RING Program: The CFAR Diversity, Equity, and Inclusion Pathway Initiative.

BACKGROUND: Case Western Reserve University (CWRU)/University Hospitals Cleveland Medical Center in Cleveland, OH, and the University of Pittsburgh (Pitt) in Pittsburgh, PA, forged a strategic alliance to form the Rustbelt Center for AIDS Research. The Rustbelt Center for AIDS Research developed a National Institutes of Health-supported diversity, equity, and inclusion pathway initiative termed the "Rustbelt Investigators for the Next Generation (RING) Program" that provides research training experiences for Puerto Rican students that will help them pursue a biomedical research career in HIV. SETTING: The RING Program provides 10-week research training experiences in different disciplines of HIV/AIDS for under-represented minority undergraduate and masters students from 4 campuses (Río Piedras, Mayagüez, Humacao, and Cayey) at the University of Puerto Rico. Mentors are drawn from both CWRU and Pitt. RESULTS: The RING Program recently completed our first wave of recruitment. Recruitment sessions were either virtual or on site at the University of Puerto Rico campuses and included an overview presentation, a Q&A session, and in-person interviews. We interviewed 32 eligible applicants and accepted 10 into the program, of which 9 were female. Five students were matched with faculty at CWRU and 5 with faculty at Pitt. CONCLUSIONS: The RING Program is a comprehensive program in laboratory and implementation science that aims to enhance under-represented Hispanic undergraduate and masters students' passion for pursuing a biomedical research career in HIV.

Inferior Vena Cava Filters: Adherence to Clinical Practice Guidelines Recommendations, Retrieval Rates, and Filter Complications in a Tertiary Hospital.

The present study evaluated the adherence to guideline recommendations regarding the indication for inferior vena cava filter (IVCF) placement, retrieval rates, complications, thrombotic recurrences, and mortality. Patients in whom an IVCF was placed between 2015 and 2020 in a tertiary hospital were retrospectively included. We considered absolute indication of IVCF placement if all the guidelines evaluated agreed on the indication, relative indication if only some guidelines recommended it and without indication if none of the evaluated guidelines recommended it. From the 185 patients included; 47% had an absolute indication, 15% a relative indication, and 38% had no indication. Filter-associated complications and non-removal rates were 12.4% and 41%, respectively. Venous thromboembolism recurrence rate was 17.8%, being filter-associated complications (24.2 vs 9.8%, P = .02) and thrombosis of the inferior cava or iliac veins (12.1 vs 2.6%, P = .03) more frequent in this group. The mortality rate was 40%, with higher mortality risk in patients with co-existing cancer. Previous major bleeding, filter-associated complications, and mortality were associated with a major risk of non-removal. In conclusion, the adherence to guidelines regarding the indication of IVCF placement is still low and IVCF complications are not negligible. This fact is of special concern in the elderly, comorbid, and cancer patients.

Percutaneous transhepatic biliary drainage for biliary obstruction in perihilar cholangiocarcinoma: a 10-year analysis of safety and outcomes using the CCI index.

PURPOSE: To evaluate percutaneous transhepatic biliary drainage (PTBD) safety and efficacy in patients with perihilar cholangiocarcinoma (PCCA). METHODS: This retrospective observational study included patients with PCCA and obstructive cholestasis referred for a PTBD in our institution between 2010 and 2020. Technical and clinical success rates and major complication and mortality rates one month after PTBD were used as main variables. Patients were divided and analyzed into two groups: > 30 and < 30 Comprehensive Complication Index (CCI). We also evaluated post-surgical outcomes in patients undergoing surgery. RESULTS: Out of 223 patients, 57 were included. Technical success rate was 87.7%. Clinical success at 1 week was 83.6%, before surgery 68.2%, 80.0% at 2 weeks and 86.7% at 4 weeks. Mean total bilirubin (TBIL) values were 15.1 mg/dL (baseline), 8.1 mg/dL one week after PTBD), 6.1 mg/dL (2 weeks) and 2.1 mg/dL (4 weeks). Major complication rate was 21.1%. Three patients died (5.3%). Risk factors for major complications after the statistical analysis were: Bismuth classification (p = 0.01), tumor resectability (p = 0.04), PTBD clinical success (p = 0.04), TBIL 2 weeks after PTBD (p = 0.04), a second PTBD (p = 0.01), total PTBDs (p = 0.01) and duration of drainage (p = 0.03). Major postoperative complication rate in patients who underwent surgery was 59.3%, with a median CCI of 26.2. CONCLUSION: PTBD is safe and effective in the management of biliary obstruction caused by PCCA. Bismuth classification, locally advanced tumors, and failure to achieve clinical success in the first PTBD are factors related to major complications. Our sample reported a high major postoperative complication rate, although with an acceptable median CCI.

Perspectives for yttrium-90 radioembolization as therapeutic option for hepatocellular carcinoma.

The therapeutic management of hepatocellular carcinoma (HCC) has achieved great advances in the past few years. Before the publication of the SHARP clinical trial, which showed the effectiveness of sorafenib in patients with advanced HCC, no effective systemic therapy was available and only transarterial chemoembolization (TACE) had shown an impact on survival in clinical trials.

Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes.

BACKGROUND: Ichthyosis is a heterogeneous group of diseases caused by genetic disorders related to skin formation. They are characterized by generalized dry skin, scaling, hyperkeratosis and frequently associated with erythroderma. Among its different types, harlequin ichthyosis (HI) stands out due to its severity. HI is caused by mutations in the ABCA12 gene, which encodes essential proteins in epidermal lipid transport, and it helps maintain the homeostasis of the stratum corneum of the epidermis. However, due to the wide spectrum of genetic alterations that can cause ichthyosis, holistic medical care, and genetic studies are required to improve the diagnosis and outcomes of these diseases. CASE PRESENTATION: Here, we presented the case of a 19 years old male patient who was a premature infant and exhibited clinical features consistent with HI, including bright yellow hyperkeratotic plates with erythematous fissures that covered his entire body like a collodion baby. Currently, he exhibited erythroderma, photosensitivity, ectropion, auricular pavilion alterations, and musculoskeletal disorders, such as equinovarus feet, fingers, hands, and hypoplastic feet with contractures in flexion and marked difficulty in fine motor skills. In addition, he presented dyschromatopsia, Achilles reflex hyporeflexia, slight speech, dental alteration and deficient cognitive performance. After the genetic sequencing, variants were found in ABCA12 and HRNR which are related to several skin diseases, including ichthyosis. CONCLUSIONS: Although in clinical practice, ichthyosis is a common entity, a severe type of ichthyosis is presented, highlighting the importance of appropriate genetic diagnosis, given the broad spectrum of genetic alterations with similar phenotypic and clinical characteristics. These pathologies must be known to guarantee initial support measures to prevent complications and offer multidisciplinary management to those patients.

Reestructuración del funcionamiento de la Unidad de Hospitalización a Domicilio del Hospital Universitario Germans Trias I Pujol para el manejo de pacientes COVID y no COVID ingresados durante la pandemia del COVID-19 en España / Restructuring the Operation of the Home Care Unit of the Germans Trias I Pujol University Hospital for the management of patients COVID and no COVID Admitted during the COVID-19 Pandemic in Spain

INTRODUCCIÓN: La Unidad de Hospitalización a Domicilio del Hospital Universitari Germans Trias I Pujol, ante la grave situación sanitaria generada por el COVID-19 optó por varias estrategias para la atención de los pacientes ingresados con o sin diagnóstico de COVID optimizando los recursos de atención sanitaria. MÉTODO: Estudio descriptivo sobre la reorganización de la Unidad de Hospitalización a Domicilio (UHAD) durante la pandemia del COVID-19 en el período comprendido entre el 14 de Marzo y 31 de Mayo del 2020. Una ampliación del número de camas virtuales, así como de los turnos e incorporación de personal sanitario (médico/enfermeros) fue necesario, activándose paralelamente 2 plataformas de telemedicina para monitorización y contacto con los pacientes (COVIDApp para los pacientes COVID y Revita para los pacientes no COVID). RESULTADOS: Un total de 781 pacientes referidos del área de hospitalización, urgencias y atención primaria fueron incluidos, 584 (74,8%) ingresados con diagnóstico de COVID-19 (por PCR = polymerase chain reaction) y 197 (25,2%) pacientes ingresados por otras patologías (no-COVID) provenientes de la zona Metropolitana Nord de Barcelona y Maresme. Un 24,6% de los pacientes no-COVID y un 2,5% de los pacientes COVID eran pacientes crónicos complejos. El porcentaje de reingreso hospitalario fue mayor en los pacientes no-COVID (11.6%) que en los pacientes COVID (4,28%). El porcentaje de altas de la UHAD aumentó hasta un 35,34%. Ambas plataformas permitieron realizar seguimiento estrecho de los pacientes. CONCLUSIONES: La pandemia del COVID-19 ha remarcado la necesidad de optimizar y reestructurar los recursos del sistema sanitario, siendo las plataformas de Telemedicina COVIDApp y Revita de ayuda como herramientas innovadoras

INTRODUCTION: The COVID-19 pandemic made that the Home Care Unit of the Germans Trias I Pujol University Hospital implement strategies for the management of patients admitted with or without COVID-19, optimizing health care resources. METHOD: A descriptive study of patients with and without COVID-19 was conducted between March 14th and May 31th, 2020. An increase in the number of virtual beds, as well as extension of working hour and incorporation of personnel health (doctor/nurses) was necessary, activating 2 telemedicine platforms for monitoring of patients (COVIDApp for COVID patients and Revita for non-COVID patients). RESULTS: A total of 781 patients referred from the hospitalization, emergency and primary care were included, 584 (74.8%) admitted with a diagnosis of COVID-19 (by PCR) and 197 (25.2%) patients admitted by other pathologies (non-COVID) from the Nord Metropolitan area of Barcelona and Maresme. 24.6% of non-COVID patients and 2.5% of COVID patients were complex chronic patients. The percentage of hospital readmission was higher in non-COVID patients (11.6%) than in COVID patients (4.28%). The percentage of discharges from the UHAD increased to 35.34%. Both platforms allowed for close monitoring of patients. CONCLUSIONS: The COVID-19 pandemic has highlighted the need to optimize and restructure the resources of the health system, with the Telemedicine platforms COVIDApp and Revita as innovative tools

14-Helical ß-Peptides Elicit Toxicity against C. albicans by Forming Pores in the Cell Membrane and Subsequently Disrupting Intracellular Organelles.

Synthetic peptidomimetics of antimicrobial peptides (AMPs) are promising antimicrobial drug candidates because they promote membrane disruption and exhibit greater structural and proteolytic stability than natural AMPs. We previously reported selective antifungal 14-helical ß-peptides, but the mechanism of antifungal toxicity of ß-peptides remains unknown. To provide insight into the mechanism, we studied antifungal ß-peptide binding to artificial membranes and living Candida albicans cells. We investigated the ability of ß-peptides to interact with and permeate small unilamellar vesicle models of fungal membranes. The partition coefficient supported a pore-mediated mechanism characterized by the existence of a critical ß-peptide concentration separating low- and high-partition coefficient regimes. Live cell intracellular tracking of ß-peptides showed that ß-peptides translocated into the cytoplasm, and then disrupted the nucleus and vacuole sequentially, leading to cell death. This understanding of the mechanisms of antifungal activity will facilitate design and development of peptidomimetic AMPs, including 14-helical ß-peptides, for antifungal applications.

Diffuse Renal Cortical Hemorrhage in the Setting of Subcapsular Hematoma: Diagnosis and Treatment with Embolization.

PURPOSE: To describe radiologic findings, embolization technique, and clinical outcomes in patients with renal subcapsular hematoma and diffuse cortical hemorrhage. MATERIALS AND METHODS: Ten patients with renal subcapsular hematoma and diffuse cortical hemorrhage were reviewed. Nine of the 10 had undergone procedures (nephrostomy, n = 4; biopsy, n = 4; embolization of a cerebral aneurysm, n = 1) and 1 patient was receiving oral anticoagulation. Computed tomography (CT), angiography, and embolization of bleeding sites were performed in all patients. RESULTS: CT and angiography revealed subcapsular hematoma with diffuse cortical hemorrhage at the level of the interlobar and/or arcuate branches. Total embolization of intrarenal arterial branches was required in 3 patients. Partial embolization, which also resulted in permanent functional loss, was required in 4. The functional loss was likely caused by the embolization procedure and the underlying renal disease. In these 4 patients, renal failure was demonstrated by scintigraphy in 3 cases and based on the need to start chronic hemodialysis in 1 case. In the remaining three patients, embolization did not compromise renal function. CONCLUSIONS: Diffuse cortical hemorrhage unrelated to the site of puncture may be seen in some cases of subcapsular hematoma. The cause is likely the laceration of transcortical capsular arteries secondary to enlargement of the subcapsular hematoma. In the present case series, embolization achieved hemorrhage control, but loss of renal function was observed in patients with underlying renal disease.

Endovascular Revascularization of Hemodialysis Thrombosed Grafts with the Hydrodynamic Thrombectomy Catheter. Our 7-Year Experience.

PURPOSE: To evaluate the efficacy and safety of the hydrodynamic thrombectomy catheter (AngioJet DVX) in the salvage of thrombosed hemodialysis vascular grafts. MATERIALS AND METHODS: A retrospective study was designed, including all patients with occluded arteriovenous grafts treated with the AngioJet system between 2007 and 2014 in our institution. Outcomes included technical success, clinical success, complications, and primary and secondary patencies. Procedural success was defined as angiographic confirmation of flow restoration, the presence of a pulsatile thrill along the graft, and successful resumption of at least one hemodialysis session. Primary and secondary patencies after first AVG thrombectomy were calculated with Kaplan-Meier curves. Cox regression was used to determine prognostic factors of primary patency after every thrombectomy episode. RESULTS: A total of 149 thrombectomies were performed in 68 grafts. After thrombectomy, endovascular treatment of one or more stenosis was performed in all cases. Technical success was 93% and clinical success was 86%. Complications occurred in 7 thrombectomies, most of them were minor except for one anastomosis rupture requiring surgery. Primary and secondary patencies were 52, 41, and 23 and 76, 68, and 57% at 3, 6 and 12 months, respectively. Independent prognostic factors of poor patency after every thrombectomy episode were the presence of residual thrombus (OR 1.831, P = 0.008) and time from last thrombosis (less than 1 month; and OR 7.116, P < 0.001). CONCLUSION: Percutaneous mechanical thrombectomy with AngioJet is a safe technique with a high-clinical success rate. The presence of residual thrombus after thrombectomy and early re-occlusions are related to poorer results.

Trastorno del comportamiento alimentario de difícil tratamiento: Caso clínico / Eating behavior disorders difficult to treat: A clinical case

La incidencia de los trastornos de la conducta alimentaria (TCA), integrados por la bulimia nerviosa (BN) y la anorexia nerviosa (AN) ha aumentado en los últimos años. Su etiología es multifactorial. Las edades de presentación son cada vez más tempranas, afectando a individuos de ambos sexos. Son trastornos crónicos, que asocian importante morbi-mortalidad y que frecuentemente se presentan con múltiples recaídas. El tratamiento requiere la participación de un equipo multidisciplinario, sin claras evidencias que indiquen la efectividad de diversas estrategias terapéuticas. Se analiza el caso clínico de una adolescente portadora de TCA: AN con componente purgativo. Presentaba varios de los factores de riesgo descriptos para la enfermedad, la forma de presentación fue característica y presentó algunas de las complicaciones más frecuentes. El tratamiento se inició con la paciente hospitalizada, realizando un abordaje multidisciplinario. La respuesta inicial no fue buena, por lo que fue necesario cambiar la estrategia terapéutica. Como objetivo terapéutico principal se planteó el cuidado de la integridad física y mental. Se buscó recuperar el estado nutricional instaurando cambios en la conducta alimentaria.

The incidence of eating behaviour disorders (EBD), represented by bulimia nervosa (BN) and anorexia nervosa (AN) has increased in recent years. Its aetiology is multifactorial. Currently, the age at presentation is increasingly younger, affecting individuals of both sexes. EBDs are chronic disorders, associated with high morbidity and mortality and often present with multiple relapses. Treatment requires the involvement of a multidisciplinary team, although there is no evidence indicating the effectiveness of various treatment strategies. The study presents the case of a EBD carrier teen (AN with purgative component). This patient had several risk factors described for the disease, the presentation was characteristic and presented some of the most frequent complications. Treatment was initiated with hospitalization and a multidisciplinary approach. The initial response was not good, so it was necessary to change the therapeutic strategy. The major therapeutic target was the physical and mental integrity care. Recovery of nutritional status was initiated and sought to establish changes in eating behaviour.

Correction: Hydrophobicity of Antifungal ß-Peptides Is Associated with Their Cytotoxic Effect on In Vitro Human Colon Caco-2 and Liver HepG2 Cells.

[This corrects the article DOI: 10.1371/journal.pone.0149271.].

Magneto-responsive liquid crystalline elastomer nanocomposites as potential candidates for dynamic cell culture substrates.

Recently, liquid crystalline elastomers (LCEs) have been proposed as active substrates for cell culture due to their potential to attach and orient cells, and impose dynamic mechanical signals through the application of external stimuli. In this report, the preparation of anisotropic and oriented nematic magnetic-sensitized LCEs with iron oxide nanoparticles, and the evaluation of the effect of particle addition at low concentrations on the resultant structural, thermal, thermo-mechanical, and mechanical properties is presented. Phase transformations produced by heating in alternating magnetic fields were investigated in LCEs in contact with air, water, and a common liquid cell culture medium was also evaluated. The inclusion of nanoparticles into the elastomers displaced the nematic-to-isotropic phase transition, without affecting the nematic structure as evidenced by similar values of the order parameter, while reducing the maximum thermomechanical deformations. Remote and reversible deformations of the magnetic LCEs were achieved through the application of alternating magnetic fields, which induces the nematic-isotropic phase transition through nanoparticle heat generation. Formulation parameters can be modified to allow for remote actuation at values closer to the human physiological temperature range and within the range of deformations that can affect the cellular behavior of fibroblasts. Finally, a collagen surface treatment was performed to improve compatibility with NIH-3T3 fibroblast cultures, which enabled the attachment and proliferation of fibroblasts on substrates with and without magnetic particles under quiescent conditions. The LCEs developed in this work, which are able to deform and experience stress changes by remote contact-less magnetic stimulation, may allow for further studies on the effect of substrate morphology changes and dynamic mechanical properties during in vitro cell culture.

Hydrophobicity of Antifungal ß-Peptides Is Associated with Their Cytotoxic Effect on In Vitro Human Colon Caco-2 and Liver HepG2 Cells.

The widespread distribution of fungal infections, with their high morbidity and mortality rate, is a global public health problem. The increase in the population of immunocompromised patients combined with the selectivity of currents treatments and the emergence of drug-resistant fungal strains are among the most imperative reasons to develop novel antifungal formulations. Antimicrobial ß-peptides are peptidomimetics of natural antimicrobial peptides (AMPs), which have been proposed as developmental platforms to enhance the AMPs selectivity and biostability. Their tunability allows the design of sequences with remarkable activity against a wide spectrum of microorganisms such as the human pathogenic Candida spp., both in planktonic and biofilm morphology. However, the ß-peptide's effect on surrounding host cells remains greatly understudied. Assessments have mainly relied on the extent of hemolysis that a candidate peptide is able to cause. This work investigated the in vitro cytotoxicity of various ß-peptides in the Caco-2 and HepG2 mammalian cell lines. Results indicated that the cytotoxic effect of the ß-peptides was influenced by cell type and was also correlated to structural features of the peptide such as hydrophobicity. We found that the selectivity of the most hydrophobic ß-peptide was 2-3 times higher than that of the least hydrophobic one, for both cell types according to the selectivity index parameter (IC50/MIC). The IC50 of Caco-2 and HepG2 increased with hydrophobicity, which indicates the importance of testing putative therapeutics on different cell types. We report evidence of peptide-cell membrane interactions in Caco-2 and HepG2 using a widely studied ß-peptide against C. albicans.

Effect of a postoperative exercise program on arteriovenous fistula maturation: A randomized controlled trial.

Exercises after arteriovenous fistula (AVF) creation may help to improve maturation; however, their usefulness has only been examined in indirect, non-comparative studies or small trials. Between June 2013 and November 2014, we included all ambulatory patients with stages 5-5D chronic kidney disease who were candidates for the creation of a native AVF in our center. After surgery, all patients were randomized to an exercise group or a control group with single-blind control. At 1 month postoperatively, clinical maturation (expert nurse inspection) and ultrasonographic maturation (flow >500 mL/min, venous diameter >5 mm and depth <6 mm) were assessed in all patients. A total of 72 patients were randomized, 3 were lost to follow-up, and 69 were finally analyzed. The mean age was 66.8 years (standard deviation 13.8), 70.0% were men, and 65.2% were in pre-dialysis. After surgery (42.0% had distal AVF), the patients were randomized (31 controls, 38 exercise group). At 1 month after surgery, global clinical and ultrasonographic maturation was assessed in 88.4% and 78.3% of AVF, respectively (kappa = 0.539). Non-significant differences in clinical or ultrasonographic maturation were seen between exercise and control group (94.7% vs. 80.6%, P = 0.069; 81.6% vs. 74.2%, P = 0.459). A stepwise logistic regression was performed to control previously analyzed asymmetrically distributed confounding factors (AVF localization), revealing that the exercise group showed greater clinical, but not ultrasonographic, maturation (odds ratio [OR] 5.861, 95% confidence interval: 1.006-34.146 and OR 2.403, 0.66-8.754). A postoperative controlled exercise program after AVF creation seems to increase 1-month clinical AVF maturation in distal accesses. Furthermore, exercise programs should be taken into account, especially in distal accesses.

Synthetic antimicrobial ß-peptide in dual-treatment with fluconazole or ketoconazole enhances the in vitro inhibition of planktonic and biofilm Candida albicans.

Fungal infections are a pressing concern for human health worldwide, particularly for immunocompromised individuals. Current challenges such as the elevated toxicity of common antifungal drugs and the emerging resistance towards these could be overcome by multidrug therapy. Natural antimicrobial peptides, AMPs, in combination with other antifungal agents are a promising avenue to address the prevailing challenges. However, they possess limited biostability and susceptibility to proteases, which has significantly hampered their development as antifungal therapies. ß-peptides are synthetic materials designed to mimic AMPs while allowing high tunability and increased biostability. In this work, we report for the first time the inhibition achieved in Candida albicans when treated with a mixture of a ß-peptide model and fluconazole or ketoconazole. This combination treatment enhanced the biological activity of these azoles in planktonic and biofilm Candida, and also in a fluconazole-resistant strain. Furthermore, the in vitro cytotoxicity of the dual treatment was evaluated towards the human hepatoma cell line, HepG2, a widely used model derived from liver tissue, which is primarily affected by azoles. Analyses based on the LA-based method and the mass-action law principle, using a microtiter checkerboard approach, revealed synergism of the combination treatment in the inhibition of planktonic C. albicans. The dual treatment proved to be fungicidal at 48 and 72 h. Interestingly, it was also found that the viability of HepG2 was not significantly affected by the dual treatments. Finally, a remarkable enhancement in the inhibition of the highly azole-resistant biofilms and fluconazole resistant C. albicans strain was obtained.

Thermodilution versus saline dilution method for vascular access blood flow measurement in high-flux and on-line hemodiafiltration.

PURPOSE: Access blood flow (Qa) measurements are one of the most important components in vascular access monitoring programs, even though these indirect methods have only been validated with high-flux hemodialysis (HF; pump flow [Qb] 300 mL/min). This study was to assess the utility from thermodilution (BTM) with respect to the saline dilution method (SDM) in HF and on-line hemodiafiltration (OL-HDF) with routinely prescribed parameters in comparison with validation conditions. METHODS: Three consecutive sessions were assessed in 31 hemodialysis patients (27AVF). The Bland-Altman method and Lin's concordance coefficient (ρc) were used to study accuracy and precision. We used the student t test for the analysis of Qa-value in the different subgroups. RESULTS: In HF-hemodialysis 1 (Qb 300 mL/min), Qa was 1109 ± 541 mL/min SDM(a) and 1213 ± 639 mL/min BTM (P=.993(a); bias 103.7 mL/min and ρc 0.78). In HF-hemodialysis 2 (Qb 420 mL/min) Qa 1071 ± 578 mL/min SDM (P=1.0(a); -38.2 mL/min and 0.96) and 1216 ± 667 mL/min BTM (P=.992(a); 127.3 mL/min and 0.70). In OL-HDF hemodialysis 3 (Qb 420 mL/min) Qa 1071 ± 510 mL/min SDM (P=1.0(a); -48.4 mL/min and 0.96) and 1219 ± 580 mL/min BTM (P=.977(a); 99.2 mL/min and 0.75). Statistically significant differences were only obtained in patients aged ≥ 65 years old (P=.016) and peripheral vascular disease (P=.007). CONCLUSIONS: Our results demonstrate how the saline dilution method was more accurate than thermodilution in the HF and OL-HDF modalities with routinely prescribed parameters. Finally, in this study, advanced age (>65 years old) and peripheral vascular disease were associated with a significantly lower Qa-value.

Embolización de las arteriasuterinas en el tratamiento delmioma uterino sintomático. Resultados en 90 pacientesa los 2 años / Uterine artery embolization in the treatment of symptomatic uterine myoma: 2-year outcomes in 90 patients

Objetivo: Evaluar los resultados a medio plazo yla satisfacción de las pacientes después de laembolización de las arterias uterinas en mujerescon miomas uterinos sintomáticos, así como laseguridad del tratamiento.Material y métodos: Estudio prospectivo queincluye 90 casos tratados en el Hospital deSabadell, entre diciembre del 2002 y octubre del2006.La recogida de datos se realizó mediante uncuestionario introducido posteriormente en unabase de datos específica; el análisis estadístico serealizó con el programa SPSS 15.0.Todas las pacientes tuvieron un seguimientode 2 años después del procedimiento a nivelclínico, analítico y mediante técnicas deimagen.Los síntomas fueron valorados como desaparición omejoría, sin cambios o empeoramiento. Los efectosadversos se anotaron según la clasificación de laSociedad de Radiología Intervencionista. Tambiénse recogió la satisfacción de las mujeresembolizadas.Se consideró un fracaso de la técnica la necesidadde histerectomía o la persistencia de clínica.Resultados: La mejoría de los síntomas a los 2años fue del 90,7%. En 4 casos se practicó unasegunda embolización y en 6 casos se realizó unahisterectomía.A los 6 meses, el 92,8 % de los miomas mostrabanuna vascularización nula o escasa. A los 2 años, ladisminución media en el volumen del miomadominante fue del 76,3%.El porcentaje de complicaciones mayores fue del12,7%.La satisfacción por el procedimiento fue del 90,2%.Conclusiones: La embolización de las arteriasuterinas en mujeres con miomas uterinossintomáticos es un tratamiento efectivo con unabuena aceptación de las pacientes después de unseguimiento a medio plazo (AU)

To evaluate the mid-term outcomes andpatient satisfaction following UAE in women withsymptomatic leiomyomata, as well as to assesssafety treatment.Material and methods: Prospective study of 90patients from Sabadell Hospital between December2002 and October 2006.Data were collected using a questionnaireand was later introduced in a specific database.Statistical analysis of data was carried out usingSPSS 15.0All patients went on a 2-year follow-up after UAE,including clinical, laboratory and diagnosticimaging examinations.Symptoms were scored as successful, improvement,unchanged or worsened. Adverse events werenoted following the Society of InterventionalRadiology’s classification. Patients were also askedabout their satisfaction.The need of an eventual hysterectomy or thepersistence of symptoms was considered to be atreatment failure.Results: The improvement of symptoms occurredin 90,7% of all the embolized women. We had toperform a second embolization in 4 cases, and ahysterectomy in 6 cases.6 months later, null vascularisation orhypovascularisation of the myoma was observed in92.8% of women. Over two years, the averagevolume reduction of the dominant myoma was76.3%.The rate of major complications was 12.7%.Patient satisfaction for the procedurewas 90.2%.Conclusions: Uterine artery embolization is aneffective treatment for women with symptomaticuterine leiomyomata, being well accepted by thepatients in the mid-term follow-up (AU)