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Martinez L, Bloch V, Jacob A, Iskra F, Barreteau H, Razurel A. Sécurisation de la dispensation individuelle et nominative suite à l’implantation d’un automate de dispensation nominative : cartographie des risques a priori au sein d’une pharmacie à usage intérieur. ANNALES PHARMACEUTIQUES FRANÇAISES 2018; 76:473-488. [DOI: 10.1016/j.pharma.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 05/27/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
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Martínez M, Palomares C, Martinez L, Fornovi A, Parreño E, Ballester R, Martinez J, Guillen M, Arjonilla E, Hernández M. Bariatric surgery: Metabolic results and complications to 5 years. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1925] [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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Bravo P, Martinez L, Metzger S, Da Costa Noble E, Meckenstock R, Greder-Belan A, Parnet L, Samdjee F, Azan S. [Medication reconciliation in a department of internal medicine and infectious and tropical diseases: Feedback after one year practice]. Rev Med Interne 2018; 40:291-296. [PMID: 30172598 DOI: 10.1016/j.revmed.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 07/03/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
Abstract
Since April 2015, medication reconciliation is performed in our Department. The objective of this study is to assess the impact of this activity on patients' care after one year of practice. METHODS All patients who received medication reconciliation between April-October 2015 and June-December 2016 were included in this retrospective study. Undocumented unintentional discrepancies (DNIND) which result from the comparison between the patient's usual treatments and the medication prescribed at admission were collected. Then, a multidisciplinary discussion was initiated to correct them. The gravity of each DNIND was determined a posteriori. RESULTS A statistical comparison between the two studies (2015 vs. 2016) showed the following significant results: decrease in DNIND (0.9 vs. 0.43), in percentage of patients with at least one DNIND (43% vs 31% P <5.10-6), in reconciliation time (43min vs. 23min) and no significant difference in the distribution of DNIND typology. The main therapeutic classes are: metabolism-diabetes-nutrition (21%), cardiology (18%), pneumology (17%) and neurology-psychiatry (15%). Drugs mainly concerned with DNIND are inhaled anti-asthmatics (13% of the medicines with DNIND), vitamins (8% of DNIND) and the levetiracetam antiepileptic drug (5% of DNIND). CONCLUSION The implementation of the reconciliation medication allowed a significant reduction of the DNIND that permits to improve the patient healthcare pathway.
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Rial Baston V, Jimenez Valero S, Meras Colunga P, Irazusta Cordoba J, Galeote Garcia G, Moreno Gomez R, Sanchez Recalde A, Rosillo Rodriguez S, Iniesta Manjavacas A, Martinez L, Rodriguez Sotelo L, Lopez Sendon JL. P699Facing malignant pericardial effusion. What to do first: pericardiocentesis or percutaneous balloon pericardiotomy? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ascherman DP, Zang Y, Fernandez I, Clark ES, Khan WN, Martinez L, Greidinger EL. An Autoimmune Basis for Raynaud's Phenomenon: Murine Model and Human Disease. Arthritis Rheumatol 2018; 70:1489-1499. [PMID: 29569858 DOI: 10.1002/art.40505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/15/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Raynaud's phenomenon (RP) is common in anti-RNP-positive patients with rheumatic diseases but is not itself known to be caused by autoimmunity. The aim of this study was to assess autoantibodies that could mediate this process. METHODS Antibodies derived from patient sera and from murine models of anti-RNP autoimmunity were screened for the ability to induce RP-like tissue ischemia and endothelial cell apoptosis in murine models and in vitro systems. RESULTS RNP-positive sera from RP patients and murine sera from RNP-positive B cell adoptive transfer recipients induced RP-like tissue ischemia and endothelial cell apoptosis. Proteomic analysis identified cytokeratin 10 (K10) as a candidate autoantigen in RP. Monoclonal anti-K10 antibodies reproduced patterns of ischemic tissue loss and endothelial cell apoptosis; K10 knockout or depletion of anti-K10 activity in serum was protective. Cold exposure enhanced K10 expression and in vivo tissue loss. CONCLUSION Anti-K10 antibodies are sufficient to mediate RP-like ischemia in murine models and are implicated in the pathogenesis of RP in patients with anti-RNP autoimmunity.
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Roussel R, Fontaine P, Gouet D, Serusclat P, Martinez L, Detournay B, Martin-Kristensen M. Le traitement du diabète de type 2 en France est dynamique plutôt qu’inerte : analyse des prescriptions de 847 122 patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1957-2557(18)30096-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Knitter J, Patel SN, Bailey O, Poongkunran C, Flores A, Martinez L, Kobayashi U, Combs D, Parthasarathy S. 0545 Comparison of Performance of Four Adaptive Servo Ventilation Devices In Patients With Complex Sleep Apnea. Sleep 2018. [DOI: 10.1093/sleep/zsy061.544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Martinez L, Demanet J, Mignaux V, Dewavrin F. [Tracheostomy performed in ICU: Professional practice assessment and patient outcome]. Rev Mal Respir 2018; 35:25-35. [PMID: 29395561 DOI: 10.1016/j.rmr.2016.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/06/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Tracheostomy is a commonly performed procedure. The aim of this study was to assess professional practice, describe patient characteristics and examine short and long-term outcomes. METHODS All patients with CCAM GEPA004 code were retrospectively included. RESULTS Two hundred and fourteen (7%) patients who were mecanically ventilated had a tracheostomy performed in intensive care unit (ICU). Median time to tracheostomy was 22 (14-28) days. In total, 95.3% of tracheostomy procedures were surgical. Median age was 58 (48-67) years. Eighty-three (38.8%) tracheostomies were performed for respiratory reasons. Twenty-eight-day and 90-day mortality were 4.2% and 35.5%. One-year mortality was 52.4%. Patients with tracheostomies performed for weaning from mechanical ventilation had a higher mortality rate. After ICU discharge, mortality rate was 29.8% and was higher in non-decannulated patients. Patient characteristics, timing, technique, indication and outcomes were stable over the years. CONCLUSION Young patients weaning from mechanical ventilation were more likely to receive a tracheostomy. More than half died during the first year. Patients discharged from ICU with a tracheostomy tube in place had higher mortality rate.
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Kamekis A, Bertsias A, Moschandreas J, Petelos E, Papadakaki M, Tsiantou V, Saridaki A, Symvoulakis EK, Souliotis K, Papadakis N, Faresjö T, Faresjö A, Martinez L, Agius D, Uncu Y, Sengezer T, Samoutis G, Vlcek J, Abasaeed A, Merkouris B, Lionis C. Patients' intention to consume prescribed and non-prescribed medicines: A study based on the theory of planned behaviour in selected European countries. J Clin Pharm Ther 2017; 43:26-35. [PMID: 28833330 DOI: 10.1111/jcpt.12601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Polypharmacy has a significant impact on patients' health with overall expenditure on over-the-counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC-SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care. METHODS A multicentre, cross-sectional study was designed and implemented in well-defined primary healthcare settings in Cyprus, the Czech Republic, France, Greece, Malta and Turkey. Patients completed a questionnaire constructed on the basis of the theory of planned behaviour (TPB), which was administered via face-to-face interviews. RESULTS AND DISCUSSION The percentage of patients who had consumed prescribed medicines over a 6-month period was consistently high, ranging from 79% in the Czech Republic and 82% in Turkey to 97% in Malta and 100% in Cyprus. Reported non-prescribed medicine consumption ranged from 33% in Turkey to 92% in the Czech Republic and 97% in Cyprus. TPB behavioural antecedents explained 43% of the variability of patients' intention to consume medicines in Malta and 24% in Greece, but only 3% in Turkey. Subjective norm was a significant predictor of the intention to consume medicines in all three countries (Greece, Malta and Turkey), whereas attitude towards consumption was a significant predictor of the expectation to consume medicines, if needed. WHAT IS NEW AND CONCLUSION This study shows that parameters such as patients' beliefs and influence from family and friends could be determining factors in explaining the high rates of medicine consumption. Factors that affect patients' behavioural intention towards medicine consumption may assist in the formulation of evidence-based policy proposals and inform initiatives and interventions aimed at increasing the appropriate use of medicines.
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Sanchez-Gonzalez B, Torres E, Ferraro M, Garcia-Pallarols F, Calafell M, Gale C, Martinez L, Sancho E, Garcia P, Gimeno E, Salar A. SUBCUTANEOUS RITUXIMAB IN B-CELL NON-HODGKIN LYMPHOMA: A SINGLE-CENTER EXPERIENCE. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Bravo P, Martinez L, Meckenstock R, Greder-Belan A, Samdjee F, Azan S. Conciliation médicamenteuse d’entrée en service de médecine interne : retour d’expérience après un an de pratique. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sadeghi B, Kaiser LL, Schaefer S, Tseregounis IE, Martinez L, Gomez-Camacho R, de la Torre A. Multifaceted community-based intervention reduces rate of BMI growth in obese Mexican-origin boys. Pediatr Obes 2017; 12:247-256. [PMID: 27071684 DOI: 10.1111/ijpo.12135] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Latino children and youth have some of the highest rates of overweight and obesity. Early intervention is important to prevent future obesity and illness in this population. METHODS A 3-year, multifaceted intervention was designed to reduce the rate of growth of body mass index (BMI) among Mexican-origin children. Two communities in California's agricultural Central Valley were targeted for intervention and comparison. To assess impact, anthropometric measures of participating children (N = 422) were collected and analysed at baseline and after 1 year of intervention. RESULTS After 1 year of intervention, triceps skin-fold thickness in girls showed a significant decrease in unadjusted analysis between children in the two communities. In multivariate analysis, a reduction in BMI growth was seen among obese boys in the intervention community (ß-coefficient = -1.94, P = 0.05). Obese boys in the intervention community also had a smaller increase in waist circumference (ß-coefficient = -5.2, P = 0.04) than the comparison community. CONCLUSIONS These early findings indicate the intervention's effectiveness for preventing BMI growth among obese boys. Longitudinal follow-up is needed to determine the sustainability of results and whether similar results extend to obese girls and overweight boys or girls.
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Alonso P, Osca J, Pimenta P, Rueda J, Cano O, Andres A, Yague J, Millet J, Sancho-Tello MJ, Martinez L. P964Elegibility for subcutaneous defibrillator in high risk patients with tetralogy of fallot. Europace 2017. [DOI: 10.1093/ehjci/eux151.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Briant N, Chouvelon T, Martinez L, Brach-Papa C, Chiffoleau JF, Savoye N, Sonke J, Knoery J. Spatial and temporal distribution of mercury and methylmercury in bivalves from the French coastline. MARINE POLLUTION BULLETIN 2017; 114:1096-1102. [PMID: 27745976 DOI: 10.1016/j.marpolbul.2016.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 09/29/2016] [Accepted: 10/05/2016] [Indexed: 06/06/2023]
Abstract
Marine mercury (Hg) concentrations have been monitored in the French coastline for the last half a century using bivalves. The analyses presented in this study concerned 192 samples of bivalves (mussels: Mytilus edulis and Mytilus galloprovincialis and oysters: Crassostrea gigas and Isognomon alatus) from 77 sampling stations along the French coast and in the French Antilles sea. The goals of this study were to assess MeHg levels in various common bivalves from French coastline, and to identify possible geographic, taxonomic or temporal variations of concentrations. We show that the evolution of methylmercury (MeHg) concentrations covary with total mercury (HgT) concentrations. Moreover, in most of the study sites, HgT concentrations have not decreased since 1987, despite regulations to decrease or ban mercury used for anthropic activities.
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Martinez L, Pitta F. A pulmonary index able to predict peripheral muscle function in COPD. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 23:1-2. [PMID: 28011115 DOI: 10.1016/j.rppnen.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Van Driessche S, Billuart F, Martinez L, Brunel H, Guiffault P, Beldame J, Matsoukis J. Short-term comparison of postural effects of three minimally invasive hip approaches in primary total hip arthroplasty: Direct anterior, posterolateral and Röttinger. Orthop Traumatol Surg Res 2016; 102:729-34. [PMID: 27289199 DOI: 10.1016/j.otsr.2016.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is renewed interest in total hip arthroplasty (THA) with the development of minimally invasive approaches. The anterior and Röttinger approaches are attractive for their anatomical and minimally invasive character, but with no comparative studies in the literature definitely suggesting superiority in terms of quality of functional recovery. We therefore performed a case-control study, assessing: 1) whether the postural parameters of patients operated on with the anterior, Röttinger and posterior minimally invasive approaches were similar to those of asymptomatic subjects, and 2) whether there were any differences in postural parameters between the three approaches at short-term follow-up. HYPOTHESIS We hypothesized that the anterior and Röttinger approaches are less disruptive of postural parameters than the posterior approach. METHODS Seventy subjects (44 primary THA patients and 26 asymptomatic control subjects) were enrolled. Operated subjects were divided into 3 experimental groups corresponding to the 3 minimally invasive approaches: posterior (n=14), anterior (n=15) and Röttinger (n=15). Two single-leg stance tests (left followed by right leg stance; 10s per test) were carried out on a stabilometric platform, within 2months after surgery for all THA patients, and for controls. Six significant parameters were selected for statistical analysis: test performance, mediolateral and anteroposterior displacements of the center of pressure (CP), path length, average CP displacement speed, and the ellipse containing 95% of CP projections. Non-parametric statistical tests were used to compare groups. RESULTS There was no difference between the 3 study groups and the control group according to age, gender, BMI, or side (or between study groups regarding WOMAC score). No significant differences between approaches were found for success on postural tests (P=0.14). Subjects operated on with the anterior or Röttinger approach showed significant differences from asymptomatic subjects for 2 postural parameters: path length (Röttinger P=0.04, anterior P=0.03) and average CP displacement speed (Röttinger P=0.04, anterior P=0.03). Subjects operated on through the posterior approach showed no significant differences from asymptomatic subjects. DISCUSSION The study hypothesis, that the anterior and Röttinger approaches for hip arthroplasty are less disruptive of postural parameters than the posterior approach, was not confirmed. The anterior and Röttinger approach groups showed higher average CP displacement speed and path length, suggesting that they use up more energy resources to maintain static balance. The posterior approach had the least impact on postural parameters in the first 2 postoperative months. LEVEL OF EVIDENCE III, case-control study.
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Hernandez-Castillo CR, Vaca-Palomares I, Barrios F, Martinez L, Boll MC, Fernandez-Ruiz J. Ataxia Severity Correlates with White Matter Degeneration in Spinocerebellar Ataxia Type 7. AJNR Am J Neuroradiol 2016; 37:2050-2054. [PMID: 27516240 DOI: 10.3174/ajnr.a4903] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/26/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE There is a scarcity of information on the effect of white matter degeneration in patients with spinocerebellar ataxia type 7. Therefore, we investigated the WM integrity in a large group of patients with spinocerebellar ataxia type 7 by using Tract-Based Spatial Statistics. MATERIALS AND METHODS Thirty-three patients with a molecular diagnosis of spinocerebellar ataxia type 7 and their age- and sex-matched healthy controls participated in this study. The patients' ataxia severity was evaluated with the Scale for the Assessment and Rating of Ataxia. Voxelwise analyses of diffusion metrics, including fractional anisotropy and mean diffusivity, were performed with Tract-Based Spatial Statistics. The correlation between WM abnormalities and ataxia severity was then calculated. RESULTS Tract-Based Spatial Statistics analysis revealed WM abnormalities in the cerebellum and the cerebellar peduncles, as well as in other major cortical and subcortical pathways. Further analysis between the Scale for the Assessment and Rating of Ataxia score and WM mean diffusivity showed significant associations only in key areas related to motor control and visuospatial processing, including the cerebellar WM, the middle occipital WM, the superior cerebellar peduncle, and bilateral anterior thalamic radiation. No significant associations between fractional anisotropy and the Scale for the Assessment and Rating of Ataxia were found. CONCLUSIONS These results suggest a significant contribution of local cerebellar and cerebellar-midbrain connections to ataxic impairment in spinocerebellar ataxia type 7. The results also suggest an involvement of cortical WM abnormalities including tracts within the occipital and frontal cortices. These findings contribute to a more comprehensive view of the clinical impact of the white matter degeneration in spinocerebellar ataxia type 7.
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Fenton JJ, Warner ML, Lammertse D, Charlifue S, Martinez L, Dannels-McClure A, Kreider S, Pretz C. A comparison of high vs standard tidal volumes in ventilator weaning for individuals with sub-acute spinal cord injuries: a site-specific randomized clinical trial. Spinal Cord 2016; 54:245. [PMID: 26935654 DOI: 10.1038/sc.2015.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Flipo RM, Martinez L, Maigret P, Reach G. FRI0145 Management of gout in Primary Care: What Are The Factors Associated with Adherence? Results from The Adagio Cohort. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kaiser M, Kretzschmar Y, Kienhöfer J, Gautier JF, Penfornis A, Charpentier G, Martinez L, Eschwège E, Gourdy P. Der Anteil der Patienten, die mit Liraglutid erfolgreich behandelt wurden – Ergebnisse einer Post-hoc-Analyse der EVIDENCE-Studie. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kahveci Z, Vázquez-Guilló R, Mira A, Martinez L, Falcó A, Mallavia R, Mateo CR. Selective recognition and imaging of bacterial model membranes over mammalian ones by using cationic conjugated polyelectrolytes. Analyst 2016; 141:6287-6296. [DOI: 10.1039/c6an01427e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This work describes the use of cationic polyfluorenes as fluorescent markers to selectively recognize bacterial membranes.
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Fenton JJ, Warner ML, Lammertse D, Charlifue S, Martinez L, Dannels-McClure A, Kreider S, Pretz C. A comparison of high vs standard tidal volumes in ventilator weaning for individuals with sub-acute spinal cord injuries: a site-specific randomized clinical trial. Spinal Cord 2015; 54:234-8. [DOI: 10.1038/sc.2015.145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/17/2015] [Accepted: 07/09/2015] [Indexed: 11/09/2022]
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Gastaca M, Matarranz A, Martinez L, Valdivieso A, Ruiz P, Ventoso A, Fernandez JR, Palomares I, Prieto M, Suarez MJ, Ortiz de Urbina J. Risk factors for biliary complications after orthotopic liver transplantation with T-tube: a single-center cohort of 743 transplants. Transplant Proc 2015; 46:3097-9. [PMID: 25420833 DOI: 10.1016/j.transproceed.2014.09.173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite recent advances in organ preservation, surgical procedures, and immunosuppression, biliary reconstruction after orthotopic liver transplantation (OLT) remains as a major source of morbidity. The purpose of this study was to identify risk factors for the development of biliary complications (BCs) after end-to-end choledochocholedochostomy (EE-CC) with a T-tube as the standard technique for biliary reconstruction after OLT. METHODS A total of 833 consecutive liver transplantations that took place from February 1996 to April 2010 were retrospectively reviewed. Patients with concomitant hepatic artery complications were excluded, as were those who underwent urgent retransplantation or died within 1 week after transplantation. Finally, the study group comprised 743 patients. RESULTS The overall BC rate was 9.8% (73 patients), including stricture in 19 patients (2.6%) and bile leakage in 39 patients (5.2%). After univariate analysis, significant risk factors for BCs were surgery time >5 hours, arterial ischemia time >30 minutes, use of a classic transplant technique, transfusion of red blood cells ≥5 units, anti-cytomegalovirus treatment, and period of transplantation between 1996 and 2002. Stepwise logistic regression study was performed, including those variables with a value of P <.200. Multivariate analysis showed that pretransplant serum creatinine (odds ratio = 1.27; 95% confidence interval [CI], 1.03-1.57; P = .025) and arterial ischemia time >30 minutes (odds ratio = 2.44; 95% CI, 1.45-4.12; P = .001) were the only independent risk factors related to the development of BCs after biliary reconstruction with the T-tube. CONCLUSIONS The performance of different variables in predicting occurrence of BCs was assessed with the use of receiver operating characteristic analysis. The area under the receiver operating characteristic curve of our model was 0.637 (95% CI, 0.564-0.710), and therefore we must conclude that other variables not included in our model may have influence in the development of BCs after OLT with an EE-CC with a T-tube as the procedure for biliary reconstruction.
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Gourdy P, Penfornis A, Charpentier G, Martinez L, Eschwège E, Madani S, Kienhöfer J, Kretzschmar Y, Gautier JF. Wirksamkeit und Verträglichkeit von Liraglutid bei Patienten mit Typ 2 Diabetes: 2-Jahresdaten der prospektiven EVIDENCE-Beobachtungsstudie. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549745] [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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Carpintero MF, Martinez L, Fernandez I, Romero ACG, Mejia C, Zang YJ, Hoffman RW, Greidinger EL. Diagnosis and risk stratification in patients with anti-RNP autoimmunity. Lupus 2015; 24:1057-66. [PMID: 25736140 DOI: 10.1177/0961203315575586] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/05/2015] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Anti-RNP autoantibodies occur either in mixed connective tissue disease (MCTD) (with a frequently favorable prognosis), or in systemic lupus erythematosus (SLE) cases with aggressive major organ disease. It is uncertain how to assess for the risk of severe disease in anti-RNP + patients. METHODS Following institutional review board-approved protocols, clinical data and blood were collected from patients with known or suspected anti-RNP autoimmunity and normal controls in a cohort study. Samples were screened for parameters of immune activation. Groups were compared based on clinical diagnoses, disease classification criteria, disease activity and specific end-organ clinical manifestations. RESULTS Ninety-seven per cent of patients satisfying Alarcon-Segovia MCTD criteria also met Systemic Lupus International Collaborating Clinic (SLICC) SLE criteria, while 47% of the anti-RNP + SLE patients also met MCTD criteria. Among SLICC SLE patients, MCTD criteria were associated with reduced rates of renal disease (odds ratio (OR) 4.3, 95% confidence interval (CI) 1.3-14.0), increased rates of Raynaud's phenomenon (OR 3.5, 95% CI 1.3-9.5) and increased serum B-cell maturation antigen, transmembrane activator and CAML interactor and TNFα levels. Circulating immune markers and markers of type I interferon activation were not effective at distinguishing clinical subgroups. CONCLUSIONS Among anti-RNP patients, the question of MCTD versus SLE is not either/or: most MCTD patients also have lupus. MCTD classification criteria (but not a broad set of immune markers) distinguish a subset of SLE patients at reduced risk for renal disease.
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