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Bernal-Perez M.,Hospital Universitario Lozano Blesa | Souza D.L.B.,Federal University of Rio Grande do Norte | Romero-Fernandez F.J.,Hospital Universitario Lozano Blesa | Gomez-Bernal G.,Hospital San Juan Of Dios
Actas Urologicas Espanolas | Year: 2013

Introduction: One of the most frequent cancers in the world is bladder cancer that affects, according to some authors, 5.4 million persons in the most developed countries. Our study has aimed to estimate the impact projections of this disease in Spain between 2007 and 2022. Material and methods: Mortality data for bladder cancer mortality was used International Classification of Diseases 10th revision (ICD-10 C67), and the population data from 1998 to 2007. The data were obtained from the National Institute of Statistics (INE). Relative survival was obtained form the EUROCARE study. The projections of incidence, prevalence, and mortality were estimated using the statistical program Mortality-Incidence Analysis MODel (MIAMOD) and after the joinpoint regression that calculates the Annual Percentage of Change (APC). Results: Between the years 1998 and 2022, it is foreseen that there will be a decrease in prevalence in the men, from 156.93 (adjusted rate AR=128.71) to 132.99 (AR=84.68) cases per 100,000 inhabitants/year in the year 2022. The incidence rate would decrease from 30.2 (AR=24.93) to 24.87 (AR=15.88) and mortality from 14.96 (AR=12.25) to 12.08 (AR=7.67). In women, an increase is expected in prevalence from 21.18 (AR=13.23) to 35.6 (AR=21.46) cases per 100.000 inhabitants/year. The incidence of 4.8 (AR=2.91) in 1998 to 7.79 (AR=4.69), Mortality will increase from 2.25 (AR=1.32) to 3.37 (AR=1.89) between the years 1998 and 2022. In men, the APCs found for prevalence, incidence and mortality were, respectively, 0.69 (95% CI%: -6.9/8.9); 0.69 (95% CI: -6.9/8.95) and -4.18 (95% CI: -11.32/3.51), these not being statistically significant. In women, the APC for prevalence was -4.44 (95% CI: -13.4/5.44). from 19.24 (95% CI: 8.93/30.52).and from -3.28 (95% CI: -20.26/17.20) for mortality. Conclusions: This cancer should be monitored and in turn prevented based on the controllable risk factors, especially in women. © 2012 AEU. Published by Elsevier España, S.L. All rights reserved.


Asin L.,University of Zaragoza | Ibarra M.R.,University of Zaragoza | Tres A.,Hospital Universitario Lozano Blesa | Goya G.F.,University of Zaragoza | Goya G.F.,Institute Nanociencia Of Aragon
Pharmaceutical Research | Year: 2012

Purpose: To investigate the effects of alternating magnetic fields (AMF) on the death rate of dendritic cells (DCs) loaded with magnetic nanoparticles (MNPs) as heating agents. AMF exposure time and amplitude as well as the MNPs concentration were screened to assess the best conditions for a controlled field-induced cell death. Methods: Human-monocyte-derived DCs were co-incubated with dextran-coated MNPs. The cells were exposed to AMF (f=260 kHz; 0


PubMed | Hospital Universitario Lozano Blesa
Type: Journal Article | Journal: Hipertension y riesgo vascular | Year: 2016

Ischemic heart disease remains a leading cause of death in Spain. According to the American Heart Association/American College of Cardiology (AHA/ACC) and European national societies, secondary prevention for these patients consists of control of major cardiovascular risk factors (CVRF) and suitable lifestyle habits.To determine the degree of control of CVRF in the Aragonese population in secondary prevention.Cross-sectional study of a sample of 705 patients of Aragon who had suffered a cardiac event, selected opportunistically in consultations of family physicians participating in the 3 provinces of Aragon. The study was conducted in the second half of 2012.To measure the degree of control of different FRVC and lifestyle habits in this population.Anthropometric, different cardiovascular risk factors, treatment and lifestyle.58% of men and 52% of women met criteria for monitoring of measured variables. The best result was obtained with smoking cessation and the worst with BMI. Hypertension, Dyslipidemia and Diabetes Mellitus achieve poor control results.The results show that the degree of control of CVRF is still low, especially in variables such as dyslipidemia and Diabetes Mellitus. Only 16.5% of control patients met criteria given the pharmacologically-modifiable cardiovascular risk factors.


PubMed | Hospital del Mar, Hospital Universitario 12 Of Octubre, Hospital Universitario Gregorio Maranon, Hospital Universitario Doctor Peset and 11 more.
Type: Journal Article | Journal: European journal of haematology | Year: 2016

Bendamustine is an increasingly used hybrid alkylating agent that is active in lymphoid neoplasias via a novel mechanism of action. There are some pending questions about its use in clinical practice because of its developmental features. A consensus panel of several leading Spanish hematologists with broad experience in the clinical use of bendamustine has established recommendations for the management and treatment of hematological patients with bendamustine based on available clinical data and the experience of the participants. These recommendations address the dose and treatment regimen for different clinical indications, the management of toxicity, and support therapy. This article contains the conclusions of this consensus panel, which are intended to serve as guidelines for the use of bendamustine.


Pascual-Pedreno A.,Hospital General la Mancha Centro | Perez-Medina T.,Hospital Universitario Puerta Of Hierro | Brouard Urkiaga I.,Hospital Of Cruces | Fernandez-Parra J.,Hospital Virgen Of Las Nieves | Sobreviela-Laserrada M.,Hospital Universitario Lozano Blesa
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2013

Objective: To evaluate the implementation of endoscopic gynecologic surgery in Spanish hospitals. Study design: In January 2011, a questionnaire was sent to 198 gynecology departments to determine the diffusion and acceptance of specific endoscopic procedures (hysteroscopy and laparoscopy) in each hospital. Results: The response rate was 52% (103/198). The practice of basic laparoscopy in Spain is high (90% of the hospitals surveyed reported that >50% of their specialists use this technique). Although advanced laparoscopic procedures are used in 83.4% of hospitals, 59.2% of these hospitals reported that <25% of gynecologists knew how to perform these techniques. In the case of adnexal masses, the approach used depends on the characteristics of the mass. Most hospitals (96.1%) reported routine use of a laparoscopic approach for benign adnexal masses measuring <10 cm, while 42% of hospitals reported routine use of a laparoscopic approach for masses that appear to be suspicious on ultrasound. Regarding hysterectomy, 38 hospitals (36.9%) reported that an abdominal approach was used in <25% of hysterectomies, 53 hospitals (51.5%) reported that a vaginal approach was used in 25-50% of hysterectomies, and 53 hospitals (52%) reported that a laparoscopic approach was used in <25% of hysterectomies. For the treatment of gynecological cancers, 53 hospitals (52%) reported that a laparoscopic approach was used in <25% of cases; this approach was reported more commonly by teaching hospitals (81.9% vs. 46.75; p < 0.001) and hospitals with >200 beds (84.3% vs. 45.5%; p < 0.001). In teaching hospitals, the concordance between what the respondents felt residents should be able to do, in terms of laparoscopic techniques, and what residents were actually able to do upon finishing their residency training was quite high, with the degree of concordance varying between 84.3% (adnexal mass approach) and 100% (diagnostic laparoscopy and tubal sterilization). Conclusions: More than 90% of the Spanish hospitals surveyed perform basic endoscopic techniques, and 83.4% are able to perform advanced endoscopic procedures. © 2013 Elsevier Ireland Ltd. All rights reserved.


Formiga F.,Lhospitalet Of Llobregat 08907 | Chivite D.,Lhospitalet Of Llobregat 08907 | Conde A.,University of Las Palmas de Gran Canaria | Ruiz-Laiglesia F.,Hospital Universitario Lozano Blesa | And 4 more authors.
International Journal of Cardiology | Year: 2014

Background Many elderly heart failure (HF) patients show some degree of functional impairment. The study aim was to evaluate the functional status of oldest-old cohort of patients hospitalized with a diagnosis of decompensated (HF), and to analyze whether preadmission functional status predicts risk of 3-month mortality. Methods We analyzed 1431 elderly (≥ 75 years) patients prospectively included in the Spanish National Registry on HF (RICA). We added Barthel Index (BI) to the usual HF patient assessment to measure patients' functional status, and we evaluated the relationship between preadmission BI values and 3-month mortality. Results The mean age of patients was 82.3 (4.6) years. Patients' mean preadmission BI score was 81.3 (21.5); 802 patients (55.9%) had BI scores < 61. Multivariate analysis confirmed an independent association between poor preadmission BI and older age, female sex, higher comorbidity, cognitive impairment, previous institutionalization, worse New York Heart Association (NYHA) functional class and lack of beta-blocker use. A total of 210 patients died (14.7%) after 3 months of follow-up. Cox multivariate analyses found that higher preadmission BI is correlated with reduced all-cause, 3-month postdischarge mortality [hazard ratio (HR) 0.981; CI95% 0.975-0.986, p < 0.001]. Other variables independently associated with 3-month mortality were male sex, lower body mass index, lower systolic blood pressure, a diagnosis of diabetes and chronic kidney disease, worse NYHA class and not receiving treatment with beta-blockers. Conclusions Severe functional disability is present among more than half of older patients admitted because of a HF decompensation. For this population, preadmission BI is a strong predictor of short-term mortality. © 2014 Elsevier Ireland Ltd.


PubMed | Complutense University of Madrid, Hospital Clinico San Carlos, Blekinge County Council Hospital, Hospital Universitario Lozano Blesa and Hospital Universitario La Paz
Type: Journal Article | Journal: Brazilian journal of anesthesiology (Elsevier) | Year: 2016

The goal directed hemodynamic therapy is an approach focused on the use of cardiac output and related parameters as end-points for fluids and drugs to optimize tissue perfusion and oxygen delivery. Primary aim: To determine the effects of intraoperative goal directed hemodynamic therapy on postoperative complications rates.A meta-analysis was carried out of the effects of goal directed hemodynamic therapy in adult noncardiac surgery on postoperative complications and mortality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A systematic search was performed in Medline PubMed, Embase, and the Cochrane Library (last update, October 2014). Inclusion criteria were randomized clinical trials in which intraoperative goal directed hemodynamic therapy was compared to conventional fluid management in noncardiac surgery. Exclusion criteria were trauma and pediatric surgery studies and that using pulmonary artery catheter. End-points were postoperative complications (primary) and mortality (secondary). Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by type of monitor, therapy, and hemodynamic goal), and predefined sensitivity analysis.51 RCTs were initially identified, 24 fulfilling the inclusion criteria. 5 randomized clinical trials were added by manual search, resulting in 29 randomized clinical trials in the final analysis, including 2654 patients. A significant reduction in complications for goal directed hemodynamic therapy was observed (RR: 0.70, 95% CI: 0.62-0.79, p<0.001). No significant decrease in mortality was achieved (RR: 0.76, 95% CI: 0.45-1.28, p=0.30). Quality sensitive analyses confirmed the main overall results.Intraoperative goal directed hemodynamic therapy with minimally invasive monitoring decreases postoperative complications in noncardiac surgery, although it was not able to show a significant decrease in mortality rate.


Marcos-Campos I.,Institute Nanociencia Of Aragon Ina | Marcos-Campos I.,Hospital Universitario Lozano Blesa | Asin L.,Institute Nanociencia Of Aragon Ina | Torres T.E.,Institute Nanociencia Of Aragon Ina | And 8 more authors.
Nanotechnology | Year: 2011

In this work, the capability of primary, monocyte-derived dendritic cells (DCs) to uptake iron oxide magnetic nanoparticles (MNPs) is assessed and a strategy to induce selective cell death in these MNP-loaded DCs using external alternating magnetic fields (AMFs) is reported. No significant decrease in the cell viability of MNP-loaded DCs, compared to the control samples, was observed after five days of culture. The number of MNPs incorporated into the cytoplasm was measured by magnetometry, which confirmed that 1-5pg of the particles were uploaded per cell. The intracellular distribution of these MNPs, assessed by transmission electron microscopy, was found to be primarily inside the endosomic structures. These cells were then subjected to an AMF for 30min and the viability of the blank DCs (i.e.without MNPs), which were used as control samples, remained essentially unaffected. However, a remarkable decrease of viability from approximately 90% to 2-5% of DCs previously loaded with MNPs was observed after the same 30min exposure to an AMF. The same results were obtained using MNPs having either positive (NH2 +) or negative (COOH-) surface functional groups. In spite of the massive cell death induced by application of AMF to MNP-loaded DCs, the number of incorporated magnetic particles did not raise the temperature of the cell culture. Clear morphological changes at the cell structure after magnetic field application were observed using scanning electron microscopy. Therefore, local damage produced by the MNPs could be the main mechanism for the selective cell death of MNP-loaded DCs under an AMF. Based on the ability of these cells to evade the reticuloendothelial system, these complexes combined with an AMF should be considered as a potentially powerful tool for tumour therapy. © 2011 IOP Publishing Ltd.


Laliena V.,Hospital Universitario Lozano Blesa | Garcia-Romero A.,Hospital Universitario Lozano Blesa
Physica Medica | Year: 2015

We have developed a new component module for the BEAMnrc software package, called SMLC, which models the tongue-and-groove structure of the Siemens Optifocus multileaf collimator. The ultimate goal is to perform accurate Monte Carlo simulations of the IMRT treatments carried out with Optifocus. SMLC has been validated by direct geometry checks and by comparing quantitatively the results of simulations performed with it and with the component module VARMLC. Measurements and Monte Carlo simulations of absorbed dose distributions of radiation fields sensitive to the tongue-and-groove effect have been performed to tune the free parameters of SMLC. The measurements cannot be accurately reproduced with VARMLC. Finally, simulations of a typical IMRT field showed that SMLC improves the agreement with experimental measurements with respect to VARMLC in clinically relevant cases. PACS number: 87.55. K-. © 2015 Associazione Italiana di Fisica Medica.


PubMed | Hospital Universitario Lozano Blesa Of Zaragoza and Hospital Universitario Lozano Blesa
Type: | Journal: Hipertension y riesgo vascular | Year: 2016

Cushings syndrome is a rare condition during pregnancy, but it is associated with serious maternal and fetal complications. The most common etiology during pregnancy is the presence of an adrenocortical adenoma. Urinary free cortisol over 3 times the upper limit of normal usually indicates Cushings syndrome during pregnancy. The treatment of choice is surgical, and the ideal time for surgery is before the third trimester.

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