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Cunningham J.,University College London | Locatelli F.,Dialysis and Renal Transplant | Rodriguez M.,Hospital Universitario Reina Sofia
Clinical Journal of the American Society of Nephrology | Year: 2011

Secondary hyperparathyroidism (SHPT) is a challenge frequently encountered in the management of patients with chronic kidney disease (CKD). Downregulation of the parathyroid vitamin D and calcium-sensing receptors represent critical steps that lead to abnormalities in mineral metabolism: high phosphate, low calcium, and vitamin D deficiency. These imbalances result in parathyroid hyperplasia and contribute to vascular calcification. New studies have established a central role for fibroblast growth factor 23 (FGF-23) in the regulation of phosphate-vitamin D homeostasis. FGF-23 concentration increases in CKD and contributes to SHPT. Achieving current targets for the key mineral parameters in the management of SHPT set by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines can be challenging. This review summarizes the current understanding and evidence supporting strategies for SHPT treatment in CKD patients. Treatment should include a combination of dietary phosphorus restriction, phosphate binders, vitamin D sterols, and calcimi-metics. Parathyroidectomy is effective in suitable candidates refractory to medical therapy and the standard against which new approaches should be measured. Future strategies may focus on the stimulation of apopto-tic activity of hyperplastic parathyroid cells. © 2011 by the American Society of Nephrology. Source


Objective: To evaluate the effectiveness of acupuncture and traditional Chinese dietary therapy (TCDT) as single therapies in reducing pain and improving quality of life in patients with fibromyalgia (FM) versus combined treatment with acupuncture and TCDT in the province of Cordoba. Design: A controlled randomized trial was performed to evaluate the effectiveness of acupuncture combined with TCDT compared with acupuncture alone or TCDT alone. The combined treatment was performed in two modalities: simultaneously and sequentially. Setting: Reina Sofía University Hospital, Cordoba, Spain. Participants: A total of 120 patients with FM clinically confirmed in the rheumatology service, divided in four groups. Interventions: Acupuncture (a cycle of 10 sessions) and TCDT, applied alone, simultaneously and sequentially. Main outcome measures: Total pain scale and each of its components, visual analog scale and a questionnaire on the impact of FM at 3, 4, 5, 6 months after the start of the interventions. Results: Treatment with TCDT alone did not improve FM symptoms. The combination of TCDT with acupuncture produced significant improvements (p < 0.05). At 6 months, the best results were achieved in the acupuncture group. Conclusions: The application of TCDT together with acupuncture is an effective measure to improve the therapeutic approach, although acupuncture produced the greatest improvements. Source


Toledano F.J.,Hospital Universitario Reina Sofia
The American journal of emergency medicine | Year: 2012

Lung cancer is one of the most common neoplasms associated with cardiac metastasis, and the pericardium is often affected. However, isolated myocardial involvement in these patients is very uncommon. Most tumor invasions into the heart are nonspecific and clinically silent. Myocardial metastasis rarely mimics an acute myocardial infarction. We report a case of a 59-year-old man with a metastatic lung cancer into the myocardium mimicking an acute myocardial infarction. Source


Codner E.,University of Chile | Merino P.M.,University of Chile | Tena-Sempere M.,University of Cordoba, Spain | Tena-Sempere M.,CIBER ISCIII | Tena-Sempere M.,Hospital Universitario Reina Sofia
Human Reproduction Update | Year: 2012

Background: The functional reproductive alterations seen in women with type 1 diabetes (T1D) have changed as therapy has improved. Historically, patients with T1D and insufficient metabolic control exhibited a high prevalence of amenorrhea, hypogonadism and infertility. This paper reviews the impact of diabetes on the reproductive axis of female T1D patients treated with modern insulin therapy, with special attention to the mechanisms by which diabetes disrupts hypothalamic-pituitary-ovarian function, as documented mainly by animal model studies. Methods: A comprehensive MEDLINE search of articles published from 1966 to 2012 was performed. Animal model studies on experimental diabetes and human studies on T1D were examined and cross-referenced with terms that referred to different aspects of the gonadotropic axis, gonadotrophins and gonadal steroids. Results: Recent studies have shown that women with T1D still display delayed puberty and menarche, menstrual irregularities (especially oligomenorrhoea), mild hyperandrogenism, polycystic ovarian syndrome, fewer live born children and possibly earlier menopause. Animal models have helped us to decipher the underlying basis of these conditions and have highlighted the variable contributions of defective leptin, insulin and kisspeptin signalling to the mechanisms of perturbed reproduction in T1D. Conclusions: Despite improvements in insulin therapy, T1D patients still suffer many reproductive problems that warrant specific diagnoses and therapeutic management. Similar to other states of metabolic stress, T1D represents a challenge to the correct functioning of the reproductive axis. © The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. Source


Tena-Sempere M.,University of Cordoba, Spain | Tena-Sempere M.,CIBER ISCIII | Tena-Sempere M.,Hospital Universitario Reina Sofia
Current Topics in Developmental Biology | Year: 2013

Puberty is the culmination of a complex series of maturational events that lead to the completion of sexual and somatic maturation and the acquisition of reproductive competence. This key developmental transition, which defines the boundary between immaturity and adulthood, is under the control of sophisticated regulatory networks that impinge upon the brain centers governing the reproductive axis. These networks are sensitive to earlier maturational events, such as brain sex differentiation, and dynamically regulated by a plethora of hormonal factors and environmental signals, which are essential for the fine-tuning of the tempo of puberty. While much knowledge on mammalian puberty had been gleaned during the last decades, important recent developments have substantially expanded our understanding of the neuroendocrine and molecular mechanisms governing puberty onset. We will provide here a synoptic account of some of these important advancements, including the identification of the essential roles of hypothalamic kisspeptin signaling, and some of its putative partners, in pubertal maturation, the characterization of novel mechanisms involved in the metabolic regulation of puberty, and the recognition of the potential roles of epigenetics and miRNA-related pathways in the central control of puberty. It is expected that further progress in these and related areas will follow in the coming years. This will permit a better understanding of the physiological mechanisms responsible for pubertal timing and will help to decipher the pathophysiological basis for pubertal alterations in humans and wildlife species. © 2013 Elsevier Inc. Source

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