Study of carbon nanotube-rich impedimetric recognition electrode for ultra-low determination of polycyclic aromatic hydrocarbons in water.

Carbon nanotubes (CNTs) have been studied as an electrochemical recognition element for the impedimetric determination of priority polycyclic aromatic hydrocarbons (PAHs) in water, using hexocyanoferrate as a redox probe. For this goal, an indium tin oxide (ITO) electrode functionalized with a silane-based self-assembled monolayer carrying CNTs has been engineered. The electroanalytical method, which is similar to an antibody-antigen assay, is straightforward and exploits the high CNT-PAH affinity obtained via π-interactions. After optimizing the experimental conditions, the resulting CNT-based impedimetric recognition platform exhibits ultra-low detection limits (1.75 ± 0.04 ng·L-1) for the sum of PAHs tested, which was also validated by using a certified reference PAH mixture. Graphical abstract Schematic of an indium-tin-oxide (ITO) electrode functionalized with a silane-based self-assembled monolayer carrying carbon nanotubes (CNTs) as a recognition platform for the ultra-low determination of total polycyclic aromatic hydrocarbons (PAHs) in water via π-interactions using Electrochemical Impedance Spectroscopy (EIS).

Non-invasive ventilation in obesity hypoventilation syndrome without severe obstructive sleep apnoea.

BACKGROUND: Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification (control group) using daytime arterial carbon dioxide tension (PaCO2) as the main outcome measure. METHODS: Between May 2009 and December 2014 we sequentially screened patients with OHS without severe OSA. Participants were randomised to NIV versus lifestyle modification and were followed for 2 months. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated. Statistical analysis was performed using intention-to-treat analysis. RESULTS: A total of 365 patients were screened of whom 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomised. NIV led to a significantly larger improvement in PaCO2 of -6 (95% CI -7.7 to -4.2) mm Hg versus -2.8 (95% CI -4.3 to -1.3) mm Hg, (p<0.001) and serum bicarbonate of -3.4 (95% CI -4.5 to -2.3) versus -1 (95% CI -1.7 to -0.2 95% CI)  mmol/L (p<0.001). PaCO2 change adjusted for NIV compliance did not further improve the inter-group statistical significance. Sleepiness, some health-related quality of life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency towards lower healthcare resource utilisation in the NIV group. CONCLUSIONS: NIV is more effective than lifestyle modification in improving daytime PaCO2, sleepiness and polysomnographic parameters. Long-term prospective studies are necessary to determine whether NIV reduces healthcare resource utilisation, cardiovascular events and mortality. TRIAL REGISTRATION NUMBER: NCT01405976; results.

A comparison of assisted cough techniques in stable patients with severe respiratory insufficiency due to amyotrophic lateral sclerosis.

Cough can be impaired in ALS. This can result in peak cough flows (PCFs) too low for an adequate airway clearance (<270 l/mn). There are several cough assistance techniques that aim at a better elimination of airway secretions, but which are effective, especially in bulbar patients, is not known. We designed the present investigation to compare the PCFs produced by a range of manual and mechanical techniques in patients with ALS, in non-bulbar but also in bulbar patients. In the whole study population, PCFs ranged from 84 (35-118) l/mn for the spontaneous cough manoeuvre to 488 (243-605) l/min for the in/exsufflator (p = 0.0005). In the bulbar group, these values were 42 (35-130) l/min versus 436 (244-630) l/min, respectively (p = 0.008), and 89 (40-106) l/min versus 491 (192-580) l/min, respectively, in the non-bulbar group (p = 0.019). There was no statistically significant difference between the bulbar and the non-bulbar groups. The in/exsufflator was not always the best tool. We conclude that capacity of coughing efforts to produce efficient peak cough flows can be dramatically improved with different tools, even in patients with very severe bulbar symptoms and that it appears useful to test an array of techniques to optimally tailor cough improvement techniques to individual patients.

Sleep-related painful erection in a 50-year-old man successfully treated with cinitapride.

INTRODUCTION: The sleep-related painful erection (SRPE) is a well-established parasomnia characterized by episodes of penile pain during an erection and typically appears during REM sleep. It is associated with nocturnal awakenings, anxiety, and irritability. AIM: To report a case study that highlights the successful treatment of SRPE with cinitapride. METHODS: We present a case report of a 50-year-old man suffering from SRPE that was studied by polysomnography. RESULTS: Severe fragmentation of rapid eye movement (REM) sleep was observed, and nine episodes of sleep-related erections were observed through the night; they were associated with REM sleep, and five of them were classified as SRPE. Cinitapride before the onset of sleep was started. Both the frequency and intensity of SRPE gradually decreased during a period of 6 months with the maintenance of normal sexual function. CONCLUSION: Cinitapride can play a role in reducing SRPE at night probably due to central modulation of neurotransmitters mediating erection.

Differences in pulmonary function based on height prediction obtained by using alternative measures.

BACKGROUND: Standing height is an independent variable used to predict pulmonary function; however, some patients are not able to stand. OBJECTIVES: The objectives of this study were to compare predicted pulmonary function values obtained by using various alternative measures to estimate height, analyse the values' reproducibility and evaluate their agreement. METHODS: Standing height, knee height, ulna length, demi-span and arm span were measured in 100 subjects who were able to stand. Five groups of values were generated for predicted FVC and FEV(1) based on measured standing height and the height estimated using each alternative measure. RESULTS: The differences found between the height estimated using the different measures and measured standing height were statistically significant. The reproducibility was excellent; however, agreement was poor and all the measures tended to overestimate the predicted values based on standing height although this tendency was less marked in the case of knee height. CONCLUSIONS: The use of alternative measures to predict height introduces a certain degree of error in predicted pulmonary function and this error should be quantified. Knee height is the measure that shows the greatest agreement and, thus, could be used in patients who are unable to stand.

Tailoring magnetic and mechanical properties of mesoporous single-phase Ni-Pt films by electrodeposition.

Homogeneous mesoporous Ni-rich Ni-Pt thin films with adjustable composition have been synthesised by one-step micelle-assisted electrodeposition. The films exhibit a face-centred cubic solid solution (single phase) and their magnetic and mechanical properties can be tuned by varying the alloy composition. In particular, the Curie temperature (TC) is shown to decrease with the Pt content and thin films with a TC close to room temperature (i.e. Ni58Pt42) and below can be produced. Hysteresis loops show a decrease of saturation magnetisation (Ms) and coercivity (Hc) with decreasing Ni content. A comparison of porous and dense films reveals significantly lower saturation magnetic field strength for porous films. Concerning mechanical properties, mainly two trends can be observed: a decrease of the Young's modulus of the nanoporous films with respect to dense films by 10% in average and a progressive increase of Young's modulus with the Ni content from 4.2 GPa to 5.7 GPa in both types of films. The tunability of properties and facility of synthesis make this alloy a promising material for microelectromechanical systems (MEMS).

Enhancing Magneto-Ionic Effects in Magnetic Nanostructured Films via Conformal Deposition of Nanolayers with Oxygen Acceptor/Donor Capabilities.

Effective manipulation of the magnetic properties of nanostructured metallic alloys, exhibiting intergrain porosity (i.e., channels) and conformally coated with insulating oxide nanolayers, with an electric field is demonstrated. Nanostructured Co-Pt films are grown by electrodeposition (ED) and subsequently coated with either AlOx or HfOx by atomic layer deposition (ALD) to promote magneto-ionic effects (i.e., voltage-driven ion migration) during electrolyte gating. Pronounced variations in coercivity (HC) and magnetic moment at saturation (mS) are found at room temperature after biasing the heterostructures. The application of a negative voltage results in a decrease of HC and an increase of mS, whereas the opposite trend is achieved for positive voltages. Although magneto-ionic phenomena are already observed in uncoated Co-Pt films (because of the inherent presence of oxygen), the ALD oxide nanocoatings serve to drastically enhance the magneto-ionic effects because of partially reversible oxygen migration, driven by voltage, across the interface between AlOx or HfOx and the nanostructured Co-Pt film. Co-Pt/HfOx heterostructures exhibit the most significant magneto-electric response at negative voltages, with an increase of mS up to 76% and a decrease of HC by 58%. The combination of a nanostructured magnetic alloy and a skinlike insulating oxide nanocoating is shown to be appealing to enhance magneto-ionic effects, potentially enabling electrolyte-gated magneto-ionic technology.

[Pleural empyema caused by Gemella species: a rare condition]. / Empiema pleural por microorganismos del género Gemella: una complicación infrecuente.

Three cases of pleural empyema caused by Gemella species--2 caused by Gemella morbillorum and 1 caused by G haemolysansare reported. Microbiological characteristics, predisposing factors, and treatment are reviewed and all cases published in the literature are analyzed.

Large Magnetoelectric Effects in Electrodeposited Nanoporous Microdisks Driven by Effective Surface Charging and Magneto-Ionics.

A synergetic approach to enhance magnetoelectric effects (i.e., control of magnetism with voltage) and improve energy efficiency in magnetically actuated devices is presented. The investigated material consists of an ordered array of Co-Pt microdisks, in which nanoporosity and partial oxidation are introduced during the synthetic procedure to synergetically boost the effects of electric field. The microdisks are grown by electrodeposition from an electrolyte containing an amphiphilic polymeric surfactant. The bath formulation is designed to favor the incorporation of oxygen in the form of cobalt oxide. A pronounced reduction of coercivity (88%) and a remarkable increase of Kerr signal amplitude (60%) are observed at room temperature upon subjecting the microdisks to negative voltages through an electrical double layer. These large voltage-induced changes in the magnetic properties of the microdisks are due to (i) the high surface-area-to-volume ratio with ultranarrow pore walls (sub-10 nm) that promote enhanced electric charge accumulation and (ii) magneto-ionic effects, where voltage-driven O2- migration promotes a partial reduction of CoO to Co at room temperature. This simple and versatile procedure to fabricate patterned "nano-in-micro" magnetic motifs with adjustable voltage-driven magnetic properties is very appealing for energy-efficient magnetic recording systems and other magnetoelectronic devices.

[Sleep apnea-hypopnea syndrome in a pediatric population: differences between children with tonsillar hypertrophy and those with concomitant disease]. / Síndrome de apneas-hipopneas durante el sueño en población infantil: diferencias en su expresión entre niños con hipertrofia amigdalar y con enfermedad concomitante.

OBJECTIVE: Our aim was to compare clinical and polysomnographic variables in pediatric patients with sleep apnea-hypopnea syndrome (SAHS) secondary to tonsillar hypertrophy with those in patients with concomitant disease. PATIENTS AND METHODS: We studied 42 children with SAHS (mean [SD] age, 8 [4] years; body mass index [BMI], 19.6 [5.2] kg/m2; neck circumference, 29 [4] cm; and BMI percentile, 67 [36]), 26 of whom were otherwise healthy (group A) and 16 of whom had concomitant disease (group B). RESULTS: A comparison of groups A and B showed no significant differences in age (7.7 [3.9] years vs 8.4 [3.9] years; P=not significant [NS]); sex, BMI (17.6 [4] kg/m2 vs 20.4 [6] kg/m2; P=NS), neck circumference (29.3 [4.7] cm vs 30.7 [3.5] cm; P=NS), or BMI percentile (61 [37] vs 76 [34]; P=NS). Tonsillar hypertrophy was more frequent in group A (P=.02) and craniofacial abnormalities (P=.008), macroglossia (P=.04), and dolichocephalia (P=.04) were more frequent in group B. No significant differences were observed in neurophysiologic variables or in the respiratory disturbance index, although group A presented higher oxygen saturation levels (97 [1.7] vs 95 [2]; P< .007), lower oxygen desaturation index scores (7 [7] vs 15 [10]; P=.007), and a lower cumulative percentage of time with oxygen saturation lower than 90% (2.2 [4] vs 16.4 [4]; P=.01). Twenty-three patients (88.5%) in group A underwent tonsillectomies compared to 7 (44%) patients in group B (P=.003). Seven patients (44%) in group B were treated with continuous positive airway pressure (CPAP) and 2 patients were treated with bi-level positive airway pressure (BiPAP), compared to 1 patient (3.8%) treated with CPAP in group A (P=.003). Three children in group B underwent maxillary surgery. The evolution of clinical and polygraphic variables was more favorable in group A (P=.04). CONCLUSIONS: Children with SAHS suffer from repeated infections, delayed weight gain, hyperactivity, and neuropsychiatric manifestations. Obesity (associated with concomitant disease) and sleepiness are uncommon. Although most patients require surgery, as many as a third require treatment with CPAP or BiPAP. Furthermore, children with SAHS and concomitant disease show no specific clinical characteristics, although they tend to be more obese, have more craniofacial abnormalities, and greater nocturnal hypoventilation.

Comparison of Costs and Clinical Outcomes Between Hospital and Outpatient Administration of Omalizumab in Patients With Severe Uncontrolled Asthma.

OBJECTIVES: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. METHOD: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. RESULTS: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50 ± 15 years, FEV1% 67 ± 22%, body mass index (BMI) 28 ± 6 kg/m(2), 639 ± 747 UI IgE/mL, followed for 24 ± 11 months (12-45), Asthma Control Test (ACT) score 12 ± 4 and Asthma Control Questionnaire (ACQ) 3 ± 2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P<0.001), ACQ (P<0.001), improvement in FEV1% (P<0.001), reduction in total admissions (P<0.001), days of hospitalization (P<0.001), emergency room visits (P<0.001), cycles and doses of oral steroids (P<0.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A. CONCLUSION: The administration of omalizumab in ambulatory health centers achieved the same clinical results as a hospital administration strategy, but with lower costs.

Adaptation and Validation of the Spanish Version of OSA-18, a Quality of Life Questionnaire for Evaluation of Children with Sleep Apnea-Hypopnea Syndrome. / Adaptación y validación al español del cuestionario de calidad de vida OSA-18 para la evaluación del síndrome de apnea-hipopnea de sueño infantil.

OBJECTIVES: To analyze the reliability and validity of the Spanish version of the OSA-18 quality of life questionnaire in children with apnea-hypopnea syndrome (SAHS). METHOD: Children with suspected SAHS were studied with polysomnography (PSG) before and after adenotonsillectomy (AA). Age, gender, clinical data, PSG, anthropometric data, and Mallampati and Brodsky scales were analyzed. OSA-18 was administered at baseline and 3-6months post AA. After translation and backtranslation by bilingual professionals, the internal consistency, reliability, construct validity, concurrent validity, predictive validity and sensitivity to change of the questionnaire was assessed. RESULTS: In total, 45 boys and 15 girls were evaluated, showing BMI 18±4, neck 28±5, Brodsky (0: 7%; <25%: 12%; 25-50%: 27%; >50 to <75%: 45%; >75%: 6%), AHI 12±7 pre AA. Global Cronbach alpha was 0.91. Correlations between domains were significant except for emotional aspects, although the total scores correlated with all domains (0.50 to 0.90). The factorial analysis was virtually identical to the original structure. The total scores showed good correlation for concurrent validity (0.2-0.45). With regard to predictive validity, the questionnaire adequately differentiated levels of severity according to Mallampati (ANOVA P=.002) and apnea-hypopnea index (ANOVA P=.006). Test-retest reliability was excellent, as was sensitivity to change, both in the total scores (P<.001) and in each domain (P<.001). CONCLUSIONS: The Spanish adaptation of the OSA-18 and its psychometric characteristics suggest that the Spanish version is equivalent to the original and can be used in Spanish-speaking countries.

Complementary home mechanical ventilation techniques. SEPAR Year 2014.

This is a review of the different complementary techniques that are useful for optimizing home mechanical ventilation (HMV). Airway clearance is very important in patients with HMV and many patients, particularly those with reduced peak cough flow, require airway clearance (manual or assisted) or assisted cough techniques (manual or mechanical) and suctioning procedures, in addition to ventilation. In the case of invasive HMV, good tracheostomy cannula management is essential for success. HMV patients may have sleep disturbances that must be taken into account. Sleep studies including complete polysomnography or respiratory polygraphy are helpful for identifying patient-ventilator asynchrony. Other techniques, such as bronchoscopy or nutritional support, may be required in patients on HMV, particularly if percutaneous gastrostomy is required. Information on treatment efficacy can be obtained from HMV monitoring, using methods such as pulse oximetry, capnography or the internal programs of the ventilators themselves. Finally, the importance of the patient's subjective perception is reviewed, as this may potentially affect the success of the HMV.

Internal consistency and validity of the Spanish version of the "Quebec Sleep Questionnaire" quality-of-life questionnaire for obstructive sleep apnea.

INTRODUCTION: There is no specific health-related quality of life (HRQL) questionnaire that has been validated in Spanish for its use in patients with sleep apnea-hypopnea syndrome (SAHS). The objective of the present study was to validate the Spanish version of the Quebec Sleep Questionnaire (QSQ). PATIENTS AND METHODS: A multi-center study including a group of patients with SAHS (AHI≥5) referred to the Sleep Unit. All patients completed the following questionnaires: SF-36, FOSQ, QSQ and Epworth scale. Internal consistency, construct validity, concurrent validity, predictive validity, repeatability and responsiveness to change of the QSQ (32 items in five domains: daytime sleepiness, diurnal symptoms, nocturnal symptoms, emotions, and social interactions) were assessed. RESULTS: A hundred twenty one patients were included in the study (mean age: 57 ± 13; mean Epworth: 9 ± 4; mean Body Mass Index (BMI): 28 ± 3 kg·m(-2) and mean AHI: 36 ± 20 hour(-1)). The factorial analysis showed a construct of five factors with similar distribution to the original questionnaire domains. Internal consistency (Cranach's alpha between 0.78 and 0.93 for the different domains), concurrent validity (compared to SF-36, Epworth scale and FOSQ), predictive validity of SAHS severity and test-retest reliability were appropriate. The test showed good responsiveness to change in diurnal (P=.003) and nocturnal symptoms domains (P=.02). CONCLUSIONS: The Spanish version of the QSQ is a valid HRQL measure with appropriate psychometric properties for use in patients with SAHS and is responsive to change in symptoms domains.

Comparación de costes y resultados clínicos entre la administración hospitalaria o ambulatoria de omalizumab, en pacientes con asma grave no controlada / Comparison of Costs and Clinical Outcomes Between Hospital and Outpatient Administration of Omalizumab in Patients With Severe Uncontrolled Asthma

Objetivos: Evaluar los resultados clínicos y los costes de 2 estrategias de administración de omalizumab. Método: Se compararon, de forma retrospectiva, 2 cohortes de pacientes con asma grave no controlada: una, procedente del hospital A, en la que el tratamiento se administró en un centro de salud, y otra, procedente del Hospital B, con administración hospitalaria convencional. Resultados: Se estudió a 130 pacientes, 86 en A y 44 en B, 30 hombres (24%) y 100 mujeres (76%), edad 50 ± 15 años, FEV1% 67 ± 22%, índice de masa corporal (IMC) 28 ± 6 kg/m2, IgE 639 ± 747 UI/mL, seguimiento de 24 ± 11 meses (12-45), Asthma Control Test (ACT) 12 ± 4 y Asthma Control Questionnaire (ACQ) 3 ± 2, sin diferencias significativas basales entre ambas cohortes en ingresos hospitalarios ni visitas a urgencias en el año previo, ni en número de pacientes con esteroides orales. Al comparar la situación basal y tras los 12 meses de tratamiento, se observaron diferencias significativas en ACT (p < 0,001), ACQ (p < 0,001) y mejoría en el FEV1% (p < 0,001), reducción en número de ingresos (p < 0,001), días de hospitalización (p < 0,001), visitas a urgencias (p < 0,001), ciclos y dosis de esteroides p < 0,001) respecto al año previo, tanto individualmente como en conjunto. Los costes de hospitalización, visitas a urgencias, visitas no programadas a Primaria y al neumólogo se redujeron significativamente en ambos hospitales, pero los costes de administración y desplazamiento fueron un 35% inferiores con la pauta ambulatoria en A. Conclusión: La administración ambulatoria de omalizumab en los centros de salud consigue los mismos resultados clínicos que una pauta de administración hospitalaria, con menores costes

Objectives: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. Method: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. Results: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50 ± 15 years, FEV1% 67 ± 22%, body mass index (BMI) 28±6kg/m2, 639 ± 747 UI IgE/mL, followed for 24 ± 11 months (12-45), Asthma Control Test (ACT) score 12 ± 4 and Asthma Control Questionnaire (ACQ) 3±2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P < 0.001), ACQ (P<0.001), improvement in FEV1% (P < 0.001), reduction in total admissions (P < 0.001), days of hospitalization (P<0.001), emergency room visits (P<0.001), cycles and doses of oral steroids (P < 0.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A