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Barcelona, Spain

Paredi P.,Imperial College London | Goldman M.,Imperial College London | Alamen A.,Imperial College London | Ausin P.,Hospital Del Mar IMIM | And 3 more authors.
Thorax | Year: 2010

Background: The usual analysis of forced oscillometry measures respiratory resistance (Rrs) and reactance (Xrs) averaged over several tidal breaths (whole-breath analysis). Recent within-breath analyses have separated Rrs and Xrs into their mean inspiratory and mean expiratory components (inspiratorye - expiratory breath analysis) but these have not been used to compare patients with asthma and those with chronic obstructive pulmonary disease (COPD). Large inspiratorye - expiratory variations in Xrs at 5 Hz (ΔX5) in an individual have been used as a surrogate marker of expiratory flow limitation. Methods: Whole-breath and inspiratorye - expiratory impulse oscillometry was assessed in 34 patients with asthma (49±3 years; 15 male, forced expiratory volume in 1 s (FEV1) 69±4% predicted), 48 patients with COPD (64±2 years; 32 male, FEV1 59±3% predicted) and 18 normal subjects (37±2 years; 8 male). Results: Whole-breath analysis failed to discriminate between patients with asthma and patients with COPD either for all patients or for patients with FEV1 <60% predicted. Inspiratorye - expiratory analysis in patients with FEV1 <60% predicted showed that in the COPD group mean expiratory X5 (-0.44±0.04 kPa/l/s) was greater than inspiratory X5 (-0.23±0.02 kPa/l/s, p<0.001) whereas patients with asthma did not show such changes (-0.36±0.07 kPa/l/s vs -0.2660.03 kPa/l/s, p=0.23). Even though ΔX5 was larger in patients with COPD (0.21±0.03 kPa/l/s) than in patients with asthma (0.10±0.07 kPa/l/s), this was not significant (p=0.15). Conclusions: Whole-breath impulse oscillation system analysis failed to discriminate between patients with asthma and those with COPD. Inspiratorye - expiratory X5 analysis differentiated patients with asthma from those with COPD presumably reflecting enhanced dynamic airway narrowing on expiration in COPD. Further studies are needed to confirm these differences and investigate their cause. Source

Batlle D.,Northwestern University | Wysocki J.,Northwestern University | Soler M.J.,Hospital Del Mar IMIM | Ranganath K.,Northwestern University
Kidney International | Year: 2012

Angiotensin-converting enzyme 2 (ACE2) is a monocarboxypeptidase that degrades angiotensin II with high efficiency leading to the formation of angiotensin-(1-7). ACE2 within the kidneys is largely localized in tubular epithelial cells and in glomerular epithelial cells. Decreased glomerular expression of this enzyme coupled with increased expression of ACE has been described in diabetic kidney disease, both in mice and humans with type 2 diabetes. Moreover, both ACE2 genetic ablation and pharmacological ACE2 inhibition have been shown to increase albuminuria and promote glomerular injury. Studies using recombinant ACE2 have shown the ability of ACE2 to rapidly metabolize Ang II in vivo and form the basis for future studies to examine the potential of ACE2 amplification in the therapy of diabetic kidney disease and cardiovascular disease. © 2012 International Society of Nephrology. Source

Martinez-Alonso M.,Biomedical Research Institute of Lleida IRBLLEIDA | Martinez-Alonso M.,University of Lleida | Vilaprinyo E.,Hospital Del Mar IMIM | Marcos-Gragera R.,Epidemiology Unit | And 3 more authors.
Breast Cancer Research | Year: 2010

Introduction: Early detection of breast cancer (BC) with mammography may cause overdiagnosis and overtreatment, detecting tumors which would remain undiagnosed during a lifetime. The aims of this study were: first, to model invasive BC incidence trends in Catalonia (Spain) taking into account reproductive and screening data; and second, to quantify the extent of BC overdiagnosis.Methods: We modeled the incidence of invasive BC using a Poisson regression model. Explanatory variables were: age at diagnosis and cohort characteristics (completed fertility rate, percentage of women that use mammography at age 50, and year of birth). This model also was used to estimate the background incidence in the absence of screening. We used a probabilistic model to estimate the expected BC incidence if women in the population used mammography as reported in health surveys. The difference between the observed and expected cumulative incidences provided an estimate of overdiagnosis.Results: Incidence of invasive BC increased, especially in cohorts born from 1940 to 1955. The biggest increase was observed in these cohorts between the ages of 50 to 65 years, where the final BC incidence rates more than doubled the initial ones. Dissemination of mammography was significantly associated with BC incidence and overdiagnosis. Our estimates of overdiagnosis ranged from 0.4% to 46.6%, for women born around 1935 and 1950, respectively.Conclusions: Our results support the existence of overdiagnosis in Catalonia attributed to mammography usage, and the limited malignant potential of some tumors may play an important role. Women should be better informed about this risk. Research should be oriented towards personalized screening and risk assessment tools. © 2010 Martinez-Alonso et al.; licensee BioMed Central Ltd. Source

Mar J.,Clinical Management Unit | Mar J.,Research Unit | Arrospide A.,Research Unit | Comas M.,Hospital Del Mar IMIM | Comas M.,CIBER ISCIII
Value in Health | Year: 2010

Objective: Thrombolysis within the first 3 hours after the onset of symptoms of a stroke has been shown to be a cost-effective treatment because treated patients are 30% more likely than nontreated patients to have no residual disability. The objective of this study was to calculate by means of a discrete event simulation model the budget impact of thrombolysis in Spain. Methods: The budget impact analysis was based on stroke incidence rates and the estimation of the prevalence of stroke-related disability in Spain and its translation to hospital and social costs. A discrete event simulation model was constructed to represent the flow of patients with stroke in Spain. Results: If 10% of patients with stroke from 2000 to 2015 would receive thrombolytic treatment, the prevalence of dependent patients in 2015 would decrease from 149,953 to 145,922. For the first 6 years, the cost of intervention would surpass the savings. Nevertheless, the number of cases in which patient dependency was avoided would steadily increase, and after 2006 the cost savings would be greater, with a widening difference between the cost of intervention and the cost of nonintervention, until 2015. Conclusion: The impact of thrombolysis on society's health and social budget indicates a net benefit after 6 years, and the improvement in health grows continuously. The validation of the model demonstrates the adequacy of the discrete event simulation approach in representing the epidemiology of stroke to calculate the budget impact. © 2009, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Source

Meune C.,University of Basel | Meune C.,University of Paris Descartes | Drexler B.,University of Basel | Haaf P.,University of Basel | And 8 more authors.
Heart | Year: 2011

Objective: To compare the accuracy of the GRACE score, a strong prognosticator in acute coronary syndrome (ACS) that is calculated using conventional cardiac troponin (cTn) assays, with that calculated with high-sensitivity cTn (hs-cTn) and with the combination of the GRACE score with hs-cTn or B-type natriuretic peptide (BNP). Design: Prospective international cohort. Settings: University Hospital. Patients: Patients enrolled in the Predictors of Acute Coronary Syndromes Evaluation prospective study with proven ACS. Main outcome measured: The capacity to predict in-hospital mortality, 1-year mortality and combined death/acute myocardial infarction (AMI) at 1 year. Results: 370 patients were enrolled (173 with unstable angina and 197 with AMI). In-hospital mortality was 4.1%; 1-year mortality was 12.5%. The GRACE score was significantly higher in patients who died than in those discharged alive (200 (174-222) vs 125 (98-155); p<0.001), and in those who died than in those who survived for 1 year (151 (133-169) vs 104 (85-125); p<0.001). The area under the curve of the GRACE score was 0.87 regarding in-hospital mortality and 0.88 for 1-year mortality; if calculated with hs-cTn, it was 0.87 and 0.88, respectively (p=NS for all comparisons). The addition of hs-cTn to the GRACE score resulted in no increased value, whereas the addition of BNP tended to improve 1-year mortality prediction (p=0.058). Conclusion: The GRACE score is accurate for determining both in-hospital and long-term mortality in patients with ACS in the era of hs-cTn. The addition of hs-cTn or BNP to the GRACE score does not significantly improve risk prediction. Source

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