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Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel β-coronavirus, causes severe pneumonia and has spread throughout the globe rapidly. The disease associated with SARS-CoV-2 infection is named coronavirus disease 2019 (COVID-19). To date, real-time reverse-transcription polymerase chain reaction (RT-PCR) is the only test able to confirm this infection. However, the accuracy of RT-PCR depends on several factors; variations in these factors might significantly lower the sensitivity of detection. Methods In this study, we developed a peptide-based luminescent immunoassay that detected immunoglobulin (Ig)G and IgM. The assay cutoff value was determined by evaluating the sera from healthy and infected patients for pathogens other than SARS-CoV-2. Results To evaluate assay performance, we detected IgG and IgM in the sera from confirmed patients. The positive rate of IgG and IgM was 71.4% and 57.2%, respectively. Conclusions Therefore, combining our immunoassay with real-time RT-PCR might enhance the diagnostic accuracy of COVID-19.

BackgroundThe purpose of current study is to evaluate the analytical performance of seven kits for detecting IgM/IgG antibody of corona virus (2019-nCoV) by using four chemiluminescence immunoassay systems.Methods50 patients diagnosed with 2019-nCoV infection and 130 controls without corona virus infection from the General Hospital of Chongqing were enrolled in current retrospective study. Four chemiluminescence immunoassay systems including seven IgM/IgG antibody detection Kits for 2019-nCoV (A_IgM, A_IgG, B_IgM, B_IgG, C_IgM, C_IgG, D_Ab) were employed to detecting antibody concentration. Chi-square test, receiver operating characteristic (ROC) curve and Youden’s index were demonstrated to verify the cutoff value of each detection system.ResultsThe repeatability verification results of the A, B, C, and D system are all qualified. D-Ab performances best (92% sensitivity and 99.23% specificity), and B_IgM worse than other systems. Except for the system of A_IgM and C_IgG, the optimal diagnostic thresholds and cutoff value of other kits from recommendations are inconsistent with each other. B_IgM got the worst AUC and C_IgG had the best diagnostic accuracy. More importantly, B_IgG system have the highest false positive rate for testing patients with AIDS, tumor and pregnant. A_IgM system test showed highest false positive rates among elder over 90 years old.ConclusionsSystems for CoVID-2019 IgM/IgG antibody test performance difference. Serum diagnosis kit of D-Ab is the most reliable detecting system for 2019-nCoV antibody, which can be used as an alternative method for nucleic acid testing.

Background: IgA antibodies against Epstein-Barr virus (EBV) capsid antigen (VCA) and nuclear antigen 1 (EBNA1) have been proposed to facilitate the diagnosis and early detection of nasopharyngeal carcinoma (NPC) in high-incidence regions. However, while new methodologies and new platforms for the detection of VCA-IgA and EBNA1-IgA have become available, proper interassay simultaneous comparisons have not been carried out. The study was to compare the performance of the chemiluminescent immunoassays (CLIA) and enzyme-linked immunosorbent assay (ELISA) for VCA-IgA and EBNA1-IgA antibodies, and to evaluate the levels of EBV antibodies in healthy population from different areas of China. Methods: CLIA and ELISA for VCA-IgA and EBNA1-IgA were performed in NPC and healthy populations from high-incidence areas of NPC in South China (N=555), medium-incidence areas of NPC in Central China (N=318) and low-incidence areas of NPC in North China (N=379), and the results were compared and analyzed. Results: (1) The highest sensitivity in total, early and advanced NPC were 91.5% (CLIA for VCA-IgA), 86.4% (CLIA and ELISA-2 for EBNA1-IgA) and 93.6% (CLIA for VCA-IgA). However, the specificity of EBV-IgA measured by CLIA was relatively lower than ELISA. The top three seromarkers with the largest AUC was CLIA for VCA-IgA (AUC: 0.929, 95% CI: 0.905-0.953), ELISA-2 for EBNA1-IgA (AUC: 0.922, 95% CI: 0.896-0.947) and CLIA for EBNA1-IgA (AUC:0.919, 95% CI: 0.893-0.945), respectively. The positive and negative coincidence rates of the two EBNA1-IgA kits were 69.5% and 91.9%, respectively. However, the coincidence rates of VCA-IgA were relatively low. CLIA kits had good repeatability between different laboratories. (2) The positive rates of EBV-IgA antibodies were relatively high in high-incidence areas of NPC (P < 0.017), while there was no significant difference in the antibody positive rates between medium-incidence areas and low-incidence areas of NPC (P > 0.05). Conclusions: The performance of EBV-IgA antibodies measured by CLIA has good repeatability, higher sensitivity and similar specificity. The higher EBV-IgA positive rate in healthy subjects by CLIA raises concern about its suitability for NPC-risk screening and requires further analysis.

Background The information on mortality after an acute stroke patient is still limited. Objectives The aim of this study was to investigate the prognostic potential of procalcitonin (PCT) serum levels in acute ischemic stroke. Methods A total of 748 patients were enrolled in this study. Prognostic potential of PCT was evaluated by Kaplan‐Meier analysis and multivariable Cox hazard regression analyses. Results Procalcitonin levels were found to be significantly higher in acute ischemic stroke patients who died in 30 days than those who survived. Univariate logistic regression analysis showed that PCT was significantly associated with 30‐day mortality, and Cox regression analysis revealed that PCT was a strong predictor of 30‐day overall mortality. Kaplan‐Meier analysis revealed that overall cumulative 30‐day mortality was significantly higher in those with PCT levels >1.5 ng/mL when compared to those with PCT levels

BackgroundWe aim to investigate the profile of acute antibody response in COVID-19 patients, and provide proposals for the usage of antibody test in clinical practice.MethodsA multi-center cross-section study (285 patients) and a single-center follow-up study (63 patients) were performed to investigate the feature of acute antibody response to SARS-CoV-2. A cohort of 52 COVID-19 suspects and 64 close contacts were enrolled to evaluate the potentiality of the antibody test.ResultsThe positive rate for IgG reached 100% around 20 days after symptoms onset. The median day of seroconversion for both lgG and IgM was 13 days after symptoms onset. Seroconversion of IgM occurred at the same time, or earlier, or later than that of IgG. IgG levels in 100% patients (19/19) entered a platform within 6 days after seroconversion. The criteria of ‘IgG seroconversion’ and ‘> 4-fold increase in the IgG titers in sequential samples’ together diagnosed 82.9% (34/41) of the patients. Antibody test aided to confirm 4 patients with COVID-19 from 52 suspects who failed to be confirmed by RT-PCR and 7 patients from 148 close contacts with negative RT-PCR.ConclusionIgM and IgG should be detected simultaneously at the early phase of infection. The serological diagnosis criterion of seroconversion or the ‘>; 4-fold increase in the IgG titer’ is suitable for a majority of COVID-19 patients. Serologic test is helpful for the diagnosis of SARS-CoV-2 infection in suspects and close contacts.

A respiratory illness has been spreading rapidly in China, since its outbreak in Wuhan city, Hubei province in December 2019. The illness was caused by a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical manifestations related to SARS-CoV-2 infection ranged from no symptom to fatal pneumonia. World Health Organization (WHO) named the diseases associated with SARS-CoV-2 infection as COVID-19. Real time RT-PCR is the only laboratory test available till now to confirm the infection. However, the accuracy of real time RT-PCR depends on many factors, including sampling location and of methods, quality of RNA extraction and training of operators etc.. Variations in these factors might significantly lower the sensitivity of the detection. We developed a peptide-based luminescent immunoassay to detect IgG and IgM. Cut-off value of this assay was determined by the detection of 200 healthy sera and 167 sera from patients infected with other pathogens than SARS-CoV-2. To evaluate the performance of this assay, we detected IgG and IgM in the 276 sera from confirmed patients. The positive rate of IgG and IgM were 71.4% (197/276) and 57.2% (158/276) respectively. By combining with real time RT-PCR detection, this assay might help to enhance the accuracy of diagnosis of SARS-CoV-2 infection.

Hepatitis C virus (HCV) genotype (GT) distribution in China shows significant geographical and demographic difference. As a routinely tested virus in Chinese blood bank systems, rare molecular epidemiology research in blood donors is reported. Our purpose is to investigate the HCV GT/subtypes distribution, phylogenetic analysis and population genetics in Chinese blood donors. Anti-HCV screen positive samples and donor demographics were collected. HCV Core and E1 gene fragments were amplified by RT-PCR, followed by sequencing and phylogenetic analysis to determine HCV GTs/subtypes using MEGA 7.0. The population genetics were performed using Arlequin v3.0 and Beast v1.10.4. SPSS Statistics 17.0 software was used to analyze the correlation between HCV GTs/subtypes distribution and demographic characteristics. 419 and 293 samples based on Core and E1 gene respectively were successfully amplified. HCV la, lb, 2a, 3a, 3b, 6a, 6e and 6n were found, and the corresponding proportions were 0.66% (3/455), 58.68% (267/455), 17.80% (81/455) and 5.05% (23/455), 3.52% (16/455), 12.31% (56/455), 0.88% (4/455) and 0.66% (3/455). Samples from Guangxi showed the most abundant genetic diversity with 8 subtypes were found. The number of haplotypes in HCV-1b is higher than 2a and 6a. The negative Tajima's D and Fu's Fs values of HCV-1b, 2a and 6a suggested the population expansion of those HCV subtypes. The distribution of HCV GT showed significant statistical difference by age and ethnicity. Conclusion: An abundance of HCV genetic diversity was found in Chinese blood donors with mainly 1b and then 2a subtype. There were significant geographical and demographic differences in HCV GTs/subtypes among Chinese blood donors. HCV subtype 1b has stronger viability and HCV subtype 6a has experienced significant expansion.

Crop insurance in China is currently adopting the premium pricing strategy of “One Province One Rate”, which appears to be in line with the systematic risk characteristics within crop insurance. This research aims to investigate the theoretical rationalization of this pricing strategy and its implications using the spatial lag model and the county-level data from the 45 corn plant counties of Jilin Province, China. Results corroborate that: (1) the spatial spillover effect of the corn yield risk is significant in Jilin but decreases rapidly when the risk unit includes more than eight counties; and (2) separating Jilin Province into eight risk zones for corn insurance will significantly reduce the high cross-subsidy phenomenon arising from the “One Province One Rate” strategy and shall benefit poor peasants in the region as well. This paper not only proves the existence of a systematic risk of crop insurance but also reveals that the spatial correlation and systemic features of the crop yield risk do not create a solid foundation for the current pricing strategy of “One Province One Rate”. These conclusions will undoubtedly provide important references and empirical evidence for the role of China's crop insurance in poverty alleviation.

Graphene quantum dots (GQDs)-based nanohybrid materials have gained great attention in multiple research applications, particularly in biomedical fields due to their unique physicochemical properties and outstanding biocompatibility compared to other nanomaterials. In this review, we focus on the most recent emerging developments including synthesis methods, in vivo imaging and in vitro biosensing applications. We also discuss these unresolved problematic and controversial issues facing their biomedical applications. Consequently, trends in approaches to improve the analytical performance of GQDs-based nanomaterials have also been put forward. Keywords: Graphene quantum dots (GQDs), Immunosensors, Imaging, Drug delivery, Toxicity

Background Surgical patients with OSA are at increased risk for perioperative complications. Postoperative supplemental oxygen is commonly used, but it may contribute to respiratory depression in patients with OSA receiving opioids. The objective of the study is to investigate the effect of postoperative supplemental oxygen on arterial oxygen saturation (Sao 2 ), sleep respiratory events, and CO 2 level in patients with untreated OSA. Methods Consented patients with an apnea hypopnea index (AHI) > 5 events per hour on a preoperative polysomnography were randomized (1:1) to oxygen (O 2 group) or no oxygen (control group). The O 2 group received oxygen at 3 L/min via nasal prongs for three postoperative nights. The primary outcomes were polysomnographic parameters measuring Sao 2 , sleep respiratory events, and Pco 2 measured by transcutaneous CO 2 monitor (P tc CO 2 ) on nights 1 through 3. The intention-to-treat and per protocol analysis were completed. Results There were 123 patients randomized (O 2 group: n = 62; control group: n = 61). On night 3, the O 2 vs control group had a higher average Sao 2 (95.2% ± 3% vs 91.4% ± 4%, respectively; P P 2 group had a decreased AHI (median, 8.0; 25th-75th percentile, 2.1-19.9 vs median, 15.6; 25th-75th percentile, 9.5-45.8, respectively; P = .016), hypopnea index ( P P = .026) and a shortened longest apnea hypopnea duration ( P = .002). Although time percentage with P tc CO 2 ≥ 55 mm Hg ≥ 10% on postoperative night 1, 2, or 3 was found in 11.4% patients, there was no difference in P tc CO 2 between the groups. Conclusions Postoperative supplemental oxygen was found to improve oxygenation and decrease the AHI without increasing the duration of apnea-hypopnea event or P tc CO 2 level. A small number of patients had significant CO 2 retention while receiving supplemental oxygen. Trial Registry ClinicalTrials.gov; No.: NCT01552304; URL: www.clinicaltrials.gov

There exists a high prevalence of OSA in the general population, a great proportion of which remains undiagnosed. The snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) questionnaire was specifically developed to meet the need for a reliable, concise, and easy-to-use screening tool. It consists of eight dichotomous (yes/no) items related to the clinical features of sleep apnea. The total score ranges from 0 to 8. Patients can be classified for OSA risk based on their respective scores. The sensitivity of STOP-Bang score ≥ 3 to detect moderate to severe OSA (apnea-hypopnea index [AHI] > 15) and severe OSA (AHI > 30) is 93% and 100%, respectively. Corresponding negative predictive values are 90% and 100%. As the STOP-Bang score increases from 0 to 2 up to 7 to 8, the probability of moderate to severe OSA increases from 18% to 60%, and the probability of severe OSA rises from 4% to 38%. Patients with a STOP-Bang score of 0 to 2 can be classified as low risk for moderate to severe OSA whereas those with a score of 5 to 8 can be classified as high risk for moderate to severe OSA. In patients whose STOP-Bang scores are in the midrange (3 or 4), further criteria are required for classification. For example, a STOP-Bang score of ≥ 2 plus a BMI > 35 kg/m(2) would classify that patient as having a high risk for moderate to severe OSA. In this way, patients can be stratified for OSA risk according to their STOP-Bang scores.

Cupriavidus gilardii was first identified as an aerobic, gram-negative, glucose-nonfermenting rod. C. gilardii has been characterized as an organism with low pathogenicity that causes opportunistic infections and few case reports of infection caused by this organism previously. We encountered the first case of bloodstream infection caused in China by C. gilardii in a 87-year old man without obvious immunodeficiency. The isolate were identified as C. gilardii by 16S rRNA sequencing. The infected patient was treated according to the laboratory's antibiogram of this strain. Similar to the case report in Japan, this is the second report of an infection caused by this organism without obvious immunodeficiency, suggesting that C. gilardii exerts its pathogenicity both in immunodeficient and immunocompetent hosts.

Date Presented 03/27/20 One-third of the survey respondents reported engaging in new leisure activities after stroke, as a response to lifestyle change. These new leisure activities represented a greater emphasis on physical, mental, and spiritual health, supported by family and friends. During client-centered goal-setting, OT practitioners may consider incorporating new leisure activities to promote health for stroke survivors. Primary Author and Speaker: Yen-Pu Liao Additional Authors and Speakers: Chinyu Wu Contributing Authors: Chia-Yi Lee

This work uses different classes of premium principles (including the expected value premium principle, the variance premium principle and the exponential premium principle) as well as optimal reinsurance problems to minimize the probability of ruin and maximize the expected utility in both a diffusion insurance risk model and a compound Poisson insurance risk model. The optimal reinsurance strategy with a nontrivial structure and its respective optimal value function are obtained. Specifically, the optimal reinsurance strategy has a curved form, which is distinguished from the conventional proportional and excess-of-loss reinsurance strategies. Numerical analyses are provided to illustrate the behaviors of the optimal reinsurance strategies under different objective criteria and different insurance risk processes.

It was demonstrated in previous studies that cysteine-rich angiogenic inducer 61 (Cyr61) plays vital roles in hematological disorders, and we have already reported that the Cyr61 protein is a tumor promoter in acute myeloid leukemia (AML). Here, we investigated the association between CYR61 gene polymorphisms and susceptibility to AML. We genotyped 2 single-nucleotide polymorphisms (rs2297141 and rs6576776) in the region of the CYR61 gene by improved multiplex ligase detection reaction genotyping assays in a total of 275 samples, including samples from 137 AML patients and 138 healthy controls. Chi-squared tests and logistic regression analysis were performed to compare the different distributions of the genotypes and alleles between patients and healthy controls. The rs2297141 A allele was associated with lower risk of AML compared with the G allele (odds ratio [OR] = 0.704, 95% confidence interval [CI] = 0.503–0.985, P = .04) in both the dominant (OR = 0.447, 95% CI = 0.22–0.909, P = .025, AA vs GG) and recessive inheritance models (OR = 0.419, 95% CI = 0.23–0.763, P = .004, AA vs GA + GG). Although the distribution of the rs6576776 alleles was not different between patients with AML and normal controls, the CC genotype significantly increased the risk of AML in the dominant inheritance model (OR = 6.064, 95% CI = 1.303–28.216, P = .01, CC vs GG) and the recessive inheritance model (OR = 5.937, 95% CI = 1.291–27.306, P = .01, CC vs GC + GG). Additionally, it was shown that the rs2297141 and rs6576776 genotypes were associated with AML-M5 and AML-M2, respectively. Our findings indicated that genetic polymorphisms in the CYR61 gene may be considered potential AML risk factors in the Han Chinese population.

The aim of this study was to investigate the association between interleukin (IL)-10-1082 (G/A) promoter polymorphism and acute rejection (AR) in renal transplant recipients.We searched MEDLINE, EMBASE, Web of Science, and Cochrane Central Register from the inception to March 2015 for relevant studies. Data concerning publication information, population characteristics, and transplant information were extracted. Odds ratios (ORs) was calculated for the association between IL-10-1082 GG genotype (or IL-10-1082 G allele) and AR risk.This meta-analysis included 22 case-control studies including 2779 cases of renal transplant recipients. The pooled estimate showed that the IL-10-1082 GG genotype was not significantly associated with AR risk (ORrandom=1.07, 95% CI 0.80-1.43, p = 0.64). Similarly, the pooled estimate showed that the IL-10-1082 G allele was not significantly associated with AR risk (ORfixed=1.02, 95% CI 0.90-1.16, p = 0.74). None of subgroup analyses yielded significant results in the association between IL-10-1082 GG genotype (or IL-10-1082 G allele) and AR risk. Meta-regression confirmed that there was no significant correlation between the pre-selected trial characteristics and our study results.This meta-analysis suggests that IL-10-1082 G/A polymorphism is not significantly associated with AR risk in renal transplant recipients.

Recently published data show that postoperative apnea-hypopnea index (AHI) is significantly increased in some patients without preoperative sleep apnea. These patients may be at risk of developing perioperative adverse events related to sleep-disordered breathing (SDB). The objective of this study was to investigate the incidence and predictors of postoperative moderate-to-severe SDB (AHI15 events/h) in patients without sleep apnea preoperatively.In a prospective observational fashion, patients were invited to undergo sleep studies with a portable device (Embletta X100) preoperatively at home and postoperatively on the first and third night after surgery in the hospital or at home. The primary outcome was the incidence of postoperative moderate-to-severe SDB (AHI15 events/h) in non-sleep apnea patients (preoperative AHI ≤ 5 events/h). Logistic regression was used to evaluate the association of clinical factors and preoperative sleep parameters with the occurrence of postoperative moderate-to-severe SDB.A total of 120 non-sleep apnea patients completed the study, of which 31 (25.8% [95% confidence interval: 18.3%-34.6%]) patients were found to have AHI15 events/h on postoperative night 1 and/or postoperative night 3 (postoperative SDB group), and 89 (74%) patients had an AHI ≤ 15 events/h on both postoperative night 1 and 3 (postoperative non-SDB group). The patients in the postoperative SDB group were older (60 ± 13 vs 53 ± 12 years, P = 0.008) with more smokers (32.3% vs 15.7%, P = 0.048) and had a greater increase in the obstructive apnea index (adjusted P = 0.0003), central apnea index (adjusted P = 0.0012), and hypopnea index (adjusted P = 0.0004). Multivariate logistic regression analysis found that age and preoperative respiratory disturbance index (RDI) were significantly associated with the occurrence of postoperative moderate-to-severe SDB, P = 0.018 and P = 0.006, respectively. The sensitivity privilege cutoff of RDI at 4.9 events/h identified 70.2% to 96.4%patients developing postoperative moderate-to-severe SDB.At least 18.3% of non-sleep apnea patients developed moderate-to-severe SDB after surgery. Age and preoperative RDI were associated with the occurrence of postoperative moderate-to-severe SDB.

The relationship between viral infections and first-trimester spontaneous abortions is not well-understood. The study aim was to investigate the prevalence of cytomegalovirus (CMV), human parvovirus B19 (B19V), and herpes simplex virus-1/2 (HSV-1/2) infection by molecular and serological techniques in women experiencing spontaneous miscarriage in the first trimester of pregnancy. Plasma samples were examined for CMV, B19V, and HSV-1/2 DNA using real-time quantitative polymerase chain reaction (Real-time qPCR), and for specific IgG antibodies against B19V, CMV, and HSV-1/2 using serological assays. The abortion group consisted of women (n = 1,716) with a history of two or more first-trimester spontaneous abortions. Women younger than 30 years possess higher portion to experience spontaneous abortion. No specimens were positive for B19V or CMV DNA. Seven out of the 1,716 specimens were positive for HSV-1/2 DNA. By serology, 47.24% of patients were positive for B19V IgG, 39.66% for HSV IgG, 79.31% for CMV IgG, and 9.31% for B19V IgM. The high rate of positivity for CMV IgG suggests that the majority of women with first-trimester spontaneous abortions are not susceptible to primary CMV infection. The lack of virus DNA in the majority of cases indicates that B19V, CMV, and HSV-1/2 infection is not commonly associated with first-trimester spontaneous abortion. J. Med. Virol. 87:1749–1753, 2015. © 2015 Wiley Periodicals, Inc.

Streptococcus pneumoniae, a major respiratory pathogen, is a leading cause of death among children worldwide. Mucosal vaccination is a recommended method to prevent respiratory infection. However, development of mucosal vaccination is usually hindered due to the lack of safe and effective mucosal adjuvants. Mast cell activator compound 48/80 (C48/80) has been used as a mucosal adjuvant in immunization of adult mice, but its adjuvanticity is not clear in the immunization of young mice. In this study, the adjuvanticity of C48/80 was evaluated when intranasally co-administrated with a pneumococcal vaccine candidate strain SPY1 in a young mice model in comparison with a classical mucosal adjuvant cholera toxin (CT) and a relatively safe mucosal adjuvant Pam2CSK4. All three adjuvants enhanced antibody responses, whereas serum IgG titers were maintained at a stable level during the 3 months after the last immunization only in the SPY1+C48/80 and SPY1+CT groups. Furthermore, both the SPY1+CT group and the SPY1+C48/80 group induced strong Th17 immune response. Notably, C48/80 showed the exceptional ability to promote the clearance of nasal pneumococcal colonization which CT and Pam2CSK4 did not show. We found that C48/80's ability to induce protection against nasal pneumococcal colonization depended on B cells and IL-17A. Additionally, C48/80, as a mucosal adjuvant, showed a greater ability to protect young mice against lethal pneumococcal infection than CT. In comparison with CT, C48/80 also showed a favorable safety. These results reveal a promising perspective for using C48/80 as a mucosal adjuvant to improve protection against pneumococcal diseases early in life.

Herein, a novel electrochemiluminescence (ECL) biosensor was proposed for ultrasensitive detection of laminin (LN), in which DNA dendrimer (D) as a promising nanocarrier for luminophore and DNA nanomachine as tactic for target recycling. The DNA dendrimer was synthesized by hybridization between sense and its antisense Y-shaped DNAs which were formed via reaction between single-stranded DNA (ssDNA) with a thiol group at the 5'-end and a synthesized trimeric cross-linker of tris(2-maleimidoethyl)amine. This dendrimer provided abundant double-stranded DNA (dsDNA) to achieve high loading efficiency for ECL luminophore. Simultaneously, N-(aminobutyl)-N-(ethylisoluminol) (ABEI) was conjugated with doxorubicin (Dox, a intercalator of dsDNA) to form the ECL indicator (Dox-ABEI) which could effectively intercalate DNA dendrimer to form the ECL probe (D-Dox-ABEI). Subsequently, a DNA nanomachine activated by target protein was involved to obtain numerous output ssDNA (S2) which was amplified by exonuclease III-assisted recycle and immobilized on ssDNA (S1)-modified sensing electrode surface via complementation. Thereby, abundant D-Dox-ABEI probes were captured by S2 to construct the biosensor for target protein detection. The proposed ECL biosensor realized the ultrasensitive detection of LN with a linear range from 0.1pg/mL to 100ng/mL and a low detection limit of 0.0661pg/mL. Impressively, the application of this ECL biosensor would provide the great potential for analysis of other proteins, revealing a new avenue for early diagnosis and the prognosis evaluation of various diseases.

Obstructive sleep apnea (OSA) is common among surgical patients. The STOP-Bang questionnaire is a validated screening tool with a high sensitivity. However, its moderate specificity may yield fairly high false positive rate. We hypothesized that the specific combinations of predicting factors in the STOP-Bang questionnaire would improve its specificity.After research ethics approval, consented patients were asked to complete the STOP-Bang questionnaire and then underwent sleep studies. The predictive performance of the STOP-Bang alternative scoring models was evaluated. Five hundred sixteen patients with complete data on the STOP-Bang questionnaire and polysomnography were reported.When the STOP-Bang score was ≥ 3 (any 3 positive items), the sensitivity and specificity for identifying moderate-severe OSA was 87% and 31%, respectively. The specificity for any 2 positive items from the 4 STOP questions plus BMI35 kg/m(2), male gender, or neck circumference40 cm for identifying moderate-severe OSA was 85%, 77%, and 79%, respectively. Compared with STOP-Bang score ≥ 3, the predicted probability for severe OSA of the specific combinations of STOP score ≥ 2 + male and STOP score ≥ 2 + BMI increased by 36% and 42%, respectively. For severe OSA, the specific combination of STOP score ≥ 2 + BMI + male demonstrated a specificity of 97% and 86% increase in predicted probability versus any 4 positive items of STOP-Bang questionnaire.The specific constellations of predictive factors improved the specificity of STOP-Bang questionnaire. For patients with STOP score ≥ 2, male gender, and BMI35 kg/m(2) were more predictive than age ≥ 50 and neck circumference40 cm.

Background:Anesthetics, analgesics, and surgery may profoundly affect sleep architecture and aggravate sleep-related breathing disturbances. The authors hypothesized that patients with preoperative polysomnographic evidence of obstructive sleep apnea (OSA) would experience greater changes in these parameters than patients without OSA.Methods:After obtaining approvals from the Institutional Review Boards, consented patients underwent portable polysomnography preoperatively and on postoperative nights (N) 1, 3, 5, and 7 at home or in hospital. The primary and secondary outcome measurements were polysomnographic parameters of sleep-disordered breathing and sleep architecture.Results:Of the 58 patients completed the study, 38 patients had OSA (apnea hypopnea index [AHI] >5) with median preoperative AHI of 18 events per hour and 20 non-OSA patients had median preoperative AHI of 2. AHI was increased after surgery in both OSA and non-OSA patients (P < 0.05), with peak increase on postoperative N3 (OSA vs. non-OSA, 29 [14, 57] vs. 8 [2, 18], median [25th, 75th percentile], P < 0.05). Hypopnea index accounted for 72% of the postoperative increase in AHI. The central apnea index was low (median = 0) but was significantly increased on postoperative N1 in only non-OSA patients. Sleep efficiency, rapid eye movement sleep, and slow-wave sleep were decreased on N1 in both groups, with gradual recovery.Conclusions:Postoperatively, sleep architecture was disturbed and AHI was increased in both OSA and non-OSA patients. Although the disturbances in sleep architecture were greatest on postoperative N1, breathing disturbances during sleep were greatest on postoperative N3.

Introduction: The knowledge on the mechanism of the postoperative exacerbation of sleep-disordered breathing may direct the perioperative management of patients with obstructive sleep apnea. The objective of this study is to investigate the factors associated with postoperative severity of sleep-disordered breathing. Methods: After obtaining approvals from Institutional Review Boards, consenting patients underwent portable polysomnography preoperatively, and on postoperative nights 1 and 3 in hospital or at home. The primary outcomes were polysomnography parameters measuring the sleep-disordered breathing. They were treated as repeated measurement variables and analyzed for associated factors by mixed models. Results: Three hundred seventy-six patients, 168 men and 208 women, completed polysomnography on preoperative and postoperative night 1. Age was 59 ± 12 yr (mean ± SD). Preoperative apnea–hypopnea index (AHI) was 12 (4, 26) (median [25th, 75th percentile]) events per hour. Thirty-five patients had minor surgeries, 292 intermediate surgeries, and 49 major surgeries, with 210 general anesthesia and 166 regional anesthesia. The 72-h opioid dose was 55 (14, 85) mg intravenous morphine-equivalent dose. Preoperative AHI, age, and 72-h opioid dose were associated with postoperative AHI. Preoperative central apnea index, male sex, and general anesthesia were associated with postoperative central apnea index. Slow wave sleep percentage was inversely associated with postoperative AHI and central apnea index. Conclusions: Patients with a higher preoperative AHI were predicted to have a higher postoperative AHI. Preoperative AHI, age, and 72-h opioid dose were positively associated with postoperative AHI. Preoperative central apnea, male sex, and general anesthesia were associated with postoperative central apnea index.

The quick spread of nosocomial bacterial infections and the increasing prevalence of drugresistant strains make the development of novel drugs for pathogens an urgent priority. Quorum sensing (QS) is a communication mechanism used by bacteria to recognize population density fluctuations and control gene expression, which play a critical role both in intraspecies and interspecies communications and regulates microbe-host interactions. Low-molecular-weight signal compounds, such as acyl-homoserine lactone and autoinducing peptide, are used by QS to control the expression of different pathogenic factors. Thus QS--and QS signal molecules in particular--is an attractive target for developing novel antimicrobial methods. Quorum-quenching enzymes, which hydrolyze or modify signal molecules in QS circuit systems to inhibit the expression of bacteria virulence factors, have been identified both in prokaryotes and eukaryotes. Understanding the mechanism of action of quorum-quenching enzymes also provides a promising means to control bacterial infection. This review first introduces the novel principle underling signal-based QS systems in several important pathogens and then focuses on the newly identified quorum-quenching enzymes, including lactonases, acylases, oxidoreductases, and paraoxonases; this summary introduces new concepts of antimicrobial infection.

Ischemia-modified protein (IMA) is the most sensitive diagnostic biomarker of ischemic heart disease, but differentiation of IMA from human serum albumin (HSA), a ubiquitous serum protein, is still challenging owing to the shared antigenicity. In this investigation, we developed a rapid and interference-free approach for IMA determination using quantum dots-coupled X-ray Fluorescence Spectroscopy (Q-XRF). In a typical Q-XRF assay, serum total HSA is quantified using quantum dot-coupled sandwich immunoassay, and intact HSA (iHSA) is determined using a XRF spectroscopy, by measuring XRF intensity of Co (II) bonded to iHSA. IMA concentration is automatically determined within 30 min by calculating the difference between total HSA and iHSA. This strategy can effectively eliminate the interference from native HSA level. Results show that no significant influences have been observed from hemolysis or high levels of cholesterol (7 mg/L), triglyceride (5.2 mg/L), IgG (10 g/L), and fibrinogen (4 g/L). A linearity of 1-100mg/mL is obtained in iHSA determination using XRF (r(2)=0.979). The proposed Q-XRF assay demonstrates a lowest detection limit of 0.05 U/mL. Receiver-operating characteristic (ROC) curves reveal that Q-XRF assay provide an improved sensitivity than ACB assay (95.9% vs. 82.9%) in differentiating ischemic patients from health individuals, at an optimal cutoff point of 79.2U/mL. The proposed approach provides a new strategy for interference-free, simple and rapid evaluation of IMA concentration by combining sandwich immunoassay and XRF spectroscopy.

Background and aim It is commonly noticed that chaotic and inefficient subgenotyping are universally used academically and clinically, a standardized HBV genotype/subgenotype classification criterion is urgently acquired. Sequence similarity, which was commonly used for the last three decades, should be upgraded by phylogenetic analysis in genotyping of recombinant-free HBV strains. Methods In this study, 4,429 HBV whole-genome sequences were employed to reconstruct the phylogeny of HBV using Bayesian inference. After excluding recombinant sequences, calculating partitioned evolutionary models, excluding recombinant sequences, reconstructing phylogenetic trees, and performing a correlation analysis of genetic distances, geographical distribution and serotypes, we systematically redefined the genotypes and subgenotypes of HBV. Results Compared to previous taxonomy, fourteen subgenotypes (A5-A7; B5-B9; C2-C4, C7; and D6-D7) were revised in the new standard. Now the HBV is divided into ten genotypes (A-J) and 24 subgenotypes (A1-A3; B1-B5; C1-C6; D1-D6; and F1-F4). Conclusion Our robust genotype/subgenotype new taxonomy has objectively re-molded the current shape of HBV classification. We believe that all future hepatitis B related researches or diagnosis will be benefited under the new HBV genotyping/subgenotyping standards.

This article uses overlapping generation (OLG) model to study individuals' optimal decision on consumption, investment, insurance, and education expenses. To the best of our knowledge, we are the first to discuss the individuals' demand for insurance with the consideration of intergenerational transfer payments. In the article, we incorporate insurance into the OLG model to describe individuals' optimization problem on consuming and saving, and we solve the optimal proportions of expenditure on investment, survival insurance, life insurance, and education, with the optimal consumption to be the remaining parts of expenditure. We observe that the numerical outputs are consistent with the actual data. It is also interesting to find that the human capital investment is independent of both risky asset investment and individuals' risk aversion coefficient.

Background: Obstructive sleep apnea (OSA) may worsen postoperatively. The objective of this randomized open-label trial is to determine whether perioperative auto-titrated continuous positive airway pressure (APAP) treatment decreases postoperative apnea hypopnea index (AHI) and improves oxygenation in patients with moderate and severe OSA. Methods: The consented patients with AHI of more than 15 events/h on preoperative polysomnography were randomized into the APAP or control group (receiving routine care). The APAP patients received APAP for 2 or 3 preoperative, and 5 postoperative nights. All patients were monitored with oximetry for 7 to 8 nights (N) and underwent polysomnography on postoperative N3. The primary outcome was AHI on the postoperative N3. Results: One hundred seventy-seven OSA patients undergoing orthopedic and other surgeries were enrolled (APAP: 87 and control: 90). There was no difference between the two groups in baseline data. One hundred six patients (APAP: 40 and control: 66) did polysomnography on postoperative N3, and 100 patients (APAP: 39 and control: 61) completed the study. The compliance rate of APAP was 45%. The APAP usage was 2.4–4.6 h/night. In the APAP group, AHI decreased from preoperative baseline: 30.1 (22.1, 42.5) events/h (median [25th, 75th percentile]) to 3.0 (1.0, 12.5) events/h on postoperative N3 (P < 0.001), whereas, in the control group, AHI increased from 30.4 (23.2, 41.9) events/h to 31.9 (13.5, 50.2) events/h, P = 0.302. No significant change occurred in the central apnea index. Conclusions: The trial showed the feasibility of perioperative APAP for OSA patients. Perioperative APAP treatment significantly reduced postoperative AHI and improved oxygen saturation in the patients with moderate and severe OSA.

Hepatitis B virus infection is highly endemic in China, especially in rural areas such as Dianjiang County with poor-quality health care and little local HBV information. Therefore, for the first time, the present study was carried out to investigate the molecular epidemiology, phylogeny and population dynamics of HBV based on 146 HBV-infected patients. A 435-bp portion of the HBV S region was sequenced, and the phylogeny was reconstructed, indicating that three genotypes, B, C and D of HBV were distributed in Dianjiang County. The predominant genotype is B (67.12 %), followed by C (32.19 %) and D (0.68 %). Patient demographic information and clinical outcomes were examined by genotypes, and no significant association was found. Population dynamics analysis suggested that both genotype B and C have experienced a tenfold expansion during the last five years for reasons that are unclear. Thus, a thorough molecular epidemiology investigation is strongly recommended in the future.

Editor's key points † Obstructive sleep apnoea (OSA) is associated with perioperative morbidity but is under-diagnosed in the community. † In this study of Canadian surgical patients, both anaesthetists and surgeons often failed to diagnose OSA. † Preoperative diagnosis Background. Obstructive sleep apnoea (OSA) affects � 9-24% of the general population, and 90% remain undiagnosed. Those patients with undiagnosed moderate-to-severe OSA may be associated with an increased risk of perioperative complications. Our objective was to evaluate the proportion of surgical patients with undiagnosed moderate-to-severe OSA. Methods. After research ethics board approval, patients visiting preoperative clinics were recruited over 4 yr and screened with the STOP-BANG questionnaire. The 1085 patients, who consented, subsequently underwent polysomnography (PSG) (laboratory or portable) before operation. Chart review was conducted in this historical cohort to ascertain the clinical diagnosis of OSA by surgeons and anaesthetists, blinded to the PSG results. The PSG study-identified OSA patients were further classified based on severity using the apnoea- hypopnoea index (AHI) cut-offs. Results. Of 819 patients, 111 patients had pre-existing OSA and 58% (64/111) were not diagnosed by the surgeons and 15% (17/111) were not diagnosed by the anaesthetists. Among the 708 study patients, PSG showed that 233 (31%) had no OSA, 218 (31%) patients had mild OSA (AHI: 5- 15); 148 (21%) had moderate OSA (AHI: 15 -30), and 119 (17%) had severe OSA (AHI.30). Before operation, of the 267 patients with moderate- to-severe OSA, 92% (n¼245) and 60% (n¼159) were not diagnosed by the surgeons and the anaesthetists, respectively. Conclusions. We found that anaesthetists and surgeons failed to identify a significant number of patients with pre-existing OSA and symptomatic undiagnosed OSA, before operation. This study may provide an impetus for more diligent case finding of OSA before operation.

The objective of the study is to test the hypothesis that a level 2 portable sleep device (Embletta X100) is a reliable alternative for standard PSG in surgical patients. After hospital ethics approvals, preoperative patients over 18 years old were recruited. The patients for validation underwent standard PSG and Embletta X100 simultaneously in a sleep laboratory before surgery. The other patients received sleep studies with Embletta X100 perioperatively. The correlation analysis and paired Student t test between variables from Embletta and from standard PSG were used to evaluate the accuracy of Embletta. The quality of PSG recordings with Embletta was summarized. Twenty-one patients completed sleep study on both systems; ten females and ten males, age was 54 ± 11 and BMI was 36 ± 9. There was a significant correlation between the majority of parameters from standard PSG and Embeltta X100 with manual scoring. The inter-rater agreement was substantial to perfect at different AHI cutoffs with a Kappa coefficient of 0.69 to 1. A significant correlation between standard PSG and Embletta X100 with automatic scoring was found only in AHI and a few other parameters. In 385 patients, 1,002 perioperative PSG recordings were carried out with Embletta. Of them, 889(88.7%) were technically good and 90(9%) technically acceptable. Only 23 (2.3%) PSG recordings failed. Embletta X100, installed by a well-trained sleep technician, is a good alternative when standard PSG was not available or impractical. Manual scoring by a certified PSG technologist is the key for reliable results.

Obstructive sleep apnea (OSA) is presumed to be a risk factor for postoperative morbidity and mortality, but the current evidence is incomplete. This retrospective matched cohort study tested the hypothesis that OSA is a risk factor for the development of postoperative complications.Hospital ethics approval was obtained for the conduct of this study. The patients who were selected for the study were18 yr of age, diagnosed preoperatively with OSA, and scheduled to undergo elective surgery. A cohort of surgical patients without OSA was used as a comparator group based on a one-to-one match. Matching criteria included gender, age difference5 yr, type of surgery, and a5 yr difference between two surgery dates. Summary data are presented and conditional logistic regression was used to identify risk factors for postoperative complications.The 240 pairs of study subjects aged 57 +/- 13 yr included 184 (77%) males and 56 (23%) females. The OSA patients had a higher mean body mass index relative to their non-OSA counterparts (35 +/- 9 vs 28 +/- 6 kg . m-2, respectively) and a higher frequency of co-morbidities, including hypertension (48% vs 36%, respectively) and obesity (61% vs 23%, respectively). Also, the incidence of postoperative complications in the OSA patients was significantly greater (44% OSA group vs 28% non-OSA group; P0.05). The most commonly observed between-group difference was oxygen desaturation90% (17% OSA group vs 8% non-OSA group). The OSA patients who did not use home continuous positive airway pressure (CPAP) devices prior to surgery but required the use of a CPAP device after surgery had the highest rate of complications. Conditional logistic regression was used to diagnose OSA and pre-existing stroke as significant risk factors for developing postoperative complications. The hazard ratio for OSA was 2.0 (1.25-3.19).Patients with diagnosed OSA have an increased incidence of postoperative complications, the most frequent being oxygen desaturation.

Background Obstructive sleep apnea (OSA) is a major risk factor for perioperative adverse events. However, no screening tool for OSA has been validated in surgical patients. This study was conducted to develop and validate a concise and easy-to-use questionnaire for OSA screening in surgical patients. Methods After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. After a factor analysis, reliability check, and pilot study; four yes/no questions were used to develop this screening tool. The four questions were respectively related to snoring, tiredness during daytime, observed apnea, and high blood pressure (STOP). For validation, the score from the STOP questionnaire was evaluated versus the apnea-hypopnea index from monitored polysomnography. Results The STOP questionnaire was given to 2,467 patients, 27.5% classified as being at high risk of OSA. Two hundred eleven patients underwent polysomnography, 34 for the pilot test and 177 for validation. In the validation group, the apnea-hypopnea index was 20 +/- 6. The sensitivities of the STOP questionnaire with apnea-hypopnea index greater than 5, greater than 15, and greater than 30 as cutoffs were 65.6, 74.3, and 79.5%, respectively. When incorporating body mass index, age, neck circumference, and gender into the STOP questionnaire, sensitivities were increased to 83.6, 92.9, and 100% with the same apnea-hypopnea index cutoffs. Conclusions The STOP questionnaire is a concise and easy-to-use screening tool for OSA. It has been developed and validated in surgical patients at preoperative clinics. Combined with body mass index, age, neck size, and gender, it had a high sensitivity, especially for patients with moderate to severe OSA.

There exists a high prevalence of OSA in the general population, a great proportion of which remains undiagnosed. The snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) questionnaire was specifically developed to meet the need for a reliable, concise, and easy-to-use screening tool. It consists of eight dichotomous (yes/no) items related to the clinical features of sleep apnea. The total score ranges from 0 to 8. Patients can be classified for OSA risk based on their respective scores. The sensitivity of STOP-Bang score ≥ 3 to detect moderate to severe OSA (apnea-hypopnea index [AHI]15) and severe OSA (AHI30) is 93% and 100%, respectively. Corresponding negative predictive values are 90% and 100%. As the STOP-Bang score increases from 0 to 2 up to 7 to 8, the probability of moderate to severe OSA increases from 18% to 60%, and the probability of severe OSA rises from 4% to 38%. Patients with a STOP-Bang score of 0 to 2 can be classified as low risk for moderate to severe OSA whereas those with a score of 5 to 8 can be classified as high risk for moderate to severe OSA. In patients whose STOP-Bang scores are in the midrange (3 or 4), further criteria are required for classification. For example, a STOP-Bang score of ≥ 2 plus a BMI35 kg/m(2) would classify that patient as having a high risk for moderate to severe OSA. In this way, patients can be stratified for OSA risk according to their STOP-Bang scores.

The relationship between viral infections and first-trimester spontaneous abortions is not well-understood. The study aim was to investigate the prevalence of cytomegalovirus (CMV), human parvovirus B19 (B19V), and herpes simplex virus-1/2 (HSV-1/2) infection by molecular and serological techniques in women experiencing spontaneous miscarriage in the first trimester of pregnancy. Plasma samples were examined for CMV, B19V, and HSV-1/2 DNA using real-time quantitative polymerase chain reaction (Real-time qPCR), and for specific IgG antibodies against B19V, CMV, and HSV-1/2 using serological assays. The abortion group consisted of women (n = 1,716) with a history of two or more first-trimester spontaneous abortions. Women younger than 30 years possess higher portion to experience spontaneous abortion. No specimens were positive for B19V or CMV DNA. Seven out of the 1,716 specimens were positive for HSV-1/2 DNA. By serology, 47.24% of patients were positive for B19V IgG, 39.66% for HSV IgG, 79.31% for CMV IgG, and 9.31% for B19V IgM. The high rate of positivity for CMV IgG suggests that the majority of women with first-trimester spontaneous abortions are not susceptible to primary CMV infection. The lack of virus DNA in the majority of cases indicates that B19V, CMV, and HSV-1/2 infection is not commonly associated with first-trimester spontaneous abortion.

BACKGROUND The role of PCT (procalcitonin) in elderly patients with bacterial infection has not fully been investigated. In previous studies, the role of PCT in diagnosing bacterial infection has mainly been studied in patients with severe infections. This study was to access a diagnostic value of PCT in elderly patients with local infection. METHODS A total of 259 elderly patients were enrolled in this study. Serum concentration of PCT and whole blood concentration of CRP was measured by immunofluorescence assay. RESULTS The concentration of PCT was significantly higher in patients with infection than those without. In predicting bacterial infection, with a PCT cutoff value of 0.055 ng/mL, the specificity and sensitivity were 92.4% and 63.6%, respectively, while the specificity and sensitivity was 80.0% and 81.3% with a CRP cutoff value of 10.96 mg/L. The areas under the receiver operating characteristic curves (ROC-AUCs) of PCT and CRP were 0.792 and 0.858, respectively (p < 0.05). CONCLUSIONS PCT may not be a better predictor than CRP for diagnosing bacterial infection in elderly patients, but its high specificity is helpful to rule in a bacterial infection.

BACKGROUND Obstructive sleep apnea (OSA) may worsen postoperatively. The objective of this randomized open-label trial is to determine whether perioperative auto-titrated continuous positive airway pressure (APAP) treatment decreases postoperative apnea hypopnea index (AHI) and improves oxygenation in patients with moderate and severe OSA. METHODS The consented patients with AHI of more than 15 events/h on preoperative polysomnography were randomized into the APAP or control group (receiving routine care). The APAP patients received APAP for 2 or 3 preoperative, and 5 postoperative nights. All patients were monitored with oximetry for 7 to 8 nights (N) and underwent polysomnography on postoperative N3. The primary outcome was AHI on the postoperative N3. RESULTS One hundred seventy-seven OSA patients undergoing orthopedic and other surgeries were enrolled (APAP: 87 and control: 90). There was no difference between the two groups in baseline data. One hundred six patients (APAP: 40 and control: 66) did polysomnography on postoperative N3, and 100 patients (APAP: 39 and control: 61) completed the study. The compliance rate of APAP was 45%. The APAP usage was 2.4-4.6 h/night. In the APAP group, AHI decreased from preoperative baseline: 30.1 (22.1, 42.5) events/h (median [25th, 75th percentile]) to 3.0 (1.0, 12.5) events/h on postoperative N3 (P < 0.001), whereas, in the control group, AHI increased from 30.4 (23.2, 41.9) events/h to 31.9 (13.5, 50.2) events/h, P = 0.302. No significant change occurred in the central apnea index. CONCLUSIONS The trial showed the feasibility of perioperative APAP for OSA patients. Perioperative APAP treatment significantly reduced postoperative AHI and improved oxygen saturation in the patients with moderate and severe OSA.

A panel of seven aptamers to antitoxoplasma IgG is first discovered in this report. The aptamers are selected using systematic evolution of ligands by exponential enrichment (SELEX) technology, cloned, and identified by sequencing and affinity assay. Among them, two aptamers (TGA6 and TGA7) with the highest affinities are employed as capture probe and detection probe in developing a quantum dots-labeled dual aptasensor (Q-DAS). In the presence of antitoxoplasma IgG, an aptamer-protein-aptamer sandwich complex (TGA6-IgG-TGA7) is formed and captured on a multiwell microplate, whose fluorescence can be read out using quantum dots as the fluorescence label, ensuring highly sensitive and specific sensing of antitoxoplasma IgG. The operating characteristics of the proposed assay are guaranteed using dual aptamers as the recognizing probes when compared with antibody-based immunoassay. Q-DAS has a linearity within the range of 0.5-500 IU with a lowest detection of 0.1 IU. Receiver operating curves of 212 clinical samples show a 94.8% sensitivity and 95.7% specificity when the cutoff value is set as 6.5 IU, indicating the proposed Q-DAS is a promising assay in large-scale screening of toxoplasmosis.

The loud Snoring, Tiredness, Observed apnea, high blood Pressure (STOP)-Body mass index (BMI), Age, Neck circumference, and gender (Bang) questionnaire is a validated screening tool for identifying obstructive sleep apnea in surgical patients. However, the predictive performance of the STOP-Bang score in obese and morbidly obese patients remains unknown.Preoperative patients were approached for consent and were screened for obstructive sleep apnea (OSA) by the STOP questionnaire. Information concerning Bang was collected. Laboratory or portable polysomnography were performed in 667 patients. Patients with BMI of ≥ 30 kg/m(2) were defined as obese patients and ≥ 35 kg/m(2) as morbidly obese. The predictive parameters (sensitivity, specificity, and positive and negative predictive values) for the STOP-Bang score in obese and morbidly obese patients were analyzed.In 310 obese patients, a STOP-Bang score of 3 has high sensitivity of 90 % and high positive predictive value of 85 % for identifying obese patient with OSA. A STOP-Bang score of 4 had high sensitivity (87.5 %) and high negative predictive value (90.5 %) for identifying severe OSA, whereas a STOP-Bang score of 6 had high specificity (85.2 %) to identify severe OSA. The diagnostic odds ratio of a STOP-Bang score of 4 was 4.9 for identifying severe OSA. In 140 morbidly obese patients, a STOP-Bang score of 4 had high sensitivity (89.5 %) for identifying severe OSA.The STOP-Bang score was validated in the obese and morbidly obese surgical patients. For identifying severe OSA, a STOP-Bang score of 4 has high sensitivity of 88 %. For confirming severe OSA, a score of 6 is more specific.

The STOP-Bang questionnaire is a validated screening tool for the identification of surgical patients with obstructive sleep apnea (OSA). A STOP-Bang score ≥ 3 is highly sensitive but only moderately specific. Apnea/hypopnea during sleep can lead to intermittent hypercapnia and may result in serum bicarbonate (HCO₃⁻) retention. The addition of serum HCO₃⁻ level to the STOP-Bang questionnaire may improve its specificity.Four thousand seventy-seven preoperative patients were approached for consent and screened by the STOP-Bang questionnaire. Polysomnography was performed and preoperative HCO₃⁻ level was collected in 384 patients. Study participants were randomly assigned to a derivation or validation cohort. Predictive parameters (sensitivity, specificity, positive and negative predictive values) for STOP-Bang score and serum HCO₃⁻ level were calculated.In the derivation cohort, with a STOP-Bang score ≥ 3, the specificity for all OSA, moderate/severe OSA, and severe OSA was 37.0%, 30.4%, and 27.7%, respectively. HCO₃⁻ level of 28 mmol/L was selected as a cutoff for analysis. With the addition of HCO₃⁻ level ≥ 28 mmol/L to the STOP-Bang score ≥ 3, the specificity for all OSA, moderate/severe OSA, and severe OSA improved to 85.2%, 81.7%, and 79.7%, respectively. Similar improvement was observed in the validation cohort.Serum HCO₃⁻ level increases the specificity of STOP-Bang screening in predicting moderate/severe OSA. We propose a two-step screening process. The first step uses a STOP-Bang score to screen patients, and the second step uses serum HCO₃⁻ level in those with a STOP-Bang score ≥ 3 for increased specificity.

This paper presents a new thermal compensation system for low temperature-bias-drift (TBD) MEMS based gyroscope. The temperature-dependent characteristics of proposed micro-gyroscope are firstly investigated and discussed in this work. The absolute temperature of the gyroscope is obtained by the frequency synthesizer, which is implemented by field programmable gate array (FPGA), in the thermal compensation system. Besides, the digital trimming mechanism, which implemented in CMOS readout ASIC, is actively tuned by the frequency synthesizer such that the temperature-bias-drift of gyrosocpe can be compensated. The experimental results shows that the temperature resolution of thermal compensation system is about 0.2° and the TBD of the uncompensated and compensated gyroscope is about 0.47 DPS/° and ±0.02 DPS/°.

It is impractical to perform polysomnography (PSG) in all surgical patients suspected of having sleep disordered breathing (SDB). We investigated the role of nocturnal oximetry in diagnosing SDB in surgical patients.All patients 18 years and older who visited the preoperative clinics for scheduled inpatient surgery were approached for study participation. Patients expected to have abnormal electroencephalographic findings were excluded. All patients underwent an overnight PSG at home with a portable device and a pulse oximeter. The PSG recordings were scored by a certified sleep technologist. The oximetry recordings were processed electronically.Four hundred seventy-five patients completed the study: 217 males and 258 females, aged 60 ± 11 years, and body mass index 31 ± 7 kg/m(2). The apnea-hypopnea index (AHI), the average number of episodes of apnea and hypopnea per hour of sleep, was 9.1 (2.8 to 21.4) [median (interquartile range)] and 64% patients had AHI5. There was a significant correlation between oxygen desaturation index (ODI, hourly average number of desaturation episodes) and cumulative time percentage with SpO(2)90% (CT90) from nocturnal oximetry, with the parameters measuring sleep breathing disorders from PSG. Compared to CT90, ODI had a stronger correlation and was a better predictor for AHI. The area under receiver operator characteristics curve for ODI to predict AHI5, AHI15, and AHI30 was 0.908 (CI: 0.880 to 0.936), 0.931 (CI: 0.090 to 0.952), and 0.958 (CI: 0.937 to 0.979), respectively. The cutoff value based on the maximal accuracy for ODI to predict AHI5, AHI15, and AHI30 was ODI5, ODI15, and ODI30. The accuracy was 86% (CI: 83%-88%), 86% (CI: 83%-89%), and 94% (CI: 92%-96%), respectively. The ODI10 demonstrated a sensitivity of 93% and a specificity of 75% to detect moderate and severe SDB.ODI from a high-resolution nocturnal oximeter is a sensitive and specific tool to detect undiagnosed SDB in surgical patients.

This article uses the Over-lapping Generation model to study individuals' optimal decision on consumption, insurance, investment, and education expenses. We first discuss the individuals' demand for insurance considering intergenerational transfer payments and education expenses. We show that survival insurance is more like an investment closely related to risky assets and human capital, while life insurance serves more as an indemnity; the optimal education expenses ratio is independent of individuals' risk aversion coefficient, and the ratio of optimal investment expenditures only relies on social risk attitudes, the characteristics of risky assets, and the price of survival insurance.

For enzymatic analysis to quantify a substrate or enzyme, kinetic analysis of reaction curve can be integrated with a proper classical approach. For their integration, they should have consistent slopes and intercepts of linear response and an overlapped region of analyte quantities measurable under optimized conditions. To quantify a substrate after optimizations of tool enzyme activity and reaction duration, the equilibrium method works when the reaction is completed within the reaction duration; otherwise, kinetic analysis of reaction curve applies providing at least seven data with sufficient consumption of substrate. To quantify an enzyme after optimizations of initial substrate concentration and reaction duration, the classical initial rate method works when an estimated initial rate locates within the linear range; otherwise, kinetic analysis of reaction curve applies after the conversion of the quantification index with optimized parameters. This integration strategy has ideal linear ranges and practical efficiency for quantifying an enzyme at moderate substrate levels and for quantifying a substrate at moderate cost on tool enzyme; it has promise to simultaneous assays of multiple enzymes in one reaction vessel each time and ,thus, potential applications to concurrently quantify multiple serum enzymes, screen inhibitors against multiple enzyme targets, and detect multiple serum components by enzymeimmunoassay.