Efficacy and safety of digital therapeutic application of Sleep Index-Based Treatment for Insomnia (dSIBT-I): a pilot study.

The aim of this study was to evaluate the safety and efficacy of digital therapeutic application of Sleep Index-Based Treatment for Insomnia (dSIBT-I) and compare them with those of digital application of Cognitive Behavioural Therapy for Insomnia (dCBT-I). This randomised prospective pilot study was conducted at the Asan Medical Center. A total of 50 patients with insomnia were recruited between December 2022 and January 2023 and randomly allocated to the dSIBT-I or dCBT-I group. The study was carried out for one month. The primary outcome was the significant reduction in Insomnia Severity Index score at Week 4 compared to baseline, while the secondary outcome was proportion of participants whose Insomnia Severity Index scores were reduced to <15 at Week 4. We performed linear mixed model and generalised estimating equation analyses. Both dSIBT-I and dCBT-I groups showed significant improvements in Insomnia Severity Index scores at Week 4. There was no significant difference between two groups in terms of Insomnia Severity Index scores at Week 4 (group × time effect, F = 1.07, p = 0.382) and proportion of participants whose Insomnia Severity Index scores were reduced to <15 at Week 4 (group × time effects, F = 1.80, p = 0.615). However, at Week 2, the dSIBT-I group showed better results than the dCBT-I group in terms of both Insomnia Severity Index scores (p = 0.044) and proportion of participants whose Insomnia Severity Index scores were reduced to <15 (82.6% vs. 48.0%, p = 0.017). No treatment-emergent adverse events were reported in either group. The dSIBT-I is a safe and effective therapy for insomnia, with rapid treatment effects.

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.

Limited Palatal Muscle Resection for the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

Background and Objectives: Limited palatal muscle resection (PMR) is a surgical technique employed to alleviate respiratory disturbances in obstructive sleep apnea (OSA) patients with retropalatal narrowing by reducing soft palate volume and tightening the muscles. Although some previous publications have demonstrated the effectiveness of limited PMR, the overall efficacy and therapeutic role of limited PMR for the treatment of OSA remain uncertain. This study utilized meta-analysis and a systematic literature review to estimate the overall effectiveness of limited PMR in treating OSA. Materials and Methods: Multiple databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, were searched using specific keywords related to OSA and limited PMR. Original articles assessing respiratory disturbances before and after limited PMR in patients with OSA were included. Data from selected articles were collected using standardized forms, including clinicodemographic characteristics, apnea-hypopnea index (AHI), and lowest pulse oximetry values (minimum SpO2). Random effect models were used for analyzing significant heterogeneity. Egger's test and funnel plot were used to identify publication bias. Results: Four studies were included in this meta-analysis for AHI, and three studies were included for minimum SpO2 during sleep. A significant reduction in the AHI and an increase in the minimum SpO2 were shown following limited PMR as the standardized mean difference (95% confidence interval) was 2.591 (1.092-4.090) and 1.217 (0.248-2.186), respectively. No publication bias was found in either analysis. Conclusions: The results of the meta-analysis and systemic review add to the literature that limited PMR can result in a reduction in the AHI and an increase in min SaO2. In OSA patients with suspected retropalatal obstruction, limited PMR may be efficiently performed.

Validation Study on Automated Sleep Stage Scoring Using a Deep Learning Algorithm.

Background and Objectives: Polysomnography is manually scored by sleep experts. However, manual scoring is a time-consuming and labor-intensive task. The goal of this study was to verify the accuracy of automated sleep-stage scoring based on a deep learning algorithm compared to manual sleep-stage scoring. Materials and Methods: A total of 602 polysomnography datasets from subjects (Male:Female = 397:205) aged 19 to 65 years (mean age, 43.8, standard deviation = 12.2) were included in the study. The performance of the proposed model was evaluated based on kappa value and bootstrapped point-estimate of median percent agreement with a 95% bootstrap confidence interval and R = 1000. The proposed model was trained using 482 datasets and validated using 48 datasets. For testing, 72 datasets were selected randomly. Results: The proposed model exhibited good concordance rates with manual scoring for stages W (94%), N1 (83.9%), N2 (89%), N3 (92%), and R (93%). The average kappa value was 0.84. For the bootstrap method, high overall agreement between the automated deep learning algorithm and manual scoring was observed in stages W (98%), N1 (94%), N2 (92%), N3 (99%), and R (98%) and total (96%). Conclusions: Automated sleep-stage scoring using the proposed model may be a reliable method for sleep-stage classification.

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.

Preventive and therapeutic effects of vitamin D in a mouse model of allergic asthma.

BACKGROUND: Vitamin D produces an anti-allergic effect that prevents inflammation due to asthma. OBJECTIVE: We investigated whether vitamin D has an anti-inflammatory effect on the sensitization and challenge stages of asthma development in a murine model. METHODS: Mice were divided into the following five groups according to ovalbumin (OVA) and vitamin D (VD) administration: control group, OVA group, preventive VD group (VD injection before OVA sensitization), inhibitory VD group (VD injection after OVA challenge), and dual VD groups (VD injection before OVA sensitization and after OVA challenge). Each group was evaluated for airway hyperresponsiveness (AHR), cell counts, cytokines, total IgE, and OVA-specific IgE using bronchoalveolar lavage fluid (BALF). Cytokines in the lysate and eosinophils in the lung tissue were also evaluated. RESULTS: AHR occurred less in the groups to which VD was administered than in the OVA group. The eosinophils, neutrophils, IL-5 in BALF, IL-4, TGF-ß, and eosinophils in lysate decreased with the administration of VD in the preventive, inhibitory, and dual VD groups compared with the OVA group. Although the lymphocytes, macrophages, IL-4 in BALF, and IL-5 in lysate decreased with administration of VD in the inhibitory and dual VD groups, they were not affected by preventive VD administration. These anti-allergic effects of VD were most noticeable with VD administration for dual (preventive and inhibitory) purposes. CONCLUSIONS: VD may produce preventive and inhibitory effects on the development and exacerbation of asthma in a murine model. These effects are most noticeable when VD is used for dual purposes.

Association between sleep duration and the prevalence of atopic dermatitis and asthma in young adults.

BACKGROUND: Sleep duration affects allergic diseases; however, this association requires further investigation. OBJECTIVE: To evaluate the association between sleep duration and the prevalence of atopic dermatitis and asthma in young Korean adults. METHOD: We analyzed data of 10,148 subjects (4,239 men; 5,909 women) aged 19-39 years from the Korean National Health and Nutrition Examination Survey 2008-2010. Self-reported sleep duration was categorized into five groups: ≤5h, 6h, 7h, 8h, and ≥9h. The prevalence of atopic dermatitis and asthma was examined based on a questionnaire and compared between participants from five sleep duration groups after adjusting for potential confounding factors, including model 1 [age], model 2 [model 1 + BMI, current smoking, current alcohol use, regular physical activity, household income, and serum 25(OH)D level], and model 3 [model 2 + stress levels]. RESULTS: In female participants, a higher risk of atopic dermatitis was associated with sleep duration ≤5 hours [odds ratio (OR): 1.665, 95% confidence interval (CI): 1.004-2.762; model 1], and ≥9 hours (OR, 1.746, 95% CI, 1.145-2.661; model 3), compared to a 7-hour sleep duration. Similarly, a higher risk of asthma was associated with sleep duration ≤5 hours and ≥9 hours (OR, 1.553, 95% CI, 1.023-2.359 and OR, 1.569, 95% CI, 1.048-2.349, respectively; model 3). In male participants, there was no significant association between sleep duration and the prevalence of atopic dermatitis or asthma. CONCLUSIONS: Sleep duration ≤5 and ≥9 hours may be a risk factor for atopic dermatitis and asthma in young female adults.

Effect of Sleep Deprivation on the Male Reproductive System in Rats.

There has been no study reporting on the influence of sleep deprivation on the male reproductive system including sperm quality. In this study, we hypothesized that sleep deprivation could lead to adverse effect on the male reproductive system. The rats were divided into three groups: 1) control (home-cage, n = 10); 2) SD4 (sleep deprivation for 4 days, n = 10); and 3) SD7 (sleep deprivation for 7 days, n = 10). Sleep deprivation was performed by a modified multiple platform method. Sperm quality (sperm motion parameters and counts), hormone levels (corticosterone and testosterone), and the histopathology of testis were evaluated and compared between the three groups. A statistically significant reduction (P = 0.018) was observed in sperm motility in the SD7 group compared to those of the control group. However, there were no significant differences in other sperm motion parameters, or in sperm counts of the testis and cauda epididymis between three groups. Compared with the control group, the SD4 (P = 0.033) and SD7 (P = 0.002) groups exhibited significant increases of corticosterone levels, but significant decreases of testosterone levels were found in the SD4 (P = 0.001) and SD7 (P < 0.001) groups. Seminiferous tubular atrophy and/or spermatid retention was partially observed in the SD4 and SD7 groups, compared with the normal histopathology of the control group. Sleep deprivation may have an adverse effect on the male reproductive system in rats.

Validity of Modified STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea.

OBJECTIVES: The aim of this study was to evaluate the validity of a modified STOP-Bang questionnaire with different body mass index reference as a screening tool for obstructive sleep apnea in Korean population. METHODS: The medical records of 1417 participants who underwent overnight Level I polysomnography were retrospectively analyzed. Predictive parameters were calculated for each of the 3 groups classified by obstructive sleep apnea severity with a cut-off value of 3 or 4. Responses to modified and traditional questionnaires were comparatively analyzed by receiver-operator characteristic curves and area under the receiver-operator characteristic curves. RESULTS: The optimal cut-off values of the modified and traditional questionnaires were both 3.5. The area under the receiver-operator characteristic curve of modified STOP-Bang questionnaire for any obstructive sleep apnea group was 0.786 ± 0.018, which was significantly higher than that of the traditional questionnaire. The modified STOP-Bang questionnaire with a cut-off value ≥4 showed significantly higher sensitivity than the traditional one for any obstructive sleep apnea group. The diagnostic accuracy of the modified questionnaire was also significantly higher for the any obstructive sleep apnea group when the cut-off value was 4. CONCLUSION: The modified STOP-Bang questionnaire, with a cut-off value of 4, can be used as an alternative to the traditional screening tool for the Korean population.

Hybrid Organic-Si C-MOSFET Image Sensor Designed with Blue-, Green-, and Red-Sensitive Organic Photodiodes on Si C-MOSFET-Based Photo Signal Sensor Circuit.

The resolution of Si complementary metal-oxide-semiconductor field-effect transistor (C-MOSFET) image sensors (CISs) has been intensively enhanced to follow the technological revolution of smartphones, AI devices, autonomous cars, robots, and drones, approaching the physical and material limits of a resolution increase in conventional Si CISs because of the low quantum efficiency (i.e., ~40%) and aperture ratio (i.e., ~60%). As a novel solution, a hybrid organic-Si image sensor was developed by implementing B, G, and R organic photodiodes on four n-MOSFETs for photocurrent sensing. Photosensitive organic donor and acceptor materials were designed with cost-effective small molecules, i.e., the B, G, and R donor and acceptor small molecules were Coumarin6 and C_60, DMQA and MePTC, and ZnPc and TiOPc, respectively. The output voltage sensing margins (i.e., photocurrent signal difference) of the hybrid organic-Si B, G, and R image sensor pixels presented results 17, 11, and 37% higher than those of conventional Si CISs. In addition, the hybrid organic-Si B, G, and R image sensor pixels could achieve an ideal aperture ratio (i.e., ~100%) compared with a Si CIS pixel using the backside illumination process (i.e., ~60%). Moreover, they may display a lower fabrication cost than image sensors because of the simple image sensor structure (i.e., hybrid organic-Si photodiode with four n-MOSFETs).

Optimal level of continuous positive airway pressure: auto-adjusting titration versus titration with a predictive equation.

OBJECTIVES: The aims of the present study were twofold. We sought to compare two methods of titrating the level of continuous positive airway pressure (CPAP) - auto-adjusting titration and titration using a predictive equation - with full-night manual titration used as the benchmark. We also investigated the reliability of the two methods in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Twenty consecutive adult patients with OSAS who had successful, full-night manual and auto-adjusting CPAP titration participated in this study. The titration pressure level was calculated with a previously developed predictive equation based on body mass index and apnea-hypopnea index. RESULTS: The mean titration pressure levels obtained with the manual, auto-adjusting, and predictive equation methods were 9.0 +/- 3.6, 9.4 +/- 3.0, and 8.1 +/- 1.6 cm H2O,respectively. There was a significant difference in the concordance within the range of +/- 2 cm H2O (p = 0.019) between both the auto-adjusting titration and the titration using the predictive equation compared to the full-night manual titration. However, there was no significant difference in the concordance within the range of +/- 1 cm H2O (p > 0.999). CONCLUSIONS: When compared to full-night manual titration as the standard method, auto-adjusting titration appears to be more reliable than using a predictive equation for determining the optimal CPAP level in patients with OSAS.

Estimation of the Effectiveness of a Tighter, Reinforced Quarantine for the Coronavirus Disease 2019 (COVID-19) Outbreak: Analysis of the Third Wave in South Korea.

It has been claimed that a tighter, reinforced quarantine strategy was advocated to reduce the transmission of coronavirus disease 2019 (COVID-19) during major outbreaks; however, there have been no prior quantitative studies examining the effectiveness and duration of such a reinforced quarantine. Consequently, the purpose of this research was to determine the impact of a "tighter, reinforced" quarantine during the third COVID-19 breakout wave in South Korea, which occurred between late 2020 and early 2021. The efficacy of the quarantine was determined by comparing the number of newly diagnosed COVID-19 patients between the "prediction model" and "actual observed data." Two prediction models were developed using the autoregressive integrated moving average (ARIMA; 1, 0, 0) model. The effect of a "tighter, reinforced" quarantine, which would show as an immediate drop in the number of new cases, predicted its efficacy by lowering the number of new cases by 20,400. In addition, the efficacy of the quarantine lasted up to more than three months. The findings of our investigation confirmed the beneficial influence of "tighter, controlled" quarantine laws during a widespread COVID-19 epidemic. During an epidemic, when the population has not yet developed immunity to respiratory viral diseases, our study may be evidence for implementing stricter quarantine restrictions in order to reduce the number of new cases.

Fumed Silica-Based Ultra-High-Purity Synthetic Quartz Powder via Sol-Gel Process for Advanced Semiconductor Process beyond Design Rule of 3 nm.

Fumed silica-based ultra-high-purity synthetic quartz powder was developed via the sol-gel process to apply to quartz wares and quartz crucibles for use in advanced semiconductor processes. The process conditions of preparing potassium silicate solution, gelation, and cleaning were optimized, i.e., the relative ratio of fumed silica (10 wt%) to KOH (4 wt%) for potassium silicate solution, gelation time 3 h, and cleaning for 1 h with 5 wt% HCl solution. It was observed that the gelation time strongly affected the size distribution of the quartz powder; i.e., a longer gelation time led to a larger size (d50) of the synthesized quartz powder: 157 µm for 2 h and 331 µm for 5 h. In particular, it was found that the morphology of the as-synthesized quartz powder greatly depended on the pulverizing process; i.e., the shape of quartz powder was shown to be rod-shaped for the without-gel-pulverizing process and granular-shaped with the process. We expect that the fumed silica-based ultra-high-purity quartz powder with an impurity level of 74.1 ppb synthesized via the sol-gel process is applicable as a raw material for quartz wares and crucibles for advanced semiconductor processes beyond the design rule of 3 nm.

Incidence disparities of obstructive sleep apnea-associated lung cancer by gender; Korean National Health Insurance data analysis.

Introduction: Obstructive sleep apnea (OSA) is known to increase the risk of various cancers. By analyzing the Korea National Health Insurance Service (KNHIS) registry, the impact of OSA on the lung cancer incidence was analyzed in a retrospective cohort group. Methods: A retrospective cohort of adult patients newly registered with OSA in the KNHIS data from 2007 to 2017 was included and observed until December 2019 (12 years). The main outcome measure was newly diagnosed lung cancer. The control group was set with age and sex that matched those in the OSA group. Results: The hazard ratio (HR) of OSA for lung cancer incidence showed a significantly reduced HR of 0.87 (95% CI, 0.82-0.93). The observed significance of this finding was limited to male OSA patients [HR, 0.84 (95% CI, 0.78-0.90)], while no significant association was found in female OSA patients [HR, 1.05 (95% CI, 0.91-1.21)], irrespective of their age. Discussion: OSA patients have a lower risk of developing lung cancer, but this risk reduction is gender-specific, as female OSA patients do not show a reduction in hazard ratio.

Testicular Cancer Incidence among Obstructive Sleep Apnea (OSA) Patients: South Korean National Health Insurance Data.

Obstructive sleep apnea (OSA) has been linked to an increased risk of acquiring many types of cancer. No data on the prevalence of testicular cancer in OSA patients have been reported in the literature. The goal of the present investigation is to find out the impact of OSA on the incidence of testicular cancer based on the Korea National Health Insurance Service (KNHIS) dataset. A cohort of adult male patients newly registered with OSA in the KNHIS data from 2007 to 2014 who had no history of any previous cancer diagnosis was included. The main outcome measure was newly diagnosed testicular cancer in the National Medical Expenses Support Program. The control group was set at five times larger than the OSA group, and it was matched with age and sex. The cumulative incidence and hazard ratio (HR) for the development of testicular cancer were compared between the OSA and control groups. Further subgroup analysis was conducted in the three different age groups. In the study period, a total of 152,801 male adult patients newly diagnosed with OSA were included, whereas 764,005 individuals were recruited as the control group. The HR of OSA for developing testicular cancer was 1.58 (95% confidence interval [CI]: 0.92-2.60), showing no significant HR regardless of confounding adjustment. However, the subgroup analysis revealed a significantly increased HR to develop testicular cancer of 3.39 (95% CI: 1.08-10.06) in groups aged more than 65, whereas the age ranges of 20-40 and 40-64 showed no significance (1.19 (0.44-2.75) and 1.27 (0.50-2.80), respectively). OSA may not influence the incidence of testicular cancer in the general adult population. However, compared to younger males, males over 65 may be more susceptible to OSA when it comes to developing testicular cancer.

Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway obstruction during sleep. To reduce the morbidity of OSA, sleep specialists have explored various methods of managing the condition, including manifold positive airway pressure (PAP) techniques and surgical procedures. Nasal obstruction can cause significant discomfort during sleep, and it is likely that improving nasal obstruction would enhance the quality of life and PAP compliance of OSA patients. Many reliable studies have offered evidence to support this assumption. However, few comprehensive guidelines for managing OSA through nasal surgery encompass all this evidence. In order to address this gap, the Korean Society of Otorhinolaryngology-Head and Neck Surgery (KORL-HNS) and the Korean Society of Sleep and Breathing designated a guideline development group (GDG) to develop recommendations for nasal surgery in OSA patients. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. The types of nasal surgery included septoplasty, turbinate surgery, nasal valve surgery, septorhinoplasty, and endoscopic sinus surgery. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians' grading system. The GDG developed 10 key action statements with supporting text to support them. Three statements are ranked as strong recommendations, three are only recommendations, and four can be considered options. The GDG hopes that this clinical practice guideline will help physicians make optimal decisions when caring for OSA patients. Conversely, the statements in this guideline are not intended to limit or restrict physicians' care based on their experience and assessment of individual patients.

Effect of upper airway surgery on heart rate variability in patients with obstructive sleep apnoea syndrome.

To determine whether surgery influences cardiovascular autonomic modulation in obstructive sleep apnoea syndrome (OSAS), the present study was performed to evaluate the effect of upper airway (UA) surgery on heart rate variability (HRV) using frequency domain analysis for patient groups who have had either successful or unsuccessful surgery. We compared body mass index (BMI), polysomnographic [apnoea index (AI), apnoea-hypopnoea index (AHI), minimum SaO(2)] and HRV [very low frequency (VLF) power, low frequency (LF) power, high frequency (HF) power, HF/LF ratio, LFnu = LF/(LF + HF), HFnu = HF/(LF + HF)] parameters between the unsuccessful (n = 14) and successful (n = 22) surgical groups before and after UA surgery. Significant changes were observed for the successful patient group with respect to mean AI (from 29.1 ± 21.3 to 2.0 ± 3.2 events h(-1), P < 0.001), AHI (from 38.6 ± 20.0 to 5.6 ± 5.1 events h(-1), P < 0.001), minimum SaO(2) (from 73.3 ± 12.7 to 86.3 ± 6.5%, P < 0.001), VLF power (from 25599 ± 12906 to 20014 ± 9839 ms(2), P = 0.013), LF power (from 17293 ± 7278 to 14155 ± 4980 ms(2), P = 0.016), LFnu (from 0.700 ± 0.104 to 0.646 ± 0.128, P = 0.031) and HFnu (from 0.300 ± 0.104 to 0.354 ± 0.128, P = 0.031); however, mean BMI, HF power and LF/HF ratio did not change significantly after UA surgery. No significant changes were observed in the unsuccessful surgical group. Successful UA surgery may improve cardiac sympathetic and parasympathetic modulation in patients with OSAS.

Metabolomics-based optimal koji fermentation for tyrosinase inhibition supplemented with Astragalus radix.

The present study was focused on improving the quality of rice koji by fermentation with a selected Aspergillus oryzae strain and a plant Astragalus radix. A. oryzae KCCM 60345 was used as main inoculant and the Astragalus radix was added as supplement in rice koji preparation. LC-MS based metabolite analysis and tyrosinase inhibitory activities were studied for different time periods. A. oryzae KCCM 60345 fermented rice koji supplemented with Astragalus showed higher tyrosinase inhibition activity at 4 d of fermentation and metabolite analysis with PCA and PLS-DA indicated differences in kojic acid, calycosin-7-O-ß-D-glucoside, ononin, calycosin, and formononetin as compared with other forms of rice koji fermentation. By correlation analysis between metabolites and tyrosinase inhibitory activity, calycosin and kojic acid were identified as major tyrosinase inhibitors. Based on these results, we concluded that A. oryzae KCCM 60345 supplemented with Astragalus radix is useful for whitening effects, and we identified optimal conditions for rice koji preparation.

Associations of respiratory mechanic instability with respiratory parameters in pediatric patients with obstructive sleep apnea syndrome.

OBJECTIVES: This study aimed to identify the effectiveness of respiratory mechanic instability (RMI) in the diagnosis of pediatric obstructive sleep apnea syndrome (OSAS). We sought to evaluate the correlations of RMI with sleep-related parameters and determine the effectiveness of using RMI for diagnosing OSAS in children. METHODS: Children who underwent polysomnography (PSG) for various reasons were enrolled in this study. Patients' clinical and PSG data at two university hospitals were reviewed retrospectively. During PSG, RMI parameters were automatically calculated according to the phase relationship between thoracic and abdominal movement signals. RESULTS: Among 263 children who underwent PSG, 183 (70.4%) were diagnosed with OSAS (apnea-hypopnea index [AHI] ≥ 1). RMI parameters were higher in the OSAS group than in the control group. They also tended to increase with disease severity. RMI scores were well correlated with respiratory parameters, showing a stronger correlation in those with moderate or severe OSAS without central apnea. Areas under the receiver operating characteristics curves (AUROCs) of RMI indicators were over 0.65. The percentage of RMI in stage duration showed the highest value of the AUROCs. CONCLUSION: Paradoxical thoraco-abdominal movement assessed by RMI provides additional information. It may be useful in diagnosing OSAS in children.