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Domínguez-Gallardo C, Ginjaume-García N, Ullmo J, Parra J, Vázquez A, Cruz-Lemini M, Llurba E. Fetal Left Ventricle Function Evaluated by Two-Dimensional Speckle-Tracking Echocardiography across Clinical Stages of Severity in Growth-Restricted Fetuses. Diagnostics (Basel) 2024; 14:548. [PMID: 38473020 DOI: 10.3390/diagnostics14050548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Fetal growth restriction (FGR) can result in adverse perinatal outcomes due to cardiac dysfunction. This study used 2D speckle-tracking echocardiography to assess left ventricle (LV) longitudinal strain across FGR severity stages. A prospective longitudinal cohort study measured global (GLS) and segmental LV longitudinal strain in FGR fetuses, with evaluations conducted at various time points. FGR was classified into subtypes based on published criteria using fetal weight centile and Doppler parameters. A linear mixed model was employed to analyze repeated measures and compare Z-score measurements between groups throughout gestational age. The study included 40 FGR fetuses and a total of 107 evaluations were performed: 21 from small for gestational age (SGA), 74 from the FGR stage I, and 12 from the FGR stage ≥ II. The results indicate that SGA and stage I FGR fetuses exhibit higher LV GLS than stages ≥ II. Throughout gestation, SGA and FGR stage I fetuses showed similar behavior with consistently better LV GLS values when compared to FGR stages ≥ II. No significant differences were observed in LV GLS strain behavior between SGA and FGR stage I. In conclusion, all FGRs show signs of early cardiac dysfunction, with severe cases demonstrating significantly a lower LV GLS when compared to mild cases, suggesting deterioration of cardiac dysfunction with progression of fetal compromise.
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Affiliation(s)
- Carla Domínguez-Gallardo
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Nuria Ginjaume-García
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Johana Ullmo
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan Parra
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana Vázquez
- Applied Statistics Department, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Mónica Cruz-Lemini
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Elisa Llurba
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Domínguez-Gallardo C, Ginjaume-García N, Ullmo J, Fernández-Oliva A, Parra J, Vázquez A, Cruz-Lemini M, Llurba E. Longitudinal Behavior of Left-Ventricular Strain in Fetal Growth Restriction. Diagnostics (Basel) 2023; 13:diagnostics13071252. [PMID: 37046470 PMCID: PMC10093576 DOI: 10.3390/diagnostics13071252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
Fetal growth restriction (FGR) is associated with an increased risk of adverse outcomes resulting from adaptive cardiovascular changes in conditions of placental insufficiency, leading to cardiac deformation and dysfunction, which can be evaluated with 2D speckle tracking echocardiography (2D-STE). The aim of the present study was to evaluate whether reduced fetal growth is associated with cardiac left-ventricle (LV) dysfunction, using 2D-STE software widely used in postnatal echocardiography. A prospective longitudinal cohort study was performed, and global (GLO) and segmental LV longitudinal strain was measured offline and compared between FGR and appropriate-for-gestational-age (AGA) fetuses throughout gestation. All cases of FGR fetuses were paired 1:2 to AGA fetuses, and linear mixed model analysis was performed to compare behavior differences between groups throughout pregnancy. Our study shows LV fetal longitudinal strain in FGR and AGA fetuses differed upon diagnosis and behaved differently throughout gestation. FGR fetuses had lower LV strain values, both global and segmental, in comparison to AGA, suggesting subclinical cardiac dysfunction. Our study provides more data regarding fetal cardiac function in cases of placental dysfunction, as well as highlights the potential use of 2D-STE in the follow-up of cardiac function in these fetuses.
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Gabriel PE, Pinar U, Parra J, Vaessen C, Mozer P, Chartier-Kastler E, Rouprêt M, Seisen T. [Pathological pelvic lymph node involvement in muscle-invasive bladder cancer patients treated with radical cystectomy: A narrative review]. Prog Urol 2023; 33:145-154. [PMID: 36604248 DOI: 10.1016/j.purol.2022.12.013] [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: 05/23/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To perform a narrative review of the contemporary literature on the diagnosis, prognosis and adjuvant management of muscle-invasive bladder cancer (MIBC) patients with pathological pelvic lymph node involvement (pN+) at radical cystectomy. METHOD A narrative review of the contemporary literature available on Medline was conducted to report studies evaluating the diagnosis, prognosis and/or adjuvant treatments for MIBC patients with pN+ disease at radical cystectomy. RESULTS Open or robotic extended pelvic lymph node dissection up to the crossing of the ureter with common iliac vessels can enhance the diagnosis of pN+ MIBC, especially using separate packages for the submission of a maximum number of lymph nodes. The main prognosis factors for pN+ patients are the number of positive and retrieved lymph nodes, lymph node density, extranodal extension as well as lymph node metastasis diameter. Adjuvant chemotherapy is likely to prolong overall survival in pN+ patients treated with radical cystectomy alone while adjuvant immunotherapy using nivolumab has been shown to decrease the risk of recurrence in all pN+ patients, especially those with ypN+ disease after neoadjuvant chemotherapy followed by radical cystectomy. However, few data are currently available on the role of adjuvant radiation therapy, which remains currently experimental for these patients. CONCLUSION Multiple parameters have been reported to impact the diagnosis and prognosis of patients with pN+ MIBC at radical cystectomy. Adjuvant management is currently based on chemotherapy and immunotherapy with preliminary data on radiation therapy.
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Affiliation(s)
- P-E Gabriel
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France.
| | - U Pinar
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - J Parra
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - C Vaessen
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - P Mozer
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - E Chartier-Kastler
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - M Rouprêt
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - T Seisen
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
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Krings G, Ayoub E, Campi R, Rouprêt M, Vaessen C, Parra J, Mozer P. Ureteropelvic junction obstruction and renal calculi: Simultaneous treatment by robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde flexible ureteroscopy. Technique description and early outcomes. Prog Urol 2023; 33:279-284. [PMID: 36792487 DOI: 10.1016/j.purol.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Ureteropelvic junction obstruction (UPJO) and renal calculi are associated in 20 to 30% of cases and treatment is mandatory. The simultaneous surgical management is a therapeutic challenge that is still a source of controversy. We describe our technique combining robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde flexible ureteroscopy (fURS), assessing the feasibility of simultaneous treatment through an original technique. METHODS This single centre series reports our initial experience with 12 patients. From January 2014 to September 2018, 12 patients underwent robot-assisted laparoscopic pyeloplasty with simultaneous fURS for UPJO and renal calculi. Mean age was 46 years (24-68). 92% had multiple renal stones and the mean cumulative stone diameter was 31,3mm. Robot-assisted pyeloplasty was performed with peroperative transcutaneous retrograde fURS through a ureteral access sheath introduced in an incision on the bassinet through a subcostal trocar. Stone extraction was performed using a basket. RESULTS All patients underwent surgery successfully, achieving UPJ repair and complete stone extraction. Mean operating time was 92,5min (85-110). All reported Clavien-Dindo complications were grade 1. Non-contrast enhanced abdominal CT performed 1 month after surgery confirmed the absence of residual stones in all patients. Mean follow-up time was 10 months with no recurrence of UPJO. CONCLUSION This small series confirms the feasibility with good surgical results of concomitant robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde fURS stone extraction. No major complications were observed. This technique is easily reproducible but requires 2 experienced urologists to be achieved in a contained operative time.
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Affiliation(s)
- G Krings
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Urology Department, CHU UCL Namur, 1 Av Gaston Therasse, 5530 Yvoir, Belgium.
| | - E Ayoub
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France.
| | - R Campi
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Department of Urology, University of Florence, Careggi Hospital, Urology, Florence, Italy..
| | - M Rouprêt
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France.
| | - C Vaessen
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France.
| | - J Parra
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France.
| | - P Mozer
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Sorbonne Université, Institut des Systèmes Intelligents et de Robotique (ISIR) UPMC - CNRS/UMR 7222, 75005 Paris, France.
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Joyeux L, van der Merwe J, Aertsen M, Patel PA, Khatoun A, Mori da Cunha MGMC, De Vleeschauwer S, Parra J, Danzer E, McLaughlin M, Stoyanov D, Vercauteren T, Ourselin S, Radaelli E, de Coppi P, Van Calenbergh F, Deprest J. Neuroprotection is improved by watertightness of fetal spina bifida repair in the sheep model. Ultrasound Obstet Gynecol 2023; 61:81-92. [PMID: 35353933 DOI: 10.1002/uog.24907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES A contributing factor to unsuccessful prenatal spina bifida aperta (SBA) repair via an open approach may be incomplete neurosurgical repair causing persistent in-utero leakage of cerebrospinal fluid (CSF) and exposure of the fetal spinal cord to amniotic fluid. We aimed to investigate the neurostructural and neurofunctional efficacy of watertight prenatal SBA repair in a validated SBA fetal lamb model. METHODS A well-powered superiority study was conducted in the validated SBA fetal lamb model (n = 7 per group). The outcomes of lambs which underwent watertight or non-watertight multilayer repair through an open approach were compared to those of unrepaired SBA lambs (historical controls) at delivery (term = 145 days). At ∼75 days, fetal lambs underwent standardized induction of lumbar SBA. At ∼100 days, they were assigned to an either watertight or non-watertight layered repair group based on an intraoperative watertightness test using subcutaneous fluorescein injection. At 1-2 days postnatally, as primary outcome, we assessed reversal of hindbrain herniation using magnetic resonance imaging (MRI). Secondary proxies of neuroprotection were: absence of CSF leakage at the repair site; hindlimb motor function based on joint-movement score, locomotor grade and Motor Evoked Potential (MEP); four-score neuroprotection scale, encompassing live birth, complete hindbrain herniation reversal, absence of CSF leakage and joint-movement score ≥ 9/15; and brain and spinal cord histology and immunohistochemistry. As the watertightness test cannot be used clinically due to its invasiveness, we developed a potential surrogate intraoperative three-score skin-repair-quality scale based on visual assessment of the quality of the skin repair (suture inter-run distance ≤ 3 mm, absence of tear and absence of ischemia), with high quality defined by a score ≥ 2/3 and low quality by a score < 2/3, and assessed its relationship with improved outcome. RESULTS Compared with unrepaired lambs, lambs with watertight repair achieved a high level of neuroprotection (neuroprotection score of 4/4 in 5/7 vs 0/7 lambs) as evidenced by: a significant 100% (vs 14%) reversal of hindbrain herniation on MRI; low CSF leakage (14% vs 100%); better hindlimb motor function, with higher joint-movement score, locomotor grade and MEP area under the curve and peak-to-peak amplitude; higher neuronal density in the hippocampus and corpus callosum; and higher reactive astrogliosis at the SBA lesion epicenter. Conversely, lambs with non-watertight SBA repair did not achieve the same level of neuroprotection (score of 4/4 in 1/7 lambs) compared with unrepaired lambs, with: a non-significant 86% (vs 14%) reversal of hindbrain herniation; high CSF leakage (43% vs 100%); no improvement in motor function; low brain neuron count in both the hippocampus and corpus callosum; and small spinal astroglial cell area at the epicenter. Both watertight layered repair and high (≥ 2/3) intraoperative skin-repair-quality score were associated with improved outcome, but the watertightness test and skin-repair-quality scale could not be used interchangeably due to result discrepancies. CONCLUSIONS Watertight layered fetal SBA repair is neuroprotective since it improves brain and spinal-cord structure and function in the fetal lamb model. This translational research has important clinical implications. A neurosurgical technique that achieves watertightness should be adopted in all fetal centers to improve neuroprotection. Future clinical studies could assess whether a high skin-repair-quality score (≥ 2/3) correlates with neuroprotection. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Joyeux
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - J van der Merwe
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - M Aertsen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - P A Patel
- Radiology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - A Khatoun
- Exp ORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - M G M C Mori da Cunha
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - S De Vleeschauwer
- Animal Research Center, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - J Parra
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- BCNatal, Fetal Medicine Research Center, Hospital Clinic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - E Danzer
- Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - M McLaughlin
- Radiology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - D Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - T Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - S Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - E Radaelli
- Department of Pathobiology, Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA
| | - P de Coppi
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Specialist Neonatal and Pediatric Surgery Unit, Great Ormond Street Hospital, University College London Hospitals, NHS Foundation Trust, London, UK
| | - F Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - J Deprest
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
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Trilla C, Mora J, Ginjaume N, Nan MN, Alejos O, Domínguez C, Vega C, Godínez Y, Cruz-Lemini M, Parra J, Llurba E. Reduction in Preterm Preeclampsia after Contingent First-Trimester Screening and Aspirin Prophylaxis in a Routine Care Setting. Diagnostics (Basel) 2022; 12:diagnostics12081814. [PMID: 36010165 PMCID: PMC9406877 DOI: 10.3390/diagnostics12081814] [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: 06/17/2022] [Revised: 07/17/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives: Several multivariate algorithms for preeclampsia (PE) screening in the first trimester have been developed over the past few years. These models include maternal factors, mean arterial pressure (MAP), uterine artery Doppler (UtA-PI), and biochemical markers (pregnancy-associated plasma protein-A (PAPP-A) or placental growth factor (PlGF)). Treatment with low-dose aspirin (LDA) has shown a reduction in the incidence of preterm PE in women with a high-risk assessment in the first trimester. An important barrier to the implementation of first-trimester screening is the cost of performing tests for biochemical markers in the whole population. Theoretical contingent strategies suggest that two-stage screening models could also achieve high detection rates for preterm PE with lower costs. However, no data derived from routine care settings are currently available. This study was conducted to validate and assess the performance of a first-trimester contingent screening process using PlGF for PE, with prophylactic LDA, for decreasing the incidence of preterm PE. Methods: This was a two-phase study. In phase one, a contingent screening model for PE was developed using a multivariate validated model and a historical cohort participating in a non-interventional PE screening study (n = 525). First-stage risk assessment included maternal factors, MAP, UtA-PI, and PAPP-A. Several cut-off levels were tested to determine the best screening performance, and three groups were then defined (high-, medium-, and low-risk groups). PlGF was determined in the medium-risk group to calculate the final risk. Phase two included a validation cohort of 847 singleton pregnancies prospectively undergoing first-trimester PE screening using this approach. Women at high risk of PE received prophylactic treatment with 150 mg of LDA. The clinical impact of the model was evaluated by comparing the incidence of early-onset (<34 weeks) and preterm (<37 weeks) PE between groups. Results: Cut-off levels for the contingent screening model were chosen in the first and second stages of screening to achieve a performance with sensitivities of 100% and 80% for early-onset and preterm PE detection, respectively, with a 15% false positive rate. In the development phase, 21.5% (n = 113) of the women had a medium risk of PE and required second-stage screening. In the prospective validation phase, 15.3% (n = 130) of the women required second-stage screening for PlGF, yielding an overall screen-positive rate of 14.9% (n = 126). The incidence of preterm PE was reduced by 68.4% (1.9% vs. 0.6%, p = 0.031) after one year of screening implementation. Conclusions: Implementation of contingent screening for PE using PlGF in a routine care setting led to a significant reduction (68.4%) in preterm PE, suggesting that contingent screening can achieve similar results to protocols using PlGF in the whole population. This could have financial benefits, with a similar reduction in the rate of preterm PE.
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Affiliation(s)
- Cristina Trilla
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Josefina Mora
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Nuria Ginjaume
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
| | - Madalina Nicoleta Nan
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Obdulia Alejos
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
| | - Carla Domínguez
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
| | - Carmen Vega
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
| | - Yessenia Godínez
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
| | - Monica Cruz-Lemini
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan Parra
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
| | - Elisa Llurba
- Department of Obstetrics and Gynaecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.T.); (N.G.); (O.A.); (C.D.); (C.V.); (Y.G.); (M.C.-L.); (J.P.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-935-337-041
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Lluís N, Parra J, Villodre C, Zapater P, Jalali A, Cantó M, Mena L, Ramia JM, Lluís F. Prediction of peritoneal soiling in acute appendicitis with simple clinical and laboratory data. Prospective, multicenter, cohort study of 2,645 adult patients nationwide. Int J Surg 2022; 104:106741. [PMID: 35772594 DOI: 10.1016/j.ijsu.2022.106741] [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: 03/06/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS In order to facilitate the preoperative prediction of complicated appendicitis, we propose a complementary approach by selecting an endpoint defined by the intraoperative finding of peritoneal soiling (PS). METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending emergency general surgery patients on a 24-hour, 7-days a week basis, enrolled consecutive adult patients requiring appendectomy. Patients were stratified according to the absence or the finding of PS during the surgical procedure. RESULTS A total of 2645 patients were included; median age (IQR) was 35 (22-51) years, 44.3% were female. The laparoscopic approach was used in 70.8% of appendectomies. In a third of patients (31.7%), there was PS with pus around the appendix, or bowel contents, free pus, or blood in the peritoneal cavity. To develop the prediction model, 1764 patients were randomly selected for the derivation cohort and the remaining 881 patients were assigned to the validation cohort. On multivariable logistic regression analysis of all patients, two clinical variables (age, and pulse) and three laboratory variables (serum urea, serum sodium, and white blood cell count) were individually associated (P < .05) with a greater probability of having PS (Hosmer-Lemeshow chi, 1.63; P = .99; C-statistic, 0.7). Based on the multivariable regression model, both static and dynamic nomograms were developed for the prediction of PS in patients with acute appendicitis. CONCLUSIONS The entry of simple clinical and laboratory variables in the dynamic nomogram may be useful in guiding the initial management of patients with acute appendicitis in resource-limited settings.
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Affiliation(s)
- N Lluís
- Hepatobiliary and Pancreas Surgery, Department of Surgical Oncology, Miami Cancer Institute, Miami, FL, USA
| | - J Parra
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - C Villodre
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.
| | - P Zapater
- Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - A Jalali
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - M Cantó
- Computing, BomhardIP, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - L Mena
- Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - J M Ramia
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - F Lluís
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
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Chmielak B, Suckow S, Parra J, Duarte VC, Mengual T, Piqueras MA, Giesecke AL, Lemme MC, Sanchis P. High-efficiency grating coupler for an ultralow-loss Si 3N 4-based platform. Opt Lett 2022; 47:2498-2501. [PMID: 35561384 DOI: 10.1364/ol.455078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
Integrated silicon nitride waveguides of 100 nm height can achieve ultralow propagation losses below 0.1 dB/cm at the 1550 nm wavelength band but lack the scattering strength to form efficient grating couplers. An enhanced grating coupler design based on an amorphous silicon layer on top of silicon nitride is proposed and demonstrated to improve the directionality of the coupler. The fabrication process is optimized for a self-alignment process between the amorphous silicon and silicon nitride layers without increasing waveguide losses. Experimental coupling losses of 5 dB and a 3 dB bandwidth of 75 nm are achieved with both regular and focusing designs.
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Benarroche D, Paladini A, Grobet-Jeandin E, Vaessen C, Parra J, Seisen T, Pinar U, Roupret M. Robotic vs. open simple prostatectomy for benign prostatic hyperplasia in large glands: Single-centre study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00962-9] [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: 11/25/2022]
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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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Asensio G, Benito-Garzón L, Ramírez-Jiménez RA, Guadilla Y, Gonzalez-Rubio J, Abradelo C, Parra J, Martín-López MR, Aguilar MR, Vázquez-Lasa B, Rojo L. Biomimetic Gradient Scaffolds Containing Hyaluronic Acid and Sr/Zn Folates for Osteochondral Tissue Engineering. Polymers (Basel) 2021; 14:12. [PMID: 35012034 PMCID: PMC8747647 DOI: 10.3390/polym14010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/24/2022] Open
Abstract
Regenerative therapies based on tissue engineering are becoming the most promising alternative for the treatment of osteoarthritis and rheumatoid arthritis. However, regeneration of full-thickness articular osteochondral defects that reproduces the complexity of native cartilage and osteochondral interface still remains challenging. Hence, in this work, we present the fabrication, physic-chemical characterization, and in vitro and in vivo evaluation of biomimetic hierarchical scaffolds that mimic both the spatial organization and composition of cartilage and the osteochondral interface. The scaffold is composed of a composite porous support obtained by cryopolymerization of poly(ethylene glycol) dimethacrylate (PEGDMA) in the presence of biodegradable poly(D,L-lactide-co-glycolide) (PLGA), bioactive tricalcium phosphate β-TCP and the bone promoting strontium folate (SrFO), with a gradient biomimetic photo-polymerized methacrylated hyaluronic acid (HAMA) based hydrogel containing the bioactive zinc folic acid derivative (ZnFO). Microscopical analysis of hierarchical scaffolds showed an open interconnected porous open microstructure and the in vitro behaviour results indicated high swelling capacity with a sustained degradation rate. In vitro release studies during 3 weeks indicated the sustained leaching of bioactive compounds, i.e., Sr2+, Zn2+ and folic acid, within a biologically active range without negative effects on human osteoblast cells (hOBs) and human articular cartilage cells (hACs) cultures. In vitro co-cultures of hOBs and hACs revealed guided cell colonization and proliferation according to the matrix microstructure and composition. In vivo rabbit-condyle experiments in a critical-sized defect model showed the ability of the biomimetic scaffold to promote the regeneration of cartilage-like tissue over the scaffold and neoformation of osteochondral tissue.
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Affiliation(s)
- Gerardo Asensio
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, Calle Juan de la Cierva 3, 28006 Madrid, Spain; (G.A.); (R.A.R.-J.); (M.R.A.); (B.V.-L.)
| | - Lorena Benito-Garzón
- Departamento de Anatomía e Histología Humanas, Facultad de Medicina, Universidad de Salamanca, 37007 Salamanca, Spain;
| | - Rosa Ana Ramírez-Jiménez
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, Calle Juan de la Cierva 3, 28006 Madrid, Spain; (G.A.); (R.A.R.-J.); (M.R.A.); (B.V.-L.)
| | - Yasmina Guadilla
- Departamento de Cirugía, Facultad de Medicina, Universidad de Salamanca, 37007 Salamanca, Spain;
| | - Julian Gonzalez-Rubio
- Departamento de Química y Bioquímica, Facultad de Farmacia, Universidad San Pablo-CEU, Urbanización Montepríncipe, CEU Universities, 28925 Alcorcon, Spain; (J.G.-R.); (C.A.)
| | - Cristina Abradelo
- Departamento de Química y Bioquímica, Facultad de Farmacia, Universidad San Pablo-CEU, Urbanización Montepríncipe, CEU Universities, 28925 Alcorcon, Spain; (J.G.-R.); (C.A.)
| | - Juan Parra
- Unidad Asociada de I+D al CSIC Unidad de Investigación Clínica y Biopatología Experimental, Complejo Asistencial de Ávila, SACYL, 05003 Avila, Spain; (J.P.); (M.R.M.-L.)
- Centro de Investigación Biomédica en Red de Bioingienería, Biomateriales y Biotecnología CIBER-BBN, Instituto de Salud Carlos III, Calle Monforte de Lemos S/N, 28029 Madrid, Spain
| | - María Rocío Martín-López
- Unidad Asociada de I+D al CSIC Unidad de Investigación Clínica y Biopatología Experimental, Complejo Asistencial de Ávila, SACYL, 05003 Avila, Spain; (J.P.); (M.R.M.-L.)
| | - María Rosa Aguilar
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, Calle Juan de la Cierva 3, 28006 Madrid, Spain; (G.A.); (R.A.R.-J.); (M.R.A.); (B.V.-L.)
- Centro de Investigación Biomédica en Red de Bioingienería, Biomateriales y Biotecnología CIBER-BBN, Instituto de Salud Carlos III, Calle Monforte de Lemos S/N, 28029 Madrid, Spain
| | - Blanca Vázquez-Lasa
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, Calle Juan de la Cierva 3, 28006 Madrid, Spain; (G.A.); (R.A.R.-J.); (M.R.A.); (B.V.-L.)
- Centro de Investigación Biomédica en Red de Bioingienería, Biomateriales y Biotecnología CIBER-BBN, Instituto de Salud Carlos III, Calle Monforte de Lemos S/N, 28029 Madrid, Spain
| | - Luis Rojo
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, Calle Juan de la Cierva 3, 28006 Madrid, Spain; (G.A.); (R.A.R.-J.); (M.R.A.); (B.V.-L.)
- Centro de Investigación Biomédica en Red de Bioingienería, Biomateriales y Biotecnología CIBER-BBN, Instituto de Salud Carlos III, Calle Monforte de Lemos S/N, 28029 Madrid, Spain
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Benarroche D, Rouprêt M, Chartier-Kastler E, Pinar U, Vaessen C, Seisen T, Parra J. Résultats de l’adénomectomie voie haute par voie laparoscopique robot-assistée : analyse monocentrique. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.050] [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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Petri E, Virto R, Mottura M, Parra J. Comparison of Peracetic Acid and Chlorine Effectiveness during Fresh-Cut Vegetable Processing at Industrial Scale. J Food Prot 2021; 84:1592-1602. [PMID: 34015109 DOI: 10.4315/jfp-20-448] [Citation(s) in RCA: 3] [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: 11/09/2020] [Accepted: 05/16/2021] [Indexed: 11/11/2022]
Abstract
ABSTRACT This study was conducted to compare the efficacy of two sanitizing agents, chlorine and peracetic acid (PAA), in reducing spoilage and pathogenic microorganisms and disinfection by-products in the washing stage of three types of minimally processed vegetables: iceberg lettuce, carrots, and baby leaves. These fresh-cut products are consumed uncooked; thus, proper sanitation is essential in preventing foodborne illness outbreaks. The comparison was done at industrial scale with equipment already used in the fresh-cut industry and with washers designed and manufactured for this purpose. Results showed that for washing water hygiene and final product microbial quality, the use of PAA or chlorine had similar efficacy. Different scenarios combining PAA, chlorine, and water were tested, simulating the current industrial processes for each of the tested vegetables. Overall, results confirmed that the use of a sanitizer, PAA or chlorine, in the washing water is effective for the prevention of cross-contamination during the washing process and hence for produce food safety. For final product microbiological quality and shelf life, the use of chlorine or PAA showed no significant differences in lettuce or baby leaves. Chlorinated disinfection by-products in processing water were not formed in significant amounts when washing water was treated with PAA in all scenarios and for all tested vegetables, whereas washing with chlorine (80 mg/L) generated important amounts of trihalomethanes, chlorates, and chlorites. Although chlorates and chlorites were always below the recommended levels or legal limits established for drinking water, trihalomethanes exceeded the legal limits. For perchlorates, values were below the quantification limit in all scenarios. Our results show that PAA is a reliable alternative to chlorine disinfection strategies in the fresh-cut industry. HIGHLIGHTS
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Affiliation(s)
- E Petri
- R&D&I Area, Centro Nacional de Tecnología y Seguridad Alimentaria (CNTA), Carretera NA-134, Km. 53, 31570 Navarra, Spain
| | - R Virto
- R&D&I Area, Centro Nacional de Tecnología y Seguridad Alimentaria (CNTA), Carretera NA-134, Km. 53, 31570 Navarra, Spain
| | - M Mottura
- Productos Citrosol S.A., Partida Alameda, Parcela C, 46721 Potries, Valencia, Spain
| | - J Parra
- Productos Citrosol S.A., Partida Alameda, Parcela C, 46721 Potries, Valencia, Spain
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Filfilan A, Anract J, Chartier-Kastler E, Parra J, Vaessen C, de La Taille A, Roupret M, Pinar U. Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area. Prog Urol 2021; 31:1133-1138. [PMID: 34454847 PMCID: PMC8387203 DOI: 10.1016/j.purol.2021.08.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/24/2021] [Accepted: 08/07/2021] [Indexed: 11/19/2022]
Abstract
Introduction Greenhouse gas (GHG) emissions are a serious environmental issue. The healthcare sector is an important emitter of GHGs. Our aim was to assess the environmental cost of teleconsultations in urology compared to face-to-face consultations. Materials and methods Prospective study of all patients who had a remote teleconsultation over a 2-week period during COVID-19 pandemic. Main outcome was the reduction in CO2e emissions related to teleconsultation compared to face-to-face consultation and was calculated as: total teleconsultation CO2e emissions–total face-to-face consultation CO2e emissions. Secondary outcome measures were the reduction in travel distance and travel time related to teleconsultation. Results Eighty patients were included. Face-to-face consultations would have resulted in 6699 km (4162 miles) of travel (83.7 km (52 miles) per patient). Cars were the usual means of transport. CO2e avoided due to lack of travel was calculated at 1.1 tonnes. Teleconsultation was responsible for 1.1 kg CO2e while face-to-face consultation emitted 0.5 kg of CO2e. Overall, the total reduction in GHGs with teleconsultation was 1141 kg CO2e, representing a 99% decrease in emissions. Total savings on transport were 974 € and savings on travel time were 112 h (1.4 h/patient). Conclusions Teleconsultation reduces the environmental impact of face-to-face consultations. The use of teleconsultation in our urology departments resulted in the avoidance of more than 6000 km of travel, equivalent to a reduction of 1.1 tonnes of CO2e. Teleconsultation should be considered for specific indications as the healthcare system attempts to become greener. Level of evidence 3.
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Affiliation(s)
- A Filfilan
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| | - J Anract
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| | - E Chartier-Kastler
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| | - J Parra
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| | - C Vaessen
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| | - A de La Taille
- Henri Mondor hôpital, urology, hôpitaux universitaires Henri Mondor, AP-HP, 94010 Créteil, France
| | - M Roupret
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France.
| | - U Pinar
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
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Vives-Rego J, Vaque MD, Sanchez Leal J, Parra J. Surfactants Biodegradation in Sea Water / Biologischer Tensidabbau in Meerwasser. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1987-240110] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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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Pinar U, Clerget A, Perrot O, Beaud N, Akakpo W, Ruggiero M, Parra J, Vaessen C, Guillot-Tantay C, Conort P, Campedel L, Girault J, Simon J, Maingon P, Renard-Penna R, Mozer P, Chartier-Kastler E, Roupret M, Seisen T. Assessment of physicians’ satisfaction with a virtual tumour board in a French academic centre during the COVID-19 pandemic. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01362-2] [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] [Indexed: 10/20/2022]
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Pinar U, Anract J, Chartier-Kastler E, Parra J, Vaessen C, De La Taille A, Roupret M. Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01358-0] [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] [Indexed: 11/26/2022]
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Abdessater M, Alechinsky L, Parra J, Malaquin G, Huot O, Bastien O, Barrou B, Drouin SJ. Anatomical variations of the renal artery based on the surgeon's direct observation: A French perspective. Morphologie 2021; 106:15-22. [PMID: 33745846 DOI: 10.1016/j.morpho.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Renal arterial vasculature presents a great anatomical variation. A good knowledge of this anatomy is essential in the field of kidney transplantation. The aim of this study is to describe the anatomical variations of the renal arterial vasculature based on the retrieved but not transplanted kidneys (RNTK) and their contralateral grafted kidneys (CGK), which anatomy is described by surgeons themselves after aortic dissection during multi-organ procurement (MOP). MATERIAL AND METHODS Using the "Crystal" database of the French "Agence de la biomédecine" (ABM), all RNTK were retrospectively selected over one year. Then, the arterial anatomy of each RNTK and their CGK was studied using the surgical and the histopathological reports. The surgical report was completed by the surgeon at the end of the MOP from deceased donors. The qualitative variables were expressed in numbers (percentage of the population) and were compared by a Chi2 test or an exact Fisher test depending on the sample size. A P-value of less than 0.05 was considered statistically significant. RESULTS In total, 356 kidneys were studied (241 RNTK - 115 CGK), 69% had a single artery and 31% had multiple arteries (26% with two arteries and 5% with three or more). The incidence of multiple arteries was similar between the right and left kidneys (32% vs. 30% respectively). A modal arrangement with 1 artery on each side was present in 51% of cases. Thus, 1 in 2 donors had at least 2 arteries on one side. Multiple arteries were bilateral in 12% of cases. The RNTK group presented more kidneys with multiple arteries than the CGK group (35% vs. 22%). CONCLUSION Our study shows a higher incidence of multiple renal arteries than the literature (31% vs. 25%). Thus, MOP can be considered as an accurate and reliable method of describing renal arterial anatomy, especially that some small arteries may be missed when using radiological or cadaveric dissection techniques.
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Affiliation(s)
- M Abdessater
- Department of urology and renal transplantation, Sorbonne University, Pitié Salpêtrière University Hospital, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France.
| | - L Alechinsky
- Department of urology and renal transplantation, Sorbonne University, Pitié Salpêtrière University Hospital, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France
| | - J Parra
- Department of urology and renal transplantation, Sorbonne University, Pitié Salpêtrière University Hospital, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France
| | - G Malaquin
- Agence de la biomédecine, 1, avenue du stade de France, 93212 Saint-Denis-la-Plaine cedex, France
| | - O Huot
- Agence de la biomédecine, 1, avenue du stade de France, 93212 Saint-Denis-la-Plaine cedex, France
| | - O Bastien
- Agence de la biomédecine, 1, avenue du stade de France, 93212 Saint-Denis-la-Plaine cedex, France
| | - B Barrou
- Department of urology and renal transplantation, Sorbonne University, Pitié Salpêtrière University Hospital, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France.
| | - S J Drouin
- Department of urology and renal transplantation, Sorbonne University, Pitié Salpêtrière University Hospital, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France
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Quiroz Y, Llorens E, Novoa R, Motta G, Llurba E, Porta O, Parra J, Ballarin J, Palou J, Bujons A. Pregnancy in Pateints With Exstrophy-Epispadias Complex: Are Higher Rates of Complications and Spontaneous Abortion Inevitable? Urology 2021; 154:326-332. [PMID: 33662406 DOI: 10.1016/j.urology.2021.01.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report on the characteristics of pregnancy in female patients with EEC (exstrophy-epispadias complex), determining in particular whether they are at higher risk of spontaneous abortion or complications. MATERIALS AND METHOD Fifty patients diagnosed with EEC and treated in a reference center for this pathology were reviewed. Those with an incomplete medical history were excluded, leaving a total of 37 women with a median follow-up of 26 years (1-48 years). The outcome measurements were successful pregnancies, miscarriages, urological, gynecological and obstetric complications, impaired renal function, newborn characteristics, and postpartum urogynecological complications. Descriptive statistics was used. RESULTS Eight patients achieved 17 pregnancies (88.2% spontaneous). Of these pregnancies, 10 (58.8%) were successful, while 7 (41.2%) terminated in miscarriages. Urinary tract infection (UTI) was the most frequent complication (41.6%) and intestinal occlusion was the most severe. A total of 62.5% of the patients presented genital prolapses after pregnancies. A total of 85.7% of patients were dry during the follow-up after their pregnancies. No newborn presented EEC or any other type of malformation. Our study has the limitation of being a retrospective review of a very heterogeneous and small group of patients. CONCLUSION EEC patients can achieve spontaneous pregnancies but have an increased risk of miscarriage. For this reason, monitoring and control by a specialized and integrated multidisciplinary team is required to minimize complications.
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Affiliation(s)
- Yesica Quiroz
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Erika Llorens
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Rosa Novoa
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | | | - Elisa Llurba
- Gynecology and Obstetrics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Oriol Porta
- Gynecology and Obstetrics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Parra
- Gynecology and Obstetrics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Ballarin
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Joan Palou
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Anna Bujons
- Urology Department, Fundació Puigvert, Barcelona, Spain.
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21
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Pinar U, Anract J, Perrot O, Tabourin T, Chartier-Kastler E, Parra J, Vaessen C, De La Taille A, Roupret M. Évaluation préliminaire de la satisfaction des patients et des médecins concernant l’utilisation de la téléconsultation en urologie pendant la pandémie COVID-19. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Quiroz Y, Llorens E, Novoa R, Motta G, Llurba E, Porta O, Parra J, Da Silva I, Palou J, Bujons A. [High risk pregnancy in patients with extrophy-epispadia complex: Uro-gynecological characteristics and management.]. ARCH ESP UROL 2020; 73:813-818. [PMID: 33144535] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The exstrophy-epispadias complex (EEC) ranges from distal epispadias to cloacal exstrophy, with serious repercussions on the quality of life of patients. However, reconstructive surgery offers the opportunity to reach adulthood and consider motherhood.The objective of this work is to assess the uro-gynecological characteristics and the risks that pregnant women have with EEC. MATERIALS AND METHOD: Retrospective study of 50 patients diagnosed with EEC and treated in a reference center for this pathology, born between 1968 and 2000. Their medical records were reviewed and all demographic, pathological and gynecological data were collected. RESULTS: 37 patients have the inclusion criteria and of these 8 achieved 17 pregnancies (90% spontaneous and 10% through IVF). 10 were successful (50% at term) and 7 were abortions, 87.5% of which were in the first trimester. Urinary tract infection (UTI) was the most frequent complication (41.6%) and the most severe was intestinal occlusion. None of the patients presented renal function impairment during the gestation or dilation of the pathological upper urinary tract (UUT). 62.5% of the patients presented genital prolapses after pregnancies, 80% of which were grade III and IV. 87.5% were dry in the follow-up after their pregnancies. CONCLUSION: Pregnancy in the EEC patients is high risk and it is crucial that the follow-up is carried out by a specialized and integrated multidisciplinary team to minimize complications.
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Affiliation(s)
- Yesica Quiroz
- Departamento de Urología. Fundació Puigvert. Barcelona. España
| | - Erika Llorens
- Departamento de Urología. Fundació Puigvert. Barcelona. España
| | - Rosa Novoa
- Departamento de Urología. Fundació Puigvert. Barcelona. España
| | - Guilherme Motta
- Departamento de Urología. Fundació Puigvert. Barcelona. España
| | - Elisa Llurba
- Departamento de Ginecología y Obstetricia. Hospital de la Santa Creu i Sant Pau, Barcelona. España
| | - Oriol Porta
- Departamento de Ginecología y Obstetricia. Hospital de la Santa Creu i Sant Pau, Barcelona. España
| | - Juan Parra
- Departamento de Ginecología y Obstetricia. Hospital de la Santa Creu i Sant Pau, Barcelona. España
| | - Iara Da Silva
- Departamento de Nefrología de Fundació Puigvert. Barcelona. España
| | - Joan Palou
- Departamento de Urología. Fundació Puigvert. Barcelona. España
| | - Ana Bujons
- Departamento de Urología. Fundació Puigvert. Barcelona. España
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Abdessater M, Akakpo W, Kanbar A, Parra J, Chartier-Kastler E, Roupret M. Traitement de la maladie de Lapeyronie par les ondes de choc de faible intensité : expérience monocentrique. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Bentellis I, Chartier-Kastler E, Guillot-Tantay C, Parra J, Phé V. Cystectomie robot-assistée avec dérivation urinaire non continente trans-iléale intracorporelle chez les patients neuro-urologiques. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.08.021] [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: 10/23/2022]
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25
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Tabourin T, Sarfati J, Pinar U, Beaud N, Parra J, Vaessen C, Gomez F, Benamran D, Canlorbe G, Belghiti J, Chartier-Kastler E, Cussenot O, Seisen T, Roupret M. Évaluation du risque de contamination par le coronavirus après chirurgie robotique durant la pandémie COVID-19. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.011] [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: 10/23/2022]
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26
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Trilla C, Medina MC, Parra J, Llurba E, Espinós JJ. Inter- and Intraobserver Agreement in First Trimester Ultrasound Evaluation of Placental Biometry. Fetal Diagn Ther 2020; 47:834-840. [PMID: 32784297 DOI: 10.1159/000509707] [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: 12/17/2019] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the clinical applicability of a new analytical software program by determining the inter- and intraobserver agreement for 2D placental biometry and three-dimensional (3D) placental volume (PV) in the first trimester. METHODS A prospective study of 25 singleton pregnancies between 11 and 14 weeks was conducted. 3D datasets were captured, and PV was estimated using the Phillips QLAB GI3DQ ultrasound quantification software. The basal plate (BP), chorionic plate (CP), placental thickness (PT), and the free uterine surface (FUS) area not occupied by placenta were considered for 2D biometry evaluation. Each variable was measured in 2 orthogonal planes with mean values used for the analysis. Intra- and interobserver agreement was evaluated. RESULTS Intraobserver agreement for both 2D and 3D measurements was high, particularly for the PV and PT (interclass correlation coefficient [ICC] 0.989 [95% confidence interval (CI) 0.97-0.99] and ICC 0.936 [95% CI 0.86-0.97], respectively). Interobserver agreement was good for the PV (ICC 0.963 [95% CI 0.91-0.98]), PT (ICC 0.822 [95% CI 0.63-0.91]), and CP (ICC 0.708 [95% CI 0.44-0.86]), but moderate for BP and FUS. CONCLUSIONS PV, PT, and CP are reproducible measurements to evaluate first trimester placental biometry. Further research is needed to assess the clinical utility of these variables as predictors of poor obstetric outcomes.
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Affiliation(s)
- Cristina Trilla
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria C Medina
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Parra
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elisa Llurba
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain,
| | - Juan José Espinós
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Rivera D, Parra J, Rodríguez D. Caso clínico: manejo anestésico en corrección de atresia esofágica en recién nacido. Rev chil anest 2020. [DOI: 10.25237/revchilanestv49n02.13] [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: 11/24/2022] Open
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Olveira G, Abuín J, López R, Herranz S, García-Almeida JM, García-Malpartida K, Ferrer M, Cancer E, Luengo-Pérez LM, Álvarez J, Aragón C, Ocón MJ, García-Manzanares Á, Bretón I, Serrano-Aguayo P, Pérez-Ferre N, López-Gómez JJ, Olivares J, Arraiza C, Tejera C, Martín JD, Urioste-Fondo A, Abad ÁL, Alhambra MR, Zugasti A, Parra J, Torrejón S, Tapia MJ. RISK FACTORS FOR HYPOGLYCEMIA IN INPATIENTS WITH TOTAL PARENTERAL NUTRITION AND TYPE 2 DIABETES: A POST HOC ANALYSIS OF THE INSUPAR STUDY. Endocr Pract 2020; 26:604-611. [PMID: 32160049 DOI: 10.4158/ep-2019-0482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Treatment of hyperglycemia with insulin is associated with increased risk of hypoglycemia in type 2 diabetes mellitus (T2DM) patients receiving total parenteral nutrition (TPN). The aim of this study was to determine the predictors of hypoglycemia in hospitalized T2DM patients receiving TPN. Methods: Post hoc analysis of the INSUPAR study, which is a prospective, open-label, multicenter clinical trial of adult inpatients with T2DM in a noncritical setting with indication for TPN. Results: The study included 161 patients; 31 patients (19.3%) had hypoglycemic events, but none of them was severe. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes with end-organ damage, duration of diabetes, use of insulin prior to admission, glycemic variability (GV), belonging to the glargine insulin group in the INSUPAR trial, mean daily grams of lipids in TPN, mean insulin per 10 grams of carbohydrates, duration of TPN, and increase in urea during TPN. Multiple logistic regression analysis showed that the presence of diabetes with end-organ damage, GV, use of glargine insulin, and TPN duration were risk factors for hypoglycemia. Conclusion: The presence of T2DM with end-organ damage complications, longer TPN duration, belonging to the glargine insulin group, and greater GV are factors associated with the risk of hypoglycemia in diabetic noncritically ill inpatients with parenteral nutrition. Abbreviations: ADA = American Diabetes Association; BMI = body mass index; CV% = coefficient of variation; DM = diabetes mellitus; GI = glargine insulin; GV = glycemic variability; ICU = intensive care unit; RI = regular insulin; T2DM = type 2 diabetes mellitus; TPN = total parenteral nutrition.
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29
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Alés-Martínez JE, Tur R, Parra J, De Castro A, Ceballos J, Martín R, Marcos RA, Blanco P, Velasco MJ. Abstract P4-02-03: Cancer phenotype is the key factor in axillary involvement and distant recurrence in early breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-02-03] [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: 11/16/2022]
Abstract
Abstract
BACKGROUND: Factors by which breast cancer cells invade blood and lymphatic capillaries and metastasize regional lymph nodes and distant sites are not well understood. Genetics, molecular subtype, epidemiological, mechanical and pathological factors are being considered. Once breast cancer cells invade lymphatic or blood vessels the route of spread is still unclear. Cells could access the systemic circulation through the sentinel lymph node or directly avoiding the lymph node step. Molecular subtype is one of the most important factors associated with the risk of metastases. Our objective is to determine the influence of immunophenotype and the sentinel lymph node (SLN) status to predict the risk of locoregional relapses and distant metastases in early breast cancer. In our center we are using a molecular technique (OSNA) to ascertain if there is sentinel lymph node involvement, this technique creates a new continuous variable, Total Tumor Load (TTL), defined as the total number of CK19 mRNA copies in all positive SLN (copies/microL), indicating the total tumor volume of axillary tumor involvement.
METHODS: Clinicopathological and follow up data were obtained from all patients with early breast cancer treated with Tumorectomy (Tx) and Sentinel Lymph Node (SLN) assessed by OSNA with the decision to proceed to ALND based on Z0011 criteria and systemic therapy between 2011 and 2018 at our center (J Clin Oncol 37, 2019 (suppl; abstr 564))
RESULTS: 304 breast cancer patients underwent Tx and SLN assessed by OSNA followed by systemic therapy with an average follow-up of 64.9 months. SLN was positive in 122 cases and negative in 182. SLN negative patients were Luminal A (LA) 58%, Luminal B (LB) 14%, HER2 10% and Triple-Negative (TN) 7%. SLN positive patients were LA 52%, LB 35%, HER2 7% and TN 5%. Mean TTL was 136,244 copies (see table). As of now, 11 patients have had recurrence (locoregional relapse and distant disease): 6 of them with positive SLN (54,54%) and 5 with negative SLN (45,45%). A total of 4 patients have had locoregional relapse, two of them with negative SLN (50%) both non luminal tumors (1 HER2, 1 TN), and 7 have had distant disease, three of them with negative SLN (43%). Only one patient has died from metastatic breast cancer (HER2 positive, SLN negative).
CONCLUSIONS:
1. In our series, almost half of the patients (45%) with recurrence were negative SLN.
2. The probability of recurrence when the sentinel lymph node is negative is higher in HER2 and TN tumors (60%).
3. The probability of recurrence when the SLN is positive is higher in luminal tumors (66,6%).
4. Luminal tumors with positive SLN and large volume axillary involvement (median 1.419.450 copies) have a higher probability of recurrence (statistically significant) than luminal tumors with positive SLN and small volume axillary involvement (median 131.479 copies).
PATIENTS AND OUTCOMES
VARIABLE N=304Number of cases (n,%)Median age, range (years)LOCOREGIONAL RELAPSEMETASTASIC BREAST CANCEREXITUSMean TTL with NO recurrenceMean TTL with recurrencePOSITIVE SLN122 (40%)59,8 (33-87)2 (1,63%)4 (3,27%)0By ImmunophenotypeLuminal A64 (52,4%)59,3 (36-87)1 (1,5%)2 (3,1%)0371.5592.838.333Luminal B43 (35,2%)59,5 (36-84)1 (2,32%)00258.6221600HER29 (7,3%)61 (33-80)01 (11,1%)021.582640Triple Negative6 (5%)59,6 (50-80)01 (16,6%)0108.181184.000NEGATIVE SLN182 (60%)59,3 (27-89)2 (1,09%)3 (1,64%)1 (0,5%)By ImmunophenotypeLuminal A106 (58%)59,3 (33-82)000Luminal B43 (14,1%)59,5 (36-89)1 (2,32%)1 (2,32%)0HER219 (10,4%)59,3 (40-82)01 (5,2%)1 (5,2%)Triple Negative14 (7,7%)59,4 (27-85)1 (7,14%)1 (7,14%)0
Citation Format: José Enrique Alés-Martínez, Raquel Tur, Juan Parra, Ana De Castro, Jaime Ceballos, Rocío Martín, Rosa Ana Marcos, Paz Blanco, MJose Velasco. Cancer phenotype is the key factor in axillary involvement and distant recurrence in early breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-02-03.
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Affiliation(s)
| | - Raquel Tur
- Complejo Asistencial De Ávila, Ávila, Spain
| | - Juan Parra
- Complejo Asistencial De Ávila, Ávila, Spain
| | | | | | | | | | - Paz Blanco
- Complejo Asistencial De Ávila, Ávila, Spain
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Hessler D, Fisher L, Polonsky W, Strycker L, Parra J, Bowyer V, Dedhia M, Masharani U. There is value in treating elevated levels of diabetes distress: the clinical impact of targeted interventions in adults with Type 1 diabetes. Diabet Med 2020; 37:71-74. [PMID: 31314907 DOI: 10.1111/dme.14082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 11/28/2022]
Abstract
AIM To compare the effect of targeted interventions to reduce high diabetes distress among adults with Type 1 diabetes with a comparison sample of similar but untreated individuals, and to document the stability of untreated diabetes distress over time. METHODS A total of 51 adults with Type 1 diabetes with elevated baseline diabetes distress (distress score ≥ 2.0) and HbA1c levels (≥ 58 mmol/mol) were identified from a longitudinal, non-intervention study, and compared with a similar sample of 51 participants in an intervention study. Both groups completed the T1-DDS diabetes distress questionnaire at baseline and 9 months. RESULTS Large and significant reductions in diabetes distress scores were recorded in the intervention group (mean ± sd change = -0.6 ± 0.6), while minimal change was found in the non-intervention group (-0.2 ± 0.6, group effect P = 0.002; effect size d = 0.67). Additional analyses using the established minimal clinically important difference for the T1-DDS showed that diabetes distress increased significantly (minimal clinically important difference ≥ 1) or persisted at high levels for 51% of participants in the non-intervention group, compared with 23.5% in the intervention group. CONCLUSION Our results showed that targeted interventions led to dramatic reductions in diabetes distress compared with a lack of treatment. We also conclude that elevated diabetes distress, when left unaddressed, does not resolve over time and often remains chronic. (Clinical Trials Registry no.: NCT02175732).
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Affiliation(s)
- D Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - W Polonsky
- Behavioural Diabetes Institute, Department of Psychiatry, University of California, San Diego, CA, USA
| | - L Strycker
- Oregon Research Institute, Eugene, OR, USA
| | - J Parra
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - V Bowyer
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - M Dedhia
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - U Masharani
- Department of Medicine, University of California, San Francisco, CA, USA
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Chico A, Aguilera E, Ampudia-Blasco FJ, Bellido V, Cardona-Hernández R, Escalada FJ, Fernández D, Gómez-Peralta F, González Pérez de Villar N, Gorgojo JJ, Mezquita-Raya P, Morales C, de Pablos Velasco P, Palomares R, Parra J, Rivero MT, González-Blanco C. Clinical Approach to Flash Glucose Monitoring: An Expert Recommendation. J Diabetes Sci Technol 2020; 14:155-164. [PMID: 31081362 PMCID: PMC7189166 DOI: 10.1177/1932296819841911] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The flash glucose monitoring (FGM) system FreeStyle Libre® is a device that measures interstitial glucose in a very simple way and indicates direction and speed of glucose change. This allows persons with diabetes to prevent hypoglycemic and hyperglycemic events. Scientific evidence indicates that the system can improve glycemic control and quality of life. To obtain the maximum benefit, it is necessary to properly handle glucose values and trends. Due to the generalization of the system use, the purpose of the document is to provide recommendations for the optimal use of the device, not only in the management of glucose values and trends but also in the prevention of hypoglycemia, actuation in exercise, special situations, and retrospective analysis of the glucose data, among others.
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Affiliation(s)
- Ana Chico
- Endocrinology Department, Hospital Santa
Creu i Sant Pau, CIBER-BBN, Universitat Autònoma de Barcelona, Barcelona,
Spain
- Ana Isabel Chico, MD, PhD, Endocrinology
Department, Hospital Santa Creu i Sant Pau, Av Pare Claret 167, 08025
Barcelona,, Spain.
| | - Eva Aguilera
- Endocrinology Department, Hospital
Germans Trias i Pujol, Badalona, Spain
| | | | - Virgina Bellido
- Endocrinology Department, Hospital
Universitario Central de Asturias, Oviedo, Spain
| | - Roque Cardona-Hernández
- Division of Pediatric Endocrinology,
Diabetes Unit, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona,
Spain
| | | | - Diego Fernández
- Endocrinology Department, Hospital
Universitario Virgen de la Victoria, Málaga, Spain
| | | | | | - Juan José Gorgojo
- Endocrinology Department, Hospital
Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Pedro Mezquita-Raya
- Endocrinology Department, Hospital
Universitario Torrecárdenas, Almería, Spain
| | - Cristóbal Morales
- Endocrinology Department, Hospital
Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Rafael Palomares
- Endocrinologist, Hospital
Universitario Reina Sofía, Córdoba, Spain
| | - Juan Parra
- Endocrinology Department, Hospital de
Mérida, Mérida, Badajoz, Spain
| | - María Teresa Rivero
- Endocrinology Department, Complexo
Hospitalario Universitario de Ourense, Orense, Spain
| | - Cintia González-Blanco
- Endocrinology Department, Hospital Santa
Creu i Sant Pau, CIBER-BBN, Universitat Autònoma de Barcelona, Barcelona,
Spain
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Msika J, Seisen T, Vaessen C, Parra J, Cohen J, Chartier Kastler E, Bitker M, Roupret M. Faisabilité de la prostatectomie totale laparoscopique robot-assistée en unité de chirurgie ambulatoire pour la prise en charge du cancer de prostate. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kaulanjan K, Drouin S, Vaessen C, Parra J, Arzouk N, Tourret J, Ourahma S, Cazenave M, Barrou B. Prélèvement robot assisté du rein de donneur vivant : expérience monocentrique. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ales-Martinez J, Tur R, Parra J, Ceballos J, Filipovich E, Segovia B, Revestido R, De Castro ANA, Blanco P, Velasco MJ, Martin MR. No relationship of axillary total tumor load (TTL) by PCR (OSNA) in early breast cancer and local and distant clinical outcomes. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
564 Background: The study of sentinel lymph nodes (SLN) assessed by One Step Nucleic Acid Amplification (OSNA, Sysmex, Kobe, Japan) creates a new variable, Total Tumor Load (TTL). This variable is defined as the total number of CK19 mRNA copies in all positive SLN (copies/microL). The latest edition of the Spanish Oncological Gynecology Society (SEGO) Guideline (2017) proposes a complete axillary lymph node dissection (ALND) when TTL is 15,000 copies or more in early breast cancer. In our center we are using OSNA to ascertain if there is axillary node involvement but the decision to proceed to ALND is based on Z0011 criteria. We want to determine if there is a correlation between clinical outcomes and TTL values, between TTL and pathological variables and if TTL is a useful tool to decide when to complete an ALND. Methods: Clinicopathological and follow up data were obtained from all patients with invasive breast cancer and SLN assessed by OSNA between 2011 and 2017 at our center. Results: A total of 321 patients underwent SNB assessed by OSNA with an average follow-up of 56 months. 320 were female and 1 male. Age range 27-89 years (mean 58.9). 85 % were ductal, 10 % lobular and 5 % other. 53.5% were luminal A, 28.66% luminal B, 7.78%, triple negative, 4.3%, Her2 positive and 4.3%. luminal B-Her2 positive.TTL was equal to 0 in 183 cases and greater than zero in 138 cases.71 cases showed a TTL higher than 15,000 copies. Only 21 cases met Z0011 criteria and had ALND. As of now, 3 patients have had locoregional relapse and 8 metastatic disease. 12 have died, only two from metastatic breast cancer. Conclusions: Using Z0011 criteria, we have adequate clinical outcomes with a low rate of ALND; If we had based the axillary management on TTL values we would have multiplied the number of ALND by a factor of 3.3 (from 21 to 71); We have observed a tendency to higher TTL in luminal phenotypes and to lower TTL in HER2 positive and triple negative subtypes; Work is in progress to increase our sample size.
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Affiliation(s)
| | | | - Juan Parra
- Investigation Unit, UICBE, CIBER, Ávila, Spain
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Olveira G, Abuín J, López R, Herranz S, García-Almeida JM, García-Malpartida K, Ferrer M, Cancer E, Luengo-Pérez LM, Álvarez J, Aragón C, Ocón MJ, García-Manzanares Á, Bretón I, Serrano-Aguayo P, Pérez-Ferre N, López-Gómez JJ, Olivares J, Arraiza C, Tejera C, Martín JD, García S, Abad ÁL, Alhambra MR, Zugasti A, Parra J, Torrejón S, Tapia MJ. Regular insulin added to total parenteral nutrition vs subcutaneous glargine in non-critically ill diabetic inpatients, a multicenter randomized clinical trial: INSUPAR trial. Clin Nutr 2019; 39:388-394. [PMID: 30930133 DOI: 10.1016/j.clnu.2019.02.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is no established insulin regimen in T2DM patients receiving parenteral nutrition. AIMS To compare the effectiveness (metabolic control) and safety of two insulin regimens in patients with diabetes receiving TPN. DESIGN Prospective, open-label, multicenter, clinical trial on adult inpatients with type 2 diabetes on a non-critical setting with indication for TPN. Patients were randomized on one of these two regimens: 100% of RI on TPN or 50% of Regular insulin added to TPN bag and 50% subcutaneous GI. Data were analyzed according to intention-to-treat principle. RESULTS 81 patients were on RI and 80 on GI. No differences were observed in neither average total daily dose of insulin, programmed or correction, nor in capillary mean blood glucose during TPN infusion (165.3 ± 35.4 in RI vs 172.5 ± 43.6 mg/dL in GI; p = 0.25). Mean capillary glucose was significantly lower in the GI group within two days after TPN interruption (160.3 ± 45.1 in RI vs 141.7 ± 43.8 mg/dL in GI; p = 0.024). The percentage of capillary glucose above 180 mg/dL was similar in both groups. The rate of capillary glucose ≤70 mg/dL, the number of hypoglycemic episodes per 100 days of TPN, and the percentage of patients with non-severe hypoglycemia were significantly higher on GI group. No severe hypoglycemia was detected. No differences were observed in length of stay, infectious complications, or hospital mortality. CONCLUSION Effectiveness of both regimens was similar. GI group achieved better metabolic control after TPN interruption but non-severe hypoglycemia rate was higher in the GI group. CLINICAL TRIAL REGISTRY This trial is registered at clinicaltrials.gov as NCT02706119.
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Affiliation(s)
- Gabriel Olveira
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Universidad de Málaga, Spain; CIBERDEM (CB07/08/0019), Instituto de Salud Carlos III, Madrid, Spain.
| | - Jose Abuín
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Universidad de Málaga, Spain
| | - Rafael López
- Servicio de Endocrinología y Nutrición, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Sandra Herranz
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Jose M García-Almeida
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Mercedes Ferrer
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Emilia Cancer
- Sección de Endocrinología y Nutrición, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Luis M Luengo-Pérez
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Julia Álvarez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Carmen Aragón
- Servicio de Endocrinología y Nutrición, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María J Ocón
- Servicio de Endocrinología y Nutrición, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Álvaro García-Manzanares
- Servicio de Endocrinología y Nutrición, Hospital General La Mancha Centro, Alcázar de San Juan, Spain
| | - Irene Bretón
- Servicio de Endocrinología y Nutrición, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Serrano-Aguayo
- Unidad de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Natalia Pérez-Ferre
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Juan J López-Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Josefina Olivares
- Servicio de Endocrinología y Nutrición, Hospital Universitario Son Llatzer, Illes Balears, Spain
| | - Carmen Arraiza
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Cristina Tejera
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Jorge D Martín
- Servicio de Endocrinología y Nutrición, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Sara García
- Servicio de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain
| | - Ángel L Abad
- Unidad de Nutrición - Sección de Endocrinología, Hospital General Universitario de Alicante, Alicante, Spain
| | - María R Alhambra
- Servicio de Endocrinología y Nutrición, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ana Zugasti
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Juan Parra
- Servicio de Endocrinología y Nutrición, Hospital de Mérida, Badajoz, Spain
| | - Sara Torrejón
- Servicio de Endocrinología y Nutrición, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - María J Tapia
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
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Lenfant L, Verhoest G, Campi R, Parra J, Graffeille V, Masson-Lecomte A, Vordos D, De La Taille A, Roumiguie M, Lesourd M, Taksin L, Vaessen C, Ploussard G, Granger B, Rouprêt M. Comparaison des résultats périopératoires entre la reconstruction urinaire intracorporelle et extracorporelle après cystectomie robot-assistée pour cancer de vessie : une étude multicentrique française. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alvarez Villarraga J, Parra J, Diaz D, Cardenas A, Chavarriaga J, Godoy M. Guía de práctica clínica de infección de vías urinarias en el adulto. Rev Urol 2018. [DOI: 10.1055/s-0038-1660528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Juan Parra
- Clínica Nueva Rafael Uribe, Cali, Colombia
| | | | | | | | - M.P. Godoy
- Universidad del Rosario, Bogotá, Colombia
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Abstract
SummaryIntroduction. Hereditary macrothrombocytopenias (HM) are a group of infrequent disorders characterized by hereditary giant platelets. Little has been published about the course of these diseases during pregnancy and delivery. Subjects and methods. Forty consecutive thrombocytopenic pregnant women were studied. Platelet count, mean platelet volume and blood smear examination were performed. Platelet antibodies were studied by immunofluorescence. Familial study, bleeding time, ultrastructural platelet examination, a von Willebrand disease screening and aggregation tests were carried out when HM was suspected. Results. Four cases of HM were diagnosed. Giant platelets were observed in all cases, with the typical ultrastructural pattern. Dohle-like cytoplasmic inclusions in granulocytes were observed in one case. Platelet antibodies were detected in only one case. No prophylactic measures to prevent haemorrhage were adopted, and all patients underwent vaginal deliveries. Haemorrhagic events were absent in both mothers and children. Conclusions. The prevalence of HM in pregnant trombocytopenic women is higher than assumed. Prophylactic treatment should be avoided in the absence of a history of haemorrhagic complications and obstetrical risk factors.
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Affiliation(s)
- Albert Altès
- The Departments of Obstetrics and Gynaecology Hospital de la Santa Creu I Sant Pau de Barcelona, Spain
| | - Nuria Pujol-Moix
- The Departments of Obstetrics and Gynaecology Hospital de la Santa Creu I Sant Pau de Barcelona, Spain
| | - Eduardo Muñiz-Diaz
- The Hemotherapy Service, Hospital de la Santa Creu I Sant Pau de Barcelona, Spain
| | - Pedro Madoz
- The Hemotherapy Service, Hospital de la Santa Creu I Sant Pau de Barcelona, Spain
| | - Juan Parra
- Haematology, Hospital de la Santa Creu I Sant Pau de Barcelona, Spain
| | - Jordi Fontcuberta
- The Departments of Obstetrics and Gynaecology Hospital de la Santa Creu I Sant Pau de Barcelona, Spain
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Alés-Martínez JE, Tur R, Parra J, Martín MDR, Filipovich E, Segovia B, Ceballos J, Revestido R, De Castro J, De Grado C. Relationship of axillary total tumoral load (TTL) in early breast cancer and local and distant clinical outcomes. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e12574] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Raquel Tur
- Pathology Department, Complejo Asistencial de Ávila, Ávila, Spain
| | - Juan Parra
- Investigation Unit, UICBE, CIBER, Ávila, Spain
| | | | | | | | | | | | | | - Carlos De Grado
- Gynecological Department, Complejo Asistencial de Ávila, Ávila, Spain
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Wafi A, Faron G, Parra J, Gucciardo L. Influence of cervical cerclage interventions upon the incidence of neonatal death: a retrospective study comparing prophylactic versus rescue cerclages. Facts Views Vis Obgyn 2018; 10:29-36. [PMID: 30510665 PMCID: PMC6260668] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy of prophylactic and rescue cervical cerclages for pregnant patients with an incompetent cervix, and to assess the neonatal outcomes of both clinical conditions. METHODS This was a retrospective observational study of all women who had an elective or rescue cerclage between January 2008 and December 2016 in our institution. Prophylactic cerclage was defined as a cerclage before 16 weeks of gestation, while rescue cerclages were performed between 16 and 23 weeks of gestation. RESULTS In total, we analyzed the outcomes of 212 cervical interventions; 71% of the recruited patients experienced prophylactic cerclage, while 29% underwent rescue cerclage. Most of the patients delivered vaginally (70%) and were able to leave the hospital with a healthy newborn (78%). The mean pregnancy prolongation time after cerclage in the prophylactic and rescue groups were 21 weeks and 10 weeks, respectively. CONCLUSION Prophylactic cerclage interventions are most likely to be associated with a reduction of fetal demise because of the correlation between fetal prognosis and the gestational age at which cerclage is performed. Once the diagnosis of cervical insufficiency is confirmed, cerclage should be recommended as this will help to prolong the pregnancy.
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Affiliation(s)
- A Wafi
- Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - G Faron
- Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - J Parra
- Faculty of Medicine and Pharmacy, Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | - L Gucciardo
- Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Tur R, De Grado C, Martin MR, De Castro J, Filipovich E, Segovia B, Ceballos J, Parra J, Revestido R, Alés-Martínez JE. Abstract P3-01-19: Relationship of axillary total tumor load (TTL) by OSNA (one step nucleic acid amplification) in early breast cancer and clinical outcomes using strict Z0011 study criteria for axilla management. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-01-19] [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: 11/16/2022]
Abstract
Abstract
Background: The study of sentinel lymph node (SNL) assessed by OSNA provides a new variable, Total Tumoral Load (TTL).This variable is defined as the amount of CK19 mRNA copies number in all positives SLN. TTL has been showed to predict the axillary node status and has been analysed to determine its usefulness in the axillary surgical management. Based on TTL values different cut-off points have been proposed (last 25.000 copies) to establish a new tool to practice axillary lymph node dissection (ALND). We present the follow-up data of at least 5 years of breast cancer patients who underwent ALND according, strictly, to Z0011 trial criteria. We hypothesized that there will be no correlation between TTL and locoregional relapse if Z0011 are followed.
Methods: Clinicopathological and follow up data were obtained from patients with invasive breast cancer and SLN assessed by OSNA between 2011 and 2012 at Complejo Asistencial de Ávila, Spain. ALND was decided based on Z0011 study criteria independently of TTL. All patients have been followed for a minimun of 5 years.
Results: A total of 106 patients underwent SN assessed by OSNA, age range 27-85 years (mean 58,96). Of them 90% were ductal, 7,5% lobular and 2% others. By inmunophenotype: Luminal A 55%, Luminal B 28%, Triple Negative 9,4%, Her2 positive 3,7% and Luminal B-Her2 positive 2,8%. TTL was equal to zero in 58 cases and greater than zero in 48 cases with a range of 280-2.700.000 copies. Only 5 cases met ALND criteria (average TTL 68.164). Average TTL in cases without ALND was 111.000. For the time being, none of them has had locoregional relapse (median follow up 65 months). 3 patients have died one metastatic desease (Negative SN), one uterine cervix cancer and one neutropenic fever.
Baseline and outcomes dataVARIABLE N%Age, years (median, range) 59 (27-85) Tumour TypeDuctal9690,5 Lobular87,5 Others21,8InmunophenotypeLuminal A5955,6 Luminal B3028,3 Luminal B-Her232,8 Her243,7 Triple Negative109,4Total Tumoral Load (TTL)=05854,7 >04845,2Axillary Lymph Node Dissection (ALND) 254,7TTL >25.000 2321,7Locoregional relapse 00Overall Survival 95,2
Conclusions:
-Using Z0011 criteria and OSNA no locoregional recurrence has been observed so far.
-TTL did not predict risk of recurrence
-If we had based axillary management only on TTL values (i.e higher than 25.000 copies) we would have unnecessarily increased the number of lymphadenectomies in a 22%.
This is an ongoing study that designed to increased the sample size and obtain longer follow-up data.
Citation Format: Tur R, De Grado C, Martin MR, De Castro J, Filipovich E, Segovia B, Ceballos J, Parra J, Revestido R, Alés-Martínez JE. Relationship of axillary total tumor load (TTL) by OSNA (one step nucleic acid amplification) in early breast cancer and clinical outcomes using strict Z0011 study criteria for axilla management [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-19.
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Affiliation(s)
- R Tur
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - C De Grado
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - MR Martin
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - J De Castro
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - E Filipovich
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - B Segovia
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - J Ceballos
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - J Parra
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - R Revestido
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - JE Alés-Martínez
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
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Unuane D, Velkeniers B, Bravenboer B, Drakopoulos P, Tournaye H, Parra J, De Brucker M. Impact of thyroid autoimmunity in euthyroid women on live birth rate after IUI. Hum Reprod 2017; 32:915-922. [PMID: 28333271 DOI: 10.1093/humrep/dex033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 11/13/2016] [Accepted: 02/06/2017] [Indexed: 12/26/2022] Open
Abstract
Study question Does thyroid autoimmunity (TAI) predict live birth rate in euthyroid women after one treatment cycle in IUI patients? Summary answer TAI as such does not influence pregnancy outcome after IUI treatment. What is known already The role of TAI on pregnancy outcome in the case of IVF/ICSI is largely debated in the literature. This is the first study to address this issue in the case of IUI. Study design, size, duration This was a retrospective cohort study. A two-armed study design was performed: patients anti-thyroid peroxidase (TPO)+ and patients anti-TPO-. All patients who started their first IUI cycle in our fertility center between 1 January 2010 and 31 December 2014 were included. After exclusion of those patients with or being treated for thyroid dysfunction, 3143 patients were finally included in the study. Participants/materials, setting, methods After approval by the institutional review board we retrospectively included all patients who started their first IUI cycle in our center between 1 January 2010 and 31 December 2014 with follow-up of outcome until 31 December 2015. Patients with clinical thyroid dysfunction were excluded (thyroid-stimulating hormone (TSH) <0.01 mIU/l; TSH >5 mIU/l) as were patients under treatment with levothyroxine or anti-thyroid drugs. These patients were then divided into two main groups: patients anti-TPO+ and patients anti-TPO- (= control group). Live birth delivery after 25 weeks of gestation was taken as the primary endpoint of our study. As a secondary endpoint, we evaluated differences in live birth delivery after IUI according to different upper limits of preconception TSH thresholds (<2.5 and <5.0 mIU/l). Furthermore, the influence of thyroid function (TSH, free thyroxine (fT4)), anti-TPO status, age, smoking, BMI, parity, ovarian reserve (anti-mullerian hormone (AMH) and FSH), IUI indication and IUI stimulation on live birth rate was analyzed. Main results and the role of chance Between-group comparison did not show any significant difference between the anti-TPO+ and anti-TPO- group with respect to live birth delivery-, pregnancy- or miscarriage rate with odds ratio at 1.04 (95% CI: 0.63; 1.69), 0.98 (95% CI: 0.62; 1.55) and 0.74 (95% CI: 0.23; 2.39), respectively. In addition, there were no significant differences in live birth delivery-, pregnancy- or miscarriage rate when comparing subgroups according to TSH level (TSH ≥2.5 mIU/l vs. TSH <2.5 mIU/l) with an odds ratio at 1.05 (95% CI: 0.76; 1.47), 1.04 (95% CI: 0.77; 1.41) and 0.95 (95% CI: 0.47; 1.94), respectively. Limitations, reasons for caution This study was powered for the primary aim, live birth rate. The limitations of this study are the absence of region-specific reference ranges for thyroid hormones and the absence of follow-up of TSH values during ART and subsequent pregnancy. Moreover, there was a time difference of 5 months between thyroid assessment and the start of stimulation. The area where the study was conducted corresponds to a mild iodine deficient area and data should be translated with caution to areas with different iodine backgrounds. Wider implications of the findings Our findings indicate comparable pregnancy-, abortion- and delivery rates in women with and without TAI undergoing IUI. Moreover, we were unable to confirm a negative effect of TSH level above 2.5 mIU/l on live birth delivery rate. We therefore believe that advocating Levothyroxine treatment at TSH levels between 2.5 and 4 mIU/l needs to be considered with caution and requires further analysis in a prospective cohort study. Study funding/competing interest(s) No external funding was used for this study. No conflicts of interest are declared.
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Affiliation(s)
- D Unuane
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - B Velkeniers
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - B Bravenboer
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - P Drakopoulos
- Department of Gynaecology and Fertility, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - H Tournaye
- Department of Gynaecology and Fertility, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - J Parra
- Department of Statistics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - M De Brucker
- Department of Gynaecology and Fertility, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium.,Department of Obstetrics and Gynaecology, CHU Tivoli, Avenue Max Buset, La Louvière, Belgium
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Drakopoulos P, van de Vijver A, Parra J, Anckaert E, Schiettecatte J, Smitz J, Blockeel C, Hund M, Verhagen-Kamerbeek W, He Y, Polyzos N, Tournaye H. Effect of GnRH agonist downregulation on serum AMH levels: a prospective cohort study with repeated measurements. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.648] [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: 10/18/2022]
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Flippot R, Mouawad R, Spano JP, Rouprêt M, Compérat E, Bitker MO, Parra J, Vaessen C, Allanic F, Manach Q, Tannir N, Khayat D, Su X, Malouf G. Expression of long non-coding RNA MFI2-AS1 is a strong predictor of recurrence in sporadic localized clear-cell renal cell carcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Estadella J, Español P, Grandal B, Gine M, Parra J. Laparoscopy during pregnancy: Case report and key points to improve laparoscopic management. Eur J Obstet Gynecol Reprod Biol 2017; 217:83-88. [PMID: 28858685 DOI: 10.1016/j.ejogrb.2017.08.013] [Citation(s) in RCA: 4] [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: 02/14/2017] [Revised: 08/01/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Abstract
CASE REPORT A 34-year-old woman in her 19th week of gestation was admitted to the Emergency Department of our hospital for acute abdominal pain. The patient was diagnosed with haemoperitoneum. Laparoscopy was performed and revealed acute bleeding from a crumbly superficial uterine vascular network. Haemostasis was achieved and both mother and foetus recovered well after surgery. A caesarean section was performed at 38 weeks, delivering a healthy newborn and revealing that the pregnancy had developed in a rudimentary hemiuterus. Laparoscopy during pregnancy is safe and feasible and can be performed in any trimestre of pregnancy with no differences in perinatal outcomes but, as intervention complexity increases with gestational age, laparoscopy during pregnancy should be performed by experienced surgeons To minimise surgical risk several recommendations should be taken into account: gravid patients should be positioned in a left-tilted supine position, trocar placement should be adjusted to uterine size and gas insuflattion of 10-15mmHg can be used.
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Affiliation(s)
- Josep Estadella
- Obstetrics and Gynecology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Pia Español
- Obstetrics and Gynecology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Grandal
- Obstetrics and Gynecology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Gine
- Anesthesiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Parra
- Obstetrics and Gynecology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Goñi I, Rodríguez R, García-Arnáez I, Parra J, Gurruchaga M. Preparation and characterization of injectable PMMA-strontium-substituted bioactive glass bone cement composites. J Biomed Mater Res B Appl Biomater 2017; 106:1245-1257. [PMID: 28580716 DOI: 10.1002/jbm.b.33935] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 12/31/2022]
Abstract
In most minimally-invasive procedures used to address severe pain arising from compression fractures of the vertebral bodies, such as percutaneous vertebroplasty (PVP), a poly(methyl methacrylate) (PMMA) bone cement is used. Shortcomings of this type of cement, such as high exotherm temperature and lack of bioactivity, are well known. We prepared different formulations of a composite bone cement, whose solid constituents consisted of PMMA beads and particles of a bioactive glass (BG), where 0-20%(w/w) of the calcium component was substituted by strontium. The difference between the formulations was in the relative amounts of the solid phase constituents and in the Sr-content of BG. We determined the influence of the mixture of solid phase constituents of the cement formulation on a collection of properties, such as maximum exotherm temperature (Tmax ), setting time (tset ), and injectability (I). The selection of the PMMA beads was crucial to obtain cement composite formulations capable to be efficiently injected. Results allowed to select nine solid phase mixtures to be further tested. Then, we determined the influence of the composition of these composite bone cements on Tmax , tset , I, and cell proliferation. The results showed that the performance of various of the selected composite cements was better than that of PMMA cement reference, with lower Tmax , lower tset , and higher I. We found that incorporation of Sr-substituted BGs into these materials bestows bioactivity properties associated with the role of Sr in bone formation, leading to some composite cement formulations that may be suitable for use in PVP. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1245-1257, 2018.
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Affiliation(s)
- I Goñi
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
| | - R Rodríguez
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
| | - I García-Arnáez
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
| | - J Parra
- Unidad Asociada CAA-CSIC. Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Complejo Asistencial de Ávila. Hospital Provincial., 05071, Ávila, Spain
| | - M Gurruchaga
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
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Parra J, García Páez IH, De Aza AH, Baudin C, Rocío Martín M, Pena P. In vitro study of the proliferation and growth of human fetal osteoblasts on Mg and Si co-substituted tricalcium phosphate ceramics. J Biomed Mater Res A 2017; 105:2266-2275. [PMID: 28426904 DOI: 10.1002/jbm.a.36093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/31/2017] [Accepted: 04/14/2017] [Indexed: 11/11/2022]
Abstract
The objective of this work was to study the feasibility of the solid state sintering, a conventional ceramic processing method, to obtain Mg and Si co-substituted tricalcium phosphate bioceramics and composites containing diopside. A series of new Ca3 (PO4 )2 based ceramics has been prepared from attrition milled mixtures of synthetic Ca3 (PO4 )2 and CaMg(SiO3 )2 powders, isostatically pressed and sintered at 1250-1300°C. Materials containing 0, 1, and 5 wt % of CaMg(SiO3 )2 were constituted by β + α - Ca3 (PO4 )2 solid solutions while the material containing 60 wt % of CaMg(SiO3 )2 was a constituted by β- Ca3 (PO4 )2 and CaMg(SiO3 )2 . The biological responses of the developed ceramics were studied in vitro using human fetal osteoblast cultures. Culture times ranged from 1 to 21 days. The new family of materials promotes the adhesion and proliferation of human osteoblasts cultured onto their surface forming a monolayer and showing a normal morphology. The results of the MTT and Alamar Blue assays showed that the soluble components extracted from the Mg/Si- co-substituted Ca3 (PO4 )2 and the Ca3 (PO4 )2 -CaMg(SiO3 )2 composite were noncytotoxic. The specimens with diopside exhibited a better in vitro behavior which is attributed to the release of Si and Mg ions to the culture medium, enhancing the activity of cells. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2266-2275, 2017.
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Affiliation(s)
- Juan Parra
- Unidad de Investigación Clínica y Biopatología Experimental. Unidad Asociada al CSIC. Servicio de Anatomía Patológica. Complejo Asistencial de Ávila. SACYL, Jesús del Gran Poder 42, Ávila, 05002, Spain.,Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Health Institute Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
| | - Ismael H García Páez
- Instituto de Cerámica y Vidrio ICV, CSIC. C/Kelsen 5, Madrid, 28049, Spain.,Universidad Francisco de Paula Santander, Ave. Gran Colombia 12E-96B Colsag, San José de Cúcuta, Colombia
| | - Antonio H De Aza
- Instituto de Cerámica y Vidrio ICV, CSIC. C/Kelsen 5, Madrid, 28049, Spain
| | - Carmen Baudin
- Instituto de Cerámica y Vidrio ICV, CSIC. C/Kelsen 5, Madrid, 28049, Spain
| | - M Rocío Martín
- Unidad de Investigación Clínica y Biopatología Experimental. Unidad Asociada al CSIC. Servicio de Anatomía Patológica. Complejo Asistencial de Ávila. SACYL, Jesús del Gran Poder 42, Ávila, 05002, Spain
| | - Pilar Pena
- Instituto de Cerámica y Vidrio ICV, CSIC. C/Kelsen 5, Madrid, 28049, Spain
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El Hadad AA, Peón E, García-Galván FR, Barranco V, Parra J, Jiménez-Morales A, Galván JC. Biocompatibility and Corrosion Protection Behaviour of Hydroxyapatite Sol-Gel-Derived Coatings on Ti6Al4V Alloy. Materials (Basel) 2017; 10:E94. [PMID: 28772455 PMCID: PMC5459123 DOI: 10.3390/ma10020094] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 01/28/2023]
Abstract
The aim of this work was to prepare hydroxyapatite coatings (HAp) by a sol-gel method on Ti6Al4V alloy and to study the bioactivity, biocompatibility and corrosion protection behaviour of these coatings in presence of simulated body fluids (SBFs). Thermogravimetric/Differential Thermal Analyses (TG/DTA) and X-ray Diffraction (XRD) have been applied to obtain information about the phase transformations, mass loss, identification of the phases developed, crystallite size and degree of crystallinity of the obtained HAp powders. Fourier Transformer Infrared Spectroscopy (FTIR) has been utilized for studying the functional groups of the prepared structures. The surface morphology of the resulting HAp coatings was studied by Scanning Electron Microscopy (SEM). The bioactivity was evaluated by soaking the HAp-coatings/Ti6Al4V system in Kokubo's Simulated Body Fluid (SBF) applying Inductively Coupled Plasma (ICP) spectrometry. 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) and Alamar blue cell viability assays were used to study the biocompatibility. Finally, the corrosion behaviour of HAp-coatings/Ti6Al4V system was researched by means of Electrochemical Impedance Spectroscopy (EIS). The obtained results showed that the prepared powders were nanocrystalline HAp with little deviations from that present in the human bone. All the prepared HAp coatings deposited on Ti6Al4V showed well-behaved biocompatibility, good bioactivity and corrosion protection properties.
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Affiliation(s)
- Amir A El Hadad
- Centro Nacional de Investigaciones Metalúrgicas (CSIC), Madrid 28040, Spain.
- Biophysics Branch, Physics Department, Al-Azhar University, Nasr City, Cairo 11884, Egypt.
| | - Eduardo Peón
- Centro de Biomateriales, Universidad de La Habana, Havana 10600, Cuba.
| | | | - Violeta Barranco
- Instituto de Ciencia de Materiales de Madrid (CSIC), Madrid 28049, Spain.
| | - Juan Parra
- Unidad de Investigación Clínica y Biopatología Experimental, Hospital Provincial de Ávila, Unidad Asociada al CSIC, Ávila 05003, Spain.
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain.
| | - Antonia Jiménez-Morales
- Departamento de Ciencia e Ingeniería de Materiales e Ingeniería Química, Universidad Carlos III de Madrid, Leganés (Madrid) 28911, Spain.
| | - Juan Carlos Galván
- Centro Nacional de Investigaciones Metalúrgicas (CSIC), Madrid 28040, Spain.
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Pascual A, Guerriero S, Rams N, Juez L, Ajossa S, Graupera B, Hereter L, Cappai A, Pero M, Perniciano M, Errasti T, Parra J, Solis M, Alcázar JL. Clinical and ultrasound features of benign, borderline, and malignant invasive mucinous ovarian tumors. EUR J GYNAECOL ONCOL 2017. [PMID: 29693878 DOI: 10.1002/uog.14971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To compare clinical and sonographic features of benign, borderline, and malignant invasive mucinous ovarian tumors (MOTs). MATERIALS AND METHODS Retrospective observational multicenter study comprising 365 women (mean age: 46.1 years) with a histologically confirmed benign, borderline or malignant invasive MOT. Clinical data (patient's age, patient's complaints), tumor markers (CA-125 and CA-1 9.9), and sonographic data (tumor size, bilaterality, morphology -unilocular, multilocular, unilocular-solid, multilocular-solid and solid-, and IOTA color score) were reviewed and compared among these three groups. Women with ultrasound evidence on intra-abdominal disease spread were excluded. RESULTS Three hundred seventy-eight MOTs (14 women had bilateral lesions) were analyzed. Histologically, 287 tumors were benign, 51 were borderline, and 40 were malignant. No difference in patient's mean age was observed. Women with borderline or invasive tumors were less frequently asymptomatic. Tumors were larger in case of invasive lesions. Borderline and invasive tumors showed solid components and exhibited IOTA color score 3 or 4, more frequently than benign lesions (p < 0.001). However, the authors discovered that 16 out of 51 (31.4%) of borderline tumors and six out of 40 (15.0%) of invasive cancers had no solid components and a color score 1 or 2, and were considered as a benign lesion by the sonolo- gist. On the other hand, 96 out of 287 (33.4%) benign mucinous cystadenoma exhibited solid components and/or a color score of 3 or 4. CONCLUSIONS In spite of statistical differences, the authors observed significant overlapping in ultrasound features among benign, borderline, and invasive ovarian mucinous tumors that renders a difficult accurate preoperative discrimination among these lesions.
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Drouin S, Raux M, Tourret J, Lebreton G, Coffin G, Cohen J, Arzouk N, Ourahma S, Parra J, Riou B, Leprince P, Barrou B. Transplantation rénale issue de donneurs décédés d’arrêt cardiaque de la catégorie III de Maastricht. Résultats après un an d’expérience. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.086] [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: 10/20/2022]
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