AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive ...pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients' characteristics, and adherence to guidelines.
An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0-35%). Among discharged patients, 37% required readmission (0-62%) and 6.5% died (0-35%). The overall mortality rate was 11.6% (0-50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50%) addressed guidance on healthy life-styles.
The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
All metazoans depend on the consumption of O
by the mitochondrial oxidative phosphorylation system (OXPHOS) to produce energy. In addition, the OXPHOS uses O
to produce reactive oxygen species that ...can drive cell adaptations
, a phenomenon that occurs in hypoxia
and whose precise mechanism remains unknown. Ca
is the best known ion that acts as a second messenger
, yet the role ascribed to Na
is to serve as a mere mediator of membrane potential
. Here we show that Na
acts as a second messenger that regulates OXPHOS function and the production of reactive oxygen species by modulating the fluidity of the inner mitochondrial membrane. A conformational shift in mitochondrial complex I during acute hypoxia
drives acidification of the matrix and the release of free Ca
from calcium phosphate (CaP) precipitates. The concomitant activation of the mitochondrial Na
/Ca
exchanger promotes the import of Na
into the matrix. Na
interacts with phospholipids, reducing inner mitochondrial membrane fluidity and the mobility of free ubiquinone between complex II and complex III, but not inside supercomplexes. As a consequence, superoxide is produced at complex III. The inhibition of Na
import through the Na
/Ca
exchanger is sufficient to block this pathway, preventing adaptation to hypoxia. These results reveal that Na
controls OXPHOS function and redox signalling through an unexpected interaction with phospholipids, with profound consequences for cellular metabolism.
Este estudio tuvo como objetivo estimar la degradabilidad ruminal y cinética degradativa de la materia seca (MS)
del fruto cuajilote (Parmentiera edulis DC) en tres estados de madurez colectado ...durante la época seca en una
región de clima cálido húmedo de la costa del estado de Chiapas, México, para analizar su potencial forrajero.
La técnica de la bolsa de nylon fue aplicada, con vaquillas permanentemente fistuladas del rumen (usándose
como unidades experimentales), que pastorearon zacate estrella de África y una suplementación con 400 g/d de
un concentrado (grano de sorgo molido, pasta de soya y minerales). Se incubaron en el rumen 5 g de muestra
molida de cuajilote (chilillos, verde y maduro) en bolsas nylon a períodos de 0, 4, 8, 12, 24, 36, 48 y 72 h. Los
tratamientos (estados de madurez) se distribuyeron en un diseño completamente al azar con cuatro repeticiones
por tratamiento. Se encontró que la desaparición de la MS (DISMS, %) de los chilillos fue dos veces mayor
(P<0,001) que la de los verdes, aunque menor que la DISMS del fruto maduro. El tipo de MS fluctuó (P<0,001)
dependiendo del estado de madurez, mostrando que la MS soluble y MS degradable fueron más elevadas en el
fruto maduro, seguido de los chilillos que en los verdes (14,6 y 7,3 vs. 1,5%, así como de 29,3, 25,2 vs. 15,7%,
respectivamente). Por otro lado, la MS degradable del fruto maduro se empieza a degradar más pronto (0,0 1,6 y
1,8 h, para los maduros, chilillos y verdes, respectivamente) y a una tasa más rápida que los chilillos o los verdes
(0,04 vs. 0,03). La digestibilidad potencial de la MS (DPMS, %) resultó más alta (P<0,05) en el fruto maduro
(43,9) que en los chilillos (32,0) y los verdes (17,2). La misma tendencia se presentó para la degradabilidad
efectiva. Se concluye que la MS del fruto maduro presentó mayor disponibilidad de degradación ruminal que el
estado de chilillos o verde, pero la materia seca de este fruto muestra baja disponibilidad ruminal indicando que
no es un material forrajero que pueda sustituir a forrajes tropicales.
Endoscopic variceal ligation plus beta‐blockers (EVL+BB) is currently recommended for variceal rebleeding prophylaxis, a recommendation that extends to all patients with cirrhosis with previous ...variceal bleeding irrespective of prognostic stage. Individualizing patient care is relevant, and in published studies on variceal rebleeding prophylaxis, there is a lack of information regarding response to therapy by prognostic stage. This study aimed at comparing EVL plus BB with monotherapy (EVL or BB) on all‐source rebleeding and mortality in patients with cirrhosis and previous variceal bleeding stratified by cirrhosis severity (Child A versus B/C) by means of individual time‐to‐event patient data meta‐analysis from randomized controlled trials. The study used individual data on 389 patients from three trials comparing EVL plus BB versus BB and 416 patients from four trials comparing EVL plus BB versus EVL. Compared with BB alone, EVL plus BB reduced overall rebleeding in Child A (incidence rate ratio 0.40; 95% confidence interval, 0.18‐0.89; P = 0.025) but not in Child B/C, without differences in mortality. The effect of EVL on rebleeding was different according to Child (P for interaction <0.001). Conversely, compared with EVL, EVL plus BB reduced rebleeding in both Child A and B/C, with a significant reduction in mortality in Child B/C (incidence rate ratio 0.46; 95% confidence interval, 0.25‐0.85; P = 0.013). Conclusion: Outcomes of therapies to prevent variceal rebleeding differ depending on cirrhosis severity: in patients with preserved liver function (Child A), combination therapy is recommended because it is more effective in preventing rebleeding, without modifying survival, while in patients with advanced liver failure (Child B/C), EVL alone carries an increased risk of rebleeding and death compared with combination therapy, underlining that BB is the key element of combination therapy. (Hepatology 2017;66:1219‐1231).
Abstract
The accurate identification and description of the genes in the human and mouse genomes is a fundamental requirement for high quality analysis of data informing both genome biology and ...clinical genomics. Over the last 15 years, the GENCODE consortium has been producing reference quality gene annotations to provide this foundational resource. The GENCODE consortium includes both experimental and computational biology groups who work together to improve and extend the GENCODE gene annotation. Specifically, we generate primary data, create bioinformatics tools and provide analysis to support the work of expert manual gene annotators and automated gene annotation pipelines. In addition, manual and computational annotation workflows use any and all publicly available data and analysis, along with the research literature to identify and characterise gene loci to the highest standard. GENCODE gene annotations are accessible via the Ensembl and UCSC Genome Browsers, the Ensembl FTP site, Ensembl Biomart, Ensembl Perl and REST APIs as well as https://www.gencodegenes.org.
The genus Oreochromis is among the most popular of the tilapiine cichlid tribe for aquaculture. However, their temperature and hypoxia tolerance, if tested at all, is usually tested at temperatures ...of 20–25°C, rather than at the considerably higher temperatures of 30–35°C typical of tropical aquaculture.
We hypothesized that both larvae and adults of the heat and hypoxia‐adapted Tabasco‐line of the Nile tilapia Oreochromis niloticus would be relatively hypoxia‐tolerant. Oxygen consumption rate (M˙O2), Q10 and aquatic surface respiration (ASR) was measured using closed respirometry at 2 (c. 0.2 g), 30 (c. 2–5 g), 105 c. (10–15 g) and 240 (c. 250 g) days of development, at 25°C, 30°C and 35°C. M˙O2at 30°C was inversely related to body mass: c. 90 μM O2 g−1/h in larvae down to c. 1 μM O2 g−1/h in young adults. Q10 for M˙O2 was typical for fish over the range 25–35°C of 1.5–2.0. ASR was exhibited by 50% of the fish at pO2 of 15–50 mmHg in a temperature‐dependent fashion. However, the largest adults showed notable ASR only when pO2 fell to below 10 mmHg. Remarkably, pcrit for M˙O2 was 12–17 mmHg at 25–30°C and still only 20–25 mmHg across development at 35°C. These values are among the lowest measured for teleost fishes. Noteworthy is that all fish maintain equilibrium, ventilated their gills and showed routine locomotor action for 10–20 min after M˙O2 ceased at near anoxia and when then returned to oxygenated waters, all fish survived, further indicating a remarkable hypoxic tolerance. Remarkably, data assembled for M˙O2 from >30 studies showed a > x2000 difference, which we attribute to calculation or conversion errors. Nonetheless, pcrit was very low for all Oreochromis sp. and lowest in the heat and hypoxia‐adapted Tabasco line.
Background and Objective
Caregiver burden in Parkinson's disease (PD) has been studied in many cross‐sectional studies but poorly in longitudinal ones. The aim of the present study was to analyze the ...change in burden, strain, mood, and quality of life (QoL) after a 2‐year follow‐up in a cohort of caregivers of patients with PD and also to identify predictors of these changes.
Patients and Methods
PD patients and their caregivers who were recruited from January/2016 to November/2017 from 35 centers of Spain from the COPPADIS cohort were included in the study. They were evaluated again at 2‐year follow‐up. Caregivers completed the Zarit Caregiver Burden Inventory (ZCBI), Caregiver Strain Index (CSI), Beck Depression Inventory‐II (BDI‐II), and EUROHIS‐QOL 8‐item index (EUROHIS‐QOL8) at baseline (V0) and at 2‐year follow‐up (V2). General linear model repeated measure and lineal regression models were applied.
Results
Significant changes, indicating an impairment, were detected on the total score of the ZCBI (p < 0.0001), CSI (p < 0.0001), BDI‐II (p = 0.024), and EUROHIS‐QOL8 (p = 0.002) in 192 PD caregivers (58.82 ± 11.71 years old; 69.3% were females). Mood impairment (BDI‐II; β = 0.652; p < 0.0001) in patients from V0 to V2 was the strongest factor associated with caregiver's mood impairment after the 2‐year follow‐up. Caregiver's mood impairment was the strongest factor associated with an increase from V0 to V2 on the total score of the ZCBI (β = 0.416; p < 0.0001), CSI (β = 0.277; p = 0.001), and EUROHIS‐QOL (β = 0.397; p = 0.002).
Conclusion
Burden, strain, mood, and QoL were impaired in caregivers of PD patients after a 2‐year follow‐up. Mood changes in both the patient and the caregiver are key aspects related to caregiver burden increase.
Key points
The present study is, to date, the largest prospective longitudinal study conducted for analyzing how burden, strain, mood, and quality of life change (QoL) in the principal caregiver of a patient with Parkinson's disease (PD).
After 2 years of follow‐up, the status of the principal caregiver of a patient with PD worsens as a whole with an increase in burden and stress and a worsening in mood and QoL.
Mood changes in the patient and in the caregiver as well are key aspects related to increase in caregiver burden.
These findings suggest that it could be essential to detect depressive symptoms both in the patient and in the caregiver too.
The goal of this trial was to study the long-term effects of intravenous (IV) metoprolol administration before reperfusion on left ventricular (LV) function and clinical events.
Early IV metoprolol ...during ST-segment elevation myocardial infarction (STEMI) has been shown to reduce infarct size when used in conjunction with primary percutaneous coronary intervention (pPCI).
The METOCARD-CNIC (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) trial recruited 270 patients with Killip class ≤II anterior STEMI presenting early after symptom onset (<6 h) and randomized them to pre-reperfusion IV metoprolol or control group. Long-term magnetic resonance imaging (MRI) was performed on 202 patients (101 per group) 6 months after STEMI. Patients had a minimal 12-month clinical follow-up.
Left ventricular ejection fraction (LVEF) at the 6 months MRI was higher after IV metoprolol (48.7 ± 9.9% vs. 45.0 ± 11.7% in control subjects; adjusted treatment effect 3.49%; 95% confidence interval CI: 0.44% to 6.55%; p = 0.025). The occurrence of severely depressed LVEF (≤35%) at 6 months was significantly lower in patients treated with IV metoprolol (11% vs. 27%, p = 0.006). The proportion of patients fulfilling Class I indications for an implantable cardioverter-defibrillator (ICD) was significantly lower in the IV metoprolol group (7% vs. 20%, p = 0.012). At a median follow-up of 2 years, occurrence of the pre-specified composite of death, heart failure admission, reinfarction, and malignant arrhythmias was 10.8% in the IV metoprolol group versus 18.3% in the control group, adjusted hazard ratio (HR): 0.55; 95% CI: 0.26 to 1.04; p = 0.065. Heart failure admission was significantly lower in the IV metoprolol group (HR: 0.32; 95% CI: 0.015 to 0.95; p = 0.046).
In patients with anterior Killip class ≤II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer heart failure admissions. (Effect of METOprolol in CARDioproteCtioN During an Acute Myocardial InfarCtion. The METOCARD-CNIC Trial; NCT01311700).
Display omitted
•Hepatic venous pressure gradient is a prognostic factor in cirrhotic patients undergoing surgery.•ASA class and the type of surgery are the other main prognostic factors.•Hepatic ...venous pressure gradient values >16 mmHg are independently associated with higher mortality.•Hepatic venous pressure gradient values ≥20 mmHg identify the patients at highest risk.•The potential of pre-surgery TIPS in high-risk patients deserves further study.
Surgery in cirrhosis is associated with a high morbidity and mortality. Retrospectively reported prognostic factors include emergency procedures, liver function (MELD/Child-Pugh scores) and portal hypertension (assessed by indirect markers). This study assessed the prognostic role of hepatic venous pressure gradient (HVPG) and other variables in elective extrahepatic surgery in patients with cirrhosis.
A total of 140 patients with cirrhosis (Child-Pugh A/B/C: 59/37/4%), who were due to have elective extrahepatic surgery (121 abdominal; 9 cardiovascular/thoracic; 10 orthopedic and others), were prospectively included in 4 centers (2002–2011). Hepatic and systemic hemodynamics (HVPG, indocyanine green clearance, pulmonary artery catheterization) were assessed prior to surgery, and clinical and laboratory data were collected. Patients were followed-up for 1 year and mortality, transplantation, morbidity and post-surgical decompensation were studied.
Ninety-day and 1-year mortality rates were 8% and 17%, respectively. Variables independently associated with 1-year mortality were ASA class (American Society of Anesthesiologists), high-risk surgery (defined as open abdominal and cardiovascular/thoracic) and HVPG. These variables closely predicted 90-, 180- and 365-day mortality (C-statistic >0.8). HVPG values >16 mmHg were independently associated with mortality and values ≥20 mmHg identified a subgroup at very high risk of death (44%). Twenty-four patients presented persistent or de novo decompensation at 3 months. Low body mass index, Child-Pugh class and high-risk surgery were associated with death or decompensation. No patient with HVPG <10 mmHg or indocyanine green clearance >0.63 developed decompensation.
ASA class, HVPG and high-risk surgery were prognostic factors of 1-year mortality in cirrhotic patients undergoing elective extrahepatic surgery. HVPG values >16 mmHg, especially ≥20 mmHg, were associated with a high risk of post-surgical mortality.
The hepatic venous pressure gradient is associated with outcomes in patients with cirrhosis undergoing elective extrahepatic surgery. It enables a better stratification of risk in these patients and provides the foundations for potential interventions to improve post-surgical outcomes.
PDF
