Papers by Arantza Iriarte Campo
OBJECTIVE-Impaired lung function and innate immunity have both attracted growing interest as a po... more OBJECTIVE-Impaired lung function and innate immunity have both attracted growing interest as a potentially novel risk factor for glucose intolerance, insulin resistance, and type 2 diabetes. We aimed to evaluate whether surfactant protein D (SP-D), a lung-derived innate immune protein, was behind these associations. RESEARCH DESIGN AND METHODS-Serum SP-D was evaluated in four different cohorts. The cross-sectional associations between SP-D and metabolic and inflammatory parameters were evaluated in two cohorts, the cross-sectional relationship with lung function in one cohort, and the longitudinal effects of weight loss on fasting and circadian rhythm of serum SP-D and cortisol concentrations in one prospective cohort. RESULTS-In the cross-sectional studies, serum SP-D concentration was significantly decreased in subjects with obesity and type 2 diabetes (P ϭ 0.005) and was negatively associated with fasting and postload serum glucose. SP-D was also associated with A1C, serum lipids, insulin sensitivity, inflammatory parameters, and plasma insulinase activity. Smoking subjects with normal glucose tolerance, but not smoking patients with type 2 diabetes, showed significantly higher serum SP-D concentration than nonsmokers. Serum SP-D concentration correlated positively with end-tidal carbon dioxide tension (r ϭ 0.54, P ϭ 0.034). In the longitudinal study, fasting serum SP-D concentration decreased significantly after weight loss (P ϭ 0.02). Moreover, the main components of cortisol and SP-D rhythms became synchronous after weight loss. CONCLUSIONS-These findings suggest that lung innate immunity, as inferred from circulating SP-D concentrations, is at the crossroads of inflammation, obesity, and insulin resistance.
American Journal of Respiratory and Critical Care Medicine, 2005
Rationale: Lung cancer screening using computed tomography (CT) is effective in detecting lung ca... more Rationale: Lung cancer screening using computed tomography (CT) is effective in detecting lung cancer in early stages. Concerns regarding false-positive rates and unnecessary invasive procedures have been raised. Objective: To study the efficiency of a lung cancer protocol using spiral CT and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET). Methods: High-risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for noncalcified nodules of 5 mm or greater, and FDG-PET was done for nodules 10 mm or larger or smaller (Ͼ 7 mm), growing nodules. Results: A total of 911 individuals completed a baseline CT study and 424 had at least one annual follow-up study. Of the former, 14% had noncalcified nodules of 5 mm or larger, and 3.6% had nodules of 10 mm or larger. Eleven non-small cell lung cancers (NSCLC) and one small cell lung cancer (SCLC) were diagnosed in the baseline study (prevalence rate, 1.32%), and two NSCLCs in the annual study (incidence rate, 0.47%). All NSCLCs (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69, 91, 90, and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%. Conclusion: A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions.
European Respiratory Journal, 2016
Telomeres are DNA-protein structures that protect chromosome ends from degradation and shorten pr... more Telomeres are DNA-protein structures that protect chromosome ends from degradation and shorten progressively with each cell division [1].
European Respiratory Journal, 2016
European Respiratory Journal, 2016
Chronic Obstructive Pulmonary Disease (COPD) has been associated with osteoporosis. Little is kno... more Chronic Obstructive Pulmonary Disease (COPD) has been associated with osteoporosis. Little is known about the potential role of radiological emphysema on the presence of osteoporosis. Our objective was to determine the putative role of emphysema in the presence of osteoporosis in active and former smokers with and without COPD.
Chest, 2017
Rationale: The clinical characteristics of patients with emphysema but without airway limitation ... more Rationale: The clinical characteristics of patients with emphysema but without airway limitation remain unknown. Objective: To compare the clinical features of current and former smokers without airflow limitation who have radiological emphysema on chest CT with a control group of current and ex-smokers without emphysema. Methods: Subjects enrolled had anthropometrics, medical history and a low dose chest computed tomography (LDCT). The following parameters were also evaluated: pulmonary function tests (PFT) including diffusion capacity for carbon monoxide (DLCO), modified MRC dyspnea score, COPD assessment test (CAT) and 6-min walk distance (6MWD). A comparison was conducted between those with and those without CT emphysema. Results: Of the 203 subjects, 154 had emphysema (78%) while 49 did not. Adjusted group comparisons revealed that a higher proportion of patients with emphysema on LDCT had an abnormal DLCO (<80%) (46% vs 19%, p=0.02), a fall of SpO 2 % >4% during the 6MWD (8,5% vs 0%, p= 0,04) and an altered quality of life (CAT score ≥ 10) (32% vs 14%, p=0.01). A detailed analysis of the CAT questionnaire items revealed that more patients with emphysema had a score≥1 in the "chest tightness" (p=0.05), and "limitation when doing activities at home" items (p<0.01) compared with no emphysema. They also had significantly more exacerbations in the previous year (0.19 vs 0.04, p=0.02). Conclusions: A significant proportion of smokers with emphysema on LDCT but without airway limitation have alterations in their quality of life, number of exacerbations, diffusion capacity and oxygen saturation during the 6MWD test.
Chest Journal, Dec 1, 2007
Identification of risk factors for lung cancer can help in selecting patients who may benefit the... more Identification of risk factors for lung cancer can help in selecting patients who may benefit the most from smoking cessation interventions, early detection, or chemoprevention. Objective: To evaluate whether the presence of emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk factor for lung cancer. Methods: The study used data from a prospective cohort of 1,166 former and current smokers participating in a lung cancer screening study. All individuals underwent a baseline LDCT and spirometry followed by yearly repeat LDCT studies. The incidence density of lung cancer among patients with and without emphysema on LDCT was estimated. Stratified and multiple regression analyses were used to assess whether emphysema is an independent risk factor for lung cancer after adjusting for age, gender, smoking history, and the presence of airway obstruction on spirometry. Results: On univariate analysis, the incidence density of lung cancer among individuals with and without emphysema on LDCT was 25.0 per 1,000 person-years and 7.5 per 1,000 person-years, respectively (risk ratio [RR], 3.33; 95% confidence interval [CI], 1.41 to 7.85). Emphysema was also associated with increased risk of lung cancer when the analysis was limited to individuals without airway obstruction on spirometry (RR, 4.33; 95% CI, 1.04 to 18.16). Multivariate analysis showed that the presence of emphysema (RR, 2.51; 95% CI, 1.01 to 6.23) on LDCT but not airway obstruction (RR, 2.10; 95% CI, 0.79 to 5.58) was associated with increased risk of lung cancer after adjusting for potential cofounders. Conclusions: Results suggest that the presence of emphysema on LDCT is an independent risk factor for lung cancer.
European Respiratory Journal, Sep 1, 2014
Objective: To explore NLST criteria among COPD patients and to develop a COPD-tailored score that... more Objective: To explore NLST criteria among COPD patients and to develop a COPD-tailored score that improves it9s predictive capability for LC risk. Methods: We analyzed the databases from the Pamplona-IELCAP LC screening study (P-IELCAP) and the Pittsburgh Lung Screening Study (PLuSS). Only patients with spirometricaly proven COPD were included. NLST criteria were applied to both populations. By logistic regression we determined which factors were independently associated with LC, and then developed a COPD screening score (COPDss). Results: Forty-eight percent of COPD patients in P-IELCAP and 30% in PluSS did not meet NLST criteria (Table 1, panel A), resulting in the exclusion of 33% and 22% of lung cancers in each cohort, respectively (panel B). Factors associated with lung cancer risk are shown in Table 2. Variables finally included in the calculation of the COPDss are shown in Table 3. Figure 1 shows the ROC for NLST criteria and for COPDss in each COPD cohort (panels 2 & 3), and in both combined (panel 1). Conclusions: In patients with COPD undergoing screening, NLST criteria results in the exclusion of a large proportion of patients with LC. The COPDss improves the prediction of lung cancer risk among COPD patients.
Lung Cancer, 2016
Background: A major drawback of lung cancer screening programs is the high frequency of false-pos... more Background: A major drawback of lung cancer screening programs is the high frequency of false-positive findings on computed tomography (CT). We investigated the accuracy of selective 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) Positron Emission Tomography/Computed Tomography (PET/CT) scan in assessing radiologically indeterminate lung nodules detected in lung cancer screening. Methods: FDG PET/CT was performed to characterize 64 baseline lung nodules >10 mm and 36 incidence nodules detected on low-dose CT screening in asymptomatic current or former smokers (83 men, age range 40-83 years) at high risk for lung cancer. CT images were acquired without intravenous contrast. Nodules were analyzed by size, density, and metabolic activity and visual scored on a 5-point scale for FDG uptake. Nodules were classified as negative for malignancy when no FDG uptake was observed, or positive when focal uptake was observed in the visual analysis, and the maximum standardized uptake value (SUVmax) was measured. Final diagnosis was based on histopathological evaluation or at least 24 months of follow-up. Results: A total of 100 nodules were included. The prevalence of lung cancer was 1%. The sensitivity, specificity, NPV and PPV of visual analysis to detect malignancy were 84%, 95%, 91%, and 91%, respectively, with an accuracy of 91% (AUC 0.893). FDG PET/CT accurately detected 31 malignant tumors (diameters 9-42 mm, SUVmax range 0.6-14.2) and was falsely negative in 6 patients. With SUVmax thresholds for malignancy of 1.5, 2, and 2.5, specificity was 97% but sensitivity decreased to 65%, 49%, and 46% respectively, and accuracy decreased to 85%, 79%, and 78% respectively (AUC 0.872). Conclusions: The visual analysis of FDG PET/CT scan is highly accurate in characterizing indeterminate pulmonary nodules detected in lung cancer screening with low-dose CT. Semi-quantitative analysis does not improve the accuracy of FDG PET/CT over that obtained with a qualitative method for lung nodule characterization.
An insulating flexible panel adapted to be releasably joined to like panels in side by side relat... more An insulating flexible panel adapted to be releasably joined to like panels in side by side relationship, said panel comprising enclosure means for enclosing insulating material therein, said enclosure means presenting a first border and a second border, said second border extending generally outwardly of said enclosure, and releasable fastening means associated with said first and second borders adapted to releasably fasten said first border of one panel to said second border of another panel.
American Journal of Respiratory and Critical Care Medicine, Jan 30, 2015
Rationale: Patients with chronic obstructive pulmonary disease (COPD) are at high risk for lung c... more Rationale: Patients with chronic obstructive pulmonary disease (COPD) are at high risk for lung cancer (LC) and represent a potential target to improve the diagnostic yield of screening programs. Objectives: To develop a predictive score for LC risk for patients with COPD. Methods: The Pamplona International Early Lung Cancer Detection Program (P-IELCAP) and the Pittsburgh Lung Screening Study (PLuSS) databases were analyzed. Only patients with COPD on spirometry were included. By logistic regression we determined which factors were independently associated with LC in PLuSS and developed a COPD LC screening score (COPD-LUCSS) to be validated in P-IELCAP. Measurements and Main Results: By regression analysis, age greater than 60, body mass index less than 25 kg/m 2 , pack-years history greater than 60, and emphysema presence were independently associated with LC diagnosis and integrated into the COPD-LUCSS, which ranges from 0 to 10 points. Two COPD-LUCSS risk categories were proposed: low risk (scores 0-6) and high risk (scores 7-10). In comparison with low-risk patients, in both cohorts LC risk increased 3.5-fold in the high-risk category. Conclusions: The COPD-LUCSS is a good predictor of LC risk in patients with COPD participating in LC screening programs. Validation in two different populations adds strength to the findings.
European Respiratory Journal, Sep 1, 2013
Body: Rationale: Coronary Artery Calcium (CAC) and Epicardial Adipose Tissue (EAT) volume as dete... more Body: Rationale: Coronary Artery Calcium (CAC) and Epicardial Adipose Tissue (EAT) volume as determined by CT is an independent marker of cardiovascular events in the general population. Objectives: To assess CAC and EAT volume in COPD and explore its association with clinical and physiological variables of disease severity. Methods: We measured EAT and CAC using CT in 171 stable COPD patients and 70 controls matched by age, smoking history and BMI.
American Journal of Respiratory and Critical Care Medicine, Feb 10, 2015
Rationale: Lung cancer (LC) screening using low-dose chest computed tomography is now recommended... more Rationale: Lung cancer (LC) screening using low-dose chest computed tomography is now recommended in several guidelines using the National Lung Screening Trial (NLST) entry criteria (age, 55-74; >30 pack-years; tobacco cessation within the previous 15 yr for former smokers). Concerns exist about their lack of sensitivity. Objectives: To evaluate the performance of NLST criteria in two different LC screening studies from Europe and the United States, and to explore the effect of using emphysema as a complementary criterion. Methods: Participants from the Pamplona International Early Lung Action Detection Program (P-IELCAP; n = 3,061) and the Pittsburgh Lung Screening Study (PLuSS; n = 3,638) were considered. LC cumulative frequencies, incidence densities, and annual detection rates were calculated in three hypothetical cohorts, including subjects who met NLST criteria alone, those with computed tomography-detected emphysema, and those who met NLST criteria and/or had emphysema. Measurements and Main Results: Thirty-six percent and 59% of P-IELCAP and PLuSS participants, respectively, met NLST criteria. Among these, higher LC incidence densities and detection rates were observed. However, applying NLST criteria to our original cohorts would miss as many as 39% of all LC. Annual screening of subjects meeting either NLST criteria or having emphysema detected most cancers (88% and 95% of incident LC of P-IELCAP and PLuSS, respectively) despite reducing the number of screened participants by as much as 52%. Conclusions: LC screening based solely on NLST criteria could miss a significant number of LC cases. Combining NLST criteria and emphysema to select screening candidates results in higher LC detection rates and a lower number of cancers missed.
European Respiratory Journal, 2015
Chronic Obstructive Pulmonary Disease (COPD) is associated with numerous extrapulmonary diseases ... more Chronic Obstructive Pulmonary Disease (COPD) is associated with numerous extrapulmonary diseases including osteoporosis. The incidence of osteoporosis in COPD patients is high and its early detection would prevent significant associated morbidity. To determine the utility of Fracture Risk Assessment Tool (FRAX) index and bone turnover markers (BTM) for the diagnosis of osteoporosis in COPD patients. This is a pilot study of 50 COPD patients followed at a Pulmonary Service. Age, sex, pack-years of smoking status, lung function, FRAX index and BTM (betacrosslap, osteocalcin and N-terminal propeptide of type 1 procollagen [P1NP]) were recorded. Bone densitometry was performed on all patients, and was classified as healthy or osteoporotic according to WHO criteria. The potential utility of FRAX index and BTM was explored by ROC analysis. Patient characteristics are described in Table 1. Excluding densitometric values, the area under the curve (AUC) for major fracture and hip fracture was 0.72 and 0.73, respectively; and the AUC for betacrosslap, osteocalcin and P1NP were 0.70, 0.74 and 0.63, respectively (Figure 1). The FRAX index and BTM have potential value in the screening for the early diagnosis of osteoporosis in COPD patients. The completion of our study will allow the identification of a useful cutoff point for early screening.
Sleep Medicine, 2015
Background: The International Classification of Sleep Disorders-Third Edition (ICSD-3) classifies... more Background: The International Classification of Sleep Disorders-Third Edition (ICSD-3) classifies catathrenia among the respiratory disorders and not as a parasomnia as in ICSD-2. Few patients have been reported during these years, and the clinical description of the sound is different from group to group. In fact, there is no full agreement about its nature, origin, meaning, and treatment. Methods and results: In this paper we review the literature on catathrenia focusing on the characteristics of the sound, demographics of the patients, aetiology, response to treatment, etc., in order to support its classification as a respiratory disorder or a parasomnia. We also discuss the possibility of Catathrenia being not one disorder but two variants or two different disorders.
Razionale: L'identificazione dei fattori di rischio del cancro al polmone può aiutare nella s... more Razionale: L'identificazione dei fattori di rischio del cancro al polmone può aiutare nella sele- zione dei pazienti che possono maggiormente trarre beneficio da interventi per la cessazione dell'abitudine al fumo, da una diagnosi precoce o dalla chemioprevenzione. Obiettivo: Valutare se la presenza di enfisema attraverso TC del torace a bassa dose di radia- zione (LDCT) è un fattore di rischio
Medicine - Programa de Formaci?n M?dica Continuada Acreditado, 2005
testinal sean graves y provoquen malabsorción secundaria, está indicado un ingreso hospitalario p... more testinal sean graves y provoquen malabsorción secundaria, está indicado un ingreso hospitalario para instauración de hidratación y nutrición parenterales. Afectación renal e hipertensión arterial La hipertensión arterial asociada a esclerodermia responde bien a los IECA, que constituyen los fármacos de primera elección. En caso de falta de respuesta o que ésta sea incompleta está indicado añadir doxazosina y fármacos bloqueadores beta (con precaución en pacientes con síndrome de Raynaud). En la crisis renal esclerodérmica, los fármacos de elección son los IECA solos o asociados a nifedipino o nitroprusiato en perfusión. En caso de insuficiencia renal crónica terminal la diálisis se realizará en los casos en que esté indicado siguiendo los criterios habituales. Afectación musculoesquelética Para el tratamiento de la miositis se recomienda la utilización de prednisona a dosis de 1 mg/kg de peso/día. El tratamiento de las artralgias, artritis o tendosinovitis requiere la utilización de antiinflamatorios no esteroideos (AINE) y reposo. Afectación cardíaca El tratamiento de la insuficiencia cardíaca, las alteraciones del ritmo y el dolor torácico atípico es el convencional para estos casos, siempre restringiéndose al máximo el uso de diuréticos. Para la pericarditis se recomienda la utilización de AINE o prednisona en caso de ausencia de respuesta a las 48-72 horas.
American Journal of Respiratory and Critical Care Medicine, 2015
Rationale: Patients with chronic obstructive pulmonary disease (COPD) are at high risk for lung c... more Rationale: Patients with chronic obstructive pulmonary disease (COPD) are at high risk for lung cancer (LC) and represent a potential target to improve the diagnostic yield of screening programs. Objectives: To develop a predictive score for LC risk for patients with COPD. Methods: The Pamplona International Early Lung Cancer Detection Program (P-IELCAP) and the Pittsburgh Lung Screening Study (PLuSS) databases were analyzed. Only patients with COPD on spirometry were included. By logistic regression we determined which factors were independently associated with LC in PLuSS and developed a COPD LC screening score (COPD-LUCSS) to be validated in P-IELCAP. Measurements and Main Results: By regression analysis, age greater than 60, body mass index less than 25 kg/m 2 , pack-years history greater than 60, and emphysema presence were independently associated with LC diagnosis and integrated into the COPD-LUCSS, which ranges from 0 to 10 points. Two COPD-LUCSS risk categories were proposed: low risk (scores 0-6) and high risk (scores 7-10). In comparison with low-risk patients, in both cohorts LC risk increased 3.5-fold in the high-risk category. Conclusions: The COPD-LUCSS is a good predictor of LC risk in patients with COPD participating in LC screening programs. Validation in two different populations adds strength to the findings.
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Papers by Arantza Iriarte Campo