Hospital Clinic Universitari Of Barcelona

Barcelona, Spain

Hospital Clinic Universitari Of Barcelona

Barcelona, Spain
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Castro-Fornieles J.,Hospital Clinic Universitari of Barcelona | Castro-Fornieles J.,University of Barcelona | Castro-Fornieles J.,IDIBAPS Institute dInvestigacions Biomediques August Pi i Sunyer | Caldu X.,University of Barcelona | And 10 more authors.
Neuropsychologia | Year: 2010

Structural and functional brain abnormalities have been described in anorexia nervosa (AN). The objective of this study was to examine whether there is abnormal regional brain activation during a working memory task not associated with any emotional stimuli in adolescent patients with anorexia and to detect possible changes after weight recovery. Fourteen children and adolescents (age range 11-18 years) consecutively admitted with DSM-IV diagnosis of AN and fourteen control subjects of similar age were assessed by means of psychopathological scales and functional magnetic resonance imaging (fMRI) during a working memory task. After seven months of treatment and weight recovery, nine AN patients were reassessed. Before treatment, the AN group showed significantly higher activation than controls in temporal and parietal areas and especially in the temporal superior gyrus during performance of the cognitive task. Control subjects did not show greater activation than AN patients in any region. A negative correlation was found between brain activation and body mass index and a positive correlation between activation and depressive symptomatology. At follow-up after weight recovery, AN patients showed a decrease in brain activation in these areas and did not present differences with respect to controls. These results show that adolescent AN patients showed hyperactivation in the parietal and especially the temporal lobe during a working memory task, suggesting that they must make an additional effort to perform at normal levels. This activation correlated with clinical variables. In these young patients, differences with respect to controls disappeared after weight recovery. © 2010 Elsevier Ltd.

Trabal J.,Hospital Clinic Universitari Of Barcelona | Forga M.,Hospital Clinic Universitari Of Barcelona | Leyes P.,Hospital Clinic Universitari Of Barcelona | Torres F.,Data Management | And 3 more authors.
Clinical Interventions in Aging | Year: 2015

Objective: To assess the effect of free leucine supplementation combined with resistance training versus resistance training only on muscle strength and functional status in older adults. Methods: This was a randomized, double-blind, placebo-controlled, parallel study with two intervention groups. Thirty older adults were randomly assigned to receive either 10 g leucine/day (leucine group [LG], n=15) or a placebo (control group [CG], n=15), plus resistance training over a 12-week period. Maximal overcoming isometric leg strength, functional status, nutritional status, body composition, health-related quality of life, depression, and dietary intake were assessed at 4 and 12 weeks. Missing data at 12 weeks were handled using mixed models for repeated measurements for data imputation. Results: Twenty-four subjects completed the 4-week assessment and eleven completed the 12-week intervention. Clinically significant gains were found in isometric leg strength at both assessment time points. Analysis of the effect size also showed how participants in LG outperformed those in CG for chair stands and the timed up and go test. No significant changes were observed for the rest of the outcomes. Conclusion: Our combined analysis showed moderate changes in isometric leg muscle strength and certain components of functional status. The magnitude of changes found on these outcomes should be qualified as a positive effect of the concomitant intervention. © 2015 Trabal et al.

PubMed | Complutense University of Madrid, University of Groningen, University of Cagliari, University of Heidelberg and 6 more.
Type: Journal Article | Journal: BMC pediatrics | Year: 2016

To create a self-reported, internet-based questionnaire for the assessment of suicide risk in children and adolescents.As part of the EU project Suicidality: Treatment Occurring in Paediatrics (STOP project), we developed web-based Patient Reported Outcome Measures (PROMs) for children and adolescents and for proxy reports by parents and clinicians in order to assess suicidality. Based on a literature review, expert panels and focus groups of patients, we developed the items of the STOP Suicidality Assessment Scale (STOP-SAS) in Spanish and English, translated it into four more languages, and optimized it for web-based presentation using the HealthTrackerThe STOP-SAS comprises 19 items in its adolescent, parent, and clinician versions, and 14 items in its childrens version. Good internal consistency was found for adolescents (Cronbachs alpha: 0.965), children (Cronbachs alpha: 0.922), parents (Cronbachs alpha: 0.951) and clinicians (Cronbachs alpha: 0.955) versions. A strong correlation was found between the STOP-SAS and the C-SSRS for adolescents (r:0.670), parents (r:0.548), clinicians (r:0.863) and children (r:0.654). The ROC area was good for clinicians (0.917), adolescents (0.834) and parents (0.756) versions but only fair (0.683) for childrens version.The STOP-SAS is a comprehensive, web-based PROM developed on the HealthTracker

PubMed | Maudsley Hospital, Hospital Clinic Universitari of Barcelona and Complutense University of Madrid
Type: Journal Article | Journal: European child & adolescent psychiatry | Year: 2016

To analyze weight gain, metabolic hormones, and homocysteine (Hcys) levels in children and adolescents on antipsychotics (AP) during a year-long follow-up. 117 patients, AP-nave or quasi-nave (less than 30days on AP), were included. Weight, body mass index (BMI), BMI z-score (z-BMI), and levels of leptin, insulin, insulin resistance (HOMA-IR), adiponectin, ghrelin, thyroid stimulating hormone (TSH), free thyroxine (FT4), and Hcys were measured at baseline, and at 3, 6, and 12months, while patients remained on the same AP. Patients (mean age: 14.43years; 64.1% male) were on risperidone (N=84), olanzapine (N=20) or quetiapine (N=13) from baseline up to 1-year follow-up and significantly increased weight (5.84.3kg at 3-month, 8.16.1kg at 6-month, and 11.67.0kg at 1 year), BMI, and z-BMI. Leptin levels significantly increased from baseline to 3 and 6 months, as did TSH levels from baseline to 3 months, while FT4 levels decreased from baseline to 3 and 6 months. Patients with BMI>85th percentile at baseline (N=16) significantly increased weight, BMI, and z-BMI, more than patients with normal BMI over time. Higher baseline levels of insulin, HOMA-IR, and leptin were associated with increased weight/BMI during follow-up, while higher baseline levels of FT4, adiponectin, and ghrelin were associated with lower weight/BMI during follow-up. All AP were associated with increased weight and BMI/z-BMI in all of the assessments; however, at 1-year assessment, this increase was significantly higher for patients on quetiapine. Both higher baseline levels of insulin, HOMA-IR, and leptin, as well as being overweight/obese at baseline were associated with increased weight/BMI during 1-year follow-up in children and adolescents on AP. Awareness of weight-related parameters in this population may help inform decisions regarding AP prescriptions.

PubMed | Royal Infirmary, Netherlands Cancer Institute, Leiden University, Paracelsus Medical University and 5 more.
Type: | Journal: European urology | Year: 2016

Extended pelvic lymph node dissection (ePLND) is the gold standard for detecting lymph node (LN) metastases in prostate cancer (PCa). The benefit of sentinel node biopsy (SNB), which is the first draining LN as assessed by imaging of locally injected tracers, remains controversial.To assess the diagnostic accuracy of SNB in PCa.A systematic literature search of Medline, Embase, and the Cochrane Library (1999-2016) was undertaken using PRISMA guidelines. All studies of SNB in men with PCa using PLND as reference standard were included. The primary outcomes were the nondiagnostic rate (NDR), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false positive (FP) and false negative (FN) rates. Relevant sensitivity analyses based on SN definitions, ePLND as reference standard, and disease risk were undertaken, including a risk of bias (RoB) assessment.Of 373 articles identified, 21 studies recruiting a total of 2509 patients were eligible for inclusion. Median cumulative percentage (interquartile range) results were 4.1% (1.5-10.7%) for NDR, 95.2% (81.8-100%) for sensitivity, 100% (95.0-100%) for specificity, 100% (87.0-100%) for PPV, 98.0% (94.3-100%) for NPV, 0% (0-5.0%) for the FP rate, and 4.8% (0-18.2%) for the FN rate. The findings did not change significantly on sensitivity analyses. Most studies (17/22) had low RoB for index test and reference standard domains.SNB appears to have diagnostic accuracy comparable to ePLND, with high sensitivity, specificity, PPV and NPV, and a low FN rate. With a low FP rate (rate of detecting positive nodes outside the ePLND template), SNB may not have any additional diagnostic value over and above ePLND, although SNB appears to increase nodal yield by increasing the number of affected nodes when combined with ePLND. Thus, in high-risk disease it may be prudent to combine ePLND with SNB.This literature review showed a high diagnostic accuracy for sentinel node biopsy in detecting positive lymph nodes in prostate cancer, but further studies are needed to explore the effect of sentinel node biopsy on complications and oncologic outcome.

Magallon-Neri E.M.,Hospital Clinic Universitari of Barcelona | Magallon-Neri E.M.,University of Barcelona | Canalda G.,Hospital Clinic Universitari of Barcelona | De La Fuente J.E.,Hospital Clinic Universitari of Barcelona | And 6 more authors.
Comprehensive Psychiatry | Year: 2012

Objective: The aims of this study were to explore the influence of personality disorders (PDs) in Spanish adolescents with Axis I psychiatric disorders on their use of mental health services and to analyze the risk of having a comorbid PD in relation to psychiatric service use. Methods: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases, Tenth Revision (ICD-10) modules of the semistructured interview International Personality Disorders Examination were administered to a sample of 112 adolescent psychiatric patients (mean age = 15.8 years; SD, 0.8; range, 15-17; 79% women) at the point of initiating treatment. On the basis of the interview, subjects were divided into two groups: a PD group (PDG) and a non-PD group (NPDG). After 3 years of treatment, clinical records were retrospectively analyzed. Results: The PDG showed a significantly higher number of psychiatric admissions (P <.001), days per psychiatric admission (P <.001), and psychiatric emergencies (P <.010) than the NPDG, although the number of outpatient consultations was not significantly higher. Logistic regression analysis showed that the probability of belonging to the PDG rather than the NPDG increased with each psychiatric admission (odds ratio [OR] = 1.67 for DSM-IV criteria and OR = 1.59 for ICD-10 criteria), after controlling by sex, age, and comorbidity (Axis I disorders). Conclusions: Patients with comorbid PD used more inpatient and emergency psychiatric services than did patients without a PD. Large number of psychiatric hospitalizations suggests the likelihood of a PD being present. © 2012 Elsevier Inc.

Escribese M.M.,Mount Sinai School of Medicine | Rodriguez-Garcia M.,Hospital Clinic Universitari Of Barcelona | Rodriguez-Garcia M.,Dartmouth College | Sperling R.,Mount Sinai School of Medicine | And 3 more authors.
Reproductive Biology and Endocrinology | Year: 2011

Background: During pregnancy the immune system of the mother must protect any activation that may negatively affect the fetus. Changes in susceptibility to infection as well as resolution of some autoimmune disorders represent empirical evidence for pregnancy related alterations in immunity. Sex hormones reach extremely high levels during pregnancy and have been shown to have direct effects on many immune functions including the antiviral response of dendritic cells. Among the immunologically active proteins secreted by monocyte derived DCs (MDDC) are the alpha-defensins 1-3. This family of cationic antimicrobial peptides has a broad spectrum of microbicidal activity and has also been shown to link innate to adaptive immunity by attracting T cells and immature DCs, which are essential for initiating and polarizing the immune response.Methods: We compare culture-generated monocyte derived DCs (MDDCs) with directly isolated myeloid dendritic cells (mDCs) and plasmacytoid dendritic cells (pDCs) and measure their alpha-defensins 1-3 secretion by ELISA both, in basal situations and after hormone (E2 or PG) treatments. Moreover, using a cohort of pregnant women we isolated mDCs from blood and also measure the levels of these anti-microbial peptides along pregnancy.Results: We show that mDCs and pDCs constitutively produce alpha-defensins 1-3 and at much higher levels than MDDCs. Alpha-defensins 1-3 production from mDCs and MDDCs but not pDCs is inhibited by E2. PG does not affect alpha-defensins 1-3 in any of the populations. Moreover, alpha-defensins 1-3 production by mDCs was reduced in the later stages of pregnancy in 40% of the patients.Conclusions: Here, we demonstrate that mDCs and pDCs secrete alpha-defensins 1-3 and present a novel effect of E2 on the secretion of alpha-defensins 1-3 by dendritic cells. © 2011 Escribese et al; licensee BioMed Central Ltd.

Trabal J.,Hospital Clinic Universitari Of Barcelona | Farran-Codina A.,University of Barcelona
Nutrition Reviews | Year: 2015

Context: Decreased food intake is a common problem among older adults; it is a known cause of weight loss and may lead to malnutrition. Objective: The objective of this systematic review was to determine the effects of dietary enrichment with conventional foods on energy and protein intake in older adults. Data Sources: Studies were identified through systematic searches of the following electronic databases: MEDLINE, via PubMed; CINAHL, via EBSCO; Web of Science; Scopus; and Google Scholar. Study Selection: Studies in older adults were included without restrictions for sample size, length of follow-up, comparators, or date or status of publication. Eligible studies were dietary-enrichment interventions with conventional foods and powdered modules that aimed to increase the energy and protein density of meals without significantly increasing the final volume of the meals. Data Extraction: Outcomes assessed included changes in energy intake, protein intake, nutritional status, body weight, functional status, and episodes of infection. Data Synthesis: Nine studies were included. The results suggest that dietary enrichment can improve energy intake in older adults. While dietary enrichment seems to increase protein intake, there is not enough evidence of sufficient quality to confirm this observation or to determine whether dietary enrichment improves other outcomes assessed in this population. Conclusions: Additional large clinical trials with long-term interventions are needed to establish the effects of dietary enrichment in older people at risk of malnutrition. © The Author(s) 2015.

PubMed | Hospital Clinic Universitari Of Barcelona
Type: Journal Article | Journal: Cardiac electrophysiology clinics | Year: 2015

Lead malfunction is a common problem in implantable cardiac device patients and is expected to increase with the aging of leads. There is a weak indication for extraction of superfluous leads with the potential for cardiac implantable electronic device interference and abandoned or redundant leads; much remains to be learned from clinical practice. Lead extraction, although safe in experienced hands, remains a high-risk procedure, especially in lower-volume centers and/or when performed by lower-volume operators. Therefore, a strategy of abandoning nonfunctioning leads is reasonable, and lead extractions should be reserved for cases with system infection or high lead burden.

PubMed | Hospital Clinic Universitari Of Barcelona
Type: Comparative Study | Journal: European child & adolescent psychiatry | Year: 2015

To compare a sample of adolescents with schizophrenia spectrum disorders (SSD) treated with either ECT or antipsychotics (AP) alone at long-term follow-up. Patients diagnosed with SSD (n=21) treated with ECT due to resistance to AP or catatonia under the age of 18years (ECT group), were compared to a randomly selected group of patients with SSD treated only with AP (non-ECT group) (n=21) and matched for age, gender, diagnosis and duration of illness. Baseline data were gathered retrospectively from medical records. Subjects were assessed at follow-up (mean of follow-up period=5.5years; range 2-9years) using several clinical scales such as the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI) and the Global Assessment of Functioning (GAF). Improvement in PANSS positive, negative, general, total and CGI and GAF scores between baseline and follow-up assessment did not differ significantly between groups. At follow-up, no differences were observed for the PANSS negative, CGI and GAF scores between groups, but patients in the ECT group still had higher PANSS total, positive and general scores. ECT treatment followed by AP medication in treatment-resistant SSD or catatonia is at least as effective in the long term as AP alone in non-resistant patients.

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