Clinical evaluation of in silico planning and real-time simulation of hepatic radiofrequency ablation (ClinicIMPPACT Trial).

OBJECTIVES: To evaluate the accuracy and clinical integrability of a comprehensive simulation tool to plan and predict radiofrequency ablation (RFA) zones in liver tumors. METHODS: Forty-five patients with 51 malignant hepatic lesions of different origins were included in a prospective multicenter trial. Prior to CT-guided RFA, all patients underwent multiphase CT which included acquisitions for the assessment of liver perfusion. These data were used to generate a 3D model of the liver. The intra-procedural position of the RFA probe was determined by CT and semi-automatically registered to the 3D model. Size and shape of the simulated ablation zones were compared with those of the thermal ablation zones segmented in contrast-enhanced CT images 1 month after RFA; procedure time was compared with a historical control group. RESULTS: Simulated and segmented ablation zone volumes showed a significant correlation (ρ = 0.59, p < 0.0001) and no significant bias (Wilcoxon's Z = 0.68, p = 0.25). Representative measures of ablation zone comparison were as follows: average surface deviation (absolute average error, AAE) with 3.4 ± 1.7 mm, Dice similarity coefficient 0.62 ± 0.14, sensitivity 0.70 ± 0.21, and positive predictive value 0.66 ± 0. There was a moderate positive correlation between AAE and duration of the ablation (∆t; r = 0.37, p = 0.008). After adjustments for inter-individual differences in ∆t, liver perfusion, and prior transarterial chemoembolization procedures, ∆t was an independent predictor of AAE (ß = 0.03 mm/min, p = 0.01). Compared with a historical control group, the simulation added 3.5 ± 1.9 min to the procedure. CONCLUSION: The validated simulation tool showed acceptable speed and accuracy in predicting the size and shape of hepatic RFA ablation zones. Further randomized controlled trials are needed to evaluate to what extent this tool might improve patient outcomes. KEY POINTS: • More reliable, patient-specific intra-procedural estimation of the induced RFA ablation zones in the liver may lead to better planning of the safety margins around tumors. • Dedicated real-time simulation software to predict RFA-induced ablation zones in patients with liver malignancies has shown acceptable agreement with the follow-up results in a first prospective multicenter trial suggesting a randomized controlled clinical trial to evaluate potential outcome benefit for patients.

Depresión y factores de riesgos asociados en embarazadas de 18 a 45 años asistentes al Hospital Niño Jesús en Barranquilla (Colombia) / Depression and risk factors in pregnant women of 18 and 45 years old who attended in the Hospital Niño Jesús in Barranquilla (Colombia)

Objetivo: Determinar la prevalencia de factores de riesgo para depresión en embarazadas atendidas en el Hospital Niño Jesús, en Barranquilla, en el primer semestre de 2012. Materiales y métodos: Estudio descriptivo transversal, en muestra de 151 embarazadas en control prenatal. Se estudiaron variables sociodemográficas, ginecobstétricas y antecedentes psicológicos y psiquiátricos. Se midió depresión con el Edinburgh Postnatal Depressión Scale, se clasificó con un punto de corte mayor o igual a 13. Se tabuló mediante los software Excel y Epi-info 2000, V 3.5.3; se presentan resultados en tablas y gráficos y se analizan con porcentajes, media y desviación estándar, Odd Rato e IC 95%, chi-cuadrado y p. Resultados: La depresión fue de 19.2 %. Edad media de 24,78 años (+/- 5,35); 57,6 % era de estrato económico bajo; 72,6 % amas de casa; 88,7 % convivía con su pareja; edad gestacional media de 28 (+/-4) y 25 % de mujeres con depresión tenía antecedente de esta. Los factores de riesgo, con tendencia a la asociación, fueron: historia de aborto anterior OR 3,39 (IC95 % 1,41-8,15), algún grado de disfunción familiar OR 2,78 (IC95 % 1,08- 7,1) y actividad fuera del hogar 2,92 (IC95%1,03 - 8,23). Conclusiones: La depresión en el embarazo se presentó cuando existió antecedente de aborto, algún grado de disfunción familiar y actividad fuera del hogar.

Objective: To determine prevalence of risk factors for depression in pregnant women of the Hospital Niño Jesus, in Barranquilla, in the first semester of 2012. Materials and Methods: Cross-sectional study in a sample of 151 pregnant women in prenatal care. We study variables: socio demographic, gynecological and obstetric, psychological and psychiatric history. Depression was measured with the Edinburgh Postnatal Depression Scale, is classified with a cutoff greater than or equal to 13. Tabulated by the software: Excel and Epi-info 2000, V 3.5.3, results are presented in tables and graphs and analyzed with: percentages, mean and standard deviation, Odd Ratio and 95%, Chisquare and p. Results: depression was 19.2 %. Average age: 24.78 years (± 5.35), 57.6 % were of lower class, housewives 72.6 % and 88.7% lived with their partners, mean gestational age of: 28 (±-4) and 25% of women with depression had a history of this. Risk factors, tending to the association were: history of previous abortion OR 3.39 (95 % CI 1.41 to 8.15), some degree of family dysfunction OR 2.78 (95 % CI 1.08 to 7,1) activity outside the home and 2.92 (95 % CI 1.03 to 8.23). Conclusions: Depression in pregnancy was appeared when exist a background of abortion, some degree of family dysfunction and activity outside the home.