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Biomedical subjects

F Franco

Publications and source records attributed to F Franco.

At least 19 recordsLinked to original sources
PubMed2003

Corticosteroids for idiopathic pulmonary fibrosis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF), also called cryptogenic fibrosing alveolitis (CFA), is a lethal form of diffuse lung disorder of unknown origin; the mean survival being two to four years. Currently recommended and most prescribed therapy for IPF is based on the use of systemic corticosteroids, even if no formal demonstration of efficacy of this treatment of IPF is available. Furthermore, new insights from pathological studies have produced a new hypothesis, based upon the central role played by aberrant wound healing following repeated lung injury, weakening the rationale basis of the use of corticosteroids in IPF, previously considered simply a chronic inflammatory disease. OBJECTIVES: The objective of the review was to determine the efficacy of corticosteroids in the treatment of adults with IPF. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2002), MEDLINE (January 1966 to May 2002) and EMBASE (January 1985 to December 2002) and reference lists of articles. We searched reference lists of published articles to identify trials. SELECTION CRITERIA: Randomised controlled trials (RCT) and controlled clinical trials (CCT) using corticosteroids alone for the treatment of adults with IPF. DATA COLLECTION AND ANALYSIS: Abstracts of identified articles were retrieved and articles possibly fulfilling inclusion criteria were retrieved in full. Two reviewers would have independently assessed trial quality if there had been any included studies. MAIN RESULTS: Fifteen studies were selected as potentially eligible for meta-analysis. After further analysis of full text papers, no RCTs or CCTs were identified as suitable and therefore no data was available for inclusion in any meta-analysis. All studies were excluded due to inadequate methodologies. REVIEWER'S CONCLUSIONS: At present, there is no evidence for an effect of corticosteroid treatment in patients with Idiopathic pulmonary fibrosis(IPF)/usual interstitial pneumonia (UIP). Given developments in understanding of the pathogenesis of IPF, randomised controlled trials designed to test the efficacy of corticosteroids will probably never be designed. As other forms of pulmonary fibrosis such as non-specific interstitial pneumonia are reported to show a better response to corticosteroids, it is crucial to make an accurate diagnosis in each patient. Moreover, therapies with immunomodulatory rather than anti-inflammatory or immunosuppressive effects may be more promising for the effective treatment of IPF/UIP.

Adrenal Cortex Hormones↗
PubMed2003

Short acting beta-2 agonists for bronchiectasis.

BACKGROUND: Bronchiectasis is a condition characterized by an abnormal and irreversible dilatation of the sub segmental airways and it may be caused by a variety of disease processes. Currently medical treatment includes physiotherapy, antibiotics and occasionally mucolytics. Many people with bronchiectasis receive bronchodilator therapy, since many people with the condition show signs of airflow obstruction and bronchial hyper-responsiveness. Evidence on effectiveness of bronchodilator therapy in bronchiectasis has only recently started to be systematically studied. OBJECTIVES: The present review examined the effectiveness of short acting beta-2 agonist therapy in bronchiectasis, as this is the most frequently used treatment for airflow obstruction in people with this condition. SEARCH STRATEGY: We systematically searched four databases: CENTRAL (Issue 2, 2002); MEDLINE (1966 to September 2002); EMBASE (1980 to September 2002); and CINAHL (1982 to September 2002). We also checked bibliographies of all identified RCTs to identify potentially relevant citations. SELECTION CRITERIA: All randomised controlled trials were considered for inclusion, whether single or double blind. The control group was placebo/no treatment or other drug/physical therapy. Participants could be children or adults diagnosed with bronchiectasis by plain-film chest radiograph, bronchography or high resolution computerized tomography. Patients were excluded if they had cystic fibrosis. Any type of short acting beta-2 agonist administered by inhalation or systemic route, used in conjunction with conventional treatment was included. DATA COLLECTION AND ANALYSIS: In the absence of any relevant RCTs, we were unable to extract or analyse data. MAIN RESULTS: We identified 48 articles by the search, the majority of which could be excluded on the basis of the abstract as they were not RCTs. Six articles were retrieved and were all excluded after careful consideration because they were either not RCTs or they did not deal with the question of interest. REVIEWER'S CONCLUSIONS: We failed to identify any RCTs investigating the role of short acting beta agonists in bronchiectasis. Since short acting beta-2 agonist therapy is the most frequently used treatment for airflow obstruction in bronchiectasis, there appears to be the need to investigate the effectiveness of this therapy using an RCT.

Adrenergic beta-Agonists↗
PubMed2002

Clinical use of Levofloxacin in the long-term treatment of drug resistant tuberculosis.

Multidrug-resistant (MDR) tuberculosis (TB) is a form of TB that is resistant to some of the first-line drugs used for the treatment of the disease. It is associated both with a higher incidence of treatment failures and of disease recurrence, as well as with higher mortality than forms of TB sensitive to first-line drugs. Levofloxacin (LFX) represents one of the few second-line drugs recently introduced in the therapeutic regimens for MDR TB. We report our experience concerning in vitro activity and clinical safety of LFX in long term second-line regimens for MDR TB. IN VITRO ACTIVITY ON MYCOBACTERIA: The in vitro activity of ciprofloxacin, ofloxacin and LFX was studied on 28 strains belonging to different species of Mycobacteria. In Dubos medium, LFX inhibited the growth of both library and MDR clinical Mycobacteria strains in a range of 0.25-1 mcg/ml. In International Union Tuberculosis Medium (IUTM) the minimum inhibitory concentrations (MIC) were slightly higher, but LFX activity was not affected by the higher complexity of the medium. CLINICAL EXPERIENCE: Four patients with MDR TB were treated with a second-line regimen comprising oral LFX 500 mg twice daily, for at least 9 months. Two isolates obtained from the patients reported here showed multi resistance to isoniazid and rifampin, one to rifampin and streptomycin and one to isoniazid and ethambutol. During therapy, no significant alteration of either liver function tests, blood tests or any other described side effect of the fluoroquinolone class was observed. The 3 patients with pulmonary MDR TB showed radiologic and clinical improvement. CONCLUSION: We confirm the higher in vitro activity of LFX compared to older fluoroquinolones. Furthermore, in a limited number of MDR TB patients, second-line regimens comprising LFX 500 mg b.i.d. administered in a range of 9-24 months were well tolerated and safe.

Adult↗
PubMed2001

The surface variational principle applied to an acoustic cavity.

This paper presents the development and application of the Surface Variational Principle (SVP) for the evaluation of axisymmetric interior acoustic domains. The interior form of the SVP is first developed in the same manner as the existing exterior form. Then, the surface pressure and normal velocity are represented with a Ritz expansion using basis functions that span the entire wetted surface of the object of interest. The resultant formulation is used to analyze the interior acoustic response of a harmonically forced, right circular elastic cylinder. This validation model was chosen as both the structural and acoustic responses can be solved analytically. Results are presented for two models: one with a length to radius ratio of 2.4, and another with a ratio of 12.3. The SVP is shown to well reproduce the analytical solution for this geometry, and displays the asymptotic convergence expected of its variational formulation. The SVP formulation developed here is not restricted to right-circular cylindrical geometries, and may, indeed, be readily applied to any axisymmetric body.

Journal Article↗
PubMed2001

Cardiac atrophy after bed rest and spaceflight.

Cardiac muscle adapts well to changes in loading conditions. For example, left ventricular (LV) hypertrophy may be induced physiologically (via exercise training) or pathologically (via hypertension or valvular heart disease). If hypertension is treated, LV hypertrophy regresses, suggesting a sensitivity to LV work. However, whether physical inactivity in nonathletic populations causes adaptive changes in LV mass or even frank atrophy is not clear. We exposed previously sedentary men to 6 (n = 5) and 12 (n = 3) wk of horizontal bed rest. LV and right ventricular (RV) mass and end-diastolic volume were measured using cine magnetic resonance imaging (MRI) at 2, 6, and 12 wk of bed rest; five healthy men were also studied before and after at least 6 wk of routine daily activities as controls. In addition, four astronauts were exposed to the complete elimination of hydrostatic gradients during a spaceflight of 10 days. During bed rest, LV mass decreased by 8.0 +/- 2.2% (P = 0.005) after 6 wk with an additional atrophy of 7.6 +/- 2.3% in the subjects who remained in bed for 12 wk; there was no change in LV mass for the control subjects (153.0 +/- 12.2 vs. 153.4 +/- 12.1 g, P = 0.81). Mean wall thickness decreased (4 +/- 2.5%, P = 0.01) after 6 wk of bed rest associated with the decrease in LV mass, suggesting a physiological remodeling with respect to altered load. LV end-diastolic volume decreased by 14 +/- 1.7% (P = 0.002) after 2 wk of bed rest and changed minimally thereafter. After 6 wk of bed rest, RV free wall mass decreased by 10 +/- 2.7% (P = 0.06) and RV end-diastolic volume by 16 +/- 7.9% (P = 0.06). After spaceflight, LV mass decreased by 12 +/- 6.9% (P = 0.07). In conclusion, cardiac atrophy occurs during prolonged (6 wk) horizontal bed rest and may also occur after short-term spaceflight. We suggest that cardiac atrophy is due to a physiological adaptation to reduced myocardial load and work in real or simulated microgravity and demonstrates the plasticity of cardiac muscle under different loading conditions.

Adult↗
PubMed2001

[Evaluation of oocyte maturity in patients undergoing ICSI and R-FSH treatment].

BACKGROUND: This study compares embryo quality, fertilisation rate and pregnancy rates after ICSI related with the quality of oocytes achieved after r-FSH stimulation. METHODS: We evaluated 955 oocytes from patients following r-FSH and 643 oocytes from patients stimulated with ultrapure urinary FSH. The oocytes were divided into: a) normal oocytes; b) ooctyes with extra cytoplasmatic abnormalities (dark zona pellucida, wide perivitelline space); c) oocytes with cytoplasmatic abnormalities (dark cytoplasm, granular cytoplasm, retractile body), d) oocytes with shape abnormalities; e) oocytes with double abnormalities; f) oocytes with triple abnormalities. The embryos were divided into: A) even and homogeneous blastomeres without fragmentation; B) even and homogeneous blastomeres with <20% fragmentation; C) uneven and non-homogeneous blastomeres with 20-50% fragmentation; D) uneven and non homogeneous blastomere with >50% fragmentation. RESULTS: 40.9% of oocytes from patients treated with r-FSH have a normal morphology vs 35.2% of control groups (p<0.04). Abnormalities have a similar frequency in the two groups, except for the presence of three combined abnormalities (7.7 vs 5.4%; p<0.04). Fertilisation rate, cleavage rate, oocyte quality and pregnancy rate do not appear to be influenced by oocyte morphology and the type of FSH used for stimulation. CONCLUSIONS: The administration of r-FSH allows a large number of oocytes to be rescued, with a high incidence of normal morphology. The fertilisation rate and the quality of embryos obtained from oocytes with structural abnormalities are similar to those observed in morphologically normal oocytes. Even the probability of pregnancy is similar in the two groups.

Adult↗
PubMed1999

Effect of contrast enhancement on transthoracic echocardiographic assessment of left ventricular regional wall motion.

The use of contrast-enhanced transthoracic echocardiography to evaluate left ventricular regional wall motion was determined by comparison of echocardiographic data with assessments obtained by magnetic resonance imaging. When left ventricular endocardial segments are well visualized after contrast enhancement, the ability to determine normal versus abnormal endocardial thickening with echocardiography is similar to cine magnetic resonance imaging.

Adult↗
PubMed1999

Magnetic resonance imaging and invasive evaluation of development of heart failure in transgenic mice with myocardial expression of tumor necrosis factor-alpha.

BACKGROUND: Transgenic mice expressing tumor necrosis factor-alpha (TNF-alpha) in cardiac myocytes develop dilated cardiomyopathy, but the temporal progression to cardiac dysfunction is not well characterized. We asked (1) Does magnetic resonance imaging (MRI) provide a reproducible assessment of cardiac output in mice that correlates with invasive measurements obtained with thermodilution? (2) What is the time course of left ventricular (LV) remodeling in transgenic mice with myocardial expression of TNF-alpha? METHODS AND RESULTS: Transgenic mice from 2 different lineages with differing amounts of myocardial TNF-alpha expression [lineage 1 (L1) and lineage 2 (L2)] and littermate controls (LC) were studied. In protocol 1, cardiac output (CO) and stroke volume (SV) were measured by MRI and thermodilution (TD) in 15 mice (3 L1, 4 L2, 8 LC). In protocol 2, 23 mice (7 L1, 8 L2, 8 LC) were scanned at 1 month of life and every 4 weeks thereafter. In both protocols, cine-MRI was performed with the use of a 1.5-T clinical system (1.5-mm slices, 195x195 microm in-plane resolution). MRI CO and SV correlated well with TD [COTD (mL/min)=0.94*COMRI+0.72, r=0.84; SVTD( microL)=1. 01*SVMRI-1.07, r=0.94]. Serial MRI studies showed significant increase in LV mass and volumes over time and a significant decrease in ejection fraction in transgenic mice when compared with littermate controls. Compared with lineage 2, lineage 1 showed significantly larger LV mass and volumes and significantly lower ejection fraction. CONCLUSIONS: MRI assessment of cardiac function in mice correlates well with invasive measurements. Serial MRI studies in the TNF-alpha mouse model demonstrate that the rate of progression and severity of LV dysfunction are dependent on the degree of TNF-alpha overexpression.

Animals↗
PubMed1998

Cardiac failure in transgenic mice with myocardial expression of tumor necrosis factor-alpha.

BACKGROUND: Tumor necrosis factor-alpha (TNF-alpha) is a multifunctional cytokine that has been detected in several human cardiac-related conditions, including congestive heart failure and septic cardiomyopathy. In these conditions, the origin of TNF-alpha secretion is, at least in part, cardiac myocytes. METHODS AND RESULTS: To determine the consequences of TNF-alpha production by cardiac myocytes in vivo, we developed transgenic mice in which expression of a murine TNF-alpha coding sequence was driven by the murine alpha-myosin heavy chain promoter. Four transgenic founders developed an identical illness consisting of tachypnea, decreased activity, and hunched posture. In vivo, ECG-gated MRI of symptomatic transgenic mice documented a severe impairment of cardiac function evidenced by biventricular dilatation and depressed ejection fractions. All transgenic mice died prematurely. Pathological examination of affected animals revealed a globular dilated heart, bilateral pleural effusions, myocyte apoptosis, and transmural myocarditis in both the right and left ventricular free walls, septum, and atrial chambers. In all terminally ill animals, there was significant biventricular fibrosis and atrial thrombosis. CONCLUSIONS: This is the first report detailing the effects of tissue-specific production of TNF-alpha by cardiac myocytes in vivo. These findings indicate that production of TNF-alpha by cardiac myocytes is sufficient to cause severe cardiac disease and support a causal role for this cytokine in the pathogenesis of human cardiac disease.

Animals↗
PubMed1998

Milking action: a new functional concept of a different orthotopic neobladder: 4-year followup.

PURPOSE: We demonstrate how the combined use of detubularized and remodeled intestine with intact cecum in the construction of an orthotopic colonic neobladder determines different functioning. MATERIALS AND METHODS: Since February 1993, 11 men who underwent radical cystectomy due to invasive bladder carcinoma have received a new bladder substitute consisting of an upper component of ascending colon and a detubularized and remodeled right half of transverse colon, and a lower component with intact cecum. During postoperative years 1 and 4 all patients were evaluated with urodynamics and cystography. RESULTS: The detubularized upper component of the neobladder acts as a large capacity, low pressure filling reservoir, while the intact cecum with its haustral contractions (inverted milking action) contributes as an additional continence mechanism. The mass contractions (milking action) with abdominal wall tension actively collaborate to evacuate the reservoir completely. CONCLUSIONS: This new structural concept of a neobladder constructed from detubularized and intact intestine has a different functional behavior than neobladders described in literature. This neobladder enables complete evacuation and total continence in the immediate postoperative period.

Cecum↗
PubMed1998

Administration of an intravenous perfluorocarbon contrast agent improves echocardiographic determination of left ventricular volumes and ejection fraction: comparison with cine magnetic resonance imaging.

OBJECTIVES: The purpose of this study was to determine whether contrast-enhanced transthoracic echocardiography improves the evaluation of left ventricular (LV) volumes and ejection fraction (EF). BACKGROUND: Echocardiographic assessment of LV volumes and EF is widely used but may be inaccurate when the endocardium is not completely visualized. Recently the intravenous (i.v.) administration of perfluorocarbon microbubbles has been shown to enhance opacification of the LV cavity, but the utility of these agents to improve the echocardiographic assessment of LV systolic function is unknown. METHODS: In 40 subjects (29 men and 11 women, aged 24 to 81 years) an assessment of LV volumes and EF was performed with a magnetic resonance imaging examination, followed immediately by a transthoracic echocardiogram before and after the intravenous administration of 2% dodecafluoropentane emulsion (EchoGen; Sonus Pharmaceuticals, Bothell, Washington). RESULTS: Contrast enhanced the echocardiographic assessment of LV end diastolic volume (p < 0.02), end systolic volume (p < 0.01) and LVEF (p < 0.03). The percentage of subjects in whom the correct echocardiographic classification EF was normal, mild to moderately depressed or severely reduced improved significantly after contrast enhancement (from 71% before contrast to 94% after, p < 0.03). These findings were most striking in the subjects with two or more adjacent endocardial segments not visualized at baseline. CONCLUSIONS: Administration of an intravenous contrast agent improves the ability to accurately assess LV volumes and EF in humans. Contrast enhancement is most useful in subjects with two or more adjacent endocardial segments not seen at baseline.

Adult↗
PubMed1998

The development of a quality information system: a case study of Mexico.

One of the primary obstacles in the implementation of continuous quality improvement (CQI) programmes in developing countries is the lack of timely and appropriate information for decentralized decision-making. The integrated quality information system (QIS) described herein demonstrates Mexico's unique effort to package four separate, yet mutually reinforcing, tools for the generation and use of quality-related information at all levels of the Mexican national health care system. The QIS is one element of the continuous quality improvement programme administered by the Secretariat of Health in Mexico. Mexico's QIS was designed to be flexible and capable of adapting to local needs, while at the same time allowing for the standardization of health care quality assurance indicators, and subsequent ability to measure and compare the quality performance of health facilities nationwide. The flexibility of the system extends to permit the optimal use of available data by health care managers at all levels of the health care system, as well as the generation of new information in important areas often neglected in more traditional information systems. Mexico's QIS consists of four integrated components: 1) a set of client and provider surveys, to assess specific issues in the quality of health services delivered; 2) client and provider national satisfaction surveys; 3) a sentinel health events strategy; and 4) a national Comparative Performance Evaluation System, for use by the Secretariate of Health for the quality assessment of state and provincial health care services (internal benchmarking). The QIS represents another step in Mexico's ongoing effort to use data for effective decision-making in the planning, monitoring and evaluation of services delivered by the national health care system. The design and application of Mexico's QIS provides a model for decentralized decision-making that could prove useful for developing countries, where the effective use of quality indicators is often limited. Further, the system could serve as a mechanism for motivating positive change in the way information is collected and used in the process of ensuring high quality health care service delivery.

Benchmarking↗
PubMed1998

Magnetic resonance imaging accurately estimates LV mass in a transgenic mouse model of cardiac hypertrophy.

Transgenic mice with a dysfunctional guanylyl cyclase A gene (GCA -/-) are unable to transduce the signals from atrial naturetic peptide and develop hypertension and cardiac hypertrophy. Magnetic resonance imaging (MRI) was performed to assess cardiac hypertrophy in these animals, using wild-type siblings as controls. Anesthetized mice were studied by gated multislice, multiphase cine MRI at 1.5 T. Simpson's rule was used to estimate left ventricle (LV) mass and volumes from short-axis images. Correlation between LV mass evaluated by MRI and at necropsy was excellent, with LVnecropsy = 1.04 x LVMRI + 4.69 mg (r2 = 0.95). By MRI, GCA -/- LV mass was significantly different when compared with isogenic controls [GCA -/-, 226 +/- 43 mg (n = 14) vs. controls, 156 +/- 14 mg (n = 10); P < 0.0001]. LV volumes and ejection fraction in the two groups were not significantly different. MRI provides an accurate means for the noninvasive assessment of murine cardiac phenotype and may be useful in following the effects of genetic modification.

Animals↗
PubMed1996

Structure-activity relationships for inhibition of inosine monophosphate dehydrogenase by nuclear variants of mycophenolic acid.

Structure-activity relationships in the region of the phthalide ring of the inosine monophosphate dehydrogenase inhibitor mycophenolic acid have been explored. Replacement of the lactone ring with other cyclic moieties resulted in loss of potency, especially for larger groups. Replacement of the ring by acyclic substituents also indicated a strong sensitivity to steric bulk. A phenolic hydroxyl group, with an adjacent hydrogen bond acceptor, was found to be essential for high potency. The aromatic methyl group was essential for activity; the methoxyl group could be replaced by ethyl to give a compound with 2-4 times the potency of mycophenolic acid in vitro and in vivo.

Animals↗
PubMed1996

The experiences of ataques de nervios: towards an anthropology of emotions in Puerto Rico.

Ataques de nervios are an idiom of distress used by Puerto Ricans and other Latinos to express dislocations in the social world of the family. This paper contributes to the growing study of the "anthropology of the emotions". Through detailed interviews with 121 people in Puerto Rico, 78 of whom had had an ataque de nervios, we are developing a thick description of both the prototypical models for ataques de nervios and the varied individual experiences of ataques. The interview used in this study is a version of the Explanatory Model Interview Catalogue specifically adapted for use in a community study of ataques de nervios in Puerto Rico. Responses to questions on the experience of ataque de nervios were analyzed using a team of reviewers who represented differing knowledge and experience with Puerto Rican culture and mental health practice. The experience of ataques de nervios involves a loss of control in several important domains of experience: emotional expressions, bodily sensations, action dimensions and alterations in consciousness. That loss of control is closely linked to important social contexts relating to major life problems and the experience of suffering.

Adolescent↗
PubMed1996

Pointing and social awareness: declaring and requesting in the second year.

The production of pointing and other gestures (e.g. reaching or indicative gestures) by 47 infants aged 1;0 to 1;6 was investigated in two experiments contrasting declarative-referential vs. imperative-instrumental conditions of communication. A further group of seven infants aged 0;10 was examined in order to highlight pre-pointing transitional phenomena. Data analyses concerned gestures and associated vocalizations and visual checking with a social partner. Results show that gestures are produced differentially in the experimental conditions: while reaching is only produced in imperative-instrumental contexts, pointing is characteristic of declarative-referential contexts. The pattern of visual checking with the social partner also differentiates gestures; moreover, it shows developmental changes in the case of pointing. Results suggest that pointing relies on some awareness of 'psychological' processes (e.g. attention and sharing) in the other and the self, and that it is this which may account for the specific relevance of pointing for language development.

Awareness↗
PubMed1995

Human T-cell leukemia virus type II infection among high risk groups and its influence on HIV-1 disease progression.

The prevalence and the risk factors of the human T-cell leukemia virus type I/II (HTLV-I/II) infection were evaluated among 552 individuals at high risk for HIV-1. HTLV infections showed a low (1.6%) prevalence, were restricted to intravenous drug addicts and were due to HTLV-II alone. Moreover, in order to weigh the influence of HTLV-II on the natural history of HIV-1 infection, the clinical outcome of HIV-1 disease was compared between subjects with and without HTLV-II coinfection. Our findings showed that HTLV-II does not adversely affect the outcome of HIV-1 infection. Infact, a slower disease progression has been recorded in some HTLV-II coinfected subjects.

Acquired Immunodeficiency Syndrome↗