The mobile sleep medicine model in neurologic practice: Rationale and application

BACKGROUND: Undiagnosed obstructive sleep apnea (OSA) is prevalent in neurological practice and significantly contributes to morbidity and mortality. OSA is prevalent in US adults and causes poor quality sleep and significant neurocognitive, cardiovascular, and cerebrovascular impairments. Timely treatment of OSA reduces cardio-cerebrovascular risks and improves quality of life. However, most of the US population has limited systematic access to sleep medicine care despite its clinical significance. FOCUS: We discuss the importance of systematic screening, testing, and best-practice management of OSA and hypoventilation/hypoxemia syndromes (HHS) in patients with stroke, neurocognitive impairment, and neuromuscular conditions. This review aims to introduce and describe a novel integrated Mobile Sleep Medicine (iMSM) care model and provide the rationale for using an iMSM in general neurological practice to assist with systematic screening, testing and best-practice management of OSA, HHS, and potentially other sleep conditions. KEY POINTS: The iMSM is an innovative, patient-centered, clinical outcome-based program that uses a Mobile Sleep Medicine Unit-a sleep lab on wheels -designed to improve access to OSA management and sleep care at all levels of health care system. The protocol for the iMSM care model includes three levels of operations to provide effective and efficient OSA screening, timely testing/treatment plans, and coordination of further sleep medicine care follow-up. The iMSM care model prioritizes effective, efficient, and patient-centered sleep medicine care; therefore, all parties and segments of care that receive and provide clinical sleep medicine services may benefit from adopting this innovative approach

Inhalation of Hydrogen Attenuates Progression of Chronic Heart Failure via Suppression of Oxidative Stress and P53 Related to Apoptosis Pathway in Rats

Background: Continuous damage from oxidative stress and apoptosis are the important mechanisms that facilitate chronic heart failure (CHF). Molecular hydrogen (H2) has potentiality in the aspects of anti-oxidation. The objectives of this study were to investigate the possible mechanism of H2 inhalation in delaying the progress of CHF.Methods and Results: A total of 60 Sprague-Dawley (SD) rats were randomly divided into four groups: Sham, Sham treated with H2, CHF and CHF treated with H2. Rats from CHF and CHF treated with H2 groups were injected isoprenaline subcutaneously to establish the rat CHF model. One month later, the rat with CHF was identified by the echocardiography. After inhalation of H2, cardiac function was improved vs. CHF (p < 0.05), whereas oxidative stress damage and apoptosis were significantly attenuated (p < 0.05). In this study, the mild oxidative stress was induced in primary cardiomyocytes of rats, and H2 treatments significantly reduced oxidative stress damage and apoptosis in cardiomyocytes (p < 0.05 or p < 0.01). Finally, as a pivotal transcription factor in reactive oxygen species (ROS)-apoptosis signaling pathway, the expression and phosphorylation of p53 were significantly reduced by H2 treatment in this rat model and H9c2 cells (p < 0.05 or p < 0.01).Conclusion: As a safe antioxidant, molecular hydrogen mitigates the progression of CHF via inhibiting apoptosis modulated by p53. Therefore, from the translational point of view and speculation, H2 is equipped with potential therapeutic application as a novel antioxidant in protecting CHF in the future

Signal transduction pathways in mast cell granule-mediated endothelial cell activation

Background: We have previously shown that incubation of human endothelial cells with mast cell granules results in potentiation of lipopolysaccharide-induced production of interleukin-6 and interleukin-8

Hydrogen Gas Attenuates Myocardial Ischemia Reperfusion Injury Independent of Postconditioning in Rats by Attenuating Endoplasmic Reticulum Stress-Induced Autophagy

Background/Aims: To study the effect of inhaling hydrogen gas on myocardial ischemic/reperfusion(I/R) injury in rats. Methods: Seventy male Wistar albino rats were divided into five groups at random as the sham group (Sham). The I/R group (I/R), The ischemic postconditioning group (IPo), The I/R plus hydrogen group (IH2) and the ischemic postconditioning plus hydrogen group (IPoH2). The Sham group was without coronary occlusion. In I/R group, Ischemic/reperfusion injury was induced by coronary occlusion for 1 hour. Followed by 2 hours of reperfusion. In the IPo and IPoH2 group, four cycles of 1 min reperfusion/1 min ischemia was given at the end of 1 hour coronary occlusion. While 2% hydrogen was administered by inhalation 5 min before reperfusion till 2 hours after reperfusion in both the IPoH2 and IH2 group. The heart and blood samples were harvested at the end of the surgical protocol. Then the myocardium cell endoplasmic reticulum(ER) stress and autophagy was observed by electron microscope. In addition, the cardiac ER stress and autophagy related proteins expression were detected by Western blotting analysis. Results: Both inhaling 2% hydrogen and ischemic postconditioning treatment reduced the ischemic size and serum troponin I level in rats with I/R injury, and inhaling hydrogen showed a more curative effect compared with ischemic postconditioning treatment. Meanwhile inhaling hydrogen showed a better protective effect in attenuating tissue reactive oxygen species. Malondialdehyde levels and immunoreactivities against 8-hydroxy-2’-deoxyguanosine and inhibiting cardiac endoplasmic reticulum stress and down-regulating autophagy as compared with ischemic postconditioning treatment. Conclusion: These results revealed a better protective effect of hydrogen on myocardial ischemic/reperfusion injury in rats by attenuating endoplasmic reticulum stress and down-regulating autophagy compared with ischemic postconditioning treatment

Antimicrobial peptide nanoparticles coated with macrophage cell membrane for targeted antimicrobial therapy of sepsis

Sepsis is a serious life-threatening disease. Bacterial infection is one of the main causes of sepsis. Although etiopathogenesis is gradually understood, the treatment is still scarce. Mortality caused by sepsis is still challenge. Herein, macrophage membrane coated antimicrobial peptide nanoparticles (M−AMPNP) was explored based on the specific binding of bacterial recognition receptors on macrophage membrane to bacteria. M−AMPNP was used to treat sepsis caused by bacterial infection. In vivo results showed that M−AMPNP was effectively delivered and retained at the site of infection by intravenous injection, which reduced the level of inflammatory factors and ultimately gave infected mice a significant survival advantage. M−AMPNP provides a potential strategy for targeted therapy of sepsis

Differences in three-dimensional upper airway anatomy between Asian and European patients with obstructive sleep apnea.

To access publisher's full text version of this article click on the hyperlink belowStudy objectives: This study evaluated differences in upper airway, soft tissues and craniofacial structures between Asians from China and Europeans from Iceland with OSA using three-dimensional magnetic resonance imaging (MRI). Methods: Airway sizes, soft tissue volumes, and craniofacial dimensions were compared between Icelandic (N = 108) and Chinese (N = 57) patients with oxygen desaturation index (ODI) ≥ 10 events/h matched for age, gender, and ODI. Mixed effects models adjusting for height or BMI and residual differences in age and ODI were utilized. Results: In our matched sample, compared to Icelandic OSA patients, Chinese patients had smaller BMI (p < 0.0001) and neck circumference (p = 0.011). In covariate adjusted analyses, Chinese showed smaller retropalatal airway size (p ≤ 0.002), and smaller combined soft tissues, tongue, fat pads, and pterygoid (all p ≤ 0.0001), but male Chinese demonstrated a larger soft palate volume (p ≤ 0.001). For craniofacial dimensions, Chinese demonstrated bigger ANB angle (p ≤ 0.0196), differently shaped mandibles, including shorter corpus length (p < 0.0001) but longer ramus length (p < 0.0001), and a wider (p < 0.0001) and shallower (p ≤ 0.0001) maxilla. Conclusions: Compared to Icelandic patients of similar age, gender and ODI, Chinese patients had smaller retropalatal airway and combined soft tissue, but bigger soft palate volume (in males), and differently shaped mandible and maxilla with more bony restrictions. Results support an ethnic difference in upper airway anatomy related to OSA, which may inform targeted therapies. Keywords: ethnicity; obstructive sleep apnea; three-dimensional magnetic resonance imaging; upper airway structure.United States Department of Health & Human Services National Institutes of Health (NIH) - US

Harnessing anti-parity-time phase transition in coupled topological photonic valley waveguides

Topological and non-Hermitian physics provide powerful tools for manipulating light in different ways. Recently, intense studies have converged on the interplay between topology and non-Hermiticity, and have produced fruitful results in various photonic settings. Currently, the realization of this interplay falls under the paradigm of enabling energy exchange between topological systems and the environment. Beyond this paradigm, it is revealed that a non-Hermitian phenomenon, i.e., the anti-parity-time phase transition, naturally emerges from a Hermitian system realized by coupled topological valley waveguides. Such phase transition gives two exotic topological superstates in the spectral domain. By further combining the two phases with topological robustness, a photonic topological bi-functional device is realized on a silicon-on-insulator platform at telecommunications frequencies. The results provide a new perspective on light manipulation and integrated device applications.This work was supported by the National Key Research and Development Program of China under Grants no. 2022YFA1404902, 2022YFA1404704, 2022YFA1405200 and 2019YFB2203002, the National Natural Science Foundation of China (NNSFC) under grant no. 62171406, 11961141010, 61975176, 91950204, 61975177, and U20A20164, the Zhejiang Provincial Natural Science Foundation under grants no. Z20F010018, the Key Research and Development Program of Zhejiang Province under grant no. 2022C01036, and the Fundamental Research Funds for the Central Universities