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Barclay M, Renzi C, Antoniou A, Denaxas S, Harrison H, Ip S, Pashayan N, Torralbo A, Usher-Smith J, Wood A, Lyratzopoulos G. Phenotypes and rates of cancer-relevant symptoms and tests in the year before cancer diagnosis in UK Biobank and CPRD Gold. PLOS Digit Health 2023; 2:e0000383. [PMID: 38100737 PMCID: PMC10723831 DOI: 10.1371/journal.pdig.0000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/05/2023] [Indexed: 12/17/2023]
Abstract
Early diagnosis of cancer relies on accurate assessment of cancer risk in patients presenting with symptoms, when screening is not appropriate. But recorded symptoms in cancer patients pre-diagnosis may vary between different sources of electronic health records (EHRs), either genuinely or due to differential completeness of symptom recording. To assess possible differences, we analysed primary care EHRs in the year pre-diagnosis of cancer in UK Biobank and Clinical Practice Research Datalink (CPRD) populations linked to cancer registry data. We developed harmonised phenotypes in Read v2 and CTV3 coding systems for 21 symptoms and eight blood tests relevant to cancer diagnosis. Among 22,601 CPRD and 11,594 UK Biobank cancer patients, 54% and 36%, respectively, had at least one consultation for possible cancer symptoms recorded in the year before their diagnosis. Adjusted comparisons between datasets were made using multivariable Poisson models, comparing rates of symptoms/tests in CPRD against expected rates if cancer site-age-sex-deprivation associations were the same as in UK Biobank. UK Biobank cancer patients compared with those in CPRD had lower rates of consultation for possible cancer symptoms [RR: 0.61 (0.59-0.63)], and lower rates for any primary care consultation [RR: 0.86 (95%CI 0.85-0.87)]. Differences were larger for 'non-alarm' symptoms [RR: 0.54 (0.52-0.56)], and smaller for 'alarm' symptoms [RR: 0.80 (0.76-0.84)] and blood tests [RR: 0.93 (0.90-0.95)]. In the CPRD cohort, approximately representative of the UK population, half of cancer patients had recorded symptoms in the year before diagnosis. The frequency of non-specific presenting symptoms recorded in the year pre-diagnosis of cancer was substantially lower among UK Biobank participants. The degree to which results based on highly selected biobank cohorts are generalisable needs to be examined in disease-specific contexts.
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Affiliation(s)
- Matthew Barclay
- Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
| | - Cristina Renzi
- Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
- Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Antonis Antoniou
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Hannah Harrison
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Samantha Ip
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
| | - Ana Torralbo
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Juliet Usher-Smith
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Angela Wood
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Cambridge Centre for Artificial Intelligence in Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Georgios Lyratzopoulos
- Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
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Chung S, Providencia R, Sofat R, Pujades‐Rodriguez M, Torralbo A, Fatemifar G, Fitzpatrick NK, Taylor J, Li K, Dale C, Rossor M, Acosta‐Mena D, Whittaker J, Denaxas S. Incidence, morbidity, mortality and disparities in dementia: A population linked electronic health records study of 4.3 million individuals. Alzheimers Dement 2023; 19:123-135. [PMID: 35290719 PMCID: PMC10078672 DOI: 10.1002/alz.12635] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 11/08/2021] [Accepted: 01/30/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION We report dementia incidence, comorbidities, reasons for health-care visits, mortality, causes of death, and examined dementia patterns by relative deprivation in the UK. METHOD A longitudinal cohort analysis of linked electronic health records from 4.3 million people in the UK was conducted to investigate dementia incidence and mortality. Reasons for hospitalization and causes of death were compared in individuals with and without dementia. RESULTS From 1998 to 2016 we observed 145,319 (3.1%) individuals with incident dementia. Repeated hospitalizations among senior adults for infection, unknown morbidity, and multiple primary care visits for chronic pain were observed prior to dementia diagnosis. Multiple long-term conditions are present in half of the individuals at the time of diagnosis. Individuals living in high deprivation areas had higher dementia incidence and high fatality. DISCUSSION There is a considerable disparity of dementia that informs priorities of prevention and provision of patient care.
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Affiliation(s)
- Sheng‐Chia Chung
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | | | - Reecha Sofat
- Department of Health InformaticsHealth Data Research UKLondonUK
| | | | - Ana Torralbo
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Ghazaleh Fatemifar
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Natalie K. Fitzpatrick
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Julie Taylor
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Ken Li
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Caroline Dale
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Martin Rossor
- Department of NeurodegenerationUCL Institute of NeurologyLondonUK
| | | | | | - Spiros Denaxas
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
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Thygesen JH, Tomlinson C, Hollings S, Mizani MA, Handy A, Akbari A, Banerjee A, Cooper J, Lai AG, Li K, Mateen BA, Sattar N, Sofat R, Torralbo A, Wu H, Wood A, Sterne JAC, Pagel C, Whiteley WN, Sudlow C, Hemingway H, Denaxas S. COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records. Lancet Digit Health 2022; 4:e542-e557. [PMID: 35690576 PMCID: PMC9179175 DOI: 10.1016/s2589-7500(22)00091-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. FINDINGS Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. INTERPRETATION Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. FUNDING British Heart Foundation Data Science Centre, led by Health Data Research UK.
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Affiliation(s)
- Johan H Thygesen
- Institute of Health Informatics, University College London, London, UK
| | - Christopher Tomlinson
- Institute of Health Informatics, University College London, London, UK; UK Research and Innovation Centre for Doctoral Training in AI-enabled Healthcare Systems, University College London, London, UK; University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | | | - Mehrdad A Mizani
- Institute of Health Informatics, University College London, London, UK
| | - Alex Handy
- Institute of Health Informatics, University College London, London, UK
| | - Ashley Akbari
- Population Data Science, Swansea University, Swansea, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Jennifer Cooper
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alvina G Lai
- Institute of Health Informatics, University College London, London, UK
| | - Kezhi Li
- Institute of Health Informatics, University College London, London, UK; UK Research and Innovation Centre for Doctoral Training in AI-enabled Healthcare Systems, University College London, London, UK
| | - Bilal A Mateen
- Institute of Health Informatics, University College London, London, UK; The Wellcome Trust, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Reecha Sofat
- Institute of Health Informatics, University College London, London, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Ana Torralbo
- Institute of Health Informatics, University College London, London, UK
| | - Honghan Wu
- Institute of Health Informatics, University College London, London, UK
| | - Angela Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, and Cambridge Centre for AI in Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Cathie Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK; Health Data Research UK, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK; University College London Hospitals Biomedical Research Centre, University College London, London, UK; Health Data Research UK, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK; British Heart Foundation Research Accelerator, University College London, London, UK; University College London Hospitals Biomedical Research Centre, University College London, London, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK; Health Data Research UK, London, UK.
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Denaxas S, Shah AD, Mateen BA, Kuan V, Quint JK, Fitzpatrick N, Torralbo A, Fatemifar G, Hemingway H. A semi-supervised approach for rapidly creating clinical biomarker phenotypes in the UK Biobank using different primary care EHR and clinical terminology systems. JAMIA Open 2020; 3:545-556. [PMID: 33619467 PMCID: PMC7717266 DOI: 10.1093/jamiaopen/ooaa047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/10/2020] [Accepted: 09/14/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The UK Biobank (UKB) is making primary care electronic health records (EHRs) for 500 000 participants available for COVID-19-related research. Data are extracted from four sources, recorded using five clinical terminologies and stored in different schemas. The aims of our research were to: (a) develop a semi-supervised approach for bootstrapping EHR phenotyping algorithms in UKB EHR, and (b) to evaluate our approach by implementing and evaluating phenotypes for 31 common biomarkers. MATERIALS AND METHODS We describe an algorithmic approach to phenotyping biomarkers in primary care EHR involving (a) bootstrapping definitions using existing phenotypes, (b) excluding generic, rare, or semantically distant terms, (c) forward-mapping terminology terms, (d) expert review, and (e) data extraction. We evaluated the phenotypes by assessing the ability to reproduce known epidemiological associations with all-cause mortality using Cox proportional hazards models. RESULTS We created and evaluated phenotyping algorithms for 31 biomarkers many of which are directly related to COVID-19 complications, for example diabetes, cardiovascular disease, respiratory disease. Our algorithm identified 1651 Read v2 and Clinical Terms Version 3 terms and automatically excluded 1228 terms. Clinical review excluded 103 terms and included 44 terms, resulting in 364 terms for data extraction (sensitivity 0.89, specificity 0.92). We extracted 38 190 682 events and identified 220 978 participants with at least one biomarker measured. DISCUSSION AND CONCLUSION Bootstrapping phenotyping algorithms from similar EHR can potentially address pre-existing methodological concerns that undermine the outputs of biomarker discovery pipelines and provide research-quality phenotyping algorithms.
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Affiliation(s)
- Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
- The Alan Turing Institute, London UK
- British Heart Foundation Research Accelerator, University College London, London, UK
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Bilal A Mateen
- The Alan Turing Institute, London UK
- King’s College Hospital, London, UK
| | - Valerie Kuan
- Health Data Research UK, University College London, London, UK
- British Heart Foundation Research Accelerator, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Jennifer K Quint
- Health Data Research UK, University College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Natalie Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Ana Torralbo
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Ghazaleh Fatemifar
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
- British Heart Foundation Research Accelerator, University College London, London, UK
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Banerjee A, Pasea L, Harris S, Gonzalez-Izquierdo A, Torralbo A, Shallcross L, Noursadeghi M, Pillay D, Sebire N, Holmes C, Pagel C, Wong WK, Langenberg C, Williams B, Denaxas S, Hemingway H. Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study. Lancet 2020; 395:1715-1725. [PMID: 32405103 PMCID: PMC7217641 DOI: 10.1016/s0140-6736(20)30854-0] [Citation(s) in RCA: 306] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The medical, societal, and economic impact of the coronavirus disease 2019 (COVID-19) pandemic has unknown effects on overall population mortality. Previous models of population mortality are based on death over days among infected people, nearly all of whom thus far have underlying conditions. Models have not incorporated information on high-risk conditions or their longer-term baseline (pre-COVID-19) mortality. We estimated the excess number of deaths over 1 year under different COVID-19 incidence scenarios based on varying levels of transmission suppression and differing mortality impacts based on different relative risks for the disease. METHODS In this population-based cohort study, we used linked primary and secondary care electronic health records from England (Health Data Research UK-CALIBER). We report prevalence of underlying conditions defined by Public Health England guidelines (from March 16, 2020) in individuals aged 30 years or older registered with a practice between 1997 and 2017, using validated, openly available phenotypes for each condition. We estimated 1-year mortality in each condition, developing simple models (and a tool for calculation) of excess COVID-19-related deaths, assuming relative impact (as relative risks [RRs]) of the COVID-19 pandemic (compared with background mortality) of 1·5, 2·0, and 3·0 at differing infection rate scenarios, including full suppression (0·001%), partial suppression (1%), mitigation (10%), and do nothing (80%). We also developed an online, public, prototype risk calculator for excess death estimation. FINDINGS We included 3 862 012 individuals (1 957 935 [50·7%] women and 1 904 077 [49·3%] men). We estimated that more than 20% of the study population are in the high-risk category, of whom 13·7% were older than 70 years and 6·3% were aged 70 years or younger with at least one underlying condition. 1-year mortality in the high-risk population was estimated to be 4·46% (95% CI 4·41-4·51). Age and underlying conditions combined to influence background risk, varying markedly across conditions. In a full suppression scenario in the UK population, we estimated that there would be two excess deaths (vs baseline deaths) with an RR of 1·5, four with an RR of 2·0, and seven with an RR of 3·0. In a mitigation scenario, we estimated 18 374 excess deaths with an RR of 1·5, 36 749 with an RR of 2·0, and 73 498 with an RR of 3·0. In a do nothing scenario, we estimated 146 996 excess deaths with an RR of 1·5, 293 991 with an RR of 2·0, and 587 982 with an RR of 3·0. INTERPRETATION We provide policy makers, researchers, and the public a simple model and an online tool for understanding excess mortality over 1 year from the COVID-19 pandemic, based on age, sex, and underlying condition-specific estimates. These results signal the need for sustained stringent suppression measures as well as sustained efforts to target those at highest risk because of underlying conditions with a range of preventive interventions. Countries should assess the overall (direct and indirect) effects of the pandemic on excess mortality. FUNDING National Institute for Health Research University College London Hospitals Biomedical Research Centre, Health Data Research UK.
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Affiliation(s)
- Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK; University College London Hospitals NHS Trust, London, UK; Barts Health NHS Trust, The Royal London Hospital, London, UK.
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
| | - Steve Harris
- University College London Hospitals NHS Trust, London, UK
| | | | - Ana Torralbo
- Institute of Health Informatics, University College London, London, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Deenan Pillay
- Division of Infection and Immunity, University College London, London, UK
| | | | - Chris Holmes
- University of Oxford, Oxford, UK; Alan Turing Institute, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Wai Keong Wong
- University College London Hospitals NHS Trust, London, UK
| | | | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, UK; University College London Hospitals NHS Trust, London, UK; University College London Hospitals National Institute for Health Research Biomedical Research Centre, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK; Alan Turing Institute, London, UK; Health Data Research UK, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, London, UK
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Jurado-Tarifa E, Torralbo A, Borge C, Cerdà-Cuéllar M, Ayats T, Carbonero A, García-Bocanegra I. Genetic diversity and antimicrobial resistance of Campylobacter and Salmonella strains isolated from decoys and raptors. Comp Immunol Microbiol Infect Dis 2016; 48:14-21. [DOI: 10.1016/j.cimid.2016.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/23/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022]
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Torralbo A, Kelley TA, Rees G, Lavie N. Attention induced neural response trade-off in retinotopic cortex under load. Sci Rep 2016; 6:33041. [PMID: 27625311 PMCID: PMC5021995 DOI: 10.1038/srep33041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 08/12/2016] [Indexed: 11/30/2022] Open
Abstract
The effects of perceptual load on visual cortex response to distractors are well established and various phenomena of ‘inattentional blindness’ associated with elimination of visual cortex response to unattended distractors, have been documented in tasks of high load. Here we tested an account for these effects in terms of a load-induced trade-off between target and distractor processing in retinotopic visual cortex. Participants were scanned using fMRI while performing a visual-search task and ignoring distractor checkerboards in the periphery. Retinotopic responses to target and distractors were assessed as a function of search load (comparing search set-sizes two, three and five). We found that increased load not only increased activity in frontoparietal network, but also had opposite effects on retinotopic responses to target and distractors. Target-related signals in areas V2–V3 linearly increased, while distractor response linearly decreased, with increased load. Critically, the slopes were equivalent for both load functions, thus demonstrating resource trade-off. Load effects were also found in displays with the same item number in the distractor hemisphere across different set sizes, thus ruling out local intrahemispheric interactions as the cause. Our findings provide new evidence for load theory proposals of attention resource sharing between target and distractor leading to inattentional blindness.
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Affiliation(s)
- Ana Torralbo
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Todd A Kelley
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Geraint Rees
- Institute of Cognitive Neuroscience, University College London, London, UK.,Wellcome Trust Centre for Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Nilli Lavie
- Institute of Cognitive Neuroscience, University College London, London, UK
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Carbonero A, Paniagua J, Torralbo A, Arenas-Montes A, Borge C, García-Bocanegra I. Campylobacter infection in wild artiodactyl species from southern Spain: Occurrence, risk factors and antimicrobial susceptibility. Comp Immunol Microbiol Infect Dis 2014; 37:115-21. [DOI: 10.1016/j.cimid.2014.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 11/08/2013] [Accepted: 01/04/2014] [Indexed: 11/26/2022]
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Scalf PE, Torralbo A, Tapia E, Beck DM. Competition explains limited attention and perceptual resources: implications for perceptual load and dilution theories. Front Psychol 2013; 4:243. [PMID: 23717289 PMCID: PMC3650668 DOI: 10.3389/fpsyg.2013.00243] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/14/2013] [Indexed: 11/25/2022] Open
Abstract
Both perceptual load theory and dilution theory purport to explain when and why task-irrelevant information, or so-called distractors are processed. Central to both explanations is the notion of limited resources, although the theories differ in the precise way in which those limitations affect distractor processing. We have recently proposed a neurally plausible explanation of limited resources in which neural competition among stimuli hinders their representation in the brain. This view of limited capacity can also explain distractor processing, whereby the competitive interactions and bias imposed to resolve the competition determine the extent to which a distractor is processed. This idea is compatible with aspects of both perceptual load and dilution models of distractor processing, but also serves to highlight their differences. Here we review the evidence in favor of a biased competition view of limited resources and relate these ideas to both classic perceptual load theory and dilution theory.
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Affiliation(s)
- Paige E. Scalf
- Department of Psychology, University of ArizonaTucson, AZ, USA
| | - Ana Torralbo
- Institute of Cognitive Neuroscience, University College LondonLondon, UK
| | - Evelina Tapia
- Department of Psychology, Beckman Institute, University of IllinoisUrbana, IL, USA
| | - Diane M. Beck
- Department of Psychology, Beckman Institute, University of IllinoisUrbana, IL, USA
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Abstract
Flexibility in conceptual projection constitutes one of the most challenging issues in the embodiment and conceptual metaphor literatures. We sketch a theoretical proposal that places the burden of the explanation on attentional dynamics in interaction with mental models in working memory that are constrained to be maximally coherent. A test of this theory is provided in the context of the conceptual projection of time onto the domain of space. Participants categorized words presented at different spatial locations (back-front, left-right) as referring to the past or to the future. Responses were faster when the irrelevant word location was congruent with the back-past, front-future metaphoric mapping. Moreover, when a new highly task-relevant spatial frame of reference was introduced, it changed the projection of past and future onto space in a way that was congruent with the new frame (past was now projected to left space and future to right space), as predicted by the theory. This study shows that there is substantial flexibility in conceptual projection and opens a venue to study metaphoric variation across tasks, individuals, and cultures as the result of attentional dynamics.
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Affiliation(s)
- Ana Torralbo
- Departamento de Metodología, Universidad Autonoma de Madrid, SpainDept. de Psicología Experimental y Fisiología del Comportamiento, Universidad de Granada, Spain
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Abstract
Load theory of attention proposes that distractor processing is reduced in tasks with high perceptual load that exhaust attentional capacity within task-relevant processing. In contrast, tasks of low perceptual load leave spare capacity that spills over, resulting in the perception of task-irrelevant, potentially distracting stimuli. Tsal and Benoni (2010) find that distractor response competition effects can be reduced under conditions with a high search set size but low perceptual load (due to a singleton color target). They claim that the usual effect of search set size on distractor processing is not due to attentional load but instead attribute this to lower level visual interference. Here, we propose an account for their findings within load theory. We argue that in tasks of low perceptual load but high set size, an irrelevant distractor competes with the search nontargets for remaining capacity. Thus, distractor processing is reduced under conditions in which the search nontargets receive the spillover of capacity instead of the irrelevant distractor. We report a new experiment testing this prediction. Our new results demonstrate that, when peripheral distractor processing is reduced, it is the search nontargets nearest to the target that are perceived instead. Our findings provide new evidence for the spare capacity spillover hypothesis made by load theory and rule out accounts in terms of lower level visual interference (or mere "dilution") for cases of reduced distractor processing under low load in displays of high set size. We also discuss additional evidence that discounts the viability of Tsal and Benoni's dilution account as an alternative to perceptual load.
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Affiliation(s)
- Nilli Lavie
- Institute of Cognitive Neuroscience, University College London,London, UK.
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Carbonero A, Maldonado A, Perea A, García-Bocanegra I, Borge C, Torralbo A, Arenas-Montes A, Arenas-Casas A. Factores de riesgo del síndrome respiratorio bovino en terneros lactantes de Argentina. Arch zootec 2011. [DOI: 10.4321/s0004-05922011000100005] [Citation(s) in RCA: 3] [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: 11/11/2022] Open
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13
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Torralbo A, Chai B, Caddigan E, Walther D, Beck D, Fei-Fei L. Categorization of good and bad examples of natural scene categories. J Vis 2010. [DOI: 10.1167/9.8.940] [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: 11/24/2022] Open
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14
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Beck D, Torralbo A. Perceptual load-induced selection as a consequence of spatial interactions in visual cortex. J Vis 2010. [DOI: 10.1167/8.6.993] [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: 11/24/2022] Open
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15
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Lustig A, Torralbo A, Beck DM. Global feature-based inhibition for a task-irrelevant feature of an unattended stimulus. J Vis 2010. [DOI: 10.1167/9.8.138] [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: 11/24/2022] Open
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Carbonero A, Maldonado A, Perea A, García-Bocanegra I, Borge C, Torralbo A, Arenas-Montes A, Arenas-Casas A. Factores de riesgo del Síndrome respiratorio bovino en terneros lactantes de Argentina. ARCH ZOOTEC 2009. [DOI: 10.21071/az.v60i229.4687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Se ha realizado un estudio epidemiológico observacional de tipo transversal para conocer los factores que actúan sobre la seropositividad de los principales agentes víricos del síndrome respiratorio bovino: el herpesvirus bovino tipo 1 (HVB1), el virus de la diarrea vírica bovina (VDVB), el virus respiratorio sincitial bovino (VRSB) y el virus de la parainfluenza 3 (VPI3). Se tomaron muestras de sangre de terneros procedentes de explotaciones lecheras situadas en las provincias argentinas de Córdoba y Santa Fé, y se cumplimentaron cuestionarios epide-miológicos. Los análisis serológicos se realizaron mediante la técnica ELISA. En total se tomaron muestras de sangre de 852 terneros procedentes de 55 explotaciones entre los años 2000 y 2002. Se realizaron cuatro modelos epidemiológicos mediante regresión logística, uno por cada virus donde, entre otras, aparecen variables asociadas a la infección relacionadas con la edad del ternero, la estación del año, el número de animales, la alimentación, las vacunaciones o el sistema de crianza.
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Abstract
A growing literature suggests that the degree to which distracting information can be ignored depends on the perceptual load of the task, or the extent to which the task exhausts perceptual capacity. However, there is currently no a priori definition of what constitutes high or low perceptual load. We propose that interactions among cells in visual cortex that represent nearby stimuli determine the perceptual load of a task, and that manipulations designed to modulate these competitive spatial interactions should modulate distractor processing. We found that either spatially separating the task-relevant items in a display or placing the target and nontargets in different visual fields increased interference from a distractor that was to be ignored. These data are consistent with the idea that the ability to ignore such distracting information results in part from the need to actively resolve competitive interactions in visual cortex, and is not the consequence of an exhausted capacity per se.
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Affiliation(s)
- Ana Torralbo
- Facultad Psicología Universidad Autónoma de Madrid, Spain.
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López Revuelta K, Saracho R, García López F, Gentil MA, Castro P, Castilla J, Gutiérrez JA, Martín-Martínez E, Alonso R, Bernabéu R, Munar MA, Lorenzo V, Vega N, Escallada R, Sierra T, Lara M, Estébanez C, Clèries M, Vela E, Tallón S, García-Blasco MJ, Zurriaga O, Vázquez C, Sánchez-Casajús A, Torralbo A, Rodado R, Genovés A, Ripoll J, Asín JL, Magaz A, Aranzábal J. [Dialysis and Transplant Registry of the Spanish Society of Nephrology and regional registries. Rapport 2001]. Nefrologia 2004; 24:21-6, 28-33. [PMID: 15083954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- K López Revuelta
- Comité de Regristro de la SEN, comunidades y Registros Autonómicos
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Amenábar JJ, García López F, Robles NR, Saracho R, Pinilla J, Gentil MA, Castilla J, Gutiérrez JA, Martín-Martínez E, Alonso R, Bernabéu R, Lorenzo V, Vega N, Escallada R, Sierra T, Clèries M, Vela E, Tallón S, Cancho B, Vázquez C, Sánchez-Casajús A, Torralbo A, Ripoll J, Asín JL, Magaz A, García MJ, Zurriaga O. [Dialysis and transplantation report of the Spanish Nephrology Society and Autonomous Registries for the year 2000]. Nefrologia 2002; 22:310-7. [PMID: 12369121] [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: 02/26/2023] Open
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Portolés J, Torralbo A, Martin P, Rodrigo J, Herrero JA, Barrientos A. Cardiovascular effects of recombinant human erythropoietin in predialysis patients. Am J Kidney Dis 1997; 29:541-8. [PMID: 9100042 DOI: 10.1016/s0272-6386(97)90335-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.8] [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: 02/04/2023]
Abstract
Treatment with recombinant human erythropoietin (rHuEPO) has solved the problem of anemia in patients on dialysis. However, its application to predialysis patients has raised some doubts about its effects on the progression of renal disease and on blood pressure (BP) and hemodynamic regulation. We have prospectively studied over at least 6 months a group of 11 predialysis patients receiving rHuEPO treatment (initial dose, 1,000 U subcutaneously three times a week). Clinical assessment and biochemical and hematologic measurements were made once every 2 weeks. Twenty-four-hour ambulatory BP monitoring, echocardiography, and determination of neurohumoral mediators of hemodynamics were performed once every 3 months. An adequate hematologic response was found (hemoglobin, 11.7 +/- 0.4 g/dL v 9 +/- 0.3 g/dL) without changes in the progression of renal disease. A decrease in cardiac output and an increase in total peripheral resistance was seen as anemia improved. A trend toward decreased left ventricular (LV) thickness and a significant decrease in LV mass index (from 178.2 +/- 20.6 g/m2 to 147.3 +/- 20.6 g/m2) were observed. Blood pressure control did not improve; moreover, in some patients an increase in systolic values was detected by ambulatory BP. Casual BP remained seemingly stable. Sequential determinations of neurohumoral mediators of hemodynamic substances (endothelin, renin, norepinephrine, epinephrine, dopamine) failed to explain these results. Ambulatory BP reveals a worse control in some patients who were previously hypertensive and confirms the utility of this technique in the assessment of patients under erythropoietin treatment. The trend toward LV hypertrophy regression without improved BP control confirms the role of anemia among the multiple factors leading to LV hypertrophy in end-stage renal disease (ESRD), and opens therapeutic possibilities. Better control of BP may avoid a potential offsetting of beneficial effects that correcting anemia would have on the cardiovascular system.
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Affiliation(s)
- J Portolés
- Servicios de Nefrología y Cardiología, Hospital Universitario San Carlos, Madrid, Spain
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Fontanellas A, Torralbo A, Santos JL, Morán MJ, Barrientos A, Enríquez de Salamanca R. Reduced aminolevulinic dehydrase activity with increased blood porphyrins in experimental chronic renal failure. Exp Nephrol 1997; 5:95-9. [PMID: 9052854] [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: 02/03/2023]
Abstract
In the absence of anemia, rats with nephrectomy-induced renal failure displayed a reduced activity of erythrocyte aminolevulinate dehydrase, increased blood porphyrin levels, and a plasma capacity to inhibit the activity of the erythrocyte aminolevulinate dehydrase in vitro. Even though it did increase hemoglobin and hematocrit levels, treatment with erythropoietin had no effect on the derangements of porphyrin metabolism. No abnormalities of the heme pathway were observed in liver tissue. Experimental chronic renal failure reproduced the same abnormalities of porphyrin metabolism usually detected in patients with end-stage renal disease.
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Affiliation(s)
- A Fontanellas
- Porphyria Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
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Sanchez-Fructuoso AI, Torralbo A, Arroyo M, Luque M, Ruilope LM, Santos JL, Cruceyra A, Barrientos A. Occult lead intoxication as a cause of hypertension and renal failure. Nephrol Dial Transplant 1996. [DOI: 10.1093/oxfordjournals.ndt.a027667] [Citation(s) in RCA: 24] [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: 11/12/2022] Open
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Sánchez-Fructuoso AI, Torralbo A, Arroyo M, Luque M, Ruilope LM, Santos JL, Cruceyra A, Barrientos A. Occult lead intoxication as a cause of hypertension and renal failure. Nephrol Dial Transplant 1996. [DOI: 10.1093/ndt/11.9.1775] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sánchez-Fructuoso AI, Torralbo A, Arroyo M, Luque M, Ruilope LM, Santos JL, Cruceyra A, Barrientos A. Occult lead intoxication as a cause of hypertension and renal failure. Nephrol Dial Transplant 1996; 11:1775-80. [PMID: 8918621] [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: 02/03/2023] Open
Abstract
BACKGROUND The true incidence of lead (Pb) overload as a cause of chronic renal failure (CRF) is unknown. Also, it is unclear if CRF per se could generate an increment in the body Pb burden. Most studies of chronic Pb intoxication have been performed on cohorts or patients with a past history of occupational exposure. Therefore we studied the body Pb burden in CRF of known aetiology versus those patients with CRF with gout and hypertension of unclear aetiology without a past history of Pb exposure. In addition we studied patients diagnosed with essential hypertension. METHODS We studied 296 patients lacking a past history of Pb exposure, who were subdivided into four groups: group I (n = 30), normal control subjects; group II (n = 104), patients with 'essential' hypertension and normal renal function; group III (n = 132), patients with CRF of uncertain aetiology in association with hypertension and/or gout, and group IV (n = 30), patients with CRF of known aetiology. The blood and urine Pb levels were assessed before and after an EDTA test. RESULTS No abnormal test results were obtained for patients in groups I and IV. The EDTA test was abnormal in 16 patients (15.4%) in group II and in 74 patients (56.1%) in group III. A positive correlation was observed between plasma creatinine levels and post-EDTA urinary Pb in group III, but not in group I. No correlation regarding plasma creatinine and the duration of hypertension or gout were demonstrated. The bone Pb levels, measured in 12 patients with pathological EDTA test results, were positively correlated to the plasma creatinine levels. CONCLUSIONS A high percentage of patients with gout, hypertension, and CRF have an excessive Pb burden, and about 15% of the patients diagnosed as 'essential' hypertensives also show high Pb burdens. It is remarkable that a history of overt Pb exposure was lacking in the whole study population.
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Torralbo A, Blanco J, Fontanellas A, Herrero JA, Cruceyra A, González-Lŏpez P, Barrientos A. Long-term erythropoietin in rats with reduced renal mass. Nephron Clin Pract 1996; 73:280-5. [PMID: 8773356 DOI: 10.1159/000189052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 02/02/2023] Open
Abstract
Hematocrit increase with recombinant erythropoietin (rEPO) has been associated with increased progression of renal insufficiency in experimental models of renal mass reduction. The aim of the present study was to assess the effects of therapy with rEPO and various antihypertensives on the progression of chronic renal insufficiency and on arterial hypertension in an experimental model of renal mass reduction. Rats subjected to a two-thirds nephrectomy were randomly assigned to an untreated control group or to therapy with rEPO (subcutaneously, at an initial dose of 40 U/kg thrice weekly), rEPO plus verapamil (subcutaneously, 0.5 mg/kg/day), or rEPO plus enalapril (orally, 50 mg/l in the drinking water). Combining enalapril and rEPO therapy controlled systemic blood pressure (BP) and the increase in proteinuria. Glomerular injury, as assessed 16 weeks after renal ablation, was more marked in the animals treated with rEPO with or without either antihypertensive. The morphometric analyses showed greater glomerular tuft areas in the three groups receiving rEPO than in the controls. The glomerular tuft area was directly correlated with the rate of glomerulosclerosis. In about 11% of the rEPO-treated hypertensive rats, the lesions showed severe hypertensive vasculopathy; in the animals treated with rEPO plus enalapril, the lesions were less severe. We conclude that therapy with rEPO was associated to renal damage which could not be attenuated by enalapril despite controlling BP and proteinuria, and may have a nonhemodynamic cause. Therapy with rEPO might trigger lesions usually associated with severe arterial hypertension; concomitant therapy with enalapril attenuates hypertensive vasculopathy.
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Affiliation(s)
- A Torralbo
- Nephrology Service, Hospital Universitario San Carlos, Madrid, Spain
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Torralbo A, Trobo JI, Borque M, Herrero JA, Velasco E, Marcello M, González-Mate A, Barrientos A. Alterations in renal endothelin production in rats with reduced renal mass. Am J Kidney Dis 1995; 25:918-23. [PMID: 7771489 DOI: 10.1016/0272-6386(95)90575-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 01/27/2023]
Abstract
Renal endothelin-1 (ET-1) production is diminished in spontaneously hypertensive rats. An increase has been reported of renal ET-1 production associated with progression of renal disease in rats with reduced renal mass. The purpose of the present study was to investigate the evolution over time of the urinary ET-1 excretion in an experimental model of renal mass reduction not caused by renal infarction. Rats were subjected to 2/3 nephrectomy (right nephrectomy and resection of the lower left renal pole) and thereafter randomly assigned to a no-treatment control group or to treatment with recombinant erythropoietin, recombinant erythropoietin plus verapamil, or recombinant erythropoietin plus enalapril. The urinary ET-1 excretion was decreased by week 16 after nephrectomy as compared with healthy animals and with the levels 6 weeks after nephrectomy. The temporal evolution of urinary ET-1 excretion in the various groups of rats showed a trend toward decrease in all groups except the one receiving enalapril. The urinary ET-1 excretion correlated directly with creatinine clearance and inversely with tubulointerstitial damage. We observed an inverse correlation between urinary ET-1 excretion and arterial blood pressure 16 weeks after nephrectomy. These results indicate that renal ET-1 production decreases with the progression of renal disease and in relation with the severity of tubulointerstitial damage. The decrease in renal ET-1 production might contribute to the development and perpetuation of renal disease-associated arterial hypertension; this situation may be favorably modified by the use of enalapril.
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Affiliation(s)
- A Torralbo
- Nephrology Service, San Carlos University Hospital, Madrid, Spain
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Torralbo A, Portolés J, Maqueda S, Blanco J, Barrientos A. Sarcoidosis with normocalcemic interstitial nephritis. Clin Nephrol 1995; 43:65-6. [PMID: 7697939] [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: 01/26/2023] Open
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Torralbo A, Pina E, Portolés J, Sánchez-Fructuoso A, Barrientos A. Renal magnesium wasting with hypercalciuria, nephrocalcinosis and ocular disorders. Nephron Clin Pract 1995; 69:472-5. [PMID: 7777115 DOI: 10.1159/000188522] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [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: 01/27/2023] Open
Abstract
We report a case of congenital magnesium-losing kidney with associated hypercalciuria and ocular derangements consisting of myopia, bilateral macular colobomata and bilateral papillary dysversion and hypoplasia. Our patient provides further evidence of the existence of an oculorenal syndrome associating abnormalities in the renal handling of magnesium and calcium, and myopia and chorioretinal disease.
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Affiliation(s)
- A Torralbo
- Department of Nephrology, San Carlos University Hospital, Madrid, Spain
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Torralbo A, Herrerro JA, Portolés J, Fontanellas A, Barrientos A. Activation of the sympathetic nervous system in hemodialyzed patients treated with erythropoietin. Nephron Clin Pract 1995; 69:350. [PMID: 7753279 DOI: 10.1159/000188491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Herrero JA, Trobo JI, Torrente J, Torralbo A, Tornero F, Cruceyra A, Coronel F, Barrientos A. Hemodialysis with acetate, DL-lactate and bicarbonate: a hemodynamic and gasometric study. Kidney Int 1994; 46:1167-77. [PMID: 7861713 DOI: 10.1038/ki.1994.381] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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: 01/27/2023]
Abstract
Using invasive techniques we have studied various hemodynamic and gasometric parameters in the course of hemodialysis (HD) with different buffers in an animal model. HD sessions of 180 minutes at zero ultrafiltration were carried out on three groups of eight uremic dogs each, under anesthesia and constant mechanical ventilation. The three groups differed only in the buffer used: acetate (Group AC), equal proportions of DL-lactate and acetate (Group AC+LA), and bicarbonate (Group BC). No hemodynamic changes were seen in Group BC. In the AC and AC+LA groups we observed on minute 1 a decrease of the mean blood pressure (MBP) and of the systemic vascular resistances (SVR). These parameters returned to baseline values within the first 30 minutes in Group AC+LA. In Group AC the SVR also returned to baseline values after the minute 30, but the MBP remained below baseline throughout the study period, together with cardiac index and left ventricular stroke work index decreases. Only in Group AC did we see a flattening of the ventricular function curves. Only in this Group was there a decrease of the arterial oxygen pressure (PaO2) with an associated increase of the alveolo-arterial and arterio-venous O2 differences. The O2 consumption was not modified in any of the groups. Acetate as a single buffer induces hemodynamic instability through peripheral vasodilation and reduction of myocardial contractility. The myocardial depression induced by acetate, in its turn, causes a reduction in PaO2. The mixed acetate+lactate buffer is hemodynamically better tolerated than acetate as single buffer, as it induces only vasodilation.
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Affiliation(s)
- J A Herrero
- Nephrology Service, Hospital Universitario San Carlos, Madrid, Spain
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Portolés J, Prats D, Torralbo A, Herrero JA, Torrente J, Barrientos A. Visceral leishmaniasis: a cause of opportunistic infection in renal transplant patients in endemic areas. Transplantation 1994; 57:1677-9. [PMID: 8009605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J Portolés
- Nephrology Service, Hospital Universitario San Carlos, Madrid, Spain
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Torralbo A, Herrero JA, Portolés J, Barrientos A. Alveolar hemorrhage associated with antineutrophil cytoplasmic antibodies in rheumatoid arthritis. Chest 1994; 105:1590-2. [PMID: 8181365 DOI: 10.1378/chest.105.5.1590] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [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: 01/29/2023] Open
Abstract
A 65-year-old woman with previously known rheumatoid arthritis and chronic renal failure of possible glomerular origin was admitted to the hospital because of hemoptysis and respiratory insufficiency. Antineutrophil cytoplasmic antibodies (ANCAs) with antimyeloperoxidase activity were detected in her serum. The lung biopsy specimen evidenced alveolar hemorrhage. Under immunosuppressive therapy with steroids and cyclophosphamide, the patient's condition improved both clinically and radiologically, and the ANCA became negative after 6 months' therapy.
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Affiliation(s)
- A Torralbo
- Nephrology Service, Hospital Universitario San Carlos, Madrid, Spain
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Barrientos A, Portolés J, Herrero JA, Torralbo A, Prats D, Gutierrez-Millet V, Blanco J. Glomerular hyperfiltration as a nonimmunologic mechanism of progression of chronic renal rejection. Transplantation 1994; 57:753-6. [PMID: 8140641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- A Barrientos
- Nephrology Service, Hospital Universitario San Carlos, Spain
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Torralbo A, Portolés J, Ortega L, Barrientos A. [Correction of resistance to erythropoietin after parathyroidectomy]. Med Clin (Barc) 1993; 101:515. [PMID: 8231388] [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: 01/29/2023]
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Abstract
Hypomagnesemic hypocalcemia in chronic renal disease is a rare finding. Controversy remains regarding the role of decreased magnesium in producing impaired parathyroid hormone (PTH) secretion versus target organ unresponsiveness to PTH. We describe six patients with severe chronic renal disease in whom hypocalcemia and hypomagnesemia were detected. Five patients had chronic interstitial nephropathy; all of them showed renal magnesium wasting. One patient had chronic glomerulonephritis and a malabsorption syndrome and showed a low rate of urinary excretion of magnesium. The administration of magnesium increased calcium levels in all patients. We have found elevated PTH levels in absolute terms, which, however, were inappropriate to correct hypocalcemia; the PTH levels increased in three patients and not in the other three after magnesium replacement. We conclude that in patients with tubulointerstitial nephropathies, chronic renal losses of magnesium can produce hypomagnesemic hypocalcemia.
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Affiliation(s)
- A Torralbo
- Nephrology Service, Hospital Universitario San Carlos, Madrid, Spain
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