ABSTRACT
OBJECTIVES: to evaluate the performance of magnetic resonance elastography (MRE) to stage liver fibrosis in patients with histologically confirmed nonalcoholic fatty liver disease (NAFLD) and to assess the impact of potential confounding factors in MRE diagnostic accuracy. The secondary objective was to compare MRE with other non-invasive methods for staging fibrosis such as transient elastography (TE) and non-invasive scores (APRI and FIB-4). METHODS: sixty-five histologically confirmed NAFLD patients were prospectively enrolled at the Hospital Universitario Virgen del Rocío (Seville, Spain). Liver stiffness was measured by MRE, TE and non-invasive scores (APRI and FIB-4). Fibrosis was assessed by liver biopsy using the steatosis, activity and fibrosis (SAF) score. Patients were classified into three groups according to the consistency between MRE and histopathological findings: underestimation, concordance and overestimation groups. Areas under the ROC curve (AUROC) and diagnostic performance were evaluated. RESULTS: the area under the ROC curve (AUROC) of MRE in advanced fibrosis (≥ F3) was 0.90 (0.82-0.97), while TE AUROC was 0.82 (0.72-0.93) (p = 0.22) and lower for the non-invasive test (FIB-4 0.67 and APRI 0.62). Inflammatory activity, steatosis grade and higher levels of liver biochemistry appeared to overestimate MRE results in the univariate analysis, but only gamma-glutamyl transferase (GGT) was statistically significant in the multivariate analysis (p < 0.01). Age, sex, body mass index (BMI), weight, diabetes mellitus (DM), high blood pressure (HBP), platelets or lipidic profile did not affect MRE accuracy. CONCLUSIONS: MRE is an effective and non-invasive method for detecting and staging liver fibrosis in NAFLD patients. MRE is more accurate than TE and allows the study of liver anatomy. Histological inflammation and surrogate biomarkers of inflammation can overestimate liver stiffness, but only GGT was statistically significant in the multivariate analysis. Important features of NAFLD patients such as obesity, DM, or lipidic profile did not affect MRE accuracy.
Subject(s)
Elasticity Imaging Techniques , Non-alcoholic Fatty Liver Disease , Humans , Non-alcoholic Fatty Liver Disease/complications , Elasticity Imaging Techniques/methods , Magnetic Resonance Imaging/methods , Liver/diagnostic imaging , Liver/pathology , Liver Cirrhosis/complications , Fibrosis , Inflammation , ROC Curve , BiopsyABSTRACT
Objectives: to evaluate the performance of magnetic resonance elastography (MRE) to stage liver fibrosis in patients with histologically confirmed nonalcoholic fatty liver disease (NAFLD) and to assess the impact of potential confounding factors in MRE diagnostic accuracy. The secondary objective was to compare MRE with other non-invasive methods for staging fibrosis such as transient elastography (TE) and non-invasive scores (APRI and FIB-4). Methods: sixty-five histologically confirmed NAFLD patients were prospectively enrolled at the Hospital Universitario Virgen del Rocío (Seville, Spain). Liver stiffness was measured by MRE, TE and non-invasive scores (APRI and FIB-4). Fibrosis was assessed by liver biopsy using the steatosis, activity and fibrosis (SAF) score. Patients were classified into three groups according to the consistency between MRE and histopathological findings: underestimation, concordance and overestimation groups. Areas under the ROC curve (AUROC) and diagnostic performance were evaluated. Results: the area under the ROC curve (AUROC) of MRE in advanced fibrosis (≥ F3) was 0.90 (0.82-0.97), while TE AUROC was 0.82 (0.72-0.93) (p = 0.22) and lower for the non-invasive test (FIB-4 0.67 and APRI 0.62). Inflammatory activity, steatosis grade and higher levels of liver biochemistry appeared to overestimate MRE results in the univariate analysis, but only gamma-glutamyl transferase (GGT) was statistically significant in the multivariate analysis (p < 0.01). Age, sex, body mass index (BMI), weight, diabetes mellitus (DM), high blood pressure (HBP), platelets or lipidic profile did not affect MRE accuracy. Conclusions: MRE is an effective and non-invasive method for detecting and staging liver fibrosis in NAFLD patients. MRE is more accurate than TE and allows the study of liver anatomy (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Magnetic Resonance Imaging/methods , Liver/diagnostic imaging , Liver Cirrhosis/diagnostic imaging , Non-alcoholic Fatty Liver Disease/diagnostic imaging , Prospective StudiesABSTRACT
Gastric cancer (GC) is one of the leading causes of cancer-related death. The combination of new molecular classifications with clinicopathological data could contribute to the individualization of patients and to the development of new therapeutic strategies. We examined the various associations in two molecular types of GC: HER2-positive (human epidermal growth factor receptor 2) and microsatellite instability (MSI), assessing their influence on treatment and prognosis. A retrospective study of 142 GC patients was performed with molecular characterization through HER2 overexpression and DNA repair protein expression for MSI. The percentage of HER2-positive tumors was 13.4%, predominantly in men. Correlations were found with intestinal type, metastases, advanced stages and chemotherapy. Almost 75% of HER2-positive patients died. MSI occurred in 16.2%, associated with advanced age, female sex, distal location and intestinal type. These patients had few metastases and low stages. The percentage of deaths was higher among MSI patients who received perioperative chemotherapy. The determination of HER2 and MSI status in GC is important for their association with specific clinicopathological features and for their prognostic and predictive value.
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PURPOSE: To develop an objective intraocular inflammation composite score. METHODS: Cross-sectional study. Non-invasive image acquisition and processing were conducted from April 2017 to April 2019. Inflammation-grade stratified eyes from patients with active, inactive uveitis and healthy controls were recruited. After clinical assessment, four anterior and posterior segment image acquisition protocols per eye, using swept-source optical coherence tomography (SS-OCT), were performed at inclusion. Eight imaging biomarkers in three domains: anterior, intermediate and posterior were studied. They were ranked and selected by discriminatory power and correlation with clinical scores. A final SS-OCT-derived composite uveitis activity score (SS-UAS) was developed through multiple linear regression. RESULTS: We studied 224 eyes with uveitis (165 active and 59 inactive) from 165 patients (mean age 46.6 SD 15.5 years; 55.3% women) and 38 eyes from 19 healthy controls (mean age 43.6 SD 17.1; 47% women). The selected SS-OCT-derived biomarkers to build the final score were anterior chamber hyper-reflective dots (anterior), high-definition relative vitreous intensity (intermediate) and the averaged thickened retinal index (posterior). Swept-source (SS)-UAS was highly discriminant between active and inactive, and between active and healthy eyes (means 2.06 SD 1.86, 0.93 SD 0.44, and 0.96 SD 0.38, respectively, both p -, Mann-Whitney U). Construct validity (Cronbach's alpha = 0.7), internal consistency, criterion validity and reliability (concordance correlation coefficient intra-rater = 0.99, 95% CI: 0.98-0.99; inter-rater = 0.98, 95% CI: 0.96-0.99) were favourable. CONCLUSIONS: Global intraocular inflammation can potentially be staged and scored objectively, continuously, consistently and in a valid manner through the combined processing of SS-OCT scans.
Subject(s)
Anterior Chamber/diagnostic imaging , Tomography, Optical Coherence/methods , Uveitis/diagnosis , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Purpose: To study the risk factors for visual loss in presumed tuberculosis-related uveitis (TRU).Methods: Retrospective observational cohort study of patients with TRU, either treated or not for tuberculosis, from January 2005 to January 2017. Clinical and demographic variables were recorded. Main outcome measure was a loss of visual acuity (VA) of ≥2 Snellen lines. A Generalized Estimation Equation was used to control between-eyes bias. A backward stepwise logistic regression multivariate analysis was conducted to elucidate independent risk factors.Results: One hundred and thirty-eight eyes from 82 patients were included. There were 45 males, median age at onset of uveitis was 40 years (Interquartile range, IQR 24). The median follow-up was 36 months (IQR 49.75) and 51 patients completed antituberculous treatment (ATT) for a mean of 9.37 months. In the multivariate model, ATT was the only independent protective factor for loss of VA (OR 0.13, 95% CI 0.04-0.37, p < 0.001).Conclusion: ATT itself may prevent visual loss in TRU.
Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis, Ocular/drug therapy , Uveitis/drug therapy , Vision Disorders/prevention & control , Adult , Aged , Cohort Studies , Female , Follow-Up Studies , Humans , Interferon-gamma Release Tests , Male , Middle Aged , Retrospective Studies , Tuberculin Test , Tuberculosis, Ocular/diagnosis , Uveitis/diagnosis , Visual Acuity/physiologyABSTRACT
Hematopoietic stem cells (HSC) are defined by their cardinal properties, such as sustained proliferation, multilineage differentiation, and self-renewal, which give rise to a hierarchy of progenitor populations with more restricted potential lineage, ultimately leading to the production of all types of mature blood cells. HSC are anchored by cell adhesion molecules to their specific microenvironment, thus regulating their cell cycle, while cell migration is essentially required for seeding the HSC of the fetal bone marrow (BM) during development as well as in adult BM homeostasis. The dystrophin-associated protein complex (DAPC) is a large group of membrane-associated proteins linking the cytoskeleton to the extracellular matrix and exhibiting scaffolding, adhesion, and signaling roles in muscle and non-muscle cells including mature blood cells. Because adhesion and migration are mechanisms that influence the fate of the HSC, we explored the presence and the feasible role of DAPC. In this study, we characterized the pattern expression by immunoblot technique and, by confocal microscopy analysis, the cellular distribution of dystrophin and utrophin gene products, and the dystrophin-associated proteins (α-, ß-dystroglycan, α-syntrophin, α-dystrobrevin) in relation to actin filaments in freshly isolated CD34+ cells from umbilical cord blood. Immunoprecipitation assays demonstrated the presence of Dp71d/Dp71Δ110m â¼DAPC and Up400/Up140â¼DAPC. The subcellular distribution of the two DAPC in actin-based structures suggests their dynamic participation in adhesion and cell migration. In addition, the particular protein pattern expression found in hematopoietic stem/progenitor cells might be indicative of their feasible participation during differentiation.
Subject(s)
Dystrophin/metabolism , Hematopoietic Stem Cells/metabolism , Utrophin/metabolism , Fluorescent Antibody Technique , Homeostasis , Humans , Microscopy, ConfocalSubject(s)
Bezoars/complications , Superior Mesenteric Artery Syndrome/complications , Abdominal Pain/etiology , Bezoars/diagnosis , Bezoars/diagnostic imaging , Diet, Vegetarian , Dietary Fiber/adverse effects , Endoscopy, Digestive System , Humans , Intubation, Gastrointestinal , Male , Middle Aged , Parenteral Nutrition , Proton Pump Inhibitors/therapeutic use , Radiography , Superior Mesenteric Artery Syndrome/diagnosis , Superior Mesenteric Artery Syndrome/diagnostic imagingABSTRACT
Este artículo presenta los hallazgos relativos a un grupo de no pacientes que participó como grupo de control en una Tesis Doctoral sobre Anorexia Nerviosa y Depresión. La hipótesis sometida a verificación postulaba que la Depresión es, frecuentemente, una patología comórbida con la Anorexia Nerviosa. A tal fin se diseñó un estudio comparativo con 50 pacientes anoréxicas, tipo restrictivo (PAN), 50 deprimidas (DP) y 50 no pacientes (NP), de 13 a 16 años. Se utilizó el Test de Rorschach y el Minnesota Multiphasic Personality Inventory (MMPI), comparándose sus resultados con las observaciones de los padres, recogidas de forma estandarizada a través del Child Behavior Checklist (CBCL). Estos resultados ya han sido publicados (García Alba, 2003 a, b; 2004; en prensa). En el grupo de no pacientes, como era de esperar, se constata la ausencia de psicopatología depresiva. No obstante, los datos obtenidos permiten reflexionar sobre el alto grado de vulnerabilidad psicológica detectado en este grupo y sus posibles repercusiones, aunque para poder generalizar estos resultados sería necesario ampliar la muestra. Se subraya la importancia de lograr diagnósticos diferenciales para evitar intervenciones iatrogénicas. Finalmente se enfatiza la necesidad de utilizar en investigación diversos tests y grupos de control para minimizar sesgos en resultados y conclusiones (AU)
This paper focuses on results of a non-patient group that participated as control group in a research about anorexia nervosa and depression. As it is assumed that depression is frequently a concomitant pathology in anorexia nervosa, we carried out a comparative case/control study with 50 restrictivetype (PAN) anorexic patients, 50 depressed patients (PD) and 50 non patients (NP), aged between 13 and 16. We used the Rorschach test and the Minnesota Multiphasic Personality Inventory (MMPI) and compared results to parents observations collected by means of the Child Behavior Checklist (CBCL). These results have already been published (García Alba, 2003 a, 2003 b; 2004, in press). As expected, we did not find depressive symptoms in NP group. However, data invite to think of the existence of a high psychological vulnerability in this group and of its impact, although we would need to increase group size in order to generalize results. We also emphasize the importance of getting differential diagnosis in order to avoid iatrogenic interventions. Finally, we point out the convenience of using different tests and control groups that minimize biases in results and conclusions (AU)
Subject(s)
Humans , Female , Adolescent , Adolescent Behavior , Anorexia Nervosa/psychology , Depressive Disorder/psychology , Case-Control Studies , Comorbidity , Risk Factors , Rorschach Test , MMPI , Signal Detection, PsychologicalABSTRACT
Frequently, depression is a concomitant pathology in anorexia nervosa. To verify this, we carried out a comparative case/control study with 50 anorexic patients, restricting-type (ANP), 50 depressed patients (DP) and 50 non-patients (NP), aged between 13 and 16. We used the Rorschach Test and the Minnesota Multiphasic Personality Inventory (MMPI) and compared the results to parent's observations collected from the Achenbach Child Behavior Checklist (CBCL). Results showed two clearly different groups among participants: ANP with depression (36%) and ANP without depression (64%). This seems to indicate that depression is not a core element in anorexic disorders. However, we also observed a significant increase in the MMPI scale 2, which was probably related to starvation and weight loss. We confirmed the absence of general anxiety in the ANP group and obtained differences between depressive symptoms and those derived from coping deficit disorders. The discussion emphasizes the importance of using several tests to reduce bias in results and conclusions.
Subject(s)
Anorexia Nervosa/epidemiology , Anorexia/epidemiology , Depression/epidemiology , Adaptation, Psychological , Adolescent , Comorbidity , Female , Humans , MMPI , Male , Reproducibility of Results , Rorschach TestABSTRACT
La hipótesis inicial postula que hay una alteración en el funcionamiento cognitivo de las pacientes anoréxicas. Para verificarla, se diseña un estudio comparativo de casos y controles con 50 pacientes anoréxicas tipo restrictivo (PAN), 50 pacientes deprimidas (PD) y 50 no pacientes o controles (NP), de edades comprendidas entre 13 y 16 años, evaluadas con el test Rorschach. En PAN se detecta una correcta captación de los datos del entorno (Procesamiento), una traducción a otros códigos bastante adecuada (Mediación), pero alteraciones significativas cuando esta información va a ser conceptualizada y utilizada como ideas (Ideación). En este área aparece un pensamiento distorsionado, con eventuales operaciones semejantes a las de tipo delirante, pasivo, utilizado de forma rígida, improductivo y poco eficaz; se establecen diferencias con el pensamiento obsesivo. Se señalan las dificultades del abordaje psicoterapéutico de estas pacientes y se considera la necesidad de incluir, dentro de una intervención terapéutica global, la reestructuración cognitiva como terapéutica idónea para modificar esta ideación (AU)
Subject(s)
Adolescent , Female , Humans , Anorexia Nervosa/psychology , Cognition Disorders/psychology , Case-Control Studies , Cognitive Behavioral Therapy/methods , Mental Processes , Rorschach Test/statistics & numerical dataABSTRACT
El presente documento contribuye a mejorar la administración hospitalaria, para una prestación de servicios, eficaces, eficientes y equitativos, acorde con los requerimientos de las leyes vigentes en el municipio de Santa Cruz de la Sierra. Contar con un sistema de información unificado en la red de servicios hospitalarios de la primera sección municipal. Asimismo estar a la altura de los requerimientos de los avances tecnológicos para una administración ágil moderna y oportuna
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Se destaca que el ingreso de un niño en terapia intensiva es una situación de tensión psicológica. Se estudia mediante un cuestionario cómo las madres prefieren permanecer junto a su hijo, pues se sienten más seguras, con más esperanzas, mejor informadas, los lactan, alimentan, cambian de ropa y apoyan emocionalmente. Se da a conocer la importancia de que la madre sea atendida e informada por el pediatra, así como el esfuerzo conjunto de todos
Subject(s)
Humans , Female , Medical Chaperones , Intensive Care Units , Stress, PsychologicalABSTRACT
Se destaca que el ingreso de un niño en terapia intensiva es una situación de tensión psicológica. Se estudia mediante un cuestionario cómo las madres prefieren permanecer junto a su hijo, pues se sienten más seguras, con más esperanzas, mejor informadas, los lactan, alimentan, cambian de ropa y apoyan emocionalmente. Se da a conocer la importancia de que la madre sea atendida e informada por el pediatra, así como el esfuerzo conjunto de todos