FDG-PET: a new diagnostic approach in hip prosthesis infection

Infection following hip arthroplasties can present a diagnostic challenge. No test is 100 % sensitive and 100 % specific; this prospective study was undertaken to evaluate the utility of FDG-PET imaging for diagnosing infected joint replacements. 24 hip joint replacements were studied prospectively and we have complete diagnoses with clinical signs and symptoms, laboratory test, radiography, joint aspiration, radionuclide imaging including FDG-PET, and histopathologic examination. 11 of 24 prostheses were infected. The sensitivity and specificity of PET for detecting infection associated with prostheses were 64,3 % and 64,7 % respectively, in our hands. FDG imaging is not useful in patients with suspected prosthetic infection like a screening tes

Single-institution experience in clinical trials during the COVID-19 pandemic in Spain: Not so bad after all?

The impact of the COVID-19 outbreak in Spain during March-April 2020 has been unbalanced throughout the different regions of the country. The alarm status defined by the government on March 14, and still in place at the time of this writing, has transformed the country in different perspectives, including care of patients with cancer.1 In many centers, clinical trial activity was suspended, because it was not considered a priority under the health care challenge of the COVID-19 pandemic.2 Nevertheless, experimental therapy is the only and/or best therapeutic option for many patients with cancer

Tumor necrosis factor-alpha inhibition reduces CXCL-8 levels but fails to prevent fibrin generation and does not improve outcome in a rabbit model of endotoxic shock

The effects of a monoclonal antibody (mAb) to tumor necrosis factor-alpha (TNF-alpha) were examined in a rabbit model of endotoxic shock. Intravenous administration of lipopolysaccharide (100 microg/kg/hr) for 6 hours (n = 11) increased TNF-alpha levels. Fibrinogen was partially consumed, and fibrin deposits were seen in kidney and lungs at 24 hours. Mortality at 24 hours was 64%. Levels of interleukin-8 (aka CXCL-8) were notably increased. Mean arterial pressure (MAP) and leukocyte counts decreased, whereas creatinine levels were enhanced. The anti-TNF-alpha mAb (20 mg/kg i.v. bolus + 5 mg/kg/h i.v. for the first 90 minutes) (n = 10) efficiently inhibited the TNF-activity. Rabbits exhibited lower CXCL-8 levels; MAP improved, the decrease in leukocyte counts was partially prevented and creatinine levels were lower, but fibrinogen, fibrin deposits in kidneys and lungs and mortality, 55%, were similar to the LPS group. Rabbits that did not survive exhibited lower fibrinogen levels, more fibrin in kidneys and lungs and higher CXCL-8 and creatinine levels than survivors, while there were no differences in TNF-alpha, MAP and leukocytes. Thus, the inhibition of TNF-alpha, although beneficial through lowering CXCL-8 levels, is not enough to improve the outcome, which could be partly due to the inability to prevent the fibrin deposits formation in kidneys and lungs

Analysis of the key features of the seismic actions due to the three main earthquakes of May 11, 2011 in Lorca, Spain

The seismic records are in general valuable information, especially in cases where damage in buildings has occurred. The main purpose of the present document is to describe the principal results of the analysis of features of ground motions due to the main three earthquakes that occurred in Spain on May 11, 2011. In this day the major earthquake had a magnitude of 5.1 Mw. This event triggered different levels of damage in numerous buildings in the city of Lorca located in southern Spain. Unfortunately, 9 persons died due mainly to the collapse of non-structural elements. We describe in the present paper the application of the software Seismograms Analyzer-e (SA-e) to perform the processing and the analysis of the seismic records obtained in five stations during the main three earthquakes on May 11 (the largest earthquake of magnitude 5.1 Mw, the precursor of magnitude 4.5 Mw, and the aftershock of magnitude 3.9 Mw). We also highlight the significant similitudes between the seismograms generated in the LOR station during these three earthquakes. Additionally, we determined the values of acceleration that occurred in the roof of the buildings of Lorca, because these values of acceleration contributed both to the damage of numerous buildings and the collapse of several parapets of some buildings. The analysis of these accelerations is relevant because the collapse of some parapets was the cause of the death of the 9 people that died during the main earthquake. For example, according to our study in the roof of a building with a fundamental period of 0.25 s the acceleration could have reached values near to 1.04 g. We also analyzed the potential of damage in function of the values of CAVSTD. Additionally, we determined hypothetical seismic forces for the design of parapets in buildings of Lorca considering the NCSE-02 normative, and the values of Sa based on the seismic records. We determined a significant difference between the seismic forces that could have been used to design the parapets of the buildings in the Lorca city and the forces determined according to the values of PGA that were proposed in a recent study of seismic hazard for Spain.The first author acknowledges to CONACYT, Barcelona Supercomputing Center, and to the Universidad Veracruzana by their contribution to the development of the present study. Complementary information about Seismograms Analyzer-e is available on the WEB page of SA-e2 . .Peer ReviewedPostprint (published version

Use of colonoscopy as a primary screening test for colorectal cancer in average risk people

The use of colonoscopy as a primary screening test for colorectal cancer (CRC) in average risk adults is a subject of controversy. Our primary objective was to build a predictive model based on a few simple variables that could be used as a guide for identifying average risk adults more suitable for examination with colonoscopy as a primary screening test. METHODS: The prevalence of advanced adenomas was assessed by primary screening colonoscopy in 2210 consecutive adults at least 40 yr old, without known risk factors for CRC. Age, gender, and clinical and biochemical data were compared among people without adenomas, those with non-advanced adenomas, and those with any advanced neoplasm. A combined score to assess the risk of advanced adenomas was built with the variables selected by multiple logistic regression analysis. RESULTS: Neoplastic lesions were found in 617 subjects (27.9%), including 259 with at least one neoplasm that was 10 mm or larger, villous, or with moderate-to-severe dysplasia, and 11 with invasive cancers. Advanced lesions were more frequent among men, older people, and those with a higher body mass index (BMI). These three variables were independent predictors of advanced adenomas in multivariate analysis. A score combining age, sex, and BMI was developed as a guide for identifying individuals more suitable for screening colonoscopy. CONCLUSIONS: Age, gender, and BMI can be used to build a simple score to select those average risk adults who might be candidates for primary screening colonoscop

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

For colorectal cancer screening, the predictive value of distal findings in the ascertainment of proximal lesions is not fully established. The aims of this study were to assess distal findings as predictors of advanced proximal neoplasia and to compare the predictive value of endoscopy alone vs. combined endoscopic and histopathologic data. METHODS: Primary colonoscopy screening was performed in 2210 consecutive, average-risk adults. Age, gender, endoscopic (size, number of polyps), and histopathologic distal findings were used as potential predictors of advanced proximal neoplasms (i.e., any adenoma > or =1 cm in size, and/or with villous histology, and/or with severe dysplasia or invasive cancer). Polyps were defined as distal if located in the descending colon, the sigmoid colon, or the rectum. Those in other locations were designated proximal. RESULTS: Neoplastic lesions, including 11 invasive cancers, were found in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not associated with any distal polyp. Older age, male gender, and distal adenoma were independent predictors of advanced proximal neoplasms. The predictive ability of a model with endoscopic data alone did not improve after inclusion of histopathologic data. In multivariate logistic regression analysis, the predictive ability of models that use age, gender, and any combination of distal findings was relatively low. The proportion of advanced proximal neoplasms identified if any distal polyp was an indication for colonoscopy was only 62%. CONCLUSIONS: A strategy in which colonoscopy is performed solely in patients with distal colonic findings is not effective screening for the detection of advanced proximal neoplasms in an average-risk populatio

Transcatheter heart valve selection and permanent pacemaker implantation in patients with pre-existent right bundle branch block

Background-Right bundle branch block is an established predictor for new conduction disturbances and need for a permanent pacemaker (PPM) after transcatheter aortic valve replacement. The aim of the study was to evaluate the absolute rates of transcatheter aortic valve replacement related PPM implantations in patients with pre-existent right bundle branch block and categorize for different transcatheter heart valves. Methods and Results-We pooled data on 306 transcatheter aortic valve replacement patients from 4 high-volume centers in Europe and selected those with right bundle branch block at baseline without a previously implanted PPM. Logistic regression was used to evaluate whether PPM rate differed among transcatheter heart valves after adjustment for confounders. Mean age was 83±7 years and 63% were male. Median Society of Thoracic Surgeons score was 6.3 (interquartile range, 4.1-10.2). The following transcatheter valve designs were used: Medtronic CoreValve (n=130; Medtronic, Minneapolis, MN); Edwards Sapien XT (ES-XT; n=124) and Edwards Sapien 3 (ES-3; n=32; Edwards Lifesciences, Irvine, CA); and Boston Scientific Lotus (n=20; Boston Scientific Corporation, Marlborough, MA). Overall permanent pacemaker implantation rate post-transcatheter aortic valve replacement was 41%, and per valve design: 75% with Lotus, 46% with CoreValve, 32% with ES-XT, and 34% with ES-3. The indication for PPM implantation was total atrioventricular block in 98% of the cases. Lotus was associated with a higher PPM rate than all other valves. PPM rate did not differ between ES-XT and ES-3. Ventricular paced rhythm at 30-day and 1-year follow-up was present in 81% at 89%, respectively. Conclusions-Right bundle branch block at baseline is associated with a high incidence of PPM implantation for all transcatheter heart valves. PPM rate was highest for Lotus and lowest for ES-XT and ES-3. Pacemaker dependency remained high during followup