The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and ...treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.
Lung transplantation is a life-saving therapy for patients suffering from end stage lung diseases. Despite the many advances in the field, there is a clear shortage of donors primarily explained by ...the low utilization rate of the donor lungs offered for transplant. This underutilization is mainly a consequence of the surgeons being cautious about using more marginal lungs, because of the concern that patients will develop primary graft dysfunction (PGD) after transplant. PGD accounts for 30% of the mortality seen during the first month after transplant and it is also related to worse long term survival. Ischemia reperfusion injury (IRI) is a well-known contributing factor to the development of PGD. There is currently no therapy to prevent or treat PGD. In order to examine potential therapies to decrease IRI and reduce the incidence of PGD, there is a need for a relevant large animal lung transplant survival model. A1AT is a serine protease inhibitor, its main function is to act as an antiprotease for neutrophil elastase. It acts like an acute phase protein increasing its concentration during inflammation. A1AT as a drug was purified from human plasma for A1AT deficiency patients. Subsequent studies have shown that A1AT has anti-inflammatory effects in different settings. We have been studying the effect of A1AT in ischemia reperfusion injury in a systematic translational research approach testing its effects in progressively more complex models. Our hypothesis was that A1AT administered before transplantation in an attempt to reduce ischemia reperfusion injury would not have any detrimental side effects, and that A1AT dispensed to EVLP perfusate would improve human donor lungs that were previously rejected for transplantation. The first part of the thesis is centered in developing a relevant pig lung transplant survival model to later on be able to test potential therapeutics to prevent PGD. The second part of this work details the studies done to test alpha-1 antitrypsin (A1AT) in the pig single lung transplant survival model. Using the previously developed pig lung transplant survival model we were able to prove that A1AT is safe, well tolerated and if given to lung transplant recipient animals prior reperfusion, has beneficial effects including faster recovery and improved lung function after transplant. For the third part of this thesis we used ex vivo lung perfusion (EVLP) as a platform to treat human lungs with A1AT. We explored the effect of A1AT treatment given during EVLP to injured human lungs that were not suitable for transplantation. For each case we divided the double lung block and treated one of the lungs in a randomized and blinded fashion. Using this approach we were able to assess the treatment effect of A1AT in the treated lung compared with the untreated one (both from the same donor), as well as compare all cases together (treatment vs control). A1AT was shown to have a beneficial effect on lung function measured by oxygenation function (pO2) and compliance. Biologically, A1AT treatment reduced lung endothelial injury (protected tight junctions) and decreased important pro-inflammatory cytokines that are relevant to endothelial dysfunction. A1AT has been proven to have beneficial anti-inflammatory and immunomodulatory effects. A1AT is an already approved drug that has shown to be well tolerated and has the potential to improve human donor lungs that were previously rejected for transplantation. Based on our findings, we are confident to move forward with a randomized prospective clinical trial to use A1AT to prevent PGD in human lung transplantation.
Evolution and complications of chest trauma Ávila Martínez, Régulo José; Hernández Voth, Ana; Marrón Fernández, Carmen ...
Archivos de bronconeumología (English ed.),
05/2013, Letnik:
49, Številka:
5
Journal Article
Recenzirano
OBJECTIVETo describe the clinical characteristics and risk factors of patients with chest trauma, and to evaluate their correlation with the development of complications.METHODSDescriptive, ...prospective and analytical study of a patient cohort with chest trauma who underwent follow-up for a period of 30 days. Excluded from the study were those patients with moderate to severe traumatic brain injury, long-bone fractures, abdominal trauma and patients requiring mechanical ventilation.RESULTSA total of 376 patients met the inclusion criteria, 220 of whom were males (58.5%). The most frequent causes of trauma were falls (218 cases; 57.9%) and motor vehicle accidents (57 cases; 15.1%). The most frequent type of trauma was rib contusion (248 cases; 65.9%) and rib fractures (61 cases; 16.2%). Complications were observed in 43 patients (11.4%), mainly hemothorax (13 cases), pneumothorax (9 cases), pneumonia (6 cases) and acute renal failure (4 cases). Four patients died due to pneumonia and hemothorax. Thirty-three patients were hospitalized (8.7%) and 10 (2.6%) required later re-admittance. The risk for complications increased significantly in patients with more than 2 rib fractures, in those over the age of 85 and in the presence of certain comorbidities, such as COPD and pathologies requiring anticoagulation therapy. The risk for re-admittance is higher in patients over the age of 60.CONCLUSIONSPatients with chest trauma who present certain comorbidities, are over the age of 85 and have more than 2 rib fractures may present more complications. These factors should be contemplated in the evaluation, management and follow-up of these subjects.
Resumen La Sociedad Española de Neumología y Cirugía Torácica (SEPAR), a través de las áreas de Cirugía Torácica y de Oncología Torácica, ha promovido la realización de un manual de recomendaciones ...para el diagnóstico y el tratamiento del cáncer de pulmón de células no pequeñas. Las elevadas incidencia y mortalidad de esta patología hacen necesaria una constante actualización de las mejores evidencias científicas para su consulta por parte de los profesionales de la salud. Para su confección se ha contado con un amplio grupo de profesionales de distintas especialidades que han elaborado una revisión integral, que se ha concretado en 4 apartados principales. En el primero se ha estudiado la prevención y el cribado de la enfermedad, incluyendo los factores de riesgo, el papel de la deshabituación tabáquica y el diagnóstico precoz mediante programas de cribado. En un segundo apartado se ha analizado la presentación clínica, los estudios de imagen y el riesgo quirúrgico, incluyendo el cardiológico y la evaluación funcional respiratoria. Un tercero trata sobre los estudios de confirmación cito-histológica y de estadificación, con un análisis de las clasificaciones TNM e histológica, métodos no invasivos y mínimamente invasivos, así como las técnicas quirúrgicas para el diagnóstico y estadificación. En un cuarto y último capítulo se han abordado aspectos del tratamiento, como el papel de las técnicas quirúrgicas, la quimioterapia, la radioterapia, el abordaje multidisciplinar por estadios y otros tratamientos dirigidos frente a dianas específicas, terminando con recomendaciones acerca del seguimiento del cáncer de pulmón y los tratamientos paliativos quirúrgicos y endoscópicos en estadios avanzados.
Evolución y complicaciones del traumatismo torácico Ávila Martínez, Régulo José; Hernández Voth, Ana; Marrón Fernández, Carmen ...
Archivos de bronconeumología,
20/May , Letnik:
49, Številka:
5
Journal Article
Recenzirano
Resumen Objetivo Describir las características clínicas y los factores de riesgo de los pacientes con traumatismo torácico, y evaluar su relación en el desarrollo de complicaciones. Metodología ...Estudio de tipo descriptivo, prospectivo y analítico de una cohorte de pacientes con traumatismo torácico a los que se les hizo seguimiento durante un periodo de 30 días. Se excluyeron pacientes con traumatismo craneoencefálico moderado a severo, fracturas de huesos largos, traumatismo abdominal, y pacientes que requirieron ventilación mecánica. Resultados Un total 376 pacientes cumplieron criterios de inclusión, y de ellos 220 eran varones (58,5%). Las causas más frecuentes de traumatismo fueron las caídas (218 casos; 57,9%) y los accidentes de tráfico (57 casos; 15,1%). El tipo de traumatismo más frecuente fue la contusión costal (248 casos; 65,9%) y la fractura de un arco costal (61 casos; 16,2%). Se observaron complicaciones en 43 pacientes (11,4%), principalmente por hemotórax (13 casos), neumotórax (9 casos), neumonía (6 casos) e insuficiencia renal aguda (4 casos). De estos pacientes, 4 fallecieron por neumonía y hemotórax. Treinta y tres pacientes (8,7%) fueron ingresados y 10 (2,6%) requirieron reingreso hospitalario. El riesgo de complicaciones aumenta significativamente en pacientes con más de 2 fracturas costales, en mayores de 85 años y en presencia de algunas comorbilidades como la EPOC y patologías que requieren anticoagulación. El riesgo de reingreso es mayor en pacientes con más de 60 años. Conclusiones Los pacientes con traumatismo torácico que presentan algunas comorbilidades, son mayores de 85 años y tienen más de 2 fracturas costales pueden presentar más complicaciones, y se deben considerar estos factores en su evaluación, manejo y seguimiento.
Evolution and Complications of Chest Trauma Ávila Martínez, Régulo José; Hernández Voth, Ana; Marrón Fernández, Carmen ...
Archivos de bronconeumología (English ed.)
49, Številka:
5
Journal Article
Recenzirano
Abstract Objective To describe the clinical characteristics and risk factors of patients with chest trauma, and to evaluate their correlation with the development of complications. Methods ...Descriptive, prospective and analytical study of a patient cohort with chest trauma who underwent follow-up for a period of 30 days. Excluded from the study were those patients with moderate to severe traumatic brain injury, long-bone fractures, abdominal trauma and patients requiring mechanical ventilation. Results A total of 376 patients met the inclusion criteria, 220 of whom were males (58.5%). The most frequent causes of trauma were falls (218 cases; 57.9%) and motor vehicle accidents (57 cases; 15.1%). The most frequent type of trauma was rib contusion (248 cases; 65.9%) and rib fractures (61 cases; 16.2%). Complications were observed in 43 patients (11.4%), mainly hemothorax (13 cases), pneumothorax (9 cases), pneumonia (6 cases) and acute renal failure (4 cases). Four patients died due to pneumonia and hemothorax. Thirty-three patients were hospitalized (8.7%) and 10 (2.6%) required later re-admittance. The risk for complications increased significantly in patients with more than 2 rib fractures, in those over the age of 85 and in the presence of certain comorbidities, such as COPD and pathologies requiring anticoagulation therapy. The risk for re-admittance is higher in patients over the age of 60. Conclusions Patients with chest trauma who present certain comorbidities, are over the age of 85 and have more than 2 rib fractures may present more complications. These factors should be contemplated in the evaluation, management and follow-up of these subjects.
Abstract The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the ...diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.
This study investigated the relationship between physical activity, inactivity, physical function, and sleep in older adults with a frailty phenotype. A total of 184 pre-frail/frail older adults were ...included. Physical activity, inactive behavior, and sleep parameters were assessed using a wrist-worn accelerometer. Participants were categorized into four groups based on their levels of inactivity and physical activity. The results showed that individuals with lower levels of inactivity had better lower body mean velocity and sleep regularity than those with higher levels of inactivity. Physically active older adults exhibited faster gait speed and performed better in lower body strength tests than physically inactive participants. Further analysis revealed that specific combinations of inactivity and physical activity were associated with varying levels of physical function. The findings highlight the importance of physical activity and the negative impact of inactivity on physical function and sleep in older adults with a frailty phenotype.
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