Innovación continuada en cirugía radioguiada de precisión / Continuous innovation in precision radio-guided surgery

Desde sus inicios, la medicina nuclear se ha enfrentado a cambios tecnológicos que la han obligado a modificar sus modos operativos y a adecuar sus protocolos. En el campo de la cirugía radioguiada (CRG), la incorporación de la imagen gammagráfica preoperatoria y la detección intraoperatoria con la sonda gamma proporcionó un impulso definitivo a la biopsia del ganglio centinela (GC) para convertirse en el procedimiento estándar de aplicación en el melanoma y el cáncer de mama. Las diversas innovaciones tecnológicas y la adaptación consiguiente de protocolos confluyen en lo disruptivo y lo gradual. Como ejemplos evidentes tenemos la introducción de la tomografía por emisión de fotón único/tomografía computarizada (SPECT/TC) en el campo preoperatorio y las sondas Drop-in (Lightpoint Medical Ltd; Crystal photonics, Eurorad) en el intraoperatorio. Otros aspectos innovadores con posible aplicación en la CRG se basan en la utilización de la inteligencia artificial (IA), navegación y teleasistencia (AU)

Since its origins, nuclear medicine has faced technological changes that led to modifying operating modes and adapting protocols. In the field of radioguided surgery, the incorporation of preoperative scintigraphic imaging and intraoperative detection with the gamma probe provided a definitive boost to sentinel lymph node biopsy to become a standard procedure for melanoma and breast cancer. The various technological innovations and consequent adaptation of protocols come together in the coexistence of the disruptive and the gradual. As obvious examples we have the introduction of SPECT/CT in the preoperative field and Drop-in probes in the intraoperative field. Other innovative aspects with possible application in radio-guided surgery are based on the application of artificial intelligence, navigation and telecare (AU)

Efficacy of different 8 h time-restricted eating schedules on visceral adipose tissue and cardiometabolic health: A study protocol.

BACKGROUND AND AIMS: To investigate the efficacy and feasibility of three different 8 h time-restricted eating (TRE) schedules (i.e., early, late, and self-selected) compared to each other and to a usual-care (UC) intervention on visceral adipose tissue (VAT) and cardiometabolic health in men and women. METHODS AND RESULTS: Anticipated 208 adults (50% women) aged 30-60 years, with overweight/obesity (25 ≤ BMI<40 kg/m2) and with mild metabolic impairments will be recruited for this parallel-group, multicenter randomized controlled trial. Participants will be randomly allocated (1:1:1:1) to one of four groups for 12 weeks: UC, early TRE, late TRE or self-selected TRE. The UC group will maintain their habitual eating window and receive, as well as the TRE groups, healthy lifestyle education for weight management. The early TRE group will start eating not later than 10:00, and the late TRE group not before 13:00. The self-selected TRE group will select an 8 h eating window before the intervention and maintain it over the intervention. The primary outcome is changes in VAT, whereas secondary outcomes include body composition and cardiometabolic risk factors. CONCLUSION: This study will determine whether the timing of the eating window during TRE impacts its efficacy on VAT, body composition and cardiometabolic risk factors and provide insights about its feasibility.

Continuous innovation in precision radio-guided surgery.

Since its origins, nuclear medicine has faced technological changes that led to modifying operating modes and adapting protocols. In the field of radioguided surgery, the incorporation of preoperative scintigraphic imaging and intraoperative detection with the gamma probe provided a definitive boost to sentinel lymph node biopsy to become a standard procedure for melanoma and breast cancer. The various technological innovations and consequent adaptation of protocols come together in the coexistence of the disruptive and the gradual. As obvious examples we have the introduction of SPECT/CT in the preoperative field and Drop-in probes in the intraoperative field. Other innovative aspects with possible application in radio-guided surgery are based on the application of artificial intelligence, navigation and telecare.

Sentinel Lymph Node Biopsy in Breast Cancer with 99mTc-Tilmanocept: A Multicenter Study on Real-Life Use of a Novel Tracer.

99mTc-tilmanocept is a novel radiopharmaceutical for sentinel lymph node (SLN) biopsy in breast cancer. Our aim was to describe results with 99mTc-tilmanocept in a heterogeneous group of breast cancer patients scheduled for SLN biopsy. Methods: Radiotracer preparation followed the manufacturer's indications. Local protocols for SLN detection within 9 participant centers were not changed for the entire duration of the study. In total, 344 patients with T1-T4, N0-N2 breast cancer (352 lesions) were included. Superficial (intradermal or periareolar) or deep (peritumoral or intratumoral) injections were performed. The doses were adjusted depending on the scheduled time for surgery. Results: Lymphoscintigraphy was able to depict at least 1 SLN in 339 of 352 breast lesions (96.3%), and the intraoperative SLN detection rate reached 97.2%. On univariable analysis, SLN detection rates did not differ by age, clinical T or N stage, tumor location, histologic subtype, or prior neoadjuvant therapy. Lymphoscintigraphy showed higher SLN detection in patients with a normal weight (body mass index < 25) than in those who were overweight or obese (body mass index ≥ 25), at 99.2% versus 94.6%, respectively (P = 0.031). The proportion of patients with preoperative lymphoscintigraphic detection or excised SLNs was higher with superficial than deep injections. Reinjected cases were significantly lower when superficial injection was chosen first (P < 0.001). Injection site and the tumor markers human epidermal growth factor receptor 2 and estrogen receptor had an impact on preoperative SLN visualization and intraoperative localization. In 80 cases, SLN biopsy resulted in a positive lymph node. During a mean follow-up of 19 mo, no axillary recurrences were observed. Conclusion: Whatever the protocol, 99mTc-tilmanocept showed good results in a heterogeneous breast cancer population, although the best results were achieved when a superficial injection was chosen.

Dosimetry and prescription in liver radioembolization with 90Y microspheres: 3D calculation of tumor-to-liver ratio from global 99mTc-MAA SPECT information.

Dosimetry in liver radioembolization with 90Y microspheres is a fundamental tool, both for the optimization of each treatment and for improving knowledge of the treatment effects in the tissues. Different options are available for estimating the administered activity and the tumor/organ dose, among them the so-called partition method. The key factor in the partition method is the tumor/normal tissue activity uptake ratio (T/N), which is obtained by a single-photon emission computed tomography (SPECT) scan during a pre-treatment simulation. The less clear the distinction between healthy and tumor parenchyma within the liver, the more difficult it becomes to estimate the T/N ratio; therefore the use of the method is limited. This study presents a methodology to calculate the T/N ratio using global information from the SPECT. The T/N ratio is estimated by establishing uptake thresholds consistent with previously performed volumetry. This dose calculation method was validated against 3D voxel dosimetry, and was also compared with the standard partition method based on freehand regions of interest (ROI) outlining on SPECT slices. Both comparisons were done on a sample of 20 actual cases of hepatocellular carcinoma treated with resin microspheres. The proposed method and the voxel dosimetry method yield similar results, while the ROI-based method tends to over-estimate the dose to normal tissues. In addition, the variability associated with the ROI-based method is more extreme than the other methods. The proposed method is simpler than either the ROI or voxel dosimetry approaches and avoids the subjectivity associated with the manual selection of regions.

[Cardiac catheterism. Nursing performance in the critical unit]. / Cateterismo cardíaco. Actuación de enfermería en una unidad de críticos.

In acute myocardial infarction (AMI), ischemia is acute, intense and maintained, it being one of the main causes of death in our society. Immediate treatment may reduce it considerably. The objectives established in this study were the following: Verify the course of the AMI treatments Verify the evolution in hemostatic methods in patients subjected to cardiac catheterism. Elaborate new nursing protocols for pre- and post-catheterism care. A retrospective, descriptive study was done. From October 1999 to December 2002, a total of 1969 patients were admitted to our unit. Of these, 818 were admitted due to heart disease. Those whose diagnosis was AMI or Angina were selected among the latter and then those in whom cardiac catheterism was done were chosen. It was conducted in a 12 bed polyvalent ICU, the data collection being done by five nurses from that unit based on clinical and nursing history. An increase in the performance of diagnostic and therapeutic cardiac catheterism in recent years was observed, and there was also an increase in intraarterial suture as hemostasis method in detriment to mechanical compression. New standardized nursing products were elaborated to facilitate and improve the care of these patients and try to reduce preparation time for their transfer to the hemodynamics unit, given the urgency existing in most of the cases.

Cateterismo cardíaco. Actuación de enfermería en una unidad de críticos / Cardiac catheterism. Nursing performance in the critical unit

En el infarto agudo de miocardio (IAM), la isquemia es aguda, intensa y mantenida, y es una de las principales causas de muerte en nuestra sociedad. El tratamiento inmediato puede reducirla considerablemente. Los objetivos marcados en este estudio fueron: verificar la evolución de los tratamientos en el IAM; comprobar la evolución en los métodos hemostáticos en pacientes sometidos a cateterismo cardíaco, y elaborar nuevos protocolos de enfermería para el cuidado pre y poscateterismo. Se realizó un estudio retrospectivo descriptivo. Desde octubre de 1999 hasta diciembre de 2002 ingresaron en nuestra unidad 1.969 pacientes, de los cuales 818 lo hicieron por patología cardíaca, de ellos se seleccionaron los que el diagnóstico fue de IAM o angina de pecho, y de entre ellos a los que se les realizó cateterismo cardíaco. Se desarrolló en una unidad de cuidados intensivos (UCI) polivalente de 12 camas, y la recogida de datos se realizó por 5 enfermeras de dicha unidad, a partir de la historia clínica y de enfermería. Se observó un incremento en la realización del cateterismo cardíaco en los últimos años, tanto diagnóstico como terapéutico, así como un incremento de la sutura intraarterial como método de hemostasia, en detrimento de la compresión mecánica. Se elaboraron nuevos protocolos de enfermería estandarizados para facilitar y mejorar el cuidado de estos pacientes e intentar reducir el tiempo de preparación para su traslado a la unidad de hemodinámica, dada la urgencia que se presentaba en la mayoría de los casos

In acute myocardial infarction (AMI), ischemia is acute, intense and maintained, it being one of the main causes of death in our society. Immediate treatment may reduce it considerably. The objectives established in this study were the following: Verify the course of the AMI treatments Verify the evolution in hemostatic methods in patients subjected to cardiac catheterism. Elaborate new nursing protocols for pre- and post-catheterism care. A retrospective, descriptive study was done. From October 1999 to December 2002, a total of 1969 patients were admitted to our unit. Of these, 818 were admitted due to heart disease. Those whose diagnosis was AMI or Angina were selected among the latter and then those in whom cardiac catheterism was done were chosen. It was conducted in a 12 bed polyvalent ICU, the data collection being done by five nurses from that unit based on clinical and nursing history. An increase in the performance of diagnostic and therapeutic cardiac catheterism in recent years was observed, and there was also an increase in intraarterial suture as hemostasis method in detriment to mechanical compression. New standardized nursing products were elaborated to facilitate and improve the care of these patients and try to reduce preparation time for their transfer to the hemodynamics unit, given the urgency existing in most of the cases