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Gil-Martínez P, Curbelo J, Roy-Vallejo E. Response to the letter regarding the article "Assessment of clinical and haemodynamic congestion as predictors of mortality in elderly outpatients with heart failure". Rev Clin Esp 2023; 223:122-123. [PMID: 36796933 DOI: 10.1016/j.rceng.2022.12.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 02/17/2023]
Affiliation(s)
- P Gil-Martínez
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Grupo de Trabajo de Insuficiencia Cardiaca de la Sociedad Española de Medicina Interna, Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain.
| | - J Curbelo
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Grupo de Trabajo de Insuficiencia Cardiaca de la Sociedad Española de Medicina Interna, Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain
| | - E Roy-Vallejo
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Grupo de Trabajo de Insuficiencia Cardiaca de la Sociedad Española de Medicina Interna, Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain
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Gil-Martínez P, Curbelo J, Roy-Vallejo E, Mesado-Martínez D, Ciudad-Sañudo M, Suárez-Fernández C. Assessment of clinical and hemodynamic congestion as predictors of mortality in elderly outpatients with heart failure. Rev Clin Esp 2022; 222:377-384. [PMID: 35537991 DOI: 10.1016/j.rceng.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This work aims to evaluate whether a clinical examination and measurement of N-terminal pro-brain natriuretic peptide can predict poor prognosis in outpatients with heart failure. PATIENTS AND METHODS We carried out a retrospective study from 2010 to 2018 in 238 patients diagnosed with heart failure. At baseline, we evaluated the presence of pulmonary rales and bilateral leg edema (clinical congestion) together with N-terminal pro-brain natriuretic peptide ≥ 1500 pg/mL (hemodynamic congestion). Patients were classified into 4 groups depending on their congestion pattern: no congestion (G1) (n = 50); clinical congestion (G2) (n = 43); hemodynamic congestion (G3) (n = 73); and clinical and hemodynamic congestion (G4) (n = 72). The primary outcome was all-cause mortality at one year of follow-up. RESULTS A total of 238 patients were included. The mean age was 82 years, 61.8% were women, and 20.7% had reduced left ventricular ejection fraction. Thirty patients died in the first year of follow-up (12.6%). After controlling for confounding variables (sex, recent discharge for heart failure, estimated glomerular filtration rate, and left ventricular ejection fraction), the independent risk of death in each group compared to G1 as the reference group was: G2: HR 4.121 (95%CI 1.131-15.019); G3: HR 2.511 (95%CI 1.007-6.263); and G4: HR 7.418 (95%CI 1.630-33.763). CONCLUSION Congestion in outpatients with heart failure correlates with prognosis. Patients with both clinical and hemodynamic congestion had the highest risk of all-cause death at one year.
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Affiliation(s)
- P Gil-Martínez
- Servicio de Medicina Interna, Hospital Universitario de la Princesa. Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain; Grupo de trabajo de Insuficiencia Cardíaca de la Sociedad Española de Medicina Interna, Madrid, Spain.
| | - J Curbelo
- Servicio de Medicina Interna, Hospital Universitario de la Princesa. Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain; Grupo de trabajo de Insuficiencia Cardíaca de la Sociedad Española de Medicina Interna, Madrid, Spain
| | - E Roy-Vallejo
- Servicio de Medicina Interna, Hospital Universitario de la Princesa. Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain; Grupo de trabajo de Insuficiencia Cardíaca de la Sociedad Española de Medicina Interna, Madrid, Spain
| | - D Mesado-Martínez
- Grupo de trabajo de Insuficiencia Cardíaca de la Sociedad Española de Medicina Interna, Madrid, Spain; Servicio de Medicina Interna, Hospital Universitario General de Villalba, Villalba, Madrid, Spain
| | - M Ciudad-Sañudo
- Servicio de Medicina Interna, Hospital Universitario de la Princesa. Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain
| | - C Suárez-Fernández
- Servicio de Medicina Interna, Hospital Universitario de la Princesa. Fundación Investigación Biosanitaria del Hospital de la Princesa, Madrid, Spain
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Gil-Martínez P, Sanz P, López-Torres I, Arnal-Burró J, Chana F, Vaquero J. Influence of the cause of the revision on the outcome after revision knee arthroplasty with condylar constrained implant. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Borque-Fernando Á, Esteban-Escaño LM, Rubio-Briones J, Lou-Mercadé AC, García-Ruiz R, Tejero-Sánchez A, Muñoz-Rivero MV, Cabañuz-Plo T, Alfaro-Torres J, Marquina-Ibáñez IM, Hakim-Alonso S, Mejía-Urbáez E, Gil-Fabra J, Gil-Martínez P, Ávarez-Alegret R, Sanz G, Gil-Sanz MJ. A Preliminary Study of the Ability of the 4Kscore test, the Prostate Cancer Prevention Trial-Risk Calculator and the European Research Screening Prostate-Risk Calculator for Predicting High-Grade Prostate Cancer. Actas Urol Esp 2016; 40:155-63. [PMID: 26598800 DOI: 10.1016/j.acuro.2015.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To prevent the overdiagnosis and overtreatment of prostate cancer (PC), therapeutic strategies have been established such as active surveillance and focal therapy, as well as methods for clarifying the diagnosis of high-grade prostate cancer (HGPC) (defined as a Gleason score ≥7), such as multiparametric magnetic resonance imaging and new markers such as the 4Kscore test (4KsT). By means of a pilot study, we aim to test the ability of the 4KsT to identify HGPC in prostate biopsies (Bx) and compare the test with other multivariate prognostic models such as the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPTRC 2.0) and the European Research Screening Prostate Cancer Risk Calculator 4 (ERSPC-RC 4). MATERIAL AND METHODS Fifty-one patients underwent a prostate Bx according to standard clinical practice, with a minimum of 10 cores. The diagnosis of HGPC was agreed upon by 4 uropathologists. We compared the predictions from the various models by using the Mann-Whitney U test, area under the ROC curve (AUC) (DeLong test), probability density function (PDF), box plots and clinical utility curves. RESULTS Forty-three percent of the patients had PC, and 23.5% had HGPC. The medians of probability for the 4KsT, PCPTRC 2.0 and ERSPC-RC 4 were significantly different between the patients with HGPC and those without HGPC (p≤.022) and were more differentiated in the case of 4KsT (51.5% for HGPC [25-75 percentile: 25-80.5%] vs. 16% [P 25-75: 8-26.5%] for non-HGPC; p=.002). All models presented AUCs above 0.7, with no significant differences between any of them and 4KsT (p≥.20). The PDF and box plots showed good discriminative ability, especially in the ERSPC-RC 4 and 4KsT models. The utility curves showed how a cutoff of 9% for 4KsT identified all cases of HGPC and provided a 22% savings in biopsies, which is similar to what occurs with the ERSPC-RC 4 models and a cutoff of 3%. CONCLUSIONS The assessed predictive models offer good discriminative ability for HGPCs in Bx. The 4KsT is a good classification model as a whole, followed by ERSPC-RC 4 and PCPTRC 2.0. The clinical utility curves help suggest cutoff points for clinical decisions: 9% for 4KsT and 3% for ERSPC-RC 4. This preliminary study should be interpreted with caution due to its limited sample size.
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Affiliation(s)
- Á Borque-Fernando
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza, España; Grupo Consolidado de Investigación "Modelos Estocásticos", Gobierno de Aragón, European Social Fund, Zaragoza, España.
| | - L M Esteban-Escaño
- Escuela Universitaria Politécnica La Almunia, Zaragoza, España; Grupo Consolidado de Investigación "Modelos Estocásticos", Gobierno de Aragón, European Social Fund, Zaragoza, España
| | - J Rubio-Briones
- Servicio de Urología, Instituto Valenciano de Oncología, Valencia, España
| | - A C Lou-Mercadé
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - R García-Ruiz
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Tejero-Sánchez
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M V Muñoz-Rivero
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - T Cabañuz-Plo
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Alfaro-Torres
- Servicio de Anatomía Patológica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - I M Marquina-Ibáñez
- Servicio de Anatomía Patológica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - S Hakim-Alonso
- Servicio de Anatomía Patológica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - E Mejía-Urbáez
- Servicio de Anatomía Patológica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Gil-Fabra
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - P Gil-Martínez
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Ávarez-Alegret
- Servicio de Anatomía Patológica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - G Sanz
- Departamento de Métodos Estadísticos, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, España; Grupo Consolidado de Investigación "Modelos Estocásticos", Gobierno de Aragón, European Social Fund, Zaragoza, España
| | - M J Gil-Sanz
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza, España
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Gil-Martínez P, Sanz P, López-Torres I, Arnal-Burró J, Chana F, Vaquero J. Influence of the cause of the revision on the outcome after revision knee arthroplasty with condylar constrained implant. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:184-91. [PMID: 26968375 DOI: 10.1016/j.recot.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/29/2015] [Revised: 08/12/2015] [Accepted: 12/27/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Revision total knee arthroplasty (TKA) is a common procedure with varying results depending on the cause. Our objective was to compare the clinical and radiological outcomes in patients undergoing aseptic revision versus revision due to prosthetic infection. MATERIAL AND METHODS The study included 41 patients who underwent TKA revision with the same varus-valgus constrained implant. In all cases a clinical evaluation was performed including pain, range of motion (ROM), Knee Society Score (KSS), complications, as well as radiological study. A comparative analysis was performed on the pre- and postoperative results between septic and aseptic groups. The mean follow-up was 6 years. RESULTS ROM had a mean increase of 17 degrees (p<.01). KSS and functional KSS improved significantly postoperatively. In the radiological study, joint interline and limb alignment were restored in all cases. Radiolucencies were found in 36.5% of cases; however they were unrelated to the appearance of loosening of the implant. There were complications in 29.2% of cases, mostly related to the surgical wound. Mobility, KSS, KSS functional and satisfaction at follow-up were better in the septic group. Implant survival was 95% at follow-up. CONCLUSION Revision arthroplasty with constrained varus-valgus implant is safe, and has successful mid-term results despite the cause of the replacement procedure.
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Affiliation(s)
- P Gil-Martínez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Gregorio Marañón, Madrid, España.
| | - P Sanz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Gregorio Marañón, Madrid, España
| | - I López-Torres
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Gregorio Marañón, Madrid, España
| | - J Arnal-Burró
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Gregorio Marañón, Madrid, España
| | - F Chana
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Gregorio Marañón, Madrid, España
| | - J Vaquero
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Gregorio Marañón, Madrid, España
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Arnal-Burró J, Calvo-Haro J, Igualada-Blazquez C, Gil-Martínez P, Cuervo-Dehesa M, Vaquero-Martín J. Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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