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Resumen Introduccion y objetivos La ventilacion no invasiva (VNI) es capaz de reducir la necesidad de intubacion endotraqueal y la mortalidad de los pacientes con insuficiencia cardiaca aguda (ICA). Sin embargo, de muchos de los ensayos clinicos se ha excluido a los pacientes con ICA secundaria a sindrome coronario agudo o infarto agudo de miocardio (SCA-IAM). El objetivo de este estudio es comparar la efectividad de la VNI entre pacientes con ICA desencadenada por SCA-IAM y por otras causas. Metodos Estudio prospectivo de cohortes, durante un periodo de 20 anos, de todos los pacientes con ICA tratados con VNI ingresados en una unidad de cuidados intensivos. Se agrupo a los pacientes por la presencia o ausencia de SCA-IAM como causante del evento de ICA. Se definio el fracaso de la VNI por la necesidad de intubacion endotraqueal o muerte. Resultados Se analizo a 1.009 pacientes, 403 (40%) con SCA-IAM y 606 (60%) con otras etiologias. La VNI fracaso en 61 casos (15,1%) del grupo de SCA-IAM y 64 (10,6%) del grupo sin SCA-IAM (p = 0,031), sin diferencias en la mortalidad hospitalaria (el 16,6 y el 14,9%; p = 0,478). Conclusiones El SCA-IAM como causa desencadenante de la ICA no influye en el pronostico de los pacientes con insuficiencia respiratoria aguda que precisan asistencia respiratoria no invasiva.

Introduction and objectives Noninvasive ventilation (NIV) has been shown to reduce the rate of endotracheal intubation and mortality in patients with acute heart failure (AHF). However, patients with AHF secondary to acute coronary syndrome/acute myocardial infarction (ACS-AMI) have been excluded from many clinical trials. The purpose of this study was to compare the effectiveness of NIV between patients with AHF triggered by ACS-AMI and by other etiologies. Methods Prospective cohort study of all patients with AHF treated with NIV admitted to the intensive care unit for a period of 20 years. Patients were divided according to whether they had ACS-AMI as the cause of the AHF episode. NIV failure was defined as the need for endotracheal intubation or death. Results A total of 1009 patients were analyzed, 403 (40%) showed ACS-AMI and 606 (60%) other etiologies. NIV failure occurred in 61 (15.1%) in the ACS-AMI group and in 64 (10.6%) in the other group (P = .031), without differences in in-hospital mortality (16.6% and 14.9%, respectively; P = .478). Conclusions The presence of ACS-AMI as the triggering cause of AHF did not influence patients with acute respiratory failure requiring noninvasive respiratory support .

Muscle training, a component of pulmonary rehabilitation (PR), improves the physical performance of patients with chronic obstructive pulmonary disease (COPD). Despite the existing evidence, the traditional center-based PR model is applied to a small percentage of patients and presents numerous problems of accessibility, adherence, and costs. This study present a home model of simple muscle training, non-presential, monitored by telephone and individualized, according to the severity of the COPD. In addition, to evaluate the results, simple tests associated with the physical performance of the lower limbs, previously validated in COPD, have been used, such as the four-meter walk, speed test (4MGS) and the five-repetition test sitting and standing (5STS). The objective was to evaluate whether the Individualized Non-Presential Exercise Training PrOgram (NIETO) induces improvements in the 4MGS, 5STS and quadriceps muscle strength (QMS) tests in outpatients with advanced COPD (FEV1 ≤ 50%). After one year, the QMS was significantly higher in the intervention group (IG) than in the control group (CG) (2.44 ± 4.07 vs. 0.05 ± 4.26 kg, p = 0.009). The 4MGS and 5STS tests were significantly shorter in IG than in CG (−0.39 ± 0.86 vs. 0.37 ± 0.96 s, p = 0.001) and (−1.55 ± 2.83 vs. 0.60 ± 2.06 s, p = 0.001), respectively. A home model of simple muscle training monitored by telephone such as NIETO, can improve 4MGS, 5STS, and quadriceps strength tests in outpatients with advanced COPD.

The changes that drive differentiation create a large potential for the emergence of abnormal cells that need to be removed before they contribute to further development or the germline. This removal is in part achieved by cells becoming hypersensitive to death upon exit of naïve pluripotency. What causes this change in apoptotic response is unknown. Here we identify that it is controlled by the regulator of mitochondrial dynamics DRP1. We show that in mouse, naïve pluripotent cells have fragmented mitochondria due to high DRP1-mediated fission, but upon differentiation, DRP1 activity decreases, inducing mitochondria to fuse and form complex networks. We demonstrate that this decrease in DRP1 activity lowers the apoptotic threshold, as mutation of DRP1 increases the sensitivity to cell death and its over-expression protects against apoptosis. Together, our findings highlight how regulation of mitochondrial dynamics allows cells to adapt their apoptotic response to the changing environment of differentiation.

Juan Miguel Sánchez-Nieto,1,2 Rubén Andújar-Espinosa,3 Roberto Bernabeu-Mora,1,2 Chunshao Hu,1 Beatriz Gálvez-Martínez,1 Andrés Carrillo-Alcaraz,1 Carlos Federico Álvarez-Miranda,3 Olga Meca-Birlanga,1 Eva Abad-Corpa4 1Division of Pneumology, Hospital Morales Meseguer, 2University of Murcia, 3Division of Pneumology, Hospital Arrixaca, Murcia, 4Department of Professional Development Unit, Murcia, Spain Background: Self-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD.Methods: Multicenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E) department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD. The intervention consisted of a group education session on the main characteristics of the disease, an individual training session on inhalation techniques, at the start and during the 3rd month, and a written action plan containing instructions for physical activity and treatment for stable phases and exacerbations. We determined the combined number of COPD-related hospitalizations and emergency visits per patient per year. Secondary endpoints were number of patients with visits to A&E and the number of patients hospitalized because of exacerbations, use of antibiotics and corticosteroids, length of hospital stay, and all-cause mortality.Results: After 1 year, the rate of COPD exacerbations with visits to A&E or hospitalization had decreased from 1.37 to 0.89 (P=0.04) and the number of exacerbations dropped from 52 to 42 in the group of patients who received the intervention. The numbers of patients hospitalized, at 19 (40.4%) versus 20 (52.6%) (P=0.26), and those who went to A&E, at 9 (19.1%) versus 14 (36.8%) (P=0.06), due to exacerbation of COPD were also lower in this group. Intake of antibiotics was higher in the intervention group, whereas use of glucocorticoids was slightly lower, though there were no significant differences (P=0.30). There were also no differences between groups in the length of hospital stay (P=0.154) or overall mortality (P=0.191).Conclusion: The implementation of a self-management program for patients with advanced COPD reduced exacerbations that required hospital care. Keywords: self-management, COPD, severe exacerbations

From fertilization until the onset of gastrulation the early mammalian embryo undergoes a dramatic series of changes that converts a single fertilized cell into a remarkably complex organism. Much attention has been given to the molecular changes occurring during this process, but here we will review what is known about the changes affecting the mitochondria and how they impact on the energy metabolism and apoptotic response of the embryo. We will also focus on understanding what quality control mechanisms ensure optimal mitochondrial activity in the embryo, and in this way provide an overview of the importance of the mitochondria in determining cell fitness during early mammalian development.

Bernabeu-Mora R, Medina-Mirapeix F, Llamazares-Herrán E, et al. Int J Chron Obstruct Pulmon Dis. 2015;10:619–2626. Page 2626, Acknowledgments section, the text “The authors wish to thank the patients and personnel of the hospital unit for their cooperation during the course of this study. The study was supported by medical manager of AstraZeneca Pharmaceutical Spain, S.A. and Maite Pérez.” Should read “The authors wish to thank the patients and personnel of the hospital unit for their cooperation during the course of this study. The study was supported by medical manager AstraZeneca Pharmaceutical Spain, S.A. Maite Pérez, Pfizer and Menarini.”Read the original article

Primary pulmonary lymphoma (PPL) is an uncommon pathology and is usually of the B-cell type, originating in lymphoid tissue associated with the bronchial mucosa (MALT/BALT lymphoma). Very few cases of T-cell PPL, the majority diagnosed by open lung biopsy, have been described in medical literature. We report a case of an immunocompetent patient with fever and bilateral pulmonary nodules, diagnosed with T-cell PPL by transbronchial biopsy. The patient's condition deteriorated and she responded poorly to chemotherapy. PPL should be included in the differential diagnosis of patients with fever and bilateral pulmonary nodules.

Roberto Bernabeu-Mora,1,2 Françesc Medina-Mirapeix,2 Eduardo Llamazares-Herrán,3 Gloria García-Guillamón,2 Luz María Giménez-Giménez,2 Juan Miguel Sánchez-Nieto1,4 1Division of Pneumology, Hospital Morales Meseguer, 2Department of Physical Therapy, University of Murcia, Murcia, 3Department of Physical Therapy, Alcala University, Alcala de Henares, 4Department of Intern Medical, University of Murcia, Murcia, Spain Background: Limited mobility is a risk factor for developing chronic obstructive pulmonary disease (COPD)-related disabilities. Little is known about the validity of the Short Physical Performance Battery (SPPB) for identifying mobility limitations in patients with COPD. Objective: To determine the clinical validity of the SPPB summary score and its three components (standing balance, 4-meter gait speed, and five-repetition sit-to-stand) for identifying mobility limitations in patients with COPD.Methods: This cross-sectional study included 137 patients with COPD, recruited from a hospital in Spain. Muscle strength tests and SPPB were measured; then, patients were surveyed for self-reported mobility limitations. The validity of SPPB scores was analyzed by developing receiver operating characteristic curves to analyze the sensitivity and specificity for identifying patients with mobility limitations; by examining group differences in SPPB scores across categories of mobility activities; and by correlating SPPB scores to strength tests.Results: Only the SPPB summary score and the five-repetition sit-to-stand components showed good discriminative capabilities; both showed areas under the receiver operating characteristic curves greater than 0.7. Patients with limitations had significantly lower SPPB scores than patients without limitations in nine different mobility activities. SPPB scores were moderately correlated with the quadriceps test (r>0.40), and less correlated with the handgrip test (r

Introduction: Non-pharmacological interventions in COPD can save care resources. Material and Methods: A multicentre, randomized, single-blind, parallel-group clinical trial with a one-year follow-up of a self-treatment programme (STP) versus conventional management. The STP intervention group included a group education centre, training in inhaler technique and a written treatment plan. The control group received standard care. The main variable was the severe exacerbations rate. Secondary variables were number of admissions and mortality. Results: Of the 250 patients recruited, 101 (40.4%) were included in the trial; 38 (37.62%) patients in the control group (CG) completed the trial and 47 (46.53%) in the intervention group (IG). There were no significant differences in the baseline characteristics of the patients. Twenty (52.6%) patients in the CG presented severe exacerbations vs 19 (40.4%) in the IG (P=0.262). Sixteen patients (42.1%) in the CG were hospitalised vs 12 (25.5%) in the IG (P=0.106). Two patients (5.26%) in the control group died vs none in the intervention group (P=0.383). The severe exacerbations rate was 1.37 (1.02–1.79) in the CG vs 0.89 (0.64-1.21) in the IG (P=0.049) (rate ratio, 1.53 [1.01-2.29]). The NNT (STP vs conventional treatment) to prevent one severe exacerbation per year was 6.25 (5.0-8.0). Conclusions: 1. In the first year, the STP reduced the severe exacerbations rate in patients with COPD. 2. The STP reduced the number of hospitalizations and of severe exacerbations. 3. The STP could be used in less than half of the selected population.

Resumen Objetivos Identificar y cuantificar factores que motivan la inasistencia de diplomados y auxiliares de enfermeria a los cursos de formacion continuada. Material y metodos Mediante tecnica cualitativa de busqueda de consenso, con 2 grupos (enfermeria y auxiliares de enfermeria), se identificaron las razones que influian en la inasistencia a cursos de formacion continuada. A partir de esta informacion, se elaboro y valido un cuestionario para, posteriormente, realizar un estudio de casos y controles, con la comparacion de las respuestas del personal inscrito a cursos que no realiza y personal inscrito en cursos que si realiza. Se ha utilizado la prueba de la t de Student, de Mann-Whitney y la prueba exacta de Fisher. Resultados Muestra estudiada formada por 58 profesionales, edad media de 38 anos, de los que el 70% eran mujeres. El porcentaje de inasistencias fue elevado (34%). El cuestionario exploro 15 factores condicionantes de inasistencias. La facilitacion de horas por el hospital fue el factor mas importante para 30 encuestados (51,7%), seguido de la aplicabilidad del curso (39,7%). Hallamos diferencias entre ambos grupos unicamente en la importancia atribuida a la capacidad docente del profesor (100% del grupo que asiste y 85,7% en grupo que no acude; p = 0,048). Conclusiones Las ausencias injustificadas a cursos de formacion continuada es un fenomeno frecuente. Una adecuada seleccion del profesorado y la facilitacion en la alternancia de turno podria disminuir este problema.

Resumen Introduccion La eficacia de los programas de prevencion de drogodependencias en la escuela muestra diferencias entre su administracion por docentes o sanitarios. Este estudio compara la aplicacion de un programa de prevencion de tabaquismo por docentes o sanitarios en un mismo centro educativo. Material y metodos Estudio cuasiexperimental pretest-postest con grupo control de un ano de duracion. Se aplica programa de 4 sesiones de una hora de duracion, mensual, entre enero y abril a alumnos de 1.° de ESO. El grupo 1 (n = 115) lo recibe de docents en el curso 2001-2002 y el grupo 2 (n = 92) de sanitarios durante 2002-2003. La evaluacion se realiza mediante el cuestionario FRISC en 2 momentos: inicial en diciembre y final al ano de la primera. Resultados Grupo 1 (G1): responden 107 alumnos (66 chicos), edad media 12,2 ± 0,4 en evaluacion inicial; 100 alumnos (71 chicos) en evaluacion final. Grupo 2 (G2): responden 86 alumnos (42 chicos), edad media 12,1 ± 0,4 en evaluacion inicial; 86 alumnos (42 chicos) en evaluacion final. La experimentacion con el tabaco aumenta en el 12,5% en G1 y el 8,1% en G2 (p = 0,161). El consumo diario aumenta el 7% en G1 y el 2,3% en G2 (p = 0,230) y el tabaquismo semanal no se modifica en G1 y aumenta el 4,6% en G2 (p = 0,019). Conclusiones La evaluacion anual del programa preventivo por profesionales sanitarios muestra menor inclusion en consumo diario y experimentacion, con aumento del consumo semanal. La incorporacion al tabaquismo se retrasa mas en el grupo dirigido por sanitarios que en el de docentes.

Background The community outbreak of legionnaires disease that occurred in Murcia, Spain, in July 2001--to our knowledge, the largest such outbreak ever reported--afforded an unusual opportunity to compare the clinical response of patients with Legionella pneumonia treated with levofloxacin with that of patients treated with macrolides and to determine the role of rifampicin combined with levofloxacin in treating severe legionellosis. Methods An observational, prospective, nonrandomized study was conducted involving 292 patients seen at our hospital (Hospital "J. M. Morales Meseguer"; Murcia, Spain) who received a diagnosis of Legionella pneumonia during the Murcia outbreak. To compare both antibiotic regimens (macrolides vs. levofloxacin), patients were stratified by the severity of pneumonia. Duration of fever, clinical outcome, complications, side effects, and length of hospital stay were recorded. To assess the potential effects of adjuvant therapy with rifampicin, 45 case patients treated with levofloxacin plus rifampicin were evaluated and compared with 45 control pairs who were treated with levofloxacin alone. Results With the exception of 2 patients who died, all patients were cured. There were no significant differences between treatment groups in clinical outcome for patients with mild-to-moderate pneumonia. Nevertheless, in patients with severe pneumonia, levofloxacin exerted superior activity; it was associated with fewer complications (3.4% of patients receiving levofloxacin experienced complications, compared with 27.2% of patients receiving macrolides; P=.02) and shorter mean hospital stays (5.5 vs. 11.3 days; P=.04). Addition of rifampicin to the treatment regimen for patients receiveing levofloxacin for severe pneumonia provides no additional benefit. Conclusions Our findings strongly suggest that monotherapy with levofloxacin is a safe and effective treatment for legionnaires disease, including in patients with severe disease. In these patients, levofloxacin appears to be more effective than clarithromycin.

Minute pulmonary meningothelial-like nodules (MPMNs) are usually unique lesions in the lung parenchyma. Diffuse pulmonary meningotheliomatosis, which is presented as multiple MPMNs, has been less frequently described. MPMNs are mainly asymptomatic and are diagnosed after lung surgery or during autopsy. We report on a patient with multiple and bilateral pulmonary nodules, some of which were cavitated, diagnosed with diffuse pulmonary meningotheliomatosis by transbronchial lung biopsy. Diffuse pulmonary meningotheliomatosis should be included in the differential diagnosis of bilateral lung nodules.

Urinothorax or urothorax (UT) is a rare condition which often goes undiagnosed. In published cases of UT, the pleural fluid is usually transudative and is very rarely exudative. We present a case of UT after right nephroureterectomy for urothelial carcinoma, in which the pleural fluid presented characteristics of exudate. The diagnosis of UT was confirmed with the finding of a pleural/serum creatinine ratio above one and after demonstrating the presence of a postsurgical urinoma in the right renal fossa. UT should be included in the differential diagnosis of pleural effusion in patients with a recent urinary tract disorder, even when it is pleural exudate.