Cross-sensitization between inhalant allergens and food allergens: the extent, intensity, and age-related shifts.

BACKGROUND: Encountering individuals sensitized to both inhalant and food allergens is challenging in clinical practice. Despite its rarity, studies have documented cross-sensitization between these allergens. However, the extent, diversity, and age-related variations of this phenomenon remain unclear. OBJECTIVE: Hence, our objective was to investigate a substantial quantity of allergy sensitivity test results in which both inhalant and food allergens were concurrently examined. The primary goal of our study is to calculate the cross-sensitization ratio, with a secondary objective of analyzing this phenomenon across four age groups. METHODS: A retrospective analysis was conducted on a multiple-antigen simultaneous test (MAST) obtained from a domestic laboratory medicine facility and comprising 55 food allergens and 49 inhalant allergens from 368,156 individuals aged 1 to 89. By calculating the cross-sensitization ratio, the degree of cross-sensitization between each food allergen and inhalant allergen was determined. Further subgroup analysis was conducted to ascertain the cross-sensitization ratio between the four subgroups categorized by age. RESULTS: The median cross-sensitization ratio between food and inhalant allergens was 5.14, indicating a significant level of cross-sensitization. The cross-sensitization ratio was greatest among pollen allergens and plant-derived food allergens, followed by between some animal aeroallergens and meat/fish/dairy/poultry food allergens. The degree of overall cross-sensitization was least prominent in adolescents, greater in adults and children, and most pronounced in the elderly. CONCLUSION: Our findings reveal that various inhalant and dietary allergens have considerable cross-sensitivity, with the elderly having the highest degree of cross-sensitivity and adolescents the lowest.

Exogenous Lipoxin A4 attenuates IL4-induced Mucin Expression in Human Airway Epithelial Cells.

Introduction: The proinflammatory cytokine interleukin-4 (IL-4) induces mucus hypersecretion by human airway epithelial cells and the MAP kinase signalling pathway may be important in terms of IL-4-induced MUC5AC gene expression. Lipoxin A4 (LXA4) is an arachidonic acid-derived mediator that promotes inflammation by binding to the anti-inflammatory receptors (ALXs) or the formyl-peptide receptor like-1 (FPRL1) protein expressed by airway epithelial cells. Here, we explore the effects of LXA4 on IL-4-induced mucin gene expression in, and secretion from, human airway epithelial cells. Methods: We co-treated cells with IL-4 (20 ng/mL) and LXA4 (1 nM) and measured the expression levels of mRNAs encoding MUC5AC and 5B via real-time polymerase chain reaction; protein expression levels were determined by Western blotting and immunocytofluorescence. The ability of IL-4 and LXA4 to suppress protein expression was determined by Western blotting. Results: IL-4 increased MUC5AC and 5B gene and protein expression. LXA4 suppressed IL-4-induced MUC5AC and 5B gene and protein expression by interacting with the IL4 receptor and mitogen-activated protein kinase (MAPK) pathway, including both phospho-p38 MAPK and phospho-extracellular signal-regulated kinase (phospho-ERK). IL-4 and LXA4 increased and decreased, respectively, the number of cells that stained with anti-MUC5AC and 5B antibodies. Conclusions: LXA4 may regulate mucus hypersecretion induced by IL4 in human airway epithelial cells.

Comparative Analysis of Olfactory and Gustatory Function of Patients With COVID-19 Olfactory Dysfunction and Non-COVID-19 Postinfectious Olfactory Dysfunction.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is known to have a high incidence of loss of smell and taste. However, studies in the early stages of the COVID-19 pandemic have evaluated these symptoms using subjective surveys and simple olfactory tests only. Hence, we compared the olfactory and gustatory characteristics of patient groups with COVID-19 olfactory dysfunction (C19OD) and non-COVID-19 postinfectious olfactory dysfunction (PIOD) using an objective olfactory test and evaluated the significance of olfactory training in both patient groups. METHODS: We retrospectively analyzed the medical records of 14 patients with a decreased sense of smell after having positive COVID-19 polymerase chain reaction results, and 56 patients with PIOD with no history of confirmed COVID-19. Participants were evaluated using the Korean version of the Sniffin' stick (KVSS) II, and chemical gustometry and olfactory training was assessed during their first visit. Olfactory training was then re-evaluated after an average of 8 (± 6) weeks. RESULTS: The average age of participants in the C19OD group was lower than in those in the non-COVID-19 PIOD group. The proportion of men in the C19OD group was higher than in the non-COVID-19 PIOD group. At baseline assessment, the C19OD group had better olfactory and gustatory functions. After olfactory training, the non-COVID-19 PIOD patient group showed a significant increase in all KVSS II Total, T, D, and I scores, but there was a non-significant increase in all scores in the C19OD group. CONCLUSION: The C19OD group had better olfactory and gustatory function than the non-COVID-19 PIOD group at the initial assessment. After olfactory training, there was an increase in olfactory function test scores in both groups. Olfactory training may be helpful in C19OD, as in non-COVID-19 PIOD.

Comparison of body size perception of young women in Korea and the United States.

Body size perception among young women in Asian and Western countries is believed to be quite different, however, there are no confirming studies. We analyzed the data from young women aged between 20 and 40 who participated in the National Health and Nutrition Examination Survey (2001-2018) of the United States (US) and Korea. US young women had higher rates of being overweight and obesity than Korean young women, and there was no significant change over 20 years. In both countries, the percentage of properly estimating one's own weight exceeded 70 percent and remained relatively steady. The percentage of overestimating one's own weight was only about 10 percent in Korea in 2001, but increased to 20 percent. In the case of the US, the percentage was about 15 percent in 2001-2002, but has since continued to decline. The percentage of underestimating one's own body weight was about 18 percent in Korea in 2001, but decreased to about 8 percent. In the case of the US, the percentage was very low at about 10 percent in 2001-2002, but gradually increased to about 18 percent in 2017-2018. In conclusion, young women in the US tend to underestimate their body size, and those in Korea tend to overestimate it.

Compressed Deep Learning to Classify Arrhythmia in an Embedded Wearable Device.

The importance of an embedded wearable device with automatic detection and alarming cannot be overstated, given that 15-30% of patients with atrial fibrillation are reported to be asymptomatic. These asymptomatic patients do not seek medical care, hence traditional diagnostic tools including Holter are not effective for the further prevention of associated stroke or heart failure. This is likely to be more so in the era of COVID-19, in which patients become more reluctant on hospitalization and checkups. However, little literature is available on this important topic. For this reason, this study developed efficient deep learning with model compression, which is designed to use ECG data and classify arrhythmia in an embedded wearable device. ECG-signal data came from Korea University Anam Hospital in Seoul, Korea, with 28,308 unique patients (15,412 normal and 12,896 arrhythmia). Resnets and Mobilenets with model compression (TensorFlow Lite) were applied and compared for the diagnosis of arrhythmia in an embedded wearable device. The weight size of the compressed model registered a remarkable decrease from 743 MB to 76 KB (1/10000), whereas its performance was almost the same as its original counterpart. Resnet and Mobilenet were similar in terms of accuracy, i.e., Resnet-50 Hz (97.3) vs. Mo-bilenet-50 Hz (97.2), Resnet-100 Hz (98.2) vs. Mobilenet-100 Hz (97.9). Here, 50 Hz/100 Hz denotes the down-sampling rate. However, Resnets took more flash memory and longer inference time than did Mobilenets. In conclusion, Mobilenet would be a more efficient model than Resnet to classify arrhythmia in an embedded wearable device.

Risk Model Establishment of Endoscopic Sinus Surgery for Patients with Chronic Rhinosinusitis: a Multicenter Study in Korea.

BACKGROUND: Endoscopic sinus surgery (ESS) is the mainstay treatment for refractory chronic rhinosinusitis (CRS). Since various factors may contribute to the surgical outcome, it is challenging for physicians to predict surgical outcomes. The aim of study was to analyze the prognostic factors of postoperative outcomes and to establish the prediction model with the risk factors that impact the postoperative outcomes. METHODS: Medical records of CRS patients who underwent ESS at 9 institutions in 2005, 2010, and 2016 were retrospectively reviewed. We classified the patients into 2 groups based on postoperative objective endoscopic outcomes. Demographics, nose-specific symptoms, olfactory function, eosinophil counts in blood (EoB) and nasal tissue (EoT), and Lund-Mackay CT score (LMS) were collected. Univariate and multivariate analyses were performed and established a prediction equation for postoperative endoscopic objective outcomes. RESULTS: In total (n = 1,249), 27.0% were not satisfied under postoperative endoscopic examination. Of 10 variables, LMS (> 5), sinus dominancy (maxillary sinus and ethmoid sinus), EoB (> 210), and EoT (> 100) were statistically significant in univariate analysis (P < 0.05, all). In multivariate analysis, EoT (> 100) and LMS (> 5) were significantly associated with poor postoperative outcome. Furthermore, 5 significant variables were employed to establish the risk model of postoperative outcomes and P (the value of prediction probability) = 1 / (1 + exp [-0.392 + 1.088 × EoT (> 100) + 0.123 × mean LMS (> 5) - 0.366 × sinus dominancy (maxillary) + 0.064 × sinus dominancy (similar) + 0.200 × EoB (4%) + 0.344 × EoB (> 210)] was developed. CONCLUSION: Tissue eosinophil count and radiographic severity predispose to a poorer outcome of ESS and the risk model established may be helpful to predict postoperative outcomes of ESS.

Efficacy of Rhino-Protect ointment after endoscopic sinus surgery: a prospective, randomized, multicenter study.

OBJECTIVE: Blocking airflow into the sinonasal cavity after surgery may help to keep the cavity moist and thus decrease postoperative crusting. Here we investigated the efficacy of Rhino-Protect ointment following endoscopic sinus surgery (ESS). SUBJECTS AND METHODS: A total of 93 patients with chronic rhinosinusitis who underwent identical ESS were enrolled. After surgery, all patients were instructed to perform nasal saline irrigation and deliver a nasal spray to each nostril, then to apply Rhino-Protect ointment to one nostril only; the other nostril served as a control. Subjective symptoms, postoperative Lund-Kennedy (LK) endoscopic scores, and adverse reactions 14 and 28 days after treatment were evaluated. RESULTS: The Rhino-Protect ointment significantly reduced pain (p = 0.015 at 28 days), dryness (p = 0.009 at 14 days and p = 0.045 at 28 days), and crusting (p = 0.047 at 14 days), and was associated with significantly lower LK scores 14 and 28 days after treatment (p = 0.037 and p = 0.007, respectively). Statistically significant differences were noted in the LK edema subscore at 14 days (p = 0.043) and in LK crusting subscores at 14 and 28 days (p = 0.005 and p = 0.006, respectively). No patient reported any serious adverse event associated with Rhino-Protect use. CONCLUSION: Applying Rhino-Protect after ESS significantly reduced the formation of edema and crusts, leading to improving the patients' discomfort for pain, dryness, and crust.

Association between obstructive sleep apnea and thyroid cancer incidence: a national health insurance data study.

PURPOSE: Little is known about the incidence of thyroid cancer in patients with obstructive sleep apnea (OSA). This study aimed to evaluate whether OSA is associated with the incidence of thyroid cancer based on the Korea National Health Insurance Service (KNHIS) database. METHODS: This study was designed as a retrospective cohort data analysis of the KNHIS dataset. A total of 198,574 patients who were over 20 years of age and had been newly diagnosed with OSA between 2007 and 2014 were enrolled. A control group of 992,870 individuals was selected based on propensity score matching by age and sex. The mean follow-up duration was 4.5 ± 2.3 years. The primary endpoint was the incidence of newly diagnosed thyroid cancer. RESULTS: The hazard ratio (HR) for thyroid cancer incidence among OSA patients compared to the control was 1.72 (95% confidence interval [CI] 1.60-1.84) based on Model 1 (not adjusted by any covariate) and 1.64 (95% CI 1.53-1.76) based on Model 2 (adjusted by income level, diabetes, hypertension, and dyslipidemia). Thyroid cancer incidence was significantly higher in male patients (HR = 1.93, 95% CI 1.74-2.12) than female ones (HR = 1.39, 95% CI 1.26-1.54). When compared by age, the HR of thyroid cancer was higher in middle-aged (40 ≤ age < 65 years) patients (HR = 1.68, 95% CI 1.55-1.83) than in young (20 ≤ age < 40 years, HR = 1.53, 95% CI 1.32-1.77) or old (65 ≤ age, HR = 1.28, 95% CI 0.94-1.74) patients. CONCLUSION: OSA may increase the risk of developing thyroid cancer, especially in middle-aged men.

Efficacy and safety of rupatadine fumarate in the treatment of perennial allergic rhinitis: A multicenter, double-blinded, randomized, placebo-controlled, bridging study in Koreans.

BACKGROUND: The efficacy of rupatadine for the treatment of AR has been confirmed in numerous clinical studies, however there are very few studies on asian patients. OBJECTIVE: To assess the safety and efficacy of rupatadine fumarate in the treatment of Korean perennial allergic rhinitis (PAR) patients. METHODS: A multicenter, double-blind, randomized, placebo-controlled, comparative study of rupatadine fumarate and bepotastine besilate was conducted. Each group was administered rupatadine, bepotastine or placebo for 4 weeks. Primary parameters for efficacy included morning and evening symptom reduction from baseline at 4 weeks. Treatment safety and tolerability were evaluated according to a self-reported incidence and type of adverse events at each follow up visit. RESULTS: Rupatadine showed a significant reduction in symptoms at morning and evening evaluations, in both 5TSS (-5.69, P < 0.0006) and 4NTSS (-4.74, P < 0.0015) compared to placebo. There was a significant reduction from baseline for 5TSS (-65.4%, P = 0.002) and 4NTSS (-63.7%, P = 0.003) with rupatadine compared with placebo. At evening evaluations, there were significant reductions of 5TSS (-63.2%, P = 0.009) and 4NTSS (-61.6%, P = 0.013) for the rupatadine group. Compared with bepotastine, rupatadine showed greater reduction in the morning symptoms at 4 weeks. When individual symptoms were assessed with 12-hour reflective mean daily symptom score, rupatadine showed better efficacy than placebo in sneezing (P = 0.016) and rhinorrhea (P = 0.097). The rate of adverse events showed no statistical significance. CONCLUSIONS: Rupatadine is a safe and effective treatment option for Korean PAR patients and possibly a better choice over bepotastine for controlling morning symptom.

Reduction of corneal epithelial thickness during medical treatment for myopic regression following FS-LASIK.

BACKGROUND: To evaluate corneal epithelial thickness change during medical treatment for eyes with myopic regression after femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS: This study included 84 eyes of 54 subjects diagnosed with myopic regression after FS-LASIK and treated using topical steroid and anti-glaucoma drugs. Corneal epithelial thickness was measured using Fourier-domain optical coherence tomography before and after treatment. Subjects were divided into three groups based on their corneal epithelial thickness at the time of myopic regression and regression analyses were used to investigate the association between corneal epithelial thickness, visual acuity, and refraction. Logistic regression and receiver operating characteristic (ROC) curve analysis was performed to determine whether corneal epithelial thickness could predict the success of treatment, improvements of ≥ two lines in uncorrected distance visual acuity and ≥ 0.5 diopter in refraction or K. RESULTS: Corneal epithelial thickness decreased with greater change in the center as myopic regression subsided during medical treatment. Subgroup with the thickest epithelium (≥ 62 µm) showed a higher success rate and greater changes in refraction and vision. Reduced magnitude of corneal epithelial thickness showed significant correlations with changes of K and refractive error (all P < 0.001). Corneal epithelial thickness was a significant factor for the success of treatment and ROC curve showed that corneal epithelial thickness > 60.50 µm had 81.5% sensitivity and 84.2% specificity for the success of medical treatment. CONCLUSION: Corneal epithelial thickness decreases proportionally with the magnitude of improvement of myopic regression during treatment with steroid and anti-glaucoma drugs in post-LASIK eyes with myopic regression.

Clinicopathologic characteristics of paranasal sinus fungus ball: retrospective, multicenter study in Korea.

PURPOSE: Fungus ball (FB) is the most common type of fungal rhinosinusitis and the prevalence of FB has increased over the past 10 years. The aim of this study was to compare the clinical characteristics of Korean adult patients with FB and chronic rhinosinusitis (CRS) without FB. METHODS: We retrospectively analyzed data on 1362 patients (147 FB and 1215 CRS) who underwent endoscopic sinus surgery at nine Korean medical centers in 2005, 2010, and 2016. We evaluated the prevalence of FB and compared the clinical characteristics of FB and CRS. Medical records, computed tomography (CT) findings, atopic status, concomitant diseases, tissue, and blood eosinophil count were assessed. RESULTS: The prevalence of FB was significantly higher in 2016 (15.9%) than in the other years (7.8% in 2005 and 7.5% in 2010). The FB patients were more likely to be female, older, have unilateral disease and less likely to have allergy compared to the CRS patients. The most common main complaint related to CRS and FB was nasal obstruction. CT determined that unilateral disease and maxillary sinus dominancy were common in patients with FB. The incidence of concomitant diseases was much higher in FB, with lower tissue and blood eosinophilia. CONCLUSION: FB is commonly encountered in older women with the increased prevalence. FB had a different clinical presentation, radiological findings, and prognosis than CRS. Further studies are needed to understand the pathophysiologic mechanisms underlying the development of FB.

Arterial supply of the human soft palate.

PURPOSE: Palatal surgery for snoring or obstructive sleep apnea is commonly performed; however, the vascular anatomy of the soft palate is not well described. The purpose of this study was to evaluate the vascular anatomy of the soft palate. METHODS: This study was performed on 22 adult cadaveric heads. All specimens were prepared with vascular injections using red liquid silicone through the common carotid artery. The palate was then harvested and decolorized, and the vascular anatomy was studied. RESULTS: Of 22 specimens, 20 had sufficient uptake of the silicone dye. The anterior and posterior branches of the ascending palatine artery were the main feeding vessels of the soft palate; however, they were not always present simultaneously. The anterior branch alone was identified 25% of the time (5/20), while the posterior branch alone was found in 35% (7/20) of specimens. Both anterior and posterior branches were simultaneously present in 40% (8/20) of cases. Mean diameter of the anterior branch (0.73 ± 0.09 mm) was significantly greater than that of the posterior branch (0.48 ± 0.08 mm, p < 0.001). Mean vertical distance from the palatal arch to the posterior branch was 9.3 ± 2.4 mm. CONCLUSIONS: The soft palate is supplied by the anterior and posterior branches of the ascending palatine artery; however, the arteries were not always present simultaneously. In cases where the anterior branch is absent and the posterior branches terminate close to the uvula, injury to the primary blood supply to the palate might occur more frequently during surgery.

Changes in the upper airway after counterclockwise maxillomandibular advancement in young Korean women with class II malocclusion deformity.

PURPOSE: To evaluate the change in the upper airway in a Class II malocclusion deformity after counterclockwise maxillomandibular advancement. MATERIALS AND METHODS: Seventeen young Korean women with a Class II malocclusion deformity who had undergone Le Fort I and bilateral mandibular ramus sagittal split osteotomy in a counterclockwise rotation were enrolled in the present study. The upper airway was measured at 3 different levels (uvula tip, low C2, and mid C3) using lateral cephalograms at 3 points: preoperatively (T0) and 2 (T2) and 12 (T12) months postoperatively. The changes in the upper airway were then compared. RESULTS: The mandible advanced an average of 7.0 ± 3.8 mm. The upper airway had widened considerably at all 3 levels at T2 and had decreased slightly at T12, especially at the low C2 level compared with T0. However, the upper airway at T12 remained wider than at T0 at all 3 levels. The mandibular advancement and upper airway width correlated only at T12 at the mid C3 level. CONCLUSIONS: The upper airway became wider in patients with a Class II malocclusion deformity who had undergone mandibular advancement. However, this might become narrower with time.

The Olfactory System: Basic Anatomy and Physiology for General Otorhinolaryngologists.

Olfaction is one of the five basic human senses, and it is known to be one of the most primitive senses. The sense of olfaction may have been critical for human survival in prehistoric society, and although many believe its importance has diminished over time, it continues to have an impact on human interaction, bonding, and propagation of the species. Even if we are unaware of it, the sense of smell greatly affects our lives and is closely related to overall quality of life and health. Nonetheless, olfaction has been neglected from a scientific perspective compared to other senses. However, olfaction has recently received substantial attention since the loss of smell and taste has been noted as a key symptom of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Studies investigating olfaction loss in association with coronavirus disease 2019 (COVID-19) have revealed that olfactory dysfunction can be both conductive and sensorineural, possibly causing structural changes in the brain. Olfactory training is an effective treatment for olfactory dysfunction, suggesting the reorganization of neural associations. A reduced ability to smell may also alert suspicion for neurodegenerative or psychiatric disorders. Here, we summarize the basic knowledge that we, as otorhinolaryngologists, should have about the sense of smell and the peripheral and central olfactory pathways for managing and helping patients with olfactory dysfunction.

Improving generalization performance of electrocardiogram classification models.

Objective.Recently, many electrocardiogram (ECG) classification algorithms using deep learning have been proposed. Because the ECG characteristics vary across datasets owing to variations in factors such as recorded hospitals and the race of participants, the model needs to have a consistently high generalization performance across datasets. In this study, as part of the PhysioNet/Computing in Cardiology Challenge (PhysioNet Challenge) 2021, we present a model to classify cardiac abnormalities from the 12- and the reduced-lead ECGs.Approach.To improve the generalization performance of our earlier proposed model, we adopted a practical suite of techniques, i.e. constant-weighted cross-entropy loss, additional features, mixup augmentation, squeeze/excitation block, and OneCycle learning rate scheduler. We evaluated its generalization performance using the leave-one-dataset-out cross-validation setting. Furthermore, we demonstrate that the knowledge distillation from the 12-lead and large-teacher models improved the performance of the reduced-lead and small-student models.Main results.With the proposed model, our DSAIL SNU team has received Challenge scores of 0.55, 0.58, 0.58, 0.57, and 0.57 (ranked 2nd, 1st, 1st, 2nd, and 2nd of 39 teams) for the 12-, 6-, 4-, 3-, and 2-lead versions of the hidden test set, respectively.Significance.The proposed model achieved a higher generalization performance over six different hidden test datasets than the one we submitted to the PhysioNet Challenge 2020.

Clinical Trial to Reconfirm the Efficacy and Safety of Cefetamet Pivoxil Treatment in Sinusitis Patients: A Double-Blind, Randomized, Parallel Designed, Multicenter, Active Comparator Study (CASIS Study).

OBJECTIVE: To evaluate the clinical efficacy and safety of cefetamet pivoxil for the treatment of acute bacterial rhinosinusitis in Korean patients compared to treatment with cefdinir. METHODS: A prospective, multicenter, randomized double-blind, comparative study was conducted by the Departments of Otorhinolaryngology-Head and Neck Surgery at 17 hospitals or universities in the Republic of Korea from March 2017 to April 2019. A total of 309 patients were screened and 249 patients participated in the study. RESULTS: Treatment with cefetamet pivoxil for 2 weeks showed 82.4% clinical cure and improvement rates in patients with acute bacterial rhinosinusitis compared to 84.68% in those taking cefdinir for 2 weeks, showing that cefetamet pivoxil administered twice a day for 2 weeks was as effective as cefdinir 3 times a day for 2 weeks for the treatment of acute bacterial rhinosinusitis. The overall adverse reaction rates of both drugs were 10.56% in the cefetamet pivoxil group and 15.49% in the cefdinir group, without serious adverse events or drug reactions. CONCLUSIONS: Cefetamet pivoxil twice a day was as efficacious and safe as cefdinir 3 times a day for the treatment of acute bacterial rhinosinusitis, which suggested that cefetamet pivoxil may be a suitable alternative to cefdinir.

Effects of sleep-disordered breathing on physical traits, school performance, and behavior of Korean elementary school students in the upper grade levels.

OBJECTIVES: We investigated the physical traits, school performance, and behavior of Korean children with sleep-disordered breathing (SDB). METHODS: We recruited 679 students from an elementary school in Seoul, Korea. We used a survey to collect information on the absence or presence of SDB at both the child's preschool age and his or her current age and on the degree of behavioral disturbance. Physical traits and examination scores were also analyzed. We divided the children into 4 groups: non-SDB group, past SDB group, recent SDB group, and continuous SDB group. Comparisons between these four groups were conducted. RESULTS: Sixty-one students were excluded because of incomplete information. The current body mass index was significantly higher in the past (19.7 +/- 3.6), recent (21.2 +/- 3.6), and continuous SDB groups (20.7 +/- 3.9) than in the non-SDB group (18.8 +/- 3.2), but only for male students (p < 0.001). The examination scores were not different among the four groups, but the behavioral disturbance scores were much higher in the past, recent, and continuous SDB groups than in the non-SDB group for both genders. CONCLUSIONS: Among these Korean elementary school students in the upper grade levels, the presence of current or past SDB appeared to influence the current body mass index in boys and the presence of behavioral disturbances in both genders. However, SDB was not associated with school performance.

CNN-based Two Step R Peak Detection Method: Combining Segmentation and Regression.

For semantic segmentation, U-Net provides an end-to-end trainable framework to detect multiple class objects from background. Due to its great achievements in computer vision tasks, U-Net has broadened its application to biomedical signal processing, especially, segmentation of waveforms in ECG signal. Despite its superior performance for QRS complex detection to other traditional signal processing methods, direct application of the U-Net to R peak detection has limitation since the U-Net structures tend to predict high probability around true peak. Such multiple detection results require additional process to determine a unique peak location in each QRS complex. In this study, we use a regression process to detect R peak instead of pixel-wise classification. Such regression process guarantees a unique peak location prediction. We collect data from resting ECG systems and wearable ECG devices as well as public ECG databases and the proposed model is trained on various combinations of the data sources. Especially, we investigate the robustness of the model for input data from the wearable devices when the model is trained by data from heterogeneous devices.