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Pardo F, Aedo A, Silva L, Chiarello D, Leiva A, Sobrevia L. Excessive gestational weight gain reduces the response to vasoactive molecules in human fetoplacental microvessels. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Silva L, Subiabre M, Villalobos-Labra R, Salsoso R, López A, Paulo M, Pardo F, Leiva A, Sobrevia L. Insulin therapy restores the equilibrative nucleoside transporter 1 expression in human umbilical vein endothelial cells from gestational diabetes mellitus. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gutiérrez J, Mora J, Salsoso R, Leiva A, Sobrevia L. Reck expression is induced in placentas from preeclampsia and reduces migration, invasion, and endovascular remodelling of first trimester human trophoblast. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Salsoso R, Pardo F, Leiva A, Sobrevia L. Insulin recovers endothelial dysfunction requiring A 2B adenosine receptor activation in human umbilical vein endothelium from late-onset preeclampsia. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carvajal L, Cantin C, Fuenzalida B, Contreras-Duarte S, Sobrevia L, Leiva A. Maternal supraphysiological dyslipidemia in pregnancy worse vascular response of umbilical vein rings from gestational diabetes mellitus. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Subiabre M, Salsoso R, Villalobos-Labra R, Silva L, Fuenzalida B, Araos J, López A, Paulo M, Pardo F, Leiva A, Sobrevia L. Insulin therapy fails to reverse the human foetoplacental endothelial dysfunction in gestational diabetes mellitus. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Contreras-Duarte S, Carvajal L, Cantin C, Fuenzalida B, Sobrevia L, Leiva A. Prevalence of maternal supraphysiological dyslipidemia in a group of Chilean pregnant women with gestational diabetes mellitus. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fuenzalida B, Sobrevia B, Cantin C, Carvajal L, Contreras-Duarte S, Sobrevia L, Leiva A. Human maternal supraphysiological hypercholesterolemia leads to endothelial dysfunction of the placental microvasculature. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cantin C, Carvajal L, Fuenzalida B, Contreras-Duarte S, Sobrevia L, Leiva A. Modulation of the placental HDL and LDL cholesterol uptake by the maternal lipids level in human trophoblast. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Araos J, Saavedra A, Sanhueza C, Leiva A, Ramírez M, Sobrevia L. Sodium/proton exchanger subtype 1 regulates intracellular pH in human umbilical vein endothelial cells from gestational diabetes mellitus. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chiarello D, Pardo F, Salsoso R, Fuenzalida B, Gutiérrez J, Leiva A, Sobrevia L. Effect of MgSO 4 on protein expression and exosomes release from human placental microvascular endothelial cells from late-onset preeclampsia. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Villalobos-Labra R, Salsoso R, Subiabre M, Silva L, Farías-Jofré M, Leiva A, Sobrevia L. Endoplasmic reticulum stress in human umbilical vein endothelial cells from pre-gestational maternal obesity. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Leiva A, Esteva M, Llobera J, Macià F, Pita-Fernández S, González-Luján L, Sánchez-Calavera MA, Ramos M. Time to diagnosis and stage of symptomatic colorectal cancer determined by three different sources of information: A population based retrospective study. Cancer Epidemiol 2017; 47:48-55. [PMID: 28126583 DOI: 10.1016/j.canep.2016.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/29/2016] [Accepted: 10/31/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Survival rates from colorectal cancer (CRC) are highly variable in Europe. This variability could potentially be explained by differences in healthcare system delays in diagnosis. However, even when such delays are reduced, the relationship of the diagnostic interval (time from presentation with symptoms to diagnosis) with outcome is uncertain. METHODS A total of 795 patients with CRC from 5 regions of Spain were retrospectively examined in this population-based multicenter study. Consecutive incident cases of CRC were identified from pathology services. The total diagnostic interval (TDI) was defined as the time from the first presentation with symptoms to diagnosis based on 3 different sources of information: (i) patient-recorded data (PR-TDI) by interview, (ii) hospital-recorded data (HR-TDI), and (iii) general practitioner-recorded data (GPR-TDI). Concordance correlation coefficients (CCCs) were used to estimate the agreement of 3 different TDIs. The TDIs of patients with different stages of CRC were also compared using the Kruskal-Wallis test. RESULTS The median TDI was 131days based on patient interview data, 91days based on HR data, and 111days based on GPR data. Overall, the agreement of these TDIs was poor (CCCPRvsHR=0.399, CCCPRvsGPR=0.518, CCCHRvsGPR=0.383). Univariate analysis indicated that the TDI was greater in those with less advanced CRC for all 3 methods of calculation, but this association was only statistically significant for the HR-TDI (p=0.021). CONCLUSION There is no evidence that patients with more advanced CRC have longer TDIs. In fact, we found an inverse relationship between the TDI and CRC stage, an example of the "waiting time paradox". This association may likely be due to the presence of unmeasured confounders as the stage when symptoms appear or the tumour aggressiveness.
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Rullán M, Bulilete O, Leiva A, Soler A, Roca A, González-Bals MJ, Lorente P, Llobera J. Efficacy of gabapentin for prevention of postherpetic neuralgia: study protocol for a randomized controlled clinical trial. Trials 2017; 18:24. [PMID: 28088231 PMCID: PMC5237496 DOI: 10.1186/s13063-016-1729-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 11/25/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is a chronic neuropathic pain that results from alterations of the peripheral nervous system in areas affected by the herpes zoster virus. The symptoms include pain, paresthesia, dysesthesia, hyperalgesia, and allodynia. Despite the availability of pharmacological treatments to control these symptoms, no treatments are available to control the underlying pathophysiology responsible for this disabling condition. METHODS/DESIGN Patients with herpes zoster who are at least 50 years old and have a pain score of 4 or higher on a visual analogue scale (VAS) will be recruited. The aim is to recruit 134 patients from the practices of general physicians. Participants will be randomized to receive gabapentin to a maximum of 1800 mg/day for 5 weeks or placebo. Both arms will receive 1000-mg caplets of valacyclovir three times daily for 7 days (initiated within 72 h of the onset of symptoms) and analgesics as needed. The primary outcome measure is the percentage of patients with a VAS pain score of 0 at 12 weeks from rash onset. The secondary outcomes measures are changes in quality of life (measured by the SF-12 questionnaire), sleep disturbance (measured by the Medical Outcomes Study Sleep Scale), and percentage of patients with neuropathic pain (measured by the Douleur Neuropathique in 4 Questions). DISCUSSION Gabapentin is an anticonvulsant type of analgesic that could prevent the onset of PHN by its antihypersensitivity action in dorsal horn neurons. TRIAL REGISTRATION ISRCTN Registry identifier: ISRCTN79871784 . Registered on 2 May 2013.
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Sanhueza C, Araos J, Naranjo L, Villalobos R, Westermeier F, Salomon C, Beltrán AR, Ramírez MA, Gutiérrez J, Pardo F, Leiva A, Sobrevia L. Modulation of intracellular pH in human ovarian cancer. Curr Mol Med 2016; 16:23-32. [PMID: 26695697 DOI: 10.2174/1566524016666151222143437] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/29/2015] [Accepted: 12/18/2015] [Indexed: 11/22/2022]
Abstract
To sustain tumor growth, the cancer cells need to adapt to low levels of oxygen (i.e., hypoxia) in the tumor tissue and to the tumor-associated acidic microenvironment. In this phenomenon, the activation of the sodium/proton exchanger 1 (NHE1) at the plasma membrane and the hypoxia-inducible factor (HIF) are critical for the control of the intracellular pH (pHi) and for hypoxia adaptation, respectively. Interestingly, both of these mechanisms end in sustaining cancer cell proliferation. However, regulatory mechanisms of pHi in human ovary tissue and in malignant ascites are unknown. Additionally, a potential role of NHE1 in the modulation of H(+) efflux in human ovarian cancer cells is unknown. In this review, we discussed the characteristics of tumor microenvironment of primary human ovarian tumors and tumor ascites, in terms of pHi regulatory mechanisms and oxygen level. The findings described in the literature suggest that NHE1 may likely play a role in pHi regulation and cell proliferation in human ovarian cancer, potentially involving HIF2α activation. Since ovarian cancer is the fifth cause of prevalence of women cancer in Chile and is usually of late diagnosis, i.e., when the disease jeopardizes peritoneal cavity and other organs, resulting in reduced patient survival, new efforts are required to improve patient-life span and for a better understanding of the pathophysiology of the disease. The potential advantage of the use of amiloride and amiloride-derivatives for cancer treatment in terms of NHE1 expression and activity is also discussed as a therapeutic approach in human ovarian cancer.
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Westermeier F, Sáez T, Arroyo P, Toledo F, Gutiérrez J, Sanhueza C, Pardo F, Leiva A, Sobrevia L. Insulin receptor isoforms: an integrated view focused on gestational diabetes mellitus. Diabetes Metab Res Rev 2016; 32:350-65. [PMID: 26431063 DOI: 10.1002/dmrr.2729] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/14/2015] [Accepted: 09/27/2015] [Indexed: 12/17/2022]
Abstract
The human insulin receptor (IR) exists in two isoforms that differ by the absence (IR-A) or the presence (IR-B) of a 12-amino acid segment encoded by exon 11. Both isoforms are functionally distinct regarding their binding affinities and intracellular signalling. However, the underlying mechanisms related to their cellular functions in several tissues are only partially understood. In this review, we summarize the current knowledge in this field regarding the alternative splicing of IR isoform, tissue-specific distribution and signalling both in physiology and disease, with an emphasis on the human placenta in gestational diabetes mellitus (GDM). Furthermore, we discuss the clinical relevance of IR isoforms highlighted by findings that show altered insulin signalling due to differential IR-A and IR-B expression in human placental endothelium in GDM pregnancies. Future research and clinical studies focused on the role of IR isoform signalling might provide novel therapeutic targets for treating GDM to improve the adverse maternal and neonatal outcomes.
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Tapsfield J, Hall C, Lunan C, McCutcheon H, McLoughlin P, Rhee J, Leiva A, Spiller J, Finucane A, Murray SA. Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners. BMJ Support Palliat Care 2016; 9:e28. [PMID: 27075983 PMCID: PMC6923937 DOI: 10.1136/bmjspcare-2015-001014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/11/2016] [Accepted: 01/18/2016] [Indexed: 12/05/2022]
Abstract
Background Key Information Summaries (KIS) were introduced throughout Scotland in 2013 so that anticipatory care plans written by general practitioners (GPs) could be routinely shared electronically and updated in real time, between GPs and providers of unscheduled and secondary care. Aims We aimed to describe the current reach of anticipatory and palliative care, and to explore GPs’ views on using KIS. Methods We studied the primary care records of all patients who died in 2014 in 9 diverse Lothian practices. We identified if anticipatory or palliative care had been started, and if so how many weeks before death and which aspects of care had been documented. We interviewed 10 GPs to understand barriers and facilitating factors. Results Overall, 60% of patients were identified for a KIS, a median of 18 weeks before death. The numbers identified were highest for patients with cancer, with 75% identified compared with 66% of those dying with dementia/frailty and only 41% dying from organ failure. Patients were more likely to die outside hospital if they had a KIS. GPs identified professional, patient and societal challenges in identifying patients for palliative care, especially those with non-cancer diagnoses. Conclusions GPs are identifying patients for anticipatory and palliative care more equitably across the different disease trajectories and earlier in the disease process than they were previously identifying patients specifically for palliative care. However, many patients still lack care planning, particularly those dying with organ failure.
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García-Toro M, Vicens-Pons E, Gili M, Roca M, Serrano-Ripoll MJ, Vives M, Leiva A, Yáñez AM, Bennasar-Veny M, Oliván-Blázquez B. Obesity, metabolic syndrome and Mediterranean diet: Impact on depression outcome. J Affect Disord 2016; 194:105-8. [PMID: 26807670 DOI: 10.1016/j.jad.2015.12.064] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/10/2015] [Accepted: 12/26/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Obesity, metabolic syndrome (MetS) and low adherence to Mediterranean diet are frequent in major depression patients and have been separately related with prognosis. The aim of this study is to analyse their predictive power on major depression outcome, at 6 and 12 months. METHODS 273 Major depressive patients completed the Beck Depression Inventory for depressive symptoms and the 14-item Mediterranean diet adherence score. MetS was diagnosed according to the International Diabetes Federation (IDF). RESULTS At the baseline Mediterranean diet adherence was inversely associated with depressive symptoms (p=0.007). Depression response was more likely in those patients with normal weight (p=0.006) and not MetS (p=0.013) but it was not associated with Mediterranean diet adherence (p=0.625). Those patients with MetS and obesity were less likely to improve symptoms of depression than patients with obesity but not MetS. CONCLUSIONS Obesity and MetS, but not low adherence to the Mediterranean diet at baseline, predicted a poor outcome of depression at 12 months. Our study suggests that MetS is the key factor that impacts negatively in depression prognosis, rather than obesity or diet. If this finding is confirmed, clinicians should be aware about MetS diagnosis and treatment in overweight depressed patients, especially if outcome is not being satisfactory enough.
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Serrano Ripoll MJ, Oliván-Blázquez B, Vicens-Pons E, Roca M, Gili M, Leiva A, García-Campayo J, Demarzo MP, García-Toro M. Lifestyle change recommendations in major depression: Do they work? J Affect Disord 2015; 183:221-8. [PMID: 26025368 DOI: 10.1016/j.jad.2015.04.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Modifying some lifestyle factors can be useful in depression, at least as an adjuvant treatment. Combining different lifestyle interventions seems to be an adequate strategy to increase their antidepressant efficacy according with preliminary studies, but this issue has not been enough investigated. METHODS The present study is a randomized, double-blinded, multicentre, two arm-parallel clinical trials, with a 12 month follow-up. The sample consisted of 273 Primary Care patients. Four combined hygienic-dietary written recommendations were given to the patients about diet, exercise, light exposure and sleep hygiene. RESULTS Both active and control interventions were associated with improvement on BDI (Beck Depression Inventory) scores. However, there were not statistically significant differences (7.0 vs. 7.6; p=0.594). LIMITATIONS We were unable to monitor whether patients carry out recommendations. Intervention could be too difficult to accomplish for depressed patients without enough support and supervision. CONCLUSIONS Just giving written lifestyle recommendations are not enough for depressive patients to benefit from them, so perhaps lifestyle change recommendations work or do not work on Depression depending on how they are presented to patients and on monitoring systems of their implementation.
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Sanhueza C, Araos J, Naranjo L, Sáez T, Silva L, Salsoso R, Pardo F, Leiva A, Cuello MA, Cornejo M, Ramírez MA, Sobrevia L. NHE1 PROMOTE CELL PROLIFERATION IN OVARIAN CANCER: A ROLE OF HYPOXIA-INDUCIBLE FACTORS.: IGCS-0038 06. Ovarian Cancer. Int J Gynecol Cancer 2015. [DOI: 10.1136/00009577-201505001-00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Sobrevia L, Sáez T, Salsoso R, Silva L, Villalobos R, Araos J, Naranjo L, Guzmán-Gutiérrez E, Gutiérrez J, Sanhueza C, Pardo F, Leiva A. Insulin restores L-arginine and adenosine transport requiring adenosine receptors espression in human fetoplacentaL endothelium from gestational diabetes mellitus. Placenta 2015. [DOI: 10.1016/j.placenta.2015.01.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Beca JP, Leiva A. [Could infant euthanasia be ever acceptable?]. REVISTA CHILENA DE PEDIATRIA 2014; 85:608-612. [PMID: 25697439 DOI: 10.4067/s0370-41062014000500013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/25/2014] [Indexed: 06/04/2023]
Abstract
The recent enactment of a law that allows infant euthanasia in Belgium raises questions with varied answers. To contribute to a better understanding of the topic, euthanasia and legislation concepts are described. After a bioethical analysis, we propose as conclusion that children euthanasia could only be acceptable in very exceptional situations in which palliative measures have failed. The answer should be that it is not acceptable in our setting, not until we have public policies, protocols and palliative care services for terminally ill children.
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Leiva A, Fuenzalida B, Sobrevia B, Pardo F, Sobrevia L. Maternal supraphysiological hypercholesterolemia leads to reduced nitric oxide synthase activity associated with reduced levels of tetrahydrobiopterin in huvec. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Esteva M, Ruiz A, Ramos M, Casamitjana M, Sánchez-Calavera MA, González-Luján L, Pita-Fernández S, Leiva A, Pértega-Díaz S, Costa-Alcaraz AM, Macià F, Espí A, Segura JM, Lafita S, Novella MT, Yus C, Oliván B, Cabeza E, Seoane-Pillado T, López-Calviño B, Llobera J. Age differences in presentation, diagnosis pathway and management of colorectal cancer. Cancer Epidemiol 2014; 38:346-53. [DOI: 10.1016/j.canep.2014.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 01/12/2023]
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Vicens C, Bejarano F, Sempere E, Mateu C, Fiol F, Socias I, Aragonès E, Palop V, Beltran JL, Piñol JL, Lera G, Folch S, Mengual M, Basora J, Esteva M, Llobera J, Roca M, Gili M, Leiva A. Comparative efficacy of two interventions to discontinue long-term benzodiazepine use: cluster randomised controlled trial in primary care. Br J Psychiatry 2014; 204:471-9. [PMID: 24526745 DOI: 10.1192/bjp.bp.113.134650] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Benzodiazepines are extensively used in primary care, but their long-term use is associated with adverse health outcomes and dependence. AIMS To analyse the efficacy of two structured interventions in primary care to enable patients to discontinue long-term benzodiazepine use. METHOD A multicentre three-arm cluster randomised controlled trial was conducted, with randomisation at general practitioner level (trial registration ISRCTN13024375). A total of 532 patients taking benzodiazepines for at least 6 months participated. After all patients were included, general practitioners were randomly allocated (1:1:1) to usual care, a structured intervention with follow-up visits (SIF) or a structured intervention with written instructions (SIW). The primary end-point was the last month self-declared benzodiazepine discontinuation confirmed by prescription claims at 12 months. RESULTS At 12 months, 76 of 168 (45%) patients in the SIW group and 86 of 191 (45%) in the SIF group had discontinued benzodiazepine use compared with 26 of 173 (15%) in the control group. After adjusting by cluster, the relative risks for benzodiazepine discontinuation were 3.01 (95% CI 2.03-4.46, P<0.0001) in the SIW and 3.00 (95% CI 2.04-4.40, P<0.0001) in the SIF group. The most frequently reported withdrawal symptoms were insomnia, anxiety and irritability. CONCLUSIONS Both interventions led to significant reductions in long-term benzodiazepine use in patients without severe comorbidity. A structured intervention with a written individualised stepped-dose reduction is less time-consuming and as effective in primary care as a more complex intervention involving follow-up visits.
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