RESUMEN
The aim of the present study was to assess the impact of nasal continuous positive airway pressure (nCPAP) in ischaemic stroke patients followed for 2 yrs. Stroke patients with an apnoea-hypopnoea index ≥ 20 events·h⻹ were randomised to early nCPAP (n = 71; 3-6 days after stroke onset) or conventional treatment (n = 69). The Barthel Index, Canadian Scale, Rankin Scale and Short Form-36 were measured at baseline, and at 1, 3, 12 and 24 months. The percentage of patients with neurological improvement 1 month after stroke was significantly higher in the nCPAP group (Rankin scale 90.9 versus 56.3% (p < 0.01); Canadian scale 88.2 versus 72.7% (p < 0.05)). The mean time until the appearance of cardiovascular events was longer in the nCPAP group (14.9 versus 7.9 months; p = 0.044), although cardiovascular event-free survival after 24 months was similar in both groups. The cardiovascular mortality rate was 0% in the nCPAP group and 4.3% in the control group (p = 0.161). Early use of nCPAP seems to accelerate neurological recovery and to delay the appearance of cardiovascular events, although an improvement in patients' survival or quality of life was not shown.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Apnea Obstructiva del Sueño/terapia , Accidente Cerebrovascular/terapia , Anciano , Presión de las Vías Aéreas Positiva Contínua/instrumentación , Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/mortalidad , Calidad de Vida , Recurrencia , Accidente Cerebrovascular/mortalidad , Resultado del TratamientoRESUMEN
The implication of the STAT6 transcription factor in several human diseases makes the regulation of its activity a topic of great biological interest. The activation of this transcription factor is tightly regulated by kinases, phosphatases, and proteases. The initial aim of this study was to investigate the utility of protease inhibitors in controlling STAT6 activation. Among all inhibitors analyzed, n-alpha-tosyl-L-phenylalanine-chloromethyl ketone (TPCK) was found to inhibit the IL-4-induced STAT6 activation. Unexpectedly, this inhibition was accompanied by a loss of STAT6 protein. Thus, TPCK promoted the loss of STAT6 by a mechanism sensitive to the serine-protease inhibitor 4-(2-aminoetyl)-benzenesulfonyl fluoride. However, the effects of TPCK seemed not to be mediated by its protease inhibitory activity since multiple protease inhibitors tested had no effect on STAT6 expression. The results found suggest that the effect of TPCK was mediated by its alkylating activity. Thus, cysteine reactive and thiol antioxidant compounds prevented the loss of STAT6 induced by TPCK. The reactivity of thiol groups on STAT6 was moreover demonstrated with biotinylated sulfhydryl-reactive compounds. Analysis of other signaling molecules indicated that STAT5, but not other STATs, Shc, or c-Rel, was also affected by TPCK, suggesting a common downregulatory mechanism for STAT6 and STAT5. These results reveal a novel mechanism of action of TPCK in inducing a selective loss of STAT proteins. These findings may have implications for diseases in which STAT proteins are involved.
Asunto(s)
Antioxidantes/farmacología , Inhibidores de Proteasas/farmacología , Factor de Transcripción STAT6/metabolismo , Clorometilcetona de Tosilfenilalanila/farmacología , Animales , Línea Celular , Ratones , Proteínas Proto-Oncogénicas c-rel/fisiología , Factor de Transcripción STAT5/metabolismo , Proteínas Adaptadoras de la Señalización Shc/fisiología , Transducción de Señal , Sulfonas/farmacologíaRESUMEN
The impact of ozonation on textural and chemical surface characteristics of two granular activated carbons (GAC), namely F400 and AQ40, and their ability to adsorb phenol (P), p-nitrophenol (PNP), and p-chlorophenol (PCP) from aqueous solutions have been studied. The porous structure of the ozone-treated carbons remained practically unchanged with regard to the virgin GAC. However, important modifications of the chemical surface and hydrophobicity were observed from FTIR spectroscopy, pH titrations, and determination of pH(PZC). As a rule, the ozone treatment at either room temperature (i.e., about 25 degrees C) or 100 degrees C gave rise to acidic surface oxygen groups (SOG). At 25 degrees C primarily carboxylic acids were formed while a more homogeneous distribution of carboxylic, lactonic, hydroxyl, and carbonyl groups was obtained at 100 degrees C. The experimental isotherms for phenolic compounds on both GAC were analyzed using the Langmuir model. Dispersive interactions between pi electrons of the ring of the aromatics and those of the carbon basal planes were thought to be the primary forces responsible for the physical adsorption whereas oxidative coupling of phenolic compounds catalyzed by basic SOG was a major cause of irreversible adsorption. The exposure of both GAC to ozone at room temperature decreased their ability to adsorb P, PNP, and PCP. However, when ozone was applied at 100 degrees C adsorption was not prevented but in some cases (P and PNP on F400) the adsorption process was even enhanced.
Asunto(s)
Carbono/química , Ozono/química , Fenoles/química , Adsorción , Oxidación-Reducción , Soluciones/química , Propiedades de Superficie , Temperatura , Agua/químicaRESUMEN
OBJECTIVE: We have studied the usefulness of squamous cell carcinoma antigen (SCC Ag) in diagnosis and prognosis of lung cancer (LC). MATERIAL AND METHODS: We have measured the serum SCC Ag levels in 388 subjects: 69 healthy persons; 103 with nonmalignant lung diseases (NMLD); 24 with lung metastasis of extrapulmonary origin (LMEO); and 192 with LC (88, with squamous cell carcinoma [SCC] type). In 55 with SCC, we analyzed the survival time. RESULTS: Serum SCC Ag was above 2.5 ng/ml in 1.4 percent of healthy persons; 2.9 percent of those with NMLD; 8.3 percent of those with LMEO; and 27.6 percent of those with LC. Such percentage was 47.7 percent in SCC. In this type, there were significant differences according to the extent of disease (61.6 percent in advanced stages, and 26.5 percent in localized stages, p = 0.002). In the other types, the sensitivity was substantially lower. The initial SCC Ag has prognostic significance (p = 0.02) in the univariate analysis, but it loses such significance in a multivariate model, including the stage. CONCLUSIONS: Therefore, we do not recommend this marker in the clinical management of patients with LC, even it can be useful in the differential diagnosis if used in combination with other markers.
Asunto(s)
Antígenos de Neoplasias/sangre , Biomarcadores de Tumor/sangre , Carcinoma de Células Escamosas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Serpinas , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Sensibilidad y Especificidad , Análisis de Supervivencia , Factores de TiempoRESUMEN
OBJECTIVE: To ascertain the differences in smoking characteristics between a group of smokers with COPD and another group of healthy smokers, both of which were identified in a population-based epidemiologic study. DESIGN AND PARTICIPANTS: This is an epidemiologic, multicenter, population-based study conducted in seven areas of SPAIN: A total of 4,035 individuals, men and women aged 40 to 69 years, who were selected randomly from a target population of 236,412 subjects, participated in the study. INTERVENTIONS: Eligible subjects answered the European Commission for Steel and Coal questionnaire. Spirometry was performed followed by a bronchodilator test when bronchial obstruction was present. The Fagerström questionnaire was used for study of the degree of physical nicotine dependence, and the Prochazka model was followed for analysis of the smoking cessation phase. RESULTS: Of 1,023 active smokers, 153 (15%) met the criteria for COPD. Smokers with COPD were more frequently men (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.21 to 3.95), were > or = 46 years of age (OR, 1.97; 95% CI, 1.18 to 3.31), had a lower educational level (OR, 1.96; 95% CI, 1.23 to 3.14), and had smoked > 30 pack-years (OR, 3.70; 95% CI, 2.42 to 5.65). Smokers with COPD showed a higher dependence on nicotine than healthy smokers (mean [+/- SD] Fagerström test score, 4.77 +/- 2.45 vs 3.15 +/- 2.38, respectively; p < 0.001) and higher concentrations of CO in exhaled air (mean concentration, 19.7 +/- 16.3 vs 15.4 +/- 12.1 ppm, respectively; p < 0.0001). Thirty-four percent of smokers with COPD and 38.5% of smokers without COPD had never tried to stop smoking. CONCLUSIONS: Smokers with COPD have higher tobacco consumption, higher dependence on nicotine, and higher concentrations of CO in exhaled air, suggesting a different pattern of cigarette smoking. Cases of COPD among smokers predominate in men and in individuals with lower educational levels. A significant proportion of smokers have never tried to stop smoking; thus, advice on cessation should be reinforced in both groups of smokers.
Asunto(s)
Actitud , Enfermedades Pulmonares Obstructivas/complicaciones , Enfermedades Pulmonares Obstructivas/psicología , Fumar/psicología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosAsunto(s)
Síndromes de la Apnea del Sueño/terapia , Inhibidores de Captación Adrenérgica/uso terapéutico , Antidepresivos Tricíclicos/uso terapéutico , Humanos , Medroxiprogesterona/uso terapéutico , Respiración con Presión Positiva , Congéneres de la Progesterona/uso terapéutico , Protriptilina/uso terapéutico , Síndromes de la Apnea del Sueño/tratamiento farmacológico , Síndromes de la Apnea del Sueño/cirugíaAsunto(s)
Síndromes de la Apnea del Sueño/diagnóstico , Adulto , Diagnóstico Diferencial , Electrocardiografía , Femenino , Humanos , Masculino , Oximetría , Oxihemoglobinas/análisis , Polisomnografía , Respiración , Síndromes de la Apnea del Sueño/fisiopatología , Síndromes de la Apnea del Sueño/terapiaRESUMEN
BACKGROUND: A study was undertaken to evaluate exacerbations and their impact on the health related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD). METHODS: A 2 year follow up study was performed in 336 patients with COPD of mean (SD) age 66 (8.2) years and mean (SD) forced expiratory volume in 1 second (FEV(1)) 33 (8)% predicted. Spirometric tests, questions regarding exacerbations of COPD, and HRQL measurements (St George's Respiratory Questionnaire (SGRQ) and SF-12 Health Survey) were conducted at 6 month intervals. RESULTS: A total of 1015 exacerbations were recorded, and 103 (30.7%) patients required at least one hospital admission during the study. After adjustment for baseline characteristics and season of assessment, frequent exacerbations had a negative effect on HRQL in patients with moderate COPD (FEV(1) 35-50% predicted); the change in SGRQ total score of moderate patients with > or =3 exacerbations was almost two points per year greater (worse) than those with <3 exacerbations during the follow up (p = 0.042). For patients with severe COPD (FEV(1) <35% predicted) exacerbations had no effect on HRQL. The change in SGRQ total score of patients admitted to hospital was almost 2 points per year greater (worse) than patients not admitted, but this effect failed to show statistical significance in any severity group. There was a significant and independent seasonal effect on HRQL since SGRQ total scores were, on average, 3 points better in measurements performed in spring/summer than in those measured in the winter (p<0.001). CONCLUSIONS: Frequent exacerbations significantly impair HRQL of patients with moderate COPD. A significant and independent effect of seasonality was also observed.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida , Adulto , Anciano , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado/fisiología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Capacidad Vital/fisiologíaRESUMEN
Treatments administered to patients with chronic obstructive pulmonary disease (COPD), especially when used in multiple combinations, are not free of interactions and side effects that can potentially impair health-related quality of life (HRQL). We studied HRQL and its relationship with treatment in a group of 441 patients with stage II or III COPD (age: 66.6 (SD: 8.3) years; FEV1: 32.4% (SD: 8.1%)) using the St George's Respiratory Questionnaire (SGRQ) and the 12-item short form (SF-12) Health Survey. The most prescribed drugs were ipratropium bromide (87.5%), inhaled corticosteroids (69.4%) and short-acting beta-2 agonists (64.9%). Patients with stage III of the disease were receiving more drugs, particularly short-acting beta-2 agonists (p = 0.002) and inhaled corticosteroids (p = 0.031). The use of theophyllines was associated with a worse total SGRQ score (beta = 4.49; p < 0.001), although this negative association decreased with advanced age. A trend towards worse SGRQ scores was observed with the use of high doses of long-acting beta-2 agonists (beta = 3.22; p = 0.072). Patients receiving three drugs or more presented worse total SGRQ scores than patients receiving fewer drugs (beta = 6.1, p < 0.001; and beta = 7.64, p < 0.001, respectively). These findings suggest that the use of multiple drugs in the treatment of patients with COPD is associated with worse total SGRQ scores. The effect of drugs, their dosages and associations with other drugs on HRQL merit further research.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/terapia , Calidad de Vida , Perfil de Impacto de Enfermedad , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Antagonistas Adrenérgicos beta/administración & dosificación , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Broncodilatadores/administración & dosificación , Broncodilatadores/uso terapéutico , Expectorantes/administración & dosificación , Expectorantes/uso terapéutico , Femenino , Humanos , Ipratropio/administración & dosificación , Ipratropio/uso terapéutico , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , España , Encuestas y Cuestionarios , Teofilina/administración & dosificación , Teofilina/uso terapéuticoRESUMEN
El tabaquismo es la consecuencia de un proceso que comienza incluso antes de probar el primer cigarrillo, ya que en él intervienen factores sociales y conductuales, y que culmina con décadas de dependencia física y psicológica al tabaco. Este artículo discute el proceso de iniciación al tabaquismo desde una perspectiva global, explicando los efectos fisiológicos de la nicotina, su carácter adictivo y los factores ambientales y personales que desencadenan el tabaquismo. Dado que la iniciación al consumo de tabaco se produce por lo general durante la adolescencia, el artículo se centra de forma particular en esta etapa del desarrollo, y en las situaciones que favorecen el que un joven encienda el primer cigarrillo. Finalmente, se analizan las consecuencias del proceso de iniciación tanto en la epidemiología como en la prevención del tabaquismo, lo que puede resultar de gran utilidad al profesional de salud interesado en contribuir al control de tabaquismo mediante intervenciones en el medio clínico (AU)