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

Simultaneous Contralateral Vestibular Schwannoma and Middle Ear Paraganglioma Tumor

To the best of our knowledge, only 2 cases of a simultaneous contralateral vestibular schwannoma (VS) and middle ear paraganglioma (MEP) have previously been reported in literature. We report the third case observed in a 43-year-old male, who presented with an 11-year history of right-sided hearing loss and a 1-year history of left-sided pulsatile tinnitus. A magnetic resonance imaging (MRI) showed a VS on the right side and computer tomography (CT) identified a Fisch type A1 paraganglioma on the left side. The VS was treated using a translabyrinthine approach and the MEP was kept under radiological observation for 1 year. Due to the growth of the MEP (Fisch type A2), it was treated with excision via a retroauricular approach. Our case was very challenging because there was a different and important pathology on each side, both carrying a risk of deafness as a consequence of the disease and/or the treatments

Behavior of polyethylene-based nanocomposites containing multi-layer graphene filler

open4siIn this research, the results regarding the characterization of electrical and mechanical properties of a low-density polyethylene (LDPE) - graphene-like (G) nanocomposite are presented. The processing technique used to fabricate the material was high-energy ball milling. This method was utilized to fabricate samples with a filler loading ranging from 1 wt% up to 7wt%. Low voltage broadband dielectric spectroscopy (BDS), erosion tests and breakdown tests (BD) were the measurements carried out in order to characterize the electrical behavior of the fabricated composites. Then, some of the mechanical properties of the LDPE-G nanocomposites were determined with dynamic mechanical analysis (DMA) and, finally, the crystalline structure of the material was investigated with differential scanning calorimetry (DSC).embargoed_20200114Rosi, G.F.; Frechette, M.; David, E.; Fabiani, D.Rosi, G.F.; Frechette, M.; David, E.; Fabiani, D

Use of a Realistic Ray-Based Model for the Evaluation of Indoor RF Coverage Solutions Using Reconfigurable Intelligent Surfaces

A previously developed Huygens-based, “antenna-array-like” macroscopic model for scattering from metasurfaces is embedded into a ray-tracing tool and used to carry out realistic RF-coverage evaluations in indoor environment. Using the reciprocity of the link, we extend prediction to multiple-bounce paths that include metasurface scattering at the beginning or at the end of the interaction chain. The proposed model allows us to carry out coverage evaluations for any realistic RIS design by modifying a few simple parameters. In this work, reference environments such as T–shaped and L–shaped corridor cases are considered with different deployment solutions of anomalous and focusing reflectors. The results show that a gain of about 15–20 dB can be obtained in blind-spot locations with proper RIS placement and configuration, without the use of any additional active radio head, even when using simple designs such as pre-configured lossy phase-gradient metasurfaces

Floristic composition of weeds in different winter and summer covers.

The usage of cover crops is an adopted cultural measure that shows positive effects when associated with the no-till system and weed management. During the cycle of the plants there might be competition within them for water, solar radiation and nutrients and effects of allelopathic substances released by leaching, volatilization and/or root exudation in the environment might also coexist. The study aimed to quantify the floristic composition of weed species in an cultivated area with cover crops during winter and summer, for two years, 2011/12 and 2012/13, in an experimental area of UFSM, Campus of Frederico Westphalen ? RS state, Brazil. The treatments consisted of Italian ryegrass, wild radish, black oat, vetch, wheat and uncultivated, in winter, and, sorghum, sunflower, black velvet bean, dwarf velvet bean, gray velvet bean and green velvet bean in the summer. In the first year of the experiment, a diversity of weeds in winter was observed, especially occuring Stellaria media and Bowlesia incana. In summer, the weeds of higher importance were Ipomoea spp. and Bidens spp., both of utter importance in agricultural systems. Winter cover crops of wild radish and Italian ryegrass and summer cover crops of sorghum and sunflower provided a lower weed infestatio

Role of stochastic noise and generalization error in the time propagation of neural-network quantum states

Neural-network quantum states (NQS) have been shown to be a suitable variational ansatz to simulate out-of-equilibrium dynamics in two-dimensional systems using time-dependent variational Monte Carlo (t-VMC). In particular, stable and accurate time propagation over long time scales has been observed in the square-lattice Heisenberg model using the Restricted Boltzmann machine architecture. However, achieving similar performance in other systems has proven to be more challenging. In this article, we focus on the two-leg Heisenberg ladder driven out of equilibrium by a pulsed excitation as a benchmark system. We demonstrate that unmitigated noise is strongly amplified by the nonlinear equations of motion for the network parameters, which causes numerical instabilities in the time evolution. As a consequence, the achievable accuracy of the simulated dynamics is a result of the interplay between network expressiveness and measures required to remedy these instabilities. We show that stability can be greatly improved by appropriate choice of regularization. This is particularly useful as tuning of the regularization typically imposes no additional computational cost. Inspired by machine learning practice, we propose a validation-set based diagnostic tool to help determining optimal regularization hyperparameters for t-VMC based propagation schemes. For our benchmark, we show that stable and accurate time propagation can be achieved in regimes of sufficiently regularized variational dynamics

5-Azacytidine in Chronic Myelomonocytic Leukemia: Case Report and Review of Literature.

Hypomethylating drugs are useful in the management of Myelodysplastic syndromes, but there are only few reports on chronic myelomonocycitic (CMML) leukemia patients. We describe our experience in 3 CMML patients treated with azacitidine. Two patients obtained partial response after 4 treatment cycles with only minor toxicity and are in continuous partial response, with stable peripheral blood counts, at 29 and 30 cycles from treatment start

Biologic therapies and small molecules for the management of non-infectious scleritis: a narrative review

Scleritis refers to a wide spectrum of ocular conditions ranging from mild to sight-threatening scleral inflammation that may compromise visual function and threaten the anatomical integrity of the ocular globe. Most aggressive forms like necrotizing or posterior scleritis are often difficult-to-treat cases, refractory to conventional treatment. The association with systemic diseases, namely rheumatoid arthritis, Sjögren syndrome, granulomatosis with polyangiitis, and relapsing polychondritis, may have prognostic implications as well. A better understanding of the pathogenesis of ocular inflammatory diseases have paved the way to more effective and targeted treatment approaches. In this regard, a growing body of evidence supports the potential role of biologic agents in the management of non-infectious scleral inflammation, either idiopathic or in a background of immune-mediated systemic disorders. Biologic agents such as anti-tumor necrosis factor agents, interleukin-1 and interleukin-6 inhibitors as well as CD20 blockade have displayed promising results. More specifically, several studies have reported their ability to control scleral inflammation, reduce the overall scleritis relapses, and allow a glucocorticoid-sparing effect while being generally well tolerated. Anecdotal reports have also been described with other biologic agents including abatacept, ustekinumab, daclizumab, and alemtuzumab as well as targeted small molecules such as tofacitinib. Further studies are warranted to fully elucidate the role of biologic agents in non-infectious scleritis and investigate specific areas with the aim to administer treatments in the context of personalized medicine. This review summarizes the available data regarding clinical trials, small pilot studies, and real-life experience of the last two decades reporting the use of biologic agents in the management of non-infectious scleritis

Mitochondrial dysfunction increases fatty acid β-oxidation and translates into impaired neuroblast maturation

The metabolic transition from anaerobic glycolysis and fatty acid \u3b2-oxidation to glycolysis coupled to oxidative phosphorylation is a key process for the transition of quiescent neural stem cells to proliferative neural progenitor cells. However, a full characterization of the metabolic shift and the involvement of mitochondria during the last step of neurogenesis, from neuroblasts to neuron maturation, is still elusive. Here, we describe a model of neuroblasts, Neuro2a cells, with impaired differentiation capacity due to mitochondrial dysfunction. Using a detailed biochemical characterization consisting of steady-state metabolomics and metabolic flux analysis, we find increased fatty acid \u3b2-oxidation as a peculiar feature of neuroblasts with altered mitochondria. The consequent metabolic switch favors neuroblast proliferation at the expense of neuron maturation