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Wanderlei-Flores B, Rey-Brandariz J, Rodrigues Pinto Corrêa PC, Ruano-Ravina A, Guerra-Tort C, Candal-Pedreira C, Varela-Lema L, Montes A, Pérez-Ríos M. Smoking-attributable mortality by sex in the 27 Brazilian federal units: 2019. Public Health 2024; 229:24-32. [PMID: 38382178 DOI: 10.1016/j.puhe.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/23/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES The aim of this study was to estimate smoking-attributable mortality (SAM) in the population aged 35 years and over in Brazil's 27 federal units by sex, in 2019. STUDY DESIGN This is an attributable mortality analysis. METHODS We applied a method dependent on the prevalence of smoking, based on the population attributable fractions. Data on mortality due to causes causally related to smoking were derived from Brazil's Death Registry, data on prevalence of smoking from a survey conducted in Brazil in 2019, and data on relative risks from five US cohorts. Crude and age-adjusted SAM rates were calculated by sex. Estimates of SAM were calculated by specific causes of death and major mortality groups for each federal unit by sex. RESULTS In 2019, smoking caused 480 deaths per day in Brazil. Although the SAM varied among the federal units, the pattern is not clear, with the greatest difference being between Rio Grande do Sul (crude rate: 248.8/100,000 inhabitants) and Amazonas (106.0/100,000). When the rates were adjusted by age, the greatest differences were observed between Acre (271.1/100,000) and Distrito Federal (131.1/100,000). SAM was higher in males; however, while the main specific cause of SAM in men was ischemic heart disease, in women it was chronic obstructive pulmonary disease. The major mortality group having the greatest impact on SAM across all federal units was the cardiometabolic diseases. CONCLUSIONS The variability in the burden of SAM in the different regions of Brazil reaffirms the need for SAM data disaggregated at the geographic level.
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Affiliation(s)
- B Wanderlei-Flores
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - J Rey-Brandariz
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain.
| | | | - A Ruano-Ravina
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - C Guerra-Tort
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - C Candal-Pedreira
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
| | - L Varela-Lema
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - A Montes
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - M Pérez-Ríos
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Valor D, García-Casas I, Montes A, Danese E, Pereyra C, de la Ossa EM. Supercritical Impregnation of Mangifera indica Leaves Extracts into Porous Conductive PLGA-PEDOT Scaffolds. Polymers (Basel) 2023; 16:133. [PMID: 38201798 PMCID: PMC10780670 DOI: 10.3390/polym16010133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Plant leaves, such as those from Mangifera indica, represent a potential utilization of waste due to their richness in bioactive compounds. Supercritical CO2 allows these compounds to be incorporated into various matrices by impregnation. Combined with its ability to generate polymeric scaffolds, it represents an attractive strategy for the production of biomedical devices. For this purpose, conjugated polymeric scaffolds of biodegradable PLGA (poly(lactic-co-glycolic acid)) and PEDOT:PSS (poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate)), generated in situ by foaming, were employed for the supercritical impregnation of ethanolic mango leaves extract (MLE) in tissue engineering as a potential application. The extraction of MLE was performed by Enhanced Solvent Extraction. The effects of pressure (120-300 bar), temperature (35-55 °C), and depressurization rate (1-50 bar/min) on the physical/conductive properties and the impregnation of MLE were studied. The scaffolds have been characterized by liquid displacement, scanning electron microscope, resistance to conductivity techniques, measurements of impregnated load, antioxidant capacity and antimicrobial activity. Porosity values ranging 9-46% and conductivity values between 10-4-10-5 S/cm were obtained. High pressures, low temperatures and rapid depressurization favored the impregnation of bioactive compounds. Scaffolds with remarkable antioxidant activity were obtained (75.2-87.3% oxidation inhibition), demonstrating the ability to inhibit S. aureus bacterial growth (60.1 to 71.4%).
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Affiliation(s)
- Diego Valor
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, International Excellence Agrifood Campus (CeiA3), University of Cádiz, 11510 Puerto Real, Spain; (D.V.); (I.G.-C.); (C.P.); (E.M.d.l.O.)
| | - Ignacio García-Casas
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, International Excellence Agrifood Campus (CeiA3), University of Cádiz, 11510 Puerto Real, Spain; (D.V.); (I.G.-C.); (C.P.); (E.M.d.l.O.)
| | - Antonio Montes
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, International Excellence Agrifood Campus (CeiA3), University of Cádiz, 11510 Puerto Real, Spain; (D.V.); (I.G.-C.); (C.P.); (E.M.d.l.O.)
| | - Ella Danese
- Faculty of Chemistry and Technology, University of Split, 21000 Split, Croatia;
| | - Clara Pereyra
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, International Excellence Agrifood Campus (CeiA3), University of Cádiz, 11510 Puerto Real, Spain; (D.V.); (I.G.-C.); (C.P.); (E.M.d.l.O.)
| | - Enrique Martínez de la Ossa
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, International Excellence Agrifood Campus (CeiA3), University of Cádiz, 11510 Puerto Real, Spain; (D.V.); (I.G.-C.); (C.P.); (E.M.d.l.O.)
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García-Casas I, Montes A, de los Santos DM, Valor D, Pereyra C, de la Ossa EM. Generation of high-porosity cerium oxide nanoparticles and their functionalization with caryophyllene oxide using supercritical carbon dioxide. J Supercrit Fluids 2023. [DOI: 10.1016/j.supflu.2023.105901] [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: 03/04/2023]
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Samani A, Bennett R, Eremeishvili K, Kalofonou F, Whear S, Montes A, Kristeleit R, Krell J, McNeish I, Ghosh S, Tookman L. Corrigendum to 'Glomerular filtration rate estimation for carboplatin dosing in patients with gynaecological cancers': [ESMO Open volume 7 (2022) 10.1016/j.esmoop.2022.100401]. ESMO Open 2023; 8:100640. [PMID: 37071958 PMCID: PMC10130064 DOI: 10.1016/j.esmoop.2022.100640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Affiliation(s)
- A Samani
- Department of Surgery and Cancer, Imperial College London, London; Department of Medical Oncology, Imperial College Healthcare NHS Trust, London
| | - R Bennett
- Department of Medical Oncology, Imperial College Healthcare NHS Trust, London
| | - K Eremeishvili
- Guy's Cancer Centre, Guy's and St. Thomas'NHS Foundation Trust, London, UK
| | - F Kalofonou
- Department of Medical Oncology, Imperial College Healthcare NHS Trust, London
| | - S Whear
- Department of Surgery and Cancer, Imperial College London, London
| | - A Montes
- Guy's Cancer Centre, Guy's and St. Thomas'NHS Foundation Trust, London, UK
| | - R Kristeleit
- Guy's Cancer Centre, Guy's and St. Thomas'NHS Foundation Trust, London, UK
| | - J Krell
- Department of Surgery and Cancer, Imperial College London, London; Department of Medical Oncology, Imperial College Healthcare NHS Trust, London
| | - I McNeish
- Department of Surgery and Cancer, Imperial College London, London; Department of Medical Oncology, Imperial College Healthcare NHS Trust, London
| | - S Ghosh
- Guy's Cancer Centre, Guy's and St. Thomas'NHS Foundation Trust, London, UK
| | - L Tookman
- Department of Surgery and Cancer, Imperial College London, London; Department of Medical Oncology, Imperial College Healthcare NHS Trust, London.
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Novella SR, Cobo A, Montes A, Lopez JS, Rondan MA, Palanca SN, Tena I, Miguel J, Navarro B, Domingo I, Esteban SC, Díaz M, Andrade P, Rosello E, Santander JL, Estelles DL, Hernández AS. 70P Impact of TP53/KRAS mutations on overall survival of metastatic non-small cell lung cancer patients (pts) treated with systemic first-line therapy. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00324-6] [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: 04/03/2023]
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Montes A, Valor D, Penabad Y, Domínguez M, Pereyra C, de la Ossa EM. Formation of PLGA-PEDOT: PSS Conductive Scaffolds by Supercritical Foaming. Materials (Basel) 2023; 16:2441. [PMID: 36984321 PMCID: PMC10057315 DOI: 10.3390/ma16062441] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
The usage of conjugated materials for the fabrication of foams intended to be used as therapeutic scaffolds is gaining relevance these days, as they hold certain properties that are not exhibited by other polymer types that have been regularly used until the present. Hence, this work aims to design a specific supercritical CO2 foaming process that would allow the production of porous polymeric devices with improved conductive properties, which would better simulate matrix extracellular conditions when used as therapeutic scaffolds (PLGA-PEDOT:PSS) systems. The effects of pressure, temperature, and contact time on the expansion factor, porosity, mechanical properties, and conductivity of the foam have been evaluated. The foams have been characterized by scanning electron and atomic force microscopies, liquid displacement, PBS degradation test, compression, and resistance to conductivity techniques. Values close to 40% porosity were obtained, with a uniform distribution of polymers on the surface and in the interior, expansion factors of up to 10 orders, and a wide range of conductivity values (2.2 × 10-7 to 1.0 × 10-5 S/cm) and mechanical properties (0.8 to 13.6 MPa Young's modulus in compression test). The conductive and porous scaffolds that have been produced by supercritical CO2 in this study show an interesting potential for tissue engineering and for neural or cardiac tissue regeneration purposes due to the fact that electrical conductivity is a crucial factor for proper cell function and tissue development.
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Affiliation(s)
- Antonio Montes
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, University of Cadiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Cadiz, Spain
| | - Diego Valor
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, University of Cadiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Cadiz, Spain
| | - Yaiza Penabad
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, University of Cadiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Cadiz, Spain
| | - Manuel Domínguez
- Department Condensed Matter Physics and Institute of Electron Microscopy and Materials, Faculty of Sciences, University of Cadiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Cadiz, Spain
| | - Clara Pereyra
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, University of Cadiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Cadiz, Spain
| | - Enrique Martínez de la Ossa
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, University of Cadiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Cadiz, Spain
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Ríos MP, López-Medina DC, Tort CG, Brandariz JR, Lema LV, Santiago-Pérez MI, Candal C, Montes A, López MJ, Dalmau R, Provencio M, Fernández E, Blanco A, Ravina AR. Mortality attributable to environmental tobacco smoke exposure in Spain in 2020. Arch Bronconeumol 2023; 59:305-310. [PMID: 36967344 DOI: 10.1016/j.arbres.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Exposure to environmental tobacco smoke (ETS) is associated with increased mortality and morbidity. The objective of this study was to estimate the impact of ETS exposure in Spain on mortality in 2020 in the population aged 35 years and over. METHODS A method of estimating attributable mortality (AM) based on the prevalence of ETS exposure was applied. Prevalence data were obtained from a representative study conducted in Spain and the relative risks were derived from a meta-analysis. AM point estimates are presented along with 95% confidence intervals (95% CI), calculated using a bootstrap naive procedure. AM, both overall and by smoking habit, was estimated for each combination of sex, age group, and cause of death (lung cancer and ischemic heart disease). A sensitivity analysis was performed. RESULTS A total of 747 (95% CI 676-825) deaths were attributable to ETS exposure, of which 279 (95% CI 256-306) were caused by lung cancer, and 468 (95% CI 417-523) by ischemic heart disease. Three-quarters (75.1%) of AM occurred in men and 60.9% in non-smokers. When chronic obstructive pulmonary disease and cerebrovascular disease are included, the burden of AM is estimated at 2242 deaths. CONCLUSIONS ETS exposure is associated with 1.5% of all deaths from lung cancer and ischemic heart disease in the population aged 35 and over. These data underline the need for health authorities to focus on reducing exposure to ETS in all settings and environments.
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Canillas L, Pelegrina A, Álvarez J, Colominas-González E, Salar A, Aguilera L, Burdio F, Montes A, Grau S, Grande L, Carrión JA. Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease. Life (Basel) 2023; 13:life13010132. [PMID: 36676081 PMCID: PMC9860873 DOI: 10.3390/life13010132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
(1) Background: Patients with advanced chronic liver disease (ACLD) are living longer with more comorbidities because of improved medical and surgical management. However, patients with ACLD are at increased risk of perioperative morbidity and mortality; (2) Methods: We conducted a comprehensive review of the literature to support a narrative clinical guideline about the assessment of mortality risk and management of perioperative morbidity in patients with ACLD undergoing surgical procedures; (3) Results: Slight data exist to guide the perioperative management of patients with ACLD, and most recommendations are based on case series and expert opinion. The severity of liver dysfunction, portal hypertension, cardiopulmonary and renal comorbidities, and complexity of surgery and type (elective versus emergent) are predictors of perioperative morbidity and mortality. Expert multidisciplinary teams are necessary to evaluate and manage ACLD before, during, and after surgical procedures; (4) Conclusions: This clinical practice document updates the available data and recommendations to optimize the management of patients with advanced chronic liver disease who undergo surgical procedures.
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Affiliation(s)
- Lidia Canillas
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Liver Section, Gastroenterology Department, Hospital del Mar, 08003 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Amalia Pelegrina
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Department of Surgery, Hospital del Mar, 08003 Barcelona, Spain
| | - Juan Álvarez
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Anesthesia Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Elena Colominas-González
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Pharmacy Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Antonio Salar
- Haematology Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Lluís Aguilera
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Anesthesia Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Fernando Burdio
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Department of Surgery, Hospital del Mar, 08003 Barcelona, Spain
| | - Antonio Montes
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Anesthesia Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Santiago Grau
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Pharmacy Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Luis Grande
- Department of Surgery, Hospital del Mar, 08003 Barcelona, Spain
- Department de Medicina, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
| | - José A. Carrión
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Liver Section, Gastroenterology Department, Hospital del Mar, 08003 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Correspondence: ; Tel.: +93-248-3220; Fax: +93-221-8644
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Montes A, Merino E, Valor D, Guamán-Balcázar MC, Pereyra C, Martínez de la Ossa EJ. From olive leaves to spherical nanoparticles by one-step RESS process precipitation. Eur Food Res Technol 2022. [DOI: 10.1007/s00217-022-04127-3] [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: 11/03/2022]
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Vera Sainz A, Cecconi A, Ximenez Carrillo A, Ramos C, Martinez Vives P, Lopez Melgar B, Sanz Garcia A, Ortega G, Montes A, Aguirre C, Vivancos J, Alfonso F, Jimenez-Borreguero LJ. Advanced echocardiography with left atrial strain and indexed left atrial 3D volume for predicting underlying atrial fibrillation after cryptogenic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cryptogenic stroke (CS) represents one-third of ischemic strokes. Atrial fibrillation (AF) can be detected in up to 30% of CS. Therefore, there is a clinical need for predicting AF to guide the optimal secondary prevention strategy. The evidence about the role of advanced echocardiography, including left atrial 3D index volume and left atrial strain (LAS) techniques, to predict underlying AF in this setting is lacking.
Methods
From April 2019 to November 2021 seventy-eight consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Echocardiography was performed during admission. All patients underwent 15 days wearable Holter monitoring. The primary outcome measure was AF detection during follow-up.
Results
Twenty -two patients (28%) developed AF. Patients in the AF group were older (81±6.3 vs 76.5±7.8 years; p=0.012). Left atrial (LA) diastolic indexed volume was higher in AF group (37.2±12.8 vs 29.7±11 ml/m2 p=0.01). 3D LA indexed volume were also higher in patients with AF (41.4±14 vs 32.2±10 ml/m2 p=0.009). LAS reservoir, LAS conduct and LAS contraction (LASct) were significantly lower in patients with AF (19±5.6 vs 32±10.3%; 9±4.5 vs 15±7.6; 10±5.3 vs 17±6.4, respectively, all p<0.001). On multivariate analysis LASct <13.5% and LA 3D indexed volume >44.5 ml/m2 were independent predictors of AF (OR 10.9 [95% CI 1.09–108.2], p=0.042) (Table 1, Figure 1)
Conclusion
LASct <13.5% and LA 3D indexed volume >44.5 ml/m2 are independent predictors of underlying AF in patients with CS. Our results demonstrate the usefulness of advanced echocardiography in this challenging clinical setting.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Spanish Society of Cardiology
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Affiliation(s)
- A Vera Sainz
- Navarra University Hospital, Pamplona , Navarra , Spain
| | - A Cecconi
- University Hospital of La Princesa , Madrid , Spain
| | | | - C Ramos
- University Hospital of La Princesa , Madrid , Spain
| | | | | | | | - G Ortega
- University Hospital of La Princesa , Madrid , Spain
| | - A Montes
- University Hospital of La Princesa , Madrid , Spain
| | - C Aguirre
- University Hospital of La Princesa , Madrid , Spain
| | - J Vivancos
- University Hospital of La Princesa , Madrid , Spain
| | - F Alfonso
- University Hospital of La Princesa , Madrid , Spain
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Guamán-Balcázar MDC, Montes A, Valor D, Coronel Y, De los Santos DM, Pereyra C, Martínez de la Ossa EJ. Inclusion of Natural Antioxidants of Mango Leaves in Porous Ceramic Matrices by Supercritical CO 2 Impregnation. Materials (Basel) 2022; 15:5934. [PMID: 36079317 PMCID: PMC9457324 DOI: 10.3390/ma15175934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Mango is one of the most important, medicinal tropical plants in the world from an economic point of view due to the presence of effective bioactive substances as co-products in its leaves. The aim of this work was to enhance the impregnation of natural antioxidants from mango leaves into a porous ceramic matrix. The effects of pressure, temperature, impregnation time, concentration of the extract and different porous silica on impregnation of phenolic compounds and antioxidant activity were analyzed. The volume of the pressurized fluid extract and amount of porous ceramic matrix remained constant. The best impregnation conditions were obtained at 6 h, 300 bar, 60 mg/mL, 35 °C and with MSU-H porous silica. The results indicated that increasing the pressure, concentration of the extract and temperature during impregnation with phenolic compounds such as gallic acid and iriflophenone 3-C (2-O-p-hydroxybenzolyl)-β-D-glucoside increased the antioxidant activity and the amount of total phenols.
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Affiliation(s)
- María del Cisne Guamán-Balcázar
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, University of Cádiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Spain
- Departamento de Química, Universidad Técnica Particular de Loja, San Cayetano Alto sn, AP, Loja 1101608, Ecuador
| | - Antonio Montes
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, University of Cádiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Spain
| | - Diego Valor
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, University of Cádiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Spain
| | - Yorky Coronel
- Departamento de Química, Universidad Técnica Particular de Loja, San Cayetano Alto sn, AP, Loja 1101608, Ecuador
| | - Desireé M. De los Santos
- Department of Physical Chemistry, Faculty of Sciences, University of Cádiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Spain
| | - Clara Pereyra
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, University of Cádiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Spain
| | - Enrique J. Martínez de la Ossa
- Department of Chemical Engineering and Food Technology, Faculty of Sciences, University of Cádiz, International Excellence Agrifood Campus (CeiA3), 11510 Puerto Real, Spain
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Machado APDF, Montes A, Valor D, Fernández-Ponce MT, Barbero GF, Maróstica Júnior MR, Pereyra C, de la Ossa EM. Co-precipitation of grape residue extract using sub- and supercritical CO2 technology. J CO2 UTIL 2022. [DOI: 10.1016/j.jcou.2022.102010] [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: 10/18/2022]
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Polanco-García M, Granero R, Gallart L, García-Lopez J, Montes A. Finding the vulnerable postoperative population: A two-step cluster analysis of the PAIN-OUT registry. Eur J Pain 2022; 26:1732-1745. [PMID: 35762292 DOI: 10.1002/ejp.1997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/08/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Identifying predictors of poor postoperative outcomes is crucial for planning personalized pain treatments. The aim of this study was to examine pain outcomes using cluster analysis in N=2,678 patients from the PAIN-OUT registry at first postoperative day. METHODS Indicator variables of the clustering analysis assessed multiple domains, such as clinical and surgical conditions, analgesic-anesthetic variables, desire for more pain treatment and outcome variables of the International Pain Outcome Questionnaire (IPO) summarized as factor scores. RESULTS Two-step cluster identified the three-cluster solution as the optimal. Two empirical groups (C1 and C2) included patients with good postoperative outcomes discriminated by peripheral nerve block use, while the other cluster (C3) grouped patients with the worst outcomes, where all patients desired more pain treatment. C3 comprised about 20% of the participants, mostly lower limb, abdominal and spine procedures. The best predictors of belonging to C3 included younger age, being male, preoperative opioid use, bone and fracture reduction procedures, institution, number of comorbidities and morphine equivalents in the recovery room. CONCLUSIONS IPO factor scores can be used to select pain outcomes phenotypes in large clinical databases. Most of the predictors were present before the recovery period so perioperative planning should focus in the preoperative and intraoperative periods.
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Affiliation(s)
- Mauricio Polanco-García
- Department of Anesthesiology, Consorci Sanitari Integral, Hospital Sant Joan Despí Moisès Broggi and Hospital General de l'Hospitalet, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain.,Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Spain
| | - Lluís Gallart
- Department of Anesthesiology, Hospital del Mar. IMIM (Hospital del Mar Medical Research Institute). Universitat Autònoma de Barcelona, Spain
| | - Jaume García-Lopez
- Department of Anesthesiology, Hospital del Mar. IMIM (Hospital del Mar Medical Research Institute). Universitat Autònoma de Barcelona, Spain
| | - Antonio Montes
- Department of Anesthesiology, Hospital del Mar. IMIM (Hospital del Mar Medical Research Institute). Universitat Autònoma de Barcelona, Spain
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Medel J, Serrano A, Batet C, Lorente L, Bella S, Ferrandiz M, Monerris MDM, Boada S, Villoria J, Ribera MV, Montes A, Videla S. Advances and Pitfalls of Specialized Pain Care through Public and Private Health Care Providers in Catalonia and the Balearic Islands: A Physician's Survey. Pain Res Manag 2022; 2022:4077139. [PMID: 35637851 PMCID: PMC9148249 DOI: 10.1155/2022/4077139] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/08/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
Optimal diagnosis and treatment of pain require a multidisciplinary approach that demands considerable coordination and forethought. A cross-sectional physician survey based on an online questionnaire was carried out to assess the adoption of multidisciplinary working patterns, compare the public and private models, and provide an update on the resources and organization of specialized pain care in Catalonia and the Balearic Islands. Active pain practitioners identified through the Catalan Health Service and Pain Society databases were sent an invitation in December 2020. Of the 321 physicians contacted, 91 (28.3%) answered and 71 provided complete responses (commonly anesthesiologists, representing 92 different sites; some worked at public and private sites). Up to 78.7% reported working in pain management teams, but only 53.5% were regularly involved in teaching or research activities. Thus, the proportion of multidisciplinary sites lies somewhere in-between. Median wait times were significantly shorter and within the recommended standards in private practices (e.g., 15 vs. 90 days in public practices for noncancer patients). In turn, private practices were slightly less staffed and equipped, albeit the differences did not reach statistical significance. Respondents made a median of 530 regular and 30 emergency visits per year, of which 190 involved interventional procedures. They offered a wide range of pharmacological and interventional therapies, although psychotherapy and the most sophisticated procedures were only available in ≤50% of sites. Pain clinicians and facilities are reasonably available in Catalonia, but barely more than half are truly multidisciplinary. Public and private practices differ in some aspects; the latter seems to be more accessible, but it is restricted to patients who can afford it. Compared to previous reports, this update shows both advances and outstanding issues. Multidisciplinary care could be expanded by incorporating more psychologists and some interventional procedures. The public practices should reduce wait times.
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Affiliation(s)
- Javier Medel
- Pain Unit, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebron 119, Barcelona 08035, Spain
| | - Ancor Serrano
- Pain Unit, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, L'Hospitalet de Llobregat 08907, Spain
| | - Carme Batet
- Pain Unit, Consorci Sanitari Integral, Hospital de Sant Joan Despí Moisès Broggi, Carrer Oriol Martorell 12, Sant Joan Despí 08907, Spain
| | - Lluis Lorente
- Pain Unit, Institut de Medicina i Cirurgia de Barcelona, Carrer Bisbe Sivilla 46, Barcelona 08022, Spain
| | - Susana Bella
- Pain Unit, Hospital Universitari Sant Joan de Reus, Avinguda Del Doctor Josep Laporte 2, Reus 43204, Spain
| | - Marta Ferrandiz
- Pain Unit, Hospital Universitari de La Santa Creu i Sant Pau, Carrer de Sant Quintí 89, Barcelona 08041, Spain
| | | | - Sergi Boada
- Pain Unit, Hospital Universitari Joan 23, Carrer Dr. Mallafrè Guasch 4, Tarragona 43005, Spain
| | - Jesus Villoria
- Department of Design and Biometrics, Medicxact, Plaza Ermita 4, Alpedrete, Spain
| | - Maria-Victoria Ribera
- Pain Unit, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebron 119, Barcelona 08035, Spain
| | - Antonio Montes
- Pain Unit, Hospital Del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain
| | - Sebastian Videla
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, Carrer de La Feixa Llarga, L'Hospitalet de Llobregat 08907, Spain
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, Carrer de La Feixa Llarga, L'Hospitalet de Llobregat 08907, Spain
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15
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Samani A, Bennett R, Eremeishvili K, Kalofonou F, Whear S, Montes A, Kristeleit R, Krell J, McNeish I, Ghosh S, Tookman L. Glomerular filtration rate estimation for carboplatin dosing in patients with gynaecological cancers. ESMO Open 2022; 7:100401. [PMID: 35227967 PMCID: PMC9058909 DOI: 10.1016/j.esmoop.2022.100401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/29/2021] [Revised: 12/31/2021] [Accepted: 01/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background Carboplatin remains integral for treatment of gynaecological malignancies and dosing is based on glomerular filtration rate (GFR). Measurement via radiotracer decay [nuclear medicine GFR (nmGFR)] is ideal. However, this may be unavailable. Therefore GFR is often estimated using formulae that have not been validated in patients with cancer and/or specifically for gynaecological malignancies, leading to debate over optimal estimation. Suboptimal GFR estimation may affect efficacy or toxicity. Methods We surveyed several UK National Health Service Trusts to assess carboplatin dosing practise. We then explored single-centre accuracy, bias and precision of various formulae for GFR estimation, relative to nmGFR, before validating our findings in an external cohort. Results Across 18 Trusts, there was considerable heterogeneity in GFR estimation, including the formulae used [Cockcroft–Gault (CG) versus Wright], weight adjustment and area under the curve (AUC; 5 versus 6). We analysed 274 and 192 patients in two centres. Overall, CamGFR v2 (a novel formula for GFR estimation developed at Cambridge University Hospitals NHS Foundation Trust) excelled, showing the highest accuracy and precision. This translated into accuracy of hypothetical carboplatin dosing; nmGFR-derived carboplatin dose fell within 20% of the Cam GFR v2-derived dose in 86.5% and 87% of patients across the cohorts. Among the CG formula and its derivatives, using adjusted body weight in those with body mass index ≥25 kg/m2 [CG-adjusted body weight (CG-AdBW)] was optimal. The Wright and unadjusted CG estimators performed most poorly. Conclusions When compared with nmGFR assessment, accuracy, bias and precision varied widely between GFR estimators, with the newly developed Cam GFR v2 and CG-AdBW performing best. In general, weight (or body surface area)-adjusted formulae excelled, while the unadjusted CG and Wright formulae or the use of AUC6 (versus nmGFR AUC5) produced risk of significant overdose. Thus, individual centres should validate their GFR estimation methods. In the absence of validation, CG-AdBW or CamGFR v2 is likely to perform well while unadjusted CG/Wright formulae or AUC6 dosing should be avoided. Despite therapeutic advances, carboplatin is still used repeatedly for treatment of gynaecological cancers. Between centres, there is heterogenous use of GFR estimation methods for carboplatin dosing. The novel CamGFR v2 and CG-AdBW are the most accurate estimators. The Wright formula, unadjusted CG and the use of AUC6 with estimated GFR should all be avoided. If internal validation unavailable, centres should use CamGFR v2 or CG-AdBW for GFR estimation.
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Affiliation(s)
- A Samani
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Medical Oncology, Imperial College Healthcare NHS Trust, London, UK. https://twitter.com/amit_samani1
| | - R Bennett
- Department of Medical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - K Eremeishvili
- Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - F Kalofonou
- Department of Medical Oncology, Imperial College Healthcare NHS Trust, London, UK. https://twitter.com/FKalofonou
| | - S Whear
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Montes
- Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - R Kristeleit
- Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J Krell
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Medical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - I McNeish
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Medical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - S Ghosh
- Guy's Cancer Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK. https://twitter.com/sharmisthaghosh
| | - L Tookman
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Medical Oncology, Imperial College Healthcare NHS Trust, London, UK.
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16
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Valor D, Montes A, Cózar A, Pereyra C, Martínez de la Ossa E. Development of Porous Polyvinyl Acetate/Polypyrrole/Gallic Acid Scaffolds Using Supercritical CO 2 as Tissue Regenerative Agents. Polymers (Basel) 2022; 14:polym14040672. [PMID: 35215583 PMCID: PMC8878901 DOI: 10.3390/polym14040672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/24/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 01/15/2023] Open
Abstract
Scaffolds are advanced devices employed in tissue engineering, as they are intended to mimic the characteristics of extracellular matrices. In this respect, conjugated materials are gaining relevance in the manufacturing of the foams used for therapeutic scaffolds, since they can provide certain properties that are missing in the other polymers used to form the scaffolds. This work has, therefore, focused on the development of functional scaffolds formed by conjugated-non-conjugated polymers such as polyvinyl acetate and polypyrrole, impregnated with gallic acid as the model drug and produced by means of a supercritical CO2 foaming/impregnation process. The effects from a series of parameters such as pressure, temperature, depressurization rate, and contact time of the scaffold production process have been determined. The impregnated foams have been characterized according to their morphology, including their porosity and expansion factor, their drug loading and delivering capabilities, and their mechanical and electrical properties. The characterization of the experiments was carried out using scanning electron microscopy, liquid displacement, in vitro release, electrochemical impedance spectroscopy, and compression techniques. The results from our tests have revealed a considerable influence of all the input variables studied, as well as relevant interactions between them. Values close to 35% porosity were obtained, with a drug release of up to 10 h with a fast initial release. The best operating conditions were 353 K, 30 MPa, 0.5 MPa/min depressurization rate, and 1 h contact time. By means of the supercritical foaming/impregnation technique, scaffolds with potential in tissue engineering due to their studied properties were obtained.
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17
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Montes A, Pozo Osinalde E, Bastante T, Cecconi A, Garcia-Guimaraes M, Rivero F, De Rueda C, Rojas Gonzalez A, Olivera MJ, Salamanca J, De Agustin JA, Caballero P, Aguilar Torres R, Jimenez Borreguero LJ, Alfonso Manterola F. Intracoronary thrombus assessment with cardiac computed tomography angiography in a deferred stenting strategy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background.
Cardiac computed tomography angiography (CCTA) is precise in non-invasive coronary atherosclerosis characterization but its value in the diagnosis of intracoronary thrombus remains unknown. Therefore, our aim was to evaluate the diagnostic accuracy of CCTA for intracoronary thrombus and stenosis detection in acute coronary syndromes (ACS) with high thrombus burden selected for a deferred stenting (DS) strategy.
Methods.
We systematically performed a CCTA in consecutive DS patients 24 hours before the scheduled repeated coronary angiography that also included optical coherence tomography (OCT) imaging. Intracoronary thrombus and residual stenosis were blindly and independently evaluated by both non-invasive and invasive diagnostic tests. Agreement was determined per lesion using weighted Kappa (K) coefficient and absolute intra-class correlation coefficient (ICC). A stratified analysis according to OCT-detected thrombus burden was also performed.
Results.
Thirty lesions in 28 consecutive patients with a large thrombus burden were analyzed. Concordance between CCTA and repeated coronary angiography in thrombus detection was good (K= 0.554; p< 0.001), but both showed a poor agreement with OCT. CCTA needed >11.5% thrombus burden on OCT to obtain adequate diagnostic accuracy. The lesions detected by angiography were more frequently classified as red thrombus (76.5 vs 33.3%; p= 0.087) on OCT. CCTA showed an excellent concordance with coronary angiography in diameter stenosis (ICC= 0.85; p< 0.001), and was able to identify all the patients with severe residual stenosis.
Conclusion.
CCTA is able to assess intracoronary thrombus. Although CCTA showed just a good concordance with angiography in thrombus detection, the agreement in residual stenosis was excellent. Thus, in patients with a high-thrombus burden CCTA may substitute repeat angiography in patients considered for DS. Abstract Figure.
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Affiliation(s)
- A Montes
- University Hospital De La Princesa, Madrid, Spain
| | - E Pozo Osinalde
- Hospital Clinico San Carlos, Cardiology Department, Madrid, Spain
| | - T Bastante
- University Hospital De La Princesa, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Madrid, Spain
| | | | - F Rivero
- University Hospital De La Princesa, Madrid, Spain
| | - C De Rueda
- University Hospital De La Princesa, Madrid, Spain
| | | | - MJ Olivera
- University Hospital De La Princesa, Madrid, Spain
| | - J Salamanca
- University Hospital De La Princesa, Madrid, Spain
| | - JA De Agustin
- Hospital Clinico San Carlos, Cardiology Department, Madrid, Spain
| | - P Caballero
- University Hospital De La Princesa, Madrid, Spain
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18
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Montes A, Cecconi A, Monguio E, Martinez Vives P, Rojas AM, Lopez Melgar B, Diego G, Benedicto A, Dominguez L, Olviera MJ, Caballero P, Hernandez Muniz S, Reyes G, Jimenez Borreguero LJ, Alfonso F. Exploring the feasibility of the aorta to pulmonary artery ratio as novel risk marker of acute aortic syndromes in dilated aorta without conventional criteria for surgery. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Based on current guidelines, surgery indication of thoracic ascending aortic aneurysm (TAAA) is mainly driven by the aortic diameter. However, most cases of TAAA acute complications occur in patients who did not previously meet the 55 mm criteria for preventive surgical replacement (1). Both aorta indexed to height and to body surface area have been proposed as possible solution but indexed diameters of healthy aortas widely vary (2). Accordingly, new individualized biomarkers to improve the risk stratification of dilated aorta without a conventional criteria for surgery remain an unmet clinical need. Since aorta and pulmonary artery have an established ratio in general population (upper normal ratio of 1.2) (3), the aorta-to-pulmonary-artery ratio (A:PA) may better define the wall stress in a dilated aorta, overcoming the individual limitations of conventional size criteria.
Purpose
The aim of our study is to find a novel aortic indexed diameter with better prognostic performance. Therefore, we aimed to explore the feasibility of using the A:PA as risk predictor in TAAA with aortic diameter < 55 mm.
Methods
All consecutive patients with an acute aortic syndrome (AAS), diagnosed by CT scan in our tertiary hospital between January 2010 and June 2021 undergoing surgical repair, were retrospectively analyzed. Patients with pulmonary hypertension were excluded to prevent distortions in the pulmonary artery diameter. Basic clinical characteristics regarding indications of surgery were collected along with measurements of the aortic maximum diameter and pulmonary artery maximum diameter, obtained by multiplane reconstruction (Figure, Panels A, B). Patients were categorized into three groups based on aortic diameter terciles: group A included patients with < 47 mm, group B ≥ 47 mm but < 55 mm and group C ≥ 55 mm. Considering a high risk of concomitant confounding factors the lower tercile was subsequently excluded of the analysis.
Results
A total 48 patients were included. 69% of the patients had an aortic diameter that would have not fulfilled a preventive surgery indication. Two patients had bicuspid aortic valve, both of them with aortic aneurysms > 55 mm. None had high risk connective tissue disorders. There were no significant differences in baseline characteristics between the groups (Table 1).
A
PA ratio was similar in group B and C [1.91 (0.41) versus 2.11(0.45); p = 0.251], suggesting a similar aortic wall stress between aortas despite the difference in aortic diameters [49.5 mm (5.0) versus 58 mm (4.7); p < 0.001] (Figure 1, Panels C, D).
Conclusions: Our findings suggest that the A
PA ratio may be a promising risk stratification biomarker for TAAA without a conventional criteria for preventive surgery. This novel parameter should be prospectively tested in cohorts of TAAA. To the best of our knowledge, this is the first attempt to describe the usefulness of this parameter. Abstract FIGURE 1 Abstract TABLE 1
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Affiliation(s)
- A Montes
- University Hospital De La Princesa, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Madrid, Spain
| | - E Monguio
- University Hospital De La Princesa, Madrid, Spain
| | | | - AM Rojas
- University Hospital De La Princesa, Madrid, Spain
| | | | - G Diego
- University Hospital De La Princesa, Madrid, Spain
| | - A Benedicto
- University Hospital De La Princesa, Madrid, Spain
| | - L Dominguez
- University Hospital De La Princesa, Madrid, Spain
| | - MJ Olviera
- University Hospital De La Princesa, Madrid, Spain
| | - P Caballero
- University Hospital De La Princesa, Madrid, Spain
| | | | - G Reyes
- University Hospital De La Princesa, Madrid, Spain
| | | | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
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Vera Sainz A, Cecconi A, Ximenez-Carrillo A, Ramos C, Martinez-Vives P, Lopez Melgar B, Sanz A, Ortega G, Aguirre C, Gamarra A, Montes A, De Rueda C, Vivancos J, Alfonso F, Jimenez Borreguero LJ. CHA2DS2VASC score for predicting atrial fibrillation in patients with cryptogenic stroke. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Society of Cardiology
Introduction
CHA2DS2-VASc Score is widely used to predict thromboembolic risk in patients with Atrial Fibrillation (AF). However the role of CHA2DS2-VASC score for predicting AF in patients with cryptogenic stroke (CS) remains unknown.
Methods
Sixty-three consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale≥4 of unknown etiology, were prospectively recruited. They were classified according to
CHA2DS2-VASc Score: group 1 (score ≤ 5), and group 2 (score >5). The primary outcome measure was the occurrence of AF during clinical follow-up.
Results
Twenty-six (41%) patients had a CHA2DS2VASC score > 5 (group 2). Patients in this group were older (81 ± 5.5 vs 75 ± 8 years; p < 0.001) and more frequently female (73% vs 43% p = 0.019). Patients in group 2 present more often hypertension (84% vs 43% p = 0.001), diabetes (38% vs 11%, p = 0.009) , dyslipidemia 77% vs 49%, p = 0.024), and a prior history of coronary artery disease (27% vs 5%, p = 0.026). Notably, patients with higher CHA2DS2VASC showed worse left atrial ejection fraction (41.7 ± 13.1 vs 52.2 ± 15%, p = 0.009) and worse left atrial strain reservoir (21.5 ± 7.1 vs 33.8 ± 11%, p < 0.001), conduct (9.5 ± 4.8 vs 16.6 ± 8.4%;p < 0.001) and contraction (12 ± 4.6 vs 17.2 ± 7.3, p = 0.002). During follow-up AF was detected more often in group 2 (42% vs 11% p = 0.006). In multivariate analysis CHA2SD2VAS > 5 was an independent predictor of AF in patients with CS (HR 7.3 [95% CI 1.2-45.6] p = 0.032)
Conclusion
A CHA2DS2VASC score >5 is an independent predictor of AF in patients with CS. This score provides a new clinical tool to inform clinicians with regards to the optimal treatment of these challenging patients
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Affiliation(s)
- A Vera Sainz
- University Hospital De La Princesa, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Madrid, Spain
| | | | - C Ramos
- University Hospital De La Princesa, Madrid, Spain
| | | | | | - A Sanz
- University Hospital De La Princesa, Madrid, Spain
| | - G Ortega
- University Hospital De La Princesa, Madrid, Spain
| | - C Aguirre
- University Hospital De La Princesa, Madrid, Spain
| | - A Gamarra
- University Hospital De La Princesa, Madrid, Spain
| | - A Montes
- University Hospital De La Princesa, Madrid, Spain
| | - C De Rueda
- University Hospital De La Princesa, Madrid, Spain
| | - J Vivancos
- University Hospital De La Princesa, Madrid, Spain
| | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
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20
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Montes A, Cecconi A, Martinez Vives P, De Rueda C, Gamarra A, Perich J, Roquero P, Martinez Avial M, Rojas AM, Lopez Melgar B, Diego G, Benedicto A, Dominguez L, Jimenez Borreguero LJ, Alfonso F. Feasibility of blood speckle imaging parameters as predictors of intracavitary thrombus in apical aneurysm. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
In patients with apical aneurysm, left ventricular thrombus (LVT) is a major complication associated with systemic embolism. Likely, abnormalities in apical wall contraction produce stagnant flow which leads to the thrombus formation. Currently, there is a lack of knowledge about predictors of thrombus in such patients. However, new imaging techniques might be able to identify flow properties useful for risk stratification. Specifically, blood speckle imaging (BSI), a technology based on high-frame rate ultrasound, is a promising pattern-matching technique that could allow a comprehensive assessment of blood flow in patients with apical aneurysms (1,2).
Purpose
The aim of the study was to demonstrate the feasibility of obtaining quantitative and qualitative measurements with BSI in patients with apical aneurysms and to explore which parameters may be associated with LVT.
Methods
We examined cases of patients with apical aneurysm and LVT studied in our tertiary center. In order to exclude from our analysis the pro-inflammatory effects of the acute event, patients with thrombus formation within the first month after the ischemic event were excluded. Patients with current presence of thrombus were also discarded. A control group of patients with apical aneurysm but without history of LVT was included.
A basic 2-dimensional echocardiography study was obtained, along with BSI images. BSI acquisitions were performed with a 29 cm/s (2.5 mHz) scale. Data regarding vortex flow were collected, including its presence, area, length, besides area without BSI vectors (Image 1). All measures were indexed by telediastolic left ventricular volume.
Results
Eight patients with apical aneurysms were enrolled in the study, four of them with history of LVT. Although in patients with history of thrombus a larger vortex area was found (Table 1), none of the differences in the BSI parameters was statistically significant.
Conclusion
This study shows for the first time the feasibility of BSI for characterizing complex flow patterns such as vortex in patients with apical aneurysms. Explorations in larger cohorts of patients are needed to prove significant findings with this technology in the future. Abstract Figure. Image 1 Abstract TABLE 1
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Affiliation(s)
- A Montes
- University Hospital De La Princesa, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Madrid, Spain
| | | | - C De Rueda
- University Hospital De La Princesa, Madrid, Spain
| | - A Gamarra
- University Hospital De La Princesa, Madrid, Spain
| | - J Perich
- University Hospital De La Princesa, Madrid, Spain
| | - P Roquero
- University Hospital De La Princesa, Madrid, Spain
| | | | - AM Rojas
- University Hospital De La Princesa, Madrid, Spain
| | | | - G Diego
- University Hospital De La Princesa, Madrid, Spain
| | - A Benedicto
- University Hospital De La Princesa, Madrid, Spain
| | - L Dominguez
- University Hospital De La Princesa, Madrid, Spain
| | | | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
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Valor D, Montes A, García-Casas I, Pereyra C, Martínez de la Ossa E. Supercritical solvent impregnation of alginate wound dressings with mango leaves extract. J Supercrit Fluids 2021. [DOI: 10.1016/j.supflu.2021.105357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dolly S, Russell B, Moss C, Tsotra E, Gousis C, Roca J, Sita-Lumsden A, Khan M, Josephs D, Zaki K, Smith D, Michalarea V, Kristeleit R, Enting D, Flanders L, Lei M, Sawyer E, Spicer J, Ross P, Montes A, Van Hemelrijick M. 1608P The impact of COVID-19 on the delivery of systemic anti-cancer treatment at Guy’s Cancer Centre. Ann Oncol 2021. [PMCID: PMC8454366 DOI: 10.1016/j.annonc.2021.08.1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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García-López J, Polanco-García M, Montes A. Factors Associated With the Risk of Developing Moderate to Severe Acute Postoperative Pain After Primary Total Knee Arthroplasty: Results From the PAIN OUT Registry. J Arthroplasty 2021; 36:1966-1973. [PMID: 33637382 DOI: 10.1016/j.arth.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/08/2021] [Accepted: 02/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is one of the most common procedures in orthopedic surgery and not always matches with patient's expectations of pain relief and function improvement. The aim of this study was to assess risk factors for developing moderate to severe acute postoperative pain (APOP) after TKA using the PAIN OUT questionnaire. METHODS Prospective, multicentre, international cohort study within the PAIN OUT project. Patients' outcomes were measured with 11-point numerical rating scales (0 = null, 10 = worst possible). Patient and analgesic/anesthetic treatment were assessed. Odds ratio for moderate-severe pain was calculated for each variable and if they were statistically significant in the univariate logistic model, variables were fitted into a multivariate logistic regression model. The effect size was assessed by Cohen's d coefficient. RESULTS In total, 968 patients were evaluated. The multivariate model identified chronic preoperative pain (P < .001), general anesthesia (P = .020), and receiving chronic opioids before (P = .020) or after the surgery (P < .001) as factors associated with moderate-severe APOP. No protective factors were observed. CONCLUSIONS Our model identified several risk factors for APOP. From our results, preoperative chronic pain, general anesthesia and the use of opioid analgesics could be predictors for higher APOP. These findings may help establish new strategies for the treatment of pain in TKR. More studies should be carried out to identify acute pain predictors and to develop better strategies of pain management for risk patients.
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Affiliation(s)
- Jaume García-López
- Department of Anaesthesiology IMIM-Hospital del Mar-UAB, Barcelona, Spain
| | | | - Antonio Montes
- Department of Anaesthesiology IMIM-Hospital del Mar-UAB, Barcelona, Spain
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24
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Pallarés S, Colado R, Botella‐Cruz M, Montes A, Balart‐García P, Bilton DT, Millán A, Ribera I, Sánchez‐Fernández D. Loss of heat acclimation capacity could leave subterranean specialists highly sensitive to climate change. Anim Conserv 2020. [DOI: 10.1111/acv.12654] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- S. Pallarés
- Marine Biology and Ecology Research Centre School of Biological and Marine Sciences University of Plymouth Plymouth UK
- Instituto de Ciencias Ambientales Universidad de Castilla‐La Mancha Toledo Spain
| | - R. Colado
- Instituto de Ciencias Ambientales Universidad de Castilla‐La Mancha Toledo Spain
- Departamento de Ecología e Hidrología Universidad de Murcia Murcia Spain
| | - M. Botella‐Cruz
- Departamento de Ecología e Hidrología Universidad de Murcia Murcia Spain
| | - A. Montes
- Basque Society for Biology Conservation Guipúzcoa Spain
- Cuevas de Oñati‐Arrikrutz Guipúzcoa Spain
| | - P. Balart‐García
- Institut de Biologia Evolutiva (CSIC‐Universitat Pompeu Fabra) Barcelona Spain
| | - D. T. Bilton
- Marine Biology and Ecology Research Centre School of Biological and Marine Sciences University of Plymouth Plymouth UK
- Department of Zoology University of Johannesburg Johannesburg South Africa
| | - A. Millán
- Departamento de Ecología e Hidrología Universidad de Murcia Murcia Spain
| | - I. Ribera
- Institut de Biologia Evolutiva (CSIC‐Universitat Pompeu Fabra) Barcelona Spain
| | - D. Sánchez‐Fernández
- Instituto de Ciencias Ambientales Universidad de Castilla‐La Mancha Toledo Spain
- Departamento de Ecología e Hidrología Universidad de Murcia Murcia Spain
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Benoit T, Shreim S, Torna E, Montes A, Andrade J. Desired Skills, Attributes and Training Needs of Dietetic Preceptors: A Qualitative Study. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.09.004] [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: 11/25/2022]
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26
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Colombo N, Gadducci A, Sehouli J, Biagioli E, Nyvang GB, Riniker S, Montes A, Ottevanger N, Zeimet A, Vergote I, Funari G, Baldoni A, Tognon G, De Censi A, Galaz CC, Chekerov R, Maenpaa J, Rulli E, Fossati R, Poveda A. LBA30 INOVATYON study: Randomized phase III international study comparing trabectedin/PLD followed by platinum at progression vs carboplatin/PLD in patients with recurrent ovarian cancer progressing within 6-12 months after last platinum line. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2260] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bande D, Moltó L, Pereira JA, Montes A. Chronic pain after groin hernia repair: pain characteristics and impact on quality of life. BMC Surg 2020; 20:147. [PMID: 32631293 PMCID: PMC7336434 DOI: 10.1186/s12893-020-00805-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/20/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background Chronic postsurgical pain (CPSP) after hernia repair research has mainly relied on unconfirmed self-reporting. We aimed to describe confirmed CPSP incidence, management, and quality of life (QoL) in a 2-year prospective study. Methods Multicenter study (GENDOLCAT) of 3890 patients undergoing 4 common surgical procedures in 23 hospitals to develop a risk model for CPSP; 2352 men underwent open hernia repair. Patients with pain were identified by telephone at 1 and 3 months and referred to the hospital 4 months after surgery for a physical examination to confirm CPSP. Three validated tools were used: the Brief Pain Inventory (BPI) for severity, analgesic use, and interference with activities; the SF-12 questionnaire for QoL (validated Spanish version), and the Douleur Neuropathique 4 (DN4). Patients with CPSP were called again at 1 and 2 years. Results In 1761 patients who underwent hernia repair and were eligible for physical examination for CPSP, the incidence of confirmed pain at 4 months was 13.6% (patient-reported pain, 6.2% at 1 year and 4.0% at 2 years). Neuropathic pain was diagnosed in 38.5% of the CPSP patients at 4 months. The incidences of neuropathic CPSP in patients with mesh or non-mesh repairs were similar (38.6 and 33.3%, respectively). SF-12 physical component scores changed little in all patients, whether or not they developed CPSP. The SF-12 mental component decreased significantly in all patients, but the decrease was clinically significant only in CPSP patients. CPSP interfered with activities (18%), work (15.6%), walking (15%) and mood (10.2%). At 2 years 52.1% of CPSP patients had moderate/intense pain and 28.2% took analgesics. Conclusion CPSP affects QoL-related activities, and although it diminishes over the course of 2 years after surgery, many patients continue to have moderate/intense pain and take analgesics. CPSP and neuropathic pain rates seem to be similar after mesh and non-mesh repair. BPI and SF-12 mental component scores detect effects on QoL. Trial registration ClinicalTrials.gov NCT01510496.
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Affiliation(s)
- David Bande
- Pain Clínic, Department of Anaesthesiology, Institut Municipal d'Investigació Médica. Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Martím 25-29, 08003, Barcelona, Spain.
| | - Luis Moltó
- Pain Clínic, Department of Anaesthesiology, Institut Municipal d'Investigació Médica. Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Martím 25-29, 08003, Barcelona, Spain
| | - Jose Antonio Pereira
- General Surgery Department, Institut Municipal d'Investigació Médica. Parc de Salut Mar, Departament de Ciéncies Experimentals i de la Salut (CEXS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Antonio Montes
- Pain Clínic, Department of Anaesthesiology, Institut Municipal d'Investigació Médica. Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Martím 25-29, 08003, Barcelona, Spain
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Monge‐Escartín I, Montes A, Comas M, Grau S. Strong opioid consumption and its correlation with pain intensity and inpatient complexity. A 6‐year analysis in a tertiary hospital. Eur J Pain 2020; 24:1151-1159. [DOI: 10.1002/ejp.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/12/2022]
Affiliation(s)
| | - Antonio Montes
- Department of Anaesthesiology Pain Unit Hospital del Mar Parc de Salut Mar Barcelona Spain
- Universitat Autònoma de Barcelona Barcelona Spain
| | - Merce Comas
- Department of Epidemiology and Evaluation Hospital del Mar Parc de Salut Mar Barcelona Spain
| | - Santiago Grau
- Department of Pharmacy, Hospital del Mar Parc de Salut Mar Barcelona Spain
- Universitat Autònoma de Barcelona Barcelona Spain
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Merino A, Montes A, Sablik M, Korevaar S, Lopez-Iglesias C, Baan C, Molina-Molina M, Hoogduijn M. Membrane particles derived from mesenchymal stromal cells as a novel cell free therapy for immunomodulation and regeneration. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.146] [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: 11/28/2022]
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Galarce-Bustos O, Fernández-Ponce MT, Montes A, Pereyra C, Casas L, Mantell C, Aranda M. Usage of supercritical fluid techniques to obtain bioactive alkaloid-rich extracts from cherimoya peel and leaves: extract profiles and their correlation with antioxidant properties and acetylcholinesterase and α-glucosidase inhibitory activities. Food Funct 2020; 11:4224-4235. [PMID: 32353090 DOI: 10.1039/d0fo00342e] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The agroindustrial sector is highly concerned with regards to reducing the environmental impact of waste from pruning activities (leaves, branches and bark) and from food industry processes (peels and seeds). In this sense, the wastes generated by cherimoya cultivation and processing industries should be contemplated as a valuable source of biologically active compounds. In this work, we have studied the bioactivity of alkaloid-rich Annona cherimola Mill. extracts obtain by means of supercritical fluid extraction techniques. The extracts were obtained from the peel and leaves using the following optimal conditions: 100 bar of pressure, 75 °C and 15% methanol as co-solvent. High antioxidant capacity (5304.23 ± 73.60 to 21 705.20 ± 1069.31 μmol Trolox equivalent per 100 g), and acetylcholinesterase (IC50 = 87.69 ± 3.42 to 515.02 ± 29.25 μg mL-1) and α-glucosidase (IC50 = 1097.76 ± 121.12 to 3206.88 ± 97.06 μg mL-1) inhibitory activities were exhibited by both peel and leaf extracts. Larger alkaloid contents were determined by UHPLC-ESI-MS analysis, with peel extracts presenting a high concentration of N-trans-feruloyl phenethylamine, while leaf extracts were rich in anonine. This work reports novel data on bioactivity of cherimoya peel and leaves and their potential as a source of bioactive compounds.
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Affiliation(s)
- Oscar Galarce-Bustos
- Department of Preclinical Sciences, Faculty of Medicine, Center of Translational Medicine Scientific and Technological Nucleus (CEMT-BIOREN), University of La Frontera, Temuco, Chile.
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Gamarra Lobato AL, Rojas AM, Cecconi A, Dominguez L, Benedicto A, Diego G, Nogales MT, Monguio E, Munoz D, Perich J, Montes A, De Rueda C, Jimenez C, Jimenez LJ, Alfonso F. 1640 Pulmonary valve in carcinoid disease: be suspicious of functional assessment. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Carcinoid heart disease occurs in 50% of patients with carcinoid syndrome, especially on serotonin-secreting neuroendocrine tumors (NET) [1, 2]. Carcinoid heart disease"s typical findings are carcinoid plaques, composed of smooth muscle, myofibroblasts and endothelium. These plaques, most frequently localized on the right side valvular cusps and leaflets, produce fixation and retraction, causing regurgitation and/or stenosis [3, 4, 5]. Left-sided heart disease is rare (<10%), as serotonin is purified in the pulmonary circulation [3, 6, 7].
We present the case of a 67 year old female patient with previous history of right ovarian NET. She presented with dyspnea (II-III NYHA functional class), and slight edema in lower limbs. She denied symptoms of carcinoid syndrome before or after the ovarian surgery.
Examination showed an increased jugular venous pulse.
Transthoracic echocardiography (TTE) showed severely dilated right cavities and a rigid, immobile tricuspid valve, with massive tricuspid regurgitation (Panel A, 1). Anatomy of
pulmonary valve was not properly visualized but jet area of pulmonary regurgitation was small (Panel A, 2). Left cavities and valves were intact.
As TTE was not anatomically conclusive, a cardiac magnetic resonance (CMR) and a cardiac computed tomography (CCT) were performed to assess the carcinoid involvement of pulmonary valve.
CMR showed severely dilated right ventricle with mild impairment of systolic function (Panel A, 3). Based on phase contrast imaging, pulmonary regurgitation fraction was 14%,
suggestive of a mild grade. However, CCT showed a diffuse thickening of the pulmonary valve, with complete opening during diastole (Panel A, 4, arrowhead). Finally, the patient underwent replacement of tricuspid valve and pulmonary valve for biological prosthesis without complications.
Our case is remarkable because it highlights the limitations of the functional assessment of pulmonary regurgitation in the presence of a concomitant massive tricuspid valve regurgitation, since the rapid equalization of pressure between pulmonary artery and right ventricle reduces the expression of pulmonary regurgitation. For these reason, the anatomic assessment of the pulmonary valve is mandatory to stage the involvement of pulmonary valve in carcinoid disease.
Abstract 1640 Figure. Panel A
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Affiliation(s)
| | - A M Rojas
- University Hospital De La Princesa, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Madrid, Spain
| | - L Dominguez
- University Hospital De La Princesa, Madrid, Spain
| | - A Benedicto
- University Hospital De La Princesa, Madrid, Spain
| | - G Diego
- University Hospital De La Princesa, Madrid, Spain
| | - M T Nogales
- University Hospital De La Princesa, Madrid, Spain
| | - E Monguio
- University Hospital De La Princesa, Madrid, Spain
| | - D Munoz
- University Hospital De La Princesa, Madrid, Spain
| | - J Perich
- University Hospital De La Princesa, Madrid, Spain
| | - A Montes
- University Hospital De La Princesa, Madrid, Spain
| | - C De Rueda
- University Hospital De La Princesa, Madrid, Spain
| | - C Jimenez
- University Hospital De La Princesa, Madrid, Spain
| | - L J Jimenez
- University Hospital De La Princesa, Madrid, Spain
| | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
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Vera Sainz A, Garcia Guimaraes M, Jimenez C, De La Cuerda F, Gonzalez E, Montes A, De Rueda C, Rojas A, Cecconi A, Diego G, Benedicto A, Dominguez L, Monguio E, Jimenez Borreguero LJ, Alfonso F. P845 Deep vein thrombosis, pulmonary embolism and patent foramen ovale: a lethal mix. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
A 50-year-old woman without remarkable medical history was admitted at the Emergency Department for acute dyspnoea. The patient had been recently submitted to C5-C6 microdiscectomy. She was tachypneic and oxygen saturation was 88%. CT angiography showed bilateral pulmonary embolism (PE) (Figure 1A, yellow arrowheads) with signs of right ventricle overload. Bilateral deep vein thrombosis was also confirmed. The patient was admitted at the Intensive Care Unit, clinically stable. Few hours later, she presented sudden hemodynamic and respiratory deterioration, requiring invasive mechanical ventilation and vasopressors. Due to recent cervical surgery, systemic fibrinolysis was ruled out. Decision for percutaneous thrombectomy and inferior vena cava filter placement was made. Nevertheless, percutaneous thrombectomy was unsuccessful due to the impossibility to catheterize pulmonary artery. Contrast injection demonstrated that the guiding catheter was located in the left atrium (Figure 1B), suggesting a patent foramen ovale (PFO). Transoesophageal echocardiogram confirmed the presence of a 5x6 mm PFO with right-to-left shunt (Figures 1C – yellow arrows, and 1D). In addition, a 4 cm mobile mass attached to the aortic valve and protruding throughout the left ventricle outflow tract was visualized, suggesting paradoxical embolism (Figure 1E – white arrows). Accordingly, open surgical approach with pulmonary thrombectomy, PFO closure and removal of the left-sided thrombus was decided. Unfortunately, despite careful cannulation, thrombus was not found when aortic valve was inspected. Worst suspicions were confirmed, when the patient presented non-reactive mydriatic pupils. A brain CT showed signs of an extensive bihemisferic ischemic stroke (Figure 1F) presumably related to cerebral embolization of aortic thrombus. The patient finally died. Autopsy study was not consented.
PFO has been associated with paradoxical embolisms and risk of stroke in PE. This case strikingly illustrates that treatment of these patients may be challenging in spite of an adequate diagnosis and management.
Abstract P845 Figure.
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Affiliation(s)
- A Vera Sainz
- University Hospital De La Princesa, Madrid, Spain
| | | | - C Jimenez
- University Hospital De La Princesa, Madrid, Spain
| | | | - E Gonzalez
- University Hospital De La Princesa, Madrid, Spain
| | - A Montes
- University Hospital De La Princesa, Madrid, Spain
| | - C De Rueda
- University Hospital De La Princesa, Madrid, Spain
| | - A Rojas
- University Hospital De La Princesa, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Madrid, Spain
| | - G Diego
- University Hospital De La Princesa, Madrid, Spain
| | - A Benedicto
- University Hospital De La Princesa, Madrid, Spain
| | - L Dominguez
- University Hospital De La Princesa, Madrid, Spain
| | - E Monguio
- University Hospital De La Princesa, Madrid, Spain
| | | | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
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Montes A, Cecconi A, Alvarado T, Vera A, Barrios A, Caballero P, Olivera MJ, De Rueda C, Gonzalez E, De La Cuerda F, Jimenez C, Perich J, Gamarra A, Jimenez Borreguero LJ, Alfonso F. 1095 Effective image-guided medical management in effusive constrictive pericarditis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
A 59 year old man was admited to hospitalization for persistent chest pain related to acute pericarditis. Within the admision tests, a transthoracic echography was performed, showing a moderate pericardial effusion with ventricular septal bounce and significant respiratory variations in mitral and tricuspid inflows, all of it consistent with effusive-constrictive pericarditis (Panel A). Anti-inflammatory treatment with ibuprofen and colchicine was started.
During the first 48 hours of admission there was a clinical and hemodinamic worsening in the patient’s condition that forced the performance of a pericardial window, obtaining a very little quantity of dense pericardial fluid. Looking for a more accurate study of the pericardium, a cardiovascular magnetic resonance (CMR) was performed, revealing a thick heterogeneous pericardial effusion (Panel B) and a significant late gadolinium enhancement of both pericardial layers (Panel C). All these findings where consistent with an effusive constrictive pericarditis with persistent inflammatory activity despite high doses of conventional inflammatory treatment. Furthermore, the growth of Propionibacterium acnes in the pericardial fluid disclosed the etiology of this condition.
Medical treatment was enhanced with high doses of intravenous corticosteroid, ceftriaxone and doxycycline. During the following days, the patient showed an excellent response achieving the complete clinical and echocardiographic relief of constrictive signs (Panel D).
Effusive constrictive pericarditis is characterized by the presence of pericardial effusion and constriction secondary to an inflammatory process of the pericardium. Pericardiectomy might be necessary in case of failure of medical treatment, a very common scenario in this kind of .pericarditis.
Our case is remarkable because it demonstrates the value of CMR to detect persistent inflammation of pericardium despite high doses of conventional medical treatment for pericaricarditis guiding the successful escalation to intravenous corticosteroid and avoiding the risk of an unnecessary cardiac surgery.
Abstract 1095 Figure.
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Affiliation(s)
- A Montes
- University Hospital De La Princesa, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Madrid, Spain
| | - T Alvarado
- University Hospital De La Princesa, Madrid, Spain
| | - A Vera
- University Hospital De La Princesa, Madrid, Spain
| | - A Barrios
- University Hospital De La Princesa, Madrid, Spain
| | - P Caballero
- University Hospital De La Princesa, Madrid, Spain
| | - M J Olivera
- University Hospital De La Princesa, Madrid, Spain
| | - C De Rueda
- University Hospital De La Princesa, Madrid, Spain
| | - E Gonzalez
- University Hospital De La Princesa, Madrid, Spain
| | | | - C Jimenez
- University Hospital De La Princesa, Madrid, Spain
| | - J Perich
- University Hospital De La Princesa, Madrid, Spain
| | - A Gamarra
- University Hospital De La Princesa, Madrid, Spain
| | | | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
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Cecconi A, Salamanca J, Antuna P, Alvarado T, Nogales-Romo MT, Pozo E, Viliani D, Veloso S, Montes A, De Rueda C, Olivera MJ, Hernandez-Muniz S, Caballero P, Jimenez-Borreguero LJ, Alfonso F. P183Appropriate quantification of myocardial edema extension in tako-tsubo syndrome: high correlation between visual and semi-quantitative method of T2 signal intensity ratio. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Cecconi
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - J Salamanca
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - P Antuna
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - T Alvarado
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | | | - E Pozo
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - D Viliani
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - S Veloso
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - A Montes
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - C De Rueda
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - M J Olivera
- University Hospital De La Princesa, Radiology, Madrid, Spain
| | | | - P Caballero
- University Hospital De La Princesa, Radiology, Madrid, Spain
| | | | - F Alfonso
- University Hospital De La Princesa, Cardiology, Madrid, Spain
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Montes A, Hanke F, Williamson D, Guamán-Balcázar M, Valor D, Pereyra C, Teipel U, Martínez de la Ossa E. Precipitation of powerful antioxidant nanoparticles from orange leaves by means of supercritical CO2. J CO2 UTIL 2019. [DOI: 10.1016/j.jcou.2019.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Goranova T, Ennis D, Piskorz AM, Macintyre G, Lewsley LA, Stobo J, Wilson C, Kay D, Glasspool RM, Lockley M, Brockbank E, Montes A, Walther A, Sundar S, Edmondson R, Hall GD, Clamp A, Gourley C, Hall M, Fotopoulou C, Gabra H, Freeman S, Moore L, Jimenez-Linan M, Paul J, Brenton JD, McNeish IA. Correction: Safety and utility of image-guided research biopsies in relapsed high-grade serous ovarian carcinoma-experience of the BriTROC consortium. Br J Cancer 2019; 120:868. [PMID: 30862952 PMCID: PMC6474310 DOI: 10.1038/s41416-019-0433-6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This article was originally published under a CC BY NC SA License, but has now been made available under a CC BY 4.0 License.
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Affiliation(s)
- T Goranova
- Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK
| | - D Ennis
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - A M Piskorz
- Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK
| | - G Macintyre
- Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK
| | - L A Lewsley
- Cancer Research UK Clinical Trials Unit, Glasgow, G12 0YN, UK
| | - J Stobo
- Cancer Research UK Clinical Trials Unit, Glasgow, G12 0YN, UK
| | - C Wilson
- Cancer Research UK Clinical Trials Unit, Glasgow, G12 0YN, UK
| | - D Kay
- Department of Radiology, Gartnavel General Hospital, Glasgow, G12 0YN, UK
| | - R M Glasspool
- Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK
| | - M Lockley
- Barts Cancer Institute, London, EC1M 6BQ, UK
- University College Hospital, London, WC1E 6BD, UK
| | - E Brockbank
- Barts Cancer Institute, London, EC1M 6BQ, UK
| | - A Montes
- Guy's Hospital, London, SE1 9RT, UK
| | - A Walther
- Bristol Haematology and Oncology Centre, Bristol, BS2 8ED, UK
| | - S Sundar
- City Hospital, Birmingham, B18 7QH, UK
| | | | - G D Hall
- St James Hospital, Leeds, LS9 7TF, UK
| | - A Clamp
- The Christie Hospital, Manchester, M20 4BX, UK
| | - C Gourley
- Edinburgh Cancer Research Centre, Edinburgh, EH4 2XR, UK
| | - M Hall
- Mount Vernon Cancer Centre, Northwood, HA6 2RN, UK
| | | | - H Gabra
- Imperial College, London, W12 0HS, UK
| | - S Freeman
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - L Moore
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | | | - J Paul
- Cancer Research UK Clinical Trials Unit, Glasgow, G12 0YN, UK
| | - J D Brenton
- Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK.
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
| | - I A McNeish
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK.
- Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK.
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García-Casas I, Crampon C, Montes A, Pereyra C, Martínez de la Ossa E, Badens E. Supercritical CO2 impregnation of silica microparticles with quercetin. J Supercrit Fluids 2019. [DOI: 10.1016/j.supflu.2018.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guamán-Balcázar M, Montes A, Pereyra C, Martínez de la Ossa E. Production of submicron particles of the antioxidants of mango leaves/PVP by supercritical antisolvent extraction process. J Supercrit Fluids 2019. [DOI: 10.1016/j.supflu.2018.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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García-Casas I, Montes A, Valor D, Pereyra C, Martínez de la Ossa E. Impregnation of mesoporous silica with mangiferin using supercritical CO2. J Supercrit Fluids 2018. [DOI: 10.1016/j.supflu.2018.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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García-Casas I, Montes A, Pereyra C, Martínez de la Ossa E. Co-precipitation of mangiferin with cellulose acetate phthalate by Supercritical antisolvent process. J CO2 UTIL 2017. [DOI: 10.1016/j.jcou.2017.10.003] [Citation(s) in RCA: 10] [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: 10/18/2022]
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Montes A, Merino R, De los Santos D, Pereyra C, Martínez de la Ossa E. Micronization of vanillin by rapid expansion of supercritical solutions process. J CO2 UTIL 2017. [DOI: 10.1016/j.jcou.2017.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Montes A, Fernández A, Camacho V, de Quintana C, Gallego O, Craven-Bartle J, López D, Molet J, Gómez-Ansón B, Carrió I. The usefulness of 18 F-fluorocholine PET/CT in the detection of recurrence of central nervous system primary neoplasms. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.03.001] [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: 11/27/2022]
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Sadurni M, Corcoy M, Bande D, Castelltort L, Ortiz JC, Montes A. Intravenous lidocaine + ketamine instead of tramadol for postoperative analgesia in laparoscopic colon surgery. Does it decrease postoperative nausea, vomiting and ileus without worsening analgesia control? Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.04.035] [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]
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Goranova T, Ennis D, Piskorz AM, Macintyre G, Lewsley LA, Stobo J, Wilson C, Kay D, Glasspool RM, Lockley M, Brockbank E, Montes A, Walther A, Sundar S, Edmondson R, Hall GD, Clamp A, Gourley C, Hall M, Fotopoulou C, Gabra H, Freeman S, Moore L, Jimenez-Linan M, Paul J, Brenton JD, McNeish IA. Safety and utility of image-guided research biopsies in relapsed high-grade serous ovarian carcinoma-experience of the BriTROC consortium. Br J Cancer 2017; 116:1294-1301. [PMID: 28359078 PMCID: PMC5482731 DOI: 10.1038/bjc.2017.86] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Investigating tumour evolution and acquired chemotherapy resistance requires analysis of sequential tumour material. We describe the feasibility of obtaining research biopsies in women with relapsed ovarian high-grade serous carcinoma (HGSC). METHODS Women with relapsed ovarian HGSC underwent either image-guided biopsy or intra-operative biopsy during secondary debulking, and samples were fixed in methanol-based fixative. Tagged-amplicon sequencing was performed on biopsy DNA. RESULTS We screened 519 patients in order to enrol 220. Two hundred and two patients underwent successful biopsy, 118 of which were image-guided. There were 22 study-related adverse events (AE) in the image-guided biopsies, all grades 1 and 2; pain was the commonest AE. There were pre-specified significant AE in 3/118 biopsies (2.5%). 87% biopsies were fit-for-purpose for genomic analyses. Median DNA yield was 2.87 μg, and was higher in biopsies utilising 14 G or 16 G needles compared to 18 G. TP53 mutations were identified in 94.4% patients. CONCLUSIONS Obtaining tumour biopsies for research in relapsed HGSC is safe and feasible. Adverse events are rare. The large majority of biopsies yield sufficient DNA for genomic analyses-we recommend use of larger gauge needles and methanol fixation for such biopsies, as DNA yields are higher but with no increase in AEs.
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Affiliation(s)
- T Goranova
- Cancer Research UK Cambridge Institute, Cambridge CB2 0RE, UK
| | - D Ennis
- Institute of Cancer Sciences, University of Glasgow, G61 1QH, UK
| | - A M Piskorz
- Cancer Research UK Cambridge Institute, Cambridge CB2 0RE, UK
| | - G Macintyre
- Cancer Research UK Cambridge Institute, Cambridge CB2 0RE, UK
| | - L A Lewsley
- Cancer Research UK Clinical Trials Unit, Glasgow G12 0YN, UK
| | - J Stobo
- Cancer Research UK Clinical Trials Unit, Glasgow G12 0YN, UK
| | - C Wilson
- Cancer Research UK Clinical Trials Unit, Glasgow G12 0YN, UK
| | - D Kay
- Department of Radiology, Gartnavel General Hospital, Glasgow G12 0YN, UK
| | - R M Glasspool
- Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, UK
| | - M Lockley
- Barts Cancer Institute, London EC1M 6BQ, UK
- University College Hospital, London WC1E 6BD, UK
| | | | - A Montes
- Guy’s Hospital, London SE1 9RT, UK
| | - A Walther
- Bristol Haematology and Oncology Centre, Bristol BS2 8ED, UK
| | - S Sundar
- City Hospital, Birmingham B18 7QH, UK
| | | | - G D Hall
- St James Hospital, Leeds LS9 7TF, UK
| | - A Clamp
- The Christie Hospital, Manchester M20 4BX, UK
| | - C Gourley
- Edinburgh Cancer Research Centre, Edinburgh EH4 2XR, UK
| | - M Hall
- Mount Vernon Cancer Centre, Northwood HA6 2RN, UK
| | | | - H Gabra
- Imperial College, London W12 0HS, UK
| | - S Freeman
- Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - L Moore
- Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | | | - J Paul
- Cancer Research UK Clinical Trials Unit, Glasgow G12 0YN, UK
| | - J D Brenton
- Cancer Research UK Cambridge Institute, Cambridge CB2 0RE, UK
- Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - I A McNeish
- Institute of Cancer Sciences, University of Glasgow, G61 1QH, UK
- Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, UK
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Montes A, Aguilar JL, Benito MC, Caba F, Margarit C. Management of postoperative pain in Spain: a nationwide survey of practice. Acta Anaesthesiol Scand 2017; 61:480-491. [PMID: 28261783 DOI: 10.1111/aas.12876] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/05/2017] [Accepted: 02/04/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although the need for structured assessment and management of acute postoperative pain has been recognized, practices and responsibilities vary between and within hospitals and countries. We sought to determine current pain management practices in Spanish hospitals with and without acute pain services (APSs) or acute pain management programmes (APMPs) and compare them to practices reported for 1997-1998. METHODS Members of the Spanish Pain Society and APS/APMP heads were asked to respond to a survey. Responses were stratified by hospital size (< 200 or ≥ 200 beds) and APS/APMP presence or not. Categorical variables were described by percentages and the 95% confidence interval and continuous ones by the median and interquartile range. RESULTS Responses were received from 42.4% of hospitals with ≥ 200 beds (vs. 9.6% of the smaller ones). We fully analysed only data for the larger hospitals, 57.7% of which had an APS or APMP. Full-time pain physicians were on staff in 28.6% of large hospitals; 25% had full-time nurses. Patients received written information about postoperative pain in 34.8% of APS/APMP hospitals, and 72% of them recorded pain assessments routinely. Protocols reflected interdepartmental consensus in 80.8%; training in postoperative pain was organised in 54%. Respondents thought pain was well or very well managed in 46.4%. In APS/APMP hospitals the following results had improved: provision of written information for patients (58.5% vs. 0%), the recording of pain assessments (93% vs. 43.8%), consensus on a pain scale (92.5% vs. 41.9%), use of protocols (99.7% vs. 55.2%), analysis of quality indicators (52.8% vs. 15.4%), training (73% vs. 26.9%), and respondents' satisfaction with pain management in their hospital (68.6% vs. 9.5%). CONCLUSIONS The presence of an APS or APMP is associated with better results on indicators of quality of acute postoperative pain management.
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Affiliation(s)
- A. Montes
- Pain Clinic; Department of Anaesthesiology; Parc de Salut MAR; Fundació IMIM; Neurosciences Programme; Perioperative Medicine Research Group; Universitat Autònoma de Barcelona; Barcelona Spain
| | - J. L. Aguilar
- Anaesthesia Department and Pain Clinic; Hospital Universitario Son Llatzer; Palma de Mallorca Spain
| | - M. C. Benito
- Acute Pain Service; Hospital General Gregorio Marañón; Madrid Spain
| | - F. Caba
- Department of Anaesthesiology; Hospital Nuestra Señora de Valme; Sevilla Spain
| | - C. Margarit
- Pain Clinic; Department of Anaesthesiology; Hospital General Universitario de Alicante; Alicante Spain
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Serván B, Montes A, Machín M, Gómez P, García-Albea J, González S, Ibáñez J, Morón M. Efficacy and Tolerability of Aripiprazole Intramuscular as Maintenance Treatment in Patients with Paranoid Schizophrenia. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionPatients suffering from paranoid schizophrenia, require long-term anti-psychotic treatment, which provide, in addition to adequate efficacy both positive and negative symptoms, a good safety and tolerability profile that would ensure adequate adherence to prevent relapse.ObjectivesTo analyze the efficacy, tolerability and therapeutic adherence over a year after the introduction of aripiprazole depot in patients diagnosed with paranoid schizophrenia previously treated with other oral or depot anti-psychotics [1,2,3].MethodsOne-year prospective longitudinal study with a sample size of 23 patients diagnosed with schizophrenia in outpatient treatment. Study variables (baseline, 6 and 12 months): Brief Psychiatric Rating Scale (BPRS), clinical global impression (CGI), mean dose of aripiprazole depot, previous treatments, adherence, relapse rate, prolactin levels, sexual dysfunction, BMIs.ResultsTwenty-three patients (71% men, 29% women) diagnosed with paranoid schizophrenia were identified. Improvement was obtained in the different study variables with statistically significant difference (P ≤ 0.05).ConclusionsFollowing the introduction of aripiprazole depot in patients diagnosed with schizophrenia previously treated with other oral or depot anti-psychotics in our study, we conclude that maintaining therapeutic efficacy a better tolerability and safety profile, better therapeutic adherence and consequently lower relapse rate were achieved.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Montes A, Fernández A, Camacho V, de Quintana C, Gallego O, Craven-Bartle J, López D, Molet J, Gómez-Ansón B, Carrió I. The usefulness of 18F-fluorocholine PET/CT in the detection of recurrence of central nervous system primary neoplasms. Rev Esp Med Nucl Imagen Mol 2017; 36:227-232. [PMID: 28219644 DOI: 10.1016/j.remn.2016.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 01/21/2023]
Abstract
AIM To study the usefulness of 18F-fluorocholine (FCH) in detecting the recurrence of primary brain tumours. MATERIAL AND METHODS A prospective study was conducted on brain PET/CT with FCH for compassionate use in 21 patients with suspected recurrence of a primary brain tumour. The distribution by pathology was: three grade ii astrocytomas, three grade iii astrocytomas, one grade ii oligodendroglioma, three grade iii oligodendrogliomas, one grade iii oligoastrocytoma, four glioblastoma multiform, one gliomatosis cerebri, and five meningiomas. Studies in which there was a visually significant uptake in the brain parenchyma were classified as positive. RESULTS A total of 17 patients were classified as positive, with the results being confirmed by histology (10 cases) or clinical follow-up and imaging, with no false positives or negatives. The mean SUVmax for positive patients was 8.02 and 0.94 for the negative ones, which was significantly different (P=.003) CONCLUSION: PET/CT with FCH shows encouraging results in the evaluation of patients with suspected recurrence of primary brain neoplasms.
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Affiliation(s)
- A Montes
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - A Fernández
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - V Camacho
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - C de Quintana
- Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - O Gallego
- Servicio de Oncología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Craven-Bartle
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - D López
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Molet
- Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - B Gómez-Ansón
- Servicio de Radiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - I Carrió
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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de Luna AG, Link A, Montes A, Alfonso F, Mendieta L, Di Fiore A. Increased folivory in brown spider monkeys Ateles hybridus living in a fragmented forest in Colombia. ENDANGER SPECIES RES 2017. [DOI: 10.3354/esr00787] [Citation(s) in RCA: 6] [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: 11/23/2022] Open
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Merrick S, Hunter S, Dalby M, Neat M, McMunagle E, Montes A, Lal R, Ghosh S. 63: Crizotinib for ALK rearrangement in non small cell lung cancer. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30113-7] [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: 11/28/2022]
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Montes A, Wehner L, Pereyra C, Martínez de la Ossa E. Precipitation of submicron particles of rutin using supercritical antisolvent process. J Supercrit Fluids 2016. [DOI: 10.1016/j.supflu.2016.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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