Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomised, controlled, parallel-group study.

INTRODUCTION: The effectiveness of non-invasive positive pressure ventilation (NIV) in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure (ARF) remains unclear. We investigated if nocturnal NIV in these patients prolongs the time to readmission for respiratory causes or death (primary endpoint) in the following 12 months. METHODS: 201 COPD patients admitted to hospital with ARF and prolonged hypercapnia >48 h after termination of ventilatory support were randomised to NIV or standard treatment. Secondary outcomes were daytime arterial blood gasses, transcutaneous PCO2 during the night, lung function, health-related quality-of-life (HRQL), mood state, daily activities and dyspnoea. RESULTS: 1 year after discharge, 65% versus 64% of patients (NIV vs standard treatment) were readmitted to hospital for respiratory causes or had died; time to event was not different (p=0.85). Daytime PaCO2 was significantly improved in NIV versus standard treatment (PaCO2 0.5 kPa (95% CI 0.04 to 0.90, p=0.03)) as was transcutaneous PCO2 during the night. HRQL showed a trend (p=0.054, Severe Respiratory Insufficiency questionnaire) in favour of NIV. Number of exacerbations, lung function, mood state, daily activity levels or dyspnoea was not significantly different. DISCUSSIONS: We could not demonstrate an improvement in time to readmission or death by adding NIV for 1 year in patients with prolonged hypercapnia after an episode of NIV for ARF. There is no reason to believe the NIV was not effective since daytime PaCO2 and night-time PCO2 improved. The trend for improvement in HRQL favouring NIV we believe nevertheless should be explored further. TRIAL REGISTRATION NUMBER: NTR1100.

Results of the oral egg-challenge test performed on two different groups of children. One group with a history, suggestive of allergic reaction with egg intake and the other group sensitised to hen's egg without previous egg intake.

INTRODUCTION: Egg allergy is an adverse immune-system reaction of an IgE-mediated type, which can happen in children after egg intake and several times after their first egg intake. OBJECTIVES: Compare the results of the oral egg-challenge test in two groups of egg-sensitised children, with and without prior intake. PATIENTS AND METHODS: Retrospective study of two egg-sensitised groups (72 subjects). Group 1: 22 children without prior egg-intake. Group 2: 50 children with a clinical history of adverse reactions after egg intake. Skin prick tests, egg-white specific IgE (sIgE) and yolk specific IgE, were performed on all children. The oral egg-challenge tests were performed after a period of egg-avoidance diet and when egg-white specific IgE levels were lower than 1.5K U/L. RESULTS: 31.8% of the children in Group 1 did not tolerate egg-intake whereas 38% of the children in Group 2 did not tolerate egg-intake. Egg-avoidance periods lasted 19.5 and 18 months, respectively. Egg-white specific IgE levels went down in both groups after an egg-avoidance diet. No statistically significant differences were found between the groups and the positivity of oral egg-challenge test. CONCLUSIONS: No statistically significant differences were found in the behaviour of the two groups studied. Given the high risk of adverse reactions, it was recommended that any egg-introduction tests were to be performed in a hospital environment on the children who were sensitised to hen's egg (including children without prior egg intake).

Epithelial-Mesenchymal Transition in a Case of Metastatic Thyroid Carcinoma in a Brown Bear (Ursus arctos).

A 20-year-old male brown bear (Ursus arctos) with a 20 × 25 cm necrotic mass adjacent to the trachea was diagnosed as having an anaplastic thyroid carcinoma. Metastases were observed in the lungs and one adrenal gland and, histologically, these had anaplastic and follicular carcinoma patterns, respectively. E-cadherin labelling was observed in the adrenal mass only, while N-cadherin immunolabelling was detected in the thyroid gland and lung masses. Thyroid-specific markers (thyroid transcription factor-1, thyroglobulin) were expressed in the adrenal gland metastasis. This case illustrates an example of a primary epithelial-mesenchymal transition (EMT) enabling metastasis to distant organ sites, followed by a mesenchymal-epithelial transition within the adrenal gland microenvironment, allowing invasion and reacquisition of thyroid epithelial cell features. EMTs help to understand the phenomenon of carcinoma cell plasticity in enabling colonization and growth of metastases.

From the bluetongue vaccination campaigns in sheep to overimmunization and ovine ASIA syndrome.

The use of vaccines has proven to be very effective in controlling and eradicating infectious diseases, both in veterinary and human medicine; however, vaccines can be also the source of an array of problems caused by procedures such as overimmunization. Bluetongue, an orbiviral disease that affects ruminants, is best controlled by the use of inactivated vaccines. During the last years of the past decade, these vaccines were applied all over Europe to control the spreading of the disease, a goal that was accomplished; however, at the same time, several adverse effects related to the vaccination were reported. Especially in sheep, this vaccination campaign brought out a new cachectic and neurologic disease with harmful consequences for the ovine industry. This disease is now recognized as the ovine version of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) and poses an immense challenge in veterinary medicine, immunology, and vaccinology.

Iron(II) induces changes in the conformation of mammalian mitochondrial DNA resulting in a reduction of its transcriptional rate.

Living isolated mitochondria incubated with iron(II) show a major alteration in mitochondrial DNA (mtDNA) conformational forms as assessed by Southern blot analysis of undigested mtDNA. In the presence of iron(II), form I is transformed into form III in a dose-dependent manner. This alteration in mtDNA conformation shows a strong correlation with a decrease in the mtDNA transcription rate (r=0.965, P < 0.002), suggesting that iron(II) load results in double-strand breaks and unwinding of mtDNA, which, in turn, is unable to maintain its normal transcriptional rate.

1,3-dipolar cycloadditions as a tool for the preparation of multivalent structures.

The construction of multivalent structures such as sugar heterodimers, glycoclusters, calix sugars, multicalixarenes, and glycocyclodextrins is designed by using 1,3-dipolar cycloaddition as a versatile and efficient tool which allows the creation of heterocyclic bridges between the different units that are coupled.

Conduction velocity through the somesthetic pathway in chronic renal failure.

The latencies of evoked potentials recorded at different levels of the peripheral and central nervous system by median nerve stimulation were measured before and after dialysis, and compared with similar recordings in normal volunteers. Abnormally slow conduction velocity was more often found in proximal rather than in distal segments of the peripheral pathway in patients with chronic renal failure. This abnormality was not correlated with the presence of clinical signs of neuropathy or low values of motor conduction velocity, neither was it affected by dialysis. These findings support the hypothesis of peripheral nerve dysfunction secondary to metabolic derangement in uraemic patients.

Calcitonin and metabolic alkalosis.

Calcitonin is used in the treatment of osteoporosis and several adverse effects, such as rash, antibody presence, hypocalcemia, etc have been reported with the therapeutic use of large quantities of this hormone. The results found in this paper show that 7 h after administration of large doses of calcitonin to osteoporotic patients on hormone treatment, the acid-base status shifts to metabolic alkalosis. This represents another adverse effect of the use of pharmacological doses of calcitonin.

Thiolprotease activity in skeletal and myocardial muscle and liver of fasted rats.

The activity of the thiolproteases, cathepsins B, H, and B + L, one of the most important groups of endoproteases, was measured in skeletal and myocardial muscle and liver of Sprague-Dawley rats submitted to fasts of different duration (control and 24, 48, and 72 h). After the fasting period, the animals were killed, and fresh tissue samples were collected. Enzyme activity was determined in vitro with the specific substrates Z-Arg-Arg-MCA for cathepsin B, Z-Phe-Arg-MCA for cathepsin B + L, and Arg-MCA for cathepsin H. Results show different patterns in the organs studied: activity increased linearly in liver, decreased in myocardial muscle, and had no change in skeletal muscle. These results suggest that the expected alteration observed in proteolytic activity in fasted tissues is produced to a certain degree by changes in thiolprotease activity.

Drug leads from the Kallawaya herbalists of Bolivia. 1. Background, rationale, protocol and anti-HIV activity.

Aqueous, organic and alcoholic extracts of over 100 samples of 60 species of Kallawaya medicinal herbs representing 30 plant families were assayed to compare their toxicity and ability to protect MT-2 T-lymphoblastoid cells from the cytopathic effect of human immunodeficiency virus (HIV). The results are reported as a therapeutic index (TI) which was > 25 for eighteen species, including seven > 50 and one > 100. The anti-HIV activity resided primarily in the aqueous rather than in the organic extracts and was concentrated in plants used in ethnomedicine to treat lung and liver diseases.

PIP: Plants are a rich source of anti-viral substances. The National Cancer Institute therefore annually screens about 1500 species from Africa, Southeast Asia, and South and Central America, but not Bolivia, for anti-HIV activity. Several unique compounds with anti-HIV activity have emerged from the program. The Kallawaya Indians of Bolivia follow a medical tradition from the Tiahuanaco (400-1145), Mollo (1145-1435), Inca (1438-1532), Spanish (1532-1825), and Bolivian Republic (from 1825) which is only recently starting to be reported. They use approximately 900 of the more than 2000 medicinal plants found across Bolivia. Aqueous, organic, and alcoholic extracts of more than 100 samples of 60 species of Kallawaya medicinal herbs representing 30 plant families were assayed to compare their toxicity and ability to protect MT-2 T-lymphoblastoid cells from the cytopathic effects of HIV. The therapeutic index (TI) of sampled species is defined as the ratio of anti-HIV activity to toxic concentration. A TI of greater than 25 was chosen as the prerequisite for future bioassay-directed isolation of the active components as leads for potential new anti-HIV drugs. TI was greater than 25 for 18 species, including seven greater than 50 and one greater than 100. The anti-HIV activity resided mainly in the aqueous extracts and was concentrated in plants used in ethnomedicine to treat lung and liver diseases.

[Right coronary artery originating from the left sinus of Valsalva. Surgical repair]. / Nacimiento de la arteria coronaria derecha en seno de Valsalva izquierdo. Corrección quirúrgica.

Anomalous origin of right coronary artery from left coronary sinus has been considered a minor disease without relevance. Currently it is associated with all symptoms derived from myocardial ischemia because of its lower coronary reserve. We present one patient with anomalous origin of right coronary artery from left coronary sinus surgically treated with saphenous vein aorto-coronary bypass. Doppler velocimetry shows the improvement of myocardial reserve after surgery.

[Surgical tongue-base suspension for obstructive sleep apnea syndrome. Our experience]. / Estabilización quirúrgica de la base de la lengua en el síndrome de apnea obstructiva del sueño. Nuestra experiencia.

There are a lot of techniques involves to surgical treatment of the Obstructive Sleep Apnea Syndrome. Surgical treatments of tongue-base and hypopharyngeal colapse include glossectomy, hyoid suspension, mandibular osteotomy with genioglossal advancement and maxillay-mandibular advancement. Many or these procedures are associated with extreme morbidity. In this paper is evaluated the effectiveness of a minimally invasive technique for tongue-base suspension. The procedure was performed in 12 male patients whit O.S.A.S. that were evaluated with cefalometric and fiberoptic analysis. These preliminary results show the initial efficacy of this new surgical procedure.

[Multi-level treatment for obstructive sleep apnea syndrome: comparative study of four different surgical techniques of palate]. / Tratamiento multinivel en el síndrome de apnea obstructiva del sueño: estudio comparativo de cuatro técnicas quirúrgicas del paladar.

Palatopharyngeal surgery is a therapeutic option for Obstructive Sleep Apnea Syndrome. This surgery is based on the assumption that the soft palate is the principal apneogenic area of the upper airway. We report a comparison of four techniques of palatopharyneal surgery. In the other hand, the effectiveness of palatopharyngeal surgery for correcting other obstructions when present, was also evaluated.

Bottom-up implementation of disease-management programmes: results of a multisite comparison.

OBJECTIVES: To evaluate the implementation of three regional disease-management programmes on chronic obstructive pulmonary disease (COPD) based on bottlenecks experienced in professional practice. METHODS: The authors performed a multisite comparison of three Dutch regional disease-management programmes combining patient-related, professional-directed and organisational interventions. Process (Assessing Chronic Illness Care survey) and outcome (disease specific quality of life (clinical COPD questionnaire (CCQ); chronic respiratory questionnaire (CRQ)), Medical Research Council dyspnoea and patients' experiences) data were collected for 370 COPD patients and their care providers. RESULTS: Bottlenecks in region A were mostly related to patient involvement, in region B to organisational issues and in region C to both. Selected interventions related to identified bottlenecks were implemented in all programmes, except for patient-related interventions in programme A. Within programmes, significant improvements were found on dyspnoea and patients' experiences with practice nurses. Outcomes on quality of life differed between programmes: programme A did not show any significant improvements; programme B did show any significant improvements on CCQ total (p<0.001), functional (p=0.011) and symptom (p<0.001), CRQ fatigue (p<0.001) and emotional scales (p<0.001); in programme C, CCQ symptom (p<0.001) improved significantly, whereas CCQ mental score (p<0.001) deteriorated significantly. Regression analyses showed that programmes with better implementation of selected interventions resulted in relatively larger improvements in quality of life (CCQ). CONCLUSIONS: Bottom-up implementation of COPD disease-management programmes is a feasible approach, which in multiple settings leads to significant improvements in outcomes of care. Programmes with a better fit between implemented interventions and bottlenecks showed more positive changes in outcomes.