Background and purpose
Cholangiocarcinoma is an infrequent neoplasm barely studied with
18
F-FDG–PET/CT. We evaluated the metabolic behavior of cholangiocarcinoma in PET/CT according to its location ...(intra or extrahepatic) and analyzed the relationship between metabolic parameters of the primary tumor and tumor markers (CA19-9 and CEA), determining their prognostic significance.
Methods
Retrospective study of PET/CT of 60 patients with untreated cholangiocarcinoma, divided into two groups according to tumor location. FDG uptake was evaluated visually and semiquantitatively SUVmax and tumor-to-liver ratio (TLR), and differences between intra and extrahepatic cholangiocarcinomas were tested, both for FDG uptake in the primary tumor and for the presence of regional or distant disease (per-patient), as well as regarding tumor marker levels. A correlation between metabolic parameters and tumor markers was performed, and prognostic value of these factors was determined (univariate and multivariate analyses).
Results
Intrahepatic cholangiocarcinomas were significantly more FDG-avid than extrahepatic ones (
p
= 0.006 for SUVmax;
p
= 0.002 for TLR). There were differences neither between both groups considering the capacity of PET/CT to detect regional (
p
= 0.261) and distant involvement (
p
= 0.876), nor regarding the levels of tumor markers (
p
= 0.160 for CA19-9;
p
= 0.708 for CEA). Metabolic parameters and tumor markers showed a weak positive correlation (
R
2
0.22–0.27). At the multivariate analysis, advanced stage (
p
= 0.024), increased CEA (
p
= 0.022), and higher TLR (
p
= 0.003) were significantly related with shorter overall survival.
Conclusions
Intra and extrahepatic cholangiocarcinomas behave differently on PET/CT, though no differences between both groups exist in its capacity to detect regional or distant disease. Metabolic parameters and levels of tumor markers seem to relate with tumor burden, impacting in prognosis.
Recent trials have shown hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients. It is uncertain whether these adverse effects also affect ...surgical patients. We sought to determine the renal safety of modern tetrastarch (6% HES 130/0.4) use in cardiac surgical patients.
In this multicentre prospective cohort study, 1058 consecutive patients who underwent cardiac surgery from 15th September 2012 to 15th December 2012 were recruited in 23 Spanish hospitals.
We identified 350 patients (33%) administered 6% HES 130/0.4 intraoperatively and postoperatively, and 377 (36%) experienced postoperative AKI (AKI Network criteria). In-hospital death occurred in 45 (4.2%) patients. Patients in the non-HES group had higher Euroscore and more comorbidities including unstable angina, preoperative cardiogenic shock, preoperative intra-aortic balloon pump use, peripheral arterial disease, and pulmonary hypertension. The non-HES group received more intraoperative vasopressors and had longer cardiopulmonary bypass times. After multivariable risk-adjustment, 6% HES 130/0.4 use was not associated with significantly increased risks of AKI (adjusted odds ratio 1.01, 95% CI 0.71-1.46, P=0.91). These results were confirmed by propensity score-matched pairs analyses.
The intraoperative and postoperative use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with increased risks of AKI and dialysis after cardiac surgery in our multicentre cohort.
Background
Thromboelastometry may reduce red blood cell (RBC) transfusion in liver transplantation (LT). Fibrinogen concentration is a primary determinant of FIBTEM maximum clot firmness (MCF), but ...several factors could affect the correlation between FIBTEM MCF and fibrinogen values. We aimed to investigate (1) the concordance between fibrinogen level and FIBTEM MCF and (2) the association of fibrinogen level and FIBTEM MCF with RBC transfusion during LT.
Methods
A post hoc analysis of data from a randomized, multicentre, double‐blind, saline/fibrinogen trial was used (NCT01539057). A total of 86 adult patients were included.
Results
The Lin concordance coefficient (LCC) between FIBTEM MCF and fibrinogen levels with the model formula 1·3679 + 0·05414* FIBTEM MCF was poor overall (LLC 95% CI: 0·387 0·340 to 0·432) and moderate for the preperfusion period (LLC 95% CI: 0·789 0·747 to 0·824), but very poor for the postreperfusion period (LLC 95% CI 0·170 0·105 to 0·233). The model assessed for RBC transfusion for FIBTEM MCF showed an area under the curve of 0·788 0·745‐0·832. Patients with FIBTEM MCF values <8 mm had a significantly higher likelihood of receiving RBC than patients with higher values. (OR 95% CI: 2·08 1·30‐3·33, P = 0·002). FIBTEM MCF values over 10 mm do not appear to reduce the likelihood of RBC transfusion.
Conclusion
FIBTEM MCF is not a good indicator of plasma fibrinogen values after graft reperfusion. FIBTEM MCF >8 mm during the LT procedure is associated with less RBC transfusion. FIBTEM MCF values over 10 mm could lead to unnecessary fibrinogen administration.
We aimed to describe and characterize the gut microbiota composition and diversity in children with obesity according to their metabolic health status.
Anthropometry, Triglycerides, HDL cholesterol, ...HOMA-IR, and systolic and diastolic blood pressure (SBP, DBP) were evaluated (and z-score calculated) and faecal samples were collected from 191 children with obesity aged from 8 to 14. All children were classified depending on their cardiometabolic status in either a “metabolically healthy” (MHO; n = 106) or “metabolically unhealthy” (MUO; n = 85) group. Differences in gut microbiota taxonomies and diversity between groups (MUO vs MHO) were analysed. Alpha diversity index was calculated as Chao1 and Simpson’s index, and β-diversity was calculated as Adonis Bray–Curtis index. Spearman’s correlations and logistic regressions were performed to study the association between cardiometabolic health and the microbiota.
Children in the MUO presented significantly lower alpha diversity and richness than those in the MHO group (Chao1 index p = 0.021, Simpson’s index p = 0.045, respectively), whereas microbiota β-diversity did not differ by the cardiometabolic health status (Adonis Bray–Curtis, R2 = 0.006; p = 0.155). The MUO group was characterized by lower relative abundances of the genera Christensenellaceae R7 group (MHO:1.42% 0.21–2.94; MUO:0.47% 0.02–1.60, p < 0.004), and Akkermansia (MHO:0.26% 0.01–2.19; MUO:0.01% 0.00–0.36, p < 0.001) and higher relative abundances of Bacteroides (MHO:10.6% 4.64–18.5; MUO:17.0% 7.18–27.4, p = 0.012) genus. After the adjustment by sex, age, and BMI, higher Akkermansia (OR: 0.86, CI: 0.75–0.97; p = 0.033), Christensenellaceae R7 group (OR: 0.86, 95% CI: 075–0.98; p = 0.031) and Chao1 index (OR: 0.86, CI: 0.96–1.00; p = 0.023) represented a lower risk of the presence of one or more altered cardiovascular risk factors.
Lower proportions of Christensenellaceae and Akkermansia and lower diversity and richness seem to be indicators of a metabolic unhealthy status in children with obesity.
A through description of the left ventricle functionality requires combining complementary regional scores. A main limitation is the lack of multiparametric normality models oriented to the ...assessment of regional wall motion abnormalities (RWMA). This paper covers two main topics involved in RWMA assessment. We propose a general framework allowing the fusion and comparison across subjects of different regional scores. Our framework is used to explore which combination of regional scores (including 2-D motion and strains) is better suited for RWMA detection. Our statistical analysis indicates that for a proper (within interobserver variability) identification of RWMA, models should consider motion and extreme strains.
Abstract Risk of bleeding and transfusion in liver transplantation is determined by age, severity of liver disease, as well as hemoglobin and plasma fibrinogen values. During the hepatectomy and the ...anhepatic phase, the coagulopathy is related to a decrease in clotting factors caused by surgical bleeding, facilitated by the increased portal hypertension and esophageal-gastric venous distension. Corrections of hematologic disturbances by administration of large volumes of crystalloid, colloid, or blood products may worsen the coagulopathy. Also, impaired clearance of fibrinolytic enzymes released from damaged cells can lead to primary fibrinolysis. At time of graft reperfusion further deterioration may occur as characterized by global reduction among all coagulation factors, decreased plasminogen activator inhibitor factors, and simultaneous generation of tissue plasminogen activator. In situations with inherent risk of bleeding, hypofibrinogenemia must be corrected. Concern about unwanted events is a major limitation of preventive therapy. There is some evidence for the efficacy of antifibrinolytic drugs to reduce red blood cell requirements. A guide for antifibrinolytic therapy are clot firmness in trhomboelastometry or alternatively, diffuse bleeding associated to a fibrinogen value less than 1 g/L. Because thrombin generation is limited in severe thrombocytopenia, platelet administration is recommended when active bleeding coexists with a platelet count below 50,000/mm3 . When the administration of hemoderivates and antifibrinolytic drugs does not correct severe bleeding, consumption coagulopathy and secondary fibrinolysis should be suspected. Treatment of affected patients should be based upon correcting the underlying cause, mostly related to tissue hypoxia due to critical hypoperfusion.
Granule sizes, macromolecular features and thermal and pasting properties of starches from seven tropical sources (Florido, Kponan and Esculenta yams, cocoyam, cassava, sweet potato and ginger) were ...compared with those of several well-known cereal, legume and tuber starches. The aim of the study was to characterise some non-conventional starches with a view to possibly marketing them. Amylose content varied from 148 mg g(-1) in Esculenta starch to 354 mg g(-1) in smooth pea starch. For total starches, weight-average molar mass (M(w)) ranged between 0.94 x 10(8) and 1.80 x 10(8) g mo(l-1) for potato and normal maize starches respectively. Gyration radius (R(G)) varied from 157 nm for ginger starch to 209 nm for normal maize starch. Gelatinisation enthalpy (deltaH) ranged between 9.8 and 20.7 J g(-1) for wheat and Florido starches respectively. Gelatinisation peak temperature (T(g)) varied from 58.1 °C for wheat starch to 87.3 °C for ginger starch. Native starch granule mean diameter ranged between 5.1 and 44.5 μm for Esculenta and potato starches respectively. Cassava and potato starches had the highest swelling power and dispersed volume fraction at all treatment temperatures, while ginger starch had the lowest. Cocoyam starch had the highest and ginger starch the lowest solubility at 85 and 95 °C. Cassava starch was the most stable under cold storage conditions. Roots and tubers such as ginger and cassava produced in the Ivory Coast are new sources of starches with very interesting properties. Thus these starches could be isolated on an industrial level in order to market them.
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