Hemodynamic factors are thought to be implicated in the progression and rupture of intracranial aneurysms. Current efforts aim to study the possible associations of hemodynamic characteristics such ...as complexity and stability of intra-aneurysmal flow patterns, size and location of the region of flow impingement with the clinical history of aneurysmal rupture. However, there are no reliable methods for measuring blood flow patterns in vivo. In this paper, an efficient methodology for patient-specific modeling and characterization of the hemodynamics in cerebral aneurysms from medical images is described. A sensitivity analysis of the hemodynamic characteristics with respect to variations of several variables over the expected physiologic range of conditions is also presented. This sensitivity analysis shows that although changes in the velocity fields can be observed, the characterization of the intra-aneurysmal flow patterns is not altered when the mean input flow, the flow division, the viscosity model, or mesh resolution are changed. It was also found that the variable that has the greater impact on the computed flow fields is the geometry of the vascular structures. We conclude that with the proposed modeling pipeline clinical studies involving large numbers cerebral aneurysms are feasible.
Abstract
Background
IMPACT-III and IMPACT-III-P are Health-Related Quality of Life (HRQoL) questionnaires for pediatric Inflammatory Bowel Disease (p-IBD) patients and their parents/caregivers. They ...consist of 35 items answered with a 1-5 points Likert scale that evaluate six domains. Higher scores indicate better HRQoL. IMPACT-III has been translated into over 70 languages and validated in several countries. However, the existing IMPACT-III Spanish translation showed room for improvement and none of the tools had been validated in our population. We aimed to perform a transcultural adaptation and validation of the Spanish versions.
Methods
With permission from the questionnaires’ authors, we performed the translation and back-translation by professional translators, followed by evaluation by an expert committee and a small group of p-IBD families (n=12). Members of the SEGHNP (Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition) were invited to recruit p-IBD patients aged 10-18 and their families (February’21-November’22) to complete the questionnaires. Demographical and clinical data of the p-IBD participants were analyzed. Validation was performed with the Cronbach's alpha coefficient (considering 0.8-0.9 a good internal consistency) and a confirmatory factorial analysis with Varimax rotation (desirable values >0.5). The Kaiser Meyer Olkin (KMO) measure (>0.5 good correlation) and the Bartlett’s sphericity test (p<0.05) were calculated to confirm the adequacy of the factor analysis. The utility (method and completion time) was considered. The correlation coefficient between IMPACT-III and IMPACT-III-P was analyzed. Data were collected and analyzed with REDCap and Stata 16.
Results
We included 370 patients and 356 parents/guardians from 37 hospitals. Descriptive statistics of the participants are shown in table 1. The KMO measure (0.8998 and 0.9228, respectively) and the Bartlett's sphericity test (p-value <0.001 for both) confirmed the factor analysis’ adequacy. The factorial model with four factors, complying with Kaiser’s criterion, explained 89.19% and 88.87% of the variance in the model. Cronbach's alpha (0.9123 and 0.9383) indicated excellent internal consistency. The use of a Likert scoring system and the completion median time of 10 minutes for both tools was considered optimal. The correlation coefficient was 0.92, which was considered excellent.
Conclusion
The SEGHNP versions of the IMPACT-III and IMPACT-III-P are valid and reliable to use with Spanish p-IBD families. Our findings suggest a 4-factor scores in both questionnaires, although the optimal factor structure should be further examined. In our sample, parents/caregivers were good proxies for rating their p-IBD children overall HRQoL.
Abstract Introduction Studies on biomarkers of tolerance in organ transplantation have been widely performed during the last decade. Aim To assess biomarkers in relation to evolution of the immune ...response among lung transplant recipients. Methods This multicenter study included 27 lung transplant recipients followed before as well as at 7, 14, 30, 60, 90, and 180 days posttransplantation. Biomarkers of the immune response based on flow cytometry technology were validated in each center. They included intracellular cytokine expression, regulatory T-cell level, as well as lymphocyte surface antigen and CD28 expressions. Results The 13 patients who developed acute rejection episodes showed increased numbers of regulatory T cells at 12 months posttransplant. Sixteen patients experiencing infections displayed decreased expression of CD69 on CD8 T cells within the first year of follow-up. Conclusion High Treg levels in the peripheral blood of lung transplant recipients were associated with an increased risk of rejection but not infection. Inversely, we observed low levels of activated CD8 T cells in infected patients.
Purpose
To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA).
Methods
A retrospective multicenter ...study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register).
Results
Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 1.68–9.53), the coexistence of dyslipidemia (OR 3.57 1.51–8.43) and advanced age (OR 1.04 per year of increase 1.00–1.09) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months IQR 7.5–63.0, 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 0.49–2.36, p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05).
Conclusion
DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.
Previous studies have indicated that long-chain linear carboxylic acids form commensurate packed crystalline monolayers on graphite even at temperatures above their melting point. This study examines ...the effect on the monolayer formation and structure of adding one or more secondary hydroxyl, functional groups to the stearic acid skeleton (namely, 12-hydroxystearic and 9,10-dihydroxystearic acid). Moreover, a comparative study of the monolayer formation on recompressed and monocrystalline graphite has been performed through X-ray diffraction (XRD) and Scanning Tunneling Microscopy (STM), respectively. The Differential Scanning Calorimetry (DSC) and XRD data were used to confirm the formation of solid monolayers and XRD data have provided a detailed structural analysis of the monolayers in good correspondence with obtained STM images. DSC and XRD have demonstrated that, in stearic acid and 12-hydroxystearic acid adsorbed onto graphite, the monolayer melted at a higher temperature than the bulk form of the carboxylic acid. However, no difference was observed between the melting point of the monolayer and the bulk form for 9,10-dihydroxystearic acid adsorbed onto graphite. STM results indicated that all acids on the surface have a rectangular p2 monolayer structure, whose lattice parameters were uniaxially commensurate on the a-axis. This structure does not correlate with the initial structure of the pure compounds after dissolving, but it is conditioned to favor a) hydrogen bond formation between the carboxylic groups and b) formation of hydrogen bonds between secondary hydroxyl groups, if spatially permissible. Therefore, the presence of hydroxyl functional groups affects the secondary structure and behavior of stearic acid in the monolayer.
•Hydroxyl functional groups affect structure and behavior of acids in the monolayer.•Acids on the surface have a rectangular p2 monolayer structure.•Lattice parameters of acids are uniaxially commensurate on the a-axis.•Stearic and 12-hydroxystearic acids monolayers melt point is higher than bulk.•For 9,10-dihydroxystearic acid, melting point of monolayer and bulk are equal.
Abstract
Background
It has been suggested that the transition of patients from paediatric to adult care units may be key in the outcomes of inflammatory bowel disease (IBD). However, the impact of ...transition in real clinical practice has been barely studied. Aims: Principal: to evaluate the impact of transition on clinical outcomes in IBD. Secondary: to describe the prevalence of transition programs in Spain; to identify predictive factors of poor clinical outcomes; and to evaluate the percentage of patients with loss to follow-up.
Methods
Multicenter, retrospective, and observational study of IBD patients transferred between 2017-2020. Two groups (transition/no-transition) were compared retrospectively. Transition was defined as a structured process with at least 1 join visit involving the gastroenterologist, paediatrician, and a program coordinator, as well as the parents and the patient. Outcomes within the first 12 months after transfer were analysed. The main variable was the presence of “poor clinical outcome” defined as an IBD flare, hospitalisation, surgery or any change of the treatment due to an IBD flare. Predictive factors of poor clinical outcome were identified in multivariate analysis.
Results
A total of 278 patients from 34 Spanish hospitals were included: 185 patients (67%) from 22 hospitals (65%) performed a structured transition. In hospitals without transition, 91% of the patients were transferred to an IBD-specialist. In 66% of the patients in the transition group, 1 joint visit was performed. The median age of transfer was 16 years interquartile range (IQR)=12-20. Baseline characteristics of both groups are detailed in Figure 1.
At 1-year after transfer, hospitalisations and corticosteroid treatment were more frequent in the no-transition group (10 vs. 3%; p=0.025; 16 vs. 5%; p=0.002). At 1-year after transfer, 89 patients (27% transition vs. 43% no-transition; p=0.005) had poor clinical outcome median time: 9.3 months; 95% confidence interval (CI)=8.4-10.1 in no-transition; 10.4 months (95%CI 9.9-10.9) in the transition group. In the multivariate analysis, the lack of transition Hazard Ratio (HR)=2.1; 95%CI=1.4-3.3, IBD activity at transfer (HR=4.9; 95%CI=3.1-7.9), BMI <18.5 (HR=1.9; 95%CI=1.1-3.2) and corticosteroid treatment at transfer (HR=4.8; 95%CI=2.1-10.9) were associated with a poor clinical outcome. Twelve patients (4%) were lost to follow-up 1.1% in the no-transition vs. 5.9% in the transition group (p=0.06).
Conclusion
In the present study, to our knowledge the largest performed so far, the benefit of paediatric to adult transition program on patients’ outcomes has been demonstrated. The importance of achieving remission before transfer has also been highlighted.
BACKGROUNDSpain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVETo create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge ...of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODSA multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTSUp to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥80 years: 46.0%). CONCLUSIONSThe SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality.
Pancreatic cancer. 2019, single center review Moretón, Á.M. Montero; Criado, R. Bonoso; De Castro, E. Gonzalez ...
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... et al.,
July 2021, 2021-07-00, 20210701, Letnik:
21
Journal Article
Background and ImportanceThe FDA Adverse Reporting System (FAERS) is a tool to voluntary report adverse events (AE), These data can be downloaded and used to apply ‘Machine learning’(ML) techniques. ...The bibliography is limited, although it has already been the subject of a systematic review (Kim et al, 2022). FAERS data set could be useful to elaborate potential predictive modelling.Aim and ObjectivesTo test a tool of ML to develop a potential predictive model of AE caused by immune checkpoint inhibitors (ICI), using FAERS data set.To contrast and explain the ML results with a reference model (RM), obtained through conventional processing data (spreadsheet).Material and MethodsAll FAERS records from 2022 were downloaded, selecting those of the group ICIs group notified as ‘main suspected drug’ (inclusion criteria). Collected variables from FAERS data set were:AE, age, drug and sex. The ML decision tree classification algorithm J48 implemented in the Weka application (version 3.8.6) was used to elaborate the ML model. The RM was built using a spreadsheet to tabulate and analyse the data (pivot tables and descriptive statistics).Results1,702,222 notifications were downloaded and 86,053 records were selected according to inclusion criteria. The J48 algorithm applied to a subset including ‘adverse effect’, ‘sex’ and ‘drug’, allowed us to estimate, for each AE the most likely responsible ICI drug. The metrics of the ML model obtained were satisfactory and compatible with the RM analysis. The J48 algorithm produced a complex tree (to be expected given the large number of AE). The application of J48 on another subset that includes ‘adverse effect’, ‘age’ and ‘drug’, had a lower predictive capacity, due to the lower consistency of the data (age is only recorded as younger or older than 65 years) and that there is a higher proportion of missing values. The RM allows the results obtained with ML to be easily explained and understood.Conclusion and RelevanceThe results of the J48 algorithm were useful for the association between AE, sex and drug. Despite the inherent limitations of voluntary AE reporting, this study will serve as a starting point for applying ML techniques in any other group, using FAERS data.References and/or Acknowledgements1. Kim, et al. 2022. 10.1097/MD.0000000000029387Conflict of InterestNo conflict of interest.
Rapid diagnostic unit and pancreatic cancer. 10 year study Moretón, Á.M. Montero; Molleda, L. Cabezudo; Criado, R. Bonoso ...
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... et al.,
July 2021, 2021-07-00, 20210701, Letnik:
21
Journal Article
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