - Alexis Luna
- Service of Surgery, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain.
| | - Aurora Aldeano
- Service of Surgery, Hospital General de Granollers, Granollers, Barcelona, Spain.
| | - Carles Olona
- Service of Surgery, Hospital Universitari de Tarragona, Joan XXIII, Tarragona, Spain.
| | - Laura Pulido
- Service of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
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Puértolas N, Osorio J, Jericó C, Miranda C, Santamaría M, Artigau E, Galofré G, Garsot E, Luna A, Aldeano A, Olona C, Molinas J, Pulido L, Gimeno M, Pera M. Effect of Perioperative Blood Transfusions and Infectious Complications on Inflammatory Activation and Long-Term Survival Following Gastric Cancer Resection. Cancers (Basel) 2022; 15:cancers15010144. [PMID: 36612141 PMCID: PMC9818188 DOI: 10.3390/cancers15010144] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Background: The aim of this study was to evaluate the impact of perioperative blood transfusion and infectious complications on postoperative changes of inflammatory markers, as well as on disease-free survival (DFS) in patients undergoing curative gastric cancer resection. Methods: Multicenter cohort study in all patients undergoing gastric cancer resection with curative intent. Patients were classified into four groups based on their perioperative course: one, no blood transfusion and no infectious complication; two, blood transfusion; three, infectious complication; four, both transfusion and infectious complication. Neutrophil-to-lymphocyte ratio (NLR) was determined at diagnosis, immediately before surgery, and 10 days after surgery. A multivariate Cox regression model was used to analyze the relationship of perioperative group and dynamic changes of NLR with disease-free survival. Results: 282 patients were included, 181 in group one, 23 in group two, 55 in group three, and 23 in group four. Postoperative NLR changes showed progressive increase in the four groups. Univariate analysis showed that NLR change > 2.6 had a significant association with DFS (HR 1.55; 95% CI 1.06−2.26; p = 0.025), which was maintained in multivariate analysis (HR 1.67; 95% CI 1.14−2.46; p = 0.009). Perioperative classification was an independent predictor of DFS, with a progressive difference from group one: group two, HR 0.80 (95% CI: 0.40−1.61; p = 0.540); group three, HR 1.42 (95% CI: 0.88−2.30; p = 0.148), group four, HR 2.85 (95% CI: 1.64−4.95; p = 0.046). Conclusions: Combination of perioperative blood transfusion and infectious complications following gastric cancer surgery was related to greater NLR increase and poorer DFS. These findings suggest that perioperative blood transfusion and infectious complications may have a synergic effect creating a pro-inflammatory activation that favors tumor recurrence.
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Affiliation(s)
- Noelia Puértolas
- Service of Surgery, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
- Department of Surgery, Hospital Universitari de Bellvitge, L’Hospitalet del Llobregat, 08037 Barcelona, Spain
| | - Javier Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L’Hospitalet del Llobregat, 08037 Barcelona, Spain
- Correspondence: ; Tel.: +34-637286009
| | - Carlos Jericó
- Service of Internal Medicine, Hospital de Sant Joan Despí Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Coro Miranda
- Service of Surgery, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Maite Santamaría
- Service of Surgery, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
| | - Eva Artigau
- Service of Surgery, Hospital Universitari Josep Trueta, 17007 Girona, Spain
| | - Gonzalo Galofré
- Service of Surgery, Hospital de Sant Joan Despí Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Elisenda Garsot
- Service of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Alexis Luna
- Service of Surgery, Consorci Corporació Sanitària Parc Taulí de Sabadell, 08208 Sabadell, Spain
| | - Aurora Aldeano
- Service of Surgery, Hospital General de Granollers, 08402 Granollers, Spain
| | - Carles Olona
- Service of Surgery, Hospital Universitari de Tarragona, Joan XXIII, 43005 Tarragona, Spain
| | - Joan Molinas
- Service of Surgery, Hospital Universitari de Vic, 08500 Vic, Spain
| | - Laura Pulido
- Service of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Marta Gimeno
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
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Lind RP, Ghanem M, Teixeira AF, Jawad MA, Osorio J, Lazzara C, Sobrino L, Ortiz-Ciruela D, de Gordejuela AGR. Single- Versus Double-Anastomosis Duodenal Switch: Outcomes Stratified by Preoperative BMI. Obes Surg 2022; 32:3869-3878. [DOI: 10.1007/s11695-022-06315-2] [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] [Received: 09/09/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 10/31/2022]
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Hussein A, Delaughter MC, Monir G, Natale A, Dukkipati S, Oza S, Daoud E, Di Biase L, Mansour M, Fishel R, Valderrabano M, Ellenbogen K, Osorio J. Safety and effectiveness of near-zero fluoroscopy paroxysmal AF radiofrequency ablation with a temperature-controlled, contact force-sensing catheter: a Q-FFICIENCY study sub-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Q-FFICIENCY evaluated 12-month (M) safety and efficacy of temperature-controlled paroxysmal atrial fibrillation ablation with a novel contact force-sensing, radiofrequency catheter with 3 microelectrodes and 6 thermocouples. Patients underwent pulmonary vein isolation with very high-power short-duration (vHPSD; 90 W/ up to 4 s) mode in combination with conventional-power temperature-controlled (CPTC; 25–50 W) mode.
Purpose
To assess procedural efficiency, safety, and 12M outcomes of participants ablated under near-zero fluoroscopy guidance compared to procedures performed with standard fluoroscopy.
Methods
In this US multi-centre (22 sites), non-randomised investigational study, patients underwent pulmonary vein isolation with vHPSD as primary ablation mode; CPTC was used for PV touch-up or non-PV ablation. Primary safety endpoint was incidence of primary adverse events ≤7 days post-procedure. Primary effectiveness was freedom from documented atrial tachyarrhythmia recurrence and additional pre-defined failure modes (acute failure, repeat ablation, new/higher dose anti-arrhythmic drug). Participants were followed-up through 12M post-ablation (3M blanking & 9M evaluation) to assess safety, effectiveness, and healthcare utilisation.
Results
Of 191 participants enrolled (63.5±10.7 years, CHA2DS2-VASc 2.4±1.5, 60.7% men), 166 were ablated with the investigational catheter, and 165 had fluoroscopy data available for inclusion in this analysis. Forty-four participants received ≤1 minute of fluoroscopy. Compared to the >1-minute of fluoroscopy cohort, the ≤1-minute group showed improved efficiencies in all procedural parameters (Table). Primary adverse event rates were similar among groups (≤1-minute, 4.5%; >1-minute, 3.3%). Kaplan-Meier estimated 12M clinical success rates (i.e., freedom from documented symptomatic recurrence) were similar regardless of fluoroscopy exposure (≤1-minute, 85.4%; >1-minute, 86.0%). Freedom from cardiovascular hospitalisation 12M post-ablation was comparable among groups (90.8% vs 88.0%).
Conclusion
Near-zero fluoroscopy paroxysmal atrial fibrillation ablation with the novel temperature-controlled catheter in vHPSD mode, alone or combined with CPTC, led to enhanced procedural efficiencies with good effectiveness and clinical success without comprising safety.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Biosense Webster, Inc.
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Affiliation(s)
- A Hussein
- Cleveland Clinic Foundation, Cleveland , OH , United States of America
| | - M C Delaughter
- Texas Health Heart & Vascular, Arlington , TX , United States of America
| | - G Monir
- AdvantHealth Orlando, Orlando , FL , United States of America
| | - A Natale
- Texas Cardiac Arrhythmia Institute, Austin , TX , United States of America
| | - S Dukkipati
- Mount Sinai School of Medicine, New York , NY , United States of America
| | - S Oza
- St Vincent's Medical Center, Jacksonville , FL , United States of America
| | - E Daoud
- Ohio State University Medical Center, Columbus , OH , United States of America
| | - L Di Biase
- Montefiore Medical Center at Albert Einstein College of Medicine, Bronx , NY , United States of America
| | - M Mansour
- Massachusetts General, Boston , MA , United States of America
| | - R Fishel
- JFK Medical Center, Atlantis , FL , United States of America
| | - M Valderrabano
- Houston Methodist Research Institute, Houston , TX , United States of America
| | - K Ellenbogen
- Virginia Commonwealth University, Richmond , VA , United States of America
| | - J Osorio
- Grandview Medical Center Alabama Cardiovascular Group, Birmingham , AL , United States of America
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Osorio J, Sobrino L, Baena E, Lazzara C. Use of the Branco-Zorron Switch in a case of hyperinsulinemic hypoglicemia after Roux en Y gastric bypass. Cir Esp 2022; 100:647-648. [PMID: 36109117 DOI: 10.1016/j.cireng.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Lucia Sobrino
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Elisabet Baena
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Claudio Lazzara
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.
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9
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Osorio J, Madrazo Z, Videla S, Sainz B, Rodríguez-Gonzalez A, Campos A, Santamaria M, Pelegrina A, Gonzalez-Serrano C, Aldeano A, Sarriugarte A, Gómez-Díaz CJ, Ruiz-Luna D, García-Ruiz-de-Gordejuela A, Gomez-Gavara C, Gil-Barrionuevo M, Vila M, Clavell A, Campillo B, Millan L, Olona C, Sanchez-Cordero S, Medrano R, Lopez-Arevalo CA, Pérez-Romero N, Artigau E, Calle M, Echenagusia V, Otero A, Tebe C, Pallares N, Biondo S, Valderas JM. Use of failure-to-rescue after emergency surgery as a dynamic indicator of hospital resilience during the COVID-19 pandemic. A multicenter retrospective propensity score-matched cohort study. Int J Surg 2022; 106:106890. [PMID: 36089261 PMCID: PMC9458615 DOI: 10.1016/j.ijsu.2022.106890] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/17/2022] [Accepted: 08/28/2022] [Indexed: 11/25/2022]
Abstract
Background Surgical failure-to-rescue (FTR, death rate following complications) is a reliable cross-sectional quality of care marker, but has not been evaluated dynamically. We aimed to study changes in FTR following emergency surgery during the COVID-19 pandemic. Material and methods Matched cohort study including all COVID-19-non-infected adult patients undergoing emergency general surgery in 25 Spanish hospitals during COVID-19 pandemic peak (March–April 2020), non-peak (May–June 2020), and 2019 control periods. A propensity score-matched comparative analysis was conducted using a logistic regression model, in which period was regressed on observed baseline characteristics. Subsequently, a mixed effects logistic regression model was constructed for each variable of interest. Main variable was FTR. Secondary variables were post-operative complications, readmissions, reinterventions, and length of stay. Results 5003 patients were included (948, 1108, and 2947 in the pandemic peak, non-peak, and control periods), with comparable clinical characteristics, prognostic scores, complications, reintervention, rehospitalization rates, and length of stay across periods. FTR was greater during the pandemic peak than during non-peak and pre-pandemic periods (22.5% vs. 17.2% and 12.7%), being this difference confirmed in adjusted analysis (odds ratio [OR] 2.13, 95% confidence interval [95% CI] 1.27–3.66). There was sensible inter-hospital variability in FTR changes during the pandemic peak (median FTR change +8.77%, IQR 0–29.17%) not observed during the pandemic non-peak period (median FTR change 0%, IQR -6.01−6.72%). Greater FTR increase was associated with higher COVID-19 incidence (OR 2.31, 95% CI 1.31–4.16) and some hospital characteristics, including tertiary level (OR 3.07, 95% CI 1.27–8.00), medium-volume (OR 2.79, 95% CI 1.14–7.34), and high basal-adjusted complication risk (OR 2.21, 95% CI 1.07–4.72). Conclusion FTR following emergency surgery experienced a heterogeneous increase during different periods of the COVID-19 pandemic, suggesting it to behave as an indicator of hospital resilience. FTR monitoring could facilitate identification of centres in special needs during ongoing health care challenges.
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Affiliation(s)
- Javier Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet Del Llobregat, Barcelona, Spain.
| | - Zoilo Madrazo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet Del Llobregat, Barcelona, Spain
| | - Sebastian Videla
- Department of Clinical Pharmacology, Clinical Research Support Unit (HUB-IDIBELL), Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Beatriz Sainz
- Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Andrea Campos
- Department of Surgery, Parc Taulí Health Corporation, Sabadell Hospital, Sabadell, Spain
| | - Maite Santamaria
- Department of Surgery, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Amalia Pelegrina
- Department of Surgery, Hospital Del Mar University Hospital, Barcelona, Spain
| | | | - Aurora Aldeano
- Department of Surgery, Granollers General Hospital, Granollers, Spain
| | | | | | - David Ruiz-Luna
- Department of Surgery, Terrassa Health Consortium, Terrassa Hospital, Terrassa, Spain
| | | | - Concepción Gomez-Gavara
- Hepatobiliopancreatic Surgery and Transplantation Department, Vall D'Hebrón University Hospital, Barcelona, Spain
| | | | - Marina Vila
- Department of Surgery, Mataró Hospital, Maresme Health Consortium, Mataró, Spain
| | - Arantxa Clavell
- Department of Surgery, Germans Trias I Pujol University Hospital, Badalona, Spain
| | - Beatriz Campillo
- Department of Surgery, Sant Joan de Deu Hospital Foundation, Martorell, Spain
| | - Laura Millan
- Department of Surgery, Dr. José Molina Orosa Hospital, Lanzarote, Spain
| | - Carles Olona
- Department of Surgery, Joan XXIII University Hospital, Tarragona, Spain
| | - Sergi Sanchez-Cordero
- Department of Surgery, Igualada University Hospital, Anoia Health Consortium, Igualada, Spain
| | - Rodrigo Medrano
- Department of Surgery, Sant Pau University Hospital, Barcelona, Spain
| | | | - Noelia Pérez-Romero
- Department of Surgery, Mútua de Terrassa University Hospital, Terrassa, Spain
| | - Eva Artigau
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Miguel Calle
- Department of Surgery, Alto Deba Hospital, Mondragon, San Sebastian, Spain
| | - Víctor Echenagusia
- Department of Surgery, Araba University Hospital, Txagorritxu Hospital, Vitoria, Spain
| | - Aurema Otero
- Clinical Research Support Unit, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet Del Llobregat, Barcelona, Spain
| | - Cristian Tebe
- Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Natàlia Pallares
- Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastiano Biondo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet Del Llobregat, Barcelona, Spain
| | - Jose Maria Valderas
- Department of Family Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
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Osorio J, Arana VA, Medina JM, Alarcon R, Moreno E, Wist J. 1D and 2D NMR spectra of coffee from 27 countries. GigaByte 2022; 2022:gigabyte50. [PMID: 36824514 PMCID: PMC9650224 DOI: 10.46471/gigabyte.50] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/09/2022] [Indexed: 11/09/2022] Open
Abstract
Between 2012 and 2014, 715 green coffee samples were gathered by Almacafé S.A. (Bogotá, Colombia) from 27 countries. These were analysed at the nuclear magnetic resonance (NMR) laboratory at Universidad del Valle (Cali, Colombia). Over 1000 methanolic coffee extracts were prepared and 4563 spectra were acquired in a fully automatic manner using a 400 MHz NMR spectrometer (Bruker Biospin, Germany). The dataset spans the variance that could be expected for an industrial application of origin monitoring, including samples from different harvest times, collected over several years, and processed by at least two distinct operators. The resulting 1D and 2D spectra can be used to develop and evaluate feature extraction methods, multivariate algorithms, and automation monitoring techniques. They can also be used as datasets for teaching, or as a reference for new studies of similar samples and approaches.
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Affiliation(s)
- Javier Osorio
- Chemistry Department, Universidad del Valle, 760008 Cali, Colombia
| | - Victoria A. Arana
- Chemistry Program, Basic Science Faculty, Universidad del Atlantico, 081007, Puerto Colombia, Colombia
| | - Jessica M. Medina
- Chemistry Program, Basic Science Faculty, Universidad del Atlantico, 081007, Puerto Colombia, Colombia
| | | | | | - Julien Wist
- Chemistry Department, Universidad del Valle, 760008 Cali, Colombia,Australian National Phenome Centre, Computational and Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Building, Perth WA 6150, Australia, Corresponding author. E-mail:
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Sorribas M, Casajoana A, Sobrino L, Admella V, Osorio J, Pujol-Gebellí J. Experience in biliopancreatic diversion with duodenal switch: Results at 2, 5 and 10 years. Cir Esp 2022; 100:202-208. [PMID: 35431160 DOI: 10.1016/j.cireng.2022.03.015] [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: 11/04/2020] [Accepted: 01/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Duodenal switch (DS) is considered one of the most effective techniques to achieve weight loss and reduce comorbidities in patients with morbidly obesity. MATERIAL AND METHODS Descriptive single-center study. 224 patients were analyzed who underwent direct laparoscopic DS in our center. The objective was to describe the results of weight, resolution of comorbidities, nutritional supplementation and postoperative complications at 2, 5 and 10 years. RESULTS The mean age of the cohort was 49.3 [23-65] years and the mean weight and BMI were 131.8 [20] kg and 49.8 [5] kg/m2. The excess weight lost percentage at 2, 5 and 10 years was 80.6[15]%, 69.3[18]%, 67.4[18]%, respectively. Complete remission of diabetes was evidenced at 2 and 5 years in 35 (85.4%) and 27 (70.4%) patients. In the immediate postoperative period, the complication rate for Clavien-Dindo ≥ III was 15 patients (6.7%) and mortality at 30 and 90 days was 1 (0.4%) and 2 (0.9%) patients. Revisional surgery was performed in 2 patients (0.9%). 80% of the patients required an extra nutritional supplement up to 10 years after surgery. CONCLUSIONS Direct DS is a safe and effective technique in patients with a BMI between 45 and 55 kg/m2. Weight loss is maintained with a low rate of revision surgery. It is a metabolically effective technique that entails the need for a close postoperative follow-up to assess nutritional supplementation.
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Affiliation(s)
- Maria Sorribas
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Casajoana
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Lucía Sobrino
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Admella
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Osorio
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Pujol-Gebellí
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Lazzara C, Merino D, Osorio J, Sobrino L, Pujol-Gebellí J. Intestinal Bipartition After Failed Sleeve Gastrectomy: a Safe and Simple Alternative Technique in a Challenging Case with Vascular Anomalies. Obes Surg 2022; 32:1788-1790. [DOI: 10.1007/s11695-022-06004-0] [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] [Received: 12/31/2021] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
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Osorio J, Sobrino L, Baena E, Lazzara C. Use of the Branco-Zorron Switch in a case of hyperinsulinemic hypoglicemia after Roux en Y gastric bypass. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.02.013] [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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Tur-Martínez J, Osorio J, Pérez-Romero N, Puértolas-Rico N, Pera M, Delgado S, Rodríguez-Santiago J. Preoperative neutrophil-to-lymphocyte ratio behaves as an independent prognostic factor even in patients with postoperative complications after curative resection for gastric cancer. Langenbecks Arch Surg 2022; 407:1017-1026. [PMID: 34999967 PMCID: PMC9151531 DOI: 10.1007/s00423-022-02432-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to determine if the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) could be modified by the presence of postoperative complications (POC) and their severity in patients with gastric adenocarcinoma resected with curative intent. Methods A retrospective study based on a prospective database of patients with resectable gastric adenocarcinoma treated with radical intention (R0) between January 1998 and February 2012. The primary endpoint was overall survival according to preoperative peripheral blood NLR and postoperative complications. Clinicopathological variables, preoperative blood tests, POC and its severity (Clavien–Dindo classification), type of POC (infectious or not infectious) and mortality were registered. A univariate and multivariate analysis (step forward Cox regression) was performed. The Kaplan–Meier method was used to assess overall survival. Results The 147 patients with gastric cancer who had undergone radical resection were included from an initial cohort of 209 patients. Univariant analysis: type of surgery, pT, pN, postoperative complications (Clavien–Dindo ≥ 3) and preoperative NLR ≥ 2.4 were significantly associated with survival (p < 0.05). Patients with POC showed worse long-term survival (p = 0.000), with no difference (p = 0.867) between infectious or non-infectious POC. NLR ≥ 2.4 was associated with infectious POC (p < 0.001). Patients with preoperative NLR ≥ 2.4 (p = 0.02) had a worse prognosis. Multivariate analysis: pN (p < 0.001), postoperative complications (p < 0.001) (HR 3.04; 95% CI: 1.97–4.70) and NLR ≥ 2.4 (p = 0.04) (HR = 1.55; 95% CI: 1.02–2.3) were independent prognostic factors. Conclusion The preoperative inflammatory state of patients with gastric cancer measured by NLR behaves as an independent prognostic factor, even in patients with POC.
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Affiliation(s)
- Jaume Tur-Martínez
- Service of General Surgery, University Hospital Mútua Terrassa, Terrassa, Barcelona, Spain. .,Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Javier Osorio
- Service of General Surgery, University Hospital Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Noelia Pérez-Romero
- Service of General Surgery, University Hospital Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Noelia Puértolas-Rico
- Service of General Surgery, University Hospital Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery. Hospital del Mar, Universitat Autónoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Bellaterra, Spain
| | - Salvadora Delgado
- Service of General Surgery, University Hospital Mútua Terrassa, Terrassa, Barcelona, Spain
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García Ruiz de Gordejuela A, Ibarzabal A, Osorio J. Bariatric Surgery and Solid-Organ Transplantation. Transplant Proc 2022; 54:87-90. [PMID: 34973842 DOI: 10.1016/j.transproceed.2021.11.008] [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] [Received: 08/30/2021] [Revised: 10/16/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022]
Abstract
Morbid obesity and being overweight are a growing problem worldwide. They also affect patients with end-stage solid-organ disease and patients after transplant. Bariatric surgery is the most effective available weight loss procedure. Bariatric surgery can be helpful for the treatment of some conditions, such as nonalcoholic fatty liver disease or nonalcoholic steatohepatitis, which may lead to transplant, and weight loss can improve or even reverse them. In other cases, morbid obesity is a limitation to accessing a transplant program, so bariatric surgery can serve as a conduit to transplant. After transplant, obesity and obesity-related comorbidities can be a significant health problem that may be treated, as in patients without a transplant, with bariatric surgery. There are some specific conditions and issues to be considered in patients with end-stage solid-organ disease who are candidates for bariatric surgery, such as increased morbidity and mortality. After transplant, immunosuppressant regimens and technical limitations may be also significant.
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Affiliation(s)
- Amador García Ruiz de Gordejuela
- Bariatric Surgery Unit, General Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
| | - Ainitze Ibarzabal
- Gastrointestinal Surgery Department, Clinic Hospital Barcelona, University of Barcelona, Barcelona, Spain
| | - Javier Osorio
- Bariatric Surgery Unit, General Surgery Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
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Villodre C, Taccogna L, Zapater P, Cantó M, Mena L, Ramia JM, Lluís F, Afonso N, Aguilella V, Aguiló J, Alados JC, Alberich M, Apio AB, Balongo R, Bra E, Bravo-Gutiérrez A, Briceño FJ, Cabañas J, Cánovas G, Caravaca I, Carbonell S, Carrera-Dacosta E, Castro EE, Caula C, Choolani-Bhojwani E, Codina A, Corral S, Cuenca C, Curbelo-Peña Y, Delgado-Morales MM, Delgado-Plasencia L, Doménech E, Estévez AM, Feria AM, Gascón-Domínguez MA, Gianchandani R, González C, Hevia RJ, González MA, Hidalgo JM, Lainez M, Lluís N, López F, López-Fernández J, López-Ruíz JA, Lora-Cumplido P, Madrazo Z, Marchena J, de la Cuadra MB, Martín S, Casas MI, Martínez P, Mena-Mateos A, Morales-García D, Mulas C, Muñoz-Forner E, Naranjo A, Navarro-Sánchez A, Oliver I, Ortega I, Ortega-Higueruelo R, Ortega-Ruiz S, Osorio J, Padín MH, Pamies JJ, Paredes M, Pareja-Ciuró F, Parra J, Pérez-Guarinós CV, Pérez-Saborido B, Pintor-Tortolero J, Plua-Muñiz K, Rey M, Rodríguez I, Ruiz C, Ruíz R, Ruiz S, Sánchez A, Sánchez D, Sánchez R, Sánchez-Cabezudo F, Sánchez-Santos R, Santos J, Serrano-Paz MP, Soria-Aledo V, Tallón-Aguilar L, Valdivia-Risco JH, Vallverdú-Cartié H, Varela C, Villar-Del-Moral J, Zambudio N. Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study. Int J Surg 2022; 97:106168. [PMID: 34785344 DOI: 10.1016/j.ijsu.2021.106168] [Citation(s) in RCA: 2] [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: 09/09/2021] [Revised: 10/24/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.
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Affiliation(s)
- C Villodre
- Hospital Gran Canaria Doctor Negrín, Las Palmas de Gran Canarias, Spain Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain Hospital Lluís Alcanyís de Xàtiva, Valencia, Spain Hospital Universitario de Badajoz, Badajoz, Spain Hospital Universitario de Bellvitge, Barcelona, Spain Hospital Marina Baixa, Alicante, Spain Hospital Juan Ramón Jiménez, Infanta Elena, Huelva, Spain Hospital Infanta Cristina, Parla, Madrid, Spain Hospital Universitario de Canarias, Tenerife, Spain Hospital Reina Sofía de Córdoba, Córdoba, Spain H. Ramón y Cajal, Madrid, Spain Hospital Parc Taulí de Sabadell, Barcelona, Spain Hospital General Universitario de Alicante, Alicante, Spain Complejo Hospitalario Universitario de Vigo, Hospital Pontevedra, Spain Hospital Trueta de Girona, Girona, Spain Hospital Universitario Rio Hortega, Valladolid, Spain Hospital Mutua Terrassa, Barcelona, Spain Consorci Hospitalari de Vic, Barcelona, Spain POVISA, Pontevedra, Spain Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain Hospital Universitario Basurto, Bizkaia, Spain Hospital Universitario Marqués de Valdecilla, Santander, Spain Hospital de Viladecans, Barcelona, Spain Hospital Clínico de Valencia, Valencia, Spain Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain Hospital Vírgen de la Macarena, Sevilla, Spain Hospital Cabueñes, Gijón, Spain Complejo Hospitalario de Jaén, Jaén, Spain Hospital Universitari Sant Joan de Reus, Tarragona, Spain Hospital Universitario Infanta Sofía, Madrid, Spain Complejo Hospitalario Torrecárdenas, Almería, Spain Hospital Sant Pau i Santa Tecla, Tarragona, Spain Hospital General Rafael Méndez de Lorca, Murcia, Spain Hospital Vírgen del Rocío, Sevilla, Spain Hospital Morales Meseguer, Murcia, Spain Hospital del Vinalopó, Alicante, Spain Hospital Universitario del Vinalopó, Alicante, Spain Hospital Universitario Virgen de las Nieves, Granada, Spain Department of Surgery, General University Hospital of Alicante, Alicante, Spain Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain Computing, BomhardIP, Alicante, Spain Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
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Madrazo Z, Osorio J, Videla S, Sainz B, Rodríguez-González A, Campos A, Santamaría M, Pelegrina A, González-Serrano C, Aldeano A, Sarriugarte A, Gómez-Díaz CJ, Ruiz-Luna D, García-Ruiz-de-Gordejuela A, Gómez-Gavara C, Gil-Barrionuevo M, Vila M, Clavell A, Campillo B, Millán L, Olona C, Sánchez-Cordero S, Medrano R, López-Arévalo CA, Pérez-Romero N, Artigau E, Calle M, Echenagusia V, Otero A, Tebé C, Pallarès N, Biondo S. P-POSSUM as mortality predictor in COVID-19-infected patients submitted to emergency digestive surgery. A retrospective cohort study. Int J Surg 2021; 96:106171. [PMID: 34774727 PMCID: PMC8580568 DOI: 10.1016/j.ijsu.2021.106171] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND COVID-19 infection is associated with a higher mortality rate in surgical patients, but surgical risk scores have not been validated in the emergency setting. We aimed to study the capacity for postoperative mortality prediction of the P-POSSUM score in COVID-19-positive patients submitted to emergency general and digestive surgery. MATERIAL AND METHODS Consecutive patients undergoing emergency general and digestive surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective cohort study. MAIN OUTCOME 30-day mortality. P-POSSUM discrimination was quantified by the area under the curve (AUC) of ROC curves; calibration was assessed by linear regression slope (β estimator); and sensitivity and specificity were expressed as percentage and 95% confidence interval (CI). RESULTS 4988 patients were included: 177 COVID-19-positive; 2011 intra-pandemic COVID-19-negative; and 2800 pre-pandemic. COVID-19-positive patients were older, with higher surgical risk, more advanced pathologies, and higher P-POSSUM values (1.79% vs. 1.09%, p < 0.001, in both the COVID-19-negative and control cohort). 30-day mortality in the COVID-19-positive, intra-pandemic COVID-19-negative and pre-pandemic cohorts were: 12.9%, 4.6%, and 3.2%. The P-POSSUM predictive values in the three cohorts were, respectively: AUC 0.88 (95% CI 0.81-0.95), 0.89 (95% CI 0.87-0.92), and 0.91 (95% CI 0.88-0.93); β value 0.97 (95% CI 0.74-1.2), 0.99 (95% CI 0.82-1.16), and 0.78 (95% CI 0.74-0.82); sensitivity 83% (95% CI 61-95), 91% (95% CI 84-96), and 89% (95% CI 80-94); and specificity 81% (95% CI 74-87), 76% (95% CI 74-78), and 80% (95% CI 79-82). CONCLUSION The P-POSSUM score showed a good predictive capacity for postoperative mortality in COVID-19-positive patients submitted to emergency general and digestive surgery.
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Affiliation(s)
- Zoilo Madrazo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain Clinical Research Support Unit (HUB-IDIBELL), Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain Department of Surgery, Donostia University Hospital, San Sebastian, Spain Department of Surgery, Parc Taulí Health Corporation, Sabadell Hospital, Sabadell, Spain Department of Surgery, Arnau de Vilanova University Hospital, Lleida, Spain Department of Surgery, Hospital del Mar University Hospital, Barcelona, Spain Department of Surgery. Basurto University Hospital, Bilbao, Spain Department of Surgery, Granollers General Hospital, Granollers, Spain Department of Surgery, Cruces University Hospital, Bilbao, Spain Department of Surgery, Althaia Foundation, Manresa, Spain Department of Surgery, Terrassa Health Consortium, Terrassa Hospital, Terrassa, Spain General Surgery Department, Vall d'Hebrón University Hospital, Barcelona, Spain Hepatobiliopancreatic Surgery and Transplantation Department, Vall d'Hebrón University Hospital, Barcelona, Spain Department of Surgery, Viladecans Hospital, Viladecans, Spain Department of Surgery, Mataró Hospital, Maresme Health Consortium, Mataró, Spain Department of Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain Department of Surgery, Sant Joan de Deu Hospital Foundation, Martorell, Spain Department of Surgery, Dr. José Molina Orosa Hospital, Lanzarote, Spain Department of Surgery, Joan XXIII University Hospital, Tarragona, Spain Department of Surgery, Igualada University Hospital, Anoia Health Consortium, Igualada, Spain Department of Surgery, Sant Pau University Hospital, Barcelona, Spain Department of Surgery. Moisès Broggi Hospital, Sant Joan Despí, Spain Department of Surgery, Mútua de Terrassa University Hospital, Terrassa, Spain Department of Surgery, Girona Dr.Josep Trueta University Hospital, Girona, Spain Department of Surgery, Alto Deba Hospital, Mondragon, San Sebastián, Spain Department of Surgery, Araba University Hospital, Txagorritxu Hospital, Vitoria, Spain Clinical Research Support Unit, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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18
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Osorio J, Madrazo Z, Biondo S. [To answer quickly or rigorously? Scientific strategies for the new surgical questions after the emergence of COVID-19]. Cir Esp 2021; 100:725-726. [PMID: 34840337 PMCID: PMC8604713 DOI: 10.1016/j.ciresp.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Javier Osorio
- Servicio de cirugía general y digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Zoilo Madrazo
- Servicio de cirugía general y digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Sebastiano Biondo
- Servicio de cirugía general y digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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19
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Osorio J, Madrazo Z, Videla S, Sainz B, Rodríguez-González A, Campos A, Santamaría M, Pelegrina A, González-Serrano C, Aldeano A, Sarriugarte A, Gómez-Díaz CJ, Ruiz-Luna D, García-Ruiz-de-Gordejuela A, Gómez-Gavara C, Gil-Barrionuevo M, Vila M, Clavell A, Campillo B, Millán L, Olona C, Sánchez-Cordero S, Medrano R, López-Arévalo CA, Pérez-Romero N, Artigau E, Calle M, Echenagusia V, Otero A, Tebe C, Pallares N, Biondo S. Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic. Br J Surg 2021; 108:1438-1447. [PMID: 34535796 DOI: 10.1093/bjs/znab299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/25/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection. METHODS Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). The main outcome was 30-day mortality. Secondary outcomes included postoperative complications and failure to rescue (mortality among patients who developed complications). Propensity score-matched comparisons were performed between patients who were positive and those who were negative for COVID-19; and between COVID-19-negative cohorts before and during the pandemic. RESULTS Some 5307 patients were included in the study (183 COVID-19-positive and 2132 COVID-19-negative during pandemic; 2992 treated before pandemic). During the pandemic, patients with COVID-19 infection had greater 30-day mortality than those without (12.6 versus 4.6 per cent), but this difference was not statistically significant after propensity score matching (odds ratio (OR) 1.58, 95 per cent c.i. 0.88 to 2.74). Those positive for COVID-19 had more complications (41.5 versus 23.9 per cent; OR 1.61, 1.11 to 2.33) and a higher likelihood of failure to rescue (30.3 versus 19.3 per cent; OR 1.10, 0.57 to 2.12). Patients who were negative for COVID-19 during the pandemic had similar rates of 30-day mortality (4.6 versus 3.2 per cent; OR 1.35, 0.98 to 1.86) and complications (23.9 versus 25.2 per cent; OR 0.89, 0.77 to 1.02), but a greater likelihood of failure to rescue (19.3 versus 12.9 per cent; OR 1.56, 95 per cent 1.10 to 2.19) than prepandemic controls. CONCLUSION Patients with COVID-19 infection undergoing emergency general and gastrointestinal surgery had worse postoperative outcomes than contemporary patients without COVID-19. COVID-19-negative patients operated on during the COVID-19 pandemic had a likelihood of greater failure-to-rescue than prepandemic controls.
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Affiliation(s)
- J Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Z Madrazo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - S Videla
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - B Sainz
- Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - A Campos
- Department of Surgery, Parc Taulí Health Corporation, Sabadell Hospital, Sabadell, Spain
| | - M Santamaría
- Department of Surgery, Arnau de Vilanova University Hospital, Lleida, Spain
| | - A Pelegrina
- Department of Surgery, Hospital del Mar University Hospital, Barcelona, Spain
| | | | - A Aldeano
- Department of Surgery, Granollers General Hospital, Granollers, Spain
| | - A Sarriugarte
- Department of Surgery, Cruces University Hospital, Bilbao, Spain
| | - C J Gómez-Díaz
- Department of Surgery, Althaia Foundation, Manresa, Spain
| | - D Ruiz-Luna
- Department of Surgery, Terrassa Health Consortium, Terrassa Hospital, Terrassa, Spain
| | | | - C Gómez-Gavara
- Hepatobiliopancreatic Surgery and Transplantation Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | - M Vila
- Department of Surgery, Mataró Hospital, Maresme Health Consortium, Mataró, Spain
| | - A Clavell
- Department of Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - B Campillo
- Department of Surgery, Sant Joan de Deu Hospital Foundation, Martorell, Spain
| | - L Millán
- Department of Surgery, Dr José Molina Orosa Hospital, Lanzarote, Spain
| | - C Olona
- Department of Surgery, Joan XXIII University Hospital, Tarragona, Spain
| | - S Sánchez-Cordero
- Department of Surgery, Igualada University Hospital, Anoia Health Consortium, Igualada, Spain
| | - R Medrano
- Department of Surgery, Sant Pau University Hospital, Barcelona, Spain
| | - C A López-Arévalo
- Department of Surgery, Moisès Broggi Hospital, Sant Joan Despí, Spain
| | - N Pérez-Romero
- Department of Surgery, Mútua de Terrassa University Hospital, Terrassa, Spain
| | - E Artigau
- Department of Surgery, Girona Dr Josep Trueta University Hospital, Girona, Spain
| | - M Calle
- Department of Surgery, Alto Deba Hospital, Mondragon, San Sebastián, Spain
| | - V Echenagusia
- Department of Surgery, Araba University Hospital, Txagorritxu Hospital, Vitoria, Spain
| | - A Otero
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Tebe
- Statistical Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - N Pallares
- Statistical Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Biondo
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
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20
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Admella V, Osorio J, Sorribas M, Sobrino L, Casajoana A, Pujol-Gebellí J. Direct and two-step single anastomosis duodenal switch (SADI-S): Unicentric comparative analysis of 232 cases. Cir Esp 2021; 99:514-520. [PMID: 34217637 DOI: 10.1016/j.cireng.2021.06.017] [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: 04/13/2020] [Accepted: 09/14/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The "Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy" (SADI-S) is a bariatric surgery conceived to simplify the duodenal switch in order to reduce its postoperative complications. The objective of this study is to assess the safety and efficacy of SADI-S, comparing its results in both direct and two-step procedure. METHODS Unicentric cohort study that includes patients submitted to SADI-S, both direct or in two-step, between 2014 and 2019. RESULTS Two hundred thirty-two patients were included, 192 were submitted to direct SADI-S and 40 had previously undergone a sleeve gastrectomy. The severe complications rate (Clavien-Dindo ≥ IIIA) was 7.8%, being hemoperitoneum and duodenal stump leak the most frequent ones. One patient was exitus between the first 90 days after surgery (0.4%). Patients submitted to direct SADI-S had an initial body mass index (BMI) of 49.6 kg/m2 in comparison of 56.2 kg/m2 in the two-step SADI-S (P < .001). The mean excess weight loss (EWL) at two years was higher in direct SADI-S (77.3 vs. 59.3%, P < .05). Rate of comorbidities resolution was 88.5% for diabetes, 73.0% for hypertension, 77.0% for dyslipidemia and 85.7% for sleep apnea, with no differences between both techniques. CONCLUSION In medium term, SADI-S is a safe and effective technique that offers a satisfactory weight loss and remission of comorbidities. Patients submitted to two-step SADI-S had a higher initial BMI and presented a lower EWL than direct SADI-S.
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Affiliation(s)
- Víctor Admella
- Unidad de Cirugía Bariátrica, Hospital Universitario de Bellvitge - IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Osorio
- Unidad de Cirugía Bariátrica, Hospital Universitario de Bellvitge - IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
| | - Maria Sorribas
- Unidad de Cirugía Bariátrica, Hospital Universitario de Bellvitge - IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Lucía Sobrino
- Unidad de Cirugía Bariátrica, Hospital Universitario de Bellvitge - IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Casajoana
- Unidad de Cirugía Bariátrica, Hospital Universitario de Bellvitge - IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Pujol-Gebellí
- Unidad de Cirugía Bariátrica, Hospital Universitario de Bellvitge - IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
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21
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Aksu T, Yalin K, John L, Osorio J, Winterfield J, Aras D, Gopinathannair R. Effect of general and local anesthesia on the vagal response characteristics during ganglionated plexus ablation. Europace 2021. [DOI: 10.1093/europace/euab116.324] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The effect of different anesthetics on the function of the autonomic nervous system (ANS) is not well known. As a relatively new treatment option, ganglionated plexus (GP) ablation aims to modify the behavior of the cardiac ANS to prevent some/all of the autonomic processes occurring in vasovagal syncope (VVS) by using endocardial ablation techniques.
Purpose
The purpose of this study was to determine the effects midazolam and propofol on the vagal response (VR) characteristics during GP ablation in patients with vasovagal syncope (VVS).
Methods
Forty consecutive patients undergoing GP ablation for VVS were divided to receive local anesthesia with midazolam (group 1, n = 29) or general anesthesia with propofol (group EA, n = 11). All GP sites were detected by using previously defined fragmented electrogram based strategy. VR was defined on 3 levels: 1) R-R interval increased by 50% (level 1); 2) R-R interval increased by 20-50% (level 2); and 3) R-R interval increase lower than 20% (level 3).
Results
Baseline characteristics and mean follow-up times were comparable between groups. In both groups, the left superior GP (LSGP) was the most common GP site at which a VR was observed. However, there was a significant difference between groups for level of VR. While ablation on the LSGP caused a level 1 VR in 89.6% of cases in group 1, level 1 VR was seen in 22.2% of cases in group 2 (p < 0.0001). Similarly, ratio of level 1 VR during ablation on the left inferior GP (LIGP) was significantly lower in group 2 (44.8% vs 9%, p = 0.034). Once cut-off for VR was decreased to level 2, the ratio of (+) VR increased to 90.9% during ablation on the LSGP in group 2. Level 2 VR was detected in 45.4% of cases during ablation on the LIGP. Ratio of positive VRs in any level was lower than 20% during ablation on the right superior and inferior GPs in both groups. During a mean follow-up time of 12.1 ± 7 months, all but 2 (5%) of 40 patients were free of syncope.
Conclusions
The autonomic nervous tone might be affected in different ways by local and general anesthesia. Propofol may reveal a shift in the sympathovagal balance toward sympathetic predominance which may cause a blunting on VR during GP ablation. Further randomized, controlled and multicenter studies should be performed to confirm these findings.
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Affiliation(s)
- T Aksu
- Kocaeli Derince Hospital, Kocaeli, Turkey
| | - K Yalin
- Istanbul University Cerrahpasa Faculty of Medicine, Cardiology, Istanbul, Turkey
| | - L John
- medical university of southern california, southern california, United States of America
| | - J Osorio
- Arrhythmia Institute at Grandview, Alabama, United States of America
| | - J Winterfield
- medical university of southern california, southern california, United States of America
| | - D Aras
- Ankara City Hospital, Ankara, Turkey
| | - R Gopinathannair
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, United States of America
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22
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Lazzara C, Osorio J, Valcarcel J, Pujol-Gebellí J. Gastrointestinal Bleeding After Laparoscopic Duodenal Switch and SADI-S Caused by Pseudoaneurysm of Gastroduodenal Artery: First Reported Cases. Obes Surg 2021; 31:3330-3332. [PMID: 33754276 DOI: 10.1007/s11695-021-05358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Claudio Lazzara
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.
| | - Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Joana Valcarcel
- Department of Radiology, Vascular and Interventional Radiology Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Jordi Pujol-Gebellí
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
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Madrazo Z, Osorio J, Biondo S, Otero A, Videla S. Comments on: Patterns of acute surgical inflammatory processes presentation of in the COVID-19 outbreak (PIACO Study): surgery may be the best treatment option. Br J Surg 2021; 108:e40-e41. [PMID: 33640954 PMCID: PMC7929193 DOI: 10.1093/bjs/znaa024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Z Madrazo
- Department of General and Digestive Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - J Osorio
- Department of General and Digestive Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - S Biondo
- Department of General and Digestive Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - A Otero
- Research Support Unit, Bellvitge Biomedical Research Institute, Department of Clinical Pharmacology, University of Barcelona, Barcelona, Spain
| | - S Videla
- Research Support Unit, Bellvitge Biomedical Research Institute, Department of Clinical Pharmacology, University of Barcelona, Barcelona, Spain
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Sorribas M, Casajoana A, Sobrino L, Admella V, Osorio J, Pujol-Gebellí J. Experience in biliopancreatic diversion with duodenal switch: results at 2, 5 and 10 years. Cir Esp 2021; 100:S0009-739X(21)00030-0. [PMID: 33593597 DOI: 10.1016/j.ciresp.2021.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/17/2020] [Accepted: 01/15/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Duodenal switch (DS) is considered one of the most effective techniques to achieve weight loss and reduce comorbidities in patients with morbidly obesity. MATERIAL AND METHODS Descriptive single-center study. 224 patients were analyzed who underwent direct laparoscopic DS in our center. The objective was to describe the results of weight, resolution of comorbidities, nutritional supplementation and postoperative complications at 2, 5 and 10 years. RESULTS The mean age of the cohort was 49.3 [23-65] years and the mean weight and BMI were 131.8 [20]kg and 49.8 [5]kg/m2. The excess weight lost percentage at 2, 5 and 10 years was 80.6[15]%, 69.3[18]%, 67.4[18]%, respectively. Complete remission of diabetes was evidenced at 2 and 5 years in 35 (85.4%) and 27 (70.4%) patients. In the immediate postoperative period, the complication rate for Clavien-Dindo ≥ III was 15 patients (6.7%) and mortality at 30 and 90 days was 1 (0.4%) and 2 (0.9%) patients. Revisional surgery was performed in 2 patients (0.9%). 80% of the patients required an extra nutritional supplement up to 10 years after surgery. CONCLUSIONS Direct DS is a safe and effective technique in patients with a BMI between 45 and 55 kg/m2. Weight loss is maintained with a low rate of revision surgery. It is a metabolically effective technique that entails the need for a close postoperative follow-up to assess nutritional supplementation.
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Affiliation(s)
- Maria Sorribas
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Anna Casajoana
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - Lucía Sobrino
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Víctor Admella
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Javier Osorio
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Jordi Pujol-Gebellí
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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25
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Madrazo Z, Osorio J, Otero A, Biondo S, Videla S. Postoperative complications and mortality following emergency digestive surgery during the COVID-19 pandemic: A multicenter collaborative retrospective cohort study protocol (COVID-CIR). Medicine (Baltimore) 2021; 100:e24409. [PMID: 33592888 PMCID: PMC7870207 DOI: 10.1097/md.0000000000024409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/25/2020] [Accepted: 01/04/2021] [Indexed: 01/19/2023] Open
Abstract
ABSTRACT Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).
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Affiliation(s)
- Zoilo Madrazo
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Javier Osorio
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Aurema Otero
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Sebastian Videla
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)
- Department of Pathology and Experimental Therapeutics, Faculty of Medicine, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
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Blondon M, Jimenez D, Robert‐Ebadi H, Del Toro J, Lopez‐Jimenez L, Falga C, Skride A, Font L, Vazquez FJ, Bounameaux H, Monreal M, Prandoni P, Brenner, B, Farge‐Bancel D, Barba R, Di Micco P, Bertoletti L, Schellong S, Tzoran I, Reis A, Bosevski M, Malý R, Verhamme P, Caprini JA, My Bui H, Adarraga MD, Agud M, Aibar J, Aibar MA, Alfonso J, Amado C, Arcelus JI, Baeza C, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón‐Andrés B, Blanco‐Molina A, Botella E, Camon AM, Castro J, Caudevilla MA, Cerdà P, Chasco L, Criado J, de Ancos C, de Miguel J, Demelo‐Rodríguez P, Díaz‐Peromingo JA, Díez‐Sierra J, Díaz‐Simón R, Domínguez IM, Encabo M, Escribano JC, Falgá C, Farfán AI, Fernández‐Capitán C, Fernández‐Reyes JL, Fidalgo MA, Flores K, Font C, Francisco I, Gabara C, Galeano‐Valle F, García MA, García‐Bragado F, García‐Mullor MM, Gavín‐Blanco O, Gavín‐Sebastián O, Gil‐Díaz A, Gómez‐Cuervo C, González‐Martínez J, Grau E, Guirado L, Gutiérrez J, Hernández‐Blasco L, Jara‐Palomares L, Jaras MJ, Jiménez D, Joya MD, Jou I, Lacruz B, Lecumberri R, Lima J, Lobo JL, López‐Brull H, López‐Jiménez L, López‐Miguel P, López‐Núñez JJ, López‐Reyes R, López‐Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Maestre A, Marchena PJ, Martín del Pozo M, Martín‐Martos F, Martínez‐Baquerizo C, Mella C, Mellado M, Mercado MI, Moisés J, Morales MV, Muñoz‐Blanco A, Muñoz‐Guglielmetti D, Muñoz‐Rivas N, Nart E, Nieto JA, Núñez MJ, Olivares MC, Ortega‐Michel C, Ortega‐Recio MD, Osorio J, Otalora S, Otero R, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez‐Jacoiste A, Peris ML, Pesántez D, Porras JA, Portillo J, Reig L, Riera‐Mestre A, Rivas A, Rodríguez‐Cobo A, Rodríguez‐Matute C, Rogado J, Rosa V, Rubio CM, Ruiz‐Artacho P, Ruiz‐Giménez N, Ruiz‐Ruiz J, Ruiz‐Sada P, Sahuquillo JC, Salgueiro G, Sampériz A, Sánchez‐Muñoz‐Torrero JF, Sancho T, Sigüenza P, Sirisi M, Soler S, Suárez S, Suriñach JM, Tiberio G, Torres MI, Tolosa C, Trujillo‐Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vidal G, Vilar C, Villares P, Zamora C, Gutiérrez P, Vázquez FJ, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bertoletti L, Bura‐Riviere A, Crichi B, Debourdeau P, Espitia O, Farge‐Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Ciammaichella M, Colaizzo D, Dentali F, Di Micco P, Giammarino E, Grandone E, Mangiacapra S, Mastroiacovo D, Maida R, Mumoli N, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Vo Hong N, Zalunardo B, Kalejs RV, Maķe K, Ferreira M, Fonseca S, Martins F, Meireles J, Bosevski M, Zdraveska M, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, Bui HM. Comparative clinical prognosis of massive and non-massive pulmonary embolism: A registry-based cohort study. J Thromb Haemost 2021; 19:408-416. [PMID: 33119949 DOI: 10.1111/jth.15146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
AIMS Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. METHODS AND RESULTS We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time-to-event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28-2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75-1.74) than non-massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non-massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51-1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82-16.24). CONCLUSION In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.
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Affiliation(s)
- Marc Blondon
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - David Jimenez
- Respiratory Department Hospital Ramón y Cajal and Medicine Department Universidad de Alcalá (IRYCIS) Madrid Spain
| | - Helia Robert‐Ebadi
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Jorge Del Toro
- Department of Internal Medicine Hospital General Universitario Gregorio Marañón Madrid Spain
| | | | - Conxita Falga
- Department of Internal Medicine Hospital de Mataro Barcelona Spain
| | - Andris Skride
- Department of Cardiology Ospedale Pauls Stradins Clinical University Hospital Riga Latvia
| | - Llorenç Font
- Department of Haematology Hospital de Tortosa Verge de la Cinta Tarragona Spain
| | | | - Henri Bounameaux
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Manuel Monreal
- Department of Internal Medicine Hospital Germans Trias i Pujol Badalona Spain
- Universidad Catolica de Murcia Murcia Spain
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Morales G, Boghossian E, Rajendra A, Osorio J. Durable pulmonary vein (PV) isolation at repeat atrial fibrillation (AF) ablation procedure: a comparison between 4 ablation technologies. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Durable PV isolation is the sought-after endpoint to obtain long term success after AF catheter ablation. Evolution in technology improves efficiency, safety and effectiveness in AF catheter ablation.
Purpose
To investigate the effectiveness of different catheter technologies in obtaining durable PV isolation in a real-world practice.
Methods
Retrospective analysis of prospectively collected data of patients undergoing repeat procedures for recurrence of AF or atrial flutter at our institution was performed. Incidence of all PVs being isolated at repeat procedure was recorded and patients 4 groups created based on catheter technology used during index AF ablation procedure (SF: multipored, irrigated catheter; ST: contact force sensor catheter; Cryo: 2nd generation cryobaloon; and STSF: multipored, irrigated, contact force sensing catheter).
Results
We identified 269 subjects undergoing repeat ablation from May 2014 to September 2019. Mean age was 67±9.7 years, 54.6% were males, 74.4% non-paroxysmal AF at the index procedure. The mean CHA2DS2Vasc score was 2.5±0.26, LA size 4.2±0.6 cm, EF 55.3±10%. The mean time from index to redo procedure was 374±331 days. At repeat procedure all veins were isolated in 24% (6/25) who were initially ablated using SF; 36% (8/22) with Cryo; 44% (47/108) with ST; and 74% (84/114) with STSF catheter. (Figure)
Conclusion
Patients undergoing index ablation with STSF catheter technology were significantly more likely to have all 4 PVs isolated at repeat procedure compared to previous generation technology.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Biosense Webster
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Affiliation(s)
- G Morales
- Arrhythmia Institute at Grandview, Birmingham, United States of America
| | - E Boghossian
- Arrhythmia Institute at Grandview, Birmingham, United States of America
| | - A Rajendra
- Arrhythmia Institute at Grandview, Birmingham, United States of America
| | - J Osorio
- Arrhythmia Institute at Grandview, Birmingham, United States of America
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Natale A, Calkins H, Osorio J, Pollack S, Melby D, Marchlinski F, Athill C, Delaughter C, Patel A, Gentlesk P, Deville B, Macle L, Ellenbogen K, Dukkipati S, Mansour M. Positive clinical benefit on patient care, quality of life and symptoms after radiofrequency ablation with contact force in persistent atrial fibrillation: analyses from PRECEPT. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The management of persistent (PsAF) aims to prevent AF recurrence and associated disabilities while reducing side effects from treatment. Contact force (CF)-guided RF catheters have proven efficacious and safe for pulmonary vein isolation (PVI) to treat paroxysmal AF; however, there is limited evidence on clinical benefits with ablation of PsAF.
Purpose
To assess long-term clinical effects on patients care, symptoms and QOL after CF-guided RF ablation in PsAF.
Methods
PRECEPT was a multicenter study evaluating the safety and efficacy of CF RF catheters in the treatment of symptomatic PsAF (NCT02817776). PVI was performed with or without substrate modification. Patients were followed at 6, 9, 12 and 15 mos to collect the following data: Atrial Fibrillation Effect on Quality-of-Life (AFEQT) score, Canadian Cardiovascular Society Severity of Atrial Fibrillation (CCS-SAF) score, Class I/III AAD use, and incidence of cardioversion and cardiovascular hospitalization.
Results
A total of 333 enrolled patients (65.4±8.8 yrs, 71.2% male, CHA2DS2-VASC score 2.3±1.5) underwent PVI. Compared to baseline, 1) improvements in the AFEQT composite and subscores were seen from 6–15 mos, exceeding Clinical Important Difference (±5 points) in majority of subjects (Figure), 2) proportion of CCS-SAF Class 0 patients (asymptomatic with respect to AF) rose from 0.7% to 81.0%, 3) class I/III AAD use was reduced from 97.0% to 24.7%, and 4) incidence of cardioversion decreased from 62.0% to 10.7%. Moreover, the 1-yr Kaplan-Meier estimate of freedom from hospitalization was 84.2% [95% CI: 80.2%, 88.2%].
Conclusion
CF-guided RF ablation in PsAF patients led to a clinically meaningful improvement in QOL, as well as a reduction in AAD use, cardioversion, and hospitalization.
Figure 1. Mean AFEQT composite and subscore
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This study was funded by Biosense Webster, Inc.
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Affiliation(s)
- A Natale
- St. David's Medical Center, Austin, United States of America
| | - H Calkins
- Johns Hopkins University, Baltimore, United States of America
| | - J Osorio
- University of Alabama Birmingham, Arrhythmia Institute at Grandview, Birmingham, United States of America
| | - S.J Pollack
- Florida Hospital Medical Group, Orlando, United States of America
| | - D Melby
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - F.E Marchlinski
- University of Pennsylvania, Philadelphia, United States of America
| | - C.A Athill
- Scripps Clinic, San Diego, United States of America
| | | | - A Patel
- Saint Joseph's Translational Research Institute, Atlanta, United States of America
| | - P.J Gentlesk
- Sentara Cardiovascular Research Institute, Norfolk, United States of America
| | - B Deville
- Baylor Scott & White Health, Dallas, United States of America
| | - L Macle
- Montreal Heart Institute, Montreal, Canada
| | - K.A Ellenbogen
- Virginia Commonwealth University, Richmond, United States of America
| | - S Dukkipati
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Mansour
- Mass General Hopital (MGH), Boston, United States of America
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Osorio J, Hunter T, Rajendra A, Zei P, Morales G. First pass isolation predicts clinical success after contact force guided paroxysmal atrial fibrillation ablation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0421] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Contact force (CF) ablation of AF with a focus on catheter-tissue contact stability optimizes clinical success and may help the operator to achieve pulmonary vein (PV) isolation in a single encirclement. While it seems evident that first pass isolation reduces procedure time, the effect on long term clinical success has not been reported.
Purpose
To evaluate the relationship between first pass isolation and freedom from atrial tachyarrhythmia recurrence at 1 year after PAF ablation.
Methods
Consecutive de novo PAF ablations were performed with a porous tip contact force catheter in 2017. All ablations used wide-area circumferential ablation and first pass isolation was captured separately for the left and right PVs. CF was held between 10–20 g and the catheter was moved every 10–20 s. RF energy was set at 40W throughout the atrium. Clinical success was defined as freedom from recurrent atrial tachyarrhythmia through 1 year following a 90-day blanking period and freedom from reablation at any time through 1 year.
Results
The population included 157 patients, age 62.7±11.5, 54.8% male, with mean CHA2DS2-VASc score of 2.3±1.5. Mean procedure times were 76.2±29.8 minutes and 89.2% of the ablations were performed with no fluoroscopy. The overall clinical success rate at 1 year was 86.1%. The number of ipsilateral PV pairs that could be isolated in a single pass was significantly associated with 1-year success (p=0.0043). Achieving first pass isolation on even one ipsilateral PV pair vs. neither pair was significantly associated with clinical success (Table).
Conclusion
In a real-world setting, first pass isolation on at least one PV side was predictive of 1 year clinical success in a PAF population ablated with CF.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Biosense Webster, Inc.
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Affiliation(s)
- J Osorio
- Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, United States of America
| | - T.D Hunter
- CTI Clinical Trial & Consulting Services, Real World Evidence, Covington, United States of America
| | - A Rajendra
- Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, United States of America
| | - P Zei
- Brigham and Women'S Hospital, Harvard Medical School, Medicine, Boston, United States of America
| | - G Morales
- Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, United States of America
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Schafasand M, Kragl G, Osorio J, Vatnitsky S, Stock M, Carlino A. PO-1410: Trend lines on patient specific quality assurance in ion beam therapy with protons and carbon ions. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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31
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Marín Ramírez JM, Oblak E, Riego P, Campillo G, Osorio J, Arnache O, Berger A. Experimental exploration of dynamic phase transitions and associated metamagnetic fluctuations for materials with different Curie temperatures. Phys Rev E 2020; 102:022804. [PMID: 32942401 DOI: 10.1103/physreve.102.022804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/28/2020] [Indexed: 11/07/2022]
Abstract
We study dynamic magnetic behavior in the vicinity of the dynamic phase transition (DPT) for a suitable series of samples that have different Curie temperatures T_{C}, which thus enables us to experimentally explore the role of the reduced temperature T/T_{C} in the DPT. For this purpose, we fabricate Co_{1-x}Ru_{x} epitaxial thin films with uniaxial in-plane anisotropy by means of sputter deposition in the concentration range 0.0≤x≤0.26. All samples are ferromagnetic at room temperature, exhibit an abrupt magnetization reversal along their easy axis, and represent a unique T_{C} and thus T/T_{C} ratio according to their Ru concentration. The dynamic magnetic behavior is measured by using an ultrasensitive transverse magneto-optical detection method and the resulting dynamic states are explored as a function of the applied magnetic field amplitude H_{0} and period P, as well as an additional bias field H_{b}, which is the conjugate field of the dynamic order parameter Q. Our experimental results demonstrate that the qualitative behavior of the dynamic phase diagram is independent of the T/T_{C} ratio and that for all T/T_{C} values we observe metamagnetic anomalies in the dynamic paramagnetic state, which do not exist in the corresponding thermodynamic phase diagram. However, quantitatively, these metamagnetic anomalies are very strongly dependent on the T/T_{C} ratio, leading to an about 20-fold increase of large metamagnetic fluctuations in the paramagnetic regime as the T/T_{C} ratio increases from 0.37 to 0.68. Also, the phase space range in which these anomalous metamagnetic fluctuations occur extends closer and closer to the critical point as T/T_{C} increases.
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Affiliation(s)
- J M Marín Ramírez
- CIC nanoGUNE BRTA, 20018 Donostia - San Sebastián, Spain.,Instituto de Física, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Apartado Aéreo 1226, Medellín, Colombia
| | - E Oblak
- CIC nanoGUNE BRTA, 20018 Donostia - San Sebastián, Spain
| | - P Riego
- CIC nanoGUNE BRTA, 20018 Donostia - San Sebastián, Spain.,Departamento de Física de la Materia Condensada, Universidad del País Vasco (UPV/EHU), 48080 Bilbao, Spain
| | - G Campillo
- Facultad de Ciencias Básicas, Universidad de Medellín, Medellín, Colombia
| | - J Osorio
- Instituto de Física, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Apartado Aéreo 1226, Medellín, Colombia
| | - O Arnache
- Instituto de Física, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Apartado Aéreo 1226, Medellín, Colombia
| | - A Berger
- CIC nanoGUNE BRTA, 20018 Donostia - San Sebastián, Spain
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Guerrero-Pérez F, Casajoana A, Gómez-Vaquero C, Virgili N, López-Urdiales R, Hernández-Montoliu L, Pujol-Gebelli J, Osorio J, Alves C, Perez-Maraver M, Pellitero S, Vidal-Alabró A, Fernández-Veledo S, Vendrell J, Vilarrasa N. Changes in Bone Mineral Density in Patients with Type 2 Diabetes After Different Bariatric Surgery Procedures and the Role of Gastrointestinal Hormones. Obes Surg 2020; 30:180-188. [PMID: 31420830 DOI: 10.1007/s11695-019-04127-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
BACKGROUND To compare changes in bone mineral density (BMD) in patients with morbid obesity and type 2 diabetes (T2D) a year after being randomized to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP). We also analyzed the association of gastrointestinal hormones with skeletal metabolism. METHODS Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Before and 12 months after surgery, anthropometric, body composition, biochemical parameters, fasting plasma glucagon, ghrelin, and PYY as well as GLP-1, GLP-2, and insulin after a standard meal were determined. RESULTS After surgery, the decrease at femoral neck (FN) was similar but at lumbar spine (LS), it was greater in the mRYGB group compared with SG and GCP - 7.29 (4.6) vs. - 0.48 (3.9) vs. - 1.2 (2.7)%, p < 0.001. Osteocalcin and alkaline phosphatase increased more after mRYGB. Bone mineral content (BMC) at the LS after surgery correlated with fasting ghrelin (r = - 0.412, p = 0.01) and AUC for GLP-1 (r = - 0.402, p = 0.017). FN BMD at 12 months correlated with post-surgical fasting glucagon (r = 0.498, p = 0.04) and insulin AUC (r = 0.384, p = 0.030) and at LS with the AUC for GLP-1 in the same time period (r = - 0.335, p = 0.049). However, in the multiple regression analysis after adjusting for age, sex, and BMI, the type of surgery (mRYGB) remained the only factor associated with BMD reduction at LS and FN. CONCLUSIONS mRYGB induces greater deleterious effects on the bone at LS compared with SG and GCP, and gastrointestinal hormones do not play a major role in bone changes.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Casajoana
- Department of General and Gastrointestinal Surgery. Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Gómez-Vaquero
- Department of Rheumatology, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael López-Urdiales
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Hernández-Montoliu
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Pujol-Gebelli
- Department of General and Gastrointestinal Surgery. Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Osorio
- Department of General and Gastrointestinal Surgery. Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carolina Alves
- Clinical Nutrition Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Perez-Maraver
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia Pellitero
- Department of Endocrinology and Nutrition and Health Sciences Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
| | - Anna Vidal-Alabró
- Instituto de Investigación Biomédica-IDIBELL,, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sonia Fernández-Veledo
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain.,Diabetes and Metabolic Associated Diseases Research Group, Hospital Joan XXIII, School of Medicine, Rovira i Virgili University, Tarragona, Spain
| | - Joan Vendrell
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain. .,Diabetes and Metabolic Associated Diseases Research Group, Hospital Joan XXIII, School of Medicine, Rovira i Virgili University, Tarragona, Spain.
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. .,CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain.
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Guerrero-Pérez F, Casajoana A, Gómez-Vaquero C, Virgili N, López-Urdiales R, Hernández-Montoliu L, Pujol-Gebelli J, Osorio J, Prats A, Vidal-Alabró A, Pérez-Maraver M, Fernández-Veledo S, Vendrell J, Vilarrasa N. Long-Term Effects in Bone Mineral Density after Different Bariatric Procedures in Patients with Type 2 Diabetes: Outcomes of a Randomized Clinical Trial. J Clin Med 2020; 9:jcm9061830. [PMID: 32545353 PMCID: PMC7356739 DOI: 10.3390/jcm9061830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/08/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
There is scant evidence of the long-term effects of bariatric surgery on bone mineral density (BMD). We compared BMD changes in patients with severe obesity and type 2 diabetes (T2D) 5 years after randomization to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG) and greater curvature plication (GCP). We studied the influence of first year gastrointestinal hormone changes on final bone outcomes. Forty-five patients, averaging 49.4 (7.8) years old and body mass index (BMI) 39.4 (1.9) kg/m2, were included. BMD at lumbar spine (LS) was lower after mRYGB compared to SG and GCP: 0.89 [0.82;0.94] vs. 1.04 [0.91;1.16] vs. 0.99 [0.89;1.12], p = 0.020. A higher percentage of LS osteopenia was present after mRYGB 78.6% vs. 33.3% vs. 50.0%, respectively. BMD reduction was greater in T2D remitters vs. non-remitters. Weight at fifth year predicted BMD changes at the femoral neck (FN) (adjusted R2: 0.3218; p = 0.002), and type of surgery (mRYGB) and menopause predicted BMD changes at LS (adjusted R2: 0.2507; p < 0.015). In conclusion, mRYGB produces higher deleterious effects on bone at LS compared to SG and GCP in the long-term. Women in menopause undergoing mRYGB are at highest risk of bone deterioration. Gastrointestinal hormone changes after surgery do not play a major role in BMD outcomes.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Anna Casajoana
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.C.); (J.P.-G.); (J.O.)
| | - Carmen Gómez-Vaquero
- Department of Rheumatology, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Rafael López-Urdiales
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Laura Hernández-Montoliu
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Jordi Pujol-Gebelli
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.C.); (J.P.-G.); (J.O.)
| | - Javier Osorio
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.C.); (J.P.-G.); (J.O.)
| | - Anna Prats
- Clinical Nutrition Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Anna Vidal-Alabró
- Instituto de Investigación Biomédica-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Manuel Pérez-Maraver
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
- Instituto de Investigación Biomédica-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
| | - Sonia Fernández-Veledo
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
- Pere Virgili Research Institute (IISPV), University Hospital Joan XXIII, 43005and Rovira i Virgili University, 43003 Tarragona, Spain
| | - Joan Vendrell
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
- Pere Virgili Research Institute (IISPV), University Hospital Joan XXIII, 43005and Rovira i Virgili University, 43003 Tarragona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
- Correspondence: ; Tel.: +34-932-602-784
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Pardo F, Osorio J, Miranda C, Castro S, Miró M, Luna A, Garsot E, Momblán D, Galofré G, Rodríguez-Santiago J, Pera M. A real-life analysis on the indications and prognostic relevance of perioperative chemotherapy in locally advanced resectable gastric adenocarcinoma. Clin Transl Oncol 2019; 22:1335-1344. [PMID: 31865605 DOI: 10.1007/s12094-019-02261-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/01/2019] [Accepted: 12/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Perioperative chemotherapy (periCTX) based on the "MAGIC" scheme has become a standard treatment in Europe for locally advanced oesophagogastric cancer. We assessed implementation and long-term oncological outcomes of MAGIC periCTX for locally advanced gastric cancer. METHODS Population-based cohort study of all patients with locally advanced gastric cancer undergoing surgical resection with curative intent in Catalonia and Navarra (the first two autonomous communities included in the EURECCA Upper GI Spanish Working Group) between January 2011 and December 2013. The main variable was the percentage of patients treated with MAGIC periCTX. Kaplan-Meier analysis and Cox proportional hazards model were used to assess the survival benefit of periCTX. RESULTS Among 814 patients, 217 (26.6%) received periCTX (especially patients more likely to receive it: aged < 70 years, with proximal tumors, low anesthetic risk, and cT3-4/cN+ clinical stage). 35% did not complete perioperative chemotherapy, with no relationship with age. PeriCTX showed no effect on postoperative morbimortality. Histological tumor regression was more often absent or poor (38.2%) than total or almost total (27.8%), although clinico-pathological lymph-node downstaging was higher than expected by staging inaccuracy (38.7% vs. 24.2%). PeriCTX was associated with a better survival only in cT3-4 and cN+ patients, showing less prognostic relevance than optimal oncological surgery with D2 lymphadenectomy. CONCLUSIONS Only 26.6% of locally advanced resectable gastric cancer patients received PeriCTX. Pathological response was poor, although some degree of nodal downstaging was observed. Survival benefit of periCTX was limited to cT3-4 and cN+ patients, being less relevant than D2 lymphadenectomy.
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Affiliation(s)
- F Pardo
- Service of Digestive Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain.
| | - J Osorio
- Service of General and Digestive Surgery, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - C Miranda
- Esophagogastric Surgery Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - S Castro
- Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Miró
- Service of General and Digestive Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Luna
- Department of General Surgery, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - E Garsot
- Service of Digestive Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain
| | - D Momblán
- Service of Gastrointestinal Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - G Galofré
- Department of Surgery, Hospital de Sant Joan Despí Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - J Rodríguez-Santiago
- Service of General and Digestive Surgery, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - M Pera
- Section of Gatrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
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Rajendra A, Hunter T, Morales G, Osorio J. P2835Feasibility and safety of same day discharge after radiofrequency catheter ablation for paroxysmal atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation catheter ablation (CA) is the most frequent arrhythmia ablation and accounts for a significant proportion of treatment cost. Same day discharge (SDD) after paroxysmal atrial fibrillation (PAF) ablation is an attractive strategy for both patients and hospitals.
Objective
To understand the eligibility criteria and outcomes for PAF patients who can safely undergo same day discharge after radiofrequency catheter ablation.
Methods
Patients undergoing CA for PAF were evaluated for SDD at a pre-procedure visit to assess the risk of groin, respiratory, cardiac or bleeding complications. Eligibility criteria for SDD were stable anticoagulation and absence of bleeding history, systolic/diastolic heart failure, or interventional procedures within 60 days, with recommended BMI <35. Patient proximity to the hospital was also considered. Anesthesia included propofol with endotracheal intubation and all patients were ablated with a porous tip contact force catheter (STSF). Patients were on bed rest for 6 hours post-procedure, then ambulated intermittently for 1–2 hours. Discharge followed if they were stable with no evidence of vascular access complications or bleeding. A dedicated RN telephoned patients the following morning to ask a series of standard questions designed to elicit evidence of any complications.
Results
52 procedures were identified for SDD, with 7 patients declining. 45 planned SDD procedures for 43 patients occurred 4/17–6/18. Average age was 57±11 years and CHA2DS2-VASc was 1.5±1.1 at procedure. Procedure time was 69±26 min (IQR: 49 - 84 min) with maximum fluoroscopy usage of 0.2 min and 508±149 mL of fluid infused through the catheter. Two patients stayed overnight due a groin bleed and atelectasis with fever, and one chose to stay for comfort. The remaining 42 discharges occurred after 7.2±1.0 hours in recovery, with no SDD-related complications and no required return visits after the follow-up call. There were 3 AF recurrences (6.7%) as of the 10 week visit.
Conclusion
Appropriate low risk patients identified by simple clinical criteria can be safely discharged the same day after CA of PAF. Further evaluation is required for higher risk patients.
Acknowledgement/Funding
The study was funded by Biosense Webster Inc.
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Affiliation(s)
- A Rajendra
- Alabama Cardiovascular Group, Birmingham, United States of America
| | - T Hunter
- CTI Clinical Trial and Consulting Services, Inc, Cincinnati, United States of America
| | - G Morales
- Alabama Cardiovascular Group, Birmingham, United States of America
| | - J Osorio
- Alabama Cardiovascular Group, Birmingham, United States of America
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Carlino A, Böhlen T, Vatnitsky S, Grevillot L, Osorio J, Dreindl R, Palmans H, Stock M, Kragl G. Commissioning of pencil beam and Monte Carlo dose engines for non-isocentric treatments in scanned proton beam therapy. ACTA ACUST UNITED AC 2019; 64:17NT01. [DOI: 10.1088/1361-6560/ab3557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jericó C, Osorio J, García-Erce JA, Pera M. Patient Blood Management strategies for iron deficiency anemia management in gastric cancer. Eur J Gastroenterol Hepatol 2019; 31:547-548. [PMID: 30829765 DOI: 10.1097/meg.0000000000001383] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisés Broggi, Sant Joan Despi.,Spanish Multidisciplinary Group for the Study and Management of Surgical Patient Anemia
| | - Javier Osorio
- Department of Surgery, University Hospital Mutua Terrasa, Terrassa, Barcelona.,EUropean REgister for Cancer CARe-EURECCA-Oesophago-Gastric Cancer Registry, Barcelona and Pamplona
| | - José A García-Erce
- EUropean REgister for Cancer CARe-EURECCA-Oesophago-Gastric Cancer Registry, Barcelona and Pamplona.,Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona.,Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain
| | - Manuel Pera
- Department of Surgery, University Hospital del Mar, Barcelona.,EUropean REgister for Cancer CARe-EURECCA-Oesophago-Gastric Cancer Registry, Barcelona and Pamplona
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Márquez W, Gómez-Hoyos J, Gallo J, Espinosa B, Rivas N, Llano J, Osorio J, Martin H. Prevalence of labrum and articular cartilage injuries of the hip on 3T magnetic resonance imaging of asymptomatic elite soccer players. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Márquez WH, Gómez-Hoyos J, Gallo JA, Espinosa B, Rivas N, Llano JF, Osorio J, Martin HD. Prevalence of labrum and articular cartilage injuries of the hip on 3T magnetic resonance imaging of asymptomatic elite soccer players. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:77-85. [PMID: 30722978 DOI: 10.1016/j.recot.2018.10.008] [Citation(s) in RCA: 5] [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: 11/24/2017] [Revised: 07/26/2018] [Accepted: 10/29/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To establish the prevalence of lesions of the labrum and articular cartilage of the hip in asymptomatic elite soccer players by performing 3T magnetic resonance imaging. METHODS Eighty-four asymptomatic hips of 42 professional soccer players were evaluated. Male subjects older than 18 years were included. Cam and pincer deformity were defined as an alpha angle greater than 55 degrees and a lateral centre edge angle greater than 39 degrees, respectively. Labral injuries were classified with the Czerny classification and cartilage damage was classified with the Outerbridge classification. Specific statistical tests were used to establish the relationship between anatomical variances of the hip and the presence of chondral and labral injuries. RESULTS FAI morphology prevalence was 25%. Abnormalities such as cam (22.5%) and labral injuries (33.8%) were found. Those cases with reported labral injury were predominantly intrasubstance damage (18.8%). Anatomical features of FAI were found to be related to lesions of the femoral cartilage (P<.001), chondrolabral damage (P=.042), or both injuries (P<.001). CONCLUSION Asymptomatic labral or cartilaginous injuries of the hip were reported in 25% of the included professional soccer players. These injuries were associated with anatomical features of FAI.
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Affiliation(s)
- W H Márquez
- Posgrado de Medicina Aplicada a la Actividad Física y el Deporte, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Clínica Las Américas, Medellín, Colombia; Grupo de investigación en Medicina Aplicada a la Actividad Física y el Deporte GRINMADE, Medellín, Colombia
| | - J Gómez-Hoyos
- Posgrado de Medicina Aplicada a la Actividad Física y el Deporte, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Clínica Las Américas, Medellín, Colombia; Grupo de investigación en Medicina Aplicada a la Actividad Física y el Deporte GRINMADE, Medellín, Colombia; Hip Preservation Center at Baylor Scott and White University Medical Center, Dallas, Estados Unidos.
| | - J A Gallo
- Posgrado de Medicina Aplicada a la Actividad Física y el Deporte, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de investigación en Medicina Aplicada a la Actividad Física y el Deporte GRINMADE, Medellín, Colombia
| | - B Espinosa
- Posgrado de Medicina Aplicada a la Actividad Física y el Deporte, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - N Rivas
- Posgrado de Medicina Aplicada a la Actividad Física y el Deporte, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - J F Llano
- Posgrado de Medicina Aplicada a la Actividad Física y el Deporte, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Instituto de Alta Tecnología Médica IATM, Medellín, Colombia
| | - J Osorio
- Posgrado de Medicina Aplicada a la Actividad Física y el Deporte, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de investigación en Medicina Aplicada a la Actividad Física y el Deporte GRINMADE, Medellín, Colombia
| | - H D Martin
- Hip Preservation Center at Baylor Scott and White University Medical Center, Dallas, Estados Unidos
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Jeong J, Wagner K, Flores JJ, Cawthon T, Her Y, Osorio J, Yen H. Linking watershed modeling and bacterial source tracking to better assess E. coli sources. Sci Total Environ 2019; 648:164-175. [PMID: 30114587 DOI: 10.1016/j.scitotenv.2018.08.097] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/27/2018] [Accepted: 08/06/2018] [Indexed: 06/08/2023]
Abstract
Terrestrial fate and transport processes of E. coli can be complicated by human activities like urbanization or livestock grazing. There is a critical need to address contributing sources of bacterial contamination, properly assess the management of critical sources, and ultimately reduce E. coli concentrations in impaired water bodies. In particular, characterization of wildlife animal contributions and other "background" input sources of microbial pollution are highly uncertain and data are scarce. This study attempts to identify critical sources of E. coli and the efficacy of conservation practices for mitigating E. coli concentrations in the Arroyo Colorado watershed, Texas, using a process-based hydrologic and water quality model. We propose to incorporate a bacterial source tracking assessment into the modeling framework to fill the gap in data on wildlife and human contribution. In addition, other sources identified through a GIS survey, national census, and local expert knowledge were incorporated into the model as E. coli sources. Results suggest that simulated distribution of E. coli sources significantly improved after incorporating this enhanced data on E. coli sources into the model (R2 = 0.90) compared to the SWAT result without BST (R2 = 0.59). Scenario assessments indicate that wildlife contributions may remain significant despite land use change and urbanization, expected to mostly occur in agricultural and range lands. A combination of nonpoint source management measures, voluntary implementation of advanced treatment by wastewater plants where possible, and installation of aerators in the zone of impairment were demonstrated to be effective measures for restoring the recreation and aquatic life uses of the Arroyo Colorado.
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Affiliation(s)
- Jaehak Jeong
- Blackland Research Center, Texas A&M AgriLife Research, Texas A&M University, 720 East Blackland Road, Temple, TX 76502, USA.
| | - Kevin Wagner
- Oklahoma Water Resources Center, Oklahoma State University, 139 Ag Hall, Stillwater, OK 74078, USA
| | - Jaime J Flores
- Texas Water Resources Institute, 2260 TAMU, College Station, TX 77843, USA
| | - Tim Cawthon
- Texas Commission on Environmental Quality, 2100 Park 35 Circle, Austin, TX 78753, USA
| | - Younggu Her
- Agricultural and Biological Engineering Department/Tropical Research and Education Center, Institute of Food and Agricultural Sciences, University of Florida, Homestead, FL 33031, USA
| | - Javier Osorio
- Blackland Research Center, Texas A&M AgriLife Research, Texas A&M University, 720 East Blackland Road, Temple, TX 76502, USA
| | - Haw Yen
- Blackland Research Center, Texas A&M AgriLife Research, Texas A&M University, 720 East Blackland Road, Temple, TX 76502, USA
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Osorio J, Jericó C, Miranda C, Garsot E, Luna A, Miró M, Santamaría M, Artigau E, Rodríguez-Santiago J, Castro S, Feliu J, Aldeano A, Olona C, Momblan D, Ruiz D, Galofré G, Pros I, García-Albéniz X, Lozano M, Pera M. Conducta transfusional perioperatoria en la cirugía del cáncer gástrico: análisis del registro del grupo español EURECCA de cáncer esófago-gástrico. Cir Esp 2018; 96:546-554. [DOI: 10.1016/j.ciresp.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 03/24/2018] [Indexed: 11/16/2022]
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Carlino A, Stock M, Zagler N, Marrale M, Osorio J, Vatnitsky S, Palmans H. Characterization of PTW-31015 PinPoint ionization chambers in photon and proton beams. ACTA ACUST UNITED AC 2018; 63:185020. [DOI: 10.1088/1361-6560/aadd39] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Stock M, Grevillot L, Kragl G, Ableitinger A, Palmans H, Osorio J, Böhlen T, Gora J, Hopfgartner J, Letellier V, Dreindl R, Fuchs H, Knäusl B, Carlino A, Utz A, Mumot M, Zechner A, Elia A, Vatnitsky S. 46. Medical commissioning of a Light Ion Beam Therapy facility: The MedAustron experience of starting up using innovative technology. Phys Med 2017. [DOI: 10.1016/j.ejmp.2017.10.071] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Imber B, Hellmann M, Kris M, Santomasso B, Callahan M, Osorio J, Rizvi H, Chan T, Yang T, Yamada Y, Beal K. Lesion Response and Intracranial Control of Brain Metastases From Non–small Cell Lung Cancer After Stereotactic Radiosurgery or Hypofractionated Radiation Therapy Combined With Checkpoint Inhibitors. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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45
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Correa EM, Osorio J, Osorio A, Fernandez J, Cruz W, Moya E, Rojas P, Brinckmann J, Villar M. The effect of a natural supplement containing glucosinolates, β-sitosterol and citrus flavonoids over menopausal symptoms in postmenopausal women. Maturitas 2017. [DOI: 10.1016/j.maturitas.2017.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Osorio J, Hunter T, Bubien RS, Thorington S, Rajendra A, Arciniegas J. P1717A comparison of paroxysmal atrial fibrillation ablation efficiency and clinical outcomes across technologies in a high-volume center. Europace 2017. [DOI: 10.1093/ehjci/eux161.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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47
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Osorio J, Hunter T, Bubien RS, Thorington S, Rajendra A, Arciniegas JG. P1719Efficiency and predictability in paroxysmal atrial fibrillation ablation with contact force catheter and stability module integration. Europace 2017. [DOI: 10.1093/ehjci/eux161.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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48
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Böhlen T, Dreindl R, Osorio J, Kragl G, Stock M. PO-0800: Log file based performance characterization of a PBS dose delivery system with dose re-computation. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31237-9] [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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49
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Grevillot L, Osorio J, Letellier V, Dreindl R, Elia A, Fuchs H, Carlino A, Vatnitsky S, Palmans H, Stock M. EP-1450: Implementation of dosimetry equipment and phantoms in clinical practice of light ion beam therapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31885-6] [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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50
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Kragl G, Böhlen T, Carlino A, Grevillot L, Palmans H, Elia A, Knäusl B, Osorio J, Dreindl R, Hopfgartner J, Vatnitsky S, Stock M. EP-1556: Dosimetric commissioning of a TPS for a synchrotron-based proton PBS delivery system. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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