Polysomnography scoring-related training and quantitative assessment for improving interscorer agreement.

STUDY OBJECTIVES: To efficiently improve the scoring competency of scorers with varying levels of experience across regions in Taiwan, we developed a training program with a cloud-based polysomnography scoring platform to evaluate and improve interscorer agreement. METHODS: A total of 70 scorers from 34 sleep centers in Taiwan (job tenure: 0.5-39.0 years) completed a scoring test. All scorers scored a 742-epoch (30 s/epoch) overnight polysomnography recording of a patient with a moderate apnea-hypopnea index. Subsequently, 8 scoring experts delivered 8 interactive online lectures (each lasting 30 minutes). The training program included identifying scoring weaknesses, highlighting the latest scoring rules, and providing physicians' perspectives. Afterward, the scorers completed the second scoring test on the same participant. Changes in agreement from the first to second scoring test were identified. Sleep staging, sleep parameters, and respiratory events were considered for evaluating scoring agreement. RESULTS: The scorers' agreement in overall sleep stage scoring significantly increased from 74.6 to 82.3% (median score). The proportion of scorers with an agreement of ≥ 80% increased from 20.0% (14/70) to 58.6% (41/70) after the online training program. In addition, the scorers' agreement in overall respiratory-event scoring increased to 88.8% (median score) after training. The scorers with a job tenure of 2.0-4.9 years exhibited the highest level of improvement in overall sleep staging (their median agreement increased from 72.8 to 84.9%; P < .001). CONCLUSIONS: Our interactive online training program efficiently targeted the scorers' scoring weaknesses identified in the first scoring test, leading to substantial improvements in scoring proficiency. CITATION: Liao Y-S, Wu M-C, Li C-X, Lin W-K, Lin C-Y, Liang S-F. Polysomnography scoring-related training and quantitative assessment for improving interscorer agreement. J Clin Sleep Med. 2024;20(2):271-278.

Assessing the Effects of Ozonation on the Concentrations of Personal Care Products and Acute Toxicity in Sludges of Wastewater Treatment Plants.

The aim of this study was to understand the distribution of the personal care products nonylphenol (NP), triclosan (TCS), benzophenone-3 (BP-3), and caffeine in the sludges from three wastewater treatment plants (WWTP-A, -B, and -C) in southern Taiwan. The four compounds were analyzed from activated sludge and dewatered sludge samples, and then the samples were treated with pressure-assisted ozonation under different conditions and removal efficiencies. All four target compounds were detected, especially NP, which was detected in the highest concentrations in the activated sludges of WWTP-A and dewatered sludges of WWTP-C at 17.19 ± 4.10 and 2.41 ± 1.93 µg/g, respectively. TCS was dominant in dewatered sludges from WWTP-B, and the highest detected concentration was 13.29 ± 6.36 µg/g. Removals of 70% and 90% were attained under 150 psi at 40 cycles for NP and TCS, respectively, with 5 min of ozonation reaction time, a solid/water ratio of 1:20, and 2% ozone concentration. Ecological risk quotients (RQs) were calculated by the ratios of the 10-day Hyalella azteca (freshwater amphipod) LC50 to the environmental concentrations of the target compounds. High RQs were found to be >10 for NP, TCS, and BP-3 in untreated sludges, resulting in significant ecological risks to aquatic organisms when the sludges are arbitrarily disposed. However, the toxic effects on Hyalella azteca were not significantly different among ozone sludge treatments. The reason for this may be related to the formation of toxic oxidation by-products and incomplete mineralization of organic compounds. This could also be true for unknown intermediates. The relatively high detection frequencies of these emerging compounds in WWTP sludges requires further applications and treatments.

Elucidation of a Causal Relationship Between Platelet Count and Hypertension: A Bi-Directional Mendelian Randomization Study.

Hypertension has been reported as a major risk factor for diseases such as cardiovascular disease, and associations between platelet activation and risk for hypertension are well-established. However, the exact nature of causality between them remains unclear. In this study, a bi-directional Mendelian randomization (MR) analysis was conducted on 15,996 healthy Taiwanese individuals aged between 30 and 70 years from the Taiwan Biobank, recorded between 2008 and 2015. The inverse variance weighted (IVW) method was applied to determine the causal relationship between platelet count and hypertension with single nucleotide polymorphisms as instrumental variables (IVs). Furthermore, to check for pleiotropy and validity of the IVs, sensitivity analyses were performed using the MR-Egger, weighted median and simple median methods. This study provided evidence in support of a positive causal effect of platelet count on the risk of hypertension (odds ratio: 1.149, 95% confidence interval: 1.131-1.578, P < 0.05), using the weighted median method. A significant causal effect of platelet count on hypertension was observed using the IVW method. No pleiotropy was observed. The causal effect of hypertension on platelet count was found to be non-significant. Therefore, the findings from this study provide evidence that higher platelet count may have a significant causal effect on the elevated risk of hypertension for the general population of Taiwan.

Invasive Blood Pressure Measurement and In-hospital Mortality in Critically Ill Patients With Hypertension.

Background: Invasive blood pressure (IBP) measurement is common in the intensive care unit, although its association with in-hospital mortality in critically ill patients with hypertension is poorly understood. Methods and Results: A total of 11,732 critically ill patients with hypertension from the eICU-Collaborative Research Database (eICU-CRD) were enrolled. Patients were divided into 2 groups according to whether they received IBP. The primary outcome in this study was in-hospital mortality. Propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) models were used to balance the confounding covariates. Multivariable logistic regression was used to evaluate the association between IBP measurement and hospital mortality. The IBP group had a higher in-hospital mortality rate than the no IBP group in the primary cohort [238 (8.7%) vs. 581 (6.5%), p < 0.001]. In the PSM cohort, the IBP group had a lower in-hospital mortality rate than the no IBP group [187 (8.0%) vs. 241 (10.3%), p = 0.006]. IBP measurement was associated with lower in-hospital mortality in the PSM cohort (odds ratio, 0.73, 95% confidence interval, 0.59-0.92) and in the IPTW cohort (odds ratio, 0.81, 95% confidence interval, 0.67-0.99). Sensitivity analyses showed similar results in the subgroups with high body mass index and no sepsis. Conclusions: In conclusion, IBP measurement was associated with lower in-hospital mortality in critically ill patients with hypertension, highlighting the importance of IBP measurement in the intensive care unit.

After remediation - Using toxicity identification evaluation of sediment contamination in the subtropical Erren river basin.

This study utilized the freshwater amphipod (Hyalella azteca) for the indication of contamination risk levels of sediment-associated contaminants in the Erren (ER1∼ER10) and Sanye Rivers (SY1∼SY5) which were contaminated by metal scrap and smelting industries for decades. Toxicity identification evaluations involving the manipulation of pore water and whole-sediment samples were conducted to identify causative pollutants. Impacts on the aquatic environment were then evaluated in order to explore how industrial development led to contaminant accumulation in sediments and resulted in biological effects. A whole-sediment TIE indicated that the major toxicant at sampling sites ER8 and SY5 was ammonia and that its toxicity was significantly reduced by the addition of zeolite. Toxicity at sampling sites ER4 and ER9 was induced by ammonia and heavy metals (Zn, Cd, Cr, As), whereas Cr was at toxic levels at ER6. ∑PAHs was another major class of contaminants at site ER2. Metals (Zn, Ni, Pb, Cd, Cr, and As) were identified as major toxic contaminants at three sites (ER3, SY1, and SY3). The application of TIEs confirmed that a causative toxicant can be identified and that its measured toxicity correlated with its concentration. In conclusion, a TIE approach was successful in demarcating most effective contaminant groups (ammonia, heavy metals, and non-polar organic compounds) in whole-sediment cores, their porewaters and potential toxicities from a highly polluted river after remediation in southern Taiwan to an invertebrate animal model H. azteca.

Estuarine sediment toxicity testing with an indigenous subtropical amphipod.

This study reports on a sediment toxicity test developed with a native amphipod strain of Ptilohyale barbicornis where sediments from 10 estuarine stations along the western coastline of Taiwan were evaluated with respect to trace metals and PAHs. The test was validated by determining dose-response relationships for aqueous copper, and cadmium and sodium dodecyl sulfate as well as copper-spiked sediment, showing a sensitivity of P. barbicornis indicating its capability serving as a toxicity test species. A significant negative correlation between growth effects after 28 days of exposure to field-collected contaminated sediments and PAHs concentrations was observed. Similarly, the chronic toxicity test showed that growth was mostly inhibited compared to controls, body lengths in particular being significantly different from controls (p < 0.05). Various estuarine sediment pollutants in the quality guidelines can be further evaluated using P. barbicornis to understand their comprehensive biological effects and ecological risks.

Structural insights into the histidine-containing phospho-transfer protein and receiver domain of sensor histidine kinase suggest a complex model in the two-component regulatory system in Pseudomonas aeruginosa.

In Pseudomonas aeruginosa, an important opportunistic pathogen that causes numerous acute and chronic infections, the hybrid two-component system (TCS) regulates the swarming ability and biofilm formation with a multistep phospho-relay, and consists of hybrid-sensor histidine kinase (HK), histidine-containing phospho-transfer protein (Hpt) and response regulator (RR). In this work, two crystal structures of HptB and the receiver domain of HK PA1611 (PA1611REC) of P. aeruginosa have been determined in order to elucidate their interactions for the transfer of the phospho-ryl group. The structure of HptB folds into an elongated four-helix bundle - helices α2, α3, α4 and α5, covered by the short N-terminal helix α1. The imidazole side chain of the conserved active-site histidine residue His57, located near the middle of helix α3, protrudes from the bundle and is exposed to solvent. The structure of PA1611REC possesses a conventional (ß/α)5 topology with five-stranded parallel ß-sheets folded in the central region, surrounded by five α-helices. The divalent Mg2+ ion is located in the negatively charged active-site cleft and interacts with Asp522, Asp565 and Arg567. The HptB-PA1611REC complex is further modeled to analyze the binding surface and interactions between the two proteins. The model shows a shape complementarity between the convex surface of PA1611REC and the kidney-shaped HptB with fewer residues and a different network involved in interactions compared with other TCS complexes, such as SLN1-R1/YPD1 from Saccharomyces cerevisiae and AHK5RD/AHP1 from Arabidopsis thaliana. These structural results provide a better understanding of the TCS in P. aeruginosa and could potentially lead to the discovery of a new treatment for infection.

Identification, contribution, and estrogenic activity of potential EDCs in a river receiving concentrated livestock effluent in Southern Taiwan.

We assessed 22 selected endocrine-disrupting compounds (EDCs) and other emerging, potentially endocrine-active compounds with estrogenic activity from the waters of the Wuluo River, southern Taiwan. This watershed receives high amounts of livestock and untreated household wastewaters. The river is surrounded by concentrated animal feedlot operations (CAFOs). River water samples were analyzed for selected compounds by liquid chromatography-tandem mass spectrometry (LC-MS/MS), T47D-KBluc reporter gene assay, and E-screen cell proliferation in vitro bioassay. Total concentrations of ∑alkylphenolic compounds (bisphenol A, 4-nonylphenol, t-nonylphenol, octylphenol, nonylphenol mono-ethoxylate, nonylphenol di-ethoxylate) were much higher than ∑estrogens (estrone, 17 ß-estradiol, estriol, 17ß-ethynylestradiol, diethylstilbestrol), ∑preservatives (methyl paraben, ethyl paraben, propyl paraben, butyl paraben), ∑UV-filters (benzophenone, methyl benzylidene camphor, benzophenone-3), ∑antimicrobials (triclocarben, triclosan, chloroxylenol), and an insect repellent (diethyltoluamide) over four seasonal sampling periods. The highest concentration was found for bisphenol A with a mean of 302 ng/L. However, its contribution to estrogenic activity was not significant due to its relatively low estrogenic potency. Lower detection rates were found for BP, EE2, TCS, and PCMX, while DES and EP were not detected. E1 and E2 levels in raw water samples were 50% higher than the predicted no-effect concentrations (PNEC) for aquatic organisms of 6 and 2 ng/L, respectively. The potency of estrogenic activity ranged from 11.7 to 190.1 ng/L E2T47D-Kbluc and 6.63 to 84.5 ng/L E2E-Screen for extracted samples. Importantly, estrone contributed 50% of the overall activity in 60% and 44% of the samples based on T47D-KBluc and MCF-7 bioassays, followed by 17 ß-estradiol, highlighting the importance of total steroid estrogen loading. This study demonstrates that the estrogenic activity of target chemicals was comparable to levels found in different countries worldwide. More intense wastewater treatment is required in areas of intensive agriculture in order to prevent adverse impacts on the ambient environment and aquatic ecosystems.

The effect of nasogastric tubes on swallowing function in persons with dysphagia following stroke.

OBJECTIVE: To determine whether the use of a nasogastric tube influences swallowing function in stroke patients with dysphagia. DESIGN: Before-after trial. SETTING: Primary care center. PARTICIPANTS: A total of 22 patients with stroke (12 men, 10 women; mean age, 69.7 y; range, 19-85 y) participated in the study. Time from onset of stroke to time of assessment averaged 20.3 days (range, 14-38 d). All participants continued to use a nasogastric tube for nutrition supply and had either minor or no aspiration of barium on videofluoroscopic examination of swallowing (VFES). INTERVENTION: The swallowing function was evaluated by VFES with thin and thick bariums (5 mL each) as a contrast medium. MAIN OUTCOME MEASURES: The oral transit, swallowing trigger, and pharyngeal transit times were measured and compared before and after the removal of the nasogastric tube. The patients were also observed for changes in velopharyngeal closure, pharyngeal contraction, epiglottic tilt, valleculae stasis, pyriform sinus stasis, penetration, and aspiration. RESULTS: Transit times were reduced by 0.2 to 0.6 seconds after removal of the nasogastric tube, but the reduction was not statistically significant. These transit times were slightly longer with thick barium than with thin barium, but were without statistical significance. Similarly, most of the patients had no change in nontemporal assessment of swallowing function after the tube was removed. CONCLUSIONS: The placement of a nasogastric tube did not affect temporal and nontemporal measurement of swallowing in stroke patients with dysphagia with or without minor aspiration.

Evaluating swallowing dysfunction using a 100-ml water swallowing test.

This study used comparison with videofluoroscopic examination of swallowing (VFES) to examine the validity of a 100-ml water swallowing test (WST) in assessing swallowing dysfunction. Fifty-nine consecutive outpatients (15 females, 44 males) with clinically suspected dysphagia were enrolled in this study. Each subject underwent a 100-ml WST followed by VFES. Data was obtained on swallowing speed and signs of choking (coughing and a wet-hoarse voice). The analytical results revealed that 49 subjects had abnormal swallowing speeds (< 10 ml/s) in the 100-ml WST, and 47 of them were identified as having dysphagia by VFES. Among the ten participants with normal swallowing speed (> 10 ml/s), eight were diagnosed with dysphagia by VFES. Notably, 14 participants choked in the 100-ml WST, 11 of whom exhibited aspiration or penetration in VFES. Among the 45 participants without choking in WST, 12 displayed aspiration or penetration in VFES. The sensitivity of swallowing speed in detecting the swallowing dysfunction was 85.5%, and the specificity was 50%. Moreover, the sensitivity of using choking or wet-horse voice in the 100-ml WST as the sole factor for predicting the presence of aspiration was 47.8%, while the specificity was 91.7%. Therefore, this study concluded that swallowing speed is a sensitive indicator for identifying patients at risk for swallowing dysfunction. Moreover, choking in the 100-ml WST may be a potential specific indicator for followup aspiration.