Venous Thromboembolism in Korean Patients Undergoing Major Orthopedic Surgery: A Prospective Observational Study using Computed Tomographic (CT) Pulmonary Angiography and Indirect CT Venography

In patients undergoing major orthopedic surgery, data of deep venous thrombosis (DVT) and pulmonary embolism (PE) are lacking as studied by computed tomographic (CT) pulmonary angiography and indirect CT venography (CTPA-CTV). A prospective observational study was performed for 363 Korean patients undergoing major orthopedic surgery to determine the incidence of venous thromboembolism (VTE), especially proximal DVT and PE. The incidence of VTE was 16.3% (n=59). Of them, 8 patients (2.2%) were symptomatic. The rate of VTE was the highest in patients who underwent total knee replacement (40.4%), followed by hip fracture surgery (16.4%), and total hip replacement (8.7%; P<0.001). The incidence of PE was 6.6% (n=24). Of them, 4 patients (1.1%) were symptomatic. Forty-one patients (11.3%) were in the proximal DVT or PE group. Based on multivariate analysis, total knee replacement and age ≥65 yr were significant risk factors for proximal DVT or PE in patients undergoing major orthopedic surgery (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1-5.1; P=0.025; and OR, 2.1; 95% CI, 1.0-4.4; P=0.046, respectively). Taken together, the overall incidence of PE was 6.6% and rate of symptomatic PE rate was 1.1%. Knee joint replacement and age ≥65 yr were significant risk factors for proximal DVT or PE

Spatiotemporal characteristics of cortical activities of REM sleep behavior disorder revealed by explainable machine learning using 3D convolutional neural network

Abstract Isolated rapid eye movement sleep behavior disorder (iRBD) is a sleep disorder characterized by dream enactment behavior without any neurological disease and is frequently accompanied by cognitive dysfunction. The purpose of this study was to reveal the spatiotemporal characteristics of abnormal cortical activities underlying cognitive dysfunction in patients with iRBD based on an explainable machine learning approach. A convolutional neural network (CNN) was trained to discriminate the cortical activities of patients with iRBD and normal controls based on three-dimensional input data representing spatiotemporal cortical activities during an attention task. The input nodes critical for classification were determined to reveal the spatiotemporal characteristics of the cortical activities that were most relevant to cognitive impairment in iRBD. The trained classifiers showed high classification accuracy, while the identified critical input nodes were in line with preliminary knowledge of cortical dysfunction associated with iRBD in terms of both spatial location and temporal epoch for relevant cortical information processing for visuospatial attention tasks

Reliability of Manual and Automatic Scoring of Single Channel Nasal Airflow Device (ApneaLink) in Determining Moderate or Severe Obstructive Sleep Apnea Syndrome

Background and Objective ApneaLink (AL) is a single-channel portable monitoring device that identifies apnea or hypopnea from nasal airflow and is commonly used for screening and diagnosis of obstructive sleep apnea (OSA). This study aimed to evaluate the reliability of automatic and manual scoring of AL in patients with moderate or severe OSA. Methods This was a retrospective single-center study. Consecutive patients who underwent AL and confirmatory standard polysomnography (PSG) for evaluation of OSA within a 3-month interval were included. Sensitivity, specificity and receiver operating characteristic curves for AL were calculated for automatic and manual scoring with the apnea-hypopnea index (AHI). Pearson correlations and Bland-Altman plots were computed. Results Eighty-one patients were included. Overall, their mean age was 56 ± 10 years, and 80% were male. A correlation was found between the AL and PSG AHI and the apnea index but not with the hypopnea index. AL showed high sensitivity (82.7%) for moderate OSA with a good area under the curve (AUC) value of 0.710. Compared with automatic scoring methods, manual scoring provided higher AUC and specificity as well as positive and negative predictive value. Conclusion sThis study shows a high level of agreement in the AHI between AL and PSG performed within 3 months. The result of manual scoring with AL was more in agreement with overnight PSG than the result of automatic scoring was

Neuropsychiatric Symptoms in Patients with Idiopathic Rapid Eye Movement Sleep Behavior Disorder

Background and Objective Idiopathic rapid eye movement sleep behavior disorder (IRBD) is a strong predictor of the development of synucleinopathies, including Parkinson’s disease. Neuropsychiatric symptoms are common in patients with Parkinson’s disease but have not been properly evaluated in IRBD. We used the Symptom Checklist-90-Revision (SCL-90-R) to evaluate the symptom profile of patients with drug-naïve IRBD. Methods Consecutive drug-naïve patients with video-polysomnography-confirmed IRBD that visited Kyung Hee University Hospital at Gangdong sleep clinic January 2009–November 2016 were reviewed. Age- and sex-matched healthy volunteers served as controls. Questionnaires evaluating sleep [Pittsburgh sleep quality index (PSQI) and insomnia severity index (ISI)] and depression [beck depression inventory-II (BDI-II)] were conducted with the SCL-90-R in IRBD patients and controls. Results Twenty patients with IRBD and 20 age- and sex-matched controls were analyzed. In IRBD patients, the mean age was 59.5, 55% were male, and the mean disease duration was 55.1 months. PSQI scores (5.7 ± 2.2 vs. 3.2 ± 1.4, p < 0.0001) and ISI scores (11.2 ± 8.7 vs. 4.1 ± 3.4, p < 0.0001) were higher in patients with IRBD than in the controls. Three IRBD patients (15%) had abnormal SCL-90-R T-scores over 70. The T-scores for phobic anxiety (p=0.009), interpersonal sensitivity (p = 0.011), psychoticism (p = 0.013), hostility (p = 0.014), anxiety (p = 0.020), and depression (p = 0.049) were higher in the patients. After adjusting for age, BDI-II scores were positively correlated with RBD disease duration (r = 0.484, p = 0.042) in IRBD patients. Conclusions The results of our study demonstrate that neuropsychiatric distress is more severe in patients with IRBD with no comorbidities than in otherwise healthy individuals

Comparison of rapid eye movement without atonia quantification methods to diagnose rapid eye movement sleep behavior disorder: a systematic review

Study Objectives Rapid eye movement (REM) sleep without atonia (RWA) is essential for diagnosing REM sleep behavior disorder (RBD). Manual and automatic quantifications of RWA that use different criteria have been validated. This study compared the RWA quantification methods for diagnosing RBD. Methods The PubMed, EMBASE, Web of Science, and Cochrane Library databases were systemically searched for studies published from inception to December 2021. The inclusion criteria were cohort, cross-sectional, and case-control studies assessing the sensitivity and specificity of RWA quantification methods. Pooled estimates of the sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were determined. Risk of bias and certainty of evidence was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool and the Grading of Recommendations, Assessment, Development, and Evaluations framework, respectively. Results Fourteen articles including 402 patients with RBD met the inclusion criteria. Manual methods evaluating any chin and phasic flexor digitorum superficialis (FDS) activity had the highest DOR (138.8, 95% CI = 21.8% to 881.7%) and AUC (0.9686). The automatic REM atonia index (RAI) showed similar or higher sensitivity (89.1%, 95% CI = 84.6% to 92.7%) but a lower specificity (73.5%), DOR (43.1), and AUC (0.9369) than the manual techniques. Conclusions In this meta-analysis, manual RWA quantification that employed chin or phasic FDS activity had the best RBD diagnostic performance. The automatic RAI method may be useful for screening patients with RBD. The results should be interpreted carefully because of the high risk of bias in patient selection and significant heterogeneity among the studies. PROSPERO Registration number CRD42021276445.N

Cardiac Function and Outcome in Patients with Cardio-Embolic Stroke

<div><p>Background</p><p>The relationship between whole spectrum of Ejection fraction (EF) and cardioembolic stroke (CES) outcome has not been fully described yet. Notably, it remains unclear whether borderline EF (41∼49%) is related with poor outcome after CES. We sought to evaluate whether lower ejection fraction and borderline EF could predict the outcome in patients with CES.</p><p>Method and Results</p><p>We evaluated the relationship between EF and functional outcome in 437 consecutive patients with CES. EF was introduced as continuous and categorical (EF≤40%, EF 41∼49%, EF≥50%) variable. Patients with CES and the subgroup with AF were evaluated separately. Poor short-term outcome (modified Rankin Score≥3at discharge or death within 90 days after stroke onset) and long-term mortality were evaluated. A total of 165 patients (37.8%) had poor short-term outcomes. EF tends to be lower in patients with poor short-term outcome (56.8±11.0 vs. 54.8±12.0, p-value 0.086). Overall cumulative death was136 (31.1%) in all CES patients and 106 (31.7%) in the AF subgroup. In a multivariable model adjusted for possible covariates, the hazard ratio for mortality significantly decreased by 3% for every 1% increase in ejection fraction in CES patients and 2% for every 1% increase in the AF subgroup. Reduced EF (EF≤40%) showed higher mortality (HR 2.61), and those with borderline EF (41∼49%) had a tendency of higher mortality (HR 1.65, p-value 0.067)compared with those with normal EF.</p><p>Conclusion</p><p>We found a strong association between lower EF and CES outcome. Echocardiographic evaluation helps to better determine the prognosis in CES patients, even in subgroup of patients with AF.</p></div

Distribution of EF in included CES patients.

<p>Abbreviations: EF:Ejection fraction, CES: Cardioembolic stroke.</p