Proton pump inhibitor-responsive oesophageal eosinophilia correlates with downregulation of eotaxin-3 and Th2 cytokines overexpression.

BACKGROUND: The molecular basis and effects of proton pump inhibitor (PPI) therapy on PPI-responsive oesophageal eosinophilia (PPI-REE) and eosinophilic oesophagitis (EoE) remain unknown. AIM: To compare symptom-histological and cytokine gene expression in PPI-REE and EoE patients, at baseline and after specific treatment. METHODS: In consecutive adult patients with an EoE phenotype (dysphagia/food impaction, typical endoscopic findings and > 15 eos/HPF), gene expression of eotaxin-3, IL-13, and IL-5 were determined in distal and proximal oesophagus, at baseline and after omeprazole 40 mg b.d. for 8 weeks. PPI-REE was defined by clinicohistological response. PPI nonresponders (EoE) were offered treatment with topical steroids. RESULTS: Fifty three patients were re-evaluated on PPI therapy. 23 patients (43%) had PPI-REE and 30 patients (57%) had EoE. At baseline, eotaxin-3/IL-13/IL-5 gene expression was indistinguishable between EoE and PPI-REE, excepting increased IL-5 expression in proximal oesophagus (12.54 vs. 57, P = 0.029). PPI therapy significantly decreased eotaxin-3/IL-13 in PPI-REE, at both oesophageal sites (P ≤ 0.008), and IL-5 in distal (P = 0.016), but not in proximal oesophagus. Patients with steroid-responsive EoE also showed a significant decrease in eotaxin-3/IL-5 expression at both oesophageal sites. In EoE patients, initial PPI trial significantly decreased distal oesophageal eosinophilia (63.78 to 41.79 eos/HPF, P = 0.025) and led to symptom remission in 16%, but did not influence Th2 markers. CONCLUSIONS: Baseline cytokine gene expression in PPI-REE was nearly indistinguishable from EoE. PPI therapy significantly downregulated oesophageal eotaxin-3/Th2-cytokine gene expression in PPI-REE, similarly to that seen in steroid-responsive EoE. A subset of EoE patients showed clinicohistological improvement on PPI therapy.

Development of a versatile experimental setup for the evaluation of the photocatalytic properties of construction materials under realistic outdoor conditions.

The interest on outdoor photocatalytic materials is growing in the last years. Nevertheless, most of the experimental devices designed for the assessment of their performance operate at controlled laboratory conditions, i.e., pollutant concentration, temperature, UV irradiation, and water vapor contents, far from those of real outdoor environments. The aim of the present study was the design and development of an experimental device for the continuous test of photocatalytic outdoor materials under sun irradiation using real outdoor air as feed, with the concomitant fluctuation of pollutant concentration, temperature, and water vapor content. A three-port measurement system based on two UV-transparent chambers was designed and built. A test chamber contained the photoactive element and a reference chamber to place the substrate without the photoactive element were employed. The third sampling point, placed outdoors, allowed the characterization of the surrounding air, which feeds the test chambers. Temperature, relative humidity (RH), and UV-A irradiance were monitored at each sampling point with specific sensors. NO x concentration was measured by a chemiluminescence NO x analyzer. Three automatic valves allowed the consecutive analysis of the concentration at the three points at fixed time intervals. The reliability of the analytical system was demonstrated by comparing the NO x concentration data with those obtained at the nearest weather station to the experimental device location. The use of a chamber-based reaction system leads to an attenuation of NO x and atmospheric parameter profiles, but maintaining the general trends. The air characterization results showed the wide operating window under which the photoactive materials should work outdoors, depending on the traffic intensity and the season, which are reproduced inside the test chambers. The designed system allows the measurement of the photoactivity of outdoor materials or the comparison of several samples at the same time. The suitability of the system for the evaluation of the DeNO x properties of construction elements at realistic outdoor conditions was demonstrated. The designed experimental device can be used 24/7 for testing materials under real fluctuations of NO x concentration, temperature, UV irradiation, and relative humidity and the presence of other outdoor air pollutants such as VOCs, SO x , or NH3. The chamber-based design allows comparing a photocatalytic material with respect to a reference substrate without the photoactive phase, or even the comparison of several outdoor elements at the same time.

Photocatalysis for continuous air purification in wastewater treatment plants: from lab to reality.

The photocatalytic efficiency of TiO(2)-SiMgO(x) plates to oxidize H(2)S was first evaluated in a flat laboratory reactor with 50 mL min(-1) synthetic air containing 100 ppm H(2)S in the presence of humidity. The use of the photocatalyst-adsorbent hybrid material enhanced the photocatalytic activity in terms of pollutant conversion, selectivity, and catalyst lifetime compared to previous H(2)S tests with pure TiO(2) because total H(2)S elimination was maintained for more than 30 operating hours with SO(2) appearing in the outlet as reaction product only after 18 h. Subsequently, the hybrid material was successfully tested in a photoreactor prototype to treat real polluted air in a wastewater treatment plant. For this purpose, a new tubular photocatalytic reactor that may use solar radiation in combination with artificial radiation was designed; the lamp was turned on when solar UV-A irradiance was below 20 W m(-2), which was observed to be the minimum value to ensure 100% conversion. The efficient distribution of the opaque photocatalyst inside the tubular reactor was achieved by using especially designed star-shaped structures. These structures were employed for the arrangement of groups of eight TiO(2)-SiMgO(x) plates in easy-to-handle channelled units obtaining an adequate flow regime without shading. The prototype continuously removed during one month and under real conditions the H(2)S contained in a 1 L min(-1) air current with a variable inlet concentration in the range of tens of ppmv without release of SO(2).

Revisiting the hydrothermal synthesis of titanate nanotubes: new insights on the key factors affecting the morphology.

Recently, titanate nanotubes have attracted a significant deal of interest, but the mechanism of formation as well as some structural aspects of these materials is still under debate. In this context, the main goal of the present study is to identify the key factors affecting the morphology of the titanate nanostructures during hydrothermal synthesis in order to increase the homogeneity and control, as finely as possible, the dimensions of the nanotubes. Previous studies also analyzed the influence of synthesis conditions but, unlike other works, the simultaneous assessment of the influence of parameters such as the phase and crystal size of the TiO(2) used as precursor, and the time and temperature of the hydrothermal treatment has been now analyzed under the same experimental context. The characterization of the prepared materials by means of TEM, XRD, N(2) adsorption isotherms and Raman spectroscopy was performed to establish correlations between the structural features and the preparation conditions. In this research, special attention has been paid to study the non-washed materials, which most of the previous studies have excluded from characterization. After hydrothermal treatment amorphous particles with different morphologies are isolated before acidification, which seems to be a crucial stage in controlling nanotube formation. Besides, the obtained data indicate that some characteristics of the nanotubes, such as the degree of conversion, the homogeneity and crystallinity of the structures or the aspect ratio, can be easily selected by adjusting the synthesis parameters.

Clinical trial: clarithromycin vs. levofloxacin in first-line triple and sequential regimens for Helicobacter pylori eradication.

BACKGROUND: Helicobacter pylori eradication rates with standard triple therapy have declined to unacceptable levels. AIM: To compare clarithromycin and levofloxacin in triple and sequential first-line regimens. METHODS: A total of 460 patients were randomized into four 10-day therapeutic schemes (115 patients per group): (i) standard OCA, omeprazole, clarithromycin and amoxicillin; (ii) triple OLA, omeprazole, levofloxacin and amoxicillin; (iii) sequential OACM, omeprazole plus amoxicillin for 5 days, followed by omeprazole plus clarithromycin plus metronidazole for 5 days; and (iv) modified sequential OALM, using levofloxacin instead of clarithromycin. Eradication was confirmed by 13C-urea breath test. Adverse effects and compliance were assessed by a questionnaire. RESULTS: Per protocol cure rates were: OCA (66%; 95% CI: 57-74%), OLA (82.6%; 75-89%), OACM (80.8%; 73-88%) and OALM (85.2%; 78-91%). Intention-to-treat cure rates were: OCA (64%; 55-73%), OLA (80.8%; 73-88%), OACM (76.5%; 69-85%) and OALM (82.5%; 75-89%). Eradication rates were lower with OCA than with all the other regimens (P < 0.05). No differences in compliance or adverse effects were demonstrated among treatments. CONCLUSIONS: Levofloxacin-based and sequential therapy are superior to standard triple scheme as first-line regimens in a setting with high clarithromycin resistance. However, all of these therapies still have a 20% failure rate.

Condrosarcoma de pared torácica secundario a condroma de larga evolución / Chondrosarcoma of the thoracic wall secondary to long course chondroma

No disponible

[The prognosis of mediastinal lymph node infiltration (N2) in patients with non-small-cell lung carcinoma (NSCLC) who have undergone curative treatment]. / Pronóstico de la infiltración ganglionar mediastínica (N2) en pacientes con carcinoma de pulmón de células no microcelulares (CPCNM) intervenidos con intenciones curativas.

In this prospective study of 148 surgically treated patients with non-small cell carcinoma of the lung (NSCLC) who were followed for 5 to 7 years, we analyzed the prognostic value of mediastinal lymph node invasion (N2) and survival after 5 years depending on different characteristics. Forty-two (28.4%) patients were N2. Survival in this sample was 9%. Twenty-seven T2N2 patients (among whom survival was 13%) were selected from this group and classified according to whether lymph node invasion was intranodal (survival 39%) or extracapsular (survival 5%) (p < or = 0.05). We also evaluated the prognostic value of different ganglionic areas in accordance to the maps suggested by the American Thoracic Society (ATS). There were no survivors for areas 2, 8 and 9, and no patient with invasion of more than two areas lived more than 18 months. Significant differences in survival were found among patients with invasion of areas 10 and 11. We conclude a) that global analysis of N2 is of such little value in predicting survival that surgery is not justified unless screening criteria are applied; b) that extracapsular invasion rules out surgical treatment; c) that the prognostic value of ganglionic areas is not entirely clear, although the prognosis seems to be poorer for invasion of areas 2, 8 and 9 or invasion of more than 2 areas, and d) that invasion of area 10 would appear to be better classified as N2 than as N1.

[A multivariate prospective study of prognostic factors in non-small-cell lung carcinoma (NSCLC): the results at 5 years]. / Estudio prospectivo multivariante sobre factores pronósticos en el carcinoma de pulmón no microcelular (CPNM): resultados a 5 años.

We present the results of a 5-year prospective study of 153 patients with a diagnosis of bronchogenic carcinoma (BC) who underwent curative surgery. Clinical and anatomical variables were analyzed by multiple regression analysis for prediction of death. Among the anatomical variables, the most significant were the following: stages of anatomical spread (p < or = 0.00000), ganglionic state (p < or = 0.00000), type for surgery (curative or non-curative) (p < or = 0.00000) and state of tumor (p = 0.00012). Significant clinical variables were clinical stage by Feinstein's classification (p = 0.00037), functional capacity (ECOG scale) (p = 0.01196) and tumor size measured conventionally (p = 0.01196). These variables were entered into a multivariate model for prognostic prediction in order to determine the patient's relative risk over time. The best combination of anatomical variables was obtained by associating the stages of spread and ganglionic state (chi 2 = 34.24; p = < 0.00000); the best combination of clinical variables was clinical stage and tumor size (chi 2 = 17.37; p = 0.00023). Thus, although the anatomical variables are more important than clinical ones, the latter have independent prognostic value, are easy to obtain and are available before surgery. They therefore represent an alternative to prognosis based on anatomical spread.

[The role of computed tomography (CT) of the thorax in defining the anatomical extent in bronchogenic carcinoma (BC)]. / Papel de la tomografía computarizada (TC) de tórax en la definición de la extensión anatómica en el carcinoma broncogénico (CB).

A series of 129 carriers of non-small cell bronchogenic carcinoma (BC), in whom computed tomography (CT) of the thorax was performed as part of the preoperative study, are presented. The results of CT were compared with those of thoracotomy in terms of sensitivity (SEN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV). Thoracic wall (prevalence 0.18): SEN, SP, PPV and NPV were 0.65, 0.92, 0.63 and 0.92, respectively. In peripheral tumors these values were 0.85, 0.90, 0.69 and 0.96, respectively. CT demonstrating invasion of the thoracic wall thus requires confirmation for the purpose of surgical staging. If CT reveals an intact wall, however, surgery may take place immediately. Malignant mediastinal lymph nodes: (prevalence 0.36): SEN, SP, PPV, and NPV were 0.70, 0.89, 0.78 and 0.84, respectively. For peripheral tumors these values were 0.78, 0.93, 0.82 and 0.91, respectively. CT demonstrating malignant mediastinal lymph nodes should be confirmed by mediastinoscopy. If mediastinal malignancy is not observed by CT, thoracotomy may be performed in peripherally located tumors; in centrally located tumors, however, the absence of adenopathy should be confirmed by mediastinoscopy.