Symbolic dynamics marker of heart rate variability combined with clinical variables enhance obstructive sleep apnea screening.

Many sleep centres try to perform a reduced portable test in order to decrease the number of overnight polysomnographies that are expensive, time-consuming, and disturbing. With some limitations, heart rate variability (HRV) has been useful in this task. The aim of this investigation was to evaluate if inclusion of symbolic dynamics variables to a logistic regression model integrating clinical and physical variables, can improve the detection of subjects for further polysomnographies. To our knowledge, this is the first contribution that innovates in that strategy. A group of 133 patients has been referred to the sleep center for suspected sleep apnea. Clinical assessment of the patients consisted of a sleep related questionnaire and a physical examination. The clinical variables related to apnea and selected in the statistical model were age (p < 10(-3)), neck circumference (p < 10(-3)), score on a questionnaire scale intended to quantify daytime sleepiness (p < 10(-3)), and intensity of snoring (p < 10(-3)). The validation of this model demonstrated an increase in classification performance when a variable based on non-linear dynamics of HRV (p < 0.01) was used additionally to the other variables. For diagnostic rule based only on clinical and physical variables, the corresponding area under the receiver operating characteristic (ROC) curve was 0.907 (95% confidence interval (CI) = 0.848, 0.967), (sensitivity 87.10% and specificity 80%). For the model including the average of a symbolic dynamic variable, the area under the ROC curve was increased to 0.941 (95% = 0.897, 0.985), (sensitivity 88.71% and specificity 82.86%). In conclusion, symbolic dynamics, coupled with significant clinical and physical variables can help to prioritize polysomnographies in patients with a high probability of apnea. In addition, the processing of the HRV is a well established low cost and robust technique.

[Emergency cesarean in a patient with Coffin-Siris syndrome]. / Cesárea urgente en una paciente con síndrome de Coffin-Siris.

Coffin-Siris syndrome is a rare genetic disease characterized by coarse facial features, sparse scalp hair, hirsutism, hypoplasia of the distal phalanges, hypoplastic nail in the fifth digit, and mental retardation and delayed growth evident in both weight and height. Most cases are sporadic, but the possibility of recessive or dominant autosomal inheritance has been suggested. Facial abnormalities that make intubation difficult and mental retardation that interferes with cooperation are aspects of this disease that can affect the choice of type of anesthesia. We report the case of a parturient with Coffin-Siris syndrome who refused epidural analgesia for labor pain and for whom the obstetrician later decided that an emergency cesarean was necessary due to fetal distress.

Serum lipids, body mass index and waist circumference during pubertal development in Spanish adolescents: the AVENA Study.

AIM: To describe the effects of chronological age and biological age (pubertal development) on serum lipid and lipoprotein levels, body mass index (BMI) and waist circumference in Spanish adolescents. METHODS: A representative Spanish sample of 526 adolescents (254 males and 272 females), were studied. Total cholesterol (TC), high density lipoprotein cholesterol (HDLc), triglycerides, apolipoprotein A1 and B, and lipoprotein(a) were measured, and low density lipoprotein cholesterol (LDLc) was calculated. Additional measurements included BMI and waist circumference. Adolescents were classified according to chronological age, and pubertal development (also age of menarche in females). RESULTS: In males, serum TC levels were lower at late puberty in comparison with early puberty, and serum LDLc levels were lower at late puberty in comparison with mid and early puberty. Serum HDLc levels were lower at mid puberty in comparison with early and late puberty. Serum TC and LDLc levels were not different when analyzed according to chronological age. In females, HDLc levels were lower at late puberty in comparison with early and mid puberty, but no differences were found when HDLc and the other studied lipid and lipoprotein variables were analyzed according to chronological age, or age of menarche. All the observed differences persisted after adjusting for BMI and waist circumference. In female adolescents, both BMI and waist circumference were higher at late puberty in comparison with early and mid puberty, while in males, BMI and waist circumference were different when analyzed according to chronological age. CONCLUSION: The results suggest that the assessment of pubertal development may provide additional valuable information when interpreting lipid profile and body fat in adolescents.

Aspectos fisiológicos deportivos del futbolista de elite / Physiologic characteristics of elite football (soccer) players

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Sauna-induced rapid weight loss decreases explosive power in women but not in men.

This study aimed at investigating to what extent sauna-induced dehydration is effective to rapidly decrease body weight and whether this practice alters strength and/or explosive power (jump capacity) in healthy athletes. We also investigated whether the observed changes could be rapidly reversed through rehydration. Six male (aged 21.6 +/- 1.8 y) and six female (aged 24.5 +/- 3.7 y) athletes who were not familiar with weight cutting procedures were tested on three occasions: 1) before sauna, 2) after three consecutive sauna sessions (3 x 20 min at 70 degrees C, with 5 min rest interval), and 3) after one hour rehydration period (2.5 ml/kg body weight every 15 min). For rehydration, a carbohydrate beverage (6.3 % glucose, 9.5 mmol/l Na (+), 10 degrees C) was used. Evaluation consisted of body composition, strength (row-strength, handgrip-strength) and jump capacity (squat jump, counter-movement jump and elastic capacity). Sauna-induced dehydration, significantly decreased body weight in men (- 1.8 +/- 0.5 %) and women (-1.4 +/- 0.6 %). This reduction could not be rapidly reversed through rehydration. This weight cutting scheme did not affect strength or jump capacity in men. In women, a statistically significant decrease in squat jump was manifested after rehydration compared to pre-sauna values 23.7 +/- 2.2 vs. 25.2 +/- 1.4 cm, p < 0.05). The squat jump decrease in women was linearly and directly related to the percent reduction of body weight.

Acute exposure to moderate high altitude decreases growth hormone response to physical exercise in untrained subjects.

AIM: Physical exercise in recreational mountain sports is frequently performed without acclimatization to hypoxic conditions. Hypoxia may modify the hormonal and metabolic adaptive response to exercise depending on the type of exercise and on the physical fitness of the subject. This study aims at investigating the growth hormone (GH) response to submaximal exercise after acute exposure to moderate high altitude. METHODS: Ten trained (T) and 10 untrained (UT) male volunteers (mean age 23.8+/-3.2 y) underwent, in random order, 2 submaximal exercise (ergocycle) tests of the same absolute intensity. One test was performed at their habitual living altitude (690 m above sea level); the other, after acute exposure to 2325 m above sea level. Plasma levels of GH, Insulin-like growth factor-1 (IGF-1) and lactate were measured before and immediately after the exercise tests. RESULTS: Plasma GH levels increased after exercise (p<0.05) in both experimental conditions, and for both T and UT subjects. Hypoxia decreased the GH-IGF-1 response to exercise in the UT group. By contrast, the GH-IGF-1 response to exercise was not modified in the T group. The increase in plasma lactate levels induced by exercise was much higher in the UT than in the T group, and it was not affected by hypoxia. CONCLUSION: Acute exposure to hypoxia blunts the GH response to submaximal physical exercise in untrained individuals.

Estudios observacionales vs experimentales: casualidad y asociación vs causalidad / Observational vs experimental studies: fortuitous and association vs causality

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Hydrothermal synthesis and structural characterization of the (C(n)H(2n+6)N(2)[Mn(3)(HPO(3))4] (n = 3-8) new layered inorganic-organic hybrid manganese(II) phosphites. Crystal structure and spectroscopic and magnetic properties of (C(3)H(12)N(2)[Mn(3)(HPO(3))4].

The (C(n)H(2n+6)N(2))[Mn(3)(HPO(3))(4)] (n = 3-8) compounds have been prepared by hydrothermal synthesis and characterized by X-ray diffraction data and spectroscopic techniques. The crystal structure of (C(3)H(12)N(2))[Mn(3)(HPO(3))(4)] has been solved from single-crystal X-ray diffraction. The unit-cell parameters are a = 9.502(1), b = 5.472(1), c = 14.523(4) A, beta = 95.01(3) degrees, monoclinic, C2/m, with Z = 2. The compound shows a layered structure stacked along the c-axis with the alkyldiammonium cations placed in the interlayer space. The sheets are formed by Mn(3)O(12) trimer units extended in the ab-plane and connected by (HPO(3))(2-) anions. The study of the (C(n)H(2n+6)N(2))[Mn(3)(HPO(3))(4)] (n = 4-8) phases by X-ray powder diffraction indicates an isotype relation with the propanediammonium compound. The Dq and Racah parameters calculated for (C(3)H(12)N(2))[Mn(3)(HPO(3))(4)] are Dq = 880, B = 660 and C = 3610 cm(-1). The ESR spectra show isotropic signals with a g-value of 2.008. Magnetic measurements indicate the presence of antiferromagnetic interactions inside the [Mn(3)(HPO(3))(4)](2-) sheets. The J/K value has been estimated to be -15 K by considering that the system behaves like an isolated trimer at high temperatures.

[Nutrition in the sport practice: adaptation of the food guide pyramid to the characteristics of athletes diet]. / La nutrición en la práctica deportiva: adaptación de la pirámide nutricional a las características de la dieta del deportista.

In spite of all the advances in sport nutrition and the importance of an adequate food intake in order to improve sport performance, both recreational and professional athletes forget frequently to include planning an optimum diet and fluid intake in their global strategy for performance. Physiological and metabolic adaptations produced as a consequence of physical exercise lead to the necessity of increasing caloric (in accordance to energy output) and protein (based on the trophic needs of the organism) intake. Likewise, paying major attention to vitamin and mineral intake, specifically B vitamins and zinc and chromium, is required, in order to optimize carbohydrate metabolism, the ultimate limiting factor for sport performance. During the training phase, 60% of calories should come from carbohydrates, protein intake should be 1.2-2 g/kg/day and athletes should follow the recommendations of the food guide pyramid. During the pre-, per- and post-competition phase the healthy aspect of the diet passes to a second level, in order to obtain good sport performance and to guarantee a fast and effective recovery. Again, carbohydrates with a high or medium glycaemic index and water are the nutrients which have to be calculated more thoroughly. In conclusion, athletes have to follow a diet that is adequate to their higher energy output and to their higher metabolic turnover. The food guide pyramid is a graphic expression which facilitates the comprehension and following of a healthy diet. In the present article, the authors introduce the pyramid adapted to the characteristics of sports nutrition, with easy-to-follow practical recommendations regarding the kind and amounts of foodstuffs that should be consumed in order to cover nutrient needs of people who exercise regularly.

A new inorganic-organic hybrid iron(III) arsenate: (C2H10N2)[Fe(HAsO4)2(H2AsO4)](H2O). Hydrothermal synthesis, crystal structure, and spectroscopic and magnetic properties.

A new iron(III) arsenate templated by ethylenediamine, (C2H10N2) [Fe(HAsO4)2(H2AsO4)](H2O), has been prepared by hydrothermal synthesis. The unit-cell parameters are a = 8.705(3) A, b = 16.106(4) A, c = 4.763(1) A, beta = 90.63(3) degrees; monoclinic, P2(1) with Z = 2. The compound exhibits a chain structure along the c-axis with the ethylenediammonium cations as counterion. The chains show isolated FeO6 octahedra with two HAsO4 and one H2AsO4 tetrahedra per FeO6 octahedron. The ESR spectrum at 5.0 K is isotropic with a g-value of 2.0, which remains practically unchanged at room temperature. Magnetic measurements indicate the presence of antiferromagnetic interactions. A value of -0.835 K for the J-exchange parameter has been calculated by fitting the magnetic data to a model for antiferromagnetic chains of spin S = 5/2.

[The application of the hybridization in colonies technic for the identification of toxigenic Vibrio cholerae 01]. / Aplicación de la técnica de hibridación en colonias para la identificación de Vibrio cholerae 01 toxigénico.

By means of the polymerase chain reaction (PCR) it was obtained a probe for the gen that codifies the subunit B of cholerae toxin (CTxB), which carried a Vibrio cholerae 01 reference strain. The checking of the amplified product was performed by using the hybridization techniques in colonies. This product hybridized with the gen that codifies for the subunit B of cholerae toxin isolated from Peru and Ecuador, representing the present epidemics in Latin America, but it did not so with the phylogenetically related strains.

[Microscopic polyarteritis]. / Poliarteritis microscópica.

The microscopic polyarteritis is a vasculitis related to necrotizing glomerolunephritis. It always damages at renal and systemic level (a third of the cases presented hemorrhage alveolar). We have showed a case that took place with hemoptysis and renal progressive insufficiency. Among the patient antecedents, we can find arterial hypertension hematuria, rhinitis, epistaxis and artromyalgias. Just before his admittance it showed edemas on lower limbs and eyelids, dysnea, severe hemoptysis, paresthesias and general malaise. The immunologic analysis: Acs. glomerular basal antimembrane: negative, ANCA positive with antimieloperoxidasa specificity. The renal biopsy: focal necrotizing glomerulonephritis with semilunar and negative immunofluorescent. The nasas biopsy: unspecified chronic rhinitis. From the clinic point of view, the patient seemed to have the Wegener granulomatosis apart from the fact that he had hemoptysis which is a rare sign in this cases. However, we could not find any granuloma anatomopatologically, which did not clarify this diagnosis. We diagnosed microscopis Poliarteritis, as a third of the cases presented intrapulmonary haemorrhage. Moreover the renal damage it is identical than in the in Wegener granulomatosis. On the top of that, often we can find p-ANCA, which confirms the diagnosis in 99% of cases. Despite our doubt according to the diagnosis the therapeutical treatment of both illnesses is nowadays identical. This means that we were able to begin a precocious treatment with plasmapheresis, metilprednisolona and ciclofosfamida. After a week treatment there was an evident improvement. Five moth later the illness relapsed.

[Microscopic polyarteritis]. / Poliarteritis microscópica.

Microscopic polyarteritis is a type of vasculitis that shows similar characteristics to other illnesses from the same group. This group presents a common clinical fact: a rapidly progressive glomerulonephritis. We specially point out among this group of illnesses the Wegener granulomatosis. The anti-neutrophil cytoplasmic antibodies is important for two different reasons. The fact that sometimes they have allowed to make differential diagnosis and that they represents so far the only serologic marking of such vasculitis. The ANCA antimieloperoxidasa (p-ANCA) can be found in a greater level in microscopic poliarteritis as well as the antiproteinasa-3 (c-ANCA) in the Wegener granulomatosis. The current revision tries to clarify the differential diagnosis of the microscopic poliarteritis, which nowadays is still quite vague. This lack can be compensated thanks to the fact that the therapeutic treatment of this group of illnesses is very similar.