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Evaluation of Oral Appliance Therapy in Patients with Obstructive Sleep Apnea Syndrome : A Comparative Analysis by Age, Severity, and BMI
Full text linkBackground, Obstructive sleep apnea syndrome is a common disorder characterized by repeated upper airway obstruction during sleep. Oral appliance therapy is a noninvasive treatment option commonly recommended for patients who are intolerant to continuous positive airway pressure. This study aimed to evaluate the treatment outcomes of oral appliance therapy in patients with obstructive sleep apnea syndrome and to examine the relationship between therapeutic effectiveness and patient characteristics, including age, disease severity, and body mass index. Methods, A total of 42 patients diagnosed with obstructive sleep apnea syndrome and treated with oral appliance therapy were retrospectively analyzed. The treatment effect was assessed using the apnea–hypopnea index measured before and after therapy (by polysomnography or portable monitoring). Effective treatment was defined as a post-treatment apnea–hypopnea index of <15 events per hour and a ≥ 50% reduction from baseline. Results, The mean apnea–hypopnea index decreased significantly from 27.6 ± 15.7 to 10.3 ± 8.7 events per hour following oral appliance therapy, with a mean improvement in AHI of 59.6%. Effectiveness was achieved in 66.7% of patients. A significant overall improvement was observed. Reductions in the apnea–hypopnea index were seen across age, severity, and body mass index (BMI) strata. However, only three patients had BMI ≥30 kg/m2; hence, BMI-stratified findings for this subgroup are descriptive and no inferential testing was conducted. Conclusion, Oral appliance therapy was effective in reducing the apnea–hypopnea index in a broad range of patients, including those traditionally considered less responsive because of advanced age, obesity, or severe disease. These findings suggest a potential role for oral appliance therapy as an alternative to continuous positive airway pressure treatment within the examined strata (age, severity, and BMI), particularly when continuous positive airway pressure therapy is not feasible. Larger prospective studies are warranted
Thoughts on “Meyasu” : How to handle “Meyasu” in the Process of Determining Regional Minimum Wage Amounts
No full textAllogeneic Hematopoietic Stem Cell Transplantation for Older Patients with Hematological Malignancies
No full textAllogeneic hematopoietic stem cell transplantation (allo-HCT) has been established as a curative treatment for hematological malignancies such as acute myeloid leukemia and myelodysplastic syndrome. Patients aged ≥ 70 years have traditionally been considered ineligible for this procedure, because of concerns over high transplant-related mortality rates and difficulties managing post-transplant complications. However, recent advances in supportive care, expanded donor availability, and the development of reduced-intensity conditioning (RIC) regimens have increased the availability of allo-HCT for older patients. Notably, the number of allo-HCT procedures performed in patients aged ≥ 70 has been steadily increasing in Japan and Western countries, reflecting a re-evaluation of transplant eligibility in older patients. When assessing transplant eligibility in older patients, it is crucial to consider not only disease risk stratification and treatment response, but also comprehensive evaluations of general health status, comorbidities, cognitive function, and social backgrounds. In particular, indexes such as the Hematopoietic Cell Transplantation-Comorbidity Index and Comprehensive Geriatric Assessment have proven useful for predicting patient prognoses and non-relapse mortality. Donor selection and the intensity of the conditioning regimen used can both significantly influence transplant outcomes. RIC or non-myeloablative regimens are generally recommended for patients aged ≥ 70 years. Human leukocyte antigen-matched related or younger unrelated donors are preferred, while haploidentical donors or cord blood may be considered when matched donors are unavailable, although evidence in older patients is limited. This review provides a comprehensive overview of the current status of and challenges related to allo-HCT in patients aged ≥ 70 years. Patient eligibility, conditioning strategies, donor selection, and transplant outcomes are discussed in detail, based on the latest available evidence
A New Approach for Respiratory Droplet Trajectory : Implications for Viral and Bacterial Disease Transmission in Emergency Departments
No full textBackground, The objective of this study is to devise a simplified approach for estimating respiratory particle trajectory to avoid infection in gathering places of emergency departments. Methods, To the authors’ knowledge, no sufficient/obvious data exist on lateral routes of disease transmission through respiratory droplets along the x-axis. The present study establishes a preliminary baseline approach based on the upper pharynx-mouth geometry for lateral social distancing to protect susceptible persons from the droplets of an infected person. An enhanced version of ART (Aydin’s Research Team) model has been employed as a supplementary tool of Stokes’s law for quantification of motion dynamics of the virus/bacterium-laden droplets in public indoor places. Results, A range of droplet diameters varying from 1 μm to 2000 μm were considered in this study. The droplets with a diameter of ≤ 22.5 μm can completely evaporate during settling and droplet nuclei can remain in the air for extended periods. An individual Influenza virus can stay airborne for 34.4 days, while a single Streptococcus bacterium remains suspended for 18.6 hours. The proper social distancing between infected and healthy persons should be about 2.9 and 0.9 m longitudinally, and 0.45 and 0.15 m laterally based on the novel aspects of the present study for sneezing/coughing and breathing/talking, respectively. The trajectory of respiratory particles in the streamwise and radial directions resembles the shape of a truncated cone due to the upper pharynx-mouth relationship. Conclusion, The outcomes of this study can help further understanding of respiratory particle trajectory, thereby improving measures to mitigate disease transmission
The Learning Theory of Learning by Teaching : A Reconsideration of Teaching and Learning
No full textThe Wnt/β-Catenin Inhibitor HC-1 Suppresses Liver Fibrosis by Inhibiting Activated Hepatic Stellate Cells and Inducing Matrix Metalloproteinase-1
No full textBackground : Liver fibrosis is characterized by the excessive accumulation of extracellular matrix (ECM) and is a risk factor for liver cancer. This study investigated the anti-fibrotic effect of the Wnt/β-catenin signalling inhibitor HC-1 in human hepatic stellate cells and a mouse liver fibrosis model. Methods : The effects of HC-1 on Wnt/β-catenin and transforming growth factor (TGF)-β/Smad signalings were examined by a reporter assay. The effects of HC-1 on the mRNA expression of fibrogenesis- and fibrolysis-related genes were analysed after 24 and 48 h of exposure of HC-1. In the animal study, 30 male C57/BL6 mice treated with CCl4 for 4 weeks were divided into three groups, namely vehicle, 8.7 mg/kg HC-1 and 17.4mg/kg HC-1, respectively. Mice in the vehicle group underwent continued treatment with CCl4, whereas those in the HC-1 groups were treated with both CCl4 and HC-1 for another 4 weeks. The livers of mice were examined by histological and biochemical analyses. Results : HC-1 decreased Wnt/β-catenin and TGF-β/Smad signallings. HC-1 potently reduced the mRNA expression of α-smooth muscle actin, collagen 1A1, TGF-β and lysyl oxidase. Conversely, HC-1 increased matrix metalloproteinase-1 expression in a concentration-dependent manner. In the animal model, HC-1 treatment significantly suppressed liver fibrosis in association with the inhibition of activated hepatic stellate cells. Although the Mmp-13, the murine functional homologue of MMP-1, was not increased, collagenase activity was increased in 8.7 mg/kg HC-1 group. Conclusion : HC-1 exerts potent anti-fibrotic effects on liver fibrosis
