Data-Fusion-Based Quality Enhancement for HR Measurements Collected by Wearable Sensors.

The advancements of Internet of Things (IoT) technologies have enabled the implementation of smart and wearable sensors, which can be employed to provide older adults with affordable and accessible continuous biophysiological status monitoring. The quality of such monitoring data, however, is unsatisfactory due to excessive noise induced by various disturbances, such as motion artifacts. Existing methods take advantage of summary statistics, such as mean or median values, for denoising, without taking into account the biophysiological patterns embedded in data. In this research, a functional data analysis modeling method was proposed to enhance the data quality by learning individual subjects' diurnal heart rate (HR) patterns from historical data, which were further improved by fusing newly collected data. This proposed data-fusion approach was developed based on a Bayesian inference framework. Its effectiveness was demonstrated in an HR analysis from a prospective study involving older adults residing in assisted living or home settings. The results indicate that it is imperative to conduct personalized healthcare by estimating individualized HR patterns. Furthermore, the proposed calibration method provides a more accurate (smaller mean errors) and more precise (smaller error standard deviations) HR estimation than raw HR and conventional methods, such as the mean.

Variations in the sleep-related breathing disorder index on polysomnography between men with HIV and controls: a matched case-control study.

BACKGROUND: Both sleep-related breathing disorders (SRBDs) and HIV infection can interfere with normal sleep architecture, and also cause physical and psychological distress. We aimed to understand the differences in the obstructive patterns, sleep architecture, physical and psychological distress when compared between people living with HIV (PLWH) and matched the severity of SRBDs controls. METHODS: A comparative study using matched case-control design was conducted. Men with HIV infection (case group) were enrolled from 2016 to 2019. A control group with HIV seronegative men were matched for SRBDs severity, and were selected from sleep medicine center database for comparison. RESULTS: The mean age of the 108 men (including 54 cases and 54 matched controls) was 33.75 years. Central-apnea index (CI) was higher in the case group rather than matched controls (mean CI, 0.34 vs. 0.17, p = 0.049). PLWH had a lower mean percentage of stage 3 sleep (10.26% vs. 13.94%, p = 0.034) and a higher percentage of rapid eye movement sleep (20.59% vs. 17.85%, p = 0.011) compared to matched controls. Nocturnal enuresis and sleepiness causing traffic accidents were more frequent complaint in PLWH compared to controls. CONCLUSIONS: Early detected SRBDs and subtypes in PLWH to begin treatment for the underlying cause could reduce the risk of sleepiness-related traffic accidents.

Early changes in skin surface temperature predict body temperature increases in patients with fever: A pilot study.

OBJECTIVE: To investigate the correlation between body temperature and skin surface temperature in intensive care unit patients and to identify specific indicators of skin surface temperature for early fever detection. RESEARCH METHODOLOGY/DESIGN: This pilot study was a prospective, observational investigation conducted at National Cheng Kung University Hospital in Tainan, Taiwan. A total of 54 patients admitted to the Surgical Intensive Care Unit of a tertiary hospital between April and August 2020 were included. Patients utilized the wearable device HEARThremoTM to continuously monitor skin surface temperature and heart rate. Analysis of Variance was applied to identify the association of skin surface temperature with different body temperature groups. The comparison between skin surface temperature and fever over eight time intervals was studied using a generalized estimating equation. RESULTS: In 34 patients (63 %) with a fever (≥38 °C), skin surface temperature increased (P < 0.001) when body temperature increased. The maximum skin surface temperature was significantly associated with fever 180-210 min before the fever events occurred (OR: 2.22, 95 % CI: 1.30-3.80). The mean skin surface temperature was associated with fever 120-150 min before the fever events (OR: 8.70, 95 % CI: 2.08-36.36). CONCLUSIONS: Skin surface temperature can be an important early predictive sign before the onset of fever. Continuous temperature monitoring can detect fever early and initiate treatment in advance. This study serves as a preliminary exploration in this area, laying the groundwork for future comprehensive research. IMPLICATIONS FOR CLINICAL PRACTICE: Continuous monitoring of skin surface temperature empowers nurses to swiftly detect fever, transcending conventional methods. This proactive approach allows for the early identification of physiological abnormalities, facilitating the prompt initiation of further physical assessments and relevant examinations for early treatment commencement.

Characteristics of flash droughts and their association with compound meteorological extremes in China: Observations and model simulations.

Flash droughts have gained considerable public attention due to the imminent threats they pose to food security, ecological safety, and human health. Currently, there has been little research exploring the projected changes in flash droughts and their association with compound meteorological extremes (CMEs). In this study, we applied the pentad-mean water deficit index to investigate the characteristics of flash droughts and their association with CMEs based on observational data and downscaled model simulations. Our analysis reveals an increasing trend in flash drought frequency in China based on historical observations and model simulations. Specifically, the proportion of flash drought frequency with a one-pentad onset time showed a consistent upward trend, with the southern parts of China experiencing a high average proportion during the historical period. Furthermore, the onset dates of the first (last) flash droughts during year are projected to shift earlier (later) in a warmer world. Flash droughts become significantly more frequent in the future, with a growth rate approximately 1.3 times higher in the high emission scenario than in the medium emission scenario. The frequency of flash droughts with a one-pentad onset time also exhibits a significant upward trend, indicating that flash droughts will occur more rapidly in the future. CMEs in southern regions of China were found to be more likely to trigger flash droughts in the historical period. The probability of CMEs triggering flash droughts is expected to increase with the magnitude of warming, particularly in the far-future under the high emissions scenario.

Brain photobiomodulation therapy on neurological and psychological diseases.

Photobiomodulation (PBM) therapy is an innovative treatment for neurological and psychological conditions. Complex IV of the mitochondrial respiratory chain can be stimulated by red light, which increases ATP synthesis. In addition, the ion channels' light absorption causes the release of Ca2+, which activates transcription factors and changes gene expression. Neuronal metabolism is improved by brain PBM therapy, which also promotes synaptogenesis and neurogenesis as well as anti-inflammatory. Its depression-treating potential is attracting attention for other conditions, including Parkinson's disease and dementia. Giving enough dosage for optimum stimulation using the transcranial PBM technique is challenging because of the rapidly increasing attenuation of light transmission in tissue. Different strategies like intranasal and intracranial light delivery systems have been proposed to overcome this restriction. The most recent preclinical and clinical data on the effectiveness of brain PBM therapy are studied in this review article.

Dissecting the genetic landscape of GPCR signaling through phenotypic profiling in C. elegans.

G protein-coupled receptors (GPCRs) mediate responses to various extracellular and intracellular cues. However, the large number of GPCR genes and their substantial functional redundancy make it challenging to systematically dissect GPCR functions in vivo. Here, we employ a CRISPR/Cas9-based approach, disrupting 1654 GPCR-encoding genes in 284 strains and mutating 152 neuropeptide-encoding genes in 38 strains in C. elegans. These two mutant libraries enable effective deorphanization of chemoreceptors, and characterization of receptors for neuropeptides in various cellular processes. Mutating a set of closely related GPCRs in a single strain permits the assignment of functions to GPCRs with functional redundancy. Our analyses identify a neuropeptide that interacts with three receptors in hypoxia-evoked locomotory responses, unveil a collection of regulators in pathogen-induced immune responses, and define receptors for the volatile food-related odorants. These results establish our GPCR and neuropeptide mutant libraries as valuable resources for the C. elegans community to expedite studies of GPCR signaling in multiple contexts.

Iterative editing of multiple genes using CRISPR/Cas9 in C. elegans.

Certain sets of genes are derived from gene duplication and share substantial sequence similarity in C. elegans , presenting a significant challenge in determining the specific roles of each gene and their collective impact on cellular processes. Here, we show that a collection of genes can be disrupted in a single animal via multiple rounds of CRISPR/Cas9 mediated genome editing. We found that up to three genes can be simultaneously disrupted in a single editing event with high efficiency. Our approach offers an opportunity to explore the genetic interaction and molecular underpinning of gene clusters with redundant function.

Transcriptomic analysis reveals upregulated host metabolisms and downregulated immune responses or cell death induced by acute African swine fever virus infection.

The African swine fever virus is a virulent and communicable viral disease that can be transmitted by infected swine, contaminated pork products, or soft tick vectors. Nonstructural proteins encoded by ASFV regulate viral replication, transcription, and evasion. However, the mechanisms underlying the host response to ASFV infection remain incompletely understood. In order to enhance comprehension of the biology and molecular mechanisms at distinct time intervals (6, 12, 24 h) post infection, transcriptome analyses were executed to discern differentially expressed genes (DEGs) between ASFV and mock-infected PAMs. The transcriptomic analysis unveiled a total of 1,677, 2,122, and 2,945 upregulated DEGs and 933, 1,148, and 1,422 downregulated DEGs in ASFV- and mock-infected groups at 6, 12, and 24 h.p.i.. The results of the transcriptomic analysis demonstrated that the infection of ASFV significantly stimulated host metabolism pathways while concurrently inhibiting the expression of various immune responses and cell death pathways. Our study offers crucial mechanistic insights into the comprehension of ASFV viral pathogenesis and the multifaceted host immune responses. The genes that were dysregulated may serve as potential candidates for further exploration of anti-ASFV strategies.

Repetitive transcranial magnetic stimulation for stroke rehabilitation: insights into the molecular and cellular mechanisms of neuroinflammation.

Stroke is a leading cause of mortality and disability worldwide, with most survivors reporting dysfunctions of motor, sensation, deglutition, cognition, emotion, and speech, etc. Repetitive transcranial magnetic stimulation (rTMS), one of noninvasive brain stimulation (NIBS) techniques, is able to modulate neural excitability of brain regions and has been utilized in neurological and psychiatric diseases. Moreover, a large number of studies have shown that the rTMS presents positive effects on function recovery of stroke patients. In this review, we would like to summarized the clinical benefits of rTMS for stroke rehabilitation, including improvements of motor impairment, dysphagia, depression, cognitive function, and central post-stroke pain. In addition, this review will also discuss the molecular and cellular mechanisms underlying rTMS-mediated stroke rehabilitation, especially immune regulatory mechanisms, such as regulation of immune cells and inflammatory cytokines. Moreover, the neuroimaging technique as an important tool in rTMS-mediated stroke rehabilitation has been discussed, to better understanding the mechanisms underlying the effects of rTMS. Finally, the current challenges and future prospects of rTMS-mediated stroke rehabilitation are also elucidated with the intention to accelerate its widespread clinical application.

Hypoxia induces food leaving in C. elegans.

Hypoxia alters eating behavior in different animals. In C. elegans , hypoxia induces a strong food leaving response. We found that this behavior was independent of the known O 2 response mechanisms including acute O 2 sensation and HIF-1 signaling of chronic hypoxia response. Mutating egl-3 and egl-21 , encoding the neuropeptide pro-protein convertase and carboxypeptidase, led to defects in hypoxia induced food leaving, suggesting that neuropeptidergic signaling was required for this response. However, we failed to identify any neuropeptide mutants that were severely defective in hypoxia induced food leaving, suggesting that multiple neuropeptides act redundantly to modulate this behavior.

Thermally constructed stable Zn-doped NiCoOx-z alloy structures on stainless steel mesh for efficient hydrogen production via overall hydrazine splitting in alkaline electrolyte.

Hydrogen has a high energy density of approximately 120 to 140 MJ kg-1, which is very high compared to other natural energy sources. However, hydrogen generation through electrocatalytic water splitting is a high electricity consumption process due to the sluggish oxygen evolution reaction (OER). As a result, hydrogen generation through hydrazine-assisted water electrolysis has recently been intensively investigated. The hydrazine electrolysis process requires a low potential compared to the water electrolysis process. Despite this, the utilization of direct hydrazine fuel cells (DHFCs) as portable or vehicle power sources necessitates the development of inexpensive and effective anodic hydrazine oxidation catalysts. Here, we prepared oxygen-deficient zinc-doped nickel cobalt oxide (Zn-NiCoOx-z) alloy nanoarrays on stainless steel mesh (SSM) using a hydrothermal synthesis method followed by thermal treatment. Furthermore, the prepared thin films were used as electrocatalysts, and the OER and hydrazine oxidation reaction (HzOR) activities were investigated in three- and two-electrode systems. In a three-electrode system, Zn-NiCoOx-z/SSM HzOR requires -0.116 V (vs RHE) potential to achieve a 50 mA cm-2 current density, which is dramatically lower than the OER potential (1.493 V vs RHE). In a two-electrode system (Zn-NiCoOx-z/SSM(-)∥Zn-NiCoOx-z/SSM(+)), the overall hydrazine splitting potential (OHzS) required to reach 50 mA cm-2 is only 0.700 V, which is dramatically less than the required potential for overall water splitting (OWS). These excellent HzOR results are due to the binder-free oxygen-deficient Zn-NiCoOx-z/SSM alloy nanoarray, which provides a large number of active sites and improves the wettability of catalysts after Zn doping.

Substantial increase in abrupt shifts between drought and flood events in China based on observations and model simulations.

Drought-flood abrupt alternation (DFAA) refers to the rapid transformation between droughts and floods, posing serious threats to ecological security, food production, and human safety. Previous studies have insufficiently investigated DFAA events at large regional scales using high-resolution observations and model simulations. In this study, the standardized precipitation evapotranspiration index was used to construct the DFAA magnitude index, which considers the asymmetric effects of drought and flood alternations. Four types of DFAA events were then investigated using high-resolution station observations and NEX-GDDP-CMIP6 model simulations. The results showed that hotspot areas of drought-flood and flood-drought alternation events were mainly in the northern and eastern parts of China, while the hotspot areas of drought-flood-drought and flood-drought-flood alternation events were obviously smaller than those of drought-flood and flood-drought alternation events. Drought-flood, flood-drought, and drought-flood-drought alternation events showed significant upward trends at rates of 0.075, 0.057, and 0.051 events/decade, respectively, and these increases were attributed to significant increases in moderate, severe, and extreme events across China during 1981-2020. Generally, the total number of DFAA events above moderate grade in the northern, central, and some areas in the southern parts of China increased obviously (>50 %) during 2001-2020 compared to 1981-2000. NEX-GDDP-CMIP6 can reasonably represent the multi-year averages and long-term trends of precipitation, temperature, and DFAA events in China. Except for the flood-drought-flood alternation events, the other three types of DFAA events showed significant increasing trends in the future, with higher rates under the SSP585 scenario than under the SSP245 scenario (e.g., drought-flood alternation events at rates of 0.033 and 0.046 events/decade under SSP245 and SSP585, respectively, during 1981-2100). DFAA events above the moderate grade were predicted to increase significantly in both 2032-2065 and 2066-2099 compared to 1981-2014, especially in northern China for the 2066-2099 under the SSP585 scenario.

[Detection of Fever Using Continuous Skin Temperature Monitoring in Hospitalized Older Adults].

BACKGROUND: The continuous monitoring of body surface temperature has been proven to help detect potential fever events in hospitalized patients. However, the efficacy of using body surface temperature to detect fever in older adults remains unclear due to the relatively low and slower-to-change body surface temperature in this population. PURPOSE: This study was designed to investigate 1) the relationship between changes in body surface and routine tympanic temperatures, 2) the correlation between body surface temperature measurement frequency and detection of fever, and 3) the factors related to the incidence of fever in hospitalized older adults. METHODS: A prospective study was conducted on 33 hospitalized older adults aged 65 years or older who were suspected to have or diagnosed with an infection in an infectious disease and medical ward at a medical center in southern Taiwan from March to November 2020. Demographic, routine tympanic temperature, and heart rate data were collected by reviewing the participants' medical records. Body surface temperatures were monitored continuously using HEARThermo every 10 seconds until one of the following conditions were met: hospital discharge, no fever for three continuous days, and HEARThermo was removed. Descriptive analysis was used to compare the variations in body surface temperature and routine tympanic temperature measurements. Pearson correlation was used to analyze the correlation between different measurement frequencies and fever events. Finally, mixed effects logistic regression was used to analyze the factors significantly related to fever events. RESULTS: Seven hundred and twenty routine body temperature measurements were taken, with 209 (29.0%) fever events detected in 23 (69.7%) of the participants. The body surface temperatures were more closely correlated with tympanic temperatures during fever events than non-fever events (r = .260, p < .001). More fever events were detected using body surface temperature monitoring frequencies of every 10 seconds and every 1 minute. After controlling for demographic factors, the results of the mixed effect model indicate that body surface temperature and heart rate are significant factors related to fever events in hospitalized older adults (odds ratio, OR: 1.74, p < .001; OR: 1.11, p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The continuous monitoring of body surface temperature may improve the detection of fever events in hospitalized older adults. The application of wearable devices and cloud platforms may further facilitate the real-time assessment and care capabilities of nurses, thus reducing their workload and improving care quality.

Cucurbitane-type triterpenoids from the fruits of Citrullus colocynthis.

A phytochemical investigation of the fruits of Citrullus colocynthis resulted in the isolation of 21 structurally diverse cucurbitane triterpenoids, including 9 previously undescribed ones, colocynins A-I (1-9). Their absolute configurations were elucidated by means of quantum chemical electronic circular dichroism (ECD) calculations, CD exciton chirality method, and single-crystal X-ray crystallography. Colocynins A-C (1-3) represent the first examples of nonanorcucurbitane-type triterpenoids. An anti-acetylcholinesterase activity assay showed that 6, 10, 13, 18, and 20 exhibited inhibitory activities, with IC50 values ranging from 5.0 to 21.7 µM. In addition, 18 and 21 showed significant cytotoxicity against PACA, A431, and HepG2 cells, with IC50 values ranging from 0.042 to 0.60 and 3.6-14.4 µM, respectively.

Dynamic changes in quality of life, psychological status, and body image in women who underwent a mastectomy as compared with breast reconstruction: an 8-year follow up.

BACKGROUND: Surgical decisions and methods of surgery highly influence long term QoL for breast cancer (BC) survivors. This study is aimed towards an exploration of the dynamic changes in quality of life (QoL), anxiety/depression status, and body image (BI) among women with BC who received a mastectomy compared with those receiving breast reconstruction (BR) within an 8-year follow-up period. METHODS: Women with major BC surgeries were invited to complete the World Health Organization Quality of Life-Brief (WHOQOL-BREF), the European quality of life five dimensions questionnaire (EQ-5D), and a body image scale within 8 years of surgery. Kernel smoothing methods were applied to describe dynamic changes in QoL, anxiety/depression, and BI at different time points. Linear mixed effects models were constructed to identify the interaction between time, different types of surgery, and the determinants of QoL in these patients. RESULTS: After 1:10 propensity score matching, a total of 741 women who had undergone a BR and mastectomy were included. The BR group exhibited a high WHOQOL QoL score one to five years after surgery with some fluctuations. The mastectomy group had comparatively stable QoL scores on WHOQOL items and were less depressed/anxious. The BR group generally showed fluctuating, higher BI scores two years after surgery, but they exhibited more anxiety/depression during follow up for 8 years. Medical comorbidities, the status of anxiety/depression, and BI were the major factors influencing all domains and items of the WHOQOL BREF among women with BC. CONCLUSION: The mastectomy group showed a decreased trend toward depression in patients with BC. The BR group showed a significant improvement in QoL in the first 5 years with massive fluctuations. These findings should be considered and discussed in patient participatory decision-making and promotion of QoL for breast cancer survivors.

Relationships Among Trajectories of Sleep Disturbance, Depression, and Antiretroviral Therapy in Persons Newly Diagnosed with HIV: A One-and-a-Half-Year Observational Longitudinal Study.

Purpose: Sleep disturbance is one of the most prevalent symptoms among persons living with HIV (PLWH). However, the trajectory of sleep patterns in persons newly diagnosed with HIV remains underrecognized. The current study aimed to estimate the trajectory of sleep quality and its associated factors among newly diagnosed PLWH. Patients and Methods: A prospective study was conducted in the outpatient clinic of a medical center in southern Taiwan from January 2015 to December 2017. Our primary outcome was sleep quality using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Participants completed the questionnaire at baseline and at four follow-up interval visits: at 3-6, 6-9, 9-12 and 12-15 months. A generalized equation estimation (GEE) model was applied to analyze the relationships among poor sleep quality, depression and antiretroviral therapy among persons newly diagnosed with HIV. Results: A total of 217 PLWH were included. The mean age of the sample was 29.3 years, and males (98.6%) were predominant. A total of 56.2% of HIV-infected persons were considered to have poor sleep quality at baseline. After controlling for the confounding effects of demographic characteristics, the following factors increased the risk of poor sleep quality: older age (ß= 0.07, CI: 0.03-0.11, p=0.001), level of depression (ß= 0.32, CI: 0.27-0.37, p<0.001) and detectable viral load (ß= 0.61, CI: 0.04 - 1.18, p= 0.037). However, there was no significant difference in BMI, CD4 counts, HIV viral load, disclosure status, or highly active antiretroviral therapy (HAART) regimen. Conclusion: Our results demonstrate that one in two persons with newly diagnosed HIV had poor sleep quality. Being older, having higher levels of depression, and having detectable HIV viral loads were identified as risk factors for developing poor sleep quality in persons living with HIV.

Endovascular Treatment Versus Best Medical Management in Acute Basilar Artery Occlusion Strokes: Results From the ATTENTION Multicenter Registry.

BACKGROUND: The authors compare the effectiveness and safety of endovascular treatment (EVT) versus best medical management (BMM) in strokes attributable to acute basilar artery occlusion (BAO). METHODS: The present analysis was based on the ongoing, prospective, multicenter ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion) trial registry in China. Our analytic sample comprised 2134 patients recruited at 48 sites between 2017 and 2021 and included 462 patients who received BMM and 1672 patients who received EVT. We performed an inversed probability of treatment weighting analysis. Qualifying patients had to present within 24 hours of estimated BAO. The primary clinical outcome was favorable functional outcome (modified Rankin Scale score, 0-3) at 90 days. We also performed a sensitivity analysis with the propensity score matching-based and the instrumental variable-based analysis. RESULTS: In our primary analysis using the inversed probability of treatment weighting-based analysis, there was a significantly higher rate of favorable outcome at 90 days among EVT patients compared with BMM-treated patients (adjusted relative risk, 1.42 [95% CI, 1.19-1.65]; absolute risk difference, 11.8% [95% CI, 6.9-16.7]). The mortality was significantly lower (adjusted relative risk, 0.78 [95% CI, 0.69-0.88]; absolute risk difference, -10.3% [95% CI, -15.8 to -4.9]) in patients undergoing EVT. Results were generally consistent across the secondary end points. Similar associations were seen in the propensity score matching-based and instrumental variable-based analysis. CONCLUSIONS: In this real-world study, EVT was associated with significantly better functional outcomes and survival at 90 days. Well-designed randomized studies comparing EVT with BMM in the acute BAO are needed. REGISTRATION: URL: www.chictr.org.cn; Unique identifier: ChiCTR2000041117.

ROS and cGMP signaling modulate persistent escape from hypoxia in Caenorhabditis elegans.

The ability to detect and respond to acute oxygen (O2) shortages is indispensable to aerobic life. The molecular mechanisms and circuits underlying this capacity are poorly understood. Here, we characterize the behavioral responses of feeding Caenorhabditis elegans to approximately 1% O2. Acute hypoxia triggers a bout of turning maneuvers followed by a persistent switch to rapid forward movement as animals seek to avoid and escape hypoxia. While the behavioral responses to 1% O2 closely resemble those evoked by 21% O2, they have distinct molecular and circuit underpinnings. Disrupting phosphodiesterases (PDEs), specific G proteins, or BBSome function inhibits escape from 1% O2 due to increased cGMP signaling. A primary source of cGMP is GCY-28, the ortholog of the atrial natriuretic peptide (ANP) receptor. cGMP activates the protein kinase G EGL-4 and enhances neuroendocrine secretion to inhibit acute responses to 1% O2. Triggering a rise in cGMP optogenetically in multiple neurons, including AIA interneurons, rapidly and reversibly inhibits escape from 1% O2. Ca2+ imaging reveals that a 7% to 1% O2 stimulus evokes a Ca2+ decrease in several neurons. Defects in mitochondrial complex I (MCI) and mitochondrial complex I (MCIII), which lead to persistently high reactive oxygen species (ROS), abrogate acute hypoxia responses. In particular, repressing the expression of isp-1, which encodes the iron sulfur protein of MCIII, inhibits escape from 1% O2 without affecting responses to 21% O2. Both genetic and pharmacological up-regulation of mitochondrial ROS increase cGMP levels, which contribute to the reduced hypoxia responses. Our results implicate ROS and precise regulation of intracellular cGMP in the modulation of acute responses to hypoxia by C. elegans.

Long-term survival in a patient with advanced lung adenocarcinoma harboring synchronous EGFR exon 18 G719A and BRAF V600E mutations and treated with afatinib: a case report.

EGFR and BRAF V600E mutations are both early driven and usually mutually exclusive. We report the case of a 59-year-old woman diagnosed with advanced lung adenocarcinoma harboring coexisting EGFR exon 18 G719A and BRAF V600E mutations. She experienced a long-term response to oral afatinib, with a progression-free survival rate of 33 months and an overall survival rate of 11 years. Lung adenocarcinoma with synchronous EGFR G719A and BRAF V600E mutations is rare and has not been previously reported. This case highlights the importance of an adequate response to afatinib and provides an optimal therapeutic option for such patients.

Differences in Sleep Disorders between HIV-Infected Persons and Matched Controls with Sleep Problems: A Matched-Cohort Study Based on Laboratory and Survey Data.

OBJECTIVES: Sleep disturbances are prevalent problems among human immunodeficiency virus (HIV)-infected persons. The recognition of comorbid sleep disorders in patients with HIV is currently hampered by limited knowledge of sleep-related symptoms, sleep architecture, and types of sleep disorders in this population. We aimed to compare the differences in sleep-related symptoms and polysomnography-based sleep disorders between HIV-infected persons and controls. METHODS: The study evaluated 170 men with a Pittsburgh sleep quality index scores greater than 5, including 44 HIV-infected men and 126 male controls who were frequency-matched by sex, age (±3.0 years) and BMI (±3.0 kg/m2). For all participants, an overnight sleep study using a Somte V1 monitor was conducted. Differences in sleep-related symptoms and sleep disorders between HIV-infected patients and controls were examined using t-tests or chi-square tests. RESULTS: HIV-infected persons with sleep disturbances more often had psychological disturbances (72.7% vs. 40.5%, p < 0.001) and suspected rapid eye movement behavior disorder (25.0% vs. 4.8%, p < 0.01) than controls. Sleep-disordered breathing was less common in HIV-infected persons than in controls (56.8% vs. 87.3%, p < 0.001). The mean percentage of rapid eye movement sleep was higher among HIV-infected patients than among controls (20.6% vs. 16.6%, p < 0.001). Nocturia was more common in HIV-infected persons than in controls (40.9% vs. 22.2%, p = 0.02). CONCLUSIONS: Psychological disturbances and sleep-disordered breathing can be possible explanations of sleep disturbances in HIV-infected persons in whom sleep-disordered breathing is notable. Further studies are warranted to examine the underlying factors of rapid eye movement behavior disorder among HIV-infected persons with sleep disturbances.