Verificación artroscópica del diagnóstico por resonancia magnética de las lesiones meniscales

La utilización de la Imagen por Resonancia Magnética (IRM) como prueba diagnóstica en la patología de la rodilla, se presenta como alternativa no invasiva fundamental. Se ha diseñado un protocolo a doble ciego junto al servicio de radiodiagnóstico de nuestro hospital a través del cual se han evaluado un total de 31 pacientes donde los hallazgos de la IRM son contrastados con la exploración artroscópica posterior. Para el menisco interno, la precisión diagnóstica de la IRM es del 93 % y del 87% para el externo. Como conclusiones de mayor relieve, la sensibilidad de la exploración fue del 90% para el interno y del 75% para el externo y respecto a la especificidad, en el interno resultó ser del 100% y del 91% en el externo. Los valores predictivo negativo y positivo fueron respectivamente del 85 y 100% en el menisco interno y del 84 y 75% en el externo. Se encontró mayor dificultad diagnóstica en la porción anterior del menisco externo y falta de precisión ocasional en definir el tipo y extensión de la lesión.The use of Magnetic Resonance Imaging (MIR) as a diagnostic trial in the pathology of the knee, has become an important non invasive alternative. We have designed a double blind protocol with the Department of Radiology through we have evaluated 31 patients analyzing the MRI results in relation with the arthroscopic findings. For the medial meniscus, the accuracy of the MRI was 93 % and 87% for the lateral. As main conclusions, the sensibility was 90% for the medial meniscus and 75% for the lateral one and about specificity, we found a result of 100% for the medial meniscus and 91% for the lateral. The negative and positive predictive values were respectively 85% and 100% for the medial and 84% and 75% for the lateral. We noted more diagnostic difficulties in the anterior portion of lateral meniscus and lack of precission in the determination of the type and extension of the meniscal injury

Reconstrucción del ligamento cruzado anterior con plastia mixta de semitendinoso y fibra de Kennedy-Lad

—Se han evaluado los resultados de la reconstrucción del ligamento cruzado anterior (LCA) con una plastia mixta de tendón del semitendinoso y fibra sintética de KennedyLAD en veinticinco pacientes con un mínimo de dos años de seguimiento postoperatorio (media de treinta y ocho meses). Se trataba en todos los casos de lesiones crónicas donde la cirugía consistió en la reconstrucción del LCA y meniscectomías parciales cuando fueron necesarias. La evaluación se llevó a cabo mediante pruebas funcionales (Lysholm) y clínicas (Marshall), pruebas de estabilidad manual (Lachman, pivot, cajón neutro anterior), medidas instrumentales de estabilidad con artrómetro (KT-1000), índice de actividad y apreciación subjetiva. Los datos indican que el comportamiento de la plastia es adecuado en el 92% de los casos proporcionando a los pacientes una función articular satisfactoria en su vida diaria incluyendo la actividad deportiva.The authors assess the results of the anterior cruciate ligament (ACL) reconstruction by means of a semitendinous tendon and Kennedy LAD composite graft. Minimum followup has been two years (mean of thirty eight months). In every cases the lesion was considered as chronic and surgery consisted of ACL reconstruction and partial meniscectomy if neccessary. Studies performed to asses the results included: functional (Lysholm) and clinical (Marshall) tests, manual stability tests (Lachman, pivot-shift, neutral anterior drawer), instrumented stability measurement (KT-1000 arthrometer), activity score and subjective patient self-assessment. The data collected indicate that the performance of the composite graft is adequate in 92% of the cases, allowing the patients a satisfactory knee joint function in their daily life including sporting activities

Indicaciones Límite de las Fracturas de Húmero con Clavo Endomedular Cerrojado

El tratamiento de las fracturas diafisarias del húmero ha entrado en controversia en los últimos años, como lo refleja la literatura internacional. La problemática aumenta cuando se trata de fracturas diafisarias límites que alcanzan la zona metafisaria superior e inferior. En un intento de mejora terapéutica este grupo de autores ha testado un clavo cerrojado para el húmero diseñado por Seidel. El promedio de seguimiento ha sido de 12 meses con un mínimo de 6 meses. El número de casos evaluados ha sido 6. Siguiendo la cotación de Stewart, 4 de los seis pacientes obtuvieron resultados buenos o excelentes. Todos los pacientes consolidaron sus fracturas en un período de tiempo normal, entre 3 y 5 meses, con una media de 4 meses, 4 de los seis pacientes no se inmovilizaron con yeso en ningún momento. La bondad y sencillez del método hace augurar buenos resultados en otros grupos ampliando sus indicaciones.Treatment of dyaphyseal fractures of the humerus has been the source of considerable controversy in recent years. The problem increases in dimension when one is dealing with limiting diaphyseal fractures that invole the upper and lower metaphyseal zone. In an attempt to improve the therapy of this circunstance, the members of this research team have tested a locking nail for the humerus designed by Seidel. The mean follow-up time has been 12 months, with a minimum of six months. The number of cases evaluated was 6. According to the scale of Stewart, four of the cases obtained good or excellent results. All the patients consolidated their fractures within a normal period of time -between 3 and 5 months-, with a mean of 4 months. Four of the 6 patients wer e not immobilized with paster at any time. The goodness and simplicity of the method are suggestive of promising results in other groups by broadening its indications

Ruxolitinib in refractory acute and chronic graft-versus-host disease : a multicenter survey study

Graft-versus-host disease is the main cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation. First-line treatment is based on the use of high doses of corticosteroids. Unfortunately, second-line treatment for both acute and chronic graft-versus-host disease, remains a challenge. Ruxolitinib has been shown as an effective and safe treatment option for these patients. Seventy-nine patients received ruxolitinib and were evaluated in this retrospective and multicenter study. Twenty-three patients received ruxolitinib for refractory acute graft-versus-host disease after a median of 3 (range 1-5) previous lines of therapy. Overall response rate was 69.5% (16/23) which was obtained after a median of 2 weeks of treatment, and 21.7% (5/23) reached complete remission. Fifty-six patients were evaluated for refractory chronic graft-versus-host disease. The median number of previous lines of therapy was 3 (range 1-10). Overall response rate was 57.1% (32/56) with 3.5% (2/56) obtaining complete remission after a median of 4 weeks. Tapering of corticosteroids was possible in both acute (17/23, 73%) and chronic graft-versus-host disease (32/56, 57.1%) groups. Overall survival was 47% (CI: 23-67%) at 6 months for patients with aGVHD (62 vs 28% in responders vs non-responders) and 81% (CI: 63-89%) at 1 year for patients with cGVHD (83 vs 76% in responders vs non-responders). Ruxolitinib in the real life setting is an effective and safe treatment option for GVHD, with an ORR of 69.5% and 57.1% for refractory acute and chronic graft-versus-host disease, respectively, in heavily pretreated patients

Automatic extraction of shorelines from Landsat TM and ETM+ multi-temporal images with subpixel precision

A high precision geometric method for automated shoreline detection from Landsat TM and ETM+ imagery is presented. The methodology is based on the application of an algorithm that ensures accurate image geometric registration and the use of a new algorithm for sub-pixel shoreline extraction, both at the sub-pixel level. The analysis of the initial errors shows the influence that differences in reflectance of land cover types have over shoreline detection, allowing us to create a model to substantially reduce these errors. Three correction models were defined according to the type of gain used in the acquisition of the original Landsat images. Error assessment tests were applied on three artificially stabilised coastal segments that have a constant and well-defined land-water boundary. A testing set of 45 images (28 TM, 10 ETM high-gain and 7 ETM low-gain) was used. The mean error obtained in shoreline location ranges from 1.22 to 1.63. m, and the RMSE from 4.69 to 5.47. m. Since the errors follow a normal distribution, then the maximum error at a given probability can be estimated. The results confirm that the use of Landsat imagery for detection of instantaneous coastlines yields accuracy comparable to high-resolution techniques, showing the potential of Landsat TM and ETM images in those applications where the instantaneous lines are a good geomorphological descriptor. © 2012 Elsevier Inc.The authors appreciate the financial support provided by the Spanish Ministerio de Ciencia e Innovacion and the Spanish Plan E in the framework of the Projects CGL2009-14220-C02-01 and CGL2010-19591.Pardo Pascual, JE.; Almonacid Caballer, J.; Ruiz Fernández, LÁ.; Palomar-Vázquez, J. (2012). Automatic extraction of shorelines from Landsat TM and ETM+ multi-temporal images with subpixel precision. Remote Sensing of Environment. 123:1-11. doi:10.1016/j.rse.2012.02.024S11112

A Cloud Architecture for the Execution of Medical Imaging Biomarkers

Digital Medical Imaging is increasingly being used in clinical routine and research. As a consequence, the workload in medical imaging departments in hospitals has multiplied by over 20 in the last decade. Medical Image processing requires intensive computing resources not available at hospitals, but which could be provided by public clouds. The article analyses the requirements of processing digital medical images and introduces a cloud-based architecture centred on a DevOps approach to deploying resources on demand, adjusting them based on the request of resources and the expected execution time to deal with an unplanned workload. Results presented show a low overhead and high flexibility executing a lung disease biomarker on a public cloud.The work in this article has been co-funded by project SME Instrument Phase II - 778064, QUIBIM Precision, funded by the European Commission under the INDUSTRIAL LEADERSHIP - Leadership in enabling and industrial technologies - Information and Communication Technologies (ICT), Horizon 2020, project ATMOSPHERE, funded jointly by the European Commission under the Cooperation Programme, Horizon 2020 grant agreement No 777154 and the Brazilian Ministerio de Ciencia, Tecnologia e Inovacao (MCTI), number 51119. The authors would like also to thank the Spanish Ministerio de Economia, Industria y Competitividad¿ for the project BigCLOE with reference number TIN2016-79951-R.López-Huguet, S.; García-Castro, F.; Alberich-Bayarri, A.; Blanquer Espert, I. (2019). A Cloud Architecture for the Execution of Medical Imaging Biomarkers. 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Peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome in COVID-19 patients admitted to intermediate respiratory and intensive care units

Background: COVID-19 is primarily a respiratory disease; however, there is also evidence that it causes endothelial damage in the microvasculature of several organs. The aim of the present study is to characterize in vivo the microvascular reactivity in peripheral skeletal muscle of severe COVID-19 patients. Methods: this is a prospective observational study carried out in Spain, Mexico and Brazil. Healthy subjects and severe COVID-19 patients admitted to the intermediate respiratory (IRCU) and intensive care units (ICU) due to hypoxemia were studied. Local tissue/blood oxygen saturation (StO2) and local hemoglobin concentration (THC) were non-invasively measured on the forearm by near-infrared spectroscopy (NIRS). A vascular occlusion test (VOT), a three-minute induced ischemia, was performed in order to obtain dynamic StO2 parameters: deoxygenation rate (DeO2), reoxygenation rate (ReO2), and hyperemic response (HAUC). In COVID-19 patients, the severity of ARDS was evaluated by the ratio between peripheral arterial oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) (SF ratio). Results: healthy controls (32) and COVID-19 patients (73) were studied. Baseline StO2 and THC did not differ between the two groups. Dynamic VOT-derived parameters were significantly impaired in COVID-19 patients showing lower metabolic rate (DeO2) and diminished endothelial reactivity. At enrollment, most COVID-19 patients were receiving invasive mechanical ventilation (MV) (53%) or high-flow nasal cannula support (32%). Patients on MV were also receiving sedative agents (100%) and vasopressors (29%). Baseline StO2 and DeO2 negatively correlated with SF ratio, while ReO2 showed a positive correlation with SF ratio. There were significant differences in baseline StO2 and ReO2 among the different ARDS groups according to SF ratio, but not among different respiratory support therapies. Conclusion: patients with severe COVID-19 show systemic microcirculatory alterations suggestive of endothelial dysfunction, and these alterations are associated with the severity of ARDS. Further evaluation is needed to determine whether these observations have prognostic implications. These results represent interim findings of the ongoing HEMOCOVID-19 trial. Trial registration ClinicalTrials.gov NCT04689477 . Retrospectively registered 30 December 2020.The study has received funding from Fundació CELLEX Barcelona, Fundació Mir-Puig, Ajuntament de Barcelona, Agencia Estatal de Investigación (PHOTOMETABO, PID2019-106481RB-C31/10.13039/501100011033), the "Severo Ochoa" Programme for Centers of Excellence in R&D (CEX2019-000910-S), the Obra social “La Caixa” Foundation (LlumMedBcn), Generalitat de Catalunya (CERCA, AGAUR-2017-SGR-1380, RIS3CAT-001-P-001682 CECH), European Commission Horizon 2020 (FEDER, 688303/LUCA, 101016087/VASCOVID, 87114/LASERLAB-EUROPE V). We also acknowledge the collaboration and an instrument loan from Artinis (Netherlands)