Effect of Dynamic Binaural Beats on Sleep Quality: A Proof-of-Concept Study with Questionnaire and Biosignals.

Binaural beat (BB) has been investigated as a potential modality to enhance sleep quality. In this study, we introduce a new form of BB, referred to as dynamic BB (DBB), which incorporates dynamically changing carrier frequency differences between the left and right ears. Specifically, the carrier frequency of the right ear varied between 100 and 103 Hz over a period, while the left ear remained fixed at 100 Hz, yielding a frequency difference range of 0 to 3 Hz. The objective of this study was to examine the effect of DBB on sleep quality. Ten healthy participants were included in a cross-over design, where they experienced both DBB and a SHAM (absence of sound) condition across two consecutive nights, with polysomnography evaluation. DBB was administrated during pre-sleep initiation, sleep onset, and transition from rapid-eye-movement (REM) to non-REM stage. DBB significantly reduced sleep latency compared to the SHAM condition. Electrocardiogram analysis revealed that exposure to DBB led to diminished heart rate variability during the pre-sleep initiation and sleep onset periods, accompanied by a decrease in low frequency power of heart rate during the sleep onset period. DBB might be effective in improving the sleep quality, suggesting its possible application in insomnia treatments.

Straight nail insertion through a laterally shifted entry for diaphyseal atypical femoral fractures with bowing: good indications and limitations of this technique.

PURPOSE: Inserting a straight (piriformis fossa entry) nail through the tip of the greater trochanter has been used for treating atypical femoral fractures (AFFs) with bowing. This study aimed to determine what degree of bowing can be successfully treated using a laterally shifted entry technique. METHODS: Twenty-three complete and six incomplete diaphyseal AFFs treated using the shifted entry technique were retrospectively analysed. Radiologic parameters and complications were evaluated. The complete AFFs were divided into two groups based on the severity of preoperative bowing: grade 0-II bowing and < 20° lateral bowing (minimal/moderate) and grade III bowing or ≥ 20° lateral bowing (severe). Comparison according to postoperative malalignment, a change of lateral or anterior bowing ≥ 5° was also performed. RESULTS: Three complete AFFs in the minimal/moderate group showed malalignment, as did all in the severe group (p < 0.001). The change of bowing was greater for the severe group in lateral and anterior bowing (p = 0.004 and 0.001, respectively). A greater fracture gap was found on AP and lateral radiographs in the severe group (p = 0.044 and 0.026, respectively). In the comparison according to postoperative malalignment, a significant difference was found for the percentage of severe deformity (p < 0.001). All incomplete AFFs were united without complication. CONCLUSION: Diaphyseal AFFs with grade 0-II bowing and < 20° anterior bowing were treated successfully by the shifted entry technique. However, postoperative malalignment was found in all cases of AFFs with severe bowing. Therefore, other techniques should be considered for AFFs with grade III bowing or ≥ 20° anterior bowing.

Therapeutic effects of human mesenchymal stem cell microvesicles in an ex vivo perfused human lung injured with severe E. coli pneumonia.

BACKGROUND: We previously reported that microvesicles (MVs) released by human mesenchymal stem cells (MSC) were as effective as the cells themselves in both Escherichia coli lipopolysaccharide and live bacteria-induced acute lung injury (ALI) mice models. However, it remained unclear whether the biological effect of MSC MV can be applied to human ALI. METHODS: In the current study, we tested the therapeutic effects of MSC MVs in a well-established ex vivo perfused human model of bacterial pneumonia. Using human donor lungs not used for transplantation, we instilled E. coli bacteria intrabronchially and, 1 hour later, administered MSC MVs into the perfusate as therapy. RESULTS: After 6 hours, instillation of E. coli bacteria caused influx of inflammatory cells, which resulted in significant inflammation, lung protein permeability and pulmonary oedema formation. Administration of MSC MV significantly increased alveolar fluid clearance and reduced protein permeability and numerically lowered the bacterial load in the injured alveolus. The beneficial effect on bacterial killing was more pronounced with pretreatment of MSCs with a Toll-like receptor 3 agonist, polyinosinic:polycytidylic acid (Poly (I:C)), prior to the isolation of MVs. Isolated human alveolar macrophages had increased antimicrobial activity with MSC MV treatment in vitro as well. Although oxygenation and lung compliance levels were similar between injury and treatment groups, administration of MSC MVs numerically decreased median pulmonary artery pressure at 6 hours. CONCLUSIONS: In summary, MSC MVs increased alveolar fluid clearance and reduced lung protein permeability, and pretreatment with Poly (I:C) enhanced the antimicrobial activity of MVs in an ex vivo perfused human lung with severe bacteria pneumonia.

Diet control to achieve euglycemia induces significant loss of heart and liver weight via increased autophagy compared with ad libitum diet in diabetic rats.

Intensive glucose control increases the all-cause mortality in type 2 diabetes mellitus (T2DM); however, the underlying mechanisms remain unclear. We hypothesized that strict diet control to achieve euglycemia in diabetes damages major organs, increasing the mortality risk. To evaluate effects on major organs when euglycemia is obtained by diet control, we generated a model of end-stage T2DM in 13-week-old Sprague-Dawley rats by subtotal pancreatectomy, followed by ad libitum feeding for 5 weeks. We divided these rats into two groups and for the subsequent 6 weeks provided ad libitum feeding to half (AL, n=12) and a calorie-controlled diet to the other half (R, n=12). To avoid hypoglycemia, the degree of calorie restriction in the R group was isocaloric (g per kg body weight per day) compared with a sham-operated control group (C, n=12). During the 6-week diet control period, AL rats ate three times more than rats in the C or R groups, developing hyperglycemia with renal hyperplasia. R group achieved euglycemia but lost overall body weight significantly compared with the C or AL group (49 or 22%, respectively), heart weight (39 or 23%, respectively) and liver weight (50 or 46%, respectively). Autophagy levels in the heart and liver were the highest in the R group (P<0.01), which also had the lowest pAkt/Akt levels among the groups (P<0.05 in the heart; P<0.01 in the liver). In conclusion, glycemic control achieved by diet control can prevent hyperglycemia-induced renal hyperplasia in diabetes but may be deleterious even at isocaloric rate when insulin is deficient because of significant loss of heart and liver mass via increased autophagy.

Improvement of ß-cell function after achievement of optimal glycaemic control via long-term continuous subcutaneous insulin infusion therapy in non-newly diagnosed type 2 diabetic patients with suboptimal glycaemic control.

BACKGROUND: Achieving euglycaemia by continuous subcutaneous insulin infusion (CSII) therapy alone has been shown to restore ß-cell function in patients with newly diagnosed type 2 diabetes. However, the efficacy has not been evaluated in patients with non-newly diagnosed type 2 diabetes and suboptimal glycaemic control. METHODS: Of the 1220 patients with type 2 diabetes who began CSII therapy from March 2000 to March 2007, we retrospectively selected patients using the following inclusion criteria: glycosylated haemoglobin (HbA1c ) ≥ 7.0%, diabetes duration ≥ 1 year before CSII therapy, and duration of CSII therapy ≥ 6 months. We evaluated sequential changes in HbA1c and serum C-peptide levels measured at a 6- to 12-month intervals during CSII therapy. RESULTS: In the 521 subjects included in this study [median diabetes duration 10 years; interquartile range (IQR) 6.0-17.0; CSII therapy ≤ 30 months], median HbA1c decreased from 8.7% (IQR 7.7-10.0) at baseline to 6.3% (IQR 5.9-6.9) after 6 months of CSII therapy (p < 0.0001). During the subsequent 24 months, median HbA1c levels were maintained between 6.3% and 6.5% (p < 0.0001 for all time points vs baseline). At 12 months after CSII therapy, median C-peptide levels began to increase compared with baseline (fasting level 23% increase, p < 0.0001; 2-h postprandial level 26% increase, p = 0.022), and the increase was maintained at 30 months (fasting level 39%; 2-h postprandial level 53%; p < 0.0001 for all vs baseline). CONCLUSIONS: ß-Cell function was significantly improved in patients with non-newly diagnosed and suboptimally controlled type 2 diabetes after achieving and maintaining optimal glycaemic control with long-term CSII therapy alone.

The impact of implementing critical care team on open general intensive care unit.

BACKGROUND: There are a plethora of literatures showing that high-intensity intensive care unit (ICU) physician staffing is associated with reduced ICU mortality. However, it is not widely used in ICUs because of limited budgets and resources. We created a critical care team (CCT) to improve outcomes in an open general ICU and evaluated its effectiveness based on patients' outcomes. METHODS: We conducted this prospective, observational study in an open, general ICU setting, during a period ranging from March of 2009 to February of 2010. The CCT consisted of five teaching staffs. It provided rapid medical services within three hours after calls or consultation. RESULTS: We analyzed the data of 830 patients (157 patients of the CCT group and 673 patients of the non-CCT one). Patients of the CCT group presented more serious conditions than those of the non-CCT group (acute physiologic and chronic health evaluation II [APACHE II] 20.2 vs. 15.8, p<0.001; sequential organ failure assessment [SOFA] 5.5 vs. 4.6, p=0.003). The CCT group also had significantly more patients on mechanical ventilation than those in the non-CCT group (45.9% vs. 23.9%, p<0.001). Success rate of weaning was significantly higher in the CCT group than that of the non-CCT group (61.1% vs. 44.7%, p=0.021). On a multivariate logistic regression analysis, the increased ICU mortality was associated with the older age, non-CCT, higher APACHE II score, higher SOFA score and mechanical ventilation (p<0.05). CONCLUSION: Although the CCT did not provide full-time services in an open general ICU setting, it might be associated with a reduced ICU mortality. This is particularly the case with patients on mechanical ventilation.

Early changes in SOFA score as a prognostic factor in pediatric oncology patients requiring mechanical ventilatory support.

PURPOSE: To evaluate whether changes in outcome prediction scores during the first 72 hours after admission to a pediatric intensive care unit (PICU) are more predictive of outcome than single assessments at admission in pediatric oncology patients requiring mechanical ventilatory support for more than 3 days. PATIENTS AND METHODS: The medical records of 54 consecutive pediatric oncology patients requiring mechanical ventilation over 72 hours in the PICU of the Asan Medical Center, Seoul, Korea, between January 2006 and December 2008, were retrospectively reviewed. RESULTS: Although both initial Sequential Organ Failure Assessment (SOFA) score and change in SOFA score (Δ-SOFA) correlated well with mortality, Δ-SOFA score showed a significantly stronger correlation (P<0.001) and a larger area under the receiver operating characteristic curve than did initial SOFA score. Patients with positive and negative Δ-SOFA scores showed statistically significant differences in mortality (18.5% vs. 88.2%, P<0.001). In addition, early changes in respiratory parameters, such as PaO2/FiO2 (P/F) ratio, oxygenation index (OI), and ventilation index (VI), evaluated serially during the first 3 days, also correlated with mortality. Patients showing improvement in these respiratory parameters displayed significantly lower mortality than did patients with worsening of these parameters (P<0.01). CONCLUSIONS: Serial evaluation of SOFA score during the first few days after PICU admission was a good predictor of prognosis in pediatric oncology patients mechanically ventilated over 3 days. Independent of initial SOFA score, Δ-SOFA score during the first 72 hours closely correlated with outcome. Early changes in respiratory parameters, such as P/F ratio, OI, and VI, may also provide valuable prognostic information in such patients.

Insulin requirement profiles of patients with type 2 diabetes after achieving stabilized glycemic control with short-term continuous subcutaneous insulin infusion.

BACKGROUND: As in type 1 diabetes, continuous subcutaneous insulin infusion (CSII) therapy is emerging as a promising therapeutic option in type 2 diabetes. However, the insulin requirement profiles of patients with type 2 diabetes when treated via CSII with rapid-acting insulin analogs have not been well investigated. METHODS: We examined insulin requirement profiles of type 2 diabetes patients (n = 300; age, 57.9 +/- 11.4 years; hemoglobin A1c [HbA(1c)], 9.1 +/- 2.2%) for 3 days after achieving normoglycemia via 1-2 weeks of CSII therapy. We also analyzed the total daily dose (TDD) of insulin-associated clinical and laboratory parameters at baseline. RESULTS: The mean TDD was 45.1 +/- 24.7 IU/day (range, 4.8-145.8 IU/day). The total daily bolus (TBo) (range 2.8-111.3 IU/day) was 64.1 +/- 12.1% of the TDD. The rates of infusion for day and night in total daily basal dose (TBa) were 0.74 +/- 0.35 and 0.41 +/- 0.32 IU/h, respectively. The dose ratio (in IU/day) was 2.7 : 1.9 : 1.6 : 1.8 : 1 (breakfast, lunch, and dinner bolus and day and night basal, respectively). After adjusting for age, gender, and body mass index, TDD was associated with HbA(1c), fasting and 2-h postprandial plasma glucose, fasting C-peptide, and carbohydrate-to-insulin ratio (P < 0.05). CONCLUSIONS: Initial TDD in type 2 diabetes patients on CSII showed a wide range of distribution with a TBo-to-TBa ratio >2.0 and was associated with parameters indicating glycemic control but not with body weight, suggesting that the currently used protocol in dose determination of insulin, including allocation of half of the TDD to TBa or weight-based determination of initial TDD, may need to be reexamined when treating type 2 diabetes with CSII therapy.