Mild-moderate Patients Research Articles

Clinical features and risk factors for severe-critically ill COVID-19 adult patients in Jiangsu, China: A multiple-centered, retrospective study.

Coronavirus disease 2019 (COVID-19) becomes a global pandemic in 2020. Early identification of severe ill patients is a top priority for clinicians. We aimed to describe clinical features and risk factors of severe-critically ill patients with COVID-19 in Jiangsu Province.This multi-centered retrospective study collected the information of 631 laboratory-confirmed COVID-19 patients hospitalized at 28 authorized hospitals in Jiangsu province from January 23, 2019 to March 13, 2020.A total of 583 adult patients with laboratory-confirmed COVID-19 were enrolled for final analysis, including 84 severe-critically ill patients and 499 mild-moderate patients. Median age of the severe-critically ill patients was 57.0 years old (interquartile range, 49.0–65.8), and 50 (59.5%) were males. Multisystemic laboratory abnormalities were observed on admission for severe-critically ill patients. These patients showed more noticeable radiologic abnormalities and more coexisting health issues as compared to the mild-moderate patients. Most of the severe-critically ill COVID-19 patients became deteriorated in 2 weeks after diagnosis. Age, D-dimer, and lymphocytes were independently associated with the progression of severe-critically illness.Older age, higher D-dimer levels and less lymphocyte counts on admission are potential risk factors for COVID-19 patients to develop into severe and critically illness.

DIAMETER OF CORPORA CAVERNOSA, CORPORA SPONGIOSA AND CAVERNOSA ARTERY IN PATIENTS WITH ERECTILE DYSFUNCTION USING GRAYSCALE ULTRASONOGRAPHY ON FLACCID PHASE AT DR. SUTOMO REGIONAL PUBLIC HOSPITAL, SURABAYA

Background : Erectile dysfunction is a condition in men that often has a negative impact on quality of life. Penile grayscale ultrasonography in the flaccid phase is a non-invasive imaging modality to evaluate anatomy of the right and left corpora cavernosa, cavernosa artery, and corpora spongiosa of the penis. Objective : To determine the profile of penile structure in patients with erectile dysfunction evaluated using a gray scale ultrasonography in the flaccid phase. Methods: This was a retrospective descriptive study in male patients (aged 30-65 years) with erectile dysfunction who underwent an ultrasonography examination at the Radiology Department of Dr. Soetomo Hospital, Surabaya in December 2019 to June 2020. The degree of erectile dysfunction is based on the value of International Index of Erectile Function-5 (IIEF-5). Penile ultrasonography was performed during the flaccid phase, cavernous artery diameter was measured, diameter of the right and left corpora cavernosa and corpora spongiosa were measured at the base of the penis. Results: 30 patients with erectile dysfunction, 11 (36%) mild patients, 8 (27%) mild-moderate patients, 8 (27%) moderate grade patients, and 3 (10%) severe patients. Mean diameter of cavernous artery, corpora cavernosa, corpora spongiosa of erectile dysfunction patients measured in the flaccid phase was 0.062 cm, 1.0 cm, and 0.9 cm, respectively. Conclusion: Penile grayscale ultrasonography in the flaccid phase can be used to measure the diameter, where the more severe degree of erectile dysfunction, diameter of corpora cavernosa, corpora spongiosa, and cavernosa artery became smaller.

Neurocognitive and Affective Sequelae Following Complicated Mild and Moderate Traumatic Brain Injury: A Case Series.

Traumatic brain injury (TBI) leads to various sequelae that affect the day-to-day functioning of patients. However, there is a dearth of studies investigating these sequelae in complicated mild TBI and moderate TBI patients. The prime objective of the present study was to present the neurocognitive and affective profile of complicated mild and moderate TBI patients along with to compare the neurocognitive and affective sequelae in patients with complicated mild and moderate TBI. Twenty-two patients with complicated mild TBI and 17 patients with Moderate TBI, each with an intracranial lesion were recruited from level 1 trauma center in Varanasi. All patients were assessed with neurocognitive measures, Rivermead Post Concussive Symptoms Questionnaire, and Hospital Anxiety and Depression Scale. The patients' profiles were presented as clinical series using descriptive analysis. Further, comparison was done by using the Chi-square test and Fisher's exact test. Findings revealed that complicated mild TBI patients reported significantly higher psychological distress and post head injury symptoms in comparison to patients with moderate TBI. Further, the complicated mild TBI and moderate TBI groups showed differences with respect to verbal fluency, mental speed, and flexibility tasks. Complicated mild TBI and moderate TBI groups have not differed significantly on most of the cognitive tasks. Furthermore, affective symptoms were found more prominent in complicated mild TBI group as compared to the moderate TBI group.

Automatic assessment with EEG‐based brain‐computer interface shows difference between healthy population, mild cognitive impairment and moderate cognitive decline patients

AbstractBackgroundCognitive decline is still under‐diagnosed due to the lack of objective biomarkers. Brain‐ Computer Interface (BCI) combined with inexpensive mobile EEG devices have been used to assess mental workload revealed different neurological biomarkers to detect cognitive load. However, they are still scarcely implemented among the elderly and cognitively impaired populations. We introduce novel cognitive biomarkers obtained from a single‐EEG‐channel (by Neurosteer Aurora) to indicate cognitive decline. The assessment is fully automated using auditory verbal and musical stimulation.MethodsHealthy participants (N=40) and mild‐to‐moderate cognitive decline (MMSE score 17‐23, N=10; and 24‐27, N=14) were tested in three conditions: an auditory detection task with two difficulty levels and a resting state task. Two biomarkers, previously extracted from healthy participants data through machine learning, VC9 and T2, were used in the statistical analysis.ResultsFor the healthy population, VC9 activity was significantly increased for higher cognitive load (p<.001); for the mild‐to‐moderate cognitive decline group, VC9 activity was significantly higher than healthy group (p=.004), and remained similar for all tasks and levels (see figure 1 for the mean activity of VC9 biomarker per each condition: detection level 1, level 2 and resting state, for the healthy participants and cognitively impaired group). The biomarker showed a difference in mean activation during the cognitive and resting tasks (p=.022), separating between the two groups of cognitive decline (MMSE<24 & MMSE>24) (see figure 2 for the mean activity of T2 biomarker comparing the two cognitively impaired groups and the healthy group). Furthermore, the T2 feature was negatively correlated with participants’ MMSE score (p=.013, see figure 3 for correlation between MMSE score and T2 activity).ConclusionsThese initial results show two novel biomarkers of cognitive activity, which are able to differentiates between patient groups and detect MCI. The study shows different patterns of cognitive functions for patients with cognitive impairment, as well as difference in total activity between healthy subjects and mild cognitive impairment patients, to patients with moderate cognitive impairment. Results were obtained with an inexpensive BCI combined with an easy and automatic cognitive assessment, which provides more objective evaluation and decreases the need of highly trained personnel.

Identification and Classification of Alzheimer's Disease Patients Using Novel Fractional Motion Model.

Most diffusion magnetic resonance imaging (dMRI) techniques use the mono-exponential model to describe the diffusion process of water in the brain. However, the observed dMRI signal decay curve deviates from the mono-exponential form. To solve this problem, the fractional motion (FM) model has been developed, which is regarded as a more appropriate model for describing the complex diffusion process in brain tissue. It is still unclear in the identification and classification of Alzheimer’s disease (AD) patients using the FM model. The purpose of this study was to investigate the potential feasibility of FM model for differentiating AD patients from healthy controls and grading patients with AD. Twenty-four patients with AD and 11 healthy controls were included. The left and right hippocampus were selected as regions of interest (ROIs). The apparent diffusion coefficient (ADC) values and FM-related parameters, including the Noah exponent (α), the Hurst exponent (H), and the memory parameter (μ=H−1/α), were calculated and compared between AD patients and healthy controls and between mild AD and moderate AD patients using a two-sample t-test. The correlations between FM-related parameters α, H, μ, and ADC values and the cognitive functions assessed by mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scales were investigated using Pearson partial correlation analysis in patients with AD. The receiver-operating characteristic analysis was used to assess the differential performance. We found that the FM-related parameter α could be used to distinguish AD patients from healthy controls (P < 0.05) with greater sensitivity and specificity (left ROI, 0.917 and 0.636; right ROI, 0.917 and 0.727) and grade AD patients (P < 0.05) showed higher sensitivity and specificity (right ROI, 0.917, 0.75). The α was found to be positively correlated with MMSE (P < 0.05) and MoCA (P < 0.05) scores in patients with AD, indicating that the α values in the bilateral hippocampus were a potential MRI-based biomarker of disease severity in AD patients. This novel diffusion model may be useful for further understanding neuropathologic changes in patients with AD.

Symptomatology of COVID-19 from the otorhinolaryngology perspective: a survey of 223 SARS-CoV-2 RNA-positive patients.

PurposeTo determine prevalence, severity, duration, and time from onset to diagnosis of general and Otorhinolaryngologic symptoms related to COVID-19 in whole disease spectrum: from mild to critical patients.MethodsAll adult patients with positive SARS-CoV-2 RNA found in nasopharyngeal and oropharyngeal swabs between March 10 and April 21, 2020 were surveyed by the authors for new onset symptoms during disease course. Demographic features, general symptoms, and Otorhinolaryngological symptoms were evaluated and compared by disease severity.ResultsOf 223 included patients, 18.4% had mild, 61.4%; moderate, 14.3%; severe, and 5.8%; critical disease. Median age was 51 (range 20–93), 113 (50.7%) were male and 110 (49.3%) were female. The most common general symptoms were fatigue, cough, and fever with respective frequencies of 71.3%, 54.3%, and 50.7%. The most common Otorhinolaryngologic symptoms were taste loss, smell loss, and sore throat with respective frequencies of 34.5%, 31.8%, and 26%. Fatigue, fever, and dyspnea were more common in severe-critical patients compared to mild–moderate patients (p = 0.029, p = 0.016, and p < 0.001, respectively). Only smell loss was more common in mild–moderate group (p = 0.003). Prevalence of other symptoms did not differ between groups. Symptom durations and onset time to diagnosis varied.ConclusionWhen compared to the previous studies, while general symptoms were less common, Otorhinolaryngologic symptoms were more common in our study population. Considering high infection risks, Otorhinolaryngologists should be aware of COVID-19 patients presenting with Otorhinolaryngologic complaints.Electronic supplementary materialThe online version of this article (10.1007/s00405-020-06284-1) contains supplementary material, which is available to authorized users.

The Clinical Characteristics and Prognosis Factors of Mild-Moderate Patients With COVID-19 in a Mobile Cabin Hospital: A Retrospective, Single-Center Study.

Background: Novel mobile cabin hospitals have been built to provide more makeshift beds for patients with COVID-19 in Wuhan. However, the characteristics of these patients needed be further described.Methods: This was a retrospective, single-center study. A total of 869 patients with confirmed COVID-19 were admitted to Wuchang Mobile Cabin Hospital in Wuhan, between February 6th, 2020 and February 20th, 2020. The final date of follow-up was March 6th, 2020. Clinical characteristics and outcome data were collected and analyzed.Results: Of 869 patients, the median age was 51 years (IQR, 40–58 years), and 377 patients (377/869; 43.4%) were men. A total of 616 patients (616/869; 70.9%) were discharged, 95 patients (95/869; 10.9%) were transferred to the designated hospital due to worsening condition (endpoint), and 158 patients (158/869; 18.2%) were still in the hospital. The incidence of the main symptoms, including fever, cough, fatigue, muscle aches, and anorexia, decreased with time. However, there were no differences in outcome among the patients with different onset times. Generally, both patients aged 45 years or older and patients with comorbidities were more likely to reach the endpoint (transfer to designated high-level hospitals due to condition worsen). In the other model, patients with the lung CT feature (e.g., ground-glass opacity, reticular/linear, air bronchogram, or consolidation shadow) were more likely to reach the endpoint.Conclusion: Older age, comorbidity, special chest CT features (e.g., ground-glass opacity, reticular/linear, air bronchogram, or consolidation shadow) are associated with poor prognosis for mild-moderate patients. The initial symptoms of mild-moderate patients may become insidious, which deserves our attention.

Elevated Serum IgM Levels Indicate Poor Outcome in Patients with Coronavirus Disease 2019 Pneumonia: A Retrospective Case-Control Study

Background: The coronavirus disease 2019 (COVID-19) pneumonia outbreak began in Wuhan and pandemics tend to occur. Although SARS-CoV-2-specific immunoglobulins have been detected in serum of COVID-19 patients, their dynamics and association with outcomes have not been characterized. Methods: A total of 116 hospitalized patients with confirmed COVID-19 pneumonia and SARS-CoV-2-specific immunoglobulins tested in Tongji Hospital were retrospectively investigated. Clinical, laboratory, radiological characteristics and outcomes data were compared between mild-moderate group and died group. Further, a paired case-control study was conducted where each dead case was matched to three mild-moderate patients of similar age. Findings: Among 116 subjects included, 101 mild-moderate patients survived and 15 cases died. SARS-CoV-2-specific IgM levels peaked in forth week after onset of COVID-19 pneumonia, while serum IgG levels increased over 8 weeks. Serum IgM levels were higher in dead patients than mild-moderate patients (p =0.024), but not IgG. Serum IgM levels were negatively correlated with clinical outcome, eosinophil count and albumin levels (r = -0.269, P=0.003; r = -0.188, P = 0.043; and r = -0.198, P=0.033, resp.). The area under the ROC curve (AUC) for IgM antibody was 0.681 (95% CI: 0.517-0.845, P = 0.024). In case-control study paired by age, serum IgM was higher in dead patients than mild-moderate patients (p =0.019), positively correlated with leucocyte count (r = 0.260, P = 0.045), while negatively correlated with clinical outcome and albumin levels (r = -0.337, P=0.008; r = -0.265, P = 0.041). AUC for IgM levels was 0.704 (95% CI: 0.534-0.873, P = 0.019). Interpretation: These results indicate that dynamics of SARS-CoV-2 specific IgM and IgG antibodies was similar with that of SARS-CoV, while elevated serum IgM levels indicate poor outcome in patients with COVID-19 pneumonia. Funding Statement: This work was supported by National Natural Science Foundation of China (No.81702989). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This study was reviewed and approved by the Medical Ethical Committee of Tongji Hospital of Huazhong University of Science and Technology (IRB ID: TJIRB20200343).

The influence of excessive daytime sleepiness and sleep quality on anxiety and depression in patients with obstructive sleep apnea hypopnea syndrome

Objective: To explore the factors that contribute to the anxiety and depression in obstructive sleep apnea hypopnea syndrome (OSAHS) patients in terms of excessive daytime sleepiness (EDS) and sleep quality. Methods: A total of 196 OSAHS patients, including 103 severe patients and 93 mild-moderate patients, were enrolled. Polysomnography was carried on at the sleep center of the First Hospital of China Medical University between May 2013 and November 2015. According to the Epworth sleepiness scale (ESS) and the subject daytime sleepiness symptom, all patients were divided into EDS group and non-EDS group. The patients' general information and subjective symptoms were recorded. Emotional states were assessed with self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Sleep quality was evaluated with Pittsburgh sleep quality index (PSQI). The anxiety and depression related factors were studied by regression analysis. Results: (1) In severe OSAHS group, the patients with EDS showed higher PSQI(6.22±2.57 vs. 4.05±3.72, P<0.01) and oxygen desaturation index(ODI)[(57.70±17.53) events/h vs. (48.23±22.01) events/h, P<0.05] when compared with those without EDS. (2) In both severe and mild-moderate OSAHS groups, the patients with EDS presented higher SAS scores (severe: 33.86±7.60 vs.28.95±4.71, mild-moderate: 37.46±10.68 vs. 33.40±11.07, P<0.05) and SDS scores (severe: 32.81±8.36 vs. 28.90±4.53, mild-moderate:36.98±12.77 vs. 31.70±10.94, P<0.05) when compared with those without EDS. (3) The multiple regression analysis showed that the SAS scores were related to ESS, PSQI, insomnia and nasal obstruction (R(2)=0.356, P<0.05), and the SDS scores were related to ESS, PSQI and insomnia(R(2)=0.344, P<0.05). Conclusions: The anxiety and depression of OSAHS patients are closely related to the severity of EDS and sleep quality. Both severe and mild-moderate OSAHS patients with EDS have worse anxiety and depression scores.

Study on correlation between fatigue status and self-management behavior and quality of life in maintenance hemodialysis patients

Objective To explore the relationship between status of maintenance hemodialysis patients, self-management behavior and quality of life, and provide theoretical basis for clinical individualized care and improvement of patients' quality of life. Methods The Fatigue Assessment Instrument (FAI), the self-management scale of hemodialysis patients and the MOS 36-item short-form health survey (SF-36) were used to investigate 140 patients who received long-term hemodialysis treatment in the hospital from June 2014 to June 2016. Results According to the score of FAI rating scale factor 1, there were 45 cases of mild fatigue , 73 cases of moderate fatigue and 22 cases of severe fatigue . There was no significant difference in the total score of self-management behavior between mild fatigue and moderate fatigue patients(P>0.05). The total scores of self-management behaviors, SF-36 physical health and SF-36 mental health of patients with mild fatigue , moderate fatigue and severe fatigue all showed a downward trend, with statistically significant differences (P<0.05). Spearman correlation analysis showed that the factor of maintenance hemodialysis patients were negatively correlated with the total score of self-management behavior, SF-36 physical health score and SF-36 mental health score (P<0.05). Conclusions Fatigue is common in maintenance hemodialysis patients.Severe is not conducive to the maintenance of patients' self-management behavior and can reduce their quality of life. Key words: Hemodialysis; Fatigue; Self-management; Quality of life

Protocol for Fecal Microbiota Transplantation in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.

Background Fecal microbiota transplantation (FMT) is an emerging treatment approach for inflammatory bowel disease (IBD). The donor selection, the separation of fecal bacteria, the frequency of FMT, the way of infusion, the long-term safety, and efficacy are still uncertain. Aim To further study the efficacy and safety and protocol of FMT for IBD. Methods A systematic review and meta-analysis were conducted until February, 2018. Clinical remission was established as the primary outcome. Results A total of 596 paediatric and adult IBD patients were enrolled, and 459 patients received FMT therapy. 28.8% (132/459) patients achieved clinical remission during follow-up. 53% (241/459) patients achieved clinical response. The pooled estimated clinical remission for ulcerative colitis (UC) was 21% (95% CI: 8%-37%) and 30% (95% CI: 11%-52%) for Crohn's disease (CD), both with a risk of heterogeneity; 10% (95% CI: 0%-43%) for paediatric UC; 26% (95% CI: 10%-48%) for adult UC; 45% for paediatric CD (95% CI: 24%-66%); 22% (95% CI: 3%-52%) for adult CD. Meta-analysis of cohort studies showed that moderate-severe IBD patients could achieve more significant remission from FMT than mild-moderate patients (P=0.037). Delivery route has no impact on the efficacy of FMT in UC and CD. Based on current available evidence, a trend was observed towards higher clinical remission rate of frozen stool FMT than that of fresh stool for UC, while there was no significant difference between fresh and frozen FMT for CD. The optimal donor stool for FMT is still uncertain. Meta-analysis of RCTs showed that FMT treatment achieved significantly higher clinical remission rate than placebo for UC (28% versus 9%, P=0.0003). Conclusion FMT is an effective and safe therapy for both paediatric and adult IBD; fresh or frozen donor stool, delivery route, and antibiotic pretreatment or not have no impact on the efficacy of FMT in IBD. FMT might be a potential rescue therapy and even an initial standardized therapy for IBD. However, few data exist on long-term safety and efficacy and further validation is needed.

Obstructive sleep apnea and the effect of CPAP treatment on ischemia-modified albumin levels: a multi effect size meta-analysis with diagnostic test accuracy

A close association of oxidative stress (OS) and ischemia-modified albumin (IMA) with obstructive sleep apnea (OSA) has been reported in the literature, but the results on IMA are ambiguous. We conducted a meta-analysis to evaluate the association of IMA with OSA and the effect of continuous positive airway pressure (CPAP) therapy on IMA in patients with OSA. Relevant studies were identified by searching PubMed and other databases in addition to manual searching of cross-references. Using random-effects model, the standardized mean differences (SMDs), pooled correlation coefficients and summary of diagnostic test accuracies were obtained with 95% confidence intervals (CIs). The meta-regression, sub-group and sensitivity analyses were performed to explore heterogeneity. The presence of publication bias was tested using funnel plot analysis followed by Begg's and Egger's tests for statistical signidicance. This meta-analysis finally included nine studies. When comparing with non-OSA controls, the OSA patients showed a significantly increased circulatory IMA levels (SMD = 1.15, p = 0.0001). And, this increase is even more pronounced in severe-OSA group as compared to mild-moderate OSA patients (SMD = 076, p = 0.0006). A decrease in post-CPAP treatment IMA was observed when compared with that of baseline values. Meta-analysis of correlations showed significant associations of IMA with polysomnographic parameters. The pooled diagnostic odds ratio and area under curve were 19.58 and 0.888 (Q* = 0.819), respectively. There was no evidence of publication bias for the association of IMA with OSA. This meta-analysis suggests that OSA is associated with significantly increased IMA levels which may indicate OS, ischemia and subclinical cardiovascular risk. In the diagnostic test accuracy meta-analysis, IMA showed good accuracy for OSA detection. However, further studies are required to establish its clinical utility.

Presence and Types of Systemic Diseases among Patients with Periodontitis in Suva, Fiji

Objectives: Periodontitis is an infection which is caused by micro-organisms like Porphyromonas gingivalis. Periodontitis patients can have one or more systemic diseases such as heart diseases, diabetes, renal diseases, respiratory diseases etc. Due to lack of study in Fiji, this study is aimed to determine the presence and types of systemic diseases among patients with periodontitis in Suva, Fiji. Methods: This is a descriptive study on periodontitis patients with complete self-reported systemic disease history carried out in two dental clinics operated by the Fiji National University. Periodontitis patients with or without self-reported systemic disease history were included in this study. Patients without periodontitis were excluded from this study. The patient clinical records are recorded from 1st January 2013 to 31st December 2014. SPSS was used to analysis the data and all the categorical variables were presented by numbers and percentages. Results: The total number of periodontitis patients who reported having at least one type of systemic diseases was 35.5% (n=131). The most common types of diseases were heart disease 55.7% ~ 56% (n=73) and diabetes 45% (n=59). The age group 40-64-year-old periodontitis patients showed the highest number of heart diseases and diabetes, (68.1%) and (79.3%), respectively. Amongst all the ethnic groups, the Fijians of Indian Descent showed the highest number of heart diseases (49.1%), and the I-Taukei Fijians showed highest number of diabetes (42.4%). The use of tobacco was 39.7%, alcohol was 38.4% and betel-nut was 5.6% among periodontitis patients with heart diseases. And the use of tobacco was 33.9%, alcohol was 39% and betel-nut was 3.4% among periodontitis patients with diabetes mellitus. Severe periodontitis patients showed high percentages of diabetes (50.9%) among the mild periodontitis and moderate periodontitis patients. However, the occurrence of heart diseases was the same, (40.6%) among moderate and severe periodontitis patients. Conclusion: The study concluded that the number of periodontitis patients with any one type of systemic disease was 35.5%. And the most common types of systemic diseases seen among the periodontitis patients were heart disease and diabetes. Further research studies in future will provide more insight to the association of periodontitis and systemic diseases.

Study on hyponatremia in patients with severe dementia

Objective To investigate the incidence and outcome of hyponatremia in patients with severe dementia. Methods Dementia patients were retrospectively analyzed in 80 cases, including 45 patients with severe dementia complicating 30 cases of hyponatremia, and 35 patients with mild and moderate dementia complicating 5 cases of hyponatremia.The incidence rate of dementia patients complicating hyponatremia and its fatality rate were analyzed by χ2 tests.The effect of dementia severity on hyponatremia and fatality rate was studied. Results The incidence rate of hyponatremia was higher in severe dementia patients(30 cases, 66.7%)than in mild-moderate dementia patients(5 cases, 14.3%)(χ2=21.95, P 0.05). Conclusions Hyponatremia is more likely to occur in patients with severe dementia.However, hyponatremia does not affect survival time in the severe dementia patients. Key words: Dementia; Hyponatremia

A 7-year follow-up study of obstructive sleep apnoea in healthy elderly: The PROOF cohort study.

Clinical and epidemiological cohort studies have shown that obstructive sleep apnoea (OSA) is a common but largely undiagnosed disorder in senior subjects, where progressive deterioration of the pathology would be expected as a consequence of the ageing processes. Our study examines the longitudinal progression of OSA over a 7-year period in a community-based sample of healthy subjects. The sample consisted of 284 volunteers, aged >65 years (52% women, 48% men) accepting clinical and instrumental follow-up at 7 years. OSA was defined as an apnoea-hypopnoea index (AHI) of ≥15. Between evaluations in the total sample, AHI slightly decreased from 17.8 ± 14 to 16.7 ± 11 with a decrease affecting more the hypopnoea index (P < 0.001) and associated with significant changes (P < 0.001) in all indices of hypoxaemia. While in the non-OSA group there was a slight but significant increase of AHI, a significant AHI decrease was noted in mild-moderate patients (P < 0.01) and a significant rise of nocturnal hypoxaemia in severe OSA patients (P < 0.001). The AHI decrease was not associated with clinical, weight, metabolic and blood pressure changes between the two evaluations; the baseline AHI value being the only factor correlated to the degree of AHI decline. In elderlies, the severity and prevalence of OSA decrease progressively with ageing without effect of factors commonly influencing OSA severity. This trend may support the hypothesis that in healthy elderly, OSA is a phenomenon related to ageing.

Abstract WP325: Designing Patient-centered Solutions for Enhanced Home-based Recovery After Mild-moderate Stroke

Introduction: After discharge from a structured rehabilitation setting, mild-moderate stroke patients report feeling unprepared to manage their home recovery plan. Through Design for America, we worked with undergraduate students to develop prototypes to empower patients in their post-stroke home-based recovery. Methods: “User centered design”, a six step process, was applied over a 6-week summer program, with design and process experts’ mentorship. We obtained qualitative data from patients, caregivers and healthcare professionals through focus groups, interviews and web-based surveys (N=60). The insights gained from users were utilized to design solutions. Results: Insights gained include: 1) 96% of patients reported they were unable to follow home rehabilitation schedules; 2) 66.7% reported being “comfortable” with technology and 10% having previously used Apps for exercise; 3) often insurance does not cover rehabilitation in mild strokes cases; and 4) patients like to hear from others and often develop their own exercises. Solutions designed included:1) a wearable device (Figure 1A) for stroke survivors to alert them of exercise schedule, track activity, appointments, and medication reminders, 2) a website (Figure 1B) that provides patients an online community to find user-submitted therapeutic exercises, share stories, and motivate others. Conclusion: In partnership with Design for America, we created unique solutions that fill a gap in the continuity of stroke recovery: community-based, patient-centered, and self-empowering tools. In the coming months, we plan to build and pilot test these products in a clinical setting.

Stromelysin-1 polymorphism as a new potential risk factor in progression of chronic obstructive pulmonary disease

Chronic obstructive lung disease (COPD) is characterised by partially reversible usually progressive airflow limitation caused by inflammation and remodelling. Stromelysin-1 (MMP-3) has regulatory activity on other matrix-metalloproteinases. Altered MMP-3 activity has been described in different diseases. We investigated the role of a promoter MMP-3 polymorphism in determining susceptibility and severity of COPD. We studied 147 patients with COPD in stable conditions and distinguished two groups based on FEV1 values. In 100 patients functional modifications across a two-year period were noted. 133 healthy subjects were used as controls. Genotyping for the -1171 5A/6A MMP-3 polymorphism was performed using nucleotide sequencing. No difference was noted in the genotype distribution between COPD patients and controls. However, among patients with severe disease 6A/6A genotype and 6A allelic frequency were significantly more represented than among mild-moderate patients (p < 0.05). The 6A/6A genotype was also associated with a higher FEV1 decline over time. Our data suggests that -1171 6A allele does not represent a risk factor for the development of COPD while it is associated with more severe disease and different functional decline. We hypothesis that a disregulation of MMP-3, possibly caused by the -1171 5A/6A polymorphism or other linked variants, may lead to different progression in COPD.

CPAP effect on Daytime Sleepiness in Patients with Mild-Moderate and Severe Obstructive Sleep Apnea

Background: Continuous positive airway pressure (CPAP) treatment has been consistently shown to have a positive effect on excessive daytime sleepiness (EDS), however no studies comparing subgroups of patients with different levels of mild-moderate and severe obstructive sleep apnea (OSA) has been performed. Objective: This study evaluated the efficacy of CPAP on quality of sleep by using the Epworth Sleepiness Scale (ESS) in patients with mild-moderate and severe (OSA). Methods: This before-and-after clinical trial evaluated elderly with OSA. CPAP treatment was performed for five working days. Daytime sleepiness was evaluated by the ESS scale applied immediately before and after intervention. Results: 62 participants aging from 60 to 63 (61.1 ± 8.1) were studied; 42 (68%) males and 20 (32%) females. OSA was considered mild-moderate in 37 (60%) and severe in 25 (40%) patients. The daytime sleepiness evaluated by ESS decreased in both groups: from 20.23 ± 2.07 to 10.47 ± 0.42 in mild-moderate group and from 20.06 ± 1.66 to 10.24 ± 0.36 in severe after the intervention, both p<0,001. Conclusion: CPAP treatment for a short period can improve significantly the daytime sleepiness in both mild-moderate and severe OSA patients.

Drug-induced sleep endoscopy as a selection tool for mandibular advancement therapy by oral device in patients with mild to moderate obstructive sleep apnoea.

SUMMARYNowadays oral appliance therapy is recognised as an effective therapy for many patients with primary snoring and mild to moderate obstructive sleep apnoea (OSA), as well as those with more severe OSA who cannot tolerate positive airway pressure (PAP) therapies. For this reason, it is important to focus on objective criteria to indicate which subjects may benefit from treatment with a mandibular advancement device (MAD). Various anthropometric and polysomnographic predictors have been described in the literature, whereas there are still controversies about the role of drug-induced sleep endoscopy (DISE) and advancement bimanual manoeuvre as predictor factors of treatment outcome by oral device. Herein, we report our experience in treatment of mild moderate OSA by oral appliance selected by DISE. We performed a single institution, longitudinal prospective evaluation of a consecutive group of mild moderate patients with obstructive sleep apnoea syndrome who underwent DISE. During sleep endoscopy, gentle manoeuvre of mandibular advancement less than 5 mm was performed. In 30 of 65 patients (46.2%) we obtained an unsuccessful improvement of airway patency whereas in 35 of 65 patients (53.8%) the improvement was successful and patients were considered suitable for oral device application. Because 7 of 35 patients were excluded due to conditions interfering with oral appliance therapy, we finally treated 28 patients. After 3 months of treatment, we observed a significant improvement in the Epworth medium index [(7.35 ± 2.8 versus 4.1 ± 2.2 (p < 0.05)], in mean AHI [(21.4 ± 6 events per hour versus 8.85 ± 6.9 (p < 0.05)] and in mean ODI [(18.6 ± 8 events per hour to 7 ± 5.8 (p < 0.05)]. We observed that the apnoea/hypopnoea index (AHI) improved by up to 50% from baseline in 71.4% of patients selected after DISE for MAD therapy. In the current study, mandibular advancement splint therapy was successfully prescribed on the basis not only of severity of disease, as determined by the subject's initial AHI, but also by DISE findings combined with results of gentle mandibular advancement manoeuvre allowing direct view of the effects of mandibular protrusion on breathing spaces in obstruction sites, and showing good optimisation of selection of patients for oral device treatment.

Soleus MEP-80 response latency in restless legs syndrome

Introduction The purpose of this study was to investigate the latency of soleus MEP-80 response in patients with restless legs syndrome (RLS). We aimed to figure out the etiopathogenesis and to determine an objective diagnostic tool and prognosis indicator. Materials and methods In this study, 40 patients with RLS and 40 controls were included. For all patients and controls routine laboratory investigations, electroneurography (ENG) and transcranial cortical magnetic stimulation (TCCMS) were performed. Finally the MEP-80 response latency of 40 RLS patients and 40 age and gender matched controls were compared. All patients were diagnosed with the 4 criteria defined by ICSD 2 and the severity was classified according to the international restless legs syndrome scaling group (IRLSSG) classification. Results The soleus MEP-80 response latency in RLS patients and controls was 96 ms (SD: ± 12.5) and 81.8 ms (SD: ± 3.4), respectively. The difference between both groups was statistically significant (p ± 8.3 ms n = 24) than in mild-moderate RLS patients (83.2 ms; SD: ± 3.4; n = 16). Conclusion In restless legs syndrome it is known that the corticospinal tract is not directly affected but subcortical inhibition is influenced due to functional spinal neuron impairment. As a result of this study we determined a direct functional impairment of spinal afferent and efferent long reflexes and we recognized that corticospinal late responses are affected in RLS. According to the results of our study we think that Soleus MEP 80 responce can be a new diagnostic modality and a prognostic indicator for RLS patients. Acknowledgements Department of Neurophysiology, Dokuz Eylul University Medical School.