Long term management of obstructive sleep apnea and its comorbidities

Obstructive sleep apnea (OSA) is a worldwide highly prevalent disease associated with systemic consequences, including excessive sleepiness, impairment of neurocognitive function and daytime performance, including driving ability. The long-term sequelae of OSA include and increase risk for cardiovascular, cerebrovascular and metabolic syndrome disorders that ultimately lead to premature death if untreated. To ensure optimal long-term outcomes, the assessment and management of OSA should be personalized with the involvement of the appropriate specialist. Most studies have demonstrated inmediate improvement in daytime somnolence and quality of life with CPAP and other therapies, but the effect of long-term treatment on mortality is still under debate. Currently, the long-term management of OSA should be based on a) identifying physiological or structural abnormalities that are treatable at the time of patient evaluation and b) comprehensive lifestyle interventions, especially weight-loss interventions, which are associated with improvements in OSA severity, cardiometabolic comorbidities, and quality of life. In long-term management, attention should be paid to the clinical changes related to a potential reoccurrence of OSA symptoms and it is also necessary to monitor throughout the follow up how the main associated comorbidities evolve

Efficient Transport Protocol for Networked

The performance of haptic application is highly sensitive to communication delays and losses of data. It implies several constraints in developing networked haptic applications. This paper describes a new internet protocol called Efficient Transport Protocol (ETP), which aims at developing distributed interactive applications. TCP and UDP are transport protocols commonly used in any kind of networked communication, but they are not focused on real time application. This new protocol is focused on reducing roundtrip time (RTT) and interpacket gap (IPG). ETP is, therefore, optimized for interactive applications which are based on processes that are continuously exchanging data. ETP protocol is based on a state machine that decides the best strategies for optimizing RTT and IPG. Experiments have been carried out in order to compare this new protocol and UD

Forkhead Box P3 Methylation and Expression in Men with Obstructive Sleep Apnea

BACKGROUND: Epigenetic changes in obstructive sleep apnea (OSA) have been proposed as a mechanism for end-organ vulnerability. In children with OSA, Forkhead Box P3 (FOXP3) DNA methylation were associated with inflammatory biomarkers; however, the methylation pattern and its effect in the expression of this gene have not been tested in adults with OSA. METHODS: Plasma samples from subjects without comorbid conditions other than OSA were analyzed (the Epigenetics Status and Subclinical Atherosclerosis in Obstructive Sleep Apnea (EPIOSA) Study: NCT02131610). In 16 patients with severe OSA (Apnea-Hypopnea Index-AHI- > 30 events/h) and seven matched controls (AHI 10) and 31 controls, we quantified FOXP3 protein expression by ELISA and gene expression by quantitative real-time PCR. C-reactive protein (CRP) and plasma Treg cells were also evaluated. RESULTS: Neither the levels of the promoter nor the TSDR demethylated region were different between controls and patients with OSA, whether they were grouped by normal or high CRP. FOXP3 protein and mRNA expression did not differ between groups. CONCLUSIONS: FOXP3 methylation or its expression is not altered in adults with OSA, whatever their inflammatory status

Experiencia inicial con la prótesis de despliegue rápido en posición aórtica Edwards Intuity

ResumenObjetivoDisponemos de una nueva clase de prótesis aórticas de despliegue rápido para tratamiento quirúrgico de la estenosis aórtica. Permitirían disminuir los tiempos quirúrgicos y facilitarían la cirugía mínimamente invasiva. Presentamos nuestra experiencia inicial con la válvula Edwards Intuity en el contexto del estudio multicéntrico Foundation.Pacientes y métodosEntre septiembre de 2012 y febrero de 2014 se implantaron 25 prótesis aórticas Edwards Intuity en 26 pacientes (77±4,3años; 52% varones). Veinticuatro (96%) fueron reemplazo valvular aislado, y 9 pacientes (36%) tuvieron abordaje mínimamente invasivo. Los pacientes fueron estudiados al alta, a los 3meses y al año de la intervención.ResultadosHubo éxito en el implante en el 96,2% de los pacientes (25/26). No hubo mortalidad hospitalaria. Seguimiento medio de 11±5,4meses, supervivencia acumulada del 96%. Un paciente falleció a los 11meses por un ictus isquémico. El tiempo medio de pinzamiento aórtico fue de 38,2±10,1min y el tiempo medio de circulación extracorpórea, de 62,4±11,1min. A los 3meses, el área valvular efectiva media fue de 1,70±0,42cm2. El 91% de los pacientes (23/25) estaban en grado funcionali en el seguimiento.ConclusionesEl implante de la válvula Edwards Intuity para el tratamiento de la estenosis aórtica ha sido factible, seguro y eficaz. Los tiempos de isquemia miocárdica y de circulación extracorpórea parecen reducirse en comparación con la cirugía valvular aórtica habitual. El comportamiento hemodinámico inicial de la prótesis Edwards Intuity es excelente.AbstractObjectiveA new class of rapid deployment prostheses is now available for surgical treatment of aortic stenosis. These prostheses offer the possibility of reducing the duration of cardiopulmonary bypass and aortic clamping times, and facilitate the use of minimally invasive surgery. We present our initial experience with the Edwards Intuity valve in the context of a multicentre Foundation study.Patients and methodsBetween September 2012 and February 2014, 25 Edwards Intuity valves were implanted in 26 patients (77±4.3years; 52% male). Twenty-four (96%) were isolated aortic valve replacement; a minimally invasive approach was used on 9 patients (36%). Patients were studied at discharge, three months, and one year after surgery.ResultsImplantation success rate was 96.2% (25/26). There was no hospital mortality. Mean follow-up of 11±5.54months, cumulative survival of 96%. One patient died eleven months after surgery due to ischaemic stroke. The mean aortic clamping time was 38.2±10.1minutes, and the mean cardiopulmonary bypass (CPB) time was 62.4±11.1minutes. In the echocardiography at 3months, the mean effective valve area was 1.70±0.42cm2, and 91% of patients (23/25) were in functional classi NYHA at follow-up.ConclusionsThe implantation of the Edwards Intuity valve for surgical treatment of aortic stenosis has shown to be feasible, safe and effective. Times of myocardial ischaemia and extracorporeal circulation appear to be reduced compared with normal aortic valve surgery. The initial haemodynamic performance of the Edwards Intuity prosthesis is excellent

Soluble RAGE in COPD, with or without coexisting obstructive sleep apnoea

Background: Hypoxia can reduce the levels of soluble receptor for advanced glycation end-products (sRAGE), a new anti-infammatory biomarker of COPD. We assessed sRAGE in patients with hypoxia-related diseases such as COPD, OSA and OSA-COPD overlap. Methods: Plasma levels of sRAGE were measured in 317 subjects at baseline (57 heathy nonsmokers [HNS], 84 healthy smokers [HS], 79 OSA, 62 COPD and 35 OSA-COPD overlap patients) and in 294 subjects after one year of follow-up (50 HNS, 74 HS, 77 OSA, 60 COPD and 33 overlap). Results: After adjusting for age, sex, smoking status and body mass index, sRAGE levels showed a reduction in OSA (− 12.5%, p=0.005), COPD (− 14.8%, p<0.001) and OSA-COPD overlap (− 12.3%, p=0.02) compared with HNS. There were no diferences when comparing sRAGE plasma levels between overlap patients and those with OSA or COPD alone. At follow-up, sRAGE levels did not change signifcantly in healthy subjects, COPD and OSA or OSA-COPD overlap nontreated with continuous positive airway pressure (CPAP). Moreover, in patients with OSA and OSA-COPD overlap who were treated with CPAP, sRAGE increased signifcantly. Conclusions: The levels of sRAGE are reduced in COPD and OSA. Treatment with CPAP appears to improve sRAGE levels in patients with OSA who also had COPD.The EPIOSA study (NCT02131610) was supported by Grants Number PI12/02175, PI15/01940 and PI18/01524 from the Instituto Salud Carlos III, Spanish Ministry of Health, Madrid, Spain and the European Regional Development Fund (FEDER) and by a Grant Number 01/2010 from the SADAR-Pneumo Aragón, Zaragoza, Spain

Interplay of glycemic index, glycemic load, and dietary antioxidant capacity with insulin resistance in subjects with a cardiometabolic risk profile

Background: Dietary total antioxidant capacity (TAC), glycemic index (GI), and glycemic load (GL) are accepted indicators of diet quality, which have an effect on diet–disease relationships. The aim of this study was to evaluate potential associations of dietary TAC, GI, and GL with variables related to nutritive status and insulin resistance (IR) risk in cardiometabolic subjects. Methods: A total of 112 overweight or obese adults (age: 50.8 ± 9 years old) were included in the trial. Dietary intake was assessed by a validated 137-item food frequency questionnaire (FFQ), which was also used to calculate the dietary TAC, GI, and GL. Anthropometrics, blood pressure, body composition by dual-energy X-ray absorptiometry (DXA), glycemic and lipid profiles, C-reactive protein (CRP), as well as fatty liver quantification by magnetic resonance imaging (MRI) were assessed. Results: Subjects with higher values of TAC had significantly lower circulating insulin concentration and homeostatic model assessment of insulin resistance (HOMA-IR). Participants with higher values of HOMA-IR showed significantly higher GI and GL. Correlation analyses showed relevant inverse associations of GI and GL with TAC. A regression model evidenced a relationship of HOMA-IR with TAC, GI, and GL. Conclusion: This data reinforces the concept that dietary TAC, GI, and GL are potential markers of diet quality, which have an impact on the susceptible population with a cardiometabolic risk profile

Evaluation of the risks of the professionally exposed staff after the expansion of the storage of corrosive raw materials

[EN] This work deals with the expansion of the storage of corrosive raw materials in a company dedicated to the manufacture and packaging of ecological fertilizers, carried out in accordance with the new Regulation of Storage of Chemical Products, in force since September 2017. To secure the safety and health of the workers of the company with access to the storage, an identification and evaluation of the main risks of the professionally exposed workers in the raw materials storage is done. After this, the preventive measures to be applied will be proposed, so that the work carried out in the raw materials warehouse is done under optimal safety conditions.[ES] Este trabajo aborda la ampliación del almacenamiento de materias primas corrosivas de una empresa dedicada a la fabricación y envasado de fertilizantes ecológicos, realizado de acuerdo con el nuevo Reglamento de Almacenamiento de Productos Químicos, en vigor desde septiembre de 2017. Para garantizar la seguridad y salud de los trabajadores de la empresa con acceso a dicho almacenamiento, se realizará una identificación y evaluación de los principales riesgos del personal profesionalmente expuesto del almacén de materias primas. Tras ello, se propondrán las medidas preventivas a aplicar, con la finalidad de que el trabajo realizado en el almacén de materias primas se realice bajo unas condiciones de seguridad óptimas.Ferrer Marin, J.; Arnal Arnal, JM.; García-Fayos, B.; Sancho, M. (2019). Evaluación de los riesgos del personal profesionalmente expuesto tras la ampliación de un almacén de materias primas corrosivas. AEIPRO. 1754-1766. http://hdl.handle.net/10251/181195S1754176

Association between Different Animal Protein Sources and Liver Status in Obese Subjects with Non-Alcoholic Fatty Liver Disease: Fatty Liver in Obesity (FLiO) Study

Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome. Obesity and unhealthy dietary habits are described as risk factors for NAFLD. The aim of this study was to investigate the association between the consumption of different animal protein sources and hepatic status in NAFLD adults. A total of 112 overweight/obese participants with NAFLD from Fatty Liver in Obesity (FLiO) study were evaluated at baseline. Diet, body composition, and biochemical variables were evaluated. Hepatic status was also assessed by Magnetic Resonance Imaging, ultrasonography, and elastography. Red meat consumption showed a positive relationship with liver iron content (r = 0.224; p = 0.021) and ferritin concentration (r = 0.196; p = 0.037). Processed meat consumption exhibited a positive association with liver iron content (r = 0.308; p = 0.001), which was also found in the quantile regression (β = 0.079; p = 0.028). Fish consumption was related with lower concentration of ferritin (r = -0.200; p = 0.034). This association was further evidenced in the regression model (β = -0.720; p = 0.033). These findings suggest that the consumption of different animal protein sources differentially impact on liver status in obese subjects with NAFLD, showing fish consumption as a healthier alternative for towards NAFLD features

Association of the SH2B1 rs7359397 gene polymorphism with steatosis severity in subjects with obesity and non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide. Some genetic variants might be involved in the progression of this disease. The study hypothesized that individuals with the rs7359397 T allele have a higher risk of developing severe stages of NAFLD compared with non-carriers where dietary intake according to genotypes could have a key role on the pathogenesis of the disease. SH2B1 genetic variant was genotyped in 110 overweight/obese subjects with NAFLD. Imaging techniques, lipidomic analysis and blood liver biomarkers were performed. Body composition, general biochemical and dietary variables were also determined. The SH2B1 risk genotype was associated with higher HOMA-IR p equal 0.001; and Fatty Liver Index (FLI) p equal 0.032. Higher protein consumption (p equal 0.028), less mono-unsaturated fatty acid and fiber intake (p equal 0.045 and p equal 0.049, respectively), was also referred to in risk allele genotype. Lipidomic analysis showed that T allele carriers presented a higher frequency of non-alcoholic steatohepatitis (NASH) (69.1/100 vs. 44.4/100; p equal 0.006). In the genotype risk group, adjusted logistic regression models indicated a higher risk of developing an advanced stage of NAFLD measured by FLI (OR 2.91) and ultrasonography (OR 4.15). Multinomial logistic regression models showed that risk allele carriers had higher liver fat accumulation risk (RRR 3.93) and an increased risk of NASH (RRR 7.88). Consequently, subjects carrying the T allele were associated with a higher risk of developing a severe stage of NAFLD. These results support the importance of considering genetic predisposition in combination with a healthy dietary pattern in the personalized evaluation and management of NAFLD