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OBJETIVO: Comparar la expresión de marcadores de respuesta a hipoxia, inflamatorios y de estrés oxidativo en biopsia muscular de grupos de pacientes con hipoxia crónica continua, crónica intermitente y ambas combinadas. Evaluar el estado de la musculatura periférica y compararla entre grupos. METODOLOGÍA: Incluimos varones mayores de 18 años, diagnosticados de EPOC, Apnea Obstructiva del Sueño (AOS) o AOS-EPOC, a los que se realizó biopsia muscular del cuádriceps. Los biomarcadores seleccionados para su estudio en músculo fueron factores de transcripción asociados a la hipoxia, como el factor inducible por hipoxia HIF-1, HIF-2 y el factor nuclear. También biomarcadores inflamatorios como factor de necrosis tumoral-α, interkeukina 6 y 8, factor de crecimiento endotelial vascular y proteína de adhesión celular vascular 1 (VCAM-1), así como biomarcadores de estrés oxidativo, como superóxidodismutasa (SOD) y actividad catalasa. Además se realizó evaluación de la función muscular en los tres grupos. RESULTADOS: Reclutamos 29 sujetos: 4 con EPOC, 12 con AOS y 13 EPOC-AOS. En el músculo, encontramos diferencias entre los grupos de estudio en VCAM-1 (casos de EPOC que expresan 2,1 veces más que AOS y 1,16 veces más que EPOC-AOS) y SOD (EPOC-AOS que expresan 3,48 veces más que EPOC, y AOS 3,02 veces más que EPOC). CONCLUSIONES: La expresión de biomarcadores estudiados es de intensidad similar en los tres grupos de pacientes referidos, con pocas excepciones.La fuerza muscular periférica y el porcentaje de masa libre de grasa es significativamente menor en los pacientes con EPOC que en los pacientes con AOS. (AU)

OBJECTIVE: Compare the expression of markers of response to hypoxia, inflammation and oxidative stress in biopsy muscle of groups of patients with continuous chronic hypoxia, intermittent chronic and both combined. Evaluate the state of the peripheral musculature and compare it between groups. METHODOLOGY: We included males older than 18 years, diagnosed of COPD, Obstructive Sleep Apnea (OSA) or OSA-COPD, to quadriceps muscle biopsy was performed. biomarkers selected for study in muscle were factors of transcription associated with hypoxia, such as the factor inducible by hypoxia HIF-1, HIF-2 and nuclear factor. Also biomarkers Inflammatory agents such as tumor necrosis factor-α, interkeukin 6, and 8, vascular endothelial growth factor and adhesion protein vascular cell 1 (VCAM-1), as well as stress biomarkers oxidative, such as superoxide dismutase (SOD) and catalase activity. In addition, evaluation of muscle function was performed in the three groups. RESULTS: We recruited 29 subjects: 4 with COPD, 12 with OSA and 13 COPD-OSA. In muscle, we found differences between the study groups in VCAM-1 (COPD cases expressing 2.1-fold more than OSA and 1.16 times more than COPD-OSA) and SOD (COPD-OSA than express 3.48 times more than COPD, and OSA 3.02 times more than COPD). CONCLUSIONS: The expression of studied biomarkers is of similar intensity in the three groups of referred patients, with few exceptions. Peripheral muscle strength and percentage of fat-free mass is significantly lower in patients with COPD than in patients with OSA. (AU)

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Título abreviado: Se exponen los recursos asistenciales del Sistema Sanitario Público de Andalucía relacionados con el diagnóstico, tratamiento y seguimiento de los pacientes con apnea obstructiva del sueño. Igualmente se describen propuestas para una optimización en el manejo de esta entidad enfatizando la necesidad de recursos y colaboración entre diferentes niveles asistenciales. Objetivo: Determinar en el Sistema Sanitario Público de Andalucía (SSPA) los recursos actuales en la apnea obstructiva del sueño (AOS) e identificar propuestas de mejora. Método: Estudio transversal, basado en encuestas realizadas en 49 hospitales del SSPA. Se registraron variables relacionadas al diagnóstico, tratamiento y seguimiento de la AOS, distinguiendo entre centros que realizaban polisomnografía y los que no. Incluimos un apartado sobre propuestas de mejora. Resultados: Un 97% de los centros realizan poligrafía y un 29% polisomnografía, y sólo el 39,5% disponen de consulta específica. La demora diagnóstica para la poligrafía es de 169 ± 163,4 días y para la polisomnografía de 173 ± 152,5 días. Se realizan un total de 1.113 ± 1.004,6 pruebas por 100.000 habitantes y año, de ellas 235 ± 166,2 son poligrafías diagnósticas. La presión eficaz se titula en un 49% con auto-CPAP y el control terapéutico lo realiza frecuentemente la empresa suministradora (77%). Entre las propuestas de mejora, destacan la falta de un protocolo de derivación y coordinación entre diferentes niveles asistenciales (90% de los encuestados), y la demora diagnóstica, atribuible en un 63% de los casos al déficit de recursos físicos y de personal. Conclusión: El número de pruebas diagnósticas aún son insuficientes y la demora diagnóstica es excesiva. Sobre todo, en el control terapéutico la empresa suministradora tiene un papel relevante. Se propone la realización de protocolos entre diferentes unidades asistenciales y aumentar los recursos actuales. (AU)

Short title: The healthcare resources of the Andalusian Public Health System related to the diagnosis, treatment and follow-up of patients with obstructive sleep apnea are presented. Proposals for optimizing the management of this entity are also described, emphasizing the need for resources and collaboration between different levels of care. Objective: Determine the current resources in the Public Health System of Andalusia (SSPA) in obstructive sleep apnea (OSA) and identify proposals for improvement. Method: Cross-sectional study, based on surveys conducted in 49 SSPA hospitals. Variables related to the diagnosis, treatment, and follow-up of OSA were recorded, distinguishing between centers that performed polysomnography and those that did not. We include a section on proposals for improvement. Results: 97% of the centers perform polygraphy and 29% polysomnography, and only 39.5% have a specific consultation. The diagnostic delay for polygraphy is 169 ± 163.4 days and for polysomnography 173 ± 152.5 days. A total of 1,113 ± 1,004.6 tests are performed per 100,000 inhabitants per year, of which 235 ± 166.2 are diagnostic polygraphs. The effective pressure is titrated in 49% with auto-CPAP and therapeutic control is frequently carried out by the supplying company (77%). Among the proposals for improvement, the lack of a protocol for referral and coordination between different levels of care (90% of those surveyed), and the diagnostic delay, attributable in 63% of cases to the lack of physical and personnel resources, stand out. Conclusion: The number of diagnostic tests are still insufficient and the diagnostic delay is excessive. Above all, in therapeutic control, the supplier company has a relevant role. It is proposed to carry out protocols between different care units and increase current resources

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BACKGROUND: The relationship between cancer and venous thromboembolic disease (VTD) are complex because the activated coagulation factors are not only involved in thrombosis but also in malignant processes, such as angiogenesis and metastasis. OBJECTIVE: To compare phenotypes of extracellular vesicles (EVs), and levels of D-dimer, soluble P-selectin (sP-selectin) and antigenic tissue factor (TF) between unprovoked VTD patients, who did not develop cancer during one-year follow-up, and those with advanced stage of cancer but not associated with VTD. METHODS: A prospective study in which we included 138 unprovoked VTD patients and 67 advanced cancer patients, who did not develop thrombosis. Levels of EVs of different cellular origin (platelet, endothelium and leukocyte), EVs positive for tissue factor (TF) and P-selectin glycoprotein ligand 1 were quantified by flow cytometry. D-dimer, soluble P-selectin (sP-selectin) and antigenic TF were determined by ELISA. RESULTS: TF-positive EVs, D-dimer, and sP-selectin were markedly elevated in unprovoked VTD patients compared to cancer patients without association with thrombosis. CONCLUSIONS: Levels of TF-positive EVs, D-dimer and sP-selectin are able to discriminate between unprovoked VTD patients not related to cancer and cancer patients not associated with VTD. These results could lead to the application of EVs as biomarkers of both diseases. Key messages: Circulating EVs, specifically TF-positive EVs, in combination with plasmatic markers of hypercoagulable states, such as D-dimer, sP-selectin and antigen TF, are able to discriminate between cancer patients without thrombosis and patients with unprovoked VTD. Research fields could be opened. Future studies will assess if these biomarkers together serve as predicting thrombotic events in cancer populations.

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