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Trias-Sabrià P, Dorca Duch E, Molina-Molina M, Aso S, Díez-Ferrer M, Marín Muñiz A, Bordas-Martínez J, Sabater J, Luburich P, del Rio B, Solanich X, Dorca J, Santos S, Suárez-Cuartin G. Radio-Histological Correlation of Lung Features in Severe COVID-19 Through CT-Scan and Lung Ultrasound Evaluation. Front Med (Lausanne) 2022; 9:820661. [PMID: 35514757 PMCID: PMC9063463 DOI: 10.3389/fmed.2022.820661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patients with coronavirus disease 2019 (COVID-19) can develop severe bilateral pneumonia leading to respiratory failure. Lung histological samples were scarce due to the high risk of contamination during autopsies. We aimed to correlate histological COVID-19 features with radiological findings through lung ultrasound (LU)-guided postmortem core needle biopsies (CNBs) and computerized tomography (CT) scans. Methodology We performed an observational prospective study, including 30 consecutive patients with severe COVID-19. The thorax was divided into 12 explorations regions to correlate LU and CT-scan features. Histological findings were also related to radiological features through CNBs. Results Mean age was 62.56 ± 13.27 years old, with 96.7% male patients. Postmortem LU-guided CNBs were performed in 13 patients. Thirty patients were evaluated with both thoracic LU and chest CT scan, representing a total of 279 thoracic regions explored. The most frequent LU finding was B2-lines (49.1%). The most CT-scan finding was ground-glass opacity (GGO, 29%). Pathological CT-scan findings were commonly observed when B2-lines or C-lines were identified through LU (positive predictive value, PPV, 87.1%). Twenty-five postmortem echo-guided histological samples were obtained from 12 patients. Histological samples showed diffuse alveolar damage (DAD) (75%) and chronic interstitial inflammation (25%). The observed DAD was heterogeneous, showing multiple evolving patterns of damage, including exudative (33.3%), fibrotic (33.3%), and organizing (8.3%) phases. In those patients with acute or exudative pattern, two lesions were distinguished: classic hyaline membrane; fibrin "plug" in alveolar space (acute fibrinous organizing pneumonia, AFOP). C-profile was described in 33.3% and presented histological signs of DAD and lung fibrosis. The predominant findings were collagen deposition (50%) and AFOP (50%). B2-lines were identified in 66.7%; the presence of hyaline membrane was the predominant finding (37.5%), then organizing pneumonia (12.5%) and fibrosis (37.5%). No A-lines or B1-lines were observed in these patients. Conclusion LU B2-lines and C-profile are predominantly identified in patients with severe COVID-19 with respiratory worsening, which correspond to different CT patterns and histological findings of DAD and lung fibrosis.
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Affiliation(s)
- Pere Trias-Sabrià
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona-Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Eduard Dorca Duch
- Pathology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Maria Molina-Molina
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona-Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Samantha Aso
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Marta Díez-Ferrer
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Alfredo Marín Muñiz
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Jaume Bordas-Martínez
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Joan Sabater
- Universitat de Barcelona-Campus Bellvitge, L'Hospitalet de Llobregat, Spain
- Critical Care Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Patricio Luburich
- Radiology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Belén del Rio
- Radiology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Xavier Solanich
- Radiology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Jordi Dorca
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona-Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Salud Santos
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona-Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Guillermo Suárez-Cuartin
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona-Campus Bellvitge, L'Hospitalet de Llobregat, Spain
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2
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Diez-Ferrer M, Torrejon-Escribano B, Baixeras N, Tebe C, Cubero N, Lopez-Lisbona R, Dorca J, Rosell A. Comparing Probe-Based Confocal Laser Endomicroscopy With Histology. Are We Looking at the Same Picture? Arch Bronconeumol 2021; 57:778-780. [PMID: 35698992 DOI: 10.1016/j.arbr.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/20/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Marta Diez-Ferrer
- Department of Respiratory Medicine, Hospital de Bellvitge-IDIBELL-University of Barcelona, Barcelona,Spain.
| | - Benjamin Torrejon-Escribano
- Unit of Advanced Optical Microscopy, Scientific and Technological Centers (CCiTUB) University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Baixeras
- Department of Pathology, Hospital de Bellvitge-IDIBELL-University of Barcelona, Barcelona, Spain
| | - Cristian Tebe
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL). L'Hospitalet de Llobregat, Barcelona,Spain; Department of Basic Medical Sciences, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Noelia Cubero
- Department of Respiratory Medicine, Hospital de Bellvitge-IDIBELL-University of Barcelona, Barcelona,Spain
| | - Rosa Lopez-Lisbona
- Department of Respiratory Medicine, Hospital de Bellvitge-IDIBELL-University of Barcelona, Barcelona,Spain
| | - Jordi Dorca
- Department of Respiratory Medicine, Hospital de Bellvitge-IDIBELL-University of Barcelona, Barcelona,Spain
| | - Antoni Rosell
- Thorax Institute, Hospital Germans Trias i Pujol-IGTP-UAB, Badalona, Barcelona, Spain
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3
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Trias-Sabrià P, Molina-Molina M, Aso S, Argudo MH, Diez-Ferrer M, Sabater J, Dorca J, Santos S, Suarez-Cuartin G. Lung Ultrasound Score to Predict Outcomes in COVID-19. Respir Care 2021; 66:1263-1270. [PMID: 34006594 PMCID: PMC9994360 DOI: 10.4187/respcare.08648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with coronavirus disease 2019 (COVID-19) can develop severe bilateral pneumonia leading to respiratory failure. We aimed to study the potential role of lung ultrasound score (LUS) in subjects with COVID-19. METHODS We conducted an observational, prospective pilot study, including consecutive subjects admitted to an intermediate care unit due to COVID-19 pneumonia. LUS is a 12-zone examination method for lung parenchyma assessment. LUS was performed with a portable convex transducer, scores from 0 to 36 points. Clinical and demographic data were collected at LUS evaluation. Survival analysis was performed using a composite outcome including ICU admission or death. Subjects were followed for 30 d from LUS assessment. RESULTS Of 36 subjects included, 69.4% were male, and mean age was 60.19 ± 12.75 y. A cutoff LUS ≥ 24 points showed 100% sensitivity, 69.2% specificity, and an area under the receiver operating characteristic curve of 0.85 for predicting worse prognosis. The composite outcome was present in 10 subjects (55.6%) with LUS ≥ 24 points, but not in the group with lower LUS scores (P < .001). Subjects with LUS ≥ 24 points had a higher risk of ICU admission or death (hazard ratio 9.97 [95% CI 2.75-36.14], P < .001). Significant correlations were observed between LUS and [Formula: see text], serum D-dimer, C-reactive protein, lactate dehydrogenase, and lymphocyte count. CONCLUSIONS LUS ≥ 24 points can help identify patients with COVID-19 who are likely to require ICU admission or to die during follow-up. LUS also correlates significantly with clinical and laboratory markers of COVID-19 severity.
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Affiliation(s)
- Pere Trias-Sabrià
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Maria Molina-Molina
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Samantha Aso
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Marta Hernández Argudo
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Marta Diez-Ferrer
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Sabater
- Critical Care Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Jordi Dorca
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Salud Santos
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Guillermo Suarez-Cuartin
- Respiratory Department, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
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4
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Planas-Cerezales L, Arias-Salgado EG, Berastegui C, Montes-Worboys A, González-Montelongo R, Lorenzo-Salazar JM, Vicens-Zygmunt V, Garcia-Moyano M, Dorca J, Flores C, Perona R, Román A, Molina-Molina M. Lung Transplant Improves Survival and Quality of Life Regardless of Telomere Dysfunction. Front Med (Lausanne) 2021; 8:695919. [PMID: 34395476 PMCID: PMC8362799 DOI: 10.3389/fmed.2021.695919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/27/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction: Fibrotic interstitial lung diseases (ILDs) are the first indication for lung transplantation (LT). Telomere dysfunction has been associated with poor post-transplant outcomes. The aim of the study was to evaluate the morbi-mortality and quality of life in fibrotic ILDs after lung transplant depending on telomere biology. Methods: Fibrotic ILD patients that underwent lung transplant were allocated to two arms; with or without telomere dysfunction at diagnosis based on the telomere length and telomerase related gene mutations revealed by whole-exome sequencing. Post-transplant evaluation included: (1) short and long-term mortality and complications and (2) quality of life. Results: Fifty-five percent of patients that underwent LT carried rare coding mutations in telomerase-related genes. Patients with telomere shortening more frequently needed extracorporeal circulation and presented a higher rate of early post-transplant hematological complications, longer stay in the intensive care unit (ICU), and a higher number of long-term hospital admissions. However, post-transplant 1-year survival was higher than 80% regardless of telomere dysfunction, with improvement in the quality of life and oxygen therapy withdrawal. Conclusions: Post-transplant morbidity is higher in patients with telomere dysfunction and differs according to elapsed time from transplantation. However, lung transplant improves survival and quality of life and the associated complications are manageable.
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Affiliation(s)
- Lurdes Planas-Cerezales
- ILD Multidisciplinary Unit, Hospital Universitari Bellvitge, IDIBELL, Universitat de Barcelona, Hospitalet de Llobregat, Spain
| | - Elena G Arias-Salgado
- Biomedical Research Institute CSIC/UAM, IdIPAZ, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Berastegui
- Respiratory Department, Institute of Research, Hospital Universitari Vall d'Hebrón, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Ana Montes-Worboys
- ILD Multidisciplinary Unit, Hospital Universitari Bellvitge, IDIBELL, Universitat de Barcelona, Hospitalet de Llobregat, Spain
| | | | - José M Lorenzo-Salazar
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Vanesa Vicens-Zygmunt
- ILD Multidisciplinary Unit, Hospital Universitari Bellvitge, IDIBELL, Universitat de Barcelona, Hospitalet de Llobregat, Spain
| | | | - Jordi Dorca
- ILD Multidisciplinary Unit, Hospital Universitari Bellvitge, IDIBELL, Universitat de Barcelona, Hospitalet de Llobregat, Spain
| | - Carlos Flores
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain.,Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.,Instituto de Tecnologías Biomédicas, Universidad de La Laguna, Santa Cruz de Tenerife, Spain.,Centro Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosario Perona
- Biomedical Research Institute CSIC/UAM, IdIPAZ, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Román
- Respiratory Department, Institute of Research, Hospital Universitari Vall d'Hebrón, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - María Molina-Molina
- ILD Multidisciplinary Unit, Hospital Universitari Bellvitge, IDIBELL, Universitat de Barcelona, Hospitalet de Llobregat, Spain.,Centro Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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5
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Diez-Ferrer M, Torrejon-Escribano B, Baixeras N, Tebe C, Cubero N, Lopez-Lisbona R, Dorca J, Rosell A. Comparing Probe-Based Confocal Laser Endomicroscopy With Histology. Are We Looking at the Same Picture? Arch Bronconeumol 2021; 57:S0300-2896(21)00042-9. [PMID: 33722423 DOI: 10.1016/j.arbres.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Marta Diez-Ferrer
- Department of Respiratory Medicine, Hospital de Bellvitge-IDIBELL-University of Barcelona, Barcelona, Spain.
| | - Benjamin Torrejon-Escribano
- Unit of Advanced Optical Microscopy, Scientific and Technological Centers (CCiTUB) University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Baixeras
- Department of Pathology, Hospital de Bellvitge-IDIBELL-University of Barcelona, Barcelona, Spain
| | - Cristian Tebe
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL). L'Hospitalet de Llobregat, Barcelona, Spain; Department of Basic Medical Sciences, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Noelia Cubero
- Department of Respiratory Medicine, Hospital de Bellvitge-IDIBELL-University of Barcelona, Barcelona, Spain
| | - Rosa Lopez-Lisbona
- Department of Respiratory Medicine, Hospital de Bellvitge-IDIBELL-University of Barcelona, Barcelona, Spain
| | - Jordi Dorca
- Department of Respiratory Medicine, Hospital de Bellvitge-IDIBELL-University of Barcelona, Barcelona, Spain
| | - Antoni Rosell
- Thorax Institute, Hospital Germans Trias i Pujol-IGTP-UAB, Badalona, Barcelona, Spain
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6
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Shull JG, Pay MT, Lara Compte C, Olid M, Bermudo G, Portillo K, Sellarés J, Balcells E, Vicens-Zygmunt V, Planas-Cerezales L, Badenes-Bonet D, Blavia R, Rivera-Ortega P, Moreno A, Sans J, Perich D, Barril S, Esteban L, Garcia-Bellmunt L, Esplugas J, Suarez-Cuartin G, Bordas-Martinez J, Castillo D, Jolis R, Salvador I, Eizaguirre Anton S, Villar A, Robles-Perez A, Cardona MJ, Barbeta E, Silveira MG, Guevara C, Dorca J, Rosell A, Luburich P, Llatjós R, Jorba O, Molina-Molina M. Mapping IPF helps identify geographic regions at higher risk for disease development and potential triggers. Respirology 2020; 26:352-359. [PMID: 33167075 DOI: 10.1111/resp.13973] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE The relationship between IPF development and environmental factors has not been completely elucidated. Analysing geographic regions of idiopathic pulmonary fibrosis (IPF) cases could help identify those areas with higher aggregation and investigate potential triggers. We hypothesize that cross-analysing location of IPF cases and areas of consistently high air pollution concentration could lead to recognition of environmental risk factors for IPF development. METHODS This retrospective study analysed epidemiological and clinical data from 503 patients registered in the Observatory IPF.cat from January 2017 to June 2019. Incident and prevalent IPF cases from the Catalan region of Spain were graphed based on their postal address. We generated maps of the most relevant air pollutant PM2.5 from the last 10 years using data from the CALIOPE air quality forecast system and observational data. RESULTS In 2018, the prevalence of IPF differed across provinces; from 8.1 cases per 100 000 habitants in Barcelona to 2.0 cases per 100 000 in Girona. The ratio of IPF was higher in some areas. Mapping PM2.5 levels illustrated that certain areas with more industry, traffic and shipping maintained markedly higher PM2.5 concentrations. Most of these locations correlated with higher aggregation of IPF cases. Compared with other risk factors, PM2.5 exposure was the most frequent. CONCLUSION In this retrospective study, prevalence of IPF is higher in areas of elevated PM2.5 concentration. Prospective studies with targeted pollution mapping need to be done in specific geographies to compile a broader profile of environmental factors involved in the development of pulmonary fibrosis.
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Affiliation(s)
- Jessica Germaine Shull
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Maria Teresa Pay
- Barcelona Supercomputing Center, BSC, c/Jordi Girona, 29,, Barcelona, Spain
| | - Carla Lara Compte
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Miriam Olid
- Barcelona Supercomputing Center, BSC, c/Jordi Girona, 29,, Barcelona, Spain
| | - Guadalupe Bermudo
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Karina Portillo
- ILD Multidisciplinary Unit, University Hospital Trias i Pujol, Badalona, Spain
| | - Jacobo Sellarés
- ILD Multidisciplinary Unit, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Eva Balcells
- Respiratory Medicine Department, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain
| | - Vanesa Vicens-Zygmunt
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Lurdes Planas-Cerezales
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Diana Badenes-Bonet
- Respiratory Medicine Department, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain.,School of Health & Life Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Rosana Blavia
- Respiratory Department, Hospital Moises Broggi, San Joan Despi, Spain
| | - Pilar Rivera-Ortega
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Amalia Moreno
- Respiratory Department, Hospital Parc Taulí, Sabadell, Spain
| | - Jordi Sans
- Respiratory Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Damià Perich
- Respiratory Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Silvia Barril
- Respiratory Department, Hospital Arnau de Vilanova, Lleida, Spain
| | | | | | - Jordi Esplugas
- Respiratory Department, Hospital de Martorell, Barcelonès, Spain
| | - Guillermo Suarez-Cuartin
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Jaume Bordas-Martinez
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Diego Castillo
- ILD Multidisciplinary Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain
| | - Rosa Jolis
- Respiratory Department, Hospital de Figueres, Figueres, Spain
| | - Inma Salvador
- Respiratory Department, Hospital de Tortosa, Tortosa, Spain
| | | | - Ana Villar
- ILD Multidisciplinary Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Enric Barbeta
- Respiratory Department, Hospital de Granollers, Granollers, Spain
| | | | - Claudia Guevara
- Respiratory Department, Hospital Sant Camil, Vilanova, Spain
| | - Jordi Dorca
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Antoni Rosell
- ILD Multidisciplinary Unit, University Hospital Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Translational Respiratory Research Group, Institut de Recerca Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Patricio Luburich
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Roger Llatjós
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain
| | - Oriol Jorba
- Barcelona Supercomputing Center, BSC, c/Jordi Girona, 29,, Barcelona, Spain
| | - Maria Molina-Molina
- ILD Multidisciplinary Unit, Bellvitge University Hospital, IDIBELL, Hospitalet de Llobregat, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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7
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Rombauts A, Abelenda-Alonso G, Càmara J, Lorenzo-Esteller L, González-Díaz A, Sastre-Escolà E, Gudiol C, Dorca J, Tebé C, Pallarès N, Ardanuy C, Carratalà J. Host- and Pathogen-Related Factors for Acute Cardiac Events in Pneumococcal Pneumonia. Open Forum Infect Dis 2020; 7:ofaa522. [PMID: 33335932 PMCID: PMC7727332 DOI: 10.1093/ofid/ofaa522] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background Acute cardiac events (ACEs) are increasingly being recognized as a major complication in pneumococcal community-acquired pneumonia (CAP). Information regarding host- and pathogen-related factors for ACEs, including pneumococcal serotypes and clonal complexes, is scarce. Methods A retrospective study was conducted of a prospective cohort of patients hospitalized for CAP between 1996 and 2019. Logistic regression and funnel plot analyses were performed to determine host- and pathogen-related factors for ACEs. Results Of 1739 episodes of pneumococcal CAP, 1 or more ACEs occurred in 304 (17.5%) patients, the most frequent being arrhythmia (n = 207), heart failure (n = 135), and myocardial infarction (n = 23). The majority of ACEs (73.4%) occurred within 48 hours of admission. Factors independently associated with ACEs were older age, preexisting heart conditions, pneumococcal bacteremia, septic shock at admission, and high-risk pneumonia. Among 983 pneumococcal isolates, 872 (88.7%) were serotyped and 742 (75.5%) genotyped. The funnel plot analyses did not find any statistically significant association between serotypes or clonal complexes with ACEs. Nevertheless, there was a trend toward an association between CC230 and these complications. ACEs were independently associated with 30-day mortality (adjusted odds ratio, 1.88; 95% CI, 1.11-3.13). Conclusions ACEs are frequent in pneumococcal pneumonia and are associated with increased mortality. The risk factors defined in this study may help identify patients who must undergo close follow-up, including heart rhythm monitoring, and special care to avoid fluid overload, particularly during the first 48 hours of admission. These high-risk patients should be the target for preventive intervention strategies.
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Affiliation(s)
- Alexander Rombauts
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Gabriela Abelenda-Alonso
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Càmara
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Department of Microbiology, Bellvitge Universtiy Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Research Network for Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Laia Lorenzo-Esteller
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Aida González-Díaz
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Department of Microbiology, Bellvitge Universtiy Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Research Network for Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Enric Sastre-Escolà
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Carlota Gudiol
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain.,University of Barcelona, Barcelona, Spain
| | - Jordi Dorca
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Department of Pneumology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebé
- Biostatistics Unit at Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Natàlia Pallarès
- Biostatistics Unit at Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Ardanuy
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Department of Microbiology, Bellvitge Universtiy Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Research Network for Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,University of Barcelona, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain.,University of Barcelona, Barcelona, Spain
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8
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Robles-Pérez A, Luburich P, Bolivar S, Dorca J, Nolla JM, Molina-Molina M, Narváez J. A prospective study of lung disease in a cohort of early rheumatoid arthritis patients. Sci Rep 2020; 10:15640. [PMID: 32973236 PMCID: PMC7515904 DOI: 10.1038/s41598-020-72768-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 09/02/2020] [Indexed: 01/26/2023] Open
Abstract
Lung disease is common in patients with rheumatoid arthritis (RA). The onset of lung involvement in RA is not well known. The objective is to describe the features and evolution of lung involvement in early RA, its relationship with disease activity parameters, smoking and treatments. Consecutive patients with early RA without respiratory symptoms were included and tracked for 5 years. Lung assessment included clinical, radiological and pulmonary function tests at diagnosis and during follow-up. Peripheral blood parameters (erythrocyte sedimentation rate, C reactive protein, rheumatoid factor and anti-citrullinated peptide autoantibodies) and scales of articular involvement, such as DAS28-CRP, were evaluated. 40 patients were included and 32 completed the 5-year follow up. 13 patients presented lung involvement in the initial 5 years after RA diagnosis, 3 of them interstitial lung disease. Significant decrease of diffusion lung transfer capacity of carbon monoxide over time was observed in six patients, 2 of them developed interstitial lung disease. DLCO decrease was correlated with higher values of CRP and ESR at diagnosis. Methotrexate was not associated with DLCO deterioration or lung disease development. Subclinical progressive lung disease correlates with RA activity parameters. Smoking status and methotrexate were not associated with development or progression of lung disease.
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Affiliation(s)
- A Robles-Pérez
- ILD Unit, Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga S/N, 08907, Barcelona, Spain
| | - P Luburich
- Servei de Diagnòstic Per La Imatge El Prat (SDPI El Prat), Department of Radiology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - S Bolivar
- Servei de Diagnòstic Per La Imatge El Prat (SDPI El Prat), Department of Radiology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - J Dorca
- ILD Unit, Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga S/N, 08907, Barcelona, Spain
| | - J M Nolla
- Department of Rheumatology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - M Molina-Molina
- ILD Unit, Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga S/N, 08907, Barcelona, Spain.
| | - J Narváez
- Department of Rheumatology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
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9
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López-Padrós C, Salord N, Alves C, Vilarrasa N, Gasa M, Planas R, Montsserrat M, Virgili MN, Rodríguez C, Pérez-Ramos S, López-Cadena E, Ramos MI, Dorca J, Monasterio C. Effectiveness of an intensive weight-loss program for severe OSA in patients undergoing CPAP treatment: a randomized controlled trial. J Clin Sleep Med 2020; 16:503-514. [PMID: 32003737 DOI: 10.5664/jcsm.8252] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVES To determine whether an intensive weight-loss program (IWLP) is effective for reducing weight, the severity of obstructive sleep apnea (OSA), and metabolic variables in patients with obesity and severe OSA undergoing continuous positive airway pressure treatment. METHODS Forty-two patients were randomized to the control (CG, n = 20) or the intervention group (IG, n = 22), who followed a 12-month IWLP. The primary outcome was a reduction in the apnea-hypopnea index (AHI) as measured at 3 and 12 months by full polysomnography. Metabolic variables, blood pressure, body fat composition by bioimpedance, carotid intima media thickness, and visceral fat by computed tomography were also assessed. RESULTS Mean age was 49 (6.7) years, body mass index 35 (2.7) kg/m², and AHI 69 (20) events/h. Weight reduction was higher for the IG than the CG at 3 and 12 months, -10.5 versus -2.3 kg (P < .001), and -8.2 versus -0.1 kg (P < .001), respectively, as was loss of visceral fat at 12 months. AHI decreased more in the IG at 3 months (-23.72 versus -9 events/h) but the difference was not significant at 12 months, though 28% of patients from the IG had an AHI < 30 events/h compared to none in the CG (P = .046). At 12 months, the IG showed a reduction in C-reactive protein (P = .013), glycated hemoglobin (P = .031) and an increase in high density lipoprotein cholesterol (P = .027). CONCLUSIONS An IWLP in patients with obesity and severe OSA is effective for reducing weight and OSA severity. It also results in an improvement in lipid profiles, glycemic control, and inflammatory markers. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Effectiveness of an Intensive Weight Loss Program for Obstructive Sleep Apnea Syndrome (OSAS) Treatment; Identifier: NCT02832414; URL: https://clinicaltrials.gov/ct2/show/record/NCT02832414.
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Affiliation(s)
- Carla López-Padrós
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Neus Salord
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Carolina Alves
- Section of Endocrinology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Núria Vilarrasa
- Section of Endocrinology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Endocrinology and Nutrition Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM-CIBER), Spain
| | - Merce Gasa
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Rosa Planas
- Department of Rehabilitation, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Monica Montsserrat
- Department of Endocrinology and Nutrition Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - M Nuria Virgili
- Section of Endocrinology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Endocrinology and Nutrition Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Department of Medicine, Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Rodríguez
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sandra Pérez-Ramos
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Esther López-Cadena
- Respiratory Medicine Department, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | | | - Jordi Dorca
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Medicine, Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Monasterio
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
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10
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Robles-Perez A, Dorca J, Castellví I, Nolla JM, Molina-Molina M, Narváez J. Rituximab effect in severe progressive connective tissue disease-related lung disease: preliminary data. Rheumatol Int 2020; 40:719-726. [DOI: 10.1007/s00296-020-04545-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/28/2020] [Indexed: 01/22/2023]
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11
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Camprubí D, Gomila A, Grijota-Camino MD, Soldevila L, Luque MJ, Alcaide F, Dorca J, Santin M. Infectiousness of patients with smear-negative pulmonary tuberculosis, assessed by Real-time Polymerase Chain Reaction, Xpert ⓇMTB/RIF. J Infect 2020; 80:298-300. [PMID: 31954744 DOI: 10.1016/j.jinf.2019.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/22/2019] [Accepted: 12/17/2019] [Indexed: 11/16/2022]
Abstract
Currently, pulmonary tuberculosis (TB) isolation recommendations are based on serial sputum smear microscopy. To assess infectiousness of smear-negative/GeneXpert-positive (Sm-/GXpert+) pulmonary TB, we evaluated 511 contacts of pulmonary TB patients attended at a teaching hospital in Spain (2010-2018). There were no statistically significant differences in rates of Mycobacterium tuberculosis infection (46.2% contacts of smear-positive and 34.6% contacts of Sm-/GXpert+ pulmonary TB patients, p = 0.112). Sm-/GXpert+ pulmonary TB poses a substantial risk of transmission of M. tuberculosis infection. Our results add evidence to support including Real-time Polymerase Chain Reaction (XpertⓇMTB/RIF) in the work-up diagnosis of suspected pulmonary TB cases to make decisions on air-borne isolation.
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Affiliation(s)
- Daniel Camprubí
- Tuberculosis Unit, Infectious Disease Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, c/ de la Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain; ISGlobal, Hospital Clínic - University of Bercelona, Barcelona, Spain.
| | - Aina Gomila
- Tuberculosis Unit, Infectious Disease Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, c/ de la Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain; Infectious Diseases Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Maria D Grijota-Camino
- Tuberculosis Unit, Infectious Disease Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, c/ de la Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Soldevila
- Tuberculosis Unit, Infectious Disease Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, c/ de la Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria J Luque
- Tuberculosis Unit, Infectious Disease Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, c/ de la Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Alcaide
- Microbiology Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Dorca
- University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Respirology Service, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Santin
- Tuberculosis Unit, Infectious Disease Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, c/ de la Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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12
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López-Padrós C, Rodríguez C, Salord N, Alves C, Vilarrasa N, Gasa M, Planas R, Montserrat M, Virgili M, Pérez-Ramos S, López-Cadena E, Ramos M, Dorca J, Monasterio C. Effectiveness of an intensive weight-loss program for severe obstructive sleep apnea syndrome (OSA) in patients undergoing CPAP treatment: a randomized controlled trial. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Recalde S, Quiroga V, del Barco S, Falo C, Dorca J, Margeli M, Stradella A, Soler T, Te García IR, Viñas G, Fernandez A, Vázquez RV, Vethencourt A, Marin MR, Gil-Gil M. Influence of age on the indication of adjuvant chemotherapy in early breast cancer using Oncotype DX. An analysis of 240 patients treated in the Institut Catala d’Oncologia (ICO) hospitals. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Santin M, Barrabeig I, Malchair P, Gonzalez-Luquero L, Benitez MA, Sabria J, Palau-Benavent M, Cañete C, Lloret-Queraltó JA, Grijota-Camino MD, Dorca J, Alcaide F. Pulmonary Infections with Nontuberculous Mycobacteria, Catalonia, Spain, 1994-2014. Emerg Infect Dis 2019; 24:1091-1094. [PMID: 29774836 PMCID: PMC6004863 DOI: 10.3201/eid2406.172095] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In Spain, systematic reporting of pulmonary infections with nontuberculous mycobacteria is not mandatory. Therefore, to determine trends, we retrospectively identified cases for January 1994–December 2014 in Catalonia. Over the 21 years, prevalence increased and was associated with being male. Mycobacterium avium complex and M. abscessus prevalence increased; M. kansasii prevalence decreased.
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15
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Careta O, Cuevas E, Muñoz-Esquerre M, López-Sánchez M, Pascual-González Y, Dorca J, Aliagas E, Santos S. Imbalance in the Expression of Genes Associated with Purinergic Signalling in the Lung and Systemic Arteries of COPD Patients. Sci Rep 2019; 9:2796. [PMID: 30808894 PMCID: PMC6391454 DOI: 10.1038/s41598-019-39233-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/18/2019] [Indexed: 12/14/2022] Open
Abstract
Growing evidence indicates that purinergic signalling is involved in the pathogenesis of chronic obstructive pulmonary disease (COPD) and in the vascular remodelling that occurs in other disorders; however, its role in initial vascular changes of COPD is not entirely known. We hypothesised that expression of genes regulating extracellular ATP and adenosine levels would be altered in the lung and systemic arteries of COPD patients. Quantitative real-time PCR was performed to analyse the relative expression of 17 genes associated with purinergic signalling and inflammation in lungs and intercostal arteries of never smokers (NS) (n = 16), non-obstructed smokers (NOS) (n = 17) and COPD patients (n = 21). Gene expression of ATP-degrading enzymes was decreased in both tissues of NOS and COPD patients compared to NS. NT5E expression (gene transcribing for an AMP hydrolyzing ectonucleotidase) was increased in both tissues in NOS compared to the other groups. P1 and P2 receptors did not show changes in expression. Expression of genes associated with inflammation (interleukin-13) was upregulated only in lung tissues of COPD. These findings suggest that the expression of different extracellular ATP-degrading enzymes is altered in smokers (NOS and COPD patients), promoting inflammation. However, the high NT5E expression found only in NOS could compensate this inflammatory environment.
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Affiliation(s)
- Oriol Careta
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Respiratory Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ester Cuevas
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Respiratory Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mariana Muñoz-Esquerre
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Respiratory Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta López-Sánchez
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Respiratory Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Yuliana Pascual-González
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Respiratory Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Dorca
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Respiratory Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elisabet Aliagas
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
- Department of Respiratory Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Salud Santos
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
- Department of Respiratory Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
- Research Network in Respiratory Diseases (CIBERES), Madrid, Spain.
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16
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Pernas S, Villagrasa P, Nuciforo PG, Vivancos A, Scaltriti M, Rodón J, Burgués O, Canes J, Dueñas M, Cecchi F, Vidal M, Lluch A, Perelló A, Llombart A, Dorca J, Montaño A, Oliveira M, Ribas G, Rapado I, Paré L, Prat A, Ciruelos E. Abstract P6-18-02: Primary and secondary results of the first nationwide molecular screening program in Spain for patients with advanced breast cancer (AGATA SOLTI-1301 study). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Metastatic breast cancer is the second leading cause of death among women globally. A better understanding of tumor biology, and the availability of high-throughput technologies, have enabled the emergence of precision medicine bringing new expectations and giving rise to molecular screening programs (MSP). SOLTI, as a collaborative Spanish network, designed AGATA, the first multi-institutional MSP ever implemented in this country. Here, we report both the primary and some of the secondary results of the pilot study.
Methods: A total of 10 sites within SOLTI network in Spain participated. DNA-sequencing of 56 cancer related genes was performed using FFPE tumor samples (primary or metastatic). Each clinical case was reviewed by a multidisciplinary advisory board (MAB), which recommended, in a prospective manner, potential experimental treatments, mainly in the context of clinical trials. The primary objective was to determine the success rate of matching a DNA alteration to an experimental drug or drug class. Secondary objectives included a comprehensive molecular characterization of tumor samples by PAM50 subtyping and quantification of protein expression levels by MASS-SPEC (70 proteins panel).
Results: 305 patients (pts) were screened from September 2014 to July 2017 and 260 (85.3%) were finally evaluated by the MAB. Pts characteristics were: mean age 54 years (29-80), ER+/HER2- (n=192; 74%), HER2+ (n=30; 11.5%) and TNBC (n=38; 14.5%). 163 primary tumors and 97 metastatic samples were profiled. Regarding the primary objective, 116 pts (45%) presented at least one mutation (range 1-6) that could be matched to a drug or drug class. Of these, 13 pts (11.2%) received therapy matched to their molecular profile according to the MAB recommendation and their follow-up is still on-going. No mutation was detected in 97 (37%) pts (WT), and 47 patients (18.1%) presented a mutation but no match was possible. The most common mutations were PIK3CA (34%), TP53 (22%), AKT1 (5%), ESR1 (3%) and ERBB2 (3%). Intrinsic subtype distribution in 177 samples was as follows: 34% Luminal A (n=60); 21% Luminal B (n=36); 13% HER2E (n=22); 19% Basal-like (n=34) and 13% Normal-like (n=23). Compared to primary tumors (n=110), the proportion of HER2-enriched disease in metastatic tumors (n=63) was significantly higher (6% vs 20%; p=0.005). Protein expression analysis was performed in 146 samples (94 primary and 57 metastasis). In 19 cases (13%), the outlier expression of some targetable proteins (FGFR1 [n=4, 2.7%], IGF1R [n=4, 2.7%], EGFR [n=1, 0.7%], CEACAM5 [n=6, 4.1%], IDO1 [n=2, 1.37%], TROP2 [n=2, 1.37%]) were identified. Of note, HER2 overexpression (>740 amol/μg) was observed in 4 HER2- cases. Finally, among WT tumors, 21% presented a potential drug-matched protein target.
Conclusions: Nationwide molecular screening in Spain is feasible. Nearly half of patients had tumors with mutation(s), mostly PIK3CA, that could be matched to a potential drug or drug class. PAM50 profile might be helpful to navigate towards a therapeutic decision making, although the MAB could not make any targeted-driven recommendation yet with this data. More clinical evidence is needed to use MASS-SPEC as a diagnostic tool.
Citation Format: Pernas S, Villagrasa P, Nuciforo PG, Vivancos A, Scaltriti M, Rodón J, Burgués O, Canes J, Dueñas M, Cecchi F, Vidal M, Lluch A, Perelló A, Llombart A, Dorca J, Montaño A, Oliveira M, Ribas G, Rapado I, Paré L, Prat A, Ciruelos E. Primary and secondary results of the first nationwide molecular screening program in Spain for patients with advanced breast cancer (AGATA SOLTI-1301 study) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-02.
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Affiliation(s)
- S Pernas
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - P Villagrasa
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - PG Nuciforo
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Vivancos
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - M Scaltriti
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - J Rodón
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - O Burgués
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - J Canes
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - M Dueñas
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - F Cecchi
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - M Vidal
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Lluch
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Perelló
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Llombart
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - J Dorca
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Montaño
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - M Oliveira
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - G Ribas
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - I Rapado
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - L Paré
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - A Prat
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
| | - E Ciruelos
- Institut Català d'Oncologia, Hospitalet del Llobregat, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebrón Institute of Oncology, Barcelona, Spain; Genomics, Vall d'Hebron University Hospital, Barcelona, Spain; Memorial Sloan-Kettering Cancer Center, New York; Vall d'Hebron University Hospital, Barcelona, Spain; Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIEMAT, Madrid, Spain; Nantomics, LLC, Rockville, WA; Hospital Clínic de Barcelona, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Hospital Universitario Arnau Vilanova de Lleida, Lleida, Spain; Institut Català d'Oncologia, Girona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Genomics, Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Genomics, University Hospital 12 de Octubre, Madrid, Spain; IDIBAPS, Barcelona, Spain; Hospital Universitario 12 de Octubre,
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17
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Gasa M, López‐Padrós C, Monasterio C, Salord N, Mayos M, Vilarrasa N, Fernandez‐Aranda F, Montserrat JM, Dorca J. Anthropometrical phenotypes are important when explaining obstructive sleep apnea in female bariatric cohorts. J Sleep Res 2019; 28:e12830. [DOI: 10.1111/jsr.12830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/27/2018] [Accepted: 12/27/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Mercè Gasa
- Sleep Unit Department of Respiratory Medicine Hospital Universitari de Bellvitge Hospitalet de Llobregat Spain
- Section of Respiratory Medicine Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Spain
- Department of Medicine Universtitat de Barcelona Campus Bellvitge Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Madrid Spain
| | - Carla López‐Padrós
- Sleep Unit Department of Respiratory Medicine Hospital Universitari de Bellvitge Hospitalet de Llobregat Spain
- Section of Respiratory Medicine Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Spain
- Department of Medicine Universtitat de Barcelona Campus Bellvitge Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Madrid Spain
| | - Carmen Monasterio
- Sleep Unit Department of Respiratory Medicine Hospital Universitari de Bellvitge Hospitalet de Llobregat Spain
- Section of Respiratory Medicine Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Spain
- Department of Medicine Universtitat de Barcelona Campus Bellvitge Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Madrid Spain
| | - Neus Salord
- Sleep Unit Department of Respiratory Medicine Hospital Universitari de Bellvitge Hospitalet de Llobregat Spain
- Section of Respiratory Medicine Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Spain
- Department of Medicine Universtitat de Barcelona Campus Bellvitge Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Madrid Spain
| | - Mercedes Mayos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Madrid Spain
- Sleep Unit Department of Respiratory Medicine Hospital de la Santa Creu i Sant Pau Barcelona Spain
- Department of Medicine Universtitat Autonoma de Barcelona Barcelona Spain
| | - Núria Vilarrasa
- Department of Endocrinology and Nutrition University Hospital of Bellvitge‐IDIBELL Barcelona Spain
- CIBERDEM‐CIBER de Diabetes y Enfermedades Metabólicas Asociadas Instituto de Salud Carlos III Madrid Spain
| | - Fernando Fernandez‐Aranda
- Department of Psychiatry University Hospital of Bellvitge‐IDIBELL Barcelona Spain
- Clinical Sciences Department University of Barcelona School of Medicine Barcelona Spain
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn) Instituto de Salud Carlos III Barcelona Spain
| | - Josep M. Montserrat
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Madrid Spain
- Sleep Unit Department of Respiratory Medicine Hospital Clinic de Barcelona Barcelona Spain
| | - Jordi Dorca
- Sleep Unit Department of Respiratory Medicine Hospital Universitari de Bellvitge Hospitalet de Llobregat Spain
- Section of Respiratory Medicine Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat Spain
- Department of Medicine Universtitat de Barcelona Campus Bellvitge Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Madrid Spain
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18
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Máiz L, Girón RM, Prats E, Clemente MG, Polverino E, Caño S, Cordovilla R, Dorca J, Peñalver C, Baranda F, Martínez-García MA. Addition of hyaluronic acid improves tolerance to 7% hypertonic saline solution in bronchiectasis patients. Ther Adv Respir Dis 2019; 12:1753466618787385. [PMID: 30014774 PMCID: PMC6050802 DOI: 10.1177/1753466618787385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The excessive retention of sputum in the airways, leading to pulmonary
infections, is a common consequence of bronchiectasis. Although inhalation
of 7% hypertonic saline (HS) has proven an effective method to help remove
the mucus, many patients are intolerant of this treatment. The addition of
0.1% hyaluronic acid to HS (HS+HA) could increase tolerance to HS in these
patients. The main objective of this study was to evaluate the tolerability
of HS+HA in bronchiectasis patients who are intolerant to HS. Methods: This prospective, observational, open-label study analysed the outcomes of
two groups of bronchiectasis patients previously scheduled to start HS
therapy. Patients were assessed for tolerance to HS by a questionnaire,
spirometry and clinical evaluation. Patients who were intolerant were
evaluated for tolerance to HS+HA approximately one week later. All patients
were evaluated for their tolerance to HS or HS+HA 4 weeks after the start of
their treatment. Patients were also assessed with quality-of-life and
adherence questionnaires, and all adverse events were registered. Results: A total of 137 bronchiectasis patients were enrolled in the study (age = 63.0
± 14.7 years; 63.5% women). Of these, 92 patients (67.1%) were tolerant and
45 patients (32.9%) were intolerant to HS. Of the 45 patients intolerant to
HS, 31 patients (68.9%) were tolerant and 14 patients (31.1%) intolerant to
HS+HA. Of these 31 tolerant patients, 26 (83.9%) could complete the 4-week
treatment with HS+HA. Conclusions: Two-thirds of bronchiectasis patients that presented intolerance to inhaled
HS alone are tolerant to inhaled HS+HA, suggesting that HA improves
tolerance to HS therapy.
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Affiliation(s)
- Luis Máiz
- Chronic Bronchial Infection, Cystic Fibrosis and Bronchiectasis Unit, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo, km. 9,100, Madrid 28034, Spain
| | | | - Eva Prats
- Fuenlabrada University Hospital, Madrid, Spain
| | | | - Eva Polverino
- Clínico y Provincial Hospital and Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Jordi Dorca
- Bellvitge University Hospital, Hospitalet, Barcelona, Spain
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Diez-Ferrer M, Morales A, Tebé C, Cubero N, López-Lisbona R, Padrones S, Aso S, Dorca J, Gil D, Rosell A. Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield. Respiration 2018; 97:252-258. [DOI: 10.1159/000493270] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/23/2018] [Indexed: 11/19/2022] Open
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20
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Pascual-González Y, López-Sánchez M, Dorca J, Santos S. Defining the role of neutrophil-to-lymphocyte ratio in COPD: a systematic literature review. Int J Chron Obstruct Pulmon Dis 2018; 13:3651-3662. [PMID: 30464448 PMCID: PMC6225854 DOI: 10.2147/copd.s178068] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
COPD is characterized by a pulmonary and systemic inflammatory process. Several authors have reported the elevation of multiple inflammatory markers in patients with COPD; however, their use in routine clinical practice has limitations. The neutrophil-to-lymphocyte ratio (NLR) is a useful and cost-effective inflammatory marker derived from routine complete blood count. We performed a systematic literature review using the PRISMA statement. Twenty-two articles were included, recruiting 7,601 COPD patients and 784 healthy controls. Compared with controls, COPD patients had significantly higher NLR values. We found a significant correlation between the NLR and clinical/functional parameters (FEV1, mMRC, and BODE index) in COPD patients. Elevation of the NLR is associated with the diagnosis of acute exacerbation of COPD (pooled data propose a cut-off value of 3.34 with a median sensitivity, specificity, and area under the curve of 80%, 86%, and 0.86, respectively). Additionally, increased NLR is also associated with the diagnosis of a bacterial infection in exacerbated patients, with a cut-off value of 7.30, although with a low sensitivity and specificity. The NLR is an independent predictor of in-hospital and late mortality after exacerbation. In conclusion, the NLR could be a useful marker in COPD patients; however, further studies are needed to better identify the clinical value of the NLR.
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Affiliation(s)
- Yuliana Pascual-González
- Department of Respiratory Medicine, Bellvitge University Hospital - IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain,
| | - Marta López-Sánchez
- Department of Respiratory Medicine, Bellvitge University Hospital - IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain,
| | - Jordi Dorca
- Department of Respiratory Medicine, Bellvitge University Hospital - IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain,
| | - Salud Santos
- Department of Respiratory Medicine, Bellvitge University Hospital - IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain, .,Biomedical Research Networking Center Consortium - Respiratory Diseases (CIBERES), Barcelona, Spain,
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21
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Pernas S, Villagrasa P, Vivancos A, Scaltriti M, Rodon J, Burgues O, Nuciforo P, Canes J, Dueñas M, Vidal M, Lluch A, Perelló A, Llombart A, Dorca J, Montaño Á, Oliveira M, Ribas G, Rapado I, Prat A, Ciruelos E. Primary results of the first nationwide molecular screening program in Spain for patients with advanced breast cancer (AGATA SOLTI-1301 study). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Diez-Ferrer M, Gil D, Tebe C, Sanchez C, Cubero N, López-Lisbona R, Dorca J, Rosell A. Positive Airway Pressure to Enhance Computed Tomography Imaging for Airway Segmentation for Virtual Bronchoscopic Navigation. Respiration 2018; 96:525-534. [DOI: 10.1159/000490915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/11/2018] [Indexed: 11/19/2022] Open
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23
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Rodríguez-Jiménez P, Mir-Viladrich I, Chicharro P, Solano-López G, López-Longo F, Taxonera C, Sánchez-Martínez P, Martínez-Lacasa X, García-Gasalla M, Dorca J, Arias-Guillén M, García-García J, Dauden E. Consenso multidisciplinar sobre prevención y tratamiento de la tuberculosis en pacientes candidatos a tratamiento biológico. Adaptación al paciente dermatológico. Actas Dermo-Sifiliográficas 2018; 109:584-601. [DOI: 10.1016/j.ad.2018.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 02/08/2023] Open
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24
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Rodríguez-Jiménez P, Mir-Viladrich I, Chicharro P, Solano-López G, López-Longo F, Taxonera C, Sánchez-Martínez P, Martínez-Lacasa X, García-Gasalla M, Dorca J, Arias-Guillén M, García-García J, Dauden E. Prevention and treatment of tuberculosis infection in candidates for biologic therapy: A multidisciplinary consensus statement adapted to the dermatology patient. Actas Dermo-Sifiliográficas (English Edition) 2018. [DOI: 10.1016/j.adengl.2018.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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25
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Aliagas E, Muñoz-Esquerre M, Cuevas E, Careta O, Huertas D, López-Sánchez M, Escobar I, Dorca J, Santos S. Is the purinergic pathway involved in the pathology of COPD? Decreased lung CD39 expression at initial stages of COPD. Respir Res 2018; 19:103. [PMID: 29807526 PMCID: PMC5972409 DOI: 10.1186/s12931-018-0793-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/27/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Extracellular adenosine triphosphate (ATP) is up-regulated in the airways of patients with chronic obstructive pulmonary disease (COPD), resulting in increased inflammation, bronchoconstriction, and cough. Although extracellular ATP levels are tightly controlled by nucleoside triphosphate diphosphohydrolase-1 (NTPDase1; also known as CD39) in the lungs, the role of CD39 in the pathology of COPD is unknown. We hypothesized that alterations in the expression and activity of CD39 could be part of the mechanisms for initiating and perpetuating the disease. METHODS We analyzed CD39 gene and protein expression as well as ATPase enzyme activity in lung tissue samples of patients with COPD (n = 17), non-obstructed smokers (NOS) (n = 16), and never smokers (NS) (n = 13). Morphometry studies were performed to analyze pulmonary vascular remodeling. RESULTS There was significantly decreased CD39 gene expression in the lungs of the COPD group (1.17 [0.85-1.81]) compared with the NOS group (1.88 [1.35-4.41]) and NS group (3.32 [1.23-5.39]) (p = 0.037). This attenuation correlated with higher systemic inflammation and intimal thickening of muscular pulmonary arteries in the COPD group. Lung CD39 protein levels were also lower in the COPD group (0.34 [0.22-0.92]) compared with the NOS group (0.67 [0.32-1.06]) and NS group (0.95 [0.4-1.1) (p = 0.133). Immunohistochemistry showed that CD39 was downregulated in lung parenchyma, epithelial bronchial cells, and the endothelial cells of pulmonary muscular arteries in the COPD group. ATPase activity in human pulmonary structures was reduced in the lungs of patients with COPD. CONCLUSION An attenuation of CD39 expression and activity is presented in lung tissue of stable COPD patients, which could lead to pulmonary ATP accumulation, favoring the development of pulmonary inflammation and emphysema. This may be a mechanism underlying the development of COPD.
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Affiliation(s)
- Elisabet Aliagas
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Respiratory Medicine, Unit of Chronic Obstructive Pulmonary Disease, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mariana Muñoz-Esquerre
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Respiratory Medicine, Unit of Chronic Obstructive Pulmonary Disease, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ester Cuevas
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Respiratory Medicine, Unit of Chronic Obstructive Pulmonary Disease, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Careta
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Respiratory Medicine, Unit of Chronic Obstructive Pulmonary Disease, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Huertas
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Respiratory Medicine, Unit of Chronic Obstructive Pulmonary Disease, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta López-Sánchez
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Respiratory Medicine, Unit of Chronic Obstructive Pulmonary Disease, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignacio Escobar
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Thoracic Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Dorca
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Respiratory Medicine, Unit of Chronic Obstructive Pulmonary Disease, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Salud Santos
- Pneumology Research Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Respiratory Medicine, Unit of Chronic Obstructive Pulmonary Disease, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. .,Research Network in Respiratory Diseases (CIBERES), Madrid, Spain. .,Department of Respiratory Medicine, Bellvitge University Hospital - IDIBELL, University of Barcelona, c/ Feixa Llarga s/n. CP 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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26
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Molina-Molina M, Machahua-Huamani C, Vicens-Zygmunt V, Llatjós R, Escobar I, Sala-Llinas E, Luburich-Hernaiz P, Dorca J, Montes-Worboys A. Anti-fibrotic effects of pirfenidone and rapamycin in primary IPF fibroblasts and human alveolar epithelial cells. BMC Pulm Med 2018; 18:63. [PMID: 29703175 PMCID: PMC5922028 DOI: 10.1186/s12890-018-0626-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/16/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Pirfenidone, a pleiotropic anti-fibrotic treatment, has been shown to slow down disease progression of idiopathic pulmonary fibrosis (IPF), a fatal and devastating lung disease. Rapamycin, an inhibitor of fibroblast proliferation could be a potential anti-fibrotic drug to improve the effects of pirfenidone. METHODS Primary lung fibroblasts from IPF patients and human alveolar epithelial cells (A549) were treated in vitro with pirfenidone and rapamycin in the presence or absence of transforming growth factor β1 (TGF-β). Extracellular matrix protein and gene expression of markers involved in lung fibrosis (tenascin-c, fibronectin, collagen I [COL1A1], collagen III [COL3A1] and α-smooth muscle actin [α-SMA]) were analyzed. A cell migration assay in pirfenidone, rapamycin and TGF-β-containing media was performed. RESULTS Gene and protein expression of tenascin-c and fibronectin of fibrotic fibroblasts were reduced by pirfenidone or rapamycin treatment. Pirfenidone-rapamycin treatment did not revert the epithelial to mesenchymal transition pathway activated by TGF-β. However, the drug combination significantly abrogated fibroblast to myofibroblast transition. The inhibitory effect of pirfenidone on fibroblast migration in the scratch-wound assay was potentiated by rapamycin combination. CONCLUSIONS These findings indicate that the combination of pirfenidone and rapamycin widen the inhibition range of fibrogenic markers and prevents fibroblast migration. These results would open a new line of research for an anti-fibrotic combination therapeutic approach.
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Affiliation(s)
- M. Molina-Molina
- Department of Pneumology, Bellvitge University Hospital, Barcelona, Spain
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Research Network in Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - C. Machahua-Huamani
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
| | - V. Vicens-Zygmunt
- Department of Pneumology, Bellvitge University Hospital, Barcelona, Spain
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
| | - R. Llatjós
- Department of Pathology, Bellvitge University Hospital, Barcelona, Spain
| | - I. Escobar
- Department of Thoracic Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - E. Sala-Llinas
- Research Network in Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
- Department of Penumology, Son Espases University Hospital, Palma de Mallorca, Spain
| | - P. Luburich-Hernaiz
- Servei de Diagnostic per la Imatge El Prat (SDPI El Prat) Department of Radiology, Bellvitge University Hospital, Barcelona, Spain
| | - J. Dorca
- Department of Pneumology, Bellvitge University Hospital, Barcelona, Spain
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Research Network in Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - A. Montes-Worboys
- Department of Pneumology, Bellvitge University Hospital, Barcelona, Spain
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Research Network in Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
- Laboratori de Pneumologia Experimental (Lab. 4126). IDIBELL, Pavelló de Govern. Campus de Bellvitge, Universitat de Barcelona, Hospital de Bellvitge, Carrer de la Feixa Llarga, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
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27
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Muñoz-Esquerre M, Ferreiro JL, Huertas D, Marcano AL, López-Sánchez M, Roura G, Gómez-Hospital JA, Dorca J, Cequier A, Santos S. Impact of acute exacerbations on platelet reactivity in chronic obstructive pulmonary disease patients. Int J Chron Obstruct Pulmon Dis 2017; 13:141-148. [PMID: 29343953 PMCID: PMC5749392 DOI: 10.2147/copd.s152660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A higher risk of atherothrombotic cardiovascular events, which are platelet-driven processes, has been described during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, the relevance of platelet reactivity during AECOPD and whether this is affected by antiplatelet agents are not fully elucidated to date. This study aimed to evaluate whether platelet reactivity is augmented during an exacerbation in COPD patients with and without antiplatelet therapy and its association with systemic inflammatory parameters. Materials and methods Prospective, observational, ex vivo investigation was conducted in consecutive patients suffering an exacerbation of COPD. Platelet reactivity was assessed during AECOPD and at stable state. Platelet function assays included: 1) vasodilator-stimulated phosphoprotein assay expressed as P2Y12 reactivity index (PRI), 2) multiple electrode aggregometry and 3) optical aggregometry. Systemic inflammatory parameters such as leukocyte count, interleukin-6 and fibrinogen were also assessed. Results Higher platelet reactivity was observed during AECOPD compared to stability measured by vasodilator-stimulated phosphoprotein (PRI: 75.2%±1.9% vs 68.8%±2.4%, p=0.001). This augmented platelet aggregability was also observed in the subset of patients on antiplatelet therapy (PRI: 72.8%±3.1% vs 61.7%±7.5%, p=0.071). Consistent findings were observed with all other platelet function tests. Patients with greater enhancement of inflammatory markers during AECOPD were more likely to present a higher increase in platelet reactivity. Conclusion Platelet reactivity is increased during AECOPD, which may contribute to the augmented cardiovascular risk of these patients. Additionally, the increase in platelet reactivity might be associated with an increment in inflammatory markers during exacerbations.
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Affiliation(s)
- Mariana Muñoz-Esquerre
- Department of Pulmonary Medicine, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - José Luis Ferreiro
- Heart Diseases Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Daniel Huertas
- Department of Pulmonary Medicine, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat.,Biomedical Research Networking Centre Consortium Respiratory Diseases, CIBERES, Barcelona, Spain
| | - Ana Lucrecia Marcano
- Heart Diseases Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Marta López-Sánchez
- Department of Pulmonary Medicine, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Gerard Roura
- Heart Diseases Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Joan Antoni Gómez-Hospital
- Heart Diseases Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Jordi Dorca
- Department of Pulmonary Medicine, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Angel Cequier
- Heart Diseases Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Salud Santos
- Department of Pulmonary Medicine, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat.,Biomedical Research Networking Centre Consortium Respiratory Diseases, CIBERES, Barcelona, Spain
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Ortiz Comino R, Gil D, Minchole E, Diez-Ferrer M, Cubero N, Lopez-Lisbona R, Sanchez C, Ramos O, Esteban A, Dorca J, Rosell A. MA 20.08 Classification of Confocal Endomicroscopy Patterns for Diagnosis of Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Comino RO, Morales A, Minchole E, Diez-Ferrer M, Lopez-Lisbona R, Cubero N, Dorca J, Rosell A. P1.12-009 Experience with Fully Covered Metallic Stents in Patients with Malignant Airway Obstruction. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Diez-Ferrer M, Torrejon B, Baixeras N, Minchole E, Ortiz R, Cubero N, Lopez-Lisbona R, Dorca J, Rosell A. MA 20.06 Discerning Lung Cancer Cell Patterns with Confocal Endomicroscopy. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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Millares L, Martí S, Ardanuy C, Liñares J, Santos S, Dorca J, García-Nuñez M, Quero S, Monsó E. Specific IgA against Pseudomonas aeruginosa in severe COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2807-2811. [PMID: 29033561 PMCID: PMC5628678 DOI: 10.2147/copd.s141701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The bronchial mucosa is protected by a specialized immune system focused on the prevention of colonization and infection by potentially pathogenic microorganisms (PPMs). Immunoglobulin A (IgA) is the principal antibody involved in this mechanism. A defective immune barrier may facilitate the recurrent presence of PPMs in COPD. Purpose The aim of this study was to determine IgA-mediated bronchial specific immune responses against Pseudomonas aeruginosa in stable patients with severe disease. Methods COPD patients with good-quality sputum samples obtained during stability were included and classified according to the presence or absence of chronic bronchial colonization by P. aeruginosa. Levels of specific IgA for P. aeruginosa in sputum were determined by ELISA and expressed as ratios, using the pooled level of 10 healthy subjects as reference (optical density450 patient/control). Results Thirty-six stable COPD patients were included, 15 of whom had chronic colonization by P. aeruginosa. Levels of specific IgA against P. aeruginosa in stable non-colonized patients were lower than those in healthy subjects (IgA ratio: median =0.15 [interquartile range {IQR} 0.05–0.36]). Colonized patients had higher levels, (1.56 [IQR 0.59–2.79]) (p<0.001, Mann–Whitney U test), with figures equivalent but not exceeding the reference value. Conclusion IgA-based immune response against P. aeruginosa was low in severe COPD patients. Levels of specific IgA against this microorganism were higher in colonized patients, but did not attain clear-cut levels above the reference. An impaired local response against P. aeruginosa may favor chronic colonization and recurrent infections in severe COPD.
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Affiliation(s)
- Laura Millares
- Department of Respiratory Medicine, Fundació Parc Taulí, Sabadell, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain.,Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
| | - Sara Martí
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain.,Department of Microbiology, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Carmen Ardanuy
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain.,Department of Microbiology, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Josefina Liñares
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain.,Department of Microbiology, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Salud Santos
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain.,Department of Respiratory Medicine, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Jordi Dorca
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Marian García-Nuñez
- Department of Respiratory Medicine, Fundació Parc Taulí, Sabadell, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain.,Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain.,Infectious Diseases Unit, Fundació Insitut d'Investigació GermansTrias i Pujol, Badalona, Spain
| | - Sara Quero
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain.,Infectious Diseases Unit, Fundació Insitut d'Investigació GermansTrias i Pujol, Badalona, Spain
| | - Eduard Monsó
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain.,Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Pernas Simon S, Villagrasa Gonzalez P, Vivancos A, Prat A, Scaltriti M, Burgues O, Rodon J, Canes J, Lluch A, Llombart A, Dorca J, Perelló Martorell A, Oliveira M, Montaño A, Garcia-Estevez L, Nuciforo P, Ribas G, Rapado I, de la Pena L, Ciruelos E. AGATA molecular screening program: Implementing precision medicine in patients with advanced breast cancer in Spain. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Muñoz L, Gonzalez L, Soldevila L, Dorca J, Alcaide F, Santin M. QuantiFERON®-TB Gold In-Tube for contact screening in BCG-vaccinated adults: A longitudinal cohort study. PLoS One 2017; 12:e0183258. [PMID: 28854216 PMCID: PMC5576668 DOI: 10.1371/journal.pone.0183258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 08/01/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the utility of QuantiFERON®-TB Gold In-tube (QFT-GIT) for targeting preventive therapy in BCG-vaccinated contacts of tuberculosis (TB), based on its high specificity and negative predictive value for development of TB. METHODS We compared two screening strategies for TB contact tracing in two consecutive periods: the tuberculin skin test (TST) period, when all contacts were screened with the TST alone; and the QFT-GIT period, when BCG-vaccinated contacts underwent TST and QFT-GIT. Diagnosis of TB infection among BCG-vaccinated contacts relied on TST ≥5 mm in the TST period, while in the QFT-GIT period either a positive QFT-GIT or a TST ≥15 mm was required. MEASUREMENTS AND MAIN RESULTS Six hundred and sixty-one contacts were compared. In the QFT-GIT period there was a reduction in diagnoses of TB infection (77.4% vs. 51.2%; p <0.01) and preventive therapy prescribed (62.1% vs. 48.2%; p = 0.02) among the 290 BCG-vaccinated contacts. After a median follow-up of 5 years, cumulative incidences of TB were 0.62 and 0.29 in the TST and QFT-GIT periods respectively (p = 0.59). CONCLUSIONS In BCG-vaccinated TB contacts, the addition of QFT-GIT safely reduced TB diagnosis and treatment rates without increasing the risk of subsequent active TB.
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Affiliation(s)
- Laura Muñoz
- Infectious Diseases Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Lucia Gonzalez
- Infectious Diseases Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Laura Soldevila
- Infectious Diseases Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Jordi Dorca
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
- Respiratory Medicine, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Fernando Alcaide
- Microbiology Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
| | - Miguel Santin
- Infectious Diseases Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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Faner R, Sibila O, Agustí A, Bernasconi E, Chalmers JD, Huffnagle GB, Manichanh C, Molyneaux PL, Paredes R, Pérez Brocal V, Ponomarenko J, Sethi S, Dorca J, Monsó E. The microbiome in respiratory medicine: current challenges and future perspectives. Eur Respir J 2017; 49:49/4/1602086. [PMID: 28404649 DOI: 10.1183/13993003.02086-2016] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/08/2017] [Indexed: 12/15/2022]
Abstract
The healthy lung has previously been considered to be a sterile organ because standard microbiological culture techniques consistently yield negative results. However, culture-independent techniques report that large numbers of microorganisms coexist in the lung. There are many unknown aspects in the field, but available reports show that the lower respiratory tract microbiota: 1) is similar in healthy subjects to the oropharyngeal microbiota and dominated by members of the Firmicutes, Bacteroidetes and Proteobacteria phyla; 2) shows changes in smokers and well-defined differences in chronic respiratory diseases, although the temporal and spatial kinetics of these changes are only partially known; and 3) shows relatively abundant non-cultivable bacteria in chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis and bronchiectasis, with specific patterns for each disease. In all of these diseases, a loss of diversity, paralleled by an over-representation of Proteobacteria (dysbiosis), has been related to disease severity and exacerbations. However, it is unknown whether dysbiosis is a cause or a consequence of the damage to bronchoalveolar surfaces.Finally, little is known about bacterial functionality and the interactions between viruses, fungi and bacteria. It is expected that future research in bacterial gene expressions, metagenomics longitudinal analysis and host-microbiome animal models will help to move towards targeted microbiome interventions in respiratory diseases.
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Affiliation(s)
- Rosa Faner
- Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias - CIBERES, Madrid, Spain.,These co-primary authors contributed equally to this work
| | - Oriol Sibila
- Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autónoma Barcelona, Barcelona, Spain.,These co-primary authors contributed equally to this work
| | - Alvar Agustí
- Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias - CIBERES, Madrid, Spain
| | - Eric Bernasconi
- Service de Pneumologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | - Chaysavanh Manichanh
- Dept of Gastroenterology, Vall d'Hebron Research Institute, Barcelona, Spain.,CIBER de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - Roger Paredes
- Hospital Universitari Germans Trias i Pujol, Universitat Autónoma Barcelona, Barcelona, Spain
| | - Vicente Pérez Brocal
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Joint Research Unit on Genomics and Health, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health) and Cavanilles Institute for Biodiversity and Evolutionary Biology, University of Valencia, Valencia, Spain
| | - Julia Ponomarenko
- Centro de Regulación Genómica, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Jordi Dorca
- Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Hospitalet del Llobregat, Barcelona, Spain.,These co-senior authors contributed equally to this work
| | - Eduard Monsó
- CIBER de Enfermedades Respiratorias - CIBERES, Madrid, Spain .,Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Barcelona, Spain.,These co-senior authors contributed equally to this work
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Alcaide F, Peña MJ, Pérez-Risco D, Camprubi D, Gonzalez-Luquero L, Grijota-Camino MD, Dorca J, Santin M. Increasing isolation of rapidly growing mycobacteria in a low-incidence setting of environmental mycobacteria, 1994-2015. Eur J Clin Microbiol Infect Dis 2017; 36:1425-1432. [PMID: 28321580 DOI: 10.1007/s10096-017-2949-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/23/2017] [Indexed: 11/25/2022]
Abstract
To determine trends in incidence and clinical relevance of rapidly growing mycobacteria (RGM) in a low-prevalence region of non-tuberculous mycobacteria. We retrospectively identified all patients with RGM-positive cultures between January 1994 and December 2015. Trends in incidence, clinical significance, and outcomes were assessed. One hundred and forty patients had RGM-positive cultures (116 respiratory and 24 extra-respiratory sources). The incidence of RGM isolates increased steadily from 2003 (0.34 per 100,000) to 2015 (1.73 per 100,000), with an average annual increase of 8.3%. Thirty-two patients (22.9%) had clinical disease, which trended to cluster in the second half of the study period. A positive acid-fast bacilli smear (odds ratio [OR] 97.7, 95 % CI 13.8-689.4), the presence of extra-respiratory isolates (OR 19.4, 95 % CI 5.2-72.7), and female gender (OR 5.9, 95 % CI 1.9-19.1) were independently associated with clinical disease. Cure rates were 73.3 and 87.5% for pulmonary and extra-pulmonary disease respectively. Although the burden of disease remains low, the presence of RGM isolates is increasing in our geographical setting. Whether this rise will be sustained over time and will coincide with an increase in clinical disease, or whether it is merely a cycle in the poorly understood epidemiological behaviour of environmental mycobacteria, will be seen in the near future.
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Affiliation(s)
- F Alcaide
- Service of Microbiology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M J Peña
- Service of Microbiology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Pérez-Risco
- Service of Microbiology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Camprubi
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Gonzalez-Luquero
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M D Grijota-Camino
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Dorca
- Service of Pneumology, Bellvitge University Hospital-IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Santin
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
- University of Barcelona, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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Huertas D, Montón C, Marín A, Solanes I, López-Sánchez M, Pomares X, Muñoz-Esquerre M, Dorca J, Santos S. Effectiveness of a Respiratory Day Hospital Program to Reduce Admissions for Exacerbation in Patients with Severe COPD: A Prospective, Multicenter Study. COPD 2017; 14:304-310. [DOI: 10.1080/15412555.2017.1279598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel Huertas
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Concepción Montón
- Respiratory Department, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
- REDISSEC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Madrid, Spain
| | - Alicia Marín
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ingrid Solanes
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Marta López-Sánchez
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Pomares
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
| | - Mariana Muñoz-Esquerre
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Dorca
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Salud Santos
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Diez-Ferrer M, Morales A, Cubero N, Lopez-Lisbona R, Koufos N, Dorca J, Rosell A. MA05.01 Virtual Bronchoscopic Navigation-Guided Ultrathin Bronchoscopy for Diagnosing Peripheral Pulmonary Lesions. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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38
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Aso S, Navarro-Martin A, Padrones S, Cardenal F, Cubero N, Lopez-Lisbona R, Arnaiz MD, Palmero R, Montes A, Nadal E, Molina M, Dorca J. P2.05-054 Radiation Pneumonitis; Early Diagnosis and Protein Expression Profile in NSCLC Patients. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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39
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Diez-Ferrer M, Gil D, Carreño E, Padrones S, Aso S, Vicens V, Cubero N, Lopez-Lisbona R, Sanchez C, Borras A, Dorca J, Rosell A. P1.04-002 Positive Airway Pressure-Enhanced CT to Improve Virtual Bronchoscopic Navigation. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Ariza-Prota M, Morales A, Grajeda J, López-Lisbona R, Cubero N, Dorca J, Rosell A. Successful Healing of Tracheal Radionecrosis. Chest 2016; 150:e147-e150. [DOI: 10.1016/j.chest.2016.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/29/2016] [Accepted: 03/21/2016] [Indexed: 10/20/2022] Open
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41
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Robles-Perez A, Luburich P, Rodriguez-Sanchon B, Dorca J, Nolla JM, Molina-Molina M, Narvaez-Garcia J. Preclinical lung disease in early rheumatoid arthritis. Chron Respir Dis 2016; 13:75-81. [PMID: 26846584 DOI: 10.1177/1479972315620746] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Early detection and treatment of lung disease in patients with rheumatoid arthritis (RA) may ameliorate disease progression. The objectives of this study were to investigate the frequency of asymptomatic lung abnormalities in early RA patients and the potential association of positive RA blood reactive biomolecules with lung involvement. A prospective observational study was performed in a cohort of patients with early RA (joint symptoms < 2 years) without respiratory symptoms, who were included in a screening program for lung disease with a baseline chest radiograph (CR) and complete pulmonary function tests (PFTs). In those patients with lung abnormalities on the CR or PFTs, a high-resolution chest computed tomography scan (HRCT) was performed. We included 40 patients (30 women). Altered PFTs were detected in 18 (45%) of these patients. These cases had a diffusion lung transfer capacity of carbon monoxide (DLCO) of <80% of predicted, without a significant reduction in the forced vital capacity. The HRCT detected abnormalities in 11 of the 18 patients. Diffuse bronchiectasis was the main finding. An inverse correlation between the anti-citrullinated peptide antibody (ACPA) levels and DLCO was found. Asymptomatic lung disease is present in up to 45% of early RA patients and can be determined by PFTs and ACPA levels.
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Affiliation(s)
- Alejandro Robles-Perez
- Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Patricio Luburich
- Servei de Diagnòstic per la Imatge El Prat (SDPI El Prat), Department of Radiology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Benigno Rodriguez-Sanchon
- Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Dorca
- Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain CIBER de Enfermedades Respiratorias (CIBERES)
| | - Joan Miquel Nolla
- Department of Rheumatology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Maria Molina-Molina
- Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain CIBER de Enfermedades Respiratorias (CIBERES)
| | - Javier Narvaez-Garcia
- Department of Rheumatology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
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42
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Machahua C, Montes-Worboys A, Llatjos R, Escobar I, Dorca J, Molina-Molina M, Vicens-Zygmunt V. Increased AGE-RAGE ratio in idiopathic pulmonary fibrosis. Respir Res 2016; 17:144. [PMID: 27816054 PMCID: PMC5097848 DOI: 10.1186/s12931-016-0460-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The abnormal epithelial-mesenchymal restorative capacity in idiopathic pulmonary fibrosis (IPF) has been recently associated with an accelerated aging process as a key point for the altered wound healing. The advanced glycation end-products (AGEs) are the consequence of non-enzymatic reactions between lipid and protein with several oxidants in the aging process. The receptor for AGEs (RAGEs) has been implicated in the lung fibrotic process and the alveolar homeostasis. However, this AGE-RAGE aging pathway has been under-explored in IPF. METHODS Lung samples from 16 IPF and 9 control patients were obtained through surgical lung biopsy. Differences in AGEs and RAGE expression between both groups were evaluated by RT-PCR, Western blot and immunohistochemistry. The effect of AGEs on cell viability of primary lung fibrotic fibroblasts and alveolar epithelial cells was assessed. Cell transformation of fibrotic fibroblasts cultured into glycated matrices was evaluated in different experimental conditions. RESULTS Our study demonstrates an increase of AGEs together with a decrease of RAGEs in IPF lungs, compared with control samples. Two specific AGEs involved in aging, pentosidine and Nε-Carboxymethyl lysine, were significantly increased in IPF samples. The immunohistochemistry identified higher staining of AGEs related to extracellular matrix (ECM) proteins and the apical surface of the alveolar epithelial cells (AECs) surrounding fibroblast foci in fibrotic lungs. On the other hand, RAGE location was present at the cell membrane of AECs in control lungs, while it was almost missing in pulmonary fibrotic tissue. In addition, in vitro cultures showed that the effect of AGEs on cell viability was different for AECs and fibrotic fibroblasts. AGEs decreased cell viability in AECs, even at low concentration, while fibroblast viability was less affected. Furthermore, fibroblast to myofibroblast transformation could be enhanced by ECM glycation. CONCLUSIONS All of these findings suggest a possible role of the increased ratio AGEs-RAGEs in IPF, which could be a relevant accelerating aging tissue reaction in the abnormal wound healing of the lung fibrotic process.
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Affiliation(s)
- Carlos Machahua
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Department of Pneumology, Unit of Interstitial Lung Diseases, University Hospital of Bellvitge, Barcelona, Spain
| | - Ana Montes-Worboys
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Department of Pneumology, Unit of Interstitial Lung Diseases, University Hospital of Bellvitge, Barcelona, Spain
- Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Roger Llatjos
- Department of Pathology, University Hospital of Bellvitge, Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Jordi Dorca
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Department of Pneumology, Unit of Interstitial Lung Diseases, University Hospital of Bellvitge, Barcelona, Spain
- Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Maria Molina-Molina
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Department of Pneumology, Unit of Interstitial Lung Diseases, University Hospital of Bellvitge, Barcelona, Spain
- Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Vanesa Vicens-Zygmunt
- Pneumology Research Group, IDIBELL, University of Barcelona, Barcelona, Spain
- Department of Pneumology, Unit of Interstitial Lung Diseases, University Hospital of Bellvitge, Barcelona, Spain
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Viasus D, Simonetti AF, Garcia-Vidal C, Niubó J, Dorca J, Carratalà J. Impact of antibiotic de-escalation on clinical outcomes in community-acquired pneumococcal pneumonia. J Antimicrob Chemother 2016; 72:547-553. [PMID: 27798219 DOI: 10.1093/jac/dkw441] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/22/2016] [Accepted: 09/19/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although antibiotic de-escalation is regarded as a measure that reduces selection pressure, adverse drug effects and costs, evidence supporting this practice in community-acquired pneumococcal pneumonia (CAPP) is lacking. METHODS We carried out a retrospective analysis of prospectively collected data of a cohort of hospitalized adults with CAPP. Pneumococcal aetiology was established in patients with one or more positive cultures for Streptococcus pneumoniae obtained from blood, sterile fluids or sputum, and/or a positive urinary antigen test. De-escalation therapy was considered when the initial antibiotic therapy was narrowed to penicillin, amoxicillin or amoxicillin/clavulanate within the first 72 h after admission. The primary outcomes were 30 day mortality and length of hospital stay (LOS). Adjustment for confounders was performed with multivariate and propensity score analyses. RESULTS Of 1410 episodes of CAPP, antibiotic de-escalation within the first 72 h after admission was performed in 166 cases. After adjustment, antibiotic de-escalation was not associated with a higher risk of mortality (OR = 0.83, 95% CI = 0.24-2.81), but it was found to be a protective factor for prolonged LOS (above the median) (OR = 0.46, 95% CI = 0.30-0.70). Similar results were found in patients classified into high-risk pneumonia severity index classes (IV-V), those with clinical instability and those with bacteraemia. No significant differences were documented in adverse drug reactions or readmission (<30 days). CONCLUSIONS Antibiotic de-escalation seems to be safe and effective in reducing the duration of LOS, and did not adversely affect outcomes of patients with CAPP, even those with bacteraemia and severe disease, and those who were clinically unstable.
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Affiliation(s)
- Diego Viasus
- Health Sciences Division, Faculty of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Antonella F Simonetti
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Sevilla, Spain
| | - Jordi Niubó
- Microbiology Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Jordi Dorca
- Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain.,Respiratory Medicine Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain
| | - Jordi Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Sevilla, Spain.,Clinical Science Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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González-Fernández C, Dorca J, Molina-Molina M. [Lymphoproliferative pulmonary infiltration: A diagnosis to keep in mind in pulmonary infiltrates in patient with chronic lymphocytic leukemia]. Med Clin (Barc) 2016; 147:224-225. [PMID: 27181216 DOI: 10.1016/j.medcli.2016.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/26/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Jordi Dorca
- Servicio de Neumología, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - María Molina-Molina
- Servicio de Neumología, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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Vogelmeier C, Paggiaro PL, Dorca J, Sliwinski P, Mallet M, Kirsten AM, Beier J, Seoane B, Segarra RM, Leselbaum A. Efficacy and safety of aclidinium/formoterol versus salmeterol/fluticasone: a phase 3 COPD study. Eur Respir J 2016; 48:1030-1039. [DOI: 10.1183/13993003.00216-2016] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/03/2016] [Indexed: 12/22/2022]
Abstract
The efficacy and safety of twice-daily aclidinium bromide/formoterol fumarate was compared with that of salmeterol/fluticasone propionate in patients with stable, moderate-to-severe chronic obstructive pulmonary disease (COPD).AFFIRM COPD (Aclidinium and Formoterol Findings in Respiratory Medicine COPD) was a 24-week, double-blind, double-dummy, active-controlled study. Patients were randomised (1:1) to aclidinium/formoterol 400/12 µg twice-daily via Genuair/Pressair or salmeterol/fluticasone 50/500 µg twice-daily via Accuhaler. The primary end-point was peak forced expiratory volume in 1 s (FEV1) at week 24. Other end-points included Transition Dyspnoea Index (TDI) focal score at week 24, TDI and St George's Respiratory Questionnaire (SGRQ) responders, COPD Assessment Test and SGRQ scores, assessment of COPD symptoms and exacerbations, use of reliever medication, and device preference. Adverse events were monitored throughout.In total, 933 patients were eligible (mean age 63.4 years, 65.1% male). Aclidinium/formoterol was superior to salmeterol/fluticasone in peak FEV1 and noninferior in TDI. Health status and reduction in exacerbation risk were similar in both groups. While both treatments were well tolerated, pneumonia occurred less frequently with aclidinium/formoterol than salmeterol/fluticasone.In stable COPD, aclidinium/formoterol significantly improved bronchodilation versus salmeterol/fluticasone, with equivalent benefits in symptom control and reduction in exacerbation risk. Both treatments were well tolerated and treatment-related adverse events were less common with aclidinium/formoterol.
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Diez-Ferrer M, Luburich P, Llatjós R, Xaubet A, Dorca J, Molina-Molina M. Dendriform Pulmonary Ossification in a Subclinical Case of Familial Pulmonary Fibrosis. Arch Bronconeumol 2016; 52:e9-e10. [PMID: 27396926 DOI: 10.1016/j.arbres.2016.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Marta Diez-Ferrer
- Unidad de Enfermedades Pulmonares Intersticiales, Servicio de Neumología, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Patricio Luburich
- Servicio de Radiología, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Roger Llatjós
- Servicio de Anatomía Patológica, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Antoni Xaubet
- Servicio de Neumología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Jordi Dorca
- Unidad de Enfermedades Pulmonares Intersticiales, Servicio de Neumología, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - María Molina-Molina
- Unidad de Enfermedades Pulmonares Intersticiales, Servicio de Neumología, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España.
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Muñoz-Esquerre M, López-Sánchez M, Escobar I, Huertas D, Penín R, Molina-Molina M, Manresa F, Dorca J, Santos S. Systemic and Pulmonary Vascular Remodelling in Chronic Obstructive Pulmonary Disease. PLoS One 2016; 11:e0152987. [PMID: 27046203 PMCID: PMC4821623 DOI: 10.1371/journal.pone.0152987] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/22/2016] [Indexed: 11/23/2022] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is associated with subclinical systemic atherosclerosis and pulmonary vascular remodelling characterized by intimal hyperplasia and luminal narrowing. We aimed to determine differences in the intimal thickening of systemic and pulmonary arteries in COPD subjects and smokers. Secondary aims include comparisons with a non-smokers group; determining the clinical variables associated with systemic and pulmonary intimal thickening, and the correlations between systemic and pulmonary remodelling changes. Methods All consecutive subjects undergoing lung resection were included and divided into 3 groups: 1) COPD, 2) smokers, and 3) non-smokers. Sections of the 5th intercostal artery and muscular pulmonary arteries were measured by histo-morphometry. Four parameters of intimal thickening were evaluated: 1) percentage of intimal area (%IA), 2) percentage of luminal narrowing, 3) intimal thickness index, and 4) intima-to-media ratio. Results In the adjusted analysis, the systemic arteries of COPD subjects showed greater intimal thickening (%IA) than those of smokers (15.6±1.5% vs. 14.2±1.6%, p = 0.038). In the pulmonary arteries, significant differences were observed for %IA between the 2 groups (37.3±2.2% vs. 29.3±2.3%, p = 0.016). Among clinical factors, metabolic syndrome, gender and COPD status were associated with the systemic intimal thickening, while only COPD status was associated with pulmonary intimal thickening. A correlation between the %IA of the systemic and pulmonary arteries was observed (Spearman’s rho = 0.46, p = 0.008). Conclusions Greater intimal thickening in systemic and pulmonary arteries is observed in COPD patients than in smokers. There is a correlation between systemic and pulmonary vascular remodelling in the overall population.
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Affiliation(s)
- Mariana Muñoz-Esquerre
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marta López-Sánchez
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Huertas
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Penín
- Department of Pathology, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - María Molina-Molina
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Networking Center Consortium -Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Frederic Manresa
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Dorca
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Salud Santos
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Networking Center Consortium -Respiratory Diseases (CIBERES), Barcelona, Spain
- * E-mail:
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Simonetti AF, Garcia-Vidal C, Viasus D, García-Somoza D, Dorca J, Gudiol F, Carratalà J. Declining mortality among hospitalized patients with community-acquired pneumonia. Clin Microbiol Infect 2016; 22:567.e1-7. [PMID: 27021421 DOI: 10.1016/j.cmi.2016.03.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/25/2016] [Accepted: 03/13/2016] [Indexed: 11/15/2022]
Abstract
Little information is available on the changes over time in community-acquired pneumonia (CAP) management and their impact on 30-day mortality in hospitalized patients. We performed a prospective, observational study of non-severely immunosuppressed hospitalized adults with CAP from 1995 to 2014. A total of 4558 patients were included. Thirty-day mortality decreased from 9.6% in the first study period (1995-99) to 4.1% in the last period (2010-14); with a progressive downward trend (-0.2% death/year; p for trend = 0.003). Over time, patients were older (p 0.02), had more co-morbidities (p 0.037), more frequently presented severe illness according to the Pneumonia Severity Index (p <0.001) and septic shock (p <0.001), and more often required intensive care unit admission (p <0.001). Combination antibiotic therapy (p <0.001) and fluoroquinolone use (p <0.001) increased. Factors independently associated with 30-day mortality were increasing age (OR 1.04; 95% CI 1.03-1.05), co-morbidities (OR 1.48; 95% CI 1.04-2.11), shock at admission (OR 4.95; 95% CI 3.49-7.00), respiratory failure (OR 1.89; 95% CI 1.42-2.52), bacteraemia (OR 2.16; 95% CI 1.58-2.96), Gram-negative bacilli aetiology (OR 4.79; 95% CI 2.52-9.10) and fluoroquinolone use (OR 0.45; 95% CI 0.29-0.71). When we adjusted for a propensity score to receive fluoroquinolones, the protective effect of fluoroquinolone use was not confirmed. In conclusion, 30-day mortality decreased significantly over time in hospitalized patients with CAP in spite of an upward trend in patient age and other factors associated with poor outcomes. Several changes in the management of CAP and a general improvement in global care over time may have caused the observed outcomes.
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Affiliation(s)
- A F Simonetti
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - C Garcia-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain.
| | - D Viasus
- Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Barranquilla, Colombia
| | - D García-Somoza
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Dorca
- Department of Respiratory Diseases, Hospital Universitari de Bellvitge Barcelona, Spain
| | - F Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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Rosell A, Rodríguez N, Monsó E, Taron M, Millares L, Ramírez JL, López-Lisbona R, Cubero N, Andreo F, Sanz J, Llatjós M, Llatjós R, Fernández-Figueras MT, Mate JL, Català I, Setó L, Roset M, Díez-Ferrer M, Dorca J. Aberrant gene methylation and bronchial dysplasia in high risk lung cancer patients. Lung Cancer 2016; 94:102-7. [PMID: 26973214 DOI: 10.1016/j.lungcan.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/29/2015] [Accepted: 02/02/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The risk for lung cancer is incremented in high degree dysplasia (HGD) and in subjects with hypermethylation of multiple genes. We sought to establish the association between them, as well as to analyze the DNA aberrant methylation in sputum and in bronchial washings (BW). METHODS Cross sectional study of high risk patients for lung cancer in whom induced sputum and autofluorescence bronchoscopy were performed. The molecular analysis was determined on DAPK1, RASSF1A and p16 genes using Methylation-specific PCR. RESULTS A total of 128 patients were enrolled in the study. Dysplasia lesions were found in 79 patients (61.7%) and high grade dysplasia in 20 (15.6%). Ninety eight patients out of 128 underwent molecular analysis. Methylation was observed in bronchial secretions (sputum or BW) in 60 patients (61.2%), 51 of them (52%) for DAPK1, in 20 (20.4%) for p16 and in three (3.1%) for RASSF1A. Methylated genes only found in sputum accounted for 38.3% and only in BW in 41.7%, and in both 20.0%. In the 11.2% of the patients studied, HGD and a hypermethylated gene were present, while for the 55.1% of the sample only one of both was detected and for the rest of the subjects (33.6%), none of the risk factors were observed. CONCLUSIONS Our data determines DNA aberrant methylation panel in bronchial secretions is present in a 61.2% and HGD is found in 15.6%. Although both parameters have previously been identified as risk factors for lung cancer, the current study does not find a significative association between them. The study also highlights the importance of BW as a complementary sample to induced sputum when analyzing gene aberrant methylation.
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Affiliation(s)
- A Rosell
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain.
| | - N Rodríguez
- Department of Respiratory Medicine, Hospital Comarcal de l'Alt Penedès, Vilafranca, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - E Monsó
- Deparment of Respiratory Medicine, Fundació Parc Taulí, Sabadell, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - M Taron
- Laboratory of Molecular Biology, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - L Millares
- Fundació Parc Taulí, Sabadell, Barcelona, Spain
| | - J L Ramírez
- Laboratory of Molecular Biology, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - R López-Lisbona
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - N Cubero
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - F Andreo
- Department of Respiratory Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - J Sanz
- Department of Respiratory Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - M Llatjós
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - R Llatjós
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M T Fernández-Figueras
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J L Mate
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - I Català
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Setó
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Roset
- IMS Health, Barcelona, Spain
| | - M Díez-Ferrer
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
| | - J Dorca
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Mallorca, Spain
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Morales A, Pari M, López-Lisbona R, Cubero N, Dorca J, Rosell A. Colchicine Treatment for Tracheobronchial Amyloidosis. Respiration 2016; 91:251-5. [DOI: 10.1159/000443669] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 12/21/2015] [Indexed: 11/19/2022] Open
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