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Measured energy expenditure in mildly hypothermic critically ill patients with traumatic brain injury: A sub-study of a randomized controlled trial.

Clin Nutr 2021 May 24;40(6):3875-3882. Epub 2021 May 24.

Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, St Kilda Road, Melbourne, 3004, Australia; Intensive Care Unit, The Alfred Hospital, Commercial Road, Melbourne, 3004, Australia.

Background & Aims: Prophylactic hypothermia, often used in critically ill patients with traumatic brain injury, reduces energy expenditure and may affect energy delivered by nutrition therapy. The primary objective of this study was to measure energy expenditure in hypothermic patients over the first 3 days after traumatic brain injury (TBI). Secondary objectives included comparison of measured energy expenditure and nutrition delivery to day 7. Read More

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Telehealth Sustainability in a Neurosurgery Department During the COVID-19 Pandemic.

World Neurosurg 2021 Jun 12. Epub 2021 Jun 12.

Neurosurgery, University of Kentucky, 800 Rose St., Lexington, KY, 40508 USA; Brain Restoration Center, University of Kentucky, 800 Rose St., Lexington, KY, 40508 USA; Neuroscience, University of Kentucky, 800 Rose St., Lexington, KY, 40508 USA. Electronic address:

Background: The pandemic shifted the dynamics of healthcare and neurosurgical practice. Elective surgeries were suspended for 8 weeks in Kentucky. Our objective was to determine if telehealth (TH) visits could be sustained as an alternative to in-person visits. Read More

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Role of lactulose for prophylaxis against hepatic encephalopathy in cirrhotic patients with upper gastrointestinal bleeding: A randomized trial.

Indian J Gastroenterol 2021 Jun 15. Epub 2021 Jun 15.

NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Background: We aimed to assess the efficacy of lactulose as prophylaxis against hepatic encephalopathy (HE) in cirrhotic patients with acute upper gastrointestinal bleeding (AUGIB).

Methods: We conducted a randomized, double-blinded, placebo-controlled, multicenter study from October 2012 to February 2014. Cirrhotic patients presenting with AUGIB (aged 18-80 years, without HE at the time of admission) were enrolled and randomized to receive blinded medications (both physically indistinguishable), labeled "Lactulose A" and "Lactulose B" for 5 days along with standard treatment depending on the type of bleeding (variceal and nonvariceal). Read More

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Nonlesional diffusely abnormal appearing white matter in clinically isolated syndrome: Prevalence, association with clinical and MRI features, and risk for conversion to multiple sclerosis.

J Neuroimaging 2021 Jun 15. Epub 2021 Jun 15.

Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.

Background And Purpose: While diffusely abnormal white matter (DAWM) is a nonlesional MRI abnormality identified in ∼25% of patients with multiple sclerosis (MS), it has yet to be investigated in patients at an earlier disease stage, namely clinically isolated syndrome (CIS). The goals of this study were to (1) determine the prevalence of DAWM in patients with a CIS suggestive of MS, (2) evaluate the association between DAWM and demographic, clinical, and MRI features, and (3) evaluate the prognostic significance of DAWM on conversion from CIS to MS.

Methods: One hundred and forty-two CIS participants were categorized into DAWM and non-DAWM groups at baseline and followed for up to 24 months or until MS diagnosis. Read More

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Aortic Root Dilation in Patients with 22q11.2 Deletion Syndrome Without Intracardiac Anomalies.

Pediatr Cardiol 2021 Jun 14. Epub 2021 Jun 14.

Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Aortic root dilation (ARD) has been reported in patients with 22q11.2 deletion syndrome (22q11.2DS) with and without congenital heart defects (CHDs). Read More

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Hospital initiation of benzodiazepines and Z-drugs in older adults and discontinuation in primary care.

Res Social Adm Pharm 2021 Jun 5. Epub 2021 Jun 5.

HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address:

Objective: To examine factors associated with continuation of hospital-initiated benzodiazepine receptor agonists (BZRAs) among adults aged ≥65 years, specifically instructions on hospital discharge summaries.

Methods: This retrospective cohort study involved anonymised electronic record data on prescribing and hospitalisations for 38,229 patients aged ≥65 from forty-four GP practices in Ireland 2011-2016. BZRA initiations were identified among patients with no BZRA prescription in the previous 12 months. Read More

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A comparative study on using superior thyroid artery perforator flaps versus traditional sternocleidomastoid myocutaneous flaps for reconstructions after oral cancer ablation: "New tricks for old dogs"?

Oral Oncol 2021 Jun 11:105374. Epub 2021 Jun 11.

Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China. Electronic address:

Objectives: To introduce new superior thyroid artery perforator flaps (STAPF), and to compare the clinical outcomes with sternocleidomastoid myocutaneous flaps (SCMMF) for their intraoral applications.

Materials And Methods: Between January 2013 and December 2020, forty-three oral cancer patients who received post-oncologic reconstructions with one of these two regional flaps were retrospectively collected. Their techniques and outcomes were compared. Read More

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Short-term and long-term safety and efficacy of tenofovir alafenamide, tenofovir disoproxil fumarate and entecavir treatment of acute-on-chronic liver failure associated with hepatitis B.

BMC Infect Dis 2021 Jun 14;21(1):567. Epub 2021 Jun 14.

Department of Infectious Diseases, First Affiliated Teaching Hospital, School of Medicine, Xi'an Jiaotong University, Yanta Road (w), No. 277, Xi'an City, 710061, Shaanxi Province, China.

Background & Aims: There is limited evidence on the efficacy and safety of nucleos(t) ide analogues (NAs) in the treatment of HBV-ACLF. Our objective was to evaluate the outcomes among TAF, TDF and ETV, three first-line antivirals against chronic hepatitis B, in patients with HBV-ACLF.

Methods: Patients with HBV-related ACLF were recruited and received daily TAF (25 mg/d), TDF (300 mg/d) and ETV (0. Read More

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Microtia Reconstruction and Erector Spinae Block in Children: A Case Series With Chart Review.

Otolaryngol Head Neck Surg 2021 Jun 15:1945998211018382. Epub 2021 Jun 15.

Division of Anesthesia and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.

Objectives: Autologous reconstruction of microtia is advantageous due to its inherent biocompatibility and long-term stability, but postoperative pain associated with costal harvest is a significant issue. A well-planned pain management approach is imperative. Our objective is to introduce the novel application of erector spinae block anesthesia in pediatric microtia reconstruction and evaluate its impact on pain scores, use of opioids, and hospital length of stay. Read More

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Subclinical depression and anxiety impact verbal memory functioning differently in men and women -an fMRI study.

J Psychiatr Res 2021 May 27;140:308-315. Epub 2021 May 27.

Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.

Background: Depressive symptoms are known to affect memory efficiency in various populations. More specifically, several studies conducted in patients suffering from schizophrenia have indicated that memory efficiency is affected by depressed mood in female patients and by anxiety in male patients. We investigated, using neuroimaging techniques, whether similar gender-specific associations with subclinical depression and anxiety could be observed in a non-clinical sample. Read More

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Factors influencing nursing students' intention to accept COVID-19 vaccination: A pooled analysis of seven European countries.

Nurse Educ Today 2021 Jun 10;104:105010. Epub 2021 Jun 10.

Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, Crete, Greece. Electronic address:

Background: Experiencing the third wave of COVID-19 pandemic, high vaccination coverage by a safe and effective vaccine globally would be a great achievement. Acceptance of vaccination by nursing students is an important issue as they play a decisive role as future professionals in educating patients, counselling, and guiding them to the right clinical decision.

Objectives: To explore the intention of nursing students to get vaccinated for SARS-CoV-2 infection and the factors acting either as motivators or as barriers towards vaccination. Read More

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Complement activation is associated with poor outcome after out-of-hospital cardiac arrest.

Resuscitation 2021 Jun 11. Epub 2021 Jun 11.

Dept. of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway; Dept. of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. Electronic address:

Background: Cardiopulmonary resuscitation after cardiac arrest initiates a whole-body ischemia-reperfusion injury, which may activate the innate immune system, including the complement system. We hypothesized that complement activation and subsequent release of soluble endothelial activation markers were associated with cerebral outcome including death.

Methods: Outcome was assessed at six months and defined by cerebral performance category scale (1-2; good outcome, 3-5; poor outcome including death) in 232 resuscitated out-of-hospital cardiac arrest patients. Read More

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Conformation sensitive gel electrophoresis for the detection of calreticulin mutations in BCR-ABL1-negative myeloproliferative neoplasms.

Int J Lab Hematol 2021 Jun 14. Epub 2021 Jun 14.

Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Introduction: Calreticulin (CALR) mutations in myeloproliferative neoplasms (MPN) have been reported to be key markers in the molecular diagnosis, particularly in patients lacking JAK2 V617F mutation. In most current reports, CALR mutations were analysed by either allele-specific PCR (AS-PCR), or the more expensive quantitative real-time PCR, pyrosequencing and next-generation sequencing. Hence, we report the use of an alternative method, the conformation sensitive gel electrophoresis (CSGE) for the detection of CALR mutations in BCR-ABL1-negative MPN patients. Read More

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Shear-wave elastography as a tool in the assessment of thyroid nodules.

Gac Med Mex 2021 ;157(1):18-23

Specialty Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.

Introduction: Shear-wave elastography (SWE) has been shown to be predictive of malignancy in thyroid nodules.

Objective: To determine, by SWE, the stiffness cutoff point with the highest specificity and sensitivity to detect thyroid nodules that require surgery.

Methods: Cross-sectional study of ultrasonographically-evaluated patients for thyroid nodules over a period of three years; the TI-RADS classification system was used, and nodule stiffness was determined by SWE. Read More

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January 2021

Characteristics and Outcomes of Adults Hospitalized with Dengue Viral Infection and Acute Kidney Injury in Southern Thailand.

Am J Trop Med Hyg 2021 Jun 14. Epub 2021 Jun 14.

Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Dengue viral infection (DVI) among adult patients is increasingly problematic in tropical and subtropical regions. Acute kidney injury (AKI) after DVI poses substantial clinical outcomes and economic impact. This prospective study focused on the characteristics, risk factors, and outcomes of adult patients with AKI due to DVI hospitalized in nine network hospitals within Southern Thailand from January 2017 to December 2019. Read More

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Pregnancy-associated breast cancer: evaluating maternal and foetal outcomes. A national study.

Breast Cancer Res Treat 2021 Jun 14. Epub 2021 Jun 14.

Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland.

Purpose: Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during the gestational period (gp-PABC) or in the first postpartum year (pp-PABC). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments, and maternal and foetal outcomes. Read More

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Good to excellent long-term survival of a single-design condylar constrained knee arthroplasty for primary and revision surgery.

Knee Surg Sports Traumatol Arthrosc 2021 Jun 14. Epub 2021 Jun 14.

Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, MuensterMuenster, Germany.

Purpose: The purpose of the study was to determine the long-term survivorship, functional outcomes of a single-design condylar constrained (CCK) TKA in primary and revision cases as well as to assess specific risk factors for failure. It was hypothesized that primary CCK TKA had a better survival than revision knees.

Methods: One hundred and forty three patients who underwent revision TKA (n = 119) or complex primary TKA (n = 24) using a single-design condylar constrained knee system (Genesis CCK, Smith & Nephew) performed at a single institution between 1999 and 2008 were retrospectively included. Read More

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Outcomes of pregnancy and delivery in women with continent lower urinary tract reconstruction: systematic review of the literature.

Int Urogynecol J 2021 Jun 14. Epub 2021 Jun 14.

Department of Urology, CHU-Université de Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France.

Introduction And Hypothesis: The aim of this systematic review of the literature was to pool all the existing data regarding pregnancy and delivery in women with neurogenic bladder or bladder exstrophy who had undergone previous lower urinary tract reconstruction (LUTR).

Methods: We conducted a systematic review of the literature from PubMed/MedLine, ClinicalTrials.gov and the Google Scholar database, from 1972 to July 2020. Read More

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Long term outcomes of laparoscopic sacro/colpo-hysteropexy with and without rectopexy for the treatment of prolapse.

Int Urogynecol J 2021 Jun 14. Epub 2021 Jun 14.

Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France.

Introduction And Hypothesis: Laparoscopic sacrohysteropexy (LSH), sacrocolpopexy (LSC) and ventral rectopexy (LVR) with mesh are advocated for surgical treatment of pelvic and rectal prolapse. Our study aims at showing the feasibility of concomitant laparoscopic prolapse repair by comparing perioperative and long-term outcomes of LSH or LSC with and without LVR.

Methods: This is a retrospective study carried out on 348 women operated on between July 2009 and July 2019. Read More

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Glucose-lowering Drugs and Hospitalization for Heart Failure: A Systematic Review and Additive-effects Network Meta-Analysis with over 500,000 Patient-Years.

J Clin Endocrinol Metab 2021 Jun 14. Epub 2021 Jun 14.

Atherosclerosis and Vascular Biology Laboratory (Atherolab), Cardiology Department, State University of Campinas (Unicamp), Campinas, SP, Brazil.

Background: Sodium glucose co-transporter 2 inhibitors (SGLT2i) prevent hospitalization due to heart failure (HHF). However, patients with type 2 diabetes mellitus (T2DM) use multiple anti-hyperglycemic drugs to achieve glycosylated hemoglobin (HbA1c) targets. In these drug combinations the risk of HHF is unpredictable, so is the parallel effect of glucose-lowering. Read More

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The Power of an Active Shooter Simulation: Changing Ethical Beliefs.

West J Emerg Med 2021 May 21;22(3):510-517. Epub 2021 May 21.

Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.

Introduction: During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. Read More

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The Implementation of a Collaborative Pediatric Telesimulation Intervention in Rural Critical Access Hospitals.

AEM Educ Train 2021 Jul 31;5(3):e10558. Epub 2021 Jan 31.

Department of Pediatrics Johns Hopkins University School of Medicine Baltimore MD USA.

Background: Over 5.8 million pediatric visits to rural emergency department (EDs) occur each year in the United States. Most rural EDs care for less than five pediatric patients per day and are not well prepared for pediatrics. Read More

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Cryoballoon Ablation of Atrial Fibrillation Without Demonstration of Pulmonary Vein Occlusion-The Simplify Cryo Study.

Front Cardiovasc Med 2021 26;8:664538. Epub 2021 May 26.

Department of Cardiology, University Hospital of Basel, Basel, Switzerland.

The demonstration of pulmonary vein (PV) occlusion is routinely performed and considered a prerequisite for successful cryoballoon (CB) ablation of atrial fibrillation (AF). The purpose of this study was to assess the feasibility and impact on procedural parameters and outcome of a standardized procedural protocol without demonstrating PV occlusion. Consecutive patients undergoing CB pulmonary vein isolation (PVI) were studied. Read More

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Clinical performance of class I cavities restored with bulk fill composite at a 1-year follow-up using the FDI criteria: a randomized clinical trial.

Restor Dent Endod 2021 May 16;46(2):e24. Epub 2021 Apr 16.

Department of Conservative Dentistry and Endodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India.

Objectives: The present study aimed to evaluate the survival rate and clinical performance of class 1 composite restorations restored with the Filtek Bulk Fill composite material using either the bulk fill technique or the incremental technique at baseline (1 week) and at 3, 6 and 12 months of follow-up.

Materials And Methods: Forty-two patients with at least 2 carious teeth were selected. Following randomization, one tooth was restored with the Filtek Bulk Fill composite using the incremental fill technique, and the other tooth was restored with the same material using the bulk fill technique. Read More

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Ocrelizumab after natalizumab in JC-virus positive relapsing remitting multiple sclerosis patients.

Mult Scler J Exp Transl Clin 2021 Apr-Jun;7(2):20552173211013831. Epub 2021 Jun 1.

Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.

Ocrelizumab is often used as an alternative therapy in natalizumab-treated MS patients at risk for progressive multifocal leukoencephalopathy (PML). Our objective was to assess efficacy and safety of JC-virus positive patients switching (either directly or indirectly) from natalizumab to ocrelizumab. Forty-two patients were included from an observational cohort (median follow-up 21 months). Read More

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Therapeutic effects of the TST36 stapler on rectocele combined with internal rectal prolapse.

World J Gastrointest Surg 2021 May;13(5):443-451

Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China.

Background: The most common causes of outlet obstructive constipation (OOC) are rectocele and internal rectal prolapse. The surgical methods for OOC are diverse and difficult, and the postoperative complications and recurrence rate are high, which results in both physical and mental pain in patients. With the continuous deepening of the surgeon's concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC, the treatment concepts and surgical methods are continuously improved. Read More

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Reproducibility of vaginal immobilization balloons overnight for cervical cancer brachytherapy.

J Contemp Brachytherapy 2021 Jun 13;13(3):280-285. Epub 2021 May 13.

Department of Radiation Oncology, University of Arizona College of Medicine, Tucson, USA.

Purpose: The use of vaginal immobilization balloons placed into the vagina for immobilization of tandem and ovoid (T+O) applicator during high-dose-rate (HDR) brachytherapy delivery has been used at our institution, and seems to have improved our patient comfort, decreased procedure time, and minimized applicator misplacement. We aimed to show that these balloons, while originally marketed for single-day use, are safe and maintain applicator positioning/dosimetry when left overnight for treatment delivery on sequential days.

Material And Methods: Forty-two paired computed tomography (CT) scans from thirteen patients who underwent T+O HDR treatments on sequential days with vaginal immobilization balloons overnight were retrospectively compared to calculate mean change of balloon volumes and balloon/T+O distance to bony landmarks. Read More

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Endovascular Treatment of Intracranial Aneurysms in Small Peripheral Vessel Segments-Efficacy and Intermediate Follow-Up Results of Flow Diversion With the Silk Vista Baby Low-Profile Flow Diverter.

Front Neurol 2021 28;12:671915. Epub 2021 May 28.

Department of Neuroradiology, Clinic & Policlinic of Radiology, University Hospital Halle, Halle (Saale), Germany.

Low-profile flow diverter stents (FDS) quite recently amended peripheral segments as targets for hemodynamic aneurysm treatment; however, reports on outcomes, especially later than 3 months, are scarce. This study therefore reports our experience with the novel silk vista baby (SVB) FDS and respective outcomes after 8 and 11 months with special respect to specific adverse events. Forty-four patients (mean age, 53 years) harboring 47 aneurysms treated with the SVB between June 2018 and December 2019 were included in our study. Read More

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Dream Activity in Narcoleptic Patients During the COVID-19 Lockdown in Italy.

Front Psychol 2021 26;12:681569. Epub 2021 May 26.

Department of Medicine and Surgery, University of Parma, Parma, Italy.

Some studies highlighted that patients with narcolepsy type-1 (NT1) experience high lucid dream frequency, and this phenomenon has been associated with a creative personality. Starting from the well-known "pandemic effect" on sleep and dreaming, we presented a picture of dream activity in pharmacologically treated NT1 patients during the Italian lockdown. Forty-three NT1 patients completed a web-survey during Spring 2021 and were compared with 86 matched-controls. Read More

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Comparison of Cortical Autonomic Network-Linked Sympathetic Excitation by Mueller Maneuvers and Breath-Holds in Subjects With and Without Obstructive Sleep Apnea.

Front Physiol 2021 26;12:678630. Epub 2021 May 26.

University Health Network and Mount Sinai Hospital Department of Medicine, Toronto General Hospital Research Institute and the Department of Medicine, University of Toronto, Toronto, ON, Canada.

In healthy young volunteers, acquisition of blood oxygen level-dependent (BOLD) magnetic resonance (MR) and muscle sympathetic nerve (MSNA) signals during simulation of obstructive or central sleep apnea identified cortical cardiovascular autonomic regions in which the BOLD signal changed synchronously with acute noradrenergic excitation. In the present work, we tested the hypothesis that such Mueller maneuvers (MM) and breath-holds (BH) would elicit greater concomitant changes in mean efferent nerve firing and BOLD signal intensity in patients with moderate to severe obstructive sleep apnea (OSA) relative to age- and sex-matched individuals with no or only mild OSA (Apnea Hypopnea Index, AHI, <15 events/h). Forty-six participants, 24 with OSA [59 ± 8 years; AHI 31 ± 18 events/h (mean ± SD); seven women] and 22 without (58 ± 11 years; AHI 7 ± 4; nine women), performed a series of three MM and three BH, in randomly assigned order, twice: during continuous recording of MSNA from the right fibular nerve and, on a separate day, during T2-weighted echo planar functional MR imaging. Read More

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