Lung cancer risk and do-it-yourself activities. A neglected risk factor for lung cancer.

BACKGROUND: The aim of this study was to assess the relationship between do-it-yourself activities entailing the exposure to carcinogenic substances and the risk of lung cancer. METHODS: We pooled individual data from different case-control studies conducted in Northwestern Spain which investigated residential radon and lung cancer. Cases had an anatomopathologically confirmed primary lung cancer and controls were selected at the pre-surgery unit with uncomplicated surgeries. Both cases and controls were older than 30 years with no previous cancer history. All participants were interviewed face-to-face using a specific questionnaire. Painting, model building, furniture refinishing and woodworking or home carpentry were the do-it-yourself activities considered risky due to exposure to carcinogenic agents. RESULTS: We included 1528 cases and 1457 controls. Practicing do-it-yourself risk activities was more frequent among cases: 16.0% were exposed to carcinogenic exposures during leisure time, compared to 11.8% for controls. The overall adjusted OR for lung cancer risk among individuals who practiced do-it-yourself risk activities, was 1.77 (95% CI: 1.36-2.31); this was 2.17 (95% CI: 1.51-3.11) when the analysis was restricted to individuals who performed these activities for at least 10 years. These risks were greater when the analyses were carried out exclusively among never-smokers, with the respective ORs being 2.04 (95% CI: 1.38-3.01) and 3.10 (95% CI: 1.78-5.40). CONCLUSION: These results support the hypothesis that do-it-yourself activities involving exposure to certain carcinogens are associated with an increased risk of lung cancer, both in ever and never-smokers.

Alcohol consumption and lung cancer risk in never smokers: a pooled analysis of case-control studies.

Background: Lung cancer is the deadliest cancer in developed countries but the etiology of lung cancer risk in never smokers (LCRINS) is largely unknown. We aim to assess the effects of alcohol consumption, in its different forms, on LCRINS. Methods: We pooled six multi-center case-control studies developed in the northwest of Spain. Cases and controls groups were composed of never smokers. We selected incident cases with anatomopathologically confirmed lung cancer diagnoses. All participants were personally interviewed. We performed two groups of statistical models, applying unconditional logistic regression with generalized additive models. One considered the effect of alcohol type consumption and the other considered the quantity of each alcoholic beverage consumed. Results: A total of 438 cases and 863 controls were included. Median age was 71 and 66, years, respectively. Adenocarcinoma was the predominant histological type, comprising 66% of all cases. We found that any type of wine consumption posed an OR of 2.20 OR 95%CI 1.12-4.35), and spirits consumption had an OR of 1.90 (95%CI 1.13-3.23). Beer consumption had an OR of 1.33 (95%CI 0.82-2.14). These results were similar when women were analyzed separately, but for men there was no apparent risk for any alcoholic beverage. The dose-response analysis for each alcoholic beverage revealed no clear pattern. Conclusions: Wine and spirits consumption might increase the risk of LCRINSs, particularly in females. These results have to be taken with caution given the limitations of the present study.

[Chronic obstructive pulmonary disease in real life. LEONPOC study]. / Enfermedad pulmonar obstructiva crónica: los pacientes en la vida real. Estudio LEONPOC.

OBJECTIVE: The purpose of this study was to evaluate different characteristics of COPD patients according to phenotypes and GOLD guidelines.according to GesEPOC phenotypes and GOLD 2011 ABCD guidelines and pharmacological treatment agreement. DESIGN: Cross-sectional survey. LOCATION: COPD patients aged 40-85 from León were randomly selected from Primary Care database, MEDORA. PARTICIPANTS: 5222 eligible COPD patients were collected from MEDORA database. We calculated a sample size of 734 patients and finally studied 577 of them. MAIN MEASUREMENTS: Patients clinical, functional and health related quality of life information were collected. Spirometry and postbroncodilator test were performed. RESULTS: A total of 577 patients were included in this study. 28.7% of them did not have a spirometry recorded in their files. 123 patients had a normal or non-obstructive spirometry pattern, so they were excluded from a COPD diagnostic. With regard to treatments, there was an overprescribing of inhaled steroids in patients from GOLD A and B groups, and also in patients with the called exacerbator phenotype (GesEPOC). CONCLUSION: Although there have been several published guidelines, management of COPD patients in real life should be improved.

Microarray analysis of Mycobacterium tuberculosis-infected monocytes reveals IL26 as a new candidate gene for tuberculosis susceptibility.

Differences in the activity of monocytes/macrophages, important target cells of Mycobacterium tuberculosis, might influence tuberculosis progression. With the purpose of identifying candidate genes for tuberculosis susceptibility we infected monocytes from both healthy elderly individuals (a tuberculosis susceptibility group) and elderly tuberculosis patients with M. tuberculosis, and performed a microarray experiment. We detected 78 differentially expressed transcripts and confirmed these results by quantitative PCR of selected genes. We found that monocytes from tuberculosis patients showed similar expression patterns for these genes, regardless of whether they were obtained from younger or older patients. Only one of the detected genes corresponded to a cytokine: IL26, a member of the interleukin-10 (IL-10) cytokine family which we found to be down-regulated in infected monocytes from tuberculosis patients. Non-infected monocytes secreted IL-26 constitutively but they reacted strongly to M. tuberculosis infection by decreasing IL-26 production. Furthermore, IL-26 serum concentrations appeared to be lower in the tuberculosis patients. When whole blood was infected, IL-26 inhibited the observed pathogen-killing capability. Although lymphocytes expressed IL26R, the receptor mRNA was not detected in either monocytes or neutrophils, suggesting that the inhibition of anti-mycobacterial activity may be mediated by lymphocytes. Additionally, IL-2 concentrations in infected blood were lower in the presence of IL-26. The negative influence of IL-26 on the anti-mycobacterial activity and its constitutive presence in both serum and monocyte supernatants prompt us to propose IL26 as a candidate gene for tuberculosis susceptibility.

[Estimate of the real incidence of tuberculosis in the Leon Health Area: application of the capture-recapture method to compare two information sources]. / Aproximación a la incidencia real de tuberculosis en el Área de Salud de León: aplicación del método captura-recaptura para comparar 2 fuentes de información.

INTRODUCTION: The actual incidence of tuberculosis is probably higher than that previously published in national and international records. Under-reporting is estimated to fluctuate between 7% and 27%, according to studies. OBJECTIVE: To estimate the incidence rate of tuberculosis in the area of León for 2008 and 2009 using the capture-recapture method in order to compare two sources of information: prescribed tuberculostatic drugs (combination of rifampicin-isoniazid) and the regional epidemiological surveillance system register (SIVE). METHOD: Retrospective descriptive study in an area of 351,086 inhabitants of tuberculosis cases using as sources: (i), information on prescribed tuberculostatic drugs, and (ii), the SIVE register. We calculated incidence rates for each source by the capture-recapture method. We analyzed epidemiological and demographic data, symptoms, diagnosis, treatment and follow-up. RESULTS: The incidence based on the SIVE data for 2008 was 18.80/100,000 inhabitants and according to the pharmacy register, the rate was 26.77. The estimated value for 2009 based on the SIVE data was 18.23/100,000 inhabitants, and according to the pharmacy register, it was 22.50. After applying the capture-recapture method, the annual incidence for 2008 was 44.14/100,000 (95% CI; 37.88-50.41) and for 2009, it was 34.17/100,000 (95% CI; 30.19-38.17). In the study of all these years we have found that the number of cases were higher in the pharmacy register than the SIVE one. CONCLUSIONS: The SIVE data on the incidence of tuberculosis in our study area underestimates the actual incidence rate. The source of information that involves case record of tuberculosis in the community is under-used. The capture-recapture method is a good alternative to measure the incidence of tuberculosis, and to check the surveillance systems.

Immunological response to Mycobacterium tuberculosis infection in blood from type 2 diabetes patients.

The convergence of tuberculosis and diabetes represents a co-epidemic that threatens progress against tuberculosis. We have investigated type 2 diabetes as a risk factor for tuberculosis susceptibility, and have used as experimental model whole blood infected in vitro with Mycobacterium tuberculosis. Blood samples from diabetic patients were found to have a higher absolute neutrophil count that non-diabetic controls, but their immune functionality seemed impaired because they displayed a lower capacity to phagocytose M. tuberculosis, a finding that had been previously reported only for monocytes. In contrast, an increased production of TNFα was detected in infected blood from diabetic patients. Despite the altered phagocytic capacity showed by cells from these patients, the antimicrobial activity measured in both whole blood and monocyte derived macrophages was similar to that of controls. This unexpected result prompts further improvements in the whole blood model to analyze the immune response of diabetes patients to tuberculosis.

In vitro infection with Mycobacterium tuberculosis induces a distinct immunological pattern in blood from healthy relatives of tuberculosis patients.

Part of the susceptibility to tuberculosis has a genetic basis, which is clear in primary immunodeficiencies, but is less evident in apparently immunocompetent subjects. Immune responses were analysed in blood samples from tuberculosis patients and their healthy first-degree relatives who were infected in vitro with mycobacteria (either Mycobacterium tuberculosis or M. bovis BCG). The antimicrobial activity against M. tuberculosis in blood from relatives was significantly lower than that observed in healthy controls. Tuberculosis patients exhibited a higher number of neutrophils, and monocyte phagocytosis was inhibited in both relatives and tuberculosis patients. A remarkable finding was that the production of reactive oxygen species by infected neutrophils was higher in relatives than in healthy controls. A higher production of TNFα in infected blood from relatives was also observed. These results may indicate that relatives display a stronger inflammatory response and that their immune response to M. tuberculosis is different from those of unrelated controls. First-degree relatives may represent a highly informative group for the analysis of tuberculosis susceptibility.

Small Cell Lung Cancer. Methodology and Preliminary Results of the SMALL CELL Study. / Cáncer de pulmón microcítico. Metodología y resultados preliminares del estudio SMALL CELL.

INTRODUCTION: Small cell lung cancer (SCLC) is the most aggressive histologic type of lung cancer, and accounts for approximately 10%-15% of all cases. Few studies have analyzed the effect of residential radon. Our aim is to determine the risk factors of SCLC. METHODS: We designed a multicenter, hospital-based case-control study with the participation of 11 hospitals in 4 autonomous communities. RESULTS: Results of the first 113 cases have been analyzed, 63 of which included residential radon measurements. Median age at diagnosis was 63 years; 11% of cases were younger than 50 years of age; 22% were women; 57% had extended disease; and 95% were smokers or former smokers. Median residential radon concentration was 128Bq/m3. Concentrations higher than 400Bq/m3 were found in 8% of cases. The only remarkable difference by gender was the percentage of never smokers, which was higher in women compared to men (P<.001). Radon concentration was higher in patients with stageIV disease (non-significant difference) and in individuals diagnosed at 63 years of age or older (P=.032). CONCLUSIONS: A high percentage of SCLC cases are diagnosed early and there is a predominance of disseminated disease at diagnosis. Residential radon seems to play an important role on the onset of this disease, with some cases having very high indoor radon concentrations.

Plasma contributes to the antimicrobial activity of whole blood against Mycobacterium tuberculosis.

The whole blood model for infection has proven useful to analyze the immunological response to Mycobacterium tuberculosis, because it exerts a significant antimicrobial activity. Although this activity has been generally assumed to be cellular, we have found that the leukocyte fraction of blood from healthy volunteers did not kill the bacilli. We have discovered that plasma was responsible for a large proportion, but not all, of the antimicrobial activity. Furthermore, infected monocytes controlled the mycobacterial multiplication when cultivated in the presence of plasma. Intriguingly, serum from the same donors did not share this activity, although it was able to eliminate the non-pathogenic Mycobacterium gordonae To identify the remaining components that participate in the antimycobacterial activity we fractionated blood in leukocytes, plasma, erythrocytes and platelets, and analyzed the bactericidal power of each fraction and their combinations using a factorial design. We found that erythrocytes, but not platelets, participated and showed by flow cytometry that mycobacteria physically associated with erythrocytes. We propose that in exposed healthy individuals that show 'early clearance' of the mycobacteria, the innate response is predominantly humoral, probably through the effect of antimicrobial peptides and proteins.

Test de electroestimulación vagal en la vagotomía superselectiva / Vagal electrostimulation test in superselective vagotomy

Después de utilizar el test de estimulación vagal para la correcta determinación transoperatoria del límite cuerpo-antro en la vagotomía superselectiva (VSS), diseñado y comprobada su efectividad en el trabajo experimental de los autores, se pasó a la fase de aplicación clínica. En este trabajo exponemos los resultados de 56 casos, 46 de los mismos entre 1 y 4 años de operados. Los resultados han sido muy alentadores y consideramos que el test representa un gran apoyo al éxito de la vagotomía superselectiva

Test de estimulación vagal en la vagotomía superselectiva: resultados clínicos / Vagal stimulation test in superselective vagotomy: clinical results

Se realizó un estudio perspectivo longitudinal de 94 pacientes con úlceras duodenales a fin de aplicarles vagotomía superselectiva como trtamiento quirúrgico. Por la técnica clásica fue intervenido un grupo control de 34 pacientes. Se aplicó un test de estimulación vagal a los otros 60, los cuales fueron operados electivamente con el objetivo de determinar el límite cuerpo-antro. Se demostró que la vagotomía superselectiva es la técnica quirúrgica para el tratamiento de la úlcera péptica crónica del duodeno que reduce en mayor medida la mortalidad y morbilidad y es, al mismo tiempo, efectiva en la disminución de la secreción gástrica. Se pone de manifiesto la necesidad de adoptar un método para la delimitación cuerpo-antro en la desnervación distal cuando se aplica la vagotomía superselectiva sin drenaje. El test de estimulación vagal propuesto es seguro y rápido, al mismo tiempo que garantiza una desnervación exacta mediante la utilización de este test, no es necesario abrir la cavidad gástrica ni utilizar otra instrumentación, elimina los éstasis gástricos post-operatorios y disminuye las recidivas. Su efectividad queda demostrada por los índices porcentuales de éxito