Characterization of mammary neoplasia by electrical impedance spectroscopy: canine model

Introducción: La espectroscopia de impedancia eléctrica (EIE) es una técnica fácil de usar y de bajo costo que se puede utilizar para analizar tejidos biológicos en condiciones normales o patológicas. El objetivo de este trabajo fue caracterizar neoplasias de glándula mamaria benignas y malignas aplicando la técnica EIE en muestras extraídas de 45 caninos hembras (Canis lupus familiaris). Métodos: Se utilizó un medidor de impedancia eléctrica, Hioki 3532-50, para determinar los parámetros bioeléctricos: resistencia de la matriz extracelular (R), resistencia de la matriz intracelular (S), frecuencia característica (Fc) y capacitancia de membrana (Cm) en un rango de frecuencias entre 42 Hz y 5 MHz y se analizaron estadísticamente mediante la prueba no paramétrica U de Mann-Whitney (Wilcoxon) de dos colas. La precisión diagnóstica de la EIE se efectuó a través de curvas características de operación del receptor (COR) y tablas de doble entrada, con la histopatología como referencia. Resultados: Se encontraron diferencias estadísticamente significativas entre el tejido mamario sano y las neoplasias benignas para los parámetros R, Fc y Cm, p-value < 0,05. Entre tejido mamario sano y neoplasias mamarias malignas se encontraron diferencias estadísticamente significativas para R y Fc con un p-value < 0,05. La comparación entre lesiones tumorales benignas y malignas no presentó diferencias estadísticamente significativas, p-value > 0,05, para ninguna de las variables incluidas en este estudio. Conclusiones: De los parámetros analizados por EIE, la resistencia de la matriz extracelular es la que mejor permite diferenciar entre tejidos mamarios normales y neoplásicos. La EIE es una herramienta diagnóstica potencial que puede ser utilizada en la detección de cáncer mamario, con una precisión diagnóstica cercana al 80%.Introduction: Electrical Impedance Spectroscopy (EIS) it is an easy to use and low-cost technique that can be used to analyze biological tissues in normal or pathological condition. The goal of this work was to characterize benign and malign mammary gland neoplasms applying the EIS technique in 45 female dogs (Canis lupus familiaris). Methods: An impedance meter Hioki 3532-50 was used to determine bioelectric parameters, extracellular matrix resistance (R), intracellular matrix resistance (S), characteristic frequency (Cf), and membrane capacitance (Mc), which were obtained in a 42 Hz and 5 MHz frequencies range. Were statistically analyzed with the non-parametric test of two-tailed MannWhitney (Wilcoxon). The diagnostic precision of the test was performed using receiver operating characteristics (ROC) and two-way tables using histopathology results as reference. Results: Significant differences between healthy mammary tissue and benign neoplasms were found for variables R, Cf and Mc (p < 0.05). There were statistically major differences between the healthy mammary tissue and malign mammary tumors groups for R and Cf (p < 0.05). The comparison between malign and benign tumor lesions did not show a statistically significant difference, p-value > 0.05, for any of the variables included in this study. Conclusion: Among all parameters analyzed for EIS, the extracellular matrix resistance R is the one that best allows differentiating between healthy and neoplastic mammary tissues. EIS is a diagnostic tool that can be used for breast cancer detection with a diagnostic precision close to 80%

Echocardiographic Changes with Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome. Long-Term Pickwick Randomized Controlled Clinical Trial

Spanish Sleep Network.[Rationale] Obesity hypoventilation syndrome (OHS) has been associated with cardiac dysfunction. However, randomized trials assessing the impact of long-term noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) on cardiac structure and function assessed by echocardiography are lacking. Rationale: Obesity hypoventilation syndrome (OHS) has been associated with cardiac dysfunction. However, randomized trials assessing the impact of long-term noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) on cardiac structure and function assessed by echocardiography are lacking.[Objectives] In a prespecified secondary analysis of the largest multicenter randomized controlled trial of OHS (Pickwick Project; N = 221 patients with OHS and coexistent severe obstructive sleep apnea), we compared the effectiveness of three years of NIV and CPAP on structural and functional echocardiographic changes.[Methods] At baseline and annually during three sequential years, patients underwent transthoracic two-dimensional and Doppler echocardiography. Echocardiographers at each site were blinded to the treatment allocation. Statistical analysis was performed using a linear mixed-effects model with a treatment group and repeated measures interaction to determine the differential effect between CPAP and NIV. Measurements and Main Results: A total of 196 patients were analyzed: 102 were treated with CPAP and 94 were treated with NIV. Systolic pulmonary artery pressure decreased from 40.5 ± 1.47 mm Hg at baseline to 35.3 ± 1.33 mm Hg at three years with CPAP, and from 41.5 ± 1.56 mm Hg to 35.5 ± 1.42 with NIV (P < 0.0001 for longitudinal intragroup changes for both treatment arms). However, there were no significant differences between groups. NIV and CPAP therapies similarly improved left ventricular diastolic dysfunction and reduced left atrial diameter. Both NIV and CPAP improved respiratory function and dyspnea.[Conclusions] In patients with OHS who have concomitant severe obstructive sleep apnea, long-term treatment with NIV and CPAP led to similar degrees of improvement in pulmonary hypertension and left ventricular diastolic dysfunction

Risk factors associated with pulmonary hypertension in obesity hypoventilation syndrome

Pulmonary hypertension (PH) is prevalent in obesity hypoventilation syndrome (OHS). However, there is a paucity of data assessing pathogenic factors associated with PH. Our objective is to assess risk factors that may be involved in the pathogenesis of PH in untreated OHS.Peer reviewe

Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components. Dendritic cells (DCs) play a key role in the defense against viral infections, for instance plasmacytoid DCs (pDCs), have the capacity to produce vast amounts of interferon-alpha (IFN-α). In COVID-19 there is a deficit in DC numbers and IFN-α production, which has been associated with disease severity. In this work, we described that in addition to the DC deficiency, several DC activation and homing markers were altered in acute COVID-19 patients, which were associated with multiple inflammatory markers. Remarkably, previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+ myeloid DCs and pDCs seven months after SARS-CoV-2 infection. Moreover, the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients, while no restoration of integrin β7 and indoleamine 2,3-dyoxigenase (IDO) levels were observed. These findings contribute to a better understanding of the immunological sequelae of COVID-19

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.Fil: Pons Estel, Bernardo A.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Bonfa, Eloisa. Universidade de Sao Paulo; BrasilFil: Soriano, Enrique R.. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cardiel, Mario H.. Centro de Investigación Clínica de Morelia; MéxicoFil: Izcovich, Ariel. Hospital Alemán; ArgentinaFil: Popoff, Federico. Hospital Aleman; ArgentinaFil: Criniti, Juan M.. Hospital Alemán; ArgentinaFil: Vásquez, Gloria. Universidad de Antioquia; ColombiaFil: Massardo, Loreto. Universidad San Sebastián; ChileFil: Duarte, Margarita. Hospital de Clínicas; ParaguayFil: Barile Fabris, Leonor A.. Hospital Angeles del Pedregal; MéxicoFil: García, Mercedes A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Amigo, Mary Carmen. Centro Médico Abc; MéxicoFil: Espada, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Catoggio, Luis J.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Sato, Emilia Inoue. Universidade Federal de Sao Paulo; BrasilFil: Levy, Roger A.. Universidade do Estado de Rio do Janeiro; BrasilFil: Acevedo Vásquez, Eduardo M.. Universidad Nacional Mayor de San Marcos; PerúFil: Chacón Díaz, Rosa. Policlínica Méndez Gimón; VenezuelaFil: Galarza Maldonado, Claudio M.. Corporación Médica Monte Sinaí; EcuadorFil: Iglesias Gamarra, Antonio J.. Universidad Nacional de Colombia; ColombiaFil: Molina, José Fernando. Centro Integral de Reumatología; ColombiaFil: Neira, Oscar. Universidad de Chile; ChileFil: Silva, Clóvis A.. Universidade de Sao Paulo; BrasilFil: Vargas Peña, Andrea. Hospital Pasteur Montevideo; UruguayFil: Gómez Puerta, José A.. Hospital Clinic Barcelona; EspañaFil: Scolnik, Marina. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Pons Estel, Guillermo J.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; Argentina. Hospital Provincial de Rosario; ArgentinaFil: Ugolini Lopes, Michelle R.. Universidade de Sao Paulo; BrasilFil: Savio, Verónica. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Drenkard, Cristina. University of Emory; Estados UnidosFil: Alvarellos, Alejandro J.. Hospital Privado Universitario de Córdoba; ArgentinaFil: Ugarte Gil, Manuel F.. Universidad Cientifica del Sur; Perú. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Babini, Alejandra. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cavalcanti, André. Universidade Federal de Pernambuco; BrasilFil: Cardoso Linhares, Fernanda Athayde. Hospital Pasteur Montevideo; UruguayFil: Haye Salinas, Maria Jezabel. Hospital Privado Universitario de Córdoba; ArgentinaFil: Fuentes Silva, Yurilis J.. Universidad de Oriente - Núcleo Bolívar; VenezuelaFil: Montandon De Oliveira E Silva, Ana Carolina. Universidade Federal de Goiás; BrasilFil: Eraso Garnica, Ruth M.. Universidad de Antioquia; ColombiaFil: Herrera Uribe, Sebastián. Hospital General de Medellin Luz Castro de Gutiérrez; ColombiaFil: Gómez Martín, DIana. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Robaina Sevrini, Ricardo. Universidad de la República; UruguayFil: Quintana, Rosana M.. Hospital Provincial de Rosario; Argentina. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Gordon, Sergio. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Fragoso Loyo, Hilda. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Rosario, Violeta. Hospital Docente Padre Billini; República DominicanaFil: Saurit, Verónica. Hospital Privado Universitario de Córdoba; ArgentinaFil: Appenzeller, Simone. Universidade Estadual de Campinas; BrasilFil: Dos Reis Neto, Edgard Torres. Universidade Federal de Sao Paulo; BrasilFil: Cieza, Jorge. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: González Naranjo, Luis A.. Universidad de Antioquia; ColombiaFil: González Bello, Yelitza C.. Ceibac; MéxicoFil: Collado, María Victoria. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Sarano, Judith. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Retamozo, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Sattler, María E.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gamboa Cárdenas, Rocio V.. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Cairoli, Ernesto. Universidad de la República; UruguayFil: Conti, Silvana M.. Hospital Provincial de Rosario; ArgentinaFil: Amezcua Guerra, Luis M.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Silveira, Luis H.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Borba, Eduardo F.. Universidade de Sao Paulo; BrasilFil: Pera, Mariana A.. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Alba Moreyra, Paula B.. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Arturi, Valeria. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Berbotto, Guillermo A.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gerling, Cristian. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Gobbi, Carla Andrea. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gervasoni, Viviana L.. Hospital Provincial de Rosario; ArgentinaFil: Scherbarth, Hugo R.. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Brenol, João C. Tavares. Hospital de Clinicas de Porto Alegre; BrasilFil: Cavalcanti, Fernando. Universidade Federal de Pernambuco; BrasilFil: Costallat, Lilian T. Lavras. Universidade Estadual de Campinas; BrasilFil: Da Silva, Nilzio A.. Universidade Federal de Goiás; BrasilFil: Monticielo, Odirlei A.. Hospital de Clinicas de Porto Alegre; BrasilFil: Seguro, Luciana Parente Costa. Universidade de Sao Paulo; BrasilFil: Xavier, Ricardo M.. Hospital de Clinicas de Porto Alegre; BrasilFil: Llanos, Carolina. Universidad Católica de Chile; ChileFil: Montúfar Guardado, Rubén A.. Instituto Salvadoreño de la Seguridad Social; El SalvadorFil: Garcia De La Torre, Ignacio. Hospital General de Occidente; MéxicoFil: Pineda, Carlos. Instituto Nacional de Rehabilitación; MéxicoFil: Portela Hernández, Margarita. Umae Hospital de Especialidades Centro Medico Nacional Siglo Xxi; MéxicoFil: Danza, Alvaro. Hospital Pasteur Montevideo; UruguayFil: Guibert Toledano, Marlene. Medical-surgical Research Center; CubaFil: Reyes, Gil Llerena. Medical-surgical Research Center; CubaFil: Acosta Colman, Maria Isabel. Hospital de Clínicas; ParaguayFil: Aquino, Alicia M.. Hospital de Clínicas; ParaguayFil: Mora Trujillo, Claudia S.. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Muñoz Louis, Roberto. Hospital Docente Padre Billini; República DominicanaFil: García Valladares, Ignacio. Centro de Estudios de Investigación Básica y Clínica; MéxicoFil: Orozco, María Celeste. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Burgos, Paula I.. Pontificia Universidad Católica de Chile; ChileFil: Betancur, Graciela V.. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Alarcón, Graciela S.. Universidad Peruana Cayetano Heredia; Perú. University of Alabama at Birmingahm; Estados Unido

Caracterización de neoplasias mamarias mediante espectroscopia de impedancia eléctrica: modelo canino

Introducción: La espectroscopia de impedancia eléctrica (EIE) es una técnica fácil de usar y de bajo costo que se puede utilizar para analizar tejidos biológicos en condiciones normales o patológicas. El objetivo de este trabajo fue caracterizar neoplasias de glándula mamaria benignas y malignas aplicando la técnica EIE en muestras extraídas de 45 caninos hembras (Canis lupus familiaris). Métodos: Se utilizó un medidor de impedancia eléctrica, Hioki 3532-50, para determinar los parámetros bioeléctricos: resistencia de la matriz extracelular (R), resistencia de la matriz intracelular (S), frecuencia característica (Fc) y capacitancia de membrana (Cm) en un rango de frecuencias entre 42 Hz y 5 MHz y se analizaron estadísticamente mediante la prueba no paramétrica U de Mann-Whitney (Wilcoxon) de dos colas. La precisión diagnóstica de la EIE se efectuó a través de curvas características de operación del receptor (COR) y tablas de doble entrada, con la histopatología como referencia. Resultados: Se encontraron diferencias estadísticamente significativas entre el tejido mamario sano y las neoplasias benignas para los parámetros R, Fc y Cm, p-value &amp;lt; 0,05. Entre tejido mamario sano y neoplasias mamarias malignas se encontraron diferencias estadísticamente significativas para R y Fc con un p-value &amp;lt; 0,05. La comparación entre lesiones tumorales benignas y malignas no presentó diferencias estadísticamente significativas, p-value &amp;gt; 0,05, para ninguna de las variables incluidas en este estudio. Conclusiones: De los parámetros analizados por EIE, la resistencia de la matriz extracelular es la que mejor permite diferenciar entre tejidos mamarios normales y neoplásicos. La EIE es una herramienta diagnóstica potencial que puede ser utilizada en la detección de cáncer mamario, con una precisión diagnóstica cercana al 80%.Introduction: Electrical Impedance Spectroscopy (EIS) it is an easy to use and low-cost technique that can be used to analyze biological tissues in normal or pathological condition. The goal of this work was to characterize benign and malign mammary gland neoplasms applying the EIS technique in 45 female dogs (Canis lupus familiaris). Methods: An impedance meter Hioki 3532-50 was used to determine bioelectric parameters, extracellular matrix resistance (R), intracellular matrix resistance (S), characteristic frequency (Cf), and membrane capacitance (Mc), which were obtained in a 42 Hz and 5 MHz frequencies range. Were statistically analyzed with the non-parametric test of two-tailed MannWhitney (Wilcoxon). The diagnostic precision of the test was performed using receiver operating characteristics (ROC) and two-way tables using histopathology results as reference. Results: Significant differences between healthy mammary tissue and benign neoplasms were found for variables R, Cf and Mc (p &amp;lt; 0.05). There were statistically major differences between the healthy mammary tissue and malign mammary tumors groups for R and Cf (p &amp;lt; 0.05). The comparison between malign and benign tumor lesions did not show a statistically significant difference, p-value &amp;gt; 0.05, for any of the variables included in this study. Conclusion: Among all parameters analyzed for EIS, the extracellular matrix resistance R is the one that best allows differentiating between healthy and neoplastic mammary tissues. EIS is a diagnostic tool that can be used for breast cancer detection with a diagnostic precision close to 80%

Diseño de software educativo en el área de Ciencias Naturales para el Ciclo Superior de EGB

Diseñar modos de utilización de ordenadores en el aula que ayuden eficazmente a alcanzar, al final del período de Educación Obligatoria, el nivel de destrezas básico que el cambio social y tecnológico demanda en los alumnos. El objeto de trabajo es la informática en la enseñanza de las Ciencias Experimentales en la segunda etapa de EGB. Investigación teórica y aplicada con fin prospectivo que sigue el proceso: I. Aspectos teóricos del problema: Desarrollo de la didáctica. Desarrollo de la Psicología educacional y Ciencia Cognitiva. II. Revisión y selección de las teorías de aprendizaje más válidas y estudio de los modelos de instrucción derivados. III. Estudio de la herramienta informática: A. Desde su característica lingüística como sistema. B. De procesamiento formal de símbolos. IV. Propuesta metodológica para la integración de actividades con ordenador en unidades didácticas de Ciencia: lenguaje logo adaptado a los aspectos conceptuales específicos. Aplicación al caso de fuerza gravitatoria. 1. Ni en España ni en el entorno europeo existen bancos de software educativo para equipos PC-compatibles susceptibles de ser analizados. 2. Los países vecinos siguen con Thomson y BBC y avanzan lentamente hacia PC Standar. 3. La calidad del software es en conjunto baja y no vale la pena adaptarlos al castellano. 4. Los modelos de aprendizaje/enseñanza que subyacen son en su mayoría esquemas conductistas, excepción hecha de ejemplos de simulación (BBC) y programación anexa a la utilización de micros en el laboratorio. 1. No se esperan cambios sustanciales repentinos. Se tiende a un uso más explícito de la Ciencia Cognitiva aplicada a implementaciones de inteligencia artificial con ordenadores más potentes. 2. Se manifiesta una doble evolución: A. La utilización telemática de acceso a bancos de datos y comunicación de centros entre sí. B. Uso de ordenadores en tecnologías de control. 3. Se propone que se estudien usos del ordenador en la enseñanza de las ciencias que corrijan la carencia de un software específico. Deben ser coherentes con los modelos cognitivos de aprendizaje y con las posibilidades de los micros actuales, se recomienda la utilización de microentornos formalizados con el lenguaje logo, tal y como se expone en el modelo.NavarraES

Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial

Spanish Sleep Network: Galo Fernández, Estrella Ordax-Carbajo, Nicolás González-Mangado, Teresa Gómez-García, María-Ángeles Martínez-Martínez, Elena Ojeda-Castillejo, Daniel López Padilla, Santiago J Carrizo, Begoña Gallego, Mercedes Pallero, Odile Romero, María Antonia Ramón, Eva Arias, Jesús Muñoz-Méndez, Cristina Senent, José N.Sancho-Chust, Nieves Belén Navarro Soriano, Emilia Barrot, José M. Benítez, Jesús Sánchez-Gómez, Rafael Golpe, Ana Santiago-Recuerda Silvia Gómez, Mónica Bengoa.[Background] Obesity hypoventilation syndrome is commonly treated with continuous positive airway pressure or non-invasive ventilation during sleep. Non-invasive ventilation is more complex and costly than continuous positive airway pressure but might be advantageous because it provides ventilatory support. To date there have been no long-term trials comparing these treatment modalities. We therefore aimed to determine the long-term comparative effectiveness of both treatment modalities.[Methods] We did a multicentre, open-label, randomised controlled trial at 16 clinical sites in Spain. We included patients aged 15–80 years with untreated obesity hypoventilation syndrome and an apnoea-hypopnoea index of 30 or more events per h. We randomly assigned patients, using simple randomisation through an electronic database, to receive treatment with either non-invasive ventilation or continuous positive airway pressure. Both investigators and patients were aware of the treatment allocation. The research team was not involved in deciding hospital treatment, duration of treatment in the hospital, and adjustment of medications, as well as adjudicating cardiovascular events or cause of mortality. Treating clinicians from the routine care team were not aware of the treatment allocation. The primary outcome was the number of hospitalisation days per year. The analysis was done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, number NCT01405976.[Findings] From May 4, 2009, to March 25, 2013, 100 patients were randomly assigned to the non-invasive ventilation group and 115 to the continuous positive airway pressure group, of which 97 patients in the non-invasive ventilation group and 107 in the continuous positive airway pressure group were included in the analysis. The median follow-up was 5·44 years (IQR 4·45–6·37) for all patients, 5·37 years (4·36–6·32) in the continuous positive airway pressure group, and 5·55 years (4·53–6·50) in the non-invasive ventilation group. The mean hospitalisation days per patient-year were 1·63 (SD 3·74) in the continuous positive airway pressure group and 1·44 (3·07) in the non-invasive ventilation group (adjusted rate ratio 0·78, 95% CI 0·34–1·77; p=0·561). Adverse events were similar between both groups.[Interpretation] In stable patients with obesity hypoventilation syndrome and severe obstructive sleep apnoea, non-invasive ventilation and continuous positive airway pressure have similar long-term effectiveness. Given that continuous positive airway pressure has lower complexity and cost, continuous positive airway pressure might be the preferred first-line positive airway pressure treatment modality until more studies become available.This study was funded by the Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias, Ministerio de Sanidad y Consumo; number PI050402), Spanish Respiratory Foundation 2005 (FEPAR), and Air Liquide Spain.Peer reviewe

El impacto de la terapia de presión positiva de larga duración en el síndrome de hipoventilación-obesidad en función de la gravedad de la enfermedad

[Rationale] Obesity hypoventilation syndrome (OHS) with concomitant severe obstructive sleep apnea (OSA) is treated with CPAP or noninvasive ventilation (NIV) during sleep. NIV is costlier, but may be advantageous because it provides ventilatory support. However, there are no long-term trials comparing these treatment modalities based on OHS severity.[Objective] To determine if CPAP have similar effectiveness when compared to NIV according to OHS severity subgroups.[Methods] Post hoc analysis of the Pickwick randomized clinical trial in which 215 ambulatory patients with untreated OHS and concomitant severe OSA, defined as apnoea-hypopnea index (AHI) ≥ 30 events/h, were allocated to NIV or CPAP. In the present analysis, the Pickwick cohort was divided in severity subgroups based on the degree of baseline daytime hypercapnia (PaCO2 of 45–49.9 or ≥50 mmHg). Repeated measures of PaCO2 and PaO2 during the subsequent 3 years were compared between CPAP and NIV in the two severity subgroups. Statistical analysis was performed using linear mixed-effects model.[Results] 204 patients, 97 in the NIV group and 107 in the CPAP group were analyzed. The longitudinal improvements of PaCO2 and PaO2 were similar between CPAP and NIV based on the PaCO2 severity subgroups.[Conclusion] In ambulatory patients with OHS and concomitant severe OSA who were treated with NIV or CPAP, long-term NIV therapy was similar to CPAP in improving awake hypercapnia, regardless of the severity of baseline hypercapnia. Therefore, in this patient population, the decision to prescribe CPAP or NIV cannot be solely based on the presenting level of PaCO2.[Introducción] El síndrome de hipoventilación-obesidad (SHO) con apnea obstructiva del sueño (AOS) grave concomitante se trata con CPAPo ventilación no invasiva (VNI) durante el sueño. La VNI es más costosa, pero puede ser beneficiosa porque proporciona soporte ventilatorio; sin embargo, no existen estudios a largo plazo que comparen estas modalidades de tratamiento basándose en la gravedad del SHO.[Objetivo] Determinar si la CPAP tiene una eficacia similar a la VNI según los subgrupos de gravedad del SHO.[Métodos] Análisis a posteriori del ensayo clínico aleatorizado Pickwick en el que 215 pacientes ambulatorios con SHO sin tratar y con AOS grave concomitante (definida como un índice de apnea-hipopnea [IAH] ≥ 30 episodios/hora) recibieron tratamiento con VNI o CPAP. En el presente análisis, la cohorte Pickwick se dividió en subgrupos según la gravedad basándose en el grado de hipercapnia diurna al inicio del estudio (PaCO2 de 45-49.9 mm Hg o ≥ 50 mm Hg). Se compararon las mediciones periódicas de PaCO2 y PaO2 durante los 3 años siguientes entre la CPAP y la VNI entre los dos subgrupos de gravedad. Se realizó un análisis estadístico utilizando un modelo lineal mixto.[Resultados] Se analizaron 204 pacientes, 97 en el grupo de VNI y 107 en el grupo de CPAP. Las mejoras lineales de PaCO2 y PaO2 fueron similares entre la CPAP y la NIV según los subgrupos de gravedad en función de la PaCO2.[Conclusión] En los pacientes ambulatorios con SHO y AOS grave concomitante a los que se trató con VNI o CPAP, el tratamiento a largo plazo con VNI resultó similar a la CPAP, en cuanto a la mejora de la hipercapnia en vigilia, independientemente de la gravedad de la hipercapnia de inicio. Por lo tanto, en esta población de pacientes la decisión de prescribir CPAP o VNI no puede basarse exclusivamente en el nivel de partida de PaCO2.Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias, Ministerio de Sanidad y Consumo, Madrid, Spain) PI050402, Spanish Respiratory Foundation 2005 (FEPAR) and Air Liquide Spain.Peer reviewe