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Abstract To assess the utility of IVIM parameters in evaluating uterine fibroid blood flow compared to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) derived blood flow. Sixteen premenopausal women with uterine fibroids were enrolled in this prospective study. Pelvic MRI scans were obtained for each subject, both with and without continuous intravenous infusion of oxytocin, known to decrease significantly uterine fibroid blood flow, to assess the changes in blood flow of uterine fibroids. IVIM and DCE analyses were conducted using separate dedicated software. The bi-exponential IVIM model was used to estimate perfusion fraction (f), pseudo-diffusion coefficient (D*), and diffusion coefficient (D). DCE blood flow values were derived via T1 perfusion deconvolution arithmetic, utilizing a first pass of an AIF curve. The correlation between the parameters were analyzed by Spearman’s rank correlation analysis due to small sample size. Means of the parameters were compared with a nonparametric Wilcoxon sign rank method for each pair. Statistically significant positive correlations were found between perfusion fraction values and DCE blood flow values with oxytocin (Spearson’s ρ = 0.78, p = 0.0004), and between fD* values and DCE blood flow values with oxytocin (Spearson’s ρ = 0.64, p = 0.0071). Significant differences in blood flow were detected across most IVIM parameters: f, D*, and fD* (p

Background and objective: Toxicity from local salvage therapy for radiorecurrent prostate cancer (PCa) remains a concern. This phase 2 study evaluates the outcomes of salvage magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (sTULSA). Methods: Men with biochemically relapsed, biopsy-proven PCa following definitive radiotherapy underwent whole- or partial-gland sTULSA (NCT03350529). Prostate-confined recurrence was confirmed by MRI and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) computed tomography (CT). The primary endpoints were safety (Clavien-Dindo classification) and efficacy (prostate-specific antigen [PSA], PSMA PET-CT, and MRI-targeted biopsy at 12 mo). The secondary endpoints included functional and survival outcomes. Key findings and limitations: Thirty-nine patients underwent sTULSA (64% whole gland), with a median age of 73 yr (interquartile range [IQR]: 69–77) and PSA of 3.3 ng/ml (IQR: 2–6.2). Three patients had undergone prior salvage therapy, 16 were receiving hormonal therapy at enrollment, and 12 had a history of transurethral interventions. Eighteen patients had incidental urethral strictures on baseline cystoscopy. Over a median follow-up of 40 mo (IQR: 24–55), 56% experienced adverse events. Severe genitourinary toxicity (Clavien-Dindo ≥3 or hospitalization) occurred in 28%, including three patients with puboprostatic fistulas and two patients requiring cystectomy. Leak-free continence was maintained in 53%. At 12 mo, 89% showed no cancer in the targeted area, with a median PSA reduction of 95% (p

Introduction: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease that in most cases manifests in the first months of life, being a well-studied entity of myocardial ischaemia in young patients. It has been reported that up to 90 % of infants die without treatment in the first year, although late diagnosis is increasingly reported in adults. Case summary: We present the case of a 23-year-old woman of Moroccan origin with no medical history of interest, who was admitted to the cardiac intensive care unit after an episode of sustained ventricular tachycardia (VT) that required electrical cardioversion. On admission, the electrocardiogram and blood test were normal, but the transthoracic echocardiogram showed moderate left ventricular systolic dysfunction and severe mitral regurgitation of rheumatic aetiology which was later confirmed with a transesophageal echocardiogram. In view of the arrhythmic event presented, a complete study was performed with cardiac magnetic resonance imaging (MRI) which showed no pathological enhancements. Nevertheless, coronary artery angiography revealed an anomalous origin of the left coronary artery in the pulmonary artery which was confirmed by cardiac computed tomography (CT). Corrective surgery was performed with direct translocation of the left coronary artery to the aorta and mitral valve replacement. Discussion: In ALCAPA, the coronary steal phenomenon produced from the pulmonary artery to the coronary circulation causes myocardial ischaemia and involves a left-to-right shunt. Myocardial ischaemia is cause of angina, systolic dysfunction, mitral regurgitation and sudden cardiac death in children and young adults.

ABSTRACT Introduction and objectives: The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) and the Interventional Working Group of the Spanish Society of Pediatric Cardiology (GTH-SECPCC) present their annual activity report for 2022. Methods: All Spanish centers with catheterization laboratories and interventional activity in congenital heart diseases were invited to participate. Data were collected online and analyzed by an external company, together with the members of the ACI-SEC and the GTH-SECPCC. Results: A total of 22 centers participated (19 public and 3 private). Interventional data on adult congenital diseases contributed by another 99 hospitals to the Registry of Cardiac Catheterization and Interventional Cardiology of the ACI-SEC in 2022 were incorporated into the analysis. A total of 1141 diagnostic studies (4.3% more than in 2021) and 2508 interventional catheterizations (61.5% more than in 2020) were registered. The most frequent procedures were atrial septal defect closure (1135 cases), percutaneous closure of patent ductus arteriosus (262 cases), and pulmonary branch artery angioplasty (234 cases). The most significant increases in volume were related to balloon aortic valvuloplasty (48.9%), atrial septal defect closure (45.2%), and ventricular septal defect closure (40.7%). Interventional procedures were successful in 97.6%, with major procedural complications occurring in 1.4% and in-hospital mortality in 0.2%. Conclusions: This report is the third publication of the Spanish Cardiac Catheterization in Congenital Heart Diseases Registry. Both diagnostic and interventional procedures substantially increased, particularly in balloon aortic valvuloplasty, atrial septal defect closure, and ventricular septal defect closure. Most interventional techniques continue to demonstrate excellent safety and effectiveness outcomes.

RESUMEN Introducción y objetivos: La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) y el Grupo de Trabajo de Hemodinámica de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (GTH-SECPCC) presentan su informe anual de actividad hemodinámica en cardiopatías congénitas correspondiente al año 2022. Métodos: Se invitó a participar a los centros españoles con laboratorio de hemodinámica y actividad intervencionista en cardiopatías congénitas. La recogida de datos se realizó mediante un cuestionario telemático. Una empresa externa analizó los resultados, que fueron revisados por miembros de la ACI-SEC y el GTH-SECPCC. Resultados: Participaron en el registro 22 centros (19 públicos y 3 privados). Se incorporaron al análisis los datos de intervencionismo en cardiopatías congénitas del adulto aportados por otros 99 hospitales al Registro de Hemodinámica y Cardiología Intervencionista de la ACI-SEC del año 2022. Se registraron 1.141 estudios diagnósticos (un 4,3% más que en 2021) y 2.508 cateterismos intervencionistas (un 61,5% más que en 2021). Las técnicas con mayor casuística fueron el cierre de defectos interauriculares (1.135 casos), el cierre de ductus arterioso (262 casos) y la angioplastia de ramas pulmonares (234 casos). El incremento más significativo se comunicó en la valvuloplastia aórtica (48,9%), el cierre de defectos interauriculares (45,2%) y el cierre de comunicación interventricular (40,7%). La tasa de éxito en los procedimientos intervencionistas fue del 97,6%, con una tasa de complicaciones mayores del 1,4 % y una mortalidad intrahospitalaria del 0,2%. Conclusiones: El presente trabajo es la tercera publicación del Registro Español de Intervencionismo en Cardiopatías Congénitas. Se ha comunicado un aumento muy significativo de la mayoría de los procedimientos terapéuticos, destacando el incremento de la valvuloplastia aórtica, del cierre de defectos interauriculares y del cierre de comunicación interventricular. Todas las técnicas intervencionistas han comunicado excelentes datos de seguridad y eficacia.

Regarding our publication, entitled “Discrepancies between Radiology Specialists and Residents in Fracture Detection from Musculoskeletal Radiographs” [...]

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P

RESUMEN Introducción y objetivos: La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) y el Grupo de Trabajo de Hemodinámica de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (GTH-SECPCC) presentan su informe anual de actividad hemodinámica en cardiopatías congénitas correspondiente al año 2021. Métodos: Se invitó a participar a los centros españoles con laboratorio de hemodinámica y actividad intervencionista en cardiopatías congénitas. La recogida de datos fue telemática y su análisis lo efectuó una empresa externa junto con miembros de la ACI-SEC y el GTH-SECPCC. Resultados: Participaron 16 centros (15 públicos y 1 privado) que acumulan 34 salas de hemodinámica con actividad en cardiopatías congénitas, 7 (20,5%) de ellas con dedicación exclusiva a pacientes pediátricos. Se registraron 1.094 estudios diagnósticos (5,1% más que en 2020) y 1.553 cateterismos intervencionistas (6,4% más que en 2020). Las técnicas más frecuentes fueron el cierre de comunicación interauricular (336 casos), la angioplastia de ramas pulmonares (231 casos) y el cierre de ductus (228 casos). Respecto al año anterior se incrementaron significativamente las técnicas de implantación de válvulas percutáneas (29,3%), cierre de ductus (20,6%) y angioplastia aórtica (12,8%). La tasa de éxito en los procedimientos intervencionistas fue del 95%, con una tasa de complicaciones mayores del 2,7% y una mortalidad intrahospitalaria del 0,2%. Conclusiones: Este trabajo es la segunda publicación del Registro Español de Intervencionismo en Cardiopatías Congénitas. Se ha constatado un aumento significativo de los procedimientos diagnósticos y terapéuticos, destacando el incremento en la implantación de válvulas percutáneas, el cierre de ductus y la angioplastia aórtica. La mayoría de las técnicas intervencionistas siguen demostrando excelentes datos de seguridad y eficacia.

ABSTRACT Introduction and objectives: This is the 2021 annual activity report from the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC), and the Interventional Working Group of the Spanish Society of Pediatric Cardiology (GTH-SECPCC). Methods: All Spanish centers with cath lab capabilities and interventional activity in congenital heart diseases were invited to participate. Data were collected online, analyzed by an external company, and ACI-SEC and GTH-SECPCC members. Results: A total of 16 centers participated—15 public and 1 private—including 34 cath labs with experience in congenital heart diseases, 7 of them (20.5%) exclusively dedicated to pediatric patients. A total of 1094 diagnostic studies (4.5% more than 2020) and 1553 interventional catheterizations (5.8% more than 2020) were registered. The most common procedures were atrial septal defect closure (336 cases), pulmonary branch artery angioplasty (231 cases), and percutaneous closure of the patent ductus arteriosus (228 cases). Interventional procedures were considered successful in 95% of the cases with rates of major procedural complication and in-hospital mortality of 2.7% and 0.2%, respectively. Conclusions: This is the second Spanish Cardiac Catheterization in Congenital Heart Diseases Registry report. A significant increase of diagnostic and interventional procedures was reported with a special increase of percutaneous valve implantation, ductus arteriosus closure, and aortic angioplasty. Most interventional techniques continue to demonstrate excellent safety and efficacy outcomes.

Abstract Background Lumbar disc degeneration (LDD) is associated with low back pain (LBP). Although both insomnia and mental distress appear to influence the pain experience, their role in the association between LDD and LBP is uncertain. Our objective was to investigate the role of co-occurring insomnia and mental distress in the association between LDD and LBP-related disability. Methods A total of 1080 individuals who had experienced LBP during the previous year underwent 1.5-T lumbar magnetic resonance imaging, responded to questionnaires, and participated in a clinical examination at the age of 47. Full data was available for 843 individuals. The presence of LBP and LBP-related disability (numerical rating scale, range 0–10) were assessed using a questionnaire. LDD was assessed by a Pfirrmann-based sum score (range 0–15, higher values indicating higher LDD). The role of insomnia (according to the five-item Athens Insomnia Scale) and mental distress (according to the Hopkins Symptom Check List-25) in the association between the LDD sum score and LBP-related disability was analyzed using linear regression with adjustments for sex, smoking, body mass index, education, leisure-time physical activity, occupational physical exposure, Modic changes, and disc herniations. Results A positive association between LDD and LBP-related disability was observed among those with absence of both mental distress and insomnia (adjusted B = 0.132, 95% CI = 0.028–0.236, p = 0.013), and among those with either isolated mental distress (B = 0.345 CI = 0.039 –0.650, p = 0.028) or isolated insomnia (B = 0.207, CI = 0.040–0.373, p = 0.015). However, among individuals with co-occurring insomnia and mental distress, the association was not significant (B = -0.093, CI = -0.346-0.161, p = 0.470). Conclusions LDD does not associate with LBP-related disability when insomnia and mental distress co-occur. This finding may be useful when planning treatment and rehabilitation that aim to reduce disability among individuals with LDD and LBP. Future prospective research is warranted.

Background: A detailed understanding of the non-perfused volume (NPV) evolution after prostate ablation therapy is lacking. The impact of different diseased prostate tissues on NPV evolution post-ablation is unknown. Purpose: To characterize the NPV evolution for three treatment groups undergoing heat-based prostate ablation therapy, including benign prostatic hyperplasia (BPH), primary prostate cancer (PCa), and radiorecurrent PCa. Materials and methods: Study design and data analysis were performed retrospectively. All patients received MRI-guided transurethral ultrasound ablation (TULSA). 21 BPH, 28 radiorecurrent PCa and 40 primary PCa patients were included. Using the T1-weighted contrast-enhanced MR image, the NPV was manually contoured by an experienced radiologist. All patients received an MRI immediately following the ablation. Follow-up included MRI at 3- and 12 months for BPH and radiorecurrent PCa patients and at 6- and 12 months for primary PCa patients. Results: A significant difference between BPH and radiorecurrent PCa patients was observed at three months (p

AbstractPurpose Magnetic resonance – high-intensity focused ultrasound (MR-HIFU) is a noninvasive treatment option for symptomatic uterine leiomyomas. Currently, pretreatment MRI is used to assess tissue characteristics and predict the most likely therapeutic response for individual patients. However, these predictions still entail significant uncertainties. The impact of tissue properties on therapeutic outcomes remains poorly understood and detailed knowledge of the histological effects of ultrasound ablation is lacking. Investigating these aspects could aid in optimizing patient selection, enhancing treatment effects and improving treatment outcomes.Methods and materials We present seven patients who underwent MR-HIFU treatment for leiomyoma followed by second-line surgical treatment. Tissue samples obtained during the surgery were stained with hematoxylin and eosin, Masson’s trichrome and Herovici to evaluate general morphology, fibrosis and collagen deposition of leiomyomas. Immunohistochemical CD31, Ki-67 and MMP-2 stainings were performed to study vascularization, proliferation and matrix metalloproteinase-2 protein expression in leiomyomas, respectively.Results The clinical characteristics and radiological findings of the leiomyomas prior to treatment as well as qualitative histological findings after the treatment are presented and discussed in the context of current literature. A tentative model for volume reduction is presented.Conclusion These findings provide insights into potential factors contributing to suboptimal therapeutic outcomes and the variability in histological changes following treatment.

AbstractIntroduction Uterine fibroids are the most common benign tumors in healthy women. High Intensity Focused Ultrasound (HIFU) is a modern, noninvasive thermal ablation method for treating uterine fibroids. There is increasing evidence that ultrasound guided HIFU (US-HIFU) has no adverse impact on ovarian reserve but little data exists on magnetic resonance guided HIFU (MR-HIFU). There are different options to estimate ovarian reserve, perhaps the most reliable being the measurement of serum Anti-Müllerian hormone (AMH).Material and methods Seventy-four (74) premenopausal women with serum AMH 0.1 ug/L or over, aged 24–48 and with fibroids or adenomyosis treated with MR-HIFU were enrolled in our study. AMH levels were analyzed before and 3 months after the MR-HIFU treatment. Correlations between AMH level changes and position of fibroids, fibroid volume, non-perfused volume ratio, and treatment energies were studied.Results The median AMH level before the HIFU treatment was 1.20 (range: 0.1–7.75 ug/L) and after the treatment 1.23 (range: 0.1–8.51 ug/L). No significant change was detected (p = .90). The patients were divided in three subgroups depending on the baseline AMH levels. The changes were not significant in any of the subgroups. Neither did the location of the treated fibroid affect the change of AMH levels nor the total energy used during treatment.Conclusions MR-HIFU does not compromise the ovarian reserve. Neither the location of the treated fibroid nor the total energy used during MR-HIFU had any effect on the change of AMH levels.

We present the case of a 19-year-old woman with DiGeorge syndrome associated with psychomotor retardation, tetralogy of Fallot, and right pulmonary artery agenesis, treated with right ventricular outflow tract (RVOT) transannular patch augmentation during childhood, with severe pulmonary regurgitation and progressive right ventricular enlargement. As a result, pulmonary valve replacement was indicated. Cardiac computed tomography (CT) revealed the presence of severe scoliosis, right sternal deviation, and an elongated RVOT with a minimum diameter of 26 mm at the annular level and 30 mm at the supravalvular level (figure 1A-D, arrows). Because of the clinical and biomechanical characteristics, the anatomy of the RVOT, and the presence of a single pulmonary artery, we performed transcatheter implantation of a self-expanding bioprosthetic Venus valve (Medtech, China). Other valves suitable for large-caliber RVOTs, such as the Myval (Meril, India) have not been granted CE marking for pulmonary implantation. Figure 1. Prior to implantation, the RVOT was sized, and coronary compression was ruled out after occlusive inflation with a 35-mm PTS-X sizing balloon catheter (NuMED, United States). The measurements obtained were consistent with the CT scan results. Consequently, a 30-mm to 25-mm valve was selected (figure 2A,B). A 24-Fr GORE DrySeal introducer sheath and an extra...

Abstract Background Cancer-induced bone pain (CIBP), caused by bone metastases, is a common complication of cancer and strongly impairs quality of life (QoL). External beam radiotherapy (EBRT) is the current standard of care for treatment of CIBP. However, approximately 45% of patients have no adequate pain response after EBRT. Magnetic resonance image-guided high-intensity focused ultrasound (MR-HIFU) may improve pain palliation in this patient population. The main objective of this trial was to compare MR-HIFU, EBRT, and MR-HIFU + EBRT for the palliative treatment of bone metastases. Methods/design The FURTHER trial is an international multicenter, three-armed randomized controlled trial. A total of 216 patients with painful bone metastases will be randomized in a 1:1:1 ratio to receive EBRT only, MR-HIFU only, or combined treatment with EBRT followed by MR-HIFU. During a follow-up period of 6 months, patients will be contacted at eight time points to retrieve information about their level of pain, QoL, and the occurrence of (serious) adverse events. The primary outcome of the trial is pain response at 14 days after start of treatment. Secondary outcomes include pain response at 14 days after trial enrolment, pain scores (daily until the 21st day and at 4, 6, 12 and 24 weeks), toxicity, adverse events, QoL, and survival. Cost-effectiveness and cost-utility analysis will be conducted. Discussion The FURTHER trial aims to evaluate the effectiveness and cost-effectiveness of MR-HIFU—alone or in combination with EBRT—compared to EBRT to relieve CIBP. The trial will be performed in six hospitals in four European countries, all of which are partners in the FURTHER consortium. Trial registration The FURTHER trial is registered under the Netherlands Trials Register number NL71303.041.19 and ClinicalTrials.gov registration number NCT04307914. Date of trial registration is 13–01-2020.

Abstract Background Diabetes Mellitus (DM) affects a third of patients with symptomatic severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). DM is a well-known risk factor for cardiac surgery, but its prognostic impact in TAVI patients remains controversial. This study aimed to evaluate outcomes in diabetic patients undergoing TAVI. Methods This multicentre registry includes data of > 12,000 patients undergoing transfemoral TAVI. We assessed baseline patient characteristics and clinical outcomes in patients with DM and without DM. Clinical outcomes were defined by the second valve academic research consortium. Propensity score matching was applied to minimize potential confounding. Results Of the 11,440 patients included, 31% (n = 3550) had DM and 69% (n = 7890) did not have DM. Diabetic patients were younger but had an overall worse cardiovascular risk profile than non-diabetic patients. All-cause mortality rates were comparable at 30 days (4.5% vs. 4.9%, RR 0.9, 95%CI 0.8–1.1, p = 0.43) and at one year (17.5% vs. 17.4%, RR 1.0, 95%CI 0.9–1.1, p = 0.86) in the unmatched population. Propensity score matching obtained 3281 patient-pairs. Also in the matched population, mortality rates were comparable at 30 days (4.7% vs. 4.3%, RR 1.1, 95%CI 0.9–1.4, p = 0.38) and one year (17.3% vs. 16.2%, RR 1.1, 95%CI 0.9–1.2, p = 0.37). Other clinical outcomes including stroke, major bleeding, myocardial infarction and permanent pacemaker implantation, were comparable between patients with DM and without DM. Insulin treated diabetics (n = 314) showed a trend to higher mortality compared with non-insulin treated diabetics (n = 701, Hazard Ratio 1.5, 95%CI 0.9–2.3, p = 0.08). EuroSCORE II was the most accurate risk score and underestimated 30-day mortality with an observed-expected ratio of 1.15 in DM patients, STS-PROM overestimated actual mortality with a ratio of 0.77 and Logistic EuroSCORE with 0.35. Conclusion DM was not associated with mortality during the first year after TAVI. DM patients undergoing TAVI had low rates of mortality and other adverse clinical outcomes, comparable to non-DM TAVI patients. Our results underscore the safety of TAVI treatment in DM patients. Trial registration The study is registered at clinicaltrials.gov (NCT03588247).

RESUMEN Introducción y objetivos: La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) y el Grupo de Trabajo de Hemodinámica de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (GTH-SECPCC) presentan el informe de actividad hemodinámica en cardiopatías congénitas de 2020, año de inicio de la pandemia de la enfermedad coronavírica de 2019 (COVID-19). Métodos: Se invitó a participar a los centros españoles con laboratorio de hemodinámica y actividad intervencionista en cardiopatías congénitas. La recogida de datos se realizó telemáticamente; una empresa externa, junto con miembros de la ACI-SEC y el GTH-SECPCC, los analizó. Resultados: Participaron 16 centros (todos públicos), que acumulan 30 salas de hemodinámica con actividad en cardiopatías congénitas, 7 (23,3%) de ellas con dedicación exclusiva a pacientes pediátricos. Se registraron 1.046 estudios diagnósticos y 1.468 cateterismos intervencionistas. Los procedimientos terapéuticos fueron exitosos en el 94,9%, con una tasa de complicaciones mayores del 2% y una mortalidad del 0,1%. Las técnicas más frecuentes fueron el cierre de comunicación interauricular (377 casos), la angioplastia pulmonar (244 casos) y el cierre de ductus arterioso (199 casos). Conclusiones: El presente trabajo representa la primera publicación del Registro Español de Intervencionismo en Cardiopatías Congénitas. La casuística registrada está condicionada por la pandemia de la COVID-19. Los cateterismos diagnósticos siguen teniendo un papel relevante en esta actividad. Para la mayoría de las técnicas intervencionistas se han reportado excelentes datos de seguridad y eficacia.

ABSTRACT Introduction and objectives: The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) and the Spanish Society of Pediatric Cardiology Working Group on Interventional Cardiology (GTH-SECPCC) introduce their annual activity report for 2020, the starting year of the pandemic of coronavirus disease (COVID-19). Methods: All Spanish centers with cath labs and interventional activity in congenital heart diseases were invited to participate. Data were collected online, and analyzed by an external company together with members from the ACI-SEC and the GTH-SECPCC. Results: A total of 16 centers participated (all of them public) including 30 cath labs experienced in the management of congenital heart diseases, 7 of them (23.3%) dedicated exclusively to pediatric patients. A total of 1046 diagnostic studies, and 1468 interventional cardiac catheterizations were registered. The interventional procedures were considered successful in 93.4% of the cases with rates of major procedural complications and mortality of 2%, and 0.1%, respectively. The most frequent procedures were atrial septal defect closure (377 cases), pulmonary angioplasty (244 cases), and the percutaneous closure of the patent ductus arteriosus (199 cases). Conclusions: This report is the first publication from the Spanish Cardiac Catheterization in Congenital Heart Diseases Registry. The data recorded are conditioned by the COVID-19 pandemic. Diagnostic cardiac catheterization still plays a key role in this field. Most interventional techniques have reported excellent security and efficacy rates.

Abstract Joint effusion due to elbow fractures are common among adults and children. Radiography is the most commonly used imaging procedure to diagnose elbow injuries. The purpose of the study was to investigate the diagnostic accuracy of deep convolutional neural network algorithms in joint effusion classification in pediatric and adult elbow radiographs. This retrospective study consisted of a total of 4423 radiographs in a 3-year period from 2017 to 2020. Data was randomly separated into training (n = 2672), validation (n = 892) and test set (n = 859). Two models using VGG16 as the base architecture were trained with either only lateral projection or with four projections (AP, LAT and Obliques). Three radiologists evaluated joint effusion separately on the test set. Accuracy, precision, recall, specificity, F1 measure, Cohen’s kappa, and two-sided 95% confidence intervals were calculated. Mean patient age was 34.4 years (1–98) and 47% were male patients. Trained deep learning framework showed an AUC of 0.951 (95% CI 0.946–0.955) and 0.906 (95% CI 0.89–0.91) for the lateral and four projection elbow joint images in the test set, respectively. Adult and pediatric patient groups separately showed an AUC of 0.966 and 0.924, respectively. Radiologists showed an average accuracy, sensitivity, specificity, precision, F1 score, and AUC of 92.8%, 91.7%, 93.6%, 91.07%, 91.4%, and 92.6%. There were no statistically significant differences between AUC's of the deep learning model and the radiologists (p value > 0.05). The model on the lateral dataset resulted in higher AUC compared to the model with four projection datasets. Using deep learning it is possible to achieve expert level diagnostic accuracy in elbow joint effusion classification in pediatric and adult radiographs. Deep learning used in this study can classify joint effusion in radiographs and can be used in image interpretation as an aid for radiologists.

Los meningiomas de la fosa posterior representan el 10% en relación con los otros sitios en los que pueden estar localizados. Estas lesiones pueden provocar compromiso de la circulación de líquido cerebroespinal. Se presentó el caso de una paciente de 67 años de edad con antecedentes previos de presentar trastornos en la deambulación, observándose dificultad para caminar, de 15 días de evolución. Se realizó diagnóstico por tomografía de lesión ocupante de espacio localizada en fosa posterior. La paciente fue operada y secundariamente presentó hidrocefalia aguda, no comunicante, la cual se le realiza derivación ventrículo-peritoneal. No existieron otras complicaciones asociadas a la intervención quirúrgica.

Abstract Background Although it has been suggested that lumbar disc degeneration (LDD) is a significant risk factor for low back pain (LBP), its role remains uncertain. Our objective was to clarify the association between LDD and LBP and whether mental distress modifies the association. Methods Participants of a birth cohort underwent 1.5-T lumbar magnetic resonance imaging at the age of 47. The association between the sum score of LDD (Pfirrmann classification, range 0–15) and LBP (categorized into “no pain”, “mild-to-moderate pain”, “bothersome-and-frequent pain”) was assessed using logistic regression analysis, with sex, smoking, body mass index, physical activity, occupational exposure, education, and presence of Modic changes and disc herniations as confounders. The modifying role of mental distress (according to the Hopkins Symptom Check List-25 [HSCL-25], the Beck Depression Inventory and the Generalized Anxiety Disorder Scale) in the association was analyzed using linear regression. Results Of the study population (n = 1505), 15.2% had bothersome and frequent LBP, and 29.0% had no LBP. A higher LDD sum score increased the odds of belonging to the “mild-to-moderate pain” category (adjusted OR corresponding to an increase of one point in the LDD sum score 1.11, 95% CI 1.04–1.18, P = 0.003) and the “bothersome-and-frequent pain” category (adjusted OR 1.20, 95% CI 1.10–1.31, P

Mujer de 68 años ingresada por politraumatismo tras precipitarse desde una gran altura. Mientras estaba conectada a ventilación mecánica presenta un cuadro de hemoptisis autolimitada sin afectación hemodinámica, por lo que se le realizan varias tomografías computarizadas (TC) que muestran un seudoaneurisma de rama lobar superior derecha con unas dimensiones de 20 × 15 × 15 mm, sin datos de sangrado activo ni erosión, aunque con crecimiento progresivo (5 mm) en 3 TC sucesivas realizadas durante 5 días (figura 1, flechas). Dado el riesgo de rotura, se decide realizar una intervención percutánea para intentar el sellado del seudoaneurisma. Se obtuvieron los consentimientos informados pertinentes. Figura 1. En la angiografía se observa el seudoaneurisma englobando la bifurcación de 2 ramas lobares (figura 2A, flecha; vídeo 1 del material adicional), no favorable para el sellado con coils o con tapón intravascular, y sin una zona adecuada para el implante de stent clara, por lo que se decide implantar un stent recubierto hacia la subdivisión superior para aislarlo. Con un catéter Judkins right 4 (Launcher, Medtronic, Estados Unidos) se consigue el sondaje selectivo avanzando una guía de 0,035 pulgadas. Seguidamente, se avanza una vaina Destination (Terumo, Japón) de 7 Fr, a través de la que...

This is the case of a 68-year-old woman admitted due to polytrauma following a fall from a great height. While on mechanical ventilation she shows signs of self-limited hemoptysis without hemodynamic impairment. Several computed tomography (CT) scans reveal the presence of a 20 mm × 15 mm × 15 mm pseudoaneurysm at right upper lobe branch level without any data of active bleeding or erosion, but presence of progressive growth (5 mm) in 3 successive CT scans performed within 5 days (figure 1, arrows). Given the risk of rupture, percutaneous coronary intervention is attempted to seal the pseudoaneurysm. All the corresponding informed consents were obtained. Figure 1. The angiography confirms the presence of the pseudoaneurysm including the bifurcation of 2 lobar branches (figure 2A, arrow; video 1 of the supplementary data) unsuitable for sealing with coils or intravascular plug and without a clear proper landing zone for stenting, which is why it is decided to implant a covered stent towards the upper subdivision to isolate it. Using a Judkins right 4 catheter (Launcher, Medtronic, United States) selective catheterization is achieved by advancing a 0.035 in guidewire. Afterwards, a 7-Fr Destination sheath (Terumo, Japan) is advanced through which a 6 mm × 28...

(1) Background: The aim of this study was to compare the competence in appendicular trauma radiograph image interpretation between radiology specialists and residents. (2) Methods: In this multicenter retrospective cohort study, we collected radiology reports from radiology specialists (N = 506) and residents (N = 500) during 2018–2021. As a reference standard, we used the consensus of two subspecialty-level musculoskeletal (MSK) radiologists, who reviewed all original reports. (3) Results: A total of 1006 radiograph reports were reviewed by the two subspecialty-level MSK radiologists. Out of the 1006 radiographs, 41% were abnormal. In total, 67 radiographic findings were missed (6.7%) and 31 findings were overcalled (3.1%) in the original reports. Sensitivity, specificity, positive predictive value, and negative predictive value were 0.86, 0.92, 0.91 and 0.88 respectively. There were no statistically significant differences between radiology specialists’ and residents’ competence in interpretation (p = 0.44). However, radiology specialists reported more subtle cases than residents did (p = 0.04). There were no statistically significant differences between errors made in the morning, evening, or night shifts (p = 0.57). (4) Conclusions: This study found a lack of major discrepancies between radiology specialists and residents in radiograph interpretation, although there were differences between MSK regions and in subtle or obvious radiographic findings. In addition, missed findings found in this study often affected patient treatment. Finally, there are MSK regions where the sensitivity or specificity is below 90%, and these should raise concerns and highlight the need for double reading and should be taken into consideration in radiology education.

Introducción y objetivos: Los nonagenarios son un grupo de edad en rápido crecimiento entre los pacientes cardiovasculares, en especial con estenosis aórtica, pero los datos sobre su pronóstico después de la implantación transcatéter de válvula aórtica (TAVI) son escasos. El objetivo de este estudio es analizar las características basales de los nonagenarios tratados con TAVI y determinar si la edad "65; 90 años está relacionada con un peor pronóstico en comparación con los pacientes no nonagenarios. Métodos: Se incluyó a todos los pacientes "65; 75 años inscritos en el registro prospectivo multicéntrico español de TAVI entre 2009 y 2018. Se excluyó a aquellos < 75 años. Resultados: Se inscribieron en el registro español de TAVI 8.073 pacientes "65; 75 años de 46 centros de España; 7.686 de > 75 a 90 años (95,2%) y 387 nonagenarios (4,79%). Se observó un aumento progresivo de los nonagenarios. El acceso transfemoral se utilizó en el 91,6% de los casos, predominantemente en los nonagenarios (91,4 frente a 95,1%; p = 0,01). Los nonagenarios tenían más probabilidades de morir durante la hospitalización (4,3 frente a 7,0%; p = 0,01). Sin embargo, no hubo diferencia en la tasa de mortalidad por cualquier causa al año de seguimiento (8,8 frente a 11,3%; p = 0,07). En el análisis multivariable, la edad "65; 90 años no se asoció de forma independiente con un aumento de la mortalidad por cualquier causa ajustada (HR = 1,37; IC95%, 0,91-1,97; p = 0,14). La creatinina basal y las complicaciones hemorrágicas intrahospitalarias se asociaron a un peor pronóstico a largo plazo en pacientes nonagenarios tratados con TAVI. Conclusiones: Los nonagenarios son una población creciente y de muy alto riesgo, con estenosis aórtica grave, para quienes la TAVI podría representar una estrategia segura y efectiva. Una cuidadosa selección de los pacientes por un equipo multidisciplinario la máxima eficiencia en esta población, en la que la función renal basal y las complicaciones hemorrágicas pueden determinar el pronóstico a largo plazo tras la TAVI.

ABSTRACT Introduction and objectives: Nonagenarians are a fast-growing age group among cardiovascular patients, especially with aortic stenosis, but data about their prognosis after transcatheter aortic valve implantation (TAVI) is scarce. The objective of our study is to analyze the baseline characteristics of nonagenarians treated with TAVI and determine whether age ≥ 90 years is associated with a worse prognosis compared to non-nonagenarian patients. Methods: We included all patients ≥75 years enrolled in the multicenter prospective Spanish TAVI registry between 2009 and 2018. Patients < 75 years were excluded. Results: A total of 8073 elderly patients (≥ 75 years) from 46 Spanish centers were enrolled in the Spanish TAVI registry; 7686 were between ≥ 75 and < 90 years old (95.2%), and 387 were nonagenarian patients (4.79%). A gradual increase of nonagenarians was observed. The transfemoral access was used in 91.6% of the cases, predominantly among the nonagenarian patients (91.4% vs 95.1%, P = .01). Nonagenarians were more likely to die during their hospital stay (4.3% vs 7.0% among nonagenarians, P = .01). However, no difference was seen in the all-cause mortality rates reported at the 1-year follow-up (8.8% vs 11.3%, P =.07). In the multivariate analysis, age ≥ 90 years was not independently associated with a higher adjusted all-cause mortality rate (HR, 1.37, 95%CI, 0.91–1.97, P = .14). The baseline creatinine levels, and the in-hospital bleeding complications were all associated with a worse long-term prognosis in nonagenarians treated with TAVI. Conclusions: Nonagenarians are a very high-risk and growing population with severe AS in whom TAVI may be a safe and effective strategy. Careful patient selection by the TAVI heart team is mandatory to achieve maximum efficiency in this population where the baseline kidney function and bleeding complications may determine the long-term prognosis after TAVI.

¿CÓMO LO HARÍA? Los autores presentan un interesante caso de una paciente de 10 años, con antecedentes familiares de enfermedad de Rendu-Osler-Weber, que presenta cianosis, poliglobulia y saturación basal del 85%, secundarias a una malformación arteriovenosa pulmonar (MAVP) grande y compleja, que genera desaturación sistémica por la existencia de un cortocircuito derecha-izquierda significativo. Las MAVP son comunicaciones directas entre ramas arteriales, generalmente de arteria pulmonar, y venas pulmonares, sin que exista un lecho capilar normal, unidas mediante un saco aneurismático, que puede estar parcialmente septado en su interior. Se dividen en simples, cuando reciben sangre de una única arteria aferente, y complejas, cuando la aferencia es múltiple. La mayoría son de origen congénito y en más del 70% de los casos se asocian a enfermedad de Rendu-Osler-Weber, o telangiectasia hemorrágica hereditaria. Esta es una enfermedad autosómica dominante que, aunque se puede confirmar por estudio genético, dispone de unos criterios diagnósticos, denominados criterios de Curaçao1, que permiten su diagnóstico: Epistaxis recurrente. Múltiples telangiectasias en localizaciones típicas: labios, cavidad oral, dedos y nariz. Malformaciones vasculares viscerales: gastrointestinales, pulmonares, hepáticas, cerebrales o espinales. Familiar en primer grado con la enfermedad. Si se cumplen 3 o más criterios, el diagnóstico es definitivo, y se considera posible con la existencia de 2 de...

HOW WOULD I APPROACH IT? Authors present an interesting case of a 10-year-old with a familial history of Rendu-Osler-Weber disease. The patient shows signs of cyanosis, polyglobulia, and baseline oxygen saturation levels of 85% due to a large and complex pulmonary arteriovenous malformation (PAVM) that is causing systemic desaturation due to the existence of a significant right-to-left shunt. PAVMs are direct connections between arterial branches—often the pulmonary artery—and pulmonary veins without a normal capillary bed connected through an aneurysmal sac that can be partially septated in the inside. PAVMs can be categorized into simple, when they receive blood from a single afferent arterial vessel, and complex, when afference is multiple. Most of them are congenital and in over 70% of the cases they are associated with Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia. Although it is a dominant autosomal disease that can be diagnosed through a genetic study the so-called Curaçao diagnostic criteria1 are often used to achieve diagnosis: Recurrent epistaxis. Multiple telangiectasias in typical locations: lips, oral cavity, fingers, and nose. Visceral vascular malformations: gastrointestinal, pulmonary, hepatic, cerebral or spinal. First-degree relative who is a disease carrier. With 3 or more criteria, the diagnosis becomes conclusive. With just 2 the diagnosis is possible. Most of the times this disease...

Established therapies for prostate cancer (PCa), surgery and radiotherapy, treat the entire gland regardless of the location of the cancerous lesion within the prostate. Although effective, these methods include a significant risk of worsening genitourinary outcomes. Targeted image-guided cancer therapy has gained acceptance through improved PCa detection, localization, and characterization by magnetic resonance imaging (MRI). Minimally-invasive ablative techniques aim to achieve comparable oncological outcomes to radical treatment while preserving genitourinary function. Transurethral ultrasound ablation (TULSA) and next-generation transrectal high-intensity focused ultrasound (HIFU) utilize MRI guidance to thermally ablate prostate tissue under real-time MRI monitoring and active temperature feedback control. Previous trials performed by our group and others, including a large multicenter study in men with localized favorable-risk disease, have demonstrated that TULSA provides effective prostate ablation with a favorable safety profile and low impact on quality of life. Recently, MRI-guided HIFU focal therapy was also shown as a safe and effective treatment of intermediate-risk PCa. Here we review the current literature on ablative techniques in the treatment of localized PCa with a focus on TULSA and HIFU methods.

Varón de 53 años con estenosis aórtica, aneurisma de aorta ascendente y disección de aorta de tipo B, intervenido con cirugía de Bentall en la que se anastomosó al extremo distal del injerto aórtico una endoprótesis autoexpandible no recubierta (AMDS, JOTEC GmbH, Alemania) de 40 mm con intención de colapsar la puerta de entrada (figura 1A). Se obtuvo el consentimiento informado por escrito del paciente para realizar las pruebas y para la publicación del caso. Figura 1. En el control radiológico posterior se observó una marcada torsión de la endoprótesis, permaneciendo la puerta de la disección abierta. (figura 1B-F). Dado el alto riesgo de la reintervención, se decidió tratamiento endovascular. Con una guía hidrófila y control con ecocardiografía intravascular, se consiguió cruzar a la luz de la endoprótesis; la guía se intercambió por otra de más soporte para proceder a dilataciones con balones semidistensibles, observándose importante recoil tras el desinflado (figura 2A-C). Figura 2. Para conseguir una mayor fuerza radial se decidió implantar 2 capas de stent, primero uno no recubierto con el cual expandir la endoprótesis y seguidamente otro recubierto de politetrafluoroetileno expandible (e-PTFE) para sellar la puerta de entrada de la disección. Con una vaina DrySeal (Gore Inc., Estados Unidos) de 18 Fr...

This is the case of a 53-year-old man with aortic stenosis, ascending aortic aneurysm, and type B aortic dissection treated with Bentall procedure where a 40 mm uncovered self-expanding stent-graft (AMDS, JOTEC GmbH, Germany) was anastomosed to the aortic graft distal border with the intent to collapse the entry (figure 1A). The patient’s written informed consent was obtained to run the tests and publish the case. Figure 1. The follow-up radiographic monitoring revealed significant stent-graft kinking while the dissection entry remained opened (figure 1B,F). Given the high risk involved in the reintervention, endovascular treatment was decided. Under intravascular echocardiography guidance a hydrophilic guidewire was used to cross the stent-graft lumen. Afterwards, the guidewire was exchanged for a different one with stronger support to proceed with dilatations using semi-compliant balloons with significant recoil being reported after balloon deflation (figure 2A,C). Figure 2. To achieve greater radial strength, we decided to implant a double-layer stent. An uncovered stent to expand the stent-graft was implanted followed by 1 covered expandable polytetrafluoroethylene (e-PTFE) stent to seal the dissection entry. An 18 Fr DrySeal sheath (Gore Inc, United States) was used to implant 2 60 mm 10-zig CP stents (NuMED Inc, United States), 1 covered and the other one not....

Objectives Fiducial markers improve accuracy in external beam radiation therapy (EBRT) for treatment of prostate cancer (PCa). However, many patients recur after EBRT necessitating additional treatment, such as MR-guided transurethral ultrasound ablation (TULSA). Residual markers may compromise TULSA through ultrasound field distortions and generation of local susceptibility artifacts. The objective was to investigate how markers affect the ablation outcome during clinical TULSA treatments. Subjects and methods A retrospective analysis was performed on nine patients with radiorecurrent PCa and residual markers who received TULSA. The MR susceptibility artifact was quantified as a function of marker type, size and orientation, in particular for thermometry. The spatial distribution of markers inside the prostate was recorded, and the resulting impact on the thermal dose was measured. The thermal dose measurements were directly compared to the residual enhancing prostatic tissue observed on the immediate and control post-TULSA contrast enhanced (CE) image. Results Successful thermal dose accumulation to the target boundary occurred for 14/20 (70%) of markers, confirmed with CE imaging. Gold markers situated simultaneously close to the urethra (≤12 mm) and far from the target boundary (≥13 mm) reduced the ultrasound depth of heating. Nitinol markers produced large, hypointense artifacts that disrupted thermometry and compromised treatment. Artifacts from gold markers were less pronounced, but when located near the target boundary, also affected treatment. Conclusion Marker composition, orientation and location inside the prostate can all potentially impact treatment outcome. Proper patient selection through detailed MRI screening is critical to ensure successful radiorecurrent PCa treatment outcomes with TULSA.

Purpose To investigate the feasibility of using an apparent diffusion coefficient (ADC) classification in predicting the technical outcome of magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU) treatment of symptomatic uterine fibroids and to compare it to the Funaki classification. Materials and methods Forty-two patients with forty-eight uterine fibroids underwent diffusion-weighted imaging (DWI) before MRgHIFU treatment. The DW images were acquired with five different b-values. Correlations between ADC values and treatment parameters were assessed. Optimal ADC cutoff values were determined to predict technical outcomes, that is, nonperfused volume ratios (NPVr) such that three classification groups were created (NPVr of 80%). Results were compared to the Funaki classification using receiver-operating-characteristic (ROC) curve analysis, with statistical significance being tested with the Chi-square test. Results A statistically significant negative correlation (Spearman’s ρ = –0.31, p-value < 0.05) was detected between ADC values and NPV ratios. ROC curve analysis indicated that optimal ADC cutoff values of 980 × 10−6mm2/s (NPVr > 80%) and 1800 × 10−6mm2/s (NPVr < 30%) made it possible to classify fibroids into three groups: ADC I (NPVr > 80%), ADC II (NPVr 30–80%) and ADC III (NPVr < 30%). Analysis of the whole model area under the curve resulted in values of 0.79 for the ADC classification (p-value = 0.0007) and 0.62 for the Funaki classification (p-value = 0.0527). Conclusions Lower ADC values prior to treatment correlate with higher NPV ratios. The ADC classification seems to be able to predict the NPV ratio and may even outperform the Funaki classification. Based on these results DWI and ADC maps should be included in the MRI screening protocol.

Purpose The aim of this study was to assess the feasibility of T2 relaxation time in predicting the immediate technical outcome i.e., nonperfused volume ratio (NPVr) of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) treatment of symptomatic uterine fibroids and to compare it with existing T2-weighted imaging methods (Funaki classification and scaled signal intensity, SSI). Materials and methods 30 patients with 32 uterine fibroids underwent an MRI study including a quantitative T2 relaxation time measurement prior to MRgHIFU treatment. T2 relaxation times were measured with a multi-echo fast imaging-based technique with 16 echoes. The correlation between pretreatment values of the uterine fibroids and treatment outcomes, that is nonperfused volume ratios (NPVr), was assessed with nonparametric statistical measures. T2 relaxation time-based method was compared to existing T2-weighted imaging-based methods using receiver-operating-characteristics (ROC) curve analysis and Chi-square test. Results Nonparametric measures of association revealed a statistically significant negative correlation between T2 relaxation time values and NPVr. The T2 relaxation time classification (T2 I, T2 II, and T2 III) resulted in the whole model p-value of 0.0019, whereas the Funaki classification resulted in a p-value of 0.56. The T2 relaxation time classification (T2 I and T2 II) achieved a whole model of a p-value of 0.0024, whereas the SSI classification had a p-value of 0.0749. Conclusions A longer T2 relaxation time of the fibroid prior to treatment correlated with a lower NPVr. Based on our results, the T2 relaxation time classifications seem to outperform the Funaki classification and the SSI method.

The Set Partitioning Problem (SPP) aims to obtain non-empty disjoint subsets of objects such that their union equals the whole set of objects, and the partition meets some prespecified criteria. The ubiquity of SPP is impressive, given that it has a lot of theoretical and practical motivations. In the theoretical side, the study of the SPP is closely related to Bell numbers, Stirling numbers of the second kind, integer partitions, Eulerian numbers, Restricted Growth Strings (RGS), factoradic number system, power calculations, etc. In the practical side, SPP is intimately related to classification problems, clustering problems, reduction of dimensionality problems, and so on. In this work, three representations for instances of SPP are presented, these representations use: Restricted Growth Strings (RGS), factoradic number system, and a number system with a fixed base. Two cases for these representations will be presented: where the number of subsets is unbounded (i.e. the number of subsets can be the number of objects); and where the number of subsets is less than the number of objects. Bidirectional mappings between these three representations will be introduced, also the mapping among these three representations and the power of a base is defined. Given, that these three representations can be used to solve instances of SPP using exact, greedy, and metaheuristic algorithms, that require to do small changes to one possible solution and/or recombination of two possible solutions, definitions of mutation and recombination operators for the three representations will be shown. In order to motivate the use of the three representations for the solution of particular instances of SPP, it was decided to present their application to solve an instance of a set partition of integers problem (SPIP) using a simple genetic algorithm.

Background: Up to half of all men who undergo primary radiotherapy for localized prostate cancer (PCa) experience local recurrence. Objective: To evaluate the safety and early functional and oncological outcomes of salvage magnetic resonance imaging–guided transurethral ultrasound ablation (sTULSA) for men with localized radiorecurrent PCa. Design, setting, and participants: This prospective, single-center phase 1 study (NCT03350529) enrolled men with biopsy-proven localized PCa recurrence after radiotherapy. Multiparametric magnetic resonance imaging (mpMRI) and 18F prostate-specific membrane antigen-1007 (18F PSMA-1007) positron emission tomography (PET)-computed tomography (CT) were used to confirm organ-confined disease localization. Patients underwent either whole-gland or partial sTULSA, depending on their individual tumor characteristics. Outcome measurements and statistical analysis: Patients were followed at 3-mo intervals. Adverse events (AEs, Clavien-Dindo scale), functional status questionnaires (Expanded Prostate Cancer Index [EPIC]-26, International Prostate Symptom Score, International Index of Erectile Function-5), uroflowmetry, and prostate-specific antigen (PSA) were assessed at every visit. Disease control was assessed at 1 yr using mpMRI and 18F-PSMA-1007 PET-CT, followed by prostate biopsies. Results and limitations: Eleven patients (median age 69 yr, interquartile range [IQR] 68–74) underwent sTULSA (3 whole-gland, 8 partial sTULSA) and have completed 12-mo follow-up. Median PSA was 7.6 ng/ml (IQR 4.9–10) and the median time from initial PCa diagnosis to sTULSA was 11 yr (IQR 9.5–13). One grade 3 and three grade 2 AEs were reported, related to urinary retention and infection. Patients reported a modest degradation in functional status, most significantly a 20% decline in the EPIC-26 irritative/obstructive domain at 12 mo. A decline in maximum flow rate (24%) was also observed. At 1 yr, 10/11 patients were free of any PCa in the targeted ablation zone, with two out-of-field recurrences. Limitations include the nonrandomized design, limited sample size, and short-term oncological outcomes. Conclusions: sTULSA appears to be safe and feasible for ablation of radiorecurrent PCa, offering encouraging preliminary oncological control. Patient summary: We present safety and 1-yr functional and oncological outcomes of magnetic resonance imaging–guided transurethral ultrasound ablation (TULSA) as a salvage treatment for local prostate cancer recurrence after primary radiation. Salvage TULSA is safe and shows the ability to effectively ablate prostate cancer recurrence, with acceptable toxicity.

Abstract Background At present, the treatment of recurrent glioblastoma is extremely challenging. In this study, we used a novel three-dimensional non-coplanar template (3DNPT) combined with open MR to guide 125I seed implantation for recurrent glioblastoma. The aim of this study was to evaluate the feasibility, accuracy, and effectiveness of this technique. Methods Twenty-four patients of recurrent glioblastoma underwent 3DNPT with open MR-guided 125I brachytherapy from August 2017 to January 2019. Preoperative treatment plan and 3DNPT were made according to enhanced isovoxel T1-weighted MR images. 125I seeds were implanted using 3DNPT and 1.0-T open MR imaging guidance. Dosimetry verification was performed after brachytherapy based on postoperative CT/MR fusion images. Preoperative and postoperative dosimetry parameters of D90, V100, V200, conformity index (CI), external index (EI) were compared. The objective response rate (ORR) at 6 months and 1-year survival rate were calculated. Median overall survival (OS) measured from the date of brachytherapy was estimated by Kaplan-Meier method. Results There were no significant differences between preoperative and postoperative dosimetry parameters of D90, V100, V200, CI, EI (P > 0.05). The ORR at 6 months was 75.0%. The 1-year survival rate was 58.3%. Median OS was 12.9 months. One case of small amount of epidural hemorrhage occurred during the procedure. There were 3 cases of symptomatic brain edema after brachytherapy treatment, including grade three toxicity in 1 case and grade two toxicity in 2 cases. The three patients were treated with corticosteroid for 2 to 4 weeks. The clinical symptoms related to brain edema were significantly alleviated thereafter. Conclusions 3DNPT combined with open MR-guided 125I brachytherapy for circumscribed recurrent glioblastoma is feasible, effective, and with low risk of complications. Postoperative dosimetry matched the preoperative treatment plan. The described method can be used as a novel implantation technique for 125I brachytherapy in the treatment of recurrent gliomas. Trial registration The study was approved by the Institutional Review Board of Shandong Provincial Hospital Affiliated to Shandong University (NSFC:NO.2017–058), registered 1st July 2017.

RESUMEN Introducción y objetivos: El objetivo primario de este estudio fue presentar la mortalidad total intrahospitalaria del registro español de implante percutáneo de válvula aórtica (TAVI) desde su inicio hasta el año 2018, y como objetivos secundarios otros eventos clínicos intrahospitalarios, la mortalidad total a los 30 días y la evaluación de cuál ha sido la evolución temporal de este registro. Métodos: Fueron analizados todos los pacientes consecutivos incluidos en el registro español de TAVI. En este análisis temporal se dividió la población en pacientes tratados antes de 2014 (cohorte A: 2009-2013) y pacientes tratados entre los años 2014 y 2018 (cohorte B). Resultados: Desde agosto de 2007 hasta junio de 2018 se incluyeron 7.180 pacientes. La edad media fue de 81,2 ± 6,5 años y el 53% eran mujeres. El EuroSCORE logístico fue del 12% (8-20). Se utilizó un acceso transfemoral en el 89%. La mortalidad total intrahospitalaria fue del 4,7% y a los 30 días fue del 5,7%. En el análisis temporal durante la fase hospitalaria, las tasas de infarto, accidente cerebrovascular, necesidad de marcapasos, taponamiento, obstrucción coronaria y complicaciones vasculares fueron similares en ambos grupos. Sin embargo, en la cohorte B se observó una reducción de la necesidad de conversión a cirugía y de mala posición de la válvula, y además la tasa de éxito del implante fue mayor (93 frente a 96%; p < 0,001). La mortalidad por cualquier causa ajustada tanto intrahospitalaria como a los 30 días, fue significativamente menor en la cohorte B (odds ratio [OR] = 0,65; intervalo de confianza del 95% [IC95%], 0,48-0,86; p = 0,003; y OR = 0,71; IC95%, 0,54-0,92; p = 0,002, respectivamente). Conclusiones: En el análisis temporal del registro español de TAVI se observan un cambio en el perfil clínico de los pacientes y una mejora en la evolución clínica tanto intrahospitalaria como a los 30 días en los pacientes tratados en los últimos años.

ABSTRACT Introduction and objectives: This study primary endpoint was to present the in-hospital all-cause mortality of the Spanish TAVI registry from its inception until 2018. Secondary endpoints included other in-hospital clinical events, 30-day all-cause mortality, and an assessment of the time trend of this registry. Methods: All consecutive patients included in the Spanish TAVI registry were analyzed. In this time-based analysis, the population was been divided into patients treated before 2014 (cohort A: 2009-2013) and patients treated between 2014 and 2018 (cohort B). Results: From August 2007 to June 2018, 7180 patients were included. The mean age was 81.2 ± 6.5 years and 53% were women. The logistic EuroSCORE was 12% (8-20). Transfemoral access was used in 89%. In-hospital and 30-day all-cause mortality was 4.7% and 5.7%, respectively. On the time-based analyses during the hospital stay, the rate of myocardial infarction, stroke, need for pacemakers, tamponade, coronary obstruction, and vascular complications was similar between both groups. However, cohort B showed less need for conversion to surgery and malapposition of the valve. Also, the implant success rate increased from 93% to 96% (P< .001). In-hospital and 30-day all-cause mortality was significantly lower in cohort B, ([OR, 0.65; IC95%, 0.48-0.86; P= .003] and [OR, 0.71; IC95%, 0.54-0.92; P= .002], respectively). Conclusions: The time trend analysis of the Spanish TAVI registry showed a change in the patients’ clinical profile and an improvement in the in-hospital clinical outcomes and 30-day all-cause mortality in patients treated more recently.

Introducción: La angioplastia con balón es una técnica que ofrece buenos resultados, especialmente en los casos de recoartación tras cirugía correctora. Objetivo: Analizar los resultados de un centro hospitalario a partir de la introducción de la técnica. Método: Se analizaron 73 pacientes con una edad media de 3.3 años; el 74% eran menores de 1 año y el 72.6% estaban por debajo de 10 kg de peso. Todos los pacientes incluidos fueron casos de recoartación tras cirugía correctora. Resultados: Se observó un resultado efectivo en el 93.1% de los casos, con gradiente residual < 20 mmHg. Durante el seguimiento, el 20.5% precisaron reintervención, la cual fue más frecuente en caso de angioplastia sobre el arco, lesiones asociadas y menores de 1 año. Solo se objetivó una complicación grave relacionada con el procedimiento, que correspondió a una rotura aórtica que no pudo ser solventada con implante de stent cubierto. Conclusiones: La angioplastia percutánea de recoartación de aorta es una técnica segura y efectiva, en especial en los casos de recoartación tras cirugía correctora de lesiones circunscritas al istmo.

El presente artículo pretende elaborar una relectura de la novela Mamita Yunai, del escritor costarricense Carlos Luis Fallas, publicada en 1941, desde los planteamientos literarios y teóricos de la autoficción. Para ello se analizan los principales mecanismos autoficcionales utilizados por el narrador y se examinan los vínculos existentes entre la literatura de compromiso sociopolítico, la cual postula una estrategia de divulgación y concientización social, y la correlación con las estrategias de la autoficción, destacando la formación de una identidad literaria de corte comunista-proletario. La importancia de realizar este estudio radica en el hecho de que, hasta el momento, no existe ninguna investigación que haya abordado la novela desde un acercamiento autoficcional. Además, el análisis procura plantear la obra como un antecedente de la formulación del debate teórico de la autoficción, surgido en 1977, con la creación del neologismo “autoficción”, acuñado por Serge Doubrovsky.