共查询到20条相似文献,搜索用时 62 毫秒
1.
Jon Zabaleta Borja Aguinagalde José Miguel Izquierdo Mikel Mendoza Francisco Basterrechea Maialen Martin-Arruti Carmen Lobo José Ignacio Emparanza 《Archivos de bronconeumología》2013
Introduction
In recent years, there has been debate regarding the diagnostic accuracy of computed tomography (CT) in the identification of lung metastases and the need for lung palpation to determine the number of metastatic nodules. The aim of this study was to determine in which patients the CT scan was more effective in detecting all metastases.Methods
We studied all patients who underwent curative thoracotomy for pulmonary metastasis between 1998 and 2012. All cases were reviewed by two expert pulmonary radiologists before surgery. Statistical analyses were performed using Systat version 13.Results
The study included 183 patients (63.6% male) with a mean age of 61.7 years who underwent 217 interventions. The CT scan was correct in 185 cases (85.3%). Discrepancies observed: 26 patients (11.9%) with more metastases resected than observed and 6 cases (2.8%) with fewer metastases. In patients with one or two metastases of colorectal origin or a single metastasis of any other origin, the probability of finding extra nodules was 9.5%. In the remaining patients, the probability was 27.8%, with statistically significant differences (P = .001). The mean age of the patients in whom no unobserved nodules were detected was 62.9 years compared to 56.5 years on average in patients who were free from any metastases (P = .001).Conclusions
Patients older than 60 years, with one or two metastases of colorectal origin or a single metastasis from any other origin were considered to be the group with low probability of having more metastases resected than observed. 相似文献2.
3.
Marcos Rodríguez-Esteban Manuel Anguita Sara Miranda-Montero Juan Carlos Castillo Luis Álvarez-Acosta Francisco Castillo Rafael Llorens-León José Suárez-de Lezo 《Enfermedades infecciosas y microbiología clínica》2014
Objectives
To assess possible differences in clinical presentation, microbiology, morbidity and mortality of infective endocarditis between two Spanish hospitals, one on the mainland that has cardiac surgery and one in the Canary Islands without this service.Method
A total of 229 patients consecutively diagnosed of endocarditis between 2005 and 2012, including pediatric population, were studied in the Reina Sofía Hospital (Córdoba, n = 119) and Nuestra Señora de Candelaria Hospital (Tenerife, n = 110). We compared the clinical, microbiological and echocardiographic data and analyzed mortality differences by binary logistic regression analysis.Results
There were no differences in underlying heart disease, proportion of surgery, or the microbiological profile. The proportion of infections attributable to catheter was higher in the Canary Islands hospital (13.6% vs 3.4%). Mortality was also higher (31.8% vs 18.5%, P = .020), although this difference was no longer significant in the multivariate analysis (OR = 1.85; 95% CI, 0.70-4.87; P = .213). Age (OR = 1.04/year; 95% CI, 1.01-1.07; P = .006), cardiac complications (OR = 5.05; 95% CI, 1.78-14.34; P = .002), persistent sepsis (OR = 4.89; 95% CI, 2.09-11.46; P < .001), and emergent surgery (OR = 4.43, 95% CI, 1.75-11.19; P = .002) were independent predictors of death. Time to surgery, length of stay in the hospital without a surgical service (20 [13-30.5] vs 13 [6-25] days; P = .019) was not associated with outcome.Conclusions
There are differences in the presentation of endocarditis between two distant hospitals in Spain. The different hospital mortality can not be directly related to the presence of a surgery service. 相似文献4.
Miriam Delgado M. Mar Álvarez Inés Carrascosa María Rodríguez-Velasco José Luis Barrios Andrés Canut 《Enfermedades infecciosas y microbiología clínica》2013
Objective
To evaluate process-of-care indicators (inappropriate hospitalisation, suitability and early antibiotic treatment) and outcome indicators (length of hospital stay, hospital readmission, ICU admission, and mortality) in the management of community-acquired pneumonia (CAP) when the SEPAR/IDSA guidelines were applied.Patients and methods
An observational retrospective study conducted on patients diagnosed with CAP during the first semester of 2007 and 2008 (186 and 161 patients, respectively) in the emergency unit of a general hospital. Differences in the process-of-care and outcome indicators between 2007 and 2008 (with and without the Pneumonia Severity Index [PSI]) were evaluated. Moreover, the indicators were compared with those obtained in 2006 (110 patients), when the current guidelines were those of SEQ/ATS.Results
The SEPAR/IDSA guidelines improved the following process-of-care indicators: appropriateness of treatment, unjustified hospital readmission (39.4% in 2006 vs. 8.5% in 2007 [P < .001], and 17,2% in 2008 [P = .005]), and early treatment. However, outcome indicators did not change. In 2008, a decrease in the mortality of the patients of risk classes IV-V in which the PSI had been estimated was observed in comparison with the patients in which the PSI was not estimated (2.3% vs. 28.3%; P < .001). Moreover, the mortality rate of the patients of risk classes IV-V in which the PSI had been estimated was lower than those measured using the SEQ/ATS guidelines (22.7%; P = .003).Conclusion
SEPAR/IDSA guidelines decreased the unjustified hospital readmission. In the second year of its application an increase in the number of patients who received early treatment, and a decrease of the mortality rate of the patients of risk classes IV-V in which the PSI had been estimated, were also observed. 相似文献5.
Rafael Golpe Pilar Sanjuán LópezEsteban Cano Jiménez Olalla Castro AñónLuis A. Pérez de Llano 《Archivos de bronconeumología》2014
Introduction
Exposure to biomass smoke is a risk factor for chronic obstructive pulmonary disease (COPD). It is unknown whether COPD caused by biomass smoke has different characteristics to COPD caused by tobacco smoke.Objective
To determine clinical differences between these two types of the disease.Methods
Retrospective observational study of 499 patients with a diagnosis of COPD due to biomass or tobacco smoke. The clinical variables of both groups were compared.Results
There were 122 subjects (24.4%) in the biomass smoke group and 377 (75.5%) in the tobacco smoke group. In the tobacco group, the percentage of males was higher (91.2% vs 41.8%, P < .0001) and the age was lower (70.6 vs 76.2 years, P < .0001). Body mass index and FEV1% values were higher in the biomass group (29.4 ± 5.7 vs 28.0 ± 5.1, P = .01, and 55.6 ± 15.6 vs 47.1 ± 17.1, P < .0001, respectively). The mixed COPD-asthma phenotype was more common in the biomass group (21.3% vs 5%, P < .0001), although this difference disappeared when corrected for gender. The emphysema phenotype was more common in the tobacco group (45.9% vs 31.9%, P = .009). The prevalence of the chronic bronchitis and exacerbator phenotypes, the comorbidity burden and the rate of hospital admissions were the same in both groups.Conclusion
Differences were observed between COPD caused by biomass and COPD caused by tobacco smoke, although these may be attributed in part to uneven gender distribution between the groups. 相似文献6.
Albert Ariza-Solé Francesc Formiga Victoria Lorente José C. Sánchez-Salado Guillermo Sánchez-Elvira Gerard Roura Remedios Sánchez-Prieto Maria Vila Pedro Moliner Angel Cequier 《Revista espa?ola de cardiología》2014
Introduction and objectives
The incidence of acute coronary syndromes is high in the elderly population. Bleeding is associated with a poorer prognosis in this clinical setting. The available bleeding risk scores have not been validated specifically in the elderly. Our aim was to assess predictive ability of the most important bleeding risk scores in patients with acute coronary syndrome aged ≥ 75 years.Methods
We prospectively included consecutive acute coronary syndromes patients. Baseline characteristics, laboratory findings, and hemodynamic data were collected. In-hospital bleeding was defined according to CRUSADE, Mehran, ACTION, and BARC definitions. CRUSADE, Mehran, and ACTION bleeding risk scores were calculated for each patient. The ability of these scores to predict major bleeding was assessed by binary logistic regression, receiver operating characteristic curves, and area under the curves.Results
We included 2036 patients, with mean age of 62.1 years; 369 patients (18.1%) were ≥ 75 years. Older patients had higher bleeding risk (CRUSADE, 42 vs 22; Mehran, 25 vs 15; ACTION, 36 vs 28; P<.001) and a slightly higher incidence of major bleeding events (CRUSADE bleeding, 5.1% vs 3.8%; P=.250). The predictive ability of these 3 scores was lower in the elderly (area under the curve, CRUSADE: 0.63 in older patients, 0.81 in young patients; P = .027; Mehran: 0.67 in older patients, 0.73 in younger patients; P = .340; ACTION: 0.58 in older patients, 0.75 in younger patients; P = .041).Conclusions
Current bleeding risk scores showed poorer predictive performance in elderly patients with acute coronary syndromes than in younger patients.Full English text available from:www.revespcardiol.org/en 相似文献7.
Bienvenida Carpe-Carpe Lauro Hernando-Arizaleta M. Carmen Ibáñez-Pérez Joaquín A. Palomar-Rodríguez Antonio M. Esquinas-Rodríguez 《Archivos de bronconeumología》2013
Introduction
Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain).Subjects and methods
A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression.Results
We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC] = −3.4, 95% CI: − 4.8; −2.0, P <.05) and in the group without ventilatory intervention (APC = −4.2%, −5.6; −2.8, P <.05); upward trend in the use of NIV (APC = 16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC = −4.5%, −10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC = 0.5, −1.3; 2.4) and in the group without intervention (APC = 0.1, −1.6; 1.9); downward trend with statistical significance in the NIV group (APC = −7.1, −11.7; −2.2, P <.05) and not statistically significant in the IMV group (APC = −0,8, −6, 1; 4.8). The mean stay did not change substantially.Conclusions
The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay. 相似文献8.
Efecto de la infección por Clostridium difficile sobre la estancia hospitalaria. Estudio de cohortes
Diana Monge Isabel Millán Alba González-Escalada Ángel Asensio 《Enfermedades infecciosas y microbiología clínica》2013
Introduction
Clostridium difficile is responsible for a spectrum of diseases known as “Clostridium difficile infection” (CDI). It is currently the leading cause of nosocomial diarrhea in developed countries. This infection has been associated with both increased hospital stay and mortality, and to a greater likelihood of readmission. In our country these undesirable effects have not yet been characterized. Our objective was to quantify the increase in hospital stay attributable to infection by C. difficile.Methods
A retrospective cohort study matched by age, sex and admission date, was conducted in a tertiary care university hospital during an outbreak of nosocomial transmission of CDI.Results
The cohort study included 38 infected, and 76 non-infected patients. Patients who developed CDI showed a higher proportion of malnutrition at admission (OR = 10.3; 3.6 to 29.6), were exposed to a wider range of antibiotics (mean difference = 1.5; 0.7-2.2), had a higher mortality (31.6% vs. 6.6% of controls, P < .001), and a longer hospital stay (median 31.5 days versus 5.5 days for controls, P < .001). After adjustment, infection by C. difficile was associated with an increase in hospital stay of 4 days (P < .001).Conclusions
C. difficile infection has important consequences on the length of hospital stay, and therefore on health costs. 相似文献9.
Marina Sánchez-Yepes Eduardo Aznar-Oroval Pablo Lorente-Alegre Tomás García-Lozano Isabel Picón-Roig Pilar Pérez-Ballestero Blanca Ortiz-Muñoz 《Enfermedades infecciosas y microbiología clínica》2014
Introduction and objective
Neutropenia is a frequent sign in patients who are going to have a haematopoietic stem cell transplant (HSCT). Infection is an important complication in these patients, which is favoured by immunosuppression and the degree of neutropenia. This study aims to evaluate the diagnostic usefulness of procalcitonin (PCT) and C-reactive protein (CRP) in onco-haematological patients undergoing chemotherapy and HSCT to determine the origin of the fever.Patients and methods
PCT and CRP values were measured in 30 episodes of febrile neutropenia: before starting chemotherapy, appearance of neutropenia, onset of fever, days 1, 2, 3 and 6 after the onset of fever, and when the febrile episode ended. The episodes were classified as 5 bacteraemia, 3 microbiologically documented infections, 10 clinical infections, and 12 fevers of unknown origin.Results
The highest PCT mean values corresponded to the group of patients with bacteraemia. Statistically significant differences (P = .04) were found on the second day after the onset of fever. The cut-off point of 0.5 ng/ml showed a sensitivity of 66% and a specificity of 75%. PCR results showed statistically significant differences on days 1, 2 and 3 after the onset of fever (P = .01, P = .003, and P = .002, respectively). The cut-off point of 7.5 mg/L had a sensitivity of 88% and a specificity of 58%.Conclusions
The combination of PCT and CRP is an insufficient method to detect bacterial infections and may not replace the proper clinical and microbiological diagnosis. 相似文献10.
Alicia Calle Miguel Angel Márquez Marta Arellano Laura Mónica Pérez Maria Pi-Figueras Ramón Miralles 《Archivos de bronconeumología》2014
Introduction
To assess the relationship between the parameters obtained in the geriatric assessment and mortality in elderly people with community-acquired pneumonia in an acute care geriatric unit.Methods
Four hundred fifty-six patients (≥ 75 years). Variables: age, sex, referral source, background, consciousness level, heart rate, breathing rate, blood pressure, laboratory data, pleural effusion, multilobar infiltrates, functional status (activities of daily living) prior to admission [Lawton index (LI), Barthel index (BIp)] prior to and at admission (BIa), cognitive status [Pfeiffer test (PT)], comorbidity [Charlson index (ChI)] and nutrition (total protein, albumin).Results
A hundred ten patients died (24.2%) during hospitalization. These patients were older (86.6 ± 6.4 vs 85.1 ± 6.4, P < .04), had more comorbidity (ChI 2.35 ± 1.61 vs 2.08 ± 1.38; P < .083), worse functional impairment [(LI: 0.49 ± 1.15 vs 1.45 ± 2.32, P < .001) (BIp: 34.6 ± 32.9 vs 54.0 ± 34.1, P < .001) (BIa: 5.79 ± 12.5 vs 20.5 ± 22.9, P < .001)], a higher percentage of functional loss at admission (85.9 ± 23.2 vs 66.4 ± 28.6; P < .0001), worse cognitive impairment (PT: 7.20 ± 3.73 vs 5.10 ± 3.69, P < .001) and malnutrition (albumin 2.67 ± 0.54 vs 2.99 ± 0.49, P < .001). Mortality was higher with impaired consciousness [49.2% (P < .01)], tachypnea [33.3% (P < .01)], tachycardia [44.4% (P < .002), high urea levels [31.8 (P < .001)], anemia [44.7% (P < .02)], pleural effusion [42.9% (P < .002)], and multilobar infiltrates [43.2% (P < .001)]. In the multivariate analysis, variables associated with mortality were: age ≥ 90 years [OR: 3.11 (95% CI: 1.31 to 7.36)], impaired consciousness [3.19 (1.66 to 6.15)], hematocrit < 30% [2.87 (1.19 to 6.94)], pleural effusion [3.77 (1.69 to 8.39)] and multilobar infiltrates [2.76 (1.48 to 5.16)]. Female sex and a preserved functional status prior (LI ≥ 5) and during admission (BIa ≥ 40) were protective of mortality [0.40 (0.22 to 0.70), 0.09 (0.01 to 0.81) and 0.11 (0.02 to 0.51)].Conclusions
Geriatric assessment parameters and routine clinical variables were associated with mortality. 相似文献11.
Agustín Julián-Jiménez Jesús Timón Zapata Emilio José Laserna Mendieta Isabel Sicilia-Bravo María José Palomo-de los Reyes Ángeles Cabezas-Martínez Natividad Laín-Terés Josefa Estebaran-Martín Agustín Lozano-Ancín Rafael Cuena-Boy 《Enfermedades infecciosas y microbiología clínica》2014
Objectives
To analyse the usefulness and performance of several biomarkers [C-reactive protein (CRP), mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT)] and lactate in predicting short- and medium-term mortality compared with the prognostic severity scales (PSS) usually employed for community-acquired pneumonia (CAP) and in assessing the aetiological suspicion of infection by Streptococcus pneumoniae and bacteraemia.Methods
Observational, prospective and analytical study was conducted on patients who were diagnosed with CAP in our emergency department (ED). The data collected included socio-demographic and comorbidity variables, Charlson index, priority level according to the Spanish Triage System (STS), stage in the Pneumonia Severity Index (PSI) and in the CURB-65 (confusion, urea, respiratory rate, blood pressure and age ≥ 65 years), criteria of severe CAP, microbiological studies, and biomarkers determinations. The patients were followed-up for 180 days to calculate the prognostic power and the diagnostic performance for bacteraemia and aetiology.Results
A total of 127 patients were finally enrolled in the study. The 30-day mortality was 10.3% (13), and 22.6% (28) at 180 days. Blood cultures were positive in 29 patients (23%) and S. pneumoniae was identified as the responsible pathogen in 28 cases (22.2%). The area under the ROC curve (AUC-ROC) for lactate and MR-proADM to predict 30-day mortality was 0.898 (95% CI: 0.824-0.973; P < .0001) and 0.892 (95% CI: 0.811-0.974; P < .0001), respectively, and for MR-proADM at 180 days it was 0.921 (95% CI: 0.874-0.968; P < .0001). The AUC-ROC for PCT to predict bacteraemia was 0.952 (95% CI: 0.898-1.000; P < .0001) and, considering a cut-off value ≥ 0.95 ng/ml, the negative predictive value (NPV) and the likelihood ratio (LR+) were 97.8% and 9.03, respectively. Using a PCT cut-off value > 0.85 ng/ml, the NPV and the LR+ were 96.6% and 5.89%, respectively, to predict a S. pneumoniae infection.Conclusions
MR-proADM and lactate showed a similar or even better performance for 30-day intra-hospital mortality than PSI, CURB-65, STS and CAP severity criteria in patients diagnosed with CAP (P > .05). Furthermore, the MR-proADM capacity to predict 180-day mortality was higher than PSS and the rest of biomarkers (P > .05), and its AUC-ROC increased if it was used in combination with PSI, CURB65 and STS. The determination of PCT has a remarkable diagnostic performance to rule out bacteraemia and to orientate the aetiology towards a S. pneumoniae infection. 相似文献12.
Tamara Lourido-Cebreiro Virginia Leiro-Fernández Antoni Tardio-Baiges Maribel Botana-Rial Manuel Núñez-Delgado M. Jesús Álvarez-Martín Alberto Fernández-Villar 《Archivos de bronconeumología》2014
Background
Cell block material from puncture can be obtained with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in many cases. The aim of this study was to analyse the value of additional information from cell blocks obtained with EBUS-TBNA samples from mediastinal and hilar lymph nodes and masses.Methods
Review of pathology reports with a specific diagnosis obtained from EBUS-TBNA samples of mediastinal or hilar lesions, prospectively obtained over a two-year period. The generation of cell blocks from cytology needle samples, the contribution to morphological diagnosis, and the possible use of samples for immunohistochemistry were analysed.Results
One hundred and twenty-nine samples corresponding to 110 patients were reviewed. The diagnosis was lung cancer in 81% of cases, extrapulmonary carcinoma in 10%, sarcoidosis in 4%, lymphoma in 2.7%, and tuberculosis in 0.9%. Cell blocks could be obtained in 72% of cases. Immunohistochemistry studies on the cell blocks were significantly easier to perform than on conventional smears (52.6% vs. 14%, P < .0001). In 4 cases, the cell block provided an exclusive morphological diagnosis (3 sarcoidosis and one metastasis from prostatic carcinoma) and in 3 carcinomas, subtype and origin could be identified. Exclusive diagnoses from the cell block were significantly more frequent in benign disease than in malignant disease (25% vs 0.9%, P = .002).Conclusions
Cell blocks were obtained from 72% of EBUS-TBNA diagnostic procedures. The main contributions of cell blocks to pathology examinations were the possibility of carrying out immunohistochemical staining for the better classification of neoplasms, especially extrapulmonary metastatic tumours, and the improved diagnosis of benign lesions. 相似文献13.
José L. Zamorano Xavier García-Moll Roberto Ferrari Nicola Greenlaw 《Revista espa?ola de cardiología》2014
Introduction and objectives
Coronary artery disease is associated with high morbidity and mortality. The objective of the CLARIFY registry is to study the treatment of outpatients with coronary artery disease in the setting of daily clinical practice.Methods
The CLARIFY registry is a prospective registry conducted in 41 countries that included outpatients with stable coronary artery disease attending primary care or specialist units between October 2009 and June 2010. The present study describes the baseline characteristics of the Spanish cohort compared with the western European cohorts included in the registry.Results
A total of 33 248 patients were included: 14 726 in western Europe and 2257 in Spain (selected by 192 cardiologists). The majority of the participants in Spain were men (81%) with a mean age of 65 years. There was a higher frequency of diabetes (34% vs 25%; P < .0001), coronary artery disease family history (19% vs 31%; P < .0001), myocardial infarction (64% vs 60%; P < .0001), and stroke (5% vs 3%; P = .0007) in the Spanish cohort than in the western European cohorts. The most common treatments in the Spanish sample were lipid-lowering drugs (96%), acetylsalicylic acid (89%), and beta-blockers (74%).Conclusions
Patients in the Spanish cohort are similar to those in the western European cohorts and seem to be representative of the Spanish population with coronary artery disease. Therefore, they form a suitable basis for the study of prognostic factors at 5-year follow-up.Full English text available from: www.revespcardiol.org/en 相似文献14.
Yolanda Molina-Salas María de las Mercedes Lomas-Campos Francisco José Romera-Guirado María Jesús Romera-Guirado 《Archivos de bronconeumología》2014
Aims
To describe the epidemiology of tuberculosis and analyzing the differences among native and immigrant patients in Area III of the Region of Murcia.Methods
Cohort study of tuberculosis cases reported to the Epidemiological Surveillance Service from 2004 to 2009. Data collection was performed through the System of Notification Diseases, reviewing clinical files and epidemiological surveys.Results
One hundred sixty two cases were detected; 110 (67.9%) were immigrants, whose incidence rates ranged from 43.4 to 101.2 cases per 100,000 inhabitants. Ecuador (42.7%), Bolivia (30%) and Morocco (18.2%) were the main nationalities.Immigrants were younger than Spanish population (P < .001). The overall diagnostic delay was 50.5 days: 59.5 in Spanish and 47 in foreigners. Moroccans had higher proportions of extrapulmonary TB (P = .02). Mainly, immigrant population took treatment with four drugs (P < .001). Natives had better treatment adherence (P = .04). Spanish cases tuberculosis were associated with smoking (P < .001), the same as alcohol consumption (P = .01) and injection drug use (P < .001), nevertheless in the foreign-born population the most relevant risk factor was overcrowding (P < .001).Conclusions
The incidence tuberculosis rates are higher among immigrant population, whose the main risk factor is overcrowding. In contrast, Spanish cases are associated with toxic substances consumption and increasing age. 相似文献15.
Armando Pérez de Prado Claudia Pérez-Martínez Carlos Cuellas Ramón Marta Regueiro Purriños Alejandro Diego Nieto José M. Gonzalo-Orden María Molina Crisol Alex Gómez Castel Luis Duocastella Codina Felipe Fernández-Vázquez 《Revista espa?ola de cardiología》2014
Introduction and objectives
Paclitaxel-eluting balloons have shown high antiproliferative efficacy in the treatment and prevention of restenosis. Nevertheless, not all available devices are equally effective, which makes it interesting to compare results in a preclinical model. Our objective was to assess the preclinical efficacy and safety of different devices.Methods
We implanted 51 metallic stents (Architect®, iVascular) in 17 domestic swine (mean, 25 [3] kg), inserting 1 stent per major coronary artery. Stent postdilatation was performed with different control balloons (n = 10) or paclitaxel-eluting balloons: paclitaxel-eluting balloon 1 (iVascular) (n = 15); paclitaxel-eluting balloon 2 (iVascular) (n = 16) and In.Pact Falcon® (Medtronic) (n = 10). The restenosis rate (using angiography and histomorphometry) and vascular healing parameters (balloon-related vascular injury score, endothelialization rate, and fibrin and inflammation scores) were analyzed at 28 days.Results
The distinct paclitaxel-eluting balloons showed a similar degree of stenosis at follow-up, which was significantly lower than that in the control group: diameter stenosis was 9% (12%) vs 34% (18%) by angiography (P < .0001) and was 22% (8%) vs 51% (18%) by histomorphometry (P < .0001). Scores for vascular injury (mean, 0.6 [0.5]) and inflammation (mean, 0.8 [0.3]) were uniformly low across all groups. Drug effect markers differed significantly between the paclitaxel-eluting balloons and control groups, with lower endothelialization rates (87% [10%] vs 99% [2%]; P = .0007) and higher fibrin scores (2.1 [0.7] vs 0.4 [0.5]; P < .0001) in the paclitaxel-eluting balloons groups. There were no differences between the different paclitaxel-eluting balloons.Conclusions
In this preclinical model, the paclitaxel-eluting balloons studied significantly reduced in-stent restenosis compared with the control balloons. Although there were no findings of persistent vascular injury or inflammation, delayed endothelialization and fibrin aggregate suggest a drug deposition response.Full English text available from:www.revespcardiol.org/en 相似文献16.
Petri O. Tuomainen Jussi Sia Wail Nammas Matti Niemelä Juhani K.E. Airaksinen Fausto Biancari Pasi P. Karjalainen 《Revista espa?ola de cardiología》2014
Introduction and objectives
We performed a pooled analysis based on patient-level data from the TITAX-AMI and BASE-ACS trials to evaluate the outcome of titanium-nitride-oxide-coated bioactive stents vs drug-eluting stents in patients with ST-segment elevation myocardial infarction at 2-year follow-up.Methods
The TITAX-AMI trial compared bioactive stents with paclitaxel-eluting stents in 425 patients with acute myocardial infarction. The BASE-ACS trial compared bioactive stents with everolimus-eluting stents in 827 patients with acute coronary syndrome. The primary endpoint for the pooled analysis was major adverse cardiac events: a composite of cardiac death, recurrent myocardial infarction, or ischemia-driven target lesion revascularization at 2-year follow-up.Results
The pooled analysis included 501 patients; 245 received bioactive stents, and 256 received drug-eluting stents. The pooled bioactive stent group was associated with a risk ratio of 0.85 for major adverse cardiac events (95% confidence interval, 0.53-1.35; P = .49) compared to the pooled drug-eluting stent group. Similarly, the pooled bioactive stent group was associated with a risk ratio of 0.71 for cardiac death (95% confidence interval, 0.26-1.95; P = .51), 0.44 for recurrent myocardial infarction (95% confidence interval, 0.20-0.97; P = .04), and 1.39 for ischemia-driven target lesion revascularization (95% confidence interval, 0.74-2.59; P = .30), compared to the pooled drug-eluting stent group. These results were confirmed by propensity-score adjusted analysis of the combined datasets.Conclusions
In patients with ST-segment elevation myocardial infarction, bioactive stents were associated with lower rates of recurrent myocardial infarction compared to drug-eluting stents at 2-year follow-up; yet, the rates of cardiac death and ischemia-driven target lesion revascularization were similar.Full English text available from: www.revespcardiol.org/en 相似文献17.
Introduction and Objectives
To determine the causes of death in patients operated on for stage IB non-small cell lung cancer (NSCLC) and to assess the impact on survival of the number of lymph nodes removed.Patients and Method
We studied 300 patients operated on for stage IB NSCLC. Only palpable or visible lymph nodes were excised. Kaplan-Meier survival estimates were calculated and the survival curves were compared using the log-rank test.Results
The mean (SD) age of the patients was 62.9 (9.7) years; 280 were men, 20 were women. Pneumonectomy was performed in 84 patients, lobectomy in 186, double lobectomy in 23, and segmentectomy in 7. Squamous cell carcinoma was the most common histologic type. The mean number of lymph nodes excised was 5.05 (5.01). At the time of the study 201 patients (67%) had died, 63.2% from causes related to the NSCLC. Overall 5-year survival for the patient series was 51.9% (median, 5.50 years; 95% confidence interval [CI], 4.14–6.87 years), though the 5-year survival rate was 61.87% after non-NSCLC–related deaths were excluded (median, 11.05 years; 95% CI, 7.63–14.48 years). Tumor size and the number of lymph nodes examined significantly affected survival. In the multivariate analysis, these 2 variables were also significantly correlated with the risk of death from NSCLC (P<.0001), with relative risks of 1.158 (95% CI, 1.081–1.240) and 0.387 (95% CI, 0.254–0.591), respectively.Conclusion
Besides being affected by stage and tumor size, survival in patients operated on for stage IB NSCLC is significantly influenced by the total number of lymph nodes examined. Therefore, surgical treatment of such patients should include the examination of as many lymph nodes as possible. 相似文献18.
Antonio Sancho-Muñoz Carlos Trampal Sergi Pascual Juana Martínez-Llorens Roberto Chalela Joaquim Gea Mauricio Orozco-Levi 《Archivos de bronconeumología》2014
Introduction
Muscle dysfunction is one of the most extensively studied manifestations of COPD. Metabolic changes in muscle are difficult to study in vivo, due to the lack of non-invasive techniques. Our aim was to evaluate metabolic activity simultaneously in various muscle groups in COPD patients.Methods
Thirty-nine COPD patients and 21 controls with normal lung function, due to undergo computed axial and positron emission tomography for staging of localized lung lesions were included. After administration of 18-fluordeoxyglucose, images of 2 respiratory muscles (costal and crural diaphragm, and rectus abdominus) and 2 peripheral muscles (brachial biceps and quadriceps) were obtained, using the standard uptake value as the glucose metabolism index.Results
Standard uptake value was higher in both portions of the diaphragm than in the other muscles of all subjects. Moreover, the crural diaphragm and rectus abdominus showed greater activity in COPD patients than in the controls (1.8 ± 0.7 vs 1.4 ± 0.8; and 0.78 ± 0.2 vs 0.58 ± 0.1; respectively, P < .05). A similar trend was observed with the quadriceps. In COPD patients, uptake in the two respiratory muscles and the quadriceps correlated directly with air trapping (r = 0.388, 0.427 and 0.361, respectively, P < .05).Conclusions
There is greater glucose uptake and metabolism in the human diaphragm compared to other muscles when the subject is at rest. Increased glucose metabolism in the respiratory muscles (with a similar trend in their quadriceps) of COPD patients is confirmed quantitatively, and is directly related to the mechanical loads confronted. 相似文献19.
Introduction
Primary hyperhidrosis is characterized by excessive sweating of the palms, soles, and axillae due to overactivity of the sympathetic nervous system at the level of the second and third sympathetic thoracic ganglia. The treatment of choice is bilateral dorsal sympathectomy performed using video-assisted thoracic surgery (VATS). The objective of our study was to determine whether lung function changes observed in a group of patients prior to bilateral dorsal sympathectomy performed using VATS were still evident 3 years after surgery.Patients and methods
Of the 20 patients studied at baseline, we were able to obtain data for 18 (3 men and 15 women; mean age, 35 y). They underwent spirometry and a bronchial challenge test with methacholine, and the fraction of exhaled nitric oxide (FENO) was measured. The results were compared with those of the tests performed before surgery.Results
At 3 years from baseline, we detected a statistically significant increase in forced vital capacity from a mean (SD) of 96% (10%) to 101% (11%) (P=.008), and a statistically significant decrease in midexpiratory flow rate from 3.8 (0.9) L/s to 3.5 (0.9) L/s (P=.01). The results of the bronchial challenge test with methacholine and the FENO remained unchanged.Conclusions
The lung function changes detected point toward minimal, clinically insignificant small airway alterations due to sympathetic denervation following bilateral dorsal sympathectomy performed 3 years earlier. 相似文献20.
Javier Hueto Pérez De Heredia Pilar Cebollero RivasJosé Antonio Cascante Rodrigo Isabel Andrade VelaIdoya Pascal Martínez Joan Boldú MitjansVíctor Manuel Eguía Astibia 《Archivos de bronconeumología》2012