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Cañueto J, Muñoz-Couselo E, Cardona-Machado C, Becerril-Andrés S, Martín-Vallejo J, Serra-Guillén C, Soria A, Serrano-Domingo JJ, Ortiz-Velez C, Lostes J, García-Castaño A, Puig S, Fernández de Misa R, Medina J, Aguado C, Ayala de Miguel P, Navarro-Navarro I, Masferrer E, Delgado M, Bellido-Hernández L, Sanmartin O. Efficacy and safety of cemiplimab in the treatment of advanced cutaneous squamous cell carcinoma: A multicentre real-world retrospective study from Spain and systematic review of the published data. J Eur Acad Dermatol Venereol 2024. [PMID: 38308557 DOI: 10.1111/jdv.19821] [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: 09/30/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Affiliation(s)
- J Cañueto
- Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - E Muñoz-Couselo
- Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - C Cardona-Machado
- Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - S Becerril-Andrés
- Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - J Martín-Vallejo
- Departamento de Estadística, Universidad de Salamanca y Unidad de Bioestadistica del IBSAL, Salamanca, Spain
| | - C Serra-Guillén
- Dermatology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - A Soria
- Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - C Ortiz-Velez
- Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Lostes
- Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - A García-Castaño
- Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - S Puig
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, IDIBAPS, CIBERER, Barcelona, Spain
| | - R Fernández de Misa
- Dermatology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - J Medina
- Medical Oncology, Hospital Virgen de la Salud, Toledo, Spain
| | - C Aguado
- Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - E Masferrer
- Dermatology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - M Delgado
- Medical Oncology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - L Bellido-Hernández
- Medical Oncology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - O Sanmartin
- Dermatology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain
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Mas-Llado C, Rossello X, González-Del-Hoyo M, Pocock S, de Werf FV, Chin CT, Danchin N, Lee SWL, Medina J, Huo Y, Bueno H. Secondary Prevention Therapies in Real-World Patients with Myocardial Infarction: Eligibility Based on Randomized Trials Supporting European and American Guidelines. Am J Med 2024; 137:137-146.e10. [PMID: 37838236 DOI: 10.1016/j.amjmed.2023.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE We aimed to evaluate the applicability of the eligibility criteria of randomized controlled trials (RCTs) cited in guideline recommendations in a real-world cohort of patients receiving secondary prevention after acute myocardial infarction from the EPICOR registries. METHODS Recommendations provided by American and European guidelines for acute myocardial infarction were classified into general (applying to all patients) and specific (applying to patients with left ventricular dysfunction or heart failure). Randomized controlled trials cited in these recommendations were selected, and their entry criteria were applied to our international cohort of 18,117 patients. RESULTS There were 91.5% patients eligible for beta blockers (84.6% for general, and 5.9% for specific recommendations), 97.7% eligible for renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers [ACEI/ARB]) recommendations (69.9% for general, 27.9% for specific) and 4.1% eligible for mineralocorticoid receptor antagonists (only specific recommendations). The percentages of patients with eligibility criteria who were discharged with a prescription of the recommended therapies were 80%-85% for beta blockers, 70%-75% for ACEI/ARB, and 29% for mineralocorticoid receptor antagonists. There were large regional variations in the percentage of eligible patients and in those receiving the medications (eg, 95% in Northern Europe and 57% in Southeast Asia for beta blockers). CONCLUSION Most real-world acute myocardial infarction patients are eligible for secondary prevention therapy in both general and specific guideline recommendations, and the percentage of those on beta blockers and ACEI/ARB at hospital discharge is high. There are large regional variations in the proportion of patients receiving recommended therapies. Local targeted interventions are needed for quality improvement.
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Affiliation(s)
- Caterina Mas-Llado
- Cardiology Department, Hospital de Manacor, Spain; Health Research Institute of the Balearic Islands, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears, Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears, Palma, Spain; Cardiology Department, Health Research Institute of the Balearic Islands, Hospital Universitari Son Espases, Palma, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
| | | | | | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, France
| | | | | | - Yong Huo
- Beijing University First Hospital, China
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación i+12, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
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González-Del-Hoyo M, Rossello X, Peral V, Pocock S, Van de Werf F, Chin CT, Danchin N, Lee SWL, Medina J, Huo Y, Bueno H. Impact of standard modifiable cardiovascular risk factors on 2-year all-cause mortality: Insights from an international cohort of 23,489 patients with acute coronary syndrome. Am Heart J 2023; 264:20-30. [PMID: 37279841 DOI: 10.1016/j.ahj.2023.05.023] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/20/2023] [Accepted: 05/28/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Controversial findings have been reported in the literature regarding the impact of the absence of standard modifiable cardiovascular risk factors (SMuRFs) on long-term mortality risk in patients with acute coronary syndrome (ACS). While the prognostic additive value of SMuRFs has been well described, the prognostic role of prior cardiovascular disease (CVD) by sex is less well-known in patients with and without SMuRFs. METHODS EPICOR and EPICOR Asia are prospective, observational registries conducted between 2010 and 2014, which enrolled ACS patients in 28 countries across Europe, Latin America, and Asia. Association between SMuRFs (diabetes, dyslipidaemia, hypertension, and smoking) and 2-year postdischarge mortality was evaluated using adjusted Cox models stratified by geographical region. RESULTS Among 23,489 patients, the mean age was 60.9 ± 11.9 years, 24.3% were women, 4,582 (20.1%) presented without SMuRFs, and 16,055 (69.5%) without prior CVD. Patients with SMuRFs had a higher crude 2-year postdischarge mortality (HR 1.86; 95% CI, 1.56-2.22; P < .001), compared to those without SMuRFs. After adjustment for potential confounding, the association between SMuRFs and 2-year mortality risk was substantially attenuated (HR 1.17, 95% CI 0.98-1.41; P = .087), regardless of the type of ACS. The risk conferred by prior CVD was added to the underlying risk of SMuRFs to provide risk-specific phenotypes (eg, women with SMuRFs and with prior CVD were at higher risk of dying than women without SMuRFs and without CVD; HR 1.67, 95% CI 1.34-2.06). CONCLUSIONS In this large-scale international ACS cohort the absence of SMuRFs was not associated with a lower adjusted 2-year postdischarge mortality risk. Patients with both SMuRFs and prior CVD had a higher mortality irrespective of their sex.
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Affiliation(s)
- Maribel González-Del-Hoyo
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain.
| | - Vicente Peral
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
| | - Stuart Pocock
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain; London School of Hygiene and Tropical Medicine, London, UK
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, Paris, France
| | | | - Jesús Medina
- BioPharmaceuticals Medical, AstraZeneca, Madrid, Spain
| | - Yong Huo
- Beijing University First Hospital, Beijing, China
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de investigación i+12, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Aarskog P, Cid-Ruzafa J, Chen H, Fenici P, Gutierrez LR, Hammar N, Medina J, Pascual E, Saraiva GL, Surmont F, Sweet S, Ji L, Khunti K, Cooper A. Considerations when planning and conducting large global observational studies: Experience from the DISCOVER study of patients with type 2 diabetes. Prim Care Diabetes 2023; 17:411-419. [PMID: 37544790 DOI: 10.1016/j.pcd.2023.07.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
DISCOVER is a global programme of observational research that includes patients with type 2 diabetes initiating second-line glucose-lowering therapy from 38 countries worldwide, including many with little or no previous epidemiological data available. More than 15,000 patients were followed-up for 3 years, and comprehensive data were collected using a standardized electronic case report form at enrolment, and 6, 12, 24 and 36 months. The study has formed the basis for a long-term registry that is intended to expand the geographic and clinical scope of the study and allow data collection beyond 3 years. In this review, critical aspects of study planning and implementation are summarized, along with challenges that were faced, to provide a resource for researchers planning similar studies. In particular, it is essential to set realistic expectations regarding the degree of study representativeness that can be achieved, allow for sufficient time to obtain ethics committee approval, develop tools to help recruit patients effectively, ensure that data collection systems are robust, user-friendly and adaptable, plan adequate remote and on-site monitoring, maximize patient retention through continuous engagement with study sites and ensure that everyone involved in the study forms a friendly and effective team. Observational studies such as DISCOVER are crucial for understanding disease epidemiology and management in real-world settings. They are also increasingly used by governmental, regulatory and payor agencies for post-marketing surveillance and when considering new drug submissions. The development of future studies of similar scope and ambition to DISCOVER is encouraged.
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Affiliation(s)
| | | | | | | | | | - Niklas Hammar
- AstraZeneca Gothenburg, Mölndal, Sweden; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | | | | | | | | | - Stephen Sweet
- Research Evaluation Centre, Oxford PharmaGenesis Ltd, Oxford, UK
| | - Linong Ji
- Peking University People's Hospital, Beijing, China
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Miller K, Gannon MR, Medina J, Clements K, Dodwell D, Horgan K, Park MH, Cromwell DA. Variation in Rates of Post-Mastectomy Radiotherapy Among Women with Early Invasive Breast Cancer in England and Wales: A Population-Based Cohort Study. Clin Oncol (R Coll Radiol) 2023; 35:e549-e560. [PMID: 37321887 DOI: 10.1016/j.clon.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/28/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
AIMS This study examined whether patterns of post-mastectomy radiotherapy (PMRT) among women with early invasive breast cancer (EIBC) varied within England and Wales and explored the role of different patient factors in explaining any variation. MATERIALS AND METHODS The study used national cancer data on women aged ≥50 years diagnosed with EIBC (stage I-IIIa) in England and Wales between January 2014 and December 2018 who had a mastectomy within 12 months of diagnosis. A multilevel mixed-effects logistic regression model was used to calculate risk-adjusted rates of PMRT for geographical regions and National Health Service acute care organisations. The study examined the variation in these rates within subgroups of women with different risks of recurrence (low: T1-2N0; intermediate: T3N0/T1-2N1; high: T1-2N2/T3N1-2) and investigated whether the variation was linked to patient case-mix within regions and organisations. RESULTS Among 26 228 women, use of PMRT increased with greater recurrence risk (low: 15.0%; intermediate: 59.4%; high: 85.1%). In all risk groups, use of PMRT was more common among women who had received chemotherapy and decreased among women aged ≥80 years. There was weak or no evidence of an association between use of PMRT and comorbidity or frailty, for each risk group. In women with an intermediate risk, unadjusted rates of PMRT varied substantially between geographical regions (range 40.3-77.3%), but varied less for the high-risk (range 77.1-91.6%) and low-risk groups (range 4.1-32.9%). Adjusting for patient case-mix reduced the variation in regional and organisational PMRT rates to a small degree. CONCLUSIONS Rates of PMRT are consistently high across England and Wales among women with high-risk EIBC, but variation exists across regions and organisations for women with intermediate-risk EIBC. Effort is required to reduce unwarranted variation in practice for intermediate-risk EIBC.
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Affiliation(s)
- K Miller
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - M R Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - J Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - K Clements
- National Cancer Registration and Analysis Service, NHS Digital, Birmingham, UK
| | - D Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - K Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - M H Park
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Miller K, Gannon MR, Medina J, Clements K, Dodwell D, Horgan K, Park MH, Cromwell DA. The Association Between Survival and Receipt of Post-mastectomy Radiotherapy According to Age at Diagnosis Among Women With Early Invasive Breast Cancer: A Population-Based Cohort Study. Clin Oncol (R Coll Radiol) 2023; 35:e265-e277. [PMID: 36764877 DOI: 10.1016/j.clon.2023.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
AIMS Clinical trials of post-mastectomy radiotherapy (PMRT) for early invasive breast cancer (EIBC) have included few older women. This study examined whether the association between overall survival or breast cancer-specific survival (BCSS) and receipt of PMRT for EIBC altered with age. MATERIALS AND METHODS The study used patient-level linked cancer registration, routine hospital and radiotherapy data for England and Wales. It included 31 243 women aged ≥50 years diagnosed between 2014 and 2018 with low- (T1-2N0), intermediate- (T3N0/T1-2N1) or high-risk (T1-2N2/T3N1-2) EIBC who received a mastectomy within 12 months from diagnosis. Patterns of survival were analysed using a landmark approach. Associations between overall survival/BCSS and PMRT in each risk group were analysed with flexible parametric survival models, which included patient and tumour factors; whether the association between PMRT and overall survival/BCSS varied by age was assessed using interaction terms. RESULTS Among 4711 women with high-risk EIBC, 86% had PMRT. Five-year overall survival was 70.5% and BCSS was 79.3%. Receipt of PMRT was associated with improved overall survival [adjusted hazard ratio (aHR) 0.75, 95% confidence interval 0.64-0.87] and BCSS (aHR 0.78, 95% confidence interval 0.65-0.95) compared with women who did not have PMRT; associations did not vary by age (overall survival, P-value for interaction term = 0.141; BCSS, P = 0.077). Among 10 814 women with intermediate-risk EIBC, 59% had PMRT; 5-year overall survival was 78.4% and BCSS was 88.0%. No association was found between overall survival (aHR 1.01, 95% confidence interval 0.92-1.11) or BCSS (aHR 1.16, 95% confidence interval 1.01-1.32) and PMRT. There was statistical evidence of a small change in the association with age for overall survival (P = 0.007), although differences in relative survival were minimal, but not for BCSS (P = 0.362). CONCLUSIONS The association between PMRT and overall survival/BCSS does not appear to be modified by age among women with high- or intermediate-risk EIBC and, thus, treatment recommendations should not be modified on the basis of age alone.
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Affiliation(s)
- K Miller
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - M R Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - K Clements
- National Cancer Registration and Analysis Service, NHS Digital, Birmingham, UK
| | - D Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - K Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - M H Park
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Charbonnel BH, Chen H, Cid-Ruzafa J, Cooper A, Fenici P, Gomes MB, Saraiva GL, Medina J, Nicolucci A, Shestakova MV, Shimomura I, Surmont F, Tang F, Vora J, Watada H, Khunti K. Treatment patterns and glycated haemoglobin levels over 36 months in individuals with type 2 diabetes initiating second-line glucose-lowering therapy: The global DISCOVER study. Diabetes Obes Metab 2023; 25:46-55. [PMID: 36111434 PMCID: PMC10087302 DOI: 10.1111/dom.14842] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
AIMS To describe glucose-lowering treatment regimens and glycated haemoglobin (HbA1c) trajectories in individuals with type 2 diabetes (T2D) over 36 months of follow-up from the start of second-line therapy. MATERIALS AND METHODS This data analysis from the 3-year, observational DISCOVER study programme included 14 687 participants from 37 countries with T2D initiating second-line glucose-lowering therapy. Treatment and HbA1c data were collected at baseline (start of second-line therapy) and at 6, 12, 24 and 36 months. Treatment regimen changes over follow-up were analysed using the McNemar test, with carry-forward imputation for intermediate missing values. RESULTS A total of 11 592 participants had treatment data at baseline and 36 months, and 11 882 had HbA1c data at baseline. At baseline and 36 months, respectively, rates of oral monotherapy use were 12.1% and 12.4% (P = 0.22), rates of dual oral therapy use were 63.4% and 47.6% (P < 0.0001), rates of ≥ triple oral therapy use were 17.5% and 25.4% (P < 0.0001), and rates of injectable treatment use were 7.0% and 13.7% (P < 0.0001). Use of injectable drugs was most common among participants with an HbA1c level ≥64 mmol/mol (≥8.0%). Overall, 42.9% of participants changed treatment during follow-up. Mean HbA1c levels at baseline and 6 months were 67 mmol/mol (8.3%) and 55 mmol/mol (7.2%), respectively, remaining stable thereafter. CONCLUSIONS Dual oral therapy was the most common treatment regimen at the start of second-line treatment, and over half of the participants remained on the same treatment during follow-up.
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Affiliation(s)
| | - Hungta Chen
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | | | - Andrew Cooper
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Peter Fenici
- BioPharmaceuticals Medical, AstraZeneca, Milan, Italy
| | - Marilia B Gomes
- Department of Internal Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Jesús Medina
- BioPharmaceuticals Medical, AstraZeneca, Madrid, Spain
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Marina V Shestakova
- Endocrinology Research Centre, Diabetes Institute, Moscow, Russian Federation
| | | | | | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Jiten Vora
- Royal Liverpool University Hospital, Liverpool, UK
| | - Hirotaka Watada
- Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Povedano M, Vázquez-Costa J, Pitarch I, López-Lobato M, Medina J, Fernández-Ramos J, Lafuente-Hidalgo M, Rojas-García R, Caballero-Caballero J, Málaga I, Eirís J, De Lemus M, Cattinari M, Madruga-Garrido M, Branas M, Cabello-Moruno R, Díaz-Abós P, Terrancle A, Maurino J, Rebollo P. VP.55 Fatigue, pain, breathing, voice, fatigability, sleep, rest and vulnerability as meaningful outcomes in SMA care: the patients´ and caregivers' voice. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.209] [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: 11/05/2022]
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Gamarra F, Medina J, Lanchipa W, Tamayo R, Sacari E. Structural, Optical, and Arsenic Removal Properties of Sol-Gel Synthesized Fe-Doped TiO 2 Nanoparticles. Nanomaterials (Basel) 2022; 12:3402. [PMID: 36234527 PMCID: PMC9565318 DOI: 10.3390/nano12193402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Pure and Fe-doped TiO2 nanoparticles were synthesized by the sol-gel method. The samples were characterized by X-ray diffraction, Raman spectroscopy, BET, UV-vis diffuse reflectance spectroscopy, and scanning electron microscopy. The results show a dependence between the crystallite size and the amount of dopant, which decreases from 13.02 to 12.81 nm. The same behavior was observed in the optical properties, where the band gap decreased from 3.2 to 2.86 eV. The arsenic (V) adsorption was tested in aqueous solution containing 5 mg/L of arsenic and 0.5 g/L of adsorbent at pH 7 and in dark conditions. The results indicate that the TiO2-B sample shows a higher arsenic removal, reaching 88% arsenic removal from the water at pH 7. Thus, it is also shown that the best performance occurs at pH 5, where it reaches an arsenic removal of 94%. Ion competition studies show that arsenic removal capacity is slightly affected by chloride, carbonate, nitrate, and sulfate ions. According to the results, the synthesized samples are a promising material for treating arsenic-contaminated water.
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Affiliation(s)
- Francisco Gamarra
- Laboratorio de Nanotecnología, Facultad de Ingeniería, Universidad Nacional Jorge Basadre Grohmann, Av. Miraflores s/n, Tacna 23003, Perú
| | - Jesús Medina
- Laboratorio de Nanotecnología, Facultad de Ingeniería, Universidad Nacional Jorge Basadre Grohmann, Av. Miraflores s/n, Tacna 23003, Perú
| | - Wilson Lanchipa
- Laboratorio de Nanotecnología, Facultad de Ingeniería, Universidad Nacional Jorge Basadre Grohmann, Av. Miraflores s/n, Tacna 23003, Perú
| | - Rocío Tamayo
- Departamento de Ingeniería de Materiales, Facultad de Ingeniería de Procesos, Universidad Nacional de San Agustín, Arequipa 04001, Perú
- Laboratorio de Microscopia Electrónica de Transmisión, Centro de Microscopia Electrónica, Facultad de Ingeniería de Procesos, Universidad Nacional de San Agustín, Arequipa 04001, Perú
| | - Elisban Sacari
- Laboratorio de Nanotecnología, Facultad de Ingeniería, Universidad Nacional Jorge Basadre Grohmann, Av. Miraflores s/n, Tacna 23003, Perú
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Hejjaji V, Gorgojo-Martinez JJ, Tang F, Garnelo JB, Cooper A, Medina J, Mutiozabal MS, Khunti K, Nicolucci A, Shestakova MV, Ji L, Gomes MB, Watada H, Vora J, Malik AO, Kosiborod M, Arnold SV. Factors associated with weight loss in people with overweight or obesity living with type 2 diabetes mellitus: Insights from the global DISCOVER study. Diabetes Obes Metab 2022; 24:1734-1740. [PMID: 35546275 DOI: 10.1111/dom.14745] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/12/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
AIMS To estimate real-world change in weight over 3 years and the factors influencing it in participants who are overweight and live with type 2 diabetes. MATERIALS AND METHODS DISCOVER is a multinational prospective observational study that enrolled participants with type 2 diabetes between December 2014 and June 2016 at the time of initiation of a second-line glucose-lowering medication (GLM). Demographic, anthropometric, and quality-of-life data were collected at baseline, and after 6, 12, 24 and 36 months of follow-up. Using a hierarchical, repeated-measures linear regression model, we examined factors associated with weight change over time. RESULTS Of 10 675 participants with type 2 diabetes who were overweight/obese (mean age 57.1 ± 11.1 years, 46% women), 21% lost ≥5% weight over 3 years, which was associated with modestly improved physical and mental health. Advancing age, female sex, and higher baseline weight were associated with weight loss. Most importantly, the type of GLM prescribed at previous visit had the strongest impact on weight change over time independent of participant factors, with use of a sodium-glucose cotransporter-2 inhibitor or glucagon-like peptide-1 receptor agonist associated with 1.0% weight loss versus a 0.6% weight gain with sulphonylureas, thiazolidinediones, meglitinides or insulin. CONCLUSION In this large contemporary prospective study, approximately one in five participants with early-stage type 2 diabetes and overweight/obesity lost ≥5% weight over 3 years. The type of GLM has the most impact on weight loss over time, highlighting the need for a careful selection of agents that takes baseline weight into consideration.
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Affiliation(s)
- Vittal Hejjaji
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Juan J Gorgojo-Martinez
- Unit of Endocrinology and Nutrition, Hospital Universitario Fundación Alcorcón Madrid, Madrid, Spain
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | | | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Marina V Shestakova
- Endocrinology Research Center, Diabetes Institute, Moscow, Russian Federation
| | - Linong Ji
- Peking University Subjects's Hospital, Beijing, China
| | | | - Hirotaka Watada
- Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | - Ali O Malik
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
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Jiménez I, Medina J, Marcos-García A, Garcés G. [Translated article] Out-of-sheath corticosteroid injections through the dorsal webspace for trigger finger and trigger thumb. A prospective cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Gannon MR, Dodwell D, Miller K, Horgan K, Clements K, Medina J, Kunkler I, Cromwell DA. Change in the Use of Fractionation in Radiotherapy Used for Early Breast Cancer at the Start of the COVID-19 Pandemic: A Population-Based Cohort Study of Older Women in England and Wales. Clin Oncol (R Coll Radiol) 2022; 34:e400-e409. [PMID: 35691761 PMCID: PMC9151525 DOI: 10.1016/j.clon.2022.05.019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/28/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022]
Abstract
Aims Adjuvant radiotherapy is recommended for most patients with early breast cancer (EBC) receiving breast-conserving surgery and those at moderate/high risk of recurrence treated by mastectomy. During the first wave of COVID-19 in England and Wales, there was rapid dissemination of randomised controlled trial-based evidence showing non-inferiority for five-fraction ultra-hypofractionated radiotherapy (HFRT) regimens compared with standard moderate-HFRT, with guidance recommending the use of five-fraction HFRT for eligible patients. We evaluated the uptake of this recommendation in clinical practice as part of the National Audit of Breast Cancer in Older Patients (NABCOP). Materials and methods Women aged ≥50 years who underwent surgery for EBC from January 2019 to July 2020 were identified from the Rapid Cancer Registration Dataset for England and from Wales Cancer Network data. Radiotherapy details were from linked national Radiotherapy Datasets. Multivariate mixed-effects logistic regression models were used to assess characteristics influential in the use of ultra-HFRT. Results Among 35 561 women having surgery for EBC, 71% received postoperative radiotherapy. Receipt of 26 Gy in five fractions (26Gy5F) increased from <1% in February 2020 to 70% in April 2020. Regional variation in the use of 26Gy5F during April to July 2020 was similar by age, ranging from 49 to 87% among women aged ≥70 years. Use of 26Gy5F was characterised by no known nodal involvement, no comorbidities and initial breast-conserving surgery. Of those patients receiving radiotherapy to the breast/chest wall, 85% had 26Gy5F; 23% had 26Gy5F if radiotherapy included regional nodes. Among 5139 women receiving postoperative radiotherapy from April to July 2020, nodal involvement, overall stage, type of surgery, time from diagnosis to start of radiotherapy were independently associated with fractionation choice. Conclusions There was a striking increase in the use of 26Gy5F dose fractionation regimens for EBC, among women aged ≥50 years, within a month of guidance published at the start of the COVID-19 pandemic in England and Wales.
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Affiliation(s)
- M R Gannon
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
| | - D Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - K Miller
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - K Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - K Clements
- National Cancer Registration and Analysis Service, NHS Digital, Birmingham, UK
| | - J Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - I Kunkler
- University of Edinburgh, Edinburgh, UK
| | - D A Cromwell
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
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Rull F, Veneranda M, Manrique-Martinez JA, Sanz-Arranz A, Saiz J, Medina J, Moral A, Perez C, Seoane L, Lalla E, Charro E, Lopez JM, Nieto LM, Lopez-Reyes G. Spectroscopic study of terrestrial analogues to support rover missions to Mars - A Raman-centred review. Anal Chim Acta 2022; 1209:339003. [PMID: 35569840 DOI: 10.1016/j.aca.2021.339003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/12/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
The 2020s could be called, with little doubt, the "Mars decade". No other period in space exploration history has experienced such interest in placing orbiters, rovers and landers on the Red Planet. In 2021 alone, the Emirates' first Mars Mission (the Hope orbiter), the Chinese Tianwen-1 mission (orbiter, lander and rover), and NASA's Mars 2020 Perseverance rover reached Mars. The ExoMars mission Rosalind Franklin rover is scheduled for launch in 2022. Beyond that, several other missions are proposed or under development. Among these, MMX to Phobos and the very important Mars Sample Return can be cited. One of the key mission objectives of the Mars 2020 and ExoMars 2022 missions is the detection of traces of potential past or present life. This detection relies to a great extent on the analytical results provided by complementary spectroscopic techniques. The development of these novel instruments has been carried out in step with the analytical study of terrestrial analogue sites and materials, which serve to test the scientific capabilities of spectroscopic prototypes while providing crucial information to better understand the geological processes that could have occurred on Mars. Being directly involved in the development of three of the first Raman spectrometers to be validated for space exploration missions (Mars 2020/SuperCam, ExoMars/RLS and RAX/MMX), the present review summarizes some of the most relevant spectroscopy-based analyses of terrestrial analogues carried out over the past two decades. Therefore, the present work describes the analytical results gathered from the study of some of the most distinctive terrestrial analogues of Martian geological contexts, as well as the lessons learned mainly from ExoMars mission simulations conducted at representative analogue sites. Learning from the experience gained in the described studies, a general overview of the scientific outcome expected from the spectroscopic system developed for current and forthcoming planetary missions is provided.
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Affiliation(s)
- Fernando Rull
- University of Valladolid, Plaza de Santa Cruz 8, 47002, Valladolid, Spain.
| | - Marco Veneranda
- University of Valladolid, Plaza de Santa Cruz 8, 47002, Valladolid, Spain
| | | | | | - Jesus Saiz
- University of Valladolid, Plaza de Santa Cruz 8, 47002, Valladolid, Spain
| | - Jesús Medina
- University of Valladolid, Plaza de Santa Cruz 8, 47002, Valladolid, Spain
| | - Andoni Moral
- National Institute for Aerospace Technology (INTA), Torrejón de Ardoz, Spain
| | - Carlos Perez
- National Institute for Aerospace Technology (INTA), Torrejón de Ardoz, Spain
| | - Laura Seoane
- National Institute for Aerospace Technology (INTA), Torrejón de Ardoz, Spain
| | - Emmanuel Lalla
- York University, Centre for Research in Earth and Space Science, Toronto, Canada
| | - Elena Charro
- University of Valladolid, Plaza de Santa Cruz 8, 47002, Valladolid, Spain
| | - Jose Manuel Lopez
- University of Valladolid, Plaza de Santa Cruz 8, 47002, Valladolid, Spain
| | - Luis Miguel Nieto
- University of Valladolid, Plaza de Santa Cruz 8, 47002, Valladolid, Spain
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Rossello X, Mas-Lladó C, Pocock S, Vicent L, van de Werf F, Chin CT, Danchin N, Lee SWL, Medina J, Huo Y, Bueno H. Sex differences in mortality after an acute coronary syndrome increase with lower country wealth and higher income inequality. Rev Esp Cardiol (Engl Ed) 2022; 75:392-400. [PMID: 34175245 DOI: 10.1016/j.rec.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Although several factors associated with sex differences in the management and outcomes after acute coronary syndrome (ACS) have been reported, little is known about the influence of socioeconomic factors on sex disparities. Our aim was to evaluate the influence of country wealth and income inequality on national sex differences in mortality after ACS. METHODS Sex differences in 2-year postdischarge mortality were evaluated in 23 489 ACS patients from the EPICOR and EPICOR Asia registries. Adjusted Cox regression models by country-based terciles of gross national income per capita and income inequality were used. RESULTS Women (24.3%) were older than men (65.5 vs 59.4 years, P <.001), had more comorbidities, were less often revascularized (63.6% vs 75.6%, P <.001) and received fewer guideline recommended therapies at discharge. Compared with men, a higher percentage of women died during follow-up (6.4% vs 4.9%, P <.001). The association between sex and mortality changed direction from hazard ratio (HR) 1.32 (95%CI, 1.17-1.49) in the univariate assessment to HR 0.76 (95%CI, 0.67-0.87) after adjustment for confounders. These differences were more evident with increasing country wealth (HRlow-incomecountries = 0.85; 95%CI, 0.72-1.00; HRmid-incomecountries = 0.66; 95%CI, 0.50-0.87; HRhigh-incomecountries = 0.60; 95%CI, 0.40-0.90; trend test P = .115) and with decreasing income inequality (HRlow-inequalityindex = 0.54; 95%CI, 0.36-0.81; HRintermediate-inequalityindex = 0.66; 95%CI, 0.50-0.88; HRhigh-inequalityindex = 0.87; 95%CI, 0.74-1.03; trend test P = .031). CONCLUSIONS Women with ACS living in high socioeconomic countries showed a lower postdischarge mortality risk compared with men. This risk was attenuated in countries with poorer socioeconomic background, where adjusted mortality rates were similar between women and men.
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Affiliation(s)
- Xavier Rossello
- Servicio de Cardiología, Hospital Universitari Son Espases (HUSE), Palma, Balearic Islands, Spain; Grupo de Fisiopatología y Terapéutica Cardiovascular, Institut d'Investigació Sanitària Illes Balears (IdISBa), University Hospital Son Espases, Palma, Balearic Islands, Spain; Laboratorio Traslacional para la Imagen y Terapia Cardiovascular, Centro Nacional de Investigaciones Cardiovasculares Carlos (CNIC), Madrid, Spain; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom; Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Balearic Islands, Spain
| | - Caterina Mas-Lladó
- Servicio de Cardiología, Hospital Universitari Son Espases (HUSE), Palma, Balearic Islands, Spain; Grupo de Fisiopatología y Terapéutica Cardiovascular, Institut d'Investigació Sanitària Illes Balears (IdISBa), University Hospital Son Espases, Palma, Balearic Islands, Spain
| | - Stuart Pocock
- Laboratorio Traslacional para la Imagen y Terapia Cardiovascular, Centro Nacional de Investigaciones Cardiovasculares Carlos (CNIC), Madrid, Spain; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lourdes Vicent
- Instituto de Investigación i+12 y Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Frans van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Chee Tang Chin
- Cardiology Department, National Heart Centre Singapore, Singapore, Republic of Singapore
| | - Nicolas Danchin
- Service de Cardiologie, Hôpital Européen Georges Pompidou & René Descartes University, Paris, France
| | - Stephen W L Lee
- Cardiology Department, Queen Mary Hospital, Pok Fu Lam, China
| | | | - Yong Huo
- Cardiology Department, Beijing University First Hospital, Beijing, China
| | - Héctor Bueno
- Laboratorio Traslacional para la Imagen y Terapia Cardiovascular, Centro Nacional de Investigaciones Cardiovasculares Carlos (CNIC), Madrid, Spain; Instituto de Investigación i+12 y Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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Rossello X, Mas-Lladó C, Pocock S, Vicent L, Van de Werf F, Chin CT, Danchin N, Lee SW, Medina J, Huo Y, Bueno H. Las diferencias por sexo en la mortalidad tras un síndrome coronario agudo se incrementan en los países de menor riqueza y mayor desigualdad de ingresos. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fitzsimons KJ, Hamilton MJ, van der Meulen J, Medina J, Wahedally M, Park MH, Russell C. Range and Frequency of Congenital Malformations Among Children With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2022:10556656221089160. [PMID: 35382604 DOI: 10.1177/10556656221089160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To assess the range and frequency of additional congenital malformations identified among children born alive with CL/P. Analysis of patient-level data from a national registry of cleft births linked to national administrative data of hospital admissions. National Health Service, England. Children born between 2000 and 2012 receiving cleft care in English NHS hospitals. The proportion of children with ICD-10 codes for additional congenital malformations, according to cleft type. The study included 9403 children. Of these 2114 (22.5%) had CL±A, 4509 (48.0%) had CP, 1896 (20.2%) had UCLP, and 884 (9.4%) had BCLP. A total of 3653 (38.8%) children had additional congenital malformations documented in their hospital admission records. The prevalence of additional congenital malformations was greatest among children with CP (53.0%), followed by those with BCLP (33.5%), UCLP (26.3%), and then CL±A (22.2%) (P < .001). Among those with UCLP, children with right-sided clefts were more likely to have additional malformations than those with left-sided clefts (31.6% vs 23.0%, P < .001). Malformations of the skeletal system and circulatory system were most common, affecting 10.5% and 10.2% of the included children, respectively. A total of 16.8% of children had additional congenital malformations affecting 2 or more structural systems. Congenital malformations are common among children born alive with a cleft, affecting over half of some cleft subgroups. Given the frequency of certain structural malformations, clinicians should consider standardized screening for these children. Establishing good links with pediatric and genetic services is recommended.
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Affiliation(s)
- K J Fitzsimons
- Clinical Effectiveness Unit, 14211Royal College of Surgeons of England, London, UK
| | - M J Hamilton
- West of Scotland Centre for Genomic Medicine, 473300Queen Elizabeth University Hospital, Glasgow, UK
| | - J van der Meulen
- Department of Health Services Research and Policy, 4906London School of Hygiene and Tropical Medicine, London, UK
| | - J Medina
- Clinical Effectiveness Unit, 14211Royal College of Surgeons of England, London, UK
| | - Mah Wahedally
- Clinical Effectiveness Unit, 14211Royal College of Surgeons of England, London, UK
| | - M H Park
- Department of Health Services Research and Policy, 4906London School of Hygiene and Tropical Medicine, London, UK
| | - Cjh Russell
- 59842Royal Hospital for Children, 473300Queen Elizabeth University Hospital, Glasgow, UK
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Arnold SV, Khunti K, Tang F, Chen H, Nicolucci A, Gomes MB, Ji L, Shestakova MV, Watada H, Cooper A, Fenici P, Hammar N, Medina J, Kosiborod M. Impact of micro‐ and macrovascular complications of type 2 diabetes on quality of life: Insights from the DISCOVER prospective cohort study. Endocrinol Diabetes Metab 2022; 5:e00321. [PMID: 35029066 PMCID: PMC8917866 DOI: 10.1002/edm2.321] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/14/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background The key goals of management in patients with type 2 diabetes (T2D) are to prolong life and improve quality of life. Micro‐ and macrovascular complications of T2D not only increase the risk of morbidity and mortality, but cross‐sectional studies indicate they may also worsen quality of life. We prospectively examined the association of complications that developed during the follow‐up with concurrent changes in quality of life. Materials and methods DISCOVER is a multinational, prospective, observational cohort study of T2D patients enrolled at initiation of second‐line glucose‐lowering therapy. Quality of life was assessed with the SF‐36 Physical (PCS) and Mental Components Summary (MCS) scores at baseline, 6 months, and 1, 2 and 3 years. Hierarchical repeated measures regression models for PCS and MCS were constructed with complications included as time‐dependent covariates; first each complication was modelled alone and then second including all interval complications (to account for different complications occurring in the same patient). Results Among 7830 patients with T2D from 30 countries (mean age 56.6 years, 47.6% women, mean duration of T2D 5.6 years), baseline mean SF‐36 PCS was 48.0 ± 7.8 and SF‐36 MCS was 45.5 ± 10.4. At baseline, 1422 (18.2%) patients had a known microvascular complication, and 966 (12.3%) had a macrovascular complication. Over the 3 years of the study, 641 (12.0%) developed a new microvascular complication (most commonly neuropathy) and 372 (5.8%) developed a new macrovascular complication (most commonly coronary disease). New diagnoses of coronary disease, peripheral artery disease, heart failure and neuropathy were each associated with subsequent moderate reductions in SF‐36 PCS (range 0.7 to 1.6 points) and new cerebrovascular disease was associated with a reduction in SF‐36 MCS (2.6 points). Results were consistent when all interval complications were considered in the same model. Conclusion In a prospective, multinational study of patients with T2D, the development of macrovascular complications and neuropathy was associated with decreases in both physical and mental quality of life. Our results provide additional support for clinicians to focus on the prevention, detection and management of the complications of T2D.
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Affiliation(s)
- Suzanne V. Arnold
- Saint Luke’s Mid America Heart Institute Kansas City Missouri USA
- University of Missouri Kansas City Missouri USA
| | | | - Fengming Tang
- Saint Luke’s Mid America Heart Institute Kansas City Missouri USA
| | | | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology Pescara Italy
| | | | - Linong Ji
- Peking University People’s Hospital Beijing China
| | | | | | | | | | - Niklas Hammar
- AstraZeneca Gothenburg Mölndal Sweden
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | | | - Mikhail Kosiborod
- Saint Luke’s Mid America Heart Institute Kansas City Missouri USA
- University of Missouri Kansas City Missouri USA
- The George Institute for Global Health and University of New South Wales Sydney Australia
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Arnold SV, Khunti K, Tang F, Chen H, Cid-Ruzafa J, Cooper A, Fenici P, Gomes MB, Hammar N, Ji L, Saraiva GL, Medina J, Nicolucci A, Ramirez L, Rathmann W, Shestakova MV, Shimomura I, Surmont F, Vora J, Watada H, Kosiborod M. Incidence rates and predictors of microvascular and macrovascular complications in patients with type 2 diabetes: Results from the longitudinal global discover study. Am Heart J 2022; 243:232-239. [PMID: 34666013 DOI: 10.1016/j.ahj.2021.10.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Micro- and macrovascular complications are a major cause of morbidity and mortality in people with type 2 diabetes (T2D). We sought to understand the global incidence rates and predictors of these complications. METHODS We examined the incidence of vascular complications over 3 years of follow-up in the DISCOVER study-a global, observational study of people with T2D initiating second-line glucose-lowering therapy. Hierarchical Cox proportional hazards regression models examined factors associated with development of micro- and macrovascular complications during follow-up. RESULTS Among 11,357 people with T2D from 33 countries (mean age 56.9 ± 11.7 years, T2D duration 5.7 ± 5.1 years, HbA1c 8.4 ± 1.7%), 19.0% had a microvascular complication at enrolment (most commonly neuropathy), and 13.2% had a macrovascular complication (most commonly coronary disease). Over 3 years of follow-up, 16.0% developed an incident microvascular complication, and 6.6% had an incident macrovascular complication. At the end of 3 years of follow-up, 31.5% of patients had at least one microvascular complication, and 16.6% had at least one macrovascular complication. Higher HbA1c and smoking were associated with greater risk of both incident micro- and macrovascular complications. Known macrovascular complications at baseline was the strongest predictor for development of new microvascular complications (HR 1.40, 95% CI 1.21 -1.61) and new macrovascular complications (HR 3.39, 95% CI 2.84 -4.06). CONCLUSIONS In this global study, both the prevalence and 3-year incidence of vascular complications were high in patients with relatively short T2D duration, highlighting the need for early risk-factor modification.
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Beisheim E, Pohlig R, Medina J, Hicks G, Sions J. Body representation among adults with phantom limb pain: Results from a foot identification task. Eur J Pain 2022; 26:255-269. [PMID: 34490685 PMCID: PMC8671232 DOI: 10.1002/ejp.1860] [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] [Indexed: 01/03/2023]
Abstract
BACKGROUND Impaired body representation (i.e. disrupted body awareness or perception) may be a critical, but understudied, factor underlying phantom limb pain (PLP). This cross-sectional study investigated whether adults with lower-limb loss (LLL) and PLP demonstrate impaired body representation as compared to Pain-Free peers with and without LLL. METHODS Participants (n = 41 adults with PLP, n = 27 Pain-Free peers with LLL, n = 39 Controls with intact limbs) completed an online foot identification task. Participants judged whether randomized images depicted left or right feet (i.e. left-right discrimination) as quickly as possible without limb movement. Using two Generalized Estimating Equations, effects of group, image characteristics (i.e. side, foot type, view, angle) and trial block (i.e. 1-4) were evaluated, with task response time and accuracy as dependent variables (a ≤ 0.050). RESULTS Adults with PLP demonstrated slower and less accurate performance as compared to Controls with intact limbs (p = 0.018) but performed similarly to Pain-Free peers with LLL (p = 0.394). Significant three-way interactions of group, view and angle indicated between-group differences were greatest for dorsal-view images, but smaller and angle-dependent for plantar-view images. While all groups demonstrated significant response time improvements across blocks, improvements were greatest among adults with PLP, who also reported significant reductions in pain intensity. CONCLUSIONS Adults with PLP demonstrate body representation impairments as compared to Controls with intact limbs. Body representation impairments, however, may not be unique to PLP, given similar performance between adults with and without PLP following LLL. SIGNIFICANCE Following lower-limb loss, adults with phantom limb pain (PLP) demonstrate impaired body representation as compared to Controls with intact limbs, evidenced by slower response times and reduced accuracy when completing a task requiring mental rotation. Importantly, 80% of participants with pre-task PLP reported reduced pain intensity during the task, providing compelling evidence for future investigations into whether imagery-based, mind-body interventions have positive effects on PLP.
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Affiliation(s)
- E.H. Beisheim
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
| | - R.T. Pohlig
- University of Delaware Biostatistics Core, 102B STAR Tower, Newark, DE, 19713, USA
| | - J. Medina
- University of Delaware Department of Psychological and Brain Sciences, 105 The Green, Room 108, Newark, DE, 19716, USA
| | - G.E. Hicks
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
| | - J.M. Sions
- University of Delaware Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA
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Gomes MB, Tang F, Chen H, Cid-Ruzafa J, Fenici P, Khunti K, Rathmann W, Shestakova MV, Surmont F, Watada H, Medina J, Shimomura I, Saraiva GL, Cooper A, Nicolucci A. Socioeconomic Factors Associated With Glycemic Measurement and Poor HbA1c Control in People With Type 2 Diabetes: The Global DISCOVER Study. Front Endocrinol (Lausanne) 2022; 13:831676. [PMID: 35527995 PMCID: PMC9072655 DOI: 10.3389/fendo.2022.831676] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
DISCOVER is a 3-year observational study program of 15,983 people with type 2 diabetes initiating second-line glucose-lowering therapy in 38 countries. We investigated the association between socioeconomic status and both the availability of a baseline glycated hemoglobin (HbA1c) measurement and poor glycemic control (HbA1c level ≥ 9.0%) in participants enrolled in DISCOVER. Factors associated with a lack of baseline HbA1c measurement or an HbA1c level ≥ 9.0% were assessed using three-level hierarchical logistic models. Overall, 19.1% of participants did not have a baseline HbA1c measurement recorded. Lower-middle country income (vs. high) and primary/no formal education (vs. university education) were independently associated with a reduced likelihood of having a baseline HbA1c measurement (odds ratio [95% confidence interval]: 0.11 [0.03-0.49] and 0.81 [0.66-0.98], respectively. Of the participants with an available HbA1c measurement, 26.9% had an HbA1c level ≥ 9.0%; 68.7% of these individuals were from lower- or upper-middle-income countries. Factors associated with an increased likelihood of poor glycemic control included low country income, treatment at a site with public and/or governmental funding (vs. private funding) and having public or no health insurance (vs. private). A substantial proportion of DISCOVER participants did not have an HbA1c measurement; more than one-quarter of these participants had poorly controlled type 2 diabetes. Both individual- and country-level socioeconomic factors are associated with the quality of care regarding glycemic control. Awareness of these factors could help improve the management of patients with type 2 diabetes.
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Affiliation(s)
- Marília B. Gomes
- Department of Medicine, Diabetes Unit, Rio de Janeiro State University, Rio de Janeiro, Brazil
- *Correspondence: Marília B. Gomes,
| | - Fengming Tang
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, United States
| | - Hungta Chen
- Medical/Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
| | | | - Peter Fenici
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Kamlesh Khunti
- Primary Care Diabetes and Vascular Medicine, University of Leicester, Leicester, United Kingdom
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Düsseldorf, Germany
| | | | - Filip Surmont
- BioPharmaceuticals Medical, AstraZeneca, Luton, United Kingdom
| | - Hirotaka Watada
- Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Jesús Medina
- BioPharmaceuticals Medical, AstraZeneca, Madrid, Spain
| | | | - Gabriela Luporini Saraiva
- Medical/Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
| | - Andrew Cooper
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Antonio Nicolucci
- Centre for Outcomes Research and Clinical Epidemiology, Pescara, Italy
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22
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Ruiz-Cabello Subiela J, Martinez-Sepulveda T, Medina J, Varona JF, Zorita B, Fuertes B, Pastor A, Osende J, Palomo J, Castellano JM, Parra Jimenez FJ, Fernandez-Friera L, Lopez-Melgar B. Usefulness of carotid and femoral plaque burden quantification by 3-dimensional vascular ultrasound for cardiovascular risk assessment in the cardiovascular disease prevention unit. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Subclinical atherosclerosis improves cardiovascular risk assessment and is considered a risk modifier in individuals at borderline-to-intermediate estimated risk by clinical risk scores.
Purpose
We seek to propose a new decision algorithm for statin allocation based on the quantification of carotid and/or femoral atherosclerosis burden by novel 3-dimensional vascular ultrasound (3DVUS) and to explore its potential additive value when used in combination with conventional risk evaluation.
Methods
We conducted an observational study in all outpatients without previous history of cardiovascular events assessed in the Cardiovascular Disease Prevention Unit during 2017–2020. Cardiovascular risk was assessed with the ACC/AHA 10-year atherosclerotic cardiovascular disease (ASCVD) risk algorithm to establish the indication for initiating statin therapy following current clinical guidelines. All patients underwent 3DVUS evaluation for carotid plaque burden (CPB) calculated as the sum of all plaque volumes present in bilateral carotid arteries. Femoral 3DVUS evaluation was included later in the study protocol. Global plaque burden (GPB) was calculated in patients with both carotid and femoral 3DVUS as the sum of all plaque volumes present in bilateral carotid and femoral arteries. Carotid and global plaque burden was classified as high, moderate and low if a patient presented a percentile (p) >75, p50–75 and p<50, respectively, based on the age and sex-adjusted reference values reported by PESA study (1). We determined the percentage of patients reclassified for considering (p>75) or discouraging (p<50) statin therapy over clinical recommendation.
Results
One hundred sixty-three patients (age 51±8 years; 72,4% men; 10y-ASCVD 5,9%±4,8%) were included, being the most frequent reason for referral the presence of metabolic syndrome (37%), followed by intermediate or indeterminate estimated CV risk (33%), one markedly elevated single risk factor (15%) and family history of early CVD (13%). 10y-ASCVD score classified 80 (49%) patients as low-risk without recommendation for initiating statins, 18 (11%) as high-risk indicating statin therapy and 65 (40%) patients that needed clinical-patient risk discussion. Among patients under risk discussion, the CPB percentile re-stratified 51 (78%) of them, recommending statins in 26 (40%) and discouraging statins in 25 (38%). In addition, CPB re-stratified 24 (30%) low-risk patients to recommend statins. A sub-group of 114 patients additionally underwent femoral 3DVUS, and calculated GPB led to similar results of patient re-stratification (Figure).
Conclusions
Quantification of 3D atherosclerosis burden and its percentile would re-stratify a significant number of patients with intermediate risk, becoming a potentially useful tool for clinical decision making. In addition, it possibly improves the detection of low-risk patients who would benefit from statin therapy.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dr. Lόpez-Melgar has received a grant from the Spanish Society of Cardiology “Proyecto de investigaciόn traslacional en Cardiología 2020” Patient re-stratification with CPB/GPB
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Affiliation(s)
| | | | - J Medina
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J F Varona
- University Hospital HM Montepríncipe, Internal Medicine Department, Boadilla del Monte, Spain
| | - B Zorita
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - B Fuertes
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - A Pastor
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J Osende
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J Palomo
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J M Castellano
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - F J Parra Jimenez
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - L Fernandez-Friera
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiovascular Imaging Unit, Madrid, Spain
| | - B Lopez-Melgar
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
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23
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Manzano J, Martín-Liberal J, Fernandez-Morales L, Benítez G, Medina J, Quindós M, García-Castaño A, Fernández O, Vilchez Simo R, Majem M, Bellido Hernández L, Ayala de Miguel P, Campos B, Espinosa E, Macías Cerrolaza J, Gil-Arnaiz I, Lorente D, Martínez-Fernández A, Martín-Sánchez E, Cerezuela-Fuentes P. 1088P Adjuvant dabrafenib plus trametinib (DT) treatment completion in patients with resected melanoma in Spain: A retrospective observational study (GEM 1901 - DESCRIBE-AD). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1473] [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: 10/20/2022] Open
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Jiménez I, Medina J, Marcos-García A, Garcés GL. Out-of-sheath corticosteroid injections through the dorsal webspace for trigger finger and trigger thumb. A prospective cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:260-266. [PMID: 34366261 DOI: 10.1016/j.recot.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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Steroid injections are effective in the treatment of trigger digits but the pain during the injection is an always-present accompanying effect. The aim of this study was to assess the effectiveness and perceived pain during an out-of-sheath corticosteroid injection through the dorsal webspace in the treatment of trigger digits. MATERIAL AND METHOD A total of 126 consecutive patients were included. A subcutaneous (out-of-sheath) corticosteroid injection was performed through the dorsal webspace in all digits. In cases where signs or symptoms persisted, a second injection was offered. Visual analog scale for pain during the injection, DASH questionnaire, success rate and complications were collected. RESULTS There were 86 women and 40 men with a mean age of 61 years. The mean visual analog scale for pain during the injection was 3.8. Twelve patients were lost to follow-up. The overall success was 68% and success after a single injection was 54%. The best result was achieved on the ring finger. Patients who were not previously operated on carpal tunnel syndrome responded better. No complications were noted. CONCLUSIONS The extra-sheath corticosteroid injection through the dorsal webspace is effective and safe. It seems to be less painful than the reported scores for the palmar midline technique although it should be assessed in a comparative study.
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Affiliation(s)
- I Jiménez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España; Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
| | - J Medina
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España; Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - A Marcos-García
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España; Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | - G L Garcés
- Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Perpetuo Socorro, Las Palmas de Gran Canaria, Las Palmas, España
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25
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Ji L, Bonnet F, Chen H, Cooper A, Hammar N, Leigh P, Luporini Saraiva G, Ramirez L, Medina J, Nicolucci A, Rathmann W, Shestakova MV, Surmont F, Tang F, Watada H. Early versus late intensification of glucose-lowering therapy in patients with type 2 diabetes: Results from the DISCOVER study. Diabetes Res Clin Pract 2021; 178:108947. [PMID: 34252505 DOI: 10.1016/j.diabres.2021.108947] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022]
Abstract
AIMS To assess the effects of glycated haemoglobin (HbA1c) levels at time of glucose-lowering treatment intensification in DISCOVER, a global observational study of patients with type 2 diabetes (T2D) initiating second-line therapy. Outcomes of interest were glycaemic control, hypoglycaemia, and need for further intensification during 3 years of follow-up. METHODS We included patients who intensified treatment (add-on or insulin initiation) upon initiation of second-line therapy (baseline). Outcomes were assessed according to baseline HbA1c: HbA1c ≤ 7·5% (early intensification) or HbA1c > 7·5% (late intensification). Factors associated with early or late intensification were assessed using multivariate logistic regression. RESULTS Of the 9575 patients included, 3275 (34·2%) intensified treatment early and 6300 (65·8%) intensified treatment late. During follow-up, mean (SD) HbA1c was lower in the early- than in the late-intensification group (6·9% [0·95%] vs 7·5% [1·28%] at 36 months). More patients had HbA1c < 7·0% in the early- than in the late-intensification group (61·8% vs 37·9% at 36 months; p < 0·001). The risk of further intensification was higher in the late-intensification group (hazard ratio 1·88 [95% confidence interval 1·68-2·09]). Occurrence of hypoglycaemia was similar in both groups. CONCLUSIONS Late intensification of glucose-lowering therapy after first-line treatment failure reduces the likelihood of reaching recommended treatment goals.
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Affiliation(s)
- Linong Ji
- Peking University People's Hospital, Beijing, China.
| | | | | | | | - Niklas Hammar
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; AstraZeneca Gothenburg, Mölndal, Sweden
| | | | | | | | | | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Marina V Shestakova
- Endocrinology Research Center, Diabetes Institute, Moscow, Russian Federation
| | | | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
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26
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Khunti K, Charbonnel B, Chen H, Cherney DZ, Cooper A, Fenici P, Gomes MB, Hammar N, Heerspink HJL, Ji L, Medina J, Nicolucci A, Ramirez L, Rathmann W, Shestakova MV, Shimomura I, Tang F, Watada H, Kosiborod M. Prevalence and progression of chronic kidney disease among patients with type 2 diabetes: Insights from the DISCOVER study. Diabetes Obes Metab 2021; 23:1956-1960. [PMID: 33852196 DOI: 10.1111/dom.14401] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/21/2023]
Abstract
We report the prevalence and change in severity of chronic kidney disease (CKD) in DISCOVER, a global, 3-year, prospective, observational study of patients with type 2 diabetes (T2D) initiating second-line glucose-lowering therapy. CKD stages were defined according to estimated glomerular filtration rate (eGFR). Overall, 7843 patients from 35 countries had a baseline serum creatinine measurement. Of these (56.7% male; mean age: 58.1 years; mean eGFR: 87.5 mL/min/1.73 m2 ), baseline prevalence estimates for stage 0-1, 2, 3 and 4-5 CKD were 51.4%, 37.7%, 9.4% and 1.4%, respectively. A total of 5819 patients (74.2%) also had at least one follow-up serum creatinine measurement (median time between measurements: 2.9 years, interquartile range: 1.9-3.0 years). Mean eGFR decreased slightly to 85.7 mL/min/1.73 m2 over follow-up. CKD progression (increase of ≥1 stage) occurred in 15.7% of patients, and regression (decrease of ≥1 stage) in 12.0%. In summary, a substantial proportion of patients with T2D developed CKD or had CKD progression after the initiation of second-line therapy. Renal function should be regularly monitored in these patients, to ensure early CKD diagnosis and treatment.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | | | - David Z Cherney
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Marilia B Gomes
- Department of Internal Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Niklas Hammar
- AstraZeneca Gothenburg, Mölndal, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hiddo J L Heerspink
- University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | | | - Antonio Nicolucci
- Department of Metabolic Medicine, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Wolfgang Rathmann
- German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Marina V Shestakova
- Endocrinology Research Centre, Diabetes Institute, Moscow, Russian Federation
| | | | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Hirotaka Watada
- Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri, Kansas City, Missouri, USA
- The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia
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27
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Huo Y, Van de Werf F, Han Y, Rossello X, Pocock SJ, Chin CT, Lee SWL, Li Y, Jiang J, Vega AM, Medina J, Bueno H. Long-Term Antithrombotic Therapy and Clinical Outcomes in Patients with Acute Coronary Syndrome and Renal Impairment: Insights from EPICOR and EPICOR Asia. Am J Cardiovasc Drugs 2021; 21:471-482. [PMID: 33537947 PMCID: PMC8263456 DOI: 10.1007/s40256-020-00447-5] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information is lacking on long-term management of patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2). OBJECTIVES Our objectives were to describe antithrombotic management patterns and outcomes in patients with ACS with varying renal function from the EPICOR (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients; NCT01171404) and EPICOR Asia (NCT01361386) studies. METHODS EPICOR and EPICOR Asia were prospective observational studies of patients who survived hospitalization for ACS and were enrolled at discharge in 28 countries across Europe, Latin America, and Asia. The studies were conducted from 2010 to 2013 and from 2011 to 2014, respectively. This analysis evaluated patient characteristics and oral antithrombotic management patterns and outcomes up to 2 years post-discharge according to admission eGFR: ≥ 90, 60-89, 30-59, or < 30 mL/min/1.73 m2. RESULTS Among 22,380 patients with available data, eGFR < 60 mL/min/1.73 m2 was observed in 16.7%. Patients with poorer renal function were older, were at greater cardiovascular risk, and had more prior cardiovascular disease and bleeding. Patients with CKD underwent fewer cardiovascular interventions and had more in-hospital cardiovascular and bleeding events. Dual antiplatelet therapy was less likely at discharge in patients with eGFR < 30 (82.3%) than in those with ≥ 90 (91.3%) mL/min/1.73 m2 and declined more sharply during follow-up in patients with low eGFR (p < 0.0001). An adjusted proportional hazards model showed that patients with lower eGFR levels had a higher risk of cardiovascular events and bleeding. CONCLUSIONS The presence of CKD in patients with ACS was associated with less aggressive cardiovascular management and an increased risk of cardiovascular events.
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Affiliation(s)
- Yong Huo
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St., Xicheng District, Beijing, 100034, China.
| | | | - Yaling Han
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Yi Li
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St., Xicheng District, Beijing, 100034, China
| | | | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Instituto de investigación i+12 and Cardiology Department, Hospital Universitario, 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Veneranda M, Lopez-Reyes G, Manrique-Martinez JA, Sanz-Arranz A, Medina J, Pérez C, Quintana C, Moral A, Rodríguez JA, Zafra J, Nieto Calzada L, Rull F. Raman spectroscopy and planetary exploration: Testing the ExoMars/RLS system at the Tabernas Desert (Spain). Microchem J 2021. [DOI: 10.1016/j.microc.2021.106149] [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: 10/21/2022]
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29
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Bongaerts B, Arnold SV, Charbonnel BH, Chen H, Cooper A, Fenici P, Gomes M, Ji L, Khunti K, Kosiborod M, Medina J, Nicolucci A, Shestakova M, Shimomura I, Tang F, Watada H, Rathmann W. Inappropriate intensification of glucose-lowering treatment in older patients with type 2 diabetes: the global DISCOVER study. BMJ Open Diabetes Res Care 2021; 9:9/1/e001585. [PMID: 33941550 PMCID: PMC8098925 DOI: 10.1136/bmjdrc-2020-001585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Although individualized target glycated hemoglobin (HbA1c) levels are recommended in older people with type 2 diabetes, studies report high levels of potential overtreatment. We aimed to investigate the proportion of older patients (aged ≥65 years) who potentially received an inappropriately intensive treatment (HbA1c level <7.0% (53.0 mmol/mol)) in a global study. Factors associated with intensive glycemic management and using glucose-lowering medications associated with a high risk of hypoglycemia (high-risk medications (insulin, sulfonylureas, and meglitinides)) were also assessed. RESEARCH DESIGN AND METHODS DISCOVER is a 3-year observational study program of 15 992 people with type 2 diabetes initiating second-line glucose-lowering therapy in 38 countries. Data were collected at baseline (initiation of second-line therapy) and at 6, 12, and 24 months. Factors associated with an inappropriately intensive treatment or using high-risk medications were assessed using a hierarchical regression model. RESULTS Of the 3344 older patients with baseline HbA1c data in our analytic cohort, 23.5% received inappropriate treatment intensification. Among those who had follow-up HbA1c data, 55.2%, 54.2%, and 53.5% were inappropriately tightly controlled at 6, 12, and 24 months, respectively, with higher proportions in high-income than in middle-income countries. The proportion of patients receiving high-risk medications was higher in middle-income countries than in high-income countries. Gross national income (per US$5000 increment) was associated with increased odds of inappropriately intensive treatment but with decreased odds of receiving high-risk medications. CONCLUSIONS A large proportion of older DISCOVER patients received an inappropriately intensive glucose-lowering treatment across the 2 years of follow-up, with substantial regional variation. The use of high-risk medications in these patients is particularly concerning.
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Affiliation(s)
- Brenda Bongaerts
- Institute for Biometrics and Epidemiology, German Diabetes Center Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | | | | | | | | | - Marilia Gomes
- Internal Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | | | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Iichiro Shimomura
- Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Hirotaka Watada
- Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Dusseldorf, Germany
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30
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Jauhari Y, Gannon MR, Dodwell D, Horgan K, Clements K, Medina J, Cromwell DA. Surgical decisions in older women with early breast cancer: patient and disease factors. Br J Surg 2021; 108:160-167. [PMID: 33711149 PMCID: PMC7954278 DOI: 10.1093/bjs/znaa042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/20/2020] [Revised: 06/27/2020] [Accepted: 09/19/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Studies reporting lower rates of surgery for older women with early invasive breast cancer have focused on women with oestrogen receptor (ER)-positive tumours. This study examined the factors that influence receipt of breast surgery in older women with ER-positive and ER-negative early invasive breast cancer . METHODS Women aged 50 years or above with unilateral stage 1-3A early invasive breast cancer diagnosed in 2014-2017 were identified from linked English and Welsh cancer registration and routine hospital data sets. Logistic regression analysis was used to evaluate the influence of tumour and patient factors on receipt of surgery. RESULTS Among 83 188 women, 86.8 per cent had ER-positive and 13.2 per cent had ER-negative early invasive breast cancer. These proportions were unaffected by age at diagnosis. Compared with women with ER-negative breast cancer, a higher proportion of women with ER-positive breast cancer presented with low risk tumour characteristics: G1 (20.0 versus 1.5 per cent), T1 (60.8 versus 44.2 per cent) and N0 (73.9 versus 68.8 per cent). The proportions of women with any recorded co-morbidity (13.7 versus 14.3 per cent) or degree of frailty (25 versus 25.8 per cent) were similar among women with ER-positive and ER-negative disease respectively. In women with ER-positive early invasive breast cancer aged 70-74, 75-79 and 80 years or above, the rate of no surgery was 5.6, 11.0 and 41.9 per cent respectively. Among women with ER-negative early invasive breast cancer, the corresponding rates were 3.8, 3.7 and 12.3 per cent. The relatively lower rate of surgery for ER-positive breast cancer persisted in women with good fitness. CONCLUSION The reasons for the observer differences should be further explored to ensure consistency in treatment decisions.
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Affiliation(s)
- Y Jauhari
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - M R Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - K Horgan
- Department of Breast Surgery, St James’s University Hospital, Leeds, UK
| | - K Clements
- National Disease Registration Service, Public Health England, Birmingham, UK
| | - J Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Veneranda M, Lopez-Reyes G, Pascual Sanchez E, Krzesińska AM, Manrique-Martinez JA, Sanz-Arranz A, Lantz C, Lalla E, Moral A, Medina J, Poulet F, Dypvik H, Werner SC, Vago JL, Rull F. ExoMars Raman Laser Spectrometer: A Tool to Semiquantify the Serpentinization Degree of Olivine-Rich Rocks on Mars. Astrobiology 2021; 21:307-322. [PMID: 33252242 DOI: 10.1089/ast.2020.2265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We evaluated the effectiveness of the ExoMars Raman laser spectrometer (RLS) to determine the degree of serpentinization of olivine-rich units on Mars. We selected terrestrial analogs of martian ultramafic rocks from the Leka Ophiolite Complex (LOC) and analyzed them with both laboratory and flight-like analytical instruments. We first studied the mineralogical composition of the samples (mostly olivine and serpentine) with state-of-the-art diffractometric (X-ray diffractometry [XRD]) and spectroscopic (Raman, near-infrared spectroscopy [NIR]) laboratory systems. We compared these results with those obtained using our RLS ExoMars Simulator. Our work shows that the RLS ExoMars Simulator successfully identified all major phases. Moreover, when emulating the automatic operating mode of the flight instrument, the RLS ExoMars Simulator also detected several minor compounds (pyroxene and brucite), some of which were not observed by NIR and XRD (e.g., calcite). Thereafter, we produced RLS-dedicated calibration curves (R2 between 0.9993 and 0.9995 with an uncertainty between ±3.0% and ±5.2% with a confidence interval of 95%) to estimate the relative content of olivine and serpentine in the samples. Our results show that RLS can be very effective in identifying serpentine, a scientific target of primary importance for the potential detection of biosignatures on Mars-the main objective of the ExoMars rover mission.
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Affiliation(s)
- Marco Veneranda
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Valladolid, Spain
| | - Guillermo Lopez-Reyes
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Valladolid, Spain
| | - Elena Pascual Sanchez
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Valladolid, Spain
| | - Agata M Krzesińska
- Department of Geosciences, Centre for Earth Evolution and Dynamics, University of Oslo, Oslo, Norway
| | | | - Aurelio Sanz-Arranz
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Valladolid, Spain
| | - Cateline Lantz
- Institut d'Astrophysique Spatiale, CNRS/Université Paris-Sud, Orsay, France
| | - Emmanuel Lalla
- Department of Earth and Space Science and Engineering, York University, Toronto, Canada
| | - Andoni Moral
- Department of Space Programs, Instituto Nacional de Técnica Aeroespacial (INTA), Madrid, Spain
| | - Jesús Medina
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Valladolid, Spain
| | - Francois Poulet
- Institut d'Astrophysique Spatiale, CNRS/Université Paris-Sud, Orsay, France
| | - Henning Dypvik
- Department of Geosciences, Centre for Earth Evolution and Dynamics, University of Oslo, Oslo, Norway
| | - Stephanie C Werner
- Department of Geosciences, Centre for Earth Evolution and Dynamics, University of Oslo, Oslo, Norway
| | | | - Fernando Rull
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Valladolid, Spain
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Arnold SV, Khunti K, Bonnet F, Charbonnel B, Chen H, Cid-Ruzafa J, Cooper A, Fenici P, Gomes MB, Hammar N, Ji L, Luporini-Saraiva G, Medina J, Nicolucci A, Ramirez L, Shestakova MV, Shimomura I, Surmont F, Tang F, Vora J, Watada H, Kosiborod M. Type 2 diabetes and heart failure: insights from the global DISCOVER study. ESC Heart Fail 2021; 8:1711-1716. [PMID: 33570253 PMCID: PMC8006680 DOI: 10.1002/ehf2.13235] [Citation(s) in RCA: 6] [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: 07/17/2020] [Revised: 12/04/2020] [Accepted: 01/19/2021] [Indexed: 01/18/2023] Open
Abstract
Aims Heart failure (HF) is increasingly recognized as a major cause of morbidity and mortality in patients with type 2 diabetes (T2D), but the global epidemiology and treatment of HF in T2D are not well defined. This study aimed to examine the global prevalence of HF and the incidence of HF over 3 years of follow‐up in patients with T2D [by presence and absence of co‐existing coronary artery disease (CAD)]. Methods and results DISCOVER was a 3 year, prospective, observational study of T2D patients enrolled at initiation of second‐line glucose‐lowering therapy. Among 14 057 patients with T2D from 36 countries, 289 (2.1%) had a diagnosis of HF at enrolment; median prevalence across countries was 2.0% (inter‐quartile range 1.0–3.1%). Patients with HF at baseline were more likely to be older [HF vs. no HF: 67 ± 12 vs. 57 ± 12 years, standardized difference (StDiff) = 84%] and have longer duration of T2D (8.1 ± 7.2 vs. 5.6 ± 5.2 years, StDiff = 40%), CAD (44% vs. 6%, StDiff = 97%), atrial fibrillation (21% vs. 1%, StDiff = 66%), and kidney disease (23% vs. 4%, StDiff = 55%). Patients with HF were less likely to be on metformin (66% vs. 79%, StDiff = 28%) and thiazolidinediones (5.5% vs. 10.6%, StDiff = 19%) but had similar use of other glucose‐lowering medications. Among 9313 patients with follow‐up data, there were 70 incident cases of HF, which translates to an incidence of 2.6 cases per 1000 person years. Of these incident HF cases, 60% occurred in the absence of pre‐existing or concomitant CAD, and 73% were diagnosed in the outpatient setting. Conclusions In a large, global cohort of patients with T2D, the majority of incident cases of HF occurred in outpatients and in the absence of known CAD. These findings highlight the need for greater awareness of HF risk in patients with T2D.
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Affiliation(s)
- Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO, 64111, USA.,University of Missouri, Kansas City, MO, USA
| | | | | | | | | | | | | | | | | | - Niklas Hammar
- AstraZeneca Gothenburg, Mölndal, Sweden.,Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Linong Ji
- Peking University People's Hospital, Beijing, China
| | | | | | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Marina V Shestakova
- Endocrinology Research Centre, Diabetes Institute, Moscow, Russian Federation
| | | | | | - Fengming Tang
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO, 64111, USA
| | - Jiten Vora
- Royal Liverpool University Hospital, Liverpool, UK
| | - Hirotaka Watada
- Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO, 64111, USA.,University of Missouri, Kansas City, MO, USA
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Veneranda M, Lopez-Reyes G, Saiz J, Manrique-Martinez JA, Sanz-Arranz A, Medina J, Moral A, Seoane L, Ibarmia S, Rull F. ExoFiT trial at the Atacama Desert (Chile): Raman detection of biomarkers by representative prototypes of the ExoMars/Raman Laser Spectrometer. Sci Rep 2021; 11:1461. [PMID: 33446849 PMCID: PMC7809400 DOI: 10.1038/s41598-021-81014-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/30/2020] [Indexed: 11/22/2022] Open
Abstract
In this work, the analytical research performed by the Raman Laser Spectrometer (RLS) team during the ExoFiT trial is presented. During this test, an emulator of the Rosalind Franklin rover was remotely operated at the Atacama Desert in a Mars-like sequence of scientific operations that ended with the collection and the analysis of two drilled cores. The in-situ Raman characterization of the samples was performed through a portable technology demonstrator of RLS (RAD1 system). The results were later complemented in the laboratory using a bench top RLS operation simulator and a X-Ray diffractometer (XRD). By simulating the operational and analytical constraints of the ExoMars mission, the two RLS representative instruments effectively disclosed the mineralogical composition of the drilled cores (k-feldspar, plagioclase, quartz, muscovite and rutile as main components), reaching the detection of minor phases (e.g., additional phyllosilicate and calcite) whose concentration was below the detection limit of XRD. Furthermore, Raman systems detected many organic functional groups (–C≡N, –NH2 and C–(NO2)), suggesting the presence of nitrogen-fixing microorganisms in the samples. The Raman detection of organic material in the subsurface of a Martian analogue site presenting representative environmental conditions (high UV radiation, extreme aridity), supports the idea that the RLS could play a key role in the fulfilment of the ExoMars main mission objective: to search for signs of life on Mars.
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Affiliation(s)
- Marco Veneranda
- Department of Condensed Matter Physics, Crystallography and Mineralogy, Univ. of Valladolid, Spain, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain.
| | - Guillermo Lopez-Reyes
- Department of Condensed Matter Physics, Crystallography and Mineralogy, Univ. of Valladolid, Spain, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
| | - Jesus Saiz
- Department of Condensed Matter Physics, Crystallography and Mineralogy, Univ. of Valladolid, Spain, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
| | - Jose Antonio Manrique-Martinez
- Department of Condensed Matter Physics, Crystallography and Mineralogy, Univ. of Valladolid, Spain, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
| | - Aurelio Sanz-Arranz
- Department of Condensed Matter Physics, Crystallography and Mineralogy, Univ. of Valladolid, Spain, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
| | - Jesús Medina
- Department of Condensed Matter Physics, Crystallography and Mineralogy, Univ. of Valladolid, Spain, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
| | - Andoni Moral
- National Institute for Aerospace Technology (INTA), Torrejón de Ardoz, Spain
| | - Laura Seoane
- National Institute for Aerospace Technology (INTA), Torrejón de Ardoz, Spain
| | - Sergio Ibarmia
- National Institute for Aerospace Technology (INTA), Torrejón de Ardoz, Spain
| | - Fernando Rull
- Department of Condensed Matter Physics, Crystallography and Mineralogy, Univ. of Valladolid, Spain, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
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Martín-Asenjo R, Gregson J, Rossello X, Van de Werf F, Medina J, Danchin N, Pocock S, Bueno H. Number of Antithrombotic Drugs Used Early and In-hospital Outcomes in Acute Coronary Syndromes. J Cardiovasc Transl Res 2021; 14:790-798. [PMID: 33420682 DOI: 10.1007/s12265-020-10094-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
Antithrombotic drug use for acute coronary syndromes (ACS) varies considerably. The number of antithrombotic drugs (excluding oral anticoagulants) used pre- and in-hospital was recorded in ACS survivors enrolled at hospital discharge in the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry ( NCT01171404 ), a prospective cohort study. Among 10,568 patients, the number of antithrombotic drugs used early/patient ranged from 0 to 8 (interquartile range = 3-4). Overall, 250 patients (2.4%) experienced ≥ 1 in-hospital ischemic event and 343 (3.2%) ≥ 1 non-fatal bleeding event. While there was no difference in the rate of ischemic events (p = 0.75 for-trend) according to the number of antithrombotic drugs, a significantly higher incidence of non-fatal bleeds was observed (p < 0.0001 for-trend), with OR = 1.68 (95%CI = 1.51-1.88) per additional antithrombotic drug, which remained after adjustment by patient characteristics. In conclusion, careful balancing of the short-term risks for ischemic and bleeding events should be considered when adding new antithrombotic drugs.
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Affiliation(s)
- Roberto Martín-Asenjo
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Xavier Rossello
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jesús Medina
- Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, Paris, France
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain
| | - Héctor Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain.
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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Medina J, Moreno-García J, Ramírez-Poussa E, Kóczy LT. Mathematics and Computational Intelligence Synergies for Emerging Challenges. INT J COMPUT INT SYS 2021. [DOI: 10.2991/ijcis.d.210121.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Rossello X, Medina J, Pocock S, Van de Werf F, Chin CT, Danchin N, Lee SWL, Huo Y, Bueno H. Assessment of quality indicators for acute myocardial infarction management in 28 countries and use of composite quality indicators for benchmarking. European Heart Journal. Acute Cardiovascular Care 2020; 9:911-922. [DOI: 10.1177/2048872620911853] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background:
The European Society of Cardiology established a set of quality indicators for the management of acute myocardial infarction. Our aim was to evaluate their degree of attainment, prognostic value and potential use for centre benchmarking in a large international cohort.
Methods:
Quality indicators were extracted from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) (555 hospitals, 20 countries in Europe and Latin America, 2010–2011) and EPICOR Asia (218 hospitals, eight countries, 2011–2012) registries, including non-ST-segment elevation acute myocardial infarction (n=6558) and ST-segment elevation acute myocardial infarction (n=11,559) hospital survivors. The association between implementation rates for each quality indicator and two-year adjusted mortality was evaluated using adjusted Cox models. Composite quality indicators were categorized for benchmarking assessment at different levels.
Results:
The degree of attainment of the 17 evaluated quality indicators ranged from 13% to 100%. Attainment of most individual quality indicators was associated with two-year survival. A higher compliance with composite quality indicators was associated with lower mortality at centre-, country- and region-level. Moreover, the higher the risk for two-year mortality, the lower the compliance with composite quality indicators.
Conclusions:
When EPICOR and EPICOR Asia were conducted, the European Society of Cardiology quality indicators would have been attained to a limited extent, suggesting wide room for improvement in the management of acute myocardial infarction patients. After adjustment for confounding, most quality indicators were associated with reduced two-year mortality and their prognostic value should receive further attention. The two composite quality indicators can be used as a tool for benchmarking either at centre-, country- or world region-level.
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Affiliation(s)
- Xavier Rossello
- Department of Cardiology, Hospital Universitari Son Espases (HUSE), Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain
| | | | - Stuart Pocock
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
- London School of Hygiene and Tropical Medicine, UK
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, France
| | | | - Yong Huo
- Beijing University First Hospital, China
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
- Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
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Veneranda M, Lopez-Reyes G, Manrique-Martinez JA, Sanz-Arranz A, Lalla E, Konstantinidis M, Moral A, Medina J, Rull F. ExoMars Raman Laser Spectrometer (RLS): development of chemometric tools to classify ultramafic igneous rocks on Mars. Sci Rep 2020; 10:16954. [PMID: 33046782 PMCID: PMC7550563 DOI: 10.1038/s41598-020-73846-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/18/2020] [Indexed: 11/20/2022] Open
Abstract
This work aims to evaluate whether the multi-point analysis the ExoMars Raman Laser Spectrometer (RLS) will perform on powdered samples could serve to classify ultramafic rocks on Mars. To do so, the RLS ExoMars Simulator was used to study terrestrial analogues of Martian peridotites and pyroxenites by applying the operational constraints of the Raman spectrometer onboard the Rosalind Franklin rover. Besides qualitative analysis, RLS-dedicated calibration curves have been built to estimate the relative content of olivine and pyroxenes in the samples. These semi-quantitative results, combined with a rough estimate of the concentration ratio between clino- and ortho-pyroxene mineral phases, were used to classify the terrestrial analogues. XRD data were finally employed as reference to validate Raman results. As this preliminary work suggests, ultramafic rocks on Mars could be effectively classified through the chemometric analysis of RLS data sets. After optimization, the proposed chemometric tools could be applied to the study of the volcanic geological areas detected at the ExoMars landing site (Oxia Planum), whose mineralogical composition and geological evolution have not been fully understood.
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Affiliation(s)
- Marco Veneranda
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain.
| | - Guillermo Lopez-Reyes
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
| | - Jose Antonio Manrique-Martinez
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
| | - Aurelio Sanz-Arranz
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
| | - Emmanuel Lalla
- Centre for Research in Earth and Space Science, York University, Toronto, Canada
| | | | - Andoni Moral
- Department of Space Programs, National Institute of Aerospace Technology (INTA), Madrid, Spain
| | - Jesús Medina
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
| | - Fernando Rull
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, 47151, Boecillo, Spain
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Ortez C, Carrera L, Exposito J, Natera D, Zambudio S, Colomer J, Bazán A, Pareja A, Bobadilla E, Sáez V, Medina J, Jou C, Codina A, Corbera J, Yubero D, Martorell L, Jimenez-Mallebrera C, Nascimento A. AUTOPHAGIC MYOPATHIES / MYOFIBRILLAR MYOPATHIES / DISTAL MYOPATHIES / POMPE DISEASE. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.014] [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]
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Miller K, Gannon M, Medina J, Clements K, Dodwell D, Horgan K, Cromwell D. Surgery of the primary tumour in women with metastatic breast cancer at diagnosis in England and Wales – how do treatment rates vary at an individual and regional level? Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30850-9] [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: 12/01/2022]
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Jiménez I, Garcés G, Caballero-Martel J, Medina J. Dorsal web injection technique in the treatment of trigger finger and trigger thumb. Anatomical study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Medina J, Aramburu F, González Montagut C, Sánchez D, Loza E. OP0122 SUBCLINICAL ATHEROSCLEROSIS OF FEMORAL ARTERIES IN RHEUMATOID ARTHRITIS. AN ULTRASOUND STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Cardiovascular morbidity and mortality is increased in patients with rheumatoid arthritis (RA). This cannot be entirely explained by traditional risk factors. Inflammation and autoimmunity may play a role in the cardiovascular risk excess. Subclinical atherosclerosis is associated with a risk comparable to established coronary heart disease. In RA it has been investigated by carotid artery ultrasound and carotid atherosclerotic plaques are more prevalent in RA patients than controls. EULAR recommendations for cardiovascular disease risk management consider that carotid ultrasound may be part of the risk evaluation in patients with RA. Recent studies in general population have shown that plaques in femoral arteries are more common and are associated with higher cardiovascular risk.Objectives:To study the usefulness of femoral artery ultrasound for the detection of subclinical atherosclerosis and its ability to improve cardiovascular risk assessment in RA patients.Methods:Cross-sectional observational study of prevalence in 140 RA patients aged 40 to 65 years. Subclinical atherosclerosis was evaluated by carotid and femoral artery ultrasound.Results:Atherosclerotic plaques were found in 86.4% of RA patients (60.7% in carotid arteries and 78.6% in femoral arteries). Patients with plaques were older and more frequently past or present tobacco users. Femoral plaques were larger and more numerous than the carotid plaques and people with plaques in both locations had more extensive subclinical atherosclerotic disease (table). Only 7.9% of RA patients were considered as having very high cardiovascular risk by clinical factors, after carotid ultrasound this increased to 57.1% and after femoral ultrasound to 86.4%.Conclusion:Ultrasound examinations of the femoral artery in addition to the carotid artery increased the detection of subclinical atherosclerosis and determine a group of patients with higher intensity of atherosclerotic disease. Examinations of both arteries allowed a greater number of RA patients previously considered to have low to moderate cardiovascular risk to be classified as very high cardiovascular risk.References:[1]Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJL, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017 Jan;76(1):17–28.[2]Ambrosino P, Lupoli R, Di Minno A, Tasso M, Peluso R, Di Minno MND. Subclinical atherosclerosis in patients with rheumatoid arthritis. A meta-analysis of literature studies. Thromb Haemost. 2015 May;113(5):916–30.[3]Laclaustra M, Casasnovas JA, Fernández-Ortiz A, Fuster V, León-Latre M, Jiménez-Borreguero LJ, et al. Femoral and Carotid Subclinical Atherosclerosis Association With Risk Factors and Coronary Calcium: The AWHS Study. J Am Coll Cardiol. 2016 Mar 22;67(11):1263–74.TableOnly carotid plaquesn= 11Only femoral plaquesn= 36Femoral and carotid plaquesn= 74Number of carotid plaques per patient1,3 ± 0,5-2,5 ±2,0*Carotid plaques size (mm)1,63 ±0,20-2,08 ±0,69*Number of femoral plaques per patient-2,3 ±1,73,7 ± 2,9**Femoral plaque size (mm)-2,20 ± 0,593,10 ± 1,10**Total number of plaques per patient1,3 ± 0,52,3 ± 1,7*6,2 ± 4,3***†Results in mean ± sd. *p<0,05 vs only carotid plaques. **p<0,05 vs only femoral plaques. ***p<0,05 vs only carotid plaques and only femoral plaques.Disclosure of Interests:Julio Medina: None declared, Francisco Aramburu: None declared, Carmen González Montagut: None declared, Dolores Sánchez: None declared, Estíbaliz Loza Grant/research support from: Roche, Pfizer, Abbvie, MSD, Novartis, Gebro, Adacap, Astellas, BMS, Lylly, Sanofi, Eisai, Leo, Sobi
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Sanchez Leon C, Cordones Cano I, Gomez Climent M, Carretero Guillen A, Cheron G, Medina J, Marquez Ruiz J. P101 Assymetric immediate and long-term effects induced by transcranial direct current stimulation on alert mice somatosensory cortex. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.212] [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: 10/24/2022]
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Sanchez Leon C, Cordones Cano I, Sanchez Lopez A, Cheron G, Medina J, Marquez Ruiz J. P102 Effects of transcranial direct current stimulation on morphologically identified purkinje cells activity and cerebellar sensory processing. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.213] [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: 10/24/2022]
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Jiménez I, Garcés GL, Caballero-Martel J, Medina J. Dorsal web injection technique in the treatment of trigger finger and trigger thumb. Anatomical study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:355-360. [PMID: 32199767 DOI: 10.1016/j.recot.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Corticosteroid injection is an effective treatment for trigger digits but the pain during the injection is an ever-present side effect. Since the palmar skin has a high density of sensitive receptors, injecting through dorsal skin could be less painful. Our aim was to assess whether a dorsal technique through the dorsal web is safe for extra-sheath injection of trigger fingers and thumb. MATERIAL AND METHOD This is an anatomical study in sixteen cadaveric hands. An injection through the dorsal web was performed on each digit. After careful resection of the palmar skin, the distance between the needle and the main anatomical structures was measured. The risk of major injury was considered high when the mean distance from the needle to the neurovascular bundle was below 1mm. RESULTS The mean distance from the needle to the neurovascular bundle was 1.77mm. Two neurovascular injuries in 112 injections were observed, one nerve and one artery. The safest digit was the thumb while the most dangerous was the index finger. At the ring finger, the technique was safer when it was carried out from the dorso-radial. CONCLUSIONS A subcutaneous injection near the flexor tendon sheath can be carried out through the dorsal web with a low, but present, risk of neurovascular injury. It could be useful for injection in the treatment of trigger finger and trigger thumb but it should be assessed in a clinical study.
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Affiliation(s)
- I Jiménez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España; Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - G L Garcés
- Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España; Departamento de Cirugía Ortopédica y Traumatología, Hospital Perpetuo Socorro, Las Palmas de Gran Canaria, España
| | - J Caballero-Martel
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - J Medina
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España; Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
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Carrizo D, Muñoz-Iglesias V, Fernández-Sampedro MT, Gil-Lozano C, Sánchez-García L, Prieto-Ballesteros O, Medina J, Rull F. Detection of Potential Lipid Biomarkers in Oxidative Environments by Raman Spectroscopy and Implications for the ExoMars 2020-Raman Laser Spectrometer Instrument Performance. Astrobiology 2020; 20:405-414. [PMID: 31985262 DOI: 10.1089/ast.2019.2100] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The aim of the European Space Agency's ExoMars rover mission is to search for potential traces of present or past life in the swallow subsurface (2 m depth) of Mars. The ExoMars rover mission relies on a suite of analytical instruments envisioned to identify organic compounds with biological value (biomarkers) associated with a mineralogical matrix in a highly oxidative environment. We investigated the feasibility of detecting basic organics (linear and branched lipid molecules) with Raman laser spectroscopy, an instrument onboard the ExoMars rover, when exposed to oxidant conditions. We compared the detectability of six lipid molecules (alkanes, alkanols, fatty acid, and isoprenoid) before and after an oxidation treatment (15 days with hydrogen peroxide), with and without mineral matrix support (amorphous silica rich vs. iron rich). Raman and infrared spectrometry was combined with gas chromatography-mass spectrometry to determine detection limits and technical constraints. We observed different spectral responses to degradation depending on the lipid molecule and mineral substrate, with the silica-rich material showing better preservation of organic signals. These findings will contribute to the interpretation of Raman laser spectroscopy results on cores from the ExoMars rover landing site, the hydrated silica-enriched delta fan on Cogoon Vallis (Oxia Planum).
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Affiliation(s)
| | | | | | | | | | | | - Jesús Medina
- Unidad Asociada UVa-CSIC al Centro de Astrobiología (CSIC-INTA), University of Valladolid, Valladolid, Spain
| | - Fernando Rull
- Unidad Asociada UVa-CSIC al Centro de Astrobiología (CSIC-INTA), University of Valladolid, Valladolid, Spain
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López-Medina M, Espinilla M, Cleland I, Nugent C, Medina J. Fuzzy cloud-fog computing approach application for human activity recognition in smart homes. IFS 2020. [DOI: 10.3233/jifs-179443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M.A. López-Medina
- Council of Health for the Andalucian Health Service, Av. de la Constitucion, Sevilla, Spain
| | - M. Espinilla
- Computer Science, University of Jaén, Campus Las Lagunillas Jaén, Spain
| | - I. Cleland
- School of Computing, Ulster University, Jordanstown Co. Antrim BT37 0QB, UK
| | - C. Nugent
- School of Computing, Ulster University, Jordanstown Co. Antrim BT37 0QB, UK
| | - J. Medina
- Computer Science, University of Jaén, Campus Las Lagunillas Jaén, Spain
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Rubio-Manzano C, Díaz JC, Alfonso-Robaina D, Malleuve A, Medina J. A Novel Cause-Effect Variable Analysis in Enterprise Architecture by Fuzzy Logic Techniques. INT J COMPUT INT SYS 2020. [DOI: 10.2991/ijcis.d.200415.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Manrique JA, Lopez-Reyes G, Cousin A, Rull F, Maurice S, Wiens RC, Madsen MB, Madariaga JM, Gasnault O, Aramendia J, Arana G, Beck P, Bernard S, Bernardi P, Bernt MH, Berrocal A, Beyssac O, Caïs P, Castro C, Castro K, Clegg SM, Cloutis E, Dromart G, Drouet C, Dubois B, Escribano D, Fabre C, Fernandez A, Forni O, Garcia-Baonza V, Gontijo I, Johnson J, Laserna J, Lasue J, Madsen S, Mateo-Marti E, Medina J, Meslin PY, Montagnac G, Moral A, Moros J, Ollila AM, Ortega C, Prieto-Ballesteros O, Reess JM, Robinson S, Rodriguez J, Saiz J, Sanz-Arranz JA, Sard I, Sautter V, Sobron P, Toplis M, Veneranda M. SuperCam Calibration Targets: Design and Development. Space Sci Rev 2020; 216:138. [PMID: 33281235 PMCID: PMC7691312 DOI: 10.1007/s11214-020-00764-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/09/2020] [Indexed: 05/09/2023]
Abstract
SuperCam is a highly integrated remote-sensing instrumental suite for NASA's Mars 2020 mission. It consists of a co-aligned combination of Laser-Induced Breakdown Spectroscopy (LIBS), Time-Resolved Raman and Luminescence (TRR/L), Visible and Infrared Spectroscopy (VISIR), together with sound recording (MIC) and high-magnification imaging techniques (RMI). They provide information on the mineralogy, geochemistry and mineral context around the Perseverance Rover. The calibration of this complex suite is a major challenge. Not only does each technique require its own standards or references, their combination also introduces new requirements to obtain optimal scientific output. Elemental composition, molecular vibrational features, fluorescence, morphology and texture provide a full picture of the sample with spectral information that needs to be co-aligned, correlated, and individually calibrated. The resulting hardware includes different kinds of targets, each one covering different needs of the instrument. Standards for imaging calibration, geological samples for mineral identification and chemometric calculations or spectral references to calibrate and evaluate the health of the instrument, are all included in the SuperCam Calibration Target (SCCT). The system also includes a specifically designed assembly in which the samples are mounted. This hardware allows the targets to survive the harsh environmental conditions of the launch, cruise, landing and operation on Mars during the whole mission. Here we summarize the design, development, integration, verification and functional testing of the SCCT. This work includes some key results obtained to verify the scientific outcome of the SuperCam system.
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Affiliation(s)
- J. A. Manrique
- Unidad Asocida UVA-CSIC-CAB, University of Valladolid (UVA), Valladolid, Spain
| | - G. Lopez-Reyes
- Unidad Asocida UVA-CSIC-CAB, University of Valladolid (UVA), Valladolid, Spain
| | - A. Cousin
- Institut de Recherche en Astrophysique et Planétologie (IRAP), CNRS, CNES, Université de Toulouse, Toulouse, France
| | - F. Rull
- Unidad Asocida UVA-CSIC-CAB, University of Valladolid (UVA), Valladolid, Spain
| | - S. Maurice
- Institut de Recherche en Astrophysique et Planétologie (IRAP), CNRS, CNES, Université de Toulouse, Toulouse, France
| | - R. C. Wiens
- Los Alamos National Laboratory, Los Alamos, NM USA
| | - M. B. Madsen
- Niels Bohr Institute (NBI), University of Copenhagen, Copenhagen, Denmark
| | | | - O. Gasnault
- Institut de Recherche en Astrophysique et Planétologie (IRAP), CNRS, CNES, Université de Toulouse, Toulouse, France
| | - J. Aramendia
- University of the Basque Country (UPV/EHU), Leioa, Spain
| | - G. Arana
- University of the Basque Country (UPV/EHU), Leioa, Spain
| | - P. Beck
- CNRS, Institut de Planetologie et d’Astrophysique de Grenoble (IPAG), Universite Grenoble Alpes, Saint-Martin d’Heres, France
| | - S. Bernard
- Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie (IMPMC), CNRS, MNHN, Sorbonne Université, Paris, France
| | - P. Bernardi
- Laboratoire d’Etudes Spatiales et d’Instrumentation en Astrophysique, Observatoire de Paris-PSL, CNRS, Sorbonne Université, Université de Paris, Meudon, France
| | - M. H. Bernt
- Niels Bohr Institute (NBI), University of Copenhagen, Copenhagen, Denmark
| | - A. Berrocal
- Ingeniería de Sistemas para la Defensa de España S.A. (ISDEFE), Madrid, Spain
| | - O. Beyssac
- Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie (IMPMC), CNRS, MNHN, Sorbonne Université, Paris, France
| | - P. Caïs
- Laboratoire d’astrophysique de Bordeaux, CNRS, Univ. Bordeaux, Bordeaux, France
| | - C. Castro
- Added Value Solutions (AVS), Elgóibar, Spain
| | - K. Castro
- University of the Basque Country (UPV/EHU), Leioa, Spain
| | - S. M. Clegg
- Los Alamos National Laboratory, Los Alamos, NM USA
| | | | - G. Dromart
- Univ Lyon, ENSL, CNRS, LGL-TPE, Univ Lyon 1, 69007 Lyon, France
| | - C. Drouet
- CIRIMAT, Université de Toulouse, CNRS/UT3/INP, Ensiacet, Toulouse, France
| | - B. Dubois
- Observatoire Midi-Pyrénées, Toulouse, France
| | - D. Escribano
- Instituto Nacional de Técnica Aeroespacial, Torrejón de Ardoz, Spain
| | - C. Fabre
- GeoRessources, Vandoeuvre les Nancy, France
| | | | - O. Forni
- Institut de Recherche en Astrophysique et Planétologie (IRAP), CNRS, CNES, Université de Toulouse, Toulouse, France
| | - V. Garcia-Baonza
- Instituto de Geociencias CSIC, Universidad Complutense de Madrid, Madrid, Spain
| | - I. Gontijo
- Jet Propulsion Laboratory, Pasadena, CA USA
| | - J. Johnson
- Applied Physics Laboratory, Johns Hopkins University, Laurel, MD USA
| | - J. Laserna
- University of Malaga (UMA), Málaga, Spain
| | - J. Lasue
- Institut de Recherche en Astrophysique et Planétologie (IRAP), CNRS, CNES, Université de Toulouse, Toulouse, France
| | - S. Madsen
- Jet Propulsion Laboratory, Pasadena, CA USA
| | - E. Mateo-Marti
- Centro de Astrobiología-CSIC-INTA, Torrejón de Ardoz, Spain
| | - J. Medina
- Unidad Asocida UVA-CSIC-CAB, University of Valladolid (UVA), Valladolid, Spain
| | - P.-Y. Meslin
- Institut de Recherche en Astrophysique et Planétologie (IRAP), CNRS, CNES, Université de Toulouse, Toulouse, France
| | - G. Montagnac
- Univ Lyon, ENSL, CNRS, LGL-TPE, Univ Lyon 1, 69007 Lyon, France
| | - A. Moral
- Instituto Nacional de Técnica Aeroespacial, Torrejón de Ardoz, Spain
| | - J. Moros
- University of Malaga (UMA), Málaga, Spain
| | - A. M. Ollila
- Los Alamos National Laboratory, Los Alamos, NM USA
| | - C. Ortega
- Added Value Solutions (AVS), Elgóibar, Spain
| | | | - J. M. Reess
- Laboratoire d’Etudes Spatiales et d’Instrumentation en Astrophysique, Observatoire de Paris-PSL, CNRS, Sorbonne Université, Université de Paris, Meudon, France
| | - S. Robinson
- Los Alamos National Laboratory, Los Alamos, NM USA
| | - J. Rodriguez
- Ingeniería de Sistemas para la Defensa de España S.A. (ISDEFE), Madrid, Spain
| | - J. Saiz
- Unidad Asocida UVA-CSIC-CAB, University of Valladolid (UVA), Valladolid, Spain
| | - J. A. Sanz-Arranz
- Unidad Asocida UVA-CSIC-CAB, University of Valladolid (UVA), Valladolid, Spain
| | - I. Sard
- Added Value Solutions (AVS), Elgóibar, Spain
| | - V. Sautter
- Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie (IMPMC), CNRS, MNHN, Sorbonne Université, Paris, France
| | - P. Sobron
- SETI Institute, Mountain View, CA USA
| | - M. Toplis
- Observatoire Midi-Pyrénées, Toulouse, France
| | - M. Veneranda
- Unidad Asocida UVA-CSIC-CAB, University of Valladolid (UVA), Valladolid, Spain
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Veneranda M, Manrique-Martinez JA, Lopez-Reyes G, Medina J, Torre-Fdez I, Castro K, Madariaga JM, Lantz C, Poulet F, Krzesińska AM, Hellevang H, Werner SC, Rull F. Spectroscopic study of olivine-bearing rocks and its relevance to the ExoMars rover mission. Spectrochim Acta A Mol Biomol Spectrosc 2019; 223:117360. [PMID: 31319272 DOI: 10.1016/j.saa.2019.117360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/01/2019] [Accepted: 07/07/2019] [Indexed: 06/10/2023]
Abstract
We present the compositional analysis of three terrestrial analogues of Martian olivine-bearing rocks derived from both laboratory and flight-derived analytical instruments. In the first step, state-of-the-art spectroscopic (XRF, NIR and Raman) and diffractometric (XRD) laboratory systems were complementary used. Besides providing a detailed mineralogical and geochemical characterization of the samples, results comparison shed light on the advantages ensured by the combined use of Raman and NIR techniques, being these the spectroscopic instruments that will soon deploy (2021) on Mars as part of the ExoMars/ESA rover payload. In order to extrapolate valuable indicators of the mineralogical data that could derive from the ExoMars/Raman Laser Spectrometer (RLS), laboratory results were then compared with the molecular data gathered through the RLS ExoMars Simulator. Beside correctly identifying all major phases (feldspar, pyroxene and olivine), the RLS ExoMars Simulator confirmed the presence of additional minor compounds (i.e. hematite and apatite) that were not detected by complementary techniques. Furthermore, concerning the in-depth study of olivine grains, the RLS ExoMars simulator was able to effectively detect the shifting of the characteristic double peak around 820 and 850 cm-1, from which the FeMg content of the analyzed crystals can be extrapolated. Considering that olivine is one of the main mineral phases of the ExoMars landing site (Oxia Planum), this study suggests that the ExoMars/RLS system has the potential to provide detailed information about the elemental composition of olivine on Mars.
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Affiliation(s)
- Marco Veneranda
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, Boecillo 47151, Spain.
| | - Jose Antonio Manrique-Martinez
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, Boecillo 47151, Spain
| | - Guillermo Lopez-Reyes
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, Boecillo 47151, Spain
| | - Jesús Medina
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, Boecillo 47151, Spain
| | - Imanol Torre-Fdez
- Department of Analytical Chemistry, University of the Basque Country (UPV/EHU), 48080 Bilbao, Spain
| | - Kepa Castro
- Department of Analytical Chemistry, University of the Basque Country (UPV/EHU), 48080 Bilbao, Spain
| | - Juan Manuel Madariaga
- Department of Analytical Chemistry, University of the Basque Country (UPV/EHU), 48080 Bilbao, Spain
| | - Cateline Lantz
- Institut d'Astrophysique Spatiale, CNRS/Université Paris-Sud, France
| | - Francois Poulet
- Institut d'Astrophysique Spatiale, CNRS/Université Paris-Sud, France
| | - Agata M Krzesińska
- Department of Geosciences, Centre for Earth Evolution and Dynamics, University of Oslo, Norway
| | - Helge Hellevang
- Department of Geosciences, Centre for Earth Evolution and Dynamics, University of Oslo, Norway
| | - Stephanie C Werner
- Department of Geosciences, Centre for Earth Evolution and Dynamics, University of Oslo, Norway
| | - Fernando Rull
- Department of Condensed Matter Physics, Crystallography and Mineralogy, University of Valladolid, Ave. Francisco Vallés, 8, Boecillo 47151, Spain
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Jiménez I, Marcos-García A, Romero-Pérez B, Garcés-Martín G, Medina J. Effectivité et sécurité de l’injection à travers la peau dorsale dans le traitement du doigt et du pouce à ressaut: étude clinique prospective. Hand Surgery and Rehabilitation 2019. [DOI: 10.1016/j.hansur.2019.10.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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