Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea with Schizophrenia.

INTRODUCTION: To determine the 1-year and 3-year adherence rates with Positive Airway Pressure (PAP) therapy in patients with schizophrenia compared to matched controls. METHODS: A case-control retrospective analysis was performed in a Veterans Affairs hospital. All symptomatic patients with schizophrenia ever started on PAP therapy between 2007 and 2015 were compared with controls matched for severity of sleep apnea based on AHI, BMI, and age at the time of diagnosis. RESULTS: Total number of subjects in both groups was 39. Mean AHI among cases and controls was 27.63 ± 22.16 and 33.59 ± 44.04 (p = 0.32), mean BMI was 34.91 ± 5.87 and 33.92 ± 5.21 (p = 0.43), and mean age at diagnosis was 53.6 ± 11.75 and 55.97 ± 11.92 (p = 0.36), respectively. There was no statistically significant difference in PAP use between patients with schizophrenia and controls at 1-year (percent days device use > 4 h-36.43% ± 31.41 vs. 49.09% ± 38.76; p = 0.17) and 3-year (percent days device use > 4 h-42.43 ± 35.50 vs. 60.53 ± 38.56; p = 0.089) visits CONCLUSIONS: PAP adherence and usage is not significantly different among patients with schizophrenia compared to matched controls. Therefore, schizophrenia does not appear to influence CPAP compliance.

Complex multimodality central airway management of aspergillus pseudomembranous tracheobronchitis.

A 69-year-old woman developed central airway obstruction due to invasive Aspergillus infection resulting in pseudomembranous tracheobronchitis (PTB). Several challenges were encountered in the airway management of this patient including her having relatively smaller airways which were more prone to obstruction by pseudomembranes and made airway interventions difficult. The patient had clinical deterioration in spite of antifungal therapy and bronchoscopic debridement. The multimodality airway techniques included the use of smaller biliary balloons for dilatation, using a hybrid stent to slowly dilate and maintain patency of right main stem and finally the insertion of right secondary carina peripheral Y stent, which resulted in clinical improvement and allowed time for antifungal therapy to take effect. To the best of our knowledge, the use of a peripheral Y stent has never been described in the setting of PTB.

Management of Benign Pleural Effusions Using Indwelling Pleural Catheters: A Systematic Review and Meta-analysis.

BACKGROUND: The indwelling pleural catheter (IPC), which was initially introduced for the management of recurrent malignant effusions, could be a valuable management option for recurrent benign pleural effusion (BPE), replacing chemical pleurodesis. The purpose of this study is to analyze the efficacy and safety of IPC use in the management of refractory nonmalignant effusions. METHODS: We conducted a systematic review and meta-analysis on the published literature. Retrospective cohort studies, case series, and reports that used IPCs for the management of pleural effusion were included in the study. RESULTS: Thirteen studies were included in the analysis, with a total of 325 patients. Congestive heart failure (49.8%) was the most common cause of BPE requiring IPC placement. The estimated average rate of spontaneous pleurodesis was 51.3% (95% CI, 37.1%-65.6%). The estimated average rate of all complications was 17.2% (95% CI, 9.8%-24.5%) for the entire group. The estimated average rate of major complications included the following: empyema, 2.3% (95% CI, 0.0%-4.7%); loculation, 2.0% (95% CI, 0.0%-4.7%); dislodgement, 1.3% (95% CI, 0.0%-3.7%); leakage, 1.3% (95% CI, 0.0%-3.5%); and pneumothorax, 1.2% (95% CI, 0.0%-4.1%). The estimated average rate of minor complications included the following: skin infection, 2.7% (95% CI, 0.6%-4.9%); blockage and drainage failure, 1.1% (95% CI, 0.0%-3.5%); subcutaneous emphysema, 1.1% (95% CI, 0.0%-4.0%); and other, 2.5% (95% CI, 0.0%-5.2%). One death was directly related to IPC use. CONCLUSIONS: IPCs are an effective and viable option in the management of patients with refractory BPE. The quality of evidence to support IPC use for BPE remains low, and high-quality studies such as randomized controlled trials are needed.

Linker immobilization of protein and oligonucleotide on indium-tin-oxide for detection of probe-target interactions by Kelvin physics.

This work describes a label-free microarray analysis technique capable of detecting biomolecule target interactions with probes being anchored with a new linker-diluent system on indium-tin-oxide. The method is based on the differential work function characteristics of the substrate measured by a scanning Kelvin nanoprobe in terms of contact potential difference signals.