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Suárez-Lledó Grande A, Llop Talaveron JM, Leiva Badosa E, Farran Teixido L, Miró Martín M, Bas Minguet J, Navarro Velázquez S, Creus Costas G, Virgili Casas N, Fernández Álvarez M, Badía Tahull MB. Effect of Fish Oil Parenteral Emulsion Supplementation on Inflammatory Parameters after Esophagectomy. Nutrients 2023; 16:40. [PMID: 38201870 PMCID: PMC10780468 DOI: 10.3390/nu16010040] [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: 11/23/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
(Background) Esophagectomy (EPG) presents high morbidity and mortality. Omega-3 fatty acids (ω-3FA) are a pharmaconutrient with benefits for postoperative morbidity. Studies of ω-3FA administered parenterally after esophagectomy are scarce. This study proposes to investigate the effect of combining fish oil lipid emulsions (LE) administered parenterally with enteral nutrition support. (Methods) Randomization was 1:1:1 in three groups: Group A received a LE mixture of 0.4 g/kg/day of fish oil and 0.4 g/kg/day of LCT/MCT 50:50, Group B received 0.8 g/kg/day of fish oil LE, and Group C received 0.8 g/kg/day of LCT/MCT 50:50. Variables were measured at recruitment time and day +1, +3, and +5. Inflammatory variables studied were Interlukin-6, C-reactive protein (CRP), tumoral necrosis factor-α (TNF-α), IL-10, IL-8 and CD25s. Safety, nutritional parameters and complications were analyzed. (Results) Administration of ω-3LE in the immediate postoperative period did not modulate the earlier inflammatory response. Statistically significant differences were found in IL-6 and CRP overall temporal evolution but were not found when studying the type of LE administered or in patients needing critical care. Administration of ω-3 resulted in safe and improved hypertriglyceridemia, depending on the dose. (Conclusions) ω-3FA has no impact on the early inflammatory postoperative response assessed for a short period but was safe. More studies for longer periods are needed.
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Affiliation(s)
- Ana Suárez-Lledó Grande
- Pharmacy Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
| | - Josep M. Llop Talaveron
- Pharmacy Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
| | - Elisabet Leiva Badosa
- Pharmacy Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
| | - Leandre Farran Teixido
- General Digestive Surgery Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
| | - Mónica Miró Martín
- General Digestive Surgery Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
| | - Jordi Bas Minguet
- Immunology Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
| | - Sergio Navarro Velázquez
- Immunology Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
| | - Gloria Creus Costas
- Endocrinology and Nutrition Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
| | - Nuria Virgili Casas
- Endocrinology and Nutrition Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
| | - Mónica Fernández Álvarez
- Pharmacy Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
| | - María B. Badía Tahull
- Pharmacy Department, Bellvitge University Hospital, University of Barcelona—IDIBELL, 08907 L’Hospitalet de Llobregat, Spain
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Lorente L, Martín MM, Ortiz-López R, Pérez-Cejas A, Ferrer-Moure C, Jiménez A, González-Rivero AF. Association between septic patient mortality and blood survivin concentrations. Med Intensiva 2023; 47:84-89. [PMID: 36272905 DOI: 10.1016/j.medine.2021.12.017] [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: 10/11/2021] [Accepted: 12/26/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Survivin is a member of inhibitors of apoptosis proteins family. There are not data about the association between mortality of septic patients and blood survivin concentrations. Therefore, the objective of this study was to determine whether exist that association. DESIGN Observational and prospective study. SETTING Three Spanish Intensive Care Units. PATIENTS Patients with sepsis or septic shock according to Sepsis-3 Consensus criteria. INTERVENTIONS Serum survivin concentrations were determined at moment of sepsis diagnosis. MAIN VARIABLE OF INTEREST Mortality at 30 days. RESULTS A total of 204 patients were included in the study, of which 75 (36.8%) died in the first 30 days. Lower age (p<0.001), serum lactic acid levels (p=0.001), rate of septic shock (p=0.001) and SOFA (p<0.001), and higher serum survivin levels (p=0.001) exhibited surviving (n=129) than non-surviving patients (n=75). We found in multiple logistic regression analysis an association between serum survivin concentrations and mortality independently of SOFA, lactic acid, age, INR, activated partial thromboplastin time (aPTT) and empiric antimicrobial treatment adequate (OR=0.968; 95% CI=0.946-0.990; p=0.005), and also independently of APACHE-II, lactic acid, platelet, INR, aPTT and empiric antimicrobial treatment adequate (OR=0.966; 95% CI=0.943-0.989; p=0.004). CONCLUSIONS There is an association between septic patient mortality and low blood survivin concentrations.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain.
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora Candelaria, Santa Cruz Tenerife, Spain
| | - R Ortiz-López
- Intensive Care Unit, Hospital General de La Palma, Breña Alta, La Palma, Spain
| | - A Pérez-Cejas
- Laboratory Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - C Ferrer-Moure
- Laboratory Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
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3
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Alberich Prats M, Bettonica Larrañaga C, Miró Martín M, Aranda Danso H, Estremiana García F, Farran Teixidor L. Robotic surgery for the treatment of achalasia. Cir Esp 2022; 100:410-415. [PMID: 35550447 DOI: 10.1016/j.cireng.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/17/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the experience of the robotic approach for achalasia surgery in a tertiary center. MATERIAL AND METHODS Patients with achalasia who underwent robotic surgery between May 2010 and April 2019 were analyzed. The study variables were collected in a prospective database and a descriptive analysis was performed. RESULTS 45 patients (55.6% male) with a mean age of 44 years were included. The main symptom at diagnosis was dysphagia. 19 patients (42.2%) received endoscopic treatment prior to surgery, mostly pneumatic dilation (84.2%). Heller's myotomy associated with Toupet fundoplication was the surgical technique of choice, with a mean operative time of 211 min. The average stay was 5 days. There were 2 postoperative perforations (4.4%). Perioperative mortality was 0%. The mean follow-up was 64 months. At 3 and 5 years, a significant decrease in the Eckardt score was observed and the manometric study showed a decrease in the lower esophageal sphincter pressure at rest of 58% and 70%, respectively, with persistence of hypomotility of the esophageal body. Pathological gastroesophageal reflux was diagnosed in two patients (5.4%) and 4 (10.8%) presented recurrence of symptoms, requiring endoscopic pneumatic dilations. In 2 cases, the dilations were not effective, so an endoscopic myotomy was considered. CONCLUSIONS In our experience, robotic surgery is a safe and effective procedure for the treatment of achalasia.
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Affiliation(s)
- Marta Alberich Prats
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | - Carla Bettonica Larrañaga
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Miró Martín
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Humberto Aranda Danso
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Estremiana García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Leandre Farran Teixidor
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Lorente L, Martín MM, Pérez-Cejas A, González-Rivero AF, Ramos-Gómez L, Solé-Violán J, Cáceres JJ, Villacampa-Jiménez JJ, Jiménez A. Association between blood caspase-8 levels and mortality of patients with malignant middle cerebral artery infarction. Med Intensiva 2022; 46:305-311. [PMID: 35688578 DOI: 10.1016/j.medine.2021.03.004] [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: 11/23/2020] [Accepted: 03/08/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE High concentrations of caspase-8 (main initiator caspase of apoptosis extrinsic pathway) have been found in brain tissue from traumatic brain injury patients and in blood of patients with different diseases. However, there are not data on blood caspase-8 concentrations in ischemic stroke patients. Therefore, the objective of this study was to determine whether there is an association between blood caspase-8 concentrations and the probability and speed of mortality at 30 days in patients with malignant middle cerebral artery infarction (MMCAI). DESIGN Observational prospective study. SETTING Five Intensive Care Units (ICU). PATIENTS Patients with severe malignant middle cerebral artery infarction (MMCAI) defined as acute infarction in more than of 50% of that territory and Glasgow Coma Scale (GCS)<9. INTERVENTIONS Determination of serum caspase-8 levels when MMCAI was diagnosed. MAIN VARIABLES OF INTEREST Mortality at 30 days and time until this event. RESULTS Severe MMCAI patients (n=28) compared to survivor patients (n=28) showed higher serum caspase-8 concentrations (p<0.001), lower platelet count (p=0.01) and lower GCS (p=0.002). We found an area under the curve for mortality prediction of 78% (95% CI=65%-91%; p<0.001) by serum caspase-8 levels. Kaplan-Meier analysis found higher mortality rate in patients with serum caspase-8 levels >62.8ng/mL (hazard ratio=11.2; 95% CI=4.4-28.4; p<0.001). CONCLUSIONS The association of high blood caspase-8 concentrations with the rate and the velocity of 30-day mortality in MMCAI patients is the main new finding of our study.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna 38320, Santa Cruz de Tenerife, Spain.
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario, s/n, Santa Cruz de Tenerife 38010, Spain
| | - A Pérez-Cejas
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna 38320, Tenerife, Spain
| | - A F González-Rivero
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna 38320, Santa Cruz de Tenerife, Spain
| | - L Ramos-Gómez
- Intensive Care Unit, Hospital General de La Palma, Buenavista de Arriba, s/n, Breña Alta, La Palma 38713, Spain
| | - J Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Barranco de la Ballena, s/n, Las Palmas de Gran Canaria 35010, Spain
| | - J J Cáceres
- Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n, Las Palmas de Gran Canaria 35016, Spain
| | - J J Villacampa-Jiménez
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna 38320, Tenerife, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna 38320, Santa Cruz de Tenerife, Spain
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Lorente L, Martín MM, Ortiz-López R, González-Rivero AF, Pérez-Cejas A, Martín M, Gonzalez V, Pérez A, Rodin M, Jiménez A. Blood caspase-8 concentrations and mortality among septic patients. Med Intensiva 2022; 46:8-13. [PMID: 34991877 DOI: 10.1016/j.medine.2020.06.015] [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: 04/19/2020] [Accepted: 06/27/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE No data are available on blood caspase-8 concentrations (the initiator caspase in the extrinsic apoptosis pathway) in septic patients. The present study thus describes the blood caspase-8 concentrations in survivors and non-survivors, and examines the possible association between blood caspase-8 concentrations and mortality in septic patients. DESIGN A prospective observational study was carried out. SETTING Three Spanish Intensive Care Units. PATIENTS Septic patients. INTERVENTIONS Serum caspase-8 concentrations were determined at the diagnosis of sepsis. MAIN VARIABLE OF INTEREST Mortality after 30 days. RESULTS Patients not surviving at day 30 (n=81) compared to surviving patients (n=140) showed higher serum caspase-8 levels (p<0.001). Multiple logistic regression analysis found an association between serum caspase-8 levels>43.5ng/ml and mortality (OR=3.306; 95%CI=1.619-6.753; p=0.001). The area under the curve (AUC) for mortality predicted by serum caspase-8 levels was 67% (95% CI=60-73%; p<0.001). CONCLUSIONS The novel findings of our study were that blood caspase-8 concentrations are higher in non-survivors than in survivors, and that there is an association between blood caspase-8 concentrations and mortality in septic patients.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Tenerife, Spain.
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora Candelaria, Crta Rosario s/n., Santa Cruz Tenerife 38010, Spain
| | - R Ortiz-López
- Intensive Care Unit, Hospital General de La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma 38713, Spain
| | - A F González-Rivero
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Santa Cruz de Tenerife, Spain
| | - A Pérez-Cejas
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Tenerife, Spain
| | - M Martín
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n., La Laguna, Santa Cruz de Tenerife 38320, Spain
| | - V Gonzalez
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n., La Laguna, Santa Cruz de Tenerife 38320, Spain
| | - A Pérez
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n., La Laguna, Santa Cruz de Tenerife 38320, Spain
| | - M Rodin
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n., La Laguna, Santa Cruz de Tenerife 38320, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Tenerife, Spain
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Alberich Prats M, Bettonica Larrañaga C, Miró Martín M, Aranda Danso H, Estremiana García F, Farran Teixidor L. Robotic surgery for the treatment of achalasia. Cir Esp 2021; 100:S0009-739X(21)00161-5. [PMID: 34059311 DOI: 10.1016/j.ciresp.2021.04.013] [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: 02/22/2021] [Revised: 04/09/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the experience of the robotic approach for achalasia surgery in a tertiary center. MATERIAL AND METHODS Patients with achalasia who underwent robotic surgery between May 2010 and April 2019 were analyzed. The study variables were collected in a prospective database and a descriptive analysis was performed. RESULTS 45 patients (55.6% male) with a mean age of 44 years were included. The main symptom at diagnosis was dysphagia. 19 patients (42.2%) received endoscopic treatment prior to surgery, mostly pneumatic dilation (84.2%). Heller's myotomy associated with Toupet fundoplication was the surgical technique of choice, with a mean operative time of 211minutes. The average stay was 5 days. There were 2 postoperative perforations (4.4%). Perioperative mortality was 0%. The mean follow-up was 64 months. At 3 and 5 years, a significant decrease in the Eckardt score was observed and the manometric study showed a decrease in the lower esophageal sphincter pressure at rest of 58% and 70%, respectively, with persistence of hypomotility of the esophageal body. Pathological gastroesophageal reflux was diagnosed in two patients (5.4%) and 4 (10.8%) presented recurrence of symptoms, requiring endoscopic pneumatic dilations. In 2 cases, the dilations were not effective, so an endoscopic myotomy was considered. CONCLUSIONS In our experience, robotic surgery is a safe and effective procedure for the treatment of achalasia.
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Affiliation(s)
- Marta Alberich Prats
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
| | - Carla Bettonica Larrañaga
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Mónica Miró Martín
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Humberto Aranda Danso
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Fernando Estremiana García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Leandre Farran Teixidor
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
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Lorente L, Martín MM, Pérez-Cejas A, González-Rivero AF, Ramos-Gómez L, Solé-Violán J, Cáceres JJ, Villacampa-Jiménez JJ, Jiménez A. Association between blood caspase-8 levels and mortality of patients with malignant middle cerebral artery infarction. Med Intensiva 2021; 46:S0210-5691(21)00036-X. [PMID: 33926751 DOI: 10.1016/j.medin.2021.03.001] [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: 11/23/2020] [Revised: 02/09/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE High concentrations of caspase-8 (main initiator caspase of apoptosis extrinsic pathway) have been found in brain tissue from traumatic brain injury patients and in blood of patients with different diseases. However, there are not data on blood caspase-8 concentrations in ischemic stroke patients. Therefore, the objective of this study was to determine whether there is an association between blood caspase-8 concentrations and the probability and speed of mortality at 30 days in patients with malignant middle cerebral artery infarction (MMCAI). DESIGN Observational prospective study. SETTING Five Intensive Care Units (ICU). PATIENTS Patients with severe malignant middle cerebral artery infarction (MMCAI) defined as acute infarction in more than of 50% of that territory and Glasgow Coma Scale (GCS)<9. INTERVENTIONS Determination of serum caspase-8 levels when MMCAI was diagnosed. MAIN VARIABLES OF INTEREST Mortality at 30 days and time until this event. RESULTS Severe MMCAI patients (n=28) compared to survivor patients (n=28) showed higher serum caspase-8 concentrations (p<0.001), lower platelet count (p=0.01) and lower GCS (p=0.002). We found an area under the curve for mortality prediction of 78% (95% CI=65%-91%; p<0.001) by serum caspase-8 levels. Kaplan-Meier analysis found higher mortality rate in patients with serum caspase-8 levels >62.8ng/mL (hazard ratio=11.2; 95% CI=4.4-28.4; p<0.001). CONCLUSIONS The association of high blood caspase-8 concentrations with the rate and the velocity of 30-day mortality in MMCAI patients is the main new finding of our study.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna 38320, Santa Cruz de Tenerife, Spain.
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario, s/n, Santa Cruz de Tenerife 38010, Spain
| | - A Pérez-Cejas
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna 38320, Tenerife, Spain
| | - A F González-Rivero
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna 38320, Santa Cruz de Tenerife, Spain
| | - L Ramos-Gómez
- Intensive Care Unit, Hospital General de La Palma, Buenavista de Arriba, s/n, Breña Alta, La Palma 38713, Spain
| | - J Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Barranco de la Ballena, s/n, Las Palmas de Gran Canaria 35010, Spain
| | - J J Cáceres
- Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n, Las Palmas de Gran Canaria 35016, Spain
| | - J J Villacampa-Jiménez
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna 38320, Tenerife, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna 38320, Santa Cruz de Tenerife, Spain
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Lorente L, Martín MM, Franco A, Barrios Y, Cáceres JJ, Solé-Violán J, Perez A, Marcos Y Ramos JA, Ramos-Gómez L, Ojeda N, Jiménez A. HLA genetic polymorphisms and prognosis of patients with COVID-19. Med Intensiva 2021; 45:96-103. [PMID: 38620408 PMCID: PMC7474921 DOI: 10.1016/j.medin.2020.08.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 12/22/2022]
Abstract
Objective Different genetic polymorphisms of human leukocyte antigen (HLA) have been associated with the risk and prognosis of autoimmune and infectious diseases. The objectives of this study were to determine whether there is an association between HLA genetic polymorphisms and the susceptibility to and mortality of coronavirus disease 2019 (COVID-19) patients. Design Observational and prospective study. Setting Eight Intensive Care Units (ICU) from 6 hospitals of Canary Islands (Spain). Patients COVID-19 patients admitted in ICU and healthy subjects. Interventions Determination of HLA genetic polymorphisms. Main variable of interest Mortality at 30 days. Results A total of 3886 healthy controls and 72 COVID-19 patients (10 non-survivors and 62 survivor patients at 30 days) were included. We found a trend to a higher rate of the alleles HLA-A*32 (p = 0.004) in healthy controls than in COVID-19 patients, and of the alleles HLA-B*39 (p = 0.02) and HLA-C*16 (p = 0.02) in COVID-19 patients than in healthy controls; however, all these p-values were not significant after correction for multiple comparisons. Logistic regression analysis showed that the presence of certain alleles was associated with higher mortality, such as the allele HLA-A*11 after controlling for SOFA (OR = 7.693; 95% CI = 1.063-55.650; p = 0.04) or APACHE-II (OR = 11.858; 95% CI = 1.524-92.273; p = 0.02), the allele HLA-C*01 after controlling for SOFA (OR = 11.182; 95% CI = 1.053-118.700; p = 0.04) or APACHE-II (OR = 17.604; 95% CI = 1.629-190.211; p = 0.02), and the allele HLA-DQB1*04 after controlling for SOFA (OR = 9.963; 95% CI = 1.235-80.358; p = 0.03). Conclusions The new finding from our preliminary study of small sample size was that HLA genetic polymorphisms could be associated with COVID-19 mortality; however, studies with a larger sample size before definitive conclusions can be drawn.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Santa Cruz de Tenerife, Spain
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n., Santa Cruz de Tenerife 38010, Spain
| | - A Franco
- Immunology Unit of Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Santa Cruz de Tenerife, Spain
| | - Y Barrios
- Immunology Unit of Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Santa Cruz de Tenerife, Spain
| | - J J Cáceres
- Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n., Las Palmas de Gran Canaria 35016, Spain
| | - J Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n., Las Palmas de Gran Canaria 35010, Spain
| | - A Perez
- Internal Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Santa Cruz de Tenerife, Spain
| | - J A Marcos Y Ramos
- Intensive Care Unit, Hospital Doctor José Molina Orosa, Ctra. Arrecife-Tinajo, km 1.300, Arrecife, Lanzarote 35550, Spain
| | - L Ramos-Gómez
- Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma 38713, Spain
| | - N Ojeda
- Department of Anesthesiology, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n., Las Palmas de Gran Canaria 35010, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Santa Cruz de Tenerife, Spain
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Lorente L, Gómez-Bernal F, Martín MM, Navarro-Gonzálvez JA, Argueso M, Perez A, Ramos-Gómez L, Solé-Violán J, Marcos Y Ramos JA, Ojeda N, Jiménez A. High serum nitrates levels in non-survivor COVID-19 patients. Med Intensiva 2020; 46:S0210-5691(20)30336-3. [PMID: 33293102 PMCID: PMC7654288 DOI: 10.1016/j.medin.2020.10.003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Higher blood nitrate and nitrite levels have been found in coronavirus disease 2019 (COVID-19) patients than in healthy subjects. The present study explores the potential association between serum nitrate levels and mortality in COVID-19 patients. DESIGN A prospective observation study was carried out. SETTING Eight Intensive Care Units (ICUs) from 6 hospitals in the Canary Islands (Spain). PATIENTS COVID-19 patients admitted to the ICU. INTERVENTIONS Determination of serum nitrate levels at ICU admission. MAIN VARIABLE OF INTEREST Mortality at 30 days. RESULTS Non-surviving (n=11) compared to surviving patients (n=42) showed higher APACHE-II (p<0.001) and SOFA scores (p=0.004), and higher serum nitrate levels (p=0.001). Logistic regression analyses showed serum nitrate levels to be associated to 30-day mortality after controlling for SOFA (OR=1.021; 95%CI=1.006-1.036; p=0.01) or APACHE-II (OR=1.023; 95%CI=1.006-1.041; p=0.01). There were no differences in the area under the curve (AUC) for mortality prediction by serum nitrate levels (AUC=83%; 95%CI=73-92%; p<0.001), APACHE II (AUC=85%; 95%CI=75-96%; p<0.001) and SOFA (AUC=78%; 95%CI=63-92%; p=0.005) based on the DeLong method. The Kaplan-Meier analysis found patients with serum nitrates levels>68.4μmol/l to have a higher mortality rate (hazard ratio=138.8; 95%CI=22.3-863.9; p<0.001). CONCLUSIONS The main novel finding was the association between serum nitrate levels and mortality in COVID-19 patients controlling for the SOFA or APACHE-II scores, though larger studies are needed to confirm this observation.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
| | - F Gómez-Bernal
- Laboratory Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - J A Navarro-Gonzálvez
- Laboratory Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - M Argueso
- Intensive Care Unit, Complejo Hospitalario Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - A Perez
- Internal Intensive Care Unit, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - L Ramos-Gómez
- Intensive Care Unit, Hospital General La Palma, Breña Alta, Santa Cruz de Tenerife, Spain
| | - J Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - J A Marcos Y Ramos
- Intensive Care Unit, Hospital Doctor José Molina Orosa, Arrecife, Las Palmas, Spain
| | - N Ojeda
- Department of Anesthesiology, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
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Lorente L, Martín MM, Ortiz-López R, González-Rivero AF, Pérez-Cejas A, Martín M, Gonzalez V, Pérez A, Rodin M, Jiménez A. Blood caspase-8 concentrations and mortality among septic patients. Med Intensiva 2020; 46:S0210-5691(20)30246-1. [PMID: 32843190 DOI: 10.1016/j.medin.2020.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/19/2020] [Revised: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE No data are available on blood caspase-8 concentrations (the initiator caspase in the extrinsic apoptosis pathway) in septic patients. The present study thus describes the blood caspase-8 concentrations in survivors and non-survivors, and examines the possible association between blood caspase-8 concentrations and mortality in septic patients. DESIGN A prospective observational study was carried out. SETTING Three Spanish Intensive Care Units. PATIENTS Septic patients. INTERVENTIONS Serum caspase-8 concentrations were determined at the diagnosis of sepsis. MAIN VARIABLE OF INTEREST Mortality after 30 days. RESULTS Patients not surviving at day 30 (n=81) compared to surviving patients (n=140) showed higher serum caspase-8 levels (p<0.001). Multiple logistic regression analysis found an association between serum caspase-8 levels>43.5ng/ml and mortality (OR=3.306; 95%CI=1.619-6.753; p=0.001). The area under the curve (AUC) for mortality predicted by serum caspase-8 levels was 67% (95% CI=60-73%; p<0.001). CONCLUSIONS The novel findings of our study were that blood caspase-8 concentrations are higher in non-survivors than in survivors, and that there is an association between blood caspase-8 concentrations and mortality in septic patients.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Tenerife, Spain.
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora Candelaria, Crta Rosario s/n., Santa Cruz Tenerife 38010, Spain
| | - R Ortiz-López
- Intensive Care Unit, Hospital General de La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma 38713, Spain
| | - A F González-Rivero
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Santa Cruz de Tenerife, Spain
| | - A Pérez-Cejas
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Tenerife, Spain
| | - M Martín
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n., La Laguna, Santa Cruz de Tenerife 38320, Spain
| | - V Gonzalez
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n., La Laguna, Santa Cruz de Tenerife 38320, Spain
| | - A Pérez
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n., La Laguna, Santa Cruz de Tenerife 38320, Spain
| | - M Rodin
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n., La Laguna, Santa Cruz de Tenerife 38320, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, Ofra, s/n., La Laguna 38320, Tenerife, Spain
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Lorente L, Martín MM, Pérez-Cejas A, González-Rivero AF, Argueso M, Ramos L, Solé-Violán J, Cáceres JJ, Jiménez A, García-Marín V. Serum caspase-3 levels during the first week of traumatic brain injury. Med Intensiva 2019; 45:131-137. [PMID: 31677852 DOI: 10.1016/j.medin.2019.09.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/10/2019] [Accepted: 09/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Confluence between the intrinsic and extrinsic apoptosis pathways is reached at the point of caspase-3 activation, which induces death cell. Higher serum caspase-3 levels have been recorded on day 1 of traumatic brain injury (TBI) in 30-day non-survivors compared to survivors. The objectives of this study therefore were to determine whether serum caspase-3 levels are persistently higher in non-survivors than in survivors, and whether these levels may be used to predict 30-day mortality. DESIGN A prospective observational study was carried out. SETTING Six Spanish Intensive Care Units. PATIENTS Patients with severe isolated TBI (defined as Glasgow Coma Scale <9 points and non-cranial Injury Severity Score <10 points). INTERVENTIONS Serum caspase-3 concentrations were measured on days 1, 4 and 8 of TBI. MAIN VARIABLES OF INTEREST Thirty-day mortality was considered as the study endpoint. RESULTS In comparison with non-survivors (n=34), 30-day survivors (n=90) showed lower serum caspase-3 levels on days 1 (p=0.001), 4 (p<0.001) and 8 (p<0.001) of TBI. Analysis of the ROC curves showed serum caspase-3 concentrations on days 1, 4 and 8 of TBI to have an AUC (95% CI) in predicting 30-day mortality of 0.70 (0.61-0.78; p=0.001), 0.83 (0.74-0.89; p<0.001) and 0.87 (0.79-0.93; p<0.001), respectively. CONCLUSIONS The novel findings of our study were that serum caspase-3 levels during the first week of TBI were lower in survivors and could predict 30-day mortality.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - A Pérez-Cejas
- Laboratory Department, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - A F González-Rivero
- Laboratory Department, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - M Argueso
- Intensive Care Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - L Ramos
- Intensive Care Unit, Hospital General de La Palma, Breña Alta, La Palma, Spain
| | - J Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Las Palmas de Gran Canaria, Spain
| | - J J Cáceres
- Intensive Care Unit, Hospital Insular, Las Palmas de Gran Canaria, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - V García-Marín
- Department of Neurosurgery, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
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Lorente L, Martín MM, González-Rivero AF, Pérez-Cejas A, Abreu-González P, Ramos L, Argueso M, Cáceres JJ, Solé-Violán J, Alvarez-Castillo A, Jiménez A, García-Marín V. DNA and RNA oxidative damage are associated to mortality in patients with cerebral infarction. Med Intensiva 2019; 45:35-41. [PMID: 31492477 DOI: 10.1016/j.medin.2019.07.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/07/2019] [Accepted: 07/14/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Secondary injury due to oxidation may occur during ischemic stroke, possibly leading to oxidative damage to deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). Higher blood concentrations of 8-hydroxy-2'-deoxyguanosine (8-OHdG) (through the oxidation of guanosine from DNA) have been found in ischemic stroke patients than in healthy subjects, and in patients with versus without post-ischemic stroke depression. The present study was carried out to explore the possible association between serum DNA and RNA oxidative damage and mortality in patients with cerebral infarction. METHODS A prospective, multicenter observational study was carried out in the Intensive Care Units of 6 Spanish hospitals. We included patients with severe malignant middle cerebral artery infarction (MMCAI) defined as ischemic changes evidenced by computed tomography in more than 50% of the middle cerebral artery territory and a Glasgow Coma Score (GCS)<9. Serum concentrations of the three oxidized guanine species (OGS) (8-hydroxyguanine from DNA or RNA, 8-hydroxyguanosine from RNA, and 8-OHdG from DNA) on the day of MMCAI diagnosis were determined. The study endpoint was 30-day mortality. RESULTS We found higher serum OGS levels (p<0.001) in non-surviving (n=34) than in surviving patients (n=34). Logistic regression analyses showed serum OGS levels to be associated to 30-day mortality controlling for lactic acid, GCS and platelet count (OR=1.568; 95%CI=1.131-2.174; p=0.01). CONCLUSIONS The novel observation in this study is the association between global serum OGS concentration and mortality in ischemic stroke patients.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain.
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife 38010, Spain
| | - A F González-Rivero
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - A Pérez-Cejas
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Tenerife, Spain
| | - P Abreu-González
- Department of Physiology, Faculty of Medicine, University of the La Laguna, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - L Ramos
- Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma 38713, Spain
| | - M Argueso
- Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez n°17-19, Valencia 46004, Spain
| | - J J Cáceres
- Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n, Las Palmas de Gran Canaria 35016, Spain
| | - J Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, Las Palmas de Gran Canaria 35010, Spain
| | - A Alvarez-Castillo
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - V García-Marín
- Department of Neurosurgery, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
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13
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Díez Del Val I, Loureiro González C, Asensio Gallego JI, Bettonica Larrañaga C, Leturio Fernández S, Eizaguirre Letamendia E, Miró Martín M, García Fernández MM, Martí Gelonch L, Aranda Danso H, Barrenetxea Asua J, Estremiana García F, Ortiz Lacorzana J, Farran Teixidó L. Minimally invasive and robotic surgery in the surgical treatment of esophagogastric junction cancer. Cir Esp 2019; 97:451-458. [PMID: 31047649 DOI: 10.1016/j.ciresp.2019.03.013] [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: 02/16/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022]
Abstract
Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments.
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Affiliation(s)
- Ismael Díez Del Val
- Sección de Cirugía esofagogástrica, Hospital Universitario Basurto, Bilbao, España.
| | | | | | - Carla Bettonica Larrañaga
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Mónica Miró Martín
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Laura Martí Gelonch
- Sección de Cirugía esofagogástrica, Hospital Universitario Donostia, Donostia-San Sebastián, España
| | - Humberto Aranda Danso
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Fernando Estremiana García
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Leandre Farran Teixidó
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Verdugo A, Matesanz N, González-Terán B, Bernardo E, Leiva L, Rodriguez E, Ligos JM, Rincón M, Martín MM, Hernández L, Torres JL, Rozo R, Cuenda A, Sabio G. Role of MAPKp38 in liver steatosis. Exp Clin Endocrinol Diabetes 2012. [DOI: 10.1055/s-0032-1330831] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lorente L, Jiménez A, Roca I, Martín MM, Mora ML. Influence of tracheostomy on the incidence of catheter-related bloodstream infection in the catheterization of jugular vein by posterior access. Eur J Clin Microbiol Infect Dis 2011; 30:1049-51. [PMID: 21301912 DOI: 10.1007/s10096-011-1190-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 01/21/2011] [Indexed: 12/29/2022]
Abstract
There are no data about the influence of tracheostomy in the incidence of catheter-related bloodstream infection (CRBSI) on the catheterization of the jugular vein by posterior access and there are no recommendations relating to this circumstance in the guidelines of the Centers for Disease Control and Prevention (CDC) and of Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) for the prevention of CRBSI. The novel finding of this observational study was that there was a higher incidence of CRBSI in the catheterization of jugular vein by posterior access in patients with tracheostomy than without it (13.24 vs 0 episodes of CRBSI per 1,000 catheter-day; odds ratio = 23.92; 95% CI = 1.86-infinite; p = 0.008). Thus, the presence of tracheostomy is a risk factor of CRBSI on the catheterization of jugular vein by posterior access.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n La Cuesta, La Laguna, 38320 Santa Cruz de Tenerife, Spain.
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Farran Teixidor L, Viñals Viñals JM, Miró Martín M, Higueras Suñé C, Bettónica Larrañaga C, Aranda Danso H, López Ojeda A, Rafecas Renau A. Ileocoloplastia supercharged: una opción para reconstrucciones esofágicas complejas. Cir Esp 2011; 89:87-93. [DOI: 10.1016/j.ciresp.2010.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 11/24/2022]
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Lorente L, Martín MM, Solé-Violán J, Blanquer J, Labarta L, Díaz C, Borreguero-León JM, Páramo JA. Influence of TIMP-1/MMP-9 ratio on the severity and mortality in sepsis. Crit Care 2011. [PMCID: PMC3066951 DOI: 10.1186/cc9697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lorente L, Jiménez A, Martín MM, Palmero S, Jiménez JJ, Mora ML. Lower incidence of catheter-related bloodstream infection in subclavian venous access in the presence of tracheostomy than in femoral venous access: prospective observational study. Clin Microbiol Infect 2010; 17:870-2. [PMID: 21682804 DOI: 10.1111/j.1469-0691.2010.03406.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Guidelines for the prevention of catheter-related bloodstream infection (CRBSI) recommend subclavian rather than femoral venous access to minimize the risk of CRBSI. However, they do not address the issue of CRBSI with subclavian venous access in the presence of tracheostomy, where the incidence of CRBSI has been found to be higher than without tracheostomy. In this study, we found lower CRBSI in subclavian venous access in the presence of tracheostomy than in femoral venous access (3.9 vs. 10.1 CRBSI per 1000 catheter-days; odds ratio = 0.39; 95% confidence interval ≤0.001-0.91; p 0.03).
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Affiliation(s)
- L Lorente
- Intensive Care Unit Research Unit of the Hospital Universitario de Canarias, Tenerife, Spain
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19
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Lorente L, Jiménez A, Martín MM, Castedo J, Galván R, García C, Brouard MT, Mora ML. Influence of tracheostomy on the incidence of central venous catheter-related bacteremia. Eur J Clin Microbiol Infect Dis 2009; 28:1141-5. [PMID: 19370367 DOI: 10.1007/s10096-009-0742-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
Abstract
Although there are many studies on catheter-related infection, there are scarce data about the influence of tracheostomy in the incidence of central venous catheter-related bacteremia (CRB). In this cohort study, we found a higher incidence of CRB in patients with tracheostomy than without (11.25 vs. 1.43 per 1,000 catheter-days; odds ratio [OR] = 7.99; 95% confidence interval [CI] = 4.38-infinite; P < 0.001). Besides, we found a higher incidence of CRB in patients with tracheostomy using the jugular access compared to subclavian access (21.64 vs. 5.11 per 1,000 catheter-days; OR = 4.23; 95% CI = 1.44-infinite; P = 0.0097).
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n. La Cuesta, La Laguna, 38320 Santa Cruz de Tenerife, Spain.
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Lorente L, Galvan R, Martín M, García C, Huidobro S, Mora M. Crit Care 2003; 7:P138. [DOI: 10.1186/cc2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Lorente L, García C, Martín M, Galvan R, Villegas J, Mora M. Crit Care 2003; 7:P128. [DOI: 10.1186/cc2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Lorente L, Galvan R, Martín M, Málaga J, García C, Mora M. Crit Care 2003; 7:P142. [DOI: 10.1186/cc2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lorente L, Málaga J, Galván R, García C, Martín M, Mora M. Crit Care 2002; 6:P85. [DOI: 10.1186/cc1789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lorente L, Málaga J, Galván R, Martín M, Mora M. Crit Care 2002; 6:P74. [DOI: 10.1186/cc1777] [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: 11/10/2022] Open
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Abstract
This cross-sectional study was conducted on permanently disabled workers assisted by the Center for Occupational Rehabilitation (CRP) in Belo Horizonte, Minas Gerais, Brazil, to evaluate factors associated with their chances of readmission into the labor market. A logistic model was used to investigate workers' acceptance into the professional rehabilitation program and their return into the market. The most decisive factors for their acceptance were age, presence of repetitive strain injury (RSI), and educational level. The most favorable situation was that of workers with RSI under 40 years of age and with average schooling (75.6%). Results showed that young male workers with high educational levels were the ones with the best chances of rejoining the market (90.9%). A controversial issue relates to workers' acceptance and program results. In order to be accepted, the worker had to display a given age and educational profile. Workers with RSI had this profile, but once accepted they were the ones with the greatest difficulty in rejoining the work force. In addition, discrimination against female workers was observed, despite their characteristics being similar to those of males.
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Affiliation(s)
- R F Sampaio
- Departamento de Fisioterapia, EEF, Universidade Federal de Minas Gerais, Unidade Administrativa II, 2o. andar, Av. Antônio Carlos 6627, Pampulha, Belo Horizonte, MG 31270-901, Brasil
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Fuentes F, Izquierdo J, Martín MM, Gomez-Lus ML, Prieto J. Postanitbiotic and sub-MIC effects of azithromycin and isepamicin against Staphylococcus aureus and Escherichia coli. Antimicrob Agents Chemother 1998; 42:414-8. [PMID: 9527796 PMCID: PMC105424 DOI: 10.1128/aac.42.2.414] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Investigations of pharmacodynamic parameters (postantibiotic effect [PAE], sub-MIC effects [SMEs], etc.) have been progressively employed for the design of dosing schedules of antimicrobial agents. However, there are fewer in vivo than in vitro data, probably because of the simplicity of the in vitro procedures. In this study, we have investigated the in vitro PAE, SME, and previously treated (postantibiotic [PA]) SME (1/2 MIC, 1/4 MIC and 1/8 MIC) of azithromycin and isepamicin against standard strains of Staphylococcus aureus and Escherichia coli by using centrifugation to remove the antibiotics. In addition, the in vivo PAE and SME have been studied with the thigh infection model in neutropenic mice. Finally, in vivo killing curves with two dosing schedules were determined to examine whether the PAE can cover the time that antimicrobial agents are below the MIC. The two antimicrobial agents induced moderate-to-high in vitro PAEs, SMEs, and PA SMEs against S. aureus (>8 h) and E. coli (3.38 to >7.64 h). The in vivo PAEs were also high (from 3.0 to 3.6 h), despite the fact that isepamicin had lower times above the MIC in serum. Only azithromycin showed a high in vivo SME against the two strains (1.22 and 1.75 h), which indicated that the in vivo PAEs were possibly overestimated. In the killing kinetics, no great differences (<0.5 log10) were observed between the schedule that took the PAE into account and the continuous administration of doses. These results are comparable with those of other authors and suggest that these antimicrobial agents could be administered at longer intervals without losing effectiveness.
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Affiliation(s)
- F Fuentes
- Department of Microbiology, Faculty of Medicine, Complutense University of Madrid, Spain
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Fuentes F, Martín MM, Izquierdo J, Gomez-Lus ML, Prieto J. Pharmacodynamic effects of ciprofloxacin, fleroxacin and lomefloxacin in vivo and in vitro. Chemotherapy 1996; 42:354-62. [PMID: 8874975 DOI: 10.1159/000239467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The present study investigates the postantibiotic effect (PAE) in vivo, and the postantibiotic subinhibitory concentration effects (PA-SE) in vitro and SE in vivo of three 4-fluoroquinolones (ciprofloxacin, fleroxacin and lomefloxacin) against standard strains of Staphylococcus aureus and Escherichia coli. In vivo killing kinetics have also been performed using two different short administrations to study if the PAE duration could cover the time that the antibiotic was below the minimal inhibitory concentration (MIC) in serum. The results show that the three antimicrobial agents induced long PAEs (1.9-3.1 h) against the two microorganisms. Moderate but significant in vitro PA-SEs were also produced (1-->9 h). The in vivo SEs were not significant except when the effect of lomefloxacin on E. coli was assayed (0.54 h). Finally, the in vivo killing kinetics showed that the administrations that included the PAE duration were as effective as the schedule that maintained the antibiotic levels in serum above the MIC. Only when fleroxacin and S. aureus were assayed, this last administration was more effective (+0.9 log10 colony-forming units/thigh).
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Affiliation(s)
- F Fuentes
- Department of Microbiology, Faculty of Medicine, University Complutense of Madrid, Spain
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Fuentes F, Martín MM, Izquierdo J, Gomez-Lus ML, Prieto J. In vivo and in vitro study of several pharmacodynamic effects of meropenem. Scand J Infect Dis 1995; 27:469-74. [PMID: 8588137 DOI: 10.3109/00365549509047048] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Several pharmacodynamic parameters are being studied and applied to the design of dosage regimens. The thigh infection model in neutropenic mice has been used in this study to investigate the in vivo postantibiotic effect (PAE) of meropenem against S. aureus, E. coli and P. aeruginosa. The sub-minimum inhibitory concentration (sub-MIC) postantibiotic effect (PA SME) of 1/2, 1/4 and 1/8 x MIC was also determined in vitro on S. aureus and E. coli after pre-exposure of these microorganisms to 10 x MIC of meropenem. The in vitro PAE was also determined. In vivo killing curves using 2 different short dosage regimens were also studied to relate the lethal effect to the time that serum levels were above the MIC. No significant in vivo and in vitro PAEs were observed. The PA SMEs were higher for S. aureus than for E. coli. The 2 short dosage regimens, in vivo, were equally effective in killing S. aureus, but not E. coli. These results suggest that the pharmacodynamics of meropenem on Gram-negative strains may need further study to elucidate the mechanisms and characteristics of these parameters. On the other hand, we need to standardize a reliable in vitro method to monitor regrowth with a good correlation with the in vivo conditions.
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Affiliation(s)
- F Fuentes
- Department of Microbiology, Faculty of Medicine, Complutense University of Madrid, Spain
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