Generating spatially entangled itinerant photons with waveguide quantum electrodynamics

Realizing a fully connected network of quantum processors requires the ability to distribute quantum entanglement. For distant processing nodes, this can be achieved by generating, routing, and capturing spatially entangled itinerant photons. In this work, we demonstrate the deterministic generation of such photons using superconducting transmon qubits that are directly coupled to a waveguide. In particular, we generate two-photon N00N states and show that the state and spatial entanglement of the emitted photons are tunable via the qubit frequencies. Using quadrature amplitude detection, we reconstruct the moments and correlations of the photonic modes and demonstrate state preparation fidelities of 84%. Our results provide a path toward realizing quantum communication and teleportation protocols using itinerant photons generated by quantum interference within a waveguide quantum electrodynamics architecture.

Safety of Consecutive Bilateral Decubitus Digital Subtraction Myelography in Patients with Spontaneous Intracranial Hypotension and Occult CSF Leak

BACKGROUND AND PURPOSE

Digital subtraction myelography performed with the patient in the lateral decubitus position has the potential for increased sensitivity over prone-position myelography in the detection of spinal CSF-venous fistulas, a well-established cause of spontaneous intracranial hypotension. We report on the safety of performing routine, consecutive-day right and left lateral decubitus digital subtraction myelography in these patients.

MATERIALS AND METHODS

In this retrospective case series, all patients undergoing consecutive-day lateral decubitus digital subtraction myelography for suspected spinal CSF leak between September 2018 and September 2019 were identified. Chart review was performed to identify any immediate or delayed adverse effects associated with the procedures. Procedural parameters were also analyzed due to inherent variations associated with the positive-pressure myelography technique that was used.

RESULTS

A total of 60 patients underwent 68 pairs of consecutive-day lateral decubitus digital subtraction myelographic examinations during the study period. No major adverse effects were recorded. Various minor adverse effects were observed, including pain requiring analgesics (27.2%), nausea/vomiting requiring antiemetics (8.1%), and transient neurologic effects such as syncope, vertigo, altered mental status, and autonomic dysfunction (5.1%). Minor transient neurologic effects were correlated with increasing volumes of intrathecal saline injectate used for thecal sac prepressurization.

CONCLUSIONS

In patients with spontaneous intracranial hypotension and suspected spontaneous spinal CSF leak, consecutive-day lateral decubitus digital subtraction myelography demonstrates an acceptable risk profile without evidence of neurotoxic effects from cumulative intrathecal contrast doses. Higher intrathecal saline injectate volumes may correlate with an increased incidence of minor transient periprocedural neurologic effects.

Multiple membership multilevel model to estimate intersection crashes

Numerous studies have developed intersection crash prediction models to identify crash hotspots and evaluate safety countermeasures. These studies largely considered only micro-level crash contributing factors such as traffic volume, traffic signals, etc. Some recent studies, however, have attempted to include macro-level crash contributing factors, such as population per zone, to predict the number of crashes at intersections. As many intersections are located between multiple zones and thus affected by factors from the multiple zones, the inclusion of macro-level factors requires boundary problems to be resolved. In this study, we introduce an advanced multilevel model, the multiple membership multilevel model (MMMM), for intersection crash analysis. Our objective was to reduce heterogeneity issues between zones in crash prediction model while avoiding misspecification of the model structure. We used five years of intersection crash data (2009-2013) for the City of Regina, Saskatchewan, Canada and identified micro- and macro-level factors that most affected intersection crashes. We compared the fitting performance of the MMMM with that of two existing models, a traditional single model (SM) and a conventional multilevel model (CMM). The MMMM outperformed the SM and CMM in terms of fitting capability. We found that the MMMM avoided both the underestimation of macro-level variance and the type I statistical error that tend to occur when the crash data are analyzed using a SM or CMM. Statistically significant micro-level and macro-level crash contributing factors in Regina included major roadway AADT, four legs, traffic signals, speed, young drivers, and different types of land use.

Time to Resolution of Inadvertent Subdural Contrast Injection during a Myelogram: When Can the Study Be Reattempted?

BACKGROUND AND PURPOSE

Inadvertent subdural contrast injections can occur during any myelogram. Currently, there are no guidelines defining when residual subdural iodinated contrast will be cleared and no longer interfere with subsequent procedure and imaging. We investigated the time to resolution of subdural contrast using a 2-day lateral decubitus digital subtraction myelogram and associated CT myelogram data in patients undergoing evaluation for spontaneous intracranial hypotension.

MATERIALS AND METHODS

Retrospective review of 63 patients with lateral decubitus digital subtraction myelograms from September 4, 2018, to October 1, 2019, was performed. Patients with 2-day lateral decubitus digital subtraction myelograms on 2 consecutive days, with or without a same-day CT myelogram on day 1 and with a same-day CT myelogram on day 2, were included. Patients with next-day CT covering at least the abdomen and pelvis after either-day injection were also included. In cases of subdural injection, next-day CT scans were evaluated for residual subdural contrast.

RESULTS

Of 49 included patients, 5 had subdural injection on day 1, with the second-day CT myelogram available for review. One of these 5 patients had subdural injections on 2 different days and subsequently had chest/abdomen/pelvis CTA a day after the second subdural injection. In all 6 cases of subdural injections, there was complete resolution of subdural contrast on the next-day CT, with the shortest time to resolution of approximately 20.5 hours (range, 20.5-28.5 hours).

CONCLUSIONS

Our study suggests that resolution of inadvertently injected subdural contrast occurs within 1 day, and the myelogram can be reattempted as early as the next day.

Exophytic Lumbar Vertebral Body Mass in an Adult with Back Pain

Chordomas are rare primary bone malignancies derived from notochord remnants. The tumors often are slow-growing and often present with indolent, nonspecific symptoms. Nevertheless, chordomas are locally aggressive and highly prone to local recurrence, necessitating precise planning before biopsy and/or surgical resection. Familiarity with the imaging features of chordomas is, therefore, essential. This case highlights the typical imaging and pathologic features of a spinal chordoma as well as the surgical approach and the patient's subsequent outcome.

Big Data Analysis of Sports and Physical Activities among Korean Adolescents

The Korean government (Ministry of Culture, Sports and Tourism, Ministry of Health and Welfare, and Ministry of Education) has framed policies and conducted many projects to encourage adolescents to be more physically active. Despite these efforts, the participation rate of physical activity in Korean adolescents keeps decreasing. Thus, the purpose of this study was to analyze the perception of sports and physical activity in Korean adolescents through big data analysis of the last 10 years and to provide research data and statistical direction with regard to sports and physical activity participation in Korean adolescents. For data collection, data from 1 January 2010 to 31 December 2019 were collected from Naver (NAVER Corp., Seongnam, Korea), Daum (Kakao Corp., Jeju, Korea), and Google (Alphabet Inc., Mountain View, CA, USA), which are the most widely used search engines in Korea, using TEXTOM 4.0 (The Imc Inc., Daegu, Korea), a big data collection and analysis solution. Keywords such as “adolescent + sports + physical activity” were used. TEXTOM 4.0 can generate various collection lists at once using keywords. Collected data were processed through text mining (frequency analysis, term frequency–inverse document frequency analysis) and social network analysis (SNA) (degree centrality, convergence of iterated correlations analysis) by using TEXTOM 4.0 and UCINET 6 social network analysis software (Analytic Technologies Corp., Lexington, KY, USA). A total of 9278 big data (10.36 MB) were analyzed. Frequency analysis of the top 50 terms through text mining showed exercise (872), mind (851), health (824), program (782), and burden (744) in a descending order. Term frequency–inverse document frequency analysis revealed exercise (2108.070), health (1961.843), program (1928.765), mind (1861.837), and burden (1722.687) in a descending order. SNA showed that the terms with the greatest degree of centrality were exercise (0.02857), program (0.02406), mind (0.02079), health (0.02062), and activity (0.01872) in a descending order. Convergence of the iterated correlations analysis indicated five clusters: exercise and health, child to adult, sociocultural development, therapy, and program. However, female gender, sports for all, stress, and wholesome did not have a high enough correlation to form one cluster. Thus, this study provides basic data and statistical direction to increase the rate of physical activity participation in Korean adolescents by drawing significant implications based on terms and clusters through bid data analysis.

Spontaneous Intracranial Hypotension: Atypical Radiologic Appearances, Imaging Mimickers, and Clinical Look-Alikes

Spontaneous intracranial hypotension is a condition characterized by low CSF volume secondary to leakage through a dural defect with no identifiable cause. Patients classically present with orthostatic headaches, but this symptom is not specific to spontaneous intracranial hypotension, and initial misdiagnosis is common. The most prominent features of spontaneous intracranial hypotension on intracranial MR imaging include "brain sag" and diffuse pachymeningeal enhancement, but these characteristics can be seen in several other conditions. Understanding the clinical and imaging features of spontaneous intracranial hypotension and its mimickers will lead to more prompt and accurate diagnoses. Here we discuss conditions that mimic the radiologic and clinical presentation of spontaneous intracranial hypotension as well as other disorders that CSF leaks can imitate.

Cluster Analysis of Inhalant Allergens in South Korea: A Computational Model of Allergic Sensitization

Objectives.

Sensitization to specific inhalant allergens is a major risk factor for the development of atopic diseases, which impose a major socioeconomic burden and significantly diminish quality of life. However, patterns of inhalant allergic sensitization have yet to be precisely described. Therefore, to enhance the understanding of aeroallergens, we performed a cluster analysis of inhalant allergic sensitization using a computational model.

Methods.

Skin prick data were collected from 7,504 individuals. A positive skin prick response was defined as an allergen-to-histamine wheal ratio ≥1. To identify the clustering of inhalant allergic sensitization, we performed computational analysis using the four-parameter unified-Richards model.

Results.

Hierarchical cluster analysis grouped inhalant allergens into three clusters based on the Davies-Bouldin index (0.528): cluster 1 (Dermatophagoides pteronyssinus and Dermatophagoides farinae), cluster 2 (mugwort, cockroach, oak, birch, cat, and dog), and cluster 3 (Alternaria tenus, ragweed, Candida albicans, Kentucky grass, and meadow grass). Computational modeling revealed that each allergen cluster had a different trajectory over the lifespan. Cluster 1 showed a high level (>50%) of sensitization at an early age (before 19 years), followed by a sharp decrease in sensitization. Cluster 2 showed a moderate level (10%–20%) of sensitization before 29 years of age, followed by a steady decrease in sensitization. However, cluster 3 revealed a low level (<10%) of sensitization at all ages.

Conclusion.

Computational modeling suggests that allergic sensitization consists of three clusters with distinct patterns at different ages. The results of this study will be helpful to allergists in managing patients with atopic diseases.

Characterizing osmolyte chemical class hierarchies and functional group requirements for thermal stabilization of proteins

Osmolytes are naturally occurring organic compounds that protect cellular proteins and other macromolecules against various forms of stress including temperature extremes. While biological studies have correlated the accumulation of certain classes of osmolytes with specific forms of stress, including thermal stress, it remains unclear whether or not these observations reflect an intrinsic chemical class hierarchy amongst the osmolytes with respect to effects on protein stability. In addition, very little is known in regards to the molecular elements of the osmolytes themselves that are essential for their functions. In this study, we use differential scanning fluorimetry to quantify the thermal stabilizing effects of members from each of the three main classes of protecting osmolytes on two model protein systems, C-reactive protein and tumor necrosis factor alpha. Our data reveals the absence of a strict chemical class hierarchy amongst the osmolytes with respect to protein thermal stabilization, and indicates differential responses of these proteins to certain osmolytes. In the second part of this investigation we dissected the molecular elements of amino acid osmolytes required for thermal stabilization of myoglobin and C-reactive protein. We show that the complete amino acid zwitterion is required for thermal stabilization of myoglobin, whereas removal of the osmolyte amino group does not diminish stabilizing effects on C-reactive protein. These disparate responses of proteins to osmolytes and other small molecules are consistent with previous observations that osmolyte effects on protein stability are protein-specific. Moreover, the data reported in this study support the view that osmolyte effects cannot be fully explained by considering only the solvent accessibility of the polypeptide backbone in the native and denatured states, and corroborate the need for more complex models that take into account the entire protein fabric.

Arylsulfatase A, a genetic modifier of Parkinson's disease, is an α-synuclein chaperone

Mutations in lysosomal genes increase the risk of neurodegenerative diseases, as is the case for Parkinson's disease. Here, we found that pathogenic and protective mutations in arylsulfatase A (ARSA), a gene responsible for metachromatic leukodystrophy, a lysosomal storage disorder, are linked to Parkinson's disease. Plasma ARSA protein levels were changed in Parkinson's disease patients. ARSA deficiency caused increases in α-synuclein aggregation and secretion, and increases in α-synuclein propagation in cells and nematodes. Despite being a lysosomal protein, ARSA directly interacts with α-synuclein in the cytosol. The interaction was more extensive with protective ARSA variant and less with pathogenic ARSA variant than wild-type. ARSA inhibited the in vitro fibrillation of α-synuclein in a dose-dependent manner. Ectopic expression of ARSA reversed the α-synuclein phenotypes in both cell and fly models of synucleinopathy, the effects correlating with the extent of the physical interaction between these molecules. Collectively, these results suggest that ARSA is a genetic modifier of Parkinson's disease pathogenesis, acting as a molecular chaperone for α-synuclein.

Comparative outcomes of robot-assisted minimally invasive versus open esophagectomy in patients with esophageal squamous cell carcinoma: a propensity score-weighted analysis

Robots are increasingly used in minimally invasive surgery. We evaluated the clinical benefits of robot-assisted minimally invasive esophagectomy (RAMIE) in comparison with the conventional open esophageal surgery. From 2012 to 2016, 371 patients with esophageal squamous cell carcinoma underwent an Ivor Lewis or McKeown procedure at our institution. Of these, 130 patients underwent laparoscopic gastric conduit formation followed by RAMIE, whereas 241 patients underwent conventional esophageal surgery, including laparotomy and open esophagectomy (OE). We compared the short- and long-term clinical outcomes of these patients using the propensity score-based inverse probability of treatment weighting technique (IPTW). Among the early outcomes, the OE group showed a higher incidence of pneumonia (P = 0.035) and a higher requirement for vasopressors (P = 0.001). Regarding the long-term outcomes, all-cause mortality was significantly higher (P = 0.001) and disease-free survival was lower (P = 0.006) in the OE group. Wound-related problems also occurred more frequently in the OE group (P = 0.020) during the long-term follow-up. There was no statistical intergroup difference in the recurrence rates (P = 0.191). The Cox proportional-hazard analysis demonstrated that wound problems (HR 0.16, 95% CI 0.02-0.57; P = 0.017), pneumonia (HR 0.23, 95% CI 0.06-0.68; P = 0.019), and use of vasopressors (HR 0.14, 95% CI 0.08-0.25; P = 0.001) were independent predictors of mortality. RAMIE could be a better surgical option for selected patients with esophageal squamous cell carcinoma.

Age-associated changes in chronic rhinosinusitis endotypes

BACKGROUND

Immunologic function in innate and adaptive immunity changes with the ageing process. Thus, age-related cytokine profiles in chronic rhinosinusitis (CRS) need to be investigated for precision medicine.

OBJECTIVE

The objective of this study was to characterize age-related changes in immunologic profiles according to CRS subtypes.

METHODS

Subjects in control (n = 29), CRS without nasal polyps (CRSsNP, n = 86), and CRS with nasal polyps (eosinophilic NP: ENP, n = 81; non-eosinophilic NP: NENP, n = 113) were enrolled in this study. Twenty markers for type 1/2/3 inflammation and other inflammatory processes were measured in homogenates of sinonasal tissues and statistically analysed.

RESULTS

In control tissues, type 2/3 and proinflammatory mediators showed an inverse correlation with age. CRSsNP and NENP showed an age-related increase in type 2 cytokines and a decline in type 3 cytokines. Interestingly, the age-related decrease in type 3 mediators was associated with those of CT scores in NENP. ENP showed an age-related increase in type 3 cytokines with type 2 mediators sustained at high levels. Smokers with ENP demonstrated age-associated increases in type 1/2/3 mediators as well as CT scores. These age-related patterns in each CRS were confirmed by statistically adjusting atopy status, smoking history, and disease duration.

CONCLUSION

Age-associated cytokine changes differed among CRS subtypes and control tissues. CRSsNP and NENP demonstrated a decline in type 3 mediators and increase in type 2 mediators, whereas type 3 mediators increased with age in ENP.

Association of Chronic Rhinosinusitis With Depression and Anxiety in a Nationwide Insurance Population

Importance

Chronic rhinosinusitis (CRS) is associated with a decreased quality of life, affecting physical and emotional aspects of daily function, the latter of which could manifest as depression and anxiety.

Objective

To evaluate the risk of depression and anxiety in CRS, depending on the CRS phenotype (CRS without nasal polyps [CRSsNP] and CRS with nasal polyps [CRSwNP]).

Design, Setting, and Participants

This retrospective nationwide cohort study used population-based insurance data (consisting of data from approximately 1 million patients). The study population included 16 224 patients with CRS and 32 448 individuals without CRS, with propensity score matching between groups according to sociodemographic factors and enrollment year. Data were collected from January 1, 2002, through December 31, 2013, and analyzed from July 1 through November 15, 2018.

Main Outcomes and Measures

Survival analysis, the log-rank test, and Cox proportional hazards regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of depression and anxiety for each group.

Results

Among the 48 672 individuals included in the study population (58.8% female), the overall incidence of depression during the 11-year follow-up was 1.51-fold higher in the CRS group than in the non-CRS group (24.2 vs 16.0 per 1000 person-years; adjusted HR, 1.54; 95% CI, 1.48-1.61). The incidence of anxiety was also higher in the CRS group than in the comparison group (42.2 vs 27.8 per 1000 person-years; adjusted HR, 1.57; 95% CI, 1.52-1.62). Moreover, the adjusted HRs of developing depression (CRSsNP, 1.61 [95% CI, 1.54-1.69]; CRSwNP, 1.41 [95% CI, 1.32-1.50]) and anxiety (CRSsNP, 1.63 [95% CI, 1.57-1.69]; CRSwNP, 1.45 [95% CI, 1.38-1.52]) were greater in patients with CRSsNP than in those with CRSwNP.

Conclusions and Relevance

This observational study suggests that CRS is associated with an increased incidence of depression and anxiety. Specifically, findings from this study found that patients without nasal polyps showed a higher risk of developing depression and anxiety than those with nasal polyps.

An optimal network screening method of hotspot identification for highway crashes with dynamic site length

We propose a novel network screening method for hotspot (i.e., sites that suffer from high collision concentration and have high potential for safety improvement) identification based on the optimization framework to maximize the total summation of a selected safety measure for all hotspots considering a resource constraint for conducting detailed engineering studies (DES). The proposed method allows the length of each hotspot to be determined dynamically based on constraints the users impose. The calculation of the Dynamic Site Length (DSL) method is based on Dynamic Programming, and it is shown to be effective to find the close-to-optimal solution with computationally feasible complexity. The screening method has been demonstrated using historical crash data from extended freeway routes in San Francisco, California. Using the Empirical Bayesian (EB) estimate as a safety measure, we compare the performance of the proposed DSL method with other conventional screening methods, Sliding Window (SW) and Continuous Risk Profile (CRP), in terms of their optimal objective value (i.e., performance of detecting sites under the highest risk). Moreover, their spatio-temporal consistency is compared through the site and method consistency tests. Findings show that DSL can outperform SW and CRP in investigating more hotspots under the same amount of resources allocated to DES by pinpointing hotspot locations with greater accuracy and showing improved spatio-temporal consistency.

Lateral Decubitus Digital Subtraction Myelography: Tips, Tricks, and Pitfalls

Digital subtraction myelography is a valuable diagnostic technique to detect the exact location of CSF leaks in the spine to facilitate appropriate diagnosis and treatment of spontaneous spinal CSF leaks. Digital subtraction myelography is an excellent diagnostic tool for assessment of various types of CSF leaks, and lateral decubitus digital subtraction myelography is increasingly being used to diagnose CSF-venous fistulas. Lateral decubitus digital subtraction myelography differs from typical CT and fluoroscopy-guided myelograms in many ways, including equipment, supplies, and injection and image-acquisition techniques. Operators should be familiar with techniques, common pitfalls, and artifacts to improve diagnostic yield and prevent nondiagnostic examinations.

Prevalence of Intracranial Aneurysms in Patients With Systemic Vessel Aneurysms: A Nationwide Cohort Study

Background and Purpose- Most aneurysms are a focal manifestation of a systemic condition. Some reports have suggested genetic and environmental factors may play a role in pathogenesis. The aim of the present study was to evaluate the prevalence of intracranial aneurysms (IA) in a large cohort of patients with other systemic vessel aneurysms and dissections (OVAD) and identify potential risk factors for IA in this population. Methods- We defined OVAD as systemic vessel aneurysms, excluding aortic dissections and aneurysms. A cohort of 1.1 million patients was extracted from the population-based cohort from the Korea National Health Insurance Service, which holds almost all medical data including diagnostic codes, procedures, and personal information. Using χ² or Fisher exact test, the prevalence of the IA concerning OVAD status was analyzed. Results- In OVAD individuals, 25.7% (261/1017) of patients had been concurrently diagnosed with IA. The odds ratios for having concurrent IA in patients with OVAD were 56.31 (95% CI, 48.821-64.949; P=0.000). OVAD patients with dyslipidemia were >7× likely to be affected by IA (adjusted odds ratio, 7.7 [95% CI, 6.59-9.01]; P=0.000). Hypertension, diabetes mellitus, old age (>60 years), and male sex had increased odds for having concurrent IA by 5.89, 3.48, 1.83, and 1.35, respectively. Subgroup analysis with socioeconomic or disability revealed that the prevalence of IA was significantly higher in all groups. Uncertainty regarding the temporal sequence of onset and lack of detail on disease severity and subtype prevented more conclusive results. Conclusions- Patients with OVAD have a higher prevalence of IA than control groups. Therefore, we may approach aneurysms as systemic disease, and further investigations about their pathophysiology must follow.

Association of Obstructive Sleep Apnea With the Risk of Affective Disorders

Importance

Obstructive sleep apnea (OSA) is a common subtype of sleep breathing disorder; however, the association between OSA and the psychological health of affected individuals has not been fully evaluated.

Objective

To investigate the association between OSA and development of affective disorders.

Design, Setting, and Participants

This study used a nationwide representative cohort sample from the Korea National Health Insurance Service-National Sample Cohort database comprising data from 1 025 340 patients. The study included 197 patients with OSA diagnosed between January 2004 and December 2006 and 780 individuals without OSA who were matched using propensity score matching. Data were analyzed from September 28, 2018, to March 30, 2019.

Main Outcomes and Measures

Affective disorder events over a 9-year follow-up period. Kaplan-Meier survival curves with log-rank tests and Cox proportional hazards regression models were used to calculate cumulative incidence and hazard ratios (HRs) of affective disorders for each group.

Results

Of the total population of 985 (860 male [87.3%], 540 [54.8%] were aged <45 years), the incidences per 1000 person-years of affective disorders were 49.57 and 27.18 in the OSA and comparison groups, respectively. A total of 1371.7 person-years in the OSA group and 6328.6 person-years in the comparison group were evaluated for affective disorder events. After adjustment for sociodemographic factors (age, residential area, and household income), disability, and comorbidities, the adjusted HRs for patients with OSA developing affective disorders in patients with OSA during the 9-year follow-up period was 2.04 (95% CI, 1.53-2.70). In a subgroup analysis, the adjusted HRs for patients with OSA who developed depressive and anxiety disorders were 2.90 (95% CI, 1.98-4.24) and 1.75 (95% CI, 1.26-2.44), respectively. Moreover, female patients with OSA had a significant likelihood of prospective development of depression and anxiety (adjusted HR for depression, 3.97 [95% CI, 1.54-10.19]; adjusted HR for anxiety, 2.42 [95% CI, 1.17-5.02]) compared with male patients with OSA (adjusted HR for depression, 2.74 [95% CI, 1.80-4.17]; adjusted HR for anxiety, 1.64 [95% CI, 1.13-2.39]).

Conclusions and Relevance

This observational study using nationwide data suggests that OSA is associated with an increased incidence of affective disorder, such as depression and anxiety. Further studies appear to be needed to confirm our findings and, if validated, then studies are needed to explore the nature of the observed association, including potential causality, between OSA and affective symptoms.

The release of surface-anchored α-tectorin, an apical extracellular matrix protein, mediates tectorial membrane organization

The tectorial membrane (TM) is an apical extracellular matrix (ECM) that hovers over the cochlear sensory epithelium and plays an essential role in auditory transduction. The TM forms facing the luminal endolymph-filled space and exhibits complex ultrastructure. Contrary to the current extracellular assembly model, which posits that secreted collagen fibrils and ECM components self-arrange in the extracellular space, we show that surface tethering of α-tectorin (TECTA) via a glycosylphosphatidylinositol anchor is essential to prevent diffusion of secreted TM components. In the absence of surface-tethered TECTA, collagen fibrils aggregate randomly and fail to recruit TM glycoproteins. Conversely, conversion of TECTA into a transmembrane form results in a layer of collagens on the epithelial surface that fails to form a multilayered structure. We propose a three-dimensional printing model for TM morphogenesis: A new layer of ECM is printed on the cell surface concomitant with the release of a preestablished layer to generate the multilayered TM.

1423Adherence to triple component antihypertensive regimen is higher in single-pill combination than two-pill regimen: data from a randomized controlled trial using medication event monitoring system

Background

Simplicity of regimen is known to be an important determinant of medication adherence and using single-pill combination (SPC) in hypertension treatment resulted in better adherence and persistence than free-equivalent combination. However, this finding has been studied only in dual-component antihypertensive treatments and in observational studies using medication possession ratio as an index of adherence. Medication event monitoring system (MEMS) is considered to be the gold standard in estimating medication adherence.

Purpose

To investigate the superiority in adherence of triple-component SPC compared to equivalent two-pill regimen using MEMS

Methods

This is a multi-center open-label randomized controlled trial. Inclusion criteria were hypertensive patients whose clinic blood pressure is not adequately controlled (systolic >140 mmHg or diastolic >90 mmHg) with combination antihypertensive regimen comprising two of three classes (angiotensin receptor blocker, calcium channel blocker and thiazide diuretics) for at least 4 weeks. Eligible patients were randomized either to single-pill (triple-component SPC, olmesartan/amlodipine/ hydrochlorothiazide 20/5/12.5 mg) or two-pill (dual-component SPC + one free pill, olmesartan/hydrochlorothiazide 20/12.5 mg + amlodipine 5 mg) groups and maintained for 12 weeks. Medications were dispensed in MEMS. Primary outcomes were the difference of percentage of dose taken (PDT) and percentage of days with prescribed dose taken correctly (PDTc) between single- and two-pill therapy, calculated from MEMS data.

Results

From 8 hospitals, 146 hypertensive patients were randomized into single- and two-pill groups. Final analysis was done in 65 and 66 patients in each group from which adherence index could be obtained. Baseline clinical characteristics of the two groups were not different. The single-pill group had significantly higher PDT and PDTc compared to the two-pill group. (median (25–75 percentile) (%), PDT 95.1 (87.9 - 100.0) vs 91.2 (79.8 - 96.5); PDTc 93.1 (79.8 - 96.5) vs 91.3 (70.7 - 96.4), p = both 0.04, by Wilcoxon rank sum test)

Percent dose taken

Conclusion

Single-pill combination of triple-component antihypertensive regimen showed superior adherence compared to equivalent two-pill therapy. Reducing pill burden by using SPC is a relevant strategy to enhance the adherence to multi-drug antihypertensive therapy.

Acknowledgement/Funding

Daiichi-Sankyo

Association of Idiopathic Sudden Sensorineural Hearing Loss With Affective Disorders

Importance

Patients with idiopathic sudden sensorineural hearing loss (ISSNHL) often experience permanent hearing impairment, which could result in psychological perturbations. However, the relationship between ISSNHL and affective disorders, including depression, anxiety, and bipolar disorder, has not been fully evaluated.

Objective

To investigate the potential relationship between ISSNHL and affective disorders using nationwide representative cohort sample data.

Design, Setting, and Participants

This study used a nationwide propensity score-matched cohort sample from the Korean National Health Insurance Service database from 2002 through 2013, which comprises data from approximately 1 million patients. The study included 1425 patients with ISSNHL and 7125 individuals without ISSNHL who were matched using propensity score matching, according to sociodemographic factors and enrollment year.

Main Outcomes and Measures

Survival analysis, the log-rank test, and Cox proportional hazards regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of developing affective disorders (anxiety, depression, and bipolar disorder) for each group.

Results

Of the total study population of 8550 (51.5% female), 961 developed affective disorders during the 11-year follow-up: 225 in the ISSNHL group (15.8%) and 736 in the comparison group (10.3%). We examined a total of 96 885.5 person-years (81 177.4 person-years in the comparison group and 15 708.1 person-years in the ISSNHL group). The incidence of affective disorders was 14.3 per 1000 person-years in the ISSNHL group and 9.1 per 1000 person-years in the comparison group. After adjustment for other factors, individuals with ISSNHL developed affective disorders more frequently than those in the comparison group (HR, 1.50; 95% CI, 1.30-1.75). Among the affective disorders, the HR of developing depression (HR, 1.66; 95% CI, 1.44-1.91) and anxiety disorder (HR, 1.79; 95% CI, 1.56-2.05) but not bipolar disorder (HR, 0.95; 95% CI, 0.54-1.70), was significantly greater in patients with ISSNHL.

Conclusions and Relevance

This cohort study suggests that ISSNHL is associated with an increased incidence of affective disorders, specifically depression and anxiety. Therefore, these findings suggest that clinicians should monitor patients with ISSNHL carefully, and take specific precautions to reduce their risk of depression and anxiety disorder.

Relationship of Chronic Rhinosinusitis with Asthma, Myocardial Infarction, Stroke, Anxiety, and Depression

BACKGROUND

Chronic rhinosinusitis (CRS) is a common chronic inflammatory disease of the nose and paranasal sinuses. It often has a high burden and is difficult to treat because of comorbidities. However, no population-based, long-term longitudinal study has investigated the relationship between CRS and its comorbidities.

OBJECTIVE

To investigate the potential relationship between CRS and its comorbidities-asthma, acute myocardial infarction (AMI), stroke, anxiety disorder, and depression-using a representative sample.

METHODS

Data for a total of 1,025,340 patients from the Korean National Health Insurance Service database from 2002 to 2013, including 14,762 patients with CRS and 29,524 patients without CRS, were used for this study. A 1:2 propensity score matching was performed using the nearest-neighbor matching method and sociodemographic factors and enrollment year. Cox proportional hazards model was used to analyze the hazard ratio (HR) of CRS for asthma, AMI, stroke, anxiety disorder, and depression.

RESULTS

The incidence rates of asthma, AMI, and stroke were 71.1, 3.1, and 7.7 per 1000 person-years in patients with CRS, respectively. The adjusted HRs of asthma, AMI, and stroke were 2.06 (95% CI, 2.00-2.13), 1.29 (95% CI, 1.15-1.44), and 1.16 (95% CI, 1.08-1.24), respectively, in patients with CRS versus patients without CRS. The incidence rates of anxiety disorder and depression in patients with CRS were 42.1 and 24.2 per 1000 person-years, respectively. The adjusted HRs of anxiety disorder (HR, 1.54; 95% CI, 1.49-1.60) and depression (HR, 1.50; 95% CI, 1.44-1.57) were significantly greater in patients with CRS versus patients without CRS.

CONCLUSIONS

CRS is associated with an increased incidence of asthma, AMI, stroke, anxiety disorder, and depression. Therefore, we suggest that clinicians should monitor patients with CRS carefully, and optimize management as a means to potentially decrease these other associated comorbid conditions.

Association of Obstructive Sleep Apnea With the Risk of Ménière's Disease and Sudden Sensorineural Hearing Loss: A Study Using Data From the Korean National Health Insurance Service

STUDY OBJECTIVES

Several studies have reported an association between obstructive sleep apnea (OSA) and neuro-otologic diseases, such as Ménière's disease or sudden sensorineural hearing loss (SSNHL). However, the exact relationship between OSA and those diseases has not been fully evaluated. Therefore, the aim of this study was to investigate the prospective link between OSA and Ménière's disease or SSNHL.

METHODS

We used a nationwide cohort sample of data for 2002-2013 representing approximately 1 million patients. The OSA group (n = 942) included patients diagnosed between 2004 and 2006; the comparison group was selected using propensity score matching (n = 3,768). We investigated Ménière's disease and SSNHL events over a 9-year follow-up period. Survival analysis, log-rank test, and Cox proportional hazards regression models were used to calculate incidence, survival rate, and hazard ratios for each group.

RESULTS

In the OSA group, the incidences of Ménière's disease and SSNHL were 7,854.4 and 7,876.3 person-years, respectively. Cox proportional hazards analysis revealed no overall association between patients with OSA and the risk of subsequent Ménière's disease or SSNHL. In a subgroup analysis, female and middle-aged patients with OSA were independently associated with a two-fold higher incidence of subsequent Ménière's disease, compared to those without OSA. However, we could not find any significant association between patients with OSA and SSNHL even in the subgroup analysis.

CONCLUSIONS

Our findings suggest that female or middle-aged patients with OSA are associated with an increased incidence of Ménière's disease. However, there was no association between OSA and SSNHL.

CITATION

Kim J-Y, Ko I, Cho B-J, Kim D-K. Association of obstructive sleep apnea with the risk of Ménière's disease and sudden sensorineural hearing loss: a study using data from the Korean National Health Insurance Service. J Clin Sleep Med. 2019;15(9):1293-1301.

Association of Sudden Sensorineural Hearing Loss With Risk of Cardiocerebrovascular Disease: A Study Using Data From the Korea National Health Insurance Service

Importance

The interruption of vascular supply to the cochlea has been proposed as a major etiological factor for sudden sensorineural hearing loss (SSNHL), and several risk factors for cardiocerebrovascular disease (CCVD) are associated with SSNHL, including heavy smoking, alcohol consumption, and thromboembolic events. However, the link between SSNHL and CCVD has not been fully evaluated.

Objective

To investigate the association between SSNHL and CCVD.

Design, Setting, and Participants

A retrospective propensity score-matched cohort study was conducted using a nationwide representative sample from the National Sample Cohort 2002 through 2013 data from the Korea National Health Insurance Service. The SSNHL group (n = 154) included certain patients who were diagnosed with SSNHL between January 2003 and December 2005. The comparison group was selected (4 patients for every 1 patient with SSNHL; n = 616) using propensity score matching, according to sociodemographic factors and the year of enrollment. Each patient was monitored until 2013.

Main Outcomes and Measures

Survival analysis, the log-rank test, and Cox proportional hazards regression models were used to calculate the incidence, survival rate, and hazard ratio of CCVD for each group.

Results

Among the 770 patients, 385 (50.0%) were female and 370 (48.1%) were aged between 45 and 64 years. Of the total study population, 66 patients developed CCVD, such as stroke and acute myocardial infarction, during the 11-year follow-up period: 18 patients in the SSNHL group (incidence, 13.5 cases per 1000 person-years) and 48 from the comparison group (incidence, 7.5 cases per 1000 person-years). After adjustment for other factors, the hazard ratio of CCVD during the 11-year follow-up period was 2.18 times (95% CI, 1.20-3.96) greater for patients with SSNHL. An increased risk of stroke was associated with SSNHL (HR, 2.02; 95% CI, 1.16-3.51); however, there was no relation between SSNHL and risk of myocardial infarction (HR, 1.18; 95% CI, 0.25-5.50).

Conclusions and Relevance

This observational study using nationwide data suggests that SSNHL is associated with an increased incidence of CCVD, specifically stroke. Therefore, patient surveillance for signs of CCVD should be considered for patients who receive a diagnosis of SSNHL.