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Garcia-Albea Ristol E.,Hospital Universitario Principe Of Asturias | Garcia-Albea Martin J.,Hospital Universitario San Carlos
Revista de Neurologia

Introduction. The neurosciences developed at a swift pace throughout the 19th century. In Spain, following the intellectual poverty of the absolutist rule of King Ferdinand, medicine took on a new flourishing lease of life in the last third of the century under the leadership of its most distinguished proponent, Santiago Ramón y Cajal. In April 1903, and in spite of the country's multiple political and social ups and downs, Madrid organised a great medical convention (14th International Congress of Medicine) that gathered together the foremost figures in the neurosciences. Development. This work attempts to describe the situation in which neurology found itself at that time, as well as the socio-political context, and to highlight the most important contributions that were made in our specialty. Conclusions. A whole medical generation from around the world enthusiastically took part and 1681 communications and papers were presented, many of which dealt with neurological topics. Special mention should be made of the presentations by Cajal, who described the histological structure of the optic thalamus, and by Pavlov, who gave details of his theory of conditioned reflexes for the very first time. © 2010 Revista de Neurología. Source

Lopez-Campos J.L.,Hospital Universitario Virgen Del Rocio | Lopez-Campos J.L.,Institute Salud Carlos III | Soriano J.B.,Fundacion Caubet Cimera Balearic Islands | Calle M.,Hospital Universitario San Carlos

Background: We aimed to evaluate the availability and practice of spirometry, training of technicians, and spirometer features and maintenance in Spain in both primary care (PC) and secondary care (SC) centers. Methods: We used a nationwide, cross-sectional, 36-item telephone survey of health-care centers in Spain to target the technician in charge of conducting spirometries in PC and SC centers where outpatient respiratory patients are routinely evaluated. The questions surveyed for resources, training, spirometer use, bronchodilator tests, and spirometer features and maintenance. Results: Of a total of 1,259 centers screened, 605 PC centers (21.2% of the PC centers in Spain) and 200 SC centers (24.9% of the SC centers in Spain) were surveyed. The response rate was 85.4% for PC centers and 75.1% for SC centers. All together, 19% of screened centers did not have a spirometer or were not using it. The number of spirometers per center and spirometries conducted per week was higher in SC centers than in PC centers (P < .001). Most centers received training for conducting spirometries, but this was periodically done in < 40%. Most centers used two inhalations of salbutamol for the bronchodilator test, but the international criteria of a positive test was considered only in 55.8% of PC and 52.8% of SC centers. Calibration of the spirometer was never done in 10.5% of PC and 3.1% of SC centers. Conclusions: This survey maps for the fi rst time, to our knowledge, the current situation of spirometry in Spain, identifying bottlenecks and suggesting future directions applicable in both PC and SC centers and elsewhere. © 2013 American College of Chest Physicians. Source

Dumontet C.,French Institute of Health and Medical Research | Krajewska M.,Sanford Burnham Institute for Medical Research | Treilleux I.,French Institute of Health and Medical Research | Mackey J.R.,Cross Cancer Institute | And 4 more authors.
Clinical Cancer Research

Purpose: There are currently no validated factors predictive of response to taxanes in patients with breast cancer. We analyzed specimens from patients included in the Breast Cancer International Research Group (BCIRG) 001 trial, a randomized study which showed the superiority of docetaxel/doxorubicin/ cyclophosphamide over fluorouracil/doxorubicin/cyclophosphamide as adjuvant therapy for nodepositive operable breast cancer in terms of disease-free survival (DFS) and overall survival (OS). Experimental Design: Immunohistochemical assessment of biological markers included histologic grade, tumor size, estrogen and progesterone receptors, lymph node status, HER2, MUC1, Ki-67/MIB-1, p53, Bcl-2, Bax, Bcl-XL, BAG-1, β-tubulin isotypes II, III and IV, τ protein, and detyrosinated α tubulin. Associations between selected parameters and survival were tested through univariate analyses, then completed with multivariate analyses and a bootstrap resampling technique. Results: In univariate analysis histologic grade, tumor size, number of involved nodes, estrogen and progesterone receptor status, p53, Ki-67, tubulin III, and τ protein were associated both with DFS and with OS. In multivariate analysis estrogen and progesterone receptors, tumor size, number of involved nodes, and Ki-67 protein were associated both with DFS and with OS, whereas τ protein levels were correlated with DFS and tubulin III and P53 were correlated with OS. No interaction was observed between Ki-67 and treatment allocation. Conclusions: We conclude that the expression in primary tumors of Ki-67 and p53 protein, as well as of the microtubule-related parameters ô protein and tubulin III, are independent prognostic factors in patients receiving adjuvant chemotherapy for node-positive breast cancer but are not predictive of benefit from docetaxel-containing adjuvant chemotherapy. ©2010 AACR. Source

Rodriguez A.,Eli Lilly and Company | Calle A.,Hospital Universitario San Carlos | Vazquez L.,Hospital Universitario Marques Of Valdecilla | Chacon F.,Eli Lilly and Company | And 2 more authors.
Diabetic Medicine

Aims To assess blood glucose control and quality of health care provided to non-insulin-treated patients with Type2 diabetes mellitus in routine clinical practice in Spain. Methods In this observational, retrospective, cross-sectional study, patients were grouped as either having good or suboptimal blood glucose control according to International Diabetes Federation or American Diabetes Association HbA1c goals. Clinical and socio-demographic data and compliance with the main standard level of care recommendations of the International Diabetes Federation were recorded during a routine visit. Correlates of glucose control were analysed by logistic regression. Results Many patients were grouped as having suboptimal control under International Diabetes Federation (61.9%) or American Diabetes Association (45.0%) criteria. The mean number of accomplished International Diabetes Federation recommendations (7.3 out of 11) was higher for endocrinologists (than for internists or primary care physicians), and significantly more patients under their care were in the good glucose control group (than with primary care physicians). More recommendations were associated with blood glucose control using International Diabetes Federation than American Diabetes Association criteria, demanding higher quality of health care for achieving stricter goals. Some recommendations were poorly observed, particularly those concerning patients' education on diabetes, the prompt prescription of effective treatments and monitoring of complications. Diabetes complications were associated with being in the suboptimal control group. Patients' education on diabetes and HbA1c monitoring were associated with being in the good control group. Conclusions These results demonstrate the need for improvement in the management of patients with non-insulin-treated Type2 diabetes in actual clinical practice in Spain. Such improvement would entail a stricter adherence to International Diabetes Federation recommendations. © 2011 Eli Lilly and Company. Diabetic Medicine © 2011 Diabetes UK. Source

Trimbos B.,Leiden University | Timmers P.,Medisch Centrum Rijnmond Zuid | Timmers P.,Data Center | Pecorelli S.,University of Brescia | And 5 more authors.
Journal of the National Cancer Institute

A long-term follow-up analysis of the randomized clinical trial Adjuvant Chemotherapy in Ovarian Neoplasm (ACTION) from the European Organization for Research and Treatment of Cancer was undertaken to determine whether the original results with a median follow-up of 5.5 years could be verified after longer follow-up with more events. In the ACTION trial, 448 patients with early ovarian cancer were randomly assigned, after surgery, to adjuvant chemotherapy or to observation (no further treatment). The original analysis found that adjuvant chemotherapy improved recurrence-free survival but not overall survival and found in a subgroup analysis that completeness of surgical staging was an independent prognostic factor, with better recurrence-free and overall survival among those with complete (optimal) surgical staging. After a median follow-up of 10.1 years, we analyzed the more mature data from the ACTION trial and found support for most of the main conclusions of the original analysis, except that overall survival after optimal surgical staging was improved, even among patients who received adjuvant chemotherapy (hazard ratio of death = 1.89, 95% confidence interval = 0.99 to 3.60; overall two-sided log-rank test P =. 05). More cancer-specific deaths were observed among nonoptimally staged patients (40 [27%] of the 147 deaths in the observation arm and 11 [14%] of the 76 deaths in the adjuvant chemotherapy arm) than among optimally staged patients (seven [9%] of the 75 deaths in the observation arm and 11 [14%] of the 76 deaths in the adjuvant chemotherapy arm) (two-sided χ2 test for heterogeneity, P =. 06). Thus, completeness of surgical staging in patients with early ovarian cancer was found to be statistically significantly associated with better outcomes, and the benefit from adjuvant chemotherapy appeared to be restricted to patients with nonoptimal surgical staging. © 2010 The Author. Published by Oxford University Press. Source

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