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Grzybowski A.,Poznan City Hospital | Grzybowski A.,University of Warmia and Mazury | Ascaso F.J.,Lozano Blesa University Clinic Hospital | Ascaso F.J.,Aragon Health science Institute | And 2 more authors.
Current Opinion in Ophthalmology | Year: 2015

Purpose of review The objective of this review is to evaluate the result of cataract surgery in patients continuing antiplatelet and/or anticoagulant treatment.Recent findings The number of elderly patients using anticoagulant and antiplatelet treatment in prevention of venous thromboembolism has significantly increased in recent years. It was believed for many years that those patients might be at higher risk for complications during ocular surgery. Thus, different strategies were proposed to prevent these complications, including discontinuation of anticoagulants, dose reduction, or low-molecular-weight heparin replacement. We performed a PubMed search over a period of 7 years (2007-2013) about possible intraoperative and postoperative complications in patients receiving anticoagulant and/or antiplatelet therapy at the time of cataract surgery. No significant increase in intraoperative or postoperative complications has been identified.Summary Phacoemulsification of uncomplicated cataracts with intraocular lens implantation can be performed safely in high-risk patients, taking both anticoagulants and antiplatelet drugs when topical anesthesia is administered and cataract surgery is performed through a clear corneal incision by a skilled surgeon. Copyright © Lippincott Williams & Wilkins. Source


Ortega-Molina A.,Tumor Suppression Group | Efeyan A.,Tumor Suppression Group | Lopez-Guadamillas E.,Tumor Suppression Group | Munoz-Martin M.,Tumor Suppression Group | And 12 more authors.
Cell Metabolism | Year: 2012

Aging in worms and flies is regulated by the PI3K/Akt/Foxo pathway. Here we extend this paradigm to mammals. Pten tg mice carrying additional genomic copies of Pten are protected from cancer and present a significant extension of life span that is independent of their lower cancer incidence. Interestingly, Pten tg mice have an increased energy expenditure and protection from metabolic pathologies. The brown adipose tissue (BAT) of Pten tg mice is hyperactive and presents high levels of the uncoupling protein Ucp1, which we show is a target of Foxo1. Importantly, a synthetic PI3K inhibitor also increases energy expenditure and hyperactivates the BAT in mice. These effects can be recapitulated in isolated brown adipocytes and, moreover, implants of Pten tg fibroblasts programmed with Prdm16 and Cebpβ form subcutaneous brown adipose pads more efficiently than wild-type fibroblasts. These observations uncover a role of Pten in promoting energy expenditure, thus decreasing nutrient storage and its associated damage. © 2012 Elsevier Inc. Source


Jimenez B.,University of Zaragoza | Ascaso F.J.,University of Zaragoza | Ascaso F.J.,Aragon Health science Institute | Cristobal J.A.,University of Zaragoza | Lopez del Val J.,University of Zaragoza
Movement Disorders | Year: 2014

The aims of this study were to assess the peripapillary retinal nerve fiber layer (RNFL) thickness in patients with Parkinson's disease (PD), to determine its correlation with disease severity, and to define a simple biomarker for predicting clinical severity. One hundred two eyes from 52 patients affected by PD were compared with 97 eyes from 50 age-comparable controls. In all patients, peripapillary RNFL thickness was measured by optical coherence tomography (OCT). We used the Unified Parkinson's Disease Rating Scale (UPDRS) total score and measured responses in the on medication state. Eyes from patients with PD had a statistically significant decrease in average peripapillary RNFL thickness compared with control eyes (P<0.001). This reduction was observed in every quadrant (inferior, superior, nasal [P<0.001], and temporal [P=0.017]) in patients with PD. Furthermore, a strong inverse correlation was found between the PD severity measured according to the UPDRS score and the average peripapillary RNFL thickness (r=-0.615; P<0.001) and PD duration (r=-0.303; P=0.002). From these results, we defined a regression equation that predicts the UPDRS score from the above-mentioned variables: UPDRS= 81.6+29.6 * log PD duration (years)-0.6 * RFNL thickness (μm). We observed that, as the evolution and severity of PD progress, the peripapillary RNFL layer thickness, as evaluated by OCT, gradually diminishes. These results suggest that the average peripapillary RNFL thickness measured by OCT might be useful as a biomarker to detect the early onset and progression of PD. © 2013 Movement Disorder Society. Source


Nita M.,Domestic and Specialized Medicine Center Dilmed | Grzybowski A.,University of Warmia and Mazury | Ascaso F.J.,University of Zaragoza | Ascaso F.J.,Aragon Health science Institute | Huerva V.,University of Lleida
Mediators of Inflammation | Year: 2014

The products of oxidative stress trigger chronic low-grade inflammation (pathophysiological parainflammation) process in AMD patients. In early AMD, soft drusen contain many mediators of chronic low-grade inflammation such as C-reactive protein, adducts of the carboxyethylpyrrole protein, immunoglobulins, and acute phase molecules, as well as the complement-related proteins C3a, C5a, C5, C5b-9, CFH, CD35, and CD46. The complement system, mainly alternative pathway, mediates chronic autologous pathophysiological parainflammation in dry and exudative AMD, especially in the Y402H gene polymorphism, which causes hypofunction/lack of the protective complement factor H (CFH) and facilitates chronic inflammation mediated by C-reactive protein (CRP). Microglial activation induces photoreceptor cells injury and leads to the development of dry AMD. Many autoantibodies (antibodies against alpha beta crystallin, alpha-actinin, amyloid, C1q, chondroitin, collagen I, collagen III, collagen IV, elastin, fibronectin, heparan sulfate, histone H2A, histone H2B, hyaluronic acid, laminin, proteoglycan, vimentin, vitronectin, and aldolase C and pyruvate kinase M2) and overexpression of Fcc receptors play role in immune-mediated inflammation in AMD patients and in animal model. Macrophages infiltration of retinal/choroidal interface acts as protective factor in early AMD (M2 phenotype macrophages); however it acts as proinflammatory and proangiogenic factor in advanced AMD (M1 and M2 phenotype macrophages). © 2014 Małgorzata Nita et al. Source


Calderon-Larranaga A.,Imperial College London | Calderon-Larranaga A.,Aragon Health science Institute | Carney L.,Imperial College London | Soljak M.,Imperial College London | And 6 more authors.
Thorax | Year: 2011

Background: Hospital admission rates for chronic obstructive pulmonary disease (COPD) are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little direct supporting evidence. Objectives: To determine associations between population characteristics, diagnosed and undiagnosed COPD prevalence, primary healthcare factors, and COPD admission rates primary care trust (PCT) and general practice levels in England. Design, setting, and participants: National cross-sectional study (53,676,051 patients in 8,064 practices in 152 English PCTs), combining data on hospital admissions, populations, primary healthcare staffing, clinical practice quality and access, and prevalence. Main outcome measures: Directly and indirectly standardised hospital admission rates for COPD, for PCT and practice populations. Results: Mean annual COPD admission rates per 100 000 population varied from 124.7 to 646.5 for PCTs and 0.0 to 2175.2 for practices. Admissions were strongly associated with population deprivation at both levels. In a practice-level multivariate Poisson regression, registered and undiagnosed COPD prevalence, smoking prevalence and deprivation were risk factors for admission (p<0.001), while healthcare factors- influenza immunisation, patient-reported access to consultations within two days, and primary care staffing, were protective (p<0.05). Conclusion: Associations of COPD admission rates with deprivation, primary healthcare access and supply highlight the need for adequate services in deprived areas. An association between admission rates and undiagnosed COPD prevalence suggests that case-finding strategies should be evaluated. Of the COPD clinical quality indicators, only influenza immunisation was associated with reduced admission rates. Patients' experience of access to primary care may also be clinically important. Source

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