Obstructive sleep apnea and heart rate asymmetry microstructure during sleep

Purpose

Heart rate decelerations and accelerations have unequal input to heart rate variability (HRV) and patterns created by consecutive cardiac cycles—this phenomenon is known as heart rate asymmetry (HRA). The analysis of monotonic runs of heart rate decelerations and accelerations provides a detailed insight into the HRA microstructure and thus of HRV.

Aim

To evaluate the relation between the severity of obstructive sleep apnea (OSA) and the HRA microstructure during sleep.

Methods

Seventy-eight patients with suspected OSA underwent overnight polysomnography. The 300-min ECGs from the polysomnography were selected and analyzed. The HRA microstructure was quantified by measuring (1) the contribution of monotonic runs of decelerations or accelerations of different lengths to the number of all sinus beats, and (2) the length of the longest deceleration and acceleration runs.

Results

There were 19 patients with no/mild OSA (Apnea/Hypopnea Index (AHI) 5.1 ± 2.5/h), 18 with moderate OSA (AHI 21.8 ± 4.0/h) and 41 with severe OSA (AHI 42.8 ± 17.4/h). Patients with severe OSA had significantly reduced deceleration and acceleration runs of length 1 compared to the moderate OSA group, and compared to patients with no/mild OSA they had an increased number of longer runs (from 5 to 10 for accelerations and from 5 to 8 for decelerations; p < 0.05 for all comparisons). The longest acceleration runs were significantly longer in severe OSA group (p < 0.05) than in subjects with no/mild OSA.

Conclusions

HRA microstructure is related with OSA severity. An increased number of longer deceleration and acceleration runs is more common in severe OSA patients.     

Phenolic water toxins: redox mechanism and method of their detection in water and wastewater

Phenolic pollutants are highly toxic and persistent in the environment. Their efficient detection is a pressing social demand. In this regard we introduce a novel ultrasensitive electroanalytical platform for the individual and synchronized detection of three phenolic isomers commonly known as hydroquinone (HQ), resorcinol (RC), and catechol (CC). The sensing device consists of a glassy carbon electrode (GCE) modified with functionalized carbon nanotubes (fCNTs) and gold–silver (Au–Ag NPs) bimetallic nanoparticles. The sandwiched scaffold represented as fCNTs/Au–Ag NPs/fCNTs/GCE efficiently senses HQ, RC, and CC with detection limits of 28.6 fM, 36.5 fM and 42.8 fM respectively. The designed sensor is more promising than reported sensors for phenolic toxins in the context of high sensitivity, selectivity, and rapid responsiveness. The designed sensor also shows the qualities of stability, reproducibility, reliability, and selective recognition capacity for target analytes in multiple real water samples. Moreover, computational calculations explain the function of the electrode modifier in facilitating charge transfer between the transducer and analytes.

Phenolic pollutants are highly toxic and persistent in the environment.     

Development of a practical tool for assessing the severity of acute otitis media

BACKGROUND: Watchful waiting management of nonsevere acute otitis media (AOM) can reduce the use of antibiotics, but it requires a reliable means of assessing clinical severity. OBJECTIVE: We present the development of a pocket AOM card with which the clinician can rapidly assess total AOM severity. DESIGN/METHODS: The components of the pocket card consisted of a faces scale, to assess parent perception of severity, and a standard set of tympanic membrane photographs, with which the pediatrician can grade the severity of tympanic membrane inflammation. The components of the pocket card were tested for validity, reliability and responsiveness with the use of data from parents, pediatricians and pediatric otolaryngologists. STATISTICS: Instruments were assessed for concurrent correlation, sequence validity and reliability against previously published questionnaires with the use of Spearman correlation. Responsiveness was calculated with the use of enrollment, day 12 and day 30 data from a randomized clinical trial. RESULTS: The components of the pocket AOM card demonstrated excellent sequence validity, concurrent correlation and reliability (r = 0.58-0.99). Total AOM card severity, consisting of the sum of the 2 scales, demonstrated better responsiveness to change than any of the scales taken individually. CONCLUSIONS: The AOM card combines a parent assessment of symptoms and the clinician assessment of the tympanic membrane to provide an assessment of total AOM severity that can be used to facilitate shared decision making between parent and clinician. The combined score of the AOM card was more responsive to change than any of the instruments used alone. The AOM card provides a useful tool for teaching and research.     

Short Durations of Radial Hemostatic Device After Diagnostic Transradial Cardiac Catheterization: The PRACTICAL-2 Randomized Trial

BackgroundRadial artery occlusion (RAO) is the most common complication following transradial approach (TRA) for cardiac catheterisation. Our aim was to assess if decreasing radial hemostatic device (RHD) time reduces the risk of RAO among individuals receiving small sheath sizes with no adjunctive heparin.MethodsWe randomised 450 individuals undergoing diagnostic cardiac catheterization via TRA to 3 durations of RHD time: 10, 20, or 30 minutes. After these time periods, the RHD was gradually released over 20 minutes. The primary efficacy end point was forearm hematoma grade ≥ 2 (5-10 cm) and the primary safety end point was RAO (as determined by Doppler ultrasound) 1 hour after RHD removal (before discharge).ResultsThe mean age was 66 years and 64% were male. Five-French sheaths were used in all patients. Hematoma grade ≥ 2 occurred in only 1 patient, who was in the 20-minute group (P = 0.39). RAO occurred in 6.7% of patients in the 10-minute group, 10.7% in the 20-minute group and 6% in the 30-minute group (P = 0.26).ConclusionsAmong patients receiving small-caliber sheaths without adjunctive heparin, the incidence of forearm hematoma and RAO are low. Shorter durations of RHD time did not further reduce the risk of these complications.     

Electrochemical sensing platform for the simultaneous femtomolar detection of amlodipine and atorvastatin drugs

The development of a proficient and ultra-high sensitive functionalized electrode for accurate analysis of drugs is a long-standing challenge. Herein, we report an electrochemical nanocomposite scaffold, comprising of silver nanoparticles integrated with functionalized carbon nanotubes (COOH-CNTs/Ag/NH₂-CNTs) for the simultaneous quantification of two widely used amlodipine (AM) and atorvastatin (AT) drugs. The sandwiched nanocomposite materials were thoroughly characterized morphologically and structurally. The nanocomposite COOH-CNTs/Ag/NH₂-CNTs immobilized over glassy carbon electrode catalyzed electron transfer reactions at the electrode–electrolyte interface and facilitated detection of targeted drugs, as revealed by the significant decrease in oxidation potentials at 879 mV and 1040 mV and improved current signals. Electrochemical characterization and testing show that the functionalized porous architecture with a large effective surface area is a promising scaffold for the sensing of a binary mixture of AM and AT with limits of detection in the femtomolar range (77.6 fM, and 83.2 fM, respectively). Besides, the specificity, stability, and reliability of the electrochemical sensing platform in simple and complex biological and pharmaceutical samples with high percentage recoveries highlight its scope for practical applications. Computational studies supported the experimental outcomes and offered insights about the role of modifier in facilitating electron transfer between transducer and analytes.

Development of an ultra-sensitive electrochemical platform for the simultaneous detection of two high blood pressure drugs.     

Metformin treatment in different phenotypes of polycystic ovary syndrome

Background

The aim of this study was to evaluate the effectiveness of Metformin on ovulation and eventual clinical pregnancy in different phenotypes of polycystic ovary syndrome (PCOS).

Materials and methods

A total of 359 subjects who had proven PCOS according to Rotterdam criteria were prospectively selected. Patients’ PCOS phenotypes were determined and recorded. All patients were younger than 35 years. Clinical and biochemical assays in all patients were initially obtained. Then patients were divided into two separate groups. One group received both 1,500 mg of Metformin and 1 mg of folic acid per day and the other group received only 1 mg of folic acid for a total of 2 months. Subsequently, all patients underwent ovulation stimulation with 5 mg of Letrozole per day for 5 days followed by an intra-uterine insemination. Finally, ovulation and pregnancy rates were evaluated for all four PCOS phenotypes. Effect of Metformin therapy was evaluated for each group and each phenotype.

Results

The pregnancy rate in Metformin and non-Metformin groups were, respectively, as follows: in phenotype A (39.2 vs. 33.7 %, p = 0.270), phenotype B (43.8 vs. 20 %, p = 0.210), phenotype C (44 vs. 20 %, p = 0.064), and phenotype D (36.5 vs. 28.6 %, p = 0.279).

Conclusion

Although there was a little improvement in ovulation and pregnancy rates among patients with B and C phenotypes, there was not a statistically significant difference between the two groups. Based on our study, Metformin therapy does not change the ovulation and pregnancy rate.