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Hospital de Órbigo, Spain

Canadas I.,IMIM Hospital del Mar Medical Research Institute | Taus A.,Servei dOncologia Medica | Gonzalez I.,Servei dOncologia Medica | Villanueva X.,Servei dOncologia Medica | And 13 more authors.
Oncotarget | Year: 2014

We have previously shown that Met activation through the hepatocyte growth factor (HGF) increases tumorogenesis, induces epithelial-to-mesenchymal transition (EMT) and chemoresistance in SCLC. We sought to evaluate circulating HGF levels in SCLC patients and assess correlation with outcome and EMT features in the tumor. Serum samples from patients with SCLC were prospectively obtained at diagnosis, response evaluation and progression. HGF serum (sHGF) was quantified by ELISA. EMT markers and p-Met/Met were assayed by immunohistochemistry in tumor samples. Clinical data were prospectively recorder. One-hundred twelve patients were included. High baseline levels of sHGF were associated with shorter overall survival (p=0.006) and remained independently associated with survival in the multivariate analysis (p=0.016). For stage IV patients, an increase of sHGF levels at response evaluation (p=0.042) and at progression (p=0.003) were associated with poor outcome. sHGF levels were associated (p<0.05) with a mesenchymal phenotype in the tumor. In conclusion, high sHGF at diagnosis and increases during the course of the disease predict for poor outcome in SCLC patients and associate with EMT in the tumor. These data provide novel evidence on a role of sHGF in the adverse clinical behavior of SCLC and supports testing Met inhibitors in patients with high sHGF. Source


Torres A.,Institute Clinic del Torax | Torres A.,Institute dInvestigacions Biomediques August Pi i Sunyer | Torres A.,Research Center Biomedica en Red Enfermedades Respiratorias | Torres A.,University of Barcelona | And 23 more authors.
JAMA - Journal of the American Medical Association | Year: 2015

Importance: In patients with severe community-acquired pneumonia, treatment failure is associated with excessive inflammatory response and worse outcomes. Corticosteroids may modulate cytokine release in these patients, but the benefit of this adjunctive therapy remains controversial. Objective: To assess the effect of corticosteroids in patients with severe communityacquired pneumonia and high associated inflammatory response. Design, Setting, and Participants: Multicenter, randomized, double-blind, placebo-controlled trial conducted in 3 Spanish teaching hospitals involving patients with both severe community-acquired pneumonia and a high inflammatory response, which was defined as a level of C-reactive protein greater than 150mg/L at admission. Patients were recruited and followed up from June 2004 through February 2012. Interventions: Patients were randomized to receive either an intravenous bolus of 0.5mg/kg per 12 hours of methylprednisolone (n = 61) or placebo (n = 59) for 5 days started within 36 hours of hospital admission. Main Outcomes and Measures: The primary outcomewas treatment failure (composite outcome of early treatment failure defined as [1] clinical deterioration indicated by development of shock, [2] need for invasive mechanical ventilation not present at baseline, or [3] death within 72 hours of treatment; or composite outcome of late treatment failure defined as [1] radiographic progression, [2] persistence of severe respiratory failure, [3] development of shock, [4] need for invasive mechanical ventilation not present at baseline, or [5] death between 72 hours and 120 hours after treatment initiation; or both early and late treatment failure). In-hospital mortalitywas a secondary outcome and adverse eventswere assessed. Results: There was less treatment failure among patients from the methylprednisolone group (8 patients [13%]) compared with the placebo group (18 patients [31%]) (P = .02), with a difference between groups of 18% (95% CI, 3% to 32%). Corticosteroid treatment reduced the risk of treatment failure (odds ratio, 0.34 [95% CI, 0.14 to 0.87]; P = .02). In-hospital mortality did not differ between the 2 groups (6 patients [10%] in the methylprednisolone group vs 9 patients [15%] in the placebo group; P = .37); the difference between groups was 5% (95% CI, -6% to 17%). Hyperglycemia occurred in 11 patients (18%) in the methylprednisolone group and in 7 patients (12%) in the placebo group (P = .34). Conclusions and Relevance: Among patients with severe community-acquired pneumonia and high initial inflammatory response, the acute use of methylprednisolone compared with placebo decreased treatment failure. If replicated, these findings would support the use of corticosteroids as adjunctive treatment in this clinical population. Trial Registration: clinicaltrials.gov Identifier: NCT00908713. Copyright © 2015 American Medical Association. All rights reserved. Source


Raimondi A.,University of Barcelona | Blanco I.,University of Barcelona | Pomares X.,Servei de Pneumologia | Barbera J.A.,University of Barcelona
Archivos de Bronconeumologia | Year: 2013

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by the triad of epistaxis, telangiectasia and vascular malformations. Pulmonary vascular complications associated with this disease include pulmonary arteriovenous malformations (AVM) and, less frequently, pulmonary hypertension (PH).We report the case of a patient who presented multiple pulmonary AVM and PH probably due to HHT. Embolization was carried out on one of the AVM and the patient received specific pulmonary arterial hypertension treatment with an endothelin receptor antagonist. We also described the patient's functional and hemodynamic improvement after almost 3 years of follow-up. © 2012 SEPAR. Source


Sibila O.,Servei de Pneumologia | Sibila O.,Biomedical Research Institute Sant Pau | Soto-Gomez N.,South Texas Veterans Health Care System | Soto-Gomez N.,University of Texas Health Science Center at San Antonio | And 2 more authors.
Pulmonary Pharmacology and Therapeutics | Year: 2015

Corticosteroids are frequently prescribed anti-inflammatory medications. Inhaled corticosteroids (ICS) are indicated for Chronic Obstructive Pulmonary Disease (COPD) and asthma. ICS are associated with a decrease in exacerbations and improved quality of life in COPD, however multiple studies have linked the chronic use of ICSs with an increased risk of developing pneumonia, though the effect on mortality is unclear. We review the association of ICS with the risk of pneumonia and the implications on clinical outcomes. © 2015. Source


Sintes H.,Servei de Pneumologia | Sibila O.,Servei de Pneumologia | Sibila O.,Biomedical Research Institute Sant Pau | Waterer G.W.,University of Western Australia | And 2 more authors.
European Respiratory Monograph | Year: 2014

Community-acquired pneumonia (CAP) remains a leading cause of death worldwide and a major burden on healthcare resources. CAP may vary in severity, from a mild disease managed in the community to a very severe illness requiring hospital or intensive care unit (ICU) admission. Illness severity is not always obvious at presentation and therefore a range of severity assessment tools have been developed to aid clinical decision making. Severity assessment toolshavebeenproventoaidthesiteofcaredecision,increasing the proportion of low-risk patients managed at home. Most severity tools were initially developed to predict mortality risk, and recent validation studies have demonstrated that risk of death is not always a good indicator for ICU care. Other severity scores have been developed recently with the aim to predict ICU admission or other clinical decisions. The introduction of biomarkers as prognostic indicators of severe CAP, whether used alone or in conjunction with other clinical severity of illness scores, is a promising area for future research. There remains no consensus on which is the best severity assessment tool in CAP. The most recent and relevant data regarding clinical prediction tools and biomarkers to predict severity in CAP are reviewed in this chapter. © 2014. Source

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