Abiguei Torrents | UPC - Barcelona (original) (raw)

Papers by Abiguei Torrents

The Journal of Nuclear Medicine, Jun 27, 2012

Lymphoscintigraphy is an important part of the mapping and identification of sentinel lymph nodes... more Lymphoscintigraphy is an important part of the mapping and identification of sentinel lymph nodes (SLNs). However, few studies report its reproducibility, and some concerns prevail. The aim of the study was to determine the reproducibility of lymphoscintigraphy performed by different team members following a strict protocol to assess lymphatic drainage and the location and number of SLNs. Methods: Sixty-eight melanoma patients were included. All underwent 2 separate lymphoscintigraphy studies, which followed the same acquisition protocol. Discordance was defined as a change in localization or a failure to identify the SLN in one of the studies. Results: All patients showed lymphatic drainage, and in all cases at least 1 sentinel node was identified. In 65 of 68 patients (96%), the findings of the first lymphoscintigraphy study were similar to those of the second. This similarity was also found in the number of sentinel nodes (171 in the first study and 173 in the second). Eighty percent of patients showed 1-3 SLNs in both lymphoscintigraphy studies. The 2 studies differed in 3 patients (4%): 2 melanomas were located on the trunk and 1 on the head and neck. Drainage was visualized to more than 1 lymphatic basin in 19 patients (28%) in the first study versus 18 patients in the second study. Conclusion: Lymphoscintigraphy is highly reproducible in the detection of sentinel nodes in melanoma patients. The classic protocol of radiotracer injection is reproducible and reliable enough to guarantee SLN identification, although a slight variation in isolated cases (especially when primary lesions are located on the trunk or the head and neck regions) is inevitable.

Revista Española de Cirugía Ortopédica y Traumatología, May 1, 2018

RECOT-717; No. of Pages 7 2 S. Lasurt-Bachs et al. Conclusiones: El polietileno altamente entrecr... more RECOT-717; No. of Pages 7 2 S. Lasurt-Bachs et al. Conclusiones: El polietileno altamente entrecruzado no reduce significativamente la generación de partículas de polietileno en aquellos pacientes intervenidos mediante una artroplastia total de rodilla, con muestras a 3 años postintervención.

Archives of internal medicine, Jan 9, 2012

Lancet Neurology, Feb 1, 2014

Background-We aimed to assess the sensitivity/specificity of serum and CSF antibody-testing in pa... more Background-We aimed to assess the sensitivity/specificity of serum and CSF antibody-testing in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, and the correlation between titers, relapses, outcome, and epitope repertoire. Methods-In this observational study, brain immunohistochemistry and cell-based assays (CBA) with fixed and live NMDAR-expressing cells were used to determine the sensitivity/specificity of antibody-testing in paired serum/CSF obtained at diagnosis of 250 patients with anti-NMDAR

Revista Española de Cirugía Ortopédica y Traumatología, May 1, 2018

Aim: To compare two different types of inserts: ultra-high molecular weight polyethylene (UHMWPE)... more Aim: To compare two different types of inserts: ultra-high molecular weight polyethylene (UHMWPE) and cross-linked polyethylene with a quantitative and qualitative study of polyethylene wear particles in synovial fluid 3 years after total knee arthroplasty. Material and methods: A prospective, randomised, controlled cohort study with blinded evaluation was carried out on 25 patients undergoing staged bilateral total knee replacement, 6 months apart. Knee arthrocentesis was performed on 12 patients 3 years after surgery, and the polyethylene particles were analysed. Results: No significant differences were found in the number of particles generated by the two different types of inserts at 3 years from total knee arthroplasty (3000×:x cross-linked = 849.7; x UHMWPE = 796.9; p = .63; 20,000×:x cross-linked = 66.3;x UHMWPE = 73.1; p = .76). Likewise, no differences in the probability of finding elongated (2 = .19; p = .66) or rounded (2 = 1.44; p = .23) particles in both types of inserts were observed. However, the probability of finding fibrillar particles is 3.08 times greater in UHMWPE.

Annals of Hepatology, 2015

Background and rationale for the study. Hyperglycemia after graft reperfusion is a consistent fin... more Background and rationale for the study. Hyperglycemia after graft reperfusion is a consistent finding in liver transplantation (LT) that remains poorly studied. We aim to describe its appearance in LT recipients of different types of grafts and its relation to the graft function. Material & methods. 436 LT recipients of donors after brain death (DBD), donors after cardiac death (DCD), and familial amyloidotic polyneuropathy (FAP) donors were reviewed. Serum glucose was measured at baseline, during the anhepatic phase, after graft reperfusion, and at the end of surgery. Early graft dysfunction (EAD) was assessed by Olthoff criteria. Caspase-3, IFN-γ, IL1β, and IL6 gene expression were measured in liver biopsy. Results. The highest increase in glucose levels after reperfusion was observed in FAP LT recipients and the lowest in DCD LT recipients. Glucose level during the anhepatic phase was the only modifiable predictive variable of hyperglycemia after reperfusion. No relation was found between hyperglycemia after reperfusion and EAD. However, recipients with the highest glucose levels after reperfusion tended to achieve the best glucose control at the end of surgery and those who were unable to control the glucose value after reperfusion showed EAD more frequently. The highest levels of caspase-3 were found in recipients with the lowest glucose values after reperfusion. In conclusion, glucose levels increased after graft reperfusion to a different extent according to the donor type. Contrary to general belief, transient hyperglycemia after reperfusion does not appear to impact negatively on the liver graft function and could even be suggested as a marker of graft quality.

Archives of Orthopaedic and Trauma Surgery, 2015

Stiffness after a total knee arthroplasty (TKA) is one of the most common post-operative complica... more Stiffness after a total knee arthroplasty (TKA) is one of the most common post-operative complications. The purpose of this study is the evaluation of the effectiveness of TT proximalization osteotomy of improving a lack of flexion and secondary pain in patella baja (infera) post-TKA. Between April 2007 and July 2012, TT proximalization osteotomy was performed on 21 patients. The average preoperative flexion was 70° (in a range of 60-80). Clinical pre- and post-operative evaluations were performed with Knee Society Score, Western Ontario and McMaster Universities Arthritis Index scales and a satisfaction survey. Modified Blackburn-Peel index and Portner angle were used to evaluate patellar height. After an average follow-up of 35 months (range 18-48), an average flexion of 100° (range 90-100) and an overall satisfaction were obtained. Clinical scores improved significantly. The Blackburn-Peel index and Portner angle improved significantly from 0.3 (range 0.1-0.5) to 0.4 (0.3-0.5) and from 9 (3-15) to 12 (9-18), respectively. Three patients showed no signs of osteotomy consolidation. However, this was not linked to a lack of extension or an increase in local pain. TT proximalization osteotomy provides satisfactory results in improving a lack of flexion and pain in patella baja post-TKR.

Translational Oncology, 2018

Cirurgia oncològica; Avaluació; IndicadorsCirugía oncológica; Evaluación; IndicadoresOncological ... more Cirurgia oncològica; Avaluació; IndicadorsCirugía oncológica; Evaluación; IndicadoresOncological surgery; Evaluation; IndicatorsEl presente trabajo corresponde a la segunda evaluación de los resultados de la cirugía oncológica digestiva de alta especialización con intención curativa de cirugía de esófago, de páncreas y de hígado (que incluye metástasis hepáticas desde la primera evaluación, actualmente ampliado a vías biliares y tumor hepático primario) para los años 2014 y 2015. A diferencia de la primera evaluación basada en el uso de la auditoría clínica "externa", la metodología aplicada en esta segunda evaluación incorpora información directa de los propios profesionales. En ambos casos ha habido feedback, y validación de los resultados finales por su parte.El present treball correspon a la segona avaluació dels resultats de la cirurgia oncològica digestiva d’alta especialització amb intenció curativa de cirurgia d’esòfag, de pàncrees i de fetge (que inclou metàstasis...

Journal of Hepatology, 2021

BACKGROUND AND AIMS to what extent patients with alcohol-related decompensated cirrhosis can impr... more BACKGROUND AND AIMS to what extent patients with alcohol-related decompensated cirrhosis can improve until recovery from decompensation remains unclear. We aimed to investigate the probability of recovery and delisting due to improvement in patients with alcohol-related decompensated cirrhosis in the waiting list (WL) for liver transplantation (LT). METHODS we conducted a registry-based, multicenter, retrospective study including all patients admitted to the LT-WL in Catalonia (Spain) with the indication of alcohol-, HCV-, cholestatic- or NASH- decompensated cirrhosis between January 2007 and December 2018. Competing risk analysis was used to investigate variables associated with delisting due to improvement in patients with alcohol-related decompensated cirrhosis. Criteria for delisting after improvement were not predefined. Outcomes of patients after delisting were also studied. RESULTS one-thousand-and-one patients were included, 420 (37%) with alcohol-related decompensated cirrhosis. Thirty-six (8.6%) patients with alcohol-related decompensated cirrhosis were delisted after improvement at a median time of 29 months after WL admission. Lower MELD score, higher platelets and either female sex or lower height were independently associated with delisting due to improvement, while time of abstinence did not reach statistical significance in multivariate analysis (p=0.055). Five years after delisting, cumulative probability of remaining free from liver-related death or LT was 76%, similar to patients with HCV decompensated cirrhosis delisted after improvement. CONCLUSIONS a significant proportion of LT candidates with alcohol-related cirrhosis can be delisted due to improvement, that is predicted by low MELD score and higher platelets at WL admission. Women also have higher probability of being delisted after improvement, partially due to a lower early access to LT for height discrepancies. Early identification of patients with potential for improvement may avoid unnecessary transplants. LAY SUMMARY Patients with alcohol-related cirrhosis can improve until being delisted in approximately 9% of cases. Low MELD score and high platelets levels at WL admission predict delisting after improvement, and women have higher probabilities of being delisted due to improvement. Long-term outcomes after delisting are in general favourable.

Journal of Hepatology, 2021

BACKGROUND AND AIMS to what extent patients with alcohol-related decompensated cirrhosis can impr... more BACKGROUND AND AIMS to what extent patients with alcohol-related decompensated cirrhosis can improve until recovery from decompensation remains unclear. We aimed to investigate the probability of recovery and delisting due to improvement in patients with alcohol-related decompensated cirrhosis in the waiting list (WL) for liver transplantation (LT). METHODS we conducted a registry-based, multicenter, retrospective study including all patients admitted to the LT-WL in Catalonia (Spain) with the indication of alcohol-, HCV-, cholestatic- or NASH- decompensated cirrhosis between January 2007 and December 2018. Competing risk analysis was used to investigate variables associated with delisting due to improvement in patients with alcohol-related decompensated cirrhosis. Criteria for delisting after improvement were not predefined. Outcomes of patients after delisting were also studied. RESULTS one-thousand-and-one patients were included, 420 (37%) with alcohol-related decompensated cirrhosis. Thirty-six (8.6%) patients with alcohol-related decompensated cirrhosis were delisted after improvement at a median time of 29 months after WL admission. Lower MELD score, higher platelets and either female sex or lower height were independently associated with delisting due to improvement, while time of abstinence did not reach statistical significance in multivariate analysis (p=0.055). Five years after delisting, cumulative probability of remaining free from liver-related death or LT was 76%, similar to patients with HCV decompensated cirrhosis delisted after improvement. CONCLUSIONS a significant proportion of LT candidates with alcohol-related cirrhosis can be delisted due to improvement, that is predicted by low MELD score and higher platelets at WL admission. Women also have higher probability of being delisted after improvement, partially due to a lower early access to LT for height discrepancies. Early identification of patients with potential for improvement may avoid unnecessary transplants. LAY SUMMARY Patients with alcohol-related cirrhosis can improve until being delisted in approximately 9% of cases. Low MELD score and high platelets levels at WL admission predict delisting after improvement, and women have higher probabilities of being delisted due to improvement. Long-term outcomes after delisting are in general favourable.

Neurology, 2013

Objective: To describe the clinical features and outcome of anti-NMDA receptor (NMDAR) encephalit... more Objective: To describe the clinical features and outcome of anti-NMDA receptor (NMDAR) encephalitis in patients 45yearsold.Method:Observationalcohortstudy.Results:Inacohortof661patientswithanti−NMDARencephalitis,weidentified31patients45 years old. Method: Observational cohort study. Results: In a cohort of 661 patients with anti-NMDAR encephalitis, we identified 31 patients 45yearsold.Method:Observationalcohortstudy.Results:Inacohortof661patientswithanti−NMDARencephalitis,weidentified31patients45 years old. Compared with younger adults (18-44 years), older patients were more often male (45% vs 12%, p , 0.0001), had lower frequency of tumors (23% vs 51%, p 5 0.002; rarely teratomas), had longer median time to diagnosis (8 vs 4 weeks, p 5 0.009) and treatment (7 vs 4 weeks, p 5 0.039), and had less favorable outcome (modified Rankin Scale score 0-2 at 2 years, 60% vs 80%, p , 0.026). In multivariable analysis, younger age (odds ratio [OR] 0.15, confidence interval [CI] 0.05-0.39, p 5 0.0001), early treatment (OR 0.60, CI 0.47-0.78, p , 0.0001), no need for intensive care (OR 0.09, CI 0.04-0.22, p , 0.0001), and longer follow-up (p , 0.0001) were associated with good outcome. Rituximab and cyclophosphamide were effective when first-line immunotherapies failed (OR 2.93, CI 1.10-7.76, p 5 0.031). Overall, 60% of patients older than 45 years had full or substantial recovery at 24 months follow-up. Conclusions: Anti-NMDAR encephalitis is less severe in patients $45 years old than in young adults, but the outcome is poorer in older patients. In this age group, delays in diagnosis and treatment are more frequent than in younger patients. The frequency of underlying tumors is low, but if present they are usually carcinomas instead of teratomas in younger patients. Early and aggressive immunotherapy will likely improve the clinical outcome. Neurology â 2013;81:1058-1063 GLOSSARY CI 5 confidence interval; IQR 5 interquartile range; mRS 5 modified Rankin Scale; NMDAR 5 NMDA receptor; OR 5 odds ratio.

Neurology, 2013

Objective: To describe the clinical features and outcome of anti-NMDA receptor (NMDAR) encephalit... more Objective: To describe the clinical features and outcome of anti-NMDA receptor (NMDAR) encephalitis in patients 45yearsold.Method:Observationalcohortstudy.Results:Inacohortof661patientswithanti−NMDARencephalitis,weidentified31patients45 years old. Method: Observational cohort study. Results: In a cohort of 661 patients with anti-NMDAR encephalitis, we identified 31 patients 45yearsold.Method:Observationalcohortstudy.Results:Inacohortof661patientswithanti−NMDARencephalitis,weidentified31patients45 years old. Compared with younger adults (18-44 years), older patients were more often male (45% vs 12%, p , 0.0001), had lower frequency of tumors (23% vs 51%, p 5 0.002; rarely teratomas), had longer median time to diagnosis (8 vs 4 weeks, p 5 0.009) and treatment (7 vs 4 weeks, p 5 0.039), and had less favorable outcome (modified Rankin Scale score 0-2 at 2 years, 60% vs 80%, p , 0.026). In multivariable analysis, younger age (odds ratio [OR] 0.15, confidence interval [CI] 0.05-0.39, p 5 0.0001), early treatment (OR 0.60, CI 0.47-0.78, p , 0.0001), no need for intensive care (OR 0.09, CI 0.04-0.22, p , 0.0001), and longer follow-up (p , 0.0001) were associated with good outcome. Rituximab and cyclophosphamide were effective when first-line immunotherapies failed (OR 2.93, CI 1.10-7.76, p 5 0.031). Overall, 60% of patients older than 45 years had full or substantial recovery at 24 months follow-up. Conclusions: Anti-NMDAR encephalitis is less severe in patients $45 years old than in young adults, but the outcome is poorer in older patients. In this age group, delays in diagnosis and treatment are more frequent than in younger patients. The frequency of underlying tumors is low, but if present they are usually carcinomas instead of teratomas in younger patients. Early and aggressive immunotherapy will likely improve the clinical outcome. Neurology â 2013;81:1058-1063 GLOSSARY CI 5 confidence interval; IQR 5 interquartile range; mRS 5 modified Rankin Scale; NMDAR 5 NMDA receptor; OR 5 odds ratio.

The Lancet Neurology, 2013

Background Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune disorder in which the use of ... more Background Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune disorder in which the use of immunotherapy and the long-term outcome have not been defi ned. We aimed to assess the presentation of the disease, the spectrum of symptoms, immunotherapies used, timing of improvement, and long-term outcome. Methods In this multi-institutional observational study, we tested for the presence of NMDAR antibodies in serum or CSF samples of patients with encephalitis between Jan 1, 2007, and Jan 1, 2012. All patients who tested positive for NMDAR antibodies were included in the study; patients were assessed at symptom onset and at months 4, 8, 12, 18, and 24, by use of the modifi ed Rankin scale (mRS). Treatment included fi rst-line immunotherapy (steroids, intravenous immunoglobulin, plasmapheresis), second-line immunotherapy (rituximab, cyclophosphamide), and tumour removal. Predictors of outcome were determined at the Universities of Pennsylvania (PA, USA) and Barcelona (Spain) by use of a generalised linear mixed model with binary distribution. Results We enrolled 577 patients (median age 21 years, range 8 months to 85 years), 211 of whom were children (<18 years). Treatment eff ects and outcome were assessable in 501 (median follow-up 24 months, range 4-186): 472 (94%) underwent fi rst-line immunotherapy or tumour removal, resulting in improvement within 4 weeks in 251 (53%). Of 221 patients who did not improve with fi rst-line treatment, 125 (57%) received second-line immunotherapy that resulted in a better outcome (mRS 0-2) than those who did not (odds ratio [OR] 2•69, CI 1•24-5•80; p=0•012). During the fi rst 24 months, 394 of 501 patients achieved a good outcome (mRS 0-2; median 6 months, IQR 2-12) and 30 died. At 24 months' follow-up, 203 (81%) of 252 patients had good outcome. Outcomes continued to improve for up to 18 months after symptom onset. Predictors of good outcome were early treatment (0•62, 0•50-0•76; p<0•0001) and no admission to an intensive care unit (0•12, 0•06-0•22; p<0•0001). 45 patients had one or multiple relapses (representing a 12% risk within 2 years); 46 (67%) of 69 relapses were less severe than initial episodes (p<0•0001). In 177 children, predictors of good outcome and the magnitude of eff ect of second-line immunotherapy were similar to those of the entire cohort. Interpretation Most patients with anti-NMDAR encephalitis respond to immunotherapy. Second-line immunotherapy is usually eff ective when fi rst-line treatments fail. In this cohort, the recovery of some patients took up to 18 months.

Journal of Nuclear Medicine, 2012

Lymphoscintigraphy is an important part of the mapping and identification of sentinel lymph nodes... more Lymphoscintigraphy is an important part of the mapping and identification of sentinel lymph nodes (SLNs). However, few studies report its reproducibility, and some concerns prevail. The aim of the study was to determine the reproducibility of lymphoscintigraphy performed by different team members following a strict protocol to assess lymphatic drainage and the location and number of SLNs. Methods: Sixty-eight melanoma patients were included. All underwent 2 separate lymphoscintigraphy studies, which followed the same acquisition protocol. Discordance was defined as a change in localization or a failure to identify the SLN in one of the studies. Results: All patients showed lymphatic drainage, and in all cases at least 1 sentinel node was identified. In 65 of 68 patients (96%), the findings of the first lymphoscintigraphy study were similar to those of the second. This similarity was also found in the number of sentinel nodes (171 in the first study and 173 in the second). Eighty percent of patients showed 1-3 SLNs in both lymphoscintigraphy studies. The 2 studies differed in 3 patients (4%): 2 melanomas were located on the trunk and 1 on the head and neck. Drainage was visualized to more than 1 lymphatic basin in 19 patients (28%) in the first study versus 18 patients in the second study. Conclusion: Lymphoscintigraphy is highly reproducible in the detection of sentinel nodes in melanoma patients. The classic protocol of radiotracer injection is reproducible and reliable enough to guarantee SLN identification, although a slight variation in isolated cases (especially when primary lesions are located on the trunk or the head and neck regions) is inevitable.

The Journal of Nuclear Medicine, Jun 27, 2012

Lymphoscintigraphy is an important part of the mapping and identification of sentinel lymph nodes... more Lymphoscintigraphy is an important part of the mapping and identification of sentinel lymph nodes (SLNs). However, few studies report its reproducibility, and some concerns prevail. The aim of the study was to determine the reproducibility of lymphoscintigraphy performed by different team members following a strict protocol to assess lymphatic drainage and the location and number of SLNs. Methods: Sixty-eight melanoma patients were included. All underwent 2 separate lymphoscintigraphy studies, which followed the same acquisition protocol. Discordance was defined as a change in localization or a failure to identify the SLN in one of the studies. Results: All patients showed lymphatic drainage, and in all cases at least 1 sentinel node was identified. In 65 of 68 patients (96%), the findings of the first lymphoscintigraphy study were similar to those of the second. This similarity was also found in the number of sentinel nodes (171 in the first study and 173 in the second). Eighty percent of patients showed 1-3 SLNs in both lymphoscintigraphy studies. The 2 studies differed in 3 patients (4%): 2 melanomas were located on the trunk and 1 on the head and neck. Drainage was visualized to more than 1 lymphatic basin in 19 patients (28%) in the first study versus 18 patients in the second study. Conclusion: Lymphoscintigraphy is highly reproducible in the detection of sentinel nodes in melanoma patients. The classic protocol of radiotracer injection is reproducible and reliable enough to guarantee SLN identification, although a slight variation in isolated cases (especially when primary lesions are located on the trunk or the head and neck regions) is inevitable.

Revista Española de Cirugía Ortopédica y Traumatología, May 1, 2018

RECOT-717; No. of Pages 7 2 S. Lasurt-Bachs et al. Conclusiones: El polietileno altamente entrecr... more RECOT-717; No. of Pages 7 2 S. Lasurt-Bachs et al. Conclusiones: El polietileno altamente entrecruzado no reduce significativamente la generación de partículas de polietileno en aquellos pacientes intervenidos mediante una artroplastia total de rodilla, con muestras a 3 años postintervención.

Archives of internal medicine, Jan 9, 2012

Lancet Neurology, Feb 1, 2014

Background-We aimed to assess the sensitivity/specificity of serum and CSF antibody-testing in pa... more Background-We aimed to assess the sensitivity/specificity of serum and CSF antibody-testing in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, and the correlation between titers, relapses, outcome, and epitope repertoire. Methods-In this observational study, brain immunohistochemistry and cell-based assays (CBA) with fixed and live NMDAR-expressing cells were used to determine the sensitivity/specificity of antibody-testing in paired serum/CSF obtained at diagnosis of 250 patients with anti-NMDAR

Revista Española de Cirugía Ortopédica y Traumatología, May 1, 2018

Aim: To compare two different types of inserts: ultra-high molecular weight polyethylene (UHMWPE)... more Aim: To compare two different types of inserts: ultra-high molecular weight polyethylene (UHMWPE) and cross-linked polyethylene with a quantitative and qualitative study of polyethylene wear particles in synovial fluid 3 years after total knee arthroplasty. Material and methods: A prospective, randomised, controlled cohort study with blinded evaluation was carried out on 25 patients undergoing staged bilateral total knee replacement, 6 months apart. Knee arthrocentesis was performed on 12 patients 3 years after surgery, and the polyethylene particles were analysed. Results: No significant differences were found in the number of particles generated by the two different types of inserts at 3 years from total knee arthroplasty (3000×:x cross-linked = 849.7; x UHMWPE = 796.9; p = .63; 20,000×:x cross-linked = 66.3;x UHMWPE = 73.1; p = .76). Likewise, no differences in the probability of finding elongated (2 = .19; p = .66) or rounded (2 = 1.44; p = .23) particles in both types of inserts were observed. However, the probability of finding fibrillar particles is 3.08 times greater in UHMWPE.

Annals of Hepatology, 2015

Background and rationale for the study. Hyperglycemia after graft reperfusion is a consistent fin... more Background and rationale for the study. Hyperglycemia after graft reperfusion is a consistent finding in liver transplantation (LT) that remains poorly studied. We aim to describe its appearance in LT recipients of different types of grafts and its relation to the graft function. Material & methods. 436 LT recipients of donors after brain death (DBD), donors after cardiac death (DCD), and familial amyloidotic polyneuropathy (FAP) donors were reviewed. Serum glucose was measured at baseline, during the anhepatic phase, after graft reperfusion, and at the end of surgery. Early graft dysfunction (EAD) was assessed by Olthoff criteria. Caspase-3, IFN-γ, IL1β, and IL6 gene expression were measured in liver biopsy. Results. The highest increase in glucose levels after reperfusion was observed in FAP LT recipients and the lowest in DCD LT recipients. Glucose level during the anhepatic phase was the only modifiable predictive variable of hyperglycemia after reperfusion. No relation was found between hyperglycemia after reperfusion and EAD. However, recipients with the highest glucose levels after reperfusion tended to achieve the best glucose control at the end of surgery and those who were unable to control the glucose value after reperfusion showed EAD more frequently. The highest levels of caspase-3 were found in recipients with the lowest glucose values after reperfusion. In conclusion, glucose levels increased after graft reperfusion to a different extent according to the donor type. Contrary to general belief, transient hyperglycemia after reperfusion does not appear to impact negatively on the liver graft function and could even be suggested as a marker of graft quality.

Archives of Orthopaedic and Trauma Surgery, 2015

Stiffness after a total knee arthroplasty (TKA) is one of the most common post-operative complica... more Stiffness after a total knee arthroplasty (TKA) is one of the most common post-operative complications. The purpose of this study is the evaluation of the effectiveness of TT proximalization osteotomy of improving a lack of flexion and secondary pain in patella baja (infera) post-TKA. Between April 2007 and July 2012, TT proximalization osteotomy was performed on 21 patients. The average preoperative flexion was 70° (in a range of 60-80). Clinical pre- and post-operative evaluations were performed with Knee Society Score, Western Ontario and McMaster Universities Arthritis Index scales and a satisfaction survey. Modified Blackburn-Peel index and Portner angle were used to evaluate patellar height. After an average follow-up of 35 months (range 18-48), an average flexion of 100° (range 90-100) and an overall satisfaction were obtained. Clinical scores improved significantly. The Blackburn-Peel index and Portner angle improved significantly from 0.3 (range 0.1-0.5) to 0.4 (0.3-0.5) and from 9 (3-15) to 12 (9-18), respectively. Three patients showed no signs of osteotomy consolidation. However, this was not linked to a lack of extension or an increase in local pain. TT proximalization osteotomy provides satisfactory results in improving a lack of flexion and pain in patella baja post-TKR.

Translational Oncology, 2018

Cirurgia oncològica; Avaluació; IndicadorsCirugía oncológica; Evaluación; IndicadoresOncological ... more Cirurgia oncològica; Avaluació; IndicadorsCirugía oncológica; Evaluación; IndicadoresOncological surgery; Evaluation; IndicatorsEl presente trabajo corresponde a la segunda evaluación de los resultados de la cirugía oncológica digestiva de alta especialización con intención curativa de cirugía de esófago, de páncreas y de hígado (que incluye metástasis hepáticas desde la primera evaluación, actualmente ampliado a vías biliares y tumor hepático primario) para los años 2014 y 2015. A diferencia de la primera evaluación basada en el uso de la auditoría clínica "externa", la metodología aplicada en esta segunda evaluación incorpora información directa de los propios profesionales. En ambos casos ha habido feedback, y validación de los resultados finales por su parte.El present treball correspon a la segona avaluació dels resultats de la cirurgia oncològica digestiva d’alta especialització amb intenció curativa de cirurgia d’esòfag, de pàncrees i de fetge (que inclou metàstasis...

Journal of Hepatology, 2021

BACKGROUND AND AIMS to what extent patients with alcohol-related decompensated cirrhosis can impr... more BACKGROUND AND AIMS to what extent patients with alcohol-related decompensated cirrhosis can improve until recovery from decompensation remains unclear. We aimed to investigate the probability of recovery and delisting due to improvement in patients with alcohol-related decompensated cirrhosis in the waiting list (WL) for liver transplantation (LT). METHODS we conducted a registry-based, multicenter, retrospective study including all patients admitted to the LT-WL in Catalonia (Spain) with the indication of alcohol-, HCV-, cholestatic- or NASH- decompensated cirrhosis between January 2007 and December 2018. Competing risk analysis was used to investigate variables associated with delisting due to improvement in patients with alcohol-related decompensated cirrhosis. Criteria for delisting after improvement were not predefined. Outcomes of patients after delisting were also studied. RESULTS one-thousand-and-one patients were included, 420 (37%) with alcohol-related decompensated cirrhosis. Thirty-six (8.6%) patients with alcohol-related decompensated cirrhosis were delisted after improvement at a median time of 29 months after WL admission. Lower MELD score, higher platelets and either female sex or lower height were independently associated with delisting due to improvement, while time of abstinence did not reach statistical significance in multivariate analysis (p=0.055). Five years after delisting, cumulative probability of remaining free from liver-related death or LT was 76%, similar to patients with HCV decompensated cirrhosis delisted after improvement. CONCLUSIONS a significant proportion of LT candidates with alcohol-related cirrhosis can be delisted due to improvement, that is predicted by low MELD score and higher platelets at WL admission. Women also have higher probability of being delisted after improvement, partially due to a lower early access to LT for height discrepancies. Early identification of patients with potential for improvement may avoid unnecessary transplants. LAY SUMMARY Patients with alcohol-related cirrhosis can improve until being delisted in approximately 9% of cases. Low MELD score and high platelets levels at WL admission predict delisting after improvement, and women have higher probabilities of being delisted due to improvement. Long-term outcomes after delisting are in general favourable.

Journal of Hepatology, 2021

BACKGROUND AND AIMS to what extent patients with alcohol-related decompensated cirrhosis can impr... more BACKGROUND AND AIMS to what extent patients with alcohol-related decompensated cirrhosis can improve until recovery from decompensation remains unclear. We aimed to investigate the probability of recovery and delisting due to improvement in patients with alcohol-related decompensated cirrhosis in the waiting list (WL) for liver transplantation (LT). METHODS we conducted a registry-based, multicenter, retrospective study including all patients admitted to the LT-WL in Catalonia (Spain) with the indication of alcohol-, HCV-, cholestatic- or NASH- decompensated cirrhosis between January 2007 and December 2018. Competing risk analysis was used to investigate variables associated with delisting due to improvement in patients with alcohol-related decompensated cirrhosis. Criteria for delisting after improvement were not predefined. Outcomes of patients after delisting were also studied. RESULTS one-thousand-and-one patients were included, 420 (37%) with alcohol-related decompensated cirrhosis. Thirty-six (8.6%) patients with alcohol-related decompensated cirrhosis were delisted after improvement at a median time of 29 months after WL admission. Lower MELD score, higher platelets and either female sex or lower height were independently associated with delisting due to improvement, while time of abstinence did not reach statistical significance in multivariate analysis (p=0.055). Five years after delisting, cumulative probability of remaining free from liver-related death or LT was 76%, similar to patients with HCV decompensated cirrhosis delisted after improvement. CONCLUSIONS a significant proportion of LT candidates with alcohol-related cirrhosis can be delisted due to improvement, that is predicted by low MELD score and higher platelets at WL admission. Women also have higher probability of being delisted after improvement, partially due to a lower early access to LT for height discrepancies. Early identification of patients with potential for improvement may avoid unnecessary transplants. LAY SUMMARY Patients with alcohol-related cirrhosis can improve until being delisted in approximately 9% of cases. Low MELD score and high platelets levels at WL admission predict delisting after improvement, and women have higher probabilities of being delisted due to improvement. Long-term outcomes after delisting are in general favourable.

Neurology, 2013

Objective: To describe the clinical features and outcome of anti-NMDA receptor (NMDAR) encephalit... more Objective: To describe the clinical features and outcome of anti-NMDA receptor (NMDAR) encephalitis in patients 45yearsold.Method:Observationalcohortstudy.Results:Inacohortof661patientswithanti−NMDARencephalitis,weidentified31patients45 years old. Method: Observational cohort study. Results: In a cohort of 661 patients with anti-NMDAR encephalitis, we identified 31 patients 45yearsold.Method:Observationalcohortstudy.Results:Inacohortof661patientswithanti−NMDARencephalitis,weidentified31patients45 years old. Compared with younger adults (18-44 years), older patients were more often male (45% vs 12%, p , 0.0001), had lower frequency of tumors (23% vs 51%, p 5 0.002; rarely teratomas), had longer median time to diagnosis (8 vs 4 weeks, p 5 0.009) and treatment (7 vs 4 weeks, p 5 0.039), and had less favorable outcome (modified Rankin Scale score 0-2 at 2 years, 60% vs 80%, p , 0.026). In multivariable analysis, younger age (odds ratio [OR] 0.15, confidence interval [CI] 0.05-0.39, p 5 0.0001), early treatment (OR 0.60, CI 0.47-0.78, p , 0.0001), no need for intensive care (OR 0.09, CI 0.04-0.22, p , 0.0001), and longer follow-up (p , 0.0001) were associated with good outcome. Rituximab and cyclophosphamide were effective when first-line immunotherapies failed (OR 2.93, CI 1.10-7.76, p 5 0.031). Overall, 60% of patients older than 45 years had full or substantial recovery at 24 months follow-up. Conclusions: Anti-NMDAR encephalitis is less severe in patients $45 years old than in young adults, but the outcome is poorer in older patients. In this age group, delays in diagnosis and treatment are more frequent than in younger patients. The frequency of underlying tumors is low, but if present they are usually carcinomas instead of teratomas in younger patients. Early and aggressive immunotherapy will likely improve the clinical outcome. Neurology â 2013;81:1058-1063 GLOSSARY CI 5 confidence interval; IQR 5 interquartile range; mRS 5 modified Rankin Scale; NMDAR 5 NMDA receptor; OR 5 odds ratio.

Neurology, 2013

Objective: To describe the clinical features and outcome of anti-NMDA receptor (NMDAR) encephalit... more Objective: To describe the clinical features and outcome of anti-NMDA receptor (NMDAR) encephalitis in patients 45yearsold.Method:Observationalcohortstudy.Results:Inacohortof661patientswithanti−NMDARencephalitis,weidentified31patients45 years old. Method: Observational cohort study. Results: In a cohort of 661 patients with anti-NMDAR encephalitis, we identified 31 patients 45yearsold.Method:Observationalcohortstudy.Results:Inacohortof661patientswithanti−NMDARencephalitis,weidentified31patients45 years old. Compared with younger adults (18-44 years), older patients were more often male (45% vs 12%, p , 0.0001), had lower frequency of tumors (23% vs 51%, p 5 0.002; rarely teratomas), had longer median time to diagnosis (8 vs 4 weeks, p 5 0.009) and treatment (7 vs 4 weeks, p 5 0.039), and had less favorable outcome (modified Rankin Scale score 0-2 at 2 years, 60% vs 80%, p , 0.026). In multivariable analysis, younger age (odds ratio [OR] 0.15, confidence interval [CI] 0.05-0.39, p 5 0.0001), early treatment (OR 0.60, CI 0.47-0.78, p , 0.0001), no need for intensive care (OR 0.09, CI 0.04-0.22, p , 0.0001), and longer follow-up (p , 0.0001) were associated with good outcome. Rituximab and cyclophosphamide were effective when first-line immunotherapies failed (OR 2.93, CI 1.10-7.76, p 5 0.031). Overall, 60% of patients older than 45 years had full or substantial recovery at 24 months follow-up. Conclusions: Anti-NMDAR encephalitis is less severe in patients $45 years old than in young adults, but the outcome is poorer in older patients. In this age group, delays in diagnosis and treatment are more frequent than in younger patients. The frequency of underlying tumors is low, but if present they are usually carcinomas instead of teratomas in younger patients. Early and aggressive immunotherapy will likely improve the clinical outcome. Neurology â 2013;81:1058-1063 GLOSSARY CI 5 confidence interval; IQR 5 interquartile range; mRS 5 modified Rankin Scale; NMDAR 5 NMDA receptor; OR 5 odds ratio.

The Lancet Neurology, 2013

Background Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune disorder in which the use of ... more Background Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune disorder in which the use of immunotherapy and the long-term outcome have not been defi ned. We aimed to assess the presentation of the disease, the spectrum of symptoms, immunotherapies used, timing of improvement, and long-term outcome. Methods In this multi-institutional observational study, we tested for the presence of NMDAR antibodies in serum or CSF samples of patients with encephalitis between Jan 1, 2007, and Jan 1, 2012. All patients who tested positive for NMDAR antibodies were included in the study; patients were assessed at symptom onset and at months 4, 8, 12, 18, and 24, by use of the modifi ed Rankin scale (mRS). Treatment included fi rst-line immunotherapy (steroids, intravenous immunoglobulin, plasmapheresis), second-line immunotherapy (rituximab, cyclophosphamide), and tumour removal. Predictors of outcome were determined at the Universities of Pennsylvania (PA, USA) and Barcelona (Spain) by use of a generalised linear mixed model with binary distribution. Results We enrolled 577 patients (median age 21 years, range 8 months to 85 years), 211 of whom were children (<18 years). Treatment eff ects and outcome were assessable in 501 (median follow-up 24 months, range 4-186): 472 (94%) underwent fi rst-line immunotherapy or tumour removal, resulting in improvement within 4 weeks in 251 (53%). Of 221 patients who did not improve with fi rst-line treatment, 125 (57%) received second-line immunotherapy that resulted in a better outcome (mRS 0-2) than those who did not (odds ratio [OR] 2•69, CI 1•24-5•80; p=0•012). During the fi rst 24 months, 394 of 501 patients achieved a good outcome (mRS 0-2; median 6 months, IQR 2-12) and 30 died. At 24 months' follow-up, 203 (81%) of 252 patients had good outcome. Outcomes continued to improve for up to 18 months after symptom onset. Predictors of good outcome were early treatment (0•62, 0•50-0•76; p<0•0001) and no admission to an intensive care unit (0•12, 0•06-0•22; p<0•0001). 45 patients had one or multiple relapses (representing a 12% risk within 2 years); 46 (67%) of 69 relapses were less severe than initial episodes (p<0•0001). In 177 children, predictors of good outcome and the magnitude of eff ect of second-line immunotherapy were similar to those of the entire cohort. Interpretation Most patients with anti-NMDAR encephalitis respond to immunotherapy. Second-line immunotherapy is usually eff ective when fi rst-line treatments fail. In this cohort, the recovery of some patients took up to 18 months.

Journal of Nuclear Medicine, 2012

Lymphoscintigraphy is an important part of the mapping and identification of sentinel lymph nodes... more Lymphoscintigraphy is an important part of the mapping and identification of sentinel lymph nodes (SLNs). However, few studies report its reproducibility, and some concerns prevail. The aim of the study was to determine the reproducibility of lymphoscintigraphy performed by different team members following a strict protocol to assess lymphatic drainage and the location and number of SLNs. Methods: Sixty-eight melanoma patients were included. All underwent 2 separate lymphoscintigraphy studies, which followed the same acquisition protocol. Discordance was defined as a change in localization or a failure to identify the SLN in one of the studies. Results: All patients showed lymphatic drainage, and in all cases at least 1 sentinel node was identified. In 65 of 68 patients (96%), the findings of the first lymphoscintigraphy study were similar to those of the second. This similarity was also found in the number of sentinel nodes (171 in the first study and 173 in the second). Eighty percent of patients showed 1-3 SLNs in both lymphoscintigraphy studies. The 2 studies differed in 3 patients (4%): 2 melanomas were located on the trunk and 1 on the head and neck. Drainage was visualized to more than 1 lymphatic basin in 19 patients (28%) in the first study versus 18 patients in the second study. Conclusion: Lymphoscintigraphy is highly reproducible in the detection of sentinel nodes in melanoma patients. The classic protocol of radiotracer injection is reproducible and reliable enough to guarantee SLN identification, although a slight variation in isolated cases (especially when primary lesions are located on the trunk or the head and neck regions) is inevitable.