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1.
J Vasc Interv Radiol ; 35(5): 751-758, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38342222

RESUMEN

PURPOSE: To assess the incidence of fever at diagnosis in children with leukemia and determine if fever at diagnosis is a predictor of bloodstream infection (BSI) or central venous access device (CVAD) removal for infection either within the first 30 days or between 30 and 90 days after CVAD insertion. MATERIALS AND METHODS: One hundred fifty-one patients with acute leukemia (July 1, 2018, to December 31, 2020) who underwent a CVAD insertion within 2 weeks of diagnosis were included. Patient data included demographic characteristics, fever at diagnosis, CVAD type, antibiotics before and/or on the day of CVAD insertion, BSI incidence, BSI rates per 1,000 catheter days, and need for catheter removal after CVAD insertion within 30 days and between 30 and 90 days. RESULTS: Patients with fever at diagnosis had a significantly higher incidence of BSI within the first 30 days after CVAD insertion (17/23) than that among patients without fever (6/23) (P = .046) at diagnosis. No statistically significant difference was observed in the incidence of BSI between 30 and 90 days after CVAD insertion between patients with fever (5/11) and those without fever at diagnosis (6/11) (P = .519). Fever at diagnosis was not a predictor of CVAD removal within 30 days (9 patients required CVAD removal; 7/9 had fever and 2/9 had no fever) (P = .181) or between 30 and 90 days (4 patients required CVAD removal; 1/4 had fever and 3/4 had no fever at diagnosis) (P = .343) after insertion. CONCLUSIONS: Fever at diagnosis in patients with leukemia is not a predictor of CVAD removal for infection.


Asunto(s)
Infecciones Relacionadas con Catéteres , Cateterismo Venoso Central , Catéteres Venosos Centrales , Remoción de Dispositivos , Fiebre , Humanos , Masculino , Femenino , Niño , Preescolar , Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/epidemiología , Incidencia , Factores de Tiempo , Fiebre/diagnóstico , Fiebre/etiología , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Estudios Retrospectivos , Factores de Riesgo , Adolescente , Catéteres Venosos Centrales/efectos adversos , Lactante , Medición de Riesgo , Leucemia/terapia , Leucemia/complicaciones , Resultado del Tratamiento , Factores de Edad , Valor Predictivo de las Pruebas , Bacteriemia/diagnóstico , Bacteriemia/epidemiología
2.
J Vasc Interv Radiol ; 34(12): 2110-2119.e1, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37652298

RESUMEN

PURPOSE: To assess the reported safety and effectiveness of sclerotherapy for the treatment of nonparasitic splenic cysts through a systematic review and meta-analysis. MATERIALS AND METHODS: A systematic search of PubMed MEDLINE, Embase, Web of Science, and the Cochrane Library through July 2023 was performed. Studies including at least 5 patients reporting percutaneous sclerotherapy of nonparasitic splenic cysts, initial and posttreatment cyst size, clinical symptoms as well as adverse events (AEs), and recurrence rates were included. A 0-8-point scale for case reports and case series was used to assess bias. Data were analyzed using random-effects meta-analysis. RESULTS: Twenty-three of 833 citations were selected for full-text assessment, and 7 studies were included for a total of 99 patients. The methodological quality of the studies included scored 3-7. Composite analysis demonstrated 38% (95% CI, 23%-55%) rate of recurrence after treatment with significant heterogeneity; however, when assessed for a cyst size of <8 cm, recurrence dropped to 7% (95% CI, 2%-20%). Residual symptoms after treatment completion were present in 17% (95% CI, 7%-33%). Intraprocedural and postprocedural AE rates were 6% (95% CI, 3%-13%) and 6% (95% CI, 3%-12%) respectively. CONCLUSIONS: Sclerotherapy of splenic cysts seemed to be safe, with a high rate of recurrence for cysts ≥8 cm.


Asunto(s)
Quistes , Enfermedades del Bazo , Humanos , Escleroterapia/efectos adversos , Quistes/diagnóstico por imagen , Quistes/terapia , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades del Bazo/terapia
3.
BMC Pediatr ; 23(1): 22, 2023 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-36639762

RESUMEN

BACKGROUND: Biliary atresia (BA) is one of the causes of conjugated hyperbilirubinemia in infants which if untreated leads to end-stage liver disease and death. Percutaneous Trans-hepatic Cholecysto-Cholangiography (PTCC) is a minimally invasive study which can be utilized in the diagnostic work-up of these patients. This study's purpose is to describe the experience with PTCC in neonates, the imaging findings encountered, and the abnormal patterns which warrant further investigation. METHODS: A 16-year single-center retrospective study of patients with persistent neonatal cholestasis (suspected BA) undergoing PTCC. Patient demographics, laboratory values, PTCC images, pathology and surgical reports were reviewed. RESULTS: 73 patients underwent PTCC (68% male, mean age 8.7 weeks, mean weight 4.0 Kg). The majority of studies were normal (55%). Abnormal patterns were identified in 33 cases, 79% were diagnosed with BA and 12% with Alagille syndrome. Non-opacification of the common hepatic duct with a narrowed common bile duct (42%) and isolated small gallbladder (38%) were the most common patterns in BA. CONCLUSION: PTCC is a minimally invasive study in the diagnostic work-up of infants presenting with conjugated hyperbilirubinemia (suspected BA). Further invasive investigations or surgery can be avoided when results are normal.


Asunto(s)
Atresia Biliar , Colestasis , Recién Nacido , Lactante , Humanos , Masculino , Femenino , Vesícula Biliar/diagnóstico por imagen , Diagnóstico Diferencial , Estudios Retrospectivos , Colangiografía/métodos , Colestasis/diagnóstico por imagen , Colestasis/etiología , Atresia Biliar/diagnóstico , Atresia Biliar/diagnóstico por imagen , Hiperbilirrubinemia/etiología
4.
Pediatr Radiol ; 53(5): 942-952, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36595081

RESUMEN

BACKGROUND: Knowledge of radiation quantities delivered in routine practice is an essential responsibility of a pediatric interventional radiology department. OBJECTIVE: To review radiation indices in frequently performed vascular and enterostomy access procedures at a quaternary pediatric hospital to formulate dosimetric reference levels and achievable levels. MATERIALS AND METHODS: A retrospective review of patient demographics, procedure information and quantitative dose metrics over a 2-year period was performed. Dosimetric details for common procedures (central line insertions, gastrostomy/gastrojejunostomy insertions and maintenance) were evaluated, correlated with demographic data and stratified across five weight groups (0-5 kg, 5-15 kg, 15-30 kg, 30-50 kg, 50-80 kg). Achievable (50th percentile) and reference (75th percentile) levels with confidence intervals were established for each procedure. RESULTS: Within the evaluation period, 3,165 studies satisfied the inclusion criteria. Five were classified as device insertions (peripherally inserted central catheter, n=1,145; port-a-catheter, n=321; central venous line, n=285; gastrostomy-tube [G-tube], n=262, and gastrojejunostomy-tube [GJ-tube], n=66), and two were classified as maintenance procedures (G-tube, n=358, and GJ-tube, n=728, checks, exchanges and reinsertions). Representative reference and achievable levels were calculated for each procedure category and weight group. CONCLUSION: This work highlights the creation of local reference and achievable levels for common pediatric interventional procedures. These data establish a dosimetric reference to understand the quantity of radiation routinely applied, allowing for improved relative radiation risk assessment and enriched communication to interventionalists, health care providers, parents and patients.


Asunto(s)
Cateterismo Venoso Central , Enterostomía , Niño , Humanos , Radiología Intervencionista , Radiografía Intervencional/métodos , Gastrostomía , Estudios Retrospectivos , Dosis de Radiación
5.
Pediatr Radiol ; 53(11): 2245-2252, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37568041

RESUMEN

BACKGROUND: Due to the rarity of pediatric diseases, collaborative research is the key to maximizing the impact of research studies. A research needs assessment survey was created to support initiatives to foster pediatric interventional radiology research. OBJECTIVE: To assess the status of pediatric interventional radiology research, identify perceived barriers, obtain community input on areas of research/education/support, and create metrics for evaluating changes/responses to programmatic initiatives. MATERIALS AND METHODS: A survey link was sent to approximately 275 members of the Society for Pediatric Interventional Radiology (SPIR) between May and October 2020. Data was collected using a web-based interface. Data collected included practice setting, clinical role, research experience, research barriers, and suggestions for future initiatives. RESULTS: Fifty-nine surveys were analyzed with a staff physician survey response rate of 28% (56/198). A wide range of practice sizes from 15 countries were represented. Respondents were predominantly staff physicians (95%; 56/59) with an average of 11 years (range: 1-25 years) of clinical experience working at academic or freestanding children's hospitals. A total of 100% (59/59) had research experience, and 70% (41/58) had published research with a mean of 30 peer-reviewed publications (range: 1-200). For job security, 56% (33/59) of respondents were expected or required to publish, but only 19% (11/58) had research support staff, and 42% (25/59) had protected research time, but of those, 36% (9/25) got the time "sometimes or never." Lack of support staff, established collaborative processes, and education were identified as top barriers to performing research. CONCLUSIONS: The needs assessment survey demonstrated active research output despite several identified barriers. There is a widespread interest within the pediatric interventional radiology community for collaborative research.

6.
Mol Phylogenet Evol ; 173: 107509, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35589052

RESUMEN

Bald uakaris, genus Cacajao, are Amazonian primates currently classified as one species and four subspecies based on the patterns of pelage coloration. In this study, we test if their current taxonomy is represented by the phylogenetic relationship of the main lineages retrieved from molecular data. We included, for the first time, all bald uakari taxa in a mitochondrial (cytochrome b) and genome-wide (ddRAD) phylogenetic analyses. We also examined the pattern of pelage colouration in specimens from zoological collections. Having determined the number of lineages using Maximum Likelihood and the species tree using coalescent analyses, we test their divergence time using a Bayesian approach. While the cytochrome b analysis only recovered two clades, the ddRAD analysis supported the reciprocal monophyly of five lineages of bald uakaris, with all clades including only individuals with distinct and exclusive diagnostic phenotypic characters. We found that species diversification in Cacajao occurred during the last 300 Kya and may have been influenced by the formation of rivers and flooded forests in western Amazonia. We propose that the four bald uakari subspecies currently recognised can be upgraded to species level and we describe the white uakaris from the basin of the Rio Tarauacá as a new species.


Asunto(s)
Pitheciidae , Animales , Teorema de Bayes , Citocromos b/genética , ADN Mitocondrial/genética , Genoma , Filogenia
7.
Chemistry ; 28(61): e202203093, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36253142

RESUMEN

Invited for the cover of this issue is the group of Tito Trindade and colleagues at the University of Aveiro. The image depicts dendritic magneto-plasmonic substrates for surface-enhanced Raman scattering (SERS) detection. Read the full text of the article at 10.1002/chem.202202382.


Asunto(s)
Nanoestructuras , Espectrometría Raman , Espectrometría Raman/métodos , Nanoestructuras/química
8.
Chemistry ; 28(61): e202202382, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36083195

RESUMEN

Chemical analyses in the field using surface-enhanced Raman scattering (SERS) protocols are expected to be part of several analytical procedures applied to water quality monitoring. To date, these endeavors have been supported by developments in SERS substrate nanofabrication, instrumentation portability, and the internet of things. Here, we report distinct chemical strategies for preparing magneto-plasmonic (Fe3 O4 : Au) colloids, which are relevant in the context of trace-level detection of water contaminants due to their inherent multifunctionality. The main objective of this research is to investigate the role of poly(amidoamine) dendrimers (PAMAMs) in the preparation of SERS substrates integrating both functionalities into single nanostructures. Three chemical routes were investigated to design magneto-plasmonic nanostructures that translate into different ways for assessing SERS detection by using distinct interfaces. Hence, a series of magneto-plasmonic colloids have been characterized and then assessed for their SERS activity by using a model pesticide (thiram) dissolved in aqueous samples.


Asunto(s)
Nanopartículas del Metal , Nanoestructuras , Espectrometría Raman/métodos , Oro/química , Nanopartículas del Metal/química , Nanoestructuras/química , Tiram/análisis
9.
BMC Ophthalmol ; 22(1): 296, 2022 Jul 07.
Artículo en Inglés | MEDLINE | ID: mdl-35799154

RESUMEN

BACKGROUND: Firework-related ocular injuries (FWROI) are a major cause of preventable visual impairment. This study aimed to analyze the occurrence and outcome of FWROI in Switzerland. METHODS: This retrospective multicenter study included patients with FWROI from seven centers in Switzerland from January 2009 to August 2020. Demographic information, type of injuries, medical and surgical treatments, the best corrected visual acuity (BCVA) at baseline and end of follow-up, occurrence and type of secondary complications, and duration of hospitalization were analyzed. RESULTS: A total of 105 patients (119 eyes) with a mean age of 27.1 ± 15.9 years were included in the study (71.4% male patients; 29.5% underage). Most injuries occurred around New Year's Eve (32.4%) and the Swiss national holiday on 1 August (60.9%). The most common anterior segment findings were conjunctival or corneal foreign bodies (58%), whereas Berlin's edema was the most common posterior segment finding (11.4%). Globe ruptures were found in four patients. The mean BCVA in all patients at first presentation was 0.4 ± 0.8 logMAR and improved to 0.3 ± 0.8 logMAR at last follow-up. A primary surgical intervention was performed in 48 eyes (40.3%). Hospitalization directly after the trauma was necessary for 18 patients for a mean of 5.8 ± 4.1 days, and a total of 4.9 ± 7.6 follow-up visits were needed. CONCLUSION: This study provides the first data on FWROI in Switzerland, which are helpful for further preventive and educational programs and comparisons with other countries.


Asunto(s)
Traumatismos por Explosión , Cuerpos Extraños en el Ojo , Adolescente , Adulto , Traumatismos por Explosión/epidemiología , Traumatismos por Explosión/cirugía , Niño , Femenino , Humanos , Masculino , Estudios Retrospectivos , Suiza/epidemiología , Agudeza Visual , Adulto Joven
10.
Pediatr Radiol ; 52(2): 249-261, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34984511

RESUMEN

Vascular anomalies are classified as vascular tumors or vascular malformations according to their cellular features and biological behavior. Detailed history and clinical assessment allow for the proper clinical diagnosis of most vascular anomalies and guide the choice of imaging to evaluate them. This article discusses the general information needed from a clinical history and physical exam to formulate a diagnosis of vascular anomaly. Then, the authors review the clinical findings from the most common vascular tumors and vascular malformations.


Asunto(s)
Malformaciones Vasculares , Humanos , Malformaciones Vasculares/diagnóstico por imagen
11.
Phys Chem Chem Phys ; 23(30): 16053-16059, 2021 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-34287451

RESUMEN

The search for magnetoelectric materials typically revolves around the struggle to make magnetic and ferroelectric orders simultaneously coexist in the same material, using either an intrinsic or an extrinsic/composite approach. Via ab initio calculations of a prototypical Fe/BaTiO3 interface, we predict that it is possible to tune the magnitude of the individual magnetic moments even for non-polar BaTiO3. By comparing polar and non-polar Fe/BaTiO3 heterostructures, we show that the Fe, Ti and equatorial O atomic magnetic moments are induced and enhanced as a result of their local crystal field. The crystal field may be controlled solely by manipulation of the inter-atomic distances of their neighbouring atoms (which will affect their electrostatic fields and orbital hybridizations), or by the BaTiO3 electric dipole moments, working as a local polarization. When this polarization is present, it dominates the crystal field contributions, thus constraining the effects of other perturbations such as strain. We also find that, contrary to conventional expectations, the non-polar heterostructure shows higher strain induced magnetization sensitivity than its polar counterpart.

12.
Graefes Arch Clin Exp Ophthalmol ; 259(6): 1435-1441, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33074373

RESUMEN

PURPOSE: To investigate the dependence of the ciliary body length (CBL) on the axial length (AL) and to draw conclusions on implications regarding safe pars plana access for intravitreal injections and vitreoretinal surgery. METHODS: A total of 200 individuals (mean age 42 years, SD ± 15.4) were enrolled in the study. Objective refraction and AL were obtained. Spherical equivalent (SE) was calculated. Anterior segment optical coherence tomography (ASOCT) was used to image and measure the CBL. RESULTS: The mean SE was - 1.64 diopters (SD ± 3.15, range - 14.5 to + 9 diopters) and the mean AL was 24.19 mm (SD ± 1.65, range 19.8-32.2 mm). There was a significant correlation between SE and AL (r2 = 0.62, p < 0.0001). Mean CBL correlated significantly with age (r2 = 0.11, p < 0.0001), AL (r2 = 0.23, p < 0.0001) and SE (r2 = 0.25, p < 0.0001). The mean CBL was 3351 µm (SD ± 459, range 2184-4451 µm). Three separate groups were defined by their AL with a normal AL group (AL 22.5 to 25 mm), a short AL group (AL < 22.5 mm) and a long AL group (AL > 25 mm). The mean CBL in the normal AL group was 3311 µm (SD ± 427), in the short AL group 2936 µm (SD ± 335) and in the long AL group 3715 µm (SD ± 365), and differed significantly (p < 0.0001) when compared. CONCLUSION: For interventions requiring pars plana access (as an intravitreal injection or vitreoretinal surgery), an incision distance of 3.5-4.0 mm posterior to the limbus is recommended. In our research, however, a difference of 0.77 mm in mean CBL between the group with short AL and the group with long AL is demonstrated, implying that the mean CBL in very short and very long eyes differs significantly. These findings suggest that the AL should be taken into account for pars plana access and that it would be advisable to prefer the shorter or longer recommended distance (3.5 and 4.0 mm, respectively) from the limbus, which correlates with the AL. If AL is > 25 mm, a distance of 4.0 mm from the limbus should be chosen; and if AL is < 22.5 mm, a distance of 3.5 mm seems adequate. TRIAL REGISTRATION NUMBER AND DATE: NCT00564291, 27 Nov 2007.


Asunto(s)
Cuerpo Ciliar , Tomografía de Coherencia Óptica , Adulto , Cuerpo Ciliar/diagnóstico por imagen , Cuerpo Ciliar/cirugía , Femenino , Humanos , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad
13.
Pediatr Radiol ; 51(5): 822-830, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33515053

RESUMEN

BACKGROUND: In children, chylothorax post cardiac surgery can be difficult to treat, may run a protracted course, and remains a source of morbidity and mortality. OBJECTIVE: To analyze the experience with percutaneous image-guided chest-tube drainage in the management of post-cardiac-surgery chylothoraces in children. MATERIALS AND METHODS: We conducted a single-center retrospective case series of 37 post-cardiac-surgery chylothoraces in 34 children (20 boys; 59%), requiring 48 drainage procedures with placement of 53 image-guided chest tubes over the time period 2004 to 2015. We analyzed clinical and procedural details, adverse events and outcomes. Median age was 0.6 years, median weight 7.2 kg. RESULTS: Attempted treatments of chylothoraces prior to image-guided chest tubes included dietary restrictions (32/37, 86%), octreotide (12/37, 32%), steroids (7/37, 19%) and thoracic duct ligation (5/37, 14%). Image-guided chest tubes (n=43/53, 81%) were single unilateral in 29 children, bilateral in 4 (n=8/53, 15%), and there were two ipsilateral tubes in one (2/53, 4%). Effusions were isolated, walled-off, in 33/53 (62%). In 20/48 procedures (42%) effusions were septated/complex. The mean drainage through image-guided chest tubes was 17.3 mL/kg in the first 24 h, and 13.4 mL/kg/day from diagnosis to chest tube removal; total mean drainage from all chest tubes was 19.6 mL/kg/day. Nine major and 27 minor maintenance procedures were required during 1,207 tube-days (rate: 30 maintenance/1,000 tube-days). Median tube dwell time was 21 days (range 4-57 days). There were eight mild adverse events, three moderate adverse events and no severe adverse events related to image-guided chest tubes. Radiologic resolution was achieved in 26/37 (70%). Twenty-three children (68%) survived to discharge; 11 children (32%) died from underlying cardiac disease. CONCLUSION: Management of chylothorax post-cardiac-surgery in children is multidisciplinary, requiring concomitant multipronged approaches, often through a protracted course. Multiple image-guided chest tube drainages can help achieve resolution with few complications. Interventional radiology involvement in tube care and maintenance is required. Overall, mortality remains high.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Quilotórax , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Tubos Torácicos , Niño , Quilotórax/diagnóstico por imagen , Quilotórax/cirugía , Drenaje , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
14.
Can Assoc Radiol J ; 72(3): 577-584, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32281404

RESUMEN

PURPOSE: To establish the efficacy of once-per-day intracavitary tissue plasminogen activator (tPA) in the treatment of pediatric intra-abdominal abscesses. METHODS: A single-center prospective, double-blinded, randomized controlled trial of the use of intracavitary tPA in abdominal abscesses in children. Patients were randomized to either tPA-treatment or saline-treatment groups. Primary outcome was drainage catheter dwell (hours). Secondary outcomes were length of hospital stay, times to discharge, clinical and sonographic resolution, and adverse events (AEs). RESULTS: Twenty-eight children were randomized to either group (n = 14 each). Demographics between groups were not significantly different (age P = .28; weight P = .40; gender P = .44). There were significantly more abscesses in the tPA-treated group (P = .03). Abscesses were secondary to perforated appendicitis (n = 25) or postappendectomy (n = 3). Thirty-four abscesses were drained, 4 aspirated, 3 neither drained/aspirated. There was no significant difference in number of drains (P = .14), drain size (P = .19), primary outcome (P = .077), or secondary outcomes found. No procedural or intervention drug-related AEs occurred. No patient in the saline-treated group required to be switched/treated with tPA. CONCLUSION: No significant difference in the length of catheter dwell time, procedure time to discharge, or time to resolution was found. Intracavitary tPA was not associated with morbidity or mortality. The results neither support nor negate routine use of tPA in the drainage of intra-abdominal abscess in children. It is possible that a multicentre study with a larger number of patients may answer this question more definitively.


Asunto(s)
Absceso Abdominal/terapia , Fibrinolíticos/uso terapéutico , Activador de Tejido Plasminógeno/uso terapéutico , Absceso Abdominal/diagnóstico por imagen , Adolescente , Niño , Preescolar , Método Doble Ciego , Drenaje , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Tiempo de Internación , Masculino , Estudios Prospectivos , Factores de Tiempo , Activador de Tejido Plasminógeno/administración & dosificación , Resultado del Tratamiento
15.
Paediatr Child Health ; 26(1): e25-e32, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34434292

RESUMEN

OBJECTIVES: To assess the safety and efficacy of rapamycin in treating children with vascular tumours and malformations. STUDY DESIGN: We performed a retrospective review at a large tertiary care paediatric centre to assess the efficacy and safety of using rapamycin to treat vascular tumours and malformations. Response to therapy was defined by patient-reported symptom improvement, radiological reduction in size of lesions, and/or improvement of laboratory parameters. RESULTS: Forty-two patients (7 with vascular tumours and 35 with vascular malformations) have been treated with rapamycin. Despite 33 of 42 patients being diagnosed in the first year of life, the median age of initiating rapamycin was 11 years. Of the 38 children treated for a minimum of 4 months, 29 (76%) exhibited a clinical response. Twenty-one patients had follow-up imaging studies and of these, 16 (76%) had radiographic decrease in lesion size. Median time to demonstration of response was 49 days. All five children with vascular tumours and all three children with vascular malformations under the age of 4 years showed a clinical response. Response rate was lower for children ≥ 4 years of age (0/2, 0% for vascular tumours; 21/28, 75% for vascular malformations). No patient experienced an infection directly related to rapamycin or discontinued rapamycin due to toxicity. CONCLUSIONS: Rapamycin is safe and efficacious in most children with select vascular tumours and malformations. Young children appear to respond better, suggesting that early initiation of rapamycin should be considered.

16.
J Vasc Interv Radiol ; 31(2): 276-281.e1, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31883934

RESUMEN

PURPOSE: To assess the utility of routine preprocedural bloodwork during elective removal of central venous access devices (CVADs) with respect to bleeding complications. MATERIALS AND METHODS: Patients who underwent removal of a CVAD (tunneled central venous catheter [CVC] or port) by the interventional radiology service between January 2009 and December 2013 were retrospectively reviewed. Removals for infection or malfunction, without preprocedural bloodwork, with another concurrent procedure at the time of CVAD removal, or in patients with a bleeding dyscrasia were excluded. Peripherally inserted central catheter removals and temporary CVAD removals were also excluded. Routine preprocedural bloodwork included hemoglobin, platelet count, partial thromboplastin time, and International Normalized Ratio. Postprocedural complications were classified according to the Society of Interventional Radiology clinical practice guidelines. RESULTS: There were 802 CVAD removals in 777 patients (351 female, 426 male). Average patient age was 8.6 years (range, 5 wk to 19 y). In total, 246 permanent CVCs and 556 ports were removed. A total of 802 cases had preprocedural bloodwork. Of the 49 patients who had a bleeding complication after the procedure (6.1%; 49 of 802), 44 had normal findings on preprocedural bloodwork and 5 had abnormal findings. There was no statistically significant difference in bleeding complications between those with normal and abnormal bloodwork results (P = .7740). CONCLUSIONS: Routine bloodwork is not necessary before elective CVAD removal in children without a bleeding dyscrasia. Most children have normal findings on preprocedural bloodwork, and the incidence of postprocedural bleeding is low and not determined by bloodwork results.


Asunto(s)
Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia , Catéteres Venosos Centrales , Remoción de Dispositivos , Enfermedades Hematológicas/diagnóstico , Pruebas Hematológicas , Hemorragia Posoperatoria/etiología , Adolescente , Factores de Edad , Niño , Preescolar , Remoción de Dispositivos/efectos adversos , Femenino , Enfermedades Hematológicas/sangre , Enfermedades Hematológicas/complicaciones , Humanos , Lactante , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Procedimientos Innecesarios , Adulto Joven
17.
J Vasc Interv Radiol ; 31(5): 778-786, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32305244

RESUMEN

PURPOSE: Evaluate technical aspects and outcomes of insertion/maintenance of hemodialysis (HD) central venous catheter (CVC) during infancy. MATERIALS AND METHODS: Single-center retrospective study of 29 infants who underwent 49 HD-CVC insertions between 2002 and 2016. Demographics, procedural, and post-procedural details, interventional radiology (IR) maintenance procedures, technical modifications, complications, and outcomes were evaluated. Technical adjustments during HD-CVC placement to adapt catheter length to patient size were labeled "modifications." CVCs requiring return visit to IR were called IR-maintenance procedures. Mean age and weight at HD-CVC insertion were 117 days and 4.9 kg. RESULTS: Of the 29 patients, 13 (45%) required renal-replacement-therapy (RRT) as neonates, 10 (34%) commenced RRT with peritoneal dialysis (PD), and 19 (66%) with HD. Fifteen nontunneled and 34 tunneled HD-CVCs were inserted while patients were ≤1 year. Technical modifications were required placing 25/49 (51%) HD-CVCs: 5/15 (33%) nontunneled and 20/34 (59%) tunneled catheters (P = .08). Patients underwent ≤6 dialysis-cycles/patient during infancy (mean 2.3), and a mean of 4.1 and 49 HD-sessions/catheter for nontunneled and tunneled HD-CVCs, respectively. Mean primary and secondary device service, and total access site intervals for tunneled HD-CVCs were 75, 115, and 201 days, respectively. A total of 26 of 49 (53%) patients required IR-maintenance procedures. Nontunneled lines had greater catheter-related bloodstream infections per 1,000 catheter-days than tunneled HD-CVCs (9.25 vs. 0.85/1,000 catheter days; P = .02). Nineteen patients (65%) survived over 1 year. At final evaluation (December 2017): 8/19 survived transplantation, 5/19 remained on RRT, 2/19 completely recovered, 1/19 lost to follow-up, and 3 died at 1.3, 2, and 10 years. CONCLUSIONS: Placement/maintenance of HD-CVCs in infants pose specific challenges, requiring insertion modifications, and IR-maintenance procedures to maintain function.


Asunto(s)
Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia , Catéteres Venosos Centrales , Fallo Renal Crónico/terapia , Diálisis Renal/instrumentación , Factores de Edad , Peso Corporal , Obstrucción del Catéter/etiología , Infecciones Relacionadas con Catéteres/etiología , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/mortalidad , Diseño de Equipo , Humanos , Lactante , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/mortalidad , Trasplante de Riñón , Recuperación de la Función , Diálisis Renal/efectos adversos , Diálisis Renal/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
18.
Pediatr Transplant ; 24(5): e13713, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32406984

RESUMEN

This case report describes a 13-year 10-month-old girl who underwent a deceased-donor split LT for primary diagnosis of biliary atresia at the age of 12 months, who presented with a lower GI bleed. Ultrasound and CT revealed a venous vascular anomaly involving the cecum and ascending colon, with communication of the SMV and pelvic veins consistent with a CEPS. Associated varices were noted in the pelvis along the uterus and urinary bladder. These findings were confirmed by trans-hepatic porto-venography, which was diagnostic and therapeutic as a successful embolization of the CEPS was performed using micro-coils. There were no complications following the procedure and no further GI bleeding occurred, illustrating the efficacy of this treatment option for CEPS. We discuss the literature regarding the presenting complaint of GI bleeding post-LT, CEPS as a rare cause of GI bleeding and its association with PV, and the classification and treatment of CEPS.


Asunto(s)
Anomalías Múltiples/terapia , Atresia Biliar/cirugía , Embolización Terapéutica/métodos , Hemorragia Gastrointestinal/terapia , Trasplante de Hígado , Hemorragia Posoperatoria/terapia , Malformaciones Vasculares/terapia , Anomalías Múltiples/inducido químicamente , Anomalías Múltiples/diagnóstico por imagen , Adolescente , Embolización Terapéutica/instrumentación , Femenino , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Humanos , Venas Mesentéricas/anomalías , Hemorragia Posoperatoria/diagnóstico por imagen , Hemorragia Posoperatoria/etiología , Tomografía Computarizada por Rayos X , Ultrasonografía , Malformaciones Vasculares/complicaciones , Malformaciones Vasculares/diagnóstico por imagen
19.
Phys Chem Chem Phys ; 22(32): 18050-18059, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32760930

RESUMEN

The search for better and inexpensive magnetoelectric materials is now commonplace in solid state physics. Intense coupling between technologically viable electric and magnetic properties, embedded in a single material, is still an attribute greatly pursued by the scientific community. Following this line of thought, using DFT, the study of a specific interface between the TiO2 layer of BaTiO3 and a monolayer of Fe atoms is presented, probing different uni-axial strain effects of the considered supercell. Depending on the strain, several different metastable magnetic states are predicted: a perfectly balanced antiferromagnetic state, an unbalanced ferrimagnetic state, a ferromagnetic state, and a non-magnetic state where each atom has its total magnetic moment quenched. Since these multiple magnetic states can be reversibly controlled by strain, under optimized conditions, this interface can switch from the ferromagnetic state (µ≈ 2.2 µB per Featom) to the non-magnetic state (µ = 0 µB per Featom), enabling enticing prospects for technological applications.

20.
Appl Opt ; 59(6): 1553-1557, 2020 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-32225655

RESUMEN

Determination of orbital angular momentum of optical vortex beams has attracted the attention of many researchers over the last few years. For some applications, it is convenient to use a partially coherent vortex beam because of its robustness. In this work, we developed a method to measure the topological charge of a partially coherent vortex beam. Our method relies simply in the measurement of the minimum radius of a zero contour of the modulus of the cross-correlation function and in the measurement of the full width at half maximum of its central spot.

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