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Merino A.,Hospital Universitario Reina Sofia | Portoles J.,Hospital Universitario Fundacion Of Alcorcon | Selgas R.,Hospital Universitario La Paz | Ojeda R.,Hospital Universitario Reina Sofia | And 8 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2010

Background and objectives: We studied the relationship between microinflammation and endothelial damage in chronic kidney disease (CKD) patients on different dialysis modalities. Design, setting, participants, & measurements: Four groups of CKD stage 5 patients were studied: 1) 14 nondialysis CKD patients (CKD-NonD); 2) 15 hemodialysis patients (HD); 3) 12 peritoneal dialysis patients with residual renal function >1 ml/min (PD-RRF >1); and 4) 13 peritoneal dialysis patients with residual renal function <1 ml/min (PD-RRF <1). Ten healthy subjects served as controls. CD14 +CD16+ cells and apoptotic endothelial microparticles (EMPs) were measured by flow cytometry. Serum vascular endothelial growth factor (VEGF) was measured by ELISA. Results: CKD-NonD and HD patients had a higher percentage of CD14+CD16+ monocytes than PD groups and controls. CD14+CD16+ was similar in the PD groups, regardless of their RRF, and controls. The four uremic groups displayed a marked increase in apoptotic EMPs and VEGF compared with controls. Apoptotic EMPs and VEGF were significantly higher in HD patients than in CKD-NonD and both PD groups. However, there were no significant differences between CKD-NonD and the two PD groups. There was a correlation between CD14+CD16+ and endothelial damage in CKD-NonD and HD patients, but not in PD and controls. Conclusions: There was an increase in CD14+CD16+ only in CKD-NonD and HD patients. In these patients, there was a relationship between increased CD14+CD16+ and endothelial damage. These results strongly suggest that other factors unrelated to the microinflammatory status mediated by CD14+CD16+ are promoting the endothelial damage in PD, regardless of their RRF. Copyright © 2010 by the American Society of Nephrology.


Munoz-Fernandez S.,Hospital Infanta Sofia | Carmona L.,Research Unit | Collantes E.,Hospital Universitario Reina Sofia | Collantes E.,University of Cordoba, Spain | And 8 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objectives: To evaluate the performance of a healthcare programme in early spondyloarthritis (SpA). Methods: Based on previous analyses and expectations of a nominal group, the following were set: (1) minimum standards to create early SpA units; (2) standard operating procedures; and (3) eight performance indicators that can be measured in real time using a web-based platform. Results: At the end of the evaluation of the programme the expected level of performance was achieved in three of the indicators:'referral reliability' (standard (S) >50%, real value (RV) 92%), 'accessibility' (S >90%, RV=91%) and 'duration of first visit' (S >50%, RV=53%). The performance in the remaining indicators was inferior: 'success of referral criteria' (S >50%, RV=28%), 'clinical reports issued' (S >90%, RV=25%), 'feedback guarantee' (S >85%, RV=2%), 'missing data' (S <10%, RV=24%) and 'frequency of review' (S >90%, RV=84%). Explanations for the low performance are provided. Conclusions: It is possible to implement a large-scale programme that is measurable.


PubMed | Hospital Universitario La Paz, Hospital Joan XXIII, Hospital Universitario Gregorio Maranon and Institute Investigacion Sanitaria Gregorio Maranon, Hospital Of Torrejon Of Ardoz and 70 more.
Type: Journal Article | Journal: The American journal of gastroenterology | Year: 2016

The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed.This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included.A total of 1,055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohns disease and ulcerative colitis patients, respectively. In both Crohns disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI=1.07-3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27-2.02) vs. a top-down strategy, colonic localization (HR=1.51; 95% CI=1.13-2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohns disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51-0.87) and age (HR=0.98; 95% CI=0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe.The incidence rate of inflammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identified. Retreatment with the same anti-TNF drug was effective and safe.


Garcia-Garcia J.M.,CSIC - Institute of Polymer Science and Technology | Lopez L.,Hospital Universitario Fundacion Of Alcorcon | Paris R.,CSIC - Institute of Polymer Science and Technology | Nunez-Lopez M.T.,Hospital Universitario Fundacion Of Alcorcon | And 3 more authors.
Journal of Biomedical Materials Research - Part A | Year: 2012

Often bladder dysfunction and diseases lead to therapeutic interventions that require partial or complete replacement of damaged tissue. For this reason, the development of biomaterials to repair the bladder by promoting the adhesion and growth of urothelial cells is of interest. With this aim, a modified copolyester of biocompatible and biodegradable poly(3-hydroxybutyrate-co-3- hydroxyvalerate) [P(HB-co-HV)] was used as scaffold for porcine urothelial cell culture. In addition to good biocompatibility, the surface of P(HB-co-HV) substrates was modified to provide both, higher hydrophilicity and a better interaction with urothelial cells. Chemical treatments with ethylenediamine (ED) and sodium hydroxide (NaOH) led to substrate surfaces with decreasing hydrophobicity and provided functional groups that enable the grafting of bioactive molecules, such as a laminin derived YIGSR sequence. Physico-chemical properties of modified substrates were studied and compared with those of the pristine P(HB-co-HV). Urothelial cell morphology on treated substrates was studied. The results showed that focal attachment and cell-related properties were improved for peptide grafted polymer compared with both, the unmodified and functionalized copolyester. Copyright © 2011 Wiley Periodicals, Inc.


Nuno-Gonzalez A.,Hospital Universitario Fundacion Of Alcorcon | Vicente-Martin F.J.,Hospital Universitario Fundacion Of Alcorcon | Pinedo-Moraleda F.,Hospital Universitario Fundacion Of Alcorcon | Lopez-Estebaranz J.L.,Hospital Universitario Fundacion Of Alcorcon
Actas Dermo-Sifiliograficas | Year: 2012

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer and its incidence has increased in recent decades. Most cSCCs are successfully treated by surgery, but local and distant metastases develop in approximately 5% of cases; this proportion is higher in certain forms of cSCC with high-risk factors, namely: tumor size >2 cm, depth >2 mm, Clark level ≥IV, perineural invasion, lymphovascular invasion, poor differentiation, certain histologic subtypes (desmoplastic or adenosquamous carcinoma, invasive Bowen disease, or a cSCC arising in areas of chronic inflammation), immunosuppression, human papillomavirus infection, high-risk anatomic location (pinna of the ear, labial mucosa), expression of certain tumor genes, and inadequate tumor resection. The latest TNM (tumor, lymph node, metastasis) classification of cSCC published by the American Joint Committee on Cancer (AJCC) in the seventh edition of its Cancer Staging Manual now incorporates several of these risk factors to improve disease staging. We review all the factors currently considered to be markers of poor prognosis in cSCC and analyze the new AJCC classification and the different treatment options for high-risk cSCC. *Carcinoma epidermoide cutáneo*Factores de alto riesgo*Metástasis*Recidiva. © 2011 Elsevier España, S.L. y AEDV. Todos los derechos reservados.


El-Yaagoubi M.,Rey Juan Carlos University | El-Yaagoubi M.,Hospital Universitario Fundacion Of Alcorcon | Mora-Jimenez I.,Rey Juan Carlos University | Rojo-Alvarez J.L.,Rey Juan Carlos University
IFMBE Proceedings | Year: 2016

Cluster headache diagnosis is an open problem, whose signs are often noticeable in terms of changes in texture, color, or clarity of the eye of the induced pain side. The color difference is sometimes visible by the naked eye, hence it is close to the diagnosis of the cluster headache. Preliminary diagnosis tests on patients with cluster headache have shown that all of them have hypo-pigmented iris in the symptomatic side. We present here a color quantization method which can document the pigmentation differences of the iris, aiming to develop the first step towards an automatic diagnosis detection system. To do this, we used a statistical learning approach, specifically a Support Vector Classifier, to detect differences between iris pigmentation by using the error probability as a surrogate of color differences between the pigmentation in both eyes. The classification performance was compared when considering several features from different color spaces, in such a way that the error probability provided by the classifier when comparing the iris color of both eyes of the same patient provides a quantitative measure of the headache diagnosis. Systematic tests were performed on a database with images of 11 patients (seven patients with cluster headache and four control subjects). We can conclude from the present work that the study of the iris color features through statistical learning emerges as a technique of interest in the study of disorders affecting the sympathetic system. © Springer International Publishing Switzerland 2016.


Hernandez V.,Hospital Universitario Fundacion Of Alcorcon | Blazquez C.,Hospital Universitario Fundacion Of Alcorcon | De La Pena E.,Hospital Universitario Fundacion Of Alcorcon | Perez-Fernandez E.,Hospital Universitario Fundacion Of Alcorcon | And 2 more authors.
Actas Urologicas Espanolas | Year: 2013

Objectives To evaluate the acceptance of active monitoring by patients treated in our healthcare community and to report the clinical results of an active surveillance program in patients with low-risk prostate cancer. Material and methods Prospective study of patients enrolled in an active surveillance programme at our centre between 2004 and 2012. The inclusion criteria were PSA <10 ng/ml, Gleason score ≤ 6, clinical stage T1c/T2a, ≤ 2 positive cores, and no more than 50% of the core being affected. Curative treatment was proposed when faced with pathological progression over the course of the monitoring. Results In 2011, only 17% of the total number of potential candidate patients rejected their inclusion in a surveillance programme and were treated actively. We analysed a series of 144 patients included in our active surveillance protocol. The mean follow-up time was 3.22 years (SD 2.08). A total of 110 patients (76.3%) remained under active monitoring, with an estimated median treatment-free survival after diagnosis of 6.9 years (95% CI: 6.2-7.6). The percentage of patients who remained free of treatment at 2 and 5 years was 96.3% (95% CI: 92.8%-99.8%) and 70.9% (95% CI: 59.3%-85.5%), respectively. Thirty four patients (23.6%) required curative treatment. The mean time to treatment was 4.6 years (SD 2.3). Conclusions Active surveillance of highly selected patients with low-risk prostate cancer is a valid alternative therapy that is accepted by patients in our community. © 2012 AEU. Publicado por Elsevier España, S.L. Todos los derechos reservados.


Hernandez V.,Hospital Universitario Fundacion Of Alcorcon | de la Pena E.,Hospital Universitario Fundacion Of Alcorcon | Martin M.D.,Hospital Universitario Fundacion Of Alcorcon | Blazquez C.,Hospital Universitario Fundacion Of Alcorcon | And 2 more authors.
World Journal of Urology | Year: 2011

Purpose: To perform an external validation of the EORTC risk tables and to evaluate their applicability in the patients of our institution by comparing the actual risk of recurrence and progression in our series to those obtained through the application of the EORTC tables. Methods: Retrospective study, based on a prospective cohort of 417 patients in follow-up with primary TaT1 bladder tumors, operated on in our center between 1998 and 2008 and collected in our database. Risk scores were assigned depending on the tumor characteristics to divide our series into four risk groups according to these ratings. An analysis of survival was carried out to calculate the probability of recurrence by the method of Kaplan-Meier. Results: A total of 417 patients with a median follow-up of 59 months were studied. The overall recurrence and progression rates of our series were 25.95% (21.97-30.49) and 4.86% (3.16-7.43) at 1 year and 53.46% (48.06-59.05) and 8.43% (5.95-11.86) at 5 years, respectively. When we compare our rates of recurrence and progression by groups with the corresponding values from Sylvester's publication, an overlapping of the confidence intervals between both populations is detected. Conclusions: In terms of the applicability of the EORTC risk tables in our patients' population, we conclude that these tables predict accurately the clinical course of patients with NMIBC. Due to the sample size of our study, we can only validate the recurrence model of the EORTC tables. © 2010 Springer-Verlag.


PubMed | Hospital Universitario Fundacion Of Alcorcon
Type: Journal Article | Journal: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia | Year: 2016

Screening colonoscopy with polipectomy reduces colonorectal cancer incidence and mortality. An adequate bowel cleansing is one of the keys to achieving best results with this technique. Oral sodium phosphate solution (OSP) had a widespread use in the 90s decade. Its efficacy was similar to polyethylene glycol (PEG) solution, but with less cost and convenient administration. Series of patients with acute renal failure due to OSP use have been reported. However, large cohorts of patients found no difference in the incidence of renal damage between these two solutions.From 2006 to 2009 we identified twelve cases of phosphate nephropathy after colonoscopy prepared with OSP. All patients were followed up to six months. All patients had received just a single dose.We analyzed 12 cases with phosphate nephropathy; three patients debuted with AKI and nine patients had chronic renal injury. Four cases were confirmed with renal biopsy. One patient with AKI needed hemodialysis at diagnosis without subsequent recovery. Two patients (both with chronic damage) fully recovered their previous renal function. The remaining patients (nine) had an average loss of estimated glomerular filtration rate of 24ml/min/1.73m(2).The use of OSP can lead to both acute and chronic renal damage. However, chronic injury was the most common pattern. Both forms of presentation imply a significant and irreversible loss of renal function. Further studies analyzing renal damage secondary to bowel cleaning should consider these two different patterns of injury.


PubMed | Hospital Universitario Fundacion Of Alcorcon
Type: Journal Article | Journal: Actas dermo-sifiliograficas | Year: 2016

Lentigo maligna is the most common type of facial melanoma. Diagnosis is complicated, however, as it shares clinical and dermoscopic characteristics with other cutaneous lesions of the face. Reflectance confocal microscopy is an imaging technique that permits the visualization of characteristic features of lentigo maligna. These include a disrupted honeycomb pattern and pagetoid cells with a tendency to show folliculotropism. These cells typically have a dendritic morphology, although they may also appear as round cells measuring over 20m with atypical nuclei. Poorly defined dermal papillae and atypical cells may be seen at the dermal-epidermal junction and can form bridges resembling mitochondrial structures. Other characteristic findings include junctional swelling with atypical cells located around the follicles, resembling caput medusae. Reflectance confocal microscopy is a very useful tool for diagnosing lentigo maligna.

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