Sleep apnea is common in hospitalized heart failure (HF) patients and is associated with increased morbidity and mortality.
The CAT-HF (Cardiovascular Improvements With MV-ASV Therapy in Heart ...Failure) trial investigated whether minute ventilation (MV) adaptive servo-ventilation (ASV) improved cardiovascular outcomes in hospitalized HF patients with moderate-to-severe sleep apnea.
Eligible patients hospitalized with HF and moderate-to-severe sleep apnea were randomized to ASV plus optimized medical therapy (OMT) or OMT alone (control). The primary endpoint was a composite global rank score (hierarchy of death, cardiovascular hospitalizations, and percent changes in 6-min walk distance) at 6 months.
126 of 215 planned patients were randomized; enrollment was stopped early following release of the SERVE-HF (Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure) trial results. Average device usage was 2.7 h/night. Mean number of events measured by the apnea-hypopnea index decreased from 35.7/h to 2.1/h at 6 months in the ASV group versus 35.1/h to 19.0/h in the control group (p < 0.0001). The primary endpoint did not differ significantly between the ASV and control groups (p = 0.92 Wilcoxon). Changes in composite endpoint components were not significantly different between ASV and control. There was no significant interaction between treatment and ejection fraction (p = 0.10 Cox model); however, pre-specified subgroup analysis suggested a positive effect of ASV in patients with HF with preserved ejection fraction (p = 0.036).
In hospitalized HF patients with moderate-to-severe sleep apnea, adding ASV to OMT did not improve 6-month cardiovascular outcomes. Study power was limited for detection of safety signals and identifying differential effects of ASV in patients with HF with preserved ejection fraction, but additional studies are warranted in this population. (Cardiovascular Improvements With MV ASV Therapy in Heart Failure CAT-HF; NCT01953874).
Most vendors offer scanners capable of dual- or multi-energy computed tomography (CT) imaging. Advantages of multi-energy CT scanning include superior tissue characterization, detection of subtle ...iodine uptake differences, and opportunities to reduce contrast dose. However, utilization of this technology in the emergency department (ED) remains low. The purpose of this pictorial essay is to illustrate the value of multi-energy CT scanning in emergency body imaging.
In this work, inclusive electron scattering from nuclear targets has been measured to extract the nuclear dependence of the inelastic cross section in Hall C at the Thomas Jefferson National ...Accelerator facility. Results are presented for 2H, 3He, 4He, 9B, 12C, 63Cu and 197Au at an incident electron beam energy of 5.77 GeV for a range of momentum transfer from Q2 = 2 to 7 (GeV/c)2. These data improve the precision of the existing measurements of the EMC effect in the nuclear targets at large x, and allow for more detailed examinations of the A dependence of the EMC effect.
Obstructive sleep apnoea, a syndrome that leads to recurrent intermittent hypoxia, is associated with insulin resistance in
obese individuals, but the mechanisms underlying this association remain ...unknown. We utilized a mouse model to examine the
effects of intermittent hypoxia on insulin resistance in lean C57BL/6J mice and leptin-deficient obese (C57BL/6Jâ Lep ob ) mice. In lean mice, exposure to intermittent hypoxia for 5 days (short term) resulted in a decrease in fasting blood glucose
levels (from 173 ± 11 mg dl â1 on day 0 to 138 ± 10 mg dl â1 on day 5, P < 0.01), improvement in glucose tolerance without a change in serum insulin levels and an increase in serum leptin levels
in comparison with control (2.6 ± 0.3 vs. 1.7 ± 0.2 ng ml â1 , P < 0.05). Microarray mRNA analysis of adipose tissue revealed that leptin was the only upregulated gene affecting glucose
uptake. In obese mice, short-term intermittent hypoxia led to a decrease in blood glucose levels accompanied by a 607 ± 136
% ( P < 0.01) increase in serum insulin levels. This increase in insulin secretion after 5 days of intermittent hypoxia was completely
abolished by prior leptin infusion. Obese mice exposed to intermittent hypoxia for 12 weeks (long term) developed a time-dependent
increase in fasting serum insulin levels (from 3.6 ± 1.1 ng ml â1 at baseline to 9.8 ± 1.8 ng ml â1 at week 12, P < 0.001) and worsening glucose tolerance, consistent with an increase in insulin resistance. We conclude that the increase
in insulin resistance in response to intermittent hypoxia is dependent on the disruption of leptin pathways.
New Jefferson Lab data are presented on the nuclear dependence of the inclusive cross section from (2)H, (3)He, (4)He, (9)Be and (12)C for 0.3 < x < 0.9, Q(2) approximately 3-6 GeV(2). These data ...represent the first measurement of the EMC effect for (3)He at large x and a significant improvement for (4)He. The data do not support previous A-dependent or density-dependent fits to the EMC effect and suggest that the nuclear dependence of the quark distributions may depend on the local nuclear environment.
The experiment E94-107 in Hall A at Jefferson Lab started a systematic study of high resolution hypernuclear spectroscopy in the 0p-shell region of nuclei such as the hypernuclei produced in ...electroproduction on 9Be, 12C and 16O targets. In order to increase counting rates and provide unambiguous kaon identification two superconducting septum magnets and a ring-imaging Cherenkov detector were added to the Hall A standard equipment. The high-quality beam, the good spectrometers and the new experimental devices allowed us to obtain very good results. For the first time, measurable strength with sub-MeV energy resolution was observed for the core-excited states of Lambda 12B. A high-quality Lambda 16N hypernuclear spectrum was likewise obtained. A first measurement of the Lambda binding energy for Lambda 16N, calibrated against the elementary reaction on hydrogen, was obtained with high precision, 13.76 +/- 0.16 MeV. Similarly, the first Lambda 9Li hypernuclear spectrum shows general agreement with theory (distorted-wave impulse approximation with the SLA and BS3 electroproduction models and shell-model wave functions). Some disagreement exists with respect to the relative strength of the states making up the first multiplet. A Lambda separation energy of 8.36 MeV was obtained, in agreement with previous results. It has been shown that the electroproduction of hypernuclei can provide information complementary to that obtained with hadronic probes and the gamma-ray spectroscopy technique.
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