Telemonitoring-guided ambulatory fixed CPAP titration versus ambulatory APAP titration in moderate obstructive sleep apnea: A non-inferiority randomized controlled trial.

The present study aimed to evaluate whether titration of fixed continuous positive airway pressure at home using telemonitoring produces patient outcomes equal to auto-adjusting positive airway pressure titration at home for patients with moderate obstructive sleep apnea. Patients were randomized with a 1:1 allocation ratio to receive either auto-adjusting positive airway pressure titration based on the median of the 95th percentile pressure across seven nights or fixed continuous positive airway pressure titration based on a fixed calculated pressure and specific adaptations after telemonitoring of device data after 3 and 7 nights. The results of the ambulatory titration were evaluated with in-laboratory polysomnography after 2 weeks. We hypothesized that fixed continuous positive airway pressure titration would be non-inferior to auto-adjusting positive airway pressure titration in respect to continuous positive airway pressure adherence at a 3-month follow-up. A non-inferiority margin of -0.75 hr was prespecified. One-hundred and four patients were randomly allocated to fixed continuous positive airway pressure (n = 52) and auto-adjusting positive airway pressure (n = 52) titration. The mean difference and the 95% confidence intervals in continuous positive airway pressure adherence after 3 months between the two arms were 0.80 (-0.08, 1.69) hr. The non-inferiority hypothesis was confirmed as the lower one-sided 97.5% confidence interval for the mean difference was above the prespecified margin. Patients in the fixed continuous positive airway pressure titration arm were titrated at significantly lower pressure level and had a significantly lower amount of average leaks compared with auto-adjusting positive airway pressure-titrated patients, while there was no difference in residual obstructive apnea-hypopnea index on polysomnography. Telemonitoring enables ambulatory continuous positive airway pressure titration with fixed pressure that is non-inferior to ambulatory titration with auto-adjusting pressure in patients with moderate obstructive sleep apnea.

Employing body-fixed sensors and machine learning to predict physical activity in military personnel.

INTRODUCTION: This was a feasibility pilot study aiming to develop and validate an activity recognition system based on a custom-made body-fixed sensor and driven by an algorithm for recognising basic kinetic movements in military personnel. The findings of this study are deemed essential in informing our development process and contributing to our ultimate aim which is to develop a low-cost and easy-to-use body-fixed sensor for military applications. METHODS: Fifty military participants performed a series of trials involving walking, running and jumping under laboratory conditions in order to determine the optimal, among five machine learning (ML), classifiers. Thereafter, the accuracy of the classifier was tested towards the prediction of these movements (15 183 measurements) and in relation to participants' gender and fitness level. RESULTS: Random forest classifier showed the highest training and validation accuracy (98.5% and 92.9%, respectively) and classified participants with differences in type of activity, gender and fitness level with an accuracy level of 83.6%, 70.0% and 62.2%, respectively. CONCLUSIONS: The study showed that accurate prediction of various dynamic activities can be achieved with high sensitivity using a low-cost easy-to-use sensor and a specific ML model. While this technique is in a development stage, our findings demonstrate that our body-fixed sensor prototype alongside a fully trained validated algorithm can strategically support military operations and offer valuable information to commanders controlling operations remotely. Further stages of our developments include the validation of our refined technique on a larger range of military activities and groups by combining activity data with physiological variables to predict phenomena relating to the onset of fatigue and performance decline.

Retraction Note: Insomnia, sleepiness, anxiety and depression among different types of gamers in African countries.

This Article has been retracted.

Insomnia, sleepiness, anxiety and depression among different types of gamers in African countries.

Gaming has increasingly become a part of life in Africa. Currently, no data on gaming disorders or their association with mental disorders exist for African countries. This study for the first time investigated (1) the prevalence of insomnia, excessive daytime sleepiness, anxiety and depression among African gamers, (2) the association between these conditions and gamer types (i.e., non-problematic, engaged, problematic and addicted) and (3) the predictive power of socioeconomic markers (education, age, income, marital status, employment status) on these conditions. 10,566 people from 2 low- (Rwanda, Gabon), 6 lower-middle (Cameroon, Nigeria, Morocco, Tunisia, Senegal, Ivory Coast) and 1 upper-middle income countries (South Africa) completed online questionnaires containing validated measures on insomnia, sleepiness, anxiety, depression and gaming addiction. Results showed our sample of gamers (24 ± 2.8 yrs; 88.64% Male), 30% were addicted, 30% were problematic, 8% were engaged and 32% were non-problematic. Gaming significantly contributed to 86.9% of the variance in insomnia, 82.7% of the variance in daytime sleepiness and 82.3% of the variance in anxiety [p < 0.001]. This study establishes the prevalence of gaming, mood and sleep disorders, in a large African sample. Our results corroborate previous studies, reporting problematic and addicted gamers show poorer health outcomes compared with non-problematic gamers.

Association of malnutrition with surgical site infection following spinal surgery: systematic review and meta-analysis.

BACKGROUND: Surgical site infection (SSI) following spinal surgery is a frequent clinical problem with significant clinical and socio-economic consequences. Malnutrition has been linked with SSI in various other surgical procedures. AIM: To investigate whether malnutrition is a risk factor for SSI following spinal surgery. METHODS: Two electronic databases (PUBMED and SCOPUS) and the Cochrane Library were searched systematically from inception to May 2019. Cohort and case-control studies assessing malnutrition as a risk factor for SSI in patients undergoing spinal procedures were considered eligible. Μalnutrition was defined according to laboratory measurements or by relevant International Classification of Diseases-9 codes. SSI was the outcome of interest. Two reviewers independently abstracted study data and assessed the risk of bias for each study. Pooled effect estimates were calculated using random effects models. FINDINGS: In total, 22 studies (20 retrospective cohort and two case-control) with over 175,000 participants (of whom 2.14% developed postoperative SSI) were analysed. SSIs were more likely to develop in malnourished patients [odds ratio (OR) 2.31, 95% confidence interval (CI) 1.75-3.05]. While pre-operative malnutrition was significantly associated with SSI in patients undergoing thoracolumbar spinal and sacral surgery, no significant difference was seen in patients undergoing cervical spinal surgery. In subgroup analyses, similar results were observed for both hospital-based (OR 3.16, 95% CI 1.84-5.43) and population-based (OR 2.00, 95% CI 1.63-2.46) studies. CONCLUSIONS: Malnutrition is associated with increased risk of developing SSI after spinal surgery. Further high-quality research is warranted to investigate whether improvement of pre-operative nutritional status can decrease SSI rates.

Potential dietary feed additives with antibacterial effects and their impact on performance of weaned piglets: A meta-analysis.

This meta-analysis evaluated the use of potential dietary feed additives (pDFA) with antibacterial effects and their impact on the perfomance of weaned piglets. Twenty-three peer-reviewed in vivo studies, comprising 50 trials, were identified between January 2010 and January 2017. The pDFA in these studies could be grouped in 5 classes: antimicrobial peptides, chitosan, lysozyme, medium chain fatty acids/ triglycerides and plant extracts. Mixed-effect meta-analyses with type of pDFA as fixed effect were performed for the growth parameters 'average daily gain' (ADG) and 'feed conversion ratio' (FCR), which are the two most important and used economic performance parameters for farmers. For each class of pDFA, results of the meta-analysis showed significantly higher average daily gain in the group with pDFA compared to the negative control group, while no significant difference with the positive control group was observed. Furthermore, a positive effect on FCR was found, i.e. significantly less feed was needed to gain 1 kg of body weight in the group with pDFA compared to the negative control group. No significant differences with positive control groups were observed for each class of pDFA, except for plant extracts, where the FCR was also significantly reduced in the treatment group. These results suggest that pDFA could reduce the use of antimicrobials without significant negative effects on performance indicators.

Association of malnutrition with periprosthetic joint and surgical site infections after total joint arthroplasty: a systematic review and meta-analysis.

BACKGROUND: A growing body of evidence associates malnutrition with several adverse outcomes. AIM: To investigate the link between malnutrition with surgical site and periprosthetic joint infections (SSIs and PJIs) following total knee and hip arthroplasty (TKA and THA) through a comprehensive meta-analysis of observational studies. METHODS: A systematic search was conducted on PubMed and Scopus databases through December 2018, and recent proceedings of major orthopaedic meetings. Data from eligible studies were extracted and synthesized; pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. FINDINGS: Seven publications were included, reporting eight independent cohort studies with >250,000 subjects. SSIs and PJIs were more likely to develop in malnourished patients (OR: 2.49; 95% CI: 2.13-2.90; and 3.62; 2.33-5.64, respectively). The association of SSI with malnutrition was evident both after TKA (2.42; 1.94-3.02) and after THA (2.66; 1.64-4.30). Similarly, PJI was associated with malnutrition after TKA (2.55; 1.10-5.91) and after THA (3.10; 1.84-5.25). Finally, PJI correlated with malnutrition both after primary arthroplasty (3.58; 1.82-7.03) and revision arthroplasty (3.96; 2.47-6.33). The subgroup analysis by study setting confirmed the relationship between PJI and malnutrition in hospital (6.02; 3.07-11.81) and population-based (2.80; 1.76-4.44) studies. CONCLUSION: Malnutrition is associated with PJIs and SSIs after total joint arthroplasty. Further high-quality research is warranted to confirm or refute these findings.

Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension.

BACKGROUND: Hypertension (HT) is an important risk factor for cardiovascular disease and might precipitate pathology of the aortic valve. OBJECTIVE: To investigate the association of HT with aortic dysfunction (including both aortic regurgitation and stenosis) and the impact of antihypertensive treatment on the natural course of underlying aortic disease. METHODS: We performed a systematic review of the literature for all relevant articles assessing the correlation between HT and phenotype of aortic disease. RESULTS: Co-existence of HT with aortic stenosis and aortic regurgitation is highly prevalent in hypertensive patients and predicts a worse prognosis. Certain antihypertensive agents may improve haemodynamic parameters (aortic jet velocity, aortic regurgitation volume) and remodeling of the left ventricle, but there is no strong evidence of benefit regarding clinical outcomes. Renin-angiotensin system inhibitors, among other vasodilators, are well-tolerated in aortic stenosis. CONCLUSION: Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis.

Intratesticular Angiolipoma: A Rare Case of Adipose Tissue Presence in the Testis.

INTRODUCTION: Solid, fat-containing tumors of the testes are extremely rare with only a few cases having been reported so far, contrary to the more frequent occurrence of paratesticular lipomatosis. Testicular angiomyolipomas and gonadal involvement in Cowden's disease, although infrequently occurring, are known examples of fat-bearing testicular lesions. Hereby, we present an extremely rare case of intratesticular angiolipoma. Angiolipomas are benign tumors of the subcutaneous tissue commonly occurring in the trunk and the extremities. Histologically, they are characterized by ample vascularity and an excess of mature adipocytes. Definitive diagnosis is established by biopsy of the lesion. PRESENTATION OF THE CASE: A 35-year-old patient presented to our andrology outpatient clinic for fertility assessment. Physical examination of external genitalia revealed no significant pathology. Testicular ultrasound however depicted an isoechoic lesion on the upper pole of the right testis measuring 1.8 cm × 0.8 cm × 1 cm and exhibiting intense arterial flow. After sonographic and MRI investigation, the patient was referred for semen analysis and cryopreservation. Subsequently, the patient underwent testicular biopsy (frozen section biopsy) and right partial orchiectomy. Final histology reported a noninfiltrating testicular angiolipoma. No recurrences have been observed in the follow-up period. DISCUSSION: Angiolipomas, which mainly occur in the trunk and extremities, are classified as infiltrating and noninfiltrating. The diagnosis is based on both clinical and histologic criteria, and the main method of treatment for both types is by surgical excision. The infiltrating type exhibits higher recurrence rates. CONCLUSION: Angiolipomas commonly occur in the subcutaneous tissue and have been invariably treated by radical excision. Hereby, we report the first case of an intratesticular, noninfiltrating type angiolipoma which was treated by partial orchiectomy.

Hemorrhagic pneumonia in neonatal minks in Greece concomitant with Leismania infantum detection.

In the present study a severe outbreak of hemorrhagic pneumonia (HP) in neonatal minks concomitant with Leismania infantum (L. infantum) detection is reported. The outbreak took place on a Greek mink farm and affected 1,362 mink kits, with 524 dying. Macroscopic lesions of 14 necropsied affected kits were confined to the respiratory system with dark red, consolidated lung lobes and to the small intestine with severe, acute, hemorrhagic and necrotic enteritis. Microscopic examination of lung sections revealed severe hemorrhagic pyogranulomatous pneumonia. Bacteria were obtained in pure culture from the lungs of all necropsied animals and were confirmed as Pseudomonas aeruginosa (P. aeruginosa). Three out of 14 (21.4%) animals were positive for the presence of L. infantum DNA. The outbreak was attributed to the infection of minks with P. aeruginosa, possibly as a consequence of being immuno-suppressed by L. infantum. Further research is necessary, especially on the pathogenesis of P. aeruginosa/L. infantum co-infection and the implications of this interaction on HP disease outcome.

High-contrast 10 fs OPCPA-based front end for multi-PW laser chains.

Applications using multi-PW lasers necessitate high temporal pulse quality with a tremendous contrast ratio (CR). The first crucial prerequisite to achieve multi-PW peak power is the generation of ultrashort pulses with good spectral phase quality. Second, to avoid any deleterious pre-ionization effect on targets, nanosecond contrast better than 1012 is also targeted. In the framework of the Apollon 10 PW French laser program, we present a high-contrast 10 fs front-end design study to inject highly energetic Ti:sapphire PW lasers. The CR has been measured and analyzed in different time ranges highlighting the different major contributions for each scale.

Regional cerebral blood flow and cellular environment in subarachnoid hemorrhage: A thermal doppler flowmetry and microdialysis study.

BACKGROUND: Cerebral microdialysis enables assessment of regional metabolic physiology and provides biomarkers for clinical correlation in critical conditions, such as subarachnoid hemorrhage (SAH). The aim of our current study was to investigate the correlation between regional cerebral blood flow and microdialysis parameters (glucose, lactate, glycerol, pyruvate concentrations, and lactate/pyruvate metabolic ratio) in patients with SAH. MATERIALS AND METHODS: Twenty-one patients with SAH were enrolled in our retrospective study. Cerebral blood flow (CBF) based on thermal diffusion methodology, the thermal coefficient K, and microdialysis biochemical markers were recorded. The duration of the brain monitoring was 10 days. RESULTS: Microdialysis glucose concentration was inversely related to the cerebral temperature and to the L/P ratio. Furthermore, it was positively correlated to all other microdialysis parameters but glycerol. The K coefficient was strongly and positively correlated with the temperature and marginally with the CBF. The L/P ratio was positively correlated with glycerol, while it was inversely correlated with the CBF. Patients who died had elevated L/P ratio and K coefficient compared to the survivors in our series. CONCLUSIONS: Thermal conductivity coefficient may change over time as cerebral injury progresses and tissue properties alter. These alterations were found to be associated with the microdialysis metabolite concentrations and the CBF itself. The microdialysis biochemical indices of cell stress and death (glycerol, L/P ratio) were positively related to each other, while the measured L/P metabolic ratio was higher among patients who died.

Cardiovascular hypertensive emergencies.

Inevitably, a small proportion of patients with systematic hypertension will develop hypertensive crisis at some point. Hypertensive crises can be divided into hypertensive emergency or hypertensive urgency according to the presence or lack of acute target organ damage. In this review, we discuss cardiovascular hypertensive emergencies, including acute coronary syndrome, aortic dissection, congestive heart failure, and sympathomimetic hypertensive crises, including those caused by cocaine use. Each presents in a unique fashion, although some hypertensive emergency patients report nonspecific symptoms. Treatment includes several effective and rapid-acting medications to safely reduce the blood pressure, protect remaining end-organ function, relieve symptoms, minimize the risk of complications, and thereby improve patient outcomes.

Continuous wave and passively Q-switched Nd:YAG laser with a multisegmented crystal diode-pumped at 885 nm.

Mitigation of thermal effects in a 1064 nm Nd:YAG laser is demonstrated through the combination of a multisegmented crystal rod and upper laser level pumping by diode at 885 nm toward optimizing the generated beam profile. Continuous wave (cw) and passively Q-switched operation is demonstrated obtaining 7.5 W and 2 mJ at 100 Hz, respectively, with excellent beam quality. Comparison with a conventional uniform Nd:YAG rod reveals improvements of up to 64% in optical conversion efficiency and 67% in output power for retaining the beam quality. Thermal-lensing measurements validate the improved thermal management in the multisegmented crystal in conjunction with M-square values better than 1.3.

High peak-power stretcher-free femtosecond fiber amplifier using passive spatio-temporal coherent combining.

We report on the passive coherent combining of up to 8 temporally and spatially separated ultrashort pulses amplified in a stretcher-free ytterbium-doped fiber system. An initial femtosecond pulse is split into 4 temporal replicas using divided-pulse amplification, and subsequently divided in two counter-propagating beams in a Sagnac interferometer containing a fiber amplifier. The spatio-temporal distribution of the peak-power inside the amplifier allows the generation of record 3.1 µJ and 50 fs pulses at 1 MHz of repetition rate with 52 MW of peak-power from a stretcher-free fiber amplifier and without additional nonlinear post-compression stages.

Passive coherent combination of two ultrafast rod type fiber chirped pulse amplifiers.

Using passive coherent beam combining of two ultrafast fiber amplifiers, we demonstrate the generation of high temporal quality 300 fs and 650 µJ pulses corresponding to 60 W of average power at a repetition rate of 92 kHz. Furthermore, at 2 MHz of repetition rate record coherent combining average powers of 135 W before and 105 W after compression are measured. A combining efficiency higher than 90% is maintained over the whole range of output powers and repetition rates investigated demonstrating the efficiency and robustness of the passive combining technique. The measured pulse-to-pulse relative power fluctuation at high energy is 2%, indicating that the system is essentially immune to environmental phase noise. We believe the passive combining method to be an attractive approach for compact multi-GW peak power femtosecond fiber-based sources.

High-power diode-pumped cryogenically cooled Yb:CaF2 laser with extremely low quantum defect.

High-power diode-pumped laser operation at 992-993 nm under a pumping wavelength of 981 of 986 nm is demonstrated with Yb:CaF2 operating at cryogenic temperature (77 K), leading to extremely low quantum defects of 1.2% and 0.7%, respectively. An average output power of 33 W has been produced with an optical efficiency of 35%. This represents, to the best of our knowledge, the best laser performance ever obtained at such low quantum defects on intense laser lines.