Long-term prediction of adherence to continuous positive air pressure therapy for the treatment of moderate/severe obstructive sleep apnea syndrome

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is a highly effective treatment for obstructive sleep apnea syndrome (OSAS). However, poor adherence is a limiting factor, and a significant proportion of patients are unable to tolerate CPAP. The aim of this study was to determine predictors of long-term non-compliance with CPAP. METHODS: CPAP treatment was prescribed to all consecutive patients with moderate or severe OSAS (AHI ≥15 events/h) (n = 295) who underwent a full-night CPAP titration study at home between February 1, 2002 and December 1, 2016. Adherence was defined as CPAP use for at least 4 h per night and five days per week. Subjects had periodical follow-up visits including clinical and biochemical evaluation and assessment of adherence to CPAP. RESULTS: Median follow-up observation was 74.8 (24.2/110.9) months. The percentage of OSAS patients adhering to CPAP was 41.4% (42.3% in males and 37.0% in females), and prevalence was significantly higher in severe OSAS than in moderate (51.8% vs. 22.1%; p < 0.001; respectively). At multivariate analysis, lower severity of OSAS (HR = 0.66; CI 95 0.46-0.94) p < 0.023), cigarette smoking (HR = 1.72; CI 95 1.13-2.61); p = 0.011), and previous cardiovascular events (HR = 1.95; CI 95 1.03-3.70; p = 0.04) were the only independent predictors of long-term non-adherence to CPAP after controlling for age, gender, and metabolic syndrome. CONCLUSIONS: In our cohort of patients with moderate/severe OSAS who were prescribed CPAP therapy, long-term compliance to treatment was present in less than half of the patients. Adherence was positively associated with OSAS severity and negatively associated with cigarette smoking and previous cardiovascular events at baseline

Avaliação dos impactos econômico, social e ambiental do uso da alfafa em sistemas de produção de leite.

Foram avaliados os impactos econômico, social e ambiental do uso da alfafa na produção de leite. Compararam-se dois sistemas de produção: a) confinamento com fornecimento de silagem de milho (seca) e pastejo rotacionado de forrageira tropical (chuvas); b) pastejo rotacionado de alfafa e suplementação com silagem de milho (seca), e pastejo rotacionado de alfafa e de forrageira tropical (chuvas). Utilizou-se a metodologia do sistema Ambitec, composto por indicadores sociais e ambientais agrupados em planilhas eletrônicas. Na análise econômica calculou-se o custo operacional efetivo (COE), do custo operacional total (COT), do custo total de produção (CT) e do lucro operacional (LO). Utilizou-se a análise de probabilidade para avaliar o risco econômico da adoção da tecnologia, por meio de uma função de lucro operacional. Os coeficientes técnicos utilizados foram fornecidos por pesquisadores da Embrapa Pecuária Sudeste, com dados da unidade de demonstração da tecnologia, e por técnicos extensionistas e produtores rurais, com dados de propriedades dos Estados do PR e de SP. A tecnologia teve índice de 1,76 para o impacto social e índice de 0,43 para o impacto ambiental. O uso da alfafa reduziu em 40% o consumo de silagem de milho na estação seca e possibilitou a redução de 8% no teor de proteína bruta do concentrado, sem prejuízo da produção média das vacas em lactação (25 L/vaca.dia em ambos os sistemas). A introdução da alfafa na dieta (20% do consumo de matéria seca) reduziu em 9% e 7% o COE e o COT de produção de leite, respectivamente. Na análise de risco, o sistema sem alfafa teve LO de R$/L 0,26 (19,2$/L 0,26)

Opportunistic screening for type 2 diabetes in community pharmacies. Results from a region-wide experience in Italy

BACKGROUND AND AIMS:Given the paucity of symptoms in the early stages of type 2 diabetes, its diagnosis is often made when complications have already arisen. Although systematic population-based screening is not recommended, there is room to experience new strategies for improving early diagnosis of the disease in high risk subjects. We report the results of an opportunistic screening for diabetes, implemented in the setting of community pharmacies. METHODS AND RESULTS:To identify people at high risk to develop diabetes, pharmacists were trained to administer FINDRISC questionnaire to overweight, diabetes-free customers aged 45 or more. Each interviewee was followed for 365 days, searching in the administrative database whether he/she had a glycaemic or HbA1c test, or a diabetologists consultation, and to detect any new diagnosis of diabetes defined by either a prescription of any anti-hyperglycaemic drug, or the enrolment in the register of patients, or a hospital discharge with a diagnosis of diabetes. Out of 5977 interviewees, 53% were at risk of developing diabetes. An elevated FINDRISC score was associated with higher age, lower education, and living alone. Excluding the number of cases expected, based on the incidence rate of diabetes in the population, 51 new cases were identified, one every 117 interviews. FINDRISC score, being a male and living alone were significantly associated with the diagnosis. CONCLUSIONS:The implementation of a community pharmacy-based screening programme can contribute to reduce the burden of the disease, particularly focusing on people at higher risk, such as the elderly and the socially vulnerable

Protective Effects of Pyridoxamine Supplementation in the Early Stages of Diet-Induced Kidney Dysfunction

Pyridoxamine, a structural analog of vitamin B6 that exerts antiglycative effects, has been proposed as supplementary approach in patients with initial diabetic nephropathy. However, the molecular mechanism(s) underlying its protective role has been so far slightly examined. C57Bl/6J mice were fed with a standard diet (SD) or a diet enriched in fat and fructose (HD) for 12 weeks. After 3 weeks, two subgroups of SD and HD mice started pyridoxamine supplementation (150 mg/kg/day) in the drinking water. HD fed mice showed increased body weight and impaired glucose tolerance, whereas pyridoxamine administration significantly improved insulin sensitivity, but not body weight, and reduced diet-induced increase in serum creatinine and urine albumin. Kidney morphology of HD fed mice showed strong vacuolar degeneration and loss of tubule brush border, associated with a drastic increase in both advanced glycation end products (AGEs) and AGEs receptor (RAGE). These effects were significantly counteracted by pyridoxamine, with consequent reduction of the diet-induced overactivation of NF-kB and Rho/ROCK pathways. Overall, the present study demonstrates for the first time that the administration of the antiglycative compound pyridoxamine can reduce the early stages of diet-dependent kidney injury and dysfunction by interfering at many levels with the profibrotic signaling and inflammatory cascades

Muscular dysfunction elicited by creep of lumbar viscoelastic tissues.

Abstract The biomechanics, histology and electromyography of the lumbar viscoelastic tissues and multifidus muscles of the in vivo feline were investigated during 20 min of static as well as cyclic flexion under load control and during 7 h of rest following the flexion. It was shown that the creep developed in the viscoelastic tissues during the 20 min of static or cyclic flexion did not fully recover over the 7 h of following rest. It was further seen that a neuromuscular disorder with five distinct components developed during and after the static and cyclic flexion. The neuromuscular disorder consisted of a decreasing magnitude of reflexive EMG from the multifidus upon flexion as well as of superimposed spasms. The recovery period was characterized by an initial muscle hyperexcitability, a slowly increasing reflexive EMG and a delayed hyperexcitability. Histological data from the supraspinous ligament demonstrate significant increase (× 10) in neutrophil density in the ligament 2 h into the recovery and even larger increase (×100) 6 h into the recovery from the 20 min flexion, indicating an acute soft tissue inflammation. It was concluded that sustained static or cyclic loading of lumbar viscoelastic tissues may cause micro-damage in the collagen structure, which in turn reflexively elicit spasms in the multifidus as well as hyperexcitability early in the recovery when the majority of the creep recovers. The micro-damage, however, results in the time dependent development of inflammation. In all cases, the spasms, initial and delayed hyperexcitabilities represent increased muscular forces applied across the intervertebral joints in an attempt to limit the range of motion and unload the viscoelastic tissues in order to prevent further damage and to promote healing. It is suggested that a significant insight is gained as to the development and implications of a common idiopathic low back disorder as well as to the development of cumulative trauma disorders

Proprotein convertase subtilisin kexin type 9 inhibitors reduce platelet activation modulating ox-LDL pathways

Background: Proprotein convertase subtilisin kexin type 9 inhibitors (PCSK9i) lower LDL-cholesterol and slow atherosclerosis preventing cardiovascular events. While it is known that circulating PCSK9 enhances platelet activation (PA) and that PCSK9i reduce it, the underlying mechanism is not still clarified. Methods: In a multicenter before–after study in 80 heterozygous familial hypercholesterolemia (HeFH) patients on treatment with maximum tolerated statin dose ± ezetimibe, PA, soluble-NOX2-derived peptide (sNOX2-dp), and oxidized-LDL (ox-LDL) were measured before and after six months of PCSK9i treatment. In vitro study investigates the effects of plasma from HeFH patients before and after PCK9i on PA in washed platelets (wPLTs) from healthy subjects. Results: Compared to baseline, PCSK9i reduced the serum levels of LDL-c, ox-LDL, Thromboxane (Tx) B2, sNOX2-dp, and PCSK9 (p Conclusions: PCSK9i treatment reduces PA modulating NOX2 activity and in turn ox-LDL formation in HeFH patients

The Stellar Composition of the Star Formation Region CMa R1 -- III. A new outburst of the Be star component in Z CMa

We report on a recent event in which, after more than a decade of slowly fading, the visual brightness of the massive young binary Z CMa suddenly started to rise by about 1 magnitude in December 1999, followed by a rapid decline to its previous brightness over the next six months. This behaviour is similar to that exhibited by this system around its eruption in February 1987. A comparison of the intrinsic luminosities of the system with recent evolutionary calculations shows that Z CMa may consist of a 16 M_sun B0 IIIe primary star and a ~ 3 M_sun FUOr secondary with a common age of ~ 3 x 10^5 yr. We also compare new high-resolution spectra obtained in Jan. and Feb. 2000, during the recent rise in brightness, with archive data from 1991 and 1996. The spectra are rich in emission lines, which originate from the envelope of the early B-type primary star. The strength of these emission lines increased strongly with the brightness of Z CMa. We interpret the collected spectral data in terms of an accretion disc with atmosphere around the Herbig B0e component of Z CMa, which has expanded during the outbursts of 1987 and 2000. A high resolution profile of the 6300 A [O I] emission line, obtained by us in March 2002 shows an increase in flux and a prominent blue shoulder to the feature extending to ~ -700 km/s, which was much fainter in the pre-outburst spectra. We propose that this change in profile is a result of a strong change in the collimation of a jet, as a result of the outburst at the start of this century.Comment: 22 pages, 12 figures, accepted for publication in MNRA

Overview of the results of the organics PET Study of the cometary samples returned from comet Wild 2 by the Stardust mission

This presenation will provide an overview of the efforts and results produced by the Organics Preliminary Examination Team during their studies of the samples returned from comet Wild 2 by the Stardust spacecraft