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Publicaciones científicas más recientes (desde 2010)

Autores: Lara, J. P. , (Autor de correspondencia); Compan, A.; Vargas-Nunez, J. A.; et al.
Revista: REVISTA CLINICA ESPAÑOLA
ISSN 0014-2565  Vol. 219  Nº 2  2019  págs. 84 - 89
The significant and progressive reduction in the number of permanent teachers in medical schools (professor, associate professor and assistant professor) is a reason for concern for the National Conference of Deans. This reduction will intensify in the coming decade (2017-2026). Forty-three percent of the permanent faculty will retire, as will 55% of the faculty linked to clinical areas, 34% of the faculty not linked to clinical areas and 32% of the faculty of basic areas. This deficit is significant now, and, in a few years, the situation wilt be unsustainable, especially in the clinical areas. This report reveals the pressing need to adopt urgent measures to alleviate the present situation and prevent a greater problem. The training of future physicians, immediately responsible for the health of our society, depends largely on the theoretical and practical training taught in medical schools, with the essential collaboration of healthcare institutions. Paradoxically, while the number of teachers decreases substantially, there is an exponential increase in the number of medical schools and students who are admitted every year without academic or healthcare justification.
Autores: Moreno-Artero, Ester; Querol-Cisneros, E; et al.
Revista: JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY
ISSN 0926-9959  Vol. 32  Nº 9  2018  págs. 1420 - 1426
Cocaine is an alkaloid extracted from the leaves of the Erythroxylum coca plant that emerged in the 1970s as a fashionable drug among members of certain social backgrounds. Cocaine abuse is a problem of current interest, which is mostly hidden and underdiagnosed, but dramatically widespread among all socio-economic strata, and with an incidence which is increasing at an alarming rate. There are 1.5 million cocaine consumers in the USA. In Spain, the prevalence of consumption among the population between 15 and 65 years old is higher, reaching 3.1%. Because of this, it seems important to understand and recognize all the mucocutaneous manifestations of cocaine abuse which have been reported in the literature to clarify and to help dermatologists in their daily practice. In this article, we describe the principal mucocutaneous manifestations of cocaine abuse and we review isolated case reports which have been published in the literature. Because the dermatologist may deal with an unknown problem as well as with an already well-known history of cocaine abuse, it seems logical to separate the mucocutaneous manifestations into those which are frequent and highly suggestive, such as those caused by vascular injury, damage to mucosal membranes, infectious diseases or neutrophilic dermatosis, especially when suffered by young people and in consonance with other systemic manifestations and, those which have been reported in the literature as isolated case reports. We also summarize the main aspects of its pathogeny, principal pharmacodynamic and pharmacokinetic characteristics, and diagnostic tools.
Autores: Moreno-Artero, Ester; Querol-Cisneros, E; et al.
Revista: JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY
ISSN 0926-9959  Vol. 32  Nº 9  2018  págs. 1420 - 1426
Cocaine is an alkaloid extracted from the leaves of the Erythroxylum coca plant that emerged in the 1970s as a fashionable drug among members of certain social backgrounds. Cocaine abuse is a problem of current interest, which is mostly hidden and underdiagnosed, but dramatically widespread among all socio-economic strata, and with an incidence which is increasing at an alarming rate. There are 1.5 million cocaine consumers in the USA. In Spain, the prevalence of consumption among the population between 15 and 65 years old is higher, reaching 3.1%. Because of this, it seems important to understand and recognize all the mucocutaneous manifestations of cocaine abuse which have been reported in the literature to clarify and to help dermatologists in their daily practice. In this article, we describe the principal mucocutaneous manifestations of cocaine abuse and we review isolated case reports which have been published in the literature. Because the dermatologist may deal with an unknown problem as well as with an already well-known history of cocaine abuse, it seems logical to separate the mucocutaneous manifestations into those which are frequent and highly suggestive, such as those caused by vascular injury, damage to mucosal membranes, infectious diseases or neutrophilic dermatosis, especially when suffered by young people and in consonance with other systemic manifestations and, those which have been reported in the literature as isolated case reports. We also summarize the main aspects of its pathogeny, principal pharmacodynamic and pharmacokinetic characteristics, and diagnostic tools.
Autores: Giraldo-Cadavid, L. F.; Burguete, Javier; Rueda, F.; et al.
Revista: DYSPHAGIA
ISSN 0179-051X  Vol. 33  Nº 1  2018  págs. 15 - 25
Recent studies have shown an association between alterations in laryngopharyngeal mechanosensitivity (LPMS) and dysphagia, obstructive sleep apnea, and chronic cough hypersensitivity syndrome. A previous reliability study of a new laryngopharyngeal endoscopic esthesiometer and rangefinder (LPEER) showed high intra- and inter-rater reliability; however, its accuracy has not been tested. We performed an accuracy study of the LPEER in a prospectively and consecutively recruited cohort of 118 patients at two tertiary care university hospitals. Most of the patients were suffering from dysphagia, and all of them underwent a standard clinical evaluation and fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) using a new sensory testing protocol. The sensory test included determinations of the laryngeal adductor reflex threshold (LART), the cough reflex threshold (CRT) and the gag reflex threshold (GRT). Abnormalities on these reflex thresholds were evaluated for associations with major alterations in swallowing safety (pharyngeal residues, penetration, and aspiration). We evaluated the discriminative capacity of the LPMS test using ROC curves and the area under the curve (AUC-ROC) and its relationship with the eight-point penetration-aspiration scale (PAS) using the Spearman's ¿ correlation coefficient (SCC). We found a positive correlation between the PAS and LART (SCC 0.47; P < 0.001), CRT (SCC 0.46; P < 0.001) and GRT (SCC 0.34; P = 0.002). The AUC-ROC values for detecting a PAS ¿7 were as follows: LART, 0.83 (P < 0.0001); CRT, 0.79 (P < 0.0001); GRT, 0.72 (P < 0.0001). In this study, the LPEER showed good accuracy for evaluating LPMS. These results justify further validation studies in independent populations.
Autores: Giraldo-Cadavid, L. F. ; Fernández, Secundino; Burguete, Javier; et al.
Revista: EUROPEAN RESPIRATORY JOURNAL
ISSN 0903-1936  Vol. 52  Nº Supl. 62  2018 
Autores: España, Agustín; Fernández, Secundino;
Revista: JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY
ISSN 0926-9959  Vol. 31  Nº 5  2017  págs. 791 - 797
Autoimmune blistering diseases (AIBD) comprise several entities characterized by the presence of autoantibodies targeted against structural proteins either in desmosomes or in the dermoepidermal junction of polystratified squamous epithelium. Patients develop blisters, erosions in cutaneous surfaces or mucosas. Diagnosis is based on the characteristic mucocutaneous lesions, the typical findings on histological studies and direct immunofluorescence assays, and the presence of specific autoantibodies against the epidermal antigens. It may not be possible for dermatologists to appropriately explore the nose and throat (NT). Thus, a clinical exploration by endoscopic procedures of NT may be a useful tool during the conventional dermatological exam. The aims of this review are to draw attention to the most frequent NT manifestations in AIBD patients, and underline the utility of endoscopic procedures to achieve a more successful and rationale management of patients. Additionally, we will provide brief information related to the anatomical structures and type of epithelium in NT areas which may explain the extent and type of NT involvement in AIBD. Endoscopic exploration in AIBD patients is important for several reasons. Firstly, it will allow the real NT mucosal involvement in each patient to be determined, thus making a differential diagnosis during the endoscopic exam possible, based on the localization of mucosal lesions. Secondary mucosal morbidity can also be ruled out. Secondly, the clinical response to treatment may be established, especially in NT mucosa, as these are anatomical areas subjected to important local traumas, and physiological functions such as breathing, swallowing, speech production and phonation may be damaged. Therefore, a multidisciplinary management in AIBD is mandatory by both dermatologists and otorhinolaryngologists, adding the clinical exploration by endoscopic procedures of NT to the conventional dermatological exam in all AIBD patients, irrespective of whether they exhibit associated symptoms.
Autores: España, Agustín; Fernández, Secundino;
Revista: JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY
ISSN 0926-9959  Vol. 31  Nº 5  2017  págs. 791 - 797
Autoimmune blistering diseases (AIBD) comprise several entities characterized by the presence of autoantibodies targeted against structural proteins either in desmosomes or in the dermoepidermal junction of polystratified squamous epithelium. Patients develop blisters, erosions in cutaneous surfaces or mucosas. Diagnosis is based on the characteristic mucocutaneous lesions, the typical findings on histological studies and direct immunofluorescence assays, and the presence of specific autoantibodies against the epidermal antigens. It may not be possible for dermatologists to appropriately explore the nose and throat (NT). Thus, a clinical exploration by endoscopic procedures of NT may be a useful tool during the conventional dermatological exam. The aims of this review are to draw attention to the most frequent NT manifestations in AIBD patients, and underline the utility of endoscopic procedures to achieve a more successful and rationale management of patients. Additionally, we will provide brief information related to the anatomical structures and type of epithelium in NT areas which may explain the extent and type of NT involvement in AIBD. Endoscopic exploration in AIBD patients is important for several reasons. Firstly, it will allow the real NT mucosal involvement in each patient to be determined, thus making a differential diagnosis during the endoscopic exam possible, based on the localization of mucosal lesions. Secondary mucosal morbidity can also be ruled out. Secondly, the clinical response to treatment may be established, especially in NT mucosa, as these are anatomical areas subjected to important local traumas, and physiological functions such as breathing, swallowing, speech production and phonation may be damaged. Therefore, a multidisciplinary management in AIBD is mandatory by both dermatologists and otorhinolaryngologists, adding the clinical exploration by endoscopic procedures of NT to the conventional dermatological exam in all AIBD patients, irrespective of whether they exhibit associated symptoms.
Autores: Méndez-Giménez, L.; Becerril, Sara; Moncada, Rafael; et al.
Revista: OBESITY SURGERY
ISSN 0960-8923  Vol. 27  Nº 7  2017  págs. 1763 - 1774
BACKGROUND: Gastric plication is a minimally invasive bariatric surgical procedure, where the greater curvature is plicated inside the gastric lumen. Our aims were to analyze the effectiveness of gastric plication on the resolution of obesity, impaired glucose tolerance, and fatty liver in an experimental model of diet-induced obesity (DIO) and to evaluate changes in glycerol metabolism, a key substrate for adiposity and gluconeogenesis, in adipose tissue and the liver. METHODS: Male Wistar DIO rats (n = 58) were subjected to surgical (sham operation and gastric plication) or dietary interventions [fed a normal diet (ND) or high-fat diet (HFD) or pair-fed to the amount of food eaten by gastric-plicated animals]. The expression of aquaglyceroporins (AQPs) in epididymal (EWAT) and subcutaneous (SCWAT) fat and the liver was analyzed by real-time PCR and Western blot. RESULTS: Gastric plication did not result in a significant weight loss in DIO rats, showing a modest reduction in whole-body adiposity and hepatic steatosis. However, gastric-plicated animals exhibited an improvement in basal glycemia and glucose clearance, without changes in hepatic gluconeogenic genes. DIO was associated with an increase in glycerol, higher AQP3 and AQP7 in EWAT and SCWAT, and a decrease in hepatic AQP9. Gastric plication downregulated AQP3 in both fat depots without changes in adipose AQP7 and hepatic AQP9. CONCLUSION: Gastric plication results in a modest reduction in adiposity and hepatosteatosis but restores glycemia by downregulating AQP3, which entails lower efflux of glycerol from fat, lower plasma glycerol availability, and a reduced use of glycerol as a substrate for hepatic gluconeogenesis.
Autores: Giraldo-Cadavid, L. F., (Autor de correspondencia); Burguete, Javier; Rueda, F.; et al.
Revista: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY
ISSN 0937-4477  Vol. 274  Nº 7  2017  págs. 2861 - 2870
BACKGROUND: There are not reliable methods for measuring laryngo-pharyngeal mechano-sensitivity (LPMS). We aimed to determine the reliability of a new method for measuring LPMS using a new laryngo-pharyngeal esthesiometer (LPEER) in a prospective cohort of dysphagic stroke and non-dysphagic patients. The patients underwent clinical and endoscopic evaluations of swallowing (FESSST). The LPMS assessments consisted of measurements by an expert and a novel rater of the laryngeal-adductor reflex threshold (LART), cough reflex threshold (CRT) and gag reflex threshold (GRT) using the LPEER. We assessed the Bland-Altman limits of agreement, the intraclass correlation coefficients (ICCs) and Spearman correlation coefficients (SCCs). For the inter-rater comparisons, we contrasted the expert and novel raters. A total of 1608 measurements were obtained from 34 dysphagic stroke patients and 33 non-dysphagic patients. The intra-rater ICCs for all reflex thresholds were >0.90. The inter-rater ICCs were 0.87 for the LART, 0.79 for the CRT and 0.70 for the GRT. The intra-rater SCCs for all reflex thresholds were above 0.88 (P¿<¿0.0001). The inter-rater SCC were 0.80 for the LART, 0.79 for the CRT and 0.70 for the GRT (all P¿<¿0.0001). The Bland-Altman plots revealed good agreement for the LART and CRT and moderate agreement for the GRT. The median normal value was 0.14 mN for the LART, 4.4 mN for the CRT and 11.9 mN for the GRT. The median thresholds values in patients with aspiration were LART: 1.31 mN; CRT: 32.9 mN and GRT: 32.9 mN (all P¿<¿0.006 vs normal thresholds). The LPEER exhibited substantial to excellent intra- and inter-rater reliability.
Autores: Giraldo-Cadavid, L. F. ; Agudelo-Otalora, L. M.; Burguete, Javier; et al.
Revista: BIOMEDICAL ENGINEERING ONLINE
ISSN 1475-925X  Vol. 15  Nº 1  2016  págs. 52
BACKGROUND: Laryngo-pharyngeal mechano-sensitivity (LPMS) is involved in dysphagia, sleep apnea, stroke, irritable larynx syndrome and cough hypersensitivity syndrome among other disorders. These conditions are associated with a wide range of airway reflex abnormalities. However, the current device for exploring LPMS is limited because it assesses only the laryngeal adductor reflex during fiber-optic endoscopic evaluations of swallowing and requires a high degree of expertise to obtain reliable results, introducing intrinsic expert variability and subjectivity. METHODS: We designed, developed and validated a new air-pulse laryngo-pharyngeal endoscopic esthesiometer with a built-in laser range-finder (LPEER) based on the evaluation and control of air-pulse variability determinants and on intrinsic observer variability and subjectivity determinants of the distance, angle and site of stimulus impact. The LPEER was designed to be capable of delivering precise and accurate stimuli with a wide range of intensities that can explore most laryngo-pharyngeal reflexes. RESULTS: We initially explored the potential factors affecting the reliability of LPMS tests and included these factors in a multiple linear regression model. The following factors significantly affected the precision and accuracy of the test (P < 0.001): the tube conducting the air-pulses, the supply pressure of the system, the duration of the air-pulses, and the distance and angle between the end of the tube conducti
Autores: Moncada, Rafael; Becerril, Sara; Rodríguez, Amaia; et al.
Revista: OBESITY SURGERY
ISSN 0960-8923  Vol. 26  Nº 7  2016  págs. 1537-48
Background: Susceptibility to obesity is associated with a notable inter-individual variation. The aim of the present study was to compare the effectiveness of sleeve gastrectomy (SG) on weight loss and metabolic profile in obesity-prone (OP) rats vs animals that are non-susceptible to obesity (NSO). Methods: Young male Wistar rats (n = 101) were put in a diet-induced obesity (DIO) programme with ad libitum access to a high-fed diet (HFD) during 12 months. Body weight and food intake were regularly registered. Thereafter, rats were ranked by final body weight to identify the obesity-prone (OP) (n = 13) and non-susceptible to obesity (NSO) (n = 14) animals. OP and NSO rats were submitted to surgical interventions (sham operation, SG and pair-fed to the amount of food eaten by sleeve-gastrectomized rats). Body weight, food intake, energy expenditure, body temperature, fat pads weight, and metabolic profiling were analysed 4 weeks after surgical or dietary interventions. Results: SG in both OP and NSO rats decreased body weight as compared to sham and pair-fed groups (P < 0.05), mainly due to reductions in subcutaneous and perirenal fat mass (P < 0.001). Total weight loss achieved in sleeve-gastrectomized OP and NSO rats was higher than that of pair-fed ones (P < 0.05), showing that the SG effect goes beyond caloric restriction. In this regard, sleeve-gastrectomized rats exhibited significantly (P < 0.05) increased basal rectal temperature together with upregulated brown adipose tissue Ucp-1 protein expression levels. A significant (P < 0.05) improvement in insulin sensitivity was also observed in both OP and NSO animals that underwent SG as compared with pair-fed counterparts. Conclusion: Our findings provide the first evidence that obesity-prone rats also benefit from surgery responding effectively to SG, as evidenced by the significant body weight reduction and the metabolic profile improvement.
Autores: Fernández, Secundino;
Revista: JOURNAL OF VOICE
ISSN 0892-1997  Vol. 30  Nº 1  2016  págs. 114 -119
Objective The purpose of this study was to detect specific vocal aerodynamic patterns in attention deficit hyperactivity disorder (ADHD) patients and to define a possible new phenotypic feature of this disorder that must be diagnosed and treated. Study Design This is a prospective study. Methods Seventy-nine children aged 5¿13 years were recruited: 44 children with ADHD diagnosis and 35 children, as a control group, matched according to age and gender. All children were evaluated in the voice laboratory. Each subject repeated sustained vowels, syllables, words, and sentences several times. Intraoral pressure, transglottal airflow, microphone, and electroglottograph results were recorded and analyzed. Children affected by ADHD, with adequate tolerance, were evaluated endoscopically and by the speech therapist. Results The aerodynamic analysis shows that the subglottal pressure is higher and transglottal airflow is lower in ADHD children compared with the children of the control group. Those differences are statistically significant. The endoscopic physical examination showed vocal nodules in 25 children (78.125%) and hyperfunctional vocal behavior in all ADHD children studied. Conclusions We proposed that every child with ADHD disorder must be evaluated from a laryngeal point of view (otolaryngologist and speech therapist) as an important part of the diagnosis and global treatment. It could be considered as a new phenotypic characteristic of this disorder.
Autores: Moncada, Rafael; Rodríguez, Amaia; Becerril, Sara; et al.
Revista: OBESITY SURGERY
ISSN 0960-8923  Vol. 26  Nº 7  2016  págs. 1549-58
Background Aging and obesity are two conditions associated with increased risk of cardiovascular disease. Our aim was to analyze whether an advanced age affects the beneficial effects of sleeve gastrectomy on weight loss and blood pressure in an experimental model of diet-induced obesity (DIO). Methods Young (6-month-old) and old (18-month-old) male Wistar DIO rats (n¿=¿101) were subjected to surgical (sham operation and sleeve gastrectomy) or dietary interventions (pair-fed to the amount of food eaten by sleeve gastrectomized animals). Systolic (SBP), diastolic (DBP), and mean (MBP) blood pressure values and heart rate (HR) were recorded in conscious, resting animals by non-invasive tail-cuff plethysmography before and 4 weeks after surgical or dietary interventions. Results Aging was associated with higher (P¿<¿0.05) body weight and subcutaneous and perirenal fat mass as well as mild cardiac hypertrophy. Sleeve gastrectomy induced a reduction in body weight, whole-body adiposity, and serum total ghrelin in both young and old DIO rats. The younger group achieved a higher excess weight loss than the older group (164¿±¿60 vs. 82¿±¿17 %, P¿<¿0.05). A significant (P¿<¿0.05) decrease in insulin resistance, SBP, DBP, MBP, and HR without changes in heart weight was observed after sleeve gastrectomy independently of age. Conclusion Our results provide evidence for the effectiveness of sleeve gastrectomy without increased operative risk in body weight and blood pressure reduction
Autores: Busto-Crespo, O; Uzcanga Lacabe, M; Abad Marco, A; et al.
Revista: JOURNAL OF VOICE
ISSN 0892-1997  Vol. 30  Nº 6  2016  págs. 767.e9-767e15.
Voice therapy is effective in patients with UVFP and its benefits are sustained over time. Early referral for voice therapy seems to be associated with greater benefit, but quality of life also improves for patients despite delayed treatment.
Autores: Busto Crespo, O.; Uzcanga Lacabe, M.; Abad Marco, A.; et al.
Revista: ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN 1137-6627  Vol. 39  Nº 1  2016  págs. 69 - 75
BACKGROUND: To describe demographic factors and voice quality parameters of patients with unilateral vocal fold paralysis (UVFP) after a voice therapy protocol. METHODS: Forty-seven patients with a diagnosis of UVFP by video-laryngoscopy were included. Voice therapy was applied to all patients during 15 sessions that were structured in three progressive stages. The objective was to train patients in vocal techniques, phonic-breathing coordination,blow control, vocal exercises for glottic closure and vocal setting. Glottal closure, Voice Handicap Index-10 for perception of voice impairment and GRBAS scale were used before and after the speech therapy. RESULTS: The average age was 51 years (range 20-80), 60%women. Surgery was the most frequent cause (72%), and 40% had a profession related to voice use. Median time from diagnosis to treatment was 5 months (2-12). After voice therapy, 80% had complete glottal closure, previously this had been 34% (p<0.001), the score of VHI-10 decreased from 24.24 to 16.09 points (p<0.001) and GRBAS values improved in all the qualities of voice (p<0.001).Only 8.5% of the patients required surgical intervention after treatment. CONCLUSIONS: Voice therapy is effective as first line therapy in patients with UVFP, reserving medialization with non-absorbable material or thyroplasty surgery for those with a poor outcome. However, it is necessary to reduce the time it takes the patient to reach the Voice Unit after laryngoscopic diagnosis.
Autores: Iriarte, Jorge; Campo, Arantza; Alegre, Manuel; et al.
Revista: SLEEP MEDICINE
ISSN 1389-9457  Vol. 16  Nº 7  2015  págs. 827 - 830
Background The International Classification of Sleep Disorders ¿ Third Edition (ICSD-3) classifies catathrenia among the respiratory disorders and not as a parasomnia as in ICSD-2. Few patients have been reported during these years, and the clinical description of the sound is different from group to group. In fact, there is no full agreement about its nature, origin, meaning, and treatment. Methods and results In this paper we review the literature on catathrenia focusing on the characteristics of the sound, demographics of the patients, aetiology, response to treatment, etc., in order to support its classification as a respiratory disorder or a parasomnia. We also discuss the possibility of Catathrenia being not one disorder but two variants or two different disorders.
Autores: Iriarte, Jorge; Fernández, Secundino; et al.
Revista: CLINICAL AUTONOMIC RESEARCH
ISSN 0959-9851  Vol. 25  Nº 4  2015  págs. 225 - 232
BACKGROUND: Cardiac autonomic tone after long-term continuous positive airway pressure therapy in patients with obstructive sleep apnea remains unexplored. METHODS: Thirty patients with obstructive sleep apnea (14 with moderate and 16 with severe obstructive sleep apnea) were studied during a baseline polysomnographic study, after a full night of acute continuous positive airway pressure treatment, and after long-term (~2 years) chronic continuous positive airway pressure therapy. Twenty age- and gender-matched controls with baseline sleep study were selected for comparison purposes. Cross-spectral analysis and the low-frequency (LF) and high-frequency (HF) components of the heart rate variability were computed separately over 10-min ECG epochs during rapid eye movement sleep, non-rapid eye movement sleep, and wakefulness. RESULTS: During the baseline study, obstructive sleep apnea patients exhibited increased LF, decreased HF, and increased LF/HF ratio during sleep when compared to controls. In a multiple regression model, the mean oxygen saturation explained the increased LF during rapid and non-rapid eye movement sleep in obstructive sleep apnea patients. Acute continuous positive airway pressure therapy decreased the LF modulations and the LF/HF ratio and increased the HF modulations during sleep in patients with severe obstructive sleep apnea. Long-term continuous positive airway pressure therapy decreased LF modulations and LF/HF ratio with increased HF modulations during sleep in patients with moderate and severe obstructive sleep apnea. CONCLUSIONS: Long-term continuous positive airway pressure reduces the sympathovagal imbalance in patients with moderate and severe obstructive sleep apnea, both during rapid and non-rapid eye movement sleep. Continuous positive airway pressure seems to exert its changes in cardiac autonomic modulation by decreasing the burden of nocturnal hypoxia.
Autores: Méndez-Giménez, L.; Becerril, Sara; Moncada, Rafael; et al.
Revista: OBESITY SURGERY
ISSN 0960-8923  Vol. 25  Nº 9  2015  págs. 1723 - 1734
BACKGROUND: Glycerol constitutes an important metabolite for the control of lipid accumulation and glucose homeostasis. Our aim was to investigate the potential role of aquaglyceroporins, which are glycerol channels mediating glycerol efflux in adipocytes (AQP3 and AQP7) and glycerol influx (AQP9) in hepatocytes, in the improvement of adiposity and hepatic steatosis after sleeve gastrectomy in an experimental model of diet-induced obesity (DIO). METHODS: Male Wistar DIO rats (n = 161) were subjected to surgical (sham operation and sleeve gastrectomy) or dietary interventions [fed ad libitum a normal diet (ND) or a high-fat diet (HFD) or pair-fed to the amount of food eaten by sleeve-gastrectomized animals]. The tissue distribution and expression of AQPs in biopsies of epididymal (EWAT) and subcutaneous (SCWAT) white adipose tissue and liver were analyzed by real-time PCR, Western blot, and immunohistochemistry. RESULTS: Four weeks after surgery, DIO rats undergoing sleeve gastrectomy showed a reduction in body weight, whole-body adiposity, and hepatic steatosis. DIO was associated with a tendency towards an increase in EWAT AQP3 and SCWAT AQP7 and a decrease in hepatic AQP9. Sleeve gastrectomy downregulated AQP7 in both fat depots and upregulated AQP3 in EWAT, without changing hepatic AQP9. Aqp7 transcript levels in EWAT and SCWAT were positively associated with adiposity and glycemia, while Aqp9 mRNA was negatively correlated with markers of hepatic steatosis and insulin resistance. CONCLUSION: Our results show, for the first time, that sleeve gastrectomy, a widely applied bariatric surgery procedure, restores the coordinated regulation of fat-specific AQP7 and liver-specific AQP9, thereby improving whole-body adiposity and hepatic steatosis.
Autores: Frühbeck, Gema; Méndez-Giménez, L.; Fernández-Formoso, J. A.; et al.
Revista: NUTRITION RESEARCH REVIEWS
ISSN 0954-4224  Vol. 27  Nº 1  2014  págs. 63 - 93
In adipocytes the hydrolysis of TAG to produce fatty acids and glycerol under fasting conditions or times of elevated energy demands is tightly regulated by neuroendocrine signals, resulting in the activation of lipolytic enzymes. Among the classic regulators of lipolysis, adrenergic stimulation and the insulin-mediated control of lipid mobilisation are the best known. Initially, hormone-sensitive lipase (HSL) was thought to be the rate-limiting enzyme of the first lipolytic step, while we now know that adipocyte TAG lipase is the key enzyme for lipolysis initiation. Pivotal, previously unsuspected components have also been identified at the protective interface of the lipid droplet surface and in the signalling pathways that control lipolysis. Perilipin, comparative gene identification-58 (CGI-58) and other proteins of the lipid droplet surface are currently known to be key regulators of the lipolytic machinery, protecting or exposing the TAG core of the droplet to lipases. The neuroendocrine control of lipolysis is prototypically exerted by catecholaminergic stimulation and insulin-induced suppression, both of which affect cyclic AMP levels and hence the protein kinase A-mediated phosphorylation of HSL and perilipin. Interestingly, in recent decades adipose tissue has been shown to secrete a large number of adipokines, which exert direct effects on lipolysis, while adipocytes reportedly express a wide range of receptors for signals involved in lipid mobilisation. Recently recognised mediators of lipolysis include some adipokines, structural membrane proteins, atrial natriuretic peptides, AMP-activated protein kinase and mitogen-activated protein kinase. Lipolysis needs to be reanalysed from the broader perspective of its specific physiological or pathological context since basal or stimulated lipolytic rates occur under diverse conditions and by different mechanisms.
Autores: Iriarte, Jorge, (Autor de correspondencia); Fernández, Secundino; et al.
Revista: CLINICAL NEUROPHYSIOLOGY
ISSN 1388-2457  Vol. 125  Nº 9  2014  págs. 1783 - 1791
OBJECTIVE: The pathophysiological basis of obstructive sleep apnea (OSA) is not completely understood and likely varies among patients. In this regard, some patients with OSA do not exhibit hypoxemia. We aimed to analyze the clinical, sleep, and autonomic features of a group of patients with severe OSA without hypoxia (OSA-h) and compare to OSA patients with hypoxia (OSA+h) and controls. METHODS: Fifty-six patients with OSA-h, 64 patients with OSA+h, and 44 control subjects were studied. Clinical and sleep features were analyzed. Besides, time- and frequency-domain heart rate variability (HRV) measures comprising the mean R-R interval, the standard deviation of the RR intervals (SDNN), the low frequency (LF) oscillations, the high frequency (HF) oscillations, and the LF/HF ratio, were calculated across sleep stages during a one-night polysomnography. RESULTS: OSA-h patients had a lower body mass index, a lower waist circumference, lower apnea duration, and a higher frequency of previous naso-pharyngeal surgery when compared to OSA+h patients. In terms of heart rate variability, OSA+h had increased LF oscillations (i.e., baroreflex function) during N1-N2 and rapid eye movement (REM) sleep when compared to OSA-h and controls. Both OSA+h and OSA-h groups had decreased HF oscillations (i.e., vagal inputs) during N1-N2, N3 and REM sleep when compared to controls. The LF/HF ratio was increased during N1-N2 and REM sleep, only in patients with OSA+h. CONCLUSIONS: Patients with OSA-h exhibit distinctive clinical, sleep, and autonomic features when compared to OSA with hypoxia. SIGNIFICANCE: OSA is a heterogeneous entity. These differences must be taken into account in future studies when analyzing therapeutic approaches for sleep apnea patients.
Autores: Lancha, Andoni; Moncada, Rafael; Valentí, Víctor; et al.
Revista: SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
ISSN 0930-2794  Vol. 28  Nº 2  2014  págs. 2412 - 2420
Background Bariatric surgery (BS) has proven to be an effective treatment for morbid obesity. Osteopontin (OPN) is a proinflammatory cytokine involved in the development of obesity. The aim of our study was to determine the effect of weight loss following BS on circulating levels of OPN in humans. Methods Body composition and circulating concentrations of OPN and markers of bone metabolism were determined in obese patients who underwent Roux-en-Y gastric bypass (RYGB; n = 40) or sleeve gastrectomy (SG; n = 11). Results Patients who underwent RYGB or SG showed decreased body weight (P < 0.001) and body fat percentage (P < 0.001) as well as lower insulin resistance. However, plasma OPN levels were significantly increased after RYGB (P < 0.001) but remained unchanged following SG (P = 0.152). Patients who underwent RYGB also showed significantly increased C-terminal telopeptide of type-I collagen (ICTP) (P < 0.01) and osteocalcin (P < 0.001) while bone mineral density tended to decrease (P = 0.086). Moreover, OPN concentrations were positively correlated with the bone resorption marker ICTP after surgery. On the other hand, patients who underwent SG showed significantly increased ICTP levels (P < 0.05), and the change in OPN was positively correlated with the change in ICTP and negatively with the change in vitamin D after surgery (P < 0.05). Conclusions RYGB increased circulating OPN levels, while they remained unaltered after SG. The increase in OPN levels after RYGB could be related to the increased bone resorption in relation to its well-known effects on bone of this malabsorptive procedure in comparison to the merely restrictive SG.
Autores: Fernández, Secundino; Alcalde, Juan Manuel; Baptista, Peter Michael; et al.
Revista: OTOLARYNGOLOGY-HEAD AND NECK SURGERY
ISSN 0194-5998  Vol. 151  Nº 1 Suppl  2014  págs. P185-186
Autores: Urrestarazu, Elena; López, Jon; et al.
Revista: SLEEP
ISSN 0161-8105  Vol. 36  Nº 6  2013  págs. 933 - 940
OBJECTIVE: To assess autonomic function by heart rate variability (HRV) during sleep in patients with sleep related alveolar hypoventilation (SRAH) and to compare it with that of patients with obstructive sleep apnea (OSA) and control patients. DESIGN: Cross-sectional study. SETTING: Sleep Unit, University Hospital of University of Navarra. PATIENTS: Fifteen idiopathic and obesity related-SRAH patients were studied. For each patient with SRAH, a patient with OSA, matched in age, sex, body mass index (BMI), minimal oxygen saturation (SatO2), and mean SatO2 was selected. Control patients were also matched in age, sex, and BMI with patients with OSA and those with SRAH, and in apnea/hypopnea index (AHI) with patients with SRAH. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Time- and frequency-domain HRV measures (R-R, standard deviation of normal-to-normal RR interval [SDNN], very low frequency [VLF], low frequency [LF], high frequency [HF], LF/HF ratio) were calculated across all sleep stages as well as during wakefulness just before and after sleep during a 1-night polysomnography. In patients with SRAH and OSA, LF was increased during rapid eye movement (REM) when compared with control patients, whereas HF was decreased during REM and N1-N2 sleep stages. The LF/HF ratio was equally increased in patients with SRAH and OSA during REM and N1-N2. Correlation analysis showed that LF and HF values during REM sleep were correlated with minimal SatO2 and mean SatO2. CONCLUSIONS: Patients with SRAH exhibited an abnormal cardiac tone during sleep. This fact appears to be related to the severity of nocturnal oxygen desaturation. Moreover, there were no differences between OSA and SRAH, supporting the hypothesis that autonomic changes in OSA are primarily related to a reduced nocturnal oxygen saturation, rather than a consequence of other factors such as nocturnal respiratory events.
Autores: Díez, María de las Nieves; Rodríguez, María Cristina; et al.
Revista: SIMULATION IN HEALTHCARE
ISSN 1559-2332  Vol. 8  Nº 4  2013  págs. 234 - 241
Introduction: Current European Resuscitation Guidelines 2010 recommend the use of prompt/feedback devices when training for cardiopulmonary resuscitation (CPR). We aimed to assess the quality of CPR training among second-year medical students with a voice advisory mannequin (VAM) compared to guidance provided by an instructor. Methods: Forty-three students received a theoretical reminder about CPR followed by a 2-minute pretest on CPR (compressions/ventilations cycle) with Resusci Anne SkillReporter (Laerdal Medical). They were then randomized into a control group (n = 22), trained by an instructor for 4 minutes per student, and an intervention group (n = 21) trained individually with VAM CPR mannequin for 4 minutes. After training, the students performed a 2-minute posttest, with the same method as the pretest. Results: Participants in the intervention group (VAM) performed more correct hand position (73% vs. 37%; P = 0.014) and tended to display better compression rate (124 min-1 vs. 135 min-1; P = 0.089). In a stratified analyses by sex we found that only among women trained with VAM was there a significant improvement in compression depth before and after training (36 mm vs. 46 mm, P = 0.018) and in the percentage of insufficient compressions before and after training (56% vs. 15%; P = 0.021). Conclusions: In comparison to the traditional training method involving an instructor, training medical students in CPR with VAM improves the quality of chest compressions in hand position and in compression rate applied to mannequins. Only among women was VAM shown to be superior in compression depth training. This technology reduces costs in 14% in our setup and might potentially release instructors' time for other activities.
Autores: Iriarte, Jorge; Fernández, Secundino; et al.
Revista: SLEEP MEDICINE
ISSN 1389-9457  Vol. 14  Nº 2  2013  págs. 217 - 219
Objectives This is a video case report of a 58-year-old male patient with severe obstructive sleep apnea (OSA) who underwent a pharyngo-laryngoscopy during non-drug-induced sleep. Methods The pharyngo-laryngoscopy was performed transnasally during a 30-minute nap, in the afternoon, with a flexible endoscope in supine position. During the procedure, the patient was monitored with polysomnography. Results The patient slept for 20 minutes in supine position, reaching N2 sleep stage. During the sleep, 15 respiratory events (apneas or hypopneas) were recorded. The video-recording showed that, during apneas, the obstruction at the pharyngeal level was never complete, although the nasal sensor showed a total stop in the nasal airflow. Conclusions This case highlights that OSA could not be as obstructive as generally thought, at least during N2 sleep; moreover, it suggests that apneic episodes are not a totally passive and monomorphic phenomenon, but a rather complex event.
Autores: Martín, Marina; Burrell, María Ángela; Gómez-Ambrosi, J; et al.
Revista: OBESITY SURGERY
ISSN 0960-8923  Vol. 22  Nº 4  2012  págs. 634 - 640
Background: Sleeve gastrectomy (SG) has been used as a multipurpose surgical procedure for the treatment of morbid obesity. The aim of the study was to analyze gastric morphology and histology at two different time points after SG in rats. Methods: Thirty-five male Wistar rats were fed ad libitum during 3 months on a high-fat diet to induce obesity. Subsequently, 25 diet-induced obese rats underwent either SG (n=12) or a sham operation (n=13). The remaining ten obese animals encompassed the nonoperated control group (Co). Four weeks postoperatively, 15 rats (n05 rats/experimental group) were sacrificed, while the remaining 20 rats were sacrificed after 16 weeks (animals/group; Co=5, sham=8, SG=7) to compare the gastric morphological and histopathological changes over time. Body weight and food intake were regularly recorded. Results: For both time periods, the Co groups exhibited the highest body weight, while the rats undergoing the SG showed the lowest weight gain (P<0.05). Initially, significant differences (P<0.005) in food intake relative to body weight were observed between the Co rats and animals undergoing surgery, which disappeared thereafter. The actual total stomach sizeafter both experimental periods in the SG group was similar to that of non- and sham-operated rats mainly due to a forestomach enlargement, which was more pronounced after 16 weeks. Traits of gastritis cystica profunda characterized by gastric foveolae elongation with hyperplasia and cystic dilatation of the glandswere observed in the residual stomachs of the sleeve-gastrectomized rats. These findings were mostly observed after 16 weeks of performing the SG, although they were also detected occasionally following 4 weeks postoperatively. No intestinal metaplasia was observed. Conclusion: After SG gastric macro- and microscopic changes with functional implications in both the short and long term take place.
Autores: Fernández, Secundino; España, Agustín; et al.
Revista: BRITISH JOURNAL OF DERMATOLOGY
ISSN 0007-0963  Vol. 167  Nº 5  2012  págs. 1011 - 1016
Summary Background¿ Pemphigus vulgaris (PV) is an autoimmune blistering skin disorder characterized by the presence of suprabasal acantholysis and autoantibodies against desmoglein 3. There are two different clinical forms: mucocutaneous (MCPV) and mucosal (MPV). However, little is known about PV lesions in oral, ear, nose and throat (OENT) areas produced by the very dynamic of the anatomical structures involved in the functions of the aerodigestive tract. Objectives¿ To investigate the pattern of OENT manifestations in PV, and their relationship with physiological traumatic mechanisms in stratified squamous epithelial structures. Methods¿ A prospective analysis of 40 patients diagnosed with MCPV (22 patients) or MPV (18 patients) was carried out at the University Clinic of Navarra. OENT manifestations were evaluated in all patients endoscopically. OENT involvement was divided into anatomical areas. Results¿ The most frequent symptom was pain, mainly on oral mucosa (87·5%). Buccal mucosa (90%), posterior wall of pharynx (67·5%), upper edge of epiglottis (85%) and nasal vestibule (70%) were the areas most frequently affected in the OENT mucosa. These localizations were related to physiological traumatic mechanisms in polystratified squamous epithelial structures. Conclusions¿ OENT endoscopy should be included in the examination of all patients with PV. Knowledge of the most frequent localizations of active lesions on OENT mucosa in PV will help us to interpret more efficiently the findings from OENT endoscopy. Also, information related to traumatic physiological mechanisms on OENT areas must be offered to patients in order to avoid the appearance of new active PV lesions.
Autores: Iriarte, Jorge; Fernández, Secundino; Fernández-Arrechea, Natalia; et al.
Revista: SLEEP AND BREATHING
ISSN 1520-9512  Vol. 15  Nº 2  2011  págs. 229 - 235
Purpose: Catathrenia (nocturnal groaning) is a rare and relatively little-understood parasomnia. The characteristics of the sound and the recordings are not similar in all the relevant research papers. Indeed, there is currently some discussion regarding whether or not this is a single entity. For some authors, catathrenia is a particular form of parasomnia; for others, it may be a variant of snoring or a respiratory problem. The goal is to establish whether or not catathrenia may be regarded as an expiratory vocal sound. An attempt was made to classify the origin of this sound according to its sound structure. Methods: We present the sound analysis of two patients, a man and a woman, with clinically diagnosed catathrenia and we compared them with the analysis of snoring. We use the spectrogram and the oscillogram. We classified the sounds according to the Yanagihara criteria. Results: The vocal nature of the sound was confirmed, and several significant differences to some snoring sounds were discovered. The analysis of the catathrenia samples demonstrated that these signals are type II according to Yanagihara classification; these signals had a very short jitter, and had formants and harmonics. However, snoring is a type III, very irregular and had formants but not harmonics. Conclusions: The oscillogram and the spectrogram in these patients show that the origins of the sounds are clearly different: catathrenia is laryngeal, while snoring is guttural. Catathrenia cannot be considered as expiratory snoring.
Autores: Valentí, Víctor; Martín, Marina; BEa; et al.
Revista: OBESITY SURGERY
ISSN 0960-8923  Vol. 21  Nº 9  2011  págs. 1438 - 1443
Background: Sleeve gastrectomy (SG) has been used for the surgical treatment of morbid obesity as a first or definitive procedure with satisfactory results. The objective of this study in rats was to establish the effects of SG on weight loss depending on the post-surgical type of diet followed. Methods: Thirty male Wistar rats were fed ad libitum during 3 months on a high-fat diet (HFD) to induce obesity. After this first phase, rats were subdivided in three groups of ten rats each and underwent a sham intervention, an SG, or no surgery but were pair-fed to the amount of food eaten by the animals of the SG group. At this time point, half of the animals in each group continued to be fed on the HFD, while the other half was switched to a normal chow diet (ND). Thus, the following subgroups were established: sham-ND, sleeve-ND, pair-fed-ND as well as sham-HFD, sleeve-HFD, and pair-fed-HFD. Body weight and food intake were recorded daily for 4 weeks. The feed efficiency rate (FER) was determined from weekly weight gains and caloric consumption during this period. Results: Statistically significant (P¿<¿0.05) differences in body weight were observed between the six experimental groups after 4 weeks of the interventions with rats in the sleeve-ND group experimenting the highest weight loss (-78.2¿±¿10.3 g) and animals in the pair-fed-HFD group exhibiting the lowest weight reduction (-4.0¿±¿0.1 g). Interestingly, the FER value of rats that underwent the SG and continued to be fed on a HFD was significantly (P¿<¿0.05) lower than that of sham operated and pair-fed animals on the same diet. Conclusion: The positive effects of SG on weight reduction are observed in obese rats submitted to the intervention and subsequently following an ND or even an HFD.
Autores: Fernández, Secundino; Guillén-Grima, F; et al.
Revista: AURIS NASUS LARYNX
ISSN 0385-8146  Vol. 37  Nº 4  2010  págs. 409 - 414
Objective: To evaluate the value of different variables of the clinical history, auditory and vestibular tests and handicap measurements to define intractable or disabling Meniere's disease. Methods: This is a prospective study with 212 patients of which 155 were treated with intratympanic gentamicin and considered to be suffering a medically intractable Meniere's disease. Age and sex adjustments were performed with the 11 variables selected. Discriminant analysis was performed either using the aforementioned variables or following the stepwise method. Results: Different variables needed to be sex and/or age adjusted and both data were included in the discriminant function. Two different mathematical formulas were obtained and four models were analyzed. With the model selected, diagnostic accuracy is 77.7%, sensitivity is 94.9% and specificity is 52.8%. Conclusion: After discriminant analysis we found that the most informative variables were the number of vertigo spells, the speech discrimination score, the time constant of the VOR and a measure of handicap, the "dizziness index". (C) 2009 Elsevier Ireland Ltd. All rights reserved.
Autores: Baptista, Peter Michael; Bejarano, Bartolomé; Fernández, Secundino; et al.
Revista: OTOLARYNGOLOGY-HEAD AND NECK SURGERY
ISSN 0194-5998  Vol. 143  Nº 2 Supl.2  2010  págs. 296
OBJECTIVE Fibrin sealants are widely used as topical hemostatic agents, sealants and tissue adhesives that contain fibrinogen and thrombin. They have become a valuable adjunct in a broad range of surgical procedures (neurosurgery, skull base surgery) to control bleeding, to provide a firm seal in seconds to minutes and to promote tissue growth and repair. A large number of clinical applications are referenced in the medical literature, from closures of fistula to seroma prevention. Provide information about the usefulness and results of fibrin sealants in skull base surgery at our institution. Previous Section Next Section METHOD We present our experience with Vivostat (a patient-derived fibrin sealant, only available in Europe), which was used in 36 patients that were operated for skull base or sinus pathology at the University Clinic of Navarra. Previous Section Next Section RESULTS The experience encompasses Selar pathology (pituitary adenomas), CSF fistulas, vestibular schwannomas, cholesteatoma, carcinoma and endoscopic sinus surgery. We applied Vivostat since it has the advantage of being a patient-derived hemostat and sealant with an efficient component mix and a delivery dosage control. We did not have any complications regarding the use of this product and our results were satisfactory. Previous Section CONCLUSION Fibrin sealant Vivostat has been used as a useful sealant and tissue adhesive with enhanced elasticity and tensile strength that allows a safer and better performance of wound management, especially in skull base surgery.
Autores: Fernández, Secundino;
Libro:  Patología de la voz
2013  págs. 23 - 28
Autores: Giraldo, L. F. ; Agudelo, M. ; Arbulu, M. ; et al.
Libro:  13th International Conference on Bioinformatics and Bioengineering
2013  págs. 1 - 4
Factors determining the variability of air-pulse pressure to determine the thresholds of laryngeal-pharyngeal reflexes, which are related to swallowing and airway protection, were explored. Potential factors affecting the reproducibility of air-pulses were experimentally evaluated and included in a multiple linear regression model. A novel device controlling these factors and minimizing variability was designed. Its reproducibility was assessed by the coefficient of variation (CV) of the pressures and duration of air-pulses, and its validity was assessed by comparing obtained pressures and durations with desired pressures and durations. Differences in the pressures of airpulse categories were assessed by a one-way ANOVA of repeated measures, a Tukey test and a box and whisker plot. The distance and angle between the exit of the tube conducting the pulses and the surface to be impacted, the diameter of the tube, the feeding pressure of the system, and the duration of air-pulses significantly affected the accuracy of air-pulses. The novel device incorporated electronic valves and a telemeter for use during the fiberoptic endoscopic evaluation of swallowing. The differences between the desired and obtained pressures and durations were below 3%. The CV of the air-pulse pressures of the novel device was 0.02. The CV of air-pulse duration was 0.05. The oneway ANOVA, Tukey test and box and whisker plot showed that the outlet pressures of air-pulse categories had statistically significant differences between them without overlap between categories, which helps to obtain an accurate threshold.
Autores: Cobeta, I.; Núñez, F.; Fernández, Secundino;
Libro:  Patología de la voz
2013  págs. 237 - 241
Autores: Núñez, F.; Fernández, Secundino;
Libro:  Patología de la voz
2013  págs. 242 - 257
Autores: Cobeta, I.; Núñez, F.; Fernández, Secundino;
Título: Estroboscopia
Libro:  Patología de la voz
2013  págs. 146 - 158
Autores: Cobeta, I.; Núñez, F.; Fernández, Secundino;
Libro:  Patología de la voz
2013  págs. 323 - 333
Autores: Cobeta, I.; Núñez, F.; Fernández, Secundino;
Título: Introducción
Libro:  Patología de la voz
2013  págs. 17 - 19
Autores: Fernández, Secundino; Cobeta, I.; Vaca, M.;
Título: Presbifonía
Libro:  Patología de la voz
2013  págs. 305 - 312
Autores: Fernández, Secundino; Núñez, F.;
Libro:  Patología de la voz
2013  págs. 178 - 187
Autores: Cobeta, I., (Coordinador); Núñez, F., (Coordinador); Fernández, Secundino, (Coordinador)
2013