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1.
J Clin Sleep Med ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32003732

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is thought to be associated with dyslipidemia. However, differences concerning dyslipidemia during rapid eye movement (REM) and non-REM (NREM) sleep have yet to be determined. OBJECTIVES: This study was designed to explore the association between lipid profiles and OSA during REM or NREM sleep. METHODS: This is a clinical cohort. A total of 2,619 participants with at least 30 min of REM sleep were included. Sleep variables and fasting lipid profiles [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo)A-I, apoB, apoE, and lipoprotein(a) (Lp(a))] were obtained from each subject. Apnea-hypopnea indices (AHIs) in REM and NREM sleep (AHIREM and AHINREM, respectively) were recorded. Linear regression analysis was used to assess the associations of AHIREM and AHINREM with lipid profiles. RESULTS: When stratified by the AHIREM severity of OSA, all demographics, clinical variables, and sleep parameters differed between the groups except for apoA-I. In fully adjusted multivariate linear regression models, AHIREM was independently associated with increasing levels of TG, HDL-C, and apoE (p = 0.04, p = 0.01 and p = 0.01, respectively). AHINREM was independently associated with increasing levels of TC, TG, LDL and apoB, and lower level of HDL-C (all p < 0.05). In sensitivity analyses by only exploring associations in patients who had an AHINREM < 5 or AHIREM < 5 times per hour in separate regression models, AHIREM was not associated with all lipid profile in almost all adjusted models (all p > 0.05), while AHINREM was associated with elevated TC, LDL-C, and apoB (p = 0.03, p = 0.01 and p = 0.01, respectively). CONCLUSION: AHINREM was independently associated with the greatest alterations in serum lipids, including TC, LDL-C, and apoB.

2.
World Neurosurg ; 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32059967

RESUMO

OBJECT: FMD remains the first-line treatment for CM-I associated with syringomyelia, although consistent approaches are not used. However, there are few reports on a persistent or recurrent syrinx or worsening neurological symptoms after FMD. METHODS: We retrospectively reviewed medical records of patients who attended Xuanwu Hospital between January 2018 and July 2019 with persistent or recurrent syringomyelia after FMD. RESULTS: All eight patients had syringomyelia preoperatively with a mean disease course of 43 (range 3-120) months and underwent FMD. The presenting symptoms improved in 1 patient. There was radiologic evidence decreased syrinx size in 1 patient. Worsening syringomyelia presented at a median of 65 (range 7-168) months after the primary FMD. Secondary decompression was performed in all patients. A structural, pathological cause for the first FMD failure was identified in all cases at the time of the second decompression. Symptoms were resolved in all patients after repeat decompression surgery. Radiologically, 6 patients had a decrease in syringomyelia size. The level of the upper segment of the syringomyelia was higher in 7 of our revision patients, among which 6 patients had a decrease in syringomyelia size. The median follow-up duration after the secondary decompression was 11.5 (range 6-22) months. CONCLUSIONS: Adults with persistent syringomyelia after FMD and the higher level of the upper segment of the syringomyelia often have a surgically remediable structural cause. The beneficial effect of a secondary decompression should be considered and guide the decision-making of patients with CM-I related syringomyelia.

3.
Abdom Radiol (NY) ; 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31897684

RESUMO

Obstructive azoospermia (OA) is caused by excurrent duct obstruction, which can occur anywhere along the course of the male reproductive tract and is classically characterized by normal spermatogenesis. To be familiar with the imaging anatomy of normal and abnormal male genital ducts is essential to the diagnosis of OA. In some circumstances, OA can also be related to some specific syndromes; thus, making an accurate diagnosis may require an integral view of the whole abdomen and pelvis. MR is a great complementary imaging modality either for the detection of obstructive factors, especially for characterization of those indeterminate features on ultrasound, or for the identification of specific syndromes related to OA. In this article, a series of patients with OA caused by different kinds of lesions in and out of the pelvic cavity (abdomen) shown on MR imaging were included, and some cases of specific syndromes related to OA were also reviewed.

4.
Proc Natl Acad Sci U S A ; 117(5): 2255-2264, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-31964850

RESUMO

A climate/vegetation model simulates episodic wetter and drier periods at the 21,000-y precession period in eastern North Africa, the Arabian Peninsula, and the Levant over the past 140,000 y. Large orbitally forced wet/dry extremes occur during interglacial time, ∼130 to 80 ka, and conditions between these two extremes prevail during glacial time, ∼70 to 15 ka. Orbital precession causes high seasonality in Northern Hemisphere (NH) insolation at ∼125, 105, and 83 ka, with stronger and northward extended summer monsoon rains in North Africa and the Arabian Peninsula and increased winter rains in the Mediterranean Basin. The combined effects of these two seasonally distinct rainfall regimes increase vegetation and narrow the width of the Saharan-Arabian desert and semidesert zones. During the opposite phase of the precession cycle (∼115, 95, and 73 ka), NH seasonality is low, and decreased summer insolation and increased winter insolation cause monsoon and storm track rains to decrease and the width of the desert zone to increase. During glacial time (∼70 to 15 ka), forcing from large ice sheets and lowered greenhouse gas concentrations combine to increase winter Mediterranean storm track precipitation; the southward retreat of the northern limit of summer monsoon rains is relatively small, thereby limiting the expansion of deserts. The lowered greenhouse gas concentrations cause the near-equatorial zone to cool and reduce convection, causing drier climate with reduced forest cover. At most locations and times, the simulations agree with environmental observations. These changing regional patterns of climate/vegetation could have influenced the dispersal of early humans through expansions and contractions of well-watered corridors.

5.
J Neuroinflammation ; 17(1): 2, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900229

RESUMO

BACKGROUND: Diabetes mellitus (DM) and chronic cerebral hypoperfusion(CCH)are both risk factors for cognitive impairment. However, whether DM and CCH can synergistically promote cognitive impairment and the related pathological mechanisms remain unknown. METHODS: To investigate the effect of DM and CCH on cognitive function, rats fed with high-fat diet (HFD) and injected with low-dose streptozotocin (STZ) followed by bilateral common carotid artery occlusion (BCCAO) were induced to mimic DM and CCH in vivo and mouse BV2 microglial cells were exposed to hypoxia and/or high glucose to mimic CCH complicated with DM pathologies in vitro. To further explore the underlying mechanism, TREM-2-specific small interfering RNA and TREM-2 overexpression lentivirus were used to knock out and overexpress TREM-2, respectively. RESULTS: Cognitive deficits, neuronal cell death, neuroinflammation with microglial activation, and TREM-2-MAPK signaling were enhanced when DM was superimposed on CCH both in vivo and in vitro. Manipulating TREM-2 expression levels markedly regulated the p38 MAPK signaling and the inflammatory response in vitro. TREM-2 knockout intensified while TREM-2 overexpression suppressed the p38 MAPK signaling and subsequent pro-inflammatory mediator production under high glucose and hypoxia condition. CONCLUSIONS: These results suggest that TREM-2 negatively regulates p38 MAPK-mediated inflammatory response when DM was synergistically superimposed on CCH and highlight the importance of TREM-2 as a potential target of immune regulation in DM and CCH.

6.
Carbohydr Polym ; 230: 115601, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31887891

RESUMO

The objective of this study is to investigate the influence of drug-alginate miscibility on maintaining drug supersaturation. Using lovastatin, indomethacin, itraconazole as model drugs, drug-alginate miscibility was estimated by Hansen solubility parameters. The mechanism of drug-alginate miscibility on maintaining drug supersaturation was elucidated by microscopy, molecular mobility (T2), FTIR and X-ray crystallography. The influence of alginate properties on maintaining drug supersaturation was also examined. It was demonstrated that the capacity of alginate to maintain drug supersaturation was dependent on alginate-drug miscibility. Further mechanistic study revealed that alginate interacts with drugs via hydrogen bonding at different extent based on varied drug-alginate miscibility. Alginate could suppress drug molecular mobility and corresponding crystal growth inhibition. The properties of alginate also play an important role in maintaining drug supersaturation. In conclusion, alginate could be used as a potential crystal growth inhibitor, and the crystal growth inhibition effect depends on drug-alginate miscibility and alginate properties.

7.
World Neurosurg ; 133: e76-e83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521757

RESUMO

OBJECTIVE: Spine fractures, including associated spinal cord injury, account for 3%-6% of all skeletal fractures annually in the United States. Patients who undergo interhospital transfer after injury may have a greater likelihood of nonroutine disposition, longer hospital stay, and higher cost. We evaluated the effects of patient transfer on functional outcomes after spine trauma. METHODS: Patients were treated after acute traumatic spine injury at a rehabilitation hospital in 2011-2017. Compared patients were those directly admitted to the tertiary hospital or transferred from a community hospital. RESULTS: A total of 188 patients (mean age 46.1 ± 18.6 years, 77.1% men) were evaluated, including 130 (69.1%) directly admitted and 58 (30.9%) transferred patients. The most common levels of injury were at C5 (19.1%) and C6 (12.2%), and most injuries were American Spinal Injury Association injury severity score grade D (33.2%) or grade A (32.1%). No statistical difference in age, injury pattern, timing from injury to surgery, or rehabilitation length of stay was seen between admitted and transferred patients. A significant improvement in ambulation distances was seen at discharge for directly admitted compared with transferred patients (447.7 ± 724.9 vs. 159.9 ± 359.5 feet; P = 0.005). However, no significant difference primary outcomes, namely American Spinal Injury Association injury severity score distribution (P = 0.2) or Functional Independence Measures (Δ30.9 ± 15.9 vs. 30.1 ± 17.1; P = 0.7), were seen between admitted and transferred patients at time of rehabilitation discharge. CONCLUSIONS: Interhospital transfer status did not diminish time to rehabilitation after injury or reduce functional recovery, suggesting early surgical treatment in community settings may have merit prior to transfer.


Assuntos
Transferência de Pacientes , Traumatismos da Coluna Vertebral/reabilitação , Atividades Cotidianas , Adulto , Idoso , Continuidade da Assistência ao Paciente , Feminino , Hospitais Comunitários , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/cirurgia , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/cirurgia , Centros de Atenção Terciária , Centros de Traumatologia , Índices de Gravidade do Trauma , Resultado do Tratamento , Adulto Jovem
8.
Drug Discov Today ; 25(1): 150-159, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31600580

RESUMO

The inhaled delivery of nanomedicines has attracted much attention in the treatment of lung diseases or systemic diseases. However, there is a lack of understanding about their fate upon lung delivery. Thus, the objective of this review is to summarize physicochemical properties affecting the fate of nanoparticles after deposition in the lung. First, physiological structure and characteristics of the lung are described. Thereafter, physicochemical properties that could influence the clearance and translocation of nanoparticles in the lung are discussed, including particle size, surface charge and surface hydrophilicity. It is believed that, with a better understanding of the fate of nanoparticles in the lung, it will broaden their application in inhalation for a better therapeutic effect in the future.

9.
World Neurosurg ; 133: e774-e783, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605841

RESUMO

BACKGROUND: The use of venous duplex ultrasonography (VDU) for confirmation of deep venous thrombosis in neurosurgical patients is costly and requires experienced personnel. We evaluated a protocol using D-dimer levels to screen for venous thromboembolism (VTE), defined as deep venous thrombosis and asymptomatic pulmonary embolism. METHODS: We used a retrospective bioinformatics analysis to identify neurosurgical inpatients who had undergone a protocol assessing the serum D-dimer levels and had undergone a VDU study to evaluate for the presence of VTE from March 2008 through July 2017. The clinical risk factors and D-dimer levels were evaluated for the prediction of VTE. RESULTS: In the 1918 patient encounters identified, the overall VTE detection rate was 28.7%. Using a receiver operating characteristic curve, an area under the curve of 0.58 was identified for all D-dimer values (P = 0.0001). A D-dimer level of ≥2.5 µg/mL on admission conferred a 30% greater relative risk of VTE (sensitivity, 0.43; specificity, 0.67; positive predictive value, 0.27; negative predictive value, 0.8). A D-dimer value of ≥3.5 µg/mL during hospitalization yielded a 28% greater relative risk of VTE (sensitivity, 0.73; specificity, 0.32; positive predictive value, 0.24; negative predictive value, 0.81). Multivariable logistic regression showed that age, male sex, length of stay, tumor or other neurological disease diagnosis, and D-dimer level ≥3.5 µg/mL during hospitalization were independent predictors of VTE. CONCLUSIONS: The D-dimer protocol was beneficial in identifying VTE in a heterogeneous group of neurosurgical patients by prompting VDU evaluation for patients with a D-dimer values of ≥3.5 µg/mL during hospitalization. Refinement of this screening model is necessary to improve the identification of VTE in a practical and cost-effective manner.


Assuntos
Biomarcadores/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Tromboembolia Venosa/sangue , Tromboembolia Venosa/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Trombose Venosa/sangue
10.
Nutr Metab Cardiovasc Dis ; 30(2): 339-346, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-31753784

RESUMO

BACKGROUND AND AIMS: Insulin-like growth factor (IGF)-1 deficiency is associated with a range of metabolic disorders. Cyclic glycine-proline (cGP) is a natural nutrient and regulates the amount of active IGF-1 in plasma. Plasma cGP decreases in hypertensive women whereas increases in obese women, suggesting its involvement in cardio-metabolic function. We therefore examined the effects of cGP on metabolic profiles and blood pressure in high-fat diet (HFD)-induced obese male rats. METHODS: Male rats were fed either a HFD or a standard chow diet (STD) ad-libitum from 3 to 15 weeks of age. Rats were administered either saline or cGP from 11 to 15 weeks of age. At 14 weeks of age, systolic-blood pressure (SBP) was measured by tail-cuff plethysmography and body composition quantified by DEXA. Blood and retroperitoneal fat tissues were collected. Plasma concentrations of insulin, IGF-1, IGF binding protein (IGFBP)-3 and cGP were evaluated using ELISA and HPLC-MS respectively. RESULTS: Compared to STD, HFD feeding increased SBP, total fat mass and fat/lean ratio, retroperitoneal fat weight, fasting plasma insulin and cGP concentrations whereas decreased plasma IGF-1 and IGFBP-3 concentrations. Administration of cGP reduced SBP and retroperitoneal fat weight, but had no effect on body composition and plasma insulin concentrations. CONCLUSION: HFD-associated decreases in IGFBP-3 and increases in cGP represent an autocrine response to normalize IGF-1 function through improving the amount of bioavailable IGF-1 in the circulation of obese male rats. The beneficial effects of cGP on SBP and retroperitoneal fat mass may suggest a therapeutic potential for cGP in HFD-associated cardio-metabolic complications.

11.
Nutr Metab Cardiovasc Dis ; 30(1): 23-32, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31753787

RESUMO

BACKGROUND AND AIMS: The apolipoprotein B/apolipoprotein A-I (ApoB/ApoA-I) and insulin resistance has been recognized as common cardiovascular diseases (CVD) risk factors. However, whether they were biomarkers for 10-year CVD risk in obstructive sleep apnea (OSA) had been rarely studied. Besides, interrelationships between the ApoB/ApoA-I, insulin resistance and OSA remain unclear. METHODS AND RESULTS: A total of 4010 subjects were finally included. Anthropometric, fasting biochemical, and polysomnographic parameters were collected. 10-year Framingham CVD risk score (FRS) was calculated for each subjects. The relationships between insulin resistance, OSA risk and the ApoB/ApoA-I was evaluated through logistic regressions analysis, restricted cubic spline (RCS) analysis and mediation analysis. ApoB/ApoA-I, HOMA-IR and AHI were all risk factors for high10-year CVD risk as assessed by FRS (odds ratios (OR) = 5.365, 1.094, 1.010, respectively, all P < 0.001)). The fully adjusted OR (95% confidence intervals) for both OSA [1 (reference), 1.308 (1.027-1.665), 1.517 (1.178-1.953), and 1.803 (1.371-2.372)] and insulin resistance [1 (reference), 1.457 (1.173-1.711), 1.701 (1.369-2.113), 2.051(1.645-2.558)] increased from the first to the fourth quartiles of the ApoB/ApoA-I. The RCS mapped a nonlinear dose-effect relationship between the ApoB/ApoA-I and risk of insulin resistance and OSA. Mediation analyses showed HOMA-IR explain 9.7%, 4.7% and 10.8% of the association between apnea-hypopnea index, oxygen desaturation index, micro-arousal index and ApoB/ApoA-I, respectively. CONCLUSIONS: Our study revealed that ApoB/ApoA-I, insulin resistance and OSA were risk factors for CVD. Insulin resistance may serve as a potential mediator in OSA-related lipoprotein disorders and further increase CVD risk.

12.
Eur J Mass Spectrom (Chichester) ; 26(1): 63-77, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31357879

RESUMO

A simple, rapid, and efficient liquid chromatography tandem mass spectrometry (LC-MS/MS) method, operated in electrospray ionization and quadrupole linear ion trap modes, has been developed for the identification and structural characterization of aflatoxins in peanuts and its derivative products or bean sauce. Samples (5 g) were extracted with acetonitrile/water/formic acid (79:20:1, v/v). After centrifugation and dilution, the extracts were separated on a C18 analytical column by gradient elution (acetonitrile/0.2% formic acid) and analyzed by UPLC-MS/MS. External calibration was used for qualification. The developed multiple reaction monitoring-information-dependent acquisition-enhanced product ion method enabled quantification and confirmation of the analytes in a single run. Enhanced product ion mode was used for qualitative analysis, while multiple reaction monitoring mode was used for quantitative analysis. An in-house library was constructed for identification. Calibration curves showed good linearity with correlation coefficients (r) higher than 0.994. Limits of detection were determined to be below 0.26 µg kg-1 for most analytes. The recoveries for those substances were in the acceptable range of 80.2%-119.1%. A new LC-MS3 method was established for further confirmation. One pickled pepper peanut was found to contain aflatoxins B1, B2, and G1 with contents of 90.93, 26.64, and 1.92 µg kg-1, respectively.

13.
Acta Neurochir (Wien) ; 162(1): 157-167, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31811467

RESUMO

BACKGROUND: Previous studies have not evaluated the impact of illness severity and postrupture procedures in the cost of care for intracranial aneurysms. We hypothesize that the severity of aneurysm rupture and the aggressiveness of postrupture interventions play a role in cost. METHODS: The Value Driven Outcomes database was used to assess direct patient cost during the treatment of ruptured intracranial aneurysm with clipping, coiling, and Pipeline flow diverters. RESULTS: One hundred ninety-eight patients (mean age 52.8 ± 14.1 years; 40.0% male) underwent craniotomy (64.6%), coiling (26.7%), or flow diversion (8.6%). Coiling was 1.4× more expensive than clipping (p = .005) and flow diversion was 1.7× more expensive than clipping (p < .001). More severe illness as measured by American Society of Anesthesia, Hunt/Hess, and Fisher scales incurred higher costs than less severe illness (p < .05). Use of a lumbar drain protocol to reduce subarachnoid hemorrhage and use of an external ventricular drain to manage intracranial pressure were associated with reduced (p = .05) and increased (p < .001) total costs, respectively. Patients with severe vasospasm (p < .005), those that received shunts (p < .001), and those who had complications (p < .001) had higher costs. Multivariate analysis showed that procedure type, length of stay, number of angiograms, vasospasm severity, disposition, and year of treatment were independent predictors of cost. CONCLUSIONS: These results show for the first time that disease and vasospasm severity and intensity of treatment directly impact the cost of care for patients with aneurysms in the USA. Strategies to alter these variables may prove important for cost reduction.

14.
J Pharm Sci ; 2019 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-31821822

RESUMO

High drug cargo loading in polymer and physical stability was essential for the development of orodispersible films (ODFs) because of the small amount of excipients used in a thin film. The present study aimed to investigate the mechanism of ion-pair strategy in improving drug cargo loading and physical stability of drug in ODFs. The results showed that the ion pair, especially ibuprofen-ethanolamine, improved the drug solubility in polymer up to 60% (w/w) and physical stability by 30% than the pure ibuprofen film. In addition, drug dissolution rate was increased over 2 times. The high drug cargo loading, physical stability and drug dissolution rate was derived from the improved the drug-polymer miscibility introduced by the formation of ion-pair complex. Investigations from the standpoint of physicochemical properties, intermolecular interaction, and polymer mobility indicated the modulation mechanism of ion-pair complexes in the ODFs at molecular level. The amino group and -OH of counter ion exhibited strong hydrogen bond forming ability, which increased the bilateral interaction with both drug and polymer, delayed the onset temperature of sublimation and decreased the polymer mobility. Therefore, ion-pair technology is a promising strategy for high drug loading ODFs in improving the drug-excipient miscibility and stability.

15.
J Vis Exp ; (153)2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31789308

RESUMO

Chimeric antigen receptor (CAR) T-cell therapy for cancer has achieved significant clinical benefit for resistant and refractory hematological malignancies such as childhood acute lymphocytic leukemia. Efforts are currently underway to extend this promising therapy to solid tumors in addition to other hematological cancers. Here, we describe the development and production of potent CAR T cells targeting antigens with unique or preferential expression on solid and liquid tumor cells. The in vitro potency of these CAR T cells is then evaluated in real-time using the highly sensitive impedance-based xCELLigence assay. Specifically, the impact of different costimulatory signaling domains, such as glucocorticoid-induced tumor necrosis factor receptor (TNFR)-related protein (GITR), on the in vitro potency of CAR T cells is examined. This report includes protocols for: generating CAR T cells for preclinical studies using lentiviral gene transduction, expanding CAR T cells, validating CAR expression, and running and analyzing xCELLigence potency assays.

16.
Respir Res ; 20(1): 276, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801522

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) were considered to contribute to MetS. This study was performed to assess the association between MetS and EDS in two independent large-scale populations, and in subjects who underwent upper-airway surgery. METHODS: A total of 6312 patients without self-reported depression and 3578 suspected OSA patients were consecutively recruited, during health screening examinations and from our sleep center, respectively. A total of 57 subjects with OSA who underwent upper-airway surgery were also included. Demographic, anthropometric, biochemical, and polysomnographic data were obtained. RESULTS: In the health screening examination group, 233 (9.23%) women and 350 (10.93%) men had complaints of EDS. A total of 229 (7.04%) women and 1182 (36.88%) men met the criteria for MetS. In the OSA group, 147 (21.18%) women and 1058 (36.69%) men reported EDS. In addition, 93 (13.4%) women and 1368 (47.43%) men reported MetS. In the health screening examination group, EDS did not contribute significantly to MetS (OR = 1.125, 95% CI: 0.907-1.395; p = 0.283). In the OSA group, EDS significantly contributed to MetS (OR = 1.249, 95% CI: 1.063-1.468; p = 0.007); however, the results were not significant after adjusting for sleep variables (OR = 1.071, 95% CI: 0.905-1.268; p = 0.423). Upper-airway surgery did not affect cardio-metabolic variables in OSA patients with or without EDS. CONCLUSIONS: EDS was not associated with MetS in two independent large-scale cohorts. In addition, upper-airway surgery did not affect components of MetS in OSA patients with and without EDS.

17.
J Neurosurg Spine ; : 1-10, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31812142

RESUMO

OBJECTIVE: Discharge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis. METHODS: The authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility. RESULTS: Of the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42-62.12] vs 46 [IQR 34.4-58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308-0.708] vs 0.597 [IQR 0.358-0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3-5] vs 2 days [IQR 1-3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79-22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31-3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96-9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1-1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4-10.9, p < 0.001). CONCLUSIONS: In this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

18.
Sleep Breath ; 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31832983

RESUMO

PURPOSE: The purposes of this study were to evaluate the ability of visceral adiposity variables [the lipid accumulation product (LAP), the visceral adiposity index (VAI), and the triglyceride-glucose index (TyG)] in predicting obstructive sleep apnea hypopnea syndrome (OSAHS) and to determine the effect of sex on the prediction. METHODS: A total of 5539 subjects admitted to the sleep center for suspected OSAHS were consecutively recruited from 2007 to 2016. Anthropometric measurements, biological indicators, Epworth sleepiness scale score, and polysomnographic variables were collected. Prediction models for diagnosing OSAHS were established in the test group by logistic regression and verified in the validation group by receiver operating characteristic (ROC) curves. RESULTS: A total of 4703 patients were included in total. LAP and TyG were of moderate diagnostic accuracy for OSAHS, with the diagnostic efficiency differing between men and women. A prediction model was developed that combined visceral adiposity indicators with waist circumstance and the lowest SpO2. The sensitivity of those indicators were both 84% in men and women, respectively, and their specificity were both 90%. In addition, the model was confirmed in the validation group with a sensitivity and specificity of 83% and 85% in men and 85% and 84% in women. CONCLUSIONS: LAP and TyG were of moderate efficiency in screening for OSAHS. The prediction model provides a simple and practical screening tool for OSAHS.

19.
Water Environ Res ; 2019 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-31837273

RESUMO

Three microalgae-based treatment technologies were applied for removing nutrients in piggery wastewater and CO2 in biogas simultaneously. Chlorella vulgaris (C. vulgaris), Scenedesmus obliquus (S. obliquus), and Neochloris oleoabundans (N. oleoabundans) were selected for mono-cultivation or co-cultivation with fungi or activated sludge. The effects of initial inoculum concentration (low of 62.06 ± 6.23 mg/L, medium of 121 ± 9.34 mg/L, and high of 180 ± 12.78 mg/L) of microalgae/algal symbiont on the pollutant removal efficiency were evaluated. The results showed that cultivation of S. obliquus with activated sludge had a relatively high CO2 and nutrients removal efficiency at a medium concentration of initial inoculum. The highest removal efficiency of total organic carbon, total nitrogen, and total phosphorus in piggery wastewater was 87.29%, 87.26%, and 90.17% by co-cultivation of S. obliquus with activated sludge. The highest CO2 removal of 64.28% could be achieved under co-cultivation of S. obliquus and fungi at medium initial inoculum concentrations. This work will be helpful to promote the study of microalgae-based biogas upgrading and piggery wastewater purification. PRACTITIONER POINTS: Nutrient and CO2 were efficiently removed in moderate microalgal initial inoculum. Scenedesmus obliquus-activated sludge cultivation achieved the highest nutrient removal. Co-cultivation of S. obliquus and fungi showed the highest CO2 removal. Zinc was removed efficiently in high microalgal initial inoculum. Chlorella vulgaris/S. obliquus-activated sludge performed economically.

20.
Sci Rep ; 9(1): 20157, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882827

RESUMO

The objective of our study was to evaluate the effects of upper-airway surgery on improvement of endothelial function-related markers in patients with obstructive sleep apnea (OSA). Subjects with moderate to severe OSA who underwent upper-airway surgery, with a follow-up duration of at least 6 months, were included. Pre- and postoperative polysomnographic variables and endothelial function-related markers were compared. Subgroup and correlation analyses were conducted to find possible indicators for better endothelial function-related markers after upper-airway surgery. In total, 44 patients with OSA were included. The mean follow-up duration was 1.72 ± 0.92 years. Serum VEGFA [-20.29 (CI: -35.27, -5.31), p < 0.05], Ang2 [-0.06 (CI: -0.16, 0.03), p < 0.05], E-selectin [-7.21 (CI: -11.01, -3.41), p < 0.001], VWF [-58.83 (CI: -103.93, -13.73), p < 0.05], VWFCP [-33.52 (CI: -66.34, -0.70), p < 0.05], and TM [-0.06 (CI: -0.09, -0.03), p < 0.05] were significantly lower after upper-airway surgery. However, other risk markers of endothelial function, such as Ang1, ICAM1, VEGFR1, and VCAM, did not change significantly. Correlations between improved endothelial function-related markers and ameliorated oxyhemoglobin saturation and glucolipid metabolism were established. Upper-airway surgery might be associated with an improvement in endothelial function in patients with OSA. These changes may be associated with improved oxygen saturation after upper-airway surgery.

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