Artículos de revista (CUN)
Permanent URI for this collectionhttps://hdl.handle.net/10171/70263
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- Ablative radioembolization of hepatocellular carcinoma with total arterial supply originating from the superior adrenal artery achieved complete pathologic necrosis(Elsevier, 2022) Lewis, A.R. (Andrew R.); Arotzarena, G. (Gonzalo); Paz-Fumagalli, R. (Ricardo); Toskich, B.B. (Beau B.)Exclusively extrahepatic arterial perfusion to previously untreated, early-stage, hepatocellular carcinoma (HCC) is uncommon. We present a case of right superior adrenal artery completely supplying a subcapsular HCC in a 68-year-old male. The extrahepatic arterial territory targeted excluded structures potentially vulnerable to radiation, which allowed safe ablative Y-90 radioembolization that achieved complete pathological necrosis.
- Impact of a longitudinal course on medical professionalism on the empathy of medical students(Elsevier, 2024) García-del-Barrio, L. (Loreto); Rodriguez-Diez, M.C. (María Cristina); Arbea, L. (Leire); Diez-Goñi, N. (Nieves); Gea, A. (Alfredo); Pereira, J. (José)Objective: Medical education should enhance empathy. We examined, using self-assessment instruments and standardized patients (SPs), the impact on empathy, of a multi-year intervention (years 4–6 of medical training) that uses reflective learning approaches. Methods: 241 final-year medical students participated; 110 from the 2018 graduation class (non-intervention group) and 131 from the 2019 graduation class (intervention group). Participants completed two self-reported empathy questionnaires – the Jefferson Scale of Empathy-Students (JSE-S) and the Interpersonal Reactivity Index (IRI) – and a personality questionnaire, the NEO Five-Factor Inventory. Additionally, SPs in a simulated station assessed participants’ empathy with two patient-reported instruments: the Consultation and Relational Empathy (CARE) scale and the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). Results: Empathy scores were significantly higher in the intervention group compared to the non-intervention group when assessed by the SP (p < 0.001). No differences were found in self-reported questionnaires between the two groups. Conclusion: A longitudinal, multi-year reflection-based intervention enhanced empathy amongst medical students as assessed by SPs, but not when assessed by student self-reported measures. Practice Implications: Multi-year reflective learning interventions during clinical training nurture empathy in medical students. Assessments completed by SPs or patients may enhance the evaluation of empathy.
- Structural neuroimaging changes associated with subjective cognitive decline from a clinical sample(Elsevier, 2024) Dominguez, P. (Pablo); Solis-Barquero, S.M. (Sergio M.); Arrondo, C. (Carlota); Montoya-Murillo, G. (Genoveva); Garcia-Eulate, R. (Reyes); Fernández-Seara, M.A. (María A.); Ríos-Rivera, M.M. (Mirla); Riverol, M. (Mario); Villino, R. (Rafael); Imaz-Aguayo, L. (Laura)Background: Alzheimer's disease (AD) is characterized by progressive deterioration of cognitive functions. Some individuals with subjective cognitive decline (SCD) are in the early phase of the disease and subsequently progress through the AD continuum. Although neuroimaging biomarkers could be used for the accurate and early diagnosis of preclinical AD, the findings in SCD samples have been heterogeneous. This study established the morphological differences in brain magnetic resonance imaging (MRI) findings between individuals with SCD and those without cognitive impairment based on a clinical sample of patients defined according to SCD-Initiative recommendations. Moreover, we investigated baseline structural changes in the brains of participants who remained stable or progressed to mild cognitive impairment or dementia. Methods: This study included 309 participants with SCD and 43 healthy controls (HCs) with high-quality brain MRI at baseline. Among the 99 subjects in the SCD group who were followed clinically, 32 progressed (SCDp) and 67 remained stable (SCDnp). A voxel-wise statistical comparison of gray and white matter (WM) volume was performed between the HC and SCD groups and between the HC, SCDp, and SCDnp groups. XTRACT ATLAS was used to define the anatomical location of WM tract damage. Region-of-interest (ROI) analyses were performed to determine brain volumetric differences. White matter lesion (WML) burden was established in each group. Results: Voxel-based morphometry (VBM) analysis revealed that the SCD group exhibited gray matter atrophy in the middle frontal gyri, superior orbital gyri, superior frontal gyri, right rectal gyrus, whole occipital lobule, and both thalami and precunei. Meanwhile, ROI analysis revealed decreased volume in the left rectal gyrus, bilateral medial orbital gyri, middle frontal gyri, superior frontal gyri, calcarine fissure, and left thalamus. The SCDp group exhibited greater hippocampal atrophy (p < 0.001) than the SCDnp and HC groups on ROI analyses. On VBM analysis, however, the SCDp group exhibited increased hippocampal atrophy only when compared to the SCDnp group (p < 0.001). The SCD group demonstrated lower WM volume in the uncinate fasciculus, cingulum, inferior fronto-occipital fasciculus, anterior thalamic radiation, and callosum forceps than the HC group. However, no significant differences in WML number (p = 0.345) or volume (p = 0.156) were observed between the SCD and HC groups. Conclusions: The SCD group showed brain atrophy mainly in the frontal and occipital lobes. However, only the SCDp group demonstrated atrophy in the medial temporal lobe at baseline. Structural damage in the brain regions was anatomically connected, which may contribute to early memory decline.
- Long-term results of intraoperative multicatheter breast implant (IOMBI) for accelerated partial breast irradiation (APBI) on early breast cancer patients(Elsevier, 2024) Martinez-Monge, R. (Rafael); Blanco, J. (Javier); Martinez-Regueira, F. (Fernando); Rodriguez-Spiteri, N. (Natalia); Jablonska, P.A. (Paola Anna); Elizalde, A. (Arlette); Pina-Insausti, L. (Luis); Abengozar-Muela, M. (Marta); Cambeiro, M. (Mauricio); Olartecoechea, B. (Begoña); Gimeno-Morales, M. (Marta); Ramos, L. (Luis); Martínez-Lage, A. (Adriana)Background and purpose: Multicatheter breast brachytherapy is a standard technique for accelerated partial breast irradiation (APBI) in early breast cancer patients. Intraoperative multicatheter breast implant (IOMBI) followed by perioperative high-dose-rate brachytherapy (PHDRBT) offers a novel and advantageous approach. We present long-term oncological, toxicity, and cosmesis outcomes for a well-experienced single institution. Materials and methods: Eligible women aged ≥ 40 years with clinically and radiologically confirmed unifocal invasive or in situ ≤ 3 cm breast tumors underwent IOMBI during breast-conserving surgery. Patients meeting APBI criteria by definitive pathologic results received 3.4 Gy × 10fx with PHDRBT. Patients not suitable for APBI received PHDRBT-boost followed by WBRT. Results: A total of 171 patients underwent IOMBI during BCS, 120 patients (70.1 %) were suitable for APBI and 51 (29.8 %) for anticipated PHDRBT-boost. The median age was 61 years (range: 40-78), the median tumor size was 1.1 cm (range: 0.2-3.5), with a histological diagnosis of invasive ductal carcinoma in 78.9 % and ductal in situ in 21.1 %. A median of 9 catheters (range: 4-14) were used. For APBI, the median CTV and V100 were 40.8 cc (range: 8.6-99) and 35.4 cc (range: 7.2-94). The median of healthy breast tissue irradiated represents 7.2 % (range: 2.3-28 %) and the median local treatment duration was 10 days (range: 7-16). With a median follow-up of 8.8 years (range: 0.3-16.25), the 8-year local, locoregional, and distant control rates were 99 %, 98.1 %, and 100 %. G1-G2 late-toxicity rate was 53.4 %. Long-term cosmetic evaluation was excellent-good in 90.8 %. Conclusion: IOMBI&PHDRBT program reports excellent long-term oncological outcomes, with a reduction from unnecessary irradiation exposure which translates into low long-term toxicity and good cosmesis outcomes, especially on well-selected APBI patients.
- Comparison of myocardial blood flow quantification models for double ECG gating arterial spin labeling MRI: reproducibility assessment(Wiley Periodicals LLC, 2024) Solis-Barquero, S.M. (Sergio M.); Echeverría-Chasco, R. (Rebeca); Bastarrika, G. (Gorka); Aramendía-Vidaurreta, V. (Verónica); Vidorreta, M. (Marta); Fernández-Seara, M.A. (María A.); Ezponda, A. (Ana)Background: Arterial spin labeling (ASL) allows non-invasive quantification of myocardial blood flow (MBF). Double-ECG gating (DG) ASL is more robust to heart rate variability than single-ECG gating (SG), but its reproducibility requires further investigation. Moreover, the existence of multiple quantification models hinders its application. Frequency-offset-corrected-inversion (FOCI) pulses provide sharper edge profiles than hyperbolic-secant (HS), which could benefit myocardial ASL. Purpose: To assess the performance of MBF quantification models for DG compared to SG ASL, to evaluate their reproducibility and to compare the effects of HS and FOCI pulses. Study Type: Prospective. Subjects: Sixteen subjects (27 8 years). Field Strength/Sequence: 1.5 T/DG and SG flow-sensitive alternating inversion recovery ASL. Assessment: Three models for DG MBF quantification were compared using Monte Carlo simulations and in vivo experiments. Two models used a fitting approach (one using only a single label and control image pair per fit, the other using all available image pairs), while the third model used a T1 correction approach. Slice profile simulations were conducted for HS and FOCI pulses with varying B0 and B1. Temporal signal-to-noise ratio (tSNR) was computed for different acquisition/quantification strategies and inversion pulses. The number of images that minimized MBF error was investigated in the model with highest tSNR. Intra and intersession reproducibility were assessed in 10 subjects. Statistical Tests: Within-subject coefficient of variation, analysis of variance. P-value <0.05 was considered significant. Results: MBF was not different across acquisition/quantification strategies (P = 0.27) nor pulses (P = 0.9). DG MBF quantification models exhibited significantly higher tSNR and superior reproducibility, particularly for the fitting model using multiple images (tSNR was 3.46 2.18 in vivo and 3.32 1.16 in simulations, respectively; wsCV = 16%). Reducing the number of ASL pairs to 13/15 did not increase MBF error (minimum = 0.22 mL/g/min). Data Conclusion: Reproducibility of MBF was better for DG than SG acquisitions, especially when employing a fitting model. Level of Evidence: 2 Technical Efficacy: Stage 1
- Automatic segmentation and quantification of Nigrosome-1 Neuromelanin and Iron in MRI: a candidate biomarker for Parkinson’s disease(Wiley Periodicals LLC, 2023) Martinez, M. (Martín); Castellanos, G. (Gabriel); Ortiz-de-Solorzano, C. (Carlos); Pastor, P. (Pau); Fernández-Seara, M.A. (María A.); Pastor, M.A. (María A.); Álvarez, I. (Ignacio); Ariz, M. (Mikel)Parkinson’s disease (PD) is caused by the loss of dopaminergic neurons in the substantia nigra pars compacta (SNc). The incidence of PD increases with age and is one of the major causes of disability. PD early diagnosis is still a challenge as it is based on the clinical assessment of the subject discarding other potential causes of parkinsonism, and the patient’s positive response to Levodopa therapy, leading to a misdiagnosis rate of approximately 16%. The substantia nigra (SN), located in the ventral tegmentum of the midbrain, is divided into two main regions: the iron-rich ventral SN pars reticulata (SNr), and the dorsal SNc, where the neuromelanin-containing dopaminergic neurons (NM) are located. NM is believed to have a neuroprotective function against the toxicity of iron-mediated oxidative processes. Specifically, the death of dopaminergic neurons of the SNc causes NM depigmentation, followed by an increase of iron load. Indeed, it has been reported that a relative decrease of SNc NM leads to a relative increase of SNc iron in PD patients, when compared with age-matched healthy controls (HCs).
- Tracking dynamic evolution of low‐ and intermediate‐risk differentiated thyroid cancer: Identification of individuals at risk of recurrence(John Wiley & Sons, 2024) Alegre, E. (Estibaliz); Lozano, M.D. (María Dolores); Volpi, F. (Federico); Colombo, C. (Carla); Argueta, A. (Allan); Larrache, J. (Javier); Alcalde, J. (Juan); Galofre, J.C. (Juan Carlos)Objective: The generally good prognosis of low- and intermediate-risk differentiated thyroid cancer (DTC) underscored the need to identify those few patients who relapse. Design: Records of 299 low- or intermediate-risk DTC patients (mean follow-up 8.2 ± 6.2 years) were retrospectively reviewed. The sample was classified following the American Thyroid Association (ATA) dynamic risk stratification (DRS) system. Patients and measurement: After classifying patients according to DRS at the first visit following initial therapy (FU1), structural recurrence occurred in 2/181 (1.1%), 5/81 (6.2%) and 13/26 (50.0%) with excellent, indeterminate and biochemical incomplete response to treatment, respectively. All relapses but one happened within 5 years from FU1. Univariate analysis comparing excellent, indeterminate and biochemical incomplete with structural incomplete responses at the end of the follow-up, identified tumour size (p < .001), T status (<0.001), positive lymph nodes (N) (p < .01), multifocality (p < .004), need of additional radioactive iodine (RAI) (p < .0001) and first DRS status (p < .0003) as risk factors of recurrence. In the multivariate analysis, only RAI remained statistically significant (p < .02). Comparison between excellent and indeterminate with biochemical and structural incomplete responses, identified tumour size (p < .0004), T (p < .01), N (p < .0001), bilaterality (p < .03), first DRS status (p < .0001) and RAI (p < .001) as recurrence risk factors. T (p < .01) and first DRS (p < .0006) were confirmed in the multivariate analysis. Conclusions: Patients with DTC classified as low- or intermediate-risk of recurrence with excellent response to treatment at FU1 rarely develop structural disease and this occurs almost exclusively in the first 5 years. Initial DRS status is an accurate tool for determining the risk of recurrence.
- Agrypnia Excitata and Supranuclear Vertical Gaze Palsy Linked to Anti-Ma Encephalitis(Wiley Periodicals LLC, 2024) Arbizu, J. (Javier); Espinoza-Vinces, C. (Christian); Horrillo-Maysonnial, A. (Alejandro); Aviles-Olmos, I. (Iciar); Calvo-Imirizaldu, M. (Marta); Pérez-Álvarez, A.I (Ángel Ignacio); Urrestarazu, E. (Elena); Gallego-Perez-Larraya, J. (Jaime)Paraneoplastic neurological syndromes result from cancer’s immune impact on the nervous system.1 Anti-Ma-associated encephalitis causes diencephalic, brainstem, and limbic symptoms such as memory loss, narcolepsy and rapid eye movement (REM) behavior disorder (RBD), eye movement abnormalities, and parkinsonism. It can precede cancer diagnosis, often linked to testicular tumors. Agrypnia excitata (AE) is a unique electroclinical syndrome that can disrupt sleep structure with changes in physiological cyclic organization, autonomic overactivity, and oneiric stupor episodes. We report on a patient with anti-Ma encephalitis who exhibits a diencephalic syndrome and AE, not previously reported to our knowledge.
- Consensus-based technical recommendations for clinical translation of renal phase contrast MRI(Wiley, 2020) Serai, S.D. (Suraj D.); Morris, D.M. (David M.); Ringgaard, S. (Sreffen); Sourbron, S. (Steven); Zöllner, F.G. (Frank G.); Hermann, I. (Ingo); Boer, A. (Anneloes) de; Dekkers, I. (Ilona); Laustsen, C. (Christoffer); Nery, F. (Fabio); Lim, R.P. (Ruth P.); Cox, E.F. (Eleanor F.); Hall, M.E. (Michael E.); Caroli, A. (Anna); Bock, M. (Michael); Eckerbom, P. (Per); Wentland, A.L. (Andrew L.); Hockings, P.D. (Paul D.); Bane, O. (Octavia); Fernández-Seara, M.A. (María A.); Lamb, H.J. (Hildo J.); Haddock, B. (Bryan); Takehara, Y. (Yasuo); Wolf, M. (Marcos); Sharma, K. (Kanishka); Villa, G. (Giula); Francis, S.T. (Susan T.); Hall-Barrientos, P. (Pauline)Background: Phase-contrast (PC) MRI is a feasible and valid noninvasive technique to measure renal artery blood flow, showing potential to support diagnosis and monitoring of renal diseases. However, the variability in measured renal blood flow values across studies is large, most likely due to differences in PC-MRI acquisition and processing. Standardized acquisition and processing protocols are therefore needed to minimize this variability and maximize the potential of renal PCMRI as a clinically useful tool. Purpose: To build technical recommendations for the acquisition, processing, and analysis of renal 2D PC-MRI data in human subjects to promote standardization of renal blood flow measurements and facilitate the comparability of results across scanners and in multicenter clinical studies. Study Type: Systematic consensus process using a modified Delphi method. Population: Not applicable. Sequence Field/Strength: Renal fast gradient echo-based 2D PC-MRI. Assessment: An international panel of 27 experts from Europe, the USA, Australia, and Japan with 6 (interquartile range 4–10) years of experience in 2D PC-MRI formulated consensus statements on renal 2D PC-MRI in two rounds of surveys. Starting from a recently published systematic review article, literature-based and data-driven statements regarding patient preparation, hardware, acquisition protocol, analysis steps, and data reporting were formulated. Statistical Tests: Consensus was defined as ≥75% unanimity in response, and a clear preference was defined as 60–74% agreement among the experts. Results: Among 60 statements, 57 (95%) achieved consensus after the second-round survey, while the remaining three showed a clear preference. Consensus statements resulted in specific recommendations for subject preparation, 2D renal PC-MRI data acquisition, processing, and reporting. Data Conclusion: These recommendations might promote a widespread adoption of renal PC-MRI, and may help foster the set-up of multicenter studies aimed at defining reference values and building larger and more definitive evidence, and will facilitate clinical translation of PC-MRI. Level of Evidence: 1 Technical Efficacy Stage: 1
- Good tolerance to iobitridol in a patient with sialadenitis induced by iohexol and iopromide: a case report(2024) Argiz, L. (Laura); Gastaminza, G. (Gabriel); Liaño, G. (Gloria); Fraile, C. (Carlos); Vega, F. (Francisco); Toscano, T. (Teresa); Crespo, J. (Jimena)