PubMed | Hospital Universitario La Paz, Complejo Hospitalario Of Jaen, Hospital Universitario 12 Of Octubre, Hospital Universitario Central Of Asturias and 16 more.
Type: | Journal: Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico | Year: 2016
Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered in the previous stages, such as acquired resistance, type of progression, time to relapse, tumor aggressiveness, age, comorbidities, pre- and post-menopausal status, and patient preferences. Moreover, tumor genomic signatures can identify different subtypes, which can be used to create patient profiles and design specific therapies. However, there is no consensus regarding the best treatment sequence for each subgroup of patients. During the SABCC Congress of 2014, specialized breast cancer oncologists from referral hospitals in Europe met to define patient profiles and to determine specific treatment sequences for each one. Conclusions were then debated in a final meeting in which a relative degree of consensus for each treatment sequence was established. Four patient profiles were defined according to established breast cancer phenotypes: pre-menopausal patients with luminal subtype, post-menopausal patients with luminal subtype, patients with triple-negative subtype, and patients with HER2-positive subtype. A treatment sequence was then defined, consisting of hormonal therapy with tamoxifen, aromatase inhibitors, fulvestrant, and mTOR inhibitors for pre- and post-menopausal patien ts; a chemotherapy sequence for the first, second, and further lines for luminal and triple-negative patients; and an optimal sequence for treatment with new antiHER2 therapies. Finally, a document detailing all treatment sequences, that had the agreement of all the oncologists, was drawn up as a guideline and advocacy tool for professionals treating patients with this disease.
Lopez-Labrador F.X.,University of Valencia |
Lopez-Labrador F.X.,CIBER ISCIII |
Berenguer M.,University of Valencia |
Berenguer M.,CIBER ISCIII |
And 2 more authors.
Future Microbiology | Year: 2015
Although vaccination has provided as a very efficient preventive tool, antiviral therapy is still needed to control viral infections not avoidable by prophylaxis with vaccines; those caused by viruses for which a vaccine is available, but vaccination is not universally implemented or does not result in complete, long-term protection; and in immunocompromised individuals with reduced immune control of viral replication. After more than 50 years of the first licensing for an antiherpetic drug, novel compounds for herpes-simplex viruses and human cytomegalovirus will open new strategies for better control and management of these two recurrent viral infections. Besides, the development and use of antiviral drugs for hepatitis viruses causing chronic liver disease has evolved from the unavailability of compounds targeting virus-specific pathways, to the generalization of different treatment regimes based on specific antiviral drugs, both for hepatitis B and C viruses. However, due to the nature of the viral genomes and their replication, in the face of the selective pressure imposed by antiviral drugs viral-resistant variants inevitably emerge, and specific strategies are needed to avoid, or reduce, their clinical and public health impact. © 2015 Future Medicine Ltd.
Vila-Frances J.,University of Valencia |
Sanchis J.,Hospital Clinic Universitari Of Valencia |
Soria-Olivas E.,University of Valencia |
JoseSerrano A.,University of Valencia |
And 3 more authors.
Expert Systems with Applications | Year: 2013
The use of computer-based clinical decision support (CDS) tools is growing significantly in recent years. These tools help reduce waiting lists, minimise patient risks and, atthe same time, optimise the cost health resources. In this paper, we present a CDS application that predicts the probability of having unsta- ble angina based on clinical data.Due to the characteristics of the variables (mostly binary) a Bayesian network model was chosen to support the system.Bayesian-network model was constructed using a population of 1164 patients, and subsequently was validated with apopulation of 103 patients.The val- idation results, with anegative predictive value (NPV) of 91%, demonstrate its applicability to help clini- cians. The final model was implemented as a web application that is currently been validated by clinician specialists. © 2013 Elsevier Ltd. All rights reserved.
PubMed | Hospital Clinic Universitari Of Valencia, University of Valencia, Hospital Clinic Universitari Of Valencia 17 and Consorci Hospital General Universitari Of Valencia
Type: Journal Article | Journal: Vaccine | Year: 2016
Pneumococcal 13-valent vaccine (PCV-13) has a potential role in preventing bacteraemic pneumococcal pneumonia and its complications, but little is known about its ability to specifically prevent respiratory complications. Our aim were to analyse the pneumococcal serotypes associated with the development of respiratory complications and the potential role of PCV-13 in preventing respiratory complications in bacteraemic pneumococcal pneumonia.We analysed demographic characteristics, comorbidities, antibiotic resistances and the outcomes of a cohort of 65 vaccine-nave bacteraemic pneumococcal pneumonias, stratified by the pneumococcal serotypes included in PCV13 vs. those not included. Complications were clustered as follows: respiratory complications (hypoxemic respiratory failure; mechanical ventilation), systemic complications (septic shock; multiorgan failure), suppurative complications (empyema; pleural effusion; lung abscess).From a population of 65 CAP-SP, 47.7% of the isolates belonged to PCV-13 serotypes group. No differences in comorbidities or clinical manifestations were found between groups. With regard to biochemical parameters, we found more profound hypoxemia levels in PCV-13 serotypes group comparing to non-vaccine group [PaO2/FiO2 209 (63) vs. 268 (57); p=0.007]. Global complications were identified in 69.2% (45 patients), and the most frequent were respiratory complications, found in 47.7%. Respiratory complications were detected more frequently in PCV-13 groups compared to non-vaccine groups (61.3% vs. 35.3%; p=0.036). Overall 30-day mortality was 30.8%. Mortality was similar between both groups (25.8% vs. 35.3%; p=0.408).Pneumococcal 13-valent conjugate vaccine includes the serotypes which cause more respiratory complications in our series; these serotypes were not associated with higher mortality in our series. PCV-13 may have a potential role in preventing respiratory complications due to bacteraemic pneumonoccal pneumonia.
PubMed | Hospital Clinic Universitari Of Valencia and University of Valencia
Type: Journal Article | Journal: Future microbiology | Year: 2015
Although vaccination has provided as a very efficient preventive tool, antiviral therapy is still needed to control viral infections not avoidable by prophylaxis with vaccines; those caused by viruses for which a vaccine is available, but vaccination is not universally implemented or does not result in complete, long-term protection; and in immunocompromised individuals with reduced immune control of viral replication. After more than 50 years of the first licensing for an antiherpetic drug, novel compounds for herpes-simplex viruses and human cytomegalovirus will open new strategies for better control and management of these two recurrent viral infections. Besides, the development and use of antiviral drugs for hepatitis viruses causing chronic liver disease has evolved from the unavailability of compounds targeting virus-specific pathways, to the generalization of different treatment regimes based on specific antiviral drugs, both for hepatitis B and C viruses. However, due to the nature of the viral genomes and their replication, in the face of the selective pressure imposed by antiviral drugs viral-resistant variants inevitably emerge, and specific strategies are needed to avoid, or reduce, their clinical and public health impact.
Sanz Herrero F.,Consorci Hospital General Universitari Of Valencia |
Perez T.L.,Consorci Hospital General Universitari Of Valencia |
Olivas J.B.,Hospital Clinic Universitari Of Valencia
Current Respiratory Medicine Reviews | Year: 2010
Invasive pneumococcal disease is a major cause of morbimortality worldwide. The presence of bacteremia in pneumococcal pneumonia constitutes an additional factor of worse prognosis, although the highest virulence of invasive pneumococcal infection is clustered in certain serotypes. Antibiotic resistances are a challenge for the clinician when choosing the most appropriate antibiotic treatment. However, the influence of these in the evolution of the disease is a controversial issue, and it is clinically irrelevant if the MIC is lower than 4 g/ml. The control of antibiotic pressure on Streptococcus pneumoniae has proved the most effective tool for monitoring resistances. Prevention strategies through pneumococcal vaccination have been shown to reduce the incidence of invasive pneumococcal disease in vaccinated children and the unvaccinated adult population. However, a phenomenon of increased infections by serotypes not included in the vaccine has been described. The development of antibiotics and vaccination have achieved great progress in the control of this disease, although Streptococcus pneumoniae continues to develop mechanisms of survival and adaptation. © 2010 Bentham Science Publishers Ltd.
Juste B.,Polytechnic University of Valencia |
Miro R.,Polytechnic University of Valencia |
Campayo J.M.,Hospital Clinic Universitari Of Valencia |
Diez S.,Hospital Clinic Universitari Of Valencia |
Verdu G.,Polytechnic University of Valencia
Applied Radiation and Isotopes | Year: 2010
Commercial planning systems used in radiotherapy treatments use determinist correlations to evaluate dose distribution around regions of interest. Estimated dose with this type of planners can be problematic, especially when analyzing heterogeneous zones. The present work is focused in quantifying the dose distribution in a heterogeneous medium irradiated by a 6 MeV photon beam emitted by an Elekta Precise Radiotherapy Unit head. Dose mapping inside the heterogeneous water phantom has been simulated with the photon and electron transport with Monte Carlo computer code MCNP5 and also, using a commercial treatment planning software in the same irradiation conditions. The calculated results were compared with experimental relative dose curves. This comparison shows that inside the heterogeneity region, the commercial algorithms are not able to predict the variation of dose in the heterogeneous zones with the same precision as MCNP5. Crown Copyright © 2009.
Badenes R.,Hospital Clinic Universitari Of Valencia |
Bilotta F.,University of Rome La Sapienza
British Journal of Anaesthesia | Year: 2015
Intracerebral haemorrhage (ICH) is associated with significant early mortality (up to 50% at 30 days) and long-term morbidity (with permanent neurological deficits in 75-80% of patients) and represents a serious health issue worldwide. The past decade has seen a dramatic increase in clinical research on ICH diagnosis and treatment that has led to revision of the guidelines for the diagnosis and management of ICH from the American Heart Association and American Stroke Association in 2013. This systematic review reports recent clinical evidence (original studies published between September 2013 and July 2015) related to neurocritical care and intensive care unit management of patients with ICH. All but one publication included in this review report original studies related to managment of patients with intracerebral or subarachnoid haemorrhage. These include insights on risk stratification and neurocritical care or intensive care unit treatment, management of haemodynamic variables and mechanical ventilation (goal-directed fluid therapy, advanced haemodynamic monitoring, and avoidance of hyperoxia and hyperventilation), and pharmacological neuroprotection. © 2015 The Author.
PubMed | Instituto Valenciano Of Dermatologia and Hospital Clinic Universitari Of Valencia
Type: Journal Article | Journal: Actas dermo-sifiliograficas | Year: 2016
Patients with melanoma appear to take extreme sun-protection measures, which could influence 25-hydroxyvitamin D [25(OH)D] levels. The aim of this study was to measure 25(OH)D levels in patients with cutaneous melanoma and identify factors associated with inadequate levels.Over a period of 1 year, we prospectively measured serum 25(OH)D in patients with cutaneous melanoma and used logistic regression analysis to identify environmental, phenotypic, and genotypic factors that were associated with insufficient and deficient levels.Of 215 patients analyzed, 8.8% had deficient 25(OH)D levels (<10ng/mL) and just 24.7% had normal levels. Insufficient levels (<30ng/mL) were associated with obesity (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.3-13.3) and blood sampling in autumn/winter (OR, 2.1; 95% CI, 1.1-4). Deficient levels (<10ng/mL) were associated with obesity (OR, 7.1; 95% CI, 1.1-46.9), blood sampling in autumn/winter (OR, 9.0; 95% CI, 1.7-47.0), absence of freckles (OR, 5.4; 95% CI, 1.2-23.4), and, with marginal significance, the presence of fewer than 2 nonsynonymous melanocortin-1 receptor (MC1R) polymorphisms (OR, 5.0; 95% CI, 0.9-28.9).Some factors related to 25(OH)D levels, such as food, were not included in the analyses.25(OH)D levels should be monitored in patients with melanoma and the need for oral supplements should be contemplated where appropriate.
PubMed | Hospital Clinic Universitari Of Valencia
Type: Journal Article | Journal: Obesity surgery | Year: 2015
Morbidly obese patients show an increased risk of postoperative hypoxemia and pulmonary complications when compared with normal weight subjects. The purpose of this study was to determine the effects of preoperative inspiratory muscular training (IMT) on postoperative arterial oxygenation in morbidly obese patients submitted to laparoscopic bariatric surgery.Forty-four morbidly obese patients were randomly assigned to receive either preoperative usual care (control group, n=21) or preoperative IMT (trained group, n=23) for a month prior to the date of surgery. Data on oxygenation (PaO2/FiO2 ratio) were obtained at 1 h and at 12 h after surgery (PACU 1 h and PACU 12 h, respectively). Data on maximum static inspiratory pressure (MIP) were obtained before and after the training period, and at postanesthesia care unit (PACU) 12-h time point.PaO2/FiO2 was significantly higher in the trained group than in the control group, both at PACU 1 h (305.277.6 vs. 248.853.8, P=0.008) and at PACU 12 h (333.559.6 vs. 289.779.6, P=0.044). As a consequence, the percentage of patients with relative hypoxemia (PaO2/FiO2 lower than 300 mmHg) at the time of PACU discharge was higher in the control group (57 vs. 17 %, P: 0.006). MIP was significantly higher in the trained group compared with the control group at the preoperative time point (89.8719.00 vs. 77.0021.20 cm H2O, P=0.04).Preoperative IMT improved postoperative oxygenation and increased inspiratory muscular strength in morbidly obese patients submitted to laparoscopic bariatric surgery.