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Villar Del Moral J.,University of Granada | Jimenez-Garcia A.,University of Seville | Salvador-Egea P.,Complejo Hospitalario Of Navarra | Martos-Martinez J.M.,University of Seville | And 6 more authors.
Surgery (United States) | Year: 2014

Methods A multicenter review of patients with surgically resected PC was performed, led by the Spanish Association of Surgery. All surgical units affiliated with its endocrine surgery section were invited to answer a questionnaire that collected several hospital-related, clinical, biochemical, operative, pathologic, and follow-up data. Their relationships with prognosis were assessed by both univariate and multivariate analysis, as well as the effectiveness of three staging systems for parathyroid carcinoma. Result Of the 6,863 patients undergoing parathyroidectomy, 62 (0.9%) had PC. Of them, 12 (19.3%) died, in 5 cases (8%) because of disease, and 14 (22.6%) suffered recurrence, after a median follow-up of 55 months. The most predictive independent variables on tumor recurrence were intraoperative tumor rupture (hazard ratio [HR] 6.22; 95% confidence interval [CI] 1.19-32.36; P =.030); the presence of mitotic figures within tumor parenchyma cells (HR 4.76; 95% CI 1.24-18.21; P =.022); and allocation in class III according to Schulte differentiated staging classification (HR 5.23; 95% CI 1.41-19.31; P =.013). As to disease-specific survival, poor outcomes were associated with intraoperative tumor rupture (HR 58.71; 95% CI 2.39-1,439.96; P =.013) and distant recurrence (HR 38.74; 95% CI 3.44-435.62; P =.003).Conclusion In addition to factors associated with tumor histopathology and stage, prognosis of PC is greatly influenced by surgeon's performance, which emphasizes the importance of preoperative diagnosis.Background Parathyroid carcinoma (PC) is an uncommon disease that generally is detected postoperatively and traditionally is associated with a poor prognosis. Our purpose was to evaluate treatment outcomes, prognostic factors, and usefulness of some proposed staging systems for this disease. © 2014 Elsevier Inc. All rights reserved.


Sabate M.,University of Barcelona | Windecker S.,University of Bern | Iniguez A.,Meixoeiro Hospital | Okkels-Jensen L.,University of Southern Denmark | And 15 more authors.
European Heart Journal | Year: 2016

Aims: Patients with ST-segment elevation myocardial infarction (STEMI) feature thrombus-rich lesions with large necrotic core, which are usually associated with delayed arterial healing and impaired stent-related outcomes. The use of bioresorbable vascular scaffolds (Absorb) has the potential to overcome these limitations owing to restoration of native vessel lumen and physiology at long term. The purpose of this randomized trial was to compare the arterial healing response at short term, as a surrogate for safety and efficacy, between the Absorb and the metallic everolimus-eluting stent (EES) in patients with STEMI. Methods and results: ABSORB-STEMI TROFI II was a multicentre, single-blind, non-inferiority, randomized controlled trial. Patients with STEMI who underwent primary percutaneous coronary intervention were randomly allocated 1:1 to treatment with the Absorb or EES. The primary endpoint was the 6-month optical frequency domain imaging healing score (HS) based on the presence of uncovered and/or malapposed stent struts and intraluminal filling defects. Main secondary endpoint included the device-oriented composite endpoint (DOCE) according to the Academic Research Consortium definition. Between 06 January 2014 and 21 September 2014, 191 patients (Absorb [n + 95] or EES [n = 96]; mean age 58.6 years old; 17.8% females) were enrolled at eight centres. At 6 months, HS was lower in the Absorb arm when compared with EES arm [1.74 (2.39) vs. 2.80 (4.44); difference (90% CI) 21.06 (21.96, 20.16); Pnon-inferiority <0.001]. Device-oriented composite endpoint was also comparably low between groups (1.1% Absorb vs. 0% EES). One case of definite subacute stent thrombosis occurred in the Absorb arm (1.1% vs. 0% EES; P = ns). Conclusion: Stenting of culprit lesions with Absorb in the setting of STEMI resulted in a nearly complete arterial healing which was comparable with that of metallic EES at 6 months. These findings provide the basis for further exploration in clinically oriented outcome trials. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.


Luchessi A.D.,University of Sao Paulo | Silbiger V.N.,University of Sao Paulo | Silbiger V.N.,Federal University of Rio Grande do Norte | Hirata R.D.C.,University of Sao Paulo | And 9 more authors.
Clinica Chimica Acta | Year: 2013

Background: To investigate genes differentially expressed in peripheral blood cells (PBCs) from patients with coronary arterial disease (CAD) under double anti-platelet therapy. Methods: Twenty-six CAD patients that were submitted to percutaneous coronary intervention (PCI) were selected to participate in this study. These patients took 100. mg/day of acetylsalicylic acid (ASA) and 75. mg/day of clopidogrel. Blood samples were collected before PCI to evaluate platelet reactivity using VerifyNow ASA and P2Y12 assays (Accumetrics). The patients were stratified into 4 quartiles based on ASA reaction units (ARUs) and P2Y12 reaction units (PRUs). Quartile 1 (Q1) patients were classified as responders and quartile 4 (Q4) patients as non-responders. Global mRNA expression from Q1 to Q4 was analyzed by microarray using the GeneChip Exon 1.0 ST array (Affymetrix) and was confirmed by RT-qPCR. Results: Patients with ARU or PRU values within the first quartile (Q1, ARU. <. 390 and PRU. <. 151) were considered responders, while those who had ARU or PRU within the fourth quartile (Q4, ARU. >. 467 and PRU. >. 260) were considered nonresponders. The risk factors associated for CAD showed expected frequencies and no difference was found between Q1 and Q4. Microarray analysis identified 117 genes differentially expressed for ASA and 29 for clopidogrel between Q1 and Q4 groups (p. <. 0.01, FC. >. 1.2). Conclusion: The variation in response to ASA may be related with an increased expression of IGF1 and IGF1R, as well as a response to clopidogrel can be affected by pharmacokinetic change related to the reverse transport pathway by increased expression of ABCC3. © 2013 Elsevier B.V.


PubMed | University of Barcelona, St Antonius Hospital, Imperial College London, The Heart Center and 6 more.
Type: Journal Article | Journal: European heart journal | Year: 2016

Patients with ST-segment elevation myocardial infarction (STEMI) feature thrombus-rich lesions with large necrotic core, which are usually associated with delayed arterial healing and impaired stent-related outcomes. The use of bioresorbable vascular scaffolds (Absorb) has the potential to overcome these limitations owing to restoration of native vessel lumen and physiology at long term. The purpose of this randomized trial was to compare the arterial healing response at short term, as a surrogate for safety and efficacy, between the Absorb and the metallic everolimus-eluting stent (EES) in patients with STEMI.ABSORB-STEMI TROFI II was a multicentre, single-blind, non-inferiority, randomized controlled trial. Patients with STEMI who underwent primary percutaneous coronary intervention were randomly allocated 1:1 to treatment with the Absorb or EES. The primary endpoint was the 6-month optical frequency domain imaging healing score (HS) based on the presence of uncovered and/or malapposed stent struts and intraluminal filling defects. Main secondary endpoint included the device-oriented composite endpoint (DOCE) according to the Academic Research Consortium definition. Between 06 January 2014 and 21 September 2014, 191 patients (Absorb [n = 95] or EES [n = 96]; mean age 58.6 years old; 17.8% females) were enrolled at eight centres. At 6 months, HS was lower in the Absorb arm when compared with EES arm [1.74 (2.39) vs. 2.80 (4.44); difference (90% CI) -1.06 (-1.96, -0.16); Pnon-inferiority < 0.001]. Device-oriented composite endpoint was also comparably low between groups (1.1% Absorb vs. 0% EES). One case of definite subacute stent thrombosis occurred in the Absorb arm (1.1% vs. 0% EES; P = ns).Stenting of culprit lesions with Absorb in the setting of STEMI resulted in a nearly complete arterial healing which was comparable with that of metallic EES at 6 months. These findings provide the basis for further exploration in clinically oriented outcome trials.


Raposeiras Roubin S.,University of Santiago de Compostela | Barreiro Pardal C.,Montecelo Hospital | Roubin-Camina F.,Meixoeiro Hospital | Ocaranza Sanchez R.,University of Santiago de Compostela | And 11 more authors.
Revista Portuguesa de Cardiologia | Year: 2013

Introduction: Atherosclerosis is an active process and the inflammatory component appears to be particularly correlated with the development of acute coronary syndromes (ACS). C-reactive protein (CRP) is an acute phase protein that appears in the circulation in response to inflammatory cytokines. The present study investigated the association between high-sensitivity C-reactive protein (hsCRP) on admission and follow-up prognosis after an ACS. Methods: We included 151 consecutive patients admitted to the coronary care unit with a diagnosis of ACS (47% ST-segment elevation myocardial infarction [STEMI]). The primary endpoint was the combination of cardiac death and myocardial reinfarction during the follow-up period (median 19.8 months, interquartile range 16.3-23.7 months). Results: The occurrence of follow-up events was significantly related to admission hsCRP level, which was an excellent predictor of cardiac death and reinfarction during follow-up (HR 1.091, 95% CI 1.014-1.174; p=0.019). Stratifying the population based on type of ACS, adjusted by variables associated with cardiac events in univariate analysis (hsCRP, diabetes, depressed ejection fraction and GRACE risk score), hsCRP proved to be an independent predictor of follow-up outcomes only in non-STEMI patients (HR 1.217, 95% CI: 1.093-1.356, p<7.001), not in STEMI patients. The best cutoff level of hsCRP to predict follow-up outcomes was 1.1 mg/dl, with sensitivity of 77.8% and specificity of 63.2%. Conclusion: Although the GRACE risk score is routinely used for stratification of patients with ACS, assessment of hsCRP may provide additional prognostic value in the follow-up of non-STEMI patients. © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved.


Raposeiras-Roubin S.,University of Santiago de Compostela | Abu-Assi E.,University of Santiago de Compostela | Cabanas-Grandio P.,University of Santiago de Compostela | Agra-Bermejo R.M.,University of Santiago de Compostela | And 11 more authors.
JACC: Cardiovascular Interventions | Year: 2012

Objectives: This study sought to compare the in-hospital prognostic values of the original and updated GRACE (Global Registry of Acute Coronary Events) risk score (RS) and the AR-G (ACTION [Acute Coronary Treatment and Intervention Outcomes Network] Registry and the GWTG [Get With the Guidelines] Database) RS in acute coronary syndromes (ACS). To evaluate the utility of recalculating risk after percutaneous coronary intervention (PCI) with newer RS models (NCDR [National Cardiovascular Data Registry] and EHS [EuroHeart Score] RS). Background: Defined in 2003, GRACE is among the most popular systems of risk stratification in ACS. An updated version of GRACE has since appeared and new RS have been developed, aiming to improve risk prediction. Methods: From 2004 to 2010, 4,497 consecutive patients admitted to a single center in Spain with an ACS were included (32.1% ST-segment elevation myocardial infarction, 19.2% unstable angina). Discrimination (C-statistic) and calibration (Hosmer-Lemeshow [HL]) indexes were used to assess performance of each RS. A comparative analysis of RS designed to predict post-PCI mortality NCDR and EHS RS versus the GRACE and AR-G RS was performed in a subgroup of 1,113 consecutive patients included in the study. Results: There were 265 in-hospital deaths (5.9%). Original and updated GRACE RS and the AR-G RS all demonstrated good discrimination for in-hospital death (C-statistics: 0.91, 0.90 and 0.90, respectively) with optimal calibration (HL p: 0.42, 0.50, and 0.47, respectively) in all spectra of ACS, according to different managements (PCI vs. conservative) and without significant differences between the 3 different RS. In patients undergoing PCI, EHS and NCDR RS (C-statistic = 0.80 and 0.84, respectively) were not superior to GRACE RS (C-statistic = 0.91), albeit in the subgroup of patients undergoing PCI who were categorized as high risk using the GRACE RS, both EHS and NCDR have contributed to decrease the false positive rate generated by using the GRACE RS. Conclusions: Despite having been developed over 8 years ago, the GRACE RS still maintains its excellent performance for predicting in-hospital risk of death among ACS patients. © 2012 American College of Cardiology Foundation.


Martinez-Romero M.,University of La Coruña | Vazquez-Naya J.M.,University of La Coruña | Pereira J.,University of La Coruña | Pereira M.,Meixoeiro Hospital | And 2 more authors.
Computational and Mathematical Methods in Medicine | Year: 2013

Physicians in the Intensive Care Unit (ICU) are specially trained to deal constantly with very large and complex quantities of clinical data and make quick decisions as they face complications. However, the amount of information generated and the way the data are presented may overload the cognitive skills of even experienced professionals and lead to inaccurate or erroneous actions that put patients' lives at risk. In this paper, we present the design, development, and validation of iOSC3, an ontology-based system for intelligent supervision and treatment of critical patients with acute cardiac disorders. The system analyzes the patient's condition and provides a recommendation about the treatment that should be administered to achieve the fastest possible recovery. If the recommendation is accepted by the doctor, the system automatically modifies the quantity of drugs that are being delivered to the patient. The knowledge base is constituted by an OWL ontology and a set of SWRL rules that represent the expert's knowledge. iOSC3 has been developed in collaboration with experts from the Cardiac Intensive Care Unit (CICU) of the Meixoeiro Hospital, one of the most significant hospitals in the northwest region of Spain. © 2013 Marcos Martínez-Romero et al.


Castro A.,University of La Coruña | Rey A.,University of La Coruña | Boveda C.,University of La Coruña | Arcay B.,University of La Coruña | Sanjurjo P.,Meixoeiro Hospital
BioMed Research International | Year: 2016

The detection of pulmonary nodules is one of the most studied problems in the field of medical image analysis due to the great difficulty in the early detection of such nodules and their social impact. The traditional approach involves the development of a multistage CAD system capable of informing the radiologist of the presence or absence of nodules. One stage in such systems is the detection of ROI (regions of interest) that may be nodules in order to reduce the space of the problem. This paper evaluates fuzzy clustering algorithms that employ different classification strategies to achieve this goal. After characterising these algorithms, the authors propose a new algorithm and different variations to improve the results obtained initially. Finally it is shown as the most recent developments in fuzzy clustering are able to detect regions that may be nodules in CT studies. The algorithms were evaluated using helical thoracic CT scans obtained from the database of the LIDC (Lung Image Database Consortium). © 2016 Alfonso Castro et al.


Marino A.T.,Meixoeiro Hospital | Sanchez E.C.,Meixoeiro Hospital | De Castro N.M.L.,Meixoeiro Hospital | Bobo M.T.I.,Meixoeiro Hospital
Pharmacy World and Science | Year: 2010

Case: A 44-year-old man was diagnosed with ankylosing spondylitis, on treatment with infliximab. After three doses, he was admitted to hospital with fever, fatigue and nausea. A bone marrow biopsy confirmed haemophagocytic syndrome. He was treated with immunoglobulin, cyclosporine and corticosteroids. CT scan revealed tuberculosis. Tuberculostatic treatment was started 26 days after admission. One month later, he was transferred intensive care with septic shock and acute respiratory distress syndrome. After improvement, he was transferred to the medical ward and later discharged. Two weeks after discharge, he was readmitted with a suspected paradoxical reaction (PR) to tuberculostatics and treated with prednisone. He was discharged 15 days later. Conclusions: In patients treated with anti-TNF therapy it may be advisable to monitor the signs and symptoms of tuberculosis. HPS is a rare complication of rheumatic diseases. The possibility of developing a PR in immunosuppressed patients treated with antituberculous should be considered. © Springer Science+Business Media B.V. 2010.


PubMed | University of La Coruña and Meixoeiro Hospital
Type: | Journal: BioMed research international | Year: 2016

The detection of pulmonary nodules is one of the most studied problems in the field of medical image analysis due to the great difficulty in the early detection of such nodules and their social impact. The traditional approach involves the development of a multistage CAD system capable of informing the radiologist of the presence or absence of nodules. One stage in such systems is the detection of ROI (regions of interest) that may be nodules in order to reduce the space of the problem. This paper evaluates fuzzy clustering algorithms that employ different classification strategies to achieve this goal. After characterising these algorithms, the authors propose a new algorithm and different variations to improve the results obtained initially. Finally it is shown as the most recent developments in fuzzy clustering are able to detect regions that may be nodules in CT studies. The algorithms were evaluated using helical thoracic CT scans obtained from the database of the LIDC (Lung Image Database Consortium).

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