Implantation of an Atrial Flow Regulator in a Child on Venoarterial Extracorporeal Membrane Oxygenator as a Bridge to Heart Transplant: A Case Report

BackgroundBalloon dilation and stenting of the atrial septum are techniques used to unload left heart cavities in acute or end-stage heart failure in children. However, they carry significant risks such as tamponade or device embolization.Case PresentationWe report the first case of a child with an end-stage mitochondrial cardiomyopathy on a venoarterial extracorporeal membrane oxygenator as a bridge to heart transplant where an atrial flow regulator device has been implanted.ConclusionsThis case illustrates the feasibility and safety of atrial flow regulator implantation in this setting. This procedure allowed to wean inotropic support while awaiting heart transplantation.     

La pandemia COVID-19 y su repercusión en la unidad de radiología intervencionista: nuestra experiencia

This paper aims to describe our experience in an interventional radiology unit in a hospital in Spain that was severely affected by the COVID-19 pandemic. To this end, we did a prospective observational study of 20 consecutive patients with COVID-19 who underwent 21 interventional radiology procedures between March 13, 2020 and May 11, 2020. We describe the measures taken to reorganize the work and protective measures, as well as the repercussions of the situation on our unit's overall activity and activity in different phases. The COVID-19 pandemic has represented a challenge in our daily work, but learning from our own experience and the recommendations of the Spanish radiological societies (SERVEI and SERAM) has enabled us to adapt successfully. Our activity dropped only 22% compared to the same period in 2019.     

Mixed central and peripheral nervous system disorders in severe SARS-CoV-2 infection

Journal of Neurology -     

Prodromal Parkinson disease in patients with idiopathic hyposmia

Journal of Neurology - Idiopathic hyposmia (IH) is a prodromal marker of Parkinson disease (PD). However, IH is common in the general population and only a minority will develop PD. Identification...     

Anti‐tumour immune response in GL261 glioblastoma generated by Temozolomide Immune‐Enhancing Metronomic Schedule monitored with MRSI‐based nosological images

Glioblastomas (GB) are brain tumours with poor prognosis even after aggressive therapy. Improvements in both therapeutic and follow‐up strategies are urgently needed. In previous work we described an oscillatory pattern of response to Temozolomide (TMZ) using a standard administration protocol, detected through MRSI‐based machine learning approaches. In the present work, we have introduced the Immune‐Enhancing Metronomic Schedule (IMS) with an every 6‐d TMZ administration at 60 mg/kg and investigated the consistence of such oscillatory behaviour. A total of n = 17 GL261 GB tumour‐bearing C57BL/6j mice were studied with MRI/MRSI every 2 d, and the oscillatory behaviour (6.2 ± 1.5 d period from the TMZ administration day) was confirmed during response. Furthermore, IMS‐TMZ produced significant improvement in mice survival (22.5 ± 3.0 d for controls vs 135.8 ± 78.2 for TMZ‐treated), outperforming standard TMZ treatment. Histopathological correlation was investigated in selected tumour samples (n = 6) analyzing control and responding fields. Significant differences were found for CD3+ cells (lymphocytes, 3.3 ± 2.5 vs 4.8 ± 2.9, respectively) and Iba‐1 immunostained area (microglia/macrophages, 16.8% ± 9.7% and 21.9% ± 11.4%, respectively). Unexpectedly, during IMS‐TMZ treatment, tumours from some mice (n = 6) fully regressed and remained undetectable without further treatment for 1 mo. These animals were considered “cured” and a GL261 re‐challenge experiment performed, with no tumour reappearance in five out of six cases. Heterogeneous therapy response outcomes were detected in tumour‐bearing mice, and a selected group was investigated (n = 3 non‐responders, n = 6 relapsing tumours, n = 3 controls). PD‐L1 content was found ca. 3‐fold increased in the relapsing group when comparing with control and non‐responding groups, suggesting that increased lymphocyte inhibition could be associated to IMS‐TMZ failure. Overall, data suggest that host immune response has a relevant role in therapy response/escape in GL261 tumours under IMS‐TMZ therapy. This is associated to changes in the metabolomics pattern, oscillating every 6 d, in agreement with immune cycle length, which is being sampled by MRSI‐derived nosological images.     

VIG-Express: Consenso de un sistema de valoración multidimensional/geriátrica rápida en Cataluña

ObjetivoConsensuar una herramienta de valoración multidimensional/geriátrica rápida (VMGR), como sistema compartido y universal de valoración multidimensional de personas con multimorbilidad, fragilidad, complejidad o situación avanzada, para todos los profesionales del sistema de salud y social de Cataluña.DiseñoConsenso de profesionales en tres fases, combinando sesiones presenciales con trabajo telemático.EmplazamientoCataluña.ParticipantesSe constituyó un grupo de 27 profesionales de carácter interdisciplinario representativo de los distintos ámbitos de atención.MétodoSe han combinado las metodologías de Design thinking para el consenso inicial de características de la herramienta de VMGR (fase 1), con la metodología Lean Start-Up para el diseño de la nueva herramienta de VMGR (fase 2), que finalmente se testeó en un grupo de pacientes (fase 3).ResultadosEn la fase 1 se consensuó que la herramienta de VMGR ideal debía permitir una valoración ad hoc de las personas, ser rápida y ágil (tiempo < 10 minutos), identificar las dimensiones alteradas mediante preguntas trigger y facilitar el diagnóstico de situación (idealmente cuantificado). En la fase 2 se elaboró el prototipo de una nueva herramienta de VMGR de 15 + dos preguntas (VIG-Express), finalmente testeada en 35 personas en la fase 3.ConclusionesEn los resultados preliminares, la herramienta VIG-Express parece facilitar una valoración multidimensional sencilla y rápida y la personalización de las intervenciones, así como una mirada única y un relato compartido entre los profesionales de los distintos ámbitos de atención. Serán necesarios más estudios para corroborar estos hallazgos.Palabras clave: Evaluación geriátrica, Consenso, Diagnóstico de la situación, Atención dirigida al paciente, Sistemas de atención de salud integrada     

Extraction of artefactual MRS patterns from a large database using non-negative matrix factorization

Despite the success of automated pattern recognition methods in problems of human brain tumor diagnostic classification, limited attention has been paid to the issue of automated data quality assessment in the field of MRS for neuro-oncology. Beyond some early attempts to address this issue, the current standard in practice is MRS quality control through human (expert-based) assessment. One aspect of automatic quality control is the problem of detecting artefacts in MRS data. Artefacts, whose variety has already been reviewed in some detail and some of which may even escape human quality control, have a negative influence in pattern recognition methods attempting to assist tumor characterization. The automatic detection of MRS artefacts should be beneficial for radiology as it guarantees more reliable tumor characterizations, as well as the development of more robust pattern recognition-based tumor classifiers and more trustable MRS data processing and analysis pipelines. Feature extraction methods have previously been used to help distinguishing between good and bad quality spectra to apply subsequent supervised pattern recognition techniques. In this study, we apply feature extraction differently and use a variant of a method for blind source separation, namely Convex Non-Negative Matrix Factorization, to unveil MRS signal sources in a completely unsupervised way. We hypothesize that, while most sources will correspond to the different tumor patterns, some of them will reflect signal artefacts. The experimental work reported in this paper, analyzing a combined short and long echo time ¹H-MRS database of more than 2000 spectra acquired at 1.5T and corresponding to different tumor types and other anomalous masses, provides a first proof of concept that points to the possible validity of this approach.