93 research outputs found
Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a Bronchus sign on CT imaging: results from a prospective study
Electromagnetic navigation bronchoscopy (ENB) has been developed as a
novel ancillary tool for the bronchoscopic diagnosis of pulmonary nodules.
Despite successful navigation in 90% of patients, ENB diagnostic yield does not
generally exceed 70%. We sought to determine whether the presence of a bronchus
sign on CT imaging conditions diagnostic yield of ENB and might account for the
discrepancy between successful navigation and diagnostic yield. METHODS: We
conducted a prospective, single-center study of ENB in 51 consecutive patients
with pulmonary nodules. ENB was chosen as the least invasive diagnostic technique
in patients with a high surgical risk, suspected metastatic disease, or
advanced-stage disease, or in those who demanded a preoperative diagnosis prior
to undergoing curative resection. We studied patient and technical variables that
might condition diagnostic yield, including size, cause, location, distance to
the pleural surface, and fluorodeoxyglucose uptake of a given nodule; the
presence of a bronchus sign on CT imaging; registration point divergence; and the
minimum distance from the tip of the locatable guide to the nodule measured
during the procedure. RESULTS: The diagnostic yield of ENB was 67% (34/51). The
sensitivity and specificity of ENB for malignancy in this study were 71% and
100%, respectively. ENB was diagnostic in 79% (30/38) patients with a bronchus
sign on CT imaging but only in 4/13 (31%) with no discernible bronchus sign.
Univariate analysis identified the bronchus sign (P = .005) and nodule size (P =
.04) as statistically significant variables conditioning yield, but on
multivariate analysis, only the bronchus sign remained significant (OR, 7.6; 95%
CI, 1.8-31.7). No procedure-related complications were observed. CONCLUSIONS: ENB
diagnostic yield is highly dependent on the presence of a bronchus sign on CT
imaging
Unravelling the skills and motivations of Magdalenian artists in the depths of Atxurra Cave (Northern Spain)
Atxurra cave has a decorated assemblage composed of more than a hundred engraved animal depictions. All of them are located in deep parts of the cave and most of them are hidden in raised areas, away from the main path. The main sector is the ?Ledge of the Horses?, located at 330 m from the entrance of the cave. It is a space of 12 m long and 1.5 m wide, elevated 4 m above the cave floor. This area includes almost fifty engraved and painted animals accompanied by a dozen flint tools, three fireplaces, and around one hundred charcoal fragments from torches. This extraordinary archaeological record allows us to value the complexity of the artistic production inside the caves during the Upper Palaeolithic. Our study has confirmed that there is planning prior to artistic production, both in terms of the iconographic aspects (themes, techniques, formats), its location (visibility, capacity), and the lighting systems. Furthermore, the data indicates the panel was decorated to be seen by third parties from different positions and was expressly illuminated for this purpose. This evidence supports the role of rock art as a visual communication system in Upper Palaeolithic societies.This research was made inside the 4-year multidisciplinary study project (2016–2020) “Study of rock art in
Atxurra cave” directed by Dr Diego Garate and funded by the Cultural Heritage Service of the Diputación Foral
de Bizkaia
Unravelling the skills and motivations of Magdalenian artists in the depths of Atxurra Cave (Northern Spain)
Atxurra cave has a decorated assemblage composed of more than a hundred engraved animal depictions. All of them are located in deep parts of the cave and most of them are hidden in raised areas, away from the main path. The main sector is the “Ledge of the Horses”, located at 330 m from the entrance of the cave. It is a space of 12 m long and 1.5 m wide, elevated 4 m above the cave floor. This area includes almost fifty engraved and painted animals accompanied by a dozen flint tools, three fireplaces, and around one hundred charcoal fragments from torches. This extraordinary archaeological record allows us to value the complexity of the artistic production inside the caves during the Upper Palaeolithic. Our study has confirmed that there is planning prior to artistic production, both in terms of the iconographic aspects (themes, techniques, formats), its location (visibility, capacity), and the lighting systems. Furthermore, the data indicates the panel was decorated to be seen by third parties from different positions and was expressly illuminated for this purpose. This evidence supports the role of rock art as a visual communication system in Upper Palaeolithic societies.The authors wish to thank the Cultural Heritage Service of the Diputación Foral de Bizkaia for funding the 4-year multidisciplinary study project (2016–2020) “Study of rock art in Atxurra cave” directed by Dr Diego Garate. The present study has been carried out within the framework of the research project "Before art: social investment in symbolic expressions during the Upper Palaeolithic in the Iberian Peninsula” (PID2019-107262GB-I00), PI: Diego Garate, funded by the Ministerio de Ciencia, Innovación y Universidades (Spain), the research projet “Scientific virtual reality for the study and dissemination of the scenarios of artistic creation in Palaeolithic caves (RealCaveART)” (PDC2022-133124-I00), PI: Diego Garate, funded by MCIN/AEI/10.13039/501100011033 and the European Union Next Generation EU/PRTR, and the research project “Creation and perception in Anatomically Modern Humans: analysis of the biological, cognitive and social skills linked to the production of Paleolithic art (ArtMindHuman)” (PID2021-125166OB-I00), PI: Olivia Rivero, funded by the Ministerio de Ciencia, Innovación y Universidades (Spain). I. Intxaurbe’s PhD research is funded by a grant for the training of research personnel (PIF 2019) at the University of the Basque Country (UPV/EHU). M.A. Median-Alcaide developpes lighting system analyses inside the framework of her “A-Light” project of the HORIZON-MSCA-2021-PF-01-01 (101066376)
Emphysema presence, severity, and distribution has little impact on the clinical presentation of a cohort of patients with mild to moderate COPD
Phenotypic characterization of patients with COPD may have potential
prognostic and therapeutic implications. Available information on the
relationship between emphysema and the clinical presentation in patients with
COPD is limited to advanced stages of the disease. The objective of this study
was to describe emphysema presence, severity, and distribution and its impact on
clinical presentation of patients with mild to moderate COPD. METHODS: One
hundred fifteen patients with COPD underwent clinical and chest CT scan
evaluation for the presence, severity, and distribution of emphysema. Patients
with and without emphysema and with different forms of emphysema distribution
(upper/lower/core/peel) were compared. The impact of emphysema severity and
distribution on clinical presentation was determined. RESULTS: Fifty percent of
the patients had mild homogeneously distributed emphysema (1.84; 0.76%-4.77%).
Upper and core zones had the more severe degree of emphysema. Patients with
emphysema were older, more frequently men, and had lower FEV(1)%, higher total
lung capacity percentage, and lower diffusing capacity of the lung for carbon
monoxide. No differences were found between the clinical or physiologic
parameters of the different emphysema distributions. CONCLUSIONS: In patients
with mild to moderate COPD, although the presence of emphysema has an impact on
physiologic presentation, its severity and distribution seem to have little
impact on clinical presentation
Trabecular bone score in active or former smokers with and without COPD
Background Smoking is a recognized risk factor for osteoporosis. Trabecular bone score (TBS) is a novel texture parameter to evaluate bone microarchitecture. TBS and their main determinants are unknown in active and former smokers. Objective To assess TBS in a population of active or former smokers with and without Chronic Obstructive Pulmonary Disease (COPD) and to determine its predictive factors. Methods Active and former smokers from a pulmonary clinic were invited to participate. Clinical features were recorded and bone turnover markers (BTMs) measured. Lung function, low dose chest Computed Tomography scans (LDCT), dual energy absorptiometry (DXA) scans were performed and TBS measured. Logistic regression analysis explored the relationship between measured parameters and TBS. Results One hundred and forty five patients were included in the analysis, 97 (67.8%) with COPD. TBS was lower in COPD patients (median 1.323; IQR: 0.13 vs 1.48; IQR: 0.16, p = 0.003). Regression analysis showed that a higher body mass index (BMI), younger age, less number of exacerbations and a higher forced expiratory volume-one second (FEV1%) was associated with better TBS (β = 0.005, 95% CI:0.000–0.011, p = 0.032; β = -0.003, 95% CI:-0.007(-)-0.000, p = 0.008; β = -0.019, 95% CI:-0.034(-)-0.004, p = 0.015; β = 0.001, 95% CI:0.000–0.002, p = 0.012 respectively). The same factors with similar results were found in COPD patients. Conclusions A significant proportion of active and former smokers with and without COPD have an affected TBS. BMI, age, number of exacerbations and the degree of airway obstruction predicts TBS values in smokers with and without COPD. This important information should be considered when evaluating smokers at risk of osteoporosis
Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest.
Identification of risk factors for lung cancer can help in selecting
patients who may benefit the most from smoking cessation interventions, early
detection, or chemoprevention. OBJECTIVE: To evaluate whether the presence of
emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk
factor for lung cancer. METHODS: The study used data from a prospective cohort of
1,166 former and current smokers participating in a lung cancer screening study.
All individuals underwent a baseline LDCT and spirometry followed by yearly
repeat LDCT studies. The incidence density of lung cancer among patients with and
without emphysema on LDCT was estimated. Stratified and multiple regression
analyses were used to assess whether emphysema is an independent risk factor for
lung cancer after adjusting for age, gender, smoking history, and the presence of
airway obstruction on spirometry. RESULTS: On univariate analysis, the incidence
density of lung cancer among individuals with and without emphysema on LDCT was
25.0 per 1,000 person-years and 7.5 per 1,000 person-years, respectively (risk
ratio [RR], 3.33; 95% confidence interval [CI], 1.41 to 7.85). Emphysema was also
associated with increased risk of lung cancer when the analysis was limited to
individuals without airway obstruction on spirometry (RR, 4.33; 95% CI, 1.04 to
18.16). Multivariate analysis showed that the presence of emphysema (RR, 2.51;
95% CI, 1.01 to 6.23) on LDCT but not airway obstruction (RR, 2.10; 95% CI, 0.79
to 5.58) was associated with increased risk of lung cancer after adjusting for
potential cofounders. CONCLUSIONS: Results suggest that the presence of emphysema
on LDCT is an independent risk factor for lung cancer
Immunological function restoration with Lopinavir/ritonavir vs Efavirenz containing regimens in HIV infected patients: a randomized clinical trial
CD4+ count increase has been reported to be different with lopinavir/r (LPV/r) and efavirenz (EFV)-containing regimens. The different effect of these two regimens on other immune function parameters and the relationship with the gain of CD4+ count have not been assessed in a randomized clinical trial. Fifty antiretroviral treatment (cART) naïve HIV-infected individuals were randomized to receive LPV/r or EFV both with tenofovir/emtricitabine for 48 weeks. A substudy of immunological function restoration was performed in 22 patients (LPV/r n=10 and EFV n=12). Activation, thymic function, apoptosis, senescence, exhaustion, Treg cells, interleukin (IL)-7-receptor/IL-7 system, thymic volume, and lymphoid tissue fibrosis were evaluated at baseline and at week 48. Both groups experienced a CD4+ count increase that was higher in the EFV group (ΔCD4+ 88 vs. 315 cells/μl LPV/r vs. EFV, respectively, p<0.001). Despite this difference in CD4+ gain, the change in other immune function parameters was similar in both treatment groups. Most of parameters evaluated tended to normalize after 48 weeks of cART. A significant decrease in levels of activation, senescence, exhaustion, and apoptosis on CD4+ and CD8+ T cells (p<0.001 for all) and a significant increase in markers of thymic function, IL-7 receptor, and in the levels of central memory CD4+ T cells and naive subsets of CD8+ T cells (p<0.001 for all) with respect to baseline values were observed without any difference between groups. These data indicate that the differences in CD4+ gain with different cART regimens are not immunologically meaningful and might explain the similar clinical efficacy of these regimens
Smokers with CT detected emphysema and no airway obstruction have decreased plasma levels of EGF, IL-15, IL-8 and IL-1ra
Current or former smokers expressing a well-defined disease characteristic such as emphysema, has a specific plasma cytokine profile. This includes a decrease of cytokines mainly implicated in activation of apoptosis or decrease of immunosurveillance. This information should be taken into account when evaluated patients with tobacco respiratory diseases
Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)
This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe
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