Adsorption of cadmium (II) on organic xerogel microspheres: effect of adding sepiolite or vermiculite and operating conditions on the adsorption capacity.

The organic xerogel (OX) was synthesized through sol-gel polymerization of formaldehyde and resorcinol in inverse emulsion using Na2CO3 as a catalyst. Meanwhile, OX containing sepiolite (OX-Sep) and vermiculite (OX-Ver) were prepared similarly to OX but adding clays during synthesis. All materials were mesoporous and presented spherical morphology, and the surface of these materials exhibited an acidic character because the concentration of acidic sites was higher than those of basic sites. Cd(II) adsorption from aqueous solutions onto OX, OX-Sep, and OX-Ver was examined, and the OX-Sep showed the highest adsorption capacity towards Cd(II) of 189.7 mg/g, being 1.5, 2, and 36 times higher than that of OX-Ver, OX, and Sep. The OX-Sep capacity for adsorbing Cd(II) was significantly lessened by decreasing the pH from 7 to 4 and raising the ionic strength from 0.01 N to 0.1 N. This trend was ascribed to electrostatic attraction between the Cd+2 in water and the negatively charged surface of OX-Sep. Besides, desorption studies at pH 4 showed that the average desorption percentage of Cd(II) adsorbed on OX-Sep was 80%. The characterization results and the effect of the operating conditions on the adsorption capacity proved that electrostatic attraction and cation exchange play a crucial role in the adsorption mechanism.

Cardiac Amyloidosis in Venezuela: A Pending Issue.

Cardiac amyloidosis (CA) is an infiltrative disease characterized by the deposition of misfolded proteins in cardiac interstitial tissue. Interest towards studying this pathology has been growing in the last decade, as new epidemiological insights have revealed that it is not as uncommon as previously believed. Likewise, advances in non-invasive diagnostic approaches and the identification of molecules that modify its long-term progression, even in terms of mortality, have also bolstered interest in CA. Despite this global panorama, in Venezuela, limitations remain regarding the diagnosis of CA, partly associated with a lack of knowledge of the disease. Therefore, additional efforts are necessary for clinical cardiologists to hone their diagnostic skills regarding this disease, as opportune identification is an essential step for its effective management.

Durable response after tisagenlecleucel in adults with relapsed/refractory follicular lymphoma: ELARA trial update.

ABSTRACT: Tisagenlecleucel is approved for adults with relapsed/refractory (r/r) follicular lymphoma (FL) in the third- or later-line setting. The primary analysis (median follow-up, 17 months) of the phase 2 ELARA trial reported high response rates and excellent safety profile in patients with extensively pretreated r/r FL. Here, we report longer-term efficacy, safety, pharmacokinetic, and exploratory biomarker analyses after median follow-up of 29 months (interquartile range, 22.2-37.7). As of 29 March 2022, 97 patients with r/r FL (grades 1-3A) received tisagenlecleucel infusion (0.6 × 108-6 × 108 chimeric antigen receptor-positive viable T cells). Bridging chemotherapy was allowed. Baseline clinical factors, tumor microenvironment, blood soluble factors, and circulating blood cells were correlated with clinical response. Cellular kinetics were assessed by quantitative polymerase chain reaction. Median progression-free survival (PFS), duration of response (DOR), and overall survival (OS) were not reached. Estimated 24-month PFS, DOR, and OS rates in all patients were 57.4% (95% confidence interval [CI], 46.2-67), 66.4% (95% CI, 54.3-76), and 87.7% (95% CI, 78.3-93.2), respectively. Complete response rate and overall response rate were 68.1% (95% CI, 57.7-77.3) and 86.2% (95% CI, 77.5-92.4), respectively. No new safety signals or treatment-related deaths were reported. Low levels of tumor-infiltrating LAG3+CD3+ exhausted T cells and higher baseline levels of naïve CD8+ T cells were associated with improved outcomes. Tisagenlecleucel continued to demonstrate highly durable efficacy and a favorable safety profile in this extended follow-up of 29 months in patients with r/r FL enrolled in ELARA. This trial was registered at www.clinicaltrials.gov as #NCT03568461.

Comparative efficacy and safety of tisagenlecleucel and axicabtagene ciloleucel among adults with r/r follicular lymphoma.

Regulatory approvals of tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (axi-cel) have established the feasibility of chimeric antigen receptor T-cell therapies for the treatment of adults with relapsed or refractory follicular lymphoma (r/r FL). This study used individual patient data from ELARA (tisa-cel) and aggregate published patient data from ZUMA-5 (axi-cel) to compare efficacy and safety outcomes in r/r FL using matching-adjusted indirect comparison methods. After adjustment for baseline differences in the trial populations, the results suggested that tisa-cel (n = 52), compared with axi-cel (n = 86), had similar effects on overall response rate (91.2% vs. 94.2%; p = .58), complete response rate (74.0% vs. 79.1%; p = .60), progression-free survival (HR [95% CI]: 0.8 [0.4, 1.9]; p = .67), and overall survival (HR [95% CI]: 0.5 [0.2, 1.5]; p = .21). Tisa-cel (n = 53) was associated with better safety outcomes than axi-cel (n = 124), reflected by lower rates of any grade and grade ≥3 cytokine release syndrome and neurological events.

Efficient removal of triclosan from water through activated carbon adsorption and photodegradation processes.

This study investigated the application of adsorption with activated carbons (ACs) and photodegradation to reduce the concentration of triclosan (TCS) in aqueous solutions. Concerning adsorption, ACs (Darco, Norit, and F400) were characterised and batch experiments were performed to elucidate the effect of pH on equilibrium. The results showed that at pH = 7, the maximum adsorption capacity of TCS onto the ACs was 18.5 mg g-1 for Darco, 16.0 mg g-1 for Norit, and 15.5 mg g-1 for F400. The diffusional kinetic model allowed an adequate interpretation of the experimental data. The effective diffusivity varied and increased with the amount of TCS adsorbed, from 1.06 to 1.68 × 10-8 cm2 s-1. In the case of photodegradation, it was possible to ensure that the triclosan molecule was sensitive to UV light of 254 nm because the removal was over 80 % using UV light. The removal of TCS increased in the presence of sulfate radicals. It was possible to identify 2,4-dichlorophenol as one of the photolytic degradation products of triclosan, which does not represent an environmental hazard at low concentrations of triclosan in water. These results confirm that the use of AC Darco, Norit, and F400 and that photodegradation processes with UV light and persulfate radicals are effective in removing TCS from water, reaching concentration levels that do not constitute a risk to human health or environmental hazard. Both methods effectively eliminate pollutants with relatively easy techniques to implement.

Chlorphenamine adsorption on commercial activated carbons: Effect of Operating Conditions and Surface Chemistry.

Chlorphenamine (CPA) adsorption onto three activated carbons (ACs), namely, Megapol M (MM), Micro 10 (M10), and GAMA B (GB), was studied in this work. The textural properties, concentrations of active sites, surface charge and point of zero charge of the ACs were assessed. The surface areas (SBET) of MM, GB and M10 were 1107, 812 and 766 m2/g, respectively. The MM surface had an acidic character, while the surfaces of M10 and GB were basic. The adsorption capacity of MM, M10, and GB towards CPA was studied at pH 7 and 11, and the adsorption capacity decreased in the order MM > M10 ≈ GB, which was ascribed to the magnitude of SBET and the concentration of acidic sites. The solution pH significantly increased the adsorption capacity of MM towards CPA by raising the solution pH from 5 to 9, and this behavior was attributed to the electrostatic attraction between the negatively charged surface of MM and the cationic species of CPA. The maximum uptake of CPA adsorbed on MM was 574.6 mg/g at pH = 11 and T = 25 °C. The adsorption capacity of MM was slightly raised by incrementing the temperature. Lastly, the zeta potential measurements of pristine MM and MM saturated with CPA confirmed that the electrostatic attraction predominated in the pH range of 5-9, and the π-π stacking interactions were the principal mechanism of CPA adsorption on MM at pH 11.

Detection and mapping of the seasonal distribution of water hyacinth (Eichhornia crassipes) and valorization as a biosorbent of Pb(II) in water.

In the present research, the presence of water hyacinth (Eichhornia crassipes) on the surface of the San Jose Dam located in the city of San Luis Potosi, S.L.P, Mexico, was monitored and mapped. The monitoring was conducted for 2 years (2018-2020) with remote sensing data from OLI Landsat 8 sensors, based on the normalized difference vegetation index (NDVI). The results demonstrated the capability and accuracy of this method, where it was observed that the aboveground cover area, proliferation, and distribution of water hyacinth are influenced by climatic and anthropogenic factors during the four seasons of the year. As part of a sustainable environmental control of this invasive species, the use of water hyacinth (WH) root (RO), stem (ST), and leaf (LE) components as adsorbent material for Pb(II) present in aqueous solution was proposed. The maximum adsorption capacity was observed at pH 5 and 25 °C and was 107.3, 136.8, and 120.8 mg g-1 for RO, ST, and LE, respectively. The physicochemical characterization of WH consisted of scanning electron microscopy (SEM), N2 physisorption, infrared spectroscopy (FT-IR), thermogravimetric analysis (TGA), charge distribution, and zero charge point (pHPZC). Due to the chemical nature of WH, several Pb(II) adsorption mechanisms were proposed such as electrostatic attractions, ion exchange, microprecipitation, and π-cation.

Use of Yarn and Carded Jute as Epoxy Matrix Reinforcement for the Production of Composite Materials for Application in the Wind Sector: A Preliminary Analysis for the Manufacture of Blades for Low-Intensity Winds.

The development of wind turbines for regions with low wind speeds imposes a challenge to the expansion of the corresponding energy generation capacity. The present work consists of an evaluation of the potential carded jute fiber and jute yarn to be used in the construction of a wind blade for regions of low wind intensity. The fibers used were supplied by Company Textile of Castanhal (Castanhal-Para-Brazil) and used in the study without chemical treatment in the form of single-filament fibers and yarns with a surface twist of 18.5°. The composites were produced through the resin infusion technique and underwent tensile and shear tests using 120-Ohm strain gauges and a blade extensometer to obtain the Young's modulus. In the analysis of the results, the ANOVA test was applied with a 0.05 significance level, followed by Tukey's test. The results showed that long, aligned jute fibers can be a good option for laminated structures applied in composites for small wind turbine blades.

Binary fluoride and As(V) adsorption in water using pleco fish bone chars.

The present work studied individual and binary adsorption of fluorides and As(V) in water on pleco fish bone chars (BC), as well as the effect of BC mass variation on the adsorption capacity of fluoride and As(V) in water for human consumption. The results of individual adsorption indicated that the adsorption of fluoride and As(V) on BC depends on solution pH. The adsorption capacity of fluorides at an initial concentration of 30 mg L-1 increases approximately 3 times, from 5.9 to 15.3 mg g-1, when decreasing the pH of the solution from 9 to 5, however, for the case of As(V) an antagonistic effect is observed, the adsorption capacity increases 7 times when raising the pH from 5 to 9, from 18.4 to 132.1 µg g-1 at an initial As(V) concentration of 300 µg L-1. Besides, in the binary adsorption, BC showed a higher affinity to adsorb fluoride since its adsorption capacity decreased from 16.55 to 12.50 mg g-1 as the As(V) concentration increased from 0 to 800 µg L-1 in solution. In contrast, As(V) adsorption was severely affected, decreasing from 140.2 to 32.7 µg g-1 when the fluoride concentration in the solution increased from 0 to 100 mg L-1. On the other hand, in the adsorption of groundwater contaminated with fluoride and As(V), it was determined that increasing the mass of BC from 0.5 to 20 g increases the removal percentage, reaching 99.3 and 75.7% removal for fluoride and As(V), respectively, due to the fact that increasing the mass of the adsorbent leads to a larger area and a greater number of sites that allow the adsorption of these contaminants. The thermodynamic study revealed the spontaneity of fluoride and As(V) adsorption, better affinity for fluoride but higher adsorption rate of As(V) on BC. Characterization techniques such as XRD and EDS allowed identifying hydroxyapatite as the mineral phase of BC, which is responsible for the adsorption of BC. By studying the effect of solution pH on the adsorption capacities and the characterization of BC such as XRD, EDS and TGA, it was determined that the mechanisms of fluoride adsorption are by electrostatic attractions and ion exchange, and for As(V) it is by coprecipitation and ion exchange. It was concluded that BC from pleco fish could be an alternative for treating water contaminated by fluorides and As(V).

Single adsorption of diclofenac and ronidazole from aqueous solution on commercial activated carbons: effect of chemical and textural properties.

The importance of the textural and physicochemical characteristics upon the adsorption capacity of the commercial activated carbons (ACs) Coconut, Wood, Merck, Darco, and Norit towards ronidazole (RNZ) and diclofenac (DCF) from water solution was investigated thoroughly in this work. At pH = 7, Coconut AC and Wood AC presented the highest adsorption capacity towards RNZ (444 mg/g) and DCF (405 mg/g). The maximum mass of RNZ adsorbed onto Coconut AC was higher in this study than those outlined previously in other works. Besides, the maximum capacity of Wood AC for adsorbing DCF was comparable to those found for other ACs. The adsorption capacity of all the ACs was increased by surface area and was favored by incrementing the acidic site concentration. The π-π stacking interactions were the predominant adsorption mechanism for the RNZ and DCF adsorption on ACs, and the acidic sites favored the adsorption capacity by activating the π-π stacking. Electrostatic interactions did not influence the adsorption of RNZ on Coconut AC, but electrostatic repulsion decreased that of DCF on Wood AC. The adsorption of DCF on Wood AC was reversible but not that of RNZ on Coconut AC. Besides, the adsorption of RNZ and DCF on the Coconut and Wood ACs was endothermic in the range of 15-25 °C.

Synthesis, characterization, and application of pristine and clay-templated carbon xerogel microspheres for removing diclofenac and heavy metals from water solution.

Organic xerogel microspheres (SX) were synthesized by inverse emulsion sol-gel polymerization and carbonized to obtain carbon xerogel spheres (SXCs). The catalyst was K2CO3 or Fe(C2H3O2)2, and the clay sodium sepiolite (SNa) or exfoliated vermiculite (Vexf) was added during the synthesis. Depending on the catalyst and clays, the SXCs were designated SXC-K, SXC-Fe, Vexf-K, Vexf-Fe, SNa-Fe, and SNa-K. At pH = 7 and T = 25 °C, the SXCs' adsorption capacities towards diclofenac (DCF) in water increased as follows: SXC-K < Vexf-Fe < SXC-Fe < SNa-Fe < SNa-K < Vexf-K and this order is associated with the SXCs' surface area and mesopore volume. The Vexf-K displayed the highest capacity for DCF due to its optimal textural and chemical properties, and the DCF maximum uptake was 560 mg/g at pH = 6 and T = 35 °C. The adsorption capacity towards Cd2+ and Pb2+ decreased as SX-K > SX-Fe > SXC-K > SXC-Fe, indicating that the non-carbonized materials (SX) presented higher adsorption capacity than the SXCs because the SXs had a higher acidic site content. Adding SNa or Vexf to SXs enhanced the adsorption capacity towards Cd(II), and SNa-SX-K presented an exceptionally high capacity of 182.7 mg/g. This synergistic effect revealed that the Cd2+ was adsorbed on the SX-K acidic sites and by cation exchange on the SNa.

Assessment of Healthcare Resource Utilization and Hospitalization Costs in Patients With Relapsed or Refractory Follicular Lymphoma Undergoing CAR-T Cell Therapy With Tisagenlecleucel: Results From the ELARA Study.

Follicular lymphoma (FL) is generally considered an indolent disease, although patients with relapsing FL experience progressively shorter durations of response to second or later lines of therapy. The ongoing ELARA trial in adult patients with relapsed/refractory (r/r) FL treated with tisagenlecleucel demonstrated an overall response rate of 86.2% and a complete response rate of 69.1%, with no treatment-related deaths. Tisagenlecleucel was administered in the outpatient setting in 18% of patients in ELARA; however, there is limited knowledge concerning the impact of inpatient versus outpatient tisagenlecleucel administration on healthcare resource utilization (HCRU) among patients with r/r FL. Here, we present the first HCRU analysis among patients with r/r FL who received tisagenlecleucel in the Phase II, single-arm, multicenter ELARA trial. HCRU was characterized using hospitalization data from day 1 to month 2 after tisagenlecleucel infusion. Information on length of stay, facility use, and discharge was assessed in patients who received tisagenlecleucel in the outpatient or inpatient setting. All costs were inflated to 2020 US dollars. As of August 3, 2021 (20-month median follow-up), 17/97 (18%) r/r FL patients were infused in an outpatient setting. Patients infused in the outpatient setting generally had favorable Eastern Cooperative Oncology Group performance status and Follicular Lymphoma International Prognostic Index scores, and less bulky disease at baseline. However, the outpatients had higher proportions of patients with grade 3A FL, primary refractory disease, and >5 lines of prior therapy compared with inpatients. Forty-one percent of patients treated in the outpatient setting did not require hospitalization within 30 days after infusion, and outpatients who did require hospitalization had a shorter average length of stay compared with inpatients (5 versus 13 days). No outpatients required intensive care unit (ICU) admission, whereas 9% of inpatients were admitted to the ICU. The mean postinfusion hospitalization costs were $7477 and $40,054 in the outpatient and inpatient settings, respectively. Efficacy between both groups was similar. Tisagenlecleucel can be safely administered to some patients in the outpatient setting, which may reduce HCRU for patients with r/r FL.

Morphological, clinical, and functional efficacy in the short and medium-term after radiofrequency treatment of predominantly solid, large, and clinically relevant thyroid nodules in patients who are not candidates for surgery: The experience after 100 procedures.

INTRODUCTION: Thyroid nodules (TN) are a prevalent pathology that can generate morbidity, in which case the traditional treatment is usually surgery. OBJECTIVE: To analyse the efficacy of radiofrequency ablation (RFA) treatment as a therapeutic alternative in the combined clinical, morphological, and functional control of predominantly solid, benign and clinically relevant TNs in patients not subsidiary to surgery. MATERIALS AND METHODS: A descriptive, retrospective, case series study was carried out to assess the efficacy and safety of the use of RFA. According to medical criteria, the selected patients underwent a clinical, ultrasound, and biochemical assessment prior to the procedure and then after the procedure at 1, 3, 6, and 12 months and then every 6-12 months according to medical criteria. RESULTS: A total of 100 RFA were performed on 83 patients with 85 TNs of ≥2.5 cm with an initial volume (IV) of 21.48 ±â€¯15.89 ml. After a mean of 1.17 RFA sessions per TN, the volume decreased progressively and significantly (p < 0.01 for all times compared to the initial value), with a mean volume reduction rate (VRR) in relation to the IV of 54.43 ±â€¯19.56% at 1-month follow-up; 67.69 ±â€¯17% at 3 months; 70.38 ±â€¯15.46% at 6 months; 70.67 ±â€¯17.27% at 12 months and 70.24 ±â€¯17.7% at the last follow-up. 88% of the patients followed up >6 months achieved the combined objective of a volume reduction rate of more than 50% of the VI, thyroid normal function and absence of clinic; and in all of these, it was maintained until the final follow-up date. Acute complications (mostly mild and all transient) were reported in 9 of the 100 RFA performed. CONCLUSION: Our findings validate in our setting the efficacy and safety of RFA in predominantly large and solid TNs, and add undescribed information to position the technique more favourably as a therapeutic alternative.

El material restaurador ideal en la era de la odontología de invasión mínima. Rescatando al oro directo / The ideal restorative material at the minimal invasive dentistry era. Rescuing direct gold

Los logros de los avances obtenidos en el manejo actual de la caries han dado la oportunidad a los odontólogos de detectar lesiones de caries en sus estadios incipientes. A pesar de la existencia de una gran variedad de materiales restauradores directos disponibles en el mercado actual y que pueden utilizarse para restaurar lesiones pequeñas de caries, el material que tiene más posibilidades de éxito para este tipo de lesiones es sin duda alguna el oro cohesivo, también conocido como oro directo (AU)

The goals obtained with the current management of dental caries has given the dentists the opportunity to detect incipient caries lesions in early stages. Although, the current existence of a great variety of direct restorative materials available in the market to restore small caries lesions, the material that may show better success for these type of lesions, is without any doubt: the gold foil or direct gold (AU)

The miR156 juvenility factor and PLETHORA 2 form a regulatory network and influence timing of meristem growth and lateral root emergence.

Plants develop throughout their lives: seeds become seedlings that mature and form fruits and seeds. Although the underlying mechanisms that drive these developmental phase transitions have been well elucidated for shoots, the extent to which they affect the root is less clear. However, root anatomy does change as some plants mature; meristems enlarge and radial thickening occurs. Here, in Arabidopsis thaliana, we show that overexpressing miR156A, a gene that promotes the juvenile phase, increased the density of the root system, even in grafted plants in which only the rootstock had the overexpression genotype. In the root, overexpression of miR156A resulted in lower levels of PLETHORA 2, a protein that affects formation of the meristem and elongation zone. Crossing in an extra copy of PLETHORA 2 partially rescued the effects of miR156A overexpression on traits affecting root architecture, including meristem length and the rate of lateral root emergence. Consistent with this, PLETHORA 2 also inhibited the root-tip expression of another miR156 gene, miR156C. We conclude that the system driving phase change in the shoot affects developmental progression in the root, and that PLETHORA 2 participates in this network.

A Retrospective Cohort Study of Treatment Outcomes of Adult Patients With Relapsed or Refractory Follicular Lymphoma (ReCORD-FL).

This study (ReCORD-FL) sought to construct a historical control cohort to augment single-arm trials in relapsed/refractory follicular lymphoma (r/r FL). A retrospective study in 10 centers across North America and Europe was conducted. Adults with grade 1-3A FL were required to be r/r after ≥2 therapy lines including an anti-CD20 and an alkylator. After first becoming r/r, patients were required to initiate ≥1 additional therapy line, which defined the study index date. Endpoints were observed from start of each therapy line (including index line) until death, last follow-up, or December 31, 2020. Endpoints were complete response (CR) rate, overall response rate (ORR), time to next treatment or death (TNT-D), event-free survival (EFS), and overall survival (OS). One hundred eighty-seven patients were identified. Most patients' (80.2%) index therapy occurred in third line (3L) (range, 3L-6L). Median follow-up from FL diagnosis was 9 years (range, 1-21 years). CR and ORR to the index therapy were 39.0% and 70.6%, respectively. Median (95% confidence interval) EFS from index was 14.6 (11.0-18.0) months; median OS from index was 10.6 years. Outcomes worsened across successive treatment lines and for patients who were double refractory (r/r to both an anti-CD20 monoclonal antibody and an alkylator) or POD24 (progressed ≤24 months after front-line anti-CD20) at index. Findings demonstrate the unmet need of FL patients with multiply relapsed, double refractory, or POD24 disease. Based on robustness of the historical data collected and comparability with a previous study (SCHOLAR-5), ReCORD-FL presents a valuable source of control data for comparative studies in r/r FL.

Comparison of Young's Modulus of Continuous and Aligned Lignocellulosic Jute and Mallow Fibers Reinforced Polyester Composites Determined Both Experimentally and from Theoretical Prediction Models.

Mechanical properties of composites reinforced with lignocellulosic fibers have been researched in recent decades. Jute and mallow fibers are reinforcement alternatives, as they can contribute to increase the mechanical strength of composite materials. The present work aims to predict the Young's modulus with application of continuous and aligned lignocellulosic fibers to be applied as reinforcement in polyester matrix. Fibers were manually separated and then arranged and aligned in the polyester matrix. Composites with addition 5, 15, and 25 vol% jute and mallow fibers were produced by vacuum-assisted hand lay-up/vaccum-bagging procedure. Samples were tested in tensile and the tensile strength, elasticity modulus, and deformation were determined. Results showed that the intrinsic Young's modulus of the fibers was set at values around 17.95 and 11.72 GPa for jute and mallow fibers, respectively. Statistical analysis showed that composites reinforced with 15 and 25 vol% jute and mallow presented the highest values of tensile strength and Young's modulus. The incorporation of 25 vol% of jute and mallow fibers increased the matrix Young's modulus by 534% and 353%, respectively, effectively stiffening the composite material. Prediction models presented similar values for the Young's modulus, showing that jute and mallow fibers might be used as potential reinforcement of polymeric matrices.

Inferior petrosal sinus sampling and stimulation with CRH: 15 years of experience in a tertiary hospital.

BACKGROUND: Inferior petrosal sinus sampling (IPSS) is indicated in the diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS), especially when the results of the initial diagnostic tests are discordant. OBJECTIVE: To describe the patients who underwent this invasive functional test in a tertiary hospital. METHODS: This was an observational study of a retrospective cohort of patients with ACTH-dependent CS and IPSS between 2004 and 2019. We determined their epidemiological, hormonal, radiological and functional characteristics, and evaluated their diagnostic capacity and optimal cut-off points to differentiate between Cushing's disease (CD) and ectopic Cushing's syndrome (ECS). RESULTS: 23 patients were evaluated, of which 65.2% were women with the average age of 42 (36-62) years. ACTH secretion of pituitary origin was evident in 82.6% of the patients and of ectopic origin in 17.4%. Plasma cortisol, urinary free cortisol, and ACTH levels were higher in patients with ECS. Regarding IPSS, the baseline central/peripheral ACTH gradient detected 89.5% of patients with CD and after stimulation with CRH, 100%. The optimal cut-off points in the diagnosis of CD were 2.06 at baseline and 2.49 after CRH stimulation. CONCLUSION: IPSS with CRH stimulation is a test with a high diagnostic accuracy for correctly classifying patients with CD and ECS. The cut-off points of the gradients may be different from the classic ones. Therefore, we recommend that each center perform its own evaluation.