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Introduction: Sleep apnoea-hypopnoea syndrome (SAHS) and childhood obesity are two high prevalence conditions that represent a public health challenge. Objective: To analyse the association between both and comparing child groups that had or did not have both conditions. Patients and methods: A prospective study in children (3–14 years), referred to the “Multidisciplinary Sleep Unit” due to suspected SAHS, between 1 November 2015 and 1 August 2017. The following parameters were evaluated: anthropometry, symptoms, blood pressure, ear, nose, and throat examination, polysomnography (nocturnal PSG) and laboratory tests. Results: A total of 67 children were evaluated (64% non-obese (NOb) and 36% obese (Ob). It was observed that the Ob were older (P

A more environmentally friendly replacement for SF6 must be found for medium voltage switchgear, as a change in European regulations will come into force soon. The mixing process of alternative binary and ternary gas mixtures is studied, which are made up of the hydrofluoroolefin HFO-1336mzz(E) (C4F6H2) and the heptafluoroisopropil trifluoromethyl ketone (C5F10O), using dry air or N2 as carrier gases. The mixture's monitoring, meaning the evolution of the concentration concerning time and position, is carried out by UV-VIS spectroscopy technology in a gas chamber that has been designed to be analogous to a medium voltage cell. The mixing process is described using a mathematical model that considers molecular diffusion, Fick’s Law, and natural convection, the effect of gravity. This work aims to configure a tool for predicting the dynamics of gas mixtures of different components, estimating the diffusivities of the mixture's components, and analyzing the behaviors derived from the use of different concentrations.

In this work, binary and ternary gas mixtures of 1,3,3,3-tetrafluoropropene, HF0234ze(E), and perfluoro-(3-methylbutan-2-one), CF3C(0)CF(CF3)2 with CO, and synthetic air, are presented as alternatives to SF6 in medium-voltage electrical equipment. They were used in four medium voltage switchgear cubicles replacing SF6 gas, and after a period of time, under permanent 30 kV AC voltage, gas mixture samples were extracted and analyzed on the same day using a validated methodology' based on gas chromatography (GC) coupled to mass spectrometry (MS) and thermal conductivity (TCD). CF4 (tetrafluoromethane), C2F6 (hexafluoroethane), C,F6 (hexafluoropropylene), C3FIF7 (1,1,1,2,2,3,3-heptafluoropropane), CHF, (difluoromethane), and the cis and trans-C3H2F4 (1,3,3,3 tetrafluoropropene) have been identified as decomposition products in these gas mixtures. In addition, a quantity of water has been observed, as well as CO in one of the cubicles. The most abundant decomposition products identified in gas mixture samples (C3HF7 and C3F6) together with water and CO content have been quantified using commercial gas mixture reference standards. The toxicity and global warming of the analyzed compounds are evaluated to determine the most adequate gas mixture among those studied as a candidate to substitute SF6. This work was supported the Basque Country Government (project Elkartek KK-2017/00090)

Background Noninvasive ventilation (NIV) is an effective form of treatment in obesity hypoventilation syndrome (OHS) with severe OSA. However, there is paucity of evidence in patients with OHS without severe OSA phenotype. Research Question Is NIV effective in OHS without severe OSA phenotype? Study Design and Methods In this multicenter, open-label parallel group clinical trial performed at 16 sites in Spain, we randomly assigned 98 stable ambulatory patients with untreated OHS and apnea-hypopnea index Results Forty-nine patients in the NIV group and 49 in the control group were randomized, and 48 patients in each group were analyzed. During a median follow-up of 4.98 years (interquartile range, 2.98-6.62), the mean hospitalization days per year ± SD was 2.60 ± 5.31 in the control group and 2.71 ± 4.52 in the NIV group (adjusted rate ratio, 1.07; 95% CI, 0.44-2.59; P = .882). NIV therapy, in contrast with the control group, produced significant longitudinal improvement in Paco2, pH, bicarbonate, quality of life (Medical Outcome Survey Short Form 36 physical component), and daytime sleepiness. Moreover, per-protocol analysis showed a statistically significant difference for the time until the first ED visit favoring NIV. In the subgroup with high NIV adherence, the time until the first event of hospital admission, ED visit, and mortality was longer than in the low adherence subgroup. Adverse events were similar between arms. Interpretation In stable ambulatory patients with OHS without severe OSA, NIV and lifestyle modification had similar long-term hospitalization days per year. A more intensive program aimed at improving NIV adherence may lead to better outcomes. Larger studies are necessary to better determine the long-term benefit of NIV in this subgroup of OHS. Trial Registry ClinicalTrials.gov; No.: NCT01405976; URL: www.clinicaltrials.gov

Sleep is considered an essential part of life and plays a vital role in good health and well-being. Equally important as a balanced diet and adequate exercise, quality and quantity of sleep are essential for maintaining good health and quality of life. Sleep-disordered breathing is one of the most prevalent conditions that compromises the quality and duration of sleep, with obstructive sleep apnea (OSA) being the most prevalent disorder among these conditions. OSA is a chronic and highly prevalent disease that is considered to be a true public health problem. OSA has been associated with increased cardiovascular, neurocognitive, metabolic and overall mortality risks, and its management is a challenge facing the health care system. To establish the main future lines of research in sleep respiratory medicine, the Spanish Sleep Network (SSN) promoted the 1st World Café experts' meeting. The overall vision was established by consensus as "Sleep as promoter of health and the social impact of sleep disturbances". Under this leitmotiv and given that OSA is the most prevalent sleep disorder, five research lines were established to develop a new comprehensive approach for OSA management: (1) an integrated network for the comprehensive management of OSA; (2) the biological impact of OSA on comorbidities with high mortality, namely, cardiovascular and metabolic diseases, neurocognitive diseases and cancer; (3) Big Data Analysis for the identification of OSA phenotypes; (4) personalized medicine in OSA; and (5) OSA in children: current needs and future perspectives.

To evaluate the differences in reliability and costs of home respiratory polygraphy (HRP) when installed by the patient and by a nurse, in order to determine the factors affecting and to consider the possible generalization of self-setup procedure. Several HRP devices have been validated for obstructive sleep apnea (OSA) diagnosis but convenience of a nurse intervention in HRP installation has been scarcely studied. This is a prospective and interventional study. About 301 participants were assigned to 2 groups: self-setup and nurse intervention. Sleep study, questionnaires, and diagnostic procedures were performed following the clinical practice in 2016. Signals were considered lost above 3 min, and success of the test was established according to guidelines. Costs were calculated according to a previous multicenter study. Both groups (self-setup and nurse intervention) resulted homogeneous in age, gender, BMI, and final diagnosis of OSA. Signal losses during the test were similar in both groups. Slightly higher percentage of unsuccessful tests were obtained in the self-setup procedure (5.3 vs 2.0%, p = 0.121). The costs were similar (107 vs 105 €) in the self-setup group as compared to the nurse setup group. The setup of HRP by either the patient or nurse had similar costs and data acquisition. Both installation procedures of HRP were similar regarding test reliability and costs. Main findings are that self-installation by the patient could be similarly reliable and economic as installation by a nurse, as far as consensus guidelines are followed. This study demonstrates that self-setup of HRP is a potentially viable option for the diagnosis of OSA.

Insect plagues are a problem often hard to solve due to the harmful effects caused by the pesticides used to combat them. Consequently, the pesticide market is increasingly trying to develop new technologies to prevent the unwanted effects that common plague treatments usually bring with them. In this work, four specific bioattractants of Musca domestica, extracted from fungi (β-ocimene, phenol, p-cresol, and indole) were microencapsulated with β-cyclodextrin in order to produce an economically and environmentally sustainable bait containing biocides in the near future. Cyclodextrins will retain these volatile compounds until their use by the consumer when the product comes into contact with water. Then, the bioattractants will be released in the medium in a controlled manner. An analytical methodology based on headspace extraction coupled to gas chromatography and mass spectrometry (HS-GC/MS) has been developed and validated following Environmental Protection Agency (EPA) and European Commission Directorate General for Health and Food Safety guidelines for the bioattractants controlled release study from the microencapsulated product. The analytical method has been shown to be accurate and precise and has the sensitivity required for controlled release studies of the four bioattractants analyzed. The release of the bioattractants from microencapsulated products achieved the “plateau” after 3 h in all cases. This research was funded by University of the Basque Country (UPV/EHU) (project GIU19/068).

Rationale: Noninvasive ventilation (NIV) is an effective treatment in obesity hypoventilation syndrome (OHS) with severe obstructive sleep apnoea (OSA) but there is paucity of evidence in OHS patients without severe OSA phenotype. Methods: In this multicentre (16 sites in Spain), open-label parallel group clinical trial, we randomly assigned 98 stable ambulatory patients with untreated OHS and apnoea-hypopnoea index Results:49 patients were randomised in each group and 48 patients were analysed in each one of them. During a median [IQR] follow-up of 4.98 [2.98; 6.62] years, mean (SD) hospitalization days/year was 2.60 (5.31) in the control group and 2.71 (4.52) in the NIV group [adjusted rate ratio (95% CI) 1.07 (0.44; 2.59) (p = 0.882)]. Cardiovascular events occurred in 11 (23%) participants in the control group and 10 (21%) in the NIV group (hazard ratio (95% CI) 0.96 (0.40;2.30), p=0.927). Similar results were observed in the per-protocol analysis [rate ratio (95% CI) 1.21 (0.43;3.41) (p=0.717)]. Death occurred in 9 (19%) participants in both arms (adjusted hazard ratio (95% CI) 1.07 (0.41;2.82), p=0.893). Similar results were found in the per-protocol analysis [rate ratio (95% CI) 1.38 (0.50;3.79) (p=0.529)]. Conclusion: In stable ambulatory patients with OHS without severe OSA, NIV and lifestyle modification had similar long-term hospitalization days-year. Larger studies are necessary to better determine the long-term benefit of NIV in this subgroup of OHS.

Rationale: Obesity hypoventilation syndrome (OHS) has been associated with cardiac dysfunction. However, randomized trials have assessing the impact of long-term noninvasive ventilation (NIV) or CPAP on cardiac structure and function assessed by echocardiography are lacking. Methods: In a pre-specified secondary analysis of the largest multicenter randomized controlled trial of OHS〔Pickwick project, n=221 patient with OHS and coexistent severe obstructive sleep apnea (OSA)〕, we compared the effectiveness of 3 years of NIV and CPAP on structural and functional echocardiographic changes. At baseline and annually during 3 sequential years patients underwent transthoracic two-dimensional and doppler echocardiography. Echocardiographers were blinded to the treatment allocation. Statistical analysis was performed using a linear mixed-effects model with a treatment group/repeated measures interaction to determine the differential effect between CPAP and NIV. Results:196 patients were analyzed, 102 treated with CPAP and 94 treated with NIV. Systolic pulmonary artery pressure decreased from 40.5±1.47 mmHg at baseline to 35.3±1.33 mmHg at 3 years with CPAP and from 41.5±1.56 mmHg to 35.5±1.42 with NIV (p Conclusion: In patients with OHS and concomitant severe OSA, long-term treatment with NIV and CPAP led to similar degrees of improvement in pulmonary hypertension and LVDF.

The main methods for dating ballpoint pen inks in questioned documents used up to day are based mainly on the analysis of ink volatile components. These methods have some limitations still unresolved, such as the impossibility for dating documents older than two to five years and the destruction in part or totally of the questioned document after the analysis. This study aims to overcome these drawbacks by exploring the feasibility of dating inks based on their spectroscopic UV–vis-NIR diffuse reflectance spectra monitoring combined with a Partial Least-Squares (PLS) multivariate modelling. Inoxcrom® ink samples were exposed to artificial aging, their reflectance spectra were measured and a multivariate calibration was applied. Mathematical pretreatments of the spectroscopic data were carried out to enhance the prediction ability of the models and the qualitative interpretation of the spectra. The best PLS model was obtained after SNV spectral filter. Accurate predictions (RSD of 25%) were obtained for two of the five pen inks analysed and a correlation between the natural aging and the accelerated artificial aging could be established. Moreover, the spectra region more closely related to the ink aging process could be delimited, in which younger inks were characterized by modifications in the visible and NIR spectra region, while after aging the most influential region was the NIR spectrum. The mismatch with the other three pen inks tested could be attributed to consistent differences in ink formulations. Inks sharing a common chromatographic profile proved to fit correctly in the predictive model indicating that the methodology shows a great potential for future applications in the field of questioned documents dating.

The search of alternative methods associated with the problems of environ-mental health is one of the great challenges of this century. The microencapsulation represents an acceptable choice to face this problem because of the numerous advan-tages which it has in this field. Among these advantages, the possibility of the reduc-tion of the toxicity for the environment and the mammals, the increase of the security in the handling for the worker and the customer, and last but not least the possibility to synthesise hydrosoluble compounds high (the solubility increases, thus the use of toxic and expensive organic solvents is eliminated) can be found.Our research group has synthesised microencapsulated products to be used as baits in the control of insect plagues. These baits contain biocides and natural bioattractants in order to create a more respectful product with the environment and the human being. Moreover, thanks to the use of bioattractants a commercially available more effective and selective product for particular species will be obtained.The microencapsulated biocides are pesticides that belong to the family of the in-secticides like nicotinoid and carbamates; fungicides as tebuconazole and synergists which increase the effectiveness of the pesticides, like piperonyl butoxide. On the other hand, the natural bioattractants are volatile compounds belonging to the family of ter-penes and alcohols. This research group has carried out different methods of microen-capsulation: spray drying, ionic gelation and inclusion complex formation. These mi-croencapsulation methods are fast and efficient using different encapsulation agents like polymers, gums and carbohydrates. Analytical methodologies have been also de-veloped to determine the concentrations of the active compounds and to monitor the release of bioattractants from the encapsulated product. A static headspace coupled to gas chromatography–mass spectrometry (HS-GC/MS) method has been developed and validated for this purpose.The achieved advances in microencapsulation represent a significant milestone to solve the problems associated with environmental health.; XXI. mendeko erronken artean, ingurumen-osasunean kalte egin dezake-ten arazoei aurre egiteko metodo alternatiboen bilaketa aurkitzen da. Arlo honetan, mi-krokapsularatzearen abantaila anitzek arazo horiei aurre egiteko baliozko aukera bat erakusten dute. Abantaila garrantzitsu horien artean aurkitzen dira ingurumenean eta ugaztunetan toxikotasuna murriztea, langileen zein bezeroen manipulazioan segurta-suna hobetzea eta uretan disolbagarritasun baxua duten konposatuen sintesia uretan ahalbidetzea. Horrela, ura disolbatzaile gisa erabiliz, disolbatzaile organiko toxikoen eta garestien erabilpena ekiditen da.Gure ikerkuntza-taldeak intsektuen izurriteen kontroleko amuen parte izango diren produktu mikrokapsularatuak sintetizatu ditu. Mikrokapsularatutako produktu horiek biozida eta bioerakarle naturalak dituzte, ingurumenarentzat zein gizakiarentzat erres-petagarriagoa den produktua lortzeko asmoz. Gainera, bioerakarleen erabilpenaren on-dorioz, amaierako produktu komertziala selektiboagoa eta eraginkorragoa izango da espezie zehatz batzuen aurka.Mikrokapsularatutako biozidak sinergisten familiako pestizidak dira. Adibide eza-gun bat piperonilo butoxidoa da. Biozidek intsektiziden, (piretroideak, nikotinoideak, karbamatoak...), fungiziden (tebukonazola) zein pestiziden gaitasuna areagotzeko gai-tasuna dute. Bioerakarle naturalak, berriz, alkoholen eta terpenoen familiako konposatu hegazkorrak dira. Mikrokapsularatze-metodo arinak eta errendimendu estekiometriko altukoak garatu izan dira polimeroekin, gomekin eta karbohidratoekin erabiltzeko, hala nola ihinztadura bidezko lehorketa, gelifikazio ionikoa eta inklusio-konplexuen era-ketako mikrokapsularatze-metodoak. Era berean, konposatu aktiboen kontzentrazioak determinatzeko, metodologia analitiko ezberdinak ikertu dira eta buruguneko gas-kro-matografia / masa-espektrometria detektoreko (Headspace Gas Chromatography-Mass Spectrometry, HS-GC/MS) teknika erabiliz giro-tenperaturan eta hezetasunean konpo-satu hegazkorren askapenaren monitorizazioa ikertu da.Mikrokapsularatze-prozesuan lortutako aurrerapenek mugarri esanguratsu bat adierazten dute ingurumen-osasunean dauden ingurumen-arazoak ebazteko.

This work reports the development and validation of an ultra-high-performance liquid chromatography method to separate 11 different cardiovascular drugs: acenocoumarol, amiloride, bisoprolol, fluvastatin, furosemide, glibenclamide, hydrochlorothiazide, rosiglitazone (internal standard), valsartan, verapamil and warfarin. Detection of the analytes was carried out by means of photodiode array and fluorescence detection. Initially, the most significant variables in liquid chromatography (pH of the mobile phase, nature of the organic modifier and stationary phase type) were studied simultaneously in a systematic way. Taking into account the resolution obtained for the different chromatographic separations, pH 4.5, methanol and C18 were chosen as mobile phase pH, organic modifier and stationary phase, respectively. The method was validated and applied to the analysis of real human plasma samples using a solid phase extraction sample treatment, and the robustness of the chromatographic separation was studied by experimental design. The reported method allows the separation of all the analytes and the IS in less than 6 min, and, furthermore, it simplifies the analysis of drugs used in combined cardiovascular therapy by applying a fast and simple methodology.

Dried blood spot (DBS) has lately experienced an increase in its use in bioanalysis due to its several advantages compared with traditional blood sampling methods. Nevertheless, the use of DBS with quantitative purposes is hindered by the heterogeneous distribution of some compounds in the supporting matrix and the dependence of the response on different factors, such as the hematocrit, blood volume, and sampling position. In this study the effect of those factors in the analytical response was investigated by ultra high performance liquid chromatography coupled to fluorescence detection, using amiloride and propranolol as model compounds. The results showed a heterogeneous and drug-dependent distribution of the compounds in the blood spot. While amiloride concentration was higher in the center, propranolol concentration was higher in the periphery of the spot. Besides, the influence of the hematocrit on the quantitative results was observed. MALDI mass spectrometry imaging (MALDI-IMS) has allowed study of the distribution of the two cardiovascular drugs when they were placed in the DBS card using water:methanol solutions, demonstrating that they followed a similar distribution pattern as in blood. This work has showed the potentiality of the MALDI-IMS technique to predict the distribution of the drugs in the DBS card.

Rationale: Obesity hypoventilation syndrome (OHS) is commonly treated with noninvasive ventilation (NIV) or CPAP. NIV is more complex and costly but provides ventilatory support. To date there have been no long-term or cost trials comparing these treatment modalities. Methods: We performed a large, randomized, multicenter, open-label controlled trial in Spain to compare the long-term effectiveness of NIV and CPAP using hospitalization days/year-patient as the primary end point. We carried out a simple cost analysis including effectiveness cost during 3 year of follow-up. We included the following cost groups: visits, adjustment of NIV, tests, medication, therapies and hospital resources utilization. A sensitivity analysis was conducted according to 3 different scenarios guided by the International Gross Domestic Product. Results: In total, 215 patients with untreated OHS and severe obstructive sleep apnea (OSA) were randomized to NIV or CPAP therapy and followed at least 3 years. The effectiveness was close between arms (mean difference NIV-CPAP: -0.19, 95% CI -1.13 to 0.75). The cost per patient/year was lower in the CPAP arm (1,898.2€; SD 1939.5) than the cost in the NIV arm (2,809.3€; SD 2901.6), mean difference -911.1€ (p Conclusions: In stable patients with OHS and severe OSA, despite NIV having a slight advantage in effectiveness, CPAP could be considered the first line of treatment due to its lower cost but, a case-by-case assessment is recommended to detect patients who would benefit from a switch to NIV.

Rationale: Obesity hypoventilation syndrome (OHS) is commonly treated with CPAP or noninvasive ventilation (NIV). NIV is more complex and costly but it provides ventilatory support. To date there have been no long-term trials comparing these treatment modalities. Methods: We performed a large, multicenter, open-label controlled trial in Spain to compare the long-term effectiveness of NIV and CPAP: respiratory function, Epworth sleepness scale (ESS), other clinical symptoms, blood pressure (BP) and health related quality of life (HRQL). The analysis was performed according to the intention-to-treat principle. Results: In total, 215 patients with untreated OHS and severe obstructive sleep apnea (OSH) were randomized to NIV or CPAP therapy and followed at least 3 years. PaCO2, bicarbonate and pH improved significantly with both treatments without group differences. FEV1 and FVC improved with positive airway pressure (PAP) but without significant group differences. The 6-MWD test did not improve with either PAP modality and there were no significant group differences. ESS and other clinical symptoms like dyspnea or unrefreshing sleep improved similarly with CPAP and NIV therapy. Both systolic and diastolic BP improved significantly with PAP but without group differences. HRQL tests (SF-36 physical and mental, FOSQ and VAWS) improved with PAP without any significant group differences. Conclusions: In stable patients with OHS and severe OSA, NIV and CPAP have similar long-term effectiveness improving respiratory function, symptoms, BP and HRQL. Given that CPAP has lower complexity and cost, CPAP may be the preferred treatment modality until more studies become available.

Introducción y objetivo:El síndrome de apnea - hipopnea obstructiva del sueño (SAHOS) es un grupo de signos y síntomas que ocurren como consecuencia de episodios repetidos de obstrucción parcial o completa de la vía respiratoria. En la edad pediátrica las consecuencias incluyen alteraciones ponderoestaturales, cardioavasculares, cognitivas y conductuales En el grupo de edad mencionado, dicho colapso se debe en la mayor parte de los casos a hipertrofia adenoamigdalar, siendo por tanto de elección la exéresis quirúrgica de dichas estructuras. Las complicaciones post operatorias de esta intervención son escasas, pero especialmente frecuentes en menores de 3 años, pacientes con anomalías craniofaciales, retraso de crecimiento, obesidad, parálisis cerebral o con diagnóstico de SAHS grave. El objetivo de este estudio es el análisis de las complicaciones postquirúrgicas en los pacientes ingresados en la Unidad de Cuidados Intensivos Pediátricos (UCIP) con monitorización cardiorrespiratoria continua tras realizar adenoamigdalectomía para el tratamiento del SAHOS.Material y Método:Estudio observacional, retrospectivo y descriptivo mediante registro consecutivo de los pacientes ingresados en UCIP del Hospital Universitario de Burgos, que fueron intervenidos por diagnóstico de SAHS durante el año 2018. Se realizó recogida de datos, análisis descriptivo y analítico con el sistema informático IBM SPSS 19.Resultados: Se recogieron datos de 46 pacientes con una media de edad de 4,17 +/-2,01 años siendo el 69,6% niños. En los estudios prequirúrgicos el 67,4% de los pacientes presentaron hipertrofia amígdalar grado III-IV y el 78,3% grado II-III de hipertrofia adenoidea. Asimismo se clasificaron a los pacientes según grado ASA. En cuanto a las comorbilidades que presentaron estos pacientes cabe destacar patología respiratoria previa (19,6%), malformaciones craneofaciales (13%), patología neuromuscular (8,7%), prematuridad (6,5%), patología cardiaca (4,3%) y Síndrome de Down (4,3%). Previo a la cirugía se realizó estudio del sueño al 95,7% de los pacientes; polisomnografía en el 71,7% y poligrafía en el 23,9% evidenciándose en el 76,1% SAHS grave. La media del índice de apnea-hipopnea fue 21,3 Se realizó adenoamigdalectomía en el 100% de los pacientes y se colocaron drenajes transtimpánicos en el 23,9%. Tras la intervención quirúrgica la media de horas de ingreso en UCIP fue de 37 horas. Precisaron soporte respiratorio el 39,1% de los pacientes, ninguno presentó sangrado ni fiebre postcirugía. El 50% de los pacientes fueron dados de alta con antibioterapia.Conclusiones: Pacientes con ASA de mayor grado, diagnóstico de Síndrome de Down, patología cardiaca o respiratoria precisaron más noches de ingreso en UCIP y presentaron más eventos respiratorios con necesidad de soporte respiratorio. Por lo tanto nuestro estudio reafirma que los pacientes con comorbilidades o con diagnóstico de SAHS grave precisan estrecha monitorización postquirúrgica en una UCIP.

The molecular microencapsulation process, through the formation of the inclusion complex with β-cyclodextrin (β-CD), shows numerous environmental and industrial cost advantages, such as, stability improvement of the active substance, synthesis of water-based products, option of commercializing the final product either in solid state or in solution and avoidance of the undesired side-effects derived from the use of insecticides. Furthermore, the inclusion complexes have other advantages that involve controlled and specific release of active component in the medium. In this work the synthesis of the inclusion complex formed by β-CD and the acetamiprid (ACET) nicotinoid insecticide ((E)-N1-[(6-chloro-3-pyridyl)methyl]-N2-cyano-N1-methyl-acetamidine) was done and their molecular structure was studied in solid state and in solution, by means of experimental techniques. The 2:2 stoichiometry found in solid state, a structure based on dimmers classified as a channel type, is similar to that found in solution (1:1 stoichiometry). In both cases, the nitrile and chloropyridine groups of the insecticide molecules are oriented toward primary rim and secondary rim of the β-CD molecule, respectively.

Obese children are at increased risk for developing obstructive sleep apnea (OSA), and both of these conditions are associated with an increased risk for end-organ morbidities. Both OSA and obesity (OB) have been associated with increased risk for Alzheimer disease (AD). This study aimed to assess whether OSA and OB lead to increased plasma levels of 2 AD markers amyloid β protein 42 (Aβ42) and pre-senilin 1 (PS1).Fasting morning plasma samples from otherwise healthy children with a diagnosis of OB, OSA, or both (OSA+OB), and controls, and in a subset of children with OSA after adenotonsillectomy (TA) were assayed for Aβ42 and PS1 levels using commercial enzyme-linked immunosorbent assay kits.286 children (mean age of 7.2 ± 2.7 y) were evaluated. Compared to control subjects, OB children had similar Aβ42 (108.3 ± 31.7 pg/mL versus 83.6 ± 14.6 pg/mL) and PS1 levels (0.89 ± 0.44 ng/mL versus 0.80 ± 0.29 pg/mL). However, OSA children (Aβ42: 186.2 ± 66.7 pg/mL; P0.001; PS1: 3.42 ± 1.46 ng/mL; P0.001), and particularly OSA+OB children had significant elevations in both Aβ42 (349.4 ± 112.9 pg/mL; P0.001) and PS1 (PS1: 4.54 ± 1.16 ng/mL; P0.001) circulating concentrations. In a subset of 24 children, TA resulted in significant reductions of Aβ42 (352.0 ± 145.2 versus 151.9 ± 81.4 pg/mL; P0.0001) and PS1 (4.82 ± 1.09 versus 2.02 ± 1.18 ng/mL; P0.0001).Thus, OSA, and particularly OSA+OB, are associated with increased plasma levels of AD biomarkers, which decline upon treatment of OSA in a representative, yet not all- encompassing subset of patients, suggesting that OSA may accelerate AD-related processes even in early childhood. However, the cognitive and overall health-related implications of these findings remain to be defined.

Background: Noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP) are the habitual treatments for obesity hypoventilation syndrome (OHS). Despite differences in cost and complexity between them, there are no long-term effectiveness studies comparing both treatments. Objectives: We performed a large multicenter randomized open-labell controlled study to determine the comparative long-term effectiveness of NIV and CPAP using hospitalization days as the primary outcome measure. Methods: Sequentially screened OHS patients with severe sleep apnea were randomized into the above-mentioned arms for at least 3 years of follow-up. Hospital resources utilization, mortality, cardiovascular events incidence, dropouts, compliance and side effects were evaluated. Statistical analysis was performed using intention-to-treat protocol evaluating event/year per patient and incidence by negative binomial, logistic and Cox regressions models and survival analysis. A secundary analysis by compliance subgroups was performed. Results: 215 patients were randomized and 202 were available for primary analysis. The median follow-up was 5.42 years. The hospital days/year was 2.19±5.65 for CPAP and 1.44±3.07 for NIV (adjusted p=0.12). Other hospital resources utilization, cardiovascular events incidence, mortality, dropouts, compliance and side effects were similar between arms. The better compliance subgroup had lower hospital resources utilization and mortality regardless of the treatment used. Conclusion: NIV and CPAP have similar long-term effectiveness. Because CPAP has economical advantages and simplicity, CPAP should be the preferable treatment for OHS patients with severe OSA.

BackgroundObesity and obstructive sleep apnea syndrome (OSA) are highly prevalent and frequently overlapping conditions in children that lead to systemic inflammation, the latter being implicated in the various end-organ morbidities associated with these conditions.AimTo examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community.MethodsObese children prospectively diagnosed with OSA, underwent T&A and a second overnight polysomnogram (PSG) after surgery. Plasma fasting morning samples obtained after each of the two PSGs were assayed for multiple inflammatory and metabolic markers including interleukin (IL)-6, IL-18, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), adiponectin, apelin C, leptin and osteocrin.ResultsOut of 122 potential candidates, 100 obese children with OSA completed the study with only one-third exhibiting normalization of their PSG after T&A (that is, apnea-hypopnea index (AHI) ≤1/hour total sleep time). However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A. Several of the T&A-responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (that is, AHI⩾5/hTST).ConclusionsA defined subset of systemic inflammatory and metabolic biomarkers is reversibly altered in the context of OSA among community-based obese children, further reinforcing the concept on the interactive pro-inflammatory effects of sleep disorders such as OSA and obesity contributing to downstream end-organ morbidities.

Introducción y Objetivo: La patología de vía aérea comprende un amplio espectro de manifestaciones clínicas que incluyen distintos grados de insuficiencia respiratoria y/o trastornos respiratorios durante el sueño. El manejo se realiza de forma multidisciplinar, colaborando con ORL, Cirugía Infantil y Unidad de trastornos respiratorios del sueño. La ventilación no invasiva (VNI) ha mostrado su utilidad terapéutica en el paciente pediátrico, tanto en situaciones agudas como crónicas. La indicación más frecuente es el fallo respiratorio agudo. Aunque no existen numerosas contraindicaciones para su aplicación deben conocerse para evitar los fallos de esta técnica. Material y método: Presentamos una revisión de los conceptos básicos, indicaciones, contraindicaciones y nuestra metodología de aplicación de VNI en pacientes pediátricos. Conclusiones: Un porcentaje importante de los niños ingresados en UCIP precisan ventilación mecánica, siendo la insuficiencia respiratoria aguda la indicación más frecuente. En situaciones agudas, se aplica VNI para estabilizar al paciente, mientras que en casos crónicos puede ser útil durante la fase de estudio. Puede precisarse como apoyo durante el estudio fibroscópico, y para titular los parámetros de VNI en pacientes subsidiarios de soporte domiciliario., Introduction and Objective: Airway pathology comprises a broad spectrum of clinical manifestations that include different degrees of respiratory failure and / or respiratory disorders during sleep. The management is done in a multidisciplinary way, collaborating with ENT, Pediatric surgeon and Sleep Respiratory Disorders Unit. Noninvasive Ventilation (NIV) has shown its therapeutic utility in the pediatric patient, in both acute and chronic situations. The most frequent indication is acute respiratory failure. Although there are not many contraindications for its application should be known to avoid failures of this technique. Material and method: We present a review of basic concepts, indications, contraindications and our methodology of NIV in pediatric patients. Conclusions: A significant percentage of children admitted to PICU require mechanicaln ventilation. The most frequent indication is respiratory failure. In acute situations, NIV is applied to stabilize the patient, while in chronic cases can be useful during the study phase. It can be specified as support during the Fibroscopic study, and to titrate NIV parameters in supportive patients domiciliary.