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Nova E, Lopez-Vidriero I, Varela P, Casas J, Marcos A. Evolution of serum biochemical indicators in anorexia nervosa patients: a 1-year follow-up study. J Hum Nutr Diet 2008; 21:23-30. [PMID: 18184391 DOI: 10.1111/j.1365-277x.2007.00833.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term studies on the evolution of serum biochemical indicators in anorexia nervosa (AN) patients during treatment are lacking in the literature. Thus, a 1-year follow-up of serum biochemical parameters in a homogeneous group of AN patients was performed. METHODS Fourteen restricting-type AN patients were studied on admission to hospital, after 1 month of inpatient treatment and after 6 and 12 months after admission. RESULTS Red blood cell count (RBC) and haemoglobin, serum glucose, total protein and the enzyme activities aspartate aminotransferase (AST), alkaline phosphatase (AlP), lactate dehydrogenase (LDH) and creatine kinase (CK) were significantly lower in patients on admission than in the control group. Total protein, high-density lipoprotein cholesterol (HDL-c), AST, AlP and CK showed significant changes among time points (anova, P < 0.05). Significant correlations were found between the change in RBC, haemoglobin, haematocrit, and the change in weight and body mass index (r = 0.74-0.86; P < 0.01). High cholesterol and amylase activity were found at all time points. While AST, LDH and CK reached control values within 6 months of treatment, AlP was always lower. CONCLUSION Serum AlP, hypercholesterolaemia and RBC seem to need longer periods of treatment with further weight gain to fully normalize. Therefore, these parameters should be monitored in AN patients long-term follow-up.
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Moreno LA, González-Gross M, Kersting M, Molnár D, de Henauw S, Beghin L, Sjöström M, Hagströmer M, Manios Y, Gilbert CC, Ortega FB, Dallongeville J, Arcella D, Wärnberg J, Hallberg M, Fredriksson H, Maes L, Widhalm K, Kafatos AG, Marcos A. Assessing, understanding and modifying nutritional status, eating habits and physical activity in European adolescents: The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr 2008; 11:288-99. [PMID: 17617932 DOI: 10.1017/s1368980007000535] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesTo identify the main knowledge gaps and to propose research lines that will be developed within the European Union-funded ‘Healthy Lifestyle in Europe by Nutrition in Adolescence’ (HELENA) project, concerning the nutritional status, physical fitness and physical activity of adolescents in Europe.DesignReview of the currently existing literature.ResultsThe main gaps identified were: lack of harmonised and comparable data on food intake; lack of understanding regarding the role of eating attitudes, food choices and food preferences; lack of harmonised and comparable data on levels and patterns of physical activity and physical fitness; lack of comparable data about obesity prevalence and body composition; lack of comparable data about micronutrient and immunological status; and lack of effective intervention methodologies for healthier lifestyles.ConclusionsThe HELENA Study Group should develop, test and describe harmonised and state-of-the-art methods to assess the nutritional status and lifestyle of adolescents across Europe; develop and evaluate an intervention on eating habits and physical activity; and develop and test new healthy food products attractive for European adolescents.
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Shapiro R, Ellis D, Tan HP, Moritz ML, Basu A, Vats AN, Kayler LK, Erkan E, McFeaters CG, James G, Grosso MJ, Zeevi A, Gray EA, Marcos A, Starzl TE. Alemtuzumab pre-conditioning with tacrolimus monotherapy in pediatric renal transplantation. Am J Transplant 2007; 7:2736-8. [PMID: 17908272 PMCID: PMC2952494 DOI: 10.1111/j.1600-6143.2007.01987.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We employed antibody pre-conditioning with alemtuzumab and posttransplant immunosuppression with low-dose tacrolimus monotherapy in 26 consecutive pediatric kidney transplant recipients between January 2004 and December 2005. Mean recipient age was 10.7 +/- 5.8 years, 7.7% were undergoing retransplantation, and 3.8% were sensitized, with a PRA >20%. Mean donor age was 32.8 +/- 9.2 years. Living donors were utilized in 65% of the transplants. Mean cold ischemia time was 27.6 +/- 6.4 h. The mean number of HLA mismatches was 3.3 +/- 1.3. Mean follow-up was 25 +/- 8 months. One and 2 year patient survival was 100% and 96%. One and 2 year graft survival was 96% and 88%. Mean serum creatinine was 1.1 +/- 0.6 mg/dL, and calculated creatinine clearance was 82.3 +/- 29.4 mL/min/1.73 m(2). The incidence of pre-weaning acute rejection was 11.5%; the incidence of delayed graft function was 7.7%. Eighteen (69%) of the children were tapered to spaced tacrolimus monotherapy, 10.5 +/- 2.2 months after transplantation. The incidence of CMV, PTLD and BK virus was 0%; the incidence of posttransplant diabetes was 7.7%. Although more follow-up is clearly needed, antibody pre-conditioning with alemtuzumab and tacrolimus monotherapy may be a safe and effective regimen in pediatric renal transplantation.
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Silveira FP, Husain S, Kwak EJ, Linden PK, Marcos A, Shapiro R, Fontes P, Marsh JW, de Vera M, Tom K, Thai N, Tan HP, Basu A, Soltys K, Paterson DL. Cryptococcosis in liver and kidney transplant recipients receiving anti-thymocyte globulin or alemtuzumab. Transpl Infect Dis 2007; 9:22-7. [PMID: 17313467 DOI: 10.1111/j.1399-3062.2006.00149.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Rabbit anti-thymocyte globulin (ATG) and alemtuzumab have been used for induction or preconditioning and for the treatment of acute rejection in organ transplant recipients in many centers. Such regimens may lead to a substantial decline in the CD4 lymphocyte count to levels seen in other population groups at high risk of cryptococcosis. In view of this, we examined the impact of such therapy on the cumulative incidence of cryptococcosis among liver and kidney recipients. A total of 834 liver and 727 kidney transplants were performed during the study period. Seven hundred and eighty-one patients did not receive ATG or alemtuzumab; 646 received 1 dose of either drug, and 134 patients received 2 doses of either drug. The cumulative incidence of cryptococcosis was 0.26% (2/781) among those who did not receive ATG or alemtuzumab; 0.3% (2/646) among those who received only 1 dose, and 2.24% (3/134) among those who received 2 doses (P=0.03). There were 5 cases of cryptococcosis in liver recipients and 2 in kidney recipients. There were 3 cases of cryptococcal meningitis, 3 of pneumonia, and 1 of disseminated disease. The 2 kidney recipients had meningitis. Diagnosis occurred at a median of 255 days (range 7-517) after transplantation. The mortality rate was 14.2%. We conclude that the use of 1 dose of ATG or alemtuzumab is not associated with an increased cumulative incidence of cryptococcosis, but that those patients receiving 2 doses are at increased risk.
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Posadas P, Fernández A, Brasero J, Valentín JL, Marcos A, Rodríguez A, González L. Vulcanization of polybutadiene rubber with dipentamethylene thiuram tetrasulfide. J Appl Polym Sci 2007. [DOI: 10.1002/app.27026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Moreno LA, Mesana MI, González-Gross M, Gil CM, Ortega FB, Fleta J, Wärnberg J, León J, Marcos A, Bueno M. Body fat distribution reference standards in Spanish adolescents: the AVENA Study. Int J Obes (Lond) 2007; 31:1798-805. [PMID: 17607324 DOI: 10.1038/sj.ijo.0803670] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To present body fat patterning reference standards to identify children with a predominant distribution of body fat in the abdominal or truncal region of the body. DESIGN Cross-sectional study in a representative sample of Spanish adolescents aged 13-18 years. SUBJECTS A total of 2160 adolescents with a complete set of anthropometric measurements (1109 males and 1051 females). MEASUREMENTS Weight, height, body mass index, skinfold thickness (biceps, triceps, subscapular, suprailiac, thigh, calf) and waist and hip circumferences. RESULTS In the majority of the age groups, subscapular/triceps skinfolds ratio, trunk-to-total skinfolds percent (TTS%)and waist circumference values were significantly higher in males than in females; hip circumference was higher in females than in males, except at 15.5 years. In males, age showed a significant effect for all the body fat distribution indices; however, in females, the effect was only significant for triceps skinfold, waist and hip circumferences and waist-to-hip ratio. Smoothed age- and sex-specific triceps skinfold, subscapular skinfold, subscapular/triceps skinfolds ratio, TTS%, waist circumference and hip circumference, waist-to-hip and waist-to-height ratio percentile values for male and female adolescents have been established. CONCLUSION These reference data for waist circumference and the other fat patterning indices, together with data from other countries, will help to establish international central obesity criteria for adolescents. The presented percentile values will give the possibility to estimate the proportion of adolescents with high or low regional adiposity amounts.
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Romeo J, Wärnberg J, Díaz LE, González-Gross M, Marcos A. Effects of moderate beer consumption on first-line immunity of healthy adults. J Physiol Biochem 2007; 63:153-9. [DOI: 10.1007/bf03168226] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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De Henauw S, Gottrand F, De Bourdeaudhuij I, Gonzalez-Gross M, Leclercq C, Kafatos A, Molnar D, Marcos A, Castillo M, Dallongeville J, Gilbert CC, Bergman P, Widhalm K, Manios Y, Breidenassel C, Kersting M, Moreno LA. Nutritional status and lifestyles of adolescents from a public health perspective. The HELENA Project—Healthy Lifestyle in Europe by Nutrition in Adolescence. J Public Health (Oxf) 2007. [DOI: 10.1007/s10389-007-0107-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Basu A, Falcone JL, Tan HP, Hassan D, Dvorchik I, Bahri K, Thai N, Randhawa PS, Marcos A, Starzl TE, Shapiro R. Chronic allograft nephropathy score before sirolimus rescue predicts allograft function in renal transplant patients. Transplant Proc 2007; 39:94-8. [PMID: 17275482 PMCID: PMC2963426 DOI: 10.1016/j.transproceed.2006.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Indexed: 12/21/2022]
Abstract
Chronic allograft nephropathy (CAN) is a major indication for initiation of sirolimus (SRL) in renal transplantation (TX) to prevent deterioration of renal function. We evaluated whether the CAN score at time of sirolimus rescue (SRL-R) predicts renal allograft function. CAN score is the sum of the following 4 categories: glomerulopathy (cg, 0-3), interstitial fibrosis (ci, 0-3), tubular atrophy (ct, 0-3), and vasculopathy (cv, 0-3). This is a retrospective cohort study of renal transplant recipients from July 2001 to March 2004. Immunosuppression consisted of preconditioning with rabbit anti-thymocyte globulin or alemtuzumab and maintenance with tacrolimus (TAC) monotherapy with spaced weaning, if applicable, SRL-R was achieved by conversion from TAC, or by addition to reduced doses of TAC. Ninety patients received SRL. Thirty-three of these patients met the inclusion criteria of the following: (1) receipt of SRL for >6 months, and (2) follow-up of > or =6 months. There were 16 patients in the low-CAN (0-4) group and 17 patients in the high-CAN (>4) group. Cockcroft-Gault (C-G) glomerular filtration rate (GFR) was calculated at SRL-R and at 1, 3, 6, and 12 months. The DeltaGFR was significantly better in the low-CAN group at 1, 3, and 6 months. A trend toward an improved DeltaGFR was present at 12 months in the low-CAN group (P = .16). CAN scoring at the time of SRL-R predicts recovery of renal allograft function (as measured using DeltaGFR), and should be used in preference to biochemical markers (Cr and C-G GFR), which may not be reliable predictors.
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Gruttadauria S, Marsh JW, Cintorino D, Biondo D, Luca A, Arcadipane A, Vizzini G, Volpes R, Marcos A, Gridelli B. Adult to adult living-related liver transplant: report on an initial experience in Italy. Dig Liver Dis 2007; 39:342-50. [PMID: 17337259 DOI: 10.1016/j.dld.2007.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 12/21/2006] [Accepted: 01/09/2007] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Living-related liver transplantation has become the treatment of choice for many liver diseases. We present our initial analysis of 53 cases of adult to adult living-related liver transplantation performed in a single institute in Italy. MATERIALS AND METHODS From January 2002 to September 2006, we performed 53 adult to adult living-related liver transplantations. The donors (age 18-53) all had genetic or emotional relationships; they were all ABO identical or compatible. Recipients (ages 18-68) suffered from cirrhosis secondary to viral etiology (18), hepatocellular carcinoma with viral cirrhosis (24), cystic fibrosis (2), primary biliary cirrhosis (2), hepatocellular carcinoma with non-viral cirrhosis (2), alcoholic cirrhosis (1), ornithine transcarbamylase deficiency (OTC), (1) criptogenic cryptogenic cirrhosis, (1) primary sclerosing cholangitis, (1) biliary atresia and metastatic carcinoid (1). Donor liver resection resulted in 51 right hepatectomies and two left hepatectomies. Graft body weight ratio was always above 0.8%; graft implantation was performed with the piggy back technique and, in 43 cases, with the use of veno-venous bypass. RESULTS There was neither donor mortality nor need of blood transfusion. Actuarial recipient survival rate at 3 years was 82.66% and graft survival rate was 75.34%. Six patients underwent retransplantation: in four cases due to hepatic artery thrombosis, and in two, due to graft dysfunction. Three patients had one episode each of acute cellular rejection. CONCLUSION Adult to adult living-related liver transplantation represents a resource to be used in confronting organ shortage, and is a valuable option for decreasing mortality and drop out from the waiting list.
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Gruttadauria S, Mandalà L, Biondo D, Spampinato M, Lamonaca V, Volpes R, Vizzini G, Marsh JW, Marcos A, Gridelli B. Role of basiliximab in the prevention of acute cellular rejection in adult to adult living-related liver transplantation: a single center experience. Biologics 2007; 1:69-73. [PMID: 19707350 PMCID: PMC2721340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report our single center experience with the use of basiliximab, a chimeric monoclonal antibody directed against the alpha chain of the interleukin-2 (IL-2) receptor (CD25), in combination with a steroid- and tacrolimus-based regimen in adult to adult living-related liver transplantation (ALRLT). Sixty consecutive ALRLTs were analyzed. All patients received two 20-mg doses of basiliximab (days 0 and 4 after transplantation) followed by tacrolimus (0.15 mg/kg/day; 10-15 ng/mL target trough levels) and a dose regimen of steroids (starting with 20 mg iv, switched to po as soon as the patient was able to eat, and weaned off within 1-2 months). Follow-up ranged from 6 to 1699.4 days after transplantation (mean 517.5 days, SD +/- 413.4; median 424 days). Of the recipients, 95% remained rejection-free during follow-up, with an actuarial rejection-free probability of 96.61% within 3 months. Three patients had episodes of biopsy-proven acute cellular rejection (ACR). Actuarial patient and graft survival rates at 3 years were 82.09% and 75.61%. Six patients (10%) experienced sepsis. There was no evidence of cytomegalovirus infections or side-effects related to the basiliximab. We found zero de novo malignancy, although we observed 5 patients with metastatic spread of their primary malignancy during the follow-up. Basiliximab in association with tacrolimus and steroids is effective in reducing episodes of ACR and increasing ACR-free survival after ALRLT.
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Romeo J, González-Gross M, Wärnberg J, Díaz LE, Marcos A. [Does beer have an impact on weight gain? Effects of moderate beer consumption on body composition]. NUTR HOSP 2007; 22:223-8. [PMID: 17416040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND The effects of alcohol consumption on body weight have been evaluated in a large number of studies suggesting to be inversely as well as positively related to body weight and body fat. OBJECTIVE This study examined the relationships between moderate beer consumption and anthropometrical parameters in Spanish healthy adults. METHOD After a 30 day alcohol abstemious period, 58 healthy volunteers were submitted to a daily moderate consumption of beer during the following 30 days. Weight, height, skinfolds and circumferences were measured at three points: (a) basal; (b) abstemious and (c) after moderate consumption of beer. RESULTS Biceps skinfold (mm) increased (p < 0.05) in men after moderate beer consumption in regard to abstinence period (5.74 +/- 1.70 vs. 6.23 +/- 1.74). No significant differences were observed in the rest of anthropometrical parameters studied in both women and men along the study intervention. CONCLUSION Moderate beer consumption during one month did not mostly change weight and weight-related parameters in healthy adults.
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Siliani M, López-Manchado MA, Valentín JL, Arroyo M, Marcos A, Khayet M, Villaluenga JPG. Millable polyurethane/organoclay nanocomposites: preparation, characterization, and properties. JOURNAL OF NANOSCIENCE AND NANOTECHNOLOGY 2007; 7:634-40. [PMID: 17450806 DOI: 10.1166/jnn.2007.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Novel millable polyurethane (PU)/organoclay nanocomposites have been successfully prepared by conventional transformation techniques. One natural (C6A) and two organically modified (C15A and C30B) montmorillonites have been used as clays for preparing PU nanocomposites. The optimum dispersion of nanofiller at a nanometer scale in PU matrix was confirmed by X-ray diffraction patterns and transmission electron microscopy. A substantial improvement of the PU properties by addition of only a small amount of organoclay was observed. It is worthy to note that the organoclays show a different interfacial interaction with the PU matrix, which was reflected in different macroscopic properties. Thus, C30B organoclay seems to react with PU chains to form covalent bonds, while C15A only interacts physically with PU chains. Mechanical and barrier properties are analyzed.
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Lucas M, Suarez R, Marcos A, Solano F, Venegas A, Garcia-Sanchez MI, Ortiz L, Izquierdo G. Arg113His mutation of vanishing white matter is not present in multiple sclerosis. Mult Scler 2007; 13:424-7. [PMID: 17439913 DOI: 10.1177/1352458506070248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vanishing white matter (VWM) is a childhood leukoencephalopathy with central hypomyelination, white matter rarefaction, and cystic degeneration. Adult onset, variable phenotype, and high frequency characterize Arg113His mutation caused by G338A polymorphism associated with VWM. A patient with trauma-associated onset, and clinical features compatible with multiple sclerosis (MS), was homozygous for G338A mutation of eukaryotic translation initiation factor (eIF2B5). The authors checked a cohort of 101 MS patients, including 19 with head/neck trauma-associated onset, and failed to find the mutation, described above, in MS chromosomes. Our report does not exclude the presence in MS chromosomes of other mutations in the eIF2B gene family. Multiple Sclerosis 2007; 13: 424-427. http://msj.sagepub.com
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Ruiz JR, Ortega FB, Tresaco B, Wärnberg J, Mesa JL, González-Gross M, Moreno LA, Marcos A, Gutiérrez A, Castillo MJ. Serum lipids, body mass index and waist circumference during pubertal development in Spanish adolescents: the AVENA Study. Horm Metab Res 2006; 38:832-7. [PMID: 17163360 DOI: 10.1055/s-2006-956503] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To describe the effects of chronological age and biological age (pubertal development) on serum lipid and lipoprotein levels, body mass index (BMI) and waist circumference in Spanish adolescents. METHODS A representative Spanish sample of 526 adolescents (254 males and 272 females), were studied. Total cholesterol (TC), high density lipoprotein cholesterol (HDLc), triglycerides, apolipoprotein A1 and B, and lipoprotein(a) were measured, and low density lipoprotein cholesterol (LDLc) was calculated. Additional measurements included BMI and waist circumference. Adolescents were classified according to chronological age, and pubertal development (also age of menarche in females). RESULTS In males, serum TC levels were lower at late puberty in comparison with early puberty, and serum LDLc levels were lower at late puberty in comparison with mid and early puberty. Serum HDLc levels were lower at mid puberty in comparison with early and late puberty. Serum TC and LDLc levels were not different when analyzed according to chronological age. In females, HDLc levels were lower at late puberty in comparison with early and mid puberty, but no differences were found when HDLc and the other studied lipid and lipoprotein variables were analyzed according to chronological age, or age of menarche. All the observed differences persisted after adjusting for BMI and waist circumference. In female adolescents, both BMI and waist circumference were higher at late puberty in comparison with early and mid puberty, while in males, BMI and waist circumference were different when analyzed according to chronological age. CONCLUSION The results suggest that the assessment of pubertal development may provide additional valuable information when interpreting lipid profile and body fat in adolescents.
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de Vera ME, Dvorchik I, Tom K, Eghtesad B, Thai N, Shakil O, Marcos A, Demetris A, Jain A, Fung JJ, Ragni MV. Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. Am J Transplant 2006; 6:2983-93. [PMID: 17062005 DOI: 10.1111/j.1600-6143.2006.01546.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Although liver transplantation (LTx) in HIV-positive patients receiving highly active antiretroviral therapy (HAART) has been successful, some have reported poorer outcomes in patients coinfected with hepatitis C virus (HCV). Here we discuss the impact of recurrent HCV on 27 HIV-positive patients who underwent LTx. HIV infection was well controlled post-transplantation. Survival in HIV-positive/HCV-positive patients was shorter compared to a cohort of HIV-negative/HCV-positive patients matched in age, model for end-stage liver disease (MELD) score, and time of transplant, with cumulative 1-, 3- and 5-year patient survival of 66.7%, 55.6% and 33.3% versus 75.7%, 71.6% and 71.6%, respectively, although not significantly (p = 0.07), and there was a higher likelihood of developing cirrhosis or dying from an HCV-related complication in coinfected subjects (RR = 2.6, 95% CI, 1.06-6.35; p = 0.03). Risk factors for poor survival included African-American race (p = 0.02), MELD score > 20 (p = 0.05), HAART intolerance postLTx (p = 0.01), and postLTx HCV RNA > 30000000 IU/mL (p = 0.00). Recurrent HCV in 18 patients was associated with eight deaths, including three from fibrosing cholestatic hepatitis. Among surviving coinfected recipients, five are alive at least 3 years after LTx, and of 15 patients treated with interferon-alpha/ribavirin, six (40%) are HCV RNA negative, including four with sustained virological response. Hepatitis C is a major cause of graft loss and patient mortality in coinfected patients undergoing LTx.
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Gruttadauria S, Mandala' L, Cintorino D, Biondo D, Panarello G, Verzaro R, Spada M, Marsh J, Marcos A, Gridelli B. L/I-2 Living related liver transplants: preliminary report on an initial experience in Italy. Clin Transplant 2006. [DOI: 10.1111/j.1399-0012.2006.00577_3_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tan HP, Kaczorowski DJ, Basu A, Unruh M, McCauley J, Wu C, Donaldson J, Dvorchik I, Kayler L, Marcos A, Randhawa P, Smetanka C, Starzl TE, Shapiro R. Living donor renal transplantation using alemtuzumab induction and tacrolimus monotherapy. Am J Transplant 2006; 6:2409-17. [PMID: 16889606 PMCID: PMC3154761 DOI: 10.1111/j.1600-6143.2006.01495.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Alemtuzumab was used as an induction agent in 205 renal transplant recipients undergoing 207 living donor renal transplants. All donor kidneys were recovered laparoscopically. Postoperatively, patients were treated with tacrolimus monotherapy, and immunosuppression was weaned when possible. Forty-seven recipients of living donor renal transplants prior to the induction era who received conventional triple drug immunosuppression without antibody induction served as historic controls. The mean follow-up was 493 days in the alemtuzumab group and 2101 days in the historic control group. Actuarial 1-year patient and graft survival were 98.6% and 98.1% in the alemtuzumab group, compared to 93.6% and 91.5% in the control group, respectively. The incidence of acute cellular rejection (ACR) at 1 year was 6.8% in the alemtuzumab group and 17.0% (p < 0.05) in the historic control group. Most (81.3%) episodes of ACR in the alemtuzumab group were Banff 1 (a or b) and were sensitive to steroid pulses for the treatment of rejection. There was no cytomegalovirus disease or infection. The incidence of delayed graft function was 0%, and the incidence of posttransplant insulin-dependent diabetes mellitus was 0.5%. This study represents the largest series to date of live donor renal transplant recipients undergoing alemtuzumab induction, and confirms the short-term safety and efficacy of this approach.
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Tan H, Marsh J, Tom K, Thai N, Shaw-Stiffel T, Lopez R, Boig L, Caponi T, Starzl T, Marcos A. L/I-12 Living donor hepatectomies: program experience and lessons learned. Clin Transplant 2006. [DOI: 10.1111/j.1399-0012.2006.00577_3_12.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gómez S, Marcos A. [A comprehensive approach to treating adolescent obesity]. REVISTA DE MEDICINA DE LA UNIVERSIDAD DE NAVARRA 2006; 50:23-5. [PMID: 17424765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Obesity started to appear as a public health problem at the end of the 20th century; however, it is currently acquiring epidemic dimensions. In most cases this pathology is the result of inappropriate eating habits, which are becoming a major dietary, psychological and social problem in developed countries. In fact, the most serious consequences of obesity in adolescence appear in adulthood. Eating behavior should be conceived in an all-round perspective, including the interaction of the characteristics of the subject (biological, psychological, cultural), with the food the subject can easily access and the environment around him/her (especially peer-group and advertising pressure). In view of these conditions, it remains clear that the treatment of these patients should be individual and integral. In order to obtain a good prognosis in obese adolescents, not just weight loss through restricting their diet, an increase in physical activity should be encouraged, as well as a behavioral change affecting whole lifestyle habits. To this end, an adequate psychological monitoring is essential.
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Tan H, Tom K, Thai N, Marsh J, Shaw-Stiffel T, Fontes P, DeVera M, Daily M, Donaldson J, Starzl T, Marcos A. L/I-4 Living donor liver transplants with alemtuzumab induction and steroid-free tacrolimus monotherapy. Clin Transplant 2006. [DOI: 10.1111/j.1399-0012.2006.00577_3_4.x] [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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97
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Gruttadauria S, Cintorino D, Piazza T, Mandala L, Doffria E, Musumeci A, Di Trapani G, Arcadipane A, Scianna G, Spada M, Verzaro R, Volpes R, Vizzini G, Palazzo U, Minervini M, Marsh JW, Marcos A, Gridelli B. A Safe Immunosuppressive Protocol in Adult-to-Adult Living Related Liver Transplantation. Transplant Proc 2006; 38:1106-8. [PMID: 16757278 DOI: 10.1016/j.transproceed.2006.02.141] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In this series of 32 adult-to-adult living related liver transplantations, we assessed the efficacy and safety of basiliximab in combination with a tacrolimus-based regimen. Basiliximab, a chimeric monoclonal antibody directed against the alpha chain of the interleukin-2 (IL-2) receptor (CD25), has been extensively evaluated as induction therapy for cadaveric liver transplant recipients. PATIENTS AND METHODS Thirty-two adult-to-adult living related liver transplantations were performed in the last 3 years. All patients received two 20 mg doses of basiliximab (days 0 and 4 posttransplantation) followed by tacrolimus (0.15 mg/kg/d; 10-15 ng/mL target trough levels) and steroids (starting with 20 mg IV switched to PO as soon as the patient was able to eat and weaned within 1-2 months). The average follow-up was 395 days after transplantation. RESULTS Of the patients, 93.75% remained rejection-free during follow-up with an actuarial rejection-free probability of 92.59% within 3 months. Two patients (6%) had one episode of biopsy-proven acute cellular rejection (ACR). Actuarial patient and graft survival rates at 3 years were 86.85% and 81.25%. One patient (3%) experienced one episode of sepsis. There was no evidence of cytomegalovirus infections or side effects related to the basiliximab. We found zero de novo malignancy but we observed two patients with metastatic spread of their primary malignancy during the follow-up. CONCLUSION Basiliximab in association with tacrolimus and steroids is effective as prophylaxis of ACR among adult living related liver transplant recipients.
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Tan HP, Kaczorowski D, Basu A, McCauley J, Marcos A, Donaldson J, Unruh M, Randhawa P, Zeevi A, Shapiro R. Steroid-free tacrolimus monotherapy after pretransplantation thymoglobulin or Campath and laparoscopy in living donor renal transplantation. Transplant Proc 2006; 37:4235-40. [PMID: 16387087 DOI: 10.1016/j.transproceed.2005.10.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Indexed: 01/31/2023]
Abstract
Living donor renal transplantation was performed under a regimen of recipient pretreatment and low-dose postoperative immunosuppression with subsequent weaning. From October 9, 2002, to December 31, 2004, 196 consecutive, unselected laparoscopic live donor nephrectomies resulting in 196 living donor renal transplantations were performed. Recipients were pretreated with rabbit antithymocyte globulin (thymoglobulin; 24 patients or [12%]) or Campath 1H (alemtuzumab; 166 patients [85%]), or were not in protocol (6 patients [3%]), and were given postoperative steroid-free low-dose tacrolimus immunosuppressive monotherapy with subsequent weaning. There was no donor mortality. Major and minor donor morbidities were 2.6% and 4.2%, respectively. Laparoscopic live donor nephrectomy recipient outcomes with a mean follow-up of 401 days included (1) recipient and graft survival of 99.0% and 97.4%, respectively; (2) no ureteral stenosis; (3) 0.5% delayed graft function, from recurrent focal segmental glomerulosclinosis; and (4) no vascular thrombosis. The incidence of acute rejection at 30, 90, and 401 days was 1.5%, 3.8%, and 11.2% (all 196 recipients), 0%, 25%, and 29.2% (thymoglobulin recipients), and 1.8%, 3.9%, and 8.4% (Campath 1H recipients), respectively. Sixty-six patients (33.7%) are receiving spaced-dose immunosuppressive monotherapy. The mean creatinine concentration in all recipients was 1.5 +/- 1.1 mg/dL. There were no instances of cytomegalovirus tissue invasive disease or posttransplantation lymphoproliferative disease. The incidence of new-onset posttransplantation insulin-dependent diabetes was 0.5%. At current follow-up, the use of Campath 1H rather than thymoglobulin for pretreatment seems to have significantly improved the efficacy of our regimen.
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Gruttadauria S, Mandalà L, Vasta F, Cintorino D, Musumeci A, Marsh W, Marcos A, Gridelli B. Improvements in hepatic parenchymal transection for living related liver donor. Transplant Proc 2006; 37:2589-91. [PMID: 16182753 DOI: 10.1016/j.transproceed.2005.06.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION To eliminate mortality and morbidity risk in living related liver donors, we developed a new surgical technique to resect hepatic parenchyma using an ultrasonic surgical aspirator in association with a monopolar floating ball cautery. METHODS We performed 17 right hepatectomies and 2 left hepatectomies using this technique. We performed a retrospective analysis of perioperative mortality, length of hospitalization (LOS), blood transfused during surgery (IBT), intraoperative blood lost (IBL), biliary complications (BC), and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) peak in the first postoperative week. This group of patients (Group A) was compared, using the analysis of variance (ANOVA) test (P < .05) with 2 different groups of 19 patients: Group B with liver neoplasms that had the same technique as Group A, and Group C wherein a crushing clamp technique was used. RESULTS All of the analyzed variables showed significative statistical differences, especially between Group A and Group C (IBL, P < .000; IBT, P < .006; LOS, P < .028; BC, P < .000; AST peak, P < .041; and ALT peak, P < .023). DISCUSSION The association of these 2 techniques seems to reduce the LOS, and the need for intraoperative blood transfusions. Moreover, the surgical complications (biliary leaks) and the postoperative parenchymal cytonecrosis seem to be less using this technique.
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Romeo J, Díaz L, González-Gross M, Wärnberg J, Marcos A. [Contribution to the intake of macro and micro nutrients exerted by moderate beer consumption]. NUTR HOSP 2006; 21:84-91. [PMID: 16562818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVE Moderate beer consumption can be part of a healthy diet, like the Mediterranean diet. The aim of the present study was to analyse the contribution a moderate beer consumption makes to energy and nutrient intake in Spanish healthy adults. MATERIAL AND METHODS As part of a larger intervention study, dietary intake was measured by means of a 7-day food dietary record in 24 men and 22 women (age 34.18 +/- 5.80 years) twice: during the last week of the 30 days of complete alcohol abstinence and during the last week of 30 days of moderate beer consumption. Energy and nutrient content of food was analysed by means of the GEA program, based on the Spanish food composition tables. RESULTS In women, moderate beer consumption increased significantly (p < 0.05) mean vitamin B6 (1.24 +/- 0.32 to 1.47 +/- 0.34 mg), B12 (3.87 +/- 1.46 to 5.58 +/- 2.76 microg), A (614.45 +/- 224.75 to 788.3 +/- 486.1 microg), and folate (139.5 +/- 39.88 to 168.25 +/- 56.32 microg) intake, whereas there was a decrease in mean iodine intake (327.1 +/- 148.4 to 281.2 +/- 135.02 microg). In men, mean vitamin B2 (1.64 +/- 0.62 to 1.91 +/- 0.46 mg), B6 (1.54 +/- 0.63 to 1.80 +/- 0.37 mg), niacin (30.01 +/- 8.13 to 34.78 +/- 6.26 mg) and folate (153.23 +/- 68.70 to 192.32 +/- 46.73 mg) intake also increased significantly. Energy, macronutrient and mineral intake had non-significant oscillations. CONCLUSION Moderate beer consumption can improve diet quality in regard to B vitamins in healthy adults.
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