Análise computadorizada do ronco na síndrome da apneia do sono

The International Classification of Sleep Disorders lists 90 disorders. Manifestations, such as snoring, are important signs in the diagnosis of the Obstructive Sleep Apnea Syndrome; they are also socially undesirable. OBJECTIVE: The aim of this paper was to present and evaluate a computerized tool that automatically identifies snoring and highlights the importance of establishing the duration of each snoring event in OSA patients. MATERIAL AND METHODS: The low-sampling (200 Hz) electrical signal that indicates snoring was measured during polysomnography. The snoring sound of 31 patients was automatically classified by the software. The Kappa approach was applied to measure agreement between the automatic detection software and a trained observer. Student's T test was applied to evaluate differences in the duration of snoring episodes among simple snorers and OSA snorers. RESULTS: Of a total 43,976 snoring episodes, the software sensitivity was 99. 26%, the specificity was 97. 35%, and Kappa was 0. 96. We found a statistically significant difference (p <0. 0001) in the duration of snoring episodes (simple snoring x OSA snorers). CONCLUSIONS: This computer software makes it easier to generate quantitative reports of snoring, thereby reducing manual laborA classificação internacional de distúrbios do sono enumera aproximadamente 90 distúrbios. Manifestações, como o ronco, são um sinal no diagnóstico da Síndrome da Apneia Obstrutiva, além de ser um incômodo social. OBJETIVO: O objetivo deste artigo é apresentar e avaliar a ferramenta computacional que identifica o ronco automaticamente e destacar a importância da quantificação da duração de cada evento do ronco em pacientes com SAHOS. MATERIAL E MÉTODOS: O sinal elétrico que representa o ronco de baixa amostragem (200 hz) foi captado enquanto os pacientes eram submetidos à polissonografia. O sinal do ronco dos 31 pacientes foi classificado pelo programa computacional automaticamente. Utilizamos o valor de Kappa para avaliar a concordância entre o programa de detecção automática e o observador treinado (teste t-student). Avaliamos a diferença da duração dos episódios de ronco entre simples roncadores e roncadores com SAOS. RESULTADOS: De um total de 43,976 roncos, o programa computacional obteve uma sensibilidade de 99,26%, especificidade de 97,35% e Kappa de 0,96. Foi observada diferença estatística significante (p<0,0001) na duração de episódios de ronco (simples roncadores x roncadores com SAOS). CONCLUSÃO: Este programa computacional facilita a criação de relatórios quantitativos do ronco, oferecendo redução do trabalho manualInstituto Federal de Educação Tecnológica de São PauloUNIFESP Health Informatics Department graduate programUNIFESP, Health Informatics Department graduate programSciEL

Bidirectional modulation of synaptic transmission by insulin-like growth factor-I

Insulin-like growth factor-I (IGF-I) plays a key role in the modulation of synaptic plasticity and is an essential factor in learning and memory processes. However, during aging, IGF-I levels are decreased, and the effect of this decrease in the induction of synaptic plasticity remains unknown. Here we show that the induction of N-methyl-D-aspartate receptor (NMDAR)-dependent long-term potentiation (LTP) at layer 2/3 pyramidal neurons (PNs) of the mouse barrel cortex is favored or prevented by IGF-I (10 nM) or IGF-I (7 nM), respectively, when IGF-I is applied 1 h before the induction of Hebbian LTP. Analyzing the cellular basis of this bidirectional control of synaptic plasticity, we observed that while 10 nM IGF-I generates LTP (LTPIGF-I) of the post-synaptic potentials (PSPs) by inducing long-term depression (LTD) of the inhibitory post-synaptic currents (IPSCs), 7 nM IGF-I generates LTD of the PSPs (LTDIGF-I) by inducing LTD of the excitatory post-synaptic currents (EPSCs). This bidirectional effect of IGF-I is supported by the observation of IGF-IR immunoreactivity at both excitatory and inhibitory synapses. Therefore, IGF-I controls the induction of Hebbian NMDARdependent plasticity depending on its concentration, revealing novel cellular mechanisms of IGF-I on synaptic plasticity and in the learning and memory machinery of the brainThe author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the following Grants: BFU2016-80802-P and PID2020-119358GB-I00 (AEI/FEDER, UE) to DS, PID2019-104376RB-I00 (AEI/FEDER, UE) to IA and PI21/00915 (Instituto Salud Carlos III/ FEDER, UE) to A

Tumores de células da granulosa do ovário: estadiamento e tratamento

O objetivo deste trabalho foi o de analisar a importância dos achados cirúrgicos e histológicos para a definição dos estadiamento e tratamento dos tumores de células da camada granulosa do ovário. Foram avaliados o estadiamento e os resultados do tratamento de 11 pacientes, atendidas entre janeiro de 1990 e dezembro de 1994, no Centro de Atenção Integral à Saúde da Mulher, da Universidade Estadual de Campinas, no Estado de São Paulo. O seguimento foi atualizado em agosto de 1996. A idade das pacientes variou de 18 a 67 anos, com média de 46 anos. Duas pacientes foram submetidas à salpingo-ooforectomia bilateral, histerectomia total, apendicectomia e omentectoinia e, em sete, acrescentou-se a linfadenectomia retroperitoneal. Em dois casos a doença era irressecável. Cinco pacientes encontravam-se com tumor em estádio IIIC; uma, em estádio IC; e cinco, em estádio IA. A revisão histopatológica revelou 10 neoplasias do tipo adulto e uma do tipo juvenil. Em todos os casos encontrou-se mais de um tipo histopatológico de tumor de células granulosas, sendo dominante o tipo sólido (7/11 casos). o tratamento complementar com antiblásticos - seis ciclos de carboplatina (300 mg/ m2) e ciclofosfamida (500 mg/ m2) – foi aplicado nas pacientes com doença em estádios IC e IIIC. No último controle, com um seguimento variando de 20 a 71 meses, todas as pacientes com tumores no estádio inicial encontravam-se sem doença; contudo, das cinco pacientes com neoplasia em estádio IIIC, três apresentavam progressão da doença apesar do tratamento antiblástico

Impacts of desert dust outbreaks on air quality in urban areas

Air pollution has many adverse effects on health and is associated with an increased risk of mortality. Desert dust outbreaks contribute directly to air pollution by increasing particulate matter concentrations. We investigated the influence of desert dust outbreaks on air quality in Santa Cruz de Tenerife, a city located in the dust export pathway off the west coast of North Africa, using air-quality observations from a six-year period (2012–2017). During winter intense dust outbreaks PM10 mean (24-h) concentrations increased from 14 µg m−3 to 98 µg m−3 , on average, and PM2.5 mean (24-h) concentrations increased from 6 µg m−3 to 32 µg m−3 . Increases were less during summer outbreaks, with a tripling of PM10 and PM2.5 daily mean concentrations. We found that desert dust outbreaks reduced the height of the marine boundary layer in our study area by >45%, on average, in summer and by ∼25%, on average, in winter. This thinning of the marine boundary layer was associated with an increase of local anthropogenic pollution during dust outbreaks. NO2 and NO mean concentrations more than doubled and even larger relative increases in black carbon were observed during the more intense summer dust outbreaks; increases also occurred during the winter outbreaks but were less than in summer. This has public health implications; local anthropogenic emissions need to be reduced even further in areas that are impacted by desert dust outbreaks to reduce adverse health effects.This activity has been undertaken in the framework of the World Meteorological Organisation Global Atmosphere Watch Urban Research Meteorology and Environment (GURME) project

Dispositivo de rotación de tubos de resonancia magnética nuclear

Número de publicación: ES2522718 A1 (17.11.2014) También publicado como: ES2522718 B1 (12.11.2015) Número de Solicitud: Consulta de Expedientes OEPM (C.E.O.) P201400655 (24.07.2014)La invención un dispositivo especialmente diseñado para llevar a cabo la agitación de un tubo de resonancia magnética nuclear (RMN) que comprende: un soporte (2) al que está fijado un motor (3) eléctrico de eje horizontal; un adaptador (4) de tubos (100) de resonancia magnética nuclear fijado al eje del motor (3) eléctrico; un sensor Hall (5) dispuesto para detectar una posición inicial de dicho eje; un medio (6) de procesamiento conectado al motor (3) eléctrico y al sensor Hall (5); un módulo (7) de comunicaciones para llevar a cabo la programación del medio (6) de procesamiento; y una interfaz (8) de control y visualización conectada al medio (5) de procesamiento para operar el dispositivo (1) y visualizar datos acerca de su funcionamiento.Universidad de Almerí

Implementation of sensory stimulation technology in an interactive room for the diffusion of wine making activities

El presente proyecto de innovación intenta impulsar la promoción y difusión de las actividades de vinificación a través de la introducción de la tecnología de "estimulación sensorial dinámica" (DSS). El primer objetivo de este trabajo es describir la implementación de un salón interactivo que utiliza esta tecnología para mostrar algunas características organolépticas del pisco y el vino. La tecnología DSS está equipada con equipos sincronizados que brindan a los visitantes una experiencia sensorial integral que consiste en estimulación climática, similar a la del viñedo (principalmente en cuanto a temperatura y humedad relativa); estimulación olfativa con diferentes aromas a través de un aerosol controlado (simulando la recolección de olores asociados con los procesos de fermentación y destilación); estimulación científico-gustativa (degustación técnica); y estimulación audiovisual a través de imágenes y sonidos típicos de un viñedo. El segundo objetivo del artículo es describir la percepción y el nivel de satisfacción de los visitantes de la sala interactiva. Los resultados indican que es posible utilizar la tecnología DSS en un salón interactivo para promover la difusión de las actividades de vinificación en Arequipa, Perú.The present innovation project attempts to bolster the promotion and diffusion of wine-making activities through the introduction of 'dynamic sensory stimulation' technology (DSS). The first objective of this paper is to describe the implementation of an interactive lounge that uses this technology for the display of some organoleptic characteristics of pisco and wine. DSS technology is outfitted with synchronized equipment which provides the visitors with an integral, sensory experience consisting of climatic stimulation, similar to the one of the vineyard (principally in regard to temperature and relative humidity); olfactory stimulation with different aromas via a controlled spray (simulating the collection of smells associated with the processes of fermentation and distillation); scientific-gustatory stimulation (technical tasting); and audiovisual stimulation through images and sounds typical of a vineyard. The paper's second aim is to describe the perception and satisfaction level of the visitors of the interactive lounge. The results indicate that it is possible to utilize DSS technology in an interactive lounge in order to further the diffusion of wine-making activities in Arequipa, Peru.Revisión por paresCampus Arequip

Efeito da suplementação protéica a pasto sobre consumo de forragens, ganho de peso e condição corporal, em vacas Nelore

Tem um autor que tem Neto no sobrenome. Tem que pegar os dois últimos nomes como sobrenome.O objetivo do presente trabalho foi verificar o efeito da utilização de concentrado protéico, durante a época de verão, sobre consumo de forragem e variação no ganho de peso e no escore da condição corporal após o parto. Foram utilizadas 51 vacas paridas da raça Nelore, distribuídas ao acaso nos seguintes tratamentos: T0 = sem suplementação; T1 = suplementação com 1 kg; e T2 = suplementação com 2 kg de concentrado contendo 40,8% de PB, durante 105 dias. Neste período, foram determinados o escore corporal e o peso. Para determinar o consumo, utilizaram-se o marcador externo óxido de cromo, em dose única diária de 20 g, e o marcador interno FDA indigestível das extrusas, coletadas por meio de fístulas esofágicas. A suplementação não influenciou o consumo de MS de pasto, que ficou em torno de 9,87 kg MS/dia, correspondente a 2,13% do peso vivo, mas o consumo total de MS foi superior nos tratamentos T1 e T2. Escore da condição corporal, ganho de peso diário e peso final das vacas mostraram-se superiores nos animais suplementados em relação aos não-suplementados. Não foi observada diferença entre os pesos das crias ao final do período experimental.Fifty-one postpartum Nellore cows were used to study the effect of the utilization of protein concentrate, during the summer time, on the forage intake, weight gain and body condition score changes after parturition of Nellore cows. The animals were randomly allotted in the following treatments: T0 - without supplementation; T1 - supplemented with 1 kg and T2 - supplemented with 2 kg of concentrate with 40.8% of crude protein, during 105 days. During this period, body score and body weight were determined. In order to determine the intake, an external marker chromium oxide, in a daily dose of 20 g, and an internal marker (indigestible FDA of extrusa collected by esophageal fistula) were used. The supplementation with concentrate did not affect the dry matter (DM) intake from the pasture, that was around 9.87 kg DM/day, corresponding to 2.13% of the live weight, but the total DM intake was greater in the animals of T1 and T2. Body condition score, daily weight gain and final weight of the cows were greater in the supplemented animals as compared to the non-supplemented treatment. There was no difference among the calves weights at the end of the experimental period

Risk-of-Malignancy Index in preoperative evaluation of clinically restricted ovarian cancer

CONTEXT: There is no adequate preoperative method for differentiating between benign and malignant pelvic masses. Evaluations of CA 125 serum levels, ultrasonography findings and menstrual state have been tested in isolation as diagnostic methods. The evaluation of these three methods in association with each other could improve diagnostic performance. OBJECTIVE: To evaluate the risk-of-malignancy index by combining serum CA 125 levels, ultrasound score and menopausal status in preoperative diagnoses for women with pelvic masses clinically restricted to the ovaries and without clear evidence of malignancy. DESIGN: Cross-sectional study. SETTING: Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. PARTICIPANTS: 158 women admitted between January 1996 and March 1998 for surgical exploration of pelvic masses. PROCEDURES: The risk-of-malignancy index was calculated as US x M x CA 125, performed preoperatively. Ultrasound findings were classified according to the shape, size, multiplicity, presence of wall expansion involvement or ascites, using a score system (US). Menopausal status was considered as 1 for premenopausal and 3 for postmenopausal (M), and CA 125 serum levels were considered in absolute values. STATISTICAL ANALYSIS: Most relevant variables were included in a logistic multiple regression model, fitted using the ultrasound score, the serum CA 125 level and the menopausal status. The model was used for evaluating the performance of each individual predictor in determining the malignancy of these tumors and identifying the risk-of-malignancy index. RESULTS: The best individual performance was found in CA 125 levels (sensitivity of 78%, specificity of 75%), followed by ultrasound score (sensitivity of 75%, specificity of 73%) and menopausal status (sensitivity of 73%, specificity of 69%). The performance obtained for the risk-of-malignancy index at the cut-off point of 150 was a sensitivity and specificity of 79%. The area under the ROC curve for the risk-of-malignancy index was 0.90, which was greater than the area for CA 125 levels (0.83) or ultrasound score (0.79). CONCLUSION: The risk-of-malignancy index using ultrasound morphological score, serum CA 125 levels and menopausal status might be of value in the preoperative assessment of ovarian carcinomas.CONTEXTO: Não existem métodos pré-operatórios adequados para diferenciar massas pélvicas benignas de malignas. A avaliação do CA 125, dos achados ultra-sonográficos e do estado menstrual têm sido testados como métodos diagnósticos isolados. O uso destes três métodos em associação poderia levar a um aumento do seu desempenho. OBJETIVOS: Avaliar o índice de risco de malignidade incorporando a dosagem de CA 125 sérico, escore ultra-sonográfico e estado menopausal, no diagnóstico pré-operatório de mulheres com massas pélvicas clinicamente restritas ao ovário e sem evidências claras de malignidade. TIPO DE ESTUDO: Estudo de corte transversal. LOCAL: Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas. PARTICIPANTES: 158 mulheres admitidas entre janeiro de 1996 à março de 1998 para exploração cirúrgica de massa pélvica ovariana. PROCEDIMENTOS: O índice de risco de malignidade foi calculado como US x M x CA 125, avaliados pré-operatoriamente. Achados ultra-sonográficos foram classificados de acordo com a forma, tamanho, multiplicidade, presença de envolvimento de parede ou ascite em um sistema de escore (US). Para o estado menopausal foi considerada a pontuação de 1 para pré-menopausal e 3 para pós-menopausal (M), e a dosagem dos níveis séricos de CA 125 sérico foi considerada em seu valor absoluto. ANÁLISE ESTATÍSTICA: As variáveis mais relevantes foram incluídas em um modelo de regressão logística múltipla, usando o escore ultra-sonográfico, o nível de CA 125 e o estado menopausal. Foi usada para avaliar o desempenho de cada preditor individual em determinar a malignidade destes tumores e identificar o índice de risco de malignidade. RESULTADOS: O melhor desempenho individual foi encontrado na dosagem de CA 125 (sensibilidade de 78%, especificidade de 75%), seguido pelo escore ultra-sonográfico (sensibilidade de 75%, especificidade de 73%) e estado menopausal (sensibilidade de 73%, especificidade de 69%). O desempenho obtido pelo índice de risco de malignidade no ponto de corte de 150 foi sensibilidade e especificidade de 79%. A área sob a curva ROC para o índice de risco de malignidade foi 0,90, maior que a área para o CA 125 (0,83) ou escore ultra-sonográfico (0,79). CONCLUSÃO: O índice de risco de malignidade usando escore morfológico ultra-sonográfico, dosagem de CA 125 sérico e estado menopausal pode ser de valor no acesso pré-operatório do carcinoma ovariano.727

Angiosome study of the first digital feet space, for reconstruction of the digital tip

Background: The concept of angiosome explains the anatomical variations that exist between the vessels of different regions of the body and helps to understand the contributions of arterial blood supply to the skin and adjacent structures, dividing the human body into three-dimensional vascular blocks.Methods: This was an observational and descriptive study. In both lower extremities of 5 corpses with adequate tissue preservation in the operating room attached to the teaching area of the National Institute of Forensic Sciences in Mexico City. Angiosome study of the medial neurocutaneous flap of the second toe of both feet was performed.Results: The average, in centimeters, of the surface of the flaps was 1.57 cm x 2.47 cm, the average diameter of the inter-metatarsal digital artery was 1.1 millimeters and the average diameter of the veins draining the angiosome was 1.4 millimeters. The most constant anatomy was that of the nerve, which was present in all cases, with the digital nerve forming the neurosome of the flap.Conclusions: To obtain optimal results in microsurgery transfers, it is necessary to have a technique that is quick for harvesting the flap and with adequate systematization so as not to injure the neurovascular bundle, this is achieved through complete anatomical knowledge, without forgetting the main variants

Natural Course of the Diffusing Capacity of the Lungs for Carbon Monoxide in COPD: Importance of Sex

[Background] The value of the single-breath diffusing capacity of the lungs for carbon monoxide (Dlco) relates to outcomes for patients with COPD. However, little is known about the natural course of Dlco over time, intersubject variability, and factors that may influence Dlco progression.[Research Question] What is the natural course of Dlco in patients with COPD over time, and which other factors, including sex differences, could influence this progression?[Study Design and Methods] We phenotyped 602 smokers (women, 33%), of whom 506 (84%) had COPD and 96 (16%) had no airflow limitation. Lung function, including Dlco, was monitored annually over 5 years. A random coefficients model was used to evaluate Dlco changes over time.[Results] The mean (± SE) yearly decline in Dlco % in patients with COPD was 1.34% ± 0.015%/y. This was steeper compared with non-COPD control subjects (0.04% ± 0.032%/y; P = .004). Sixteen percent of the patients with COPD, vs 4.3% of the control subjects, had a statistically significant Dlco % slope annual decline (4.14%/y). At baseline, women with COPD had lower Dlco values (11.37% ± 2.27%; P < .001) in spite of a higher FEV1 % than men. Compared with men, women with COPD had a steeper Dlco annual decline of 0.89% ± 0.42%/y (P = .039).[Interpretation] Patients with COPD have an accelerated decline in Dlco compared with smokers without the disease. However, the decline is slow, and a testing interval of 3 to 4 years may be clinically informative. The lower and more rapid decline in Dlco values in women, compared with men, suggests a differential impact of sex in gas exchange function.[Trial Registry] ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.govThis study was funded in part by an unrestricted grant from AstraZeneca, and also by the COPD Research Program of the Spanish Respiratory Society (PII de EPOC of SEPAR).Peer reviewe