Small Extracellular Vesicles and Oxidative Pathophysiological Mechanisms in Retinal Degenerative Diseases.

This review focuses on the role of small extracellular vesicles in the pathophysiological mechanisms of retinal degenerative diseases. Many of these mechanisms are related to or modulated by the oxidative burden of retinal cells. It has been recently demonstrated that cellular communication in the retina involves extracellular vesicles and that their rate of release and cargo features might be affected by the cellular environment, and in some instances, they might also be mediated by autophagy.

Characteristics and outcomes of advanced melanoma patients with complete response and elective discontinuation of first-line anti-programmed death-1 monotherapy: A real-world multicentre observational cohort study.

Anti-programmed death-1 (anti-PD1) treatment has significantly improved outcomes of advanced melanoma with a considerable percentage of patients achieving complete response (CR). This real-world study analyzed the feasibility of elective anti-PD1 discontinuation in advanced melanoma patients with CR and evaluated factors related to sustained response. Thirty-five patients with advanced cutaneous or primary unknown melanoma with CR to nivolumab or pembrolizumab from 11 centers were included.

Characterization of Circulating T Cell Receptor Repertoire Provides Information about Clinical Outcome after PD-1 Blockade in Advanced Non-Small Cell Lung Cancer Patients.

Despite the success of immunotherapies in lung cancer, development of new biomarkers for patient selection is urgently needed. This study aims to explore minimally invasive approaches to characterize circulating T cell receptor beta chain (TCR-β) repertoire in a cohort of advanced non-small cell lung cancer (NSCLC) patients treated with first-line pembrolizumab. Peripheral blood samples were obtained at two time points: i) pretreatment (PRE) and ii) first response assessment (FR).

Analysis of the Gut Microbiota: An Emerging Source of Biomarkers for Immune Checkpoint Blockade Therapy in Non-Small Cell Lung Cancer.

Background: The human gut harbors around 10-10 microorganisms, collectively referred to as gut microbiota. Recent studies have found that the gut microbiota may have an impact on the interaction between immune regulation and anti-cancer immunotherapies.

Methods: In order to characterize the diversity and composition of commensal microbiota and its relationship with response to immune checkpoint blockade (ICB), 16S ribosomal DNA (rDNA) sequencing was performed on 69 stool samples from advanced non-small cell lung cancer (NSCLC) patients prior to treatment with ICB.

PEDIA: prioritization of exome data by image analysis.

Purpose: Phenotype information is crucial for the interpretation of genomic variants. So far it has only been accessible for bioinformatics workflows after encoding into clinical terms by expert dysmorphologists.

Methods: Here, we introduce an approach driven by artificial intelligence that uses portrait photographs for the interpretation of clinical exome data.

Simplification of the Barthel scale for screening for frailty and severe dependency in polypathological patients.

Objectives: To analyse the sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each measure of the Barthel index (BI) compared with the full questionnaire for polypathological patients (PPPs).

Methods: Multicentre cross-sectional study. We considered 2 cut-off points for the BI (≥90 points for screening frailty and <60 points for diagnosing severe dependence).

Surgical treatment of acute diverticulitis. A retrospective multicentre study.

Introduction: To analyze short and medium-term results of different surgical techniques in the treatment of complicated acute diverticulitis (CAD).

Methods: Multicentre retrospective study including patients operated on as surgical emergency or deferred-urgency with the diagnosis of CAD.

Results: A series of 385 patients: 218 men and 167 women, mean age 64.

Clinical application of the COPD assessment test: longitudinal data from the COPD History Assessment in Spain (CHAIN) cohort.

Objective: The COPD Assessment Test (CAT) has been proposed for assessing health status in COPD, but little is known about its longitudinal changes. The objective of this study was to evaluate 1-year CAT variability in patients with stable COPD and to relate its variations to changes in other disease markers.

Methods: We evaluated the following variables in smokers with and without COPD at baseline and after 1 year: CAT score, age, sex, smoking status, pack-year history, BMI, modified Medical Research Council (mMRC) scale, 6-min walk distance (6MWD), lung function, BODE (BMI, obstruction, dyspnea, exercise capacity) index, hospital admissions, Hospital and Depression Scale, and the Charlson comorbidity index.

Distribution and prognostic validity of the new Global Initiative for Chronic Obstructive Lung Disease grading classification.

Background: The new Global Initiative for Chronic Obstructive Lung Disease (GOLD) update includes airflow limitation, history of COPD exacerbations, and symptoms to classify and grade COPD severity. We aimed to determine their distribution in 11 well-defined COPD cohorts and their prognostic validity up to 10 years to predict time to death.

Methods: Spirometry in all 11 cohorts was postbronchodilator.

[Treatment of non-cystic fibrosis bronchiectasis].

Bronchiectasis is currently growing in importance due to both the increase in the number of diagnoses made as well as the negative impact that its presence has on the baseline disease that generates it. A fundamental aspect in these patients is the colonization and infection of the bronchial mucous by potentially pathogenic microorganisms (PPM), which are the cause in most cases of the start of the chronic inflammatory process that results in the destruction and dilatation of the bronchial tree that is characteristic in these patients. The treatment of the colonization and chronic bronchial infection in these patients should be based on prolonged antibiotic therapy in its different presentations.

[Inhaled antibiotics in the treatment of noncystic fibrosis bronchiectasis].

Inhaled antibiotics are increasingly used in patients with non-cystic fibrosis (CF) bronchiectasis. Currently, there is no formal indication for the use of this therapy in these patients as inhaled antibiotics are currently only indicated in patients with CF. Therefore, prescription in patients with non-CF bronchiectasis will continue to be based on compassionate use until scientific evidence from ongoing clinical trials becomes available.

[Impact of exacerbations on the clinical course of chronic obstructive pulmonary disease].

The clinical course of chronic obstructive pulmonary disease (COPD) is marked by frequent exacerbations. Not all patients suffer exacerbations and not all decompensations have the same consequences; however, in the last few years, these episodes of clinical instability - especially if recurrent - have come to be viewed as a major element in the natural history of the disease insofar as they generate heavy workload and high costs, síntonegatively affect patients' quality of life, contribute to the multidimensional progression of the disease and, finally, affect its prognosis. The present article reviews the current scientific evidence on the impact of exacerbations on the clinical course of COPD and analyzes this impact from a multidimensional perspective.

[Multidimensional impact of COPD exacerbations].

One of the inherent characteristics of chronic obstructive pulmonary disease (COPD) is the occurrence of exacerbations. These episodes of clinical decompensation, which used to be considered epiphenomena of the disease, are now viewed as key elements in the natural history of COPD. Exacerbations generate huge clinical workload and enormous costs, impair patients' quality of life, make a decisive contribution to the multidimensional progression of the disease and affect prognosis.

[Chronic obstructive pulmonary disease and bronchiectasias].

Chronic obstructive pulmonary disease (COPD) and bronchiectasias are two of the most frequent and underdiagnosed diseases of the airways. The association between these two entities can be established from different points of view. On the one hand, because of their high prevalence, the co-occurrence of COPD and bronchiectasias in the same patient is not unusual.

[Impact of efficacy and mortality studies (TORCH and UPLIFT) in bronchodilator treatment of chronic obstructive pulmonary disease].

The TORCH and UPLIFT studies are probably the most ambitious clinical trials performed to date in chronic obstructive pulmonary disease (COPD). Unfortunately, the main objectives were not achieved. Compared with placebo, combination therapy with salmeterol and fluticasone did not significantly reduce all-cause mortality, nor did tiotropium slow lung function deterioration over 4 years.

[Cardiovascular comorbidity in COPD].

The presence of cardiovascular alterations in patients with chronic obstructive pulmonary disease (COPD) is no coincidence. Smoking, a risk factor for both entities, could partly explain the strength of the association; however, there are data that suggest that other determining factors such as systemic inflammation, oxidative stress, hypoxemia, endothelial dysfunction and even aging could also be involved. Prognosis is worse in patients with both entities.

Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study.

Rationale: Obstructive sleep apnea (OSA) is an independent risk factor for stroke, but little is known about the role of continuous positive airway pressure (CPAP) on mortality in patients with stroke.

Objectives: To analyze the independent impact of long-term CPAP treatment on mortality in patients with ischemic stroke.

Methods: Prospective observational study in 166 patients with ischemic stroke.

[Bronchiectasis treatment in adults].

Bronchiectasis is characterized by the dilation and progressive destruction of the bronchial wall. Its actual importance lies in two points: the increased number of diagnoses due to increased chronic diseases and the use of new diagnostic tools, and its negative impact on quality of life and lung function of patients and the negative prognosis of the causative disease. In practical terms, the treatment of bronchiectasis in adults is based on eight basic pillars: treatment of the etiology if it is known, treatment of the bronchial colonization or infection by potentially pathogenic microorganisms including Pseudomonas aeruginosa (inhaled or systemic antibiotics), treatment of bronchial secretions (chest physiotherapy and mucolytics), treatment of bronchial inflammation (inhaled steroids and macrolides) and hyperresponsiveness (inhaled steroids and bronchodilators), treatment of systemic manifestations (malnutrition), treatment of exacerbations (oral antibiotics, removing secretions and the associated bronchospasm), treatment of complications (hemoptysis, respiratory failure and mucous plugs), and finally, surgical treatment (lung transplantation or resection surgery).

Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients.

Objectives: 1) To determine whether severe exacerbation of COPD is a BODE index independent risk factor for death; 2) whether the combined application of exacerbations and BODE (e-BODE index), offers greater predictive capacity than BODE alone or can simplify the model, by replacing the exercise capacity (BODEx index).

Methods: A prospective study was made of a cohort of COPD patients. In addition to calculation of the BODE index we register frequency of exacerbations.

[Efficacy of a training program on sleep apnea-hypopnea syndrome aimed at primary care physicians].

Objective: The level of clinical suspicion of sleep apnea-hypopnea syndrome (SAHS) among primary care physicians is low. The aim of this study was to analyze the impact of a primary care training program on the quality and quantity of referrals made due to suspected SAHS.

Material And Methods: A group of 16 primary care physicians were offered the option of participating in a training program consisting of 2 talks-workshops, the provision of up-to-date information on SAHS and a form for making referrals according to an established protocol, and the opportunity to contact the sleep department at our hospital directly.

[The association between bronchiectasis, systemic inflammation, and tumor necrosis factor alpha].

Objective: The relationship between systemic inflammation and different measures of bronchiectasis severity has not been described. The objective of this study was to analyze the relationship between plasma concentrations of tumor necrosis factor alpha (TNF-alpha), as a marker of systemic inflammation, and some commonly used criteria for quantifying bronchiectasis severity in clinically stable patients whose disease was not caused by cystic fibrosis.

Patients And Methods: Sixty-eight clinically stable patients with bronchiectasis and 19 age- and sex-matched healthy control subjects were included in the study.

Obstructive sleep apnea has little impact on quality of life in the elderly.

Study Objective: To analyze the impact of the number of respiratory sleep disorders or clinically related conditions (especially excessive daytime sleepiness [EDS]), on health related quality of life (HRQoL) in subjects over 65 years of age, as compared to younger subjects and the general population.

Methods: Two hundred and twelve adult patients with obstructive sleep apnea (OSA, AHI> or =10) divided into two age groups, over 65 (n=109, mean age 74.6 [6,8] years, and 65 or under (n=103, mean age 51.

[Prognostic factors in chronic obstructive pulmonary disease].

Efforts over the last few decades to extend the life expectancy of patients with chronic obstructive pulmonary disease (COPD) have faced difficulties, but our perception of the problems involved is now starting to change. Improvements in our understanding of the pathogenic and etiological mechanisms of the disease, analysis of the causes of death, and, in particular, identification of the relevant prognostic factors have resulted in firm advances that allow us to face the future with greater optimism. The aim of this review is to provide a detailed analysis of the chief prognostic factors described in the literature and to evaluate the therapeutic implications of these findings.