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Duong PT, Santos L, Hsu HY, Jambawalikar S, Mutasa S, Nguyen MK, Guariento A, Jaramillo D. Deep Learning-Assisted Diffusion Tensor Imaging for Evaluation of the Physis and Metaphysis. J Imaging Inform Med 2024; 37:756-765. [PMID: 38321313 PMCID: PMC11031540 DOI: 10.1007/s10278-024-00993-3] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024]
Abstract
Diffusion tensor imaging of physis and metaphysis can be used as a biomarker to predict height change in the pediatric population. Current application of this technique requires manual segmentation of the physis which is time-consuming and introduces interobserver variability. UNET Transformers (UNETR) can be used for automatic segmentation to optimize workflow. Three hundred and eighty-five DTI scans from 191 subjects with mean age of 12.6 years ± 2.01 years were retrospectively used for training and validation. The mean Dice correlation coefficient was 0.81 for the UNETR model and 0.68 for the UNET. Manual extraction and segmentation took 15 min per volume, whereas both deep learning segmentation techniques took < 1 s per volume and were deterministic, always producing the same result for a given input. Intraclass correlation coefficient (ICC) for ROI-derived femur diffusion metrics was excellent for tract count (0.95), volume (0.95), and FA (0.97), and good for tract length (0.87). The results support the hypothesis that a hybrid UNETR model can be trained to replace the manual segmentation of physeal DTI images, therefore automating the process.
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Affiliation(s)
- Phuong T Duong
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Laura Santos
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Hao-Yun Hsu
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Michael K Nguyen
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Diego Jaramillo
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
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Patel V, Tariq SM, Hong S, Guariento A, Davidson R, Nguyen JC. Identification of fractures on pediatric foot radiographs: do localization cues improve diagnostic accuracy and reduce interpretation time? Skeletal Radiol 2024; 53:345-352. [PMID: 37490103 DOI: 10.1007/s00256-023-04401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To investigate the diagnostic accuracy and time in the detection of fractures on pediatric foot radiographs marked without and with localization cues. METHOD One-hundred randomly selected foot radiographic examinations that were performed on children (<18 years old) after injury and with at least 4 weeks of follow-up were included. Blinded to history and diagnosis, 4 readers (one each: medical student, pediatrician, pediatric orthopedic surgeon, and pediatric musculoskeletal radiologist) retrospectively and independently reviewed each examination twice (without and with cue, at least 1 month apart, and after randomization). Each reader recorded the presence or absence of a fracture, fracture location, diagnostic confidence, and the total (interpretation) time spent on each study. Diagnostic accuracy, reader confidence, and interpretation time were compared between examinations without and with cues. RESULTS Our study included 59 examinations without and 41 with fractures (21 phalangeal, 18 metatarsal, and 2 tarsal fractures). Localization cues improved inter-reader agreement (κ=0.36 to 0.64), overall sensitivity (68 to 72%), specificity (66 to 73%), and diagnostic accuracy (67 to 73%); thus, overcalled and missed rates also improved from 34 to 27% and 32 to 28%, respectively. Reader confidence improved with cue (49 to 61%, p<0.01) with higher incremental improvement with younger children (30% for 1-6 years; 14% for 7-11 years; and 10% for 12-17 years). Interpretation time decreased by 40% per examination (40±22 s without to 24±13 s with cues, p<0.001). CONCLUSION Localization cues improved diagnostic accuracy and reader confidence, reducing interpretation time in the detection of pediatric foot fractures.
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Affiliation(s)
- Vandan Patel
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Shahwar M Tariq
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Shijie Hong
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Richard Davidson
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Guariento A, Sharma P, Andronikou S. MRI features of spinal chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis in children. Pediatr Radiol 2023; 53:2092-2103. [PMID: 37204463 DOI: 10.1007/s00247-023-05688-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Spinal lesions in pediatric chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis (CRMO/CNO) can cause permanent sequelae; thus, early recognition of these is vital for management. OBJECTIVE To characterize the MR imaging features and patterns of pediatric spinal CRMO/CNO. MATERIALS AND METHODS This cross-section study received IRB approval. The first available MRI with documented spine involvement in children with CRMO/CNO was reviewed by a pediatric radiologist. Descriptive statistics were used to describe the characteristics of vertebral lesions, disc involvement, and soft tissue abnormality. RESULTS Forty-two patients were included (F:M, 30:12); median age was 10 years (range 4-17). At diagnosis, 34/42 (81%) had spine involvement. Kyphosis in 9/42 (21%) and scoliosis in 4/42 (9.5%) patients were present at the time of spinal disease recognition. Vertebral involvement was multifocal in 25/42 (59.5%). Disc involvement was found in 11/42 (26%) patients, commonly in the thoracic spine and often with adjacent vertebrae height loss. Posterior element abnormalities were present in 18/42 patients (43%) and soft tissue involvement in 7/42 (17%). One hundred nineteen vertebrae were affected, commonly the thoracic vertebrae (69/119; 58%). Vertebral body edema was focal in 77/119 (65%) and frequently superior (42/77; 54%). Sclerosis and endplate abnormality were present in 15/119 (13%) and 31/119 (26%) vertebrae, respectively. Height loss was present in 41/119 (34%). CONCLUSION Chronic non-bacterial osteomyelitis of spine is usually thoracic. Vertebral body edema is often focal at the superior vertebral body. Kyphosis and scoliosis occur in a quarter and vertebral height loss in a third of children at spinal disease recognition.
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Affiliation(s)
- Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Parth Sharma
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Bertelli F, Guariento A, Gervasi MT, Galliotto F, Sirico D, Blitzer D, Veronese P, Vida VL. Free interactive mobile app with 3D-reconstructed virtual models of congenital heart disease for prenatal parental counseling. Ultrasound Obstet Gynecol 2023; 62:152-153. [PMID: 36609983 DOI: 10.1002/uog.26154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Affiliation(s)
- F Bertelli
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - A Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M T Gervasi
- Obstetrics and Gynecology Unit, Department of Woman and Child Health, University of Padua, Padua, Italy
| | - F Galliotto
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - D Sirico
- Pediatric Cardiology Unit, Department of Woman and Child Health, University of Padua, Padua, Italy
| | - D Blitzer
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - P Veronese
- Obstetrics and Gynecology Unit, Department of Woman and Child Health, University of Padua, Padua, Italy
| | - V L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Patel V, Gendler L, Barakat J, Lim R, Guariento A, Chang B, Nguyen JC. Pediatric hand fractures detection on radiographs: do localization cues improve diagnostic performance? Skeletal Radiol 2023; 52:167-174. [PMID: 35982274 DOI: 10.1007/s00256-022-04156-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/05/2022] [Accepted: 08/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the diagnostic accuracy and interpretation time for detection of pediatric fractures on hand radiographs with and without localization cues. MATERIALS AND METHODS Consecutive children, who underwent radiographic examinations after injury, over 2 years (2019-2021) and with > 2 weeks of follow-up to confirm the presence or absence of a fracture, were included. Four readers, blinded to history and diagnosis, retrospectively reviewed all images twice, without and with cue, at least 1 week apart and after randomization, to determine the presence or absence of a fracture, and if present, anatomic location and diagnostic confidence were recorded. Interpretation time for each study was also recorded and averaged across readers. Inter-reader agreement was calculated using Fleiss' kappa. Diagnostic accuracy and interpretation time were compared between examinations using sensitivity, specificity, and Mann-Whitney U correlation. RESULTS Study group included 92 children (61 boys, 31 girls; 10.8 ± 3.4 years) with and 40 (31 boys, 9 girls; 10.9 ± 3.7 years) without fractures. Cue improved inter-reader agreement (κ = 0.47 to 0.62). While the specificity decreased (63 to 62%), sensitivity (75 to 78%), diagnostic accuracy (71 to 73%), and confidence improved (78 to 87%, p < 0.01), and interpretation time (median: 40 to 22 s, p < 0.001) reduced with examinations with localization cue. Specifically, examinations with fracture and cue had the shortest interpretation time (median: 16 s), whereas examinations without fracture and without cue had the longest interpretation time (median: 48 s). CONCLUSION Localization cues increased inter-reader agreement and diagnostic confidence, reduced interpretation time in the detection of fractures on pediatric hand radiographs, while maintaining diagnostic accuracy.
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Affiliation(s)
- Vandan Patel
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Liya Gendler
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jude Barakat
- University of Pennsylvania Undergraduate Institute, Philadelphia, PA, USA
| | - Ryan Lim
- University of Pennsylvania Undergraduate Institute, Philadelphia, PA, USA
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Benjamin Chang
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. .,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Nguyen JC, Gendler L, Guariento A, Nguyen MK, Hong S, Grady MF, Caine D. MRI findings of growth plate fractures of the knee: are there age- and fracture-dependent differences? Skeletal Radiol 2023; 52:1321-1329. [PMID: 36598521 DOI: 10.1007/s00256-022-04262-8] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/20/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate MRI findings in children with physeal fractures of the knee with respect to age, location, and articular involvement. METHODS Children with physeal fractures who underwent knee MRI between 2008 and 2021 were included. Two radiologists retrospectively reviewed all examinations to determine articular involvement, findings of physeal instability (perichondral disruption, periosteal entrapment), and internal derangement (cruciate ligament injury, meniscal tear, chondromalacia). Independent samples t, Mann-Whitney U, Pearson's chi-square, and Fisher's exact tests were used to compare findings. RESULTS Fifty-six patients (37 boys, 19 girls; mean age: 12.2 ± 2.5 years; 32 distal femur, 24 proximal tibial fractures) included 24(43%) intraarticular fractures. Fractures were more common in the tibia than the femur (67% versus 25%, p = 0.004) and intraarticular fractures were more common in older than younger children (13.1 ± 2.0 versus 11.5 ± 2.7 years, p = 0.01), to associate with chondromalacia (46% versus 12%, p = 0.02) and undergo surgery (33% versus 10%, p = 0.04) when compared to extraarticular fractures. Perichondral disruption (n = 44, 79%) and periosteal entrapment (n = 13, 23%) did not significantly differ based on location or articular involvement (p > 0.05). At a median follow-up of 17.5 months (interquartile range: 1.25-34), 3 patients (2 intraarticular, 1 extraarticular fractures) developed osteoarthritis, osteochondral lesion, and leg-length discrepancy from growth arrest, which required additional surgery. CONCLUSION Intraarticular physeal fractures were more common with older children, associate with chondromalacia, and underdo surgical intervention when compared to extraarticular fractures of the knee. While MRI findings of physeal instability were common, no significant differences were found between fractures based on anatomic location or fracture pattern.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd , Philadelphia, PA, USA. .,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Liya Gendler
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd , Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd , Philadelphia, PA, USA
| | - Michael K Nguyen
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Shijie Hong
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd , Philadelphia, PA, USA
| | - Matthew F Grady
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dennis Caine
- Kinesiology and Public Health Education, Division of Education, Health and Behavior Studies, University of North Dakota, Grand Forks, ND, USA
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Padalino M, Azzolina D, Puricelli F, Reffo E, Cabrelle G, Cavaliere AC, Guariento A, Castaldi B, Biffanti R, Vida V, Disalvo G. The impact of dominant ventricle morphology and accessory ventricle size on clinical outcomes after Fontan procedure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
the physio-pathological role of the morphological ventricular dominance (left, FSLV; right, FSRV), and the hemodynamic contribute of an accessory ventricular chamber (AVC), in patients with functional single ventricle (FSV) after Fontan operation are still uncertain due to conflicting data. We analyzed a cohort of Fontan patients to assess and correlate such anatomical features to late clinical outcomes.
Methods
We enrolled all patients after a Fontan procedure who underwent a cardiac magnetic resonance (CMR) and a cardiopulmonary exercise test (CPET) in the previous 3 years. Clinical, CMR and CPET data from the last follow-up visit were retrieved to analyze whether the size of any AVC and the morphological ventricular dominance (FSLV vs FSRV) were correlated with clinical outcomes (NYHA, need for reinterventions or cardiac transplantation, mortality, arrhythmias, liver disease and protein-losing enteropathy) and functional parameters (including FSV ejection fraction and presence of late gadolinium enhancement, LGE, on CMR and peak metabolic equivalents, pMETs, and peak oxygen consumption, pVO2, at CPET). All statistical tests were two tailed and significance was set at 0.05.
Results
we enrolled 50 patients: 29 had FSLV (58%), FSRV in 21 (42%). Median age at evaluation was 19.5 years [IQR 15–26]; median follow-up was 16 years [4–42]. NYHA class III or IV was present in 6%, while 4 (8%) underwent a re-do Fontan, 2 (4%) entered transplantation waiting list and one of these received a transplant. 2 patients (4%) died at follow-up. Statistical analysis showed that the accessory chamber was larger (>20 cc/m2) in FSLV than in FSRV (p=0.01). In the post-operative period, FSRV was associated with higher incidence of low-cardiac output syndrome (p=0.043). In the long-term, there was no statistically significant difference in major clinical outcomes or NYHA class between the two groups. FSLV was associated with a better cardiac function (median FSV ejection fraction 56% vs 52%; p=0.041), less extent of LGE [p = 0.022], better functional capacity expressed by METs (14.1 vs 12.3; p=0.01) and pVO2 (1.625 ml/min vs 1.233 ml/min; p=0.033). An AVC was detected in all: its size was <5 ml/m2 in 31%, 5–20 ml/m2 in 47%, and >20 ml/m2 in 22%. A larger AVC was associated with higher need for postoperative ECMO support (p=0.007), while size of AVC was not associated to any statistically difference in clinical outcomes, cardiac function and functional capacity.
Conclusions
In Fontan circulation, a FSLV is correlated to better clinical and functional outcomes when compared to FSRV. On the other side, an AVC appears to be not significantly related to any clinical disadvantage. However, the immediate postoperative course may be influenced negatively by the presence of a larger AVC.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - D Azzolina
- University of Ferrara, Biomedical Statistics , Ferrara , Italy
| | | | - E Reffo
- University of Padova , Padua , Italy
| | | | | | | | | | | | - V Vida
- University of Padova , Padua , Italy
| | - G Disalvo
- University of Padova , Padua , Italy
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Nguyen JC, Guariento A, Williams BA, Lawrence JTR, Ganley TJ, Venkatesh TP, Sze RW. MRI evaluation of pediatric tibial eminence fractures: comparison between conventional and "CT-like" ultrashort echo time (UTE) images. Skeletal Radiol 2022; 51:1603-1610. [PMID: 35112140 DOI: 10.1007/s00256-022-04000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE UTE MRI offers a radiation-free alternative to CT for bone depiction, but data on children is lacking. The purpose of this study was to determine whether UTE images improve detection and characterization of pediatric tibial eminence fractures. METHODS Fifteen MRIs with UTE from 12 children (10 boys, 2 girls; mean age: 12.6 ± 3.3 years) with tibial eminence fractures (2018-2020) and 15 age-matched MRIs without fractures were included. After randomization, 5 readers reviewed images without and with UTE, at least 1 month apart, and recorded the presence of fracture and preferred images. If fracture is present, radiologists also recorded fragment size, number, and displacement; surgeons assigned Meyers-McKeever grade and management. Disagreements on management were resolved through consensus review. Kappa and intra-class correlation (ICC), sensitivity, and specificity were used to compare agreement between readers and fracture detection between images without and with UTE. RESULTS For fracture detection, inter-reader agreement was almost perfect (κ-range: 0.91-0.93); sensitivity and specificity were equivalent between images without and with UTE (range: 95-100%). For fracture characterization, UTE improved agreement on size (ICC = 0.88 to 0.93), number (ICC = 0.52 to 0.94), displacement (ICC = 0.74 to 0.86), and grade (ICC = 0.92 to 0.93) but reduced agreement on management (κ = 0.68 to 0.61), leading to a change in consensus management in 20% (3/15). Radiologists were more likely to prefer UTE for fracture and conventional images for non-fracture cases (77% and 77%, respectively, p < 0.001). CONCLUSION While UTE did not improve diagnosis, it improved agreement on characterization of pediatric tibial eminence fractures, ultimately changing the preferred treatment in 20%.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Brendan A Williams
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J Todd R Lawrence
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Theodore J Ganley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tanvi P Venkatesh
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- University of Pennsylvania Undergraduate Program, Philadelphia, PA, USA
| | - Raymond W Sze
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Nguyen JC, Baghdadi S, Pogoriler J, Guariento A, Rajapakse CS, Arkader A. Pediatric Osteosarcoma: Correlation of Imaging Findings with Histopathologic Features, Treatment, and Outcome. Radiographics 2022; 42:1196-1213. [PMID: 35594197 DOI: 10.1148/rg.210171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Osteosarcoma is the most common primary bone sarcoma in children. Imaging plays a pivotal role in diagnostic workup, surgical planning, and follow-up monitoring for possible disease relapse. Survival depends on multiple factors, including presence or absence of metastatic disease, chemotherapy response, and surgical margins. At diagnosis, radiography and anatomic MRI are used to characterize the primary site of disease, whereas chest CT and whole-body bone scintigraphy and/or PET are used to identify additional sites of disease. Treatment starts with neoadjuvant chemotherapy, followed by en bloc tumor resection and limb reconstruction, and finally, adjuvant chemotherapy. Preoperative planning requires precise tumor delineation, which traditionally has been based on high-spatial-resolution anatomic MRI to identify tumor margins (medullary and extraosseous), skip lesions, neurovascular involvement, and joint invasion. These findings direct the surgical approach and affect the options for reconstruction. For skeletally immature children, the risk of cumulative limb-length discrepancy and need for superior longevity of the reconstruction have led to the advent and preferential use of several pediatric-specific surgical techniques, including rotationplasty, joint preservation surgery, autograft or allograft reconstruction, and extendible endoprostheses. A better understanding of the clinically impactful imaging features can directly and positively influence patient care. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Jie C Nguyen
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Soroush Baghdadi
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Jennifer Pogoriler
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Andressa Guariento
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Chamith S Rajapakse
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Alexandre Arkader
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
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Nguyen MK, Arkader A, Kaplan SL, Guariento A, Hong S, Moore ZR, Nguyen JC. Radiographic characterization of acute scaphoid fractures in children under 11 years of age. Pediatr Radiol 2021; 51:1690-1695. [PMID: 33783579 DOI: 10.1007/s00247-021-05052-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/28/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Delayed diagnosis of scaphoid fractures can lead to long-term morbidity. While radiography is the preferred screening examination, there is a relative paucity of literature that examines fracture visibility in younger children, who have smaller ossification centers, an abundance of unossified cartilage and fractures that preferentially involve the distal scaphoid. OBJECTIVE To characterize acute scaphoid fractures in younger children on radiographs with observer agreement and with respect to fracture location. MATERIALS AND METHODS This institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant cross-sectional study included children (≤10 years of age) with acute scaphoid fractures (≤7 days), who underwent radiographic examinations at a tertiary children's hospital between December 2008 and June 2019. Three readers (two pediatric radiologists and one orthopedic surgeon) reviewed each examination to determine fracture visibility on each radiographic view and fracture location. Kruskal-Wallis, Fisher exact and Cochran-Armitage tests were used to compare fracture visibility and location, and Kappa tests were used to calculate observer agreement. RESULTS Twenty-eight children (15 boys, 13 girls; mean age: 9.5±0.6 years) with 10 (36%) distal corner, 11 (39%) distal body and 7 (25%) mid-body fractures, underwent 7 (25%) 4-view, 18 (64%) 3-view and 3 (11%) 2-view examinations. Twenty-six (93%) fractures were visible on at least one view with six (21%) fractures visible on all available views. No significant association was found between fracture visibility and fracture location (P=0.32). Observer agreement was substantial to almost perfect. CONCLUSION Only 7% of these acute scaphoid fractures in younger children are inconspicuous on the initial radiographic examination.
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Affiliation(s)
- Michael K Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Alexandre Arkader
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Shijie Hong
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Zonia R Moore
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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11
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Nguyen JC, Davis KW, Arkader A, Guariento A, Sze A, Hong S, Jaramillo D. Pre-treatment MRI of leukaemia and lymphoma in children: are there differences in marrow replacement patterns on T1-weighted images? Eur Radiol 2021; 31:7992-8000. [PMID: 33768286 DOI: 10.1007/s00330-021-07814-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/18/2020] [Accepted: 02/18/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the prevalence and distribution of specific marrow patterns on pre-treatment magnetic resonance imaging (MRI) examinations in children with leukaemia and lymphoma and with respect to the anatomic location. MATERIALS AND METHODS This retrospective IRB-approved and HIPAA-compliant study included children with leukaemia or lymphoma who underwent pre-treatment MRI examinations over 18 years (between 1 January 1995 and 31 August 2013). Two radiologists blinded to the clinical diagnosis reviewed each study to determine the presence or absence of abnormal marrow signal and, when present, sub-categorised the pattern into diffuse, patchy, or focal abnormal marrow. Chi-square and Fisher's exact tests were used to compare marrow patterns between leukaemia and lymphoma. RESULTS The study included 50 children (32 males and 18 females; mean age 9.5 ± 5.3 years) with 54 MRI examinations (27 leukaemia and 27 lymphoma) that included 26 spine and 28 non-spine studies. Marrow replacement was present on 43 (80%) studies, significantly more common with leukaemia than with lymphoma (p = 0.039). The diffuse replacement pattern was significantly more common with leukaemia when compared to lymphoma (p < 0.001) and the focal pattern was only observed with lymphoma. In the spine, the diffuse pattern was observed with lymphoma (3/14, 21%). All patients with leukaemia and MRI outside of the spine showed marrow involvement. CONCLUSION Marrow replacement is common on MRI from children with leukaemia and lymphoma. A diffuse pattern was significantly associated with leukaemia on studies outside of the spine and a focal pattern was only observed with lymphoma, independently of the anatomic location. KEY POINTS • Bone marrow replacement on pre-treatment MRI examinations in children with leukaemia and lymphoma was observed in 93% (25/27) and 67% (18/27), respectively. • Diffuse pattern of marrow replacement was significantly more common in leukaemia even though this pattern was also observed with lymphoma on the spine MRI studies. • Focal pattern of marrow replacement was present only with lymphoma and not with leukaemia regardless of the anatomic location.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Kirkland W Davis
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alexandre Arkader
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Divison of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Alyssa Sze
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Shijie Hong
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Medical Center, New York City, NY, USA
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12
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Avesani M, Guariento A, Schiena CA, Reffo E, Castaldi B, Padalino M, Vida V, Di Salvo G. Echocardiographic comparison between pulmonary valve preservation and transannular patch techniques in children with repaired Tetralogy of Fallot. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
Many centers have recently adopted pulmonary valve (PV) preservation procedures to prevent the detrimental long-term effects of chronic pulmonary regurgitation after tetralogy of Fallot (ToF) repair.
PURPOSE
The aim of our study was to investigate pulmonary valve (PV) and right ventricular function by echocardiography in paediatric patients with repaired Tetralogy of Fallot (ToF), comparing PV preservation surgical strategies to standard transannular patch (TAP) repair.
METHODS
All patients undergoing transatrial-transpulmonary repair for ToF at our institution between January 2007 and May 2020 were reviewed retrospectively. Patients were divided into 2 main groups, according to the different techniques used: patients undergoing a PV preservation strategy and patients undergoing TAP repair. All patients underwent standard echo-Doppler study including RV end-diastolic area (RVEDA), end-systolic area (RVESA), fractional area change (FAC) and TAPSE; PR was assessed by Color Doppler, continuous-wave (CW) Doppler and derived parameters such as pressure half time (PHT) and pulmonary regurgitation (PR) index. By speckle tracking we measured also, in a subgroup of patients, right atrial strain (RAS), RV and left ventricle (LV) global longitudinal strain (RVGLS, LVGLS) and their time to peak (TTP) values.
RESULTS
Overall, 82 patients underwent a successful PV preservation strategy while 34 underwent a standard TAP repair. At index surgery, BSA (0.31 ± 0.1 m2, P = 0.3), age (4.8 ± 0.3 months, P = 0.5) and preoperative PV Z-score (-3.20 ± 0.1, P = 0.1) did not different between groups. Five-year actuarial freedom from moderate/severe PV regurgitation was significantly higher in the PV preservation group compared to the TAP (61.3% [95% CI: 48-73%] vs 25.9% [95% CI: 12-43%], respectively; p = 0.02). After adjusting for age, gender, BSA, and type of PV, the use of a TAP was still significantly associated with an increased risk for PV regurgitation at follow up (HR: 1.85, 95% CI: 1.09, 3.15; p = 0.02). At a mean follow-up of 6.9 ± 0.3 years, patients undergoing PV preservation showed an increased right ventricular fractional area change (46.9 ± 0.8% vs 42.5 ± 1.7%, P < 0.001) and tricuspid annular plane systolic excursion (TAPSE) z-score (-3.36 ± 0.3% vs -4.7 ± 0.4%, P = 0.005), while maintaining better PV competence in terms of pulmonary regurgitation index (87.9 ± 1.2% vs 82.7 ± 2.4%, P = 0.02). At speckle tracking subanalysis, patients undergoing PV preservation (n= 23), compared to the TAP group (n = 13) showed also higher values of RAS (37.5 ± 6.0% vs 29.3 ± 8.2% , P < 0.006), shorter right TTP (319 ± 39ms vs 357.5 ± 45.2 ms, P < 0.01) and higher values of LVGLS (-20,6 ± 4,2% vs -17.5 ± 3.0, P < 0.03).
CONCLUSIONS
Surgical repair of ToF with PV preservation provides excellent outcomes in terms of PV competence and right ventricular function and should be advocated whenever possible.
Abstract Figure. Degree of pulmonary regurgitation
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Affiliation(s)
- M Avesani
- University of Padova, Pediatric Cardiology Unit, Departments of Women’s and Children’s Health, University of Padua, Padua,, Padua, Italy
| | - A Guariento
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - CA Schiena
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - E Reffo
- University of Padova, Pediatric Cardiology Unit, Departments of Women’s and Children’s Health, University of Padua, Padua,, Padua, Italy
| | - B Castaldi
- University of Padova, Pediatric Cardiology Unit, Departments of Women’s and Children’s Health, University of Padua, Padua,, Padua, Italy
| | - M Padalino
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - V Vida
- University of Padova, Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - G Di Salvo
- University of Padova, Pediatric Cardiology Unit, Departments of Women’s and Children’s Health, University of Padua, Padua,, Padua, Italy
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13
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Nguyen JC, Shah AS, Nguyen MK, Baghdadi S, Nicholson A, Guariento A, Kaplan SL. Pediatric scaphoid fracture: diagnostic performance of various radiographic views. Emerg Radiol 2021; 28:565-572. [PMID: 33447903 DOI: 10.1007/s10140-020-01897-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to systematically investigate the performance of different radiographic views in the identification of scaphoid fractures in children. METHODS AND MATERIALS This case-control study compared 4-view radiographic examinations of the wrist between children with scaphoid fracture and age- and sex-matched children without fractures performed between January 2008 and July 2019. After randomization, each examination was reviewed 3 times, at least 1 week apart, first using each view separately and later using multiple views without (3-view) and with the posteroanterior (PA) scaphoid view (4-view), to determine the presence or absence of a scaphoid fracture. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with inter-rater agreement. RESULTS The study group of 58 children (48 boys and 10 girls; mean age 13.1 ± 2.1 years) included 29 with scaphoid fractures (8 corner, 9 distal pole, 10 waist, and 2 proximal pole) and 29 without fractures. Multiple views had higher sensitivity (3-view, 93.0%; 4-view, 96.5%) for fracture identification when compared to individual views (41.0-89.6%). The oblique view was 100% specific for the identification of a scaphoid fracture, but it lacked sensitivity. The PA scaphoid view had the highest sensitivity (89.6%) and NPV (90%) when compared to other individual views and its inclusion in the 4-view examinations produced the highest inter-rater agreement (93%, κ = 0.86). CONCLUSION Multiple radiographic views of the wrist with the inclusion of a PA scaphoid view (4-view) produced the highest sensitivity, NPV, and inter-rater agreement for the identification of a scaphoid fracture in children.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. .,University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - Apurva S Shah
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael K Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Soroush Baghdadi
- Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anthony Nicholson
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.,University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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14
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Guariento A, Honjo O, Barron D, Haller C. MINIMALLY INVASIVE RIGHT POSTEROLATERAL MINI-THORACOTOMY IN PEDIATRIC CARDIAC SURGERY. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.070] [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] Open
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15
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Guariento A, Doulamis I, Duignan T, Kido T, Regan W, Saeed M, Hoganson D, Emani S, Matte G, del Nido P, McCully J. Mitochondrial Transplantation for Myocardial Protection in Ex-Situ Perfused Hearts Donated after Cardio-Circulatory Death. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1319] [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: 10/24/2022] Open
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16
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Saccomanno B, Tibaldi J, Minoia F, Bagnasco F, Pistorio A, Guariento A, Caorsi R, Consolaro A, Gattorno M, Ravelli A. Predictors of Effectiveness of Anakinra in Systemic Juvenile Idiopathic Arthritis. J Rheumatol 2019; 46:416-421. [PMID: 30647180 DOI: 10.3899/jrheum.180331] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To seek predictors of therapeutic response to the interleukin (IL)-1 inhibitor anakinra in children with systemic-onset juvenile idiopathic arthritis (sJIA). METHODS The clinical charts of all patients with sJIA who were newly treated with anakinra at our center between 2004 and 2017 were reviewed retrospectively. Predictors included baseline demographic, clinical, and laboratory variables as well as previous or concomitant therapies. The effectiveness of anakinra was assessed at 1 year after treatment start. Complete clinical response (CCR) was defined as absence of fever, physician's global assessment ≤ 1, count of active joints ≤ 1, negative C-reactive protein, and ≥ 75% reduction of corticosteroid dose. According to the intention-to-treat principle, patients who had anakinra discontinued before 1 year for any reasons other than disease remission were classified as nonresponders. Statistics included univariate and multivariable analyses. RESULTS Of the 62 patients included in the study, 24 (39%) met the criteria for CCR at 1 year, whereas 38 (61%) did not. On multivariable analysis, independent correlations with achievement of CCR were identified for shorter disease duration, lower active joint count, higher ferritin level, and greater activity of systemic manifestations. The area under the curve of the model was 0.83. CONCLUSION Our findings help to delineate the clinical profile of patients with sJIA who are more likely to benefit from IL-1 blockade. They also underscore the need for studies aimed at examining the therapeutic role of early IL-1 inhibition and to identify biomarkers predicting response to either IL-1 or IL-6 antagonists.
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Affiliation(s)
- Benedetta Saccomanno
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Jessica Tibaldi
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Francesca Minoia
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Francesca Bagnasco
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Angela Pistorio
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Andressa Guariento
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Roberta Caorsi
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Alessandro Consolaro
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Marco Gattorno
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil.,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini
| | - Angelo Ravelli
- From the Università degli Studi di Genova, and the Istituto Giannina Gaslini, Genoa; Fondazione Institute for Research and Health Care (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Instituto de Criança - Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil. .,B. Saccomanno, MD, Research Fellow, Università degli Studi di Genova; J. Tibaldi, MD, PhD Student, Università degli Studi di Genova; F. Minoia, MD, Dirigente Medico, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; F. Bagnasco, PhD, Biostatistician, Istituto Giannina Gaslini; A. Pistorio, MD, PhD, Dirigente Medico, Istituto Giannina Gaslini; A. Guariento, MD, Research Fellow, Istituto Giannina Gaslini, and Instituto de Criança - FMUSP; R. Caorsi, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Consolaro, MD, PhD, Assistant Professor, Università degli Studi di Genova and Istituto Giannina Gaslini; M. Gattorno, MD, Dirigente Medico, Istituto Giannina Gaslini; A. Ravelli, MD, Professor of Pediatrics, Università degli Studi di Genova and Istituto Giannina Gaslini.
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Weixler V, Lapusca R, Guariento A, Saeed M, McCully D, del Nido P, Friehs I. Preventing Right Heart Failure in Pressure-Overload Hypertrophy through Transplantation of Autologous Mitochondria. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678837] [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: 10/27/2022]
Affiliation(s)
- V. Weixler
- Boston Children’s Hospital, Boston, United States
| | | | - A. Guariento
- Boston Children’s Hospital, Boston, United States
| | - M. Saeed
- Boston Children’s Hospital, Boston, United States
| | - D. McCully
- Boston Children’s Hospital, Boston, United States
| | - P. del Nido
- Boston Children’s Hospital, Boston, United States
| | - I. Friehs
- Boston Children’s Hospital, Boston, United States
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Weixler V, Zurakowski D, Guariento A, Rhodes J, del Nido P, Emani S. Ventricular Dominance and Cardiac Morphology as Independent Predictors of the Outcome of Fontan Procedures—A Single-Center Experience. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678787] [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: 10/27/2022]
Affiliation(s)
- V. Weixler
- Boston Children’s Hospital, Boston, United States
| | | | - A. Guariento
- Boston Children’s Hospital, Boston, United States
| | - J. Rhodes
- Boston Children’s Hospital, Boston, United States
| | - P. del Nido
- Boston Children’s Hospital, Boston, United States
| | - S. Emani
- Boston Children’s Hospital, Boston, United States
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Padalino M, Franchetti N, Boccuzzo G, Hazekamp M, Carrel T, Frigiola A, Rito ML, Horer J, Cleuziou J, Meyns B, Fragata J, Polimenakos A, Francois K, Veshti A, Salminen J, Rocafort AG, Nosal M, Guariento A, Vida V, Stellin G. OC68 SURGERY FOR ANOMALOUS AORTIC ORIGIN OF CORONARY ARTERIES (AAOCA). A MULTICENTER STUDY FROM THE EUROPEAN CONGENITAL HEART SURGEONS ASSOCIATION (ECHSA). J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549879.49449.8b] [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: 11/05/2022]
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Moskowitzova K, Liu K, Shin B, Ramirez-Barbieri G, Guariento A, Blitzer D, Cowan D, Thedsanamoorthy J, Yao R, Orfany A, Visner G, del Nido P, McCully J. Mitochondrial Transplantation Prolongs Cold Preservation Time in Murine Cardiac Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Novak GV, Marques M, Balbi V, Gormezano NWS, Kozu K, Sakamoto AP, Pereira RMR, Terreri MT, Magalhães CS, Guariento A, Sallum AME, Marini R, Ferriani VPL, Barbosa CM, de Castro TCM, Ramos VC, Bonfá E, Silva CA. Anti-RO/SSA and anti-La/SSB antibodies: Association with mild lupus manifestations in 645 childhood-onset systemic lupus erythematosus. Autoimmun Rev 2016; 16:132-135. [PMID: 27988434 DOI: 10.1016/j.autrev.2016.12.004] [Citation(s) in RCA: 24] [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: 09/05/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND To our knowledge there are no studies assessing anti-Ro/SSA and anti-La/SSB autoantibodies in a large population of childhood-systemic lupus erythematosus (cSLE) patients. METHODS This was a retrospective multicenter cohort study performed in 10 Pediatric Rheumatology services, São Paulo state, Brazil. Anti-Ro/SSA and anti-La/SSB antibodies were measured by enzyme linked immunosorbent assay (ELISA) in 645 cSLE patients. RESULTS Anti-Ro/SSA and anti-La/SSB antibodies were evidenced in 209/645 (32%) and 102/645 (16%) of cSLE patients, respectively. Analysis of cSLE patients with and without anti-Ro/SSA antibodies revealed higher frequencies of malar rash (79% vs. 71%, p=0.032), photosensitivity (73% vs. 65%, p=0.035), cutaneous vasculitis (43% vs. 35%, p=0.046) and musculoskeletal involvement (82% vs. 75%, p=0.046) in spite of long and comparable disease duration in both groups (4.25 vs. 4.58years, p=0.973). Secondary Sjögren syndrome was observed in only five patients with this antibody (2.5% vs. 0%, p=0.0035), two of them with concomitant anti-La/SSB. The presence of associated autoantibodies: anti-Sm (50% vs. 30%, p<0.0001), anti-RNP (39% vs. 21%, p<0.0001) and anti-ribossomal P protein (46% vs. 21%, p=0.002) was also significantly higher in patients with anti-Ro/SAA antibodies. Further evaluation of cSLE patients with the presence of anti-La/SSB antibodies compared to those without these autoantibodies showed that the frequency of alopecia (70% vs. 51%, p=0.0005), anti-Sm (59% vs. 31%, p<0.0001) and anti-RNP (42% vs. 23%, p<0.0001) were significantly higher in the former group. CONCLUSIONS Our large multicenter cohort study provided novel evidence in cSLE that anti-Ro/SSA and/or anti-La/SSB antibodies were associated with mild manifestations, particularly cutaneous and musculoskeletal. Secondary Sjögren syndrome was rarely observed in these patients, in spite of comparable frequencies of anti-Ro/SSA and/or anti-La/SSB reported for adult SLE.
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Affiliation(s)
- Glaucia V Novak
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Mariana Marques
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Verena Balbi
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Natali W S Gormezano
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Kátia Kozu
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Ana P Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Brazil
| | - Rosa M R Pereira
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Maria T Terreri
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Brazil
| | - Claudia S Magalhães
- Pediatric Rheumatology Division, São Paulo State University (UNESP) - Faculdade de Medicina de Botucatu, Brazil
| | - Andressa Guariento
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
| | - Adriana M E Sallum
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Roberto Marini
- Pediatric Rheumatology Unit, State University of Campinas (UNICAMP), Brazil
| | | | | | | | | | - Eloisa Bonfá
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Marques VLS, Guariento A, Simões MSM, Blay G, Lotito APN, Silva CA. Childhood-onset systemic polyarteritis nodosa and systemic lupus erythematosus: an overlap syndrome? Rev Bras Reumatol Engl Ed 2016; 56:551-553. [PMID: 27914603 DOI: 10.1016/j.rbre.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/11/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Victor L S Marques
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Andressa Guariento
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil; Santa Casa de Misericórdia de São Paulo, Departamento de Pediatria, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Marlise S M Simões
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Gabriela Blay
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Ana Paola N Lotito
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Clovis A Silva
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil.
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Lopes VAP, Lourenço DMR, Guariento A, Trindade MA, Avancini J, Silva CA. Borderline tuberculoid leprosy in childhood onset systemic lupus erythematosus patient. Lupus 2015; 24:1448-51. [DOI: 10.1177/0961203315593167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/03/2015] [Indexed: 11/16/2022]
Abstract
Leprosy is a contagious and chronic systemic granulomatous disease caused by the bacillus Mycobacterium leprae. To our knowledge, no case of leprosy in a childhood-onset systemic lupus erythematosus (c-SLE) patient has been reported. For a period of 31 years, 312 c-SLE patients were followed at the Pediatric Rheumatology Unit of our University Hospital. One of them (0.3%) had tuberculoid leprosy skin lesions during the disease course and is here reported. A 10-year-old boy from Northwest of Brazil was diagnosed with c-SLE based on malar rash, photosensitivity, oral ulcers, lymphopenia, proteinuria, positive antinuclear antibodies, anti-double-stranded DNA, anti-Sm and anti-Ro/SSA autoantibodies. He was treated with prednisone, hydroxychloroquine and intravenous cyclophosphamide, followed by mycophenolate mofetil. At 12-years-old, he presented asymmetric skin lesions characterized by erythematous plaques with elevated external borders and hypochromic center with sensory loss. Peripheral nerve involvement was not evidenced. No history of familial cases of leprosy was reported, although the region where the patient resides is considered to be endemic for leprosy. Skin biopsy revealed a well-defined tuberculoid form. A marked thickening of nerves was observed, often destroyed by granulomas, without evidence of Mycobacterium leprae bacilli. At that time, the SLEDAI-2K score was 4 and he had been receiving prednisone 15 mg/day, hydroxychloroquine 200 mg/day and mycophenolate mofetil 3 g/day. Paucibacillary treatment for leprosy with dapsone and rifampicine was also introduced. In conclusion, we have reported a rare case of leprosy in the course of c-SLE. Leprosy should always be considered in children and adolescents with lupus who present skin abnormalities, particularly with hypoesthesic or anesthesic cutaneous lesions.
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Affiliation(s)
- V A P Lopes
- Centro Universitário de Saúde, Ciências Humanas e Tecnologia do Piauí UNINOVAFAPI, Teresina, Brazil
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo (FMUSP), São Paulo, Brazil
| | - D M R Lourenço
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo (FMUSP), São Paulo, Brazil
| | - A Guariento
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo (FMUSP), São Paulo, Brazil
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - M A Trindade
- Dermatology Department, FMUSP, São Paulo, Brazil
| | - J Avancini
- Dermatology Department, FMUSP, São Paulo, Brazil
| | - C A Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo (FMUSP), São Paulo, Brazil
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Bejko J, Bottio T, Bortolussi G, Gallo M, Bianco R, Tarzia V, Guariento A, Gerosa G. Fortuity or Causality in Minimally Invasive LVAD Implantation: Relation Between Outflow Graft Height of Implantation Along the Ascending Aorta and Cerebral Ischemic Events. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Marques VLS, Guariento A, Simões MSM, Blay G, Lotito APN, Silva CA. [Childhood-onset systemic polyarteritis nodosa and systemic lupus erythematosus: an overlap syndrome?]. Rev Bras Reumatol 2015; 56:S0482-5004(15)00029-7. [PMID: 25824573 DOI: 10.1016/j.rbr.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 12/04/2014] [Accepted: 01/11/2015] [Indexed: 12/30/2022] Open
Abstract
We described herein a patient who presented an overlap syndrome of childhood-onset systemic polyarteritis nodosa (c-PAN) and childhood-onset systemic lupus erythematosus (c-SLE). A 9-year-old girl presented tender subcutaneous nodules on feet, arterial hypertension, right hemiplegia and dysarthric speech. She was hospitalized due to stroke and left foot drop. Brain computer tomography showed ischemic stroke. Magnetic resonance angiography revealed stenosis in the middle cerebral and internal carotid arteries. Electroneuromyography identified a mononeuropathy of left posterior tibial nerve and she fulfilled the c-PAN validated criteria. She was treated with intravenous methylprednisolone pulse therapy followed by prednisone, that was progressively tapered, six months of intravenous cyclophosphamide and after that she received azathioprine for 19 months. At the age of 14 years and 9 months, she presented malar rash, photosensitivity, edema in lower limbs and arterial hypertension. The proteinuria was 1.7g/day. Antinuclear antibodies (ANA) were 1/1280 (homogeneous nuclear pattern) and anti-dsDNA antibodies were positive. Renal biopsy showed focal proliferative and membranous glomerulonephritis. Therefore, she fulfilled the American College of Rheumatology classification criteria for SLE and she was treated with prednisone, hydroxychloroquine and mycophenolate mofetil. In conclusion, we described herein a possible overlap syndrome of two autoimmune diseases, where c-PAN occurred five years before the c-SLE diagnosis.
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Affiliation(s)
- Victor L S Marques
- Unidade de Reumatologia Pediátrica do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Andressa Guariento
- Unidade de Reumatologia Pediátrica do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil; Unidade de Reumatologia Pediátrica do Departamento de Pediatria da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Marlise S M Simões
- Unidade de Reumatologia Pediátrica do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Gabriela Blay
- Unidade de Reumatologia Pediátrica do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ana Paola N Lotito
- Unidade de Reumatologia Pediátrica do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Clovis A Silva
- Unidade de Reumatologia Pediátrica do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil.
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Guariento A, Silva MF, Tassetano PSF, Rocha SM, Campos LM, Valente M, Silva CA. Liver and spleen biometrics in childhood-onset systemic lupus erythematosus patients. Pediatr Rheumatol Online J 2014. [PMCID: PMC4191654 DOI: 10.1186/1546-0096-12-s1-p327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Montoro Lopez M, Pons De Antonio I, Itziar Soto C, Florez Gomez R, Alonso Ladreda A, Rios Blanco J, Refoyo Salicio E, Moreno Yanguela M, Lopez Sendon J, Guzman Martinez G, Van De Heyning CM, Magne J, Pierard L, Bruyere P, Davin L, De Maeyer C, Paelinck B, Vrints C, Lancellotti P, Michalski B, Krzeminska-Pakula M, Lipiec P, Szymczyk E, Chrzanowski L, Kasprzak J, Leao RN, Florencio AF, Oliveira AR, Bento B, Lopes S, Calaca J, Palma Reis R, Krestjyaninov M, Gimaev R, Razin V, Arangalage D, Chiampan A, Cimadevilla C, Touati A, Himbert D, Brochet E, Iung B, Nataf P, Vahanian A, Messika-Zeitoun D, Guvenc T, Karacimen D, Erer H, Ilhan E, Sayar N, Karakus G, Eren M, Iriart X, Tafer N, Roubertie F, Mauriat P, Thambo J, Wang J, Fang F, Yip GW, Sanderson J, Feng W, Yu C, Lam Y, Assabiny A, Apor A, Nagy A, Vago H, Toth A, Merkely B, Kovacs A, Castaldi B, Vida V, Guariento A, Padalino M, Cerutti A, Maschietto N, Biffanti R, Reffo E, Stellin G, Milanesi O, Baronaite-Dudoniene K, Urbaite L, Smalinskas V, Veisaite R, Vasylius T, Vaskelyte J, Puodziukynas A, Wieczorek J, Rybicka-Musialik A, Berger-Kucza A, Hoffmann A, Wnuk-Wojnar A, Mizia-Stec K, Melao F, Ribeiro V, Amorim S, Araujo C, Torres J, Cardoso J, Pinho P, Maciel M, Storsten P, Eriksen M, Boe E, Estensen M, Erikssen G, Smiseth O, Skulstad H, Miglioranza M, Gargani L, Sant`Anna R, Rover M, Martins V, Mantovanni A, Kalil R, Leiria T, Luo X, Fang F, Lee P, Zhang Z, Lam Y, Sanderson J, Kwong JS, Yu C, Borowiec A, Dabrowski R, Wozniak J, Jasek S, Chwyczko T, Kowalik I, Janas J, Musiej-Nowakowska E, Szwed H, Palinsky M, Petrovicova J, Pirscova M, Baricevic Z, Lovric D, Cikes M, Skoric B, Ljubas Macek J, Reskovic Luksic V, Separovic Hanzevacki J, Milicic D, Elmissiri A, El Shahid G, Abdal-Wahhab S, Vural MG, Yilmaz M, Cetin S, Akdemir R, Yoldas TK, Yeter E, Karamanou A, Hamodraka E, Lekakis I, Paraskevaidis I, Kremastinos D, Appiah-Dwomoh EK, Wang V, Otto C, Mayar F, Bonaventura K, Sunman H, Canpolat U, Kuyumcu M, Yorgun H, Sahiner L, Ozer N. Club 35 Poster Session Wednesday 11 December: 11/12/2013, 09:30-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Salomone T, Boni P, Serra C, Morselli-Labate AM, Di Gioia AL, Romboli M, Guariento A. The soluble interleukin-2 receptor, peripheral blood, and reticulocyte fractions in acute pancreatitis. Int J Pancreatol 1996; 20:197-203. [PMID: 9013281 DOI: 10.1007/bf02803769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CONCLUSION In acute pancreatitis (AP), the peripheral blood analysis, including reticulocytes (RC) and RC fractions, and its relationship to the changes of the levels of the soluble interleukin 2 receptor (sIL-2R) can provide useful information about the involvement of the immunoinflammatory system in AP and can indicate the severity of the disease. BACKGROUND In the disease clinical assessment, we correlated the sIL-2R serum levels to the peripheral blood components (including RC and RC fractions) to serum albumin and C-reactive protein (CRP) during AP. METHODS In 21 patients with AP, sIL-2R, the total and differential white blood cell (WBC) counts, red blood cell (RBC) counts, RC, RC fractions, hemoglobin (Hb), hematocrit (Ht), platelets (PLT), albumin, and CRP were evaluated from the onset to the sixth day of illness. RESULTS sIL-2R increased in all the patients. The increase was directly related to eosinophils, monocytes, and to middle-aged (MFR) RC, and inversely related to neutrophils and the old (LFR) RC. MFR-RC were directly related to the total WBC count, eosinophils, and basophils, and inversely related to Hb and albumin. LFR-RC behaved in the opposite manner. CRP increased in 16 patients; this rise was directly related to WBC, RC, and MFR-RC, and inversely related to Hb, LFR-RC, and albumin. sIL-2R and CRP values were not statistically interrelated, but when the CRP levels were higher, the increase in sIL-2R was greater and more sustained.
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Manfredi R, Ricchi E, Costigliola P, Borderi M, Guariento A, Silvestri MG, Chiodo F. [Monitoring of several hematological parameters of the erythroid series in patients with HIV infection treated with zidovudine]. Recenti Prog Med 1992; 83:361-6. [PMID: 1496188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Haematologic toxicity is the most common adverse effect related to long-term administration of zidovudine (AZT). We evaluated the kinetics of modifications of some haematologic parameters of erythroid series in 65 patients with HIV infection treated with AZT for a mean duration of 7.6 +/- 4.7 months (13 of them with a previous diagnosis of AIDS, 34 with ARC, 18 asymptomatic or with LAS/PGL), in order to correlate the observation and the evolution of these laboratory changes with the onset of severe anaemia. The development of macrocytosis occurs in a large majority of AZT-treated subjects, in spite of folate and vitamin B12 supplementation; the monitoring of erythrocytes distribution according to cellular volume and cellular haemoglobin concentration makes it possible to early recognize the occurrence of modification in erythropoiesis. There is no correlation between an elevated mean corpuscular volume and the development of severe anaemia (Hb less than or equal to 9 g/dl) in an individual patient; a fall in the reticulocyte count appears to be the earliest peripheral blood sign of the development of bone marrow toxicity.
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Affiliation(s)
- R Manfredi
- Istituto di Malattie infettive, Università, Bologna
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de Lima GR, Guariento A, Luisi A, de Almeida UR. [Polycystic kidney and pregnancy]. Matern Infanc (Sao Paulo) 1965; 24:523-36. [PMID: 5896515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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31
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de Lima GR, Guariento A. [On the use of a new analgesic spasmolytic drug in obstetrics]. Matern Infanc (Sao Paulo) 1965; 24:641-4. [PMID: 5888920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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32
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de Lima GR, França LC, Guariento A, Netto CDG. [Theca-lutein cysts of the ovaries in normal pregnancy]. Matern Infanc (Sao Paulo) 1965; 24:631-40. [PMID: 4297229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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33
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de Lima GR, Barbosa MJ, Guariento A. [Acute hydramnios]. Matern Infanc (Sao Paulo) 1965; 24:593-600. [PMID: 4868602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Guariento A, Delascio D, de Macedo OB, Luisi A. [Granuloma venereum and pregnancy]. Matern Infanc (Sao Paulo) 1965; 24:124-47. [PMID: 5320412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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