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Stepwise Approach Using Combined Operations throughout Sufferers along with Congenital Cardiovascular disease and Borderline Pulmonary Vascular Ailment.
BACKGROUND Primary central sleep apnea (PCSA) is believed to be rare and data regarding its prevalence and long-term outcomes are sparse. We used the Rochester Epidemiology Project (REP) resources to identify all Olmsted County, Minnesota, residents with an incident diagnosis of PCSA and their clinical outcomes. METHODS We searched the REP database for all residents with polysomnography (PSG)-confirmed diagnoses of central sleep apnea (CSA) between 2007 and 2015. From these, we reviewed the PSGs and medical records to find those who had PCSA based upon accepted diagnostic criteria. Data based on detailed review of the medical records, including all clinical notes and tests were recorded for analysis. RESULTS Of 650 patients identified with CSA, 25 (3.8%; 23 male) had PCSA, which was severe in most patients (n = 16, 64%). Of those, 23 (92%) patients were prescribed and 18/23 (78.2%) adherent to positive airway pressure therapy. Median duration of follow-up was 4.4 years (IQR4.2). Four (16%) patients were subsequently diagnosed with cardiac arrhythmias, one (4%) with unstable angina, two (8%) with heart failure, five (20%) with mild cognitive impairment (MCI)/dementia and two (8%) with depression. Six (25%) patients died (median time to death = 5 years; IQR4.8), three of whom had Lewy body dementia. CONCLUSIONS In this population-based study, PCSA was rare and when present, was severe in a majority of patients. The mortality rate was high. Most frequently observed disorders during follow-up were mild cognitive impairment (MCI)/dementia followed by cardiac arrhythmias; it is possible that these entities were present and not recognized prior to the diagnosis of PCSA. BACKGROUND The McGill score is used to stratify severity of oximetry in children referred for investigation of obstructive sleep apnoea (OSA) to identify those with more severe disease and prioritize treatment. We hypothesized that its positive predictive value (PPV) and negative predictive value (NPV) in detecting OSA differs significantly between children with medical conditions and otherwise healthy children. METHODS We performed a two-year retrospective analysis of children referred for investigation of OSA who underwent a cardiorespiratory (CR) polygraphy study. McGill score was calculated from the oximetry trace blinded to polygraphy results. We looked at two definitions of OSA Obstructive Apnoea Hypopnoea Index (oAHI) ≥1 and ≥ 5. McGill sensitivity, specificity, PPV and NPV were calculated. McGill score = 1 was considered normal or inconclusive, >1 abnormal. RESULTS We studied 312 children, 190 males (61%), median age 4.5 (2.4-7.9) years. 129 were otherwise healthy and 183 had associated medical conditions. The PPV of the McGill score was significantly lower in children with medical conditions than otherwise healthy children. The NPV was similar in both groups of children. CONCLUSIONS The higher number of false positives in children with medical conditions may be due to non-obstructive causes such as central apnoeas. Children with underlying lung disease are also more likely to desaturate following a brief apnoea or hypopnoea. Children with co-morbidities who have an abnormal McGill score should not be assumed to have OSA and need more detailed sleep studies to determine the reason for the oxygen desaturations. OBJECTIVE Previous studies have suggested that brain-derived neurotrophic factor (BDNF) is associated with sleep regulation in humans. However, its relationship with self-reported sleep problems has not been clarified. The aim of the present study was to examine the association between serum BDNF levels and sleep problems among hospital nurses. METHODS Participants were enrolled from among nurses working at a general hospital in Tokyo, Japan. Data from 577 women (age 35.45 ± 10.90 years) were analyzed. Antioxidant chemical This cross-sectional survey was conducted from November to December 2015. Serum BDNF concentrations were evaluated. Participants completed a self-reported questionnaire on sleep including the presence or absence of insomnia symptoms (ie, difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening [EMA]), and sleep duration. Insomnia with short sleep duration (ISS) was defined as DIS, or DMS, or EMA; and less then 6 h sleep duration. RESULTS Among 577 participants, 21.3% reported insomnia, 41.4% slept less than 6 h, and finally 12.5% suffered from ISS. Serum BDNF levels were significantly lower in subjects with ISS than in those without ISS. The serum BDNF levels in insomniacs were significantly lower than in non-insomniacs for short sleep duration ( less then 6 h), while serum BDNF levels did not differ between insomniacs and non-insomniacs for normal sleep duration (≥6 h). CONCLUSION This is the first documented study to indicate that ISS is associated with reduced serum BDNF levels. These results may lead to clarification of the underlying pathophysiological relationship between BDNF and poor sleep. STUDY OBJECTIVES To describe sleep manifestations, polysomnographic (PSG) findings, and specific sleep disorders in children with Eosinophilic Esophagitis (EoE). METHODS This retrospective study included children with EoE who were referred to sleep clinics. Clinical manifestations, PSG variables, and diagnosis of sleep disorders were analyzed. Sleep architecture of patients with EoE was compared to control subjects. RESULTS In sum, 81 children with EoE met the criteria for entry into the analysis with a mean age of 10.1 ± 4.4 years. Of those, 46 children (57%) presented in the sleep clinic with active EoE symptoms, while 35 (43%) children did not have active EoE symptoms at presentation. Several sleep complaints were common in children with EoE, including snoring (62, 76.5%), restless sleep (54, 66.6%), legs jerking or leg discomfort (35, 43.2%) and daytime sleepiness (47, 58.0%). Comparing sleep architecture with controls, children with EoE had significantly higher NREM2 (P= less then 0.001), lower NREM3 (P= less then 0.001), lower rapid eye movement (REM) (P = 0.017), increased periodic leg movements (PLM) index (P= less then 0.001) and increased arousal index (P = 0.007). There were no significant differences in the sleep efficiency between the EoE and control subjects. Common sleep diagnoses included obstructive sleep apnea (OSA, 30, 37.0%) and periodic limb movements disorder (PLMD, 20, 24.6%). Of note, we found a much higher percentage of PLMD in active EoE compared to inactive EoE (P = 0.004). CONCLUSIONS Children with EoE have frequent sleep complaints and several sleep disorders identified from the sleep study, including sleep-disordered breathing and PLMD. Analysis of sleep architecture demonstrates significant sleep fragmentation as evidenced by decreased slow-wave sleep and REM sleep and increased arousal index. OBJECTIVE To determine whether sleep state maturity can be estimated accurately using conventional electroencephalography (cEEG) or amplitude-integrated electroencephalography (aEEG) features concerning sleep in neurologically unimpaired preterm infants. METHODS A total of 51 preterm infants were monitored with cEEG-polygraphy and simultaneous aEEG. Sleep state maturity of EEG corresponded to specific postmenstrual age (PMA). PMA on cEEG was blindly estimated according to cEEG patterns (indicated as background continuity, frequencies, and voltages) as well as developmental markers in specific states. PMA on aEEG was blindly estimated based on the cycling score (cycling representing sleep state transitions) according to a pre-established scoring system. RESULTS A total of 51 EEGs recorded between 32 and 37 weeks PMA were analysed. A significant relationship between estimated PMA (ePMA) and actual chronological PMA (cPMA) was shown by linear regression both on cEEG (r = 0.93, β = 0.98, 95% confidence interval (CI) 0.87-1.09, p less then 0.001) and aEEG (r = 0.85, β = 0.83, 95% CI 0.69-0.98, p less then 0.001). The estimation gap (defined as ePMA minus cPMA) was between -2 and +2 weeks both on cEEG and aEEG. The percentage of estimation gap between -1 and +1 weeks was 96% for cEEG, which was higher than the estimate of 88% for aEEG. CONCLUSION Estimated maturity of sleep state was well correlated with cPMA both on cEEG and aEEG. PMA corresponding to state maturity could be estimated within two weeks of actual cPMA using either of these two tools. However, cEEG had higher accuracy compared with aEEG in the evaluation of sleep state maturity. Antibiotic-resistant bacteria are a threat to human and animal health. In recent years, the presence of extended-spectrum-β-lactamase (ESBL)-producing Escherichia (E.) coli in chicken manure, which is used as organic fertilizer, is a concern. The aim of the present study was to determine the effects of the carbon/nitrogen (C/N) ratio and moisture content (MC) on the survival of ESBL-producing E. coli during laboratory-scale composting of chicken manure. Nine different compost mixtures were enriched with an ESBL-producing E. coli strain to an initial concentration of 7 log10 CFU/g, and the number of E. coli, temperature, and chemical conditions during composting were determined. The fastest decrease in E. coli occurred for all mixtures with a C/N ratio of 101. Additionally, dry mixtures with an MC of 20% and a C/N ratio of either 101 or 401 exhibited faster reductions in E. coli than the moist mixtures did, despite having lower maximum temperatures within the bioreactors. The decimal reduction times ranged from 0.27 days in a mixture with a C/N ratio of 101 and 40% MC to 4.82 days in a mixture with a C/N ratio of 401 and 40% MC. Both the C/N ratio and MC had a significant effect on the number of ESBL-producing E. coli and on temperature development; the C/N ratio additionally affected the pH value and content of ammoniacal nitrogen during chicken manure composting. The results of this study demonstrate a considerable range of mechanisms involved in the inactivation of E. coli during chicken manure composting. Cork is light, porous, carbon-rich, and renewable, which leads to competitive advantages in the preparation of biochar, as compared to other biomass material. In this work, we propose to convert cork powder into cork-based biochar as Cu (II) adsorbent via slow pyrolysis, thereby providing a reliable and simple method for recycling cork industrial waste. The physicochemical properties of cork-based biochar prepared under different pyrolysis temperatures (450, 550, 650, and 750 °C) and pyrolysis time (0.5, 1.0, 1.5, and 2.0 h) were characterized by elemental analysis, FT-IR, XRD, N2 adsorption and SEM. The adsorption capacity of cork-based biochar on heavy metal ions was further evaluated by Cu ion adsorption testing. Results showed that the cork-based biochar produced under conditions of higher pyrolysis temperature and time, has higher aromaticity and lower polarity, larger specific surface area, and enhanced Cu ion adsorption capacity. The maximum specific surface area of cork-based biochar prepared at 750 °C for 0.5 h was 392.5 m2/g, which surpasses most other biochars reported in previous studies, which are beneficial to the application of wastewater management. The SEM image demonstrated that the biochar retains the special hollow polyhedral cell structure of raw material cork. Furthermore, a large number of pores formed on the cell wall after high temperature pyrolysis, and the cells are connected with each other through these open pores. Finally, cork-based biochar exhibits superior Cu ion adsorption capacity (18.5 mg/g) with a shorter equilibrium time (4 h), which gives it a competitive advantage to similar adsorbents.
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