Institution
Hospital Universitario La Paz
Healthcare•Madrid, Spain•
About: Hospital Universitario La Paz is a healthcare organization based out in Madrid, Spain. It is known for research contribution in the topics: Population & Medicine. The organization has 8960 authors who have published 11499 publications receiving 191509 citations.
Topics: Population, Medicine, Cancer, Transplantation, Haemophilia
Papers published on a yearly basis
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TL;DR: CD94/NKG2C might be involved in triggering cytotoxic lymphocytes in patients with SJS and TEN and found that keratinocytes from affected skin expressed HLA-E and that cell-surface Hla-E sensitizes keratinocyte to killing by CD94/ NKG 2C(+) CTLs.
Abstract: Background Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are severe, bullous cutaneous diseases with uncertain pathogenesis, although cytotoxic T cells seem to be involved. Natural killer (NK)–like activity has been found in blister infiltrates. Cytotoxic T lymphocytes (CTLs) with NK-like activity (NK-CTLs) have been shown to express T-cell receptors restricted by the HLA-Ib molecule HLA-E. Alternatively, the HLA-E–specific activating receptor CD94/NKG2C can trigger T-cell receptor–independent cytotoxicity in CTLs. Objective Our aim was to test whether HLA-E expression sensitizes keratinocytes to killing by CTLs with NK-like activity and to explore the expression of activating receptors specific for HLA-E in blister cytotoxic lymphocytes. Methods We used flow cytometry and immunohistochemistry to analyze HLA-E expression in keratinocytes from affected skin in patients with SJS, TEN, and other less severe drug-induced exanthemas. The expression of CD94/NKG2C was analyzed by means of flow cytometry in PBMCs and blister cells from patients. PBMCs and blister cells were analyzed for their ability to kill HLA-E–expressing cells. Involvement of CD94/NKG2C in triggering degranulation of cytolytic cells was explored by means of CD107a mobilization assays and standard cytotoxicity chromium release assays. Results We found that keratinocytes from affected skin expressed HLA-E and that cell-surface HLA-E sensitizes keratinocytes to killing by CD94/NKG2C + CTLs. Frequencies of CD94/NKG2C + peripheral blood T and NK cells were increased in patients with SJS and TEN during the acute phase. Moreover, activated blister T and NK lymphocytes expressed CD94/NKG2C and were able to degranulate in response to HLA-E + cells in an NKG2C-dependent manner. Conclusion CD94/NKG2C might be involved in triggering cytotoxic lymphocytes in patients with SJS and TEN.
61 citations
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TL;DR: Early resuscitation guided by lactate levels and below-normal preload volume targets appears safe and avoids unnecessary fluid input, and initial hypovolemia may be detected by TPTD monitoring during the early resuscitation phase.
Abstract: The use of urinary output and vital signs to guide initial burn resuscitation may lead to suboptimal resuscitation. Invasive hemodynamic monitoring may result in over-resuscitation. This study aimed to evaluate the results of a goal-directed burn resuscitation protocol that used standard measures of mean arterial pressure (MAP) and urine output, plus transpulmonary thermodilution (TPTD) and lactate levels to adjust fluid therapy to achieve a minimum level of preload to allow for sufficient vital organ perfusion. We conducted a three-year prospective cohort study of 132 consecutive critically burned patients. These patients underwent resuscitation guided by MAP (>65 mmHg), urinary output (0.5 to 1 ml/kg), TPTD and lactate levels. Fluid therapy was adjusted to achieve a cardiac index (CI) >2.5 L/minute/m2 and an intrathoracic blood volume index (ITBVI) >600 ml/m2, and to optimize lactate levels. Statistical analysis was performed using mixed models. We also used Pearson or Spearman methods and the Mann-Whitney U-test. A total of 98 men and 34 women (mean age, 48 ± 18 years) was studied. The mean total body surface area (TBSA) burned was 35% ± 22%. During the early resuscitation phase, lactate levels were elevated (2.58 ± 2.05 mmol/L) and TPTD showed initial hypovolemia by the CI (2.68 ± 1.06 L/minute/m2) and the ITBVI (709 ± 254 mL/m2). At 24 to 32 hours, the CI and lactic levels were normalized, although the ITBVI remained below the normal range (744 ± 276 ml/m2). The mean fluid rate required to achieve protocol targets in the first 8 hours was 4.05 ml/kg/TBSA burned, which slightly increased in the next 16 hours. Patients with a urine output greater than or less than 0.5 ml/kg/hour did not show differences in heart rate, mean arterial pressure, CI, ITBVI or lactate levels. Initial hypovolemia may be detected by TPTD monitoring during the early resuscitation phase. This hypovolemia might not be reflected by blood pressure and hourly urine output. An adequate CI and tissue perfusion can be achieved with below-normal levels of preload. Early resuscitation guided by lactate levels and below-normal preload volume targets appears safe and avoids unnecessary fluid input.
61 citations
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Copenhagen University Hospital1, Utrecht University2, Cambridge University Hospitals NHS Foundation Trust3, University College Cork4, University of Tübingen5, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico6, University of Zurich7, Hospital Universitario La Paz8, Medical University of Graz9
TL;DR: Treatment guided by NIRS reduced the cerebral burden of hypoxia without affecting EEG or the selected blood biomarkers.
Abstract: The SafeBoosC II randomized trial: treatment guided by near-infrared spectroscopy reduces cerebral hypoxia without changing early biomarkers of brain injury
61 citations
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TL;DR: In patients with coronary total occlusions, everolimus-eluting stent is as effective as sirolimus-eluted stent.
Abstract: Background—Patients with coronary total occlusions are at especially high risk for restenosis and new revascularizations Sirolimus-eluting stents dramatically improved the clinical outcome of this subset of patients in randomized trials, but other drug-eluting stents, mainly the everolimus-eluting stent (currently the most frequently used stent), have not yet been evaluated in patients with coronary total occlusions The objective was to compare the second-generation everolimus-eluting stent with the first-generation sirolimus-eluting stent in patients with coronary total occlusions Methods and Results—A total of 207 patients with coronary total occlusions and estimated time since occlusion >2 weeks were randomized to everolimus- or sirolimus-eluting stent The primary end point was in-stent late loss at 9-month angiographic follow-up (noninferiority trial) Clinical follow-up was performed at 1 and 12 months In-stent late loss at 9 months was 029±060 versus 013±069 mm in patients allocated to siro
61 citations
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TL;DR: This consensus statement on the use of ITB in paediatric patients with spasticity was developed on the basis of currently available evidence, with the aim of providing information for clinicians, promoting an expert opinion and a consistent approach to the management of these patients and emphasising the need for further prospective, large-scale studies.
60 citations
Authors
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Name | H-index | Papers | Citations |
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Jaakko Tuomilehto | 115 | 1285 | 210682 |
Vincent Soriano | 87 | 762 | 34084 |
Lina Badimon | 86 | 682 | 35774 |
Francisco J. Blanco | 84 | 789 | 33319 |
Michael A. Gatzoulis | 82 | 478 | 32562 |
Jose Lopez-Sendon | 81 | 460 | 41809 |
Victor Moreno | 80 | 635 | 31511 |
Joaquín Dopazo | 75 | 396 | 24790 |
Fernando Rodríguez-Artalejo | 74 | 512 | 23296 |
José R. Banegas | 74 | 421 | 28249 |
Michael Becker | 72 | 317 | 18189 |
Gianfranco Ferraccioli | 70 | 402 | 26515 |
Maria-Victoria Mateos | 66 | 480 | 24278 |
Manuel Romero-Gómez | 64 | 420 | 19006 |
Eulogio García | 63 | 270 | 15354 |