A protocol proposition of cell therapy for the treatment of chronic obstructive pulmonary disease.

The main feature of pulmonary emphysema is airflow obstruction resulting from the destruction of the alveolar walls distal to the terminal bronchioles. Existing clinical approaches have improved and extended the quality of life of emphysema patients. However, no treatment currently exists that can change the disease course and cure the patient. The different therapeutic approaches that are available aim to increase survival and/or enhance the quality of life of emphysema patients. In this context, cell therapy is a promising therapeutic approach with great potential for degenerative pulmonary diseases. In this protocol proposition, all patients will be submitted to laboratory tests, such as evaluation of heart and lung function and routine examinations. Stem cells will be harvested by means of 10 punctures on each anterior iliac crest, collecting a total volume of 200mL bone marrow. After preparation, separation, counting and labeling (optional) of the mononuclear cells, the patients will receive an intravenous infusion from the pool of Bone Marrow Mononuclear Cells (BMMC). This article proposes a rational and safe clinical cellular therapy protocol which has the potential for developing new projects and can serve as a methodological reference for formulating clinical application protocols related to the use of cellular therapy in COPD. This study protocol was submitted and approved by the Brazilian National Committee of Ethics in Research (CONEP - Brazil) registration number 14764. It is also registered in ClinicalTrials.gov (NCT01110252).

[Why does a patient on hemodialysis have radiopaque material in his abdomen?]. / Perchè questo paziente emodializzato ha materiale radiopaco in addome?

Lanthanum is a third-generation, non-calcium and non-aluminium-based phosphate binder indicated for the treatment of hyperphosphatemia in stage 5 chronic kidney disease. The drug is well tolerated, with gastrointestinal complications as its main side effect. Recently, some case reports have described the typical X-ray features of this compound. We report another case of the radiopaque appearance of lanthanum carbonate, which underlines that clinicians need to be aware that its ingestion may cause opacifications in the colon.

[Spontaneous pneumoperitoneum: a case secondary to thoracic trauma]. / Pneumoperitoneo spontaneo: presentazione di un caso secondario a trauma toracico.

Spontaneous pneumoperitoneum is the radiographic manifestation of free air in the peritoneal cavity without visceral perforations and peritoneal signs, and it occurs in about 10% of the cases of pneumoperitoneum. The etiology can be postoperative, thoracic, abdominal, gynecologic, idiopathic; it generally introduces a benign evolution and does not require surgical treatment but just a conservative approach. The authors describe here a case of spontaneous pneumoperitoneum secondary to thoracic trauma. This case is interesting for the occurrence of pneumoperitoneum without clinical peritoneal signs such as fever and leucocytosis, after closed thoracic trauma in absence of pneumothoracic and pneumomediastinum. Correct clinical approach has allowed a conservative treatment avoiding an useless laparotomy.

Teaching patients to communicate with physicians: the impact of race.

Research on physician-patient communication has focused on the effect of physician communication training on health care outcomes. Much less is known about patient communication training, and even less about the impact of patient race on the effectiveness of patient communication interventions. One hundred and fifty patients of 25 family physicians were randomly assigned to one of three groups: 14-page patient communication workbook received 2-3 days pre-visit, 2-page patient communication handout received in the waiting room, or control group. Racial differences in the impact of patient communication training communication variables, immediate and delayed recall of information, and adherence to treatment were analyzed by t-test and ANOVA techniques. Across analyses, workbook communication skills training had a strong and significant effect on white patients but minimal or no effect on African-American patients. Minimal differences in dependent variables between racial groups existed for the patient handout and control groups. A partial correlation analysis was conducted to factor out the variance due to education. Results suggested that patient race accounted for the results over and above differences in education between racial groups. Our results suggested that the benefits of communication training can be enhanced by taking into account patient characteristics such as race and culture.

The effects of patient communication skills training on compliance.

OBJECTIVE: To examine the relationship between communication skills training for patients and their compliance with recommended treatment. DESIGN: A randomized control design was used, with patients nested within physicians. Each physician was audiotaped with 6 patients, 2 patients in each of the 3 intervention conditions: (1) a trained group (n = 50) received a training booklet in the mail 2 to 3 days prior to the scheduled appointment, (2) an informed group (n = 49) received a brief written summary of the major points contained in the training booklet while in the waiting room prior to the scheduled appointment, and (3) an untrained group (n = 51) did not receive any form of communication skills intervention. SETTING: Participants included physicians and patients from 9 different primary care, family practice locations. Two locations were clinics associated with a large, university-based medical school and hospital, while 7 were private practice offices in the community. PARTICIPANTS: The sample included 25 family physicians (averaging 11 years postresidency) and 150 patients. Patients were randomly selected from appointment records and randomly assigned to 1 of 3 intervention conditions. INTERVENTION: A training booklet designed to instruct patients in information seeking, provision, and verification. MAIN OUTCOME MEASURE: Patients' compliance with medications, behavioral treatment (e.g., diet, exercise, smoking cessation), and/or follow-up appointments and referrals. RESULTS: Trained patients were more compliant overall than untrained or informed patients. Training positively influenced compliance with behavioral treatments and follow-up appointments and referrals. CONCLUSION: Training patients in communication skills may be a cost-effective way of increasing compliance and improving the overall health of patients.

The effects of communication skills training on patients' participation during medical interviews.

Recent models of physician-patient communication emphasize information exchange in promoting partnership. Although considerable attention has been given to physicians' information exchange, little research has examined patients' communication contributions. The purpose of this research was to test the effectiveness of a training booklet designed to enhance patients' communication skills in information exchange. A nested design was used, such that 25 physicians each saw six patients, two patients in each of three communication skills interventions (i.e. trained, informed, control). The dependent variables included several discourse categories designed to assess patients' information seeking, provision, and verifying. Results indicate that trained patients engaged in more effective and efficient information seeking, provided physicians with more detailed information about their medical condition, and used more summarizing utterances to verify information they received from physicians. Additionally, dyads consisting of trained patients demonstrated a more patient-controlled style of communication than did dyads consisting of informed or untrained patients.

Differential effects of chylomicron remnants derived from corn oil or palm oil on bile acid synthesis and very low density lipoprotein secretion in cultured rat hepatocytes.

The effects of chylomicron remnants derived from corn oil (rich in n-6 polyunsaturated fatty acids) and palm oil (rich in long chain saturated fatty acids) on bile acid synthesis and very low density lipoprotein secretion in cultured rat hepatocytes were studied. Incubation of the cells with corn oil remnants led to increased bile acid production, while the secretion of lipid in very low density lipoprotein remained unchanged. In contrast, addition of palm oil remnants to the medium did not affect bile acid synthesis, but resulted in the secretion of cholesterol-rich very low density lipoprotein. These findings show that chylomicron remnants of different fatty acid composition have differential effects on cholesterol metabolism in liver cells, and provide part of the explanation for the hyper- and hypocholesterolaemic effects of saturated and polyunsaturated fatty acids.

Age-related variations in plasma and liver lipids of Yoshida rats: a comparison with Wistar rats.

Lipoprotein and liver lipids of spontaneously hyperlipidemic Yoshida rats were compared with those of normolipidemic Wistar animals for studying their age- and strain-related differences. Both strains showed an age-related increase in the total plasma cholesterol concentration. However, the Yoshida strain had a higher content of cholesteryl esters and triglycerides than the Wistar strain in both young and adult animals (2- and 8-month-old animals, respectively). The free cholesterol content was also higher, but only in the 8-month-old animals. Both strains showed an age-related increase in the proportion of HDL1 and a symmetrical decrease in both the HDL2 and HDL3 subfractions, but the variations were more evident in the Yoshida strain. The study of strain-related differences suggested that the spontaneous hypertriglyceridemia of the Yoshida strain was not only related to the higher amount and proportion of the VLDL fraction, but also to the higher content of triglycerides in the LDL fraction. The livers of Yoshida rats accumulated more triglycerides (with an age-related progression) than those of Wistar rats. The major lipid classes in the liver of Yoshida rats contained a significantly higher proportion of monounsaturated fatty acyls. Furthermore, this proportion showed an age-related increase in all the lipid classes, but in cholesteryl esters. This suggested that liver desaturases had a relevant role in the development of hyperlipidemia, and of its age-related variations, in the Yoshida strain.(ABSTRACT TRUNCATED AT 250 WORDS)

Decreased hepatic uptake and processing of high density lipoprotein unesterified cholesterol and cholesteryl ester with age in the rat.

As part of a study of the effects of aging on lipoprotein metabolism, the uptake and processing in vivo of cholesterol from high density lipoprotein (HDL) was compared in young (3 months of age) and mature (10-12 months of age) rats by studying the fate of HDL [3H] unesterified cholesterol or [3H] cholesteryl ester after intravenous administration. Radioactivity from [3H] unesterified cholesterol was cleared from the blood more slowly in older rats, and this difference was accounted for by decreased uptake by the liver. Uptake by other tissues were unaffected. In addition, a shift in the distribution of radioactivity across the plasma lipoprotein density range from the d = 1.125-1.250 g/ml (HDL3) to the d = 1.050-1.085 g/ml (HDL1) fraction was observed in the mature as compared to the young rat group. The secretion of radioactivity from [3H] unesterified cholesterol into bile was also decreased in the older animals, particularly in the first hour after injection of the label. In the case of HDL labeled with [3H] cholesteryl ester, clearance from the blood was similar in both age groups in the first 30 min after injection, but was significantly lower in older rats at later time points. After 180 min, less radioactivity was found in the VLDL density fraction in mature as compared to young rats, suggesting that hepatic secretion of VLDL cholesterol originating from HDL cholesteryl ester is less efficient in the older animals. The amount of radioactivity from HDL [3H] cholesteryl ester secreted in bile was less in the mature rat group at all time points measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation in vivo of the differential uptake and processing of high-density lipoprotein unesterified cholesterol and cholesteryl ester in the rat.

The uptake and processing of high-density lipoprotein (HDL) unesterified and esterified cholesterol were compared in vivo in the rat. HDL labelled with 3H in either unesterified cholesterol or cholesteryl ester was administered intravenously, and the clearance of radioactivity from the blood, its distribution in plasma lipoprotein density fractions, uptake by tissues, and appearance in bile were studied at intervals up to 180 min. 3H in HDL unesterified cholesterol was cleared more rapidly from the blood than that in HDL cholesteryl ester, and this difference was mainly due to rapid sequestration of [3H]unesterified cholesterol by the liver, with 58.2% of the administered dose found in this tissue after 10 min, compared to 6.8% of the [3H]cholesteryl ester dose. Non-hepatic tissues took up only a small proportion of the administered label from both HDL unesterified and esterified cholesterol, but on a per gram wet weight basis, the specific uptake of HDL cholesteryl ester in the adrenal glands and the spleen was higher than in the liver, particularly in the first 60 min. The distribution of radioactivity in the plasma lipoprotein density fractions remained constant between 10 and 180 min when [3H]unesterified cholesterol was used, but the proportion of plasma radioactivity from HDL labelled in esterified cholesterol in the very-low-density lipoprotein (VLDL) fraction increased from 0% to 26%, while in HDL there was a shift in the distribution of radioactivity from the most (d 1.125-1.250 g/ml) to the least (d 1.050-1.085 g/ml) dense sub-fractions. A greater percentage of the administered label from HDL unesterified cholesterol (8.8%) than from HDL cholesteryl ester (3.3%) was secreted into bile during 180 min, but the proportions secreted in bile acids and unesterified cholesterol were similar with both labels. These findings indicate that there are significant differences in the uptake and processing of HDL unesterified as compared to esterified cholesterol in the rat in vivo.