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Martinez-Recio S, Barba A, Farré N, Majem M. Oligometastatic disease: a need for consensus to cure the incurable in a multidisciplinary approach. Chin Clin Oncol 2024; 13:28. [PMID: 38199796 DOI: 10.21037/cco-23-118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Sergio Martinez-Recio
- Department of Medical Oncology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Andres Barba
- Department of Medical Oncology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Nuria Farré
- Department of Radiation Oncology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Margarita Majem
- Department of Medical Oncology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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Manito N, Cepeda‐Rodrigo JM, Farré N, Castillo Orive M, Galve E, Jiménez‐Candil J, García‐Pinilla JM, López Sánchez ES, Rafols C, Gómez Doblas JJ. Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban. Clin Cardiol 2024; 47:e24189. [PMID: 38018889 PMCID: PMC10823448 DOI: 10.1002/clc.24189] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and heart failure (HF) have a high risk of thromboembolism and other outcomes and anticoagulation is recommended. HYPOTHESIS This study was aimed to explore the risk factors associated with HF worsening in patients with AF and HF taking rivaroxaban in Spain. METHODS Multicenter, prospective, observational study that included adults with AF and chronic HF, receiving rivaroxaban ≥4 months before entering. HF worsening was defined as first hospitalization or emergency visit because of HF exacerbation. RESULTS A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, mean age was 73.7 ± 10.9 years, 64.9% were male, CHA2 DS2 -VASc was 4.1 ± 1.5, HAS-BLED was 1.6 ± 0.9% and 51.3% had HF with preserved ejection fraction. After 24 months of follow-up, 24.9% of patients developed HF worsening, 11.6% died, 2.9% had a thromboembolic event, 3.1% a major bleeding, 0.5% an intracranial bleeding and no patient had a fatal hemorrhage. Older age, the history of chronic obstructive pulmonary disease, the previous use of vitamin K antagonists, and restrictive or infiltrative cardiomyopathies, were independently associated with HF worsening. Only 6.9% of patients permanently discontinued rivaroxaban treatment. CONCLUSIONS Approximately one out of four patients with HF and AF treated with rivaroxaban developed a HF worsening episode after 2 years of follow-up. The identification of those factors that increase the risk of HF worsening could be helpful in the comprehensive management of this population.
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Affiliation(s)
- Nicolás Manito
- Cardiology DepartmentHospital Universitario de BellvitgeBarcelonaSpain
| | | | - Nuria Farré
- Cardiology DepartmentHospital del MarBarcelonaSpain
| | | | | | - Javier Jiménez‐Candil
- Cardiology DepartmentIBSAL‐Hospital Universitario de Salamanca, Universidad de Salamanca, CIBER‐CVSalamancaSpain
| | - José M. García‐Pinilla
- Cardiology DepartmentHospital Universitario Virgen de la VictoriaMálagaSpain
- Instituto de Investigación Biomédica de Málaga‐Plataforma BIONANDMálagaSpain
- Ciber‐CardiovascularInstituto de Salud Carlos IIIMadridSpain
- Department of Medicine and DermatologyUniversidad de MálagaMálagaSpain
| | | | | | - Juan José Gómez Doblas
- Cardiology DepartmentHospital Universitario Virgen de la VictoriaMálagaSpain
- Instituto de Investigación Biomédica de Málaga‐Plataforma BIONANDMálagaSpain
- Ciber‐CardiovascularInstituto de Salud Carlos IIIMadridSpain
- Department of Medicine and DermatologyUniversidad de MálagaMálagaSpain
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Escobar C, Luis-Bonilla J, Crespo-Leiro MG, Esteban-Fernández A, Farré N, Garcia A, Nuñez J. Individualizing the treatment of patients with heart failure with reduced ejection fraction: a journey from hospitalization to long-term outpatient care. Expert Opin Pharmacother 2022; 23:1589-1599. [PMID: 35995759 DOI: 10.1080/14656566.2022.2116275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Despite the relevant advances achieved thanks to the traditional step-by-step therapeutic approach, heart failure with reduced ejection fraction (HFrEF) remains associated with considerable morbidity and mortality. The pathogenesis of HFrEF is complex, with the implication of various neurohormonal systems, including activation of deleterious pathways (i.e. renin-angiotensin-aldosterone, sympathetic, and sodium-glucose cotransporter-2 [SGLT2] systems) and the inhibition of protective pathways (i.e. natriuretic peptides and the guanylate cyclase system). Therefore, the burden of HF can only be reduced through a comprehensive approach that involves all evidence-based use of available HF drugs targeting the neurohormonal systems involved. AREAS COVERED : We performed a critical analysis of evidence from recent clinical trials and assessed the effects of HF therapies on hemodynamics and renal function. EXPERT OPINION : HF therapy must be adapted to the clinical profile (i.e. congestion, blood pressure, heart rate, renal function, and electrolytes). Consequently, blood pressure is reduced by beta blockers, renin-angiotensin-aldosterone system inhibitors, sacubitril/valsartan, and, minimally, by SGLT2 inhibitors and vericiguat; heart rate decreases with beta blockers and ivabradine; and renal function is impaired and potassium are levels increased with renin-angiotensin-aldosterone system inhibitors and sacubitril/valsartan. Practical recommendations on how to individualize HF therapy according to patient profile are provided.
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Affiliation(s)
- Carlos Escobar
- Cardiology Service, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | - Ana Garcia
- Hospital Clinic I Provincial De Barcelona, Barcelona, Spain
| | - Julio Nuñez
- Hospital Clinico de Valencia, Valencia, Spain
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4
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Cabrera-Aguilera I, Ivern C, Badosa N, Marco E, Duran X, Mojón D, Vicente M, Llagostera M, Farré N, Ruíz-Bustillo S. Prognostic Utility of a New Risk Stratification Protocol for Secondary Prevention in Patients Attending Cardiac Rehabilitation. J Clin Med 2022; 11:jcm11071910. [PMID: 35407518 PMCID: PMC8999920 DOI: 10.3390/jcm11071910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 02/01/2023] Open
Abstract
Several risk scores have been used to predict risk after an acute coronary syndrome (ACS), but none of these risk scores include functional class. The aim was to assess the predictive value of risk stratification (RS), including functional class, and how cardiac rehabilitation (CR) changed RS. Two hundred and thirty-eight patients with ACS from an ambispective observational registry were stratified as low (L) and no-low (NL) risk and classified according to exercise compliance; low risk and exercise (L-E), low risk and control (no exercise) (L-C), no-low risk and exercise (NL-E), and no-low risk and control (NL-C). The primary endpoint was cardiac rehospitalization. Multivariable analysis was performed to identify variables independently associated with the primary endpoint. The L group included 56.7% of patients. The primary endpoint was higher in the NL group (18.4% vs. 4.4%, p < 0.001). After adjustment for age, sex, diabetes, and exercise in multivariable analysis, HR (95% CI) was 3.83 (1.51−9.68) for cardiac rehospitalization. For RS and exercise, the prognosis varied: the L-E group had a cardiac rehospitalization rate of 2.5% compared to 26.1% in the NL-C group (p < 0.001). Completing exercise training was associated with reclassification to low-risk, associated with a better outcome. This easy-to-calculate risk score offers robust prognostic information. No-exercise groups were independently associated with the worst outcomes. Exercise-based CR program changed RS, improving classification and prognosis.
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Affiliation(s)
- Ignacio Cabrera-Aguilera
- Unit of Biophysics and Bioengineering, Faculty of Medicine and Health Sciences, Universitat de Barcelona, 08036 Barcelona, Spain;
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (C.I.); (N.B.); (S.R.-B.)
- Department of Human Movement Sciences, School of Kinesiology, Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile
| | - Consolació Ivern
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (C.I.); (N.B.); (S.R.-B.)
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
| | - Neus Badosa
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (C.I.); (N.B.); (S.R.-B.)
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
| | - Ester Marco
- Cardiac Rehabilitation Unit, Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar—Hospital de l’Esperança), 08003 Barcelona, Spain;
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
| | - Xavier Duran
- Methodological and Biostatistical Advisory Service, IMIM (Institut Hospital del Mar d’Investigacions Mèdiques), 08003 Barcelona, Spain;
| | - Diana Mojón
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
| | - Miren Vicente
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
| | - Marc Llagostera
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
| | - Nuria Farré
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (C.I.); (N.B.); (S.R.-B.)
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
- Correspondence:
| | - Sonia Ruíz-Bustillo
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (C.I.); (N.B.); (S.R.-B.)
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.V.); (M.L.)
- Department of Medicine, Universitat Pompeu Fabra, 08003 Barcelona, Spain
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Blázquez‐Bermejo Z, Farré N, Caravaca Perez P, Llagostera M, Morán‐Fernández L, Fort A, de Juan Bagudá J, García‐Cosio MD, Ruiz‐Bustillo S, Delgado JF. Dose of furosemide before admission predicts diuretic efficiency and long-term prognosis in acute heart failure. ESC Heart Fail 2022; 9:656-666. [PMID: 34766460 PMCID: PMC8788037 DOI: 10.1002/ehf2.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/21/2021] [Accepted: 10/29/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS The outpatient diuretic dose is a marker of diuretic resistance and prognosis in chronic heart failure (HF). Still, the impact of the preadmission dose on diuretic efficiency (DE) and prognosis in acute HF is not fully known. METHODS AND RESULTS We conducted an observational and prospective study. All patients admitted for acute HF treated with intravenous diuretic and at least one criterion of congestion on admission were evaluated. Decongestion [physical examination, hemoconcentration, N-terminal pro-brain natriuretic peptide (NT-proBNP) change, and lung ultrasound], DE (weight loss and urine output per unit of 40 mg furosemide), and urinary sodium were monitored on the fifth day of admission. DE was dichotomized into high-low based on the median value. A multivariate Cox regression analysis was conducted to find predictors of HF readmission or mortality. A total of 105 patients were included between July 2017 and July 2019. Mean age was 74.5 ± 12.0 years, 64.8% were male, 33.3% had de novo HF, and mean left ventricular ejection fraction was 46 ± 17%. Median follow-up was 26 [15-35] months. Low DE based on weight loss was associated with a higher previous dose of furosemide (odds ratio [OR] 1.01 [1.00-1.02]), thiazide treatment before admission (OR 9.37 [2.19-40.14]), and lower diastolic blood pressure (OR 0.95 [0.91-0.98]) in the multivariate regression model. Only previous dose of furosemide (OR 1.01 [1.00-1.02]) and haemoglobin at admission (OR 0.76 [0.58-0.99]) were associated with low DE based on urine output in the multivariate analysis. The correlation between the previous dose of furosemide and DE based on weight loss was poor (r = -0.12; P = 0.209) and with DE based on urine output was weak to moderate (r = -0.33; P < 0.001). Low DE based on weight loss and urine output was associated with lesser decongestion measured by NT-proBNP (P = 0.011; P = 0.007), hemoconcentration (P = 0.006; P = 0.044), and lung ultrasound (P = 0.034; P = 0.029), but not by physical examination (P = 0.506; P = 0.560). Survival and event-free survival in acute decompensated HF (ADHF) were lower than in de novo HF; a preadmission dose of furosemide > 80 mg in ADHF identified patients with particularly poor prognosis (log-rank < 0.001). In ADHF, the preadmission dose of furosemide (hazard ratio [HR] 1.34 [1.08-1.67] per 40 mg) and NT-proBNP at admission (HR 1.03 [1.01-1.06] per 1000 pg/mL) were independently associated with mortality or HF readmission in the multivariate Cox regression analysis. CONCLUSIONS The outpatient dose of furosemide before acute HF admission predicts DE and must be taken into account when deciding on the initial diuretic dose. In ADHF, the outpatient dose of furosemide can predict long-term prognosis better than DE during hospitalization.
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Affiliation(s)
- Zorba Blázquez‐Bermejo
- Cardiology DepartmentHospital del MarBarcelonaSpain
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
| | - Nuria Farré
- Cardiology DepartmentHospital del MarBarcelonaSpain
- Biomedical Research Group on Heart Disease (GREC)Hospital del Mar Medical Research Group (IMIM)BarcelonaSpain
- Department of MedicineUniversidad Autónoma de BarcelonaBarcelonaSpain
| | - Pedro Caravaca Perez
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
| | | | - Laura Morán‐Fernández
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
| | - Aleix Fort
- Cardiology DepartmentHospital del MarBarcelonaSpain
| | - Javier de Juan Bagudá
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
| | - María Dolores García‐Cosio
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
| | - Sonia Ruiz‐Bustillo
- Cardiology DepartmentHospital del MarBarcelonaSpain
- Biomedical Research Group on Heart Disease (GREC)Hospital del Mar Medical Research Group (IMIM)BarcelonaSpain
- Department of MedicineUniversitat Pompeu FabraBarcelonaSpain
| | - Juan F. Delgado
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
- Faculty of MedicineUniversidad Complutense de MadridMadridSpain
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Cabrera-Aguilera I, Ivern C, Badosa N, Marco E, Salas-Medina L, Mojón D, Vicente M, Llagostera M, Farré N, Ruiz-Bustillo S. Impact of and Reasons for Not Performing Exercise Training After an Acute Coronary Syndrome in the Setting of an Interdisciplinary Cardiac Rehabilitation Program: Results From a Risk-Op- Acute Coronary Syndrome Ambispective Registry. Front Physiol 2021; 12:768199. [PMID: 34899392 PMCID: PMC8654103 DOI: 10.3389/fphys.2021.768199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/31/2021] [Indexed: 12/24/2022] Open
Abstract
Background and Aims: Exercise training (ET) is a critical component of cardiac rehabilitation (CR), but it remains underused. The aim of this study was to compare clinical outcomes between patients who completed ET (A-T), those who accepted ET but did not complete it (A-NT), and those who did not accept to undergo it (R-NT), and to analyze reasons for rejecting or not completing ET. Methods and Results: A unicenter ambispective observational registry study of 497 patients with acute coronary syndrome (ACS) was carried out in Barcelona, Spain, from 2016 to 2019. The primary endpoint was a composite of all-cause mortality, hospitalization for ACS, or need for revascularization during follow-up. Multivariable analysis was carried out to identify variables independently associated with the primary outcome. Initially, 70% of patients accepted participating in the ET, but only 50.5% completed it. The A-T group were younger and had fewer comorbidities. Baseline characteristics in A-NT and R-NT groups were very similar. The main reason for not undergoing or completing ET was rejection (reason unknown) or work/schedule incompatibility. The median follow-up period was 31 months. Both the composite primary endpoint and mortality were significantly lower in the A-T group compared to the A-NT and R-NT (primary endpoint: 3.6% vs. 23.2% vs. 20.4%, p < 0.001, respectively; mortality: 0.8% vs. 9.1% vs. 8.2%, p < 0.001; respectively). During multivariable analysis, the only variables that remained statistically significant with the composite endpoint were ET completion, previous ACS, and anemia. Conclusion: Completion of ET after ACS was associated with improved prognosis. Only half of the patients completed the ET program, with the leading reasons for not completing it being refusal (reason unknown) and work/schedule incompatibility. These results highlight the need to focus on the needs of patients in order to guarantee that structural barriers to ET no longer exist.
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Affiliation(s)
- Ignacio Cabrera-Aguilera
- Facultat de Medicina i Ciències de la Salut, Unitat de Biofísica i Bioenginyeria, Universitat de Barcelona, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Human Movement Sciences, Faculty of Health Sciences, School of Kinesiology, Universidad de Talca, Talca, Chile
| | - Consolació Ivern
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Neus Badosa
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Ester Marco
- Cardiac Rehabilitation Unit, Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Spain.,Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luís Salas-Medina
- Cardiac Rehabilitation Unit, Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Spain
| | - Diana Mojón
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Miren Vicente
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Marc Llagostera
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Nuria Farré
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Ruiz-Bustillo
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
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7
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León X, García J, Farré N, Majercakova K, Avilés-Jurado FX, Quer M, Camacho M. Predictive capacity of IL-8 expression in head and neck squamous carcinoma patients treated with radiotherapy or chemoradiotherapy. Acta Otorrinolaringol Esp (Engl Ed) 2021; 72:337-343. [PMID: 34844671 DOI: 10.1016/j.otoeng.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the relationship between the transcriptional expression of interleukin-8 (IL-8) and response to treatment with radiotherapy or chemo-radiotherapy in patients with squamous cell carcinoma of the head and neck (SCCHN). MATERIAL AND METHODS Retrospective study from tumour biopsies obtained before a treatment with radiotherapy or chemo-radiotherapy in 87 patients with SCCHN. We had a sample of healthy mucosa in 35 cases. We determined the transcriptional expression of IL-8 with RT-PCR. The transcriptional expression of IL-8 was categorized according to the local control of the disease with a recursive partitioning analysis. RESULTS The transcriptional expression of IL-8 in tumour tissue was about 50 times higher than that in the samples of healthy mucosa. Patients with a high transcriptional expression of IL-8 (n = 56) had a 5-year local recurrence-free survival of 65.6%, and for patients with low expression (n = 31) it was 90.2% (P = 0.017). According to the results of a multivariate analysis, patients with high expression of IL-8 had a 4.1 higher risk of local recurrence of the tumour. CONCLUSIONS SCCHN have a significant increase in transcriptional expression of IL-8 in relation to non-tumour tissue. Tumours with high IL-8 expression have an increased risk of local recurrence after treatment with radiotherapy or chemo-radiotherapy.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Farré
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Katarina Majercakova
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc-Xavier Avilés-Jurado
- Servicio de Otorrinolaringología, Hospital Clínic, IDIBAPS Universitat de Barcelona, Barcelona, Spain; Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR), Generalitat de Catalunya. 2017-SGR-01581, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Mercedes Camacho
- Genomics of Complex Diseases, Research Institute Hospital Sant Pau, IIB Sant Pau, Barcelona, Spain
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Calvo-Fernández A, Izquierdo A, Subirana I, Farré N, Vila J, Durán X, García-Guimaraes M, Valdivielso S, Cabero P, Soler C, García-Ribas C, Rodríguez C, Llagostera M, Mojón D, Vicente M, Solé-González E, Sánchez-Carpintero A, Tevar C, Marrugat J, Vaquerizo B. Markers of myocardial injury in the prediction of short-term COVID-19 prognosis. Rev Esp Cardiol (Engl Ed) 2021; 74:576-583. [PMID: 33153955 PMCID: PMC7522647 DOI: 10.1016/j.rec.2020.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES COVID-19 is currently causing high mortality and morbidity worldwide. Information on cardiac injury is scarce. We aimed to evaluate cardiovascular damage in patients with COVID-19 and determine the correlation of high-sensitivity cardiac-specific troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) with the severity of COVID-19. METHODS We included 872 consecutive patients with confirmed COVID-19 from February to April 2020. We tested 651 patients for high-sensitivity troponin T (hs-TnT) and 506 for NT-proBNP on admission. Cardiac injury was defined as hs-TnT> 14ng/L, the upper 99th percentile. Levels of NT-proBNP> 300 pg/mL were considered related to some extent of cardiac injury. The primary composite endpoint was 30-day mortality or mechanical ventilation (MV). RESULTS Cardiac injury by hs-TnT was observed in 34.6% of our COVID-19 patients. Mortality or MV were higher in cardiac injury than noncardiac injury patients (39.1% vs 9.1%). Hs-TnT and NT-proBNP levels were independent predictors of death or MV (HR, 2.18; 95%CI, 1.23-3.83 and 1.87 (95%CI, 1.05-3.36), respectively) and of mortality alone (HR, 2.91; 95%CI, 1.211-7.04 and 5.47; 95%CI, 2.10-14.26, respectively). NT-ProBNP significantly improved the troponin model discrimination of mortality or MV (C-index 0.83 to 0.84), and of mortality alone (C-index 0.85 to 0.87). CONCLUSIONS Myocardial injury measured at admission was a common finding in patients with COVID-19. It reliably predicted the occurrence of mortality and need of MV, the most severe complications of the disease. NT-proBNP improved the prognostic accuracy of hs-TnT.
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Affiliation(s)
- Alicia Calvo-Fernández
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Andrea Izquierdo
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Isaac Subirana
- Centro de Investigaciones Biomédicas en Red Epidemiología y Salud Pública (CIBERESP), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain
| | - Nuria Farré
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Joan Vila
- Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Xavier Durán
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain
| | - Marcos García-Guimaraes
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | | | - Paula Cabero
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Cristina Soler
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | | | | | | | - Diana Mojón
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Miren Vicente
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | | | - Andrea Sánchez-Carpintero
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain
| | - Cristina Tevar
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Jaume Marrugat
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigaciones Biomédicas en Red Epidemiología y Salud Pública (CIBERESP), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain.
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9
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Calvo-Fernández A, Izquierdo A, Subirana I, Farré N, Vila J, Durán X, García-Guimaraes M, Valdivielso S, Cabero P, Soler C, García-Ribas C, Rodríguez C, Llagostera M, Mojón D, Vicente M, Solé-González E, Sánchez-Carpintero A, Tevar C, Marrugat J, Vaquerizo B. [Markers of myocardial injury in the prediction of short-term COVID-19 prognosis]. Rev Esp Cardiol 2021; 74:576-583. [PMID: 33262553 PMCID: PMC7691144 DOI: 10.1016/j.recesp.2020.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES COVID-19 is currently causing high mortality and morbidity worldwide. Information on cardiac injury is scarce. We aimed to evaluate cardiovascular damage in patients with COVID-19 and determine the correlation of high-sensitivity cardiac-specific troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) with the severity of COVID-19. METHODS We included 872 consecutive patients with confirmed COVID-19 from February to April 2020. We tested 651 patients for high-sensitivity troponin T (hs-TnT) and 506 for NT-proBNP on admission. Cardiac injury was defined as hs-TnT > 14 ng/L, the upper 99th percentile. Levels of NT-proBNP > 300 pg/mL were considered related to some extent of cardiac injury. The primary composite endpoint was 30-day mortality or mechanical ventilation (MV). RESULTS Cardiac injury by hs-TnT was observed in 34.6% of our COVID-19 patients. Mortality or MV were higher in cardiac injury than noncardiac injury patients (39.1% vs 9.1%). Hs-TnT and NT-proBNP levels were independent predictors of death or MV (HR, 2.18; 95%CI, 1.23-3.83 and 1.87 (95%CI, 1.05-3.36), respectively) and of mortality alone (HR, 2.91; 95%CI, 1.211-7.04 and 5.47; 95%CI, 2.10-14.26, respectively). NT-ProBNP significantly improved the troponin model discrimination of mortality or MV (C-index 0.83 to 0.84), and of mortality alone (C-index 0.85 to 0.87). CONCLUSIONS Myocardial injury measured at admission was a common finding in patients with COVID-19. It reliably predicted the occurrence of mortality and need of MV, the most severe complications of the disease. NT-proBNP improved the prognostic accuracy of hs-TnT.
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Affiliation(s)
- Alicia Calvo-Fernández
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
| | - Andrea Izquierdo
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
| | - Isaac Subirana
- Centro de Investigaciones Biomédicas en Red Epidemiología y Salud Pública (CIBERESP), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
- Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
| | - Nuria Farré
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
- Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - Joan Vila
- Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - Xavier Durán
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
| | - Marcos García-Guimaraes
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | | | - Paula Cabero
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
- Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - Cristina Soler
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
- Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | | | - Clara Rodríguez
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | - Marc Llagostera
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | - Diana Mojón
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | - Miren Vicente
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | | | - Andrea Sánchez-Carpintero
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
| | - Cristina Tevar
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
| | - Jaume Marrugat
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
- Centro de Investigaciones Biomédicas en Red Epidemiología y Salud Pública (CIBERESP), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
- Epidemiología y Genética Cardiovascular, Grupo REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Barcelona, España
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Hospital del Mar, Barcelona, España
- Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
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10
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Farré N, Almendros I, Otero J, Navajas D, Farré R. Realizing the actual magnitudes of aortic diameter and cardiac output: a multisensory learning approach. Adv Physiol Educ 2021; 45:322-326. [PMID: 33861152 DOI: 10.1152/advan.00003.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
The conventional physiology courses consist of theoretical lectures, clinical application seminars, numerical exercises, simulations, and laboratory practices. However, in subjects that involve relevant physical quantities, even students who successfully pass exams may be unable to realize the actual quantities involved. For example, students may know what the values of the aortic diameter and cardiac output are, and they may be skilled at calculating changes in variables without being able to realize the actual physical magnitudes of the variables, resulting in limited understanding. To address this problem, here we describe and discuss simple practical exercises specifically designed to allow students to multisensory experience (touch, see, hear) the actual physical magnitudes of aortic diameter and cardiac output in adult humans at rest and exercise. The results obtained and the feedback from a student survey both clearly show that the described approach is a simple and interesting tool for motivating students and providing them with more realistic learning.
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Affiliation(s)
- Nuria Farré
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Jorge Otero
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Navajas
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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11
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León X, Montoro V, García J, López M, Farré N, Majercakova K, Gallego Ó, López-Pousa A, Quer M. Organ Preservation in Patients With Advanced Laryngeal Tumours. Results of Induction Chemotherapy Versus Chemoradiotherapy in Actual Clinical Practice. Acta Otorrinolaringologica (English Edition) 2021. [DOI: 10.1016/j.otoeng.2020.02.011] [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: 10/21/2022]
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12
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García-Guimaraes M, Mojón D, Calvo A, Izquierdo A, Belarte-Tornero L, Salvatella N, Llagostera M, Negrete A, Mas-Stachurska A, Ruiz S, Valdivielso S, Ribas N, Marrugat J, Farré N, Vaquerizo B. Influence of cardiovascular disease and cardiovascular risk factors in COVID-19 patients. Data from a large prospective Spanish cohort. REC: CardioClinics 2021. [PMCID: PMC7670893 DOI: 10.1016/j.rccl.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Lozano A, Marruecos J, Rubió J, Farré N, Gómez-Millán J, Morera R, Planas I, Lanzuela M, Vázquez-Masedo MG, Cascallar L, Giralt J, Escames G, Valentí V, Grima P, Bosser R, Tarragó C, Mesía R. Randomized placebo-controlled phase II trial of high-dose melatonin mucoadhesive oral gel for the prevention and treatment of oral mucositis in patients with head and neck cancer undergoing radiation therapy concurrent with systemic treatment. Clin Transl Oncol 2021; 23:1801-1810. [PMID: 33738704 DOI: 10.1007/s12094-021-02586-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/04/2021] [Accepted: 03/06/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE The objective of this trial was to evaluate the safety and efficacy of melatonin oral gel mouthwashes in the prevention and treatment of oral mucositis (OM) in patients treated with concurrent radiation and systemic treatment for head and neck cancer. METHODS Randomized, phase II, double-blind, placebo-controlled trial (1:1 ratio) of 3% melatonin oral gel mouthwashes vs. placebo, during IMRT (total dose ≥ 66 Gy) plus concurrent Q3W cisplatin or cetuximab. Primary endpoint: grade 3-4 OM or Severe Oral Mucositis (SOM) incidence by RTOG, NCI, and a composite RTOG-NCI scales. Secondary endpoints: SOM duration and grade 2-4 OM or Ulcerative Oral Mucositis (UOM) incidence and duration. RESULTS Eighty-four patients were included in the study. Concurrent systemic treatments were cisplatin (n = 54; 64%) or cetuximab (n = 30; 36%). Compared with the placebo arm, RTOG-defined SOM incidence was numerically lower in the 3% melatonin oral gel arm (53 vs. 64%, P = 0.36). In patients treated with cisplatin, assessed by the RTOG-NCI composite scale, both SOM incidence (44 vs. 78%; P = 0.02) and median SOM duration (0 vs. 22 days; P = 0.022) were significantly reduced in the melatonin arm. Median UOM duration assessed by the RTOG-NCI scale was also significantly shorter in the melatonin arm (49 vs. 73 days; P = 0.014). Rate of adverse events and overall response rate were similar between the two arms. CONCLUSIONS Treatment with melatonin oral gel showed a consistent trend to lower incidence and shorter SOM duration and shorter duration of UOM. These results warrant further investigation in phase III clinical trial.
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Affiliation(s)
- A Lozano
- Institut Català d'Oncologia (ICO), Hospital Durán I Reynals, Avda de la Granvia de l'Hospitalet, 199, L'Hospitalet, 08907, Barcelona, Spain.
| | - J Marruecos
- Institut Català d'Oncologia (ICO), Hospital Universitari Dr. Josep Trueta, Avda França s/n, 17007, Girona, Spain
| | - J Rubió
- Institut Català d'Oncologia (ICO), Hospital Universitari Dr. Josep Trueta, Avda França s/n, 17007, Girona, Spain
| | - N Farré
- Hospital de la Santa Creu i Sant Pau, C/Sant Quintí, 89, 08041, Barcelona, Spain
| | - J Gómez-Millán
- Hospital Universitario Virgen de la Victoria, Campus de Teatinos, s/n, 29010, Málaga, Spain
| | - R Morera
- Hospital Universitario la Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - I Planas
- Institut Català d'Oncologia (ICO), Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, Badalona, 08916, Barcelona, Spain
| | - M Lanzuela
- Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain
| | - M G Vázquez-Masedo
- Hospital Clínico San Carlos, C/Profesor Martín Lagos, s/n, 28040, Madrid, Spain
| | - L Cascallar
- Hospital Clínico Universitario de Santiago, CHUS, Rúa da Choupana, s/n, Santiago de Compostela, 15706, A Coruña, Spain
| | - J Giralt
- Hospital Universitari de la Vall d'Hebron, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - G Escames
- Biomedical Research Center, Health Sciences Technology Park, University of Granada, Granada Hospital Complex, 18016, Granada, Spain.,Department of Physiology, University of Granada, CIBERFES, IBS, Granada Hospital Complex, 18016, Granada, Spain
| | - V Valentí
- Hospital de Sant Pau i Santa Tecla, C/ Rambla Vella, 14, 43003, Tarragona, Spain
| | - P Grima
- Ferrer Internacional SA, Avenida Diagonal, 549, 08029, Barcelona, Spain
| | - R Bosser
- Spherium Biomed, S.L.U., C/ Joan XXIII, 10, 08950, Esplugues de Llobregat, Spain
| | - C Tarragó
- Ferrer Internacional SA, Avenida Diagonal, 549, 08029, Barcelona, Spain.,Spherium Biomed, S.L.U., C/ Joan XXIII, 10, 08950, Esplugues de Llobregat, Spain
| | - R Mesía
- Institut Català d'Oncologia (ICO), Hospital Durán I Reynals, Avda de la Granvia de l'Hospitalet, 199, L'Hospitalet, 08907, Barcelona, Spain.,Institut Català d'Oncologia (ICO), Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, Badalona, 08916, Barcelona, Spain
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14
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Khannous-Lleiffe O, Willis JR, Saus E, Cabrera-Aguilera I, Almendros I, Farré R, Gozal D, Farré N, Gabaldón T. A Mouse Model Suggests That Heart Failure and Its Common Comorbidity Sleep Fragmentation Have No Synergistic Impacts on the Gut Microbiome. Microorganisms 2021; 9:microorganisms9030641. [PMID: 33808770 PMCID: PMC8003359 DOI: 10.3390/microorganisms9030641] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Heart failure (HF) is a common condition associated with a high rate of hospitalizations and adverse outcomes. HF is characterized by impairments of either the cardiac ventricular filling, ejection of blood capacity or both. Sleep fragmentation (SF) involves a series of short sleep interruptions that lead to fatigue and contribute to cognitive impairments and dementia. Both conditions are known to be associated with increased inflammation and dysbiosis of the gut microbiota. In the present study, mice were distributed into four groups, and subjected for four weeks to either HF, SF, both HF and SF, or left unperturbed as controls. We used 16S metabarcoding to assess fecal microbiome composition before and after the experiments. Evidence for distinct alterations in several bacterial groups and an overall decrease in alpha diversity emerged in HF and SF treatment groups. Combined HF and SF conditions, however, showed no synergism, and observed changes were not always additive, suggesting preliminarily that some of the individual effects of either HF or SF cancel each other out when applied concomitantly.
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Affiliation(s)
- Olfat Khannous-Lleiffe
- Barcelona Supercomputing Centre (BSC-CNS), 08034 Barcelona, Spain; (O.K.-L.); (J.R.W.); (E.S.)
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, 08028 Barcelona, Spain
| | - Jesse R. Willis
- Barcelona Supercomputing Centre (BSC-CNS), 08034 Barcelona, Spain; (O.K.-L.); (J.R.W.); (E.S.)
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, 08028 Barcelona, Spain
| | - Ester Saus
- Barcelona Supercomputing Centre (BSC-CNS), 08034 Barcelona, Spain; (O.K.-L.); (J.R.W.); (E.S.)
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, 08028 Barcelona, Spain
| | - Ignacio Cabrera-Aguilera
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain; (I.C.-A.); (I.A.); (R.F.)
- Department of Human Movement Sciences, Faculty of Health Sciences, School of Kinesiology, Universidad de Talca, Talca 3460000, Chile
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain; (I.C.-A.); (I.A.); (R.F.)
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain; (I.C.-A.); (I.A.); (R.F.)
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain
| | - David Gozal
- Department of Child Health and Child Health Research Institute, The University of Missouri School of Medicine, Columbia, MO 65212, USA;
| | - Nuria Farré
- Heart Failure Unit, Department of Cardiology, Hospital del Mar (Parc de Salut Mar), 08003 Barcelona, Spain
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Correspondence: (N.F.); (T.G.)
| | - Toni Gabaldón
- Barcelona Supercomputing Centre (BSC-CNS), 08034 Barcelona, Spain; (O.K.-L.); (J.R.W.); (E.S.)
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, 08028 Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010 Barcelona, Spain
- Correspondence: (N.F.); (T.G.)
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Blázquez-Bermejo Z, Farré N, Llagostera M, Caravaca Perez P, Morán-Fernández L, Fort A, De-Juan J, Ruiz S, Delgado JF. The development of chronic diuretic resistance can be predicted during a heart-failure hospitalization. Results from the REDIHF registry. PLoS One 2020; 15:e0240098. [PMID: 33007024 PMCID: PMC7531800 DOI: 10.1371/journal.pone.0240098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Diuretic resistance (DR) is a common condition during a heart failure (HF) hospitalization, and is related to worse prognosis. Although the risk factors for DR during a HF hospitalization are widely described, we do not know whether the risk of chronic DR could be predicted during admission. Material and methods We conducted a multicenter, prospective observational study between July 2017 and July 2019. All patients admitted for acute HF with intravenous diuretic treatment and at least one criterion of congestion on admission were invited to participate. Patients on renal replacement therapy, under intravenous diuretic treatment for >72 hours before screening and those who were unable to sign the informed consent were excluded. We monitored decongestion (physical exam, hemoconcentration, NTproBNP change and lung ultrasound) and DR (diuresis and weight loss per unit of 40mg furosemide and fractional excretion of sodium) on the fifth day of admission. Chronic DR was evaluate two months after hospitalization and was defined as persistent signs of congestion despite ≥80 mg furosemide per day. We compared variables from the hospitalization between patients with and without chronic DR. A multivariate logistic regression analysis was conducted to find predictors of chronic DR. Results A total of 105 patients were included in the study. Mean age was 74.5±12.0 years, 64.8% were male and mean LVEF was 46±17%. In the two months follow-up, five patients have died and one patient has had a heart transplant. Of the 99 remaining patients, 21 patients (21.2%) had chronic DR. The dose of furosemide before admission and the decrease in NT-proBNP ≤30% during admission were predictors of chronic DR in the multivariate analysis. Conclusions We can predict during a HF hospitalization which patients will develop chronic DR. The dose of furosemide before admission and the change in NT-proBNP are independent predictors of chronic DR.
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Affiliation(s)
| | - Nuria Farré
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Biomedical Research Group on Heart Disease (GREC), Hospital del Mar Medical Research Group (IMIM), Barcelona, Spain
- Department of Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Pedro Caravaca Perez
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Laura Morán-Fernández
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Aleix Fort
- Cardiology Department, Hospital del Mar, Barcelona, Spain
| | - Javier De-Juan
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Sonia Ruiz
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Biomedical Research Group on Heart Disease (GREC), Hospital del Mar Medical Research Group (IMIM), Barcelona, Spain
| | - Juan F. Delgado
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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16
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Gonzalez-Costello J, Cainzos-Achirica M, Lupón J, Farré N, Moliner-Borja P, Enjuanes C, de Antonio M, Fuentes L, Díez-López C, Bayés-Genis A, Manito N, Pujol R, Comin-Colet J. Use of intravenous iron in patients with iron deficiency and chronic heart failure: Real-world evidence. Eur J Intern Med 2020; 80:91-98. [PMID: 32439287 DOI: 10.1016/j.ejim.2020.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/11/2020] [Accepted: 04/13/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Treatment with intravenous iron in patients with heart failure (HF) and iron deficiency (ID) improves symptoms, however its impact on survival and safety is unknown. We aimed to evaluate the management of ID and anemia with intravenous iron in patients with HF and long-term safety of intravenous iron. METHODS We evaluated anemia and ID in patients with chronic HF at 3 university hospitals. Anemia was defined using the World Health Organization definition and ID was defined as ferritin <100 ug/L or a Transferrin Saturation <20% if ferritin between 100 and 299 ug/L. We assessed treatment with intravenous iron during follow-up and its association with mortality and HF hospitalizations using multivariate cox regression analysis. RESULTS We included 2,114 patients, median age 72 years and 57% had reduced left ventricular ejection fraction. ID was present in 55% and ID and anemia in 29%. Treatment with intravenous iron was used in 24% of patients with ID and 34% of patients with ID and anemia. In patients with ID, after multivariate adjustment, treatment with intravenous iron was associated with lower all-cause mortality: HR = 0.38 (0.28-0.56), lower cardiovascular mortality: HR = 0.34 (0.20-0.57) and no differences in HF hospitalizations: HR = 1.15 (0.88-1.50). Similar outcomes were found for patients with anemia and ID. CONCLUSIONS In a real-world cohort of patients with HF, treatment with intravenous iron was used in one third of patients with ID and anemia and appears safe in mid-term follow-up.
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Affiliation(s)
- José Gonzalez-Costello
- Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Community Heart Failure Program, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles, Barcelona, Spain
| | - Josep Lupón
- Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Farré
- Heart Diseases Biomedical Research Group Program of Research in Inflammatory and Cardiovascular Disorders, Hospital del Mar Biomedical Research Institute (IMIM), Barcelona, Spain; Heart Failure Program, Department of Cardiology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Pedro Moliner-Borja
- Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Enjuanes
- Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Community Heart Failure Program, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta de Antonio
- Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Lara Fuentes
- Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Díez-López
- Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayés-Genis
- Heart Failure Unit and Cardiology Department. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Manito
- Advanced heart failure and transplant Unit, Department of Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón Pujol
- Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Community Heart Failure Program, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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León X, García J, Farré N, Majercakova K, Avilés-Jurado FX, Quer M, Camacho M. Predictive capacity of IL-8 expression in head and neck squamous carcinoma patients treated with radiotherapy or chemoradiotherapy. Acta Otorrinolaringol Esp (Engl Ed) 2020; 72:S0001-6519(20)30146-1. [PMID: 32972719 DOI: 10.1016/j.otorri.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyse the relationship between the transcriptional expression of interleukin-8 (IL-8) and response to treatment with radiotherapy or chemo-radiotherapy in patients with squamous cell carcinoma of the head and neck (SCCHN). MATERIAL AND METHODS Retrospective study from tumour biopsies obtained before a treatment with radiotherapy or chemo-radiotherapy in 87 patients with SCCHN. We had a sample of healthy mucosa in 35 cases. We determined the transcriptional expression of IL-8 with RT-PCR. The transcriptional expression of IL-8 was categorized according to the local control of the disease with a recursive partitioning analysis. RESULTS The transcriptional expression of IL-8 in tumour tissue was about 50 times higher than that in the samples of healthy mucosa. Patients with a high transcriptional expression of IL-8 (n=56) had a 5-year local recurrence-free survival of 65.6%, and for patients with low expression (n=31) it was 90.2% (P=.017). According to the results of a multivariate analysis, patients with high expression of IL-8 had a 4.1 higher risk of local recurrence of the tumour. CONCLUSIONS SCCHN have a significant increase in transcriptional expression of IL-8 in relation to non-tumour tissue. Tumours with high IL-8 expression have an increased risk of local recurrence after treatment with radiotherapy or chemo-radiotherapy.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Nuria Farré
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Katarina Majercakova
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Francesc-Xavier Avilés-Jurado
- Servicio de Otorrinolaringología, Hospital Clínic, IDIBAPS Universitat de Barcelona, Barcelona, España; Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR), Generalitat de Catalunya. 2017-SGR-01581, Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
| | - Mercedes Camacho
- Genomics of Complex Diseases, Research Institute Hospital Sant Pau, IIB Sant Pau, Barcelona, España
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Borras JM, Font R, Solà J, Macia M, Tuset V, Arenas M, Eraso A, Verges R, Farré N, Pedro A, Mollà M, Algara M, Solé JM, Mira M, Espinàs JA. Impact of non-adherence to radiotherapy on 1-year survival in cancer patients in Catalonia, Spain. Radiother Oncol 2020; 151:200-205. [PMID: 32771615 DOI: 10.1016/j.radonc.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/23/2020] [Accepted: 08/01/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aims to assess the effects of non-adherence to external beam radiation therapy in cancer patients receiving treatment with a curative. METHODS This retrospective cohort study collected health records data for all cancer patients treated with external beam radiotherapy with curative intent in 2016 in Catalonia, Spain. Adherence was defined as having received at least 90% of the total dose prescribed. A logistic regression model was used to assess factors related to non-adherence, and its association with one-year survival was evaluated using Cox regression. RESULTS The final sample included 8721 patients (mean age 63.6 years): breast cancer was the most common tumour site (38.1%), followed by prostate and colon/rectum. Treatment interruptions prolonged the total duration of therapy in 70.7% of the patients, and 1.0% were non-adherent. Non-adherence was associated with advanced age, female gender, and some localization of primary tumour (head and neck, urinary bladder, and haematological cancers). The risk of death in non-adherent patients was higher than in adherent patients (hazard ratio [HR] 1.63, 95% confidence interval 0.97-2.74), after adjusting for the potential confounding effect of age, gender, tumour site and comorbidity. CONCLUSION Non-adherence to radiotherapy, as measured by the received dose, is very low in our setting, and it may have an impact on one-year survival.
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Affiliation(s)
- Josep M Borras
- Department of Clinical Sciences, University of Barcelona and Bellvitge Biomedical Research Institute (IDIBELL), Spain.
| | - Rebeca Font
- Cancer Strategy, Department of Health, Barcelona, Spain
| | - Judit Solà
- Cancer Strategy, Department of Health, Barcelona, Spain
| | - Miquel Macia
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Spain
| | - Victòria Tuset
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Meritxell Arenas
- Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Spain; Faculty of Medicine, University of Rovira i Virgili, Spain
| | - Arantxa Eraso
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Trueta, Girona, Spain
| | - Ramona Verges
- Radiation Oncology Department, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Nuria Farré
- Radiation Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Agustin Pedro
- Radiation Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Meritxell Mollà
- Department of Radiation Oncology, Hospital Clinic de Barcelona, Spain
| | - Manel Algara
- Radiation Oncology Department, Hospital del Mar, Radiation Oncology Research Group, IMIM and Universitat Autònoma de Barcelona, Spain
| | - Josep M Solé
- Radiation Oncology Department, Consorci Sanitari Terrassa- Hospital General Catalunya- Hospital Manresa, Barcelona, Spain
| | - Moises Mira
- Radiation Oncology Department, H.U. Arnau de Vilanova, Lleida, Spain
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León X, García J, López M, Farré N, Majercakova K, Gallego Ó, López-Pousa A, Quer M. Organ preservation after treatment with induction chemotherapy in patients with locally advanced carcinomas (T3-T4) of oral cavity and oropharynx. Acta Otorrinolaringol Esp (Engl Ed) 2020; 72:27-36. [PMID: 32513455 DOI: 10.1016/j.otorri.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/27/2019] [Accepted: 01/19/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES With the goal of achieving functional preservation, one of the treatment strategies for patients with locally advanced squamous cell carcinomas of the head and neck is to initiate treatment with induction chemotherapy (CT) and decide the second therapeutic manoeuvre depending on the response. The objective of this study is to evaluate organ preservation capacity based on this therapeutic approach in patients with tumours of the oral cavity and oropharynx. METHODS A retrospective study of 246 patients with locally advanced carcinomas of the oral cavity or oropharynx (cT3-T4) initially treated with induction CT. RESULTS After induction CT 28% of patients achieved a complete response of the primary location of the tumour, 43.1% a partial response greater than 50%, and 28.9% a reduction less than 50% or persistence. After the induction CT treatment 70 patients (28.5%) underwent surgical treatment, and 176 (71.5%) radiotherapy (RT) or chemoradiotherapy (CRT). Considering the patients treated non-surgically (n=176), organ preservation for patients with a complete response (n=66) was 65.2%, for those patients with a partial response greater than 50% (n=75) it was 30.7%, and for patients with a partial response less than 50% or persistence (n=35) it was 14.3%. CONCLUSION The response to treatment with induction CT has prognostic value in patients with locally advanced carcinomas of the oral cavity and oropharynx. Patients who are candidates for conservative treatment with RT or CRT would be those who achieve a complete response after induction treatment.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Nuria Farré
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Katarina Majercakova
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Óscar Gallego
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Antonio López-Pousa
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
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20
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León X, Montoro V, García J, López M, Farré N, Majercakova K, Gallego Ó, López-Pousa A, Quer M. Organ preservation in patients with advanced laryngeal tumours. Results of induction chemotherapy versus chemoradiotherapy in actual clinical practice. Acta Otorrinolaringol Esp (Engl Ed) 2020; 72:143-151. [PMID: 32475610 DOI: 10.1016/j.otorri.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/19/2020] [Accepted: 02/04/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES A high percentage of patients with locally advanced larynx carcinomas are candidates for inclusion in organ preservation protocols. The objective of this study is to compare the results of two schemes of preservation, induction chemotherapy versus chemoradiotherapy, in patients with locally advanced larynx carcinomas in the context of actual clinical practice. METHODS Our retrospective study included 157 patients with locally advanced tumours of the larynx (T3-T4) treated with induction chemotherapy (n = 121) or chemoradiotherapy (n = 36). RESULTS From 121 patients who began treatment with induction chemotherapy, 6 died due to toxicity, 37 were treated with surgery, and 78 completed the preservation scheme; 36 patients received treatment with chemoradiotherapy. There were no significant differences in 5-year disease-specific survival between both treatments: 68.9% in induction chemotherapy versus 75.7% in chemoradiotherapy (p = 0.259). In 45.9% of patients the laryngeal function was preserved. Patients treated with chemoradiotherapy had a tendency to have better 5-year laryngeal dysfunction-free survival than patients treated with induction chemotherapy (55.6% versus 44.8%, p = 0.079). CONCLUSION Patients included in a protocol of organ preservation achieved a 5-year laryngeal dysfunction-free survival of 45.9%. There were no significant differences in disease-specific survival among patients treated with induction chemotherapy or chemoradiotherapy.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Victoria Montoro
- Servicio de Otorrinolaringología, Hospital de Mollet, Mollet del Vallés, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Nuria Farré
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Katarina Majercakova
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Óscar Gallego
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Antonio López-Pousa
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
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Cabrera-Aguilera I, Benito B, Tajes M, Farré R, Gozal D, Almendros I, Farré N. Chronic Sleep Fragmentation Mimicking Sleep Apnea Does Not Worsen Left-Ventricular Function in Healthy and Heart Failure Mice. Front Neurol 2020; 10:1364. [PMID: 31993015 PMCID: PMC6962346 DOI: 10.3389/fneur.2019.01364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/10/2019] [Indexed: 12/30/2022] Open
Abstract
Aims: Obstructive sleep apnea (OSA) has been associated with heart failure (HF). Sleep fragmentation (SF), one of the main hallmarks of OSA, induces systemic inflammation, oxidative stress and sympathetic activation, hence potentially participating in OSA-induced cardiovascular consequences. However, whether SF per se is deleterious to heart function is unknown. The aim of this study was to non-invasively evaluate the effect of SF mimicking OSA on heart function in healthy mice and in mice with HF. Methods and Results: Forty C57BL/6J male mice were randomized into 4 groups: control sleep (C), sleep fragmentation (SF), isoproterenol-induced heart failure (HF), and mice subjected to both SF+HF. Echocardiography was performed at baseline and after 30 days to evaluate left ventricular end-diastolic (LVEDD) and end-systolic (LVESD) diameters, left ventricular ejection fraction (LVEF) and fraction shortening (FS). The effects of SF and HF on these parameters were assessed by two-way ANOVA. Mice with isoproterenol-induced HF had significant increases in LVEDD and LVESD, as well as a decreases in LVEF and FS (p = 0.013, p = 0.006, p = 0.027, and p = 0.047, respectively). However, no significant effects emerged with SF (p = 0.480, p = 0.542, p = 0.188, and p = 0.289, respectively). Conclusion: Chronic SF mimicking OSA did not induce echocardiographic changes in cardiac structure and function in both healthy and HF mice. Thus, the deleterious cardiac consequences of OSA are likely induced by other perturbations associated with this prevalent condition, or result from interactions with underlying comorbidities in OSA patients.
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Affiliation(s)
- Ignacio Cabrera-Aguilera
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Departament of Human Movement Sciences, Faculty of Health Sciences, School of Kinesiology, Universidad de Talca, Talca, Chile
| | - Begoña Benito
- Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Tajes
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - David Gozal
- Department of Child Health and Child Health Research Institute, The University of Missouri School of Medicine, Columbia, MO, United States
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Nuria Farré
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Heart Failure Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
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de Frutos F, Mirabet S, Ortega-Paz L, Buera I, Darnés S, Farré N, Perez B, Adeliño R, Bascompte R, Pérez-Rodón J, Aparicio X, Sutil-Vega M, Soto A, Faraudo M, Cainzos-Achirica M, Manito N. Management of Heart Failure with Reduced Ejection Fraction after ESC 2016 Heart Failure Guidelines: The Linx Registry. ESC Heart Fail 2020; 7:25-35. [PMID: 31916413 PMCID: PMC7083472 DOI: 10.1002/ehf2.12567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
Aims In May 2016, a new version of the European Society of Cardiology (ESC) Guidelines for the management of heart failure (HF) was released. The aim of this study was to describe the management of HF with reduced ejection fraction after the publication of ESC Guidelines. Methods and results The Linx registry is a multicentre, observational, cross‐sectional study from 14 Catalan hospitals that enrolled 1056 patients with HF and reduced left ventricular ejection fraction (≤40%) from 1 February to 30 April 2017 in outpatient cardiology clinics. Results were compared between hospitals according to their level of complexity in our own registry and compared with previously published registries similar to ours. Sacubitril/valsartan was prescribed to 23.9% of patients in our population, as a consequence, use of angiotensin‐converting enzyme inhibitor and angiotensin receptor blockers in monotherapy decreased to 48.1% and 16.9%, respectively, and prescription of beta‐blockers (91.8%), mineralocorticoid receptor antagonists (72.7%), and ivabradine (21.4%) remained similar to previous registries. Target doses of beta‐blockers (25.4%), angiotensin‐converting enzyme inhibitors (24.9%), angiotensin receptor blockers (7.7%), sacubitril/valsartan (8.1%), and mineralocorticoid receptor antagonists (19.7%) were accomplished in a low proportion of patients. Our results also suggest that prescription and up‐titration of class I HF drugs were greater in hospitals with higher level of complexity. Conclusions The Linx registry shows an appropriate adherence to pharmacological recommendations from ESC HF Guidelines despite a low proportion of patients reached target doses. Almost one‐quarter of patients were under treatment with sacubitril/valsartan a few months after ESC HF Guidelines recommendations.
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Affiliation(s)
- Fernando de Frutos
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Sonia Mirabet
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Irene Buera
- Department of Cardiology, Hospital de Viladecans, Barcelona, Spain
| | - Sara Darnés
- Department of Cardiology, Hospital de Figueres, Girona, Spain
| | - Nuria Farré
- Department of Cardiology, Hospital del Mar, Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), and Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bernardo Perez
- Department of Cardiology, Hospital de Granollers, Barcelona, Spain
| | - Raquel Adeliño
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Ramón Bascompte
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Jordi Pérez-Rodón
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Vall d'Hebrón Institut de Recerca, CIBER-CV, Barcelona, Spain
| | - Xavier Aparicio
- Department of Cardiology, Hospital de Mataró, Barcelona, Spain
| | - Mario Sutil-Vega
- Department of Cardiology, Corporacio Sanitaria Parc Taulí, Barcelona, Spain
| | - Adriana Soto
- Department of Cardiology, Hospital de Martorell, Barcelona, Spain
| | - Mercedes Faraudo
- Department of Cardiology, Hospital Moises Broggi, Barcelona, Spain
| | | | - Nicolás Manito
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
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Peiró ÓM, Farré N, Cediel G, Bonet G, Rojas S, Quintern V, Bardají A. Stromal cell derived factor-1 and long-term prognosis in acute coronary syndrome. Biomark Med 2019; 13:1187-1198. [PMID: 31559838 DOI: 10.2217/bmm-2019-0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore long-term prognostic value of SDF-1 in acute coronary syndrome (ACS). Materials & methods: We included 254 patients with ACS. Plasma SDF-1 was measured and patients were classified into tertiles of SDF-1. Results: Multivariate analysis showed third tertile of SDF-1 as an independent predictor of all-cause death (HR: 2.5; 95% CI: 1.2-5.2; p = 0.011) and the composite of major adverse cardiovascular and cerebrovascular events (HR: 1.8; 95% CI: 1.1-3.1; p = 0.031). SDF-1 added to a clinical model can improve all-cause death prediction (net reclassification improvement 0.362; 95% CI: 0.423-0.681; p = 0.027). Conclusion: SDF-1 is an independent predictor of all-cause mortality and major adverse cardiovascular and cerebrovascular events in long-term follow-up of patients with ACS and adds prognostic information beyond traditional cardiovascular risks factors.
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Affiliation(s)
- Óscar M Peiró
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Nuria Farré
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - German Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Gil Bonet
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Sergio Rojas
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Verónica Quintern
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Alfredo Bardají
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
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Almendros I, Martínez-Ros P, Farré N, Rubio-Zaragoza M, Torres M, Gutiérrez-Bautista ÁJ, Carrillo-Poveda JM, Sopena-Juncosa JJ, Gozal D, Gonzalez-Bulnes A, Farré R. Placental oxygen transfer reduces hypoxia-reoxygenation swings in fetal blood in a sheep model of gestational sleep apnea. J Appl Physiol (1985) 2019; 127:745-752. [PMID: 31369330 DOI: 10.1152/japplphysiol.00303.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnea (OSA), characterized by events of hypoxia-reoxygenation, is highly prevalent in pregnancy, negatively affecting the gestation process and particularly the fetus. Whether the consequences of OSA for the fetus and offspring are mainly caused by systemic alterations in the mother or by a direct effect of intermittent hypoxia in the fetus is unknown. In fact, how apnea-induced hypoxemic swings in OSA are transmitted across the placenta remains to be investigated. The aim of this study was to test the hypothesis, based on a theoretical background on the damping effect of oxygen transfer in the placenta, that oxygen partial pressure (Po2) swings resulting from obstructive apneas mimicking OSA are mitigated in the fetal circulation. To this end, four anesthetized ewes close to term pregnancy were subjected to obstructive apneas consisting of 25-s airway obstructions. Real-time Po2 was measured in the maternal carotid artery and in the umbilical vein with fast-response fiber-optic oxygen sensors. The amplitudes of Po2 swings in the umbilical vein were considerably smaller [3.1 ± 1.0 vs. 21.0 ± 6.1 mmHg (mean ± SE); P < 0.05]. Corresponding estimated swings in fetal and maternal oxyhemoglobin saturation tracked Po2 swings. This study provides novel insights into fetal oxygenation in a model of gestational OSA and highlights the importance of further understanding the impact of sleep-disordered breathing on fetal and offspring development.NEW & NOTEWORTHY This study in an airway obstruction sheep model of gestational sleep apnea provides novel data on how swings in oxygen partial pressure (Po2) translate from maternal to fetal blood. Real-time simultaneous measurement of Po2 in maternal artery and in umbilical vein shows that placenta transfer attenuates the magnitude of oxygenation swings. These data prompt further investigation of the extent to which maternal apneas could induce similar direct oxidative stress in fetal and maternal tissues.
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Affiliation(s)
- Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain.,Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
| | - Paula Martínez-Ros
- Animal Production and Health Department, Veterinary Faculty, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain
| | - Nuria Farré
- Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mónica Rubio-Zaragoza
- Bioregenerative Medicine and Applied Surgery Research Group, Animal Medicine and Surgery Department, Veterinary Faculty, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain.,García Cugat Foundation for Biomedical Research, Barcelona, Spain
| | - Marta Torres
- CIBER de Enfermedades Respiratorias, Madrid, Spain.,Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
| | - Álvaro J Gutiérrez-Bautista
- Anaesthesia Unit, Veterinary Teaching Hospital, Animal Medicine and Surgery Department, Veterinary Faculty, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain
| | - José M Carrillo-Poveda
- Bioregenerative Medicine and Applied Surgery Research Group, Animal Medicine and Surgery Department, Veterinary Faculty, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain.,García Cugat Foundation for Biomedical Research, Barcelona, Spain
| | - Joaquín J Sopena-Juncosa
- Bioregenerative Medicine and Applied Surgery Research Group, Animal Medicine and Surgery Department, Veterinary Faculty, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain.,García Cugat Foundation for Biomedical Research, Barcelona, Spain
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri
| | - Antonio Gonzalez-Bulnes
- Department of Animal Reproduction, Deputy Directorate General of Research and Technology-Spanish National Institute for Agricultural and Food Research and Technology, Madrid, Spain
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain.,Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
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25
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Borras J, Font R, Solà J, Macià M, Arenas M, Verges R, Eraso A, Tuset V, Biete A, Solé J, Farré N, Pedro A, Mira M, Espinàs J. OC-0600 Assessment of non-adherence to external radiotherapy treatment in cancer patients in Catalonia,Spain. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31020-5] [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: 11/26/2022]
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26
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González-Costello J, Comín-Colet J, Lupón J, Enjuanes C, de Antonio M, Fuentes L, Moliner-Borja P, Farré N, Zamora E, Manito N, Pujol R, Bayés-Genis A. Importance of iron deficiency in patients with chronic heart failure as a predictor of mortality and hospitalizations: insights from an observational cohort study. BMC Cardiovasc Disord 2018; 18:206. [PMID: 30382817 PMCID: PMC6211465 DOI: 10.1186/s12872-018-0942-x] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
Background Iron deficiency (ID) in patients with chronic heart failure (CHF) is considered an adverse prognostic factor. We aimed to evaluate if ID in patients with CHF is associated with increased mortality and hospitalizations. Methods We evaluated ID in patients with CHF at 3 university hospitals. ID was defined as absolute (ferritin < 100 μg/L) or functional (transferrin Saturation index < 20% and ferritin between 100 and 299 μg/L). We excluded patients who received treatment with intravenous Iron or Erythropoietin during follow-up. We evaluated if ID was a predictor of death or hospitalization due to heart failure or any cause using univariate and multivariate cox regression analysis. Results We included 1684 patients, 65% males, 38% diabetics, median age of 72 years, 37% in functional class III-IV and 30% of patients with a left ventricular ejection fraction > 45%. Patients were well treated, with 87% and 88% of patients receiving renin-angiotensin inhibitors and beta-blockers, respectively. Median transferrin saturation index was 20%, median ferritin 155 ng/mL and median haemoglobin 13 g/dL. ID was present in 53% of patients; in 35% it was absolute and in 18% functional. Median follow-up was 20 months. ID was a predictor of death, hospitalization due to heart failure or to any cause in univariate analysis but not after multivariate analysis. No differences were found between absolute or functional ID regarding prognosis. Conclusion In a real life population of patients with CHF and a high prevalence of heart failure with preserved ejection fraction, ID did not predict mortality or hospitalizations after adjustment for comorbidities, functional class and neurohormonal treatment.
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Affiliation(s)
- José González-Costello
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain.
| | - Josep Comín-Colet
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Josep Lupón
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Cristina Enjuanes
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta de Antonio
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Lara Fuentes
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Pedro Moliner-Borja
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Farré
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisabet Zamora
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Nicolás Manito
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Ramón Pujol
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayés-Genis
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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Majercakova K, Valero C, López M, García J, Farré N, Quer M, Craven-Bartle J, León X. Postoperative Staging of the Neck Dissection Using Extracapsular Spread and Lymph Node Ratio As Prognostic Factors in HPV-Negative Head and Neck Squamous Cell Carcinoma Patients (HNSCC). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Farré N, Gozal D. Sleep and the Microbiome: A Two-Way Relationship. Arch Bronconeumol 2018; 55:7-8. [PMID: 29801675 DOI: 10.1016/j.arbres.2018.04.007] [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] [Received: 04/10/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Nuria Farré
- Heart Failure Programme, Department of Cardiology, Hospital del Mar, Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute (IMIM), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, España
| | - David Gozal
- Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Biological Sciences Division, The University of Chicago, Chicago, IL, Estados Unidos.
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Bonet M, Arenas M, Farré N, García V, Algara M, Farrús B, Fernández J, Reyes V, Eraso A, Alvarez A, Cambra M, Pedro A, Vayreda J, Montero A, Poortmans P. EP-1297: RT for bone-only oligometastases in breast cancer patients: a survey of current clinical practice. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31607-4] [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: 11/28/2022]
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30
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Sancho Pardo G, Acosta E, Tilea L, Hernández D, Farré N, Balart J, Jornet N, Gómez de Segura G, Craven-Bartle J. PO-0829: Postprostatectomy dose intensified salvage radiotherapy is associated with grade 3 late haematuria. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31139-3] [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: 11/16/2022]
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31
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Majercakova K, Valero C, López M, García J, Farré N, Quer M, León X. Postoperative staging of the neck dissection using extracapsular spread and lymph node ratio as prognostic factors in HPV-negative head and neck squamous cell carcinoma patients. Oral Oncol 2018; 77:37-42. [DOI: 10.1016/j.oraloncology.2017.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/08/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022]
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Farré N, Lupon J, Roig E, Gonzalez-Costello J, Vila J, Perez S, de Antonio M, Solé-González E, Sánchez-Enrique C, Moliner P, Ruiz S, Enjuanes C, Mirabet S, Bayés-Genís A, Comin-Colet J. Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: a multicentre prospective observational study in Catalonia (Spain). BMJ Open 2017; 7:e018719. [PMID: 29273666 PMCID: PMC5778274 DOI: 10.1136/bmjopen-2017-018719] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to analyse baseline characteristics and outcome of patients with heart failure and mid-range left ventricular ejection fraction (HFmrEF, left ventricular ejection fraction (LVEF) 40%-49%) and the effect of 1-year change in LVEF in this group. SETTING Multicentre prospective observational study of ambulatory patients with HF followed up at four university hospitals with dedicated HF units. PARTICIPANTS Fourteen per cent (n=504) of the 3580 patients included had HFmrEF. INTERVENTIONS Baseline characteristics, 1-year LVEF and outcomes were collected. All-cause death, HF hospitalisation and the composite end-point were the primary outcomes. RESULTS Median follow-up was 3.66 (1.69-6.04) years. All-cause death, HF hospitalisation and the composite end-point were 47%, 35% and 59%, respectively. Outcomes were worse in HF with preserved ejection fraction (HFpEF) (LVEF>50%), without differences between HF with reduced ejection fraction (HFrEF) (LVEF<40%) and HFmrEF (all-cause mortality 52.6% vs 45.8% and 43.8%, respectively, P=0.001). After multivariable Cox regression analyses, no differences in all-cause death and the composite end-point were seen between the three groups. HF hospitalisation and cardiovascular death were not statistically different between patients with HFmrEF and HFrEF. At 1-year follow-up, 62% of patients with HFmrEF had LVEF measured: 24% had LVEF<40%, 43% maintained LVEF 40%-49% and 33% had LVEF>50%. While change in LVEF as continuous variable was not associated with better outcomes, those patients who evolved from HFmrEF to HFpEF did have a better outcome. Those who remained in the HFmrEF and HFrEF groups had higher all-cause mortality after adjustment for age, sex and baseline LVEF (HR 1.96 (95% CI 1.08 to 3.54, P=0.027) and HR 2.01 (95% CI 1.04 to 3.86, P=0.037), respectively). CONCLUSIONS Patients with HFmrEF have a clinical profile in-between HFpEF and HFrEF, without differences in all-cause mortality and the composite end-point between the three groups. At 1 year, patients with HFmrEF exhibited the greatest variability in LVEF and this change was associated with survival.
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Affiliation(s)
- Nuria Farré
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
| | - Josep Lupon
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
| | - Eulàlia Roig
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
- Heart Failure Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Gonzalez-Costello
- Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL (Bellvitge Biomedical Reserach Institute), Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Vila
- Cardiovascular Epidemiology and Genetics (EGEC), REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBERESP, CIBER Epidemiología y Salud Publica, Barcelona, Spain
| | - Silvia Perez
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
- Cardiovascular Epidemiology and Genetics (EGEC), REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Marta de Antonio
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eduard Solé-González
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
- Heart Failure Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Sánchez-Enrique
- Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL (Bellvitge Biomedical Reserach Institute), Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Sonia Ruiz
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - C Enjuanes
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL (Bellvitge Biomedical Reserach Institute), Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Badalona, Spain
| | - Sonia Mirabet
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
- Heart Failure Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antoni Bayés-Genís
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
| | - Josep Comin-Colet
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL (Bellvitge Biomedical Reserach Institute), Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Badalona, Spain
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Filella G, Soldevila A, Cabello E, Franco L, Morell A, Farré N. Diseño, aplicación y evaluación de un programa de educación emocional en un centro penitenciario. EJREP 2017. [DOI: 10.25115/ejrep.v6i15.1283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introducción. El propósito de este estudio ha sido evaluar la incidencia que, sobre un grupo de internos de un centro penitenciario, ha tenido la aplicación de un programa de educación emocional para la mejora de la conciencia y la regulación emocional. Se pretendía ofrecer a los internos estrategias de regulación emocional que les fueran útiles en el centro penitenciario y a su vez les facilitaran su futura inclusión social.Método. Se ha utilizado un diseño cuasiexperimental de grupo único con grupo control. Para medir las variables se utilizaron distintos instrumentos, entre ellos una adaptación del CEE (GROP, 2001), un caso práctico (planteamiento de una situación generadora de emociones negativas), un análisis de las sanciones durante dos meses y un cuestionario de valoración de las actividades del programa por parte de los participantes.Resultados. Se destaca que la mayoría de ítems del cuestionario aplicado al grupo experimental mejoran después de formarse así como las respuestas dadas en la resolución del caso práctico. Sin embargo no se puede hablar de diferencias significativas en el caso de las sanciones si se compara con el grupo control. También los implicados valoraron positivamente el programa.Discusión. Los resultados manifiestan que la intervención del programa de educación emocional ha contribuido a la mejora de la conciencia y la regulación emocional del grupo experimental.
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Farré N, Acosta E, Balart J, Sancho G, Majercakova K, Carrasco P, Fernández A, Camacho M, Majem M, Giménez A, Martínez E, Trujillo J, Torrego A, Pajares V, Craven-Bartle J. P3.14-014 Lung Stereotactic Body Radiotherapy (SBRT): Patient's Outcome and Prognostic Factors. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1787] [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: 10/18/2022]
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Melia MR, Del Carpio Huerta L, Joaquín AB, Palacios GA, Sullivan I, Perez AC, Farré N, Torrego A, Pajares V, Martínez E, Trujillo J, De Quinana C, Tarruella MM. P2.01-072 Local Management of Oligometastases in Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1173] [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: 11/16/2022]
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Majem Tarruella M, Isla Casado L, Guirado M, Massuti Sureda B, Ortega Granados A, Marse Fabregat R, Domine Gomez M, de las Peñas R, Moran Bueno M, Vazquez Estevez S, Sala Gonzalez M, Coves Sarto J, Sánchez-Torres J, Vicente Baz D, Gonzalez-Larriba J, Paredes A, Farré N, Fernández Fornos L, Mena A, Provencio Pulla M. Preliminar analysis of the Spanish Lung Cancer Group (SLCG) phase II trial of concurrent chemo-radiotherapy (CT-RT) with cisplatin (P) plus metronomic oral vinorelbine (mOV) for unresectable locally advanced non-small cell lung cancer (LA-NSCLC): NORA trial (GECP 15/02). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx379.007] [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: 11/13/2022] Open
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León X, Rigó A, Farré N, López M, García J, de Juan J, Quer M. Prognostic significance of extracapsular spread in isolated neck recurrences in head and neck squamous cell carcinoma patients. Eur Arch Otorhinolaryngol 2016; 274:527-533. [DOI: 10.1007/s00405-016-4249-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]
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Farré N, Vela E, Clèries M, Bustins M, Cainzos-Achirica M, Enjuanes C, Moliner P, Ruiz S, Verdú-Rotellar JM, Comín-Colet J. Medical resource use and expenditure in patients with chronic heart failure: a population-based analysis of 88 195 patients. Eur J Heart Fail 2016; 18:1132-40. [PMID: 27108481 DOI: 10.1002/ejhf.549] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [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: 11/28/2015] [Revised: 02/22/2016] [Accepted: 03/19/2016] [Indexed: 12/11/2022] Open
Abstract
AIMS Heart failure (HF) is one of the diseases with greater healthcare expenditure. However, little is known about the cost of HF at a population level. Hence, our aim was to study the population-level distribution and predictors of healthcare expenditure in patients with HF. METHODS AND RESULTS This was a population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on 31 December 2012 (n = 88 195). We evaluated 1-year healthcare resource use and expenditure using the Health Department (CatSalut) surveillance system that collects detailed information on healthcare usage for the entire population. Mean age was 77.4 (12) years; 55% were women. One-year mortality rate was 14%. All-cause emergency department visits and unplanned hospitalizations were required at least once in 53.4% and 30.8% of patients, respectively. During 2013, a total of €536.2 million were spent in the care of HF patients (7.1% of the total healthcare budget). The main source of expenditure was hospitalization (39% of the total) whereas outpatient care represented 20% of the total expenditure. In the general population, outpatient care and hospitalization were the main expenses. In multivariate analysis, younger age, higher presence of co-morbidities, and a recent HF or all-cause hospitalization were independently associated with higher healthcare expenditure. CONCLUSIONS In Catalonia, a large portion of the annual healthcare budget is devoted to HF patients. Unplanned hospitalization represents the main source of healthcare-related expenditure. The knowledge of how expenditure is distributed in a non-selected HF population might allow health providers to plan the distribution of resources in patients with HF.
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Affiliation(s)
- Nuria Farré
- Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Emili Vela
- Analysis on Demand and Activity Division, Catalan Health Service, Barcelona, Spain
| | - Montse Clèries
- Analysis on Demand and Activity Division, Catalan Health Service, Barcelona, Spain
| | - Montse Bustins
- Analysis on Demand and Activity Division, Catalan Health Service, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.,Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Cristina Enjuanes
- Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,School of Medicine, Universitat Pompeu Fabra and Universitat Autònoma de Barcelona, Spain
| | - Pedro Moliner
- Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,School of Medicine, Universitat Pompeu Fabra and Universitat Autònoma de Barcelona, Spain
| | - Sonia Ruiz
- Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jose Maria Verdú-Rotellar
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,School of Medicine, Universitat Pompeu Fabra and Universitat Autònoma de Barcelona, Spain.,Jordi Gol Primary Care Research Institute, Catalan Institute of Heath, Barcelona, Spain
| | - Josep Comín-Colet
- Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,School of Medicine, Universitat Pompeu Fabra and Universitat Autònoma de Barcelona, Spain
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Enjuanes C, Bruguera J, Grau M, Cladellas M, Gonzalez G, Meroño O, Moliner-Borja P, Verdú JM, Farré N, Comín-Colet J. Estado del hierro en la insuficiencia cardiaca crónica: impacto en síntomas, clase funcional y capacidad de ejercicio submáxima. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.08.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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León X, Agüero A, López M, García J, Farré N, López-Pousa A, Quer M. Salvage surgery after local recurrence in patients with head and neck carcinoma treated with chemoradiotherapy or bioradiotherapy. Auris Nasus Larynx 2014; 42:145-9. [PMID: 25459494 DOI: 10.1016/j.anl.2014.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 07/22/2014] [Accepted: 10/02/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the oncologic outcomes and surgical complications after salvage surgery for recurrence following chemoradiotherapy or bioradiotherapy for advanced head and neck squamous cell carcinoma. METHODS From 2007 to 2011, 187 patients were treated with chemoradiotherapy (n=154) or bioradiotherapy (n=33). Patients treated with bioradiotherapy were older and showed a tendency to poorer general condition. During the follow-up, 43 patients treated with chemoradiotherapy (27.9%) and 13 patients treated with bioradiotherapy (39.3%) had a local recurrence of the tumor. We analyzed the patient candidates to salvage surgery, and the associated complications and outcome of these surgeries. RESULTS Sixteen patients treated with chemoradiotherapy (37.2%) and eight treated with bioradiotherapy (61.5%) had salvage surgery. Multivariate analysis showed that the variable most strongly related to salvage surgery after local recurrence of the tumor was the type of initial treatment. The frequency of postoperative complications was higher in patients who received chemoradiotherapy (62.5% versus 12.5%, P=0.03). Five-year adjusted-survival after salvage surgery was 26.0% for patients receiving chemoradiotherapy and 70.0% for patients undergoing bioradiotherapy (P=0.156). CONCLUSION Patients who presented recurrence after bioradiotherapy were more likely candidates to salvage surgery than those who had chemoradiotherapy. Patients undergoing salvage surgery had fewer postoperative complications and better adjusted survival after bioradiotherapy than after chemoradiotherapy.
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Affiliation(s)
- Xavier León
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain.
| | - Adriana Agüero
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Montserrat López
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jacinto García
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Nuria Farré
- Radiation Oncology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio López-Pousa
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
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Farré N, Rojas J, Díez L, Latorre-musoll A, Camacho V, Fernández A, Majem M, Pallarés C, Majercakova K, Buitrago P, Giménez D, Craven-bartle J. Role of 18FDG-PET/CT for radiotherapy planning in lung cancer. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Pallarés C, Capdevila J, Paredes A, Farré N, Ciria JP, Membrive I, Basterrechea L, Gomez-Segura G, Barnadas A. Induction chemotherapy with paclitaxel plus carboplatin followed by paclitaxel with concurrent radiotherapy in stage IIIB non-small-cell lung cancer (NSCLC) patients: A phase II trial. Lung Cancer 2007; 58:238-45. [PMID: 17658655 DOI: 10.1016/j.lungcan.2007.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 04/02/2007] [Accepted: 06/05/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE We conducted a prospective phase II trial to evaluate the efficacy and toxicity of induction chemotherapy with paclitaxel plus carboplatin followed by concurrent radiotherapy with weekly paclitaxel in stage IIIB non-small-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS Patients with stage IIIB NSCLC received two 3-week cycles of paclitaxel 200mg/m(2) combined with carboplatin (target area under the plasma concentration curve (AUC) of 6 mg/ml) followed by weekly paclitaxel 50mg/m(2) concurrently with radiotherapy consisted of 2 Gy daily, 5 days per week (60 Gy total dose in 6 weeks). The median follow-up period was 5 years. RESULTS Between March 1999 and January 2002, 21 patients were enrolled and analyzed. Ninety percent of patients completed the planned treatment schedule. The overall response rate was 76% (24% complete response and 52% partial response). The median overall survival time was 15 months and the 1-year, 2-year and 5-year overall survival rates were 57, 33 and 24%, respectively. The disease progression rate at 1 year was 43% and the median progression-free survival was 8 months. During the chemoradiation period, grade 3-4 oesophagitis and pneumonitis were observed in 24 and 14% of patients, respectively. CONCLUSIONS Induction chemotherapy with carboplatin and paclitaxel followed by weekly paclitaxel with concurrent radiotherapy was found to be active and tolerable in selected stage IIIB NSCLC patients. Further studies are needed to improve the safety profile and outcome in this setting.
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Affiliation(s)
- C Pallarés
- Department of Medical Oncology, Sant Pau University Hospital, St. Antoni M(a) Claret 167, 08025 Barcelona, Spain
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Abstract
The case of a 56-year-old man with osteogenic sarcoma of the mandible diagnosed 7 years after radiotherapy treatment of a laryngeal cancer is reported. Surgery was the initial treatment. The progress was poor after local and pulmonary relapse, without response to chemotherapy treatment. Radiation-induced sarcomas are uncommon tumors that are diagnosed by meeting some diagnostic criteria. The mandible is a location very sensitive to radiation effects. The authors have found in the literature 30 cases of mandibular radiation-induced osteogenic sarcomas, most of them secondary to treatment of benign lesions, none of them secondary to treatment of a laryngeal cancer, as was seen in their case.
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Affiliation(s)
- Vicente Valentí
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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