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- Carraminana, Albert, et al.
(författare)
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Rationale and Study Design for an Individualized Perioperative Open Lung Ventilatory Strategy in Patients on One-Lung Ventilation (iPROVE-OLV)
- 2019
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : W B SAUNDERS CO-ELSEVIER INC. - 1053-0770 .- 1532-8422. ; 33:9, s. 2492-2502
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this clinical trial is to examine whether it is possible to reduce postoperative complications using an individualized perioperative ventilatory strategy versus using a standard lung-protective ventilation strategy in patients scheduled for thoracic surgery requiring one-lung ventilation. Design: International, multicenter, prospective, randomized controlled clinical trial. Setting: A network of university hospitals. Participants: The study comprises 1,380 patients scheduled for thoracic surgery. Interventions: The individualized group will receive intraoperative recruitment maneuvers followed by individualized positive end-expiratory pressure (open lung approach) during the intraoperative period plus postoperative ventilatory support with high-flow nasal cannula, whereas the control group will be managed with conventional lung-protective ventilation. Measurements and Main Results: Individual and total number of postoperative complications, including atelectasis, pneumothorax, pleural effusion, pneumonia, acute lung injury; unplanned readmission and reintubation; length of stay and death in the critical care unit and in the hospital will be analyzed for both groups. The authors hypothesize that the intraoperative application of an open lung approach followed by an individual indication of high-flow nasal cannula in the postoperative period will reduce pulmonary complications and length of hospital stay in high-risk surgical patients. (C) 2019 Published by Elsevier Inc.
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- de la Fuente, Luis, et al.
(författare)
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HTLV infection among young injection and non-injection heroin users in Spain: Prevalence and correlates
- 2006
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Ingår i: Journal of Clinical Virology. - : Elsevier. - 1386-6532 .- 1873-5967. ; 35:3, s. 244-249
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAlthough some studies have described the epidemiology of infection with HIV or hepatitis B and C in young users in Spain – one of the European countries with the highest prevalences – there are no studies of the prevalence of HTLV infection and the most important associated factors.ObjectivesTo evaluate the prevalence and main determinants of HTLV-1 and HTLV-2 infection in young heroin users (including both injection (IDUs) and non-injection drug users (NIDUs)) recruited outside health care services in three of Spain's principal cities.Study designCross-sectional cohort study. All participants (981) were street-recruited by chain referral procedures between April 2001 and December 2003. Face-to-face interviews were conducted using a structured questionnaire and dried blood spot samples were collected for serological testing.ResultsNo sample was positive for HTLV-1 and 27 samples were positive for HTLV-2; all of these were found only in Spanish IDUs in the cities of Madrid (17, 6.2%) and Barcelona (10, 3.5%). The only two factors significantly associated with HTLV infection in the logistic regression analysis were HIV infection (OR 5.7; 95% CI 2.2–14.8) and having injected in the last 30 days (OR 6.5; 95% CI 1.4–29.8). Having been in prison (OR 2.4; 95% CI 0.9–6.4) and HCV infection (OR 3.8; 95% CI 0.5–30.7), which were strongly and significantly associated in the bivariate analysis, were no longer significant in the logistic analysis. Almost the same variables were selected in the tree analysis, in which subjects could be classified into three groups: high prevalence (28.5%, HIV+ and HBV+ who had injected in the last 30 days), medium prevalence (17.8%) and low (<3%) or zero prevalence (HIV−, HCV− and HBV−).ConclusionsHTLV-1 was not detected among young Spanish heroin users. HTLV-2 was not found in NIDUs (perhaps due to the low rate of sexual transmission); it was found only in IDUs from Madrid and Barcelona, but not in those from Seville. Its prevalence is very low and the main correlates of infection were HIV infection and injection as the usual route of heroin administration.
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| 4. |
- de la Fuente, Luis, et al.
(författare)
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Metodología del estudio de cohortes del proyecto ITINERE sobre consumidores de heroína en tres ciudades españolas y características básicas de los participantes
- 2005
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Ingår i: Revista Española de Salud Pública. - 1135-5727. ; 79, s. 475-491
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Tidskriftsartikel (refereegranskat)abstract
- Cohort Study Methodology of the ITINERE Project on Heroin Users in Three Spanish Cities and Main Characteristics of the ParticipantsBackground: Cohort studies make it possible to monitor the health impact of drug use and to identify related factors. We describe the methodology and baseline characteristics of a cohort of heroin users designed with this objective. Methods: The participants were 991 young, community-recruited heroin users in Barcelona, Madrid and Seville. Most subjects were named by other participants (39.7%) or by non-participating drug users or ex-users (44.7%). A computer-aided questionnaire was administered (self-administered with audio for questions related with sex). A dried-blood spot sample was collected and anthropometric measurements were made. Both participants and recruiters received remuneration. Univariate and bivariate statistical methods were used. Results: Some 42.4% had changed the main route of heroin administration, mainly to injection in Barcelona and to the pulmonary route in Seville. About 75.8% (Barcelona), 49.8% (Madrid), and 15.5% (Seville) had injected drugs in the last 12 months. In Madrid and Seville, 96-97% used heroin in base form, while in Barcelona heroin hydrochloride predominated. Heroin and cocaine were frequently mixed in the same dose (generally base cocaine in Madrid and Seville, and cocaine hydrochloride in Barcelona). Conclusions: Important geographic differences persist in the prevalence of drug injection and in the patterns of heroin and cocaine use, which could explain the unequal distribution of some health problems. The difficulties encountered in recruiting the sample suggest that the incidence of heroin use has declined considerably.
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- González-Saiz, Francisco, et al.
(författare)
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Validity of the Severity of Dependence Scale (SDS) construct applying the Item Response Theory to a non-clinical sample of heroin users
- 2008
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Ingår i: Substance Use & Misuse. - : Taylor & Francis. - 1082-6084 .- 1532-2491. ; 43:7, s. 919-935
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The purpose of this work is to study the validity of the Severity of Dependence Scale (SDS) construct by applying Rasch models to a non-clinical sample of heroin abusers. Subjects: 982 (73% men) young people 30 years old or under (mean age 25.9 years) participated. All of them were captured from the community in the metropolitan areas of Madrid, Barcelona and Seville, between April 2002 and December 2003. Analysis: Dimensionality of the scale and calibration of items were studied using the Rating Scale model, which is a Rasch-type model. A factorial analysis was also performed to check the dimensionality of the scale. Results: The analysis of fit shows that all the items have infit and outfit values between ± 2 logits, indicating that the data fit the model and that it may be assumed to be unidimensional. The principal components analysis also showed the existence of a principal factor that explains 52.5% of the variance observed. Item calibration found that they are between +0.89 and −1.04 logits on the scale. Conclusion: The results show unidimensional structure of the SDS scale. Item calibration shows they are distributed along the continuum, which must be taken into account when calculating total scores. The study's limitations are noted.
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| 7. |
- Vallejo, Fernando, et al.
(författare)
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Prevalence of and risk factors for hepatitis B virus infection among street-recruited young injection and non-injection heroin users in Barcelona, Madrid and Seville
- 2008
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Ingår i: European Addiction Research. - : S. Karger. - 1022-6877 .- 1421-9891. ; 14:3, s. 116-124
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Tidskriftsartikel (refereegranskat)abstract
- Background: To evaluate the prevalence of hepatitis B virus (HBV) and associated factors in 949 heroin users (HU): injectors (IHUs) and non-injectors (NIHUs). Methods: Cross-sectional study; structured questionnaire administered by computer-assisted personal interviewing and audio computer-assisted self-interviewing; dry blood samples analysed for the hepatitis B core antigen and hepatitis B surface antigen; bivariate analysis and logistic regression. Results: The prevalence of infection was significantly higher in IHUs (22.5%) than in NIHUs (7.4%) in the three cities. In the logistic analysis of male IHUs, infection was found to be associated with living in Seville, age over 25, foreign nationality, having had a sexual partner who traded sex, hepatitis C virus infection, and having injected for more than 5 years. In female IHUs, HBV infection was associated with age over 25, having injected as the first main route of administration, and having begun to inject before 18 years of age. In NIHUs, the associated factors were female gender, foreign nationality and having been tattooed. In young IHUs, the prevalence of HBV infection remains four times higher than in the general population of the same age group. Conclusion: The vaccination strategy urgently needs to be reinforced and redesigned to achieve acceptable control of the HBV infection in the most vulnerable groups, with special attention to immigrants.
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| 8. |
- Arévalo-Martínez, Marycarmen, et al.
(författare)
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Myocardin-Dependent Kv1.5 Channel Expression Prevents Phenotypic Modulation of Human Vessels in Organ Culture
- 2019
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Ingår i: Arteriosclerosis, Thrombosis, and Vascular Biology. - 1524-4636. ; 39:12, s. 273-286
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We have previously described that changes in the expression of Kv channels associate to phenotypic modulation (PM), so that Kv1.3/Kv1.5 ratio is a landmark of vascular smooth muscle cells phenotype. Moreover, we demonstrated that the Kv1.3 functional expression is relevant for PM in several types of vascular lesions. Here, we explore the efficacy of Kv1.3 inhibition for the prevention of remodeling in human vessels, and the mechanisms linking the switch in Kv1.3 /Kv1.5 ratio to PM. Approach and Results: Vascular remodeling was explored using organ culture and primary cultures of vascular smooth muscle cells obtained from human vessels. We studied the effects of Kv1.3 inhibition on serum-induced remodeling, as well as the impact of viral vector-mediated overexpression of Kv channels or myocardin knock-down. Kv1.3 blockade prevented remodeling by inhibiting proliferation, migration, and extracellular matrix secretion. PM activated Kv1.3 via downregulation of Kv1.5. Hence, both Kv1.3 blockers and Kv1.5 overexpression inhibited remodeling in a nonadditive fashion. Finally, myocardin knock-down induced vessel remodeling and Kv1.5 downregulation and myocardin overexpression increased Kv1.5, while Kv1.5 overexpression inhibited PM without changing myocardin expression. CONCLUSIONS: We demonstrate that Kv1.5 channel gene is a myocardin-regulated, vascular smooth muscle cells contractile marker. Kv1.5 downregulation upon PM leaves Kv1.3 as the dominant Kv1 channel expressed in dedifferentiated cells. We demonstrated that the inhibition of Kv1.3 channel function with selective blockers or by preventing Kv1.5 downregulation can represent an effective, novel strategy for the prevention of intimal hyperplasia and restenosis of the human vessels used for coronary angioplasty procedures.
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