Summary Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder; however, it remains underdiagnosed and undertreated. Although screening tools such as the Berlin questionnaire (BQ), ...STOP-BANG questionnaire (SBQ), STOP questionnaire (STOP), and Epworth sleepiness scale (ESS) are widely used for OSA, the findings regarding their diagnostic accuracy are controversial. Therefore, this meta-analysis investigated and compared the summary sensitivity, specificity, and diagnostic odds ratio (DOR) among the BQ, SBQ, STOP, and ESS according to the severity of OSA. Electronic databases, namely the Embase, PubMed, PsycINFO, ProQuest dissertations and theses A&I databases, and China knowledge resource integrated database, were searched from their inception to July 15, 2016. We included studies examining the sensitivity and specificity of the BQ, SBQ, STOP, and ESS against the apnea–hypopnea index (AHI) or respiratory disturbance index (RDI). The revised quality assessment of diagnostic accuracy studies was used to evaluate the methodological quality of studies. A random-effects bivariate model was used to estimate the summary sensitivity, specificity, and DOR of the tools. We identified 108 studies including a total of 47 989 participants. The summary estimates were calculated for the BQ, SBQ, STOP, and ESS in detecting mild (AHI/RDI ≥ 5 events/h), moderate (AHI/RDI ≥ 15 events/h), and severe OSA (AHI/RDI ≥ 30 events/h). The performance levels of the BQ, SBQ, STOP, and ESS in detecting OSA of various severity levels are outlined as follows: for mild OSA, the pooled sensitivity levels were 76%, 88%, 87%, and 54%; pooled specificity levels were 59%, 42%, 42%, and 65%; and pooled DORs were 4.30, 5.13, 4.85, and 2.18, respectively. For moderate OSA, the pooled sensitivity levels were 77%, 90%, 89%, and 47%; pooled specificity levels were 44%, 36%, 32%, and 621%; and pooled DORs were 2.68, 5.05, 3.71, and 1.45, respectively. For severe OSA, the pooled sensitivity levels were 84%, 93%, 90%, and 58%; pooled specificity levels were 38%, 35%, 28%, and 60%; and pooled DORs were 3.10, 6.51, 3.37, and 2.10, respectively. Therefore, for mild, moderate, and severe OSA, the pooled sensitivity and DOR of the SBQ were significantly higher than those of other screening tools ( P < .05); however, the specificity of the SBQ was lower than that of the ESS ( P < .05). Moreover, age, sex, body mass index, study sample size, study populations, presence of comorbidities, PSG or portable monitoring performance, and risk of bias in the domains of the index test and reference standard were significant moderators of sensitivity and specificity ( P < .05). Compared with the BQ, STOP, and ESS, the SBQ is a more accurate tool for detecting mild, moderate, and severe OSA. Sleep specialists should use the SBQ to conduct patient interviews for the early diagnosis of OSA in clinical settings, particularly in resource-poor countries and sleep clinics where PSG is unavailable.
Checkpoint immunotherapy that inhibits tumour immune evasion has demonstrated significant clinical success. However, the therapeutic response is limited to certain patient populations, and ...immunotoxicity as well as autoimmunity have compromised the therapeutic benefits. Here, we report on an inherently therapeutic fucoidan-dextran-based magnetic nanomedicine (IO@FuDex
) conjugated with a checkpoint inhibitor (anti-PD-L1) and T-cell activators (anti-CD3 and anti-CD28). IO@FuDex
can repair the immunosuppressive tumour microenvironment by reinvigorating tumour-infiltrating lymphocytes, while targeting the nanomedicine via magnetic navigation to the tumour to minimize off-target effects. Treatment that combines IO@FuDex
and magnetic navigation reduces the occurrence of adverse events and extends the median survival from 32 to 63 days with less than 1 per cent dose compared with soluble anti-PD-L1. Thus, we demonstrate the potential of integrating anti-PD-L1 and T-cell activators as a form of inherently therapeutic nanomedicine to augment the therapeutic index of combination checkpoint immunotherapy.
Abstract Background Insomnia is a highly prevalent health complaint in the modern societies; however, insomnia remains under-diagnosed and under-treated. Although screening tools, including the ...Insomnia Severity Index (ISI), Athens Insomnia Scale (AIS), and Pittsburg Sleep Quality Index (PSQI), are widely used for assessing the risk of insomnia, the diagnostic properties have yet to be summarized in a systematic manner. Objectives To estimate and to compare the diagnostic accuracy of the ISI, AIS, and PSQI for insomnia screening. Data sources We systematically searched EMBASE, PubMed, PsycINFO, CINAHL and Chinese Electronic Periodic Services for data from their inception to May 20, 2015. Data selection Original articles that had assessed the sensitivity and specificity of the ISI, AIS, or PSQI against a reference standard in adult participants (age > 18) were included. Results A total of 19 studies comprising 4693 participants were included. The pooled sensitivity for the ISI, AIS, and PSQI was 88% (95% confidence interval CI = 0.79 to 0.93), 91% (0.87 to 0.93), and 94
% (0.86 to 0.98), respectively. The pooled specificity was 85% (0.68 to 0.94), 87% (0.68 to 0.95), and 76% (0.64 to 0.85); and the pooled DORs was 41.93 (8.77 to 200.33), 67.7 (23.4 to 196.1), and 53 (15.5 to 186.2), respectively. The summary estimates did not differ significantly among the ISI, AIS and PSQI (all P > 0
.05). Conclusions The current evidence indicates that the ISI, AIS, and PSQI yield comparable diagnostic properties for insomnia screening.
This study investigated the associations of non-aerobic fitness (NAF) and motor competence (MC) with attention in 4-6 year-old preschoolers. The allocation of attentional resources and speed of ...stimulus categorization were examined using the amplitude and latency of P3 of event-related potentials respectively, while cortical activation related to general attention and task-specific discriminative processes were examined using event-related desynchronization (ERD) at lower (8-10 Hz) and upper (10-12 Hz) alpha frequencies, respectively. Seventy-six preschoolers completed NAF (muscular power, muscular endurance, flexibility, balance) and MC (coordination and dexterity, ball skills, agility and balance) test batteries. Electroencephalogram was recorded while participants performed an auditory oddball task. After controlling for age and MC, muscular endurance was positively related to P3 amplitude. MC and its coordination and dexterity sub-component were positively related to task performance, with higher levels of coordination and dexterity showing an additional association with greater upper alpha ERD between 700 and 1000 ms following stimulus onset after controlling for age and NAF. These findings suggest relationships of NAF and MC with early childhood neurocognitive function. Specifically, muscular endurance is related to the neuroinhibition in facilitating effective allocation of attentional resources to stimulus evaluation while coordination and dexterity are related to cortical activation underlying strategic attentional preparation for subsequent stimulus evaluation.
Lead halide perovskite materials have recently received considerable attention for achieving an economic and tunable laser owing to their solution-processable feature and promising optical ...properties. However, most reported perovskite-based lasers operate with a large lasing-mode volume, resulting in a high lasing threshold due to the inefficient coupling between the optical gain medium and cavity. Here, we demonstrate a continuous-wave nanolasing from a single lead halide perovskite (CsPbBr3) quantum dot (PQD) in a plasmonic gap-mode nanocavity with an ultralow threshold of 1.9 Wcm–2 under 120 K. The calculated ultrasmall mode volume (∼0.002 λ3) with a z-polarized dipole and the significantly large Purcell enhancement at the corner of the nanocavity inside the gap dramatically enhance the light-matter interaction in the nanocavity, thus facilitating lasing. The demonstration of PQD nanolasing with an ultralow-threshold provides an approach for realizing on-chip electrically driven lasing and integration into on-chip plasmonic circuitry for ultrafast optical communication and quantum information processing.
Corosolic acid (CA; 2α-hydroxyursolic acid) is a natural pentacyclic triterpenoid with antioxidant, antitumour and antimetastatic activities against various tumour cells during tumourigenesis. ...However, CA’s antitumour effect and functional roles on human oral squamous cell carcinoma (OSCC) cells are utterly unknown. In this study, our results demonstrated that CA significantly exerted an inhibitory effect on matrix metalloproteinase (MMP)1 expression, cell migration and invasion without influencing cell growth or the cell cycle of human OSCC cells. The critical role of MMP1 was confirmed using the GEPIA database and showed that patients have a high expression of MMP1 and have a shorter overall survival rate, confirmed on the Kaplan–Meier curve assay. In the synergistic inhibitory analysis, CA and siMMP1 co-treatment showed a synergically inhibitory influence on MMP1 expression and invasion of human OSCC cells. The ERK1/2 pathway plays an essential role in mediating tumour progression. We found that CA significantly inhibits the phosphorylation of ERK1/2 dose-dependently. The ERK1/2 pathway played an essential role in the CA-mediated downregulation of MMP1 expression and in invasive motility in human OSCC cells. These findings first demonstrated the inhibitory effects of CA on OSCC cells’ progression through inhibition of the ERK1/2–MMP1 axis. Therefore, CA might represent a novel strategy for treating OSCC.
Mesenchymal stem cells (MSCs) are known to play a role in postnatal vasculogenesis and hold great promise for vascular regeneration. However, the mechanisms by which the endothelial differentiation ...and specification of MSCs remain unclear. We examined the potential role and molecular mechanisms of atypical chemokine receptor ACKR3/CXCR7 in MSC-mediated endothelial cell differentiation and specification. Here, we showed that vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) activate CXCR7 expression on MSCs through PDGF receptors, PDGFRα and PDGFRβ-mediated phosphoinositide 3-kinase (PI3K)/Akt signaling. Genetic and pharmacologic blockage of CXCR7 on MSCs suppressed the VEGF or stromal cell-derived factor 1 (SDF)-1-induced the capacity for vasculogenesis in vitro and in vivo. Moreover, CXCR7 gain of function markedly promoted vasculogenesis by MSCs in vitro and in vivo and induced endothelial differentiation along the arterial endothelial cell lineage via upregulation of Notch signaling. However, blockade of Notch signaling inhibited CXCR7-induced vasculogensis by MSCs. These results indicate CXCR7 is a critical regulator of MSC-mediated postnatal vasculogenesis and arterial specification via Notch signaling.
Virtual microscopy (VM) has been utilized to improve students' learning experience in microscope laboratory sessions, but minimal attention has been given to determining how to use VM more ...effectively. The study examined the influence of VM on academic performance and teacher and student perceptions and compared laboratory test scores before and after VM incorporation. A total of 662 third‐year students studying histology and 651 fourth‐year students studying pathology were divided into two groups. The light microscopy (LM) group used a light microscope in 2014 and 2015, while the LM + VM group used the VM platform and a light microscope in 2016 and 2017. Four factors positively predict laboratory scores (R square, 0.323; P < 0.001): (i) the pathology course and test‐enhanced learning, (ii) the VM platform and experience, (iii) medical students and lecture scores, and (iv) female students. The LM + VM group exhibited less score variability on laboratory examinations relative to their mean than the LM group. The LM + VM group was also associated with fewer failing grades (F grade; odds ratio, 0.336; P < 0.001) and higher scores (A grade; odds ratio, 2.084; P < 0.001) after controlling for sex, school, course, and lecture grades. The positive effect of the VM platform on laboratory test grades was associated with prior experience using the VM platform and was synergistic with more interim tests. Both teachers and students agreed that the VM platform enhanced laboratory learning. The incorporation of the VM platform in the context of test‐enhanced learning may help more students to master microscopic laboratory content.
An intrinsic {0001} GaN wafer cut to expose the {101&cmb.macr;0}/{1&cmb.macr;100} side faces allows examination of its conductivity properties with respect to the crystal faces. Interestingly, the ...{101&cmb.macr;0} face shows a 10-fold higher photoluminescence peak intensity than the {0001} face. The {0001} face is 60-fold more conductive at 6 V than the {101&cmb.macr;0} face, demonstrating the presence of an electrical facet effect. The conductivity difference can be rationalized assuming different degrees of band bending at these crystal surfaces. Asymmetric
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V
curves were obtained with electrical connections made to both faces simultaneously, showing the potential of using this behavior to fabricate transistors.
A large conductivity difference exists between the {0001} and {101&cmb.macr;0} faces of a GaN wafer. Current-rectifying
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curves were obtained with electrodes contacting both faces simultaneously.
This study assessed the effects of Health Qigong on sleep quality in adults.
Systematic review and meta-analysis.
We searched 10 databases to identify relevant randomized controlled trials (RCTs) ...published in English or Chinese languages that evaluated the effects of Health Qigong on sleep quality in participants aged ≥18 years old with or without diseases in comparison with any type of controls. Quality of the included studies was assessed by the revised Cochrane risk-of-bias tool for randomized trials. The between-group treatment effect size was estimated by calculating Hedges’ g and associated confidence interval (CI) through a random effects model. Cochran’s Q test and I2 were used to determine heterogeneity.
The initial search yielded 730 articles, of which 13 studies involving 1147 participants were included in the systematic review and meta-analysis. The overall effect size was −0.955 (95 % CI: −1.601 to −0.309, p = 0.004). A homogeneity test revealed high heterogeneity (Q = 278.187, p < 0.001, I2 = 95.686 %). A sensitivity analysis was conducted through the exclusion of an outlier, which revealed a small but statistically significant effect size (Hedges’ g = −0.423, 95 % CI: −0.603 to −0.243, p < 0.001; Q = 18.073, p = 0.08, I2 = 39.137 %).
Our study results suggest that Health Qigong is beneficial for improving sleep quality in adults with and without disease. However, the effects of Health Qigong could be partially due to nonspecific effects as half of the included studies did not employ an active control.
•Health Qigong, particularly Baduanjin, improved sleep quality in adult populations with and without disease.•The diseased population had significantly greater sleep improvements after Health Qigong training.•The effect of Health Qigong may be, at least in part, attributed to nonspecific effects.
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