Fumadores y riesgo de muerte hospitalaria por COVID calculado con el procesamiento de lenguaje natural de SAVANA en el ámbito de Castilla-La Mancha / Smokers and risk of hospital death by COVID calculated with SAVANA's natural language processing in the Castilla-La Mancha area

Introducción Durante la pandemia de COVID se especuló que los pacientes con el virus que tenían relación con el tabaco podrían tener una menor probabilidad de agravamiento de la enfermedad o muerte. Para evaluar si existe una asociación entre el tabaquismo y el riesgo de mortalidad intrahospitalaria se utiliza la tecnología de Big Data y Procesamiento del Lenguaje Natural (PLN) de SAVANA. Método Se llevó a cabo un estudio de cohortes retrospectivo, observacional y sin intervención basado en datos de vida real extraídos de registros médicos de toda Castilla-La Mancha utilizando las técnicas de PLN e inteligencia artificial desarrolladas por SAVANA. El estudio abarcó toda la población de esta Comunidad con historia clínica electrónica en SESCAM que presentara diagnóstico de COVID desde el 1 de marzo de 2020 al 28 de febrero de 2021. Resultados Los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular (hipertensión arterial, dislipemia y diabetes), EPOC, asma, EPID, CI, ECV, TEP, cáncer en general y cáncer de pulmón en particular, bronquiectasias, insuficiencia cardíaca y antecedentes de neumonía, de forma significativa (p<0,0001). Los pacientes exfumadores, fumadores y no fumadores tienen una diferencia de edad significativa. En cuanto a las muertes hospitalarias, fueron más frecuentes en el caso de los exfumadores, siguiendo los fumadores y luego los no fumadores (p<0,0001). Conclusión Existe un mayor riesgo de mortalidad intrahospitalaria en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado. (AU)

Introduction During the COVID pandemic, it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death. To assess whether there is an association between smoking and risk of in-hospital mortality, SAVANA's big data and natural language processing (NLP) technology is used. Method A retrospective, observational, non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla-La Mancha using natural language processing and artificial intelligence techniques developed by SAVANA. The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1, 2020 to February 28, 2021. Results Smokers had a significantly higher percentage of cardiovascular risk factors (hypertension, dyslipidemia and diabetes), COPD, asthma, IDP, IC, CVD, PTE, cancer in general and lung cancer in particular, bronchiectasis, heart failure and a history of pneumonia (P<.0001). Former smokers, current smokers and non-smokers have a significant age difference. As for in-hospital deaths, they were more frequent in the case of ex-smokers, followed by smokers and then non-smokers (P<.0001). Conclusion There is an increased risk of dying in hospital in SARS-CoV-2-infected patients who are active smokers or have smoked in the past. (AU)

Fumadores y riesgo de muerte hospitalaria por COVID calculado con el procesamiento de lenguaje natural de SAVANA en el ámbito de Castilla-La Mancha / Smokers and risk of hospital death by COVID calculated with SAVANA's natural language processing in the Castilla-La Mancha area

Introducción Durante la pandemia de COVID se especuló que los pacientes con el virus que tenían relación con el tabaco podrían tener una menor probabilidad de agravamiento de la enfermedad o muerte. Para evaluar si existe una asociación entre el tabaquismo y el riesgo de mortalidad intrahospitalaria se utiliza la tecnología de Big Data y Procesamiento del Lenguaje Natural (PLN) de SAVANA. Método Se llevó a cabo un estudio de cohortes retrospectivo, observacional y sin intervención basado en datos de vida real extraídos de registros médicos de toda Castilla-La Mancha utilizando las técnicas de PLN e inteligencia artificial desarrolladas por SAVANA. El estudio abarcó toda la población de esta Comunidad con historia clínica electrónica en SESCAM que presentara diagnóstico de COVID desde el 1 de marzo de 2020 al 28 de febrero de 2021. Resultados Los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular (hipertensión arterial, dislipemia y diabetes), EPOC, asma, EPID, CI, ECV, TEP, cáncer en general y cáncer de pulmón en particular, bronquiectasias, insuficiencia cardíaca y antecedentes de neumonía, de forma significativa (p<0,0001). Los pacientes exfumadores, fumadores y no fumadores tienen una diferencia de edad significativa. En cuanto a las muertes hospitalarias, fueron más frecuentes en el caso de los exfumadores, siguiendo los fumadores y luego los no fumadores (p<0,0001). Conclusión Existe un mayor riesgo de mortalidad intrahospitalaria en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado. (AU)

Introduction During the COVID pandemic, it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death. To assess whether there is an association between smoking and risk of in-hospital mortality, SAVANA's big data and natural language processing (NLP) technology is used. Method A retrospective, observational, non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla-La Mancha using natural language processing and artificial intelligence techniques developed by SAVANA. The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1, 2020 to February 28, 2021. Results Smokers had a significantly higher percentage of cardiovascular risk factors (hypertension, dyslipidemia and diabetes), COPD, asthma, IDP, IC, CVD, PTE, cancer in general and lung cancer in particular, bronchiectasis, heart failure and a history of pneumonia (P<.0001). Former smokers, current smokers and non-smokers have a significant age difference. As for in-hospital deaths, they were more frequent in the case of ex-smokers, followed by smokers and then non-smokers (P<.0001). Conclusion There is an increased risk of dying in hospital in SARS-CoV-2-infected patients who are active smokers or have smoked in the past. (AU)

Tabaquismo y otras formas de fumar entre los estudiantes de Medicina / Smoking and other forms of smoking among medical students

Introducción. El tabaco es la segunda sustancia psicoactiva más consumida en España y cuyo consumo es causa de la principal tasa de mortalidad evitable en el mundo, además de producir enfermedades muy graves en muchos sistemas como el respiratorio, cardiovascular y ser factor de riesgo para gran número de tumores. Objetivo. Conocer la prevalencia del consumo de tabaco y otras sustancias asociadas entre los estudiantes de 1º, 4º y 6º de la Facultad de Medicina de Albacete. Material y métodos. Estudio trasversal utilizando una encuesta anónima y voluntaria entre los estudiantes de 1º, 4º y 6º de la Facultad de Medicina de Albacete. Resultados. El 66% de los estudiantes han probado el tabaco, de los cuales al 97% fueron sus amigos los que se lo ofrecieron. El 100% cree que el tabaco es perjudicial.Entre los que han probado el tabaco, el 9,5% son fumadores habituales y entre ellos, el 57,9% son de sexto curso de Medicina. Hay una relación estadísticamente significativa entre ser varón y ser fumador. Un estudiante fuma IQOS y otro utiliza vapeadores, a diferencia de los 54 estudiantes (27%) que consumen cachimba, siendo lo más frecuente el consumo en finde semana. El 6% de los estudiantes consume marihuana, con una relación estadísticamente significativa entre ser de sexto curso y su consumo. Conclusión. Hay una prevalencia bastante alta de consumo de tabaco y productos relacionados entrelos estudiantes, a pesar de que todos ellos tienen conocimiento de los efectos perjudiciales para la salud. (AU)

Introduction. Tobacco is the second most consumed psychoactive substance in Spain and whose use is the cause of the main avoidable mortality rate in the world, as well as producing very serious diseases in many systems such as the respiratory, and cardiovascular ones and being a risk factor for a large number of tumors. Objective. To know the prevalence of tobacco consumption and other associated substances among 1st,4th and 6th year students of the Medical Faculty of Albacete. Material and methods. Cross-sectional study usingan anonymous and voluntary survey among 1st, 4th and 6th year students of the Medical Faculty of Albacete. Results.Sixty-six percent of the students have tried smoking, 97% of whom were offered it by their friends. A total of 100% believe that tobacco is harmful.Among those who have tried smoking, 9.5% are regular smokers and among them 57.9% are in the sixth year of medicine. There is a statistically significant relationship between being male and being a smoker. One student smoked IQOS and another one used vapers, unlike 54 students (27%) who consumed hookah, with weekend consumption being the most frequent. Six percent of the students consumed marihuana, there being a statistically significant relationship between being in the sixth year and its consumption. Conclusion. The prevalence of consumption of tobacco and related products is fairly high among the students, even though all of them are aware of its harmful effects on health. (AU)

Telemedicina y otros programas innovadores aplicados al tratamiento del tabaquismo / Telemedicine and its application in tobacco programs

La telemedicina tiene múltiples aplicaciones en los programas de deshabituación tabáquica. Los estudios utilizan las nuevas tecnologías con la intención de cambiar los hábitos de vida, dar mensajes de refuerzo y monitorizar los avances de los usuarios. Los recursos más habitualmente utilizados fueron las aplicaciones móviles, páginas webs y el asesoramiento telefónico. Los resultados son prometedores, aunque son necesarios más estudios y analizar los motivos de la lenta implementación de estos programas. La aparición de nuevas tecnologías como el Big Data, la minería de datos, la gamificación, entre otros, van a darnos nuevas oportunidades para mejorar los programas de innovación en el tratamiento del tabaquismo

Telemedicine has several applications in the treatment of smoking cessation. The aim of new technologies was to promote changes in life habits, reinforcement messages and monitored patients’ achievements. Smartphone applications, web and telephone were the most used tools in telemedicine programs. The results are promising, although more studies are required and it is necessary to analyze other applications and the reasons of slow implementations. Big Data, data mining and gamification, among others, will give us new opportunities to improve these innovations programs

Situación de la ventilación mecánica domiciliaria en la Comunidad de Madrid, visión desde Castilla La Mancha / Situation of home mechanical ventilation in Madrid area, view from Castilla La Mancha

No disponible

Eficacia analgésica del bloqueo pectoral modificado más bloqueo del plano del serrato en mamoplastia subpectoral: ensayo clínico, controlado, aleatorizado, triple ciego / Analgesic efficacy of modified pectoral block plus serratus plane block in breast augmentation surgery: A randomised, controlled, triple-blind clinical trial

Introducción: La cirugía protésica de mama es un procedimiento de cirugía plástica muy común, cuyo manejo analgésico postoperatorio es un reto para el equipo quirúrgico. El propósito del presente estudio fue validar la eficacia analgésica del bloqueo de los nervios pectorales y plano del serrato en mamoplastia de aumento retropectoral. Pacientes y métodos: Se diseñó un ensayo clínico, controlado, aleatorizado, triple ciego, que incluyó a 30 pacientes intervenidas mediante mamoplastia de aumento retropectoral. En ambos grupos se realizaron bloqueo pectoral modificado y bloqueo del plano serrato con un volumen total de 40ml por mama. En 15 de ellas se inyectó bupivacaína 0,25% con epinefrina (GPEC), y en las otras 15 se administró suero fisiológico (GC). Se hizo manejo estandarizado de la anestesia y la analgesia postoperatoria. Se midieron parámetros hemodinámicos intraoperatorios, necesidad de analgesia postoperatoria y la escala numérica verbal a su llegada a reanimación, a las 3, 6 y 24h, así como la calidad percibida por los pacientes y cirujanos. Resultados: En el postoperatorio inmediato, se pudo percibir una disminución del dolor en las pacientes del GPEC (5,3±2,3 vs. 2,9±2,7; p=0,018). No se observaron diferencias significativas a las 3, 6 y 24h. Los cirujanos valoraron la calidad anestésico-analgésica como muy buena en el 80% de los casos en el GPEC frente al 33% en el GC (p=0,01). Conclusiones: El uso de estos bloqueos es una buena estrategia analgésica perioperatoria en el manejo multimodal en la mamoplastia de aumento retropectoral

Introduction: Prosthetic breast surgery is a very common plastic surgery procedure, but its postoperative analgesic management is a challenge for the surgical team. The purpose of the present study is to validate the analgesic efficacy of pectoral block and serratus plane block in retropectoral mammoplasty. Patients and methods: A randomised, controlled, triple-blind, clinical trial was designed, and included 30 patients undergoing retropectoral augmentation mammoplasty. All of them had a modified PECII block and a serratus plane block with a total volume of 40ml per breast. In 15 of them bupivacaine 0.25% (GPEC) was injected and in the other 15 patients saline was used (GC). Standardised management of anaesthesia and postoperative analgesia was performed. Intra-operative haemodynamic parameters required for postoperative analgesia, and a numeric verbal scale on arrival in the recovery unit were measured and at 3, 6, and 24h. The quality perceived by patients and surgeons was also measured. Results: Post-operative pain was significantly better in GPEC (5.3±2.3 vs. 2.9±2.7; P=.018). No significant differences were observed at 3, 6, and 24h. The surgeons rated the anaesthetic-analgesic quality as very good in 80% of the cases in GPEC versus 33% in CG (P=.01). Conclusions: The use of these blocks is a good perioperative analgesic strategy in the multimodal management of retropectoral augmentation mammoplasty

Analgesic efficacy of modified pectoral block plus serratus plane block in breast augmentation surgery: A randomised, controlled, triple-blind clinical trial. / Eficacia analgésica del bloqueo pectoral modificado más bloqueo del plano del serrato en mamoplastia subpectoral: ensayo clínico, controlado, aleatorizado, triple ciego.

INTRODUCTION: Prosthetic breast surgery is a very common plastic surgery procedure, but its postoperative analgesic management is a challenge for the surgical team. The purpose of the present study is to validate the analgesic efficacy of pectoral block and serratus plane block in retropectoral mammoplasty. PATIENTS AND METHODS: A randomised, controlled, triple-blind, clinical trial was designed, and included 30 patients undergoing retropectoral augmentation mammoplasty. All of them had a modified PECII block and a serratus plane block with a total volume of 40ml per breast. In 15 of them bupivacaine 0.25% (GPEC) was injected and in the other 15 patients saline was used (GC). Standardised management of anaesthesia and postoperative analgesia was performed. Intra-operative haemodynamic parameters required for postoperative analgesia, and a numeric verbal scale on arrival in the recovery unit were measured and at 3, 6, and 24h. The quality perceived by patients and surgeons was also measured. RESULTS: Post-operative pain was significantly better in GPEC (5.3±2.3 vs. 2.9±2.7; P=.018). No significant differences were observed at 3, 6, and 24h. The surgeons rated the anaesthetic-analgesic quality as very good in 80% of the cases in GPEC versus 33% in CG (P=.01). CONCLUSIONS: The use of these blocks is a good perioperative analgesic strategy in the multimodal management of retropectoral augmentation mammoplasty.

Spectral Analysis of the Slip-Length Model for Turbulence over Textured Superhydrophobic Surfaces.

We assess the applicability of slip-length models to represent textured superhydrophobic surfaces. From the results of direct numerical simulations, and by considering the slip length from a spectral perspective, we discriminate between the apparent boundary conditions experienced by different lengthscales in the overlying turbulent flow. In particular, we focus on the slip lengths experienced by lengthscales relevant to the near wall turbulent dynamics. Our results indicate that the apparent failure of homogeneous slip-length models is not the direct effect of the texture size becoming comparable to the size of eddies in the flow. The texture-induced signal scatters to the entire wavenumber space, affecting the perceived slip length across all lengthscales, even those much larger than the texture. We propose that the failure is caused by the intensity of the texture-induced flow, rather than its wavelength, becoming comparable to the background turbulence.

Turbulent Drag Reduction Using Anisotropic Permeable Substrates.

The behaviour of turbulent flow over anisotropic permeable substrates is studied using linear stability analysis and direct numerical simulations (DNS). The flow within the permeable substrate is modelled using the Brinkman equation, which is solved analytically to obtain the boundary conditions at the substrate-channel interface for both the DNS and the stability analysis. The DNS results show that the drag-reducing effect of the permeable substrate, caused by preferential streamwise slip, can be offset by the wall-normal permeability of the substrate. The latter is associated with the presence of large spanwise structures, typically associated to a Kelvin-Helmholtz-like instability. Linear stability analysis is used as a predictive tool to capture the onset of these drag-increasing Kelvin-Helmholtz rollers. It is shown that the appearance of these rollers is essentially driven by the wall-normal permeability Ky+ . When realistic permeable substrates are considered, the transpiration at the substrate-channel interface is wavelength-dependent. For substrates with low Ky+ , the wavelength-dependent transpiration inhibits the formation of large spanwise structures at the characteristic scales of the Kelvin-Helmholtz-like instability, thereby reducing the negative impact of wall-normal permeability.

Bloqueo PEC II como componente mayor analgésico para operaciones de clavícula: descripción de 7 casos y revisión de la literatura / The PECS II block as a major analgesic component for clavicle operations: a description of 7 case reports

Las fracturas de clavícula corresponden al 35% de las fracturas por traumatismo de la cintura escapular. La anestesia regional ha demostrado mejores resultados analgésicos en el perioperatorio que el tratamiento sistémico. La inervación de la clavícula es compleja; en la actualidad, su conocimiento suscita controversia. El nervio pectoral lateral, a través de la musculatura que inerva, participa de manera predominante en el extremo lateral y anterior de la clavícula. El siguiente reporte de 7 casos describe la eficaz analgesia postoperatoria del bloqueo PEC II modificado en pacientes con fractura del tercio medio clavicular o luxación acromioclavicular a los que se les realizó un bloqueo PEC II modificado para manejo del dolor postoperatorio, en el contexto de un tratamiento multimodal. La posible ventaja de este manejo frente a otros procedimientos analgésicos deberá ser evaluado en ensayos clínicos específicos (AU)

Clavicle fractures correspond to 35% of traumatic fractures of the shoulder girdle. Regional anaesthesia has shown better analgesic results than systemic treatment for perioperative management. Innervation of the clavicle is complex, at present its knowledge raises controversy. The lateral pectoral nerve through the innervating musculature predominantly participates in the lateral and anterior part of the clavicle. The following report of 7 cases describes the effective postoperative analgesia of modified PEC II block in patients with middle third clavicle fracture or acromioclavicular dislocation who underwent a modified PEC II block for postoperative pain management, in the context of a multimodal analgesia. The potential advantage of this management over other analgesic procedures should be evaluated in specific clinical trials (AU)

The PECS II block as a major analgesic component for clavicle operations: A description of 7 case reports. / Bloqueo PEC II como componente mayor analgésico para operaciones de clavícula: descripción de 7 casos y revisión de la literatura.

Clavicle fractures correspond to 35% of traumatic fractures of the shoulder girdle. Regional anaesthesia has shown better analgesic results than systemic treatment for perioperative management. Innervation of the clavicle is complex, at present its knowledge raises controversy. The lateral pectoral nerve through the innervating musculature predominantly participates in the lateral and anterior part of the clavicle. The following report of 7 cases describes the effective postoperative analgesia of modified PEC II block in patients with middle third clavicle fracture or acromioclavicular dislocation who underwent a modified PEC II block for postoperative pain management, in the context of a multimodal analgesia. The potential advantage of this management over other analgesic procedures should be evaluated in specific clinical trials.

Asociación entre la carga tabáquica, el tamaño tumoral y los tipos histológicos en el cáncer de pulmón. Resumen bibliográfico / Association between smoking habit burden, tumor size and histological types in lung cancer. Bibliographic summary

En 1929 se realizó el primer estudio en el que se relacionaba el tabaco con el carcinoma pulmonar (CP). Son muy escasas las publicaciones que hablan sobre la posible asociación entre la carga tabáquica con el tamaño tumoral al diagnóstico, así como de la asociación de la carga tabáquica con los distintos tipos histológicos de cáncer de pulmón. El objetivo de este artículo es analizar, de forma descriptiva, los resultados obtenidos en las publicaciones más relevantes entre la asociación de la carga tabáquica con el tamaño tumoral al diagnóstico y con el tipo histológico del CP. Tamaño tumoral: las publicaciones apoyan el hecho de que fumar puede promover el crecimiento tumoral y, por tanto, estar en relación con el tamaño tumoral al diagnóstico. Tipo histológico: distintas publicaciones concluyen que fumar ejerce un gradiente de riesgo mayor en el carcinoma escamoso y en el microcítico con respecto al adenocarcinoma. En conclusión, es una línea de investigación que debe continuarse para avanzar en el estudio de la influencia del tabaco en el cáncer de pulmón (AU)

In 1929 it was carried out the first study in which tobacco was related to lung carcinoma (LC). There are very few publications that discuss the possible association between amount smoked and tumour size at diagnosis. As well as in the association between amount smoked and the different histological types of lung cancer. The objective of this article is analyze descriptively the results that were obtained in the most relevant publications between the association of amount. smoked by the tumour size at diagnosis and by the histological type of LC. Tumour Size: the publications support the fact that smoking can promote tumour growth and, therefore, be related with tumour size at diagnosis. Histological type: different publications conclude that smoking exercises a higher gradient risk in squamous cell carcinoma and in the small cell with respect to adenocarcinoma (AU)

Fibrosis pulmonar idiopática, tenemos alteranativas / No disponible

Presentamos un paciente con diagnóstico de fibrosis pulmonar idiopática (FPI) de grado moderado, en el que se inicia tratamiento con pirfenidona. Ante los efectos secundarios cutáneos recidivantes, a pesar de correctas medidas preventivas de protección solar, se suspende dicho fármaco y se inicia tratamiento alternativo con nintedanib, con efectos gastrointestinales leves que se controlan con tratamiento sintomático. A los 4 meses se observa mejoría clínica y leve mejoría funcional

We present a patient diagnosed with idiopathic pulmonary fibrosis (IPF) of moderate degree, in which treatment is initiated with pirfenidone. Given the recurrent cutaneous side effects, although correct sunscreen preventive measures, the drug is discontinued and alternative treatment begins with nintedanib with mild gastrointestinal effects that are controlled with symptomatic treatment. At 4 months mild clinical improvement and functional improvement is observed

Abstinencia a los 3, 6, 9 y 12 meses en la consulta especializada de deshabituación tabáquica del Complejo Hospitalario Universitario de Albacete / Abstinence rates at 3, 6, 9 and 12 months in the tobacco cessation unit in Albacete University Hospital

Introducción. Análisis de tasas de abstinencia continua a los 3, 6, 9 y 12 meses en consulta especializada de deshabituación tabáquica durante el año 2010. Pacientes y métodos. Estudio retrospectivo descriptivo de 314 fumadores atendidos en la Unidad Especializada de Tabaquismo del Complejo Hospitalario de Albacete desde el 1 de enero de 2010 al 31 de diciembre de 2010 y seguimiento posterior durante un año. Resultados. 462 se han remitido, han acudido 314 y 158 han iniciado tratamiento (34%): 44,3% eran varones (n = 70) y un 55,7% mujeres (n = 88), con una edad media de 47,19 años. Las comorbilidades más importantes han sido la respiratoria (42,4%), la psiquiátrica (49,4%) y los factores de riesgo cardiovascular (FRCV) (68,2%). Los diferentes tratamientos utilizados han sido la terapia sustitutiva nicotínica (TSN) (31,8%), bupropión (9,6%), vareniclina (VRN) (27,4%), combinación de varios (5,4%) o consejo psicológico sin tratamiento farmacológico (25,8%). Las tasas de abstinencia continua a los 3, 6, 9 y 12 meses han resultado del 53,2, 39,2, 36,7 y del 33,5%, respectivamente. De los 158 pacientes que iniciaron tratamiento, el éxito, considerado como un año sin fumar, se dio en 53 pacientes (33,5%), 18 hombres y 35 mujeres, y el fracaso, considerado como pacientes nunca abstinentes, en 20 (12,7%), 12 hombres y 8 mujeres. De los pacientes tratados farmacológicamente, han presentado mayor éxito e.s. (p = 0,022) aquellos que tomaron vareniclina (17, 30,9%) frente a los que habían recibido TSN (10; 18,9%), bupropión (12; 22,6%) o psicoterapia (10; 18,9%). Conclusiones. El éxito del tratamiento, considerado como 12 meses de abstinencia continua, fue del 33,5% en nuestra muestra (AU)

Introduction. Review the continuous abstinence rates at 3, 6, 9 and 12 months obtained in a Tobacco Cessation Unit (TCU) during 2010. Patients and methods. Retrospective descriptive analysis of the results obtained from 314 patients who were attended to in a TCU from January 1st. to December 31st. in 2010 and subsequent follow-up to complete a year. Results. 452 patients referred, 314 attended to and only 158 were treated (34%). 44,3% males (n = 70) and 55,7% females (n = 88), and mean age, 47,19 years-old. The most important comorbidities were respiratory (42,4%), psychiatric (49,4%) and cardiovascular (68,2%). As for treatment, 31,8% used nicotine replacement therapy (NRT), 27,4% used varenicline (VRN), 9,6% bupropion, 5,4% combined pharmacological therapies and 25,8%, psychological counseling only. Continuous abstinence rates at 3, 6, 9 y 12 months were 53,2, 39,2, 36,7 and 33,5%, respectively. The treatment success, considered as one year with continuous abstinence, did appear in 33,5% of the sample, 18 males and 35 females, and the failure, considered as abstinence never, was presented by 20 (12,7%), 12 males and 8 females. Of the patients with treatment success, VRN showed the better success rate (17; 30,9%) s.s. (p = 0,022) vs. NRT (10; 18,9%), bupropion (12; 22,6%) and psycotherapy (10; 18,9%). Conclusion. The treatment success, considered as one year with continuous abstinence, did appear in 33,5% of the sample (AU)

Nueva indicación para acudir a nuestra consulta: deshabituación a chicles / New indication to go to our consultation room: addiction to chewing gum

El tabaquismo es la causa más importante de morbilidad y mortalidad prevenible y evitable en los países desarrollados, por eso es tan importante el tratamiento para lograr la deshabituación tabáquica. Entre los tratamientos se encuentra la terapia con nicotina, que es la droga que produce la dependencia física del tabaco. Contamos el caso de un paciente que logró dejar de fumar gracias a los chicles de nicotina, pero que tuvo que acudir a la consulta para dejar estos (AU)

Smoking is the most important cause of morbidity and preventable and avoidable mortality in developed countries, so the treatment is so important to achieve smoking cessation. Among the treatments is nicotine therapy, which is the tobacco drug that causes physical dependence. We have the case of a patient who managed to quit smoking with nicotine gum, but had to go to our medical consultation to leave them (AU)

UPLIFT study - understanding potential long-term impacts on function with tiotropium - and sub-analyses. Bibliographic resume of the obtained results.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a respiratory problem with the highest prevalence and strongest socio-economic impact in the world and whose morbimortality keeps increasing. Treating this disease is a challenge in the field of pneumology since the market now offers a wide range of bronchodilators. Tiotropium bromide, a long-acting anticholinergic bronchodilator, is a drug used to deal with this pathology. AREAS COVERED: The UPLIFT study was a 4-year (2004-2008) clinical multi-center trial in which tiotropium bromide was compared with a placebo. We present a bibliographic resume covering the multiple sub-analyses published since the end of the clinical trial, between 2009-2015. These sub-analyses analyzed the results obtained in UPLIFT in parallel, provided additional data about safety profiles, exacerbations, hospitalization and mortality rates, and lung function, among others. Expert Commentary: Tiotropium bromide is a significant advance for the maintenance treatment of patients with COPD. The favorable results obtained leave the door open to the possibility of improving the natural history of COPD and confirmed tiotropium bromide as the gold standard drug as monotherapy for treatment of COPD.

Neumorraquis / No disponible

Presentamos el caso de un paciente con infección respiratoria, que acude a urgencias por molestias torácicas. En la radiografía se observa un neumomediastino y enfisema subcutáneo. En la TAC se ve que el aire envuelve y diseca la médula espinal. El caso tiene interés por el escaso número que hay descritos en la literatura

We report a patient with respiratory infection, which came to the emergencyroom with chest discomfort. Radiography pneumomediastinum and subcutaneous emphysema is observed. In the TAC you can see the air surrounds the spinal cord and dissected it. The case is of interest for the small number that have been described in the literature

Omega-3 fatty acids reduce obesity-induced tumor progression independent of GPR120 in a mouse model of postmenopausal breast cancer.

Obesity and inflammation are both risk factors for a variety of cancers, including breast cancer in postmenopausal women. Intake of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) decreases the risk of breast cancer, and also reduces obesity-associated inflammation and insulin resistance, but whether the two effects are related is currently unknown. We tested this hypothesis in a postmenopausal breast cancer model using ovariectomized, immune-competent female mice orthotopically injected with Py230 mammary tumor cells. Obesity, whether triggered genetically or by high-fat diet (HFD) feeding, increased inflammation in the mammary fat pad and promoted mammary tumorigenesis. The presence of tumor cells in the mammary fat pad further enhanced the local inflammatory milieu. Tumor necrosis factor-alpha (TNF-α) was the most highly upregulated cytokine in the obese mammary fat pad, and we observed that TNF-α dose-dependently stimulated Py230 cell growth in vitro. An ω-3 PUFA-enriched HFD (referred to as fish oil diet, FOD) reduced inflammation in the obese mammary fat pad in the absence of tumor cells and inhibited Py230 tumor growth in vivo. Although some anti-inflammatory effects of ω-3 PUFAs were previously shown to be mediated by the G-protein-coupled receptor 120 (GPR120), the FOD reduced Py230 tumor burden in GPR120-deficient mice to a similar degree as observed in wild-type mice, indicating that the effect of FOD to reduce tumor growth does not require GPR120 in the host mouse. Instead, in vitro studies demonstrated that ω-3 PUFAs act directly on tumor cells to activate c-Jun N-terminal kinase, inhibit proliferation and induce apoptosis. Our results show that obesity promotes mammary tumor progression in this model of postmenopausal breast cancer and that ω-3 PUFAs, independent of GPR120, inhibit mammary tumor progression in obese mice.

Caveolin-1 is required for TGF-ß-induced transactivation of the EGF receptor pathway in hepatocytes through the activation of the metalloprotease TACE/ADAM17.

Transforming growth factor-beta (TGF-ß) plays a dual role in hepatocytes, inducing both pro- and anti-apoptotic responses, whose balance decides cell fate. Survival signals are mediated by the epidermal growth factor receptor (EGFR) pathway, which is activated by TGF-ß in these cells. Caveolin-1 (Cav1) is a structural protein of caveolae linked to TGF-ß receptors trafficking and signaling. Previous results have indicated that in hepatocytes, Cav1 is required for TGF-ß-induced anti-apoptotic signals, but the molecular mechanism is not fully understood yet. In this work, we show that immortalized Cav1(-/-) hepatocytes were more sensitive to the pro-apoptotic effects induced by TGF-ß, showing a higher activation of caspase-3, higher decrease in cell viability and prolonged increase through time of intracellular reactive oxygen species (ROS). These results were coincident with attenuation of TGF-ß-induced survival signals in Cav1(-/-) hepatocytes, such as AKT and ERK1/2 phosphorylation and NFκ-B activation. Transactivation of the EGFR pathway by TGF-ß was impaired in Cav1(-/-) hepatocytes, which correlated with lack of activation of TACE/ADAM17, the metalloprotease responsible for the shedding of EGFR ligands. Reconstitution of Cav1 in Cav1(-/-) hepatocytes rescued wild-type phenotype features, both in terms of EGFR transactivation and TACE/ADAM17 activation. TACE/ADAM17 was localized in detergent-resistant membrane (DRM) fractions in Cav1(+/+) cells, which was not the case in Cav1(-/-) cells. Disorganization of lipid rafts after treatment with cholesterol-binding agents caused loss of TACE/ADAM17 activation after TGF-ß treatment. In conclusion, in hepatocytes, Cav1 is required for TGF-ß-mediated activation of the metalloprotease TACE/ADAM17 that is responsible for shedding of EGFR ligands and activation of the EGFR pathway, which counteracts the TGF-ß pro-apoptotic effects. Therefore, Cav1 contributes to the pro-tumorigenic effects of TGF-ß in liver cancer cells.

Impaired autophagic flux is associated with increased endoplasmic reticulum stress during the development of NAFLD.

The pathogenic mechanisms underlying the progression of non-alcoholic fatty liver disease (NAFLD) are not fully understood. In this study, we aimed to assess the relationship between endoplasmic reticulum (ER) stress and autophagy in human and mouse hepatocytes during NAFLD. ER stress and autophagy markers were analyzed in livers from patients with biopsy-proven non-alcoholic steatosis (NAS) or non-alcoholic steatohepatitis (NASH) compared with livers from subjects with histologically normal liver, in livers from mice fed with chow diet (CHD) compared with mice fed with high fat diet (HFD) or methionine-choline-deficient (MCD) diet and in primary and Huh7 human hepatocytes loaded with palmitic acid (PA). In NASH patients, significant increases in hepatic messenger RNA levels of markers of ER stress (activating transcription factor 4 (ATF4), glucose-regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP)) and autophagy (BCN1) were found compared with NAS patients. Likewise, protein levels of GRP78, CHOP and p62/SQSTM1 (p62) autophagic substrate were significantly elevated in NASH compared with NAS patients. In livers from mice fed with HFD or MCD, ER stress-mediated signaling was parallel to the blockade of the autophagic flux assessed by increases in p62, microtubule-associated protein 2 light chain 3 (LC3-II)/LC3-I ratio and accumulation of autophagosomes compared with CHD fed mice. In Huh7 hepatic cells, treatment with PA for 8 h triggered activation of both unfolding protein response and the autophagic flux. Conversely, prolonged treatment with PA (24 h) induced ER stress and cell death together with a blockade of the autophagic flux. Under these conditions, cotreatment with rapamycin or CHOP silencing ameliorated these effects and decreased apoptosis. Our results demonstrated that the autophagic flux is impaired in the liver from both NAFLD patients and murine models of NAFLD, as well as in lipid-overloaded human hepatocytes, and it could be due to elevated ER stress leading to apoptosis. Consequently, therapies aimed to restore the autophagic flux might attenuate or prevent the progression of NAFLD.