Heat-Resistant Aphanizomenon flos-aquae (AFA) Extract (Klamin®) as a Functional Ingredient in Food Strategy for Prevention of Oxidative Stress.

Microalgae are generally considered an excellent source of vitamins, minerals, and bioactive molecules that make them suitable to be introduced in cosmetics, pharmaceuticals, and food industries. Aphanizomenon flos-aquae (AFA), an edible microalga, contains numerous biomolecules potentially able to prevent some pathologies including age-related disorders. With the aim to include an AFA extract (Klamin®) as a functional ingredient in baked products, we investigated if its bioactive molecules are destroyed or inactivated after standard cooking temperature. The AFA extract was exposed to heat stress (AFA-HS), and no significant decrease in pigment, polyphenol, and carotenoid content was detected by spectroscopic analysis. Thermal stability of AFA-HS extract was demonstrated by thermogravimetric analysis (TGA), and no change in the morphology of the granules of the powder was noticed by SEM microscopic observation. By Folin-Ciocalteu, ORAC, and ABTS assays, no change in the antioxidant activity and polyphenol contents was found after high-temperature exposition. When added in cell culture, solubilized AFA-HS lost neither its scavenging ability against ROS generation nor its protective role against Abeta, the main peptide involved in Alzheimer's disease. Prebiotic and antioxidant activities of AFA extract that are not lost after thermal stress were verified on E. coli bacteria. Finally, AFA-HS cookies, containing the extract as one of their ingredients, showed increased polyphenols. Here, we evaluate the possibility to use the AFA extract to produce functional food and prevent metabolic and age-related diseases.

Hyperbaric oxygen therapy in Plastic Surgery practice: case series and literature overview.

Hyperbaric oxygen therapy (HBOT) is the use of 100% oxygen at pressures more than atmospheric. Several approved applications and indications exist for HBOT in the literature. Non-healing wounds, such as diabetic and vascular insufficiency ulcers, have 1 Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University Hospital of Padova, Padova, Italy 2 Department of Physiology, University of Padova, Padova, Italy Corresponding author: Ilaria Tocco-Tussardi, e-mail: ilaria.toccotussardi@gmail.com © Copyright 2019, CIC Edizioni Internazionali, Romabeen a major area of application, and the use of HBOT as an adjunct has been approved by several studies and trials. HBOT is also indicated for acute soft tissue infections like clostridial myonecrosis, necrotising soft tissue infections, as also for traumatic wounds, crush injury, compartment syndrome, and compromised skin grafts and flaps. Another major area of application of HBOT is radiation-induced wounds. With increasing availability of chambers and studies proving the benefits of use, HBOT should be considered as an essential part of the overall management strategy for plastic surgeons.

Structural connectome of the human vestibular, pre-motor, and navigation network.

The aim of this study is to characterize modules and hubs within the multimodal vestibular system and, particularly, to test the centrality of posterior peri-sylvian regions. Structural connectivity matrices from 50 unrelated healthy right-handed subjects from the Human Connectome Project (HCP) database were analyzed using multishell diffusion-weighted data, probabilistic tractography (constrained spherical-deconvolution informed filtering of tractograms) in combination with subject-specific grey matter parcellations. Network nodes included parcellated regions within the vestibular, pre-motor and navigation system. Module calculation produced two and three modules in the right and left hemisphere, respectively. On the right, regions were grouped into a vestibular and pre-motor module, and into a visual-navigation module. On the left this last module was split into an inferior and superior component. In the thalamus, a region comprising the mediodorsal and anterior complex, and lateral and inferior pulvinar, was included in the ipsilateral navigation module, while the remaining thalamus was clustered with the ipsilateral vestibular pre-motor module. Hubs were located bilaterally in regions encompassing the inferior parietal cortex and the precuneus. This analysis revealed a dorso-lateral path within the multi-modal vestibular system related to vestibular / motor control, and a ventro-medial path related to spatial orientation / navigation. Posterior peri-sylvian regions may represent the main hubs of the whole modular network.

Cerebellar compartments for the processing of kinematic and kinetic information related to hindlimb stepping.

We previously showed that proprioceptive sensory input from the hindlimbs to the anterior cerebellar cortex of the cat may not be simply organized with respect to a body map, but it may also be distributed to multiple discrete functional areas extending beyond classical body map boundaries. With passive hindlimb stepping movements, cerebellar activity was shown to relate to whole limb kinematics as does the activity of dorsal spinocerebellar tract (DSCT) neurons. For DSCT activity, whole limb kinematics provides a solid functional framework within which information about limb forces, such as those generated during active stepping, may also be embedded. In this study, we investigated this idea for the spinocerebellar cortex activity by examining the activity of cerebellar cortical neurons during both passive bipedal hindlimb stepping and active stepping on a treadmill. Our results showed a functional compartmentalization of cerebellar responses to hindlimb stepping movements depending on the two types of stepping and strong relationships between neural activities and limb axis kinematics during both. In fact, responses to passive and active stepping were generally different, but in both cases their waveforms were related strongly to the limb axis kinematics. That is, the different stepping conditions modified the kinematics representation without producing different components in the response waveforms. In sum, cerebellar activity was consistent with a global kinematics framework serving as a basis upon which detailed information about limb mechanics and/or about individual limb segments might be imposed.

Nonlinear mitigation on subcarrier-multiplexed PM-16QAM optical systems.

We report a comprehensive set of experimental, simulation and analytical results on the benefit of nonlinear mitigation strategies for multi-subcarrier (MSC) PM-16QAM transmission systems. First, we demonstrate ~9% maximum reach gain enabled by symbol-rate optimization (SRO) of MSC-PM-16QAM in a 31 channels WDM transmission experiment. Then, we demonstrate that, in the considered experimental scenario, the gain provided by digital backpropagation (DBP) over single-carrier (SC) transmission is similar to that achieved by SRO over MSC transmission. Furthermore, we show that the SRO phenomenon can be weakened after self-channel interference (SCI) removal through DBP. As a result, and due to DBP performance limitations in the experiment, the combined effect of SRO and DBP was found to enable only an additional 4% gain in maximum reach. Finally, we address the impact and symbol-rate dependence of nonlinear phase noise (NLPN) in MSC-PM-16QAM transmission, discussing on the NLPN mitigation capability of standard carrier phase estimation (CPE) and on respective gains that could be achieved through its enhanced mitigation.

Hypothermia attenuates NO production in anesthetized rats with endotoxemia.

Sepsis is often associated with upregulation of nitric oxide production and fever, and it is common to control an excessive febrile response with antipyretic therapy and external cooling. Our aim was to evaluate the effect of hypothermia on NO production in a model of septic shock. Rats were anesthetized, ventilated, and instrumented for hemodynamic monitoring and divided into four groups. Normothermic controls (NC) received saline intravenously and were maintained at 37 °C. Hypothermic controls (HC) received saline but were allowed to become hypothermic. Normothermic endotoxic (NE) received Escherichia Coli lipopolysaccharides (LPS) intravenously to induce endotoxic shock and was maintained at 37 °C. Hypothermic endotoxic (HE) received LPS intravenously and was allowed to become hypothermic. Exhaled NO (NOe) was measured from mixed expired gas at time zero and every 30 min, for 5 h. After injection of LPS, NOe increased substantially in the NE group (700 ± 24 ppb), but increased only to 25 ± 2 ppb in the HE group. NOe increased to 90 ± 3 ppb in the NC group, and to 17.6 ± 3.1 ppb in the HC group after 5 h (P < 0.05), whilst blood pressure remained stable. In the HE group, blood pressure fell immediately after injection of the LPS, but thereafter remained stable despite the rise in NOe. In the NE group, the blood pressure fell gradually, and the animals became hypotensive. During the natural course of endotoxemia in anesthetized rats, allowing severe hypothermia to ensue by not actively managing temperature and hemodynamics resulted in significantly reduced expired NO concentrations, lung injury, and prolonged survival. The clinical benefits of such a finding currently remain unclear and merit further investigation.

Compatibility between coherent reflective burst-mode PON and TWDM-PON physical layers.

We discuss the compatibility between reflective PON architectures and the recently defined ITU-T G.989.1 TWDM-PON. Focusing on the upstream, we experimentally demonstrate that, by using burst-mode coherent detection at OLT, reflective PON can achieve the specification target set for TWDM-PON, without requiring precise wavelength accuracy at ONU. Compared to the companion ECOC 2013 paper, we investigate on the differential optical path loss (DOPL) issue, proposing a simple SOA gain control algorithm to achieve reliable transmission for DOPL up to 17 dB.

1306-km 20x124.8-Gb/s PM-64QAM transmission over PSCF with net SEDP 11,300 (b ∙ km)/s/Hz using 1.15 samp/symb DAC.

We demonstrated the transmission of a Nyquist-WDM signal based on PM-64QAM modulation in an EDFA-only submarine configuration composed of 54.4 km-long fiber spans: 20 channels at 124.8-Gb/s were propagated over 1306 km of low-loss pure-silica-core fiber (PSCF). Thanks to an aggressive digital spectral shaping, we achieved a raw spectral efficiency (SE) of 10.4 b/s/Hz, corresponding to 8.67 b/s/Hz net SE when considering a 20% FEC overhead. Transmitter DACs are operated at a record-low 1.15 samples/symbol, enabled by the insertion of advanced anti-alias filters. The achieved SE-times-distance product was 11,327 (b ∙ km)/(s ∙ Hz), the highest reported so far for PM-64QAM. Combining the experimental results with the performance predictions obtained using an analytical model of nonlinear propagation in uncompensated coherent optical systems (the so-called "GN-model"), we show that PM-64QAM is a realistic option for ultra-high capacity systems in the 1,000 km range, carrying up 40 Tb/s in the C-band.

Results in treatment of distal femur fractures using polyaxial locking plate.

Indications and techniques of locked plate fixation for the treatment of challenging fractures continue to evolve. As design variant of classic locked plates, the polyaxial locked plate has the ability to alter the screw angle and thereby, enhance fracture fixation. The aim of this observational study was to evaluate clinical and radiographic results in 89 patients with 90 fractures of the distal femur treated, between June 2006 and November 2011, with such a polyaxial locked plating system (Polyax™ Locked Plating System, DePuy, Warsaw, IN, USA). Seventy-seven fractures formed the report of this study. These cases were followed up until complete fracture healing or for a mean time of 77 weeks. At the time of last follow-up, 58 of 77 fractures (75.3 %) progressed to union without complication and radiographic healing occurred at a mean time of 16.3 weeks. Complications occurred in ten fractures that did not affect the healing and in nine fractures that showed delayed or non-union. The mean American Knee Society Score at the time of final follow-up was 83 for the Knee Score and 71.1 for the Functional Score. In conclusion, there is a high union rate for complex distal femoral fractures associated with a good clinical outcome in this series.

The role of surgical treatment in the rehabilitation protocols of thoraco-lumbar spine injuries.

BACKGROUND: Rehabilitation is a crucial issue in the management of spinal cord injuries (SCI) but, in these patients, the primary treatment can bias the outcome of recovery protocols. AIM: Purpose of this paper is to review our case load in the treatment of surgical failures and to define the role of surgery in thoraco-lumbar injuries rehabilitation. PATIENTS AND METHODS: Between 2000 and 2009 seventy patients with post-traumatic paraplegia were referred to Surgical Department as rehabilitation was unfeasible due to inadequate spine injury treatment. Forty-six had had surgery, 24 were treated conservatively Twenty-five patients had a thoracic lesion, 9 a lumbar lesion and 36 a lesion of the thoraco-lumbar junction. A total of 44 surgical procedures were performed (by anterior, posterior or anterior-posterior). RESULTS: On postoperative imaging sagittal alignment was found good in 93% of cases and acceptable in 7%. All patients regained the sitting position within 5 days after surgery. Wound healing problems requiring revision were observed in 4 cases. Major complications were a cerebro spinal fluid (CSF) leakage and a massive pulmonary embolism case in the early post-op. CONCLUSIONS: Wrong primary treatment frequently leads to demanding revision procedures with increased risks for the patient and more than double costs for the health care system. Whatever the technique a stable spine is the target in surgery of SCI allowing a quick and effective rehabilitation without external orthosis.

Blocked atrial bi/trigeminy in utero evolving in supraventricular tachycardia after birth.

Transient episodes of fetal bradycardia (heart rate less than 110 bpm) are usually benign and typically result from increased vagal stimulation in the fetus. Causes of sustained fetal bradycardia include sinus bradycardia, blocked atrial bigeminy/trigeminy, high-degree atrioventricular block, and long QT syndrome. We present the case of a 34-year-old Caucasian patient referred to our department for "blocked atrial bigeminy with pseudobradycardia" detected elsewhere at 33 weeks of gestation. A fetal echocardiography showed during all the examination a blocked atrial trigeminy with a mean fetal heart rate of 100 bpm. After birth three subsequent ECGs until day 3 showed no evidence of atrial extrasystoles, confirming the well-known frequent regression of this kind of fetal benign arrhythmia, but on day 11 recurrence of supraventricular trigeminy and development of episodes of paroxystic supraventricular tachycardia were observed. On the basis of this observation, we recommend that fetuses with complex atrial ectopic beats should be closely monitored before and after birth for evidence of new arrhythmias.

Posterior lumbar fusion by peek rods in degenerative spine: preliminary report on 30 cases.

PURPOSE: Pre-curved peek rods to support posterior lumbar fusion have been available in the market since 4 years. Potential advantages using this new technology are increased load sharing on the anterior column promoting interbody fusion, reduced stress on bone-screw interface decreasing the rate of screw mobilization and, in the long term, reduced incidence of adjacent level disc degeneration. METHODS: The authors retrospectively reviewed 30 cases in which posterior fusion was supported by peek rods, analyzing early complications, rate of fusion and clinical outcome. RESULTS: At an average follow-up of 18 months, both clinical and radiographic results were satisfactory with only one case requiring surgical revision for a mechanical complication. CONCLUSIONS: The semi-rigid systems can now be considered a viable option in the lumbar degenerative disease, although clinical evaluations are necessary in the longer term.

The organization of cortical activity in the anterior lobe of the cat cerebellum during hindlimb stepping.

We recorded from over 280 single cortical neurons throughout the medial anterior lobe of the cat cerebellum during passive movements of the hindlimbs resembling stepping on a moving treadmill. We used three stepping patterns, unilateral stepping of either the ipsilateral or contralateral leg and bipedal stepping in an alternating gait pattern. We found that over 60% of the neurons, mostly Purkinje cells, responded to stepping of one or both legs, and over 40% to more than one type of stepping pattern. Responsive cells were distributed throughout the five anterior lobules, and the highest concentration was found in traditional hindlimb areas in lobules 2 and 3. A comparison of response waveforms showed that they are similar for neighboring cells in many parts of the cerebellar cortex, and they tend to form local blob-like groupings. Response patterns, i.e., relationship among responses to each stepping type, tended to be similar within a local group. The groupings extend further in the parasagittal dimension (up to about a third of a lobule) than in the transverse dimension (about 1 mm), and they may form functional modules. A principal component analysis also showed that the responses were composed of a four basis waveforms (principal components) that explained about 80% of the response waveform variance that were nearly identical to those derived from dorsal spinocerebellar tract (DSCT) responses to similar stepping movements. We reconstructed the locations of the recorded neurons on a 2D map of the cerebellar cortex showing the spatial distribution of responsive cells according to their response characteristics. We propose, on the basis of these results, that the sensory input to the cerebellum from the hindlimbs is distributed to multiple zones that may each contribute to a different component of cerebellar function.

Effect of pre-breathing oxygen at different depth on oxidative status and calcium concentration in lymphocytes of scuba divers.

AIM: In-water pre-breathing oxygen at various depths reduces decompression-induced bubble formation and platelet activation, but it could induce side effects such as oxidative stress. The aim of this study was to investigate the effect of in-water pre-breathing oxygen, at different depths, on the oxidative status and intracellular calcium ([Ca(2+) ]i) of peripheral blood lymphocytes isolated from six divers. They participated in a 4-diving protocol. Two week recovery time was allowed between successive dives. Before diving, all divers, for 20 min, breathed normally at sea level (dive 1), 100% oxygen at sea level (dive 2), 100% oxygen at 6 msw (dive 3), 100% oxygen at 12 msw (dive 4). Then they dived to 30 msw for 20 min with air tank. METHODS: Blood samples were collected before and after each dive. Hydrogen peroxide (H(2) O(2) ) levels, catalase (CAT) activity, mRNA expression of CAT, glutathione peroxidase (GPx) and superoxide dismutase (SOD), and the [Ca(2+) ]i in lymphocytes were measured. RESULTS: The dives slightly decreased lymphocyte number and significantly reduced lymphocyte H(2) O(2) levels. CAT activity was higher after scuba diving and, dive 3 enhanced mRNA gene expression of CAT, GPx and SOD. The [Ca(2+) ]i was higher after dive 1 and 2 than pre-diving, while was maintained at pre-diving value after dive 3 and 4. CONCLUSION: Our results suggest that pre-breathing oxygen, in particular at 12 msw, may enhance lymphocyte antioxidant activity and reduce reactive oxygen species levels. Pre-breathing oxygen in water may also preserve calcium homeostasis, suggesting a protective role in the physiological lymphocyte cell functions.

Analytical results on channel capacity in uncompensated optical links with coherent detection.

Based on a recently introduced model of non-linear propagation, we propose analytical formulas for the capacity limit of polarization-multiplexed ultra-dense WDM uncompensated coherent optical systems at the Nyquist limit, assuming both lumped and ideally distributed amplification. According to these formulas, capacity fundamentally depends on the transmitted power spectral density and on the total optical WDM bandwidth, whereas it does not depend on symbol-rate. Also, capacity approximately decreases by 2 [bit/s/Hz] for every doubling of link length. We show examples of capacity calculations for specific ultra-long-haul links with different polarization-multiplexed (PM) constellations, i.e. ideal PM-Gaussian, PM-QPSK (quadrature-phase shift keying) and PM-QAM (quadrature amplitude modulation). We show that the launch power maximizing capacity is independent of link length and modulation format. We also discuss the usable range of PM-QAM systems and validate analysis with simulations.

Experimental validation of an analytical model for nonlinear propagation in uncompensated optical links.

Link design for optical communication systems requires accurate modeling of nonlinear propagation in fibers. This topic has been widely analyzed in last decades with partial successes in special conditions, but without a comprehensive solution. Since the introduction of coherent detection with electronic signal processing the scenario completely changed because this category of systems shows better performances in links without in-line dispersion management. This change to uncompensated transmission allowed to modify the approach in the study of nonlinear fiber propagation and in recent years a series of promising analytical models have been proposed. In this paper, we present an experimental validation over different fiber types of an analytical model for nonlinear propagation over uncompensated optical transmission links. Considering an ultra-dense WDM system, we transmitted ten 120-Gb/s PM-QPSK signals over a multi-span system probing different fiber types: SSMF, PSCF and NZDSF. A good matching was found in all cases showing the potential of the analytical model for accurate performance estimation that could lead to powerful tools for link design.

Suspeita de Apneia Obstrutiva do Sono definida pelo Questionário de Berlim prediz eventos em pacientes com Síndrome Coronariana Aguda / Suspicion of Obstructive Sleep Apnea by Berlin Questionnaire predicts events in patients with Acute Coronary Syndrome / Sospecha de apnea obstructiva del sueño definida por el cuestionario de Berlín predice eventos en pacientes con síndrome coronario agudo

FUNDAMENTO: De um ponto de vista mecanístico, a apneia obstrutiva do sono (SAOS) pode causar distúrbios extras à homeostase cardiovascular na presença de síndrome coronariana aguda (SCA). OBJETIVO: Investigar se um diagnóstico clínico padronizado de SAOS, em pacientes com SCA, prediz o risco de eventos cardiovasculares durante hospitalização. MÉTODOS: Em um estudo de coorte prospectivo, um grupo de 200 pacientes com diagnóstico de SCA estabelecido entre Setembro de 2005 e Novembro de 2007, foram estratificados pelo Questionário de Berlim (QB) para o risco de SAOS (alto ou baixo risco). Foi testado se o subgrupo de alto risco para SAOS apresenta maior tendência à eventos cardiovasculares. O endpoint primário avaliado foi um desfecho composto de morte cardiovascular, eventos cardíacos isquêmicos recorrentes, edema pulmonar agudo e acidente vascular cerebral durante a hospitalização. RESULTADOS: Noventa e quatro (47 por cento) dos pacientes identificados pelo QB apresentavam suspeita de SAOS. Alto risco para SAOS estava associado com uma mortalidade mais elevada, embora sem diferença estatística (4,25 por cento vs 0,94 por cento; p=0,189), mas com uma estatisticamente significante maior incidência de desfecho composto de eventos cardiovasculares (18,08 por cento vs 6,6 por cento; p=0,016). No modelo de regressão logística, os preditores multivariados de desfecho composto de eventos cardiovasculares foram idade (OR = 1,048; IC95 por cento: 1,008 a 1,090; p=0,019), fração de ejeção do VE (OR = 0,954; IC95 por cento: 0,920 a 0,989; p=0,010), e risco mais elevado de SAOS (OR = 3,657; IC95 por cento: 1,216 a 10,996; p=0,021). CONCLUSÃO: O uso de um questionário simples e validado (QB) para identificar pacientes com risco mais elevado de SAOS pode ajudar a prever o desfecho cardiovascular durante a hospitalização. Além disso, nossos dados sugerem que SAOS é muito comum em pacientes com SCA.

BACKGROUND: From a mechanistic standpoint, obstructive sleep apnea (OSA) may further disturb cardiovascular homeostasis in the setting of acute coronary syndrome (ACS). OBJECTIVE: We sought to investigate if a standardized clinical diagnosis of OSA, in acute coronary syndrome patients, predicts the risk of cardiovascular events during hospitalization. METHODS: In a prospective cohort study, a group of 200 patients diagnosed with ACS between September 2005 and November 2007 were stratified by the Berlin Questionnaire (BQ) regarding the risk for OSA (high or low risk). We tested if the subgroup of high risk for OSA was prone to a higher frequency of cardiovascular events. The primary endpoint evaluated was a composite outcome of cardiovascular death, recurrent cardiac ischemic events, acute pulmonary edema and stroke during hospitalization. RESULTS: Ninety four (47 percent) patients assessed by the BQ were likely to have OSA. High risk for OSA was associated with a non-significant higher mortality (4.25 percent vs 0.94 percent; p=0.189), but a significant higher incidence of composite cardiovascular events (18.08 percent vs 6.6 percent; p=0.016). In the logistic regression model, multivariate predictors of composite cardiovascular events were age (OR= 1.048; 95 percent CI 1.008 to 1.090; p=0.019), left ventricular ejection fraction (OR= 0.954; 95 percent CI 0.920 to 0.989; p=0.010), and higher risk for OSA (OR= 3.657; 95 percent CI 1.216 to 10.996; p=0.021). CONCLUSION: The use of a simple and validated questionnaire (BQ) to identify patients with higher risk for OSA may help in the prediction of cardiovascular outcome during hospitalization. Moreover, our data suggests that OSA is very common in patients with ACS.

FUNDAMENTO: Desde un punto de vista mecanístico, la apnea obstructiva del sueño (SAOS) puede ocasionar disturbios extras a la homeostasis cardiovascular en la presencia del síndrome coronario aguda (SCA) OBJETIVO: Investigar si un diagnóstico clínico estandarizado de SAOS, en pacientes con SCA, predice el riesgo de eventos cardiovasculares durante la hospitalización. MÉTODOS: En un estudio de cohorte prospectivo, un grupo de 200 pacientes con diagnóstico de SCA elecido entre Septiembre de 2005 y Noviembre de 2007, fueron estratificados por el Cuestionario de Berlín (CB) para el riesgo de SAOS (alto o bajo riesgo). Se probó si el subgrupo de alto riesgo para SAOS presenta mayor tendencia a eventos cardiovasculares. El endpoint primario evaluado fue un desenlace conformado por muerte cardiovascular, eventos cardíacos isquémicos recurrentes, edema pulmonar agudo y accidente vascular cerebral durante la hospitalización. RESULTADOS: Noventa y cuatro (47 por ciento) de los pacientes identificados por el CB presentaban sospecha de SAOS. Alto riesgo para SAOS estaba asociado con una mortalidad más elevada, aunque sin diferencia estadística (4,25 por ciento vs 0,94 por ciento; p=0,189), pero con una estadísticamente significativa mayor incidencia de desenlace conformada por eventos cardiovasculares (18,08 por ciento vs 6,6 por ciento; p=0,016). En el modelo de regresión logística, los predictores multivariados de desenlace conformado por eventos cardiovasculares fueron edad (OR= 1,048; IC95 por ciento: 1,008 a 1,090; p=0,019), fracción de eyección del VI (OR= 0,954; IC95 por ciento: 0,920 a 0,989; p=0,010), y riesgo más elevado de SAOS (OR= 3,657; IC95 por ciento: 1,216 a 10,996; p=0,021). CONCLUSIÓN: El uso de un cuestionario sencillo y validado (CB) para identificar a pacientes con riesgo más elevado de SAOS puede ayudar a prever el desenlace cardiovascular durante la hospitalización. Además de ello, nuestros datos sugieren que SAOS es mucho común en pacientes con SCA.

Suspicion of obstructive sleep apnea by Berlin Questionnaire predicts events in patients with acute coronary syndrome.

BACKGROUND: From a mechanistic standpoint, obstructive sleep apnea (OSA) may further disturb cardiovascular homeostasis in the setting of acute coronary syndrome (ACS). OBJECTIVE: We sought to investigate if a standardized clinical diagnosis of OSA, in acute coronary syndrome patients, predicts the risk of cardiovascular events during hospitalization. METHODS: In a prospective cohort study, a group of 200 patients diagnosed with ACS between September 2005 and November 2007 were stratified by the Berlin Questionnaire (BQ) regarding the risk for OSA (high or low risk). We tested if the subgroup of high risk for OSA was prone to a higher frequency of cardiovascular events. The primary endpoint evaluated was a composite outcome of cardiovascular death, recurrent cardiac ischemic events, acute pulmonary edema and stroke during hospitalization. RESULTS: Ninety four (47%) patients assessed by the BQ were likely to have OSA. High risk for OSA was associated with a non-significant higher mortality (4.25% vs 0.94%; p=0.189), but a significant higher incidence of composite cardiovascular events (18.08% vs 6.6%; p=0.016). In the logistic regression model, multivariate predictors of composite cardiovascular events were age (OR= 1.048; 95% CI 1.008 to 1.090; p=0.019), left ventricular ejection fraction (OR= 0.954; 95% CI 0.920 to 0.989; p=0.010), and higher risk for OSA (OR= 3.657; 95% CI 1.216 to 10.996; p=0.021). CONCLUSION: The use of a simple and validated questionnaire (BQ) to identify patients with higher risk for OSA may help in the prediction of cardiovascular outcome during hospitalization. Moreover, our data suggests that OSA is very common in patients with ACS.