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Jeronimo Baza A, Olmos C, Vilacosta I, Ortega-Candil A, Rodriguez-Rey C, Perez-Castejon M, Fernandez-Perez C, Perez-Garcia C, Garcia-Arribas D, Ferrera C, Carreras J. Accuracy of 18F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections: good for pocket, not so good for endocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0285] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The usefulness of 18F-FDG PET/CT in the diagnosis of infective endocarditis (IE) associated with cardiac implantable electronic devices (CIED) is not well established.
Purpose
To assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, placing special emphasis on differentiating between pocket infection (PI) and CIED-IE.
Methods
From 2013 to 2018, all patients (n=63) admitted to a tertiary care hospital with suspected CIED infection were prospectively recruited, undergoing a thorough diagnostic work-up that included blood cultures extraction, transthoracic (TTE) and transoesophageal echocardiography (TEE) and a PET/CT. When device explantation was required, material from the pocket, generator and leads were also cultured. The gold standard for the diagnosis of CIED-IE was a positive lead culture in the absence of PI when percutaneous extraction was performed or a positive culture from a surgically removed lead. In spite of negative lead cultures, the presence of typical TEE images of vegetations in a clinical context of positive blood cultures was also considered as CIED-IE.
Results
After the whole diagnostic process, 14 (22.2%) cases corresponded to isolated PI and 13 (20.6%) were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, values of sensitivity, specificity and global diagnostic accuracy of PET/CT for CIED-IE were 38.5%, 98.0% and 85.7%, respectively. Positive and negative likelihood ratio values, 19.2 and 0.6 respectively, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis in case of a negative result. In the case of PI, fair sensitivity (72.2%) and good specificity values (95.6%) were obtained. Extracardiac lead SUVmax and SUVratio in PI were good, with an area under the ROC curve (AUC) of 0.870 and 0.879, respectively. However, semiquantitative analysis was not useful for the diagnosis of CIED-IE.
Conclusions
In patients with suspected CIED infection, the yield of 18F-FDG PET/CT differs depending on the site of infection, showing a very high specificity but poor sensitivity in CIED-IE; so negative studies must be interpreted with caution if the suspicion of CIED-IE is high.
ROC curves SUVmax and SUV ratio for PI
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | | | | | | | | | | | | | | | - C Ferrera
- Hospital Clinico San Carlos, Madrid, Spain
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Bonilla Palomas J, Anguita-Sanchez M, Elola F, Bernal J, Fernandez-Perez C, Ruiz-Ortiz M, Jimenez-Navarro M, Bueno H, Cequier A, Marin F. Trends in hospitalization and in-hospital mortality of patients with heart failure in Spain. A population-based study (2003–2015). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1187] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is one of the most pressing current public health concerns. However, in Spain there is a lack of population data.
Purpose
To investigate trends in HF hospitalization and in-hospital mortality rates.
Methods
We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2003–2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We analyzed trends in hospital discharge rates for HF (discharge rates were weighted by age and gender) an in-hospital mortality. The risk-standardized in-hospital mortality ratio (RSMR) was defined as the ratio between predicted mortality (which individually considers the performance of the hospital where the patient is attended) and expected mortality (which considers a standard performance according to the average of all hospitals) multiplied by the crude rate of mortality. RSMR was calculated using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Temporal trend during the observed period was modelled using Poisson regression analysis with year as the only independent variable. In this model, the incidence rate ratio (IRR) and their 95% confidence intervals (95% CI) was calculated.
Results
A total of 1 254 830 episodes of HF were selected. Throughout 2003–2015 the number of hospital discharges with principal diagnosis of HF increased by 61% (IRR: 1.04; CI: 1.03–1.04; p<0.001), meanwhile the crude mortality rate and the mean length of stay (LOS) diminished significantly (IRR: 0.99; CI: 0.98–1; and IRR: 1.04; CI: 0.99–0.99; p<0.001, for both). Discharge rates weighted by age and sex showed a statistically significant increase during the period (IRR: 1.03; CI: 1.03–1.03; p<0.001); however, whereas discharge rates increased significantly in older groups of age (≥75 years old) (IRR: 1–1.02; p<0.001) they diminished in younger groups of age (45–74 years old) (IRR: 0.99; p<0.001 and there was not a significant trend in the discharge rates for the group of 35–44 years old (Figure). The risk-standardized in-hospital mortality ratio did not significantly change throughout 2003–2015 (IRR: 0.997; CI: 0.992–1; p=0.32), however the risk-standardized LOS ratio diminished from 1.07 in 2003 to 0.97 in 2015 (IRR: 0.98: IC: 0.98–0.99; p<0.001).
Conclusions
From 2003 to 2015, HF admission rate increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population over 75. The crude in-hospital mortality rate diminished significantly for the same period, but the risk-standardized in-hospital mortality ratio did not significantly change.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - F.J Elola
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - J.L Bernal
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - C Fernandez-Perez
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - M Ruiz-Ortiz
- Hospital Universitario Reina Sofía, Cόrdoba, Spain
| | | | - H Bueno
- University Hospital 12 de Octubre, Madrid, Spain
| | - A Cequier
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
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Bonilla Palomas J, Anguita-Sanchez M, Elola F, Bernal J, Fernandez-Perez C, Ruiz-Ortiz M, Jimenez-Navarro M, Bueno H, Cequier A, Marin F. Impact of hospital volume on in-hospital mortality and 30-day cardiac readmission of hospitalized patients with heart faliure. A population based study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1180] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is a major health care problem. Epidemiological data from hospitalized patients are scarce and the association between hospital volume and patient outcomes is largely unknown.
Purpose
The aim of this study was to analyze the relationship between hospital volume and outcomes (in-hospital mortality and 30-day cardiac readmission).
Methods
We conducted an observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We calculated risk-standardized mortality rates (RSMR) at the index episode and risk-standardized cardiac diseases readmissions rates (RSRR) within 30 days after discharge by using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Information on the number of HF discharges at each hospital in 2015 was analysed to classify centres into 2 categories (high- and low-volume hospitals). To discriminate between high- and low-volume centers, a K-means clustering algorithm was used. The association between volume and RSMR or RSRR was tested with the Pearson correlation coefficient and linear regression models.
Results
A total of 117 233 episodes of HF were selected during 2015. The mean age was 80±10 years and 46% were women. The crude in-hospital mortality rate was 12.1% and 30-day cardiac readmission rate was 18%. The cut-off point was set at 517 HF discharges per hospital during 2015. High volume hospitals had a statistically lower RSMR (10.3±2.8 vs 11.3±3.6; p<0.001) and higher RSRR (10.7±1.9 vs 9.2±1.6; p<0.001) than low volume hospitals. Low-volume hospitals showed higher dispersion of outcomes than high-volume, both for RSMR and RSRR (Figure).
Conclusions
We found that patients hospitalized for HF in 2105 had lower in-hospital mortality if they were admitted to a high-volume hospital. We have also found that high-volume hospitals had higher 30-day cardiac readmission rates.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - F.J Elola
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - J.L Bernal
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - C Fernandez-Perez
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - M Ruiz-Ortiz
- Hospital Universitario Reina Sofía, Cόrdoba, Spain
| | | | - H Bueno
- University Hospital 12 de Octubre, Madrid, Spain
| | - A Cequier
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
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Moreno-Sierra J, Galante-Romo M, Senovilla-Perez J, Redondo-Gonzalez E, Galindo-Herrero I, Barrera-Ortega J, Vives-Dilmes R, Ariño-Irujo J, Fernández-Montarroso L, Fernandez-Perez C. Oncologic outcomes in 408 consecutive patient cohort treated with da Vinci robot-assisted radical prostatectomy. Actas Urol Esp 2020; 44:179-186. [PMID: 32151469 DOI: 10.1016/j.acuro.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 11/24/2022]
Abstract
The objective of this study is to evaluate the general characteristics and oncological results in a cohort of 408 cases submitted to da Vinci Standard 4-armed robot-assisted radical prostatectomy (RARP), performed between October 2006 and February 2015 at Clínico San Carlos hospital. Statistical analysis was performed with the SPSS 20.0 program. Qualitative variables are presented with their frequency distribution and quantitative variables with their mean and standard deviation or median and interquartile range. The χ2 test was used to analyze the association of qualitative variables. The disease-free survival outcome variable was evaluated with a Kaplan-Meier curve analysis, and the differences were contrasted with the Breslow test. A Cox regression model was adjusted. Among the results, we highlight the follow-up of 47 months (32-68.75m), recurrence-free survival of 90 months (95% CI, 86-94), median time to recurrence of 23 months (10.5-37 m), recurrence 16'6% (68/408), biochemical recurrence (62/498, 15'2%) and 22% of complications, mostly Clavien I-II. The results are summarized in Tables 1 to 7 and Figure 1. CONCLUSIONS: 1) RARP is a safe technique with an acceptable percentage of complications, mostly minor (Clavien grades iandii), 2) We found a higher probability of remaining recurrence-free in the lower grades of the ISUP classification and a higher probability of recurrence in high-risk cases, and 3) The multivariate model showed that the ISUP grade was significantly related to survival and the ISUP and PSM classification grades were independent prognostic variables.
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Zapatero-Gaviria A, Gomez-Huelgas R, Diez-Manglano J, Barba-Martín R, Carretero-Gomez J, Maestre-Peiró A, Bernal-Sobrino J, Marco-Martinez J, Fernandez-Perez C, Elola-Somoza F. RECALMIN. Four years of growth of the internal medicine units of the Spanish National Health System (2013–2016). Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.03.004] [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: 11/25/2022]
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6
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Olmos C, Perez-Garcia C, Garcia-Arribas D, Perez-Castejon MJ, Sanchez-Enrique C, Jimenez-Ballve A, Ortega-Candil A, Fernandez-Perez C, Vilacosta I. P4193The real diagnostic accuracy of 18F-FDG PET/CT in patients with suspected cardiac implantable electronic device infective endocarditis: a meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Perez-Garcia
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - D Garcia-Arribas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | | | | | | | | | | | - I Vilacosta
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
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7
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Reche-Frutos J, Calvo-Gonzalez C, Donate-Lopez J, Garcia-Feijoo J, Saenz-Frances F, Fernandez-Perez C, Garcia-Sanchez J. Retinal Angiomatous Proliferation Reactivation 6 Months after High-Dose Intravitreal Acetonide Triamcinolone and Photodynamic Therapy. Eur J Ophthalmol 2018; 17:979-82. [DOI: 10.1177/112067210701700619] [Citation(s) in RCA: 10] [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] [Indexed: 11/16/2022]
Abstract
Purpose To describe the incidence of retinal angiomatous proliferation (RAP) reactivation after combined treatment with a high-dose intravitreal triamcinolone acetonide (IVTA) and photodynamic therapy (PDT) at 1-year follow-up. Methods All patients had undergone a full ophthalmic examination. High-dose IVTA (20 mg) was injected via pars plana. Four to 7 days later, PDT was delivered. Results Fourteen eyes of 13 patients were included. Eight lesions (57%) reopened and needed retreatment with combined therapy at 6 months follow-up. At 1-year follow up, the lesion was obliterated in nine cases (64.2%) and best-corrected visual acuity improved from 0.87 logMar (range, 0.7–1) to 0.79 logMar (range, 0.5–1). Conclusions Combined therapy using high-dose IVTA and PDT is beneficial in stabilizing RAP. However, a high incidence of RAP reactivation has been observed at 6 months, even with a high-dose IVTA injection.
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Gomez Polo J, Vilacosta I, Martin-Garcia A, Fortuny E, Fernandez-Perez C, Garcia-Bouza M, Carnero M, Vivas D, Higueras J, Cobiella J, Ferrera C, Martin-Benitez J, Acedo Diaz-Pache M, Olmos C, Maroto L. P2702Use of corticosteroids in the prophylaxis of atrial fibrillation after cardiac surgery (ECOFA study). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2702] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Olmos C, Fernandez-Perez C, Elola J, Bernal J, Islas F, Perez-Garcia C, Garcia-Arribas D, Ferrera C, Vilacosta I. 127The increasing incidence and changing profile of infective endocarditis in Spain: a population-based study (2003-2014). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.127] [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: 11/12/2022] Open
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10
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Burney PGJ, Potts J, Kummeling I, Mills ENC, Clausen M, Dubakiene R, Barreales L, Fernandez-Perez C, Fernandez-Rivas M, Le TM, Knulst AC, Kowalski ML, Lidholm J, Ballmer-Weber BK, Braun-Fahlander C, Mustakov T, Kralimarkova T, Popov T, Sakellariou A, Papadopoulos NG, Versteeg SA, Zuidmeer L, Akkerdaas JH, Hoffmann-Sommergruber K, van Ree R. The prevalence and distribution of food sensitization in European adults. Allergy 2014; 69:365-71. [PMID: 24372074 DOI: 10.1111/all.12341] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Complaints of 'food allergy' are increasing. Standardized surveys of IgE sensitization to foods are still uncommon and multicountry surveys are rare. We have assessed IgE sensitization to food-associated allergens in different regions of Europe using a common protocol. METHODS Participants from general populations aged 20-54 years in eight European centres (Zurich, Madrid, Utrecht, Lodz, Sophia, Athens, Reykjavik and Vilnius) were asked whether they had allergic symptoms associated with specific foods. Weighted samples of those with and without allergic symptoms then completed a longer questionnaire and donated serum for IgE analysis by ImmunoCAP for 24 foods, 6 aeroallergens and, by allergen microarray, for 48 individual food proteins. RESULTS The prevalence of IgE sensitization to foods ranged from 23.6% to 6.6%. The least common IgE sensitizations were to fish (0.2%), milk (0.8%) and egg (0.9%), and the most common were to hazelnut (9.3%), peach (7.9%) and apple (6.5%). The order of prevalence of IgE sensitization against different foods was similar in each centre and correlated with the prevalence of the pollen-associated allergens Bet v 1 and Bet v 2 (r = 0.86). IgE sensitization to plant allergen components unrelated to pollen allergens was more evenly distributed and independent of pollen IgE sensitization (r = -0.10). The most common foods containing allergens not cross-reacting with pollens were sesame, shrimp and hazelnut. DISCUSSION IgE sensitization to foods is common, but varies widely and is predominantly related to IgE sensitization to pollen allergens. IgE sensitization to food allergens not cross-reacting with pollens is rare and more evenly distributed.
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Affiliation(s)
- P. G. J. Burney
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - J. Potts
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - I. Kummeling
- Department of Respiratory Epidemiology and Public Health; National Heart and Lung Institute; Imperial College London; London UK
| | - E. N. C. Mills
- Institute of Inflammation and Repair; Manchester Institute of Biotechnology; Manchester UK
| | - M. Clausen
- Children's Hospital Iceland; Landspitali, University Hospital; Reykjavik Iceland
| | - R. Dubakiene
- Clinics of Chest, Allergology and Radiology; Medical faculty; Vilnius University; Vilnius Lithuania
| | - L. Barreales
- Clinical Epidemiology Unit; Preventive Medicine Department; Hospital Clinico San Carlos; IdISSC; Madrid Spain
| | - C. Fernandez-Perez
- Clinical Epidemiology Unit; Preventive Medicine Department; Hospital Clinico San Carlos; IdISSC; Madrid Spain
| | | | - T.-M. Le
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht the Netherlands
| | - A. C. Knulst
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht the Netherlands
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Faculty of Medicine; Medical University of Lodz; Lodz Poland
| | - J. Lidholm
- Thermo Fisher Scientific; Uppsala Sweden
| | - B. K. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital of Zurich; Zurich Switzerland
| | - C. Braun-Fahlander
- Swiss Tropical and Public Health Institute; Basel Switzerland
- University of Basel; Basel Switzerland
| | - T. Mustakov
- Clinical Centre of Allergology of the Alexandrovska Hospital; Medical University; Sofia Bulgaria
| | - T. Kralimarkova
- Clinical Centre of Allergology of the Alexandrovska Hospital; Medical University; Sofia Bulgaria
| | - T. Popov
- Clinical Centre of Allergology of the Alexandrovska Hospital; Medical University; Sofia Bulgaria
| | - A. Sakellariou
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | - S. A. Versteeg
- Department of Experimental Immunology and Department of Otorhinolaryngology; Academic Medical Center; Amsterdam the Netherlands
| | - L. Zuidmeer
- Department of Experimental Immunology and Department of Otorhinolaryngology; Academic Medical Center; Amsterdam the Netherlands
| | - J. H. Akkerdaas
- Department of Experimental Immunology and Department of Otorhinolaryngology; Academic Medical Center; Amsterdam the Netherlands
| | - K. Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna Austria
| | - R. van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology; Academic Medical Center; Amsterdam the Netherlands
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Luaces M, Martinez-Martinez E, Medina M, Miana M, Gonzalez N, Fernandez-Perez C, Cachofeiro V. The impact of bariatric surgery on renal and cardiac functions in morbidly obese patients. Nephrol Dial Transplant 2012; 27 Suppl 4:iv53-7. [DOI: 10.1093/ndt/gfs529] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Reche-Frutos J, Calvo-González C, Donate-López J, García-Feijoó J, Wasfy M, Saenz-Frances F, Fernandez-Perez C, Garcia-Sanchez J. Photodynamic therapy in non-subfoveal choroidal neovascularization secondary to pathological myopia: 1-year outcome. Br J Ophthalmol 2007; 91:1722-3. [PMID: 18024827 DOI: 10.1136/bjo.2006.112045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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