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Ruiz J, López-Vinardell L, Juanes A, Riera-Magallon A, Puig M, Mangues MA. Risk factors for emergency department revisit in elderly patients with gastrointestinal bleeding secondary to anticoagulant therapy. Eur J Hosp Pharm 2022; 29:271-274. [PMID: 33293283 PMCID: PMC9660616 DOI: 10.1136/ejhpharm-2020-002426] [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: 06/20/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the frequency of emergency department (ED) revisits among elderly patients with gastrointestinal bleeding secondary to anticoagulant treatment and identify factors associated with an increased risk of ED revisits. METHODS A 3-year retrospective observational study was designed, including elderly patients (≥65 years) with atrial fibrillation and undergoing oral anticoagulation therapy who visited the ED for gastrointestinal bleeding. To evaluate the risk factors for 30-day revisit, a multivariate analysis was designed including comorbidities, concomitant treatment, change in anticoagulant treatment and prescription of direct-acting oral anticoagulants. RESULTS 80 patients were included. At discharge, anticoagulation therapy was modified in 21 (26.2%) patients; and changed from an oral anticoagulant to heparin in 17 (21.2%) patients and to another oral anticoagulant in 4 (5.0%) patients. Anticoagulant treatment was withdrawn in 5 (6.3%) patients at discharge. Eleven (13.7%) patients revisited the ED 30 days after hospital discharge for bleeding episodes. No differences in the frequency of revisit to the ED were observed in the patients who changed their anticoagulant treatment at discharge. In the multivariate analysis, chronic kidney disease was the only factor significantly associated with revisits at 30 days. CONCLUSIONS Elderly patients who experience a first episode of gastrointestinal bleeding have a high risk of revisiting the ED for a bleeding episode, with no particular differences between the types of anticoagulant prescribed at discharge.
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Affiliation(s)
- Jesus Ruiz
- Pharmacy, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
| | | | - Ana Juanes
- Pharmacy, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
| | | | - Mireia Puig
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
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Falgàs A, Pallarès V, Unzueta U, Céspedes MV, Arroyo-Solera I, Moreno MJ, Sierra J, Gallardo A, Mangues MA, Vázquez E, Villaverde A, Mangues R, Casanova I. A CXCR4-targeted nanocarrier achieves highly selective tumor uptake in diffuse large B-cell lymphoma mouse models. Haematologica 2019; 105:741-753. [PMID: 31248974 PMCID: PMC7049335 DOI: 10.3324/haematol.2018.211490] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 11/19/2018] [Accepted: 06/26/2019] [Indexed: 12/22/2022] Open
Abstract
One-third of diffuse large B-cell lymphoma patients are refractory to initial treatment or relapse after rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy. In these patients, CXCR4 overexpression (CXCR4+) associates with lower overall and disease-free survival. Nanomedicine pursues active targeting to selectively deliver antitumor agents to cancer cells; a novel approach that promises to revolutionize therapy by dramatically increasing drug concentration in target tumor cells. In this study, we intravenously administered a liganded protein nanocarrier (T22-GFP-H6) targeting CXCR4+ lymphoma cells in mouse models to assess its selectivity as a nanocarrier by measuring its tissue biodistribution in cancer and normal cells. No previous protein-based nanocarrier has been described as specifically targeting lymphoma cells. T22-GFP-H6 achieved a highly selective tumor uptake in a CXCR4+ lymphoma subcutaneous model, as detected by fluorescent emission. We demonstrated that tumor uptake was CXCR4-dependent because pretreatment with AMD3100, a CXCR4 antagonist, significantly reduced tumor uptake. Moreover, in contrast to CXCR4+ subcutaneous models, CXCR4– tumors did not accumulate the nanocarrier. Most importantly, after intravenous injection in a disseminated model, the nanocarrier accumulated and internalized in all clinically relevant organs affected by lymphoma cells with negligible distribution to unaffected tissues. Finally, we obtained antitumor effect without toxicity in a CXCR4+ lymphoma model by administration of T22-DITOX-H6, a nanoparticle incorporating a toxin with the same structure as the nanocarrier. Hence, the use of the T22-GFP-H6 nanocarrier could be a good strategy to load and deliver drugs or toxins to treat specifically CXCR4-mediated refractory or relapsed diffuse large B-cell lymphoma without systemic toxicity.
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Affiliation(s)
- Aïda Falgàs
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau.,CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)
| | - Victor Pallarès
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau.,Department of Hematology, Hospital de la Santa Creu i Sant Pau
| | - Ugutz Unzueta
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau.,CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)
| | - María Virtudes Céspedes
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau.,CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)
| | - Irene Arroyo-Solera
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau.,CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)
| | - María José Moreno
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau
| | - Jorge Sierra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau.,Josep Carreras Research Institute
| | - Alberto Gallardo
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau.,Department of Pathology, Hospital de la Santa Creu i Sant Pau
| | | | - Esther Vázquez
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN) .,Institut de Biotecnologia i de Biomedicina, Universitat Autonoma de Barcelona.,Departament de Genètica i de Microbiologia, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Antonio Villaverde
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN).,Institut de Biotecnologia i de Biomedicina, Universitat Autonoma de Barcelona.,Departament de Genètica i de Microbiologia, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ramon Mangues
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau .,CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN).,Josep Carreras Research Institute
| | - Isolda Casanova
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau.,CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN).,Josep Carreras Research Institute
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3
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Arroyo-Solera I, Pavón MÁ, León X, López M, Gallardo A, Céspedes MV, Casanova I, Pallarès V, López-Pousa A, Mangues MA, Barnadas A, Quer M, Mangues R. Effect of serpinE1 overexpression on the primary tumor and lymph node, and lung metastases in head and neck squamous cell carcinoma. Head Neck 2018; 41:429-439. [PMID: 30548470 DOI: 10.1002/hed.25437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 11/30/2017] [Revised: 07/24/2018] [Accepted: 09/12/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Serpin Family E Member 1 (SerpinE1) overexpression associates with poor clinical outcome in head and neck squamous cell carcinoma (HNSCC) patients. This study analyzed the role of serpinE1 in HNSCC dissemination. METHODS We studied the phenotypic characteristics and dissemination of HNSCC cells overexpressing serpinE1 using an orthotopic model and the association between serpinE1 overexpression and clinicopathological variables in patients included in The Cancer Genome Atlas database. RESULTS SerpinE1 overexpression increased proliferation, tumor budding, and the stromal component, while inhibiting apoptosis in primary tumors. It also enhanced the affectation and metastatic growth in lymph nodes, and the dispersion and growth of metastatic foci in the lung. High serpinE1 expression was associated with larger tumor size, undifferentiated tumors, lymph node metastasis, extracapsular spread, and the presence of perineural and angiolymphatic invasion. CONCLUSION SerpinE1 overexpression promotes tumor aggressiveness and metastatic dissemination to lymph nodes and lung consistently with its association with poor outcome in HNSCC patients.
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Affiliation(s)
- Irene Arroyo-Solera
- Grup d'Oncogènesi i Antitumorals, lnstitut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Barcelona, Spain
| | - Miguel Ángel Pavón
- Infection and Cancer Laboratory. Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL and CIBER-ONC, Barcelona, Spain
| | - Xavier León
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Barcelona, Spain.,Department of Otorrinolaryngology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Montserrat López
- Department of Otorrinolaryngology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alberto Gallardo
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Virtudes Céspedes
- Grup d'Oncogènesi i Antitumorals, lnstitut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Barcelona, Spain
| | - Isolda Casanova
- Grup d'Oncogènesi i Antitumorals, lnstitut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Barcelona, Spain
| | - Víctor Pallarès
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio López-Pousa
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Barcelona, Spain.,Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Antonia Mangues
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Barcelona, Spain.,Department of Pharmacy, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Agustí Barnadas
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Miquel Quer
- Department of Otorrinolaryngology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ramón Mangues
- Grup d'Oncogènesi i Antitumorals, lnstitut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Barcelona, Spain
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4
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Céspedes MV, Unzueta U, Álamo P, Gallardo A, Sala R, Casanova I, Pavón MA, Mangues MA, Trías M, López-Pousa A, Villaverde A, Vázquez E, Mangues R. Cancer-specific uptake of a liganded protein nanocarrier targeting aggressive CXCR4 + colorectal cancer models. Nanomedicine: Nanotechnology, Biology and Medicine 2016; 12:1987-1996. [DOI: 10.1016/j.nano.2016.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/28/2016] [Accepted: 04/06/2016] [Indexed: 01/22/2023]
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Alamo P, Gallardo A, Di Nicolantonio F, Pavón MA, Casanova I, Trias M, Mangues MA, Lopez-Pousa A, Villaverde A, Vázquez E, Bardelli A, Céspedes MV, Mangues R. Higher metastatic efficiency of KRas G12V than KRas G13D in a colorectal cancer model. FASEB J 2014; 29:464-76. [PMID: 25359494 DOI: 10.1096/fj.14-262303] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although all KRas (protein that in humans is encoded by the KRas gene) point mutants are considered to have a similar prognostic capacity, their transformation and tumorigenic capacities vary widely. We compared the metastatic efficiency of KRas G12V (Kirsten rat sarcoma viral oncogene homolog with valine mutation at codon 12) and KRas G13D (Kirsten rat sarcoma viral oncogene homolog with aspartic mutation at codon 13) oncogenes in an orthotopic colorectal cancer (CRC) model. Following subcutaneous preconditioning, recombinant clones of the SW48 CRC cell line [Kras wild-type (Kras WT)] expressing the KRas G12V or KRas G13D allele were microinjected in the mouse cecum. The percentage of animals developing lymph node metastasis was higher in KRas G12V than in KRas G13D mice. Microscopic, macroscopic, and visible lymphatic foci were 1.5- to 3.0-fold larger in KRas G12V than in KRas G13D mice (P < 0.05). In the lung, only microfoci were developed in both groups. KRas G12V primary tumors had lower apoptosis (7.0 ± 1.2 vs. 7.4 ± 1.0 per field, P = 0.02), higher tumor budding at the invasion front (1.2 ± 0.2 vs. 0.6 ± 0.1, P = 0.04), and a higher percentage of C-X-C chemokine receptor type 4 (CXCR4)-overexpressing intravasated tumor emboli (49.8 ± 9.4% vs. 12.8 ± 4.4%, P < 0.001) than KRas G13D tumors. KRas G12V primary tumors showed Akt activation, and β5 integrin, vascular endothelial growth factor A (VEGFA), and Serpine-1 overexpression, whereas KRas G13D tumors showed integrin β1 and angiopoietin 2 (Angpt2) overexpression. The increased cell survival, invasion, intravasation, and specific molecular regulation observed in KRas G12V tumors is consistent with the higher aggressiveness observed in patients with CRC expressing this oncogene.
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Affiliation(s)
- Patricia Alamo
- Oncogenesis and Antitumor Drug Group, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain
| | - Alberto Gallardo
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain; Department of Pathology, Clínica Girona, Girona, Spain
| | - Federica Di Nicolantonio
- Department of Oncology, University of Torino, Torino, Italy; Candiolo Cancer Institute-Fondazione del Piemonte per l'Oncologia, Istituto Di Ricovero e Cura a Carattere Scientifico, Torino, Italy
| | - Miguel Angel Pavón
- Oncogenesis and Antitumor Drug Group, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain
| | - Isolda Casanova
- Oncogenesis and Antitumor Drug Group, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain
| | - Manuel Trias
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain; Departments of General and Digestive Surgery
| | | | - Antonio Lopez-Pousa
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain; Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Villaverde
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain; Institut de Biotecnologia i de Biomedicina, and
| | - Esther Vázquez
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain; Institut de Biotecnologia i de Biomedicina, and
| | - Alberto Bardelli
- Department of Oncology, University of Torino, Torino, Italy; Candiolo Cancer Institute-Fondazione del Piemonte per l'Oncologia, Istituto Di Ricovero e Cura a Carattere Scientifico, Torino, Italy; Department de Genètica i de Microbiologia, Universitat Autònoma de Barcelona, Barcelona, Spain; and FIRC Institute of Molecular Oncology, Milan, Italy
| | - María Virtudes Céspedes
- Oncogenesis and Antitumor Drug Group, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain
| | - Ramón Mangues
- Oncogenesis and Antitumor Drug Group, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain;
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Fonts N, Moreno ME, Anguera G, Pallarès MC, Mangues MA. PKP-002 Severe hepatotoxicity in a patient treated with chemotherapy and phytotherapy: a case report. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Garin N, de Pourcq JT, Cardona D, Martín-Venegas R, Gich I, Cardenete J, Mangues MA. [Viscosity changes in thickened water due to the addition of highly prescribed drugs in geriatrics]. NUTR HOSP 2013; 27:1298-303. [PMID: 23165577 DOI: 10.3305/nh.2012.27.4.5838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 03/27/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Dysphagia is a swallowing disorder with a high incidence in the geriatric patient related with an increased risk for undernutrition and pneumonia due to bronchial aspiration. In this condition, it is usual to add commercial thickeners in liquids, as well as the addition of drugs in this mixture to improve their administration. However, there are no studies regarding the possible change in viscosity produced by their addition. OBJECTIVES To assess the change in viscosity of water thickened with commercial products by adding the drugs frequently used in elderly patients. METHODS Samples of water mixed with the commercial thickener Resource (modified corn starch) or Nutilis (modified corn starch, maltodextrin, and gums: tara, xhantan, and guar) to achieve an intermediate consistence as "honey". The viscosity of these samples was measured as well as for similar samples to which one of the following drugs was added: galantamine, rivastigmin, ciprofloxacin, cholecalciferol, memantine, fosfomycin, calcium, and amoxicillin/clavulanic acid. RESULTS In the samples with Resource thickener we observed decreased viscosity by adding galantamine, memantine, fosfomycin or calcium, and increased viscosity with amoxicillin/clavulanic acid. The viscosity of the samples with Nutilis® decreased with galantamine, rivastigmine, amoxicillin/clavulanic acid, fosfomycin and calcium. CONCLUSION The viscosity of water with commercial thickeners may be affected by some drugs or their preservatives, which may influence the swallowing capability. It is recommended to perform further in vitro and in vivo studies in order to adjust these formulations if necessary.
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Affiliation(s)
- N Garin
- Servicio de Farmacia, Hospital de Santa Creu i Sant Pau, Barcelona, España.
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8
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Pavón MA, Parreño M, Téllez-Gabriel M, Sancho FJ, López M, Céspedes MV, Casanova I, Lopez-Pousa A, Mangues MA, Quer M, Barnadas A, León X, Mangues R. Gene expression signatures and molecular markers associated with clinical outcome in locally advanced head and neck carcinoma. Carcinogenesis 2012; 33:1707-16. [PMID: 22696598 DOI: 10.1093/carcin/bgs207] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study was to identify molecular markers associated with tumor recurrence and survival in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). We studied the expression profile of 63 pre-treatment tumor biopsies obtained from locally advanced HNSCCs treated with standard treatments. Cluster analysis identified three tumor subtypes associated with significant differences in local recurrence-free survival (LRFS) (P<0.001), progression free-survival (PFS) (P<0.009) and overall survival (OS) (P<0.004). Tumor subtype 1, associated with short LRFS, PFS and OS, showed features of epithelial-mesenchymal transition and undifferentiation. It also overexpressed genes involved in cell adhesion, NF-κB and integrin signalling. Tumor subtype 3, associated with longer LRFS, PFS and OS, showed a high degree of differentiation and overexpressed genes located in chromosomal regions 19q13 and 1q21. Tumor subtype 2, which had an intermediate clinical outcome between subtype 1 and subtype 3, overexpressed genes involved in branching morphogenesis. Finally, we validated the association between gene cluster classification and patient survival using Gene Set Enrichment Analysis and two HNSCC data sets obtained from two independent patient cohorts. In conclusion, we generated a gene prognostic signature associated with survival in locally advanced patients using the expression profile of the pre-treatment tumor biopsy. Independent prospective studies would be necessary to assess if the proposed survival signature could help to guide clinical management of HNSCC.
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Affiliation(s)
- M A Pavón
- Grup d'Oncogènesi i Antitumorals, Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain
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Clopés A, Sureda A, Sierra J, Queraltó JM, Broto A, Farré R, Moreno E, Brunet S, Martino R, Mangues MA. Absence of veno-occlussive disease in a cohort of multiple myeloma patients undergoing autologous stem cell transplantation with targeted busulfan dosage. Eur J Haematol 2006; 77:1-6. [PMID: 16573745 DOI: 10.1111/j.0902-4441.2006.t01-1-ejh2478.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Plasma concentrations of oral busulfan (BU) were measured in multiple myeloma (MM) patients undergoing autologous peripheral blood stem cell transplantation (ASCT) with a double alkylating conditioning protocol in order to individualise doses of BU based on individual pharmacokinetic parameters and to reduce toxicities related to BU exposure. PATIENTS AND METHODS Forty-four consecutive patients with MM participating in the co-operative Spanish protocol were prospectively evaluated. Conditioning regimen prior to autologous infusion consisted of BU followed by melphalan. BU pharmacokinetic parameters were estimated for each patient after the first dose based on measured concentrations and subsequent doses were modified as necessary to achieve target exposure. RESULTS Mean BU exposure (AUCss) (+/-DS) before dosage modification range from 3192 to 12 180 ng h/mL. Twenty-six out of 44 (59%) patients required dose adjustment. None of the patients developed hepatic veno-occlusive disease (VOD). Grade > or = II oropharyngeal mucositis was observed in the majority of patients (95%) and the severity of mucositis increased with increasing average steady-state BU plasma concentration. There were four treatment-related deaths: two patients died from multiorgan failure and two of respiratory infections. Of the remaining 40 patients, 15 were in complete remission with negative immunofixation, 21 in partial remission and four in stable disease 3 months after ASCT. CONCLUSIONS The results of the present study show the variability in BU pharmacokinetic parameters and suggest the possible relationship between toxicities and BU exposure. Individualising BU dosage in MM patients undergoing ASCT we observed the absence of VOD.
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Affiliation(s)
- A Clopés
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Montejo O, Alba G, Cardona D, Estelrich J, Mangues MA. [Relation between the viscosity of enteral diets and mechanical complications in their administration according to the nasogastric catheters]. NUTR HOSP 2001; 16:41-5. [PMID: 11443832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
OBJECTIVE The use of enteral nutrition has increased enormously over the last few years and at the same time the standard indications for parenteral nutrition, whether in hospitals or at home, have gradually been defined. The most common way to administer enteral nutrition is intermittently and using gravity, through a nasogastric catheter or through gastrostomy. In our daily practice it has been observed that there was at times a considerable delay in the administration of the diet by means of a nasogastric catheter and the tube was sometimes blocked due to its small calibre and/or the excessive viscosity of the formula. It was therefore proposed to study the viscosities of polymeric enteral diets with and without fibre at this hospital to identify the relationship with the time taken for their intermittent, gravity-driven administration through different calibres of nasogastric catheter at the maximum flow rate. RESULTS Some of the enteral diets under study exceeded the recommended time for intermittent administration by gravity (20-40 minutes). CONCLUSIONS We feel it is essential for the product label to provide information on the optimal calibre of the nasogastric catheter required for administration of the product.
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Affiliation(s)
- O Montejo
- Servicio de Farmacia, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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Kádár E, Sureda A, Mangues MA, Inglés-Esteve J, Valls A, García J. Serum levels of G-CSF, IL-3, IL-6 and GM-CSF after a single intraperitoneal dose of rhG-CSF in lethally irradiated B6D2F1 mice. Acta Haematol 1997; 98:119-24. [PMID: 9352740 DOI: 10.1159/000203604] [Citation(s) in RCA: 8] [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: 02/05/2023]
Abstract
The objective of this study was to assess the pharmacokinetics of rhG-CSF after a single intraperitoneal injection 2 h post-TBI in B6D2F1 lethally irradiated mice and to analyze the effect of rhG-CSF on the endogenous response of interleukin-3 (IL-3), interleukin-6 (IL-6) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in these animals. For comparison, these cytokine serum levels have also been measured in nonirradiated mice. The serum concentrations of rhG-CSF in irradiated mice were higher than in nonirradiated mice at all time points during the first 60 min after injection. Furthermore, rhG-CSF administration failed to induce detectable endogenous serum levels of IL-3, IL-6 and GM-CSF, at least in the 72-hour period after administration of the rhG-CSF. The radioprotective effect of rhG-CSF in lethally irradiated mice is not mediated by an increase in endogenous serum levels of these three cytokines.
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Affiliation(s)
- E Kádár
- Departament de Criobiologia i Teràpia Cellular, Hospital Duran i Reynals, Barcelona, Spain
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Garcia-Capdevila L, López-Calull C, Arroyo C, Moral MA, Mangues MA, Bonal J. Determination of imipenem in plasma by high-performance liquid chromatography for pharmacokinetic studies in patients. J Chromatogr B Biomed Sci Appl 1997; 692:127-32. [PMID: 9187391 DOI: 10.1016/s0378-4347(96)00498-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A rapid and simple HPLC method is described for the determination of imipenem in human plasma. After blood collection, plasma was separated by centrifugation and immediately stabilized with 3-morpholinopropanesulfonic acid (MOPS) and ethylene glycol solution (1:1). The sample preparation, before injection into HPLC, was ultrafiltration. The mobile phase was boric acid buffer. The imipenem was detected at 300 nm and cilastatin sodium, coadministered, did not interfere. Calibration curves in human plasma were linear from 0.1 to 100 microg/ml. The limit of detection was 0.030 microg/ml. Inter-day precision at 0.1 microg/ml, determined as the coefficient of variation, was 6.26%. Only 250 microl of plasma was required in our assay. Due to the limited stability of imipenem [G.B. Smith et al., J. Pharm. Sci., 79 (1990) 732], stability studies in plasma were done to establish appropriate storage conditions. The assay was applied to pharmacokinetic studies in patients.
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Abstract
Theophylline is widely prescribed in Spain. Because this drug has a narrow therapeutic range and high interindividual pharmacokinetic variability, it is essential to adapt the dosage to each patient. In order to simplify the drug individualization we are proposing three algorithms to apply to intravenous loading and maintenance doses and to oral doses. The initial recommended dosages have been established using the pharmacokinetic parameters obtained from patients treated with theophylline in our hospital. Because the pharmacokinetic behavior of theophylline may be different in other populations, dosage requirements may not be the same. A minimum number of blood sample collections is proposed in an attempt to improve the cost-benefit relationship in theophylline therapy.
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Affiliation(s)
- M A Mangues
- Clinical Pharmacokinetics Section, Hospital Sta. Creu i St. Pau, Barcelona, Spain
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Binimelis J, Bassas L, Marruecos L, Rodriguez J, Domingo ML, Madoz P, Armengol S, Mangues MA, de Leiva A. Massive thyroxine intoxication: evaluation of plasma extraction. Intensive Care Med 1987; 13:33-8. [PMID: 3558934 DOI: 10.1007/bf00263555] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Six patients were admitted after erroneous massive intake of levothyroxine (70-1200 mg over an interval of 2-12 days). All patients developed classical symptoms of thyrotoxicosis within 3 days of the first dose; five patients presented grade II-III coma and one became stuporous (days 7-10). Two patients developed left ventricular failure and three had arrhythmias (days 8-11). Total thyroid hormone levels in serum on admission ranged 935-7728 nmol/l for T4 (TT4) and 23-399 nmol/l for T3 (TT3). All patients received treatment with hydrocortisone and Propranolol. Propylthiouracil was also given in 3 cases. Extractive techniques (charcoal haemoperfusion and/or plasmapheresis) were initiated 8-14 days after the first dose of L-T4. The plasma disappearance rate (K) of TT4 with plasmapheresis was 30 times higher, on average, than under standard medical treatment (M). Also, K of TT4 under haemoperfusion was about five times higher than K under M. K changes for TT3 were higher under haemoperfusion than under plasmapheresis. Furthermore, extractive procedures shortened the average half life of TT4, (from 106.5 +/- 44.6 to 59.7 +/- 20.2 h, p less than 0.05).
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Mangues MA, Pérez C, Castellano A, Bonal J. [Increase in the clearance of theophylline with activated carbon]. Med Clin (Barc) 1986; 87:306. [PMID: 3762259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Puig I, Mangues MA, Torras A, Canals MP, Cubells J, Arcelus R, Farré R, Bonal J. [Effectiveness of rectal metromidazole in acute infantile appendicitis]. An Esp Pediatr 1986; 25:161-4. [PMID: 3789549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Thirty two consecutive children who underwent surgery for suspected acute appendicitis, were treated with prophylactic metronidazole suppositories. A serum sample was taken at surgery to determine the serum concentration of the drug. After a preoperative dose of 15-20 mg/kg the minimal bactericidal concentration was achieved in almost all cases at the time of anesthetic induction. This drug showed an optimal biodisponibility when used rectally and no side-effects was noted. Neither a wound-infection, nor a wound-sepsis was reported and a satisfactory outcome was registered. We conclude that rectal dosing with metronidazole is effective for prophylactic wound infection in acute appendicitis.
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