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Sanz-Ruiz P.,General University Hospital Gregorio Maranon | Paz E.,Comillas Pontifical University | Abenojar J.,Charles III University of Madrid | Carlos del Real J.,Comillas Pontifical University | And 2 more authors.
Journal of Arthroplasty | Year: 2014

Antibiotic cement has been recommended in the treatment of prosthetic infections. The purpose of this study was to investigate the mechanical behavioral changes in cement loaded with two antibiotics, vancomycin and cefazolin, in dry and liquid medium. Six groups and four study conditions were established according to the doses of antibiotic used and the ageing (immersion in phosphate buffered saline) of the samples. Properties evaluated were friction coefficient and wear. Samples in dry medium showed higher wears than in liquid. Antibiotic selection did not influence wear properties tested in dry conditions, however, in liquid medium, there were higher frictional coefficients and wear for cefazolin loaded cement after one week and for vancomycin and cefazolin after one month. The results suggest that antibiotic cements behave differently in liquid and that the molecular characteristics of antibiotics are essential for determining this influence. © 2014 Elsevier Inc.


Villanueva-Martinez M.,General University Hospital Gregorio Maranon | De la Torre-Escudero B.,H.G.U. Guadalajara | Rojo-Manaute J.M.,General University Hospital Gregorio Maranon | Chana-Rodriguez F.,General University Hospital Gregorio Maranon
Journal of Arthroplasty | Year: 2013

Twenty-nine porous tantalum metaphyseal cones were implanted in 21 patients (14 women and 7 men) during revision TKA. The average age at the time of the procedure was 73.3. years. Sixteen revisions were considered aseptic and 5 were reimplantations after sepsis. Eight patients had stemmed revision implants and thirteen primary designs. According to the Anderson Orthopaedic Research Institute bone defect classification, femoral defects were rated as F3 in 14 knees and F2B in 3 knees. Tibial defects were rated as T2A in 3 cases, T2B in 3 cases and T3 in 5 cases. A femoral cone was inserted in 10 patients, a double cone (femur and tibia) in 8, and a single tibial cone in 3. A rotating hinge knee prosthesis (RHK, Zimmer) was inserted in 10 patients and a constrained condylar prosthesis (LCCK, Zimmer) in 11 patients. The diaphysis was cemented in 9 cases and, in 11 cases, just the metaphysis. At an average follow up of 36. months only one reconstruction was removed due to persistent infection. All metaphyseal cones showed evidence of stable osseointegration. According to the Knee Society Score the results were rated as excellent in 12 cases, good in 5 cases, fair in 3 and poor in 1 case. In the short term, porous tantalum metaphyseal cones provided structural support for large femoral and tibial defects. They also provided the environment for bone graft osseointegration, repair of femoral fractures and effective interdigitation of cement mantle into the trabecular metal cone. © 2013 Elsevier Inc.


Paz E.,Comillas Pontifical University | Sanz-Ruiz P.,General University Hospital Gregorio Maranon | Abenojar J.,Charles III University of Madrid | Vaquero-Martin J.,General University Hospital Gregorio Maranon | And 2 more authors.
Journal of Arthroplasty | Year: 2015

Use of antibiotic-loaded bone cements is one of the most effective methods for the prevention and treatment of prosthetic joint infection. However, there is still controversy about the optimal combination and doses of antibiotics that provide the maximum antimicrobial effect without compromising cement properties. In this study, vancomycin and cefazolin were added to a bone cement (Palacos R. +. G). Antibiotic release, fluid absorption, and mechanical properties were evaluated under physiological conditions. The results show that the type of antibiotic selected has an important impact on cement properties. In this study, groups with cefazolin showed much higher elution than those containing the same concentration of vancomycin. In contrast, groups with cefazolin showed a lower strength than vancomycin groups. © 2015 Elsevier Inc..


PubMed | General University Hospital Gregorio Maranon and University of Seville
Type: | Journal: Scientific reports | Year: 2016

Hirschsprung disease (HSCR) is attributed to a failure of neural crest derived cells to migrate, proliferate, differentiate or survive in the bowel wall during embryonic Enteric Nervous System (ENS) development. This process requires a wide and complex variety of molecules and signaling pathways which are activated by transcription factors. In an effort to better understand the etiology of HSCR, we have designed a study to identify new transcription factors participating in different stages of the colonization process. A differential expression study has been performed on a set of transcription factors using Neurosphere-like bodies from both HSCR and control patients. Differential expression levels were found for CDYL, MEIS1, STAT3 and PAX6. A significantly lower expression level for PAX6 in HSCR patients, would suit with the finding of an over-representation of the larger tandem (AC)m(AG)n repeats within the PAX6 promoter in HSCR patients, with the subsequent loss of protein P300 binding. Alternatively, PAX6 is a target for DNMT3B-dependant methylation, a process already proposed as a mechanism with a role in HSCR. Such decrease in PAX6 expression may influence in the proper function of signaling pathways involved in ENS with the confluence of additional genetic factors to the manifestation of HSCR phenotype.


Maas M.,Maastricht University | Nelemans P.J.,Maastricht University | Valentini V.,University Cattolica ore | Das P.,University of Houston | And 14 more authors.
The Lancet Oncology | Year: 2010

Background: Locally advanced rectal cancer is usually treated with preoperative chemoradiation. After chemoradiation and surgery, 15-27% of the patients have no residual viable tumour at pathological examination, a pathological complete response (pCR). This study established whether patients with pCR have better long-term outcome than do those without pCR. Methods: In PubMed, Medline, and Embase we identified 27 articles, based on 17 different datasets, for long-term outcome of patients with and without pCR. 14 investigators agreed to provide individual patient data. All patients underwent chemoradiation and total mesorectal excision. Primary outcome was 5-year disease-free survival. Kaplan-Meier survival functions were computed and hazard ratios (HRs) calculated, with the Cox proportional hazards model. Subgroup analyses were done to test for effect modification by other predicting factors. Interstudy heterogeneity was assessed for disease-free survival and overall survival with forest plots and the Q test. Findings: 484 of 3105 included patients had a pCR. Median follow-up for all patients was 48 months (range 0-277). 5-year crude disease-free survival was 83·3% (95% CI 78·8-87·0) for patients with pCR (61/419 patients had disease recurrence) and 65·6% (63·6-68·0) for those without pCR (747/2263; HR 0·44, 95% CI 0·34-0·57; p<0·0001). The Q test and forest plots did not suggest significant interstudy variation. The adjusted HR for pCR for failure was 0·54 (95% CI 0·40-0·73), indicating that patients with pCR had a significantly increased probability of disease-free survival. The adjusted HR for disease-free survival for administration of adjuvant chemotherapy was 0·91 (95% CI 0·73-1·12). The effect of pCR on disease-free survival was not modified by other prognostic factors. Interpretation: Patients with pCR after chemoradiation have better long-term outcome than do those without pCR. pCR might be indicative of a prognostically favourable biological tumour profile with less propensity for local or distant recurrence and improved survival. Funding: None. © 2010 Elsevier Ltd.


PubMed | General University Hospital Gregorio Maranon, Institute of Economics, Institute of Health Carlos III and REDISSEC, European University at Madrid and CIBER ISCIII
Type: | Journal: Geriatrics & gerontology international | Year: 2016

To carry out an analysis of the psychometric properties of the Disease Burden Morbidity Assessment (DBMA) according to the assumptions of the Classical Test Theory.A sample of 707 community-dwelling adults aged 65years and older, living in Spain, completed the DBMA. Psychometric properties of the scale (feasibility, acceptability, scaling assumptions, reliability and construct validity) were analyzed.The mean DBMA score was 6.8. Feasibility and acceptability were satisfactory, except for large floor effects (>50%), as well as a skewed distribution (1.8). Item-total corrected correlation ranged 0.10-0.49, item homogeneity index was 0.09 and Cronbachs alpha was 0.72. Disease burden correlated strongly with physical functioning (r=-0.56) and perceived health (r=-0.56), and moderately with depression (r=0.41) and the Personal Wellbeing Index (r=-0.41). Exploratory factor analysis extracted five factors, explaining 44% of the variance.The DBMA is an acceptable and valid instrument for measuring disease burden in older adults. Future studies should include Rasch analysis to further assess dimensionality and explore other measurement properties. Geriatr Gerontol 2016; : -.


Gutierrez A.,University Hospital Son Dureta | Mestre F.,University Hospital Son Dureta | Perez-Manga G.,General University Hospital Gregorio Maranon | Rodriguez J.,General University Hospital Gregorio Maranon
Critical Reviews in Oncology/Hematology | Year: 2011

The incidence of diffuse large B-cell lymphoma (DLCL) in the older is growing to the point of becoming a health priority in the next decades. Prognostic factors and the biology of the tumor are not very different between younger and older populations. Furthermore, it seems that the response rate is basically similar in both populations, provided an appropriate dose of chemotherapy is administered. However, there seem to be differences with regard to a lower tolerance to treatment and a higher relapse rate in responsive older patients. To analyze these problems we review the most important differences between young and older DLCL patients in terms of immunologic status, treatment toxicity and the presence of other concomitant diseases or organ dysfunctions. We also consider the most relevant clinical studies that may allow us to make the appropriate decisions regarding DLCL therapy in this older population. © 2010 Elsevier Ireland Ltd.


Chana-Rodriguez F.,General University Hospital Gregorio Maranon | Villanueva-Martinez M.,General University Hospital Gregorio Maranon | Crego-Vita D.,General University Hospital Gregorio Maranon | Rojo-Manaute J.,General University Hospital Gregorio Maranon | Vaquero-Martin J.,General University Hospital Gregorio Maranon
Journal of Arthroplasty | Year: 2013

Removal of an acetabular prosthesis that has migrated into the pelvis can be hazardous. We describe the preoperative planning and the surgical procedure for removing a severely displaced acetabular component in one patient and outline our recommendation for the use of Stoppa approach because it has advantages of simple dissection, a low complication rate, and may help in preventing life-threatening problems. © 2013 Elsevier Inc.


Chana-Rodriguez F.,General University Hospital Gregorio Maranon | Villanueva-Martinez M.,General University Hospital Gregorio Maranon | Rojo-Manaute J.,General University Hospital Gregorio Maranon | Sanz-Ruiz P.,General University Hospital Gregorio Maranon | Vaquero-Martin J.,General University Hospital Gregorio Maranon
Injury | Year: 2012

Acetabular fractures in the elderly are challenging injuries. The use of a trabecular metal acetabular cage was investigated as the treatment option in a series of elderly patients with acetabular fractures. At a 2-year follow up, 6 elderly patients were found to have mimimum pain, increased function, and increased scores using the Merle d'Aubigné and Postel system modified by Charnley. Radiographically, the areas of morsellised autograft that surrounded the cups were seen to have incorporated uniformly well, and the acetabular fractures were healed within six months after surgery. No mechanical failure, screw breakage, loosening, or migration was noticed. This novel indication of the cup-cage construction that uses revision techniques, for selected patients and fractures, to achieve an acute stable reconstruction, should be considered as an alternative reconstruction option in elderly patients presenting with acetabular fractures. © 2012 Elsevier Ltd.


PubMed | General University Hospital Gregorio Maranon and Rey Juan Carlos University
Type: Journal Article | Journal: Journal for specialists in pediatric nursing : JSPN | Year: 2016

To determine the prevalence and predictors of parental administration of over-the-counter (OTC) medications to children in Spain.This was a cross-sectional study performed with data from the 2011 to 2012 Spanish National Health Survey among children (birth to 14 years old) of both sexes.Of the 5,495 children analyzed, 8.2% had received OTC drugs in the 2 weeks preceding the survey. Medicines for colds (25.5%), analgesics (30.3%), and antipyretics (22.8%) were the most commonly used drugs. Some of the predictor variables of parental administration of OTC medications included older age groups (10- to 15-year-olds, adjusted odds ratio [AOR] = 1.45), no chronic illness (AOR = 1.21), children with limitations of normal activity (AOR = 3.05), parents of middle (AOR = 1.42) and higher (AOR = 1.38) social status, and completion of secondary school (AOR = 1.50) or higher education (AOR = 1.38).Understanding these factors may assist nurses to identify parents most likely to administer OTCs to their children, and to ensure that parents are aware of the purpose, dosage, side effects, and overall safety of OTC medications.

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