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Campuzano R, Barrios V, Mostaza JM, Egocheaga I, Perez Roman I, Martinez Lopez A, Sicras-Mainar A, Morant Talamante N, Parrondo J, Gomez Cerezo JF, Pallares V, Martinez Lopez I, Castellanos M, Gamez JM. Preliminary results from REALITY: a nation-wide study of a database with 1.8 million real-life patients to study atherosclerotic cardiovascular disease and familial hypercholesterolemia in Spain. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2672] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Ischemic heart disease and stroke are the leading causes of premature death worldwide. Atherosclerotic cardiovascular disease (ASCVD) is the main determining factor for these and other life-threatening pathologies, such as peripheral artery disease (PAD). LDL-lowering therapies are the gold standard to prevent ASCVD. These treatments are also used for familial hypercholesterolemia (FH), a genetic disorder manifesting with high LDL levels. It is crucial to evaluate the management and level of LDL control in “real-life” patients with ASCVD and FH, but so far very few large-scale studies have focussed on these issues. REALITY is an observational retrospective study of ASCVD and FH in Spain.
Purpose
The goals of REALITY included the analysis of the demographic and clinical characteristics, comorbidities, and concomitant medication of patients with ASCVD and/or FH by a multidisciplinary group of experts. The lipid-lowering therapies used in Spain were assessed, and patient LDL levels were evaluated according to treatment intensity during the two-year follow-up period.
Methods
Electronic medical records were retrieved from the BIG-PAC® database that includes anonymized data of patients from seven health areas in Spain. The study population included patients presenting a new or recurrent episode of ASCVD (n=26,976) or a new diagnosis of FH (n=572) during the recruitment period (from 01/01/2017 to 31/12/2018). The index date was defined as the date of the event/diagnosis, and a 2-year follow-up was established.
Results
The average age was 69.9±11.5 for ASCVD patients and 60.1±12 for FH patients (59.4% and 48.6% males, respectively). The average Charlson index was 2.2±1.6 in ASCVD and 1.2±1.4 in FH. The comorbidities most frequently observed in ASCVD vs. FH were hypercholesterolaemia (55% vs. 100%), arterial hypertension (65% vs. 54%), diabetes mellitus (31% vs. 29%) and obesity (31% vs. 21%). Around 25% and 6% of patients with ASCVD and FH, respectively, presented CV events in the follow-up. During the 24-month period, the highest rate of ischemic heart disease was observed in patients with LDL levels of 55–69 mg/dL, whereas LDL levels below 55 mg/dL were associated with the highest incidence of PAD. The highest lipid biochemical reductions in ASCVD vs. FH were observed in total cholesterol (−52±17.4 vs. −53.5±21.3 mg/dL), triglycerides (−53±7.9 vs. −54.2±8.8 mg/dL) and LDL (−27.4±10.4 vs. −29±12.3 mg/dL). HDL levels showed an average increase of 8.5±2 vs. 9.3±2.5 mg/dL. Treatment intensity correlated with reduction of LDL levels in all ASCVD disease subgroups and FH patients (Table 1).
Conclusions
The results of REALITY provide an estimated clinical picture of ASCVD and FH in Spain. The impact of therapeutical approaches on LDL levels and the prevention of CV events were evaluated by a multidisciplinary group of experts. The findings of the study will help lower the burden of ASCVD and FH in Spain.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): REALITY study was sponsored by Novartis. Statistical analysis of the BIG-PAC® database was performed by Atrys Health. Medical writing and editing were provided by Medical Science Consulting. All funded by Novartis.
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Affiliation(s)
- R Campuzano
- Alcorcon Foundation University Hospital, Cardiac Rehabilitation Unit - Cardiology Service , Madrid , Spain
| | - V Barrios
- Ramon y Cajal University Hospital, Cardiology Service , Madrid , Spain
| | - J M Mostaza
- La Paz University Hospital, Internal Medicine Section , Madrid , Spain
| | - I Egocheaga
- Clinic centre of Isla de Oza, Family Medicine Service , Madrid , Spain
| | - I Perez Roman
- Atrys Health, Health Economics and Outcomes Research Department , Madrid , Spain
| | - A Martinez Lopez
- Atrys Health, Health Economics and Outcomes Research Department , Madrid , Spain
| | - A Sicras-Mainar
- Atrys Health, Health Economics and Outcomes Research Department , Madrid , Spain
| | | | - J Parrondo
- Novartis Pharmaceuticals, Medical Department , Madrid , Spain
| | - J F Gomez Cerezo
- Infanta Sofia University Hospital, Internal Medicine Section , Madrid , Spain
| | - V Pallares
- Union de Mutuas, Health Surveillance Unit , Castellon , Spain
| | - I Martinez Lopez
- Son Espases University Hospital, Pharmacy Service and Molecular Diagnostic and Clinical Genetics Unit , Palma de Mallorca , Spain
| | - M Castellanos
- A Coruña University Hospital and Biomedical Research Institute, Department of Neurology , A coruña , Spain
| | - J M Gamez
- Son Llatzer University Hospital, Cardiology Service , Palma de Mallorca , Spain
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Barrios V, Campuzano R, Egocheaga I, Martinez Lopez I, Castellanos M, Perez Roman I, Martinez Lopez A, Sicras-Mainar A, Morant Talamante N, Parrondo J, Mostaza JM, Gomez Cerezo JF, Gamez JM, Pallares V. The REALITY project: analysis of a national database with 1.8 million real-life patients to study atherosclerotic cardiovascular disease and familial hypercholesterolemia in Spain. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2861] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Atherosclerotic cardiovascular disease (ASCVD), hypercholesterolaemia, and familial hypercholesterolaemia (FH) are associated with high mortality, morbidity and direct/indirect economic costs worldwide. However, information about patient characteristics, clinical practice, treatment effectiveness, and economic costs is limited in Spain. To address this issue, a multidisciplinary working group of cardiologists, hospital pharmacists, family physicians, internal medicine specialists, and neurologists took part in the nationwide, observational, retrospective REALITY study. Using information from the Spanish National Health System (SNHS), the group will describe the treatment patterns and clinical profiles of patients with ASCVD and/or FH in Spain.
Methods and results
REALITY will access 1.8 million electronic medical records in the BIG-PAC® database, which collects anonymised data (in compliance with Organic Law 3/2018 of 5 December) from SNHS primary care centres and hospitals across seven regional health areas in Spain. REALITY was approved by the Hospital of Terrassa Ethics Committee on 17/11/2020. Patients presenting a new/recurrent episode of ASCVD or diagnosed with FH from 01/01/2017 to 31/12/2018 were recruited. The index date was the date of the event/diagnosis, and a two-year follow-up was established. Patients were classified as FH or ASCVD on the basis of their primary diagnosis (five subgroups: stable/unstable angina, acute myocardial infarction, ischemic stroke, transient ischemic attack, and peripheral arterial disease). Primary objectives were to determine demographic and clinical characteristics, comorbidities, and concomitant medication. Secondary objectives were to determine the lipid-lowering therapy applied, persistence of medication and modifications, the rationale for switching therapy, and treatment adherence (including data from non-adherent patients). Endpoints were low-density lipoprotein (LDL) levels, prevalence and incidence of new events, use of healthcare resources (e.g., medical visits or tests, coronary artery bypass surgery, hospitalizations, etc.), and healthcare costs. Using the aforementioned variables, these endpoints were analysed globally according to disease classification. Exploratory objectives included estimation of the percentage of statin-intolerant patients, and a subanalysis of costs according to the intensity of the lipid-lowering treatment and LDL levels.
Conclusions
The power of the “real-life” data from the BIG-PAC® database and the multidisciplinary approach used in this study will facilitate a wide range of analyses/subanalyses of various clinical issues, including treatment, disease burden, and economic costs. This study will give healthcare practitioners and policy makers valuable data for cardiovascular secondary prevention, control, and strategies to improve management.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The REALITY study is sponsored by Novartis. Statistical analysis of the BIG-PAC® database was performed by Atrys Health. Medical writing and editing were provided by Medical Science Consulting. All funded by Novartis.
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Affiliation(s)
- V Barrios
- Ramon y Cajal University Hospital, Cardiology Service , Madrid , Spain
| | - R Campuzano
- Alcorcon Foundation University Hospital, Cardiac Rehabilitation Unit - Cardiology Service , Madrid , Spain
| | - I Egocheaga
- Clinic centre of Isla de Oza, Family Medicine Service , Madrid , Spain
| | - I Martinez Lopez
- Son Espases University Hospital, Pharmacy Service and Molecular Diagnostic and Clinical Genetics Unit , Palma de Mallorca , Spain
| | - M Castellanos
- A Coruña University Hospital and Biomedical Research Institute, Department of Neurology , A coruña , Spain
| | - I Perez Roman
- Atrys Health, Health Economics and Outcomes Research Department , Madrid , Spain
| | - A Martinez Lopez
- Atrys Health, Health Economics and Outcomes Research Department , Madrid , Spain
| | - A Sicras-Mainar
- Atrys Health, Health Economics and Outcomes Research Department , Madrid , Spain
| | | | - J Parrondo
- Novartis Pharmaceuticals, Medical Department , Madrid , Spain
| | - J M Mostaza
- La Paz University Hospital, Internal Medicine Section , Madrid , Spain
| | - J F Gomez Cerezo
- Infanta Sofia University Hospital, Internal Medicine Section , Madrid , Spain
| | - J M Gamez
- Son Llatzer University Hospital, Cardiology Service , Palma de Mallorca , Spain
| | - V Pallares
- Union de Mutuas, Health Surveillance Unit , Castellon , Spain
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Alonso de Leciñana M, Morales A, Martínez-Zabaleta M, Ayo-Martín Ó, Lizán L, Castellanos M. Characteristics of stroke units and stroke teams in Spain in 2018. Pre2Ictus project. Neurologia (Engl Ed) 2022; 38:173-180. [PMID: 35780047 DOI: 10.1016/j.nrleng.2022.03.001] [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: 02/18/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain. METHODS We performed a cross-sectional study based on an ad-hoc questionnaire designed by 5 experts and addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year. RESULTS The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. A mean (standard deviation) of 4 (3) neurologists were assigned to each stroke unit/team; 98% of stroke units (and 38% of stroke teams) have an on-call neurologist available 24 hours a day, 98% of units (79% of stroke teams) included specialised nurses, 86% of units (71% of stroke teams) included a social worker, and 81% of units (71% of stroke teams) included a rehabilitation physician. Most stroke units (80%) had 4--6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds was 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring was 3 (1) days. All stroke units and 86% of stroke teams had intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams were able to perform mechanical thrombectomy, whereas the remaining centres had referral pathways in place. Telestroke systems were in place at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases. CONCLUSIONS Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care.
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Affiliation(s)
- M Alonso de Leciñana
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Ó Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - L Lizán
- Outcomes'10 SLU, Castellón, Spain; Departamento de Medicina, Universitat Jaume I, Castellón, Spain
| | - M Castellanos
- Servicio de Neurología, Hospital Universitario e Instituto de Investigación Biomédica, La Coruña, Spain
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Gil-Núñez A, Masjuan J, Montaner J, Castellanos M, Segura T, Cardona P, Tembl JI, Purroy F, Arenillas J, Palacio E. Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. Neurologia 2022; 37:136-150. [PMID: 33358061 DOI: 10.1016/j.nrl.2020.11.006] [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: 06/22/2020] [Revised: 08/31/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels <20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.
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Affiliation(s)
- A Gil-Núñez
- Sección Neurología Vascular-Centro de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, España; Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Montaner
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, La Coruña, España
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J I Tembl
- Servicio de Neurología, Hospital La Fe, Valencia, España
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova, Lérida, España
| | - J Arenillas
- Servicio de Neurología, Hospital de Valladolid, Valladolid, España
| | - E Palacio
- Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, España
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Palacio-Portilla EJ, Roquer J, Amaro S, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, Fuentes B, García-Pastor A, Gomis M, Gómez-Choco M, López-Cancio E, Martínez-Sánchez P, Morales A, Rodríguez-Yáñez M, Segura T, Serena J, Vivancos-Mora J, de Leciñana MA. Dyslipidemias and stroke prevention: recommendations of the Study Group of Cerebrovascular Diseases of the Spanish Society of Neurology. Neurologia 2022; 37:61-72. [PMID: 33160722 DOI: 10.1016/j.nrl.2020.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/15/2020] [Accepted: 07/19/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE We present an update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. DEVELOPMENT We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. CONCLUSIONS In primary prevention, the patient's vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value <55mg/dL is recommended; in non-atherothombotic ischaemic strokes, given the unclear relationship with dyslipidaemia, target value should be established according to the vascular risk group of each patient. In both primary and secondary prevention, statins are the drugs of first choice, and ezetimibe and/or PCSK9 inhibitors may be added in patients not achieving the target value.
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Affiliation(s)
- E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, España.
| | - J Roquer
- Servicio de Neurología, IMIM-Hospital del Mar, Barcelona, España.
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari; Departamento de Medicina, Universidad de Barcelona. Instituto de Investigación Biomédica Augut Pi i Sunyer (IDIBAPS), Barcelona, España
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, España
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario de Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, España
| | - B Fuentes
- Servicio de Neurología, Centro de ictus, Hospital Universitario La Paz. IdiPAZ. Universidad Autónoma de Madrid, Madrid, España
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón. Universidad Complutense de Madrid, Madrid, España
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, España
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España
| | - P Martínez-Sánchez
- Servicio de Neurología, Hospital Universitario Torrecárdenas, Almería, España
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - M A de Leciñana
- Servicio de Neurología, Centro de ictus, Hospital Universitario La Paz. IdiPAZ. Universidad Autónoma de Madrid, Madrid, España
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Kinneally T, Danda N, Castellanos M, Emeto T, Weerasooriya S. Outpatient Parenteral Antimicrobial Therapy (OPAT) Program for Infective Endocarditis in North Queensland. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.359] [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: 10/16/2022]
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7
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Palacio-Portilla EJ, Roquer J, Amaro S, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, Fuentes B, García-Pastor A, Gomis M, Gómez-Choco M, López-Cancio E, Martínez-Sánchez P, Morales A, Rodríguez-Yáñez M, Segura T, Serena J, Vivancos-Mora J, de Leciñana MA. Dyslipidemias and stroke prevention: Recommendations of the Study Group of Cerebrovascular Diseases of the Spanish Society of Neurology. Neurologia 2022; 37:61-72. [PMID: 35074190 DOI: 10.1016/j.nrleng.2020.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/19/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We present an update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. DEVELOPMENT We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. CONCLUSIONS In primary prevention, the patient's vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value <55 mg/dL is recommended; in non-atherothombotic ischaemic strokes, given the unclear relationship with dyslipidaemia, target value should be established according to the vascular risk group of each patient. In both primary and secondary prevention, statins are the drugs of first choice, and ezetimibe and/or PCSK9 inhibitors may be added in patients not achieving the target value.
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Affiliation(s)
- E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
| | - J Roquer
- Servicio de Neurología, IMIM-Hospital del Mar, Barcelona, Spain.
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari, Departamento de Medicina, Universidad de Barcelona, Instituto de Investigación Biomédica Augut Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, Spain
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario de Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - B Fuentes
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - P Martínez-Sánchez
- Servicio de Neurología, Hospital Universitario Torrecárdenas, Almería, Spain
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, Spain
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - M A de Leciñana
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
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Gil-Núñez A, Masjuan J, Montaner J, Castellanos M, Segura T, Cardona P, Tembl JI, Purroy F, Arenillas J, Palacio E. Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. Neurologia (Engl Ed) 2021; 37:136-150. [PMID: 34906541 DOI: 10.1016/j.nrleng.2020.11.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels < 20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.
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Affiliation(s)
- A Gil-Núñez
- Sección Neurología Vascular-Centro de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Montaner
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, La Coruña, Spain
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, Spain
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J I Tembl
- Servicio de Neurología, Hospital La Fe, Valencia, Spain
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova, Lérida, Spain
| | - J Arenillas
- Servicio de Neurología, Hospital de Valladolid, Valladolid, Spain
| | - E Palacio
- Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, Spain
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9
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García Pastor A, López-Cancio Martínez E, Rodríguez-Yáñez M, Alonso de Leciñana M, Amaro S, Arenillas JF, Ayo-Martín O, Castellanos M, Fuentes B, Freijo MM, Gomis M, Gómez Choco M, Martínez Sánchez P, Morales A, Palacio-Portilla EJ, Segura T, Serena J, Vivancos-Mora J, Roquer J. Recommendations of the Spanish Society of Neurology for the prevention of stroke. Interventions on lifestyle and air pollution. Neurologia 2021; 36:377-387. [PMID: 34714236 DOI: 10.1016/j.nrleng.2020.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To update the recommendations of the Spanish Society of Neurology regarding lifestyle interventions for stroke prevention. DEVELOPMENT We reviewed the most recent studies related to lifestyle and stroke risk, including randomised clinical trials, population studies, and meta-analyses. The risk of stroke associated with such lifestyle habits as smoking, alcohol consumption, stress, diet, obesity, and sedentary lifestyles was analysed, and the potential benefits for stroke prevention of modifying these habits were reviewed. We also reviewed stroke risk associated with exposure to air pollution. Based on the results obtained, we drafted recommendations addressing each of the lifestyle habits analysed. CONCLUSIONS Lifestyle modification constitutes a cornerstone in the primary and secondary prevention of stroke. Abstinence or cessation of smoking, cessation of excessive alcohol consumption, avoidance of exposure to chronic stress, avoidance of overweight or obesity, a Mediterranean diet supplemented with olive oil and nuts, and regular exercise are essential measures in reducing the risk of stroke. We also recommend implementing policies to reduce air pollution.
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Affiliation(s)
- A García Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañon, Madrid, Spain; Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - E López-Cancio Martínez
- Servicio de Neurología, Hospital Universitario Gregorio Marañon, Madrid, Spain; Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, A Coruña, Spain
| | | | - S Amaro
- Servicio de Neurología, Hospital Clinic i Universitari, Barcelona, Spain
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, Spain
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario de Cruces, Baracaldo, Spain
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - M Gómez Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broogi, Barcelona, Spain
| | | | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Girona, Spain
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, Spain
| | - J Roquer
- Servicio de Neurología, IMIM-Hospital del Mar, Barcelona, Spain
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10
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Fuentes B, Amaro S, Alonso de Leciñana M, Arenillas J, Ayo-Martín O, Castellanos M, Freijo M, García-Pastor, Gomis M, Gómez Choco M, López-Cancio E, Martínez Sánchez P, Morales A, Palacio-Portilla E, Rodríguez-Yáñez M, Roquer J, Segura T, Serena J, Vivancos-Mora J. Stroke prevention in patients with type 2 diabetes mellitus or prediabetes: recommendations of the Spanish Society of Neurology’s Stroke Study Group. Neurología (English Edition) 2021. [DOI: 10.1016/j.nrleng.2020.04.022] [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: 11/29/2022] Open
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11
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Rodríguez-Yañez M, Gómez-Choco M, López-Cancio E, Amaro S, Alonso de Leciñana M, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, García-Pastor A, Gomis M, Martínez Sánchez P, Morales A, Palacio-Portilla EJ, Roquer J, Segura T, Serena J, Vivancos-Mora J, Fuentes B. Stroke prevention in patients with arterial hypertension: Recommendations of the Spanish Society of Neurology's Stroke Study Group. Neurologia (Engl Ed) 2021; 36:462-471. [PMID: 34238528 DOI: 10.1016/j.nrleng.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension. DEVELOPMENT We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations. CONCLUSIONS In primary stroke prevention, antihypertensive treatment should be started in patients with BP levels > 140/90 mmHg, with a target BP of < 130/80 mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24 hours), with a target BP of < 130/80 mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable.
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Affiliation(s)
- M Rodríguez-Yañez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari; Departamento de Medicina, Universidad de Barcelona. Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Departamento de Medicina, Universidad Autónoma de Madrid, Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, Spain
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, Spain
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
| | | | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, Spain
| | - E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - J Roquer
- Servicio de Neurología, Hospital del Mar, Barcelona, Spain
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Departamento de Medicina, Universidad Autónoma de Madrid, Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, Spain
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Masjuan J, Gállego J, Aguilera J, Arenillas J, Castellanos M, Díaz F, Portilla J, Purroy F. Use of cardiovascular polypills for the secondary prevention of cerebrovascular disease. Neurología (English Edition) 2021. [DOI: 10.1016/j.nrleng.2017.10.008] [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: 10/26/2022] Open
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13
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Alonso de Leciñana M, Morales A, Martínez-Zabaleta M, Ayo-Martín Ó, Lizán L, Castellanos M. Characteristics of stroke units and stroke teams in Spain in 2018. Pre2Ictus project. Neurologia 2020; 38:S0213-4853(20)30222-X. [PMID: 32917435 DOI: 10.1016/j.nrl.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain. METHOD We performed a cross-sectional study based on an ad hoc questionnaire designed by 5 experts and addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year. RESULTS The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. The mean (SD) number of neurologists assigned to each unit/team is 4±3. 98% of stroke units (and 38% of stroke teams) have a neurologist on-call available 24hours, 365 days. 98% of stroke units (79% of stroke teams) have specialised nurse, 95% of units (71% of stroke teams) auxiliary personnel, 86% of units (71% of stroke teams) social worker, 81% of stroke units (71% of stroke teams) have a rehabilitation physician and 81% of stroke units (86% of stroke teams) a physiotherapist. Most stroke units (80%) have 4-6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds is 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring is 3 (1) days. All stroke units and 86% of stroke teams have intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams are able to perform mechanical thrombectomy, whereas the remaining centres have referral pathways in place. Telestroke systems are available at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases. CONCLUSIONS Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care.
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Affiliation(s)
- M Alonso de Leciñana
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, España.
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario de Donostia, San Sebastián, España
| | - Ó Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - L Lizán
- Outcomes'10 SLU, Castellón, España; Departamento de Medicina, Universitat Jaume I, Castellón, España
| | - M Castellanos
- Servicio de Neurología, Hospital Universitario e Instituto de Investigación Biomédica, La Coruña, España
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14
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García Pastor A, López-Cancio Martínez E, Rodríguez-Yáñez M, Alonso de Leciñana M, Amaro S, Arenillas JF, Ayo-Martín O, Castellanos M, Fuentes B, Freijo MM, Gomis M, Gómez Choco M, Martínez Sánchez P, Morales A, Palacio-Portilla EJ, Segura T, Serena J, Vivancos-Mora J, Roquer J. Recommendations of the Spanish Society of Neurology for the prevention of stroke. Interventions on lifestyle and air pollution. Neurologia 2020. [PMID: 32917433 DOI: 10.1016/j.nrl.2020.05.018] [Citation(s) in RCA: 2] [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] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To update the recommendations of the Spanish Society of Neurology regarding lifestyle interventions for stroke prevention. DEVELOPMENT We reviewed the most recent studies related to lifestyle and stroke risk, including randomised clinical trials, population studies, and meta-analyses. The risk of stroke associated with such lifestyle habits as smoking, alcohol consumption, stress, diet, obesity, and sedentary lifestyles was analysed, and the potential benefits for stroke prevention of modifying these habits were reviewed. We also reviewed stroke risk associated with exposure to air pollution. Based on the results obtained, we drafted recommendations addressing each of the lifestyle habits analysed. CONCLUSIONS Lifestyle modification constitutes a cornerstone in the primary and secondary prevention of stroke. Abstinence or cessation of smoking, cessation of excessive alcohol consumption, avoidance of exposure to chronic stress, avoidance of overweight or obesity, a Mediterranean diet supplemented with olive oil and nuts, and regular exercise are essential measures in reducing the risk of stroke. We also recommend implementing policies to reduce air pollution.
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Affiliation(s)
- A García Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañon, Madrid, España; Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España.
| | - E López-Cancio Martínez
- Servicio de Neurología, Hospital Universitario Gregorio Marañon, Madrid, España; Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España.
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, A Coruña, España
| | | | - S Amaro
- Servicio de Neurología, Hospital Clinic i Universitari, Barcelona, España
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, España
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario de Cruces, Baracaldo, España
| | - M Gomis
- Servicio de Neurología, Hospital Universitari Germans Trias i Pujol, Barcelona, España
| | - M Gómez Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broogi, Barcelona, España
| | | | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Girona, España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, España
| | - J Roquer
- Servicio de Neurología, IMIM-Hospital del Mar, Barcelona, España
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15
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Rodríguez-Yañez M, Gómez-Choco M, López-Cancio E, Amaro S, Alonso de Leciñana M, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, García-Pastor A, Gomis M, Martínez Sánchez P, Morales A, Palacio-Portilla EJ, Roquer J, Segura T, Serena J, Vivancos-Mora J, Fuentes B. Stroke prevention in patients with arterial hypertension: Recommendations of the Spanish Society of Neurology's Stroke Study Group. Neurologia 2020. [PMID: 32893074 DOI: 10.1016/j.nrl.2020.04.031] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension. DEVELOPMENT We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations. CONCLUSIONS In primary stroke prevention, antihypertensive treatment should be started in patients with BP levels >140/90mmHg, with a target BP of <130/80mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24hours), with a target BP of <130/80mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable.
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Affiliation(s)
- M Rodríguez-Yañez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España.
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España.
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari; Departamento de Medicina, Universidad de Barcelona. Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz; Departamento de Medicina, Universidad Autónoma de Madrid. Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, España
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña; Instituto de Investigación Biomédica A Coruña, A Coruña, España
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario Cruces. Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, España
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón; Universidad Complutense de Madrid, Madrid, España
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, España
| | | | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca; Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, España
| | - E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
| | - J Roquer
- Servicio de Neurología, Hospital del Mar, Barcelona, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - J Serena
- Servicio de Neurología; Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz; Departamento de Medicina, Universidad Autónoma de Madrid. Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, España
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Desai N, Nadella S, Oshodi C, Desir H, Hibner M, Castellanos M. 082 Prevalence of Adenomyosis in Chronic Pelvic Pain Patients Undergoing Hysterectomy. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.387] [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: 10/23/2022]
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Martínez-Barrio J, Villar O, Armijo O, Castellanos M, Marín Huarte N, Mareque M, Casado MA, Martínez N. THU0562 ECONOMIC IMPACT ASSOCIATED WITH COMPLICATIONS OF WOMEN IN REPRODUCTIVE AGE LIVING WITH INFLAMMATORY IMMUNE-MEDIATED DISEASES (PSO, PSA, RA, AXSPA) IN SPAIN. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6075] [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] [Indexed: 11/04/2022]
Abstract
Background:Cost of the complications that may appear during reproductive age in women living with inflammatory immune-mediated diseases have scarcely been studied.Objectives:To obtain an expert consensus in the use of resources associated to complications of women in reproductive age living with immune-mediated diseases: psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) and estimate an economic impact.Methods:A cost-analysis was developed to estimate the impact associated with the complications of women of reproductive age with PSO, PsA, RA and axSpA.The analysis considered the complications during fertility and conception (preconception consultation and assisted reproduction), in pregnancy (miscarriage in the first trimester, late abortion in the second trimester, preeclampsia, delayed or restricted intrauterine growth and threat of premature delivery) and in the postpartum (admissions in neonatology of premature infants).An online questionnaire was designed for the validation of the inputs used in the cost-analysis. Subsequently, the questionnaire was sent to a multidisciplinary panel composed of, rheumatologist, gynecologists, neonatologists and dermatologist. A consensus meeting was carried out to validate and agree the parameters used in the analysis.Unitary cost for resources (€,2019) were obtained from national local databases.The perspective of analysis was the National Healthcare System and the time horizon was one year.Results:During fertility and conception, an annual cost per patient of € 229 was estimated for a preconception consultation in a patient with PSO, of € 3,642 for a preconception consultation in patients with PsA, RA and axSpA and € 4,339 for assisted reproduction.Women with complications in pregnancy had an annual cost per patient of € 1,214 for a miscarriage in the first trimester, € 4,419 for a late abortion in the second trimester, € 11,251 for preeclampsia € 3,183 for delayed or restricted intrauterine growth and € 12,122 for the threat of premature delivery.In the postpartum complications, an annual cost per patient of € 120,364, € 44,709 and € 5,507 were estimated associated with admissions in neonatology of premature infants of <28 weeks, from 28 to 32 weeks and from 33 to 37 weeks, respectively.Conclusion:This modeling provides insight on the economic burden of complications associated with women in reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.Disclosure of Interests:Julia Martínez-Barrio Consultant of: UCB Pharma, Olga Villar Consultant of: UCB Pharma, Oníca Armijo Consultant of: UCB Pharma, María Castellanos Consultant of: UCB Pharma, Natalia Marín Huarte Consultant of: UCB Pharma, María Mareque Consultant of: UCB Pharma, Miguel Angel Casado Consultant of: UCB Pharma, Nuria Martínez Consultant of: UCB Pharma
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18
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Matías-Guiu J, Matias-Guiu JA, Alvarez-Sabin J, Ramon Ara J, Arenillas J, Casado-Naranjo I, Castellanos M, Jimenez-Hernandez MD, Lainez-Andres JM, Moral E, Morales A, Rodriguez-Antigüedad A, Segura T, Serrano-Castro P, Diez-Tejedor E. Will neurological care change over the next 5 years due to the COVID-19 pandemic? Key informant consensus survey. Neurologia 2020; 35:252-257. [PMID: 32364126 PMCID: PMC7165283 DOI: 10.1016/j.nrl.2020.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable. MATERIAL AND METHODS A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic. RESULTS Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination. CONCLUSION The key informant survey identified the foreseeable changes in neurological care after the pandemic.
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Affiliation(s)
- J Matías-Guiu
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España.
| | - J A Matias-Guiu
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - J Alvarez-Sabin
- Servicio de Neurología, Hospital Universitario de Vall d'Hebron, Barcelona, España
| | - J Ramon Ara
- Servicio de Neurología, Hospital Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - J Arenillas
- Servicio de Neurología, Hospital Clínico de Valladolid, Valladolid, España
| | - I Casado-Naranjo
- Servicio de Neurología, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, España
| | | | - J M Lainez-Andres
- Servicio de Neurología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - E Moral
- Hospital Moisès Broggi y Hospital General de l'Hospitalet, Barcelona, España
| | - A Morales
- Servicio de Neurología, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | | | - T Segura
- Servicio de Neurología, Hospital General Universitario de Albacete, Albacete, España
| | - P Serrano-Castro
- Servicio de Neurología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - E Diez-Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, España
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Peralta-Reyes E, Natividad R, Castellanos M, Mentado-Morales J, Cordero ME, Amado-Piña D, Regalado-Méndez A. Electro-oxidation of 2-chlorophenol with BDD electrodes in a continuous flow electrochemical reactor. J Flow Chem 2020. [DOI: 10.1007/s41981-020-00079-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ugedo Alzaga K, Candina R, Lambarri A, Castellanos M, Aurrekoetxea G, Bravo I, Codina M, Manzanal A, Garcia N, Ramirez-Escudero G, Ruiz L, Ormaetxe JM. P867 Mitral stenosis: from mild to severe in less than a year. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.511] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
We report the case of an 82-year-old woman, with personal history of hypertension, diabetes mellitus, dyslipemia and permanent atrial fibrillation. In 2013 aortic valve substitution surgery was performed with a mechanic prosthetic valve. In her last echocardiogram in May 2018 a mild double mitral lesion was detected, with a normal aortic valve functioning.
In March of 2019 she was admitted in hospital with symptoms of heart failure and 38ºC fever.
A transthoracic echocardiogram was performed, which revealed a vegetation in the native mitral valve that caused a severe mitral stenosis (area 0.64 cm2). In blood cultures Streptococcus gallolyticycus was isolated.
In this situation, a tranesophagical echocardiogram was performed, which confirmed the diagnosis of an infective endocarditis in the native mitral valve. It also showed spontaneous echocontrast as well as a thrombus in the left atrial appendage, despite anticoagulant medication.
Given these findings, antibiotic therapy was initiated and surgery programmed. Substitution of the native mitral valve for a biological prosthesis was made. In the transthoracic echocardiographic control the prosthesis was normal functioning. A colonoscopy was performed taking into account the strong association between Streptococcus gallolyticus and colonic lesions, which showed no abnormal findings. At the discharge the patient had no signs or symptoms suggestive of heart failure or infection.
Streptococcus gallolytycus is included in the D group of Streptococci. Among hospitalized patients, this group accounts for approximately 5% of streptococcal bloodstream isolates. For humans, the gastrointestinal tract is the most frequent entry point, other potential sources include the hepatobiliary tree and the urinary tract. Clinical manifestations include bacteremia and endocarditis, which is usually highly destructive and frequently bivalvular. Bone infection, meningitis or peritonitis can also be present. Due to the frequent association between this microorganism and colonic neoplasm, colonoscopy is necessary to dismiss pathological findings. Typically D Streptococci can be treated with penicillins, ceftriaxone, carbapenems, vancomycin, daptomycin, and linezolid. The preferred regimen for streptococcal prosthetic valve endocarditis includes a beta-lactam combined with an aminoglycoside, to achieve synergistic effect.
Abstract P867 Figure. Mitral stenosis
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Affiliation(s)
| | | | | | | | | | - I Bravo
- Hospital de Basurto, Bilbao, Spain
| | - M Codina
- Hospital de Basurto, Bilbao, Spain
| | | | - N Garcia
- Hospital de Basurto, Bilbao, Spain
| | | | - L Ruiz
- Hospital de Basurto, Bilbao, Spain
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Gomez N, Luján O, Bustos M, Bendeck J, Arias A, Castellanos M, Torres C, Prieto C, Polania D, Martinez M, Casas M, Estrada M, Fernandez I, Gustavo LC. Characterization of an endogamic Colombian family with steinert myotonic dystrophy. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1460] [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: 11/25/2022]
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Cernicharo J, Gallego JD, López-Pérez JA, Tercero F, Tanarro I, Beltrán F, de Vicente P, Lauwaet K, Alemán B, Moreno E, Herrero VJ, Doménech JL, Ramírez SI, Bermúdez C, Peláez RJ, Patino-Esteban M, López-Fernández I, García-Álvaro S, García-Carreño P, Cabezas C, Malo I, Amils R, Sobrado J, Diez-González C, Hernandéz J, Tercero B, Santoro G, Martínez L, Castellanos M, Vaquero Jiménez B, Pardo JR, Barbas L, López-Fernández J, Aja B, Leuther A, Martín-Gago JA. Broad band high resolution rotational spectroscopy for Laboratory Astrophysics. Astron Astrophys 2019; 626:10.1051/0004-6361/201935197. [PMID: 31186577 PMCID: PMC6557716 DOI: 10.1051/0004-6361/201935197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present a new experimental setup devoted to the study of gas phase molecules and processes using broad band high spectral resolution rotational spectroscopy. A reactor chamber has been equipped with radio receivers similar to those used by radio astronomers to search for molecular emission in space. The whole Q (31.5-50 GHz) and W bands (72-116.5 GHz) are available for rotational spectroscopy observations. The receivers are equipped with 16×2.5 GHz Fast Fourier Transform spectrometers with a spectral resolution of 38.14 kHz allowing the simultaneous observation of the complete Q band and one third of the W band. The whole W band can be observed in three settings in which the Q band is always observed. Species such as CH3CN, OCS, and SO2 are detected, together with many of their isotopologues and vibrationally excited states, in very short observing times. The system permits automatic overnight observations and integration times as long as 2.4×105 seconds have been reached. The chamber is equipped with a radiofrequency source to produce cold plasmas and with four ultraviolet lamps to study photochemical processes. Plasmas of CH4, N2, CH3CN, NH3, O2, and H2, among other species, have been generated and the molecular products easily identified by their rotational spectrum, and mass spectrometry and optical spectroscopy. Finally, the rotational spectrum of the lowest energy conformer of CH3CH2NHCHO (N-Ethylformamide), a molecule previously characterized in microwave rotational spectroscopy, has been measured up to 116.5 GHz allowing the accurate determination of its rotational and distortion constants and its search in space.
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Affiliation(s)
- J. Cernicharo
- Instituto de Física Fundamental (IFF. CSIC). Group of Molecular Astrophysics, C/Serrano 123, 28006 Madrid, Spain
| | - J. D. Gallego
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - J. A. López-Pérez
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - F. Tercero
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - I. Tanarro
- Instituto de Estructura de la Materia (IEM. CSIC). Molecular Physics Department. C/Serrano 123, 28006 Madrid, Spain
| | - F. Beltrán
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - P. de Vicente
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - K. Lauwaet
- Instituto de Ciencia de Materiales de Madrid (ICMM. CSIC). Materials Science Factory. Structure of Nanoscopic Systems Group, ESISNA. C/Sor Juana Inés de la Cruz 3, 28049 Cantoblanco, Madrid, Spain
- IMDEA Nanociencia, Ciudad Universitaria de Cantoblanco, 28049 Cantoblanco, Madrid, Spain
| | - B. Alemán
- Instituto de Ciencia de Materiales de Madrid (ICMM. CSIC). Materials Science Factory. Structure of Nanoscopic Systems Group, ESISNA. C/Sor Juana Inés de la Cruz 3, 28049 Cantoblanco, Madrid, Spain
- IMDEA Materiales, C/Eric Kandel 2, Tecnogetafe, 28906 Getafe, Madrid, Spain
| | - E. Moreno
- Instituto de Física Fundamental (IFF. CSIC). Group of Molecular Astrophysics, C/Serrano 123, 28006 Madrid, Spain
| | - V. J. Herrero
- Instituto de Estructura de la Materia (IEM. CSIC). Molecular Physics Department. C/Serrano 123, 28006 Madrid, Spain
| | - J. L. Doménech
- Instituto de Estructura de la Materia (IEM. CSIC). Molecular Physics Department. C/Serrano 123, 28006 Madrid, Spain
| | - S. I. Ramírez
- Instituto de Física Fundamental (IFF. CSIC). Group of Molecular Astrophysics, C/Serrano 123, 28006 Madrid, Spain
- Centro de Investigaciones Químicas, UAEM. Av. Universidad, 1001 Col. Chamilpa 62209, Cuernavaca, Morelos Mexico
| | - C. Bermúdez
- Instituto de Física Fundamental (IFF. CSIC). Group of Molecular Astrophysics, C/Serrano 123, 28006 Madrid, Spain
| | - R. J. Peláez
- Instituto de Estructura de la Materia (IEM. CSIC). Molecular Physics Department. C/Serrano 123, 28006 Madrid, Spain
| | - M. Patino-Esteban
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - I. López-Fernández
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - S. García-Álvaro
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - P. García-Carreño
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - C. Cabezas
- Instituto de Física Fundamental (IFF. CSIC). Group of Molecular Astrophysics, C/Serrano 123, 28006 Madrid, Spain
| | - I. Malo
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - R. Amils
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - J. Sobrado
- Centro de Astrobiología (CSIC-INTA), Crta. de Torrejón de Ardoz a Ajalvir, km 4. Torrejón de Ardoz, 28850, Spain
| | - C. Diez-González
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - J.M. Hernandéz
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - B. Tercero
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - G. Santoro
- Instituto de Ciencia de Materiales de Madrid (ICMM. CSIC). Materials Science Factory. Structure of Nanoscopic Systems Group, ESISNA. C/Sor Juana Inés de la Cruz 3, 28049 Cantoblanco, Madrid, Spain
| | - L. Martínez
- Instituto de Ciencia de Materiales de Madrid (ICMM. CSIC). Materials Science Factory. Structure of Nanoscopic Systems Group, ESISNA. C/Sor Juana Inés de la Cruz 3, 28049 Cantoblanco, Madrid, Spain
| | - M. Castellanos
- Instituto de Física Fundamental (IFF. CSIC). Group of Molecular Astrophysics, C/Serrano 123, 28006 Madrid, Spain
| | - B. Vaquero Jiménez
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - J. R. Pardo
- Instituto de Física Fundamental (IFF. CSIC). Group of Molecular Astrophysics, C/Serrano 123, 28006 Madrid, Spain
| | - L. Barbas
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - J.A. López-Fernández
- Centro de Desarrollos Tecnológicos, Observatorio de Yebes (IGN), 19141 Yebes, Guadalajara, Spain
| | - B. Aja
- Universidad de Cantabria, Department of Communication Engineering, Avda. Los Castros, 39005 Santander, Spain
| | - A. Leuther
- Fraunhofer Institut fur Angewandte Festkorperphysik, Tullastresse 72, 79108 Freiburg, Germany
| | - J. A. Martín-Gago
- Instituto de Ciencia de Materiales de Madrid (ICMM. CSIC). Materials Science Factory. Structure of Nanoscopic Systems Group, ESISNA. C/Sor Juana Inés de la Cruz 3, 28049 Cantoblanco, Madrid, Spain
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23
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Masjuan J, Gállego J, Aguilera JM, Arenillas JF, Castellanos M, Díaz F, Portilla JC, Purroy F. Use of cardiovascular polypills for the secondary prevention of cerebrovascular disease. Neurologia 2018; 36:1-8. [PMID: 29325730 DOI: 10.1016/j.nrl.2017.10.013] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/28/2017] [Accepted: 10/03/2017] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION There is little control of cardiovascular (CV) risk factors in secondary prevention after an ischaemic stroke, in part due to a lack of adherence to treatment. The CV polypill may contribute to proper treatment adherence, which is necessary for CV disease prevention. This study aimed to establish how and in what cases the CV polypill should be administered. METHODS A group of 8 neurologists drafted consensus recommendations using structured brainstorming and based on their experience and a literature review. RESULTS These recommendations are based on the opinion of the participating experts. The use of the CV polypill is beneficial for patients, healthcare professionals, and the health system. Its use is most appropriate for atherothrombotic stroke, lacunar stroke, stroke associated with cognitive impairment, cryptogenic stroke with CV risk factors, and silent cerebrovascular disease. It is the preferred treatment in cases of suspected poor adherence, polymedicated patients, elderly people, patients with polyvascular disease or severe atherothrombosis, young patients in active work, and patients who express a preference for the CV polypill. Administration options include switching from individual drugs to the CV polypill, starting treatment with the CV polypill in the acute phase in particular cases, use in patients receiving another statin or an angiotensin ii receptor antagonist, or de novo use if there is suspicion of poor adherence. Nevertheless, use of the CV polypill requires follow-up on the achievement of the therapeutic objectives to make dose adjustments. CONCLUSIONS This document is the first to establish recommendations for the use of the CV polypill in cerebrovascular disease, beyond its advantages in terms of treatment adherence.
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Affiliation(s)
- J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Invictus Plus, Red Nacional de Investigación en Ictus, Madrid, España.
| | - J Gállego
- Complejo Hospitalario de Navarra, Pamplona, España
| | - J M Aguilera
- Hospital Universitario de Nuestra Señora de Valme, Sevilla, España
| | - J F Arenillas
- Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Castellanos
- Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de Coruña INIBIC, La Coruña, España
| | - F Díaz
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J C Portilla
- Hospital Universitario San Pedro de Alcántara, Cáceres, España
| | - F Purroy
- Hospital Arnau de Vilanova, Lérida, España
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Tanarro I, Alemán B, de Vicente P, Gallego JD, Pardo JR, Santoro G, Lauwaet K, Tercero F, Díaz-Pulido A, Moreno E, Agúndez M, Goicoechea JR, Sobrado JM, López JA, Martínez L, Doménech JL, Herrero VJ, Hernández JM, Peláez RJ, López-Pérez JA, Gómez-González J, Alonso JL, Jiménez E, Teyssier D, Makasheva K, Castellanos M, Joblin C, Martín-Gago JA, Cernicharo J. Using radio astronomical receivers for molecular spectroscopic characterization in astrochemical laboratory simulations: A proof of concept. Astron Astrophys 2018; 609:A15. [PMID: 29277841 PMCID: PMC5741178 DOI: 10.1051/0004-6361/201730969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We present a proof of concept on the coupling of radio astronomical receivers and spectrometers with chemical reactors and the performances of the resulting setup for spectroscopy and chemical simulations in laboratory astrophysics. Several experiments including cold plasma generation and UV photochemistry were performed in a 40 cm long gas cell placed in the beam path of the Aries 40 m radio telescope receivers operating in the 41-49 GHz frequency range interfaced with fast Fourier transform spectrometers providing 2 GHz bandwidth and 38 kHz resolution. The impedance matching of the cell windows has been studied using different materials. The choice of the material and its thickness was critical to obtain a sensitivity identical to that of standard radio astronomical observations. Spectroscopic signals arising from very low partial pressures of CH3OH, CH3CH2OH, HCOOH, OCS, CS, SO2 (<10-3 mbar) were detected in a few seconds. Fast data acquisition was achieved allowing for kinetic measurements in fragmentation experiments using electron impact or UV irradiation. Time evolution of chemical reactions involving OCS, O2 and CS2 was also observed demonstrating that reactive species, such as CS, can be maintained with high abundance in the gas phase during these experiments.
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Affiliation(s)
- I Tanarro
- IEM. CSIC. Instituto de Estructura de la Materia. Molecular Physics Department. C/Serrano 123, 28006 Madrid, Spain
| | - B Alemán
- ICMM. CSIC. Molecular Astrophysics Group. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
| | - P de Vicente
- Centro Nacional de Tecnologías Radioastronómicas y Aplicaciones Geoespaciales (CNTRAG), Observatorio de Yebes (IGN), Spain
| | - J D Gallego
- Centro Nacional de Tecnologías Radioastronómicas y Aplicaciones Geoespaciales (CNTRAG), Observatorio de Yebes (IGN), Spain
| | - J R Pardo
- ICMM. CSIC. Molecular Astrophysics Group. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
| | - G Santoro
- ICMM. CSIC. Materials Science Factory. Structure of Nanoscopic Systems Group, ESISNA. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
| | - K Lauwaet
- ICMM. CSIC. Materials Science Factory. Structure of Nanoscopic Systems Group, ESISNA. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
| | - F Tercero
- Centro Nacional de Tecnologías Radioastronómicas y Aplicaciones Geoespaciales (CNTRAG), Observatorio de Yebes (IGN), Spain
| | - A Díaz-Pulido
- Centro Nacional de Tecnologías Radioastronómicas y Aplicaciones Geoespaciales (CNTRAG), Observatorio de Yebes (IGN), Spain
| | - E Moreno
- ICMM. CSIC. Molecular Astrophysics Group. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
| | - M Agúndez
- ICMM. CSIC. Molecular Astrophysics Group. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
| | - J R Goicoechea
- ICMM. CSIC. Molecular Astrophysics Group. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
| | - J M Sobrado
- Centro de Astrobiología, (CAB-CSIC/INTA). Carretera Torrejón a Ajalvir km 4, Torrejón de Ardoz 28850 (Madrid), Spain
| | - J A López
- Centro Nacional de Tecnologías Radioastronómicas y Aplicaciones Geoespaciales (CNTRAG), Observatorio de Yebes (IGN), Spain
| | - L Martínez
- ICMM. CSIC. Materials Science Factory. Structure of Nanoscopic Systems Group, ESISNA. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
| | - J L Doménech
- IEM. CSIC. Instituto de Estructura de la Materia. Molecular Physics Department. C/Serrano 123, 28006 Madrid, Spain
| | - V J Herrero
- IEM. CSIC. Instituto de Estructura de la Materia. Molecular Physics Department. C/Serrano 123, 28006 Madrid, Spain
| | - J M Hernández
- Centro Nacional de Tecnologías Radioastronómicas y Aplicaciones Geoespaciales (CNTRAG), Observatorio de Yebes (IGN), Spain
| | - R J Peláez
- IEM. CSIC. Instituto de Estructura de la Materia. Molecular Physics Department. C/Serrano 123, 28006 Madrid, Spain
| | - J A López-Pérez
- Centro Nacional de Tecnologías Radioastronómicas y Aplicaciones Geoespaciales (CNTRAG), Observatorio de Yebes (IGN), Spain
| | - J Gómez-González
- Centro Nacional de Tecnologías Radioastronómicas y Aplicaciones Geoespaciales (CNTRAG), Observatorio de Yebes (IGN), Spain
| | - J L Alonso
- Grupo de Espectroscopía Molecular (GEM), Edificio Quifima, Área de Química-Física, Laboratorios de Espectroscopía y Bioespectroscopía, Parque Científico UVa, Unidad Asociada CSIC, Universidad de Valladolid, 47011 Valladolid, Spain
| | - E Jiménez
- Departamento de Química Física, Facultad de Ciencias y Tecnologías Químicas, Universidad de Castilla-La Mancha, Avda. Camilo José Cela 1B, E-13071, Ciudad Real, Spain
| | - D Teyssier
- European Space Astronomy Centre, ESA, PO Box 78, 28691 Villanueva de la Cañada, Madrid, Spain
| | - K Makasheva
- LAPLACE (Laboratoire Plasma et Conversion dÉnergie); Université de Toulouse; CNRS, UPS, INPT; 118 route de Narbonne, F-31062 Toulouse cedex 9, France
| | - M Castellanos
- ICMM. CSIC. Molecular Astrophysics Group. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
| | - C Joblin
- Université de Toulouse, UPS-OMS, IRAP, 31000 Toulouse, France
- CNRS, IRAP, 9 Av. Colonel Roche, BP 44346, 31028 Toulouse Cedex 4, France
| | - J A Martín-Gago
- ICMM. CSIC. Materials Science Factory. Structure of Nanoscopic Systems Group, ESISNA. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
| | - J Cernicharo
- ICMM. CSIC. Molecular Astrophysics Group. C/ Sor Juana Inés de la Cruz 3. Cantoblanco, 28049 Madrid. Spain
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Nael K, Doshi A, De Leacy R, Puig J, Castellanos M, Bederson J, Naidich TP, Mocco J, Wintermark M. MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps. AJNR Am J Neuroradiol 2017; 39:219-225. [PMID: 29217747 DOI: 10.3174/ajnr.a5454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 09/14/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with acute stroke with robust collateral flow have better clinical outcomes and may benefit from endovascular treatment throughout an extended time window. Using a multiparametric approach, we aimed to identify MR perfusion parameters that can represent the extent of collaterals, approximating DSA. MATERIALS AND METHODS Patients with anterior circulation proximal arterial occlusion who had baseline MR perfusion and DSA were evaluated. The volume of arterial tissue delay (ATD) at thresholds of 2-6 seconds (ATD2-6 seconds) and >6 seconds (ATD>6 seconds) in addition to corresponding values of normalized CBV and CBF was calculated using VOI analysis. The association of MR perfusion parameters and the status of collaterals on DSA were assessed by multivariate analyses. Receiver operating characteristic analysis was performed. RESULTS Of 108 patients reviewed, 39 met our inclusion criteria. On DSA, 22/39 (56%) patients had good collaterals. Patients with good collaterals had significantly smaller baseline and final infarct volumes, smaller volumes of severe hypoperfusion (ATD>6 seconds), larger volumes of moderate hypoperfusion (ATD2-6 seconds), and higher relative CBF and relative CBV values than patients with insufficient collaterals. Combining the 2 parameters into a Perfusion Collateral Index (volume of ATD2-6 seconds × relative CBV2-6 seconds) yielded the highest accuracy for predicting collateral status: At a threshold of 61.7, this index identified 15/17 (88%) patients with insufficient collaterals and 22/22 (100%) patients with good collaterals, for an overall accuracy of 94.1%. CONCLUSIONS The Perfusion Collateral Index can predict the baseline collateral status with 94% diagnostic accuracy compared with DSA.
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Affiliation(s)
- K Nael
- From the Departments of Radiology (K.N., A.D., T.P.N.)
| | - A Doshi
- From the Departments of Radiology (K.N., A.D., T.P.N.)
| | - R De Leacy
- Neurosurgery (R.D.L., J.B., JM.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Puig
- Department of Radiology (J.P.), Girona Biomedical Research Institute, Diagnostic Imaging Institute, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - M Castellanos
- Department of Neurology (M.C.), A Coruña University Hospital, A Coruña Biomedical Research Institute, A Coruña, Spain
| | - J Bederson
- Neurosurgery (R.D.L., J.B., JM.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - T P Naidich
- From the Departments of Radiology (K.N., A.D., T.P.N.)
| | - J Mocco
- Neurosurgery (R.D.L., J.B., JM.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Wintermark
- Department of Radiology (M.W.), Neuroradiology Section, Stanford University, Palo Alto, California
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Kanwar S, Castellanos M. Radiofrequency Ablation of Ilioinguinal Nerve for the Management of Inguinodynia–Our Experience. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Abilleira S, Ribera A, Cardona P, Rubiera M, López-Cancio E, Amaro S, Rodríguez-Campello A, Camps-Renom P, Cánovas D, de Miquel MA, Tomasello A, Remollo S, López-Rueda A, Vivas E, Perendreu J, Gallofré M, Martí-Fàbregas J, Delgado-Mederos R, Martínez-Domeño A, Marín R, Roquer J, Ois Á, Jiménez-Conde J, Guimaraens L, Chamorro Á, Obach V, Urra X, Macho J, Blasco J, San Roman L, Martínez-Yélamos A, Quesada H, Lara B, Cayuela N, Aja L, Mora P, Molina C, Ribó M, Pagola J, Rodríguez-Luna D, Muchada M, Coscojuela P, Dávalos A, Millán M, Pérez de la Ossa N, Gomis M, Dorado L, Castaño C, Garcia M, Estela J, Krupinski J, Huertas-Folch S, Nicolás-Herrerias M, Gómez-Choco M, García S, Martínez R, Sanahuja J, Purroy F, Serena J, Castellanos M, Silva Y, Marés R, Pellisé A, Ustrell X, Baiges J, Garcés M, Saura J, Soler-Insa J, Aragonés J, Cocho D, Palomeras E. Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different. Stroke 2017; 48:375-378. [DOI: 10.1161/strokeaha.116.015857] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 10/24/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients.
Methods—
Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel–Haenszel test statistic.
Results—
We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74–1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74–1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25–1.27).
Conclusions—
This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care.
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Affiliation(s)
- Sònia Abilleira
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Aida Ribera
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Pedro Cardona
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Marta Rubiera
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Elena López-Cancio
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Sergi Amaro
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Ana Rodríguez-Campello
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Pol Camps-Renom
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - David Cánovas
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Maria Angels de Miquel
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Alejandro Tomasello
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Sebastian Remollo
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Antonio López-Rueda
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Elio Vivas
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Joan Perendreu
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Miquel Gallofré
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
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Giralt-Steinhauer E, Ois A, Abilleira S, Urra X, Cardona-Portela P, Gomis M, Castellanos M, Molina C, Martí-Fàbregas J, Pellisé A, Cànovas D, Gómez-Choco M, Kuprinski J, Cocho D, Roquer J. Frequency and outcome of total anterior circulation strokes without intracranial large-vessel occlusion. Eur J Neurol 2016; 24:11-17. [DOI: 10.1111/ene.13187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- E. Giralt-Steinhauer
- Neurovascular Research Group; Neurology Department; Hospital del Mar; Barcelona Spain
| | - A. Ois
- Neurovascular Research Group; Neurology Department; Hospital del Mar; Barcelona Spain
| | - S. Abilleira
- Stroke Programme; Catalan Agency for Health Information, Assessment and Quality (CAHIAQ); Barcelona Spain
| | - X. Urra
- Hospital Clínic; Barcelona Spain
| | | | - M. Gomis
- Hospital GermansTrias i Pujol de Badalona; Badalona Spain
| | - M. Castellanos
- Hospital Universitari JosepTrueta de Girona; Girona Spain
| | - C. Molina
- Hospital Universitari de la Valld'Hebron; Barcelona Spain
| | | | - A. Pellisé
- Hospital Universitari Joan XXIII de Tarragona; Tarragona Spain
| | - D. Cànovas
- Hospital Parc Taulí de Sabadell; Barcelona Spain
| | | | - J. Kuprinski
- Hospital Universitari Mútua Terrassa; Barcelona Spain
- Healthcare Sciences; MMU; Manchester UK
| | - D. Cocho
- Hospital de Granollers; Granollers Spain
| | - J. Roquer
- Neurovascular Research Group; Neurology Department; Hospital del Mar; Barcelona Spain
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29
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Abilleira S, Ribera A, Quesada H, Rubiera M, Castellanos M, Vargas M, Gomis M, Krupinski J, Delgado-Mederos R, Gómez-Choco M, Giralt-Steinhauer E, Garcia M, Pellisé A, Purroy F, Garcés M, Gallofré M. Applicability of the SPAN-100 index in a prospective and contemporary cohort of patients treated with intravenous rtPA in Catalonia. Neurología (English Edition) 2016. [DOI: 10.1016/j.nrleng.2014.10.014] [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: 10/20/2022] Open
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30
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Barnes DM, Garza EC, Garza A, Castellanos M, Hibner M. A Temporal Evaluation of Pain Improvement in Women with Chronic Pelvic Pain After Adhesiolysis Procedure. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.768] [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: 11/17/2022]
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31
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Georgiou EX, Lei K, Lai PF, Yulia A, Herbert BR, Castellanos M, May ST, Sooranna SR, Johnson MR. The study of progesterone action in human myometrial explants. Mol Hum Reprod 2016; 22:877-89. [PMID: 27235325 DOI: 10.1093/molehr/gaw037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 02/26/2016] [Accepted: 05/20/2016] [Indexed: 12/31/2022] Open
Abstract
STUDY HYPOTHESIS Myometrial explants represent a superior model compared with cell culture models for the study of human myometrial progesterone (P4) signalling in parturition. STUDY FINDING Gene expression analysis showed myometrial explants closely resemble the in vivo condition and the anti-inflammatory action of P4 is not lost with labour onset. WHAT IS KNOWN ALREADY Circulating P4 levels decline before the onset of parturition in most animals, but not in humans. This has led to the suggestion that there is a functional withdrawal of P4 action at the myometrial level prior to labour onset. However, to date, no evidence of a loss of P4 function has been provided, with studies hampered by a lack of a physiologically relevant model. STUDY DESIGN, SAMPLES/MATERIALS, METHODS Myometrial biopsies obtained at Caesarean section were dissected into explants after a portion was immediately snap frozen (t = 0). Microarray analysis was used to compare gene expression of t = 0 with paired (i) explants, (ii) passage 4 myometrial cell cultures or (iii) the hTERT myometrial cell line. Western blotting and chemokine/cytokine assays were used to study P4 signalling in myometrial explants. MAIN RESULTS AND THE ROLE OF CHANCE Gene expression comparison of t = 0 to the three models demonstrated that explants more closely resemble the in vivo status. At the protein level, explants maintain both P4 receptor (PR) and glucocorticoid receptor (GR) levels versus t = 0 whereas cells only maintain GR levels. Additionally, treatment with 1 µM P4 led to a reduction in interleukin-1 (IL-1) β-driven cyclooxygenase-2 in explants but not in cells. P4 signalling in explants was PR-mediated and associated with a repression of p65 and c-Jun phosphorylation. Furthermore, the anti-inflammatory action of P4 was maintained after labour onset. LIMITATIONS/REASONS FOR CAUTION There is evidence of basal inflammation in the myometrial explant model. WIDER IMPLICATIONS OF THE FINDINGS Myometrial explants constitute a novel model to study P4 signalling in the myometrium and can be used to further elucidate the mechanisms of P4 action in human labour. LARGE SCALE DATA Data deposited at http://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?token=gvmpggkurbgxfqf&acc=GSE77830. STUDY FUNDING AND COMPETING INTEREST This work was supported by grants from the Joint Research Committee of the Westminster Medical School Research Trust, Borne (No. 1067412-7; a sub-charity of the Chelsea and Westminster Health Charity) and the Imperial NIHR Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS or the Department of Health. The authors have no conflict of interest.
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Affiliation(s)
- E X Georgiou
- Imperial College Parturition Research Group, Department of Obstetrics and Gynecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - K Lei
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - P F Lai
- Imperial College Parturition Research Group, Department of Obstetrics and Gynecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - A Yulia
- Imperial College Parturition Research Group, Department of Obstetrics and Gynecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - B R Herbert
- Imperial College Parturition Research Group, Department of Obstetrics and Gynecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - M Castellanos
- Nottingham Arabidopsis Stock Centre, Plant Science Building, School of Biosciences, Sutton Bonington Campus, University of Nottingham, Loughborough LE12 5RD, UK
| | - S T May
- Nottingham Arabidopsis Stock Centre, Plant Science Building, School of Biosciences, Sutton Bonington Campus, University of Nottingham, Loughborough LE12 5RD, UK
| | - S R Sooranna
- Imperial College Parturition Research Group, Department of Obstetrics and Gynecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - M R Johnson
- Imperial College Parturition Research Group, Department of Obstetrics and Gynecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
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Pérez de la Ossa N, Abilleira S, Dorado L, Urra X, Ribó M, Cardona P, Giralt E, Martí-Fàbregas J, Purroy F, Serena J, Cánovas D, Garcés M, Krupinski J, Pellisé A, Saura J, Molina C, Dávalos A, Gallofré M, Delgado Mederos R, Martínez Domeño A, Marín Bueno R, Roquer J, Rodríguez-Campello A, Ois Á, Jiménez-Conde J, Cuadrado-Godia E, Guimaraens L, Chamorro A, Obach V, Amaro S, Macho JM, Blasco J, San Roman Manzanera L, López A, Martínez-Yélamos A, Quesada H, Lara B, Cayuela N, Aja L, de Miquel MA, Mora P, Rubiera M, Pagola J, Rodríguez-Luna D, Muchada M, Tomasello A, Coscojuela P, Millán M, Gomis M, López-Cancio E, Castaño C, Remollo S, Del Carmen Garcia M, Estela J, Perendreu J, Huertas S, Nicolás MC, Gómez-Choco M, García S, Martínez R, Sanahuja J, Castellanos M, Silva Y, van Eendenburg C, Marés R, Ustrell X, Baiges J, Soler Insa JM, Aragonés JM, Cocho Calderón L, Otermin P, Palomeras E. Access to Endovascular Treatment in Remote Areas. Stroke 2016; 47:1381-4. [DOI: 10.1161/strokeaha.116.013069] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/24/2016] [Indexed: 01/19/2023]
Abstract
Background and Purpose—
Since demonstration of the benefit of endovascular treatment (EVT) in acute ischemic stroke patients with proximal arterial occlusion, stroke care systems need to be reorganized to deliver EVT in a timely and equitable way. We analyzed differences in the access to EVT by geographical areas in Catalonia, a territory with a highly decentralized stroke model.
Methods—
We studied 965 patients treated with EVT from a prospective multicenter population-based registry of stroke patients treated with reperfusion therapies in Catalonia, Spain (SONIIA). Three different areas were defined: (A) health areas primarily covered by Comprehensive Stroke Centers, (B) areas primarily covered by local stroke centers located less than hour away from a Comprehensive Stroke Center, and (C) areas primarily covered by local stroke centers located more than hour away from a Comprehensive Stroke Center. We compared the number of EVT×100 000 inhabitants/year and time from stroke onset to groin puncture between groups.
Results—
Baseline characteristics were similar between groups. Throughout the study period, there were significant differences in the population rates of EVT across geographical areas. EVT rates by 100 000 in 2015 were 10.5 in A area, 3.7 in B, and 2.7 in C. Time from symptom onset to groin puncture was 82 minutes longer in group B (312 minutes [245–435]) and 120 minutes longer in group C (350 minutes [284–408]) compared with group A (230 minutes [160–407];
P
<0.001).
Conclusions—
Accessibility to EVT from remote areas is hampered by lower rate and longer time to treatment compared with areas covered directly by Comprehensive Stroke Centers.
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Affiliation(s)
- Natalia Pérez de la Ossa
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Sònia Abilleira
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Laura Dorado
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Xabier Urra
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Marc Ribó
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Pere Cardona
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Eva Giralt
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Joan Martí-Fàbregas
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Francisco Purroy
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Joaquín Serena
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - David Cánovas
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Moisés Garcés
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Jurek Krupinski
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Anna Pellisé
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Júlia Saura
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Carlos Molina
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Antoni Dávalos
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Miquel Gallofré
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
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Martínez J, Sánchez R, Castellanos M, Fernández-Escamilla AM, Vazquez-Cortés S, Fernández-Rivas M, Gasset M. Fish β-parvalbumin acquires allergenic properties by amyloid assembly. Swiss Med Wkly 2015; 145:w14128. [DOI: 10.4414/smw.2015.14128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Mva H, Anglada LL, Caballero J, Cadenas FL, Lopéz JP, Vidriales M, Garcia-Sancho AM, Puig N, Alonso J, Albarrán B, Olivier C, Hurtado JG, Castellanos M, Cañizo M, Campelo MD. 230 CHARACTERISTICS OF BLASTS IN THE PERIPHERAL BLOOD AND BONE MARROW OF THE PATIENTS WITH MDS TREATED WITH 5-AZACITADINE USING MULTIPARAMETRIC FLOW CYTOMETRY. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30231-9] [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: 11/27/2022]
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Schiavelli R, Bonaventura R, Rial M, Petrone H, Pujol GS, Gaite L, Acosta M, Gutierrez A, Acosta F, Valdez G, Raffaele P, Chanta G, Perez M, Potes L, Suso E, Cremades G, Ibañez J, Imperiali N, Luxardo R, Castellanos M, Maggiora E, Carreño CA, Cobos M, Marinic K, Sinchi J, Otero A, Freire M. First Epidemiologic Study in Argentina of the Prevalence of BK Viruria in Kidney Transplant Patients. Transplant Proc 2014; 46:3010-4. [DOI: 10.1016/j.transproceed.2014.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Vivancos J, Gilo F, Frutos R, Maestre J, García-Pastor A, Quintana F, Roda J, Ximénez-Carrillo A, Díez Tejedor E, Fuentes B, Alonso de Leciñana M, Álvarez-Sabin J, Arenillas J, Calleja S, Casado I, Castellanos M, Castillo J, Dávalos A, Díaz-Otero F, Egido J, Fernández J, Freijo M, Gállego J, Gil-Núñez A, Irimia P, Lago A, Masjuan J, Martí-Fábregas J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Nombela F, Purroy F, Ribó M, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment. Neurología (English Edition) 2014. [DOI: 10.1016/j.nrleng.2012.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Fadel S, Aly A, Massoud S, Kedr W, Farhod A, Srinivasan A, Satish G, Scott JX, Rao SM, Chidambaram B, Chandrashekar S, Chintagumpala M, He X, Ma J, Trehan A, Salunke P, Singla N, Kumar N, Radotra BD, Bansal D, Marwaha RK, Chinnaswamy G, Prasad M, Dhamankar V, Vora T, Gupta T, Moiyadi A, Sridhar E, Jalali R, Banavali S, Kurkure P, Kaur K, Kakkar A, Purkait S, Suri V, Sharma M, Mallick S, Jhulka PK, Suri A, Sharma BS, Sarkar C, Giron AV, Castellanos M, Valverde P, Garrido C, Letona T, Antillon F, Bartel U, Yuan X, Wang C, Adesina A, Lau C, Jiang M, Ma J. NEURO-ONCOLOGY IN DEVELOPING COUNTRIES. Neuro Oncol 2014; 16:i97-i98. [PMCID: PMC4046291 DOI: 10.1093/neuonc/nou075] [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: 11/26/2023] Open
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Camós S, Gubern C, Sobrado M, Rodríguez R, Romera V, Moro M, Lizasoain I, Serena J, Mallolas J, Castellanos M. The high-mobility group I-Y transcription factor is involved in cerebral ischemia and modulates the expression of angiogenic proteins. Neuroscience 2014; 269:112-30. [DOI: 10.1016/j.neuroscience.2014.03.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 03/07/2014] [Accepted: 03/18/2014] [Indexed: 12/24/2022]
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Fuentes B, Gállego J, Gil-Nuñez A, Morales A, Purroy F, Roquer J, Segura T, Tejada J, Lago A, Díez-Tejedor E, Alonso de Leciñana M, Álvarez-Sabin J, Arenillas J, Calleja S, Casado I, Castellanos M, Castillo J, Dávalos A, Díaz-Otero F, Egido J, López-Fernández J, Freijo M, García Pastor A, Gilo F, Irimia P, Maestre J, Masjuan J, Martí-Fábregas J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Nombela F, Ribó M, Rodríguez-Yañez M, Rubio F, Serena J, Simal P, Vivancos J. Guía para el tratamiento preventivo del ictus isquémico y AIT (II). Recomendaciones según subtipo etiológico. Neurologia 2014; 29:168-83. [DOI: 10.1016/j.nrl.2011.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/29/2011] [Indexed: 11/28/2022] Open
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Ewalt M, Metcalf R, Castellanos M, Zhao S, Natkunam Y, Luna-Feinman S. Classical Hodgkin Lymphoma in Guatemalan Children of Age Less than Six Show High pPrevalence of EBV, HGAL and CD137: Prognostic and Therapeutic Implications. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Freigeiro D, Arancibia A, Dibar E, Contreras A, Garcia J, Castellanos M. Is it Possible to Work together in Latin America? Creation of a Latin American Consortium (CLEHOP). Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gubern C, Camós S, Hurtado O, Rodríguez R, Romera VG, Sobrado M, Cañadas R, Moro MA, Lizasoain I, Serena J, Mallolas J, Castellanos M. Characterization of Gcf2/Lrrfip1 in experimental cerebral ischemia and its role as a modulator of Akt, mTOR and β-catenin signaling pathways. Neuroscience 2014; 268:48-65. [PMID: 24637094 DOI: 10.1016/j.neuroscience.2014.02.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 10/26/2013] [Revised: 02/03/2014] [Accepted: 02/27/2014] [Indexed: 01/27/2023]
Abstract
Leucine-rich repeat in Flightless-1 interaction protein 1 (Lrrfip1) is an up-regulated protein after cerebral ischemia whose precise role in the brain both in healthy and ischemic conditions is unclear. Different Lrrfip1 isoforms with distinct roles have been reported in human and mouse species. The present study aimed to analyze the Lrrfip1 transcriptional variants expressed in rat cortex, to characterize their expression patterns and subcellular location after ischemia, and to define their putative role in the brain. Five transcripts were identified and three of them (Lrrfip1, CRA_g and CRA_a' (Fli-I leucine-rich repeat associated protein 1 - Flap-1)) were analyzed by quantitative real-time polymerase chain reaction (qPCR). All the transcripts were up-regulated and showed differential expression patterns after in vivo and in vitro ischemia models. The main isoform, Lrrfip1, was found to be up-regulated from the acute to the late phases of ischemia in the cytoplasm of neurons and astrocytes of the peri-infarct area. This study demonstrates that Lrrfip1 activates β-catenin, Akt, and mammalian target of rapamycin (mTOR) proteins in astrocytes and positively regulates the expression of the excitatory amino acid transporter subtype 2 (GLT-1). Our findings point to Lrrfip1 as a key brain protein that regulates pro-survival pathways and proteins and encourages further studies to elucidate its role in cerebral ischemia as a potential target to prevent brain damage and promote functional recovery after stroke.
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Affiliation(s)
- C Gubern
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain.
| | - S Camós
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain
| | - O Hurtado
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - R Rodríguez
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain
| | - V G Romera
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - M Sobrado
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - R Cañadas
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - M A Moro
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - I Lizasoain
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - J Serena
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain
| | - J Mallolas
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain.
| | - M Castellanos
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain
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Sanz-Bueno J, Pérez-Rial G, Castellanos M, Vanaclocha F. Lichenoid Graft-vs-Host Disease With Exclusively Cutaneous Involvement After Liver Transplant. Actas Dermo-Sifiliográficas (English Edition) 2014. [DOI: 10.1016/j.adengl.2013.04.020] [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: 10/25/2022] Open
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Alonso de Leciñana M, Egido J, Casado I, Ribó M, Dávalos A, Masjuan J, Caniego J, Martínez Vila E, Díez Tejedor E, Fuentes (Secretaría) B, Álvarez-Sabin J, Arenillas J, Calleja S, Castellanos M, Castillo J, Díaz-Otero F, López-Fernández J, Freijo M, Gállego J, García-Pastor A, Gil-Núñez A, Gilo F, Irimia P, Lago A, Maestre J, Martí-Fábregas J, Martínez-Sánchez P, Molina C, Morales A, Nombela F, Purroy F, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J, Vivancos J. Guidelines for the treatment of acute ischaemic stroke. Neurología (English Edition) 2014. [DOI: 10.1016/j.nrleng.2011.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Sanz-Bueno J, Pérez-Rial G, Castellanos M, Vanaclocha F. Lichenoid graft-vs-host disease with exclusively cutaneous involvement after liver transplant. Actas Dermosifiliogr 2013; 105:198-200. [PMID: 23809586 DOI: 10.1016/j.ad.2013.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 03/26/2013] [Accepted: 04/01/2013] [Indexed: 11/20/2022] Open
Affiliation(s)
- J Sanz-Bueno
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - G Pérez-Rial
- Servicio de Medicina del Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, España
| | - M Castellanos
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Vanaclocha
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
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Matías-Guiu J, García-Ramos R, Castellanos M, Martínez-Vila E, Matías-Guiu J. What happens to medical articles submitted in Spanish that are not accepted for publication? Neurología (English Edition) 2013. [DOI: 10.1016/j.nrleng.2012.05.006] [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: 11/25/2022] Open
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Rodríguez-Yáñez M, Castellanos M, Freijo M, López Fernández J, Martí-Fàbregas J, Nombela F, Simal P, Castillo J, Díez-Tejedor E, Fuentes B, Alonso de Leciñana M, Álvarez-Sabin J, Arenillas J, Calleja S, Casado I, Dávalos A, Díaz-Otero F, Egido J, Gállego J, García Pastor A, Gil-Núñez A, Gilo F, Irimia P, Lago A, Maestre J, Masjuan J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Purroy F, Ribó M, Roquer J, Rubio F, Segura T, Serena J, Tejada J, Vivancos J. Clinical practice guidelines in intracerebral haemorrhage. Neurología (English Edition) 2013. [DOI: 10.1016/j.nrleng.2011.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Matías-Guiu J, García-Ramos R, Castellanos M, Martínez-Vila E, Matías-Guiu J. ¿Qué ocurre con los artículos médicos remitidos en español que no son aceptados para publicación? Neurologia 2013; 28:205-11. [DOI: 10.1016/j.nrl.2012.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 05/28/2012] [Indexed: 11/26/2022] Open
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Bojorquez-Chapela I, Bäcker CE, Orejel I, López A, Díaz-Quiñonez A, Hernández-Serrato MI, Balandrano S, Romero M, Téllez-Rojo Solís MM, Castellanos M, Alpuche C, Hernández-Ávila M, López-Gatell H. Drug resistance in Mexico: results from the National Survey on Drug-Resistant Tuberculosis. Int J Tuberc Lung Dis 2013; 17:514-9. [DOI: 10.5588/ijtld.12.0167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hayward LF, Castellanos M, Noah C. Cardiorespiratory variability following repeat acute hypoxia in the conscious SHR versus two normotensive rat strains. Auton Neurosci 2012; 171:58-65. [PMID: 23154112 DOI: 10.1016/j.autneu.2012.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 10/18/2012] [Accepted: 10/19/2012] [Indexed: 12/26/2022]
Abstract
A link between exaggerated chemoreceptor sensitivity and hypertension has been documented in the spontaneously hypertensive rat (SHR) but has also been questioned when comparisons with normotensive strains other than the Wistar Kyoto (WKY) rat are made. To further evaluate the link between hypertension and chemoreflex sensitivity, changes in cardiorespiratory variability in response to three successive bouts of 5 min of hypoxia (21%→10%) were evaluated in conscious male SHR, and WKY and Sprague Dawley (SD) rats (n=7-8/group). In response to the first bout of hypoxia, the change in respiratory frequency (RF) was greatest in the SHR, but the increase in mean arterial pressure (MAP) was similar in both SHRs and WKY rats and all strains demonstrated a similar rise in heart rate (HR). All strains showed some level of response accommodation during subsequent bouts of hypoxia. Spectral analysis of HR variability identified a significant difference in high frequency (HF) power between strains during hypoxia, including an increase in HF power in the WKY rats, a decrease in the SHRs and little overall change in the SD rats. Alternatively, all strains demonstrated a rise in systolic arterial pressure (SAP) variability in the low frequency (LF) range in response to hypoxia but the increase was greatest in the SHR. Since SAP LF power is linked to vasosympathetic tone, these results support the hypothesis that essential hypertension is linked to exaggerated sympathetic responses to chemoreceptor stimulation but confirm that estimation of augmented reflex function cannot be determined by quantifying simple changes in MAP or HR.
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Affiliation(s)
- L F Hayward
- Univ. of Florida, Dept. Physiological Sciences, 1333 Center Dr., BSB 3-4, Gainesville, FL 32610-0144, USA.
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