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Introduction: This study aims to create an artificial intelligence (AI) based machine learning (ML) model capable of predicting a spirometric obstructive pattern using variables with the highest predictive power derived from an active case-finding program for COPD in primary care. Material and methods: A total of 1190 smokers, aged 30-80 years old with no prior history of respiratory disease, underwent spirometry with bronchodilation. The sample was analyzed using AI tools. Based on an exploratory data analysis (EDA), independent variables (according to mutual information analysis) were trained using a gradient boosting algorithm (GBT) and validated through cross-validation. Results: With an area under the curve close to unity, the model predicted a spirometric obstructive pattern using variables with the highest predictive power: FEV1_theoretical_pre values. Sensitivity: 93%. Positive predictive value: 94%. Specificity: 97%. Negative predictive value: 96%. Accuracy: 95%. Precision: 94%. Conclusion: An ML model can predict the presence of an obstructive pattern in spirometry in a primary care smoking population with no prior diagnosis of respiratory disease using the FEV1_theoretical_pre values with an accuracy and precision exceeding 90%. Further studies including clinical data and strategies for integrating AI into clinical workflow are needed.
Introducción: Este estudio tiene como objetivo crear un modelo de aprendizaje automático (ML) basado en inteligencia artificial (IA) capaz de predecir un patrón obstructivo espirométrico utilizando variables con el mayor poder predictivo derivado de un programa activo de búsqueda de casos de enfermedad pulmonar obstructiva crónica (EPOC) en Atención Primaria. Materiales y métodos: Un total de 1.190 fumadores, de entre 30 y 80 años, sin antecedentes de enfermedad respiratoria, fueron sometidos a espirometría con IA artificial. Sobre la base de un análisis de datos exploratorio (EDA), las variables independientes (según el análisis de información mutua) se entrenaron utilizando un algoritmo de gradiente de aumento (GBT) y se validaron mediante validación cruzada. Resultados: Con un área bajo la curva cercana a la unidad, el modelo predijo un patrón obstructivo espirométrico utilizando los valores del FEV1 prebroncodilatador. Sensibilidad: 93%. Valor predictivo positivo: 94%. Especificidad: 97%. Valor predictivo negativo: 96%. Precisión: 95%. Precisión: 94%. Conclusión: Un modelo ML puede predecir la presencia de un patrón obstructivo en la espirometría en una población fumadora de atención primaria sin diagnóstico previo de enfermedad respiratoria utilizando los valores FEV1 prebroncodilatadores con una exactitud y precisión superiores al 90%. Se necesitan más estudios que incluyan datos clínicos y estrategias para integrar la IA en el flujo de trabajo clínico.
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The consumption of fresh water has generated additional problems in certain territories, along with the consequences of global warming. This has meant that in the most vulnerable areas, such as the Balearic archipelago in the Mediterranean, alternative water supply systems have been established: desalination plants. However, the ecological impact of these infrastructures is great, mainly affecting aquatic ecosystems. In light of the above, this paper addresses the ecological harm caused by desalination and brine discharges on a protected and priority species, P. Oceanica. Taking as ethico-legal foundation the theory of ecological justice, a multilevel analysis was carried out from an ecocriminology perspective on the impacts of this authorized practice on P. Oceanica and other species. Finally, a restorative justice view will allow us to understand and envision possible solutions to this ecological harm.
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INTRODUCTION: In recent decades, life expectancy has increased considerably. The cardiovascular effects of Obstructive Sleep Apnea (OSA) in the elderly lead to patient disability and high resource consumption. Intermittent nocturnal hypoxia leads to hemodynamic stress and adrenergic activation, which promotes cardiovascular disease. However, chronic intermittent hypoxia may protect elderly patients from cardiovascular events (CVE) due to biological adaptation. AREAS COVERED: OSA patients are at increased risk of cardiovascular events. The severity of OSA increases cardiovascular risk, and this association also exists in the elderly. This article reviews the association between OSA, CPAP treatment, and CVE, particularly stroke and coronary heart disease (CHD), in the elderly. MEDLINE and the Cochrane Collaboration databases were searched from inception to July 2021. EXPERT COMMENTARY: Although a positive association between OSA and the incidence of cardiovascular disease in the elderly has been established, the role of sleep apnea in certain cardiovascular events remains controversial. Most authors agree that untreated OSA is a risk factor for stroke or worse stroke prognosis. However, the association between OSA and CHD is usually less pronounced than between OSA and stroke, especially in the elderly.
Subject(s)
Cardiovascular Diseases , Sleep Apnea Syndromes , Sleep Apnea, Obstructive , Aged , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Continuous Positive Airway Pressure , Humans , Risk Factors , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/epidemiologySubject(s)
Pulmonary Disease, Chronic Obstructive , Sleep Apnea, Obstructive , Humans , Polysomnography , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/physiopathology , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/physiopathology , SleepinessABSTRACT
STUDY OBJECTIVES: Chronic obstructive pulmonary disease and obstructive sleep apnea overlap syndrome is associated with excess mortality, and outcomes are related to the degree of hypoxemia. People at high altitudes are susceptible to periodic breathing, and hypoxia at altitude is associated with cardio-metabolic dysfunction. Hypoxemia in these scenarios may be described as superimposed sustained hypoxia (SH) plus intermittent hypoxia (IH), or overlap hypoxia (OH), the effects of which have not been investigated. We aimed to characterize the cardio-metabolic consequences of OH in mice. METHODS: C57BL/6J mice were subjected to either SH (FiO2 = 0.10), IH (FiO2 = 0.21 for 12 h, and FiO2 oscillating between 0.21 and 0.06, 60 times/hour, for 12 h), OH (FiO2 = 0.13 for 12 h, and FiO2 oscillating between 0.13 and 0.06, 60 times/hour, for 12 h), or room air (RA), n = 8/group. Blood pressure and intraperitoneal glucose tolerance test were measured serially, and right ventricular systolic pressure (RVSP) was assessed. RESULTS: Systolic blood pressure transiently increased in IH and OH relative to SH and RA. RVSP did not increase in IH, but increased in SH and OH by 52% (p < .001) and 20% (p = .001). Glucose disposal worsened in IH and improved in SH, with no change in OH. Serum low- and very-low-density lipoproteins increased in OH and SH, but not in IH. Hepatic oxidative stress increased in all hypoxic groups, with the highest increase in OH. CONCLUSIONS: OH may represent a unique and deleterious cardio-metabolic stimulus, causing systemic and pulmonary hypertension, and without protective metabolic effects characteristic of SH.
Subject(s)
Hypoxia , Sleep Apnea, Obstructive , Animals , Disease Models, Animal , Humans , Mice , Mice, Inbred C57BL , Oxygen/metabolism , PhenotypeABSTRACT
BACKGROUND: Bronchiectasis (BE) impact the clinical course and prognosis of patients with chronic obstructive pulmonary disease (COPD). Yet, the temporal evolution of BE in these patients is unknown. This study seeks to assess the temporal evolution of BE in persons with COPD. METHODS: 201 moderate-to-severe patients were recruited between 2004 and 2007 and followed up at least every 6 monts (median of 102 months). To investigate the temporal evolution of BE, in 2015 a second high-resolution computed tomography scan (HRCT) was obtained in survivors and compared with the one obtained at recruitment. RESULTS: 99 (49.3%) died during follow-up. The second HRCT could be obtained in 77 patients and showed that (1) in 27.3% of patients BE never developed, in 36.4% they remained stable, in 16.9% they increased in size and/or extension, and in 19.5% new BE emerged; and that (2) the presence of chronic purulent sputum (hazard ratio [HR], 2.8 [95% confidence interval {CI}, 1.3-5.8]), number of hospitalizations due to exacerbatons (HR, 1.2 [95% CI, 1.1-1.5]), and number of pathogenic microorganism (PPM) isolations (HR, 1.1 [95% CI, 1.02-1.3]) were independent risk factors for the progression or development of BE. CONCLUSIONS: The presence of chronic purulent sputum production, number of PPMs isolated in sputum, and number of hospitalizations due to exacerbations of COPD are independent risk factors of BE progression in patients with COPD.
Subject(s)
Bronchiectasis , Bronchitis , Pulmonary Disease, Chronic Obstructive , Bronchiectasis/complications , Bronchiectasis/diagnostic imaging , Bronchiectasis/epidemiology , Disease Progression , Humans , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/epidemiology , Severity of Illness Index , SputumABSTRACT
Background and Purpose- The influence of age on the relationship between obstructive sleep apnea (OSA) and the incidence of hard cardiovascular events remains controversial. We sought to analyze the relationship between OSA and the incidence of stroke and coronary heart disease in a large cohort of elderly patients, as well as to investigate the role of continuous positive airway pressure (CPAP) treatment in these associations. Methods- Post hoc analysis of a prospective observational study of consecutive patients ≥65 years studied for OSA suspicion at 2 Spanish University Hospitals. Patients with an apnea-hypopnea index (AHI) <15 were the reference group. OSA was defined by an AHI ≥15 and classified as untreated (CPAP not prescribed or compliance <4 hours/day), mild-moderate (AHI 15-29), untreated severe (AHI ≥30), and CPAP-treated (AHI ≥15 and CPAP compliance ≥4 hours/day). Results- 859 and 794 elderly patients were included in the stroke and coronary heart disease analyses, respectively. The median (interquartile range) follow-up was 72 (50-88.5) and 71 (51.5-89) months, respectively. Compared with the reference group, the fully adjusted hazard ratios for the incidence of stroke were 3.42 (95% CI, 1.37-8.52), 1.02 (95% CI, 0.41-2.56), and 1.76 (95% CI, 0.62-4.97) for the untreated severe OSA group, CPAP-treated group, and untreated mild-moderate OSA group, respectively. No associations were shown between any of the different OSA groups and coronary heart disease incidence. Conclusions- The incidence of stroke, but not coronary heart disease, is increased in elderly patients with untreated severe OSA. Adequate CPAP treatment may reduce this risk.
Subject(s)
Coronary Disease , Sleep Apnea Syndromes , Stroke , Aged , Aged, 80 and over , Coronary Disease/epidemiology , Coronary Disease/etiology , Female , Humans , Incidence , Male , Prospective Studies , Severity of Illness Index , Sleep Apnea Syndromes/complications , Sleep Apnea Syndromes/epidemiology , Stroke/epidemiology , Stroke/etiologyABSTRACT
We present an analytical and numerical study of the Ising model on a bilayer honeycomb lattice including interlayer frustration and coupling with an external magnetic field. First, we discuss the exact T=0 phase diagram, where we find finite entropy phases for different magnetizations. Then, we study the magnetic properties of the system at finite temperature using complementary analytical techniques (Bethe lattice) and two types of Monte Carlo algorithms (Metropolis and Wang-Landau). We characterize the phase transitions and discuss the phase diagrams. The system presents a rich phenomenology: There are first- and second-order transitions, low-temperature phases with extensive degeneracy, and order-by-disorder state selection.
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The family of compounds CBrnCl4-n has been proven helpful in unraveling microscopic mechanisms responsible for glassy behavior. Some of the family members show translational ordered phases with minimal disorder which appears to reveal glassy features, thus deserving special attention in the search for universal glass anomalies. In this work, we studied CBrCl3 dynamics by performing extensive molecular dynamics simulations. Molecules of this compound perform reorientational discrete jumps, where the atoms exchange equivalent positions among each other revealing a cage-orientational jump motion fully comparable to the cage-rototranslational jump motion in supercooled liquids. Correlation times were calculated from rotational autocorrelation functions showing good agreement with previous reported dielectric results. From mean waiting and persistence times calculated directly from trajectory results, we are able to explain which microscopic mechanisms lead to characteristic times associated with α- and ß-relaxation times measured experimentally. We found that two nonequivalent groups of molecules have a longer characteristic time than the other two nonequivalent groups, both of them belonging to the asymmetric unit of the monoclinic (C2/c) lattice.
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Carbon tetrachloride (CCl4) is one of the simplest compounds having a translationally stable monoclinic phase while exhibiting a rich rotational dynamics below 226 K. Recent nuclear quadrupolar resonance experiments revealed that the dynamics of CCl4 is similar to that of the other members of the isostructural series CBrnCl4-n, suggesting that the universal relaxation features of canonical glasses such as α and ß relaxation are also present in nonglass formers. Using molecular dynamics simulations we studied the rotational dynamics in the monoclinic phase of CCl4. The molecules undergo C3-type jump-like rotations around each one of the four C-Cl bonds. The rotational dynamics is very well described with a master equation using as the only input the rotational rates measured from the simulated trajectories. It is found that the heterogeneous dynamics emerges from faster and slower modes associated with different rotational axes, which have fixed orientations relative to the crystal and are distributed among the four nonequivalent molecules of the unit cell.
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A thorough characterization of the γ, ß, and glass phases of deuterated 1,1,2,2 tetrachloroethane (C2D2Cl4) via nuclear quadrupole resonance and Molecular Dynamic Simulations (MDSs) is reported. The presence of molecular reorientations was experimentally observed in the glass phase and in the ß phase. In the ß phase, and from MDS, these reorientations are attributed to two possible movements, i.e., a 180° reorientation around the C2 molecular symmetry axis and a reorientation of the molecule between two non-equivalent positions. In the glass phase, the spin-lattice relaxation time T1 is of the order of 16 times lower than in the crystalline phase and varies as T(-1) below 100 K in good agreement with the strong quadrupolar relaxation observed in amorphous materials and in the glassy state of molecular organic systems. The activation energy of molecular reorientations in the glass phase (19 kJ/mol) is comparable to that observed in the glassy crystal of a "molecular cousin" compound, Freon 112 (C2F2Cl4), for the secondary ß-relaxation. Moreover, the on-site orientational motion of tetrachloroethane molecules offers a new indirect evidence of the prominent role of such orientational disorder in glassy dynamics.
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OBJECTIVE: The association between obstructive sleep apnea (OSA) and cancer mortality has scarcely been studied. The objective of this study was to investigate whether OSA is associated with increased cancer mortality in a large cohort of patients with OSA suspicion. METHODS: This was a multicenter study in consecutive patients investigated for suspected OSA. OSA severity was measured by the apnea-hypopnea index (AHI) and the hypoxemia index (% night-time spent with oxygen saturation <90%, TSat90). The association between OSA severity and cancer mortality was assessed using Cox's proportional regression analyses after adjusting for relevant confounders. RESULTS: In all, 5427 patients with median follow-up of 4.5 years were included. Of these, 527 (9.7%) were diagnosed with cancer. Log-transformed TSat90 was independently associated with increased cancer mortality in the entire cohort (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.42), as well as in the group of patients with cancer (HR, 1.19; 95% CI, 1.02-1.41). The closest association was shown in patients <65years in both the AHI (continuous log-transformed AHI: HR, 1.87; 95% CI, 1.1-3.2; upper vs lower AHI tertile: HR, 3.98; 95% CI, 1.14-3.64) and the TSat90 (continuous log-transformed TSat90: HR, 1.73; 95% CI, 1.23-2.4; upper vs. lower TSat90 tertile: HR, 14.4; 95% CI, 1.85-111.6). CONCLUSIONS: OSA severity was associated with increased cancer mortality, particularly in patients aged <65 years.
Subject(s)
Neoplasms/mortality , Sleep Apnea, Obstructive/complications , Age Factors , Aged , Continuous Positive Airway Pressure , Female , Humans , Hypoxia/complications , Hypoxia/etiology , Male , Middle Aged , Neoplasms/etiology , Proportional Hazards Models , Retrospective Studies , Severity of Illness Index , Sleep Apnea, Obstructive/therapyABSTRACT
RATIONALE: It is unknown whether obstructive sleep apnea (OSA) may be a risk factor for incident cardiovascular events in women. OBJECTIVES: We sought to investigate whether OSA increases the incidence of a composite of stroke or coronary heart disease (CHD) in women, and the role of continuous positive airway pressure (CPAP) treatment on this association. METHODS: This was a prospective, observational study conducted in two Spanish teaching hospitals between 1998 and 2007. Consecutive women referred for suspected OSA and free of previous stroke and CHD were analyzed. Women with an apnea-hypopnea index (AHI) less than 10 comprised the control group, and those with an AHI greater than or equal to 10 were diagnosed with OSA and classified as CPAP-treated (adherence ≥ 4 h/d) or untreated (adherence < 4 h/d or not prescribed). The follow-up ended in December 2010. MEASUREMENTS AND MAIN RESULTS: A total of 967 women were studied (median follow-up, 6.8 yr; interquartile range, 5.2-8.2). The untreated OSA group showed a greater incidence rate of the composite outcome than the control group (2.19 vs. 0.54 per 100 person-years; P < 0.0005). Compared with the control group, the fully adjusted hazard ratios for the composite outcome incidence were 2.76 (95% confidence interval [CI], 1.35-5.62) for the untreated OSA group, and 0.91 (95% CI, 0.43-1.95) for the CPAP-treated group. When the type of cardiovascular event was separately assessed, untreated OSA showed a stronger association with incident stroke (adjusted hazard ratio, 6.44; 95% CI, 1.46-28.3) than with CHD (adjusted hazard ratio, 1.77; 95% CI, 0.76-4.09). CONCLUSIONS: In women, untreated OSA is associated with increased incidence of serious cardiovascular outcomes, particularly incident stroke. Adequate CPAP treatment seems to reduce this risk.
Subject(s)
Continuous Positive Airway Pressure , Coronary Disease/etiology , Coronary Disease/prevention & control , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/therapy , Stroke/etiology , Stroke/prevention & control , Adult , Aged , Case-Control Studies , Coronary Disease/epidemiology , Female , Follow-Up Studies , Humans , Incidence , Kaplan-Meier Estimate , Middle Aged , Proportional Hazards Models , Prospective Studies , Risk Factors , Stroke/epidemiology , Treatment OutcomeABSTRACT
All blood cell lineages start from hematopoietic stem cells (HSCs), which were recently shown to represent a heterogeneous group of cells. In mice, Notch signaling promotes the maintenance of "stemness" as well as the expansion of self-renewing HSCs in vitro. Additionally, human CD34(+) cells were shown to expand in vitro in response to Notch signals. However, it is unclear whether Notch directly affects all HSCs, and whether this role is relevant in vivo. Here, we developed culture conditions that support the maintenance of CD34(+)CD133(+)CD90(low)CD38(-)CD7(-)CD10(-)CD45RA(-) (CD90(low)) cells, phenotypically defined HSCs, as well as 2 early progenitor cells (CD34(+)CD38(-)CD7(-)CD10(-)CD45RA(int) [RA(int)] and CD34(+)CD38(-)CD7(-)CD10(-)CD45RA(hi) [RA(hi)]) that were functionally equivalent to multipotent progenitor-2 and lymphoid-primed multipotent progenitor, respectively, found in cord blood. Using a genetic approach, we show that Notch signals were required for HSC preservation, with cultured HSCs being equal to ex vivo HSC cells in their ability to reconstitute immunodeficient mice; however, dnMaml-transduced HSCs were not maintained in vitro. Interestingly, Notch signaling did not appear to be required for the self-renewal of human HSCs in vivo. Our findings support the notion that Notch signals maintain human HSCs in vitro that have hematopoietic-reconstituting ability in vivo and delay the appearance of 2 newly described early progenitor cells.
Subject(s)
Hematopoietic Stem Cells/cytology , Hematopoietic Stem Cells/metabolism , Multipotent Stem Cells/cytology , Multipotent Stem Cells/metabolism , Receptors, Notch/metabolism , Signal Transduction/physiology , Animals , Cell Differentiation/physiology , Cells, Cultured , Coculture Techniques , Female , Fetal Blood/cytology , Humans , Immunophenotyping , Leukocyte Common Antigens/metabolism , Male , Mice , Mice, Inbred BALB C , Mice, Inbred NOD , Mice, SCID , Receptors, Notch/geneticsABSTRACT
La prevalencia y la gravedad del Síndrome de Apneas-Hipopneas durante el sueño (SAHS) aumentan con la edad. A pesar de ello se trata de una enfermedad infradiagnosticada y actualmente no existe un consenso claro sobre cual debe ser el enfoque diagnóstico y terapéutico de los pacientes de edad avanzada. El número de ancianos está aumentando en nuestro país de manera significativa en los últimos años, así como el número de pacientes de edad avanzada remitidos a las Unidades de Sueño para estudio de un posible SAHS, probablemente como consecuencia de una mayor concienciación de las consecuencias negativas sobre la salud de esta enfermedad. Se estima que una cuarta parte de los estudios de sueño se realiza en pacientes mayores de 65 años y de estos a más de la mitad se les prescribe tratamiento con presión positiva continua en la vía aérea (CPAP) sin una evidencia científica clara que lo justifique. A falta de nuevas recomendaciones específicas, las guías vigentes sostienen que la edad no debe ser un factor limitante a la hora de decidir el tratamiento de los pacientes de edad avanzada. Dado el incremento en la longevidad observado en las últimas décadas en nuestro país, el elevado gasto que supone esta patología y las consecuencias sobre la salud en los individuos que la padecen, descubrir cuál es el diagnóstico y tratamiento más apropiado en los pacientes de edad avanzada con SAHS debe ser un objetivo prioritario en la investigación clínica (AU)
The prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) increases with age. Nevertheless it is an underdiagnosed disease and there is currently no clear consensus on which should be the diagnostic and therapeutic approach in the elderly. In the last few years the elderly population is significantly increasing in our country, and the number of elderly patients referred to the Sleep Unit for suspected SAHS is also increasing, probably due to the increased awareness of the negative consequences of this disease on health. It is estimated that a quarter of the sleep studies are performed in patients older than 65 years and in more than a half of them the treatment with continuous positive airway pressure (CPAP) is prescribed with no clear scientific evidence to support it. In the absence of specific recommendations, current guidelines state that age should not be a limiting factor when deciding on the treatment of elderly patients. Considering the increased longevity observed in recent decades in our country, the high economic cost of this pathology and its consequences on health, it should be a priority in clinical research to find out what is the most appropriate diagnosis and treatment in this age froup (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Sleep Apnea Syndromes/complications , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/therapy , Health Services for the Aged/organization & administration , Health Services for the Aged/trends , Health of the Elderly , Frail Elderly , Quality of Life , Sleep Apnea Syndromes/prevention & control , Sleep Apnea Syndromes/physiopathology , Indicators of Morbidity and MortalityABSTRACT
Hematopoietic stem cell transplantation (HSCT) is followed by a period of immune deficiency due to a paucity in T-cell reconstitution. Underlying causes are a severely dysfunctional thymus and an impaired production of thymus-seeding progenitors in the host. Here, we addressed whether in vitro-derived human progenitor T (proT)-cells could not only represent a source of thymus-seeding progenitors, but also able to influence the recovery of the thymic microenvironment. We examined whether co-transplantation of in vitro-derived human proT-cells with hematopoietic stem cells (HSCs) was able to facilitate HSC-derived T-lymphopoiesis posttransplant. A competitive transfer approach was used to define the optimal proT subset capable of reconstituting immunodeficient mice. Although the 2 subsets tested (proT1, CD34(+)CD7(+)CD5(-); proT2, CD34(+)CD7(+)CD5(+)) showed thymus engrafting function, proT2-cells exhibited superior engrafting capacity. Based on this, when proT2-cells were coinjected with HSCs, a significantly improved and accelerated HSC-derived T-lymphopoiesis was observed. Furthermore, we uncovered a potential mechanism by which receptor activator of nuclear factor κb (RANK) ligand-expressing proT2-cells induce changes in both the function and architecture of the thymus microenvironment, which favors the recruitment of bone marrow-derived lymphoid progenitors. Our findings provide further support for the use of Notch-expanded progenitors in cell-based therapies to aid in the recovery of T-cells in patients undergoing HSCT.
Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Hematopoietic Stem Cells/cytology , Immunologic Deficiency Syndromes/therapy , Lymphopoiesis/immunology , T-Lymphocytes/cytology , Thymus Gland/cytology , Animals , Cell Differentiation/immunology , Cells, Cultured , Coculture Techniques , Disease Models, Animal , Humans , Immunologic Deficiency Syndromes/immunology , Mice , Mice, Inbred NOD , Mice, Knockout , Regeneration/immunology , Stromal Cells/cytology , Stromal Cells/immunology , T-Lymphocytes/immunology , Thymus Gland/immunologyABSTRACT
RATIONALE: The prevalence of bronchiectasis is high in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and it has been associated with exacerbations and bacterial colonization. These have demonstrated some degree of prognostic value in patients with COPD but no information about the relationship between bronchiectasis and mortality in patients with COPD is currently available. OBJECTIVES: To assess the prognostic value of bronchiectasis in patients with moderate-to-severe COPD. METHODS: Multicenter prospective observational study in consecutive patients with moderate-to-severe COPD. Bronchiectasis was diagnosed by high-resolution computed tomography scan. A complete standardized protocol was used in all patients covering general, anthrophometric, functional, clinical, and microbiologic data. After follow-up, the vital status was recorded in all patients. Multivariate Cox analysis was used to determine the independent adjusted prognostic value of bronchiectasis. MEASUREMENTS AND MAIN RESULTS: Ninety-nine patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) II, 85 in GOLD III, and 17 in GOLD IV stages were included. Bronchiectasis was present in 115 (57.2%) patients. During the follow-up (median, 48 mo [interquartile range, 35-53]) there were 51 deaths (43 deaths in the bronchiectasic group). Bronchiectasis was associated with an increased risk of fully adjusted mortality (hazard ratio, 2.54; 95% confidence interval, 1.16-5.56; P = 0.02). CONCLUSIONS: Bronchiectasis was associated with an independent increased risk of all-cause mortality in patients with moderate-to-severe COPD.
Subject(s)
Bronchiectasis/etiology , Pulmonary Disease, Chronic Obstructive/complications , Aged , Ambulatory Care Facilities/statistics & numerical data , Bronchiectasis/diagnostic imaging , Bronchiectasis/epidemiology , Comorbidity , Disease Progression , Female , Humans , Incidence , Kaplan-Meier Estimate , Male , Prevalence , Prognosis , Proportional Hazards Models , Prospective Studies , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Disease, Chronic Obstructive/physiopathology , Severity of Illness Index , Spain/epidemiology , Sputum/microbiology , Tomography, X-Ray ComputedABSTRACT
Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea (OSA), but compliance and variables involved in long-term CPAP adherence in females with OSA are unknown. We performed an observational study including all consecutive females diagnosed with CPAP who started CPAP treatment in two Spanish teaching hospitals between 1999 and 2007 and were followed-up until December 2010. The Kaplan-Meier method was used to calculate the probability of continuing with CPAP treatment and a multivariate Cox regression analysis was used to identify baseline predictors of CPAP dropout. We analysed 708 females, median (interquartile range) age 60 (52-67) years and apnoea-hypopnoea index 43.0 (27.2-66.8). Females were followed for a median of 6.2 (4.2-7.7) years. The probability of still being on CPAP at 5 and 10 years was 82.8% and 79.9%, respectively. The median CPAP use was 6 (interquartile range 4-7) h · day(-1). In the multivariate analysis, independent baseline predictors of CPAP dropout were psychoactive medication (hazard ratio 1.47, 95% CI 1.03-2.08), age (hazard ratio 1.01, 95% CI 1.00-1.03) and CPAP pressure (hazard ratio 0.89, 95% CI 0.81-0.96). Long-term CPAP adherence in females with OSA is good. Psychoactive medication and increasing age were independent predictors of CPAP dropout, whereas higher CPAP was associated with continued treatment.
Subject(s)
Continuous Positive Airway Pressure , Patient Compliance , Sleep Apnea, Obstructive/therapy , Aged , Female , Follow-Up Studies , Humans , Middle Aged , Probability , Proportional Hazards Models , Prospective Studies , Psychotropic Drugs/therapeutic useABSTRACT
RATIONALE: Obstructive sleep apnea (OSA) is a risk factor for cardiovascular death in middle-aged subjects, but it is not known whether it is also a risk factor in the elderly. OBJECTIVES: To investigate whether OSA is a risk factor for cardiovascular death and to assess whether continuous positive airway pressure (CPAP) treatment is associated with a change in risk in the elderly. METHODS: Prospective, observational study of a consecutive cohort of elderly patients (≥65 yr) studied for suspicion of OSA between 1998 and 2007. Patients with an apnea-hypopnea index (AHI) less than 15 were the control group. OSA was defined as mild to moderate (AHI, 15-29) or severe (AHI, ≥30). Patients with OSA were classified as CPAP-treated (adherence ≥ 4 h/d) or untreated (adherence < 4 h/d or not prescribed). Participants were monitored until December 2009. The end point was cardiovascular death. A multivariate Cox survival analysis was used to determine the independent impact of OSA and CPAP treatment on cardiovascular mortality. MEASUREMENTS AND MAIN RESULTS: A total of 939 elderly were studied (median follow-up, 69 mo). Compared with the control group, the fully adjusted hazard ratios for cardiovascular mortality were 2.25 (confidence interval [CI], 1.41 to 3.61) for the untreated severe OSA group, 0.93 (CI, 0.46 to 1.89) for the CPAP-treated group, and 1.38 (CI, 0.73 to 2.64) for the untreated mild to moderate OSA group. CONCLUSIONS: Severe OSA not treated with CPAP is associated with cardiovascular death in the elderly, and adequate CPAP treatment may reduce this risk.
Subject(s)
Cardiovascular Diseases/mortality , Continuous Positive Airway Pressure/statistics & numerical data , Sleep Apnea, Obstructive/mortality , Aged , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Cause of Death , Female , Humans , Kaplan-Meier Estimate , Long-Term Care , Male , Proportional Hazards Models , Prospective Studies , Risk Factors , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/therapy , Spain/epidemiologyABSTRACT
We present a molecular dynamics study of the liquid and plastic crystalline phases of CCl(3)Br. We investigated the short-range orientational order using a recently developed classification method and we found that both phases behave in a very similar way. The only differences occur at very short molecular separations, which are shown to be very rare. The rotational dynamics was explored using time correlation functions of the molecular bonds. We found that the relaxation dynamics corresponds to an isotropic diffusive mode for the liquid phase but departs from this behavior as the temperature is decreased and the system transitions into the plastic phase.