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Galindo Puerto MJ, Puig J, Pérez-Molina JA, Fuster-Ruiz de Apodaca MJ. Perspectives of people with HIV and HIV clinicians on characteristics of antiretroviral treatment and HIV-related symptoms. HIV Med 2024; 25:565-576. [PMID: 38214438 DOI: 10.1111/hiv.13609] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES We aimed to assess HIV symptoms from the perspective of both patients and HIV specialists and the impact of discontinuing antiretroviral treatment (ART) on symptomology. We gathered opinions from HIV specialists and people living with HIV about ideal ART parameters and treatment satisfaction. METHODS Ex post-facto cross-sectional surveys were administered to 502 people living with HIV and 101 HIV clinicians in Spain (18 sites). RESULTS The median age of participants with HIV was 43.2 years, 74.5% were male, and 91.6% had an undetectable viral load. The mean time since initiation of ART was 10.2 years. Between 54% and 67% of people living with HIV reported experiencing nervousness or anxiety, sadness, fatigue, sleep problems, or muscle/joint pain during the preceding 4 weeks. However, only 22%-27% of specialists acknowledged the presence of these symptoms. The most bothersome symptoms were related to mental health or the central nervous system. There were significant differences between the burden of symptoms reported by people living with HIV and those acknowledged by specialists. The symptoms that more frequently caused ART discontinuation were depression, dizziness, and sleep problems. Both people living with HIV and specialists prioritized ART efficacy and low toxicity, but their importance ratings differed for 5 of the 11 ART characteristics assessed. People living with HIV rated their satisfaction with ART at a mean (± standard deviation) of 8.9 ± 1.5 out of 10, whereas HIV specialists rated it lower, at 8.3 ± 0.7 (p < 0.001). CONCLUSIONS Despite advances in HIV care and treatment, a large proportion of patients still experience symptoms. HIV specialists may not be fully aware of these. People living with HIV and HIV specialists are, overall, satisfied with ART. However, the importance they place on different ART characteristics may vary.
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Affiliation(s)
- M José Galindo Puerto
- Spanish AIDS Interdisciplinary Society (SEISIDA), Madrid, Spain
- Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - J Puig
- Spanish AIDS Interdisciplinary Society (SEISIDA), Madrid, Spain
- Fundación Llucha contra las Infecciones, Nurecare-IGTP, Hospital Germans Trias, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J A Pérez-Molina
- Spanish AIDS Interdisciplinary Society (SEISIDA), Madrid, Spain
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - M J Fuster-Ruiz de Apodaca
- Spanish AIDS Interdisciplinary Society (SEISIDA), Madrid, Spain
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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2
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Remollo S, Werner M, Blasco J, López-Rueda A, San Roman L, Jimenez-Gomez E, Bravo Rey I, Vega P, Murias E, Rosati S, Pérez-García C, González E, Manso X, Aixut S, Chirife Chaparro O, Terceño M, Bashir S, Pumar JM, Ruiz-González E, Méndez JC, Aguilar Tejedor Y, Zamarro J, Castaño M, Daunis-I-Estadella P, Puig J. First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy. Clin Neuroradiol 2023; 33:701-708. [PMID: 36856786 DOI: 10.1007/s00062-023-01264-4] [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: 10/19/2022] [Accepted: 01/17/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers. METHODS We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device. RESULTS We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004). CONCLUSION Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.
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Affiliation(s)
- S Remollo
- Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Werner
- Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - J Blasco
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A López-Rueda
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - L San Roman
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - E Jimenez-Gomez
- Diagnostic and Therapeutical Neuroradiology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - I Bravo Rey
- Neuroradiology Department, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - P Vega
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Murias
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Rosati
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - C Pérez-García
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - E González
- Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain
| | - X Manso
- Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain
| | - S Aixut
- Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain
| | - O Chirife Chaparro
- Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain
| | - M Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - S Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - J M Pumar
- Neuroradiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E Ruiz-González
- Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - J C Méndez
- Interventional Neuroradiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Y Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain
| | - J Zamarro
- Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Castaño
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - P Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - J Puig
- Department of Radiology (IDI) and Institut d'Investigació Biomèdica de Girona, Hospital Universitari Doctor Josep Trueta, Girona, Spain.
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3
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Martínez-Castro S, Monleón B, Puig J, Ferrer Gomez C, Quesada M, Pestaña D, Balvis A, Maseda E, de la Rica AS, Feijoo AM, Badenes R. Sedation with Sevoflurane versus Propofol in COVID-19 Patients with Acute Respiratory Distress Syndrome: Results from a Randomized Clinical Trial. J Pers Med 2023; 13:925. [PMID: 37373914 DOI: 10.3390/jpm13060925] [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: 03/13/2023] [Revised: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) related to COVID-19 (coronavirus disease 2019) led to intensive care units (ICUs) collapse. Amalgams of sedative agents (including volatile anesthetics) were used due to the clinical shortage of intravenous drugs (mainly propofol and midazolam). METHODS A multicenter, randomized 1:1, controlled clinical trial was designed to compare sedation using propofol and sevoflurane in patients with ARDS associated with COVID-19 infection in terms of oxygenation and mortality. RESULTS Data from a total of 17 patients (10 in the propofol arm and 7 in the sevoflurane arm) showed a trend toward PaO2/FiO2 improvement and the sevoflurane arm's superiority in decreasing the likelihood of death (no statistical significance was found). CONCLUSIONS Intravenous agents are the most-used sedative agents in Spain, even though volatile anesthetics, such as sevoflurane and isoflurane, have shown beneficial effects in many clinical conditions. Growing evidence demonstrates the safety and potential benefits of using volatile anesthetics in critical situations.
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Affiliation(s)
- Sara Martínez-Castro
- Department Anesthesiology, Surgical-Trauma Intensive Care and Pain Clinic, Hospital Clínic Universitari, University of Valencia, 46010 Valencia, Spain
| | - Berta Monleón
- Department Anesthesiology, Surgical-Trauma Intensive Care and Pain Clinic, Hospital Clínic Universitari, University of Valencia, 46010 Valencia, Spain
| | - Jaume Puig
- Anesthesiology and Intensive Care Department, Consorcio Hospital General Universitario, 46014 Valencia, Spain
| | - Carolina Ferrer Gomez
- Anesthesiology and Intensive Care Department, Consorcio Hospital General Universitario, 46014 Valencia, Spain
| | - Marta Quesada
- Anesthesiology and Intensive Care Department, Consorcio Hospital General Universitario, 46014 Valencia, Spain
| | - David Pestaña
- Anesthesiology and Intensive Care Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Alberto Balvis
- Anesthesiology and Intensive Care Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Emilio Maseda
- Surgical Critical Care Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Alejandro Suárez de la Rica
- Anesthesiology and Surgical Critical Care Department, Hospital Universitario De La Princesa, 28006 Madrid, Spain
| | - Ana Monero Feijoo
- Surgical Critical Care Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Rafael Badenes
- Department Anesthesiology, Surgical-Trauma Intensive Care and Pain Clinic, Hospital Clínic Universitari, University of Valencia, 46010 Valencia, Spain
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Alemany A, Perez-Zsolt D, Raïch-Regué D, Muñoz-Basagoiti J, Ouchi D, Laporte-Villar C, Baro B, Henríquez N, Prat N, Gianinetto MO, Gutiérrez MV, Sánchez-Paniagua MG, Henríquez NL, Vicente JM, Ara J, Rodriguez-Arias MA, Puig J, Blanco I, Lopez CC, Hernández Á, Bordoy AE, Redondo CE, Soler VG, Giménez M, Blanc V, León R, Gispert J, Clotet B, Izquierdo-Useros N, Mitjà O. Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial. J Dent Res 2022; 101:1450-1456. [PMID: 35727681 DOI: 10.1177/00220345221102310] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via respiratory fluids and droplets suggests that mouthwashes containing substances with virucidal activity can help reduce viral spread. We conducted a multicenter, double-blind, placebo-controlled, randomized trial to assess the virucidal activity of cetylpyridinium chloride (CPC) mouthwashes. Outpatients who tested positive for SARS-CoV-2 infection with or without symptoms were randomized to perform washes and gargles for 1 min with 15 mL of either colored distilled water or 0.07% CPC (Vitis CPC Protect) mouthwash. The study outcomes were the SARS-CoV-2 log10 viral RNA load and the nucleocapsid protein levels, both in saliva at 1 and 3 h after the intervention. In total, 118 patients were enrolled and randomized (mean [SD], age 46 [14] y). Thirteen of 118 participants (11%) did not complete follow-up or had insufficient sample volume for testing and were excluded from the analysis. The assessment of the viral load showed no significant differences between groups at any of the investigated points. However, the levels of SARS-CoV-2 nucleocapsid protein of lysed viruses were significantly higher in the CPC group compared with the control group at 1 h (adjusted difference 269.3 pg/mL; 95% confidence interval [CI], 97.1-441.5) and at 3 h postintervention (561.1 pg/mL; 95% CI, 380.0-742.2). In nonhospitalized patients with asymptomatic or mild symptomatic SARS-CoV-2 infection, a 0.07% CPC mouthwash, compared to placebo, was associated with a significant increase of nucleocapsid protein levels in saliva, indicating enhanced disruption of viral particles.
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Affiliation(s)
- A Alemany
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Facultat de Medicina-Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - D Ouchi
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - B Baro
- ISGlobal, Hospital Clinic Universitat de Barcelona, Barcelona, Spain
| | - N Henríquez
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - N Prat
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - M Ochoa Gianinetto
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - M Viaplana Gutiérrez
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | | | - N Larrosa Henríquez
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - J Moreno Vicente
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - J Ara
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - M A Rodriguez-Arias
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - J Puig
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain
| | - I Blanco
- Metropolitana Nord Laboratory, Institut Català de la Salut, Badalona, Spain
| | - C Casañ Lopez
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain
| | - Á Hernández
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain
| | - A E Bordoy
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain
| | - C Esteban Redondo
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain
| | - V González Soler
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain.,Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - M Giménez
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - V Blanc
- DENTAID Research Center, Cerdanyola del Vallès, Spain
| | - R León
- DENTAID Research Center, Cerdanyola del Vallès, Spain
| | - J Gispert
- DENTAID Research Center, Cerdanyola del Vallès, Spain
| | | | - B Clotet
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,IrsiCaixa AIDS Research Institute, Badalona, Spain.,Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
| | - N Izquierdo-Useros
- IrsiCaixa AIDS Research Institute, Badalona, Spain.,Germans Trias i Pujol Research Institute, Badalona, Spain
| | - O Mitjà
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain.,Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
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5
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Errando CL, Romero-García CS, Hernández-Cádiz MJ, Pallardó-López MÁ, Puig J. SARS-CoV-2 infection. Descriptive analysis of a selected case series. Revista Española de Anestesiología y Reanimación (English Edition) 2022; 69:34-42. [PMID: 35039243 PMCID: PMC8747947 DOI: 10.1016/j.redare.2021.03.006] [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] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022]
Abstract
Objectives COVID-19 was declared pandemic by March 2020. Clinical, analytical, and radiological findings have been reported. Detailed different evolution of patients of the same local outbreak has been scarcely reported. We report 6 selected cases of such an evolution. Clinical cases The clinical, radiological, analytical evolution of 6 patients is reported. Patients were selected as it were epidemiological close contacts, and showed particular different clinical evolution. Results The clinical course at the start of infection (first week) was similar among patients. In relationship with clinical evolution, middle to severe course were related with inflammation markers levels evolution (D-dimer, IL-6, ferritin, lymphocytes count, etc.). Specially lung alterations were observed, but neurological/neuropsychiatric findings are still common. In evolution, 2 patients showed middle symptoms, but the 2 most severely affected died. Conclusions It remains to be elucidated the different evolutive pathways and outcomes of COVD-19. In our 6 patients of the same local outbreak, clinical, laboratory and radiological features were different. We discuss some aspects of the pathophysiology of the disease, other than the widely described of the respiratory system.
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Affiliation(s)
- C L Errando
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - C S Romero-García
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - J Puig
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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6
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Contreras-Rodriguez O, Arnoriaga-Rodríguez M, Miranda-Olivos R, Blasco G, Biarnés C, Puig J, Rivera-Pinto J, Calle ML, Pérez-Brocal V, Moya A, Coll C, Ramió-Torrentà L, Soriano-Mas C, Fernandez-Real JM. Obesity status and obesity-associated gut dysbiosis effects on hypothalamic structural covariance. Int J Obes (Lond) 2022; 46:30-38. [PMID: 34471225 PMCID: PMC8748191 DOI: 10.1038/s41366-021-00953-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functional connectivity alterations in the lateral and medial hypothalamic networks have been associated with the development and maintenance of obesity, but the possible impact on the structural properties of these networks remains largely unexplored. Also, obesity-related gut dysbiosis may delineate specific hypothalamic alterations within obese conditions. We aim to assess the effects of obesity, and obesity and gut-dysbiosis on the structural covariance differences in hypothalamic networks, executive functioning, and depressive symptoms. METHODS Medial (MH) and lateral (LH) hypothalamic structural covariance alterations were identified in 57 subjects with obesity compared to 47 subjects without obesity. Gut dysbiosis in the subjects with obesity was defined by the presence of high (n = 28) and low (n = 29) values in a BMI-associated microbial signature, and posthoc comparisons between these groups were used as a proxy to explore the role of obesity-related gut dysbiosis on the hypothalamic measurements, executive function, and depressive symptoms. RESULTS Structural covariance alterations between the MH and the striatum, lateral prefrontal, cingulate, insula, and temporal cortices are congruent with previously functional connectivity disruptions in obesity conditions. MH structural covariance decreases encompassed postcentral parietal cortices in the subjects with obesity and gut-dysbiosis, but increases with subcortical nuclei involved in the coding food-related hedonic information in the subjects with obesity without gut-dysbiosis. Alterations for the structural covariance of the LH in the subjects with obesity and gut-dysbiosis encompassed increases with frontolimbic networks, but decreases with the lateral orbitofrontal cortex in the subjects with obesity without gut-dysbiosis. Subjects with obesity and gut dysbiosis showed higher executive dysfunction and depressive symptoms. CONCLUSIONS Obesity-related gut dysbiosis is linked to specific structural covariance alterations in hypothalamic networks relevant to the integration of somatic-visceral information, and emotion regulation.
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Affiliation(s)
- O Contreras-Rodriguez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, and CIBERSam-17 and CIBERObn (CB06/03/0034), Barcelona, Spain.
- Department of Radiology-Medical Imaging (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain.
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Health Institute Carlos III (ISCIII), Barcelona, Spain.
| | - M Arnoriaga-Rodríguez
- Health Institute Carlos III (ISCIII), Barcelona, Spain
- Department of Diabetes, Endocrinology and Nutrition-UDEN, and CIBERObn (CB06/03/0010), Girona, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - R Miranda-Olivos
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, and CIBERSam-17 and CIBERObn (CB06/03/0034), Barcelona, Spain
| | - G Blasco
- Department of Radiology-Medical Imaging (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - C Biarnés
- Department of Radiology-Medical Imaging (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - J Puig
- Department of Radiology-Medical Imaging (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - J Rivera-Pinto
- IrsiCaixa AIDS Research Institute, Badalona, Spain
- Biosciences Department, Faculty of Sciences and Technology, University of Vic-Central University of Catalonia, VIC, Badalona, Spain
| | - M L Calle
- Biosciences Department, Faculty of Sciences and Technology, University of Vic-Central University of Catalonia, VIC, Badalona, Spain
| | - V Pérez-Brocal
- Department of Genomics and Health, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain, and CIBEResp- CB06/02/0050, Madrid, Spain
| | - A Moya
- Department of Genomics and Health, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain, and CIBEResp- CB06/02/0050, Madrid, Spain
- Institute for Integrative Systems Biology (I2SysBio), The University of Valencia and The Spanish National Research Council (CSIC-UVEG), Valencia, Spain
| | - C Coll
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Girona Biomedical Research Institute (IdIBGi), Dr. Josep Trueta University Hospital, Girona, Spain
| | - L Ramió-Torrentà
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Girona Biomedical Research Institute (IdIBGi), Dr. Josep Trueta University Hospital, Girona, Spain
| | - C Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, and CIBERSam-17 and CIBERObn (CB06/03/0034), Barcelona, Spain
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M Fernandez-Real
- Health Institute Carlos III (ISCIII), Barcelona, Spain.
- Department of Diabetes, Endocrinology and Nutrition-UDEN, and CIBERObn (CB06/03/0010), Girona, Spain.
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.
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7
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Puig J, Knödlseder N, Quera J, Algara M, Güell M. DNA Damage Protection for Enhanced Bacterial Survival Under Simulated Low Earth Orbit Environmental Conditions in Escherichia coli. Front Microbiol 2022; 12:789668. [PMID: 34970246 PMCID: PMC8713957 DOI: 10.3389/fmicb.2021.789668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/05/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Some organisms have shown the ability to naturally survive in extreme environments, even outer space. Some of these have natural mechanisms to resist severe DNA damage from conditions such as ionizing and non-ionizing radiation, extreme temperatures, and low pressures or vacuum. A good example can be found in Deinococcus radiodurans, which was exposed to severe conditions such as those listed in the Exposure Facility of the International Space Station (ISS) for up to three years. Another example are tardigrades (Ramazzottius varieornatus) which are some of the most resilient animals known. In this study, the survival under simulated Low earth Orbit (LEO) environmental conditions was tested in Escherichia coli. The radiation resistance of this bacteria was enhanced using the Dsup gene from R. varieornatus, and two more genes from D. radiodurans involved in DNA damage repair, RecA and uvrD. The enhanced survival to wide ranges of temperatures and low pressures was then tested in the new strains. This research constitutes a first step in the creation of new bacterial strains engineered to survive severe conditions and adapting existing species for their survival in remote environments, including extra-terrestrial habitats. These strains could be key for the development of environments hospitable to life and could be of use for ecological restoration and space exploration. In addition, studying the efficacy and the functioning of the DNA repair mechanisms used in this study could be beneficial for medical and life sciences engineering.
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Affiliation(s)
- Jaume Puig
- Translational Synthetic Biology Laboratory, Experimental and Health Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain.,Experimental and Health Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Nastassia Knödlseder
- Translational Synthetic Biology Laboratory, Experimental and Health Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain.,Experimental and Health Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jaume Quera
- Experimental and Health Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain.,Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.,IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Manuel Algara
- Experimental and Health Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain.,Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.,IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Marc Güell
- Translational Synthetic Biology Laboratory, Experimental and Health Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain.,Experimental and Health Sciences Department, Universitat Pompeu Fabra, Barcelona, Spain
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8
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Peña Borras JJ, Pajares Moncho A, Puig J, Mateo Rodríguez E, López Forte C, Peña Pérez L, Moreno Pachón J, Gabaldón Conejos T, Pérez Artacho J, Ferrer Gómez C, Férez Martí A, López Cantero M, de Andrés Ibáñez J. Tranexamic acid in cardiac surgery: Are low doses enough? Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:576-583. [PMID: 34857506 DOI: 10.1016/j.redare.2021.02.005] [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] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 02/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Tranexamic acid is used to prevent hyperfibrinolysis and reduce postoperative bleeding and blood transfusions in on-pump cardiac surgery. We evaluate the efficacy of low or high dose tranexamic acid in a prospective cohort study conducted in Valencia. MATERIALS AND METHODS A total of 427 patients were recruited between January 2019 and January 2020, 207 in the Hospital General Universitario (low dose [LD]) and 220 in the Hospital Universitario y Politécnico La Fe (high dose [HD] and intermediate dose [ID]). We recorded the presence of hyperfibrinolysis on rotational thromboelastometry, intra- and postoperative administration of blood products, chest tube output within the first 12 h, and incidence of convulsions. Univariate and multivariate comparisons were performed. Univariate analysis of all categories was performed after propensity score matching between LD and HD and between LD and ID. RESULTS There were no statistically significant differences in: appearance of hyperfibrinolysis, administration of blood products, postoperative chest tube output within the first 12 h, or occurrence of convulsions. Group LD received less fibrinogen than group HD (P = .014) and ID (P = .040) but more fresh frozen plasma than group ID (P = .0002). CONCLUSIONS Administration of low-dose tranexamic acid is as effective as higher doses in hyperfibrinolysis prophylaxis and the prevention of postoperative bleeding in cardiac surgery.
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Affiliation(s)
- J J Peña Borras
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Pajares Moncho
- Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J Puig
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; Departamento de Cirugía, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain.
| | - E Mateo Rodríguez
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C López Forte
- Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - L Peña Pérez
- Centre for Haematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Moreno Pachón
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - T Gabaldón Conejos
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J Pérez Artacho
- Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - C Ferrer Gómez
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Férez Martí
- Servicio de Análisis Clínicos, Hospital General Universitario de Valencia, Valencia, Spain
| | - M López Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J de Andrés Ibáñez
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; Departamento de Cirugía, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain
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9
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Peña Borras JJ, Pajares Moncho A, Puig J, Mateo Rodríguez E, López Forte C, Peña Pérez L, Moreno Pachón J, Gabaldón Conejos T, Pérez Artacho J, Ferrer Gómez C, Férez Martí A, López Cantero M, de Andrés Ibáñez J. Tranexamic acid in cardiac surgery: Are low doses enough? Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:S0034-9356(21)00105-5. [PMID: 34538453 DOI: 10.1016/j.redar.2021.02.008] [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] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/04/2020] [Accepted: 02/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Tranexamic acid is used to prevent hyperfibrinolysis and reduce postoperative bleeding and blood transfusions in on-pump cardiac surgery. We evaluate the efficacy of low or high dose tranexamic acid in a prospective cohort study conducted in Valencia. MATERIALS AND METHODS A total of 427 patients were recruited between January 2019 and January 2020, 207 in the Hospital General Universitario (low dose [LD]) and 220 in the Hospital Universitario y Politécnico La Fe (high dose [HD] and intermediate dose [ID]). We recorded the presence of hyperfibrinolysis on rotational thromboelastometry, intra- and postoperative administration of blood products, chest tube output within the first 12h, and incidence of convulsions. Univariate and multivariate comparisons were performed. Univariate analysis of all categories was performed after propensity score matching between LD and HD and between LD and ID. RESULTS There were no statistically significant differences in: appearance of hyperfibrinolysis, administration of blood products, postoperative chest tube output within the first 12h, or occurrence of convulsions. Group LD received less fibrinogen than group HD (P=.014) and ID (P=.040) but more fresh frozen plasma than group ID (P=.0002). CONCLUSIONS Administration of low-dose tranexamic acid is as effective as higher doses in hyperfibrinolysis prophylaxis and the prevention of postoperative bleeding in cardiac surgery.
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Affiliation(s)
- J J Peña Borras
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - A Pajares Moncho
- Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J Puig
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España; Departamento de Cirugía, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España.
| | - E Mateo Rodríguez
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - C López Forte
- Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - L Peña Pérez
- Centre for Haematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Suecia
| | - J Moreno Pachón
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - T Gabaldón Conejos
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Pérez Artacho
- Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - C Ferrer Gómez
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - A Férez Martí
- Servicio de Análisis Clínicos, Hospital General Universitario de Valencia, Valencia, España
| | - M López Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J de Andrés Ibáñez
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España; Departamento de Cirugía, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España
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10
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Merino-Gutierrez V, Borrego JF, Puig J, Hernández A, Clemente-Vicario F. Treatment of advanced-stage canine nasal carcinomas with toceranib phosphate: 23 cases (2015-2020). J Small Anim Pract 2021; 62:881-885. [PMID: 34131916 DOI: 10.1111/jsap.13387] [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: 02/07/2021] [Revised: 04/07/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the median survival time (MST) of dogs with nasal carcinoma treated with toceranib phosphate. MATERIAL AND METHODS The databases of four Spanish referral hospitals were retrospectively searched for dogs with a diagnosis of nasal tumours presented between January 2015 and October 2020. Dogs treated with radiotherapy or other chemotherapies prior toceranib were excluded. RESULTS Twenty-three dogs with a confirmed nasal carcinoma treated with toceranib phosphate and with a CT scan for initial staging according to Adams Modified Staging System were included. Nine dogs had a stage III nasal carcinoma whereas 14 dogs had a stage IV nasal carcinoma. No dog had stages I and II nasal carcinoma. The median overall survival time was 139 days. The difference between the MST between dogs with stages III and IV was not statistically significant [P = 0.6, 140 days for stage III (range 46-401) vs 120 days for stage IV (range 23-600)]. Overall, dogs with epistaxis achieved a longer median survival (166 days) than dogs without epistaxis (83 days). Toceranib phosphate was generally well tolerated. Most dogs had an initial clinical benefit followed by progressive disease. SIGNIFICANCE This is the first study to report the MST in dogs with stages III and IV nasal carcinoma treated with toceranib phosphate. This retrospective study showed that toceranib phosphate decreases the clinical signs associated with nasal carcinomas.
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Affiliation(s)
- V Merino-Gutierrez
- Department of Internal Medicine, AniCura Ars Veterinaria Hospital Veterinari, Barcelona, Spain
| | - J F Borrego
- Department of Medical Oncology, Hospital Aúna Especialidades Veterinarias, Valencia, Spain
| | - J Puig
- Department of Internal Medicine, AniCura Ars Veterinaria Hospital Veterinari, Barcelona, Spain
| | - A Hernández
- Department of Medical Oncology, Hospital Veterinario Vetsia, Madrid, Spain
| | - F Clemente-Vicario
- Department of Internal Medicine, AniCura Ars Veterinaria Hospital Veterinari, Barcelona, Spain.,Department of Medical Oncology, Hospital Veterinario Vetsia, Madrid, Spain.,Department of Medical Oncology, La Merced Oncología Veterinaria, Calpe, Spain
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11
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Errando CL, Romero-García CS, Hernández-Cádiz MJ, Pallardó-López MÁ, Puig J. SARS-CoV-2 infection. Descriptive analysis of a selected case series. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00136-5. [PMID: 34518043 PMCID: PMC8031254 DOI: 10.1016/j.redar.2021.03.009] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES COVID-19 was declared pandemic by March 2020. Clinical, analytical, and radiological findings have been reported. Detailed different evolution of patients of the same local outbreak has been scarcely reported. We report 6 selected cases of such an evolution. CLINICAL CASES The clinical, radiological, analytical evolution of 6patients is reported. Patients were selected as it were epidemiological close contacts, and showed particular different clinical evolution. RESULTS The clinical course at the start of infection (first week) was similar among patients. In relationship with clinical evolution, middle to severe course were related with inflammation markers levels evolution (D-dimer, IL-6, ferritin, lymphocytes count, etc.). Specially lung alterations were observed, but neurological/neuropsychiatric findings are still common. In evolution, 2patients showed middle symptoms, but the 2most severely affected died. CONCLUSIONS It remains to be elucidated the different evolutive pathways and outcomes of COVD-19. In our 6patients of the same local outbreak, clinical, laboratory and radiological features were different. We discuss some aspects of the pathophysiology of the disease, other than the widely described of the respiratory system.
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Affiliation(s)
- C L Errando
- Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - C S Romero-García
- Consorcio Hospital General Universitario de Valencia, Valencia, España
| | | | | | - J Puig
- Consorcio Hospital General Universitario de Valencia, Valencia, España
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12
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Ryan D, Pérez-Accino J, Gonçalves R, Czopowicz M, Bertolani C, Tabar MD, Puig J, Ros C, Suñol A. Clinical findings, neurological manifestations and survival of dogs with insulinoma: 116 cases (2009-2020). J Small Anim Pract 2021; 62:531-539. [PMID: 33724496 DOI: 10.1111/jsap.13318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/23/2020] [Accepted: 01/25/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To review the clinical findings and outcome in dogs diagnosed with insulinoma, and to assess which factors are predictors of overall survival. Additionally, to describe the neurological manifestations of this population and their correlation with survival. MATERIALS AND METHODS Retrospective multicentric study of canine insulinoma cases (2009 to 2020). Signalment, clinical history, neurological examination, diagnostic findings, treatment and outcome were obtained from clinical records. Univariate and multivariate analyses were used to compare the overall survival. RESULTS One hundred and sixteen cases were included. Median duration of clinical signs before presentation was 1.5 months. The most common presenting clinical signs were weakness (59.5%), epileptic seizures (33.6%) and changes in consciousness or behaviour (27.6%). Three dogs were suspected to have paroxysmal dyskinesia. Thirty-two dogs had an abnormal neurological examination, most commonly showing obtundation (28.1%), decreased withdrawal reflexes (21.9%) and absent menace response (18.8%). Overall survival for dogs undergoing surgery (20 months) was significantly longer than in medically treated (8 months; adjusted hazard ratio: 0.33; 95% confidence interval: 0.18, 0.59). Presence of metastases was the only other variable associated with prognosis (adjusted hazard ratio 1.72; 95% confidence interval: 1.02, 2.91). CLINICAL SIGNIFICANCE Clinical signs of canine insulinoma are vague and non-specific. Weakness, epileptic seizures and changes in mentation or behaviour were the most commonly reported. Obtunded mentation and forebrain neurolocalisation were the main neurological manifestations. Dogs undergoing surgery had a longer overall survival compared to medically treated cases, and dogs with metastasis had a shorter overall survival regardless of treatment modality. Abnormalities in the neurological examination did not correlate with prognosis.
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Affiliation(s)
- D Ryan
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian, EH25 9RG, UK
| | - J Pérez-Accino
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian, EH25 9RG, UK
| | - R Gonçalves
- Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, CH64 7TE, UK
| | - M Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Warsaw, 02-776, Poland
| | - C Bertolani
- Internal Medicine Service, Hospital Veterinari Canis Mallorca, Palma, 07010, Spain
| | - M D Tabar
- Internal Medicine Service, Hospital Veterinario San Vincente, Alicante, 03690, Spain
| | - J Puig
- Internal Medicine Service, Ars Veterinaria, Barcelona, 08034, Spain
| | - C Ros
- Hospital Veterinario UCV, Universidad Católica de Valencia, Valencia, 46018, Spain
| | - A Suñol
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian, EH25 9RG, UK
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13
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Azarfane B, Puig J, Jurado E, Bergés M, Kirkegaard E. [Iris prolapse in Terrien's marginal degeneration]. J Fr Ophtalmol 2020; 44:618-619. [PMID: 33388189 DOI: 10.1016/j.jfo.2020.07.006] [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: 05/21/2020] [Accepted: 07/30/2020] [Indexed: 10/22/2022]
Affiliation(s)
- B Azarfane
- Service d'ophtalmologie, hôpital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelone, Espagne.
| | - J Puig
- Service d'ophtalmologie, hôpital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelone, Espagne
| | - E Jurado
- Service d'ophtalmologie, hôpital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelone, Espagne
| | - M Bergés
- Service d'ophtalmologie, hôpital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelone, Espagne
| | - E Kirkegaard
- Service d'ophtalmologie, hôpital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelone, Espagne
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14
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Giavedoni P, Morgado-Carrasco D, Puig J, Malvehy S. Differences in Ultrasound Scanners’ Detection of Metastasis in Melanoma. Actas Dermo-Sifiliográficas (English Edition) 2020. [DOI: 10.1016/j.adengl.2020.10.029] [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: 10/23/2022] Open
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15
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Jensen M, Boutitie F, Cheng B, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Ford I, Galinovic I, Königsberg A, Puig J, Roy P, Wouters A, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G. Polypharmacy, functional outcome and treatment effect of intravenous alteplase for acute ischaemic stroke. Eur J Neurol 2020; 28:532-539. [PMID: 33015924 DOI: 10.1111/ene.14566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/08/2020] [Accepted: 09/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Polypharmacy is an important challenge in clinical practice. Our aim was to determine the effect of polypharmacy on functional outcome and treatment effect of alteplase in acute ischaemic stroke. METHODS This was a post hoc analysis of the randomized, placebo-controlled WAKE-UP trial of magnetic resonance imaging guided intravenous alteplase in unknown onset stroke. Polypharmacy was defined as an intake of five or more medications at baseline. Comorbidities were assessed by the Charlson Comorbidity Index (CCI). The primary efficacy variable was favourable outcome defined by a score of 0-1 on the modified Rankin Scale at 90 days. Logistic regression analysis was used to test for an association of polypharmacy with functional outcome, and for interaction of polypharmacy and the effect of thrombolysis. RESULTS Polypharmacy was present in 133/503 (26%) patients. Patients with polypharmacy were older (mean age 70 vs. 64 years; p < 0.0001) and had a higher score on the National Institutes of Health Stroke Scale at baseline (median 7 vs. 5; p = 0.0007). A comorbidity load defined by a CCI score ≥ 2 was more frequent in patients with polypharmacy (48% vs. 8%; p < 0.001). Polypharmacy was associated with lower odds of favourable outcome (adjusted odds ratio 0.50, 95% confidence interval 0.30-0.85; p = 0.0099), whilst the CCI score was not. Treatment with alteplase was associated with higher odds of favourable outcome in both groups, with no heterogeneity of treatment effect (test for interaction of treatment and polypharmacy, p = 0.29). CONCLUSION In stroke patients, polypharmacy is associated with worse functional outcome after intravenous thrombolysis independent of comorbidities. However, polypharmacy does not interact with the beneficial effect of alteplase.
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Affiliation(s)
- M Jensen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Boutitie
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - B Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T-H Cho
- Department of Stroke Medicine, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - M Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Neurologie der Rehaklinik Medical Park Humboldtmühle, Berlin, Germany
| | - M Endres
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Partner Site Berlin, German Center for Neurodegenerative Disease (DZNE), Berlin, Germany.,Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - J B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - J Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, University Avenue, Glasgow, UK
| | - I Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - A Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Institut d'Investigació Biomèdica de Girona (IDIBGI), Hospital Dr Josep Trueta, Parc Hospitalari Martí i Julià de Salt - Edifici M2, Girona, Spain
| | - P Roy
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - A Wouters
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium.,Center for Brain and Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, VIB, Leuven, Belgium
| | - V Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Vic., Australia.,Department of Neurology, Austin Health, Heidelberg, Vic., Australia
| | - R Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium.,Center for Brain and Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, VIB, Leuven, Belgium
| | - K W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, University Avenue, Glasgow, UK
| | - N Nighoghossian
- Department of Stroke Medicine, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - S Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Institut d'Investigació Biomèdica de Girona (IDIBGI), Hospital Dr Josep Trueta, Parc Hospitalari Martí i Julià de Salt - Edifici M2, Girona, Spain
| | - C Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - C Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Pérez-Accino J, Feo Bernabe L, Manzanilla EG, Puig J. The utility of combined urine dipstick analysis and specific gravity measurement to determine feline proteinuria. J Small Anim Pract 2020; 61:541-546. [PMID: 32692434 DOI: 10.1111/jsap.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/27/2020] [Accepted: 05/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the utility of urine dipstick strips for detection of feline proteinuria when used in combination with urine-specific gravity, compared with urine protein-to-creatinine ratio as the gold standard. MATERIALS AND METHODS Retrospective analysis of clinical records of comprehensive urine examination obtained from cats presented to a referral hospital. Diagnostic agreement and test accuracy were calculated for the dipstick test alone and in combination with the urine-specific gravity, using different cut-off values for proteinuria. Receiver-operating characteristic curves were also calculated. RESULTS A total of 121 urine samples were included. The diagnostic agreement between dipstick and urine protein-creatinine ratio was poor. A dipstick result of equal or greater than "Trace" (0.1-0.3 g/L) had a sensitivity of 81% and a specificity of 31% to detect proteinuria. Grouping the samples by urine-specific gravity did not increase dipstick agreement with the urine protein-creatinine ratio and only resulted in a slight improvement in the accuracy of detecting proteinuria. CLINICAL SIGNIFICANCE The dipstick test was not accurate for detecting proteinuria when combined with urine-specific gravity in cats. Clinicians should not rely on this test and, regardless of the urine concentration, other appropriate quantitative methods such as urine protein-creatinine ratio should always be performed to detect proteinuria in cats.
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Affiliation(s)
- J Pérez-Accino
- Ars Veterinaria Hospital, Carrer dels Cavallers 37, Barcelona, 08034, Spain.,Royal (Dick) School of Veterinary Studies, Easter Bush Campus, Roslin, EH25 9RG, UK
| | - L Feo Bernabe
- Ars Veterinaria Hospital, Carrer dels Cavallers 37, Barcelona, 08034, Spain
| | - E G Manzanilla
- Moorepark Animal and Grassland Research Centre, Teagasc, Cork, P61 C996, Ireland.,School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - J Puig
- Ars Veterinaria Hospital, Carrer dels Cavallers 37, Barcelona, 08034, Spain
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17
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Gómez-Huelgas R, González D, Abadias M, Puig J, Ena J. Prescription patterns of antihyperglycemic drugs in elderly patients in Spain: A national cross-sectional study. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.05.007] [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: 10/26/2022]
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18
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Soriano-Bru JL, Puig J, Bauset JC. Measurement above the carina of FiO2 and Positive Pressure changes using different HFNO rates. Trends in Anaesthesia and Critical Care 2020. [DOI: 10.1016/j.tacc.2019.12.179] [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: 11/30/2022]
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19
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Sundaram VK, Goldstein J, Wheelwright D, Aggarwal A, Pawha PS, Doshi A, Fifi JT, Leacy RD, Mocco J, Puig J, Nael K. Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion. AJNR Am J Neuroradiol 2019; 40:2033-2038. [PMID: 31727750 DOI: 10.3174/ajnr.a6303] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Automated ASPECTS has the potential of reducing interobserver variability in the determination of early ischemic changes. We aimed to assess the performance of an automated ASPECTS software against the assessment of a neuroradiologist in a comparative analysis with concurrent CTP-based CBV ASPECTS. MATERIALS AND METHODS Patients with anterior circulation stroke who had baseline NCCT and CTP and underwent successful mechanical thrombectomy were included. NCCT-ASPECTS was assessed by 2 neuroradiologists, and discrepancies were resolved by consensus. CTP-CBV ASPECTS was assessed by a different neuroradiologist. Automated ASPECTS was provided by Brainomix software. ASPECTS was dichotomized (ASPECTS ≥6 or <6) and was also based on the time from onset (>6 or ≤6 hours). RESULTS A total of 58 patients were included. The interobserver agreement for NCCT ASPECTS was moderate (κ = 0.48) and marginally improved (κ = 0.64) for dichotomized data. Automated ASPECTS showed excellent agreement with consensus reads (κ = 0.84) and CTP-CBV ASPECTS (κ = 0.84). Intraclass correlation coefficients for ASPECTS across all 3 groups were 0.84 (95% CI, 0.76-0.90, raw scores) and 0.94 (95% CI, 0.91-0.96, dichotomized scores). Automated scores were comparable with consensus reads and CTP-CBV ASPECTS in patients when grouped on the basis of time from symptom onset (>6 or ≤6 hours). There was significant (P < .001) negative correlation with final infarction volume and the 3 ASPECTS groups (r = -0.52, consensus reads; -0.58, CTP-CBV; and -0.66, automated). CONCLUSIONS ASPECTS derived from an automated software performs equally as well as consensus reads of expert neuroradiologists and concurrent CTP-CBV ASPECTS and can be used to standardize ASPECTS reporting and minimize interpretation variability.
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Affiliation(s)
- V K Sundaram
- From the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
| | - J Goldstein
- From the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
| | - D Wheelwright
- Neuroimaging Advanced and Exploratory Lab, Department of Neurology (D.W., J.T.F., R.D.L.)
| | - A Aggarwal
- From the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
| | - P S Pawha
- From the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
| | - A Doshi
- From the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
| | - J T Fifi
- Neuroimaging Advanced and Exploratory Lab, Department of Neurology (D.W., J.T.F., R.D.L.)
- Department of Neurosurgery (J.T.F., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - R De Leacy
- Neuroimaging Advanced and Exploratory Lab, Department of Neurology (D.W., J.T.F., R.D.L.)
- Department of Neurosurgery (J.T.F., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Mocco
- Department of Neurosurgery (J.T.F., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Puig
- Department of Radiology (J.P.). University of Manitoba, Winnipeg, Manitoba, Canada
| | - K Nael
- From the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
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20
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Llupià A, Torà I, Cobo T, Sotoca JM, Puig J. Breatsfeeding supression in a Spanish referral hospital (2011-17): a retrospective cohort study. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
WHO recommends measuring the role of social determinants in the initiation of breastfeeding, given that they will have an impact on the health of these mothers and babies throughout their lives. The present study, the first in Spain, describes the onset of breastfeeding through maternal and pregnancy characteristics related to breastfeeding suppression with cabergoline.
Methods
We assessed 20965 opportunities of breastfeeding initiation, collecting data of deliveries that had an obstetric clinic history record and resulted with at least one alive baby at the Hospital Clinic of Barcelona (HCB) between January 2011 and December 2017. Adjusted odds ratios for cabergoline use during hospitalization considering maternal, neonatal and pregnancy characteristics were obtained.
Results
Adjusting for the set of variables, inhibition of lactation was significantly higher in women without or primary studies with respect to women with higher education (OR 2.5, CI95% 2.0-3.0) and living in economically more depressed areas (OR 1.08, 1.04-1.2). Breastfeeding was also more inhibited in women who did not express intention of natural birth (OR 2.3, 1.9-2.9), smokers (OR 2.2, 1.9-2.6), with more previous children (OR 1.2 for each sibling,1.1-1.3), in term versus pre-term birth (OR 1.3, 1.2-1.4), in women with multiple births (OR 1.6, 1.2-2.1) and with higher risk pregnancy (OR 1.3 per risk point, 1.2-1.4). According to the mother’s country of birth, and taking Spanish women as a reference, women born in Northern Africa (OR 0.2, 0.1-0.3), in India and Pakistan (0.2, 0.1-0.3), in Eastern Europe (0.4, 0.2-0.6) and Western Europe (0.5, 0.4-0.8) are less likely to inhibit breastfeeding. Chinese women are significantly more likelier to inhibit breastfeeding (OR 7 (5.7-8.6)).
Conclusions
Inequalities have been detected in the inhibition of lactation in puerperal women. Knowing these inequalities in breastfeeding initiation is the first step to address them.
Key messages
This is the first study to describe disparities in breastfeeding inhibition in puerperal women. Factors related to lower socioeconomic status and poor health are more likely associated with breatfeeding suppression.
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Affiliation(s)
- A Llupià
- Preventive Medicine and Epidemiology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - I Torà
- Preventive Medicine and Epidemiology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T Cobo
- BCNatal, IDIBAPS, UB, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J M Sotoca
- Pharmacy Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Puig
- Department of Mathematics, Universitat Politècnica de Catalunya, Barcelona, Spain
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21
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Puig J, Blasco G, Terceño M, Daunis-I-Estadella P, Schlaug G, Hernandez-Perez M, Cuba V, Carbó G, Serena J, Essig M, Figley CR, Nael K, Leiva-Salinas C, Pedraza S, Silva Y. Predicting Motor Outcome in Acute Intracerebral Hemorrhage. AJNR Am J Neuroradiol 2019; 40:769-775. [PMID: 31000524 DOI: 10.3174/ajnr.a6038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/15/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Predicting motor outcome following intracerebral hemorrhage is challenging. We tested whether the combination of clinical scores and DTI-based assessment of corticospinal tract damage within the first 12 hours of symptom onset after intracerebral hemorrhage predicts motor outcome at 3 months. MATERIALS AND METHODS We prospectively studied patients with motor deficits secondary to primary intracerebral hemorrhage within the first 12 hours of symptom onset. Patients underwent multimodal MR imaging including DTI. We assessed intracerebral hemorrhage and perihematomal edema location and volume, and corticospinal tract involvement. The corticospinal tract was considered affected when the tractogram passed through the intracerebral hemorrhage or/and the perihematomal edema. We also calculated affected corticospinal tract-to-unaffected corticospinal tract ratios for fractional anisotropy, mean diffusivity, and axial and radial diffusivities. Motor impairment was graded by the motor subindex scores of the modified NIHSS. Motor outcome at 3 months was classified as good (modified NIHSS 0-3) or poor (modified NIHSS 4-8). RESULTS Of 62 patients, 43 were included. At admission, the median NIHSS score was 13 (interquartile range = 8-17), and the median modified NIHSS score was 5 (interquartile range = 2-8). At 3 months, 13 (30.23%) had poor motor outcome. Significant independent predictors of motor outcome were NIHSS and modified NIHSS at admission, posterior limb of the internal capsule involvement by intracerebral hemorrhage at admission, intracerebral hemorrhage volume at admission, 72-hour NIHSS, and 72-hour modified NIHSS. The sensitivity, specificity, and positive and negative predictive values for poor motor outcome at 3 months by a combined modified NIHSS of >6 and posterior limb of the internal capsule involvement in the first 12 hours from symptom onset were 84%, 79%, 65%, and 92%, respectively (area under the curve = 0.89; 95% CI, 0.78-1). CONCLUSIONS Combined assessment of motor function and posterior limb of the internal capsule damage during acute intracerebral hemorrhage accurately predicts motor outcome.
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Affiliation(s)
- J Puig
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - G Blasco
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - M Terceño
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - P Daunis-I-Estadella
- Department of Computer Science (P.D.-i.-E.), Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - G Schlaug
- Neuroimaging and Stroke Recovery Laboratory (G.S.), Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - M Hernandez-Perez
- Department of Neurosciences (M.H.-P.), Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Badalona, Spain
| | - V Cuba
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - G Carbó
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - J Serena
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - M Essig
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
| | - C R Figley
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
| | - K Nael
- Department of Radiology (K.N.), Icahn School of Medicine at Mount Sinai, New York
| | - C Leiva-Salinas
- Department of Radiology (C.L.-S.), University of Missouri, Columbia, Missouri
| | - S Pedraza
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - Y Silva
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
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22
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Ferrando C, Puig J, Serralta F, Carrizo J, Pozo N, Arocas B, Gutierrez A, Villar J, Belda FJ, Soro M. High-flow nasal cannula oxygenation reduces postoperative hypoxemia in morbidly obese patients: a randomized controlled trial. Minerva Anestesiol 2019; 85:1062-1070. [PMID: 30994312 DOI: 10.23736/s0375-9393.19.13364-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) are common in high-risk surgical patients. Postoperative ventilatory management may improve their outcome. Supplemental oxygen through a high-flow nasal cannula (HFNC) has become an alternative to classical oxygenation techniques, although the results published for postoperative patients are contradictory. We examined the efficacy of HFNC in postoperative morbidly obese patients who were ventilated intraoperatively with an open-lung approach (OLA). METHODS We performed an open, two-arm, randomized controlled trial in 64 patients undergoing bariatric surgery (N.=32 in each arm) from May to November 2017 at the Hospital Clínico of Valencia. Patients were randomly assigned to receive HFNC oxygen therapy at the time of extubation or to receive conventional oxygen therapy, both applied during the first three postoperative hours. Intraoperatively, a recruitment maneuver and individualized positive end-expiratory pressure was applied in all patients. The primary outcome was postoperative hypoxemia. RESULTS All patients were included in the final analysis. There were no significant differences between the baseline characteristics. Postoperative hypoxemia was less frequent in the HFNC group compared to those who received standard care (28.6% vs. 80.0%, relative risk [RR]: 0.35; 95%CI: 0.150-0.849, P=0.009). Prevalence of atelectasis was lower in the HFNC group (31% vs. 77%, RR: 0.39; 95%CI: 0.166-0.925, P=0.013). No severe PPCs were reported in any patient. CONCLUSIONS Early application of HFNC in the operating room before extubation and during the immediate postoperative period decreases postoperative hypoxemia in obese patients after bariatric surgery who were intraoperatively ventilated using an OLA approach.
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Affiliation(s)
- Carlos Ferrando
- CIBER de Enfermedades Respiratorias, Carlos III Health Institute, Madrid, Spain - .,Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain -
| | - Jaume Puig
- Department of Anesthesiology and Critical Care, General University Hospital, Valencia, Spain
| | - Ferran Serralta
- Department of Anesthesiology and Critical Care, Clinical University Hospital, Valencia, Spain
| | - Juan Carrizo
- Department of Anesthesiology and Critical Care, Clinical University Hospital, Valencia, Spain
| | - Natividad Pozo
- Department of Anesthesiology and Critical Care, Clinical University Hospital, Valencia, Spain
| | - Blanca Arocas
- Department of Anesthesiology and Critical Care, Clinical University Hospital, Valencia, Spain
| | - Andrea Gutierrez
- Department of Anesthesiology and Critical Care, Clinical University Hospital, Valencia, Spain
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Carlos III Health Institute, Madrid, Spain.,Research Unit, Multidisciplinary Organ Dysfunction Evaluation Research Network, Dr. Negrin University Hospital, Las Palmas de Gran Canaria, Spain.,Keenan Research Center for Biomedical Sciences, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Francisco J Belda
- Department of Anesthesiology and Critical Care, Clinical University Hospital, Valencia, Spain
| | - Marina Soro
- Department of Anesthesiology and Critical Care, Clinical University Hospital, Valencia, Spain
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23
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Yogendrakumar V, Al-Ajlan F, Najm M, Puig J, Calleja A, Sohn SI, Ahn SH, Mikulik R, Asdaghi N, Field TS, Jin A, Asil T, Boulanger JM, Hill MD, Demchuk AM, Menon BK, Dowlatshahi D. Clot Burden Score and Early Ischemia Predict Intracranial Hemorrhage following Endovascular Therapy. AJNR Am J Neuroradiol 2019; 40:655-660. [PMID: 30872416 DOI: 10.3174/ajnr.a6009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial hemorrhage is a known complication following endovascular thrombectomy. The radiologic characteristics of a CT scan may assist with hemorrhage risk stratification. We assessed the radiologic predictors of intracranial hemorrhage following endovascular therapy using data from the INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) study. MATERIALS AND METHODS Patients undergoing endovascular therapy underwent baseline imaging, postprocedural angiography, and 24-hour follow-up imaging. The primary outcome was any intracranial hemorrhage observed on follow-up imaging. The secondary outcome was symptomatic hemorrhage. We assessed the relationship between hemorrhage occurrence and baseline patient characteristics, clinical course, and imaging factors: baseline ASPECTS, thrombus location, residual flow grade, collateralization, and clot burden score. Multivariable logistic regression with backward selection was used to adjust for relevant covariates. RESULTS Of the 199 enrolled patients who met the inclusion criteria, 46 (23%) had an intracranial hemorrhage at 24 hours. On multivariable analysis, postprocedural hemorrhage was associated with pretreatment ASPECTS (OR, 1.56 per point lost; 95% CI, 1.12-2.15), clot burden score (OR, 1.19 per point lost; 95% CI, 1.03-1.38), and ICA thrombus location (OR, 3.10; 95% CI, 1.07-8.91). In post hoc analysis, clot burden scores of ≤3 (sensitivity, 41%; specificity, 82%; OR, 3.12; 95% CI, 1.36-7.15) and pretreatment ASPECTS ≤ 7 (sensitivity, 48%; specificity, 82%; OR, 3.17; 95% CI, 1.35-7.45) robustly predicted hemorrhage. Residual flow grade and collateralization were not associated with hemorrhage occurrence. Symptomatic hemorrhage was observed in 4 patients. CONCLUSIONS Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy.
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Affiliation(s)
- V Yogendrakumar
- From the Department of Medicine (Neurology) (V.Y., D.D.), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - F Al-Ajlan
- Department of Neurosciences (F.A.-A.), King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M Najm
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - J Puig
- Institut de Diagnostic per la Imatge (J.P.), Girona Biomedical Research Institute, University Hospital Dr Josep Trueta, Girona, Spain
| | - A Calleja
- Department of Neurology (A.C.), Stroke Unit, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - S-I Sohn
- Department of Neurology (S-.I.S.), Keimyung University, Daegu, Republic of Korea
| | - S H Ahn
- Department of Neurology (S.H.A.), Chosun University School of Medicine and Hospital, Gwangju, Republic of Korea
| | - R Mikulik
- International Clinical Research Center (R.M.), St. Anne's University Hospital, Brno, Czech Republic
| | - N Asdaghi
- Department of Neurology (N.A.), Miller School of Medicine, University of Miami, Miami, Florida
| | - T S Field
- Division of Neurology (T.S.F.), Vancouver Stroke Program, University of British Columbia, Vancouver, Canada
| | - A Jin
- Division of Neurology (A.J.), Queen's University, Kingston, Canada
| | - T Asil
- Bezmialem Vakif Üniversitesi Nöroloji (T.A., J.-M.B.), Istanbul, Turkey
| | - J-M Boulanger
- Bezmialem Vakif Üniversitesi Nöroloji (T.A., J.-M.B.), Istanbul, Turkey
- Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, Greenfield Park, Canada
| | - M D Hill
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - A M Demchuk
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - B K Menon
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - D Dowlatshahi
- From the Department of Medicine (Neurology) (V.Y., D.D.), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
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24
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Valls Sanchez F, Puig J, Olivares G, Holloway A, Seth M. Association between ultrasonographic appearance of urine and urinalysis in dogs and cats. J Small Anim Pract 2019; 60:361-366. [PMID: 30868599 DOI: 10.1111/jsap.12996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate association between ultrasonographic urine echogenicity and sediment examination in dogs and cats. MATERIALS AND METHODS Dogs and cats undergoing ultrasound-guided cystocentesis at a multidisciplinary referral hospital. Ultrasonographic images were stored and reviewed by a single, blinded, board-certified radiologist. Urine appearance was described as "echoic" or "anechoic". Urine sediment was examined for bacteriuria, pyuria, haematuria, crystalluria and urine-specific gravity and then classified as "active" or "inactive." RESULTS Of the 194 cases included in this study, urine was echoic in 52 and anechoic in 142. Sediment was active in 52 and inactive in 142 samples. Sensitivity and specificity of echoic urine for active sediment were 40% (95% CI: 27 to 55%) and 78% (95% CI: 70 to 85%), respectively. Positive predictive value and negative predictive value of echoic urine for active sediment were 40% (CI 30 to 52%) and 78% (CI 74 to 82%), respectively. If urine-specific gravity was <1.015 urine was always described ultrasonographically as anechoic. CLINICAL SIGNIFICANCE Association between sediment analysis and ultrasonographic appearance of urine is poor. Echoic urine had low positive predictive value for active sediment in this study, suggesting that echoic urine alone should not prompt urinary investigations in the absence of other clinical suspicion. Despite a negative predictive value of 78%, urinalysis is still indicated for anechoic urine, especially if urine specific gravity is low.
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Affiliation(s)
- F Valls Sanchez
- Department of Small Animal Internal Medicine, Animal Health Trust, Newmarket, Suffolk, CB8 7UU, UK
| | - J Puig
- Department of Small Animal Internal Medicine, Animal Health Trust, Newmarket, Suffolk, CB8 7UU, UK
| | - G Olivares
- Department of Small Animal Internal Medicine, Animal Health Trust, Newmarket, Suffolk, CB8 7UU, UK
| | - A Holloway
- Department of Radiology, Animal Health Trust, Newmarket, Suffolk, CB8 7UU, UK
| | - M Seth
- Department of Small Animal Internal Medicine, Animal Health Trust, Newmarket, Suffolk, CB8 7UU, UK
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25
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Pradas I, Jové M, Huynh K, Puig J, Ingles M, Borras C, Viña J, Meikle PJ, Pamplona R. Exceptional human longevity is associated with a specific plasma phenotype of ether lipids. Redox Biol 2019; 21:101127. [PMID: 30711699 PMCID: PMC6357979 DOI: 10.1016/j.redox.2019.101127] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/09/2019] [Accepted: 01/28/2019] [Indexed: 12/15/2022] Open
Abstract
A lipid profile resistant to oxidative damage is an inherent trait associated with animal lifespan. However, there is a lack of lipidomic studies on human longevity. Here we use mass spectrometry based technologies to detect and quantify 137 ether lipids to define a phenotype of healthy humans with exceptional lifespan. Ether lipids were chosen because of their antioxidant properties and ability to modulate oxidative stress. Our results demonstrate that a specific ether lipid signature can be obtained to define the centenarian state. This profile comprises higher level of alkyl forms derived from phosphatidylcholine with shorter number of carbon atoms and double bonds; and decreased content in alkenyl forms from phosphatidylethanolamine with longer chain length and higher double bonds. This compositional pattern suggests that ether lipids from centenarians are more resistant to lipid peroxidation, and that ether lipid signature expresses an optimized feature associated with exceptional human longevity. These results are in keeping with the free radical theory of aging.
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Affiliation(s)
- I Pradas
- Department of Experimental Medicine, University of Lleida-Institute for Research in Biomedicine of Lleida (UdL-IRBLleida), Lleida 25198, Spain.
| | - M Jové
- Department of Experimental Medicine, University of Lleida-Institute for Research in Biomedicine of Lleida (UdL-IRBLleida), Lleida 25198, Spain.
| | - K Huynh
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
| | - J Puig
- Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona 17007, Spain.
| | - M Ingles
- Department of Physiology, University of Valencia, Valencia 46004, Spain.
| | - C Borras
- Department of Physiology, University of Valencia, Valencia 46004, Spain.
| | - J Viña
- Department of Physiology, University of Valencia, Valencia 46004, Spain.
| | - P J Meikle
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
| | - R Pamplona
- Department of Experimental Medicine, University of Lleida-Institute for Research in Biomedicine of Lleida (UdL-IRBLleida), Lleida 25198, Spain.
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Rodríguez M, Blasco G, Coll C, Ricart W, Puig J, Garre-Olmo J, Gich J, Ramió-Torrentà L, Fernández-Real J. Cognitive function in obese subjects. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1923] [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: 10/28/2022]
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Funcke S, Saugel B, Koch C, Schulte D, Zajonz T, Sander M, Gratarola A, Ball L, Pelosi P, Spadaro S, Ragazzi R, Volta CA, Mencke T, Zitzmann A, Neukirch B, Azparren G, Giné M, Moral V, Pinnschmidt HO, Díaz-Cambronero O, Estelles MJA, Velez ME, Montañes MV, Belda J, Soro M, Puig J, Reuter DA, Haas SA. Individualized, perioperative, hemodynamic goal-directed therapy in major abdominal surgery (iPEGASUS trial): study protocol for a randomized controlled trial. Trials 2018; 19:273. [PMID: 29743101 PMCID: PMC5944092 DOI: 10.1186/s13063-018-2620-9] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/28/2018] [Indexed: 01/04/2023] Open
Abstract
Background Postoperative morbidity and mortality in patients undergoing surgery is high, especially in patients who are at risk of complications and undergoing major surgery. We hypothesize that perioperative, algorithm-driven, hemodynamic therapy based on individualized fluid status and cardiac output optimization is able to reduce mortality and postoperative moderate and severe complications as a major determinant of the patients’ postoperative quality of life, as well as health care costs. Methods/design This is a multi-center, international, prospective, randomized trial in 380 patients undergoing major abdominal surgery including visceral, urological, and gynecological operations. Eligible patients will be randomly allocated to two treatment arms within the participating centers. Patients of the intervention group will be treated perioperatively following a specific hemodynamic therapy algorithm based on pulse-pressure variation (PPV) and individualized optimization of cardiac output assessed by pulse-contour analysis (ProAQT© device; Pulsion Medical Systems, Feldkirchen, Germany). Patients in the control group will be treated according to standard local care based on established basic hemodynamic treatment. The primary endpoint is a composite comprising the occurrence of moderate or severe postoperative complications or death within 28 days post surgery. Secondary endpoints are: (1) the number of moderate and severe postoperative complications in total, per patient and for each individual complication; (2) the occurrence of at least one of these complications on days 1, 3, 5, 7, and 28 in total and for every complication; (3) the days alive and free of mechanical ventilation, vasopressor therapy and renal replacement therapy, length of intensive care unit, and hospital stay at day 7 and day 28; and (4) mortality and quality of life, assessed by the EQ-5D-5L™ questionnaire, after 6 months. Discussion This is a large, international randomized controlled study evaluating the effect of perioperative, individualized, algorithm-driven ,hemodynamic optimization on postoperative morbidity and mortality. Trial registration Trial registration: NCT03021525. Registered on 12 January 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2620-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Funcke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Koch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Dagmar Schulte
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Thomas Zajonz
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Angelo Gratarola
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Savino Spadaro
- Department of Anesthesia and Intensive Care, University of Ferrara, Sant Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Riccardo Ragazzi
- Department of Anesthesia and Intensive Care, University of Ferrara, Sant Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Carlo Alberto Volta
- Department of Anesthesia and Intensive Care, University of Ferrara, Sant Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Thomas Mencke
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Amelie Zitzmann
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Benedikt Neukirch
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Gonzalo Azparren
- Department of Anesthesiology, Hospital Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
| | - Marta Giné
- Department of Anesthesiology, Hospital Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
| | - Vicky Moral
- Department of Anesthesiology, Hospital Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
| | - Hans Otto Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Oscar Díaz-Cambronero
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Maria Jose Alberola Estelles
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Marisol Echeverri Velez
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Maria Vila Montañes
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Javier Belda
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Marina Soro
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Jaume Puig
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Daniel Arnulf Reuter
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Sebastian Alois Haas
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
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Ferrando C, Tusman G, Suarez-Sipmann F, León I, Pozo N, Carbonell J, Puig J, Pastor E, Gracia E, Gutiérrez A, Aguilar G, Belda FJ, Soro M. Individualized lung recruitment maneuver guided by pulse-oximetry in anesthetized patients undergoing laparoscopy: a feasibility study. Acta Anaesthesiol Scand 2018; 62:608-619. [PMID: 29377061 DOI: 10.1111/aas.13082] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 12/21/2017] [Accepted: 01/02/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND We conducted this study to test whether pulse-oximetry hemoglobin saturation (SpO2 ) can personalize the implementation of an open-lung approach during laparoscopy. Thirty patients with SpO2 ≥ 97% on room-air before anesthesia were studied. After anesthesia and capnoperitoneum the FIO2 was reduced to 0.21. Those patients whose SpO2 decreased below 97% - an indication of shunt related to atelectasis - completed the following phases: (1) First recruitment maneuver (RM), until reaching lung's opening pressure, defined as the inspiratory pressure level yielding a SpO2 ≥ 97%; (2) decremental positive end-expiratory (PEEP) titration trial until reaching lung's closing pressure defined as the PEEP level yielding a SpO2 < 97%; (3) second RM and, (4) ongoing ventilation with PEEP adjusted above the detected closing pressure. RESULTS When breathing air, in 24 of 30 patients SpO2 was < 97%, PaO2 /FIO2 ˂ 53.3 kPa and negative end-expiratory transpulmonary pressure (PTP-EE ). The mean (SD) opening pressures were found at 40 (5) and 33 (4) cmH2 O during the first and second RM, respectively (P < 0.001; 95% CI: 3.2-7.7). The closing pressure was found at 11 (5) cmH2 O. This SpO2 -guided approach increased PTP-EE (from -6.4 to 1.2 cmH2 O, P < 0.001) and PaO2 /FIO2 (from 30.3 to 58.1 kPa, P < 0.001) while decreased driving pressure (from 18 to 10 cmH2 O, P < 0.001). SpO2 discriminated the lung's opening and closing pressures with accuracy taking the reference parameter PTP-EE (area under the receiver-operating-curve of 0.89, 95% CI: 0.80-0.99). CONCLUSION The non-invasive SpO2 monitoring can help to individualize an open-lung approach, including all involved steps, from the identification of those patients who can benefit from recruitment, the identification of opening and closing pressures to the subsequent monitoring of an open-lung condition.
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Affiliation(s)
- C. Ferrando
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
- CIBER de Enfermedades Respiratorias; Instituto de Salud Carlos III; Madrid Spain
| | - G. Tusman
- Department of Anesthesiology; Hospital Privado de Comunidad Mar de Plata; Mar de Plata Argentina
| | - F. Suarez-Sipmann
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
- Deparment of Intensive Care; Hospital Universitario La Princesa; Madrid Spain
| | - I. León
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
| | - N. Pozo
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
| | - J. Carbonell
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
| | - J. Puig
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
| | - E. Pastor
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
| | - E. Gracia
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
| | - A. Gutiérrez
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
| | - G. Aguilar
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
| | - F. J. Belda
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
| | - M. Soro
- Department of Anaesthesiology and Critical Care; Hospital Clínico Universitario; Valencia Spain
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Echeverría P, Gómez-Mora E, Roura S, Bonjoch A, Puig J, Pérez-Alvarez N, Bayés-Genís A, Clotet B, Blanco J, Negredo E. Variable endothelial cell function restoration after initiation of two antiretroviral regimens in HIV-infected individuals. J Antimicrob Chemother 2018; 72:2049-2054. [PMID: 28369542 DOI: 10.1093/jac/dkx074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Accepted: 02/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background The effect of ART on endothelial cell function is incompletely characterized. Methods We performed a 24 week prospective, case-control and comparative pilot study of ART-naive HIV-infected patients who started a darunavir- or rilpivirine-based regimen, matched with non-HIV-infected volunteers, to compare changes at week 24 from baseline in levels of circulating endothelial cells (CECs), endothelial progenitor cells (EPCs) and circulating angiogenic cells, as well as changes in immune-activation markers. Results The study population comprised 24 HIV-infected patients and 24 non-infected volunteers. Both HIV groups completely suppressed viraemia. HIV-infected patients had higher levels of activation markers than the control group in CD8 T cells at baseline; these decreased after 24 weeks of treatment, but without reaching the levels of the control group. No statistical differences in immune activation were seen between the darunavir and rilpivirine groups. Levels of CECs were higher and levels of EPCs and circulating angiogenic cells were lower in HIV-infected patients than in the control group, although these parameters were similar between the darunavir group and the control group, but not the rilpivirine group, at week 24. An unfavourable association was observed between rilpivirine, age and increased number of CECs. Conclusions Restoration of circulating levels of EPCs and CECs in darunavir-treated patients was greater than in those treated with rilpivirine, suggesting ongoing endothelial repair mechanisms.
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Affiliation(s)
- P Echeverría
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona, Catalonia 08916, Spain
| | - E Gómez-Mora
- AIDS Research Institute-IRSICAIXA, Institut Germans Trias I Pujol (IGTP), Hospital Universitari Germans Trias i Pujol, Badalona 08916, Spain
| | | | - A Bonjoch
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona, Catalonia 08916, Spain
| | - J Puig
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona, Catalonia 08916, Spain
| | - N Pérez-Alvarez
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona, Catalonia 08916, Spain.,Statistics and Operations Research, Technical University of Catalunya, Barcelona 08020, Spain
| | - A Bayés-Genís
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona 08916, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona 08020, Spain
| | - B Clotet
- Universitat de Vic - Universidad Central de Catalunya UVIC-UCC, Vic 08500, Spain
| | - J Blanco
- AIDS Research Institute-IRSICAIXA, Institut Germans Trias I Pujol (IGTP), Hospital Universitari Germans Trias i Pujol, Badalona 08916, Spain.,Universitat de Vic - Universidad Central de Catalunya UVIC-UCC, Vic 08500, Spain
| | - E Negredo
- Lluita contra la Sida Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona, Catalonia 08916, Spain.,Universitat de Vic - Universidad Central de Catalunya UVIC-UCC, Vic 08500, Spain
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Ferrando C, Soro M, Unzueta C, Suarez-Sipmann F, Canet J, Librero J, Pozo N, Peiró S, Llombart A, León I, India I, Aldecoa C, Díaz-Cambronero O, Pestaña D, Redondo FJ, Garutti I, Balust J, García JI, Ibáñez M, Granell M, Rodríguez A, Gallego L, de la Matta M, Gonzalez R, Brunelli A, García J, Rovira L, Barrios F, Torres V, Hernández S, Gracia E, Giné M, García M, García N, Miguel L, Sánchez S, Piñeiro P, Pujol R, García-Del-Valle S, Valdivia J, Hernández MJ, Padrón O, Colás A, Puig J, Azparren G, Tusman G, Villar J, Belda J. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. Lancet Respir Med 2018; 6:193-203. [PMID: 29371130 DOI: 10.1016/s2213-2600(18)30024-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. METHODS We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m2. Patients were randomly assigned (1:1:1:1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. FINDINGS Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0·89 [95% CI 0·74-1·07; p=0·25]), OLA-CPAP (111 [47%] of 238, 0·91 [0·76-1·09; p=0·35]), or STD-CPAP groups (118 [48%] of 244, 0·95 [0·80-1·14; p=0·65]) when compared with patients in the STD-O2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. INTERPRETATION In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation. FUNDING Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness, and Grants Programme of the European Society of Anaesthesiology.
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Affiliation(s)
- Carlos Ferrando
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marina Soro
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Carmen Unzueta
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Fernando Suarez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Jaume Canet
- Department of Anesthesiology & Critical Care, Hospital Universitario Germans Tries i Pujol, Badalona, Spain
| | - Julián Librero
- Navarrabiomed-Fundación Miguel Servet. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
| | - Natividad Pozo
- INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Salvador Peiró
- Centro Superior de Investigación en Salud Publica (CSISP-FISABIO), REDISSEC, Valencia, Spain
| | - Alicia Llombart
- IISLAFE Clinical Research Institute, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Irene León
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Inmaculada India
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Cesar Aldecoa
- Department of Anesthesiology & Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Oscar Díaz-Cambronero
- Department of Anesthesiology & Critical Care, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Pestaña
- Department of Anesthesiology & Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Francisco J Redondo
- Department of Anesthesiology & Critical Care, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Ignacio Garutti
- Department of Anesthesiology & Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jaume Balust
- Department of Anesthesiology & Critical Care, Hospital Clínic i Provincial Universitario, Barcelona, Spain
| | - Jose I García
- Department of Anesthesiology & Critical Care, Hospital Fundación de Alcorcón, Alcorcón, Spain
| | - Maite Ibáñez
- Department of Anesthesiology, Hospital de la Marina Baixa de la Vila Joiosa, Alicante, Spain
| | - Manuel Granell
- Department of Anesthesiology & Critical Care, Hospital General Universitario, Valencia, Spain
| | - Aurelio Rodríguez
- Department of Anesthesiology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Lucía Gallego
- Department of Anesthesiology & Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Manuel de la Matta
- Department of Anesthesiology & Critical Care, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Rafael Gonzalez
- Department of Anesthesiology, Hospital Universitario de León, León, Spain
| | - Andrea Brunelli
- Department of Anesthesiology & Critical Care, Hospital Universitario Germans Tries i Pujol, Badalona, Spain
| | - Javier García
- Department of Anesthesiology & Critical Care, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Lucas Rovira
- Department of Anesthesiology, Hospital de Manises, Valencia, Spain
| | - Francisco Barrios
- Department of Anesthesiology & Critical Care, Hospital Principe de Asturias, Madrid, Spain
| | - Vicente Torres
- Department of Anesthesiology & Critical Care, Hospital Son Espases, Palma de Mallorca, Spain
| | - Samuel Hernández
- Department of Anesthesiology, Hospital NS de Candelaria, Santa Cruz de Tenerife, Spain
| | - Estefanía Gracia
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Marta Giné
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - María García
- Department of Anesthesiology & Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Nuria García
- Department of Anesthesiology & Critical Care, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lisset Miguel
- Department of Anesthesiology & Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Sergio Sánchez
- Department of Anesthesiology & Critical Care, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Patricia Piñeiro
- Department of Anesthesiology & Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Roger Pujol
- Department of Anesthesiology & Critical Care, Hospital Clínic i Provincial Universitario, Barcelona, Spain
| | | | - José Valdivia
- Department of Anesthesiology, Hospital de la Marina Baixa de la Vila Joiosa, Alicante, Spain
| | - María J Hernández
- Department of Anesthesiology & Critical Care, Hospital General Universitario, Valencia, Spain
| | - Oto Padrón
- Department of Anesthesiology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Ana Colás
- Department of Anesthesiology & Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jaume Puig
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Gonzalo Azparren
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad Mar de Plata, Mar de Plata, Argentina
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Multidisciplinary Organ Dysfunction Evaluation Research Network, Hospital Universitario Doctor Negrin, Las Palmas, Spain
| | - Javier Belda
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain; Department of Surgery, Universidad de Valencia, Valencia, Spain
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Nael K, Doshi A, De Leacy R, Puig J, Castellanos M, Bederson J, Naidich TP, Mocco J, Wintermark M. MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps. AJNR Am J Neuroradiol 2017; 39:219-225. [PMID: 29217747 DOI: 10.3174/ajnr.a5454] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 09/14/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with acute stroke with robust collateral flow have better clinical outcomes and may benefit from endovascular treatment throughout an extended time window. Using a multiparametric approach, we aimed to identify MR perfusion parameters that can represent the extent of collaterals, approximating DSA. MATERIALS AND METHODS Patients with anterior circulation proximal arterial occlusion who had baseline MR perfusion and DSA were evaluated. The volume of arterial tissue delay (ATD) at thresholds of 2-6 seconds (ATD2-6 seconds) and >6 seconds (ATD>6 seconds) in addition to corresponding values of normalized CBV and CBF was calculated using VOI analysis. The association of MR perfusion parameters and the status of collaterals on DSA were assessed by multivariate analyses. Receiver operating characteristic analysis was performed. RESULTS Of 108 patients reviewed, 39 met our inclusion criteria. On DSA, 22/39 (56%) patients had good collaterals. Patients with good collaterals had significantly smaller baseline and final infarct volumes, smaller volumes of severe hypoperfusion (ATD>6 seconds), larger volumes of moderate hypoperfusion (ATD2-6 seconds), and higher relative CBF and relative CBV values than patients with insufficient collaterals. Combining the 2 parameters into a Perfusion Collateral Index (volume of ATD2-6 seconds × relative CBV2-6 seconds) yielded the highest accuracy for predicting collateral status: At a threshold of 61.7, this index identified 15/17 (88%) patients with insufficient collaterals and 22/22 (100%) patients with good collaterals, for an overall accuracy of 94.1%. CONCLUSIONS The Perfusion Collateral Index can predict the baseline collateral status with 94% diagnostic accuracy compared with DSA.
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Affiliation(s)
- K Nael
- From the Departments of Radiology (K.N., A.D., T.P.N.)
| | - A Doshi
- From the Departments of Radiology (K.N., A.D., T.P.N.)
| | - R De Leacy
- Neurosurgery (R.D.L., J.B., JM.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Puig
- Department of Radiology (J.P.), Girona Biomedical Research Institute, Diagnostic Imaging Institute, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - M Castellanos
- Department of Neurology (M.C.), A Coruña University Hospital, A Coruña Biomedical Research Institute, A Coruña, Spain
| | - J Bederson
- Neurosurgery (R.D.L., J.B., JM.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - T P Naidich
- From the Departments of Radiology (K.N., A.D., T.P.N.)
| | - J Mocco
- Neurosurgery (R.D.L., J.B., JM.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Wintermark
- Department of Radiology (M.W.), Neuroradiology Section, Stanford University, Palo Alto, California
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Chacón MR, Lozano-Bartolomé J, Portero-Otín M, Rodríguez MM, Xifra G, Puig J, Blasco G, Ricart W, Chaves FJ, Fernández-Real JM. The gut mycobiome composition is linked to carotid atherosclerosis. Benef Microbes 2017; 9:185-198. [PMID: 29124969 DOI: 10.3920/bm2017.0029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The mycobiotic component of the microbiota comprises an integral, yet under-researched, part of the gastrointestinal tract. Here, we present a preliminary study of the possible contribution of gut mycobiota to sub-clinical atherosclerosis in a well-characterised group of obese and non-obese subjects in association with the Framingham Risk Score (FRS) and carotid intima-media thickness (cIMT). From all taxa identified, the relative abundance of the phylum Zygomycota, comprising the family Mucoraceae and genus Mucor, was negatively associated with cIMT and this association remained significant after controlling for false discovery rate. Obese subjects with detectable Mucor spp. had a similar cardiovascular risk profile as non-obese subjects. Interestingly, the relative abundance of Mucor racemosus was negatively associated both with FRS and cIMT. Partial least square discriminant analyses modelling, evaluating the potential relevance of gut mycobiota in patients stratified by mean values of cIMT, showed that even a 1 component model had a high accuracy (0.789), with a high R2 value (0.51). Variable importance in projection scores showed that M. racemosus abundance had the same impact in the model as waist-to-hip ratio, high-density lipoprotein-cholesterol, fasting triglycerides or fasting glucose, suggesting that M. racemosus relative abundance in the gut may be a relevant biomarker for cardiovascular risk.
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Affiliation(s)
- M R Chacón
- 1 Research Unit, Institut d'Investigació Sanitària Pere Virgili, Mallafrè Guash 4, 43007 Tarragona, Spain
| | - J Lozano-Bartolomé
- 1 Research Unit, Institut d'Investigació Sanitària Pere Virgili, Mallafrè Guash 4, 43007 Tarragona, Spain
| | - M Portero-Otín
- 2 Department of Experimental Medicine, Universitat de Lleida-IRBLleida, Avda Rovira Roure 80, 25196 Lleida, Spain
| | - M M Rodríguez
- 1 Research Unit, Institut d'Investigació Sanitària Pere Virgili, Mallafrè Guash 4, 43007 Tarragona, Spain
| | - G Xifra
- 3 Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), Carrer del Dr. Castany, s/n, 17190 Salt, Spain.,4 CIBERobn Instituto de Salud Carlos III (ISCIII), C/ Sinesio Delgado 4, 28029 Madrid, Spain
| | - J Puig
- 5 Department of Radiology, Institut d'Investigació Biomèdica de Girona (IdIBGi), Carrer del Dr. Castany, s/n, 17190 Salt, Spain
| | - G Blasco
- 5 Department of Radiology, Institut d'Investigació Biomèdica de Girona (IdIBGi), Carrer del Dr. Castany, s/n, 17190 Salt, Spain
| | - W Ricart
- 3 Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), Carrer del Dr. Castany, s/n, 17190 Salt, Spain.,4 CIBERobn Instituto de Salud Carlos III (ISCIII), C/ Sinesio Delgado 4, 28029 Madrid, Spain
| | - F J Chaves
- 6 Fundación de Investigación del Hospital Clínico de Valencia-INCLIVA, Avenida de Menéndez y Pelayo, 4, 46010 Valencia, Spain
| | - J M Fernández-Real
- 3 Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), Carrer del Dr. Castany, s/n, 17190 Salt, Spain.,4 CIBERobn Instituto de Salud Carlos III (ISCIII), C/ Sinesio Delgado 4, 28029 Madrid, Spain
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Puig J, Ceolín M, Williams RJJ, Schroeder WF, Zucchi IA. Controlling the generation of bilayer and multilayer vesicles in block copolymer/epoxy blends by a slow photopolymerization process. Soft Matter 2017; 13:7341-7351. [PMID: 28990627 DOI: 10.1039/c7sm01660c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Vesicles are a highly attractive morphology to achieve in micellar dispersions of block copolymers (BCP) in epoxy thermosets due to the fact that small amounts can affect a large volume fraction of the matrix, a fact that is important for toughening purposes. However, generating vesicles in epoxy matrices requires operating in a narrow range of formulations and processing conditions. In this report, we show that block-copolymer vesicles dispersed in an epoxy matrix could be obtained through a sphere-to-cylinder-to-vesicle micellar transition induced by visible-light photopolymerization at room temperature. A 10 wt% colloidal solution of poly(ethylene-co-butene)-block-poly(ethylene oxide) (PEB-b-PEO) block copolymer (BCP) in an epoxy monomer (DGEBA) self-assembled into spherical micelles as shown by small-angle X-ray scattering (SAXS). During a slow photopolymerization of the epoxy monomer carried out at room temperature, a sphere-to-cylinder-to-vesicle transition took place as revealed by in situ SAXS and TEM images. This was driven by the tendency of the system to reduce the local interfacial curvature as a response to a decrease in the miscibility of PEO blocks in the polymerizing epoxy matrix. When the BCP concentration was increased from 10 to 20 and 40 wt%, the final structure evolved from bilayer vesicles to multilayer vesicles and to lamellae, respectively. In particular, for 20 wt% PEB-b-PEO, transient structures such as partially fused multilayered vesicles were observed by TEM, giving insight into the growth mechanism of multilayer vesicles. On the contrary, when a relatively fast thermal polymerization was performed at 80 °C, the final morphology consisted of kinetically trapped spherical and cylindrical micelles. Hopefully, this study will lead to new protocols for the preparation of vesicles dispersed in epoxy matrices in a controlled way.
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Affiliation(s)
- J Puig
- Institute of Materials Science and Technology (INTEMA), University of Mar del Plata and National Research Council (CONICET), J. B. Justo 4302, B7608FDQ, Mar del Plata, Argentina.
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Abstract
BACKGROUND During recent years, ventilators using turbines as flow-generating systems have become increasingly more relevant. This bench study was designed to compare triggering and pressurization of 7 turbine mid-level ICU ventilators. METHODS We used a dual-chamber lung model to test 7 mid-level ICU ventilators in pressure support mode with levels of 10, 15, and 20 cm H2O with 2 PEEP levels of 5 cm H2O and the minimum level allowed by the ventilator. A ventilator was connected to the master chamber to simulate 2 different effort levels. Pressure drop, trigger delay time, time to minimum pressure, and pressure time products (PTP) during trigger and the first 300 and 500 ms were analyzed. RESULTS In the trigger evaluation, the Savina had the highest delay time, whereas the C2, the V60, and the Trilogy had the lowest pressure drops and PTP values in both effort levels. In pressurization capacity assessment using ideal PTP300 and PTP500 percentages, the C2 and the V680 had the best results, and the Carina and the Savina had lower values, with no differences between both effort levels. Differences between PEEP levels did not seem to be relevant. CONCLUSIONS Pressure support mode for tested ventilators worked properly, but pressurization capacity and trigger function performance were clearly superior in the newest machines. The use of PEEP did not modify the results.
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Affiliation(s)
- Carlos Delgado
- Department of Anesthesia and Critical Care, Hospital Clínico Universitario, Valencia, Spain.
| | - Jose E Romero
- IBIME, ITACA Center, Universidad Politécnica de Valencia, Valencia, Spain
| | - Jaume Puig
- Department of Anesthesia and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Ana Izquierdo
- Department of Anesthesia and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Carlos Ferrando
- Department of Anesthesia and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - F Javier Belda
- Department of Anesthesia and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Marina Soro
- Department of Anesthesia and Critical Care, Hospital Clínico Universitario, Valencia, Spain
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Ferriols-Lisart R, Aguilar G, Pérez-Pitarch A, Puig J, Ezquer-Garín C, Alós M. Plasma concentrations of caspofungin in a critically ill patient with morbid obesity. Crit Care 2017; 21:200. [PMID: 28764793 PMCID: PMC5540490 DOI: 10.1186/s13054-017-1774-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Rafael Ferriols-Lisart
- Department of Pharmacy, University Clinical Hospital of Valencia, Avda. Blasco Ibañez 17, Valencia, Spain.
| | - Gerardo Aguilar
- Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario, Valencia, Spain
| | - Alejandro Pérez-Pitarch
- Department of Pharmacy, University Clinical Hospital of Valencia, Avda. Blasco Ibañez 17, Valencia, Spain
| | - Jaume Puig
- Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario, Valencia, Spain
| | - Carlos Ezquer-Garín
- Health Research Institute, INCLIVA, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Manuel Alós
- Department of Pharmacy, University Clinical Hospital of Valencia, Avda. Blasco Ibañez 17, Valencia, Spain
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Echeverría P, Bonjoch A, Puig J, Ornella A, Clotet B, Negredo E. Significant improvement in triglyceride levels after switching from ritonavir to cobicistat in suppressed HIV-1-infected subjects with dyslipidaemia. HIV Med 2017; 18:782-786. [PMID: 28671337 DOI: 10.1111/hiv.12530] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Cobicistat seems to have a low rate of adverse events compared with ritonavir. METHODS This restrospective observational study to evaluated changes in lipid parameters and the percentage of subjects with dyslipidemia in virologically suppressed HIV-infected patients who were receiving a regimen containing darunavir/ritonavir and were then switched from ritonavir to cobicistat, carried out from December 2015 to May 2016, included 299 HIV-1-infected patients who were on stable antiretroviral treatment including darunavir/ritonavir (monotherapy, bitherapy or triple therapy for at least 6 months) and were then switched from ritonavir to cobicistat. Lipid parameters, as well as plasma HIV-1 RNA and CD4 cell counts, were recorded at baseline just before the switch, and 24 weeks after the switch. Patients were stratified according to the presence of hypercholesterolaemia [baseline total cholesterol > 200 mg/dL and/or low-density lipoprotein (LDL) cholesterol > 130 mg/dL] or hypertriglyceridaemia (baseline triglyceride levels > 200 mg/dL). RESULTS Two hundred and ninety-nine patients were enrolled in the study. Fifty-two per cent of the total study population showed dyslipidaemia at baseline. All patients maintained HIV-1 RNA ≤ 50 HIV-1 RNA copies/mL at week 24. No statistically significant changes were seen in CD4 T-cell count from baseline to week 24 [654 (298) to 643 (313) cells/μL; P = 0.173]. When patients were stratified according to the presence of hypercholesterolaemia at baseline (n = 124), significant changes were observed in total cholesterol (P < 0.001), LDL cholesterol (P = 0.047), high-density lipoprotein (HDL) cholesterol (P = 0.002) and triglyceride levels (P = 0.025), and when they were stratified according to the presence of hypertriglyceridaemia at baseline (n = 64), changes from baseline to week 24 in triglyceride level were statistically significant [median (interquartile range) 352 (223, 389) mg/dL at baseline and 229 (131, 279) mg/dL at week 24; P < 0.001]. CONCLUSIONS Cobicistat as a booster of darunavir in HIV-infected subjects had a beneficial effect on the lipid profile in patients with hypercholesterolaemia or hypertrigliceridaemia at baseline.
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Affiliation(s)
- P Echeverría
- Foundation Lluita against AIDS, University Hospital Germans Trias i Pujol, Badalona, Spain.,Statistics and Operations Research, Technical University of Catalonia, Barcelona, 08020, Spain
| | - A Bonjoch
- Foundation Lluita against AIDS, University Hospital Germans Trias i Pujol, Badalona, Spain.,Statistics and Operations Research, Technical University of Catalonia, Barcelona, 08020, Spain
| | - J Puig
- Foundation Lluita against AIDS, University Hospital Germans Trias i Pujol, Badalona, Spain.,Statistics and Operations Research, Technical University of Catalonia, Barcelona, 08020, Spain
| | - A Ornella
- Foundation Lluita against AIDS, University Hospital Germans Trias i Pujol, Badalona, Spain.,Autonomous University of Barcelona, Catalonia, Spain
| | - B Clotet
- Foundation Lluita against AIDS, University Hospital Germans Trias i Pujol, Badalona, Spain.,Statistics and Operations Research, Technical University of Catalonia, Barcelona, 08020, Spain.,AIDS Research Institute-IRSICAIXA, Institute Germans Trias I Pujol (IGTP), University Hospital Germans Trias i Pujol, Badalona, Spain.,University of Vic - Central University of Catalonia UVic-UCC, Department of Internal Medicine, Vic, Spain
| | - E Negredo
- Foundation Lluita against AIDS, University Hospital Germans Trias i Pujol, Badalona, Spain.,Statistics and Operations Research, Technical University of Catalonia, Barcelona, 08020, Spain.,University of Vic - Central University of Catalonia UVic-UCC, Department of Internal Medicine, Vic, Spain
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Capellades J, Puig J, Domenech S, Diaz R, Oleaga L, Pujol T, Camins A, Majos C, de Quintana C, Balana C. P04.03 Extent of surgery improves the overall survival independently of imaging characteristics in newly diagnosed glioblastoma. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.143] [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: 11/13/2022] Open
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Aguilar G, Ferriols R, Lozano A, Ezquer C, Carbonell JA, Jurado A, Carrizo J, Serralta F, Puig J, Navarro D, Alos M, Belda FJ. Optimal doses of caspofungin during continuous venovenous hemodiafiltration in critically ill patients. Crit Care 2017; 21:17. [PMID: 28132647 PMCID: PMC5278571 DOI: 10.1186/s13054-016-1594-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Gerardo Aguilar
- Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain.
| | - Rafael Ferriols
- Department of Pharmacy, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Angels Lozano
- Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Carlos Ezquer
- Instituto de Investigación Sanitaria, INCLIVA, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - José A Carbonell
- Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Ana Jurado
- Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Juan Carrizo
- Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Ferran Serralta
- Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Jaume Puig
- Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - David Navarro
- Department of Microbiology, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain.,School of Medicine, University of Valencia, Avenida Blasco Ibáñez, 15, 46010, Valencia, Spain
| | - Manuel Alos
- Department of Pharmacy, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - F Javier Belda
- Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain.,School of Medicine, University of Valencia, Avenida Blasco Ibáñez, 15, 46010, Valencia, Spain
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Aguilar G, Ferriols R, Carbonell JA, Ezquer C, Alonso JM, Villena A, Puig J, Navarro D, Alós M, Belda FJ. Pharmacokinetics of anidulafungin during venovenous extracorporeal membrane oxygenation. Crit Care 2016; 20:325. [PMID: 27745549 PMCID: PMC5066289 DOI: 10.1186/s13054-016-1501-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Gerardo Aguilar
- Department of Anesthesiology and Intensive Care, Surgical Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain.
| | - Rafael Ferriols
- Department of Pharmacy, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - José A Carbonell
- Department of Anesthesiology and Intensive Care, Surgical Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Carlos Ezquer
- INCLIVA, Institute of Research, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - José Miguel Alonso
- Department of Anesthesiology and Intensive Care, Surgical Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Abigail Villena
- Department of Anesthesiology and Intensive Care, Surgical Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Jaume Puig
- Department of Anesthesiology and Intensive Care, Surgical Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - David Navarro
- Department of Microbiology, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain.,School of Medicine, University of Valencia, Avenida Blasco Ibáñez, 15, 46010, Valencia, Spain
| | - Manuel Alós
- Department of Pharmacy, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - F Javier Belda
- Department of Anesthesiology and Intensive Care, Surgical Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain.,School of Medicine, University of Valencia, Avenida Blasco Ibáñez, 15, 46010, Valencia, Spain
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Renard M, Lloveras B, Flores J, Puig J, Benaiges D, Sitges-Serra A. Current dilemmas in the diagnosis and management of follicular thyroid tumors. Expert Rev Endocrinol Metab 2016; 11:379-385. [PMID: 30058913 DOI: 10.1080/17446651.2016.1218760] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Follicular carcinoma (FTC) is a relatively uncommon type of differentiated thyroid carcinoma. Guidelines have often dealt with FTC and papillary thyroid cancer as a single disease. Over the last decade, however, a better understanding of these two types of thyroid cancer indicates that they cannot be analysed together. Neither ultrasonography nor fine-needle aspiration cytology can provide a clear distinction between FTC and follicular adenoma. New molecular diagnostic techniques may be used to identify a subpopulation of follicular neoplasms with a low probability of being malignant. Diagnostic surgery-usually hemithyroidectomy- is recommended for most thyroid follicular lesions without a certain preoperative diagnosis. If FTC is diagnosed most-perhaps not all- patients will require a completion thyroidectomy. While widely invasive FTC usually does not pose diagnostic or therapeutic doubts, consensus on the diagnosis of non-invasive follicular lesions is still lacking. Prognosis of FTC is mostly dependent on local invasion and distant metastasis that, in turn, correlate with tumor size.
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Affiliation(s)
- Marine Renard
- a Departments of Endocrinology , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
| | - Belén Lloveras
- b Pathology , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
| | - Juana Flores
- a Departments of Endocrinology , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
| | - Jaume Puig
- a Departments of Endocrinology , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
| | - David Benaiges
- a Departments of Endocrinology , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
| | - Antonio Sitges-Serra
- c Department of Surgery , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
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Leonardi A, Puig J, Antonacci J, Arenas G, Zucchi I, Hoppe C, Reven L, Zhu L, Toader V, Williams R. Remote activation by green-light irradiation of shape memory epoxies containing gold nanoparticles. Eur Polym J 2015. [DOI: 10.1016/j.eurpolymj.2015.08.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Negredo E, Bonjoch A, Pérez-Álvarez N, Ornelas A, Puig J, Herrero C, Estany C, del Río L, di Gregorio S, Echeverría P, Clotet B. Comparison of two different strategies of treatment with zoledronate in HIV-infected patients with low bone mineral density: single dose versus two doses in 2 years. HIV Med 2015; 16:441-8. [PMID: 25944411 DOI: 10.1111/hiv.12260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Given the need for easily managed treatment of osteoporosis in HIV-infected patients, we evaluated the efficacy and tolerability of two doses of zoledronate, by comparing three groups of patients: those with annual administration, those with biennial administration (one dose in 2 years) and a control group with no administration of zoledronate. METHODS We randomized (2:1) 31 patients on antiretroviral therapy with low bone mineral density (BMD) to zoledronate (5 mg administered intravenously; 21 patients) plus diet counselling and to a control group (diet counselling; 10 patients). At week 48, patients treated with zoledronate were randomized again to receive a second dose (two-dose group; n = 12) or to continue with diet counselling only (single-dose group; n = 9). Changes in lumbar spine and hip BMD and bone turnover markers were compared. RESULTS The median percentage change from baseline to week 96 in L1-L4 BMD was -1.74% [interquartile range (IQR) -2.56, 3.60%], 7.90% (IQR 4.20, 16.57%) and 5.22% (IQR 2.02, 7.28%) in the control, two-dose and single-dose groups, respectively (P < 0.01, control vs. two doses; P = 0.02, control vs. single dose; P = 0.18, two doses vs. single dose). Hip BMD changed by a median of 2.12% (IQR -0.12, 3.08%), 5.16% (IQR 3.06, 6.74%) and 4.47% (IQR 1, 5.58%), respectively (P = 0.04, control vs. two doses; P = 0.34, two doses vs. single dose). No differences between the two-dose and single-dose groups were detected in bone markers at week 96. CONCLUSIONS The benefits for BMD of a single dose of zoledronate in 2 years may be comparable to those obtained with two doses of the drug after 96 weeks, although this study is insufficiently powered to exclude a real difference. Future studies should explore whether biennial administration of zoledronate is a useful alternative in the treatment of osteoporosis in HIV-infected patients.
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Affiliation(s)
- E Negredo
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Universitat Autònoma de Barcelona, Badalona, Spain.,Universitat de Vic-Universitat central de Catalunya, Spain
| | - A Bonjoch
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Universitat Autònoma de Barcelona, Badalona, Spain
| | - N Pérez-Álvarez
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Universitat Autònoma de Barcelona, Badalona, Spain.,Statistics and Operations Research Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - A Ornelas
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Universitat Autònoma de Barcelona, Badalona, Spain.,Department of Econometrics, University of Barcelona, Barcelona, Spain
| | - J Puig
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Universitat Autònoma de Barcelona, Badalona, Spain
| | - C Herrero
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Universitat Autònoma de Barcelona, Badalona, Spain
| | - C Estany
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Universitat Autònoma de Barcelona, Badalona, Spain
| | - L del Río
- CETIR Centre Mèdic, Barcelona, Spain
| | | | - P Echeverría
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Universitat Autònoma de Barcelona, Badalona, Spain
| | - B Clotet
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Universitat Autònoma de Barcelona, Badalona, Spain.,Universitat de Vic-Universitat central de Catalunya, Spain.,Irsicaixa Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain
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Negredo E, Diez-Perez A, Bonjoch A, Domingo P, Perez-Alvarez N, Gutierrez M, Mateo G, Puig J, Echeverria P, Escrig R, Clotet B. Switching from tenofovir to abacavir in HIV-1-infected patients with low bone mineral density: changes in bone turnover markers and circulating sclerostin levels. J Antimicrob Chemother 2015; 70:2104-7. [DOI: 10.1093/jac/dkv063] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/19/2015] [Indexed: 01/24/2023] Open
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López Aventín D, Rubio González B, Petiti Martín G, Segura S, Rodríguez-Peralto J, Riveiro-Falkenbach E, Puig J, Pujol R. Mycobacterium fortuituminfection in continuous subcutaneous insulin infusion sites. Br J Dermatol 2014; 171:418-20. [DOI: 10.1111/bjd.12926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- D. López Aventín
- Department of Dermatology; Hospital del Mar - Parc de Salut Mar; Passeig Marítim 25-29 08003 Barcelona Spain
| | - B. Rubio González
- Department of Dermatology; Hospital Universitario 12 de Octubre; Avda de Córdoba s/n 28041 Madrid Spain
| | - G. Petiti Martín
- Department of Dermatology; Hospital Universitario 12 de Octubre; Avda de Córdoba s/n 28041 Madrid Spain
| | - S. Segura
- Department of Dermatology; Hospital del Mar - Parc de Salut Mar; Passeig Marítim 25-29 08003 Barcelona Spain
| | - J.L. Rodríguez-Peralto
- Department of Pathology; Hospital Universitario 12 de Octubre; Avda de Córdoba s/n 28041 Madrid Spain
| | - E. Riveiro-Falkenbach
- Department of Pathology; Hospital Universitario 12 de Octubre; Avda de Córdoba s/n 28041 Madrid Spain
| | - J. Puig
- Department of Endocrinology; Hospital del Mar - Parc de Salut Mar; Passeig Marítim 25-29 08003 Barcelona Spain
| | - R.M. Pujol
- Department of Dermatology; Hospital del Mar - Parc de Salut Mar; Passeig Marítim 25-29 08003 Barcelona Spain
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Mauricio A, González V, Marco A, Puig J, Marco P. C0528: Antiphospholipid Antibodies Against β-2 Glycoprotein I Domain I in Antiphospholipid Syndrome: Assessment By Chemoluminescence. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50128-4] [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: 11/30/2022]
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Aguilar G, Azanza JR, Sádaba B, Badenes R, Ferrando C, Delgado C, Hernández J, Parra MA, Puig J, Carbonell JA, Navarro D, Belda FJ. Pharmacokinetics of anidulafungin during albumin dialysis. Crit Care 2014; 18:422. [PMID: 25028805 PMCID: PMC4056443 DOI: 10.1186/cc13805] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Aguilar G, Azanza JR, Carbonell JA, Ferrando C, Badenes R, Parra MA, Sadaba B, Navarro D, Puig J, Miñana A, Garcia-Marquez C, Gencheva G, Gutierrez A, Marti FJ, Belda FJ. Anidulafungin dosing in critically ill patients with continuous venovenous haemodiafiltration. J Antimicrob Chemother 2014; 69:1620-3. [DOI: 10.1093/jac/dkt542] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Forastiero R, Papalardo E, Watkins M, Nguyen H, Quirbach C, Jaskal K, Kast M, Teodorescu M, Lakos G, Binder W, Shums Z, Nelson V, Norman G, Puig J, Cox A, Vandam W, Hardy J, Pierangeli S. Evaluation of different immunoassays for the detection of antiphospholipid antibodies: Report of a wet workshop during the 13th International Congress on Antiphospholipid Antibodies. Clin Chim Acta 2014; 428:99-105. [DOI: 10.1016/j.cca.2013.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 01/04/2023]
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Allen D, Carlson B, Allen D, Carlson B, Boele F, Zant M, Heine E, Aaronson N, Taphoorn M, Reijneveld J, Heimans J, Klein M, Bradshaw M, Noll K, Ziu M, Weinberg J, Strange C, Turner C, Wefel J, Carlson-Green B, Puig J, Bendel A, Lu Y, Clark K, Conklin H, Merchant T, Klimo P, Panandiker AP, Conklin H, Ashford J, Clark K, Martin-Elbahesh K, Hardy K, Merchant T, Ogg R, Jeha S, Huang L, Zhang H, Correa D, Satagopan J, Baser R, Cheung K, Lin M, Karimi S, Lyo J, DeAngelis L, Orlow I, De Witte E, Satoer D, Erik R, Colle H, Visch-Brink E, Marien P, De Witte E, Marien P, Gehring K, Hoogendoorn P, Sitskoorn M, Gondi V, Mehta M, Pugh S, Tome W, Corn B, Caine C, Kanner A, Rowley H, Kundapur V, Greenspoon J, Konski A, Bauman G, Shi W, Kavadi V, Kachnic L, Driever PH, Soelva V, Rueckriegel S, Bruhn H, Thomale U, Lambourn C, Corbett A, Linville C, Mintz A, Hampson R, Deadwyler S, Peiffer A, Noll K, Weinberg J, Ziu M, Turner C, Strange C, Wefel J, Peters K, Kenjale A, West M, Hornsby W, Herndon J, McSherry F, Desjardins A, Friedman H, Jones L, Peters K, Woodring S, Affronti ML, Threatt S, Lindhorst S, Levacic D, Desjardins A, Ranjan T, Vlahovic G, Friedman A, Friedman H, Resendiz CV, Armstrong TS, Acquaye A, Vera-Bolanos E, Gilbert M, Wefel JS, Turner C, Strange C, Bradshaw M, Noll K, Wefel J, Wefel J, Pugh S, Armstrong T, Gilbert M, Won M, Wendland M, Brachman D, Brown P, Crocker I, Robins HI, Lee RJ, Mehta M, Ziu M, Noll K, Weinberg J, Benveniste R, Turner C, Strange C, Suki D, Wefel J, Caine C, Anderson SK, Harel BT, Brown P, Cerhan JH. NEURO-COGNITIVE. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not181] [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: 11/14/2022] Open
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Rodríguez NH, Granados RJ, Blanco-Varela MT, Cortina JL, Martínez-Ramírez S, Marsal M, Guillem M, Puig J, Fos C, Larrotcha E, Flores J. Evaluation of a lime-mediated sewage sludge stabilisation process. Product characterisation and technological validation for its use in the cement industry. Waste Manag 2012; 32:550-560. [PMID: 22119052 DOI: 10.1016/j.wasman.2011.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 09/05/2011] [Accepted: 10/14/2011] [Indexed: 05/31/2023]
Abstract
This paper describes an industrial process for stabilising sewage sludge (SS) with lime and evaluates the viability of the stabilised product, denominated Neutral, as a raw material for the cement industry. Lime not only stabilised the sludge, raised the temperature of the mix to 80-100°C, furthering water evaporation, portlandite formation and the partial oxidation of the organic matter present in the sludge. Process mass and energy balances were determined. Neutral, a white powder consisting of portlandite (49.8%), calcite (16.6%), inorganic oxides (13.4%) and organic matter and moisture (20.2%), proved to be technologically apt for inclusion as a component in cement raw mixes. In this study, it was used instead of limestone in raw mixes clinkerised at 1400, 1450 and 1500°C. These raw meals exhibited greater reactivity at high temperatures than the limestone product and their calcination at 1500°C yielded clinker containing over 75% calcium silicates, the key phases in Portland clinker. Finally, the two types of raw meal (Neutral and limestone) were observed to exhibit similar mineralogy and crystal size and distribution.
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Affiliation(s)
- N Husillos Rodríguez
- Eduardo Torroja Institute for Construction Science (CSIC), Serrano Galvache 4, 28033 Madrid, Spain.
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