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Chillarón de Cuenca, Spain

Cerrillo-Urbina A.J.,University of Castilla - La Mancha | Garcia-Hermoso A.,Autonomous University of Chile | Sanchez-Lopez M.,University of Castilla - La Mancha | Pardo-Guijarro M.J.,University of Castilla - La Mancha | And 2 more authors.
Child: Care, Health and Development | Year: 2015

Objective: The aim of this systematic review and meta-analysis was to examine the evidence for the effectiveness of exercise interventions on attention deficit hyperactivity disorder (ADHD)-related symptoms such as inattention, hyperactivity/impulsivity, anxiety and cognitive functions in children and adolescents. Method: Five databases covering the period up to November 2014 (PubMed, Scopus, EMBASE, EBSCO [E-journal, CINAHL, SportDiscus] and The Cochrane Library) were searched. Methodological quality was assessed using the Cochrane tool of bias. Standardized mean differences (SMD) and 95% confidence intervals were calculated, and the heterogeneity of the studies was estimated using Cochran's Q-statistic. Results: Eight randomized controlled trials (n=249) satisfied the inclusion criteria. The studies were grouped according to the intervention programme: aerobic and yoga exercise. The meta-analysis suggests that aerobic exercise had a moderate to large effect on core symptoms such as attention (SMD=0.84), hyperactivity (SMD=0.56) and impulsivity (SMD=0.56) and related symptoms such as anxiety (SMD=0.66), executive function (SMD=0.58) and social disorders (SMD=0.59) in children with ADHD. Yoga exercise suggests an improvement in the core symptoms of ADHD. Conclusions: The main cumulative evidence indicates that short-term aerobic exercise, based on several aerobic intervention formats, seems to be effective for mitigating symptoms such as attention, hyperactivity, impulsivity, anxiety, executive function and social disorders in children with ADHD. © 2015 John Wiley & Sons Ltd.

Calero I.,Hospital Virgen de la Luz
Discovery medicine | Year: 2010

Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease for which therapeutic advances in immunosuppressive and support therapy have significantly improved survival over the last 5 decades. Unfortunately, SLE still carries substantially increased rates of mortality and end stage renal disease which are even more elevated in younger patients. No new drugs have been approved for SLE in over 50 years. Hence, a lot of hope and excitement has been generated by the development of biological agents designed to eliminate B cells either through direct killing (anti-B cell antibodies such as rituximab) or attrition by inhibition of survival (anti-BLyS/BAFF agents such as belimumab). Indeed a strong rationale for targeting B cells in SLE is supported by the major pathogenic roles they play in SLE through both autoantibody production and multiple antibody-independent functions. These hopes, however, have been darted by the failure of two different phase III randomized placebo-controlled trials of rituximab. Yet, clinicians continue to use rituximab off-label with the belief that it provides significant benefit and can rescue patients with disease that is refractory to current modalities. Moreover, recent positive results of two large controlled trials of belimumab have restored confidence that B cell targeting may after all be of benefit in SLE. In this review we discuss the background and rationale for the use of anti-B cell agents in SLE, review the available results, and provide models that could help reconcile the opposing results observed in different studies. These models could also help frame the design and evaluation of current and future B cell therapies.

Jimenez-Perez J.,Endoscopy Unit | Casellas J.,Hospital General Universitario Of Alicante | Garcia-Cano J.,Hospital Virgen de la Luz | Vandervoort J.,Onze Lieve Vrouw Ziekenhuis | And 7 more authors.
American Journal of Gastroenterology | Year: 2011

Objectives: To date, this is the largest prospective series in patients with malignant colorectal obstruction to evaluate the effectiveness and safety of colonic self-expanding metal stents (SEMSs) as an alternative to emergency surgery. SEMSs allow restoration of bowel transit and careful tumor staging in preparation for elective surgery, hence avoiding the high morbidity and mortality associated with emergency surgery and stoma creation. Methods: This report is on the SEMS bridge-to-surgery subset enrolled in two multicenter international registries. Patients were treated per standard of practice, with documentation of clinical and procedural success, safety, and surgical outcomes. Results: A total of 182 patients were enrolled with obstructive tumor in the left colon (85%), rectum (11%), or splenic flexure (4%). Of these patients, 86% had localized colorectal cancer without metastasis. Procedural success was 98% (177/181). Clinical success was 94% (141/150). Elective surgery was performed in 150 patients (9 stomas) and emergency surgery in 7 patients for treatment of a complication (3 stomas). The overall complication rate was 7.8% (13/167), including perforation in 3% (5/167), stent migration in 1.2% (2/167), bleeding in 0.6% (1/167), persistent colonic obstruction in 1.8% (3/167), and stent occlusion due to fecal impaction in 1.2% (2/167). One patient died from complications related to surgical management of a perforation. Conclusions: SEMSs provide an effective bridge to surgery treatment with an acceptable complication rate in patients with acute malignant colonic obstruction, restoring luminal patency and allowing elective surgery with primary anastomosis in most patients. © 2011 by the American College of Gastroenterology.

Garcia-Cano J.,Hospital Virgen de la Luz
Current Gastroenterology Reports | Year: 2013

The majority of recent studies of benign biliary strictures (BBSs) have reported on treatment of stenotic injuries following cholecystectomy, orthotopic liver transplantation, living donor liver transplantation, chronic pancreatitis, and different inflammatory conditions such as common bile-duct-related strictures. Information about previous surgical procedures is very important for making a BBS diagnosis. Diagnostic tools for indeterminate strictures have increased to include (1) highly specialized cytological techniques such as fluorescence in situ hybridization, (2) cholangioscopy, and (3) endoscopic ultrasound with fine needle aspiration (FNA) and intraductal ultrasound. Magnetic resonance cholangiopancreatography before endoscopic retrograde cholangiopancreatography (ERCP) usually provides an adequate map to plan the endoscopic therapy. After traversing the stricture with a guidewire and, occasionally, performing balloon dilatation, plastic stents continue to be the basic endotherapy, trying to insert the maximum possible number, with an exchange every 3 months during a 12-month period. Progressive stenting requires a median number of five ERCPs; therefore, it is technically demanding and burdensome but has an average of 80 % long-term durable stricture dilation. For not-hilar BBS, fully covered self-expanding metal stents (FCSEMSs) are emerging as a promising therapy needing fewer of the endoscopist's technical skills and reducing ERCP procedures and, probably, costs. To equal a 10-mm diameter provided by a single FCSEMS, about three plastic stents placed side-by-side are needed. Manufacturers are working to improve FCSEMS designs to reduce migration rate and to allow an easy extraction after several months in place. Many studies have tried to show reproducible protocols for the duration of FCSEMS therapy and the results in different types of BBSs. © 2013 Springer Science+Business Media New York.

Santos J.L.,Hospital Virgen de la Luz | Aparicio A.,Hospital Virgen de la Luz | Bagney A.,Institute Investigacion Hospital 12 Of Octubre | Sanchez-Morla E.M.,Hospital Virgen de la Luz | And 5 more authors.
Bipolar Disorders | Year: 2014

Objectives: Cognitive dysfunction in bipolar disorder has been well-established in cross-sectional studies; however, there are few data regarding the longitudinal course of cognitive performance in bipolar disorder. The aim of this study was to examine the course of cognitive function in a sample of euthymic patients with bipolar disorder during a five-year follow-up period. Methods: Eighty euthymic outpatients with a DSM-IV diagnosis of bipolar disorder and 40 healthy control comparison subjects were neuropsychologically assessed at baseline (T1) and then at follow-up of five years (T2). A neurocognitive battery including the main cognitive domains of speed of processing, working memory, attention, verbal memory, visual memory, and executive function was used to evaluate cognitive performance. Results: Repeated-measures multivariate analyses showed that progression of cognitive dysfunction in patients was not different to that of control subjects in any of the six cognitive domains examined. Only a measure from the verbal memory domain, delayed free recall, worsened more in patients with bipolar disorder. Additionally, it was found that clinical course during the follow-up period did not influence the course of cognitive dysfunction. Conclusions: Cognitive dysfunction that is characteristic of bipolar disorder is persistent and stable over time. Only dysfunction in verbal recall was found to show a progressive course that cannot be explained by clinical or treatment variables. © 2014 John Wiley & Sons A/S.

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