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Reigadas E.,Hospital General Universitario Gregorio Marano n | Reigadas E.,Complutense University of Madrid | Reigadas E.,Institute Investigacion Sanitaria Gregorio Marano n | Alcala L.,Hospital General Universitario Gregorio Marano n | And 14 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2016

Objectives: Prediction of patients with poor outcome is necessary in order to plan the proper management of Clostridium difficile infection (CDI); however, clinical criteria are insufficient. In a previous study, we observed that high toxigenic C. difficile cfu stool counts at diagnosis were associated with a poor outcome. Our objective was to investigate the role of the PCR toxin B amplification cycle threshold (Ct) in the prediction of CDI poor outcome and to derive and validate a high-risk prediction rule using this marker. Methods: We prospectively included patients with CDI (derivation cohort, January 2013 to June 2014; and validation cohort, December 2014 to May 2015), who were followed for at least 2 months after their last episode/recurrence. All samples were tested with XpertTM C. difficile. Results: For the derivation cohort (n=129) toxin B Ct was independently associated with poor outcome (P<0.001). The receiver operating characteristic (ROC) curve yielded an AUC of 0.816. Using a cut-off of < 23.5 cycles for high risk of poor outcome, the diagnostic accuracywas 81.4%, the sensitivity was 46.5% (95% CI 32.5- 61.1) and the specificity was 98.8% (95% CI 93.7-99.8). For the validation cohort (n=170), the diagnostic accuracywas 81.8%, the sensitivity was 88.4% (95% CI 75.5-94.9) and the specificity was 79.5% (95% CI 71.7-85.6). The ROC curve yielded an AUC of 0.857. Conclusions: Low toxin B Ct values from samples collected at the initial moment of diagnosis appears to be a strong marker for poor outcome. This available test may identify, at an early stage, patients who are at higher risk of a poor outcome CDI. © The Author 2016.


Soto-Montenegro M.L.,Institute Investigacion Sanitaria Gregorio Marano N | Soto-Montenegro M.L.,Research Center Biomedica En Red Of Salud Mental Cibersam | Pena-Zalbidea S.,Institute Investigacion Sanitaria Gregorio Marano N | Mateos-Perez J.M.,Institute Investigacion Sanitaria Gregorio Marano N | And 5 more authors.
PLoS ONE | Year: 2014

Purpose: The goal of this study was to compare the tumor uptake kinetics and diagnostic value of three 68Ga-DOTA-labeled somatostatin analogues (68Ga-DOTATOC, 68Ga-DOTANOC, and 68Ga-DOTATATE) using PET/CT in a murine model with subcutaneous meningioma xenografts. Methods: The experiment was performed with 16 male NUDE NU/NU mice bearing xenografts of a human meningioma cell line (CH-157MN). 68Ga-DOTATOC, 68Ga-DOTANOC, and 68Ga-DOTATATE were produced in a FASTLab automated platform. Imaging was performed on an Argus small-animal PET/CT scanner. The SUVmax of the liver and muscle, and the tumor-toliver (T/L) and tumor-to-muscle (T/M) SUV ratios were computed. Kinetic analysis was performed using Logan graphical analysis for a two-tissue reversible compartmental model, and the volume of distribution (Vt) was determined. Results: Hepatic SUVmax and Vt were significantly higher with 68Ga-DOTANOC than with 68Ga-DOTATOC and 68Ga- DOTATATE. No significant differences between tracers were found for SUVmax in tumor or muscle. No differences were found in the T/L SUV ratio between 68Ga-DOTATATE and 68Ga-DOTATOC, both of which had a higher fraction than 68Ga- DOTANOC. The T/M SUV ratio was significantly higher with 68Ga-DOTATATE than with 68Ga-DOTATOC and 68Ga-DOTANOC. The Vt for tumor was higher with 68Ga-DOTATATE than with 68Ga-DOTANOC and relatively similar to that of 68Ga-DOTATOC. Conclusions: This study demonstrates, for the first time, the ability of the three radiolabeled somatostatin analogues tested to image a human meningioma cell line. Although Vt was relatively similar with 68Ga-DOTATATE and 68Ga-DOTATOC, uptake was higher with 68Ga-DOTATATE in the tumor than with 68Ga-DOTANOC and 68Ga-DOTATOC, suggesting a higher diagnostic value of 68Ga-DOTATATE for detecting meningiomas. © 2014 Soto-Montenegro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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