ABSTRACT
PURPOSE: A controlled, prospective, multicenter, randomized trial to compare primary patency after angioplasty with a drug-coated balloon versus plain angioplasty balloon in stenosis of dysfunctional fistulae and grafts for hemodialysis. MATERIALS AND METHODS: A total of 136 patients (148 angioplasties) at four centers were randomized to receive a drug-coated balloon or plain angioplasty balloon after satisfactory angioplasty with a high-pressure balloon. The inclusion criteria were clinical signs of vascular dysfunction confirmed by Doppler Ultrasound and/or angiography. The primary endpoint was target lesion patency defined as time elapsed between the completion of effective and the appearance of restenosis at 6 and 12 months after angioplasty. Secondary endpoints included the relationship between the location of the stenosis, previous angioplasty, demographic variables and survival. RESULTS: Primary patency after angioplasty was higher in the group treated with the drug-coated balloon than the plain angioplasty balloon (153.01 to 141.69 days at 6 months; 265.78 to 237.83 days at 12 months). Drug-coated balloon angioplasty resulted in superior patency after 6 and 12 months, but this result was not statically significant (P = 0.068 at 6 months; P = 0.369 at 12 months). There was no relation between target lesion patency and the other variables studied. Overall mortality in the plain angioplasty balloon group was higher (9% vs. 5.7%) but not statistically significant. CONCLUSIONS: Drug-coated balloon angioplasty resulted in superior survival of dysfunctional peripheral vascular access at 6 and 12 months, but this result was not statistically significant. Both arms show equivalent complications and similar mortality. LEVEL OF EVIDENCE: Level Ia, therapeutic study, RCT. EBM ratings will be based on a scale of 1-5.
Subject(s)
Angioplasty, Balloon/methods , Arteriovenous Shunt, Surgical/adverse effects , Fistula/therapy , Paclitaxel/therapeutic use , Renal Dialysis/instrumentation , Adult , Aged , Aged, 80 and over , Constriction, Pathologic/therapy , Female , Fistula/physiopathology , Humans , Male , Middle Aged , Paclitaxel/administration & dosage , Prospective Studies , Treatment Outcome , Tubulin Modulators/administration & dosage , Tubulin Modulators/therapeutic use , Vascular Patency/physiologyABSTRACT
OBJECTIVE: The objective was to assess the proportion of Th1, Th2 and Th17 phenotypes in senescent CD4+CD28null cells from patients with systemic lupus erythematosus (SLE) and its association with the pattern of joint involvement. METHODS: This cross-sectional study was performed in SLE patients with erosive arthritis (rhupus) or nondeforming, nonerosive arthritis. Total CD4+CD28null cells as well as the proportion of these cells expressing T-bet, GATA3 or RORγt were analyzed by color-flow cytometry. Serum osteopontin levels were measured by ELISA. RESULTS: Eighteen SLE patients (nine with rhupus and nine with nonerosive arthritis) were studied. The percentage of CD4+CD28null/CD4+ cells (17.7%, 10.3-25.0% versus 9.4%, 8.1-22.4%; P = 0.386) as well as the osteopontin levels (5800, 5,134-5995 pg/ml versus 5578, 5171-5717 pg/ml; P > 0.05) were similar in both groups. A higher percentage of CD4+CD28nullT-bet+ cells (42.8%, 33.5-53.4% versus 30.0%, 23.3-34.2%) but a lower percentage of CD4+CD28nullGATA3+ cells (3.1%, 1.7-5.6% versus 6.2%, 2.6-18.4%) was observed in patients with rhupus than in their counterparts ( P = 0.016). The frequency of CD4+CD28nullRORγt+ cells was similar between groups. CONCLUSIONS: In patients with rhupus, senescent CD4+CD28null cells are preferentially polarized to a Th1 phenotype, whereas this is partial towards Th2 in lupus patients with a nonerosive arthritis pattern.
Subject(s)
Arthritis/complications , Lupus Erythematosus, Systemic/complications , T-Lymphocytes, Helper-Inducer/cytology , Adult , Cross-Sectional Studies , Female , Flow Cytometry , Humans , Male , Mexico , Middle Aged , PhenotypeABSTRACT
Fundamento y objetivo: Las infecciones respiratorias suponen no solo los ingresos por neumonía, sino también la mayoría de las exacerbaciones agudas de EPOC (EAEPOC). El objetivo de este trabajo fue evaluar la efectividad de una intervención fisioterápica durante el período hospitalario en pacientes ingresados por EAEPOC y neumonía adquirida en la comunidad (NAC). Material y método: Ensayo clínico aleatorizado, con 44 pacientes distribuidos en 2 grupos: un grupo control que recibió el tratamiento médico estándar (oxigenoterapia y farmacoterapia) y un grupo experimental que recibió el tratamiento estándar y una intervención fisioterápica (reeducación ventilatoria, electroestimulación, ejercicios con bandas elásticas y relajación). Resultados: Al comparar ambos grupos tras las intervenciones (experimental frente a control) se encontraron diferencias significativas en la disnea percibida (p = 0,041), así como en la fuerza muscular de los cuádriceps derecho e izquierdo (p = 0,008 y p = 0,010, respectivamente). Adicionalmente, la subescala «actividades domésticas» del cuestionario de capacidad funcional relacionada con sintomatología respiratoria mostró diferencias significativas (p = 0,036). Conclusión: Una intervención fisioterápica durante el período hospitalario en pacientes con EAEPOC y NAC puede generar mejoras a nivel musculoesquelético que superen el deterioro causado por la inmovilización durante la hospitalización (AU)
Background and objective: Respiratory infections involve not only hospitalization due to pneumonia, but also acute exacerbations of COPD (AECOPD). The objective of the present study was to evaluate the effectiveness of a physical therapy intervention during hospitalization in patients admitted due to community-acquired pneumonia (CAP) and AECOPD. Material and method: Randomized clinical trial, 44 patients were randomized into 2 groups: a control group which received standard medical therapy (oxygen therapy and pharmacotherapy) and an experimental group that received standard treatment and a physical therapy intervention (breathing exercises, electrostimulation, exercises with elastic bands and relaxation). Results: Between-groups analysis showed that after the intervention (experimental vs. control) significant differences were found in perceived dyspnoea (P = .041), and right and left quadriceps muscle strength (P = .008 andP = .010, respectively). In addition, the subscale of domestic activities of the functional ability related to respiratory symptoms questionnaire showed significant differences (P = .036). Conclusion: A physical therapy intervention during hospitalization in patients with AECOPD and CAP can generate skeletal muscle level gains that exceed the deterioration caused by immobilization during hospitalization (AU)
Subject(s)
Humans , Male , Adult , Pulmonary Disease, Chronic Obstructive/diagnosis , Pneumonia/diagnosis , Physical Therapy Modalities , Hospitalization , Length of Stay , Muscle Strength , DyspneaABSTRACT
BACKGROUND AND OBJECTIVE: Respiratory infections involve not only hospitalization due to pneumonia, but also acute exacerbations of COPD (AECOPD). The objective of the present study was to evaluate the effectiveness of a physical therapy intervention during hospitalization in patients admitted due to community-acquired pneumonia (CAP) and AECOPD. MATERIAL AND METHOD: Randomized clinical trial, 44 patients were randomized into 2 groups: a control group which received standard medical therapy (oxygen therapy and pharmacotherapy) and an experimental group that received standard treatment and a physical therapy intervention (breathing exercises, electrostimulation, exercises with elastic bands and relaxation). RESULTS: Between-groups analysis showed that after the intervention (experimental vs. control) significant differences were found in perceived dyspnoea (P=.041), and right and left quadriceps muscle strength (P=.008 and P=.010, respectively). In addition, the subscale of "domestic activities" of the functional ability related to respiratory symptoms questionnaire showed significant differences (P=.036). CONCLUSION: A physical therapy intervention during hospitalization in patients with AECOPD and CAP can generate skeletal muscle level gains that exceed the deterioration caused by immobilization during hospitalization.
Subject(s)
Physical Therapy Modalities , Pneumonia/rehabilitation , Pulmonary Disease, Chronic Obstructive/rehabilitation , Acute Disease , Aged , Aged, 80 and over , Community-Acquired Infections/complications , Community-Acquired Infections/rehabilitation , Disease Progression , Female , Hospitalization , Humans , Male , Pneumonia/complications , Pulmonary Disease, Chronic Obstructive/complications , Treatment OutcomeABSTRACT
Chronic obstructive pulmonary disease (COPD) is a progressive disease, its prevalence increases with age. COPD is frequently associated with co-morbidities such as cognitive impairment, and their clinical relevance has risen in the recent past. Cognitive function may fluctuate with the variable components of COPD like hypoxaemia, hypercapnia, lung function, exacerbations or severity of the disease. The objectives of this study were to examine whether the cognitive status of COPD patients is different across clinical stages (exacerbation, at discharge and stable COPD) and also if there are cognitive areas that have more potential to change than others. Prospective observational clinical study: 62 patients admitted to hospital due to acute exacerbation of COPD were evaluated at hospital admission; 61 at discharge; and finally, 48 patients with stable COPD completed the study and were included in the analysis. Cognitive status was assessed with the Montreal Cognitive Assessment (MoCA). Our results show that all clinical variables improved from exacerbation to discharge COPD. MoCA total score, visuoconstructional, attention, language, abstraction, delayed recall and orientation subscores improved significantly from exacerbation to discharge COPD (p < 0.05). MoCA total score, visuoconstructional and naming subscores worsened significantly from discharge to stable COPD (p < 0.05). Finally, from exacerbation to stable COPD all the clinical variables improved; MoCA total score and naming, attention, language, abstraction and delayed recall subscores have shown significant differences (p < 0.05). Cognitive status of COPD patients is different across clinical stages, and there are cognitive areas with more potential to change than others.