Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) that resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists ...despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patients from the European Sleep Apnea Database (
n
= 4,853, mean age ± SD 54.8 ± 11.8 years, 26.1% females), at baseline and at the first visit (median follow-up: 5 months, interquartile range 3–13). An ESS > 10 occurred in 56% of patients at baseline and in 28.2% of patients at follow-up. Residual EDS was analyzed in 2,190 patients (age: 55.1 ± 12.0 years, 26.1% females) with sleep monitoring data (median follow-up: 3 months, interquartile range 1–15). Sleep studies during CPAP use were obtained in 58% of these patients; EDS was reported by 47.2% of patients at baseline and by 30.3% at follow-up. Residual OSA, defined as an apnea–hypopnea index >10/h, and insufficient CPAP adherence, defined as nightly use <4 h, occurred with similar frequency in patients with and without EDS at follow-up. Prevalence of residual EDS was highest (40%) in patients with a first follow-up visit at 0–3 months, then it was 13–19% in patients with a first follow-up visit after 4 months to 2 years. The change in ESS (
n
= 2,190) was weakly correlated with CPAP use (R
2
= 0.023,
p
< 0.0001). Logistic regression showed that an ESS score >10 at the first follow-up visit was associated directly with ESS at baseline and inversely with duration of follow-up, and CPAP use (R
2
of the model: 0.417). EDS showed heterogeneity in different European countries both at baseline and at the first follow-up visit, suggesting modulation by cultural and lifestyle factors. In conclusion, residual EDS in CPAP-treated OSA occurred in approximately one in four patients at follow-up; its prevalence was highest (40%) in the first 3 months of treatment and subsequently decreased. The finding of residual EDS in a significant percentage of optimally treated OSA patients suggests that wake-promoting agents may be useful, but their indication should be evaluated after at least 3 months of treatment.
•European Non-polio Enterovirus Network established.•Collect respiratory, stool and CSF samples for EV testing from patient with neurological infection.•Sensitive PCR method should be used to ...diagnose EV infection.•Sequencing of VP1 capsid protein gene is recommended for EV typing.•Standardased laboratory diagnostics and characterisation key for effective surveillancce.
Enteroviruses (EV) can cause severe neurological and respiratory infections, and occasionally lead to devastating outbreaks as previously demonstrated with EV-A71 and EV-D68 in Europe. However, these infections are still often underdiagnosed and EV typing data is not currently collected at European level. In order to improve EV diagnostics, collate data on severe EV infections and monitor the circulation of EV types, we have established European non-polio enterovirus network (ENPEN). First task of this cross-border network has been to ensure prompt and adequate diagnosis of these infections in Europe, and hence we present recommendations for non-polio EV detection and typing based on the consensus view of this multidisciplinary team including experts from over 20 European countries. We recommend that respiratory and stool samples in addition to cerebrospinal fluid (CSF) and blood samples are submitted for EV testing from patients with suspected neurological infections. This is vital since viruses like EV-D68 are rarely detectable in CSF or stool samples. Furthermore, reverse transcriptase PCR (RT-PCR) targeting the 5′noncoding regions (5′NCR) should be used for diagnosis of EVs due to their sensitivity, specificity and short turnaround time. Sequencing of the VP1 capsid protein gene is recommended for EV typing; EV typing cannot be based on the 5′NCR sequences due to frequent recombination events and should not rely on virus isolation. Effective and standardized laboratory diagnostics and characterisation of circulating virus strains are the first step towards effective and continuous surveillance activities, which in turn will be used to provide better estimation on EV disease burden.
Thermochemolysis coupled with gas chromatography and mass spectrometry were applied to determine the structure of humic acids (HA) extracted from a sewage sludge and straw mixture at different steps ...of composting. The HA extracted from sludge mixture released various compounds, such as mono-, di-, tri-methoxy (alkyl) benzene and (alkyl) benzoic acids, which originated from lignin like derivatives of
p-hydroxyphenyl, guiaicyl and syringyl units. In addition, other aromatic non-lignin derived structures were found along with series of branched C15, linear C16, C18 fatty acid methyl esters. The follow-up of various lignin-derived units during composting shows a decrease in
p-hydroxyphenyl type-compounds (C) after the stabilisation phase. In parallel the more oxidized units, derived from guaiacyl (G) and syringyl (S) units, corresponding mainly to methylated derivatives of cafeic acids, protocatechuic acids, gallic acids and aldehydes, significantly increased in comparison with the other aromatic structures. Various ratios commonly used as parameters to determine the degree of lignin decomposition during humification were followed to monitor the chemical structure changes of the HA extracted from sludge mixture during composting. In the present case, the S/G ratio did not present significant changes during composting. The acid/aldehyde ratio was supervised using the ratio of gallic acids to gallic aldehyde methylated derivatives and showed an increase from 0.73 to 2.13 after the stabilisation phase but a decrease to 0.93 at the end of composting. This evolution may be explained by the increase of acid-containing derivatives following the intense oxidation of lignin side-chains during the stabilisation phase. But, the decrease of the acid/aldehyde ratio during the maturation phase could be attributed to a decrease in acid units by polymerisation of benzoic acid type-compounds through ester/ether linkages. The follow up of six families of compounds of similar chemical structures during composting showed a decrease of lignin-type compounds C6
C3 and that C6
C1 units predominated in the humic acid isolated from end compost sludge. The fatty acid methyl esters showed an increase in the intermediate phase of composting probably originating from the activities and tissues of microorganisms, which are numerous during the process. The final decrease in the amount of fatty acids may be explained by the death of most of the microbial population at the end of composting typified by a low respiratory rate. The index of Shannon-Weaver (Ish) remained constant at about 3 in course of composting indicating the neoformation of HA from subunits of similar chemical nature. A similitude index (
S
ij
,
S
′
i
j
) showed a split between 30 and 90 days of composting indicating a change in the rate of neoformation of HA after a stabilisation phase. Afterwards, the rate of HA neoformation varied linearly with the duration of composting.
Heterochromatin is thought to play a critical role for centromeric function. However, the respective contributions of the distinct repetitive sequences found in these regions, such as minor and major ...satellites in the mouse, have remained largely unsolved. We show that these centric and pericentric repeats on the chromosomes have distinct heterochromatic characteristics in the nucleus. Major satellites from different chromosomes form clusters associated with heterochromatin protein 1α, whereas minor satellites are individual entities associated with centromeric proteins. Both regions contain methylated histone H3 (Me-K9 H3) but show different micrococcal nuclease sensitivities. A dinucleosome repeating unit is found specifically associated with major satellites. These domains replicate asychronously, and chromatid cohesion is sustained for a longer time in major satellites compared with minor satellites. Such prolonged cohesion in major satellites is lost in the absence of Suv39h histone methyltransferases. Thus, we define functionally independent centromeric subdomains, which spatio-temporal isolation is proposed to be important for centromeric cohesion and dissociation during chromosome segregation.
In the context of management of the radioactive waste in deep geological formations, the effect of temperature (20–80 °C) on U(VI) adsorption by Callovo-Oxfordian claystone (COx) was studied. A ...step-by-step approach was followed, starting with the single mineral, illite, followed by an increase in the complexity of the system, through the analysis of the clay fraction and the natural samples of the Callovo-Oxfordian formation. Depending on the study conditions, and the speciation of U(VI) in solution (hydrolysed species, carbonate species and presence of ternary U(VI)-Ca(Mg)‑carbonate complexes), the temperature effect was either negligible, or positive (where the increase in temperature favours retention). The most important positive effect was observed for the U(VI)/COx system in the presence of ternary complexes. The data were modelled considering an existing sorption model at 20 °C and the thermodynamic data available to describe the evolution of the speciation of U(VI) in solution in function of temperature. The enthalpy values associated with the surface complexes were fitted from the experimental data following a stepwise approach based on the van't Hoff equation.
•A method is developed to study U retention by clays at temperatures up to 80 °C under controlled PCO2•The temperature effect on the retention is variable depending on the speciation of U in solution•U adsorption is described quantitatively for both illite and natural clay material•As at 20 °C, the COx clay fraction governs the adsorption of U at high temperatures
Direct measurements of the wavenumber-frequency spectrum of wall pressure fluctuations beneath a turbulent plane channel flow have been performed in an anechoic wind tunnel. A rotative array has been ...designed that allows the measurement of a complete map, 63×63 measuring points, of cross-power spectral densities over a large area. An original post-processing has been developed to separate the acoustic and the aerodynamic exciting loadings by transforming space-frequency data into wavenumber-frequency spectra. The acoustic part has also been estimated from a simple Corcos-like model including the contribution of a diffuse sound field. The measured acoustic contribution to the surface pressure fluctuations is 5% of the measured aerodynamic surface pressure fluctuations for a velocity and boundary layer thickness relevant for automotive interior noise applications. This shows that for aerodynamically induced car interior noise, both contributions to the surface pressure fluctuations on car windows have to be taken into account.
.
In this paper, we describe in detail the BMV (
Biréfringence Magnétique du Vide
) experiment, a novel apparatus to study the propagation of light in a transverse magnetic field. It is based on a ...very high finesse Fabry-Perot cavity and on pulsed magnets specially designed for this purpose. We justify our technical choices and we present the current status and perspectives.
Summary
Periodic limb movements during sleep and obstructive sleep apnea are both associated with increased sympathetic tone, and have been proposed as risk factors for heart diseases and, in ...particular, cardiovascular disease. As sympathetic system activation may lead to dyslipidaemia, periodic limb movements during sleep could be an additional risk factor for cardiovascular disease in patients with obstructive sleep apnea. The aim of the study was to determine whether the presence of periodic limb movements during sleep affects serum lipid levels in obstructive sleep apnea. Total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, non‐ high‐density lipoprotein cholesterol and triglyceride levels were investigated in 4138 patients with obstructive sleep apnea in the European Sleep Apnea Database (ESADA) cohort, divided into those with periodic limb movements during sleep index ≥ 15 per hr (n = 628) and controls (n = 3510). ANCOVA adjusted for age, sex, body mass index, apnea–hypopnea index, alcohol intake, smoking status, diabetes, insomnia and study site was used to assess differences in lipids between periodic limb movements during sleep and controls. Patients with periodic limb movements during sleep (24% female, 54.4 ± 12.1 years, body mass index 31.9 ± 5.8 kg m−2, apnea–hypopnea index 36.7 ± 25.4 per hr) had higher triglyceride (1.81 ± 1.04 versus 1.69 ± 0.90 mmol L−1, p = 0.002) and lower high‐density lipoprotein cholesterol (1.19 ± 0.34 versus 1.24 ± 0.37 mmol L−1, p = 0.002) levels, whilst there was no difference in either total cholesterol (4.98 ± 1.10 versus 4.94 ± 1.07 mmol L−1), low‐density lipoprotein cholesterol (3.04 ± 0.96 versus 2.98 ± 0.98 mmol L−1) or non‐ high‐density lipoprotein cholesterol (3.78 ± 1.10 versus 3.70 ± 1.05 mmol L−1) concentrations (all p > 0.05). The results remained unchanged after most sensitivity analyses. Patients with obstructive sleep apnea with periodic limb movements during sleep had more prevalent cardiovascular disease (11% versus 6%, p < 0.01). Periodic limb movements during sleep in obstructive sleep apnea is associated with dyslipidaemia independently of important confounders. Our results highlight periodic limb movements during sleep as an additional risk factor for cardiovascular disease in obstructive sleep apnea.
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