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Sanchez-Lorenzo L, Sancho L, Iscar T, Grisham R, Chiva L. Management challenges in low-grade serous ovarian cancer with a BRCA mutation. Int J Gynecol Cancer 2024; 34:631-636. [PMID: 38561200 DOI: 10.1136/ijgc-2023-005240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
| | - Lidia Sancho
- Nuclear Medicine, Clinica Universidad de Navarra, Madrid, Spain
| | - Teresa Iscar
- Pathology, Clínica Universidad de Navarra, Madrid, Spain
| | - Rachel Grisham
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Luis Chiva
- Department of Gynecology and Obstetrics, Clinica Universidad de Navarra, Madrid, Spain
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Aliseda D, Rotellar F, Sancho L, Batidas JF, Martínez de la Cuesta A, Rodríguez-Fraile M. Surgery and radioembolization of liver tumors. Rev Esp Med Nucl Imagen Mol 2023:S2253-8089(23)00056-3. [PMID: 37321348 DOI: 10.1016/j.remnie.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
Surgical resection is considered the curative treatment par excellence for patients with primary or metastatic liver tumors. However, less than 40% of them are candidates for surgery, either due to non-modifiable factors (comorbidities, age, liver dysfunction…), or to the invasion or proximity of the tumor to the main vascular requirements, the lack of a future liver remnant (FLR) adequate to maintain postoperative liver function, or criteria of tumor size and number. In these last factors, hepatic radioembolization has been shown to play a role as a presurgical tool, either by hypertrophy of the FLR or by reducing tumor size that manages to reduce tumor staging (term known as "downstaging"). To these is added a third factor, which is its ability to apply the test of time, which makes it possible to identify those patients who present progression of the disease in a short period of time (both locally and at distance), avoiding a unnecessary surgery. This paper aims to review RE as a tool to facilitate liver surgery, both through the experience of our center and the available scientific evidence.
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Affiliation(s)
- Daniel Aliseda
- Departamento de Cirugía General, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Fernando Rotellar
- Departamento de Cirugía General, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Lidia Sancho
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Madrid, Spain
| | - Juan Fernando Batidas
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Calvo FA, Palma J, Serrano J, Cambeiro M, Meiriño R, Martin S, Azcona D, Pedrero D, Aguilar B, Delgado JM, Moran V, Viñals A, Cabello P, Panizo E, Lassaletta A, Gibert C, Sancho L, de Miguel JMF, de Sierra BA, Alcázar A, Suarez V, Alonso A, Gallardo G, Aristu J. Hospital-based proton therapy implementation during the COVID pandemic: early clinical and research experience in a European academic institution. Clin Transl Oncol 2023; 25:1268-1276. [PMID: 36961726 PMCID: PMC10036962 DOI: 10.1007/s12094-023-03127-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efficient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. METHODS A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities' recommendations. The temporary trends of patients care and research projects proposals were registered. RESULTS 3 out of 14 members of the professional staff involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientific production was adapted to the pandemic evolution and its influence upon professional time availability. Seven research projects based in public funding were activated in this period and preliminary data on molecular imaging guided proton therapy in brain tumors and post-irradiation patterns of blood biomarkers are reported. CONCLUSIONS Hospital-based PBT in European academic institutions was impacted by COVID-19 pandemic, although clinical and research activities were developed and sustained. In the post-pandemic era, the benefits of online learning will shape the future of proton therapy education.
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Affiliation(s)
- Felipe A Calvo
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain.
| | - Jacobo Palma
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Javier Serrano
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Mauricio Cambeiro
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Rosa Meiriño
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Santiago Martin
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Diego Azcona
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Diego Pedrero
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Borja Aguilar
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Jose Miguel Delgado
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Verónica Moran
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Alberto Viñals
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Pablo Cabello
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Elena Panizo
- Department of Pediatric Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Alvaro Lassaletta
- Department of Pediatric Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Carlota Gibert
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Lidia Sancho
- Department of Nuclear Medicine, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | | | | | - Andres Alcázar
- Department of Radiology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Victor Suarez
- Department of Radiology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Alberto Alonso
- Department of Radiology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Guillermo Gallardo
- Department of Radiology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Javier Aristu
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
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Manzour N, Oñate B, Chacon E, Boria F, Minguez JA, Vazquez D, Castellanos T, Brotons I, Vara J, Lopez-Picazo A, de Canales JG, Sancho L, Martin-Calvo N, Berasaluce A, Chiva L, Alcazar JL. 2022-RA-776-ESGO Validity of whole body MRI in the preoperative assessment of ovarian cancer: systematic review and meta-analysis. Diagnostics (Basel) 2022. [DOI: 10.1136/ijgc-2022-esgo.161] [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: 12/23/2022] Open
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Boria F, Chiva L, Carbonell M, Gutierrez M, Sancho L, Alcazar A, Coronado M, Hernández Gutiérrez A, Zapardiel I. 18F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18F-FDG PET/CT) predictive score for complete resection in primary cytoreductive surgery. Int J Gynecol Cancer 2022; 32:ijgc-2022-003883. [PMID: 36137576 DOI: 10.1136/ijgc-2022-003883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the value of preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan, combined with clinical variables, in predicting complete cytoreduction in selected patients with advanced ovarian cancer. METHODS We carried out a multicenter, observational, retrospective study evaluating patients who underwent primary cytoreductive surgery for advanced ovarian cancer in two Spanish centers between January 2017 and January 2022. Inclusion criteria were histological confirmation of invasive epithelial ovarian carcinoma; preoperative International Federation of Gynecology and Obstetrics (FIGO) stage III or IV; upfront cytoreductive surgery; and 18F-FDG PET/CT performed 1 month prior to surgery. A modified 18F-FDG PET/CT peritoneal cancer index score was calculated for all patients. Clinical variables and preoperative 18F-FDG PET/CT findings were analyzed and a multivariate model was constructed. A predictive score based on the odds ratio of the variables was calculated to determine patient selection. RESULTS A total of 45 patients underwent primary cytoreductive surgery. Complete resection was achieved in 36 (80%) patients. On multivariate analysis, two clinical variables (age ≥58 years and American Society of Anesthesiology score ≥3) and two preoperative 18F-FDG PET/CT scan findings (presence of extra-abdominal lymph node involvement and modified peritoneal cancer index value of 6 or more) were associated with gross residual disease. For this multivariate model predictive of non-complete cytoreduction, the area under the curve was 0.881. A predictive value of ≥5 was the most predictive cut-off for gross residual disease. Complete resection rate was 91.7% in patients with a score of ≤4 and 33.3% in patients with a score of ≥5 points on the predictive score. CONCLUSIONS In selected patients, a predictive score value ≥5 may be consider as a cut-off point for triaging patients to diagnostic laparoscopy before the primary surgery or neoadjuvant chemotherapy.
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Affiliation(s)
- Felix Boria
- Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Madrid, Spain
| | - Luis Chiva
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Maria Carbonell
- Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
| | | | - Lidia Sancho
- Nuclear Medicine, Clinica Universidad de Navarra, Madrid, Spain
| | - Andres Alcazar
- Radiology Department, Clinica Universidad de Navarra, Madrid, Spain
| | - Monica Coronado
- Nuclear Medicine, La Paz University Hospital, Madrid, University, Spain
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Morales-Lozano MI, Rodriguez-Otero P, Sancho L, Nuñez-Cordoba JM, Prieto E, Marcos-Jubilar M, Rosales JJ, Alfonso A, Guillen EF, San-Miguel J, Garcia-Velloso MJ. 11C-Methionine PET/CT in Assessment of Multiple Myeloma Patients: Comparison to 18F-FDG PET/CT and Prognostic Value. Int J Mol Sci 2022; 23:ijms23179895. [PMID: 36077292 PMCID: PMC9456410 DOI: 10.3390/ijms23179895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 12/13/2022] Open
Abstract
Multiple myeloma (MM) is the second most common haematological malignancy and remains incurable despite therapeutic advances. 18F-FDG (FDG) PET/CT is a relevant tool MM for staging and it is the reference imaging technique for treatment evaluation. However, it has limitations, and investigation of other PET tracers is required. Preliminary results with L-methyl-[11C]- methionine (MET), suggest higher sensitivity than 18F-FDG. This study aimed to compare the diagnostic accuracy and prognostic value of 1FDG and MET in MM patients. We prospectively compared FDG and MET PET/CT for assessment of bone disease and extramedullary disease (EMD) in a series of 52 consecutive patients (8 smoldering MM, 18 newly diagnosed MM and 26 relapsed MM patients). Bone marrow (BM) uptake patterns and the detection of focal lesions (FLs) and EMD were compared. Furthermore, FDG PET parameters with known MM prognostic value were explored for both tracers, as well as total lesion MET uptake (TLMU). Median patient age was 61 years (range, 37–83 years), 54% were male, 13% of them were in stage ISS (International Staging System) III, and 31% had high-risk cytogenetics. FDG PET/CT did not detect active disease in 6 patients, while they were shown to be positive by MET PET/CT. Additionally, MET PET/CT identified a higher number of FLs than FDG in more than half of the patients (63%). For prognostication we focussed on the relapsed cohort, due to the low number of progressions in the two other cohorts. Upon using FDG PET/CT in relapsed patients, the presence of more than 3 FLs (HR 4.61, p = 0.056), more than 10 FLs (HR 5.65, p = 0.013), total metabolic tumor volume (TMTV) p50 (HR 4.91, p = 0.049) or TMTV p75 (HR 5.32, p = 0.016) were associated with adverse prognosis. In MET PET/CT analysis, TMTV p50 (HR 4.71, p = 0.056), TMTV p75 (HR 6.27, p = 0.007), TLMU p50 (HR 8.8, p = 0.04) and TLMU p75 (HR 6.3, p = 0.007) adversely affected PFS. This study confirmed the diagnostic and prognostic value of FDG in MM. In addition, it highlights that MET has higher sensitivity than FDG PET/CT for detection of myeloma lesions, including FLs. Moreover, we show, for the first time, the prognostic value of TMTV and TLMU MET PET/CT in the imaging evaluation of MM patients.
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Affiliation(s)
- Maria I. Morales-Lozano
- Department of Nuclear Medicine, Clinica Universidad de Navarra, CCUN Applied Medical Research, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Paula Rodriguez-Otero
- Department of Haematology, Clínica Universidad de Navarra, CCUN Applied Medical Research, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Lidia Sancho
- Department of Nuclear Medicine, Clinica Universidad de Navarra, CCUN Applied Medical Research, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Jorge M. Nuñez-Cordoba
- Research Support Service, Central Clinical Trials Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Elena Prieto
- Department of Nuclear Medicine, Clinica Universidad de Navarra, CCUN Applied Medical Research, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Maria Marcos-Jubilar
- Department of Haematology, Clínica Universidad de Navarra, CCUN Applied Medical Research, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Juan J. Rosales
- Department of Nuclear Medicine, Clinica Universidad de Navarra, CCUN Applied Medical Research, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Ana Alfonso
- Department of Haematology, Clínica Universidad de Navarra, CCUN Applied Medical Research, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Edgar F. Guillen
- Department of Nuclear Medicine, Clinica Universidad de Navarra, CCUN Applied Medical Research, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Jesus San-Miguel
- Department of Haematology, Clínica Universidad de Navarra, CCUN Applied Medical Research, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Maria J. Garcia-Velloso
- Department of Nuclear Medicine, Clinica Universidad de Navarra, CCUN Applied Medical Research, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
- Correspondence:
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Ornilla E, Sancho L, Beorlegui C, Ribelles MJ, Aquerreta D, Prieto E, Bondia JM, Cuadrado MJ, Richter JÁ. Diagnostic value of quantitative SPECT/CT in assessing active sacroiliitis in patients with axial spondylarthritis and/or inflammatory low back pain. An Sist Sanit Navar 2021; 45:e0953. [PMID: 34142993 PMCID: PMC10100598 DOI: 10.23938/assn.0953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The diagnostic accuracy of bone scintigraphy (BS) increases with SPECT/CT imaging. It would therefore be appropriate to reassess the diagnostic utility of scintigraphy in sacroiliitis with axial spondyloarthritis (SpA). The aim of this study was to compare the diagnostic performance of MRI, SPECT/CT and a combination of both techniques in sacro-iliitis, and to evaluate the correlation between quantitative SPECT/CT indices and quantitative MRI inflammatory lesion scores. METHODS Thirty-one patients with active SpA and 22 patients with inflammatory low back pain underwent MRI and SPECT/CT of the sacroiliac joints. The diagnostic accuracy of both techniques was calculated using clinical diagnosis as the gold standard. The correlation between MRI and SPECT/CT was calculated by comparing the SPECT/CT activity indices and the Berlin/SPARCC scoring systems for MRI. RESULTS The sensitivity and specificity values in quantitative SPECT/CT, taking the sacroiliac/promontory ratio of >1.36 as the cut-off value, were close to those from MRI published in the literature. The combination of both techniques increased sensitivity while maintaining high specificity. There was a moderate correlation between SPECT/CT and MRI total scores. This correlation was improved by using solely the MRI inflammation scores. CONCLUSION Quantitative SPECT/CT showed better diagnostic accuracy than planar scintigraphy and showed a moderate correlation with MRI scores in active sacroiliitis. The combination of both tests increased the diagnostic accuracy. Quanti-tative SPECT/CT could play a relevant role in the diagnosis of active sacroiliitis in patients with high a suspicion of SpA and a negative/inconclusive MRI test or in patients with whom MRI studies cannot be carried out.
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Affiliation(s)
- E Ornilla
- Servicio de Reumatología. Clínica Universidad de Navarra. Pamplona. España..
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Grisanti F, Zulueta J, Rosales JJ, Morales MI, Sancho L, Lozano MD, Mesa-Guzman M, Garcia-Velloso MJ. Diagnostic accuracy of visual analysis versus dual time-point imaging with 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules with low uptake. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remnie.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Grisanti F, Zulueta J, Rosales JJ, Morales MI, Sancho L, Lozano MD, Mesa-Guzmán M, García-Velloso MJ. Diagnostic accuracy of visual analysis versus dual time-point imaging with 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules with low uptake. Rev Esp Med Nucl Imagen Mol 2021; 40:155-160. [PMID: 33781718 DOI: 10.1016/j.remn.2020.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/21/2020] [Accepted: 03/17/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine the accuracy of visual analysis and the retention index (RI) with dual-time point 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules (IPN) with low FDG uptake. MATERIALS AND METHODS A retrospective analysis was performed on 43 patients (28 men, 64 ± 11 years old, range 36-83 years) referred for IPN characterization with 18F-FDG-PET/CT and maximum standard uptake value ≤ 2.5 at 60 minutes post-injection (SUVmax1). Nodules were analyzed by size, visual score for FDG uptake on standard (OSEM 2,8) and high definition (HD) reconstructions, SUVmax1, SUVmax at 180 minutes post-injection (SUVmax2), and RI was calculated. The definitive diagnosis was based on histopathological confirmation (n = 28) or ≥ 2 years of follow-up. RESULTS Twenty-four (56%) nodules were malignant. RI ≥ 10% on standard reconstruction detected 18 nodules that would have been considered negative using the standard SUVmax ≥ 2.5 criterion for malignancy. RI ≥ 10% had a sensitivity, specificity, PPV, NPV and accuracy of 75, 73.7, 78.3, 70, and 74.4%, respectively, while for FDG uptake > liver on HD these were 79.1, 63.2, 73.1, 70.6, and 72.1%, respectively. SUVmax1 ≥ 2, SUVmax2 > 2.5 and FDG uptake > liver on standard reconstruction had a PPV of 100%. FDG uptake > mediastinum on HD had a NPV of 100%. CONCLUSIONS RI ≥ 10% was the most accurate criterion for malignancy, followed by FDG uptake > liver on HD reconstruction. On standard reconstruction, SUVmax1 ≥2 was highly predictive of malignancy, as well as SUVmax2 > 2.5 and FDG uptake > liver. FDG uptake < mediastinum on HD was highly predictive of benign nodules.
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Affiliation(s)
- F Grisanti
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España.
| | - J Zulueta
- Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, España
| | - J J Rosales
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España
| | - M I Morales
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España
| | - L Sancho
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Madrid, España
| | - M D Lozano
- Departamento de Patología, Clínica Universidad de Navarra, Pamplona, España
| | - M Mesa-Guzmán
- Departamento de Cirugía Torácica, Clínica Universidad de Navarra, Pamplona, España
| | - M J García-Velloso
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España
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Grisanti F, Prieto E, Bastidas JF, Sancho L, Rodrigo P, Beorlegui C, Iñarrairaegui M, Bilbao JI, Sangro B, Rodríguez-Fraile M. 3D voxel-based dosimetry to predict contralateral hypertrophy and an adequate future liver remnant after lobar radioembolization. Eur J Nucl Med Mol Imaging 2021; 48:3048-3057. [PMID: 33674893 DOI: 10.1007/s00259-021-05272-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/17/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Volume changes induced by selective internal radiation therapy (SIRT) may increase the possibility of tumor resection in patients with insufficient future liver remnant (FLR). The aim was to identify dosimetric and clinical parameters associated with contralateral hepatic hypertrophy after lobar/extended lobar SIRT with 90Y-resin microspheres. MATERIALS AND METHODS Patients underwent 90Y PET/CT after lobar or extended lobar (right + segment IV) SIRT. 90Y voxel dosimetry was retrospectively performed (PLANET Dose; DOSIsoft SA). Mean absorbed doses to tumoral/non-tumoral-treated volumes (NTL) and dose-volume histograms were extracted. Clinical variables were collected. Patients were stratified by FLR at baseline (T0-FLR): < 30% (would require hypertrophy) and ≥ 30%. Changes in volume of the treated, non-treated liver, and FLR were calculated at < 2 (T1), 2-5 (T2), and 6-12 months (T3) post-SIRT. Univariable and multivariable regression analyses were performed to identify predictors of atrophy, hypertrophy, and increase in FLR. The best cut-off value to predict an increase of FLR to ≥ 40% was defined using ROC analysis. RESULTS Fifty-six patients were studied; most had primary liver tumors (71.4%), 40.4% had cirrhosis, and 39.3% had been previously treated with chemotherapy. FLR in patients with T0-FLR < 30% increased progressively (T0: 25.2%; T1: 32.7%; T2: 38.1%; T3: 44.7%). No dosimetric parameter predicted atrophy. Both NTL-Dmean and NTL-V30 (fraction of NTL exposed to ≥ 30 Gy) were predictive of increase in FLR in patients with T0 FLR < 30%, the latter also in the total cohort of patients. Hypertrophy was not significantly associated with tumor dose or tumor size. When ≥ 49% of NTL received ≥ 30 Gy, FLR increased to ≥ 40% (accuracy: 76.4% in all patients and 80.95% in T0-FLR < 30% patients). CONCLUSION NTL-Dmean and NTL exposed to ≥ 30 Gy (NTL-V30) were most significantly associated with increase in FLR (particularly among patients with T0-FLR < 30%). When half of NTL received ≥ 30 Gy, FLR increased to ≥ 40%, with higher accuracy among patients with T0-FLR < 30%.
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Affiliation(s)
- Fabiana Grisanti
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain.
| | - Elena Prieto
- Department of Medical Physics, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Lidia Sancho
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Madrid, Spain
| | - Pablo Rodrigo
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | - Bruno Sangro
- Liver Unit, Clínica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain
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Rodríguez-Fraile M, Ezponda A, Grisanti F, Morán V, Calvo M, Berián P, de la Cuesta AM, Sancho L, Iñarrairaegui M, Sangro B, Bilbao JI. The joint use of 99mTc-MAA-SPECT/CT and cone-beam CT optimizes radioembolization planning. EJNMMI Res 2021; 11:23. [PMID: 33661428 PMCID: PMC7933314 DOI: 10.1186/s13550-021-00764-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose To determine which imaging method used during radioembolization (RE) work-up: contrast-enhanced computed tomography (CECT), 99mTc-MAA-SPECT/CT or cone beam-CT (CBCT), more accurately predicts the final target volume (TgV) as well as the influence that each modality has in the dosimetric calculation. Methods TgVs from 99mTc-MAA-SPECT/CT, CECT and CBCT were consecutively obtained in 24 patients treated with RE and compared with 90Y PET/CT TgV. Using the TgVs estimated by each imaging modality and a fictitious activity of 1 GBq, the corresponding absorbed doses by tumor and non-tumoral parenchyma were calculated for each patient. The absorbed doses for each modality were compared with the ones obtained using 90Y PET/CT TgV. Results 99mTc-MAA-SPECT/CT predicted 90Y PET/CT TgV better than CBCT or CECT, even for selective or superselective administrations. Likewise, 99mTc-MAA-SPECT/CT showed dosimetric values more similar to those obtained with 90Y PET/CT. Nevertheless, CBCT provided essential information for RE planning, such as ensuring the total coverage of the tumor and, in cases with more than one feeding artery, splitting the activity according to the volume of tumor perfused by each artery. Conclusion The joint use of 99mTc-MAA-SPECT/CT and CBCT optimizes dosimetric planning for RE procedures, enabling a more accurate personalized approach.
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Affiliation(s)
| | - Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Fabiana Grisanti
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Verónica Morán
- Medical Physics Department, Clínica Universidad de Navarra, Madrid, Spain
| | - Marta Calvo
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Pablo Berián
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Lidia Sancho
- Nuclear Medicine Department, Clínica Universidad de Navarra, Madrid, Spain
| | - Mercedes Iñarrairaegui
- Department of Internal Medicine-Hepatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Bruno Sangro
- Department of Internal Medicine-Hepatology, Clínica Universidad de Navarra, Pamplona, Spain
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Perdomo CM, García-Goñi M, Sancho L, J Paricio J, Lozano MD, de la Higuera M, Currás M, Arbizu J, Galofré JC. Evaluation of the role of thyroid scintigraphy in the differential diagnosis of thyrotoxicosis. Clin Endocrinol (Oxf) 2021; 94:466-472. [PMID: 32767493 DOI: 10.1111/cen.14308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE A differential diagnosis of thyrotoxicosis is crucial as the treatment of the main causes of this condition can vary significantly. Recently published diagnostic guidelines on thyrotoxicosis embrace the presence of thyrotropin receptor (TSH-R) antibodies (TRAb) as the primary and most important diagnostic step. The application of diagnostic algorithms to aid in the treatment of hyperthyroidism supports using thyroid radionuclide scintigraphy (TRSt) in baffling clinical scenarios, when TRAb are absent or when third-generation TRAb are not available. First-generation TRAb measurement may have limitations. Consequently, patients with thyrotoxicosis and first-generation TRAb results may be misdiagnosed and consequently improperly treated. Our purpose was to compare first-generation TRAb values to TRSt in the differential diagnosis of hyperthyroidism. METHODS We conducted a retrospective study of 201 untreated outpatients with overt or subclinical hyperthyroidism on whom first-generation TRAb and TRSt had been performed at the time of diagnosis. Histological specimens were analysed in patients who had previously undergone thyroid surgery at our centre. SPSS 20.0 was used in statistical analysis. RESULTS Seventy-three out of 201 (36.3%) patients had positive TRAb. A diffuse uptake was present in 83.5% (61/73), whereas 13.7% (10/73) had a heterogeneous uptake and 2.7% (2/73) had an absent uptake. Thirty out of 91 (33%) patients with diffuse uptake were negative for positive TRAb and were diagnosed with Graves' disease. Analysis of 37 histological specimens indicated that TRSt had greater accuracy (81% vs 75.7%) and specificity (79.2% vs 57.1%) when compared to TRAb in the differential diagnosis of thyrotoxicosis. However, TRSt sensitivity was inferior to TRAb (84.6% vs 92.3%). CONCLUSIONS Our study endorses that initial differential diagnosis of thyrotoxicosis should not be based solely on first-generation TRAb as this approach may leave nearly 20% of the patients misdiagnosed and, consequently, improperly treated. Our results underscore that thyroid scintigraphy should also be performed when only first-generation TRAb assays are available during the initial differential diagnosis of thyrotoxicosis.
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Affiliation(s)
- Carolina M Perdomo
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marta García-Goñi
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Lidia Sancho
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - José J Paricio
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - María D Lozano
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - María Currás
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier Arbizu
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan C Galofré
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain
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Antón R, Antoñana J, Aramburu J, Ezponda A, Prieto E, Andonegui A, Ortega J, Vivas I, Sancho L, Sangro B, Bilbao JI, Rodríguez-Fraile M. A proof-of-concept study of the in-vivo validation of a computational fluid dynamics model of personalized radioembolization. Sci Rep 2021; 11:3895. [PMID: 33594143 PMCID: PMC7886872 DOI: 10.1038/s41598-021-83414-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/27/2021] [Indexed: 12/15/2022] Open
Abstract
Radioembolization (RE) with yttrium-90 (90Y) microspheres, a transcatheter intraarterial therapy for patients with liver cancer, can be modeled computationally. The purpose of this work was to correlate the results obtained with this methodology using in vivo data, so that this computational tool could be used for the optimization of the RE procedure. The hepatic artery three-dimensional (3D) hemodynamics and microsphere distribution during RE were modeled for six 90Y-loaded microsphere infusions in three patients with hepatocellular carcinoma using a commercially available computational fluid dynamics (CFD) software package. The model was built based on in vivo data acquired during the pretreatment stage. The results of the simulations were compared with the in vivo distribution assessed by 90Y PET/CT. Specifically, the microsphere distribution predicted was compared with the actual 90Y activity per liver segment with a commercially available 3D-voxel dosimetry software (PLANET Dose, DOSIsoft). The average difference between the CFD-based and the PET/CT-based activity distribution was 2.36 percentage points for Patient 1, 3.51 percentage points for Patient 2 and 2.02 percentage points for Patient 3. These results suggest that CFD simulations may help to predict 90Y-microsphere distribution after RE and could be used to optimize the RE procedure on a patient-specific basis.
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Affiliation(s)
- Raúl Antón
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
| | - Javier Antoñana
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
| | - Jorge Aramburu
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
| | - Ana Ezponda
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Radiology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Elena Prieto
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Nuclear Medicine, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Asier Andonegui
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
| | - Julio Ortega
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
- Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Isabel Vivas
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Radiology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Lidia Sancho
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Nuclear Medicine, Clínica Universidad de Navarra, 28027, Madrid, Spain
| | - Bruno Sangro
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Hepatology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
- CIBEREHD, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas Y Digestivas, 28029, Madrid, Spain
| | - José Ignacio Bilbao
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Radiology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Macarena Rodríguez-Fraile
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain.
- Department of Nuclear Medicine, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
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Morán V, Prieto E, Sancho L, Rodríguez-Fraile M, Soria L, Zubiria A, Martí-Climent JM. Impact of the dosimetry approach on the resulting 90Y radioembolization planned absorbed doses based on 99mTc-MAA SPECT-CT: is there agreement between dosimetry methods? EJNMMI Phys 2020; 7:72. [PMID: 33284389 PMCID: PMC7721939 DOI: 10.1186/s40658-020-00343-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prior radioembolization, a simulation using 99mTc-macroaggregated albumin as 90Y-microspheres surrogate is performed. Gamma scintigraphy images (planar, SPECT, or SPECT-CT) are acquired to evaluate intrahepatic 90Y-microspheres distribution and detect possible extrahepatic and lung shunting. These images may be used for pre-treatment dosimetry evaluation to calculate the 90Y activity that would get an optimal tumor response while sparing healthy tissues. Several dosimetry methods are available, but there is still no consensus on the best methodology to calculate absorbed doses. The goal of this study was to retrospectively evaluate the impact of using different dosimetry approaches on the resulting 90Y-radioembolization pre-treatment absorbed dose evaluation based on 99mTc-MAA images. METHODS Absorbed doses within volumes of interest resulting from partition model (PM) and 3D voxel dosimetry methods (3D-VDM) (dose-point kernel convolution and local deposition method) were evaluated. Additionally, a new "Multi-tumor Partition Model" (MTPM) was developed. The differences among dosimetry approaches were evaluated in terms of mean absorbed dose and dose volume histograms within the volumes of interest. RESULTS Differences in mean absorbed dose among dosimetry methods are higher in tumor volumes than in non-tumoral ones. The differences between MTPM and both 3D-VDM were substantially lower than those observed between PM and any 3D-VDM. A poor correlation and concordance were found between PM and the other studied dosimetry approaches. DVH obtained from either 3D-VDM are pretty similar in both healthy liver and individual tumors. Although no relevant global differences, in terms of absorbed dose in Gy, between both 3D-VDM were found, important voxel-by-voxel differences have been observed. CONCLUSIONS Significant differences among the studied dosimetry approaches for 90Y-radioembolization treatments exist. Differences do not yield a substantial impact in treatment planning for healthy tissue but they do for tumoral liver. An individual segmentation and evaluation of the tumors is essential. In patients with multiple tumors, the application of PM is not optimal and the 3D-VDM or the new MTPM are suggested instead. If a 3D-VDM method is not available, MTPM is the best option. Furthermore, both 3D-VDM approaches may be indistinctly used.
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Affiliation(s)
- Verónica Morán
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Madrid, Spain
| | - Elena Prieto
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Lidia Sancho
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Madrid, Spain
| | - Macarena Rodríguez-Fraile
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain.,Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Leticia Soria
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Madrid, Spain
| | - Arantxa Zubiria
- Department of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Josep M Martí-Climent
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain. .,IdisNA, Navarra Institute for Health Research, Pamplona, Spain.
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de la Torre-Aláez M, Jordán-Iborra C, Casadei-Gardini A, Bilbao JI, Rodriguez-Fraile M, Sancho L, D’Avola D, Herrero JI, Iñarrairaegui M, Sangro B. The Pattern of Progression Defines Post-progression Survival in Patients with Hepatocellular Carcinoma Treated with SIRT. Cardiovasc Intervent Radiol 2020; 43:1165-1172. [DOI: 10.1007/s00270-020-02444-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/24/2020] [Indexed: 12/14/2022]
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16
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Morales Lozano MI, Ornilla E, Sancho L, Guillén EF. Single-photon emission computed tomography in the diagnosis of a case of Forestier's disease. Reumatol Clin (Engl Ed) 2019; 15:307-308. [PMID: 28532742 DOI: 10.1016/j.reuma.2017.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/20/2017] [Accepted: 03/24/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | - Enrique Ornilla
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - Lidia Sancho
- Servicio de Reumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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Prieto E, García-Velloso MJ, Rodríguez-Fraile M, Morán V, García-García B, Guillén F, Morales MI, Sancho L, Peñuelas I, Richter JÁ, Martí-Climent JM. Significant dose reduction is feasible in FDG PET/CT protocols without compromising diagnostic quality. Phys Med 2018. [PMID: 29519399 DOI: 10.1016/j.ejmp.2018.01.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To reduce the radiation dose to patients by optimizing oncological FDG PET/CT protocols. METHODS The baseline PET/CT protocol in our institution for oncological PET/CT examinations consisted of the administration of 5.18 MBq/kg of FDG and a CT acquisition with a reference current-time product of 120 mAs. In 2016, FDG activity was reduced to 4.44 and 3.70 MBq/kg and reference CT current-time-product was reduced to 100 and 80 mAs. 322 patients scanned with different protocols were retrospectively evaluated. For each patient, effective dose was calculated. The overall image quality was subjectively rated by the referring physician on a 4-point scale (IQ score: 1 excellent, 2 good, 3 poor but interpretable, 4 poor not interpretable). Image quality was quantitatively evaluated measuring noise in the liver. RESULTS CT Results: Effective dose was progressively reduced from 9.5 ± 2.8 to 8.0 ± 2.3 and 6.2 ± 1.5 mSv (p < 0.001). A mean dose reduction of 34.9% was achieved. There was a significant degradation of IQ score (p < 0.05) and noise (p < 0.001). Nevertheless, the number of poor quality studies (IQ score >2) did not increase. PET Results: Effective dose was gradually reduced from 6.5 ± 1.4 to 5.7 ± 1.3 and 5.0 ± 1.0 mSv (p < 0.001). Average dose reduction was 23.4%. IQ score (p < 0.05) and noise (p < 0.001) significantly degraded for lower activity protocols. However, all images with reduced activity were scored as interpretable (IQ score ≤ 3). CONCLUSIONS A significant radiation dose reduction of 28.7% was reached. Despite a slight reduction in image quality, the new regime was successfully implemented with readers reporting unchanged clinical confidence.
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Affiliation(s)
- Elena Prieto
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - María José García-Velloso
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Macarena Rodríguez-Fraile
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Verónica Morán
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Berta García-García
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Fernando Guillén
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Lidia Sancho
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Iván Peñuelas
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - José Ángel Richter
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Josep María Martí-Climent
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
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Martí-Climent JM, Prieto E, Morán V, Sancho L, Rodríguez-Fraile M, Arbizu J, García-Velloso MJ, Richter JA. Effective dose estimation for oncological and neurological PET/CT procedures. EJNMMI Res 2017; 7:37. [PMID: 28439843 PMCID: PMC5403773 DOI: 10.1186/s13550-017-0272-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to retrospectively evaluate the patient effective dose (ED) for different PET/CT procedures performed with a variety of PET radiopharmaceutical compounds. PET/CT studies of 210 patients were reviewed including Torso (n = 123), Whole body (WB) (n = 36), Head and Neck Tumor (HNT) (n = 10), and Brain (n = 41) protocols with 18FDG (n = 170), 11C-CHOL (n = 10), 18FDOPA (n = 10), 11C-MET (n = 10), and 18F-florbetapir (n = 10). ED was calculated using conversion factors applied to the radiotracer activity and to the CT dose-length product. RESULTS Total ED (mean ± SD) for Torso-11C-CHOL, Torso-18FDG, WB-18FDG, and HNT-18FDG protocols were 13.5 ± 2.2, 16.5 ± 4.5, 20.0 ± 5.6, and 15.4 ± 2.8 mSv, respectively, where CT represented 77, 62, 69, and 63% of the protocol ED, respectively. For 18FDG, 18FDOPA, 11C-MET, and 18F-florbetapir brain PET/CT studies, ED values (mean ± SD) were 6.4 ± 0.6, 4.6 ± 0.4, 5.2 ± 0.5, and 9.1 ± 0.4 mSv, respectively, and the corresponding CT contributions were 11, 14, 23, and 26%, respectively. In 18FDG PET/CT, variations in scan length and arm position produced significant differences in CT ED (p < 0.01). For dual-time-point imaging, the CT ED (mean ± SD) for the delayed scan was 3.8 ± 1.5 mSv. CONCLUSIONS The mean ED for body and brain PET/CT protocols with different radiopharmaceuticals ranged between 4.6 and 20.0 mSv. The major contributor to total ED for body protocols is CT, whereas for brain studies, it is the PET radiopharmaceutical.
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Affiliation(s)
- Josep M Martí-Climent
- Nuclear Medicine Department, Clínica Universidad de Navarra, 36, Pío XII Avenue, 31008, Pamplona, Spain.
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
| | - Elena Prieto
- Nuclear Medicine Department, Clínica Universidad de Navarra, 36, Pío XII Avenue, 31008, Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Verónica Morán
- Nuclear Medicine Department, Clínica Universidad de Navarra, 36, Pío XII Avenue, 31008, Pamplona, Spain
| | - Lidia Sancho
- Nuclear Medicine Department, Clínica Universidad de Navarra, 36, Pío XII Avenue, 31008, Pamplona, Spain
| | - Macarena Rodríguez-Fraile
- Nuclear Medicine Department, Clínica Universidad de Navarra, 36, Pío XII Avenue, 31008, Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Javier Arbizu
- Nuclear Medicine Department, Clínica Universidad de Navarra, 36, Pío XII Avenue, 31008, Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - María J García-Velloso
- Nuclear Medicine Department, Clínica Universidad de Navarra, 36, Pío XII Avenue, 31008, Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - José A Richter
- Nuclear Medicine Department, Clínica Universidad de Navarra, 36, Pío XII Avenue, 31008, Pamplona, Spain
- IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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Sancho L, Rodriguez-Fraile M, Bilbao JI, Beorlegui Arteta C, Iñarrairaegui M, Moran V, Sangro B. Is a Technetium-99m Macroaggregated Albumin Scan Essential in the Workup for Selective Internal Radiation Therapy with Yttrium-90? An Analysis of 532 Patients. J Vasc Interv Radiol 2017; 28:1536-1542. [DOI: 10.1016/j.jvir.2017.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/04/2017] [Accepted: 07/17/2017] [Indexed: 10/18/2022] Open
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Garcia-Velloso MJ, Bastarrika G, de-Torres JP, Lozano MD, Sanchez-Salcedo P, Sancho L, Nuñez-Cordoba JM, Campo A, Alcaide AB, Torre W, Richter JA, Zulueta JJ. Assessment of indeterminate pulmonary nodules detected in lung cancer screening: Diagnostic accuracy of FDG PET/CT. Lung Cancer 2016; 97:81-6. [PMID: 27237032 DOI: 10.1016/j.lungcan.2016.04.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/26/2016] [Accepted: 04/30/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND A major drawback of lung cancer screening programs is the high frequency of false-positive findings on computed tomography (CT). We investigated the accuracy of selective 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (FDG) Positron Emission Tomography/Computed Tomography (PET/CT) scan in assessing radiologically indeterminate lung nodules detected in lung cancer screening. METHODS FDG PET/CT was performed to characterize 64 baseline lung nodules >10mm and 36 incidence nodules detected on low-dose CT screening in asymptomatic current or former smokers (83 men, age range 40-83 years) at high risk for lung cancer. CT images were acquired without intravenous contrast. Nodules were analyzed by size, density, and metabolic activity and visual scored on a 5-point scale for FDG uptake. Nodules were classified as negative for malignancy when no FDG uptake was observed, or positive when focal uptake was observed in the visual analysis, and the maximum standardized uptake value (SUVmax) was measured. Final diagnosis was based on histopathological evaluation or at least 24 months of follow-up. RESULTS A total of 100 nodules were included. The prevalence of lung cancer was 1%. The sensitivity, specificity, NPV and PPV of visual analysis to detect malignancy were 84%, 95%, 91%, and 91%, respectively, with an accuracy of 91% (AUC 0.893). FDG PET/CT accurately detected 31 malignant tumors (diameters 9-42mm, SUVmax range 0.6-14.2) and was falsely negative in 6 patients. With SUVmax thresholds for malignancy of 1.5, 2, and 2.5, specificity was 97% but sensitivity decreased to 65%, 49%, and 46% respectively, and accuracy decreased to 85%, 79%, and 78% respectively (AUC 0.872). CONCLUSIONS The visual analysis of FDG PET/CT scan is highly accurate in characterizing indeterminate pulmonary nodules detected in lung cancer screening with low-dose CT. Semi-quantitative analysis does not improve the accuracy of FDG PET/CT over that obtained with a qualitative method for lung nodule characterization.
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Affiliation(s)
| | - Gorka Bastarrika
- Department of Radiology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Juan P de-Torres
- Department of Pulmonology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Maria D Lozano
- Department of Pathology, Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Lidia Sancho
- Department of Nuclear Medicine, Clinica Universidad de Navarra, Pamplona, Spain
| | - Jorge M Nuñez-Cordoba
- Division of Biostatistics, Research Support Service, Central Clinical Trials Unit, Clinica Universidad de Navarra, Department of Preventive Medicine and Public Health, Medical School, University of Navarra, Pamplona, Spain
| | - Arantza Campo
- Department of Pulmonology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ana B Alcaide
- Department of Pulmonology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Wenceslao Torre
- Department of Thoracic Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | - Jose A Richter
- Department of Nuclear Medicine, Clinica Universidad de Navarra, Pamplona, Spain
| | - Javier J Zulueta
- Department of Pulmonology, Clinica Universidad de Navarra, Pamplona, Spain
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21
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Meabe E, Déléris S, Soroa S, Sancho L. Performance of anaerobic membrane bioreactor for sewage sludge treatment: Mesophilic and thermophilic processes. J Memb Sci 2013. [DOI: 10.1016/j.memsci.2013.06.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Aymerich E, Esteban-Gutiérrez M, Sancho L. Analysis of the stability of high-solids anaerobic digestion of agro-industrial waste and sewage sludge. Bioresour Technol 2013; 144:107-114. [PMID: 23859986 DOI: 10.1016/j.biortech.2013.06.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/19/2013] [Accepted: 06/20/2013] [Indexed: 06/02/2023]
Abstract
The pilot-scale high-solids anaerobic digestion (HS-AD) of agro-industrial wastes and sewage sludge was analysed in terms of stability by monitoring the most common parameters used to check the performance of anaerobic digesters, i.e. Volatile Fatty Acids (VFA), ammonia nitrogen, pH, alkalinity and methane production. The results reflected similar evolution for the parameters analysed, except for an experiment that presented an unsuccessful start-up. The rest of the experiments ran successfully, although the threshold values proposed in the literature for the detection of an imbalance in wet processes were exceeded, proving the versatility of HS-AD to treat different wastes. The results evidence the need for understanding the dynamics of a high-solids system so as to detect periods of imbalance and to determine inhibitory levels for different compounds formed during anaerobic decomposition. Moreover, the findings presented here could be useful in developing an experimental basis to construct new control strategies for HS-AD.
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Affiliation(s)
- E Aymerich
- CEIT and Tecnun (University of Navarra), 15 Paseo Manuel de Lardizabal, San Sebastián 20018, Spain
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23
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David S, Sutre AF, Sanca A, Mané A, Henriques V, Portugal C, Sancho L, Cardoso A, Paixão E, Duarte EL, Leite CQF, Salem JI, Antunes A. Tuberculosis diagnosis after bleach processing for early stage tuberculosis laboratory capacity building. Int J Tuberc Lung Dis 2013; 16:1535-7. [PMID: 23044448 DOI: 10.5588/ijtld.11.0658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The diagnosis of tuberculosis is seriously hampered in the absence of standard biosafety laboratory facilities for specimen concentration and Mycobacterium tuberculosis culture. Within a laboratory twinning arrangement, heat-fixed direct smear and sediment from 74 bleach-processed and 20 non-processed specimens from Cumura Hospital, Guinea-Bissau, were sent to Lisbon for molecular evaluation of rifampicin resistance. Sequence analysis of a 369 base-pair rpoB locus detected 3.2% (3/94) resistant specimens. To our knowledge, this represents the first report on the molecular analysis of M. tuberculosis from bleach-processed sputum, an alternative to current diagnostic practice in low-resource settings.
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Affiliation(s)
- S David
- Instituto Nacional de Saúde Dr. Ricardo Jorge, INSA, IP, Lisbon, Portugal.
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Lizarralde I, Claeys F, Ordóñez R, de Gracia M, Sancho L, Grau P. Water network cost optimization in a paper mill based on a new library of mathematical models. Water Sci Technol 2012; 65:1929-1938. [PMID: 22592461 DOI: 10.2166/wst.2012.083] [Citation(s) in RCA: 1] [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: 05/31/2023]
Abstract
The increasing costs associated with water supply and the disposal of wastewater has stimulated industries to seek more efficient water management systems. Mathematical modelling and simulation can be a very valuable tool for the study of the multiple alternatives available whilst assessing optimum solutions for water management in industry. This study introduces a new steady state model library able to reproduce industrial water circuits. It has been implemented in a novel software framework for the representation, simulation and optimization of industrial water networks. A water circuit representing a paper mill has been modelled and simulated showing the capability to reproduce real case studies. Alternative scenarios for the water network have also been tested to assess the capability of the models to optimize water circuits minimizing total cost.
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Affiliation(s)
- I Lizarralde
- Department of Environmental Engineering, CEIT, Paseo Manuel Lardizábal 15, 20018 Donostia, Spain.
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25
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Ferrero G, Monclús H, Sancho L, Garrido JM, Comas J, Rodríguez-Roda I. A knowledge-based control system for air-scour optimisation in membrane bioreactors. Water Sci Technol 2011; 63:2025-2031. [PMID: 21902045 DOI: 10.2166/wst.2011.455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although membrane bioreactors (MBRs) technology is still a growing sector, its progressive implementation all over the world, together with great technical achievements, has allowed it to reach a mature degree, just comparable to other more conventional wastewater treatment technologies. With current energy requirements around 0.6-1.1 kWh/m3 of treated wastewater and investment costs similar to conventional treatment plants, main market niche for MBRs can be areas with very high restrictive discharge limits, where treatment plants have to be compact or where water reuse is necessary. Operational costs are higher than for conventional treatments; consequently there is still a need and possibilities for energy saving and optimisation. This paper presents the development of a knowledge-based decision support system (DSS) for the integrated operation and remote control of the biological and physical (filtration and backwashing or relaxation) processes in MBRs. The core of the DSS is a knowledge-based control module for air-scour consumption automation and energy consumption minimisation.
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Affiliation(s)
- G Ferrero
- Laboratory of Chemical and Environmental Engineering (LEQUiA), Environmental Institute, University of Girona, Girona E17071, Spain
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26
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Conceição T, Aires-de-Sousa M, Pona N, Brito MJ, Barradas C, Coelho R, Sardinha T, Sancho L, de Sousa G, Machado MDC, de Lencastre H. High prevalence of ST121 in community-associated methicillin-susceptible Staphylococcus aureus lineages responsible for skin and soft tissue infections in Portuguese children. Eur J Clin Microbiol Infect Dis 2010; 30:293-7. [PMID: 21046422 DOI: 10.1007/s10096-010-1087-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 09/29/2010] [Indexed: 11/29/2022]
Abstract
In order to evaluate the incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Portugal, we analyzed a collection of 38 S. aureus isolates recovered from 30 children attending the pediatric emergency department of a central hospital in Lisbon due to skin and soft tissue infections. Molecular characterization identified seven clonal lineages among the 35 methicillin-susceptible S. aureus (MSSA) isolates, of which the major lineage PFGE A/t159/ST121 included 63% of the isolates. The three MRSA isolates belonged to the Pediatric clone PFGE D/t535/ST5-IV (n = 2) and to the European CA-MRSA clone PFGE G/t044/ST80-IVc (n = 1). All isolates harbored several virulence factors, namely, leukocidins. Panton-Valentine leukocidin (PVL) was produced by isolates from five MSSA lineages and by the ST80 MRSA. Of interest, this is the first reported isolation of CA-MRSA ST80 in Portugal.
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Affiliation(s)
- T Conceição
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Oeiras, Portugal
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27
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Comas J, Meabe E, Sancho L, Ferrero G, Sipma J, Monclús H, Rodriguez-Roda I. Knowledge-based system for automatic MBR control. Water Sci Technol 2010; 62:2829-2836. [PMID: 21123912 DOI: 10.2166/wst.2010.693] [Citation(s) in RCA: 2] [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: 05/30/2023]
Abstract
MBR technology is currently challenging traditional wastewater treatment systems and is increasingly selected for WWTP upgrading. MBR systems typically are constructed on a smaller footprint, and provide superior treated water quality. However, the main drawback of MBR technology is that the permeability of membranes declines during filtration due to membrane fouling, which for a large part causes the high aeration requirements of an MBR to counteract this fouling phenomenon. Due to the complex and still unknown mechanisms of membrane fouling it is neither possible to describe clearly its development by means of a deterministic model, nor to control it with a purely mathematical law. Consequently the majority of MBR applications are controlled in an "open-loop" way i.e. with predefined and fixed air scour and filtration/relaxation or backwashing cycles, and scheduled inline or offline chemical cleaning as a preventive measure, without taking into account the real needs of membrane cleaning based on its filtration performance. However, existing theoretical and empirical knowledge about potential cause-effect relations between a number of factors (influent characteristics, biomass characteristics and operational conditions) and MBR operation can be used to build a knowledge-based decision support system (KB-DSS) for the automatic control of MBRs. This KB-DSS contains a knowledge-based control module, which, based on real time comparison of the current permeability trend with "reference trends", aims at optimizing the operation and energy costs and decreasing fouling rates. In practice the automatic control system proposed regulates the set points of the key operational variables controlled in MBR systems (permeate flux, relaxation and backwash times, backwash flows and times, aeration flow rates, chemical cleaning frequency, waste sludge flow rate and recycle flow rates) and identifies its optimal value. This paper describes the concepts and the 3-level architecture of the knowledge-based DSS and details the knowledge-based control module. Preliminary results of the application of the control module to regulate the air flow rate of an MBR working with variable flux demonstrates the usefulness of this approach.
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Affiliation(s)
- J Comas
- Laboratory of Chemical and Environmental Engineering, University of Girona, E-17071 Girona, Catalonia, Spain.
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Lamas A, López-Herce J, Sancho L, Mencía S, Carrillo A, José Santiago M, Martínez V. Responsiveness to stimuli of bispectral index, middle latency auditory evoked potentials and clinical scales in critically ill children. Anaesthesia 2008; 63:1296-301. [PMID: 19032296 DOI: 10.1111/j.1365-2044.2008.05654.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
SUMMARY We performed simultaneous recordings of Bispectral Index (BIS) and middle latency auditory evoked potentials. We also recorded two clinical scales, the Modified Ramsay scale and the COMFORT scale. Heart rate and blood pressure were measured once a day, for a maximum of 5 days, in 81 critically ill children. Changes with tactile, auditory, and painful stimuli were analysed. All the stimuli significantly increased the BIS value, the painful stimulus having the greatest effect. The painful stimulus was the only one that altered the middle latency auditory evoked potentials. Although the responses of the clinical scales to stimuli were statistically significant, they were of little clinical relevance. None of the stimuli used significantly altered the heart rate or blood pressure. We conclude that tactile, auditory and painful stimuli produced changes of little relevance in the clinical scales, BIS or middle latency auditory evoked potentials. We found the BIS was the most sensitive method and the painful stimulus had the greatest effect.
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Affiliation(s)
- A Lamas
- Pediatric Intensive Care Unit, Gregorio Marañón University General Hospital, Madrid, Spain
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29
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Manterola G, Uriarte I, Sancho L. The effect of operational parameters of the process of sludge ozonation on the solubilisation of organic and nitrogenous compounds. Water Res 2008; 42:3191-3197. [PMID: 18466950 DOI: 10.1016/j.watres.2008.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 03/06/2008] [Accepted: 03/20/2008] [Indexed: 05/26/2023]
Abstract
An evaluation of various operational parameters on the process of sludge ozonation was carried out based on semi-batch experiments. Particular reference has been given to examine the main parameters affecting the solubilisation of organic matter and nitrogenous compounds. Various sets of experiments were undertaken using real sewage sludge to feed a semi-industrial ozonation plant. Applying ozone dosages between 25 and 35 mg O(3)/gTSS, the organic matter solubilisation obtained through ozonation increases proportionally to ozone dosage until a maximum value of 430 mg COD/L. Concerning the nitrogenous compounds, no variation in nitrite concentration and a low increase in nitrate concentration were attained, regardless of the applied ozone dosage. Little increase in ammonia concentration was achieved for low ozone dosages, whilst applying dosages higher than 20 mg O(3)/gTSS, the variation of ammonia increased proportionally with ozone dosage. Experiments using hydraulic retention time (HRT) between 10 and 60 min resulted in a similar COD solubilisation, confirming a rapid rate of cell lysis during ozonation of sludge.
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Affiliation(s)
- G Manterola
- CEIT and Tecnun (University of Navarra), Manuel de Lardizabal 15, 20018 San Sebastián, Spain.
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de Gracia M, Sancho L, García-Heras JL, Vanrolleghem P, Ayesa E. Mass and charge conservation check in dynamic models: application to the new ADM1 model. Water Sci Technol 2006; 53:225-40. [PMID: 16532753 DOI: 10.2166/wst.2006.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This paper proposes a systematic methodology for the analysis of the mass and charge balances in dynamic models expressed using the Petersen matrix notation. This methodology is based on the definition of the model components via elemental mass fractions and in the estimation of the COD as a function of the redox equations associated with these elements. This approach makes the automatic calculation of all the stoichiometric coefficients under different measuring units and the study of COD, charge or mass fluxes easier. As an example of its application this methodology was applied to the ADM1 in order to illustrate its usefulness for the analysis of organic matter characterisation, nitrogen release or biogas composition in anaerobic digestion. The application of the methodology for a rigorous integration of different IWA models is proposed for further study.
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Affiliation(s)
- M de Gracia
- CEIT, Section of Environmental Engineering, P.O. Box 1555, San Sebastián, Spain.
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31
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Alcaraz AJ, Manzano L, Sancho L, Vigil MD, Esquivel F, Maroto E, Reyes E, Alvarez-Mon M. Different Proinflammatory Cytokine Serum Pattern in Neonate Patients Undergoing Open Heart Surgery. Relevance of IL-8. J Clin Immunol 2005; 25:238-45. [PMID: 15981089 DOI: 10.1007/s10875-005-4081-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Accepted: 12/29/2004] [Indexed: 11/30/2022]
Abstract
The purpose of this work was to investigate the clinical significance of serum levels of proinflammatory cytokines in pediatric patients undergoing cardiopulmonary bypass. We divided the patients in two groups: 8 neonates, and 19 non-newborn children. IL-1beta, IL-6, IL-8, and TNF serum levels were quantified before sternotomy, at admission to the PICU (30 min postoperatively), 24 h after the onset of surgery and 3 days after the operation. Surgical cardiac stress elicits significant increments of IL-6, IL-8 and TNF serum concentrations in both neonates and non-neonates, regardless of their preoperative clinical condition. However, in newborns the magnitude of the proinflammatory cytokine increments was, in particular with IL-8, remarkably greater than in older children. Moreover, neonate and non-neonate patients showed clearly disparate patterns of serum concentrations over time of both IL-8 and TNF. There was a marked relationship between IL-8 levels and postoperative morbidity, evaluated by pulmonary dysfunction, days on inotropic support and days of PICU stay in both neonates and non-neonates patients. In contrast, we found no relationship between serum levels of IL-6 and TNF and postoperative clinical data. Newborn and non-newborn patients undergoing cardiopulmonary bypass exhibit dissimilar patterns of proinflammatory cytokines. IL-8 might be implicated in the multiorganic dysfunction related to cardiopulmonary bypass in pediatric patients.
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Affiliation(s)
- A J Alcaraz
- Departamento de Pediatría y Cirugía Pediátrica, Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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32
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Amaro A, Sousa L, Sancho L, Meireles J, Calado S, Vitorino R, Amado F, Appell HJ, Duarte JA. Characteristics of the gluteus medius muscle in an asymptomatic patient with radiographic signs of coxarthrosis. Eur J Orthop Surg Traumatol 2004; 14:182-5. [PMID: 27517189 DOI: 10.1007/s00590-004-0160-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2004] [Accepted: 05/31/2004] [Indexed: 10/26/2022]
Abstract
This case study describes the micromorphology and some biochemical features of gluteus medius muscle in a 79-year-old woman with radiographic signs of coxarthrosis but with no clinical symptoms who initially was admitted in the orthopaedic emergency service with a non-displaced subcapital fracture of the femoral neck due to a domestic accident (fall). The X-ray of the hip showed some characteristic features of coxarthrosis, classified grade 2 of the Kellgren criteria. After informed consent, it was decided to carry out the functional evaluation according to the indexes of Lequesne and WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and to take a biopsy of the gluteus medius muscle for microscopical examination and myosin heavy chain isoform identification during hip replacement surgery. For the Lequesne Index (score 0-24), the total score was 0, and for the WOMAC (score 0-96), the total score was also 0, both speaking in favour of full joint and muscle function. All the structural features observed in muscle were considered not to have any pathological relevance. The composition of the myosin heavy chains in the gluteus medius muscle was 48% MHC I, 41% MHC IIa, and 11% MHC IIx. The muscle characteristics do not support earlier concepts about muscle weakness as a predisposing factor for osteoarthritis. It is moreover concluded that the diagnosis should rather consider clinical symptoms than radiographic signs of osteoarthritis.
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Affiliation(s)
- A Amaro
- Health School, University of Aveiro, Portugal
| | - L Sousa
- Department of Orthopaedics, Hospital Infante D. Pedro, Aveiro, Portugal
| | - L Sancho
- Health School, University of Aveiro, Portugal
| | - J Meireles
- Department of Orthopaedics, Hospital Infante D. Pedro, Aveiro, Portugal
| | - S Calado
- Health School, University of Aveiro, Portugal
| | - R Vitorino
- Chemistry Department, University of Aveiro, Portugal
| | - F Amado
- Chemistry Department, University of Aveiro, Portugal
| | - H J Appell
- Department of Physiology and Anatomy, DSHS Cologne, Germany.,Muscle Atrophy Research Group (MARG)
| | - J A Duarte
- Health School, University of Aveiro, Portugal. .,CIAFEL, FCDEF, University of Porto, 91 Rua Dr. Plácido Costa, 4200, Porto, Portugal. .,Muscle Atrophy Research Group (MARG), .
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Alcaraz AJ, Sancho L, Manzano L, Esquivel F, Carrillo A, Prieto A, Bernstein ED, Alvarez-Mon M. Newborn patients exhibit an unusual pattern of interleukin 10 and interferon gamma serum levels in response to cardiac surgery. J Thorac Cardiovasc Surg 2002; 123:451-8. [PMID: 11882815 DOI: 10.1067/mtc.2002.120006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to determine the clinical significance of serum levels of interleukin 10 and interferon gamma in pediatric patients undergoing cardiopulmonary bypass. METHODS We divided the patients into 2 groups: 8 neonates and 19 non-newborn children. Interleukin 10 and interferon gamma serum levels were quantified before sternotomy, at admission to the pediatric intensive care unit (30 minutes postoperatively), 24 hours after the onset of the operation, and 3 days after the operation. RESULTS Newborn patients displayed significantly greater amounts of serum interleukin 10 than older children, not only in regard to the peak level achieved but also at every postoperative time point analyzed. In contrast, no significant changes in interferon gamma serum levels were observed in neonates at any time point, whereas non-newborn pediatric patients showed a significant increase in interferon gamma serum concentrations immediately after the operation. This unusual pattern of cytokine response in newborn patients was not associated with modifications in cortisol serum levels. Furthermore, although neonates had significantly different surgical and clinical variables than did the non-newborn pediatric patients, the variation in interleukin 10 production in neonates could not be accounted for by differences in the magnitude of surgical injury. In the group of neonates, there were significant positive correlations between peak interleukin 10 serum levels and both partial pressure of arterial oxygen/fraction of inspired oxygen ratio and postoperative body weight gain. CONCLUSIONS Newborn patients undergoing cardiopulmonary bypass exhibit a distinctive biologic response pattern characterized by high levels of serum interleukin 10 without changes in serum interferon gamma. This cytokine imbalance could have potential clinical implications.
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Affiliation(s)
- A J Alcaraz
- Department of Pediatrics and Pediatric Surgery, Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Peñas Lledó E, Sancho L, Waller G. Relationships between objective physical characteristics and the use of weight control methods in adolescence: a mediating role for eating attitudes? Eat Weight Disord 2001; 6:148-56. [PMID: 11589417 DOI: 10.1007/bf03339764] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This study of non-clinical adolescent males and females examined associations of objectively measured physical characteristics with greater use of methods of weight control and considered whether the relationships between these variables might be explained by a mediating effect of a subjective characteristic--unhealthy eating attitudes. Non-clinical male and female adolescents completed measures of weight control and eating attitudes, and their physical characteristics were measured using a range of standardized anthropometry techniques. Regression analyses were used to test the role of eating attitudes as mediators in the relationship between physical characteristics and the use of weight control methods. The data were compatible with a partial mediator model, where physical characteristics influence eating attitudes, and those where attitudes drive the use of methods to control weight. However, not all of the relationship was explained by this mediator. In addition, there were different patterns of association for men and women, consistent with different patterns of bodily focus between the genders. These findings stress the importance of understanding objective physical characteristics as well as subjective eating attitudes to find out why people use different levels of weight control behaviours. Limitations, further research and potential implications for clinical and preventative programmes are discussed.
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Affiliation(s)
- E Peñas Lledó
- Department of Pharmacology and Psychiatry, Medical School, University of Extremadura, Badajoz, Spain
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35
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Abstract
OBJECTIVE: The objective of this study was to analyze the incidence and significance of hepatic dysfunction after cardiac surgery in children. DESIGN: Prospective, observational study. SETTING: Pediatric intensive care unit of a university hospital. PATIENTS: The study consisted of 232 children ranging in age from newborn to 17 years with no history of liver disease. MEASUREMENTS AND MAIN RESULTS: Aspartate aminotransferase (AST), alanine aminotransferase (ALT), gammaglutamyltranspeptidase (GGT), alkaline phosphatase, total and conjugated bilirubin, blood glucose, urea, creatinine, and coagulation studies were determined at admission, at 24 and 48 hrs, and at 7 days. Hepatic dysfunction was taken as an ALT of > 100 IU/L or a moderate or high hepatic score. The statistical study included bivariate analysis and multivariate logistic regression to study the risk factors for hepatic dysfunction. Twenty-one patients (9%) showed an ALT > 100 IU/L, and 29.3% had a moderate or high hepatic score. A relationship was found between hepatic dysfunction and the type of cardiopathy (D-transposition of the great arteries and coarctation of the aorta), shock, the administration of dopamine or epinephrine, renal insufficiency, the presence of pulmonary changes (pulmonary edema, atelectasis, pulmonary hypertension, hypoxemia), hematologic disturbances (prothrombin time, kaolin-cephalin time, fibrinogen, and platelets), and the need for a greater number of transfusions of packed cells, plasma, and platelets. Compared with 7.6% of the rest of the patients (p <.001), 38% of patients with an ALT > 100 IU/L died. The hepatic score of those patients who died was 4.2 (2.3)-higher than that of the survivors at 1.5 (1.8), (p <.001). Shock and renal insufficiency were the factors most significantly related to the development of hepatic dysfunction. CONCLUSIONS: Hepatic dysfunction is an uncommon complication in children after cardiac surgery. This complication is related mainly to hemodynamic disturbances and renal insufficiency and is an indicator of poor prognosis.
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Affiliation(s)
- P Vázquez
- Pediatric Intensive Care Unit (Drs. Vázquez, López-Herce, Carrillo, Sancho, and Bustinza), Preventive and Quality Control Service (Dr. Díaz), Gregorio Marañón, University General Hospital, Madrid, Spain E-mail:
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Abstract
OBJECTIVE To describe the organisation of paediatric intensive care units in Spain and the medical assistance provided during 1996. METHODS A written questionnaire was sent to all the paediatric ICUs linked to or within the Spanish public health system. RESULTS Thirty-one of the 34 paediatric ICUs replied. All are medico-surgical units. Eighteen treat only paediatric patients, 12 paediatric and neonatal patients, and one paediatric and adult patients. Fifteen units have fewer than seven beds, eight have between 7 and 12 beds, and eight between 13 and 18 beds. Of the paediatric ICUs, 83.8 % are staffed by paediatricians specialised in paediatric intensive care. The mean number of on-call on site periods of duty for each member of the medical staff was 5.1 +/- 1.7 per month. Thirty of the 31 units undertake paediatric resident training, 13 train residents specialising in paediatric intensive care and 12 participate in medical student training. In 1996 there were 9,585 admissions (309 +/- 182 patients per ICU) signifying 35.3 +/- 14 patients/bed. Of the patients, 65.9 % were medical and 34.1 % surgical. The mean duration of stay was 5.6 +/- 2.1 days. The mortality rate was 5.4 +/- 3.2 %. The main causes of death were multiple organ failure and brain death. CONCLUSIONS In Spain, paediatric intensive care is principally performed by specialised paediatricians. Although the general results for 1996 are similar to those of other European countries, efficiency studies are necessary to plan and re-organise the paediatric intensive care units in Spain.
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Affiliation(s)
- J López-Herce
- Paediatric Intensive Care Unit, Gregorio Marañón University Hospital, Dr Castelo 49, E-28009 Madrid, Spain.
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37
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Abstract
BACKGROUND Nutrition is important in childhood because the child has a lower energy reserve than the adult and a higher demand for calories because of ongoing growth. In this study, the utility of transpyloric enteral feeding (TEF) in critically ill children was evaluated. METHODS A prospective, descriptive study was made in a pediatric intensive care unit of a tertiary pediatric center of 41 critically ill children, 30 after surgical procedures and 11 with nonsurgical illness, aged 8 days to 12 years, who received transpyloric enteral feeding with 8- or 10-Fr weighted feeding tubes. Analysis was made of tolerance and complications (vomiting, abdominal distension, excessive gastric residual, diarrhea, and pulmonary aspiration) of TEF. RESULTS The mean duration of TEF was 19.5 +/- 26.8 days (range, 1-120 days). The administration of sedative agents or inotropic drugs did not alter toleration of TEF. Eight of 12 patients treated with continuous infusion of vecuronium tolerated TEF without complications. Eleven gastrointestinal complications occurred in 10 patients, abdominal distension and excessive gastric residual in 7 (17%), and diarrhea in 4 (9.7%). In 7 patients gastrointestinal complications improved, with decreasing use or transitory interruption of TEF, but in 4 patients (9.7%), TEF had to be withdrawn. Gastrointestinal complications were more frequent in postsurgical than in nonsurgical patients (p < 0.001). No patients suffered from pulmonary aspiration, and the incidence of pulmonary infection and hepatic dysfunction diminished during TEF. CONCLUSIONS Transpyloric enteral feeding is a good method of nutritional support in critically ill children and can be used in patients treated with neuromuscular blocking agents. The frequency and severity of complications and the risks of pulmonary infection and hepatic dysfunction related to TEF are low.
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Affiliation(s)
- E Panadero
- Pediatric Intensive Care Section, Gregorio Marañón General University Hospital, Madrid, Spain
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38
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Abstract
A newborn boy with obstructive apnea secondary to glossoptosis was treated by securing his tongue to his lower lip. Soon after, the button that served for posterior fixation became detached and was thought to have been evacuated via the digestive tract. Twenty-two months later the infant presented with pneumonia involving the right lower lobe and hemoptysis, causing an acute respiratory distress syndrome (ARDS). After mechanical ventilation was started marked gastric distention was observed. Esophagography and bronchography revealed a fistula between the right main stem bronchus and the esophagus. During surgical repair the plastic fixation button was found in the bronchial orifice of the fistula. Despite surgical correction of the fistula the child died of refractory respiratory failure.
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Affiliation(s)
- J Zunzunegui
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Alcaraz A, López-Herce J, Seriñá C, Bueso-Inchausti A, Saez MJ, Sancho L. Gastrointestinal bleeding following ketorolac administration in a pediatric patient. J Pediatr Gastroenterol Nutr 1996; 23:479-81. [PMID: 8956192 DOI: 10.1097/00005176-199611000-00023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Alcaraz
- Department of Pediatrics and Pediatric Surgery, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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40
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Abstract
OBJECTIVE to evaluate the efficiency of the first experience in pediatric basic and advanced life support courses in Spain. MATERIAL AND METHODS we have given two pediatric basic life support (PBLS) courses of 8 h each to 52 school teachers and ambulance drivers, and 10 30-h pediatric advanced life support (PALS) courses to 276 health professionals, 62 nurses and 214 physicians (80 pediatricians, 57 pediatric, anesthesiology and intensive care medicine residents, 10 general physicians and 52 emergency physicians). We developed the courses according to the guidelines for pediatric life support from the European Resuscitation Council. We performed an initial and final theoretical written test, continuous practical evaluation and a written survey about the quality of the course. RESULTS on PBLS courses, only 12% of practitioners answered at least 80% of the questions in the initial theory test correctly, compared with 77% in the final test (P < 0.001). All the students acquired skills in basic pediatric resuscitation. In the PALS courses, only 30% of practitioners answered at least 75% of the questions in the initial test correctly (35% of physicians and 12% of nurses, P < 0.01); this percentage increased to 95.6% in the final test (96% of physicians and 93.5% of nurses, P < 0.05). Of students, 95% acquired skills in advanced pediatric resuscitation. All students and teachers considered the theoretical and practical formation received adequate. CONCLUSIONS basic and advanced pediatric life support courses are a useful educational method for the general population, health professionals, physicians and nurses in theoretical and practical pediatric resuscitation.
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Affiliation(s)
- J López-Herce
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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41
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Iyer RS, Jacobs JP, Elliott MJ, de Leval MR, Stark J, Thul J, Wippermann F, Huth R, Michel-Behnke I, Schmid FX, Schranz D, Patel NR, Newth CJL, Duval ELIM, Kavelaars A, Veenhuizen L, van Vught AJ, van de Wal HJCM, Heijnen CJ, Michel-Behnke I, Schnittker C, Schmid FX, Wippermann CF, Thul J, Huth RG, Schranz D, Vázquez P, López-Herce J, Carrillo A, Sánchez M, Moral R, Bustinza A, Vassallo J, Cernadas C, Saporiti A, Landry L, Rivello G, Buamsha D, Rufach D, Magliola R, Alcaraz A, Sancho L, Manzano L, Esquivel F, Carrilo A, Alvarez-Mon M, Esquivel F, Sánchez-Galindo A. Cardiac surgery. Intensive Care Med 1996. [DOI: 10.1007/bf03216403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Carrillo A, López-Herce J, Sancho L, Moral R, Vázquez P, Sánchez A. P-92 Pediatric basic life support courses in the pregraduate medical education. Resuscitation 1996. [DOI: 10.1016/0300-9572(96)83953-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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43
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Gamba PG, Zancan L, Midrio P, Antoniello L, Tommasoni N, Talenti E, Panadero E, Caro L, López-Herce J, Sancho L, Sánchez A, Carrillo A, Tota G, Messina M, Meucci D, Buonocore G, Nocentini S, Garcia RC, Schachner B, Giraudo N, Schnitzler E, Moreno A, Dornínguez C, Goñi C, Iglesias J, Castorina M, Antuzzi D, Ricci R, Rendeli C, Polidori G, Prekajski NB, Ilić S, Ljujić M, Janevski MR, Tafur MA, Kiet DP, Chanh HC, Hrnjak D. Nutrition/Metabolism. Intensive Care Med 1996. [DOI: 10.1007/bf03216409] [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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44
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Affiliation(s)
- M Del Carmen Sanchez
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Gregorio Marañon University General Hospital, Madrid, Spain
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45
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Abstract
The objective of this study was to assess the basis for the diminished natural killer (NK) lymphocyte activity of neonates. We found either severely reduced (63% of 68 neonates) or normal (similar to healthy adult) levels of NK activity. The percentages of cord blood mononuclear cells from the two groups of infants that expressed CD16, a differentiation antigen found in NK cells, were similar and within the range found in peripheral blood mononuclear cells of adults. However, infants with low NK activity had reduced numbers of cells in the CD16+56+ subpopulation, whereas the number of these effector cells present in cord blood mononuclear cells from infants with normal NK activity was within the range found in adults. Recombinant interleukin-2, but not recombinant interferon-gamma, normalized the low NK activity of infants in a dose- and time-dependent manner. Analysis of the pattern of target cell susceptibility to lysis, together with the CD16+CD3- phenotype of the precursor and effector lymphocytes, demonstrated that the induced cytotoxicity was mediated by NK cells. In contrast, NK cells from infants with normal cytotoxic levels exhibited a functional response to interleukin-2 and interferon-gamma similar to that of adults. Our results indicate that NK cells in human neonates go through two different maturational stages.
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MESH Headings
- Adult
- Antigens, CD/analysis
- Antigens, Differentiation/analysis
- Antigens, Differentiation, T-Lymphocyte/analysis
- CD56 Antigen
- Cells, Cultured
- Fetal Blood/immunology
- Humans
- Infant, Newborn/immunology
- Interferon-gamma/pharmacology
- Interleukin-2/pharmacology
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Leukocytes, Mononuclear/immunology
- Phenotype
- Receptors, Fc/analysis
- Receptors, IgG
- Recombinant Proteins
- Reference Values
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Affiliation(s)
- L Sancho
- Department of Pediatrics, Hospital General de Móstoles, Madrid, Spain
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