Overlap syndrome of COPD and OSA in Koreans

Overlap syndrome of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) leads to increased morbidity and mortality. There have been no reports available on the overlap syndrome for Koreans. Our primary aim was to identify prevalence and predictors of the overlap syndrome in Koreans.This is a cross-sectional study with a community-based sample of 1298 participants (mean age, 59.7 ± 6.7) from the cohort of Korean Genomic and Epidemiologic Study during 2013 to 2014. OSA and COPD were assessed by apnea-hypopnea index (AHI) and the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC < 70%), respectively, based on polysomnography and spirometry measurements. Using logistic regression with adjustment for the confounders identified by univariate analysis, odds ratio (OR) was estimated with 95% confidence interval (CI) of COPD among those with OSA.The prevalence rate of OSA was 45.8%, of which 32.8% were moderate-to-severe (AHI ≥ 15); 10.8% of those having OSA also had COPD, that is, the overlap syndrome. The prevalence of COPD remained the same as 10.8% regardless of the presence of OSA. The mean ratio of FEV1/FVC for those with COPD was 0.77, regardless of OSA. The OR increased for age (OR, 1.1; 95% CI, 1.0-1.1) and smokers (OR, 3.6; 95% CI, 2.0-6.4), but decreased for body mass index (BMI) (OR, 0.84; 95% CI, 0.8-0.9) and overweight state (OR, 0.4; 95% CI, 0.2-0.7). Risk factors of the overlap syndrome differed by OSA severity, that is, BMI in those with moderate-to-severe OSA, whereas sex (OR, 4.7; 95% CI, 2.1-10.6) and age (OR, 1.1; 95% CI, 1.0-1.1) in those with mild OSA.In a population study from Korea, 10.8% of OSA patients had an overlap syndrome with COPD. Although BMI is a well-known risk factor of OSA, it is likely that being overweight may be protective for moderate-to-severe OSA patients from the risk of COPD (i.e., overlap syndrome).

Effect of Low-Dose Rapamycin on Senescence Markers and Physical Functioning in Older Adults with Coronary Artery Disease: Results of a Pilot Study

Rapamycin, an mTOR inhibitor affects senescence through suppression of senescence-associated secretory phenotype (SASP). We studied the safety and feasibility of low-dose rapamycin and its effect on SASP and frailty in elderly undergoing cardiac rehabilitation (CR). 13 patients; 6 (0.5mg), 6 (1.0mg), and 1 patient received 2mg oral rapamycin (serum rapamycin <6ng/ml) daily for 12 weeks. Median age was 73.9±7.5 years and 12 were men. Serum interleukin-6 decreased (2.6 vs 4.4 pg/ml) and MMP-3 (26 vs 23.5 ng/ml) increased. Adipose tissue expression of mRNAs (arbitrary units) for MCP-1 (3585 vs 2020, p=0.06), PPAR-γ (1257 vs 1166), PAI-1 (823 vs 338, p=0.08) increased, whereas interleukin-8 (163 vs 312), TNF-α (75 vs 94) and p16 (129 vs 169) decreased. Cellular senescence-associated beta galactosidase activity (2.2% vs 3.6%, p=0.18) tended to decrease. We observed some correlation between some senescence markers and physical performance but no improvement in frailty with rapamycin was noted. (NCT01649960).

A double blind, randomised placebo controlled trial evaluating the effect of a pholyphenolic rich plant based nail bed balm on the severity of chemotherapy-induced onycholysis

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Background: Nail damage is common amongst patients receiving chemotherapy, especially taxanes, causing pain, distress, disfigurement, infection and restricted daily activities. Cooling the nail beds helps but there has been no published evidence for the effectiveness of nail balms, despite their popular use. We investigated whether a topical nail bed balm containing bioactive polyphenolic rich African salvia officinalis, gaultheria procumbens in a natural base of olea europaea, butyrospermun parkii, cera alba and theobroma cacao protected the nail beds via their reported anti-inflammatory, analgesic, anti-oxidant and anti-microbial properties. Methods: 60 patients (23 male, 37 female) were randomized to apply to their nail bed (tds) the natural balm or a petroleum balm suitably scented for a placebo control. Demographics, type and number of chemotherapy cycles did not differ between the two groups, recruited between Sept 2016-Sept 2017. At baseline and at the end of chemotherapy both patients and physicians measured outcomes of nail health. Patients completed a Dermatology Life Quality questionnaire and a linear severity scale; physician completed a Nail Psoriasis Index (NPSI) and a linear severity scale based on clinical examination and photographs. Differences were analyzed using an unpaired t-test; significance level α = 0.05 at 95% confidence intervals (CI); probability (p). Results: The mean change in nail health outcomes over the course of chemotherapy were: (see table). Conclusions: The polyphenolics rich essential oils and plant-based waxes in this nail bed balm profoundly reduced chemotherapy related nail damage and improved nail related quality of life compared to a plain petroleum based balm. A future evaluation combining nail bed cooling and this natural balm is planned. Clinical trial information: 015-001866-24. [Table: see text]

Direct numerical simulation of the initial stage of a thermally induced microcavitation in a water-rich biotissue triggered by a nanosecond pulsed laser

A numerical analysis capable of describing the early stage of a thermal microcavitation process in a water-rich biotissue without avalanche breakdown was developed. The analysis successfully reproduced the laser-induced heating, vapor bubble formation, bubble expansion, and shockwave propagation inside a water-rich biotissue during a thermal microcavitation process. Based on the analysis, it was determined that the evolution of the temperature, pressure, and laser-induced shockwave is dependent on the incident laser energy and laser pulse width. On the other hand, the early stage dynamics of the microcavitation process showed little dependence on the elastic modulus of the biotissue for the laser and tissue conditions studied.

Ambulatory Blood Pressure Monitoring in Chinese Patients with Obstructive Sleep Apnea

STUDY OBJECTIVES

Nocturnal blood pressure (BP) dipping in patients with obstructive sleep apnea (OSA) has not yet been well investigated in Chinese patients, in whom the relationship of OSA and body mass index (BMI) is weaker than that in Caucasians. The aim of this study was to evaluate the BP profile, and the relationships between nocturnal BP and the severity of OSA, in Chinese patients.

METHODS

Consecutive Chinese adult outpatients with suspected OSA had overnight polysomnography (PSG), office BP, and 24-h ambulatory BP monitoring (ABPM). The apnea-hypopnea index (AHI) and nocturnal oxygen saturation level were recorded, and BP patterns were classified based on the ABPM.

RESULTS

Fifty-six subjects (40 male and 16 female, 48.59 ± 13.27 y) were evaluated. There were 14 patients with mild OSA (25.0%, AHI: 10.56 ± 3.42 events/h), 16 with moderate OSA (28.6%, AHI: 23.536 ± 3.42 events/h) and 26 with severe OSA (46.4%, AHI: 51.52 ± 3.42 events/h). There were 18 dippers (32.1%), 27 non-dippers (48.2%), and 11 reverse dippers (19.6%). As OSA severity increased, non-dipping also increased. A total of 67.9% of the OSA patients showed overall hypertension on ABPM, 57.1% had daytime hypertension only, and 73.2% had nighttime hypertension.

CONCLUSIONS

OSA severity is associated with 24-h BP profiles in a population with only mild increases in BMI. These results can influence clinical practice, OSA management, and hypertension treatment policies.

Enabling time resolved microscopy with random Raman lasing

Optical imaging of fast events and processes is essential for understanding dynamics of complex systems. A bright flash of illuminating light is required to acquire sufficient number of photons for superior image quality. Laser pulses can provide extreme brightness and are typically employed to achieve high temporal resolution; however, the high degree of coherence associated with the lasing process degrades the image quality with speckle formation. Random lasers are low-coherence sources of stimulated emission and do not suffer from speckle, but are rather broadband and have a relatively low output power limiting the scope of their potential applications. In this report, we demonstrate the use of random Raman lasing as a novel imaging light source with unprecedented brightness for a speckle-free and narrowband light source. We showcase the advantages of a random Raman laser to image the nanosecond scale dynamics of cavitation formation in water and quantitatively compare these images to those taken with incoherent fluorescent emission and coherent laser light as illumination source.

Interaction between Obstructive Sleep Apnea and Shortened Telomere Length on Brain White Matter Abnormality

STUDY OBJECTIVES

Age-related brain white matter changes (WMC) have been associated separately with obstructive sleep apnea (OSA) and short telomere length (TL). No studies have examined their interaction effect on WMC.

METHODS

This is a cross-sectional study with a community-based sample of 420 participants (mean age, 61.3 ± 7.2) from the Korean Genome and Epidemiology Study during 2011-2012. An overnight fasted blood sample was taken to determine glucose and blood lipid levels at the sleep laboratory of Korea University Ansan Hospital. The status of brain WMC was determined using structural magnetic resonance imaging at 1.5 Tesla. Overnight polysomnography was performed, and leukocyte TL was measured. OSA was determined based on apnea-hypopnea index, and short TL was defined as the lowest quartile of the study participants.

RESULTS

Adjusting for age, sex, BMI, smoking, drinking, snoring, and hypertension, odds ratio (OR) of brain WMC was estimated using multivariate logistic regression. The odds ratio was significant for cardiovascular disease (OR, 4.5; 95% CI, 1.2-16.3) and OSA (OR, 4.0; 95% CI, 1.0-15.2) among those with short TL; and for diabetes (OR, 3.0; 95% CI, 1.3-13.0) and age (OR, 1.1; 95% CI, 1.0-1.1) among those with longer TL. Interaction effect of OSA and short TL (OR, 4.3; 95% CI, 1.4-13.8) was significant, compared to those with neither OSA nor short TL.

CONCLUSIONS

This study provides a first evidence of mediated interaction of short TL with OSA on brain WMC in a community-based sample. The results generate new hypotheses regarding mechanisms of impaired brain health in sleep apnea.

Analysis of the sleep EEG in the complexity domain

Conventional sleep analysis relies primarily on electroencephalogram (EEG) waveform features assessed in concert with eye movements, respiration and muscle tone. We explore a complementary "complexity domain" approach based on multiscale entropy (MSE) analysis of EEG signals and discuss its relationships to standard sleep analysis and to that based on electrocardiogram (ECG)-derived cardiopulmonary coupling (CPC). We observe a progressive decrease in complexity associated with decreased arousability, as measured by both conventional sleep scoring and CPC analysis. Furthermore, complexity analysis supports the contention that stage 2 non-REM sleep has distinct sub-phases that map to CPC high- and low-frequency coupled dynamics.

The Effects of Supplementary Food on the Breeding Performance of Eurasian Reed Warblers Acrocephalus scirpaceus; Implications for Climate Change Impacts

Understanding the mechanisms by which climate variation can drive population changes requires information linking climate, local conditions, trophic resources, behaviour and demography. Climate change alters the seasonal pattern of emergence and abundance of invertebrate populations, which may have important consequences for the breeding performance and population change of insectivorous birds. In this study, we examine the role of food availability in driving behavioural changes in an insectivorous migratory songbird; the Eurasian reed warbler Acrocephalus scirpaceus. We use a feeding experiment to examine the effect of increased food supply on different components of breeding behaviour and first-brood productivity, over three breeding seasons (2012-2014). Reed warblers respond to food-supplementation by advancing their laying date by up to 5.6 days. Incubation periods are shorter in supplemented groups during the warmest mean spring temperatures. Nestling growth rates are increased in nests provisioned by supplemented parents. In addition, nest predation is reduced, possibly because supplemented adults spend more time at the nest and faster nestling growth reduces the period of vulnerability of eggs and nestlings to predators (and brood parasites). The net effect of these changes is to advance the fledging completion date and to increase the overall productivity of the first brood for supplemented birds. European populations of reed warblers are currently increasing; our results suggest that advancing spring phenology, leading to increased food availability early in the breeding season, could account for this change by facilitating higher productivity. Furthermore, the earlier brood completion potentially allows multiple breeding attempts. This study identifies the likely trophic and behavioural mechanisms by which climate-driven changes in invertebrate phenology and abundance may lead to changes in breeding phenology, nest survival and net reproductive performance of insectivorous birds.

Comparability: manufacturing, characterization and controls, report of a UK Regenerative Medicine Platform Pluripotent Stem Cell Platform Workshop, Trinity Hall, Cambridge, 14-15 September 2015

This paper summarizes the proceedings of a workshop held at Trinity Hall, Cambridge to discuss comparability and includes additional information and references to related information added subsequently to the workshop. Comparability is the need to demonstrate equivalence of product after a process change; a recent publication states that this ‘may be difficult for cell-based medicinal products’. Therefore a well-managed change process is required which needs access to good science and regulatory advice and developers are encouraged to seek help early. The workshop shared current thinking and best practice and allowed the definition of key research questions. The intent of this report is to summarize the key issues and the consensus reached on each of these by the expert delegates.