Rodriguez-Puyol D.,Hospital Universitario Principe Of Asturias
Seminars in Nephrology | Year: 2012
Endothelial cells are essential regulators of vascular tone. They accomplish this by sensing humoral mediators and transducing their effects to the underlying vascular smooth muscle as well as by synthesizing vasoactive molecules that act in a paracrine fashion. In the kidney, the local release of these endothelial mediators, together with the concourse of specialized endothelial cells in the glomerulus, contribute to regulate renal blood flow, glomerular filtration, and tubular function that are intimately linked to sodium balance because they mutually influence each other. Ultimately, renal circulation and tubular function have a profound influence in systemic blood pressure as a result of the overall regulation of volume homeostasis. © 2012 Elsevier Inc.
Lopez-Guajardo L.,Hospital Universitario Principe Of Asturias |
Benitez-Herreros J.,Hospital Universitario Principe Of Asturias |
Silva-Mato A.,University of Alcalá
Investigative Ophthalmology and Visual Science | Year: 2011
Purpose. The purpose of this study was to report a novel model for comparing mechanical resistance to intraocular pressure (IOP) increases with 23-gauge (23G) and 25G transconjunctival sutureless vitrectomy (TSV) sclerotomies in the immediate postoperative period using an experimental model of a vitrectomized eye. Methods. This was a prospective, experimental, randomized, and observer-masked experimental study in which TSV 23G and 25G oblique sclerotomies, performed in same cadaveric pig eye, were subject to an increase in IOP. Mechanical resistance was determined by the resistance to intraocular fluid leak through the sclerotomy. The simultaneous use of the different sclerotomy diameters in the same eye avoided interindividual scleral resistance differences. Results. This animal model allowed comparison of the effect of different sclerotomy diameters (23G and 25G) on incisional mechanical resistance. One hundred twenty eyes were included. In 60.7% of cases, the 23G sclerotomy first allowed intraocular fluid escape (leaked; P = 0.02). When comparing opening pressure values, 23G sclerotomies leaked at significantly lower pressure levels than 25G sclerotomies (P < 0.0001); 53% of the 25G incisions but only 16% of 23G incisions opened at pressure levels greater than 120 mm Hg. Conclusions. Oblique 23G sutureless sclerotomies offer less mechanical resistance to increases in IOP than do 25G sclerotomies. This animal model may become the basis for future studies to evaluate the advantages of using other types of incision or other surgical tools on sclerotomy closure capacity. © 2011 The Association for Research in Vision and Ophthalmology, Inc.
Albillos A.,University of Alcalá |
Albillos A.,CIBER ISCIII |
Albillos A.,Hospital Universitario Ramon y Cajal |
Lario M.,University of Alcalá |
And 3 more authors.
Journal of Hepatology | Year: 2014
The term cirrhosis-associated immune dysfunction refers to the main syndromic abnormalities of immune function, immunodeficiency and systemic inflammation that are present in cirrhosis. The course of advanced cirrhosis, regardless of its aetiology, is complicated by cirrhosis-associated immune dysfunction and this constitutes the pathophysiological hallmark of an increased susceptibility to bacterial infection, distinctive of the disease. Cirrhosis impairs the homeostatic role of the liver in the systemic immune response. Damage to the reticulo-endothelial system compromises the immune surveillance function of the organ and the reduced hepatic synthesis of proteins, involved in innate immunity and pattern recognition, hinders the bactericidal ability of phagocytic cells. Systemic inflammation, in form of activated circulating immune cells and increased serum levels of pro-inflammatory cytokines, is the result of persistent episodic activation of circulating immune cells from damage-associated molecular patterns, released from necrotic liver cells and, as cirrhosis progresses, from pathogen-associated molecular patterns, released from the leaky gut. Cirrhosis-associated immune dysfunction phenotypes switch from predominantly "pro-inflammatory" to predominantly "immunodeficient" in patients with stable ascitic cirrhosis and in patients with severely decompensated cirrhosis and extra-hepatic organ failure (e.g. acute-on-chronic liver failure), respectively. These cirrhosis-associated immune dysfunction phenotypes represent the extremes of a spectrum of reversible dynamic events that take place during the course of cirrhosis. Systemic inflammation can affect the functions of tissue somatic cells and modify the clinical manifestation of cirrhosis. The best characterized example is the contribution of systemic inflammation to the haemodynamic derangement of cirrhosis, which correlates negatively with prognosis. © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
De Abajo F.J.,Hospital Universitario Principe Of Asturias |
De Abajo F.J.,University of Alcalá
Drugs and Aging | Year: 2011
Among the antidepressants, the selective serotonin reuptake inhibitors (SSRIs) are often preferred to other classes of antidepressants in the treatment of depression in the elderly because of their better safety profile. Most of the known effects of SSRIs, either beneficial or adverse, are linked to their inhibitory action on the serotonin reuptake transporter (5-HTT). This reuptake mechanism is present not only in neurons but also in other cells such as platelets.Serotoninergic mechanisms seem to play an important role in haemostasis, and their importance in this regard has long been underestimated. Abnormal activation may lead to a pro-thrombotic state, as may occur in patients with major depressive disorder, whilst downregulation, as occurs in patients treated with SSRIs, may have two clinical consequences, both of particular interest in the elderly. On the one hand, there may be an increased risk of bleeding; on the other hand, a reduction in thrombotic risk may be possible. Polymorphism in the promoter region of the gene that transcribes the 5-HTT has been shown to have a relevant impact on its function and, in turn, on the beneficial and adverse effects of SSRIs.Bleeding has been a concern since the introduction of SSRIs, with multiple case reports published and communicated to the pharmacovigilance systems. The first epidemiological study was published in 1999 and since then, 34 epidemiological studies from different areas, most of them including elderly patients in their study populations, have been published with a variety of results. Broadly, the epidemiological evidence supports a moderately increased risk of bleeding associated with the use of SSRIs, which may be critically dependent on patient susceptibility and the presence of risk factors.The impairment of primary haemostasis induced by SSRIs may result, as a beneficial counterpart, in a reduction in the thrombotic risk. A small number of clinical trials and an increasing number of epidemiological studies that include elderly patients have been conducted to clarify whether SSRIs reduce the risk of primary and secondary ischaemic disorders. However, the results have been inconclusive with some studies suggesting a preventive effect and others no effect or even an increased risk. Behind such contradictory results may be the role of depression itself as a cardiovascular risk factor and, therefore, a major confounding factor. How to disentangle its effect from that of the antidepressants is the methodological challenge to be overcome in future studies.In this complex scenario, the elderly seem to be at a crossroads, because they are the group in which both the risks and the benefits can be the greatest. Studies performed to date have provided us with some clues that can help orient clinicians in taking the most appropriate course of action. For instance, as the gastrointestinal bleeding risk appears to increase with age, prudent advice in patients with a previous history of upper-gastrointestinal bleeding or peptic ulcer, and in those who take NSAIDs, oral anticoagulants, antiplatelet drugs or corticosteroids, would be to suggest addition of an acid-suppressing agent to the drug regimen in those elderly patients in whom SSRIs are indicated. © 2011 Adis Data Information BV. All rights reserved.
De Juan Romero C.,University Miguel Hernández |
Bruder C.,Karolinska Institutet |
Bruder C.,GeneData AG |
Tomasello U.,University Miguel Hernández |
And 2 more authors.
EMBO Journal | Year: 2015
Gyrencephalic species develop folds in the cerebral cortex in a stereotypic manner, but the genetic mechanisms underlying this patterning process are unknown. We present a large-scale transcriptomic analysis of individual germinal layers in the developing cortex of the gyrencephalic ferret, comparing between regions prospective of fold and fissure. We find unique transcriptional signatures in each germinal compartment, where thousands of genes are differentially expressed between regions, including ~80% of genes mutated in human cortical malformations. These regional differences emerge from the existence of discrete domains of gene expression, which occur at multiple locations across the developing cortex of ferret and human, but not the lissencephalic mouse. Complex expression patterns emerge late during development and map the eventual location of folds or fissures. Protomaps of gene expression within germinal layers may contribute to define cortical folds or functional areas, but our findings demonstrate that they distinguish the development of gyrencephalic cortices. Synopsis Complex patterns of gene expression emerge in germinal layers during early cortical development of gyrencephalic animals. These modular expression patterns map the eventual location of folds and fissures. Microarray analysis of developing ferret cerebral cortex reveals transcriptomic differences between prospective folds and fissures. Differential gene expression delineates mosaic patterns along proliferative zones prior to the emergence of folds. Some mosaics of gene expression correlate with the prospective location of folds versus fissures. Differentially expressed genes in our microarray analysis include 80% of those mutated in human cortical malformations. Complex patterns of gene expression emerge in germinal layers during early cortical development of gyrencephalic animals. These modular expression patterns map the eventual location of folds and fissures. © 2015 The Authors. Published under the terms of the CC BY NC ND 4.0 license.
Saez V.P.,Hospital Universitario Principe Of Asturias
Revista Espanola de Anestesiologia y Reanimacion | Year: 2012
Preventive analgesia (administration of a technique or analgesic drug with the aim of reducing postoperative pain, hyperalgesia and allodynia) has shown to be effective in experimental studies. However, the results in patients have been controversial. A review has been made of the clinical trials published during the last 5 years to test the efficacy of preventive analgesia on postoperative pain. A search was made of the published literature in Medline, with the terms ". pre-emptive analgesia", "preventive analgesia" and "postoperative pain", selecting prospective, controlled, randomised and double blind studies that compared analgesic regimens before and after the incision or the same or very similar postoperative conditions. A total of 27 studies were found during the period 2005-2010 that complied with the inclusion criteria. Analgesia measurement variables were analysed, such as postoperative pain, time passed until the first rescue, and total analgesic requirements. Preventive analgesia was effective in 15 of the 27 studies, with pre-incisional epidural drug administration being the most effective (local anaesthetics with or without opioids, clonidine). The possible effectiveness of preventive analgesia in humans is still controversial, partly due to the wide heterogeneity in the inclusion criteria, types of patients, or the analgesia measurement parameters analysed by the studies. More studies are required with common criteria and objectives. © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor.
Montero Ruiz E.,Hospital Universitario Principe Of Asturias
Revista Clinica Espanola | Year: 2016
Surgical departments have increasing difficulties in caring for their hospitalised patients due to the patients' advanced age and comorbidity, the growing specialisation in medical training and the strong political-healthcare pressure that a healthcare organisation places on them, where surgical acts take precedence over other activities. The pressure exerted by these departments on the medical area and the deficient response by the interconsultation system have led to the development of a different healthcare organisation model: Shared care, which includes perioperative medicine. In this model, 2 different specialists share the responsibility and authority in caring for hospitalised surgical patients. Internal Medicine is the most appropriate specialty for shared care. Internists who exercise this responsibility should have certain characteristics and must overcome a number of concerns from the surgeon and anaesthesiologist. © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI).
Fighting against malnutrition. Evidence of the efficiency of treating it and malnutrition costs. Optimal utilization of the available resources [La lucha contra la desnutrición. Evidencias de la eficacia de su tratamiento y coste de la desnutrición. Utilización óptima de los recursos disponibles]
Hernandez J.A.,Hospital Universitario Principe Of Asturias
Nutricion Hospitalaria | Year: 2013
Disease-related malnutrition (DRM) represents a universal, highly prevalent social and health problem, which is underdiagnosed and undertreated. It complicates the clinical course of the patients, prolongs their hospital staying, and increases the number of early re-admissions with the subsequent increase in health resources usage, increasing the costs. It is estimated that in Europe 33 million people are at risk for malnutrition, representing a cost of € 170 billion. The European Nutrition For Health Alliance (ENHEA) has been created as a lobbying group working with the aim of improving the nutritional care of European patients by actively promoting the implementation of detection of nutritional risk in Europe; public awareness; appropriate reimbursement policies, and heath teams training. In the last years, several initiatives have been developed in neighbor European countries with the implementation of programs and plans to Fight Against Malnutrition. In this manuscript, the Dutch model is reviewed in more detail by analyzing the factors that have made possible its success in a short time after its implementation. Appropriate usage of nutritional resources allows defining ways for saving. Oral supplementation is an active, rather than invasive, therapy in the management of DRM at all health care levels. It improves weight gaining and prevents weight loss in patients at risk for malnutrition. Its usage is directly related with a reduced morbimortality rate in malnourished patients.
Montero Ruiz E.,Hospital Universitario Principe Of Asturias |
Monte Secades R.,Hospital Universitario Lucus Augusti
Revista Clinica Espanola | Year: 2015
The inpatient profile is changing towards patients with multiple diseases, the elderly and those with high comorbidity. The growing complexity of their care, the progressive medical superspecialization and the organizational problems that often hinder daily patient follow-up by the same physician have contributed to a progressive increase in the participation of medical departments, especially Internal Medicine, in the care of patients hospitalized in other medical and surgical specialties. The hospital activities that the departments of internal medicine perform outside of their own department do not have well-established definitions and criteria at the organizational level; their assessment and accountability are different in each hospital. In this document, we establish the definitions for shared care, advisory medicine, perioperative medicine and interconsultation, as well as their types in terms of priority, formality, care setting, timeliness, relationship with surgery and other circumstances. © 2014 Elsevier Espana, S.L.U. y Sociedad Espanola de Medicina Interna (SEMI). Todos los derechos reservados.
Pulgar F.,Hospital Universitario Principe Of Asturias
Dermatology online journal | Year: 2013
Granulocytic sarcoma or chloroma is a tumor of immature cells from the granulocyte line that is generally associated with acute myeloid leukemia. The skin is one of the most affected organs. This lesion may complicate hematological dyscrasias, which is generally indicative of a poor prognosis. We present a case of a 51-year-old patient who was diagnosed with acute myeloid leukemia with a complex karyotype that debuted with a post-transplant cutaneous and hematological relapse, a very rare occurrence in the literature given that no extramedullary involvement was present prior to the transplant.