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Autores:
Sáenz de Pipaon Echarren, Goren;
Jover, E.;
van der Bent, M. L.;
et al.
Revista:
ATHEROSCLEROSIS
ISSN: 1879-1484
Vol.385
2023
págs. 117343
Resumen
BACKGROUND AND AIMS: Peripheral arterial disease (PAD) is a leading cause of morbimortality worldwide. Lipocalin-2 (LCN2) has been associated with higher risk of amputation or mortality in PAD and might be involved in muscle regeneration. Our aim is to unravel the role of LCN2 in skeletal muscle repair and PAD.
METHODS AND RESULTS: WT and Lcn2-/- mice underwent hindlimb ischemia. Blood and crural muscles were analyzed at the inflammatory and regenerative phases. At day 2, Lcn2-/- male mice, but not females, showed increased blood and soleus muscle neutrophils, and elevated circulating pro-inflammatory monocytes (p<0.05), while locally, total infiltrating macrophages were reduced (p<0.05). Moreover, Lcn2-/- soleus displayed an elevation of Cxcl1 (p<0.001), and Cxcr2 (p<0.01 in males), and a decrease in Ccl5 (p<0.05). At day 15, Lcn2 deficiency delayed muscle recovery, with higher density of regenerating myocytes (p<0.04) and arterioles (alphaSMA+, p<0.025). Reverse target prediction analysis identified miR-138-5p as a potential regulator of LCN2, showing an inverse correlation with Lcn2 mRNA in skeletal muscles (rho=-0.58, p<0.01). In vitro, miR-138-5p mimic reduced Lcn2 expression and luciferase activity in murine macrophages (p<0.05). Finally, in human serum miR-138-5p was inversely correlated with LCN2 (p¿0.001 adjusted, n=318), and associated with PAD (Odds ratio 0.634, p=0.02, adjusted, PAD n=264, control n=54).
CONCLUSIONS: This study suggests a possible dual role of LCN2 in acute and chronic conditions, with a probable role in restraining inflammation early after skeletal muscle ischemia, while being associated with vascular damage in PAD, and identifies miR-138-5p as one potential post-transcriptional regulator of LCN2.
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Autores:
Muñoz, A. J. (Autor de correspondencia);
Souto, J. C.;
Lecumberri Villamediana, Ramón;
et al.
Revista:
THROMBOSIS RESEARCH
ISSN: 0049-3848
Vol.228
2023
págs. 181 - 188
Resumen
Introduction: Patients with cancer and venous thromboembolism (VTE) show a high risk of VTE recurrence during anticoagulant treatment. This study aimed to develop a predictive model to assess the risk of VTE recurrence within 6 months at the moment of primary VTE diagnosis in these patients. Materials and methods: Using the EHRead & REG; technology, based on Natural Language Processing (NLP) and machine learning (ML), the unstructured data in electronic health records from 9 Spanish hospitals between 2014 and 2018 were extracted. Both clinically- and ML-driven feature selection were performed to identify predictors for VTE recurrence. Logistic regression (LR), decision tree (DT), and random forest (RF) algorithms were used to train different prediction models, which were subsequently validated in a hold-out data set. Results: A total of 16,407 anticoagulated cancer patients with diagnosis of VTE were identified (54.4 % male and median age 70). Deep vein thrombosis, pulmonary embolism and metastases were observed in 67.2 %, 26.6 %, and 47.7 % of the patients, respectively. During the study follow-up, 11.4 % of the patients developed a recurrent VTE, being more frequent in patients with lung cancer. Feature selection and model training based on ML identified primary pulmonary embolism, deep vein thrombosis, metastasis, adenocarcinoma, hemoglobin and serum creatinine levels, platelet and leukocyte count, family history of VTE, and patients' age as predictors of VTE recurrence within 6 months of VTE diagnosis. The LR model had an AUC-ROC (95 % CI) of 0.66 (0.61, 0.70), the DT of 0.69 (0.65, 0.72) and the RF of 0.68 (0.63, 0.72). Conclusions: This is the first ML-based predictive model designed to predict 6-months VTE recurrence in patients with cancer. These results hold great potential to assist clinicians to identify the high-risk patients and improve their clinical management.
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Autores:
Llau, Juan V. (Autor de correspondencia);
Aldecoa, C.;
Guasch, E.;
et al.
Revista:
MEDICINA INTENSIVA
ISSN: 0210-5691
Vol.47
N° 8
2023
págs. 454 - 467
Resumen
This document is an update of the multidisciplinary document HEMOMAS, published in 2016 with the endorsement of the Spanish Scientific Societies of Anaesthesiology (SEDAR), Intensive Care (SEMICYUC) and Thrombosis and Haemostasis (SETH). The aim of this document was to review and update existing recommendations on the management of massive haemorrhage. The methodology of the update was based on several elements of the ADAPTE method by searching and adapting guidelines published in the specific field of massive bleeding since 2014, plus a literature search performed in PubMed and EMBASE from January 2014 to June 2021. Based on the review of 9 guidelines and 207 selected articles, the 47 recommendations in the original article were reviewed, maintaining, deleting, or modifying each of them and the accompanying grades of recommendation and evidence. Following a consensus process, the final wording of the article and the resulting 41 recommendations were approved by all authors.
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Autores:
Martínez Urbistondo, Diego (Autor de correspondencia);
Huerta González, Ana;
Navarro-González, D.;
et al.
Revista:
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN: 0014-2972
Vol.53
N° 10
2023
págs. e14036
Resumen
Background: Metabolic syndrome (MetS), prediabetes (PreDM) and metabolic-associated fatty liver disease (MAFLD) share pathophysiological pathways concerning type 2 diabetes mellitus (T2DM) onset. The non-invasive assessment of MAFLD combined with PreDM and MetS features might provide further accuracy in predicting hyperglucaemic status with the description of singular clinical phenotypes.Methods: A retrospective cohort study was performed on 2799 patients recruited in the Vascular-Metabolic CUN cohort. The main outcome was the incidence of T2DM according to ADA criteria. MetS and PreDM were defined according to ATP III and ADA criteria, respectively. Hepatic steatosis index (HSI) was used to detect patients with MAFLD.Results: MetS and PreDM were more common in patients with MAFLD (35% vs. 8% and 34% vs. 18%, respectively). MAFLD showed clinical interaction with MetS and PreDM in the prediction of T2DM [MAFLD-MetS interaction HR= 4.48 (3.37-5.97) and MAFLD-PreDM interaction HR = 6.34 (4.67-8.62)]. These findings supported the description of five different liver status-linked phenotypes with increasing risk of T2DM: Metabolically healthy patients (1,5% of T2DM incidence), MAFLD (4,4% of T2DM incidence), MAFLD and MetS (10,6% of T2DM incidence), PreDM (11,1% of T2DM incidence) and MAFLD and PreDM (28,2% of T2DM incidence). These phenotypes provided independent capacity of prediction of T2DM incidence after adjustment for age, sex, tobacco and alcohol consumption, obesity and number of SMet features with a c-Harrell=0.84.Conclusions: MAFLD interplay with MetS and PreDM might help to discriminate patient risk of T2DM in the clinical setting through metabolic remodelling-based phenotypes.
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Autores:
Beddar-Chaib, F.;
Jiménez Hernández, S.;
Pedrajas-Navas, J. M.;
et al.
Revista:
EMERGENCIAS
ISSN: 1137-6821
Vol.35
N° 2
2023
págs. 109 -116
Resumen
Objetivo: Describir el manejo terapéutico de los pacientes con trombosis venosa superficial (TVS) aislada de miembros inferiores en servicios de urgencias hospitalarios (SUH) españoles. Evaluar el impacto del tratamiento instaurado en urgencias en la evolución, en términos de complicaciones de enfermedad tromboembólica venosa (ETV), y conocer las características de los pacientes que sufren complicaciones.
Metodo: El estudio multicentrico (18 SUH) ALTAMIRA (fActores de riesgo, compLicaciones y evaluación del manejo de la TVS de Miembros Inferiores en hospitales españoles atendidos en los seRvicios de urgenciAs) creó un cohorte retrospectivo de pacientes consecutivos con diagnóstico objetivo de TVS aislada. Se recogieron las complicaciones de ETV sintomáticas (trombosis venosa profunda, tromboembolia pulmonar y extensión o recurrencia de TVS), sangrados clínicamente relevantes y defunciones a 180 días. Se evaluaron las variables asociadas a las complicaciones mediante una regresión de Cox.
Resultados: Se incluyeron 703 pacientes. El 84,1% recibieron anticoagulación durante 30 días (rango intercuartil 15-42), 81,3% con heparina de bajo peso molecular (48% dosis profilácticas, 52% intermedias-terapéuticas). En 180 días, 64 pacientes (9,1%) tuvieron complicación de ETV, 12 (1,7%) tuvieron sangrado clínicamente relevante, y 4 fallecieron (0,6%). Los pacientes en que se instauró anticoagulación en urgencias tardaron más tiempo en desarrollar complicaciones (66 vs 11 días, p = 0,009). El 76,6% de los que se complicaron no estaban anticoagulados en ese momento. La ETV previa se asoció de forma independiente con el desarrollo de complicaciones (hazard ratio ajustada 2,20; intervalo de confianza del 95%: 1,34-3,62).
Conclusiones: El tratamiento en urgencias de la TVS aislada es heterogéneo y con frecuencia subóptimo. La incidencia de complicaciones de ETV es elevada. El tratamiento anticoagulante iniciado en urgencias supone un retraso en el desarrollo de complicaciones. Los pacientes con ETV previa tienen más riesgo de complicaciones.
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Autores:
Llau, J. V. (Autor de correspondencia);
Aldecoa, C.;
Guasch, E.;
et al.
Revista:
REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACION
ISSN: 0034-9356
Vol.70
N° 7
2023
págs. 409 - 421
Resumen
This document is an update of the multidisciplinary document HEMOMAS, published in 2016 with the endorsement of the Spanish Scientific Societies of Anaesthesiology (SEDAR), Intensive Care (SEMICYUC) and Thrombosis and Haemostasis (SETH). The aim of this document was to review and update existing recommendations on the management of massive haemorrhage. The methodology of the update was based on several elements of the ADAPTE method by searching and adapting guidelines published in the specific field of massive bleeding since 2014, plus a literature search performed in PubMed and EMBASE from January 2014 to June 2021. Based on the review of 9 guidelines and 207 selected articles, the 47 recommendations in the original article were reviewed, maintaining, deleting, or modifying each of them and the accompanying grades of recommendation and evidence. Following a consensus process, the final wording of the article and the resulting 41 recommendations were approved by all authors.
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Autores:
Marcos Jubilar, María;
Lecumberri Villamediana, Ramón;
Páramo Fernández, José Antonio (Autor de correspondencia)
Revista:
JOURNAL OF CLINICAL MEDICINE
ISSN: 2077-0383
Vol.12
N° 4
2023
págs. 1399
Resumen
Thromboinflammation or immunothrombosis is a concept that explains the existing link between coagulation and inflammatory response present in many situations, such as sepsis, venous thromboembolism, or COVID-19 associated coagulopathy. The purpose of this review is to provide an overview of the current data regarding the mechanisms involved in immunothrombosis in order to understand the new therapeutic strategies focused in reducing thrombotic risk by controlling the inflammation.
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Autores:
Blanco Di Matteo, Andrés Enrique;
García Fernández, Nuria;
Aguinaga Pérez, Aitziber;
et al.
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN: 0066-4804
Vol.67
N° 1
2023
págs. e0126422
Resumen
Tunneled central venous catheter (TCVC) related infection remains a challenge in the care of hemodialysis patients. We aimed to determine the best antimicrobial lock therapy (ALT) to eradicate coagulase-negative staphylococci (CoNS) biofilms. Tunneled central venous catheter (TCVC) related infection remains a challenge in the care of hemodialysis patients. We aimed to determine the best antimicrobial lock therapy (ALT) to eradicate coagulase-negative staphylococci (CoNS) biofilms. We studied the colonization status of the catheter every 30 days by quantitative blood cultures (QBC) drawn through all catheter lumens. Those patients with a significant culture (i.e.,100 to 1,000 CFU/mL) of a CoNS were classified as patients with a high risk of developing catheter-related bloodstream infections (CRBSI). They were assigned to receive daptomycin, vancomycin, teicoplanin lock solution, or the standard of care (SoC) (i.e., heparin lock). The primary endpoint was to compare eradication ability (i.e., negative QBC for 30 days after ending ALT) rates between different locks and the SoC. A second objective was to analyze the correlation between ALT exposure and isolation of CoNS with antimicrobial resistance. Daptomycin lock was associated with a significant higher eradication success than with the SoC: 85% versus 30% (relative risk [RR] = 14, 95% confidence interval [CI] = 2.4 - 82.7); followed by teicoplanin locks with a 83.3% success (RR = 11.7; 95% CI = 2 - 70.2). We observed CoNs isolates with a higher teicoplanin MIC in patients with repeated teicoplanin locks exposure (coefficient = 0.3; 95% CI = 0.11 - 0.47). However, teicoplanin MICs decreased in patients treated with vancomycin locks (coefficient = -0.56; 95% CI = -0.85 - -0.02). Methicillin-resistance decreased with accumulative ALT (RR = 0.82; 95% CI = 0.69 - 0.98). In this study, daptomycin locks achieve the highest eradication rate of CoNS from hemodialysis catheters in vivo.
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Autores:
Falanga, A.;
Ay, C.;
Di Nisio, M.;
et al.
Revista:
ANNALS OF ONCOLOGY
ISSN: 0923-7534
Vol.34
N° 5
2023
págs. 452 - 467
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Autores:
Cortés Jiménez, Adriana;
Marques Cantero, Javier;
Pejenaute Martínez de Lizarrondo, Álvaro;
et al.
Revista:
JOURNAL OF PHYSIOLOGY AND BIOCHEMISTRY
ISSN: 1138-7548
Vol.79
N° 4
2023
págs. 787 - 797
Resumen
Cardiovascular diseases and the ischemic heart disease specifically constitute the main cause of death worldwide. The ischemic heart disease may lead to myocardial infarction, which in turn triggers numerous mechanisms and pathways involved in cardiac repair and remodeling. Our goal in the present study was to characterize the effect of the NADPH oxidase 5 (NOX5) endothelial expression in healthy and infarcted knock-in mice on diverse signaling pathways. The mechanisms studied in the heart of mice were the redox pathway, metalloproteinases and collagen pathway, signaling factors such as NF & kappa;B, AKT or Bcl-2, and adhesion molecules among others. Recent studies support that NOX5 expression in animal models can modify the environment and predisposes organ response to harmful stimuli prior to pathological processes. We found many alterations in the mRNA expression of components involved in cardiac fibrosis as collagen type I or TGF-& beta; and in key players of cardiac apoptosis such as AKT, Bcl-2, or p53. In the heart of NOX5-expressing mice after chronic myocardial infarction, gene alterations were predominant in the redox pathway (NOX2, NOX4, p22phox, or SOD1), but we also found alterations in VCAM-1 and & beta;-MHC expression. Our results suggest that NOX5 endothelial expression in mice preconditions the heart, and we propose that NOX5 has a cardioprotective role. The correlation studies performed between echocardiographic parameters and cardiac mRNA expression supported NOX5 protective action.
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Autores:
Puchulu, M. B. (Autor de correspondencia);
García Fernández, Nuria;
Landry, M. J.
Revista:
JOURNAL OF RENAL NUTRITION
ISSN: 1051-2276
Vol.33
N° 5
2023
págs. 691 - 697
Resumen
The coronavirus disease 2019 pandemic has exacerbated existing health disparities related to food security status. Emerging literature suggests individuals with Chronic Kidney Disease (CKD) who are also food insecure have a greater likelihood of disease progression compared to food secure individuals. However, the complex relationship between CKD and food insecurity (FI) is understudied relative to other chronic conditions. The purpose of this practical application article is to summarize the recent literature on the social-economic, nutritional, to care through which FI may negatively impact health outcomes in individuals with CKD. While several studies have reported on the cross-sectional prevalence of FI among persons with CKD, literature is lacking about the severity and duration of exposure to FI on CKD outcomes. Future research is needed to better understand how FI impairs CKD care, nutritional and structural barriers that impact disease prevention and disease progression, and effective strategies to support patients.
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Autores:
Sánchez-Iñigo, L. (Autor de correspondencia);
Navarro-Gonzalez, D.;
Martínez Urbistondo, Diego;
et al.
Revista:
FRONTIERS IN ENDOCRINOLOGY
ISSN: 1664-2392
Vol.13
2023
págs. 1087554
Resumen
AimsThe association between body mass index (BMI) fluctuation and BMI fluctuation rate with cardiovascular stress morbidities in a Caucasian European cohort was evaluated to ascertain the impact of weight cycling. MethodsA total of 4,312 patients of the Vascular-Metabolic CUN cohort (VMCUN cohort) were examined and followed up during 9.35 years ( +/- 4.39). Cox proportional hazard ratio analyses were performed to assess the risk of developing cardiovascular stress-related diseases (CVDs) across quartiles of BMI fluctuation, measured as the average successive variability (ASV) (ASV = |BMIt0 - BMIt1| + |BMIt1 - BMIt2| + |BMIt2-BMIt3| + horizontal ellipsis + |BMItn - 1 - BMItn|/n - 1), and quartiles of BMI fluctuation rate (ASV/year). ResultsThere were 436 incident cases of CVD-associated events involving 40,323.32 person-years of follow-up. A progressively increased risk of CVD in subjects with greater ASV levels was found. Also, a higher level of ASV/year was significantly associated with an increased risk of developing CVD stress independent of confounding factors with a value of 3.71 (95% CI: 2.71-5.07) for those in the highest quartile and 1.82 (95% CI: 1.33-2.50) for those in the third quartile. ConclusionsThe BMI fluctuation rate seems to be a better predictor than BMI fluctuation of the potential development of cardiovascular stress morbidities. The time-rated weight fluctuations are apparently more determinant in increasing the risk of a CVD than the weight fluctuation itself, which is remarkable in subjects under yo-yo weight patterns for precision medicine.
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Autores:
García-Iglesias, C.;
Puledda, F.;
Echavarria-Iñiguez, A. (Autor de correspondencia);
et al.
Revista:
JOURNAL OF CLINICAL MEDICINE
ISSN: 2077-0383
Vol.12
N° 1
2023
págs. 122
Resumen
Nummular headache (NH) is a primary headache characterized by superficial coin-shaped pain. NUMITOR (NCT 05475769) is an observational study evaluating the responder rate of preventive drugs in NH patients. The treatment response was assessed between weeks 8 and 12 compared with the baseline. Patients were included between February 2002 and October 2022. Demographic and clinical variables were assessed; treatment response was estimated by 50%, 30%, and 75% responder rates and treatment discontinuation due to inadequate tolerability. A total of 183 out of 282 patients fulfilled eligibility criteria and completed the study. Patients were aged 49.5 (standard deviation (SD): 16.8) years, and 60.7% were female. NH phenotype was a parietal circular pain of four centimeters' diameter, moderate intensity, and oppressive quality. At baseline, patients had 25 (interquartile range) pain days per month. Preventive treatment was used by 114 (62.3%) patients. The highest 50% and 75% responder rates corresponded to onabotulinumtoxinA (62.5%, 47.5%), followed by gabapentin (43.7%, 35.2%). Oral preventive drugs were not tolerated by 12.9-25%. The present study provides class IV evidence of the effectiveness of oral preventive drugs and onabotulinumtoxinA in the treatment of primary NH. OnabotulinumtoxinA was the most effective and best-tolerated drug, positioning it as first-line treatment of NH.
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Autores:
Roncal Mancho, Carmen;
Cenarro, A.;
Sáenz de Pipaon Echarren, Goren;
et al.
Revista:
ATHEROSCLEROSIS
ISSN: 0021-9150
Vol.379
N° Supl. 1
2023
-
Autores:
Villino Rodríguez, Rafael Angel;
Esparragosa Vázquez, Inés;
Valentí Azcárate, Rafael;
et al.
Revista:
EUROPEAN JOURNAL OF NEUROLOGY
ISSN: 1351-5101
Vol.30
N° Supl. 1
2023
págs. 377
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Autores:
Martín-Ventura, J. L. (Autor de correspondencia);
Roncal Mancho, Carmen (Autor de correspondencia);
Orbe Lopategui, Josune;
et al.
Revista:
FRONTIERS IN CELL AND DEVELOPMENTAL BIOLOGY
ISSN: 2296-634X
Vol.10
2022
págs. 813885
Resumen
Cardiovascular diseases (CVDs) are the first cause of death worldwide. In recent years, there has been great interest in the analysis of extracellular vesicles (EVs), including exosomes and microparticles, as potential mediators of biological communication between circulating cells/plasma and cells of the vasculature. Besides their activity as biological effectors, EVs have been also investigated as circulating/systemic biomarkers in different acute and chronic CVDs. In this review, the role of EVs as potential diagnostic and prognostic biomarkers in chronic cardiovascular diseases, including atherosclerosis (mainly, peripheral arterial disease, PAD), aortic stenosis (AS) and aortic aneurysms (AAs), will be described. Mechanistically, we will analyze the implication of EVs in pathological processes associated to cardiovascular remodeling, with special emphasis in their role in vascular and valvular calcification. Specifically, we will focus on the participation of EVs in calcium accumulation in the pathological vascular wall and aortic valves, involving the phenotypic change of vascular smooth muscle cells (SMCs) or valvular interstitial cells (IC) to osteoblast-like cells. The knowledge of the implication of EVs in the pathogenic mechanisms of cardiovascular remodeling is still to be completely deciphered but there are promising results supporting their potential translational application to the diagnosis and therapy of different CVDs.
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Autores:
Casajuana, E.;
Clara, A. (Autor de correspondencia);
Grochowicz, Lukasz Karol;
et al.
Revista:
ANNALS OF VASCULAR SURGERY
ISSN: 0890-5096
Vol.80
2022
págs. 395.e1 - 395.e5
Resumen
Background: Isolated testicular pain is an unusual clinical presentation of symptomatic abdominal aortic aneurysms (AAA). We present two patients hemodynamically stable with an isolated acute testicular pain related to an AAA and a review of the published literature up to present. Methods: Two adult-old males with an acute isolated testicular pain presented to the emergency department. Although both cases had their symptoms for more than 24 hours and were hemodynamically stable, the misdiagnosis of a urological condition in one case and a delay of the intervention in the second resulted in a sudden drop of vital signs and the need of an urgent open surgery. Results: A bibliographic review of the 15 published cases is presented. Most cases occurred without a previous diagnosis of AAA. Aneurysms were characteristically very large (mean 10 cm). The initial diagnosis was frequently wrong, attributing the pain mostly to genito-urinary conditions. The testicular pain presented days and even weeks before rupture, which may offer a convenient window of hemodynamic stability for repair. Conclusions: Acute testicular pain in adult-old patients with aneurysm risk factors and specially with a first urological evaluation discarding a genitourinary disorder should alert clinicians to consider the diagnosis of a symptomatic abdominal aortic aneurysm. The early and accurate recognition of these cases may increase the survival.
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Autores:
Santos-Lasaosa, S. (Autor de correspondencia);
Belvis, R.;
Cuadradodo, M. L.;
et al.
Revista:
NEUROLOGIA
ISSN: 0213-4853
Vol.37
N° 5
2022
págs. 390 - 402
Resumen
Introduction: It has been observed in recent years that levels of such molecules as calcitonin gene-related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase-activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients' migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity.Development: The Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics.Conclusions: The clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.
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Autores:
Piñana, J. L. (Autor de correspondencia);
Vázquez, L.;
Martino, R. ;
et al.
Revista:
LEUKEMIA AND LYMPHOMA
ISSN: 1042-8194
Vol.63
N° 3
2022
págs. 538 - 550
Resumen
In the midst of the COVID-19 pandemic, different vaccines in front of SARS-CoV-2 have been approved and administered in different vulnerable populations. As patients with cancer were excluded from pivotal trials of vaccination, little is known on their immunogenic response to these vaccines, particularly in patients with severely impaired immune system. In response to that uncertainty, the Spanish Society of Hematology and Hemotherapy launched an initiative aimed to provide recommendations for vaccination of the main hematological conditions. This document is based on the available information on COVID-19 outcomes, prior knowledge on vaccination in hematological patients, recent published data on serological response in oncohematological patients and expert opinions. New information about SARS-CoV-2 vaccination will be gathered in the near future, providing new scientific grounds to delineate the most adequate management of vaccination in patients with hematological diseases. The current limited data on SARS-CoV-2 vaccines in hematological patients represents a major limitation of this expert consensus opinion. In fact, the speed in which this field evolves may reduce their validity in the near future.
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Autores:
Páramo Fernández, José Antonio (Autor de correspondencia);
Marcos Jubilar, María;
Lecumberri Villamediana, Ramón
Revista:
REVISTA CLINICA ESPAÑOLA
ISSN: 0014-2565
Vol.222
N° 2
2022
págs. 93 - 99
Resumen
Patients with cancer present with an elevated risk of thrombosis, which entails high morbidity and mortality. Various predictive scales that incorporate clinical and biological data have been developed to identify those at high risk of thrombosis, but, in general, they do not allow for the optimal selection of subjects who are candidates for thromboprophylaxis. Recent studies have demonstrated that the mutation profile has a high impact on the risk of thrombosis; this will facilitate developing new predictive models of thrombosis in patients with cancer. (C) 2021 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.
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Autores:
González-Porras, J. R. (Autor de correspondencia);
Mateo, J.;
González-Calle, V.;
et al.
Revista:
CLINICAL AND TRANSLATIONAL ONCOLOGY
ISSN: 1699-048X
Vol.24
N° 5
2022
págs. 770 - 783
Resumen
Venous thromboembolism (VTE) is a serious complication in hematologic neoplasms, so finding adequate prevention strategies is an urgent requirement. However, prospective studies with large enough cohorts are scarce, limiting the development of evidence-based thromboprophylaxis guidelines. The present position paper is addressed to all hematologists treating patients affected by hematologic neoplasms with the aim to provide clinicians with a useful tool for the prevention of VTE.
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Autores:
Marcos Jubilar, María;
Carmona de la Torre, Francisco de Asís;
Vidal, R.;
et al.
Revista:
THROMBOSIS AND HAEMOSTASIS
ISSN: 0340-6245
Vol.122
N° 2
2022
págs. 295 - 299
Resumen
Thromboprophylaxis with low molecular weight heparin in hospitalized patients with COVID-19 is mandatory, unless contraindicated. Given the links between inflammation and thrombosis, the use of higher doses of anticoagulants could improve outcomes. We conducted an open-label, multicenter, randomized, controlled trial in adult patients hospitalized with nonsevere COVID-19 pneumonia and elevated D-dimer. Patients were randomized to therapeutic-dose bemiparin (115 IU/kg daily) versus standard prophylaxis (bemiparin 3,500 IU daily), for 10 days. The primary efficacy outcome was a composite of death, intensive care unit admission, need of mechanical ventilation support, development of moderate/severe acute respiratory distress, and venous or arterial thrombosis within 10 days of enrollment. The primary safety outcome was major bleeding (International Society on Thrombosis and Haemostasis criteria). A prespecified interim analysis was performed when 40% of the planned study population was reached. From October 2020 to May 2021, 70 patients were randomized at 5 sites and 65 were included in the primary analysis; 32 patients allocated to therapeutic dose and 33 to standard prophylactic dose. The primary efficacy outcome occurred in 7 patients (22%) in the therapeutic-dose group and 6 patients (18%) in the prophylactic-dose (absolute risk difference 3.6% [95% confidence interval [CI], -16% -24%]; odds ratio 1.26 [95% CI, 0.37-4.26]; p = 0.95). Discharge in the first 10 days was possible in 66 and 79% of patients, respectively. No major bleeding event was registered. Therefore, in patients with COVID-19 hospitalized with nonsevere pneumonia but elevated D-dimer, the use of a short course of therapeutic-dose bemiparin does not appear to improve clinical outcomes compared with standard prophylactic doses. Trial Registration: ClinicalTrials.gov NCT04604327.
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Autores:
Lecumberri Villamediana, Ramón (Autor de correspondencia);
Marcos Jubilar, María;
Guillén Rienda, Carolina
Revista:
ARCHIVOS DE BRONCONEUMOLOGIA
ISSN: 0300-2896
Vol.58
N° 11
2022
págs. 744 - 745
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Autores:
Zalba Goñi, Guillermo (Autor de correspondencia);
Moreno Zulategui, María de Ujue (Autor de correspondencia)
Revista:
ANTIOXIDANTS
ISSN: 2076-3921
Vol.11
N° 8
2022
págs. 1519
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Autores:
Fernández-Alonso, S.;
Martínez-Aguilar, E.;
Ravassa Albéniz, Susana;
et al.
Revista:
LIFE
ISSN: 2075-1729
Vol.12
N° 6
2022
págs. 823
Resumen
Predicting the progression of small aneurysms is a main challenge in abdominal aortic aneurysm (AAA) management. The combination of circulating biomarkers and image techniques might provide an alternative for risk stratification. We evaluated the association of plasma TAT complexes (TAT) and D-dimer with AAA severity in 3 groups of patients: group 1, without AAA (n = 52), group 2, AAA 40-50 mm (n = 51) and group 3, AAA > 50 mm (n = 50). TAT (p < 0.001) and D-dimer (p < 0.001) were increased in patients with AAA (groups 2 and 3) vs. group 1. To assess the association between baseline TAT and D-dimer concentrations, and AAA growth, aortic diameter and volume (volumetry) were measured by computed tomography angiography (CTA) in group 2 at recruitment (baseline) and 1-year after inclusion. Baseline D-dimer and TAT levels were associated with AAA diameter and volume variations at 1-year independently of confounding factors (p <= 0.044). Additionally, surgery incidence, recorded during a 4-year follow-up in group 2, was associated with larger aneurysms, assessed by aortic diameter and volumetry (p <= 0.036), and with elevated TAT levels (sub-hazard ratio 1.3, p <= 0.029), while no association was found for D-dimer. The combination of hemostatic parameters and image techniques might provide valuable tools to evaluate AAA growth and worse evolution.
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Autores:
Páramo Fernández, José Antonio
Revista:
REUMATOLOGIA CLINICA
ISSN: 1699-258X
Vol.18
N° 1
2022
págs. 1 - 4
Resumen
The haemostatic system acts in concert with inflammation, so that after inflammatory response various mediators activate the haemostatic system through endothelial dysfunction, platelet activation and coagulation promoting thrombosis, which is termed thromboinflammation. In this process, the inflammasome acquires special relevance; its stimulation promotes innate and adaptive immune responses. Inflamma some activation plays an important physiopathological role in several disorders with inflammatory and thrombotic phenomena. The role of thromboinflammation has become relevant in the COVID-19 pandemic, in which a cytokine storm has been described as one of the mechanisms responsible.
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Autores:
Mostaza, J. M. (Autor de correspondencia);
Pinto, X.;
Armario, P.;
et al.
Revista:
CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS
ISSN: 0214-9168
Vol.34
N° 3
2022
págs. 130 - 179
Resumen
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation.
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Autores:
Bajo, M. A. (Autor de correspondencia);
Ríos Moreno, F.;
Arenas, M. D.;
et al.
Revista:
NEFROLOGIA
ISSN: 2013-2514
Vol.42
N° 5
2022
págs. 594 - 606
Resumen
Background and aims: In this study, we show the results of the subset of Spanish patients of the VERIFIE study, the first post-marketing study assessing the long-term safety and effectiveness of sucroferric oxyhydroxide (SFOH) in patients with hyperphosphatemia undergoing dialysis during clinical practice.
Patients and methods: Patients undergoing hemodialysis and peritoneal dialysis with indication of SFOH treatment were included. Follow-up duration was 12-36 months after SFOH initiation. Primary safety variables were the incidence of adverse drug reactions (ADRs), medical events of special interest (MESIs), and variations in iron-related parameters. SFOH effectiveness was evaluated by the change in serum phosphorus levels.
Results: A total of 286 patients were recruited and data from 282 were analyzed. Among those 282 patients, 161 (57.1%) withdrew the study prematurely and 52.5% received concomitant treatment with other phosphate binders. ADRs were observed in 35.1% of patients, the most common of which were gastrointestinal disorders (77.1%) and mild/moderate in severity (83.7%). MESIs were reported in 14.2% of patients, and 93.7% were mild/moderate. An increase in ferritin (386.66ng/mL vs 447.55ng/mL; p=0.0013) and transferrin saturation (28.07% vs 30.34%; p=0.043) was observed from baseline to the last visit (p=0.0013). Serum phosphorus levels progressively decreased from 5.69mg/dL at baseline to 4.84mg/dL at the last visit (p<0.0001), increasing by 32.2% the proportion of patients who achieved serum phosphorus levels ¿5.5mg/dL, with a mean daily SFOH dose of 1.98 pills/day.
Conclusions: SFOH showed a favorable effectiveness profile, a similar safety profile to that observed in the international study with most adverse events of mild/moderate severity, and a low daily pill burden in Spanish patients in dialysis.
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Autores:
Páramo Fernández, José Antonio (Autor de correspondencia);
Lozano, M. L.;
González-Porras, J. R.;
et al.
Revista:
MEDICINA CLINICA
ISSN: 0025-7753
Vol.158
N° 2
2022
págs. 82 - 89
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Autores:
Marques Cantero, Javier;
Fernández Irigoyen, Joaquín;
Ainzua Perez, Elena;
et al.
Revista:
ANTIOXIDANTS
ISSN: 2076-3921
Vol.11
N° 11
2022
págs. 2147
Resumen
NADPH oxidases (NOX) constitute the main reactive oxygen species (ROS) source in blood vessels. An oxidative stress situation due to ROS overproduction can lead into endothelial dysfunction, a molecular mechanism that precedes cardiovascular diseases (CVDs) such as atherosclerosis, myocardial infarction, and stroke. NOX5 is the last discovered member of the NOX family, studied in a lesser extent due to its absence in the rodent genome. Our objective was to describe the phenotypic alterations produced by an oxidative stress situation derived from NOX5 overexpression in an endothelial in vitro model. The in vitro model consists of the hCMEC/D3 cell line, derived from brain microvascular endothelium, infected with a recombinant NOX5-beta adenovirus. After an initial proteomic analysis, three phenotypic alterations detected in silico were studied: cell proliferation and apoptosis, general and mitochondrial metabolism, and migration capacity. NOX5 infection of hCMEC/D3 generates a functional protein and an increase in ROS production. This model produced changes in the whole cell proteome. The in silico analysis together with in vitro validations demonstrated that NOX5 overexpression inhibits proliferation and promotes apoptosis, metabolic alterations and cell migration in hCMEC/D3 cells. NOX5 overexpression in endothelial cells leads to phenotypic changes that can lead to endothelial dysfunction, the onset of atherosclerosis, myocardial infarction, and stroke.
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Autores:
Abasheva, D.;
Dolcet Negre, Marta María;
Fernández Seara, María Asunción;
et al.
Revista:
NUTRIENTS
ISSN: 2072-6643
Vol.14
N° 17
2022
págs. 3484
Resumen
Background: Matrix metalloproteinase-10 (MMP-10) levels increase progressively starting from early diabetic kidney disease (DKD) stages. Vitamin D-3 (vitD(3)) deficit is associated with a higher risk of diabetic microangiopathy. Reduced MMP-10 expression has been observed after exposure to vitD(3). Aim: to assess how vitD(3) status is related to MMP-10 levels in patients with Type 2 diabetes (T2D). Methods: 256 patients with T2D were included in this cross-sectional study. Demographic, clinical and serum MMP-10 and 25-hydroxyvitamin D-3 (25(OH)D-3) levels were collected from each patient. The association between MMP-10 and (25(OH)D-3) levels was assessed using a correlation analysis and fitting a multivariate linear regression model. Results: Serum MMP-10 levels were inversely correlated with circulating 25(OH)D-3 (rho = -0.25; p < 0.001). In the subgroup analysis this correlation was significant in patients with DKD (rho = -0.28; p = 0.001) and in subjects with vitD(3) deficit (rho = -0.24; p = 0.005). In the regression model adjusted for kidney function, body adiposity, smoking and vitD supplementation MMP-10 levels were 68.7 pg/mL lower in patients with 25(OH)D-3 > 20 ng/mL, with respect to <= 20 ng/mL (p = 0.006). Conclusions: vitD(3) repletion status is an independent predictor of MMP-10 levels in T2D patients. Perhaps, high 25(OH)D-3 values should be targeted in these patients in order to prevent vascular complications.
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Autores:
Bikdeli, B. (Autor de correspondencia);
Jiménez, D.;
Demelo-Rodríguez, P.;
et al.
Revista:
VIRUSES-BASEL
ISSN: 1999-4915
Vol.14
N° 2
2022
págs. 178
Resumen
Background: Venous thromboembolism (VTE)-including deep vein thrombosis, pulmonary embolism, and cerebral venous sinus thrombosis (CVST)-may occur early after vaccination against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We sought to describe the site, clinical characteristics, and outcomes of VTE after vaccination against SARS-CoV-2. Methods: In a prospective study using the Registro Informatizado de Enfermedad TromboEmbolica (RIETE) platform, patients with VTE 4-30 days after vaccination against SARS-CoV-2 (1 February 2021 through 30 April 2021) were included. VTE patients recruited from the same centers into RIETE in the same months in 2018-2019 were selected as the reference group. All-cause mortality and major bleeding were the main study outcomes. Results: As of 30 April 2020, 102 patients with post-vaccination VTEs had been identified (28 after adenovirus-based vaccination [ChAdOx1 nCov-19; AstraZeneca] and 74 after mRNA-based vaccination [mRNA-1273; Moderna, and BNT162b2; Pfizer]). Compared with 911 historical controls, patients with VTE after adenovirus-based vaccination more frequently had CVST (10.7% vs. 0.4%, p < 0.001) or thrombosis at multiple sites (17.9% vs. 1.3%, p < 0.001), more frequently had thrombocytopenia (40.7% vs. 14.7%, p < 0.001), and had higher 14-day mortality (14.3% vs. 0.7%; odds ratio [OR]: 25.1; 95% confidence interval [CI]: 6.7-94.9) and major bleeding rates (10.3% vs. 1.0%, OR: 12.03, 95% CI: 3.07-47.13). ...
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Autores:
Navarro Oviedo, Manuel;
Marta-Enguita, J.;
Roncal Mancho, Carmen;
et al.
Revista:
THROMBOSIS AND HAEMOSTASIS
ISSN: 0340-6245
Vol.122
N° 08
2022
págs. 1314 - 1325
Resumen
Background: Intracranial hemorrhage (ICH) is one of the major devastating complications of anticoagulation. Matrix metalloproteinase (MMP) inhibition has been proposed as a novel pharmacological approach for ICH treatment.
Objectives: We evaluated the effects of CM-352 (MMP-fibrinolysis inhibitor) in an experimental ICH model associated with oral anticoagulants as compared with clinically used prothrombin complex concentrate (PCC).
Methods: ICH was induced by collagenase injection into the striatum of wild type (C57BL/6J) anticoagulated mice (warfarin or rivaroxaban) and Mmp10 -/- mice. Hematoma volume and neurological deficits were measured 24 hours later by diaminobenzidine staining and different behavioral tests. Circulating plasminogen activator inhibitor-1 (PAI-1) activity and interleukin-6 (IL-6) were measured in plasma samples and local inflammation was assessed by neutrophil infiltration. Finally, fibrinolytic effects of MMP-10 and rivaroxaban were evaluated by thromboelastometry and thrombin-activatable fibrinolysis inhibitor (TAFI) activation assays.
Results: Only PCC reduced hemorrhage volume and improved functional outcome in warfarin-ICH, but both PCC and CM-352 treatments diminished hemorrhage volume (46%, p < 0.01 and 64%, p < 0.001, respectively) and ameliorated functional outcome in rivaroxaban-ICH. We further demonstrated that CM-352, but not PCC, decreased neutrophil infiltration in the hemorrhage area at 24 hours. The effect of CM-352 could be related to MMP-10 inhibition since Mmp10 -/- mice showed lower hemorrhage volume, better neurological score, reduced IL-6 levels and neutrophil infiltration, and increased PAI-1 after experimental ICH. Finally, we found that CM-352 reduced MMP-10 and rivaroxaban-related fibrinolytic effects in thromboelastometry and TAFI activation.
Conclusion: CM-352 treatment, by diminishing MMPs and rivaroxaban-associated fibrinolytic effects, might be a novel antihemorrhagic strategy for rivaroxaban-associated ICH.
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Autores:
Páramo Fernández, José Antonio (Autor de correspondencia)
Revista:
REUMATOLOGIA CLINICA
ISSN: 1699-258x
Vol.18
N° 1
2022
págs. 1 - 4
Resumen
The haemostatic system acts in concert with inflammation, so that after inflammatory response various mediators activate the haemostatic system through endothelial dysfunction, platelet activation and coagulation promoting thrombosis, which is termed thromboinflammation. In this process, the inflammasome acquires special relevance; its stimulation promotes innate and adaptive immune responses. Inflamma some activation plays an important physiopathological role in several disorders with inflammatory and thrombotic phenomena. The role of thromboinflammation has become relevant in the COVID-19 pandemic, in which a cytokine storm has been described as one of the mechanisms responsible.
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Autores:
Lecumberri Villamediana, Ramón (Autor de correspondencia);
Ruiz Artacho, Pedro Celso;
Tzoran, I.;
et al.
Revista:
THROMBOSIS AND HAEMOSTASIS
ISSN: 0340-6245
Vol.122
N° 9
2022
págs. 1594 - 1602
Resumen
Background: The natural history of patients with hematologic cancer and venous thromboembolism (VTE) has not been consistently evaluated. We aimed to compare the rates of symptomatic recurrent VTE, major bleeding or death during anticoagulant therapy in patients with VTE associated to hematologic vs. solid cancers.
Methods: Consecutive patients with active cancer recruited in RIETE were evaluated. Their baseline characteristics, treatments and outcomes during the course of anticoagulation were compared. Univariate and multivariate competing-risk analysis were performed.
Results: As of December 2020, 16,694 patients with cancer and VTE were recruited. Of these, 1,062 (6.4%) had hematologic cancers. Hematologic patients were less likely to initially present with pulmonary embolism (48% vs. 63%) and more likely with upper-extremity deep vein thrombosis (25% vs. 18%). They also were more likely to have severe thrombocytopenia at baseline (5.6% vs. 0.7%) or to receive chemotherapy (67% vs. 41%). During the course of anticoagulation (median, 150 vs. 127 days), 1,071 patients (6.4%) developed VTE recurrences, 806 (4.8%) suffered major bleeding and 4,136 (24.8%) died. Patients with hematologic cancers had lower rates of recurrent VTE (rate ratio [RR]: 0.73; 95% confidence interval [CI]: 0.56-0.95), major bleeding (RR: 0.72; 95%CI: 0.53-0.98) or all-cause death (RR: 0.49; 95%CI: 0.41-0.57) than those with solid cancers. Patients with multiple myeloma showed the best outcomes.
Conclusions: Patients with hematologic cancers, particularly multiple myeloma, and VTE had better outcomes than those with solid cancers. These findings are relevant for the interpretation of previous clinical trials and the design of future studies.
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Autores:
Lobo, J. L.;
Alonso, S.;
Arenas, J.;
et al.
Revista:
ARCHIVOS DE BRONCONEUMOLOGIA
ISSN: 0300-2896
Vol.58
N° 3
2022
págs. 246 - 254
Resumen
El objetivo del presente documento es actualizar el consenso previo publicado en 2013, en relación con 12 áreas controvertidas en el manejo de la tromboembolia de pulmón (TEP). Para cada área se realizó una exhaustiva revisión bibliográfica y una propuesta de recomendación, sometida a un proceso de debate interno en dos teleconferencias sucesivas. En relación con el diagnóstico, recomendamos no utilizar la escala Pulmonary Embolism Rule Out Criteria (PERC) de forma aislada para descartar la TEP y, cuando haya indicación de dímero D, recomendamos emplear un punto de corte ajustado a la edad. Sugerimos utilizar la angiotomografía computerizada de tórax como prueba de imagen para el diagnóstico de la mayoría de los pacientes con sospecha de la enfermedad. Se recomienda utilizar anticoagulantes de acción directa (en vez de antagonistas de la vitamina K) para el tratamiento de la mayoría de los pacientes con TEP, y se sugiere utilizar anticoagulación para la mayoría de los pacientes con TEP subsegmentaria. Se recomienda no colocar un filtro de vena cava inferior en la mayoría de los pacientes. Si se indica tratamiento de reperfusión, el panel recomienda utilizar fibrinolisis sistémica a dosis completas. La duración de la anticoagulación está condicionada principalmente por la presencia (o ausencia) y el tipo de factor de riesgo para enfermedad tromboembólica venosa, y recomendamos no realizar estudios de trombofilia para decidir la duración de la anticoagulación a la mayoría de los pacientes con TEP. Finalmente, sugerimos no realizar cribado extendido de cáncer oculto en pacientes con TEP.
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Autores:
González-Amor, M.;
García-Redondo, A. B.;
Jorge, I.;
et al.
Revista:
CARDIOVASCULAR RESEARCH
ISSN: 0008-6363
Vol.118
N° 16
2022
págs. 3250 - 3268
Resumen
Aims Interferon-stimulated gene 15 (ISG15) encodes a ubiquitin-like protein that induces a reversible post-translational modification (ISGylation) and can also be secreted as a free form. ISG15 plays an essential role as host-defence response to microbial infection; however, its contribution to vascular damage associated with hypertension is unknown. Methods and results Bioinformatics identified ISG15 as a mediator of hypertension-associated vascular damage. ISG15 expression positively correlated with systolic and diastolic blood pressure and carotid intima-media thickness in human peripheral blood mononuclear cells. Consistently, Isg15 expression was enhanced in aorta from hypertension models and in angiotensin II (AngII)-treated vascular cells and macrophages. Proteomics revealed differential expression of proteins implicated in cardiovascular function, extracellular matrix and remodelling, and vascular redox state in aorta from AngII-infused ISG15(-/-) mice. Moreover, ISG15(-/-) mice were protected against AngII-induced hypertension, vascular stiffness, elastin remodelling, endothelial dysfunction, and expression of inflammatory and oxidative stress markers. Conversely, mice with excessive ISGylation (USP18(C61A)) show enhanced AngII-induced hypertension, vascular fibrosis, inflammation and reactive oxygen species (ROS) generation along with elastin breaks, aortic dilation, and rupture. Accordingly, human and murine abdominal aortic aneurysms showed augmented ISG15 expression. Mechanistically, ISG15 induces vascular ROS production, while antioxidant treatment prevented ISG15-induced endothelial dysfunction and vascular remodelling. Conclusion ISG15 is a novel mediator of vascular damage in hypertension through oxidative stress and inflammation.
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Autores:
Irimia Sieira, Pablo;
García-Azorín, D.;
Núñez, M. (Autor de correspondencia);
et al.
Revista:
JOURNAL OF HEADACHE AND PAIN
ISSN: 1129-2369
Vol.23
N° 1
2022
págs. 78
Resumen
Background Migraine represents a serious burden for national health systems. However, preventive treatment is not optimally applied to reduce the severity and frequency of headache attacks and the related expenses. Our aim was to assess the persistence to traditional migraine prophylaxis available in Spain and its relationship with the healthcare resource use (HRU) and costs. Methods Retrospective observational study with retrospective cohort design of individuals with migraine treated with oral preventive medication for the first time from 01/01/2016 to 30/06/2018. One-year follow-up information was retrieved from the Big-Pac (TM) database. According to their one-year persistence to oral prophylaxis, two study groups were created and describe regarding HRU and healthcare direct and indirect costs using 95% confidence intervals (CI). The analysis of covariance (ANCOVA) was performed as a sensitivity analysis. Patients were considered persistent if they continued on preventive treatment until the end of the study or switched medications within 60 days or less since the last prescription. Non-persistent were those who permanently discontinued or re-initiated a treatment after 60 days. Results Seven thousand eight hundred sixty-six patients started preventive treatment (mean age (SD) 48.2 (14.8) and 80.4% women), of whom 2,545 (32.4%) were persistent for 6 months and 2,390 (30.4%) for 12 months. Most used first-line preventive treatments were antidepressants (3,642; 46.3%) followed by antiepileptics (1,738; 22.1%) and beta-blockers (1,399; 17.8%). The acute treatments prescribed concomitantly with preventives were NSAIDs (4,530; 57.6%), followed by triptans (2,217; 28.2%). First-time preventive treatment prescribers were mostly primary care physicians (6,044; 76.8%) followed by neurologists (1,221; 15.5%). Non-persistent patients required a higher number of primary care visits (mean difference (95%CI): 3.0 (2.6;3.4)) and days of sick leave (2.7 (0.8;4.5)) than the persistent ones. The mean annual expenditure was euro622 (415; 829) higher in patients who not persisted on migraine prophylactic treatment. Conclusions In this study, we observed a high discontinuation rate for migraine prophylaxis which is related to an increase in HRU and costs for non-persistent patients. These results suggest that the treatment adherence implies not only a clinical benefit but also a reduction in HRU and costs.
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Autores:
Falanga, A. (Autor de correspondencia);
Leader, A.;
Ambaglio, C.;
et al.
Revista:
HEMASPHERE
ISSN: 2572-9241
Vol.6
N° 8
2022
págs. e750
Resumen
In cancer patients, thrombocytopenia can result from bone marrow infiltration or from anticancer medications and represents an important limitation for the use of antithrombotic treatments, including anticoagulant, antiplatelet, and fibrinolytic agents. These drugs are often required for prevention or treatment of cancer-associated thrombosis or for cardioembolic prevention in atrial fibrillation in an increasingly older cancer population. Data indicate that cancer remains an independent risk factor for thrombosis even in case of thrombocytopenia, since mild-to-moderate thrombocytopenia does not protect against arterial or venous thrombosis. In addition, cancer patients are at increased risk of antithrombotic drug-associated bleeding, further complicated by thrombocytopenia and acquired hemostatic defects. Furthermore, some anticancer treatments are associated with increased thrombotic risk and may generate interactions affecting the effectiveness or safety of antithrombotic drugs. In this complex scenario, the European Hematology Association in collaboration with the European Society of Cardiology has produced this scientific document to provide a clinical practice guideline to help clinicians in the management of patients with cancer and thrombocytopenia. The Guidelines focus on adult patients with active cancer and a clear indication for anticoagulation, single or dual antiplatelet therapy, their combination, or reperfusion therapy, who have concurrent thrombocytopenia because of either malignancy or anticancer medications. The level of evidence and the strength of the recommendations were discussed according to a Delphi procedure and graded according to the Oxford Centre for Evidence-Based Medicine.
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Autores:
Blanco Di Matteo, Andrés Enrique;
García Fernández, Nuria;
Aguinaga Pérez, Aitziber;
et al.
Revista:
ANTIBIOTICS
ISSN: 2079-6382
Vol.11
N° 12
2022
págs. 1692
Resumen
This study aimed to prove that pre-emptive antimicrobial locks in patients at risk of bacteremia decrease infection. We performed a non-randomized prospective pilot study of hemodialysis patients with tunneled central venous catheters. We drew quantitative blood cultures monthly to detect colonization. Patients with a critical catheter colonization by coagulase-negative staphylococci (defined as counts of 100-999 CFU/mL) were at high risk of developing a catheter-related bloodstream infection. We recommended antimicrobial lock for this set of patients. The nephrologist in charge of the patient decided whether to follow the recommendation or not (i.e., standard of care). We compared bloodstream infection rates between patients treated with antimicrobial lock therapy versus patients treated with the standard of care (i.e., heparin). We enrolled 149 patients and diagnosed 86 episodes of critical catheter colonization by coagulase-negative staphylococci. Patients treated with antimicrobial lock had a relative risk of bloodstream infection of 0.19 when compared with heparin lock (CI 95%, 0.11-0.33, p < 0.001) within three months of treatment. We avoided one catheter-related bloodstream infection for every ten catheter-critical colonizations treated with antimicrobial lock [number needed to treat 10, 95% CI, 5.26-100, p = 0.046]. In conclusion, pre-emptive antimicrobial locks decrease bloodstream infection rates in hemodialysis patients with critical catheter colonization.
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Autores:
Quiroga, B.;
Soler, M. J. (Autor de correspondencia);
Ortiz, A. (Autor de correspondencia);
et al.
Revista:
CLINICAL KIDNEY JOURNAL
ISSN: 2048-8505
Vol.15
N° 10
2022
págs. 1856 - 1864
Resumen
Background Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results A total of 711 patients [67% male, median age (range) 67 (20-89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P = .001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P = .693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P = .001), lower time from booster (P = .043) and past breakthrough SARS-CoV-2 infection (P < .001). Conclusions In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection. Lay Summary Patients on hemodialysis present higher rates of complications derived from SARS-CoV-2 infections. Initial vaccination schedules have demonstrated suboptimal responses in those patients. The aim of the present study is to evaluate the time-course of the humoral response after a booster dose of SARS-CoV-2 RNA-based vaccines (BNT162b2 or mRNA-1273) in patients on hemodialysis. We included 711 patients that had received a booster dose: 545 (77%) 6 months before the initial vaccination and 166 (23%) between 6 and 9 months from the initial vaccination. After the booster, only 6 (<1%) patients presented persistent negative humoral response. During follow-up from Month 6 to Month 9, 35 patients (5%) developed a SARS-CoV-2 infection. Patients that received the booster later, breakthrough SARS-CoV-2 infection and mRNA-1273 booster were associated with higher anti-Spike titers.
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Autores:
Martínez Urbistondo, Diego (Autor de correspondencia);
D'Avola, Delia;
Navarro-González, D.;
et al.
Revista:
JOURNAL OF CLINICAL MEDICINE
ISSN: 2077-0383
Vol.11
N° 17
2022
págs. 5190
Resumen
Introduction: The combination of easy-to-obtain validated biomarkers is interesting in the prognostic evaluation of patients at cardiovascular risk in a precision medicine scenario. The evaluation of the effect modification of insulin resistance and liver fibrosis with the Triglyceride-Glucose index (TyG) and Fibrosis-4 index (FIB4) might provide prognostic information in patients at cardiovascular risk. Patients and methods: A retrospective cohort study was performed with 2055 patients recruited in the Vascular Metabolic CUN cohort. The studied outcome was the incidence rate of major cardiovascular events (MACE). The Systematic Coronary Risk Evaluation (SCORE), FIB4 and TyG indexes were calculated according to validated formulas. Results: FIB4 and TyG showed a synergistic interaction using validated cut-offs for both indexes in the prediction of MACE (Hazard ratio (HR) 1.05 CI95% 1.01-1.08) which remained after adjustment by age, sex, SCORE subgroup, presence of diabetes, or previous MACE using standardized cut-off (HR 2.29 CI95% 1.33-3.94). Finally, a subgroup with significant TyG and FIB4 showed a higher cardiovascular risk in the study population (adjusted HR 3.34 CI 95% 1.94-5.77). Conclusion: The combined interpretation of TyG and FIB4 indexes might have a potential predictive value of major cardiovascular events.
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Autores:
Irimia Sieira, Pablo;
García-Azorín, D.;
García De Polavieja, P.;
et al.
Revista:
VALUE IN HEALTH
ISSN: 1098-3015
Vol.25
N° 1
2022
págs. S269
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Autores:
Abasheva, D.;
Dolcet Negre, Marta María;
Fernández Seara, María Asunción;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.37
N° Supl. 3
2022
págs. I897 - I898
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Autores:
Pérez-Fidalgo, N.;
Marcos Jubilar, María;
Guillén Rienda, Carolina;
et al.
Revista:
THROMBOSIS RESEARCH
ISSN: 0049-3848
Vol.213
N° Supl. 2
2022
págs. S20 - S21
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Autores:
Marcos Jubilar, María;
Huerga Domínguez, Sofia;
Palacios Berraquero, María Luisa;
et al.
Revista:
THROMBOSIS RESEARCH
ISSN: 0049-3848
Vol.213
N° Supl. 2
2022
págs. S32 - S33
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Autores:
Pozo-Rosich, P.;
Poveda, J. L.;
Sánchez, S.;
et al.
Revista:
CEPHALALGIA
ISSN: 0333-1024
Vol.42
N° 1_SUPPL
2022
págs. 118 - 119
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Autores:
Muñoz-Martin, A.;
Lecumberri Villamediana, Ramón;
Souto, J. C.;
et al.
Revista:
THROMBOSIS RESEARCH
ISSN: 0049-3848
Vol.213
N° Supl. 2
2022
págs. S38 - S39
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Autores:
Irimia Sieira, Pablo;
Sánchez, S.;
Crespo, C.;
et al.
Revista:
JOURNAL OF HEADACHE AND PAIN
ISSN: 1129-2369
Vol.23
N° SUPPL 1
2022
págs. * - *
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Autores:
Poveda, J. L.;
Irimia Sieira, Pablo;
Sanchez, S.;
et al.
Revista:
VALUE IN HEALTH
ISSN: 1098-3015
Vol.25
N° 12
2022
págs. S98 - S98
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Autores:
Láinez, J. M.;
Ashina, M.;
Belvís, R.;
et al.
Revista:
REVISTA DE NEUROLOGIA
ISSN: 0210-0010
Vol.72
N° Suppl. 2
2021
págs. S1 - S19
Resumen
Introduction. After the European Headache Federation (EHF) Congress, renowned Spanish neurologists specialised in migraine presented the most significant latest developments in research in this field at the Post-EHF Meeting. Development. The main data presented concerning the treatment of chronic and episodic migraine were addressed, with attention paid more specifically to those related to preventive treatments and real-life experience in the management of the disease. An important review was carried out of the new therapeutic targets and the possibilities they offer in terms of understanding the pathophysiology of migraine and its treatment. An update was also presented of the latest developments in the treatment of migraine with fremanezumab, a monoclonal antibody recently authorised by the European Medicines Agency. Participants were also given an update on the latest developments in basic research on the pathology, as well as an overview of the symptoms of migraine and COVID-19. Finally, the repercussions of migraine in terms of its burden on the care and economic resources of the health system were addressed, along with its impact on society. Conclusions. The meeting summarised the content presented at the 10 EHF Congress, which took place in late June/early July 2020.
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Autores:
Perdomo Zelaya, Carolina María;
García Fernández, Nuria (Autor de correspondencia);
Escalada San Martín, Francisco Javier
Revista:
JOURNAL OF CLINICAL MEDICINE
ISSN: 2077-0383
Vol.10
N° 9
2021
págs. 2040
Resumen
Non-alcoholic fatty liver disease is a highly prevalent disease worldwide with a renowned relation to cardiovascular disease and chronic kidney disease. These diseases share a common pathophysiology including insulin resistance, oxidative stress, chronic inflammation, dysbiosis and genetic susceptibilities. Non-alcoholic fatty liver disease is especially prevalent and more severe in type 2 diabetes. Patients with non-alcoholic fatty liver disease should have liver fibrosis assessment in order to identify those at the highest risk of adverse outcomes so that appropriate management strategies can be implemented. Early diagnosis and treatment of non-alcoholic fatty liver disease could ameliorate the burden of cardiovascular disease and chronic kidney disease.
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Autores:
Páramo Fernández, José Antonio (Autor de correspondencia)
Revista:
MEDICINA CLINICA
ISSN: 0025-7753
Vol.157
N° 12
2021
págs. 583 - 587
Resumen
La hemofilia A y B son trastornos hemorrágicos congénitos causados por deficiencia de los factores VIII y IX de la coagulación, respectivamente. La terapia sustitutiva del factor deficitario ha sido clásicamente la base de la profilaxis y del tratamiento de las complicaciones hemorrágicas, pero presenta varias limitaciones, como la administración frecuente por vía intravenosa, el desarrollo progresivo de artropatía y la presencia de inhibidores. Ello ha motivado la búsqueda de alternativas terapéuticas para un control más efectivo de la hemorragia y mayor facilidad de administración, tales como los factores de vida media extendida, fármacos procoagulantes como emicizumab de administración subcutánea, bloqueo de las vías anticoagulantes naturales (hemostasia rebalanceada) y la terapia génica, con las que se ha conseguido un control efectivo de la hemorragia o se encuentran en fase avanzada de investigación clínica.
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Autores:
Sáenz de Pipaon Echarren, Goren;
Echeverría Andueza, Saioa;
Orbe Lopategui, Josune;
et al.
Revista:
JOURNAL OF CLINICAL MEDICINE
ISSN: 2077-0383
Vol.10
N° 10
2021
págs. 2046
Resumen
Diabetic kidney disease (DKD) is the leading cause of end stage renal disease (ESRD) in developed countries, affecting more than 40% of diabetes mellitus (DM) patients. DKD pathogenesis is multifactorial leading to a clinical presentation characterized by proteinuria, hypertension, and a gradual reduction in kidney function, accompanied by a high incidence of cardiovascular (CV) events and mortality. Unlike other diabetes-related complications, DKD prevalence has failed to decline over the past 30 years, becoming a growing socioeconomic burden. Treatments controlling glucose levels, albuminuria and blood pressure may slow down DKD evolution and reduce CV events, but are not able to completely halt its progression. Moreover, one in five patients with diabetes develop DKD in the absence of albuminuria, and in others nephropathy goes unrecognized at the time of diagnosis, urging to find novel noninvasive and more precise early diagnosis and prognosis biomarkers and therapeutic targets for these patient subgroups. Extracellular vesicles (EVs), especially urinary (u)EVs, have emerged as an alternative for this purpose, as changes in their numbers and composition have been reported in clinical conditions involving DM and renal diseases. In this review, we will summarize the current knowledge on the role of (u)EVs in DKD.
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Autores:
Páramo Fernández, José Antonio (Autor de correspondencia)
Revista:
MEDICINA CLINICA
ISSN: 0025-7753
Vol.156
N° 1
2021
págs. 20 - 25
Resumen
Major bleeding is a common complication of anticoagulant treatment. Risk assessment tools are relevant in the management of patients with atrial fibrillation and venous thromboembolism. The combination of clinical, biological and genetic markers is incorporated to build predictive scores to help in the decision process about intensity and duration of treatment. The optimal management of bleeding involves the application of predictive scores in combination with anticoagulant reversal strategies.
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Autores:
Sáenz de Pipaon Echarren, Goren;
Martínez-Aguilar, E.;
Orbe Lopategui, Josune;
et al.
Revista:
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
ISSN: 1422-0067
Vol.22
N° 7
2021
págs. 3601
Resumen
Peripheral arterial disease (PAD) of the lower extremities is a chronic illness predominantly of atherosclerotic aetiology, associated to traditional cardiovascular (CV) risk factors. It is one of the most prevalent CV conditions worldwide in subjects >65 years, estimated to increase greatly with the aging of the population, becoming a severe socioeconomic problem in the future. The narrowing and thrombotic occlusion of the lower limb arteries impairs the walking function as the disease progresses, increasing the risk of CV events (myocardial infarction and stroke), amputation and death. Despite its poor prognosis, PAD patients are scarcely identified until the disease is advanced, highlighting the need for reliable biomarkers for PAD patient stratification, that might also contribute to define more personalized medical treatments. In this review, we will discuss the usefulness of inflammatory molecules, matrix metalloproteinases (MMPs), and cardiac damage markers, as well as novel components of the liquid biopsy, extracellular vesicles (EVs), and non-coding RNAs for lower limb PAD identification, stratification, and outcome assessment. We will also explore the potential of machine learning methods to build prediction models to refine PAD assessment. In this line, the usefulness of multimarker approaches to evaluate this complex multifactorial disease will be also discussed.
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Autores:
Páramo Fernández, José Antonio (Autor de correspondencia)
Revista:
MEDICINA CLINICA
ISSN: 0025-7753
Vol.156
N° 12
2021
págs. 609 - 614
Resumen
Thrombosis is often present in the microcirculation in a variety of significant human diseases, such as disseminated intravascular coagulation, thrombotic microangiopathy, sickle cell disease, and others. Microvascular thrombosis has also recently been demonstrated in patients with COVID-19 and has been proposed to mediate the pathogenesis of organ injury in the lung and other organs. In many of these conditions, microvascular thrombosis is accompanied by inflammation, an association referred to as thromboinflammation or immunothrombosis. A greater understanding of the links between inflammation and thrombosis in the microcirculation will provide new therapeutic options for human diseases accompanied by microvascular thrombosis.
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Autores:
Gonzalez-Oria, C.;
Belvis, R.;
Cuadrado, M. L.;
et al.
Revista:
NEUROLOGIA
ISSN: 0213-4853
Vol.36
N° 3
2021
págs. 229 - 240
Resumen
Introduction: Medication overuse headache is a secondary headache in which the regular or frequent use of analgesics can increase the frequency of the episodes, causing the transition from episodic to chronic headache. The prevalence of medication overuse headache is approximately 1-2%, with higher rates among women aged 30-50 years and with comorbid psychiatric disorders such as depression or anxiety, or other chronic pain disorders. It is important to be familiar with the management of this disease. To this end, the Spanish Society of Neurology's Headache Study Group has prepared a consensus document addressing this disorder. Development: These guidelines were prepared by a group of neurologists specialising in headache after a systematic literature review and provides consensus recommendations on the proper management and treatment of medication overuse headache. The treatment of medication overuse headache is often complex, and is based on 4 fundamental pillars: education and information about the condition, preventive treatment, discontinuation of the drug being overused, and treatment for withdrawal symptoms. Follow-up of patients at risk of recurrence is important. Conclusions: We hope that this document will be useful in daily clinical practice and that it will update and improve understanding of medication overuse headache management. (C) 2020 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.
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Autores:
Marta-Enguita, J.;
Navarro Oviedo, Manuel;
Rubio-Baines, I.;
et al.
Revista:
JOURNAL OF NEUROINFLAMMATION
ISSN: 1742-2094
Vol.18
N° 1
2021
págs. 3
Resumen
Background Inflammatory response plays an important role in many processes related to acute ischemic stroke (AIS). Calprotectin (S100A8/S100A9), released by monocytes and neutrophils, is a key protein in the regulation of inflammation and thrombosis. The purpose of this study is to evaluate the association of circulating calprotectin with other inflammatory biomarkers and AIS prognosis, as well as the calprotectin content in stroke thrombi. Methods Among the 748 patients treated at a comprehensive stroke center between 2015 and 2017, 413 patients with confirmed acute ischemic injury were prospectively evaluated. Patients with systemic inflammation or infection at onset were excluded. Plasma calprotectin was measured by ELISA in blood samples of AIS patients within the first 24 h. Univariate and multivariate logistic regression models were performed to evaluate its association with mortality and functional independence (FI) at 3 months (defined as modified Rankin Scale < 3) and hemorrhagic transformation (HT) after ischemic stroke. Further, S100A9 was localized by immunostaining in stroke thrombi (n = 44). Results Higher calprotectin levels were associated with 3-month mortality, HT, and lower 3-month FI. After adjusting for potential confounders, plasma calprotectin remained associated with 3-month mortality [OR (95% CI) 2.31 (1.13-4.73)]. Patients with calprotectin >= 2.26 mu g/mL were 4 times more likely to die [OR 4.34 (1.95-9.67)]. Addition of calprotectin to clinical variables led to significant improvement in the discrimination capacity of the model [0.91 (0.87-0.95) vs 0.89 (0.85-0.93); p < 0.05]. A multimarker approach demonstrated that patients with increased calprotectin, CRP, and NLR had the poorest outcome with a mortality rate of 42.3% during follow-up. S100A9 protein, as part of the heterodimer calprotectin, was present in all thrombi retrieved from AIS patients. Mean S100A9 content was 3.5% and tended to be higher in patients who died (p = 0.09). Moreover, it positively correlated with platelets (Pearson r 0.46, p < 0.002), leukocytes (0.45, p < 0.01), and neutrophil elastase (0.70, p < 0.001) thrombus content. Conclusions Plasma calprotectin is an independent predictor of 3-month mortality and provides complementary prognostic information to identify patients with poor outcome after AIS. The presence of S100A9 in stroke thrombi suggests a possible inflammatory mechanism in clot formation, and further studies are needed to determine its influence in resistance to reperfusion.
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Autores:
Cortés Jiménez, Adriana;
Pejenaute Martínez de Lizarrondo, Álvaro;
Marques Cantero, Javier;
et al.
Revista:
ANTIOXIDANTS
ISSN: 2076-3921
Vol.10
N° 2
2021
págs. 194
Resumen
Oxidative stress constitutes a key molecular mechanism in the development of cardiovascular diseases. A potential relationship between reactive oxygen species (ROS) driven by the NADPH oxidase family (NOX) and the unfolded protein response (UPR) has been postulated. Nevertheless, there is a lack of information about the crosstalk between NOX5 homologue and the UPR in a cardiovascular context. The main aim was to analyze NOX5-mediated ROS effects in the UPR and its importance in cardiovascular diseases. To this effect, we used an adenoviral NOX5-beta overexpression model in human aortic endothelial cells (HAEC) and a conditional endothelial NOX5 knock-in mouse. Using expression arrays, we investigated NOX5-induced genomic changes in HAEC. Compared with the control HAEC, 298 genes were differentially expressed. Gene ontology analysis revealed the activation of numerous cellular routes, the most relevant being the UPR pathway. Using real-time PCR and Western Blot experiments, we confirmed that NOX5 overexpression induced changes in the expression of the UPR components, which were associated with increased apoptosis. Moreover, in endothelial-specific NOX5 knock-in mice, we found changes in the expression of the UPR components genes. In these mice, myocardial infarction was performed by permanent coronary artery ligation; however, NOX5 expression was not associated with differences in the UPR components mRNA levels. In these animals, we found significant associations between the U
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Autores:
Belvis, R.;
Irimia Sieira, Pablo (Autor de correspondencia);
Seijo-Fernandez, F.;
et al.
Revista:
NEUROLOGIA
ISSN: 0213-4853
Vol.36
N° 1
2021
págs. 61 - 79
Resumen
Introduction: Numerous invasive and non-invasive neuromodulation devices have been developed and applied to patients with headache and neuralgia in recent years. However, no updated review addresses their safety and efficacy, and no healthcare institution has issued specific recommendations on their use for these 2 conditions. Methods: Neurologists from the Spanish Society of Neurology's (SEN) Headache Study Group and neurosurgeons specialising in functional neurosurgery, selected by the Spanish Society of Neurosurgery (SENEC), performed a comprehensive review of articles on the MEDLI NE database addressing the use of the technique in patients with headache and neuralgia. Results: We present an updated review and establish the first set of consensus recommendations of the SEN and SENC on the use of neuromodulation to treat headache and neuralgia, analysing the current levels of evidence on its effectiveness for each specific condition. Conclusions: Current evidence supports the indication of neuromodulation techniques for patients with refractory headache and neuralgia (especially migraine, cluster headache, and trigeminal neuralgia) selected by neurologists and headache specialists, after pharmacological treatment options are exhausted. Furthermore, we recommend that invasive neuromodulation be debated by multidisciplinary committees, and that the procedure be performed by teams of neurosurgeons specialising in functional neurosurgery, with acceptable rates of morbidity and mortality. (C) 2020 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.
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Autores:
Irimia Sieira, Pablo (Autor de correspondencia);
Martínez Valbuena, Iván;
Mínguez Olaondo, Ane;
et al.
Revista:
CEPHALALGIA
ISSN: 0333-1024
Vol.41
N° 5
2021
págs. 604 - 612
Resumen
Background Recently, amylin and its receptors were found in different structures involved in migraine pathophysiology. Here, we evaluate interictal concentrations of amylin and calcitonin gene-related peptide in peripheral blood as biomarkers for chronic migraine. Methods We prospectively recruited patients with episodic migraine, chronic migraine and healthy controls. Interictal amylin and calcitonin gene-related peptide levels were assessed in blood samples using enzyme linked immunosorbent assay. Results We assessed plasma samples from 58 patients with episodic migraine (mean age 37.71 +/- 10.47, 87.9% female), 191 with chronic migraine (mean age 46.03 +/- 11.93, 95% female), and on 68 healthy controls (mean age 43.58 +/- 11.08 years, 86% female). Body mass index was 25.94 +/- 4.53 kg/m(2) for migraine patients and 25.13 +/- 4.92 kg/m(2) for healthy controls (p = 0.0683). Interictal plasma amylin levels were higher in chronic migraine patients (47.1 pg/mL) than in the episodic migraine patients (28.84 pg/mL, p < 0.0001) and healthy controls (24.74 pg/mL, p < 0.0001). Plasma calcitonin gene-related peptide levels were increased (20.01 pg/mL) in chronic migraine patients when compared to healthy controls (11.37 pg/mL, p = 0.0016), but not to episodic migraine patients (18.89 pg/mL, p = 0.4369). Applying a cut-off concentration of 39.68 pg/mL plasma amylin, the sensitivity to differentiate chronic migraine from healthy controls was 57.6% and the specificity was 88.2%. Variables such as age, analgesic overuse, depression, allodynia, use of preventive medication or a history of aura did not influence the plasma concentrations of amylin or calcitonin gene-related peptide. Conclusion Interictal plasma amylin levels are higher in patients with chronic migraine and may serve as a diagnostic biomarker for chronic migraine.
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Autores:
Caronna, E.;
Gallardo, V. J.;
Alpuente, A.;
et al.
Revista:
NEUROLOGIA
ISSN: 0213-4853
Vol.36
N° 8
2021
págs. 611 - 617
Resumen
Background and objective: CGRP, a neuropeptide involved in migraine pathophysiology, is also known to play a role in the respiratory system and in immunological conditions such as sepsis. We analyzed the impact of the use of CGRP antagonists in patients with migraine during the COVID-19 pandemic, caused by the SARS-CoV-2 coronavirus.
Methods: This is a multicentre cross-sectional study. From May to November 2020, through a national survey distributed by the Spanish Society of Neurology, we collected data about the presence of COVID-19 symptoms including headache and their characteristics and severity in patients with migraine treated with anti-CGRP monoclonal antibodies (mAb), and compared them with patients with migraine not receiving this treatment. We also conducted a subanalysis of patients with COVID-19 symptoms.
Results: We recruited 300 patients with migraine: 51.7% (155/300) were taking anti-CGRP mAbs; 87.3% were women (262/300). Mean age (standard deviation) was 47.1 years (11.6). Forty-one patients (13.7%) met diagnostic criteria for COVID-19, with no statistically significant difference between patients with and without anti-CGRP mAb treatment (16.1% vs 11.0%, respectively; P = .320). Of the patients with COVID-19, 48.8% (20/41) visited the emergency department and 12.2% (5/41) were hospitalised. Likewise, no clinical differences were found between the groups of patients with and without anti-CGRP mAb treatment.
Conclusion: Anti-CGRP mAbs may be safe in clinical practice, presenting no association with increased risk of COVID-19.
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Autores:
García-García, P.;
Reyes, R.;
Rodríguez García, José Antonio;
et al.
Revista:
PHARMACEUTICS
ISSN: 1999-4923
Vol.13
N° 7
2021
págs. 979
Resumen
Biomaterials-mediated bone formation in osteoporosis (OP) is challenging as it requires tissue growth promotion and adequate mineralization. Based on our previous findings, the development of scaffolds combining bone morphogenetic protein 2 (BMP-2) and matrix metalloproteinase 10 (MMP-10) shows promise for OP management. To test our hypothesis, scaffolds containing BMP-2 + MMP-10 at variable ratios or BMP-2 + Alendronate (ALD) were prepared. Systems were characterized and tested in vitro on healthy and OP mesenchymal stem cells and in vivo bone formation was studied on healthy and OP animals. Therapeutic molecules were efficiently encapsulated into PLGA microspheres and embedded into chitosan foams. The use of PLGA (poly(lactic-co-glycolic acid)) microspheres as therapeutic molecule reservoirs allowed them to achieve an in vitro and in vivo controlled release. A beneficial effect on the alkaline phosphatase activity of non-OP cells was observed for both combinations when compared with BMP-2 alone. This effect was not detected on OP cells where all treatments promoted a similar increase in ALP activity compared with control. The in vivo results indicated a positive effect of the BMP-2 + MMP-10 combination at both of the doses tested on tissue repair for OP mice while it had the opposite effect on non-OP animals. This fact can be explained by the scaffold's slow-release rate and degradation that could be beneficial for delayed bone regeneration conditions but had the reverse effect on healthy animals. Therefore, the development of adequate scaffolds for bone regeneration requires consideration of the tissue catabolic/anabolic balance to obtain biomaterials with degradation/release behaviors suited for the existing tissue status.
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Autores:
Bornstein, R. (Autor de correspondencia);
Páramo Fernández, José Antonio
Revista:
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
ISSN: 0929-5305
Vol.51
N° 3
2021
págs. 633 - 636
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Autores:
Panizo Morgado, Elena;
Páramo Fernández, José Antonio
Revista:
PEDIATRIA INTEGRAL
ISSN: 1135-4542
Vol.25
N° 5
2021
págs. 265.e1 - 265.e11
Resumen
La hemostasia comprende un complejo sistema de reacciones en cadena, sinérgicas y coordinadas, cuya finalidad última es mantener la sangre fluida en el interior de los vasos sanguíneos. Para ello, existe un delicado equilibrio entre los factores procoagulantes y anticoagulantes. Disponemos de una amplia variedad de pruebas analíticas que exploran el sistema hemostático en sus distintas fases (hemostasia primaria, hemostasia secundaria y fibrinólisis). Para poder solicitarlas con criterio y saber interpretarlas, es preciso tener unas nociones básicas de la fisiología de la hemostasia. En el presente artículo, se explican las bases fisiológicas de la coagulación, haciendo hincapié en las peculiaridades de la ¿hemostasia del desarrollo¿ del niño y se exponen las pruebas de estudio disponibles, sus indicaciones y su interpretación.
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Autores:
Avendaño-Sola, C.;
de la Cámara, R.;
Castellanos, M.;
et al.
Revista:
NEUROLOGIA
ISSN: 0213-4853
Vol.36
N° 6
2021
págs. 451 - 461
Resumen
Introduction: Cases of cerebral venous sinus thrombosis have been reported in individuals vaccinated against COVID-19 with non-replicating adenoviral vector vaccines. We issue our recommendations on the diagnosis and management of patients presenting this complication. Method: The multidisciplinary working group, led by the Spanish Federation of Medical and Scientific Associations and including representatives of several scientific societies, reviewed the available evidence from the literature and reports of the European Medicines Agency. We establish a definition for suspected cases and issue diagnostic and treatment recommendations regarding vaccine-induced immune thrombotic thrombocytopaenia. Results: We define suspected cases as those cases of cerebral venous sinus thrombosis occurring between 3 and 21 days after the administration of non-replicating adenoviral vector vaccines, in patients with a platelet count below 150,000/4 or presenting a decrease of 50% with respect to the previous value. Findings suggestive of vaccine-induced immune thrombotic thrombocytopaenia include the presence of antibodies to platelet factor 4, D-dimer levels 4 times greater than the upper limit of normal, and unexplained thrombosis. The recommended treatment includes intravenous administration of non-specific human immunoglobulin or alternatively plasmapheresis, avoiding the use of heparin, instead employing argatroban, bivalirudin, fondaparinux, rivaroxaban, or apixaban for anticoagulation, and avoiding platelet transfusion. Conclusions: Non-replicating adenoviral vector vaccines may be associated with cerebral venous sinus thrombosis with thrombocytopaenia; it is important to treat the dysimmune phenomenon and the cerebral venous sinus thrombosis. (C) 2021 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.
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Autores:
Gómez-Outes, A. (Autor de correspondencia);
Alcubilla, P.;
Calvo-Rojas, G.;
et al.
Revista:
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
ISSN: 0735-1097
Vol.77
N° 24
2021
págs. 2987 - 3001
Resumen
BACKGROUND Direct oral anticoagulants (DOACs) have shown a positive benefit-risk balance in both clinical trials and real-world data, but approximately 2% to 3.5% of patients experience major bleeding annually. Many of these patients require hospitalization, and the administration of reversal agents may be required to control bleeding. OBJECTIVES The aim of this study was to investigate clinical outcomes associated with the use of 4-factor pro thrombin complex concentrates, idarucizumab, or andexanet for reversal of severe DOAC-associated bleeding. METHODS The investigators systematically searched for studies of reversal agents for the treatment of severe bleeding associated with DOAC. Mortality rates, thromboembolic events, and hemostatic efficacy were meta-analyzed using a random effects model. RESULTS The investigators evaluated 60 studies in 4,735 patients with severe DOAC-related bleeding who were treated with 4-factor prothrombin complex concentrates (n = 2,688), idarucizumab (n = 1,111), or andexanet (n = 936). The mortality rate was 17.7% (95% confidence interval [CI]: 15.1% to 20.4%), and it was higher in patients with intracranial bleedings (20.2%) than in patients with extracranial hemorrhages (15.4%). The thromboembolism rate was 4.6% (95% CI: 3.3% to 6.0%), being particularly high with andexanet (10.7%; 95% CI: 6.5% to 15.7%). The effective hemostasis rate was 78.5% (95% CI: 75.1% to 81.8%) and was similar regardless of the reversal agent considered. The rebleed
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Autores:
Riera-Mestre, A. (Autor de correspondencia);
Jara-Palomares, L.;
Lecumberri Villamediana, Ramón;
et al.
Revista:
VIRUSES-BASEL
ISSN: 1999-4915
Vol.13
N° 11
2021
págs. 2128
Resumen
Patients with coronavirus disease 2019 (COVID-19) have a higher risk of venous thromboembolic disease (VTE) than patients with other infectious or inflammatory diseases, both as macrothrombosis (pulmonar embolism and deep vein thrombosis) or microthrombosis. However, the use of anticoagulation in this scenario remains controversial. This is a project that used DELPHI methodology to answer PICO questions related to anticoagulation in patients with COVID-19. The objective was to reach a consensus among multidisciplinary VTE experts providing answers to those PICO questions. Seven PICO questions regarding patients with COVID-19 responded with a broad consensus: 1. It is recommended to avoid pharmacological thromboprophylaxis in most COVID-19 patients not requiring hospital admission; 2. In most hospitalized patients for COVID-19 who are receiving oral anticoagulants before admission, it is recommended to replace them by low molecular weight heparin (LMWH) at therapeutic doses; 3. Thromboprophylaxis with LMWH at standard doses is suggested for COVID-19 patients admitted to a conventional hospital ward; 4. Standard-doses thromboprophylaxis with LMWH is recommended for COVID-19 patients requiring admission to Intensive Care Unit; 5. It is recommended not to determine D-Dimer levels routinely in COVID-19 hospitalized patients to select those in whom VTE should be suspected, or as a part of the diagnostic algorithm to rule out or confirm a VTE event; 6. It is recommended to discontinue pharmacological thromboprophylaxis at discharge in most patients hospitalized for COVID-19; 7. It is recommended to withdraw anticoagulant treatment after 3 months in most patients with a VTE event associated with COVID-19. The combination of PICO questions and DELPHI methodology provides a consensus on different recommendations for anticoagulation management in patients with COVID-19.
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Autores:
Marta Enguita, J.;
Navarro Oviedo, Manuel;
Muñoz, R.;
et al.
Revista:
FRONTIERS IN NEUROLOGY
ISSN: 1664-2295
Vol.12
2021
págs. 599498
Resumen
Background: Actual clinical management of ischemic stroke (IS) is based on restoring cerebral blood flow using tissue plasminogen activator (tPA) and/or endovascular treatment (EVT). Mechanical thrombectomy has permitted the analysis of thrombus structural and cellular classic components. Nevertheless, histological assessment of hemostatic parameters such as thrombin-activatable fibrinolysis inhibitor (TAFI) and matrix metalloproteinase 10 (MMP-10) remains unknown, although their presence could determine thrombus stability and its response to thrombolytic treatment, improving patient's outcome. Methods: We collected thrombi (n = 45) from large vessel occlusion (LVO) stroke patients (n = 53) and performed a histological analysis of different hemostatic parameters [TAFI, MMP-10, von Willebrand factor (VWF), and fibrin] and cellular components (erythrocytes, leukocytes, macrophages, lymphocytes, and platelets). Additionally, we evaluated the association of these parameters with plasma levels of MMP-10, TAFI and VWF activity and recorded clinical variables. Results: In this study, we report for the first time the presence of MMP-10 and TAFI in all thrombi collected from LVO patients. Both proteins were localized in regions of inflammatory cells, surrounded by erythrocyte and platelet-rich areas, and their content was significantly associated (r = 0.41, p < 0.01). Thrombus TAFI was lower in patients who died during the first 3 months after stroke onset [odds ratio (OR) (95%CI); 0.59 (0.36-0.98), p = 0.043]. Likewise, we observed that thrombus MMP-10 was inversely correlated with the amount of VWF (r = -0.30, p < 0.05). Besides, VWF was associated with the presence of leukocytes (r = 0.37, p < 0.05), platelets (r = 0.32, p < 0.05), and 3 months mortality [OR (95%CI); 4.5 (1.2-17.1), p = 0.029]. Finally, plasma levels of TAFI correlated with circulating and thrombus platelets, while plasma MMP-10 was associated with cardiovascular risk factors and functional dependence at 3 months. Conclusions: The present study suggests that the composition and distribution of thrombus hemostatic components might have clinical impact by influencing the response to pharmacological and mechanical therapies as well as guiding the development of new therapeutic strategies.
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Autores:
Marcos Jubilar, María (Autor de correspondencia);
Orbe Lopategui, Josune;
Roncal Mancho, Carmen;
et al.
Revista:
LIFE
ISSN: 2075-1729
Vol.11
N° 5
2021
págs. 414
Resumen
BACKGROUND: Atherosclerosis is the main etiology of cardiovascular diseases (CVD), associated to systemic inflammation. Matrix metalloproteinases (MMPs) are related to atherosclerosis progression through the SDF1/CXCR4 axis promoting macrophages recruitment within the vascular wall. The goal was to assess new circulatory inflammatory markers in relation to atherosclerosis. METHODS: Measurement of SDF1, MMP12 and CRP in blood samples of 298 prospective patients with cardiovascular risk. To explore atherosclerosis progression, CXCR4/SDF1 axis and MMP12 expression were determined by RT-qPCR and by immunohistochemistry in the aorta of accelerated and delayed atherosclerosis mice models (Apoe-/- and Apoe-/-Mmp10-/-). RESULTS: SDF1, MMP12 and CRP were elevated in patients with clinical atherosclerosis, but after controlling by confounding factors, only SDF1 and CRP remained increased. Having high levels of both biomarkers showed 2.8-fold increased risk of presenting clinical atherosclerosis (p = 0.022). Patients with elevated SDF1, MMP12 and CRP showed increased risk of death in follow-up (HR = 3.2, 95%CI: 1.5-7.0, p = 0.004). Gene and protein expression of CXCR4 and MMP12 were increased in aortas from Apoe-/- mice. CONCLUSIONS: The combination of high circulating SDF1, MMP12 and CRP identified patients with particular inflammatory cardiovascular risk and increased mortality. SDF1/CXCR4 axis and MMP12 involvement in atherosclerosis development suggests that they could be possible atherosclerotic targets.
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Autores:
Lecumberri Villamediana, Ramón (Autor de correspondencia);
Jiménez, L.;
Ruiz Artacho, Pedro Celso;
et al.
Revista:
TH OPEN
ISSN: 2567-3459
Vol.5
N° 3
2021
págs. e319 - e328
Resumen
The performance of validated bleeding risk scores in patients with venous thromboembolism (VTE) could be different depending on the time after index event or the site of bleeding. In this study we compared the "classic" Registro Informatizado de Enfermedad TromboEmbólica (RIETE) score and the more recently developed VTE-BLEED score for the prediction of major bleeding in patients under anticoagulant therapy in different time intervals after VTE diagnosis. Out of 82,239 patients with acute VTE, the proportion of high-risk patients according to the RIETE and VTE-BLEED scores was 7.1 and 62.3%, respectively. The performance of both scores across the different study periods (first 30 days after VTE diagnosis, days 31-90, days 91-180, and days 181-360) was similar, with areas under the receiving operating characteristics (ROC) curve (AUC) ranging between 0.69 and 0.72. However, the positive predictive values were low, ranging between 0.6 and 3.9 (better for early major bleeding than for later periods). A sensitivity analysis limited to patients with unprovoked VTE showed comparable results. Both scores showed a trend toward a better prediction of extracranial than intracranial major bleeding, the RIETE score resulting more useful for early extracranial bleeding and the VTE-BLEED for late intracranial hemorrhages. Our study reveals that the usefulness of available bleeding scores may vary depending on the characteristics of the patient population and the time frame evaluated. ...
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Autores:
Sáenz de Pipaon Echarren, Goren;
Van Der Bent, M. L.;
Martínez-Aguilar, E.;
et al.
Revista:
ATHEROSCLEROSIS
ISSN: 0021-9150
Vol.331
2021
págs. E221 - E221
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Autores:
Irimia Sieira, Pablo;
García-Azorín, D.;
Núñez, M.;
et al.
Revista:
JOURNAL OF THE NEUROLOGICAL SCIENCES
ISSN: 0022-510X
Vol.429
N° Supl. S
2021
págs. 232
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Autores:
Figueroa, R. E.;
Marcos Jubilar, María;
García-Mouriz, A.;
et al.
Revista:
THROMBOSIS RESEARCH
ISSN: 0049-3848
Vol.200
N° Supl. 1
2021
págs. S7 - S7
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Autores:
Figueroa, R. E.;
Marcos Jubilar, María;
García-Mouriz, A.;
et al.
Revista:
THROMBOSIS RESEARCH
ISSN: 0049-3848
Vol.200
N° Supl. 1
2021
págs. S77 - S78
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Autores:
Santos-Lasaosa, S. (Autor de correspondencia);
Cuadrado, M. L.;
Gago-Veiga, A. B.;
et al.
Revista:
NEUROLOGIA
ISSN: 0213-4853
Vol.35
N° 8
2020
págs. 568 - 578
Resumen
Introduction: In the field of headaches, onabotulinumtoxinA (onabotA) is well established as a treatment for chronic migraine (CM). In recent years, it has been used increasingly to treat other primary headaches (high-frequency episodic migraine, trigeminal-autonomic cephatalgias, nummular headache) and trigeminal neuralgia. As this treatment will progressively be incorporated in the management of these patients, we consider it necessary to reflect, with a fundamentally practical approach, on the possible indications of onabotA, beyond CM, as well as its administration protocol, which will differ according to the type of headache and/or neuralgia. Development: This consensus document was drafted based on a thorough review and analysis of the existing literature and our own clinical experience. The aim of the document is to serve as guidelines for professionals administering onabotA treatment. The first part will address onabotA's mechanism of action, and reasons for its use in other types of headache, from a physiopathological and clinical perspective. In the second part, we will review the available evidence and studies published in recent years. We will add an "expert recommendation" based on our own clinical experience, showing the best patient profile for this treatment and the most adequate dose and administration protocol. Conclusion: Treatment with onabotA should always be individualised and considered in selected patients who have not responded to conventional therapy. (C) 2017 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.
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Autores:
Schunemann, H. J. (Autor de correspondencia);
Ventresca, M.;
Crowther, M.;
et al.
Revista:
THE LANCET. HAEMATOLOGY
ISSN: 2352-3026
Vol.7
N° 10
2020
págs. e746 - e755
Resumen
Background Study-level meta-analyses provide high-certainty evidence that heparin reduces the risk of symptomatic venous thromboembolism for patients with cancer; however, whether the benefits and harms associated with heparin differ by cancer type is unclear. This individual participant data meta-analysis of randomised controlled trials examines the effect of heparin on survival, venous thromboembolism, and bleeding in patients with cancer in general and by type. Methods In this systematic review and meta-analysis we searched MEDLINE, Embase, and The Cochrane Library for randomised controlled trials comparing parenteral anticoagulants with placebo or standard care in ambulatory patients with solid tumours and no indication for anticoagulation published from the inception of each database to January 14, 2017, and updated it on May 14, 2020, without language restrictions. We calculated the effect of parenteral anticoagulant administration on all-cause mortality, venous thromboembolism occurrence, and bleeding related outcomes through multivariable hierarchical models with patient-level variables as fixed effects and a categorical trial variable as a random effect, adjusting for age, cancer type, and metastatic status. Interaction terms were tested to investigate effects in predefined subgroups. This study is registered with PROSPERO, CRD42013003526. Findings We obtained individual participant data from 14 of 20 eligible randomised controlled trials (8278 [79%] of 10 431 participants; 4139 included in the low-molecular-weight heparin group and 4139 in the control group). Meta-analysis showed an adjusted relative risk (RR) of mortality at 1 year of 0.99 (95% CI 0.93-1.06) and a hazard ratio of 1.01 (95% CI 0.96-1.07). The number of patients with venous thromboembolic events was 158 (4.0%) of 3958 with available data in the low-molecular-weight heparin group compared with 279 (7.1%) of 3957 in the control group. Major bleeding events occurred in 71 (1.7%) of 4139 patients in the control population and 88 (2.1%) in the low-molecular-weight heparin group, and minor bleeding events in 478 (12.1%) of 3945 patients with available data in the control group and 652 (16.6%) of 3937 patients in the low-molecular-weight heparin group. The adjusted RR was 0.58 (95% CI 0.47-0.71) for venous thromboembolism, 1.27 (0.92-1.74) for major bleeding, and 1.34 (1.19-1.51) for minor bleeding. Prespecified subgroup analysis of venous thromboembolism occurrence by cancer type identified the most certain benefit from heparin treatment in patients with lung cancer (RR 0.59 [95% CI 0.42-0.81]), which dominated the overall reduction in venous thromboembolism. Certainty of the evidence for the outcomes ranged from moderate to high. Interpretation Low-molecular-weight heparin reduces risk of venous thromboembolism without increasing risk of major bleeding compared with placebo or standard care in patients with solid tumours, but it does not improve survival. Copyright (C) 2020 Elsevier Ltd. All rights reserved.
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Autores:
García Fernández, Nuria (Autor de correspondencia);
Jacobs-Cacha, C.;
Mora Gutiérrez, Jose María;
et al.
Revista:
JOURNAL OF CLINICAL MEDICINE
ISSN: 2077-0383
Vol.9
N° 2
2020
págs. 472
Resumen
Abstract: Around the world diabetic kidney disease (DKD) is the main cause of chronic kidney disease (CKD), which is characterized by mesangial expansion, glomerulosclerosis, tubular atrophy, and interstitial fibrosis. The hallmark of the pathogenesis of DKD is an increased extracellular matrix (ECM) accumulation causing thickening of the glomerular and tubular basement membranes, mesangial expansion, sclerosis, and tubulointerstitial fibrosis. The matrix metalloproteases (MMPs) family are composed of zinc-dependent enzymes involved in the degradation and hydrolysis of ECM components. Several MMPs are expressed in the kidney; nephron compartments, vasculature and connective tissue. Given their important role in DKD, several studies have been performed in patients with DKD proposing that the measurement of their activity in serum or in urine may become in the future markers of early DKD. Studies from diabetic nephropathy experimental models suggest
that a balance between MMPs levels and their inhibitors is needed to maintain renal homeostasis. This review focuses in the importance of the MMPs within the kidney and their modifications at the circulation, kidney and urine in patients with DKD. We also cover the most important studies performed in experimental models of diabetes in terms of MMPs levels, renal expression and its down-regulation effect.
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Autores:
Lou-Mercade, A. C.;
Gavin, O.;
Oros, D.;
et al.
Revista:
ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN: 0960-7692
Vol.56
N° 1
2020
págs. 111 - 112
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Autores:
Navarro Oviedo, Manuel;
Munoz-Arrondo, R.;
Zandio, B.;
et al.
Revista:
SCIENTIFIC REPORTS
ISSN: 2045-2322
Vol.10
N° 1
2020
págs. 10329
Resumen
Matrix metalloproteinases (MMPs) are proteolytic zinc-endopeptidases regulated by tissue Inhibitors of matrix metalloproteinases (TIMPs). We evaluated the potential of MMPs and TIMPs as clinical tools for Intracranial Haemorrhage (ICH). Spontaneous non-traumatic ICH patients were recruited from two hospitals: Complejo Hospitalario de Navarra (CHN=29) and Vall d ' Hebron (VdH=76). Plasmatic levels of MMP-1, -2, -7, -9, -10 and TIMP-1 and their relationship with clinical, radiological and functional variables were evaluated. We further studied the effect of TIMP-1 (0.05-0.2mg/Kg) in an experimental tail-bleeding model. In CHN, TIMP-1 was associated with admission-hematoma volume and MMP-7 was elevated in patients with deep when compared to lobar hematoma. In VdH, admission-hematoma volume was associated with TIMP-1 and MMP-7. When data from both hospitals were combined, we observed that an increase in 1ng/ml in TIMP-1 was associated with an increase of 0.14ml in haemorrhage (combined beta =0.14, 95% CI=0.08-0.21). Likewise, mice receiving TIMP-1 (0.2mg/Kg) showed a shorter bleeding time (p<0.01). Therefore, the association of TIMP-1 with hematoma volume in two independent ICH cohorts suggests its potential as ICH biomarker. Moreover, increased TIMP-1 might not be sufficient to counterbalance MMPs upregulation indicating that TIMP-1 administration might be a beneficial strategy for ICH.
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Autores:
Mora Gutiérrez, Jose María;
Rodríguez García, José Antonio;
Fernández Seara, María Asunción;
et al.
Revista:
SCIENTIFIC REPORTS
ISSN: 2045-2322
Vol.10
N° 1
2020
Resumen
Matrix metalloproteinases have been implicated in diabetic microvascular complications. However, little is known about the pathophysiological links between MMP-10 and the renin-angiotensin system (RAS) in diabetic kidney disease (DKD). We tested the hypothesis that MMP-10 may be up-regulated in early stage DKD, and could be down-regulated by angiotensin II receptor blockade (telmisartan). Serum MMP-10 and TIMP-1 levels were measured in 268 type 2 diabetic subjects and 111 controls. Furthermore, histological and molecular analyses were performed to evaluate the renal expression of Mmp10 and Timp1 in a murine model of early type 2 DKD (db/db) after telmisartan treatment. MMP-10 (473¿±¿274¿pg/ml vs. 332¿±¿151; p¿=¿0.02) and TIMP-1 (573¿±¿296¿ng/ml vs. 375¿±¿317; p¿<¿0.001) levels were significantly increased in diabetic patients as compared to controls. An early increase in MMP-10 and TIMP-1 was observed and a further progressive elevation was found as DKD progressed to end-stage renal disease. Diabetic mice had 4-fold greater glomerular Mmp10 expression and significant albuminuria compared to wild-type, which was prevented by telmisartan. MMP-10 and TIMP-1 are increased from the early stages of type 2 diabetes. Prevention of MMP-10 upregulation observed in diabetic mice could be another protective mechanism of RAS blockade in DKD.
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Autores:
Lecumberri Villamediana, Ramón (Autor de correspondencia);
Krsnik, I. ;
Askari, E.;
et al.
Revista:
AMYLOID-JOURNAL OF PROTEIN FOLDING DISORDERS
ISSN: 1350-6129
Vol.27
N° 3
2020
págs. 163 - 167
Resumen
Management of patients with relapsed or refractory (R/R) AL amyloidosis is complex. Some initial reports have shown positive results with daratumumab in heavily pre-treated AL amyloidosis patients. In this retrospective multicentric study, 38 patients (mean age 64 +/- 9 years) with R/R AL amyloidosis treated with daratumumab were included. Cardiac and renal involvement was present in 76 and 74% of patients, and 42% had >= 3 organs involved. Median number of previous lines of therapy was 2 (range 1-8). Overall hematological response was 72%, including 28% complete responses. The median time to first hematological response was 2 weeks. A high-quality response (>= very good partial response) was obtained in 65% of patients who had never achieved such depth of response previously. Hematological responses were more frequent among patients receiving daratumumab as second-line therapy compared to subsequent therapies (92 vs. 61%). Cardiac and renal organ response rates were 37 and 59%. At 12 months, overall and progression-free survival were 59% (95%CI: 0.36-0.77) and 52% (95%CI: 0.29-0.70), respectively. Daratumumab is a safe and effective drug in the treatment of R/R AL amyloidosis and should be considered early in the course of the disease.
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Autores:
Moreno Ajona, David;
Irimia Sieira, Pablo (Autor de correspondencia);
Rodríguez García, José Antonio;
et al.
Revista:
BMC CARDIOVASCULAR DISORDERS
ISSN: 1471-2261
Vol.20
N° 1
2020
págs. 93
Resumen
Background Major adverse cardiovascular events are the main cause of morbidity and mortality over the long term in patients undergoing carotid endarterectomy. There are few reports assessing the prognostic value of markers of inflammation in relation to the risk of cardiovascular disease after carotid endarterectomy. Here, we aimed to determine whether matrix metalloproteinases (MMP-1, MMP-2, MMP-7, MMP-9 and MMP-10), tissue inhibitor of MMPs (TIMP-1) and in vivo inflammation studied by F-18-FDG-PET/CT predict recurrent cardiovascular events in patients with carotid stenosis who underwent endarterectomy. Methods This prospective cohort study was carried out on 31 consecutive patients with symptomatic (23/31) or asymptomatic (8/31) severe (> 70%) carotid stenosis who were scheduled for carotid endarterectomy between July 2013 and March 2016. In addition, 26 healthy controls were included in the study. Plasma and serum samples were collected 2 days prior to surgery and tested for MMP-1, MMP-2, MMP-7, MMP-9, MMP-10, TIMP-1, high-density lipoprotein, low-density lipoprotein, high-sensitivity C-reactive protein and erythrocyte sedimentation rate. F-18-FDG-PET/CT focusing on several territories' vascular wall metabolism was performed on 29 of the patients because of no presurgical availability in 2 symptomatic patients. Histological and immunohistochemical studies were performed with antibodies targeting MMP-10, MMP-9, TIMP-1 and CD68. Results The patients with carotid stenosis had significantly more circulating MMP-1, MMP-7 and MMP-10 than the healthy controls. Intraplaque TIMP-1 was correlated with its plasma level (r = 0.42 P = .02) and with F-18-FDG uptake (r = 0.38 P = .05). We did not find any correlation between circulating MMPs and in vivo carotid plaque metabolism assessed by F-18-FDG-PET. After a median follow-up of 1077 days, 4 cerebrovascular, 7 cardiovascular and 11 peripheral vascular events requiring hospitalization were registered. Circulating MMP-7 was capable of predicting events over and above the traditional risk factors (HR = 1.15 P = .006). When the model was associated with the variables of interest, the risk predicted by F-18-FDG-PET was not significant. Conclusions Circulating MMP-7 may represent a novel marker for recurrent cardiovascular events in patients with moderate to severe carotid stenosis. MMP-7 may reflect the atherosclerotic burden but not plaque inflammation in this specific vascular territory.
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Autores:
Alpuente, A. ;
Gallardo, V. J.;
Torres-Ferrus, M.;
et al.
Revista:
EUROPEAN JOURNAL OF NEUROLOGY
ISSN: 1351-5101
Vol.27
N° 10
2020
págs. 2102 - 2108
Resumen
Background and purpose OnabotulinumtoxinA is an effective preventive treatment for chronic migraine (CM). In CM, in addition to a reduction in headache frequency, a decreased reliance on oral prophylactics is also indicative of treatment effectiveness. This study aimed to quantify the change in the use of oral prophylactics after treatment with onabotulinumtoxinA in patients with CM. Methods This was a retrospective, multicentric, cross-sectional study. Patients with CM (International Classification of Headache Disorders-3beta) that had been treated with onabotulinumtoxinA were enrolled consecutively. We collected parameters related to each patient's pre-treatment situation, as well as their current situation, focusing on frequency and intensity of migraine, number of oral prophylactics and the respective cycle of onabotulinumtoxinA. Univariate and logistic regression analyses were performed. Results We included 542 patients, 90.0% of whom were taking oral preventive treatments. During treatment with onabotulinumtoxinA, 47.8% withdrew at least one prophylactic and 41.6% stopped using oral prophylactics altogether. Factors associated with a reduction or cessation of oral prophylactics were >50% improvement in frequency and intensity, remission to episodic migraine, use of topiramate as an initial treatment, increased number of infiltrations and shorter chronification period (P < 0.05). The multivariate analysis showed that a chronification period <20 months, more than five cycles of onabotulinumtoxinA, >50% improvement in pain intensity and topiramate as an initial treatment were predictors of a reduction in oral prophylactics (area under the curve, 70.3%;P < 0.001). Conclusions Our study demonstrated the efficacy and safety of onabotulinumtoxinA. This treatment reduced the use of oral prophylactics. Withdrawal of oral prophylactics was most likely to occur after five cycles of treatment.
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Autores:
van-Es, N.;
Ventresca, M.;
Di-Nisio, M.;
et al.
Revista:
JOURNAL OF THROMBOSIS AND HAEMOSTASIS
ISSN: 1538-7933
Vol.18
N° 8
2020
págs. 1940 - 1951
Resumen
Background Oncology guidelines suggest using the Khorana score to select ambulatory cancer patients receiving chemotherapy for primary venous thromboembolism (VTE) prevention, but its performance in different cancers remains uncertain. Objective To examine the performance of the Khorana score in assessing 6-month VTE risk, and the efficacy and safety of low-molecular-weight heparin (LMWH) among high-risk Khorana score patients. Methods This individual patient data meta-analysis evaluated (ultra)-LMWH in patients with solid cancer using data from seven randomized controlled trials. Results A total of 3293 patients from the control groups with an available Khorana score had lung (n = 1913; 58%), colorectal (n = 452; 14%), pancreatic (n = 264; 8%), gastric (n = 201; 6%), ovarian (n = 184; 56%), breast (n = 164; 5%), brain (n = 84; 3%), or bladder cancer (n = 31; 1%). The 6-month VTE incidence was 9.8% among high-risk Khorana score patients and 6.4% among low-to-intermediate-risk patients (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2). The dichotomous Khorana score performed differently in lung cancer patients (OR 1.1; 95% CI, 0.72-1.7) than in the group with other cancer types (OR 3.2; 95% CI, 1.8-5.6;P-interaction = .002). Among high-risk patients, LMWH decreased the risk of VTE by 64% compared with controls (OR 0.36; 95% CI, 0.22-0.58), without increasing the risk of major bleeding (OR 1.1; 95% CI, 0.59-2.1). Conclusion The Khorana score was unable to stratify patients with lung cancer based on their VTE risk. Among those with other cancer types, a high-risk score was associated with a three-fold increased risk of VTE compared with a low-to-intermediate risk score. Thromboprophylaxis was effective and safe in patients with a high-risk Khorana score.
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Autores:
Matilla, L.;
Roncal Mancho, Carmen;
Ibarrola, J.;
et al.
Revista:
ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY
ISSN: 1079-5642
Vol.40
N° 5
2020
págs. 1370 - 1382
Resumen
Objective: Aortic valve (AV) calcification plays an important role in the progression of aortic stenosis (AS). MMP-10 (matrix metalloproteinase-10 or stromelysin-2) is involved in vascular calcification in atherosclerosis. We hypothesize that MMP-10 may play a pathophysiological role in calcific AS. Approach and Results: Blood samples (n=112 AS and n=349 controls) and AVs (n=88) from patients undergoing valve replacement were analyzed. Circulating MMP-10 was higher in patients with AS compared with controls (P<0.001) and correlated with TNF alpha (tumor necrosis factor alpha; r(S)=0.451; P<0.0001). MMP-10 was detected by immunochemistry in AVs from patients with AS colocalized with aortic valve interstitial cells markers alpha-SMA (alpha-smooth muscle actin) and vimentin and with calcification markers Runx2 (Runt-related transcription factor 2) and SRY (sex-determining region Y)-box 9. MMP-10 expression in AVs was further confirmed by RT-qPCR and western blot. Ex vivo, MMP-10 was elevated in the conditioned media of AVs from patients with AS and associated with interleukin-1 beta (r(S)=0.5045, P<0.001) and BMP (bone morphogenetic protein)-2 (r(S)=0.5003, P<0.01). In vitro, recombinant human MMP-10 induced the overexpression of inflammatory, fibrotic, and osteogenic markers (interleukin-1 beta, alpha-SMA, vimentin, collagen, BMP-4, Sox9, OPN [osteopontin], BMP-9, and Smad 1/5/8; P<0.05) and cell mineralization in aortic valve interstitial cells isolated from human AVs, in a mechanism involving Akt (protein kinase B) phosphorylation. These effects were prevented by TIMP-1 (tissue inhibitor of metalloproteinases type 1), a physiological MMP inhibitor, or specifically by an anti-MMP-10 antibody. Conclusions: MMP-10, which is overexpressed in aortic valve from patients with AS, seems to play a central role in calcification in AS through Akt phosphorylation. MMP-10 could be a new therapeutic target for delaying the progression of aortic valve calcification in AS.
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Autores:
Mínguez Olaondo, Ane;
Martínez Valbuena, Iván;
Romero, S.;
et al.
Revista:
JOURNAL OF HEADACHE AND PAIN
ISSN: 1129-2369
Vol.21
N° 1
2020
págs. 9
Resumen
Objective To investigate the specific relationship between cutaneous allodynia (CA) and the percentages of body fat (BF) and abdominal fat in migraineurs. Additionally, we compared serum levels of inflammatory biomarkers in patients with and without CA. Background Excess abdominal fat might facilitate progressive changes in nociceptive thresholds causing central sensitization, clinically reflected as CA, which could drive migraine progression. Methods This prospective cohort study included 80 patients with migraine (mean age 39 years, 81.2% female) and 39 non-migraine controls. We analysed each participant's height, body weight, and body mass index (BMI). The amount and distribution of BF was also assessed by air displacement plethysmography (ADP) and ViScan, respectively. We analysed serum levels of markers of inflammation, during interictal periods. Results We studied 52 patients with episodic migraine (EM) and 28 with chronic migraine (CM). Of the 80 patients, 53 (53.8%) had CA. Migraineurs with CA had a higher proportion of abdominal fat values than patients without CA (p = 0.04). The independent risk factors for CA were the use of migraine prophylaxis (OR 3.26, 95% CI [1.14 to 9.32]; p = 0.03), proportion of abdominal fat (OR 1.13, 95% CI [1.01 to 1.27]; p = 0.04), and presence of sleep disorders (OR 1.13, 95% CI [00.01 to 1.27]; p = 0.04). The concordance correlation coefficient between the ADP and BMI measurements was 0.51 (0.3681 to 0.6247). CA was not correlated with the mean plasma levels of inflammatory biomarkers. Conclusions There is a relation between excess abdominal fat and CA. Abdominal obesity might contribute to the development of central sensitization in migraineurs, leading to migraine chronification.
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Autores:
Marques Cantero, Javier;
Cortés Jiménez, Adriana;
Pejenaute Martínez de Lizarrondo, Álvaro;
et al.
Revista:
INTERNATIONAL JOURNAL OF BIOCHEMISTRY AND CELL BIOLOGY
ISSN: 1357-2725
Vol.128
2020
págs. 105851
Resumen
Oxidative stress is one of the main mechanisms involved in the pathophysiology of vascular diseases. Among others, oxidative stress promotes endothelial dysfunction, and accelerated ageing and remodelling of vasculature. Lately, NADPH oxidases have been demonstrated to be involved in cardiovascular diseases. NADPH oxidase 5 has emerged as a new player in oxidative stress-mediated endothelial alterations, involved in the pathophysiology of hypertension, diabetes, atherosclerosis, myocardial infarction and stroke. This oxidase seems to mediate its detrimental effects by promoting inflammation. NADPH oxidase 5 has been studied in a lesser extent compared with the other members of the NADPH oxidase family due to its loss in the rodent genome, the main experimental research model. In addition, its potential as a therapeutic target remains unexplored given the lack of specific inhibitors. In this review the latest findings on NADPH oxidase 5 regulation, implications in vascular pathophysiology and therapeutic approaches will be updated.Oxidative stress is one of the main mechanisms involved in the pathophysiology of vascular diseases. Among others, oxidative stress promotes endothelial dysfunction, and accelerated ageing and remodelling of vasculature. Lately, NADPH oxidases have been demonstrated to be involved in cardiovascular diseases. NADPH oxidase 5 has emerged as a new player in oxidative stress-mediated endothelial alterations, involved in the pathophysiology of hypertension, diabetes, atherosclerosis, myocardial infarction and stroke. This oxidase seems to mediate its detrimental effects by promoting inflammation. NADPH oxidase 5 has been studied in a lesser extent compared with the other members of the NADPH oxidase family due to its loss in the rodent genome, the main experimental research model. In addition, its potential as a therapeutic target remains unexplored given the lack of specific inhibitors. In this review the latest findings on NADPH oxidase 5 regulation, implications in vascular pathophysiology and therapeutic approaches will be updated.
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Autores:
Robin, P. (Autor de correspondencia);
van Es, N. ;
Le Roux, P. Y.;
et al.
Revista:
THROMBOSIS RESEARCH
ISSN: 0049-3848
Vol.194
2020
págs. 153 - 157
Resumen
Introduction: Venous thromboembolism (VTE) may be the first manifestation of cancer. We aimed at evaluating the performance of F-18-Fluorodesoxyglucose Positron-Emission Tomography/Computed Tomography (FDG PET/CT) for occult cancer screening in patients with unprovoked VTE. Methods: This was a pre-specified analysis of a systematic review and individual patient data meta-analysis including prospective studies assessing cancer screening in patients with unprovoked VTE. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FDG PET/CT were calculated based on cancer diagnosis during a 1-year follow-up period. Results: Four studies were identified as using FDG PET/CT as part of their extensive screening strategy. Out of the 332 patients who underwent FDG PET/CT, the scan was interpreted as positive in 67 (20.2%), as equivocal in 27 (8.1%), and as negative in 238 (71.7%). Seventeen (5.1%) patients were diagnosed with cancer at inclusion or during the 12-month follow up period. All cancers were diagnosed at initial screening. Pooled sensitivity, specificity, NPV, and PPV were 87.3% (95% CI, 55.3 to 97.4), 70.2% (95% CI, 48.2 to 85.6), 98.9% (95% CI, 94.3 to 99.7), and 17.9% (95% CI, 8.5 to 33.6), respectively. Conclusion: FDG PET/CT appears to have satisfactory accuracy indices for cancer diagnosis in patients with unprovoked VTE. In particular, it exhibits a very high negative predictive value and could be used to rule out the presence of an underlying occult malignancy in this setting.
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Autores:
Bermejo, S.;
Gonzalez, E.;
Lopez-Revuelta, K.;
et al.
Revista:
CLINICAL KIDNEY JOURNAL
ISSN: 2048-8505
Vol.13
N° 3
2020
págs. 380 - 388
Resumen
Background. Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods. Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results. In total, 832 patients were included: 621 men (74.6%), mean age of 61.7612.8 years, creatinine was 2.862.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2-5.4) g/24 h. About 39.5% (n = 329) of patients had DN, 49.6% (n = 413) NDRD and 10.8% (n = 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n = 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) = 1.03, 95% CI: 1.02-1.05, P< 0.001], microhaematuria (OR = 1.51, 95% CI: 1.03-2.21, P = 0.033) and absence of diabetic retinopathy (DR) (OR = 0.28, 95% CI: 0.19-0.42, P< 0.001) were independently associated with NDRD. Kaplan-Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P< 0.001) and higher mortality (P = 0.029). In multivariate Cox analyses, older age (P< 0.001), higher serum creatinine (P< 0.001), higher proteinuria (P< 0.001), DR (P = 0.007) and DN (P< 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P< 0.001), peripheral vascular disease (P = 0.002), higher creatinine (P = 0.01) and DN (P = 0.015) were independent risk factors for mortality. Conclusions. The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis.
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Autores:
Irimia Sieira, Pablo (Autor de correspondencia);
Garrido-Cumbrera, M.;
Santos-Lasaosa, S.;
et al.
Revista:
EUROPEAN JOURNAL OF NEUROLOGY
ISSN: 1351-5101
Vol.27
N° 12
2020
págs. 2616 - 2624
Resumen
Background and purpose Migraine is a common and costly neurological disorder. The aims of this study were to quantify the costs of chronic (CM) and episodic migraine (EM) in Spain, evaluating the impact of psychiatric comorbidities and disability, and to estimate the economic savings associated with reducing the number of migraine-days by 50%. Methods This was an observational, cross-sectional analysis of data from migraine patients who participated in the Spanish Migraine Atlas. The participants were invited to complete a structured questionnaire including the following scales: the Headache Needs Assessment, the Hospital Anxiety and Depression Scale, and the Migraine Disability Assessment Scale (MIDAS). Results A total of 475 patients were included, of whom 187 had CM (39.4%). Total costs per patient/year were: euro16 578.2 +/- euro34 568.1 for CM and euro6227.8 +/- euro6515.7 for EM. A higher degree of disability, according to MIDAS, significantly increased the total cost of migraine, while the presence of psychiatric comorbidity increased costs for EM patients only. A reduction of 1 migraine-day per month decreased average total costs by euro744.14 per patient/year for EM and euro663.20 per patient/year for CM, while a reduction in the number of migraine-days by 50% would result in economic savings of euro2232.44 per patient/year (R-2 = 0.927) for EM and euro6631.99 per patient/year (R-2 = 0.886) for CM. Conclusions The costs associated with migraine were driven by migraine frequency and the degree of disability, whereas psychiatric comorbidity only influenced the cost of EM. These results highlight the need to optimize migraine management to reduce the economic migraine burden. Future studies are needed to confirm our results.
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Autores:
Lecumberri Villamediana, Ramón (Autor de correspondencia);
Ruiz Artacho, Pedro Celso;
Trujillo-Santos, J.;
et al.
Revista:
THROMBOSIS RESEARCH
ISSN: 0049-3848
Vol.195
2020
págs. 139 - 145
Resumen
Introduction: Treatment of venous thromboembolism (VTE) in cancer patients with thrombocytopenia is challenging due to perceived higher risk of bleeding. Material and methods: We used the RIETE registry to compare the 10- and 30-day outcomes in cancer patients with acute VTE, according to platelet count at baseline. Results: As of December 2018, 15,337 cancer patients with VTE were included: 166 (1.1%) had < 50 x 10(9) platelets/L (severe thrombocytopenia), 711 (4.6%) had 50-99 x 10(9)/L (mild thrombocytopenia) and 14,460 (94.3%) had >= 100 x 10(9)/L (normal count). Most patients in all subgroups received initial therapy with low-molecular-weight heparin (LMWH), but 62% of those with severe thrombocytopenia received < 150 IU/kg/day LMWH, 42% received < 100 IU/kg/day. The mortality rate progressively decreased with increasing platelet counts (12%, 9.4% and 3.3% respectively at 10 days, 27%, 18% and 9.4% at 30 days), but the major bleeding rates did not (1.2%, 2.5% and 1.3% respectively at 10 days, 2.4%, 4.4% and 2.2% at 30 days). On multivariable analysis, patients with severe thrombocytopenia had a similar risk for major bleeding at 10 days (OR 0.84; 95%CI 0.20-3.49) and at 30 days (OR 0.90; 95%CI 0.32-2.49), but those with mild thrombocytopenia were at increased risk both at 10 days (OR 2.11; 95%CI 1.27-3.49) and at 30 days (OR 1.91; 95%CI 1.29-2.84). Conclusions: Cancer patients with acute VTE and baseline thrombocytopenia often receive initial lower-than recommended doses of LMWH. Although caution is required, this practice seems to be safe in patients with severe thrombocytopenia. Nonetheless, there was an inverse correlation between baseline platelet count and mortality.
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Autores:
Páramo Fernández, José Antonio (Autor de correspondencia)
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN: 1137-6627
Vol.43
N° 2
2020
págs. 245 - 249
Resumen
One of the most significant negative prognostic factors in patients suffering from the disease caused by SARS-CoV-2 (COVID-19) is the development of coagulopathy, associated with abnormal laboratory findings, such as increased D-dimer, and venous thromboembolic complications, requiring thromboprophylactic strategies. The main clinical characteristics of COVID-19 patients are revised here as compared to other coronavirus infections, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), emphasizing clinical, diagnostic and therapeutic aspects.
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Autores:
Janssens, R. ;
Morgan, K. ;
Silvennoinen, R. ;
et al.
Revista:
VALUE IN HEALTH
ISSN: 1098-3015
Vol.23
2020
págs. S474 - S475
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Autores:
Marta Enguita, J. ;
Rubio Baines, I. ;
Blanco Luquin, I.;
et al.
Revista:
INTERNATIONAL JOURNAL OF STROKE
ISSN: 1747-4930
Vol.15
N° 1_SUPPL
2020
págs. 422 - 422
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Autores:
Irimia Sieira, Pablo;
Minguez-Olaondo, A. ;
Martínez Valbuena, Iván;
et al.
Revista:
CEPHALALGIA
ISSN: 0333-1024
Vol.40
N° 1_SUPPL
2020
págs. 34 - 35
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Autores:
Irimia Sieira, Pablo;
Benhaddi, H. ;
Morand, F.;
et al.
Revista:
VALUE IN HEALTH
ISSN: 1098-3015
Vol.23
2020
págs. S632 - S632
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Autores:
Mínguez-Olaondo, A.;
García-Azorín, D.;
Sánchez-Mateos, N. M.;
et al.
Revista:
EUROPEAN JOURNAL OF NEUROLOGY
ISSN: 1351-5101
Vol.27
N° Supl. 1
2020
págs. 864
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Autores:
Marta Enguita, J. ;
Navarro Oviedo, Manuel;
Rubio Baines, Íñigo;
et al.
Revista:
INTERNATIONAL JOURNAL OF STROKE
ISSN: 1747-4930
Vol.15
N° 1_SUPPL
2020
págs. 491 - 491
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Autores:
Barril, G.;
Nogueira, A.;
García Fernández, Nuria;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.35
N° Supl. 3
2020
págs. 1270
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Autores:
Gago-Veiga, A. B.;
Santos-Lasaosa, S.;
Cuadrado, M. L.;
et al.
Revista:
NEUROLOGÍA (BARCELONA. ED. IMPRESA)
ISSN: 0213-4853
Vol.34
N° 6
2019
págs. 408 - 417
Resumen
OnabotulinumtoxinA has been demonstrated to be effective as a preventive treatment in patients with chronic migraine (CM). Five years after the approval of onabotulinumtoxinA in Spain, the Headache Study Group of the Spanish Society of Neurology considered it worthwhile to gather a group of experts in treating patients with CM in order to draw up, based on current evidence and our own experience, a series of guidelines aimed at facilitating the use of the drug in daily clinical practice. For this purpose, we posed 12 questions that we ask ourselves as doctors, and which we are also asked by our patients. Each author responded to one question, and the document was then reviewed by everyone. We hope that this review will constitute a practical tool to help neurologists treating patients with CM.
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Autores:
Arrieta, V.;
Sadaba, J. R.;
Alvarez, V. ;
et al.
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN: 1137-6627
Vol.42
N° 2
2019
págs. 199 - 208
Resumen
Aortic stenosis is one of the most common heart valve diseases, as well as one of the most common causes of heart failure in the elderly. Currently, there are no medical therapies to prevent or slow the progression of the disease. When symptoms develop alongside severe aortic stenosis, there is a poor prognosis unless aortic valve replacement is performed. Aortic stenosis is a heterogeneous disease with a complex pathophysiology involving structural and biological changes of the valve, as well as adaptive and maladaptive compensatory changes in the myocardium and vasculature in response to chronic pressure overload. Galectin-3 serves important functions in numerous biological activities including cell growth, apoptosis, differentiation, inflammation and fibrosis. With evidence emerging to support the function of Galectin-3, the current review aims to summarize the latest literature regarding the potential of Galectin-3 as therapeutic target in aortic valve and cardiovascular alterations associated with aortic stenosis.
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Autores:
Doménech López, Pablo (Autor de correspondencia);
Robles García, José Enrique;
Gutiérrez Castañé, Cristina;
et al.
Revista:
ACTAS UROLOGICAS ESPAÑOLAS
ISSN: 0210-4806
Vol.43
N° 43747
2019
págs. 455 - 466
Resumen
Introduction: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. Objectives: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. Material and methods: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophytaxis in urology are based. Results: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncologicat pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases. Conclusions: According to the current guidelines, there might be an overuse of heparins in the daily clinical practice. The development of -direct oral- anticoagulants have shown to reduce the time to reintroduction of medication for chronic conditions as well as a more effective bleeding management. (C) 2019 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.
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Autores:
Irimia Sieira, Pablo (Autor de correspondencia);
Martínez Vila, Eduardo Antonio
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN: 1137-6627
Vol.42
N° 1
2019
págs. 119 - 120
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Autores:
Lasaosa, S. S. ;
Irimia Sieira, Pablo (Autor de correspondencia)
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN: 1137-6627
Vol.42
N° 2
2019
págs. 235 - 238
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Autores:
Figueroa Mora, María del Rocío;
Alfonso Piérola, Ana;
Marcos, M.;
et al.
Revista:
TH OPEN
ISSN: 2512-9465
Vol.3
N° 2
2019
págs. e153 - e156
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Autores:
Irimia Sieira, Pablo;
Esparragosa Vázquez, Inés;
Valentí Azcárate, Rafael;
et al.
Revista:
MEDICINE (ELSEVIER)
ISSN: 0304-5412
Vol.12
N° 70
2019
págs. 4075 - 4084
Resumen
Intracerebral hemorrhage (ICH) accounts for 20% of all strokes; caused by the collection of blood within the cerebral parenchyma as the result of vascular rupture. Taking into account its etiology, primary hemorrhages are the most common and are caused by the vascular wall weakness as a result of chronic arterial hypertension or due to degenerative processes as amyloid angiopathy. Secondary causes include arteriovenous malformations, tumors, hemorrhages induced by drugs and substance abuse. The most important risk factors for developing ICH are arterial hypertension, smoking, substance abuse (alcohol and drugs). Hemorrhage location and bleeding volume determine clinical manifestations. In order to distinguish between ICH and other ischemic or structural lesions, both computed tomography (CT) and magnetic resonance imaging (MRI) may be used for the diagnosis. To determine the most likely bleed cause, bleed location and microbleed detection (only detected by MRI) are necessary. Treatment for patients with ICH is fundamentally medical, and they must be cared for in a hospital with stroke unit. Surgical treatment is only recommended for a reduced number of carefully selected cases.
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Autores:
Moreno Ajona, David;
Moreno Artero, Ester;
García de Eulate Ruiz, María Reyes;
et al.
Revista:
CEPHALALGIA
ISSN: 0333-1024
Vol.39
N° 4
2019
págs. 564 - 568
Resumen
Background Localized facial scleroderma usually presents as frontal linear morphea or progressive hemifacial atrophy. Only isolated cases of trigeminal painful neuropathy have been described. Case report A 43-year-old woman developed an oval lesion on the right cheek. After 1 year, she noticed constant "pulling" pain and episodes of lancinating pain, both spontaneous and triggered by chewing and cold drinks. She was diagnosed with solitary morphea profunda and CT scan, ultrasonography, cranial MRI and biopsy were completed. Methylprednisolone (1¿gr/day for 3 days) was prescribed. For pain, gabapentin, oxcarbazepine, amitryptiline, pregabalin and eslicarbacepine were all ineffective. A capsaicin patch was placed with prolonged benefit. Later on, the pain slightly worsened; occipital blockade was effective and methotrexate was recommended. Conclusion This is the first case of solitary morphea profunda associated with painful trigeminal neuropathy. Treatment should include immunosuppressants and treatment of neuropathic pain, in which local therapies seem particularly beneficial.
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Autores:
Figueroa Mora, María del Rocío;
Alfonso Piérola, Ana;
López-Picazo González, José María;
et al.
Revista:
CLINICAL AND TRANSLATIONAL ONCOLOGY
ISSN: 1699-048X
Vol.21
N° 6
2019
págs. 805 - 809
Resumen
PURPOSE:
Thromboprophylaxis use among medical inpatients, including cancer patients, is suboptimal. We aimed to evaluate the impact of a novel multiscreen version (v2.0) of an e-alert system for VTE prevention in hospitalised cancer medical patients compared to the original software.
METHODS:
Prospective study including 989 consecutive adult cancer patients with high-risk of VTE. Patients were followed-up 30 days post-discharge. Two periods were defined, according to the operative software.
RESULTS:
E-alert v2.0 was associated with an increase in the use of LMWH prophylaxis (65.5% vs. 72.0%); risk difference (95% CI) 0.064 (0.0043-0.12). Only 16% of patients in whom LMWH prophylaxis was not prescribed lacked a contraindication. No significant differences in the rates of VTE (2.9% vs. 3.2%) and major bleeding (2.7% vs. 4.0%) were observed.
CONCLUSIONS:
E-alert v2.0 further increased the use of appropriate thromboprophylaxis in hospitalised cancer patients, although was not associated with a reduction in VTE incidence.
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Autores:
Páramo Fernández, José Antonio (Autor de correspondencia);
Lecumberri Villamediana, Ramón
Revista:
MEDICINA CLINICA
ISSN: 0025-7753
Vol.153
N° 2
2019
págs. 78 - 81
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Autores:
Pereira Sánchez, Víctor;
Molero Santos, Patricio
Revista:
MEDICINE (ELSEVIER)
ISSN: 0304-5412
Vol.12
N° 86
2019
págs. 5070 - 5074
Resumen
When adequate therapeutic measures are implemented, the response rates of depressive disorders, despite being a major cause of discomfort, disability and suicide, are acceptable. Diagnosis is based on anamnesis, detailed psychopathological exploration and data collection from third persons, if possible. In order to rule out general medical conditions, complementary tests can be requested. It is mandatory to determine the severity of the condition by assessing the impact of the symptoms and the risk of harm to oneself or third parties. Treatment has to be consistent with the severity of symptoms, personalized to each patient and based on scientific evidence. Hygienic-dietetic guides, psychotherapy, pharmacological treatments, neuromodulation therapies and functional rehabilitation, are included in the therapeutic measures. Two algorithms for clinical decision making are included in the present protocol.
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Autores:
Arrieta Pey, María;
Molero Santos, Patricio
Revista:
MEDICINE (ELSEVIER)
ISSN: 0304-5412
Vol.12
N° 86
2019
págs. 5081 - 5087
Resumen
ipolar disorder (BD) is a serious mental disorder of chronic and recurrent course, characterized by episodes of mania, hypomania, depressive or mixed. Detailed clinical history, in order to identify the symptoms of each episode, is required for a proper diagnosis. Diagnostic criteria for each episode, as well as the different BD subtypes, are well described in the main psychiatric diagnostic manuals of mental illnesses (CIE and DSM). Taking into account the episode showed by the patient, pharmacological approach varies. Early clinical and functional recovery is the main goal of therapeutic approach to acute episode; the safety of the patient and relatives or close persons has to be taking into account. Long term overall stabilization of the patient, prevention of relapses or additional episodes, together with preservation of functionality are the main therapeutic goals.
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Autores:
Martínez Vila, Eduardo Antonio;
Domínguez Echávarri, Pablo Daniel;
Toledano Illán, Carlos;
et al.
Revista:
MEDICINE (ELSEVIER)
ISSN: 0304-5412
Vol.12
N° 70
2019
págs. 4108 - 4119
Resumen
El ictus isquémico de causa inhabitual representa el 8% de los infartos y el 30% en los adultos jóvenes. Se caracteriza por su heterogeneidad etiológica y puede ser la primera manifestación de la enfermedad de base o una complicación evolutiva más. Los síntomas/signos asociados a la enfermedad subyacente suelen orientar el diagnóstico. El tratamiento es el de la enfermedad de base, si resulta posible, y los fármacos antitrombóticos. La oclusión trombótica de las venas encefálicas y senos durales es más frecuente en adultos jóvenes y predomina en las mujeres (3:1). Las trombofilias hereditarias, embarazo y puerperio, anticonceptivos orales, neoplasias, arteriopatías inflamatorias e infecciones son los principales factores de riesgo. El síntoma más frecuente es la cefalea. Los principales síndromes de presentación son: hipertensión intracraneal aislada, encefalopatía subaguda y cuadro focal. Se trata con anticoagulantes y su pronóstico es generalmente bueno.
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Autores:
Diener, H. C. (Autor de correspondencia);
Goadsby, P. J.;
Ashina, M. ;
et al.
Revista:
CEPHALALGIA
ISSN: 0333-1024
Vol.39
N° 12
2019
págs. 1475 - 1487
Resumen
Introduction Non-invasive vagus nerve stimulation (nVNS; gammaCore (R)) has the potential to prevent migraine days in patients with migraine on the basis of mechanistic rationale and pilot clinical data. Methods This multicentre study included a 4-week run-in period, a 12-week double-blind period of randomised treatment with nVNS or sham, and a 24-week open-label period of nVNS. Patients were to administer two 120-second stimulations bilaterally to the neck three times daily (6-8 hours apart). Results Of 477 enrolled patients, 332 comprised the intent-to-treat (ITT) population. Mean reductions in migraine days per month (primary outcome) were 2.26 for nVNS (n = 165; baseline, 7.9 days) and 1.80 for sham (n = 167; baseline, 8.1 days) (p = 0.15). Results were similar across other outcomes. Upon observation of suboptimal adherence rates, post hoc analysis of patients with >= 67% adherence per month demonstrated significant differences between nVNS (n = 138) and sham (n = 140) for outcomes including reduction in migraine days (2.27 vs. 1.53; p = 0.043); therapeutic gains were greater in patients with aura than in those without aura. Most nVNS device-related adverse events were mild and transient, with application site discomfort being the most common. Conclusions Preventive nVNS treatment in episodic migraine was not superior to sham stimulation in the ITT population. The "sham" device inadvertently provided a level of active vagus nerve stimulation. Post hoc analysis showed significant effects of nVNS in treatment-adherent patients. Study identification and registration: PREMIUM; NCT02378844;
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Autores:
Irimia Sieira, Pablo;
Moreno Ajona, David;
Sanchez del Río González, Margarita;
et al.
Revista:
MEDICINE (ELSEVIER)
ISSN: 0304-5412
Vol.12
N° 71
2019
págs. 4194 - 4198
Resumen
Chronic headaches encompass different types of headaches (primary and secondary). Proper clinical history and detailed physical and neurological exam are required in order to perform additional diagnostic tests. Most of the patients suffer primary headache syndromes. Sometimes, pain becomes chronic by the abuse of analgesic drugs. In patients older than 50 years of age, erythrocyte sedimentation rate has to be performed in order to rule out temporal arteritis diagnostic. When warning signs or suspicious of atypical headaches are present, brain imaging tests are required. Underlying cause determines the treatment. Sympthomatic pain treatment is required, but analgesic drugs must be limited. In order to reduce the intensity and frequency of bouts, prophylactic treatment is indicated for chronic primary headaches.
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Autores:
Calsina Juscafresa, Laura (Autor de correspondencia);
Páramo Alfaro, María;
Grochowicz, Lukasz Karol;
et al.
Revista:
DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY
ISSN: 1305-3825
Vol.25
N° 2
2019
págs. 166 - 168
Resumen
Aneurysms of the portal vein and its branches have been rarely described. Their natural history is unknown although large ones (>3 cm in diameter) have been reported to cause rupture, thrombosis, duodenal or biliary obstruction, inferior vena cava compression and/or portal hypertension. We report the case of an incidentally diagnosed 4.5 cm splenic vein aneurysm repaired by endovascular treatment through a transhepatic route. The aneurysm was successfully excluded using a covered stent (Viabahn, Gore). The transhepatic route opens the possibility of offering a minimally invasive approach to vascular lesions of the portal vein system.
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Autores:
Marcos Jubilar, María (Autor de correspondencia);
García-Erce, J. A.;
Martinez-Calle, N.;
et al.
Revista:
TRANSFUSION MEDICINE
ISSN: 0958-7578
Vol.29
N° 4
2019
págs. 268 - 274
Resumen
Objective To evaluate the effectiveness and safety of prothrombin complex concentrates (PCCs) in approved and off-label indications. Background PCCs are approved for the urgent reversal of vitamin K antagonists (VKAs). Data concerning the efficacy, safety and dosing for off-label indications are limited, but they are included in massive bleeding protocols. Methods This was a retrospective review of cases treated with four-factor PCCs (4F-PCCs) between January 2009 and 2016. Efficacy end-points include: (i) VKA reversal efficacy assessed by international normalised ratio (INR) normalisation (<1 center dot 5) and (ii) clinical efficacy as bleeding cessation and/or decreased number of transfused blood components and 24-h mortality in bleeding coagulopathy. The safety end-point is the incidence of thromboembolic events. Results A total of 328 patients were included (51 center dot 8% male, median age 78 years old). Indications were as follows: VKA reversal (66 center dot 6%), bleeding coagulopathy (30 center dot 5%) and direct anticoagulant (DOAC) reversal due to bleeding (2 center dot 5%). VKA reversal was effective in 97 center dot 1% of patients, and 76 center dot 5% demonstrated complete reversal (INR < 1 center dot 5); only 34 center dot 3% patients needed hemoderivatives. Prior to emergency procedures, PCCs achieved global responses in 83% of patients, with no bleeding complication during intervention. DOAC reversal was effective in 88 center dot 9% of patients. Bleeding cessation was associated with the dose administered (P = 0 center dot 002). In coagulopathy bleeding, haemorrhage cessation, established by the International Society of Thrombosis and Haemostais (ISTH) definition, occurred in 56 center dot 7% of massive bleeding events and in 42 center dot 5% of other coagulopathies; 24-h mortality was 30%, mainly related to active bleeding. Ten thrombotic episodes were observed (3 center dot 1%). Conclusion 4F-PCC was effective as adjuvant treatment with an acceptable safety profile, not only for the emergent reversal of VKAs but also for refractory coagulopathy associated with major bleeding.
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Autores:
Lorente, L. (Autor de correspondencia);
Martin, M. M. ;
Ramos, L.;
et al.
Revista:
BMC NEUROLOGY
ISSN: 1471-2377
Vol.19
2019
págs. 167
Resumen
Background: Higher circulating levels of tissue inhibitor of matrix metalloproteinases (TIMP)-1 early after ischemic stroke have been associated with lower survival. The objectives of this study were to determine serum TIMP-1 levels during the first week of a severe cerebral infarction in surviving and non-surviving patients, and whether those levels during the first week could be used as a mortality biomarker for these patients. Methods: We included patients with severe malignant middle cerebral artery infarction (MMCAI) defined as computer tomography showing ischaemic changes in more than 50% of the middle cerebral artery territory and Glasgow Coma Scale (GCS) <= 8. We measured serum levels of matrix metalloproteinases (MMP)-9 and TIMP-1. End-point study was 30-day mortality. Results: We found higher TIMP-1 concentrations at days 1 (p < 0.001), 4 (p = 0.001), and 8 (p = 0.03) of MMCAI in non-urviving (n = 34) than in surviving (n = 34) patients. We found lower serum MMP-9 concentrations at day 1 (p = 0.03) of MMCAI and no significant differences at days 4 and 8. ROC curve analysis of TIMP-1 concentrations performed at days 1, 4, and 8 of MMCAI showed an area under curve to predict 30-day mortality of 81% (p < 0.001), 80% (p < 0.001) and 72% (p = 0.07) respectively. Conclusions: The new findings of our study were that non-surviving MMCAI patients showed higher serum TIMP-1 levels during the first week of MMCAI that surviving patients, and those levels during the first week of MMCAI could be used as mortality biomarkers.
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Autores:
Roncal Mancho, Carmen;
Martinez-Aguilar, E.;
Orbe Lopategui, Josune;
et al.
Revista:
SCIENTIFIC REPORTS
ISSN: 2045-2322
Vol.9
2019
págs. 15580
Resumen
Peripheral artery disease (PAD) is a major cause of acute and chronic illness, with extremely poor prognosis that remains underdiagnosed and undertreated. Trimethylamine-N-Oxide (TMAO), a gut derived metabolite, has been associated with atherosclerotic burden. We determined plasma levels of TMAO by mass spectrometry and evaluated their association with PAD severity and prognosis. 262 symptomatic PAD patients (mean age 70 years, 87% men) categorized in intermittent claudication (IC, n = 147) and critical limb ischemia (CLI, n = 115) were followed-up for a mean average of 4 years (min 1-max 102 months). TMAO levels were increased in CLI compared to IC (P < 0.001). Receiver operating characteristic (ROC) curves for severity (CLI) rendered a cutoff of 2.26 mu mol/L for TMAO (62% sensitivity, 76% specificity). Patients with TMAO > 2.26 mu mol/L exhibited higher risk of cardiovascular death (sub-hazard ratios >= 2, P < 0.05) that remained significant after adjustment for confounding factors. TMAO levels were associated to disease severity and CV-mortality in our cohort, suggesting an improvement of PAD prognosis with the measurement of TMAO. Overall, our results indicate that the intestinal bacterial function, together with the activity of key hepatic enzymes for TMA oxidation (FMO3) and renal function, should be considered when designing therapeutic strategies to control gut-derived metabolites in vascular patients.
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Autores:
Soria-Juan, B.;
Escanea, N.;
Capilla-González, V.;
et al.
Revista:
FRONTIERS IN IMMUNOLOGY
ISSN: 1664-3224
Vol.10
2019
págs. 1151
Resumen
Cell therapy is a progressively growing field that is rapidly moving from preclinical model development to clinical application. Outcomes obtained from clinical trials reveal the therapeutic potential of stem cell-based therapy to deal with unmet medical treatment needs for several disorders with no therapeutic options. Among adult stem cells, mesenchymal stem cells (MSCs) are the leading cell type used in advanced therapies for the treatment of autoimmune, inflammatory and vascular diseases. To date, the safety and feasibility of autologous MSC-based therapy has been established; however, their indiscriminate use has resulted in mixed outcomes in preclinical and clinical studies. While MSCs derived from diverse tissues share common properties depending on the type of clinical application, they markedly differ within clinical trials in terms of efficacy, resulting in many unanswered questions regarding the application of MSCs. Additionally, our experience in clinical trials related to critical limb ischemia pathology (CLI) shows that the therapeutic efficacy of these cells in different animal models has only been partially reproduced in humans through clinical trials. Therefore, it is crucial to develop new research to identify pitfalls, to optimize procedures and to clarify the repair mechanisms used by these cells, as well as to be able to offer a next generation of stem cell that can be routinely used in a cost-effective and safe manner in stem cell-based therapies targeting CLI.
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Autores:
Navarro Oviedo, Manuel;
Roncal Mancho, Carmen;
Salicio Castillo, Agustina;
et al.
Revista:
TRANSLATIONAL STROKE RESEARCH
ISSN: 1868-4483
Vol.10
N° 4
2019
págs. 389 - 401
Resumen
Diabetes is an important risk factor for ischemic stroke (IS). Tissue-type plasminogen activator (tPA) has been associated with less successful revascularization and poor functional outcome in diabetes. We assessed whether a new thrombolytic strategy based on MMP10 was more effective than tPA in a murine IS model of streptozotocin (STZ)-induced diabetes. Wild-type mice were administered a single dose of streptozotocin (STZ) (180mg/kg) to develop STZ-induced diabetes mellitus. Two weeks later, IS was induced by thrombin injection into the middle cerebral artery and the effect of recombinant MMP10 (6.5 mu g/kg), tPA (10mg/kg) or tPA/MMP10 on brain damage and functional outcome were analysed. Motor activity was assessed using the open field test. Additionally, we studied plasminogen activator inhibitor-1 (PAI-1) and thrombin-antithrombin complex levels (TAT) by ELISA and oxidative stress and blood-brain barrier (BBB) integrity by immunohistochemistry and western blot. MMP10 treatment was more effective at reducing infarct size and neurodegeneration than tPA 24h and 3days after IS in diabetic mice. Locomotor activity was impaired by hyperglycemia and ischemic injury, but not by the thrombolytic treatments. Additionally, TAT, oxidative stress and BBB permeability were reduced by MMP10 treatment, whereas brain bleeding or PAI-1 expression did not differ between treatments. Thrombolytic treatment with MMP10 was more effective than tPA at reducing stroke and neurodegeneration in a diabetic murine model of IS, without increasing haemorrhage. Thus, we propose MMP10 as a potential candidate for the clinical treatment of IS in diabetic patients.
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Autores:
Reyes, L. ;
Herrero Santos, José Ignacio;
Rotellar Sastre, Fernando;
et al.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN: 1130-0108
Vol.111
N° 6
2019
págs. 437 - 444
Resumen
Introduction: portal vein thrombosis is a relatively common complication of advanced cirrhosis that increases perioperative risk in liver transplant recipients. This condition was characterized in a cohort of patients, including risk factors and their influence on survival. Material and methods: a retrospective study of liver transplant recipients at the Clinica Universidad de Navarra was performed between 2000 and 2015. Differences in clinical and biological characteristics and survival were analyzed in subjects with and without portal vein thrombosis. A predictive index was also developed. Results: a total of 288 patients were included in the study, portal vein thrombosis was recorded in 46 (16%) cases and seven (15.2%) had stage 3/4 disease according to Yerdel's classification. Factors associated with the presence of esophageal/gastric varices (OR = 3.7; p = 0.03) included variceal ligation or sclerotherapy (OR = 2.3; p = 0.01), being overweight/obesity (OR = 2.1; p = 0.04) and thrombocytopenia (OR = 3.6; p = 0.04). There were no significant differences between the groups with and without portal vein thrombosis in terms of survival according to Kaplan-Meier curve analysis (p = 0.7). However, the mortality rate was higher for Yerdel stages 3-4 (p < 0.01). A predictive index was developed that included varices, body mass index (BMI), thrombocytopenia and activated partial thromboplastin time (APTT). This index had a sensitivity of 76.1% and a specificity of 53.7% for the development of portal thrombosis. Conclusions: the presence of esophageal/gastric varices, variceal ligation/sclerotherapy, thrombocytopenia and being overweight/obesity was associated with a higher rate of portal vein thrombosis. Advanced stages had an impact on survival.
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Autores:
Marcos Jubilar, María;
Orbe Lopategui, Josune;
Roncal Mancho, Carmen;
et al.
Revista:
CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS
ISSN: 0214-9168
Vol.31
N° 4
2019
págs. 152 - 159
Resumen
Introduction: Monocytes play an important role in atherosclerotic progression having both pro and anti-inflammatory effects depending on different circulating monocyte subpopulations. The objective of this study is to characterize these subpopulations and their association with cardiovascular risk factors.
Methods: Transversal study including 102 selected patients, mean age: 65 years-old (range 41-86), 69% males. A set of specific antibodies against classical monocytes (Mont, CD14+CD16- CD300e+HLADR+), intermediate (Mon2, CD14+CD16+CD300e+HLADR+) and nonclassical (Mon3, CD14 CD16+CD300e+HLADR+) was assayed. Three groups of patients were included: 17 asymptomatic with more than one cardiovascular risk factor (group 1), 56 subjects asymptomatic but with vascular pathology assessed by ultrasound or microalbuminuria (group 2) and 19 patients with a previous atherothrombotic event (group 3). The cardiovascular risk was determined by Framingham and REGICOR scores.
Results: An association between study groups and the percentage of Mon1 and Mon2 was observed (ANOVA, p <.05), being independent of age and sex for Mon2. Likewise Mont and Mon2 subpopulations were associated with cardiovascular adverse events (beta=0.86, p=.02 beta-0.1 p=.002, respectively), independently of age and sex in the case of Mon2. Moreover the percentage of Mon3 was associated with the presence of several cardiovascular risk factors ((3 = 0.21, p =.04) in the univariate analysis. In addition, there was a correlation between the levels of Mon1 and Mon2 and leukocytes (r =0.7, p <.001 and r =0.26, p =.01, respectively).
Conclusions: The analysis of monocyte subpopulations may be clinically useful to stratify the inflammatory profile related to the different cardiovascular risk groups.
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Autores:
Martos, L. ;
Fernandez-Pardo, A. ;
Lopez-Fernandez, M. F.;
et al.
Revista:
THROMBOSIS AND HAEMOSTASIS
ISSN: 0340-6245
Vol.119
N° 9
2019
págs. 1409 - 1418
Resumen
Presently, no data on the molecular basis of hereditary protein C (PC) deficiency in Spain is available. We analyzed the PC gene ( PROC ) in 109 patients with symptomatic PC deficiency and in 342 relatives by sequencing the 9 PROC exons and their flanking intron regions. In 93 probands, we found 58 different mutations (26 novel). Thirty-seven consisted of a nucleotide change, mainly missense mutations, 1 was a 6-nucleotide insertion causing the duplication of 2 amino acids, and 4 were deletions of 1, 3, 4, and 16 nucleotides. Nine mutations caused type II deficiencies, with the presence of normal antigen levels but reduced anticoagulant activity. Using a PC level of 70% as lowest normal limit, we found no mutations in 16 probands and 25 relatives with PC levels <= 70%. On the contrary, 4 probands and 12 relatives with PC levels > 70% carried the mutation identified in the proband. The spectrum of recurrent mutations in Spain is different from that found in the Netherlands, where the most frequent mutations were p.Gln174* and p.Arg272Cys, and is more similar to that found in France, where the most frequent were p.Arg220Gln and p.Pro210Leu. In our study, p.Val339Met (9 families), p.Tyr166Cys (7), p.Arg220Gln (6), and p.Glu58Lys (5) were the most prevalent. This study confirms the considerable heterogeneity of the genetic abnormality in PC deficiencies, and allowed genetic counseling to those individuals whose PC levels were close to the lower limit of the normal reference range.
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Autores:
Arias Pou, Paloma María;
Aquerreta González, Irene;
Idoate García, Antonio Joaquín;
et al.
Revista:
EUROPEAN JOURNAL OF HOSPITAL PHARMACY - SCIENCE AND PRACTICE
ISSN: 2047-9956
Vol.26
N° 1
2019
págs. 33 - 38
Resumen
Objective Electronic alert systems have shown their capacity for improving the detection of acute kidney injury (AKI). The aim of this study was to design and implement a clinical decision support system (CDSS) for improving drug selection and reducing nephrotoxic drug use in patients with AKI.
Methods The study was designed as an intervention study comparing a pre and post cohort of patients admitted during April 2014 and April 2015, respectively (phase I and phase II). The intervention was a CDSS which provided kidney function and nephrotoxic drug information. Furthermore, an interruptive alert was designed to detect patients suffering an AKI event while taking a nephrotoxic drug and to see if the dose was then reduced or the drug was discontinued by the physicians.
Results One-third of the inpatients were included in the analysis because they met the inclusion criteria (1004 and 1002 patients in phases I and II, respectively). 735 and 761 of them received at least one nephrotoxic alert (73% vs 76%; p=0.763). 65 and 88 patients suffered AKI during admission (6.5% vs 8.8%; p=0.051). In phase I, patients received 384 nephrotoxic alerts (55%) with 78 (20%) of them provoking a change or discontinuation of the nephrotoxic drug. In phase II this value increased to 154 out of 526 (29%) after implementation of the CDSS (p<0.01).
Conclusions A CDSS with interruptive alerts that inform of the development of AKI in real time in patients with nephrotoxic drug prescription has a positive impact on the judicious use of these drugs.
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Autores:
Rabadan, I. R.;
de Lecinana, M. A.;
Martin, R. B.;
et al.
Revista:
CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS
ISSN: 0214-9168
Vol.31
N° 6
2019
págs. 263 - 270
Resumen
A multidisciplinary panel of cardiologists, neurologists, internal medicine and specialists in hemostasis and thrombosis has elaborated this document showing recent scientific evidences supporting a better profile of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKA), as well as the indications of specific antidotes and hemostatic agents to reverse the anticoagulant effects of DOACs. The analysis reinforces the best profile of DOACs and its special benefit in patients with basal high hemorrhagic risk.
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Autores:
Lorente, L. (Autor de correspondencia);
Martin, M. M.;
Ramos, L.;
et al.
Revista:
JOURNAL OF CRITICAL CARE
ISSN: 0883-9441
Vol.51
2019
págs. 117 - 121
Resumen
Purpose: Previously, higher circulating levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor matrix metalloproteinases (TIMP)-1 were reported in the first hours after TBI in blood samples from patients with poor prognosis. Thus, the objectives of this study were to determine whether MMP-9 and TIMP-1 levels during the first week of a severe TBI could be used as biomarker predictive of mortality. Methods: We included patients with severe TBI (defined as Glasgow Coma Scale lower than 9), and with Injury Severity Score in non-cranial aspects lower than 9. We determined serum concentrations of MMP-9 and TIMP-1 at days 1, 4 and 8 of TBI. Results: TIMP-1 concentrations at days 1 (p < .001), 4 (p = .001), and 8 (p = .01) of TBI were higher in nonsurviving (n = 34) than in surviving (n = 90) patients. ROC curve analyses showed an area under curve of TIMP-1 concentrations at days 1, 4, and 8 of TBI to predict 30-day mortality of 78% (p < .001), 76% (p <.001) and 71% (p= .02) respectively. Conclusions: The most relevant new findings of our study were that TIMP-1 levels during the first week of a severe TBI were higher in non-surviving than in surviving patients and that could be used as biomarker predictive of mortality. (C) 2019 Elsevier Inc. All rights reserved.
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Autores:
Jara-Palomares, L. (Autor de correspondencia);
van Es, N.;
Praena-Fernandez, J. M.;
et al.
Revista:
THROMBOSIS RESEARCH
ISSN: 0049-3848
Vol.176
2019
págs. 79 - 84
Resumen
Background: Unprovoked venous thromboembolism (VTE) may be the first manifestation of an underlying cancer. We aimed to assess the period prevalence of occult cancer detection stratified by VTE location (deep vein thrombosis [DVT], pulmonary embolism [PE] or both) and the anatomical relationship between occult cancer and VTE. Methods: Post-hoc analysis of a systematic review and individual patient data meta-analysis of adults with unprovoked VTE with at least 12 months of follow-up. Cancer types were grouped according to thoracic, abdomino-pelvic, or other locations. Results: A total of 2300 patients were eligible including 1218 with DVT only (53%), 719 with PE only (31%), and 363 with both PE and DVT (16%). The pooled 12-month period prevalence of cancer in DVT only, PE only, and DVT + PE was 5.6% (95% CI, 4.4 to 7.2), 4.3% (95% CI, 2.7 to 6.9), and 5.6% (95% CI, 1.7 to 15.5), respectively. Most occult cancers were located in the abdomen (68.4%). The proportion of patients with an abdomino-pelvic cancer was not different in patients with DVT + PE (81%; 95% CI, 54 to 96) than in those with DVT (68%; 95% CI, 57 to 78) or PE alone (65%; 95% CI, 48 to 79). Conclusion: The 12-month prevalence of occult cancer was similar in patients with DVT only, PE only, or both. Most cancers were located in the abdomen, and there was no relationship between VTE type and cancer location.
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Autores:
Lecumberri Villamediana, Ramón;
Krsnik, I. ;
Askari, E.;
et al.
Revista:
HAEMATOLOGICA
ISSN: 0390-6078
Vol.104
N° Supl. 3
2019
págs. 16 - 16
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Autores:
Figueroa Mora, María del Rocío;
Alfonso Piérola, Ana;
Garcia-Mouriz, A. ;
et al.
Revista:
HAEMATOLOGICA
ISSN: 0390-6078
Vol.104
2019
págs. 136 - 136
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Autores:
Mora Gutiérrez, Jose María;
Romeo, M. J. S.;
Fernández Seara, María Asunción;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.34
2019
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Autores:
Marcos Jubilar, María;
Pastrana Delgado, Juan Carlos;
Orbe Lopategui, Josune;
et al.
Revista:
HAEMATOLOGICA
ISSN: 0390-6078
Vol.104
2019
págs. 144 - 144
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Autores:
Sáenz de Pipaon Echarren, Goren;
Orbe Lopategui, Josune;
Aguilar, E. M.;
et al.
Revista:
ATHEROSCLEROSIS
ISSN: 0021-9150
Vol.287
2019
págs. E141 - E141
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Autores:
Roncal Mancho, Carmen;
Martinez-Aguilar, E.;
Orbe Lopategui, Josune;
et al.
Revista:
ATHEROSCLEROSIS
ISSN: 0021-9150
Vol.287
2019
págs. E233 - E233
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Autores:
Bermejo, S.;
Gonzalez, E. ;
Martin, N.;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.34
2019
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Autores:
Fernandez-Pardo, A. ;
Oto, J.;
Martos, L.;
et al.
Revista:
HAEMATOLOGICA
ISSN: 0390-6078
Vol.104
N° Supl. 3
2019
págs. 136 - 137
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Autores:
Irimia Sieira, Pablo;
Garrido-Cumbrera, M. ;
Blanch, C.;
et al.
Revista:
CEPHALALGIA
ISSN: 0333-1024
Vol.39
2019
págs. 130 - 130
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Autores:
Navarro Oviedo, Manuel;
Enguita, J. M.;
Saldise, M. B.;
et al.
Revista:
HAEMATOLOGICA
ISSN: 0390-6078
Vol.104
2019
págs. 135 - 136
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Autores:
Lavilla Royo, Francisco Javier;
Alfaro Sanchez, Christian Israel;
González Arostegui, Omar Jose;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.34
2019
págs. 152 - 152
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Autores:
Domper, L. F. ;
Roncal Mancho, Carmen;
Martinez-Aguilar, E. ;
et al.
Revista:
HAEMATOLOGICA
ISSN: 0390-6078
Vol.104
2019
págs. 137 - 137
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Autores:
Echarri González, Gemma;
Duque Sosa, Paula Andrea;
García Fernández, Nuria;
et al.
Revista:
EUROPEAN JOURNAL OF ANAESTHESIOLOGY
ISSN: 0265-0215
Vol.35
N° 1
2018
págs. 65 - 66
Resumen
BACKGROUND Four predictive models for acute kidney injury associated with cardiac surgery were developed by Demirjian in the United States in 2012. However, the usefulness of these models in clinical practice needs to be established in different populations independent of that used to develop the models. OBJECTIVES Our aim was to evaluate the predictive performance of these models in a Spanish population. DESIGN A multicentre, prospective observational study. DATA SOURCES Twenty-three Spanish hospitals in 2012 and 2013. ELIGIBILITY CRITERIA Of 1067 consecutive cardiac patients recruited for the study, 1014 patients remained suitable for the final analysis. MAIN OUTCOME MEASURES Dialysis therapy, and a composite outcome of either a doubling of the serum creatinine level or dialysis therapy, in the 2 weeks (or until discharge, if sooner) after cardiac surgery. RESULTS Of the 1014 patients analysed, 34 (3.4%) required dialysis and 95 (9.4%) had either dialysis or doubled their serum creatinine level. The areas under the receiver operating characteristic curves of the two predictive models for dialysis therapy, which include either presurgical variables only, or combined presurgical and intrasurgical variables, were 0.79 and 0.80, respectively. The model for the composite endpoint that combined presurgical and intrasurgical variables showed better discriminatory ability than the model that included only presurgical variables: the areas under the receiver operating characteristic
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Autores:
Sanz Ganuza, María (Autor de correspondencia);
Hidalgo Martínez, Francisco Nicesio;
García Fernández, Nuria
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN: 1137-6627
Vol.41
N° 1
2018
págs. 135 - 136
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Autores:
Maduell, F.;
García Fernández, Nuria;
Manrique, J.;
et al.
Revista:
HYPERTENSION
ISSN: 0194-911X
Vol.72
N° 2
2018
págs. 277 - 278
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Autores:
Páramo Fernández, José Antonio (Autor de correspondencia)
Revista:
CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS
ISSN: 0214-9168
Vol.30
N° 3
2018
págs. 133 - 136
Resumen
Recent research has revealed that clonal hematopoyesis of indeterminate potential (CHIP) characterized by the acquisition of somatic mutations in hematopoietic stem cells, is not only a common age-related disorder and a premalignant condition, but it is also associated with the development of atherosclerotic vascular diseases. Mutations in DNMT3A, TET2 and ASXL1 were each individually associated with coronary heart disease, stroke and coronary calcification. Therefore, CHIP emerges as a new risk factor for atherosclerotic vascular pathologies and its detection may be relevant as a new therapeutic target in order to modify the natural course of the disease. (C) 2018 Sociedad Espanola de Arteriosclerosis. Published by Elsevier Espana, S.L.U. All rights reserved.
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Autores:
Ibarrola, J.;
Arrieta, V.;
Sadaba, R.;
et al.
Revista:
CLINICAL SCIENCE
ISSN: 0143-5221
Vol.132
N° 13
2018
págs. 1471 - 1485
Resumen
Galectin-3 (Gal-3) is increased in heart failure (HF) and promotes cardiac fibrosis and inflammation. We investigated whether Gal-3 modulates oxidative stress in human cardiac fibroblasts, in experimental animal models and in human aortic stenosis (AS). Using proteomics and immunodetection approaches, we have identified that Gal-3 down-regulated the antioxidant peroxiredoxin-4 (Prx-4) in cardiac fibroblasts. In parallel, Gal-3 increased peroxide, nitrotyrosine, malondialdehyde, and N-carboxymethyl-lysine levels and decreased total antioxidant capacity. Gal-3 decreased prohibitin-2 expression without modifying other mitochondrial proteins. Prx-4 silencing increased oxidative stress markers. In Gal-3-silenced cells and in heart fromGal-3 knockout mice, Prx-4 was increased and oxidative stress markers were decreased. Pharmacological inhibition of Gal-3 with modified citrus pectin restored cardiac Prx-4 as well as prohibitin-2 levels and improved oxidative status in spontaneously hypertensive rats. In serum from 87 patients with AS, Gal-3 negatively correlated with total antioxidant capacity and positively correlated with peroxide. In myocardial biopsies from 26 AS patients, Gal-3 up-regulation paralleled a decrease in Prx-4 and in prohibitin-2. Cardiac Gal-3 inversely correlated with Prx-4 levels in myocardial biopsies. These data suggest that Gal-3 decreased Prx-4 antioxidant system in cardiac fibroblasts, increasing oxidative stress. In pathological models presenting enhanced cardiac Gal-3, the decrease in Prx-4 expression paralleled increased oxidative stress. Gal-3 blockade restored Prx-4 expression and improved oxidative stress status. In AS, circulating levels of Gal-3 could reflect oxidative stress. The alteration of the balance between antioxidant systems and reactive oxygen species production could be a new pathogenic mechanism by which Gal-3 induces cardiac damage in HF.
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Autores:
de Miguel, I.;
Orbe Lopategui, Josune;
Sanchez-Arias, J. A. ;
et al.
Revista:
ACS MEDICINAL CHEMISTRY LETTERS
ISSN: 1948-5875
Vol.9
N° 5
2018
págs. 428 - 433
Resumen
In an effort to find novel chemical series as antifibrinolytic agents, we explore alpha-phenylsulfonyl-alpha-spiropiperidines bearing different zinc-binding groups (ZBGs) to target those metalloproteinases involved in the fibrinolytic process: MMP3 and MMP10. Surprisingly, all these new chemical series were inactive against these metalloproteinases; however, several new molecules retained the antifibrinolytic activity in a phenotypic functional assay using thromboelastometry and human whole blood. Further optimization led to compound 38 as a potent antifibrinolytic agent in vivo, three times more efficacious than the current standard-of-care (tranexamic acid, TXA) at 300 times lower dose. Finally, in order to decipher the underlying mode-of action leading to this phenotypic response, an affinity-based probe 39 was successfully designed to identify the target involved in this response: a potentially unknown mechanism-of-action in the fibrinolytic process.
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Autores:
Avendano, M. S.;
Garcia-Redondo, A. B.;
Zalba Goñi, Guillermo;
et al.
Revista:
HYPERTENSION
ISSN: 0194-911X
Vol.72
N° 2
2018
págs. 492 - 502
Resumen
mPGES-1 (microsomal prostaglandin E synthase-1), the downstream enzyme responsible for PGE(2) (prostaglandin E-2) synthesis in inflammatory conditions and oxidative stress are increased in vessels from hypertensive animals. We evaluated the role of mPGES-1-derived PGE(2) in the vascular dysfunction and remodeling in hypertension and the possible contribution of oxidative stress. We used human peripheral blood mononuclear cells from asymptomatic patients, arteries from untreated and Ang II (angiotensin II)-infused mPGES-1(-/-) and mPGES-1(+/+) mice, and vascular smooth muscle cells exposed to PGE(2). In human cells, we found a positive correlation between mPGES-1 mRNA and carotid intima-media thickness (r=0.637; P<0.001) and with NADPH oxidase-dependent superoxide production (r=0.417; P<0.001). In Ang II-infused mice, mPGES-1 deletion prevented all of the following: (1) the augmented wall:lumen ratio, vascular stiffness, and altered elastin structure; (2) the increased gene expression of profibrotic and proinflammatory markers; (3) the increased vasoconstrictor responses and endothelial dysfunction; (4) the increased NADPH oxidase activity and the diminished mitochondrial membrane potential; and (5) the increased reactive oxygen species generation and reduced NO bioavailability. In vascular smooth muscle cells or aortic segments, PGE(2) increased NADPH oxidase expression and activity and reduced mitochondrial membrane potential, effects that were abolished by antagonists of the PGE(2) receptors (EP), EP1 and EP3, and by JNK (c-Jun N-terminal kinase) and ERK1/2 (extracellular-signal-regulated kinases 1/2) inhibition. Deletion of mPGES-1 augmented vascular production of PGI(2) suggesting rediversion of the accumulated PGH(2) substrate. In conclusion, mPGES-1-derived PGE(2) is involved in vascular remodeling, stiffness, and endothelial dysfunction in hypertension likely through an increase of oxidative stress produced by NADPH oxidase and mitochondria.
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Autores:
Purroy López, Ana Isabel;
Roncal Mancho, Carmen;
Orbe Lopategui, Josune;
et al.
Revista:
ATHEROSCLEROSIS
ISSN: 0021-9150
Vol.278
2018
págs. 124 - 134
Resumen
Background and aims: Matrix metalloproteinases (MMPs) have been implicated in atherosclerosis and vascular calcification. Among them, we reported that MMP10 is present in human atheroma, associated with atherosclerosis. However, it remains unclear whether MMP10 is involved in atherogenesis and vascular calcification. Methods: MMP10 was measured in serum from patients with subclinical atherosclerosis and analyzed in carotid endarterectomies by immunostaining. ApoE-deficient mice (Apoe(-/-)) were crossed to MMP10-deficient (Mmp10(-/-)) mice and followed up to 20 months. Plaque area and composition were assessed by histology and immunohistochemistry. Inflammatory markers were measured in atherosclerotic plaques by RT-qPCR, and leukocyte subpopulations were analyzed by flow cytometry. In vitro calcification assays were performed in aortic vascular smooth muscle cells (VSMC). Results: MMP10 serum levels were associated with coronary calcification in subjects with subclinical atherosclerosis. Immunostaining revealed MMP10 expression in human atheromas, spatially associated with calcification areas, and complicated plaques released higher amounts of MMP10 than non-diseased segments. Interestingly, vascular MMP10 expression was confined to the atherosclerotic lesion in Apoe(-/-) mice, and Apoe(-/-) Mmp10(-/-) showed a substantial reduction in atherosclerotic lesion size, macrophage content and plaque calcification. Reduced local and systemic inflammatory markers could be demonstrated in Apoe(-/-) Mmp10(-/-) by gene expression and flow cytometry analysis. Calcium phosphate deposition and vascular calcification markers were downregulated in VSMC from Apoe(-/-) Mmp10(-/-) mice. Conclusions: Delayed plaque progression and altered cellular composition in the absence of MMP10 suggests that MMP10 plays a role in atherosclerosis, favoring inflammation, development and complication of the plaque.
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Autores:
Gómez-Outes, A. (Autor de correspondencia);
Terleira-Fernández, A. I.;
Lecumberri Villamediana, Ramón;
et al.
Revista:
SEMINARS IN THROMBOSIS AND HEMOSTASIS
ISSN: 0094-6176
Vol.44
N° 4
2018
págs. 377 - 387
Resumen
Death is more frequent than nonfatal recurrent venous thromboembolism (VTE) and major bleeding after acute VTE. The analysis of the causes of death is fundamental to explore new strategies to reduce mortality rates in these patients. The authors performed a meta-analysis to analyze mortality and independently adjudicated causes of death in anticoagulated patients due to VTE, and to evaluate potential differences between different anticoagulant schemes. They searched MEDLINE and CENTRAL, from January 1, 2000, to January 31, 2017, and performed additional searches in Web sites of regulatory agencies, clinical trial registers, and conference proceedings. Two investigators independently selected studies and extracted the data. Study quality was assessed with the Cochrane Collaboration's tool for assessing the risk of bias in randomized studies. Seven prospective randomized trials in 29,844 patients (22,025 patient-year follow-up) were included, comparing dabigatran, rivaroxaban, apixaban, and edoxaban with the standard anticoagulant treatment of VTE. A total of 718 patients died during the follow-up (3.4% per year; 95% confidence interval [CI]: 2.3-4.8). The most frequent causes of death were cancer (42%), followed by VTE (20%), infections (13%), hemorrhage (6%), heart disease (4%), and stroke (2%). There were no differences in the overall survival and causes of death according to the anticoagulant type. Concomitant active cancer during the study was significantly associated with death (odds ratio: 15.2; 95% CI: 9.2-25.1). Cancer is the leading cause of death in contemporary VTE trials. Interventions beyond anticoagulation, particularly in patients with active cancer, are needed.
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Autores:
Reyes, R.;
Rodríguez García, José Antonio;
Orbe Lopategui, Josune;
et al.
Revista:
DRUG DELIVERY
ISSN: 1071-7544
Vol.25
N° 1
2018
págs. 750 - 756
Resumen
The effect of dual delivery of bone morphogenetic protein-2 (BMP-2) and matrix metalloproteinase 10 (MMP10) on bone regeneration was investigated in a murine model of calvarial critical-size defect, hypothesizing that it would result in an enhanced bone formation. Critical-size calvarial defects (4 mm diameter) were created in mice and PLGA microspheres preloaded with either BMP-2, MMP10 or a microsphere combination of both were transplanted into defect sites at different doses. Empty microspheres were used as the negative control. Encapsulation efficiency was assessed and in vivo release kinetics of BMP-2 and MMP10 were examined over 14 days. Histological analyses were used to analyze bone formation after four and eightweeks. Combination with MMP10 (30 ng) significantly enhanced BMP-2 (600ng)-mediated osteogenesis, as confirmed by the increase in percentage of bone fill (p < .05) at four weeks. Moreover, it also increased mineral apposition rate (p < .05), measured by double labeling with tetracycline and calceine. MMP10 accelerates bone repair by enhancing BMP-2-promoted bone healing and improving the mineralization rate. In conclusion combination of MMP10 and BMP-2 may become a promising strategy for repair and regeneration of bone defects.
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Autores:
Selby, N. M. (Autor de correspondencia);
Blankestijn, P. J.;
Boor, P. ;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.33
N° Supl.2
2018
págs. II4 - II14
Resumen
Functional renal magnetic resonance imaging (MRI) has seen a number of recent advances, and techniques are now available that can generate quantitative imaging biomarkers with the potential to improve the management of kidney disease. Such biomarkers are sensitive to changes in renal blood flow, tissue perfusion, oxygenation and microstructure (including inflammation and fibrosis), processes that are important in a range of renal diseases including chronic kidney disease. However, several challenges remain to move these techniques towards clinical adoption, from technical validation through biological and clinical validation, to demonstration of cost-effectiveness and regulatory qualification. To address these challenges, the European Cooperation in Science and Technology Action PARENCHIMA was initiated in early 2017. PARENCHIMA is a multidisciplinary pan-European network with an overarching aim of eliminating the main barriers to the broader evaluation, commercial exploitation and clinical use of renal MRI biomarkers. This position paper lays out PARENCHIMA's vision on key clinical questions that MRI must address to become more widely used in patients with kidney disease, first within research settings and ultimately in clinical practice. We then present a series of practical recommendations to accelerate the study and translation of these techniques.
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Autores:
Páramo Fernández, José Antonio (Autor de correspondencia)
Revista:
MEDICINA CLINICA
ISSN: 0025-7753
Vol.151
N° 5
2018
págs. 207 - 209
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Autores:
Pachón, V.;
Trujillo-Santos, J.;
Domenech, P.;
et al.
Revista:
TH OPEN
ISSN: 2567-3459
Vol.2
N° 4
2018
págs. e373 - e386
Resumen
Despite the growing interest and improved knowledge about venous thromboembolism in cancer patients in the last years, there are still many unsolved issues. Due to the limitations of the available literature, evidence-based clinical practice guidelines are not able to give solid recommendations for challenging scenarios often present in the setting of cancer-associated thrombosis (CAT). A multidisciplinary expert panel from three scientific societies-Spanish Society of Internal Medicine (SEMI), Spanish Society of Medical Oncology (SEOM), and Spanish Society Thrombosis and Haemostasis (SETH)-agreed on 12 controversial questions regarding prevention and management of CAT, which were thoroughly reviewed to provide further guidance. The suggestions presented herein may facilitate clinical decisions in specific complex circumstances, until these can be made leaning on reliable scientific evidence.
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Autores:
Iñurrieta, A.;
Pedrajas, J. M.;
Núñez, M. J.;
et al.
Revista:
TH OPEN
ISSN: 2567-3459
Vol.2
N° 4
2018
págs. e428 - e436
Resumen
Background The ideal duration of anticoagulant therapy in elderly patients with unprovoked venous thromboembolism (VTE) has not been consistently evaluated. Methods We used the RIETE ( R egistro I nformatizado E nfermedad T rombo E mbólica) registry to compare the rate and severity of pulmonary embolism (PE) recurrences versus major bleeding beyond the third month of anticoagulation in patients >75 years with a first episode of unprovoked VTE. Results As of September 2017, 7,830 patients were recruited: 5,058 (65%) presented with PE and 2,772 with proximal deep vein thrombosis (DVT). During anticoagulant therapy beyond the third month (median, 113 days), 44 patients developed PE recurrences, 36 developed DVT recurrences, 101 had major bleeding, and 241 died (3 died of recurrent PE and 19 of bleeding). The rate of major bleeding was twofold higher than the rate of PE recurrences (2.05 [95% confidence interval, CI: 1.68-2.48] vs. 0.90 [95% CI: 0.66-1.19] events per 100 patient-years) and the rate of fatal bleeding exceeded the rate of fatal PE events (0.38 [95% CI: 0.24-0.58] vs. 0.06 [95% CI: 0.02-0.16] deaths per 100 patient-years). On multivariable analysis, patients who had bled during the first 3 months (hazard ratio [HR]: 4.32; 95% CI: 1.58-11.8) or with anemia at baseline (HR: 1.87; 95% CI: 1.24-2.81) were at increased risk for bleeding beyond the third month. Patients initially presenting with PE were at increased risk for PE recurrences (HR: 3.60; 95% CI: 1.28-10.1)...
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Autores:
Calsina Juscafresa, Laura (Autor de correspondencia);
Grochowicz, Lukasz Karol
Revista:
HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE
ISSN: 0722-1819
Vol.50
N° 1
2018
págs. 52 - 56
Resumen
Introduction In 1934 von Rosen first described a posttraumatic thrombosis of the distal ulnar artery resulting from blunt a trauma to the hypothenar region. But it was Conn in 1970 who named it the hypothenar hammer syndrome (HHS) 1-2 .
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Autores:
Figueroa Mora, María del Rocío;
Alfonso Piérola, Ana;
López-Picazo González, José María;
et al.
Revista:
PLOS ONE
ISSN: 1932-6203
Vol.13
N° 8
2018
págs. e0200220
Resumen
Hospitalized cancer patients are at high risk of venous thromboembolism (VTE). Despite current recommendations in clinical guidelines, thromboprophylaxis with low molecular weight heparin (LMWH) is underused. We performed an observational prospective study to analyse factors influencing prophylaxis use, VTE events and mortality in cancer-hospitalized patients. 1072 consecutive adult cancer patients were included in an University Hospital from April 2014 to February 2017, and followed-up for 30 days after discharge. The rate of LMWH prophylaxis was 67.6% (95% confidence interval [CI]64.7% to 70.4%), with a 2.8% rate of VTE events (95% CI 1.9% to 3.9%) and 3.5% rate of major bleeding events (95% CI 2.5% to 4.8%). 80% of VTE events occurred despite appropriate thromboprophylaxis. Overall, 30-day mortality rate was 13.2% (95% C111.2% to 15.3%). Active chemotherapy treatment, hospital stay >= 4 days, and metastatic disease were associated with a higher use of LMWH. On the contrary, patients with hematologic malignancies,anemia or thrombocytopenia were less prone to receive thromboprophylaxis. The main reasons for not prescribing LMWH prophylaxis were thrombocytopenia (23.9%) and active/recent bleeding (21.8%). The PRETEMED score, used for VTE risk stratification, correlated with 30-day mortality. There is room for improvement in thromboprophylaxis use among hospitalized-cancer patients, especially among those with hematologic malignancies. A relevant number of VTE events occurred despite prophylaxis with LMWH. Therefore, identification of risk factors for thromboprophylaxis failure is needed.
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Autores:
Diener, H. C.;
Goadsby, P. J.;
Ashina, M. ;
et al.
Revista:
JOURNAL OF HEADACHE AND PAIN
ISSN: 1129-2369
Vol.19
N° Supl. 1
2018
-
Autores:
Navarro Oviedo, Manuel;
Salicio, M.;
Rabal Gracia, María Obdulia;
et al.
Revista:
HAEMATOLOGICA
ISSN: 0390-6078
Vol.103
N° Supl. 2
2018
págs. 2 - 2
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Autores:
Bermejo, S. ;
Gonzalez, E. ;
Lopez, K.;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.33
N° Supl.1
2018
págs. 491
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Autores:
Romero, S.;
Mínguez Olaondo, Ane;
Lainez, J. M.;
et al.
Revista:
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN: 0014-2972
Vol.48
N° Supl 1
2018
págs. 206 - 207
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Autores:
Lavilla Royo, Francisco Javier;
Moirón Fernández-Felechosa, José Pelayo;
Alfaro Sanchez, Christian Israel;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.33
N° Supl. 1
2018
págs. i412
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Autores:
Diener, H. C.;
Goadsby, P. J.;
Ashina, M.;
et al.
Revista:
CEPHALALGIA
ISSN: 0333-1024
Vol.38
N° Supl. 1
2018
págs. 58 - 59
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Autores:
Lainez, M. J. A.;
Santos, S. ;
Pozo-Rosich, P.;
et al.
Revista:
HEADACHE
ISSN: 0017-8748
Vol.58
N° 8
2018
págs. 1309 - 1309
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Autores:
Mínguez Olaondo, Ane;
Romero, S.;
Fruhbeck Martínez, Gema;
et al.
Revista:
JOURNAL OF HEADACHE AND PAIN
ISSN: 1129-2369
Vol.19
N° Supl. 1
2018
págs. P161
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Autores:
Roncal Mancho, Carmen;
Martinez-Aguilar, E. ;
Orbe Lopategui, Josune;
et al.
Revista:
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN: 0014-2972
Vol.48
N° Supl. 1
2018
págs. 121 - 122
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Autores:
Mora Gutiérrez, Jose María;
Fernández Seara, María Asunción;
Slon Roblero, María Fernanda;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.33
N° Supl. 1
2018
págs. SP453
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Autores:
Torres-Ferrus, M.;
Lasaosa, S. S.;
Peral, A. G.;
et al.
Revista:
JOURNAL OF HEADACHE AND PAIN
ISSN: 1129-2369
Vol.19
N° Supl. 1
2018
págs. P114
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Autores:
Alfaro Sanchez, Christian Israel;
Echarri González, Gemma;
Moirón Fernández-Felechosa, José Pelayo;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.33
N° Supl. 1
2018
págs. i425 - i426
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Autores:
Lavilla Royo, Francisco Javier;
Moirón Fernández-Felechosa, José Pelayo;
Alfaro Sanchez, Christian Israel;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.33
N° Supl. 1
2018
págs. i419
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Autores:
Bermejo, S.;
González, E.;
Lopez, K. ;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.33
N° Supl.1
2018
págs. SP416
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Autores:
Garcia-Redondo, A. B.;
Avendano, M. S.;
Aguado, A.;
et al.
Revista:
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN: 0014-2972
Vol.48
N° Supl. 1
2018
págs. 122 - 122
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Autores:
Lavilla Royo, Francisco Javier;
Moirón Fernández-Felechosa, José Pelayo;
Alfaro Sanchez, Christian Israel;
et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 0931-0509
Vol.33
N° Supl. 1
2018
págs. i418
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Autores:
Irimia Sieira, Pablo;
Garrido-Cumbrera, M. ;
Santos-Lasaosa, S.;
et al.
Revista:
JOURNAL OF HEADACHE AND PAIN
ISSN: 1129-2369
Vol.19
N° Supl. 1
2018
págs. P170
