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Guerra J, Bagur C, Girabent M. Adaptación al castellano y validación del cuestionario sobre práctica basada en la evidencia en fisioterapeutas. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.ft.2011.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Guerrier G, Guerra J, Fermon F, Talkibing WB, Sekkenes J, Grais RF. Outbreak response immunisation: The experience of Chad during recurrent measles epidemics in 2005 and 2010. Int Health 2011; 3:226-30. [PMID: 24038494 DOI: 10.1016/j.inhe.2011.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Despite impressive gains in measles control globally, measles epidemics continue to occur in countries with insufficient vaccination coverage. WHO guidelines now recommend outbreak response immunisation (ORI) for controlling measles outbreaks in certain contexts. The objective of this study was to describe late and early response vaccination activities during two consecutive measles outbreaks that occurred in 2005 and 2010 in N'Djamena, Chad. Using Lot Quality Assurance Sampling, vaccination coverage was estimated to be low before the interventions. Following mass vaccination campaigns, measles cases declined. The timeliness and quality of ORI activities are crucial determinants of success. However, effective outbreak response should be accompanied by strong routine vaccination programmes to ensure sustainable high vaccination coverage.
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Mazotti LA, Guerra J. Letters to the Editor. Perm J 2011; 15:94. [DOI: 10.7812/tpp/11.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hawksworth J, Cummings L, Guerra J, Girlanda R, Kaufman S, Johnson L, Fishbein T, Matsumoto C. Acute Cellular Rejection In Adult And Pediatric Intestinal Transplantation. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vivanco M, Gabrielli M, Jarufe N, Humeres R, Rios H, Palacios JM, Zapata R, Sanhueza E, Contreras J, Rencore G, Rossi R, Martínez J, Pérez R, Guerra J, Arrese M, Figueroa E, Soza A, Yáñes R, Hepp J. Bridge therapy in hepatocellular carcinoma before liver transplantation: the experience of two Chilean centers. Transplant Proc 2010; 42:296-8. [PMID: 20172335 DOI: 10.1016/j.transproceed.2009.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Orthotopic liver transplantation (OLT) is currently an established therapy for small, early-stage hepatocellular carcinoma (HCC) within the Milan criteria. Long waiting times due to the shortage of donor organs can result in tumor progression and drop-out from OLT candidacy. Therefore a wide variety of procedures are necessary before OLT. The aim of this retrospective study was to review our experience in relation to bridge therapy prior to OLT for HCC. METHODS This was a retrospective database review of all of the patient who underwent transplantation in our institutions between January 1993 and June 2009. We analyzed patients with a diagnosis of HCC in the explant. RESULTS Among 29 patients, including 12 who were diagnosed by the explant and 17 prior to transplantation, 88% underwent bridge therapy during a mean waiting time to OLT of 12 months. Among the 23 procedures, namely 1.5 procedures per patient, included most frequently chemoembolization (48%), alcohol ablation (30%), radiofrequency ablation (13%), and surgery (9%). Thirty-three percent of the explants contained lesions within the Milan criteria. In our series the 5-year survival rate for patients transplanted for HCC was 86%; in the bridge therapy group, it was 73%. CONCLUSIONS The incidence of patients who underwent bridge therapy (52%) was similar to other reported experiences, but the fulfillment of Milan criteria in the explants was lower. Among the bridge therapy group, the survival was slightly lower, probably because this group displayed more advanced disease.
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Katz L, Amorim M, Souza A, Guerra J, Melo A, Costa A, Heráclio S, Melo B. P1031 Agreement between initial cytology, cytology repeated at the time of colposcopy and histopathology. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Resende L, Guerra J, Santana A, Mil-Homens C, Abreu F, da Costa AG. Influence of dialysis duration and modality on kidney transplant outcomes. Transplant Proc 2009; 41:837-9. [PMID: 19376365 DOI: 10.1016/j.transproceed.2009.01.063] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The influence of pretransplantation dialysis on kidney transplant outcomes has been the subject of longstanding interest. Although increased time on dialysis prior to kidney transplantation is associated with decreased graft and patient survivals, analyses of the impact of dialysis modality on kidney allograft outcome have produced conflicting results. OBJECTIVE The objective of this study was to evaluate the influence of dialysis duration and modality on the function and survival of renal allografts. PATIENTS We retrospectively reviewed the clinical data of 421 adults who received first kidney transplantations from cadaveric heart-beating donors performed in our unit from May 1989 to May 2007. Three hundred seventy-four patients (88.8%) were on hemodialysis (HD) prior to kidney transplantation, including 247 patients (58.7%) on treatment for at least 24 months. RESULTS Patients with a dialysis duration > or =24 months were significantly older (45.9 vs 42.8 years; P = .013). Renal function at 3, 12, 60, and 96 months was similar between the 2 groups. Longer duration on dialysis was associated with poorer overall graft and patient survivals. No differences were observed in renal function or graft and patient survivals comparing HD or peritoneal dialysis (PD). Multivariate analysis confirmed the lack of correlation between dialysis duration or modality and allograft failure. CONCLUSION Longer dialysis duration influenced overall graft and patient survival. However, dialysis modality showed no influence on graft function or survival.
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Resende L, Guerra J, Santana A, Mil-Homens C, Abreu F, da Costa AG. Impact of donor age on renal allograft function and survival. Transplant Proc 2009; 41:794-6. [PMID: 19376354 DOI: 10.1016/j.transproceed.2009.01.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The lack of cadaveric donors coupled with a rapidly growing number of potential recipients have stimulated the implementation of several strategies, including the acceptance of older donors, to increase the organ pool and reduce the waiting list for kidney transplantation. However several studies have demonstrated higher incidences of delayed graft function and poor graft outcomes among kidneys harvested from older donors. OBJECTIVE The objective of this study was to evaluate the influence of donor age on the function and long-term survival of renal allografts. PATIENTS We performed a retrospective review of the clinical data from 441 adult kidney transplantation from cadaveric heart-beating donors performed in our unit from May 1989 to May 2007. RESULTS Recipients of kidney allografts from older donors were significantly older (49.2 vs 43.7 years; P < .0001) and had a higher incidence of delayed graft function (15.1% vs 5.4%; P = .005). Renal function was superior following kidney transplantation using younger donors not only at 3 months (P < .0001) and 12 months (P < .0001) posttransplantation, but also upon long-term follow-up at 60 months (P < .0001) and 96 months (P = .030). Allograft survival censored for death with a functioning graft and patient survival were not different when comparing older versus younger donors. Multivariate analysis confirmed the lack of correlation between donor age and allograft failure. CONCLUSION Donor age showed no influence on allograft survival. However, kidney allografts from older donors displayed lower first year and long-term renal function.
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Resende L, Guerra J, Santana A, Mil-Homens C, Abreu F, da Costa A. First Year Renal Function as a Predictor of Kidney Allograft Outcome. Transplant Proc 2009; 41:846-8. [DOI: 10.1016/j.transproceed.2009.01.066] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jorge S, Guerra J, Silva S, Santana A, Mil-Homens C, Prata MM. Induction immunosuppressive therapy in renal transplantation: does basiliximab make the difference? Transplant Proc 2008; 40:693-6. [PMID: 18454989 DOI: 10.1016/j.transproceed.2008.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The optimal prophylactic induction immunosuppressive therapy to prevent renal transplant rejection remains controversial. Recently, basiliximab efficiency has been reported in several studies. We sought to evaluate the efficiency of induction immunosuppressive therapy with basiliximab in renal transplantation in our unit based upon the acute rejection rate, patient and graft survivals, first hospital admission length, and incidence of infectious or malignant complications during 4 years of follow-up. We retrospectively evaluated the outcome of two groups of renal transplant recipients treated with triple immunosuppressive therapy (cyclosporine, mycophenolate mofetil, and prednisolone) without (group 1, 149 patients) or with (group 2, 104 patients) induction immunosuppression with basiliximab. The two groups did not differ in demographic characteristics, number of hypersensitized patients, cold ischemia time, or donor age. The group receiving basiliximab displayed a significantly lower acute rejection rate (7.6% vs 24%, P = .001) and shorter first hospital admission (14.4 +/- 8 vs 19.5 +/- 11 days). There was no difference in graft or patient survival, death due to sepsis, or incidence of posttransplant malignancies. Although there was no difference in graft or patient survival, immunosuppressive induction therapy with basiliximab yielded a significant reduction in the acute rejection rate.
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Jorge S, Guerra J, Santana A, Mil-Homens C, Prata MM. Mycophenolate mofetil: ten years' experience of a renal transplant unit. Transplant Proc 2008; 40:700-4. [PMID: 18454991 DOI: 10.1016/j.transproceed.2008.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mycophenolate mofetil (MMF) use in renal transplantation has allowed a significant decrease in early acute rejection rates. We retrospectively evaluated the incidence of acute rejection episodes, renal function at the first year posttransplant, patient and graft survivals, cytomegalovirus (CMV) infection rate, influence of the degree of sensitization, and number of MHC antigen mismatches on graft survival in two groups of patients receiving either MMF or azathioprine. Group 1 included 149 patients receiving cyclosporine, MMF, and prednisolone; group 2 included 191 patients receiving cyclosporine, azathioprine, and prednisolone. The two groups did not differ in terms of age, sex, degree of sensitization (expressed as percentage of antibodies reactive to panel), MHC mismatch number, cold ischemia time, donor age, or anti-thymocyte globulin induction. In group 1 (MMF) there was a significant decrease in early acute rejection rate (19% vs 57%, P < .0001), longer graft survival at 10 years (92% vs 75%, P = .006), and higher rate of CMV infection (22% vs 12%, P = .004). Renal function at the first year posttransplant and patient survival during follow-up did not differ between the groups. The degree of sensitization influenced graft survival in group 2. The number of MHC mismatches did not influence graft survival in either group. With MMF, there was a significant reduction in early acute rejection rate, a significant increase in graft survival at 10-year follow-up, and diminished impact of the degree of sensitization on graft survival.
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Satwani P, Waxman I, Bhatia M, Jin Z, Kohl V, Baldinger L, Garvin J, George D, Bradley MB, Guerra J, Cairo MS. Preliminary results of gemtuzumab ozogamicin (GO) during myeloablative conditioning for allogeneic stem cell transplantation (AlloSCT) or following reduced intensity alloSCT (RI-AlloSCT) in children with AML. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Monteagudo JM, Durán A, Guerra J, García-Peña F, Coca P. Solar TiO2-assisted photocatalytic degradation of IGCC power station effluents using a Fresnel lens. CHEMOSPHERE 2008; 71:161-167. [PMID: 18078669 DOI: 10.1016/j.chemosphere.2007.10.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 10/22/2007] [Accepted: 10/23/2007] [Indexed: 05/25/2023]
Abstract
The heterogeneous TiO2 assisted photocatalytic degradation of wastewater from a thermoelectric power station under concentrated solar light irradiation using a Fresnel lens has been studied. The efficiency of photocatalytic degradation was determined from the analysis of cyanide and formate removal. Firstly, the influence of the initial concentration of H2O2 and TiO2 on the degradation kinetics of cyanides and formates was studied based on a factorial experimental design. Experimental kinetic constants were fitted using neural networks. Results showed that the photocatalytic process was effective for cyanides destruction (mainly following a molecular mechanism), whereas most of formates (degraded mainly via a radical path) remained unaffected. Finally, to improve formates degradation, the effect of lowering pH on their degradation rate was evaluated after complete cyanide destruction. The photooxidation efficiency of formates reaches a maximum at pH around 5-6. Above pH 6, formate anion is subjected to electrostatic repulsion with the negative surface of TiO2. At pH<4.5, formate adsorption and photon absorption are reduced due to some catalyst agglomeration.
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Satwani P, Freedman J, Baldinger L, Guerra J, van de Ven C, Jin Z, Garvin J, George D, Bradley M, Bhatia M, Schwartz J, Wolownik K, Foley S, Hawks R, Cairo M. 260: Comparison of Incidence of Systemic Viral Infection (SVI) and Invasive Fungal Infection (IFI) in Children Receiving Busulfan Based Reduced Intensity Allogeneic Stem Cell Transplant (RIAlloSCT) vs. Myeloablative AlloSCT (MA-AlloSCT) for Malignant and Non-Malignant Diseases. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cortés-Funes H, Rivera F, Alés I, Márquez A, Velasco A, Colomer R, García-Carbonero R, Sastre J, Guerra J, Grávalos C. Phase II of trastuzumab and cisplatin in patients (pts) with advanced gastric cancer (AGC) with HER2/neu overexpression/amplification. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4613] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4613 Background: Trastuzumab(T) exhibits activity in human gastric cancer cells that overexpress HER2/neu. We previously reported a 13.5% HER2/neu overexpression/amplification in AGC or gastroesofageal junction (GEJ) cancers (Grávalos C, et al. J Clin Oncol 24, 18S, 200s, abstr # 4089). We designed a phase II trial to determine the efficacy and tolerability of T and cisplatin(C) in pts with ACG with HER2/neu overexpression/amplification. Exploratory objectives include analysis of c-erbB-2 extracellular domain and correlation of the results with histological erB-2/neu overexpression and with clinical response Methods: Chemo-naïve pts with adenocarcinoma histopatologically confirmed, HER2/neu overexpression/amplification, measurable, no operable, locally advanced or metastatic AGC, age ≥ 18, ECOG ≤ 2, FEVI ≥ 50% and adequate organ function were eligible. Prior adjuvant radiotherapy or/and chemotherapy were allowed. Immunohistochemistry (IHC) was performed using herceptest. A fluorescence in situ hybridization (FISH) assay was done when IHQ was = 2. HER2/neu expression was considered negative if IHC= 0, 1 or IHC=2 and FISH -; and positive if IHC=2 and FISH + or IHC=3. T 8 mg/kg d1 (loading dose in first cycle) and 6 mg/kg (maintenance doses) and C 75 mg/m2 d1 were administered every 21 days until progression, unacceptable toxicity or withdrawal inform consent Results: 21 pts has been included. 17 are evaluable. 16 were men. Median age 66 (50–78). ECOG 0/1: 5/12. Histological subtypes were: 50% intestinal, 25% diffuse and 25% unknown. 56% had gastric localization and 44% GEJ. 16 pts had metastases (59% liver, 47% lymph nodes, 23% peritoneum, 17% lung, and 24% others). Prior treatment: 5 pts underwent surgery and 2 had adjuvant chemotherapy. Median cycles 2 (1–14). Efficacy: 6 (35%) pts achieved response (1/5 CR/PR), 3 (17%) stabilization (52% control disease = RC + PR+SD), 4 pts with progression disease, 4 pts too early Tolerance: There was no grade 4 toxicity. Main grade 3 adverse events included: asthenia (3 pts), nauseas/vomiting (3), diarrhea (2), hiporexia (2) and neutropenia (1) Conclusions: Trastuzumab and cisplatin is a well tolerated regimen with a promising activity. The study is ongoing and an update will be presented at the meeting. No significant financial relationships to disclose.
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Guerra J, Garvin J, Baldinger L, van de Ven C, Roman E, Bhatia M, Satwani P, Bradley M, George D, Schwartz J, Morris E, Hawkes R, Wolownik K, Foley S, Militano O, Cairo M. 164: Risk adapted allogeneic stem cell transplantation (AlloSCT) for acquired severe aplastic anemia (SAA) in pediatric recipients. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ruiz-Casado A, Calzas J, García J, Soria A, Guerra J. Life-threatening adverse drug reaction to paclitaxel. Postmarketing surveillance. Clin Transl Oncol 2006; 8:60-1. [PMID: 16632443 DOI: 10.1007/s12094-006-0098-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The mechanism of action of hypersensitivity reactions from paclitaxel has not been fully understood. It has not even been defined if they are secondary to paclitaxel, its vehicle or the premedication. Postmarketing pharmacovigilance is predominantly based on spontaneous reporting. These reports albeit biased and incomplete serve to detect previously unrecognised adverse events. We report a life threatening adverse event related to paclitaxel without any evidence of histamine release. It consisted of a cardiac arrest probably secondary to bradiarrhythmia or branch block.
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Carvalho FA, Maria AV, Braz Nogueira JM, Guerra J, Martins-Silva J, Saldanha C. The relation between the erythrocyte nitric oxide and hemorheological parameters. Clin Hemorheol Microcirc 2006; 35:341-7. [PMID: 16899954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We stimulated human erythrocytes obtained from patients with hypercholesterolemia (HC; n = 42), renal transplantation (RT; n = 18) and hypertension (HT; n = 10) with acetylcholine (ACh 10 microM) and measured the amperometric NO production, comparing with the NO levels achieved on erythrocytes of healthy persons (n = 27). We also measured the hemoglobin, hematocrit, erythrocyte aggregation, erythrocyte deformability, plasma viscosity and fibrinogen concentration from human blood samples. The erythrocytes NO levels were of 2.5 +/- 0.7 nM (P = 0.038, HC), 2.4 +/- 1.1 nM (RT) and 2.2 +/- 0.8 nM (HT) against the 2.0 +/- 0.8 nM for the control groups. For each group and at each shear stress value, the erythrocytes deformability decreases with the increase of the NO concentration after ACh stimulation. We observed a significant increase of the control values on the erythrocyte aggregation results on each patient group. Besides the lower erythrocyte deformability obtained on HC, RT and HT blood samples, the erythrocytes produced higher NO levels after ACh stimulation than the healthy ones. The power of erythrocyte hemorheological behaviour could be compensated by the NO production at the presence of acetylcholine. We can hypothesises that cholinergic drugs could be used as co-adjuvants of specific therapeutics compounds on these studied diseases.
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Aslani M, Faria S, Tafazoli F, Duclos M, Portelance L, Guerra J, Freeman C. Does the RTOG/EORTC Scoring Schema (RESS) Truly Reflect the Late Radiation Morbidity in Lung Cancer Patients? Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Faria S, Souhami L, Duclos M, Portelance L, Guerra J, Devic S. 69 Preliminary results with hypofractionated radiation therapy (HRT) alone as the curative treatment for patients with early stage, medically inoperable non-small cell lung cancer (NSCLC). Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)80230-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Faria S, Souhami L, Dulcos M, Portelance L, Guerra J, Gruber J, Hirsh V. P-715 Hypofractionated radiation therapy (HRT) alone as the curative treatment for patients with early stage, medically inoperable non-small cell lung cancer (NSCLC). Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81208-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ligeiro D, Sancho MR, Papoila A, Barradinhas AM, Almeida A, Calão S, Machado D, Nolasco F, Guerra J, Sampaio MJ, Trindade H. Impact of donor and recipient cytokine genotypes on renal allograft outcome. Transplant Proc 2004; 36:827-9. [PMID: 15194285 DOI: 10.1016/j.transproceed.2004.03.082] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Allelic differences in gene promoter or codifying regions have been described to affect regulation of gene expression, consequently increasing or decreasing cytokine production and signal transduction responses to a given stimulus. This observation has been reported for interleukin (IL)-10 (-1082 A/G; -819/-592 CT/CA), transforming growth factor (TGF)-beta (codon 10 C/T, codon 25 G/C), tumor necrosis factor (TNF)-alpha (-308 G/A), TNF-beta (+252 A/G), interferon (IFN)-gamma (+874 T/A), IL-6 (-174 G/C), and IL-4R alpha (+1902 G/A). To evaluate the influence of these cytokine genotypes on the development of acute or chronic rejection, we correlated the genotypes of both kidney graft recipients and cadaver donors with the clinical outcome. Kidney recipients had 5 years follow-up, at least 2 HLA-DRB compatibilities, and a maximum of 25% anti-HLA pretransplantation sensitization. The clinical outcomes were grouped as follows: stable functioning graft (NR, n = 35); acute rejection episodes (AR, n = 31); and chronic rejection (CR, n = 31). The cytokine genotype polymorphisms were defined using PCR-SSP typing. A statistical analysis showed a significant prevalence of recipient IL-10 -819/-592 genotype among CR individuals; whereas among donors, the TGF-beta codon 10 CT genotype was significantly associated with the AR cohort and the IL-6 -174 CC genotype with CR. Other albeit not significant observations included a strong predisposition of recipient TGF-beta codon 10 CT genotype with CR, and TNF-beta 252 AA with AR. A low frequency of TNF-alpha -308 AA genotype also was observed among recipients and donors who showed poor allograft outcomes.
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Acunzo RS, Konopka IV, Sánchez RA, Pizzarelli N, Guerra J, Elizari MV. [Atypical behavior of QTc and ST-T intervals in a patient with the Brugada syndrome]. Rev Esp Cardiol 2004; 57:268-70. [PMID: 15056433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We present a 56-year-old man who was admitted to an emergency service after receiving an electric shock. The ECG showed a J point and ST segment elevation of up to 5 mm in leads V1 to V3, which normalized in 24 hours. The ajmaline test caused elevation of the J point and of the ST segment up to 12 mm in leads V1 to V3, QTc lengthening, and QTc and T wave alternans. These results denoted alterations in the duration of myocardial action potentials, a common finding in patients with Brugada syndrome and long QT syndrome.
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Werner O, Guerra J. Molecular phylogeography of the moss Tortula muralis Hedw (Pottiaceae) based on chloroplast rps4 gene sequence data. PLANT BIOLOGY (STUTTGART, GERMANY) 2004; 6:147-157. [PMID: 15045665 DOI: 10.1055/s-2004-817801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Tortula muralis is a moss species of cosmopolitan distribution, for which we present chloroplast rps4 sequence data. The sequences provided a sufficiently high degree of divergence ( h = 0.878, theta = 0.00989 +/- 0.0000106, a total of 18 haplotypes for 49 accessions) for the degree of differentiation between regions from different continents to be investigated. In fact, 18.53 % of the variation found corresponded to differences between these regions, while 81.43 % was attributed to intra-region differences. Only the Japanese area differed significantly from other regions. Some haplotypes are found on several continents, while others are restricted to certain areas. Six of the seven sequenced plants from Japan belong to a haplotype only found there. The phylogenetic analysis suggests that Tortula muralis might be paraphyletic, with Tortula vahliana nested within the Tortula muralis clade. At present, it is not clear whether gene flow between the different clades of Tortula muralis is a continuing process or whether Tortula muralis is an example of cryptic speciation.
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Acunzo RS, Konopka IV, Sánchez RA, Pizzarelli N, Guerra J, Elizari MV. Comportamiento atípico del QTc y del ST-T en un caso con síndrome de Brugada. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77101-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Guerra J, Bassas E, Andres M, Verdugo F, Gonzalez M. Acupuncture for soft tissue shoulder disorders: a series of 201 cases. Acupunct Med 2003; 21:18-22; discussion 22. [PMID: 12924842 DOI: 10.1136/aim.21.1-2.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A retrospective observational study was performed on shoulder pain cases seen in a community general practice. Two hundred and one patients were treated with acupuncture (on distant points plus local shoulder points), moxibustion and auriculotherapy. Data was retrieved from records over a three-year period to assess the effect of acupuncture and moxibustion on pain, mobility and disability, and to compare perceived efficacy rates with published reports from Chinese acupuncturists. Using a four-point outcome scale in this series of 201 patients the study found: one patient (0.5%) reported no improvement, 12 (6%) simple improvement, 68 (33.8%) remarkable improvement, and 120 (59.7%) clinical resolution. Only two patients left the programme. In conclusion, treatment of soft tissue shoulder disorders with acupuncture and moxibustion in this series seems to have good clinical results in diminishing symptoms, shortening disease duration time and improving functional ability, even in long-lasting disease (up to 10 years). A combination of distant points plus local points, moxibustion and auriculotherapy seems to increase effectiveness, reduce the number of sessions per patient, and increase the time between sessions, suiting the needs of patients and those of a busy National Health Service clinic. The authors report results similar to those reported by Chinese acupuncturists when using similar diagnostic procedures, techniques, outcome measures and patients. This case series is the first step towards conducting a randomised controlled trial (RCT) of acupuncture efficacy in shoulder pain. Such trials are needed to confirm the perceived efficacy of acupuncture from observational studies.
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Maio R, Carraca J, Batista L, Aldeia F, Costa P, Guerra J, Vale JM. Laparoscopic cholecystectomy and renal transplantation. Transplant Proc 2003; 35:1100-1. [PMID: 12947875 DOI: 10.1016/s0041-1345(03)00325-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Santana A, Guerra J, Milhomens C, Neves F, Prata MM. C0/C2 cyclosporine levels monitoring in renal transplantation. Transplant Proc 2003; 35:1072-3. [PMID: 12947862 DOI: 10.1016/s0041-1345(03)00312-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Barrios NJ, Montalvo F, Colon G, Santiago Borrero PJ, Guerra J. Childhood cancer and hematopoietic stem cell transplantation: a seven year experience at University Pediatric Hospital in Puerto Rico. BOLETIN DE LA ASOCIACION MEDICA DE PUERTO RICO 2003; 95:21-5. [PMID: 12898747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
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80
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Valdevenito JP, Valdevenito R, Cuevas M, Espinoza A, Guerra J. [Cyst of the prostatic utricle: report of a case complicated by giant lithiasis]. ARCH ESP UROL 2002; 55:960-2. [PMID: 12455291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
OBJECTIVE We report a case of prostatic utricle cyst complicated with giant lithiasis. METHOD/RESULTS A 42 year old man with history of surgery for bilateral cryptorchidism and hypospadias in his infancy, presented with initial and terminal hematuria and a digital rectal examination showing a rocky, smooth enlargement of the anterior rectal wall. Prostatic specific antigen was normal. Transrectal and transabdominal ultrasound showed a large retrovesical calcification and intravenous pyelogram showed normality of the upper urinary tract. The patient underwent a complete resection through a suprapubic extraperitoneal approach without complications. Histopathology revealed a 10 cm long prostatic utricle cyst complicated with lithiasis. CONCLUSIONS The prostatic utricle cysts are rare in clinical practice and associate with anomalies of testicular descent and hypospadias. They have a difficult differential diagnosis and indication for treatment depends on presenting symptoms, size and complications.
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Ramírez-Corredores MM, Romero T, Djaouadi D, Hernández Z, Guerra J. Options for Nitriles Removal from C4−C5 Cuts: 2. via Catalytic Hydrogenation. Ind Eng Chem Res 2002. [DOI: 10.1021/ie0105932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sánchez Gómez P, Carrión Vilches MÁ, Hernández González A, Guerra J. Una nueva subespecie de Moricandia moricandioides (Boiss.) Heywood (Brassicaceae). ACTA ACUST UNITED AC 2001. [DOI: 10.24310/abm.v26i0.7418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A new subspecies of Moricandia moricandioides (Boiss.) Heywood (Brassicaceae). Palabras clave: Moricandia, Brassicaceae, Murcia, España.Key words: Moricandia, Brassicaceae, Murcia, Spain.
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Barba CA, Taggert J, Morgan AS, Guerra J, Bernstein B, Lorenzo M, Gershon A, Epstein N. A new cervical spine clearance protocol using computed tomography. THE JOURNAL OF TRAUMA 2001; 51:652-6; discussion 656-7. [PMID: 11586154 DOI: 10.1097/00005373-200110000-00005] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess a cervical spine clearance protocol for blunt trauma patients using helical computed tomographic (CT) scan of the cervical spine (C-spine). METHODS A protocol using CT scan of the C-spine was implemented and the first 6 months of use reviewed. Patients requiring a CT scan of the head had the C-spine evaluated by lateral C-spine radiography and a helical CT scan. Patients without indication for CT scan of the head had the C-spine evaluated by three-view radiography (anteroposterior, lateral, and odontoid) with selective CT scan of the C-spine for imaging areas not well visualized or those with abnormalities identified by radiography or by clinical examination alone. RESULTS Three hundred twenty-four patients were admitted to the trauma center after blunt trauma during the first 6 months of protocol implementation. Head CT scans were obtained in 158 patients and lateral cervical spine radiography in conjunction with helical CT scanning evaluated the C-spine. The other 166 patients had the cervical spine cleared by three-view radiography series or by clinical examination alone. For patients in whom a head CT scan was not indicated, CT scanning was used only when plain radiographs failed to adequately visualize the entire C-spine. A total of 15 injuries (4.6% of the group) were detected. Seven injuries were suspected or detected by lateral plain radiographs and confirmed by CT scan. Six patients had an injury not detected by radiography but diagnosed by CT scan, and one patient had a false-positive radiograph. Of the remaining two injuries, one was diagnosed by magnetic resonance imaging and the other by CT scan outside of the protocol. Lateral plain radiographs alone failed to detect 46% (n = 6) of all injuries. CONCLUSION In our series, the selective use of helical CT scanning with plain radiography increased the accuracy with which cervical spine injury was detected from 54% to 100%. The protocol allowed for more rapid evaluation in many patients as well. We recommend that practice guidelines include the use of helical CT scan of the entire C-spine as the diagnostic procedure for those blunt trauma patients undergoing CT scanning of the head.
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Fernández-Natal I, Guerra J, Alcoba M, Cachón F, Soriano F. Bacteremia caused by multiply resistant corynebacterium urealyticum: six case reports and review. Eur J Clin Microbiol Infect Dis 2001; 20:514-7. [PMID: 11561814 DOI: 10.1007/pl00011297] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Williams B, Noonan G, Reiss TF, Knorr B, Guerra J, White R, Matz J. Long-term asthma control with oral montelukast and inhaled beclomethasone for adults and children 6 years and older. Clin Exp Allergy 2001; 31:845-54. [PMID: 11422148 DOI: 10.1046/j.1365-2222.2001.01085.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Leukotriene receptor antagonists have demonstrated clinical benefits in chronic asthma studies of up to 3 months in duration. The effects of these agents over extended periods of time have not been reported. OBJECTIVE To describe the long-term effect of oral montelukast, a potent and specific cysteinyl leukotriene receptor antagonist, compared with inhaled corticosteroids in both adult and paediatric patients with chronic asthma. METHODS Male and female patients with chronic, stable asthma (adults aged 15-85 years, children aged 6-14 years), who had completed double-blind, placebo-controlled clinical studies, participated in three extension studies with oral montelukast taken once daily (10 mg tablet for adults, 5 mg chewable tablet for paediatric patients) or inhaled corticosteroids (beclomethasone 200 microg twice daily for adults, beclomethasone 100 microg or equivalent three times daily for children). A double-blind adult extension study was 37 weeks in duration; open-label adult extension studies were 156 (adults) and 112 (paediatric) weeks in duration. A total of 436, 374, and 245 patients entered these extension studies, respectively. RESULTS Treatment with both montelukast and inhaled corticosteroids resulted in improvement in multiple parameters of asthma control. Improvements in daytime symptom scores were generally comparable among treatment groups. No tachyphylaxis to the effects of montelukast was evident. In the adult open-label study, however, the effect of beclomethasone on mean forced expiratory volume in 1 second (FEV1) gradually decreased from start of the study to the end of the follow-up treatment period. CONCLUSION Both montelukast and inhaled corticosteroids were effective in controlling mild to moderate chronic asthma; the relative effectiveness of montelukast and beclomethasone were similar in open-label conditions. The hypothesis, that clinical practice conditions (e.g., adherence) may have a significant impact on the effectiveness of these therapies, should be tested in future clinical trials.
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Kerr R, Resnick D, Sartoris DJ, Kursunoglu S, Pineda C, Haghighi P, Greenway G, Guerra J. Computerized tomography of proximal femoral trabecular patterns. J Orthop Res 2001; 4:45-56. [PMID: 3950808 DOI: 10.1002/jor.1100040106] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A comprehensive imaging and pathologic investigation utilizing patients and cadaver material was performed in order to identify the normal trabecular pattern of the proximal femur and to assess alterations in this pattern in various disorders. Patients and specimens were studied with computed tomography (CT), including three-dimensional CT image reconstruction in selected cases and plain film radiography. The CT imaging of the proximal femur provides insight into the dynamic state of bone in this region. Despite limited resolution, three-dimensional CT image reconstruction is capable of portraying the concentration and orientation of major trabeculae in the proximal femur. Increased trabecular spacing occurs in osteoporosis and is well depicted by CT. Proliferation and thickening of the most superior subchondral primary compressive trabeculae is an early sign of osteoarthritis. In the region of the calcar femorale, crossing trabeculae, similar to the appearance of an enchondroma or bone infarct, have been described in osteoporosis and osteoarthritis and probably represent unmasking of normally present reinforcing trabeculae. In ischemic necrosis, CT should be considered a useful modality for detection of early or mild alterations and may be valuable in treatment planning.
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de Frutos T, de Miguel LS, García-Durán M, González-Fernández F, Rodríguez-Feo JA, Montón M, Guerra J, Farré J, Casado S, López-Farré A. NO from smooth muscle cells decreases NOS expression in endothelial cells: role of TNF-alpha. THE AMERICAN JOURNAL OF PHYSIOLOGY 1999; 277:H1317-25. [PMID: 10516166 DOI: 10.1152/ajpheart.1999.277.4.h1317] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite the evidence that cytokines stimulate nitric oxide (NO) production by inducible nitric oxide synthase (iNOS), several reports recently demonstrated that the hypotensive response related to endothelial nitric oxide synthase (eNOS) activity could be inhibited by the same cytokines. The aim of the present work was to analyze whether NO generated by vascular smooth muscle cells (VSMC) could modify eNOS protein expression in endothelial cells. Bovine aortic endothelial cells (BAEC) and bovine VSMC (BVSMC) in coculture were used for the study. Interleukin-1beta (IL-1beta, 10 ng/ml)-treated BVSMC, which expressed iNOS protein, decreased eNOS protein expression in BAEC. The presence of NO antagonists N(omega)-nitro-L-arginine methyl ester (10(-3) mol/l) or N(G)-monomethyl-L-arginine (10(-3) mol/l) prevented the decrease in eNOS protein expression induced by IL-1beta-treated BVSMC. Surprisingly, two different NO donors, 3-morpholinosydnonimine (10(-4) mol/l) and S-nitroso-N-acetyl-D,L-penicillamine (10(-4) mol/l), failed to modify eNOS expression in BAEC, suggesting the existence of a diffusible mediator released from IL-1beta-treated BVSMC that acts on endothelial cells by reducing eNOS expression. The presence of NO antagonists reduced tumor necrosis factor-alpha (TNF-alpha) production by IL-1beta-stimulated BVSMC. This effect was also produced in the presence of a protein kinase G inhibitor, guanosine-5'-O-(2-thiodiphosphate) trilithium salt. A polyclonal antibody against TNF-alpha prevented eNOS expression in the BAEC-BVSMC coculture. In conclusion, NO by itself failed to modify eNOS protein expression in endothelial cells but increased TNF-alpha generation by IL-1beta-stimulated BVSMC and, in this way, reduced eNOS expression in the endothelium.
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Viallet J, Brassard MA, Souhami L, Ayoub J, Del Vecchio P, Kreisman H, Guerra J, Gruber J, Langleben A, Hohneker J, Rousseau P. A phase I/II trial of neoadjuvant chemotherapy with cisplatin and vinorelbine followed by accelerated irradiation for patients with inoperable nonsmall cell lung carcinoma. Cancer 1999; 85:2562-9. [PMID: 10375103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Both locoregional and distant disease control remains poor in the treatment of Stage III nonsmall cell lung carcinoma (NSCLC). This trial was conducted to evaluate the tolerance and responses of patients with NSCLC given a neoadjuvant regimen of cisplatin and vinorelbine chemotherapy followed by accelerated thoracic radiotherapy. METHODS Forty-two patients with Stage IIIA and IIIB NSCLC were entered into the study. Treatment consisted of cisplatin 100 mg/m2 given on Days 1 and 29 and vinorelbine 30 mg/m2 given weekly for 5 weeks, with a planned 50% dose reduction to 15 mg/m2 planned for Week 2. This was followed by thoracic irradiation of 60 gray (Gy) in 30 fractions of 2 Gy over 4 weeks (once daily during Weeks 1 and 2 and twice daily during Weeks 3 and 4). RESULTS With a median follow-up time of 12.2 months (27-65 months for survivors), the median survival was 12.2 months (16.6 months for patients with no prior weight loss and 7.8 months for those with prior weight loss). The response rate after induction chemotherapy was 46.1%, increasing to 74.4% after radiation therapy (8 complete responses and 21 partial responses). The rate of progression was 13 of 18 (72%) for those who responded to chemotherapy (4 distant, 9 local) and 18 of 21 (86%) for those who did not respond to chemotherapy (14 distant, 7 local). The most frequent acute Grade 3 toxicity was nausea (21.4%). CONCLUSIONS Accelerated thoracic irradiation after induction chemotherapy is well tolerated and yields therapeutic results that compare favorably with those reported for other regimens of chemotherapy and standard fractionated radiotherapy. The data from this study suggest that the responses of patients with clinically apparent disease to induction chemotherapy might indicate a likelihood of controlling microscopic distant metastases.
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González-Fernández F, Rodríguez-Feo JA, Farré J, Guerra J, Romero J, Gómez J, Rico L, Ayala R, Marcos P, Sánchez de Miguel L, Casado S, López-Farré A. [Expression of inducible nitric oxide synthase in the carotid of rats after endothelial skinning: the effects of platelets and treatment with abciximab]. Rev Esp Cardiol 1999; 52:422-8. [PMID: 10373776 DOI: 10.1016/s0300-8932(99)74940-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Functional evidence suggests that endothelial denudation stimulates inducible nitric oxide synthase (iNOS) activity in the vascular wall. In vitro studies done in our laboratory have shown that iNOS expression in smooth muscle cells is reduced by endothelial cells. The object of this study was to analyze the iNOS protein expression in the arterial wall after in vivo deendothelialization, and the role of platelet activation abciximab in the expression of this protein. MATERIALS AND METHODS Endothelial denudation was performed in the left carotid artery of Wistar rats. The right carotid artery was used as control. RESULTS iNOS protein was only weakly expressed at 6, 24 and 48 hours after endothelial denudation. Since platelet adhesion and aggregation occur early after endothelial damage, we have analyzed the role of activated platelets in iNOS protein expression during the first two days after angioplasty. Early after in vivo endothelial injury, thrombocytopenic rats showed a marked iNOS protein expression. Similar results were obtained by blocking the platelet glycoprotein IIb/IIIa in rats treated with abciximab (Reopro). CONCLUSIONS iNOS protein is weakly expressed in the arterial wall after endothelial denudation. Platelets play a crucial role preventing iNOS protein expression early after endothelial damage through a mechanism that depends on GP IIb/IIIa, an effect that can be avoided with glycoprotein IIb/IIIa, blockers, such as abciximab.
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Malmstrom K, Rodriguez-Gomez G, Guerra J, Villaran C, Piñeiro A, Wei LX, Seidenberg BC, Reiss TF. Oral montelukast, inhaled beclomethasone, and placebo for chronic asthma. A randomized, controlled trial. Montelukast/Beclomethasone Study Group. Ann Intern Med 1999; 130:487-95. [PMID: 10075616 DOI: 10.7326/0003-4819-130-6-199903160-00005] [Citation(s) in RCA: 489] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Oral leukotriene receptor antagonists have been shown to have efficacy in chronic asthma. OBJECTIVE To compare the clinical benefit of montelukast, a once-daily oral leukotriene receptor antagonist; placebo; and inhaled beclomethasone. DESIGN Randomized, double-blind, double-dummy, placebo-controlled, parallel-group, 12-week study. SETTING 36 sites worldwide. PATIENTS 895 patients 15 to 85 years of age with chronic asthma and an FEV1 50% to 85% of predicted. INTERVENTIONS Montelukast, 10 mg once daily at bedtime; inhaled beclomethasone, 200 microg twice daily, administered with a spacer device; or placebo. MEASUREMENTS Primary end points were daytime asthma symptom score and FEV1. Secondary end points were peak expiratory flow rates in the morning and evening, as-needed beta-agonist use, nocturnal awakenings, asthma-specific quality of life, and worsening asthma episodes. RESULTS Over the 12-week treatment period, the average percentage change from baseline in FEV1 was 13.1% with beclomethasone, 7.4% with montelukast, and 0.7% with placebo (P < 0.001 for each active treatment compared with placebo; P < 0.01 for beclomethasone compared with montelukast). The average change from baseline in daytime symptom score was -0.62 for beclomethasone, -0.41 for montelukast, and -0.17 for placebo (P < 0.001 for each active treatment compared with placebo; P < 0.01 for beclomethasone compared with montelukast). Each agent improved peak expiratory flow rates and quality of life, reduced nocturnal awakenings and asthma attacks, increased the number of asthma-control days, and decreased the number of days with asthma exacerbations (P < 0.001 for each active treatment compared with placebo for each end point; P < 0.01 for beclomethasone compared with montelukast for each end point). Although beclomethasone had a greater mean clinical benefit than montelukast, montelukast had a faster onset of action and a greater initial effect. The two agents caused similar decreases in peripheral blood eosinophil counts (P < 0.05 for each agent compared with placebo). Both agents had tolerability profiles similar to that of placebo over the 12-week study. CONCLUSIONS Although beclomethasone had a larger mean effect than montelukast, both drugs provided clinical benefit to patients with chronic asthma. This finding is consistent with the use of these agents as controller medications for chronic asthma.
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Oliva J, Pimentel G, Peralta R, Borrón M, Ortiz R, Gutiérrez J, Guerra J, Quesada W, Dopico R, Casanova F, Baum RP. [Radioimmunoscintigraphy of colorectal cancer using the anti-CEA monoclonal antibody BW 431/26. Final results]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 1999; 18:5-15. [PMID: 10074212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The anti-carcinoembryonic antigen (CEA) antibody, BW 431/26 (Scintimun CEA, Behringwerke, Marburg, Germany ) labeled with technetium pertechnectate (99mTc), is an intact immunoglobulin G1, monoclonal antibody that has been used to image colorectal cancer. Planar and SPECT images of chest, abdomen and pelvis were performed at 10 minutes, 4-6 and 18-24 hours after the intravenous antibody injection. 44 patients were studied and the pathological antibody concentration localization by radioimmunoimaging (RI) were correlated with surgical, clinical and other imaging modality findings to validate the RI. The RI was positive in 29 patients and negative in the other 15 patients. The CEA and CA 19.9 were elevated in the serum of some patients with primary tumors or recurrence. The HAMA were determined in all the patients before and after the RI.
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González-Fernández F, López-Farré A, Rodríguez-Feo JA, Farré J, Guerra J, Fortes J, Millás I, García-Durán M, Rico L, Mata P, de Miguel LS, Casado S. Expression of inducible nitric oxide synthase after endothelial denudation of the rat carotid artery: role of platelets. Circ Res 1998; 83:1080-7. [PMID: 9831702 DOI: 10.1161/01.res.83.11.1080] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is functional evidence suggesting that endothelial denudation stimulates inducible nitric oxide synthase (iNOS) activity in the vascular wall. In vitro studies have shown that iNOS expression in smooth muscle cells is reduced by endothelial cells. In the present study we have analyzed the time course of iNOS protein expression in the arterial wall after in vivo deendothelialization. Endothelial denudation was performed in the left carotid artery of Wistar rats, and the right carotid artery was used as control. Whereas iNOS protein was weakly expressed 6, 24, and 48 hours after endothelial denudation, a marked iNOS expression was found 7, 14, and 30 days after vascular damage. Because platelet adhesion and aggregation occur early after endothelial damage, we studied the role of activated platelets in the negative modulation of iNOS protein expression during the first 2 days after endothelial denudation. Early after in vivo endothelial injury, platelet-depleted rats showed a marked iNOS protein expression in the vascular wall. Similar results were obtained by blocking the platelet glycoprotein (GP) IIb/IIIa. Although iNOS protein is present in the arterial wall several days after endothelial denudation, early after arterial wall injury iNOS protein is weakly expressed. Platelets play a crucial role in preventing iNOS protein expression early after endothelial damage, an effect that can be avoided with GP IIb/IIIa blockers. Although iNOS protein was weakly expressed in vivo in the rat carotid artery wall 6, 24, and 48 hours after balloon endothelial denudation, a marked iNOS expression was found 7, 14, and 30 days after arterial damage. iNOS expression could be increased early after endothelial injury by removing circulating platelets and by an antibody against the GP IIb/IIIa. In conclusion, platelets prevent iNOS protein expression early after endothelial balloon damage, an effect that can be avoided with GP IIb/IIIa blocking agents.
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Cernadas MR, Sánchez de Miguel L, García-Durán M, González-Fernández F, Millás I, Montón M, Rodrigo J, Rico L, Fernández P, de Frutos T, Rodríguez-Feo JA, Guerra J, Caramelo C, Casado S. Expression of constitutive and inducible nitric oxide synthases in the vascular wall of young and aging rats. Circ Res 1998; 83:279-86. [PMID: 9710120 DOI: 10.1161/01.res.83.3.279] [Citation(s) in RCA: 218] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two NO synthase (NOS) isoforms have been described in vessels, an endothelial constitutive NOS (eNOS) and an inducible NOS (iNOS). The purpose of the present study was to examine the endothelium-dependent and endothelium-independent hypotensive response in aging rats, analyzing the ability of their vessels to produce NO. The studies were performed in 2 groups of euvolemic, conscious, male Wistar rats: aging rats (n=20, 18 months old) and young rats (n=20, 5 months old). The hypotensive responses to acetylcholine, bradykinin, and sodium nitroprusside were determined. Furthermore, the expression of the NOS isoforms by Western blot and the eNOS and iNOS activities, defined as Ca2+-dependent and Ca2+-independent conversion of [14C]L-arginine into [14C]L-citrulline, respectively, were also determined. In the aging rats, we found an impaired hypotensive response to acetylcholine and bradykinin (2 NO- and endothelium-dependent hypotensive agents) that was accompanied by a preserved hypotensive response to sodium nitroprusside. Aging rats also demonstrated an enhanced sensitivity response to the pressor effect of the L-arginine antagonist L-Nomega-nitro-L-arginine and a reduced vasoconstrictor response to angiotensin II. The inhibition of NO synthesis normalized the pressor effect of angiotensin II in the aging animals. Nitrite plus nitrate plasma levels were increased in aging rats. Furthermore, cGMP content was also higher in the aging vessels. In the aging aortas, the expression of both eNOS and iNOS isoforms was enhanced. However, in aging rats, the activity of the eNOS isoform was markedly reduced, a finding that was accompanied by the presence of iNOS activity. The vessel wall of aging rats showed an enhanced expression of eNOS and iNOS isoforms. However, eNOS activity was reduced in the aging animals. These findings could explain the impaired endothelium-dependent hypotensive response associated with aging.
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Hutson DG, Russell E, Yrizarry J, Levi JU, Livingstone AS, Guerra J, Reddy R, Jeffers L, Schiff ER, Scagnelli T, Mendez K. Percutaneous dilatation of biliary strictures through the afferent limb of a modified Roux-en-Y choledochojejunostomy or hepaticojejunostomy. Am J Surg 1998; 175:108-13. [PMID: 9515525 DOI: 10.1016/s0002-9610(97)00278-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This report is a 13-year prospective evaluation of percutaneous balloon dilatation of benign biliary strictures through the subcutaneous or subfascially positioned afferent limb of a choledocho or hepaticojejunostomy in 30 patients. DATA SOURCE Twenty-seven strictures developed after a common duct injury sustained at the time of cholecystectomy, two after hepatectomy reconstruction for trauma and one following a gastrectomy. Twelve injuries (40%) were recognized at operation. Of the 18 patients where the injury was unrecognized at the time of operation, 8 had not been reoperated at the time of referral, 7 had late repairs by the referring physician, and 3 had late repairs at our institution. The follow-up is 1 to 13 years. RESULTS There has been 1 late death and 6 patients are lost alive. The jejunal-limb was accessed 50 times with two minor and no major complications. There have been two parajejunal hernia repairs, but there have not been any reoperations for recurrent biliary strictures. CONCLUSIONS Benign biliary strictures can be effectively managed by repeat balloon dilatations thru the afferent limb of a choledocho or hepaticojejunostomy, thus eliminating the need for repeat surgical interventions.
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Raij L, Hayakawa H, Coffee K, Guerra J. Effect of doxazosin on endothelial dysfunction in hypercholesterolemic/antioxidant-deficient rats. Am J Hypertens 1997; 10:1257-62. [PMID: 9397245 DOI: 10.1016/s0895-7061(97)00265-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hypertension, hypercholesterolemia, atherosclerosis, and coronary heart disease are associated with abnormal endothelium-dependent, nitric oxide-mediated vasorelaxation. In rats, hypercholesterolemia in combination with deficiencies of vitamin E and selenium results in increased endogenous lipid oxidation and endothelial dysfunction. Two hydroxymetabolites of doxazosin, an alpha 1-adrenergic blocking antihypertensive agent, inhibit human lipid oxidation in vitro in a dose-dependent fashion. The present studies were performed to determine the effect of in vivo treatment with doxazosin on endothelial dysfunction in hypercholesterolemic/ antioxidant-deficient rats. Dahl rats were fed 1) a standard diet, 2) a high cholesterol (4%) diet, or 3) a high cholesterol, vitamin E- and selenium-deficient diet. A subgroup of animals in each group were administered doxazosin (3.5 mg/100 g/day) for 16 weeks. In the aortas, vascular relaxations induced by acetylcholine were significantly decreased (P < .05) in high cholesterol/antioxidant-deficient rats compared with normal and high cholesterol animals. Doxazosin treatment prevented the impairment in endothelium-dependent vascular relaxation in the high cholesterol/antioxidant-deficient group. Vasorelaxation in response to the exogenous nitric oxide donor diethylamine nanoate, which was significantly impaired (P < .05) in aortas from high cholesterol/antioxidant-deficient animals compared with normal and high cholesterol animals, was normalized in aortas from high cholesterol/ antioxidant-deficient animals that had received doxazosin. The antioxidant effect of doxazosin may have therapeutic implications in diseases associated with endothelial dysfunction linked to products of lipid oxidation.
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96
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Leal-Cerro A, Guerra J, Segura D, Chinchón I, Rafel E, Arenas J, Montemayor M, Jimenez L, Astorga R, Bautista J. 3-27-05 Growth hormone treatment in GH deficient adults: Effects on skeletal muscle and exercise. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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97
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Sullivan J, Feeley B, Guerra J, Boxer LM. Identification of the major positive regulators of c-myb expression in hematopoietic cells of different lineages. J Biol Chem 1997; 272:1943-9. [PMID: 8999884 DOI: 10.1074/jbc.272.3.1943] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The c-myb gene is primarily expressed in hematopoietic cells, and it is overexpressed in many leukemias. The regulation of its expression is of critical importance in hematopoietic cells. We identified the major positive regulatory sites in the 5'-flanking sequence of the human c-myb gene, and we found that the positive regulators differed in cells of different lineages. In the Molt-4 T-cell line, two Ets-like binding sites were required for the expression of c-myb. The 5' site played a minor role in the regulation of c-myb expression, and we demonstrated that a protein of 67 kDa bound to this site. Antibodies against Ets proteins showed no cross-reactivity with this protein. We showed that Ets-1 bound to the 3'-regulatory site in the c-myb promoter by electrophoretic mobility shift assay and antibody studies. Both of these Ets-like binding sites were nonfunctional in the DHL-9 B-cell line and the K562 myeloid cell line. We identified a novel transcription factor of 50.5 kDa that was required for expression of c-myb in these cell lines.
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98
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Martinez-Sanchez JJ, Herranz JM, Guerra J, Trabaud L. Natural recolonization of Pinus halepensis Mill, and Pinus pinaster Aitón in burnt forests of the Sierra de Al caraz-Segura mountain system (SE Spain). ACTA ACUST UNITED AC 1996. [DOI: 10.3406/ecmed.1996.1799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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99
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Raij L, Jaimes E, del Castillo D, Guerra J, Westberg G. Pathophysiology of the vascular wall: the role of nitric oxide in renal disease. Prostaglandins Leukot Essent Fatty Acids 1996; 54:53-8. [PMID: 8992494 DOI: 10.1016/s0952-3278(96)90081-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nitric oxide (NO) is formed in the endothelium by the constitutive enzyme NO synthase from the substrate amino acid L-arginine. As an endogenous vasodilator it contributes to renal arteriolar tone and modulates relaxation of the mesangium, thus contributing to regulation of glomerular microcirculation. NO also plays a role in regulating renal sodium excretion and renin release. It has antiplatelet and antithrombogenic effects and thus helps prevent thrombosis within the glomerular capillaries. In sepsis and sepsis-related syndromes, NO has a renoprotective role in that it aids in maintaining renal vasodilation and inhibiting platelet adhesion and aggregation. More knowledge of these effects may lead to the design of therapeutic interventions for preventing glomerular injury.
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100
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Lee BY, Guerra J, Civelek B. Compartment syndrome in the diabetic foot. ADVANCES IN WOUND CARE : THE JOURNAL FOR PREVENTION AND HEALING 1995; 8:36, 38, 41-2 passim. [PMID: 8696576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The compartment syndrome is a well-described clinical entity that results from increased pressure within a myofascial compartment. The infection in a diabetic foot usually presents in the whole compartment and can spread to a neighboring compartment. The association of infection and increased compartment pressure in the diabetic foot makes its treatment a formidable challenge. Fasciotomies of the feet when indicated may accelerate infection control and wound healing in the diabetic foot. The presence of a compartment syndrome in the diabetic foot is seldom recognized. Awareness of this problem is mandatory for physicians dealing with diabetic feet.
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