Articles publicats (IRBLleida)
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L'IRBLleida és un centre de recerca conjunt entre la Universitat i el Departament de Salut de la Generalitat de Catalunya. Té com a funció potenciar les sinergies de recerca biomèdica entre ambdós institucions i està compromès en avançar en la recerca biomèdica com a mitja per millorar la salut de la població i facilitar una activitat assistencial òptima en situacions de malaltia. [Més informació].
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- ItemOpen AccessPeroxisome proliferator-activated receptor alpha activates transcription of the brown fat uncoupling protein-1 gene. A link between regulation of the thermogenic and lipid oxidation pathways in the brown fat cell(American Society for Biochemistry and Molecular Biology, 2001) Barberá, María José; Schluter, Agatha; Pedraza González, Neus; Iglesias, Roser; Villarroya, Francesc; Giralt, MartaHigh expression of the peroxisome proliferator-activated receptor alpha (PPARalpha) differentiates brown fat from white, and is related to its high capacity of lipid oxidation. We analyzed the effects of PPARalpha activation on expression of the brown fat-specific uncoupling protein-1 (ucp-1) gene. Activators of PPARalpha increased UCP-1 mRNA levels severalfold both in primary brown adipocytes and in brown fat in vivo. Transient transfection assays indicated that the (-4551)UCP1-CAT construct, containing the 5'-regulatory region of the rat ucp-1 gene, was activated by PPARalpha co-transfection in a dose-dependent manner and this activation was potentiated by Wy 14,643 and retinoid X receptor alpha. The coactivators CBP and PPARgamma-coactivator-1 (PGC-1), which is highly expressed in brown fat, also enhanced the PPARalpha-dependent regulation of the ucp-1 gene. Deletion and point-mutation mapping analysis indicated that the PPARalpha-responsive element was located in the upstream enhancer region of the ucp-1 gene. This -2485/-2458 element bound PPARalpha and PPARgamma from brown fat nuclei. Moreover, this element behaved as a promiscuous responsive site to either PPARalpha or PPARgamma activation, and we propose that it mediates ucp-1 gene up-regulation associated with adipogenic differentiation (via PPARgamma) or in coordination with gene expression for the fatty acid oxidation machinery required for active thermogenesis (via PPARalpha).
- ItemOpen AccessTime spent in the emergency department and mortality rates in severely injured patients admitted to the intensive care unit: An observational study(Elsevier, 2012) Servià Goixart, Lluís; Badia Castello, Mariona; Baeza, Ignacio; Montserrat, Neus; Justes, Margarida; Cabré, Xavier; Valdrés, Pedro; Trujillano Cabello, JavierPurpose: The aim of this study was to identify the determinants of a shorter emergency department time (EDt) in patients with severe trauma (STPs) admitted to the intensive care unit and determine whether EDt influences mortality. Patients and Methods: A prospective observational study of STPs (2005-2007) was conducted. With the variables available from the ED, 2 multiple logistic regression models (MLRM) were created: one for the factors associated with EDt less than or equal to median and the other with mortality. Results: A total of 243 patients were included. The mean age was 43 years; 76% were male. The overall mortality rate was 20%. The median EDt was 120 minutes. The independent factors that were associated with the MLRM for an EDt of 120 minutes or less included age less than 60 years, mechanical ventilation, severe traumatic brain injury, and a trauma and injury severity score of 20 or higher. The MLRM for mortality was age greater than 60 years, mechanical ventilation, traumatic brain injury and shock. An EDt of 120 minutes or less was associated with an increased risk of death in the univariate analysis but not in the MLRM. Conclusions: Patients in the ED with indicators of high trauma severity have a reduced EDt but a higher mortality rate. Advanced age increases both mortality and EDt. With the factors included in the model, EDt was not an independent factor for mortality in STPs.
- ItemOpen AccessRecommendations for specialized nutritional-metabolic treatment of the critical patient: Pharmaconutrients, specific nutrients, fiber, synbiotics. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)(Elsevier, 2020) Montejo González, Juan Carlos; de la Fuente O'Connor, Eugenia; Martínez Lozano, Fátima; Servià Goixart, LluísLos farmaconutrientes se definen como sustratos que, además de su efecto nutricional intrínseco, estimulan los mediadores que favorecen la inmunidad, inhiben los factores proinflamatorios y atenúan la respuesta frente a la agresión. Dentro de este grupo se encuentran algunos aminoácidos, como glutamina y arginina, ácidos grasos ω-3, y algunos oligoelementos y vitaminas. La fibra dietética, por sus efectos sobre la barrera intestinal y el microbioma,es actualmente considerada también un farmaconutriente. Desde la descripción de las dietas enriquecidas en farmaconutrientes, hace 30 años, y su aplicación clínica, existe todavía una importante controversia, aún no aclarada, sobre el interés de este tipo de dietas en pacientes críticos.
- ItemOpen AccessSeverity scores in trauma patients admitted to ICU. Physiological and anatomic models(Elsevier, 2019) Servià Goixart, Lluís; Badia Castello, Mariona; Montserrat, Neus; Trujillano Cabello, JavierIntroducción Comparar los scores de gravedad anatómicos y fisiológicos en los pacientes traumáticos ingresados en unidad de cuidados intensivos (UCI) y crear modelos combinados que mejoren su precisión. Método Estudio prospectivo de cohorte observacional. UCI polivalente de un hospital universitario de 2.o nivel. Se incluyeron los pacientes traumáticos mayores de 16 años ingresados en UCI (n = 780). Se comparan los modelos anatómicos (ISS, NISS) con los modelos fisiológicos (T-RTS, APACHE II [APII]), MPM II). La probabilidad de muerte se calculó según metodología TRISS. La discriminación se valoró mediante curvas ROC (ABC [IC 95%]) y la calibración con el estadístico H de Hosmer-Lemeshow. Los modelos combinados se realizaron con metodología de árboles de clasificación tipo Chi Square Automatic Interaction Detection. Resultados Mortalidad global del 14%. Los modelos fisiológicos son los que presentan mejores valores de discriminación (APII con 0,87 [0,84-0,90]). Todos los modelos tienen una mala calibración (p < 0,01). El mejor modelo combinado es el que utiliza APII junto a ISS (0,88 [0,83-0,90]) y encuentra un grupo de pacientes (valores de APII entre 10-17) que necesita la puntuación ISS (punto de corte de 22) para diferenciar entre mortalidad del 7,5% asociada a pacientes mayores con antecedentes patológicos y del 25,0% en pacientes con mayor presencia de TCE. Conclusiones Los modelos fisiológicos presentan ventajas sobre los anatómicos en los pacientes traumáticos ingresados en UCI. Los pacientes con puntuaciones bajas en los modelos fisiológicos requieren del análisis anatómico de las lesiones para determinar su gravedad.
- ItemOpen AccessRisk of tuberculosis among pulmonary tuberculosis contacts: the importance of time of exposure to index cases(Elsevier, 2024) Godoy, Sofia; Parrón, Ignasi; Millet, Joan Pau; Caylà, Joan; Follia, Núria; Carol, Monica; Orcau, Angels; Alsedà Graells, Miquel; Toledo, Diana; Plans, Pere; Ferrús, Gloria; Barrabeig, Irene; Clotet, Laura; Domínguez, Angela; Godoy i García, PereIntroduction: The intensity of exposure to index cases of tuberculosis [TB] may increase the risk of TB in their contacts. The aim was to determine TB risk factors among contacts of TB index cases. Methods: A cohort study was carried out in the contacts of pulmonary TB cases registered by the epidemiological surveillance network from 01/01/2019 to 06/30/2021. The factors associated with the risk of TB in contacts were determined using the adjusted odds ratio [aOR] and its 95% confidence interval [CI]. Results: From 847 TB cases, 7087 contacts were identified. The prevalence of TB was 2.0% [145/7087] and was higher in < 5 years compared to those ≥ 65 years [4.4% versus 1.2%; p < 0.001], in those exposed ≥ 6 h daily [4%], and < 6 h daily [1.6%] with respect to weekly exposure of < 6 h [0.7%; p < 0.001]. Those contacts exposed ≥ 6 h daily [aOR= 6.9; 95%CI:2.1–22.1], < 5 years [aOR= 8.3; 95%CI:1.8–37.8] and immigrants [aOR= 1.7; 95%CI:1.1–2.7] had a higher risk of TB. Conclusions: The risk of TB increases with the time of exposure to the index case and this risk is also higher in < 5 years and immigrants. Contact tracing has a high yield for detecting new cases of TB.