Aim: Advanced glycation end-products (AGEs) have been involved in the atherogenic process in the high-risk population. The goal of this study was to demonstrate that AGEs are related to subclinical ...atheromatous disease in subjects with low to moderate vascular risk.Methods: A cross-sectional study in which 2,568 non-diabetic subjects of both sexes without cardiovascular disease were included. Subcutaneous content of AGEs was assessed by skin autofluorescence (SAF) and subclinical atheromatous disease was measured by assessing the atheromatous plaque burden in carotid and femoral regions using ultrasonography. In addition, serum pentosidine, carboxymethyl-lysine (CML) and AGE receptors (RAGE) were assessed in a nested case-control study with 41 subjects without plaque and 41 individuals subjects with generalized disease.Results: Patients with atheromatous plaque had a higher SAF than those with no plaque (1.9 1.7 to 2.3 vs. 1.8 1.6 to 2.1 arbitrary units (AU), p＜0.001). The SAF correlated with the total number of affected regions (r= 0.171, p＜0.001), increasing progressively from 1.8 1.6 to 2.1 AU in those without atheromatous disease to 2.3 1.9 to 2.7 AU in patients with ≥ 8 plaques (p＜0.001). A correlation was also observed between SAF and the total plaque area (r=0.113, p＜0.001). The area under the Receiver Operating Characteristic curve was 0.65 (0.61 to 0.68) for identifying male subjects with atheromatous disease. The multivariable logistic regression model showed a significant and independent association between SAF and the presence of atheromatous disease. However, no significant differences in serum pentosidine, CML, and RAGE were observed.Conclusions: Increased subcutaneous content of AGEs is associated with augmented atheromatous plaque burden. Our results suggest that SAF may provide clinically relevant information to the current strategies for the evaluation of cardiovascular risk, especially among the male population.
Introduction
Bronchial aspirates (BAS) obtained during invasive mechanical ventilation (IMV) constitutes a useful tool for molecular phenotyping and decision making.
Aim
To identify the proteomic ...determinants associated with disease pathogenesis, all-cause mortality and respiratory sequelae in BAS samples from critically ill patients with SARS-CoV-2-induced ARDS
Methods
Multicenter study including 74 critically ill patients with COVID-19 and non-COVID-19 ARDS. BAS were obtained by bronchoaspiration after IMV initiation. Three hundred sixty-four proteins were quantified using proximity extension assay (PEA) technology. Random forest models were used to assess predictor importance.
Results
After adjusting for confounding factors, CST5, NADK, SRPK2 and TGF-α were differentially detected in COVID-19 and non-COVID-19 patients. In random forest models for COVID-19, CST5, DPP7, NADK, KYAT1 and TYMP showed the highest variable importance. In COVID-19 patients, reduced levels of ENTPD2 and PTN were observed in nonsurvivors of ICU stay, even after adjustment. AGR2, NQO2, IL-1α, OSM and TRAIL showed the strongest associations with in-ICU mortality and were used to construct a protein-based prediction model. Kaplan-Meier curves revealed a clear separation in mortality risk between subgroups of PTN, ENTPD2 and the prediction model. Cox regression models supported these findings. In survivors, the levels of FCRL1, NTF4 and THOP1 in BAS samples obtained during the ICU stay correlated with lung function (i.e., D
LCO
levels) 3 months after hospital discharge. Similarly, Flt3L and THOP1 levels were correlated with radiological features (i.e., TSS). These proteins are expressed in immune and nonimmune lung cells. Poor host response to viral infectivity and an inappropriate reparative mechanism seem to be linked with the pathogenesis of the disease and fatal outcomes, respectively.
Conclusion
BAS proteomics identified novel factors associated with the pathology of SARS-CoV-2-induced ARDS and its adverse outcomes. BAS-based protein testing emerges as a novel tool for risk assessment in the ICU.
A few studies showed that both adherence to Mediterranean diet (MedDiet) and physical activity practice have a positive impact on pulmonary function in subjects with lung disease. These associations ...are not well studied in subjects free from lung disease. In a cross-sectional study conducted in 3020 middle-aged subjects free of lung disease, adherence to the MedDiet using the Mediterranean Diet Adherence Screener, and physical activity practice using the International Physical Activity Questionnaire short form were recorded. Respiratory function was assessed using forced spirometry and the results were evaluated according to the Global initiative for Chronic Obstructive Lung Disease. Logistic regression models were used to analyze the associations between adherence to the MedDiet and physical activity practice with the presence of ventilatory defects. Participants with a high adherence to MedDiet, in comparison to those with low adherence, had both higher forced vital capacity (FVC; 100 (87⁻109) vs. 94 (82⁻105) % of predicted,
= 0.003) and forced expired volume in the first second (FEV1; 100 (89⁻112) vs. 93 (80⁻107) % of predicted,
< 0.001). According to their degree of physical activity, those subjects with a high adherence also had both higher FVC (100 (88⁻107) vs. 94 (83⁻105) % of predicted,
= 0.027) and FEV1 (100 (89⁻110) vs. 95 (84⁻108) % of predicted,
= 0.047) in comparison with those with low adherence. The multivariable logistic regression models showed a significant and independent association between both low adherence to MedDiet and low physical activity practice, and the presence of altered pulmonary patterns, with differences between men and women. However, no joint effect between adherence to MedDiet and physical activity practice on respiratory function values was observed. Low adherence to MedDiet and low physical activity practice were independently associated with pulmonary impairment. Therefore, the lung mechanics seem to benefit from heart-healthy lifestyle behaviors.
Aims
Patients with type 2 diabetes have been considered a susceptible group for pulmonary dysfunction. Our aim was to assess pulmonary function on the prediabetes stage.
Methods
Pulmonary function ...was assessed in 4,459 non-diabetic subjects, aged between 45 and 70 years, without cardiovascular disease or chronic pulmonary obstructive disease from the ongoing study ILERVAS. A “restrictive spirometric pattern”, an “abnormal FEV1” and an “obstructive ventilatory defect” were assessed. Prediabetes was defined by glycosylated hemoglobin (HbA1c) between 5.7 and 6.4% according to the American Diabetes Association criteria.
Results
Population was composed of 52.1% women, aged 57 53;63 years, a BMI of 28.6 25.8;31.8 kg/m
2
, and with a prevalence of prediabetes of 29.9% (
n
= 1392). Subjects with prediabetes had lower forced vital capacity (FVC: 93 82;105 vs. 96 84;106,
p
< 0.001) and lower forced expired volume in the first second (FEV1: 94 82;107 vs. 96 84;108,
p
= 0.011), as well as a higher percentage of the restrictive spirometric pattern (16.5% vs. 13.6%,
p
= 0.015) and FEV1 < 80% (20.3% vs. 17.2%,
p
= 0.017) compared to non-prediabetes group. In the prediabetes group, HbA1c was negatively correlated with both pulmonary parameters (FVC:
r
= − 0.113,
p
< 0.001; FEV1:
r
= − 0.079,
p
= 0.003). The multivariable logistic regression model in the whole population showed that there was a significant and independent association between HbA1c with both restrictive spirometric pattern OR = 1.42 (1.10–1.83),
p
= 0.008 and FEV1 < 80% OR = 1.50 (1.19–1.90),
p
= 0.001.
Conclusions
The deleterious effect of type 2 diabetes on pulmonary function appears to be initiated in prediabetes, and it is related to metabolic control.
Trial registration ClinicalTrials.gov
NCT03228459.
Lung cancer is mainly diagnosed at advanced or locally advanced stages, usually when symptoms become evident. However, sometimes it may be diagnosed incidentally during routine care, while patients ...are still asymptomatic. Prognosis differences based on symptomatic presentation have been partially explored. Our aim was to analyze the prognostic value of the initial symptomatic state of the patients in a general lung cancer cohort.
Observational ambispective study including patients consecutively diagnosed with primary lung cancer between January 2016 and December 2018 via the lung cancer Fast Diagnostic Track (FDT). Patients were followed up until death or the end of the study in September 2019. Asymptomatic patients were compared with patients presenting symptoms. Overall survival (OS) of both groups was compared using the log-rank test. Cox regression analysis was performed to clarify the effect of the symptomatic status at diagnosis on survival. Additionally, propensity score (PS) matching analysis was performed.
A total of 267 patients were analyzed; 83.5% were men, with a mean (SD) age at diagnosis of 68 (10.7) years. Incidental diagnosis was ascertained in 24.7% of cases. Asymptomatic patients presented more frequently stage I and II disease compared to symptomatic patients (51.5%
14%), and exhibited a significantly better prognosis, with a 3-year OS of 63.6% (
30.3%) and a median OS that was not reached during follow-up (
10.3 months). With an adjusted multivariate Cox proportional hazard model, we obtained a HR (95% CI) of 2.63 (95% CI, 1.6-4.2; P<0.0001) associated with symptomatic presentation independently of age, sex, stage at diagnosis and ECOG scale. In addition, after performing the propensity score matching analysis, the Cox regression model continued to show a significantly worse prognosis for patients presenting with symptoms (P=0.041).
Lung cancer patients who are asymptomatic at diagnosis exhibit a significantly better prognosis, regardless of the stage of the disease, underlining the importance of an early diagnosis.
There are important advances in the management of bacterial infection in patients with cystic fibrosis (CF), but there are many gaps in the field of fungal infections.
The aim of this study was to ...analyse whether chronic respiratory filamentous fungal colonization had clinical impact and whether antifungal treatment can change the disease.
The prospective, bicentric and descriptive study was carried out within a 3-year follow-up period, with four-month periodicity medical controls. Adult patients from two CF units of tertiary hospitals were included. Clinical, microbiological, analytical and spirometric variables were collected. Quality of life was evaluated in a subgroup, using the Spanish version of the Revised Cystic Fibrosis Quality of Life Questionnaire (CFQ-R). To statistically analyze the evolution of forced expiratory along time (volume of air blown out in 1 second -FEV1-) and the forced vital capacity (FVC), mixed linear models were carried out.
From the ninety-eight patients under study, 40 suffered chronic filamentous fungal colonization. The presence of filamentous fungi in airway was associated to an annual fall of FEV1 and FVC of 0.029 and 0.017 litres, respectively (p<0.001). In addition, worse quality of life based on CFQ-R, significant when concerning physical condition and emotional state, was also linked with the fungal colonization. Protocolized antifungal therapy, nebulized or oral, improved FEV1 in 0.023 and 0.024 litres per year, respectively (p<0.001).
Chronic filamentous fungal colonization in patients with CF is associated with a significant annual decline of lung function that persists over time. Chronic antifungal therapy slows down this progression, mainly in the patient with more advanced disease.
Existen avances importantes en el manejo de la infección bacteriana en pacientes con fibrosis quística (FQ), pero hay muchas lagunas en el campo de las infecciones fúngicas.
El objetivo del estudio fue analizar si la colonización respiratoria crónica por hongos filamentosos tenía impacto clínico y si el tratamiento antifúngico modificaba la enfermedad.
Estudio prospectivo, bicéntrico y descriptivo con un seguimiento de 3 años y controles médicos cuatrimestrales. Se incluyeron pacientes adultos de dos Unidades de Fibrosis Quística de hospitales terciarios. Se recogieron datos de variables clínicas, microbiológicas, analíticas y espirométricas; en un subgrupo se evaluó la calidad de vida mediante el cuestionario específico para FQ (CFQ-R). Para analizar estadísticamente la evolución a lo largo del tiempo del volumen espiratorio máximo en el primer segundo (FEV1) y la capacidad vital forzada (FVC) se realizaron modelos lineales mixtos.
De los 98 pacientes incluidos en el estudio, 40 presentaron colonización crónica por hongos filamentosos. La presencia de hongos filamentosos en la vía aérea se asoció a una caída anual del FEV1 y FVC de 0,029 y 0,017 litros, respectivamente (p<0,001), además de a una peor calidad de vida según el CFQ-R, significativa en cuestiones como la capacidad física y el estado emocional. La terapia antifúngica protocolizada, nebulizada u oral, mejoraron el FEV1 0,023 y 0,024 litros al año, respectivamente (p<0,001).
La colonización crónica por hongos filamentosos en pacientes con FQ se asocia a una caída anual de la función pulmonar significativa que persiste en el tiempo. El tratamiento antifúngico protocolizado ralentiza este deterioro funcional, fundamentalmente en el paciente con enfermedad más avanzada.
Aim: Advanced glycation end-products (AGEs) have been involved in the atherogenic process in the high-risk population. The goal of this study was to demonstrate that AGEs are related to subclinical ...atheromatous disease in subjects with low to moderate vascular risk.Methods: A cross-sectional study in which 2,568 non-diabetic subjects of both sexes without cardiovascular disease were included. Subcutaneous content of AGEs was assessed by skin autofluorescence (SAF) and subclinical atheromatous disease was measured by assessing the atheromatous plaque burden in carotid and femoral regions using ultrasonography. In addition, serum pentosidine, carboxymethyl-lysine (CML) and AGE receptors (RAGE) were assessed in a nested case-control study with 41 subjects without plaque and 41 individuals subjects with generalized disease.Results: Patients with atheromatous plaque had a higher SAF than those with no plaque (1.9 1.7 to 2.3 vs. 1.8 1.6 to 2.1 arbitrary units (AU), p＜0.001). The SAF correlated with the total number of affected regions (r= 0.171, p＜0.001), increasing progressively from 1.8 1.6 to 2.1 AU in those without atheromatous disease to 2.3 1.9 to 2.7 AU in patients with ≥ 8 plaques (p＜0.001). A correlation was also observed between SAF and the total plaque area (r=0.113, p＜0.001). The area under the Receiver Operating Characteristic curve was 0.65 (0.61 to 0.68) for identifying male subjects with atheromatous disease. The multivariable logistic regression model showed a significant and independent association between SAF and the presence of atheromatous disease. However, no significant differences in serum pentosidine, CML, and RAGE were observed.Conclusions: Increased subcutaneous content of AGEs is associated with augmented atheromatous plaque burden. Our results suggest that SAF may provide clinically relevant information to the current strategies for the evaluation of cardiovascular risk, especially among the male population.
HIV infection occurs in disproportionately high rates among racial and ethnic minorities in the United States, making it imperative that individuals from these groups be included in research studies. ...However, it is often difficult to recruit HIV-infected Hispanics and African Americans in clinical trials, but a skilled interdisciplinary team that includes researchers with racial and ethnic diversity can help. This article describes a successful approach for building an interdisciplinary team that values the participation of racial and ethnic minorities in clinical trials and has the skills to work with these groups. The success of the Adelante (a Spanish word meaning forward) Team can be attributed to team members who actively participate in decision-making, are empowered, and function in a cohesive manner. Successful research teams build relationships with research participants to increase the probability that racial and ethnic minorities will enroll and participate fully in research.
La presente investigación tuvo como objetivo evaluar los conocimientos, actitudes y prácticas sobre el climaterio y la menopausia en mujeres de 35 a 59 años de edad, que asisten a la iglesia ...evangélica Príncipe de Paz, en el cantón Primavera del municipio Santa Ana, en El Salvador. El estudio fue mixto y empleó diversos métodos del nivel teórico, empírico y estadístico. El trabajo de campo se realizó entre los meses de enero a junio de 2019. Los resultados demostraron que, los sujetos no conocían qué es el climaterio, pero tenían una idea vaga respecto a lo que es la menopausia; conocían los métodos de planificación familiar que les permiten disminuir el riesgo reproductivo y hacer terapia hormonal de reemplazo. También se evidenció que, durante esos cambios, la relación de pareja se compromete, debido a la disminución de estrógenos por la depleción ovárica. Se concluye que las participantes en el estudio no recibieron atención médica en esta etapa de la vida y enfrentan solas el proceso del síndrome climatérico, lo cual pone en riesgo su salud.
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