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Objective: To evaluate the clinical efficacy and safety of cefetamet pivoxil for the treatment of acute bacterial rhinosinusitis in Korean patients compared to treatment with cefdinir. Methods: A prospective, multicenter, randomized double-blind, comparative study was conducted by the Departments of Otorhinolaryngology–Head and Neck Surgery at 17 hospitals or universities in the Republic of Korea from March 2017 to April 2019. A total of 309 patients were screened and 249 patients participated in the study. Results: Treatment with cefetamet pivoxil for 2 weeks showed 82.4% clinical cure and improvement rates in patients with acute bacterial rhinosinusitis compared to 84.68% in those taking cefdinir for 2 weeks, showing that cefetamet pivoxil administered twice a day for 2 weeks was as effective as cefdinir 3 times a day for 2 weeks for the treatment of acute bacterial rhinosinusitis. The overall adverse reaction rates of both drugs were 10.56% in the cefetamet pivoxil group and 15.49% in the cefdinir group, without serious adverse events or drug reactions. Conclusions: Cefetamet pivoxil twice a day was as efficacious and safe as cefdinir 3 times a day for the treatment of acute bacterial rhinosinusitis, which suggested that cefetamet pivoxil may be a suitable alternative to cefdinir.

Purpose Intermittent hypoxia (IH) is characterized by hypoxia-reoxygenation, reported to be a critical risk factor for obstructive sleep apnea (OSA). This experiment aimed to evaluate the direct effects of IH on the human nasal mucosa. Methods The direct effects of IH on the human nasal mucosa was evaluated by measuring the ciliary beat frequency (CBF) and expression levels of inflammatory cytokines (granulocyte-macrophage colony-stimulating factor, transforming growth factor-β, interleukin-6, and tumor necrosis factor-α). The normoxia group was exposed to a normoxic condition for 72 h. The IH group was exposed to 288 cycles of IH (1 cycle: hypoxia, 5 min; subsequent normoxia, 10 min) for 72 h. CBF was measured using an automated computer-based video image processing technique. Changes in the expression of cytokines were assessed by real-time reverse transcription-polymerase chain reaction (RT-PCR). Results The normoxia group revealed a persistent CBF pattern and a physiological range of inflammatory cytokines. However, the IH group showed a cyclic decrease in CBF and increased expression of inflammatory cytokines. Cytotoxicity assay indicated no difference in the survival rates between the two groups. Conclusions IH results in increased expression of inflammatory cytokines that adversely affects the mucociliary transport in the upper airway and, consequently, may result in airway inflammation.

Objective The aim of this study is to evaluate the feasibility of posterior cervical foraminotomy (PCF) for adjacent segmental disease (ASD) after anterior cervical fusion (ACF). As ACF is accepted as the standard treatment for cervical spondylosis, many studies have been conducted to evaluate the efficacy of various surgical techniques to overcome symptomatic ASD after the previous surgery. Herein, PCF was performed for the treatment of symptomatic ASD and the feasibility of the surgery was evaluated. Methods Forty nine patients who underwent PCF due to symptomatic ASD from August 2008 to November 2017 were identified. For demographic and perioperative data, the sex, age, types of previous surgery, ASD levels, operation times, and bleeding amount were recorded. The clinical outcome was assessed using the visual analogue scale for the neck and arm, the modified Odom’s criteria as well as neck disability index. Radiologic evaluations were performed by measuring disc softness, disc height, the cervical 2–7 sagittal vertical axis, cervical cobb angle, and facet violation. Results Thirty-seven patients were enrolled in this study. The patients were divided into two groups based on the location of the pathology; paracentral (group P) or foramina (group F). Both groups showed significant clinical improvement (p0.05). Conclusion PCF showed satisfactory clinical and radiologic outcomes for both paracentral and foraminal pathologies of ASD after ACF. Complications related to anterior revision were also avoided. PCF can be considered a feasible and safe surgical option for ASD after ACF.

Purpose: The purpose of this study was to evaluate the relationship between the progression of arthritis and the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) through the treatment-resistant mono joint rheumatoid arthritis treated with arthroscopic synovectomy.Methods: We retrospectively reviewed 65 patients who underwent arthroscopic synovectomy for rheumatoid wrist or elbow which had not responded to systemic treatment for at least 6 months. The main treatment response evaluation methods of rheumatologists were the American College of Rheumatology (ACR) response criteria, and the ACR/EULAR (European League Against Rheumatism) remission criteria. The medical records, results of laboratory tests and radiographs of wrist or elbow that had been performed by rheumatologists before arthroscopic synovectomy were investigated. We examined whether the results of laboratory tests and arthritic change of radiograph had statistically significant correlation. Results: The mean duration of joint symptom until referral to orthopedic department was 23 months (range, 1 month to 9.2 years). During this period, rheumatologists had took average one X-ray (range, 0–3). Forty-seven patients (72.3%) had CRP of 1 mg/dL or less as included in the ACR/EULAR remission criteria. Seventeen out of 65 patients who had two or more X-ray were able to evaluate the progression of arthritis. The change of arthritis and mean ESR (p=0.787) or CRP (p=0.303) the same period didn’t have statistically significant relationship (Spearman correlation analysis).Conclusion: Since the method of evaluating the treatment response of rheumatologists is to assess the systemic condition, arthritis of one joint that is resistant to treatment is considered to require periodic radiographs as method to assess itself.

Background: Circulating apolipoprotein J (ApoJ) is closely associated with insulin resistance; however, the effect of exercise on circulating ApoJ levels and the association of ApoJ with metabolic indices remain unknown. Here, we investigated whether a combined exercise can alter the circulating ApoJ level, and whether these changes are associated with metabolic indices in pa tients with type 2 diabetes mellitus. Methods: Postmenopausal women with type 2 diabetes mellitus were randomly assigned into either an exercise (EXE, n=30) or control (CON, n=15) group. Participants in the EXE group were enrolled in a 12-week program consisting of a combination of aerobic and resistance exercises. At baseline, 4, 8, and 12 weeks, body composition and metabolic parameters including homeo static model assessment of insulin resistance (HOMA-IR) and serum ApoJ levels were assessed. Results: In the EXE group, ApoJ levels decreased 26.3% and 19.4%, relative to baseline, at 8 and 12 weeks, respectively. Between-group differences were significant at 8 and 12 weeks (P

Benign prostatic hyperplasia (BPH) is an age-related disease characterized by prostatic enlargement and is the most common urologic symptoms in elderly men 60 years of age and older. Previously, we documented that 70% ethanol (EtOH) seed extract of Quisqualis indica (QI) attenuates pathological condition of testosterone propionate (TP)-induced BPH rat model via modulation of proliferation and apoptosis of prostate cells. Based on this potential of QI, we produced standardized seed extract of QI (HU-033) in order to prove further mechanisms. In this study, we aimed to suggest further mechanisms underlying the relationship between BPH and HU-033. Through not only cellular and nuclear receptor functional assays, but TP-mediated BPH rat model treated with HU-033, we demonstrated that HU-033 exerted antagonist effect on α1A- and α1D-adrenergic receptors in vitro and inhibitory effect on protein expression of androgen receptor and estrogen receptor alpha in vivo. Taken together, these results suggest that HU-033 is a novel candidate for the management of BPH.

Background: Concerning of progression of deformity, it is reluctant to utilize a posterior approach if preoperative sagittal alignment is kyphotic or straight. The purpose of this study was to determine interval changes in cervical segmental angles after posterior cervical foraminotomy (PCF) and analyzing factors affecting cervical sagittal re-alignment in the postoperative period. Methods: Within 2 days and 6 months after PCF, postoperative plain radiograph was obtained to compare the cervical sagittal alignment with preoperative alignment in 286 consecutive patients. Sagittal angle between C2 and C7 formed by lines drawn at the base of axis and the superior endplate of the C7 vertebral body on lateral radiograph. To evaluate clinical outcomes, patients were routinely asked to gauge levels of pain they feeling at that point in time by visual analogue scale (VAS) on admission, prior to postoperative radiographs and 6 months after operation follow-up in outpatient. Results: More than two-third of the patients presenting with kyphotic or straight curvature improved short-term following operation. On follow-up plain radiographs after 6 months, the improvement of sagittal alignment was well maintained, but rather more prominent (P

Purpose To report the case of a 25-year-old male who sustained significant ocular trauma from a confirmed foam round. To review the scientific literature on kinetic impact projectiles and legislation currently proposed to regulate their use. Observations A 25-year-old male presented to the emergency department with acute pain and vision loss in his left eye after being struck by a foam round. Initial exam showed significant periorbital ecchymosis, multiple eyelid lacerations, microhyphema, and vitreous hemorrhage. Computed tomography revealed fractures of the inferior and medial orbital walls. Optical coherence tomography also demonstrated full-thickness macular hole. Microhyphema resolved after 15 days with steroid and mydriatic drops. Vision at 60 days after injury stabilized at 20/60. Repeat OCT at this time revealed closure of the macular hole. Care for the patient is ongoing. Conclusions and Importance Foam rounds can cause a pattern of vision-threatening ocular trauma similar to that of rubber bullets with the additional risk of chemical injury. During the George Floyd protests, isolated reports of significant foam round-related ocular injuries have been reported in the press, but systematic epidemiologic and clinical data on the subject remains lacking. While accurate identification of the causative weapon is not required in the management of ocular trauma, it may impact advocacy efforts undertaken by physicians and the subsequent legislative efforts they inspire. Current state and federal law does not adequately protect individuals from these munitions. Multiple proposals in Congress aptly recognize the significant risk of blinding injury and mortality posed by all kinetic impact projectiles.

Purpose Although polysomnography (PSG) is the gold standard for monitoring sleep, it has many limitations. We aimed to prospectively determine the validity of wearable sleep-tracking devices and smartphone applications by comparing the data to that of PSGs. Methods Patients who underwent one night of attended PSG at a single institution from January, 2015 to July 2019 were recruited. Either a sleep application or wearable device was used simultaneously while undergoing PSG. Nine smartphone applications and three wearable devices were assessed. Results We analyzed the results of 495 cases of smartphone applications and 170 cases of wearables by comparing each against PSG. None of the tested applications were able to show a statistically significant correlation between sleep efficiency, durations of wake time, light sleep or deep sleep with PSG. Snore time correlated well in both of the two applications which provided such information. Deep sleep duration and WASO measured by two of the three wearable devices correlated significantly with PSG. Even after controlling for transition count and moving count, the correlation indices of the wearables did not increase, suggesting that the algorithms used by the wearables were not largely affected by tossing and turning. Conclusions Most of the applications tested in this study showed poor validity, while wearable devices mildly correlated with PSG. An effective use for these devices may be as a tool to identify the change seen in an individual's sleep patterns on a day-to-day basis, instead of as a method of detecting absolute measurements.

We report the case of a 9-month-old girl with bilateral retinoblastoma who had incomplete tumor resolution after selective ophthalmic artery infusion chemotherapy (SOAIC). Systemic chemotherapy, rarely used as salvage therapy after SOAIC, with systemic carboplatin, etoposide, and vincristine achieved complete and sustained regression in both eyes.

Purpose T' trunk, along with hemi-hypertrophy of the left side of the face and left upper limb, presented for evaluation of an intraocular mass of the left eye (OS). Anterior examination OS showed diffuse episcleral and iris melanocytosis. Fundus examination OS showed diffuse choroidal melanocytosis as well as an elevated choroidal lesion. B-scan ultrasonography demonstrated a hollow lesion, and the patient was diagnosed with choroidal melanoma OS in the setting of phakomatosis pigmentovascularis with overlap of SWS and KTS. Fine-needle aspiration biopsy confirmed the diagnosis, and Iodine-125 plaque radiotherapy was performed. Conclusion Individuals with clinical features suggestive of phakomatosis pigmentovascularis, SWS or KTS should undergo a complete ophthalmological evaluation for the presence of ocular melanocytosis and uveal melanoma.

This study aimed to compare the cognitive performance and event-related potential (ERP) patterns between females who have given birth (parous) and those who have not (nulliparous). A total of 50 female participants, including 27 who were parous (33.2 ± 3.2 years) and 23 who were nulliparous (30.8 ± 2.3 years), were recruited. Only parous females who were ≤36 months postpartum (17.7 ± 8.1 months) were included. To compare the cognitive performance between the two groups, we presented the 3-back task (a working memory task) and compared the accuracy rate (%) and reaction time (ms) between the groups. Electroencephalogram (EEG) signals were simultaneously recorded and the ERP patterns at Fz, Cz, and Pz, which are highly associated with the 3-back task, were analyzed. From the ERP patterns, we extracted N100, P300, P600, P300 peak-to-peak (P300p_p), and P600 peak-to-peak (P600p_p). There were no significant between-group differences in terms of accuracy rate, reaction time, or ERP components (N100, P300, P600, P300p_p, or P600p_p) at the three sites (Fz, Cz, and Pz). Since this study, using meaningful objective data, did not show that parity was significantly correlated with cognitive performance ability and ERP patterns, childbirth does not appear to influence cognitive decline.

Inflammation-mediated skeletal muscle wasting occurs in patients with sepsis and cancer cachexia. Both conditions severely affect patient morbidity and mortality. Lithium chloride has previously been shown to enhance myogenesis and prevent certain forms of muscular dystrophy. However, to our knowledge, the effect of lithium chloride treatment on sepsis-induced muscle atrophy and cancer cachexia has not yet been investigated. In this study, we aimed to examine the effects of lithium chloride using in vitro and in vivo models of cancer cachexia and sepsis. Lithium chloride prevented wasting in myotubes cultured with cancer cell-conditioned media, maintained the expression of the muscle fiber contractile protein, myosin heavy chain 2, and inhibited the upregulation of the E3 ubiquitin ligase, Atrogin-1. In addition, it inhibited the upregulation of inflammation-associated cytokines in macrophages treated with lipopolysaccharide. In the animal model of sepsis, lithium chloride treatment improved body weight, increased muscle mass, preserved the survival of larger fibers, and decreased the expression of muscle-wasting effector genes. In a model of cancer cachexia, lithium chloride increased muscle mass, enhanced muscle strength, and increased fiber cross-sectional area, with no significant effect on tumor mass. These results indicate that lithium chloride exerts therapeutic effects on inflammation-mediated skeletal muscle wasting, such as sepsis-induced muscle atrophy and cancer cachexia.

Positive airway pressure (PAP) devices have been widely used as the first line of treatment in obstructive sleep apnea (OSA). Most advanced PAP devices support the estimation of respiratory index (RI) using the patient’s mask airflow. In addition to the compliance factor for PAP device use, which is important for monitoring patient sleep health, RI is also becoming important for monitoring. However, there are few reports that validate RI of a PAP device with polysomnography. Between January 2015 and December 2017, 50 participants were enrolled who were diagnosed with OSA and prescribed auto-titration PAP (APAP) devices. The RIs of participants were measured at night using APAP devices, concurrently with electroencephalography, respiratory inductance plethysmography sensors, and other polysomnographic sensors in a sleep laboratory. The respiratory-related data of APAP were prospectively analyzed with the manually scored polysomnographic data. The apnea-hypopnea index and apnea index showed a statistically close relationship between the auto-scored respiratory data from the APAP device and the manually scored respiratory data from polysomnographic sensors. Obstructive apnea and central apnea indices showed relatively low correlations. The differences between the auto-scored RI and manually scored RI were influenced by BMI, waist circumference, weight, oxygen saturation, and respiratory distress indices of diagnostic polysomnographic factors. The RIs of APAP devices have a tendency to be underestimated or mismatched when compared with polysomnography. Sleep specialists are advised to consider additional anthropometric and diagnostic factors to account for these differences during PAP treatment.

Obstructive sleep apnea is a highly prevalent cyclic repetitive hypoxia-normoxia respiratory sleep disorder characterized by intermittent upper-airway collapse. It is mainly diagnosed using in-laboratory polysomnography. However, the time-spatial constraints of this procedure limit its application. To overcome these limitations, there have been studies aiming to develop clinical prediction formulas for screening of obstructive sleep apnea using the risk factors for this disorder. However, the applicability of the formula is restricted by the group specific factors included in it. Therefore, we aimed to assess the risk factors for obstructive sleep apnea and develop clinical prediction formulas, which can be used in different situations, for screening and assessing this disorder. We enrolled 3,432 Asian adult participants with suspected obstructive sleep apnea who had successfully undergone in-laboratory polysomnography. All parameters were evaluated using correlation analysis and logistic regression. Among them, age, sex, hypertension, diabetes mellitus, anthropometric factors, Berlin questionnaire and Epworth Sleepiness Scale scores, and anatomical tonsil and tongue position were significantly associated with obstructive sleep apnea. To develop the clinical formulas for obstructive sleep apnea, the participants were divided into the development (n = 2,516) and validation cohorts (n = 916) based on the sleep laboratory visiting date. We developed and selected 13 formulas and divided them into those with and without physical examination based on the ease of application; subsequently, we selected suitable formulas based on the statistical analysis and clinical applicability (formula including physical exam: sensitivity, 0.776; specificity, 0.757; and AUC, 0.835; formula without physical exam: sensitivity, 0.749; specificity, 0.770; and AUC, 0.839). Analysis of the validation cohort with developed formulas showed that these models and formula had sufficient performance and goodness of fit of model. These tools can effectively utilize medical resources for obstructive sleep apnea screening in various situations.

This study was conducted to examine predictive factors of deep vein thrombosis (DVT) in gynecologic cancer survivors with lower extremity edema (LEE). In the current single-center, retrospective study, there was a total of 315 eligible patients, including 80 patients with DVT and 235 without DVT. They were therefore divided into two groups: the DVT group (n = 80) and the non-DVT group (n = 235). Then, baseline and clinical characteristics of the patients were compared between the two groups. In our study, distant organ metastasis, advanced stage, lymphadectomy, and amount of intraoperative blood loss had a positive predictive value for the occurrence of DVT in gynecologic cancer survivors presenting LEE. In conclusion, our results indicate that it is necessary to consider the possibility of LEE arising from DVT in gynecologic cancer survivors with advanced-stage cancer, distant organ metastasis, lymphadectomy, and intraoperative blood loss over 1500 mL.

STUDY OBJECTIVES: The aim of this study was to evaluate the accuracy of the Watch-PAT 200 (WP200) for diagnosing obstructive sleep apnea (OSA) in adolescents compared with polysomnography (PSG) according to the respiratory rules for children (RRC) and adults (RRA). METHODS: A total of 38 adolescents (mean age 15.1 ± 1.4 years; male 28 [73.7%]; body mass index [BMI] 23.1 ± 5.5 kg/m(2)) with suspected OSA were assessed with the WP200 and standard PSG simultaneously between July 2014 and September 2015 at a tertiary university hospital. All WP200 data were assessed according to the automatic algorithm, and PSG data were scored according to the RRC and RRA. We examined the correlation, agreement, and concordance in the apnea-hypopnea index (AHI) and minimum arterial oxygen saturation (mSaO(2)) between the WP200 and PSG-RRC or PSG-RRA. RESULTS: There were high correlations (r = .945, P < .001 [AHI-WP200 versus AHI-PSG-RRC]; r = .945, P < .001 [AHI-WP200 versus AHI-PSG-RRA]; r = .921, P < .001 [mSaO(2)-WP versus mSaO(2)-PSG]) and good agreements in AHI and mSaO(2) between the WP200 and PSG. In addition, there were high concordances in AHI severity (Kendall tau-b = .848, P < .001 [AHI-WP200 versus AHI-PSG-RRC]; Kendall tau-b = .944, P < .001 [AHI-WP200 versus AHI-PSG-RRA]) between the WP200 and PSG. CONCLUSIONS: The WP200 may be a clinically reliable tool for diagnosing OSA in adolescents. CITATION: Choi JH, Lee B, Lee JY, Kim HJ. Validating the Watch-PAT for diagnosing obstructive sleep apnea in adolescents. J Clin Sleep Med. 2018;14(10):1741–1747.

In anterior cruciate ligament (ACL) reconstruction, there is concern regarding the potential risk of femoral tunnel widening in the anteromedial portal (AMP) technique due to the acute graft-bending angle at the aperture and the more elliptical aperture shape of the femoral tunnel compared to the transtibial (TT) techniques. Therefore, the aim of the current systematic review and meta-analysis was to compare the femoral tunnel widening between the AMP and TT techniques in patients who underwent ACL reconstruction. It should be included the studies that reported on femoral tunnel widening in patients who underwent single-bundle ACL reconstruction, using soft-tissue tendon graft, with AMP and/or TT techniques. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACL reconstruction. Twenty-one studies were finally included in this meta-analysis. The pooled changes of absolute millimeters of tunnel widening from the immediate postoperative status to the last follow-up did not differ significantly between the AMP and TT techniques at both the aperture [3.31 mm, 95% confidence interval (CI) 1.7–5.0. mm versus 2.9 mm, 95% CI 2.4–3.4 mm, P = n.s.] and the midportion (3.5 mm, 95% CI 0.8–6.3 mm versus 3.0 mm, 95% CI 2.2–3.9 mm, P = n.s.) of the femoral tunnel. No significant difference was observed between the two techniques in the relative percentage of femoral tunnel widening (AMP; 28.8%, 95% CI 14.8–42.9% vs. TT; 29.7%, 95% CI 15.6–43.7%, P = n.s.). No significant difference in femoral tunnel widening was observed between the AMP and TT techniques, both in absolute millimeter and relative percentage, in patients who underwent single-bundle ACL reconstruction. This finding could alleviate the potential concerns associated with femoral tunnels being wider for the AMP than for the TT technique. III.

Several studies indicate the mitochondrial Aldehyde Dehydrogenase‐2 (ALDH2) gene G487A polymorphism may be correlated with coronary artery disease (CAD) susceptibility, but a clear consensus has yet to be reached. To elucidate the relationship between the ALDH2 gene G487A polymorphism and CAD within the Chinese population, a meta‐analysis of 5644 subjects from nine individual studies was performed. Pooled odds ratios (ORs) and their corresponding 95% confidence intervals were assessed using random or fixed‐effect models depending the heterogeneity existence or not. Our meta‐analysis found a significant association between ALDH2 gene G487A polymorphism and CAD in the Chinese population under allele (OR: 1.830, 95% CI: 1.560–2.140, P = 1.36 × 10−13), recessive (OR: 1.920, 95% CI: 1.530–2.390, P = 1.20 × 10−8), dominant (OR: 1.593, 95% CI: 1.336–1.900, P = 2.22 × 10−7), homozygous (OR: 2.280, 95% CI: 1.810–2.870, P = 3.17 × 10−12) and heterozygous genetic models (OR: 3.330, 95% CI: 2.070–5.370, P = 7.81 × 10−7). The positive correlation between the ALDH2 gene G487A polymorphism and CAD makes the mutation a strong candidate as a genetic risk marker for CAD. Through further analysis, we also found that A allele carriers of ALDH2 gene G487A polymorphism may be particularly susceptible to CAD.

In this study, an analysis was performed to observe the effect of resistance exercise and exopolymers purified from Aureobasidium pullulans (EAP) intake for 12 weeks on muscle reduction and improvement of muscle function in the elderly. A total of 45 elderly individuals (age distribution: 60–78 years; average age: 67.24 years) were randomized into 15 subjects in the high-dosage (1 g/d) intake and exercise group, 15 subjects in the low-dosage (0.5 g/d) intake and exercise group, and 15 subjects in the placebo intake and exercise group. Body composition, physical strength, isokinetic muscle function, blood lipids and blood pressure, and muscle metabolism-related hormones were measured in all three groups before and after the same 12-week exercise–nutrition program. Resistance exercise for 12 weeks and 1 g/day intake of EAP improved physical strength, isokinetic muscle function, blood lipids, blood pressure, and some parameters related to muscle metabolism. In the hormones related to muscle metabolism, the catabolic hormones CK and LDH significantly decreased (p

Objective To determine age-based criteria for polycystic ovary morphology. Design Cross-sectional, case-control design. Setting Outpatient setting. Subject(s) Women with polycystic ovary syndrome (PCOS) defined by hyperandrogenism and irregular menses (n = 544) and controls with regular menses and no evidence of hyperandrogenism (n = 666) participated. Parameters were tested in a second cohort of women with PCOS (n = 105) and controls (n = 32) meeting the same criteria. Intervention(s) Subjects underwent a pelvic ultrasound documenting ovarian volume and maximum follicle number in a single plane. Main Outcome Measure(s) A receiver operating characteristic curve was constructed to determine the ovarian volume and follicle number with the best sensitivity and specificity to define PCOS for age groups at approximately 5-year intervals from age 18 to >44 years. Result(s) The best sensitivity and specificity were obtained using a threshold volume of 12 mL and 13 follicles for ages ≤24 years, 10 mL and 14 follicles for ages 25–29 years, 9 mL and 10 follicles for ages 30–34 years, 8 mL and 10 follicles for ages 35–39 years, 10 mL and 9 follicles for ages 40–44 years, and 6 mL and 7 follicles for ages >44 years. Data from a second cohort confirmed the need to decrease volume and follicle number with increasing age to diagnose PCOS. Polycystic ovary morphology was most accurate at predicting the PCOS diagnosis for women ages 30–39 years. Conclusion(s) The ovarian volume and follicle number threshold to define polycystic ovary morphology should be lowered starting at age 30.

Objectives. To examine disparities in chronic conditions and health indicators among lesbian, gay, and bisexual (LGB) adults aged 50 years or older in the United States. Methods. We used data from the 2013 and 2014 National Health Interview Survey to compare disparities in chronic conditions, health outcomes and behaviors, health care access, and preventive health care by sexual orientation and gender. Results. LGB older adults were significantly more likely than heterosexual older adults to have a weakened immune system and low back or neck pain. In addition, sexual minority older women were more likely than their heterosexual counterparts to report having arthritis, asthma, a heart attack, a stroke, a higher number of chronic conditions, and poor general health. Sexual minority older men were more likely to report having angina pectoris or cancer. Rates of disability and mental distress were higher among LGB older adults. Conclusions. At substantial cost to society, many disparities in chronic conditions, disability, and mental distress observed in younger LGB adults persist, whereas others, such as cardiovascular disease risks, present in later life. Interventions are needed to maximize LGB health.

The aim of this study is to evaluate the validation of ApneaLink™ Plus (ALP) based on a large number of subjects in a prospective design. We recommended enrolling of 200 consecutive patients who had been referred because of habitual snoring or witnessed apnea during sleep. If consent was obtained, patients underwent standard polysomnography (PSG) and ALP evaluation simultaneously at the hospital (ALPlab), and repeated ALP at home (ALPhome) within 1 month. The parameters of ALP were scored based on three different systems, Manual, Auto AASM, and Auto scoring systems. Among the 200 patients who were recommended for enrollment, 149 completed the study. Sensitivity was good for all three scoring systems, while specificity was poor for the Auto scoring system. The area under curve was highest for the manual scoring system and lowest for the auto scoring system, and increased as the apnea-hypopnea index (AHI) cutoff value increased from 5 to 30. Regarding agreement with PSG, the manual scoring system was most superior, followed by the Auto AASM, and Auto scoring systems. The degree of agreement between PSG and ALP was affected by sleep efficiency and the arousal index. Moderate agreement between PSG and ALP based on central apnea index was observed. ALP is an accurate and reliable device for the diagnosis of OSA. Manual scoring is recommended; however, Auto AASM is also acceptable. ALP detects central sleep apnea to a certain degree. Both sleep efficiency and the arousal index affect the results of ALP.

// Yan-Yan Li 1, * , Hui Wang 2, * , Xin-Xing Yang 1 , Jing-Jing Wu 3 , Hong-Yu Geng 1 , Hyun Jun Kim 4 , Zhi-Jian Yang 2 and Lian-Sheng Wang 2 1 Department of Gerontology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China 2 Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China 3 Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China 4 Department of Physiology, University of Cincinnati, Cincinnati, OH 45267, United States of America * These authors have contributed equally to this work Correspondence to: Yan-Yan Li, email: lyynjmu123@126.com Keywords: leptin receptor , Gln223Arg, polymorphism, type 2 diabetes mellitus Received: February 09, 2017 Accepted: May 22, 2017 Published: June 27, 2017 ABSTRACT Background: The Leptin receptor ( LEPR ) Gln223Arg gene polymorphism has been associated with an increased susceptibility to Type 2 diabetes mellitus (T2DM). Results from various studies, however, are inconsistent. Objective and methods: To better elucidate the association of LEPR Gln223Arg gene polymorphism with T2DM in the Chinese population, a meta-analysis of 3,367 subjects from seven independent studies was performed. The pooled odds ratios (ORs) and corresponding 95% confidence intervals (95% CI) were evaluated by the fixed-effects model. Results: A significant relationship between LEPR Gln223Arg gene polymorphism and T2DM in the Chinese population was found under allele (OR: 1.432, 95% CI: 1.211-1.694, P=2.67×10 -5 ), dominant (OR: 1.466, 95% CI: 1.215-1.769, P=6.33×10 -5 ), recessive (OR: 0.539, 95% CI: 0.303-0.960, P=0.036), heterozygous (OR: 0.700, 95% CI: 0.577-0.849, P=3.06×10 -4 ), and homozygous (OR: 0.472, 95% CI: 0.265-0.839, P=0.011) genetic models. Conclusions: LEPR Gln223Arg gene polymorphism was associated with an increased risk of T2DM in the Chinese population. Therefore, Chinese carriers of the G allele of LEPR Gln223Arg gene polymorphism may be more susceptible to T2DM than the general population.

Purpose of the study Optimal engagement in health care plays a critical role in the success of disease prevention and treatment, particularly for older adults who are often in greater need of health care services. However, to date, there is still limited knowledge about the relationship between depression and health care engagement among lesbian, gay, bisexual, and transgender (LGBT) older adults. Design and methods This study utilized data from Aging with Pride: National Health, Aging, Sexuality/Gender Study, from the 2014 survey with 2,450 LGBT adults 50 years old and older. Multiple-variable regression was utilized to evaluate relationships between three indicators of health care engagement and four depression groups after controlling for background characteristics and discrimination in health care. Health care engagement indicators were "not using preventive care," "not seeking care when needed," and "difficulty in adhering to treatments." Depression groups were defined by depression diagnosis and symptomatology, including Diagnosed-Symptomatic group (Diag-Sympt), Diagnosed-Nonsymptomatic group (Diag-NoSympt), Nondiagnosed-Symptomatic group (NoDiag-Sympt), and Nondiagnosed-Nonsymptomatic group (NoDiag-NoSympt). Results Depression groups displayed different patterns and levels of health care engagement. The Diag-Sympt group displayed the highest "difficulty in adhering to treatments." Diag-NoSympt group displayed the lowest "not using preventive care." The NoDiag-Sympt group reported the highest "not using preventive care" and "not seeking care when needed." The NoDiag-NoSympt group had the lowest "not seeking care when needed" and "difficulty in adhering to treatments." Implications Depression diagnosis and symptomatology are jointly associated with health care engagement among LGBT older adults. Interventions aiming to promote health care engagement among this population should simultaneously consider both depression diagnosis and symptomatology.

Purpose of the study Converging evidence from large community-based samples, Internet studies, and Veterans Health Administration data suggest that transgender adults have high rates of U.S. military service. However, little is known about the role of prior military service in their mental health later in life, particularly in relation to identity stigma. In this article, we examine relationships between prior military service, identity stigma, and mental health among transgender older adults. Design and methods We used a subsample of transgender older adults (n = 183) from the 2014 survey of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). We employed weighted multivariate linear models to evaluate the relationships between psychological health-related quality of life (HRQOL), depressive symptomatology (Center for Epidemiological Studies Depression Scale [CES-D] scores), identity stigma, and prior military service, controlling for background characteristics. Results Identity stigma was significantly related with higher depressive symptomatology and lower psychological HRQOL. Having a history of prior military service significantly predicted lower depressive symptomatology and higher psychological HRQOL. The relationships between psychological HRQOL, identity stigma, and prior military service were largely explained by depressive symptomatology. Prior military service significantly attenuated the relationship between identity stigma and depressive symptomatology. Implications By identifying the role of military service in the mental health of transgender older adults, this study provides insights into how prior military service may contribute to resilience and positive mental health outcomes. Directions for future research are discussed.

Background: Although many studies indicate a positive correlation between GHRL gene Leu72Met polymorphism and an increased susceptibility to type 2 diabetes mellitus (T2DM), inconsistencies between independent studies still remain. Objective: Considering the inconsistencies between them, we have performed the current meta-analysis study. The objective of this study is to better examine the correlation of the GHRL gene Leu72Met polymorphism and T2DM. Methods: The current meta-analysis, involving 8,194 participants from 11 independent studies, was performed. A fixed effect model was used to evaluate the pooled odds ratios (ORs) and the corresponding 95% confidence intervals (95% CIs). Results: A significant association was found between T2DM and GHRL gene Leu72Met polymorphism under recessive (OR: 1.33, 95% CI: 1.01–1.76, P = 0.04), and homozygous genetic models (OR: 1.34, 95% CI: 1.01–1.78, P = 0.04) in the whole population. The correlation was more distinct in our subgroup analysis of the Chinese population under recessive (OR: 1.52, 95% CI: 1.07–2.15, P = 0.02), dominant (OR: 1.70, 95% CI: 1.38–2.10, P < 0.00001), additive (OR: 1.16, 95% CI: 1.02–1.33, P = 0.02), and homozygous genetic models (OR: 1.54, 95% CI: 1.07–2.20, P = 0.02). Conclusions: In short, GHRL gene Leu72Met polymorphism was significantly correlated with increased T2DM risk, particularly in the Chinese population. Individuals carrying the Met72 allele of GHRL Leu72Met gene polymorphism, particularly those of Chinese ancestry, may be more susceptible to developing T2DM disease.

Respiratory inductive plethysmography (RIP) is recommended as an alternative respiratory sensor for the identification of each apnea and hypopnea event in polysomnography. Using this sensor, the cumulative RIP results from the chest and abdomen (RIP sum) and time-derived results of the RIP sum (RIP flow) are calculated to track respiratory flow. However, the effectiveness of this sensor and the calculated respiratory results is still unclear, and validation studies for the scoring of respiratory events in polysomnography are rare. Two hundred subjects were selected according to the severity of obstructive sleep apnea. A sleep specialist re-evaluated the respiratory events based on RIP flow data in a single-blind study. Statistical analysis was conducted with paired respiratory events scored in each of the RIP flow and polysomnography datasets. All respiratory events scored from the RIP flow were strongly correlated with those identified with standard sensors of polysomnography, regardless of disease severity. Most of the respiratory parameters from RIP flow trended toward underestimation. The RIP flow obtained from the alternative RIP sensor was appropriate for the diagnosis of obstructive sleep apnea based on a receiver operating characteristic curve. Scored respiratory events from RIP flow data effectively reflected the respiratory flow and statistically correlated with the results from standard polysomnography sensors. Therefore, analyzing RIP flow utilizing an RIP sensor is considered a reliable method for respiratory event scoring.

Objective: This study examines whether disparities exist in poor health and depressive symptomatology among older gay/bisexual men (50+) with ( n = 371) and without ( n = 973) HIV. If so, what risk/promoting factors account for those disparities? Method: These cross-sectional analyses used 2014 data from the Aging With Pride: National Health, Aging, and Sexuality/Gender Study. Results: Those with HIV reported poorer health and more depressive symptomatology accounted for by lower income, resilience and social support, and more lifetime victimization. Poorer health among those with HIV was associated with more chronic conditions. Higher depressive symptomatology was associated with diagnosed anxiety and drug addiction. Community engagement reduced disparities in poor health and depression. Implications: Older gay/bisexual men living with HIV infection are at greater risk for physical and mental health issues. Assessments should be conducted with attention to these risk factors. Interventions for improving social support, resilience, and community engagement are warranted.

The aim of the study was to investigate cardiopulmonary coupling (CPC) as a tool for evaluating the efficacy of continuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea (OSA). The medical records of patients who had undergone either standard polysomnography (PSG-only group, n = 62) or split-night CPAP titration (CPAP titration group, n = 115) due to habitual snoring or sleep apnea were analyzed. The apnea-hypopnea index, CPC variables, and sleep stage (%) during the first 2 h of the sleep study did not differ between the PSG-only and CPAP titration groups. A comparison of data collected over the first 2 h and that collected over the rest of the sleep study revealed that high-frequency coupling (HFC) increased, and low-frequency coupling (LFC) and elevated LFC (e-LFC) decreased only for the CPAP titration group, while they did not change for the PSG-only group. The proportions of N1 and N3 stages and arousal index decreased while the proportion of R stage increased for both groups. The proportion of N2 stage and mean O2 saturation increased only for the CPAP titration group, while they did not change significantly for the PSG-only group. HFC increased while LFC and e-LFC decreased linearly as apnea-hypopnea index decreased for the CPAP titration group. CPC effectively reflects the treatment effect of CPAP when compared with an electroencephalography-based sleep stage assessment.

Aberrant vascularization is a hallmark of cancer progression and treatment resistance. Here, we have shown that endothelial cell (EC) plasticity drives aberrant vascularization and chemoresistance in glioblastoma multiforme (GBM). By utilizing human patient specimens, as well as allograft and genetic murine GBM models, we revealed that a robust endothelial plasticity in GBM allows acquisition of fibroblast transformation (also known as endothelial mesenchymal transition [Endo-MT]), which is characterized by EC expression of fibroblast markers, and determined that a prominent population of GBM-associated fibroblast-like cells have EC origin. Tumor ECs acquired the mesenchymal gene signature without the loss of EC functions, leading to enhanced cell proliferation and migration, as well as vessel permeability. Furthermore, we identified a c-Met/ETS-1/matrix metalloproteinase–14 (MMP-14) axis that controls VE-cadherin degradation, Endo-MT, and vascular abnormality. Pharmacological c-Met inhibition induced vessel normalization in patient tumor–derived ECs. Finally, EC-specific KO of Met inhibited vascular transformation, normalized blood vessels, and reduced intratumoral hypoxia, culminating in suppressed tumor growth and prolonged survival in GBM-bearing mice after temozolomide treatment. Together, these findings illustrate a mechanism that controls aberrant tumor vascularization and suggest that targeting Endo-MT may offer selective and efficient strategies for antivascular and vessel normalization therapies in GBM, and possibly other malignant tumors.

To compare the treatment effects of a high-dose and low-dose oral steroid regimen based on changes in the radioisotope uptake ratio (RUR) observed from three-phase bone scintigraphy (TPBS) in patients with complex regional pain syndrome type I (CRPS I), we retrospectively analyzed data of 34 patients with CRPS I from traumatic brain injury and stroke. Depending on the dose of steroid administered, patients were divided into high-dose (n = 14) and low-dose steroid groups (n = 20). We compared the severity scores, Kozin&rsquo, s classification scores, and RUR observed from TPBS between the two groups. There were significant changes in the severity scores and Kozin&rsquo, s classification between the baseline and 2 weeks from baseline (p &lt, 0.05), however, there were no significant differences in terms of changes in the scores, classification, or the RUR observed from TPBS at 2 weeks from baseline (p &gt, 0.05). There were no treatment-emergent adverse events (TEAEs) such as blood pressure elevation, impaired glycemic control, or gastrointestinal disturbances. Our results indicate that the efficacy profile of a low-dose oral steroid regimen is comparable to that of a high-dose regimen in alleviating symptoms in CRPS I patients. However, additional prospective, large-scale, multi-center studies are warranted to confirm our results.

Purpose. The purpose of this study was to investigate the association of exercise capacity, cardiac function, and coronary artery calcification (CAC) with components of metabolic syndrome in Korean adults. Method. Medical records of healthy adults who underwent exercise tolerance test (ETT), coronary CT angiography (CTA), and echocardiography of the heart for cardiac health check-up were retrospectively reviewed. Patients who had a history of severe cardiovascular disease or could not perform ETT due to other musculoskeletal problems were excluded. Subjects were classified into groups based on the number of components for metabolic syndrome: no component (Group 1, n=90), 1, 2 components (Group 2, n=321), and 3 or more components (Group 3, n=154). Exercise capacity was assessed using the symptom-limited ETT, and CAC score was obtained using the coronary CTA and Agatston score. Cardiac structure and function were assessed using echocardiography. Results. A total of 565 patients (mean (SD) age 59.5 (9.1), 340 men, 225 women) were selected. Exercise capacity was significantly lower in Group 3 than in the other groups (p Conclusion. Metabolic syndrome decreases exercise capacity of the patient and contributes to CAC, thereby increasing the risk for cardiovascular diseases and deterioration in cardiac structure and function. Therefore, early detection of metabolic syndrome and subsequently the prevention and management of heart disease are necessary.

To identify risk factors for patellofemoral degenerative progression after opening-wedge high tibial osteotomy (HTO) and to investigate the effect of patellofemoral degeneration on the patellofemoral specific patient-reported outcomes.Between March 2010 and June 2016, 94 knees (86 patients) underwent hardware removal with second-look arthroscopy at 21.4 months after opening-wedge HTO with first-look arthroscopy (mean follow-up duration, 49.8 months). Predictive factors for patellofemoral degeneration, including demographics, preoperative and postoperative mechanical axis (MA) of the lower limb (positive and negative MA indicating varus and valgus, respectively), tibial slope, and modified Blackburne-Peel ratio, were evaluated. Patients were divided into the progression and nonprogression groups according to their patellofemoral degenerative progression from first to second arthroscopy. Clinical outcomes, including the Kujala score and Knee Injury and Osteoarthritis Outcome Score, and radiographic outcomes were compared between the 2 groups.Postoperative MA (adjusted odd ratio, 0.62; P.001) was the most significant predictive factor for progressive change in the patellofemoral joint (RPostoperative MA, which might be related to overcorrection, is correlated with patellofemoral degenerative progression after opening-wedge HTO. Patients with patellofemoral degenerative progression showed inferior patient-reported outcomes.Level IV, case series with subgroup analysis.

Background: Presence of the β3-Adrenergic receptor (ADRB3) gene Trp64Arg (T64A) polymorphism may be associated with an increased susceptibility for essential hypertension (EH). A clear consensus, however, has yet to be reached. Objective and methods: To further elucidate the relationship between the ADRB3 gene Trp64Arg polymorphism and EH, a meta-analysis of 9,555 subjects aggregated from 16 individual studies was performed. The combined odds ratios (ORs) and their corresponding 95% confidence intervals (CI) were evaluated using either a random or fixed effect model. Results: We found a marginally significant association between ADRB3 gene Trp64Arg polymorphism and EH in the whole population under the additive genetic model (OR: 1.200, 95% CI: 1.00–1.43, P = 0.049). Association within the Chinese subgroup, however, was significant under allelic (OR: 1.150, 95% CI: 1.002–1.320, P = 0.046), dominant (OR: 1.213, 95% CI: 1.005–1.464, P = 0.044), heterozygous (OR: 1.430, 95% CI:1.040–1.970, P = 0.03), and additive genetic models (OR: 1.280, 95% CI: 1.030–1.580, P = 0.02). A significant association was also found in the Caucasian subgroup under allelic (OR: 1.850, 95% CI: 1. 260–2.720, P = 0.002), dominant (OR: 2.004, 95% CI: 1.316–3.052, P = 0.001), heterozygous (OR: 2.220, 95% CI: 1.450–3.400, P = 0.0002), and additive genetic models (OR: 2.000, 95% CI: 1. 330–3.010, P = 0.0009). Conclusions: The presence of the ADRB3 gene Trp64Arg polymorphism is positively associated with EH, especially in the Chinese and Caucasian population. The Arg allele carriers of ADRB3 gene Trp64Arg polymorphism may be at an increased risk for developing EH.

Olfactory dysfunction and tinnitus are age-related otorhinolaryngological disorders with a high prevalence in the elderly population and share several common clinical features. However, there is no study investigating the relationship between these two diseases. We studied the prevalence of olfactory dysfunction and tinnitus among Koreans and studied the relationship between these two diseases based on the Korean National Health and Nutrition Examination Survey. The subjects of this study were enrolled from the Fifth Korean National Health and Nutrition Examination Survey (2010–2012, n = 25,534). Data of subjects aged 40 years and older who underwent physical examination and completed a self-reported questionnaire and other anthropometric variables were statistically analyzed. Odds ratios were calculated to identify the relationship between olfactory dysfunction and tinnitus, using multiple logistic regression models. Older males, non-smokers, non/lower alcohol drinker groups exhibited the relationship between olfactory dysfunction and tinnitus. Metabolic syndrome and mental health problems were associated with both olfactory dysfunction and tinnitus. After adjusting for confounding factors, olfactory dysfunction was significantly associated with tinnitus (OR 1.318). There was a dose-response relationship between tinnitus severity and the odds of olfactory dysfunction (ORs for mild, moderate and severe tinnitus were, respectively, 1.134, 1.569 and 2.044). Additional molecular genetics and animal studies are needed to determine the shared pathophysiology of the two diseases.

Objective In the treatment of metastatic soft tissue sarcoma (STS), pazopanib is considered a standard treatment after failure of chemotherapy. We retrospectively investigated outcomes of pazopanib in patients with metastatic uterine STS. Methods A retrospective study was performed on 35 consecutive patients with uterine STS treated with oral pazopanib 800 mg daily as salvage therapy for metastatic disease between September 2013 and December 2015. Endpoints included response rate, survival, and safety. Results Among 35 patients, 27 (77%) had a histologic diagnosis of leiomyosarcoma (LMS) and the median age was 57 years (range, 36-70). Median number of metastatic sites was one (range, 1-5) with lung as the most frequently involved site. Pazopanib was generally well-tolerated: the major hematologic toxicity was grade 1/2 anemia (14%). Among the non-hematologic toxicities, grade 1/2 stomatitis was most commonly observed (22%), followed by fatigue and hypertension. Objective response and stable disease were observed in 10 (29%) and 11 (31%) patients, respectively. However, most cases of clinical response were observed in patients with LMS: 33% for LMS, 20% for undifferentiated pleomorphic sarcoma, and 0% for endometrial stromal sarcoma. Median progression-free and overall survivals were 5.8 months (95% confidence interval [CI]=3.6-8.1) and 20.0 months (95% CI=11.6-28.4), respectively. Conclusion In this "real-world" retrospective study, salvage therapy with pazopanib demonstrated clinically relevant efficacy and tolerability in unselected patients with uterine STS. Although it is encouraging that outcomes for Korean patients with uterine STS were similar to those reported in the phase III trial, the clinical benefit was limited to LMS.

Background: Many studies suggest that the small ubiquitin-like modifier 4 (SUMO4) M55V gene polymorphism (rs237025) may be associated with an increased risk of type 2 diabetes mellitus (T2DM). However, due to other conflicting results, a clear consensus is lacking in the matter. Objective and methods: A meta-analysis consisting of 6,823 subjects from 10 studies was conducted to elucidate relationship between the SUMO4 M55V gene polymorphism and T2DM. Depending on the heterogeneity of the data, either a fixed or random-effects model would be used to assess the combined odds ratio (ORs) and their corresponding 95% confidence interval (CI). Results: SUMO4 gene M55V polymorphism was significantly associated with T2DM in the whole population under allelic (OR: 1.18, 95% CI: 1.10 - 1.28, P = 1.63×10-5), recessive (OR: 1.59, 95% CI: 1.14-2.23, P = 0.006), dominant (OR: 0.815, 95% CI: 0.737 - 0.901, P = 6.89×10-5), homozygous (OR: 1.415, 95% CI: 1.170 - 1.710, P = 0.0003), heterozygous (OR: 1.191, 95% CI: 1.072 - 1.323, P = 0.001), and additive genetic models (OR: 1.184, 95% CI: 1.097 - 1.279, P = 1.63×10-5). In our subgroup analysis, a significant association was found again in the Chinese population, but not in Japanese or Iranian population. Conclusion: SUMO4 gene M55V polymorphism may correlate with increased T2DM risk. Chinese carriers of the V allele of the SUMO4 gene M55V polymorphism may be predisposed to developing T2DM.

The present study compared event-related potential (ERP) patterns for two stimuli types, puff and suction, by applying these stimuli to the fingers; ERP patterns for the two stimuli were compared at C3, an area related to somatosensory perception, and at FC5, an area related to motor function. Participants were 12 healthy males in their 20s (mean age=23.1±2.0 years). One session consisted of a Control Phase (3s), a Stimulation Phase (3s), and a Rest Phase (9s). During the Stimulation Phase, a 4-psi suction or puff stimulus was applied to the first joint of the right index finger. After completion of the session, a subjective magnitude test was presented. In all phases, electroencephalography signals were recorded. We extracted maximum positive amplitude and minimum negative amplitude as well as relevant latency values for C3 and FC5 signals. Suction and puff stimuli had similar subjective magnitude scores. For both C3 and FC5, the maximum and minimum amplitude latency was reached earlier for the suction stimulus than for the puff stimulus. In conclusion, when suction and puff stimuli of the same intensity were applied to the fingers, the suction stimulus caused a more sensitive response in the somatosensory area (C3) and motor area (FC5) than did the puff stimulus.

Objectives Pediatric obstructive sleep apnea has a relatively high prevalence and has various negative health and behavioral consequences. Among the various complications of pediatric obstructive sleep apnea, growth disturbance is still controversial. Method 745 pediatric subjects with obstructive sleep apnea diagnosed by in-lab polysomnography were enrolled, after excluding ineligible subjects with abnormal growth related factors. Height, weight, and BMI of enrolled patients were measured and statistically converted to z-scores, and the converted data were analyzed statistically with the polysomnographic results. Multiple linear regression were used to analyze the relationships between age, gender, z-score for weight, polysomnography results, and z-score for height. Results Patients with higher respiratory related index or lower mean/lowest oxygen saturation of PSG showed smaller z-score for height. Mean apnea hypopnea index and standard deviation of enrolled patients was 7.46 ± 12.92, with moderate severity. And mean z-score for height and standard deviation was 0.21 ± 1.15. Apnea hypopnea index, respiratory disturbance index, obstructive apnea index, and hypopnea index, respiratory related results of polysomnography, were statistically negative correlated with a z-score for height. And mean oxygen saturation and lowest oxygen saturation, oxygen saturation results of polysomnography, were statistically positive correlated with a z-score for height. Conclusions Respiratory related results and oxygen saturation results of polysomnography show negative and positive correlation with z-score for height. Therefore, pediatric obstructive sleep apnea have a negative effect on longitudinal growth.

Background: Although endothelial cell protein C receptor (EPCR) gene Ser219Gly polymorphism has been associated with venous thromboembolism (VTE) susceptibility, no clear consensus has yet been reached. Objective and methods: A meta-analysis of 9,494 subjects from 13 individual studies was conducted to better elucidate the potential relationship between the EPCR gene Ser219Gly polymorphism and VTE. Pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were evaluated by using fixed or random effect models. Results: The current meta-analysis suggested that there was a significant association between EPCR gene Ser219Gly polymorphism and VTE under allelic (OR: 1.42, 95% CI: 1.21–1.66, P = 1.30 × 10−5), recessive (OR: 2.02, 95% CI: 1.44–2.85, P = 5.35 × 10−5), homozygous (OR: 2.24, 95% CI: 1.59–3.16, P = 3.66 × 10−6), and additive genetic models (OR: 1.63, 95% CI: 1.30–2.04, P = 2.24 × 10−5). Conclusions: EPCR gene Ser219Gly polymorphism was associated with an elevated risk of VTE and the Gly residue carriers of the EPCR gene might be predisposed to VTE.