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Biomedical subjects

Josep Roca

Publications and source records attributed to Josep Roca.

At least 19 recordsLinked to original sources
PubMed2007

The impact of home hospitalization on healthcare costs of exacerbations in COPD patients.

Home-hospitalization (HH) improves clinical outcomes in selected patients with chronic obstructive pulmonary disease (COPD) admitted at the emergency room due to an exacerbation, but its effects on healthcare costs are poorly known. The current analysis examines the impact of HH on direct healthcare costs, compared to conventional hospitalizations (CH). A randomized controlled trial was performed in two tertiary hospitals in Barcelona (Spain). A total of 180 exacerbated COPD patients (HH 103 and CH 77) admitted at the emergency room were studied. In the HH group, a specialized respiratory nurse delivered integrated care at home. The average direct cost per patient was significantly lower for HH than for CH, with a difference of euro 810 (95% CI, euro 418-1,169) in the mean cost per patient. The magnitude of monetary savings attributed to HH increased with the severity of the patients considered eligible for the intervention.

Aged↗
PubMed2006

Sustained low diffusing capacity in hepatopulmonary syndrome after liver transplantation.

AIM: To study the presence of sustained low diffusing capacity (DL(CO)) after liver transplantation (LT) in patients with hepatopulmonary syndrome (HPS). METHODS: Six patients with mild-to-severe HPS and 24 without HPS who underwent LT were prospectively followed before and after LT at mid-term (median, 15 mo). HPS patients were also assessed at long-tem (median, 86 mo). RESULTS: Before LT, HPS patients showed lower PaO(2) (71 +/- 8 mmHg), higher AaPO(2) (43 +/- 10 mmHg) and lower DL(CO) (54% +/- 9% predicted), due to a combination of moderate-to-severe ventilation-perfusion (V(A)/Q) imbalance, mild shunt and diffusion limitation, than non-HPS patients (94 +/- 4 mmHg and 19 +/- 3 mmHg, and 85% +/- 3% predicted, respectively) (P<0.05 each). Seven non-HPS patients had also reduced DL(CO) (70% +/- 4% predicted). At mid- and long-term after LT, compared to pre-LT, HPS patients normalized PaO(2) (91 +/- 3 mmHg and 87 +/- 5 mmHg), AaPO(2) (14 +/- 3 mmHg and 23 +/- 5 mmHg) and all V(A)/Q descriptors (P<0.05 each) without changes in DL(CO) (53% +/- 8% and 56% +/- 7% predicted, respectively). Post-LT DL(CO) in non-HPS patients with pre-LT low DL(CO) was unchanged (75% +/- 6% predicted). CONCLUSION: While complete V(A)/Q resolution in HPS indicates a reversible functional disturbance, sustained low DL(CO) after LT also present in some non-HPS patients, points to persistence of sub-clinical liver-induced pulmonary vascular changes.

Adult↗
PubMed2006

Training depletes muscle glutathione in patients with chronic obstructive pulmonary disease and low body mass index.

BACKGROUND: A physiological increase in muscle glutathione after training is not seen in patients with chronic obstructive pulmonary disease (COPD), indicating abnormal peripheral muscle adaptations to exercise. OBJECTIVE: We hypothesized that oxidative stress is primarily associated with low body mass index (BMI). METHODS: Eleven patients with preserved BMI (BMI(N): 28.2 +/- 1.2 kg.m(-2)), 9 patients with low BMI (BMI(L): 19.7 +/- 0.60 kg.m(-2)) and 5 age-matched controls (26.5 +/- 0.9 kg.m(-2)) were studied before and after 8 weeks of high-intensity endurance training. Reduced glutathione (GSH) and gamma-glutamyl cysteine synthase heavy-subunit chain mRNA expression (gammaGCS-HS mRNA) were measured in the vastus lateralis. RESULTS: After training, exercise capacity increased (DeltaVO(2)PEAK, 13 +/- 5.2%; 10 +/- 5.6% and 15 +/- 4.3% in BMI(L), BMI(N) and controls, respectively; p < 0.05 each). GSH levels decreased in BMI(L) (from 5.2 +/- 0.7 to 3.7 +/- 0.8 nmol/mg protein, DeltaGSH -1.5 +/- 0.7 nmol/mg protein, p < 0.05); no changes were seen in BMI(N) (from 5.4 +/- 0.7 to 6.7 +/- 0.9 nmol/mg protein, DeltaGSH 1.3 +/- 0.9 nmol/mg protein), whereas GSH markedly increased in controls (from 4.6 +/- 1 to 8.7 +/- 0.4 nmol/mg protein, DeltaGSH 4.1 +/- 1 nmol/mg protein, p < 0.01). DeltaGSH in BMI(L) was different from DeltaGSH in BMI(N) and controls (p < 0.05, each). Consistent changes were observed in gammaGCS-HS mRNA expression. CONCLUSIONS: GSH depletion after training in BMI(L) may suggest that oxidative stress plays a key role in muscle wasting in COPD patients.

Aged↗
PubMed2006

Effects of nebulized N(G)-nitro-L-arginine methyl ester in patients with hepatopulmonary syndrome.

Enhanced pulmonary production of nitric oxide (NO) has been implicated in the pathogenesis of hepatopulmonary syndrome (HPS). NO inhibition with N(G)-nitro-L-arginine methyl ester (L-NAME) in both animals and humans with HPS has improved arterial hypoxemia. We assessed the role of enhanced NO production in the pathobiology of arterial deoxygenation in HPS and the potential therapeutic efficacy of selective pulmonary NO inhibition. We investigated the effects of nebulized L-NAME (162.0 mg) at 30 and 120 minutes on all intrapulmonary and extrapulmonary factors governing pulmonary gas exchange in 10 patients with HPS (60 +/- 7 [SD] yr; alveolar-arterial oxygen gradient, range 19-76 mm Hg; arterial oxygen tension, range 37-89 mm Hg). Nebulized L-NAME maximally decreased exhaled NO (by -55%; P < .001), mixed venous nitrite/nitrate (by -12%; P = .02), and cardiac output (by -11%; P = .002) while increased systemic vascular resistance (by 11%; P = .008) and pulmonary vascular resistance (by 25%; P = .03). In contrast, ventilation-perfusion mismatching, intrapulmonary shunt and, in turn, arterial deoxygenation remained unchanged. In conclusion, gas exchange disturbances in HPS may be related to pulmonary vascular remodeling rather than to an ongoing vasodilator effect of enhanced NO production.

Adult↗
PubMed2006

Cryptic haplotypes of SERPINA1 confer susceptibility to chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity worldwide. While cigarette smoking is a major cause of COPD, only 15% of smokers develop the disease, indicating major genetic influences. The most widely recognized candidate gene in COPD is SERPINA1, although it has been suggested that SERPINA3 may also play a role. To detect cryptic genetic variants that might contribute to disease, we identified 15 SNP haplotype tags from high-density SNP maps of the two genes and evaluated these SNPs in the largest case-control genetic study of COPD conducted so far. For SERPINA1, six newly identified haplotypes with a common backbone of five SNPs were found to increase the risk of disease by six- to 50-fold, the highest risk of COPD reported to date. In contrast, no haplotype associations for SERPINA3 were identified.

Aged↗
PubMed2006

Telemedicine experience for chronic care in COPD.

Information and telecommunication technologies are called to play a major role in the changes that healthcare systems have to face to cope with chronic disease. This paper reports a telemedicine experience for the home care of chronic patients suffering from chronic obstructive pulmonary disease (COPD) and an integrated system designed to carry out this experience. To determine the impact on health, the chronic care telemedicine system was used during one year (2002) with 157 COPD patients in a clinical experiment; endpoints were readmissions and mortality. Patients in the intervention group were followed up at their homes and could contact the care team at any time through the call center. The care team shared a unique electronic chronic patient record (ECPR) accessible through the web-based patient management module or the home visit units. Results suggest that integrated home telemedicine services can support health professionals caring for patients with chronic disease, and improve their health. We have found that simple telemedicine services (ubiquitous access to ECPR, ECPR shared by care team, accessibility to case manager, problem reporting integrated in ECPR) can increase the number of patients that were not readmitted (51% intervention, 33% control), are acceptable to professionals, and involve low installation and exploitation costs. Further research is needed to determine the role of telemonitoring and televisit services for this kind of patients.

Chronic Disease↗
PubMed2005

Systemic effects of cigarette smoke exposure in the guinea pig.

Chronic obstructive pulmonary disease is associated with systemic effects including reduced body weight, oxidative stress and altered circulating TNFalpha levels. The present study was aimed to investigate whether chronic exposure to cigarette smoke induces these systemic changes in a guinea pig model. Seven animals/group were exposed to the smoke of seven cigarettes/day, 5 days/week, during 2, 4 and 6 months (chronic exposure). Three animals/group were sacrificed immediately, 3 h or 24 h after exposure to seven cigarettes (acute exposure). Chronically smoke-exposed animals exhibited lower body weight gain, starting at 5th week, and goblet cell metaplasia in small bronchioles. At 6 months there was a trend for increased plasma and lung tissue TNFalpha levels. No changes, neither in skeletal muscle glutathione (GSH) nor in plasma lipid peroxidation, were observed at any time point after chronic exposure. However, skeletal muscle GSH decreased and plasma lipid peroxidation increased immediately after acute smoke exposure, equaling control levels thereafter. We conclude that cigarette smoke exposure in the guinea pig induces a transient and repeated oxidative effect, which might result in impaired systemic metabolism and consequent failure of smoke-exposed animals to gain weight. The effects of cigarette smoke on body weight antecede and appear to be independent from the alterations produced in small airways.

Animals↗
PubMed2005

Identification of vascular progenitor cells in pulmonary arteries of patients with chronic obstructive pulmonary disease.

Progenitor cells of bone marrow origin migrate to injured vessels, where they may contribute to endothelial maintenance and vessel remodeling through vascular endothelial growth factor (VEGF)-related signals. To what extent progenitor cells may play a role in vascular changes occurring in patients with chronic obstructive pulmonary disease (COPD) remains undetermined. In this study we sought to identify vascular progenitor cells in pulmonary arteries of patients with COPD and to investigate whether the presence of these cells could be related to changes in endothelial function or the expression of VEGF. Pulmonary arteries of nine patients with COPD and six control subjects were studied. Scanning electron microscopy demonstrated areas of denuded endothelium in the arteries of patients with COPD. Vascular progenitor cells were identified by immunohistochemistry and immunogold using antibodies against AC133, CD34, and CD45. AC133+ cells were localized in the endothelial surface, close to denuded areas. The number of AC133+ and CD45+ cells in pulmonary arteries was greater in patients with COPD than in control subjects. The number of AC133+ cells correlated with the response of pulmonary artery rings to hypoxic stimulus. AC133+ and CD45+ cells were also identified in the intimal layer. The wall thickness correlated with the number of progenitor cells in the intima and with VEGF and VEGF receptor-2 mRNA expression. We conclude that patients with COPD show an increased number of bone marrow-derived progenitor cells in pulmonary arteries. These cells seem to contribute to ongoing endothelial repair, but they might also be involved in the pathogenesis of pulmonary vascular remodeling.

AC133 Antigen↗
PubMed2005

Postpartum thyroiditis: long-term follow-up.

OBJECTIVE: To determine the incidence of persistent hypothyroidism (PH) after a long follow-up in 45 patients with postpartum thyroiditis (PPT) from a nonselected population of 641 pregnant women (PPT incidence 7.8%) and the clinical and biochemical factors associated with PPT evolution. DESIGN AND PATIENTS: The 45 women who developed PPT were followed for 8.1 +/- 2.2 years after delivery. MEASUREMENTS: Age at delivery, family and personal history, smoking, newborn gender, breast-feeding, and PPT course were recorded. Thyrotropin (TSH) and free thyroxine (T(4)) concentrations and antithyroid antibodies were evaluated at each visit. PH was considered when it persisted one year after being diagnosed. RESULTS: Fourteen of 45 patients with PPT developed PH with a probability of 56% after a PPT episode with hypothyroidism. None of the patients who developed hyperthyroidism alone during PPT evolved to PH. PH risk was higher if the newborn was a girl (relative risk [RR] 3.88) and increased for each additional TSH unit during PPT and for every additional year of the mother's age. CONCLUSIONS: The probability of developing PH after a PPT with hypothyroidism episode is 56%. PPT screening in all women permits us to establish levothyroxine treatment, if necessary, before a new pregnancy.

Adult↗
PubMed2005

Heart transplant recipient clinical profile improvement following mycophenolate mofetil late incorporation into the treatment schedule.

Mycophenolate mofetil (MMF) has a better clinical profile than azathioprine in heart transplantation (HT). Forty-five recipients (aged 53 +/- 9 yr) were retrospectively evaluated (first year of follow-up) post-MMF introduction since its advent in 1997 (mean daily dose: 1.97 +/- 0.2 g). MMF was used (mean post-HT time: 40 +/- 27 months) for: (i) renal insufficiency attenuation (group 1 = 20); (ii) steroid reduction because of osteoporosis (group 2 = 12); (iii) treatment of persistent cellular rejection (group 3 = 7) and vascular graft disease (VGD) (group 4 = 6). Mean changes (groups 1-2) were: creatinine 172 +/- 59, 158 +/- 51, 153 +/- 57 mumol/L (at baseline, 6 and 12 months, respectively; p < 0.001). Cyclosporine daily dose: 219 +/- 37, 166 +/- 46, 176 +/- 98 mg, respectively (p < 0.001). Cyclosporine blood concentration: 151 +/- 40, 103 +/- 41, 83 +/- 34 ng/mL, respectively (p < 0.004). Prednisone daily dose: 8.3 +/- 2, 5.2 +/- 1, 4.1 +/- 1 mg, respectively (p < 0.001). Cellular rejection (group 3) was successfully treated (86%) but the outcome of VGD did not improve after the switch (group 4). Our limited experience (with caution) confirms the reported benefits of MMF particularly attenuating renal insufficiency.

Adolescent↗
PubMed2005

Encouraged 6-min walking test indicates maximum sustainable exercise in COPD patients.

STUDY OBJECTIVES: In patients with moderate-to-severe COPD, an encouraged 6-min walking test (6MWT) is a high-intensity submaximal exercise protocol that shows an oxygen uptake (Vo(2)) plateau after the third minute of the test. This last feature prompted the hypothesis that self-paced walking speed is set to achieve "maximal" sustainable Vo(2), namely "critical power" or "critical speed." PATIENTS AND METHODS: Eight patients with moderate-to-severe COPD (mean age, 68 +/- 7 years [+/- SD]; FEV(1), 50 +/- 13% predicted; Pao(2), 69 +/- 8 mm Hg) underwent the following tests on different days in order: (1) encouraged 6MWT; (2) standard incremental shuttle test to identify peak walking speed; (3) four different high-intensity, constant walking speed tests to exhaustion to calculate critical walking speed; and (4) timed walking test at critical walking speed (CWS) to examine sustainability of the exercise. RESULTS: 6MWT and CWS showed similar results (mean of last 3 min): Vo(2) (1,605 +/- 304 mL/min vs 1,584 +/- 319 mL/min), minute ventilation (47 +/- 12 L/min vs 48 +/- 11 L/min), respiratory exchange ratio (0.89 +/- 0.1 vs 0.90 +/- 0.1), heart rate (130 +/- 18 beats/min vs 131 +/- 16 beats/min), Borg dyspnea score (5.4 +/- 1.3 vs 5.5 +/- 2.4), and walking speed (1.49 +/- 0.1 m/s vs 1.44 +/- 0.1 m/s, respectively). CONCLUSION: This study supports that 6MWT indicates maximum sustainable exercise that might be related with its predictive value in COPD patients.

Aged↗
PubMed2004

Lack of systemic oxidative stress during PAF challenge in mild asthma.

To further establish the role of oxidative stress in the pathogenesis of acute bronchial asthma, we investigated the effects of platelet-activating factor (PAF) challenge on systemic oxidant-antioxidant balance in 12 asthmatic patients (age, 25+/-3[SEM] yr; FEV1, 95+/-10% predicted), using a double blinded, controlled with Lyso-PAF (L-PAF), cross-over design. Respiratory system resistance (Rrs), arterial blood gases, peripheral blood neutrophils and oxidant-antioxidant balance, including thiobarbituric acid (TBA)-malondialdehyde (MDA) adducts, protein sulphydryls and Trolox equivalent antioxidant capacity (TEAC), were assessed at baseline and 5, 15 and 45 min after PAF and L-PAF (18 microg each) bronchoprovocation. Urinary leukotriene E4 (uLTE4) elimination was measured 120 min after challenge. Compared with baseline, as expected, PAF increased significantly Rrs and AaPO2 and decreased PaO2 and peripheral blood neutrophils along with a rebound neutrophilia and increased uLTE4. By contrast, markers of systemic oxidative stress remained unaltered throughout the study. Unlike PAF, L-PAF-induced changes were negligible. We conclude that there is no systemic oxidant-antioxidant imbalance during acute bronchoconstriction induced by PAF in these patients with mild asthma.

Administration, Inhalation↗
PubMed2004

Gas exchange mechanism of orthodeoxia in hepatopulmonary syndrome.

The mechanism of orthodeoxia (OD), or decreased partial pressure of arterial oxygen (PaO2) from supine to upright, a characteristic feature of hepatopulmonary syndrome (HPS), has never been comprehensively elucidated. We therefore investigated the intrapulmonary (shunt and ventilation-perfusion [VA/Q] mismatching) and extrapulmonary factors governing PaO2 in 20 patients with mild to severe HPS (14 males, 6 females; 50 +/- 3 years old SE) at upright and supine, in random order. We set out a cutoff value for OD, namely a PaO2 decrease > or = 5% or > or = 4 mm Hg (area under the receiver operating characteristic curve, 0.96 each). Compared to supine, 5 patients showed OD (PaO2 change, -11% +/- 2%, -7 +/- 1 mm Hg, P < .05) with further VA/Q worsening (shunt + low VA/Q mode increased from 19% +/- 7% to 21% +/- 7% of cardiac output [QT], P < .05), as opposed to 15 patients who did not (+2% +/- 2%, +1+/- 1 mm Hg) with VA/Q improvement (from 20% +/- 4% to 16% +/- 4% of QT, P < .01). Cardiac output was significantly lower in OD patients in both positions. Changes in extrapulmonary factors at upright, such as increased minute ventilation and decreased QT, were of similar magnitude in both subsets of patients. In conclusion, our data suggest that gas exchange response to OD in HPS points to a more altered pulmonary vascular tone inducing heterogeneous blood flow redistribution to lung zones with prominent intrapulmonary vascular dilatations.

Adult↗
PubMed2004

Fatal interstitial pneumonitis associated with sirolimus therapy in a heart transplant recipient.

Interstitial pneumonitis is a temporary side effect of sirolimus therapy and has been described mainly in renal transplant recipients. It is considered to be dose dependent and has been documented in patients receiving at least 5 mg daily, or in patients with blood concentration plateaus > 15 ng/ml. In general, clinical and radiologic features improve after discontinuation and, to the best of our knowledge, no reports of fatalities have been published. Our report documents the death in a heart transplant recipient (52-year-old man) that resulted from a loading-dose administration (15 mg), and we report the association of persistently increased blood concentrations (>20 ng/ml) during most of the scheduled administration period.

Dose-Response Relationship, Drug↗
PubMed2004

Heart transplantation and chronic lymphocytic leukemia: a successful case at 2 years of follow-up.

In June 2000, we successfully performed an orthotopic cardiac transplant in a 52-year-old man who, together with a B-cell chronic lymphocytic leukemia (Binet Stage A, Rai Stage 1), also had end-stage dilated idiopathic myocardiopathy. We describe his case and the 2 years of cancer-free follow-up. To our knowledge, this is the first report of a heart transplant in this setting.

Cardiomyopathy, Dilated↗
PubMed2004

Clinical value of vasodilator test with inhaled nitric oxide for predicting long-term response to oral vasodilators in pulmonary hypertension.

Acute vasodilator tests with prostacyclin (PGI2) or inhaled nitric oxide (iNO) are used to select patients with pulmonary arterial hypertension (PAH) who should be treated with oral vasodilators. The haemodynamic effects of PGI2 and iNO are different, and the limits for considering a vasodilator response as significant are controversial. The study was aimed to investigate the diagnostic performance of acute vasodilator testing with iNO and PGI2 in predicting the clinical outcome after 1 year treatment with oral vasodilators. Twenty-seven patients with severe PAH were studied. Nineteen patients were treated with oral vasodilators and their outcome after 1 year was qualified as favourable or unfavourable. The diagnostic performance of vasodilator tests in predicting this outcome was evaluated using receiver operating characteristics (ROC) curves. The acute effects of iNO and PGI2 on pulmonary artery pressure (PAP) were similar. By contrast, PGI2 produced more marked changes on cardiac output and pulmonary vascular resistance than iNO (P<0.05). The evolution at 1 year was favourable in 11 patients and unfavourable in 8. Patients with favourable evolution showed greater decrease of PAP with iNO than with PGI2 (P<0.05). The decrease of PAP with iNO had the greatest predictive value on the clinical outcome (area under ROC curve, 0.83). We conclude that in patients with PAH, acute vasodilator testing with iNO is preferable to PGI2 because it reflects more consistently the changes in pulmonary vascular tone. The acute decrease of PAP with iNO is the best predictor of the long-term response to oral vasodilator treatment.

Administration, Inhalation↗