Beam hardening artifact reduction using dual energy computed tomography: implications for myocardial perfusion studies

Background: Myocardial perfusion computed tomography (CTP) using conventional single energy (SE) imaging is influenced by the presence of beam hardening artifacts (BHA), occasionally resembling perfusion defects and commonly observed at the left ventricular posterobasal wall (PB). We therefore sought to explore the ability of dual energy (DE) CTP to attenuate the presence of BHA. Methods: Consecutive patients without history of coronary artery disease who were referred for computed tomography coronary angiography due to atypical chest pain and a normal stress-rest SPECT and had absence or mild coronary atherosclerosis constituted the study population. The study group was acquired using DE and the control group using SE imaging. Results: Demographical characteristics were similar between groups, as well as the heart rate and the effective radiation dose. Myocardial signal density (SD) levels were evaluated in 280 basal segments among the DE group (140 PB segments for each energy level from 40 keV to 100 keV; and 140 reference segments), and in 40 basal segments (at the same locations) among the SE group. Among the DE group, myocardial SD levels and myocardial SD ratio evaluated at the reference segment were higher at low energy levels, with significantly lower SD levels at increasing energy levels. Myocardial signal-to-noise ratio was not significantly influenced by the energy level applied, although 70 keV was identified as the energy level with the best overall signal-to-noise ratio. Significant differences were identified between the PB segment and the reference segment among the lower energy levels, whereas at ≥ 70 keV myocardial SD levels were similar. Compared to DE reconstructions at the best energy level (70 keV), SE acquisitions showed no significant differences overall regarding myocardial SD levels among the reference segments. Conclusions: Beam hardening artifacts that influence the assessment of myocardial perfusion can be attenuated using DE at 70 keV or higher.Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina. Diagnóstico Maipú; ArgentinaFil: Carrascosa, Patricia. Diagnóstico Maipú; ArgentinaFil: Cipriano, Silvia. Diagnóstico Maipú; ArgentinaFil: De Zan, Macarena. Diagnóstico Maipú; ArgentinaFil: Deviggiano, Alejandro. Diagnóstico Maipú; ArgentinaFil: Capunay, Carlos. Diagnóstico Maipú; ArgentinaFil: Cury, Ricardo C.. Miami Cardiac and Vascular Institute and Baptist Health; Estados Unido

Multifunctional albumin-stabilized gold nanoclusters for the reduction of cancer stem cells

Controlled delivery of multiple chemotherapeutics can improve the effectiveness of treatments and reduce side effects and relapses. Here in, we used albumin-stabilized gold nanoclusters modified with doxorubicin and SN38 (AuNCs-DS) as combined therapy for cancer. The chemotherapeutics are conjugated to the nanostructures using linkers that release them when exposed to different internal stimuli (Glutathione and pH). This system has shown potent antitumor activity against breast and pancreatic cancer cells. Our studies indicate that the antineoplastic activity observed may be related to the reinforced DNA damage generated by the combination of the drugs. Moreover, this system presented antineoplastic activity against mammospheres, a culturing model for cancer stem cells, leading to an efficient reduction of the number of oncospheres and their size. In summary, the nanostructures reported here are promising carriers for combination therapy against cancer and particularly to cancer stem cells.This research was funded by the Spanish Ministry of Economy and Competitiveness (CTQ2016-78454-C2-2-R, SAF2014-56763-R, and SAF2017-87305-R), Comunidad de Madrid (S2013/MIT-2850), Asociación Española Contra el Cáncer, and IMDEA Nanociencia IMDEA Nanociencia acknowledges support from the ‘Severo Ochoa’ Programme for Centres of Excellence in R&D (MINECO, Grant SEV-2016-0686

Extracorporeal membrane oxygenation improves survival in a novel 24-hour pig model of severe acute respiratory distress syndrome

Indexación: Web of Science; Pub Med CentralExtracorporeal membrane oxygenation (ECMO) is increasingly being used to treat severe acute respiratory distress syndrome (ARDS). However, there is limited clinical evidence about how to optimize the technique. Experimental research can provide an alternative to fill the actual knowledge gap. The purpose of the present study was to develop and validate an animal model of acute lung injury (ALI) which resembled severe ARDS, and which could be successfully supported with ECMO. Eighteen pigs were randomly allocated into three groups: sham, ALI, and ALI + ECMO. ALI was induced by a double-hit consisting in repeated saline lavage followed by a 2-hour period of injurious ventilation. All animals were followed up to 24 hours while being ventilated with conventional ventilation (tidal volume 10 ml/kg). The lung injury model resulted in severe hypoxemia, increased airway pressures, pulmonary hypertension, and altered alveolar membrane barrier function, as indicated by an increased protein concentration in bronchoalveolar fluid, and increased wet/dry lung weight ratio. Histologic examination revealed severe diffuse alveolar damage, characteristic of ARDS. Veno-venous ECMO was started at the end of lung injury induction with a flow > 60 ml/kg/min resulting in rapid reversal of hypoxemia and pulmonary hypertension. Mortality was 0, 66.6 and 16.6% in the SHAM, ALI and ALI + ECMO groups, respectively (p < 0.05). This is a novel clinically relevant animal model that can be used to optimize the approach to ECMO and foster translational research in extracorporeal lung support.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931177

Activation of Endothelial Nitric Oxide (eNOS) Occurs Through Different Membrane Domains in Endothelial Cells.

Endothelial cells respond to a large range of stimuli including circulating lipoproteins, growth factors and changes in haemodynamic mechanical forces to regulate the activity of endo- thelial nitric oxide synthase (eNOS) and maintain blood pressure. While many signalling pathways have been mapped, the identities of membrane domains through which these sig- nals are transmitted are less well characterized. Here, we manipulated bovine aortic endo- thelial cells (BAEC) with cholesterol and the oxysterol 7-ketocholesterol (7KC). Using a range of microscopy techniques including confocal, 2-photon, super-resolution and electron microscopy, we found that sterol enrichment had differential effects on eNOS and caveolin- 1 (Cav1) colocalisation, membrane order of the plasma membrane, caveolae numbers and Cav1 clustering. We found a correlation between cholesterol-induced condensation of the plasma membrane and enhanced high density lipoprotein (HDL)-induced eNOS activity and phosphorylation suggesting that cholesterol domains, but not individual caveolae, mediate HDL stimulation of eNOS. Vascular endothelial growth factor (VEGF)-induced and shear stress-induced eNOS activity was relatively independent of membrane order and may be predominantly controlled by the number of caveolae on the cell surface. Taken together, our data suggest that signals that activate and phosphorylate eNOS are transmit- ted through distinct membrane domains in endothelial cell

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

Treatment alternatives for dry mouth : a scoping review

Saliva is a biological fluid essential for the maintenance of a proper oral health. Its absence predisposes to differences pathologies, including dental caries, fungal infections among many others, significantly affecting the oral health related quality

Valor de la PET en la recurrencia del cáncer de próstata con PSA < 5 ng/ml

We intend to evaluate the usefulness of PET scans in diagnosing recurrent prostate cancer after a curative attempt using radical treatment. MATERIAL AND METHODS: 92 consecutive prostate cancer patients in biochemical progression following radical surgery (63) or radiation treatment (29) were studied with positron emission tomography (PET). In all cases two scans were performed in the same day (11C-choline and 18F-FDG). PET efficacy was evaluated both globally (by employing the results achieved with both 11C-choline and 18F-FDG) and using both radiotracers independently to detect recurrence in patients with biochemical progression. For this purpose, we used comparison of means for k-independent samples, 2 x 2 and 2 x X contingency tables and ROC curves. RESULTS: 1. Global PET: there is evidence of PET alteration regarding the PSA level (P=.003): the clinical stage (P=.01). There are no statistically significant PET alterations regarding the affected biopsy (uni or bilateral), surgical margins, pathological stage and time to progression. ROC curve PET-PSA is statistically significant (P< .0001) permitting calculation of different cut-off points, with a specificity of 91% (highest) for a PSA of 4.3 ng/ml. 2. PET 18FDG: the area under the ROC curve is statistically significant (P< .0001) with a specificity of 91% for a PSA of 6.51 ng/ml. 3. PET 11choline: the area under the ROC curve is statistically significant (P< .0001) with a specificity of 91% for a PSA of 5.15 ng/ml. CONCLUSIONS: PET is a useful tool for diagnosing prostate cancer recurrence after a curative attempt using radical treatment

Computer physician order entry (CPOE) as a strategy to estimate laboratory activity and costs associated with cancer clinical trials

Introduction: Most of clinical laboratories are not properly reimbursed for their activity related to clinical trials (CTs) conducted in their institutions due to a lack of measurement strategies. We implemented a specific computer physician order entry (CPOE) environment for CTs in order to facilitate ordering to providers and estimate the associated costs to be compared with the standard of care (SOC). Materials and methods: Four specific electronic formularies, restricted to two new virtual CTs clinical services (onco - CT and haemo - CT), were implemented in January 2015. For each clinical trial displayed in the panels there were several box-cells that contained several profiles based on the different phase of the trials. Tests included in the profiles were the tests required by protocol. Laboratory costs (€) per patient were compared between the CTs services and their regular outpatients clinical services (onco - Out and haemo - Out, considered the SOC) for three years. Results: Costs per patient were higher for CTs services and increased progressively each year (25%, 70% and 70% and 0.6%, 2.7% and 17% in 2015, 2016 and 2017 for Oncology and Haematology, respectively). Taking into account all these differences and the number of patients attending a total difference in expense of + 130,377.7 € for the period 2015-2017 was obtained between CTs and outpatients services. Conclusions: Strategies through CPOE systems based on restricted and specific profiles for CTs ordering are a promising tool that can improve laboratory associated costs estimation and provide robust evidence in reimbursement negotiation processes with CTs sponsors

La clase invertida en los estudios universitarios de Economía

En este trabajo presentamos una nueva metodología docente a nivel universitario en los estudios de Economía. Hace años comenzamos a utilizar videos docentes a modo de complemento en clase, sin embargo la flipped classroom nos hizo plantearnos una nueva forma de enseñanza, invirtiendo los papeles: el alumno toma el papel protagonista, estudiando en casa con ayuda del material proporcionado por el profesor y aprovecha el tiempo de clase para resolver ejercicios, dudas y trabajar en equipo. Si bien esta metodología ha sido llevada a cabo con éxito en diversos niveles educativos no universitarios, en nuestra realidad, hemos tenido que adaptarla, incorporando elementos adicionales.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech