Assuntos
Neoplasias Encefálicas/secundário , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Proteínas de Ciclo Celular/genética , Neoplasias Pulmonares/tratamento farmacológico , Proteínas Associadas aos Microtúbulos/genética , Inibidores de Proteínas Quinases/uso terapêutico , Pirazóis/uso terapêutico , Piridinas/uso terapêutico , Receptores Proteína Tirosina Quinases/genética , Serina Endopeptidases/genética , Adulto , Quinase do Linfoma Anaplásico , Neoplasias Encefálicas/enzimologia , Neoplasias Encefálicas/genética , Carcinoma Pulmonar de Células não Pequenas/enzimologia , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Proteínas de Ciclo Celular/metabolismo , Crizotinibe , Feminino , Humanos , Neoplasias Pulmonares/enzimologia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Proteínas Associadas aos Microtúbulos/metabolismo , Receptores Proteína Tirosina Quinases/metabolismo , Serina Endopeptidases/metabolismo , Translocação GenéticaRESUMO
STUDY OBJECTIVES: We tested whether providing adults with obstructive sleep apnea (OSA) with daily Web-based access to their positive airway pressure (PAP) usage over 3 mo with or without a financial incentive in the first week improves adherence and functional outcomes. SETTING: Academic- and community-based sleep centers. PARTICIPANTS: One hundred thirty-eight adults with newly diagnosed OSA starting PAP treatment. INTERVENTIONS: Participants were randomized to: usual care, usual care with access to PAP usage, or usual care with access to PAP usage and a financial incentive. PAP data were transmitted daily by wireless modem from the participants' PAP unit to a website where hours of usage were displayed. Participants in the financial incentive group could earn up to $30/day in the first week for objective PAP use ≥ 4 h/day. MEASUREMENTS AND RESULTS: Mean hours of daily PAP use in the two groups with access to PAP usage data did not differ from each other but was significantly greater than that in the usual care group in the first week and over 3 mo (P < 0.0001). Average daily use (mean ± standard deviation) during the first week of PAP intervention was 4.7 ± 3.3 h in the usual care group, and 5.9 ± 2.5 h and 6.3 ± 2.5 h in the Web access groups with and without financial incentive respectively. Adherence over the 3-mo intervention decreased at a relatively constant rate in all three groups. Functional Outcomes of Sleep Questionnaire change scores at 3 mo improved within each group (P < 0.0001) but change scores of the two groups with Web access to PAP data were not different than those in the control group (P > 0.124). CONCLUSIONS: Positive airway pressure adherence is significantly improved by giving patients Web access to information about their use of the treatment. Inclusion of a financial incentive in the first week had no additive effect in improving adherence.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Renda , Internet , Motivação , Cooperação do Paciente/estatística & dados numéricos , Apneia Obstrutiva do Sono/economia , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Polissonografia , Inquéritos e Questionários , Fatores de Tempo , Resultado do TratamentoRESUMO
Serum (IS) was obtained 0.5, 2, 4 or 6 h after inoculating s.c. six rabbits (approximately 2 kg) in each time period with 1 mg/kg of Tityus discrepans (Td) venom; the control was serum obtained from four rabbits 4 h after injecting them 1 ml s.c. of 0.9% NaCl. IS produced a transient (<25 min) rise in pulmonary artery pressure of isolated and perfused rabbit lungs, other lung parameters were not altered. We found that both scorpion venom and IS produced a approximately 50% transient increase of transendothelial electric resistance in cultured tissue human umbilical cord vein. Neither venom nor IS changed the transepithelial electrical resistance of tissue cultured human airway epithelia. The experiments suggest that humoral factors contained in the inoculated serum modify vascular endothelium in a much more effective manner than the venom by itself. These experiments also make it unlikely that vascular endothelium is the source of the humoral factors contained in inflammatory serum.
Assuntos
Circulação Pulmonar/efeitos dos fármacos , Mucosa Respiratória/efeitos dos fármacos , Venenos de Escorpião/farmacologia , Animais , Células Cultivadas , Humanos , Técnicas In Vitro , Pulmão/irrigação sanguínea , Pulmão/efeitos dos fármacos , Pulmão/fisiologia , Artéria Pulmonar/efeitos dos fármacos , Artéria Pulmonar/fisiologia , Circulação Pulmonar/fisiologia , Coelhos , Mucosa Respiratória/citologia , Mucosa Respiratória/fisiologiaRESUMO
La enfermedad vascular pulmonar (EVP) que ocurre en nuestros pacientes con enfermedad broncopulmonar obstructiva crónica (EBPOC) es una complicación común y seria. Se ha estimado que el 50 por ciento de los pacientes mayores de los 50 años y que poseen una EBPOC presentan hipertensión pulmonar y, por ende EVP. La tasa de sobrevida de estos pacientes se asemeja bastante a la tasa que presentan los pacientes con cáncer de pulmón inoperable. Esta enfermedad (EVP) disminuye aún más la captación de O² por el pulmón. También produce una disminución de la calidad de vida del paciente² y como los síntomas que produce la EVPson silentes o se asemejan mucho a los que produce la EBPOC es común que el médico no se percate de que está ocurriendo. En este artículo discutimos la clínica, la fisiopatología y los nuevos métodos de tratamiento de esta complicación que con frecuencia acompaña a la enfermedad pulmonar