Impact of Applying the Global Lung Initiative Criteria for Airway Obstruction in GOLD Defined COPD Cohorts: The BODE and CHAIN Experience

INTRODUCTION

The Global Lung Function Initiative (GLI) has proposed new criteria for airflow limitation (AL) and recommends using these to interpret spirometry. The objective of this study was to explore the impact of the application of the AL GLI criteria in two well characterized GOLD-defined COPD cohorts.

METHODS

COPD patients from the BODE (n=360) and the COPD History Assessment In SpaiN (CHAIN) cohorts (n=722) were enrolled and followed. Age, gender, pack-years history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, history of exacerbations and survival were recorded. CT-detected comorbidities were registered in the BODE cohort. The proportion of subjects without AL by GLI criteria was determined in each cohort. The clinical, CT-detected comorbidity, and overall survival of these patients were evaluated.

RESULTS

In total, 18% of the BODE and 15% of the CHAIN cohort did not meet GLI AL criteria. In the BODE and CHAIN cohorts respectively, these patients had a high clinical burden (BODE≥3: 9% and 20%; mMRC≥2: 16% and 45%; exacerbations in the previous year: 31% and 9%; 6MWD<350m: 15% and 19%, respectively), and a similar prevalence of CT-diagnosed comorbidities compared with those with GLI AL. They also had a higher rate of long-term mortality - 33% and 22% respectively.

CONCLUSIONS

An important proportion of patients from 2 GOLD-defined COPD cohorts did not meet GLI AL criteria at enrolment, although they had a significant burden of disease. Caution must be taken when applying the GLI AL criteria in clinical practice.

Metallomic Signatures of Lung Cancer and Chronic Obstructive Pulmonary Disease

Lung cancer (LC) is the leading cause of cancer deaths, and chronic obstructive pulmonary disease (COPD) can increase LC risk. Metallomics may provide insights into both of these tobacco-related diseases and their shared etiology. We conducted an observational study of 191 human serum samples, including those of healthy controls, LC patients, COPD patients, and patients with both COPD and LC. We found 18 elements (V, Al, As, Mn, Co, Cu, Zn, Cd, Se, W, Mo, Sb, Pb, Tl, Cr, Mg, Ni, and U) in these samples. In addition, we evaluated the elemental profiles of COPD cases of varying severity. The ratios and associations between the elements were also studied as possible signatures of the diseases. COPD severity and LC have a significant impact on the elemental composition of human serum. The severity of COPD was found to reduce the serum concentrations of As, Cd, and Tl and increased the serum concentrations of Mn and Sb compared with healthy control samples, while LC was found to increase Al, As, Mn, and Pb concentrations. This study provides new insights into the effects of LC and COPD on the human serum elemental profile that will pave the way for the potential use of elements as biomarkers for diagnosis and prognosis. It also sheds light on the potential link between the two diseases, i.e., the evolution of COPD to LC.

Visual Performance at All Distances and Patient Satisfaction With a New Aspheric Inverted Meniscus Intraocular Lens

PURPOSE

To evaluate visual performance, spectacle independence, and quality of vision of new intraocular lenses (IOLs) for presbyopia correction with an aspheric inverted meniscus optical design (ArtIOLs; Voptica SL) in patients undergoing bilateral cataract surgery.

METHODS

In this prospective study, 60 eyes from 30 patients implanted bilaterally with Art40 and Art70 IOLs were included. These new IOLs were designed with an inverted meniscus shape to improve the peripheral performance and with aspheric surfaces to induce different amounts of negative spherical aberration in each IOL model. Distance-corrected and uncorrected through-focus visual acuities and contrast sensitivity were measured 1 to 3 months after surgery. Twenty-eight patients answered Patient Reported Spectacle Independence (PRSIQ) and Quality of Vision (QoV) questionnaires.

RESULTS

Mean monocular (Art40 and Art70) and binocular (Art40/70) corrected distance visual acuities (CDVA) were zero logMAR (20/20). Binocular uncorrected distance visual acuity (UDVA) at far, intermediate (66 cm), and near (40 cm) distances was 0.00 ± 0.01, 0.01 ± 0.03, and 0.09 ± 0.09 logMAR, respectively. Spectacle independence was achieved by 24 (85.7%) patients for far and intermediate vision and 20 patients (71.4%) for near vision. The number of patients never reporting experiencing glare, halos, and starbursts was 28, 27, and 26 (100%, 96.4%, and 92.9%), respectively.

CONCLUSIONS

The binocular combination of two ArtIOLs models (Art40 and Art70) significantly extended the depth of focus up to at least 40 cm. This combination resulted in a full range of vision with a high level of spectacle independence and without the compromise of halos or dysphotopsias. [J Refract Surg. 2023;39(9):582-588.].

Peripheral Refraction and Contrast Detection Sensitivity in Pseudophakic Patients Implanted With a New Meniscus Intraocular Lens

PURPOSE

To evaluate peripheral refraction and contrast detection sensitivity in pseudophakic patients implanted with a new type of inverted meniscus intraocular lens (IOL) (Art25; Voptica SL) that was designed to provide better peripheral optics.

METHODS

One month after cataract surgery, in 87 eyes implanted with the Art25 IOL, peripheral contrast detection sensitivity was measured psychophysically at 40° visual angle, both horizontally and vertically, and compared with a control group of 51 eyes implanted with standard biconvex IOLs. Thirty-one eyes with the Art25 IOL and 28 eyes from the control group were randomly selected to also measure peripheral refraction using a scanning Hartmann-Shack wavefront sensor along 80° in the horizontal meridian.

RESULTS

Most patients achieved emmetropia and good visual acuity, and no significant adverse events were observed after cataract surgery with Art25 IOLs. Peripheral contrast detection sensitivity was significantly better (P < .01) in the group with the Art25 IOL in both directions (7.78 ± 3.24 vs 5.74 ± 2.60 vertical, 10.98 ± 5.09 vs 7.47 ± 3.96 horizontal), which was in agreement with the optical quality improvement in the periphery due to a reduction of defocus (1.97 and 1.21 diopters [D] at 40° temporal and nasal sides) and astigmatism (1.17 and 0.37 D at 40° temporal and nasal sides) that was statistically significant (P < .01) from 20° of eccentricity.

CONCLUSIONS

Patients implanted with a new inverted meniscus IOL present a reduced amount of peripheral defocus and astigmatism compared to patients implanted with standard biconvex IOLs. This improvement in optical quality leads to better contrast detection sensitivity measured at 40° of eccentricity. [J Refract Surg. 2022;38(4):229-234.].

Ecological risk assessment of pesticides in the Mijares River (eastern Spain) impacted by citrus production using wide-scope screening and target quantitative analysis

The widespread use of pesticides, especially in agricultural areas, makes necessary to control their presence in surrounding surface waters. The current study was designed to investigate the occurrence and ecological risks of pesticides and their transformation products in a Mediterranean river basin impacted by citrus agricultural production. Nineteen sites were monitored in three campaigns distributed over three different seasons. After a qualitative screening, 24 compounds was selected for subsequent quantitative analysis. As expected, the lower section of the river was most contaminated, with total concentration >5 µg/L in two sites near to the discharge area of wastewater treatment plants. The highest concentrations were found in September, after agricultural applications and when the river flow is reduced. Ecological risks were calculated using two mixture toxicity approaches (Toxic Unit and multi-substance Potentially Affected Fraction), which revealed high acute and chronic risks of imidacloprid to invertebrates, moderate-to-high risks of diuron, simazine and 2,4-D for primary producers, and moderate-to-high risks of thiabendazole for invertebrates and fish. This study shows that intensive agricultural production and the discharge of wastewater effluents containing pesticide residues from post-harvest citrus processing plants are threatening freshwater biodiversity. Further actions are recommended to control pesticide use and to reduce emissions.

Efficacy of FF/UMEC/VI compared with FF/VI and UMEC/VI in patients with COPD: subgroup analysis of the Spain cohort in IMPACT

OBJECTIVES

The IMPACT trial has compared the benefit in the reduction of moderate/severe exacerbations of single inhaler triple therapy (SITT) with fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) versus dual therapy with FF/VI (ICS/LABA) and UMEC/VI (LAMA/LABA) in the treatment of patients with chronic obstructive disease (COPD). This study performs a subgroup analysis of the cohort from Spain in the IMPACT study.

MATERIALS AND METHODS

In IMPACT, a 52-week randomized, double-blind, parallel-group, multicenter study (N = 10,355), patients ⩾40 years of age with COPD and ⩾1 moderate/severe exacerbations in the previous year were randomized 2:2:1 to once-daily FF/UMEC/VI 100/62.5/25 µg, FF/VI 100/25 µg or UMEC/VI 62.5/25 µg administered via the Ellipta inhaler. Here, we present a subgroup analysis of the 499 patients from Spain, included in the intent-to-treat (ITT) population in the study. Endpoint assessed included exposure-adjusted rate of moderate and severe exacerbations.

RESULTS

In the Spain cohort, the exposure-adjusted rate of on-treatment moderate/severe COPD exacerbations per year for FF/UMEC/VI was 1.31 versus 1.43 and 1.57 for FF/VI and UMEC/VI, respectively. No new adverse events were identified. The results are consistent with those observed in the overall ITT study population.

CONCLUSION

In the Spain cohort of the IMPACT study, patients receiving triple therapy with FF/UMEC/VI had a lower exposure-adjusted rate of exacerbations compared with FF/VI and UMEC/VI, similar to the overall population.Study Title: A Phase III, 52 Week, Randomized, Double-blind, 3-arm Parallel Group Study, Comparing the Efficacy, Safety and Tolerability of the Fixed Dose Triple Combination FF/UMEC/VI With the Fixed Dose Dual Combinations of FF/VI and UMEC/VI, All Administered Once-daily in the Morning Via a Dry Powder Inhaler in Subjects With Chronic Obstructive Pulmonary DiseaseURL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=CTT116855/ https://clinicaltrials.gov/ct2/show/NCT02164513Registration number: GSK (CTT116855/NCT02164513).The reviews of this paper are available via the supplemental material section.

Epigenetics dysfunction in morbid obesity with or without obstructive sleep apnoea: the EPIMOOSA study

Background

Obstructive sleep apnoea (OSA) and morbid obesity (MO), defined by a body mass index ≥35 kg/m², are two closely related conditions. Recent studies suggest that circulating microRNA (miRNA) plays a potential role in the physiopathology of both conditions. To date, circulating miRNA expression has been studied separately in both conditions, but never jointly. The primary treatment of OSA is continuous positive airway pressure (CPAP), whereas bariatric surgery (BS) is the treatment of choice for MO. We have thus initiated the Epigenetics modification in Morbid Obesity and Obstructive Sleep Apnoea (EPIMOOSA) study (ClinicalTrials.gov identifier: NCT03995836).

Methods/design

EPIMOOSA is a prospective non-interventional cohort study aiming to recruit 45 MO patients who are candidates for BS. Three groups will be formed: MO without OSA, MO with OSA without CPAP and MO with OSA and CPAP. All of them will be followed up in 4 visits: baseline, 6 months prior to BS and 3, 6 and 12 months post-BS. At baseline, OSA status will be assessed by home sleep polygraphy (HSP), and CPAP will be adopted according to national guidelines. A specific standardized questionnaire (including medical conditions and AOS-related symptoms) and anthropometrical examination will be performed at each visit. Blood samples will be obtained at each visit for immediate standard biochemistry, haematology and inflammatory cytokines. For bio-banking, serum, plasma, and circulating exosomes will also be obtained. Twenty-four hours of blood pressure and electrocardiogram (ECG) Holter monitoring will be performed at all visits. A new HSP will be performed at the last visit. Finally, the three groups will be sex- and age- matched with participants in the EPIOSA study, an ongoing study aimed at understanding epigenetic changes in non-obese OSA patients.

Discussion

EPIMOOSA will evaluate changes in circulating miRNA in MO with or without OSA for the first time. In addition, EPIMOOSA will be able to elucidate the influence of OSA in MO patients and how specific and combined treatments alter miRNA expression.

Bayesian modeling of two- and three-species bacterial competition in milk

Listeria monocytogenes is a well-known food-borne pathogen and is among the bacteria best adapted to grow at low temperatures. Psychrotrophic spoilage microorganisms present in milk and milk products are primarily in the genus Pseudomonas, and their numbers increase during cold storage leading to deterioration and/or spoilage. The nature of the competition in two- or three-species bacterial systems with L. monocytogenes, L. innocua, and P. fluorescens in skimmed milk at 7 or 14°C was studied. The Baranyi growth model was used to estimate the growth rate and the maximum population density of the three microorganisms for each strain in single cultures or in two- or three-strains co-cultures. The highest Listeria populations were achieved by pure cultures, decreasing in co-culture with P. fluorescens at both temperatures. A modified deterministic logistic model was applied which includes inhibition functions for single cultures, and two- or three-species cultures. A subsequent Bayesian approach was applied for modelling the bacterial interactions. There was not a direct correlation between the growth rate of P. fluorescens and its inhibitory effect on Listeria species. The use of some species from the natural food microflora to inhibit pathogen growth may be an important tool to enhance the safety of refrigerated foods such as milk and dairy products.

Environmental and Genetic Factors Explain Differences in Intraocular Scattering

PURPOSE

To study the relative impact of genetic and environmental factors on the variability of intraocular scattering within a classical twin study.

METHODS

A total of 64 twin pairs, 32 monozygotic (MZ) (mean age: 54.9 ± 6.3 years) and 32 dizygotic (DZ) (mean age: 56.4 ± 7.0 years), were measured after a complete ophthalmologic exam had been performed to exclude all ocular pathologies that increase intraocular scatter as cataracts. Intraocular scattering was evaluated by using two different techniques based on a straylight parameter log(S) estimation: a compact optical instrument based in the principle of optical integration and a psychophysical measurement. Intraclass correlation coefficients (ICC) were used as descriptive statistics of twin resemblance, and genetic models were fitted to estimate heritability.

RESULTS

No statistically significant difference was found for MZ and DZ groups for age (P = 0.203), best-corrected visual acuity (P = 0.626), cataract gradation (P = 0.701), sex (P = 0.941), optical log(S) (P = 0.386), or psychophysical log(S) (P = 0.568), with only a minor difference in equivalent sphere (P = 0.008). Intraclass correlation coefficients between siblings were similar for scatter parameters: 0.676 in MZ and 0.471 in DZ twins for optical log(S); 0.533 in MZ twins and 0.475 in DZ twins for psychophysical log(S). For equivalent sphere, ICCs were 0.767 in MZ and 0.228 in DZ twins. Conservative estimates of heritability for the measured scattering parameters were 0.39 and 0.20, respectively.

CONCLUSIONS

Correlations of intraocular scatter (straylight) parameters in the groups of identical and nonidentical twins were similar. Heritability estimates were of limited magnitude, suggesting that genetic and environmental factors determine the variance of ocular straylight in healthy middle-aged adults.

Mid- and Long-Term Efficacy of Non-Invasive Ventilation in Obesity Hypoventilation Syndrome: The Pickwick's Study

The Pickwick project was a prospective, randomized and controlled study, which addressed the issue of obesity hypoventilation syndrome (OHS), a growing problem in developed countries. OHS patients were divided according to apnea-hypopnea index (AHI) ≥30 and <30 determined by polysomnography. The group with AHI≥30 was randomized to intervention with lifestyle changes, noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP); the group with AHI<30 received NIV or lifestyle changes. The aim of the study was to evaluate the efficacy of NIV treatment, CPAP and lifestyle changes (control) in the medium and long-term management of patients with OHS. The primary variables were PaCO2 and days of hospitalization, and operating variables were the percentage of dropouts for medical reasons and mortality. Secondary medium-term objectives were: (i)to evaluate clinical-functional effectiveness on quality of life, echocardiographic and polysomnographic variables; (ii)to investigate the importance of apneic events and leptin in the pathogenesis of daytime alveolar hypoventilation and change according to the different treatments; (ii)to investigate whether metabolic, biochemical and vascular endothelial dysfunction disorders depend on the presence of apneas and hypopneasm and (iv)changes in inflammatory markers and endothelial damage according to treatment. Secondary long-term objectives were to evaluate: (i)clinical and functional effectiveness and quality of life with NIV and CPAP; (ii)changes in leptin, inflammatory markers and endothelial damage according to treatment; (iii)changes in pulmonary hypertension and other echocardiographic variables, as well as blood pressure and incidence of cardiovascular events, and (iv)dropout rate and mortality.

Refractive accuracy with light-adjustable intraocular lenses

PURPOSE

To evaluate efficacy, predictability, and stability of refractive treatments using light-adjustable intraocular lenses (IOLs).

SETTING

University Hospital Virgen de la Arrixaca, Murcia, Spain.

DESIGN

Prospective nonrandomized clinical trial.

METHODS

Eyes with a light-adjustable IOL (LAL) were treated with spatial intensity profiles to correct refractive errors. The effective changes in refraction in the light-adjustable IOL after every treatment were estimated by subtracting those in the whole eye and the cornea, which were measured with a Hartmann-Shack sensor and a corneal topographer, respectively. The refractive changes in the whole eye and light-adjustable IOL, manifest refraction, and visual acuity were obtained after every light treatment and at the 3-, 6-, and 12-month follow-ups.

RESULTS

The study enrolled 53 eyes (49 patients). Each tested light spatial pattern (5 spherical; 3 astigmatic) produced a different refractive change (P<.01). The combination of 2 light adjustments induced a maximum change in spherical power of the light-adjustable IOL of between -1.98 diopters (D) and +2.30 D and in astigmatism of up to -2.68 D with axis errors below 9 degrees. Intersubject variability (standard deviation) ranged between 0.10 D and 0.40 D. The 2 required lock-in procedures induced a small myopic shift (range +0.01 to +0.57 D) that depended on previous adjustments.

CONCLUSIONS

Light-adjustable IOL implantation achieved accurate refractive outcomes (around emmetropia) with good uncorrected distance visual acuity, which remained stable over time. Further refinements in nomograms and in the treatment's protocol would improve the predictability of refractive and visual outcomes with these IOLs.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Spin-polarized hydrogen adsorbed on the surface of superfluid 4He

The experimental realization of a thin layer of spin-polarized hydrogen H↓ adsorbed on top of the surface of superfluid (4)He provides one of the best examples of a stable, nearly two-dimensional (2D) quantum Bose gas. We report a theoretical study of this system using quantum Monte Carlo methods in the limit of zero temperature. Using the full Hamiltonian of the system, composed of a superfluid (4)He slab and the adsorbed H↓ layer, we calculate the main properties of its ground state using accurate models for the pair interatomic potentials. Comparing the results for the layer with the ones obtained for a strictly 2D setup, we analyze the departure from the 2D character when the density increases. Only when the coverage is rather small the use of a purely 2D model is justified. The condensate fraction of the layer is significantly larger than in 2D at the same surface density, being as large as 60% at the largest coverage studied.

Chronic obstructive pulmonary disease history assessment in Spain: a multidimensional chronic obstructive pulmonary disease evaluation. Study methods and organization

INTRODUCTION

This present paper describes the method and the organization of the study known as the COPD History Assessment In SpaiN (CHAIN), whose main objective is to evaluate the long-term natural history of a chronic obstructive pulmonary disease (COPD) patient cohort from a multidimensional standpoint and to identify clinical phenotypes, in comparison with another non-COPD control cohort.

PATIENTS AND METHODS

CHAIN is a multicenter, observational study of prospective cohorts carried out at 36 Spanish hospitals. Both cohorts will be followed-up during a 5-year study period with complete office visits every 12 months and telephone interviews every 6 months in order to evaluate exacerbations and the vital state of the subjects. The recruitment period for cases was between 15 January 2010 and 31 March 2012. At each annual visit, information will be collected on: (i) clinical aspects (socio-economic situation, anthropometric data, comorbidities, smoking, respiratory symptoms, exacerbations, quality of life, anxiety-depression scale, daily life activities, treatments); (ii) respiratory function (spirometry, blood gases, hyperinflation, diffusion, respiratory pressures); (iii) BODE index (main study variable); (iv) peripheral muscle function, and (v) blood work-up (including IgE and cardiovascular risk factors). In addition, a serum bank will be created for the future determination of biomarkers. The data of the patients are anonymized in a database with a hierarchical access control in order to guarantee secure information access. The CHAIN study will provide information about the progression of COPD and it will establish a network of researchers for future projects related with COPD.

Consensus document on the overlap phenotype COPD-asthma in COPD

INTRODUCTION

Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD.

METHODS

A nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured "brainstorming" method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale.

RESULTS

Consensus was reached about the existence of a differential clinical phenotype known as"Overlap Phenotype COPD-Asthma", whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV(1) ≥ 15% and ≥ 400ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV(1) ≥ 12% and ≥ 200ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients.

CONCLUSIONS

It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment.

Metabolic syndrome, insulin resistance and sleepiness in real-life obstructive sleep apnoea

The metabolic syndrome shows a variable prevalence in obstructive sleep apnoea (OSA), and its association with insulin resistance or excessive daytime sleepiness in OSA is unclear. This study assessed the following in consecutive patients with newly diagnosed OSA: 1) the prevalence of metabolic syndrome; and 2) its association with insulin resistance and daytime sleepiness. Metabolic syndrome (National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III criteria), insulin resistance (Homeostatic Model Assessment (HOMA) index, n = 288) and daytime sleepiness (Epworth Sleepiness Scale) were assessed in 529 OSA patients. The prevalence of metabolic syndrome was 51.2%, which increased with OSA severity. Each metabolic syndrome component correlated with apnoea/hypopnoea index, but only blood pressure retained significance after correction for confounders. Both obesity and OSA contributed to metabolic abnormalities, with different sex-related patterns, since diagnosis of metabolic syndrome was significantly associated with neck circumference, age, body mass index and lowest arterial oxygen saturation in males, and with age and arousal index in females. The number of metabolic syndrome components increased with HOMA index (p<0.001). Prevalence of sleepiness was the same in patients with and without metabolic syndrome. The metabolic syndrome occurs in about half of "real-life" OSA patients, irrespective of daytime sleepiness, and is a reliable marker of insulin resistance.

Magnetron-sputtered Ag surfaces. New evidence for the nature of the ag ions intervening in bacterial inactivation

DC-magnetron sputtering with an Ag target on textile surfaces produced Ag particles with sizes approximately 4.7 nm (+/-15%). Sputtering for 15 s led to Ag layers of 15-20 nm. The threshold sputtering time precluding airborne bacterial growth was about 60 s. In this case, the coating was approximately 40-50 nm thick and the cotton Ag loading was 0.0026 wt %. The Ag particle size did not vary significantly with sputtering time between 15 and 600 s. Only coatings above this thickness lead to bacterial inactivation. Ag/Pt targets with sputtering times<60 s did not increase the bactericide performance of the Ag cotton samples with respect to sputtering from an Ag target alone, as expected from the position of Pt respect to Ag in the electrochemical series (Galvanic effect). The Ag cotton deposition led to very thin metallic semitransparent gray color coatings. X-ray of the Ag cotton suggested the presence of amorphous and crystalline Ag species. By X-ray photoelectron spectroscopy (XPS), it was found that the amount of oxidized silver species on the cotton was similar for sputtering times of 60 and 600 s, but the total amount of Ag deposited was almost two times higher after 600 s sputtering. This suggests that the positive silver-ions were located mainly at the silver interface. The type of silver ions produced using the Ag/Pt sputtering was determined to be very similar at 15, 60, and 600 s with the silver ions produced with the Ag target. This explains the lack of an increased inhibitory effect of Pt during the inactivation of airborne bacteria when present in the Pt/Ag target with respect to the Ag target, because in both cases similar silver ionic species were found.

Innovative UVC light (185 nm) and radio-frequency-plasma pretreatment of Nylon surfaces at atmospheric pressure and their implications in photocatalytic processes

Innovative pretreatment by UVC light (185 nm) and by radio-frequency (RF) plasma at atmospheric pressure to functionalize the Nylon surface, increasing its bondability toward TiO(2), is reported in this study. In the case of UVC light pretreatment in air, the molar absorption coefficient of O(2)/N(2) at 185 nm is very low and the air in the chamber absorbs very little light from the UVC source before reaching the Nylon sample. Nylon fabrics under RF plasma were also functionalized at atmospheric pressure because of the marked heating effect introduced in the Nylon by the RF plasma. This effect leads to intermolecular bond breaking and oxygenated surface groups in the topmost Nylon layers. Both pretreatments enhanced significantly the photocatalytic discoloration of the red-wine stain in Nylon-TiO(2) compared with samples without pretreatment. The UVC and RF methods in the absence of vacuum imply a considerable cost reduction to functionalize textile surfaces, suggesting a potential industrial application. Red-wine-stain discoloration under simulated sunlight was monitored quantitatively by diffuse-reflectance spectroscopy and by CO(2) evolution. X-ray photoelectron spectroscopy (XPS) was used to monitor the changes of the C, N, and S species on the Nylon topmost layers during the discoloration process. Significant changes in the XPS spectra of Ti 2p peaks were observed during discoloration of the wine spots. Wine stains attenuated the signal of the Ti 2p (458.4 eV) peak in the Nylon-TiO(2)-stained wine sample at time zero (from now on, the time before the discoloration process). Furthermore, a decrease of the wine-related O 1s signal at 529.7 eV and N 1s signal at 399.5 eV was observed during the discoloration process, indicating an efficient catalytic decomposition of the wine pigment on Nylon-TiO(2). X-ray diffraction detected the formation of anatase on the Nylon fibers. High-resolution transmission electron microscopy shows the formation of anatase particles with sizes between 8 and 20 nm.

Determination of sub-ppb epichlorohydrin levels in water by on-line solid-phase extraction liquid chromatography/tandem mass spectrometry

A new sensitive and selective method based on on-line solid-phase extraction (SPE) coupled to liquid chromatography/electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) using a triple quadrupole mass spectrometer has been developed for the determination of epichlorohydrin (ECH) in different types of water samples. ECH is not easily determined directly by ESI-MS as it is not readily ionized, and it has a low molecular mass and high polarity. Thus, prior derivatization of ECH was necessary, employing 3,5-difluorobenzylamine as a derivatizing agent with Fe(III) as a catalyst. In order to achieve accurate quantification, correcting for matrix effects, losses in the derivatization process and instrumental deviations, isotope labelled ECH (ECH-d(5)) was added as an internal standard (IS) to the water samples. The method was validated based on European SANCO guidelines using drinking and other types of treated water spiked at two concentration levels (0.1 and 1.0 microg/L), the lower level having been established as the limit of quantification (LOQ) of the method. Satisfactory accuracy (recoveries between 70 and 103%), precision (RSD <20%) and linearity (from 0.05 to 50 microg/L, r >0.99) were obtained. The limit of detection (LOD) was set up at 0.03 microg/L. The method was applied to different water samples (drinking water and water samples collected from a municipal treatment water plant). In order to enhance confidence, five selected reaction monitoring (SRM) transitions were acquired, thus obtaining a simultaneous reliable quantification and identification of ECH in water, even at sub-ppb levels.

A controlled trial of noninvasive ventilation for chronic obstructive pulmonary disease exacerbations

PURPOSE

This prospective, multicenter, double-blind, placebo-controlled study tested the hypothesis that noninvasive positive pressure ventilation reduces the need for endotracheal intubation in patients hospitalized in a pulmonary ward because of acute exacerbation of chronic obstructive pulmonary disease.

MATERIALS AND METHODS

Seventy-five consecutive patients with exacerbation (pH, 7.31 +/- 0.02; Pao(2), 45 +/- 9 mm Hg; Paco(2), 69 +/- 13 mm Hg) were randomly assigned to receive noninvasive ventilation or sham noninvasive ventilation during the first 3 days of hospitalization on top of standard medical treatment.

RESULTS

The need for intubation (according to predefined criteria) was lower in the noninvasive ventilation group (13.5% vs 34%, P < .01); in 31 patients with pH not exceeding 7.30, these percentages were 22% and 77%, respectively (P < .001). Arterial pH and Paco(2) improved in both groups, but changes were enhanced by noninvasive ventilation. Length of stay was lower in the noninvasive ventilation group (10 +/- 5 vs 12 +/- 6 days, P = .06). In-hospital mortality was similar in both groups.

CONCLUSIONS

These results demonstrate that noninvasive positive pressure ventilation, in a pulmonary ward, reduces the need for endotracheal intubation, particularly in the more severe patients, and leads to a faster recovery in patients with acute exacerbation of chronic obstructive pulmonary disease.

[Retinopathy of prematurity in the Murcia region of Spain. Incidence and severity]

OBJECTIVE

To determine the incidence and severity of Retinopathy of Prematurity (ROP) in the Murcia region of Spain.

METHODS

This was a retrospective study of all infants born preterm in the Murcia region during 2004, who were screened for ROP. Our screening criteria were: Infants with a gestational age <or= 32 weeks (GA) or with a birth weight <or= 1500 g (BW). We evaluated sex, GA, BW, parity and ophthalmologic evaluation. We then performed a descriptive study and a statistical analysis.

RESULTS

The study sample involved 115 infants with an average GA of 29.67 weeks and BW of 1325 g. The incidence of ROP and severe ROP was 32.1% and 15.6% respectively. The likelihood of the premature infant developing severe ROP was found to be 88.8% if it was born before 29 weeks GA or weighed less than 1000 g BW. Significant differences (p < 0.001), in terms of GA and BW between infants with and without ROP, were found.

CONCLUSIONS

A third of the preterm infants screened for ROP in the Murcia region developed the disease, and the 50% of these required treatment. The current screening criteria used in our region are appropriate. If more restrictive criteria were used, some severe ROP cases would not be detected. In order to be able to modify the current guidelines for screening for ROP, further studies are required.

Quantification and confirmation of anionic, cationic and neutral pesticides and transformation products in water by on-line solid phase extraction-liquid chromatography-tandem mass spectrometry

Two on-line SPE-LC-ESI-MS/MS methods have been developed for the rapid determination and confirmation of 18 polar pesticides and nine transformation products (TPs) in water samples. Given the very different physico-chemical characteristics of the analytes, it was not feasible the simultaneous determination of all selected compounds in only one method. Thus, it was necessary to use heptafluorobutyric acid and formic acid in order to obtain good retention in the SPE cartridge for basic and acidic analytes, respectively. The developed analytical methodology based on the direct injection of 2 mL of water sample in the system allowed the quantification of all analytes at the 25 ng/L level (LOQ) with limits of detection normally lower than 5 ng/L. Satisfactory recoveries (70-110%) were obtained for most compounds in ground and surface water samples. Some exceptions were found mainly in surface water, due to the ion suppression produced by the higher amount of matrix interferents in these samples. The acquisition of two MS/MS transitions for each compound allowed the reliable confirmation of positive findings even at the LOQ level. The developed methodology was applied to real ground and surface water samples showing the interest of including TPs in monitoring methods, as several of them were found at concentrations higher than that of parent compounds.

Study of different atmospheric-pressure interfaces for LC-MS/MS determination of acrylamide in water at sub-ppb levels

A rapid, sensitive and selective method based on LC-MS/MS has been developed for the direct determination of acrylamide residues in water in compliance with the current European Union (EU) 98/83 Drinking Water Directive. Given the high polarity of acrylamide, the application of a rapid on-line solid phase extraction step, commonly used for preconcentrating low analyte levels, was not found to be completely satisfactory. Therefore, an alternative approach based on the use of direct large-volume injection into the LC-MS/MS system has been used. Three atmospheric-pressure interfaces (ESI, APCI and Ion Sabre APCI) were checked to reach the required sensitivity (0.1 microg/l). All three interfaces were tested by analysis of six different water samples (surface water, groundwater, drinking water and three treated water samples) spiked at three concentration levels each (0.1, 1 and 10 microg/l). When using ESI, poor sensitivity and high matrix effects were observed. This situation improved when APCI was used as the interface because no matrix effect was found, although sensitivity was not completely satisfactory. The best results were obtained by interfacing the Ion Sabre APCI; its higher sensitivity for acrylamide (LOD 0.03 microg/l) and the absence of matrix effects recommended its selection. Using this approach, satisfactory recoveries (90-97%) and precision (<12%) were obtained for all water samples studied. Besides, the acquisition of two different MS/MS transitions allowed not only the quantification but also the confirmation of acrylamide in water at concentration levels around 0.1 microg/l.

Tongue-Base Suspension in Conjunction with Uvulopalatopharyngoplasty for Treatment of Severe Obstructive Sleep Apnea: Long-Term Follow-Up Results

OBJECTIVES/HYPOTHESIS

To evaluate the usefulness of tongue-base suspension (TBS) in addition to uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea syndrome (OSAS).

STUDY DESIGN

Long-term prospective case series.

SETTING

University tertiary care medical center.

METHODS

Fifty-five consecutive patients with severe OSAS (apnea-hypopnea index [AHI] 52.8+/-14.9 events/hr) with multilevel upper airway obstruction who refused treatment with continuous positive airway pressure underwent UPPP plus TBS with the Repose system. All patients were evaluated before surgery by clinical history, Epworth Sleepiness Scale (ESS), fiberoptic nasopharyngoscopy with Müller maneuver, and nocturnal polysomnography (PSG). After 3 years of surgery, all patients were re-evaluated at the clinic and had ESS test and full PSG. Surgical success was defined when the ESS dropped bellow 11, and the AHI decreased below the threshold of 20 events per hour of sleep and at least 50% from the preoperative value

RESULTS

There were 42 (78%) patients in which the AHI score decreased more than 50%, the AHI was lower than 20 events/hr in the PSG, and the ESS was lower than 11 after 3-years of follow-up (surgical success index). Logistic regression analysis demonstrated that body mass index at baseline was the only variable with significant statistical power to predict surgical success (odds ratio 0.85; 0.73-0.95, 95% confidence interval, P<.01)

CONCLUSION

When associated with UPPP, the TBS technique performed with the Repose system demonstrates a surgical success of up to 78% for patients with severe OSA who refused nasal continuous positive airway pressure.

An ion-pairing liquid chromatography/tandem mass spectrometric method for the determination of ethephon residues in vegetables

A rapid, sensitive and selective method has been developed for the direct determination of ethephon residues in vegetables (apple, cherry and tomato). Given the anionic character of ethephon, the use of ion-pairing liquid chromatography (LC) in combination with tandem mass spectrometry (MS/MS, triple quadrupole) allowed its direct determination in these matrices avoiding a derivatisation step and favouring the automation of the method. Samples were extracted with a mixture of dichloromethane/aqueous formic acid (pH 3) (1:1). Then, tetrabutylammonium acetate (TBA) was added as an ion-pairing reagent, and an aliquot of the aqueous extract was directly injected into the LC/MS/MS system. Quantification was performed with matrix-matched standards prepared from blank sample extracts. MS/MS measurements were made in the selected reaction monitoring (SRM) mode, using the most sensitive transition (m/z 107 > 79) for quantification, and up to four additional transitions for confirmation. Quantitative recoveries were obtained for all matrices (between 83% and 96%) at two concentration levels tested (0.05 and 0.5 mg/kg), with relative standard deviations lower than 9% in all cases. The addition of TBA directly into the sample extract contained in the injection vial was found sufficient to obtain satisfactory LC retention for the analyte. Under these conditions, the absence of ion-pairing reagent in the mobile phase minimised the ionisation suppression for ethephon in the MS source, leading to an increase in the sensitivity of the method and reaching limits of detection of 0.02 mg/kg for all matrices investigated. The acquisition of five specific MS/MS transitions for ethephon allowed the simultaneous and reliable quantification and confirmation of the analyte in the samples.

[Dyspnea in COPD: relation to the MRC scale with dyspnea induced by walking and cardiopulmonary stress testing]

OBJECTIVE

Exercise-related dyspnea is the main symptom of chronic obstructive pulmonary disease (COPD), yet its relation to lung function deterioration is weak. The aim of this study was to evaluate the relation between the patients' usual level of dyspnea and dyspnea caused by a maximum cardiopulmonary stress test or a 6-minute walking test.

METHODOLOGY

Thirty-six consecutive patients with stable COPD (age 66 7 years post-bronchodilator FEV1 47 14% of predicted) were studied. In addition to full baseline function testing, all patients underwent stress testing on a cycle ergometer and a 6-minute walking test in a corridor 50 m long. Exercise-induced dyspnea was assessed by the patient on a Borg scale before beginning and after completing each test. Chronic dyspnea during activities of daily living was quantified on the Medical Research Council (MRC) scale.

RESULTS

The MRC value was only weakly related to percent of predicted FEV1 (r = 0.34, p = 0.04). Parameters obtained during exercise tests that were associated with the MRC were SaO2 at the end of the 6-minute walking test (r = 0.49, p = 0.004) and change in dyspnea on the Borg scale during the 6-minute walking test (deltaBorg-6mWT, r = 0.54, p = 0.0008) and during the stress test (r = 0.35, p = 0.04). Multiple regression analysis, with the MRC result as the dependent variable, showed that deltaBorg-6mWT and SaO2 at the end of the walking test explained 29% of the variance.

CONCLUSION

Severity of chronic dyspnea in COPD patients assessed on the MRC scale is more related to dyspnea triggered by the walking test than with dyspnea induced by cycle ergometer stress testing.

[Strengthening of the steering role of health++ authorities in health care reforms]

Strengthening the ability of health authorities to provide leadership and guidance, now and in the future, is an important issue within the context of health sector reform. It means, among other things, redefining the role of health in light of leading social and economic trends seen in the world at the beginning of the 21st century, increasing participation in health by nongovernmental entities, moving toward participatory democracy in many countries, and modifying concepts of what is considered "public" and "private." Within this scenario, it is necessary to redirect the role of the health sector toward coordinating the mobilization of national resources, on a multisectoral scale, in order to improve equity and social well-being and to channel the limited available resources to the most disadvantaged groups in society. The liberalization of the production and distribution of health-related goods and services, including insurance, challenges the exercise of authority in the area of health. Furthermore, the formation of regional economic blocks and the enormous weight wielded by multinational companies in the areas of pharmaceuticals and other medical supplies and technologies are forcing the health sector to seek ways of harmonizing health legislation and international negotiations. According to many experts, all of these demands surpass the ability of Latin American ministries of health to effectively respond, given most countries' current organizational, legal, and political conditions and technical infrastructure. The countries of the Americas must make it a priority to strengthen their health officials' ability to provide leadership and guidance in order to meet present and future challenges.

Spontaneous regression of Elschnig pearl posterior capsule opacification

After extracapsular cataract extraction with in-the-bag intraocular lens implantation, a 72-year-old woman had reduced visual acuity from posterior capsule opacification (PCO) resulting from Elschnig pearl proliferation. No capsulotomy was performed, and the PCO decreased spontaneously over time, improving visual acuity and leaving a clear capsule.

Minimum distance estimation of mutational parameters for quantitative traits

Individual spontaneous mutations affecting the expression of quantitative traits cannot be systematically identified and, therefore, their effect on the trait cannot be measured. Thus, the rate of occurrence of such mutations and the moments of the probability distribution of the corresponding effects, which are important in evolutionary studies, remain unknown. Here we propose a method to estimate those mutational properties from the observed distribution of the trait mean in a set of independent inbred lines (all derived from the same homozygous base population) in which mutations had been allowed to accumulate randomly. It is based on the use of the well-known minimum distance method, i.e., on the minimization of a distance between the observed distribution and that expected on the basis of a genetic model. We analyze data for three morphological traits (wing length and abdominal and sternopleural bristle number) in Drosophila melanogaster. The method appears to be powerful, giving evolutionary coherent estimates of relevant mutational properties that had not been estimated previously. For all traits, mutational rates were low (smaller than 0.05). Most mutations affecting wing length or abdominal bristle number and negative effect, while almost half of those affecting sternopleural bristle number had positive effect. For each trait, results obtained from data on different generations are in qualitative agreement, although mutational effects seem to depend on generation-specific environmental factors. The method detected between-trait differences in the kurtosis coefficient of the distribution of mutational effects, which varied from values close to that of the normal distribution (wing length) to relatively high values (sternopleural bristle number). It reveals that an important proportion of the mutational input variance of each trait is due to mutations with absolute effect smaller than 0.5 environmental standard deviation units. For morphological traits undergoing weak direct selection, this suggests that large amounts of genetic variance due to genes segregating at intermediate frequencies can be present at the equilibrium.

[Continuous domiciliary oxygen therapy in Zaragoza: a cross-sectional home study]

To assess use of long-term domiciliary oxygen therapy (LDOT) in Saragossa by means of home interviews. We conducted a cross-sectional study of patients undergoing LDOT, interviewing 312 of the 614 patients who used O2 at home in January 1993 (103/100,000 h). Health care workers visited the patients at home and collected all available information related to indications, pattern of use of O2 and complementary tests done. The interviewer also took spirometric readings, SaO2 readings breathing room air and after 30 min breathing O2, and administered a quality of life questionnaire (only to patients with pneumopathies). All patients selected were assessed; 195 (62.5%) suffered from chronic obstructive pulmonary disease (COPD), 33 (10.6%) from asthma, 31 (9.9%) from other pneumopathies, and 53 (17%) from a variety of conditions that were not primarily bronchopulmonary. Thirty-six (11.5%) were active smokers. Only 101 of the 184 patients for whom arterial gasometric readings were available met the criteria for prescribing LDOT. SaO2 without O2 was > or = 92% in 89 (28.5%) patients and > or = 90% in 193 (61.8%). Only 96 (31%) patients reported using O2 more than 15 hours/day and there was a weak inverse relation (p = 0.04) between hours of use and FEV1 in the COPD group. Quality of life for patients with pneumophaties depended entirely on degree of lung function deterioration and was unrelated to use of O2. The rate of use of LDOT Saragossa is one of the highest in Spain. In an estimated 28.5-46% of cases, the indications are inappropriate, mainly due to infrequent use of arterial gas measurement and the prescription of LDOT for patients without COPD. This situation largely explains why patients hardly ever use LDOT on a daily basis.

[Active pulmonary tuberculosis in the community. Current presentation]

OBJECTIVE

To discover how patients in a provincial general hospital, diagnosed as having pulmonary tuberculosis had first clinically and radiologically presented.

DESIGN

This was a retrospective observational study. SITE. The San Jorge de Huesca General Hospital. The period of study was between January, 1986, and December, 1989.

PATIENTS AND OTHERS PARTICIPANTS

Those studied were the 59 patients diagnosed as having active pulmonary tuberculosis during the study period.

MAIN MEASUREMENTS AND RESULTS

The average age of the patients was 45.6 +/- 19.25 SD. There was greater occurrence in males. The most common form in which the disease first appeared was thoracic symptomatology (59%), followed by constitutional syndrome (45.7%). 8 patients were addicted to drugs taken parenterally (ADVP), of whom 4 were HIV-positive (6.8%). The most common radiological pattern was ulcero-caseous.

CONCLUSIONS

We underline the importance of diagnostical awareness at the Primary Care level in order to rapidly begin the correct treatment; and thus fight the adverse epidemiological situation caused by tuberculosis today.

[Symptomatic right aortic arch in adults]

A 54-year-old female presented with dyspnea on exertion and wheezing, with a negative response to inhaled beta-2 stimulating drugs and intravenous glucocorticoids. The major values of basal spirometric study were normal; however, the morphology of the flow-volume curve showed intrathoracic obstruction of large airways, with negative response to beta stimulating drugs. The bronchial provocative test with histamine was normal. Chest radiographs only showed a mild widening of the median mediastinum with left anterior tracheal displacement. Nuclear magnetic resonance showed a right aortic arch with tracheal strangulation.

[A second drug in nonatopic asthma insufficiently controlled with beta 2-adrenergic stimulants: budesonide versus theophylline]

We assessed whether theophylline or budesonide (an inhaled corticosteroid) is the most adequate drug to be added to the treatment of patients insufficiently controlled with beta agonists (procaterol). Two comparable groups of nonatopic asthmatic adults (n = 24), aged between 16 and 66 years (42 +/- 17), were investigated in a crossed, randomized study. After 4 weeks with procaterol + 800 micrograms of budesonide, the forced expiratory flow improved (p less than 0.01), the degree of bronchial hyperreactivity to histamine was reduced (p less than 0.001), the daily recorded symptomatology almost disappeared in all and the number of procaterol inhalations was reduced (p less than 0.05). The combination of theophylline + procaterol during 4 weeks did not improve these parameters from their baseline values. It was concluded that inhaled steroids are the drugs of choice in patients with asthma which is not controlled only with beta agonists.

Nifedipine in exercise-induced asthma

The calcium entry blockers may inhibit EIA in patients with bronchial asthma, but it is not demonstrated that they produced bronchodilation once the crisis is established. Nine patients with exercise induced asthma were studied. We carried out an exercise test for ten minutes with constant load and the following were measured; FVC, PEF, MEF25 and sGaw before and after test. All the values fell 20% or more than the initial values. A 20 mg was administered without modifying the studied parameters and only the administration of 400 micrograms of metaproterenol by inhalation made the sensation of dyspnea recur in all patients.