Surgical management in a severe OSA patient diagnosed with Stickler syndrome

Stickler syndrome is a genetic disorder of connective tissue. One of the major symptoms associated with this disorder is an oro-facial malformation, which may cause a submucous cleft or a complete cleft of the hard palate. A 32-year-old man diagnosed with Stickler syndrome and a submucosal cleft palate (SMCP) visited our hospital with a chief complaint of excessive daytime sleepiness. The patient was diagnosed with severe obstructive sleep apnea (OSA), and administration of a polysomnography test revealed an apnea-hypopnea index (AHI) of 30.9 events/hour (h). Auto-titrating continuous positive airway pressure was initiated to control the OSA symptoms and subsequently the patient showed some improvement. However, due to continuous velopharyngeal insufficiency symptoms, intravelar veloplasty was performed. Three months after surgery, the AHI had decreased to 12.4 events/h. Recent studies have described a greater risk for OSA in individuals with cleft palate, than in the general population. The present case demonstrates surgical success in a patient with OSA and SMCP, suggesting that palatal surgery may be considered an optional surgical treatment for OSA patients with SMCP.     

Increased expression of endoglin in the eutopic endometrium of women with endometriosis.

OBJECTIVE: To compare the angiogenic activities of endothelial cells in the eutopic endometrium of women with and without endometriosis. DESIGN: Vessels with active angiogenesis were identified using the monoclonal antibody to endoglin. SETTING: University department of obstetrics and gynecology. PATIENT(S): Twenty women with histologically confirmed endometriosis after laparotomy or laparoscopy. Women with carcinoma in situ of uterine cervix, but no evidence of endometriosis (n = 20), served as control subjects. INTERVENTION(S): Formalin-fixed, paraffin-embedded archival tissues were sectioned and stained. MAIN OUTCOME MEASURE(S): Number of vessels stained with monoclonal antibody to endoglin. RESULT(S): For all menstrual phases, the mean number of vessels with endoglin expression was significantly greater in patients with endometriosis compared with control subjects. In each menstrual phase, a significant difference was observed only during the late secretory phase. Within the group with endometriosis, the mean numbers of vessels with endoglin expression in stages I and II were not different from the numbers in stages III and IV. CONCLUSION(S): This study shows the expression of endoglin in the eutopic endometrium of women with endometriosis is significantly increased and the increase is observed only in the late secretory phase. It is suggested from these findings that activation of angiogenesis in the eutopic endometrium might be a key factor in the pathogenesis of endometriosis.     

国营航班延误下旅客群体突发事件发生机理与风险控制策略研究

  目的  了解航空旅客焦虑情绪特征及其影响因素,为提高旅客服务质量及完善航空卫生保健机制提供借鉴。  方法  2015年1月 — 2016年12月,采用简单随机抽样法,分别对民航东北、华北、华东、中南、西南等地区的10个机场共计2 526名航空旅客进行特质焦虑量表、简易应对方式量表、自编基于心理需求的焦虑倾向量表调查。  结果  旅客特质焦虑为（38.85 ± 8.23）分、积极应对为（23.65 ± 5.44）分、消极应对为（15.77 ± 3.92）分、焦虑倾向为（70.33 ± 6.55）分。航班延误知情权为（4.01 ± 0.97）分,延误餐宿解决质量为（3.83 ± 0.92）分,航班正点率为（3.68 ± 1.12）分,起飞降落平稳性为（3.62 ± 0.86）分,行李完好性为（3.57 ± 0.91）分,是影响旅客焦虑的主要因素;行李安全与质量[4.43 ± 0.82分],通知及时性[4.28 ± 0.86分],餐宿安排质量[4.27 ± 0.99分],延误知情权[4.25 ± 1.13分],延误赔偿承诺[4.14 ± 0.80分],是旅客最期望解决的因素。不同年龄、飞行时间、出行去向的旅客的特质焦虑差异有统计学意义（均P < 0.001）,不同性别、年龄、飞行频率的旅客的积极应对差异均有统计学意义（均P < 0.05）,不同性别、年龄、飞行频率、飞行时间、出行方向的旅客的消极应对差异均有统计学意义（均P < 0.01）,不同性别、年龄、飞行频率、飞行时间、出行方向的旅客的焦虑倾向差异均有统计学意义（均P < 0.001）。特质焦虑、应对方式、焦虑倾向之间均呈明显相关关系。应对方式在特质焦虑与焦虑倾向间的多重中介效应显著,其效应量占总效应量的34.8 %;积极应对、消极应对的中介作用效应显著,其中介效应量分别占间接效应的60.5 %、39.5 %。61.8 %、41.6 %、35.9 %、32.3 %、31.8 %的旅客分别在航班延误、起飞、提取行李、候机、值机阶段产生焦虑情绪,41.8 %、32.5 %、31.8 %、21.9 %的旅客分别伴随有心跳加速、耳痛、头晕头痛、恶心等身体症状,51.5 %、44.2 %的旅客常以睡觉、听音乐/看报/看视频等方式来应对。  结论  航空公司、机场等运营管理部门可在航班延误应急处置、行李安全质量保障、客舱服务等方面制定针对性强的管理策略与服务模式,提升旅客卫生保健工作质量与效率。     

心房颤动的导管消融治疗

心房颤动（房颤）是指规则有序的心房电活动丧失,代之以快速无序的颤动波,逐渐伴随心房机械功能的退化,是最严重的心房电活动紊乱。房颤常与左房室瓣疾病、心功能衰竭、缺血性心肌病以及高血压相联系,并能增加脑卒中、心功能衰竭的全因死亡率。     

The Representational Dynamics of Sequential Perceptual Averaging

It is clear that humans can extract statistical information from streams of visual input, yet how our brain processes sequential images into the abstract representation of the mean feature value remains poorly explored. Using multivariate pattern analyses of electroencephalography recorded while human observers viewed 10 sequentially presented Gabors of different orientations to estimate their mean orientation at the end, we investigated sequential averaging mechanism by tracking the quality of individual and mean orientation as a function of sequential position. Critically, we varied the sequential variance of Gabor orientations to understand the neural basis of perceptual mean errors occurring during a sequential averaging task. We found that the mean-orientation representation emerged at specific delays from each sequential stimulus onset and became increasingly accurate as additional Gabors were viewed. Especially in frontocentral electrodes, the neural representation of mean orientation improved more rapidly and to a greater degree in less volatile environments, whereas individual orientation information was encoded precisely regardless of environmental volatility. The computational analysis of behavioral data also showed that perceptual mean errors arise from the cumulative construction of the mean orientation rather than the low-level encoding of individual stimulus orientation. Thus, our findings provide neural mechanisms to differentially accumulate increasingly abstract features from a concrete piece of information across the cortical hierarchy depending on environmental volatility.SIGNIFICANCE STATEMENT The visual system extracts behaviorally relevant summary statistical representation by exploiting statistical regularity of the visual stream over time. However, how the neural representation of the abstract mean feature value develops in a temporally changing environment remains poorly identified. Here, we directly recover the mean orientation information of sequentially delivered Gabor stimuli with different orientations as a function of their positions in time. The mean orientation representation, which is regularly updated, becomes increasingly accurate with increasing sequential position especially in the frontocentral region. Further, perceptual mean errors arise from the cumulative process rather than the low-level stimulus encoding. Overall, our study reveals a role of higher cortical areas in integrating stimulus-specific information into increasingly abstract task-oriented information.     

Determining the Case Fatality Rate of COVID-19 in Italy: Novel Epidemiological Study

BackgroundCOVID-19, which emerged in December 2019, has spread rapidly around the world and has become a serious public health event endangering human life. With regard to COVID-19, there are still many unknowns, such as the exact case fatality rate (CFR).ObjectiveThe main objective of this study was to explore the value of the discharged CFR (DCFR) to make more accurate forecasts of epidemic trends of COVID-19 in Italy.MethodsWe retrieved the epidemiological data of COVID-19 in Italy published by the John Hopkins Coronavirus Resource Center. We then used the proportion of deaths to discharged cases（including deaths and recovered cases） to calculate the total DCFR (tDCFR), monthly DCFR (mDCFR), and stage DCFR (sDCFR). Furthermore, we analyzed the trend in the mDCFR between January and December 2020 using joinpoint regression analysis, used ArcGIS version 10.7 to visualize the spatial distribution of the epidemic CFR, and assigned different colors to each province based on the CFR or tDCFR.ResultsWe calculated the numbers and obtained the new indices of the tDCFR and mDCFR for calculating the fatality rate. The results showed that the tDCFR and mDCFR fluctuated greatly from January to May. They first showed a rapid increase followed by a rapid decline after reaching the peak. The map showed that the provinces with a high tDCFR were Emilia-Romagna, Puglia, and Lombardia. The change trend of the mDCFR over time was divided into the following 2 stages: the first stage (from January to May) and the second stage (from June to December). With regard to worldwide COVID-19 statistics, among 6 selected countries, the United States had the highest tDCFR (4.26%), while the tDCFR of the remaining countries was between 0.98% and 2.72%.ConclusionsWe provide a new perspective for assessing the fatality of COVID-19 in Italy, which can use ever-changing data to calculate a more accurate CFR and scientifically predict the development trend of the epidemic.     

Sodium-Glucose Cotransporter-2 Inhibitor-Related Diabetic Ketoacidosis: Accuracy Verification of Operational Definition

BackgroundThe most important aspect of a retrospective cohort study is the operational definition (OP) of the disease. We developed a detailed OP for the detection of sodium-glucose cotransporter-2 inhibitors (SGLT2i) related to diabetic ketoacidosis (DKA). The OP was systemically verified and analyzed.MethodsAll patients prescribed SGLT2i at four university hospitals were enrolled in this experiment. A DKA diagnostic algorithm was created and distributed to each hospital; subsequently, the number of SGLT2i-related DKAs was confirmed. Then, the algorithm functionality was verified through manual chart reviews by an endocrinologist using the same OP.ResultsA total of 8,958 patients were initially prescribed SGLT2i. According to the algorithm, 0.18% (16/8,958) were confirmed to have SGLT2i-related DKA. However, based on manual chart reviews of these 16 cases, there was only one case of SGLT2i-related DKA (positive predictive value = 6.3%). Even after repeatedly narrowing the diagnosis range of the algorithm, the effect of a positive predictive value was insignificant (6.3–10.0%, P > 0.999).ConclusionOwing to the nature of electronic medical record data, we could not create an algorithm that clearly differentiates SGLT2i-related DKA despite repeated attempts. In all retrospective studies, a portion of the samples should be randomly selected to confirm the accuracy of the OP through chart review. In retrospective cohort studies in which chart review is not possible, it will be difficult to guarantee the reliability of the results.