Results of the ADHERE upper airway stimulation registry and predictors of therapy efficacy.

OBJECTIVE/HYPOTHESIS: The ADHERE Registry is a multicenter prospective observational study following outcomes of upper airway stimulation (UAS) therapy in patients who have failed continuous positive airway pressure therapy for obstructive sleep apnea (OSA). The aim of this registry and purpose of this article were to examine the outcomes of patients receiving UAS for treatment of OSA. STUDY DESIGN: Cohort Study. METHODS: Demographic and sleep study data collection occurred at baseline, implantation visit, post-titration (6 months), and final visit (12 months). Patient and physician reported outcomes were also collected. Post hoc univariate and multivariate analysis was used to identify predictors of therapy response, defined as ≥50% decrease in Apnea-Hypopnea Index (AHI) and AHI ≤20 at the 12-month visit. RESULTS: The registry has enrolled 1,017 patients from October 2016 through February 2019. Thus far, 640 patients have completed their 6-month follow-up and 382 have completed the 12-month follow-up. After 12 months, median AHI was reduced from 32.8 (interquartile range [IQR], 23.6-45.0) to 9.5 (IQR, 4.0-18.5); mean, 35.8 ± 15.4 to 14.2 ± 15.0, P < .0001. Epworth Sleepiness Scale was similarly improved from 11.0 (IQR, 7-16) to 7.0 (IQR, 4-11); mean, 11.4 ± 5.6 to 7.2 ± 4.8, P < .0001. Therapy usage was 5.6 ± 2.1 hours per night after 12 months. In a multivariate model, only female sex and lower baseline body mass index remained as significant predictors of therapy response. CONCLUSIONS: Across a multi-institutional study, UAS therapy continues to show significant improvement in subjective and objective OSA outcomes. This analysis shows that the therapy effect is durable and adherence is high. LEVEL OF EVIDENCE: 2 Laryngoscope, 130:1333-1338, 2020.

Long-term follow-up of the German post-market study for upper airway stimulation for obstructive sleep apnea.

PURPOSE: Upper airway stimulation (UAS) is an effective treatment for obstructive sleep apnea (OSA) in positive airway pressure (PAP) failure. Most reports have presented short-term data, so long-term safety and efficacy reports are rare. The German post-market study (G-PMS) has followed approximately 60 patients from three implanting centers for several years. METHODS: Patients with OSA and PAP failure qualified for the G-PMS by the absence of obesity class 2 an AHI between 15 and 65 events/h and absence of complete concentric collapse at the velum during drug-induced sleep endoscopy. Optional 2- and 3-year follow-ups after implantation were collected during routine clinical practice. We measured respiratory parameters such as apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) and daytime sleepiness using the Epworth sleepiness scale (ESS) in a per protocol analysis. Usage was calculated from device-downloaded reports. Device-related complications were documented. RESULTS: Of the 60 original patients, 41 returned for 2-year follow-up, and 38 for 3 years. About 76% at 2 years and 68% at 3 years met the criterion of therapy success defined as an AHI below 15/h. The median AHI was reduced from 28.6/h (baseline) to 9.0/h (2 years) and 10.0/h (3 years); whereas median ODI decreased from 27.0 to 6.3/h (2 years), and 8.3/h (3 years). Median ESS improved from baseline 13 points to 4 (2 years) and 6 (3 years). Usage was stable at approximately 45 h per week at 2 and 3 years. Serious device-related adverse events were rare, with two-device explantation between 12 to 36 months postoperatively. CONCLUSIONS: The German multi-center long-term outcomes compare favorably with previously published studies. Respiratory and sleepiness efficacy outcomes were sustained over 2 and 3 years, with a favorable safety profile, supporting the safety and efficacy of a chronic implantable therapy.

Food quality matters: Interplay among food quality, food quantity and temperature affecting life history traits of Aurelia aurita (Cnidaria: Scyphozoa) polyps.

Understanding the interaction between organisms' life history traits and environmental factors is an essential task in ecology. In spite of the increasing appreciation of jellyfish as an important component in marine ecosystem, there are still considerable gaps in understanding how the phase transition from the benthic polyp to the pelagic medusa stage is influenced by multiple environmental factors, including nutrition. To investigate survival, growth, and phase transition of Aurelia aurita polyps, we designed a factorial experiment manipulating food quantity (20µg C, 5µg C and 1.5µg C polyp-1 every other day), food quality (Artemia salina and two dietary manipulated Acartia tonsa), and temperature (13°C, 20°C, and 27°C). Temperature was the key factor determining phase transition of polyps and negatively affecting their survival rate and growth at 27°C, which reflected a summer heatwave scenario. Furthermore, at polyps' optimum tolerance temperature (20°C) in our study, budding reproduction benefits from high food concentrations. Interestingly, polyps fed with food containing high level highly unsaturated fatty acid (HUFA) were able to compensate for physiological stress caused by the extreme temperature, and could enhance budding reproduction at optimum temperature. Moreover, benthic-pelagic coupling (strobilation) was determined by temperature but affected significantly by food conditions. Mild temperature together with optimum food conditions contributes to inducing more polyps, which may potentially bring about great ephyrae recruitments during overwintering. In contrast, heatwave events can potentially regulate plankton community structure accompanied by changes of nutritional conditions of primary and secondary producers and thus, negatively affect the population dynamics of polyps. We suggest a novel polyp tolerance curve, which can help to understand jellyfish population dynamics in different seasons and ecosystems. This sets up a baseline for understanding how anticipated global warming and food conditions may affect the population size of benthic polyps and consequently pelagic medusae.

Progressive Dispersion of Azole Resistance in Aspergillus fumigatus: Fatal Invasive Aspergillosis in a Patient with Acute Myeloid Leukemia Infected with an A. fumigatus Strain with a cyp51A TR46 Y121F M172I T289A Allele.

Patients with hematologic malignancies as well as allogeneic hematopoietic stem cell transplantation (HSCT) patients are at high risk for invasive aspergillosis. Here, we report a culture- and autopsy-proven fatal invasive aspergillosis in an allogeneic HSTC patient which he developed despite posaconazole prophylaxis. The agent was determined to be an azole-resistant Aspergillus fumigatus strain bearing the cyp51A mutation combination TR46 Y121F M172I T289A. At increasing frequency, the azole resistance of A. fumigatus is being reported globally, limiting treatment options and complicating regimens.

Responses of biological and chemical components in North East Atlantic coastal water to experimental nitrogen and phosphorus addition--a full scale ecosystem study and its relevance for management.

The objective of this study was to quantify chemical and biological responses to an experimentally increased nutrient input to an open coastal planktonic ecosystem and to contribute to a scientific concept and credible indicators for managing nutrient supply to coastal waters. Data were derived in a 5 year fertilisation experiment of a tidal driven coastal lagoon at the outer coast off Central Norway (63°36' N, 9°33' E), with a surface area of 275.000 m(2), volume of 5.5 mill m(3), mean depth of 22 m and a water exchange rate of 0.19 day(-1). The lagoon was fertilised in the summer season 1998 and 1999, while summer seasons 1996-97 and 2000 and inflowing water were used as unfertilised references. Most measured chemical and biological variables showed linear responses with an increasing loading rate of inorganic N and P (LN and LP, respectively). PON, POP and POC (< 200 µm) responded significantly (P<0.05) as did chlorophyll a and phytoplankton C. DIN and DIP remained, however, constant and independent of LN and LP, respectively (P>0.05) as did heterotrophic biomass (P>0.05). We evaluate the response variables assuming a stepwise incorporation process of nutrients in the planktonic ecosystem and how that will interact with biological response times and water dilution rates. We suggest that PON is a credible indicator of both chemical and ecological states of the planktonic ecosystem and that natural background and upper critical concentrations are 46 and 88 mg PON m(-3), respectively. The study was supported by data from mesocosms. We discuss the scientific relevance of our suggestions, how results can be extrapolated to a broader geographical scale, and we propose a science-based concept for the management of nutrient emission to open coastal waters.