IRB Lleida

Lleida, Spain

IRB Lleida

Lleida, Spain
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Sanchez-de-la-Torre M.,University of Lleida | Sanchez-de-la-Torre M.,Research Center Biomedica En Red Of Enfermedades Respiratorias Ciberes | Barcelo A.,Hospital Universitari Son Espases | Barcelo A.,Research Center Biomedica En Red Of Enfermedades Respiratorias Ciberes | And 6 more authors.
Sleep Medicine | Year: 2014

Objective: Obstructive sleep apnea (OSA) has been associated with metabolic disorders. Sleep-disordered breathing could generate an altered rhythm in the expression of metabolic hormones, which could predispose to metabolic disorders. The aim of this study was to evaluate the effect of sleep apnea on diurnal variations in metabolic hormones. Methods: Thirty-seven male, newly diagnosed, patients with OSA with an apnea-hypopnea index (AHI) ≥20/h and 11 male controls (AHI <10/h) matched for body mass index (±3kg/m2) were included. Six different samples were obtained from each subject during a period of 24h. Levels of the metabolic hormones ghrelin, leptin, resistin, and adiponectin were measured in plasma by immunoassay. Results: Patients with OSA (AHI (mean. ±. SD) 46. ±. 26/h) were older than the controls (42. ±. 9 vs 33. ±. 9. years, P= 0.01). Differences in metabolic hormones between groups did not reach statistical significance at any point in the evaluation. No significant differences were observed in the area under the curve for any of the hormones analysed. Likewise, we did not detect diurnal variations in metabolic hormones. Conclusions: The results of this study indicate that the day-night variations in the levels of several metabolic hormones are not influenced by the presence of sleep apnea. © 2014 Elsevier B.V.


Barbe F.,Hosp Universitari Arnau Of Vilanova And Santa Maria | Barbe F.,Research Center Biomedica En Red Of Enfermedades Respiratorias Ciberes | Sanchez-De-la-torre A.,Hosp Universitari Arnau Of Vilanova And Santa Maria | Sanchez-De-la-torre A.,Research Center Biomedica En Red Of Enfermedades Respiratorias Ciberes | And 17 more authors.
European Respiratory Journal | Year: 2015

The goal of this study was to evaluate the influence of obstructive sleep apnoea on the severity and short-term prognosis of patients admitted for acute coronary syndrome. Obstructive sleep apnoea was defined as an apnoea-hypopnoea index (AHI) >15 h-1. We evaluated the acute coronary syndrome severity (ejection fraction, Killip class, number of diseased vessels, and plasma peak troponin) and short-term prognosis (length of hospitalisation, complications and mortality). We included 213 patients with obstructive sleep apnoea (mean±SD AHI 30±14 h-1, 61±10 years, 80% males) and 218 controls (AHI 6±4 h-1, 57±12 years, 82% males). Patients with obstructive sleep apnoea exhibited a higher prevalence of systemic hypertension (55% versus 37%, p<0.001), higher body mass index (29±4 kg·m-2 versus 26±4 kg·m-2, p<0.001), and lower percentage of smokers (61% versus 71%, p=0.04). After adjusting for smoking, age, body mass index and hypertension, the plasma peak troponin levels were significantly elevated in the obstructive sleep apnoea group (831±908 ng·L-1 versus 987±884 ng·L-1, p=0.03) and higher AHI severity was associated with an increased number of diseased vessels (p=0.04). The mean length of stay in the coronary care unit was higher in the obstructive sleep apnoea group (p=0.03). This study indicates that obstructive sleep apnoea is related to an increase in the peak plasma troponin levels, number of diseased vessels, and length of stay in the coronary care unit. Copyright © ERS 2015.


Sanchez-De-La-Torre M.,University of Santa María in Ecuador | Sanchez-De-La-Torre M.,Research Center Biomedica En Red Of Enfermedades Respiratorias Ciberes | Nadal N.,University of Santa María in Ecuador | Nadal N.,Primary Care Unit of Lleida | And 20 more authors.
Thorax | Year: 2015

Objective To evaluate whether follow-up of patients with obstructive sleep apnoea (OSA) undergoing CPAP treatment could be performed in primary care (PC) settings. Design Non-inferiority, randomised, prospective controlled study. Settings Sleep unit (SU) at the University Hospital and in 8 PC units in Lleida, Spain. Participants Patients with OSA were randomised to be followed up at the SU or PC units over a 6-month period. Main outcomes measured The primary outcome was CPAP compliance at 6 months. The secondary outcomes were Epworth Sleep Scale (ESS) score, EuroQoL, patient satisfaction, body mass index (BMI), blood pressure and cost-effectiveness. Results We included 101 patients in PC ((mean±SD) apnoea-hypopnoea index (AHI) 50.8±22.9/h, age 56.2 ±11 years, 74% male) and 109 in the SU (AHI 51.4 ±24.4/h, age 55.8±11 years, 77% male)). The CPAP compliance was (mean (95% CI) 4.94 (4.47 to 5.5) vs 5.23 (4.79 to 5.66) h, p=0.18) in PC and SU groups, respectively. In the SU group, there were greater improvements in ESS scores (mean change 1.79, 95% CI +0.05 to +3.53, p=0.04) and patient satisfaction (-1.49, 95% CI -2.22 to -0.76); there was a significant mean difference in BMI between the groups (0.57, 95% CI +0.01 to +1.13, p=0.04). In the PC setting, there was a cost saving of 60%, with similar effectiveness, as well as a decrease in systolic blood pressure (-5.32; 95% CI -10.91 to +0.28, p=0.06). Conclusions For patients with OSA, treatment provided in a PC setting did not result in worse CPAP compliance compared with a specialist model and was shown to be a cost-effective alternative.


Martinez-Garcia M.A.,Polytechnic University of Valencia | Martinez-Garcia M.A.,CIBER ISCIII | Campos-Rodriguez F.,University of Seville | Duran-Cantolla J.,Alava University Hospital | And 20 more authors.
Sleep Medicine | Year: 2014

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 4.5years 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. © 2014 Elsevier B.V..


Bozic M.,IRB Lleida | Alvarez A.,University of Valencia | De Pablo C.,University of Valencia | Sanchez-Nino M.-D.,Metropolitan Autonomous University | And 5 more authors.
PLoS ONE | Year: 2015

Endothelial cell activation leading to leukocyte recruitment and adhesion plays an essential role in the initiation and progression of atherosclerosis. Vitamin D has cardioprotective actions, while its deficiency is a risk factor for the progression of cardiovascular damage. Our aim was to assess the role of basal levels of vitamin D receptor (VDR) on the early leukocyte recruitment and related endothelial cell-adhesion-molecule expression, as essential prerequisites for the onset of atherosclerosis. Knockdown of VDR in endothelial cells (shVDR) led to endothelial cell activation, characterized by upregulation of VCAM-1, ICAM-1 and IL-6, decreased peripheral blood mononuclear cell (PBMC) rolling velocity and increased PBMC rolling flux and adhesion to the endothelium. shVDR cells showed decreased IκBα levels and accumulation of p65 in the nucleus compared to shRNA controls. Inhibition of NF-κB activation with super-repressor IκBα blunted all signs of endothelial cell activation caused by downregulation of VDR in endothelial cells. In vivo, deletion of VDR led to significantly larger aortic arch and aortic root lesions in apoE-/- mice, with higher macrophage content. apoE-/-VDR-/-mice showed higher aortic expression of VCAM-1, ICAM-1 and IL-6 when compared to apoE-/-VDR+/+ mice. Our data demonstrate that lack of VDR signaling in endothelial cells leads to a state of endothelial activation with increased leukocyte-endothelial cell interactions that may contribute to the more severe plaque accumulation observed in apoE-/-VDR-/- mice. The results reveal an important role for basal levels of endothelial VDR in limiting endothelial cell inflammation and atherosclerosis. © 2015 Bozic et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Vilaplana J.,University of Lleida | Solsona F.,University of Lleida | Teixido I.,University of Lleida | Mateo J.,University of Lleida | And 2 more authors.
Journal of Supercomputing | Year: 2014

The ability to deliver guaranteed QoS (Quality of Service) is crucial for the commercial success of cloud platforms. This paper presents a model based on queuing theory to study computer service QoS in cloud computing. Cloud platforms are modeled with an open Jackson network that can be used to determine and measure the QoS guarantees the cloud can offer regarding the response time. The analysis can be performed according to different parameters, such as the arrival rate of customer services and the number and service rate of processing servers, among others. Detailed results for the model are presented. When scaling the system and depending on the types of bottleneck in the system, we show how our model can provide us with the best option to guarantee QoS. The results obtained confirm the usefulness of the model presented for designing real cloud computing systems. © 2014 Springer Science+Business Media New York.


Arcidiacono M.V.,University of Washington | Yang J.,University of Washington | Fernandez E.,IRB Lleida | Fernandez E.,University of Lleida | Dusso A.,University of Washington
Nephrology Dialysis Transplantation | Year: 2015

Background In secondary hyperparathyroidism (SHPT), enhanced parathyroid levels of transforming growth factor- (TGF) increase EGF receptor (EGFR) activation causing parathyroid hyperplasia, high parathyroid hormone (PTH) and also reductions in vitamin D receptor (VDR) that limit vitamin D suppression of SHPT. Since anti-EGFR therapy is not an option in human SHPT, we evaluated ADAM17 as a therapeutic target to suppress parathyroid hyperplasia because ADAM17 is required to release mature TGF, the most potent EGFR-activating ligand. Methods Computer analysis of the ADAM17 promoter identified TGF and C/EBP' 2 as potential regulators of the ADAM17 gene. Their regulation of ADAM17 expression, TGF /EGFR-driven growth and parathyroid gland (PTG) enlargement were assessed in promoter-reporter assays in A431 cells and corroborated in rat and human SHPT, using erlotinib as anti-EGFR therapy to suppress TGF signals, active vitamin D to induce C/EBP' 2 or the combination. Results While TGF induced ADAM17-promoter activity by 2.2-fold exacerbating TGF /EGFR-driven growth, ectopic C/EBP' 2 expression completely prevented this vicious synergy. Accordingly, in advanced human SHPT, parathyroid ADAM17 levels correlated directly with TGF and inversely with C/EBP' 2. Furthermore, combined erlotinib + calcitriol treatment suppressed TGF /EGFR-cell growth and PTG enlargement more potently than erlotinib in part through calcitriol induction of C/EBP' 2 to inhibit ADAM17-promoter activity, mRNA and protein. Importantly, in rat SHPT, the correction of vitamin D deficiency effectively reversed the resistance to paricalcitol induction of C/EBP' 2 to suppress ADAM17 expression and PTG enlargement, reducing PTH by 50%. Conclusion In SHPT, correction of vitamin D and calcitriol deficiency induces parathyroid C/EBP' 2 to efficaciously attenuate the severe ADAM17/TGF synergy, which drives PTG enlargement and high PTH. © The Author 2014.


Moreno S.,University of Lleida | Soria X.,University of Lleida | Martinez M.,IRB Lleida | Marti R.M.,University of Lleida | Casanova J.M.,University of Lleida
Acta Dermato-Venereologica | Year: 2016

The worldwide incidence of malignant melanoma is increasing. The number of pigmented naevi and amount of solar exposure are important risk factors. The aim of this study was to characterize a paediatric population (from Lleida, Catalonia, Spain) in terms of phenotype, sun behaviour and naevi prevalence. Data on the numbers and distributions of acquired naevi in 369 children, aged 4, 8 and 14 years, were collected and correlated with age, sex, skin phototype and environmental factors (annual/lifetime intermittent and chronic sun exposure, sunburns and sunscreen use). The density of naevi increased with age. Boys had more naevi on the trunk and girls had more naevi on the legs. Children with light skin phototype had more naevi. A higher level of accumulated sun exposure correlated with a higher number of naevi in children with non-adequate sunscreen use. In conclusion, several risk factors associated with naevi density and distribution were found, as previously reported by others. Multivariate analysis confirmed a protective role of sunscreen in the development of acquired melanocytic naevi. © 2016 The Authors.


PubMed | University of Lleida, IRB Lleida, University of Valencia and IIS Fundacion Jimenez Diaz
Type: Journal Article | Journal: PloS one | Year: 2015

Endothelial cell activation leading to leukocyte recruitment and adhesion plays an essential role in the initiation and progression of atherosclerosis. Vitamin D has cardioprotective actions, while its deficiency is a risk factor for the progression of cardiovascular damage. Our aim was to assess the role of basal levels of vitamin D receptor (VDR) on the early leukocyte recruitment and related endothelial cell-adhesion-molecule expression, as essential prerequisites for the onset of atherosclerosis. Knockdown of VDR in endothelial cells (shVDR) led to endothelial cell activation, characterized by upregulation of VCAM-1, ICAM-1 and IL-6, decreased peripheral blood mononuclear cell (PBMC) rolling velocity and increased PBMC rolling flux and adhesion to the endothelium. shVDR cells showed decreased IB levels and accumulation of p65 in the nucleus compared to shRNA controls. Inhibition of NF-B activation with super-repressor IB blunted all signs of endothelial cell activation caused by downregulation of VDR in endothelial cells. In vivo, deletion of VDR led to significantly larger aortic arch and aortic root lesions in apoE-/- mice, with higher macrophage content. apoE-/-VDR-/-mice showed higher aortic expression of VCAM-1, ICAM-1 and IL-6 when compared to apoE-/-VDR+/+ mice. Our data demonstrate that lack of VDR signaling in endothelial cells leads to a state of endothelial activation with increased leukocyte-endothelial cell interactions that may contribute to the more severe plaque accumulation observed in apoE-/-VDR-/- mice. The results reveal an important role for basal levels of endothelial VDR in limiting endothelial cell inflammation and atherosclerosis.


PubMed | IRB Lleida, Primary Care Unit of Lleida, University of Las Palmas de Gran Canaria, San Pedro Of Alcantara Hospital and 2 more.
Type: Journal Article | Journal: Thorax | Year: 2015

To evaluate whether follow-up of patients with obstructive sleep apnoea (OSA) undergoing CPAP treatment could be performed in primary care (PC) settings.Non-inferiority, randomised, prospective controlled study.Sleep unit (SU) at the University Hospital and in 8 PC units in Lleida, Spain.Patients with OSA were randomised to be followed up at the SU or PC units over a 6-month period.The primary outcome was CPAP compliance at 6months. The secondary outcomes were Epworth Sleep Scale (ESS) score, EuroQoL, patient satisfaction, body mass index (BMI), blood pressure and cost-effectiveness.We included 101 patients in PC ((meanSD) apnoea-hypopnoea index (AHI) 50.822.9/h, age 56.211years, 74% male) and 109 in the SU (AHI 51.424.4/h, age 55.811years, 77% male)). The CPAP compliance was (mean (95% CI) 4.94 (4.47 to 5.5) vs 5.23 (4.79 to 5.66)h, p=0.18) in PC and SU groups, respectively. In the SU group, there were greater improvements in ESS scores (mean change 1.79, 95% CI +0.05 to +3.53, p=0.04) and patient satisfaction (-1.49, 95% CI -2.22 to -0.76); there was a significant mean difference in BMI between the groups (0.57, 95% CI +0.01 to +1.13, p=0.04). In the PC setting, there was a cost saving of 60%, with similar effectiveness, as well as a decrease in systolic blood pressure (-5.32; 95% CI -10.91 to +0.28, p=0.06).For patients with OSA, treatment provided in a PC setting did not result in worse CPAP compliance compared with a specialist model and was shown to be a cost-effective alternative.Clinical Trials NCT01918449.

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