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1. SENECA study: staging endometrial cancer based on molecular classification

Author

Chacon, E, Boria, F, Lyer, R, Fanfani, F, Malzoni, M, Bretova, P, Luzarraga Aznar, A, Fruscio, R, Jedryka, M, Toth, R, Perrone, A, Kakkos, A, Cristobal Quevedo, I, Congedo, L, Zanagnolo, V, Fernandez-Gonzalez, S, Ferro, B, Narducci, F, Hovhannisyan, T, Aksahin, E, Cardenas, L, Oliver, M, Nozaleda, G, Arnaez, M, Misiek, M, Ferrero, A, Pain, F, Zarragoitia, J, Diaz, C, Ceppi, L, Mehdiyev, S, Roldan-Rivas, F, Guijarro-Campillo, A, Amengual, J, Manzour, N, Sanchez Lorenzo, L, Nunez-Cordoba, J, Gonzalez Martin, A, Minguez, J, Chiva, L, Chacon E., Boria F., Lyer R. R., Fanfani F., Malzoni M., Bretova P., Luzarraga Aznar A., Fruscio R., Jedryka M. A., Toth R., Perrone A. M., Kakkos A., Cristobal Quevedo I., Congedo L., Zanagnolo V., Fernandez-Gonzalez S., Ferro B., Narducci F., Hovhannisyan T., Aksahin E., Cardenas L., Oliver M. R., Nozaleda G., Arnaez M., Misiek M., Ferrero A., Pain F. A., Zarragoitia J., Diaz C., Ceppi L., Mehdiyev S., Roldan-Rivas F., Guijarro-Campillo A. R., Amengual J., Manzour N., Sanchez Lorenzo L., Nunez-Cordoba J. M., Gonzalez Martin A., Minguez J. A., Chiva L., Chacon, E, Boria, F, Lyer, R, Fanfani, F, Malzoni, M, Bretova, P, Luzarraga Aznar, A, Fruscio, R, Jedryka, M, Toth, R, Perrone, A, Kakkos, A, Cristobal Quevedo, I, Congedo, L, Zanagnolo, V, Fernandez-Gonzalez, S, Ferro, B, Narducci, F, Hovhannisyan, T, Aksahin, E, Cardenas, L, Oliver, M, Nozaleda, G, Arnaez, M, Misiek, M, Ferrero, A, Pain, F, Zarragoitia, J, Diaz, C, Ceppi, L, Mehdiyev, S, Roldan-Rivas, F, Guijarro-Campillo, A, Amengual, J, Manzour, N, Sanchez Lorenzo, L, Nunez-Cordoba, J, Gonzalez Martin, A, Minguez, J, Chiva, L, Chacon E., Boria F., Lyer R. R., Fanfani F., Malzoni M., Bretova P., Luzarraga Aznar A., Fruscio R., Jedryka M. A., Toth R., Perrone A. M., Kakkos A., Cristobal Quevedo I., Congedo L., Zanagnolo V., Fernandez-Gonzalez S., Ferro B., Narducci F., Hovhannisyan T., Aksahin E., Cardenas L., Oliver M. R., Nozaleda G., Arnaez M., Misiek M., Ferrero A., Pain F. A., Zarragoitia J., Diaz C., Ceppi L., Mehdiyev S., Roldan-Rivas F., Guijarro-Campillo A. R., Amengual J., Manzour N., Sanchez Lorenzo L., Nunez-Cordoba J. M., Gonzalez Martin A., Minguez J. A., and Chiva L.

Abstract

OBJECTIVE: Management of endometrial cancer is advancing, with accurate staging crucial for guiding treatment decisions. Understanding sentinel lymph node (SLN) involvement rates across molecular subgroups is essential. To evaluate SLN involvement in early-stage (International Federation of Gynecology and Obstetrics 2009 I-II) endometrial cancer, considering molecular subtypes and new European Society of Gynaecological Oncology (ESGO) risk classification. METHODS: The SENECA study retrospectively reviewed data from 2139 women with stage I-II endometrial cancer across 66 centers in 16 countries. Patients underwent surgery with SLN assessment following ESGO guidelines between January 2021 and December 2022. Molecular analysis was performed on pre-operative biopsies or hysterectomy specimens. RESULTS: Among the 2139 patients, the molecular subgroups were as follows: 272 (12.7%) p53 abnormal (p53abn, 1191 (55.7%) non-specific molecular profile (NSMP), 581 (27.2%) mismatch repair deficient (MMRd), 95 (4.4%) POLE mutated (POLE-mut). Tracer diffusion was detected in, at least one side, in 97.2% of the cases; with a bilateral diffusion observed in 82.7% of the cases. By ultrastaging (90.7% of the cases) or one-step nucleic acid amplification (198 (9.3%) of the cases), 205 patients were identified with affected sentinel lymph nodes, representing 9.6% of the sample. Of these, 139 (67.8%) had low-volume metastases (including micrometastases, 42.9%; and isolated tumor cells, 24.9%) while 66 (32.2%) had macrometastases. Significant differences in SLN involvement were observed between molecular subtypes, with p53abn and MMRd groups having the highest rates (12.50% and 12.40%, respectively) compared with NSMP (7.80%) and POLE-mut (6.30%), (p=0.004); (p53abn, OR=1.69 (95% CI 1.11 to 2.56), p=0.014; MMRd, OR=1.67 (95% CI 1.21 to 2.31), p=0.002). Differences were also noted among ESGO risk groups (2.84% for low-risk patients, 6.62% for intermediate-risk patients, 21.63% for high-inte

Published
2024

2. Effect of drug treatment changes and seizure outcomes on depression and suicidality in adults with drug-resistant focal epilepsy

Author

Mula, M, Borghs, S, Ferro, B, Zaccara, G, Dainese, F, Ferlazzo, E, Romigi, A, Gambardella, A, Perucca, E, Mula, M, Borghs, S, Ferro, B, Zaccara, G, Dainese, F, Ferlazzo, E, Romigi, A, Gambardella, A, and Perucca, E

Abstract

OBJECTIVE: To investigate changes in depressive and suicidality status and their relationship with seizure outcomes after the addition or substitution of another antiseizure medication (ASM) in adults with drug-resistant focal epilepsy. METHODS: Seven hundred seventy consecutively enrolled patients were assessed and followed prospectively for seizure outcome and depressive status over a 6-month period after starting treatment with a newly introduced ASM. The Neurological Disorders Depression Inventory for Epilepsy (NDDIE) was used to screen for depression and suicidality. Correlations of NDDIE results with clinical and treatment-related variables were assessed by using a stepwise logistic regression model. RESULTS: At baseline, 50% of patients had a positive screening test result for depression and 13% had a positive screening test result for suicidal ideation. A psychiatric comorbidity at baseline was associated with a 2.3 times increased risk of an initially negative NDDIE screening result becoming positive at re-assessment after 6 months. In addition, the number of ASMs taken at baseline correlated with an increased risk of a change in depression screening test results from negative to positive during follow-up, whereas no association was identified with sociodemographic and epilepsy-related variables, including seizure outcomes. Approximately 6% of patients who were initially negative at screening for suicidal ideation became positive at the 6-month re-assessment. The risk of switch from a negative to a positive screening test result for suicidal ideation was increased more than two-fold in individuals who screened positive for depression at baseline, and was unrelated to the type of ASM introduced, sociodemographic variables, or seizure outcomes. SIGNIFICANCE: Almost 1 in 5 adults with drug-resistant focal epilepsy who screen negative for depression become positive when re-assessed 6 months after a treatment change. At re-assessment 6 months later, 6.1% who scr

Published
2024

13. ACNES as a cause of chronic abdominal pain

Author

Calvo-Mosquera, G., González-Cal, A., Calvo-Rodríguez, D., López-Cela, T., and Muñoz-Ferro, B.

Subjects
dolor neuropático, atrapamientos nerviosos, cuestionarios, Dolor abdominal
Published
2018

14. Preliminary pharmacological studies on Eugenia uniflora leaves: xanthine oxidase inhibitory activity.

Author

1261551, 444503, Rojas de Arias, Gladys Antonieta, Schmeda-Hirschmann, Guillermo, Theoduloz, Cristina, Franco, Lucía, Ferro B., Esteban, 1261551, 444503, Rojas de Arias, Gladys Antonieta, Schmeda-Hirschmann, Guillermo, Theoduloz, Cristina, Franco, Lucía, and Ferro B., Esteban

Abstract

Eugenia uniflora is widely used in Paraguayan folk medicine. A hydroalcoholic extract of the leaves showed some central nervous system activity in hippocratic screening when given intraperitoneally, but little to no acute or subacute toxicity in doses up to 4200 mg/kg orally in BALB c mice. The LD50 of the extract was 220 mg/kg i.p. in mice. A decoction or infusion of the leaves is recommended for treating gout by native herbalists. The known flavonoids quercitrin, quercetin, myricitrin and myricetin were found to be responsible for the xanthine oxidase inhibitory action of the plant extract.

Published
2019

20. Jugular vein distensibility predicts fluid responsiveness in septic patients

Author

Guarracino, F, Ferro, B, Forfori, F, Bertini, P, Magliacano, L, Pinsky, MR, Guarracino, F, Ferro, B, Forfori, F, Bertini, P, Magliacano, L, and Pinsky, MR

Abstract

Introduction: The purpose of the study was to verify the efficacy of using internal jugular vein (IJV) size and distensibility as a reliable index of fluid responsiveness in mechanically ventilated patients with sepsis. Methods: Hemodynamic data of mechanically ventilated patients with sepsis were collected through a radial arterial indwelling catheter connected to continuous hemodynamic monitoring system (Most Care®, Vytech Health, Padova, Italy), including cardiac index (CI) (L/min/M2), heart rate (beats/min), mean arterial pressure (MAP) (mmHg), central venous pressure (CVP) (mmHg) and arterial pulse pressure variation (PPV), coupled with ultrasound evaluation of IJV distensibility (%), defined as a ratio of the difference between IJV maximal antero-posterior diameter during inspiration and minimum expiratory diameter to minimum expiratory diameter x100. Patients were retrospectively divided into two groups; fluid responders (R), if CI increase of more than or equal to 15% after a 7 ml/kg crystalloid infusion, and non-responders (NR) if CI increased more than 15%. We compared differences in measured variables between R and NR groups and calculated receiver-operator-characteristic (ROC) curves of optimal IJV distensibility and PPV sensitivity and specificity to predicting R. We also calculated a combined inferior vena cava distensibility-PPV ROC curve to predict R. Results: We enrolled 50 patients, of these, 30 were R. Responders presented higher IJV distensibility and PPV before fluid challenge than NR (P <0.05). An IJV distensibility more than 18% prior to volume challenge had an 80% sensitivity and 85% specificity to predict R. Pairwise comparison between IJV distensibility and PPV ROC curves revealed similar ROC area under the curve results. Interestingly, combining IJV distensibility more than 9.7% and PPV more than 12% predicted fluid responsiveness with a sensitivity of 100% and specificity of 95%. Conclusion: IJV distensibility is an accurate, easily acqui

Published
2014

21. Ventriculoarterial decoupling in human septic shock

Author

Guarracino, F, Ferro, B, Morelli, A, Bertini, P, Baldassarri, R, Pinsky, MR, Guarracino, F, Ferro, B, Morelli, A, Bertini, P, Baldassarri, R, and Pinsky, MR

Abstract

Introduction: Septic shock is the most severe manifestation of sepsis. It is characterized as a hypotensive cardiovascular state associated with multiorgan dysfunction and metabolic disturbances. Management of septic shock is targeted at preserving adequate organ perfusion pressure without precipitating pulmonary edema or massive volume overload. Cardiac dysfunction often occurs in septic shock patients and can significantly affect outcomes. One physiologic approach to detect the interaction between the heart and the circulation when both are affected is to examine ventriculoarterial coupling, which is defined by the ratio of arterial elastance (Ea) to left ventricular end-systolic elastance (Ees). In this study, we analyzed ventriculoarterial coupling in a cohort of patients admitted to ICUs who presented with vs without septic shock.Methods: In this retrospective cross-sectional opportunity study, we measured routine hemodynamics using indwelling arterial and pulmonary arterial catheters and transthoracic echocardiograms in 25 septic patients (group S) and 25 non-septic shock patients (group C) upon ICU admission. Ees was measured by echocardiography using a single-beat (EesSB) method. Ea was calculated as 0.9 systolic arterial pressure/stroke volume, and then the Ea/EesSB ratio was calculated (normal value <1.36).Results: In group S, 21 patients had an Ea/EesSB ratio >1.36 (uncoupled). The four patients with Ea/EesSB ratios ≤1.36 had higher EesSB values than patients with Ea/EesSB ratios >1.36 (P = 0.007), although Ea measurements were similar in both groups (P = 0.4). In group C, five patients had uncoupled Ea/EesSB ratios. No correlation was found between EesSB and left ventricular ejection fraction and between Ea/EesSB ratio and mixed venous oxygen saturation in septic shock patients.Conclusions: Upon admission to the ICU, patients in septic shock often display significant ventriculoarterial decoupling that is associated with impaired left ventricular performa

Published
2014

25. Club35 Poster Session Thursday 12 December: 12/12/2013, 08:30-18:00 * Location: Poster area

Author

Montoro Lopez, M., primary, Iniesta Manjavacas, A., additional, Mori Junco, R., additional, Pena Conde, L., additional, Pons De Antonio, I., additional, Garcia Blas, S., additional, Lopez Fernandez, T., additional, Moreno Gomez, R., additional, Moreno Yanguela, M., additional, Lopez Sendon, J., additional, Carro, A., additional, Kiotsekoglou, A., additional, Andoh, J., additional, Brown, S., additional, Kaski, J., additional, Imamura, Y., additional, Arai, K., additional, Uematsu, S., additional, Fukushima, K., additional, Hoshi, H., additional, Ashihara, K., additional, Takagi, A., additional, Hagiwara, N., additional, Gillis, K., additional, Bala, G., additional, Roosens, B., additional, Remory, I., additional, Droogmans, S., additional, Van Camp, G., additional, Cosyns, B., additional, Van De Heyning, C., additional, Magne, J., additional, Pierard, L., additional, Bruyere, P., additional, Davin, L., additional, De Maeyer, C., additional, Paelinck, B., additional, Vrints, C., additional, Lancellotti, P., additional, Borowiec, A., additional, Dabrowski, R., additional, Kowalik, I., additional, Firek, B., additional, Chwyczko, T., additional, Janas, J., additional, Szwed, H., additional, Tufaro, V., additional, Fragasso, G., additional, Ingallina, G., additional, Marini, C., additional, Fisicaro, A., additional, Loiacono, F., additional, Margonato, A., additional, Agricola, E., additional, Ferreira, F., additional, Pereira, T., additional, Abreu, J., additional, Labandeiro, J., additional, Fiarresga, A., additional, Ferreira, A., additional, Galrinho, A., additional, Branco, L., additional, Timoteo, A., additional, Ferreira, R., additional, Marmol, R., additional, Gomez, M., additional, Garcia, K., additional, Sanmiguel, D., additional, Cabades, C., additional, Monteagudo, M., additional, Nunez, C., additional, Fernandez, C., additional, Diez, J., additional, Roldan, I., additional, Kolesnyk, M., additional, Ancona, M., additional, Oppizzi, M., additional, Krestjyaninov, M., additional, Razin, V., additional, Gimaev, R., additional, Carminati, M., additional, Piazzese, C., additional, Tsang, W., additional, Lang, R., additional, Caiani, E., additional, Goncalves, S., additional, Ramalho, A., additional, Placido, R., additional, Marta, L., additional, Cortez Dias, N., additional, Magalhaes, A., additional, Menezes, M., additional, Martins, S., additional, Almeida, A., additional, Nunes Diogo, A., additional, Stokke, T. M., additional, Ruddox, V., additional, Sarvari, S. I., additional, Otterstad, J. E., additional, Aune, E., additional, Edvardsen, T., additional, Pirone, D., additional, De Francesco, V., additional, Marino, F., additional, Gervasi, F., additional, Demartini, C., additional, Goffredo, C., additional, Bono, M., additional, Mega, S., additional, Chello, M., additional, Di Sciascio, G., additional, Martin Hidalgo, M., additional, Seoane Garcia, T., additional, Carrasco Avalos, F., additional, Mesa Rubio, M., additional, Delgado Ortega, M., additional, Ruiz Ortiz, M., additional, Mazuelos Bellido, F., additional, Suarez De Lezo Herrero De Tejada, J., additional, Pan Alvarez De Osorio, M., additional, Suarez De Lezo Cruz Conde, J., additional, Lopez Granados, A., additional, Romero Moreno, M., additional, Pan Alvarez-Ossorio, M., additional, Menichetti, F., additional, Bongiorni, M., additional, Ferro, B., additional, Segreti, L., additional, Bertini, P., additional, Mariotti, R., additional, Baldassarri, R., additional, Di Cori, A., additional, Zucchelli, G., additional, Guarracino, F., additional, Santoro, A., additional, Federco Alvino, F., additional, Giovanni Antonelli, G., additional, Raffaella De Vito, R., additional, Roberta Molle, R., additional, Sergio Mondillo, S., additional, Mahmoud, Y., additional, Abdel-Kader, M., additional, Guindy, R., additional, Elzahwy, S., additional, Dijkema, E., additional, Molenschot, M., additional, Slieker, M., additional, Oliveira Da Silva, C., additional, Sahlen, A., additional, Winter, R., additional, Back, M., additional, Ruck, A., additional, Settergren, M., additional, Manouras, A., additional, Shahgaldi, K., additional, and Ruzov, V., additional

Published
2013
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36. A Comparative Evaluation of Amlodipine and Hydrochlorothiazide as Monotherapy in the Treatment of Isolated Systolic Hypertension in the Elderly.

Author

Herrera, J., Calvo, C., Macías, J., Gude, F., Sagastagoitia, T., Abellán, J., Ferro, B., Oliván, J., Vega, A., Olmos, M., Martínez, J., Pita, L., Sánz, D., Sarasa, J., and Bueno, J.

Subjects
DIHYDROPYRIDINE, AMLODIPINE, THERAPEUTICS, HYPERTENSION
Abstract

Objective: The purpose of this 8-week, randomised, single-blind, parallel group, multicentre, comparative study was to evaluate the efficacy, safety and tolerability of the dihydropyridine calcium antagonist amlodipine versus the thiazide diuretic hydrochlorothiazide for control of isolated systolic hypertension (ISH) in elderly patients aged 60 years or more. Design: This was a phase IV, multicentre, single-blind, comparative, parallel group, randomised clinical trial, divided into two phases. Setting, Patients and Interventions: Following a 4-week placebo wash-out period (phase I), outpatients aged 60 to 87 years with systolic blood pressure (SBP) ≥ 160mm Hg and diastolic blood pressure (DBP) ≤ 95mm Hg were randomised to receive amlodipine 5 mg/day or hydrochlorothiazide 50 mg/day for 8 weeks (phase II). After 4 weeks of active treatment, if sitting SBP (sSBP) still was above 150mm Hg, the dose had to be doubled. Demographic and safety data were assessed in all patients and efficacy only in the evaluable patients according to pre-specified criteria. Results: 197 patients (66.5% women) were assigned to received amlodipine (n = 97) or hydrochlorothiazide (n = 100). 86 patients treated with amlodipine and 98 patients treated with hydrochlorothiazide were considered evaluable for efficacy. Two (2%) and five patients (5%) from each group, respectively, did not complete the study treatment. At the end of the active treatment phase, 80% of the patients treated with amlodipine were considered therapeutic successes (sSBP ≤ 150mm Hg) compared with 54% in the hydrochlorothiazide group (p = 0.0003). The mean reduction in sitting SBP/DBP in the amlodipine group was 32.5/8.4mm Hg and 24.0/4.7mm Hg in the hydrochlorothiazide group. The difference between groups was statistically significant (p < 0.001). There were no clinically significant changes in mean heart rate values between the two treatment groups. Laboratory findings showed that amlodipine had a neutral effect on haematological and biochemical values with an improvement in serum triglyceride and creatinine levels, while in the hydrochlorothiazide group, due to the high doses studied (50 to 100 mg/day), there were some metabolic adverse effects (e.g. in blood glucose levels and serum levels of lipids, uric acid and electrolytes). Safety and tolerability data showed that both treatments were well tolerated. Only one serious adverse event occurred during the course of the trial, and it was not related to treatment. The percentage of adverse events and discontinuations was 36 and 2% with amlodipine versus 44 and 4% with hydrochlorothiazide, respectively. Conclusion: These results showed that for treatment of ISH in patients aged 60 years or more, amlodipine is significantly more effective than hydrochlorothiazide in reducing sitting SBP/DBP in monotherapy, and both drugs are well tolerated. [ABSTRACT FROM AUTHOR]

Published
2000

41. Contenido

Author

Ferro Bayona, Jesús

Published
2010

45. Preliminary pharmacological studies on Eugenia uniflora leaves: Xanthine oxidase inhibitory activity

Author

Lucia Franco, Guillermo Schmeda-Hirschmann, Esteban Ferro B, Antonieta Rojas de Arias, and Cristina Theoduloz

Subjects
Male, Pharmacology, chemistry.chemical_classification, Mice, Inbred BALB C, Xanthine Oxidase, food.ingredient, Traditional medicine, Plant Extracts, Flavonoid, Eugenia uniflora, Administration, Oral, Decoction, Biology, Quercitrin, Lethal Dose 50, Mice, chemistry.chemical_compound, food, chemistry, Drug Discovery, Animals, Myricetin, Quercetin, Xanthine oxidase, Myricitrin
Abstract

Eugenia uniflora is widely used in Paraguayan folk medicine. A hydroalcoholic extract of the leaves showed some central nervous system activity in hippocratic screening when given intraperitoneally, but little to no acute or subacute toxicity in doses up to 4200 mg kg orally in BALB c mice. The LD50 of the extract was 220 mg kg i.p. in mice. A decoction or infusion of the leaves is recommended for treating gout by native herbalists. The known flavonoids quercitrin, quercetin, myricitrin and myricetin were found to be responsible for the xanthine oxidase inhibitory action of the plant extract.

Published
1987
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47. Pe-Kiu-Yi un poeta chino espiritualista

Author

Jesús M. Ferro B., S.I.

Subjects
Poesía china, lcsh:Z, lcsh:Bibliography. Library science. Information resources
Abstract

No importa saber detalles concretos de su vida. Como muchos poetas, ha pasado ignorado a la historia. Lo he descubierto en la versión hecha por Guillermo Valencia en "Catay" y lo descifré profundo y sencillo en su filosofía del vivir. Se llama su poesía EL RETIRO (1).

Published
1964

49. Club35 Poster Session Thursday 12 December: 12/12/2013, 08:30-18:00 * Location: Poster area

Author

Montoro Lopez, M, Iniesta Manjavacas, AM, Mori Junco, R, Pena Conde, L, Pons De Antonio, I, Garcia Blas, S, Lopez Fernandez, T, Moreno Gomez, R, Moreno Yanguela, M, Lopez Sendon, JL, Carro, A, Kiotsekoglou, A, Andoh, J, Brown, S, Kaski, JC, Imamura, Y, Arai, K, Uematsu, S, Fukushima, K, Hoshi, H, Ashihara, K, Takagi, A, Hagiwara, N, Gillis, K, Bala, G, Roosens, B, Remory, I, Droogmans, S, Van Camp, G, Cosyns, B, Van De Heyning, CM, Magne, J, Pierard, LA, Bruyere, PJ, Davin, L, De Maeyer, C, Paelinck, BP, Vrints, CJ, Lancellotti, P, Borowiec, A, Dabrowski, R, Kowalik, I, Firek, B, Chwyczko, T, Janas, J, Szwed, H, Tufaro, V, Fragasso, G, Ingallina, G, Marini, C, Fisicaro, A, Loiacono, F, Margonato, A, Agricola, E, Ferreira, F, Pereira, TS, Abreu, J, Labandeiro, J, Fiarresga, A, Ferreira, AM, Galrinho, A, Branco, LM, Timoteo, AT, Ferreira, RC, Marmol, R, Gomez, M, Garcia, K, Sanmiguel, D, Cabades, C, Monteagudo, M, Nunez, C, Fernandez, C, Diez, JL, Roldan, I, Kolesnyk, MY, Borowiec, A, Dabrowski, R, Kowalik, I, Firek, B, Chwyczko, T, Janas, J, Szwed, H, Marini, C, Tufaro, V, Ancona, MB, Fisicaro, A, Oppizzi, M, Margonato, A, Agricola, E, Krestjyaninov, M, Razin, VA, Gimaev, RH, Carminati, MC, Piazzese, C, Tsang, W, Lang, RM, Caiani, EG, Goncalves, S, Ramalho, A, Placido, R, Marta, L, Cortez Dias, N, Magalhaes, A, Menezes, M, Martins, S, Almeida, A, Nunes Diogo, A, Stokke, T M, Ruddox, V, Sarvari, S I, Otterstad, J E, Aune, E, Edvardsen, T, Pirone, D, De Francesco, V, Marino, F, Gervasi, F, Demartini, C, Goffredo, C, Bono, MC, Mega, S, Chello, M, Di Sciascio, G, Martin Hidalgo, M, Seoane Garcia, T, Carrasco Avalos, F, Mesa Rubio, MD, Delgado Ortega, M, Ruiz Ortiz, M, Mazuelos Bellido, F, Suarez De Lezo Herrero De Tejada, J, Pan Alvarez De Osorio, M, Suarez De Lezo Cruz Conde, J, Seoane Garcia, T, Martin Hidalgo, M, Carrasco Avalos, F, Mesa Rubio, MD, Ruiz Ortiz, M, Delgado Ortega, M, Lopez Granados, A, Romero Moreno, M, Pan Alvarez-Ossorio, M, Suarez De Lezo Cruz Conde, J, Menichetti, F, Bongiorni, MG, Ferro, B, Segreti, L, Bertini, P, Mariotti, R, Baldassarri, R, Di Cori, A, Zucchelli, G, Guarracino, F, Santoro, A, Federco Alvino, FA, Giovanni Antonelli, GA, Raffaella De Vito, RDV, Roberta Molle, RM, Sergio Mondillo, SM, Mahmoud, Y, Abdel-Kader, M, Guindy, R, Elzahwy, S, Dijkema, EJ, Molenschot, MC, Slieker, MG, Oliveira Da Silva, C, Sahlen, A, Winter, R, Back, M, Ruck, A, Settergren, M, Manouras, A, Shahgaldi, K, Krestjyaninov, MV, and Ruzov, VI

Abstract

Purpose: The coexistence of mitral regurgitation (MR) and severe aortic stenosis is a common problem in elderly patients that limits the indication for percutaneous aortic prosthesis (TAVI). However, recent publications indicate a decrease in MR after TAVI because of the improvement of left ventricle (LV) hemodynamic conditions. The aim of our study was to investigate clinical and echocardiographic predictors of MR after TAVI. Methods: We included patients undergoing TAVI from May 2008 to November 2012. It was performed a 3D transesophageal echocardiogram during the procedure and a transthoracic echocardiogram before discharge and 12 months after implantation. We studied the etiology of MR before procedure, LV ejection fraction, chambers volume, pulmonary hypertension and tricuspid regurgitation, as well as clinical and technical variables related to the procedure. Results: 90 patients underwent TAVI successfully (Table). At the beginning, 21% of patients had MR at least grade III/IV. After TAVI, 84.4% of patients showed no change in MR degree, 12.2% improved and only 3.3% worsened. Variables related with MR worsening were rheumatic MR etiology, history of atrial fibrillation (AF) and the coexistence of significant tricuspid regurgitation (TR) in the baseline study (p <0.04, p <0.01; p <0.03, respectively). Conclusions: In patients undergoing TAVI, the rheumatic etiology of MR, the previous history of AF and significant TR coexistence were factors related to MR worsening after the procedure.   Baseline characteristics. N = 90Age81.9 ± 6.9Women49 (54.4%)LVEF56 % ± 11.6Previous stroke16 (18%)Previous AF36 (42.4%)Baseline creatinine serum level1.3 mg/dl ± 0.5EuroSCORE16.8 ± 9.2Transfemoral approach71 (79.8%)Transapical approach18 (20.2%) LVEF: ejection fraction of the left ventricle. AF: atrial fibrillation

Published
2013
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50. Do neurologists agree in diagnosing drug resistance in adults with focal epilepsy?

Author

Stefano Meletti, Paolo Tinuper, Angela La Neve, Marco Mula, Maurizio Elia, Leila Zummo, Gaetano Zaccara, Domenico Consoli, Emilio Perucca, Bruno Ferrò, Alfonso Iudice, Anna Teresa Giallonardo, Zaccara G., Mula M., Ferro B., Consoli D., Elia M., Giallonardo A.T., Iudice A., La Neve A., Meletti S., Tinuper P., Zummo L., and Perucca E.

Subjects
Adult, Male, 0301 basic medicine, Drug Resistant Epilepsy, medicine.medical_specialty, Pediatrics, Neurology, Attitude of Health Personnel, Treatment outcome, antiepileptic drugs, classification, drug-resistant epilepsy, epilepsy, ILAE definition, reliability, Neurology (clinical), Drug resistance, 03 medical and health sciences, Epilepsy, antiepileptic drug, 0302 clinical medicine, medicine, Humans, Neurologists, Prospective Studies, Cooperative Behavior, business.industry, Middle Aged, medicine.disease, Confidence interval, Inter-rater reliability, 030104 developmental biology, Anticonvulsants, Female, Epilepsies, Partial, business, 030217 neurology & neurosurgery, Kappa
Abstract

Objective: To evaluate interrater agreement in categorizing treatment outcomes and drug responsiveness status according to the International League Against Epilepsy (ILAE) definition of drug-resistant epilepsy. Methods: A total of 1053 adults with focal epilepsy considered by the investigators to meet ILAE criteria for drug resistance were enrolled consecutively at 43 centers and followed up prospectively for 18-34months. Treatment outcomes for all antiepileptic drugs (AEDs) used up to enrollment (retrospective assessment), and on an AED newly introduced at enrollment, were categorized by individual investigators and by 2 rotating members of a 16-member expert panel (EP) that reviewed the patient records independently. Interrater agreement was tested by Cohen’s kappa (k) statistics and rated according to Landis and Koch’s criteria. Results: Agreement between EP members in categorizing outcomes on the newly introduced AED was almost perfect (90.1%, k=0.84, 95% confidence interval [CI] 0.80-0.87), whereas agreement between the EP and individual investigators was moderate (70.4%, k=0.57, 95% CI 0.53-0.61). Similarly, categorization of outcomes on previously used AEDs was almost perfect between EP members (91.7%, k=0.83, 95% CI 0.81-0.84) and moderate between the EP and investigators (68.2%, k=0.50, 95% CI 0.48-0.52). Disagreement was related predominantly to outcomes considered to be treatment failures by the investigators but categorized as undetermined by the EP. Overall, 19% of patients classified as having drug-resistant epilepsy by the investigators were considered by the EP to have “undefined responsiveness.”. Significance: Interrater agreement in categorizing treatment outcomes according to ILAE criteria ranges from moderate to almost perfect. Nearly 1 in 5 patients considered by enrolling neurologists to be “drug-resistant” were classified by the EP as having “undefined responsiveness.”.

Published
2019

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