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Montes-de-Oca M.,Hospital Universitario Puerta del Mar
Liver international : official journal of the International Association for the Study of the Liver | Year: 2011

Analysis of the influence of the effects of increased intestinal permeability on haemodynamic alterations in human immunodeficiency virus (HIV)-infected patients with decompensated hepatitis C virus (HCV)-related liver disease. Forty HIV/HCV co-infected patients and 40 HCV mono-infected patients, 20 of them with compensated cirrhosis and 20 with a previous decompensation, and 20 healthy controls, were studied. Intestinal permeability was determined by serum levels of lipopolysaccharide-binding protein (LBP). Monocyte expression of toll-like receptor 4 (TLR-4), serum levels of interleukin (IL)-6 and soluble receptors of tumour necrosis factor (sTNFRI) were analysed. Cardiac index, systemic vascular resistance (SVR), plasma renin activity (PRA) and aldosterone concentration were also determined in cirrhotic patients. Serum levels of LBP, TLR-4, IL-6 and sTNFRI were significantly higher in HIV-HCV co-infected and HCV mono-infected patients with decompensated cirrhosis compared with those with compensated liver disease. Significantly lower values of SVR and higher values of cardiac index, PRA and aldosterone concentration were observed in patients with decompensated cirrhosis compared with those with compensated liver disease, particularly in those with elevated levels of IL-6. There were no significant differences between HIV/HCV co-infected and HCV mono-infected patients. Higher intestinal permeability and consequent macrophage activation is observed in patients with cirrhosis; this permeability is even higher in those with portal hypertension. Serum values of IL-6 are associated with the characteristic haemodynamic derangement observed in advanced phases of cirrhosis. HIV/HCV co-infected cirrhotic patients present inflammatory and systemic haemodynamic alterations similar to those observed in HCV mono-infected patients. © 2011 John Wiley & Sons A/S. Source


Physicians need fast access to quality information about the best diagnostic tests and treatments in each case. To meet this need, a new publishing format has emerged. Critically appraised topics (CATs) are elaborated following the five steps of evidence-based medicine. CATs are structured summaries of research articles that deal with a specific clinical query, presenting a critical evaluation of the best evidence available to support the validity of the available options. CATs have proven useful in teaching evidence-based radiology and this publishing format is becoming more common. Radiology CATs can be found on medical websites and in journals, including those dedicated to general medicine as well as those specifically dedicated to radiology. Radiología encourages the publication of CATs because we consider that they can be useful for daily decision making. © 2010 SERAM. Published by Elsevier Espana, S.L. All rights reserved. Source


Tirado-Velez J.M.,Hospital Universitario Puerta del Mar
Annals of hematology | Year: 2012

Multiple myeloma (MM) is an incurable disease accompanied by low plasma levels of low-density lipoprotein cholesterol (LDL-c). The significance of altered cholesterol metabolism in the pathophysiology of MM remains elusive. Although it has been hypothesized that myeloma cells depend on exogenous cholesterol for its survival, the role of LDL-c on myeloma cells has not been elucidated. To evaluate the impact of exogenous LDL-c on cell viability, three human myeloma cell lines (RPMI-8226, NCI-H929, and U-266B1) were grown in the presence or absence of lipoproteins. Cell viability was markedly reduced in the absence of lipoproteins in sera. However, exogenous LDL-c improved cell viability. We showed that reduced cell viability was associated with increased levels of cleaved caspase-3, whereas proliferation rate remained unchanged. Interestingly, exogenous LDL-c counteracted apoptosis in human myeloma cell lines and primary cultures of human myeloma cells. Thus, our results demonstrated that LDL-c is an important anti-apoptotic factor for myeloma cells and begin to explain the hypocholesterolemia observed in patients with MM. Source


Evidence-based radiology is defined as the decision that results from integrating clinical information to select the most appropriate imaging test on the basis of the best available evidence, the physician's experience, and the patient's expectations. The practice of evidence-based radiology consists of five steps: formulating the question, performing an efficient search of the literature, critically evaluating the literature, applying the results of the search and evaluation while taking into account our experience and the patient's values, and evaluating the results obtained within our own practice. In diagnostic imaging, the number of resources available for evidence-based radiology is increasing: apart from books, articles, and web pages on this subject, evidence-based radiology is receiving more attention at diagnostic imaging conferences. The principles of evidence-based radiology will help promote the appropriate use of resources, greatly benefiting patients (decreasing the use of examinations that use ionizing radiation), professionals (less overload), and managers (more efficient use of resources). © 2010 SERAM. Published by Elsevier España, S.L. All rights reserved. Source


Different types of critically appraised topics (CATs) can be elaborated in diagnostic imaging: comparison of diagnostic tests, evaluation of techniques for early detection (screening), economical analyses, or therapeutic aspects, among others. Their design will vary in function of the question they aim to answer. For example, for treatment evaluation, clinical trials are the best, but if there are secondary studies (systematic reviews or meta-analyses) that synthesize information from several studies, the results will be more important and the scientific conclusions will be more relevant. Regardless of the study design used, the elaboration of a CAT will involve six steps: 1) question; 2) systematic and efficient bibliographic search; 3) levels of evidence (choosing the articles that have the best level); 4) critical reading of the articles chosen; 5) applying conclusions to the context, and 6) recommendations. In this article, we will describe these steps and the nuances for different types of studies in each step. © 2013 SERAM. Source

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