To investigate the prevalence of sleep breathing disorders, loud snoring and excessive daytime sleepiness in a group of obese subjects, and to identify the predictors of obstructive sleep apnea (OSA) ...severity in these patients.
A total of 161 consecutive obese patients (body mass index (BMI)> or =30.0 kg/m(2)), ranging between 30.0 and 67.3, represented by 57 men and 104 women, aged 16-75 y. Forty (15 men and 25 women) age-matched (20-70 y) nonobese (BMI<27 kg/m(2)) volunteers were also recruited for the study.
Respiratory function parameters, nocturnal sleep quality (evaluated by a specific questionnaire), nocturnal hypoventilation and OSA (evaluated by night polysomnography) were examined in all subjects. Anthropometric parameters (neck circumference, waist circumference, waist-to-hip ratio) were also investigated.
Eighty-three obese patients (51.5% of the obese group) had a respiratory disturbance index (RDI)> or =10, corresponding to a moderate or severe sleep apnea. In particular, 24.8% (40/161), ie a quarter of all obese patients, were affected by severe OSA and this alteration was present in 42.1% of obese men (24/57) and in 15.4% (16/104) of obese women. When a stepwise multiple regression analysis was performed, neck circumference in men and BMI in women were shown to be the strongest predictors of sleep apnea. Twenty-nine percent of all obese subjects (40.3% of men and 23.1% of women) showed nocturnal hypoventilation; however, it was present as a unique breathing alteration in only 5% of the obese population. The percentage of patients having excessive daytime sleepiness was significantly higher than in nonobese subjects, even when only nonapneic obese patients were considered (P<0.001).
This study shows that OSA is present in more than 50% of a population of obese patients with a mean BMI higher than 40.0, this percentage being much higher than that commonly reported in previous studies, particularly in women. Neck circumference in men and BMI in women seem to be the strongest predictors of the severity of OSA in obese patients. Nocturnal hypoventilation seems to be present in more than 29% of a severe obese population. Moreover, this study indicates that morbid obesity can be associated with excessive daytime sleepiness even in the absence of sleep apnea.
. Resta O, Foschino‐Barbaro MP, Bonfitto P, Giliberti T, Depalo A, Pannacciulli N, De Pergola G (Respiratory Pathophysiology, University of Bari, School of Medicine, Bari, Italy; University of ...Foggia, School of Medicine, Foggia, Italy; and Internal Medicine, Endocrinology, and Metabolic Diseases, University of Bari, Bari, Italy). Low sleep quality and daytime sleepiness in obese patients without obstructive sleep apnoea syndrome. J Intern Med 2003; 253: 536–543.
Objectives. To evaluate sleep quality, sleep‐related symptoms, and degree of excessive daytime sleepiness (EDS) in severe obesity, independently of obstructive sleep apnoea syndrome (OSAS).
Design. A cross‐sectional study.
Setting. Primary‐care setting.
Subjects, main outcome measures. Anthropometric parameters, respiratory function data and sleep related symptoms were evaluated in 78 severely obese patients (aged 16–75 years) without OSAS and in 40 healthy sex‐ and age‐matched normal weight subjects, who underwent a full‐night polysomnography.
Results. Obese patients and control subjects had similar sleep latency and rapid eye movement (REM) latency, but they showed lower percentage of REM (P < 0.01) and sleep efficiency (P < 0.05) than controls. All sleep‐related symptoms (observed or reported apnoea, awakenings, choking and unrefreshing sleep) were significantly more frequent in obese patients than in control subjects. Loud snoring was present in 46.7% of the obese patients and in 8.1% of the control individuals (P < 0.01). Excess daytime sleepiness was reported by 34.7% of the obese patients and by 2.7% of the normal weight subjects (P < 0.01). The Epworth Sleepiness Scale (ESS) was higher in the obese group than in the control group (P < 0.01), whereas arousals were not different between the two groups.
Conclusions. This study clearly shows that severe obesity, even in the absence of OSAS, is associated with sleep‐related disorders and EDS. All these alterations may be partly responsible for a lower quality of life, a higher prevalence of medical complications, an increased risk of occupational injury, and both social and family problems characterizing obese patients, independently of the presence of OSAS.
A search for neutral heavy leptons (NHLs) has been performed using an instrumented decay channel at the NuTeV (E-815) experiment at Fermilab. The data were examined for NHLs decaying into muonic ...final states ({mu}{mu}{nu} , {mu}e{nu} , {mu}{pi} , and {mu}{rho} ); no evidence has been found for NHLs in the 0.25-2.0 GeV mass range. This analysis places limits on the mixing of NHLs with standard light neutrinos at a level up to an order of magnitude more restrictive than previous search limits in this mass range. (c) 1999 The American Physical Society.
We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress ...syndrome (PARDS), considering new evidence and topic areas that were not previously addressed.
International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science.
Not applicable.
Patients with or at risk for PARDS.
None.
Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%.
PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.
The NuTeV Collaboration has extracted the electroweak parameter sin(2)theta(W) from the measurement of the ratios of neutral current to charged current nu and (-)nu cross sections. Our value, ...sin(2)theta((on-shell))(W) = 0.2277 +/- 0.0013(stat) +/- 0.0009(syst), is 3 standard deviations above the standard model prediction. We also present a model independent analysis of the same data in terms of neutral-current quark couplings.
Plastic scintillators are very often used as detecting media in sampling calorimeters of High Energy Physics (HEP). Many modern HEP experimental installations are already operating or proposed to ...work at high luminosity. Plastic scintillators are the most sensitive part of such setups in terms of their radiation hardness. Improving the light collection from the most irradiated scintillators will ensure their long-term use at high luminosity. The experimental results of the measurements for different assemblies (scintillator SCSN-81 and the WLS fiber Y-11 electron-irradiated (E≈4MeV) were obtained. Calculations of the light yields for different samples based on our experimental results show the possibility of increasing the radiation hardness of plastic scintillators inside the sampling calorimeter up to 20Mrad.
Birt-Hogg-Dubé (BHD) syndrome is a rare genetic pathology characterized by cutaneous fibrofolliculomas, pulmonary cysts and kidney tumours. Severe asthma is the most serious form of asthma that does ...not respond to standard treatments. We present the case of a 68 years-old male patient who had frequent respiratory tract infections, shortness of breath and decline in lung function, nasal polyposis and hypertrophy of the nasal turbinates, for this reason was treated as a severe asthmatic patient for several years with ICS + LABA and high doses of OCS. When we tried to reduce OCS the patient had worsening of the symptoms, we requested a HRTC scan that showed presence of several cysts spread ubiquitously. The patient had a family history of pneumothorax, for this reason we requested a genetic test that resulted in a heterozygous point mutation on exon 12 (c.1429 C > T) of FLCN gene. Despite the diagnosis of BHD syndrome, the patient's clinical condition kept on suggesting an underlying severe asthma and the blood tests we requested pointed out a high percentage of eosinophils, for this reason we opted for the administration of benralizumab that resulted in an excellent asthma control and increased quality of life.
It is well known that obstructive sleep apnoea is especially frequent in the morbidly obese. In these subjects diurnal chronic hypercapnia, whose mechanism is still debated, may be present.
Our study ...was performed to evaluate the prevalence and the mechanism of diurnal hypercapnia in the morbidly obese affected by obstructive sleep apnoea. From a population referred to our centre because of suspicion of sleep related breathing disorders, we selected 285 subjects without cardiopulmonary, neuromuscular or endocrinological diseases: 89 (36 M and 53 F, aged 46±13 years) had body mass index (BMI)≥40 kg m−2(MO group: morbidly obese subjects) and 196 (99 M and 97 F, aged 48±16 years) had BMI<40 kg m−2(NMO group: non-morbidly obese subjects). Then the MO group was divided into three subgroups: normocapnic subjects without obstructive sleep apnoea, normocapnic subjects with obstructive sleep apnoea, hypercapnic subjects with obstructive sleep apnoea; while we found no hypercapnic subject without obstructive sleep apnoea.
All subjects underwent anthropometric evaluations and bioelectrical impedance analyses, respiratory function tests and arterial blood gas analysis, a modified version of the Sleep and Healthy Questionnaire and a full night polysomnography.
Our results showed that hypercapnia (P aCO2≥45 mmHg) associated with obstructive sleep apnoea respiratory disturbance index (RDI)≥,10 h−1 was found in 27% of the morbidly obese subjects, but only in 11% of the non-morbidly obese ones (P<0·01)
The comparison among the three subgroups, in which we divided the morbidly obese subjects, shows that those with hypercapnia and obstructive sleep apnoea had significantly more important ventilatory restrictive defects forced vital capacity (FVC)% of pred 73·27±14·81 vs. 82·37±16·93vs. 87·25±18·14 respectively; total lung capacity (TLC)% of pred 63·83±16·35 vs. 79·11±14·15 vs. 87·01±10·5, a significantly higher respiratory disturbance index (RDI 46·34±26·90 vs. 31·79±22·47 vs. 4·98±3·29) a longer total sleep time with oxyhaemo- globin saturation <90% total sleeptime (TST)SaO2<90%63·40±33·86 vs. 25·95±29·34 vs. 8·22±22·12 and a lower rapid eye movement (REM) stage (9·5±1·2 vs. 14·0±0·9 vs. 17·05±1·2) than normocapnic subjects with obstructive sleep apnoea or subjects without obstructive sleep apnoea.
The best model to predict P aCO2resulted from a combination of TSTS aO2<90%(r2=0·22,P <0·001), forced expiratory volume in 1sec (FEV1)% of pred (r2=0·09, P<0·01), FVC % of pred (r2=0·075, P<0·01).
In conclusion our study suggests that diurnal hypercapnia is frequently associated with obstructive sleep apnoea in the morbidly obese without chronic obstructive pulmonary disorder (COPD) and that ventilatory restriction and sleep related respiratory disturbances correlate to diurnal hypercapnia.
The CDF plug upgrade electromagnetic calorimeter: test beam results Albrow, M.; Aota, S.; Apollinari, G. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
03/2002, Letnik:
480, Številka:
2
Journal Article
Recenzirano
Odprti dostop
The CDF Plug Upgrade calorimeter, which fully exploits the tile–fiber technique, was tested at the Fermilab meson beamline. The calorimeter was exposed to positron, positively charged pion and ...positive muon beams with energies in the range of 5–
230
GeV
. The energy resolution of the electromagnetic calorimeter to the positron beam is consistent with the design value of
16%/
E
⊕1%
, where E is the energy in units of GeV and ⊕ represents sum in quadrature. The non-linearity for positrons is studied in an energy range of 11–
181
GeV
. It is important to incorporate the response of the preshower detector, the first layer of the electromagnetic calorimeter which is readout separately, into that of the calorimeter to reduce the non-linearity to 1% or less. The energy scale is about
1.46
pC/
GeV
with HAMAMATSU R4125 operated typically at a gain of 2.5×10
4. The response non-uniformity over the surface of a tower of the electromagnetic calorimeter is found to be about 2% with
57
GeV
positrons. Studies of several detailed detector characteristics are also presented.
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