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We investigated whether advanced brain biological age is associated with accelerated age-related physical and/or cognitive functional decline: mobility impairment no disability (MIND), cognitive impairment no dementia (CIND), and physio-cognitive decline syndrome (PCDS). We constructed a brain age prediction model using gray matter features from the magnetic resonance imaging of 1482 healthy individuals (aged 18–92 years). Predicted and chronological age differences were obtained (brain age gap [BAG]) and analyzed in another 1193 community-dwelling population aged ≥50 years. Among the 1193 participants, there were 501, 346, 148, and 198 in the robust, CIND, MIND, and PCDS groups, respectively. Participants with PCDS had significantly larger BAG (BAG = 2.99 ± 8.97) than the robust (BAG = −0.49 ± 9.27, p = 0.002; η2 = 0.014), CIND (BAG = 0.47 ± 9.16, p = 0.02; η2 = 0.01), and MIND (BAG = 0.36 ± 9.69, p = 0.036; η2 = 0.013) groups. Advanced brain aging is involved in the pathophysiology of the co-occurrence of physical and cognitive decline in the older people. The PCDS may be a clinical phenotype reflective of accelerated biological age in community-dwelling older individuals. [ABSTRACT FROM AUTHOR]

Background: The increase of headache frequency is associated with higher headache related disability and lower quality of life in patients with migraine. However, the pathophysiology of migraine progression, persistence, or remission is elusive. The purpose of this study is to identify the brain signatures that are predictive of the long-term outcomes among patients with high-frequency migraine (HFM: 10–30 headache days/month). Methods: We prospectively enrolled patients with HFM and healthy controls and collected their baseline clinical profiles and brain-MRI data at first visit. We longitudinally followed the patients and determined their outcomes at 2-year follow-up. Good outcome was defined as ≥50% reduction of baseline headache days and poor outcome was defined as reduction < 50% or frequency increase. Voxel-based morphometry was used to study gray matter volume (GMV), and structural covariance was used to investigate structural connectivity. Results: Among 56 patients with HFM, 37 had good outcome and 19 poor outcome. Compared to the healthy controls (n = 37), patients with poor outcome had decreased GMV over the left posterior cingulate gyrus, and increased GMV over the bilateral cerebellum and the right precentral gyrus. Further, patients with poor outcome had greater GMV over the right and the left cerebella compared to patients with good outcome, and the GMVs of the cerebella were correlated to 2-year headache frequencies (right: r = 0.38, P = 0.005; left: r = 0.35, P = 0.009). Structural connectivity were increased between the cerebellum and the cuneus, the calcarine cortex, and the temporal lobe, respectively, in patients with poor outcome, and was decreased between the cerebellum and the prefrontal cortex in patients with poor outcome. The structural covariance integrities between the right cerebellum and the right cuneus were correlated to 2-year headache frequencies (r = 0.36, P = 0.008). Conclusions: Structural volume and connectivity changes of the cerebellum may underlie headache persistence in patients with HFM. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To examine the association between snoring, sleep quality, quantity, and blood pressure in third‐trimester normotensive pregnant women. Design: This study was a cross‐sectional analysis of two cohorts of healthy pregnant women recruited from a prenatal clinic in a medical center in Northern Taiwan. Methods: A total of 322 women reported sociodemographic and health characteristics in a structured interview and wore a wrist actigraph on their nondominant wrist for 7 consecutive days to assess objective sleep patterns. The women's resting blood pressures were measured while seated in the clinic by trained personnel using an electronic sphygmomanometer. Findings: One hundred thirty‐three (41.3%) women reported snoring. Ninety‐three women (28.9%) had <6 hr of nighttime sleep, with only 95 (29.5%) women averaging 7 or more hours of nighttime sleep. In the univariate analyses, snoring was positively associated with systolic and diastolic blood pressure as well as mean arterial pressure levels (p < .05). In the multivariate analyses, snoring remained as a significant predictor of higher diastolic blood pressure (β = 2.07, p < .05) and mean arterial pressure levels (β = 2.00, p < .05), after adjustment for age, parity, gestational age, body mass index before pregnancy, and sleep quantity and quality by actigraphy. Conclusions: Snoring is a highly prevalent condition experienced by healthy third‐trimester pregnant women and is associated with elevated blood pressure. Clinical Relevance: Clinical assessment and screening of snoring are of utmost importance in obstetric nursing practice to potentially prevent or reduce the associated adverse cardiovascular consequences in women during pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: To identify disease-related spatial covariance patterns of grey matter volume as an aid in the classification of Parkinson's disease (PD).Methods: Seventy structural covariance networks (SCNs) based on grey matter volume covariance patterns were defined using independent component analysis with T1-weighted structural MRI scans (discovery sample, 70 PD patients and 70 healthy controls). An image-based classifier was constructed from SCNs using a multiple logistic regression analysis with a leave-one-out cross-validation-based feature selection scheme. A validation sample (26 PD patients and 26 healthy controls) was further collected to evaluate the generalization ability of the constructed classifier.Results: In the discovery sample, 13 SCNs, including the cerebellum, anterior temporal poles, parahippocampal gyrus, parietal operculum, occipital lobes, supramarginal gyri, superior parietal lobes, paracingulate gyri and precentral gyri, had higher classification performance for PD. In the validation sample, the classifier had moderate generalization ability, with a mean sensitivity of 81%, specificity of 69% and overall accuracy of 75%. Furthermore, certain individual SCNs were also associated with disease severity.Conclusions: Although not applicable for routine care at present, our results provide empirical evidence that disease-specific, large-scale structural networks can provide a foundation for the further improvement of diagnostic MRI in movement disorders.Key Points: • Disease-specific, large-scale SCNs can be identified from structural MRI. • A new network-based framework for PD classification is proposed. • An SCN-based classifier had moderate generalization ability in PD classification. • The selected SCNs provide valuable functional information regarding PD patients. [ABSTRACT FROM AUTHOR]

Background Daytime sleepiness is a frequent complaint in women during pregnancy. It has also been linked to negative obstetric consequences. Although high prevalence of excessive daytime sleepiness throughout pregnancy is well-documented, neither the causes of persistent daytime sleepiness nor new-onset daytime sleepiness during pregnancy have been investigated. Identifying predictive factors may play an important role in the management of daytime sleepiness in pregnant women and improve prenatal care and maternal-fetal outcomes. Objectives To examine first-trimester maternal characteristics associated with the persistence and new-onset daytime sleepiness in pregnant women. Design A longitudinal, prospective cohort design. Setting One medical center in Taipei, Taiwan and participating women’s homes. Participants A total of 204 pregnant women. Methods First-trimester pregnant women recruited from an outpatient obstetric clinic at a medical center provided socio-demographic and health information, wore an actigraphy monitor for 7 days, and completed sleep, mood, and daytime sleepiness questionnaires. Data were collected again when the women were in the second and third trimester. Results Thirty-one (15.2%) women experienced excessive daytime sleepiness that persisted across all three trimesters. Nulliparous women and women who snored in the first trimester were 2.28 and 2.10 times more at risk of being classified of persistent daytime sleepiness than multiparous women and women who did not snore in the first trimester, respectively. Thirty-one (15.2%) women developed new-onset daytime sleepiness with advancing gestation. Women were more likely to develop new-onset daytime sleepiness if they worked longer hours per week (OR = 1.04, p < 0.001), if they reported snoring (OR = 6.75, p < 0.001), and if they had elevated depressive symptoms in the first trimester of pregnancy (OR = 1.09, p = 0.01). Conclusions Snoring in the first trimester is involved in both the persistence and new-onset of daytime sleepiness with elevated depressive symptoms related to new-onset daytime sleepiness in pregnant women. Findings suggest that intervention strategies for alleviating daytime sleepiness in pregnant women should focus on managing snoring and symptoms of depression in early trimesters with special attention to nulliparous and employed women. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of metabolic syndrome (MS) has increased rapidly in Taiwan and worldwide. We aim to determine the association between sleep-disordered breathing (SDB) and MS in a Chinese general population. Methods: This case-control study recruited subjects who have undergone a prospective electrocardiogram-based cardiopulmonary coupling (CPC) sleep spectrogram as part of the periodic health check-ups at the National Taiwan University Hospital. Comprehensive anthropometrics, blood biochemistry, prevalence of MS and its individual components were compared with Bonferroni correction between 40 subjects with SDB, defined as the CPC-derived apnea–hypopnea index (CPC-AHI) >5 event/hour and 80 age- and sex-matched controls, defined as CPC-AHI <1 event/hour. MS was diagnosed based on the Adult Treatment Panel III, with a modification of waist circumference for Asians. Results: Subjects with SDB were more obese with larger waist circumferences (95.1±12.9 vs. 87.3±6.9, P < .001) and borderline higher BMI (27.0±4.9 vs. 24.3±2.5, P = .002). Waist circumference was independently associated with the presence of SDB after adjustment for BMI, systolic blood pressure and fasting blood glucose in multiple regression analyses. Subjects with SDB had a higher prevalence of central obesity (72.5% vs. 42.5%, P = .002), hyperglycemia (45.0% vs. 26.3%, P = .04), MS (45.0% vs. 22.5%, P = .01) and number of MS components (2.4 ± 1.6 vs. 1.7 ± 1.4, P = .01) than the control group. Waist circumference was significantly correlated with both CPC-AHI (r = .492, P = .0013) and PSG-AHI (r = .699, P < .0001) in the SDB group. Conclusions: SDB was associated with a higher prevalence of MS and its individual components, notably central obesity, in a Chinese general population. Large-scale screening of high risk population with MS to identify subjects with SDB for appropriate management is warranted. [ABSTRACT FROM AUTHOR]

Background Sleep disturbances are common in women, especially during pregnancy. Previous studies have confirmed the importance of sleep disturbances as a risk factor of adverse pregnancy outcomes and the need for screening and treatment of inadequate sleep. These reports, however, did not examine health-related quality of life which may be affected by sleep long before adverse clinical consequences are detectable in women during pregnancy. Objectives To examine the cross-sectional and longitudinal association between sleep and health-related quality of life in pregnant women. Design A prospective observational study. Setting A university-affiliated hospital in Taiwan and participants’ homes. Participants A total of 164 pregnant women completed questionnaires and wore a wrist actigraphy monitor for 7 days each trimester. Methods Objective sleep was measured by actigraphy, subjective sleep was measured by the Pittsburgh Sleep Quality Index, and health-related quality of life was measured using the SF-12v2 questionnaire across three trimesters. Multiple linear regression analyses were performed to evaluate the cross-sectional and longitudinal associations between sleep and health-related quality of life. Results Sixty-four (39.0%) women consistently had an average sleep efficiency < 85% by actigraphy and 40 (24.4%) had a Pittsburgh Sleep Quality Index global score > 5 in all three trimesters. Cross-sectionally, more actigraphic daytime sleep ( p = 0.04) and better subjective sleep quality ( p < 0.01) were associated with better physical health-related quality of life in first-trimester pregnant women. Better actigraphic sleep efficiency ( p = 0.04) and better subjective sleep quality ( p < 0.01) were associated with better mental health-related quality of life in second-trimester pregnant women. Longer actigraphic total nighttime sleep ( p < 0.01) and better subjective sleep quality ( p < 0.01) were associated with better mental health-related quality of life in third-trimester pregnant women. Longitudinally, first-trimester actigraphic total nighttime sleep ( p < 0.05) and subjective sleep quality ( p < 0.01) predicted mental health-related quality of life in the second and third trimester. Conclusions Sleep disturbances are a highly prevalent and persistent problem in pregnant women. Adequate sleep is essential for women at all pregnancy stages and improving nocturnal sleep quantity and quality in early gestation is of utmost importance for an optimal health-related quality of life later in pregnancy. [ABSTRACT FROM AUTHOR]

Few cross-national studies distinguish between different aspects of gender egalitarianism and compare them systematically. In this study, we examine cross-national differences in attitudes toward mothers' participation in the labor market and toward gender equality within the household, using a multilevel analysis of individual data from 33 nations. The results indicate greater support for employed mothers, but a lower level of approval of gender equality at home, among residents of countries that offer women more educational and economic opportunities. We argue that macrolevel gender equality increases individuals', particularly women's, incentives to support female labor force participation. Because of a persistent belief in gender differentiation, however, macrolevel gender equality has the opposite relationship with attitudes toward altering gendered practices beyond enabling women's public sphere participation. The fewer explicit barriers to women's achievement in society, the more likely individuals will feel a need to defend gendered roles in the private sphere. That the potential harm of advocating gendered practices in the private sphere is smaller in societies with fewer impediments for women is also likely to account for the negative association between macrolevel gender equality and support for egalitarian gender roles at home. [ABSTRACT FROM AUTHOR]

Sleep disturbances are one of the most frequent chief complaints brought to the healthcare professionals during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide with women more likely to be affected than men. However, limited studies have prospectively investigated the association between sleep disturbances and longitudinal risk of depression in pregnant women, with no studies using actigraphy to objectively estimate daytime and nighttime sleep duration and the extent of sleep disruption. To examine the predictive and longitudinal association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women. A prospective observational cohort study. 204 1st trimester pregnant women recruited from a university-affiliated hospital provided socio-demographic and health information, wore a wrist actigraph for 7 days, and completed Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies - Depression Scale, and Epworth Sleepiness Scale. Identical data collection procedures were implemented again in the 2nd and 3rd trimester, with each data collection scheduled at least 8 weeks apart. We estimated unadjusted and multivariable adjusted odds ratios and 95% confidence intervals to evaluate various types of sleep disturbances at 1st trimester and risk of depression at follow-ups. 121 (59.3%) 1st trimester women had a sleep efficiency of < 85% by actigraphy, and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores > 5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency < 85% was associated with 2.71-, 3.87-, and 5.27-fold increased odds having risk of depression at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively. Healthy pregnant women experience both objective and subjective sleep disturbances during the early trimester, with a substantial proportion of them also having high depressive symptoms throughout the pregnancy. Objectively assessed poor sleep quality in the 1st trimester, but not self-reported characteristics of disturbed sleep, may play a role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether an early intervention aiming at improving sleep may help reduce high depressive symptom risk and lower depression rate in women during pregnancy. Tweetable abstract : Objectively assessed poor sleep efficiency in the 1st trimester predicts both elevated and persistent high depressive symptoms in pregnancy. [ABSTRACT FROM AUTHOR]

Abstract: Separation of acidic dyestuffs, including Acid red 4, Acid orange 10, and Acid red 27, from aqueous solution by nanofiltration (NF) was shown to be a feasible process to accomplish an effective removal over a broad operational range. For most experiments conducted in this study, dyestuff rejections of greater than 98% were achieved. The permeate flux for experiments conducted with various dyestuffs was increased with increasing operating pressure and solution temperature. The permeability was increased and the rejection of dyestuffs was slightly decreased with increasing cross-flow velocity of solution. The effect of solution pH on the rejection of dyestuff was elucidated by the electrostatic characteristics between the species of dyestuff and the membrane surface. Maximum permeability was obtained for experiments operated in aqueous solution of pH 5, which was close to the isoelectric point of the membrane. [Copyright &y& Elsevier]

Abstract: Despite diffuse tenderness, patients with fibromyalgia (FM) have reported a wide range of areas with musculoskeletal pain. This study investigated the neural structures and neuroanatomical networks associated with self-reported widespread pain in FM using magnetic resonance imaging. We collected clinical profiles and brain magnetic resonance imaging data of newly diagnosed patients with FM. A total of 138 patients with FM were divided into 3 subgroups based on the number of pain areas, with 3 to 8, 9 to 12, and 13 to 19 areas, respectively. Using voxel-based morphometry analysis, we first identified the neural structure that showed a trend of volumetric change across the 3 subgroups. We then used it as a candidate seed of interest with a seed-to-voxel analytical approach to explore the structural covariance (SC) networks of the whole brain. Finally, we studied the trend of changes in the distribution and strength of SC networks across subgroups of patients. We found a decreasing trend in the volumes of the right anterior insular cortex (rAIC) across the 3 subgroups that had an increased number of pain areas. An increasing trend in the number of neural substrates over the subcortical regions, especially the basal ganglion, showed SC to the rAIC, and a decreasing trend of SC strength was shown between the rAIC and the precuneus, frontal cortex, anterior and posterior cingulate, and lingual gyri, across the patient subgroups with increased pain areas. The rAIC and its altered connection with specific brain regions indicates widespread pain in patients with FM. [ABSTRACT FROM AUTHOR]

Objective: C-reactive protein (CRP) is an important serum marker of inflammation associated with cardiovascular outcomes. This study aims to evaluate the association between CRP and childhood obstructive sleep apnea (OSA) and clarify the effects of adenotonsillectomy on serum CRP levels in children with OSA.Methods: Children with symptoms suggestive of OSA who underwent an overnight polysomnography were recruited from a tertiary medical center. Their serum CRP levels were measured. For children who underwent adenotonsillectomy for OSA treatment, polysomnography and serum high-sensitivity CRP (hs-CRP) level measurement were conducted after surgery.Results: This study included 326 children (mean age: 7.2 ± 3.0 years; boys: 67%). Children with apnea-hypopnea index (AHI) > 5 events/h had significantly higher hs-CRP levels than children with AHI of 1-5 events/h and AHI < 1 event/h [median (interquartile range): 0.08 (0.03-0.25) vs 0.03 (0.02-0.14) vs 0.04 (0.01-0.10), P < 0.001]. Log-transformed hs-CRP levels were positively associated with log AHI values (r = 0.2, P < 0.001). In multiple linear regression analysis, hs-CRP levels were independently associated with AHI; 101 children with OSA (ie, AHI > 1) underwent adenotonsillectomy. In children with OSA in the study cohort, a significant reduction of hs-CRP levels did not occur after surgery [from 0.07 (0.02-0.22) to 0.08 (0.03-0.17), P = 0.716]. In children with OSA having abnormal hs-CRP levels (ie, CRP > 1 mg/dL), hs-CRP levels significantly decreased after surgery [from 1.87 (1.11-2.78) to 0.20 (0.07-1.04), P = 0.043].Conclusion: Children with OSA had increased hs-CRP levels. Children with OSA and abnormal hs-CRP levels exhibited significantly reduced hs-CRP levels following adenotonsillectomy. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to identify characteristics in image‐based computational fluid dynamics (CFD) in children with obstructive sleep apnea (OSA). Design: Diagnostic study. Setting: Hospital‐based cohort. Participants: Children with symptoms suggestive of OSA were recruited and underwent polysomnography. Main outcome measures: Three‐dimensional models of computational fluid dynamics were derived from cone‐beam computed tomography. Results: A total of 68 children participated in the study (44 boys; mean age: 7.8 years), including 34 participants having moderate‐to‐severe OSA (apnea‐hypopnea index [AHI] greater than 5 events/h), and 34 age, gender, and body mass index percentile matched participants having primary snoring (AHI less than 1). Children with moderate‐to‐severe OSA had a significantly higher total airway pressure (166.3 vs. 39.1 Pa, p =.009), total airway resistance (9851 vs. 2060 Newton‐metre, p =.004) and velocity at a minimal cross‐sectional area (65.7 vs. 8.8 metre per second, p =.017) than those with primary snoring. The optimal cut‐off points for moderate‐to‐severe OSA were 46.2 Pa in the total airway pressure (area under the curve [AUC] = 73.2%), 2373 Newton‐metre in the total airway resistance (AUC = 72.5%) and 12.6 metres per second in the velocity at a minimal cross‐sectional area (AUC = 70.5%). The conditional logistic regression model revealed that total airway pressure, total airway resistance and velocity at minimal cross‐sectional area were significantly associated with an increased risk of moderate‐to‐severe OSA. Conclusions: This study demonstrates that CFD could be a useful tool for evaluating upper airway patency in children with OSA. [ABSTRACT FROM AUTHOR]

The present study aimed to determine whether a recently proposed cerebral small vessel disease (CSVD) classification scheme could differentiate the 5-year all-cause mortality in middle-to-old aged asymptomatic CSVD. Stroke-free and non-demented participants recruited from the community-based I-Lan Longitudinal Aging Study underwent baseline brain magnetic resonance imaging (MRI) between 2011 and 2014 and were followed-up between 2018 and 2019. The study population was classified into control (non-CSVD) and CSVD type 1–4 groups based on MRI markers. We determined the association with mortality using Cox regression models, adjusting for the age, sex, and vascular risk factors. A total of 735 participants were included. During a mean follow-up of 5.7 years, 62 (8.4%) died. There were 335 CSVD type 1 (57.9 ± 5.9 years), 249 type 2 (65.6 ± 8.1 years), 52 type 3 (67.8 ± 9.2 years), and 38 type 4 (64.3 ± 9.0 years). Among the four CSVD types, CSVD type 4 individuals had significantly higher all-cause mortality (adjusted hazard ratio = 5.0, 95% confidence interval 1.6–15.3) compared to controls. This novel MRI-based CSVD classification scheme was able to identify individuals at risk of mortality at an asymptomatic, early stage of disease and might be applied for future community-based health research and policy. [ABSTRACT FROM AUTHOR]

Objectives: Migraine and restless legs syndrome (RLS) are often comorbid and share elements of pathology; however, their neuroanatomical underpinnings are poorly understood. This study aimed to identify patterns of gray matter volume (GMV) alteration specific to and common among patients with RLS, migraine, and comorbid migraine and RLS. Methods: High‐resolution T1‐weighted images were acquired from 116 subjects: 27 RLS patients, 22 migraine patients, 22 patients with comorbid migraine and RLS, and 45 healthy controls. Direct group comparisons and conjunction analysis were first used to localize the distinct and shared neural signatures of migraine and RLS. We also investigated whether the shared neural signature could be replicated in an additional comorbid migraine/RLS group. Results: Compared with healthy controls, migraine patients showed GMV changes in the lateral occipital cortex, cerebellum, frontal pole, and middle frontal gyrus (MFG), and RLS patients showed GMV changes in the thalamus, middle temporal gyrus, anterior cingulate cortex, insular cortex, and MFG. In migraine, compared with RLS, GMV differences were found in the precuneus, lateral occipital and occipital fusiform cortex, superior frontal and precentral gyri, and cerebellum. Conjunction analyses for these disorders showed altered GMV in the MFG, also found in patients with comorbid migraine and RLS. The GMV of the MFG also correlated with sleep quality in patients with comorbid migraine and RLS. Interpretation: Migraine and RLS are characterized by shared and distinctive neuroanatomical characteristics, with a specific role of the MFG. These findings may be related to shared pathophysiology of these two distinct disorders. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to test if the temporal sequence between sleep apnea (SA) diagnosis and incident myocardial infarction (MI) was associated with the long-term mortality and cardiovascular event in a community-based cohort. Methods: We retrieved data from 9,453 incident MI patients between Jan. 1st 2000 and Dec. 31st 2012 from the Taiwan National Health Insurance Research Database. The study subjects included 207 MI patients with SA (SA-MI), further stratified into 110 with pre-existing SA before MI (SA-bMI) and 96 diagnosed with SA after MI (SA-pMI). The median follow-up period was 4.2 years. Propensity-score-matched controls were selected from 9,246 non-SA MI patients (non-SA-MI). The association of SA and outcomes including all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed by a Cox proportional hazards model. Results: The result showed that SA was not associated with mortality regardless of the timing of SA diagnosis. SA-pMI was associated with increased risk of MACCEs (Hazard ratio [HR]: 1.412, 95% confidence interval [CI]: 1.037~1.923, p = 0.029) including re-MI or revascularization and ischemic heart disease hospitalization. Such an association was most significant for SA diagnosed within one year after MI (HR: 2.029, 95% CI: 1.265~3.254, p = 0.003), which was not seen in patients treated with continuous positive airway pressure (CPAP). Conclusion: The temporal sequence and the time interval between SA diagnosis and incident MI was associated with the cardiovascular events after MI, especially within one year after MI. Early assessment for the presence of SA after incident MI and early CPAP intervention may reduce the risk of further adverse cardiovascular events. [ABSTRACT FROM AUTHOR]

Background: Despite evidently distinct symptoms, tension-type headache (TTH) and migraine are highly comorbid and exhibit many similarities in clinical practice. The purpose of this study was to investigate whether both types of headaches are similar in brain morphology. Methods: Consecutive patients with TTH and age- and sex-matched patients with migraine and healthy controls were enrolled for brain magnetic resonance imaging examination. Patients with TTH were excluded if they reported any headache features or associated symptoms of migraine. Changes in gray matter (GM) volume associated with headache diagnosis (TTH vs. migraine) and frequency (episodic vs. chronic) were examined using voxel-based morphometry. The correlation with headache profile and the discriminative ability between TTH and migraine were also investigated for these GM changes. Results: In comparison with controls ( n = 43), the patients with TTH (25 episodic and 24 chronic) exhibited a GM volume increase in the anterior cingulate cortex, supramarginal gyrus, temporal pole, lateral occipital cortex, and caudate. The patients with migraine (31 episodic and 25 chronic) conversely exhibited a GM volume decrease in the orbitofrontal cortex. These GM changes did not correlate with any headache profile. A voxel-wise 2 × 2 factorial analysis further revealed the substantial effects of headache types and frequency in the comparison of GM volume between TTH and migraine. Specifically, the migraine group (vs. TTH) had a GM decrease in the superior and middle frontal gyri, cerebellum, dorsal striatum, and precuneus. The chronic group (vs. episodic group) otherwise demonstrated a GM decrease in the bilateral insula and anterior cingulate cortex. In receiver operating characteristic analysis, the GM volumes of the left superior frontal gyrus and right cerebellum V combined had good discriminative ability for distinguishing TTH and migraine (area under the curve = 0.806). Conclusions: TTH and migraine are separate headache disorders with different characteristics in relation to GM changes. The major morphological difference between the two types of headaches is the relative GM decrease of the prefrontal and cerebellar regions in migraine, which may reflect a higher allostatic load associated with this disabling headache. [ABSTRACT FROM AUTHOR]

Objectives To investigate the structural changes of hippocampus and amygdala and their relationships with migraine frequency and prognosis. Methods Hippocampus and amygdala volumes were measured by 3-T brain magnetic resonance imaging (MRI) in 31 controls and 122 migraine patients who were categorized into eight groups by headache frequency: group 1 (1-2 headache days/month), 2 (3-4), 3 (5-7), 4 (8-10), 5 (11-14), 6 (15-19), 7 (20-24), and 8 (25-30). Headache frequency was reassessed 2 years later and a frequency reduction ≥50% was regarded a good outcome. Results Hippocampus and amygdala volumes fluctuated in patient groups but did not differ from the controls. In migraine patients, the bilateral hippocampus volumes peaked in group 3. The volumes and headache frequencies correlated positively in groups 2-3 on bilateral sides (L: r = 0.44, p = 0.007; R: r = 0.35, p = 0.037), and negatively in groups 3-7 on the left side (5-24 days/month; L: r = -0.31, p = 0.004) and groups 3-8 on the right side ( r = -0.31, p = 0.002). The left amygdala volume also peaked in group 3, and correlated with headache frequency in groups 1-3 ( r = 0.34, p = 0.020) and groups 3-6 ( r = -0.30, p = 0.012). The volumetric changes of the right amygdala with headache frequency did not reach statistical significance. At 2-year follow-up, the right hippocampus volume was positively associated with a good migraine outcome after adjustment of headache frequency (OR 4.72, p = 0.024). Conclusions Hippocampus and amygdala display a structural plasticity linked to both headache frequency and clinical outcome of migraine. [ABSTRACT FROM AUTHOR]

As a reversible thermochromic material, vanadium dioxide (VO 2 ) is a promising candidate for smart window applications. The trade-off between the integrated visible transmission ( T lum ) and the solar modulating ability (Δ T sol ), as well as the high phase transition temperature ( τ c ∼68 °C) are regarded as the main obstacle for practical applications of pure VO 2 nanomaterials. The combination of both high τ c reducing efficiency of W and improving T lum /Δ T sol properties of RE (rare earth: Eu, Tb), herein lies the purpose of RE/W-codoping to enhance the thermochromic performance. The RE/W-codoped VO 2 nanoparticles were synthesized under hydrothermal conditions, and exhibited grain size of less than 100 nm. The smart window which was fabricated by coating RE/W-codoped VO 2 nanoparticles onto glass, exhibits a thermochromic performance with a combination T lum = 40%, Δ T sol = 6.3%, τ c = 40.8 °C or T lum = 63%, Δ T sol = 3.6%, τ c = 31.9 °C, indicating the largely reduced absorption compared with the single W doping. Under the RE/W-codoping conditions, it was found that the ionic radius of the RE 3+ cations controlled the crystallinity of the VO 2 particles and the electron/hole carrier counteraction as well as the competition between the strain and the hole carrier played a vital role in modulating the τ c of the VO 2 products. The findings should be meaningful for investigating the codoping mechanisms for VO 2 nanomaterials. [ABSTRACT FROM AUTHOR]

Summary: Until now, no study has directly network meta‐analysed the impact of nasal masks, nasal pillows and oronasal masks on continuous positive airway pressure therapy in patients with obstructive sleep apnea. This study aimed to meta‐analyse the impact of three kinds of nasal interfaces with both network meta‐analysis and pairwise comparison. PubMed, EMBASE, CENTRAL and ClinicalTrials.gov were systematically searched from inception to December 2020 for studies that compared the three types of nasal interfaces for treating obstructive sleep apnea with continuous positive airway pressure. The outcomes were residual apnea–hypopnea index, continuous positive airway pressure, and nightly average usage. The network meta‐analysis was conducted using multivariate random‐effects in a frequentist framework where three interfaces were ranked with the surface under the cumulative ranking probabilities. The pairwise comparison was conducted using random‐effects meta‐analysis. Twenty‐nine articles comprising 6378 participants were included. The pairwise comparison showed both nasal masks and nasal pillows were associated with lower residual apnea–hypopnea index, lower continuous positive airway pressure, and higher continuous positive airway pressure adherence compared with oronasal masks. The surface under the cumulative ranking confirmed that nasal masks were associated with the lowest residual apnea–hypopnea index and highest adherence, while pillows were associated with the lowest continuous positive airway pressure. The meta‐regression identified that lower pretreatment apnea–hypopnea index and continuous positive airway pressure determined during continuous positive airway pressure titration (versus determined during continuous positive airway pressure therapy) was associated with lower continuous positive airway pressure with nasal masks and nasal pillows. In conclusion, compared with oronasal masks, nasal masks and nasal pillows are better interfaces, especially in patients with lower pretreatment apnea–hypopnea index and those with the therapeutic pressure determined during continuous positive airway pressure titration. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine the effectiveness of structural imaging as an aid in the diagnosis of Parkinson's disease (PD). Methods: High-resolution T -weighted magnetic resonance imaging was performed in 72 patients with idiopathic PD (mean age, 61.08 years) and 73 healthy subjects (mean age, 58.96 years). The whole brain was parcellated into 95 regions of interest using composite anatomical atlases, and region volumes were calculated. Three diagnostic classifiers were constructed using binary multiple logistic regression modeling: the (i) basal ganglion prior classifier, (ii) data-driven classifier, and (iii) basal ganglion prior/data-driven hybrid classifier. Leave-one-out cross validation was used to unbiasedly evaluate the predictive accuracy of imaging features. Pearson's correlation analysis was further performed to correlate outcome measurement using the best PD classifier with disease severity. Results: Smaller volume in susceptible regions is diagnostic for Parkinson's disease. Compared with the other two classifiers, the basal ganglion prior/data-driven hybrid classifier had the highest diagnostic reliability with a sensitivity of 74%, specificity of 75%, and accuracy of 74%. Furthermore, outcome measurement using this classifier was associated with disease severity. Conclusions: Brain structural volumetric analysis with multiple logistic regression modeling can be a complementary tool for diagnosing PD. [ABSTRACT FROM AUTHOR]

Aims Population aging is burdening the society globally, and the evaluation of functional networks is the key toward understanding cognitive changes in normal aging. However, the effect of age on default mode subnetworks has not been documented well, and age-related changes in many resting-state networks remain debatable. The purpose of this study was to propose more precise results for these issues using a large sample size. Methods We used group-level meta- ICA analysis and dual regression approach for identifying resting-state networks from functional magnetic resonance imaging data of 430 healthy elderly participants. Partial correlation was used to observe age-related correlations within and between resting-state networks. Results In the default mode network, only the ventral subnetwork negatively correlated with age. Age-related decrease in functional connectivity was also noted in the auditory, right frontoparietal, sensorimotor, and visual medial networks. Further, some age-related increases and decreases were observed for between-network correlations. Conclusion The results of this study suggest that only the ventral default mode subnetwork had age-related decline in functional connectivity and several reverse patterns of resting-state networks for network development. Understanding age-related network changes may provide solutions for the impact of population aging and diagnosis of neurodegenerative diseases. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a neurodegenerative disorder associated with the striatum. Previous studies indicated that subdivisions of the striatum with distinct functional connectivity profiles contribute to different pathogeneses in PD. Segregated structural covariance (SC) pattern between the striatum and neocortex observed in healthy subjects, however, remain unknown in PD. The purpose of this study is to map and compare the subregional striatal SC network organization between 30 healthy controls and 48 PD patients and to investigate their association with the disease severity. The striatal SC network was statistically inferred by correlating the mean gray matter (GM) volume of six striatal subdivisions (including the bilateral dorsal caudate, superior ventral striatum, inferior ventral striatum, dorsal caudal putamen, dorsal rostral putamen, and ventral rostral putamen) with the entire neocortical GM volume in voxel-wise manner. The PD patients revealed marked atrophy in the striatum, cerebellum, and extra-striatum neocortices. As predicted, segregated striatal SC network patterns were observed in both groups. This suggests that in PD, pathological processes occurring in the striatum affect the same striato-cortical networks that covary with the striatum in healthy brains. The PD patients further demonstrated atypical striatal SC patterns between the caudate, parahippocampus temporal cortices, and cerebellum, which corresponded to dopaminergic associated network. The areas with significant group differences in SC were further associated with disease severity. Our findings support previous studies indicating that PD is associated with altered striato-cortical networks, and suggest that structural changes in the striatum may result in a cascade of alterations in multiple neocortices. Hum Brain Mapp 36:1567-1584, 2015. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: Limited information is currently available on 24-h ambulatory blood pressure (ABP) changes after adenotonsillectomy (T&A) in children with obstructive sleep apnea (OSA). In this study, the trajectory of 24-h ABP changes after surgery in children with OSA was examined at three-month and six-month follow-up.Methods: Children aged 4-16 years with clinical symptoms of OSA and polysomnography (PSG)-diagnosed OSA (apnea-hypopnea index [AHI] >1) were included. All the children received T&A. PSG was conducted before and after surgery. Twenty four hour ABP was monitored using the linear mixed model before, three months after, and six months after surgery.Results: In total, 122 children were examined (mean age: 7.9 years; 71% were boys). The AHI significantly decreased from 12.7 ± 16.7 to 2.4 ± 3.2 events/h after T&A (P < 0.001). Overall diastolic blood pressure (DBP; from 65.1 to 63.4 mmHg, P = 0.01) and night-time DBP (from 57.4 to 55.4 mmHg, P = 0.032) decreased nonsignificantly during the six-month postoperative period. The OSA children with presurgical hypertension exhibited significant reductions in overall systolic blood pressure (SBP), overall DBP, daytime DBP, night-time SBP, and night-time DBP at the three-month and six-month postoperative follow-up (all P < 0.05). The three-month and six-month ABP data did not differ significantly in the entire cohort, even between children with presurgical hypertension and non-hypertensive children.Conclusion: The 24-h ABP decreased significantly in the OSA children with hypertension at three and six months after surgery. Moreover, ABP findings did not differ significantly between the three- and six-month follow-up. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to determine the effect of combining positive airway pressure (PAP) therapy and mandibular advancement device (MAD) in patients with severe obstructive sleep apnea (OSA) who were pressure intolerant for PAP and were unresponsive to MAD. Methods: This retrospective study reviewed the medical records of severe OSA patients with apnea-hypopnea index (AHI) ≥ 30/hr who were diagnosed between October 1, 2008 and June 30, 2014. Patients were initially treated with 2 weeks of PAP, and those who were intolerant to high-pressure PAP (≥15 cm H2O) were switched to 12 weeks of MAD, which is a monobloc designed at 75% of maximum protrusion. Patients who had high residual AHI (≥15/hr) on MAD underwent 12 weeks of combination therapy (CT) with MAD and CPAP and were enrolled in the present study. Enrolled subjects who completed the 12-week CT were followed-up until June 30, 2016. Results: A total of 14 male patients were included. All three treatments effectively reduced AHI, oxygen desaturation index (ODI), and total sleep time with SpO2 <90% (% TST-SpO2<90%) compared to pretreatment values. The residual AHI and ODI on CT was lower than that on MAD or PAP. The residual % TST-SpO2<90% was lower than that on MAD and similar to that on PAP. The therapeutic pressure on CT was on average 9.2 cm H2O lower than that on PAP. For the 11 patients who completed CT, only CT reduced ESS compared to pretreatment value. No treatment had significant impact on % slow wave sleep or overnight change of blood pressure. For patients who completed CT, the average usage was 5.9±1.7 hr/night at 12th week and 6.4±1.5 hr/night at a median follow-up of 36.5-months. Conclusions: Combining MAD and CPAP showed additive effects on reducing AHI and ODI, and lowered the therapeutic pressures. [ABSTRACT FROM AUTHOR]

To assess the craniofacial morphology in children with sleep-disordered breathing (SDB) using nonradiation and readily accessible photogrammetry technique. Included children aged 3–18 years with SDB-related symptoms from April 2019 to February 2020 in a tertiary center. All participants underwent craniofacial photogrammetry and overnight polysomnography (PSG). Participants were stratified into 2 groups (obstructive sleep apnea [OSA] group: apnea-hypopnea index [AHI] ≥ 1 and non-OSA group: AHI <1). Craniofacial photogrammetry was performed to derive variables of craniofacial features in standardized frontal and profile views. The 2 groups were propensity score matched based on age, sex, and body mass index (BMI) percentiles. Associations between craniofacial feature variables and OSA (AHI ≥1) likelihood were examined using logistic regression test. intraclass correlation coefficient (ICC) was used to evaluate the intrarater and interrater reliability. In total, 58 children were enrolled for the analysis after matching. All 3 variables representing the mandibular plane angle in the profile view were increased in the OSA group (mego-tn: 34.85 ± 5.99 vs 31.65 ± 5.96°, odds ratio [OR]: 1.10, 95% CI:1.02 to 1.18, P =.01; tn-gogn: 28.65 ± 6.38 vs 25.91 ± 5.38°, OR: 1.08, 95% CI:1.02 to 1.15, P =.012; and gome-tsup: 26.71 ± 6.13 vs 22.20 ± 5.89°, OR: 1.13, 95% CI:1.04 to 1.23, P =.003). Craniofacial photogrammetry revealed increased mandibular inclination in children with OSA. A steep mandibular plane with craniofacial photogrammetry is considered a potential predictor of pediatric OSA. Further investigation with a large sample size is required to clarify the validity of photogrammetry in evaluating pediatric OSA. • OSA children present significantly increased mandibular plane angle through photogrammetry. • A steep mandibular plane is considered a characteristic craniofacial morphology in OSA children. • Profile view is easier than frontal view to manifest craniofacial characteristics. • Craniofacial photogrammetry is a novel technique that is easily accessible and radiation free. • For screening of pediatric SDB, craniofacial photogrammetry might be a potential tool readily accessible for clinicians. [ABSTRACT FROM AUTHOR]

• A potential predictor of dementia conversion in cerebral small vessel disease (CSVD). • CSVD people with mobility frailty had higher risk of dementia at 5.7 years. • Mobility frailty may serve as one clinical marker for adverse outcomes of CSVD. • Mobility frailty might be involved in the mechanism of cognitive declines in CSVD Frailty has been shown to predict adverse outcomes in several diseases. We aimed to evaluate the associations between frailty profiles, both severity and subtype, and dementia risk in a community-based population with asymptomatic (without stroke and dementia) cerebral small vessel disease (CSVD). Individuals with asymptomatic CSVD were recruited from the community-based I-Lan Longitudinal Aging Study between 2011 and 2014 (baseline) and were followed up between 2018 and 2019. All participants underwent CSVD assessment by 3T brain MRI, as well as physical and cognitive assessments at baseline. Univariate and multivariate logistic regression analyses were performed to evaluate the associations between each factor and dementia conversion at follow-up. Among 261 participants with asymptomatic CSVD (64.8 [50.0-89.1, 8.4] years; 136 [52.1%] men), 13 (5.0%) developed dementia during a mean follow-up of 5.7 (0.7) years. Dementia converters were less likely to be robust (30.8% vs. 61.5%) and more likely to be pre-frail/frail (69.2% vs. 38.5%) than non-converters (p = 0.040). Meanwhile, there was significantly more frequent mobility frailty (53.8% vs. 19.8%, p = 0.009), but a similar prevalence of non-mobility frailty in dementia converters compared with non-converters. Univariate analyses showed that neither frailty severity nor CSVD burden was associated with a higher risk of dementia; it was the frailty subtype, the mobility frailty, which was significantly associated with dementia conversion in participants with asymptomatic CSVD, with an odds-ratio of 4.8 (95% CI = 1.5–14.8, p = 0.007). The significance remained after adjusting for age, sex, education and baseline cognitive function, respectively. Mobility frailty was associated with a higher risk of incident dementia in individuals with subclinical CSVD. Mobility frailty might be involved in the pathology of cognitive decline in CSVD and potentially serve as a marker to identify people at risk of cognitive impairment at an early stage of CSVD. [ABSTRACT FROM AUTHOR]

Background Sleep disturbance, depression, and daytime sleepiness are among the most prevalent symptoms reported by women during pregnancy. However, available data on the association between sleep disturbances and symptoms of depression and daytime sleepiness in pregnant women are sparse and methodological limitations have been acknowledged. The purpose of the study was to examine objective and self-reported sleep disturbances and symptoms of depression and daytime sleepiness in a group of healthy pregnant women. Methods A total of 274 third-trimester pregnant women wore a wrist actigraph continuously for 7 days to assess objective sleep quality and quantity. Self-reported sleep quality was assessed by the Pittsburgh Sleep Quality Index ( PSQI), with self-reported poor sleep quality defined as a PSQI score more than 5. The Center for Epidemiologic Studies-Depression Scale ( CES-D) and Epworth Sleepiness Scale were used to evaluate symptoms of depression and daytime sleepiness, respectively. Results Sixty-four (23.4%) women were at risk for clinical depression and 69 (25.2%) had daytime sleepiness. Risk of clinically meaningful depressive symptomatology was significantly increased in women with objective total nighttime sleep less than 6 hours ( OR 2.53 [95% CI 1.26-5.08]) and self-reported poor sleep quality ( OR 3.31 [95% CI 1.74-6.30]), even after multiple adjustment. Neither objective nor self-reported sleep disturbances increased daytime sleepiness in this group of pregnant women. Discussion Both objective nighttime sleep less than 6 hours and self-reported poor sleep quality in healthy third-trimester pregnant women is associated with significant risks for clinical depression. Improving sleep would likely be associated with a reduction in depression symptom severity and an attenuation of the prevalence of depression in pregnant women. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is well documented to be associated with elevated systemic oxidative stress and perceptual impairments. Furthermore, the striatum and extrastriatal cortical areas, which are involved in the coordination of perceptual functions, are impaired at an early stage of the disease. However, the possible pathophysiology involved in perceptual impairments remains unclear. This raises the possibility that structural abnormalities might mediate the relationship between oxidative stress and perceptual impairments.Methods: We explored the differences between 27 patients with PD and 25 healthy controls in terms of serum oxidative stress, perceptual functions, and regional gray matter. A single-level three-variable mediation model was used to investigate the possible relationships between serum oxidative stress, regional gray matter volume, and different domains of perceptual functioning.Results: The results demonstrate that increased serum oxidative stress (as indicated by thiobarbituric acid reactive substances) was associated with declined perceptual functioning in PD patients. We further explored significant gray matter volume reductions in the bilateral temporal gyri (middle temporal gyrus and fusiform gyrus), bilateral frontal gyri, limbic lobe (hippocampus and uncus), left inferior parietal lobule, right caudate nucleus, and insula in PD. Further mediation analysis showed that gray matter volumes in the middle temporal gyrus, inferior parietal lobule, hippocampus, and insula served as brain mediators between elevated serum oxidative stress and perceptual impairments.Conclusions: These results suggest that higher oxidative stress levels adversely impact perceptual functions by causing temporal and mesolimbic abnormalities. [ABSTRACT FROM AUTHOR]

Physical frailty has been recognized as a clinical syndrome resulting from declines in various physiological systems; however, the role of the central nervous system in the pathophysiology of frailty remains unclear. The I-Lan Longitudinal Aging Study randomly sampled community-dwelling people aged 50 or older for a brain magnetic resonance imaging study. All participants were assessed for frailty status (robust, prefrail, and frail) based on the presence of five frailty components: slow walking speed, muscle weakness, low physical activity, exhaustion and weight loss (Fried criteria). Gray matter volume (GMV) changes associated with frailty status and individual frailty components were examined. Overall, 456 participants (64.0 ± 8.5 years, 47.6% women) were included in this study. The prefrail ( n = 178, 39.0%) and frail ( n = 19, 4.2%) subjects were grouped for analysis. The prefrail-frail group showed reduced GMV, compared to the robust group ( n = 259, 56.8%), in the cerebellum, hippocampi, middle frontal gyri, and several other cerebral regions (corrected P < 0.05). Each frailty component was associated with GMV changes in functionally related brain areas. Hierarchical cluster analysis categorized these components into three subsets. Motor-related components, including weakness, low activity, and slowness, comprised one subset with a common cerebellar involvement. Exhaustion and weight loss were the other two subsets without cerebellar changes. To conclude, physical frailty is associated with a decreased reserve in specific brain regions, especially cerebellum. Further longitudinal studies are needed to explore if the cerebellum- and noncerebellum-based frailty components reflect a distinctive future risk for developing frailty. Hum Brain Mapp 36:3666-3676, 2015. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective To assess how history and/or anatomical findings differ in diagnosing pediatric obstructive sleep apnea (OSA). Methods Children aged 2–18 years were recruited and assessed for anatomical (ie, tonsil size, adenoid size, and obesity) and historical findings (ie, symptoms) using a standard sheet. History and anatomical findings, as well as those measures significantly correlated with OSA, were identified to establish the historical, anatomical, and the combined model. OSA was diagnosed by polysomnography. The effectiveness of those models in detecting OSA was analyzed by model fit, discrimination (C-index), calibration (Hosmer–Lemeshow test), and reclassification properties. Results A total of 222 children were enrolled. The anatomical model included tonsil hypertrophy, adenoid hypertrophy, and obesity, whereas the historical model included snoring frequency, snoring duration, awakening, and breathing pause. The C-index was 0.84 for the combined model, which significantly differed from that in the anatomical (0.78, p  = 0.003) and historical models (0.72, p  < 0.001). The Hosmer–Lemeshow test revealed an adequate fit for all of the models. Additionally, the combined model more accurately reclassified 10.3% ( p  = 0.044) and 21.9% ( p  = 0.003) of all of the subjects than either the anatomical or historical model. Internal validation of the combined model by the bootstrapping method showed a fair model performance. Conclusion Overall performance of combined anatomical and historical findings offers incremental utility in detecting OSA. Results of this study suggest integrating both history and anatomical findings for a screening scheme of pediatric OSA. [ABSTRACT FROM AUTHOR]

Objective To assess short-term and long-term changes in quality of life after adenotonsillectomy (T&A) in children with obstructive sleep apnea (OSA). Materials and methods Children aged 2–18 years old were enrolled. All subjects had clinical symptoms, overnight polysomnography diagnosis of OSA, and received T&A as treatment. Caregivers were asked to complete the OSA-18 survey before surgery, within 6 months after surgery (short-term), and more than 6 months after surgery (long-term). Results A total of 114 children were included (mean age, 7.0 ± 3.5 years; 75% boys). The mean OSA-18 total score was 71.5 ± 16.0 before surgery. After surgery, the mean OSA-18 total score was significantly decreased in both the short-term (40.3 ± 12.2, p < 0.001) and the long-term (42.0 ± 13.7, p < 0.001). All five OSA-18 domains were also significantly decreased during short-term and long-term postoperative follow up ( p < 0.001). Short-term and long-term outcomes were compared. Mean OSA-18 total scores, sleep disturbance score, emotional distress score, daytime function score, and caregiver concerns score did not differ significantly between the short-term and long-term periods, while the physical symptom score was slightly higher in the long-term than the short-term period (9.7 ± 3.3 vs. 8.7 ± 3.0, p = 0.02). Additionally, the physical symptoms score was higher in the long-term period in the female ( p = 0.01), older age (>6 years) ( p = 0.03), and non-obese ( p = 0.04) subgroups. Conclusion T&A improves short-term and long-term quality of life in children with OSA. Nevertheless, caregivers observed children with aggravation of physical symptoms of quality of life during long-term follow up, especially in the female, older, and non-obese subgroups. [ABSTRACT FROM AUTHOR]

Background and Objective: Several studies on diagnostic accuracy of pleural N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) for effusions from congestive heart failure (CHF) conclude that pleural NT-pro-BNP is a useful biomarker with high diagnostic accuracy for distinguishing CHF effusions. However, its applicability in critical care settings remains uncertain and requires further investigations. Methods: NT-proBNP was measured in pleural fluid samples of a prospective cohort of intensive care unit patients with pleural effusions. Receiver operating characteristic curve analysis was performed to determine diagnostic accuracy of pleural NT-proBNP for prediction of CHF effusions. Results: One hundred forty-seven critically ill patients were evaluated, 38 (26%) with CHF effusions and 109 (74%) with non-CHF effusions of various causes. Pleural NT-proBNP levels were significantly elevated in patients with CHF effusions. Pleural NT-pro-BNP demonstrated the area under the curve of 0.87 for diagnosing effusions due to CHF. With a cutoff of 2200 pg/mL, pleural NT-proBNP displayed high sensitivity (89%) but moderate specificity (73%). Notably, 29 (27%) of 109 patients with non-CHF effusions had pleural NT-proBNP levels >2200 pg/mL and these patients were more likely to experience septic shock (18/29 vs. 10/80, P<0.001) or acute kidney injury (19/29 vs. 9/80, P<0.001). Conclusions: Among critically ill patients, pleural NT-proBNP measurements remain a useful diagnostic aid in evaluation of pleural effusions. However, patients with non-CHF effusions may exhibit high pleural NT-proBNP concentrations if they suffer from septic shock or acute kidney injury. Accordingly, it is suggested that clinical context should be taken into account when interpreting pleural NT-proBNP values in critical care settings. [ABSTRACT FROM AUTHOR]

The article presents a study aimed at shedding light on the potential involvement of the pain matrix and underlying white matter (WM) microstructural alterations in episodic cluster headaches (CHs). Topics discussed include the WM changes between in-bout and out-of-bout periods, the anatomical connections between brain areas with WM changes and the hypothalamus, and the correlations between WM changes and clinical variables.

The article discusses a study which assessed mortality, disability, and intensive care in patients with mitochondrial 3243A>G mutation. Topics discussed include complications that may develop in patients harboring m.3243A>G and requiring intensive care unit (ICU) admission, and the importance of early diagnosis to avoid the administration of mitochondriontoxic drugs in the ICU.

Objective:To investigate the contributions of adenoid and tonsil size to childhood obstructive sleep apnea (OSA) and the interactions between adenotonsillar hypertrophy, age, and obesity in children with OSA. Methods:In total, 495 symptomatic patients were recruited. The patients were assigned to four groups according to age：toddler (age 1-3, n=42), preschool (age 3-6, n=164), school (age 6-12, n=200), and adolescence (age 12-18, n=89). All subjects had tonsil size graded by otolaryngologists, adenoid size determined on lateral radiographs (Fujioka method), and a full-night polysomnography. The apnea-hypopnea index (AHI), adenoid size, and tonsil size were compared in obese and non-obese children in the four age groups. Adjusted odds ratios (ORs) and 95% confidence interval (CI) of adenotonsillar hypertrophy and OSA risk were estimated by multi-logistic regression. Results:The AHI was positively related to tonsil grade (r=0.33, p <0.001) and adenoid size (r=0.24, p <0.01) in all patients. Tonsil grade was positively related to AHI in all four age groups. Adenoid size was positively related to AHI in the toddler, preschool, school groups, but not in the adolescent group (r=0.11, p=0.37). Tonsil grade and adenoid size were both positively related to AHI in obese and non-obese children. In the regression model, obesity (OR=2.89; 95% CI 1.47-5.68), tonsillar hypertrophy (OR=3.15; 95% CI 2.04-4.88), and adenoidal hypertrophy (OR=1.89; 95% CI 1.19-3.00) significantly increased OSA risk. Conclusions:Adenotonsillar hypertrophy and obesity are the major determinants of OSA in children. However, the influence of adenoid size decreases in adolescence. [ABSTRACT FROM AUTHOR]