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Joven B, Manteca CF, Rubio E, Raya E, Pérez A, Hernández R, Manrique S, Núñez M, Díaz-Cerezo S, Moyano S, Lacetera A, García-Vicuña R. Real-World Persistence and Treatment Patterns in Patients with Psoriatic Arthritis Treated with Anti-IL17 Therapy in Spain: The PerfIL-17 Study. Adv Ther 2023; 40:5415-5431. [PMID: 37804475 PMCID: PMC10611868 DOI: 10.1007/s12325-023-02693-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Given the growing interest and use of interleukin-17 inhibitors (anti-IL17) for the treatment of psoriatic arthritis (PsA), an observational study has been conducted to characterize the patient profile, treatment patterns, and persistence of ixekizumab or secukinumab in patients with PsA receiving them as first anti-IL17. METHODS This is a multicenter retrospective study, conducted at eight Spanish hospitals where data from adult patients with PsA were collected from electronic medical records. Three cohorts of patients, initiating treatment with an anti-IL17 [secukinumab 150 mg (SECU150), secukinumab 300 mg (SECU300), or ixekizumab (IXE)] between January 2019 and March 2021, were included. Demographic and clinical patient characteristics, treatment patterns, and persistence were analyzed descriptively. Continuous data were presented as mean [standard deviation (SD)] and categorical variables as frequencies with percentages. Persistence rates at 3, 6, and 12 months were calculated. RESULTS A total of 221 patients with PsA were included in the study [SECU150, 103 (46.6%); SECU300, 38 (17.2%); and IXE, 80 (36.2%)]. Treatment patterns differed by clinical characteristics: SECU150 was initiated more frequently in patients with moderate PsA and less peripheral joint involvement, while patients on SECU300 included those with a higher rate of enthesitis and active skin psoriasis, and patients on IXE showed a longer time since PsA diagnosis, more frequent comorbidities, joint involvement, and diagnosed skin psoriasis. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) were previously administered in 88.2% of patients and biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) were administered in 72.9%. The mean number of previous b/tsDMARDs was 2.4 (SD 1.5) in the IXE cohort, 1.7 (SD 0.9) in the SECU300 cohort, and 1.6 (SD 1.0) for those in the SECU150 cohort. The global persistence on all anti-IL17 was 97.2%, 88.4%, and 81.0% at 3, 6, and 12 months, respectively. The most frequent reason for discontinuation across the three cohorts was lack of effectiveness (16.7%; 37/221). CONCLUSIONS Most of the patients with PsA treated with anti-IL17 in Spain had moderate to severe disease activity, high peripheral joint and skin involvement, and had received previous b/tsDMARDs. More than 80% of patients with a 1-year follow-up persisted on anti-IL17, with the highest rate observed in the IXE cohort, followed by the SECU150 then SECU300 cohorts.
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Affiliation(s)
- Beatriz Joven
- Rheumatology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Esteban Rubio
- Rheumatology Department, Hospital Virgen del Rocío, Seville, Spain
| | - Enrique Raya
- Rheumatology Department, Hospital Universitario Clínico San Cecilio de Granada, Granada, Spain
| | - Alba Pérez
- Rheumatology and Traumatology Department Hospital Puerta del Mar, Cádiz, Spain
| | - Raquel Hernández
- Rheumatology Department, Hospital Universitario de Valme, Seville, Spain
| | - Sara Manrique
- Rheumatology Department, Hospital Carlos Haya, Málaga, Spain
| | - Mercedes Núñez
- Medical Department, Eli Lilly and Company, Av. de la Industria, 30, Alcobendas, 28108, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Medical Department, Eli Lilly and Company, Av. de la Industria, 30, Alcobendas, 28108, Madrid, Spain.
| | - Sebastián Moyano
- Medical Department, Eli Lilly and Company, Av. de la Industria, 30, Alcobendas, 28108, Madrid, Spain
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Pascual J, Núñez M, Panni T, Díaz-Cerezo S, Novick D, Ciudad A. Burden and Unmet Needs in Migraine Patients: Results from the OVERCOME (Spain) Study. Pain Ther 2023; 12:1209-1220. [PMID: 37458965 PMCID: PMC10444706 DOI: 10.1007/s40122-023-00538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/16/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION This analysis aimed to evaluate demographics, migraine-related disability, symptoms, diagnosis and healthcare consultation, work productivity, and treatment patterns according to headache frequency in adults with migraine in the OVERCOME (ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE) (Spain) study. METHODS Data were obtained from an observational, cross-sectional, web-based survey conducted between October 2020-February 2021 in Spain. Eligible participants were adult members of online survey panels living in Spain who were able to read and write Spanish and fulfilled the International Classification of Headache Disorders, third edition (ICHD-3) criteria for migraine or had a self-reported physician diagnosis. RESULTS In total, 10,229 patients comprised the Spanish sample. Only 56.2% of respondents had a confirmed healthcare professional (HCP) diagnosis of migraine, despite almost all meeting modified ICHD-3 criteria. Pain severity, migraine-related disability, and interictal burden increased with increasing number of headache days per month. Migraine impacted on respondents' work productivity, with increases in presenteeism, work productivity loss, and daily activity impairment at higher headache frequencies. Over the past year, 66.2% of all HCP visits were specifically due to migraine, most commonly with a general practitioner or pharmacist. A subgroup of 1277 patients (12.5% of the total survey population) met eligibility criteria for migraine preventive medications, of whom only 36.6% were currently taking a preventive. CONCLUSIONS Results of the OVERCOME (Spain) survey reveal the substantial burden of migraine, which is directly linked to headache frequency. However, most patients experiencing frequent headaches and eligible for migraine preventives are currently not taking them. Findings highlight the importance of addressing unmet needs for people with migraine in Spain.
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Affiliation(s)
- Julio Pascual
- Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Mercedes Núñez
- Eli Lilly and Company, Avenida de La Industria 30, Alcobendas, 28108, Madrid, Spain.
| | | | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avenida de La Industria 30, Alcobendas, 28108, Madrid, Spain
| | | | - Antonio Ciudad
- Eli Lilly and Company, Avenida de La Industria 30, Alcobendas, 28108, Madrid, Spain
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Joven B, Hernández Sánchez R, Pérez-Pampín E, Aragón Díez Á, Almodóvar R, Martínez-Ferrer Á, Belzunegui J, Rubio E, Díaz-Cerezo S, Moyano S, Gómez-Barrera M, Yébenes M, Núñez M. Persistence and Use of Ixekizumab in Patients with Psoriatic Arthritis in Real-World Practice in Spain. The PRO-STIP Study. Rheumatol Ther 2023; 10:1319-1333. [PMID: 37481752 PMCID: PMC10468471 DOI: 10.1007/s40744-023-00584-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Ixekizumab (IXE) is an IgG4-type monoclonal antibody targeting IL-17A indicated alone or in combination with methotrexate, for the treatment of active psoriatic arthritis (PsA) in adult patients with insufficient response or with intolerance to one or more disease-modifying anti-rheumatic drug (DMARD) therapy. The PRO-STIP study aimed to describe persistence, patient characteristics, treatment patterns, and effectiveness in patients with PsA receiving IXE in a real-world clinical setting in Spain. METHODS This was an observational, multicentric, retrospective, longitudinal study in adult PsA patients who started IXE between January 2019 and December 2020, with at least 24 weeks of follow-up. A descriptive analysis of patient characteristics and treatment patterns was performed. The primary objective, treatment persistence, was estimated by Kaplan-Meier survival curve. Effectiveness was evaluated by Disease Activity in Psoriatic Arthritis (DAPSA) scores at baseline and at 12 and 24 weeks. RESULTS Eighty-nine patients met the selection criteria (55.1% women and mean age 51.5 years). The median time from PsA diagnosis to starting IXE was 7.7 years (IQR 3.4-14.6). Prior to IXE, 95.5% patients had been treated with at least one biologic or targeted synthetic DMARD (b/tsDMARD). The observed persistence rates were 95.5%, 84.3% and 68.5% at 24, 48, and 104 weeks, respectively. The median persistence was not reached in the study period (mean persistence, 86.9 [95% CI 80.6-93.2] weeks). Twenty-eight (31.5%) patients discontinued IXE, 19 patients (21.3%) due to loss of effectiveness and two patients (2.2%) due to adverse events. In patients receiving treatment and with available effectiveness assessment (n = 24), DAPSA decreased significantly from baseline 23.7 (95% CI 19.5-27.9) to 14.8 (95% CI 10.5-19.2) at 12 weeks (p = 0.005) and 14.3 (95% CI 11.1-17.4) at 24 weeks (p = 0.004). CONCLUSIONS PsA patients treated with IXE in a real-world setting show high treatment persistence through 104 weeks and improvements in disease activity after treatment initiation. This suggests that IXE could be an effective treatment for patients with PsA. RETROSPECTIVELY REGISTERED Date of registration: 25th May 2021.
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Affiliation(s)
- Beatriz Joven
- Hospital Universitario, 12 de Octubre, Madrid, Spain
| | | | - Eva Pérez-Pampín
- Hospital Clínico Universitario Santiago, Santiago de Compostela, Spain
| | | | | | | | | | - Esteban Rubio
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Manuel Gómez-Barrera
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, Spain
| | - María Yébenes
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, Spain
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Porta-Etessam J, Santos-Lasaosa S, Rodríguez-Vico J, Núñez M, Ciudad A, Díaz-Cerezo S, Comellas M, Pérez-Sádaba FJ, Lizán L, Guerrero-Peral AL. Evaluating the Impact of a Training Program in Shared Decision-Making for Neurologists Treating People with Migraine. Neurol Ther 2023; 12:1319-1334. [PMID: 37310593 PMCID: PMC10310651 DOI: 10.1007/s40120-023-00495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/09/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Migraine symptoms vary significantly between patients and within the same patient. Currently, an increasing number of therapeutic options are available for symptomatic and preventive treatment. Guidelines encourage physicians to use shared decision-making (SDM) in their practice, listening to patients' treatment preferences in order to select the most suitable and effective therapy. Although training for healthcare professionals could increase their awareness of SDM, results concerning its effectiveness are inconclusive. This study aimed to analyze the impact of a training activity to promote SDM in the context of migraine care. This was addressed by evaluating the impact on patients' decisional conflict (main objective), patient-physician relationship, neurologists' perceptions of the training and patient's perception of SDM. METHODS A multicenter observational study was conducted in four highly specialized headache units. The participating neurologists received SDM training targeting people with migraine in clinical practice to provide techniques and tools to optimize physician-patient interactions and encourage patient involvement in SDM. The study was set up in three consecutive phases: control phase, in which neurologists were blind to the training activity and performed the consultation with the control group under routine clinical practice; training phase, when the same neurologists participated in the SDM training; and SDM phase, in which these neurologists performed the consultation with the intervention group after the training. Patients in both groups with a change of treatment assessment during the visit completed the Decisional conflict scale (DCS) after the consultation to measure the patient's decisional conflict. Also, patients answered the patient-doctor relationship questionnaire (CREM-P) and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). The mean ± SD scores obtained from the study questionnaires were calculated for both groups and compared to determine whether there were significant differences (p < 0.05). RESULTS A total of 180 migraine patients (86.7% female, mean age of 38.5 ± 12.3 years) were included, of which 128 required a migraine treatment change assessment during the consultation (control group, n = 68; intervention group, n = 60). A low decisional conflict was found without significant differences between the intervention (25.6 ± 23.4) and control group (22.1 ± 17.9; p = 0.5597). No significant differences in the CREM-P and SDM-Q-9 scores were observed between groups. Physicians were satisfied with the training and showed greater agreement with the clarity, quality and selection of the contents. Moreover, physicians felt confident communicating with patients after the training, and they applied the techniques and SDM strategies learned. CONCLUSION SDM is a model currently being actively used in clinical practice for headache consultation, with high patient involvement in the process. This SDM training, while useful from the physician's perspective, may be more effective at other levels of care where there is still room for optimization of patient involvement in decision-making.
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Affiliation(s)
- J Porta-Etessam
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - S Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | | | | | | | - L Lizán
- Outcomes'10, Castellón, Spain.
- Department of Medicine, Jaume I University, Av. Sos Baynat s/n, 12071, Castellón, Spain.
| | - A L Guerrero-Peral
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
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Irimia P, García-Azorín D, Núñez M, Díaz-Cerezo S, de Polavieja PG, Panni T, Sicras-Navarro A, Sicras-Mainar A, Ciudad A. Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC study. J Headache Pain 2022; 23:78. [PMID: 35794535 PMCID: PMC9261063 DOI: 10.1186/s10194-022-01448-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/23/2022] [Indexed: 01/03/2023] Open
Abstract
Background Migraine represents a serious burden for national health systems. However, preventive treatment is not optimally applied to reduce the severity and frequency of headache attacks and the related expenses. Our aim was to assess the persistence to traditional migraine prophylaxis available in Spain and its relationship with the healthcare resource use (HRU) and costs. Methods Retrospective observational study with retrospective cohort design of individuals with migraine treated with oral preventive medication for the first time from 01/01/2016 to 30/06/2018. One-year follow-up information was retrieved from the Big-Pac™ database. According to their one-year persistence to oral prophylaxis, two study groups were created and describe regarding HRU and healthcare direct and indirect costs using 95% confidence intervals (CI). The analysis of covariance (ANCOVA) was performed as a sensitivity analysis. Patients were considered persistent if they continued on preventive treatment until the end of the study or switched medications within 60 days or less since the last prescription. Non-persistent were those who permanently discontinued or re-initiated a treatment after 60 days. Results Seven thousand eight hundred sixty-six patients started preventive treatment (mean age (SD) 48.2 (14.8) and 80.4% women), of whom 2,545 (32.4%) were persistent for 6 months and 2,390 (30.4%) for 12 months. Most used first-line preventive treatments were antidepressants (3,642; 46.3%) followed by antiepileptics (1,738; 22.1%) and beta-blockers (1,399; 17.8%). The acute treatments prescribed concomitantly with preventives were NSAIDs (4,530; 57.6%), followed by triptans (2,217; 28.2%). First-time preventive treatment prescribers were mostly primary care physicians (6,044; 76.8%) followed by neurologists (1,221; 15.5%). Non-persistent patients required a higher number of primary care visits (mean difference (95%CI): 3.0 (2.6;3.4)) and days of sick leave (2.7 (0.8;4.5)) than the persistent ones. The mean annual expenditure was €622 (415; 829) higher in patients who not persisted on migraine prophylactic treatment. Conclusions In this study, we observed a high discontinuation rate for migraine prophylaxis which is related to an increase in HRU and costs for non-persistent patients. These results suggest that the treatment adherence implies not only a clinical benefit but also a reduction in HRU and costs. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01448-2.
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Affiliation(s)
- Pablo Irimia
- Department of Neurology, Headache Unit, University Clinic of Navarra, Av. Pio XII 36, 31008, Pamplona, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Mercedes Núñez
- Lilly Spain, Av. de la Industria 30, 28108, Madrid, Spain.
| | | | | | - Tommaso Panni
- Lilly Deutschland GmbH, Werner-Reimers-Strasse 2-4, 61352, Bad Homburg, Germany
| | | | | | - Antonio Ciudad
- Lilly Spain, Av. de la Industria 30, 28108, Madrid, Spain
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Hernández-Cruz B, Rosas J, Díaz-Torné C, Belzunegui J, García-Vicuña R, Inciarte-Mundo J, Pons A, Millán AM, Jeria-Navarro S, Valero JA, García-Castañeda N, Valero C, Llorente I, Calvo A, Díaz-Cerezo S, Núñez M. Correction to: Real-world Treatment Patterns and Clinical Outcomes of Baricitinib in Rheumatoid Arthritis patients in Spain: Results of a multicenter, observational study in routine clinical practice (The ORBIT-RA Study). Rheumatol Ther 2022; 9:1245-1246. [PMID: 35653064 PMCID: PMC9314490 DOI: 10.1007/s40744-022-00463-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Blanca Hernández-Cruz
- Rheumatology Department, University Hospital Virgen Macarena, Calle Dr. Fedriani, 3, 41009, Seville, Spain.
| | - José Rosas
- Rheumatology Department, Marina Baixa Hospital, Av. Alcalde En Jaume Botella Mayor, 7, Villajoyosa, 03570, Alicante, Spain
| | - César Díaz-Torné
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Santa Creu I Sant Pau Hospital, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Joaquín Belzunegui
- Rheumatology Department, Donostia University Hospital, Begiristain Doktorea Pasealekua, 20014, Guipúzcoa, Spain
| | - Rosario García-Vicuña
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - José Inciarte-Mundo
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Ana Pons
- Rheumatology Department, Marina Baixa Hospital, Av. Alcalde En Jaume Botella Mayor, 7, Villajoyosa, 03570, Alicante, Spain
| | - Ana M Millán
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Santa Creu I Sant Pau Hospital, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Sicylle Jeria-Navarro
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Santa Creu I Sant Pau Hospital, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Jesús A Valero
- Rheumatology Department, Donostia University Hospital, Begiristain Doktorea Pasealekua, 20014, Guipúzcoa, Spain
| | - Noelia García-Castañeda
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Cristina Valero
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Irene Llorente
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Alberto Calvo
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Medical Department, Lilly Spain, Av de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Mercedes Núñez
- Medical Department, Lilly Spain, Av de la Industria 30, Alcobendas, 28108, Madrid, Spain
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Hernández-Cruz B, Rosas J, Díaz-Torné C, Belzunegui J, García-Vicuña R, Inciarte-Mundo J, Pons A, Millán AM, Jeria-Navarro S, Valero JA, García-Castañeda N, Valero C, Llorente I, Calvo A, Díaz-Cerezo S, Núñez M. Real-World Treatment Patterns and Clinical Outcomes of Baricitinib in Rheumatoid Arthritis Patients in Spain: Results of a Multicenter, Observational Study in Routine Clinical Practice (The ORBIT-RA Study). Rheumatol Ther 2022; 9:589-608. [PMID: 35041155 PMCID: PMC8964893 DOI: 10.1007/s40744-021-00423-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Baricitinib is an oral Janus kinase (JAK)1/JAK2 inhibitor approved to treat rheumatoid arthritis (RA). This study aimed to investigate patients' characteristics, prescription patterns, effectiveness, and treatment persistence in patients receiving baricitinib in real-world practice in Spain. METHODS This retrospective longitudinal cohort study conducted in five rheumatology units included adults with RA initiating baricitinib (Sep-2017-May-19) with at least a 6-month-follow-up. Demographic/clinical characteristics, prescription patterns, and changes in disease activity and pain level were collected until treatment discontinuation/end of follow-up. Treatment persistence was estimated by Kaplan-Meier methods. RESULTS Data from 182 patients were included (mean (SD)): 83.5% women, 62.2 (12.3) years, body mass index 26.8 (5.1), disease duration 13.2 (10.8) years and Charlson Comorbidity Index score 2.4 (2.0). All patients had received at least one conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) before starting baricitinib and 78.0% at least one biologic disease-modifying anti-rheumatic drugs (bDMARD). Furthermore, 90.1% started with baricitinib 4 mg/day; 43.4% in monotherapy. One hundred and twelve (61.5%) of patients continued baricitinib at data collection time; mean persistence was 14.1 (0.5) months. Overall treatment persistence was 79.7/64.8/59.1% at 6/12/18 months. Seventy (38.5%) patients discontinued baricitinib during follow-up due to loss of efficacy (68.6%) or adverse events (18.6%). In those patients with available scores at the different observed cut-off points, remission or low disease activity was reported in 71.6 and 76.3% of patients at 6/12 months at any index: Disease Activity Score 28 joints using erythrocyte sedimentation rate (DAS28-ESR) (73.1 and 73.5%), Simplified Disease Activity Index (SDAI) (62.4 and 75.0%), and Clinical Disease Activity Index (CDAI) (66.7 and 78.1%). Good or moderate European League Against Rheumatism (EULAR)-response was noted in 80.0 and 78.2% of patients, respectively. Improvement from baseline in pain (Visual Analog Scale) was 2.5 cm and 3.0 cm at 6/12 months, respectively. CONCLUSIONS This Spanish cohort of patients treated with baricitinib had a long-standing and refractory disease. Nevertheless, high persistence and improvements in disease activity and pain were found at 6 and 12 months after treatment initiation, independently of the composite disease activity measure used, reinforcing the effectiveness of baricitinib in routine clinical practice.
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Affiliation(s)
- Blanca Hernández-Cruz
- Rheumatology Department, University Hospital Virgen Macarena, Calle Dr. Fedriani, 3, 41009, Seville, Spain.
| | - José Rosas
- Rheumatology Department, Marina Baixa Hospital, Av. Alcalde En Jaume Botella Mayor, 7, Villajoyosa, 03570, Alicante, Spain
| | - César Díaz-Torné
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Santa Creu i Sant Pau Hospital, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Joaquín Belzunegui
- Rheumatology Department, Donostia University Hospital, Begiristain Doktorea Pasealekua, 20014, Guipúzcoa, Spain
| | - Rosario García-Vicuña
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - José Inciarte-Mundo
- Arthritis Unit, Rheumatology Department, Hospital Clinic of Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Ana Pons
- Rheumatology Department, Marina Baixa Hospital, Av. Alcalde En Jaume Botella Mayor, 7, Villajoyosa, 03570, Alicante, Spain
| | - Ana M Millán
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Santa Creu i Sant Pau Hospital, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Sicylle Jeria-Navarro
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Santa Creu i Sant Pau Hospital, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Jesús A Valero
- Rheumatology Department, Donostia University Hospital, Begiristain Doktorea Pasealekua, 20014, Guipúzcoa, Spain
| | - Noelia García-Castañeda
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Cristina Valero
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Irene Llorente
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Alberto Calvo
- Rheumatology Department, University Hospital La Princesa, IIS-IP, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Medical Department, Lilly Spain, Av de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Mercedes Núñez
- Medical Department, Lilly Spain, Av de la Industria 30, Alcobendas, 28108, Madrid, Spain
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Lasagna M, Ventura C, Hielpos MS, Mardirosian MN, Martín G, Miret N, Randi A, Núñez M, Cocca C. Endocrine disruptor chlorpyrifos promotes migration, invasion, and stemness phenotype in 3D cultures of breast cancer cells and induces a wide range of pathways involved in cancer progression. Environ Res 2022; 204:111989. [PMID: 34506784 DOI: 10.1016/j.envres.2021.111989] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 06/13/2023]
Abstract
Organophosphorus chlorpyrifos (CPF) is currently considered an endocrine disruptor (ED), as it can imitate hormone actions both in vitro and in vivo. We recently reported that CPF induces migration and invasion in 2D cultures and changes the expression of key molecular markers involved in epithelial mesenchymal transition in MCF-7 and MDA-MB-231 cell lines. In this study, we investigated whether CPF could behave as a predisposing factor for tumors to become more metastatic and aggressive using 3D culture models. In MCF-7 cells, 0.05 μM CPF induced an increase in the number and size of mammospheres via estrogen receptor alpha (ERα) and c-SRC. Furthermore, 0.05 μM CPF increased the area of spheroids generated from MCF-7 cells, induced invasion using both Matrigel® and type 1 collagen matrices, and increased cell migration capacity via ERα in this 3D model. In turn, 50 μM CPF increased cell migration capacity and invasion using type 1 collagen matrix. In monolayers, CPF increased the phosphorylation and membrane translocation of c-SRC at both concentrations assayed. CPF at 0.05 μM boosted p-AKT, p-GSK-3β and p-P38. While p-AKT rose in a ERα-dependent way, p-GSK-3β was dependent on ERα- and c-SRC, and p-P38 was only dependent on c-SRC. On the other hand, the increase in p-AKT and p-P38 induced by 50 μM CPF was dependent on the c-SRC pathway. We also observed that 0.05 μM CPF increased IGF-1R and IRS-1 expression and that 50 μM CPF induced IGF-1Rβ phosphorylation. In the MDA-MB-231 cell line, 0.05 and 50 μM CPF increased p-c-SRC. Finally, p-AKT and p-GSK-3β were also induced by CPF at 0.05 and 50 μM, and an increase in p-P38 was observed at 50 μM. Taken together, these data provide support for the notion that CPF may represent a risk factor for breast cancer development and progression.
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Affiliation(s)
- M Lasagna
- Universidad de Buenos Aires-CONICET, Instituto de Química y Fisicoquímica Biológicas "Prof. Alejandro C. Paladini" (IQUIFIB), Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica. Cátedra de Física, Laboratorio de Radioisótopos, Buenos Aires, Argentina
| | - C Ventura
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica. Cátedra de Física, Laboratorio de Radioisótopos, Buenos Aires, Argentina; Universidad Nacional de La Plata-CONICET, Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), La Plata, Argentina
| | - M S Hielpos
- Universidad de Buenos Aires-CONICET, Instituto de Química y Fisicoquímica Biológicas "Prof. Alejandro C. Paladini" (IQUIFIB), Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica. Cátedra de Física, Laboratorio de Radioisótopos, Buenos Aires, Argentina
| | - M N Mardirosian
- Universidad de Buenos Aires-CONICET, Instituto de Química y Fisicoquímica Biológicas "Prof. Alejandro C. Paladini" (IQUIFIB), Buenos Aires, Argentina
| | - G Martín
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica. Cátedra de Física, Laboratorio de Radioisótopos, Buenos Aires, Argentina
| | - N Miret
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica. Cátedra de Física, Laboratorio de Radioisótopos, Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Medicina, Departamento de Bioquímica Humana, Laboratorio de Efectos Biológicos de Contaminantes Ambientales, Buenos Aires, Argentina
| | - A Randi
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Bioquímica Humana, Laboratorio de Efectos Biológicos de Contaminantes Ambientales, Buenos Aires, Argentina
| | - M Núñez
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica. Cátedra de Física, Laboratorio de Radioisótopos, Buenos Aires, Argentina
| | - C Cocca
- Universidad de Buenos Aires-CONICET, Instituto de Química y Fisicoquímica Biológicas "Prof. Alejandro C. Paladini" (IQUIFIB), Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica. Cátedra de Física, Laboratorio de Radioisótopos, Buenos Aires, Argentina.
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9
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Guerrero-Peral ÁL, Porta-Etessam J, Rodríguez-Vico J, Núñez M, Ciudad A, Díaz-Cerezo S, Garí-Peris C, Pérez-Sádaba FJ, Lizán L, Santos-Lasaosa S. Adaptation and Validation of the Spanish Version of Decisional Conflict Scale in People with Migraine in Spain. Patient Prefer Adherence 2022; 16:3291-3302. [PMID: 36545540 PMCID: PMC9762408 DOI: 10.2147/ppa.s384333] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE We aimed to validate the Spanish version of the Decisional Conflict Scale (DCS) and analyze its psychometric properties in people with migraine. PATIENTS AND METHODS The DCS validation comprised two phases. First, a translation and cross-cultural adaptation following the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Practices: 1-preparation, 2-independent forward translation, 3-reconciliation, 4-back-translation, 5-harmonization, 6-clinical review, and 7-content validation in a group of migraine patients. Second, the analysis of the psychometric properties. The reliability or internal consistency of the DCS scale and subscales was assessed using Cronbach's α value. The item-subscale correlation was also evaluated. A floor and ceiling effects for DCS score was considered when at least 15% of respondents obtained DCS >90 (ceiling) or <10 (floor). The construct validity was studied through the correlation between the DCS subscales and by the correlation between the DCS and other questionnaires (Decision Self-Efficacy Scale [DSES] and 9-item Shared Decision-Making [SDM-Q-9]). Spearman's coefficients were estimated for the correlations. RESULTS The cross-cultural adaptation was conducted on 17 patients who completed the questionnaire in a mean of 2.4 ±1.1 minutes. Generally, more than 75% of them considered that DCS items were adequate, easy to understand, and relevant. The psychometric properties were evaluated in a sample of n=128 patients. Accordingly, the internal consistency of DCS was high, with a Cronbach's α of 0.97 for the scale and between 0.87 to 0.96 for subscales. Also, a slight floor effect was observed, with 24.2% of patients having DCS scores <10. The correlation between subscales exceeded Spearman's coefficient of 0.7. Whereas the correlation between the DCS and the other questionnaires was generally moderate (Spearman's coefficient >0.4). CONCLUSION The Spanish version (Spain) of the DCS has very acceptable psychometric properties (reliability and construct validity) and good potential for assessing decisional conflicts among migraine patients.
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Affiliation(s)
- Ángel Luis Guerrero-Peral
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Mercedes Núñez
- Medical Department, Eli Lilly, Madrid, Spain
- Correspondence: Mercedes Núñez, Eli Lilly, Av. de la Industria, 30, Alcobendas, Madrid, 28108, Spain, Tel +34 647447827, Email
| | | | | | | | | | | | - Sonia Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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10
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Díaz-López G, Martínez-García R, Núñez M, Cazaña A. Sustainable Solutions in Agriculture: Use of Biopesticides from Vegetable Extracts. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00716-5] [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: 11/17/2022]
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11
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Díaz-López G, Martínez-García R, Medina P, Núñez M, Cazaña A. Toxicity of Vegetable Extracts in Biological Indicators of the Aquatic and Terrestrial Environment. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Lasagna M, Hielpos MS, Ventura C, Mardirosian MN, Martín G, Miret N, Randi A, Núñez M, Cocca C. Chlorpyrifos subthreshold exposure induces epithelial-mesenchymal transition in breast cancer cells. Ecotoxicol Environ Saf 2020; 205:111312. [PMID: 32956863 DOI: 10.1016/j.ecoenv.2020.111312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
Chlorpyrifos (CPF) is one of the most frequently used pesticide in extensive agriculture around the world and can be incorporated by humans and animals with possible consequences on health. The effects of this pesticide on carcinogenesis are not clear and there is no consensus concerning the risks of this compound. In previous work, we demonstrated that CPF induces proliferation of breast cancer cells both in vivo and in vitro. In this work we investigate whether CPF promotes the epithelial-mesenchymal transition (EMT) in breast cancer cells. Herein, we demonstrate that 50 μM CFP induces invasion in MCF-7 and MDA-MB-231 cells. In addition, 0.05 and 50 μM CPF increases migration in both cell lines. In MCF-7 cells, 0.05 and 50 μM CPF increase the metalloprotease MMP2 expression and decrease E-Cadherin and β-Catenin expression diminishing their membrane location. Furthermore, 50 μM CPF induces Vimentin expression and Slug nuclear translocation in MCF-7 cells. 0.05 and 50 μM CPF increase MMP2 gelatinolytic activity and expression, decrease β-Catenin expression and increase Vimentin expression in MDA-MB-231 cells. Inhibition of the oncoprotein c-Src reverses all the effects induced by CPF in MDA-MB-231 but not in MCF-7 indicating that c-Src is a kinase with a crucial role in the cells which grow in an estrogen-independent way. In MCF-7 cells both c-Src and estrogen receptor alpha must be blocked to completly inhibit the CPF-mediated effects. Our results show for the first time that the exposure to subthreshold concentrations of CPF promotes the modulation of EMT-molecular markers and pathways. These results, together with the ubiquitous distribution of the pesticide CPF, make it of utmost importance to take measures to minimize the risk of exposure to this compound.
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Affiliation(s)
- M Lasagna
- Instituto de Química y Fisicoquímica Biológicas "Prof. Alejandro C. Paladini" (IQUIFIB) UBA-CONICET, Buenos Aires, Argentina; Laboratorio de Radioisótopos, Cátedra de Física, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - M S Hielpos
- Laboratorio de Radioisótopos, Cátedra de Física, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - C Ventura
- Laboratorio de Radioisótopos, Cátedra de Física, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina; Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP) CONICET-UNLP, La Plata, Argentina
| | - M N Mardirosian
- Instituto de Química y Fisicoquímica Biológicas "Prof. Alejandro C. Paladini" (IQUIFIB) UBA-CONICET, Buenos Aires, Argentina
| | - G Martín
- Laboratorio de Radioisótopos, Cátedra de Física, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - N Miret
- Laboratorio de Efectos Biológicos de Contaminantes Ambientales, Departamento de Bioquímica Humana, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - A Randi
- Laboratorio de Efectos Biológicos de Contaminantes Ambientales, Departamento de Bioquímica Humana, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - M Núñez
- Laboratorio de Radioisótopos, Cátedra de Física, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - C Cocca
- Instituto de Química y Fisicoquímica Biológicas "Prof. Alejandro C. Paladini" (IQUIFIB) UBA-CONICET, Buenos Aires, Argentina; Laboratorio de Radioisótopos, Cátedra de Física, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.
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13
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Schweikert B, Malmberg C, Núñez M, Dilla T, Sapin C, Hartz S. Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain. BMJ Open 2020; 10:e032552. [PMID: 32792421 PMCID: PMC7430486 DOI: 10.1136/bmjopen-2019-032552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To conduct a cost-effectiveness analysis from the perspective of the Spanish National Health System (NHS) comparing ixekizumab versus secukinumab. DESIGN A Markov model with a lifetime horizon and monthly cycles was developed based on the York model. Four health states were included: a biological disease-modifying antirheumatic drug (bDMARD) induction period of 12 or 16 weeks, maintenance therapy, best supportive care (BSC) and death. Treatment response was assessed based on both Psoriatic Arthritis Response Criteria (PsARC) and ≥90% improvement in the Psoriasis Area Severity Index score (PASI90). At the end of the induction period, responders transitioned to maintenance therapy. Non-responders and patients who discontinued maintenance therapy transitioned to BSC. Clinical efficacy data were derived from a network meta-analysis. Health utilities were generated by applying a regression analysis to Psoriasis Area Severity Index and Health Assessment Questionnaire‒Disability Index scores collected in the ixekizumab SPIRIT studies. Results were subject to extensive sensitivity and scenario analysis. SETTING Spanish NHS. PARTICIPANTS A hypothetical cohort of bDMARD-naïve patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis was modelled. INTERVENTIONS Ixekizumab and secukinumab. RESULTS Ixekizumab performed favourably over secukinumab in the base-case analysis, although cost savings and quality-adjusted life-year (QALY) gains were modest. Total costs were €153 901 compared with €156 559 for secukinumab (difference -€2658). Total QALYs were 9.175 vs 9.082 (difference 0.093). Base-case results were most sensitive to the annual bDMARD discontinuation rate and the modification of PsARC and PASI90 response to ixekizumab or secukinumab. CONCLUSION Ixekizumab provided more QALYs at a lower cost than secukinumab, with differences being on a relatively small scale. Sensitivity analysis showed that base-case results were generally robust to changes in most input parameters. TRIAL REGISTRATION NUMBER SPIRIT-P1: NCT01695239; Post-results, SPIRIT-P2: NCT02349295; Post-results.
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Affiliation(s)
- Bernd Schweikert
- Real World Evidence Strategy and Analytics, Commercialisation and Outcomes, ICON, Munich, Germany
| | - Chiara Malmberg
- Access, Commercialisation and Communications, ICON, Munich, Germany
| | - Mercedes Núñez
- Health Outcomes and Real World Evidence, Eli Lilly and Company, Madrid, Spain
| | - Tatiana Dilla
- Global Patient Outcomes and Real World Evidence International, Eli Lilly and Company, Madrid, Spain
| | - Christophe Sapin
- European Statistics, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Susanne Hartz
- Global Patient Outcomes and Real World Evidence International, Eli Lilly and Company, Windlesham, UK
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Bertran MJ, Jansà M, Vidal M, Núñez M, Isla P, Escarrabill J. Methodological guidelines for preparing a structured therapeutic education program: From design to evaluation. Rev Clin Esp 2020; 221:S0014-2565(20)30035-7. [PMID: 32143833 DOI: 10.1016/j.rce.2019.12.007] [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: 08/03/2019] [Revised: 12/01/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Therapeutic patient education (TPE) is effective and essential in the context of the growing prevalence of chronic diseases, in which tools are needed for planning structured programs. The objective of this project was to develop guidelines for designing and assessing a TPE program. METHODS 1) We assembled a multidisciplinary group of 8 leaders in TPE, chronicity, quality and safety from the hospital and the university. 2) We conducted an exhaustive review of the scientific literature on the planning of TPE programs directed at chronically ill patients, their relatives and caregivers. 3) The final text underwent comments and suggestions by participants from the hospital and primary care centre during a course on information and TPE methodology. The recommendations were unanimously agreed upon by the writing group. RESULTS We obtained a standardised work procedure targeted at professionals involved in planning TPE programs, based on international recommendations. The document is structured into sections: a) Definition of the health problem and analysis of the situation; b) Program structure (human resources and materials); objectives (health-related, behaviour-related and educational) and methodology; c) Path the patient and family/caregiver follows in the program; and d) Assessment and indicators. The assessment of the procedure, in the framework of the methodology courses, was favourable. CONCLUSIONS The methodology provided by this document serves as an instrument for the standardised and systematic planning of educational programs and unifies the criteria in their drafting. However, the document needs to be adapted to the condition and population to which each program is directed.
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Affiliation(s)
- M J Bertran
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic, Barcelona, España.
| | - M Jansà
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, España; Programa de Atención a la Cronicidad, Hospital Clínic, Barcelona, España
| | - M Vidal
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, España
| | - M Núñez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - P Isla
- Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Campus Clínic, Barcelona, España
| | - J Escarrabill
- Programa de Atención a la Cronicidad, Hospital Clínic, Barcelona, España
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15
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Núñez M, Lansford JL, Vlachos DG. Optimization of the facet structure of transition-metal catalysts applied to the oxygen reduction reaction. Nat Chem 2019; 11:449-456. [DOI: 10.1038/s41557-019-0247-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 03/01/2019] [Indexed: 11/09/2022]
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16
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Núñez M, Díaz S, Dilla T, Reviriego J, Pérez A. Epidemiology, Quality of Life, and Costs Associated with Hypoglycemia in Patients with Diabetes in Spain: A Systematic Literature Review. Diabetes Ther 2019; 10:375-392. [PMID: 30661221 PMCID: PMC6437233 DOI: 10.1007/s13300-019-0563-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess the burden of hypoglycemia in patients with diabetes mellitus (DM) in Spain, including epidemiological data and information relating to healthcare resource utilization (HRU) and costs, and patients' quality of life (QoL). METHODS A systematic literature review (SLR) was conducted to identify studies that included original information on epidemiology, HRU and costs, and/or QoL associated with hypoglycemia in patients with DM in Spain, published in either Spanish or English, between January 2007 and April 2017. RESULTS Fifteen articles, involving 14 studies, were identified in the SLR and included in the analysis. The estimated rate of severe hypoglycemia (SH) events per patient per year ranged from 0.90 to 1.50 in patients with type 1 DM (T1DM) and from 0.30 to 0.63 in patients with type 2 DM (T2DM). The data on HRU differed extensively between studies, making it difficult to draw a conclusion. Total costs per SH event ranged from €409.97 in patients with T1DM to €713.10 in patients with DM. Work absence was reported in 11.80-18% of the working patients. Further, patients who experienced hypoglycemic events expressed a higher fear and had a poorer QoL than those who did not report these events. CONCLUSION Although the data included in the SLR were difficult to synthesize due to heterogeneity of the study designs and patient characteristics in the 14 studies, our search identified a high burden associated with hypoglycemic events in terms of HRU and costs, and patients' QoL. Further research is recommended to reach a consensus on hypoglycemia definition and study design to provide robust evidence on the burden of hypoglycemia and to accurately weigh the impact of this acute complication in Spain. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | | | | | | | - Antonio Pérez
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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Núñez M, Huete T, de la Cueva P, Sacristán JA, Hartz S, Dilla T. A Cost-per-Number Needed to Treat Analysis Assessing the Efficiency of Biologic Drugs in Moderate to Severe Plaque Psoriasis. Actas Dermosifiliogr (Engl Ed) 2019; 110:546-553. [PMID: 30851873 DOI: 10.1016/j.ad.2018.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Psoriasis is a chronic inflammatory skin disease with an estimated prevalence in Spain of 2.3% of the population. Approximately 30% of patients have moderate-to-severe forms. Treatment with biologic agents is proving to be a step forward in the management of the disease, although these treatments are very expensive. The objective of this study was to determine the efficiency, in terms of cost per number needed to treat (NNT), of the biologic drugs available in Spain for the treatment of moderate to severe plaque psoriasis. METHODS NNT data were obtained from a network meta-analysis that included all randomized clinical trials of biologic drugs sold in Spain. The cost of each treatment was calculated based on the approved dosage for the first year of treatment, as indicated in the Summary of Product Characteristics. These data were used to calculate the cost per NNT of the drugs for various PASI scores (75, 90, and 100). A sensitivity analysis was performed taking into consideration only the PASI-response measurement time (after 10, 12, or 16 weeks, depending on the drug). RESULTS The order of efficiency, from most to least efficient, in the case of a PASI 75 response was ixekizumab > ustekinumab 45mg > ustekinumab 90mg > secukinumab > infliximab > etanercept > adalimumab. The order for PASI 90 was ixekizumab >secukinumab >ustekinumab 45mg > ustekinumab 90mg > infliximab > adalimumab > etanercept. The order for PASI 100 was ixekizumab > secukinumab > infliximab > ustekinumab 90mg > ustekinumab 45mg > adalimumab > etanercept. The sensitivity analysis showed some changes in the order, depending on the response-assessment period. CONCLUSIONS The findings show a link between the efficacy of the biologic therapies available in Spain for the treatment of moderate-to-severe plaque psoriasis and their efficiency. Ixekizumab had the lowest cost per NNT for all PASI-response scores (75, 90, and 100) during the first year of treatment.
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Affiliation(s)
- M Núñez
- Eli Lilly and Company, Madrid, España.
| | - T Huete
- Eli Lilly and Company, Madrid, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | | | - S Hartz
- Eli Lilly and Company, Surrey, Reino Unido
| | - T Dilla
- Eli Lilly and Company, Madrid, España
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Ventura C, Zappia CD, Lasagna M, Pavicic W, Richard S, Bolzan AD, Monczor F, Núñez M, Cocca C. Effects of the pesticide chlorpyrifos on breast cancer disease. Implication of epigenetic mechanisms. J Steroid Biochem Mol Biol 2019; 186:96-104. [PMID: 30290214 DOI: 10.1016/j.jsbmb.2018.09.021] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 11/21/2022]
Abstract
Chlorpyrifos (CPF) is an organophosphorus pesticide used for agricultural pest control all over the world. We have previously demonstrated that environmental concentrations of this pesticide alter mammary gland histological structure and hormonal balance in rats chronically exposed. In this work, we analyzed the effects of CPF on mammary tumors development. Our results demonstrated that CPF increases tumor incidence and reduces latency of NMU-induced mammary tumors. Although no changes were observed in tumor growth rate, we found a reduced steroid hormone receptor expression in the tumors of animals exposed to the pesticide. Moreover, we analyzed the role of epigenetic mechanisms in CPF effects. Our results indicated that CPF alters HDAC1 mRNA expression in mammary gland, although no changes were observed in DNA methylation. In summary, we demonstrate that the exposure to CPF promotes mammary tumors development with a reduced steroid receptors expression. It has also been found that CPF affects HDAC1 mRNA levels in mammary tissue pointing that CPF may act as a breast cancer risk factor.
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Affiliation(s)
- C Ventura
- Laboratorio de Radioisótopos, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Laboratorio de Citogenética y Mutagénesis, IMBICE (CONICET La Plata-UNLP-CICPBA), Universidad Nacional de La Plata, Facultad de Ciencias Naturales y Museo. La Plata, Buenos Aires, Argentina
| | - C D Zappia
- Laboratorio de Farmacología de Receptores, ININFA, UBA-CONICET, Argentina
| | - M Lasagna
- Laboratorio de Radioisótopos, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - W Pavicic
- Laboratorio de Citogenética y Mutagénesis, IMBICE (CONICET La Plata-UNLP-CICPBA), Universidad Nacional de La Plata, Facultad de Ciencias Naturales y Museo. La Plata, Buenos Aires, Argentina
| | - S Richard
- Laboratorio de Citogenética y Mutagénesis, IMBICE (CONICET La Plata-UNLP-CICPBA), Universidad Nacional de La Plata, Facultad de Ciencias Naturales y Museo. La Plata, Buenos Aires, Argentina
| | - A D Bolzan
- Laboratorio de Citogenética y Mutagénesis, IMBICE (CONICET La Plata-UNLP-CICPBA), Universidad Nacional de La Plata, Facultad de Ciencias Naturales y Museo. La Plata, Buenos Aires, Argentina
| | - F Monczor
- Laboratorio de Farmacología de Receptores, ININFA, UBA-CONICET, Argentina
| | - M Núñez
- Laboratorio de Radioisótopos, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - C Cocca
- Laboratorio de Radioisótopos, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Instituto de Química y Fisicoquímica Biológicas "Prof. Alejandro C. Paladini", IQUIFIB UBA-CONICET, Ciudad Autónoma de Buenos Aires, Argentina.
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19
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Pinato DJ, Sharma R, Citti C, Platt H, Ventura-Cots M, Allara E, Chen TY, Dalla Pria A, Jain M, Mínguez B, Kikuchi L, Kaufman West E, Merli M, Kaplan DE, Hasson H, Marks K, Nelson M, Núñez M, Aytaman A, Bower M, Bräu N. The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma. Aliment Pharmacol Ther 2018; 47:95-103. [PMID: 29034998 DOI: 10.1111/apt.14356] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/19/2017] [Accepted: 09/11/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a leading cause of liver-related mortality in people living with HIV, where co-infection with hepatotropic viruses accelerates the course of chronic liver disease. AIM To evaluate whether the albumin-bilirubin (ALBI) grade, a more accurate marker of liver dysfunction in HCC, might identify patients with progressive liver dysfunction in the context of HIV/hepatitis co-infection. METHODS Using uni- and multi-variable analyses, we studied the albumin-bilirubin grade as a predictor of overall survival (OS) in a large, multi-center cohort of patients with HIV-associated HCC recruited from 44 centres in 9 countries within the Liver Cancer in HIV study group. Patients who underwent liver transplantation were excluded. RESULTS A total of 387 patients, predominantly HCV co-infected (78%) with balanced representation of all Barcelona Clinic Liver Cancer (BCLC) stages (A = 33%, B = 18%, C = 37%, D = 12%) were recruited. At HCC diagnosis, 84% had been on anti-retrovirals for a median duration of 8.8 years. The albumin-bilirubin grade identified significant differences in median survival of 97 months for grade 1 (95% CI 13-180 months), 17 months for grade 2 (95% CI 11-22 months) and 6 months for grade 3 (95% CI 4-9 months, P < .001). A more advanced albumin-bilirubin grade correlated with lower CD4 counts (464/373/288 cells/mm3 for grades 1/2/3) and higher HIV viraemia (3.337/8.701/61.845 copies/mL for grades 1/2/3, P < .001). CONCLUSIONS In this large, multi-center retrospective study, the albumin-bilirubin grade highlights the interplay between liver reserve and immune dysfunction as prognostic determinants in HIV-associated HCC.
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20
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Affiliation(s)
- D N Fitch
- Department of Internal Medicine, Wake Forest School of Medicine, Section on General Internal Medicine, Winston Salem, NC, USA
| | - A Dharod
- Department of Internal Medicine, Wake Forest School of Medicine, Section on General Internal Medicine, Winston Salem, NC, USA
| | - C L Campos
- Department of Internal Medicine, Wake Forest School of Medicine, Section on General Internal Medicine, Winston Salem, NC, USA
| | - M Núñez
- Department of Internal Medicine, Wake Forest School of Medicine, Section on Infectious Diseases, Winston Salem, NC, USA
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21
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Núñez M, Robie T, Vlachos DG. Acceleration and sensitivity analysis of lattice kinetic Monte Carlo simulations using parallel processing and rate constant rescaling. J Chem Phys 2017; 147:164103. [DOI: 10.1063/1.4998926] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M. Núñez
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, USA
| | - T. Robie
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, USA
| | - D. G. Vlachos
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, USA
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22
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Bonet M, Cayetano L, Núñez M, Jovell-Fernández E, Aguilar A, Ribas Y. Assessment of acute bowel function after radiotherapy for prostate cancer: Is it accurate enough? Clin Transl Oncol 2017; 20:576-583. [PMID: 28900813 DOI: 10.1007/s12094-017-1749-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/11/2017] [Accepted: 09/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Pelvic radiotherapy for prostate cancer can be associated with bowel toxicity, which may have a significant impact on quality of life. Our aim was to assess the adequacy of the tools currently used to assess bowel symptoms after radiotherapy, including physician and patient reported outcomes. This sub-study on acute toxicity was part of a prospective trial assessing long-term bowel dysfunction. MATERIALS AND METHODS Between February 2013 and July 2015, 75 patients with prostate cancer who received radiotherapy completed the LENT/SOMA and the EPIC questionnaires baseline and 2 weeks after the treatment. The Bristol stool scale and two additional questions on faecal urgency were added. Physicians assessed toxicity using Common Terminology Criteria for Adverse Events v.4.0. Agreement between patients and clinicians was assessed using the Cohen's κ coefficient. RESULTS Acute toxicity during radiotherapy was very low. The pattern of overall bowel bother was similar before and after treatment. Faecal urgency significantly increased after radiotherapy compared to baseline but was only detected by the additional questions and not by the physicians or the patient-reported outcomes (PRO) questionnaires. Correlation between physician and PRO was poor for most symptoms. CONCLUSION Bowel symptoms such as urgency may remain undetected by usual tools to assess toxicity after radiotherapy. Assessment of bowel toxicity should be reappraised in order to identify those patients who may have symptoms with an impact on their quality of life.
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Affiliation(s)
- M Bonet
- Department of Radiation Oncology, Consorci Sanitari de Terrassa, Terrassa, Spain.
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Avda. del Dr. Josep Laporte, 2, 43201, Reus, Spain.
| | - L Cayetano
- Department of Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - M Núñez
- Department of Radiation Oncology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - E Jovell-Fernández
- Department of Epidemiology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - A Aguilar
- Department of Urology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Y Ribas
- Department of Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain
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23
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Kovacs FM, Seco J, Royuela A, Betegon JN, Sánchez-Herráez S, Meli M, Martínez Rodríguez ME, Núñez M, Álvarez-Galovich L, Moyá J, Sánchez C, Luna S, Borrego P, Moix J, Rodríguez-Pérez V, Torres-Unda J, Burgos-Alonso N, Gago-Fernández I, González-Rubio Y, Abraira V. The association between sleep quality, low back pain and disability: A prospective study in routine practice. Eur J Pain 2017; 22:114-126. [PMID: 28845556 DOI: 10.1002/ejp.1095] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice. METHODS This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period. RESULTS Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]). CONCLUSIONS Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability. SIGNIFICANCE In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.
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Affiliation(s)
- F M Kovacs
- Kovacs Back Pain Unit, HLA-Moncloa University Hospital, Madrid, Spain.,Spanish Back Pain Research Network, Palma de Mallorca, Spain
| | - J Seco
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Institute of Biomedicine (IBIOMED), University of León, Spain.,University of the Basque Country, León, Spain
| | - A Royuela
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,ClinicalBiostatisticsUnit, Puerta de Hierro University Hospital, Instituto de Investigación Puerta de Hierro (IDIPHIM), Madrid, Spain
| | - J N Betegon
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León (CAULE), León, Spain
| | - S Sánchez-Herráez
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León (CAULE), León, Spain
| | - M Meli
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Aliviam - Majorca PainClinic, Palma de Mallorca, Spain
| | - M E Martínez Rodríguez
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Servicio de Rehabilitación, Hospital Ramón y Cajal, IRICYS, Universidad de Alcalá, Madrid, Spain
| | - M Núñez
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Servicio de Reumatología, Hospital Clínic, Barcelona, Spain
| | - L Álvarez-Galovich
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Servicio de Traumatología, Patología de Columna, Fundación Jiménez Díaz, Madrid, Spain
| | - J Moyá
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Unidad del Dolor, Hospital MateuOrfila, Mahón, Spain
| | - C Sánchez
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,FisysFisioterapia, Laredo, Cantabria, Spain
| | - S Luna
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Centro de Salud Alburquerque, La Codosera, Badajoz, Spain
| | - P Borrego
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Policlínica FISIOMED, Salamanca, Spain
| | - J Moix
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Departamento de Psicología Básica, Evolutiva y de la Educación, Universidad Autónoma de Barcelona, Bellaterra, Spain
| | - V Rodríguez-Pérez
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Escuela Universitaria Ciencias de la Salud, Universidad de León, Ponferrada, Spain
| | - J Torres-Unda
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Departamento de Fisiología, Universidad de El País Vasco (UPV/EHU), Leioa, Vizcaya, Spain
| | - N Burgos-Alonso
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Departamento de Medicina Preventiva y Salud Pública, Universidad de El País Vasco (UPV/EHU), Leioa, Vizcaya, Spain
| | - I Gago-Fernández
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Escuela Universitaria Ciencias de la Salud, Universidad de León, Ponferrada, Spain
| | - Y González-Rubio
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Servicio de Cirugía Ortopédica y Traumatología, Fundación Jiménez Díaz, Madrid, Spain
| | - V Abraira
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, Madrid, Spain
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Ventura C, Núñez M, Gaido V, Pontillo C, Miret N, Randi A, Cocca C. Hexachlorobenzene alters cell cycle by regulating p27-cyclin E-CDK2 and c-Src-p27 protein complexes. Toxicol Lett 2017; 270:72-79. [DOI: 10.1016/j.toxlet.2017.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/31/2017] [Accepted: 02/07/2017] [Indexed: 01/14/2023]
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Artigas F, Schenker E, Celada P, Spedding M, Lladó-Pelfort L, Jurado N, Núñez M, Santana N, Troyano-Rodriguez E, Riga MS, van den Munkhof H, Castañé A, Shaban H, Jay TM, Tripathi A, Godsil BP, Sebban C, Mariani J, Faure P, Takkilah S, Hughes ZA, Siok CJ, Hajos M, Wicke K, Gass N, Weber-Fahr W, Sartorius A, Becker R, Didriksen M, Bastlund JF, Tricklebank M, Risterucci C, Meyer-Lindenberg A, Schwarz AJ. Defining the brain circuits involved in psychiatric disorders: IMI-NEWMEDS. Nat Rev Drug Discov 2016; 16:1-2. [DOI: 10.1038/nrd.2016.205] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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27
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González-Medina MDC, Dávila-Fajardo CL, Soto-Pino MJ, Díaz-Villamarín X, Gómez-Martín A, Martínez-González LJ, Núñez M, Casas-Hidalgo I, Cabeza-Barrera J. PKP-024 The FCGR2A (A >G) (RS1801274) genetic variant and the efficacy of tocilizumab in rheumatoid arthritis patients. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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28
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Pérez-Hernández M, Matamoros M, Barana A, Amorós I, Gómez R, Núñez M, Sacristán S, Pinto Á, Fernández-Avilés F, Tamargo J, Delpón E, Caballero R. Pitx2c increases in atrial myocytes from chronic atrial fibrillation patients enhancing IKs and decreasing ICa,L. Cardiovasc Res 2016; 109:431-41. [PMID: 26714926 DOI: 10.1093/cvr/cvv280] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/15/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS Atrial fibrillation (AF) produces rapid changes in the electrical properties of the atria (electrical remodelling) that promote its own recurrence. In chronic AF (CAF) patients, up-regulation of the slow delayed rectifier K(+) current (IKs) and down-regulation of the voltage-gated Ca(2+) current (ICa,L) are hallmarks of electrical remodelling and critically contribute to the abbreviation of action potential duration and atrial refractory period. Recent evidences suggested that Pitx2c, a bicoid-related homeodomain transcription factor involved in directing cardiac asymmetric morphogenesis, could play a role in atrial remodelling. However, its effects on IKs and ICa,L are unknown. METHODS AND RESULTS Real-time quantitative polymerase chain reaction analysis showed that Pitx2c mRNA expression was significantly higher in human atrial myocytes from CAF patients than those from sinus rhythm patients. The expression of Pitx2c was positively and negatively correlated with IKs and ICa,L densities, respectively. Expression of Pitx2c in HL-1 cells increased IKs density and reduced ICa,L density. Luciferase assays demonstrated that Pitx2c increased transcriptional activity of KCNQ1 and KCNE1 genes. Conversely, its effects on ICa,L could be mediated by the atrial natriuretic peptide. CONCLUSION Our results demonstrated for the first time that CAF increases Pitx2c expression in isolated human atrial myocytes and suggested that this transcription factor could contribute to the CAF-induced IKs increase and ICa,L reduction observed in humans.
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Affiliation(s)
- Marta Pérez-Hernández
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Marcos Matamoros
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Adriana Barana
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Irene Amorós
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Ricardo Gómez
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Mercedes Núñez
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Sandra Sacristán
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Ángel Pinto
- Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
| | - Francisco Fernández-Avilés
- Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Eva Delpón
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Ricardo Caballero
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
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Matamoros M, Pérez-Hernández M, Guerrero-Serna G, Amorós I, Barana A, Núñez M, Ponce-Balbuena D, Sacristán S, Gómez R, Tamargo J, Caballero R, Jalife J, Delpón E. Nav1.5 N-terminal domain binding to α1-syntrophin increases membrane density of human Kir2.1, Kir2.2 and Nav1.5 channels. Cardiovasc Res 2016; 110:279-90. [PMID: 26786162 DOI: 10.1093/cvr/cvw009] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/13/2016] [Indexed: 01/11/2023] Open
Abstract
AIMS Cardiac excitability and refractoriness are largely determined by the function and number of inward rectifier K⁺ channels (Kir2.1-2.3), which are differentially expressed in the atria and ventricles, and Nav1.5 channels. We have focused on how Nav1.5 and Kir2.x function within a macromolecular complex by elucidating the molecular determinants that govern Nav1.5/Kir2.x reciprocal modulation. METHODS AND RESULTS The results demonstrate that there is an unexpected 'internal' PDZ-like binding domain located at the N-terminus of the Nav1.5 channel that mediates its binding to α1-syntrophin. Nav1.5 N-terminal domain, by itself (the 132 aa peptide) (Nter), exerts a 'chaperone-like' effect that increases sodium (I(Na)) and inward rectifier potassium (I(K1)) currents by enhancing the expression of Nav1.5, Kir2.1, and Kir2.2 channels as demonstrated in Chinese hamster ovary (CHO) cells and in rat cardiomyocytes. Site-directed mutagenesis analysis demonstrates that the Nter chaperone-like effect is determined by Serine 20. Nav1.5-Kir2.x reciprocal positive interactions depend on a specific C-terminal PDZ-binding domain sequence (SEI), which is present in Kir2.1 and Kir2.2 channels but not in Kir2.3. Therefore, in human atrial myocytes, the presence of Kir2.3 isoforms precludes reciprocal I(K1)-INa density modulation. Moreover, results in rat and human atrial myocytes demonstrate that binding to α1-syntrophin is necessary for the Nav1.5-Kir2.x-positive reciprocal modulation. CONCLUSIONS The results demonstrate the critical role of the N-terminal domain of Nav1.5 channels in Nav1.5-Kir2.x-reciprocal interactions and suggest that the molecular mechanisms controlling atrial and ventricular cellular excitability may be different.
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Affiliation(s)
- Marcos Matamoros
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Marta Pérez-Hernández
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Guadalupe Guerrero-Serna
- Department of Internal Medicine, Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109, USA Department of Molecular and Integrative Physiology, Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Irene Amorós
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Adriana Barana
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Mercedes Núñez
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Daniela Ponce-Balbuena
- Department of Internal Medicine, Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109, USA Department of Molecular and Integrative Physiology, Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sandra Sacristán
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Ricardo Gómez
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Ricardo Caballero
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - José Jalife
- Department of Internal Medicine, Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109, USA Department of Molecular and Integrative Physiology, Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Eva Delpón
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
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Quintero M, Núñez M, Mellado S, Maldonado M, Wehinger S. Evaluation of store lesion in platelet obtained by apheresis compared to platelet derived from whole blood and its impact on the in vitro functionality. Transfus Apher Sci 2015; 53:293-9. [PMID: 26043812 DOI: 10.1016/j.transci.2015.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/30/2015] [Accepted: 05/20/2015] [Indexed: 01/26/2023]
Abstract
Platelet units for transfusion purposes are obtained manually from whole blood or by apheresis, in an automated process. In both methods, platelets during storage present a characteristics grouped under the name "storage lesion" that are associated with adverse effects on platelet units. Oxidative stress has been claimed to be one of major causes, leading to activation and apoptosis processes affecting their post transfusion functionality. In this work, we observed an association between apheresis and a reduced presence of oxidative stress and better results in functional markers in stored platelets, compared to manually obtained platelets. Then, apheresis which would ensure a greater number of functional platelets during the 5 days of storage, compared to concentrates obtained from whole blood.
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Affiliation(s)
- M Quintero
- Blood Bank and Transfusion Service, Foundation Valle of Lili Clinic, Cali, Colombia; Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Universidad de Talca, Talca, Chile
| | - M Núñez
- Blood Bank, Santa María Clinic, Santiago de Chile, Chile
| | - S Mellado
- Blood Bank, Santa María Clinic, Santiago de Chile, Chile
| | - M Maldonado
- Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Universidad de Talca, Talca, Chile
| | - S Wehinger
- Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Universidad de Talca, Talca, Chile.
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Affiliation(s)
- M. Núñez
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, USA
| | - D. G. Vlachos
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, USA
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Gómez R, Caballero R, Barana A, Amorós I, De Palm SH, Matamoros M, Núñez M, Pérez-Hernández M, Iriepa I, Tamargo J, Delpón E. Structural basis of drugs that increase cardiac inward rectifier Kir2.1 currents. Cardiovasc Res 2014; 104:337-46. [PMID: 25205296 DOI: 10.1093/cvr/cvu203] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS We hypothesize that some drugs, besides flecainide, increase the inward rectifier current (IK1) generated by Kir2.1 homotetramers (IKir2.1) and thus, exhibit pro- and/or antiarrhythmic effects particularly at the ventricular level. To test this hypothesis, we analysed the effects of propafenone, atenolol, dronedarone, and timolol on Kir2.x channels. METHODS AND RESULTS Currents were recorded with the patch-clamp technique using whole-cell, inside-out, and cell-attached configurations. Propafenone (0.1 nM-1 µM) did not modify either IK1 recorded in human right atrial myocytes or the current generated by homo- or heterotetramers of Kir2.2 and 2.3 channels recorded in transiently transfected Chinese hamster ovary cells. On the other hand, propafenone increased IKir2.1 (EC50 = 12.0 ± 3.0 nM) as a consequence of its interaction with Cys311, an effect which decreased inward rectification of the current. Propafenone significantly increased mean open time and opening frequency at all the voltages tested, resulting in a significant increase of the mean open probability of the channel. Timolol, which interacted with Cys311, was also able to increase IKir2.1. On the contrary, neither atenolol nor dronedarone modified IKir2.1. Molecular modelling of the Kir2.1-drugs interaction allowed identification of the pharmacophore of drugs that increase IKir2.1. CONCLUSIONS Kir2.1 channels exhibit a binding site determined by Cys311 that is responsible for drug-induced IKir2.1 increase. Drug binding decreases channel affinity for polyamines and current rectification, and can be a mechanism of drug-induced pro- and antiarrhythmic effects not considered until now.
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Affiliation(s)
- Ricardo Gómez
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Ricardo Caballero
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Adriana Barana
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Hospital Clínico San Carlos, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Irene Amorós
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Sue-Haida De Palm
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Marcos Matamoros
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Mercedes Núñez
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Marta Pérez-Hernández
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Hospital Clínico San Carlos, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Isabel Iriepa
- Department of Organic Chemistry, School of Pharmacy, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Hospital Clínico San Carlos, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Eva Delpón
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
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Beleña JM, Núñez M, Gracia JL, Pérez JL, Yuste J. The Laryngeal Mask Airway Supreme™: safety and efficacy during gynaecological laparoscopic surgery. Southern African Journal of Anaesthesia and Analgesia 2014. [DOI: 10.1080/22201173.2012.10872843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- JM Beleña
- Department of Anaesthesiology and Critical Care, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | - M Núñez
- Department of Anaesthesiology and Critical Care, Hospital Ramón y Cajal, Madrid, Spain
| | - JL Gracia
- Department of Anaesthesiology and Critical Care, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | - JL Pérez
- Department of Anaesthesiology and Critical Care, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | - J Yuste
- Department of Anaesthesiology and Critical Care, Hospital del Sureste, Arganda del Rey, Madrid, Spain
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Barana A, Matamoros M, Dolz-Gaitón P, Pérez-Hernández M, Amorós I, Núñez M, Sacristán S, Pedraz Á, Pinto Á, Fernández-Avilés F, Tamargo J, Delpón E, Caballero R. Chronic atrial fibrillation increases microRNA-21 in human atrial myocytes decreasing L-type calcium current. Circ Arrhythm Electrophysiol 2014; 7:861-8. [PMID: 25107449 DOI: 10.1161/circep.114.001709] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Atrial fibrillation is characterized by progressive atrial structural and electrical changes (atrial remodeling) that favor arrhythmia recurrence and maintenance. Reduction of L-type Ca(2+) current (I(Ca,L)) density is a hallmark of the electrical remodeling. Alterations in atrial microRNAs could contribute to the protein changes underlying atrial fibrillation-induced atrial electrical remodeling. This study was undertaken to compare miR-21 levels in isolated myocytes from atrial appendages obtained from patients in sinus rhythm and with chronic atrial fibrillation (CAF) and to determine whether L-type Ca(2+) channel subunits are targets for miR-21. METHODS AND RESULTS Quantitative polymerase chain reaction analysis showed that miR-21 was expressed in human atrial myocytes from patients in sinus rhythm and that its expression was significantly greater in CAF myocytes. There was an inverse correlation between miR-21 and the mRNA of the α1c subunit of the calcium channel (CACNA1C) expression and I(Ca,L) density. Computational analyses predicted that CACNA1C and the mRNA of the β2 subunit of the calcium channel (CACNB2) could be potential targets for miR-21. Luciferase reporter assays demonstrated that miR-21 produced a concentration-dependent decrease in the luciferase activity in Chinese Hamster Ovary cells transfected with CACNA1C and CACNB2 3' untranslated region regions. miR-21 transfection in HL-1 cells produced changes in I(Ca,L) properties qualitatively similar to those produced by CAF (ie, a marked reduction of I(Ca,L) density and shift of the inactivation curves to more depolarized potentials). CONCLUSIONS Our results demonstrated that CAF increases miR-21 expression in enzymatically isolated human atrial myocytes. Moreover, it decreases I(Ca,L) density by downregulating Ca(2+) channel subunits expression. These results suggested that this microRNA could participate in the CAF-induced I(Ca,L) downregulation and in the action potential duration shortening that maintains the arrhythmia.
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Affiliation(s)
- Adriana Barana
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Marcos Matamoros
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Pablo Dolz-Gaitón
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Marta Pérez-Hernández
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Irene Amorós
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Mercedes Núñez
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Sandra Sacristán
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Álvaro Pedraz
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Ángel Pinto
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Francisco Fernández-Avilés
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Juan Tamargo
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Eva Delpón
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
| | - Ricardo Caballero
- From the Department of Pharmacology (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), and Instituto de Investigación Sanitaria Gregorio Marañón (A.B., M.M., P.D.-G., M.P.-H., I.A., M.N., S.S., J.T., E.D., R.C.), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; and Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid, Spain (Á.P., Á.P., F.F.-A.)
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Soler C, Kekäläinen J, Núñez M, Sancho M, Álvarez JG, Núñez J, Yaber I, Gutiérrez R. Male facial attractiveness and masculinity may provide sex- and culture-independent cues to semen quality. J Evol Biol 2014; 27:1930-8. [PMID: 25056484 DOI: 10.1111/jeb.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 02/21/2013] [Revised: 06/10/2014] [Accepted: 06/17/2014] [Indexed: 11/30/2022]
Abstract
Phenotype-linked fertility hypothesis (PLFH) predicts that male secondary sexual traits reveal honest information about male fertilization ability. However, PLFH has rarely been studied in humans. The aim of the present study was to test PLFH in humans and to investigate whether potential ability to select fertile partners is independent of sex or cultural background. We found that on the contrary to the hypothesis, facial masculinity was negatively associated with semen quality. As increased levels of testosterone have been demonstrated to impair sperm production, this finding may indicate a trade-off between investments in secondary sexual signalling (i.e. facial masculinity) and fertility or status-dependent differences in investments in semen quality. In both sexes and nationalities (Spanish and Colombian), ranked male facial attractiveness predicted male semen quality. However, Spanish males and females estimated facial images generally more attractive (gave higher ranks) than Colombian raters, and in both nationalities, males gave higher ranks than females. This suggests that male facial cues may provide culture- and sex-independent information about male fertility. However, our results also indicate that humans may be more sensitive to facial attractiveness cues within their own populations and also that males may generally overestimate the attractiveness of other men to females.
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Affiliation(s)
- C Soler
- Departament de Biologia Funcional i Antropologia Física, Universitat de València, Burjassot, Spain
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Caracuel F, Moya ML, Santana S, Núñez M, Ramírez G. PS-007 A 24-month study of the interventions on electronic prescribing made by the Pharmacy Department. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.358] [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: 11/04/2022] Open
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Dolz-Gaitón P, Núñez M, Núñez L, Barana A, Amorós I, Matamoros M, Pérez-Hernández M, González de la Fuente M, Álvarez-López M, Macías-Ruiz R, Tercedor-Sánchez L, Jiménez-Jáimez J, Delpón E, Caballero R, Tamargo J. Functional characterization of a novel frameshift mutation in the C-terminus of the Nav1.5 channel underlying a Brugada syndrome with variable expression in a Spanish family. PLoS One 2013; 8:e81493. [PMID: 24363796 PMCID: PMC3868464 DOI: 10.1371/journal.pone.0081493] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/14/2013] [Indexed: 12/19/2022] Open
Abstract
Introduction We functionally analyzed a frameshift mutation in the SCN5A gene encoding cardiac Na+ channels (Nav1.5) found in a proband with repeated episodes of ventricular fibrillation who presented bradycardia and paroxysmal atrial fibrillation. Seven relatives also carry the mutation and showed a Brugada syndrome with an incomplete and variable expression. The mutation (p.D1816VfsX7) resulted in a severe truncation (201 residues) of the Nav1.5 C-terminus. Methods and Results Wild-type (WT) and mutated Nav1.5 channels together with hNavβ1 were expressed in CHO cells and currents were recorded at room temperature using the whole-cell patch-clamp. Expression of p.D1816VfsX7 alone resulted in a marked reduction (≈90%) in peak Na+ current density compared with WT channels. Peak current density generated by p.D1816VfsX7+WT was ≈50% of that generated by WT channels. p.D1816VfsX7 positively shifted activation and inactivation curves, leading to a significant reduction of the window current. The mutation accelerated current activation and reactivation kinetics and increased the fraction of channels developing slow inactivation with prolonged depolarizations. However, late INa was not modified by the mutation. p.D1816VfsX7 produced a marked reduction of channel trafficking toward the membrane that was not restored by decreasing incubation temperature during cell culture or by incubation with 300 μM mexiletine and 5 mM 4-phenylbutirate. Conclusion Despite a severe truncation of the C-terminus, the resulting mutated channels generate currents, albeit with reduced amplitude and altered biophysical properties, confirming the key role of the C-terminal domain in the expression and function of the cardiac Na+ channel.
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Affiliation(s)
- Pablo Dolz-Gaitón
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mercedes Núñez
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Lucía Núñez
- Complejo Hospitalario Universitario de A Coruña and Instituto de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain
| | - Adriana Barana
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Irene Amorós
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Marcos Matamoros
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Marta Pérez-Hernández
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Marta González de la Fuente
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Miguel Álvarez-López
- Arrhytmias Unit, Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rosa Macías-Ruiz
- Arrhytmias Unit, Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Luis Tercedor-Sánchez
- Arrhytmias Unit, Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Juan Jiménez-Jáimez
- Arrhytmias Unit, Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Eva Delpón
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
- * E-mail:
| | - Ricardo Caballero
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos, School of Medicine, Universidad Complutense, Madrid, Spain
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Daidone A, Gutierrez C, Martinez E, Pera J, Pino F, Gullon C, Castells M, Núñez M, del Carpio A, Boladeras A, Ferrer F. Permanent-seed-brachytherapy in prostate cancer: The Catalan-institute-of-oncology experience. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.046] [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: 11/16/2022] Open
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Amorós I, Dolz-Gaitón P, Gómez R, Matamoros M, Barana A, de la Fuente MG, Núñez M, Pérez-Hernández M, Moraleda I, Gálvez E, Iriepa I, Tamargo J, Caballero R, Delpón E. Propafenone blocks human cardiac Kir2.x channels by decreasing the negative electrostatic charge in the cytoplasmic pore. Biochem Pharmacol 2013; 86:267-78. [PMID: 23648307 DOI: 10.1016/j.bcp.2013.04.023] [Citation(s) in RCA: 14] [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: 01/18/2013] [Revised: 04/23/2013] [Accepted: 04/25/2013] [Indexed: 11/24/2022]
Abstract
Human cardiac inward rectifier current (IK1) is generated by Kir2.x channels. Inhibition of IK1 could offer a useful antiarrhythmic strategy against fibrillatory arrhythmias. Therefore, elucidation of Kir2.x channels pharmacology, which still remains elusive, is mandatory. We characterized the electrophysiological and molecular basis of the inhibition produced by the antiarrhythmic propafenone of the current generated by Kir2.x channels (IKir2.x) and the IK1 recorded in human atrial myocytes. Wild type and mutated human Kir2.x channels were transiently transfected in CHO and HEK-293 cells. Macroscopic and single-channel currents were recorded using the patch-clamp technique. At concentrations >1μM propafenone inhibited IKir2.x the order of potency being Kir2.3∼IK1>Kir2.2>Kir2.1 channels. Blockade was irrespective of the extracellular K(+) concentration whereas markedly increased when the intracellular K(+) concentration was decreased. Propafenone decreased inward rectification since at potentials positive to the K(+) equilibrium potential propafenone-induced block decreased in a voltage-dependent manner. Importantly, propafenone favored the occurrence of subconductance levels in Kir2.x channels and decreased phosphatidylinositol 4,5-bisphosphate (PIP2)-channel affinity. Blind docking and site-directed mutagenesis experiments demonstrated that propafenone bound Kir2.x channels at the cytoplasmic domain, close to, but not in the pore itself, the binding site involving two conserved Arg residues (residues 228 and 260 in Kir2.1). Our results suggested that propafenone incorporated into the cytoplasmic domain of the channel in such a way that it decreased the net negative charge sensed by K(+) ions and polyamines which, in turn, promotes the appearance of subconductance levels and the decrease of PIP2 affinity of the channels.
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Affiliation(s)
- Irene Amorós
- Department of Pharmacology, School of Medicine, Universidad Complutense, 28040 Madrid, Spain
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López-Siguero JP, López-Canti LF, Espino R, Caro E, Fernández-García JM, Gutiérrez-Macías A, Rial JM, Lechuga JL, Macías F, Martínez-Aedo MJ, Rico S, Rodríguez I, Guillén J, Arroyo FJ, Bernal S, Espigares R, Núñez M, Escribano A, Barrionuevo JL, Gentil J, Barrios V, Fernández-Nistal A, Martos-Moreno GA, Martínez V, Argente J. Effect of recombinant growth hormone on leptin, adiponectin, resistin, interleukin-6, tumor necrosis factor-α and ghrelin levels in growth hormone-deficient children. J Endocrinol Invest 2011; 34:300-6. [PMID: 20634639 DOI: 10.1007/bf03347090] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment with GH promotes linear growth and decreases body fat in patients with isolated GH deficiency (GHD). However, few studies have analyzed how GH replacement modifies ghrelin levels and the adipokine profile and the relationship of these modifications with the metabolic changes. AIMS To analyze the eventual differences between serum levels of leptin, leptin soluble receptor (sOBR), resistin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), total (TG) and acylated ghrelin (AG) and lipid and glycemic profiles in children with GHD, as well as to determine the effect of GH replacement on these parameters during the first year of therapy. SUBJECTS AND METHODS Thirty pre-pubertal (Tanner stage I) GHD children and 30 matched controls were enrolled. Children with GHD were studied before and after 6 and 12 months of GH treatment. Weight, height, BMI, fasting glucose, insulin, lipid profile and serum levels of adipokines and ghrelin were studied at every visit. Adi - pokines, insulin and ghrelin levels were determined by using commercial radio- and enzymoimmunoassays. RESULTS At baseline children with GHD had significantly higher sOBR (p<0.01) and adiponectin (p<0.01) levels than controls. Treatment with GH resulted in a decline in leptin (p<0.05) and TG (p<0.001) levels, an increase of homeostasis model assessment index and restored IGF-I levels (p<0.001). CONCLUSIONS These data indicate that GH replacement has a negative effect on leptin levels and may also produce a slight unfavorable effect on carbohydrate metabolism. In addition, the changes observed in the adipokine profile appear to be independent of body mass index.
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Benjelloum O, Sánchez Álvarez JE, Rodríguez Suárez C, González I, Fernández-Viña A, Núñez M, Peláez B. Listeria monocytogenes: an infrequent cause of peritonitis in peritoneal dialysis. Nefrologia 2011; 31:362-365. [PMID: 21629343 DOI: 10.3265/nefrologia.pre2010.sep.10631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2010] [Indexed: 05/30/2023] Open
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Cabeza M, Cambero M, Núñez M, Medina M, de la Hoz L, Ordóñez J. Lack of growth of Listeria monocytogenes and Staphylococcus aureus in temperature abuse of E-beam treated ready-to-eat (RTE) cooked ham. Food Microbiol 2010; 27:777-82. [DOI: 10.1016/j.fm.2010.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 03/24/2010] [Accepted: 03/28/2010] [Indexed: 11/30/2022]
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Torres-Torres B, Martínez-Galán J, Del Moral R, Núñez M, González-Astorga B, Castellón V, González-Vicente A, Soberino J, Delgado J, Ruiz de Almodóvar M. Epigenetic alterations in peripheral blood cell DNA and implications for breast cancer detection, prognosis, and treatment. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13619] [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: 11/20/2022] Open
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Martínez-Galán J, Torres-Torres B, Valdivia J, Del Moral R, Núñez M, Luque R, Jurado JM, Peñalver J, Ruiz De Almodovar M, Delgado J. Correlation of serum ESR1 methylation levels with RE status in tumor and molecular subtypes of breast cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13648] [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: 11/20/2022] Open
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Mercedes S, Núñez M, Díaz O, De la Cruz E, Aquino A. Variabilidad de la presión intrabdominal en pacientes sometidos a abdominoplastia. Cir plást iberolatinoam 2009. [DOI: 10.4321/s0376-78922009000400003] [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: 11/11/2022] Open
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Núñez M, García-Lozano R, Boquera P, Gabarrell X, Rieradevall J. Temporary structures as a generator of waste in covered trade fairs. Waste Manag 2009; 29:2011-2017. [PMID: 19231151 DOI: 10.1016/j.wasman.2009.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 01/08/2009] [Accepted: 01/20/2009] [Indexed: 05/27/2023]
Abstract
Events like trade fairs are a complex service activity with a considerable economic, social and environmental impact due, among other factors, to their high level of waste generation. There are few studies of the environmental impact associated with waste generation and typology. An environmental analysis methodology has been developed to characterise the waste associated with the temporary structures used at trade fair events: stands and communal spaces. This methodology has been checked in a pilot test at 6 closed trade fairs in Barcelona, with a range of between 60 and 4400 exhibitors. The methodology developed has made possible to obtain a waste generation profile according to the size of the fair and the types of stands. The stages with the largest amount of temporary structure wastes generated are the assembly and the dismantling of the trade fair. The results indicate that the most common wastes generated are the protective plastic from carpets at the assembly stage and the carpet itself at the dismantling stage. The stand carpet is collected in bulk, while the carpet from the communal spaces is recycled. As the size of the fair increases, and with it the proportion of stands with customised design (or non-reusable stands), the quantity of wood and hazardous waste increases.
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Affiliation(s)
- M Núñez
- SosteniPrA (UAB-IRTA), Ctra. de Cabrils, Barcelona, Spain.
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Martín-Carbonero L, Puoti M, García-Samaniego J, De Luca A, Losada E, Quinzan G, Bruno R, Mariño A, González M, Núñez M, Soriano V. Response to pegylated interferon plus ribavirin in HIV-infected patients with chronic hepatitis C due to genotype 4. J Viral Hepat 2008; 15:710-5. [PMID: 18637070 DOI: 10.1111/j.1365-2893.2008.01015.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hepatitis C virus (HCV) genotypes 1 and 4 respond less well to pegylated interferon (pegIFN) plus ribavirin (RBV) therapy. For this reason most studies merge these two genotypes when assessing virological response. However, in most trials the HCV genotype 4 population is rather small, and conclusions are mainly derived from what occurs in HCV-1 patients. All HCV-4 patients coinfected with HIV who received pegIFN plus RBV in two different multicentre studies, PRESCO and ROMANCE, conducted respectively in Spain and Italy, were retrospectively analyzed. Baseline plasma HCV-RNA, proportion of patients with HCV-RNA <10 IU / mL at week 4 (rapid virological response), and HCV-RNA declines >2 logs at week 12 (early virological response, EVR) were all assessed as predictors of sustained virological response (SVR). Overall, 75 patients (60 men) were evaluated. Median age was 40 years and median CD4 count 598 cells / mm(3); 49% had plasma HIV-RNA <50 copies / mL; 71% had elevated liver enzymes and 31% had advanced liver fibrosis (Metavir F3-F4). Median serum HCV-RNA was 5.7 log IU / mL. Rapid virological response was attained by 10 (20%) patients and EVR by 26 (42%). Using intention-to-treat and on-treatment (OT) analyses, SVR was achieved by 21 / 75 (28%) and 21 / 62 (34%) of HCV-4 patients, respectively. In the multivariate analysis (OT), baseline HCV-RNA (OR 0.09 for every log increment; 95% CI: 0.01-0.7) and EVR (OR: 7.08; 95% CI: 1.8-27.2) were significantly and independently associated with SVR. This is the largest series of HIV-infected patients with chronic hepatitis C due to HCV-4 treated with pegIFN plus RBV examined so far and the results show that HCV-4 behaves similarly to HCV-1. Therefore, these patients should be considered as difficult to treat population. Baseline serum HCV-RNA and EVR are the best predictors of SVR in HCV-4 / HIV-coinfected patients.
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Torner P, Sastre S, Maculé F, Núñez M, Segur JM, Lozano L. Complex osteotomy assisted with navigation and arthroscopy around knee. Eur J Orthop Surg Traumatol 2008. [DOI: 10.1007/s00590-008-0344-3] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lozano LM, Núñez M, Segur JM, Maculé F, Sastre S, Núñez E, Suso S. Relationship between knee anthropometry and surgical time in total knee arthroplasty in severely and morbidly obese patients: a new prognostic index of surgical difficulty. Obes Surg 2008; 18:1149-53. [PMID: 18506553 DOI: 10.1007/s11695-008-9481-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 02/25/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) in patients with severe and morbid obesity is one of the current challenges in prosthetic knee surgery. The body mass index (BMI) is used to identify patients who may present difficulties during surgery and postoperative complications. We carried out a prospective study with an initial hypothesis that BMI is not associated with tourniquet time in obese patients undergoing TKA and that some anthropometric parameters may be useful in predicting tourniquet time in severely and morbidly obese patients. METHODS One hundred consecutive patients diagnosed with knee osteoarthritis with BMI > or =35 kg/m(2) scheduled for TKA were prospectively studied. Suprapatellar, infrapatellar, and supra/infrapatellar anthropometric indexes were calculated before surgery. The tourniquet time was determined. RESULTS The mean BMI was 39.81 kg/m(2) (SD +/- 3.75). A total of 58% of patients were classified as class III obesity (BMI 35-39.99) and 42% as class IV (BMI > or = 40) Mean tourniquet time was 41.67 min (SD +/- 9.26). There was no association between the BMI and tourniquet time. The suprapatellar index was negatively associated with tourniquet time (p < 0.038). DISCUSSION The BMI is not the only parameter that should be considered in order to identify severely and morbidly obese patients who may have more surgical difficulties during TKA. Preoperative determination of the suprapatellar index helped us to classify these patients according to the morphology of the knee and predicted a longer tourniquet time and, therefore, greater surgical difficulty, in patients with a suprapatellar ratio below 1.6 in this study.
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Affiliation(s)
- L M Lozano
- Knee Section, Orthopaedic Surgery Department, ICEMEQ, Hospital Clínic, University of Barcelona, Villarroel 170, Barcelona, Spain.
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