La probabilidad del síndrome de Apnea Obstructiva del Sueño (OSAS) es tres veces más alta en personas que roncan. Aunque muchos estudios han identificado diferencias en las características acústicas de los ronquidos entre pacientes con OSAS y otras personas roncadoras, normalmente solo unos pocos pacientes han sido estudiados con un énfasis en los ronquidos postapneicos.
La revista ENT Today, ha publicado, recientemente, una revisión del artículo “Análisis y seguimiento permanente de los ronquidos y su relación con el índice de apneas-hipopneas durante el sueño”. Dicho estudio cuenta con la participación del Grupo de Investigación de Señales y Sistemas Biomédicos, (Ip Raimón Jané) de la Universidad Politécnica de Cataluña, el Instituto de Bioingeniería de Cataluña y el CIBER-BBN (SISBIO-UPC-IBEC), y se relaciona directamente con el proyecto traslacional MUDIRES: “Diagnóstico Multimodal en el Sistema Respiratorio mediante la Interpretación de Señales Multiescala”.
El estudio presenta un nuevo sistema de detección y análisis automático de los ronquidos utilizado para su monitorización durante la noche, con el fin de evaluar si sus características acústicas difieren en relación con el índice de apnea-hipopnea (AHI) y clasificar a los sujetos según este índice.
37 personas no fumadoras fueron monitorizadas durante 6h en el Laboratorio de Desórdenes del Sueño del Hospital Universitario Germans Trias i Pujol de Badalona, con el propósito de estudiar el número de ronquidos, su intensidad, potencia y otros parámetros de cada sujeto y ser comparados entre grupos de estudio con diferente AHI.
Los episodios de ronquidos fueron identificados por un detector automático y analizados por el grupo de investigación. El sistema fue capaz de identificar y aislar los ronquidos de otros ruidos que podían interferir, relacionar cada ronquido con la posición del cuerpo y proveer de resultados estadísticos de la noche del estudio. Los resultados obtenidos mostraron que la intensidad de los ronquidos y el espectro de frecuencia de los mismos difieren significativamente en pacientes con distintos AHI.
Aunque es necesaria una validación, se prevé que el nuevo sistema podría ser una herramienta de utilidad para el diagnóstico temprano del síndrome de Apnea Obstructiva del Sueño.
*Reference: Fiz JA, Jané R, Solà-Soler J, et al. Continuous analysis and monitoring of snores and their relationship to the apnea-hypopnea index. Laryngoscope. 2010;120(4):853-861.
**Ver el artículo publicado en ENT Today
Boletín informativo Boletines CIBER-BBN
28 April 2011
Jornada sobre el Síndrome de Apneas durante el Sueño (SAHS)
Hoy tendrá lugar la primera jornada dirigida a médicos y enfermeros del Hospital Don Benito-Villanueva en el Hotel Vegas Altas en Don Benito sobre el Síndrome de Apneas del sueño. Esta jornada está organizada por ASPATER (Asociación de enfermos con tabaquismo y enfermedades respiratorias crónicas), la Fundación Coll Colomé, el servicio de neumología del Hospital Infanta Cristina, la sección de neumología del Hospital Don Benito-Villanueva y cuenta con el patrocinio de VitalAire.
El objetivo es concienciar a los médicos de atención primaria y a los enfermeros de la importancia del diagnóstico del Síndrome de Apneas del Sueño, ya que presenta tasas importantes de infradiagnóstico, y revisar los aspectos más relevantes de esta patología y su impacto en las enfermedades cardiovasculares. En este sentido, el Dr. Garrido Romero, especialista del área de Salud del Hospital Don Benito-Villanueva, participará con la conferencia "Síndrome de apneas durante el sueño y riesgos cardiovasculares".
El SAHS se caracteriza por la obstrucción repetida de las vías respiratorias superiores durante el sueño, situación que provoca ahogos y que impide una correcta oxigenación de la sangre. Actualmente, alrededor de 12.000 personas son tratadas de esta enfermedad en Extremadura.
Francisco Crespo, Director de Marketing de VitalAire explicó que "la apnea es el síndrome más frecuente de los trastornos respiratorios que se producen durante el sueño ya que afecta a un 4% de la población adulta. Nuestro objetivo es mejorar la calidad de vida de estos pacientes con tratamientos como la CPAP, dispositivo médico que genera aire a una presión continua con el fin de evitar el cierre de la vía aérea".
El objetivo es concienciar a los médicos de atención primaria y a los enfermeros de la importancia del diagnóstico del Síndrome de Apneas del Sueño, ya que presenta tasas importantes de infradiagnóstico, y revisar los aspectos más relevantes de esta patología y su impacto en las enfermedades cardiovasculares. En este sentido, el Dr. Garrido Romero, especialista del área de Salud del Hospital Don Benito-Villanueva, participará con la conferencia "Síndrome de apneas durante el sueño y riesgos cardiovasculares".
El SAHS se caracteriza por la obstrucción repetida de las vías respiratorias superiores durante el sueño, situación que provoca ahogos y que impide una correcta oxigenación de la sangre. Actualmente, alrededor de 12.000 personas son tratadas de esta enfermedad en Extremadura.
Francisco Crespo, Director de Marketing de VitalAire explicó que "la apnea es el síndrome más frecuente de los trastornos respiratorios que se producen durante el sueño ya que afecta a un 4% de la población adulta. Nuestro objetivo es mejorar la calidad de vida de estos pacientes con tratamientos como la CPAP, dispositivo médico que genera aire a una presión continua con el fin de evitar el cierre de la vía aérea".
Simbionix mostrará el primer estimulador de formación para reparación de suelo pélvico
Simbionix USA Corporation, el proveedor líder en el mundo de formación médica y productos de capacitación en simulación para profesionales médicos y el sector del cuidado de la salud, se complace al anunciar un nuevo estimulador de formación para la reparación del suelo pélvico, que se mostrará por primera vez durante la celebración de la en ACOG 59th Annual Clinical Meeting en Washington, DC, del 30 de abril al 4 de mayo de 2011.
El revolucionario Pelvic Mentor(TM) es un sistema híbrido integrado que combina un maniquí de plástico con un sistema virtual 3D por ordenador. El simulador tiene como objetivo preparar a los ginecólogos y urólogos para la reconstrucción del suelo pélvico, centrándose en los procedimientos de malla transvaginal. El prolapso de órganos pélvicos es un grupo común de enfermedades médicas que afectan a millones de mujeres en todo el mundo. Aproximadamente el 40% de las mujeres entre 40 y 80 años están afectadas por el prolapso de órganos pélvicos, una enfermedad en la que los músculos debilitados del suelo pélvico pueden causar que los órganos pélvicos se salgan de su lugar. El prolapso de los órganos pélvicos puede causar una presión pélvica incómoda, limitando la actividad física de la mujer y su intimidad sexual.
Las cirugías de reconstrucción del suelo pélvico necesitan de experiencia quirúrgica, conocimiento de la anatomía abdominal y psicología vaginal y experiencia con el procedimiento en sí mismo. Este sistema único se diseñó para permitir a los aprendices a conseguir un conocimiento detallado de la anatomía pélvica y para adquirir unas habilidades completas en la cirugía reconstructiva pélvica para el prolapso de los órganos pélvicos y la incontinencia urinaria de cara a mejorar la seguridad del paciente. El innovador concepto Pelvic Mentor utiliza numerosos sensores externos que están o bien integrados dentro de un instrumento médico o se llegan en el dedo del aprendiz. Estos sensores, combinados con los del maniquí y la imagen en 3D, permiten al aprendiz conseguir una indicación en tiempo real de la palpación del dedo o manipulación del instrumento en las estructuras anatómicas virtuales.
Pelvic Mentor es una importante herramienta didáctica, y permite al aprendiz recibir una retroalimentación en tiempo real al tiempo que reconoce las secciones anatómicas relevantes y/o manipula el instrumento médico relevante dentro de la cavidad pélvica. La combinación única de la estructura anatómica del modelo, sensación del dedo y modelo virtual proporciona la herramienta de formación más eficaz hasta la fecha.
"Gracias a la utilización de tecnología revolucionaria, estamos presentando nuestro primer sistema que se ocupa de las necesidades de formación para procedimientos no MIS, y vamos más allá de lo que existe en la actualidad dentro de la industria", comentó Ran Bronstein, director general de Simbionix. "El estimulador híbrido Pelvic Mentor lleva la experiencia de formación un paso más cerca de la realidad ya que combina una sensación táctil real. El nuevo hardware realiza un seguimiento de los movimientos del aprendiz de forma más precisa, permitiendo que el instructor consiga una mejor visión de los movimientos del aprendiz y proporcionando al aprendiz una experiencia de formación más completa. Simbionix Pelvic Mentor es otro ejemplo más del compromiso de la compañía para proporciona soluciones de formación completas para los cirujanos OB/GYN, y se une a las soluciones proporcionadas en LAP Mentor y VirtaMed HystSim".
Increased metabolic rate may lead to accelerated aging
A recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM) found that higher metabolic rates predict early natural mortality, indicating that higher energy turnover may accelerate aging in humans. Higher energy turnover is associated with shorter lifespan in animals, but evidence for this association in humans is limited. To investigate whether higher metabolic rate is associated with aging in humans, this study examined whether energy expenditure, measured in a metabolic chamber over 24 hours and during rest predicts natural mortality.
"We found that higher endogenous metabolic rate, that is how much energy the body uses for normal body functions, is a risk factor for earlier mortality," said Reiner Jumpertz, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Ariz., and lead author of the study. "This increased metabolic rate may lead to earlier organ damage (in effect accelerated aging) possibly by accumulation of toxic substances produced with the increase in energy turnover."
"It is important to note that these data do not apply to exercise-related energy expenditure," added Jumpertz. "This activity clearly has beneficial effects on human health."
In this study, researchers evaluated 652 non-diabetic healthy Pima Indian volunteers. Twenty four hour energy expenditure (24EE) was measured in 508 individuals, resting metabolic rate (RMR) was measured in 384 individuals and 240 underwent both measurements on separate days. Data for 24EE were collected in a respiratory chamber between 1985 and 2006 with a mean follow-up time of 11.1 years. RMR was evaluated using an open-circuit respiratory hood system between 1982 and 2006 with a mean follow-up time of 15.4 years.
During the study period, 27 study participants died of natural causes. Researchers found that as energy expenditure increased, there was also an increase in risk for natural mortality.
"The results of this study may help us understand some of the underlying mechanisms of human aging and indicate why reductions in metabolic rate, for instance via low calorie diets, appear to be beneficial for human health," said Jumpertz.
**Source: The Endocrine Society
"We found that higher endogenous metabolic rate, that is how much energy the body uses for normal body functions, is a risk factor for earlier mortality," said Reiner Jumpertz, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Ariz., and lead author of the study. "This increased metabolic rate may lead to earlier organ damage (in effect accelerated aging) possibly by accumulation of toxic substances produced with the increase in energy turnover."
"It is important to note that these data do not apply to exercise-related energy expenditure," added Jumpertz. "This activity clearly has beneficial effects on human health."
In this study, researchers evaluated 652 non-diabetic healthy Pima Indian volunteers. Twenty four hour energy expenditure (24EE) was measured in 508 individuals, resting metabolic rate (RMR) was measured in 384 individuals and 240 underwent both measurements on separate days. Data for 24EE were collected in a respiratory chamber between 1985 and 2006 with a mean follow-up time of 11.1 years. RMR was evaluated using an open-circuit respiratory hood system between 1982 and 2006 with a mean follow-up time of 15.4 years.
During the study period, 27 study participants died of natural causes. Researchers found that as energy expenditure increased, there was also an increase in risk for natural mortality.
"The results of this study may help us understand some of the underlying mechanisms of human aging and indicate why reductions in metabolic rate, for instance via low calorie diets, appear to be beneficial for human health," said Jumpertz.
**Source: The Endocrine Society
Discovery could change the way doctors treat patients with cancer and autoimmune diseases
Researchers in the Faculty of Medicine & Dentistry at the University of Alberta have made an important discovery that provides a new understanding of how our immune system "learns" not to attack our own body, and this could affect the way doctors treat patients with autoimmune diseases and cancer. When patients undergo chemotherapy for cancer or as part of experimental therapies to treat autoimmune diseases such as diabetes and lupus, the treatment kills the patients' white blood cells. What can be done afterwards, is to give these patients blood stem cells through transplantation. Stem cells are taken from patients then injected back into them – with the theory being that the patients' immune system won't attack their own cells, and the stem cells can get to work healing their bodies.
But U of A medical researchers Govindarajan Thangavelu, Colin Anderson and their collaborators discovered that if a particular molecule is not working properly in T-cells, the body will attack itself. This is significant for stem-cell transplantation treatment because it means the immune systems of the patients could consider their own cells "foreign" and initiate an attack.
"So your own cells would be killing you," says Thangavelu, a PhD student specializing in immunology, who was the first author in the research study, which was recently published in the peer-reviewed Journal of Autoimmunity. "What we found is if this molecule is absent in T-cells, if the pathway isn't intact, it will cause severe autoimmunity to the subject's own body. In essence, subjects become allergic to their own cells."
Anderson, an associate professor with the Alberta Diabetes Institute and Principal Investigator added: "The ability of our immune system to attack dangerous microbes while not attacking our own cells or tissues is a delicate balance. Restarting the immune system after wiping it out in patients with autoimmune diseases or cancer requires re-establishing this appropriate balance. We discovered that a particular immune system molecule is critical to prevent the immune system from attacking our own cells or tissues when the immune system is restarted. If that molecule is missing, the immune system will wreak havoc on the body."
T-cells are supposed to protect people and animals from things invading their bodies. But this research demonstrates if these cells become unregulated because they are missing a molecule, it can lead to autoimmunity – particularly dangerous in scenarios where patients have lost white blood cells when they are being treated for autoimmune diseases or cancer.
Thangavelu has won awards for this research. He was invited to present his work at an international conference of immunology in Japan last year. He has also travelled to the United Kingdom to talk about his findings with the medical community.
**Source: University of Alberta Faculty of Medicine & Dentistry
But U of A medical researchers Govindarajan Thangavelu, Colin Anderson and their collaborators discovered that if a particular molecule is not working properly in T-cells, the body will attack itself. This is significant for stem-cell transplantation treatment because it means the immune systems of the patients could consider their own cells "foreign" and initiate an attack.
"So your own cells would be killing you," says Thangavelu, a PhD student specializing in immunology, who was the first author in the research study, which was recently published in the peer-reviewed Journal of Autoimmunity. "What we found is if this molecule is absent in T-cells, if the pathway isn't intact, it will cause severe autoimmunity to the subject's own body. In essence, subjects become allergic to their own cells."
Anderson, an associate professor with the Alberta Diabetes Institute and Principal Investigator added: "The ability of our immune system to attack dangerous microbes while not attacking our own cells or tissues is a delicate balance. Restarting the immune system after wiping it out in patients with autoimmune diseases or cancer requires re-establishing this appropriate balance. We discovered that a particular immune system molecule is critical to prevent the immune system from attacking our own cells or tissues when the immune system is restarted. If that molecule is missing, the immune system will wreak havoc on the body."
T-cells are supposed to protect people and animals from things invading their bodies. But this research demonstrates if these cells become unregulated because they are missing a molecule, it can lead to autoimmunity – particularly dangerous in scenarios where patients have lost white blood cells when they are being treated for autoimmune diseases or cancer.
Thangavelu has won awards for this research. He was invited to present his work at an international conference of immunology in Japan last year. He has also travelled to the United Kingdom to talk about his findings with the medical community.
**Source: University of Alberta Faculty of Medicine & Dentistry
Tired neurons caught nodding off in sleep-deprived rats
A new study in rats is shedding light on how sleep-deprived lifestyles might impair functioning without people realizing it. The more rats are sleep-deprived, the more some of their neurons take catnaps – with consequent declines in task performance. Even though the animals are awake and active, brainwave measures reveal that scattered groups of neurons in the thinking part of their brain, or cortex, are briefly falling asleep, scientists funded by the National Institutes of Health have discovered. "Such tired neurons in an awake brain may be responsible for the attention lapses, poor judgment, mistake-proneness and irritability that we experience when we haven't had enough sleep, yet don't feel particularly sleepy," explained Giulio Tononi, M.D., Ph.D., of the University of Wisconsin-Madison. "Strikingly, in the sleep-deprived brain, subsets of neurons go offline in one cortex area but not in another – or even in one part of an area and not in another."
Tononi and colleagues report their findings online in the April 28, 2011 issue of the journal Nature. Their study was funded in part by the NIH's National Institute of Mental health and a NIH Director's Pioneer Award, supported through the Common Fund, and administered by NIMH and the National Institute on Neurological Disorders and Stroke.
Previous studies had hinted at such local snoozing with prolonged wakefulness. Yet little was known about how underlying neuronal activity might be changing.
To learn more, the researchers tracked electrical activity at multiple sites in the cortex as they kept rats awake for several hours. They put novel objects into their cages – colorful balls, boxes, tubes and odorous nesting material from other rats. The sleepier the rats got, more subsets of cortex neurons switched off, seemingly randomly, in various localities. These tired neurons' electrical profiles resembled those of neurons throughout the cortex during NREM or slow wave sleep. Yet, the rats' overall EEG, a measure of brain electrical activity at the scalp, confirmed that they were awake, as did their behavior. So neuronal tiredness differs from more overt microsleep – 3-15-second lapses with eyes closing and sleep-like EEG – that is sometimes experienced with prolonged wakefulness. It is more analogous to local lapses seen in some forms of epilepsy, suggest the researchers.
However subtle, having tired neurons did interfere with task performance. If neurons switched off in the motor cortex within a split second before a rat tried to reach for a sugar pellet, it decreased its likelihood of success by 37.5 percent. And the overall number of such misses increased significantly with prolonged wakefulness. This suggests that tired neurons, and accompanying increases in slow wave activity, might help to account for the impaired performance of sleep-deprived people who may seem behaviorally and subjectively awake.
Subsets of neurons going offline with longer wakefulness is, in many ways, the mirror image of progressive changes that occur during recovery sleep following a period of sleep deprivation. Tononi suggests that both serve to maintain equilibrium – part of the compensatory mechanisms that regulate sleep need. Just as sleep deprivation produces a brain-wide state of instability, it may also trigger local instability in the cortex, possibly by depleting levels of brain chemical messengers. So, tired neurons might nod off as part of an energy-saving or restorative process for overloaded neuronal connections.
"Research suggests that sleep deprivation during adolescence may have adverse emotional and cognitive consequences that could affect brain development," noted NIMH Director Thomas R. Insel, M.D. "The broader line of studies to which this belongs, are, in part, considering changes in sleep patterns of the developing brain as a potential index to the health of neural connections that can begin to go awry during the critical transition from childhood to the teen years."
Tononi and colleagues report their findings online in the April 28, 2011 issue of the journal Nature. Their study was funded in part by the NIH's National Institute of Mental health and a NIH Director's Pioneer Award, supported through the Common Fund, and administered by NIMH and the National Institute on Neurological Disorders and Stroke.
Previous studies had hinted at such local snoozing with prolonged wakefulness. Yet little was known about how underlying neuronal activity might be changing.
To learn more, the researchers tracked electrical activity at multiple sites in the cortex as they kept rats awake for several hours. They put novel objects into their cages – colorful balls, boxes, tubes and odorous nesting material from other rats. The sleepier the rats got, more subsets of cortex neurons switched off, seemingly randomly, in various localities. These tired neurons' electrical profiles resembled those of neurons throughout the cortex during NREM or slow wave sleep. Yet, the rats' overall EEG, a measure of brain electrical activity at the scalp, confirmed that they were awake, as did their behavior. So neuronal tiredness differs from more overt microsleep – 3-15-second lapses with eyes closing and sleep-like EEG – that is sometimes experienced with prolonged wakefulness. It is more analogous to local lapses seen in some forms of epilepsy, suggest the researchers.
However subtle, having tired neurons did interfere with task performance. If neurons switched off in the motor cortex within a split second before a rat tried to reach for a sugar pellet, it decreased its likelihood of success by 37.5 percent. And the overall number of such misses increased significantly with prolonged wakefulness. This suggests that tired neurons, and accompanying increases in slow wave activity, might help to account for the impaired performance of sleep-deprived people who may seem behaviorally and subjectively awake.
Subsets of neurons going offline with longer wakefulness is, in many ways, the mirror image of progressive changes that occur during recovery sleep following a period of sleep deprivation. Tononi suggests that both serve to maintain equilibrium – part of the compensatory mechanisms that regulate sleep need. Just as sleep deprivation produces a brain-wide state of instability, it may also trigger local instability in the cortex, possibly by depleting levels of brain chemical messengers. So, tired neurons might nod off as part of an energy-saving or restorative process for overloaded neuronal connections.
"Research suggests that sleep deprivation during adolescence may have adverse emotional and cognitive consequences that could affect brain development," noted NIMH Director Thomas R. Insel, M.D. "The broader line of studies to which this belongs, are, in part, considering changes in sleep patterns of the developing brain as a potential index to the health of neural connections that can begin to go awry during the critical transition from childhood to the teen years."
**Source: NIH/National Institute of Mental Health
Demuestran la ineficacia de la quimioterapia en enfermos con melanoma uveal
Un estudio del Instituto Catalán de Oncologia (ICO) ha demostrado la ineficacia de la quimioterapia en enfermos con melanoma uveal que haya hecho metástasis, según publica la revista Melanoma Research.
En estos casos, según el ICO, la administración de quimioterapia no ofrece beneficios ni mejora el pronóstico ni la supervivencia del paciente.El melanoma uveal es un tumor maligno que se origina en los melanocitos, que son las células pigmentadas que hay en la uvea y que dan color al ojo.
La incidencia de este tipo de tumor es muy baja y se registra en uno de cada 100.000 habitantes al año en España.
El tratamiento más habitual es la extracción del ojo aunque desde hace unos años se ensayan otros tratamientos alternativos como la radioterapia de intensidad modulada, la fotocoagulación, la termoterapia o la braquiterapia.
Si el tumor se diagnostica a tiempo, el pronóstico, después de la extracción del ojo, es bueno. No obstante, casi el 30 % de los enfermos desarrollan metástasis a distancia, en otras partes del cuerpo, fundamentalmente en el hígado, que resultan incurables.
Los resultados del estudio que ahora se publica en la revista especializada Melanoma Research parten de la evolución de 60 pacientes del ICO, la mitad de los cuales recibieron tratamiento de quimioterapia, y demuestran que el tratamiento no mejora la supervivencia.
El ICO tiene previsto iniciar en las próximas semanas el primer ensayo clínico con un fármaco inmunomodulador que ya ha demostrado sus beneficios en la superviviencia de pacientes con melanoma cutáneo pero que no se ha estudiado nunca en el caso de melanoma uveal.
La realización de ensayos en enfermedades de baja incidencia son muy difíciles ya que requieren muchos recursos económicos y no son rentables para la industria farmacéutica.
**"EFE"
En estos casos, según el ICO, la administración de quimioterapia no ofrece beneficios ni mejora el pronóstico ni la supervivencia del paciente.El melanoma uveal es un tumor maligno que se origina en los melanocitos, que son las células pigmentadas que hay en la uvea y que dan color al ojo.
La incidencia de este tipo de tumor es muy baja y se registra en uno de cada 100.000 habitantes al año en España.
El tratamiento más habitual es la extracción del ojo aunque desde hace unos años se ensayan otros tratamientos alternativos como la radioterapia de intensidad modulada, la fotocoagulación, la termoterapia o la braquiterapia.
Si el tumor se diagnostica a tiempo, el pronóstico, después de la extracción del ojo, es bueno. No obstante, casi el 30 % de los enfermos desarrollan metástasis a distancia, en otras partes del cuerpo, fundamentalmente en el hígado, que resultan incurables.
Los resultados del estudio que ahora se publica en la revista especializada Melanoma Research parten de la evolución de 60 pacientes del ICO, la mitad de los cuales recibieron tratamiento de quimioterapia, y demuestran que el tratamiento no mejora la supervivencia.
El ICO tiene previsto iniciar en las próximas semanas el primer ensayo clínico con un fármaco inmunomodulador que ya ha demostrado sus beneficios en la superviviencia de pacientes con melanoma cutáneo pero que no se ha estudiado nunca en el caso de melanoma uveal.
La realización de ensayos en enfermedades de baja incidencia son muy difíciles ya que requieren muchos recursos económicos y no son rentables para la industria farmacéutica.
**"EFE"
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