Preclinical Evaluation of a Microwave-Based Accessory Device for Colonoscopy in an In Vivo Porcine Model with Colorectal Polyps.

BACKGROUND AND AIMS: Colonoscopy is currently the most effective way of detecting colorectal cancer and removing polyps, but it has some drawbacks and can miss up to 22% of polyps. Microwave imaging has the potential to provide a 360° view of the colon and addresses some of the limitations of conventional colonoscopy. This study evaluates the feasibility of a microwave-based colonoscopy in an in vivo porcine model. METHODS: A prototype device with microwave antennas attached to a conventional endoscope was tested on four healthy pigs and three gene-targeted pigs with mutations in the adenomatous polyposis coli gene. The first four animals were used to evaluate safety and maneuverability and compatibility with endoscopic tools. The ability to detect polyps was tested in a series of three gene-targeted pigs. RESULTS: the microwave-based device did not affect endoscopic vision or cause any adverse events such as deep mural injuries. The microwave system was stable during the procedures, and the detection algorithm showed a maximum detection signal for adenomas compared with healthy mucosa. CONCLUSIONS: Microwave-based colonoscopy is feasible and safe in a preclinical model, and it has the potential to improve polyp detection. Further investigations are required to assess the device's efficacy in humans.

MiWEndo: Evaluation of a Microwave Colonoscopy Algorithm for Early Colorectal Cancer Detection in Ex Vivo Human Colon Models.

This study assesses the efficacy of detecting colorectal cancer precursors or polyps in an ex vivo human colon model with a microwave colonoscopy algorithm. Nowadays, 22% of polyps go undetected with conventional colonoscopy, and the risk of cancer after a negative colonoscopy can be up to 7.9%. We developed a microwave colonoscopy device that consists of a cylindrical ring-shaped switchable microwave antenna array that can be attached to the tip of a conventional colonoscope as an accessory. The accessory is connected to an external unit that allows successive measurements of the colon and processes the measurements with a microwave imaging algorithm. An acoustic signal is generated when a polyp is detected. Fifteen ex vivo freshly excised human colons with cancer (n = 12) or polyps (n = 3) were examined with the microwave-assisted colonoscopy system simulating a real colonoscopy exploration. After the experiment, the dielectric properties of the specimens were measured with a coaxial probe and the samples underwent a pathology analysis. The results show that all the neoplasms were detected with a sensitivity of 100% and specificity of 87.4%.

Microwave-Based Colonoscopy: Preclinical Evaluation in an Ex Vivo Human Colon Model.

INTRODUCTION: Microwave imaging can obtain 360° anatomical and functional images of the colon representing the existing contrast in dielectric properties between different tissues. Microwaves are safe (nonionizing) and have the potential of reducing the visualization problems of conventional colonoscopy. This study assessed the efficacy of a microwave-based colonoscopy device to detect neoplastic lesions in an ex vivo human colon model. METHODS: Fresh surgically excised colorectal specimens containing cancer or polyps were fixed to a 3D positioning system, and the accessory device was introduced horizontally inside the ex vivo colon lumen and moved along it simulating a real colonoscopy exploration. Measurements of the colon were taken every 4 mm with the microwave-based colonoscopy device and processed with a microwave imaging algorithm. RESULTS: 14 ex vivo human colorectal specimens with carcinomas (n = 11) or adenomas with high grade dysplasia (n = 3) were examined with a microwave-based device. Using a detection threshold of 2.79 for the dielectric property contrast, all lesions were detected without false positives or false negatives. CONCLUSIONS: This study demonstrates the use of a microwave-based device to be used as an accessory of a standard colonoscope to detect neoplastic lesions in surgically excised colorectal specimens.

Dielectric properties of colon polyps, cancer, and normal mucosa: Ex vivo measurements from 0.5 to 20 GHz.

PURPOSE: Colorectal cancer is highly preventable by detecting and removing polyps, which are the precursors. Currently, the most accurate test is colonoscopy, but still misses 22% of polyps due to visualization limitations. In this paper, we preliminary assess the potential of microwave imaging and dielectric properties (e.g., complex permittivity) as a complementary method for detecting polyps and cancer tissue in the colon. The dielectric properties of biological tissues have been used in a wide variety of applications, including safety assessment of wireless technologies and design of medical diagnostic or therapeutic techniques (microwave imaging, hyperthermia, and ablation). The main purpose of this work is to measure the complex permittivity of different types of colon polyps, cancer, and normal mucosa in ex vivo human samples to study if the dielectric properties are appropriate for classification purposes. METHODS: The complex permittivity of freshly excised healthy colon tissue, cancer, and histological samples of different types of polyps from 23 patients was characterized using an open-ended coaxial probe between 0.5 and 20 GHz. The obtained measurements were classified into five tissue groups before applying a data reduction step with a frequency dispersive single-pole Debye model. The classification was finally compared with pathological analysis of tissue samples, which is the gold standard. RESULTS: The complex permittivity progressively increases as the tissue degenerates from normal to cancer. When comparing to the gold-standard histological tissue analysis, the sensitivity and specificity of the proposed method is the following: 100% and 95% for cancer diagnosis; 91% and 62% for adenomas with high-grade dysplasia; 100% and 61% for adenomas with low-grade dysplasia; and 100% and 74% for hyperplastic polyps, respectively. In addition, complex permittivity measurements were independent of the lesion shape and size, which is also an interesting property comparing to current colonoscopy techniques. CONCLUSIONS: The contrast in complex permittivities between normal and abnormal colon tissues presented here for the first time demonstrate the potential of these measurements for tissue classification. It also opens the door to the development of a microwave endoscopic device to complement the outcomes of colonoscopy with functional tissue information.

Fieltro adhesivo de descarga para el tratamiento de una úlcera neuropática en un paciente diabético / Adhesive felt pads for treatment of neuropathic ulcers in diabetic patient

El pie diabético es una de las complicaciones más temidas en los pacientes con diabetes mellitus (DM), ya que el 15% de los pacientes desarrollan una úlcera a lo largo de su vida y un 12% sufre amputaciones. Esto conlleva a una disminución de la calidad de vida y un aumento de la morbimortalidad. Se expone el caso clínico de un paciente de 77 años con DM de larga evolución que desarrolla una úlcera neuropática. Estas lesiones se producen debido a la neuropatía y cambios biomecánicos del pie que provocan un aumento de las presiones plantares. Se realiza una valoración enfermera según el modelo de Virginia Henderson y se establecen los siguientes diagnósticos de Enfermería: deterioro de la integridad cutánea y desequilibrio nutricional por exceso. Se desarrolla el plan de cuidados utilizando las clasificaciones de North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC) y Nursing Interventions Classification (NIC). Los resultados se evalúan a los tres meses obteniendo la curación de la herida, se observa una reducción del peso, una mejora en el conocimiento de la dieta y el paciente demuestra un cumplimiento sobre los objetivos pautados. La curación de la úlcera ha estado directamente relacionada con la disminución de la presión y mediante el fieltro adhesivo de descarga que ha sido clave en el proceso de curación

Diabetic foot is one of the most feared complications in patients with diabetes mellitus (DM), because 15% of patients will develop an ulcer throughout their lives, and 12% will suffer amputations. This entails a reduction in quality of life and an increase in patient’s morbimortality. We present the clinical case of a 77-year-old patient with longevolution DM who developed a neuropathic ulcer. These lesions appear due to neuropathy and biomechanical changes in the foot, which will cause an increase in plantar pressures. Nursing assessment was conducted according to Virginia Henderson’s Model, and the following nursing diagnoses were established: deterioration in cutaneous integrity and nutritional excess imbalance. The care plan was prepared using the classifications by the North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC) and Nursing Interventions Classification (NIC). Outcomes were assessed at three months, achieving wound healing, weight loss, and an improvement in diet awareness; the patient showed compliance for the objectives set out. Ulcer healing has been directly associated with the reduction in pressure, and with the adhesive felt pad which has been a key element in the healing process

Abordaje enfermero de un paciente con insuficiencia cardiaca en Atención Primaria / Nursing approach to a patient with cardiac insufficiency in Primary Care

Actualmente, la insuficiencia cardiaca (IC) es una de las enfermedades más frecuentes, costosas, progresivas y discapacitantes de los países desarrollados. Representa la tercera causa de muerte cardiovascular y la primera causa de hospitalización en personas mayores de 65 años. En España, un 8% en personas de entre 65-75 años padecen IC y en mayores de 75 años su prevalencia es de 16%.Mediante la exposición del caso de un paciente con insuficiencia cardiaca y su abordaje por parte de la enfermera de Atención Primaria, se pretende mostrar la importancia del seguimiento desde dicho nivel asistencial y de la continuidad de cuidados ante un problema de salud de tal magnitud y prevalencia. La valoración enfermera se realizó según el modelo de Virginia Hendersony se establecieron los diagnósticos y el plan de cuidados utilizandolas clasificaciones de North American Nursing Diagnosis Association(NANDA), Nursing Outcome Clasification (NOC) y Nursing Interventions Classification (NIC). Los resultados se evaluaron a los tres meses. El seguimiento de la enfermera comunitaria, junto con el trabajo en equipo y el uso de guías de práctica clínica fueron determinantes para evitar descompensaciones y mejorar la calidad de vida del paciente (AU)

Currently, chronic insufficiency (CI) is one of the most prevalent, costly ,progressive and disabling disorders of developed countries. It represents the third leading cause of cardiovascular death and the leading cause of hospitalization in people over 65. In Spain, 8% of people aged 65-75years suffering from CI and in people aged over 75 years the prevalence of this condition reaches 16%.By exposing the case of a patient with cardiac insufficiency and its management on the part of the primary care nurse, we aim to show the importance of monitoring and follow up from that level of care and continuity of care when faced with a health problem of such magnitude and prevalence. The nursing assessment was performed using the Virginia Henderson's model: Diagnoses and care plans were established using the classifications of Norht American Nursing Diagnosis Association (NANDA),Nursing Outcome Clasification (NOC) and Nursing Interventions Classification(NIC). Outcomes were assessed at three months. Follow up of the community nurse, along with teamwork and use of clinical practice guidelines, were crucial to avoid decompensation and improve the quality of life of patients (AU)

Seguimiento domiciliario de una paciente con diabetes mellitus complicada entre la gestora de casos y la enfermera comunitaria II / Joint home follow-up of a patient with complicated diabetes mellitus by the case manager and the community nurse: II

El presente artículo es la continuación de la publicación «Abordaje integral de un caso de diabetes mellitus en domicilio entre la gestora de casos y la enfermera comunitaria» en Enfermería Clínica. En dicho documento se planteaba el caso de una mujer de 76 años con diabetes mellitus de larga evolución y alta complejidad clínica que formaba parte del programa de atención domiciliaria en el ámbito de atención primaria. En este trabajo se expone el seguimiento del caso en el que se aparecen nuevas complicaciones en la extremidad inferior derecha que conllevan a la amputación de la segunda extremidad. A los 6 meses del plan de cuidados inicial se realiza una nueva valoración según el modelo de Virginia Henderson y se plantean los diagnósticos de enfermería según la North American Nursing Diagnosis Association (NANDA) que conllevan a cambios en los objetivos y los criterios de resultados, Nursing Outcomes Classification (NOC) y Nursing Interventions Classification (NIC). Entre los resultados obtenidos, destacan la mejora de su bienestar al conseguir que la Sra. pudiera interaccionar e integrarse socialmente en su entorno tras movilizar los recursos sociales correspondientes y la familia. Las implicaciones en la práctica clínica son la importancia de la prevención de las complicaciones de la diabetes mellitus y el pie diabético, y la dificultad del abordaje de situaciones complejas que, en ocasiones, superan las posibilidades de la enfermera comunitaria. Ésta se puede beneficiar del apoyo clínico ofrecido por el modelo de gestión de casos y el abordaje global e integrado en un equipo muldisiciplinar (AU)

This is a continuation of the article published in this journal (Enfermeria Clinica), entitled 'Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home'. We present the case of a 76 year- old patient with long-term and clinically complex Diabetes Mellitus. The patient was taking part in the Primary Care home care program. This article describes the follow-up of the case in which new complications appeared in the right limb, which led to the amputation of the second limb. A new evaluation following Virginia's Henderson model was performed six months after the initial care plan. Nursing diagnoses were made following the North American Nursing Diagnosis Association (NANDA). These diagnoses led to changes in objectives and performance criteria using, nursing outcomes classification (NOC) and nursing interventions classification (NIC). One of the results obtained was the improvement of her well-being by enabling the patient to interact and integrate socially within her environment after mobilising the corresponding social and family resources. Involvement in clinical practice is important in the prevention of diabetes mellitus and diabetic foot complications. Difficult and complex situations are sometimes beyond the ability of the community nurse. It can be beneficial to take advantage of the clinical support offered by the case management model and the integrated approach of a multidisciplinary team (AU)

[Joint home follow-up of a patient with complicated diabetes mellitus by the case manager and the community nurse: II]. / Seguimiento domiciliario de una paciente con diabetes mellitus complicada entre la gestora de casos y la enfermera comunitaria II.

This is a continuation of the article published in this journal (Enfermeria Clinica), entitled "Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home". We present the case of a 76 year- old patient with long-term and clinically complex Diabetes Mellitus. The patient was taking part in the Primary Care home care program. This article describes the follow-up of the case in which new complications appeared in the right limb, which led to the amputation of the second limb. A new evaluation following Virginia's Henderson model was performed six months after the initial care plan. Nursing diagnoses were made following the North American Nursing Diagnosis Association (NANDA). These diagnoses led to changes in objectives and performance criteria using, nursing outcomes classification (NOC) and nursing interventions classification (NIC). One of the results obtained was the improvement of her well-being by enabling the patient to interact and integrate socially within her environment after mobilising the corresponding social and family resources.Involvement in clinical practice is important in the prevention of diabetes mellitus and diabetic foot complications. Difficult and complex situations are sometimes beyond the ability of the community nurse. It can be beneficial to take advantage of the clinical support offered by the case management model and the integrated approach of a multidisciplinary team.

Serum paraoxonase-3 concentration in HIV-infected patients. Evidence for a protective role against oxidation.

We investigated the influence of the HIV infection on serum paraoxonase-3 (PON3) concentration and assessed the relationships with lipoprotein-associated abnormalities, immunological response, and accelerated atherosclerosis. We studied 207 HIV-infected patients and 385 healthy volunteers. Serum PON3 was determined by in-house ELISA, and PON3 distribution in lipoproteins was investigated by fast-performance liquid chromatography (FPLC). Polymorphisms of the PON3 promoter were analyzed by the Iplex Gold MassArray(TM) method. PON3 concentrations were increased (about three times) in HIV-infected patients with respect to controls (P < 0.001) and were inversely correlated with oxidized LDL levels (P = 0.038). Long-term use of nonnucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy was associated with a decrease of PON3 concentrations. In a multivariate linear regression analysis, these relationships were still strong when the main confounding covariates were considered. PON3 was mainly found in HDL in HIV-infected patients, but a substantial amount of the protein was detected in LDL particles. This study reports for the first time an important increase in serum PON3 concentrations in HIV-infected patients that is associated with their oxidative status and their treatment with NNRTI. Long-term, prospective studies are needed to confirm the possible influence of this enzyme on the course of this disease and its possible utility as an analytical biomarker.

Serum paraoxonase-3 concentration is associated with the severity of hepatic impairment in patients with chronic liver disease.

OBJECTIVES: Research on paraoxonase-3 (PON3) has been hampered by the lack of methods for measurement. This is a pilot study aimed at exploring whether chronic liver impairment is associated with changes in serum PON3 concentrations, and to know whether this measurement may provide useful information to investigate this derangement. DESIGN AND METHODS: We studied 110 patients with chronic liver disease (21 minimal changes, 79 chronic hepatitis, 10 cirrhosis) and 356 healthy volunteers. Serum PON3 concentration was determined by ELISA using polyclonal antibodies generated against a synthetic peptide with a sequence specific to PON3. RESULTS: Serum PON3 concentrations were increased in patients with chronic hepatitis or cirrhosis and showed significant direct correlations with the degree of periportal abnormalities including fibrosis, and with serum FAS (a marker of antiapoptosis) concentrations. CONCLUSION: These results suggest that PON3 may play a hepatoprotective role against histological alterations and hepatic cell apoptosis leading to liver disease.

Measurement of serum PON-3 concentration: method evaluation, reference values, and influence of genotypes in a population-based study.

Experimental studies showed that paraoxonase-3 (PON3) retards lipoprotein oxidation. Our objective was to describe a new assay to measure serum PON3 concentrations and report their reference values in a population-based study. The influence of PON3 promoter polymorphisms and their relationships with PON1 and lipid profile were also studied. We generated an anti-PON3 antibody by inoculating rabbits with a synthetic peptide specific to mature PON3. This antibody was used to develop an ELISA. The average regression line of standard plots (n = 8) was y = 0.9587 (0.3392) log(10)x + 1.9466 (0.0861) [r(2) = 0.924 (0.0131); P < 0.001]. There was no cross reaction with PON1. Detection limit was 0.24 mg/l. Imprecision was ≤ 13.2%. Reference interval (n = 356) was 1.00-2.47 mg/l. PON3 was observed in HDL particles containing apolipoprotein (apo)A-I and PON1, but not apoA-II or apoE. Serum PON3 concentrations showed a moderate influence (about 10% variation) by PON3 promoter polymorphisms. Our study describes for the first time a method to measure serum PON3 concentrations. This method offers new opportunities in the investigation of the properties and role of PON3 in cardiovascular disease, with possible implications in clinical practice.

Abordaje integral de un caso complejo de diabetes mellitus en domicilio entre la gestora de casos y la enfermera comunitaria / Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home

En este artículo se presenta el caso clínico de una paciente de 76 años con diabetes mellitus de larga evolución y de alta complejidad clínica, que forma parte del programa de atención domiciliaria en el ámbito de atención primaria. Presentaba varias complicaciones de la diabetes mellitus que afectaban de forma importante su calidad de vida, tales como ceguera, insuficiencia renal tratada con hemodiálisis y accidente vascular cerebral. Se expone una valoración siguiendo el modelo de Virginia Henderson, realizada en domicilio después del alta del centro sociosanitario donde estuvo ingresada por amputación supracondílea de la extremidad inferior derecha. Posteriormente, se diseñó el plan de cuidados de enfermería con los objetivos y criterios de resultados North American Nursing Diagnosis Association, Nursing Outcomes Classification y Nursing Interventions Classification. Se llevó a cabo de forma conjunta entre la enfermera comunitaria y la enfermera gestora de casos, las que se coordinaron con el resto de los profesionales que intervinieron en el caso. Se evaluaron los resultados a los 6 meses de la valoración inicial. Este caso, que presentaba alta complejidad y alta dependencia, requería un abordaje multidisciplinario y la integración de diversos profesionales, servicios e instituciones para poder implementar el tratamiento del paciente. Por ello, se debe destacar la importancia de una gestión del caso (case management) para garantizar la continuidad asistencial y una atención global e integrada(AU)

We present the case of a patient with long-term and clinically complex Diabetes Mellitus. She was taking part in the home care program in Primary Care. The complications of her DM affected her quality of life: blindness, kidney failure, treated with hemodialysis, and a cerebrovascular attack. We describe the evaluation following Virginia's Henderson model. This evaluation was made in the patient's home after she was discharged from the socio-health centre where she was admitted as her right leg was amputated at a supracondylar level. It was designed a care plan between the community nurse and the case manager using NANDA, NOC and NIC taxonomy. The care plan was carried out as a joint effort between the community nurse and the case manager who coordinated the planning with the rest of professionals. Results were evaluated 6 months after the initial assessment. This case, which had a high dependence and a high clinical complexity, required a multidisciplinary approach and the integration of different professionals, services and institutions to implement the patient's treatment. Because of all the above, it is important to mention the case management function to guarantee continuity, and overall and integrated care (AU)

[Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home]. / Abordaje integral de un caso complejo de diabetes mellitus en domicilio entre la gestora de casos y la enfermera comunitaria.

We present the case of a patient with long-term and clinically complex Diabetes Mellitus. She was taking part in the home care program in Primary Care. The complications of her DM affected her quality of life: blindness, kidney failure, treated with hemodialysis, and a cerebrovascular attack. We describe the evaluation following Virginia's Henderson model. This evaluation was made in the patient's home after she was discharged from the socio-health centre where she was admitted as her right leg was amputated at a supracondylar level. It was designed a care plan between the community nurse and the case manager using NANDA, NOC and NIC taxonomy. The care plan was carried out as a joint effort between the community nurse and the case manager who coordinated the planning with the rest of professionals. Results were evaluated 6 months after the initial assessment. This case, which had a high dependence and a high clinical complexity, required a multidisciplinary approach and the integration of different professionals, services and institutions to implement the patient's treatment. Because of all the above, it is important to mention the case management function to guarantee continuity, and overall and integrated care.