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Luis Pérez de Llano,1 David Dacal Rivas,1 Nuria Marina Malanda,2 Vicente Plaza Moral,3 José Antonio Gullón Blanco,4 Mariana Muñoz-Esquerre,5 Ismael García-Moguel,6 Rocío M Díaz Campos,7 Eva Martínez-Moragón,8 Alicia Harbenau Mena,9 Borja G Cosío,10 Alicia Padilla Galo,11 Carolina Cisneros Serrano12 1Pneumology Service, Hospital Lucus Augusti, EOXI Lugo, Cervo e Monforte, Lugo, Spain; 2Pneumology Service, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain; 3Pneumology Service, Hospital Sta Creu i Sant Pau, Barcelona, Spain; 4Pneumology Service, University Hospital San Agustín, Avilés, Spain; 5Pneumology Service, Hospital Bellvitge-IDIBELL, Barcelona, Spain; 6Allergy Service, Hospital 12 de Octubre, Madrid, Spain; 7Pneumology Service, Institute for Health Research (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; 8Pneumology Service, Hospital Doctor Peset, Valencia, Spain; 9Allergy Service, Hospital de Mérida, Badajoz, Spain; 10Pneumology Service, Hospital Universitario Son Espases-IdISBa-CIBERES, Palma de Mallorca, Spain; 11Pneumology Service, Hospital Costa del Sol, Marbella, Málaga, Spain; 12Pneumology Service, Hospital Universitario de La Princesa, Madrid, SpainCorrespondence: David Dacal Rivas, Pneumology Service, University Hospital Lucus Augusti, Lugo, Spain, Tel +34982296000, Email daviddacalrivas@hotmail.comAbstract: Although biologics have demonstrated to be effective in T2-high asthma patients, there is little experience with these drugs in asthma–COPD overlap (ACO). The aim of this study was to compare the effectiveness of biologics in these two conditions. We included 318 patients (24 ACO and 297 asthma) treated with monoclonal antibodies and followed for at least 12 months. Omalizumab was the most frequently employed biologic agent both in patients with ACO and asthma. Asthma control test (ACT) scores after at least 12 months of biologic therapy were not significantly different between groups. The percentage of patients with ≥ 1 exacerbation and ≥ 1 corticosteroid burst was significantly higher in ACO patients (70.8 vs 27.3 and 83.3% vs 37.5%, respectively), whereas the percentage of “controlled” patients (with no exacerbations, no need for corticosteroids and ACT ≥ 20) was significantly lower (16.7% vs 39.7%). In conclusion, this report suggests that patients with ACO treated with biologics reach worse outcomes than asthma patients.Keywords: asthma, asthma–COPD overlap, COPD

Monoclonal antibodies (mABs) have become available to treat more efficiently patients with severe uncontrolled asthma (SUA). However, the use of mABs is lower than expected given the prevalence of SUA, with significant disparities in the use of these treatments.To evaluate the proportion of patients with SUA treated with mABs in Spain, and to analyze some of the factors that could determine these prescription patterns.An analysis was performed on the data provided from the Hospitals National Health System (NHS) 2018 catalogue where Chest Diseases Department and a Hospital Pharmacy were available. Random sampling was performed to determine the sample size, stratifying proportionally by geographic area and hospital level. Characteristics of the participating sites, as well as the prescribing of mABs were collected, which included geographic area, hospital levels, prescribing medical specialities, types of clinics, and mABs prescribed.Data from 90 hospitals were analyzed (Response rate 64.3%). Level 4 hospitals, the Canary Islands geographical area, and the presence of a high complexity Asthma Healthcare Unit (ACU) were associated with a higher probability that the SUA was treated with mABs.The map of the prescribing of mABs for SUA in Spain shows a significant variation by geographic area, hospital level, type of clinic, and the accreditation level of the ACUs. At the current time, there appears to be significant under-prescribing of these treatments.

El objetivo de esta revisión es facilitar al neumólogo el manejo de las enfermedades de la vía respiratoria superior ligadas a la vía respiratoria inferior, especialmente al asma, unidas por una epidemiología, una clínica y un mecanismo inflamatorio comunes e interrelacionados. El documento recoge las definiciones de los diferentes fenotipos nasosinusales ligados al asma: rinitis alérgica o no alérgica y rinosinusitis crónica con o sin pólipos nasales. Asimismo se recogen los criterios diagnósticos y su nivel de gravedad. Se dedica especial atención a los dos síndromes principales asociados al asma: 1) rinitis alérgica, la patología más frecuente, y 2) rinosinusitis crónica con pólipos nasales, la patología más ligada al asma grave. En síntesis, en el manejo del asma debe valorarse siempre la vía respiratoria superior con la finalidad de un diagnóstico unificado y un tratamiento integral de la vía respiratoria única.

Background: Patients with mild asthma represent a substantial proportion of the population with asthma, yet there are limited data on their true burden of disease. We aimed to describe the clinical and healthcare resource utilisation (HCRU) burden of physician-assessed mild asthma. Methods: Patients with mild asthma were included from the NOVEL observational longiTudinal studY (NOVELTY; NCT02760329), a global, 3-year, real-world prospective study of patients with asthma and/or chronic obstructive pulmonary disease from community practice (specialised and primary care). Diagnosis and severity were based on physician discretion. Clinical burden included physician-reported exacerbations and patient-reported measures. HCRU included inpatient and outpatient visits. Results: Overall, 2004 patients with mild asthma were included; 22.8% experienced >= 1 exacerbation in the previous 12 months, of whom 72.3% experienced >= 1 severe exacerbation. Of 625 exacerbations reported, 48.0% lasted >1 week, 27.7% were preceded by symptomatic worsening lasting >3 days, and 50.1% required oral corticosteroid treatment. Health status was moderately impacted (St George's Respiratory Questionnaire score: 23.5 [standard deviation +/- 17.9]). At baseline, 29.7% of patients had asthma symptoms that were not well controlled or very poorly controlled (Asthma Control Test score = 2 exacerbations in the previous year. In terms of HCRU, at least one unscheduled ambulatory visit for exacerbations was required by 9.5% of patients, including 9.2% requiring >= 1 emergency department visit and 1.1% requiring >= 1 hospital admission. Conclusions: In this global sample representing community practice, a significant proportion of patients with physician-assessed mild asthma had considerable clinical burden and HCRU.

Introduction: A recent meta-analysis concluded that adults with asthma have higher LDL-cholesterol levels than healthy controls. Some studies relate this increase with the inhaled corticosteroid dose. In clinical practice we frequently observe high cholesterol levels in our patients with severe asthma. The objective of this study was to evaluate the levels of total cholesterol in patients receiving treatment with high inhaled corticosteroids dose (HICD). Methods: Patients followed-up in a severe asthma unit were included in this retrospective cohort study. Patients on long-term systemic corticosteroids (SC) treatment were excluded, and doses of SC were collected in those who used short bursts during exacerbations. Given that only 35% of our patients had collected the LDL-cholesterol and HDL-cholesterol values, we could not include them in the analysis. Results: We included 70 patients, 81% women, with a mean age of 56 ± 16 years. The mean body mass index (BMI) was 28.62 ± 5.63. The average diagnose age was 30’7 years. 95’7% received fluticasone, while 4’3% beclomethasone, being the average dose (equivalent of fluticasone propionate) of 1024’29 ± 159 mcg. The mean value of total cholesterol was 213’79 ± 33’48 (70% of patients present cholesterol ≥ 200 and 21% of them ≥ 240). We found a statistically significant relationship between BMI and cholesterol levels. Conclusions: 70% of our patients had total cholesterol ≥200 mg / dL, 21% being ≥240 mg / dL. Patients with higher BMI had total cholesterol > 200 mg / dL. More studies should be carried out to clarify the possible relationship between the HICD treatment and the increase in total cholesterol levels.

Introduction: In Spain, the prevalence of severe persistent asthma is approximately 4-5% of the total asthma patients. Eosinophilic asthma patients represent 25% of these patients with severe persistent asthma. Mepolizumab is an effective treatment for these patients in reduction of systemic glucocorticoids’ dose and severe exacerbations. We aim to analyze clinical and functional efficacy of mepolizumab in our asthma unit uncontrolled patients. Methods: A retrospective observational study was performed in our asthma unit uncontrolled patients treated with mepolizumab from January 2017 to September 2018. Demographic and clinical variables were recorded. We analyzed systemic glucocorticoids´ dose, %FEV1 and the number of total exacerbations in the previous year of mepolizumab treatment. Results: 16 patients were included, 81.3% females (mean age 55 ± 11 years; mean age at diagnosis 30 ± 13 years). The main reason to start the treatment with mepolizumab was to reduce systemic glucocorticoids’ dose (SG). 11 patients required daily SG to maintain asthma control and 7 of them could achieve total cessation. Besides, the other 4 patients got SG dose reduction (mean dose before 8.8 ± 8.6 and after 6.56 ± 5.71; p Conclusions: In patient requiring daily SG to maintain asthma control, mepolizumab had a significant total cessation of SG, reduced exacerbations, control of asthma symptoms and improved lung function.

Backgrounds: Smoking is the leading cause of high levels of carboxyhemogloblin(COHb). We aimed to describe clinical and demographic features in these patients Methods: This is a retrospective observational study with 375 patients with arterial blood gas from Nursery Respiratory Clinic at La Princesa Hospital. We selected patients with high levels of COHb(>2%) and classified them in 3 groups:active smoker(A), never smokers(B) and ex-smokers(C). Socio-demographic and clinical features were correlated with levels of COHb. Results: 73% of the cohort presented high levels of COHb. Average age was 69±19 years. 52% were males. 20% were group A, 32% group B and 48 group C. Comorbidities and clinical features shown in Table1. Almost 30% of our cohort use oxygen theraphy and many of them had high levels of COHb (2.7%: >5% and 49%:2.4-4.9%, p=0.03) of which 23% were group B and whose main indication of oxygen was cardiovascular disease. 16% of patients in groups B and C had passive smoking history. CoHb levels >2.5% were observed in 47% of the patients belonging to groups B and C, while 41% of group A presented COHb levels >5. In Chronic Obstructive Pulmonary Disease (COPD) patients, 11% had COHb>5%, and 56% of COPD patients from group B and C had COHb>2.5%. Negative correlation was described between the time without smoking and levels of COHb(r:-0.22 p Conclusions: The longer the non-smoking period, the lower the levels of COHb and the better the polyglobulia levels. Almost half of non-smoking and ex-smokers in our sample presented high COHb, due to non-smoke-free environment

Introduction: The objective of this study was to assess tracheal reactivity after the deployment of different self-expandable metal stents (SEMS). Material and methods: Forty female New Zealand rabbits were divided into four groups. Three groups received three different SEMS: steel (ST), nitinol (NiTi), or nitinol drug-eluting stent (DES); the fourth group was the control group (no stent). Stents were deployed percutaneously under fluoroscopic guidance. Animals were assessed by multislice, computed tomography (CT) scans, and tracheas were collected for anatomical pathology (AP) study. Data from CT and AP were statistically analyzed and correlated. Results: The DES group had the longest stenosis (20.51±14.08 mm vs 5.84±12.43 and 6.57±6.54 mm in NiTi and ST, respectively, day 30; P

Resumen Introduccion El objetivo de este estudio es evaluar la reactividad traqueal tras la implantacion de distintos stents metalicos autoexpandibles (SMAE). Material y metodos Se utilizaron 40 conejos hembra de raza neozelandesa, que se dividieron en 4 grupos. En 3 grupos se implantaron SMAE: de acero (SA), de nitinol (NiTi) o stents liberadores de nitinol (SLF). El cuarto grupo fue el grupo de control (sin stent). Los stents se implantaron por via percutanea bajo control fluoroscopico. Los animales se evaluaron mediante tomografia axial computarizada (TAC) multicorte y las traqueas se extirparon para su estudio anatomopatologico (EAP). Los datos de la TAC y el EAP se analizaron estadisticamente y se correlacionaron. Resultados El grupo que recibio SLF presentaba la mayor longitud de estenosis (20,51 ± 14,08 mm frente a 5,84 ± 12,43 y 6,57 ± 6,54 mm en los grupos NiTi y SA, dia 30; p En el estudio AP, el grupo SA presento reactividad proliferativa intensa en comparacion con los otros 2 grupos. En el grupo SLF se observo una respuesta destructiva en el 70% de animales, mientras que el stent NiTi fue el que menos reaccion provoco. La TAC resulto ser superior para detectar el engrosamiento (correlacion positiva de un 68,9%; p Conclusiones El grupo SA desarrollo granulomas y estenosis significativas. El stent NiTi fue el que menos reaccion indujo, mientras que el SLN provoco lesiones importantes que podrian estar relacionadas con la dosis de farmaco. Por consiguiente, este tipo de SLF no se recomienda para el tratamiento de la estenosis traqueobronquial.

To evaluate the efficacy and safety of aspiration thrombectomy in combination with low-dose catheter-directed thrombolysis for acute unstable pulmonary embolism (PE).Acute unstable (PE) is a life-threatening condition requiring treatment escalation, but many patients cannot receive full-dose systemic thrombolysis due to contraindications.Eligible patients had a PE with sustained hypotension. We used a 115-cm, 8-F continuous aspiration mechanical thrombectomy catheter to perform mechanical thrombectomy, followed by catheter-directed thrombolysis with low-dose urokinase. The primary efficacy outcome was the change in the pulmonary artery pressure after aspiration thrombectomy and catheter-directed thrombolysis. Secondary efficacy outcomes were stabilization of hemodynamics post-procedure and survival to hospital discharge. The primary safety outcome was major procedure-related complications and major bleeding events.We included 54 patients with acute unstable PE. After thrombectomy, mean systolic pulmonary artery pressure decreased from 60.2 mm Hg to 55.2 mm Hg (P 0.01), and to 40.5 mm Hg after catheter thrombolysis (P 0.0001). The in-hospital PE-related death occurred in six patients (11%; 95% confidence interval [CI], 4.2-23%) at a mean follow-up of 1.1 days, and hemodynamics stabilized in the remaining 48 patients. Minor complications after thrombectomy included arrhythmias (4 of 48 patients, 8.3%; 95% CI, 2.3-20%), and minor bleeding episodes (3 of 48 patients; 6.2%; 95% CI, 1.3-17%). Major complication occurred in one patient (2.1%; 95% CI, 0.1-11%) who developed hemorrhagic transformation of paradoxical embolic stroke following catheter-directed thrombolysis.Aspiration thrombectomy followed by catheter-directed thrombolysis was overall effective and safe in treating patients with acute unstable PE.

Introduction: Sleep disturbances and night time symptoms are associated with the level of control of ashtma symptoms and quality of life Aims and objectives: Main aim: validate the Sleep Jenkins Questionnaire (SJQ) into Spanish. Secondary aim: assess quality of sleep in asthmatic patients using the SJQ and the Medical Outcome Study (MOS) sleep scale and analyse the metric properties of the SJQ Method: A multicentric prospective study with an intervention group of asthmatic patients and a control group. A total of 90 cases and 90 controls were included. The questionnaires were administered during 3 successive visits at a 3 weeks and 3 months interval Results: The test re-test of SJQ between V1 and V2 in the 90 cases showed temporary stability. Patients who had exacerbation of asthma between V2 and V3 had higher scores in SJQ (worse quality of sleep) at V3 than V2, which shows the sensivity to change of the test. A good correlation between the two measurament scales was observed at V1. The SJQ score between cases and controls during V1 showed significant differences in quality of sleep in both grooups. No statistically significant differences were found in quality of sleep depending on the severity of asthma but statistically significant differences were observed according to the control of asthma. The overall quality of sleep of our patients was good Conclusions: The SJQ showed temporary stability in the test-retest, sensitivity to change and validity criteria

Resumen Desde la publicacion, hace ya 9 anos, de la ultima normativa de la Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) sobre asma de control dificil (ACD), se han producido avances en los conocimientos de la enfermedad asmatica, que hacen necesario realizar una puesta al dia de los datos disponibles e incorporarlos tras su analisis en el nivel de evidencia y recomendacion mas adecuado. Recientemente han aparecido documentos de consenso y guias de practica clinica (GPC) que abordan este problema. En esta normativa se hara mencion explicita a lo que la previa guia de ACD definia como «verdadera asma de control dificil»; es decir, al asma que tras haber verificado su diagnostico, realizado un abordaje sistematizado para descartar factores ajenos a la propia enfermedad que conducen a un mal control de la misma («falsa asma de control dificil»), y realizar una estrategia de tratamiento adecuado (escalones 5 y 6 de la Guia espanola para el manejo del asma [GEMA]), no se consigue alcanzar el control: «asma grave no controlada» (AGNC). En esta linea la normativa propone una revision de la definicion, un intento de clasificacion de las diferentes manifestaciones de este tipo de asma, una propuesta del abordaje diagnostico por pasos y un tratamiento dirigido segun fenotipo, conjuntamente con un apartado especifico sobre este arquetipo de asma en la infancia, con el objetivo de que pueda servir de ayuda a los profesionales sanitarios y repercutir en el cuidado de estos pacientes.

Background: Revascularization with carotid stent (CAS) is considered the therapeutic alternative to endarterectomy (CEA). However, its role compared to CEA remains questioned, mainly due of the heterogeneity of long-term results. The objective of this study was to report the efficacy and durability of CAS in terms of stroke prevention in a “real world experience”. Method: This was a single-center retrospective analysis of 344 patients treated with CAS between January 2001 and December 2015. The primary outcome of the trial was stroke, myocardial infarction, or death during a periprocedural period or any stroke event over a 15-year follow-up. The secondary aim was to identify risk factors for 30-day complications, long-term neurological complications, and intra-stent restenosis. Results: The primary composite end point (any stroke, myocardial infarction, or death during the periprocedural period) was 2.3%. The use of an EPD was protective against major complications. Long-term follow-up was achieved in 294 patients (85,5%) with a median of 50 months (range 0-155 months). Fifty-six (16,3%) died within this period, most commonly of nonvascular causes (4 patients had stroke-related deaths). During the follow-up period, 8 strokes and 3 TIAs were diagnosed (3.2%). ISR determined by sequential ultrasound was assessed in 4.4% of the patients and remained asymptomatic in all but 2 patients (0.6%). All patients with restenosis underwent revascularization with balloon angioplasty. Conclusion: The long-term follow-up results of our study validate CAS as a safe and durable procedure with which to prevent ipsilateral stroke, with an acceptable rate of restenosis, recurrence and mortality.

Endotracheal stenting is a controversial treatment for tracheal stenosis. Metallic stents have advantages but also show disadvantages such as restenosis due to epithelial hyperplasia and granuloma formation. In this work we analyze the response of a rabbit tracheal wall during normal breathing under implantation of a Zilver® Flex™ Stent. Trachea geometries were reconstructed using medical images for both healthy and stented rabbit. The numerical model was used for analyzing tracheal stresses before and after prosthesis implantation using a fluid–structure interaction approach (FSI). Unstructured tetrahedral-based grids were used to perform the simulations with a finite element-based commercial software code. Experimental tests on rabbit trachea samples were performed in order to get the material property constants. Deformations of the tracheal cartilage rings and of the muscular membrane as well as the maximum principal stresses of the tracheal wall were analyzed and compared with those of the healthy trachea in absence of prosthesis. In addition, an experimental validation of the model was provided. The prosthesis was percutaneously implanted under fluoroscopic control. Period of the study was 90 days. The tracheal wall response was assessed by means of computerized tomography by endoscopy, macroscopic findings and histopathological study. Experimentally revealed tissue damages due to the stent were then compared with numerical results. Interesting correlation with maximal principal stresses and induced wall shear stress were found in the same region.

It is described a new version of modified Hotz-Celsus technique performed in four patients, two cats and two dogs. The surgery was carried out using CO(2) laser in order to avoid bleeding and decrease the anesthetic time. Besides, the wound created was not sutured and it healed by secondary intention without any complication. As a conclusion, this modification is a successful alternative to treat entropion in a safe and fast way.

Venous thromboembolism (VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism (PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.

Achromobacter xylosoxidans is a gram negative non-fermentative rod that infects adult cystic fibrosis patients with moderate to severe lung compromise. Its clinical implications are still to be determined. The aim of this study was to analyze the impact of inhaled imipenem on forced expired volume in 1 sec (FEV1) and number of exacerbations in adult cystic fibrosis patients. Patients colonized by A. xylosoxidans with more than two intravenous antibiotic cycles and/or ≥ 5% FEV1 impairment during the last year were included. We included six patients with a mean age of 24.8 years. At the beginning of treatment FEV1 was 1.18 l (52%) with a mean of 3.4 exacerbations in the previous 12 months and 2.24 (p=0.04) the following 12 months. There was a significant difference between the initial FEV1 value and three months after treatment (p=0.005).

Background Bare metal stents may cause complications like fibrous encapsulation, granulation and tracheal stenosis. We investigated the behavior of three commercially available stents in vivo (rabbits) and in vitro (co-culture of those stents with epithelial and fibroblast cell lines). Also, we investigated whether development of tracheal stenosis could be predicted by any biological marker. Methods The tracheae of 30 rabbits were implanted with either nitinol stents, with or without paclitaxel elution, or a cobalt-based stent. An additional ten rabbits underwent mock implantation (controls). Serial peripheral venous blood samples were taken throughout the study, and several cytokines measured. Animals were euthanized on day 90, with immediate tracheal endoscopy and lavage performed, then necropsy. Results Rabbits with cobalt-based stent exhibited more inflammation and the highest stenosis incidence, with reduced survival. Both in vivo and in vitro, this stent induced higher IL-8 levels than nitinol stents. Most important, presence of stent-induced tracheal stenosis was closely associated to increase of IL-8 expression in blood just one day after tracheal stent implantation: a 1.19-fold increase vs. baseline had 83% sensitivity, 83% specificity, 77% positive predictive value, 88% negative predictive value and 83% accuracy to predict development of stenosis. Conclusions The cobalt-based stent had the highest incidence of tracheal inflammation and stenosis. On the other hand, the paclitaxel-eluting nitinol stent did not prevent those complications, and provoked a marked reaction compared with the bare nitinol stent. Early increase of IL-8 expression in blood after stent implantation could predict development of tracheal stenosis in rabbits. This article is protected by copyright. All rights reserved.

A 20-year-old woman, with intolerance to non-steroid anti-inflammatory drugs (NSAIDs) who was diagnosed of asthma 2 years earlier. Both her mother and brother were asthmatic. Non-smoker. Anosmia and rhinosinusitis symptoms. Several hospitalizations for asthmatic attacks, the last one, one month before in the ICU that did not require mechanical ventilation. Skin tests negative to aeroallergens. Better personal PEF: 450 l/min. Previous treatment: salmeterol/fluticasone 50/500 1 inh/12h. and formoterol p.r.n. She came to the emergency room by ambulance due to evolution of fever, expectoration and headache after having gone to her physician, who had prescribed metamizole and azithromycin. She returned at one hour due to difficult breathing and Sat O(2) 89%. The physical examination showed abdominal breathing, 40 rpm and Sat O(2) 92% with nebulizer at 6 bpm, PEF: 180 l/min, tachycardia at 150 bpm, generalized wheezing. Hemodynamically stable. Blood gases with O(2) to 6 bpm: 7.28 pH, 45 pCO(2), 66pO(2), 21.1 HCO(3), Chest X-ray: no consolidations.

Introduction The reason why there is a higher hospitalization rate due to asthma exacerbations amongst women is unclear. The objective of this study is to explore the possible causes that may explain this fact. Methods A multi-center, prospective study including asthma patients hospitalized in the pulmonary medicine departments during a 2-year period. By means of a questionnaire, the following data were collected: demographic characteristics and treatment compliance, anxiety-depression, hyperventilation and asthma control, both prior to and during the hospitalization. Results 183 patients were included, 115 (62.84%) of whom were women. The women were older (52.4±18.3/43.4±18.7; P =.02), were more frequently prescribed inhaled corticosteroids (63.2%/47.1%; P =.03) and had a higher rate of hyperventilation syndrome (57.3/35.9; P =.02) and a longer mean hospital stay (7.3±3.4/5.9±3.6; P =.02). The percentage of smokers among the women was lower (21.2%/38.8%; P =.01) and the FEV 1 was lower at admittance (58.2%±15.9%/67.5%±17.4%; P =.03). In the 40–60-year-old age range, an association was demonstrated between being female and the ‘previous hospitalizations’ variable (OR, 16.1; 95% CI, 1.6–156.7); sex and obesity were also independently associated (OR, 4.8; 95% CI, 1.06–22). Conclusions In this cohort, the rate of hospitalization for asthma was higher in women than in men. Being a woman between the ages of 40 and 60 is associated with previous hospitalizations and is a risk factor for asthma-related hospitalization. This situation could partially be explained by the hormonal changes during menopause, where polyposis and obesity are independent risk factors.

Resumen Introduccion Las mujeres ingresan por exacerbaciones de asma con mayor porcentaje que los varones, sin que se conozcan claramente los motivos. El objetivo del estudio es explorar las posibles causas que expliquen este hecho. Pacientes y metodos Estudio prospectivo multicentrico en pacientes ingresados por asma durante 2 anos en servicios de neumologia. Mediante cuestionario se recogieron: caracteristicas demograficas, variables previas al ingreso y durante el mismo que incluian adherencia, ansiedad-depresion, hiperventilacion, y control del asma. Resultados Se recogieron datos de 183 ingresos: 115 mujeres (62,84%). Las mujeres eran de mayor edad (52,4 ± 18,3/43,4 ± 18,7; p = 0,02); habia mayor porcentaje con prescripcion de corticosteroides inhalados (63,2/47,1%; p = 0,03) y sindrome de hiperventilacion (57,3/35,9%; p = 0,02), y una estancia media mayor (7,3 ± 3,4/5,9 ± 3,6; p = 0,02). El porcentaje de fumadoras era menor (21,2/38,8%; p = 0,01), y el FEV 1 al ingreso era mas bajo (58,2% ± 15,9/67,5% ± 17,4; p = 0,03). En el rango de 40 a 60 anos se demostro una asociacion entre ser mujer y la variable ingresos previos. De forma independiente, tambien se asociaron el sexo y la obesidad, con un OR de 16,1 (IC 95%, 1,6-156,7) y de 4,8 (IC 95%, 1,06-22), respectivamente. Conclusiones El porcentaje de ingresos por asma fue mayor en mujeres. Ser mujer entre 40 y 60 anos se asocia con ingresos previos y constituye un factor de riesgo para ingreso por asma, en el que la hipotesis hormonal durante el climaterio podria explicar parte de los hechos. La poliposis y la obesidad son factores de riesgo, independientemente del sexo.

Resumen El interes por la investigacion en asma de los neumologos espanoles va en linea ascendente. En el ultimo ano han aparecido en archivos de bronconeumologia 22 articulos sobre asma, 6 mas que en el ano anterior, y se presentaron 56 comunicaciones al Congreso Nacional de la SEPAR, publicadas en el numero especial de la revista, lo que representa un 60% mas que en el congreso del ano anterior. Se realiza una revision critica de todos estos articulos. Los originales aportan nuevos conocimientos epidemiologicos, clinicos y de investigacion basica. Merece mencion especial la publicacion de 2 guias de practica clinica, la Guia Espanola para el Manejo del Asma 2009 (GEMA) y la Guia ALERTA-2 para el manejo de la exacerbacion asmatica; las 2 suponen no solo una actualizacion de su contenido, sino tambien un cambio en la metodologia en su elaboracion que mejora su calidad cientifica.

The purpose of this study was to assess whether regular instillation of urokinase during abscess drainage leads to an improved outcome compared to saline irrigation alone. One hundred patients referred for image-guided abdominal abscess drainage were randomized between thrice daily urokinase instillation or saline irrigation alone. At the end of the study, patient medical records were reviewed to determine drainage, study group, Altona (PIA II) and Mannheim (MPI) scoring, duration of drainage, procedure-related complications, hospital stay duration, and clinical outcome. The technical success rate of the percutaneous abscess drainage was 100%. The success or failure of abscess remission did not differ significantly between groups (success rate of 91.5% in the urokinase group vs. 88.8% in the saline group; failure rate was of 8.5 vs. 21.2%, respectively); however, days of drainage, main hospital stay, and overall costs were significantly reduced in patients treated with urokinase compared to the control group (P < 0.05). No adverse effects from urokinase were observed. Surgical scores were a useful homogeneity factor, and MPI showed a good correlation with prognosis, while PIA results did not have a significant correlation. For drainage of complex abscesses (loculations, hemorrhage, viscous material), fibrinolytics safely accelerate drainage and recovery, reducing the length of the hospital stay and, therefore, the total cost.

Objetivo Estudiar la posibilidad y la seguridad de recuperar filtros opcionales de vena cava Gunther-Tulip (FGT) a los 90 dias de su implantacion inicial en un modelo animal ovino. Material y metodos Se implantaron 30 FGT en otras tantas ovejas hembras y se intento recuperarlos 90 dias despues de su implantacion. Se realizo cavografia convencional en todos los casos antes y despues de la recuperacion, para evaluar la permeabilidad de la vena cava. Se obtuvieron medidas de la vena cava y se documento la presencia de complicaciones relativas a la implantacion y recuperacion del filtro de vena cava inferior (VCI). Se midio la fuerza requerida para recuperar los filtros de vena cava con un dinamometro comercial modificado y adaptado al equipo de recuperacion de FGT. El estudio histologico se centro en la pared de la VCI. Resultados La implantacion se efectuo con exito en todos los casos (100%). Una oveja desarrollo un pequeno foco de trombosis en una de las patas del filtro y otra presento un trombo pequeno en el interior del filtro. Se intento la recuperacion del filtro en las 30 ovejas y, excepto en un caso, el resultado fue satisfactorio (96,6%). En la recuperacion de los 30 FGT, la fuerza necesaria para desenganchar las patas del filtro de la VCI fue menor de 12 newtons (N). No se observo ninguna complicacion en los cavogramas ni en la autopsia. Se observaron diferentes grados de fibrosis en el estudio histologico. Conclusiones En un modelo animal ovino, la recuperacion de FGT a los 90 dias de su implantacion es posible, segura y facil, y requiere poca fuerza (mediana: 4,2 N).

Stenting technique is employed worldwide for treating atherosclerotic vessel and tracheal stenosis. Both diseases can be treated by means of metallic stents which present advantages but are affected by the main problem of restenosis of the stented area. In this study we have built a rabbit trachea numerical model and we have analyzed it before and after insertion and opening of two types of commercial stent: a Zilver® FlexTM Stent and a WallStentTM. In experimental parallel work, two types of stent were implanted in 30 New Zealand rabbits divided in two groups of 10 animals corresponding to each stent type and a third group made up of 10 animals without stent. The tracheal wall response was assessed by means of computerized tomography by endoscopy, macroscopic findings and histopathological study 90 days after stent deployment. Three idealized trachea models, one model for each group, were created in order to perform the computational study. The animal model was used to validate the numerical findings and to attempt to find qualitative correlations between numerical and experimental results. Experimental findings such as inflammation, granuloma and abnormal tissue growth, assessed from histomorphometric analyses were compared with derived numerical parameters such as wall shear stress (WSS) and maximum principal stress. The direct comparison of these parameters and the biological response supports the hypothesis that WSS and tensile stresses may lead to a greater tracheal epithelium response within the stented region, with the latter seeming to have the dominant role. This study may be helpful for improving stent design and demonstrates the feasibility offered by in-silico investigated tracheal structural and fluid dynamics. This study was supported by the CIBER-BBN financed by the Instituto de Salud Carlos III with assistance from the European Regional Development Fund and by the Spanish Ministry of Science and Technology through Research Project DPI2013-44391-P; the Department of Industry and Innovation (Government of Aragón) through the research group Grant T88 (Fondo Social Europeo). The experimental study was supported by the Instituto de Salud Carlos III, through research project PI08/1424 and was performed by the Minimally Invasive Techniques Research Group (GITMI) of Aragón Government. The experimental tests have been performed by the ICTS 'NANBIOSIS', more specifically by the Tissue & Scaffold Characterization Unit (U13) of the CIBER in Bioengineering, Biomaterials & Nanomedicne (CIBER-BBN) at the University of Zaragoza.

Although an essential diagnostic feature of restless legs syndrome (RLS) is the presence of circadian symptom variations, with an increase in the evening or at night, the mechanisms underlying this time-bound variation remain unknown. Since dopaminergic mechanisms seem to play a central role in the pathophysiology of RLS, it is likely that circadian variations in the dopaminergic system or factors affecting it cause the nightly increase. The reverse is also possible; dopaminergic medication might affect melatonin function, a key element of the circadian system. The present study investigated the effects of dopaminergic medication on melatonin secretion in RLS.Eight previously untreated patients diagnosed with idiopathic RLS underwent a three-week, open-labeled treatment with 400 mg L-DOPA (+100 mg CarbiDOPA). Dim Light Melatonin Onset (DLMO), a marker of circadian phase, was determined before and after treatment.Compared to baseline, earlier DLMO was found in L-DOPA treated patients (21:00+/-1:20 vs. 18:50+/-0:55; P0.05). Anticipation of DLMO was more marked in the subgroup of patients showing augmentation. A positive correlation was observed between change of DLMO, sleep latency and time of onset of symptoms following treatment with L-DOPA.Our results suggest that L-DOPA may exert chronobiotic effects in RLS.

Restless legs syndrome (RLS) is a common neurologic disorder whose prevalence has been estimated at 4 to 10% of the general population. Although its pathophysiology remains unknown, dopaminergic mechanisms are believed to play a central role. Furthermore, dopaminergic drugs have shown therapeutic efficacy in various large-scale therapeutic trials, and dopamine agonists now represent the first line of treatment. Several studies performed over the past years have suggested an association between RLS and Parkinson's disease (PD). However, the evidence is still limited and large controlled studies are needed to show the prevalence rates of PD in RLS patients versus controls. Furthermore, in contrast to PD, some brain imaging studies have revealed a mild striatal dysfunction in RLS. Preliminary neuropathologic evidence also suggests that the dopaminergic dysfunction does not involve neuronal degeneration at that level. Therefore, neuronal degeneration in other dopaminergic pathways than the nigrostriatal might be relevant in the pathogenesis of RLS in PD.

Since the publication, 9 years ago, of the latest SEPAR (Spanish Society of Pulmonology and Thoracic Surgery) Guidelines on Difficult-to-Control Asthma (DCA), much progress has been made in the understanding of asthmatic disease. These new data need to be reviewed, analyzed and incorporated into the guidelines according to their level of evidence and recommendation. Recently, consensus documents and clinical practice guidelines (CPG) addressing this issue have been published. In these guidelines, specific mention will be made of what the previous DCA guidelines defined as "true difficult-to-control asthma". This is asthma that remains uncontrolled after diagnosis and a systematic evaluation to rule out factors unrelated to the disease itself that lead to poor control ("false difficult-to-control asthma"), and despite an appropriate treatment strategy (Spanish Guidelines for the Management of Asthma [GEMA] steps 5 and 6): severe uncontrolled asthma. In this respect, the guidelines propose a revised definition, an attempt to classify the various manifestations of this type of asthma, a proposal for a stepwise diagnostic procedure, and phenotype-targeted treatment. A specific section has also been included on DCA in childhood, aimed at assisting healthcare professionals to improve the care of these patients.

Interest in asthma research among Spanish pneumologists is increasing. In the last year, 22 articles on asthma have been published in Archivos de Bronconeumología, six more than in the previous year. Furthermore, 56 communications were presented at the National Congress of the Spanish Society of Pneumology and Thoracic Surgery and were published in a supplement of the journal, representing 60% more than in the previous year's congress. A critical review of all these articles is provided. The original articles contribute further knowledge on epidemiological and clinical aspects of the disease and basic research. A notable contribution is the publication of two clinical practice guidelines, the Spanish Guideline for the Management of Asthma 2009 and the ALERTA-2 Guideline for the Management of Asthma Exacerbations. These two guidelines represent not only an update but also a change in the methodology used in their drafting, thus improving their scientific quality.

Purpose To verify the penetration of struts and hooks of two inferior vena cava (IVC) filters (Gunther tulip retrievable filter [GTF] and Celect filter) through the vena cava wall and to assess local or systemic complications resulting from this penetration. Materials and Methods Eight IVC filters were placed in the IVC of four ewes for 30 days (1 GTF and 1 Celect filter in each ewe). Angiographic and laparoscopic examinations of the animals were performed to demonstrate the penetration through the vena cava wall, and the filters were removed under laparoscopic control. Specimens were extracted for anatomicopathological and histologic examination. Results Two-projection cavography showed a filter leg seemingly out of the vena cava in 19 of 32 legs (59.3%). Laparoscopy showed 7 real penetrating legs (5 Celect filters and 2 GTFs) out of the 14 legs that could be identified by laparoscopy owing to technique limitations. Neither laparoscopy nor necropsy showed any sign of wall hemorrhage or other injuries. Histologic examination showed intimal remodeling and slight thickening of adventitial tissue around filter legs. Conclusions GTFs and Celect filters can produce a real penetration 1 month after implantation. This penetration did not lead to any complications in the IVC or surrounding tissues and did not compromise the subject's health in any of the studied cases.

Objective To study the feasibility and safety of removing retrievable Gunther-Tulip vena cava filters (GTFs) 90 days after their implantation in an ovine model. Material and methods Thirty GTFs were implanted in 30 ewes and retrieval was attempted at 90 days. Conventional cavography was performed in all cases before and after retrieval in order to evaluate inferior vena cava patency and record dimensions. The presence of complications related to placement and retrieval of the filter from the inferior vena cava was also recorded. The force required to remove the filters was measured using a modified commercial dynamometer adapted to the GTF retrieval set. Histologic study focused on the inferior vena cava wall. Results Implantation was performed successfully in all cases (100%). One ewe developed a small focus of thrombosis around 1 of the legs of the filter and another presented a small thrombus within the filter. Retrieval of the filter was attempted in all 30 sheep at 90 days and the result was satisfactory in all but 1 case (96.6%). None of the GTFs required a force greater than 12 N to disengage the hooks of the filter from the wall. No complications were detected on venacavography or at autopsy. Variable degrees of fibrosis were observed in the histologic study. Conclusions Retrieval of GTFs 90 days after implantation in an ovine model was feasible, safe, and easy, and required little force (median, 4.2 N).

Fluctuations in cognition and alertness (FC/FA) are key manifestations of dementia with Lewy bodies (DLB) and also have been recognized recently in patients with Parkinson's disease (PD) with dementia, a condition that shares important clinical, genetic, and neuropathologic characteristics with DLB. A comprehensive assessment of potential episodes of FC/FA is required for adequate clinical management, and several interesting clinical instruments are being developed for that purpose. FC/FA should be differentiated from episodes of excessive daytime sleepiness (EDS). Such diagnostic differentiation appears to be necessary, particularly in the light of the different therapeutic approaches to FA and EDS. Based on the deficit in cholinergic transmission observed in DLB patients, cholinesterase inhibitors, such as rivastigmine, may have a beneficial effect on FC/FA. Other therapies, such as melatonin or modafinil, require further investigation.