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receptors harboring kinase domain mutations associate with the heat shock protein 90 chaperone and are destabilized following exposure to geldanamycins. *Cancer* 

endotoxin induced monokine synthesis, following heat shock in murine peritoneal

3:1 alphaA/alphaB ratio: chaperone-like activity, structure and hydrophobicity.


**Part 2** 

**Clinical Aspects** 


**Part 2** 

**Clinical Aspects** 

102 Chronic Obstructive Pulmonary Disease – Current Concepts and Practice

Yu AL, Fuchshofer R, Birke M, Kampik A, Bloemendal H, Welge-Lüssen U (2008). Oxidative

Zhang G, Ghosh S (2000). Molecular mechanisms of NFkB induced by bacterial lypopolysaccharide through Toll-Like receptors. *J Endotoxin Res* 6(6):453-457. Zhong L, Peng X, Hidalgo GE, Doherty DE, Stromberg AJ, Hirschowitz EA. (2003).

nerve head astrocytes*. Invest. Ophthalmol*. Vis. Sci. 49: 5403-11.

*Cancer Detect Prev* 27:285-290.

stress 25and TGF-beta2 increase heat shock protein 27 expression in human optic

Antibodies to HSP70 and HSP90 in serum in non-small cell lung cancer patient*.* 

**6** 

*Spain* 

**COPD: Differential Diagnosis** 

Maria Luisa Martinez Ortiz1 and Josep Morera1,2

*2CIBER Enfermedades Respiratorias-CIberes, Barcelona* 

*1Servei de Pneumologia, Hospital Universitario Germans Trias i Pujol* 

Chronic obstructive pulmonary disease (COPD) is a high prevalent and impact socioeconomic disease. Although, cigarette smoking clearly fulfils all criteria to be classified as the etiology of COPD (Hill´s criteria), the latest version of GOLD does not include this concept clearly, therefore half century of main documents has been culminated and they has never mentioned in the definition, tobacco or cigarette smoking as cause of COPD. American Thoracic Society and European Respiratory Society (ATS / ERS) in the definition of COPD include the phrase "primarily caused by cigarette smoking". Nevertheless, the next page smoking changes from the category of "cause" to simply a "risk factor"; in fact, smoking is included in table 2 as a risk factor under the column of "exposures", together with socioeconomic status, environmental pollution, disease in childhood, or diet, among other. A reason for not to refer to cigarette smoking as aetiology is that only 15% of smokers are susceptible to COPD, a concept wrongly attributed to Fletcher. Although not all subjects exposed to cigarette smoking develop COPD does not preclude such exposure is the cause, just as not all people infected with *Mycobacterium tuberculosis* develop Tuberculosis, but there is no doubt about the etiologic role of mycobacteria. Another reason for nor establish smoking to the category of etiological factor

Therefore, when the aetiology is not part of the definition of the disease, it is usually replaced by a clinical description and the definition based on clinical findings are very poor, so a new definition of COPD is needed to ensure a more valid an accurate way to manage

In the Table 1 shows some of the criteria that different societies, guidelines and

Actually COPD is defined as postbronchodilator FEV1/FVC ratio < 70%. Threshold of FEV1/FVC <70% is agedependent and will probably lead to a significant degree of overdiagnosis of COPD in the elderly and underdiagnose young adults. GOLD guidelines recommend that using the lower limit of normal (LLN) values for FEV1/FVC is a way to minimize the misclassification. But use LLN we also overdiagnose healthy subjects. Although use post-bronchodilator FEV1/FVC ratio <0.70 simplify the diagnosis of COPD, some pulmonologists, ever more, consider a diagnosis of COPD can not be based only on spirometry parameters; it is important to include the presence of respiratory symptoms and

**1. Introduction** 

in COPD is the existence of COPD in non-smokers.

organizations have been used to diagnose COPD.

this worldwide condition.

exposure to risk factors.
