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Hospital de Órbigo, Spain

Honguero Martinez A.F.,Hospital General Universitario Of Albacete | Arnau Obrer A.,Hospital General Universitario Of Valencia | Figueroa Almazan S.,Hospital General Universitario Of Valencia | Martinez Hernandez N.,Hospital General Universitario Of Valencia | Guijarro Jorge R.,Hospital General Universitario Of Valencia
Medicina Clinica | Year: 2014

Background and objective Studies suggest that hypoxia-inducible factor 1α (HIF-1α) expression favours expression of vascular endothelial growth factor A (VEGF-A) involving cellular proliferation, angiogenesis, and metastasis in different cancers including lung cancer. We investigated the correlation of HIF-1α and VEGF-A with clinicopathologic parameters and clinical outcomes in surgically resected non-small cell lung cancer patients. Patients and method Prospective study to analyze the expression of VEGF-A and HIF-1α with real time-polymerase chain reaction in 66 patients operated on non-small cell lung cancer. Results Mean age was 62.7 ± 9.8 and male:female ratio was 7.3:1. According to the new 2009 TNM classification, stage i, ii, and iii included 27 (40.9%), 21 (31.8%) and 18 (27.3%) patients, respectively. Histological subtypes were: 47% squamous cell carcinoma, 33.3% adenocarcinoma, and 19.7% others. Mean follow-up time was 42.3 months. Median survival was 43.2 months and 5-year overall survival was 42.4%. There was no correlation between HIF-1α and VEGF-A (P =.306). The overexpression of VEGF-A was found more frequent in advanced stage and in lymph nodes metastasis (P =.034 and P =.059, respectively). In multivariate analysis, T descriptor and VEGF-A overexpression were independent prognostic factors (odds ratio [OR] = 2.37, P =.016, and OR = 2.51, P =.008, respectively). HIF-1α overexpression showed an OR = 0.540, but without statistical significance (P =.172). Conclusions The present study revealed that VEGF-A overexpression was an adverse independent prognostic factor. On the contrary, HIF-1α overexpression showed a tendency to a protective effect on survival of surgically treated non-small cell lung cancer patients, although without statistical significance. © 2012 Elsevier Espana, S.L. All rights reserved.

Espinosa De Rueda M.,Hospital Clinico Universitario Virgen Of La Arrixaca | Parrilla G.,Hospital Clinico Universitario Virgen Of La Arrixaca | Manzano-Fernandez S.,Hospital Clinico Universitario Virgen Of La Arrixaca | Garcia-Villalba B.,Hospital Clinico Universitario Virgen Of La Arrixaca | And 6 more authors.
Stroke | Year: 2015

Background and Purpose - Futile recanalization after acute ischemic stroke occurs in almost half of the patients despite optimal angiographic results. Multimodal neuroimaging may help to improve patient's selection but is still dismissed by many interventionalists. Our aim was to evaluate the accuracy of each parameter of multimodal computed tomography (CT) and their combination for predicting futile recanalization after successful thrombectomy. Methods - We retrospectively reviewed a cohort of consecutive patients with anterior circulation stroke, fully assessable multimodal CT, and successful recanalization. Nonenhanced CT, CT angiography source images, cerebral blood volume (CBV), cerebral blood flow (CBF), and mismatch CBV-CBF maps were studied by Alberta Stroke Program Early CT Score (ASPECTS); collaterals on CT angiography were graded as poor or good (≤50% or >50% of the middle cerebral artery territory). Futile recanalization was defined as modified Rankin Scale score >2 at 3 months despite successful recanalization. Results - One hundred fifty patients were included and 57% of them had futile recanalization. They had lower ASPECTS on nonenhanced CT, CT angiography source images, CBV, CBF, and mismatch CBV-CBF and presented more frequently poor collaterals (all P<0.001). Among them, CBV showed the highest area under the curve (0.83; 95% confidence interval, 0.76-0.88). In multivariate analyses, CT angiography source images ≤5 (odds ratio, 5.1; 95% confidence interval, 1.2-21.9), CBV≤6 (odds ratio, 3.5; 95% confidence interval, 1.2-9.7), and poor collaterals (odds ratio, 8.6; 95% confidence interval, 1.8-41.7) were independent predictors of futile recanalization. A combined score of these 3 parameters added complementary information: 57% of the patients with score-1, 89% with score-2, and 100% with score-3 had futile recanalization. Reclassification analyses indicated that this score improved prediction of futile recanalization. Conclusions - In this population, a combined multimodal CT score predicted futile recanalization. © 2015 American Heart Association, Inc.

Sanmartin E.,Hospital General Universitario Of Valencia | Sirera R.,Polytechnic University of Valencia | Uso M.,Hospital General Universitario Of Valencia | Blasco A.,Hospital General Universitario Of Valencia | And 11 more authors.
Annals of Surgical Oncology | Year: 2014

Background: Angiogenesis and lymphangiogenesis are key mechanisms for tumor growth and dissemination. They are mainly regulated by the vascular endothelial growth factor (VEGF) family of ligands and receptors. The aim of this study was to analyze relative expression levels of angiogenic markers in resectable non-small cell lung cancer patients in order to asses a prognostic signature that could improve characterization of patients with worse clinical outcomes. Methods: RNA was obtained from tumor and normal lung specimens from 175 patients. Quantitative polymerase chain reaction was performed to analyze the relative expression of HIF1A, PlGF, VEGFA, VEGFA165b, VEGFB, VEGFC, VEGFD, VEGFR1, VEGFR2, VEGFR3, NRP1 and NRP2. Results: Univariate analysis showed that tumor size and ECOG-PS are prognostic factors for time to progression (TTP) and overall survival (OS). This analysis in the case of angiogenic factors also revealed that PlGF, VEGFA, VEGFB and VEGFD distinguish patients with different outcomes. Taking into account the complex interplay between the different ligands of the VEGF family and to more precisely predict the outcome of the patients, we considered a new analysis combining several VEGF ligands. In order to find independent prognostic variables, we performed a multivariate Cox analysis, which showed that the subgroup of patients with higher relative expression of VEGFA plus lower VEGFB and VEGFD presented the poorest outcome for both TTP and OS. Conclusions: The relative expression of these three genes can be considered as an angiogenic gene signature whose applicability for the selection of candidates for targeted therapies needs to be further validated. © 2013 Society of Surgical Oncology.

Pardal-Fernandez J.M.,Hospital General Universitario Of Albacete | Rodriguez-Vazquez M.,Hospital General Universitario Of Albacete
Revista de Neurologia | Year: 2011

Introduction. Metatarsalgia is the main symptom of a group of frequent ailments characterised by pain in the balls of the feet. Clinical knowledge and the availability of efficient complementary examinations are useful tools for the neurologist. Aim. To describe the range of processes related with metatarsalgia and a basic diagnostic schema that allows the aetiology to be differentiated. Development. We perform an elementary review of the neurological anatomy of the foot and outline the different neuropathies affecting the region, as well as the extra neurological processes that could call for a differential diagnosis. Conclusions. Familiarity with the pathologies responsible for metatarsalgias, whether they are neurological or not, is an enriching element for the diagnosis and management of these patients, as well as for greater efficiency in the referral among the medical professionals involved. © 2011 Revista de Neurología.

Objective: To evaluate the influence of the treatment with continuous subcutaneous insulin infusion on the quality of life of type 1 diabetics. Method: An analytical study of cohorts was conducted on 80 patients diagnosed with type 1 diabetes mellitus, with more than five years of evolution and without evidence of micro-macro vascular complications, on treatment with CSII or multiple daily insulin injections (MDII). The quality of life of both groups was evaluated by means of a validated modification of the survey "Diabetes Quality of Life Measure" (DQLM). The SPSS 11.0 softwarewas used to determine Chi2 and establish statistically significant values for a P<0.05. Results: In 86% (31/36) of the questions, the patients on treatment with insulin infusion systems showed higher satisfaction with their quality of life than the patients with multiple daily insulin injections, although only in 16% (6/36) of the questions, were the scores significantly better in the first group. Conclusions: There were no significant differences in the dimensions studied between both groups, but the patients with CSII obtain better results in many variables of the fe DQLM, and they were more satisfied with the flexibility that their treatment offers them in daily life activities. © 2009 Elsevier España, S.L.

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