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de la Pinta C, Sevillano D, Colmenares R, Barrio S, Olavarria A, Palomera A, Romera R, Cobos J, Muriel A, Fernández E, Perna LC, Albillos A, Sancho S. Are liver contour and bone fusion comparable to fiducials for IGRT in liver SBRT? Tech Innov Patient Support Radiat Oncol 2023; 27:100215. [PMID: 37744524 PMCID: PMC10511841 DOI: 10.1016/j.tipsro.2023.100215] [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: 12/11/2022] [Revised: 05/28/2023] [Accepted: 06/19/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Liver stereotactic body radiotherapy (SBRT) is increasingly being used to treat tumours. The purpose of this study was to compare the differences in patient positioning when using implanted fiducials as surrogates compared to alternative methods based on liver contour or bone registration. Material and methods Eighteen patients treated with SBRT who underwent a fiducial placement procedure were included. Fiducial guidance was our gold standard to guide treatment in this study. After recording the displacements, when fusing the planning CT and CBCT performed in the treatment unit using fiducials, liver contour and bone reference, the differences between fiducials and liver contour and bone reference were calculated. Data from 88 CBCT were analyzed. The correlation between the displacements found with fiducials and those performed based on the liver contour and the nearest bone structure as references was determined. The mean, median, variance, range and standard deviation of the displacements with each of the fusion methods were obtained. μ, Ʃ, and σ values and margins were obtained. Results Lateral displacements of less than 3 mm with respect to the gold standard in 92% vs. 62.5% of cases using liver contour and bone references, respectively, with 93.2% vs. 65.9% in the AP axis and SI movement in 69.3% vs. 51.1%. The errors μ, σ and Ʃ of the fusions with hepatic contour and bone reference in SI were 0.26 mm, 4 mm and 3 mm, and 0.8 mm, 5 mm and 3 mm respectively. Conclusion Our study showed that displacements were smaller with the use of hepatic contour compared to bone reference and comparable to those obtained with the use of fiducials in the lateral, AP and SI motion axes. This would justify that hepatic contouring can be a guide in the treatment of patients in the absence of fiducials.
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Affiliation(s)
- C. de la Pinta
- Radiation Oncology Department. IRYCIS. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - D. Sevillano
- Medical Physics Department. Ramón y Cajal Hospital. IRYCIS, Crta Colmenar Viejo Km 9,100 28034, Madrid, Spain
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | - R. Colmenares
- Medical Physics Department. Ramón y Cajal Hospital. IRYCIS, Crta Colmenar Viejo Km 9,100 28034, Madrid, Spain
| | - S. Barrio
- Radiation Therapist. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - A. Olavarria
- Radiology Department. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - A. Palomera
- Radiology Department. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - R. Romera
- Radiology Department. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - J. Cobos
- Radiology Department. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - A. Muriel
- Clinical Biostatistics Unit, Ramón y Cajal University Hospital, IRYCIS, CIBERESP. Universidad de Alcalá, Madrid, Spain
| | - E. Fernández
- Radiation Oncology Department. IRYCIS. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - LC. Perna
- Pathology Department. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
| | - A. Albillos
- Dept of Gastroenterology. Hospital Universitario Ramón y Cajal. Universidad de Alcalá. IRYCIS. CIBEREHD., Madrid, Spain
| | - S. Sancho
- Radiation Oncology Department. IRYCIS. Ramón y Cajal Hospital. Crta Colmenar Viejo Km 9,100. 28034, Madrid, Spain
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Lumbreras-Fernández B, Vicente Bártulos A, Fernandez-Felix BM, Corres González J, Zamora J, Muriel A. Improvement in the management of suspected acute aortic syndrome in the emergency room through a clinical algorithm and study of predictive factors. Radiologia (Engl Ed) 2023; 65:423-430. [PMID: 37758333 DOI: 10.1016/j.rxeng.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/15/2022] [Indexed: 10/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Acute aortic syndrome (AAS) is uncommon and difficult to diagnose, with great variability in clinical presentation. To develop a computerized algorithm, or clinical decision support system (CDSS), for managing and requesting imaging in the emergency department, specifically computerized tomography of the aorta (CTA), when there is suspicion of AAS, and to determine the effect of implementing this system. To determine the factors associated with a positive radiological diagnosis that improve the predictive capacity of CTA findings. MATERIALS AND METHODS After developing and implementing an evidence-based algorithm, we studied suspected cases of AAS. Chi-squared test was used to analyze the association between the variables included in the algorithm and radiological diagnosis, with 3 categories: no relevant findings, positive for AAS, and alternative diagnoses. RESULTS 130 requests were identified; 19 (14.6%) had AAS and 34 (26.2%) had a different acute pathology. Of the 19 with AAS, 15 had been stratified as high risk and 4 as intermediate risk. The probability of AAS was 3.4 times higher in patients with known aortic aneurysm (P = .021, 95% CI 1.2-9.6) and 5.1 times higher in patients with a new aortic regurgitation murmur (P = .019, 95% CI 1.3-20.1). The probability of having an alternative severe acute pathology was 3.2 times higher in patients with hypotension or shock (P = .02, 95% CI 1.2-8.5). CONCLUSION The use of a CDSS in the emergency department can help optimize AAS diagnosis. The presence of a known aortic aneurysm and new-onset aortic regurgitation were shown to significantly increase the probability of AAS. Further studies are needed to establish a clinical prediction rule.
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Affiliation(s)
| | - A Vicente Bártulos
- Servicio de Radiología de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Centro de Investigación Biomédica en Red Enfermedades respiratorias (CIBERES), Madrid, Spain
| | - B M Fernandez-Felix
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J Corres González
- Servicio de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Zamora
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - A Muriel
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Departamento de Enfermería de la Universidad de Alcalá, Madrid, Spain
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Romero-Hernández B, Martínez-García L, Rodríguez-Dominguez M, Martínez-Sanz J, Vélez-Díaz-Pallarés M, Pérez Mies B, Muriel A, Gea F, Pérez-Elías MJ, Galán JC. The Negative Impact of COVID-19 in HCV, HIV, and HPV Surveillance Programs During the Different Pandemic Waves. Front Public Health 2022; 10:880435. [PMID: 35937266 PMCID: PMC9353175 DOI: 10.3389/fpubh.2022.880435] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has been a worldwide stress test for health systems. 2 years have elapsed since the description of the first cases of pneumonia of unknown origin. This study quantifies the impact of COVID-19 in the screening program of chronic viral infections such as human papillomavirus (HPV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV) along the six different pandemic waves in our population. Each wave had particular epidemiological, biological, or clinical patterns.MethodsWe analyzed the number of samples for screening of these viruses from March 2020 to February 2022, the new infections detected in the pandemic period compared to the previous year, the time elapsed between diagnosis and linking to treatment and follow-up of patients, and the percentage of late HIV diagnosis. Moreover, we used the origin of the samples as a marker for quantifying the restoration of activity in primary care.ResultsDuring the first pandemic year, the number of samples received was reduced by 26.7, 22.6, and 22.5% for molecular detection of HPV or serological HCV and HIV status respectively. The highest decrease was observed during the first wave with 70, 40, and 26.7% for HPV, HCV, and HIV. As expected, new diagnoses also decreased by 35.4, 58.2, and 40.5% for HPV, HCV, and HIV respectively during the first year of the pandemic. In the second year of the pandemic, the number of samples remained below pre-pandemic period levels for HCV (−3.6%) and HIV (−9.3%) but was slightly higher for HPV (8.0%). The new diagnoses in the second year of the pandemic were −16.1, −46.8, and −18.6% for HPV, HCV, and HIV respectively.ConclusionsUndoubtedly, an important number of new HPV, HCV, and HIV infections were lost during the COVID-19 pandemic, and surveillance programs were disrupted as a consequence of collapse of the health system. It is a priority to reinforce these surveillance programs as soon as possible in order to detect undiagnosed cases before the associated morbidity-mortality increases. New pandemic waves could increase the risk of reversing the achievements made over the last few decades.
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Affiliation(s)
- Beatriz Romero-Hernández
- Microbiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal for Health Research (IRYCIS), Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Martínez-García
- Microbiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal for Health Research (IRYCIS), Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mario Rodríguez-Dominguez
- Microbiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal for Health Research (IRYCIS), Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Javier Martínez-Sanz
- Instituto Ramón y Cajal for Health Research (IRYCIS), Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | | | - Belen Pérez Mies
- Instituto Ramón y Cajal for Health Research (IRYCIS), Madrid, Spain
- Pathology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A. Muriel
- Instituto Ramón y Cajal for Health Research (IRYCIS), Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Francisco Gea
- Liver Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBER of Liver and Digestive Diseases (CIBEREHD), Madrid, Spain
| | - María Jesús Pérez-Elías
- Instituto Ramón y Cajal for Health Research (IRYCIS), Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Juan Carlos Galán
- Microbiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal for Health Research (IRYCIS), Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- *Correspondence: Juan Carlos Galán
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Lumbreras-Fernández B, Vicente Bártulos A, Fernandez-Felix B, Corres González J, Zamora J, Muriel A. Mejora en el manejo de la sospecha del síndrome aórtico agudo en urgencias mediante un algoritmo clínico y el estudio de factores predictivos. Radiología 2022. [DOI: 10.1016/j.rx.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Martinez-Garcia MA, Oscullo G, Ponce S, Pastor E, Orosa B, Catalán P, Martinez A, Hernandez L, Muriel A, Chiner E, Vigil L, Carmona C, Mayos M, Garcia-Ortega A, Gomez-Olivas JD, Beauperthuy T, Bekki A, Gozal D. Effect of continuous positive airway pressure in very elderly with moderate-to-severe obstructive sleep apnea pooled results from two multicenter randomized controlled trials. Sleep Med 2021; 89:71-77. [PMID: 34915264 DOI: 10.1016/j.sleep.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/31/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE There is very limited information about the effect of continuous positive airway pressure (CPAP) in the very elderly. Here we aimed to analysed the effect of CPAP on a clinical cohort of patients with obstructive sleep apnea (OSA) ≥80 years old. METHODS Post-hoc pooled analysis of two open-label, multicenter clinical trials aimed to determine the effect of CPAP in a consecutive clinical cohort of elderly (≥70 years old) with moderate-to-severe OSA (apnea-hipopnea index ≥15 events/hour) randomized to receive CPAP or no CPAP for three months. Those consecutive patients ≥80 years old were included in the study. The primary endpoint was the change in Epworth Sleepiness scale (ESS). Secondary outcomes included sleep-related symptoms, quality of life, neurocognitive and mood status as well as office blood pressure measurements. RESULTS From the initial 369 randomized individuals with ≥70 years, 97 (26.3%) with ≥80 years old were included (47 in the CPAP group and 50 in the no-CPAP group). The mean (SD) age was 81.5 (2.4) years. Average use of CPAP was 4.3 (2.6) hours/night (53% with good adherence) Patients in the CPAP group significantly improved snoring and witnessed apneas as well as AHI (from 41.9 to 4.9 events/hour). However no clinical improvements were seen in ESS (-1.2 points, 95%CI, 0.2 to -2.6), any domain of QSQ, any neurocognitive test, OSA-related symptoms, depression/anxiety or blood pressure levels. CONCLUSIONS The present study does not support the use of CPAP in very elderly patients with moderate-to-severe OSA.
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Affiliation(s)
- M A Martinez-Garcia
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - G Oscullo
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Ponce
- Pneumology Department, Hospital Universitario Dr Peset, Valencia, Spain
| | - E Pastor
- Pneumology Department, Hospital Universitario San Juan, Alicante, Spain
| | - B Orosa
- Pneumology Department, Hospital Universitario Dr Peset, Valencia, Spain
| | - P Catalán
- Internal Medicine Department, Hospital General de Requena, Valencia, Spain
| | - A Martinez
- Pneumology Department, Hospital General Universitario de Castellón, Spain
| | - L Hernandez
- Pneumology Department, Hospital General Universitario de Alicante, Valencia, Spain
| | - A Muriel
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Nursing Department, Alcala University, Madrid, Spain
| | - E Chiner
- Pneumology Department, Hospital Universitario San Juan, Alicante, Spain
| | - L Vigil
- Pneumology Department, Hospital de Sabadell, Corporació Sanitaria Parc Tauli, Barcelona, Spain
| | - C Carmona
- Pneumology Department, Hospital Universitario Virgen Del Rocio, Sevilla, Spain
| | - M Mayos
- Pneumology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - A Garcia-Ortega
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J D Gomez-Olivas
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - T Beauperthuy
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A Bekki
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - D Gozal
- University of Missouri School of Medicine, Department of Child Health, Columbia, MO, USA
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Frutos-Vivar F, Peñuelas O, Muriel A, Mancebo J, García-Jiménez A, de Pablo R, Valledor M, Ferrer M, León M, Quiroga JM, Temprano S, Vallverdú I, Fernández R, Gordo F, Anzueto A, Esteban A. Mechanical ventilation in Spain, 1998-2016: changes in the disconnection of mechanical ventilation. Med Intensiva 2021; 46:S0210-5691(21)00079-6. [PMID: 34092422 DOI: 10.1016/j.medin.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/02/2021] [Accepted: 04/15/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. DESIGN Post-hoc analysis of four cohort studies. AMBIT 138 Spanish ICUs. PATIENTS 2141 patients scheduled extubated. INTERVENTIONS None. VARIABLES OF INTEREST Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. RESULTS There was a significant increase (p<0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p=0.435). CONCLUSIONS There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.
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Affiliation(s)
| | - O Peñuelas
- Hospital Universitario de Getafe, Madrid, España
| | - A Muriel
- Unidad de Bioestadística Clínica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - J Mancebo
- Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | | | - M Ferrer
- Hospital Clinic-IDIBAPS, Barcelona, España
| | - M León
- Hospital Arnau de Vilanova, Lleida, España
| | | | | | - I Vallverdú
- Hospital Universitari San Juan, Reus, España
| | - R Fernández
- Hospital Sant Joan de Déu, Fundació Althaia, Manresa, España
| | - F Gordo
- Grupo de Investigación en Patología Crítica. Universidad Francisco de Vitoria, Pozuelo de Alarcón. Hospital Universitario del Henares, Coslada, España
| | - A Anzueto
- South Texas Veterans Health Care System and University of Texas Health, San Antonio, Texas, Estados Unidos
| | - A Esteban
- Hospital Universitario de Getafe, Madrid, España
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Martín Duce A, Lozano O, Galván M, Muriel A, Villeta S, Gómez J. Results of Shouldice hernia repair after 18 years of follow-up in all the patients. Hernia 2021; 25:1215-1222. [PMID: 34009507 DOI: 10.1007/s10029-021-02422-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Evaluate the long-term efficacy of the Shouldice technique performed by non-specialized surgeons and also to reflex on the quality parameters necessary to safely assess hernia recurrence rates. METHODS During 3 years, a prospective study was conducted in 243 adult men who underwent surgery for primary inguinal hernias by 13 junior surgeons with an interest in hernia surgery. Using local anesthesia, a classic 4 step Shouldice repair, with polypropylene or polyester, was performed. All patients were followed for 18 years. The follow-up met the nine quality criteria proposed by the authors. RESULTS At 18 years, 80.2% of patients were followed and only 6.5% were lost. There were 7 recurrences in the first 10 years, 5 of them secondary to a direct hernia, and the same after 18 years. The recurrence rate was 2.88%. Tolerance of the local anesthesia was excellent in 91.4%of patients and, after 3 years, the pain was considered moderate or severe in 4 patients (1.8%). CONCLUSIONS It is necessary to incorporate more demanding criteria in the assessment of recurrence, to give more valid results. The Shouldice technique remains a useful technique today not only in patients under 30 years of age, and in the absence of risk factors, but also in cases of intolerance, patient rejection or absence of mesh. In addition, it provides the clinical and economic advantages of being possible to perform it under local anesthesia.
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Affiliation(s)
- A Martín Duce
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain. .,Department of General Surgery, Príncipe de Asturias University Hospital, Madrid, Spain.
| | - O Lozano
- Department of General Surgery, Los Arcos del Mar Menor University Hospital, San Javier, Spain
| | - M Galván
- Department of General Surgery, Los Arcos del Mar Menor University Hospital, San Javier, Spain
| | - A Muriel
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain.,Biostatistics Department, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Ramón y Cajal University Hospital, Madrid, Spain
| | - S Villeta
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain
| | - J Gómez
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain
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Nagore E, Martinez-Garcia MA, Gomez-Olivas JD, Manrique-Silva E, Martorell A, Bañuls J, Carrera C, Ortiz P, Gardeazabal J, Boada A, de Eusebio E, Chiner E, Gonzalez C, Pérez-Gil A, Cullen D, Formigón M, de Unamuno B, Navarro-Soriano C, Muriel A, Gozal D. Relationship between type 2 diabetes mellitus and markers of cutaneous melanoma aggressiveness: an observational multicentric study in 443 patients with melanoma. Br J Dermatol 2021; 185:756-763. [PMID: 33453061 DOI: 10.1111/bjd.19813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/01/2020] [Accepted: 01/11/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Some studies have suggested a relationship between type 2 diabetes mellitus (T2DM) and increased incidence of melanoma. Efforts are under way to identify preventable and treatable factors associated with greater melanoma aggressiveness, but no studies to date have examined the relationship between T2DM and the aggressiveness of cutaneous melanoma at diagnosis. OBJECTIVES To explore potential associations between T2DM, glycaemic control and metformin treatment and the aggressiveness of cutaneous melanoma. METHODS We conducted a cross-sectional multicentric study in 443 patients diagnosed with cutaneous melanoma. At diagnosis, all patients completed a standardized protocol, and a fasting blood sample was extracted to analyse their glucose levels, glycated haemoglobin concentration and markers of systemic inflammation. Melanoma characteristics and aggressiveness factors [Breslow thickness, ulceration, tumour mitotic rate (TMR), sentinel lymph node (SLN) involvement and tumour stage] were also recorded. RESULTS The mean (SD) age of the patients was 55·98 (15·3) years and 50·6% were male. The median Breslow thickness was 0·85 mm. In total, 48 (10·8%) patients were diagnosed with T2DM and this finding was associated with a Breslow thickness > 2 mm [odds ratio (OR) 2·6, 95% confidence interval (CI) 1·4-4·9; P = 0·004)] and > 4 mm (OR 3·6, 95% CI 1·7-7·9; P = 0·001), TMR > 5 per mm2 (OR 4·5, 95% CI 1·4-13·7; P = 0·009), SLN involvement (OR 2·3, 95% CI 1-5·7; P = 0·038) and tumour stages III-IV (vs. I-II) (OR 3·4, 95% CI 1·6-7·4; P = 0·002), after adjusting for age, sex, obesity, alcohol intake and smoking habits. No significant associations emerged between glycated haemoglobin levels, metformin treatment and melanoma aggressiveness. CONCLUSIONS T2DM, rather than glycaemic control and metformin treatment, is associated with increased cutaneous melanoma aggressiveness at diagnosis.
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Affiliation(s)
- E Nagore
- Dermatology Department, Instituto Valenciano de Oncologia, Valencia, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - M A Martinez-Garcia
- Pneumology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain.,CIBER de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | - J D Gomez-Olivas
- Pneumology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain
| | - E Manrique-Silva
- Dermatology Department, Instituto Valenciano de Oncologia, Valencia, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - A Martorell
- Dermatology Department, Hospital de Manises, Valencia, Spain
| | - J Bañuls
- Dermatology Department, Hospital General de Alicante, Alicante, Spain
| | - C Carrera
- Dermatology Department, Hospital Clinic, Barcelona, Spain
| | - P Ortiz
- Dermatology Department, Hospital 12 de Octubre, Madrid, Spain
| | - J Gardeazabal
- Dermatology Department, Hospital de Cruces, Bilbao, Spain
| | - A Boada
- Dermatology Department, Hospital Germans Trials i Pujol, Barcelona, Spain
| | - E de Eusebio
- Dermatology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - E Chiner
- Pneumology Department, Hospital San Juan de Alicante, Spain
| | - C Gonzalez
- Dermatology Department, Hospital d Getafe, Madrid, Spain
| | - A Pérez-Gil
- Dermatology Department, Hospital de Valme, Seville, Spain
| | - D Cullen
- Dermatology Department, Fundación Jiménez Diaz, Madrid, Spain
| | - M Formigón
- Dermatology Department, Consorcio Sanitario Terrassa, Barcelona, Spain
| | - B de Unamuno
- Dermatology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain
| | - C Navarro-Soriano
- Pneumology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain
| | - A Muriel
- Biostatistic Unit, Hospital Ramón y Cajal. IRYCIS, CIBERESP, Nursery Department and Physiotherapy, Alcalá University, Madrid, Spain
| | - D Gozal
- Department of Child Health, University of Missouri, Columbia, MO, USA
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9
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Peñuelas O, Frutos-Vivar F, Muriel A, Mancebo J, García-Jiménez A, de Pablo R, Valledor M, Ferrer M, León M, Quiroga JM, Temprano S, Vallverdú I, Fernández R, Gordo F, Anzueto A, Esteban A. Mechanical ventilation in Spain, 1998-2016: Epidemiology and outcomes. Med Intensiva 2020; 45:3-13. [PMID: 32723483 DOI: 10.1016/j.medin.2020.04.024] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/03/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate changes in the epidemiology of mechanical ventilation in Spain from 1998 to 2016. DESIGN A post hoc analysis of four cohort studies was carried out. SETTING A total of 138 Spanish ICUs. PATIENTS A sample of 4293 patients requiring invasive mechanical ventilation for more than 12h or noninvasive ventilation for more than 1h. INTERVENTIONS None. VARIABLES OF INTEREST Demographic variables, reason for mechanical ventilation, variables related to ventilatory support (ventilation mode, tidal volume, PEEP, airway pressures), complications during mechanical ventilation, duration of mechanical ventilation, ICU stay and ICU mortality. RESULTS There was an increase in severity (SAPSII: 43 points in 1998 vs. 47 points in 2016), changes in the reason for mechanical ventilation (decrease in chronic obstructive pulmonary disease and acute respiratory failure secondary to trauma, and increase in neurological disease and post-cardiac arrest). There was an increase in noninvasive mechanical ventilation as the first mode of ventilatory support (p<0.001). Volume control ventilation was the most commonly used mode, with increased support pressure and pressure-regulated volume-controlled ventilation. A decrease in tidal volume was observed (9ml/kg actual b.w. in 1998 and 6.6ml/kg in 2016; p<0.001) as well as an increase in PEEP (3cmH2O in 1998 and 6cmH2O in 2016; p<0.001). In-ICU mortality decreased (34% in 1998 and 27% in 2016; p<0.001), without geographical variability (median OR 1.43; p=0.258). CONCLUSIONS A significant decrease in mortality was observed in patients ventilated in Spanish ICUs. These changes in mortality could be related to modifications in ventilation strategy to minimize ventilator-induced lung injury.
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Affiliation(s)
- O Peñuelas
- Hospital Universitario de Getafe y Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - F Frutos-Vivar
- Hospital Universitario de Getafe y Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - A Muriel
- Unidad de Bioestadística Clínica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - J Mancebo
- Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | | | - M Ferrer
- Hospital Clínic-IDIBAPS, Barcelona, España
| | - M León
- Hospital Arnau de Vilanova, Lleida, España
| | | | | | - I Vallverdú
- Hospital Universitari Sant Joan, Reus, España
| | - R Fernández
- Hospital Sant Joan de Déu, Fundació Althaia, Manresa, España
| | - F Gordo
- Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Pozuelo de Alarcón. Hospital Universitario del Henares, Coslada, España
| | - A Anzueto
- South Texas Veterans Health Care System and University of Texas Health, San Antonio, Texas, Estados Unidos
| | - A Esteban
- Hospital Universitario de Getafe y Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
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10
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Martinez-García MA, Oscullo G, Posadas T, Zaldivar E, Villa C, Dobarganes Y, Girón R, Olveira C, Maíz L, García-Clemente M, Sibila O, Golpe R, Rodríguez J, Barreiro E, Rodriguez JL, Feced-Olmos L, Prados C, Muriel A, de la Rosa D. Pseudomonas aeruginosa and lung function decline in patients with bronchiectasis. Clin Microbiol Infect 2020; 27:428-434. [PMID: 32311472 DOI: 10.1016/j.cmi.2020.04.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/04/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objective of this study was to analyse lung function decline over time in bronchiectasis, along with the factors associated with it. METHODS Spirometry was measured every year in this observational, prospective study in 849 patients from the Spanish Bronchiectasis Registry (RIBRON). The main outcome was the decline in the rate of forced expiratory volume during the first second (FEV1). To be included in this study, patients needed a baseline assessment and at least one subsequent assessment. FEV1 decline was analysed using a mixed-effects linear regression model adjusted for clinically significant variables. RESULTS We recruited 849 bronchiectasis patients with at least two annual lung function measurements (follow-up range 1-4 years). A total of 2262 lung function tests were performed (mean 2.66 per patient, range 2-5). Mean baseline FEV1 was 1.78 L (standard deviation (SD) 0.76; 71.3% predicted). Mean age was 69.1 (SD 15.4) years; 543 (64% women. The adjusted rates of FEV1 decline were -0.98% predicted/year (95% confidence interval (CI) -2.41 to -0.69) and -31.6 (95% CI -44.4 to -18.8) mL. The annual FEV1 decline was faster in those patients with chronic bronchial infection by Pseudomonas aeruginosa (-1.37% (52.1 mL) vs -0.37% (-24.6 mL); p < 0.001), greater age, increased number of severe exacerbations in the previous year and higher baseline FEV1 value. DISCUSSION In patients with bronchiectasis, the annual rate of FEV1 decline was -31.6 mL/year and it was faster in older patients and those with chronic bronchial infection by P. aeruginosa, increased number of previous severe exacerbations and higher baseline FEV1 value.
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Affiliation(s)
- M A Martinez-García
- Respiratory Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain; CIBER de enfermedades respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - G Oscullo
- Respiratory Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - T Posadas
- Respiratory Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - E Zaldivar
- Respiratory Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - C Villa
- Respiratory Department, Clinica Fuensanta, Madrid, Spain
| | - Y Dobarganes
- Respiratory Department, Clinica Fuensanta, Madrid, Spain
| | - R Girón
- Respiratory Department, Hospital la Princesa, Madrid, Spain
| | - C Olveira
- Respiratory Department, Hospital Regional de Málaga, Málaga, Spain
| | - L Maíz
- Respiratory Department, Hospital Ramon y Cajal, Madrid, Spain
| | | | - O Sibila
- Respiratory Department, Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - R Golpe
- Respiratory Department, Hospital Lucus Augusti, Lugo, Spain
| | - J Rodríguez
- Respiratory Department, Hospital San Agustin, Aviles, Spain
| | - E Barreiro
- Respiratory Department, Hospital del Mar, Barcelona, Spain
| | - J L Rodriguez
- Respiratory Department, Hospital San Carlos, Madrid, Spain
| | - L Feced-Olmos
- Respiratory Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - C Prados
- Respiratory Department, Hospital la Paz, Madrid, Spain
| | - A Muriel
- Biostatistic Unit, Hospital Ramón y Cajal, IRYCIS, CIBERESP, Nursery Department and Physiotherapy, Alcalá University, Madrid, Spain
| | - D de la Rosa
- Respiratory Department, Hospital Plató, Barcelona, Spain
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11
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Escudero-Sanchez R, Senneville E, Digumber M, Soriano A, Del Toro MD, Bahamonde A, Del Pozo JL, Guio L, Murillo O, Rico A, García-País MJ, Rodríguez-Pardo D, Iribarren JA, Fernández M, Benito N, Fresco G, Muriel A, Ariza J, Cobo J. Suppressive antibiotic therapy in prosthetic joint infections: a multicentre cohort study. Clin Microbiol Infect 2020; 26:499-505. [PMID: 31539638 DOI: 10.1016/j.cmi.2019.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/09/2019] [Revised: 09/01/2019] [Accepted: 09/07/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim was to describe the effectiveness of suppressive antibiotic treatment (SAT) in routine clinical practice when used in situations in which removal of a prosthetic implant is considered essential for the eradication of an infection, and it cannot be performed. METHODS This was a descriptive retrospective and multicentre cohort study of prosthetic joint infection (PJI) cases managed with SAT. SAT was considered to have failed if a fistula appeared or persisted, if debridement was necessary, if the prosthesis was removed due to persistence of the infection or if uncontrolled symptoms were present. RESULTS In total, 302 patients were analysed. Two hundred and three of these patients (67.2%) received monotherapy. The most commonly used drugs were tetracyclines (39.7% of patients) (120/302) and cotrimoxazole (35.4% of patients) (107/302). SAT was considered successful in 58.6% (177/302) of the patients (median time administered, 36.5 months; IQR 20.75-59.25). Infection was controlled in 50% of patients at 5 years according to Kaplan-Meier analysis. Resistance development was documented in 15 of 65 (23.1%) of the microbiologically documented cases. SAT failure was associated with age <70 years (sub-hazard ratio (SHR) 1.61, 95% CI 1.1-2.33), aetiology other than Gram-positive cocci (SHR 1.56, 95% CI 1.09-2.27) and location of the prosthesis in the upper limb (SHR 2.4, 95% CI 1.5-3.84). SAT suspension was necessary due to adverse effects in 17 of 302 patients (5.6%). CONCLUSIONS SAT offers acceptable results for patients with PJI when surgical treatment is not performed or when it fails to eradicate the infection.
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Affiliation(s)
| | - E Senneville
- Centre Hospitalier Gustave Dron, Tourcoing, France
| | - M Digumber
- Centre Hospitalier Gustave Dron, Tourcoing, France
| | | | | | | | | | - L Guio
- Hospital Cruces, Vizcaya, Spain
| | - O Murillo
- Hospital Bellvitge, Barcelona, Spain
| | - A Rico
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | - N Benito
- Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - G Fresco
- Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - A Muriel
- Hospital Ramón y Cajal, IRYCIS, CIBER, Madrid, Spain
| | - J Ariza
- Hospital Bellvitge, Barcelona, Spain
| | - J Cobo
- Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
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12
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Fernández Lucas M, Ruíz-Roso G, Merino JL, Sánchez R, Bouarich H, Herrero JA, Muriel A, Zamora J, Collado A. Initiating renal replacement therapy through incremental haemodialysis: Protocol for a randomized multicentre clinical trial. Trials 2020; 21:206. [PMID: 32075665 PMCID: PMC7031943 DOI: 10.1186/s13063-020-4058-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/22/2019] [Accepted: 01/08/2020] [Indexed: 01/25/2023] Open
Abstract
Background Thrice-weekly haemodialysis is the usual dose when starting renal replacement therapy; however, this schedule is no longer appropriate since it does not consider residual renal function. Several reports have suggested the potential benefit of beginning haemodialysis less frequently and incrementally increasing the dose as the residual renal function decreases. However, all the data published so far are from observational studies. Thus, this clinical trial avoids any potential selection bias and will assess the possible benefits that have been observed in observational studies. Methods/design This report describes the study protocol of a randomized prospective multi-centre open-label clinical trial to evaluate whether starting renal replacement therapy with twice-weekly haemodialysis sessions preserves residual renal function better than the standard thrice-weekly regimen. We also explore other clinical parameters, such as concentrations of uremic toxins, dialysis doses, control of anaemia, removal of medium-weight uremic toxins, nutritional status, quality of life, hospital admissions and mortality. Only incident haemodialysis patients who can maintain a urea clearance rate KrU ≥ 2.5 mL/min/1.73 m2 are eligible. Patient recruitment began on 1 January 2017 and will last for 2 years or until the required sample size has been recruited to ensure the established statistical power has been reached. The minimum follow-up period will be 1 year. Anuric patients with acute renal failure and patients who return to haemodialysis after a kidney transplant failure are excluded. It has been calculated that 44 patients should be recruited into each group to achieve a power of 80% in a two-sided comparison of means with a usual significance level of 0.05. A time-to-event analysis will estimate the probability of kidney function survival in both groups using the Kaplan–Meier method. Survival curves will be compared with log-rank tests. This survival analysis will be complemented with a proportional hazard model to estimate the hazard ratio of kidney function survival adjusted for any confounding factors. Analyses will be carried out in accordance with the intention-to-treat principle. Discussion The incremental initiation of dialysis may preserve residual renal function better than the conventional treatment, with similar or higher survival rates, as reported by observational studies. To our knowledge, this is the first clinical trial to evaluate whether initiating renal replacement therapy with twice-weekly haemodialysis sessions preserves residual renal function better than beginning with the standard thrice-weekly regimen. Trial registration ClinicalTrials.gov, NCT03302546. Registered on 5 October 2017.
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Affiliation(s)
- M Fernández Lucas
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain. .,Departamento de Medicina, Universidad de Alcala, Alcalá de Henares, Madrid, Spain.
| | - G Ruíz-Roso
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J L Merino
- Hospital Universitario del Henares, Madrid, Spain
| | - R Sánchez
- Hospital Universitario La Paz, Madrid, Spain
| | - H Bouarich
- Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid, Spain
| | - J A Herrero
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - A Muriel
- Unidad de Bioestadística, H. U, Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J Zamora
- Unidad de Bioestadística, H. U, Ramón y Cajal, IRYCIS, Madrid, Spain
| | - A Collado
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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13
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Rincon LM, Sanmartin M, Alonso GL, Rodriguez JA, Muriel A, Casas E, Navarro M, Carbonell A, Lazaro C, Fernandez S, Jimenez Mena M, Fernandez Golfin C, Esteban A, Garcia Bermejo ML, Zamorano JL. P1551A genetic risk score predicts recurrent events after myocardial infarction in young adults. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
To evaluate whether a genetic risk score (GRS) improves the prediction of recurrent events in young non-diabetic patients presenting with an acute myocardial infarction and identifies a more aggressive form of atherosclerosis in this population.
Methods and results
We performed a prospective study including 81 consecutive non-diabetic patients aged below 55 y.o. presenting with an acute myocardial infarction (48±6 y.o., 89% male). A comprehensive study including serum biomarkers, genetic testing and cardiac CT was performed. We studied the association of a GRS composed of 11 genetic variants with a primary composite end-point (all-cause mortality, recurrent acute coronary syndrome, and cardiac re-hospitalisation). After a median follow-up of 4.1 (3.5 - 4.4) years 24 recurrent events were documented. A significantly higher prevalence of 9 out of 11 risk alleles was noted compared with general population. The GRS was significantly associated with recurrent events, especially when baseline LDL-cholesterol levels were elevated. Compared with the low-risk GRS category, the multivariate-adjusted hazard ratio for recurrent events for the intermediate-risk GRS category was 10.2 (95% CI 1.1–100.3, p=0.04) and for the high-risk GRS was 20.7 (2.4–181.0, p=0.006) when LDL-C ≥2.8 mmol/L. Inclusion of the GRS improved the C statistic (ΔC statistic =0.086), the continuous Net Reclassification Index (30%) and the Integrated Discrimination Improvement (0.05) compared with a multivariate clinical risk model. Cardiac CT detected coronary calcified atherosclerosis and numerous plaques but it had a limited value for prediction of recurrences. No association was observed between extracellular matrix metabolism biomarkers and GRS or recurrent events in this population.
Cox regression analysis between GRS terciles and LDL-C Univariate analysis Multivariate analysis* HR (95% CI) p-value HR (95% CI) p-value* Low GRS 1 1 Intermediate GRS 2.0 (0.7–5.8) 0.21 LDL-C≤110 mg/dL (≤2.8 mmol/L) 1.0 (0.3–4.0) >110 mg/dL (>2.8 mmol/L) 10.2 (1.1–100.3) 0.04 High GRS 3.0 (1.0–9.2) 0.05 LDL-C≤110 mg/dL (≤2.8 mmol/L) 0.3 (0.1–1.9) >110 mg/dL (>2.8 mmol/L) 20.7 (2.4–181.0) 0.006 *Multivariate model adjusted for GRACE risk score and LDL-C and interaction. There was a strong interaction between GRS terciles and LDL-C (p<0.01).
Recurrent events based on genetic risk
Conclusions
A multilocus genetic risk score identified non-diabetic young patients at increased risk for recurrent events after a myocardial infarction. The significance of LDL-cholesterol in relation to genetic predisposition for recurrences merits further evaluation.
Acknowledgement/Funding
Instituto de Salud Carlos III (PI12/0564, PI14/01152 and PI15/00667), the CIBERCV and the Spanish Society of Cardiology (2015/CC)
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Affiliation(s)
- L M Rincon
- University Hospital Ramon y Cajal, Madrid, Spain
| | - M Sanmartin
- University Hospital Ramon y Cajal, Madrid, Spain
| | - G L Alonso
- University Hospital Ramon y Cajal, Madrid, Spain
| | - J A Rodriguez
- Center for Applied Medical Research, Pamplona, Spain
| | - A Muriel
- Instituto Ramon y Cajal de Investigacion Sanitaria (IRYCIS), Madrid, Spain
| | - E Casas
- University Hospital Ramon y Cajal, Madrid, Spain
| | - M Navarro
- University Hospital Ramon y Cajal, Madrid, Spain
| | - A Carbonell
- University Hospital 12 de Octubre, Madrid, Spain
| | - C Lazaro
- Hospital Torrejόn, Madrid, Spain
| | - S Fernandez
- University Hospital Ramon y Cajal, Madrid, Spain
| | | | | | - A Esteban
- University Hospital Ramon y Cajal, Madrid, Spain
| | - M L Garcia Bermejo
- Instituto Ramon y Cajal de Investigacion Sanitaria (IRYCIS), Madrid, Spain
| | - J L Zamorano
- University Hospital Ramon y Cajal, Madrid, Spain
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14
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Marín MC, Elizalde J, Villagómez A, Cerón U, Poblano M, Palma-Lara I, Sánchez JR, Monares E, Arellano A, Muriel A, Peñuelas Ó, Frutos-Vivar F, Esteban A. Have there been changes in the application of mechanical ventilation in relation to scientific evidence? A multicenter observational study in Mexico. Med Intensiva 2019; 44:333-343. [PMID: 31130359 DOI: 10.1016/j.medin.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The main study objectives were to describe the practice of mechanical ventilation over an 18-year period in Mexico, and estimate changes in mortality among critical patients subjected to invasive mechanical ventilation (IMV). DESIGN A retrospective subanalysis of a prospective observational study conducted in 1998, 2004, 2010 and 2016 was carried out. SETTING Intensive Care Units (ICUs) in Mexico. PARTICIPANTS Adult patients consecutively enrolled in the ICU during one month and who underwent IMV for more than 12hours or noninvasive mechanical ventilation for more than one hour. Follow-up was performed up to a maximum of 28 days after inclusion. INTERVENTIONS None. PRINCIPAL VARIABLES OF INTEREST Age, sex, severity upon admission as estimated by SAPS II, parameters of daily arterial blood gases, treatment and complication variables, date and status at discharge from the ICU and from hospital. RESULTS A total of 959 patients were included in 81 ICUs. Tidal volume (vt) decreased significantly both in patients with acute respiratory distress syndrome (ARDS) criteria (estimated 8.5ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001) and in patients without ARDS (estimated 9ml/kg b.w. in 1998 to 6ml/kg in 2016; P<0.001). The ventilatory protective strategy (defined as vt < 6ml/kg or < 8ml/kg and a plateau pressure < 30cmH2O) was: 19% in 1998, 44% in 2004, 58% in 2010 and 75% in 2016 (P<0.001). The adjusted mortality rate in ICU over the 4 periods was: in 2004, odds ratio (OR) 1.05 (95% confidence interval, 95%CI: 0.73-1.72; P=0.764); in 2010, OR 1.68 (95%CI: 1.13-2.48; P=0.009); in 2016, OR 0.85 (95%CI: 0.60-1.20; P=0.368). CONCLUSIONS The clinical practice of IMV in Mexican ICUs has been modified over a period of 18 years. The most significant change is the ventilatory strategy based on low vt. These changes have not been associated with significant changes in mortality.
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Affiliation(s)
- M C Marín
- Unidad de Cuidados Intensivos, Hospital Regional 1.° de Octubre, ISSSTE, Ciudad de México, México; Unidad de Cuidados Intensivos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J Elizalde
- Unidad de Cuidados Intensivos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - A Villagómez
- Unidad de Cuidados Intensivos, Hospital Regional 1.° de Octubre, ISSSTE, Ciudad de México, México
| | - U Cerón
- Unidad de Cuidados Intensivos, Hospital Español de México, Ciudad de México, México
| | - M Poblano
- Unidad de Cuidados Intensivos, Hospital H+ Querétaro, Ciudad de México, México
| | - I Palma-Lara
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | - J R Sánchez
- Unidad de Cuidados Intensivos, Hospital Regional de PEMEX, Ciudad Madero (Tamaulipas), México
| | - E Monares
- Unidad de Cuidados Intensivos, Hospital San Ángel Inn Universidad, Ciudad de México, México
| | - A Arellano
- Unidad de Cuidados Intensivos, Hospital Regional de Alta Especialidad Ixtapaluca, SSA, Ixtapaluca (Estado de México)
| | - A Muriel
- Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Ó Peñuelas
- Unidad de Cuidados Intensivos y Grandes Quemados, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Getafe (Madrid), España.
| | - F Frutos-Vivar
- Unidad de Cuidados Intensivos y Grandes Quemados, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Getafe (Madrid), España
| | - A Esteban
- Unidad de Cuidados Intensivos y Grandes Quemados, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Getafe (Madrid), España
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15
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Cuello JP, Martínez Ginés ML, Kuhle J, García Domínguez JM, Lozano Ros A, Romero Delgado F, Higueras Y, Meldaña Rivera A, Goicochea Briceño H, García-Tizon Larroca S, De León-Luis J, Michalak Z, Barro C, Álvarez Lafuente R, Medina Heras S, Fernández Velasco JI, Tejeda-Velarde A, Domínguez-Mozo MI, Muriel A, de Andrés C, Villar LM. Neurofilament light chain levels in pregnant multiple sclerosis patients: a prospective cohort study. Eur J Neurol 2019; 26:1200-1204. [PMID: 30977955 DOI: 10.1111/ene.13965] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/03/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Neurofilament light chain is a cytoskeletal protein of neurons. Its levels are increasingly recognized as measures of neuroaxonal damage. The aim of this study was to explore serum neurofilament light chain (sNfL) levels in multiple sclerosis (MS) patients and healthy controls during pregnancy and puerperium. METHODS This was a prospective, longitudinal, single-center study. sNfL concentration was assessed using a highly sensitive single-molecule array during pregnancy and in puerperium, in a cohort of 39 pregnant patients with relapsing multiple sclerosis (P-MS). Twenty-one healthy pregnant women (HPW) served as a control group. Eight P-MS suffered relapses during pregnancy (P-MS-R) in the first or second trimesters. RESULTS No differences in pregnancy and delivery data were observed between P-MS and HPW. P-MS showed higher sNfL values than HPW in the first trimester, independently of the presence (P = 0.002) or not (P = 0.02) of relapses during pregnancy. However, in the third trimester, only P-MS-R showed higher sNfL values than HPW (P = 0.001). These differences extended to the puerperium, where P-MS-R showed higher sNfL values than those with no relapses during gestation (P = 0.02). CONCLUSION These data strongly suggest that sNfL levels reflect MS activity during pregnancy. Additionally, the absence of relapses during pregnancy may have a beneficial effect on neurodegeneration during puerperium.
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Affiliation(s)
- J P Cuello
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | | | - J Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - A Lozano Ros
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | - F Romero Delgado
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | - Y Higueras
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | - A Meldaña Rivera
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | | | | | - J De León-Luis
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | - Z Michalak
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - C Barro
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - R Álvarez Lafuente
- Grupo de Investigación de Esclerosis Múltiple, Instituto de investigación Sanitaria San Carlos (IdISSC)/Hospital Clínico San Carlos, Madrid, España
| | | | | | | | - M I Domínguez-Mozo
- Grupo de Investigación de Esclerosis Múltiple, Instituto de investigación Sanitaria San Carlos (IdISSC)/Hospital Clínico San Carlos, Madrid, España
| | - A Muriel
- Hospital Universitario Ramón y Cajal, Madrid, España
| | - C de Andrés
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | - L M Villar
- Hospital Universitario Ramón y Cajal, Madrid, España
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Hernandez S, Angulo B, Dominguez C, Caminoa A, Muriel A, Alonso M, Jimenez L, Peñalver R, Collazo-Lorduy A, Jimenez B, Garrido P, Paz-Ares L, De Castro J, Conde E, Lopez-Rios F. P2.09-11 TMB Estimated with Targeted NGS in Early Stage Squamous Cell Carcinoma: Correlation with PD-L1 Expression and Lymphocyte Density. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1308] [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: 10/28/2022]
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17
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De la Pinta Alonso C, Fernández-Lizarbe E, Muriel A, Pérez B, Martín Sánchez M, Muñóz Migueláñez T, Hernanz De Lucas R, Montero Luis A, Sancho García S. EP-1295: Validation of the MSKCC-nomogram in the prediction of recurrence risk after treatment in DCIS. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31605-0] [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: 10/14/2022]
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18
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Tejeda-Velarde A, Costa-Frossard L, Sainz de la Maza S, Carrasco Á, Espiño M, Picón C, Toboso I, Walo PE, Lourido D, Muriel A, Álvarez-Cermeño JC, Villar LM. Clinical usefulness of prognostic biomarkers in optic neuritis. Eur J Neurol 2018; 25:614-618. [PMID: 29272057 DOI: 10.1111/ene.13553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/18/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Different biological and radiological biomarkers predict clinical conversion to multiple sclerosis (MS) after a clinically isolated syndrome (CIS). The aim was to explore their role in predicting the outcome of patients with optic neuritis (ON), a CIS considered to have a benign prognosis. METHODS Sixty-eight consecutive ON patients were followed prospectively. Magnetic resonance imaging (MRI) and cerebrospinal fluid studies including oligoclonal immunoglobulin G (IgG) bands (OCGBs), lipid-specific oligoclonal IgM bands (LS-OCMBs) and neurofilament light chain quantification were performed at disease onset. Conversion to clinically definite MS (CDMS) was monitored. RESULTS The mean time of follow-up of our series was 46.4 months. Twenty-five patients (36.7%) developed CDMS during follow-up. Neurofilament light chain levels did not predict clinical conversion. By contrast, an abnormal MRI increased the risk of CDMS [hazard ratio (HR) 12.5, P = 0.013]. The clearest association was found in patients with more than three T2 lesions. OCGBs also predicted the onset of CDMS (HR 21.3, P = 0.003) and LS-OCMBs were associated with a shorter time to CDMS (HR = 116.6, P < 0.001). CONCLUSIONS Magnetic resonance imaging and OCGBs predicted conversion to CDMS after an ON episode. In addition, LS-OCMBs identified the ON patients more likely to develop MS early. These results, applicable to the everyday clinical setting, may be of interest for therapeutic decisions.
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Affiliation(s)
- A Tejeda-Velarde
- Immunology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain.,The Spanish Network of Multiple Sclerosis (REEM), Spain
| | - L Costa-Frossard
- The Spanish Network of Multiple Sclerosis (REEM), Spain.,Neurology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - S Sainz de la Maza
- The Spanish Network of Multiple Sclerosis (REEM), Spain.,Neurology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Á Carrasco
- Immunology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Espiño
- Immunology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain.,The Spanish Network of Multiple Sclerosis (REEM), Spain
| | - C Picón
- Immunology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain.,The Spanish Network of Multiple Sclerosis (REEM), Spain
| | - I Toboso
- Immunology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain.,The Spanish Network of Multiple Sclerosis (REEM), Spain
| | - P E Walo
- Immunology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - D Lourido
- Radiology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Muriel
- Biostatistics Unit, IRYCIS CIBERESP, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J C Álvarez-Cermeño
- The Spanish Network of Multiple Sclerosis (REEM), Spain.,Neurology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Medicine Department, Alcalá University, Alcalá de Henares, Spain
| | - L M Villar
- Immunology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain.,The Spanish Network of Multiple Sclerosis (REEM), Spain
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Pardo-Muñoz A, Muriel-Herrero A, Abraira V, Muriel A, Muñoz-Negrete FJ, Murube J. Phacoemulsification in Previously Vitrectomized Patients: An Analysis of the Surgical Results in 100 Eyes as well as the Factors Contributing to the Cataract Formation. Eur J Ophthalmol 2018; 16:52-9. [PMID: 16496246 DOI: 10.1177/112067210601600110] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate the safety and effectiveness of phacoemulsification with clear corneal incision in previously vitrectomized patients as well as factors affecting the development time and type of cataract occurring after pars plana vitrectomy (PPV). Methods The authors conducted a prospective study of 100 consecutive eyes of patients who developed a cataract after PPV. Three groups were established based on the underlying vitreoretinal pathology. The main outcome measurements were intraoperative and postoperative complications and changes in best-corrected visual acuity (BCVA). Results The median interval between PPV and phacoemulsification was 11.5 months. Patients with proliferative diabetic retinopathy required phacoemulsification earlier (p=0.018). Posterior subcapsular cataracts developed more frequently in patients <50 years (73.7%, p=0.000) and affected those who underwent vitrectomy primarily for complicated retinal detachment (48.8%, p=0.046). Intraoperative complications included posterior capsular tears (4%), luxated nucleus into vitreous (2%), and zonular dialysis (5%). Postoperative complications were vitreous hemorrhage (6%), retinalredetachment (4%), pupillary synechiae (6%), ocular hypertension (4%), and Seidel phenomenon (3%). Posterior Nd:YAG laser capsulotomy was required in 44% of eyes. BCVA was improved in 85% of cases at the end of follow-up (median, 15.5 months). Twenty-one patients with one functioning eye (61.9%) demonstrated visual improvement compared with 79 patients with bilateral vision (91.1%; p=0.003). Conclusions The technique allows stable improvement in BCVA through long follow-ups. It is more risky than in nonvitrectomized eyes. The visual results after phacoemulsification in vitrectomized eyes seem to be limited by retinal comorbidity and surgical complications.
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Affiliation(s)
- A Pardo-Muñoz
- Hospital Ramón y Cajal, University of Alcala, Ophthalmology Department, Vitreoretina Unit, Madrid, Spain.
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Manso L, Pineda R, Huertas B, Fernández-Rivas M, Diéguez MC, Cerecedo I, Muriel A, Fernández FB, DunnGalvin A, Antolín-Amérigo D, De la Hoz B. Validation of the Spanish Version of the Food Allergy Quality of Life Questionnaire- Parent Form (S-FAQLQ-PF). J Investig Allergol Clin Immunol 2017; 27:363-369. [DOI: 10.18176/jiaci.0182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Jimenez D, Martin-Saborido C, Muriel A, Zamora J, Morillo R, Barrios D, Klok E, Huisman M, Tapson V, Yusen R. P1613Efficacy and safety outcomes of recanalization procedures in patients with acute symptomatic pulmonary embolism: systematic review and network meta-analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Antolin-Amerigo D, Muriel A, Fernández-Rivas M, Diéguez Pastor M, Flokstra-de Blok B, Dubois A, De la Hoz Caballer B. Validation of the Spanish Version of the Food Allergy Quality of Life Questionnaire-Adult Form (S-FAQLQ-AF). J Investig Allergol Clin Immunol 2015; 25:270-275. [PMID: 26310041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Specific food allergy quality of life questionnaires have been developed within the context of the EuroPrevall project. We aimed to adapt and validate the Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF) in the Spanish language. METHODS The original English questionnaire was translated and culturally adapted into Spanish following World Health Organization guidelines. The final Spanish version of the FAQLQ-AF (S-FAQLQ-AF) was approved by the original authors. Consecutive patients ( 18 years old) who fulfilled the following criteria were recruited: 1) diagnosis of food allergy defined as immediate allergic symptoms and a positive prick test or IgE against the culprit food(s) and 2) physician-assessed ability to complete the questionnaires. Patients completed the S-FAQLQ-AF and a Spanish version of the SF-12 questionnaire. Reliability was assessed 10 to 14 days after completion of the first questionnaire. RESULTS Eighty-two consecutive outpatients were recruited and cross-sectional validity was.assessed based on the correlation between the S-FAQLQ-AF and the Food Allergy Independent Measure (FAIM) in this population (rho = 0.83, P < .0001). The S-FAQLQ-AF showed excellent internal consistency (Cronbach α, 0.95). S-FAQLQ-AF domains also had excellent internal consistency: α = 0.93 for allergen avoidance-dietary restrictions; α = 0.83 for emotional impact; α = 0.85 for risk of accidental exposure, and α = 0.66 for food allergy related health. Limited correlation was found between the S-FAQLQ-AF and the SF-12. CONCLUSION The S-FAQLQ-AF is a valid, short, easy-to-use, and reliable instrument that discriminates between patients with different atopic phenotypes and is suitable for assessing the impact of IgE-mediated food allergy on patient quality of life.
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Villar LM, Picón C, Costa-Frossard L, Alenda R, García-Caldentey J, Espiño M, Muriel A, Álvarez-Cermeño JC. Cerebrospinal fluid immunological biomarkers associated with axonal damage in multiple sclerosis. Eur J Neurol 2014; 22:1169-75. [PMID: 25324032 DOI: 10.1111/ene.12579] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Cerebrospinal fluid (CSF) neurofilament light protein (NFL) is a promising biomarker of axonal injury and neurodegeneration. Here CSF lymphocyte subpopulations and antibodies, potential players of neurodegeneration, are examined in relation to CSF NFL shedding in MS. METHODS Cerebrospinal fluid NFL from 127 consecutive untreated MS patients was analysed. Samples from 37 age-matched patients with other central nervous system non-inflammatory neurological diseases (NIND) were also assessed. CD4+, CD8+, CD56+ and CD19+ cell subsets were studied by flow cytometry. Oligoclonal IgG and IgM bands (OCMB) against lipids were studied by isoelectric focusing and immunoblotting. These data were analysed in relation to clinical and magnetic resonance imaging features. RESULTS A CSF NFL cut-off value of 900 ng/l (mean + 3 SD of NIND values) was calculated. MS patients with increased NFL values showed significantly higher Multiple Sclerosis Severity Score and magnetic resonance imaging lesion number. The presence of OCMB (P < 0.0001) and elevated T and B lymphocyte counts was associated with increased levels of CSF NFL. CONCLUSIONS High CSF NFL levels are associated with elevated CSF lymphocyte cell counts and intrathecal synthesis of IgM against lipids. These findings support a role for OCMB in the axonal damage of MS offering a rationale for the association of these antibodies with disability and brain atrophy progression in MS.
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Affiliation(s)
- L M Villar
- Multiple Sclerosis Unit, Department of Immunology, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - C Picón
- Multiple Sclerosis Unit, Department of Immunology, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - L Costa-Frossard
- Multiple Sclerosis Unit, Department of Neurology, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - R Alenda
- Multiple Sclerosis Unit, Department of Immunology, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - J García-Caldentey
- Multiple Sclerosis Unit, Department of Neurology, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - M Espiño
- Multiple Sclerosis Unit, Department of Immunology, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - A Muriel
- Biostatistics Unit, Ramón y Cajal Hospital, IRYCIS, CIBERESP, Madrid, Spain
| | - J C Álvarez-Cermeño
- Multiple Sclerosis Unit, Department of Neurology, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.,Department of Medicine, University of Alcalá, Madrid, Spain
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Kovacs FM, Arana E, Royuela A, Estremera A, Amengual G, Asenjo B, Sarasíbar H, Galarraga I, Alonso A, Casillas C, Muriel A, Martínez C, Abraira V. Reply: To PMID 22499847. AJNR Am J Neuroradiol 2013; 34:E9. [PMID: 23431570 DOI: 10.3174/ajnr.a3444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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25
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Letavernier E, Letavernier E, Rodenas A, Guerrot D, Haymann JP, Quaglia M, Quaglia M, Merlotti G, Fenoglio R, Menegotto A, Izzo C, Airoldi A, Guarnieri V, Stratta P, Edvardsson V, Haroarson S, Palsson R, Thorens B, Muriel A, Olivier B, Froeder L, Calabria Baxmann A, Pfeferman Heilberg I. Mineral homeostasis and nephrolithiasis. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs201] [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: 11/14/2022] Open
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26
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Riera-Mestre A, Jiménez D, Muriel A, Lobo JL, Moores L, Yusen RD, Casado I, Nauffal D, Oribe M, Monreal M. Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism. J Thromb Haemost 2012; 10:751-9. [PMID: 22417297 DOI: 10.1111/j.1538-7836.2012.04698.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
BACKGROUND While the primary therapy for most patients with a pulmonary embolism (PE) consists of anticoagulation, the efficacy of thrombolysis relative to standard therapy remains unclear. METHODS In this retrospective cohort study of 15,944 patients with an objectively confirmed symptomatic acute PE, identified from the multicenter, international, prospective, Registro Informatizado de la Enfermedad TromboEmbólica (RIETE registry), we aimed to assess the association between thrombolytic therapy and all-cause mortality during the first 3 months after the diagnosis of a PE. After creating two subgroups, stratified by systolic blood pressure (SBP) (< 100 mm Hg vs. other), we used propensity score-matching for a comparison of patients who received thrombolysis to those who did not in each subgroup. RESULTS Patients who received thrombolysis were younger, had fewer comorbid diseases and more signs of clinical severity compared with those who did not receive it. In the subgroup with systolic hypotension, analysis of propensity score-matched pairs (n = 94 pairs) showed a non-statistically significant but clinically relevant lower risk of death for thrombolysis compared with no thrombolysis (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.36-1.46; P = 0.37). In the normotensive subgroup, analysis of propensity score-matched pairs (n = 217 pairs) showed a statistically significant and clinically meaningful increased risk of death for thrombolysis compared with no thrombolysis (OR 2.32; 95% CI, 1.15-4.68; P = 0.018). When we imputed data for missing values for echocardiography and troponin tests in the group of normotensive patients, we no longer detected the increased risk of death associated with thrombolytic therapy. CONCLUSIONS In normotensive patients with acute symptomatic PE, thrombolytic therapy is associated with a higher risk of death than no thrombolytic therapy. In hemodynamically unstable patients, thrombolytic therapy is possibly associated with a lower risk of death than no thrombolytic therapy. However, study design limitations do not imply a causal relationship between thrombolytics and outcome.
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Affiliation(s)
- A Riera-Mestre
- Department of Internal Medicine, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Bellvitge, Spain
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Alvarez-Cermeno J, Espino M, Costa-Frossard L, Muriel A, Villar L. CSF Free Kappa Chains Predict Conversion to Multiple Sclerosis in Clinically Isolated Syndromes (P02.125). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.125] [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: 11/15/2022] Open
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28
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Kovacs FM, Arana E, Royuela A, Estremera A, Amengual G, Asenjo B, Sarasíbar H, Galarraga I, Alonso A, Casillas C, Muriel A, Martínez C, Abraira V. Vertebral endplate changes are not associated with chronic low back pain among Southern European subjects: a case control study. AJNR Am J Neuroradiol 2012; 33:1519-24. [PMID: 22499847 DOI: 10.3174/ajnr.a3087] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Data on the association between vertebral endplate changes and low back pain are contradictory. This study was designed to assess whether this association exists among Southern European subjects. MATERIALS AND METHODS Patients in this study serving as cases were 35-50 years of age with low back pain lasting >90 days, for whom a lumbar MR imaging had been prescribed. Controls were subjects 35-50 years of age, having a cranial MR imaging for headache with normal findings, and no history of clinically relevant LBP. Two hundred forty cases and 64 controls were recruited consecutively in the radiology services across 6 cities in Spain. Imaging findings and subject characteristics were gathered through previously validated instruments. Radiologists who interpreted MRI were blinded to the subject characteristics. A multivariate logistic regression model was developed to assess the association of vertebral endplate changes with LBP, adjusting for sex, age, body mass index, lifetime exposure to smoking, physical activity, disk degeneration, and the interaction between disk degeneration and vertebral endplate changes. RESULTS Vertebral endplate changes were found in 80.4% of the cases and in 87.5% of the controls. In the regression model, disk degeneration was the only variable showing a confounding effect. Results showed that after adjusting for disk degeneration, the presence of vertebral endplate changes is associated with the absence of chronic LBP (OR for LBP: 0.31; 95% CI, 0.10-0.95). CONCLUSIONS In Southern European subjects, vertebral endplate changes are not associated with chronic LBP.
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Affiliation(s)
- F M Kovacs
- Departamento Científico, Fundación Kovacs, Palma de Mallorca, Spain
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Abraira V, Alvarez-Cermeño J, Arroyo R, Cámara C, Casanova B, Cubillo S, de Andrés C, Espejo C, Fernández O, Ferrer J, Figueredo M, García-Merino A, García-Sánchez M, García-Trujillo J, Gómez M, González-Oria C, Gosis A, Izquierdo G, Jímenez J, López-Trascasa M, Montalbán X, Moreno M, Muñoz D, Nuñez V, Muriel A, Navarro J, Olascoaga J, Oreja-Guevara C, Prada A, Ramil E, Ramo-Tello C, Rodríguez C, Rodríguez E, Rodríguez-Frías F, Rodríguez-Antigüedad A, Rodríguez-Molina J, Ruiz E, Saiz A, Sarasola E, Simó M, Yagüe J, Villar L. Utility of oligoclonal IgG band detection for MS diagnosis in daily clinical practice. J Immunol Methods 2011; 371:170-3. [DOI: 10.1016/j.jim.2011.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 06/06/2011] [Accepted: 06/08/2011] [Indexed: 11/29/2022]
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Arana E, Kovacs FM, Royuela A, Estremera A, Sarasíbar H, Amengual G, Galarraga I, Martínez C, Muriel A, Abraira V, Zamora J, Campillo C. Influence of nomenclature in the interpretation of lumbar disk contour on MR imaging: a comparison of the agreement using the combined task force and the nordic nomenclatures. AJNR Am J Neuroradiol 2011; 32:1143-8. [PMID: 21493764 DOI: 10.3174/ajnr.a2448] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The CTF nomenclature had not been tested in clinical practice. The purpose of this study was to compare the reliability and diagnostic confidence in the interpretation of disk contours on lumbar 1.5T MR imaging when using the CTF and the Nordic nomenclatures. MATERIALS AND METHODS Five general radiologists from 3 hospitals blindly and independently assessed intravertebral herniations (Schmorl node) and disk contours on the lumbar MR imaging of 53 patients with low back pain, on 4 occasions. Measures were taken to minimize the risk of recall bias. The Nordic nomenclature was used for the first 2 assessments, and the CTF nomenclature, in the remaining 2. Radiologists had not previously used either of the 2 nomenclatures. κ statistics were calculated separately for reports deriving from each nomenclature and were categorized as almost perfect (0.81-1.00), substantial (0.61-0.80), moderate (0.41-0.60), fair (0.21-0.40), slight (0.00-0.20), and poor (<0.00). RESULTS Categorization of intra- and interobserver agreement was the same across nomenclatures. Intraobserver reliability was substantial for intravertebral herniations and disk contour abnormalities. Interobserver reliability was moderate for intravertebral herniations and fair to moderate for disk contour. CONCLUSIONS In conditions close to clinical practice, regardless of the specific nomenclature used, a standardized nomenclature supports only moderate interobserver agreement. The Nordic nomenclature increases self-confidence in an individual observer's report but is less clear regarding the classification of disks as normal versus bulged.
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Affiliation(s)
- E Arana
- Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
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Martorell A, De la Hoz B, Ibáñez MD, Bone J, Terrados MS, Michavila A, Plaza AM, Alonso E, Garde J, Nevot S, Echeverria L, Santana C, Cerdá JC, Escudero C, Guallar I, Piquer M, Zapatero L, Ferré L, Bracamonte T, Muriel A, Martínez MI, Félix R. Oral desensitization as a useful treatment in 2-year-old children with cow's milk allergy. Clin Exp Allergy 2011; 41:1297-304. [PMID: 21481024 DOI: 10.1111/j.1365-2222.2011.03749.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Limited published evidence shows oral desensitization to be a potential intervention option for cow's milk protein (CMPs) allergy. OBJECTIVE The aim of this study was to evaluate the safety and efficacy of oral desensitization in 2-year-old children with cow's milk allergy, as a treatment alternative to elimination diet. METHODS A total of 60 children aged 24-36 months with IgE-mediated allergy to CMPs were included in this multi-center study and were randomized into two groups. Thirty children (group A: treatment group) began oral desensitization immediately, whereas the remaining 30 (group B: control group) were kept on a milk-free diet and followed-up for 1 year. RESULTS After 1-year follow-up period, 90% of the children in group A had become completely tolerant vs. 23% of the children in group B. In group A, cow's milk skin reactivity and serum-specific IgE to milk and casein decreased significantly from the initial assessment, whereas group B showed no significant change after 1 year of follow-up. Twenty-four patients (80%) developed some reaction during the treatment period: 14 children developed moderate reaction (47%) and 10 mild reaction (33%). The most common manifestations were urticaria-angioedema, followed by cough. CONCLUSIONS AND CLINICAL RELEVANCE In this study, oral desensitization was found to be effective in a significant percentage of 2-year-old children with cow's milk allergy. Oral desensitization appears to be efficacious as an alternative to elimination diet in the treatment of 2-year-old children with cow's milk allergy. The side-effect profile appears acceptable but requires further study.
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Affiliation(s)
- A Martorell
- Hospital General Universitario, Unidad de Alergología, Valencia, Spain.
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Diéguez MC, Cerecedo I, Muriel A, Losada A, García E, Lázaro M, de la Hoz B. Adaptation and validation of the Spanish version of the Quality Of Life in Latex Allergy questionnaire (QOLLA). J Investig Allergol Clin Immunol 2011; 21:283-289. [PMID: 21721374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE The aim of the present study was to translate into Spanish and transculturally adapt the Quality of Life in Latex Allergy questionnaire (QOLLA) in order to provide a validated instrument for use in research and daily practice. METHODS Patients diagnosed with latex allergy were invited to participate in an observational prospective multicenter study to validate the Spanish version of the QOLLA following the recommendations of the World Health Organization. The study included 3 phases--feasibility, reliability, and cross-sectional validation-and was approved by the Ethics Committee of Hospital Ramón y Cajal. RESULTS Mean time to complete the questionnaire was 4.7 minutes. The maximum score was 28 (mean, 7.7; median, 4).The SF-12 score ranged from 25.8 to 51.6 in the physical domain and from 20.8 to 61.5 in the mental domain. Internal consistency was excellent (Cronbach alpha, 0.9348). The kappa index fluctuated between 0.40 and 0.93. A kappa of 0.84 was obtained for the global score in 5 categories. Sixty patients were included to evaluate construct validity. Mean age was 39 years and 49 patients were women (80%). The global score ranged between 0 and 30 (mean, 11.69; median, 11). Spearman correlation coefficients between the QOLLA and a visual analog scale and the SF-12 physical, mental, and severity scales according to the researcher were--0.47, 0.37, 0.29, and 0.54, respectively. CONCLUSION The QOLLA is a feasible, valid, and reliable instrument for the measurement of disease-specific quality of life in adult patients diagnosed with latex allergy. It could play an important role in determining suitable treatment for latex-allergy.
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Affiliation(s)
- M C Diéguez
- Sección de Alergia, Servicio de Medicina Interna, Hospital del Sureste, Arganda del Rey, Spain
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Ortega-Ferrusola C, González-Fernández L, Muriel A, Macías-García B, Rodríguez-Martínez H, Tapia JA, Alonso JM, Peña FJ. Does the microbial flora in the ejaculate affect the freezeability of stallion sperm? Reprod Domest Anim 2009; 44:518-22. [PMID: 19655428 DOI: 10.1111/j.1439-0531.2008.01267.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In an attempt to evaluate the possible relationship between the microbial flora in the stallion ejaculate and its ability to freeze,three ejaculates from five stallions were frozen using a standard protocol. Before freezing, an aliquot was removed for bacteriological analysis. Bacterial growth was observed in all the ejaculates studied. The isolated microorganisms were:Staphylococcus spp. and Micrococcus spp. (in all the stallions), beta-haemolytic Streptococcus (in stallions 3 and 4), Corynebacterium spp. (in stallions 1, 3-5), Rhodococcus spp. (in stallion number 2), Pseudomonas spp. (in stallion number 1) and Klebsiella spp. (in stallions 1, 3 and 5). The presence and richness of Klebsiella and beta-haemolytic Streptococcus in the ejaculate were related to two sperm variables post-thaw,namely the proportion of dead spermatozoa (ethidium+ cells; r = 0.55, p < 0.05) and the amplitude of lateral displacement of the sperm head (ALH, microm; r = -0.56, p < 0.05), respectively.The degree of growth of Corynebacterium spp. in the ejaculate was positively correlated with the percentage of spermatozoa showing high caspase activity post-thaw(r = 0.62, p < 0.05). The presence and number of colonies of beta-haemolytic Streptococcus were negatively correlated (r = -0.55, p < 0.05) with low sperm caspase activity. It is concluded that the microbial flora of the equine ejaculate maybe responsible for some of the sublethal damage experimented by the spermatozoa during cryopreservation.
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Affiliation(s)
- C Ortega-Ferrusola
- Veterinary Teaching Hospital, Laboratory of Spermatology, University of Extremadura, Cáceres, Spain
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Diéguez MC, Cerecedo I, Muriel A, Zamora J, Abraira V, Camacho E, Antón M, de la Hoz B. Utility of diagnostic tests in the follow-up of egg-allergic children. Clin Exp Allergy 2009; 39:1575-84. [DOI: 10.1111/j.1365-2222.2009.03299.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kovacs FM, Royuela A, Jensen TS, Estremera A, Amengual G, Muriel A, Galarraga I, Martínez C, Arana E, Sarasíbar H, Salgado RM, Abraira V, López Ó, Campillo C, Gil del Real MT, Zamora J. Agreement in the interpretation of magnetic resonance images of the lumbar spine. Acta Radiol 2009; 50:497-506. [PMID: 19431057 DOI: 10.1080/02841850902838074] [Citation(s) in RCA: 31] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Correlation between clinical features and magnetic resonance imaging (MRI) findings is essential in low-back-pain patients. Most previous studies have analyzed concordance in the interpretation of lumbar MRI among a few radiologists who worked together. This may have overestimated concordance. PURPOSE To evaluate intra- and interobserver agreement in the interpretation of lumbar MRI performed in an open 0.2 T system. MATERIAL AND METHODS Seven radiologists from two different geographic settings in Spain interpreted the lumbar MRIs of 50 subjects representative of the general Danish population aged 40 years. The radiologists interpreted the images in routine clinical practice, having no knowledge of the clinical and demographic characteristics of the subjects and blinded to their colleagues' assessments. Six of the radiologists evaluated the same MRIs 14 days later, having no knowledge of the previous results. Data on the existence of disc degeneration, high-intensity zones, disc contour, Schmorl nodes, Modic changes, osteophytes, spondylolisthesis, and spinal stenosis were collected in the Nordic Modic Consensus Group Classification form. Intra- and interobserver agreement was analyzed for variables with a prevalence >or=10% and <or=90% by means of the kappa statistic. RESULTS Intra- and interobserver agreement was excellent for variables related to Modic changes, and fair to good for disc contour, high-intensity zones, and Schmorl nodes. The evaluations for disc degeneration and osteophytes were found to have fair to good intraobserver agreement and poor interobserver agreement. The agreement for the evaluations of spondylolisthesis and spinal stenosis was not analyzed because they were observed in <10% of reports. CONCLUSION Images from 0.2 T MRIs appear to lead to good agreement in the reporting of disc contour, high-intensity zones, Schmorl nodes, and, in particular, Modic changes, suggesting that they can possibly be reliably used for clinical research purposes. In contrast, assessment of osteophytes and disc degeneration is not reliable.
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Affiliation(s)
- F. M. Kovacs
- Departamento Científico, Fundación Kovacs, Palma de Majorca, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - A. Royuela
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Hospital Ramón y Cajal, Madrid, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - T. S. Jensen
- Back Research Center, Backcenter Funen, Ringe, Denmark
| | - A. Estremera
- Hospital Son Llàtzer, Palma de Majorca, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - G. Amengual
- Hospital Son Llàtzer, Palma de Majorca, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - A. Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Hospital Ramón y Cajal, Madrid, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - I. Galarraga
- Hospital de Manacor, Manacor, Majorca, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - C. Martínez
- Hospital Son Llàtzer, Palma de Majorca, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - E. Arana
- Hospital Quirón, Valencia, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - H. Sarasíbar
- Hospital Son Llàtzer, Palma de Majorca, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - R. M. Salgado
- Hospital de Manacor, Manacor, Majorca, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - V. Abraira
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Hospital Ramón y Cajal, Madrid, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - Ó. López
- Hospital de Manacor, Manacor, Majorca, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - C. Campillo
- Ib-Salut, Palma de Majorca, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - M. T. Gil del Real
- Departamento Científico, Fundación Kovacs, Palma de Majorca, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
| | - J. Zamora
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Hospital Ramón y Cajal, Madrid, Spain
- Spanish Back Pain Research Network, Fundación Kovacs, Palma de Majorca, Spain
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Ruiz-Ibán M, Crespo-Hernández P, Fernández-Roldán S, Díaz-Heredia J, Martínez-Ureña P, Muriel A, Cano-Arana A. Hemiartroplastia cementada tras fractura subcapital de fémur. Análisis de supervivencia. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1888-4415(08)74822-7] [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: 11/29/2022] Open
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Ponte B, Felipe C, Muriel A, Tenorio MT, Liano F. Long-term functional evolution after an acute kidney injury: a 10-year study. Nephrol Dial Transplant 2008; 23:3859-66. [DOI: 10.1093/ndt/gfn398] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Ruiz-Ibán M, Crespo-Hernández P, Fernández-Roldán S, Díaz-Heredia J, Martínez-Ureña P, Muriel A, Cano-Arana A. Cemented hemiarthroplasty after a femoral neck fracture. Survivorship analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1988-8856(08)70097-x] [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: 10/19/2022] Open
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Diéguez MC, Cerecedo I, Muriel A, Zamora J, Sánchez-Cano M, De la Hoz B. Skin prick test predictive value on the outcome of a first known egg exposure in milk-allergic children. Pediatr Allergy Immunol 2008; 19:319-24. [PMID: 18482080 DOI: 10.1111/j.1399-3038.2007.00652.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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] [Indexed: 11/29/2022]
Abstract
Children with milk allergy have higher incidence of other food allergies, especially egg allergy. The objective of this study was to ascertain the accuracy of the prick test in children with IgE-mediated milk allergy for diagnosing egg allergy. Children under the age of 1 yr who came consecutively to Allergy Department 2003-05, and were diagnosed with IgE-mediated milk allergy were selected for this study. Egg introduction was completely avoided until the age of 14 months when clinical history, skin prick tests (SPT), specific-IgE antibodies determination and egg challenge test were performed. One hundred and four milk-allergic children were included. At least one positive prick test to any egg allergen was found in 65 out of the 104 (62.5%). Thirty-eight (36.5%) were allergic to egg proteins as well. Prick tests with egg white and ovomucoid (OVM) had the best diagnostic performances showing the largest areas under the receiver operating characteristic curve. The optimal diagnosis cut-off point was 6 mm for egg white and 5 mm for OVM. The positive likelihood ratios for these cut-off points were: 2.95 (95% CI: 1.74-4.99) for egg white prick test, and 20 (95% CI: 2.9-143.7) for OVM prick test. Children with specific IgE-mediated cow's milk allergy must be closely followed as a risk group for egg allergy. Early diagnosis is necessary and the SPT has shown itself to be a very useful tool for diagnosing immediate IgE reactions to egg on first known exposure.
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Affiliation(s)
- M C Diéguez
- Servicio de Alergología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Nilsson ME, Maciejewski PK, Zhang B, Wright AA, Trice ED, Muriel A, Friedlander Jr. R, Block SD, Prigerson HG. Mental health, treatment preferences, advance care planning, and location and quality of death in advanced cancer patients with dependent children. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Burgos F, Pascual J, Zamora J, Muriel A, Gesquitra G. SURGICAL COMPLICATION AFTER KIDNEY TRANSPLANTATION IN THE MODERN TRANSPLANT ERA. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1569-9056(08)60497-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jiménez S, Zamora J, Muriel A, Pascual J. [Is it possible to sustain adequate immunosuppressive efficacy minimizing the nephrotoxicity with a regimen including low doses of calcineurin inhibitors or sirolimus?]. Nefrologia 2008; 28 Suppl 2:40-41. [PMID: 18457563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- S Jiménez
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain
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Fernández A, Martins J, Villlafruela JJ, Marcén R, Pascual J, Cano T, Puig C, Gil-Casares B, Muriel A, Burgos FJ, Ortuño J. Variability of mycophenolate mofetil trough levels in stable kidney transplant patients. Transplant Proc 2007; 39:2185-6. [PMID: 17889132 DOI: 10.1016/j.transproceed.2007.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Great interindividual variability in the pharmacokinetics of mycophenolate mofetil (MMF) exists among kidney transplanted patients. The within-patient variability in stable transplanted patients is not well established. We performed 258 determinations of trough MMF levels in 86 stable transplant patients without hematological or gastrointestinal toxicity after at least year of a functioning kidney and a fixed dose of MMF. We examined the within-patient variability of levels related with clinical factors (age, gender, underlying cause of kidney failure, time since transplant, associated immunosuppression, and MMF dose) and analytical factors (serum creatinine, proteinuria, hemoglobin). Trough MMF levels were 3.6 mg/L, percentile (Pc) 25 1.6 mg/L, Pc 75 4.4 mg/L with intraindividual variability median of 65% (Pc 25 14%, Pc 75 79%). For the data analysis a variation of 14% was chosen, which corresponded to the 25th percentile. We did not observed differences between patients with variation below or above the Pc 25 in age, gender, underling cause of kidney failure, basal MMF levels, and MMF dose. Patients with greater variations showed significantly higher serum creatinine and proteinuria values than the others (1.84 +/- 0.54 vs 1.46 +/- 0.44 mg/dL and 0.45 +/- 0.42 vs 0.19 +/- 0.14 g/L; P < .05). Therefore, great within-patient variability in trough MMF levels was associated with poor kidney function and proteinuria.
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Affiliation(s)
- A Fernández
- Nephrology, Hospital Ramón y Cajal, Madrid, Spain.
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Ortega-Ferrusola C, Sotillo-Galán Y, Varela-Fernández E, Gallardo-Bolaños JM, Muriel A, González-Fernández L, Tapia JA, Peña FJ. Detection of "apoptosis-like" changes during the cryopreservation process in equine sperm. ACTA ACUST UNITED AC 2007; 29:213-21. [PMID: 17978341 DOI: 10.2164/jandrol.107.003640] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The kinematics of the appearance of apoptotic markers was studied by flow cytometry and immunoblot assays in equine spermatozoa subjected to freezing and thawing. Caspase activity, low mitochondrial membrane potential, and increases in sperm membrane permeability were observed in all of the phases of the cryopreservation procedure. Freezing and thawing caused an increase in membrane permeability and changes in the pattern of caspase activity; decreases in mitochondrial membrane potential were observed after centrifugation and cooling to 4 degrees C and after freezing and thawing. It is proposed that sperm mitochondria may be directly involved in the subtle damage that is present in most spermatozoa surviving freezing and thawing.
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Affiliation(s)
- C Ortega-Ferrusola
- Veterinary Teaching Hospital, Laboratory of Spermatology, University of Extremadura, Cáceres, Spain
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Fernández A, Marcén R, Pascual J, Martins J, Villafruela JJ, Cano T, Sabater J, Puig C, Gil-Casares B, Muriel A, Burgos J, Ortuño J. Mycophenolate Mofetil Levels in Stable Kidney Transplant Recipients. Transplant Proc 2007; 39:2182-4. [PMID: 17889131 DOI: 10.1016/j.transproceed.2007.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The usefulness of mycophenolate mofetil (MMF) levels in stable kidney transplant patients is not well known. We measured MMF trough levels in 137 adult kidney recipients with more than 1 year of stable graft function. The MMF dose was adjusted according to hematological or gastrointestinal toxicity, it was 500 mg in 22 (16%) patients; 750 mg in 22 (16%); 1000 mg in 69 (50.5%); 1500 mg in 15 (11%); and 2000 mg in 9 (6.5%). We analyzed the total dose, virgule dose/kg, and MMF levels in relation to efficacy parameters (creatinine, proteinuria) and hematological toxicity (erythrocytes, leukocytes, and platelets) at the time of MMF level determinations and 3 months thereafter. Statistical analyses were performed with SSPS 12.0, including sensitivity and specificity analyses by ROC. Mean MMF levels were 3.68 mg/L (Pc25, 1.6-Pc75, 4.4 mg/L) with significant differences according to dose (P < .001). Trough MMF levels did not have discriminatory capacity in the area under the ROC for anemia, renal failure, or proteinuria at the time of determination or 3 months later. The percentage of patients without proteinuria was high among patients with MMF levels between 1.6 and 4.4 mg/L. The MMF levels were low in patients who had a major increase in creatinine (1.6 vs 3.8 mg/L, P < .05). In stable renal transplant patients the levels of MMF were related to the administered dose, and they are higher than those previously described in patients with less than a year follow-up with a functioning kidney. They did not have discriminatory value at the time of determination or 3 months later. Nevertheless, low MMF levels could help recognize patients at risk of developing chronic nephropathy.
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Affiliation(s)
- A Fernández
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain.
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Saravia F, Núñez-Martínez I, Morán JM, Soler C, Muriel A, Rodríguez-Martínez H, Peña FJ. Differences in boar sperm head shape and dimensions recorded by computer-assisted sperm morphometry are not related to chromatin integrity. Theriogenology 2007; 68:196-203. [PMID: 17555808 DOI: 10.1016/j.theriogenology.2007.04.052] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 04/03/2007] [Accepted: 04/15/2007] [Indexed: 12/01/2022]
Abstract
Although sperm head shape and relative dimensions are considered reliable indicators of sperm quality, their quantification is most often operator-driven, e.g., subjective. Artificial insemination semen doses from 35 mature stud boars of known fertility and belonging to three breeds and two hybrid breeds (Duroc, Large White, Landrace, respectively, Yorker and Risco) were used in this study. Sperm samples were extended to 100x10(6) cells per mL and 10microL of the sperm suspension used to made smears which, stained, were examined using phase contrast microscopy interfaced with an automated sperm morphology analyzer (ASMA, ISAS). Each sperm head was measured for four primary parameters [area (A) microm(2), perimeter (P) mum, length (L) microm, width (W) microm], and four derived parameters of head shape [(L/W), (4piA/P(2)), ((L-W)/(L+W)), (piLW/4A)]. Definition of head size was statistically performed. The threshold for each class was established on the basis of the area values, considering the 25th percentile as small and the 75th percentile as large spermatozoa. In a second step, sperm head shape was determined as normal, elliptic, abnormal (rugose) contour, long or irregular and percentiles set as above to define spermatozoa with normal values for each shape parameter. Significant differences were found among breeds in the size of morphologically normal spermatozoa, which were significantly larger and more elliptic (P<0.001) in the Duroc breed. Sperm chromatin integrity was studied using the SCSA-assay, with significant differences observed in the degree of fragmentation intensity (DFI) although this value was consistently low in all animals studied. The hereby-validated ASMA was able to determine significant differences in sperm shape and dimensions among breeds, which were not accompanied by deviations in chromatin structure neither within nor between fertile AI-boars.
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Affiliation(s)
- F Saravia
- Division of Reproduction, Faculty of Veterinary Medicine and Animal Sciences, Swedish University of Agricultural Sciences (SLU), Ullsvägen 14C, Box 7054, SE-750 07 Uppsala, Sweden
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Pirl WF, Muriel A, Hwang V, Greer J, Kornblith A, Greenberg DB, Donelan K, Temel J, Schapira L. Quality of psychosocial care in oncology: A national survey of oncologists. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.6561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6561 Background: Little is known about the quantity and quality of psychosocial care being delivered by oncologists in the United States. This study surveyed oncologists about their management of psychosocial distress, using the National Comprehensive Cancer Network (NCCN) guidelines for psychosocial distress as a standard. Availability of mental health services and routine screening for distress were used as measures of quality care. Methods: A random sample of 1,000 oncologists in the United States belonging to ASCO were surveyed with an anonymous e-mail and mail-based questionnaire between 9/05 and 7/06. Initial univariate analyses were used to test differences in frequencies among groups using Chi-square for categorical variables, and t-tests and ANOVA for continuous variables. Variables that were associated with reported routine screening at the .05 significance level in the univariate analyses were entered into a logistic regression model to determine independent predictors of screening. Results: Forty-six percent (448/965) of oncologists responded. Almost two-thirds (63.6%, 285/448) practiced in community settings, 27.2% (122/448) at cancer centers, and 6.9% (31/448) in hospitals. Only half (50.3%, 95% CI 45.7–54.9%; 225/448) reported having any mental health services affiliated with their practice. Availability differed by practice setting, with cancer centers having the most and community having the least (P<.001). Only one-third (32.3%, 144/445) reported being at least somewhat familiar with the NCCN guidelines. Two-thirds (65.0%, 95% CI 60.6–69.4%; 290/446) reported routinely screening for distress, but only 14.3% (64/447) use a screening instrument. Availability of mental health services, knowledge of NCCN guidelines, experience, time, certainty about identifying distress and being female were independent predictors of reported screening. Conclusion: Only 36.4% (95% CI 34.1–38.7%; 162/445) reported both of our measures of quality care, available mental health services and routine screening for distress. While the majority report routinely screening for distress, only a small percentage follow NCCN guidelines by using a screening instrument, and only half report having mental health services available. No significant financial relationships to disclose.
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Affiliation(s)
- W. F. Pirl
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - A. Muriel
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - V. Hwang
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - J. Greer
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - A. Kornblith
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D. B. Greenberg
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - K. Donelan
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - J. Temel
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
| | - L. Schapira
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
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Moreno A, Bárcena R, García-Garzón S, Moreno L, Quereda C, Muriel A, Zamora J, Mateos ML, Pérez-Elías MJ, Antela A, Diz S, Moreno A, Moreno S. Viral kinetics and early prediction of nonresponse to peg-IFN-alpha-2b plus ribavirin in HCV genotypes 1/4 according to HIV serostatus. J Viral Hepat 2006; 13:466-73. [PMID: 16792540 DOI: 10.1111/j.1365-2893.2005.00710.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 12/09/2022]
Abstract
To evaluate, among 70 hepatitis C virus (HCV)-monoinfected and 36 human immunodeficiency virus (HIV)-coinfected naïve patients with genotypes 1/4 receiving weight-adjusted pegylated interferon-alpha-2b/ribavirin, viral kinetics and the feasibility to predict treatment failure measuring early HCV-RNA decreases. HCV-RNA was assessed at baseline, weeks 4, 12 and 24. Receiver operating characteristic (ROC) curves were calculated to determine the most sensitive cut-off values of viral decrease at week 4 predicting treatment failure. Baseline predictors of failure were evaluated by univariate and multivariate analyses. Despite similar baseline HCV-RNA (5.75 vs 5.72 log(10)IU/ml, P = 0.6), HCV monoinfection led to significantly lower HCV-RNA values at weeks 4 (3.7 vs 4.3 log(10)IU/ml, P = 0.01), 12 (2.3 vs 3.5 log(10)IU/ml, P = 0.01) and 24 (1.4 vs 3.3 log(10)IU/ml, P = 0.001) and a higher rates of viral clearance at weeks 24 (60%vs 36%, P = 0.02), 48 (46%vs 25%, P = 0.03) and 72 (37%vs 17%). The lack of achieving an HCV-RNA decrease of at least 1 log(10) at week 4 was highly predictive of treatment failure for HCV-monoinfected patients (Se 100%, Sp 50%, positive predictive value (PPV) 57%, negative predictive value (NPV) 100%, ROC curve area, 0.86 [95% confidence interval (CI) 0.77-0.95], but not for HCV/HIV-coinfected patients (cut-off, 0 log(10), Se 100%, Sp 27%, PPV 21%, NPV 100%, ROC curve area, 0.71 (95% CI 0.49-0.93). HIV coinfection was independently associated with failure (odds ratio 2.95, 95% CI 1.08-8.04, P = 0.01). Thus the magnitude of HCV-RNA decreases at week 4 correlated with treatment response. Significant differences in viral kinetics and cut-off values predicting nonresponse suggest a slower HCV clearance rate in HIV coinfection, which was independently associated with treatment failure.
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Affiliation(s)
- A Moreno
- Service of Infectious Diseases, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain.
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Pirl WF, Muriel A, Schapia L, Hwang V, Moore C, Temel J, Kornblith A, Holland JC. Statewide survey on the management of psychosocial distress by oncologists. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8601 Background: Although the NCCN has published guidelines for the management of psychosocial distress, no data exists on how oncologists manage it in clinical practice. This study surveyed oncologists in Massachusetts on their estimated rates of distress in their patients, beliefs about distress, and practice patterns. Methods: All Massachusetts oncologists belonging to ASCO were e-mailed an electronic survey up to three times. Survey completion was anonymous and a small incentive was offered for participation. Descriptive statistics and cross-tabulations were compiled. Chi-squared analyses investigated differences in rates. Results: 393 e-mail addresses were identified. 338 surveys were delivered, but the e-mail survey could be blocked by SPAM filters. Ninety-nine responses were obtained yielding a response rate of 29%. Oncologists estimated that 77% (sd=23%) of their patients experience distress, but only 33% (sd=20%) have distress that warrants treatment. Emotional problems unrelated to illness, practical problems, and coping with illness were the three most frequently encountered forms of distress. Sixty-five percent of oncologists reported that they routinely screened for psychosocial distress, but only 3% use a screening instrument. Almost all reported that they would at least consider using a brief screening instrument (93%). Lack of time was identified as the main barrier to screening, but lack of knowledge about treatment of distress was the only variable that predicted lower rates of screening (p=.03). While reported rates of referrals to mental health professionals were high, the majority (85%) reported that they directly address the psychosocial distress in their practice and almost half reported that they initiate psychotropic medications (45%). Conclusions: The majority of oncologists report that they do some screening and management of psychosocial distress in their clinical practices. Although screening appears to mainly be done through the usual clinical encounter, research has shown that this method has a poor rate of detection for psychological disorders. Despite the fact that the NCCN recommends the use of screening instruments and most oncologists report interest in using them, oncologists rarely actually use such measures. No significant financial relationships to disclose.
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Affiliation(s)
- W. F. Pirl
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - A. Muriel
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - L. Schapia
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - V. Hwang
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - C. Moore
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. Temel
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - A. Kornblith
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. C. Holland
- Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
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Flores C, Maca-Meyer N, Pérez-Méndez L, Sangüesa R, Espinosa E, Muriel A, Blanco J, Villar J. A CXCL2 tandem repeat promoter polymorphism is associated with susceptibility to severe sepsis in the Spanish population. Genes Immun 2006; 7:141-9. [PMID: 16421598 DOI: 10.1038/sj.gene.6364280] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Sepsis describes a complex clinical syndrome resulting from a systemic inflammatory response to bacteria. Functional studies in animal models of sepsis have catalogued CXCL2 as a candidate gene for the development of the disease. We hypothesized that CXCL2 polymorphisms may confer susceptibility to sepsis and performed an association study using 178 severe sepsis patients and 357 population-based controls. We selected two polymorphisms from the promoter of the gene (-437A/G and -665(AC)n), and analyzed whether haplotypes or single loci were associated with disease susceptibility. An overall test of differentiation showed that haplotype distribution was not different between cases and controls (P=0.407). Likewise, -437A/G was not associated with disease susceptibility (heterozygote odds ratio (OR) 0.68 (0.47-1.03), and homozygote OR 0.86 (0.56-1.32); P=0.706). However, for the -665(AC)n, we found that the 24+/-1 repeat alleles were associated with susceptibility (heterozygote OR 2.82 (1.10-7.24), and homozygote OR 3.65 (1.41-9.43); P=0.0006). This association remained significant when using a multiple logistic regression analysis (OR 2.23; 95% confidence intervals (95% CI) 1.22-4.03; P=0.008) and after a genomic control adjustment (P=0.017). Although replicate studies and functional assays are needed, these results suggest that CXCL2 gene variants may contribute to the development of severe sepsis.
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Affiliation(s)
- C Flores
- Research Institute (Research Center associated to Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid, Spain), Hospital Universitario NS de Candelaria, Tenerife, Spain
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