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Dramburg S, Grittner U, Potapova E, Travaglini A, Tripodi S, Arasi S, Pelosi S, Acar Şahin A, Aggelidis X, Barbalace A, Bourgoin A, Bregu B, Brighetti MA, Caeiro E, Caglayan Sozmen S, Caminiti L, Charpin D, Couto M, Delgado L, Di Rienzo Businco A, Dimier C, Dimou MV, Fonseca JA, Goksel O, Hernandez D, Hernandez Toro CJ, Hoffmann TM, Jang DT, Kalpaklioglu F, Lame B, Llusar R, Makris M, Mazon A, Mesonjesi E, Nieto A, Öztürk AB, Pahus L, Pajno G, Panasiti I, Papadopoulos NG, Pellegrini E, Pereira AM, Pereira M, Pinar NM, Priftanji A, Psarros F, Sackesen C, Sfika I, Suarez J, Thibaudon M, Uguz U, Verdier V, Villella V, Xepapadaki P, Yazici D, Matricardi PM. Heterogeneity of sensitization profiles and clinical phenotypes among patients with seasonal allergic rhinitis in Southern European countries-The @IT.2020 multicenter study. Allergy 2024; 79:908-923. [PMID: 38311961 DOI: 10.1111/all.16029] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Pollen allergy poses a significant health and economic burden in Europe. Disease patterns are relatively homogeneous within Central and Northern European countries. However, no study broadly assessed the features of seasonal allergic rhinitis (SAR) across different Southern European countries with a standardized approach. OBJECTIVE To describe sensitization profiles and clinical phenotypes of pollen allergic patients in nine Southern European cities with a uniform methodological approach. METHODS Within the @IT.2020 multicenter observational study, pediatric and adult patients suffering from SAR were recruited in nine urban study centers located in seven countries. Clinical questionnaires, skin prick tests (SPT) and specific IgE (sIgE) tests with a customized multiplex assay (Euroimmun Labordiagnostika, Lübeck, Germany) were performed. RESULTS Three hundred forty-eight children (mean age 13.1 years, SD: 2.4 years) and 467 adults (mean age 35.7 years SD: 10.0 years) with a predominantly moderate to severe, persistent phenotype of SAR were recruited. Grass pollen major allergenic molecules (Phl p 1 and/or Phl p 5) ranged among the top three sensitizers in all study centers. Sensitization profiles were very heterogeneous, considering that patients in Rome were highly poly-sensitized (sIgE to 3.8 major allergenic molecules per patient), while mono-sensitization was prominent and heterogeneous in other cities, such as Marseille (sIgE to Cup a 1: n = 55/80, 68.8%) and Messina (sIgE to Par j 2: n = 47/82, 57.3%). Co-sensitization to perennial allergens, as well as allergic comorbidities also broadly varied between study centers. CONCLUSIONS In Southern European countries, pollen allergy is heterogeneous in terms of sensitization profiles and clinical manifestations. Despite the complexity, a unique molecular, multiplex, and customized in-vitro IgE test detected relevant sensitization in all study centers. Nevertheless, this geographical diversity in pollen allergic patients imposes localized clinical guidelines and study protocols for clinical trials of SAR in this climatically complex region.
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Affiliation(s)
- S Dramburg
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - U Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - E Potapova
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Travaglini
- Department of Biology, Tor Vergata University, Rome, Italy
- Italian Aerobiology Monitoring Network - Italian Aerobiology Association, Rome, Italy
| | - S Tripodi
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
- Allergolology Service, Policlinico Casilino, Rome, Italy
| | - S Arasi
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children's Research Hospital (IRCCS), Rome, Italy
| | | | - A Acar Şahin
- Department of Biology, Faculty of Science, Ankara University, Ankara, Turkey
| | - X Aggelidis
- Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University Hospital "Attikon", Athens, Greece
| | - A Barbalace
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - A Bourgoin
- Department of Pneumonology and Allergy, La Timone Hospital, APHM, Aix-Marseille University, Marseille, France
| | - B Bregu
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Tirana, Albania
| | - M A Brighetti
- Department of Biology, Tor Vergata University, Rome, Italy
| | - E Caeiro
- MED- Mediterranean Institute for Agriculture, Environment and Development, Institute for Advanced Studies and Research, University of Évora, Évora, Portugal
- Portuguese Society of Allergology and Clinical Immunology, Lisbon, Portugal
| | | | - L Caminiti
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - D Charpin
- Department of Pneumonology and Allergy, La Timone Hospital, APHM, Aix-Marseille University, Marseille, France
| | - M Couto
- Immunoallergology, Hospital CUF Trindade, Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | | | - C Dimier
- Department of Pneumonology and Allergy, La Timone Hospital, APHM, Aix-Marseille University, Marseille, France
| | - M V Dimou
- Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - J A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - O Goksel
- Department of Pulmonary Medicine, Division of Immunology, Allergy and Asthma. Faculty of Medicine, Ege University, Izmir, Turkey
| | - D Hernandez
- Department of Allergy, Health Research Institute Hospital La Fe, Valencia, Spain
| | - C J Hernandez Toro
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T M Hoffmann
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - D T Jang
- Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - F Kalpaklioglu
- Department of Immunology and Allergic Diseases, Kırıkkale University School of Medicine, Kırıkkale, Turkey
| | - B Lame
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Tirana, Albania
| | - R Llusar
- Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - M Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University Hospital "Attikon", Athens, Greece
| | - A Mazon
- Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - E Mesonjesi
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Tirana, Albania
| | - A Nieto
- Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - A B Öztürk
- Division of Allergy and Immunology, Department of Pulmonary Medicine, Arel University, School of Medicine, Istanbul, Turkey
| | - L Pahus
- Aix Marseille Univ, APHM, INSERM CIC 1409, INSERM U1263, INRA 1260 (C2VN), Marseille, France
| | - G Pajno
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - I Panasiti
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | - E Pellegrini
- Department of Reggio Calabria, ARPA - Regional Agency for Environmental Protection, Calabria, Italy
| | - A M Pereira
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Pereira
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - N M Pinar
- Department of Biology, Faculty of Science, Ankara University, Ankara, Turkey
| | - A Priftanji
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Tirana, Albania
| | - F Psarros
- Allergy Department, Athens Naval Hospital, Athens, Greece
| | - C Sackesen
- Division of Pediatric Allergy, Koç University School of Medicine, Istanbul, Turkey
| | - I Sfika
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
| | - J Suarez
- Department of Biology of Organisms and Systems, Area of Botany, University of Oviedo, Oviedo, Spain
| | - M Thibaudon
- Réseau National de Surveillance Aérobiologique, Brussieu, France
| | - U Uguz
- Department of Biology, Faculty of Science, Ege University, Izmir, Turkey
| | - V Verdier
- Department of Pneumonology and Allergy, La Timone Hospital, APHM, Aix-Marseille University, Marseille, France
| | - V Villella
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
| | - P Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - D Yazici
- Cellular and Molecular Medicine, KUTTAM, Graduate School of Health Sciences, Koç University, Istanbul, Turkey
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - P M Matricardi
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Siegel-Ramsay JE, Sharp SJ, Ulack CJ, Chiang KS, Lanza di Scalea T, O'Hara S, Carberry K, Strakowski SM, Suarez J, Teisberg E, Wallace S, Almeida JRC. Experiences that matter in bipolar disorder: a qualitative study using the capability, comfort and calm framework. Int J Bipolar Disord 2023; 11:13. [PMID: 37079153 PMCID: PMC10119352 DOI: 10.1186/s40345-023-00293-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 03/22/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND When assessing the value of an intervention in bipolar disorder, researchers and clinicians often focus on metrics that quantify improvements to core diagnostic symptoms (e.g., mania). Providers often overlook or misunderstand the impact of treatment on life quality and function. We wanted to better characterize the shared experiences and obstacles of bipolar disorder within the United States from the patient's perspective. METHODS We recruited 24 individuals diagnosed with bipolar disorder and six caretakers supporting someone with the condition. Participants were involved in treatment or support services for bipolar disorder in central Texas. As part of this qualitative study, participants discussed their everyday successes and obstacles related to living with bipolar disorder during personalized, open-ended interviews. Audio files were transcribed, and Nvivo software processed an initial thematic analysis. We then categorized themes into bipolar disorder-related obstacles that limit the patient's capability (i.e., function), comfort (i.e., relief from suffering) and calm (i.e., life disruption) (Liu et al., FebClin Orthop 475:315-317, 2017; Teisberg et al., MayAcad Med 95:682-685, 2020). We then discuss themes and suggest practical strategies that might improve the value of care for patients and their families. RESULTS Issues regarding capability included the struggle to maintain identity, disruptions to meaningful employment, relationship loss and the unpredictable nature of bipolar disorder. Comfort related themes included the personal perception of diagnosis, social stigma and medication issues. Calm themes included managing dismissive doctors, finding the right psychotherapist and navigating financial burdens. CONCLUSIONS Qualitative data from patients with bipolar disorder helps identify gaps in care or practical limitations to treatment. When we listen to these individuals, it is clear that treatments must also address the unmet psychosocial impacts of the condition to improve patient care, capability and calm.
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Affiliation(s)
- J E Siegel-Ramsay
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - S J Sharp
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - C J Ulack
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - K S Chiang
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - T Lanza di Scalea
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - S O'Hara
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - K Carberry
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - S M Strakowski
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - J Suarez
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- The City University of New York School of Labor and Urban Studies, New York, NY, USA
| | - E Teisberg
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School and McCombs School of Business at the University of Texas, Austin, TX, USA
| | - S Wallace
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School and McCombs School of Business at the University of Texas, Austin, TX, USA
| | - J R C Almeida
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
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Azad TD, Shah PP, Kannapadi N, Rincon Torroella JN, Xia Y, Bernhardt L, Hansen LJ, Materi J, Raj D, Jackson CM, Mukherjee R, Gallia GL, Weingart J, Suarez J, Brem H, Bettegowda C. 772 Re-examining the Role of Post-Operative ICU Admission for Patients Undergoing Elective Craniotomy: A Systematic Review. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_772] [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: 03/18/2023] Open
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Azad TD, Rodriguez E, Raj D, Xia Y, Materi J, Rincon Torroella JN, Gonzalez LF, Suarez J, Tamargo RJ, Brem H, Haut E, Bettegowda C. 175 Patient Safety Indicator 04 Does not Consistently Identify Failure to Rescue in the Neurosurgical Population. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_175] [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: 03/18/2023] Open
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Kalinksy K, Abramson V, Chalasani P, Linden HM, Alidzanovic J, Layman RM, Vranješ Ž, Nangia JR, Crew KD, Andric Z, Milovic-Kovacevic M, Trifunovic J, Suarez J, Suster M, Ptaszynski M, Mortimer J. Abstract P1-17-02: ZN-c5, an oral selective estrogen receptor degrader (SERD), in women with advanced estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2 negative (HER2-) breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-17-02] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Hormone receptor+/HER2- breast cancer is the most common subtype of breast cancer. Resistance to endocrine therapy is a major clinical challenge. Although fulvestrant binds and degrades the ER and shows anti-tumor activity in patients with advanced breast cancer, intramuscular injection is inconvenient and precludes achievement of higher and potentially more efficacious exposure. ZN-c5 is a novel, orally bioavailable SERD with high potency and has demonstrated activity in estrogen-dependent tumor models. Methods: This Phase 1/2, open-label, multicenter study is evaluating the safety, pharmacokinetics and preliminary anti-tumor activity of ZN-c5 as monotherapy or in combination with palbociclib. In the Phase 1 portion evaluating ZN-c5 as monotherapy, participants were adult, post-menopausal (or receiving a gonadotropin-releasing hormone agonist) women with advanced adenocarcinoma of the breast, ER+/HER2- disease, and sensitive to endocrine therapy for metastatic disease (partial response [PR], complete response or stable disease [SD] lasting > 6 months or disease recurrence after at least 24 months of adjuvant endocrine treatment). ZN-c5 was administered orally and continuously in 28-day cycles until disease progression or unacceptable toxicity. Dose escalation cohorts of subjects were enrolled at several dose levels of ZN-c5, based on a modified 3+3 design. Enrollment in the Phase 1 ZN-c5 monotherapy dose escalation and expansion has been completed and results are presented. Phase 1 testing of ZN-c5 in combination with palbociclib and Phase 2 testing in monotherapy are ongoing and will be presented at a future meeting. Results: In Phase 1 monotherapy, a total of 56 female subjects were enrolled to receive ZN-c5 at dose levels of 50 mg once daily (QD, n=16), 75 mg QD (n=3), 100 mg QD (n=3), 75 mg twice daily (BID, n=6), 150 mg QD (n=15), 150 mg BID (n=3), or 300 mg QD (n=10). Median age was 58.5 years (range, 38 - 89) and ECOG performance status was 0 (55%) or 1 (45%). Subjects had a median of 2 prior therapies for advanced/metastatic disease (range, 0 - 9), with a median of 2 prior hormonal-based therapies (range, 0 - 6) and a median of 0 prior chemotherapies (range, 0 - 3). Twenty-six subjects (46%) received prior fulvestrant and 38 (68%) received a prior CDK4/6 inhibitor. Twenty subjects (38%) had a baseline ESR1 mutation. The cut-off date for this analysis was 11 May 2021. There was no increase in severity of treatment-emergent adverse events (TEAEs) with increase in dose level. No dose-limiting toxicities were reported. The most common TEAEs were nausea (30%), fatigue (25%), and arthralgia (20%). Grade 3 TEAEs reported in > 1 subject were gamma-glutamyltransferase (GGT) increased and hyponatremia (2 subjects each); no Grade 4 TEAEs were reported. Among treatment-related events, the most common were hot flushes and nausea (14% each); the only Grade 3 events were GGT increased and hypersensitivity in 1 subject each. ZN-c5 was rapidly absorbed, with a median Tmax of 2 to 4 hours. AUC and Cmax on Days 1 and 15 were less than dose proportional. No ZN-c5 accumulation after 15 days of dosing was observed. Confirmed PRs have been observed in 2 subjects (at 150 and 300 mg QD, respectively), and 14/45 (31%) evaluable subjects have experienced clinical benefit (PR or SD ≥ 24 weeks). Five of the 14 subjects with long SD received prior fulvestrant. Median progression-free survival (PFS) was 3.8 months (95% CI: 3.2, 5.3). Conclusions: In this first-in-human study, ZN-c5 monotherapy was well tolerated and showed clinical benefit, including confirmed PRs, in subjects with advanced ER+/HER2- breast cancer. These data warrant further evaluation of ZN-c5 as monotherapy and in combination with palbociclib.
Citation Format: Kevin Kalinksy, Vandana Abramson, Pavani Chalasani, Hannah M. Linden, Jasmina Alidzanovic, Rachel M. Layman, Živko Vranješ, Julie R. Nangia, Katherine D. Crew, Zoran Andric, Marijana Milovic-Kovacevic, Jasna Trifunovic, Jose Suarez, Matt Suster, Mieke Ptaszynski, Joanne Mortimer. ZN-c5, an oral selective estrogen receptor degrader (SERD), in women with advanced estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2 negative (HER2-) breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-17-02.
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Affiliation(s)
| | | | | | | | | | | | - Živko Vranješ
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | | | | | - Zoran Andric
- Clinical Hospital Centre Bezanijska Kosa, Belgrade, Serbia
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Fan T, Huang M, Price C, Premraj L, Kannapadi N, Suarez J, Cho SMC. Abstract TMP49: Prevalence Of Acute Respiratory Distress Syndrome In Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review And Meta-analysis. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tmp49] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Acute respiratory distress syndrome (ARDS) is a frequent complication seen in patients after aneurysmal subarachnoid hemorrhage (aSAH), but its prevalence, timing, and influence on neurological outcome is unclear. We aimed to investigate the prevalence, timing, risk factors, and outcome of ARDS in patients with aSAH.
Methods:
PubMed and four other databases (Embase, Cochrane Library, Web of Science Core Collection, and Scopus) from inception to July 6, 2020. We included all randomized controlled trials (RCTs) and observational studies of patients older than 18 years old. Two independent reviewers extracted the data. Study quality was assessed by the Cochrane Risk of Bias tool for RCTs, the Newcastle-Ottawa Scale for cohort and case-control studies. High-grade aSAH was defined as admission Glasgow coma scale 3-5 and/or modified fisher scale>=3 and/or Hunt Hess grade>=3. Good neurological outcome was defined as Glasgow Outcome Scale ≥ 4. Random-effects meta-analyses were conducted to estimate pooled outcome prevalence and their 95% confidence intervals (CI).
Results:
Nine observational studies (n=2,039) met the inclusion criteria, with the median age of 55 years (range=50-61, 28% male) and 71% patients suffered high-grade aSAH. Overall, 16% patients (95% CI=0.05-0.28, I2=94%) had ARDS after aSAH. The median time from SAH to ARDS was 3 days (range=2-6 days). Overall survival at discharge was 79% (95% CI=0.71-0.87; I2=95%) and good neurological outcome at any time was achieved in 65% of aSAH patients (95%CI=0.61-0.69; I2= 0.02%). aSAH cohort without ARDS had higher proportion of survival compared to those with ARDS (79% vs. 49%, p=0.028). Male sex, patients with high-grade aSAH, patients who developed pneumonia and systemic inflammatory response syndrome during hospital admission were at higher risk of developing ARDS.
Conclusions:
In this meta-analysis, approximately one in six patients developed ARDS after aSAH with the median time of 3 days from initial presentation and is associated with increased mortality. Further research to better understand the prevention and treatment strategy is necessary.
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Affiliation(s)
- Tracey Fan
- Neurology, Massachusetts General Hosp and Harvard Med Sch, Boston, MA
| | | | - Carrie Price
- Neurology, Albert S. Cook Library, Towson Univ, Towson, MD
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Cardenas-Alvarez JL, Suarez J, Motoa G, Anjan S, Natori Y, Loebe M, Breda JR, Thakkar-Rivera N, Phancao A, Ghodsizad A, Bauerlein JE, Munagala MR, Simkins J. Cefazolin plus ertapenem and heart transplantation as salvage therapy for refractory LVAD infection due to methicillin-susceptible Staphylococcus aureus: A case series. J Card Surg 2021; 36:4786-4788. [PMID: 34599521 DOI: 10.1111/jocs.16040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
The use of left ventricular assist devices (LVADs) is increasingly more common as the availability of donor organs in relation to failing hearts is outstandingly limited. Infections are the most common complications in LVAD recipients, particularly those caused by Staphylococcus spp. Refractory LVAD-related infections are not uncommon as achieving adequate source control is often not feasible before heart transplantation. Evidence suggest that cefazolin plus ertapenem is effective in refractory methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, but this approach has not been described in LVAD recipients. In this article, we report two cases of refractory MSSA bacteremia in LVAD recipients that were successfully treated with salvage therapy with cefazolin plus ertapenem and subsequent heart transplantation. This treatment strategy should be considered in patients with refractory LVAD-associated infection due to MSSA that are not responding to standard treatment.
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Affiliation(s)
- Jorge L Cardenas-Alvarez
- Department of Medicine, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Jose Suarez
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Gabriel Motoa
- Department of Medicine, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Shweta Anjan
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Yoichiro Natori
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Matthias Loebe
- Department of Surgery, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Joao R Breda
- Department of Surgery, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Nina Thakkar-Rivera
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Anita Phancao
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Ali Ghodsizad
- Department of Surgery, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Joseph E Bauerlein
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Mrudula R Munagala
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Jacques Simkins
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
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Kannis CS, Suarez J, Rakitzis TP. Macroscopic production of spin-polarised hydrogen atoms from the IR-excitation and photodissociation of molecular beams. Mol Phys 2021. [DOI: 10.1080/00268976.2021.1975053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. S. Kannis
- Institute for Nuclear Physics, Forschungszentrum Jülich, Jülich, Germany
- Department of Physics, University of Crete, Herakleio, Greece
| | - J. Suarez
- Departamento de Quimica, Modulo 13, Universidad Autonoma de Madrid, Cantoblanco, Madrid, Spain
| | - T. P. Rakitzis
- Department of Physics, University of Crete, Herakleio, Greece
- Institute of Electronic Structure and Laser, Foundation for Research and Technology Hellas, Heraklion, Crete, Greece
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9
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Abramson V, Linden H, Crew K, Mortimer J, Alidzanovic J, Nangia J, Layman R, Vranjes Z, Andric Z, Milovic-Kovacevic M, Trifunovic J, Karchmit Y, Suarez J, Suster M, Ptaszynski M, Chalasani P. 565TiP A phase I/II dose-escalation and expansion study of ZN-c5, an oral selective estrogen receptor degrader (SERD), as monotherapy and in combination with palbociclib in patients with advanced estrogen receptor (ER)+/HER2- breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1087] [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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10
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Haak HE, Beets GL, Peeters K, Nelemans PJ, Valentini V, Rödel C, Kuo L, Calvo FA, Garcia-Aguilar J, Glynne-Jones R, Pucciarelli S, Suarez J, Theodoropoulos G, Biondo S, Lambregts DMJ, Beets-Tan RGH, Maas M. Prevalence of nodal involvement in rectal cancer after chemoradiotherapy. Br J Surg 2021; 108:1251-1258. [PMID: 34240110 DOI: 10.1093/bjs/znab194] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/28/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the prevalence of ypN+ status according to ypT category in patients with locally advanced rectal cancer treated with chemoradiotherapy and total mesorectal excision, and to assess the impact of ypN+ on disease recurrence and survival by pooled analysis of individual-patient data. METHODS Individual-patient data from 10 studies of chemoradiotherapy for rectal cancer were included. Pooled rates of ypN+ disease were calculated with 95 per cent confidence interval for each ypT category. Kaplan-Meier and Cox regression analyses were undertaken to assess influence of ypN status on 5-year disease-free survival (DFS) and overall survival (OS). RESULTS Data on 1898 patients were included in the study. Median follow-up was 50 (range 0-219) months. The pooled rate of ypN+ disease was 7 per cent for ypT0, 12 per cent for ypT1, 17 per cent for ypT2, 40 per cent for ypT3, and 46 per cent for ypT4 tumours. Patients with ypN+ disease had lower 5-year DFS and OS (46.2 and 63.4 per cent respectively) than patients with ypN0 tumours (74.5 and 83.2 per cent) (P < 0.001). Cox regression analyses showed ypN+ status to be an independent predictor of recurrence and death. CONCLUSION Risk of nodal metastases (ypN+) after chemoradiotherapy increases with advancing ypT category and needs to be considered if an organ-preserving strategy is contemplated.
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Affiliation(s)
- H E Haak
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - G L Beets
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - K Peeters
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - P J Nelemans
- Department of Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - V Valentini
- Department of Radiation Oncology, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - C Rödel
- Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - L Kuo
- Department of Colorectal Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - F A Calvo
- Department of Oncology, General University Hospital Gregorio Marañón, Madrid, Spain
| | - J Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, USA
| | - R Glynne-Jones
- Department of Clinical Oncology, Mount Vernon Hospital, London, UK
| | - S Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padua, Padua, Italy
| | - J Suarez
- Department of Surgery, Hospital de Navarra, Pamplona, Spain
| | - G Theodoropoulos
- First Department of Propaedeutic Surgery, Athens Medical School, Hippocration General Hospital, Athens, Greece
| | - S Biondo
- Department of Surgery, Bellvitge University Hospital, Barcelona, Spain.,IDIBELL, University of Barcelona, Barcelona, Spain
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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11
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Chalasani P, Abramson V, Mortimer J, Nangia JR, Suarez J, Suster M, Ptaszynski M, Kalinsky K. Abstract PS12-20: A dose escalation study of the novel oral SERD-ZN-c5 in women with ER-positive, HER2-negative advanced/metastatic breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps12-20] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: ZN-c5 is an orally bioavailable selective estrogen receptor degrader (SERD) that binds potently to the estrogen receptors alpha and beta. It shows improved activity over fulvestrant in human tumor xenograft models and activity in tumor models that are resistant to tamoxifen. This is a Phase 1/2, open-label, multicenter, dose-escalation and expansion study to evaluate the safety, tolerability, pharmacokinetics (PK), and clinical activity of ZN-c5 in subjects with advanced/metastatic estrogen receptor (ER) positive/ human epidermal growth factor receptor (HER2) negative breast cancer, both as monotherapy and in combination with palbociclib. The results from the ongoing monotherapy dose escalation are reported. Methods: Single agent ZN-c5 is being evaluated at sequentially escalating doses starting at 50 mg/day, administered orally, once daily (QD). The endpoints are to determine a maximum tolerated dose (MTD) or recommended Phase 2 dose (RP2D), preliminary clinical activity and to characterize the PK profile. Subjects must be intolerant to or have breast cancer refractory to established therapies and to have received up to 2 prior lines of chemotherapy for the treatment of advanced breast cancer. Subjects must have a documented prior response to endocrine therapy for advanced/metastatic disease (SD, PR, or CR) lasting > 6 months or disease recurrence after at least 24 months of adjuvant endocrine treatment. Results: A total of 15 female subjects (median age 57 years, range 51 - 89 years) were enrolled across 5 cohorts (3 subjects/dose level). The dose levels were 50, 75, 100, 150, and 300 mg/day. The subjects had a median of 4 prior therapies for advanced/metastatic disease, with a median of 3 prior hormonal-based therapies and a median of 1 prior chemotherapy. Eleven of 15 subjects (73%) received prior fulvestrant. The cut off-date for this analysis was 30 June 2020. There was no increase in incidence or severity of TEAEs with increase in dose level. The most frequent TEAEs reported in > 1 subject were nausea (33%), arthralgia, cough, musculoskeletal pain and vomiting (20% each), alanine aminotransferase increased, anemia, back pain, blood alkaline phosphatase increased, breast pain, diarrhea, fatigue, gamma-glutamyl transferase increased, headache, hypophosphatemia, myalgia and skin mass (13% each). Grade 3 events were COVID-19, hypercalcemia, arthralgia, back pain musculoskeletal chest pain, pain in extremity and hypertension, none were deemed related to ZN-c5. Grade 4 events were not reported. No bradycardia was observed. A single subject reported a Grade 1 visual field defect, not deemed related to ZN-c5. No DLTs were reported. ZN-c5 demonstrated a best response of stable disease (SD) in 10/15 subjects (66.5%), while progression of disease (PD) was reported in 5/15 subjects (33.5%). The clinical benefit rate (CBR, SD ≥ 24 weeks) was 40%. In addition, the progression free survival (PFS) was a median of 3.8 months (95% [CI], 1.6 to 6.3). The preliminary PK was characterized by fast absorption with median Tmax values of 1 - 2 hrs. The exposures were approximately dose-proportional at the dose levels of 50 - 100 mg and less than dose-proportional between 100 - 300 mg. No ZN-c5 accumulation after 15 days of QD dosing was observed. The estimated mean elimination half-lives ranged between 11 - 18 hrs. Conclusion: This monotherapy dose escalation study demonstrates that ZN-c5 is very well-tolerated and has promising clinical activity in patients with ER+/HER2-negative advanced breast cancer who have disease that progressed on standard therapies. The trial with ZN-c5 in monotherapy and with palbociclib is ongoing and the RP2D has not been determined yet.
Citation Format: Pavani Chalasani, Vandana Abramson, Joanne Mortimer, Julie R Nangia, Jose Suarez, Matt Suster, Mieke Ptaszynski, Kevin Kalinsky. A dose escalation study of the novel oral SERD-ZN-c5 in women with ER-positive, HER2-negative advanced/metastatic breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS12-20.
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12
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McNett M, Fink EL, Schober M, Mainali S, Helbok R, Robertson CL, Mejia-Mantilla J, Kurtz P, Righy C, Roa JD, Villamizar-Rosales C, Altamirano V, Frontera JA, Maldonado N, Menon D, Suarez J, Chou SHY. The Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID): Development of Case Report Forms for Global Use. Neurocrit Care 2020; 33:793-828. [PMID: 32948987 PMCID: PMC7500499 DOI: 10.1007/s12028-020-01100-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
Since its original report in January 2020, the coronavirus disease 2019 (COVID-19) due to Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection has rapidly become one of the deadliest global pandemics. Early reports indicate possible neurological manifestations associated with COVID-19, with symptoms ranging from mild to severe, highly variable prevalence rates, and uncertainty regarding causal or coincidental occurrence of symptoms. As neurological involvement of any systemic disease is frequently associated with adverse effects on morbidity and mortality, obtaining accurate and consistent global data on the extent to which COVID-19 may impact the nervous system is urgently needed. To address this need, investigators from the Neurocritical Care Society launched the Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID). The GCS-NeuroCOVID consortium rapidly implemented a Tier 1, pragmatic study to establish phenotypes and prevalence of neurological manifestations of COVID-19. A key component of this global collaboration is development and application of common data elements (CDEs) and definitions to facilitate rigorous and systematic data collection across resource settings. Integration of these elements is critical to reduce heterogeneity of data and allow for future high-quality meta-analyses. The GCS-NeuroCOVID consortium specifically designed these elements to be feasible for clinician investigators during a global pandemic when healthcare systems are likely overwhelmed and resources for research may be limited. Elements include pediatric components and translated versions to facilitate collaboration and data capture in Latin America, one of the epicenters of this global outbreak. In this manuscript, we share the specific data elements, definitions, and rationale for the adult and pediatric CDEs for Tier 1 of the GCS-NeuroCOVID consortium, as well as the translated versions adapted for use in Latin America. Global efforts are underway to further harmonize CDEs with other large consortia studying neurological and general aspects of COVID-19 infections. Ultimately, the GCS-NeuroCOVID consortium network provides a critical infrastructure to systematically capture data in current and future unanticipated disasters and disease outbreaks.
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Affiliation(s)
- Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH, USA.
| | - Ericka L Fink
- Division of Pediatric Critical Care Medicine and Safar Center for Resuscitation Research, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle Schober
- Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Shraddha Mainali
- Division of Stroke and Neurocritical Care, Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Raimund Helbok
- Neurocritical Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Courtney L Robertson
- Departments of Anesthesiology and Critical Care Medicine, and Pediatrics, The Johns Hopkins University SOM, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - Jorge Mejia-Mantilla
- Department of Neuro-Intensive Care and Anesthesiology, Fundacio Valle del Lili, University Hospital, Cali, Colombia
| | - Pedro Kurtz
- Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Cássia Righy
- National Institute of Infectious Diseases Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Juan D Roa
- Department of Pediatric Neurology and Critical Care, Universidad Nacional de Colombia and Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | | | | | | | - Nelson Maldonado
- Department of Neurology, Universidad San Francisco de Quito (USFQ), de los Valles Quito, Ecuador
| | - David Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital Cambridge, Cambridge, UK
| | - Jose Suarez
- Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sherry H Y Chou
- Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Safar Center for Resuscitation Research, Pittsburgh, PA, USA
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13
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Hoffmann TM, Travaglini A, Brighetti MA, Acar Şahin A, Arasi S, Bregu B, Caeiro E, Caglayan Sozmen S, Charpin D, Delgado L, Dimou M, Fiorilli M, Fonseca JA, Goksel O, Kalpaklioglu F, Lame B, Mazon A, Mesonjesi E, Nieto A, Öztürk A, Pajno G, Papadopoulos NG, Pellegrini E, Pereira AM, Pereira M, Pinar NM, Pinter E, Priftanji A, Sackesen C, Sfika I, Suarez J, Thibaudon M, Tripodi S, Ugus U, Villella V, Matricardi PM, Dramburg S. Cumulative Pollen Concentration Curves for Pollen Allergy Diagnosis. J Investig Allergol Clin Immunol 2020; 31:340-343. [PMID: 32959781 DOI: 10.18176/jiaci.0646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T M Hoffmann
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - A Travaglini
- Department of Biology, Tor Vergata University, Rome, Italy.,Italian Aerobiology Monitoring Network - Italian Aerobiology Association, Italy
| | - M A Brighetti
- Department of Biology, Tor Vergata University, Rome, Italy
| | - A Acar Şahin
- Department of Biology, Faculty of Science, Ankara University, Ankara, Turkey
| | - S Arasi
- Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children´s research Hospital (IRCCS), Rome, Italy
| | - B Bregu
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Albania
| | - E Caeiro
- Mediterranean Institute for Agriculture, Environmental and Development, University of Évora, Évora, Portugal.,Portuguese Society of Allergology and Clinical Immunology, Lisbon, Portugal
| | - S Caglayan Sozmen
- Department of Pediatric Allergy and Immunology, Okan University Faculty of Medicine, Istanbul, Turkey
| | - D Charpin
- Department of Pneumonology and Allergy, La Timone Hospital, APHM, Aix-Marseille University, Marseille, France
| | - L Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS, Center for Health Technology and Services Research, Porto, Portugal.,Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - M Dimou
- Allergy Department, 2nd Pediatric Clinic, Athens General Children´s Hospital "P&A Kyriakou," University of Athens, Athens, Greece
| | - M Fiorilli
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - J A Fonseca
- CINTESIS, Center for Health Technology and Services Research, Porto, Portugal.,Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal.,MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - O Goksel
- Department of Pulmonary Medicine, Division of Immunology, Allergy and Asthma, Faculty of Medicine, Ege University, Izmir, Turkey
| | - F Kalpaklioglu
- Kırıkkale University School of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Turkey
| | - B Lame
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Albania
| | - A Mazon
- Pediatric Allergy and Pneumology Unit, Children´s Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - E Mesonjesi
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Albania
| | - A Nieto
- Pediatric Allergy and Pneumology Unit, Children´s Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - A Öztürk
- Department of Allergy and Immunology, Koç University Hospital, İstanbul, Turkey
| | - G Pajno
- Department of Pediatrics- Allergy Unit, University of Messina, Messina, Italy
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, Athens General Children´s Hospital "P&A Kyriakou," University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children´s Hospital, University of Manchester, Manchester, UK
| | - E Pellegrini
- ARPACal- Regional Agency for Environmental Protection, Department of Reggio Calabria, Italy
| | - A M Pereira
- CINTESIS, Center for Health Technology and Services Research, Porto, Portugal.,Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - M Pereira
- CINTESIS, Center for Health Technology and Services Research, Porto, Portugal.,Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - N M Pinar
- Department of Biology, Faculty of Science, Ankara University, Ankara, Turkey
| | - E Pinter
- Allergy Department, 2nd Pediatric Clinic, Athens General Children´s Hospital "P&A Kyriakou," University of Athens, Athens, Greece
| | - A Priftanji
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Albania
| | - C Sackesen
- Division of Pediatric Allergy, Koç University School of Medicine, Istanbul, Turkey
| | - I Sfika
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
| | - J Suarez
- Department of Biology of Organisms and Systems, Area of Botany, University of Oviedo, Oviedo, Spain
| | - M Thibaudon
- Réseau National de Surveillance Aérobiologique, Brussieu, France
| | - S Tripodi
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
| | - U Ugus
- Department of Biology, Faculty of Science, Ege University, Izmir, Turkey
| | - V Villella
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
| | - P M Matricardi
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - S Dramburg
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
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14
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Sanchez-Marin L, Gavito AL, Decara J, Pastor A, Castilla-Ortega E, Suarez J, de la Torre R, Pavon FJ, Rodriguez de Fonseca F, Serrano A. Impact of intermittent voluntary ethanol consumption during adolescence on the expression of endocannabinoid system and neuroinflammatory mediators. Eur Neuropsychopharmacol 2020; 33:126-138. [PMID: 32057593 DOI: 10.1016/j.euroneuro.2020.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/09/2020] [Accepted: 01/22/2020] [Indexed: 01/14/2023]
Abstract
The adolescent brain displays high vulnerability to the deleterious effects of ethanol, including greater risk of developing alcohol use disorder later in life. Here, we characterized the gene expression of the endocannabinoid system (ECS) and relevant signaling systems associated with neuroinflammation and emotional behaviors in the brain of young adult control and ethanol-exposed (EtOH) rats. We measured mRNA levels of candidate genes using quantitative real time PCR in the medial prefrontal cortex (mPFC), amygdala and hippocampus. EtOH rats were generated by maintenance on an intermittent and voluntary ethanol consumption during adolescence using the two-bottle choice paradigm (4 days/week for 4 weeks) followed by 2 week-withdrawal, a time-point of withdrawal with no physical symptoms. Mean differences and effect sizes were calculated using t-test and Cohen's d values. In the mPFC and hippocampus, EtOH rats had significantly higher mRNA expression of endocannabinoid-signaling (mPFC: Ppara, Dagla, Daglb and Napepld; and hippocampus: Cnr2, Dagla and Mgll) and neuroinflammation-associated genes (mPFC: Gfap; and hippocampus: Aif1) than in controls. Moreover, EtOH rats had significantly higher mRNA expression of neuropeptide Y receptor genes (Npy1r, Npy2r and Npy5r) in the hippocampus. Finally, EtOH rats also displayed higher plasma endocannabinoid levels than controls. In conclusion, these results suggest that adolescent ethanol exposure can lead to long-term alterations in the gene expression of the ECS and other signaling systems involved in neuroinflammation and regulation of emotional behaviors in key brain areas for the development of addiction.
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Affiliation(s)
- L Sanchez-Marin
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Avda. Carlos Haya 82, Sótano, Málaga 29010, Spain
| | - A L Gavito
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Avda. Carlos Haya 82, Sótano, Málaga 29010, Spain
| | - J Decara
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Avda. Carlos Haya 82, Sótano, Málaga 29010, Spain
| | - A Pastor
- Programa de Neurociencias, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - E Castilla-Ortega
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Avda. Carlos Haya 82, Sótano, Málaga 29010, Spain
| | - J Suarez
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Avda. Carlos Haya 82, Sótano, Málaga 29010, Spain
| | - R de la Torre
- Programa de Neurociencias, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - F J Pavon
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Avda. Carlos Haya 82, Sótano, Málaga 29010, Spain; Unidad Gestión Clínica del Corazón, IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - F Rodriguez de Fonseca
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Avda. Carlos Haya 82, Sótano, Málaga 29010, Spain.
| | - A Serrano
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Avda. Carlos Haya 82, Sótano, Málaga 29010, Spain.
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15
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Shah VA, Radzik B, Weingart J, Suarez J, Rivera-Lara L. Remarkable Recovery After a Large Thalamic-Midbrain Intracerebral and Intraventricular Hemorrhage. Neurol Clin Pract 2020; 11:85-87. [PMID: 33968477 DOI: 10.1212/cpj.0000000000000827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/17/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Vishank Arun Shah
- Department of Neurology and Neurosurgery (VAS), University of Arkansas for Medical Sciences, Little Rock; Department of Anesthesiologyand Critical Care Medicine (BR, JS, LR-L), and Department of Neurosurgery (JW), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Batya Radzik
- Department of Neurology and Neurosurgery (VAS), University of Arkansas for Medical Sciences, Little Rock; Department of Anesthesiologyand Critical Care Medicine (BR, JS, LR-L), and Department of Neurosurgery (JW), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jon Weingart
- Department of Neurology and Neurosurgery (VAS), University of Arkansas for Medical Sciences, Little Rock; Department of Anesthesiologyand Critical Care Medicine (BR, JS, LR-L), and Department of Neurosurgery (JW), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jose Suarez
- Department of Neurology and Neurosurgery (VAS), University of Arkansas for Medical Sciences, Little Rock; Department of Anesthesiologyand Critical Care Medicine (BR, JS, LR-L), and Department of Neurosurgery (JW), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lucia Rivera-Lara
- Department of Neurology and Neurosurgery (VAS), University of Arkansas for Medical Sciences, Little Rock; Department of Anesthesiologyand Critical Care Medicine (BR, JS, LR-L), and Department of Neurosurgery (JW), Johns Hopkins University School of Medicine, Baltimore, MD
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16
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Burgos-Pol R, Barrios V, Cinza-Sanjurjo S, Gavin O, Egocheaga I, Soto J, Polanco C, Suarez J, Casado MA. P3815Cost and burden of poor control of the level of anticoagulation in patients with non-valvular atrial fibrillation treated with vitamin K antagonist in the Spanish National Health Service. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0657] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Poorly controlled non-valvular atrial fibrillation (NVAF) patients treated with vitamin K antagonists (VKA) experience higher rates of clinical events compared to well controlled patients. In Spain a high percentage of NVAF patients present an inadequate control of anticoagulation therapy, whose economic impact has not been reported yet.
Purpose
To estimate the impact on resource consumption, clinical events and mortality of poorly controlled NVAF patients≥65 years treated with VKA in Spain.
Methods
A cost-consequence analytic model was developed to estimate differences on clinical events and cost between poorly controlled (TTR<65%) and well controlled (TTR≥65%) NVAF patients treated with VKA over 1 year. A hypothetical cohort of NVAF patients was estimated by using local epidemiological studies. Anticoagulation control rates, as measured by Rosendaal method, were retrieved from a literature review of Spanish real-world studies.
Clinical event rates (ischemic stroke-IS-, hemorrhagic stroke-HS-, major bleeding-MB-, systemic embolism-SE- and death for any cause) were derived from a post-hoc analysis of SPORTIF III/V trials. A sensitivity analysis (SA) was performed by using event rates from a prospective single-center study carried out in Spain.
Societal and National Health Service (NHS) perspectives were considered. Total annual costs (€ 2018) included clinical event direct, non-direct healthcare cost and indirect-costs. Potential life years lost (PLYL) were calculated to report impact on mortality. An expert panel composed by a cardiologist, a haematologist and general practitioners validated the model inputs.
Results
The target population comprised 594,855 NVAF patients treated with VKA (mean age 73.2 years, 49.4% women, 74.1% CHADS≥2). Poorly controlled anticoagulated patients accounted for 48.3% of the cohort. The inadequate control of anticoagulation was associated with a higher incidence of clinical events compared to well controlled patients within a year (additional 2,143 IS, 390 HS, 201 SE, 6,190 MB and 6,856 deaths). From NHS perspective, the incremental total annual costs associated to poorly controlled patients were €46,685,756.60 (€173.96/patient-year). When considering the societal perspective, the incremental total annual costs of inadequate anticoagulation control reached €97,787,872.59 (€367.51/patient-year). Mortality due to poorly anticoagulation control implied 80,830.65 PLYL (0.136 PLYL/patient-year). The SA confirmed the base case results.
Conclusions
In the Spanish NHS, around 50% of NVAF patients ≥65 years treated with VKA present an inadequate control of the anticoagulation therapy (287,089 patients), which is associated with the increase of clinical events, mortality and costs (up to €100 million). The results of this study highlight a call to action to increase the awareness of the consequences of a poor anticoagulation control and emphasize the need for a better clinical of patients receiving anticoagulation.
Acknowledgement/Funding
BMS and PFIZER contributed to finance the no conditioned to the results of this work.
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Affiliation(s)
- R Burgos-Pol
- Pharmacoeconomics & Outcomes Research IBERIA (PORIB), Madrid, Spain
| | - V Barrios
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | | | - O Gavin
- Clinical University Hospital Lozano Blesa, Zaragoza, Spain
| | | | - J Soto
- Pfizer Spain, MADRID, Spain
| | | | | | - M A Casado
- Pharmacoeconomics & Outcomes Research IBERIA (PORIB), Madrid, Spain
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Arias F, Asín G, Flamarique S, Hernández I, Suarez J. In favor of total neoadjuvant therapy (TNT) for locally advanced rectal carcinoma. Clin Transl Oncol 2019; 22:793-794. [PMID: 31309436 DOI: 10.1007/s12094-019-02177-w] [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: 02/05/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022]
Affiliation(s)
- F Arias
- Services of Radiation Oncology, Multidisciplinary Colorectal Cancer Unit (UMDCR), Complejo Hospitalario de Navarra, Pamplona, Spain.
| | - G Asín
- Services of Radiation Oncology, Multidisciplinary Colorectal Cancer Unit (UMDCR), Complejo Hospitalario de Navarra, Pamplona, Spain
| | - S Flamarique
- Services of Radiation Oncology, Multidisciplinary Colorectal Cancer Unit (UMDCR), Complejo Hospitalario de Navarra, Pamplona, Spain
| | - I Hernández
- Services of Medical Oncology, Multidisciplinary Colorectal Cancer Unit (UMDCR), Complejo Hospitalario de Navarra, Pamplona, Spain
| | - J Suarez
- Services of Surgery, Multidisciplinary Colorectal Cancer Unit (UMDCR), Complejo Hospitalario de Navarra, Pamplona, Spain
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Castro Peña P, Nino de Guzman C, Venencia D, Suarez Villasmil L, Suarez J, Zunino S. EP-1250 Outcomes of Multiple Brain Metastases Radiosurgery with Gantry-Based Linac. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31670-6] [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]
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Rivera Lara L, Geocadin R, Zorrilla-Vaca A, Healy RJ, Palmisano C, RadziK B, Mirski M, Anderson White M, Suarez J, Brown C, Hogue CW, Ziai W. Abstract TMP85: Optimizing Mean Arterial Pressure in Acutely Comatose Patients Using Cerebral Autoregulation Multimodal Monitoring With Near-Infrared Spectroscopy. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tmp85] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The cerebral oximetry index (COx) is a validated marker of cerebral autoregulation derived from near-infrared spectroscopy (NIRS) in comatose patients with acute neurological injury. The utility of this non-invasive technique to determine the optimal arterial blood pressure (MAP
OPT
) at the bedside in this population is not known. This study investigated whether comatose patients with greater duration and magnitude of clinically observed MAP outside MAP
OPT
have worse functional outcomes and increase mortality than those with MAP closer to MAP
OPT
calculated by bedside multimodal monitoring using NIRS.
Methods:
In this prospective observational study COx was continuously monitored with NIRS for up to three days in acutely comatose patients secondary to brain injury admitted to a neurocritical care unit. MAP
OPT
was defined as that MAP at the lowest COx (nadir index) for each 24 hour period of monitoring. Kaplan-Meier analysis and proportional hazard regression models were used to determine if survival at 3 months was associated with a shorter duration of MAP outside MAP
OPT
and the absolute difference between clinically observed MAP and MAP
OPT
(
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Narváez A, Suarez J, Riera L, Castells-Esteve M, Cocera R, Vigués F. Our experience in the management of prostate cancer in renal transplant recipients. Actas Urol Esp 2018; 42:249-255. [PMID: 29395386 DOI: 10.1016/j.acuro.2017.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES The management of Prostate cancer (PCa) in renal transplant recipients (RTR) is challenging and remain controversial. Currently there is no consensus about this condition. The aim of the study was to analyse our experience in the diagnosis and management of PCa in RTR. METHOD Retrospective monocentric study of a prospective and consecutive database from 2003-2017. Inclusion of RTR diagnosed of PCa. Staging and treatment in agreement with the contemporary guidelines. The main outcome measures included clinical staging, type of treatment, oncological outcomes and follow-up. RESULTS 1,330 renal transplants were performed (787 males), diagnosed of PCa in 33 RTR (4.2%), mean age 66years±6.3 (51-78). Median PSA was 8.8ng/ml and PSA ratio 0.19. Mean time between renal transplantation and PCa diagnosis 130months±90 (2-236). TREATMENTS Radical prostatectomy (RP) (n=22; 66.7%), Radiation therapy (RT) with Androgen deprivation therapy (ADT) (n=7; 21.2%), Active surveillance (n=3; 9.1%), ADT (n=1; 3%). No graft loss neither impaired renal function due to PCa treatment was reported. After RP two patients (9.1%) presented biochemical recurrence treated with RT. Remission of the 100%. Mean follow-up was 61months±37 (6-132). CONCLUSIONS PCa in renal transplant patients can be managed with the same therapeutic options as in the general population. Active surveillance should also be provided in RTR despite being under immunosuppressive therapy.
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Qureshi A, Palesch Y, Foster L, Qureshi M, Suarez J. Abstract TP337: Did Pre-Randomization Use of Intravenous Nicardipine Adversely Affect the Results of Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-2 Trial? Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp337] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The design of the ATACH-2 trial permitted use of intravenous (IV) nicardipine to maintain systolic blood pressure (SBP) <180 mm Hg prior to randomization. We performed an analysis to determine if pre-randomization use of IV nicardipine modified the treatment effect of intensive SBP reduction (compared with standard SBP reduction) in patients with intracerebral hemorrhage (ICH).
Methods:
ATACH-2 evaluated the treatment effect of intensive (goal 110-139 mmHg) over standard (goal 140-179 mmHg) SBP reduction using IV nicardipine within 4.5 hours of symptom onset in subjects with ICH in a generalized linear (GLM) model. The outcome was death or disability (modified Rankin scale 4-6) at 3-months post-randomization ascertained by a blinded investigator. The interaction between pre-randomization use of IV nicardipine and treatment was tested in the model at p<0.15 level. Additional variables included were age, Glasgow coma scale score category (3-11, 12-14, and 15), and presence of intraventricular hemorrhage.
Results:
Pre-randomization IV nicardipine was used in 517 of 1000 subjects who were randomized. The baseline SBP of those who did and did not receive pre-randomization nicardipine were similar. The interaction term in the GLM was significant (p=0.133). The outcome for each subgroup (with or without pre-randomization nicardipine) is given below.
Conclusions:
A small modifying effect of treatments effect with pre-randomization use of IV nicardipine was observed in ATACH-2 trial which may have implications for future clinical trial design.
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Affiliation(s)
| | - Yuko Palesch
- Med Univ of South Carolina, Med Univ of South Carolina, SC
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Qureshi A, Palesch Y, Foster L, Qureshi M, Suarez J. Abstract 128: Intensive Blood Pressure Lowering in Patients with Moderate to Severe Grade Acute Cerebral Hemorrhage: Post Hoc Subgroup Analysis of Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-2 Trial. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.128] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The intent to treat analysis of ATACH-2 trial did not demonstrate any difference in rates of death or disability with intensive systolic blood pressure (SBP) reduction compared with standard SBP reduction in patients with intracerebral hemorrhage (ICH). The benefit may have been obscured due to relatively high proportion of good grade patients (ceiling effect) in both treatment groups.
Methods:
We evaluated the effect of intensive (goal 110-139 mmHg) over standard (goal 140-179 mmHg) SBP reduction using intravenous nicardipine within 4.5 hours of symptom onset in a subgroup of moderate to severe grade subjects with ICH. Moderate to severe grade was defined by Glasgow coma scale score <13 or baseline National Institutes of Health Stroke Scale score ≥10 or baseline intraparenchymal hemorrhage volume ≥30cm
3
or presence of intraventricular hemorrhage. The primary outcome was death or disability (score 4-6 on modified Rankin scale) at 3-months post-randomization ascertained by a blinded investigator.
Results:
A total of 682 subjects (336 in intensive and 346 in standard groups) met the definition of moderate to severe grade. The primary endpoint of death or disability was observed in 52.5% of subjects receiving intensive treatment and 48.9% subjects receiving standard treatment (relative risk: 1.07; 95% confidence interval: 0.86 to 1.33). Serious adverse events were significantly higher (relative risk: 1.38; 95% confidence interval: 1.04 to 1.84), among patients randomized to intensive treatment (32.7% and 23.7% for intensive and standard treatment groups, respectively).
Conclusions:
Similar to the conclusion from the overall ATACH-2 Trial sample, the rate of death or disability in the moderate to severe ICH subjects was similar, but significantly higher rate of serious adverse events were observed in subjects randomized to intensive SBP reduction.
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Jerez A, Merino M, Buño I, Chen-Liang TH, Iniesta P, Garcia A, Teruel R, Amigo M, Alamo J, Suarez J, Ortuño F, Vicente V. Donor Cell MDS with Rare Complex Karyotype After Mismatch Alobmt for Ph+ALL. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30409-5] [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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Odenkirchen J, Amos L, Ludet C, Sheikh M, Ala’i S, Esterlitz J, Suarez J. Abstract TP419: A Common Data Language for Clinical Research Studies: The National Institute of Neurological Disorders and Stroke and National Library of Medicine Cerebral Aneurysms and Subarachnoid Hemorrhage Common Data Elements Version 1.0 Recommendations. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp419] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The National Institute of Neurological Disorders and Stroke (NINDS) and the National Library of Medicine (NLM) initiated development of cerebral aneurysms and subarachnoid hemorrhage (SAH)-specific Common Data Elements (CDEs) in 2015 as part of a joint project to develop data standards for funded clinical research in neuroscience.
Objective:
Through the development of these data standards for clinical research, the NINDS and NLM SAH joint CDE initiative strives to improve SAH data collection by increasing efficiency, improving data quality, reducing study start-up time, facilitating data sharing/meta-analyses and helping educate new clinical investigators.
Methods:
The working group consisted of international members with varied fields of expertise related to SAH and was divided into domains such as subject characteristics and assessments and exams. They developed a set of SAH-specific CDE recommendations by selecting among, refining and adding to existing field-tested data elements. Recommendations, based on reviewing the established Stroke CDEs as well as other disease-specific CDEs, were uploaded to the NIH CDE Repository. Following an internal working group review of recommendations, the SAH CDEs will be vetted during a public review on the NINDS website.
Results:
Version 1.0 of the SAH CDEs will be available in early 2017. New SAH CDEs and recommendations will include those developed for unruptured intracranial aneurysms and long-term therapies. The NINDS CDE website provides uniform names and structures for each data element, as well as guidance documents and template case report forms using the CDEs.
Conclusion:
The NINDS encourages the use of CDEs by the clinical research community in order to standardize the collection of research data across studies. The NINDS CDEs are a continually evolving resource, requiring updates as research advancements indicate. These newly developed SAH CDEs will serve to be a valuable starting point for researchers and facilitate streamlining and sharing data. Information provided at this meeting will include examples of how the SAH CDEs may be used by a research study, demonstrations of navigating the NINDS CDE and NIH CDE Repository websites and how users can submit feedback.
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Affiliation(s)
- Joanne Odenkirchen
- The National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Liz Amos
- National Library of Medicine, Bethesda, MD
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Tan B, Suarez J. Biomarkers in neurocritical care. Journal of Neuroanaesthesiology and Critical Care 2016. [DOI: 10.4103/2348-0548.174726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Benedict Tan
- Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, CHI Baylor St. Luke’s Medical Center, Houston, TX, USA
| | - Jose Suarez
- Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, CHI Baylor St. Luke’s Medical Center, Houston, TX, USA
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Suarez J. Accuracy of Malnutrition Documentation in the Hospitalized Adult: A Retrospective Analysis of Four Adult Patient Populations at the University of Virginia Health System. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Semien G, Suarez J, Patel P. Abstract PR331. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492726.04346.4f] [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: 11/05/2022]
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Braun U, Suarez J, Gasparini S, Warislohner S, Dennler M. Magnetic resonance imaging in a lamb with compression of the thoracic spinal cord by an abscess. SCHWEIZ ARCH TIERH 2016; 158:573-7. [PMID: 27518732 DOI: 10.17236/sat00079] [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] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This report describes a two-month-old Ouessant ram lamb with hind limb ataxia, knuckling and falling attributable to an abscess in the thoracic vertebral region. A swelling palpated adjacent to the spinous processes of the 9th to 12th thoracic vertebrae was identified via ultrasonography as an abscess located on the transverse processes of these vertebrae. Magnetic resonance imaging of the lamb postmortem revealed that the abscess had invaded the vertebral canal through a channel at the level of the 9th thoracic vertebra causing extradural spinal cord compression. Postmortem examination confirmed these findings, and histological examination showed acute spinal cord degeneration.
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Affiliation(s)
- U Braun
- Department of Farm Animals, Vetsuisse Faculty, University of Zurich
| | - J Suarez
- Clinic of Diagnostic Imaging, Vetsuisse-Faculty, University of Zurich
| | - S Gasparini
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Switzerland
| | - S Warislohner
- Department of Farm Animals, Vetsuisse Faculty, University of Zurich
| | - M Dennler
- Clinic of Diagnostic Imaging, Vetsuisse-Faculty, University of Zurich
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Alen F, Marban Castro T, Ballesta-Garcia A, Anton Valades M, Ramirez-Lopez M, Vazquez M, Blanco N, Ouco D, Jaimez-Alameda M, Gomez de Heras R, Serrano A, Gorriti M, Suarez J, Rodriguez de Fonseca F. Acute administration of reboxetine reduces alcohol self-administration but, after a subchronic treatment with this drug, alcohol self-administration is enhanced. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1483] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IntroductionComorbidity between alcoholism and depression has long been acknowledged, and the possibility that similar brain mechanisms, involving both serotonergic (5-HT) and noradrenergic systems (NE), underlie both pathologies has been suggested. Thus, inhibitors of NE and 5HT uptake have been proposed for the treatment of alcoholism, as they have shown to reduce alcohol intake in various animal models. However, most of the studies mentioned were carried out acutely and there is a lack of knowledge of the possible long-term effects. Clinical studies report an overall low efficacy of antidepressant treatment on alcohol consumption, or even a worsened prognosis. In addition, several cases of alcohol dependence following antidepressant treatment have been reported in the literature.ObjectivesWe aimed at comparing the acute and chronic effects of the treatment with the antidepressant drug reboxetine on alcohol consumption.MethodsWe used a rat model of alcohol self-administration, and two different schedules of reboxetine administration (acute and chronic).ResultsOur results confirm the acute suppressant effects of reboxetine on alcohol consumption but indicate that, when this drug is administered chronically in a period of abstinence from alcohol, it can significantly increase the rate of alcohol self-administration.ConclusionsThese results are important for the understanding of the clinical reports describing cases of increased alcohol consumption after antidepressant treatment, and suggest that much more research is needed to fully understand the long term effects of antidepressants, which remain the most widely prescribed class of drugs.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Gavito AL, Cabello R, Suarez J, Serrano A, Pavón FJ, Vida M, Romero M, Pardo V, Bautista D, Arrabal S, Decara J, Cuesta AL, Valverde AM, Rodríguez de Fonseca F, Baixeras E. Single administration of recombinant IL-6 restores the gene expression of lipogenic enzymes in liver of fasting IL-6-deficient mice. Br J Pharmacol 2016; 173:1070-84. [PMID: 26750868 DOI: 10.1111/bph.13423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 12/18/2015] [Accepted: 01/06/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Lipogenesis is intimately controlled by hormones and cytokines as well as nutritional conditions. IL-6 participates in the regulation of fatty acid metabolism in the liver. We investigated the role of IL-6 in mediating fasting/re-feeding changes in the expression of hepatic lipogenic enzymes. EXPERIMENTAL APPROACH Gene and protein expression of lipogenic enzymes were examined in livers of wild-type (WT) and IL-6-deficient (IL-6(-/-) ) mice during fasting and re-feeding conditions. Effects of exogenous IL-6 administration on gene expression of these enzymes were evaluated in vivo. The involvement of STAT3 in mediating these IL-6 responses was investigated by using siRNA in human HepG2 cells. KEY RESULTS During feeding, the up-regulation in the hepatic expression of lipogenic genes presented similar time kinetics in WT and IL-6(-/-) mice. During fasting, expression of lipogenic genes decreased gradually over time in both strains, although the initial drop was more marked in IL-6(-/-) mice. Protein levels of hepatic lipogenic enzymes were lower in IL-6(-/-) than in WT mice at the end of the fasting period. In WT, circulating IL-6 levels paralleled gene expression of hepatic lipogenic enzymes. IL-6 administration in vivo and in vitro showed that IL-6-mediated signalling was associated with the up-regulation of hepatic lipogenic enzyme genes. Moreover, silencing STAT3 in HepG2 cells attenuated IL-6 mediated up-regulation of lipogenic gene transcription levels. CONCLUSIONS AND IMPLICATIONS IL-6 sustains levels of hepatic lipogenic enzymes during fasting through activation of STAT3. Our findings indicate that clinical use of STAT3-associated signalling cytokines, particularly against steatosis, should be undertaken with caution.
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Affiliation(s)
- A L Gavito
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain.,UGC-Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - R Cabello
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain
| | - J Suarez
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain.,UGC-Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - A Serrano
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain.,UGC-Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - F J Pavón
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain.,UGC-Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - M Vida
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain.,UGC-Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - M Romero
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain
| | - V Pardo
- Instituto de Investigaciones Biomédicas Alberto Sols (CSIC/UAM), Madrid, 28029, Spain.,Ciber de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - D Bautista
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Regional Universitario de Málaga, Málaga 29010, Spain
| | - S Arrabal
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain.,UGC-Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - J Decara
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain.,UGC-Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - A L Cuesta
- Danish Diabetes Academy, Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - A M Valverde
- Instituto de Investigaciones Biomédicas Alberto Sols (CSIC/UAM), Madrid, 28029, Spain.,Ciber de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - F Rodríguez de Fonseca
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain.,UGC-Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - E Baixeras
- Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, 29010, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain.,UGC-Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
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Suarez J, Maldonado N, Cornejo F. High altitude neurophysiology applied knowledge: the Hanak project in Ecuador. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.232] [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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Omar S, Ali E, Mazek H, Mahmoud T, Soontrapa S, Suarez J. Takotsubo cardiomyopathy associated with hyperthyroidism treated with thyroidectomy. Proc AMIA Symp 2015; 28:194-5. [PMID: 25829652 DOI: 10.1080/08998280.2015.11929227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Takotsubo cardiomyopathy is an uncommon clinical entity, also called apical ballooning syndrome, characterized by transient systolic dysfunction of the apical and/or mid segments of the left ventricle. We report a case that highlights takotsubo syndrome in the setting of thyrotoxicosis that required thyroidectomy. The association of takotsubo syndrome and hyperthyroidism has been reported before. We found 13 previously reported cases of thyrotoxicosis-induced cardiomyopathy, most associated with Grave's disease and none treated with thyroidectomy. Awareness of this possible association is important in establishing the diagnosis and instituting proper management.
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Affiliation(s)
- Sabry Omar
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Emad Ali
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Haitham Mazek
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Tashfeen Mahmoud
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Suthipong Soontrapa
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Jose Suarez
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
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Vazquez R, Vazquez-Guillamet M, Suarez J, Mooney J, Montoya J, Dhillon G. Invasive mold infections in lung and heart-lung transplant recipients: Stanford University experience. Transpl Infect Dis 2015; 17:259-66. [DOI: 10.1111/tid.12362] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/20/2014] [Accepted: 01/19/2015] [Indexed: 01/01/2023]
Affiliation(s)
- R. Vazquez
- Department of Medicine; University of New Mexico; Albuquerque New Mexico USA
| | | | - J. Suarez
- Universidad de la Sabana; Bogota Colombia
| | - J. Mooney
- Department of Medicine; Stanford University School of Medicine; Stanford California USA
| | - J.G. Montoya
- Department of Medicine; Stanford University School of Medicine; Stanford California USA
| | - G.S. Dhillon
- Department of Medicine; Stanford University School of Medicine; Stanford California USA
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Shah S, Murthy S, Karanth S, Bershad EM, Venkatasubba Rao CP, Suarez J. Abstract W P61: Treatment of Ischemic Stroke With recombinant Tissue Plasminogen-Activator in Pregnancy: A Population Study. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.wp61] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Stroke during pregnancy is a rare but potentially devastating event. Reported experience with thrombolysis in pregnant patients is limited. Our aim is to study outcomes of thrombolysis in stroke associated with pregnancy by using Nationwide Inpatient Sample (NIS).
Methods:
Pregnant patients with Acute Ischemic Stroke (AIS) were identified from the 2005-2010 NIS using International Classification of Diseases, Ninth Revision (ICD-9) codes. Pregnant patients who received thrombolysis were compared with those who did not receive thrombolysis based on demographics, comorbidities, hospital characteristics, and outcomes. The main outcomes were in-hospital mortality, home-discharge and intracerebral hemorrhage (ICH).
Results:
We identified 2603 pregnant patients admitted with a diagnosis of AIS, of whom 56 (2.15%) of received thrombolysis. Pregnant patients with AIS were more likely to be treated with thrombolysis at teaching hospitals compared to non-teaching hospitals (2.78% vs 1.06%, p<0.05). Pregnant patients with AIS also had more severe Elixhauser comorbidity scores (p<0.001). Thrombolysis in pregnant patients was associated with higher in-hospital moratlity rate (26.8% vs 4.6%, p<0.001) and lower home discharge rate (44.6% vs 60.1% , p<0.05) but similar rate of ICH. In the regression model on pregnant patients with AIS, the main independent predictors of in-hospital mortality were thrombolysis (OR: 5.97, CI: 3.01-11.84, p<0.001) and ICH (OR: 2.34, CI: 1.34-4.07, p<0.001).
Conclusions:
Stroke outcomes following thrombolysis appears to be less favorable in pregnant patients. Prospective confirmation of these findings is warranted.
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Mazabob JM, Styron S, Brown G, Jones-Brown M, Suarez J, Bershad E, Venkatasubba Rao C. Abstract T P252: Improving Quality of Care and Outcomes in the Community Through the Inclusive Collaboration Between a Certified Comprehensive Stroke Center and Regional Hospitals. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.tp252] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
and Issues As a certified Comprehensive Stroke Center (CSC) it is our obligation to the community and regional hospitals to improve the quality of care and stroke patient outcomes. The spokes are interdependent components of our CSC program; they seek a shared value in improving the delivery of stroke care in their community. Many areas utilize telemedicine without an inclusive operational model to deliver care. Our approach to advance stroke care was to cultivate relationships between staff, physicians, Emergency Medical System (EMS) personnel and hospital administrators.
Purpose:
Construct a stroke care model, utilizing an inclusive collaborative team that consists of EMS, spoke hospitals, and regional communities.
Methods:
W. Edwards Deming’s and John A Woods’s work served as the framework for our stroke and telemedicine programs. Leaders must function with an attitude of inclusiveness, resulting in no subordinates or superiors within the multidisciplinary team. Breaking down barriers and building a shared vision in the delivery of stroke care and recognizing that each department serves the other results in shared objectives. Utilizing tele-health cloud software enhances clinical collaborations. Elimination of fear creates an environment of no-blame, permitting everyone to work at their highest potential through approachable leadership. Analyzing each step and the resultant effect involves an in-depth evaluation of processes with implementable solutions and training and education.
Results:
Results of this inclusive collaboration included: an 85% increase in administration of tissue plasminogen activator at the spoke hospitals; EMS education of over 2000 personnel; physician-driven quarterly spoke hospital case study reviews; implementation of standardized stroke order sets and algorithms; and four spoke hospitals awarded primary stroke certification and state designation.
Conclusions:
Through an inclusive quality culture and a passionate stroke team, improving regional stroke care is achievable and sustainable. A reliable cloud-based network plays a role, but leadership in collaboration with the regional entities is the strength of the program.
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Murthy S, Karanth S, Shah S, Shastri A, Rao C, Bershad E, Suarez J. Abstract W P51: Clinical Outcomes following Thrombolysis for Acute Ischemic Stroke in Patients with Systemic Malignancy: A Nationwide Case-Control Study. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.wp51] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The safety of thrombolysis for acute stroke in patients with cancer is not well established. Our aim is to study the outcomes following thrombolysis in stroke patients with cancer.
Methods:
Acute ischemic stroke (AIS) patients who received thrombolysis were identified from the 2009 and 2010 Nationwide Inpatient Sample using ICD-9 codes. Patients with cancer associated strokes (CS) and non-cancer strokes (NCS) were compared based on demographics, comorbidities, and outcomes.
Results:
There were 1,135,574 AIS in 2009-2010. Thrombolysis was administered to 807 patients out of 50,437 CS (1.6%), and 31,769 patients out of 1,085,137 non-cancer strokes (2.9%). The prevalence of stroke risk factors such as hypertension (p<0.001) and hyperlipidemia (<0.001) were significantly higher in non-cancer strokes (NCS). CS had a significantly higher percentage of patients in the third and fourth Elixhauser quartiles (p<0.001). Hospitals with > 450 beds were more likely to treat cancer patients with thrombolysis for acute stroke (p=0.011), while the hospital teaching status did not play a significant role. In the univariate analysis, CS was associated with a lower proportion of home discharge in the overall thrombolytic treatment group (OR: 0.57, CI: 0.48-0.68, p<0.001) but mortality was not significant. ICH rates were also comparable in the two groups (6.3% vs 6.4%, p= 0.927). In the regression model, there was no difference in mortality or ICH rates between CS and NCS following thrombolysis. Subgroup analysis of IV thrombolysis only and endovascular treatment also showed no difference in outcomes. Another subgroup analysis showed that compared to liquid cancers, patients with solid had worse home discharge (OR: 0.178, CI: 0.109-0.290, p<0.001), and higher in-hospital mortality (OR: 3.018, CI: 1.37-6.646, p=0.006) following thrombolysis. Metastatic cancers had poorest outcomes.
Conclusions:
Thrombolytic therapy for acute stroke in patients with cancer is not associated with increased risk of ICH or in-hospital mortality. However, careful consideration of the cancer subtype may help delineate the subset of patients with poor response to thrombolytic therapy. Prospective confirmation and attention to long-term outcomes is warranted.
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Affiliation(s)
| | | | - Shreyansh Shah
- Vascular Neurology, National Institutes of Health (NIH), Bethesda, MD
| | - Aditi Shastri
- Hematology and Oncology, Montefiore Med Cntr, Bronx, NY
| | - Chethan Rao
- Neurocritical Care, Baylor College of Medicine, Houston, TX
| | - Eric Bershad
- Neurocritical Care, Baylor College of Medicine, Houston, TX
| | - Jose Suarez
- Neurocritical Care, Baylor College of Medicine, Houston, TX
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Sutamtewagul G, Dumrongmoncolgul N, Kijsirichareanchai K, Gadwala S, Arvandi A, Suarez J, Meyerrose G. Effect of Alcohol Intake in Patients with Hypertension Currently on Medication Treatment. Alcoholism Treatment Quarterly 2014. [DOI: 10.1080/07347324.2013.833785] [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]
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Ferrer F, Guedea F, Pardo Y, Ferrer M, Suarez J, Hervás A, Mariño A, Herruzo I, Ortiz M, Sancho G. Quality of Life Impact of Treatments for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.982] [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]
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Puig L, de la Cueva P, Linares M, Suarez J, Velasco M, Vidal D, Zulaica A, García-Calvo C. Expert report on psoriasis: Spanish dermatologists' opinions on the use of biologic agents to manage moderate to severe psoriasis in adults. Actas Dermosifiliogr 2013; 104:400-8. [PMID: 23669590 DOI: 10.1016/j.adengl.2013.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/31/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although national guidelines on biologic agents for treating moderate to severe psoriasis in adults have been published in several countries, increased knowledge on the practical aspects of their implementation is required. OBJECTIVE The objective of this study was to survey Spanish dermatologists to determine their expert opinions on practical aspects of psoriasis treatment with biologics. MATERIALS AND METHODS An online survey was sent to 309 dermatologists who belong to the Spanish Psoriasis Group and/or the Spanish Academy of Dermatology and Venereology (AEDV). The questionnaire was designed specifically for the study and included items on various aspects of the treatment of psoriasis in clinical practice. Six coordinators in different geographic areas worked together to write the final expert report. RESULTS The response rate was 97% (300 returned questionnaires). The biologics preferred, or considered to be the best option (median score 4 out of 4 points) by respondents, were infliximab for its short-term efficacy (74% of the respondents) and rapid onset of action (78%); ustekinumab for convenience of administration (73%); and etanercept because of its suitability for cyclic treatment (71%), safety in long-term use (72%), and the possibility of temporary interruption of treatment under certain circumstances (76%). Etanercept was assigned the highest evaluations for safety and expected survival time (scored 5 on each item by 49% and 33% of the respondents, respectively). Thirty percent of the respondents considered that clinical guidelines contain important information for therapeutic management of psoriasis. CONCLUSIONS This study provides a unique perspective on the opinions of a large sample of dermatologists as regards current treatment of psoriasis with biologics in Spain.
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Affiliation(s)
- L Puig
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Alegre R, Moscoso J, Martinez-Laso J, Martin-Villa M, Suarez J, AlmudenaMoreno, Serrano-Vela JI, Vargas-Alarcon G, Pacheco R, Arnaiz-Villena A. Corrigendum to “HLA genes in Cubans and the detection of Amerindian alleles” [Mol. Immunol. 44 (March (7)) (2007) 2426–2435]. Mol Immunol 2013. [DOI: 10.1016/j.molimm.2012.10.040] [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: 10/27/2022]
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Murthy SB, Shah S, Hannawi Y, Georgiadis A, Smirnakis S, Bershad E, Suarez J, Venkatasubba Rao C. Abstract TP427: Comparison of Clinical Characteristics of Neurogenic Stunned Myocardium in Patients with Subarachnoid Hemorrhage and Acute Ischemic Stroke. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp427] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim:
Neurogenic stunned myocardium (NSM) after subarachnoid hemorrhage (SAH) is well known, but there is paucity of data regarding its occurrence following acute ischemic stroke. The aim of this study is to contrast the characteristics of NSM in SAH and acute stroke.
Methods:
An electronic literature search was performed with Medline and Google Scholar, for English-language articles using the terms “subarachnoid hemorrhage” along with “stunned myocardium” or “Takotsubo cardiomyopathy”. The search revealed 35 articles, from which 10 studies were selected based on the following criteria: prospective studies, non-traumatic SAH, N >25 patients and documentation of regional wall motion abnormalities (RWMA). For studies from the same institutional database, the one with most comprehensive documentation of cardiac parameters was selected. Another search was conducted using the terms “acute ischemic stroke” along with “stunned myocardium” or “Takotsubo cardiomyopathy” resulted in only 7 case reports/series.
Results:
In this descriptive study, 98 out of 504 SAH patients had NSM, evidenced by RWMA (23%). The mean age was 54.8 years and 68% of patients were females, mean Hunt Hess grade was 2.5 and mean LVEF was 55.8%. The mean troponin level was 1.24. The most commonly involved segments were mid-ventricular, basal and apical, in that order. A significant improvement in LVEF occurred in 70.4% of patients. Among stroke patients, the mean age for NSM was 72.5 years and 77% were females. Insular cortex was involved in 46% of cases. Mean troponin elevation was 0.64 and mean LVEF was 34.4%. Regarding outcomes, 84.6% of patients had significant improvement in LVEF, with full recovery in 53.8%.
Conclusion:
NSM was more common in females, with favorable prognosis. Mid-ventricular segment was most commonly involved in SAH. The mean troponin was twice higher in SAH, raising the possibility that sympathetic overdrive is stronger in these patients. Only half the patients with NSM following stroke had insular involvement, implying other structures may be involved in the neuro-cardiac axis. Lack of prospective studies in stroke patients, and reports only describing Takotsubo cardiomyopathy, which selectively involves apical segments, are limiting factors.
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Blanco A, Trujillo H, Hernández D, García D, Lobaina Y, Freyre F, Merino N, Suarez J. The Adoptive Transfer of HBsAG-specific Splenocytes from Balb/c Congenic Donors into HBsAg Transgenic Mice is not associated to Histographological Damage. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1074] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Suarez J, Huarte-Larrañaga F. Hydrogen confined in single-wall carbon nanotubes: Anisotropy effects on ro-vibrational quantum levels. J Chem Phys 2012; 137:064320. [DOI: 10.1063/1.4742129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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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Chmayssani M, Murthy S, Ghosh S, Bershad E, Suarez J. Stroke Associated with Severe Cerebral Vasospasm after Petroclival Meningioma Resection (P05.263). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.263] [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: 11/15/2022] Open
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Fong A, Bershad E, Morsi H, Shaltoni H, Mawad M, Georgiadis A, Suarez J, Venkatasubba Rao C. Hyperacute Stenting for Acute Ischemic Stroke Is Associated with a High Rate of Symptomatic Intracranial Hemorrhage (P02.200). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.200] [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: 11/15/2022] Open
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Hannawi Y, Bershad E, Suarez J, Shaltoni H, Yoshor D, Venkatasubba Rao C. Post Surgical Cerebral Venous Sinus Thrombosis: A Rare Surgical Complication and Challenging Management Case (P06.260). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.260] [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: 11/15/2022] Open
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Mazabob JM, Brown G, Livesay S, Suarez J, Bershad E, Nguyen T. Abstract 159: Acute Ischemic Stroke Quality Indicators: Implementation of Evidence-Based Practice to Improve Compliance. Circ Cardiovasc Qual Outcomes 2012. [DOI: 10.1161/circoutcomes.5.suppl_1.a159] [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: 11/16/2022]
Abstract
Background and Purpose:
Stroke is the leading cause of adult disability in the United States. Compliance with the stroke quality indicators reinforces that a stroke center is adhering to the evidence based standards of care in acute stroke patients. Hardwiring a process in the delivery of care during hospitalization will ensure improved compliance of these quality indicators.
Methods:
A core multidisciplinary team was formed that included neurointensivists, neurologist, neurointerventional radiologist, pharmacist, emergency room and neuro intensive care staff along with neuroscience administration staff. Directors of the various services impacted by the stroke patients were invited on an ad hoc basis. Retrospective chart reviews were performed to collect data on a monthly basis for the following quality indicators: DVT prophylaxis Discharged on antithrombotics Patients with a-fib receiving anticoagulation Thrombolytic therapy administration Antithrombotic by end of day 2 Discharged on cholesterol meds Dysphagia screening Stroke education Smoking cessation education Assessed for Rehab Overall compliance with these indicators was on target but areas for improvement were noted in the following areas: stroke education, discharged on statin, thrombolytic therapy administration and patients with a-fib receiving anticoagulation. Aggressive action plans for each of these areas were developed and implemented. Initiatives included standardized electronic order sets, electronic admission, consult, history and physical templates with the quality indicators listed. Presentation of compliance results with a review of outliers were part of monthly section meetings. In order to understand process deviations further discussions with section chiefs resulted in investigation and resolution of issues that led to the variances. Hiring of a research registered nurse and a stroke coordinator were added to the existing stroke service team.
Results:
Dramatic improvement was achieved with no indicator falling below <85.2% (85.2 out 100) for an entire year. Gold Plus achievement level with the American Stroke Association was achieved within a three year period. Target Stroke Honor Role was also achieved during this time period.
Conclusions:
A cohesive project team was able to identify barriers, recommend process changes and ensure the implementation of change within the institution. Data collection and process revision is ongoing
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Díaz-Arteaga A, Vázquez MJ, Vazquez-Martínez R, Pulido MR, Suarez J, Velásquez DA, López M, Ross RA, de Fonseca FR, Bermudez-Silva FJ, Malagón MM, Diéguez C, Nogueiras R. The atypical cannabinoid O-1602 stimulates food intake and adiposity in rats. Diabetes Obes Metab 2012; 14:234-43. [PMID: 21981246 DOI: 10.1111/j.1463-1326.2011.01515.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS Cannabinoids are known to control energy homeostasis. Atypical cannabinoids produce pharmacological effects via unidentified targets. We sought to investigate whether the atypical cannabinoid O-1602 controls food intake and body weight. METHODS The rats were injected acutely or subchronically with O-1602, and the expression of several factors involved in adipocyte metabolism was assessed by real-time polymerase chain reaction. In vivo findings were corroborated with in vitro studies incubating 3T3-L1 adipocytes with O-1602, and measuring intracellular calcium and lipid accumulation. Finally, as some reports suggest that O-1602 is an agonist of the putative cannabinoid receptor GPR55, we tested it in mice lacking GPR55. RESULTS Central and peripheral administration of O-1602 acutely stimulates food intake, and chronically increases adiposity. The hyperphagic action of O-1602 is mediated by the downregulation of mRNA and protein levels of the anorexigenic neuropeptide cocaine- and amphetamine-regulated transcript. The effects on fat mass are independent of food intake, and involve a decrease in the expression of lipolytic enzymes such as hormone sensitive lipase and adipose triglyceride lipase in white adipose tissue. Consistently, in vitro data showed that O-1602 increased the levels of intracellular calcium and lipid accumulation in adipocytes. Finally, we injected O-1602 in GPR55 -/- mice and found that O-1602 was able to induce feeding behaviour in GPR55-deficient mice. CONCLUSIONS These findings show that O-1602 modulates food intake and adiposity independently of GPR55 receptor. Thus atypical cannabinoids may represent a novel class of molecules involved in energy balance.
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Affiliation(s)
- A Díaz-Arteaga
- Department of Physiology, School of Medicine, University of Santiago de Compostela-Instituto de Investigación Sanitaria, S Francisco s/n, Santiago de Compostela (A Coruña), Spain
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