Publications by authors named "Eduardo Ortíz"

46 Publications

Assessing tumor response to neoadjuvant chemoradiation in rectal cancer with rectoscopy and 18F-FDG PET/CT: results from a prospective series.

Rev Esp Enferm Dig 2021 May;113(5):307-312

Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca.

Introduction: rectoscopy and 18F-FDG PET/CT as a diagnostic algorithm for the assessment of tumor response in rectal cancer after neoadjuvant chemoradiation therapy (CRT) is very useful.

Material And Methods: this was a prospective longitudinal study in patients with locally advanced rectal cancer treated with neoadjuvant CRT. Patients were assessed after CRT completion with a digital rectal examination, proctoscopy and 18F-FDG PET/CT. Patients were subdivided as clinical (cCR) or radiologic (rCR) responders and non-responders according to tumor response. Clinical and radiological re-assessment was compared with the surgical specimen. Pathological tumor regression (pCR) grade was determined according to Mandard's classification. Of the 68 patients included, 15 (22 %) presented pCR in the surgical specimen and tumor persistence (non-PCR) was detected in the remaining 53 (78 %). Clinical assessment (DRE+ rectoscopy) identified 15 patients as cCR and 53 as non-cCR, two were false positives and two were false negatives. The overall accuracy was 94 %. 18F-FDG PET/CT identified 18 patients as rCR and 50 as non-rCR, one was a false positive and four were false negatives. The overall accuracy was 92 %. A combination of clinical findings and 18F-FDG PET/CT resulted in an accuracy of 96 %. The combination of clinical findings + 18F-FDG PET/CT was able to correctly identify all cases of pCR, with the exception of one case that presented a tumor regression of 80 %. In this series, 18F-PET-CT and clinical assessment had excellent accuracies in differentiating PCR from non-PCR after CRT completion. PET-CT combined with clinical assessment had a better accuracy than both modalities independently. 18F-FDG PET/CT is a valid tool that complements the clinical assessment of tumor response.
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http://dx.doi.org/10.17235/reed.2020.6954/2020DOI Listing
May 2021

Clinical utility of radiomics at baseline rectal MRI to predict complete response of rectal cancer after chemoradiation therapy.

Abdom Radiol (NY) 2020 11;45(11):3608-3617

Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.

Purpose: To investigate the value of T2-radiomics combined with anatomical MRI staging criteria from pre-treatment rectal MRI in predicting complete response to neoadjuvant chemoradiation therapy (CRT).

Methods: This retrospective study included patients with locally advanced rectal cancer who underwent rectal MRI before neoadjuvant CRT from October 2011 to January 2015 and then surgery. Surgical histopathologic analysis was used as the reference standard for pathologic complete response. Anatomical MRI staging criteria were extracted from our institutional standardized radiology report. In radiomics analysis, one radiologist manually segmented the primary tumor on T2-weighted images for all 102 patients (i.e., training set); two different radiologists independently segmented 66/102 patients (i.e., validation set). 108 radiomics features were extracted. Then, scanner-independent features were identified and least absolute shrinkage operator analysis was used to extract a radiomics score. Finally, a support vector machine model combining the radiomics score and anatomical MRI staging criteria was compared against both anatomical MRI-only and radiomics-only models using the deLong test.

Results: The study included 102 patients (42 women; median age = 61 years).The radiomics score produced an area under the curve (AUC) of 0.75. Comparable results were found using the validation set (AUCs = 0.75 and 0.71 for each radiologist, respectively). The anatomical MRI-only model had an accuracy of 67% (sensitivity 42%, specificity 72%); when adding the radiomics score, the accuracy increased to 74% (sensitivity 58%, specificity 77%).

Conclusion: Combining T2-radiomics and anatomical MRI staging criteria from pre-treatment rectal MRI may help to stratify patients based on the prediction of treatment response to neoadjuvant therapy.
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http://dx.doi.org/10.1007/s00261-020-02502-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572430PMC
November 2020

A rectal cancer organoid platform to study individual responses to chemoradiation.

Nat Med 2019 10 7;25(10):1607-1614. Epub 2019 Oct 7.

Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Rectal cancer (RC) is a challenging disease to treat that requires chemotherapy, radiation and surgery to optimize outcomes for individual patients. No accurate model of RC exists to answer fundamental research questions relevant to patients. We established a biorepository of 65 patient-derived RC organoid cultures (tumoroids) from patients with primary, metastatic or recurrent disease. RC tumoroids retained molecular features of the tumors from which they were derived, and their ex vivo responses to clinically relevant chemotherapy and radiation treatment correlated with the clinical responses noted in individual patients' tumors. Upon engraftment into murine rectal mucosa, human RC tumoroids gave rise to invasive RC followed by metastasis to lung and liver. Importantly, engrafted tumors displayed the heterogenous sensitivity to chemotherapy observed clinically. Thus, the biology and drug sensitivity of RC clinical isolates can be efficiently interrogated using an organoid-based, ex vivo platform coupled with in vivo endoluminal propagation in animals.
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http://dx.doi.org/10.1038/s41591-019-0584-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385919PMC
October 2019

Mitral valve navigator. A new diagnostic tool for effective regurgitant orifice quantification in mitral regurgitation.

Echocardiography 2018 11 5;35(11):1812-1817. Epub 2018 Aug 5.

Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain.

Introduction: Mitral regurgitation severity assessment is usually carried out using qualitative, semiquantitative, and quantitative parameters. The mitral valve navigation (MVN) tool allows to measure the mitral effective regurgitant orifice (MERO) from 3D echo datasets. Our aim was to validate the MVN as a new tool to quantify MERO. A secondary aim was to assess the intra- and interobserver variability.

Methods: This is a retrospective study in which consecutive subjects undergoing a transoesophageal echocardiogram for more than mild mitral regurgitation evaluation were included. MERO measurement obtained by means of 3D color Doppler was used as the gold standard method for comparison. In every patient, MERO was also obtained using the MVN tool.

Results: Fifty-nine consecutive patients were analyzed (47.5% female; mean age 50.8 years). Mitral regurgitation was moderate in 23 (39%) and severe in 36 (61%) patients. Forty patients (67.8%) had a primary and 19 (32.2%) a secondary mitral regurgitation. The intraclass correlation coefficient (ICC) between 3D color Doppler and MVN was excellent (ICC: 0.95; 95% CI: 0.82 to 0.98; P < 0.001) in the total group and for patients with primary and secondary mitral regurgitation. Intra- and interobserver agreements were also good.

Conclusions: Mitral valve navigator shows an excellent accuracy for measuring MERO when the transoesophageal 3D color Doppler is used as the reference method, either primary or secondary mitral regurgitation. Intraobserver reproducibility and interobserver reproducibility are also excellent. These findings make this software a good alternative method to measure mitral regurgitation severity.
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http://dx.doi.org/10.1111/echo.14114DOI Listing
November 2018

Let's Not SPRINT to Judgment About New Blood Pressure Goals.

Ann Intern Med 2016 12;165(12):889-890

From Washington, DC; University of Iowa, Iowa City, Iowa.

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http://dx.doi.org/10.7326/L16-0442DOI Listing
December 2016

Pharmacokinetics of Miltefosine in Children and Adults with Cutaneous Leishmaniasis.

Antimicrob Agents Chemother 2017 03 23;61(3). Epub 2017 Feb 23.

Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia

An open-label pharmacokinetics (PK) clinical trial was conducted to comparatively assess the PK and explore the pharmacodynamics (PD) of miltefosine in children and adults with cutaneous leishmaniasis (CL) in Colombia. Sixty patients, 30 children aged 2 to 12 years and 30 adults aged 18 to 60 years, were enrolled. Participants received miltefosine (Impavido) at a nominal dose of 2.5 mg/kg/day for 28 days. Miltefosine concentrations were measured in plasma and peripheral blood mononuclear cells by liquid chromatography-tandem mass spectrometry of samples obtained during treatment and up to 6 months following completion of treatment, when therapeutic outcome was determined. Fifty-two patients were cured, 5 pediatric patients failed treatment, and 3 participants were lost to follow-up. () predominated among the strains isolated (42/46; 91%). Noncompartmental analysis demonstrated that plasma and intracellular miltefosine concentrations were, overall, lower in children than in adults. Exposure to miltefosine, estimated by area under the concentration-time curve and maximum concentration, was significantly lower in children in both the central and intracellular compartments ( < 0.01). persistence was detected in 43% of study participants at the end of treatment and in 27% at 90 days after initiation of treatment. Clinical response was not dependent on parasite elimination. miltefosine susceptibility was similar for strains from adults and children. Our results document PK differences for miltefosine in children and adults with cutaneous leishmaniasis that affect drug exposure and could influence the outcome of treatment, and they provide bases for optimizing therapeutic regimens for CL in pediatric populations. (This study has been registered at ClinicalTrials.gov under identifier NCT01462500.).
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http://dx.doi.org/10.1128/AAC.02198-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328512PMC
March 2017

Innovations in American Society of Clinical Oncology Practice Guideline Development.

J Clin Oncol 2016 09 5;34(26):3213-20. Epub 2016 Jul 5.

Mark R. Somerfield, Kari Bohlke, Kaitlin Einhaus, Robert S. Miller, Thomas K. Oliver, and Eduardo Ortiz, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, U.S. Oncology Network, Virginia Cancer Specialists, Arlington, VA; George P. Browman, McMaster University, Hamilton, Ontario; University of British Columbia, Vancouver, British Columbia, Canada; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Supriya G. Mohile, University of Rochester, Rochester, NY; and Gary H. Lyman, Fred Hutchinson Cancer Research Center; University of Washington, Seattle, WA.

Since the beginning of its guidelines program in 1993, ASCO has continually sought ways to produce a greater number of guidelines while maintaining its commitment to using the rigorous development methods that minimize the biases that threaten the validity of practice recommendations. ASCO is implementing a range of guideline development and implementation innovations. In this article, we describe innovations that are designed to (1) integrate consideration of multiple chronic conditions into practice guidelines; (2) keep more of its guidelines current by applying evolving signals or (more) rapid, for-cause updating approaches; (3) increase the number of high-quality guidelines available to its membership through endorsement and adaptation of other groups' products; (4) improve coverage of its members' guideline needs through a new topic nomination process; and (5) enhance dissemination and promote implementation of ASCO guidelines in the oncology practice community through a network of volunteer ambassadors. We close with a summary of ASCO's plans to facilitate the integration of data from its rapid learning system, CancerLinQ, into ASCO guidelines and to develop tactics through which guideline recommendations can be embedded in clinicians' workflow in digital form. We highlight the challenges inherent in reconciling the need to provide clinicians with more interactive, point-of-care guidance with ASCO's abiding commitment to methodologic rigor in guideline development.
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http://dx.doi.org/10.1200/JCO.2016.68.3524DOI Listing
September 2016

Let's Not SPRINT to Judgment About New Blood Pressure Goals.

Ann Intern Med 2016 May 23;164(10):692-3. Epub 2016 Feb 23.

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http://dx.doi.org/10.7326/M15-3123DOI Listing
May 2016

Evaluation of a hearing screening questionnaire for use with Ecuadorian school-aged children.

Int J Audiol 2015 25;54(9):587-92. Epub 2015 Mar 25.

* National Center for Hearing Assessment and Management, Utah State University , Logan , USA.

Objective: The purpose of this study was to evaluate the accuracy of a teacher-administered hearing screening questionnaire to detect hearing loss among first-grade Ecuadorian children in public schools.

Design: A cross-sectional design was used to compare screening results from the teacher-administered questionnaire and pure-tone audiometry.

Study Sample: Children were randomly selected from 117 schools. The study was conducted in two phases to accommodate different school calendars in the country. Data for both screening methods were available for 4616 children.

Results: For Phase 1, almost 90% who failed the questionnaire passed audiometry; and, 85% who failed audiometry passed the questionnaire. A revised questionnaire was used for Phase 2 and 70% who failed the questionnaire passed audiometry; and 85% who failed audiometry, passed the questionnaire. Of the 27 children identified in Phase 2 as having hearing loss at the time screening was done, 88.9% failed audiometry, but only 22.2% failed the questionnaire.

Conclusions: Because there was little agreement between the questionnaire and the audiometry, it was recommended that the questionnaire not be used to screen Ecuadorian children for hearing loss. The results of this evaluation of the school hearing screening program provided the Ecuadorian government with important information to guide policy decisions.
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http://dx.doi.org/10.3109/14992027.2015.1015689DOI Listing
May 2016

Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members.

JAMA 2014 Sep;312(10):1033-48

National Heart, Lung, and Blood Institute, Bethesda, Maryland.

Importance: Sickle cell disease (SCD) is a life-threatening genetic disorder affecting nearly 100,000 individuals in the United States and is associated with many acute and chronic complications requiring immediate medical attention. Two disease-modifying therapies, hydroxyurea and long-term blood transfusions, are available but underused.

Objective: To support and expand the number of health professionals able and willing to provide care for persons with SCD.

Evidence Review: Databases of MEDLINE (including in-process and other nonindexed citations), EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, TOXLINE, and Scopus were searched using prespecified search terms and keywords to identify randomized clinical trials, nonrandomized intervention studies, and observational studies. Literature searches of English-language publications from 1980 with updates through April 1, 2014, addressed key questions developed by the expert panel members and methodologists.

Findings: Strong recommendations for preventive services include daily oral prophylactic penicillin up to the age of 5 years, annual transcranial Doppler examinations from the ages of 2 to 16 years in those with sickle cell anemia, and long-term transfusion therapy to prevent stroke in those children with abnormal transcranial Doppler velocity (≥200 cm/s). Strong recommendations addressing acute complications include rapid initiation of opioids for treatment of severe pain associated with a vasoocclusive crisis, and use of incentive spirometry in patients hospitalized for a vasoocclusive crisis. Strong recommendations for chronic complications include use of analgesics and physical therapy for treatment of avascular necrosis, and use of angiotensin-converting enzyme inhibitor therapy for microalbuminuria in adults with SCD. Strong recommendations for children and adults with proliferative sickle cell retinopathy include referral to expert specialists for consideration of laser photocoagulation and for echocardiography to evaluate signs of pulmonary hypertension. Hydroxyurea therapy is strongly recommended for adults with 3 or more severe vasoocclusive crises during any 12-month period, with SCD pain or chronic anemia interfering with daily activities, or with severe or recurrent episodes of acute chest syndrome. A recommendation of moderate strength suggests offering treatment with hydroxyurea without regard to the presence of symptoms for infants, children, and adolescents. In persons with sickle cell anemia, preoperative transfusion therapy to increase hemoglobin levels to 10 g/dL is strongly recommended with a moderate strength recommendation to maintain sickle hemoglobin levels of less than 30% prior to the next transfusion during long-term transfusion therapy. A strong recommendation to assess iron overload is accompanied by a moderate strength recommendation to begin iron chelation therapy when indicated.

Conclusions And Relevance: Hydroxyurea and transfusion therapy are strongly recommended for many individuals with SCD. Many other recommendations are based on quality of evidence that is less than high due to the paucity of clinical trials regarding screening, management, and monitoring for individuals with SCD.
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http://dx.doi.org/10.1001/jama.2014.10517DOI Listing
September 2014

Guidelines for managing high blood pressure--reply.

JAMA 2014 Jul;312(3):295-6

University of Iowa, Iowa City.

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http://dx.doi.org/10.1001/jama.2014.6599DOI Listing
July 2014

2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

JAMA 2014 Feb;311(5):507-20

at the time of the project,National Heart, Lung, and Blood Institute, Bethesda, Maryland17currently with ProVation Medical, Wolters Kluwer Health, Minneapolis, Minnesota.

Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
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http://dx.doi.org/10.1001/jama.2013.284427DOI Listing
February 2014

Sixteen years follow-up results of a randomized phase II trial of neoadjuvant fluorouracil, doxorubicin, and cyclophosphamide (FAC) compared with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) in stage III breast cancer: GOCS experience.

Breast Cancer Res Treat 2014 Jan 11;143(2):313-23. Epub 2013 Dec 11.

Division of Hematology and Oncology, University of Pittsburgh Cancer Institute, UPMC Cancer Pavilion Room 463, 5150 Centre Ave, Pittsburgh, PA, 15232, USA,

Neoadjuvant chemotherapy (NAC) allows direct evaluation of the tumor's sensitivity to therapy, eradication of micrometastatic disease and the possibility of performing breast conserving surgery. The aim of this study was to describe long-term results of NAC in stage III breast cancer patients. We evaluated 126 patients that participated in a phase II randomized trial of neoadjuvant FAC compared with CMF. Chemotherapy was administered for three cycles prior to definitive surgery and radiotherapy, and then for six cycles as adjuvant. Median follow-up was 4.5 years (range 0.2-16.4). Objective response rate (OR) was similar in both groups (61 % for FAC, 66 % for CMF, P = NS). There were no differences in median disease free survival (DFS) or overall survival (OS) (5.1 vs 3.3 years and 6.7 vs 6.3 years for FAC and CMF, respectively). After 16 years of follow-up, 53 patients are still alive. Multivariate analysis showed that the number of pathologically involved lymph nodes (pLN) was the only factor associated with both, DFS and OS (P = 0.0003 and P = 0.0005, respectively). Both regimens were well tolerated, CMF had higher incidence of grade 3-4 leukopenia, thrombocytopenia, and stomatitis, whereas alopecia was more common in FAC. To the best of our knowledge, this is the first study to report long-term outcomes of FAC and CMF in the neoadjuvant setting. Within the sensitivity of our study, both regimens showed similar OR, long-term toxicity, DFS, and OS rate at 16 years. After 5 years, the hazard of death seems to decline. The prolonged follow-up of this study provides a unique opportunity to evaluate factors that predict long-term outcomes. After 16 years of follow-up, the number of pLN remains the most powerful predictor of survival.
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http://dx.doi.org/10.1007/s10549-013-2806-5DOI Listing
January 2014

National surveillance definitions for hypertension prevalence and control among adults.

Circ Cardiovasc Qual Outcomes 2012 May 1;5(3):343-51. Epub 2012 May 1.

Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention, Chamblee, GA 30341, USA.

Background: Clear and consistent definitions of hypertension and hypertension control are crucial to guide diagnosis, treatment, and surveillance. A variety of surveillance definitions are in frequent use, resulting in variation of reported hypertension prevalence and control, even when based on the same data set.

Methods And Results: To assess the variety of published surveillance definitions and rates, we performed a literature search for studies and reports that used National Health and Nutrition Examination Surveys (NHANES) data from at least as recent as the 2003 to 2004 survey cycle. We identified 19 studies that used various criteria for defining hypertension and hypertension control, as well as different parameters for age adjustment and inclusion of subpopulations. This resulted in variation of reported age-standardized hypertension prevalence from 28.9% to 32.1% and hypertension control from 35.1% to 64%. We then assessed the effects of varying the definitions of hypertension and hypertension control, parameters for age adjustment, and inclusion of subpopulations on NHANES data from both 2007 to 2008 (n=5645) and 2005 to 2008 (n=10 365). We propose standard surveillance definitions and age-adjustment parameters for hypertension and hypertension control. By using our recommended approach with NHANES 2007 to 2008 data, the age-standardized prevalence of hypertension in the United States was 29.8% (SE, 0.62%) and the rate of hypertension control was 45.8% (SE, 4.03%).

Conclusions: Surveillance definitions of hypertension and hypertension control vary in the literature. We present standard definitions of hypertension prevalence and control among adults and standard parameters for age-adjustment and population composition that will enable meaningful population comparisons and monitoring of trends.
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http://dx.doi.org/10.1161/CIRCOUTCOMES.111.963439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407684PMC
May 2012

[Soft tissue sarcomas: clinical practice guidelines].

Med Clin (Barc) 2011 Apr 15;136(9):408.e1-8. Epub 2011 Mar 15.

Servicio de Oncología Médica, Instituto Catalán de Oncología L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, España.

Soft tissue sarcomas (STS) constitute a rare heterogeneous group of tumours that include a wide variety of histological subtypes, which require a multidisciplinary and, frequently specialized and complex management. Despite advances in our understanding of the pathophysiology of the disease, there are no consensus multidisciplinary recommendations about its diagnosis and treatment in our country. The objective of these guidelines is to provide practical therapeutic recommendations that may contribute to improve the therapeutic results of this disease in our environment. With this purpose, the Spanish Group for Research in Sarcomas (GEIS) held a meeting with a multidisciplinary group of experts for the study and management of sarcomas. The results of this meeting are compiled in this document, in which recommendations on diagnosis, treatment and monitoring of soft tissue sarcomas are included. In summary, these guidelines aim to facilitate the identification and management of STS for clinical practice in Spain.
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http://dx.doi.org/10.1016/j.medcli.2011.02.004DOI Listing
April 2011

Semantic processing to support clinical guideline development.

AMIA Annu Symp Proc 2008 Nov 6:187-91. Epub 2008 Nov 6.

National Library of Medicine, Bethesda, MD, USA.

Clinical practice guidelines are one of the main resources for communicating evidence-based practice to health professionals. During guideline development, questions that express a knowledge gap are answered by finding relevant citations in MEDLINE and other biomedical databases. Determining citation relevance involves extensive manual review. We propose an automated method for finding relevant citations based on guideline question classification, semantic processing, and rules that match question classes with semantic predications. In this initial study, we focused on a pediatric cardiovascular risk factor guideline. The overall performance of the system was 40% recall, 88% precision (F0.5-score 0.71), and 98% specificity. We show that relevant and nonrelevant citations have clinically different semantic characteristics and suggest that this method has the potential to improve the efficiency of the literature review process in guideline development.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656081PMC
November 2008

Validation of a nomogram to predict the presence of sentinel lymph node metastases in melanoma.

Ann Surg Oncol 2008 Oct 22;15(10):2874-7. Epub 2008 Jul 22.

Department of General Surgery, "Virgen de la Arrixaca" University Hospital, 30120 El Palmar, Murcia, Spain.

Background: Lymph node involvement is a very important prognostic factor for cutaneous melanoma. In this paper we try to validate a nomogram that was created at the Memorial Sloan-Kettering Cancer Center, New York, to predict the probability of metastases in the sentinel nodes of patients with cutaneous melanoma.

Methods: Values of the following variables were collected in 218 patients with cutaneous melanoma and sentinel lymph node: age, thickness, level of Clark, location of the lesion, and ulceration or not, and the nomogram was applied to assess the probability of sentinel node involvement in each patient. The discrimination of the nomogram was assessed by calculating the area under the receiver operating characteristics (ROC) curve, and to assess the accuracy of the nomogram actual probabilities were plotted against the nomogram-calculated predicted probability.

Results: The overall predictive accuracy of the nomogram was 0.869 (95% confidence interval 0.813-0.925). Mean predicted probability of sentinel node metastasis was highly correlated to the observed risk (r = 0.953; P < 0.012).

Conclusion: The nomogram is a useful diagnostic tool that provides an adequate accurate prediction of the probability of sentinel lymph node metastases in patients with cutaneous melanoma.
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http://dx.doi.org/10.1245/s10434-008-0077-xDOI Listing
October 2008

Osteoid osteoma of the spine: CT-guided monopolar radiofrequency ablation.

Eur J Radiol 2009 Sep 2;71(3):564-9. Epub 2008 Jun 2.

Departamento de Diagnóstico por Imagen, Fundación Hospital Alcorcón, Alcorcón, Madrid, Spain.

CT-guided percutaneous radiofrequency ablation and laser photocoagulation have become the methods of choice for the treatment of all osteoid osteomas except those in contact with neural structures. We report 10 patients with spinal osteoid osteoma adjacent to the neural elements treated with 12 sessions of CT-guided monopolar radiofrequency ablation. The size range of the lesion was 3-14 mm (mean, 7.5 mm) and the distance between the nidus and the adjacent spinal cord or nerve root was 2-12 mm (mean, 5 mm). No intact cortex between the tumor and the spinal cord or nerve roots constituted an exclusion criterion because of a higher risk of undesirable neurotoxic effects. Patients were under general anesthesia. After location of the lesion, a 11G-bone biopsy was introduced into the nidus. The radiofrequency electrode was inserted through the biopsy needle and heated at 90 degrees C for 4 min. Primary success was obtained in eight patients. At follow-up (mean, 19.5 months; range, 6-24 months), pain persisted in two patients after 2 months. Both of them were re-treated. All patients are currently pain-free and complications were not detected. In our opinion, radiofrequency ablation can also be considered the treatment of choice for spinal osteoid osteoma.
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http://dx.doi.org/10.1016/j.ejrad.2008.04.020DOI Listing
September 2009

Separation and quantitation of several angiotensin II receptor antagonist drugs in human urine by a SPE-HPLC-DAD method.

J Sep Sci 2008 Mar;31(4):667-76

Departamento de Química Analítica, Facultad de Ciencia y Tecnología, Leioa, Spain.

In this work, an SPE-HPLC method coupled to photodiode array detection was validated in human urine matrix, in order to monitor four antihypertensive angiotensin II receptor antagonist drugs in patients under cardiovascular treatment. For that purpose, experimental design was used. Quantitation was accomplished by the internal standard method. The obtained LOQs were 95, 113, 125, and 85 ng/mL for eprosartan, telmisartan, irbesartan, and valsartan, respectively. The intraday and interday precision and accuracy at four concentration levels in the working range (LOQ-15 microg/mL) were always lower than 11% RSD and 8% relative error. The urine samples proved to be stable during 4 h at room temperature, after three thaw-freeze cycles, and for 2 months at -20 degrees C. No interferences from other endogenous compounds or co-administered drugs were found. The method has been successfully applied to monitor the renal elimination of eprosartan and valsartan during 24 h.
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http://dx.doi.org/10.1002/jssc.200700442DOI Listing
March 2008

Early experiences with e-health services (1999-2002): promise, reality, and implications.

Med Care 2006 May;44(5):491-6

Kaiser Permanente Medical Care Program, Division of Research, Oakland, California 94612, USA.

Background: E-health services may improve the quality and efficiency of care; however, there is little quantitative data on e-health use.

Objective: The objective of this study was to examine trends in e-health use and user characteristics.

Research Design: This was a longitudinal study of e-health use (1999-2002) within an integrated delivery system (IDS). We classified 4 e-health services into transactional (drug refills and appointment scheduling) and care-related (medical and medication advice) services.

Subjects: Approximately 3.3 million members of a large, prepaid IDS.

Measurements: Amount and frequency of e-health use over time and characteristics of users.

Results: The number of members registered for access to e-health increased from 20,617 (0.7% of all members) in Q1 1999 to 270,987 (8.6%) in Q3 2002. Between Q1 and Q3 2002, 42,845 members (1.3%) used the drug refill service and 55,901 (1.7%) used the appointment scheduling service compared with 10,756 members (0.3%) who used the medical advice service and 3069 (0.1%) who used the medication advice service. Over the same period, transactional service users averaged 3.5 uses/user versus 1.6 uses/user among care-related service users. Members most likely to use e-health services had a high level of clinical need, a regular primary care provider, were 30 to 64 years old, female, white, and lived in a nonlow socioeconomic status neighborhood. These findings were consistent across e-health service types.

Conclusions: Although use of all e-health services grew rapidly, use of care-related services lagged significantly behind use of transactional services. Subjects with greater clinical need and better ties to the health system were more likely to use both types of e-health services.
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http://dx.doi.org/10.1097/01.mlr.0000207917.28988.ddDOI Listing
May 2006