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Melero H.,University of Barcelona | Fargas G.,Polytechnic University of Catalonia | Garcia-Giralt N.,IMIM Institute Hospital del Mar dInvestigacions Mediques | Fernandez J.,University of Barcelona | Guilemany J.M.,University of Barcelona
Surface and Coatings Technology | Year: 2014

Plasma-sprayed hydroxyapatite coatings were used for many years to improve the osseointegration of joint implants. However, it was observed that their mechanical properties did not meet the requirements. Consequently, as in previous studies, an HAp-TiO2 mixture was considered. But, contrarily to these studies, where TiO2 is the majority phase (80-90wt.% into the mixture), in this work the feasibility of coatings containing only 20wt.% of TIO2 is proposed. Composite coatings were obtained via high-velocity oxy-fuel (HVOF) spray at four different sets of conditions. Bond strength tests, fracture toughness calculations and scratch tests together with preliminary cell viability tests were performed and compared with those of pure hydroxyapatite coatings and a powder mixture of 60wt.%HAp-40wt.%TiO2 (considered in previous studies and which showed mechanical and biological limitations, respectively). Results showed that one of the proposed 80-20 cases displayed a best combination of mechanical and biological properties than the proposed alternatives. © 2014 Elsevier B.V. Source


Bisbe Vives E.,IMIM Institute Hospital del Mar dInvestigacions Mediques | Basora Macaya M.,Servicio de Anestesiologia y Reanimacion
Revista Espanola de Anestesiologia y Reanimacion | Year: 2015

Hemoglobin optimization and treatment of preoperative anemia in surgery with a moderate to high risk of surgical bleeding reduces the rate of transfusions and improves hemoglobin levels at discharge and can also improve postoperative outcomes. To this end, we need to schedule preoperative visits sufficiently in advance to treat the anemia. The treatment algorithm we propose comes with a simple checklist to determine whether we should refer the patient to a specialist or if we can treat the patient during the same visit. With the blood count test and additional tests for iron metabolism, inflammation parameter and glomerular filtration rate, we can decide whether to start the treatment with intravenous iron alone or erythropoietin with or without iron. With significant anemia, a visit after 15 days might be necessary to observe the response and supplement the treatment if required. The hemoglobin objective will depend on the type of surgery and the patient's characteristics. © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Source


Basora Macaya M.,Servicio de Anestesiologia y Reanimacion | Bisbe Vives E.,IMIM Institute Hospital del Mar dInvestigacions Mediques
Revista Espanola de Anestesiologia y Reanimacion | Year: 2015

Patient Blood Management (PBM) is the design of a personalized, multimodal multidisciplinary plan for minimizing transfusion and simultaneously achieving a positive impact on patient outcomes. The first pillar of PBM consists of optimizing the erythrocyte mass. The best chance for this step is offered by preoperative preparation. In most cases, a detailed medical history, physical examination and laboratory tests will identify the cause of anemia. A correct evaluation of parameters that assess the state and function of iron, such as ferritin levels, and the parameters that measure functional iron, such as transferrin saturation and soluble transferrin receptor levels, provide us with essential information for guiding the treatment with iron. The new blood count analyzers that measure hypochromia (% of hypochromic red blood cells and reticulocyte hemoglobin concentrations) provide us useful information for the diagnosis and follow-up of the response to iron treatment. Measuring serum folic acid and vitamin B12 levels is essential for treating deficiencies and thereby achieving better hemoglobin optimization. © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Source


Bisbe Vives E.,IMIM Institute Hospital del Mar dInvestigacions Mediques
Revista Espanola de Anestesiologia y Reanimacion | Year: 2015

The prevalence of preoperative anemia in major orthopedic surgery is high and is the main predictive factor for allogeneic blood transfusion. The scheduling of a preoperative visit with sufficient notice (at least 3 weeks before surgery), with a blood count test and a basic iron metabolism study, enables us to treat the anemia and/or improve preoperative hemoglobin levels, thereby reducing the need for transfusion and the risks associated with transfusions. Intravenous iron and/or erythropoietin are treatments for optimizing preoperative anemia, with good levels of scientific evidence. © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Source


Bisbe Vives E.,IMIM Institute Hospital del Mar dInvestigacions Mediques
Revista Espanola de Anestesiologia y Reanimacion | Year: 2015

The liberal use of transfusions is not only a risk for patients but also represents a significant healthcare expenditure. The rational use of allogeneic blood transfusions and the use of transfusion alternatives, such as the optimization of preoperative hemoglobin levels, can offer substantial savings to health departments by reducing the cost of transfusions and the morbidity related to the transfusions. © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Source

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