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Llufriu S, Agüera E, Costa-Frossard L, Galán V, Landete L, Lourido D, Meca-Lallana JE, Moral E, Bravo-Rodríguez F, Koren L, Labiano A, León A, Martín P, Monedero MD, Requeni L, Zubizarreta I, Rovira À. Recommendations for the coordination of Neurology and Neuroradiology Departments in the management of patients with multiple sclerosis. Neurologia 2023; 38:453-462. [PMID: 37120107 DOI: 10.1016/j.nrleng.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/01/2021] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is widely used for the diagnosis and follow-up of patients with multiple sclerosis (MS). Coordination between neurology and neuroradiology departments is crucial for performing and interpreting radiological studies as efficiently and as accurately as possible. However, improvements can be made in the communication between these departments in many Spanish hospitals. METHODS A panel of 17 neurologists and neuroradiologists from 8 Spanish hospitals held in-person and online meetings to draft a series of good practice guidelines for the coordinated management of MS. The drafting process included 4 phases: 1) establishing the scope of the guidelines and the methodology of the study; 2) literature review on good practices or recommendations on the use of MRI in MS; 3) discussion and consensus between experts; and 4) validation of the contents. RESULTS The expert panel agreed a total of 9 recommendations for improving coordination between neurology and neuroradiology departments. The recommendations revolve around 4 main pillars: 1) standardising the process for requesting and scheduling MRI studies and reports; 2) designing common protocols for MRI studies; 3) establishing multidisciplinary committees and coordination meetings; and 4) creating formal communication channels between both departments. CONCLUSIONS These consensus recommendations are intended to optimise coordination between neurologists and neuroradiologists, with the ultimate goal of improving the diagnosis and follow-up of patients with MS.
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Affiliation(s)
- S Llufriu
- Servicio de Neurología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - E Agüera
- Servicio de Neurología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - L Costa-Frossard
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - V Galán
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, Spain
| | - L Landete
- Servicio de Neurología, Hospital Universitario Dr. Peset, Valencia, Spain
| | - D Lourido
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J E Meca-Lallana
- CSUR Esclerosis Múltiple y Unidad de Neuroinmunología Clínica, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - E Moral
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - F Bravo-Rodríguez
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - L Koren
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Labiano
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, Spain
| | - A León
- Sección de Neurorradiología, Servicio de Radiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - P Martín
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M D Monedero
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, Spain
| | - L Requeni
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, Spain
| | - I Zubizarreta
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - À Rovira
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Mestre-Durán C, Martín-Cortázar C, García-Solís B, Pernas A, Pertíñez L, Galán V, Sisinni L, Clares-Villa L, Navarro-Zapata A, Al-Akioui K, Escudero A, Ferreras C, Pérez-Martínez A. Ruxolitinib does not completely abrogate the functional capabilities of TLR4/9 ligand-activated NK cells. Front Immunol 2023; 13:1045316. [PMID: 36685552 PMCID: PMC9851469 DOI: 10.3389/fimmu.2022.1045316] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Natural killer (NK) cells are lymphocytes from the innate immune system part of the first defense barrier against infected and transformed cells, representing 5%-15% of peripheral blood lymphocytes. The cytotoxic capacity of NK cells is controlled by a balance between inhibitory and activating NK receptors expressed on their surface, which recognize and interact with the ligands on stressed cells. The cytokines involved in NK cell activation, proliferation, survival, and cytotoxicity are signaled mainly through the Janus kinase and signal transducer and activator of transcription proteins (JAK/STAT) pathway. NK cells are also activated in response to pathogens through Toll-like receptors (TLRs) expressed on their surface. Ruxolitinib is a specific JAK1/2 inhibitor approved for treating myelofibrosis and for steroid-refractory acute and chronic graft-versus-host disease (SR-GvHD). Methods Purified NK cells from healthy donors were stimulated with two TOLL-like receptor ligands, LPS and CpG, in the presence of different concentrations of Ruxolitinib. Results This study showed the effects of ruxolitinib on TLR4 and TLR9 ligand-activated NK cells from healthy donors. Ruxolitinib did not completely inhibit STAT3 phosphorylation and had a moderate effect on NK cell cytokine activation via the TLR pathway. Only the highest doses of ruxolitinib led to a decrease in the pro-inflammatory cytokines tumor necrosis factor α, interferon-γ, interleukin-6, and interleukin-1β. The cytotoxic capacity of stimulated NK cells versus K562, SEM, and MV-4-11 cell lines was reduced by increasing doses of ruxolitinib, but it was not completely abolished and we observed no major changes in degranulation capacity. Phenotypic changes were observed in activated NK cells in the presence of ruxolitinib. In a small cohort of pediatric patients treated with ruxolitinib for SR-GvHD, we observed no decrease in NK cell counts; however, further prospective studies with larger cohorts are necessary to confirm this finding. Discussion In summary, our results showed that the functional capabilities and phenotype of NK cells activated through TLR4/9 agonists were not completely abolished by the inhibition of the JAK-STAT pathway by ruxolitinib.
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Affiliation(s)
- Carmen Mestre-Durán
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Carla Martín-Cortázar
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Blanca García-Solís
- Laboratory of Immunogenetics of Human Diseases, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Alicia Pernas
- Department of Genetics, Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Madrid, Spain
| | - Lidia Pertíñez
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Víctor Galán
- Pediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Luisa Sisinni
- Pediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Laura Clares-Villa
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Alfonso Navarro-Zapata
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Karima Al-Akioui
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Adela Escudero
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
- Department of Genetics, Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Madrid, Spain
| | - Cristina Ferreras
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Antonio Pérez-Martínez
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
- Pediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
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Galán V, Iñigo-Dendariarena I, Galán I, Prado R, Padilla S, Anitua E. The Effectiveness of Plasma Rich in Growth Factors (PRGF) in the Treatment of Nerve Compression Syndromes of the Upper Extremity: A Retrospective Observational Clinical Study. J Clin Med 2022; 11:jcm11164789. [PMID: 36013028 PMCID: PMC9409748 DOI: 10.3390/jcm11164789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Nerve compression syndromes of the upper extremity are a common cause of neuropathic pain and functional impairment. Recently, platelet-rich plasma (PRP) infiltrations have emerged as an effective biological approach to the treatment of this type of injury. The objectives of this retrospective observational study were to assess clinical improvement in patients with median and ulnar nerve entrapment syndrome after undergoing biologically-assisted nerve release surgery with plasma-rich-in-growth-factors (PRGF) technology. Methods: Participants (n = 39) with moderate-to-severe nerve compression syndrome of the upper limb diagnosed by both electromyography and clinical examination, and who were treated with PRGF, were identified from the center’s medical records. The evaluation was based on patient-reported outcomes. Pre- and post-treatment differences in the Visual analog scale (VAS), the Boston carpal tunnel questionnaire (BCTQ), and the Quick-DASH score were assessed. Results: Three study groups were conducted: patients with carpal tunnel syndrome (n = 16), with recurrent carpal tunnel syndrome (n = 8), and with ulnar nerve entrapment (n = 15). The median follow-up was 12 months (interquartile range (IQR), 9−16). In comparison to pre-treatment values, all three study groups obtained statistically significant improvements for the three analyzed scales at the end of the follow-up, with p < 0.001 for all scales in the carpal tunnel syndrome and ulnar nerve entrapment groups and p < 0.01 for all scales in the recurrent carpal tunnel syndrome group. There were no serious adverse effects in the analyzed patients. Conclusion: PRGF-assisted open surgical nerve release treatment (intraneural and perineural liquid PRGF infiltrations and nerve wrapping with PRGF membrane) exerts long-term beneficial effects on pain reduction and functional improvement in the nerve and nerve−muscle unit in patients with upper extremity compression syndromes.
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Affiliation(s)
- Víctor Galán
- Hand, Wrist and Microsurgery Unit, Clínica Indautxu, 48010 Bilbao, Spain
- Correspondence:
| | | | - Iñigo Galán
- School of Medicine, European University, 28670 Madrid, Spain
| | - Roberto Prado
- BTI-Biotechnology Institute I MAS D, 01007 Vitoria, Spain
- University Institute for Regenerative Medicine and Oral Implantology-UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
- Eduardo Anitua Foundation for Biomedical Research, 01007 Vitoria, Spain
| | - Sabino Padilla
- BTI-Biotechnology Institute I MAS D, 01007 Vitoria, Spain
- University Institute for Regenerative Medicine and Oral Implantology-UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
- Eduardo Anitua Foundation for Biomedical Research, 01007 Vitoria, Spain
| | - Eduardo Anitua
- BTI-Biotechnology Institute I MAS D, 01007 Vitoria, Spain
- University Institute for Regenerative Medicine and Oral Implantology-UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
- Eduardo Anitua Foundation for Biomedical Research, 01007 Vitoria, Spain
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Llufriu S, Agüera E, Costa-Frossard L, Galán V, Landete L, Lourido D, Meca-Lallana JE, Moral E, Bravo-Rodríguez F, Koren L, Labiano A, León A, Martín P, Monedero MD, Requeni L, Zubizarreta I, Rovira À. Recommendations for the coordination of Neurology and Neuroradiology Departments in the management of patients with multiple sclerosis. Neurologia 2021; 38:S0213-4853(21)00029-3. [PMID: 33744061 DOI: 10.1016/j.nrl.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/01/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is widely used for the diagnosis and follow-up of patients with multiple sclerosis (MS). Coordination between Neurology and Neuroradiology departments is crucial for performing and interpreting radiological studies as efficiently and as accurately as possible. However, improvements can be made in the communication between these departments in many Spanish hospitals. METHODS A panel of 17 neurologists and neuroradiologists from 8 Spanish hospitals held in-person and online meetings to draft a series of good practice guidelines for the coordinated management of MS. The drafting process included 4 phases: 1) establishing the scope of the guidelines and the methodology of the study; 2) literature review on good practices or recommendations on the use of MRI in MS; 3) discussion and consensus between experts; and 4) validation of the contents. RESULTS The expert panel agreed a total of 9 recommendations for improving coordination between neurology and neuroradiology departments. The recommendations revolve around 4 main pillars: 1) standardising the process for requesting and scheduling MRI studies and reports; 2) designing common protocols for MRI studies; 3) establishing multidisciplinary committees and coordination meetings; and 4) creating formal communication channels between both departments. CONCLUSIONS These consensus recommendations are intended to optimise coordination between neurologists and neuroradiologists, with the ultimate goal of improving the diagnosis and follow-up of patients with MS.
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Affiliation(s)
- S Llufriu
- Servicio de Neurología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | - E Agüera
- Servicio de Neurología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - L Costa-Frossard
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - V Galán
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, España
| | - L Landete
- Servicio de Neurología, Hospital Universitario Dr. Peset, Valencia, España
| | - D Lourido
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J E Meca-Lallana
- CSUR Esclerosis Múltiple y Unidad de Neuroinmunología Clínica, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, España
| | - E Moral
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - F Bravo-Rodríguez
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, España
| | - L Koren
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Labiano
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, España
| | - A León
- Sección de Neurorradiología, Servicio de Radiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - P Martín
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - M D Monedero
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, España
| | - L Requeni
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, España
| | - I Zubizarreta
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - À Rovira
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Vall d'Hebron, Barcelona, España
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Domínguez-Mozo MI, García-Montojo M, Arias-Leal A, García-Martínez Á, Santiago JL, Casanova I, Galán V, Arroyo R, Fernández-Arquero M, Alvarez-Lafuente R. Monitoring the John Cunningham virus throughout natalizumab treatment in multiple sclerosis patients. Eur J Neurol 2015; 23:182-9. [DOI: 10.1111/ene.12834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/04/2015] [Indexed: 12/21/2022]
Affiliation(s)
- M. I. Domínguez-Mozo
- Department of Neurology; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Hospital Clínico San Carlos; Madrid Spain
| | - M. García-Montojo
- Department of Neurology; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Hospital Clínico San Carlos; Madrid Spain
| | - A. Arias-Leal
- Department of Neurology; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Hospital Clínico San Carlos; Madrid Spain
| | - Á. García-Martínez
- Department of Neurology; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Hospital Clínico San Carlos; Madrid Spain
| | - J. L. Santiago
- Department of Immunology; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Hospital Clínico San Carlos; Madrid Spain
| | - I. Casanova
- Department of Neurology; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Hospital Clínico San Carlos; Madrid Spain
| | - V. Galán
- Department of Neurology; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Hospital Clínico San Carlos; Madrid Spain
| | - R. Arroyo
- Department of Neurology; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Hospital Clínico San Carlos; Madrid Spain
| | - M. Fernández-Arquero
- Department of Immunology; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Hospital Clínico San Carlos; Madrid Spain
| | - R. Alvarez-Lafuente
- Department of Neurology; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Hospital Clínico San Carlos; Madrid Spain
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Abstract
A series of 40 patients were studied, who were operated upon for a painful total hip prosthesis, half of which were infected. In each case, preoperative scintigraphy was performed using Tc99, Ga67 and In111. The images obtained with Tc and Ga were compared with those of In111 and analysed with respect to sensitivity, specificity, accuracy and the predictive value of a positive or negative test. In111 had a predictive value of more than 90% and showed greater reliability in the diagnosis of an infection as the cause of a painful total hip prosthesis.
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Affiliation(s)
- M A Gómez-Luzuriaga
- Department of Traumatology and Orthopaedic Surgery, Cruces Hospital, Bilbao, Spain
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