Search Results (258)

Objective: The aim of this study was to describe the presenting characteristics and outcomes of neonates with respiratory failure referred for extracorporeal membrane oxygenation (ECMO) support, compare those who received ECMO support (ECMO group) to those who did not (non-ECMO group), and evaluate the predictive variables requiring ECMO support. Methods: All neonates (<15 days) with respiratory failure (without congenital diaphragmatic hernia or congenital heart disease) referred to our regional ECMO center from 2014 to 2023 were included in this retrospective study. Patient demographics, birth history, and clinical and outcome variables were analyzed. Oxygenation indices and vasoactive–inotropic scores obtained at PICU arrival and four hours after arrival were compared between the two groups using ROC analysis, with ECMO initiation as an outcome variable. Youden’s index was used for optimal threshold values. Chi-square, Mann–Whitney U, and binary logistic regression were used for comparative analyses. Results: Out of the 147 neonates, 96 (65%) required ECMO support. The two groups significantly differed in the prevalence of pulmonary hypertension (pHTN; systemic or suprasystemic pulmonary pressures), lactate level, and oxygenation indices. Mortality was not different between the two groups. Presence of oxygen saturation index (OSI) ≥ 10 had a sensitivity 96.8% in predicting the need for ECMO support. On regression analysis, OSI and pHTN were independent predictors of ECMO support. Conclusions: Oxygenation indices and echo findings predict the need for ECMO support in neonatal hypoxemic respiratory failure. These findings help non-ECMO centers make appropriate and timely transfers of neonates with respiratory failure to ECMO centers. Full article

Muscle activity during exercise is typically assessed using oximeters, to evaluate local oxygen saturation (SmO₂), or surface electromyography (sEMG), to analyze electrical activation. Despite the importance of combining these analyses, no study has evaluated both of them during specific swimming exercises in combination with mechanical power output. This study aimed to assess muscle activity during an incremental test on a swim-bench utilizing oximeters and sEMG. Nine male swimmers performed a five-steps test: PRE (3 min at rest), STEP 1, 2, and 3 (swimming at a frequency of 25, 30, and 40 cycle/min for a duration of 2, 2, and 1 min, respectively), and POST (5 min at rest). Each swimmer wore two oximeters and sEMG, one for each triceps brachii. Stroke frequency and arm mechanical power (from ~13 to ~52 watts) estimated by the swim-bench were different among all steps, while no differences between arms were found. SmO₂ (from ~70% to ~60%) and sEMG signals (from ~20 to ~65% in signal amplitude) showed a significant increase among all steps. In both arms, a large/very large correlation was found between mechanical power and SmO₂ (r < −0.634), mechanical power and sEMG onset/amplitude (r > 0.581), and SmO₂ and sEMG amplitude (r > 0.508). No correlations were found between the slope of the sEMG spectral indexes and the slope of SmO₂; only sEMG detected electrical manifestation of muscle fatigue through the steps (p < 0.05). Increased muscle activity, assessed by both oximeters and sEMG, was found at mechanical power increases, revealing both devices can detect effort variation during exercise. However, only sEMG seems to detect peripheral manifestations of fatigue in dynamic conditions. Full article

(1) Background: Previous studies indicate that individuals who engage in regular physical activity have a higher pain threshold than those who do not exercise. However, it remains unclear how this phenomenon behaves in individuals exposed to chronic hypoxia. This study evaluates pain perception at high altitude between high-altitude natives who exercised regularly and those who did not practice physical activity. (2) Methods: Eighty-four healthy volunteers aged 20 to 30 years old with a body mass index (BMI) within the normal range (18.5–24.9) residing in the city of Puno (3825 m) were recruited. The unilateral ischemia pain provocation test was used, applying pressure with a manual sphygmomanometer to generate transient ischemia in the arm while the patient opens and closes their hand. Onset, peak, and resolution times of pain, heart rate, and oxygen saturation were recorded. (3) Results: The average time to pain onset in the right arm was 30.2 s ± 14.1 during light physical activity, whereas, during moderate physical activity, it increased to 32.5 s ± 15.4. In the left arm, the average time until pain sensation was 27.9 s ± 16.8 during light physical activity and increased to 34.6 s ± 18.5 with moderate physical activity. Regarding the progression of pain intensity, the average time to reach unbearable pain in the right arm was 54.1 s ± 16.4 during light physical activity and 53.8 s ± 19.6 during moderate physical activity; in the left arm, it was 53.0 s ± 19.6 during light physical activity, increasing to 59.3 s ± 24.5 during moderate physical activity. (4) Conclusions: A more stable and slightly higher pain tolerance in the dominant arm was observed. Full article

Background/Objectives: Cerebral palsy (CP) is a neurodevelopmental disorder associated with sleep disturbances, particularly sleep-disordered breathing (SDB), and is often linked to an increased risk of obstructive sleep apnea (OSA). OSA is underdiagnosed in this population due to the lack of standardized methods and limited access to appropriate diagnostic technologies and appropriate equipment. Thus, this study aimed to investigate the presence and severity of sleep disorders, with a particular focus on OSA, in children and adolescents with CP compared to their typically developing peers. Methods: This observational, clinical, and prospective study included 28 children and adolescents with CP and 32 age- and sex-matched typically developing individuals. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children (SDSC) and a high-resolution oximeter plus actigraphy combined with a cloud-based algorithm for the detection of obstructive sleep apnea (Biologix^® system), which provided data on oxygen saturation, snoring, movement during sleep, and total sleep time. Results: According to the SDSC, 92% of children and adolescents with CP presented scores indicative of sleep disturbances, compared to 31% of typically developing individuals. SDB was the most prevalent subtype (64%) and overnight oximetry revealed that 100% of the CP group presented oxygen desaturation index (ODI) values consistent with a diagnosis of OSA. The CP group also exhibited significantly lower mean SpO₂, longer snoring duration, shorter total sleep time, and prolonged sleep latency compared to the typically developing group. Conclusions: Children and adolescents with cerebral palsy (CP) exhibit a high prevalence of sleep disturbances, with increasing evidence indicating a significant occurrence of sleep-disordered breathing (SDB), particularly obstructive sleep apnea (OSA). Full article

Cerebral near-infrared spectroscopy (NIRS) systems have been demonstrated to continuously measure aspects of oxygen delivery and cerebrovascular reactivity. However, it remains unknown whether the prediction of these cerebral physiologic signals into the future is feasible. Leveraging existing archived data sources, four point and interval-forecasting methods using autoregressive integrative moving average (ARIMA) models were evaluated to assess their ability to predict NIRS cerebral physiologic signals. NIRS-based regional cerebral oxygen saturation (rSO₂) and cerebral oximetry index signals were derived in three temporal resolutions (10 s, 1 min, and 5 min). Anchored- and sliding-window forecasting, with varying model memory, using point and interval approaches were used to forecast signals using fitted optimal ARIMA models. The absolute difference in the forecasted and measured data was evaluated with median absolute deviation, along with root mean squared error analysis. Further, Pearson correlation and Bland–Altman statistical analyses were performed. Data from 102 healthy controls, 27 spinal surgery patients, and 101 traumatic brain injury patients were retrospectively analyzed. All ARIMA-based point and interval prediction models demonstrated small residuals, while correlation and agreement varied based on model memory. The ARIMA-based sliding-window approach performed superior to the anchored approach due to data partitioning and model memory. ARIMA-based sliding-window forecasting using point and interval approaches can forecast rSO₂ and the cerebral oximetry index with reasonably small residuals across all populations. Correlation and agreement between the predicted versus actual values varies substantially based on data-partitioning methods and model memory. Further work is required to assess the ability to forecast high-frequency NIRS signals using ARIMA and ARIMA-variant models in healthy and cranial trauma populations. Full article

This observational pilot study investigated neurocardiovascular responses to an active stand test using continuous physiological monitoring and functional data analysis (FDA) in older women. A sample of 25 community-dwelling female adults aged 59–78 years (mean age: 70.3 years) participated. Participants were dichotomized into comparison groups based on five factors: age (<70 vs. ≥70 years); the presence of initial orthostatic hypotension (IOH, yes/no); body mass index (BMI < 25 vs. ≥25 kg/m²); antihypertensive medication use (yes/no); and physical frailty status assessed by the Survey of Health, Ageing and Retirement in Europe—Frailty Instrument (SHARE-FI score < −0.5 vs. ≥−0.5). Each participant completed an active stand test during which six physiological signals were continuously recorded: systolic (sBP) and diastolic (dBP) blood pressure and heart rate (HR) via digital artery photoplethysmography and left frontal oxygenated hemoglobin (O₂Hb), deoxygenated hemoglobin (HHb), and tissue saturation index (TSI) via near-infrared spectroscopy (NIRS). The signal analysis focused on a standardized 200 s window spanning 50 s before to 150 s after the stand, with all signals resampled and synchronized at 5 Hz. FDA was used to statistically compare the full time series between groups for each signal. Group-level differences revealed that younger participants (<70 years) exhibited significantly higher HR in multiple periods following the stand (~10 s, ~30 s, ~90 s, and ~140 s post-stand) compared to their older counterparts. Participants with IOH demonstrated significantly lower sBP at ~10 s, ~80 s, and ~130 s post-stand and lower dBP at ~10 s post-stand. Among participants classified as overweight/obese (BMI ≥ 25 kg/m²), significantly lower levels of HHb were observed at ~10 s, ~30–50 s, and ~60 s post-stand, while O₂Hb levels were reduced at ~50 s, ~60 s, ~70–110 s, ~130 s, and ~140 s post-stand. No statistically significant group-level differences were observed based on antihypertensive medication use or frailty status. These findings demonstrate the utility of FDA in detecting subtle, time-dependent physiological variations during orthostatic challenge and underscore the value of continuous neurocardiovascular monitoring in assessing orthostatic tolerance in aging populations. Full article

Background: This study aimed to investigate the neurocardiovascular responses during an Active Stand (AS) test, utilizing both pre-processed and raw signals, to predict adverse health outcomes including orthostatic intolerance (OI) during the AS, and future falls and mortality. Methods: A total of 2794 participants from The Irish Longitudinal Study on Ageing (TILDA) were included. Continuous cardiovascular (heart rate (HR), systolic (sBP), and diastolic (dBP) blood pressure) and near infra-red spectroscopy-based neurovascular (tissue saturation index (TSI), oxygenated hemoglobin (O₂Hb), and deoxygenated hemoglobin (HHb)) signals were analyzed using Statistical Parametric Mapping (SPM) to identify significant group differences across health outcomes. Results: The results demonstrated that raw (unprocessed) signals, particularly O₂Hb and sBP/dBP, were more effective in capturing significant physiological differences associated with mortality and OI compared to pre-processed signals. Specifically, for OI, raw sBP and dBP captured significant changes across the entire test, whereas pre-processed signals showed intermittent significance. TSI captured OI only in its pre-processed form, at approximately 10 s post-stand. For mortality, raw O₂Hb was effective throughout the AS test. No significant differences were observed in either pre-processed or raw signals related to falls, suggesting that fall risk may require a multifactorial assessment beyond neurocardiovascular responses. Conclusions: These findings highlight the potential utility of raw signal analysis in improving risk stratification for OI and mortality, with further studies needed to validate these findings and refine predictive models for clinical applications. This study underscores the importance of retaining raw data for certain physiological assessments and provides a foundation for future work in developing machine-learning models for early health outcome detection. Full article

Background/Objectives: Aortic stenosis (AS) is the most prevalent valvular disease among older adults. Although obstructive sleep apnea (OSA) has been linked to adverse cardiovascular outcomes, its specific impact on patients with severe AS remains unclear. This study aimed to determine the prevalence of OSA and its influence on postoperative recovery following aortic valve replacement. Methods: A prospective case-control study was conducted at the Instituto Nacional de Cardiología Ignacio Chávez. Patients aged 40–80 years with echocardiographically confirmed severe AS were categorized into groups with and without OSA, based on respiratory polygraphy (Apnea–Hypopnea Index [AHI] threshold of >15 events per hour). Clinical, biochemical, echocardiographic, body composition, and hemodynamic parameters were assessed. Daytime sleepiness and sleep quality were evaluated using validated questionnaires. Inflammatory biomarkers were also analyzed. This study was approved by the institutional ethics committee. Results: Of the 30 patients included, 66.6% were diagnosed with OSA. Compared to non-OSA patients, those with OSA had a higher left ventricular mass index (160 vs. 108; p = 0.001), greater postoperative increases in central venous pressure [8 (8–10) vs. 8 (6–8); p = 0.037], and lower mixed venous oxygen saturation within the first 24 h (69.2 vs. 76; p = 0.027). OSA patients also had longer hospital stays (11 vs. 8 days; p = 0.014). Trends toward a heightened subclinical inflammatory state were noted in the OSA group. Conclusions: OSA is frequent and underdiagnosed in patients with severe AS and is associated with more complicated postoperative recovery. Systematic OSA screening is recommended for candidates undergoing aortic valve surgery. Full article

Background/Objective: Obesity is a documented risk factor for impaired pulmonary function and abnormal oxyhaemoglobin levels during sleep. This functional impairment becomes more significant when there are additional respiratory pathologies, such as obstructive sleep apnea (OSA) and/or chronic obstructive pulmonary disease (COPD). Overnight pulse oximetry may offer an effective evaluation of nocturnal oxyhaemoglobin levels/waveform patterns. We evaluated the correlation between obesity, overnight pulse oximetry (parameters, waveform patterns) and pulmonary function in patients diagnosed with moderate–severe OSA and normal oxyhaemoglobin saturation levels during waking hours. We also compared the overnight oxyhaemoglobin saturation levels between patients with OSA alone and those with associated COPD. Methods: This was a retrospective, transversal, non-interventional study on consecutive patients with moderate–severe OSA diagnosed using overnight cardiorespiratory polygraphy over a period of 18 months. After analyzing the study population’s characteristics, the patients were divided into two subgroups: one consisting of patients with OSA alone (Group A), and the second with coexisting OSA and COPD (Group B). Results: Seventy-six patients were included in the study, and 18% were diagnosed with COPD. A higher body mass index (BMI) correlated with a higher number of ≥3% SpO₂ drops/h (ODI3) and percentage of time with oxyhaemoglobin saturation < 90% (t90) and a lower average nocturnal oxyhaemoglobin saturation (avgSpO₂). ODI3 correlated negatively with avgSpO₂ and positively with t90. After eliminating BMI as a confounding factor, lower values of forced expiratory volume in the first second (FEV1) were associated with lower avgSpO₂ and higher t90. FEV1 did not corelate with ODI3. After dividing the study population into the two subgroups, patients from Group B had a tendency towards lower average nocturnal SpO₂ levels compared to Group A. Conclusions: Different phenotypes/patterns of nocturnal hypoxemia can be identified using quantitative and qualitative analyses of overnight pulse oximetry: repetitive, consecutive obstructive respiratory events with a characteristic intermittent (saw-tooth) hypoxemia pattern and alveolar hypoventilation, resulting in a continuous (plateau) hypoxemia pattern. According to our findings, nocturnal hypoxemia is more important at lower FEV1 values (correlating with lower avgSpO₂/higher t90, but not with ODI3). The presence of a continuous hypoxemia pattern in patients with OSA may suggest that pulmonary function tests should be performed in order to differentiate patients with alveolar hypoventilation secondary to obesity (restrictive syndrome) from those with associated COPD (obstructive syndrome). This can have an impact on the management of the case and the therapeutic approach (positive pressure therapy with/without supplemental oxygen). Full article

This study presents a remote sensing (RS) approach for monitoring invasive aquatic species and assessing their impact on water quality in the Lis Valley Irrigation District (LVID), Portugal. Using high-resolution PlanetScope imagery (3.7 m resolution), this method overcomes spatial limitations in narrow irrigation canals. Representative sub-zones were selected to analyze spatial and temporal trends, and vegetation indices (Normalized Difference Vegetation Index—NDVI, Enhanced Vegetation Index—EVI, Green Chlorophyll Index—GCI) were calculated to map the spread of Eichhornia crassipes (water hyacinth—WH) and Myriophyllum aquaticum (parrot’s feather—PF). All three vegetation indices exhibited significant linear regressions with pH, with the EVI showing the highest coefficient of determination (R² = 0.761), followed by the NDVI (R² = 0.726) and GCI (R² = 0.663), with p-values and ANOVA p-values below 0.05. Dissolved Oxygen (DO) also showed strong correlations, particularly with the GCI (R² = 0.886 for both DO concentration and saturation). The NDVI and EVI demonstrated significant regressions for these parameters, with R² values between 0.661 and 0.862. The results demonstrate the potential of RS to detect invasive species and assess their ecological impact, providing a cost-effective tool for management strategies in irrigation systems. Future research should integrate more field data and extend the study period to enhance classification accuracy. Full article

Background/Objectives: Even with improvements in perinatal care, bronchopulmonary dysplasia (BPD) continues to be a major challenge, especially in smaller and more premature infants. Early detection of severe BPD can improve treatment outcomes. This study aims to evaluate the correlation between the oxygen saturation index (OSI) and severe BPD/death in preterm infants, with a focus on the OSI’s predictive value. Methods: In this retrospective observational study, infants with a gestational age of less than 32 weeks who required either invasive or non-invasive mechanical ventilation were included. Ventilator settings and OSI values were collected on days 3, 7, 14, 21, and 28 of life. The correlations between postnatal OSIs and outcomes such as death or severe BPD were analyzed using logistic regression. Results: Out of the 210 eligible infants, 54 (25.7%) either died or were diagnosed with severe BPD. In our study, OSI values on postnatal days 14, 21, and 28 were significantly higher in preterm infants who developed severe BPD or died, with mean OSI-14, OSI-21, and OSI-28 values of 4.9, 3.5, and 2.8, respectively. The OSI showed the highest sensitivity and specificity on postnatal days 14 and 21, with cut-off points of 3.6 and 3.1, respectively. We built a basic chart to predict severe BPD/death with OSI-14 and OSI-21 and delivery room intubation with 86% sensitivity and 84.5% specificity (increasing up to 98.8% specificity). Conclusions: This study showed that the diagnostic power of the OSI in predicting severe BPD or death was highest for OSI-14 and OSI-21. We demonstrated that calculating the OSI, a non-invasive clinical tool, can predict severe BPD/death in infants born before 32 weeks as early as the 14th day of life. Full article

Background: This study aims to identify the factors related to demographic variables and physical performance associated with quality of life (QoL) in post-COVID-19 pa-tients who have recovered from mild infection and were not hospitalized. Methods: Seventy-four post-COVID-19 individuals who recovered from mild COVID-19 infec-tion were assessed for the baseline demographic variables (age, sex, height, weight, body mass index; BMI) and clinical information (comorbidities, duration of COVID-19 infection, and exercise habits). Vital signs (heart rate, blood pressure, and oxygen sat-uration; SpO₂) were measured. Physical performance was evaluated for upper- and lower-limb muscle strength, ability of balance, and cardiorespiratory performance. All participants were assessed for QoL. Results: Hand grip strength was negatively asso-ciated with gender and age while positively associated with the duration of COVID-19. Quadricep strength also showed a negative association with gender and duration of COVID-19. Age was positively associated with multiple quality of life dimensions, while emotional role limitations were negatively associated with the duration of COVID-19 and waist circumference. Mental health was negatively linked to BMI. Conclusions: This study highlights the complex impact of COVID-19 on physical per-formance and QoL, revealing that older adults often report better QoL despite reduced muscle strength, particularly in women. The findings emphasize the need for targeted rehabilitation programs addressing both physical and emotional health for vulnerable groups. Full article

Background: Obstructive sleep apnea (OSA) is characterized by repetitive complete or partial closure of the upper airway during sleep, which is a potentially life-threatening disorder. A cephalogram is a simple and effective examination to predict the risk of OSA in orthodontic clinical practice. This study aims to analyze the relationship between craniofacial characteristics and the severity of OSA using polysomnography and cephalogram data. Gender differences in these parameters are also investigated. Methods: This study included 112 patients who underwent a complete clinical examination, standard polysomnography study, and cephalometric analysis to diagnose obstructive sleep apnea. This study divided the participants into male and female groups to study the correlation between cephalometric parameters and the severity of OSA. The analysis involved 39 cephalometric parameters. The severity of obstructive sleep apnea was evaluated by the apnea–hypopnea index (AHI) and the lowest nocturnal oxygen saturation (LSaO₂). Results: The final assessment included 112 adult participants (male/female = 67:45, mean age: 28.4 ± 7.29 years, mean male age: 28.8 ± 7.62 years, mean female age: 27.8 ± 6.79 years). Multivariate analysis revealed that the mandibular position, incisor inclination, facial height, and maxillary first molar position were strongly associated with OSA severity. Gender-specific differences in cephalometric predictors were identified, with distinct parameters correlating with the AHI and LSaO₂ in males and females. Notably, the LSaO₂ demonstrated stronger associations with craniofacial morphology in females than males. Conclusions: Cephalometric analysis can be effective in assessing the risk and severity of OSA based on the correlation between cephalometric parameters and the AHI/LSaO₂. There is a clear difference between the cephalometric parameters associated with OSA severity in male and female individuals. This gender-dependent pattern may assist the personalized diagnosis and management of OSA in clinical practice. Full article

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, underscoring the urgent need for novel therapeutic targets and strategies. The kinase MARK4 (MAP (microtubule-associated proteins)/microtubule affinity-regulating kinase 4) regulates microtubule-associated proteins pivotal for cell polarity, protein stability, and intracellular signaling. Animal models of heart failure revealed elevated MARK4 levels, which correlated with impaired cardiac contractility. However, the involvement of MARK4 and its potential as a molecular drug target has not yet been explored in the myocardium of cardiovascular patients. We investigated the MARK4 mRNA expression in human myocardial biopsies of 152 high-risk cardiovascular patients undergoing cardiac surgery. Comprehensive echocardiography as well as testing for sleep-disordered breathing (SDB), a critical comorbidity in heart failure, were assessed preoperatively. We observed a substantial upregulation of myocardial MARK4 expression in patients with impaired cardiac contractility, resulting in an inverse correlation with the left ventricular ejection fraction. Myocardial MARK4 expression also correlated with echocardiographic E/e’, a central parameter of diastolic dysfunction. Mechanistically, our analyses revealed that MARK4 expression increases in SDB and under hypoxic conditions, as evidenced by significant correlations between myocardial MARK4 expression and factors like mean oxygen saturation, time with oxygen saturation below 90%, and the oxygen desaturation index. Multivariable regression analysis revealed that both left ventricular ejection fraction and mean oxygen saturation were independently associated with dysregulated MARK4 levels, even when controlling for important clinical covariables as potential confounders. Taken together, our findings demonstrate that MARK4 expression is highly increased in the myocardium of cardiovascular high-risk patients, suggesting it is a potential molecular target against cardiovascular diseases. Full article

Background: The prone position is one of the most frequently used treatment options for infants with Robin sequence (RS), but its effect and its safety regarding the increased risk of sudden infant death syndrome are controversial. Methods: In a prospective randomized crossover study, we investigated the effects of the prone versus supine position on obstructive sleep apnea (OSA) using polygraphy. Infants with RS admitted to the University Hospital Tuebingen between 4/2021 and 5/2023 were analyzed for their obstructive apnea index (OAI), oxygen desaturation index < 80%, minimum and basal oxygen saturation, basal and highest transcutaneous carbon dioxide level, and respiratory and heart rate in both sleep positions. Results: A total of 29 children were analyzed. A total of 21/29 children were measured in both positions, while 6/29 children were only measured in the supine position and 2/29 only in the prone position. We found no significant difference in the OAI for the supine versus prone position in main effects analyses. In unadjusted linear model analysis, infants in the supine position had an OAI of 9.9 (95% CI, −2.4, 22.3) events/h higher than those in the prone position. A total of 13/21 infants benefitted from the prone position, whilst 8/21 had a worsening of their OSA. We found no evidence of a significant interaction between sleeping position and syndromic status. Conclusions: Prone positioning improves, but does not eliminate, OSA symptoms in infants with RS, and severe OSA may often persist. There are infants in whom a change to the prone position leads to a worsening of their OSA. Full article