Clinical Validation of a Size-Based Microfluidic Device for Circulating Tumor Cell Isolation and Analysis in Renal Cell Carcinoma.

Renal cell carcinoma (RCC) presents as metastatic disease in one third of cases. Research on circulating tumor cells (CTCs) and liquid biopsies is improving the understanding of RCC biology and metastases formation. However, a standardized, sensitive, specific, and cost-effective CTC detection technique is lacking. The use of platforms solely relying on epithelial markers is inappropriate in RCC due to the frequent epithelial-mesenchymal transition that CTCs undergo. This study aimed to test and clinically validate RUBYchip™, a microfluidic label-free CTC detection platform, in RCC patients. The average CTC capture efficiency of the device was 74.9% in spiking experiments using three different RCC cell lines. Clinical validation was performed in a cohort of 18 patients, eight non-metastatic (M0), five metastatic treatment-naïve (M1TN), and five metastatic progressing-under-treatment (M1TP). An average CTC detection rate of 77.8% was found and the average (range) total CTC count was 6.4 (0-27), 101.8 (0-255), and 3.2 (0-10), and the average mesenchymal CTC count (both single and clustered cells) was zero, 97.6 (0-255), and 0.2 (0-1) for M0, M1TN, and M1TP, respectively. CTC clusters were detected in 25% and 60% of M0 and M1TN patients, respectively. These results show that RUBYchip™ is an effective CTC detection platform in RCC.

COVID-19: Financial Stress and Well-Being in Families.

In all areas of knowledge, research has shown the devastating effects of COVID-19, and the impact on families' financial stress and well-being is one of them. Crises are predictors of families' financial stress as they produce changes in their income and negative feelings, such as fear and demotivation, which affect well-being. This study analyses the financial and social impact of COVID-19 on families, supported by the ABCE-WB model, with data collection being the result of snowball sampling. The results obtained allow the conclusion that the current pandemic crisis has caused financial stress in families, to a greater or lesser degree, and caused feelings of fear and demotivation as consequences of the general lockdown. The empirical evidence also shows that these effects are positively associated with the perception of their level of well-being. The contribution of the study lies in corroborating the model used. Final considerations are presented together with the limitations and suggestions for future research.

Leukapheresis guidance and best practices for optimal chimeric antigen receptor T-cell manufacturing.

Chimeric antigen receptor (CAR) T-cell therapy is an individualized immunotherapy that genetically reprograms a patient's T cells to target and eliminate cancer cells. Tisagenlecleucel is a US Food and Drug Administration-approved CD19-directed CAR T-cell therapy for patients with relapsed/refractory (r/r) B-cell acute lymphoblastic leukemia and r/r diffuse large B-cell lymphoma. Manufacturing CAR T cells is an intricate process that begins with leukapheresis to obtain T cells from the patient's peripheral blood. An optimal leukapheresis product is essential to the success of CAR T-cell therapy; therefore, understanding factors that may affect the quality or T-cell content is imperative. CAR T-cell therapy requires detailed organization throughout the entire multistep process, including appropriate training of a multidisciplinary team in leukapheresis collection, cell processing, timing and coordination with manufacturing and administration to achieve suitable patient care. Consideration of logistical parameters, including leukapheresis timing, location and patient availability, when clinically evaluating the patient and the trajectory of their disease progression must be reflected in the overall collection strategy. Challenges of obtaining optimal leukapheresis product for CAR T-cell manufacturing include vascular access for smaller patients, achieving sufficient T-cell yield, eliminating contaminating cell types in the leukapheresis product, determining appropriate washout periods for medication and managing adverse events at collection. In this review, the authors provide recommendations on navigating CAR T-cell therapy and leukapheresis based on experience and data from tisagenlecleucel manufacturing in clinical trials and the real-world setting.

Bibliometric review about eco-cites and urban sustainable development: trend topics.

The world is undergoing exponential urbanization, with consequences for society in general, both for cities and people, with serious economic, social and environmental implications. Therefore, it is crucial to reconsider urban models of cities, to ensure global, long-term sustainability. Numerous researchers have argued that one of these models involves eco-city projects, and this study aims to carry out a systematic review of the literature on this topic, through bibliometrics. To do so, the Smarter, Prisma and Vantage Point methods were used, reflecting the originality of the study. The results obtained show that China has aroused researchers' interest regarding its eco-city projects, with most studies being empirical, and so this study complements them. The main contribution of this research lies in identifying the keywords most used by authors, these being eco-cities, sustainable cities (cluster 1) and eco-cities, China, sustainable urban development and eco-cycle model (cluster 2). Finally, implications for theory and practice are presented, together with suggestions for future research.

What exists in academia on work stress in accounting professionals: a bibliometric analysis.

This study aims to fill a gap in the literature by conducting the scientific and bibliometric mapping of work stress in accounting professionals, using a methodological trilogy that contributes to this topic, namely the application of the ROC curve, Prisma and R bibliometric tools. Through the analysis of a sample of 103 articles, it was found that, in order to avoid and/or overcome the levels of stress in accountants, the following factors should be taken into account: (1) a high engagement with work, (2) reduced self-efficacy perception in the decision-making process, (3) adverse consequences in the management process, and (4) high-stress levels embedded in the individual's personality. Thus, it will be necessary for the accountant to apply strategies and change the way he/she works and perceives the work, avoiding stress levels and irreversible health damage. In addition, the importance of resilience in the professional context and mindfulness may prevent high levels of stress and maybe the subject of future research.

Open to MOOCs? Evidence of their impact on labour market outcomes.

This paper investigates the effect that participation in massive open online courses (MOOCs) ecosystem can have on workers' labour market outcomes, mainly employment retaining. We use primary data collected between 2015 and 2017 and obtained from two surveys (pre-course and follow-up questionnaires) sent to participants in six MOOCs. The treatment group is composed of individuals participating in MOOCs in 2015 and the control group is composed of individuals who enrolled in MOOCs for the first time in 2017. Using a differences-in-differences approach, we find that participation in MOOCs can improve workers' employment retaining but not their wages. The positive effect on employment retaining is homogeneous in different geographical and economic areas and tends to be higher for individuals who have participated in more MOOCs in the past.

Correction to: Picomolar concentrations of oligomeric alpha-synuclein sensitizes TLR4 to play an initiating role in Parkinson's disease pathogenesis.

In the original publication of this article, the author Magarida Rodrigues was written incorrectly.

Picomolar concentrations of oligomeric alpha-synuclein sensitizes TLR4 to play an initiating role in Parkinson's disease pathogenesis.

Despite the wealth of genomic and transcriptomic data in Parkinson's disease (PD), the initial molecular events are unknown. Using LD score regression analysis, we show significant enrichment in PD heritability within regulatory sites for LPS-activated monocytes and that TLR4 expression is highest within human substantia nigra, the most affected brain region, suggesting a role for TLR4 inflammatory responses. We then performed extended incubation of cells with physiological concentrations of small alpha-synuclein oligomers observing the development of a TLR4-dependent sensitized inflammatory response with time, including TNF-α production. ROS and cell death in primary neuronal cultures were significantly reduced by TLR4 antagonists revealing that an indirect inflammatory mechanism involving cytokines produced by glial cells makes a major contribution to neuronal death. Prolonged exposure to low levels of alpha-synuclein oligomers sensitizes TLR4 responsiveness in astrocytes and microglial, explaining how they become pro-inflammatory, and may be an early causative event in PD.

Mapping Surface Hydrophobicity of α-Synuclein Oligomers at the Nanoscale.

Proteins fold into a single structural ensemble but can also misfold into many diverse structures including small aggregates and fibrils, which differ in their toxicity. The aggregate surface properties play an important role in how they interact with the plasma membrane and cellular organelles, potentially inducing cellular toxicity, however, these properties have not been measured to date due to the lack of suitable methods. Here, we used a spectrally resolved, super-resolution imaging method combined with an environmentally sensitive fluorescent dye to measure the surface hydrophobicity of individual aggregates formed by the protein α-synuclein (αS), whose aggregation is associated with Parkinson's disease. We show that the surface of soluble oligomers is more hydrophobic than fibrils and populates a diverse range of coexisting states. Overall, our data show that the conversion of oligomers to fibril-like aggregates and ultimately to fibrils results in a reduction in both hydrophobicity and the variation in hydrophobicity. This funneling characteristic of the energy landscape explains many of the observed properties of αS aggregates and may be a common feature of aggregating proteins.

Optical Structural Analysis of Individual α-Synuclein Oligomers.

Small aggregates of misfolded proteins play a key role in neurodegenerative disorders. Such species have proved difficult to study due to the lack of suitable methods capable of resolving these heterogeneous aggregates, which are smaller than the optical diffraction limit. We demonstrate here an all-optical fluorescence microscopy method to characterise the structure of individual protein aggregates based on the fluorescence anisotropy of dyes such as thioflavin-T, and show that this technology is capable of studying oligomers in human biofluids such as cerebrospinal fluid. We first investigated in vitro the structural changes in individual oligomers formed during the aggregation of recombinant α-synuclein. By studying the diffraction-limited aggregates we directly evaluated their structural conversion and correlated this with the potential of aggregates to disrupt lipid bilayers. We finally characterised the structural features of aggregates present in cerebrospinal fluid of Parkinson's disease patients and age-matched healthy controls.

Diagnostic accuracy and functional parameters of myocardial perfusion scintigraphy using accelerated cardiac acquisition with IQ SPECT technique in comparison to conventional imaging.

BACKGROUND: IQ SPECT consists of a new pinhole-like collimator, cardio-centric acquisition, and advanced 3D iterative SPECT reconstruction. The aim of this paper was to compare diagnostic accuracy and functional parameters obtained with IQ SPECT versus conventional SPECT in patients undergoing myocardial perfusion scintigraphy with adenosine stress and at rest. METHODS: Eight patients with known or suspected coronary artery disease underwent [99mTc] tetrofosmin gated SPECT. Acquisition was performed on a Symbia T6 equipped with IQ SPECT and on a conventional gamma camera system. Gated SPECT data were used to calculate functional parameters. Scores analysis was performed on a 17-segment model. Coronary angiography and clinical follow-up were considered as diagnostic reference standard. RESULTS: Mean acquisition time was 4 minutes with IQ SPECT and 21 minutes with conventional SPECT. Agreement degree on the diagnostic accuracy between both systems was 0.97 for stress studies, 0.91 for rest studies and 0.96 for both studies. Perfusion abnormalities scores obtained by using IQ SPECT and conventional SPECT were not significant different: SSS, 9.7±8.8 and 10.1±6.4; SRS, 7.1±6.1 and 7.5±7.3; SDS, 4.0±6.1 and 3.9±4.3, respectively. However, a significant difference was found in functional parameters derived from IQ SPECT and conventional SPECT both after stress and at rest. Mean LVEF was 8% lower using IQ SPECT. Differences in LVEF were found in patients with normal LVEF and patients with reduced LVEF. CONCLUSIONS: Functional parameters using accelerated cardiac acquisition with IQ SPECT are significantly different to those obtained with conventional SPECT, while agreement for clinical interpretation of myocardial perfusion scintigraphy with both techniques is high.

Institutional Protocol for Prevention of TEVAR-related Spinal Cord Ischemia - The First 9 Cases.

INTRODUCTION: Spinal cord ischemia (SCI) is a feared complication after endovascular correction of thoracic aortic diseases (TEVAR). The guidelines of the European Society for Vascular Surgery recommend prophylactic lumbar drainage (LD) of cerebrospinal fluid in high-risk patients undergoing TEVAR. Our institutional protocol considers as high-risk patients as: coverage of the origin of the Adamkiewicz artery (T9-T12), aortic coverage >15 cm, involvement of collaterals (treated or untreated abdominal aortic aneurysm, left subclavian artery revascularization or bilateral occlusion of the internal iliac arteries) and symptomatic SCI. The objective of the study was to demonstrate the efficacy and safety of LD in preventing or treating SCI after TEVAR. METHODS: Patients submitted to LD in the perioperative period of TEVAR under the institutional protocol, between May 2015 and April 2017, were prospectively included. PRIMARY OUTCOME: prevention and/or reversal of neurological symptoms (efficacy). Secondary Outcome: complications related to the technique (safety). RESULTS: We included 8 patients with thoracoabdominal aneurysms and 1 patient with type B aortic dissection, aged 63- 75 years. Eight interventions were elective and one was urgent. The LD catheter was placed before surgery in 8 cases and in the postoperative period in 1 case due to symptomatology of SCI that reverted after liquor drainage. Of those placed pre-operatively, 2 had symptoms of SCI in the postoperative period, which alleviated with increased drainage and hemodynamic and hemoglobin optimization. The patient undergoing urgent TEVAR for ruptured thoracoabdominal aneurysm evolved with multiorgan dysfunction and death 24 hours after surgery. There were no other complications. CONCLUSION: In this initial experience, the institutional protocol with LD placement proved to be safe and effective in preventing and treating SCI after TEVAR.

Direct comparison of (68)Ga-DOTA-TOC and (18)F-FDG PET/CT in the follow-up of patients with neuroendocrine tumour treated with the first full peptide receptor radionuclide therapy cycle.

PURPOSE: To determine the value of (68)Ga-DOTA-TOC and (18)F-FDG PET/CT for initial and follow-up evaluation of patients with neuroendocrine tumour (NET) treated with peptide receptor radionuclide therapy (PRRT). METHODS: We evaluated 66 patients who had histologically proven NET and underwent both PRRT and three combined (68)Ga-DOTA-TOC and (18)F-FDG PET/CT studies. (68)Ga-DOTA-TOC PET/CT was performed before PRRT, 3 months after completion of PRRT and after a further 6 - 9 months. (18)F-FDG PET/CT was done within 2 months of (68)Ga-DOTA-TOC PET/CT. Follow-up ranged from 11.8 to 80.0 months (mean 34.5 months). RESULTS: All patients were (68)Ga-DOTA-TOC PET-positive initially and at follow-up after the first full PRRT cycle. Overall, 62 of the 198 (18)F-FDG PET studies (31 %) were true-positive in 38 of the 66 patients (58 %). Of the 66 patients, 28 (5 grade 1, 23 grade 2) were (18)F-FDG-negative initially and during follow-up (group 1), 24 (5 grade 1, 13 grade 2, 6 grade 3) were (18)F-FDG-positive initially and during follow-up (group 2), 9 patients (2 grade 1, 6 grade 2, 1 grade 3) were (18)F-FDG-negative initially but (18)F-FDG-positive during follow-up (group 3), and 5 patients (all grade 2) were (18)F-FDG-positive initially but (18)F-FDG-negative during follow-up (group 4).(18)F-FDG PET showed more and/or larger metastases than (68)Ga-DOTA-TOC PET in five patients of group 2 and four patients of group 3, all with progressive disease. In three patients with progressive disease who died during follow-up tumour SUVmax increased by 41 - 82 % from the first to the last follow-up investigation. CONCLUSION: In NET patients, the presence of (18)F-FDG-positive tumours correlates strongly with a higher risk of progression. Initially, patients with (18)F-FDG-negative NET may show (18)F-FDG-positive tumours during follow-up. Also patients with grade 1 and grade 2 NET may have (18)F-FDG-positive tumours. Therefore, (18)F-FDG PET/CT is a complementary tool to (68)Ga-DOTA-TOC PET/CT with clinical relevance for molecular investigation.

Current knowledge on the sensitivity of the (68)Ga-somatostatin receptor positron emission tomography and the SUVmax reference range for management of pancreatic neuroendocrine tumours.

Physiologically increased pancreatic uptake at the head/uncinate process is observed in more than one-third of patients after injection of one of the three (68)Ga-labelled octreotide-based peptides used for somatostatin (sst) receptor (r) imaging. There are minor differences between these (68)Ga-sstr-binding peptides in the imaging setting. On (68)Ga-sstr-imaging the physiological uptake can be diffuse or focal and usually remains stable over time. Differences in the maximal standardised uptake values (SUVmax) reported for the normal pancreas as well as for pancreatic neuroendocrine tumour (PNET) lesions may be related to several factors, including (a) differences in the peptide binding affinities as well as differences in sstr subtype expression of pancreatic α- and ß-cells, and heterogeneity / density of tumour cells, (b) differences in scanner resolution, image reconstruction techniques and acquisition protocols, (c) mostly retrospective study designs, (d) mixed patient populations, or (e) interference with medications such as treatment with long-acting sst analogues. The major limitation in most of the studies lies in the lack of histopathological confirmation of abnormal findings. There is a significant overlap between the calculated SUVmax-values for physiological pancreas and PNET-lesions of the head/uncinate process that do not favour the use of quantitative parameters in the clinical setting. Anecdotal long-term follow-up studies have even indicated that increased uptake in the head/uncinate process still can turn out to be malignant over years of follow up. SUVmax-data for the pancreatic body and tail are limited. Therefore, any visible focal tracer uptake in the pancreas must be considered as suspicious for malignancy irrespective of quantitative parameters. In general, sstr-PET/CT has significant implications for the management of NET patients leading to a change in treatment decision in about one-third of patients. Therefore, follow-up with (68)Ga-sstr-PET/CT is mandatory in the clinical setting if uptake in the head/uncinate process is observed.

Sexual dysfunction in women with Parkinson's disease.

BACKGROUND: Sexual dysfunction in women with Parkinson's disease is poorly understood and research in this area is scarce. The objectives of this study were sexual function characterization in female Parkinson's disease patients, description of sexual dysfunctions, correlation with disease characteristics, and comparison with matched healthy controls. METHODS: Social and demographic data from consecutive female patients with Parkinson's disease and matched healthy controls were collected. The following instruments were used: UPDRS, the Hoehn and Yahr scale, the Beck Depression Inventory-II, the Female Sexual Function Index, and the Sexual Dysfunction Inventory. The only exclusion criterion was cognitive deterioration precluding comprehension of the study scope and its instruments. RESULTS: Of the 95 patients identified, 61 were included. Mean age was 66 years (range 40-89 years), and mean disease duration was seven years (range 1-18 years). Twenty-nine presented an akinetic-rigid syndrome, 25 tremoric disease, and, the remaining, a mixed type of disease. Mean "on" total/part III UPDRS scores were 46 ± 15.0 and 31 ± 8.9. Sexual dysfunction was present in 86.9% of patients and 79.0% of controls, according to the Female Sexual Function Index (p < .01), and in 57.4% of patients and 22.6% of controls, according to the Sexual Dysfunction Inventory (p < .001). Multivariate binary logistic regression identified age and depressive symptoms as positive predictors in the severity of sexual dysfunction. Disease duration, UPDRS part III score, Hoehn and Yahr stage, and antiparkinsonian medication did not show significant predictive value. CONCLUSIONS: Sexual dysfunction is more prevalent in women with Parkinson's disease than in controls and is predicted by older age and severity of depressive symptoms. © 2016 International Parkinson and Movement Disorder Society.

Diagnostic performance of [18F] FDG PET-CT compared to bone scintigraphy for the detection of bone metastases in lung cancer patients.

BACKGROUND: Accurate staging of lung cancer is essential for effective patient management and selection of appropriate therapeutic strategy. The aim of this paper was to compare the value of bone scintigraphy and FDG PET-CT for detecting bone metastases in lung cancer patients and the impact of these modalities in disease staging. METHODS: One hundred sixty-four lung cancer patients who had undergone both FDG PET-CT and bone scintigraphy within 14 days were included into this study. The analysis of FDG PET-CT and bone scintigraphy was carried out patient- and lesion-based. RESULTS: One hundred twenty-one patients were negative and 43 patients positive for bone metastases. FDG PET-CT found bone metastases in 42/43 patients and bone scintigraphy in 38/43 patients. Sensitivity, specificity and accuracy of FDG PET-CT and bone scintigraphy for detecting bone metastases were 97.7%, 100% and 99.4%, and 87.8%, 97.5% and 94.2%, respectively. FDG PET-CT identified 430 bone metastases and bone scintigraphy 246 bone metastases. Skull was the only region where bone scintigraphy identified more lesions than FDG PET-CT. Based on both scintigraphic modalities disagreement concerning disease stage was found in 3 patients. CONCLUSION: FDG PET-CT yielded a higher sensitivity, specificity and accuracy than bone scintigraphy for identifying bone metastases in lung cancer patients. FDG PET-CT thus can be recommended for initial staging of lung cancer patients without applying bone scintigraphy for the detection of bone metastases.

Expression of Tenascin C, EGFR, E-Cadherin, and TTF-1 in Medullary Thyroid Carcinoma and the Correlation with RET Mutation Status.

Tenascin C expression correlates with tumor grade and indicates worse prognosis in several tumors. Epidermal growth factor receptor (EGFR) plays an important role in driving proliferation in many tumors. Loss of E-cadherin function is associated with tumor invasion and metastasis. Thyroid transcription factor-1 (TTF-1) is involved in rearranged during transfection (RET) transcription in Hirschsprung's disease. Tenascin C, EGFR, E-cadherin, TTF-1-expression, and their correlations with RET mutation status were investigated in 30 patients with medullary thyroid carcinoma (MTC) (n = 26) or C-cell hyperplasia (n = 4). Tenascin C was found in all, EGFR in 4/26, E-cadherin in 23/26, and TTF-1 in 25/26 MTC. Tenascin C correlated significantly with tumor proliferation (overall, r = 0.61, p < 0.005; RET-mutated, r = 0.81, p < 0.01). E-cadherin showed weak correlation, whereas EGFR and TTF-1 showed no significant correlation with tumor proliferation. EGFR, E-cadherin, and TTF-1 showed weak correlation with proliferation of RET-mutated tumors. Correlation between TTF-1 and tenascin C, E-cadherin, and EGFR was r = -0.10, 0.37, and 0.21, respectively. In conclusion, MTC express tenascin C, E-cadherin, and TTF-1. Tenascin C correlates significantly with tumor proliferation, especially in RET-mutated tumors. EGFR is low, and tumors expressing EGFR do not exhibit higher proliferation. TTF-1 does not correlate with RET mutation status and has a weak correlation with tenascin C, E-cadherin, and EGFR expression.

Perioperative Drainage of Cerebrospinal Fluid for Endovascular Aortic Surgery.

INTRODUCTION: Spinal cord ischemia (SCI) is a feared complication following thoracic endovascular aortic aneurysm repair (TEVAR). European Society for Vascular Surgery guidelines suggest lumbar drainage of cerebrospinal fluid (CSF) in high-risk patients. The institutional protocol proposes as indications for CSF drainage: coverage of Adamkiewicz artery origin (T9-T12), aortic length of coverage >15 cm, compromise of collateral arteries (left subclavian or internal iliac occlusion) and symptomatic SCI. The aim of this study is to demonstrate CSF drainage efficacy and safety in the prevention or treatment of TEVAR-related SCI. METHODS: Patients submitted to TEVAR with perioperative CSF drainage between May 2015 and April 2017 at our hospital were prospectively included. The primary outcome consisted of prevention or regression of neurological symptoms (efficacy). Other complications were recorded as secondary outcomes (safety). RESULTS: Nine patients, aged between 63 and 75 years, were included. Eight surgeries were elective and one was emergent. Eight lumbar catheters were placed before surgery and one in the postoperative period due to SCI symptomatology that reverted after CSF drainage. Of those placed preoperatively, 2 developed postoperative SCI symptoms that alleviated with increased drainage or haemoglobin optimization. All patients were submitted to general anaesthesia. The patient treated in the emergent setting progressed with multiorgan dysfunction and death 24 hours after surgery. There were no other complications. CONCLUSION: In this group of patients, CSF drainage was safe and effective in the prevention and treatment of TEVAR-related SCI.

Introdução: A isquemia medular (IM) é uma complicação temida após correção endovascular de aneurismas da aorta torácica (TEVAR). As guidelines da Sociedade Europeia de Cirurgia Vascular recomendam drenagem lombar (DL) de líquido cefalorraquidiano em doentes de alto risco. O protocolo institucional considera como indicações para DL: cobertura da origem da artéria de Adamkiewicz (T9-T12), cobertura aórtica >15 cm, comprometimento de colaterais (oclusão da artéria subclávia esquerda ou ilíaca interna) e IM sintomática. O objetivo do trabalho foi demonstrar a eficácia e segurança da DL na prevenção ou tratamento da IM após TEVAR. Métodos: Doentes submetidos a DL no perioperatório de TEVAR entre maio de 2015 e abril de 2017 no nosso hospital foram prospetivamente incluídos. Outcome primário: prevenção e/ou reversão de sintomas neurológicos (eficácia). Outcome secundário: complicações relacionadas com a técnica (segurança). Resultados: Incluíram-se 8 doentes com aneurismas tóraco-abdominais e 1 com disseção aórtica tipo B, com idade entre 63-75 anos. Oito cirurgias foram eletivas e uma urgente. O cateter foi colocado previamente à cirurgia em 8 casos e no pós-operatório em 1 caso por sintomatologia de IM que reverteu após a colocação. Dos colocados pré-operatoriamente, 2 tiveram sintomas de IM no pós-operatório, que aliviaram com aumento da drenagem e optimização da hemoglobina. A TEVAR urgente resultou na perfusão insuficiente de ramos viscerais com disfunção multiorgânica e morte 24h após a cirurgia. Não se registaram outras complicações. Conclusão: A colocação de DL revelou-se segura e eficaz na prevenção e tratamento de IM após TEVAR.

The value of (18)F-fluoride PET/CT in the assessment of screw loosening in patients after intervertebral fusion stabilization.

PURPOSE: We evaluated (18)F-fluoride PET/CT for the diagnosis of screw loosening after intervertebral fusion stabilization and compared the results with those from functional radiography. METHODS: A group of 59 patients with pain in the region of previous intervertebral fusion stabilization and suspicion of implant instability due to screw loosening were investigated with (18)F-fluoride PET/CT and functional radiography, 30.1 ± 3.4 and 29.3 ± 3.2 months, respectively, after surgery. The criterion for loosening was increased focal uptake surrounding the screw entry point and shaft. SUVmax and SUVmean were measured in a region of interest (ROI) drawn around each screw (334 screws analysed). The final diagnosis was established by surgical exploration in 27 patients and clinical follow-up after intervertebral fusion stabilization in 32 patients. RESULTS: Of the 59 patients, 20 were proven positive for implant failure due to screw loosening and 39 were confirmed negative. The sensitivity, specificity and accuracy of (18)F-fluoride PET/CT were 75%, 97.4% and 89.8% in the patient-based analysis, and 45.6%, 100% and 80% in the screw-based analysis, respectively. The positive and negative predictive values were 93.8% and 100 % in the patient-based analysis, and 88.4 and 76% in the screw-based analysis, respectively. CT signs in PET/CT allowed screw breakage to be detected in three patients. SUVmax, SUVmean and SUVmax/SUVmean ratios in screw ROIs and respective values in reference regions were all found to be significantly different between screws positive for loosening (58 screws) and screws negative for loosening (276 screws). The ratio between SUVmax in screw ROIs and the values in reference regions was the most significant parameter for distinguishing screws positive and screws negative for loosening. CONCLUSION: (18)F-Fluoride PET/CT imaging is useful for the diagnosis of screw loosening in patients with persistent symptoms after intervertebral fusion stabilization.