Adherencia al triaje en contexto de tamizaje con autotoma del test de virus del papiloma humano en la provincia de Jujuy / riage of Women with Human Papillomavirus Self-Collection in Jujuy Province

INTRODUCCIÓN: Es reconocida la efectividad del test del virus del papiloma humano (VPH) para prevenir el cáncer cervicouterino (CC), así como su potencial para reducir barreras de acceso al tamizaje a través de su modalidad autotoma (ATVPH). Uno de los principales desafíos consiste en garantizar el acceso a la citología de triaje de las mujeres con AT-VPH positivas (VPH+). El objetivo de este estudio fue analizar la magnitud y los determinantes sociales de la adherencia al triaje (realización de citología posterior a un resultado de test de VPH+) en mujeres de 30 años o más con AT-VPH+ dentro del sistema público de salud de la provincia de Jujuy. MÉTODOS: Se efectuó un estudio descriptivo transversal con análisis del Sistema de Información para el Tamizaje (SITAM) y encuestas domiciliarias a mujeres de 30 años o más con autotomas positivas en Jujuy durante 2015-2016, sin registro de triaje. RESULTADOS: El porcentaje estimado de adherencia al triaje fue de entre 96% y 81%. Estos porcentajes son menores a los 60 y 120 días de realizada la AT (18% y 35%, respectivamente). Las mujeres con cobertura de obra social/privada y sin condición de hacinamiento poseen mayor probabilidad de adherir al triaje. El principal motivo de no adherencia fueron los problemas con la entrega de resultados. CONCLUSIONES: Pese a los altos niveles de adherencia al triaje, es necesario incorporar intervenciones que mejoren la entrega de resultados y ayuden a enfrentar las barreras socioestructurales

Simulation-Based Training of the Nurse Practitioner in Interventional Radiology.

Advanced practice registered nurses, such as Nurse Practitioners (NPs), can be found working in a variety of settings. Niche practices, such as Interventional Radiology, are highly specialized areas and are often specialties in which few NPs get to orient through during their graduate nursing program clinical rotations. For the NP transitioning into an Interventional Radiology practice, formal on-the-job orientation and training can assist in gaining specialty-based knowledge and competencies in performing interventional procedures. Simulation-based training of the NP helps with critical thinking skills and developing techniques to safely perform minimally invasive procedures. A step-by-step approach via a simulation environment helps the NP learn image guidance, develop hand-eye coordination and become proficient in procedure techniques. Simulation-based education introduces the concept of repetitive practice resulting in the NP gaining confidence in performing procedures while decreasing performance anxiety. The result is a competent NP who can safely perform minimally invasive procedures.

Simulation-based Training for Interventional Radiology and Opportunities for Improving the Educational Paradigm.

The current model for medical education is based on the Master-Apprentice model which was adopted into practice over a century ago. Since then, there have been many changes in healthcare and the environment in which trainees learn, practice and become proficient in procedural and critical thinking skills. The current model for medical education has however, not changed considerably in this time frame, resulting in significant limitations to trainee education. Simulator-based training is a technique which can minimize the limitations of the apprenticeship model by mitigating the effect of time constraints, increased emphasis on patient safety and satisfaction and nonstandardization of Interventional Radiology (IR) curricula. Currently, simulators are utilized in some IR programs, however robust research into simulators must be performed to prove the educational validity of simulators and support formalization and widespread integration of simulation based training into a new, improved and standardized IR curriculum.

Percutaneous Image-Guided Irreversible Electroporation for the Treatment of Unresectable, Locally Advanced Pancreatic Adenocarcinoma.

PURPOSE: To describe safety and effectiveness of percutaneous irreversible electroporation (IRE) for treatment of unresectable, locally advanced pancreatic adenocarcinoma (LAPC). MATERIALS AND METHODS: This retrospective study included 50 patients (23 women, 27 men; age range, 46-91 y; median age, 62.5 y) with biopsy-proven, unresectable LAPC who received percutaneous computed tomography (CT)-guided IRE. The primary objective was to assess the safety profile of the procedure; the secondary objective was to determine overall survival (OS). All patients had prior chemotherapy (1-5 lines, median 2), and 30 (60%) of 50 patients had prior radiation therapy. Follow-up included CT at 1 month and at 3-month intervals thereafter. RESULTS: There were no treatment-related deaths and no 30-day mortality. Serious adverse events occurred in 10 (20%) of 50 patients (abdominal pain [n = 7], pancreatitis [n = 1], sepsis [n = 1], gastric leak [n = 1]). Median OS was 27.0 months (95% confidence interval [CI], 22.7-32.5 months) from time of diagnosis and 14.2 months (95% CI, 9.7-16.2 months) from time of IRE. Patients with tumors ≤ 3 cm (n = 24) had significantly longer median OS than patients with tumors > 3 cm (n = 26): 33.8 vs 22.7 months from time of diagnosis (P = .002) and 16.2 vs 9.9 months from time of IRE (P = .031). Tumor size was confirmed as the only independent predictor of OS at multivariate analysis. CONCLUSIONS: Percutaneous image-guided IRE of unresectable LAPC is associated with an acceptable safety profile.

Irreversible Electroporation for Colorectal Liver Metastases.

Image-guided tumor ablation techniques have significantly broadened the treatment possibilities for primary and secondary hepatic malignancies. A new ablation technique, irreversible electroporation (IRE), was recently added to the treatment armamentarium. As opposed to thermal ablation, cell death with IRE is primarily induced using electrical energy: electrical pulses disrupt the cellular membrane integrity, resulting in cell death while sparing the extracellular matrix of sensitive structures such as the bile ducts, blood vessels, and bowel wall. The preservation of these structures makes IRE attractive for colorectal liver metastases (CRLM) that are unsuitable for resection and thermal ablation owing to their anatomical location. This review discusses different technical and practical issues of IRE for CRLM: the indications, patient preparations, procedural steps, and different "tricks of the trade" used to improve safety and efficacy of IRE. Imaging characteristics and early efficacy results are presented. Much is still unknown about the exact mechanism of cell death and about factors playing a crucial role in the extent of cell death. At this time, IRE for CRLM should only be reserved for small tumors that are truly unsuitable for resection or thermal ablation because of abutment of the portal triad or the venous pedicles.

Proximal Splenic Artery Embolization in Chemotherapy-Induced Thrombocytopenia: A Retrospective Analysis of 13 Patients.

PURPOSE: To determine if proximal splenic artery embolization (PSAE) provides a safe and effective alternative to alleviate chemotherapy-induced thrombocytopenia (CIT), allowing patients with cancer to resume chemotherapy regimens. MATERIALS AND METHODS: Thirteen patients (9 men, 4 women; mean age, 63 y) with underlying malignancy (pancreatic adenocarcinoma, n = 6; cholangiocarcinoma, n = 5; other, n = 2) complicated by CIT underwent PSAE. Mean platelet counts were calculated before the initiation of chemotherapy, at the nadir that resulted in discontinuation of chemotherapy before the PSAE procedure, at peak values after the procedure, and at a mean follow-up of 9.2 months. The time to reinitiation of chemotherapy after PSAE was calculated. RESULTS: Baseline platelet count before initiation of chemotherapy was 162 × 10(9)/L (range, 90-272 × 10(9)/L). The platelet count nadir resulting in cessation of chemotherapy was 45 × 10(9)/L (range, 23-67 × 10(9)/L), and the pre-PSAE platelet count was 88 × 10(9)/L (range, 49-131 × 10(9)/L). The post-PSAE peak platelet count improved significantly (to 209 × 10(9)/L; range, 83-363 × 10(9)/L) compared with the nadir counts and the pre-PSAE counts (P < .01) at a mean short-term follow-up of 35 days (range, 7-91 d). The counts at follow-up to 9.2 months (range, 3-15 mo) were 152 × 10(9)/L (range, 91-241 × 10(9)/L). All patients became eligible to resume chemotherapy. The time to initiation of chemotherapy after PSAE averaged 22 days (range, 4-58 d) in 12 patients; one patient declined chemotherapy. CONCLUSIONS: Proximal splenic artery embolization appears to be safe and effective in alleviating CIT, allowing resumption of systemic chemotherapy. Further studies may help guide patient selection by identifying characteristics that allow a sustained improvement in thrombocytopenia.

Is Antibiotic Prophylaxis for Percutaneous Radiofrequency Ablation (RFA) of Primary Liver Tumors Necessary? Results From a Single-Center Experience.

PURPOSE: The purpose of this study was to evaluate need for antibiotic prophylaxis for radiofrequency ablation (RFA) of liver tumors in patients with no significant co-existing risk factors for infection. MATERIALS AND METHODS: From January 2004 to September 2013, 83 patients underwent 123 percutaneous RFA procedures for total of 152 hepatocellular carcinoma (HCC) lesions. None of the patients had pre-existing biliary enteric anastomosis (BEA) or any biliary tract abnormality predisposing to ascending biliary infection or uncontrolled diabetes mellitus. No pre- or post-procedure antibiotic prophylaxis was provided for 121 procedures. Data for potential risk factors were reviewed retrospectively and analyzed for the frequency of infectious complications, including abscess formation. RESULTS: One patient (1/121 (0.8%) RFA sessions) developed a large segment 5 liver abscess/infected biloma communicating with the gallbladder 7 weeks after the procedure, successfully treated over 10 weeks with IV and PO antibiotic therapy and percutaneous catheter drainage. This patient did not receive any antibiotics prior to RFA. During the procedure, there was inadvertent placement of RFA probe tines into the gallbladder. No other infectious complications were documented. CONCLUSION: These data suggest that the routine use of prophylactic antibiotics for liver RFA is not necessary in majority of the patients undergoing liver ablation for HCC and could be limited to patients with high-risk factors such as the presence of BEA or other biliary abnormalities, uncontrolled diabetes mellitus, and large centrally located tumors in close proximity to central bile ducts. Larger randomized studies are needed to confirm this hypothesis.

Vessel patency post irreversible electroporation.

PURPOSE: The purpose of the study was to evaluate the effect of Irreversible Electroporation (IRE) on vessel patency in close proximity to the ablation zone. MATERIALS AND METHODS: Between January 2010 and November 2013, 101 patients underwent percutaneous IRE procedures using the NanoKnife for primary and metastatic tumors in different organs. Age ranged from 24 to 83 years. A total of 129 lesions were treated. [liver (100), pancreas (18), kidney (3), pelvis (1), aorto-caval lymph nodes (2), adrenal (2), lung (1), retroperitoneal (1), surgical bed of a prior Whipple procedure (1)]. Post treatment contrast-enhanced CT and MRI scans were reviewed to evaluate caliber, patency, and flow defects of vessels in close proximity to the ablation zone (defined as vessels within 0-1 cm from the treatment zone). RESULTS: A total of 158 vessels were examined for patency on follow-up. The mean distance of the vessel from the treatment zone was 2.3 ± 2.5 mm. Ten vessels within the treatment zone were encased by tumor. Mean tumor size was 2.7 + 1.5 cm. Overall mean follow-up was 10.3 months. Abnormal vascular changes were noted in 7 of 158 (4.4%) vessels. No significant association was found between distances from the treatment zone and presence of narrowing/thrombosis at the follow-up imaging. (Mann-Whitney U, p = 0.772; logistic regression: p = 0.593; odds ratio: 0.908; CI 0.637-1.294). CONCLUSION: This study demonstrates safety of IRE for the treatment of tumors near the large blood vessels and tumors already encasing the vessels. Further studies to substantiate these findings are essential to validate this crucial advantage of IRE.

Percutaneous irreversible electroporation for the treatment of colorectal cancer liver metastases with a proposal for a new response evaluation system.

PURPOSE: To describe an initial experience with irreversible electroporation (IRE) in patients with colorectal liver metastasis (CLM). MATERIALS AND METHODS: A retrospective analysis of patients undergoing IRE for the management of CLM was performed. Procedures were done percutaneously under general anesthesia. Patients were then followed for adverse events, tumor response, and survival. RESULTS: Between March 2010 and February 2013, 29 patients underwent percutaneous ablation of 58 tumors in 36 IRE sessions. Most patients (89%) had an absolute or relative contraindication to thermal ablation. The median age was 62 years, and the median time from diagnosis to IRE was 28 months. The median number of lesions treated per patient was two, and the median tumor size was 2.7 cm. Patients had received previous chemotherapy regimens (range, 1-5 per patient). A new Metabolic Imaging And Marker Integration response evaluation criteria was used for response assessment, and was a predictor of progression-free and overall survival. The 2-year progression-free survival rate was 18% (95% confidence interval, 0%-35%), and the 2-year overall survival rate was 62% (95% confidence interval, 37%-87%). Complications included arrhythmias (n = 1) and postprocedure pain (n = 1). Both patients recovered without sequelae. CONCLUSIONS: Percutaneous IRE of CLM is feasible and safe. A new response evaluation system for colorectal cancer appears to be prognostic.

DISEÑO DE UN SISTEMA DE REHABILITACIÓN PARA MIEMBRO SUPERIOR EN ENTORNO DE REALIDAD VIRTUAL / DESIGN OF A UPPER LIMB REHABILITATION SYSTEM IN VIRTUAL REALITY ENVIRONMENT / PROJETO DO SISTEMA DE REABILITAÇÃO DO MEMBRO SUPERIOR EM AMBIENTE DE REALIDADE VIRTUAL

Este trabajo describe el diseño y desarrollo de un sistema capaz de adquirir señales electromiográficas de superficie, digitalizarlas y procesarlas en una computadora personal, para ser usadas como control de un objeto de realidad virtual que representa al miembro superior. La clasificación de la intencionalidad del usuario se realiza mediante la configuración y entrenamiento de una red neuronal artificial. Luego se presenta en tiempo real la animación en realidad virtual de los movimientos realizados por el miembro superior. Los resultados para los cuatro voluntarios estudiados, indican una tasa de clasificación positiva en promedio del 75% para cada uno de ellos.

This work presents the design and development of a six-channel system for acquisition and conditioning of electromyographic signals collected in the upper limb. The main objective of the work is to create a system that can be used as rehabilitation and training instrument for potential users of myoelectric prostheses. The software developed perform actions of feature extraction, classifier training and design of the mechanical model of the human arm, with the running movements of flexion, extension, pronation and supination of the forearm and the grasp in a reality environment virtual, providing rehabilitation therapy to different patients.

Este trabalho apresenta a concepção e desenvolvimento de um sistema de seis canais para a aquisição e condicionamento de sinais eletromiográficos coletados no membro superior. O principal objetivo do trabalho é criar um sistema que pode ser utilizado como instrumento de reabilitação e treinamento para os potenciais utilizadores de prótese mioelétrica. O software desenvolvido executar ações de extração de características, o treinamento do classificador e design do modelo mecânico do braço humano, com os movimentos da corrida de flexão, extensão, pronação e supinação do antebraço e do alcance em um ambiente de realidade virtual, fornecendo terapia de reabilitação para diferentes pacientes.

Electrocutaneous stimulation system for Braille reading.

This work is an assistive technology for people with visual disabilities and aims to facilitate access to written information in order to achieve better social inclusion and integration into work and educational activities. Two methods of electrical stimulation (by current and voltage) of the mechanoreceptors was tested to obtain tactile sensations on the fingertip. Current and voltage stimulation were tested in a Braille cell and line prototype, respectively. These prototypes are evaluated in 33 blind and visually impaired subjects. The result of experimentation with both methods showed that electrical stimulation causes sensations of touch defined in the fingertip. Better results in the Braille characters reading were obtained with current stimulation (85% accuracy). However this form of stimulation causes uncomfortable sensations. The latter feeling was minimized with the method of voltage stimulation, but with low efficiency (50% accuracy) in terms of identification of the characters. We concluded that electrical stimulation is a promising method for the development of a simple and unexpensive Braille reading system for blind people. We observed that voltage stimulation is preferred by the users. However, more experimental tests must be carry out in order to find the optimum values of the stimulus parameters and increase the accuracy the Braille characters reading.