The aim of this work was to comprehensively evaluate the cephalometric features in Japanese patients with obstructive sleep apnoea (OAS) and to elucidate the relationship between cephalometric variables and severity of apnoea.Forty-eight cephalometric variables were measured in 37 healthy males and 114 male OSA patients, who were classed into 54 non-obese (body mass index (BMI) <27 kg . m -2 , apnoea±hypopnoea index (AHI)=25.316.1 events . h -1) and 60 obese (BMI $27 kg . m -2 , AHI=45.628.0 events . h -1

Background-Despite the adverse cardiovascular consequences of obstructive sleep apnea, the majority of patients remain undiagnosed. To explore an efficient ECG-based screening tool for obstructive sleep apnea, we examined the usefulness of automated detection of cyclic variation of heart rate (CVHR) in a large-scale controlled clinical setting. Methods and Results-We developed an algorithm of autocorrelated wave detection with adaptive threshold (ACAT). The algorithm was optimized with 63 sleep studies in a training cohort, and its performance was confirmed with 70 sleep studies of the Physionet Apnea-ECG database. We then applied the algorithm to ECGs extracted from all-night polysomnograms in 862 consecutive subjects referred for diagnostic sleep study. The number of CVHR per hour (the CVHR index) closely correlated (rϭ0.84) with the apnea-hypopnea index, although the absolute agreement with the apnea-hypopnea index was modest (the upper and lower limits of agreement, 21 per hour and Ϫ19 per hour) with periodic leg movement causing most of the disagreement (PϽ0.001). The CVHR index showed a good performance in identifying the patients with an apnea-hypopnea index Ն15 per hour (area under the receiver-operating characteristic curve, 0.913; 83% sensitivity and 88% specificity, with the predetermined cutoff threshold of CVHR index Ն15 per hour). The classification performance was unaffected by older age (Ն65 years) or cardiac autonomic dysfunction (SD of normal-to-normal R-R intervals over the entire length of recording Ͻ65 ms; area under the receiver-operating characteristic curve, 0.915 and 0.911, respectively). Conclusions-The automated detection of CVHR with the ACAT algorithm provides a powerful ECG-based screening tool for moderate-to-severe obstructive sleep apnea, even in older subjects and in those with cardiac autonomic dysfunction. (Circ Arrhythm Electrophysiol. 2011;4:64-72.)

Results OHS was identified in 55 of the 611 patients with OSAS (9%). OHS patients were younger, heavier, and more somnolent than non-OHS patients and displayed more severe OSAS, liver dysfunctions, higher total cholesterol, and impaired pulmonary function. However, these differences were resolved except for pulmonary function after correction for obesity. Daytime hypercapnia was associated with impaired pulmonary function. Percent vital capacity (%VC) was most closely correlated with PaCO2 in OHS.Conclusion OHS patients display numerous abnormalities due to obesity compared with non-OHS patients. Impaired pulmonary function, particularly %VC, may play an important role in the development of daytime hypercapnia independent of obesity in OHS patients.

No abstract

Data AnalysisData from the subjects mentioned above were available for sex, age, smoking status, BI, FVC and FEV1, but did not include any personal identifiers such as name or address. We counted personyear of follow-up for each subject from the date of the baseline of the first health check-up to incidence of COPD or the last health check-up in the study period. The date of incidence of COPD was determined as a median date between the health check-ups with the first diagnosis of COPD and with the last diagnosis of not having COPD. Those who were not diagnosed as COPD during the follow-up period were treated as censored cases.The incidence rate of COPD by sex, age, smoking status, and follow-up period was calculated as the number of COPD incidence cases divided by the person-years of follow-up. The age was classified into 10 groups of 5-year intervals from 25-29 to 70-74 years old. The follow-up period was classified into less than 2 years and 2 years or more after baseline. The incidence rate ratios (IRRs) of age groups to 40-44 years old and those of smoking status to non-smokers by sex were estimated using Cox proportional hazard models with both variables. These analyses were performed using an SPSS ® 12.0J software package (SPSS Japan Inc.).

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Churg-Strauss syndrome (CSS) is characterized by the presence of asthma, eosinophilia, and small-vessel vasculitis with granuloma. It is a distinct entity, as determined from all classifications of systemic vasculitis. The poor prognostic factors in CSS are renal insufficiency, cardiomyopathy, severe gastrointestinal (GI) tract, and central nervous systems (CNS) involvement. The initial management of CSS should include a high dose of a corticosteroid: prednisone at 1 mg/kg/day or its equivalent for methylprednisolone with tapering over 6 months. In patients with severe or rapidly progressing CSS, the administration of methylprednisolone pulse at 1 g/body/day for 3 days is recommended. When corticosteroid therapy does not induce remission, or when patients have poor prognostic factors, immunosuppressive cytotoxic therapy is indicated. However, some patients with severe CSS often show resistance to conventional treatment. We think that IVIG therapy is a hopeful candidate for second-line treatment for CSS patients, particularly in the case of neuropathy and/or cardiomyopathy, which are resistant to conventional therapy. However, there is not much evidence supporting the effectiveness of IVIG in CSS, and the mechanisms underlying the action of IVIG remain unclear. Now we are performing clinical trials of IVIG therapy for CSS patients who are resistant to conventional treatment, through a nationwide double-blinded placebo-controlled study in Japan.

S-1 is an active and well-tolerated monotherapy for second-line treatment of advanced NSCLC.