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We extract the dynamics implicit in an algebraic fitted model Hamiltonian for the deuterium chromophore’s vibrational motion in the molecule CDBrClF. The original model has four degrees of freedom, three positions and one representing interbond couplings. A conserved polyad allows in a semiclassical approach the reduction to three degrees of freedom. For most quantum states we can identify the underlying motion that when quantized gives the said state. Most of the classifications, identifications, and assignments are done by visual inspection of the already available wave function semiclassically transformed from the number representation to a representation on the reduced dimension toroidal configuration space corresponding to the classical action and angle variables. The concentration of the wave function density to lower dimensional subsets centered on idealized simple lower dimensional organizing structures and the behavior of the phase along such organizing centers already reveals the atomic motion. Extremely little computational work is needed. © 2004 American Institute of Physics. [ABSTRACT FROM AUTHOR]

We study an outcome of a vote in a population of voters exposed to an externally applied bias in favour of one of two potential candidates. The population consists of ordinary individuals, that are in majority and tend to align their opinion with the external bias, and some number of contrarians – individuals who are always hostile to the bias but are not in a conflict with ordinary voters. The voters interact among themselves, all with all, trying to find an opinion reached by the community as a whole. We demonstrate that for a sufficiently weak external bias, the opinion of ordinary individuals is always decisive and the outcome of the vote is in favour of the preferential candidate. On the contrary, for an excessively strong bias, the contrarians dominate in the population's opinion, producing overall a negative response to the imposed bias. We also show that for sufficiently strong interactions within the community, either of two subgroups can abruptly change an opinion of the other group. [ABSTRACT FROM AUTHOR]

We investigated whether the current distribution of Lacerta schreiberi is likely to be constrained by incubation conditions. We used an incubation experiment in the laboratory to examine the effects of temperature and moisture on lizard reproductive traits, in order to clarify the ecological processes that underlie the distribution patterns of this lizard and to build more reliable mechanistic models. We then investigated to what extent range limits of L. schreiberi coincided with those predicted from incubation experiments and actual temperature variation experienced in the field. This was done by intersecting documented presence localities of the species with interpolated spatial layers of soil temperature. Reproductive success (hatching success, morphological traits and growth rates) was strongly and negatively affected by high temperature. In contrast, incubation moisture only affected neonate size and its positive effects were only realized at moderate to low temperature. Documented temperature sensitivity suggests that successful embryonic development is likely to be compromised by available thermal conditions, and that this species is unable to colonize warmer areas such as those where L. schreiberi is absent beyond its distribution range limits. An important addition is that incubation moisture does not appear to influence overall embryonic development. We would expect contemporary climate warming to cause upward elevational shifts which may be more or less critical depending on the availability of preferred habitat. [ABSTRACT FROM AUTHOR]

The Raman and surface enhanced Raman scattering (SERS) spectra of a black dyed silk sample (BDS) were registered. The spectral analysis was performed on the basis of Raman and SERS spectral data of isolated samples of Bombyx mori silk fibroin, its motif peptide component (GAGAGS) and the synthetic reactive black 5 dye (RB5). The macro FT-Raman spectrum of the silk sample is consistent with a silk II-Cp crystalline fraction of Bombyx mori silk fibroin; the SERS spectrum is highly consistent with conformational modifications of the fibroin due to the interactions with the Ag nanoparticles. The GAGAGS peptide sequence dominates the Raman spectrum of the silk. The SERS spectrum of the peptide suggests a random coil conformation imposed by the surface interaction; the serine residue in the new conformation is exposed to the surface. Quantum chemical calculations for a model of the GAGAGS-Ag surface predict a nearly extended conformation at the Ag surface. The Raman spectrum of the dye was analysed, and a complete band assignment was proposed; it was not possible to propose a preferential orientation or organization of the molecule on the metal surface. Quantum chemical calculations for a model of the dye interacting with a silver surface predict a rather coplanar orientation of the RB5 on the Ag metal surface. The Raman spectrum of the BDS sample is dominated by signals from the dye; the general spectral behaviour indicates that the dye mainly interacts with the silk through the sulphone (-SO2-) and sulphonate (-SO2-O-) groups. Besides the presence of dye signals, mainly ascribed to the sulphone and sulphonate bands, the SERS spectrum of the BDS sample also displays bands belonging to the amino acids alanine, glycine, serine and particularly tyrosine. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Context: Continuous positive airway pressure (CPAP) is the first-line treatment for patients with symptomatic obstructive sleep apnea (OSA). However, its indication for all patients with sleep-disordered breathing, regardless of daytime symptoms, is unclear.Objective: To evaluate the effect of CPAP treatment on the incidence of hypertension or cardiovascular events in a cohort of nonsleepy patients with OSA.Design, Setting, and Patients: Multicenter, parallel-group, randomized controlled trial in 14 teaching hospitals in Spain. Between May 2004 and May 2006, 725 consecutive patients were enrolled who had an apnea-hypopnea index of 20 h(-1) or greater and an Epworth Sleepiness Scale score of 10 or less (scores range from 0-24, with values <10 suggesting no daytime sleepiness). Exclusion criteria were previous cardiovascular event, physical or psychological incapacity, chronic disease, or drug or alcohol addiction. Follow-up ended in May 2009.Intervention: Patients were allocated to receive CPAP treatment or no active intervention. All participants received dietary counseling and sleep hygiene advice.Main Outcome Measures: Incidence of either systemic hypertension (taking antihypertensive medication or blood pressure greater than 140/90 mm Hg) or cardiovascular event (nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, hospitalization for unstable angina or arrhythmia, heart failure, or cardiovascular death).Results: Seven hundred twenty-three patients underwent follow-up for a median of 4 (interquartile range, 2.7-4.4) years (1 patient from each group did not receive allocated treatment); 357 in the CPAP group and 366 in the control group were included in the analysis. In the CPAP group there were 68 patients with new hypertension and 28 cardiovascular events (17 unstable angina or arrhythmia, 3 nonfatal stroke, 3 heart failure, 2 nonfatal myocardial infarction, 2 transient ischemic attack, 1 cardiovascular death). In the control group there were 79 patients with new hypertension and 31 cardiovascular events (11 unstable angina or arrhythmia, 8 nonfatal myocardial infarction, 5 transient ischemic attack, 5 heart failure, 2 nonfatal stroke). The hypertension or cardiovascular event incidence density rate was 9.20 per 100 person-years (95% CI, 7.36-11.04) in the CPAP group and 11.02 per 100 person-years (95% CI, 8.96-13.08) in the control group. The incidence density ratio was 0.83 (95% CI, 0.63-1.1; P = .20).Conclusions: In patients with OSA without daytime sleepiness, the prescription of CPAP compared with usual care did not result in a statistically significant reduction in the incidence of hypertension or cardiovascular events. However, the study may have had limited power to detect a significant difference.Trial Registration: clinicaltrials.gov Identifier: NCT00127348. [ABSTRACT FROM AUTHOR]

RATIONALE: Home respiratory polygraphy (HRP) is an alternative to polysomnography (PSG) for sleep apnea-hypopnea syndrome (SAHS) diagnosis. However, therapeutic decision-making is a different process than diagnosis. OBJECTIVES: This study aimed to determine the agreement between HRP and in-hospital PSG for therapeutic decision-making in a large sample. METHODS: Patients with an intermediate or high SAHS suspicion were included in a multicenter study (eight sleep centers) and assigned to home and hospital protocols in a random order. Therapeutic decisions (continuous positive airway pressure, no continuous positive airway pressure, or impossible decision) were made by an investigator in each center, based on using either HRP or PSG and a single set of auxiliary clinical variables. Patients and diagnostic methods (HRP and PSG) were assessed in random order using an electronic database. After a month the same therapeutic decision-making procedure was repeated with the same method. MEASUREMENTS AND MAIN RESULTS: Of 366 randomized patients, 348 completed the protocol. The 'impossible decision' case was not observed with either PSG or HRP. Therapeutic decisions using HRP had a sensitivity of 73%, a specificity of 77%, and an agreement level (sum of true positives and negatives) of 76%. Patients with higher HRP apnea-hypopnea index (AHI) scores (>= 30; 41% of the total sample) had a sensitivity of 94%, a specificity of 44%, and the agreement level was 91%. CONCLUSIONS: The HRP-based therapeutic decision was adequate when AHI was high, but deficient in the large population of patients with mild to moderate AHI. Therefore, both selecting patients with a high suspicion and severity of SAHS and future prospective cost-effectiveness studies are necessary. [ABSTRACT FROM AUTHOR]

We study the distribution function P(ω) of the random variable ω = τ,1/(τ1 +…+ τN), where τk's are the partial Wigner delay times for chaotic scattering in a disordered system with N independent, statistically equivalent channels. In this case, τk's are independent and identically distributed random variables with a distribution Ψ(τ) characterized by a "fat" power-law intermediate tail ~1/τ1+μ, truncated by an exponential (or a log-normal) function of τ. For N = 2 and N = 3, we observe a surprisingly rich behavior of P(ω), revealing a breakdown of the symmetry between identical independent channels. For N = 2, numerical simulations of the quasi-one-dimensional Anderson model confirm our findings. [ABSTRACT FROM AUTHOR]

RATIONALE: Continuous positive airway pressure (CPAP) is the current treatment for patients with symptomatic obstructive sleep apnea (OSA). Its use for all subjects with sleep-disordered breathing, regardless of daytime symptoms, is unclear. Objectives: This multicenter controlled trial assesses the effects of 1 year of CPAP treatment on blood pressure (BP) in nonsymptomatic, hypertensive patients with OSA. METHODS: We evaluated 359 patients with OSA. Inclusion criteria consisted of an apnea-hypopnea index (AHI) greater than 19 hour(-1), an Epworth Sleepiness Scale score less than 11, and one of the following: under antihypertensive treatment or systolic blood pressure greater than 140 or diastolic blood pressure greater than 90 mm Hg. Patients were randomized to CPAP (n = 178) or to conservative treatment (n = 181). BP was evaluated at baseline and at 3, 6, and 12 months of follow-up. MEASUREMENTS AND MAIN RESULTS: Mean (SD) values were as follows: age, 56 +/- 10 years; body mass index (BMI), 32 +/- 5 kg x m(-2); AHI, 45 +/- 20 hour(-1); and Epworth Sleepiness Scale score, 7 +/- 3. After adjusting for follow-up time, baseline blood pressure values, AHI, time with arterial oxygen saturation less than 90%, and BMI, together with the change in BMI at follow-up, CPAP treatment decreased systolic blood pressure by 1.89 mm Hg (95% confidence interval: -3.90, 0.11 mm Hg; P = 0.0654), and diastolic blood pressure by 2.19 mm Hg (95% confidence interval: -3.46, -0.93 mm Hg; P = 0.0008). The most significant reduction in BP was in patients who used CPAP for more than 5.6 hours per night. CPAP compliance was related to AHI and the decrease in Epworth Sleepiness Scale score. CONCLUSIONS: In nonsleepy hypertensive patients with OSA, CPAP treatment for 1 year is associated with a small decrease in BP. This effect is evident only in patients who use CPAP for more than 5.6 hours per night. Clinical trial registered with www.clinicaltrials.gov (NCT00127348). [ABSTRACT FROM AUTHOR]

Summary: Objective: To evaluate the postoperative pulmonary complications and the long-term impact on pulmonary function of different surgical procedures with general anaesthesia in chronic respiratory failure (CRF) patients who were using noninvasive positive pressure ventilation (NPPV). Design: We retrospectively studied 20 stable patients on NPPV for CRF secondary to: kyphoscoliosis (eight), morbid obesity (six), thoracoplasty (four), neuromuscular diseases (two), who underwent surgical procedures with general anaesthesia, between January 1998 and December 2003. Material and methods: The variables studied were: type of surgery, hours of orotracheal intubation, hours of stay in the postsurgical reanimation unit (PRU), postoperative pulmonary complications and days of hospital stay. These results were compared with those obtained in patients without respiratory pathology and who were submitted to the same type of surgical interventions during the study period. All patients were tested for: arterial blood gases, forced vital capacity (FVC) and forced expiratory volume in 1s (FVE1). These tests were carried out both prior to surgical intervention and 12 months after this intervention, and the use of medical assistance resources the year prior to and the year after the surgical intervention were also analysed. Results: Sixteen patients were using NPPV at home at the time of the intervention and four patients were adapted to NPPV before surgery. The surgical procedures were: gastroplasty: six; mastectomy: five; septoplasty: three; hip prosthesis: two; cholecystectomy: one; Gasserian ganglion thermocoagulation: one; hysterectomy: one; and endoscopic retrograde cholangiopancreatography (ERCP): one. The mean postoperative intubation time was 3.8±3.2h, and only one patient remained intubated for more than 12h. The mean stay in the PRU was 19±9h (vs 19±6h in the general population, ). The days of hospital stay for the different pathologies were in the majority of cases greater than in the general population. We did not find significant differences on comparing the arterial blood gases, in pulmonary function or in use of assistance resources between the year previous to and the year following the surgical intervention. Conclusions: In high-risk patients with chronic respiratory failure as a consequence of a restrictive lung pathology, NPPV can play an important role to confront surgical procedure with general anaesthesia with greater security. To obtain these results, it was fundamental to coordinate between the Pulmonary Services and the Anaesthesia Services as well as to follow up jointly in the PRU. [Copyright &y& Elsevier]

The utility of radiotelemetry as a tool for estimating the size and microhabitat requirements of a population of Lacerta lepida, the largest European lacertid, was investigated in central Spain. Population density estimates based on repeated marking and recapture (3.2 lizards ha−1) were much higher than those based on line transects (0.22 lizards ha−1). The probability of sighting lizards before they could retreat into a refuge was largely increased by our ability to radiolocate them. Rocks were selected as refuges 96% of the times, and the locations of radiotracked lizards were much closer to rocks than randomly expected. Rocks used as retreat sites were larger and had more crevices than those available at random, which suggests that refuge selection was primarily determined by the need to find shelter from predators. Rockrose patches, which were positively selected, might be used as refuge-connecting corridors that combine shelter with opportunities to forage and thermoregulate. Our results emphasize the need for using radiotelemetry to establish baseline information on abundance and to clarify the actuality, extent and pattern of the population declines experienced by species that may function as key links in their ecosystems, but the wariness of which poses a serious problem for monitoring their conservation status. [ABSTRACT FROM AUTHOR]

Standard practice for continuous positive airway pressure (CPAP) treatment in sleep apnea and hypopnea syndrome (SAHS) requires pressure titration during attended laboratory polysomnography. However, polysomnographic titration is expensive and time-consuming. The aim of this study was to ascertain, in a large sample of CPAP-naive patients, whether CPAP titration performed by an unattended domiciliary autoadjusted CPAP device or with a predicted formula was as effective as CPAP titration performed by full polysomnography. The main outcomes were the apnea-hypopnea index and the subjective daytime sleepiness. We included 360 patients with SAHS requiring CPAP treatment. Patients were randomly allocated into three groups: standard, autoadjusted, and predicted formula titration with domiciliary adjustment. The follow-up period was 12 weeks. With CPAP treatment, the improvement in subjective sleepiness and apnea-hypopnea index was very similar in the three groups. There were no differences in the objective compliance of CPAP treatment and in the dropout rate of the three groups at the end of the follow-up. Autoadjusted titration at home and predicted formula titration with domiciliary adjustment can replace standard titration. These procedures could lead to considerable savings in cost and to significant reductions in the waiting list. [ABSTRACT FROM AUTHOR]

Background: The sleep apnea-hypopnea syndrome is defined by a pathologic number of respiratory events during sleep (the apnea-hypopnea index, defined as the number of apnea and hypopnea episodes per hour) and daytime symptoms (mostly, excessive sleepiness). In patients with the sleep apnea syndrome, treatment with continuous positive airway pressure (CPAP) normalizes both the apnea-hypopnea index and diurnal symptoms. However, the effect of CPAP in persons with a pathologic apnea-hypopnea index without daytime sleepiness is unclear.Objective: To investigate the short-term effects of CPAP on quality of life, objective sleepiness, cognitive function, and arterial blood pressure in nonsleepy patients with a pathologic apnea-hypopnea index.Design: Multicenter randomized, placebo-controlled, parallel-group study.Setting: Six teaching hospitals in Spain.Patients: 55 patients with an apnea-hypopnea index of 30 or greater who did not have daytime sleepiness (Epworth Sleepiness Scale score Intervention: Patients were randomly assigned to receive optimal (n = 29) or sham (n = 25) CPAP and were observed for 6 weeks.Measurements: Quality of life, objective sleepiness (Multiple Sleep Latency Test score), cognitive function, and arterial blood pressure.Results: The intervention and control groups were similar in terms of mean (+/-SE) age (54 +/- 2 vs. 52 +/- 2 years), apnea-hypopnea index (54 +/- 3 vs. 57 +/- 4), Epworth Sleepiness Scale score (7.0 +/- 0.4 vs. 7.0 +/- 0.4) and adherence to CPAP treatment (5.0 +/- 0.4 vs. 4.0 +/- 0.5 hours/d). Other variables, such as quality of life, cognitive function, and arterial blood pressure, were also similar in both groups before treatment. After 6 weeks of CPAP or sham CPAP, none of these variables changed significantly.Conclusion: In patients with an apnea-hypopnea index of 30 or greater and no subjective daytime sleepiness, CPAP does not modify quality of life, objective sleepiness, vigilance, attention, memory, information processing, visuomotor coordination, or arterial blood pressure. Treatment with CPAP is therefore not indicated in nonsleepy patients with a pathologic apnea-hypopnea index. [ABSTRACT FROM AUTHOR]

We study a minimal model of active transport in crowded single-file environments which generalizes the emblematic model of single-file diffusion to the case when the tracer particle (TP) performs either an autonomous directed motion or is biased by an external force, while all other particles of the environment (bath) perform unbiased diffusions. We derive explicit expressions, valid in the limit of high density of bath particles, of the full distribution p(n) (X) of the TP position and of all its cumulants, for arbitrary values of the bias ƒ and for any time n. Our analysis reveals striking features, such as the anomalous scaling ∞ √n of all cumulants, the equality of cumulants of the same parity characteristic of a Skellam distribution and a convergence to a Gaussian distribution in spite of asymmetric density profiles of bath particles. Altogether, our results provide the full statistics of the TP position and set the basis for a refined analysis of real trajectories of active particles in crowded single-file environments. [ABSTRACT FROM AUTHOR]

Introduction: Sleep-disordered breathing (SDB) is a major comorbidity in idiopathic pulmonary fibrosis (IPF) and is associated with a poor outcome. There is a lack of knowledge regarding the impact of SDB treatment on IPF. We assessed at one year: (1) the effect of CPAP and/or nocturnal oxygen therapy on IPF regarding lung function, blood mediators, and quality of life; (2) adherence to SDB treatment and SDB changes., Methodology: This is a prospective study of consecutive newly diagnosed IPF patients initiating anti-fibrotic treatment. Lung function, polysomnography, blood tests and quality of life questionnaires were performed at inclusion and after one year. Patients were classified as obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and sleep-sustained hypoxemia (SSH). SDB therapy (CPAP and/or nocturnal oxygen therapy) was initiated if needed., Results: Fifty patients were enrolled (36% had OSA, 22% CSA, and 12% SSH). CPAP was started in 54% of patients and nocturnal oxygen therapy in 16%. At one-year, polysomnography found improved parameters, though 17% of patients had to add nocturnal oxygen therapy or CPAP, while 33% presented SDB onset at this second polysomnography. CPAP compliance at one year was 6.74 h/night (SD 0.74). After one year, matrix metalloproteinase-1 decreased in OSA and CSA (p = 0.029; p = 0.027), C-reactive protein in OSA (p = 0.045), and surfactant protein D in CSA group (p = 0.074). There was no significant change in lung function., Conclusions: Treatment of SBD with CPAP and NOT can be well tolerated with a high compliance. IPF patients may exhibit SDB progression and require periodic re-assessment. Further studies to evaluate the impact of SDB treatment on lung function and serological mediators are needed., (© 2024. The Author(s).)

Introduction: Obstructive sleep apnea (OSA) is heterogeneous and complex, but its severity is still based on the apnea-hypoapnea index (AHI). The present study explores using cluster analysis (CA), the additional information provided from routine polysomnography (PSG) to optimize OSA categorization., Methods: Cross-sectional study of OSA subjects diagnosed by PSG in a tertiary hospital sleep unit during 2016-2020. PSG, demographical, clinical variables, and comorbidities were recorded. Phenotypes were constructed from PSG variables using CA. Results are shown as median (interquartile range)., Results: 981 subjects were studied: 41% females, age 56 years (45-66), overall AHI 23events/h (13-42) and body mass index (BMI) 30kg/m 2 (27-34). Three PSG clusters were identified: Cluster 1: "Supine and obstructive apnea predominance" (433 patients, 44%). Cluster 2: "Central, REM and shorter-hypopnea predominance" (374 patients, 38%). Cluster 3: "Severe hypoxemic burden and higher wake after sleep onset" (174 patients, 18%). Based on classical OSA severity classification, subjects are distributed among the PSG clusters as severe OSA patients (AHI≥30events/h): 46% in cluster 1, 17% in cluster 2 and 36% in cluster 3; moderate OSA (15≤AHI<30events/h): 57% in cluster 1, 34% in cluster 2 and 9% in cluster 3; mild OSA (5≤AHI<15events/h): 28% in cluster 1, 68% in cluster 2 and 4% in cluster 3., Conclusions: The CA identifies three specific PSG phenotypes that do not completely agree with classical OSA severity classification. This emphasized that using a simplistic AHI approach, the OSA severity is assessed by an incorrect or incomplete analysis of the heterogeneity of the disorder., (Copyright © 2023 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

An involvement of the esophagus in patients with lichen planus was described for the first time in 1982. Ever since, it has been seen as a rarity. However, studies over the last 10 years have shown a higher prevalence than expected. It may even be supposed that esophageal lichen planus (ELP) is more common than eosinophilic esophagitis. ELP mostly affects middleaged women. The principal symptom is dysphagia. Endoscopically, ELP is characterized by denudation and tearing of the mucosa, trachealization and hyperkeratosis and esophageal stenosis may occur in patients with long courses of the disease. Histologic findings including mucosal detachment, T-lymphocytic infiltrate, intraepithelial apoptosis (civatte bodies) and dyskeratosis are crucial. Direct immunofluorescence shows fibrinogen deposits along the basement membrane zone. So far, there is no well-established therapy but a treatment with topic steroids is effective in 2/3 of the patients. Common therapy of lichen planus of the skin seems to be ineffective for treatment of ELP. Symptomatic esophageal stenosis should be endoscopically dilated. ELP joins the group of "new" immunologic diseases of the esophagus., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Lichen planus (LP) is a frequent, chronic inflammatory disease involving the skin, mucous membranes and/or skin appendages. Esophageal involvement in lichen planus (ELP) is a clinically important albeit underdiagnosed inflammatory condition. This narrative review aims to give an overview of the current knowledge on ELP, its prevalence, pathogenesis, clinical manifestation, diagnostic criteria, and therapeutic options in order to provide support in clinical management. Studies on ELP were collected using PubMed/Medline. Relevant clinical and therapeutical characteristics from published patient cohorts including our own cohort were extracted and summarized. ELP mainly affects middle-aged women. The principal symptom is dysphagia. However, asymptomatic cases despite progressed macroscopic esophageal lesions may occur. The pathogenesis is unknown, however an immune-mediated mechanism is probable. Endoscopically, ELP is characterized by mucosal denudation and tearing, trachealization, and hyperkeratosis. Scarring esophageal stenosis may occur in chronic courses. Histologic findings include mucosal detachment, T-lymphocytic infiltrations, epithelial apoptosis (Civatte bodies), dyskeratosis, and hyperkeratosis. Direct immuno-fluorescence shows fibrinogen deposits along the basement membrane zone. To date, there is no established therapy. However, treatment with topical steroids induces symptomatic and histologic improvement in two thirds of ELP patients in general. More severe cases may require therapy with immunosuppressors. In symptomatic esophageal stenosis, endoscopic dilation may be necessary. ELP may be regarded as a precancerous condition as transition to squamous cell carcinoma has been documented in literature. ELP is an underdiagnosed yet clinically important differential diagnosis for patients with unclear dysphagia or esophagitis. Timely diagnosis and therapy might prevent potential sequelae such as esophageal stenosis or development of invasive squamous cell carcinoma. Further studies are needed to gain more knowledge about the pathogenesis and treatment options., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Introduction: Continuous positive airway pressure (CPAP) titration was dramatically affected by the coronavirus disease 2019 (COVID-19) pandemic due to increased biological risk. This study aimed to compare successful CPAP adaptation and compliance with home telemedicine CPAP titration with the usual method based on face-to-face visits., Methodology: A prospective cohort using telemedicine home CPAP titration and follow-up during the COVID-19 pandemic (TC) was compared with a retrospective cohort receiving face-to-face pre-pandemic home titration (RC). The TC included a subgroup with a smartphone application (TC-APP). Successful CPAP adaptation and compliance at 1 month of follow-up were the main endpoints, while patient satisfaction and costs were secondary endpoints., Results: 210 consecutive patients were evaluated (80 RC and 130 TC). 36 patients were in the TC-APP subgroup. CPAP titration was successful in 90% in RC versus 95% in TC and 100% in TC-APP. No compliance differences between groups were found at 1  month (4.79 h·night -1 RC, 4.33  h·night -1 TC and 4.59 h·night -1 TC-APP). Mean±sd patient satisfaction out of 10 was 7.69±2.05 in RC versus 9.02±0.64 in TC (p<0.001). 64% of the TC-APP subgroup reported that their telemedicine strategy influenced an increase in CPAP use (p=0.011). CPAP adaptation with follow-up had an estimated direct staff cost per patient of EUR 19.61±8.61 in TC with no smartphone application used versus EUR 23.79±9.94 in TC-APP (p=0.048)., Conclusions: Telemedicine in CPAP titration and early follow-up is equivalent to the usual care in terms of successful adaptation and compliance, while achieving greater patient satisfaction., Competing Interests: Conflict of interest: J. Bordas-Martinez participated in the development of the smartphone application. However, this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The other authors have nothing to disclose., (Copyright ©The authors 2022.)

Patients with sleep apnea are usually treated with continuous positive airway pressure (CPAP). This therapy is very effective if the patient's adherence is satisfactory. However, although CPAP adherence is usually acceptable during the first months of therapy, it progressively decreases, with a considerable number of patients accepting average treatment duration below the effectiveness threshold (4 h/night). Herein, our aim was to describe and evaluate a novel telemedicine strategy for rescuing CPAP treatment in patients with low adherence after several months/years of treatment. This two-week intervention includes (1) patient support using a smartphone application, phone and voice recorder messages to be answered by a nurse, and (2) daily transmission and analysis of signals from the CPAP device and potential variation of nasal pressure if required. On average, at the end of the intervention, median CPAP adherence considerably increased by 2.17 h/night (from 3.07 to 5.24 h/night). Interestingly, the procedure was able to markedly rescue CPAP adherence: the number of patients with poor adherence (<4 h/night) was considerably reduced from 38 to 7. After one month, adherence improvement was maintained (median 5.09 h/night), and only 13 patients had poor adherence (<4 h/night). This telemedicine intervention (103€ per included patient) is a cost-effective tool for substantially increasing the number of patients with CPAP adherence above the minimum threshold for achieving positive therapeutic effects.

Introduction: Idiopathic pulmonary fibrosis (IPF) prognosis is heterogeneous despite antifibrotic treatment. Cluster analysis has proven to be a useful tool in identifying interstitial lung disease phenotypes, which has yet to be performed in IPF. The aim of this study is to identify phenotypes of IPF with different prognoses and requirements., Methods: Observational retrospective study including 136 IPF patients receiving antifibrotic treatment between 2012 and 2018. Six patients were excluded due to follow-up in other centres. Cluster analysis of 30 variables was performed using approximate singular value-based tensor decomposition method and comparative statistical analysis., Results: The cluster analysis identified three different groups of patients according to disease behaviour and clinical features, including mortality, lung transplant and progression-free survival time after 3-year follow-up. Cluster 1 (n=60) was significantly associated (p=0.02) with higher mortality. Diagnostic delay was the most relevant characteristic of this cluster, as 48% of patients had ≥2 years from first respiratory symptoms to antifibrotic treatment initiation. Cluster 2 (n=22) had the longest progression-free survival time and was correlated to subclinical patients evaluated in the context of incidental findings or familial screening. Cluster 3 (n=48) showed the highest percentage of disease progression without cluster 1 mortality, with metabolic syndrome and cardiovascular comorbidities as the main characteristics., Conclusion: This cluster analysis of IPF patients suggests that diagnostic and treatment delay are the most significant factors associated with mortality, while IPF progression was more related to metabolic syndrome and cardiovascular comorbidities., Competing Interests: Conflict of interest: J. Bordas-Martínez reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: R. Gavaldà reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: J.G. Shull reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: V. Vicens-Zygmunt reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: L. Planas-Cerezales reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: G. Bermudo-Peloche reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: S. Santos reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: N. Salord reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: C. Monasterio reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: M. Molina-Molina reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study. Conflict of interest: G. Suarez-Cuartin reports FIS-ISCIII grant PI18/00367 (cofunded by the European Regional Development Fund (ERDF)), Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grants 631/2018 and 685/2018, Emerging ILD Group of SEPAR grant 005 (Boehringer–Roche), Pneumology Foundation of Catalonia grant 2019, Spanish Sleep Society grant 2019, institutional support of the CERCA Programme/Generalitat de Catalunya, and research support BRN-Fundació Ramon Pla Armengol from ISCIII grant CM20/00093 (cofunded by European Regional Development Fund), during the conduct of the study., (Copyright ©The authors 2021.)

An involvement of the esophagus in patients with lichen planus was described for the first time in 1982. Ever since, it has been seen as a rarity. However, studies over the last 10 years have shown a higher prevalence than expected. It may even be supposed that esophageal lichen planus (ELP) is more common than eosinophilic esophagitis. ELP mostly affects middle-aged women. The principal symptom is dysphagia. Endoscopically, ELP is characterized by denudation and tearing of the mucosa, trachealization and hyperkeratosis and esophageal stenosis may occur in patients with long courses of the disease. Histologic findings including mucosal detachment, T-lymphocytic infiltrate, intraepithelial apoptosis (civatte bodies) and dyskeratosis are crucial. Direct immunofluorescence shows fibrinogen deposits along the basement membrane zone. So far, there is no well-established therapy but a treatment with topic steroids is effective in 2/3 of the patients. Common therapy of lichen planus of the skin seems to be ineffective for treatment of ELP. Symptomatic esophageal stenosis should be endoscopically dilated. ELP joins the group of "new" immunologic diseases of the esophagus., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose: Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5 years., Material and Methods: Forty-five patients with mean BMI of 39.4(1.9)kg/m 2 and T2DM with HbA 1c of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined., Results: Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5 years in mRYGB group - 27.32 (7.8) vs. SG - 18.00 (10.6) and GCP - 14.83 (7.8), p = 0.001. At 5 years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p < 0.001. In the multivariate analysis, shorter T2DM duration (OR 0.186), p = 0.008, and the GLP-1 AUC at 1 month (OR 7.229), p = 0.023, were prognostic factors for complete T2DM remission at 5-year follow-up., Conclusions: Long-term T2DM remission is mostly achieved with hypoabsortive techniques such as mRYGB. Increased secretion of GLP-1 after surgery and shorter disease duration were the main predictors of T2DM remission at 5 years.

Background: Sleep disturbances have been reported in obsessive-compulsive disorder (OCD) patients, with heterogeneous results. The aim of our study was to assess sleep function in OCD and to investigate the relationship between sleep and the severity of obsessive-compulsive (OC) symptoms, depressive symptoms and trait anxiety., Methods: Sleep quality was measured in 61 OCD patients and 100 healthy controls (HCs) using the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regression was conducted to explore the association between sleep and psychopathological measures; a mediation analysis was also performed., Results: OCD patients showed poor sleep quality and more sleep disturbances compared to HCs. The severity of depression, trait anxiety and OC symptomatology were correlated with poor sleep quality. Multiple linear regression analyses controlling for potential confounders revealed that the severity of depression and trait anxiety were independently related to poor sleep quality in OCD. A mediation analysis showed that both the severity of trait anxiety and depression mediate the relationship between the severity of OC symptoms and poor sleep quality among patients with OCD., Conclusions: Our findings support the existence of sleep disturbances in OCD. Trait anxiety and depression play a key role in sleep quality among OCD patients.

Diarrhea is among the most frequently reported symptoms in clinical practice. Acute diarrhea is usually caused by infectious agents with a self-limited disease course. In contrast, differential diagnosis of chronic diarrhea may be challenging. The aim of this review is to provide the reader with an overview on the causes, pathomechanisms, differential diagnosis and clinical management of acute and chronic diarrhea in adults., Competing Interests: Erklärung zu finanziellen InteressenForschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: ja; von einer anderen Institution (Pharma- oder Medizintechnikfirma usw.); Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Sponsor der Veranstaltung): ja; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Nicht-Sponsor der Veranstaltung): ja.Erklärung zu nichtfinanziellen InteressenDie Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Patient History and Clinical Findings:  A 46-year old construction worker presented at the emergency department with two orthostatic syncopes. The patient complained of prolonged fever and coughs for 7 days which had not improved after oral treatment with sultamicillin for 5 days, prescribed by the patient's general practitioner. Physical examination showed high blood pressure due to previously known hypertension. Other vital signs without pathological findings. Pulmonary auscultation showed basal soft crackling noises of the left lung., Findings and Diagnosis:  Laboratory examination showed increased values for LDH, pro-BNP and CRP and normal values for leucocytes and procalcitonin. Conventional X-Ray of the chest showed bipulmonal lateral atypical infiltrates. After the first PCR turned in negative another PCR-analysis for SARS-CoV-2 of a deep oral swab-sample was performed since the clinical, laboratory and radiological findings were typical for COVID-19. Again, SARS-CoV-2-RNA was not detected. A CT-scan of the chest showed bipulmonal lateral ground-glass attenuation, again typical for COVID-19 associated pneumonia. After a third attempt for a PCR-analysis of a deep oral swab-sample was negative, analysis of a sputum was performed which finally confirmed the diagnosis of COVID-19 associated pneumonia., Therapy and Course of Events:  The patient was admitted for evaluation of syncopes and suspect of COVID-19 associated pneumonia. The patient was prophylactically isolated while the result of SARS-CoV-2-PCR from a deep oral swab was pending. Suspecting a possible secondary bacterial infection at the beginning, intravenous antibiotic treatment with ampicillin/sulbactam was initiated. While further examinations showed no indication for bacterial infection, antibiotics were discontinued after 3 days. Due to clinical recovery antiviral therapy was not performed after confirming the diagnosis. The patient was discharged 17 days after onset of first symptoms without any requirements for further isolation., Conclusion:  This casuistic describes a case of COVID-19 associated pneumonia presenting with typical clinical features, laboratory and radiological findings. Detection of viral RNA was not successful from deep oral swab-samples despite repeated attempts. Finally, PCR-analysis of sputum confirmed the diagnosis. Analysis of deeper airway samples (sputum, bronchoalveolar lavage, tracheal secretions) or stool for SARS-CoV-2 should be performed in cases of evident clinical suspicion of COVID-19 and negative PCR results from deep oral swabs., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Study Objectives: To determine whether an intensive weight-loss program (IWLP) is effective for reducing weight, the severity of obstructive sleep apnea (OSA), and metabolic variables in patients with obesity and severe OSA undergoing continuous positive airway pressure treatment., Methods: Forty-two patients were randomized to the control (CG, n = 20) or the intervention group (IG, n = 22), who followed a 12-month IWLP. The primary outcome was a reduction in the apnea-hypopnea index (AHI) as measured at 3 and 12 months by full polysomnography. Metabolic variables, blood pressure, body fat composition by bioimpedance, carotid intima media thickness, and visceral fat by computed tomography were also assessed., Results: Mean age was 49 (6.7) years, body mass index 35 (2.7) kg/m², and AHI 69 (20) events/h. Weight reduction was higher for the IG than the CG at 3 and 12 months, -10.5 versus -2.3 kg (P < .001), and -8.2 versus -0.1 kg (P < .001), respectively, as was loss of visceral fat at 12 months. AHI decreased more in the IG at 3 months (-23.72 versus -9 events/h) but the difference was not significant at 12 months, though 28% of patients from the IG had an AHI < 30 events/h compared to none in the CG (P = .046). At 12 months, the IG showed a reduction in C-reactive protein (P = .013), glycated hemoglobin (P = .031) and an increase in high density lipoprotein cholesterol (P = .027)., Conclusions: An IWLP in patients with obesity and severe OSA is effective for reducing weight and OSA severity. It also results in an improvement in lipid profiles, glycemic control, and inflammatory markers., Clinical Trial Registration: Registry: ClinicalTrials.gov; Title: Effectiveness of an Intensive Weight Loss Program for Obstructive Sleep Apnea Syndrome (OSAS) Treatment; Identifier: NCT02832414; URL: https://clinicaltrials.gov/ct2/show/record/NCT02832414., (© 2020 American Academy of Sleep Medicine.)