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Seijo-Bestilleiro R, Seoane-Pillado T, Pertega-Diaz S, González-Martín C, Valdes-Cañedo F, Balboa-Barreiro V, Fernandez-Rivera C, Alonso-Hernandez A, Cao-Vilariño M, Gil-Guillen V, Garcia-Rodriguez MT. Randomized clinical trial to determine the effectiveness of CO-oximetry and anti-smoking brief advice in a cohort of kidney transplant patients who smoke. Int J Med Sci 2020; 17:2673-2684. [PMID: 33162795 PMCID: PMC7645331 DOI: 10.7150/ijms.49401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/25/2020] [Indexed: 12/05/2022] Open
Abstract
Background: measure the efficacy of exhaled carbon monoxide (CO) measurement plus brief advisory sessions to reduce smoking exposure and smoking behaviour in kidney transplant recipients. Methods: Randomized, controlled, open-label clinical trial at a Spanish hospital.Smoking kidney transplant recipients giving their consent to participate were randomized to control (brief advice, n=63) or intervention group (brief advisory session plus measuring exhaled CO, n=59). Measurements: Sociodemographic characteristics, cardiovascular risk factors, treatment, rejection episodes, infections, self-reported smoking, drug use, level of dependence and motivation to stop smoking (Fagerström's and Richmond's test) and stage of change (Prochaska and DiClemente's Stages). Efficacy was assessed at 3, 6, 9 and 12 months as: cotinine test, CO levels in exhaled air, nicotine dependence, motivational stages of change, motivation to stop smoking, pattern of tobacco use and smoking cessation rates. Logistic regression models were computed. Results: At 12 months of follow-up, differences were found in exhaled CO between the intervention and control group(6.1±6.8vs.10.2±9.7ppm;p=0.028). Carboxyhemoglobin levels were lower in the intervention group as well as the positive cotinine test (1.2±1.2%vs.2.0±2.4%;p=0.039),(53.4%vs.74.2%). At 12 months, intervention reduces the probability of a positive urine test by 28%. Conclusions: Co-oximetry is a clinically relevant intervention for reduction of tobacco exposure in kidney transplant recipients.
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Affiliation(s)
- Rocio Seijo-Bestilleiro
- Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña
| | - Teresa Seoane-Pillado
- Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña
| | - Sonia Pertega-Diaz
- Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña
| | - Cristina González-Martín
- Grupo de Investigacion Reumatologia y Salud Pública. Investigación en enfermería y cuidados de la salud. Complejo Hospitalario Universitario A Coruña (CHUAC), SERGAS, As Xubias 84, 15006 A Coruña. Universidade da Coruña (UDC) (A Coruña, España)
| | - Francisco Valdes-Cañedo
- Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña
| | - Vanesa Balboa-Barreiro
- Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña
| | - Constantino Fernandez-Rivera
- Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña
| | - Angel Alonso-Hernandez
- Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña
| | - Mercedes Cao-Vilariño
- Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña
| | - Vicente Gil-Guillen
- Department of Clinical Medicine; University Miguel Hernandez of San Juan de Alicante
| | - Mª Teresa Garcia-Rodriguez
- Grupo de Investigacion Reumatologia y Salud Pública. Investigación en enfermería y cuidados de la salud. Complejo Hospitalario Universitario A Coruña (CHUAC), SERGAS, As Xubias 84, 15006 A Coruña. Universidade da Coruña (UDC) (A Coruña, España)
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Martínez-Barricarte R, Heurich M, Valdes-Cañedo F, Vazquez-Martul E, Torreira E, Montes T, Tortajada A, Pinto S, Lopez-Trascasa M, Morgan BP, Llorca O, Harris CL, Rodríguez de Córdoba S. Human C3 mutation reveals a mechanism of dense deposit disease pathogenesis and provides insights into complement activation and regulation. J Clin Invest 2010; 120:3702-12. [PMID: 20852386 DOI: 10.1172/jci43343] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 07/21/2010] [Indexed: 02/06/2023] Open
Abstract
Dense deposit disease (DDD) is a severe renal disease characterized by accumulation of electron-dense material in the mesangium and glomerular basement membrane. Previously, DDD has been associated with deficiency of factor H (fH), a plasma regulator of the alternative pathway (AP) of complement activation, and studies in animal models have linked pathogenesis to the massive complement factor 3 (C3) activation caused by this deficiency. Here, we identified a unique DDD pedigree that associates disease with a mutation in the C3 gene. Mutant C(3923ΔDG), which lacks 2 amino acids, could not be cleaved to C3b by the AP C3-convertase and was therefore the predominant circulating C3 protein in the patients. However, upon activation to C3b by proteases, or to C3(H₂O) by spontaneous thioester hydrolysis, C(3923ΔDG) generated an active AP C3-convertase that was regulated normally by decay accelerating factor (DAF) but was resistant to decay by fH. Moreover, activated C(3b923ΔDG) and C3(H₂O)(923ΔDG) were resistant to proteolysis by factor I (fI) in the presence of fH, but were efficiently inactivated in the presence of membrane cofactor protein (MCP). These characteristics cause a fluid phase-restricted AP dysregulation in the patients that continuously activated and consumed C3 produced by the normal C3 allele. These findings expose structural requirements in C3 that are critical for recognition of the substrate C3 by the AP C3-convertase and for the regulatory activities of fH, DAF, and MCP, all of which have implications for therapeutic developments.
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Affiliation(s)
- Rubén Martínez-Barricarte
- Centro de Investigaciones Biológicas (CIB), Consejo Superior de Investigaciones Científicas, Centro de Investigación Biomédica en Enfermedades Raras and Instituto Reina Sofía de Investigaciones Nefrológicas, Madrid, Spain
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Pita-Fernandez S, Valdes-Cañedo F, Pertega-Diaz S, Seoane-Pillado MT, Seijo-Bestilleiro R. Cancer incidence in kidney transplant recipients: a study protocol. BMC Cancer 2009; 9:294. [PMID: 19698143 PMCID: PMC2745429 DOI: 10.1186/1471-2407-9-294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 08/22/2009] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Different publications show an increased incidence of neoplasms in renal transplant patients. The objective of this study is to determine the incidence of cancer in the recipients of renal transplants performed in the A Coruña Hospital (Spain) during the period 1981-2007. METHODS/DESIGN During the study period 1967 kidney transplants were performed, corresponding to 1710 patients. Patients with neoplasms prior to the transplant will be excluded (n = 38). A follow-up study was carried out in order to estimate cancer incidence after transplantation.For each patient, information included donor and recipient characteristics, patients and graft survival and cancer incidence after transplantation. Incident cancer is considered as new cases of cancer after the transplant with anatomopathological confirmation. Their location will be classified according to the ICD-9.The analysis will be calculated using the indirect standardisation method. Age-adjusted cancer incidence rates in the Spanish general population will be obtained from the Carlos III Health Institute, the National Epidemiology Centre of the Ministry of Science and Technology. Crude first, second and third-year post-transplantation cancer incidence rates will be calculated for male and female recipients. The number of cases of cancer at each site will be calculated from data in the clinical records. The expected number of cancers will be calculated from data supplied by the Carlos III Health Institute. For each tumour location we will estimate the standardized incidence ratios (SIRs), using sex-specific cancer incidence rates, by dividing the incidence rate for the transplant patients by the rate of the general population. The 95% confidence intervals of the SIRs and their associated p-values will be calculated by assuming that the observed cancers follow a Poisson distribution. Stratified analysis will be performed to examine the variation in the SIRs with sex and length of follow-up.Competing risk survival analysis methods will be applied to estimate the cumulative incidence of cancer and to identify variables associated to its occurrence. DISCUSSION Information about cancer incidence in kidney transplant patients could be useful to adapt the guidelines on post-kidney transplant follow-up on tumour screening, and evaluate the impact of intervention measures for the prevention of cancer in these patients.
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Affiliation(s)
- Salvador Pita-Fernandez
- Clinical Epidemiology and Biostatistics Unit, University Hospital Complex of A Coruña, Hotel de Pacientes 7a Planta, As Xubias, 84, 15006 A Coruña, Spain
| | | | - Sonia Pertega-Diaz
- Clinical Epidemiology and Biostatistics Unit, University Hospital Complex of A Coruña, Hotel de Pacientes 7a Planta, As Xubias, 84, 15006 A Coruña, Spain
| | - Maria Teresa Seoane-Pillado
- Clinical Epidemiology and Biostatistics Unit, University Hospital Complex of A Coruña, Hotel de Pacientes 7a Planta, As Xubias, 84, 15006 A Coruña, Spain
| | - Rocio Seijo-Bestilleiro
- Clinical Epidemiology and Biostatistics Unit, University Hospital Complex of A Coruña, Hotel de Pacientes 7a Planta, As Xubias, 84, 15006 A Coruña, Spain
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