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Gran F, Fidalgo A, Dolader P, Garrido M, Navarro A, Izquierdo-Blasco J, Balcells J, Codina-Sola M, Fernandez-Alvarez P, Sabaté-Rotés A, Betrián P, Fernández-Doblas J, Abella R, Roses-Noguer F. Differences between genetic dilated cardiomyopathy and myocarditis in children presenting with severe cardiac dysfunction. Eur J Pediatr 2022; 181:287-294. [PMID: 34286374 PMCID: PMC8294227 DOI: 10.1007/s00431-021-04175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/18/2021] [Accepted: 06/19/2021] [Indexed: 11/24/2022]
Abstract
Acute myocarditis is an inflammatory disease of the myocardium, and it can present as severe heart failure in children. Differential diagnosis with genetic cardiomyopathy can be difficult. The objective of this study is to identify patterns of clinical presentation and to assess invasive and non-invasive measures to differentiate patients with acute myocarditis from patients with dilated genetic cardiomyopathy. We performed a retrospective descriptive study of all paediatric patients (0-16 years old) that presented with new-onset heart failure with left ventricle ejection fraction < 35% in whom we performed an endomyocardial biopsy (EMB) during the period from April 2007 to December 2020. The patients were classified into two groups: Group 1 included 18 patients with myocarditis. Group 2 included 9 patients with genetic cardiomyopathy. Findings favouring a diagnosis of myocarditis included a fulminant or acute presentation (77.8% vs 33.3%, p = 0.01), higher degree of cardiac enzyme elevation (p = 0.011), lower left ventricular dimension z-score (2.2 vs 5.4, p = 0.03) increase of ventricular wall thickness (88.8% vs 33.3%, p = 0.03) and oedema in the EMB. Seven (77.8%) patients with genetic cardiomyopathy had inflammation in the endomyocardial biopsy fulfilling the diagnostic criteria of inflammatory cardiomyopathy.Conclusion: Differentiating patients with a myocarditis from those with genetic cardiomyopathy can be challenging, even performing an EMB. Some patients with genetic cardiomyopathy fulfil the diagnostic criteria of inflammatory cardiomyopathy. Using invasive and non-invasive measures may be useful to develop a predictive model to differentiate myocarditis from genetic cardiomyopathy. What is Known: • Acute myocarditis could present with cardiogenic shock in paediatric patients. • Parvovirus B19 is the main cause of myocarditis in this population. What is New: • Current diagnostic criteria for myocarditis have limited use in paediatric patients presenting with new-onset heart failure. • Some patients with a genetic cardiomyopathy and a new-onset heart failure fulfill the diagnostic criteria of inflammatory cardiomyopathy.
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Affiliation(s)
- Ferran Gran
- Paediatric Cardiology Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Andrea Fidalgo
- Paediatric Cardiology Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Paola Dolader
- Paediatric Cardiology Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Marta Garrido
- Department of Pathology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alexandra Navarro
- Department of Pathology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jaume Izquierdo-Blasco
- Paediatric Intensive Care Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Joan Balcells
- Paediatric Intensive Care Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta Codina-Sola
- Department of Clinical and Molecular Genetics, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute, Barcelona, Spain
| | - Paula Fernandez-Alvarez
- Department of Clinical and Molecular Genetics, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute, Barcelona, Spain
| | - Anna Sabaté-Rotés
- Paediatric Cardiology Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Pedro Betrián
- Paediatric Cardiology Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Joaquín Fernández-Doblas
- Department of Paediatric Cardiac Surgery, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Raúl Abella
- Department of Paediatric Cardiac Surgery, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ferran Roses-Noguer
- Paediatric Cardiology Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Launois P, Planas B, Pujol V, Gran F, Abella R, Albert D, Gómez-Garrido A. Functional results after a children's cardiac rehabilitation program after a heart transplant. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hernandez V, Abella R, Calvo JF, Jurado-Bruggemann D, Sancho I, Carrasco P. Determination of the optimal tolerance for MLC positioning in sliding window and VMAT techniques. Med Phys 2015; 42:1911-6. [DOI: 10.1118/1.4915541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Giménez-Barcons M, Colobran R, Gómez-Pau A, Marín-Sánchez A, Casteràs A, Obiols G, Abella R, Fernández-Doblas J, Tonacchera M, Lucas-Martín A, Pujol-Borrell R. Graves' disease TSHR-stimulating antibodies (TSAbs) induce the activation of immature thymocytes: a clue to the riddle of TSAbs generation? J Immunol 2015; 194:4199-206. [PMID: 25801430 DOI: 10.4049/jimmunol.1500183] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/24/2015] [Indexed: 01/22/2023]
Abstract
Graves' disease (GD) is an autoimmune thyroid disease defined by the production of stimulating autoantibodies to the thyroid-stimulating hormone receptor (TSHR) (TSAbs) that induce a sustained state of hyperthyroidism in patients. We previously demonstrated that TSHR, the target of this autoimmune response, is also a key susceptibility gene for GD, probably acting through thymic-dependent central tolerance. We also showed that TSHR is, unexpectedly, expressed in thymocytes. In this report, we confirm the expression of TSHR in thymocytes by protein immunoblotting and quantitative PCR, and show that expression is confined to maturing thymocytes. Using functional assays, we show that thymic TSHR is functional and that TSAbs can stimulate thymocytes through this receptor. This new activity of TSAbs on thymocytes may: 1) explain GD-associated thymic enlargement (hyperplasia), and 2) suggest the provocative hypothesis that the continuous stimulation of thymocytes by TSAbs could lead to a vicious cycle of iterative improvement of the affinity and stimulating capability of initially low-affinity antibacterial (e.g., Yersinia) Abs cross-reactive with TSHR, eventually leading to TSAbs. This may help to fill one of the gaps in our present understanding of unusual characteristics of TSAbs.
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Affiliation(s)
| | - Roger Colobran
- Vall d'Hebron Institute de Recerca, 08035 Barcelona, Spain; Departament de Biologia Cellular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - Ana Gómez-Pau
- Vall d'Hebron Institute de Recerca, 08035 Barcelona, Spain
| | - Ana Marín-Sánchez
- Servei d'Immunologia, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Anna Casteràs
- Servei de Endocrinologia, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Gabriel Obiols
- Servei de Endocrinologia, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Raúl Abella
- Servei de Cirurgia, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | | | - Massimo Tonacchera
- Department of Clinical and Experimental Medicine, Pisa University, 56126 Pisa, Italy; and
| | - Ana Lucas-Martín
- Departament de Biologia Cellular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain; Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Catalonia, Spain
| | - Ricardo Pujol-Borrell
- Vall d'Hebron Institute de Recerca, 08035 Barcelona, Spain; Departament de Biologia Cellular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain; Servei d'Immunologia, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain;
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Gran F, Albert D, Sanchez-de-Toledo J, Balcells J, Ferreres JC, Abella R. Trasplante cardiaco en pacientes pediátricos con hipertensión pulmonar. Rev Esp Cardiol (Engl Ed) 2014. [DOI: 10.1016/j.recesp.2014.03.006] [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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Gran F, Albert D, Sanchez-de-Toledo J, Balcells J, Ferreres JC, Abella R. Heart transplantation in pediatric patients with pulmonary hypertension. ACTA ACUST UNITED AC 2014; 67:669-70. [PMID: 25037549 DOI: 10.1016/j.rec.2014.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Ferran Gran
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Dimpna Albert
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joan Sanchez-de-Toledo
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joan Balcells
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joan Carles Ferreres
- Servicio de Anatomía Patológica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Raúl Abella
- Servicio de Cirugía Cardiaca Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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Hernandez V, Sempau J, Abella R, Lopez M, Perez M, Artigues M, Arenas M. A method for accurate zero calibration of asymmetric jaws in single-isocenter half-beam techniques. Med Phys 2013; 40:021706. [PMID: 23387729 DOI: 10.1118/1.4773314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To present a practical method for calibrating the zero position of asymmetric jaws that provides higher accuracy at the central axis and improves dose homogeneity in the abutting region of half-beams. METHODS Junction doses were measured for each asymmetric jaw using the double-exposure technique and electronic portal imaging devices. The junction dose was determined as a function of jaw position. The shift in the zero jaw position (or in its corresponding potentiometer readout) required to correct for the measured junction dose could thus be obtained. The jaw calibration was then modified to introduce the calculated shift and therefore achieve an accurate zero position in order to provide a relative junction dose that was as close to zero as possible. RESULTS All the asymmetric jaws from four medical linear accelerators were calibrated with the new calibration procedure. Measured relative junction doses at gantry 0° were reduced from a maximum of ±40% to a maximum of ±8% for all the jaws in the four considered accelerators. These results were valid for 6 MV and 18 MV photon beams and for any combination of asymmetric jaws set to zero. The calibration was stable over a long period of time; therefore, the need for recalibrating is seldom necessary. CONCLUSIONS Accurate calibration of the zero position of the jaws is feasible in current medical linear accelerators. The proposed procedure is fast and it improves dose homogeneity at the junction of half-beams, thus, allowing a more accurate and safer use of these techniques.
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Affiliation(s)
- V Hernandez
- Department of Medical Physics, Hospital Sant Joan de Reus, 43204 Tarragona, Spain.
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Iacona GM, Barber MA, Medina M, Abella R. Intrapericardial teratoma in a low birth weight preterm infant: a successful multidisciplinary approach. Interact Cardiovasc Thorac Surg 2011; 12:287-9. [DOI: 10.1510/icvts.2010.250746] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Thousands of children live in developing countries with untreated but correctable congenital heart disease (CHD), and most of them will die simple because they live in poor countries that do not have suitable medical/surgical facilities. The aim of the Association of Children with Heart Disease in the World is to support the operatory and teaching activities of a group of voluntary doctors engaged in the management of children with CHD in developing countries. Since 1992, the association has obtained 160 grants for foreign doctors who have been trained in our hospitals; performed 75 missions abroad, with more than 2150 cases evaluated and 404 cardiac operations performed; obtained millions of dollars worth of donated medical equipment; and constructed two cardiac surgery departments in Syria and Cameroon. Many efforts have been made, but much more can be done as we attain more experience and develop better coordination and collaboration between the international groups engaged in this emerging social need.
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Affiliation(s)
- A Giamberti
- Association of Children with Heart Disease in the World, Milan, Italy.
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Gazzolo D, Masetti P, Kornacka M, Abella R, Bruschettini P, Michetti F. Phentolamine administration increases blood S100B protein levels in pediatric open-heart surgery patients. Acta Paediatr 2004; 92:1427-32. [PMID: 14971794 DOI: 10.1080/08035250310006566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
AIM Phentolamine administration during open-heart surgery shortens the cooling and rewarming phases of cardiopulmonary bypass (CPB) and hastens weaning from mechanical ventilation and extubation. Data on the effects of phentolamine on cerebral circulation and function in this setting are lacking. This study reports the cerebral effects of phentolamine using blood S100B protein levels and the middle cerebral artery pulsatility index (MCA PI). METHODS Sixty pediatric patients undergoing congenital heart disease repair were randomly assigned to receive either phentolamine 0.2 mg kg(-1) i.v. (n = 30) or placebo (n = 30) before the cooling and rewarming phases of CPB. Samples for S100B measurement were collected at seven predetermined time-points before, during and after surgery. MCA PI values were recorded at the same times as sampling. RESULTS S100B blood levels were higher in the phentolamine-treated group than in controls after rewarming (3.53 +/- 1.88 vs 1.58 +/- 0.53 microg l(-1); p < 0.001), remained persistently higher at the end of surgery (2.95 +/- 0.91 vs 0.79 +/- 0.21 microg l(-1); p < 0.001) and returned to normal ranges 12 h later than in the placebo group (p > 0.05). MCA PI values were also significantly higher at the end of surgery in the phentolamine-treated group (1.83 +/- 0.50 vs 1.22 +/- 0.34; p < 0.01). Cooling and rewarming times were shorter in the phentolamine-treated group (p < 0.01, for all). CONCLUSION Despite improved peripheral vasodilatation and perfusion, phentolamine administration in pediatric open-heart surgery is correlated with increased cerebrovascular resistance and brain damage.
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Affiliation(s)
- D Gazzolo
- Department of Pediatrics, G Gaslini University Hospital, Genoa, Italy.
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Santoyo E, García R, Abella R, Aparicio A, Verma SP. Capillary electrophoresis for measuring major and trace anions in thermal water and condensed-steam samples from hydrothermal springs and fumaroles. J Chromatogr A 2001; 920:325-32. [PMID: 11453018 DOI: 10.1016/s0021-9673(01)00835-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A new application of capillary electrophoresis for measuring major and trace anions in thermal water and condensed-steam samples is presented. Ten fluid samples were collected from hydrothermal springs and fumaroles located in a volcanic zone of Deception Island, Antarctica. Anion separation was achieved in less than 6 min using indirect UV detection at 254 nm with a negative power supply (-15 kV). The electrolyte consisted of 4.7 mM sodium chromate, 4.0 mM electroosmotic flow modifier (OFM) hydroxide, 10 mM 2-(N-cyclohexylamino)ethanesulfonic acid and 0.1 mM calcium gluconate (pH 9.1). Major anions (Cl-, SO4(2), PO4H2+, and CO3H-) were measured using hydrostatic injection (10 cm for 30 s) at 25 degrees C. Trace amounts of anions (F-, Br-, and NO3-) were better determined by electromigration injection (4 kV, 10 s) at 15 degrees C. Good reproducibility of the migration times (<0.72% RSD), a satisfactory linear response and accuracy as well as acceptable detection limits were successfully obtained.
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Affiliation(s)
- E Santoyo
- Centro de Investigación en Energía, Universidad Nacional Autónoma de Mexico, Temixco, Mor.
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Abella R, Blondeel NJ, Roguska J, Walker C, Simon NM, Del Greco F. Periodic dialysis in terminal uremia. JAMA 1967; 199:362-8. [PMID: 4289324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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