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Alcalá Vicente C, Lacruz L, Gascón F, Carratalà S, Quintanilla-Bordás C, Sanz MT, Carcelén-Gadea M, Mallada J, Carreres J, Gabaldón Torres L, Dominguez JA, Cañizares E, Gil-Perotin S, Cubas L, Gasqué Rubio R, Castillo-Villalba J, Pérez-Miralles FC, Casanova B. Oligoclonal M bands and cervical spinal cord lesions predict early secondary progressive multiple sclerosis. Front Neurol 2022; 13:991596. [DOI: 10.3389/fneur.2022.991596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo determine baseline cerebrospinal fluid and magnetic resonance imaging (MRI) variables at the onset of a clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS) that predict evolution to secondary progressive MS (SPMS).Methods276 CIS patients with a minimum follow-up of 10 years were studied. Baseline presence of oligoclonal IgG and IgM bands (OCGB and OCMB respectively); number of brain T2 lesions (B-T2L), brain gadolinium enhancement lesions (brain-GEL), cervical spinal cord T2 lesions (cSC-T2L); and fulfillment of 2017 McDonald criteria among other variables were collected.Results14 patients ended up with a non-MS condition. 138/276 CIS patients fulfilled 2017 McDonald criteria. Mean age was 32.4 years, 185 female. 227 received treatment, 95 as CIS. After a mean follow-up of 12 years, 36 patients developed SPMS. Conversion to SPMS was associated with OCGB (p = 0.02), OCMB (p = 0.0001); ≥ 9 B-T2L (p = 0.03), brain-GEL (p = 0.03), and cSC-T2L (p = 0.03). However, after adjusting for sex, age, BT2L, brain-GEL, SC-T2, and OCMB status, only OCMB (HR 4.4, 1.9–10.6) and cSC-T2L (HR 2.2, 1.0–6.2) suggested an independent association with risk of conversion to SPMS. Patients with both risk factors had a HR of 6.12 (2.8–12.9).DiscussionOCMB and SC-T2 lesions are potential independent predictors of conversion to SPMS.
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Alcalá C, Quintanilla-Bordás C, Gascón F, Sempere ÁP, Navarro L, Carcelén-Gadea M, Landete L, Mallada J, Cañizares E, Belenguer A, Carratalá S, Domínguez JA, Pérez-Miralles FC, Gil-Perotín S, Gasqué R, Cubas L, Castillo J, Casanova B. Effectiveness of rituximab vs. ocrelizumab for the treatment of primary progressive multiple sclerosis: a real-world observational study. J Neurol 2022; 269:3676-3681. [PMID: 35107597 DOI: 10.1007/s00415-022-10989-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ocrelizumab, an antiCD-20 antibody, is the only drug approved to treat patients with primary progressive multiple sclerosis (pwPPMS). Not all candidates receive this treatment due to prescription limitations. Rituximab, another antiCD-20 antibody, has been used off-label in pwPPMS before and after ocrelizumab approval. However, studies comparing effectiveness of both drugs are lacking. OBJECTIVE To evaluate effectiveness of rituximab and ocrelizumab in pwPPMS under real-life conditions. METHODS We conducted a multicentric observational study of pwPPMS that started ocrelizumab or rituximab according to clinical practice, with a minimum follow-up of 1 year. Data was collected prospectively and retrospectively. Primary outcome was time to confirmed disability progression at 3 months (CDW). Secondary outcome was serum neurofilament light chain levels (sNFL) at the end of follow-up. RESULTS 95 out 111 pwPPMS fulfilled inclusion criteria and follow-up data availability: 49 (51.6%) received rituximab and 46 (48.4%) ocrelizumab. Rituximab-treated patients had significantly higher baseline EDSS, disease duration and history of previous disease-modifying treatment (DMT) than ocrelizumab-treated patients. After a mean follow-up of 18.3 months (SD 5.9), 26 patients experienced CDW (21.4%); 15 (30.6%) in the rituximab group; and 11 (23.9%) in the ocrelizumab group. Survival analysis revealed no differences in time to CDW. sNFL were measured in 60 patients and no differences between groups were found. INTERPRETATION We provide real-world evidence of effectiveness of ocrelizumab and rituximab in pwPPMS. No differences in time to CDW were found between treatments. However, this study cannot establish equivalence of treatments and warrant clinical trial to confirm our findings.
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Affiliation(s)
- Carmen Alcalá
- Neuroimmunology Unit, Polytechnic and University Hospital La Fe València, Avda. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Carlos Quintanilla-Bordás
- Neuroimmunology Unit, Polytechnic and University Hospital La Fe València, Avda. Fernando Abril Martorell, 106, 46026, Valencia, Spain.
| | - Francisco Gascón
- Neurology Service, Clinic University Hospital of València, Valencia, Spain
| | | | - Laura Navarro
- Neurology Service, University General Hospital of Elx, Elche, Spain
| | | | - Lamberto Landete
- Neurology Service, University Dr. Peset University Hospital of València, Valencia, Spain
| | - Javier Mallada
- Neurology Service, University General Hospital of Elda, Elda, Spain
| | | | - Antonio Belenguer
- Neurology Service, University General Hospital of Castelló, Castelló de la Plana, Spain
| | - Sara Carratalá
- Neuroimmunology Unit, Polytechnic and University Hospital La Fe València, Avda. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | | | - Francisco Carlos Pérez-Miralles
- Neuroimmunology Unit, Polytechnic and University Hospital La Fe València, Avda. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Sara Gil-Perotín
- Neuroimmunology Unit, Polytechnic and University Hospital La Fe València, Avda. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Raquel Gasqué
- Neuroimmunology Unit, Polytechnic and University Hospital La Fe València, Avda. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Laura Cubas
- Neuroimmunology Unit, Polytechnic and University Hospital La Fe València, Avda. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jéssica Castillo
- Neuroimmunology Unit, Polytechnic and University Hospital La Fe València, Avda. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Bonaventura Casanova
- Neuroimmunology Unit, Polytechnic and University Hospital La Fe València, Avda. Fernando Abril Martorell, 106, 46026, Valencia, Spain
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Alcalá C, Cubas L, Carratalá S, Gascón F, Quintanilla-Bordás C, Gil-Perotín S, Gorriz D, Pérez-Miralles F, Gasque R, Castillo J, Casanova B. NFL during acute spinal cord lesions in MS: a hurdle for the detection of inflammatory activity. J Neurol 2022; 269:3495-3500. [PMID: 35038000 DOI: 10.1007/s00415-021-10926-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Levels of neuro-filament light chain (NFL) correlate with clinical and radiological activity in multiple sclerosis (MS) and have been used as a surrogate biomarker of axonal destruction related to inflammatory activity. The main objective of this work is to explore the specific contribution of acute inflammation within the spinal cord to the elevation of NFL levels. PATIENTS AND METHODS MS patients with a baseline study of NFL at diagnosis of the disease and a brain and spinal cord MRI scan were selected. Patients were classified according to the presence, number and location of gadolinium enhancing lesion (GEL) and the relationship between NFL levels and both brain and spinal cord GEL were explored. RESULTS Seventy-seven patients were selected. NFL levels were significantly higher in patients with only one GEL restricted to the brain than those without GEL (1702 pg/ml vs 722.7 pg/mL, p = 0.03) and correlated with number. However, no differences were seen among patients with GEL limited to the spinal cord and those without GEL (735.2 pg/ml vs 722.7 pg/mL). CONCLUSION Our study reaffirms the value of NFL levels in monitoring asymptomatic inflammatory activity in the brain measured by GEL. However, NFL concentration is not as useful when only inflammatory activity occurs in the spinal cord.
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Affiliation(s)
- C Alcalá
- Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Fernando Abril Martorell Avenue 106, 46026, Valencia, Spain.
| | - L Cubas
- Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Fernando Abril Martorell Avenue 106, 46026, Valencia, Spain
| | - S Carratalá
- Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Fernando Abril Martorell Avenue 106, 46026, Valencia, Spain
| | - F Gascón
- Neurology Department, University Hospital Clinic of Valencia, Blasco Ibañez Avenue, 17, 46010, Valencia, Spain
| | - C Quintanilla-Bordás
- Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Fernando Abril Martorell Avenue 106, 46026, Valencia, Spain
| | - S Gil-Perotín
- Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Fernando Abril Martorell Avenue 106, 46026, Valencia, Spain
| | - D Gorriz
- Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Fernando Abril Martorell Avenue 106, 46026, Valencia, Spain
| | - F Pérez-Miralles
- Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Fernando Abril Martorell Avenue 106, 46026, Valencia, Spain
| | - R Gasque
- Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Fernando Abril Martorell Avenue 106, 46026, Valencia, Spain
| | - J Castillo
- Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Fernando Abril Martorell Avenue 106, 46026, Valencia, Spain
| | - B Casanova
- Neuroimmunology Unit, University and Polytechnic Hospital La Fe, Fernando Abril Martorell Avenue 106, 46026, Valencia, Spain
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Casanova B, Quintanilla-Bordás C, Gascón F. Escalation vs. Early Intense Therapy in Multiple Sclerosis. J Pers Med 2022; 12:jpm12010119. [PMID: 35055434 PMCID: PMC8778390 DOI: 10.3390/jpm12010119] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 02/01/2023] Open
Abstract
The treatment strategy of multiple sclerosis (MS) is a highly controversial debate. Currently, there are up to 19 drugs approved. However, there is no clear evidence to guide fundamental decisions such as what treatment should be chosen in first place, when treatment failure or suboptimal response should be considered, or what treatment should be considered in these cases. The “escalation strategy” consists of starting treatment with drugs of low side-effect profile and low efficacy, and “escalating” to drugs of higher efficacy—with more potential side-effects—if necessary. This strategy has prevailed over the years. However, the evidence supporting this strategy is based on short-term studies, in hope that the benefits will stand in the long term. These studies usually do not consider the heterogeneity of the disease and the limited effect that relapses have on the long-term. On the other hand, “early intense therapy” strategy refers to starting treatment with drugs of higher efficacy from the beginning, despite having a less favorable side-effect profile. This approach takes advantage of the so-called “window of opportunity” in hope to maximize the clinical benefits in the long-term. At present, the debate remains open. In this review, we will critically review both strategies. We provide a summary of the current evidence for each strategy without aiming to reach a definite conclusion.
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Affiliation(s)
- Bonaventura Casanova
- Unitat de Neuroimmunologia, Hospital Universitari i Politècnic La Fe. València, la Universitat de València, 46026 Valencia, Spain;
- Correspondence:
| | - Carlos Quintanilla-Bordás
- Unitat de Neuroimmunologia, Hospital Universitari i Politècnic La Fe. València, la Universitat de València, 46026 Valencia, Spain;
| | - Francisco Gascón
- Unitat de Neuroimmunologia, Hospital Clínic Universitari de València, 46010 Valencia, Spain;
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Escribano BM, Muñoz-Jurado A, Caballero-Villarraso J, Valdelvira ME, Giraldo AI, Paz-Rojas E, Gascón F, Santamaría A, Agüera E, Túnez I. Protective effects of melatonin on changes occurring in the experimental autoimmune encephalomyelitis model of multiple sclerosis. Mult Scler Relat Disord 2022; 58:103520. [PMID: 35038645 DOI: 10.1016/j.msard.2022.103520] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/27/2021] [Accepted: 01/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Melatonin has been related to the pathophysiology of multiple sclerosis (MS), and its anti-inflammatory and immunomodulatory properties have been proved in numerous neurodegenerative diseases. This study aimed to find out whether a melatonin supplement in MS is able to act as a benefit to its clinical status, i.e. oxidative stress, inflammation and indirect biomarkers of bacterial dysbiosis, lipopolysaccharide (LPS) and LPS-binding protein (LBP), verifying its therapeutic potential and its possible clinical use in patients with MS. METHODS The animal MS model, experimental autoimmune encephalomyelitis (EAE), was employed whereby 25 male Dark Agouti rats (5 animals per group) were divided into: a control group (not manipulated); a control+vehicle group; a control+melatonin group; an EAE group; an EAE+melatonin group. Melatonin was administered daily for 51 days, at a dose of 1 mg/kg body weight/i.p., once a day, five days a week. RESULTS The results from the administration of melatonin demonstrated an improvement in clinical status, a diminution in oxidative stress and inflammation, as well as in bacterial dysbiosis. CONCLUSION Melatonin could play an effective role against MS, either alone or as a therapy combined with traditional agents.
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Affiliation(s)
- Begoña María Escribano
- Department of Cell Biology, Physiology and Immunology, Faculty of Veterinary Medicine, Campus of Rabanales, University of Cordoba, Cordoba 14071, Spain; Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain.
| | - A Muñoz-Jurado
- Department of Cell Biology, Physiology and Immunology, Faculty of Veterinary Medicine, Campus of Rabanales, University of Cordoba, Cordoba 14071, Spain
| | - J Caballero-Villarraso
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain; Department of Biochemistry and Molecular Biology, Faculty of Medicine and Nursing, University of Cordoba, Av. Menendez Pidal, Cordoba 14004, Spain; Clinical Analysis Service, Reina Sofia University Hospital, Cordoba, Spain
| | - M E Valdelvira
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Nursing, University of Cordoba, Av. Menendez Pidal, Cordoba 14004, Spain
| | - A I Giraldo
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain; Department of Biochemistry and Molecular Biology, Faculty of Medicine and Nursing, University of Cordoba, Av. Menendez Pidal, Cordoba 14004, Spain
| | - E Paz-Rojas
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain; Multiplex Biopharma S.L., Rabanales 21, Cordoba, Spain
| | - F Gascón
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain; Clinical Analysis Service, Valle de los Pedroches, Hospital, Cordoba, Spain
| | - A Santamaría
- Laboratory of Exciting Amino Acids, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - E Agüera
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain; Neurology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Isaac Túnez
- Maimonides Institute for Research in Biomedicine of Cordoba, (IMIBC), Cordoba, Spain; Department of Biochemistry and Molecular Biology, Faculty of Medicine and Nursing, University of Cordoba, Av. Menendez Pidal, Cordoba 14004, Spain; Cooperative Research Thematic Excellent Network on Brain Stimulation (REDESTIM), Spain.
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Landete L, Pérez-Miralles F, García S, Belenguer A, Gascón F, Domínguez JA, Carcelén-Gadea M, Quintanilla-Bordás C, Navarro L, Gabaldón L, Casanova B. Treatment of Multiple Sclerosis With Teriflunomide. Multicenter Study of Real Clinical Practice in the Valencian Community-Spain. Front Neurol 2021; 12:727586. [PMID: 34803877 PMCID: PMC8603659 DOI: 10.3389/fneur.2021.727586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: We have different treatment alternatives for relapsing-remitting multiple sclerosis–RRMS–within the so-called platform drugs. It would be desirable to know the ideal drug for each patient. Real clinical practice studies provide us with data on drug efficacy in the medium and long term, safety beyond clinical trials, and can help us to know the patient profile appropriate for each therapy. Material and Methods: An observational multicenter study of real clinical practice in patients with RRMS who were treated with teriflunomide in the Valencian Community, since teriflunomide was authorized in Spain. The database created for this study collects retrospectively patients followed prospectively in the MS clinics. Objectives: To analyze the efficacy and safety of teriflunomide treatment in patients with RRMS under the conditions of real clinical practice, and to identify a patient profile responding to the treatment. Results: We obtained data from 340 patients who received at least one dose of 14 mg teriflunomide. The patients were 69.4% female to 30.6% male, had a mean age of 46.4 years, and a mean time of progression of MS of 11.5 years. The mean pre-teriflunomide relapse rate was 0.4 years, the mean EDSS scorewas 1.98, IgG Oligoclonal bands were present in the CSF of 66.2% of the patients, IgM Oligoclonal bands were present in 46.9%, and the mean number of gadolinium-enhancing lesions was 1.07 lesions per patient at the beginning of treatment. The average number of treatments previously received was 1.04, and 28.53% were naïve. After a follow-up of up to 4 years, a reduction in the annualized and cumulative annualized relapse rate was observed in the first year, in the second year, and in the third year, compared to the pre-treatment year. The EDSS scores were stabilized throughout the follow-up. Likewise, there was a reduction in gadolinium-enhancing lesions in the 1st and 2nd years compared to the pre-treatment period. Applying different generalized multiple linear regression models, we identified a profile of a responding patient to teriflunomide as a male without IgM oligoclonal bands in the CSF, a previous EDSS score of <3, and more than 5 years duration of MS.
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Affiliation(s)
- Lamberto Landete
- Neurology Service, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Francisco Pérez-Miralles
- Centro, Servicio y Unidad de Referencia, Neuroinmunology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - Sara García
- Centro, Servicio y Unidad de Referencia, Neuroinmunology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - Antonio Belenguer
- Neurology Service, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Francisco Gascón
- Demyelinating Diseases Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Jose Andres Domínguez
- Demyelinating Diseases Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Laura Navarro
- Neurology Service, Hospital Universitario de Elche, Elche, Spain
| | - Laura Gabaldón
- Neurology Service, Hospital Comarcal de Gandía, Valencia, Spain
| | - Bonaventura Casanova
- Centro, Servicio y Unidad de Referencia, Neuroinmunology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
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Nieves FJ, Bayón A, Gascón F. Optimization of the magnetic field homogeneity of circular and conical coil pairs. Rev Sci Instrum 2019; 90:045120. [PMID: 31042999 DOI: 10.1063/1.5079476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/30/2019] [Indexed: 06/09/2023]
Abstract
The magnetic field generated by a pair of coaxial circular loops is analyzed in order to find the optimum separation between the loops for each value of a prescribed homogeneity. For the maximum heterogeneities considered here, 0.1%, 1%, and 10%, the optimum loop spacing is obtained following a graphical procedure so that the length of the homogeneous field region along the axis is the longest possible. This study is extended to regions near the axis and to the entire region surrounding the center, calculating the loop separation that produces the largest homogeneous volume. The field homogeneity of a pair of "Helmholtz" coaxial conical coils is also investigated to obtain the optimum spacing between the conical coils; the volumes calculated with the desired homogeneity are compared with those obtained with a single pair of optimum coaxial loops. A new arrangement is hereby proposed based on double conical coils with optimum separation between the coils and optimum aperture of the cones. Some of the proposed arrangements are carried out in the laboratory where the experimental results are in good agreement with the theoretical predictions.
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Affiliation(s)
- F J Nieves
- ETS Arquitectura, Universidad de Sevilla, Reina Mercedes, 2, 41012 Sevilla, Spain
| | - A Bayón
- ETSI Minas y Energía, Universidad Politécnica de Madrid, Ríos Rosas, 21, 28003 Madrid, Spain
| | - F Gascón
- ETS Arquitectura, Universidad de Sevilla, Reina Mercedes, 2, 41012 Sevilla, Spain
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Pérez-Miralles F, Prefasi D, García-Merino A, Ara JR, Izquierdo G, Meca-Lallana V, Gascón F, Martínez-Ginés ML, Ramió-Torrentà L, Costa-Frossard L, Fernández Ó, Moreno-García S, Maurino J, Casanova-Estruch B. Perception of stigma in patients with primary progressive multiple sclerosis. Mult Scler J Exp Transl Clin 2019; 5:2055217319852717. [PMID: 31205741 PMCID: PMC6537064 DOI: 10.1177/2055217319852717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/14/2019] [Accepted: 04/20/2019] [Indexed: 11/17/2022] Open
Abstract
Stigma associated with neurological disorders may contribute to a poor health-related quality of life. However, limited information is available in primary progressive multiple sclerosis. We investigated the presence and impact of stigma in patients with primary progressive multiple sclerosis. A non-interventional, cross-sectional study was conducted. A total of 55 primary progressive multiple sclerosis patients were studied (mean age 55.8±9.5 years, 56.4% male). The median Expanded Disability Status Scale score was 5.5 (4.0-6.5). Stigma prevalence was 78.2% (n=43). Twenty-four patients (43.6%) were classified as depressed. Scores on the eight-item Stigma Scale for Chronic Illness correlated with physical (rho=0.464, p<0.001) and psychological (rho=0.358, p=0.007) 29-item Multiple Sclerosis Impact Scale subscores. Stigma predicted concurrent depression (odds ratio=1.13; p=0.046). Stigma was highly prevalent with a detrimental effect on quality of life and mood in primary progressive multiple sclerosis.
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Affiliation(s)
- Francisco Pérez-Miralles
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - José R Ara
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Francisco Gascón
- Department of Neurology, Hospital Clínico Universitario, Valencia, Spain
| | | | - Lluis Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari Josep Trueta, IDIBGI, University of Girona, Girona, Spain
| | | | - Óscar Fernández
- Institute of Biomedical Research (IBIMA), Hospital Regional Universitario, Málaga, Spain
| | - Sara Moreno-García
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Alcalá C, Pzére-Miralles F, Gascón F, Evole M, Estutia M, Gil-Perotín S, Casanova B. Recurrent and universal alopecia areata following alemtuzumab treatment in multiple sclerosis: A secondary autoimmune disease. Mult Scler Relat Disord 2018; 27:406-408. [PMID: 30530069 DOI: 10.1016/j.msard.2018.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 11/05/2018] [Accepted: 12/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - F Gascón
- Neurology, Hospital La Fe, Valencia, Spain
| | - M Evole
- Neurology, Hospital La Fe, Valencia, Spain
| | - M Estutia
- Neurology, Hospital La Fe, Valencia, Spain
| | | | - B Casanova
- Neurology, Hospital La Fe, Valencia, Spain
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10
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Casanova B, Lacruz L, Villar ML, Domínguez JA, Gadea MC, Gascón F, Mallada J, Hervás D, Simó-Castelló M, Álvarez-Cermeño JC, Calles C, Olascoaga J, Ramió-Torrentà L, Alcalá C, Cervelló A, Boscá I, Pérez-Mirallles FC, Coret F. Different clinical response to interferon beta and glatiramer acetate related to the presence of oligoclonal IgM bands in CSF in multiple sclerosis patients. Neurol Sci 2018; 39:1423-1430. [PMID: 29882169 DOI: 10.1007/s10072-018-3442-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the efficacy of interferon beta (IFNβ) and glatiramer acetate (GA) related to the presence of oligoclonal M bands (OCMB) in the cerebrospinal fluid in relapsing-remitting multiple sclerosis (RRMS). METHOD This is an observational, multicenter and retrospective study with prospectively collected data of patients that started treatment with IFNβ or GA. Treatment decision was made blinded to the OCMB status. Time to first attack after starting therapy was compared by using Kaplan-Meier curves, and adjustment by Cox regression analysis was performed. RESULTS Two hundred and fifty-six patients entered in the study (141-55% received IFNβ; 115-45% received GA). After a mean follow-up of 41 and 65 months, 54.7% of patients remained free from further attacks (RF). The proportion of RF patients was higher in the GA group than in the IFNβ group (72.2 vs. 40.4%, p < 0.001). The IFNβ patients with OCMB+ presented the poorest response, 31.3% RF vs. 48.1% in IFNβ without OCMB, p = 0.03. CONCLUSION OCMB in CSF could be a biomarker of treatment response in multiple sclerosis.
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Affiliation(s)
| | - Laura Lacruz
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | | | | | | | - Francisco Gascón
- Neuroimmunology Unit, Hospital Clínic Universitari de València, Valencia, Spain
| | | | - David Hervás
- Biostatistical Unit, Institut d'Investigació Sanitaria La Fe, Valencia, Spain
| | - María Simó-Castelló
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Carmen Calles
- Neurological Service, Hospital Son Espases, Mallorca, Spain
| | | | - Lluís Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Dr. Josep Trueta, IDIBGI, Girona, Spain
| | - Carmen Alcalá
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Angeles Cervelló
- Neurological Service, Hospital General de València, Valencia, Spain
| | - Isabel Boscá
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Francisco Coret
- Neuroimmunology Unit, Hospital Clínic Universitari de València, Valencia, Spain
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Gil-Perotin S, Castillo-Villalba J, Carreres-Polo J, Navarré-Gimeno A, Mallada-Frechín J, Pérez-Miralles F, Gascón F, Alcalá-Vicente C, Cubas-Nuñez L, Casanova-Estruch B. Progressive Demyelination in the Presence of Serum Myelin Oligodendrocyte Glycoprotein-IgG: A Case Report. Front Neurol 2018; 9:340. [PMID: 29867746 PMCID: PMC5962713 DOI: 10.3389/fneur.2018.00340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/30/2018] [Indexed: 01/03/2023] Open
Abstract
The clinical diagnosis of patients with autoantibodies directed to conformational myelin oligodendrocyte glycoprotein MOG-IgG, can be challenging because of atypical clinical presentation. MOG-IgG seropositivity has been reported in several demyelinating diseases, including relapsing opticospinal syndromes [in the neuromyelitis optica spectrum disorders (NMOSD) and less frequently, in multiple sclerosis (MS)], but it has rarely been associated with the progressive course of disease. To contribute to the characterization of MOG-related demyelination, we describe the case of a patient with progressive demyelinating opticospinal disease, IgG-oligoclonal bands (OCB), and serum MOG-IgG.
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Affiliation(s)
- Sara Gil-Perotin
- Multiple Sclerosis and Neural Regeneration Research Group, Hospital Universitari i Politècnic La Fe, València, Spain.,Neuroimmmunology Unit, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Jéssica Castillo-Villalba
- Multiple Sclerosis and Neural Regeneration Research Group, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Joan Carreres-Polo
- Radiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - Francisco Pérez-Miralles
- Multiple Sclerosis and Neural Regeneration Research Group, Hospital Universitari i Politècnic La Fe, València, Spain.,Neuroimmmunology Unit, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Francisco Gascón
- Neuroimmunology Unit, Hospital Clínic de València, Valencia, Spain
| | - Carmen Alcalá-Vicente
- Multiple Sclerosis and Neural Regeneration Research Group, Hospital Universitari i Politècnic La Fe, València, Spain.,Neuroimmmunology Unit, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Laura Cubas-Nuñez
- Multiple Sclerosis and Neural Regeneration Research Group, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Bonaventura Casanova-Estruch
- Multiple Sclerosis and Neural Regeneration Research Group, Hospital Universitari i Politècnic La Fe, València, Spain.,Neuroimmmunology Unit, Hospital Universitari i Politècnic La Fe, València, Spain
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12
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Alcalá C, Gascón F, Pérez-Miralles F, Gil-Perotín S, Navarré A, Boscá I, Coret F, Casanova B. Efficacy and safety of rituximab in relapsing and progressive multiple sclerosis: a hospital-based study. J Neurol 2018; 265:1690-1697. [PMID: 29785523 DOI: 10.1007/s00415-018-8899-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Rituximab is considered as a potential therapeutic option in relapsing-remitting (RRMS) and progressive forms (PMS) of multiple sclerosis (MS). OBJECTIVE To investigate the effectiveness and safety of rituximab in MS. PATIENTS AND METHODS Observational study of effectiveness (clinical and radiological) and safety of rituximab in RRMS and PMS. RESULTS A total of 90 rituximab-treated patients were collected: 31 RRMS and 59 PMS All patients had an active disease despite standard treatment. The annualized relapse rate (ARR) the year before rituximab was 0.86, 53.3% of patients had gadolinium enhanced lesion, and mean Expanded Disability Status Scale (EDSS) had increased from 4.2 to 4.9. During treatment, the ARR was reduced an 88.4% (p < 0.001). A significant decrease of EDSS to 4.6 was observed (p = 0.01) after 1 year of treatment, which remained stable during the second year in both groups. There was no evidence of disease activity in 70% of total sample, 74.2% of RRMS, and 67% of the PMS patients. Infusion-related symptoms were the most prevalent side effect (18.8%) and most were mild. Three thrombotic events were detected. CONCLUSION Rituximab could be an effective and safe treatment in aggressive RRMS. Some selected PMS patients could also benefit from this treatment.
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Affiliation(s)
- Carmen Alcalá
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, 106 Avenue Fernando Abril Martorell, 46026, Valencia, Spain.
| | - F Gascón
- Unit of Neuroimmunology, Department of Neurology, Hospital Clínico Universitario, Valencia, Spain
| | - F Pérez-Miralles
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, 106 Avenue Fernando Abril Martorell, 46026, Valencia, Spain
| | - S Gil-Perotín
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, 106 Avenue Fernando Abril Martorell, 46026, Valencia, Spain
| | - A Navarré
- Unit of Neuroimmunology, Department of Neurology, Hospital Clínico Universitario, Valencia, Spain
| | - I Boscá
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, 106 Avenue Fernando Abril Martorell, 46026, Valencia, Spain
| | - F Coret
- Unit of Neuroimmunology, Department of Neurology, Hospital Clínico Universitario, Valencia, Spain
| | - B Casanova
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, 106 Avenue Fernando Abril Martorell, 46026, Valencia, Spain
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13
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Coret F, Pérez-Miralles FC, Gascón F, Alcalá C, Navarré A, Bernad A, Boscá I, Escutia M, Gil-Perotin S, Casanova B. Onset of secondary progressive multiple sclerosis is not influenced by current relapsing multiple sclerosis therapies. Mult Scler J Exp Transl Clin 2018; 4:2055217318783347. [PMID: 30090637 PMCID: PMC6077906 DOI: 10.1177/2055217318783347] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/19/2018] [Accepted: 05/10/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Disease-modifying therapies are thought to reduce the conversion rate to secondary progressive multiple sclerosis. OBJECTIVE To explore the rate, chronology, and contributing factors of conversion to the progressive phase in treated relapsing-remitting multiple sclerosis patients. METHODS Our study included 204 patients treated for relapsing-remitting multiple sclerosis between 1995 and 2002, prospectively followed to date. Kaplan-Meier analysis was applied to estimate the time until secondary progressive multiple sclerosis conversion, and multivariate survival analysis with a Cox regression model was used to analyse prognostic factors. RESULTS Relapsing-remitting multiple sclerosis patients were continuously treated for 13 years (SD 4.5); 36.3% converted to secondary progressive multiple sclerosis at a mean age of 42.6 years (SD 10.6), a mean time of 8.2 years (SD 5.2) and an estimated mean time of 17.2 years (range 17.1-18.1). A multifocal relapse, age older than 34 years at disease onset and treatment failure independently predicted conversion to secondary progressive multiple sclerosis but did not influence the time to reach an Expanded Disability Status Scale of 6.0. CONCLUSIONS The favourable influence of disease-modifying therapies on long-term disability in relapsing-remitting multiple sclerosis is well established. However, the time to progression onset and the subsequent clinical course in treated patients seem similar to those previously reported in natural history studies. More studies are needed to clarify the effect of disease-modifying therapies once the progressive phase has been reached.
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Affiliation(s)
| | | | | | - Carmen Alcalá
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Spain
| | | | - Ana Bernad
- Neuroimmunology Unit, Hospital Clínic de València, Spain
| | - Isabel Boscá
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Spain
| | - Matilde Escutia
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Spain
| | - Sara Gil-Perotin
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Spain
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14
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Salazar FJ, Nieves FJ, Bayón A, Gascón F. Magnetic field homogeneity of a conical coaxial coil pair. Rev Sci Instrum 2017; 88:095107. [PMID: 28964184 DOI: 10.1063/1.5002572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An analytical study of the magnetic field created by a double-conical conducting sheet is presented. The analysis is based on the expansion of the magnetic field in terms of Legendre polynomials. It is demonstrated analytically that the angle of the conical surface that produces a nearly homogeneous magnetic field coincides with that of a pair of loops that fulfills the Helmholtz condition. From the results obtained, we propose an electric circuit formed by pairs of isolated conducting loops tightly wound around a pair of conical surfaces, calculating numerically the magnetic field produced by this system and its heterogeneity. An experimental setup of the proposed circuit was constructed and its magnetic field was measured. The results were compared with those obtained by numerical calculation, finding a good agreement. The numerical results demonstrate a significant improvement in homogeneity in the field of the proposed pair of conical coils compared with that achieved with a simple pair of Helmholtz loops or with a double solenoid. Moreover, a new design of a double pair of conical coils based on Braunbek's four loops is also proposed to achieve greater homogeneity. Regarding homogeneity, the rating of the analyzed configurations from best to worst is as follows: (1) double pair of conical coils, (2) pair of conical coils, (3) Braunbek's four loops, (4) Helmholtz pair, and (5) solenoid pair.
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Affiliation(s)
- F J Salazar
- ETSI Minas y Energía, Universidad Politécnica de Madrid, Ríos Rosas, 21, 28003 Madrid, Spain
| | - F J Nieves
- ETS Arquitectura, Universidad de Sevilla, Reina Mercedes, 2, 41012 Sevilla, Spain
| | - A Bayón
- ETSI Minas y Energía, Universidad Politécnica de Madrid, Ríos Rosas, 21, 28003 Madrid, Spain
| | - F Gascón
- ETS Arquitectura, Universidad de Sevilla, Reina Mercedes, 2, 41012 Sevilla, Spain
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Abstract
Cluster headache is a severe, debilitating disorder with pain that ranks among the most severe known to humans. Patients with cluster headaches have few therapeutic options and further, 10-20% develop drug-resistant attacks. The often brief duration of cluster attacks makes abortive therapy a challenge, and preventive medications are almost always provided to patients, but the side effects of these preventive medications can be significant. The sphenopalatine ganglion (SPG) is believed to play a role in headache pain and cranial autonomic symptoms associated with cluster headache, which is a result of activation of the trigeminal-autonomic reflex. For over 100 years, the SPG has been a clinical target to treat primary headache disorders using pharmacologic and nonpharmacologic methods. Radiofrequency lesioning and nerve-resection therapies, while initially beneficial, are irreversible procedures, and the use of neurostimulation provides one method of interfacing with the neural pathways without causing permanent damage to neural tissue. SPG neurostimulation is both reversible and adjustable, and has recently been tested in both proof-of-concept work and in a randomized, sham-controlled trial for the treatment of cluster headache. A randomized, sham-controlled study of 32 patients was performed to evaluate further the use of SPG stimulation for the acute treatment of chronic cluster headache. Of the 32 patients, 28 completed the randomized experimental period. Overall, 68% of patients experienced an acute response, a frequency response, or both. In this study the majority of adverse events were related to the implantation procedure, which typically resolved or remained mild in nature at 3 months following the implant procedure. This and other studies highlight the promise of using SPG stimulation to treat the pain-associated cluster headache. SPG stimulation could be a safe and effective option for chronic cluster headache.
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Affiliation(s)
- Miguel J A Láinez
- Servicio de Neurología, Hospital Clínico Universitario, Universidad Católica de Valencia, Avda Blasco Ibáñez, 17, Valencia, 46010, Spain
| | - Miguel Puche
- Department of Maxillofacial Surgery, Hospital Clínico Universitario, Valencia, Spain
| | - Ana Garcia
- Department of Neurology, Hospital Clínico Universitario, Valencia, Spain
| | - Francisco Gascón
- Department of Neurology, Hospital Clínico Universitario, Valencia, Spain
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16
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Láinez MJ, García-Casado A, Gascón F. Optimal management of severe nausea and vomiting in migraine: improving patient outcomes. Patient Relat Outcome Meas 2013; 4:61-73. [PMID: 24143125 PMCID: PMC3798203 DOI: 10.2147/prom.s31392] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Migraine is a common and potentially disabling disorder for patients, with wide-reaching implications for health care services, society, and the economy. Nausea and vomiting during migraine attacks are common symptoms that affect at least 60% of patients suffering from migraines. These symptoms are often more disabling than the headache itself, causing a great burden on the patient’s life. Nausea and vomiting may delay the use of oral abortive medication or interfere with oral drug absorption. Therefore, they can hinder significantly the management and treatment of migraine (which is usually given orally). The main treatment of pain-associated symptoms of migraine (such as nausea and vomiting) is to stop the migraine attack itself as soon as possible, with the effective drugs at the effective doses, seeking if necessary alternative routes of administration. In some cases, intravenous antiemetic drugs are able to relieve a migraine attack and associated symptoms like nausea and vomiting. We performed an exhaustive PubMed search of the English literature to find studies about management of migraine and its associated symptoms. Search terms were migraine, nausea, and vomiting. We did not limit our search to a specific time period. We focused on clinical efficacy and tolerance of the various drugs and procedures based on data from human studies. We included the best available studies for each discussed drug or procedure. These ranged from randomized controlled trials for some treatments to small case series for others. Recently updated books and manuals on neurology and headache were also consulted. We herein review the efficacy of the different approaches in order to manage nausea and vomiting for migraine patents.
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Affiliation(s)
- Miguel Ja Láinez
- Servicio de Neurología, Hospital Clínico Universitario, Valencia, Spain ; Departamento de Neurología, Universidad Católica de Valencia, Valencia, Spain
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17
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Nieves FJ, Gascón F, Bayón A, Salazar F. Straightforward estimation of the elastic constants of an isotropic cube excited by a single percussion. J Acoust Soc Am 2009; 126:EL140-EL146. [PMID: 19894789 DOI: 10.1121/1.3244038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Ritz's method is applied to calculate accurate values of the lowest non-dimensional natural frequencies of a freely vibrating isotropic cube. The dependence of such frequencies and their quotients on Poisson's ratio is established. Vibration of a cube caused by percussion is detected at a point by a laser interferometer. With the help of the tables and graphs provided and with the values of the first lowest frequencies obtained experimentally in a single test, Poisson's ratio and the shear modulus are calculated by means of elementary arithmetical operations.
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18
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Bayón A, Gascón F, Nieves FJ. Estimation of dynamic elastic constants from the amplitude and velocity of Rayleigh waves. J Acoust Soc Am 2005; 117:3469-77. [PMID: 16018451 DOI: 10.1121/1.1898663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In this paper a method is proposed to characterize the elasticity of isotropic linear materials from the generation and detection of an acoustic surface wave. For the calculation of the elastic constants, it is sufficient that only one of the faces of the sample be accessible. The methodology is based on both the measurement of the Rayleigh wave velocity and on the determination of the normal to longitudinal amplitude ratio calculated from the normal and longitudinal components of the displacement of a point. The detection of two consecutive surface wave pulses using a single experimental setup permits the determination of the elastic constants. The method is applied to calculate Young's modulus and Poisson's ratio of an aluminum sample as well as their systematic uncertainties. The results obtained give a relative uncertainty for Young's modulus on the order of the sixth part of that calculated for Poisson's ratio.
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Affiliation(s)
- Ana Bayón
- Departamento de Física Aplicada a los Recursos Naturales, Universidad Politécnica de Madrid, E.T.S. Ingenieros de Minas, C./Ríos Rosas, 21, 28003 Madrid, Spain
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19
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Valle M, Martos R, Gascón F, Cañete R, Zafra MA, Morales R. Low-grade systemic inflammation, hypoadiponectinemia and a high concentration of leptin are present in very young obese children, and correlate with metabolic syndrome. Diabetes & Metabolism 2005; 31:55-62. [PMID: 15803114 DOI: 10.1016/s1262-3636(07)70167-2] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the concentration levels of C-reactive protein (CRP), leptin and adiponectin in obese pre-pubertal children, and their possible relation with metabolic syndrome, fibrinogen and plasminogen activator inhibitor-1. METHODS A study was carried out in 51 obese children (aged 6 to 9 years) and the same number of non-obese children (control group), matched by age and sex. (Cross-sectional study of obese children). Body mass index (BMI), waist/hip ratio (WHR) and blood pressure were determined for each child. Serum CRP, leptin, adiponectin, glucose, insulin, lipid profile, plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were all measured. RESULTS The levels of CRP serum (1.67+/-0.222 vs 0.92+/-0.16 mg/l) and leptin (15.56+/-1.27 vs 4.68+/-0.62 ng/ml) were significantly higher in obese children. The adiponectin level was significantly higher in non-obese children (11.58+/-0.63 vs 9.64+/-0.49 microg/dl). In the obese group, log. CRP showed a positive correlation with BMI, insulin, homeostasis model assessment (HOMA), triglycerides, alanine aminotransferase (ALT), uric acid, PAI-1, fibrinogen and interleukin 6 (IL-6), and correlated negatively with apolipoprotein A-I and high-density lipoprotein cholesterol (HDL-C). The leptin was positively correlated with BMI, insulin, HOMA, triglycerides and PAI-1 and negatively with Apo A-I and HDL-C. Adiponectin correlated negatively with BMI, insulin, HOMA, and triglycerides. CONCLUSIONS Low-grade systemic inflammation, elevated leptin concentration and low adiponectin level are described in very young obese children, correlating with a range of variables of metabolic syndrome. Inflammation and adipocytokines can play an important role in the etiopathogeny of metabolic syndrome.
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Affiliation(s)
- M Valle
- Basic Health Zone of Pozoblanco Córdoba, Spain.
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20
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Abstract
There is growing evidence that overweight and obesity increase the risk of certain cancers. Studies in adults support the role of insulin-like growth factors (IGFs) and oestrogens in the pathogeneses of several cancers. We propose that hormone alterations described as risk factors for cancer in obese adults are present in prepubertal obese children. A group of obese children aged 6-9 years (n=40), and control group paired for age and sex, were used for the study. The obese children presented a significantly high level of IGF-I (P=0.0173) and insulin (P=0.0250), with a drop in sex hormone-binding globulin (SHBG) (P=0.0282). The 17 beta-oestradiol (E2)/SHBG ratio increase in obese subjects was marginally significant (P=0.0635). Grouping together all the children in quartiles for insulin and body mass index, the upper quartiles showed a rise in IGF-I and E2/SHBG. In a multivariant correlation analysis, only height (partial r=0.2464) and insulin (partial r=0.3002) were independent prediction variables for IGF-I concentration. The only variables statistically correlated with the E2/SHBG ratio were insulin (r=0.2879) and IGF-I (r=0.4140). The obese children in our study showed hormone changes described as risk factors for cancer in obese adults. These changes were significantly associated with the hyperinsulinaemia. We hypothesize that this potential risk should be taken into account given the long period of exposure involved in the presence of hormone alterations at such early ages.
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Affiliation(s)
- F Gascón
- Clinical Laboratory Department, Valle de los Pedroches Hospital, 14400 Pozoblanco, Cordoba, Spain.
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21
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Valle M, Gascón F, Martos R, Bermudo F, Ceballos P, Suanes A. Relationship between high plasma leptin concentrations and metabolic syndrome in obese pre-pubertal children. Int J Obes (Lond) 2003; 27:13-8. [PMID: 12532148 DOI: 10.1038/sj.ijo.0802154] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the relationship between serum leptin levels and metabolic syndrome, fasting insulin level and anthropometric index in obese pre-pubertal children. DESIGN A cross-sectional study was carried out on obese children. SUBJECTS A study was made of 41 obese children (aged 6-9 y) and the same number of non-obese children (control group), matched by age and sex. METHODS Body mass index (BMI), waist/hip ratio (WHR) and blood pressure were determined in each child. Serum leptin, glucose, insulin, lipid profile, sex hormone binding globulin (SHBG), plasminogen activator inhibitor-1 (PAI-1), tissue-plasminogen activator (t-PA) and fibrinogen were all measured. RESULTS The serum leptin level was significantly higher in obese children (15.47 vs 4.73 ng/ml). In the obese group, leptin showed a positive correlation with BMI (P<0.001), insulin (P<0.001), triglycerides (P<0.05), PAI-1 (P<0.05) and t-PA (P<0.05), and correlated negatively with SHBG (P<0.01), apolipoprotein A-I (P<0.05) and high-density lipoproteins cholesterol (HDL-C) (P<0.05). Corrected for BMI and WHR, leptin (P partial=0.002) is only an independent predictive factor for basal insulin. Using multivariant regression analysis, only insulin (P partial=0.003) and BMI (P partial=0.018) were independent predictive factors for leptin. CONCLUSION For this age group, high leptin resistance may be another component of metabolic syndrome, and may be involved in its etiopathogenesis. The involvement of leptin in this syndrome may be indirect, modulating the insulin's action.
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Affiliation(s)
- M Valle
- Clinical Laboratory Department, Valle de los Pedroches Hospital, Pozoblanco, Córdoba, Spain.
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22
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Gascón F, Valle M, Martos R, Ruz FJ, Ríos R, Montilla P, Cañete R. Sex hormone-binding globulin as a marker for hyperinsulinemia and/or insulin resistance in obese children. Eur J Endocrinol 2000; 143:85-9. [PMID: 10870035 DOI: 10.1530/eje.0.1430085] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A relationship between hyperinsulinemia and decreased serum sex hormone-binding globulin (SHBG) has been described in adults. We evaluated the usefulness of SHBG as an index of hyperinsulinemia and/or insulin resistance in obese children (aged 6-9 years) of both sexes and its possible influence on the androgenic status. DESIGN We carried out a cross-sectional study of cases and controls. We studied 61 obese children (22 males, 39 females) with body mass index (BMI) superior to the 90(th) percentile and a control group of age- and sex-matched non-obese children. We measured serum glucose, insulin, TSH, free thyroxine, 17beta-estradiol, testosterone and SHBG. Also, we correlated these parameters with anthropometric measures. RESULTS The obese group presented significantly elevated levels of insulin (P=0.001) and insulin/glucose ratio (P=0.0012) compared with the control group. SHBG (P=0.0001) and testosterone (P=0.0169) levels were significantly lower than those in the non-obese group. We did not find any difference in the free androgen index (FAI). Fasting insulin (r=-0.4512; P<0.001), BMI (r=-0.3185; P<0.05) and testosterone (r=-0.3705; P<0.01) were inversely correlated with SHBG concentration. According to multivariate analyses, insulin was the only independent predictor factor for serum SHBG concentration in the obese group (r partial=0.1280; P=0.0171). CONCLUSIONS In summary, at this age there is a strong relationship between insulin and SHBG. The changes in SHBG levels of the obese group did not affect FAI and, therefore, they did not cause changes in the androgenic status. Our data support the role of insulin in the regulation of serum SHBG levels.
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Affiliation(s)
- F Gascón
- Department of Clinical Laboratory, Valle de los Pedroches Hospital, Pozoblanco, Córdoba, Spain.
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Abstract
Obesity is a major risk factor for cardiovascular disease frequently associated with hypertension, dyslipidemia, and diabetes. In recent years, alterations in the hemostatic system have been added to these dysfunctions. We analyzed some of these alterations in coagulation and fibrinolysis in obese children (6 to 9 years old) of both sexes. We studied 61 obese children (mean body mass index [BMI], 22.35 kg/m2; 95% confidence interval [CI], 21.82 to 22.87) and 70 non-obese children (mean BMI, 16.58 kg/m2; 95% CI, 16.24 to 16.93) as a control group. The obese subjects presented significantly elevated values for insulin (P < .001), tissue-plasminogen activator ([t-PA] P < .001), plasminogen activator inhibitor-1 ([PAI-1] P < .001), and fibrinogen (P < .001) with respect to the control group. We found no significant differences in the concentration of glucose and fragment 1 + 2 of prothrombin (F1 + 2). In the obese subjects, insulin, PAI-1, and F1 + 2 were positively correlated with the BMI. On the other hand, t-PA was correlated with insulin and PAI-1 but not with the BMI. Therefore, in the obese children, there was an increment of the risk factors for cardiovascular disease.
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Affiliation(s)
- M Valle
- Clinical Laboratory, Valle de los Pedroches Hospital, Pozoblanco, Córdoba, Spain
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24
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Ríos R, Gascón F, Solé F, Garcia R, Vincente A, Ceballos P. [Analysis of response to interferon alpha-2b and the significance of antinuclear antibodies in hairy cell leukemia]. Med Clin (Barc) 1996; 106:583-5. [PMID: 8656758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hairy cell leukemia is a uncommon B-cell chronic lymphoproliferative disease rarely associated with autoimmune phenomena. We present a positive CD 5 case with a positive antinuclear antibodies test in the absence of any relation to any other clinical autoimmune disease syndrome and we analyse the evolutive profile of serum concentration of several factors with prognostic significance, relating to the interferon alpha-2b treatment: C reactive protein, beta 2-microglobulin and erythropoietin presented at first very high basal levels that descended progressively until the last two normalized completely; the tumor necrosis factor-alpha manifested stable with normal values during the whole study; the gamma-interferon and interleukin-6 revealed a precocious increase at the start of the treatment later returning to their basal levels. These parameters may aid to assess the response to treatment in these patients.
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Affiliation(s)
- R Ríos
- Servicio de Hematología, Hospital Comarcal Valle de los Pedroches, Pozoblanco, Córdoba
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Ríos R, Solé F, del Mar Pérez M, Gascón F, Garcia F, González PM. t(2;3) in a case of blastic transformation of essential thrombocythaemia. Br J Haematol 1996; 92:769-70. [PMID: 8616055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Ríos R, Solé F, Montes C, Vicente A, Pérez MM, Valle M, Gascón F. A new case of trisomy 5 as sole cytogenetic anomaly in acute myeloid leukemia. Cancer Genet Cytogenet 1995; 84:120-2. [PMID: 8536225 DOI: 10.1016/0165-4608(95)00098-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We present a case of acute myeloid leukemia (AML-M2) with trisomy 5 (+5) as the sole cytogenetic abnormality in a woman previously diagnosed with schizophrenia. To date, only two cases of AML (other than M2) with +5 as the only change have been reported. Moreover, an association between schizophrenia and partial trisomy of chromosome 5p has been described recently. To our knowledge, this is the first report of AML (subtype-M2) with +5. Noteworthy is the association with schizophrenia.
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Affiliation(s)
- R Ríos
- Unit of Hematology, Hospital Valle de los Pedroches, Córdoba, Spain
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Fraile D, Gascón F, Varadé A. Fringe pattern in holographic interferometry for thermal expansion characterization of anisotropic bodies. Appl Opt 1992; 31:7371-7374. [PMID: 20802609 DOI: 10.1364/ao.31.007371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The fringe pattern produced in a double-exposure hologram by thermal expansion of anisotropic flat plates is theoretically attained and experimentally checked.
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Balbás M, Fraile D, Gascón F, Varadé A, Vilarroig P. Fringe pattern in holographic interferometry for thermal expansion characterization of isotropic bodies. Appl Opt 1992; 31:876-880. [PMID: 20720695 DOI: 10.1364/ao.31.000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The fringe pattern produced in a double-exposure hologram by thermal expansion of isotropic flat plates is theoretically attained and experimentally checked. The change of fringe shape as a function of the observation distance is analyzed.
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Gascón F, Gil JA, Fons A, Badal R. [Experimental analysis of finishing lines in ceramometal restorations]. Av Odontoestomatol 1990; 6:525-30. [PMID: 2076124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The preparation is the first step of any tooth reconstruction. The biological integration of the protesis is depending on the marginal adaptation (finish line of the preparation), occlusal adaptation (occlusal reduction), longevity of the restoration (retention and luting) and esthetics. The effect the two finish line of the preparation is studied using experimental design. In porcelain-fused-to-metal the finish line of the preparation in chanfer is superior at the beveled shoulder, because proportioning better marginal adaptation.
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Balbás M, Fraile D, Gascón F, Varadé A, Vilarroig P. Thermal expansion tensor measurement by holographic interferometry. Appl Opt 1989; 28:5065-5068. [PMID: 20556000 DOI: 10.1364/ao.28.005065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The displacement on a plane, originated by a temperature increase of three perpendicular flat plates, is measured by means of a double exposure hologram. These displacements allow us to calculate the thermal expansion tensor of an anisotropic material.
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Gascón F, Molina E. Precision of measurement of glycated hemoglobin by affinity chromatography on regenerated columns. Clin Chem 1989; 35:191. [PMID: 2910572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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32
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Gascón F, Molina E. Precision of measurement of glycated hemoglobin by affinity chromatography on regenerated columns. Clin Chem 1989. [DOI: 10.1093/clinchem/35.1.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Gascón F, Fons A, Fernández O. [Reproduction capacity "in vitro" of elastomers: addition silicones, polyethers and polyethylene]. Arch Odonto Estomatol 1987; 3:69-74. [PMID: 3136739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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