101
|
|
102
|
Abstract
Although less than 1% of patients with the antiphospholipid syndrome (APS) develop the catastrophic variant, its potentially lethal outcome emphasises its importance in clinical medicine today. However, the rarity of this variant makes it extraordinarily difficult to study in any systematic way. To put together all the published case reports as well as the new diagnosed cases from all over the world, an international registry of patients with catastrophic APS (CAPS Registry) was created in 2000 by the European Forum on Antiphospholipid Antibodies. Currently, it documents the entire clinical, laboratory and therapeutic data of more than 300 patients whose data has been fully registered. This registry can be freely consulted at the Internet (http://www.med.ub.es/MIMMUN/FORUM/CAPS.HTM), and it is expected that the periodical analysis of these data will allow us to increase our knowledge of this condition.
Collapse
Affiliation(s)
- S Bucciarelli
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | | |
Collapse
|
103
|
Vázquez-López C, Zendejas-Leal B, Bogard J, Golzarri J, Espinosa G. A measurement of the angular distribution of the diffuse optical transmittance of etched nuclear tracks in CR-39. RADIAT MEAS 2009. [DOI: 10.1016/j.radmeas.2009.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
104
|
Sajó-Bohus L, Simon A, Csákó T, Nemeth P, Palacios D, Espinosa G, Greaves E, Szörényi T, Barros H. 10Boron distribution measurement in laser ablated B4C thin films using (n,α) reaction and LR-115 passive detector. RADIAT MEAS 2009. [DOI: 10.1016/j.radmeas.2009.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
105
|
Espinosa G, Golzarri J, Angeles A, Griffith R. Nationwide survey of radon levels in indoor workplaces in Mexico using Nuclear Track Methodology. RADIAT MEAS 2009. [DOI: 10.1016/j.radmeas.2009.10.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
106
|
|
107
|
Gómez-Puerta JA, Espinosa G, Morlà R, Cid MC, Cervera R. Interstitial lung disease as a presenting manifestation of microscopic polyangiitis successfully treated with mycophenolate mofetil. Clin Exp Rheumatol 2009; 27:166-167. [PMID: 19327249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
108
|
Cervera R, Khamashta MA, Shoenfeld Y, Camps MT, Jacobsen S, Kiss E, Zeher MM, Tincani A, Kontopoulou-Griva I, Galeazzi M, Bellisai F, Meroni PL, Derksen RHWM, de Groot PG, Gromnica-Ihle E, Baleva M, Mosca M, Bombardieri S, Houssiau F, Gris JC, Quéré I, Hachulla E, Vasconcelos C, Roch B, Fernández-Nebro A, Piette JC, Espinosa G, Bucciarelli S, Pisoni CN, Bertolaccini ML, Boffa MC, Hughes GRV. Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis 2008; 68:1428-32. [DOI: 10.1136/ard.2008.093179] [Citation(s) in RCA: 212] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:To identify the main causes of morbidity and mortality in patients with antiphospholipid syndrome (APS) during a 5-year period and to determine clinical and immunological parameters with prognostic significance.Methods:The clinical and immunological features of a cohort of 1000 patients with APS from 13 European countries who had been followed up from 1999 to 2004 were analysed.Results:200 (20%) patients developed APS-related manifestations during the 5-year study period. Recurrent thrombotic events appeared in 166 (16.6%) patients and the most common were strokes (2.4% of the total cohort), transient ischaemic attacks (2.3%), deep vein thromboses (2.1%) and pulmonary embolism (2.1%). When the thrombotic events occurred, 90 patients were receiving oral anticoagulants and 49 were using aspirin. 31/420 (7.4%) patients receiving oral anticoagulants presented with haemorrhage. 3/121 (2.5%) women with only obstetric APS manifestations at the start of the study developed a new thrombotic event. A total of 77 women (9.4% of the female patients) had one or more pregnancies and 63 (81.8% of pregnant patients) had one or more live births. The most common fetal complications were early pregnancy loss (17.1% of pregnancies) and premature birth (35% of live births). 53 (5.3% of the total cohort) patients died. The most common causes of death were bacterial infection (21% of deaths), myocardial infarction (19%) and stroke (13%). No clinical or immunological predictor of thrombotic events, pregnancy morbidity or mortality was detected.Conclusion:Patients with APS still develop significant morbidity and mortality despite current treatment (oral anticoagulants or antiaggregants, or both).
Collapse
|
109
|
|
110
|
|
111
|
Varela DC, Quintana G, Somers EC, Rojas-Villarraga A, Espinosa G, Hincapie ME, McCune WJ, Cervera R, Anaya JM. Delayed lupus nephritis. Ann Rheum Dis 2008; 67:1044-6. [DOI: 10.1136/ard.2008.088740] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
112
|
Nieto A, Galtier I, Barroso J, Espinosa G. [Verbal fluency in school-aged Spanish children: normative data and analysis of clustering and switching strategies]. Rev Neurol 2008; 46:2-6. [PMID: 18214819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Verbal fluency tasks are highly sensitive to the presence of brain pathology. The use of verbal fluency tasks in paediatric clinical neuropsychology requires knowing how the execution progresses across age. Developmental changes in children's verbal fluency were explored in this study. SUBJECTS AND METHODS Participants were 79 school-aged children divided into three age groups. Phonemic (FAM) and semantic (animals) fluency task were administered. Three scores were obtained for qualitative analyses: number of clusters, switches and mean cluster size. RESULTS Children in older groups generated more words in phonemic fluency than children in 6-7 years group. In semantic fluency differences were significant only between the 10-11 years group and the youngest group. In both tasks year-group effects were found in number of clusters and number of switches. High positive correlations were found between total production and number of cluster and number of switches. CONCLUSIONS Results suggest that the development of the capability to generate words is related to the maturation of frontal component of the task. That means, that it is related to development of a greater cognitive flexibility that allows more efficient strategic search processes. Data obtained, although preliminary, may be useful to evaluate the executive functions in Spanish speaking paediatric population.
Collapse
Affiliation(s)
- A Nieto
- Facultad de Psicología, Uniidad de Neuropsicología Clínica, Universidadde la Laguna, San Cristóbal de la Laguna, Tenerife, España
| | | | | | | |
Collapse
|
113
|
García-Carrasco M, Galarza C, Gómez-Ponce M, Cervera R, Rojas-Rodríguez J, Espinosa G, Bucciarelli S, Gómez-Puerta JA, Bové A, Escárcega RO, Font J. Antiphospholipid syndrome in Latin American patients: clinical and immunologic characteristics and comparison with European patients. Lupus 2007; 16:366-73. [PMID: 17576741 DOI: 10.1177/0961203307077108] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to analyse the prevalence and characteristics of the main clinical and immunological manifestations at the onset and during the evolution of the disease in a cohort of patients from Latin America (mainly of mestizo origin) and to compare the Latin American with the European patients. Clinical and serological characteristics of 100 APS patients from Mexico and Ecuador were collected in a protocol form that was identical to that used to study the ;Euro-Phospholipid' cohort. The cohort consisted of 93 female patients (93.0%) and seven (7.0%) male patients. There were 91 mestizos (91.0%), seven whites (7.0%) and two Amerindians (2.0%). The most common manifestations were livedo reticularis (40.0%), migraine (35.0%), inferior extremity deep vein thrombosis (32.0%), thrombocytopenia (28.0%) and hemolytic anemia (20.0%). Several clinical manifestations were more prevalent in Latin American than in European patients and they included mainly neurological (migraine, transient global amnesia, acute ischemic encephalopathy, amaurosis fugax) and cutaneous (livedo reticularis, skin ulcerations, superficial cutaneous necrosis, multiple subungual splinter hemorrhages) manifestations as well as hemolytic anemia. The APS has a wide variety of clinical and immunological manifestations at the onset and during the evolution of the disease and the ethnic origin in addition to environmental and socioeconomic factors can modify the disease expression.
Collapse
Affiliation(s)
- M García-Carrasco
- Autoimmune Diseases Unit, Instituto Mexicano del Seguro Social, Puebla, Mexico, Department of Rheumatology, School of Medicine, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
114
|
Jiménez S, Tàssies D, Espinosa G, García-Criado A, Plaza J, Monteagudo J, Cervera R, Reverter JC. Double heterozygosity polymorphisms for platelet glycoproteins Ia/IIa and IIb/IIIa increases arterial thrombosis and arteriosclerosis in patients with the antiphospholipid syndrome or with systemic lupus erythematosus. Ann Rheum Dis 2007; 67:835-40. [PMID: 17728329 DOI: 10.1136/ard.2007.077321] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We analysed the genetic polymorphisms in platelet glycoproteins (GP) Ib-alpha, Ia/IIa and IIb/IIIa and their correlation with the development of arterial thrombosis and preclinical arteriosclerosis in patients with antiphospholipid syndrome (APS) or with systemic lupus erythematosus (SLE). METHODS We included 131 patients with APS (86 with primary APS and 45 with APS associated with SLE), 102 patients with SLE and 160 healthy controls. GP Ib-alpha VNTR polymorphism, GP Ia/IIa 807 C/T polymorphism and GP IIb/IIIa PlA1/2 polymorphism were determined by polymerase chain reaction. Thrombotic events were assessed clinically and confirmed by objective methods. The presence of preclinical arteriosclerosis was evaluated by a carotid ultrasound study in a subgroup of 70 patients with SLE measuring the intima-media wall thickness and the presence of arteriosclerotic plaque. RESULTS A total of 50 episodes of arterial thrombosis in 36 patients with APS have been registered. We found a significant correlation between the 807 T/T genotype of GP Ia/IIa and arterial thrombosis (22% vs 7%, p = 0.04; OR 3.59, 95% CI 1.20 to 10.79). The VNTR Ib-alpha and P1A1/2 IIb/IIIa polymorphisms were not associated with arterial thrombosis in patients with APS when individually analysed. The coexistence of both 807 T and PlA2 alleles increased the arterial thrombosis risk (28% vs 7%, p = 0.005; OR 4.84, 95% CI 1.67 to 13.96). In patients with SLE, no relationship was found between the presence of carotid arteriosclerotic plaque and separate polymorphisms of platelet GP. The coexistence of alleles 807 T of GP Ia/IIa and PlA2 of GP IIb/IIIa was associated with the presence of carotid plaque (35% vs 4%, p = 0.002; OR 12.92, 95% CI 2.39 to 69.81). CONCLUSIONS The T/T genotype of 807 C/T polymorphism of GP Ia/IIa may be an additional risk for the development of arterial thrombosis in APS. The coexistence of both 807 T and PlA2 alleles increased the arterial thrombosis risk in patients with APS and preclinical arteriosclerosis in patients with SLE.
Collapse
Affiliation(s)
- S Jiménez
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | | | | | | | | | | | | |
Collapse
|
115
|
Fuertes I, Espinosa G, Ramos-Casals M, Cervera R. Asociación de síndrome de Sjögren, tiroiditis autoinmune, sarcoidosis, cirrosis biliar primaria y amiloidosis primaria en una misma paciente. Rev Clin Esp 2007; 207:376. [PMID: 17662210 DOI: 10.1157/13107956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
116
|
Miesbach W, Asherson RA, Cervera R, Shoenfeld Y, Puerta JG, Espinosa G, Bucciarelli S. The role of malignancies in patients with catastrophic anti-phospholipid (Asherson’s) syndrome. Clin Rheumatol 2007; 26:2109-2114. [PMID: 17522949 DOI: 10.1007/s10067-007-0634-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2006] [Revised: 04/10/2007] [Accepted: 04/11/2007] [Indexed: 11/26/2022]
Abstract
The catastrophic anti-phospholipid syndrome (CAPS) differs from the anti-phospholipid syndrome in its accelerated systemic involvement leading to multi-organic failure. In this study, the occurrence of malignancies in patients with CAPS was evaluated and the clinical findings of CAPS patients with and without malignancies were compared. We investigated the web site-based international registry of patients with CAPS for all cases in which both CAPS and underlying malignancies were present. The clinical characteristics of these cases were subsequently evaluated to establish common characteristics. The CAPS registry included information on a total of 262 cases. Twenty-three (9%) patients suffered from malignancies. In 78% of these patients, the malignancy itself or the treatment modalities instituted for the carcinoma was the precipitating factor of CAPS. Only 39% of CAPS patients with malignancies recovered in comparison to 58% of patients without malignancies (p = 0.07). Treatment modalities, however, did not differ significantly between these patients. Infections were not evident as precipitating factors for any of the malignancy patients. The mean age of patients with malignancies was 9 years older than the average age of other patients with CAPS and the prevalence of SLE was significantly less common than in patients without malignancy. Malignancy may play a pathogenic role in patients with CAPS, whereas infections are more important as triggering factors in patients without malignancies. CAPS patients with malignancies are generally older than CAPS patients without malignancies; they generally have the worst prognosis of the entire CAPS cohort.
Collapse
Affiliation(s)
- W Miesbach
- Department of Internal Medicine III / Institute of Transfusion Medicine, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - R A Asherson
- Division of Immunology, School of Pathology, University of the Witwatersrand and the Rosebank Clinic, Johannesburg, South Africa
| | - R Cervera
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Y Shoenfeld
- Department of Medicine 'B' and Center for Autoimmune Diseases, Sheba Medical Center (Affiliated to Tel-Aviv University), Tel Hashomer, Israel
| | - J Gomez Puerta
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - G Espinosa
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - S Bucciarelli
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain
| |
Collapse
|
117
|
Hernández M, Montoya J, Del Angel P, Hernández I, Espinosa G, Llanos M. Influence of the synthesis method on the nanostructure and reactivity of mesoporous Pt/Mn-WOx-ZrO2 catalysts. Catal Today 2006. [DOI: 10.1016/j.cattod.2006.02.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
118
|
Muñoz-Saá I, Cambra A, Pallarés L, Espinosa G, Juan A, Pujalte F, Matamoros N, Milà J, Julià MR. Allelic Diversity and Affinity Variants of MICA are Imbalanced in Spanish Patients with Behcet's Disease. Scand J Immunol 2006; 64:77-82. [PMID: 16784494 DOI: 10.1111/j.1365-3083.2006.01780.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aetiology of Behçet's disease (BD) is still unknown, but genetic and environmental factors are involved. HLA-B*51 is considered a susceptibility marker and some MICA alleles have also been associated. Cytotoxic T lymphocytes have been suggested as responsible for BD lesions by engaging MICA through NKG2D surface molecules. In the present study, HLA-B and MICA alleles were typed by polymerase chain reaction using sequence-specific primers, in 165 healthy Spanish controls and 42 BD patients. In the healthy group, MICA*008 (28.48%), MICA*004 (17.58%), MICA*002 (14.24%) and MICA*009 (9.39%) were the predominant alleles and the most common haplotype was MICA*004-B*44 (12.12%). MICA*001 (5.15%), MICA*004, MICA*011 (4.54%) and MICA*018 (5.15%) were more frequent, and MICA*010 (1.81%) and MICA*008 were less prevalent than in other Caucasoid populations. Similar results have been reported in North African individuals and this could support the hypothesis of a common ancestral origin of both populations. The frequencies of MICA*009 and MICA*019 were significantly increased in our BD patients in comparison with controls: 22.62% versus 9.39% and 10.71% versus 1.81% respectively. The increase of MICA*019 had not been described in other BD cohorts, and it corroborates the genetic heterogeneity at MICA locus in BD patients. High-affinity MICA alleles for NKG2D were more frequent in controls than in patients. Moreover, high-affinity alleles were not found in homozygous BD patients. These results argue against the hypothesis of an autoaggressive response in BD patients through MICA-NKG2D interactions.
Collapse
Affiliation(s)
- I Muñoz-Saá
- Immunology Service, Hospital Universitari Son Dureta, Palma de Mallorca, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
119
|
Arias IM, Ramos-Casals M, Espinosa G, Reyes R. [Sacroiliitis and Behçet disease]. An Med Interna 2006; 23:300. [PMID: 17078162 DOI: 10.4321/s0212-71992006000600020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
|
120
|
Espinosa G, Golzarri JI, Rickards J, Gammage RB. Study of gel materials as radioactive 222Rn gas detectors. Radiat Prot Dosimetry 2006; 119:425-9. [PMID: 16709716 DOI: 10.1093/rpd/nci512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Commercial hair gel material (polyvinyl pyrolydone triethanolamine carbopol in water) and bacteriological agar (phycocolloid extracted from a group of red-purple algae, usually Gelidium sp.) have been studied as radioactive radon gas detectors. The detection method is based on the diffusion of the radioactive gas in the gel material, and the subsequent measurement of trapped products of the natural decay of radon by gamma spectrometry. From the several radon daughters with gamma radiation emission (214Pb, 214Bi, 214Po, 210Pb, 210Po), two elements, 214Pb (0.352 MeV) and 214Bi (0.609 MeV), were chosen for the analysis in this work; in order to determine the best sensitivity, corrections were made for the short half-life of the analysed isotopes. For the gamma spectrometry analysis, a hyperpure germanium solid state detector was used, associated with a PC multichannel analyser card with Maestro and Microsoft Excel software. The results show the viability of the method: a linear response in a wide radon concentration range (450-10,000 Bq m(-3)), reproducibility of data, easy handling and low cost of the gel material. This detection methodology opens new possibilities for measurements of radon and other radioactive gases.
Collapse
Affiliation(s)
- G Espinosa
- Instituto de Física, UNAM, Apartado Postal 20-364, México, DF 01000, México.
| | | | | | | |
Collapse
|
121
|
Abstract
This work presents a study of commercial SiO2 optical fibre thermoluminescence (TL) properties as part of the efforts within the Dosimetric Application Project at the Physics Institute of the University of Mexico to develop new radiation detection materials and technologies. The SiO2 commercial optical fibre studied demonstrates useful TL properties and is an excellent candidate for use in TL dosimetry of ionising radiation. The optical fibre's glow curve was observed between 30 and 400 degrees C after exposure to 60Co gamma radiation. One very well-defined glow peak has a maximum at 230 degrees C. The TL response between 100 and 350 degrees C increases monotonically over a wide dose range, from 0.1 Gy to several kGy. It is linear in the range 0.1-3 Gy, which is important for clinical high dose or accident dosimetry. The optical fibre demonstrated high data reproducibility, low residual signal and almost no fading in our study. Moreover, the optical fibre can be re-used several times, after thermal annealing, without any detriment in the dose-response. All these TL characteristics, plus the small size of the 150 microm diameter SiO2 optical fibre, the high flexibility, easy handling and low cost compared with other TL materials, make the commercial optical fibre a very promising TL material for use in research, medicine, industry, reactors, and a variety of other applications.
Collapse
Affiliation(s)
- G Espinosa
- Instituto de Física, UNAM. Apartado Postal 20-364, México, D.F., Mexico.
| | | | | | | |
Collapse
|
122
|
Bucciarelli S, Espinosa G, Asherson RA, Cervera R, Claver G, Gómez-Puerta JA, Ramos-Casals M, Ingelmo M. The acute respiratory distress syndrome in catastrophic antiphospholipid syndrome: analysis of a series of 47 patients. Ann Rheum Dis 2006; 65:81-6. [PMID: 15919677 PMCID: PMC1797978 DOI: 10.1136/ard.2005.037671] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2005] [Indexed: 01/11/2023]
Abstract
BACKGROUND The acute respiratory distress syndrome (ARDS) is a non-cardiogenic form of pulmonary oedema characterised by severe hypoxaemia refractory to oxygen therapy, with diffuse pulmonary infiltrates on chest radiographs. It can be precipitated by various serious medical and surgical conditions, including systemic autoimmune diseases. The "catastrophic" variant of the antiphospholipid syndrome (APS) is an accelerated form of this systemic autoimmune condition which results in multiorgan failure because of multiple small vessel occlusions. OBJECTIVE To analyse the clinical and laboratory characteristics of patients with catastrophic APS who develop ARDS. METHODS Cases with ARDS were selected from the web site based international registry of patients with catastrophic APS (CAPS registry) (http://www.med.ub.es/MIMMUN/FORUM/CAPS.HTM) and their characteristics examined. RESULTS Pulmonary involvement was reported in 150 of 220 patients with catastrophic APS (68%) and 47 patients (21%) were diagnosed as having ARDS. Nineteen (40%) of these patients died. Pathological studies were undertaken in 10 patients and thrombotic microangiopathy was present in seven. There were no differences in age, sex, precipitating factors, clinical manifestations, or mortality between catastrophic APS patients with and without ARDS. CONCLUSIONS ARDS is the dominant pulmonary manifestation of catastrophic APS. Thus the existence of ARDS in the context of an APS makes it necessary to rule out the presence of the catastrophic variant of this syndrome.
Collapse
Affiliation(s)
- S Bucciarelli
- Department of Autoimmune Diseases, Institut Clinic de Medicina i Dermatologia, Hospital Clínic, Villarroel, Barcelona
| | | | | | | | | | | | | | | |
Collapse
|
123
|
Vázquez-López C, Hernández A, Fragoso R, Golzarri J, Espinosa G. AFM tip gauge by nuclear tracks methodology. RADIAT MEAS 2005. [DOI: 10.1016/j.radmeas.2004.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
124
|
Cervera R, Abarca-Costalago M, Abramovicz D, Allegri F, Annunziata P, Aydintug AO, Bacarelli MR, Bellisai F, Bernardino I, Biernat-Kaluza E, Blockmans D, Boki K, Bracci L, Campanella V, Camps MT, Carcassi C, Cattaneo R, Cauli A, Cervera R, Chwalinska-Sadowska H, Contu L, Cosyns JP, Danieli MG, DCruz D, Depresseux G, Direskeneli H, Domènech I, Espinosa G, Fernández-Nebro A, Ferrara GB, Font J, Frutos MA, Galeazzi M, Garcìa-Carrasco M, García Iglesias MF, García-Tobaruela A, George J, Gil A, González-Santos P, Grana M, Gül A, Haga HJ, de Haro-Liger M, Houssiau F, Hughes GRV, Ingelmo M, Jedryka-Góral A, Khamashta MA, Lavilla P, Levi Y, López-Dulpa M, López-Soto A, Maldykowa H, Marcolongo R, Mathieu A, Morozzi G, Nicolopoulou N, Papasteriades C, Passiu G, Perelló I, Petera P, Petrovic R, Piette JC, Pintado V, de Pita O, Popovic R, Pucci G, Puddu P, de Ramón E, Ramos-Casals M, Rodríguez-Andreu J, Ruiz-Irastorza G, Sanchez-Lora J, Sanna G, Scorza R, Sebastiani GD, Sherer Y, Shoenfeld Y, Simpatico A, Sinico RA, Smolen J, Tincani A, Tokgöz G, Urbano-Márquez A, Vasconcelos C, Vázquez JJ, Veronesi J, Vianna J, Vivancos J. Systemic lupus erythematosus in Europe at the change of the millennium: lessons from the "Euro-Lupus Project". Autoimmun Rev 2005; 5:180-6. [PMID: 16483917 DOI: 10.1016/j.autrev.2005.06.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 06/06/2005] [Indexed: 11/26/2022]
Abstract
The "Euro-Lupus Cohort" is composed by 1000 patients with systemic lupus erythematosus (SLE) that have been followed prospectively since 1991. These patients have been gathered by a European consortium--the "Euro-Lupus Project Group". This consortium was originated as part of the network promoted by the "European Working Party on SLE", a working group created in 1990 in order to promote research in Europe on the different problems related to this disease. The "Euro-Lupus Cohort" provides an updated information on the SLE morbidity and mortality characteristics in the present decade as well as defines several clinical and immunological prognostic factors.
Collapse
Affiliation(s)
- Ricard Cervera
- Department of Autoimmune Diseases, Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel 170, 08036-Barcelona, Catalonia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
125
|
Asherson RA, Espinosa G, Cervera R, Gómez-Puerta JA, Musuruana J, Bucciarelli S, Ramos-Casals M, Martínez-González AL, Ingelmo M, Reverter JC, Font J, Triplett DA. Disseminated intravascular coagulation in catastrophic antiphospholipid syndrome: clinical and haematological characteristics of 23 patients. Ann Rheum Dis 2005; 64:943-6. [PMID: 15897312 PMCID: PMC1755506 DOI: 10.1136/ard.2004.026377] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Disseminated intravascular coagulation (DIC) is an acquired syndrome characterised by formation of microthrombi and fibrin deposition in the microvasculature. The catastrophic antiphospholipid syndrome (APS) is characterised by multiorgan thrombosis, mainly involving small vessels. A broad spectrum of disorders may develop DIC features; however, the catastrophic APS has not previously been recognised as a cause of DIC. OBJECTIVE To analyse the clinical and laboratory characteristics of catastrophic APS patients with DIC features. METHODS The web site based international registry of patients with catastrophic APS (CAPS registry) (http://www.med.ub.es/MIMMUN/FORUM/CAPS.HTM) was analysed and the cases with DIC features selected. RESULTS In 173 patients with catastrophic APS, 23 (13%) were found with DIC features. The clinical and immunological characteristics were similar in catastrophic APS patients with and without DIC features; a significant difference was found only in the prevalence of thrombocytopenia (100% in patients with DIC features v 59% in those without DIC features). CONCLUSIONS DIC features are not rare in catastrophic APS, supporting the need for systematic screening of antiphospholipid antibodies in all patients with DIC features without precipitating factors. The presence of DIC features in the context of an APS makes it imperative to rule out the catastrophic variant of this syndrome.
Collapse
Affiliation(s)
- R A Asherson
- Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel 170, 08036-Barcelona, Catalonia, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
126
|
Espinosa G, Arostegui JI, Plaza S, Rius J, Cervera R, Yagüe J, Font J. Behçet's disease and hereditary periodic fever syndromes: casual association or causal relationship? Clin Exp Rheumatol 2005; 23:S64-6. [PMID: 16273767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Mutations in the MEFV and the type 1 TNF receptor (TNFRSF 1A) genes have recently been linked to familial Mediterranean fever (FMF) and TNF receptor-associated periodic syndrome (TRAPS), respectively. A higher prevalence of Behçet's disease (BD) among FMF patients has been described compared to the general population. The aim of this study was to evaluate whether FMF TRAPS and BD could be genetically related. METHODS We screened a cohort of 50 BD patients and 100 healthy subjects for the common MEFV and TNFRSF 1A mutations. An initial screening of exons 10 and 2 of the MEFV gene and exon 4 of the TNFRSF 1A was performed in all chromosomes. RESULTS The heterozygous MEFV mutation (K695R) was found in one (2%) BD patient. Analysis for FMF mutations in the control group revealed that 5 (5%) individuals bore MEFV gene mutations (3 were heterozygous for the E148Q and 2 were heterozygous for the A744S). At codon 202, there were no differences in allele frequencies between BD and control population: 73%R 27%Q in the BD patients vs 75%R 25%Q in controls. Concerning mutations in the TNFRSF 1A gene, the R92Q mutation was present in heterozygous state in one (2%) BD patient and in 4 (4%) controls without differences between allele frequencies: 99%R 1%Q in BD patients vs 98%R 2%Q in controls, respectively. There was no association between the clinical manifestations of BD patients and the presence of a particular polymorphism or a mutation. CONCLUSIONS Neither FMF nor TRAPS are genetically associated with BD in our cohort of Spanish patients.
Collapse
Affiliation(s)
- G Espinosa
- Systemic Autoimmune Diseases Unit, Institut d 'Inves- tigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Catalonia, Spain.
| | | | | | | | | | | | | |
Collapse
|
127
|
Cervera R, Font J, Gómez-Puerta JA, Espinosa G, Cucho M, Bucciarelli S, Ramos-Casals M, Ingelmo M, Piette JC, Shoenfeld Y, Asherson RA. Validation of the preliminary criteria for the classification of catastrophic antiphospholipid syndrome. Ann Rheum Dis 2005; 64:1205-9. [PMID: 15708888 PMCID: PMC1755612 DOI: 10.1136/ard.2004.025759] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the characteristics of patients with catastrophic antiphospholipid syndrome (APS) included in the International Registry of patients with this condition (CAPS registry) and to analyse the value of the recently proposed preliminary criteria for the classification of catastrophic APS. METHODS A review of the first 220 patients included in the website based CAPS registry was undertaken and the preliminary criteria for their classification were tested; 175 unselected patients with systemic lupus erythematosus or APS, or both, acted as controls. RESULTS The mean age of the patients was 38 (14) years (range 7 to 74), with a female preponderance (F/M, 153/67). The main clinical manifestations included renal involvement in 154 (70%), pulmonary in 146 (66%), cerebral in 133 (60%), cardiac in 115 (52%), and cutaneous in 104 (47%); 114 patients (52%) recovered after the catastrophic APS event (mortality 48%). Patients who received the combination of anticoagulation plus steroids plus plasma exchange or intravenous immunoglobulins had the best survival rate (63%, p = 0.09). Sufficient data could be analysed for application of the classification criteria in 176 patients. According to the preliminary criteria, 89 patients (51%) could be classified as having "definite" and 70 (40%) as having "probable" catastrophic APS, thus given a sensitivity of 90.3% with a specificity of 99.4%. Positive and negative predictive values were 99.4% and 91.1%, respectively. CONCLUSIONS The preliminary criteria for the classification of catastrophic APS and the CAPS registry are useful tools for epidemiological studies.
Collapse
Affiliation(s)
- R Cervera
- Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel 170, 08036-Barcelona, Catalonia, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
128
|
Gómez-Puerta JA, Cervera R, Calvo LM, Gómez-Ansón B, Espinosa G, Claver G, Bucciarelli S, Bové A, Ramos-Casals M, Ingelmo M, Font J. Dementia associated with the antiphospholipid syndrome: clinical and radiological characteristics of 30 patients. Rheumatology (Oxford) 2005; 44:95-9. [PMID: 15367749 DOI: 10.1093/rheumatology/keh408] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyse the clinical and radiological characteristics of patients with dementia associated with the antiphospholipid syndrome (APS). METHODS Twenty-five patients were identified by a computer-assisted (MEDLINE, National Library of Medicine, Bethesda, MD) search of the literature to locate all cases of dementia associated with APS published in English, Spanish and French from 1983 to 2003. Additionally, we included five patients from our clinics. RESULTS There were 21 (70%) females and 9 (30%) males. The mean age of patients was 49+/-15 yr (range 16-79 yr). Fourteen (47%) of the patients suffered from primary APS, 9 (30%) had systemic lupus erythematosus and 7 (23%) had 'lupus-like' syndrome. Ten (33%) patients had Sneddon's syndrome and 2 (7%) had cerebral lesions described as Binswanger's disease. Other APS-related manifestations included thrombocytopenia in 12 (40%) patients, cerebrovascular accidents in 11 (37%), heart valve lesions in 8 (27%), deep vein thrombosis in 7 (28%), migraine in 7 (23%), seizures in 4 (13%); five of the 21 (24%) female patients had nine spontaneous abortions. Lupus anticoagulant was present in 21/29 (72%) patients and anticardiolipin antibodies were present in 24/29 (83%) patients. Cortical infarcts were found in 19 (63%) patients, subcortical infarcts in 9 (30%), basal ganglia infarcts in 7 (23%) and signs of cerebral atrophy in 11 (37%). Anticoagulation was used in 14/25 (56%) patients, steroids in 12/25 (48%), aspirin in 6/25 (24%) and dypiridamole in 5/25 (20%). CONCLUSIONS Dementia is an unusual manifestation of APS but one which has a high disability impact in a patient's daily life. In order to prevent these consequences, an echocardiographic and cerebral CT or MRI evaluation are recommended in all patients with APS. Furthermore, ruling out APS should be recommended in the clinical approach to dementia, especially in young patients.
Collapse
Affiliation(s)
- J A Gómez-Puerta
- Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel, 170, 08036-Barcelona, Catalonia, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
129
|
Cervera R, Asherson RA, Acevedo ML, Gómez-Puerta JA, Espinosa G, De La Red G, Gil V, Ramos-Casals M, García-Carrasco M, Ingelmo M, Font J. Antiphospholipid syndrome associated with infections: clinical and microbiological characteristics of 100 patients. Ann Rheum Dis 2004; 63:1312-7. [PMID: 15361392 PMCID: PMC1754783 DOI: 10.1136/ard.2003.014175] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe and analyse the clinical characteristics of 100 patients with antiphospholipid syndrome (APS) associated with infections. METHODS Patients were identified by a computer assisted search (Medline) of published reports to locate all cases of APS published in English, Spanish, and French from 1983 to 2003. The bilateral Fisher exact test was used for statistics. RESULTS 59 female and 41 male patients were identified (mean (SD) age, 32 (18) years (range 1 to 78)): 68 had primary APS, 27 had systemic lupus erythematosus, two had "lupus-like" syndrome, two had inflammatory bowel disease, and one had rheumatoid arthritis. APS presented as a catastrophic syndrome in 40% of cases. The main clinical manifestations of APS included: pulmonary involvement (39%), skin involvement (36%), and renal involvement (35%; nine with renal thrombotic microangiopathy, RTMA). The main associated infections and agents included skin infection (18%), HIV (17%), pneumonia (14%), hepatitis C (13%), and urinary tract infection (10%). Anticoagulation was used in 74%, steroids in 53%, intravenous immunoglobulins in 20%, cyclophosphamide in 12%, plasma exchange in 12%, and dialysis in 9.6%. Twenty three patients died following infections and thrombotic episodes (16 with catastrophic APS). Patients given steroids had a better prognosis (p = 0.024). The presence of RTMA and requirement for dialysis carried a worse prognosis (p = 0.001 and p = 0.035, respectively). CONCLUSIONS Various different infections can be associated with thrombotic events in patients with APS, including the potentially lethal subset termed catastrophic APS. Aggressive treatment with anticoagulation, steroids, and appropriate antibiotic cover is necessary to improve the prognosis.
Collapse
Affiliation(s)
- R Cervera
- Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel 170, 08036-Barcelona, Catalonia, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
130
|
Sharma P, Castillo D, Rosas N, Cabrera A, Gomez E, Toscano A, Lara F, Hernández S, Espinosa G. Synthesis and structures of organoantimony compounds containing intramolecular Sb–N interactions. J Organomet Chem 2004. [DOI: 10.1016/j.jorganchem.2004.05.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
131
|
Espinosa G, Bucciarelli S, Cervera R, Lozano M, Reverter JC, de la Red G, Gil V, Ingelmo M, Font J, Asherson RA. Thrombotic microangiopathic haemolytic anaemia and antiphospholipid antibodies. Ann Rheum Dis 2004; 63:730-6. [PMID: 15140782 PMCID: PMC1755024 DOI: 10.1136/ard.2003.007245] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To analyse the clinical and laboratory features of patients with thrombotic microangiopathic haemolytic anaemia (TMHA) associated with antiphospholipid antibodies (aPL). METHODS A computer assisted (PubMed) search of the literature was performed to identify all cases of TMHA associated with aPL from 1983 to December 2002. RESULTS 46 patients (36 female) with a mean (SD) age at presentation of TMHA of 34 (15) years were reviewed. Twenty eight (61%) patients had primary antiphospholipid syndrome (APS). TMHA was the first clinical manifestation of APS in 26 (57%) patients. The clinical presentations were haemolytic-uraemic syndrome (26%), catastrophic APS (23%), acute renal failure (15%), malignant hypertension (13%), thrombotic thrombocytopenic purpura (13%), and HELLP (haemolysis, elevated liver enzymes, and low platelet count in association with eclampsia) syndrome (4%). Lupus anticoagulant was detected in 86% of the episodes of TMHA, and positive anticardiolipin antibodies titres in 89%. Steroids were the most common treatment (69% of episodes), followed by plasma exchange (PE) (62%), anticoagulant or antithrombotic agents (48%), immunosuppressive agents (29%), and immunoglobulins (12%). Recovery occurred in only 10/29 (34%) episodes treated with steroids, and in 19/27 (70%) episodes treated with PE. Death occurred in 10/46 (22%) patients. CONCLUSIONS The results emphasise the need for systematic screening for aPL in all patients with clinical and laboratory features of TMHA. The existence of TMHA in association with an APS forces one to rule out the presence of the catastrophic variant of this syndrome. PE is indicated as a first line of treatment for all patients with TMHA associated with aPL.
Collapse
Affiliation(s)
- G Espinosa
- Department of Autoimmune Diseases, Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
132
|
Giralt F, Espinosa G, Arenas A, Ferre-Gine J, Amat L, Gironés X, Carbó-Dorca R, Cohen Y. Estimation of infinite dilution activity coefficients of organic compounds in water with neural classifiers. AIChE J 2004. [DOI: 10.1002/aic.10116] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
133
|
Nadal M, Espinosa G, Schuhmacher M, Domingo JL. Patterns of PCDDs and PCDFs in human milk and food and their characterization by artificial neural networks. Chemosphere 2004; 54:1375-1382. [PMID: 14659939 DOI: 10.1016/j.chemosphere.2003.10.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Artificial neural network (ANN) has been recently introduced as a tool for data analysis. In this study, Kohonen's self-organizing maps (SOMs), a special type of neural network, were applied to a set of PCDD/PCDF concentrations found in 54 human milk and 83 food samples, which were collected in a number of countries all over the world. Data were obtained from the scientific literature. The purpose of the study was to find a potential relationship between PCDD/PCDF congener profiles in human milk and the dietary habits of the different countries in which samples were collected. The comparison of the SOM component planes for human milk and foodstuffs indicates that those countries with a greater fish consumption show also higher PCDD/PCDF concentrations in human milk. SOMs enable both the visualization of sample units and the visualization of congener distribution.
Collapse
Affiliation(s)
- M Nadal
- Laboratory of Toxicology and Environmental Health, School of Medicine, Rovira i Virgili University, San Lorenzo 21, 43201 Reus, Spain
| | | | | | | |
Collapse
|
134
|
Affiliation(s)
- N. Martín
- Departmento de Química, Universidad Autónoma MetropolitanaIztapalapa, Avenida San Rafael Atlixco 186, 09340 D.F., México, and Instituto Mexicano del Petróleo, Eje Central 152, 07730 D.F., México
| | - M. Viniegra
- Departmento de Química, Universidad Autónoma MetropolitanaIztapalapa, Avenida San Rafael Atlixco 186, 09340 D.F., México, and Instituto Mexicano del Petróleo, Eje Central 152, 07730 D.F., México
| | - E. Lima
- Departmento de Química, Universidad Autónoma MetropolitanaIztapalapa, Avenida San Rafael Atlixco 186, 09340 D.F., México, and Instituto Mexicano del Petróleo, Eje Central 152, 07730 D.F., México
| | - G. Espinosa
- Departmento de Química, Universidad Autónoma MetropolitanaIztapalapa, Avenida San Rafael Atlixco 186, 09340 D.F., México, and Instituto Mexicano del Petróleo, Eje Central 152, 07730 D.F., México
| |
Collapse
|
135
|
Abstract
Although Addison disease and hypoadrenalism are rare in patients with systemic lupus erythematosus (SLE), early reports of the association suggested the presence of antiphospholipid antibodies (aPL) in these patients. Data from literature reveal that adrenal failure was present in between 10 and 26% of patients with catastrophic APS and that one-third of patients presented with adrenal involvement during the course of catastrophic APS. Adrenal involvement may be the first clinical manifestation of this syndrome, whereas a few patients may have a history of Addison's disease in the past. The pathological mechanisms involved in the production of adrenal insufficiency in APS are still not clearly understood, but the hypercoagulable state in these patients supports the concept that adrenal haemorrhagic infarction may possibly be related to adrenal vein thrombosis. In the present article,we review the pathogenic mechanisms and main clinical, laboratory and treatment features of patients suffering adrenal involvement with aPL to support the idea that APS leads to the development of adrenal insufficiency.
Collapse
Affiliation(s)
- G Espinosa
- Department of Autoimmune Diseases, Institut Clinic d'Infeccions i Immunologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Catalonia, Spain
| | | | | | | |
Collapse
|
136
|
Espinosa G, Golzarri J, Vázquez C, Fragoso R, Chadderton L, Cruz S. AFM observations of latent fission tracks on surfaces: amorphous SiO2 and quartz. RADIAT MEAS 2003. [DOI: 10.1016/s1350-4487(03)00128-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
137
|
Saad A, Talaat T, Atwa S, Espinosa G, Fujii M. Determination of the uranium content of Egyptian phosphate ores by passive and active detectors. RADIAT MEAS 2003. [DOI: 10.1016/s1350-4487(03)00203-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
138
|
Erkan D, Asherson RA, Espinosa G, Cervera R, Font J, Piette JC, Lockshin MD. Long term outcome of catastrophic antiphospholipid syndrome survivors. Ann Rheum Dis 2003; 62:530-3. [PMID: 12759289 PMCID: PMC1754574 DOI: 10.1136/ard.62.6.530] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Catastrophic antiphospholipid syndrome (APS) is defined as life threatening multiple organ thromboses developing simultaneously or over a short period. The survival rate of catastrophic APS is about 50%, but the long term outcome of patients who survive is unknown. OBJECTIVE To determine the long term outcome of patients with catastrophic APS and provide further information on patients who survived. PATIENTS AND METHODS The clinical characteristics and outcomes of 130 patients with catastrophic APS have been reported previously. Six new cases were recently added to this series. Based on these publications, the authors who reported patients who had survived were contacted. Each author was asked (a) what treatment they gave their patients after the catastrophic APS; (b) if their patients had any further thrombosis. RESULTS 63/136 (46%) patients died at the initial event. Of the remaining 73 patients, information was available for 58 (79%). Thirty eight (66%) patients did not develop further APS related events during an average follow up of 67.2 months. Eleven (19%) patients developed further APS related events but were still alive. No patients developed further catastrophic APS. Nine (16%) patients died: due to multiple organ failure (three patients); myelofibrosis (one); pneumonia (one); and APS related events (four). CONCLUSION Sixty six per cent of patients who survive an initial catastrophic APS event remained symptom free with anticoagulation during an average follow up of 67.2 months. Twenty six per cent of the survivors developed further APS related events and the mortality rate of these patients was about 25%.
Collapse
Affiliation(s)
- D Erkan
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
| | | | | | | | | | | | | |
Collapse
|
139
|
Muñoz-Rodríguez FJ, Reverter JC, Font J, Tàssies D, Espinosa G, Cervera R, Carmona F, Balsch J, Ingelmo M, Ordinas A. Clinical significance of acquired activated protein C resistance in patients with systemic lupus erythematosus. Lupus 2003; 11:730-5. [PMID: 12475003 DOI: 10.1191/0961203302lu256oa] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antiphospholipid antibodies (aPL) may induce acquired activated protein C resistance (acquired APCR). The role of acquired APCR in patients with systemic lupus erythematosus (SLE) is not well known. To evaluate the prevalence of acquired APCR and its association with clinical manifestations we studied 103 consecutive SLE patients and 103 matched controls. APCR in the undiluted test and after dilution in factor V deficient plasma, factor V Leiden, protein C and S, lupus anticoagulant, and anti-cardiolipin, anti-beta2-glycoprotein I and anti-prothrombin antibodies were determined. Factor V Leiden was found in 4% in both patients and controls. The prevalence of acquired APCR was 22% for the undiluted assay and 17% in the diluted test. In SLE patients, acquired APCR was associated with aPL (39 vs 13% in undiluted assay, P = 0.007; and 33 vs 7% in the diluted test, P = 0.001). Arterial thromboses were found in 24% of patients with acquired APCR and in 6% of patients without (P = 0.04). However, no relationship was found with venous thrombosis. Acquired APCR was also associated with pregnancy losses: miscarriages in 70% of women with acquired APCR vs 32% in those without (P=0.03). Thus, in SLE patients acquired APCR seems to be associated with increased prevalence of arterial thrombosis and pregnancy losses.
Collapse
Affiliation(s)
- F J Muñoz-Rodríguez
- Systemic Autoimmune Diseases Service, Institit d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
140
|
Sans M, Tàssies D, Pellisé M, Espinosa G, Quintó L, Piqué JM, Reverter JC, Panés J. The 4G/4G genotype of the 4G/5G polymorphism of the type-1 plasminogen activator inhibitor (PAI-1) gene is a determinant of penetrating behaviour in patients with Crohn's disease. Aliment Pharmacol Ther 2003; 17:1039-47. [PMID: 12694086 DOI: 10.1046/j.1365-2036.2003.01536.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Crohn's disease is a heterogeneous disorder with polygenic inheritance. AIM To assess the effect of the 4G/5G polymorphism of the type-1 plasminogen activator inhibitor (PAI-1) gene, the major inhibitor of fibrinolysis, on Crohn's disease susceptibility and phenotype. METHODS One hundred and fifty-seven patients with Crohn's disease and 350 controls were included prospectively. Medical records were reviewed to determine changes in the Crohn's disease phenotype. The 4G/5G polymorphism was assessed by polymerase chain reaction techniques. RESULTS The frequencies of the 4G/4G, 4G/5G and 5G/5G genotypes were similar in patients with Crohn's disease and controls. The 4G/4G genotype (P < 0.0001; odds ratio, 4.84) and male sex (P = 0.009; odds ratio, 2.63) were independent risk factors for penetrating behaviour in Crohn's disease. Most Crohn's disease patients had a non-penetrating phenotype at diagnosis. The probability of development of a penetrating phenotype within 5 years of diagnosis was higher in patients with the 4G/4G genotype (72% vs. 19%, P < 0.0001). CONCLUSIONS The 4G/4G genotype of the PAI-1 gene does not influence Crohn's disease susceptibility, but increases by five-fold the probability of penetrating behaviour. Most patients with the 4G/4G genotype have a non-penetrating phenotype at diagnosis, but develop a penetrating behaviour within 5 years. Genotyping the 4G/5G polymorphism may be useful for the identification of a sub-group of patients with aggressive Crohn's disease, who might benefit from specific therapy.
Collapse
Affiliation(s)
- M Sans
- Department of Gastroenterology, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | | | | | | | | | | | | |
Collapse
|
141
|
Miró O, Sánchez M, Espinosa G, Coll-Vinent B, Bragulat E, Millá J. Analysis of patient flow in the emergency department and the effect of an extensive reorganisation. Emerg Med J 2003; 20:143-8; discussion 148. [PMID: 12642527 PMCID: PMC1726061 DOI: 10.1136/emj.20.2.143] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the different internal factors influencing patient flow, effectiveness, and overcrowding in the emergency department (ED), as well as the effects of ED reorganisation on these indicators. METHODS The study compared measurements at regular intervals of three hours of patient arrivals and patient flow between two comparable periods (from 10 February to 2 March) of 1999 and 2000. In between, a structural and staff reorganisation of ED was undertaken. The main reason for each patient remaining in ED was recorded and allocated to one of four groups: (1) factors related to ED itself; (2) factors related to ED-hospital interrelation; (3) factors related to hospital itself; and (4) factors related to neither ED nor hospital. The study measured the number of patients waiting to be seen and the waiting time to be seen as effectiveness markers, as well as the percentage of time that ED was overcrowded, as judged by numerical and functional criteria. RESULTS Effectiveness of ED was closely related with some ED related and hospital related factors. After the reorganisation, patients who remained in ED because of hospital related or non-ED-non-hospital related factors decreased. ED reorganisation reduced the number of patients waiting to be seen from 5.8 to 2.5 (p<0.001) and waiting time from 87 to 24 minutes (p<0.001). Before the reorganisation, 31% and 48% of the time was considered to be overcrowded in numerical and functional terms respectively. After the reorganisation, these figures were reduced to 8% and 15% respectively (p<0.001 for both). CONCLUSIONS ED effectiveness and overcrowding are not only determined by external pressure, but also by internal factors. Measurement of patient flow across ED has proved useful in detecting these factors and in being used to plan an ED reorganisation.
Collapse
Affiliation(s)
- O Miró
- Emergency Department, Hospital Clinic Barcelona, Villaroel 170, 08036 Barcelona, Catalonia, Spain.
| | | | | | | | | | | |
Collapse
|
142
|
Abstract
Mexico City, also called Federal District, covers an area of 1504 km(2), and has more than 8 million inhabitants. It is located more than 2200 m above sea level in a zone of high seismic activity, and founded on an ancient lake. At present it is one of the most crowded and contaminated cities in the world, with thermal inversions. Chemical contaminants and aerosol particles in the environmental air are high most of the year. Due to these geological, environmental and socioeconomic conditions, Federal District presents very peculiar characteristics, which are important for understanding the distribution and measurements of indoor radon concentration. In this work the results of 3 year (1998-2000) measurements of indoor radon levels in the Federal District are presented. For the detector distribution and measurements, the actual political administrative divisions of the Federal District, consisting of 16 very well defined zones, was used. Nuclear track detection methodology was selected for the measurement, with a passive device close-end-cup system with CR-39 (Lantrack) polycarbonate as the detection material, with one step chemical etching, following a very well established protocol developed at the Instituto de Física, UNAM. Calibration was carried out at the Oak Ridge National Laboratory, and verification at the Instituto de Física chamber. The results show that the arithmetical mean values of the indoor radon concentration for each region of the Federal District follow a non-homogenous distribution.
Collapse
Affiliation(s)
- G Espinosa
- Instituto de Fśica, UNAM. Apdo. Postal 20-364, 01000 México, DF.
| | | |
Collapse
|
143
|
Cervera R, Abarca-Costalago M, Abramovicz D, Allegri F, Annunziata P, Aydintug AO, Bacarelli MR, Bellisai F, Bernardino I, Biernat-Kaluza E, Blockmans D, Boki K, Bracci L, Campanella V, Camps MT, Carcassi C, Cattaneo R, Cauli A, Chwalinska-Sadowska H, Contu L, Cosyns JP, Danieli MG, D'Cruz D, Depresseux G, Direskeneli H, Domènech I, Espinosa G, Fernández-Nebro A, Ferrara GB, Font J, Frutos MA, Galeazzi M, García-Carrasco M, García-Iglesias MF, García-Tobaruela A, George J, Gil A, González-Santos P, Grana M, Gül A, Haga HJ, de Haro-Liger M, Houssiau F, Hughes GRV, Ingelmo M, Jedryka-Góral A, Khamashta MA, Lavilla P, Levi Y, López-Dupla M, López-Soto A, Maldykowa H, Marcolongo R, Mathieu A, Morozzi G, Nicolopoulou N, Papasteriades C, Passiu G, Perelló I, Petera P, Petrovic R, Piette JC, Pintado V, de Pita O, Popovic R, Pucci G, Puddu P, de Ramón E, Ramos-Casals M, Rodríguez-Andreu J, Ruiz-Irastroza G, Sánchez-Lora J, Sanna G, Scorza R, Sebastini GD, Sherer Y, Shoenfeld Y, Simpatico A, Sinico RA, Smolen J, Tincani A, Tokgöz G, Urbano-Márquez A, Vasconcelos C, Vázquez JJ, Veronesi M, Vianni J, Vivancos J. Lessons from the "Euro-Lupus Cohort". Ann Med Interne (Paris) 2002; 153:530-6. [PMID: 12610427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The "Euro-Lupus Cohort" is composed by 1,000 patients with systemic lupus erythematosus (SLE) that have been followed prospectively since 1991. These patients have been gathered by a European consortium - the "Euro-Lupus Project Group". This consortium was originated as part of the network promoted by the "European Working Party on SLE", a working group created in 1990 in order to promote research in Europe on the different problems related to this disease. The "Euro-Lupus Cohort" provides an updated information on the SLE morbidity and mortality characteristics in the present decade as well as defines several clinical and immunological prognostic factors.
Collapse
Affiliation(s)
- Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
144
|
Espinosa G. [Women and work. Panorama in Latin America 1960-1990]. Demos 2002:33-5. [PMID: 12158061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
145
|
Robainas A, Monnerot M, Solignac M, Dennebouy N, Espinosa G, Garcia-Machado E. Microsatellite loci from the pink shrimp Farfantenaeus notialis (Crustacea, Decapoda). ACTA ACUST UNITED AC 2002. [DOI: 10.1046/j.1471-8286.2002.00241.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
146
|
Espinosa G, Font J, Muñoz-Rodríguez FJ, Cervera R, Ingelmo M. Myelodysplastic and myeloproliferative syndromes associated with giant cell arteritis and polymyalgia rheumatica: a coincidental coexistence or a causal relationship? Clin Rheumatol 2002; 21:309-13. [PMID: 12189460 DOI: 10.1007/s100670200081] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A variety of systemic autoimmune disorders have been reported in patients with myelodysplastic and myeloproliferative syndromes. A possible association with polymyalgia rheumatica and giant cell arteritis has also been recognised. We report another case of polymyalgia rheumatica and one of giant cell arteritis associated with a myelodysplastic syndrome and the two first cases of giant cell arteritis associated with essential thrombocytaemia and chronic myelomonocytic leukaemia, respectively. It seems that there is a relationship between these entities, but the nature of this association is still unknown.
Collapse
Affiliation(s)
- G Espinosa
- Service of Autoimmune Diseases, Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | |
Collapse
|
147
|
Abstract
Self-organized maps (SOM) have been applied to analyze the similarities of chemical compounds and to select from a given pool of descriptors the smallest and more relevant subset needed to build robust QSAR models based on fuzzy ARTMAP. First, the category maps for each molecular descriptor and for the target activity variable were created with SOM and then classified on the basis of topology and nonlinear distribution. The best subset of descriptors was obtained by choosing from each cluster the index with the highest correlation with the target variable and then in order of decreasing correlation. This process was terminated when a dissimilarity measure increased, indicating that the inclusion of more molecular indices would not add supplementary information. The optimal subset of descriptors was used as input to a fuzzy ARTMAP architecture modified to effect predictive capabilities. The performance of the integrated SOM-fuzzy ARTMAP approach was evaluated with the prediction of the acute toxicity LC50 of a homogeneous set of 69 benzene derivatives in the fathead minnow and the oral rat toxicity LD50 of a heterogeneous set of 155 organic compounds. The proposed methodology minimized the problem of misclassification of similar compounds and significantly enhanced the predictive capabilities of a properly trained fuzzy ARTMAP network.
Collapse
Affiliation(s)
- G Espinosa
- Departament d'Enginyeria Química, Escola Tècnica Superior d'Enginyeria Química (ETSEQ), Universitat Rovira i Virgili, Av. dels Països Catalans, 26, 43007 Tarragona, Catalunya, Spain
| | | | | |
Collapse
|
148
|
Abstract
Patients with antiphospholipid syndrome (APS) may develop a broad spectrum of pulmonary disease. Pulmonary thromboembolism and pulmonary hypertension are the most common complications, but microvascular pulmonary thrombosis, pulmonary capillaritis, and alveolar haemorrhage have also been reported. Clinicians should seriously consider these types of vascular injury when evaluating patients with APS who present with dyspnoea, fever, and infiltrates on chest radiography.
Collapse
Affiliation(s)
- G Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | | | | |
Collapse
|
149
|
Castillo-Mejía F, Herrera JJE, Rangel J, Golzarri JI, Espinosa G. Neutron angular distribution in a plasma focus obtained using nuclear track detectors. Radiat Prot Dosimetry 2002; 101:557-560. [PMID: 12382811 DOI: 10.1093/oxfordjournals.rpd.a006048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The dense plasma focus (DPF) is a coaxial plasma gun in which a high-density, high-temperature plasma is obtained in a focused column for a few nanoseconds. When the filling gas is deuterium, neutrons can be obtained from fusion reactions. These are partially due to a beam of deuterons which are accelerated against the background hot plasma by large electric fields originating from plasma instabilities. Due to a beam-target effect, the angular distribution of the neutron emission is anisotropic, peaked in the forward direction along the axis of the gun. The purpose of this work is to illustrate the use of CR-39 nuclear track detectors as a diagnostic tool in the determination of the time-integrated neutron angular distribution. For the case studied in this work, neutron emission is found to have a 70% contribution from isotropic radiation and a 30% contribution from anisotropic radiation.
Collapse
|
150
|
Affiliation(s)
- G Espinosa
- Servicio de Enfermedades Autoinmunes. Instituto Clínico de Infecciones e Inmunología, Hospital Clínic, Barcelona, Spain
| | | | | |
Collapse
|