DSpace Collection:https://hdl.handle.net/10171/190152024-03-28T20:23:28Z2024-03-28T20:23:28ZEffect of sugammadex on processed EEG parameters in patients undergoing robot-assisted radical prostatectomyhttps://hdl.handle.net/10171/672862023-12-15T11:27:51Z2023-01-01T00:00:00ZTitle: Effect of sugammadex on processed EEG parameters in patients undergoing robot-assisted radical prostatectomy
Abstract: Background: Sugammadex has been associated with increases in the bispectral index (BIS). We evaluated the effects of
sugammadex administration on quantitative electroencephalographic (EEG) and electromyographic (EMG) measures.
Methods: We performed a prospective observational study of adult male patients undergoing robot-assisted radical
prostatectomy. All patients received a sevoflurane-based general anaesthetic and a continuous infusion of rocuronium,
which was reversed with 2 mg kg1 of sugammadex i.v. BIS, EEG, and EMG measures were captured with the BIS Vista™
monitor.
Results: Twenty-five patients were included in this study. Compared with baseline, BIS increased at 4e6 min (b coefficient: 3.63; 95% confidence interval [CI]: 2.22e5.04; P<0.001), spectral edge frequency 95 (SEF95) increased at 2e4 min (b
coefficient: 0.29; 95% CI: 0.05e0.52; P¼0.016) and 4e6 min (b coefficient: 0.71; 95% CI: 0.47e0.94; P<0.001), and EMG
increased at 4e6 min (b coefficient: 1.91; 95% CI: 1.00e2.81; P<0.001) after sugammadex administration. Compared with
baseline, increased beta power was observed at 2e4 min (b coefficient: 93; 95% CI: 1e185; P¼0.046) and 4e6 min (b coefficient: 208; 95% CI: 116e300; P<0.001), and decreased delta power was observed at 4e6 min (b coefficient: 526.72; 95%
CI: 778 to 276; P<0.001) after sugammadex administration. Neither SEF95 nor frequency band data analysis adjusted
for EMG showed substantial differences. None of the patients showed clinical signs of awakening.
Conclusions: After neuromuscular block reversal with 2 mg kg1 sugammadex, BIS, SEF95, EMG, and beta power showed
small but statistically significant increases over time, while delta power decreased.2023-01-01T00:00:00ZPrognostic value of serum paraprotein response kinetics in patients with newly diagnosed multiple myelomahttps://hdl.handle.net/10171/661252024-01-29T07:56:35Z2022-01-01T00:00:00ZTitle: Prognostic value of serum paraprotein response kinetics in patients with newly diagnosed multiple myeloma
Abstract: Introduction
Response kinetics is a well-established prognostic marker in acute lymphoblastic leukemia. The situation is not clear in multiple myeloma (MM) despite having a biomarker for response monitoring (monoclonal component [MC]).
Materials and Methods
We developed a mathematical model to assess the prognostic value of serum MC response kinetics during 6 induction cycles, in 373 NDMM transplanted patients treated in the GEM2012Menos65 clinical trial. The model calculated a “resistance” parameter that reflects the stagnation in the response after an initial descent.
Results
Two patient subgroups were defined based on low and high resistance, that respectively captured sensitive and refractory kinetics, with progression-free survival (PFS) at 5 years of 72% and 59% (HR 0.64, 95% CI 0.44-0.93; P = .02). Resistance significantly correlated with depth of response measured after consolidation (80.9% CR and 68.4% minimal residual disease negativity in patients with sensitive vs. 31% and 20% in those with refractory kinetics). Furthermore, it modulated the impact of reaching CR after consolidation; thus, within CR patients those with refractory kinetics had significantly shorter PFS than those with sensitive kinetics (median 54 months vs. NR; P = .02). Minimal residual disease negativity abrogated this effect. Our study also questions the benefit of rapid responders compared to late responders (5-year PFS 59.7% vs. 76.5%, respectively [P < .002]). Of note, 85% of patients considered as late responders were classified as having sensitive kinetics.
Conclusion
This semi-mechanistic modeling of M-component kinetics could be of great value to identify patients at risk of early treatment failure, who may benefit from early rescue intervention strategies.2022-01-01T00:00:00ZBaseline total metabolic tumor volume is prognostic for refractoriness to Iimunochemotherapy in DLBCL: results from GOYAhttps://hdl.handle.net/10171/661232023-05-01T05:07:42Z2022-01-01T00:00:00ZTitle: Baseline total metabolic tumor volume is prognostic for refractoriness to Iimunochemotherapy in DLBCL: results from GOYA
Abstract: Introduction
A good response to initial therapy is key to maximizing survival in patients with diffuse large B-cell lymphoma (DLBCL), but patients with chemorefractory disease and early progression have poor outcomes.
Patients and Methods
Data from the GOYA study in patients with DLBCL who received first-line rituximab or obinutuzumab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) were analyzed. Positron emission tomography/computed tomography (PET/CT)-derived characteristics associated with total metabolic tumor volume (TMTV) and clinical risk factors for primary chemorefractory disease and disease progression within 12 months (POD12) were explored.
Results
Of those patients fulfilling the criteria for analysis, 108/1126 (10%) were primary chemorefractory and 147/1106 (13%) had POD12. Primary chemorefractory and POD12 status were strongly associated with reduced overall survival. After multivariable analysis of clinical and imaging-based risk factors by backward elimination, only very high TMTV (quartile [Q] 1 vs. Q4 odds ratio [OR]: 0.45; P = .006) and serum albumin levels (low vs. normal OR of 1.86; P = .004) were associated with primary chemorefractoriness. After additionally accounting for BCL2/MYC translocation in a subset of patients, TMTV and BCL2/MYC double-hit status remained as significant predictors of primary chemorefractoriness (Q1 vs. Q4 OR: 0.32, P = .01 and double-hit vs. no-hit OR of 4.47, P = .02, respectively). Risk factors including very high TMTV, high sum of the product of the longest diameters (SPD), geographic region (Asia), short time since diagnosis, extranodal involvement and low serum albumin were retained for POD12.
Conclusion
PET-derived TMTV has prognostic value in identifying patients at risk of early treatment failure.2022-01-01T00:00:00ZCardiometabolic characterization in metabolic dysfunction-associated fatty liver diseasehttps://hdl.handle.net/10171/649522024-01-25T13:02:53Z2022-01-01T00:00:00ZTitle: Cardiometabolic characterization in metabolic dysfunction-associated fatty liver disease
Abstract: BackgroundTo better understand the patient's heterogeneity in fatty liver disease (FLD), metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed by international experts as a new nomenclature for nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the cardiovascular risk, assessed through coronary artery calcium (CAC) and epicardial adipose tissue (EAT), of patients without FLD and patients with FLD and its different subtypes. MethodsCross sectional study of 370 patients. Patients with FLD were divided into 4 groups: FLD without metabolic dysfunction (non-MD FLD), MAFLD and the presence of overweight/obesity (MAFLD-OW), MAFLD and the presence of two metabolic abnormalities (MAFLD-MD) and MAFLD and the presence of T2D (MAFLD-T2D). MAFLD-OW included two subgroups: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). The patients without FLD were divided into 2 groups: patients without FLD and without MD (non-FLD nor MD; reference group) and patients without FLD but with MD (non-FLD with MD). EAT and CAC (measured through the Agatston Score) were determined by computed tomography. ResultsCompared with the reference group (non-FLD nor MD), regarding EAT, patients with MAFLD-T2D and MAFLD-MUHO had the highest risk for CVD (OR 15.87, 95% CI 4.26-59.12 and OR 17.60, 95% CI 6.71-46.20, respectively), patients with MAFLD-MHO were also at risk for CVD (OR 3.62, 95% CI 1.83-7.16), and patients with non-MD FLD did not have a significantly increased risk (OR 1.77; 95% CI 0.67-4.73). Regarding CAC, patients with MAFLD-T2D had an increased risk for CVD (OR 6.56, 95% CI 2.18-19.76). Patients with MAFLD-MUHO, MAFLD-MHO and non-MD FLD did not have a significantly increased risk compared with the reference group (OR 2.54, 95% CI 0.90-7.13; OR 1.84, 95% CI 0.67-5.00 and OR 2.11, 95% CI 0.46-9.74, respectively). ConclusionMAFLD-T2D and MAFLD-OW phenotypes had a significant risk for CVD. MAFLD new criteria reinforced the importance of identifying metabolic phenotypes in populations as it may help to identify patients with higher CVD risk and offer a personalized therapeutic management in a primary prevention setting.2022-01-01T00:00:00Z