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Hernández-Cano L, Fernández-Infante C, Herranz Ó, Berrocal P, Lozano FS, Sánchez-Martín MA, Porras A, Guerrero C. New functions of C3G in platelet biology: Contribution to ischemia-induced angiogenesis, tumor metastasis and TPO clearance. Front Cell Dev Biol 2022; 10:1026287. [DOI: 10.3389/fcell.2022.1026287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
C3G is a Rap1 guanine nucleotide exchange factor that controls platelet activation, aggregation, and the release of α-granule content. Transgenic expression of C3G in platelets produces a net proangiogenic secretome through the retention of thrombospondin-1. In a physiological context, C3G also promotes megakaryocyte maturation and proplatelet formation, but without affecting mature platelet production. The aim of this work is to investigate whether C3G is involved in pathological megakaryopoiesis, as well as its specific role in platelet mediated angiogenesis and tumor metastasis. Using megakaryocyte-specific C3G knockout and transgenic mouse models, we found that both C3G overexpression and deletion promoted platelet-mediated angiogenesis, induced by tumor cell implantation or hindlimb ischemia, through differential release of proangiogenic and antiangiogenic factors. However, only C3G deletion resulted in a higher recruitment of hemangiocytes from the bone marrow. In addition, C3G null expression enhanced thrombopoietin (TPO)-induced platelet production, associated with reduced TPO plasma levels. Moreover, after 5-fluorouracil-induced platelet depletion and rebound, C3G knockout mice showed a defective return to homeostatic platelet levels, indicating impaired platelet turnover. Mechanistically, C3G promotes c-Mpl ubiquitination by inducing Src-mediated c-Cbl phosphorylation and participates in c-Mpl degradation via the proteasome and lysosome systems, affecting TPO internalization. We also unveiled a positive role of platelet C3G in tumor cell-induced platelet aggregation, which facilitated metastatic cell homing and adhesion. Overall, these findings revealed that C3G plays a crucial role in platelet-mediated angiogenesis and metastasis, as well as in platelet level modulation in response to pathogenic stimuli.
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Blanco-Antona F, González-Sarmiento R, García-Cenador B, Lozano FS. Corrigendum. Pain Med 2022; 23:226. [PMID: 34689203 DOI: 10.1093/pm/pnab186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Soria-Juan B, Garcia-Arranz M, Llanos Jiménez L, Aparicio C, Gonzalez A, Mahillo Fernandez I, Riera Del Moral L, Grochowicz L, Andreu EJ, Marin P, Castellanos G, Moraleda JM, García-Hernández AM, Lozano FS, Sanchez-Guijo F, Villarón EM, Parra ML, Yañez RM, de la Cuesta Diaz A, Tejedo JR, Bedoya FJ, Martin F, Miralles M, Del Rio Sola L, Fernández-Santos ME, Ligero JM, Morant F, Hernández-Blasco L, Andreu E, Hmadcha A, Garcia-Olmo D, Soria B. Efficacy and safety of intramuscular administration of allogeneic adipose tissue derived and expanded mesenchymal stromal cells in diabetic patients with critical limb ischemia with no possibility of revascularization: study protocol for a randomized controlled double-blind phase II clinical trial (The NOMA Trial). Trials 2021; 22:595. [PMID: 34488845 PMCID: PMC8420067 DOI: 10.1186/s13063-021-05430-2] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Chronic lower limb ischemia develops earlier and more frequently in patients with type 2 diabetes mellitus. Diabetes remains the main cause of lower-extremity non-traumatic amputations. Current medical treatment, based on antiplatelet therapy and statins, has demonstrated deficient improvement of the disease. In recent years, research has shown that it is possible to improve tissue perfusion through therapeutic angiogenesis. Both in animal models and humans, it has been shown that cell therapy can induce therapeutic angiogenesis, making mesenchymal stromal cell-based therapy one of the most promising therapeutic alternatives. The aim of this study is to evaluate the feasibility, safety, and efficacy of cell therapy based on mesenchymal stromal cells derived from adipose tissue intramuscular administration to patients with type 2 diabetes mellitus with critical limb ischemia and without possibility of revascularization. Methods A multicenter, randomized double-blind, placebo-controlled trial has been designed. Ninety eligible patients will be randomly assigned at a ratio 1:1:1 to one of the following: control group (n = 30), low-cell dose treatment group (n = 30), and high-cell dose treatment group (n = 30). Treatment will be administered in a single-dose way and patients will be followed for 12 months. Primary outcome (safety) will be evaluated by measuring the rate of adverse events within the study period. Secondary outcomes (efficacy) will be measured by assessing clinical, analytical, and imaging-test parameters. Tertiary outcome (quality of life) will be evaluated with SF-12 and VascuQol-6 scales. Discussion Chronic lower limb ischemia has limited therapeutic options and constitutes a public health problem in both developed and underdeveloped countries. Given that the current treatment is not established in daily clinical practice, it is essential to provide evidence-based data that allow taking a step forward in its clinical development. Also, the multidisciplinary coordination exercise needed to develop this clinical trial protocol will undoubtfully be useful to conduct academic clinical trials in the field of cell therapy in the near future. Trial registration ClinicalTrials.govNCT04466007. Registered on January 07, 2020. All items from the World Health Organization Trial Registration Data Set are included within the body of the protocol.
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Affiliation(s)
- Barbara Soria-Juan
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | - Mariano Garcia-Arranz
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | - Lucía Llanos Jiménez
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain.
| | - César Aparicio
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | - Alejandro Gonzalez
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | - Ignacio Mahillo Fernandez
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | | | | | | | - Pedro Marin
- Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | | | | | - Francisco S Lozano
- IBSAL-University Hospital of Salamanca, University of Salamanca, Salamanca, Spain
| | - Fermin Sanchez-Guijo
- IBSAL-University Hospital of Salamanca, University of Salamanca, Salamanca, Spain
| | - Eva María Villarón
- IBSAL-University Hospital of Salamanca, University of Salamanca, Salamanca, Spain
| | - Miriam Lopez Parra
- IBSAL-University Hospital of Salamanca, University of Salamanca, Salamanca, Spain
| | - Rosa María Yañez
- Hematopoietic Innovative Therapies Division, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | | | | | - Francisco J Bedoya
- University of Pablo de Olavide, Sevilla, Spain.,Network Center for Research in Diabetes and Associated Metabolic Diseases (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas-CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | - José Manuel Ligero
- Institute for Health Research Gregorio Marañón (IISGM), General University Gregorio Marañón Hospital, Madrid, Spain
| | - Francisco Morant
- Institute for Health Research-ISABIAL, General University Hospital, Alicante, Spain
| | | | - Etelvina Andreu
- Institute for Health Research-ISABIAL, General University Hospital, Alicante, Spain.,University Miguel Hernández de Elche, Alicante, Spain
| | - Abdelkrim Hmadcha
- University of Pablo de Olavide, Sevilla, Spain.,The Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,University of Alicante, Alicante, Spain
| | - Damian Garcia-Olmo
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | - Bernat Soria
- University of Pablo de Olavide, Sevilla, Spain.,Institute for Health Research-ISABIAL, General University Hospital, Alicante, Spain.,University Miguel Hernández de Elche, Alicante, Spain
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Peña R, Valverde S, Alcázar JA, Cebrián P, González-Porras JR, Lozano FS. Abdominal aortic aneurysm and acute appendicitis: a case report and review of the literature. J Med Case Rep 2021; 15:203. [PMID: 33863365 PMCID: PMC8052834 DOI: 10.1186/s13256-021-02703-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background Abdominal aortic aneurysm and acute appendicitis occur relatively frequently in elderly patients. However, the co-occurrence of the two pathologies is very rare and serious. Case presentation We present the case of an elderly Caucasian patient who was aware of having an abdominal aortic aneurysm but refused treatment and was subsequently admitted to the hospital’s emergency department with acute abdominal symptoms. A computed tomography scan raised the possibility of complication due to the characteristics of the aneurysm. The patient then agreed to emergency surgery. Laparotomy revealed the existence of an acute perforated appendicitis with a significant abscess in the right iliac fossa and an uncomplicated aneurysm. Appendectomy was performed and the abscess drained. The postoperative period passed without complications, and the patient again refused surgery for the aneurysm, which due to its anatomical characteristics was not a candidate for standard endovascular treatment. Conclusions In light of this experience, we review the literature about the relationship between abdominal aortic aneurysm and acute appendicitis.
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Affiliation(s)
- Rubén Peña
- Servicio de Angiología y Cirugía Vascular, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Paseo de San Vicente 139, 37007, Salamanca, Spain
| | - Sergio Valverde
- Servicio de Angiología y Cirugía Vascular, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Paseo de San Vicente 139, 37007, Salamanca, Spain
| | - José A Alcázar
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain
| | - Paloma Cebrián
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain
| | - José Ramón González-Porras
- Servicio de Hematología, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain
| | - Francisco S Lozano
- Servicio de Angiología y Cirugía Vascular, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Paseo de San Vicente 139, 37007, Salamanca, Spain.
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González-Juanatey JR, Almendro-Delia M, Cosín-Sales J, Bellmunt-Montoya S, Gómez-Doblas JJ, Riambau V, García-Moll X, García-Alegría J, Hernández JL, Lozano FS, Suarez Fernández C. Residual risk reduction opportunities in patients with chronic coronary syndrome. Role of dual pathway inhibition. Expert Rev Clin Pharmacol 2021; 13:695-706. [PMID: 32434452 DOI: 10.1080/17512433.2020.1772056] [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] [Indexed: 10/24/2022]
Abstract
INTRODUCTION In this review, the role of the rivaroxaban-plus-aspirin approach (dual pathway inhibition - DPI) in patients with chronic coronary syndrome (CCS) and to perform practical recommendations about its use was updated. AREAS COVERED The contents of this review were proposed in an expert meeting. To identify relevant articles, a systematic search of Medline/Embase was performed (to July 2019), using the key words 'rivaroxaban', 'vascular dose', 'COMPASS' and 'coronary artery disease' in the search strategy. EXPERT OPINION Despite current antithrombotic strategies (single/dual antiplatelet therapy) have decreased rates of recurrent cardiovascular events among patients with CCS, residual risk remains unacceptably high. The COMPASS trial showed in CCS patients that compared with aspirin 100 mg rivaroxaban 2.5 mg bid plus aspirin 100 mg reduced the risk of major cardiac events, cardiovascular hospitalization and mortality, without an increase of intracranial or fatal bleedings. Importantly, residual risk with the rivaroxaban plus aspirin approach was lower than with different dual antiplatelet therapy regimens. The rivaroxaban plus aspirin strategy is of particular benefit in patients with CCS and high-risk cardiovascular feature (i.e. ≥2 vascular beds, heart failure, renal insufficiency, peripheral artery disease, previous stroke or diabetes) and should be considered in these populations.
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Affiliation(s)
- José R González-Juanatey
- Cardiology and Intensive Cardiac Care Department, CIBERCV, University Hospital Santiago de Compostela , Santiago de Compostela, Spain
| | - Manuel Almendro-Delia
- Intensive Cardiovascular Care Unit, Cardiovascular Clinical Trials & Translational Research Unit, Cardiology and Cardiovascular Surgery Division, Virgen Macarena University Hospital , Seville, Spain
| | - Juan Cosín-Sales
- Cardiology Department, Hospital Arnau de Vilanova, Facultad de Medicina, Universidad CEU-Cardenal Herrena , Valencia, Spain
| | - Sergi Bellmunt-Montoya
- Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona, Spain
| | | | - Vincent Riambau
- Vascular Surgery Division, CardioVascular Institute Hospital Clinic University of Barcelona , Barcelona, Spain
| | | | | | - José Luis Hernández
- Internal Medicine Department, Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria , Santander, Spain
| | - Francisco S Lozano
- Department of Vascular Surgery, Hospital Clínico de Salamanca , Salamanca, Spain
| | - Carmen Suarez Fernández
- Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid , Madrid, Spain
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Soria-Juan B, Escacena N, Capilla-González V, Aguilera Y, Llanos L, Tejedo JR, Bedoya FJ, Juan V, De la Cuesta A, Ruiz-Salmerón R, Andreu E, Grochowicz L, Prósper F, Sánchez-Guijo F, Lozano FS, Miralles M, Del Río-Solá L, Castellanos G, Moraleda JM, Sackstein R, García-Arranz M, García-Olmo D, Martín F, Hmadcha A, Soria B. Corrigendum: Cost-Effective, Safe, and Personalized Cell Therapy for Critical Limb Ischemia in Type 2 Diabetes Mellitus. Front Immunol 2020; 11:2029. [PMID: 32983148 PMCID: PMC7492973 DOI: 10.3389/fimmu.2020.02029] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2019.01151.].
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Affiliation(s)
| | - Natalia Escacena
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Vivian Capilla-González
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Yolanda Aguilera
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Lucía Llanos
- Fundación Jiménez Díaz Health Research Institute, Madrid, Spain
| | - Juan R Tejedo
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Francisco J Bedoya
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | | | - Antonio De la Cuesta
- Unidad de Isquemia Crónica de Miembros Inferiores, Hospital Victoria Eugenia de la Cruz Roja, Sevilla, Spain
| | | | | | | | | | | | | | - Manuel Miralles
- Department of Surgery, University of Valencia, Valencia, Spain
| | | | - Gregorio Castellanos
- Servicio Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - José M Moraleda
- Servicio Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Robert Sackstein
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | | | | | - Franz Martín
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Abdelkrim Hmadcha
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Bernat Soria
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,ISABIAL and Institute of Bioengineering, University Miguel Hernández de Elche, Alicante, Spain
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Lozano FS, Muñoz A, de Las Heras JA, González-Porras JR. Simple and complex carotid paragangliomas. Three decades of experience and literature review. Head Neck 2020; 42:3538-3550. [PMID: 32812684 DOI: 10.1002/hed.26421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/08/2020] [Revised: 06/01/2020] [Accepted: 07/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Carotid paragangliomas are rare tumors. They are usually unique, non-secreting, resectable, and benign. However, additional rare cases of complex tumors (bilateral, secretory, nonresectable, or malignant) complicate the management and final outcomes. METHODS Records of paragangliomas from our hospital are reviewed. Criteria defining complex paragangliomas have been previously defined. These are compared with those of the simple group. RESULTS Fifty patients, two groups: simple (n = 39) and complex (n = 11). The patients in the complex group were significantly younger (47.7 vs 63.8 years). Postoperative nerve complications (45.4% vs 6.3%) and mortality during follow-up (27.3% vs 0%) were significantly more common in the complex group. Vascular complications (0% vs 3.1%) and early mortality (0%) were similarly in both groups. CONCLUSIONS Patients with complex carotid paragangliomas are heterogeneous. The former are younger, exhibit a high degree of diagnostic and therapeutic complexity, and have poorer morbidity and mortality. Surgical experience and interdisciplinary collaboration are essential.
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Affiliation(s)
- Francisco S Lozano
- Department of Angiology and Vascular Surgery, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Angel Muñoz
- Department of Otorhinolaryngology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José A de Las Heras
- Department of Radiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - José R González-Porras
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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Hernández JL, Lozano FS, Riambau V, Almendro-Delia M, Cosín-Sales J, Bellmunt-Montoya S, Garcia-Alegria J, Garcia-Moll X, Gomez-Doblas JJ, Gonzalez-Juanatey JR, Suarez Fernández C. Reducing residual thrombotic risk in patients with peripheral artery disease: impact of the COMPASS trial. Drugs Context 2020; 9:dic-2020-5-5. [PMID: 32699549 PMCID: PMC7357685 DOI: 10.7573/dic.2020-5-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/31/2022] Open
Abstract
Patients with peripheral artery disease (PAD) are at a high risk not only for the classical cardiovascular (CV) outcomes (major adverse cardiovascular events; MACE) but also for vascular limb events (major adverse limb events; MALE). Therefore, a comprehensive approach for these patients should include both goals. However, the traditional antithrombotic approach with only antiplatelet agents (single or dual antiplatelet therapy) does not sufficiently reduce the risk of recurrent thrombotic events. Importantly, the underlying cause of atherosclerosis in patients with PAD implies both platelet activation and the initiation and promotion of coagulation cascade, in which Factor Xa plays a key role. Therefore, to reduce residual vascular risk, it is necessary to address both targets. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial that included patients with stable atherosclerotic vascular disease, the rivaroxaban plus aspirin strategy (versus aspirin) markedly reduced the risk of both CV and limb outcomes, and related complications, with a good safety profile. In fact, the net clinical benefit outcome composed of MACE; MALE, including major amputation, and fatal or critical organ bleeding was significantly reduced by 28% with the COMPASS strategy, (hazard ratio: 0.72; 95% confidence interval: 0.59-0.87). Therefore, the rivaroxaban plus aspirin approach provides comprehensive protection and should be considered for most patients with PAD at high risk of such events.
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Affiliation(s)
- José Luis Hernández
- Internal Medicine Department, Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Francisco S Lozano
- Department of Vascular Surgery, Hospital Clínico de Salamanca, Salamanca, Spain
| | - Vincent Riambau
- Vascular Surgery Division, CardioVascular Institute Hospital Clinic University of Barcelona, Barcelona, Spain
| | - Manuel Almendro-Delia
- Intensive Cardiovascular Care Unit, Cardiovascular Clinical Trials & Translational Research Unit, Cardiology and Cardiovascular Surgery Division, Virgen Macarena University Hospital, Seville, Spain
| | - Juan Cosín-Sales
- Cardiology Department, Hospital Arnau de Vilanova. Facultad de Medicina, Universidad CEU-Cardenal Herrena, Valencia, Spain
| | - Sergi Bellmunt-Montoya
- Vascular Surgery Department, Universitari Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Juan José Gomez-Doblas
- Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBERCV, Malaga, Spain
| | - José R Gonzalez-Juanatey
- Cardiology and Intensive Cardiac Care Department, University Hospital Santiago de Compostela, CIBERCV, Santiago de Compostela, Spain
| | - Carmen Suarez Fernández
- Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Blanco-Antona F, González-Sarmiento R, García-Cenador B, Lozano FS. Transdermal Buprenorphine for Controlling Pain in Patients with Critical Lower-Limb Ischemia. Pain Med 2020; 21:1083-1085. [PMID: 31313809 DOI: 10.1093/pm/pnz165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Francisco Blanco-Antona
- Department of Vascular Surgery, Clinical Hospital, University of Salamanca and Institute of Biomedical Research of Salamanca, Salamanca, Spain
| | - Rogelio González-Sarmiento
- Department of Vascular Surgery, Clinical Hospital, University of Salamanca and Institute of Biomedical Research of Salamanca, Salamanca, Spain
| | - Begoña García-Cenador
- Department of Vascular Surgery, Clinical Hospital, University of Salamanca and Institute of Biomedical Research of Salamanca, Salamanca, Spain
| | - Francisco S Lozano
- Department of Vascular Surgery, Clinical Hospital, University of Salamanca and Institute of Biomedical Research of Salamanca, Salamanca, Spain
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Torres JA, Arevalo A, Sastre JA, González-Porras JR, Salvador R, González-Santos J, Lozano FS. Spontaneous rupture of a mechanical valve in a mitral position (On-X) with migration-embolization to aortic bifurcation from the perspective of the vascular surgeon. J Cardiovasc Surg (Torino) 2020; 61:256-263. [PMID: 31985187 DOI: 10.23736/s0021-9509.20.11026-7] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report on the case of spontaneous rupture of an On-X-pure pyrolytic carbon mechanical valve prosthesis implanted seven years earlier, in a mitral position, at our hospital. The patient was admitted with valvular dysfunction and acute pulmonary edema requiring emergency surgery (prosthesis replacement); the absence of a leaflet was confirmed intraoperatively. The patient presented severe respiratory failure, which prolonged the postoperative period. A CT scan showed that the migrated leaflet was located in the aortic bifurcation with no apparent arterial lesion. Four months later, once the patient had recovered, laparotomy and aortotomy were performed in order to retrieve the leaflet, which was found to have become included (neoendothelized) in the aortic wall without compromising the latter's integrity or obstructing the blood flow. A subsequent CT scan confirmed the persistence of the leaflet in its initial position. The literature review highlights two singular facts: 1) this is the second published case of the escape of a leaflet from an On-X prosthesis (the first patient died); 2) this is the first case in which a laparotomy was performed to retrieve the leaflet but finally a decision was made to leave it in situ. Seven months later, the patient remained asymptomatic.
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Affiliation(s)
- José A Torres
- Department of Angiology and Vascular Surgery, Salamanca University Hospital (CAUSA), Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain
| | - Adolfo Arevalo
- Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain.,Department of Cardiac Surgery, Salamanca University Hospital (CAUSA), Salamanca, Spain
| | - José A Sastre
- Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain.,Department of Anesthesiology, Salamanca University Hospital (CAUSA), Salamanca, Spain
| | - José R González-Porras
- Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain.,Department of Hematology, Salamanca University Hospital (CAUSA), Salamanca, Spain
| | - Roberto Salvador
- Department of Angiology and Vascular Surgery, Salamanca University Hospital (CAUSA), Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain
| | - José González-Santos
- Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain.,Department of Cardiac Surgery, Salamanca University Hospital (CAUSA), Salamanca, Spain
| | - Francisco S Lozano
- Department of Angiology and Vascular Surgery, Salamanca University Hospital (CAUSA), Salamanca, Spain - .,Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain
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11
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Soria-Juan B, Escacena N, Capilla-González V, Aguilera Y, Llanos L, Tejedo JR, Bedoya FJ, Juan V, De la Cuesta A, Ruiz-Salmerón R, Andreu E, Grochowicz L, Prósper F, Sánchez-Guijo F, Lozano FS, Miralles M, Del Río-Solá L, Castellanos G, Moraleda JM, Sackstein R, García-Arranz M, García-Olmo D, Martín F, Hmadcha A, Soria B. Cost-Effective, Safe, and Personalized Cell Therapy for Critical Limb Ischemia in Type 2 Diabetes Mellitus. Front Immunol 2019; 10:1151. [PMID: 31231366 PMCID: PMC6558400 DOI: 10.3389/fimmu.2019.01151] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 01/15/2019] [Accepted: 05/07/2019] [Indexed: 12/26/2022] Open
Abstract
Cell therapy is a progressively growing field that is rapidly moving from preclinical model development to clinical application. Outcomes obtained from clinical trials reveal the therapeutic potential of stem cell-based therapy to deal with unmet medical treatment needs for several disorders with no therapeutic options. Among adult stem cells, mesenchymal stem cells (MSCs) are the leading cell type used in advanced therapies for the treatment of autoimmune, inflammatory and vascular diseases. To date, the safety and feasibility of autologous MSC-based therapy has been established; however, their indiscriminate use has resulted in mixed outcomes in preclinical and clinical studies. While MSCs derived from diverse tissues share common properties depending on the type of clinical application, they markedly differ within clinical trials in terms of efficacy, resulting in many unanswered questions regarding the application of MSCs. Additionally, our experience in clinical trials related to critical limb ischemia pathology (CLI) shows that the therapeutic efficacy of these cells in different animal models has only been partially reproduced in humans through clinical trials. Therefore, it is crucial to develop new research to identify pitfalls, to optimize procedures and to clarify the repair mechanisms used by these cells, as well as to be able to offer a next generation of stem cell that can be routinely used in a cost-effective and safe manner in stem cell-based therapies targeting CLI.
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Affiliation(s)
| | - Natalia Escacena
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Vivian Capilla-González
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Yolanda Aguilera
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Lucía Llanos
- Fundación Jiménez Díaz Health Research Institute, Madrid, Spain
| | - Juan R Tejedo
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Francisco J Bedoya
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | | | - Antonio De la Cuesta
- Unidad de Isquemia Crónica de Miembros Inferiores, Hospital Victoria Eugenia de la Cruz Roja, Sevilla, Spain
| | | | | | | | | | | | | | - Manuel Miralles
- Department of Surgery, University of Valencia, Valencia, Spain
| | | | - Gregorio Castellanos
- Servicio Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - José M Moraleda
- Servicio Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Robert Sackstein
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | | | | | - Franz Martín
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Abdelkrim Hmadcha
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Bernat Soria
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
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12
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Martin-Rufino JD, Lozano FS, Redondo AM, Villaron EM, Rueda R, Fernandez-Samos R, Sanchez-Guijo F. Sequential intravenous allogeneic mesenchymal stromal cells as a potential treatment for thromboangiitis obliterans (Buerger's disease). Stem Cell Res Ther 2018; 9:150. [PMID: 29848379 PMCID: PMC5977545 DOI: 10.1186/s13287-018-0901-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/27/2018] [Accepted: 05/10/2018] [Indexed: 03/14/2023] Open
Abstract
Thromboangiitis obliterans (TAO), also known as Buerger’s Disease, is an occlusive vasculitis linked with high morbidity and amputation risk. To date, TAO is deemed incurable due to the lack of a definitive treatment. The immune system and inflammation are proposed to play a central role in TAO pathogenesis. Due to their immunomodulatory effects, mesenchymal stromal cells (MSCs) are the subject of intense research for the treatment of a wide range of immune-mediated diseases. Thus far, local intramuscular injections of autologous or allogeneic MSCs have shown promising results in TAO. However, sequential intravenous allogeneic MSC administration has not yet been explored, which we hypothesized could exert a systemic anti-inflammatory effect in the vasculature and modulate the immune response. Here, we report the first case of a TAO patient at amputation risk treated with four sequential intravenous infusions of bone marrow-derived allogeneic MSCs from a healthy donor. Following administration, there was significant regression of foot skin ulcers and improvements in rest pain, Walking Impairment Questionnaire scores, and quality of life. Sixteen months after the infusion, the patient had not required any further amputations. This report highlights the potential of sequential allogeneic MSC infusions as an effective treatment for TAO, warranting further studies to compare this approach with the more conventionally used intramuscular MSC administration and other cell-based therapies.
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Affiliation(s)
- Jorge D Martin-Rufino
- Department of Hematology, Cell Therapy Unit, IBSAL-Hospital Universitario de Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain.,Faculty of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Francisco S Lozano
- Department of Angiology and Vascular Surgery, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain.,Faculty of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Alba M Redondo
- Department of Hematology, Cell Therapy Unit, IBSAL-Hospital Universitario de Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain.,Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y Leon, Salamanca, Spain
| | - Eva M Villaron
- Department of Hematology, Cell Therapy Unit, IBSAL-Hospital Universitario de Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain.,Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y Leon, Salamanca, Spain
| | - Raquel Rueda
- Department of Radiology, Hospital de Leon, Leon, Spain
| | | | - Fermin Sanchez-Guijo
- Department of Hematology, Cell Therapy Unit, IBSAL-Hospital Universitario de Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain. .,Faculty of Medicine, Universidad de Salamanca, Salamanca, Spain. .,Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y Leon, Salamanca, Spain.
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13
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Lozano FS, Almazan A. Low-Molecular-Weight Heparin Versus Saphenofemoral Disconnection for the Treatment of Above-Knee Greater Saphenous Thrombophlebitis: A Prospective Study. Vasc Endovascular Surg 2016; 37:415-20. [PMID: 14671696 DOI: 10.1177/153857440303700605] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 11/15/2022]
Abstract
The objective of this study was to assess the efficacy, safety, and cost of lowmolecularweight heparin compared to saphenofemoral disconnection for the treatment of internal saphenous proximal thrombophlebitis (SPT). Eighty-four consecutive patients diagnosed as presenting SPT alone (symptoms/echo-Doppler) were divided into 2 comparable groups treated with (1) saphenofemoral disconnection under local anesthesia with a short hospital stay (n=45) or (2) prospective enoxaparin on an outpatient basis for 4 weeks (n=39). Informed consent was obtained and inclusion, exclusion, and withdrawal criteria were established. Patients were followed up at 1, 3, and 6 months. Thirty patients per group completed the study requirements. In the disconnection group, 2 patients (6.7%) presented complications of the surgical wound, 1 (3.3%) had SPT recurrence (however, there was no deep venous thrombosis), and 2 (6.7%) had nonfatal pulmonary embolism confirmed by radionuclide scan. In the enoxaparin group, there were 2 cases (6.7%) of minor bleeding (epistaxis and rectal bleeding) and 3 (10%) recurrences of SPT. In the enoxaparin group there was no case of progression of the thrombosis to the deep venous system or pulmonary embolism. The study found no statistically significant differences between saphenofemoral disconnection and enoxaparin in the treatment of SPT, but the low-molecular-weight heparin group had socioeconomic advantages.
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Affiliation(s)
- Francisco S Lozano
- Vascular Surgery Unit, Department of Surgery, University Hospital, University of Salamanca, Spain.
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14
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Blanco F, Muriel C, Labrador J, Gonzalez-Porras JR, Gonzalez-Sarmiento R, Lozano FS. Influence of UGT2B7, CYP3A4, and OPRM1 Gene Polymorphisms on Transdermal Buprenorphine Pain Control in Patients with Critical Lower Limb Ischemia Awaiting Revascularization. Pain Pract 2015; 16:842-9. [PMID: 26407542 DOI: 10.1111/papr.12343] [Citation(s) in RCA: 16] [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: 12/03/2014] [Accepted: 06/15/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pain control in critical limb ischemia (CLI) varies considerably between individuals. OBJECTIVE To evaluate pharmacogenetically the response to transdermal buprenorphine (BUP-TTS) in patients with CLI who are awaiting revascularization. METHODS One hundred and seven patients with CLI were treated with BUP-TTS. The following were analyzed: (1) pain perception (visual analog scale (VAS) before and 4 days after treatment) and (2) genetics: glucuronosyltransferase (UGT2B7), cytochrome (CYP3A4), and μ-opioid receptor (OPRM1) gene polymorphisms. RESULTS Ninety-three patients completed the study. The VAS score by the fourth day of analgesia dropped from 6.82 to 3.38 (P < 0.05). The analgesic response to BUP-TTS was greater in men than in women (P = 0.019). Patients who were AA homozygotes for the CYP3A4 gene showed the best response to analgesic treatment (P = 0.003). The combination of the CYP3A4 gene with UGT2B7 or OPRM1 was favorable to the effect of the CYP3A4 gene (P = 0.045 and P = 0.026, respectively). The combination of UGT2B7 with OPRM1 was ineffective (P = 0.648). The 3 polymorphisms together had no effect on response to treatment (P = 0.461). CONCLUSIONS BUP-TTS is efficacious in the control of pain in patients with CLI. The homozygous AA carriers of the CYP3A4 gene respond better to treatment with BUP-TTS.
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Affiliation(s)
- Francisco Blanco
- General Surgery Department, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Clemente Muriel
- Anesthesiology and Reanimation Department, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Jorge Labrador
- Hematology Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Rogelio Gonzalez-Sarmiento
- Molecular Medicine Unit-Medicine Department, Facultad de Medicina-IBSAL-Universidad de Salamanca-CSIC, Salamanca, Spain
| | - Francisco S Lozano
- Angiology and Vascular Surgery Department, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
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15
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Labrador J, López-Corral L, Vazquez L, Sánchez-Guijo F, Guerrero C, Sánchez-Barba M, Lozano FS, Alberca I, del Cañizo MC, Caballero D, González-Porras JR. Incidence and risk factors for life-threatening bleeding after allogeneic stem cell transplant. Br J Haematol 2015; 169:719-25. [DOI: 10.1111/bjh.13344] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/05/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Jorge Labrador
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
- Servicio de Hematología; Hospital Universitario de Burgos; Burgos Spain
- Centro de Investigación del Cáncer; IBMC Departamento de Medicina; USAL; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Lucia López-Corral
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Lourdes Vazquez
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Fermin Sánchez-Guijo
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Carmen Guerrero
- Centro de Investigación del Cáncer; IBMC Departamento de Medicina; USAL; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | | | - Francisco S. Lozano
- Servicio de Angiología y Cirugía Vascular; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Ignacio Alberca
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - María C. del Cañizo
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
- Centro de Investigación del Cáncer; IBMC Departamento de Medicina; USAL; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Dolores Caballero
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Jose R. González-Porras
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
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Arcelus JI, Domènech P, Fernández-Capitan MDC, Guijarro R, Jiménez D, Jiménez S, Lozano FS, Monreal M, Nieto JA, Páramo JA. Rivaroxaban in the Treatment of Venous Thromboembolism and the Prevention of Recurrences. Clin Appl Thromb Hemost 2014; 21:297-308. [DOI: 10.1177/1076029614561321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Anticoagulation therapy is the standard treatment of patients with symptomatic venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism. Until recently, treatment of VTE was based on parenteral or low-molecular-weight heparin for initial therapy (5-10 days) and oral vitamin K antagonists for long-term therapy. Those treatments have some limitations, including parenteral administration (heparins), the need for frequent monitoring and dose adjustments, interactions with several medications, and dietary restrictions (vitamin K antagonists). Rivaroxaban is a new oral direct factor Xa inhibitor with a wide therapeutic window, predictable anticoagulant effect, no food interactions, and few drug interactions. Consequently, no periodic monitoring of anticoagulation is needed, and fixed doses can be prescribed. EINSTEIN program demonstrated that rivaroxaban was as effective as and significantly safer than standard therapy for treatment of VTE. Rivaroxaban was recently authorized so doubts exist about how to use it in daily clinical practice. This document aims to clarify common questions formulated by clinicians regarding the use of this new drug.
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Affiliation(s)
- Juan I. Arcelus
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pere Domènech
- Haemostasis and Thrombosis Department. Bellvitge's University Hospital. Hospitalet de Llobregat, Barcelona, Spain
| | | | - Ricardo Guijarro
- Internal Medicine Department, Regional University Hospital of Malaga (Carlos Haya Hospital), Málaga, Spain
| | - David Jiménez
- Respiratory Department, Ramon y Cajal Hospital, Alcala de Henares University, Madrid, Spain
| | - Sonia Jiménez
- Emergency Department, Hospital Clínic and IDIBAPS, Barcelona, Spain
| | | | - Manel Monreal
- Internal Medicine Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - José A. Nieto
- Internal Medicine Service, Hospital Virgen de la Luz, Cuenca, Spain
| | - José A. Páramo
- Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain
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Abstract
INTRODUCTION The Ankle-Brachial Index (ABI) makes it possible to identify patients with peripheral artery disease (PAD). Intermittent claudication (IC) is the first major symptom of PAD, although many patients with an ABI ≤ 0.9 do not exhibit IC, and the range of ABI among those who do have IC is very variable. This study evaluates the correlation between ABI and the perception (symptomatology) of claudicant patients. MATERIAL AND METHODS An observational, cross-sectional and multicentre, study of 920 patients with IC. Clinical history, ABI, Walking Impairment Questionnaire (WIQ) and European Quality of Life Questionnaire (EQ-5D) were recorded. Associations were analysed using Spearman's correlation coefficient. RESULTS The mean ABI of the series was 0.63 (SD = 0.19). The mean WIQ-distance was 34.07 (SD = 26.77), values being smaller for lower ABI values (r = 0.343, p < 0.001). The mean EQ-5D score of the series was 0.58 (SD = 0.21), also showing lower values as the ABI decreased (r = 0.278, p < 0.001). The correlations of WIQ and EQ-5D with ABI were statistically significant in both cases, but always less than 0.400 (between 0.278 and 0.343). CONCLUSIONS The correlations of ABI with the questionnaires of walking capacity and quality of life are weak. For this reason, although in clinical practice the ABI of CI patients is commonly measured, decisions should not be taken during the development of IC exclusively on the basis of the ABI.
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Affiliation(s)
- F S Lozano
- Hospital Universitario de Salamanca and IBSAL, Salamanca, Spain
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Lozano FS, González-Porras JR, March JR, Carrasco E, Lobos JM. Differences Between Women and Men with Intermittent Claudication: A Cross-Sectional Study. J Womens Health (Larchmt) 2014; 23:834-41. [DOI: 10.1089/jwh.2013.4653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Francisco S. Lozano
- Department of Angiology and Vascular Surgery, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | | | - José R. March
- Department of Angiology and Vascular Surgery, Hospital Universitario de Getafe, Getafe, Spain
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Jimenez MF, Rodriguez-Conde MJ, Olmos-Miguelañez S, Varela G, Lozano FS, Garcia FJ, Martinez-Abad F. Impact of the Objective Evaluation of Clinical and Surgical Basic Skills (CSBS) On Medicine Students (Spain). Journal of Information Technology Research 2014. [DOI: 10.4018/jitr.2014040105] [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: 11/09/2022]
Abstract
This work presents the design, implementation and results of a research project in medical education conducted from 2007 to 2011, on the learning of some basic clinical and surgical skills in Medicine (University of Salamanca, Spain). This project has been conducted in collaboration with the Educational Research Institute of the same university. The hypothesis of the study that teaching methods based on a learning process guided by the direct practice on models, along with the modeling through an online teaching platform, produce a high level of learning, measured by using the direct observation of the behavior. The learning results are positive, although some methodological inconveniences have been found in the evaluation process, in relation with the causes of the variability between skills and evaluators.
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Lozano FS, González-Porras JR, March JR, Lobos JM, Carrasco E, Ros E. Diabetes mellitus and intermittent claudication: a cross-sectional study of 920 claudicants. Diabetol Metab Syndr 2014; 6:21. [PMID: 24533798 PMCID: PMC3937005 DOI: 10.1186/1758-5996-6-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 02/06/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) and intermittent claudication (IC) are frequently associated health conditions. Our hypothesis is that the nature, severity and quality of life (QoL) of patients with IC and DM are worse than those of claudicant patients without diabetes. MATERIAL AND METHODS An observational, cross-sectional and multicentre study of 920 patients with IC, divided into two groups: diabetic (n = 477) and non-diabetic (n = 443). For each group, we examined clinical and biological characteristics (including levels of glucose and lipids), the ankle-brachial index (ABI), responses to the Walking Impairment Questionnaire (WIQ) and the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. RESULTS Compared with claudicant patients without diabetes, claudicants with diabetes were older (p < 0.001), more likely to be female (p = 0.006), with a higher BMI (p < 0.001), more likely to have a sedentary lifestyle (p < 0.001) and to be a non-smoker (p < 0.001). Claudicant patients with diabetes also had significantly more cardiovascular risk factors (p < 0.001), more frequent ischaemic cardiopathy (p = 0.023) and chronic renal failure (p = 0.002), and fewer prior ictus events (p = 0.003). No significant differences between groups were found with respect to blood pressure, levels of cholesterol or triglycerides. The mean ABI of diabetic-IC patients was slightly lower than IC patients without diabetes (p = 0.016). All WIQ subdomains scores were significantly lower (p < 0.001), indicating poorer walking ability, in claudicant and diabetic patients with compared with those without diabetes. The mean E5-QD global scores and the mean EQ-5D visual analogue scale in the whole series were 0.58 (SD = 0.21) and 55.04 (SD = 21.30), respectively. Both E5-QD scores were significantly lower, indicating poorer QoL, in claudicant patients with diabetes than claudicant patients without diabetes (p < 0.001). CONCLUSION Patients with IC and DM had more risk cardiovascular factors, cardiovascular conditions, disability and worse haemodynamic status and QoL than claudicant patients without diabetes.
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Affiliation(s)
- Francisco S Lozano
- Hospital Universitario de Salamanca e IBSAL, Salamanca, Spain
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Salamanca, Universidad de Salamanca, Paseo de San Vicente s/n, Salamanca, 37007, Spain
| | | | | | | | | | - Eduardo Ros
- Hospital Universitario San Cecilio, Granada, Spain
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Lozano FS, Marinello J, Moreno RM, Aguilar MD, López-Quintana A, Gonzalez-Porras JR, Alvarez J, Giménez-Gaibar A, Alguacil R, Cairols MA, Marco-Luque MA, Vaquero F, Callejas JM. Monitoring the Practice of Vascular Surgery: Findings from a National Registry (1996–2011). World J Surg 2013; 38:241-51. [DOI: 10.1007/s00268-013-2272-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lozano FS, March JR, González-Porras JR, Carrasco E, Lobos JM, Areitio-Aurtena A. Validation of the Walking Impairment Questionnaire for Spanish patients. VASA 2013; 42:350-6. [DOI: 10.1024/0301-1526/a000300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: The Walking Impairment Questionnaire (WIQ) is a short, easy to complete, disease-specific questionnaire to assess intermittent claudication. A Spanish version of the WIQ for Hispanic Americans has recently been validated in Texas, but it needs to be validated for European Spanish people. Patients and methods: After translation and cultural adaptation of the WIQ, 920 patients with intermittent claudication (ankle brachial index < 0.9) completed two questionnaires (Spanish version of the WIQ and European Quality of Life 5 Dimension [EQ-5D]). The validity of the WIQ was determined by correlating WIQ and EQ-5D. Test-retest reliability and internal consistency were determined using the intra-class correlation coefficient (ICC) and Cronbachs alpha, respectively. Results: The three domains of the WIQ were moderately correlated with the EQ-5D health outcome (r = 0.54 to 0.60; p < 0.001). Test-retest reliabilities ranged from ICC = 0.89 to 0.91 and internal consistency (Cronbachs alpha = 0.92) was high. Conclusions: The Spanish version of the WIQ for European Spanish patients was valid and reproducible, suggesting that it could be used in Spanish patients with intermittent claudication.
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Labrador J, Lopez-Anglada L, Perez-Lopez E, Lozano FS, Lopez-Corral L, Sanchez-Guijo FM, Vazquez L, Perez Rivera JA, Martin-Herrero F, Sanchez-Barba M, Guerrero C, del Cañizo MC, Caballero MD, San Miguel JF, Alberca I, Gonzalez-Porras JR. Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients. Haematologica 2012; 98:437-43. [PMID: 22899581 DOI: 10.3324/haematol.2012.069559] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation recipients have an increasing risk of both hemorrhagic and thrombotic complications. However, the competing risks of two of these life-threatening complications in these complex patients have still not been well defined. We retrospectively analyzed data from 431 allogeneic transplantation recipients to identify the incidence, risk factors and mortality due to thrombosis and bleeding. Significant clinical bleeding was more frequent than symptomatic thrombosis. The cumulative incidence of a bleeding episode was 30.2% at 14 years. The cumulative incidence of a venous or arterial thrombosis at 14 years was 11.8% and 4.1%, respectively. The analysis of competing factors for venous thrombosis revealed extensive chronic graft-versus-host disease to be the only independent prognostic risk factor. By contrast, six factors were associated with an increased risk of bleeding; advanced disease, ablative conditioning regimen, umbilical cord blood transplantation, anticoagulation, acute III-IV graft-versus-host disease, and transplant-associated microangiopathy. The development of thrombosis did not significantly affect overall survival (P=0.856). However, significant clinical bleeding was associated with inferior survival (P<0.001). In allogeneic hematopoietic stem cell transplantation, significant clinical bleeding is more common than thrombotic complications and affects survival.
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Affiliation(s)
- Jorge Labrador
- Department of Hematology, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain
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Díaz E, Lozano FS, González S, Alcázar JA, Torres JA, Gónzalez-Porras JR, Gómez-Alonso A. Open and Endovascular Treatment for Pseudoaneurysms of the Superior Mesenteric Artery. Ann Vasc Surg 2010; 24:690.e9-12. [DOI: 10.1016/j.avsg.2009.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 11/17/2009] [Accepted: 11/30/2009] [Indexed: 11/27/2022]
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Lozano FS, Estevan MC, Gónzalez-Porras JR. Femoral vein injury and transposition techniques: a new approach to venous reconstruction in the setting of trauma. J Trauma 2009; 67:E118-E120. [PMID: 19820563 DOI: 10.1097/ta.0b013e31817d0557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Femoral vein (FV) injury is infrequent but potentially serious. Venous repair is the procedure of choice and multiple technical options are performed. This article describes a novel venous reconstruction technique of transposition of the injured FV into the deep femoral vein (DFV) system. Two men, 26 years and 32 years old, were evaluated after suffering penetrating wounds to the inguinal region, resulting in proximal FV injuries. Both the patients were treated with a lateral venorraphy of the common FV and transposition of the FV to DFV (end-to-side anastomosis). Venous thrombectomy was not required; intravenous unfractionated heparin and local acting heparin were administered during surgery. Low molecular weight heparin therapy was routinely administered before intervention in combination with elastic compression stockings. Duplex ultrasound at 1 month and 6 months after the injury demonstrated patency and luminal integrity of the involved vein in both the patients. Clinical follow-up without duplex at 12 months and 18 months revealed no evidence of chronic venous insufficiency. In instances of penetrating injury to the proximal FV, transposition to the DFV represents a novel and effective alternative to establishing venous outflow from the extremity. This technique is relatively simple and presents good permeability in the medium term. However, possible and often tolerated ligation of penetrating FV injuries should be considered a last option.
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Affiliation(s)
- Francisco S Lozano
- Services of Vascular Surgery, Clinic Hospital, University of Salamanca, School of Medicine, Salamanca, Spain.
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Lozano FS, García MI, García E, González B, García MB, García FJ, García JE. Activity of Ertapenem and Ceftriaxone in the eradication of Salmonella in a model of experimental peritonitis in mice. Rev Esp Quimioter 2009; 22:135-138. [PMID: 19662546] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Since the beginning of the 1990s, the prevalence of isolates of non-typhoidal Salmonella species resistant to antimicrobial agents, including those commonly used for the treatment of Salmonella infections such as fluoroquinolones, trimethoprim-sulfamethoxazole or beta-lactams, has increased substantially. Infections caused by multidrug-resistant strains of non-typhoidal Salmonella are now frequently encountered. In order to consider an appropriate role of Ertapenem in Salmonella-due intraabdominal infections, in the present study we compare the efficacy of Ertapenem versus that of Ceftriaxone in a mouse peritonitis model. Bacteriological eradication from blood, liver and mesenteric lymph nodes was observed after 5 and 7 days of treatment in all infected mice receiving ceftriaxone. Although both antimicrobial agents -Ertapenem and Ceftriaxone- were observed to be effective in reducing mortality in inoculated mice, our data suggests a reduced efficacy of Ertapenem in the bacteriological eradication of Salmonella enterica serotype Typhimurium in a mouse peritonitis model.
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Affiliation(s)
- F S Lozano
- Facultad de Medicina - Departamento de Cirugía, Universidad de Salamanca, Avda. Alfonso X El Sabio, s/n37007 Salamanca (España).
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Lozano FS, Arcelus JI, Ramos JL, Alós R, Espín E, Rico P, Ros E. [Risk of venous thromboembolic disease in general surgery]. Cir Esp 2009; 85 Suppl 1:45-50. [PMID: 19589410 DOI: 10.1016/s0009-739x(09)71628-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite preventive efforts, venous thromboembolic disease (VTED) is still a major problem for surgeons due to its frequency and the morbidity, mortality and enormous resource consumption caused by this entity. However, the most important feature of VTED is that it is one of the most easily preventable complications and causes of death. To take appropriate prophylactic decisions (indication, method, initiation, duration, etc.), familiarity with the epidemiology of VTED in general surgery and some of its most significant populations (oncologic, laparoscopic, bariatric, ambulatory and short-stay) is essential. These factors must also be known to determine the distinct risk factors in these settings with a view to stratifying preoperative risk.
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Affiliation(s)
- Francisco S Lozano
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario, Salamanca, España.
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Lozano FS, Masegosa A, Alvarez J, Marinello J. Occurrence and management of chronic venous disease in primary health care in Spain. A comparison of DETECT-2006 with DETECT-2000. INT ANGIOL 2009; 28:62-67. [PMID: 19190558] [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: 05/27/2023]
Abstract
AIM The aim of this study was to investigate the prevalence and initial treatment of chronic venous disease (CVD) in the Spanish primary health care system during 2006 and to compare the results with those obtained in 2000. METHODS The survey involved 1 118 general practitioners co-ordinated by 37 specialists in angiology and vascular surgery, assessing 15 consecutive patients, each attending the clinics between 29 May and 2 June 2006. RESULTS Of the16 186 patients reported, 82% had CVD risk factors. When asked about CVD signs or symptoms 11 277 patients (69.7%) mentioned some kind of clinical manifestation/sign compatible with the disease. Diagnosis was established in accordance with the clinical section of the CEAP classification, 38% of the total being classified as C2-C6. Sixty-two percent of the symptomatic patients had received prior treatment (vs 24.8% in year 2000), and following the survey 88% of the patients diagnosed with CVD were treated (vs 62% in 2000). CONCLUSIONS The results for 2006 confirm the high prevalence of CVD in primary health care in Spain. In comparison with the results for 2000, an improvement in the patterns of medical advice use, treatment and prescriptions are observed. Despite these findings, specific training programs in primary health care regarding the diagnosis and treatment of CVD continue to be necessary.
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Affiliation(s)
- F S Lozano
- University Hospital, University of Salamanca, Spain.
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Lozano FS, Gómez JL, Mondillo MC, González-Porras JR, González-Sarmiento R, Muñoz A. Surgery of vagal paragangliomas: Six patients and review of literature. Surg Oncol 2008; 17:281-7. [DOI: 10.1016/j.suronc.2008.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Revised: 03/12/2008] [Accepted: 03/13/2008] [Indexed: 11/15/2022]
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Rodríguez-López JM, del Barrio E, Lozano FS, Muriel C. Does Preoperative Level of Antithrombin III Predict Heparin Resistance During Extracorporeal Circulation? Anesth Analg 2008; 107:1444-5. [DOI: 10.1213/ane.0b013e3181827c67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lozano FS, Muñoz A, Gómez JL, Barros MB. The autologous superficial femoral artery as a substitute for the carotid axis in oncologic surgery. Three new cases and a review of the literature. J Cardiovasc Surg (Torino) 2008; 49:653-657. [PMID: 18670383] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
When neck cancer affects the carotid artery, the best therapeutic option is to remove the tumor en bloc, including the affected vessels. When the carotid artery is revascularized, the usual practice according to the literature is to replace the defective carotid artery with an autologous graft from the saphenous vein, although it is also possible to use an autologous superficial femoral artery (SFA). The use of the SFA in oncologic surgery does not seem to be widespread; in fact, we only found 7 references (67 cases). Here we report three cases in which the SFA was employed and offer a review of the literature. The SFA has advantages and disadvantages in comparison with the saphenous vein. The need for interdisciplinary collaboration (otorhinolaryngology/vascular surgery) is very important, especially in situations where the saphenous vein is not available.
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Affiliation(s)
- F S Lozano
- Department of Vascular Surgery, University Hospital of Salamanca, Avenida Alfonso X El Sabio, Salamanca, Spain.
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Lozano FS, Muñoz-Bellvis L, San Norberto E, Garcia-Plaza A, Gonzalez-Porras JR. Primary aortoduodenal fistula: new case reports and a review of the literature. J Gastrointest Surg 2008; 12:1561-5. [PMID: 18301952 DOI: 10.1007/s11605-008-0499-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 02/05/2008] [Indexed: 01/31/2023]
Affiliation(s)
- Francisco S Lozano
- Angiology and Vascular Surgery, University Hospital of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
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Sánchez-Conde P, Rodríguez-López JM, Nicolás JL, Lozano FS, García-Criado FJ, Cascajo C, González-Sarmiento R, Muriel C. The comparative abilities of propofol and sevoflurane to modulate inflammation and oxidative stress in the kidney after aortic cross-clamping. Anesth Analg 2008; 106:371-8, table of contents. [PMID: 18227287 DOI: 10.1213/ane.0b013e318160580b] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Propofol has been reported to provide protection against ischemia-reperfusion injury. Nuclear transcription factor kappa B (NFkappaB) plays a key role in oxidative stress and the inflammatory response during ischemia-reperfusion. We compared the effect of propofol with sevoflurane on kidney NFkappaB expression and systemic inflammatory responses induced by aortic clamping. METHODS Twenty piglets were divided into four groups: sham surgery group with propofol (group SP, n = 5); sham group with sevoflurane (group SS, n = 5); and suprarenal clamping for 30 min with aorta-aortic bypass under propofol (group CP, n = 5) or sevoflurane (group CS, n = 5) anesthesia. Propofol was administered at 4 mg x kg(-1) x h(-1) i.v. and sevoflurane given at 1.5% inspiratory concentration. Peripheral blood and kidney biopsies were taken before the start of surgery, 15 min after unclamping the aorta, 24, 48, 72 h, and 7 days after surgery. Plasma creatinine, myeloperoxidase, tumor necrosis factor-alpha, interleukin 1-beta; and kidney superoxide anion and superoxidase dismutase were measured. The expression of inducible nitric oxide synthase and renal tissue NFkappaB was measured using Western blotting. RESULTS Compared with the CS group, animals in the CP group had lower concentrations of myeloperoxidase, tumor necrosis factor-alpha, interleukin 1beta, superoxide anion, superoxidase dismutase (P < 0.05) from 24 to 72 h after surgery and diminished NFkappaB expression and inducible nitric oxide synthase activity (P < 0.05) at 48 and 72 h after surgery, respectively. CONCLUSIONS Compared with sevoflurane, propofol administration during suprarenal aortic clamping and unclamping led to modulation of markers of inflammation and decreased NFkappaB expression.
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Affiliation(s)
- Pilar Sánchez-Conde
- Department of Anesthesiology, University Hospital of Salamanca, Salamanca, Spain
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Rodríguez-López JM, Sánchez-Conde P, Lozano FS, Nicolás JL, García-Criado FJ, Cascajo C, Muriel C. Errata. Can J Anaesth 2006. [DOI: 10.1007/bf03022848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Lozano FS, Cascajo C, García-Sánchez E, Barros MB, García-Criado FJ, Parreño F, García-Sánchez JE, Gómez-Alonso A. Bacterial translocation as a source of Dacron-graft contamination in experimental aortic operation: the importance of controlling SIRS. Surgery 2006; 140:83-92. [PMID: 16857446 DOI: 10.1016/j.surg.2006.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 12/29/2005] [Accepted: 12/29/2005] [Indexed: 01/22/2023]
Abstract
BACKGROUND Several experimental studies have shown the beneficial effects of nitric oxide (NO) in the modulation of the systemic inflammatory response syndrome (SIRS). Nitric oxide is involved in and affects almost all stages in the development of inflammation. We have attempted to ascertain whether the nitric oxide donor molsidomine prevents aortic graft contamination through control of the SIRS and a decrease in bacterial translocation (BT). METHODS Twenty-four mini-pigs were divided into 4 groups. The animals were subjected to suprarenal aortic/iliac cross-clamping (for 30 minutes) and by-pass with a Dacron-collagen prosthetic graft impregnated in rifampicin. Groups: 1) sham (aortic dissection alone); 2) cross-clamping and bypass; 3) hemorrhage of 40% of total blood volume before cross-clamping and by-pass; and 4) the same as in group 3 but also including the administration of the NO donor molsidomine (4 mg/kg) 5 minutes before cross-clamping. VARIABLES 1) bacteriology of mesenteric lymph nodes (MLN), kidney, blood, and prosthesis; 2) serum TNF-alpha (ELISA); and 3) iNOS expression in kidney and liver (Western blot). RESULTS Aortic cross-clamping with or without hemorrhage was associated with BT in 80% and 100% of the animals, respectively. About 86% of the bacteria isolated in the graft were also present in MLN. This contamination coincided with an increase in TNF-alpha and with a greater expression of iNOS. Molsidomine administration decreased TNF-alpha and iNOS, decreased BT (from 100% to 20% of the animals), and decreased graft contamination (from 83% to 20%). CONCLUSIONS The present model induces high levels of BT and SIRS, both acted as sources of contamination for the implanted Dacron graft. Molsidomine administration decreased the presence of bacteria in the graft by controlling BT and modulating SIRS.
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Affiliation(s)
- Francisco S Lozano
- Service of Vascular Surgery, Salamanca, Spain; Experimental Surgery Unit, Medical School, University of Salamanca, Spain
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Rodríguez-López JM, Sánchez-Conde P, Lozano FS, Nicolás JL, García-Criado FJ, Cascajo C, Muriel C. Laboratory investigation: Effects of propofol on the systemic inflammatory response during aortic surgery. Can J Anaesth 2006; 53:701-10. [PMID: 16803918 DOI: 10.1007/bf03021629] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE A laboratory investigation was undertaken to assess the effects of propofol on renal function, through modulation of the systemic inflammatory response, in an in vivo experimental model of aortic surgery in comparison with sevoflurane. METHODS Twenty young male piglets were anesthetized with either propofol 4 mg.kg(-1).hr(-1) (n = 10) or sevoflurane 1.5% end-tidal concentration (n = 10). Animals were subjected to aorta-aortic bypass with suprarenal aortic clamping for 30 min. At specific intervals (basal -before the start of surgery; reperfusion 15 min after unclamping the aorta; at 24, 48 and 72 hr after surgery, and on the seventh day after surgery) the levels of the following were determined: plasma creatinine, renal myeloperoxidase, tumour necrosis factor-alpha, interleukin 1-ss, and interferon-gamma; kidney superoxide anion and its detoxifying enzyme superoxidase dismutase, kidney malondialdehyde and the activity of inducible nitric oxide synthase. Seven days after surgery, the animals were anesthetized using the described techniques, and after blood withdrawal and kidney sampling they were sacrificed. RESULTS In comparison with sevoflurane, propofol was associated with a lower concentration of plasma creatinine (P < 0.05) together with lower concentrations of myeloperoxidase, tumour necrosis factor-alpha, interleukin 1-ss, interferon-gamma, superoxide anion and superoxidase dismutase, malondialdehyde and inducible nitric oxide synthase (P < 0.05). CONCLUSION In an experimental model of aortic reconstructive surgery, and compared with sevoflurane, propofol anesthesia is associated with less neutrophil infiltration, lower plasma proinflammatory cytokine levels, lower production of oxygen free radicals, less lipid peroxidation, and reduced inducible nitric oxide synthase activity. These observations suggest a possible renal protective effect of propofol in this surgical setting.
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Lozano FS, Rodriguez JM, Garcia-Criado FJ, Barros MB, Conde PS, Gonzalez LM, Rodriguez M, Gomez-Alonso A. Postoperative evolution of inflammatory response in a model of suprarenal aortic cross-clamping with and without hemorrhagic shock. Systemic and local reactions. World J Surg 2006; 29:1248-58. [PMID: 16136285 DOI: 10.1007/s00268-005-7877-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Surgery of the abdominal aorta generates a systemic inflammatory response (SIR), a source of operative morbidity-mortality. In the present work we attempted to evaluate the evolution of SIR in an experimental model that simulates elective and urgent surgery on the abdominal aorta. Fifteen mini-pigs divided into three groups were used. The animals were subjected to suprarenal aortic/iliac clamping and bypass with a Dacron-collagen prosthetic graft. Groups were as follows: (1) sham (only aortic dissection); (2) clamping and bypass; (3) hemorrhage of 40%, pre-clamping, and bypass. Determinations included (1) tumor necrosis factor-alpha (TNF-alpha) interleukin (IL)-1beta, IL-6, IL-10, interferon-gamma; (2) myeloperoxidase (MPO), superoxide anion (SOA), superoxide dismutase (SOD), and malondialdehyde (MDA); (3) nitrites; (4) iNOS, (5) cell adhesion molecules (ICAM-1, VCAM-1) at 24 hours, 48 hours, and on day 7; and (6) NFkappaB at 48 hours. Our results point to an increase in all inflammatory variables, corroborated by their molecular regulators such as the expression of CAMs, iNOS, and NFkappaB. The alterations tended to normalize by day 7, after reperfusion. The results point to the great importance of SIR at all levels (molecular, nuclear, cellular, and systemic) in situations such as elective and urgent abdominal aorta surgery and the role that control of this response could represent for the future of vascular surgery.
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Affiliation(s)
- Francisco S Lozano
- Service of Angiology and Vascular Surgery, University Hospital of Salamanca, Avda. Alfonso X elsabio s/n, E-37007 Salamanca, Spain.
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Barbosa Barros M, Almazán A, Lozano FS. [Mycotic femoral pseudoaneurysm after 11 years of catheterism]. Arq Bras Cardiol 2005; 85:343-5. [PMID: 16358152 DOI: 10.1590/s0066-782x2005001800009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The authors report the unusual case of a 52-year-old mountain climber that presented with pain and swelling in his right thigh which revealed to be a ruptured mycotic pseudoaneurysm with no history of recent trauma or other apparent cause. The patient reported a past history of myocardial infarction 11 years before, with the performing of two femoral catheterisms for coronary angiography. He denied any episode of fever or diagnosis of bacteraemia at that time or later, nor any other complaint during these 11 years. The rarity of the case, the appearance of this extremely late complication together with the patient's kind of sportive activity prompted us to publish the case.
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Lozano FS, López-Novoa JM, Rodriguez JM, Barros MB, García-Criado FJ, Nicolás JL, Parreño A, Revilla J, Gómez-Alonso A. Exogenous nitric oxide modulates the systemic inflammatory response and improves kidney function after risk-situation abdominal aortic surgery. J Vasc Surg 2005; 42:129-39. [PMID: 16012462 DOI: 10.1016/j.jvs.2005.03.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 01/13/2023]
Abstract
OBJECTIVE Renal impairment is a very frequent complication of aortic surgery requiring prolonged suprarenal clamping, especially if it is associated with previous hemorrhage. The aim of this study was to assess the beneficial effect of the administration of a nitric oxide (NO) donor on renal function through a modulation of the systemic inflammatory response in a model of abdominal aortic surgery. METHODS Twenty-five minipigs were divided into five groups. Under anesthesia, the animals were subjected to suprarenal aortic-iliac clamping (for 30 minutes) and bypass with a Dacron-collagen prosthetic graft impregnated in rifampicin, with or without associated hemorrhage (40% of total blood volume). Prophylaxis with cefazolin was implemented. The five groups were (1) the sham group (only aortic dissection), (2) the clamping and bypass (C) group, (3) hemorrhage preclamping and bypass (H+C) group, (4) the same as group C but with the administration of the NO donor molsidomine (4 mg/kg intravenously) (C+NO group), (5) the same as the H+C group but with the administration of the NO donor molsidomine (4 mg/kg intravenously) (H+C+NO group). The following were determined: (1) kidney function (serum creatinine), (2) serum cytokines (tumor necrosis factor alpha [TNF-alpha] and interleukin-10 [IL-10]); (3) neutrophil infiltration (myeloperoxidase [MPO]) in the kidney, (4) oxygen free radicals (superoxide anion [SOA] and superoxide dismutase [SOD]) in the kidney, (5) serum nitrites, (6) soluble and kidney tissue cell adhesion molecule (soluble intercellular adhesion molecule-1 [sICAM-1], soluble vascular cell adhesion molecule-1 [sVCAM-1], intercellular adhesion molecule-1 [ICAM-1], and vascular cell adhesion molecule-1 [VCAM-1]), (7) inducible nitric oxide synthase (iNOS) in the kidney, and (8) nuclear factor-kappaB (NF-kappaB) in the kidney. Determinations were made during ischemia at 15 minutes post-reperfusion; at 24, 48, and 72 hours; and on day 7. RESULTS The different insults used in the experimental model led to deterioration in kidney function and an increase in the systemic (and renal) inflammatory response at all levels investigated. Treatment with an NO donor, both with and without associated hemorrhage, reduced the inflammatory response at the systemic (TNF-alpha and IL-10) and kidney (MPO, SOA, and SOD) levels, normalizing kidney function. Likewise, exogenous administration of NO improved the excessive production of NO (nitrites) via iNOS. This was also reflected in a reduction in CAMs and of NF-kappaB expression. The hypotension induced by molsidomine was transitory and did not elicit hemodynamic repercussions. CONCLUSION In our experimental model, prophylactic treatment with the NO donor molsidomine regulates the systemic inflammatory response and minimizes damage at the kidney level. Clinical Relevance The importance of this article resides in the fact that an experimental study that clarifies the effect of the donors of NO under circumstances as similar as possible to those of the human clinic, such as aortic surgery under hypovolemic shock (ruptured aortic aneurysm) have been little studied, most of these studies being performed in rodents without bypass. Using a model with one or two simultaneous insults (aortic clamping with/without previous hemorrhage) that is very similar to the human clinical situation (abdominal aortic rupture), we confirm the findings of previous work related to the beneficial effects of NO donors.
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Affiliation(s)
- Francisco S Lozano
- Angiology and Vascular Surgery Service, University Hospital of Salamanca, Spain.
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García-Criado FJ, Lozano FS, Barros MB, Parreño FC, Fresnadillo MJ, García-Sánchez JE, Gomez-Alonso A. P- and E-Selectin Blockade Can Control Bacterial Translocation and Modulate Systemic Inflammatory Response. J INVEST SURG 2005; 18:167-76. [PMID: 16126627 DOI: 10.1080/08941930591004386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bacterial translocation is an important phenomenon in clinical medicine and leads to an increase in patient morbidity and mortality by multiple organ failure. The selectin family plays an important role in the pathogenesis of inflammation, causing an increase in leukocyte-endothelium interactions and inducing a greater leukocyte's migration. This study considered the effect of a sulfo derivative of Sialyl-Lewis(X), GM 1998-016, that will block the P- and E-selectins interaction with a ligand, the Sialyl-Lewis(X), valuing the modulation of the systemic inflammatory response and the induced translocation. Seventy-five Wistar male rats were injected intraperitoneally with Zymosan A and treated with different doses of GM 1998-016 according to study groups. Measurements of values of qualitative and quantitative microbiology, neutrophil infiltration (myeloperoxidase), oxygen free radicals (superoxide anion, superoxide dismutase, catalase, and gluthatione peroxidase), and cytokines (tumor necrosis factor-alpha and interleukin-1beta) were taken at different times after Zymosan administration. A significant decrease of bacterial translocation, both local (MLN) and systemic (p < .05), was observed, with a decrease in the neutrophil infiltration (p < .001), the oxygen free radicals production (p < .01) and the studied cytokines (p < .01). In conclusion, GM 1998-016 showed a protective effect in an in vivo experimental model of bacterial translocation, downregulating the inflammatory response and the leukocyte-endothelium interactions.
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Lozano FS, Barros MB, Fresnadillo MJ, García-Criado FJ, Gomez-Alonso A. Nitric oxide prevents the bacterial translocation and inhibits the systemic inflammatory response produced by implantation of a vascular prosthesis followed by Zymosan A. Inflamm Res 2005; 54:261-70. [PMID: 15973510 DOI: 10.1007/s00011-005-1353-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE AND DESIGN To evaluate the beneficial effects of exogenous NO and its levels of action in a model of SIRS/Bacterial Translocation (BT) induced by two sequential insults. MATERIAL OR SUBJECTS Eighty-six Wistar rats were submitted to different treatments and their tissue and blood samples were accessed at the end of the experiment. TREATMENT Nitric Oxide was compared to Gentamicin as the tested guideline for our study. METHODS Dacron graft implantation (first insult) and subsequent administration of Zymosan A((R)) (second insult) were performed in Wistar rats. The animals were divided into 6 groups: I) No manipulation (BASAL: ); II) Laparotomy (L) + mineral oil (SHAM: ); III) L + Graft-Zymosan (GZ) (CONTROL: ); IV) L + GZ + Antibiotic (A) (ASSAY: I); V) L + GZ + NO (ASSAY: II) and VI) L + GZ + A + NO (ASSAY: III). Determinations: Survival, Bacterial Translocation, myeloperoxidase (MPO), Cytokines (TNF-alpha, IL-1beta, IFN-gamma), Oxygen Free Radical (OFR) SOA and detoxifying enzymes (SOD, Superoxide Dismutase, CAT, Catalase and GPX, Glutathione Peroxidase), Cell Adhesion Molecules, CAMs (ICAM-1, VCAM-1 and PECAM-1) and Nuclear Transcription Factor, NFkappaB. RESULTS The model established induced a mortality rate of 20% and generated BT in all samples. It also significantly increased all variables, with P < 0.001 for MPO and all Cytokines; P < 0.01 for all OFR, and P < 0.05 for CAMs and for NFkappaB. Treatment with A reduced mortality to 0%, significantly decreased BT, MPO, Cytokines and OFR (P < 0.05), but did not reduce CAMs or NFkappaB. NO, either alone or associated, reduced mortality to 0% and abolished BT, significantly decreasing nearly all the variables studied (P < 0.001 for MPO and all Cytokines; P < 0.01 for OFR, and P < 0.05 for CAMs and for NFkappaB). CONCLUSIONS The exogenous administration of NO before the two sequential insults prevented BT and controlled SIRS peripherally and at both cellular and transcriptional level in a lasting manner. In contrast, antibiotic treatment only exerted its action at peripheral level. The association of both treatments did not provide any important advantages.
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Affiliation(s)
- F S Lozano
- Departamento de Cirugía, Facultad de Medicina. Avda. Alfonso X El Sabio s/n, 37007, Salamanca, Spain.
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Abstract
BACKGROUND Nitric oxide (NO) participates in inflammation and affects almost all steps of its development. Several experimental studies have unveiled the beneficial effects of NO through modulation of the Systemic Inflammatory Response Syndrome (SIRS). In this sense, in the present work we attempted to evaluate the beneficial effects of exogenous NO and its levels of action (biochemical and cellular) in a model of SIRS induced by two sequential insults. MATERIALS AND METHODS Dacron graft implantation (first insult) and subsequent administration of Zymosan A (second insult) in Wistar rats. The animals were divided into four groups: 1) No manipulation (Basal); 2) Laparotomy (L) + mineral oil (Sham); 3) L + Graft-Zymosan (GZ) (Control); and 4) L + GZ + NO (Assay). Determinations: Survival, TNF-alpha, SOA, ICAM-1, and NFkappaB. RESULTS The model established (Control) induced a mortality rate of 20%. Also, it significantly increased the levels of TNF-alpha (P <0.001) and SOA (P <0.01), ICAM-1 expression, and NFkappaB levels (P <0.05). Treatment with NO reduced mortality to 0%, significantly decreasing TNF-alpha (P <0.001) and SOA (P <0.01) levels, ICAM-1 expression, and NFkappaB levels (P <0.05). CONCLUSION The exogenous administration of NO before the two sequential insults controlled SIRS at biochemical level (TNF-alpha, SOA) and at cellular level (transcription) in a lasting manner. The cascade-like interrelationship of both levels and the study design do not allow us the pinpoint the key to its modulation.
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Affiliation(s)
- Francisco S Lozano
- Department of Vascular Surgery, University Hospital, University of Salamanca, Salamanca, Spain
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Abstract
CONTEXT Iatrogenic vascular problems due to laparoscopy are a well recognized problem and lead to significant repercussions. In this context, a ten-year review of cases topic is presented, based on experience gained while heading two important vascular surgery services. CASES Five patients with vascular injuries during elective laparoscopy are described. These patients presented with seven lesions of iliac vessels. All cases were evaluated immediately and required laparotomy, provisional hemostasis and urgent attendance by a vascular surgeon. Direct suturing was performed in three cases. One aortoiliac bypass and one ilioiliac reversed venous graft were made. Venous lesions were sutured. One case of a point-like perforation of the small bowel was found. There were no deaths and no complications during the postoperative period. DISCUSSION Important points on this subject are made, and advice is given. There needs to be immediate recognition of the vascular injury, and expert repair by a vascular surgeon is recommended, in order to significantly reduce the degree of complications.
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Garcia-Criado FJ, Lozano FS, Lorenzo MF, Parreño FC, Valdunciel JJ, Gómez-Alonso A. Inflammatory response regulation by tacrolimus in an experimental model of multiorgan failure induced by bacterial translocation. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2000.01544-68.x] [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]
Abstract
Abstract
Background
Bacterial translocation may induce multiorgan failure (MF), an infrequent but very serious clinical situation. This study used the immunosuppressant tacrolimus to control the inflammatory response in order to avoid MF, and also aimed to elucidate its mode of action.
Methods
Male Wistar rats were divided into three groups: sham group, control MF group (zymosan intraperitoneal injection and studies at 2, 12 and 24 h) and tacrolimus group (different times of administration and studies at 2, 12 and 24 h). Survival, renal and hepatic function, microbiological cultures, neutrophil infiltration, oxygen free radicals, cytokines, cellular adhesion molecules and intracellular transcriptional mechanisms were studied in both renal and hepatic tissue.
Results
Use of tacrolimus before the systemic inflammatory response regulated this response (less production of free radicals, P < 0·01; of cytokines, P < 0·01; of neutrophil infiltration, P < 0·05) by control of nuclear factor κB activation which induces minor expression of cellular adhesion molecules and minor production of the inflammatory mediators controlled by κB.
Conclusion
The use of prophylactic antiflammatory therapy in MF may be useful and tacrolimus has been demonstrated to be a powerful regulator of this situation.
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Affiliation(s)
| | - F S Lozano
- Department of Surgery, University of Salamanca, Salamanca, Spain
| | - M F Lorenzo
- Department of Surgery, University of Salamanca, Salamanca, Spain
| | - F C Parreño
- Department of Surgery, University of Salamanca, Salamanca, Spain
| | - J J Valdunciel
- Department of Surgery, University of Salamanca, Salamanca, Spain
| | - A Gómez-Alonso
- Department of Surgery, University of Salamanca, Salamanca, Spain
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Lozano FS, Launois R. Quality of life (Spain and France): validation of the chronic venous insufficiency questionnaire (CIVIQ). Methods Find Exp Clin Pharmacol 2002; 24:425-9. [PMID: 12428431 DOI: 10.1358/mf.2002.24.7.696544] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A health-related quality of life (HRQOL) assessment is particularly necessary for patients with chronic venous insufficiency (CVI), as is an assessment of the objective signs (edema, dilated veins, ulceration and other lesions). A comprehensive 3-year research program was undertaken in France to construct and validate the Chronic Venous Insufficiency Questionnaire (CIVIQ), a questionnaire designed specifically to evaluate the quality of life for CVI sufferers. The next step was to implement a program of cross-cultural validation in several countries. Translation into Spanish was undertaken following international guidelines. Face validity was verified with a pilot test among 12 Spanish patients. Psychometric validation was performed in Spain (n = 476 patients with CVI). The Spanish CIVIQ demonstrated very good internal consistency, high reproducibility and responsiveness, as well as longitudinal clinical validity. It appears to be a valuable instrument for assessing improvement in patient quality of life in response to both therapy in clinical practice and clinical trials.
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Affiliation(s)
- F S Lozano
- Vascular Surgery Unit, Department of Surgery, University Hospital, University of Salamanca, Salamanca, Spain.
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Lozano FS, García-Criado FJ, Fresnadillo MJ, García E, García JE, Gómez-Alonso A. Systemic inflammatory response induced by dacron graft and modulation by antimicrobial agents: experimental study. J Surg Res 2002; 107:7-13. [PMID: 12384058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND The purpose of this work was to evaluate the effect that different antimicrobial agents and different forms of administering them would have over a systemic inflammatory response (SIR) induced by an intraperitoneally implanted collagen-coated Dacron graft. MATERIALS AND METHODS Thirty-six male Wistar rats were randomly allocated into six groups of 6 animals each: (I) control, (II) "sham," (III) graft but no antibiotic, (IV) graft plus systemic cefazolin, (V) graft plus locally applied gentamicin, and (VI) graft soaked in rifampicin. After 72 h, mesenteric lymph nodes, liver, kidney, and the implanted graft were sent to the microbiology laboratory and cultured for aerobic and anaerobic organisms in order to evaluate bacterial translocation. Serum cytokines (IL-1beta and TNF-alpha), myeloperoxidase activity in liver and kidney, and superoxide anion and superoxide dismutase activities in liver were also determined to evaluate the level of SIR. RESULTS Microbiologic and biochemical data indicated that intraperitoneal implantation of a collagen-coated Dacron graft induced a significant (P < 0.05) bacterial translocation and a high inflammatory response, both of which decreased significantly with antibiotic treatment regardless of the means of administration (P < 0.05). CONCLUSIONS The present experimental model shows that the antibiotics used, in different means of administration, reduce bacterial translocation and behave as modulators of the SIR induced by an intraperitoneal collagen-coated Dacron graft.
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Affiliation(s)
- Francisco S Lozano
- Surgical Investigations Unit, Department of Surgery, University Hospital, University of Salamanca, Spain.
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Fernandez JL, Antelo JC, Mosquera MG, Lozano FS, Alvarez MB. Management strategies in the Jimenez Diaz Foundation. NAHAM Manage J 1997; 23:3-4, 21. [PMID: 10162045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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